Sexual arousal: similarities and differences between men and women

Sexual arousal encompasses activation of physiological systems that coordinate sexual function in both sexes and can be divided into central arousal, peripheral non-genital arousal, and genital arousal. Genital arousal leads to erection in men and to vaginal lubrication and clitoral/vulvar (vestibular bulb) congestion in women. Persisting biases in the understanding of the pathophysiology of sexual arousal are exemplified by the current differences in definitions. In men, sexual arousal disorders are identified with erectile disorders. In women, a more sophisticated set of definitions is described. It includes the subjective arousal disorder, the genital arousal disorder, the mixed arousal disorder, and the persistent sexual arousal disorder. Painful arousal, although not officially included in current nosology, should be considered. A preliminary critical consideration of similarities and differences in the definitions of arousal disorders, in the physiology of sexual arousal, in the causes of arousal disorders, and the influence of arousal disorders on satisfaction with the partner and happiness will be presented. In contrast to popular opinion, women's arousal disorders influence their physical (OR = 7.04 (4.71–10.53)) more than their emotional satisfaction (OR = 4.28 (2.96–6.20)). Furthermore such disorders are reported to have a greater effect on women's physical satisfaction (OR = 7.04 (4.71–10.53)) than erectile dysfunction has on men's physical satisfaction (OR = 4.38 (2.46–7.82)). More research and clinical investigation in needed to increase clinicians’ understanding of the similarities and differences between male and female sexual physiology and pathophysiology, promote parallel thinking in sexual medicine, and facilitate clinical diagnoses of arousal disorders.     

Bone mineral density and prevalent vertebral fractures in men and women

To test the hypothesis that the association between bone mineral density (BMD) and estimated volumetric BMD and prevalent vertebral fractures differs in men and women, we studied 317 Caucasian men and 2,067 Caucasian women (average age 73 years). A total of 43 (14%) men and 386 (19%) women had a vertebral fracture identified on lateral spine radiographs using vertebral morphometry. Hip and spine areal BMD was about 1/3 standard deviation lower among men and women with a vertebral fracture. A 0.10 g/cm² decrease in areal BMD was associated with 30–40% increased odds of having a fracture in men and 60–70% increased likelihood in women. Low bone mineral apparent density (BMAD) was also associated with 40–50% increased odds of a vertebral fracture in both genders. The probability of a man having a fracture was observed at higher absolute areal BMD values than observed for women (P=values for interaction of BMD × gender: trochanter, P=0.05; femoral neck, P=0.10; total hip, P=0.09). In contrast, the probability of fracture was similar in men and women across the range of estimated volumetric BMD (BMAD). In conclusion, low BMD and low BMAD are associated with increased odds of vertebral fracture in both men and women. Measures of bone mass that partially correct for gender differences in bone size may yield universal estimates of fracture risk. Prospective studies are needed to confirm this observation.     

Caring for women living with HIV: gaps in the evidence

Introduction

In the management of HIV, women and men generally undergo the same treatment pathway, with gender differences being given limited consideration. This is in spite of accumulating evidence that there are a number of potential differences between women and men which may affect response to treatment, pharmacokinetics, toxicities and coping. There are also notable psychological, behavioural, social and structural factors that may have a unique impact on women living with HIV (WLWH). Despite our increasing knowledge of HIV and advances in treatment, there are significant gaps in the data relating specifically to women. One of the factors contributing to this situation is the under-representation of women in all aspects of HIV clinical research. Furthermore, there are clinical issues unique to women, including gynaecologic and breast diseases, menopause-related factors, contraception and other topics related to women''s and sexual health.

Methods

Using scoping review methodology, articles from the literature from 1980 to 2012 were identified using appropriate MeSH headings reflecting the clinical status of WLWH, particularly in the areas of clinical management, sexual health, emotional wellbeing and treatment access. Titles and abstracts were scanned to determine whether they were relevant to non-reproductive health in WLWH, and papers meeting inclusion criteria were reviewed.

Results

This review summarizes our current knowledge of the clinical status of WLWH, particularly in the areas of clinical management, sexual health, emotional wellbeing and treatment access. It suggests that there are a number of gender differences in disease and treatment outcomes, and distinct women-specific issues, such as menopause and co-morbidities, that pose significant challenges to the care of WLWH.

Conclusions

Based on a review of this evidence, outstanding questions and areas where further studies are required to determine gender differences in the efficacy and safety of treatment and other clinical and psychological issues specifically affecting WLWH have been identified. Well-controlled and adequately powered clinical studies are essential to help provide answers to these questions and to contribute to activities aimed at improving the health and wellbeing of WLWH.     

Sexual Satisfaction and Sexual Drive in Spinal Cord Injured Women

Abstract

Levels of sexual satisfaction and sexual drive in women with spinal cord injuries were examined. Eighty-four spinal cord injured (SCI) women and thirty-seven able-bodied (AB) control subjects completed the Derogatis Sexual Functioning Inventory which measured current level of sexual functioning in 10 areas: information, experience, drive, attitude, psychological symptoms, affect, gender role definition, fantasy, body image, and sexual satisfaction. When compared with AB women, SCI women had significantly lower levels of sexual satisfaction and sexual drive and significantly higher levels of psychological symptoms and negative affect. Among SCI women, sexual satisfaction decreased significantly with age. Among AB women, sexual satisfaction increased significantly with age. Married SCI women were no longer less sexually satisfied than AB women. Results support conclusions from previous self-report studies in which significant decreases in sexual satisfaction and drive were reported for SCI women. Implications for continued research on the psychological and physiological aspects of sexuality and sexual functioning in SCI women are discussed.     

Gender Incongruence: Gender Affirmative Care Clinic: An Overview

Transgender healthcare is an evolving multispecialty field including medical and social domains catering to the needs of a specific subset of population presenting with gender incongruence, differences in sexual development/orientation, requiring care rather than cure. Delivery of transgender healthcare is done through gender friendly healthcare facilities, which are designated as “gender affirmative care clinics (GACC).” The primary purpose of the gender affirmative care clinic is to be the “one stop solution” for a person seeking affirmative care. The main objective is to facilitate care with compassion and prevent/mitigate dysphoria. The components of the GACC should include reception cum front office; affirmative mental healthcare department; affirmative medical, surgical, and sexual healthcare department; diagnostics, legal, and ethics department, as well as inpatient care. The GACC should be preferably located in a place that is easily accessible to the community members and has an “open plan.”     

Breastfeeding in breast cancer survivors: pattern, behaviour and effect on breast cancer outcome

Little is known regarding the safety and feasibility of breastfeeding in women with a history of breast cancer. We have performed a survey among breast cancer patients who completed their pregnancy following breast cancer management to examine their lactation behaviours and its effect on breast cancer outcome. Out of 32 women identified, 20 were reachable and accepted to take the questionnaire. Ten women initiated breastfeeding, 4 stopped within one month and 6 had long-term success with a median period of 11 months (7–17 months). The latter were all previously subjected to breast conserving surgery and received qualified lactation counselling at delivery. The main reasons for not initiating breastfeeding were “uncertainty regarding maternal safety” and “a priori unfeasibility” expressed either by the obstetrician or by the oncologist. At a median follow-up of 48 months following delivery, all 20 women were alive with two relapses; one in each group (i.e., lactating and non-lactating). This analysis adds to the limited available evidence on the feasibility and safety of breastfeeding in breast cancer survivors. Proper fertility and survivorship counselling is crucial and requires more attention in breast cancer clinics.     

Anatomical Variations of the Vertebral Artery: Analysis by Three‐Dimensional Computed Tomography Angiography in Chinese Population

ObjectiveTo analyze the anatomical variations of V3 and V2 segments of the vertebral artery in the Chinese population.MethodsThe current retrospective study was an observational, anatomical, radiological research. Between 1 January 2018 to 31 December 2019, the data of 589 continuous head‐and‐neck three‐dimensional computed tomography angiography were observed and analyzed using the open‐source software of Horos. There were 415 males and 174 females with an average age of 44.63 ± 2.5(18–74) years. The variations of the V3 segment were defined as persistent first intersegmental artery (PFIA) and paracondylar processes (PP). The variations of V2 segments were unusual vertebral artery entrance transverse foreman (UE‐V2S) and midline migration (MM). The incidences of all variations were summarized and the gender, side characters were compared.ResultsAmong the patients, 4.34% (18/415) males and 4.60% (8/174) females were with the variation of PFIA. Meanwhile, 12.29% (51/415) males and 10.92% (19/174) females were with the variation of PP. Then 18.80% (78/415) males and 16.67% (29/174) females were with UE‐V2S. All the variations above were not different in genders. As for the variation of MM, 3.86% (16/415) males and 8.62% (15/174) females were identified, and the difference of genders was significant for this type of variation (P < 0.05). The differences between each side were also observed and analyzed for all variations and no differences were found.ConclusionThere are several variations of V3 and V2 segments of the vertebral artery are associated with the cervical surgeries, most were without differences in genders and sides, except the variation of MM.     

Not an equal opportunity disease – a sex and gender-based review of colorectal cancer in men and women: Part II

This paper reviews the literature on colorectal cancer from a sex and gender-based perspective. Colorectal cancer is a major cause of death in the developed world, with rates increasing in developing countries. Although described by some writers as an ‘equal opportunity’ disease, it presents more risk to men than women. Both biological, or sex-linked factors, and gender-linked factors play a part in the aetiology of the disease, while gender differences in the use of screening and treatment also help shape the mortality gap between women and men for this condition. Without an appreciation of the part played by sex and gender in the risk of colorectal cancer, and without a gender-sensitive approach to screening in particular, it is possible that the mortality gap between men and women for this condition will widen in the future.     

Biopsychosocial predictors of sexual function and quality of sexual life: a study among patients with colorectal cancer

Objective

A low sexual function (SF) has been reported in patients with colorectal cancer. However, research often focusses on clinical predictors of SF, hereby omitting patients’ subjective evaluation of SF [i.e., the quality of sexual life (QoSL)] and psychosocial predictors of SF and QoSL. In addition, research incorporating a biopsychosocial approach to SF and QoSL is scarce. Therefore, this study aimed to evaluate (I) relatedness between SF and the QoSL, (II) the course of SF and QoSL, and (III) biopsychosocial predictors of SF and QoSL.

Methods

Patients completed questionnaires assessing sociodemographic factors (i.e., age, sex) and personality characteristics (i.e., neuroticism, trait anxiety) before surgery. Questionnaires assessing psychological (i.e., anxious and depressive symptoms, body image, fatigue) and social (i.e., sexual activity, SF, non-sensuality, avoidance of sexual activity, non-communication, relationship function) aspects were measured preoperative and 3, 6, and 12 months after surgery. Clinical characteristics were obtained from the Eindhoven Cancer Registry (ECR). Bivariate correlations evaluated relatedness between SF and QoSL. Linear mixed-effects models examined biopsychosocial predictors of SF and QoSL.

Results

SF and QoSL are related constructs (r=0.206 to 0.642). Compared to preoperative scores, SF did not change over time (P>0.05). Overall, patients’ QoSL decreased postoperatively (P=0.001). A higher age (β=−0.02, P=0.006), fatigue (β=−0.02, P=0.034), not being sexually active (β=−0.081, P<0.001), and having a stoma (β=0.37, P=0.035) contributed to a lower SF. Having rectal cancer (β=−1.64, P=0.003), depressive symptoms (β=−0.09, P=0.001), lower SF (β=1.05, P<0.001), and more relationship maladjustment (β=−0.05, P=0.027) contributed to a lower QoSL (P<0.05). In addition, partners’ SF (β=0.24, P<0.001) and QoSL (β=0.30, P<0.001) were predictive for patients’ SF and QoSL, respectively. A significant interaction between time and gender was reported for both outcomes (P’s=0.002).

Conclusions

SF and QoSL are related but distinctive constructs. The course of SF and QoSL differed. Different biopsychosocial predictors were found for SF and QoSL. The contribution of partner-related variables to patients’ outcomes suggests interdependence between patients and partners. Men and women showed different SF and QoSL trajectories. We recommend that health care professionals, when discussing sexuality, realize that SF and QoSL are no interchangeable terms and should, therefore, be discussed as two separate entities. In addition, it is favored that clinicians focus not only on biological predictors of SF and QoSL, but obtain a broader perspective in which they also pay attention to psychosocial factors that may impair SF and QoSL. More in depth research on interdependence between patients and partners, biopsychosocial predictors of partners’ SF and QoSL, and gender effects is needed.     

Gender differences in general surgical careers: results of a post-residency survey

BACKGROUND: This study's purpose was to gain perspective regarding general surgery career choices while examining gender differences. METHODS: Graduates of a general surgery residency (n = 189) received surveys addressing fellowship training, practice type, case composition, work hours, academic involvement, income, residency, and career satisfaction. RESULTS: Several gender differences were identified. Most men (64%) listed general surgery as their primary work type, whereas women most commonly reported breast surgery (38%, P < .001). More women worked <40 hours per week (25% versus 9%, P = .049). There was no gender difference in income for fellowship-trained surgeons, but a disparity in income >200,000 dollars favored non-fellowship-trained men (74% versus 36%, P = .0031). Both genders reduced work hours. Women reduced them exclusively for personal/family demands. Both genders reported satisfaction with their surgical careers (93%). CONCLUSIONS: Some gender differences in surgery were identified. However, both genders maintain a high level of satisfaction with their career choice.     

Childhood Sexual Abuse is not Associated with a Poor Outcome after Gastric Banding for Severe Obesity

Background: The aim of this study was to examine whether a history of childhood sexual abuse is associated with weight, health, and depression after Laparoscopic Adjustable Gastric Banding for severe obesity. Methods: 157 patients (144 female, 13 male) filled out questionnaires on average 34 months after surgery (range 8–68 months). Results: 23% of the participants, all women, reported a history of childhood sexual abuse. There were no differences between patients with and without a history of childhood sexual abuse on weight and physical health, but the group with a history of childhood sexual abuse showed a higher level of depression. Conclusion: A reported history of childhood sexual abuse does not appear to impact on weight outcome after bariatric surgery, but some patients may need additional psychological treatment for their mental health problems.     

Effect of bone area on spine density in Chinese men and women in Taiwan

Areal bone mineral density (BMD), the quotient of bone mineral content (BMC) divided by the projectional bone area (BA), measured with dual-energy X-ray absorptiometers (DXA), is the most common parameter used today to evaluate spinal osteoporosis. To evaluate whether gender, age, weight, and height can determine spinal BA, and to compare BA and analyze its effects on spinal density in the two genders, we measured BA and BMC, and calculated areal BMD, and the bone mineral apparent density (BMAD = BMD/√BA) of the L-2 to L-4 vertebrate of 604 female and 223 male Chinese volunteers from 20 to 70 years of age using a Norland XR-26 DXA. Standardized for height and weight, BA showed a relatively large variation and a significant increase with increasing age in both genders. On the other hand, BMC stayed unchanged in men > 50 years of age and decreased with aging in postmenopausal women. Younger men (< 51 years) had a much larger mean BA (by 15.5%) and larger mean BMC (only 10%) than that of age-matched women. As a result, younger men had a slightly and significantly lower areal BMD (by 7.1%) and a much lower BMAD (by 16%) (p < 0.0001 for both) than premenopausal women of similar age. Men had higher areal BMD and BMAD values than age-matched women only after age 50 years. Although taller body height, heavier weight, and increasing age were associated with a larger BA, these factors could not explain most of the interindividual variations in BA in both genders. Thus anteroposterior BA of lumbar vertebrate measured with DXA seems to affect the areal BMD and BMAD readings in the two genders. The larger BA caused a low BMAD and probably underestimated the true volumetric spine density in men.     

Gender Differences in Predictors and Long-Term Mortality of New-Onset Postoperative Atrial Fibrillation Following Isolated Aortic Valve Replacement Surgery

Purpose: Postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG) has been associated with increased risk of death in women but not in men. We aimed to explore predictors and long-term mortality in POAF following isolated aortic valve replacement (AVR) surgery in men and women.Methods: This study included 379 severe aortic stenosis patients with no prior atrial fibrillation (AF) who underwent isolated AVR surgery. We used multiple logistic regression to investigate independent gender-specific predictors of new-onset POAF, and we performed Kaplan–Meier (KM) to determine the impact of POAF in long-term mortality according to gender.Results: Advanced age and coronary artery disease prevalence were higher among POAF patients in both genders. On multiple analysis, increased postoperative peak lactate was independently associated with POAF in men, while lower mean aortic valve gradient was associated with POAF in women. Area under the curve (AUC) for the model was 0.77 [0.68–0.86] and 0.69 [0.60–0.78] for men and women, respectively. At 4-year follow-up, POAF was linked to increased risk of death in men but not in women.Conclusion: In severe aortic stenosis, factors associated with POAF and its impact on mortality differed between genders, with an increased risk of death observed only in men.     

Depression and sexual dysfunction

For sexual medicine the relationship between depression and sexual functioning is of major importance since both affective and sexual disorders are highly prevalent, are thought to exhibit a marked co-morbidity and might even share a common etiology. A high percentage of men and women suffering from mild, moderate, or severe forms of depression experiences sexual dysfunction. However, the relationship between depressive mood and sexual dysfunction is bidirectional and further complicated by the sexual side effects of antidepressant treatment, thus constituting a complex network of factors. In women, sexual desire was found to be the sexual sphere predominantly affected by depressive illness, while in male patients both sexual desire and erectile function tend to be impaired. As a consequence, sexually dysfunctional patients should be routinely screened for symptoms of depression. Since improvements in sexual functioning consistently belong to the most significant predictors of depression remission, adequate treatment of sexual functioning should be an integral component of therapy for all depressed men and women – irrespective of the causal relationship between both conditions.     

Casual sex and concurrent sexual partnerships among young people from an Yi community with a high prevalence of HIV in China

Liangshan Prefecture in Sichuan province, China, has a high prevalence of HIV infection, which is reflective of a change in the mode of transmission from injection drug use (IDU) to heterosexual intercourse. However, few studies focus on HIV-related heterosexual risk behaviours among the majority Yi population. The objectives of this study were to explore the characteristics of an egocentric sexual network and estimate the prevalence of casual sexual behaviour. Yi villagers (n=108), aged 15–35 years, who reported having had sex within the previous year were interviewed as to their sexual behaviours and networks. In-depth interviews and focus group discussions provided supplementary information on sexual norms. Logistic regression analysis was used to calculate unadjusted odds ratios (ORs) and 95% confidence intervals (CIs). Most of the respondents reported having had casual sex at some time in their life, and 66.7% reported multiple sexual partnerships. Only 21.3% reported ever having used a condom. During the study year, a total of 137 partners were involved in 153 sexual partnerships. Among the reported sexual partnerships, 67.3% originated from a casual sexual relationship. For network members in components of size ≥3, 56.9% were involved in concurrent sexual partnerships. Having never been married (OR: 2.11; 95% CI: 1.03–4.33) and younger age (OR: 0.89; 95% CI: 0.83–0.95) were both associated with being in a component of size ≥3. Size (OR: 2.99; 95% CI: 1.17–7.66), pair (OR: 0.54; 95% CI: 0.39–0.74), the number of weak components of the egocentric sexual network (OR: 30.04; 95% CI: 6.47–139.46) and gender (OR: 0.19; 95% CI: 0.06–0.67) were all associated with being in concurrent sexual partnerships. HIV-related interventions for the Yi ethnic minority in Sichuan province must therefore address concurrent sexual partnerships and promote condom use.     

Gender differences in experiencing occupational stress: the role of age,education and marital status

Studies investigating gender differences over the past two decades have produced contradictory results, with some to indicate no differences, and some suggesting that either men or women experience more psychological stress. In this study, we examine gender differences in occupational stress, taking into consideration the role of marital status, age and education. Results from a sample of 2775 professionals suggest that women experience higher levels of occupational stress than men. Nevertheless, when marital status, age and education were introduced in the equation, no significant gender differences were identified. Implications and future research directions are discussed. Copyright © 2009 John Wiley & Sons, Ltd.     

Current status and solutions for gender equity in anaesthesia research

Despite increasing numbers of women entering anaesthesia, they remain persistently under-represented within academic anaesthesia and research. Gender discordance is seen across multiple aspects of research, including authorship, editorship, peer review, grant receipt, speaking and leading. Women are also under-represented at higher faculty ranks and in department chair positions. These inequities are further magnified for women with intersectional identities, such as those who identify as Black, indigenous and women of colour. Several barriers to participation in research have been identified to date, including a disproportionate amount of family responsibilities, a disproportionate burden of clinical service, gender bias, sexual harassment and the gender pay gap. Several strategies to improve gender equity have been proposed. Increasing access to formal mentorship of women in academic medicine is frequently cited and has been used by healthcare institutions and medical societies. Senior faculty and leaders must also be conscious of including women in sponsorship and networking opportunities. Institutions should provide support for parents of all genders, including supportive parental leave policies and flexible work models. Women should also be materially supported to attend formal educational conferences targeted for women, aimed at improving networking, peer support and professional development. Finally, leaders must display a clear intolerance for sexual harassment and discrimination to drive culture change. Peers and leaders alike, of all genders, can act as upstanders and speak up on behalf of targets of discrimination, both in the moment or after the fact. Gender inequities have persisted for far too long and can no longer be ignored. Diversifying the anaesthesia research community is essential to the future of the field.     

Breast Cancer in Women With Recent Exposure to Fertility Medications is Associated With Poor Prognostic Features

Background: Fertility drug therapy (FDT) induces supraphysiologic endogenous estrogen production and might transiently increase breast cancer risk. Tumors developing following FDT exposure have not been extensively studied.Methods: Thirty-eight breast cancer patients with 40 primary tumors and with history of FDT exposure were identified and compared with two other breast cancer groups: women with pregnancy-associated breast cancer (PABC, 22 patients with 23 tumors) and premenopausal women born during same calendar years and not exposed to hormonal manipulations or recent pregnancy (controls, 192 patients with 201 tumors). Patients were diagnosed and treated mostly during the last decade.Results: Compared with controls, tumors of patients with FDT exposure presented at advanced stages (P < .005), were more likely to be estrogen or progesterone receptor negative (P < .03) and of poor histology grade (P <.0002). Aggressive features predominated among women diagnosed within 2 years of an FDT cycle (P <.05). FDT and PABC groups shared similarities. With a median follow-up of 43 months, relapse-free and cancer-free survival rates were significantly reduced in the FDT and PABC groups (P < .01 and P < .01, respectively). Multivariate analysis revealed only treatment-defined tumor stage (operable, locally advanced, or metastatic) as predictive of survival (P < .0001).Conclusion: Breast tumors in women with recent FDT exposure present with poor prognostic features and share similarities with PABC. Survival is stage dependent.     

Sexual behaviour, sexual dysfunctions and related help seeking patterns in middle-aged and elderly Europeans: the global study of sexual attitudes and behaviors

To study the sexual activity and the prevalence of sexual dysfunctions and related help seeking behaviour, among people in Europe aged 40–80 years. A telephone survey was carried out in 2001–2002 in Sweden, the UK, Belgium, Germany, Austria, France, Spain and Italy, of 4,977 men and 5,023 women, using a structured, standardized questionnaire Eighty-three percent of men and 66% of women had sexual intercourse during the year preceding the interview. The sexual dysfunctions most frequently reported were early ejaculation (11%) and erectile dysfunction (8%) in men; and a lack of sexual interest (18%), an inability to reach orgasm (13%) and lubrication difficulties (11%) in women. Of the 23% of men and 32% of women who reported sexual dysfunction, 26% had consulted a physician, with considerable between-country differences. Sexual activity is widespread among adult middle-aged and elderly people, but many experience sexual dysfunctions and few seek medical care.     

Adverse impacts experienced by police officers following exposure to sex discrimination and sexual harassment

Adverse psychological and physical impacts have been related to experience of detriment arising from sex discrimination. In the present study detriment was operationalized in terms of differential career progress, unequal access to organizational benefits and experience of sexual harassment. A national UK sample of 1802 police women, 510 police men and 164 civilian women took part in the study. Results revealed gender differences in exposure to detriment and the suffering of associated adverse impacts. Subjective rating of impacts by police women revealed the greatest impact to be associated with frustrated career progression and the least from experience of sexual harassment. A multiple regression analysis suggested the reverse order when predicting elevated GHQ(28) scores for women officers. This is accounted for by cultural factors, which are also proposed to be influential in rates of reporting sources of discrimination.