S3. DOES SWITCHING OR AUGMENTING HELP WITH ANTIPSYCHOTIC-RELATED SEXUAL DYSFUNCTION: SYSTEMATIC REVIEW

Management of Antipsychotic-Related Sexual Dysfunction: Systematic Review

Several studies have shown that men with lower urinary tract symptoms are more likely to experience erectile dysfunction. All except 1 of these studies were cross-sectional, limiting inferences about whether lower urinary tract symptoms precipitate erectile dysfunction. The association between lower urinary tract symptoms and incident erectile dysfunction was examined prospectively in the Health Professionals Follow-Up Study. Lower urinary tract symptoms were assessed biennially by the American Urological Association symptom index, which captures symptoms of frequency, urgency and force of urinary stream. Severe lower urinary tract symptoms was defined as a symptom score of 20 points or greater and no lower urinary tract symptoms was defined as a score of 7 points or less in men not treated for lower urinary tract symptoms. In 2000 the men were asked to rate erectile function for several periods. Erectile dysfunction was defined as poor or very poor function, or erectile dysfunction medication use, while no erectile dysfunction was defined as very good or good function and no erectile dysfunction medication use. We estimated the RR using Poisson regression, adjusting for age and other potentially confounding factors. We observed 3,953 incident erectile dysfunction cases among 17,086 men. Men with severe lower urinary tract symptoms in 1994 or earlier had a statistically significant 40% higher risk of erectile dysfunction subsequently than men without lower urinary tract symptoms. The risk of erectile dysfunction increased with increasing lower urinary tract symptom severity (p trend <0.0001). The positive association between lower urinary tract symptoms and erectile dysfunction was stronger in younger than in older men (p interaction = 0.03). This study provides evidence that men with lower urinary tract symptoms are more likely to have erectile dysfunction subsequently.

The impact of sexuality and quality of life (QOL) is one of the main concerns of IBD. Despite the obvious relevance of this problem, knowledge of the extent of sexual dysfunction (SD) in IBD is limited. Aim of this study was to assess the prevalence of SD and erectile dysfunction (ED), QOL their predictors, and their age-related dynamic in IBD patients. In this cross-sectional study, 202 IBD patients [122 male, 80 female, 133 Crohn's disease (CD), 69 ulcerative colitis (UC)] fulfilled International Index of Erectile Function (IIEF) or Female Sexual Functioning Index (FSFI). QOL was assessed using IBDQ-32 through bowel, systemic, emotional and social domains. Prevalence of SD in men was 18%, ED 30.3% and SD in women 75%. Low QOL was present in 34.6% without gender difference (P=.253). In men, SD and ED were highest among 21-30years and raising after 51years of age. In women, SD was constantly highly prevalent, showing no decline over time. In multivariate analysis significant predictors of SD in men were CD phenotype, disease duration and emotional domain of IBDQ, of ED depression, emotional and bowel domain of IBDQ, and of SD in women emotional IBDQ domain. Quality of sex life is a serious concern among IBD patients and is age related. Components that play a role in sexual functioning in IBD require more clarification and further development of screening and treatment guidelines for SD to provide better care in the IBD population.

Sexual dysfunction in men with HIV is often overlooked by clinicians owing to many factors, including the taboo of sexuality. The improved life expectancy of patients with HIV requires physicians to consider their general wellbeing and sexual health with a renewed interest. However, data on sexual dysfunction in those with HIV are scarce. Erectile dysfunction (ED) is the most common sexual dysfunction in men, with a prevalence of ∼30-50% and is frequent even in men <40 years of age. HIV infection itself is the strongest predictor of ED, and many factors related to the infection-fear of virus transmission, changes in body image, HIV-related comorbidities, infection stigma, obligatory condom use-all impair erectile function. The diagnosis and treatment of sexual dysfunction is based on a multidisciplinary approach, which involves specialists in both infectious diseases and sexual medicine. Particular attention should be paid to the promotion of safer sex in these patients. This Review, describes the issues surrounding sexual dysfunction in men with HIV and aims to provide clinical advice for the physician treating these patients.

Most patients with chronic obstructive pulmonary disease (COPD) are middle-aged or older, and by definition all have a chronic illness. Aging and chronic illness decrease sexual interest, sexual function, and testosterone levels. To date, researchers have not simultaneously explored prevalence, risk factors, and impact of sexual dysfunctions on quality of life and survival in men with COPD. We tested three hypotheses: First, sexual dysfunctions, including erectile dysfunction, are highly prevalent and impact negatively the quality of life of those with COPD. Second, gonadal state is a predictor of erectile dysfunction. Third, erectile dysfunction, a potential maker of systemic atherosclerosis, is a risk factor for mortality in men with COPD. In this prospective study, sexuality was assessed in 90 men with moderate-to-severe COPD (40 hypogonadal) by questionnaire. Testosterone levels, comorbidities, dyspnea, depressive symptoms, and survival (4.8years median follow-up) were recorded. Seventy-four percent of patients had at least one sexual dysfunction, with erectile dysfunction being the most common (72%). Most were dissatisfied with their current and expected sexual function. Severity of COPD was equivalent in patients with and without erectile dysfunction. Low testosterone, depressive symptoms, and presence of partner were independently associated with erectile dysfunction. Severity of lung disease and comorbidities, but not erectile dysfunction, were independently associated with mortality (p=0.006). Sexual dysfunctions, including erectile dysfunction, were highly prevalent and had a negative impact on quality of life in men with COPD. In addition, gonadal state was an independent predictor of erectile dysfunction. Finally, erectile dysfunction was not associated with all-cause mortality.

Observational study (Ethics Committee Number 973.648). Evaluating the social and clinical factors associated with sexual dysfunction in men with traumatic spinal cord injury, as well as predictive factors for sexual dysfunction. Besides the motor and sensory loss, sexual function changes after spinal cord injury, ranging from decreased sexual desire to erectile disorders, orgasm, and ejaculation. Performed with 45 men, with traumatic spinal cord injury and sexually active. Sexual function was assessed by the International Index of Erectile Function and the level and degree of injury were determined following guidelines of International Standards for Neurological and Functional Examination Classification of Spinal Cord Injury. Bi and multivariate analysis was applied, with a 0.05 significance level. Forty-five subjects with mean injury time of 7.5 years (CI 5.2-9.9) were evaluated. Having a fixed partner is a protective factor (OR: 0.25; 95% CI: 0.07-0.92) of erectile dysfunction. Sexual desire is associated with the fixed partner (OR: 0.12; 95% CI: 0.02-0.66), masturbation (OR: 0.13; 95% CI: 0.02-0.62), and sexual intercourse in the last month (OR: 0.13; 95% IC: 0.01-0.92). Ejaculation (OR: 0.01; 95% CI: 0.00-0.15) and erectile dysfunction (OR: 15.7; 95% CI: 1.38-178.58) are associated with orgasm. Psychogenic erection (OR: 0.07; 95% CI: 0.01-0.69), monthly frequency of sexual intercourse (OR: 11.3; 95% CI: 2.0-62.8), and orgasmic dysfunction (OR: 7.1; 95% CI: 1.1-44.8) are associated with satisfaction. Fixed partner, ejaculation, masturbation are protective factors for sexual dysfunction. Erectile dysfunction, orgasmic, and infrequent sex dysfunction are predictors of sexual dysfunction. 3.

Sexual dysfunction (SD) is common in type 2 diabetic men, but few subjects are diagnosed and treated. The prevalence of diabetes mellitus is increasing worldwide. It is expected that the...

PurposeThis study aims to estimate the prevalence of sexual dysfunction in men with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) by conducting a meta-analysis.MethodsRelevant publications were searched using PubMed, Embase, CBM, China National Knowledge Infrastructure, VIP and Wanfang databases up to August 2015. Studies that reported the prevalence of erectile dysfunction, premature ejaculation and total sexual dysfunction in men with CP/CPPS were included.ResultsA total of 24 studies involving 11,189 men were included. Overall prevalence of sexual dysfunction in men with CP/CPPS was 0.62 (95 % CI 0.48–0.75), while the prevalence of erectile dysfunction and premature ejaculation was 0.29 (95 % CI 0.24–0.33) and 0.40 (95 % CI 0.30–0.50), respectively. From 1999 to 2010, the prevalence of sexual dysfunction, erectile dysfunction and premature ejaculation was 0.65 (95 % CI 0.45–0.83), 0.27 (95 % CI 0.22–0.33) and 0.41 (95 % CI 0.27–0.55), respectively. From 2011 to 2014, the prevalence of sexual dysfunction, erectile dysfunction and premature ejaculation was 0.50 (95 % CI 0.22–0.75), 0.35 (95 % CI 0.29– 0.40) and 0.39 (95 % CI 0.37–0.41), respectively.ConclusionThe prevalence of sexual dysfunction in men with CP/CPPS was high, even though overall sexual dysfunction demonstrated a slightly decreasing trend. Furthermore, erectile dysfunction prevalence rate had an increasing trend in recent years. More prospective studies are needed to evaluate sexual dysfunction improvement with better management of CP/CPPS.Electronic supplementary materialThe online version of this article (doi:10.1007/s00345-015-1720-3) contains supplementary material, which is available to authorized users.

Introduction Sexuality and religion are intricately intertwined. Although religion is associated with sexual taboos, religious texts are among the first and most consistent sources to discuss sex, and more specifically, sexual dysfunction. Sexual dysfunction has always been widely prevalent, and a cause of individual, social, and spiritual distress. As sex and society continue evolving within frameworks of religious thought and practice, it is important to understand what religions have historically taught regarding sexual dysfunction and how it may impact their communities today. Objective To provide a broad overview and comparison of how clinical literature illustrates major world religions’ understanding and management of sexual dysfunction, both in their historical texts or traditions and in the modern day. This study aims to illustrate that sexual dysfunction has been addressed by religions since their inceptions. Due to their widespread and historical popularity, we explore Judaism, Christianity, Islam, Hinduism, and Buddhism. Methods We conducted a literature search through the OVID (Medline) database using the terms “sexual dysfunction,” “erectile dysfunction,” “religion,” “Islam,” “Christianity,” “Buddhism,” “Judaism,” and “Hinduism,” with a particular focus on articles that addressed foundational ancient texts, historical teachings, or what is being taught today. From these findings, we identified any articles that explored specific religions’ perceptions and teachings (modern day or ancient) regarding sexual dysfunction. Due to the expansive and idiosyncratic nature of religious belief and practice, we cannot fully represent the unique complexities and perspectives that any of these religions may offer with respect to this topic. Instead, we emphasize the common denominators generally shared within and between religions, as well as those which were available in the literature. Results The religions of Islam, Christianity, Buddhism, Judaism, and Hinduism all acknowledge sexuality as an integral part of human society and individual expression. These religions all address sexual dysfunction as a potential threat to the ideal participation of the affected person within their community. This is universally true, despite variances in the specific statutes and guidelines defining ideal sexual practice for each religion. In addition, despite frequently opining on the management of women’s bodies, particularly the bodies of women of reproductive age, we found a relative deficit of discussion regarding sexual dysfunction among women in religious literatures. Also, we identified a possible tendency to conservativism, with religious discourse acknowledging the changes in sexual medical and surgical practice over time, but often delaying (or less frequently, declining) their integration with religious mores. Finally, we highlight the cyclical nature of many religions' discussion, or lack thereof, regarding sexual dysfunction. Conclusions Ultimately, our findings identify a constant concern with sexuality and sexual dysfunction across major religions worldwide, which is characterized by a cyclical progression and regression in the incorporation of secular biomedical attitudes, diagnostic, and therapeutic options for sexual health. Awareness of these patterns and religion-specific beliefs about sexual dysfunction has potential to optimize patient-centered care and advocacy within and on behalf of different patient populations. Disclosure No

Sexual dysfunction after treatment for testicular cancer: A systematic review

Introduction: Obesity, with more than 2.0 billion people worldwide, is associated with numerous comorbidities, affecting male and female sexual and reproductive function. Objective: This study explored the main clinical studies on the impacts of obesity on sexual dysfunction in men and women, as well as treatment proposals in an attempt to mitigate or resolve this condition. Methods: The systematic review rules of the PRISMA Platform were followed. The search was carried out from September to October 2024 in the Web of Science, Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 95 articles were found. A total of 30 articles were evaluated in full and 14 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 23 studies with high risk of bias and 25 studies that did not meet GRADE and AMSTAR-2. Most studies showed homogeneity in their results, with X2=72.5%&gt;50%. It was concluded that obesity is associated with substantial and significant impairments in quality of life. Weight loss has been shown to improve sexual function in men and women with obesity. The impact of weight loss medications and the long-term effect of bariatric surgery on sexual function require further studies. Higher visceral adiposity index is independently related to the risk of erectile dysfunction and that early intervention is necessary to reduce the progression of erectile dysfunction with high levels of visceral adiposity index. It was shown that BMI, age, smoking, diabetes and hypertension were associated with higher odds of reporting decreased sexual function.

Let’s talk about sex

Sexual dysfunction (SD) is an often overlooked disability in multiple sclerosis (MS). The purpose of this study was to investigate the relationship between SD and other disabilities in men and women with MS. The sample included 32 men and 219 women. The men ranged in age from 32 to 65 years with a mean of 47.6 years. The women ranged in age from 22 to 77 years with a mean of 45.4 years. Data were collected using Guy's Neurological Disability Scale and a demographic questionnaire. In men, a significant positive relationship was found between SD and lower-limb and bladder disability. No relationship was found between SD and other MS disabilities. The most common problems for men involved erection and ejaculation. For women, a significant positive relationship was found between SD and all other MS disabilities. The strongest correlation was between SD and fatigue. The most common problems for women involved vaginal lubrication and orgasm. No relationship was found between SD and number of years with MS or age in either men or women. An open dialogue about SD may improve quality of life for people with MS. Interventions may include symptomatic treatment, referral of the couple for sexual counseling, and other approaches that may include sensory body mapping to enhance communication and pleasure for the couple living with MS.

Sexual dysfunction pertains to any issue that hinders an individual from attaining sexual contentment. This health issue can have a significant impact on the quality of life and psychological health of affected individuals. Sexual dysfunction can generate stress, anxiety, depression, and low self-esteem, which can lead to a reduction in overall life satisfaction and the quality of interpersonal relationships. Sexual dysfunction can manifest as erectile dysfunction in men or lack of sexual desire in women. Although both sexes can experience sexual problems, there are some significant differences in the manifestation of sexual dysfunction between men and women. In men, sexual dysfunction is usually physical and associated with problems such as erectile dysfunction, while in women, sexual dysfunction is usually related to psychological factors. Additionally, there was an association between hypertension and sexual dysfunction in both the sexes. In men, hypertension can cause erection problems, whereas in women, it can cause vaginal dryness and a decrease in sexual desire. Furthermore, antihypertensive drugs can negatively impact sexual function, which can decrease adherence to drug treatment. However, nebivolol, an antihypertensive drug, has beneficial effects on erectile dysfunction in men. This is believed to be because nebivolol improves blood flow to the penis by producing nitric oxide, which can help improve erections.

22 - Sexual Dysfunction and Disability