Let us integrate sexual health—do psychiatrists integrate sexual health in patient management?

Archives of Women's Mental Health - The high prevalence of sexual dysfunction and the importance of sexual health issues in general stress the need for a physician to integrate sexual health...     

The androgen receptor and prostate cancer: A role for sexual selection and sexual conflict?

We propose and evaluate the hypothesis that the CAG repeat region of the androgen receptor represents a locus of antagonistic pleiotropy in the context of sexual selection and sexual conflict. Short repeats are associated with increased transactivation of the androgen receptor at the molecular level, and increased fertility at the phenotypic level. However, short repeats are also associated with increased risk of prostate cancer, and with more aggressive forms of the disease. The somatic evolution of cancer cell lineages also shows a repeated pattern of shortening of the CAG repeat in association with cancer progression, apparently as a result of positive selection among cell lineages. We further postulate that other genes associated with prostate cancer are likely to mediate antagonistic pleiotropy in the context of sexual selection and sexual conflict. A key prediction of this hypothesis is that the genes mediating antagonistic pleiotropy will show historical evidence of positive selection, particularly in the context of sexual conflict. Previous research on the molecular evolution of specific genes associated with prostate cancer supports this prediction, and we suggest further critical tests of the role for genomic conflicts and tradeoffs in the evolution of cancer risk.     

Young women’s alcohol expectancies for sexual risk-taking mediate the link between sexual enhancement motives and condomless sex when drinking

Alcohol use is prevalent among young women. Alcohol expectancies for sexual risk-taking and sexual enhancement motives have been associated with decreased condom use. This study investigated whether alcohol expectancies for sexual risk-taking mediated the association between sexual enhancement motives and condom use. Young women (N = 287, M age = 20.1) completed a survey assessing alcohol expectancies for sexual risk-taking, sexual enhancement motives, and characteristics of their most recent sexual encounter involving alcohol. Most participants (66.9 %) reported unprotected sex during their last sexual encounter involving alcohol. Higher sexual enhancement motives (OR = 1.35, p = .019) and alcohol expectancies for sexual risk-taking (OR = 1.89, p < .001) were associated with increased likelihood of condomless sex. Alcohol expectancies for sexual risk-taking mediated the association between sexual enhancement motives and condomless vaginal sex. Within the context of sexual encounters involving alcohol, expectancies that drinking may result in sexual risk-taking may account for why sexual enhancement motives relate to decreased condom use.     

Does antiretroviral therapy prevent HIV transmission to sexual partners?

The majority of HIV-1 infections are acquired sexually, and interventions to prevent sexual transmission are urgently needed to curb the growth of the HIV pandemic. The potential role of antiretroviral therapy in preventing sexual transmission of HIV is still emerging. Highly active antiretroviral therapy has been shown to decrease HIV RNA shedding in the genital tract, and its use among serodiscordant couples has been associated with reduced seroconversions in partners who are HIV negative. However, other studies have associated the use of antiretroviral therapy with increased HIV transmission risk behaviors. In this review, we explore the rationale for using highly active antiretroviral therapy to prevent sexual transmission of HIV including its role in prevention strategies at the population level, as well as the cost-effectiveness and potential limitations of this approach.     

��3, a transposable element that promotes host sexual reproduction

Theoretical models predict that selfish DNA elements require host sex to persist in a population. Therefore, a transposon that induces sex would strongly favor its own spread. We demonstrate that a protein homologous to transposases, called α3, was essential for mating type switch in Kluyveromyces lactis. Mutational analysis showed that amino acids conserved among transposases were essential for its function. During switching, sequences in the 5′ and 3′ flanking regions of the α3 gene were joined, forming a DNA circle, showing that α3 mobilized from the genome. The sequences encompassing the α3 gene circle junctions in the mating type α (MATα) locus were essential for switching from MATα to MATa, suggesting that α3 mobilization was a coupled event. Switching also required a DNA-binding protein, Mating type switch 1 (Mts1), whose binding sites in MATα were important. Expression of Mts1 was repressed in MATa/MATα diploids and by nutrients, limiting switching to haploids in low-nutrient conditions. A hairpin-capped DNA double-strand break (DSB) was observed in the MATa locus in mre11 mutant strains, indicating that mating type switch was induced by MAT-specific DSBs. This study provides empirical evidence for selfish DNA promoting host sexual reproduction by mediating mating type switch.     

Is there an association between menopause status and sexual functioning?

OBJECTIVE: The purpose of this study was to address whether: (1) there is an association between menopause status and various aspects of sexual functioning, and (2) the relative contributions of menopause status and other variables to various aspects of sexual functioning. DESIGN: Analyses are based on 200 women from the Massachusetts Women's Health Study II, a population-based sample of women transitioning through the menopause who were not HRT users, who had not had a surgical menopause, and who had partners. The women were classified as pre-, peri-, or postmenopausal according to menstrual cycle characteristics. Estradiol, estrone, and follicle-stimulating hormone were also measured. Sexual functioning was measured in terms of satisfaction, desire, frequency of sexual intercourse, belief that interest declines with age, arousal compared with a younger age, difficulty reaching orgasm, and pain. Predictor variables included sociodemographics, health, vasomotor symptoms, psychological variables, partner variables, and lifestyle behaviors. RESULTS: Menopause status was significantly related to lower sexual desire, a belief that interest in sexual activity declines with age, and women's reports of decreased arousal compared with when in their 40s. Menopause status was unrelated to other aspects of sexual functioning in either unadjusted or multiple regression analyses. In analyses in which log estradiol (E2) was included in addition to menopause status, log E2 was only related to pain. In multiple regression analyses, other factors such as health, marital status (or new partner), mental health, and smoking had a greater impact on women's sexual functioning than menopause status. CONCLUSIONS: Menopause status, but not E2, is related to some, but not all, aspects of sexual functioning. This may be due to menopause per se or other factors associated with menopause and aging (e.g., increased sexual dysfunction among aging men). Menopause status has a smaller impact on sexual functioning than health or other factors.     

Reducing African-American women's sexual risk: can churches play a role?

PURPOSE: This study investigates: 1) perceptions of clergy regarding their current counseling and the need for future programs concerning sexual risk-taking, 2) sexual risk behaviors among a group of African-American women, 3) women's attitudes regarding condom use, and 4) women's receptiveness to church programs regarding sexual risks. METHODS: The clergy of 50 randomly selected predominantly African-American churches in five North Carolina counties were contacted regarding participation. Female parishioners ages 18-30 from participating churches were invited to complete written surveys concerning women's health. RESULTS: Of 50 clergy repeatedly contacted, 38 declined to participate and eight did not complete the interview. Only four interviews could be completed. Counseling regarding sexual risk was not common among the four clergy. They often advised parishioners to practice abstinence. Survey data was received from 142 respondents at 14 churches. Nearly 84% of the women surveyed had a history of sexually transmitted diseases (STDs). Almost all of the respondents were receptive to a church program regarding sexual risks. CONCLUSIONS: Despite the sexual risks among African-American women, in this study, many clergy were unwilling to address prevention and were uncomfortable discussing issues related to sexual health. However, the few clergy who agreed to participate were very receptive to future programs.     

Attractive properties of sexual pheromones in mice: innate or learned?

It is generally assumed that chemical signals (sexual pheromones) constitute the primary stimulus for sexual attraction in many mammals. However, it is unclear whether these pheromones are volatile or nonvolatile and which sensory systems are involved in their detection (vomeronasal and/or olfactory). Moreover, it has been demonstrated that experience influences the behavioral response to sexual pheromones and the sensory systems implicated. In order to clarify this issue, the attractive properties of volatile and nonvolatile components of the male-soiled bedding have been analyzed in female mice that had no previous experience with adult male-derived chemical signals (chemically na?ve females) using two-choice preference tests. The results indicate that some nonvolatile male-derived substances exert an innate attraction to females, but volatiles derived from male-soiled bedding do not attract chemically nai;ve females. Therefore, the primary attractive sexual pheromone includes a nonvolatile compound (e.g. major urinary proteins, MUPs). On the other hand, male-derived volatiles become attractive to females because of repeated exposure to male-soiled bedding. This represents a Pavlovian-like associative learning in which previously neutral volatiles (very likely odorants) acquire attractive properties by association with the nonvolatile, innately attractive pheromone(s). These findings indicate that not only the sexual but also the 'chemical' experience (previous experience with sexual pheromones) has to be taken into account to interpret the role of chemicals as releaser or primer pheromones. The sensory systems involved in the detection of these stimuli and the neural basis of the odor-pheromone association are discussed.     

Should questionnaires of female sexual dysfunction be used in routine clinical practice?

Aims

The aim of this paper is to explore the potential value of questionnaires in routine clinical practice to assess female sexual dysfunction (FSD), and to identify if this could increase the competence of a physician in the initial management of women with these problems. The rationale to encourage Health Care Professionals (HCPs) to engage women in dialogue about their sexual health is that it may enhance a woman's quality of life (which may lead to improved general health) and might lead to timely interventions and possible preventative measures for certain diseases.

Method

A short literature review of the most relevant publications was undertaken evaluating current practice.

Results

FSD can have a negative impact on women's well-being and can also be an early symptom of underlying disease. Many HCPs do not broach the subject, consequently women do not get the opportunity either to voice their sexual concerns or access appropriate services. Review of currently available FSD questionnaires suggests that many but not all are generally inappropriate for use in routine clinical practice. Kriston et al.’s [1] STEFFI-2 may be an appropriate starting point. Evidence suggests that this would facilitate discussion of sexual matters between the HCP and the women, and increase the likelihood of FSD being diagnosed.

Conclusions

Following this review of the literature, the authors strongly recommend that HCPs include FSD questionnaires as part of their routine engagement with women. However, the questionnaire would need to be used as part of the overall assessment and cannot replace a detailed case history and examination, which should lead to effective treatment and management of FSD. The authors recommend further research in the following areas:

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Effective training for HCPs.

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FSD as an early presentation of sub-clinical disease.

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The cost-benefit of early treatment of FSD.

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A standardised, validated FSD screening tool.

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Benefits of using FSD screener in routine clinical practice.

     

High-risk sexual behavior in Los Angeles: who receives testing for HIV?

No recent population-based data on HIV testing in people with high-risk sexual behavior are available. We sought predictors of testing using data from the 1997 Los Angeles County Health Survey, a random-digit telephone survey of 8004 county households. An estimated 2.3 million (35.5%) adults were tested for HIV in the past 2 years and approximately 370,000 (5.6%) engaged in high-risk sexual behavior (defined as having > or =2 partners in the past 12 months and not always using condoms). Among high-risk persons, an estimated 46% of heterosexual men, 56% of heterosexual women, and 72% of men who had sex with men (MSM) were tested for HIV. In a multivariable model of high-risk people, both heterosexual men (odds ratio [OR], 0.31; 95% confidence interval [CI], 0.16-0.61) and women (OR, 0.41; 95% CI, 0.19-0.87) had significantly lower proportions of testing than MSM. Although African Americans and Hispanics had significantly higher testing proportions than whites overall among all county residents, those reporting high-risk sexual behavior did not test at higher proportions. We conclude that the proportion of adults with high-risk sexual behavior tested for HIV is higher than almost a decade ago. However, testing among this group remains suboptimal. Future public health campaigns should intensify efforts to encourage HIV testing among this population.     

Mixed stains from sexual assault cases: autosomal or Y-chromosome short tandem repeats?

We analyzed forensic DNA samples from four cases of sexual assault, using the Y-chromosome-specific human DNA markers and a panel of autosomal short tandem repeats (STRs). The presence of male contribution was evaluated by the analysis of the Amelogenin locus. A panel of tetrameric Y-STR (DYS19, DYS390, DYS391, DYS392, DYS385, DYS389I and II) was used in further analysis of samples, increasing the efficiency of the forensic genetic analyses. It was possible to identify a partial or full Y-profile of the rapists in different DNA mixtures when genetic profile could not be detected by autosomal STRs. However, in the case of male/male DNA mixture, only the victim's Y-profile could be obtained because the DNA of the offenders was present in low amounts. When the mixture contained different male/male proportion of DNA, only the full profile of the major component could be detected. In cases where male/female DNA mixed stains contained a sufficient amount of male DNA, the analysis of autosomal STRs was adequate enough to identify the full profile of the rapist. Our experience shows that the main advantage of the Y-STR approach is its ability to detect the male component in the mixed stains when the DNA of the male contributor is present only in a very small amount.     

Is the Menopause Rating Scale accurate for diagnosing sexual dysfunction among climacteric women?

Background

Although several tools have been designed to assess quality of life (QoL) among middle-aged women their capacity to specifically assess sexual dysfunction (SD) remains uncertain. Moreover, if SD impairs QoL within this population, then sexual assessment becomes a key issue.

Objectives

To evaluate the accuracy of the Menopause Rating Scale (MRS) in diagnosing SD among climacteric women.

Methods

In this cross-sectional study 370 women aged 40–59 years filled out the MRS and the Female Sexual Functioning Index (FSFI) simultaneously. SD among surveyed women was defined as those obtaining a total FSFI score of ≤26.55. A receiver-operator curve (ROC) was used to plot and measure the diagnostic accuracy of one MRS item (item 8, assessing sexual problems) using the FSFI total score as a gold standard.

Results

Mean age of surveyed women was 49.3 ± 5.8 years. A 56.5% of them were married, 44.3% were postmenopausal, 66.8% were sexually active and 57% had SD (FSFI total score ≤26.55). ROC curve determined a score ≥1 in the MRS item 8 as a cut-off value for discriminating women with SD (78% sensitivity and 62% specificity with an area below the curve of 0.70 Swett).

Conclusions

The MRS was moderately accurate for diagnosing SD among climacteric women. More research is warranted in this regard.     

Are sex steroids involved in the sexual growth dimorphism in Eurasian perch juveniles?

Individual growth and food intake were monitored in Eurasian perch (Perca fluviatilis L.) juveniles (13.5+/-3.4 g initial body weight) to determine whether androgens and estrogens may mediate sex-related growth differences. Fish were individually tagged with chips and implanted with cocoa butter containing 20 microg of either 17alpha-methyltestosterone (MT) or 17beta-estradiol (E(2)) per gram of fish body; controls were implanted with cocoa butter without hormones. All fish were bled at the end of the experiment for measurement of E(2) in females and testosterone (T) in males (MT was not measured) and triiodothyronine (T3) in both genders. Survival, gonadosomatic index and hepatosomatic index were not affected by steroid treatments. Relative food intake (RFI), feed efficiency (FE) and specific growth rate (SGR) were higher in females than in males in all treatments. MT treatment significantly lowered RIF, FE and SGR in both sexes, while E(2) treatment showed no significant effect on growth and feeding parameters. In contrast to E(2) and T concentrations, T3 levels were significantly and positively correlated with SGR and RFI. The results provide evidence that MT may affect sexually related growth dimorphism by decreasing food intake and FE in Eurasian perch.     

Selectively bred male rat lines differ in naïve and experienced sexual behavior

Ejaculatory behavior is facilitated by activating 5-hydroxytryptamine(1A) (5-HT(1A)) receptors. The present study examined male sexual behavior in rat lines that were selectively bred for their different hypothermic responses to 8-hydroxy-2-(di-n-propylamino)tetralin (8-OH-DPAT). Sexual behavior was examined in na?ve and experienced HDS (high 8-OH-DPAT sensitive), LDS (low 8-OH-DPAT sensitive), and RDS (randomly bred) rats lines. In addition, the effects of 8-OH-DPAT (0.05 mg/kg) and N-(2-[4-(2-methoxyphenyl)-1-piperazinyl]ethyl)-N-(2-pyridinyl)-cyclohexane-carboxamide (WAY 100,635; 1 mg/kg) were examined. Na?ve HDS animals had diminished ejaculatory behavior (as indicated by a decreased number of intromissions, mounts and ejaculations, increased ejaculation and intromission latency, and longer inter-copulatory interval), compared to the LDS and RDS groups. In addition, the post-ejaculatory interval (PEI) was longer in the HDS group. With experience, the HDS group improved its ejaculatory behavior. Experienced HDS animals had a lower number of intromissions and a longer PEI compared to the LDS group. 8-OH-DPAT facilitated ejaculatory behavior in both HDS and LDS groups. This effect was more pronounced in the LDS group. WAY 100,635 did not alter sexual behavior in either group. In summary, alteration in forebrain 5-HT(1A) receptors in HDS animals may be involved in the ability of na?ve rats to achieve ejaculation. 5-HT(1A) receptors are involved in the regulation of resumption of sexual behavior after ejaculation.     

Does sexual violence contribute to elevated rates of anxiety and depression in females?

BACKGROUND: It is well documented that females have higher rates of internalizing disorders (anxiety, depression) than males. It is also well known that females have higher exposure to childhood sexual abuse and sexual assault. Recently, it has been proposed that the higher levels of internalizing disorders in females may be caused by their greater exposure to sexual violence. METHOD: Data were gathered as part of the Christchurch Health and Development Study. In this study a cohort of 1265 children born in Christchurch, New Zealand, in 1977 have been studied from birth to age 21 years. The measures collected included: major depression and anxiety, childhood sexual abuse and adolescent sexual assault. RESULTS: Findings confirmed the established conclusion that internalizing disorders are over twice as common in females than males (ORs 2.2-2.7). In addition, it was found that females were exposed to higher rates of sexual violence than males (ORs 5.1-8.4). Statistical control for gender related differences in exposure to sexual violence reduced the associations between gender and anxiety and depression. Nonetheless, even after such control, gender was significantly (P < 0.0001) related to both anxiety (OR = 1.8; 95% CI, 1.3-2.4) and depression (OR = 1.9; 95% CI, 1.4-2.3). CONCLUSIONS: Greater female exposure to sexual violence may be a factor that contributes to greater female susceptibility to internalizing disorders. However, even after adjustment for gender differences in exposure to sexual violence it is clear that a substantial relationship between gender and internalizing disorder persists.