The role of the testicular factor INSL3 in establishing the gonadal position

INSL3, also designated Leydig insulin-like (Ley I-L) or relaxin-like factor (RLF), belongs to the insulin-like hormone superfamily. It is expressed in pre- and postnatal Leydig cells of the testis and in postnatal theca cells of the ovary. This sexual dimorphic pattern of INSL3 expression during development led us to suggest that the INSL3 factor could play an essential role in sexual differentiation, gonadal function and germ cell development. Key insights into the role of INSL3 came from analyses of INSL3 knockout mice. These mice showed impaired development of the gubernaculum ligament, a structure that is believed to mediate transabdominal descent of the testis during male embryogenesis. In double mutant XY-mice lacking INSL3 and a functional androgen receptor, it was demonstrated that both are essential for establishment of the sexual dimorphic position of the gonads through regulation of gubernaculum development and regression of the cranial suspensory ligament (CSL) during fetal life. Defects in this developmental process can cause cryptorchidism in the male, which is a most common disorder of sexual differentiation in human.     

A Qualitative Analysis of Father–Son Relationships among HIV-Positive Young Black Men Who Have Sex with Men

Young black men who have sex with men (YBMSM) are experiencing high and rising rates of HIV infection, more than any other age-risk group category in the USA. Contributors to HIV risk in this group remain incompletely elucidated. We conducted exploratory qualitative interviews with 20 HIV-positive YBMSM aged 17–24 and found that father–son relationships were perceived to be important sociocontextual influences in participants’ lives. Participants discussed the degree of their fathers’ involvement in their lives, emotional qualities of the father–son relationship, communication about sex, and masculine socialization. Participants also described pathways linking father–son relationships to HIV risk, which were mediated by psychological and situational risk scenarios. Our thematic analysis suggests that father–son relationships are important to the psychosocial development of YBMSM, with the potential to either exacerbate or attenuate sexual risk for HIV. Interventions designed to strengthen father–son relationships may provide a promising direction for future health promotion efforts in this population.     

Behavioral and neural trade-offs between song complexity and stress reaction in a wild and a domesticated finch strain

The Bengalese finch is the domesticated strain of the wild white-rumped munia. Bengalese finches have been domesticated and reproductively isolated for over 250 years from the wild strain. During this period, the courtship songs of the domesticated birds became phonologically and syntactically complex. In addition, psychological and physiological stress reactions to environmental and social factors diverged between the two strains. Based on our behavioral and histological studies, we consider the balance between the glucocorticoid- and mineralocorticoid receptors in song control nuclei and in the avian amygdala as to determine whether a bird can develop complex songs or rather has to devote the neural resources for the maintenance of stress reactions. We therefore suggest that phonological and syntactical complexity in Bengalese finch songs initially evolved because domestication freed them from species recognition and environmental stress, and then sexual selection increased the complexity. Neural and molecular studies also support the notion that Bengalese finches keep more song plasticity as adults. In conclusion, the present study suggests that domestication changed factors related with psychobiology of stress reactions and learning in finches.     

Association between sexuality knowledge and sexual dysfunction in hematopoietic stem cell transplantation patients and their partners

ObjectiveTo evaluate the association of sexual knowledge with sexual desire, sexual activity, and sexual satisfaction in hematopoietic stem cell transplantation (HSCT) patients and partners, and their willingness to participate in sexual education.MethodsThis is a multi-center survey. Patients were eligible if they had received HSCT. Patients’ current sexual partners were invited to the study unless they had limitations on sexual activity. Sexual desire, activity and satisfaction was assessed using the Sexual Activity Questionnaire. Sexual knowledge, experience of information seeking, sexual counseling or education, and willingness of participate in sexual education were assessed using questionnaire.ResultsOf 151 participants, 61.8 % had experience of receiving counseling about their sexual issues after HSCT. Compared to the lower sexual knowledge group, participants with higher sexual knowledge reported to be 1.91 times more sexually active with 3.04 times higher sexual desire. Among the participants, 79.4 % of participants had the willingness to receive sexual education after HSCT and preferred to receive sexual education from sexual education specialistsConclusionsHigher sexual knowledge was associated with higher sexual desire, sexual activity, and sexual satisfaction.Practice implicationsSexual education should be provided to patients and their partners after HCST by trained experts for HSCT patient’s sexual life.     

3-8岁阻塞性睡眠呼吸暂停低通气综合征儿童性激素水平的初步研究

目的检测3-8岁阻塞性睡眠暂停低通气综合征（obstructive sleep apnea-bypopnea sgn-drome,OSAHS）儿童血清性激素水平,探讨其性激素变化与下丘脑—垂体—性腺轴（hypothalamic-pituitary-gonad axis,HPGA）启动的关系。方法以76例3-8岁符合 OSAHS 的儿童和40例3-8岁健康儿童为研究对象,检测血清睾酮（T）、雌二醇（E2）、卵泡刺激素（FSH）、黄体生成素（LH）及催乳素（PRL）水平,对其 HPGA 启动、体格发育情况进行对比,分析性别、低氧、体重指数（BMI）与性激素水平之间的关系。结果OSAHS 组儿童身高、体重水平明显低于对照组（P ＜0．05）,E2水平明显高于对照组（P ＜0．01）。OSAHS 组男童 FSH 水平明显低于对照组（P ＜0.01）。OSAHS 组女童 FSH 水平明显高于 OSAHS 组男童（P ＜0．01）。结论OSAHS 可能影响儿童身高、体重,OSAHS 可能影响 E2、FSH 的分泌,3-8岁 OS-AHS 儿童体内雌激素的负反馈调节敏感性高,HPGA 尚未启动。     

Legal and Policy Considerations in Lebanon Related to Proposals for Paraphilic Disorders in World Health Organization's International Classification of Diseases Manual, 11th Version

IntroductionThe World Health Organization's general assembly, in its last meeting of May 2019, has approved the suggested changes to the International Classification of Diseases manual, 11th version (ICD-11). Some of the proposed recommendations include the revision of “Disorders of Sexual Preference”, now called Paraphilic Disorders, currently listed under the International Classification of Diseases-10 Mental and Behavioural Disorders.AimThis article presents findings on the analysis of the existing laws and policies that are relevant to paraphilic disorders in Lebanon.MethodsA literature review of all official and unofficial documents, reports, and articles published on laws and health policies relevant to paraphilic disorders in Lebanon was conducted, including a thorough review on Lebanese laws on that matter. Moreover, interviews with government representatives, including the Ministry of Public Health, the Ministry of Justice, the Ministry of Social Affairs, representatives of Non-Governmental Organizations working in child protection, and mental health professionals from the private and public sector, were conducted.Main Outcome MeasureCovered are (i) the health system in Lebanon including policies and laws related to mental health care provision and relevance to paraphilic disorders, (ii) the legal framework and the mental health evaluation and treatment in the Lebanese criminal justice system: the case of paraphilic disorders, (iii) adjudication of sex offenders in Lebanon, (iv) criminal responsibility relevant to paraphilic disorders, and (v) the relationship between legal and clinical issues for non–forensic health professionals.ResultsThe treatment of paraphilic disorders would follow the treatment of all mental health conditions in Lebanon as no specific services for paraphilic disorders are available within these health-care systems. Legally, sexual crimes in Lebanon are not judged according to the individual's urges, fantasies, or state of mind, rather are assessed according to the acts committed by the individual. Therefore, an individual diagnosed with a paraphilic disorder is not culpable of any crime should he not act on this disorder by committing acts that fall under the scope of the penal code. An analysis of sexual acts that qualify as crimes reveals that the element of consent is rarely taken into consideration as most sexual crimes are defined as such with reference to violation of social norms, primarily “morals and public morality.” Therefore, a change in the diagnostic classification of mental and behavioral disorders (ICD or Diagnostic and Statistical Manual of Mental Disorders) should not be a factor in their definition. Furthermore, in the course of enforcing criminal sanctions on individuals diagnosed with a mental disorder, the determining factor will be the individual's state of awareness at the time of the act. Psychiatric expertise initiated in that context lacks standardized criteria for diagnosis and is not bound by law to rely on international classifications; it is usually based on nonstructured interviews. Should it be assessed that the individual was fully aware of the consequences of his or her act, the paraphilic disorder diagnosis should not play any role in the sentencing.Clinical implicationsClinicians in Lebanon can now be aware of the legal sanctions that patients with paraphilic disorders may fall under, should criminal acts be committed. Clinicians can also be familiar with the role of mental health disorders in the legal system, specifically with relevance to “awareness” at the time of the criminal act. Moreover, clinicians can freely use the updated diagnoses of paraphilic disorders in the ICD-11, as they form no legal detriments in Lebanon.Strength & LimitationsThe interviewing technique used in this study ensured that participants spoke about issues pertinent to their experience and expertise and helped achieve data saturation. Nonetheless, although this is a review, a quality and bias screening tool was not used because of the search mostly pertaining to legal laws and cases instead of research articles. furthermore, no software was used to analyze the qualitative data from the interviews. In addition, some of the documents reviewed were in Arabic, and therefore, some nuances, while translating the essential findings to English, might have been lost in translation.ConclusionCompared with the ICD-10, the categories and definitions in ICD-11 should not create any additional obstacles nor offer any direct positive consideration, as the diagnostic classifications of mental disorders (ICD or Diagnostic and Statistical Manual of Mental Disorders) are not relevant to the definition of criminal sexual acts in Lebanon.Makhlouf Y, Kerbage H, Khauli N, et al. Legal and Policy Considerations in Lebanon Related to Proposals for Paraphilic Disorders in World Health Organization's International Classification of Diseases Manual, 11th Version. J Sex Med 2020;17:491–504.