Lack of Sexual Privacy Affects Psychological and Marital Domains of Male Sexual Dysfunction

IntroductionSexual dysfunctions (SDs) are dictated by predisposing, precipitating, maintaining, and contextual factors, the latter of which can help sexual problems to emerge. Even if the lack of sexual privacy is one of the most common contextual issues, it has not been extensively studied.AimInvestigation of sexual privacy in a large sample of men consulting for SD was the aim of this study.MethodsA consecutive series of 3,736 men, attending the outpatient clinic for SD for the first time, was retrospectively studied. Privacy during sexual intercourse was investigated with the following question, “During the last three months, have you had enough privacy during your sexual activity?” and rated 0 = yes, 1 = sometimes, 2 = rarely, and 3 = never.Main Outcome MeasuresSeveral clinical, biochemical, and psychological (Middlesex Hospital Questionnaire [MHQ]) parameters were studied.ResultsAmong the 3,736 patients studied, 83.9% reported enough privacy during sexual intercourse, while 8.6%, 5.7%, and 1.7% declared a decrease of sexual privacy of increasing severity. Lack of sexual privacy was associated with ejaculatory dysfunctions and with the inability to maintain an erection during intercourse. Subjects reporting lack of sexual privacy had a higher risk of relational and intrapsychic impairments, as well as psychopathology at MHQ questionnaire, even after adjusting for confounders. Fatherhood was associated with sexual privacy issues only in the lowest quartiles. In subjects without children, the absence of cohabitation with the partner was associated with an increasing risk of not having enough privacy (hazard ratio [HR] = 1.837 [1.269–2.659], P = 0.001); data confirmed, after stratification for age, only in the youngest subjects (I quartile HR = 2.159 [1.211–3.848], P = 0.009).ConclusionsThis study indicates that sexual privacy is often a poorly investigated item, which is important to evaluate in male SD. Boddi V, Fisher AD, Maseroli E, Rastrelli G, Corona G, Jannini E, Ricca V, Mannucci E, and Maggi M. Lack of sexual privacy affects psychological and marital domains of male sexual dysfunction. J Sex Med 2014;11:431–438.     

Posttraumatic Symptoms,Marital Intimacy,Dyadic Adjustment,and Sexual Satisfaction among Ex-Prisoners of War

IntroductionThe aversive impact of combat and combat-induced posttraumatic stress disorder (PTSD) on marital intimacy and sexual satisfaction has been examined in several studies. Nevertheless, the toll of war captivity on marital intimacy in relation to dyadic adjustment and sexual satisfaction remains unknown. In particular, the mediating role of marital intimacy in the relationship between PTSD symptoms and dyadic adjustment and between PTSD symptoms and sexual satisfaction has not yet been systematically explored thus far.AimsThis study aimed to examine the interrelationships of PTSD symptoms, dyadic adjustment, sexual satisfaction, and marital intimacy among ex-prisoners of war (ex-POWs).MethodsA sample of Israeli veterans ex-POWs (ex-POWs: N = 105) from the 1973 Yom Kippur War and a matched comparison group of veterans who participated in the same war but were not held captive (control: N = 94) were compared in the study variables.Main Outcome MeasuresThe PTSD inventory, dyadic adjustment scale, index of sexual satisfaction, and capacity for intimacy questionnaire.ResultsFindings revealed that ex-POWs reported higher levels of PTSD symptoms and lower levels of dyadic adjustment and sexual satisfaction than comparable controls. There were also differences between the groups in the pattern of relations between PTSD symptoms, dyadic adjustment, sexual satisfaction, and marital intimacy. Finally, for ex-POWs, marital intimacy partially mediated the relationships between PTSD symptoms and dyadic adjustment and sexual satisfaction outcome measures.ConclusionsPTSD symptoms are implicated in marital problems of ex-POWs. A significant relationship was found between the traumatized ex-POW's capacity for intimacy and both their sexual satisfaction and dyadic adjustment. Zerach G, Anat B-D, Solomon Z, and Heruti R. Posttraumatic symptoms, marital intimacy, dyadic adjustment, and sexual satisfaction among ex-prisoners of war.     

Evaluation of Marital and Sexual Interactions of Polish Infertile Couples

IntroductionThe World Health Organization defines infertility as inability to conceive despite regular sexual intercourse sustained for a period exceeding 12 months with no contraceptive methods.AimThe aim of this study was to evaluate the effect of infertility on marital and sexual interactions among infertile couples.MethodsTwo hundred six infertile couples were qualified to the study as the research group. The control group consisted of 190 fertile couples.Main Outcome MeasuresA specific questionnaire was used as a research tool in this study. It included the sociodemographic part, infertility status, and validated scales: Polish version of Index of Marital Satisfaction and Index of Sexual Satisfaction. Statistica 6.0 (Medical University of Silesia; Katowice, Poland) was used in the statistical analysis. The statistical analysis made use of: Mann–Whitney U‐test, chi‐square with Yates' continuity correction, ancova log‐linear analysis of covariance, and logistic regression analysis.ResultsThe study showed a significantly better partner relationship in female infertile as compared with female fertile. Clinically significant disorders of partnership stability were observed in 11.65% of studied women and in 20% of controls. Marital adjustment and sexual satisfaction were comparable among male groups. The probability of marital disorders increased with: age above 30 (odds ratio [OR] = 1.6), female sex (OR = 1.5), and lower education (OR = 1.7) among the study population. Diagnosed male factor and infertility duration of 3–6 years were connected with the highest relationship instability and the lowest sexual satisfaction both in female and male infertile.Conclusions.The risk factors of marital dissatisfaction in infertility include: female sex, age over 30, lower education level, diagnosis of male infertility, and infertility duration of 3–6 years. Drosdzol A, and Skrzypulec V. Evaluation of marital and sexual interactions of Polish infertile couples.     

Mediators of Sexual Functioning and Marital Quality in Chronically Depressed Adults with and Without a History of Childhood Sexual Abuse

IntroductionSexual dysfunction is common among depressed adults. Childhood sexual abuse (CSA) and depressive symptomology are among the risk factors for sexual dysfunction, and these factors may interact to predict adult relationship functioning. Several models have been developed postulating interactions between these variables.AimWe tested models of the effects of CSA and elucidate the associations between CSA, sexual dysfunction, depression severity, anxiety, and relationship quality in chronically depressed adults.MethodsBaseline data from 808 chronically depressed outpatients enrolled in the Research Evaluating the Value of Augmenting Medication with Psychotherapy study were evaluated using structural equation modeling.Main Outcome MeasuresThe Inventory of Depressive Symptomology, self‐report version (IDS‐SR) assessed depression severity, and the Mood and Anxiety Symptom Questionnaire Anxious Arousal subscale assessed anxiety. Sexual function was assessed with the Arizona Sexual Experiences Scale (ASEX), and the Quality of Marriage Index (QMI) assessed relationship quality for patients in stable relationships.ResultsCSA scores predicted depression severity on the IDS‐SR, as well as lower relationship quality and sexual satisfaction. ASEX scores were significantly associated with depression severity but were not correlated with the QMI. Two models were evaluated to elucidate these associations, revealing that (i) depression severity and anxious arousal mediated the relationship between CSA and adult sexual function, (ii) anxious arousal and sexual functioning mediated the association between CSA and depression symptoms, and (iii) when these models were combined, anxious arousal emerged as the most important mediator of CSA on depression which, in turn, mediated associations with adult sexual satisfaction and relationship quality.ConclusionsAlthough CSA predicts lower relationship and sexual satisfaction among depressed adults, the long‐term effects of CSA appear to be mediated by depressive and anxious symptoms. It is important to address depression and anxiety symptoms when treating patients with CSA who present with sexual dysfunction or marital concerns. Dunlop BW, Hill E, Johnson BN, Klein DN, Gelenberg AJ, Rothbaum BO, Thase ME, and Kocsis JH. Mediators of sexual functioning and marital quality in chronically depressed adults with and without a history of childhood sexual abuse. J Sex Med 2015;12:813–823.     

Effects of Stigma on the Relationship Between Perceived Social Support and Sexual Satisfaction Among Breast Cancer Survivors

BackgroundSexual satisfaction is one of the issues faced by breast cancer survivors (BCSs).AimThis study aims to explore the mediation of stigma in the relationship between perceived social support (PSS) and sexual satisfaction among breast cancer survivors.MethodsA cross-sectional study was conducted among 918 BCSs in Shanghai Cancer Rehabilitation Club. Data were collected using an online questionnaire including questions on sociodemographic characteristics, health status, PSS, stigma and sexual satisfaction of participants. The bootstrap method was used to test the significance of the simple mediation model.OutcomesThe simple mediation of stigma was found significant in the relationship between PSS and sexual satisfaction.ResultsStigma plays an intermediary role in the relationship between 2 dimensions of PSS (family and friends) and sexual satisfaction, but not in the relationship between the dimension of other significant people of PSS and sexual satisfaction.Clinical TranslationIt is important to reduce stigma when improving the sexual satisfaction of BCSs from the perspective of PSS.Strengths & LimitationsThe mediating role of stigma in the relationship between PSS and sexual satisfaction among BCSs has been shown for the first time. Study limitations include limitations in the representativeness of population by the study sample and the cross-sectional study design.ConclusionsStigma mediates the relationship between PSS and sexual satisfaction, which needs to be eliminated in intervention practice.Yuxin Zhang, Jie Zhao, Nan Jiang, et al. Effects of Stigma on the Relationship Between Perceived Social Support and Sexual Satisfaction Among Breast Cancer Survivors. J Sex Med 2022;19:1002–1011.     

Sexual Activity,Function and Dysfunction After a Diagnosis of Bladder Cancer

BackgroundSexual dysfunction is common in those affected by cancer and local and radical treatments for Bladder Cancer (BC) can affect sexual function directly.AimTo evaluate sexual function following a bladder cancer (BC) diagnosis.MethodsSelf-reported sexual function was collected 10 years after a diagnosis of BC as part of a cross-sectional patient reported outcome measure (PROM) survey exploring life after BC diagnosis and treatment.OutcomesParticipants completed a combined EORTC QLQ-BLM30 and QLQ-NMIBC24 questionnaire, including questions on sexual activity, intimacy, erectile/ejaculatory function and vaginal dryness.ResultsA total of 1796 participants returned a completed survey out of 3279 eligible participants (55%). Of the participants who returned a completed survey, a total of 1530 (85%) participants answered sexual function questions. The median (IQR) age was 75 (70–81). Participants were predominantly men (78%) and married/in civil partnerships (66%). In total, 31% were sexually active. Vaginal dryness was common (66%) in women. Erectile and ejaculatory dysfunction (80% and 58% respectively) were common in men. Compared to TURBT +/- intravesical treatments, those who had radical treatment were less likely to be sexually active (adjusted OR 0.56, 95% CI: 0.44–0.72, P<0.001) and had worse mean scores for intimacy problems (29.1 [radical treatment] vs 12.1, P<0.001), male sexual problems (72.2 [radical treatment] vs 45.7, P<0.001) and overall sexual function (17.1 [radical treatment] vs 20.3, P=0.01).Clinical ImplicationsThese findings highlight the magnitude of sexual dysfunction in the BC patient cohort and can help inform patients during the pre-op counselling process and shared decision making prior to BC treatments.Strengths and LimitationsThis study provides the largest in-depth analysis of sexual activity and function after BC diagnosis and treatment, to date. Limitations include the lack of data on participants’ sexual function prior to BC treatment and the heterogeneity with respect to time passed since last BC treatment.ConclusionSexual dysfunction in BC patients is common and rates appear higher following radical treatments compared to endoscopic. It is important to elicit these problems in clinics to enable counselling and treatment.Jubber I, Rogers Z, Catto JWF, et al. Sexual Activity, Function and Dysfunction After a Diagnosis of Bladder Cancer. J Sex Med 2022;19:1431–1441.     

Loss of Masculine Identity,Marital Affection,and Sexual Bother in Men with Localized Prostate Cancer

IntroductionErectile dysfunction (ED) is one of the most frequent sources of distress after treatment for prostate cancer (PCa), yet evidence suggests that men do not easily adjust to loss of sexual function over time. A hypothesized determinant of men's adaptation to ED is the degree to which they experience a loss of masculine identity in the aftermath of PCa treatment.AimsThe aims of this study were (i) to describe the prevalence of concerns related to diminished masculinity among men treated for localized PCa; (ii) to determine whether diminished masculinity is associated with sexual bother, after controlling for sexual functioning status; and (iii) to determine whether men's marital quality moderates the association between diminished masculinity and sexual bother.MethodsWe analyzed cross‐sectional data provided by 75 men with localized PCa who were treated at one of two cancer centers. Data for this study were provided at a baseline assessment as part of their enrollment in a pilot trial of a couple‐based intervention.Main Outcome MeasuresThe sexual bother subscale from the Prostate Health‐Related Quality‐of‐Life Questionnaire and the Masculine Self‐Esteem and Marital Affection subscales from Clark et al's PCa‐related quality‐of‐life scale.ResultsApproximately one‐third of men felt they had lost a dimension of their masculinity following treatment. Diminished masculinity was the only significant, independent predictor of sexual bother, even after accounting for sexual functioning status. The association between diminished masculinity and sexual bother was strongest for men whose spouses perceived low marital affection.ConclusionsDiminished masculinity is a prominent, yet understudied concern for PCa survivors. Regardless of functional status, men who perceive a loss of masculinity following treatment may be more likely to be distressed by their ED. Furthermore, its impact on adjustment in survivorship may rely on the quality of their intimate relationships. Zaider T, Manne S, Nelson C, Mulhall J, and Kissane D. Loss of masculine identity, marital affection, and sexual bother in men with localized prostate cancer.