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Aromatase Inhibitors Linked to Low Sexual Desire, Bowel Problems

Feb 19, 2018

Unfortunately, AIs do have sexual side effects. Estrogen is an important hormone for women’s sexual health, but because AIs greatly reduce the supply, many women experience vaginal dryness, pain during intercourse, and menopausal symptoms.

For a Journal of Sexual Medicine study, researchers wanted to know how AIs affect a woman’s sexual desire, pelvic floor muscles, urinary function, and bowel movements. They also questioned how much AIs might contribute to pelvic organ prolapse, when a woman’s pelvic organs “drop” into her vagina.

They asked 625 women ranging in age from 36 to 96 to complete questionnaires about their health and any sexual distress they might feel. The women had been diagnosed with breast cancer at least ten years earlier, and about 85% had hormone receptor positive cancer. Thirteen percent were still taking an AI or tamoxifen at the time of the questionnaire.

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Why Do Transmen Have Surgery?

Feb 13, 2018

Different avenues have their pros and cons. Phalloplasty usually allows for the implantation of a penile prosthesis, if needed, which can make erections easier. But this approach might result in scarring on the arm or leg. Metoidioplasty has fewer complications, but patients can’t always penetrate a sexual partner.

Healthcare providers counsel patients on their options. However, knowing the motivations of transmen – and their feelings after surgery – could help with the conversations. That’s where this study comes in.

The researchers questioned 21 transmen with an average age of 40 about their reasons for surgery and their experiences afterward.

The top motivation for surgery was confirmation of a masculine self-image, reported as “strong” for all the transmen. All of them felt that surgery helped this reach their goal.

About 95% of the transmen said successful sexual intercourse was important for them. About two-thirds said this goal was achieved.

Participants cited other reasons for choosing surgery, too. Many wanted to stand while urinating, to use the men’s bathroom, and to feel comfortable starting new relationships. Most participants attained these goals.

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Prostate Cancer Treatment Affects Both Patients and Partners

Feb 06, 2018

They found that in addition to erectile dysfunction (ED), low sex drive and difficulties with arousal and orgasm are common in prostate cancer survivors. Partners’ sexual satisfaction often worsens as well. For instance, one study reported that partners rated patients’ erection quality lower than the patients themselves did.

It’s possible that partners may have unrealistic expectations about the patients’ sexual recovery, leading to disappointment over time, the authors explained. However, cancer survival was more important to partners than sexual side effects.

The researchers also found that the mental and physical health of both partners, along with the quality of the communication between them, can affect their relationship satisfaction. When feelings are left bottled up, intimacy can be difficult for both members of the couple.

The way patients perceive their partner’s support may also play a role. Studies suggested that when partners are more cooperative and maintain a positive attitude about sex, it might lessen the sexual impact of prostatectomy.

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Sexual Problems Continue for Young Cancer Survivors

Jan 30, 2018

At the start of the study, almost 58% of the participants had romantic partners, but two years later, the figure dropped to 43%.

Women were among the participants most likely to experience sexual issues. Other high-risk groups were older patients, those who were married or in a committed relationship, those who had undergone chemotherapy, those with psychological distress, and those with less social support.

Being in a relationship was linked to worse sexual function for women, but relationship status was not a contributing factor for men.

“We concluded that sexual functioning is experienced differently among males and females. For a young woman, especially, a cancer diagnosis can disrupt her body image, the intimacy with the partner and the ability to engage in sex,” lead author Chiara Acquati told the University of Houston, where she is a professor at the Graduate College of Social Work.

She added: “Results from this study emphasize the need to monitor sexual functioning over time and to train health care providers serving young adults with cancer in sexual health. Furthermore, patients should be connected to psychosocial interventions to alleviate the multiple life disruptions caused by the illness and its treatment.”

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Transgender Americans Struggle for Proper Healthcare

Jan 23, 2018

In terms of healthcare, almost a quarter of transgender respondents said they didn’t go to the doctor because they feared discrimination. Twenty-two percent did not have health insurance at the time of the survey.

In 2016, Elizabeth Dietz and Jessica Halem discussed some of the specific barriers transgender individuals face when trying to access healthcare in the AMA Journal of Ethics. Transgender people might not be able to find a specialist in transgender health in their local area. Travel to transgender health clinics can be difficult and expensive. And health insurance plans do not always cover services.

The consequences can be serious. Transgender patients may put off seeing the doctor for a medical need, making their condition more serious. Or, they may seek help through the black market or from well-meaning but unqualified peers online.

Last fall, Dr. Laura Arrowsmith wrote of her experiences as a trans woman seeking healthcare in the Washington Post:

When I began my journey to become my authentic self, my family-practice physician of many years refused to see me. She said that I had lied to her about who I was. This was a shock — but then, I guess I had lied to myself for decades, too. On numerous other occasions I have been refused care by physicians, sometimes because of discrimination and bigotry but at other times because of an expressed concern that “we have no idea how to care for a transgender patient.”

Gender reassignment surgery is one path toward living as one’s desired gender. But, as NPR reports, patients may still develop cancers that largely affect their birth sex. For example, a transman who has had a double mastectomy can still get breast cancer, as some of the original breast tissue remains.

Others decide to keep the reproductive organs they were born with because surgery is so expensive. As a result, some transmen develop gynecological cancers (like ovarian cancer) or need regular Pap screenings for cervical cancer.

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PTSD Linked to Sexual Problems in Midlife Women

Jan 16, 2018

Three types of sexual problems were investigated: vaginal pain with intercourse (which affected 13% of the women), vaginal irritation (32%), and vaginal soreness (7%).

All three problems were more common in women with PTSD.

The scientists also found an association between emotional intimate partner violence and painful intercourse.  Sexual assault, vaginal pain, and vaginal irritation were linked as well.

“Over 20% of midlife and older women in this ethnically-diverse community-based cohort reported clinically significant PTSD symptoms and exposure to interpersonal violence, which contributed to their risk of menopause-related sexual dysfunction,” the authors wrote.

They stressed the importance of screening for PTSD and interpersonal violence in women who are middle-aged and older and the need for “trauma-informed care of genital and sexual health” for women in this age group.

The findings were presented at the annual meeting of the North American Menopause Society in Philadelphia last October.


MedPage Today

Monaco, Kristen

“PTSD Predictor of Midlife Sexual Dysfunction”

(October 17, 2017)

North American Menopause Society

Gibson, Carolyn, PhD, MPH, et al.

“Interpersonal Violence, Posttraumatic Stress Disorder, and Menopause-Related Sexual Dysfunction in an Ethnically-Diverse, Community-Based Sample of Women”

(Abstract S-21. Presented at annual meeting of the North American Menopause Society, October 17, 2017, Philadelphia, Pennsylvania, USA)

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Transgender Men Satisfied with Penile Implants

Jan 09, 2018

Men with severe erectile dysfunction (ED) may opt for an inflatable penile implant if other ED treatments, such as medications, aren’t successful or appropriate. The surgery involves removing the corpora cavernosa and replacing them with cylinders that can be inflated on demand using a special pump that is also implanted into a man’s body. (Read more about penile implants here.)

Researchers wondered how well implants would work for transgender men. They documented the experiences of 247 patients who underwent female-to-male gender reassignment surgery between January 2001 and October 2015. The patients ranged in age from 21 to 69; their average age was 38 years.

All of the men had had a neophallus (a “beginning” penis) surgically created at least a year before their implant surgery. This time frame allowed for physical sensation to build and for any complications to be taken care of.

After implantation, the patients were followed for a median of 20 months.

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Are These Words Forbidden at the CDC?

Jan 02, 2018

The situation was of great concern to medical organizations, including the American College of Obstetricians and Gynecologists (ACOG), whose president, Dr. Haywood L. Brown wrote:

As women's health care providers devoted to maternal and fetal health, our members rely on these words to ensure precision, reasoning and credibility in the provision of care. These reported word restrictions only serve to imperil the CDC’s valued position as a trusted partner in addressing the serious issues facing America’s public health.

On December 17th, the CDC posted the following message from director Dr. Brenda Fitzgerald on its Facebook page:

I want to assure you there are no banned words at CDC. We will continue to talk about all our important public health programs.

You may be understandably concerned about recent media reports alleging that CDC is banned from using certain words in budget documents. I want to assure you that CDC remains committed to our public health mission as a science- and evidence-based institution.

As part of our commitment to provide for the common defense of the country against health threats, science is and will remain the foundation of our work.

CDC has a long-standing history of making public health and budget decisions that are based on the best available science and data and for the benefit of all people—and we will continue to do so.

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Low Desire Common in Midlife Women

Dec 26, 2017

HSDD has been researched in the past, but some of those studies did not use validated assessment tools. For this study, the researchers wanted to know more about the prevalence of HSDD and its effects on women with partners and those without.

The women completed several questionnaires concerning their menopausal status, sexual function, sexual desire, sexual distress, and any symptoms of depression. They also told the researchers about any medications they were taking, as some drugs can have sexual side effects like low desire.

Just over a quarter of the women had not yet reached menopause. Nineteen percent were perimenopausal, which means they were in the midst of the menopausal transition. Fifty-five percent were postmenopausal. About 71% had a regular sexual partner.

Fourteen percent of the participants had moderate to severe depression, and 24% took medications that could affect sexual function.

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Generic Viagra Now Available in United States

Dec 19, 2017

Generic drugs are expected to work the same way and have the same benefits as their brand-name counterparts, according to the U.S. Food and Drug Administration (FDA), which regularly reviews such medications.

One of the generics is manufactured by Teva Pharmaceuticals. Greenstone, a subsidiary of Pfizer, produces the other. (Pfizer also makes brand-name Viagra, which first came on the market in 1998.)

Because of U.S. trademark laws, generic Viagra will not look like the blue diamond-shaped pill that men might be familiar with.

“Generic medicines and brand-name medicines share the same active ingredient, but other characteristics, such as colors and flavorings, that do not affect the performance, safety, or effectiveness of the generic medicine, may be different,” explains the FDA on its website.

The generic drugs are also expected to be less expensive than brand-name Viagra, making them more accessible to men. Brand-name ED drugs are not always covered by health insurance plans and, if they are, there might be steep copays.

For example, HealthDay reported that the wholesale cost for Pfizer’s 50-milligram or 100-milligram versions of Viagra is $61.54 per pill. Greenstone’s generic version will cost between $30 and $35 per pill, although those prices will vary depending on the pharmacies, insurance plans, and copays.

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Drug Found to Clear Genital Psoriasis in Most Patients

Dec 12, 2017

Ixekizumab is currently used to treat psoriasis in general, but the effects on genital psoriasis had not been widely studied.

Funded by Eli Lilly and Company, the ixekizumab trial involved 149 men and women with moderate to severe genital psoriasis. About half were assigned to receive an injection of ixekizumab once every two weeks for twelve weeks. The rest received a placebo injection for the same duration.

Some of the patients started seeing improvements in the first week. After twelve weeks, psoriasis had either cleared or almost cleared for 73% of the patients who received ixekizumab, compared to just 8% of the placebo group. Sixty percent of the treatment group and 8% of the placebo group reported less itchiness.

Seventy-eight percent of the treatment group said that their psoriasis had little or no effect on how often they had sex. For the placebo group, the figure was 21%.

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For Breast Cancer Survivors, Sexual Concerns May Last Years

Dec 05, 2017

For the breast cancer group, an average of three years had elapsed since their cancer diagnosis. Half of the women had had chemotherapy; about three-quarters had undergone radiotherapy. Two-thirds had had breast conserving surgery, and the remainder had undergone mastectomy.

Overall, the breast cancer survivors had poorer sexual health. Twenty-eight percent said they were not sexually active, compared to 20% of the women with no history of breast cancer. The primary reason for sexual inactivity was lack of a partner, followed by lack of interest in sex. Women in the breast cancer group were more likely to report discomfort during intercourse.

Low sexual interest was an issue for both groups, although it was more common among the breast cancer survivors. In fact, about 69% of the survivors and 59% of the women with no history of breast cancer met the criteria for hypoactive sexual desire disorder (HSDD) – low libido accompanied by distress.

“Our results demonstrate that [sexual health] problems persist into [breast cancer] survivorship and differ significantly from the general population,” the authors wrote.

They added that healthcare providers should address sexual health concerns when treating and counseling cancer survivors.

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Poor Health and Lack of Communication Related to Low Sexual Interest, Study Says

Nov 28, 2017

Fifteen percent of the men and 34% of the women said they had lacked sexual interest for at least three months in the past year. Of these, over half of the men the about two-thirds of the women were distressed about their situation. Low sexual interest became more frequent as people got older, although menopause did not appear to play a role for the women.

Participants with physical or mental health problems, such as depression, also reported lower sexual interest, as did those who had been diagnosed with a sexually-transmitted infection (STI) or been forced to have sex against their will.

Relationship factors had an effect, especially for the women. People tended to have lower interest if they had trouble talking about sex with their partner, didn’t share their sexual likes and dislikes, or were unhappy with their relationship. A partner’s sexual difficulties and any mismatch in sexual desire were other factors.

Women who had been pregnant during the past year and those with young children were more likely to report low interest. The researchers noted that fatigue and stress associated with childcare might affect the women’s interest in sex. However, these particular findings did not apply to men.

Also for the women, early sexual experiences had some influence, especially if they had felt pressured by a partner and regretted their decision to have sex.

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Sexual Incontinence Needs Attention, Researchers Say

Nov 21, 2017

Based on their review, the researchers noted the following:

  • Between 2% and 10% of women experience sexual incontinence, with higher rates for women who already have another type of incontinence.
  • Men often have sexual incontinence after radical prostatectomy, the surgical removal of the prostate gland. For example, one study in the review found that 20% to 64% of men had climacturia after this surgery. Some men find that their continence improves over time, however.
  • Scientists aren’t sure exactly why sexual incontinence happens. One possible explanation involves damage to important nerves, particularly the pudendal nerve, which plays roles in both genital sensation and urinary function. Such damage can occur through pelvic surgery or childbirth.
  • Many men and women with sexual incontinence avoid sexual activity because they feel embarrassed, unattractive, or anxious.
  • Sexual incontinence can affect partners and relationships, too. But some people felt their partners were more bothered by it than those partners actually were. In fact, one study found that some men didn’t know their female partner had leaked urine during sex. In the same study, 84% of the women said that their sexual incontinence was a problem, but only 35% of their partners agreed.
  • Men who have sex with men may be more bothered by sexual incontinence and need to make adjustments, especially if they engage in oral sex. (The reviewers found no studies discussing women who have sex with women or heterosexuals and oral sex.)
  • Doctors and patients often don’t discuss incontinence during office visits. The authors suggested that doctors provide relevant information in office waiting rooms or conduct simple screenings.

There are several ways to treat sexual incontinence, the authors wrote. Some are behavioral, like emptying the bladder before sex, wearing a condom, placing a tension loop at the base of the penis, or using a dental dam (a barrier method sometimes used during oral sex). Patients may benefit from pelvic floor physical therapy, which strengthens pelvic floor muscles for better urinary control. Medications and surgery are other options.

Treatment of sexual incontinence may improve sexual satisfaction for both patients and partners, the authors added.


Sexual Medicine Reviews

Melissa H. Mendez, MD, et al.

“Contemporary Review of Male and Female Climacturia and Urinary Leakage During Sexual Activities”

(Full-text. Published online: September 20, 2017)

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Men May Fracture Penis During “Doggy Style” Sex

Nov 14, 2017

Recently, a team of scientists in Brazil set out to learn more about specific sexual positions and penis fracture.

They looked at the medical records of 90 men between the ages of 18 and 66 who had been treated for fractures an emergency department in Rio de Janeiro between 2006 and 2016. Eighty-seven men were heterosexual, and 3 were homosexual.

The men were asked how the fracture had occurred and, if it was the result of sexual activity, what position they were engaged in at the time.

Sixty-nine of the men (77%) fractured their penis during sex. The three gay men had done so during “doggy style” sex. For the rest, the fracture had happened during vaginal intercourse. In this group, just over half were using “doggy style,” 35% were using man-on-top, and 14% were using the woman-on-top position.

Twenty-three of the cases were considered severe. In this group, over half of the fractures occurred during “doggy style” intercourse.

Fourteen men also had injuries to the urethra, the tube that semen travels through during ejaculation.

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What Happens in Women’s Brains During Orgasm?

Nov 07, 2017

They recruited 10 women between the age of 29 and 74 (average age 44) who were willing to have orgasms in a clinical setting. Each woman had a male partner.  The women were asked to have two orgasms, if possible, during a brain scan – one though masturbation and the other by having their partner stimulate them.

During each session, the woman pressed a button to indicate when stimulation began, when the orgasm started, when the orgasm ended, and when she had “recovered” from climax. In a nearby control room, the researchers measured brain activity in 20 second units.

The researchers did not find any significant differences between self- and partner-stimulated orgasms. Generally, the women’s brains gradually became more active as stimulation increased. This activity peaked during orgasm, then declined.

During orgasm, areas of the brain associated with sympathetic activity, pleasure, reward, and addiction were activated. There was also more activity in areas that are thought to raise pain tolerance during orgasm.

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Breast Cancer Has Sexual Impact on Both Survivors and Partners

Oct 31, 2017

The survivors’ average age was 51 years and an average of 38 months had passed since their breast cancer diagnosis. The vast majority of them were married or in a relationship. About two-thirds of the women started having sexual problems during their cancer treatment. Most had gone through menopause; for about half of that group, menopause had been induced by treatment.

The most common sexual dysfunction, affecting 83% of the women, was hypoactive sexual desire disorder (HSDD), a distressing lack of sexual interest. Forty percent had trouble becoming aroused, and a third had pain during intercourse.

Some forms of treatment were associated with specific problems among the women. For example, HSDD was more frequent in women who had had hormone therapy. Immunotherapy, which uses the patient’s immune system to fight cancer, was linked to painful intercourse.

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Vaginal Estrogen Could Be a Menopause Management Option for Women with Breast Cancer

Oct 24, 2017

Women going through natural menopause may decide to try hormone replacement therapy. This is not an option for many breast cancer patients or survivors. However, some may be able to use vaginal estrogen.

ACOG explains that unlike systemic hormone therapy, which can travel throughout the body, vaginal estrogen is a local therapy, applied only to the vagina with a cream, ring, or tablet. As such, little estrogen enters the body at a systemic level. Also, preparations of vaginal estrogen generally have lower doses of the hormone.

Still, ACOG recommends that women try non-hormonal therapies, like vaginal moisturizers or lubricants, first. If those aren’t effective, then vaginal estrogen can be considered under the guidance of a woman’s healthcare team. The lowest effective does should be used, and the course should only last until symptoms improve.

Studies have not found any increased risk of cancer recurrence in women who use vaginal estrogen to manage urogenital symptoms related to menopause, ACOG says. However, more research is needed before vaginal estrogen can be recommended for women who use aromatase inhibitors. Women taking tamoxifen might benefit from a short course of vaginal estrogen.

ACOG added that any woman considering vaginal estrogen should have complete information about the benefits and risks so that she can make an informed decision.


American Congress of Obstetricians and Gynecologists

“The Use of Vaginal Estrogen in Women With a History of Estrogen-Dependent Breast Cancer”

(Committee Opinion Number 659. March 2016)

“How Menopause Can Happen With Breast Cancer Treatments”

(Last modified: February 17, 2017)

“Vaginal Estrogen”

(Last modified: January 27, 2015)

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Scientists Explore Web-Based Educational Tools for Young Adults with Cancer

Oct 17, 2017

They designed two web-based tools, one focusing on sexuality, the other focusing on fertility. Each tool combined short readings, exercises, photos and other illustrations, and videos featuring peers with cancer who discussed their experiences with the topic at hand. The tools also gave users the option to participate in an online forum, ask questions directly to an expert, and speak to a counselor twice by phone.

The tool was divided into separate modules that became available every ten days. The sexuality and fertility interventions could be completed in 60 and 70 days, respectively.

Twenty-three people between the ages of 18 and 43 tested the program. They had been diagnosed with cancer within the previous five years. About 35% of the participants had lymphoma, the most common type in the group, followed by breast cancer, cervical cancer, cancer of the central nervous system, testicular cancer, and ovarian cancer. All of the participants were from Sweden.

Fourteen people (11 women and 3 men) signed up to test the sexuality tool. Nine (8 women and 1 man) used the fertility intervention. Overall, 15 participants (“committed users”) completed at least four modules of their chosen tool.

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Prescriptions Too Costly for Many Cancer Survivors

Oct 09, 2017

“Our findings suggest that expansions in health insurance coverage mitigated the effects of growing prescription drug costs to some extent for many individuals with and without a history of cancer,” wrote the study authors.

However, cancer survivors still had higher rates compared to people without a cancer history.

In 2010, 13.8% of cancer survivors could not afford medication during the previous twelve months. This rate had fallen to 8.6% by 2015. But the rates for people without a history of cancer were lower – 11.0% in 2015 and 6.8% in 2015.

Adults age 65 and older appeared to have similar access, regardless of cancer history.

Earlier this year, Kaiser Health News reported that high costs can cause some cancer patients and survivors to put off treatment, take smaller doses of a prescribed drug, or go without medications altogether.

The National Cancer Institute (NCI) notes that financial toxicity (financial distress) is a common problem for cancer patients and survivors. The term refers to more than prescriptions. It encompasses insurance copayments, deductibles, and coinsurance. It can also include loss of wages and lower earning power due to cancer and its treatment.

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Women With Overactive Bladder (OAB) at Higher Risk for Sexual Dysfunction

Oct 02, 2017

The women were divided into two groups based on their menopausal status. One hundred twenty-two women were premenopausal, and the remaining 145 had finished menopause, which was defined as finishing twelve months without a menstrual period. 

The women completed a questionnaire called the Female Sexual Function Index (FSFI). This tool evaluates overall sexual function along with six individual domains: desire, arousal, vaginal lubrication, orgasm, sexual satisfaction, and sexual pain. 

Based on FSFI scores, about 77% of the participants were considered at risk for sexual dysfunction. This figure included 66% of the premenopausal and 86% of the postmenopausal women. 

Severity of OAB was assessed using another questionnaire. Most of the women had severe OAB. 

However, the degree of OAB severity was linked to poorer outcomes on the arousal, lubrication, orgasm, and pain domains of the FSFI for postmenopausal women only, especially if they had urge incontinence (a strong urge to urinate that sometimes results in urine leakage). This correlation was not found for premenopausal women. 

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More Sex Might Mean More Brain Power in Older Adults

Sep 26, 2017

Researchers worked with 73 people between the ages of 50 and 83, with an average age of 62 years. Twenty-eight participants were male; the rest were female. None had a history of dementia, memory impairment, or brain injury.

The participants answered questions about their health and lifestyle, including how often they had sex. (For this study, intercourse, masturbation, petting, and fondling were all considered sexual activities.)

The also completed the Addenbrooke’s Cognitive Examination III (ACE-III). This tool evaluates overall cognitive function by focusing on five specific areas: attention, memory, verbal fluency, language, and visuospatial abilities (perceiving objects and their spatial relationships). Other questionnaires were used to assess social wellbeing.

Ten of the participants – all women – said they never engaged in sexual activity. Among the rest, 26 had sex monthly, and 37 did so weekly. The groups were fairly similar in terms of age, education, heart health, and marital status. They also had similar scores on assessments of depression, loneliness, and quality of life.

On the ACE-III however, those who had sex more frequently had better overall scores, indicating better cognitive function. These participants also had better scores on two subsections of the test: verbal fluency and visuospatial abilities.

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Study Addresses Psychological Aspects of Female Sexual Problems

Sep 19, 2017

The authors discussed two risk factors:

  • Anxiety sensitivity – fear of physiologic reactions caused by anxiety. For example, a woman may become frightened when her heartbeat increases during sex
  • Emotion regulation – ways that people respond to what they are experiencing emotionally

The researchers also looked at psychological distress in light of these risk factors.

They recruited 316 female university students between the ages of 17 and 38 years (average age 19) to complete a group of questionnaires to assess their anxiety sensitivity, depression, stress, emotion regulation, sexual function, sexual quality of life, and sexual experiences.

About 83% of the women were heterosexual, and 46% of the participants were in committed relationships. Nineteen percent said they had been diagnosed with a mental health problem in the past.

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Men with ED May Have Higher Risk of Parkinson’s Disease

Sep 12, 2017

They collected data from the National Health Insurance Research Database, which contains anonymous medical records for most of the Taiwanese population. They identified 3,153 men (average age 57 years) who were first diagnosed with ED between January 1, 2004 and December 31, 2010. Next, they identified a comparison group of 12,612 men (average age 53 years) without ED. The men were followed for an average of 5 to 6 years.

After adjusting for age, health conditions, medications, and other variables, the researchers found that men with ED had a 52% higher risk of developing Parkinson’s disease compared to men without ED.

If men with ED also had diabetes or high blood pressure, their Parkinson’s risk was twice as high.

The authors noted that other studies have shown a higher incidence of ED in their populations. They explained that ED is “a taboo subject in Taiwan” and that many men do not feel comfortable discussing it.

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Emotional Aspects of Sex Important for Midlife Women

Sep 06, 2017

All the women had been sexually active at least once during the previous year and were in varying stages of menopause. About 60% were married or cohabitating.

Desire, vaginal dryness, sexual pain, and orgasm were widely discussed. One 50-year-old woman said, “Desire . . . If I had desire, everything else would fall into place.”

When women were asked what aspects of sex were most important to them, many cited emotional concerns that involved intimacy and connection with their partner, pleasing their partner, and feeling that their partner loved and desired them:

The connection we get with each other . . . just the connection, like our souls or spirits . . . it’s a beautiful feeling for two people to be wrapped up with each other. (51-year-old woman)

But I get enjoyment out of knowing that I’m pleasing my partner, too. That’s satisfying to me. (55-year-old woman)

It makes me feel good to know that my partner is still interested in . . . wanting to have sex at this later time in our life. (58-year-old woman)

On the latter aspect, the authors added, “These women wanted to feel that their partners were not just interested in sex, but interested in sex with them specifically” [emphasis in the original].

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Some Men Regret Prostate Cancer Treatment Decisions

Aug 28, 2017

Another option is active surveillance - monitoring the patient’s condition and providing treatment if it worsens or if symptoms become bothersome. This approach is sometimes called “watchful waiting.” While it may seem counterintuitive to not treat prostate cancer immediately after diagnosis, for some men, the cancer grows so slowly that the side effects of treatment could be more harmful than treating it on an as-needed basis.

The study included 946 men under the age of 75 who had been diagnosed with localized prostate cancer between October 1994 and October 1995. (Localized cancer means that cancerous cells had not spread beyond the prostate gland.) Each man completed a follow-up survey at least 15 years after his treatment.

The researchers found that almost 15% of the men had treatment regrets. This figure represented about 17% of the men who had had radiation, 15% of those who had undergone surgery, and 8% who had had conservative treatment like active surveillance.

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Body Image, Binge Eating, and Sexual Dysfunction in Women

Aug 22, 2017

Similarly, if she feels that she is not thin enough, she may worry that her partner will find her unattractive, leading to sexual anxiety. She may become so preoccupied with her body image that she cannot enjoy the encounter with her partner. In severe cases, she might dissociate, becoming so distracted and detached from the experience that sexual issues persist.

To learn more about these concepts and how they might work together, researchers created a two-hour experiment that measured levels of cortisol – a stress hormone involved with “fight or flight” response – in women watching a sexually arousing video.

Sixty women between the ages of 25 and 35 participated in the study. All the women were heterosexual and had a regular partner. They completed several questionnaires designed to evaluate dissociative tendencies, sexual distress, body esteem, and feelings about food and eating.

Twenty percent of the women were frequent binge eaters; another 35% said they binge ate sporadically. The rest were not binge eaters.

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Rectal Cancer Survivors Can Face Sexual Challenges

Aug 15, 2017

In 2016, the Journal of Sexual Medicine published a study describing the sexual challenges and health-related quality of life among long-term rectal cancer survivors. Researchers surveyed 575 people in the United States. Almost a third (62 women and 119 men) had permanent ostomy procedures; the rest (173 women and 221 men) had undergone anastomosis. All had had surgery at least five years before the survey. The average time since surgery was 12 to 14 years.

Overall, survivors with a permanent ostomy were more likely to have sexual problems than those who underwent anastomosis. For example, about 28% of women in the ostomy group reported vaginal stricture (narrowing) at the time of the survey. For women in the anastomosis group, the rate was 17%. Also at the survey time, 22% of the women who had had an ostomy procedure had vaginal pain; only 12% of the anastomosis women did.

Erection problems were common for men in both groups. Seventy percent of the men in the ostomy group had problems getting an erection after surgery, compared to 59% of the men in the anastomosis group. However, the difference decreased as the years passed. By the time of the survey, the rates were 73% and 69%, respectively.

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Gaming Might Affect Sexual Desire and Ejaculation in Men

Aug 01, 2017

Gaming Might Affect Sexual Desire and Ejaculation in Men

From Tetris to Pokémon to Halo, videogames have been a popular form of entertainment for decades. And during that time, scientists have investigated how playing videogames affects one’s health. But how about sexual health?

In a recent Journal of Sexual Medicine study, experts found that gaming might affect men’s sexual function, in positive and negative ways.

Using social media, researchers recruited 396 men who ranged in age from 18 to 50. On average, the men were about 28 years old. All participants had had intercourse during the previous month; roughly 70% were in stable relationships. About 72% said they were “gamers” - they played videogames for at least an hour every day. The rest spent less time gaming and were considered “non-gamers.”

The men filled out two online questionnaires designed to evaluate sexual health. The International Index of Erectile Function (IIEF) focuses on five aspects: erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction. It is often used to diagnose men with erectile dysfunction (ED), the inability to get and keep an erection firm enough for sex.

The men also completed the Premature Ejaculation Diagnostic Tool (PEDT). As the name suggests, this questionnaire is used to assess premature ejaculation (PE).  Men with PE climax before they wish to, usually within two minutes of penetrating their partner.

They also answered questions about their relationship status, gaming habits, and sexual activity.

Looking at the IIEF results, the researchers found few differences between gamers and non-gamers for erectile function, orgasmic function, and overall sexual satisfaction. However, non-gamers had slightly better median scores for sexual desire. In other words, they felt slightly more sexual desire than the gamers did.

PEDT results showed that none of the gamers had PE. In contrast, 69% of the non-gamers either had PE or “probable” PE based on their questionnaire scores.

Why was there a connection between gaming and sexual health? It’s possible that videogame “rewards” are related to dopamine levels in the brain, the researchers said. Dopamine is a neurotransmitter involved with forms of pleasure, including ejaculation and orgasm. When gamers do well, their dopamine levels go up.

The study authors also pointed out that “videogame stress” could lead to higher levels of prolactin, which could impair sexual function.

They added that more research is needed to fully understand the association between videogames and sexual health. In time, however, this understanding might help doctors who treat men with PE or low desire.

The study was first published online in June in the Journal of Sexual Medicine.


The Journal of Sexual Medicine

Sansone, Andrea, MD, et al.

“Relationship Between Use of Videogames and Sexual Health in Adult Males”

(Full-text. Published online: June 1, 2017)


“Prolactin blood test”

(Review date: August 7, 2016)

Psychology Today



Cancer Organizations Stress Importance of Comprehensive and Affordable Healthcare

Jul 24, 2017

A group of 33 cancer-related organizations have banded together to support cancer patients and survivors in light of proposed healthcare legislation under debate in the United States.

The organizations include the National Coalition for Cancer Survivorship (NCCS), the American Society for Clinical Oncology (ASCO), and the Association of Oncology Social Work. Groups that support patients with specific cancers, such as the Susan G. Komen organization (breast cancer), the Colon Cancer Alliance, the Lymphoma Research Foundation, and National Brain Tumor Society are also involved. (See the complete list below.)

In particular, the organizations oppose the Better Care Reconciliation Act (BCRA) and its revised version released on July 13th. The organizations are concerned that healthcare coverage will become unaffordable and unattainable for millions of Americans.

The bill proposes cuts to Medicaid, which provides health coverage to low-income patients. It would also limit coverage options for people with pre-existing conditions.

“The Senate’s BCRA, just as the House’s AHCA [American Health Care Act], is a direct threat to America’s 16 million cancer patients and survivors who rely on timely and uninterrupted access to comprehensive and affordable health care,” said NCCS CEO Shelley Fuld Nasso in a press release on July 13th.

“It is time to end this threat that is causing fear and anxiety throughout the cancer community, and work towards bipartisan solutions to strengthen current law,” she added.

In a statement released July 14th, ASCO President Bruce E. Johnson, MD, FASCO discussed some of the reasons the U.S. healthcare debate is so important for cancer patients. “When individuals with cancer do not have adequate health insurance coverage they are diagnosed with more advanced cancers, receive care later in their disease course, have less access to needed medical care, and have worse outcomes than those with better coverage.”

“We urge policymakers to ensure that robust requirements are maintained to ensure that all health plans cover the full scope of services and therapies that cancer patients require,” said Dr. Johnson.

The complete list of organizations is as follows:

  • American Society for Clinical Oncology (ASCO)
  • American Society for Radiation Oncology (ASTRO)
  • Association of Community Cancer Centers (ACCC)
  • Association of Oncology Social Work
  • Blue Faery: The Adrienne Wilson Liver Cancer Association
  • CancerCare
  • Cancer Support Community
  • Children’s Cause for Cancer Advocacy
  • Colon Cancer Alliance
  • Cutaneous Lymphoma Foundation
  • Critical Mass
  • Deadliest Cancers Coalition
  • Fight Colorectal Cancer
  • FORCE: Facing Our Risk of Cancer Empowered
  • Inflammatory Breast Cancer Research Foundation
  • Living Beyond Breast Cancer
  • Lung Cancer Alliance
  • LUNGevity
  • Lymphoma Research Foundation
  • Melanoma Research Alliance
  • National Brain Tumor Society
  • National Breast Cancer Coalition
  • National Coalition for Cancer Survivorship
  • National Comprehensive Cancer Network
  • National Patient Advocate Foundation
  • Oncology Nursing Society
  • Ovarian Cancer Research Fund Alliance
  • Sarcoma Foundation of America
  • Stupid Cancer
  • Susan G. Komen
  • Triage Cancer
  • Us TOO International
  • Young Survival Coalition


American Society for Clinical Oncology

Johnson, Bruce E., MD, FASCO

“ASCO Remains Opposed to Senate Healthcare Bill, Urges Protections for Access to High-Quality Care”

(July 14, 2017)

National Coalition for Cancer Survivorship

“NCCS and 33 Cancer-Related Patient Advocacy and Professional Organizations Jointly Oppose Senate’s Revised BCRA”

(News release. July 13, 2017)


Grayson, Gisele, Alyson Hurt, and Alison Kodjak

“CHART: Who Wins, Who Loses With Senate Health Care Bill”

(June 22, 2017)


Range of Priorities Found in Individuals Seeking Female-to-Male Transition

Jul 11, 2017

Range of Priorities Found in Individuals Seeking Female-to-Male Transition

When people with gender dysphoria decide to undergo a female-to-male transition, there is a large variation in their priorities, according to new research in the Journal of Sexual Medicine.

Gender dysphoria refers to a mismatch between a persons’ birth gender and the gender they identify with. An individual may be born with female reproductive organs, but feel more male then female. Sometimes, people take hormones or undergo surgery to transition to their desired gender.

Surgery for female-to-male transitions involves the creation of male genitalia. There are several different ways to accomplish this, but each technique has its pros and cons. For example, a procedure called metoidioplasty uses tissue from the clitoris to form a penis. Afterward, the patient can usually feel sexual sensations, but may not be able to urinate standing up. Also, the penis may be too small to penetrate a partner during intercourse.

What aspects are most important to patients? To answer this question, researchers surveyed 47 Swedish transmen between the ages of 18 and 52 who were considering surgical transition from female to male.

The participants showed a wide range of preferences. For many, the ability to feel sexual sensations, reach orgasm, and have erections with the new penis was high on the priority list.

Low priority items included removal of the vagina and minimal scarring. Most respondents were not concerned about having a particular size penis (most said “normal”). And the use of human tissue for a new penis did not seem essential.  

The respondents had mixed feelings about urinating while standing. Some rated this attribute as most important, but others considered it less important.

More than half said they would be willing to consider a penis transplant from a deceased person, an approach that is now being investigated. However, many were not sure whether they would be open to immunotherapy, which lowers the risk of transplant rejection.

About three-quarters of the respondents identified themselves as male. For this group, removing the vagina was a priority. This group also emphasized the need for a “passable” penis that would not seem unusual in a dressing room.

The study results could help doctors and surgeons better understand the needs of their female-to-male patients, the authors noted. In turn, surgical procedures might be tailored to patient’s priorities. And patients may have a better sense of their surgical options.

“Patients must always be instructed on all available techniques in current use and their specific benefits and limitations to make an informed choice,” the authors wrote.


The Journal of Sexual Medicine

Jacobsson, Josephine, MD, et al.

“Patients’ Priorities Regarding Female-to-Male Gender Affirmation Surgery of the Genitalia—A Pilot Study of 47 Patients in Sweden”

(Full-text. Published online: May 3, 2017)


How Does Obesity Affect Sexual Function?

Jun 27, 2017

How Does Obesity Affect Sexual Function?

Obesity rates are increasing around the world. In fact, an estimated 1 billion people are considered overweight, and 300 million are obese.

Past research has shown an association between obesity and sexual problems. But just how does obesity contribute to sexual dysfunction? To address this question, researchers reviewed scientific databases and published their findings in Sexual Medicine Reviews.

They explained several ways extra weight might lead to sexual problems:

  • Biological mechanisms. Having excess fat tissue can disrupt hormonal and chemical processes needed for good sexual function. For example, fat tissue may be linked to lower levels of an enzyme needed for the production of nitric oxide, an important neurotransmitter for erections.
  • Comorbidities. Many obese people also have conditions that can cause sexual dysfunction, including metabolic syndrome, diabetes, and heart disease. For instance, men with diabetes are more likely develop erectile dysfunction (ED) than non-diabetic men. And they often start having trouble with erections at an earlier age. Diabetic women often have trouble with desire, arousal, and vaginal lubrication.
  • Psychological and emotional factors. In many cultures, “thin is in.” Obese men and women might be viewed as unattractive and are often the subject of cruel jokes and discrimination, which can damage their body image and self-esteem. Their ability to participate in everyday activities might be restricted by their weight. Or, they may shy away from socializing or seeking sexual partners. Overall, depression and anxiety related to obesity can take a toll on sexual health.

Often, a combination of factors is involved. For example, an obese man with ED might feel self-conscious about his weight and his erection troubles. He may also feel anxious about his attractiveness and about pleasing his partner. Thus, both physical and psychological factors can contribute to his ability to perform sexually.

Can weight loss help? It might. Following a healthy diet and exercising regularly can help lower one’s risk for diabetes and heart disease, which in turn could improve sexual function. Studies of bariatric surgery and sexuality have had encouraging results.

The review authors called on healthcare providers and therapists to address sexual health concerns in overweight and obese patients.

“Not only might they – in a non-castigating and supporting manner – point out the biological and psychological effects that decrease the desire for sexual engagement and sexual response, but they also are well-positioned to discuss other health-related complications from obesity,” the authors wrote.


Sexual Medicine Reviews

Rowland, David L, PhD, et al.

“Sexual Function, Obesity, and Weight Loss in Men and Women”

(Full-text. Published online: April 26, 2017)


Benzocaine Wipes Might Help Men with Premature Ejaculation

Jun 13, 2017

Benzocaine is a local topical anesthetic commonly used to treat pain or itching. Previous studies have tested topical anesthetics before, but those therapies were not found to be effective.

This study involved 21 men with premature ejaculation who were in heterosexual, monogamous relationships. Fifteen of them were assigned to use benzocaine wipes; the rest used placebo wipes with no anesthetic. The men also answered questions about their sexual function.

After two months, the men using the wipes saw improvements in their ejaculatory time, with many of them taking two minutes or longer to climax. These men also said they could better control their ejaculation and felt less sexual distress and more sexual satisfaction when compared to the placebo group.

"This study is encouraging in demonstrating a new and innovative way to reduce the symptoms of premature ejaculation," said AUA spokesperson Tobias S. Köhler, MD, MPH, FACS. "Premature ejaculation can cause a variety of issues related to negative feelings and emotions that can lead to problems with sexual relationships. This data shows topical 4% benzocaine wipes is a promising therapy to treat the most common form of sexual dysfunction among men."

While the study results are encouraging, benzocaine is still not an approved treatment for PE. Men who have trouble with ejaculation should see their urologist.

The study was funded by the Veru Healthcare, the manufacturer of the benzocaine wipes.


American Urological Association

“Study Demonstrates Effectiveness of Topical 4% Benzocaine Wipes to Improve Symptoms of Premature Ejaculation”

(Press release. May 13, 2017)

“'Special wipes' may curb premature ejaculation”

(May 16, 2017)

HealthDay via Renal & Urology News

“Topical 4% Benzocaine Wipes Can Reduce Premature Ejaculation Symptoms”

(May 18, 2017)

The Journal of Urology

Shabsigh, Ridwan, et al.

“PD69-02 Double-Blind, Randomized Controlled Trial of Topical 4% Benzocaine Wipes for Management of Premature Ejaculation: Interim Analysis”

(Abstract. April 2017)

Mayo Clinic

“Benzocaine (Topical Application Route)”

(Last updated: March 1, 2017)

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Yoga May Help Prostate Cancer Patients Cope with Radiation Side Effects

May 24, 2017

Yoga May Help Prostate Cancer Patients Cope with Radiation Side Effects

Men coping with side effects from prostate cancer treatment might want to consider taking a yoga class.

In a recent study, men who practiced yoga while receiving external beam radiation therapy became less fatigued than men who didn’t. Their sexual and urinary function remained stable, too.

External beam radiation therapy uses high-energy beams to weaken cancer cells’ ability to divide and grow. While the therapy is effective, many men experience side effects, including fatigue, sexual problems (such as erectile dysfunction), and trouble with urination.

Fifty men with localized prostate cancer participated in the study. (Their cancer had not spread to other parts of the body.) All of them underwent external beam radiation therapy for six to nine weeks. During this time, twenty-two men attended yoga classes twice a week. Twenty-eight did not.

The men in the yoga group practiced the Eischens type of yoga, which focuses more on energy than other types. Each 75-minute session included a variety of poses in sitting, standing, and reclining positions. The men used props, and poses were modified as needed.

Shortly before the study began and throughout the study period, all the men completed questionnaires designed to assess their levels of fatigue, sexual function, urinary function, and quality of life.

The men had similar levels of fatigue at the start of the study. Over time, however, the men in the yoga group had less fatigue while the men who did not practice yoga became more fatigued.

“Levels of patient-reported fatigue are expected to increase by around the fourth or fifth week of a typical treatment course, but that did not happen in the yoga group,” lead researcher Neha Vapiwala, MD, an associate professor of radiation oncology at the Perelman School of Medicine at the University of Pennsylvania said in a news release.

“Both the severity of the fatigue as well as the patients’ ability to go about their normal lives appeared to be positively impacted in the yoga group,” Dr. Vapiwala added.

Erectile function appeared to be somewhat better for the yoga group, too. The research team used the International Index of Erectile Function (IIEF) questionnaire to assess this aspect of the men’s sexual health. The IIEF is scored on a 1 – 25 point scale. Men with scores under 12 points are usually diagnosed with moderate to severe ED. In this study, scores for men in both groups were around 11 points starting out. Over time, scores for the men in the yoga group stayed roughly the same, but men in the non-yoga group saw their scores decrease.

Urinary function seemed to be better for men in the yoga group, too. It’s possible that strengthening pelvic floor muscles through yoga could help both sexual and urinary function, Dr. Vapiwala suggested.

As treatment continued, both groups of men improved in their emotional well-being, although this result happened more quickly for the yoga group.

The study was published online by the International Journal of Radiation Oncology, Biology, and Physics in March as an article in press.



Preidt, Robert

“It's Yoga to the Rescue for Prostate Cancer Patients”

(April 13, 2017)

International Journal of Radiation Oncology, Biolog7, and Physics

Ben-Josef, Avital Mazar, DMD, E- RYT, et al.

“Impact of Eischens Yoga During Radiation Therapy on Prostate Cancer Patient Symptoms and Quality of Life: A Randomized Phase II Trial”

(Article in press. Abstract. Published online: March 30, 2017)

Mayo Clinic

“External beam radiation for prostate cancer”

(May 18, 2016)


Mulcahy, Nick

“Really, Men With Prostate Cancer Do Yoga”

(April 18, 2017)

Penn Medicine News

“Clinical Trial Shows Benefit of Yoga for Side Effects of Prostate Cancer Treatment”

(News release. April 6, 2017)

MacMillan, Amanda

“Yoga May Help the Side Effects of Cancer Treatment”

(April 10, 2017)


Survey: Condom Use Rates are Low in the U.S.

May 09, 2017

Survey: Condom Use Rates are Low in the U.S.

Only one in four Americans between the ages of 18 and 44 used a condom the last time they had sex, according to a recent survey.

Condom use among people at high risk for HIV is also low, the survey revealed.

Condoms are known to reduce the risk of unplanned pregnancy and transmission of sexually transmitted infections (STIs), like HIV, chlamydia, and syphilis. But how prevalent is condom use?

Researchers analyzed data from the National Survey of Family Growth, which has been collecting information on marriage, divorce, family life, and reproductive health in the United States since 1973. For this study, the researchers focused on the 2006 – 2010 and 2011 – 2013 survey cycles.

In particular, the researchers looked at data for heterosexuals between the ages of 18 and 44 who had had vaginal or anal sex within the year before their survey interview. In total, the respondents included 13,588 women and 10,904 men, and answers pertained only to their last sexual encounter.

They also considered “HIV-related sexual risk behaviors,” which included sex with four or more opposite-sex partners, sex in exchange for money or drugs, sex with an injection drug user, sex with an HIV-positive partner, and sex with a partner who had had other partners. Men who had sex with men and women who had sex with men who had sex with men were also considered at higher risk.

Overall, the rate of condom use was just under 25%. For those who reported at least one risky behavior, the rate was 34%.

Younger people were more likely to use condoms, the researchers noted, perhaps because public health campaigns promoting safe sex are often targeted to this age group. “Continued efforts are needed for sexual health promotion in older individuals,” they wrote.

Condom use was also higher among single respondents; 51% of single men and 37% of single women said they had used a condom the last time they had had sex. The rate for married or cohabitating men was 16%; for women, it was 13%. Couples in committed relationships might be less likely to use condoms because they are trying to conceive, using other forms of birth control, or in monogamous relationships.

Regardless of marital status, healthcare providers should counsel patients on condom use, especially if they engage in high risk sexual behaviors, the authors said, explaining that women should be able to negotiate condom use if necessary.

The researchers also expressed concern that condom use was lower for those who had anal sex. People may not think they need condoms for anal sex, since it cannot lead to pregnancy. But they might not know that STIs can still be spread through anal sex.

The researchers acknowledged some limitations. For example, respondents who did not use condoms at their last sexual encounter could still be regular condom users.

Still, the authors saw a need for continued education on condom use, especially people at risk for HIV, those who engage in anal sex, and those with many sex partners.

The study was published last month in the Journal of Sexual Medicine.


Centers for Disease Control and Prevention/National Center for Health Statistics

“About the National Survey of Family Growth”

(Page last updated: May 13, 2016)

The Journal of Sexual Medicine

Nasrullah, MD, MPH, PhD, et al.

“Factors Associated With Condom Use Among Sexually Active US Adults, National Survey of Family Growth, 2006–2010 and 2011–2013”

(Full-text. April 2017)


Americans Are Having Less Sex Nowadays

Apr 25, 2017

Americans Are Having Less Sex Nowadays

A new study in the Archives of Sexual Behavior has found that Americans are having less sex than they did two decades ago. And partnered people – those who are married or living together - have seen a significant decline in sexual frequency.

The findings are based on data from the General Social Survey (GSS). Started in 1972, the GSS tracks sociological trends in the United States, addressing topics like crime, finances, civil liberties, and stress. This particular study involved 26,620 Americans who participated in the survey between 1989 and 2014.

Overall, the study found that during between 2010 and 2014, Americans had sex nine fewer times each year compared to the period of 1995 to 1999. This was the case for all genders and races and in all areas of the country. Educational level and work status did not appear to make a difference either.

Other key findings include the following:

·         The largest drop in sexual frequency occurred among people in their 50s, those who had children in school, and those who did not watch pornography.

·         Millennials and the following generation (iGen or Generation Z) had less sex than their counterparts born in the 1930s did at the same age.

·         On average, twentysomethings had sex over 80 times each year. This rate fell to about 60 times for people in their mid-40s and 20 times for those in their mid-60s.

·         Respondents had sex most often around age 25. After that, frequency decreased by about 3.2% each year.

·         Sexual activity declined for partnered people, which “[reduces] the marital/partnered advantage,” the authors wrote.

“These data show a major reversal from previous decades in terms of marriage and sex,” lead author Jean M. Twenge said in an interview with San Diego State University. Dr. Twenge is a professor of psychology at that school.

“In the 1990s, married people had sex more times per year than never-married people, but by the mid-2000s that reversed, with the never-married having more sex,” she added.

Why are Americans having less sex? The study didn’t specify a cause, but the authors did suggest some possibilities, including more time with other forms of entertainment, like social media and technology. Depression might also be a factor, especially when antidepressants can have sexual side effects.

The study authors also explained that fewer Americans are in couples nowadays and single people tend to have sex less often.

Interestingly, longer work hours and use of pornography were not associated with a decline in sexual activity, according to the study. In fact, respondents who worked longer hours tended to have more sex.


Archives of Sexual Behavior

Twenge, Jean M., et al.

“Declines in Sexual Frequency among American Adults, 1989–2014”

(Published online: March 6, 2017)

National Opinion Research Center (NORC) at the University of Chicago

“About the GSS”

The New York Times

Haag, Matthew

“It’s Not Just You. Americans Are Having Less Sex.”

(March 8, 2017)

San Diego State University

Jacobs, Gina

“New Study Shows Americans are Having Sex Less Often”

(March 7, 2017)

Washington Post

Bahrampour, Tara

“Americans are having less sex than they once did”

(March 7, 2017)


BPH Drugs Associated with Higher Risk of Depression and Self-Harm but Not Suicide

Apr 12, 2017

BPH Drugs Associated with Higher Risk of Depression and Self-Harm but Not Suicide

Men who take certain medications for an enlarged prostate or hair loss could be at higher risk for depression and self-harm, according to new research published in JAMA Internal Medicine.

However, they are not at higher risk for suicide, the study suggests.

The drugs in question are known as 5-alpha-reductase inhibitors (5ARIs) and are often prescribed for each condition. Two examples are finasteride and dutasteride.

When a man has an enlarged prostate (also called benign prostatic hyperplasia or BPH) the tissue of his prostate gland grows inward. Sometimes, it grows so much that it squeezes the urethra, making urination difficult.

Interest in 5ARIs and men’s mental health has been present for several years, with both the U.S. Food and Drug Administration (FDA) and Health Canada expressing concerns. But little was known about the potential link.

For this study, researchers used medical databases to identify 93,197 men in Ontario who had filled a prescription for an 5ARI between 2003 and 2013. All of the men were over 66 years old.

The researchers then identified an equal number of men of the same age who had not filled a 5ARI prescription. These men matched the first group in age, health status, and use of other medications.

They found that the men who took 5ARIs were at higher risk for self-harm during the first 18 months after they started the drug. This risk appeared to drop after the 18-month point.

Similarly, the men who took 5ARIs were also at higher risk for depression.

After 18 months, depression risk decreased, although it was still higher than the depression risk among men who didn’t take 5ARIs.

While the study shows an increased risk for self-harm and depression, the overall risk is actually quite low. Lead author Dr. Blayne Welk of Ontario’s Western University and the Institute for Clinical Evaluative Sciences told Reuters Health that “you’d need 470 men to take this medication for a full year to have a new case of depression.”

Overall, the study authors concluded that the benefits of 5ARIs “likely” outweigh the risks. However, men taking these medications should be aware of these side effects and seek help immediately should they start feeling depressed.

“The relatively small magnitude of these risks should not dissuade physicians from prescribing these medications in appropriate patients. This research may help physicians counsel patients on the risks of 5ARIs,” the authors wrote.


JAMA Internal Medicine

Welk, Blayne, MD, MSc, et al.

“Association of Suicidality and Depression With 5α-Reductase Inhibitors”

(Full-text. March 20, 2017)

Reuters Health

Seaman, Andrew M.

“Prostate, hair loss drugs tied to mental health risk, but not suicide”

(March 21, 2017)


Past Childhood Experiences Could Influence Sexual Satisfaction in Adulthood

Mar 29, 2017

Past Childhood Experiences Could Influence Sexual Satisfaction in Adulthood

When someone has a sexual problem, it’s not unusual for there to be lots of factors involved. There could be a medical issue, relationship strain, or miscommunication between partners. Sometimes, events that take place during childhood come into play.

Many sex therapy patients work through past childhood sexual abuse. But can other childhood experiences add to sexual problems? Recently, scientists addressed this in relation to sexual satisfaction in the Journal of Sexual Medicine.

The researchers focused on what they called cumulative adverse childhood experiences (CACEs). While such experiences do include sexual abuse, they also include other negative experiences caused by adults:

·         Physical abuse – slapping, burning, hitting, kicking, pushing, and shoving

·         Psychological abuse – ridiculing, humiliating, making the child feel unimportant

·         Psychological neglect – ignoring the child

·         Physical neglect – shutting the child in a room for a long duration, refusing to provide food, clean clothing, baths, and medical care

Witnessing violence between parents (or caretaking adults) and bullying by other children also fall into the CACE category.

Three hundred seven people took part in the study. All of them were sex therapy clients and their average age was 38 years. Fifty-five percent were women. The participants were seeking help for a variety of sexual issues, including low desire, erectile dysfunction, premature ejaculation, and problems with orgasms and sexual pain.

The group completed a number of medical questionnaires designed to assess CACEs (experiences before age 18), psychological health, and relationships. The participants’ feelings about their own sexual relationships were evaluated with a tool called the Global Measure of Sexual Satisfaction (GMSEX). Scores on this questionnaire can range from 5 to 35. Higher scores on the GMSEX mean greater sexual satisfaction.

The researchers found that 58% of the women and 52% of the men had at least four types of CACEs. Sexual satisfaction was similar for both men and women, with average GMSEX scores of 21 points.

The results could help sex therapists better understand their patients’ backgrounds, the authors suggested, noting that a “one-size-fits-all approach to sexual difficulty treatment, especially in CACE survivors, might not be optimal.”

They added that future research could concentrate on how CACEs affect the sex lives of couples as well as individuals.


The Journal of Sexual Medicine

Bigras, Noémie, MA, et al.

“Cumulative Adverse Childhood Experiences and Sexual Satisfaction in Sex Therapy Patients: What Role for Symptom Complexity?”

(Full-text. Published online: February 12, 2017)


About 2 in 3 Women Would Take a Sex Health Drug

Mar 21, 2017

About 2 in 3 Women Would Take a Sex Health Drug

Are women interested in sexuality-boosting medication? And if so, what results would they like to see? These questions and more were the focus of a survey published recently in the Journal of Sexual Medicine.

While sex health drugs like Viagra have been available for men for several years, medications for women are fairly new. Generally, women’s sexual problems have been treated with counseling and therapy.

In August 2015, the U.S. Food and Drug Administration (FDA) approved flibanserin (Addyi) for the treatment of hypoactive sexual desire disorder (HSDD). Women with HSDD struggle with low libido that can’t be explained by another medical condition or a medication they’re taking. The situation causes great distress and can affect a woman’s personal relationships.

Despite its goal of improving sexual desire in women with HSDD and increasing the number of positive sexual encounters, flibanserin has not been widely used. This study assessed women’s feelings about sexuality boosting medication.

The researchers surveyed 159 women in Switzerland. The women ranged in age from 18 to 73 years with an average age of 32 years. They answered a wide range of questions about their sex lives, relationships, and personalities. They also answered questions on their willingness to take a sex health drug and what they would expect from such a medication.

Sixty-one percent said they were open to the idea, and women with poorer sexual function were more likely to feel this way. Of those who would not take a sex health drug, 45% said they did not want to use a medication for sexual purposes and 35% said they were satisfied with their level of sexual desire, so they would have no need for a drug.

When asked which particular aspects of sex they would like to see enhanced, orgasm frequency and intensity were the two top responses. Increased desire was another concern. Overall, about three-quarters said they would like to improve their sexual satisfaction and almost half hoped they could have more fun during sex.

The researchers found that women who were more conscientious were less willing to take a sex health drug, in contrast to less conscientious women who were more willing. The latter group might have had a “more flexible and spontaneous mindset,” the authors noted.

The researchers were unsure whether medications for sexual problems would become the norm, however.

“In recent decades, the female sexual dysfunction treatment paradigm has been mostly limited to cognitive-behavioral psychotherapy, and according to our study data, it is still doubtful whether expanding it to include drug treatment would provide additional benefits,” they wrote.


The Journal of Sexual Medicine

Gutsche, Melanie, MSc and Andrea Burri, PhD

“What Women Want—An Explorative Study on Women's Attitudes Toward Sexuality Boosting Medication in a Sample of Swiss Women”

(Full-text. Published online: January 24, 2017)


After-Sex Antibiotic Could Reduce STI Rates

Mar 07, 2017

After-Sex Antibiotic Could Reduce STI Rates

Taking the antibiotic doxycycline within 72 hours of condomless sex might reduce the risk of sexually-transmitted infections (STIs) in men who have sex with men (MSM), according to a new study.

The findings, presented last month at the 2017 Conference on Retroviruses and Opportunistic Infections in Seattle, found that risk was cut by 47%. But the researchers cautioned that more study is needed before this strategy can be recommended to doctors and patients.

The study involved 232 MSM who did not have HIV, but were taking on-demand medications for HIV prevention. Half of the men were instructed to take two 100-mg pills of doxycycline within 72 hours of having sex without a condom, not exceeding 6 pills per week. The other half did not take doxycycline. All of the men were given condoms and received safe sex counseling. Every eight weeks, they were tested for HIV, gonorrhea, chlamydia, and syphilis. The median follow-up time was 8.7 months.

Overall, 73 patients contracted a bacterial STI – 28 in the doxycycline group and 45 in the non-treatment group. 71% of the STIs were asymptomatic, which means that the men did not have any symptoms, nor did they feel sick.

Seven of the men in the doxycycline group developed chlamydia infections, compared to 21 in the non-treatment group. Three men taking doxycycline developed syphilis, compared to 10 in the non-treatment group.

Rates of gonorrhea were not much different between the groups, with 25 men in the doxycycline group and 22 in the non-treatment group developing infections.

Side effects did not appear to be a problem for either group, although more men in the doxycycline group experienced gastrointestinal pain, nausea, or vomiting.

There is still more to learn about the protocol, however. Scientists are not sure how well the strategy would work over a longer term. Also, it is unclear whether antibiotic resistance would be a problem and, if so, to what extent.



Newman, Emily

“Research shows 47% reduction in STIs among gay men who took doxycycline after sex”

(February 16, 2017)

Conference on Retroviruses and Opportunistic Infections 2017

Molina, Jean-Michel, et al.

“On Demand Post Exposure Prophylaxis with Doxycycline for MSM Enrolled in a Prep Trial”

(Abstract 91LB. Presented February 16, 2017)

Medscape Medical News

Boerner, Heather

“Antibiotics After Sex Nearly Halves Incidence of STIs”

(February 16, 2017)


FDA Approves Intrarosa for Sexual Pain in Postmenopausal Women

Feb 21, 2017

FDA Approves Intrarosa for Sexual Pain in Postmenopausal Women

Postmenopausal women who experience moderate to severe pain during intercourse may have a new treatment option.

Last November, the U.S. Food and Drug Administration (FDA) approved a drug called Intrarosa (prasterone) for sexual pain caused by vulvar and vaginal atrophy (VVA) due to menopause.

When a woman goes through menopause, her body starts producing less estrogen, a hormone that keeps the vagina and vulva healthy. In particular, estrogen helps keep the vagina flexible and lubricated during sex.

For many women, declining estrogen levels bring about cellular changes to the vagina and vulva, leaving them dry and brittle. With poorer lubrication and less elasticity in the vagina, intercourse can become uncomfortable or painful.

The active ingredient in Intrarosa is the hormone dehydroepiandrosterone (DHEA), which changes to estrogen. The drug is administered as a daily vaginal insert. In general, women are advised to place one insert into the vagina each night at bedtime, using a special applicator.  

The effectiveness of Intrarosa was tested in two 12-week clinical trials of 406 postmenopausal women between the ages of 40 and 80 who had moderate to severe pain during intercourse. The women were randomly assigned to try Intrarosa or a placebo insert. Those who used Intrarosa reported less severe sexual pain.

The most common side effects were vaginal discharge and an abnormal Pap smear.

Women who have vaginal bleeding should talk to their doctor before using Intrarosa. In addition, women who have a history of breast cancer should not use Intrarosa at all.

The FDA warns that while Intrarosa contains DHEA and has been approved to treat sexual pain in postmenopausal women, other products containing DHEA, such as dietary supplements, have not.

“The efficacy and safety of those products have not been established for diagnosing, curing, mitigating, treating, or preventing of any disease,” the agency said in a press statement.


Mayo Clinic

“DHEA – Background”

(Last updated: July 1, 2014)

MedPage Today

Walker, Molly

“FDA Approves Intrarosa for Sexual Symptoms of Menopause”

(November 17, 2016)

“Vulvar and Vaginal Atrophy”

(June 26, 2013)

U.S. Food and Drug Administration

“FDA approves Intrarosa for postmenopausal women experiencing pain during sex”

(News Release. November 17, 2016)

"Full Prescribing Information”

(Revised: November 2016)


Heat-activated Penile Implant Could Be Available in 5 – 10 Years

Feb 07, 2017

Heat-activated Penile Implant Could Be Available in 5 – 10 Years

Scientists have created a heat-activated penile implant that, in time, could be an additional option for men with erectile dysfunction (ED).

ED – the inability to get and keep an erection firm enough for sex - is a common problem for men, especially as they get older. It is often a complication of other medical conditions, like diabetes or heart disease. Men may also develop ED after cancer treatment or an injury to the genitals.

Several ED treatments are available, including oral medications like Viagra, Levitra, and Cialis. However, these medications do not work for all men, and some patients cannot take them because of interactions with other drugs. Injections, suppositories, vacuum devices are alternatives, but they aren’t suitable for all men.

When these ED treatment options aren’t viable, many men turn to penile implants. Nowadays, the most popular type of implant an inflatable device. Spongy tissue in the penis is replaced with cylinders. When a man wants an erection, he activates a special pump in the scrotum, which fills the cylinders with fluid. When he is finished with sexual activity, he can deactivate the pump and the penis goes flaccid again.

While effective, inflatable implants require a rather complicated surgical process because they have separate components. Placing the heat-activated implant could be simpler, scientists say.

The new implant is made from a nickel-titanium alloy called Nitinol, a flexible metal with other medical applications. For example, stents – tubes used to keep arteries open – are sometimes made of Nitinol.

Nitinol’s chemical properties allow it to “remember” a different shape and assume that shape when heated. In the case of a penile implant, a man would wave a remote-control device over his penis when he wanted an erection. The device would heat the implant to a temperature just a few degrees above the man’s normal body temperature, causing the implant to expand in length and girth. The device would then be deactivated when desired.

Study co-author Brian Le of the University of Wisconsin-Madison and his colleagues are now working on the remote-control device. If further studies and trials are successful, the implant could be available in five to ten years.

“We’re hoping that, with a better device, a better patient experience, and a simpler surgery, more urologists would perform this operation, and more patients would want to try the device, “Dr. Le said in a university press release.

Results of the scientists’ work with a Nitinol prototype implant were published online in September in the journal Urology.


University of Wisconsin-Madison

Smith, Susan Lampert

“Heat-activated penile implant might restore sexual function in men with E.D.”

(December 28, 2016)


Le, Brian, et al.

“A Novel Thermal-activated Shape Memory Penile Prosthesis: Comparative Mechanical Testing”

(Full-text. Published online: September 14, 2016)


Radiation to Penile Bulb Might Result in Severe ED, Study Suggests

Jan 24, 2017

Radiation to Penile Bulb Might Result in Severe ED, Study Suggests

Erectile dysfunction (ED) is a common side effect of radiation therapy for prostate cancer. However, new research suggests that avoiding the penile bulb – the base of the penis – during treatment might decrease ED severity.

The study, sponsored by the Institute of Cancer Research (ICR) in London, focused specifically on image-guided radiation therapy (IGRT). This type of therapy uses images of the prostate to help doctors pinpoint exactly where the radiation should be targeted, improving the accuracy of the treatment.

Could aiming for – or avoiding – certain areas affect a man’s erections after treatment? Researchers turned to a larger study on prostate cancer (the CHHiP trial) to learn more.

They looked at data from a subgroup of 182 men who had localized prostate cancer. (Localized means that prostate cancer cells had not spread to other parts of the body.) None of the men had ED before undergoing IGRT. Between 35 and 55 months after treatment, the men completed questionnaires related to their sexual health and erections.

The scientists also wanted to know how much radiation each man had received on his penile bulb. This information was available for 90 men.

Forty-one men from this group had severe ED after IGRT. They also had the highest amounts of radiation directed at the penile bulb.

The findings suggest that avoiding the penile bulb during IGRT would have sexual benefits for men with localized prostate cancer. However, the results need to be validated with more research, the authors said.

“While finding new and better treatments for men with prostate cancer is important, it’s also essential that we find ways of diminishing the side-effects of these treatments,” said researcher David Dearnaley in an ICR news article.

Professor Dearnaley is Professor of Uro-Oncology at the ICR and Consultant Clinical Oncologist at The Royal Mardsen hospital

He added, “Erectile dysfunction can be very distressing for the patients I deal with every day. If doctors can plan radiotherapy treatment so that it avoids the penile bulb – the area at the base of the penis – we may have a real chance of reducing the severity of erectile dysfunction in these patients.”

The study was published in the International Journal of Radiation Oncology in October 2016.


American Cancer Society

“Radiation therapy for prostate cancer”

(Last revised: March 11, 2016)

“Bulb of penis”

(Reviewed: March 31, 2015)

The Institute of Cancer Research

“Avoiding penile bulb with radiotherapy could save men with prostate cancer from harmful side-effects”

(November 28, 2016)

International Journal of Radiation Oncology

Murray, J., et al.

“Effect of Dose and Image Guided Radiation Therapy (IGRT) on Patient-Reported Sexual Function in Prostate Radiation Therapy”

(Full-text. October 1, 2016)

Memorial Sloan Kettering Cancer Center

“Image-Guided Radiation Therapy”

(Last updated: April 21, 2016)

Prostate Cancer News Today

Fernandes, Joana, PhD

“Prostate Radiation Therapy Induces Changes in Penile Bulb, Causing Erectile Dysfunction”

(December 5, 2016)


What Should Physical Therapists Know About Female Sexual Pain?

Jan 09, 2017

What Should Physical Therapists Know About Female Sexual Pain?

Understanding the biopsychosocial aspects of sexual pain could help physical therapists treat women, according to a recent study in Sexual Medicine Reviews.

Female sexual pain is a common – but complex - problem for women. Physical causes can include gynecological, urinary, gastrointestinal, and muscular problems. Sometimes, a combination of these factors leads to sexual pain.

Cultural and religious beliefs may also be involved. Women may not feel comfortable with the ideas of discussing or treating sexual pain. Healthcare providers may feel uncomfortable too, and they might not refer patients to appropriate specialists.

The study authors pinpointed several areas to consider when assessing and treating female sexual pain.

First, a complete physical examination that includes the vaginal, rectal, vulvar, and anal areas is essential. Other medical conditions, such as hormonal and autoimmune disorders should also be evaluated.

Providers should also consider how the central nervous system responds to the anticipation of pain. If a woman perceives a threat to her body, her central nervous system may react with a “protective pain response that is unrelated to the health of the pelvic muscles, skin or the visceral systems and might be the driving force in the perpetuation of hypersensitivity,” the authors explained.

Second, it is important for patients to feel some hope that their pain can be successfully treated. Choosing certain words to describe the pain, such as persistent instead of chronic is one approach.

Third, taking a complete patient history can provide helpful clues that can inform treatment. “Through a careful history, the clinician might be able to identify personal challenges or threats that were present for the patient when the pain began,” the authors noted. A number of validated assessment tools can be used as well.

Fourth, patients can benefit from understanding pain biology and, in turn, re-think their responses to pain and become less fearful. “Educating patients about pain can change their pain levels more than any current modality for persistent pain,” the authors wrote.

They suggested that physical therapists undergo further training in these areas so that they can address the many complexities of female sexual pain.


Sexual Medicine Reviews

Vandyken, Carolyn, PT, Cred MDT, CCMA (Acup) and Sandra Hilton, PT, DPT, MS

“Physical Therapy in the Treatment of Central Pain Mechanisms for Female Sexual Pain”

(Published online: August 3, 2016)


Kink-oriented Individuals Address Healthcare Concerns

Dec 19, 2016

Kink-oriented Individuals Address Healthcare Concerns

Individuals who engage in kink sexual behaviors can have special healthcare needs, but they may not always see a doctor because of the stigma associated with kink sexuality, experts report.

The word kink is used to describe sexual activities outside the mainstream. These activities can include bondage, discipline, domination and submission as well as sadism and masochism. Sometimes the acronym BDSM is used to refer to these activities.

Kink sexual practices often involve power roles, with one participant taking a dominant or “top” role, while the other is in a more submissive or “bottom” position. Activities are always between consenting adults, and the specifics are usually negotiated between partners. However, some activities, such as punching or whipping, can cause injury or increase the risk of sexually-transmitted infections or blood-borne illnesses.

Seeking care for kink-related health concerns can be a challenge for those who participate. Recently, a team of healthcare providers and researchers formed the Kink Health Project to learn more about the kink community and their experience with medical care in the San Francisco Bay area.

The team conducted focus groups and interviews with 115 kink-orientated individuals between the ages of 23 and 69. The participants’ average age was 46 years. Forty-four percent of them had seen a doctor for a kink-related issue. Among those who had a primary doctor, only 38% had revealed their kink orientation to that doctor.

Bruising and open wounds were some of the more common kink-related health concerns. For example, one participant mentioned using a knife to scratch his partner, causing moderate bleeding. Others reported having multiple partners and non-traditional social structures, such as non-monogamous relationships, that healthcare providers might not understand.

Often, participants preferred to seek medical advice within the kink community rather than from a doctor. Many were afraid of being judged for their behavior. Some would lie to doctors about the source of their concerns. For example, one man told his doctor that his bruises were caused by rugby.

Fear of being investigated for abuse was a serious concern among the participants. “I know that what I’m doing is safe and consensual,” one woman explained, “but I worry if I ever went to the doctor and was covered with bruises they would not understand that they were consensual behaviors.”

However, many participants reported positive experiences with their doctors. One woman described her OB/GYN, who was open to explaining what types of kink activities would be safe during pregnancy.

The authors acknowledged that their findings may not apply to all everyone who engages in kink behaviors. “San Francisco is well known for its sexual open-mindedness, and we could have encountered different results if we had conducted the study in other parts of the United States or in other nations,” they wrote.

The study was first published online in October in the Journal of Sexual Medicine.


The Journal of Sexual Medicine

Waldura, Jessica F., MD, et al.

“Fifty Shades of Stigma: Exploring the Health Care Experiences of Kink-Oriented Patients”

(Full-text. First published online: October 27, 2016)


Study Examines Body Esteem in Female Survivors of Childhood Sexual Abuse

Dec 06, 2016

Study Examines Body Esteem in Female Survivors of Childhood Sexual Abuse

Body esteem tends to be lower in women who have been sexually abused as children, experts say. And this lower esteem can lead to more inhibited sexual responses.

Similar to self-esteem, body esteem refers to how people feel about their body. Do they feel attractive and healthy? Or do they find fault with certain body parts? These are common questions, but for women with a history of childhood sexual abuse, body esteem is particularly important. Studies have shown that women in this category feel less attractive than women without a history of abuse.

A new study, recently published in the Journal of Sexual Medicine, examined how body esteem influenced feelings about sex in women with and without a history of childhood sexual abuse.

Two hundred twenty-two women participated in the study. One hundred thirty-nine of them had a history of childhood sexual abuse, defined as any unwanted sexual contact before the age of 18. The remaining 83 women had not experienced sexual abuse as children. The women ranged in age from 18 to 64; their average age was 34 years.

The participants completed several questionnaires concerning their experiences with childhood sexual abuse, depression, body esteem, and feelings about sex.

When compared to the women who had not been abused, those with an abuse history were more likely to feel depressed and have significantly lower body esteem, especially in terms of sexual attractiveness. They also tended to feel more inhibited about sex.

It’s possible that the abused women had lower body esteem because they associated specific body parts with the abuse, the authors noted.

They added that women who have experienced sexual abuse often feel anxious and fearful in sexual situations, which might prompt them to “avoid the threat.”

The authors acknowledged some limitations in their research. For example, they did not assess to what degree a woman’s religious beliefs affected her attitudes toward sex. They also did not know if women received counseling for childhood sexual abuse before the study.

Comparing these results to those of women who had been abused (but not sexually) during childhood might provide further insights, they said.

The authors also suggested that healthcare providers who work with adult survivors of childhood sexual abuse consider building positive body esteem into their treatment plans.


The Journal of Sexual Medicine

Kilimnik, Chelsea D., MSc and Cindy M. Meston, PhD

“Role of Body Esteem in the Sexual Excitation and Inhibition Responses of Women With and Without a History of Childhood Sexual Abuse”

(Full-text. First published online: September 27, 2016)


Survey Addresses Patients’ Views on Sexual Health

Nov 22, 2016

Survey Addresses Patients’ Views on Sexual Health

How important is sexual health and satisfaction to a person’s quality of life? The answer depends on age, gender, sexual activity status, and overall health, according to a new study in the Journal of Sexual Medicine.

Sexual dysfunction - such as erectile dysfunction (ED) in men and painful intercourse for women – are common, especially for people with medical conditions like diabetes, heart disease, cancer, high blood pressure, depression, and anxiety. But sexual problems aren’t always discussed during doctor’s appointments. Some assume that doctors or patients will bring up the subject if it’s really important.

The importance of sex to one’s overall well-being hasn’t been widely studied by medical researchers. A group of American scientists decided to learn more.

They asked 3,515 people to complete an online questionnaire. The group was almost equally split between men and women, and their average age was 49.

Importance of Sexual Health

Among the entire group, about 43% of the women and 62% of the men said that sexual health was important to their quality of life. Participants who were in better overall health tended to rate sexual health as important, too.

Respondents who were not sexually active were less likely to consider sexual health to be highly important.

The researchers also examined how specific health conditions (arthritis, rheumatism, cancer, heart disease, depression, anxiety, diabetes, and high blood pressure) affected the respondents’ views. However, none of these conditions influenced the ratings.

Sexual Satisfaction

What factors contributed to satisfaction with one’s sex life? To find out, the authors analyzed information from the 55% of the men and 45% of the women who said they’d been sexually active within the last month. Findings were based on scores on one portion of the questionnaire designed to evaluate sex life satisfaction.

They found that people in their mid-to-late thirties were the most satisfied with their sex life. After age 70, satisfaction rates decreased. Health status was also an important factor, as people who rated their overall health as excellent were more satisfied than those who said they were in fair or poor health.

Certain health conditions did influence satisfaction with one’s sex life. High blood pressure was the biggest factor for women. For men, depression and anxiety had the greatest impact on satisfaction.

The authors pointed out that physical health isn’t the only factor that determines satisfaction with one’s sex life. Beliefs on what makes a satisfying sex life are quite personal, they noted.

Race was a factor only for men. Latino and Hispanic men were more likely to say sexual health was highly important, and black men had better scores on the sex life satisfaction assessment.

The survey results can be useful for healthcare providers, the authors explained, recommending that practices have “resources in place” to address patients’ sexual health issues.

“These resources should be available for all patients across the lifespan,” they added.   


The Journal of Sexual Medicine

Kathryn E. Flynn, PhD, et al.

“Sexual Satisfaction and the Importance of Sexual Health to Quality of Life Throughout the Life Course of U.S. Adults”

(Full-text. Published online: September 23, 2016)


Can Disclosing a Sexual Assault Help a Woman’s Sexual Functioning?

Nov 08, 2016

Can Disclosing a Sexual Assault Help a Woman’s Sexual Functioning?

It’s not uncommon for women to have sexual problems after a sexual assault. However, new research suggests disclosing the assault to someone might alleviate those problems to some extent.

Experts estimate that between 13% and 45% of women will be the victim of an adult sexual assault (ASA) at some point in their lives. ASA is defined as “any unwanted or non-consensual sexual experience” occurring after age 14.

But not all women tell others about their assault. Some worry that others won’t believe them or that they’ll be blamed for what happened.

Some women find that their sexual interest wanes after ASA. They might have trouble becoming aroused or reaching orgasm. Or sex might be painful. These issues might last for years.

Researchers from the University of Washington in Seattle wanted to know more about how disclosing an assault might affect a woman’s sexual health later on. They recruited 652 women between the ages of 21 and 30 to participate in an online survey. About three-quarters of the women had experienced a sexual assault. Of these, 83% had disclosed the assault to someone.

The scientists found that disclosing the assault could indirectly help with sexual function by lessening the impact of trauma symptoms. It’s possible that exposure to positive sexual experiences could create a “corrective learning experience” for the women, in which they can focus on the positive aspects of sex.

More research is still needed, the authors added. Future studies might focus on ASA victims’ feelings about non-penetrative sexual activities, such as oral sex. They might examine whether the time frame between assault and disclosure plays a role or how the reactions to the disclosures might ultimately affect the women.


The Journal of Sexual Medicine

Staples, Jennifer M., MS, et al.

“Sexual Assault Disclosure and Sexual Functioning: The Role of Trauma Symptomatology”

(Full-text. Published online: August 30, 2016)


FDA Announces New Testosterone Labeling Rules

Nov 01, 2016

FDA Announces New Testosterone Labeling Rules

Labels on all testosterone products must now include information about the risk of abuse, according to a ruling issued by the U.S. Food and Drug Administration (FDA) last week.

The agency explained that the labeling change stems from published literature and case reports on the abuse of testosterone and other anabolic androgenic steroids.

Produced by the testes, testosterone is an important hormone for men. It creates and maintains many of their masculine characteristics, including facial hair, muscle mass, and a deep voice. It is also involved with sex drive and erections.

Doctors may prescribe testosterone when men’s bodies don’t produce enough of it on their own. For example, certain genetic conditions, chemotherapy, infection, and injury to the testes can all affect a man’s testosterone production. Currently, the FDA approves the use of testosterone for men in these situations.

However, testosterone levels naturally decline as men get older. As a result, men may feel weak, fatigued, and irritable. They may also lose interest in sex and have problems getting erections. Sometimes, doctors prescribe testosterone to treat these symptoms.

Some men abuse testosterone, taking more than the recommended dose and/or taking it with other anabolic androgenic steroids. Some athletes and bodybuilders take testosterone or other drugs to enhance their performance.

The FDA reports that testosterone abuse can damage the heart, brain, liver, and the endocrine system. It may also affect a man’s mental health.

“Reported serious adverse outcomes include heart attack, heart failure, stroke, depression, hostility, aggression, liver toxicity, and male infertility,” the FDA said in a press statement, adding that men undergoing withdrawal from testosterone may have symptoms such as “depression, fatigue, irritability, loss of appetite, decreased libido, and insomnia.”

The FDA also advised healthcare providers to measure a man’s testosterone if they suspect he is abusing the hormone.


Rettner, Rachel

“Prescription Testosterone Gets New Warning”

(October 25, 2016)


MD Magazine

Black, Ryan

“FDA Announces Stern New Warning Labels for Testosterone Treatments”

(October 25, 2016)



Brooks, Megan

“FDA Adds New Warnings to All Testosterone Product Labels”

(October 25, 2016)



Clarke, Toni

“U.S. FDA adds abuse warning to prescription testosterone”

(October 25, 2016)


U.S. Food and Drug Administration

“FDA approves new changes to testosterone labeling regarding the risks associated with abuse and dependence of testosterone and other anabolic androgenic steroids (AAS)”

(Press statement. October 25, 2016)


Women’s Sexuality Affected by Body Image and Relationship Quality, Study Says

Oct 18, 2016

Women’s Sexuality Affected by Body Image and Relationship Quality, Study Says

A woman’s acceptance of her body and the quality of her relationship with her sex partner may influence her overall sexual function, according to a new study.

Researchers from Germany noted that good sexual health involves a person’s “emotional, mental, and social well-being” and is so much more than simply physical function. To learn more, they designed a study to examine the roles of body image and partnership quality.

The participants were 2,685 women age 35 or under who were medical students in Germany, Austria, and Switzerland. Their average age was 24 years. Each woman completed an anonymous online questionnaire and answered questions about their age, weight, relationship status, partnership quality, physical health, smoking status, alcohol use, history of pregnancy, and use of birth control pills.

The assessment included the Female Sexual Function Index (FSFI), a tool that is often used in medical research on female sexuality. The FSFI includes questions on a woman’s experiences with desire, arousal, vaginal lubrication, sexual satisfaction, pain, and orgasm during the previous four weeks. Lower scores on the FSFI correspond with poorer sexual function.

Also included was a questionnaire called the Self-Acceptance of the Body Scale, designed to help researchers learn about a person’s feelings about his or her own body. The woman were asked to rate their agreement with certain statements, such as “I would like to change certain parts of my body” and “I am satisfied with my appearance.”

The women categorized their relationship status using one of four terms: enamoredness, love, friendship, or conflicted.

Ninety-two percent of the women had been sexually active within the previous four weeks and almost three-quarters of them had been in a steady relationship during the previous six months. Based on FSFI scores, about 39% could be considered to have a sexual dysfunction. However, some experts feel that FSFI scores are not useful for women who are not sexually active. With this in mind, the researchers based their analysis only on sexually active women.

In this group, women who were in a steady partnership and had greater body self-acceptance tended to have higher FSFI scores. Those who called their relationship “enamored” or “loving” had the highest FSFI scores of all.

Single women and those who classified their sexual relationships as “friendship” or “conflicted” had lower FSFI scores.

While a cause and effect relationship could not be determined from the data, the researchers suggested that good relationships and positive body self-acceptance could act as “buffers” in certain situations. For example, single women and those in conflicted relationships might have better sexual function if they have a high degree of body self-acceptance. And having a good, steady relationship might contribute to better sexual function in women with low body self-acceptance.

Helping young women develop a positive body image might ultimately improve their sexual health, the authors wrote.

The study was first published online in August in the Journal of Sexual Medicine.


The Journal of Sexual Medicine

Wallwiener, Stephanie, MD, et al.

“Sexual Function Is Correlated With Body Image and Partnership Quality in Female University Students”

(Full-text. Published online: August 26, 2016)


Glaucoma and Erectile Dysfunction (ED) May Be Linked

Oct 04, 2016

Glaucoma and Erectile Dysfunction (ED) May Be Linked

Researchers from the University of British Columbia in Canada have found a link between glaucoma and erectile dysfunction (ED) – the inability to get and keep an erection firm enough for intercourse.

The study, published recently in the Journal of Glaucoma, found that men with glaucoma are over two and a half times more likely to have ED than men without the eye disease.

Glaucoma is the result of damage to the optic nerve, which is connected to the retina. When a person sees an image, the retina sends a message to the brain. The brain uses this information to interpret what is being seen. Glaucoma is often caused by excess fluid at the front of the eye, which increases pressure. But it can also be caused by inflammation and eye injury.

The scientists collected data from 128 men over age 40 who were patients at an ophthalmology clinic. Sixty-one men had open-angle glaucoma, the most common type. The remaining 67 patients did not have glaucoma.

Each man completed a questionnaire called the Index of Erectile Dysfunction (IIEF), which is commonly by scientists to assess sexual function.

Based on IIEF scores, the researchers determined that 40% of the men with glaucoma had ED. Severity of both conditions was correlated – the more severe the glaucoma, the more severe the ED.

The researchers also considered other factors that can contribute to ED, such as diabetes, high blood pressure, high lipid levels, and smoking, but the association between glaucoma and ED remained.

The findings do not mean that glaucoma causes ED or vice versa. It simply means that there is an association.

It was not clear why the two conditions were related, but the scientists thought that inflammation in the blood vessels could be involved. Problems with blood flow can cause problems with the eyes and with erections.


American Academy of Ophthalmology

Boyd, Kierstan

“Causes of Glaucoma”

(December 29, 2015)


Boyd, Kierstan

“What Is Glaucoma?”

(January 10, 2015)


Journal of Glaucoma

Law, Geoffrey BScH, et al.

“Correlation in Severity Between Glaucoma and Erectile Dysfunction”

(Abstract. September 2016)


National Post

Blackwell, Tom

“Glaucoma and impotence unexpectedly linked in new study from UBC”

(August 29, 2016)


Does a Man’s Sexual Interest Affect His Partner’s Sexual Function?

Sep 21, 2016

Does a Man’s Sexual Interest Affect His Partner’s Sexual Function?

How might a man’s sexual issue affect the sexuality of his female partner? It’s a complicated question, but a new study by Italian scientists suggests that the way women perceive their partner’s sexual interest could be a factor.

Past research has focused on sexual problems like erectile dysfunction (ED), premature ejaculation (PE), and delayed ejaculation (DE) and their effects on women’s sexual health. However, for many of these studies, the focus was on diagnosing and treating a man’s sexual problem.

In this study, the researchers wanted to know more about how a man’s sexual factors – considered from a woman’s point of view – might influence female sexual function.

The study involved 156 heterosexual women who had been in a stable relationship during the previous six months. On average, the women were around 47 years old; their partners’ average age was 50. Eighty-three percent of the couples were living together.

Each woman completed a questionnaire called the Female Sexual Function Index (FSFI). This is one of the most common tools used to assess female sexual problems, covering the domains of sexual desire, arousal, vaginal lubrication, orgasm, pain, and overall sexual satisfaction. Higher scores on the FSFI mean better sexual function.

The women also had physical exams and answered questions about their psychological well-being, sexual desire, lifestyles, medications, and relationships with their partners.

About 37% of the women had a partner with a sexual problem. About a third felt their partner had lost his desire for them. Almost a quarter of the partners had ED, 14% had PE, and 8% had delayed ejaculation.

After analyzing the data, the researchers discovered that FSFI scores tended to go down when the couple had disagreements and did not live together. Scores also went down when women had intercourse just to please their partner.

In contrast, FSFI scores generally increased when women had intercourse more often or when they were trying to conceive a child.

Women who perceived low desire in their partner had lower FSFI scores overall as well as in the arousal, lubrication, orgasm, satisfaction, and pain domains. However, no correlation was found between FSFI scores and a partner’s problems with erectile dysfunction, premature ejaculation, or delayed ejaculation.

In addition, women who felt their partner had less sexual interest tended to masturbate more often, have intercourse less often, and feel that the man did not care about the woman’s sexual pleasure.

“It can be speculated that erectile function and ejaculatory behavior are not the most pressing concerns in the perspective of women with [female sexual dysfunction],” wrote the study authors. “Conversely, among factors related to their partner’s sexuality, feeling unloved and/or undesired is the main determinant of sexual impairment.”

The study was published online in July in the journal Andrology.



Maseroli, E., et al.

“Which are the male factors associated with female sexual dysfunction (FSD)?”

(Full-text. First published: July 13, 2016)


Dapoxetine is Safe and Effective for Premature Ejaculation, Study Says

Sep 08, 2016

Dapoxetine is Safe and Effective for Premature Ejaculation

A drug called dapoxetine is a safe, effective method for treating premature ejaculation (PE), according to a team of Turkish researchers.

However, acupuncture could be a viable treatment, too, they noted.

Their study, published online in April in Urologica Internationalis, compared two dose levels of dapoxetine to acupuncture.

PE is one of the most common sexual problems for men. In general terms, it occurs when a man ejaculates before he and his partner wish it to happen. The International Society for Sexual Medicine (ISSM) defines two types of PE. Men with lifelong PE ejaculate within a minute of vaginal penetration and have done so since their first sexual experience. Those with acquired PE typically ejaculate within three minutes of penetration, but have not had the condition all their lives.

The ISSM definition also notes that men with PE are not able to delay the timing of ejaculation and feel distress over their situation.

There are several approaches for treating PE, including medication, sex therapy, and topical treatments that can be applied directly on the penis.

Acupuncture has been practiced in Chinese medicine for over 2,500 years. It involves restoring the balance of energy in the body through the manipulation of tiny needles placed in the skin in certain strategic areas called acupoints. This approach has not been widely studied for treatment of PE.

To learn more, the researchers worked with 120 men with lifelong PE. On average, the participants were in their thirties and had been married for four to five years.

One of the ways experts assess premature ejaculation is by calculating the intravaginal ejaculatory latency time (IELT). Couples measure IELT themselves, using a stopwatch during intercourse.

For this study, men and their partners measured IELT before the study began and again a month later. At these times, the men also completed questionnaires designed to evaluate their ejaculatory function.

The men were randomly assigned to one of four treatment groups. One group took 60 mg of dapoxetine on demand (one to three hours before having sex); another took 30 mg of the drug. A third group had twice-weekly acupuncture sessions. The fourth received “sham” acupuncture, during which a specialist used needles, but did not penetrate the skin. The treatment period lasted for four weeks.

Men who took 60 mg of dapoxetine saw the biggest improvements, with longer IELTs and improved scores on the PE questionnaire. Men who took 30 mg of the drug had the next-best improvements, followed by the men in the acupuncture group and those in the sham group.

Common side effects with dapoxetine included nausea, dizziness, diarrhea, insomnia, and headache.

However, the men who received acupuncture or sham treatment reported no side effects.

The absence of side effects could make acupuncture a “plausible” PE treatment, even if it wasn’t as effective as dapoxetine. But more research is needed, the authors said.

“To the best of our knowledge, this is the first report to compare acupuncture and dapoxetine in the treatment of PE and we think that our results will bring a new perspective to treatment decisions,” they wrote.

It should be noted that dapoxetine is not available in the United States, nor has it been approved for use in that country.  


Urologica Internationalis

Sahin S., et al.

“A Prospective Randomized Controlled Study to Compare Acupuncture and Dapoxetine for the Treatment of Premature Ejaculation”

(Full-text. First published online: April 7, 2016)


Men with Penile Implants Seem Satisfied With Treatment

Aug 16, 2016

Men with Penile Implants Seem Satisfied With Treatment

Men who receive penile implants for erectile dysfunction (ED) appear to be more satisfied with their treatment compared to those who try other therapies, according to a new study published in Andrology.

Men with ED – the inability to get and keep an erection firm enough for intercourse – have a variety of treatment options available to them. This study, conducted by researchers in Turkey, compared the effectiveness of and satisfaction with three types:

·         Oral medication. Drugs called phosphodiesterase type 5 (PDE5) inhibitors are usually the first treatment urologists try with their ED patients. These medications relax smooth muscle tissue in the penis and allow more blood to flow in when a man is sexually stimulated. In this study, the drug tadalafil was used.

·         Self-injection.Sometimes, oral medications either don’t work or aren’t feasible. (For example, men who take nitrates for heart disease should not take PDE5 inhibitors.) In those cases, patients might try self-injection therapy. Men inject medication into the base of their penis shortly before they’d like to have sex. The drug then triggers an erection.

·         Penile implants (prostheses).  If the above methods don’t work out, men may decide to have a penile prosthesis implanted. The penis contains two areas of spongy tissue called the corpora cavernosa, which fill with blood and give the penis the firmness it needs for an erection. In an inflatable implant procedure, these two areas are replaced with two cylinders that can fill with a reserve of saline solution when a man presses on a special pump. (Less often, malleable rods are implanted, allowing the man to raise and lower his penis by hand as needed.)

The researchers collected data from 356 men with an average age of 52 years. All of the men had ED.

The participants were divided into four groups and followed these treatment protocols for the next twelve weeks:

·         132 men (37%) took 20 mg of tadalafil twice a week.

·         106 men (30%) took 5 mg of tadalafil once a day.

·         96 men (27%) underwent injection therapy.

·         22 men (6%) underwent implant surgery (inflatable prostheses).

The men completed questionnaires that assessed their erectile function and treatment satisfaction. The satisfaction of the men’s partners was also evaluated.

Overall, the men who had penile implants had more improvement in erectile function than the men who took tadalafil (both groups) and those who used injection therapy.

In addition, the men in the implant group – and their partners – appeared to be more satisfied with their treatment than those in the other groups.

The authors reported that in general, satisfaction rates for penile implants are above 90% for both men and their partners.

However, they added that more research is needed to confirm the results of this study.



Kucuk, E. V., et al.

“Erectile dysfunction patients are more satisfied with penile prosthesis implantation compared with tadalafil and intracavernosal injection treatments”

(Full-text. First published: July 1, 2016)


Older Men May Benefit from Testosterone Treatment

Aug 03, 2016

Older Men May Benefit from Testosterone Treatment

Older men with low testosterone could see improvements in sexual symptoms with testosterone therapy, according to the results of a recent trial.

Men’s testosterone levels gradually decline as they get older. It’s a natural part of aging. But for many men, this hormonal drop leads to fatigue, weakness, and decreased muscle mass. Men might feel moody or depressed.

Their sex lives may also be affected. Men with low testosterone can have low libido and erectile dysfunction (ED).

The trial involved 470 men aged 65 or older who lived in the United States. The participants’ average age was around 71 years old. All of them were experiencing low sex drive and had low testosterone, defined as measurements below 275 ng/dL. In addition, all of the men had regular sexual partners. About 60% of the men were obese and about a third had diabetes. Over 70% of them had high blood pressure.

For the next year, roughly half the group applied a daily dose of testosterone gel to their skin. This dose was adjusted as necessary to keep testosterone levels within the range considered normal for younger men. The other half also received a gel, but it was a placebo and did not contain testosterone. None of the men knew whether they were receiving testosterone or not.

The men’s testosterone levels were checked regularly. They also filled out questionnaires to assess their sexual activities and function.

The researchers found that the men in the testosterone group had more sexual interest, more frequent intercourse, and better erectile function than the men in the placebo group.

These improvements continued through the twelve-month treatment period. Improved desire and more frequent sexual activity seemed to be linked to the degree of testosterone increase.

Still, the researchers did not find a specific threshold measurement for these improvements. In other words, they did not see that a man’s sexual interest and activity got better once his testosterone levels reached a certain measurement point.

The study was first published online in June in the Journal of Clinical Endocrinology & Metabolism.


The Journal of Clinical Endocrinology & Metabolism

Cunningham, Glenn R., et al.

“Testosterone Treatment and Sexual Function in Older Men with Low Testosterone Levels”

(Full-text. First published online: June 29, 2016)


No Connection Found Between Testosterone Therapy and Risk of Aggressive Prostate Cancer

Jul 19, 2016 TRT is a popular approach to treating low levels of testosterone, an important hormone for men. When a man has low testosterone, he may feel tired, weak, and depressed. He may lose interest in sex or develop erection problems.

Sometimes, men have low testosterone because of medical conditions that interfere with its production. But men can also develop low testosterone as a result of normal aging.

That’s because men’s testosterone levels naturally decline as they get older. The goal of testosterone therapy, which can be administered through gels, patches, and injections, is to bring a man’s testosterone levels back to a normal range.

Some experts have been concerned about TRT and prostate cancer risk, as testosterone can fuel the growth of prostate cancer cells.

To learn more, a group of American and Canadian researchers examined data from two Swedish databases related to prostate cancer and prescriptions, including testosterone.

They identified 38,570 cases of prostate cancer diagnosed between 2009 and 2012. They also looked at data from 192,838 men without prostate cancer.

Prescriptions for TRT were filled by 284 men with prostate cancer before their cancer diagnosis. TRT prescriptions were filled by 1,378 men who did not have prostate cancer.

The scientists found no connection between TRT and prostate cancer risk. They did discover that “favorable risk” prostate cancer (disease that is not aggressive and does not necessarily need immediate treatment) was more common among men who had had TRT. But these men may have gone to the doctor more often and had early biopsies, which could have increased the odds of finding cancer earlier.

Results related to aggressive prostate cancer were different, however. Men who had taken testosterone for a year or longer had their risk of aggressive disease cut in half. The researchers did not expect this finding and noted that more study is needed.

“Overall, our study suggests that what is best for men’s health is to keep testosterone levels balanced and within a normal range,” said lead investigator Stacy Loeb, MD, MSc of the NYU Langone Medical Center in a press release.

The findings were presented in May at the American Urological Association’s annual meeting in San Diego, California,


AUA 2016

Loeb, Stacy, MD, MSc, et al.

“Testosterone Therapy and Prostate Cancer Risk”

(Abstract presented at the annual meeting of the American Urological Association, May 9, 2016, San Diego, California)

NYU Langone Medical Center

“Testosterone Therapy Does Not Raise Risk of Aggressive Prostate Cancer, Study Suggests”

(Press release. May 9, 2016)


Men with ED More Likely to Have Hip Fractures, Study Reports

Jul 04, 2016

Men with ED More Likely to Have Hip Fractures, Study Reports

Men with erectile dysfunction (ED) have greater chances of getting a hip fracture than men with normal erections, according to new research out of Taiwan.

It might seem like ED and hip fracture wouldn’t have much in common. But the connection might start with coronary heart disease, which occurs when fat deposits called plaques build up on artery walls, restricting blood flow. Both ED and hip fractures are more common in people with coronary heart disease.

Using information from Taiwan’s National Health Insurance Database, scientists analyzed the medical claims records of over 23,000 men. They identified 4,636 men who were diagnosed with ED between 1996 and 2010. They also chose 18,544 men around the same age to serve as a comparison group. All of the men were age 40 and older; their average age was 58 years.

They discovered that 1.27% of the men with ED later had a hip fracture, compared to 0.75% of the men without ED. And overall, the men with ED were over three times more likely to develop a hip fracture. This likelihood increased with age.

Other medical conditions, like high cholesterol, diabetes, and osteoporosis were more common in the men with ED. About two-thirds of these men had high blood pressure. Rates of testosterone use were also higher in the ED group.

Men with ED tended to develop hip fractures in a shorter amount of time, too. Five years was the average; for men without ED, the average was almost eleven years.

Why did men with ED have a greater risk for hip fracture? The researchers weren’t entirely sure, but suggested that imbalance of hormones, such as testosterone, might be one explanation. Men with low testosterone often develop muscle weakness, which can make them more prone to falling.

Other possible explanations could involve osteoporosis, depression, vitamin D deficiency, and heart disease, the authors noted. But further research is needed.

The authors recommended that men with ED have their bone mineral density checked and be careful about falling, especially if they are over 40 years old.

The study was published online in April in PLOS One.


American Heart Association

“Coronary Artery Disease - Coronary Heart Disease”

(Updated: May 20, 2016)


Wu, Chieh-Hsin, at al.

“Hip Fracture in People with Erectile Dysfunction: A Nationwide Population-Based Cohort Study”

(April 14, 2016)

Renal and Urology News

Persaud, Natasha, et al.

“ED Patients at Higher Risk of Hip Fracture”

(April 26, 2016)


New Research on Adult-Onset Hypogonadism Provides “Conceptual Framework” for Healthcare Providers

Jun 21, 2016

A new literature review published today in Mayo Clinic Proceedings provides some insight into adult-onset hypogonadism (AOH), a condition in which middle-aged and older men have low levels of testosterone.

The research project is the result of a colloquium held in Washington DC last summer by the Sexual Medicine Society of North America (SMSNA). At that meeting, seventeen experts in the fields of men’s health, sexual medicine, urology, endocrinology, and methodology discussed the diagnosis and management of AOH as well as the reasons a physician might consider testosterone therapy for men with AOH.

The goal of the resulting study was to “support health care professionals in the development of a deeper understanding of AOH, particularly in how it differs from classical primary and secondary hypogonadism, and to provide a conceptual framework to guide its diagnosis, treatment, and follow-up.”

Primary hypogonadism occurs when a man’s testes do not function properly and, therefore, cannot produce adequate amounts of testosterone. Secondary hypogonadism is caused by problems in areas of the brain responsible for testosterone production.

A man’s testosterone levels naturally decline as he ages. But declines in testosterone are also associated with other conditions that are common in older men, like metabolic syndrome, diabetes, hypertension, and obesity.

Testosterone levels can also be affected by certain drugs, like anabolic steroids, opioids, tricyclic antidepressants, nicotine, and marijuana.

Men with low testosterone often experience sexual dysfunction, including low libido, erectile dysfunction, or delayed ejaculation. They may also feel fatigued, weak, and depressed.

Treatment of low testosterone sometimes includes lifestyle changes (like losing weight) and managing the comorbidities that could be contributing factors (such as keeping blood sugar under control).

Testosterone replacement therapy is currently approved by the U.S. Food and Drug Administration (FDA) for primary and secondary hypogonadism, but not adult-onset hypogonadism. In 2015, the FDA called for labeling changes on FDA-approved testosterone products as well as further research, as concerns had been raised about the therapy and cardiovascular risk.

In the study, the authors discuss research on the safety of testosterone therapy, noting that low testosterone is associated with an increased risk for heart disease.

They added that testosterone treatment does not increase a man’s risk for prostate cancer. Also, there is no evidence showing that testosterone therapy worsens an enlarged prostate or related urinary symptoms.

“Clinical evidence supports the authenticity of [adult-onset hypogonadism] and its health relevance,” the authors wrote in their conclusion.

“Importantly, improved clinical management can be expected to result from ongoing rigorous investigation of diagnostic criteria and demonstration of efficacy and safety of treatments for this syndrome,” they said.

Patients concerned about low testosterone are encouraged to see their healthcare provider for a complete check-up.


Mayo Clinic Proceedings

Khera, Mohit, MD, MBA, MPH, et al. “Adult-Onset Hypogonadism”

(Full-text. June 21, 2016)


Surgeons Perform First Penis Transplant in the U.S.

Jun 07, 2016

Surgeons Perform First Penis Transplant in the U.S.

The operation took about 15 hours and involved over a dozen surgical specialists. But in the end, a medical team from Massachusetts General Hospital in Boston performed the first penis transplant in the United States.

The patient, 64-year-old Thomas Manning, was recovering well when the announcement was made on May 16th. His body was not rejecting the new penis, there were no signs of infection, and blood was flowing properly.

Mr. Manning had had his penis amputated because of penile cancer, which was discovered after a work accident in 2012. Left with a short stump, he had to sit down to urinate and could not perform sexually at all.

His doctors say they are “cautiously optimistic” that he will recover his sexual function eventually. However, his urinary function is expected to return to normal and the penis should look like his natural genitals.

The transplanted penis came from a deceased donor who had the same blood type and skin tone as Mr. Manning.

As a transplant recipient, Mr. Manning will need to take immunosuppression drugs for the rest of his life. These medications ensure that his body does not reject the new penis.

Surgeons Curtis L. Cetrulo, Jr., MD and Dicken S.C. Ko, MD had been studying the feasibility of a penis transplant for over three years, with assistance from urologists, nurses, social workers, psychiatrists, and other professionals at the hospital.

After completing a successful hand transplant, the team began preparing for a penis transplant. They studied the intricate connection of tissues, blood vessels, and nerves, practicing their technique on cadavers.

Genital injuries can be devastating for men, both physically and psychologically. Damage to their “manhood” can make them feel less complete.

“We are hopeful that these reconstructive techniques will allow us to alleviate the suffering and despair of those who have experienced devastating genitourinary injuries and are often so despondent they consider taking their own lives,” said Dr. Cetrulo in a press release.

In his own statement, Mr. Manning said, “Today, I begin a new chapter filled with personal hope and hope for others who have suffered genital injuries, particularly for our service members who put their lives on the line and suffer serious damage as a result.”

He added, “In sharing this success with all of you, it’s my hope we can usher in a bright future for this type of transplantation. Thank you.”

Two other penis transplants have been performed worldwide, but only one has been successful. That patient, a 21-year-old man from South Africa, was able to impregnate his girlfriend just months after surgery.



Goldschmidt, Debra and Nadia Kounang

“Doctors perform first U.S. penis transplant”

(May 16, 2016)

Massachusetts General Hospital

“First Genitourinary Vascularized Composite Allograft (Penile) Transplant in the Nation Performed at Massachusetts General Hospital”

(Press release. May 16, 2016)

“MGH Genito-Urinary Vascularized Composite Allograft (Penile) Transplant FAQs”

“Patient Statement”

The New York Times

Grady, Denise

“Man Receives First Penis Transplant in the United States”

(May 16, 2016)


Anatomy Could Be a Key to Orgasm

May 31, 2016

Anatomy Could Be a Key to OrgasmFor many people, reaching orgasm is one of the goals of a sexual experience. But not everyone gets there, even with the “right” amount of stimulation and excitement. Many factors can be involved, including relationship stress, depression, and side effects of medications. However, a recent study published in Clinical Anatomy suggests that a person’s physical makeup plays a role, too.

Researchers from the Mayo Clinic and the Indiana University School of Medicine reviewed medical studies to see just how anatomy affected orgasms.

In a press release, lead author Dr. Elizabeth Emhardt posed the research question: “Sexual experiences are assumed to be in your control based on your attitude: your confidence, your ability to trust, your openness. What if variations in sexual anatomy actually set the foundation for differences in sexual experience, and we aren't in control of our sexual experiences as much as we once thought?”


Might your anatomy be one key to a satisfying orgasm? (Click to tweet)


The scientists found that for men to achieve orgasm, two types of nervous systems need to be in balance. One is the parasympathetic nervous system (sometimes called the “rest and digest” system), which controls the body’s functions while at rest. The other is the sympathetic nervous system, from which the “fight or flight” response originates. When these two systems are not aligned, men can experience sexual problems, sure as premature ejaculation.

For women, orgasms seem to depend more on physical structures. Many women reach orgasm with stimulation of the clitoris, a small genital organ full of sensitive nerves. The clitoris moves closer to the vaginal wall during sex. But if it doesn’t get close enough, the likelihood of orgasm is reduced.  

Similarly, the size of the clitoris can be important too. Research published in 2014 found that women with a smaller clitoris had more trouble reaching orgasm.

Ultimately, people are individuals with a number of anatomical variations. And orgasms are complex. Couples may need to experiment with different sexual positions and activities to discover what works best for them. Understanding each other’s anatomy may be one place to start.


“Do Differences in Anatomy Matter for Achieving Orgasm?”

(Press release. April 5, 2016)

Clinical Anatomy

Emhardt, E., et al.

“Anatomic variation and orgasm: Could variations in anatomy explain differences in orgasmic success?”

(Full-text. April 4, 2016)

“Parasympathetic vs. Sympathetic Nervous System”

Medical Daily

Dovey, Dana

“The Big O: Physiological Reasons Why You May Have Orgasmic Dysfunction”

(April 8, 2016)

“Size and Location of Clitoris May Affect Orgasm”

(November 12, 2014)


For Certain Men, Testosterone Therapy Might Be Good for the Heart

May 10, 2016

Testosterone replacement therapy might reduce the risk of heart attacks and strokes in older men with both low testosterone and coronary artery disease, a new study finds.

Produced by the testes, the hormone testosterone contributes much to a man’s masculinity. It’s responsible for increased his muscle mass, deeper voice, and facial hair. It’s also important for his sex drive and erections.

As men get older, their testosterone levels naturally drop. The process is gradual, but some men sense the change. They might feel fatigued and moody. Some men start to lose interest in sex.


Testosterone therapy may benefit older men with low testosterone and coronary artery disease. (Click to tweet)


Sometimes, doctors prescribe testosterone for these symptoms. But the practice has been controversial, with some studies showing increased risk of cardiovascular events – stroke, heart attack, and death – in men taking testosterone. Other studies have found no increased risk.

In this study, researchers from the Intermountain Medical Center Heart Institute in Salt Lake City worked with 755 men who ranged in age from 58 to 78. The men had low testosterone and severe coronary artery disease, a condition caused by atherosclerosis (hardening of the arteries). When plaque builds up in the coronary arteries, it becomes more difficult for blood to flow to the heart.

Three groups were formed. One group of men received a high dose of testosterone therapy; another was given a medium dose. The third group did not receive any testosterone.

After a year, 64 men in the non-treatment group had had a cardiovascular event, compared to 12 men in the medium-dose testosterone group and nine in the high-dose group.

After three years, cardiovascular events were experienced by 125 men who were not treated with testosterone, 38 men in the medium-dose group, and 22 men in the high-dose group.

Doctors shouldn’t be changing their patients’ treatment plans quite yet, however.  The scientists stressed that their study was observational and that more research is needed.

The findings were presented last month in Chicago at the American College of Cardiology’s 65th Annual Scientific Session.


Intermountain Healthcare

“New Study Finds Testosterone Supplementation Reduces Heart Attack and Stroke Risk in Men with Heart Disease”

(News release. April 3, 2016)

Feller, Stephen

“Testosterone supplement reduces heart attack risk from heart disease”

(April 4, 2016)


Operative Vaginal Delivery Could Be Linked to Sexual Problems for New Mothers

Apr 19, 2016

Italian scientists decided to investigate the issue further. They wanted to know how three types of delivery affected women’s sexual function: operative vaginal delivery, spontaneous vaginal delivery (done without forceps or vacuum pumps), and caesarian section.

The current study involved 269 women with an average age of 34 who had delivered their first babies by one of the three methods. (In Italy, vacuum extraction is customary in operative vaginal deliveries.)

About three days after childbirth, the women completed a questionnaire about their sexual function during their final trimester of pregnancy. Six months after childbirth, the women answered the same questions about their postpartum period.

Based on their questionnaire scores, about 41% of the women had some degree of sexual dysfunction at the six-month point.

Women who had had operative vaginal delivery were more likely to have trouble with arousal, vaginal lubrication, and orgasm          when compared to those who had undergone caesarian section. They also had more problems with orgasm than those who had had spontaneous vaginal delivery.


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Study: Daily Testosterone Gel Might Boost Low Levels, Improve Sex Drive

Apr 05, 2016

In this study, scientists from several continents investigated the effects of a testosterone gel on men’s overall testosterone levels, sex drive, and energy levels.

They worked with 715 men with an average age of 55 years. At the start of the study, all of the men had low testosterone, defined as levels below 300 ng/dL. They also reported having low sex drive, low energy, or both symptoms.

Many of the men had other health conditions. For example, half of them had high blood pressure, and 30% had diabetes. Thirty-eight percent had high cholesterol. Erectile dysfunction was common, too.

The men were randomly assigned to receive either a testosterone gel or a placebo gel. They were instructed to apply the gel to the armpit once a day for twelve weeks.

Periodically throughout the study, the researchers assessed the men’s testosterone levels, sex drive, and energy levels. By the end of the period, 73% of the men who used testosterone had levels in the normal range (between 300 and 1,050 ng/dL), but only 15% of the men in the placebo group had reached this benchmark.


« Previous 1 2 3 Next » (page 2 of 3)


FDA Approves Generic Viagra

Mar 22, 2016

If the blood’s pathway is blocked in any way, such as by atherosclerosis (hardening of the arteries), there will be insufficient blood in the penis, resulting in a weak erection or no erection.

Several health conditions are linked to ED, including diabetes, heart disease, nerve damage, obesity, and high blood pressure. 

Sildenafil citrate works by increasing blood flow to the penis. The drug is taken only as needed and usually produces an erection in 30 – 60 minutes.

Not all men can take sildenafil citrate, however. Men who use nitrates for heart disease are cautioned against using any PDE5 inhibitors because the interaction could cause a dangerous drop in blood pressure. It is important to take these medications under a doctor’s care.

To learn more about the causes, diagnosis, and treatment of erectile dysfunction, please check out the Sex Health Matters overview here. You’ll also find a number of helpful links with more details.

Print this article or view it as a PDF file here: FDA Approves Generic Viagra


CBS News

Marcus, Mary Brophy

“First generic version of Viagra approved by FDA”

March 10, 2016

Medscape Medical News

Brooks, Megan

“First Generic Version of Viagra Clears FDA”

(March 11, 2016)


“How does Viagra work?”

“Important Safety Information”

Sexual Medicine Society of North America

“Overview – Erectile Dysfunction”

“Treating Erectile Dysfunction”

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Testosterone Therapy Might Improve Sex Lives of Older Men

Mar 08, 2016

The current study involved 790 men over the age of 65. Their testosterone levels were below 275 ng/dL and had declined naturally. (The normal range usually begins at 300 ng/dL.)

The men were randomly divided into two groups. One group underwent testosterone therapy using a gel that they applied to the body daily. The dose brought their testosterone levels within the typical range of 19- to 40-year-old men.

The second group received a placebo gel, which contained no testosterone. The men did not know which group they were assigned to.

From there, the men participated in at least one of three trials. One trial assessed sexual function, the second evaluated physical function, and the third focused on vitality.

The researchers checked the men’s progress periodically over the next year.

They found that the men who took testosterone tended to have more interest in sex and better erections than the men who received the placebo gel. They also reported more sexual activity.

In addition, men on testosterone had better scores overall on a test of 6-minute walking distance, along with improvements in mood and energy.

The findings should help doctors decide whether testosterone replacement therapy is appropriate for their older patients. However, the authors explained that the trial was not large enough to consider potential risks of this treatment. Further research is needed in that regard.

Print this article or view it as a PDF file here: Testosterone Therapy Might Improve Sex Lives of Older Men


Medical Daily

Castillo, Stephanie

“Treating Low Testosterone Levels May Improve Physical Activity, Sexual Function In Older Men”

(February 17, 2016)

The New England Journal of Medicine

Snyder, Peter J. M.D., et al.

“Effects of Testosterone Treatment in Older Men”

(February 18, 2016)

The New York Times

Kolata, Gina

“Testosterone Gel Has Modest Benefits for Men, Study Says”

(February 17, 2016)

Yale News

Kashef, Ziba

“Testosterone therapy boosts sexual function and mood in older men”

(February 17, 2016)

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CDC: Zika Virus Can Be Sexually Transmitted

Feb 23, 2016

    According to information published by the CDC on February 5th, two cases of likely sexual transmission involved men who had symptoms. A third case occurred before a man started having symptoms.</p>
    The medical community is still learning about Zika virus and its sexual transmission. Right now, men who have traveled to an area where the virus is active are urged to use condoms, especially if they have sex with a pregnant partner. Condoms may reduce the risk of transmission, but abstaining from sex is the only surefire way to avoid spreading Zika virus.</p>
    The virus can be present in semen, even longer than in blood, experts say. However, it is unclear exactly how long the virus can remain in semen, so men with pregnant partners should use condoms throughout the pregnancy.</p>
    Pregnant women should ask their partners about their recent travel and possible exposure to the virus. If there is any doubt, condoms should be used or the couple should abstain from having sex.</p>
    Scientist do not know whether women with the virus can transmit it to their partners.</p>
    It is important that condoms be used correctly with every instance of vaginal, anal, or oral sex, notes the CDC. (More information on proper condom use may be found <a href="">here.</a>)</p>
    People who have any concerns about Zika virus are encouraged to speak to their healthcare provider. Updated information is also available on the <a href="">CDC&rsquo;s Zika virus website.</a></p>
<hr />
    Print this article or view it as a PDF file here:&nbsp;<a href=" – Headlines – CDC- Zika Virus Can Be Sexually Transmitted 02-24-16.pdf" target="_blank">CDC: Zika Virus Can Be Sexually Transmitted</a></p>
<hr />
    <em><u>U.S. Centers for Disease Control and Prevention</u></em></p>
    &ldquo;Facts about Microcephaly&rdquo;</p>
    (Page last updated: February 12, 2016)</p>
    <a href=""></a></p>
    &ldquo;Interim Guidelines for Prevention of Sexual Transmission of Zika Virus &mdash; United States, 2016&rdquo;</p>
    (February 12, 2016)</p>
    <a href=""></a></p>
    &ldquo;Questions and Answers: Zika and Sexual Transmission&rdquo;</p>
    (Page last updated: February 5, 2016)</p>
    <a href=""></a></p>
    &ldquo;Zika Travel Information&rdquo;</p>
    (Page last updated: February 18, 2016)</p>
    <a href=""></a></p>
    &ldquo;Zika Virus&rdquo;</p>
    (Page last updated: February 18, 2016)</p>
    <a href=""></a></p>
    <em><u>Medscape Multispecialty</u></em></p>
    Lowes, Robert</p>
    &ldquo;DC Update: Sex Precautions to Prevent Zika Virus&rdquo;</p>
    (February 12, 2016)</p>
    <a href=""></a></p>
    <em><u>National Institute of Neurological Disorders and Stroke</u></em></p>
    &ldquo;Guillain-Barr&eacute; Syndrome Fact Sheet&rdquo;</p>
    (Page last modified: November 19, 2015)</p>
    <a href=""></a></p>

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Study: ED Drugs Don’t Increase Risk for Prostate Cancer Recurrence

Feb 03, 2016

Two hundred ninety-three men had biochemical recurrence after treatment with radical prostatectomy (surgical removal of the prostate gland) and radiation therapy. The researchers then gathered information from 5,767 men who did not have biochemical recurrence and compared the two groups.

PDE5 inhibitors were used by 51% of the men who experienced biochemical recurrence. Among men who didn’t have a recurrence, 58% used these medications.

They research team found that using PDE5 inhibitors was not associated with biochemical recurrence for either type of treatment. Even after accounting for factors like marital status, education, income, PSA levels, and stage of cancer, there was still no connection.

The authors concluded that doctors do not need to change their approach to treating ED after prostate cancer treatment.

The study was published online in December in the journal European Urology.

Print this article or view it as a PDF file here: Study: ED Drugs Don’t Increase Risk for Prostate Cancer Recurrence


European Urology

Loeb, Stacy, et al.

“Phosphodiesterase Type 5 Inhibitor Use and Disease Recurrence After Prostate Cancer Treatment”

(Abstract. Published online: December 30, 2015)

National Cancer Institute

“Biochemical Recurrence”

“Prostate-Specific Antigen (PSA) Test”

(Reviewed: July 24, 2012)

Renal and Urology News

Charnow, Jody A.

“Erectile Dysfunction Drugs Do Not Affect Prostate Cancer Relapse Risk”

(January 5, 2016)

Reuters Health via Journal of Clinical Pathways

Boggs, Will, MD

“Erectile dysfunction meds don't boost prostate cancer recurrence”

(January 13, 2016)

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Men on Androgen Deprivation Therapy May Be at Higher Risk for Alzheimer’s

Jan 18, 2016

In this study, the researchers analyzed medical records from 16,888 men with prostate cancer. Fourteen percent of the men had had ADT. The researchers followed the patients’ progress for a median of 2.7 years.

They discovered that men on ADT were about 88% more likely to be diagnosed with Alzheimer’s disease during the follow-up period compared to those who did not have ADT.

Also, the longer men were on ADT, the greater their chances of developing Alzheimer’s. Men who underwent ADT long-term were at more than twice the risk.

Why were men on ADT more likely to have Alzheimer’s disease? The scientists weren’t completely sure, but past studies have found that low testosterone leaves brain cells more vulnerable to Alzheimer’s and may contribute to the production of the protein amyloid beta, a hallmark in the progression of Alzheimer’s disease. Clumps of amyloid beta can cause plaques in the brain, making it more difficult for brain cells to “talk” to each other.


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Scientists Explore Possibility of Penis Transplants in the United States

Jan 05, 2016

So far, only two penis transplants have been conducted in the world. Only one was successful.

The first occurred in China in 2006. The operation was successful on a physical level. After ten days, the new penis had a healthy blood supply and the recipient could urinate on his own. However, the new penis was soon removed because the man and his wife had trouble with it psychologically.

The second transplant took place just over a year ago in South Africa. The 21-year-old patient had had his penis amputated after he developed complications from a botched circumcision. (In the Xhosa culture, it is customary for males to be circumcised as teenagers or young adults.)

That transplant was a success and in 2015, the man impregnated his girlfriend.

Psychological readiness is important. Men in the Johns Hopkins program will receive psychiatric evaluations. Patients and partners will be counseled on what to expect, as there are no guarantees that urinary and sexual function will be completely restored.

The operation is intricate. Surgeons must connect tiny blood vessels and nerves under a microscope. Nerves should eventually grow at a rate of one inch per month. Experts believe it will take six to twelve months to regain urinary and sexual function. If men still have their testes, they may be able to father children eventually.


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Study: Testosterone Therapy Does Not Raise Risk for Heart Attack and Stroke in Healthy Men

Dec 24, 2015

They collected data from 1,472 men with low testosterone. The men were between 52 and 63 years old. None of them had a history of heart disease.

Some of the men received 90 days of testosterone therapy, given as either a topical gel or an injection. The dose brought the men’s testosterone up to normal levels. The rest of the men took no testosterone.

The researchers followed the men for one to three years, paying close attention to the men’s heart health.

They found that the men who took testosterone were not at increased risk for heart attack or stroke.

“In fact, testosterone therapy in this population was shown to reduce the risk of heart attack, stroke and death, when compared to those men who weren’t taking testosterone supplementation,” said researcher Brent Muhlestein, MD, in a news release. Dr. Muhlestein is the co-director of research at the Intermountain Medical Center Heart Institute.


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Obstructive Sleep Apnea Linked to Sexual Dysfunction in Both Men and Women

Dec 01, 2015

Overall, the consulted studies included 1,275 participants.

The researchers found that men with OSA had an 82% increased risk of erectile dysfunction (ED). And women with OSA were twice as likely to have sexual dysfunction as those without the condition.

Many OSA patients use a continuous positive airway pressure (CPAP) device. This treatment includes a mask connected to a special machine designed to keep the airway open. The researchers found that CPAP therapy could help men with OSA and ED. It might help women with OSA and sexual problems as well, they noted.

They also explained that OSA might interfere with the production of sex hormones like testosterone and reduce the body’s levels of nitric oxide, an important compound for sexual function. Metabolic syndrome - a group of conditions that includes insulin resistance, high cholesterol, high blood pressure, and obesity – could be involved, too.

 “Our results suggest that it is important to recognize the adverse effects of OSA on the sexual function,” the authors concluded.

Print this article or view it as a PDF file here: Obstructive Sleep Apnea Linked to Sexual Dysfunction in Both Men and Women


The Journal of Sexual Medicine

Liu, Luhao, MD, et al.

“Sexual Dysfunction in Patients with Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis”

(Full-text. First published online: September 22, 2015)


“Obstructive sleep apnea – adults”

(Updated: February 2, 2015)

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Sex is OK After Heart Attack, Study Suggests

Nov 17, 2015

Over half of the patients had had sex at least once a week in the year before their heart attack. About 25% had had sex less than once a week. Roughly 5% had had sex less than once a month and almost 15% didn’t have sex at all.

Less than 1% of the participants had sex within an hour of their heart attack. Almost 80% didn’t have sex within the previous 24 hours.

“Based on our data, it seems very unlikely that sexual activity is a relevant trigger of heart attack,” said lead author Dr. Dietrich Rothenbacher in a press release. Dr. Rothenbacher is a professor and chair of the Institute of Epidemiology and Medical Biometry at Ulm University in Germany.

The researchers reported that 100 cardiovascular events occurred among the participants during the ten year follow-up period, but these events were not linked to sexual activity.

“It is important to reassure patients that they need not be worried and should resume their usual sexual activity,” Dr. Rothenbacher said in the statement.

While sexual activity is generally considered safe for heart patients, they should still check with their doctor to be certain.


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Changes in Immune System of Sexually Active Women May Help Fertility

Nov 03, 2015

Both cells work with the immune system. Helper T cells activate other cells that fight harmful microbes. Immunoglobulins are antibodies that also fight off foreign elements.

Technically, the body could interpret sperm cells and embryos as “foreign invaders.” But in order for a woman to become pregnant, the body needs to make some adjustments.

In a press release, lead author Tierney Lorenz explained it this way:

“The female body needs to navigate a tricky dilemma. In order to protect itself, the body needs to defend against foreign invaders. But if it applies that logic to sperm or a fetus, then pregnancy can’t occur. The shifts in immunity that women experience may be a response to this problem."

Two types of helper T cells come into play. Type 1 cells help defend the body. But type 2 cells tell the body that some outside elements, like sperm cells, are okay to accept.


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ED After Transperineal Prostate Biopsy Generally Improves Within 3-6 Months

Oct 20, 2015

In this study, a pair of researchers from Italy wanted to know how a transperineal prostate biopsy (through the perineum) would affect men’s erections.

They collected information from 1,050 patients between the ages of 56 and 71 who had this type of biopsy. Just before surgery - and again at one, three, and six months following surgery - the men completed a questionnaire about their erections.

The scientists found that the men’s risk of ED increased about 5% after surgery. When ED did occur, it was moderate at the one month mark, but generally got better within three to six months. At six months, men’s erections usually were not worse than they were before biopsy.

When discussing prostate biopsy, men are encouraged to discuss their concerns with their doctor, including any worries about erections. Their doctor can give them the best advice for their personal situation.


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Non-Steroidal Anti-Inflammatory Drugs Not Linked to ED Risk

Oct 07, 2015

Health issues related to NSAID use were categorized as follows:

·         Arthritis, including rheumatoid arthritis, osteoarthritis, and joint pain

·         General musculoskeletal complaints, including tendonitis, bursitis, and repetitive motion injuries

·         Headaches

·         Sciatica, including pinched nerve

·         Atherosclerotic disease, such as coronary artery disease, ischemic heart disease, and heart attack

Almost 60% of the men reported NSAID use during the study period.

Arthritis, general musculoskeletal complaints, headaches, sciatica, and atherosclerotic disease were all associated with higher risk of mild to moderate ED, defined as a “decrease in normal function.” General musculoskeletal complaints, headaches, and atherosclerotic disease were linked to severe ED (no erections at all).

For men taking non-aspirin NSAIDs, risk for ED rose by 16%. Men who took aspirin had the same odds of developing severe ED.


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Women Stay Sexually Active as They Age

Sep 29, 2015

Almost 56% of the women said they’d had at least one sex partner in the past year. About a quarter had had no partner. (The rest either chose not to answer the question or their answers were missing.)

About 1,800 women were romantically partnered, defined as married or cohabitating with a partner. Two-thirds of the women of this group were sexually active. “Sex” was not specifically defined, however, and it was up to the women to determine which types of activities counted as sex.

Women were less likely to be sexually active as they aged. However, almost 60% of the romantically partnered women age 60 and older were still having regular sex.

“Among women who were romantically partnered, the prevalence of sexual activity was high, even for women in their 70s and 80s,” the authors wrote.

Married or cohabitating women were about 8 times more likely to be sexually active than those who were not.


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For Couples Coping with Provoked Vestibulodynia, Sexual Goals are Important

Sep 15, 2015

The interaction of couples has also been investigated. In a recent Journal of Sexual Medicine study, Canadian researchers analyzed the role of sexual goals for couples facing PVD.

They considered two types of goals: Approach goals and avoidance goals.

Approach goals are geared toward positive outcomes. For example, couples may focus on the intimacy they share during sex, bonding in their relationship, and the pleasure they bring each other.

Avoidance goals focus on preventing a negative outcome. A woman with PVD may have sex to avoid having an argument about it later. Or, she may continue having intercourse so that her partner won’t leave the relationship.

One hundred seven couples coping with PVD participated in the study. All of the women were premenopausal, with an average age of 28 years. Their partners’ mean age was 30 years.

Each couple filled out questionnaires about their sexual goals, sexual and relationship satisfaction, and depression. The women gave information about how their PVD pain and sexual function.

After analyzing the data, the researchers found that when women focused on approach goals, they were more likely to feel satisfied with sex and their relationships.

But those with avoidance goals had less sexual and relationship satisfaction. They also felt more depressed and had more problems with sexual function.


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Diabetes Screening Important for Men with ED

Sep 02, 2015

The scientists identified 4,519 men age 20 and older who reported having ED and had had their cholesterol, blood pressure, or blood sugar measured. These men had not been previously diagnosed with heart disease risk factors, however.

After analyzing the data, the team discovered that men with ED were not significantly more likely to have high cholesterol or high blood pressure. But the results for diabetes were much different.

The rate of undiagnosed diabetes was 11.5% among the men with ED, compared to just 2.8% for the men without ED.

The difference was particularly striking for men between the ages of 40 and 59. Undiagnosed diabetes was found in 19.1% of the men with ED. For men without ED, the rate was 3.3%.


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FDA Approves Drug to Treat Low Sexual Desire in Women

Aug 19, 2015

FDA Approves Drug to Treat Low Sexual Desire in WomenWomen coping with hypoactive sexual desire disorder (HSDD) may soon have a medical treatment option. 
On August 18th, the U.S. Food and Drug Administration (FDA) approved flibanserin, a drug developed to treat HSDD in premenopausal women. 
Women with HSDD have a chronic, persistent lack of interest in sex – to the point that they feel personal distress. They don’t fantasize about sex and don’t feel desire for their partner. And no health condition, drug, or substance can explain its disappearance.
HSDD is troublesome for both partners and can lead to arguments, depression, and relationship issues. 
The FDA gave the green light to treat flibanserin for cases when HSDD is acquired and generalized. “Acquired” means that the woman has had a healthy sex drive in the past. She might have been full of desire for her partner before, but no longer feels it. “Generalized” means that this lack of desire happens with any partner and with any type sexual activity.
An estimated one in ten women are believed to have HSDD. But until now, there was no FDA-approved treatment. 
The drug, which will be marketed under the name Addyi, works by balancing chemicals in the brain. It increases the levels of two neurotransmitters – dopamine and norepinephrine – which are important for sexual excitement. It also decreases levels of serotonin, which can hinder sex drive. 
The road to flibanserin’s approval was rocky. It was twice rejected by the FDA because of safety concerns. Some experts felt that it wasn’t effective enough. 
Last October, the FDA held meetings and workshops so that patients and experts could share their views on HSDD and its treatment. In June, after considering new research, an FDA advisory panel recommended approval.
Still, Addyi can have some serious side effects. A woman’s blood pressure can drop substantially (hypotension). There is also a chance that she might lose consciousness (syncope). Women should also not drink alcohol while taking Addyi.
Sprout Pharmaceuticals, the maker of Addyi, expects the drug to be available by October 17, 2015. However, not all doctors will be able to prescribe it. The FDA’s approval has some strict requirements. 
Doctors must be specially trained and certified to prescribe Addyi. They must also counsel patients on the risks, especially those concerning blood pressure, loss of consciousness, and interactions with alcohol. 
Similarly, pharmacies must be trained and certified to dispense the drug and may only do so if a certified doctor prescribes it. Pharmacists must also make sure patients are aware of the risks. 
Addyi labels will include a “boxed warning” from the FDA that explains the risks. And Sprout Pharmaceuticals is required to conduct three more studies to investigate the interaction of Addyi and alcohol. 
International Society for Sexual Medicine
“What is flibanserin and how does it work?”
Stein, Rob
“FDA Approves First Drug To Boost Women's Sexual Desire”
(August 18, 2015)
Sprout Pharmaceuticals
“Sprout Pharmaceuticals Receives FDA Approval of ADDYI™ (Flibanserin 100 MG)”
(Press release. August 18, 2015)
U.S. Food and Drug Administration 
“FDA approves first treatment for sexual desire disorder”
(News release. August 18, 2015)


Fewer Men Receiving Penile Implants

Aug 17, 2015

Semi-rigid malleable rods are another option. With this type of implant, the man moves his penis into an erect position before intercourse.

Implants are usually considered a last resort for men who do not respond to other treatments like medication or vacuum devices.  It’s also an option for men who are unable to take medication because of drug interactions.

To learn more about penile implant trends, the researchers looked at Medicare records in the United States. Medicare is the main form of health insurance for Americans age 65 and older.

The team identified 1,763,260 men who were diagnosed with ED. Of those, 3% received penile implants during that time period.

But the numbers dropped as well. In 2002, 4.6% of the men got implants. By 2010, this percentage decreased to 2.3%.


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Study: Chances Are, ED Drugs Don’t Cause Melanoma

Aug 11, 2015

Of the men with melanoma, 11% had filled a prescription for an ED drug [sildenafil (Viagra), vardenafil (Levitra), or tadalafil (Cialis)] at some point. In contrast, 8% of the men without melanoma had filled such a prescription.

Based on these results, the researchers did conclude that ED drug users were at higher risk for melanoma. However, they did not think that the drugs caused melanoma for several reasons:

·         While increased risk was seen in men who filled one prescription, men who filled more than one prescription were not at significantly higher risk.

·         ED drugs were associated with the early stages of melanoma, but not more advanced stages.

·         There was also a connection between ED drugs and basal cell carcinoma. But this type of skin cancer acts differently.


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Testosterone Replacement Therapy Not Helpful for Ejaculatory Disorders

Aug 04, 2015

Since testosterone is behind many aspects of masculinity, a group of American researchers wondered whether replacement therapy could help men with ejaculatory disorders. Such problems can include delayed ejaculation and anejaculation (inability to ejaculate). They also include situations in which a man ejaculates less semen than usual or with reduced force.

The scientists collected information from 66 men with low testosterone levels and at least one of the ejaculatory disorders mentioned above. (Men with premature ejaculation were not included in this study.)

For 16 weeks, about half of the men underwent testosterone replacement therapy, which was adjusted as needed to keep their levels in the normal range. The rest of the men received a placebo treatment (no testosterone). During the study period, men filled out questionnaires and submitted logs on their sexual activity.

While the men on testosterone did see some improvement in their ejaculatory problems, it wasn’t enough to conclude that the therapy was more helpful than the placebo. In other words, the researchers saw little difference in improvements between the two groups.


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Low Testosterone Associated with Osteopenia, Study Says

Jul 29, 2015

In men, a small amount of testosterone converts to estrogen. If a man has lower levels of testosterone, less estrogen is made. As a result, his chances of developing osteoporosis increase.

With osteoporosis in mind, researchers from New York’s Albany Medical Center wanted to know about testosterone, bone density, and osteopenia.

They collected data from 235 men with low testosterone, defined as levels less than 300 ng/dL. The average age of the men was 51 years. The researchers also took note each man’s bone density, body mass index, smoking history, diabetes status, and the length of time he had had low testosterone.

Fifty-six percent of the men had normal bone density levels, but 39% had osteopenia and 5% had osteoporosis.


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Women Have Sex Less Frequently After Treatment For Gynecologic Cancer

Jul 21, 2015

Two hundred ninety women participated in the study. Forty-one percent had been treated for uterine/endometrial cancer. Ovarian cancer had affected 37% of the women and 22% had had cervical cancer or another type.

Ninety-two percent of the women had had surgery, 62% had had chemotherapy, and 30% had undergone radiation.

Each woman completed a 181-question survey about their sexual health and relationships before and after cancer treatment.

Sexual dysfunction was more common among younger and premenopausal women, as well as those who had had chemotherapy and those who were in committed relationships.

The women with sexual problems were more likely to attend relationship counseling.


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Finasteride Linked to Sexual Problems in Men

Jul 14, 2015

A team of scientists from Boston University School of Medicine investigated this further. They collected data from 700 men with BPH. Four hundred seventy of the men took finasteride. The remaining 230 took tamsulosin, an alpha blocker that works differently from finasteride.

For almost four years, the researchers followed the men and checked to see how well the drugs were working for BPH. They also studied the drugs’ effects on testosterone levels, erections, and quality of life.

Both of the drugs relived urinary symptoms of BPH. But men on finasteride gradually developed erectile dysfunction (ED), which did not get better with continued treatment. Also, testosterone levels significantly declined for men on finasteride, resulting in hypogonadism (low testosterone).

In contrast, the men who took tamsulosin did not have these side effects.


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Women’s Sexual Function Over Time

Jul 07, 2015

In this study, researchers collected data from 507 women with an average age of 56 years. One hundred seventy-eight women had not yet gone through menopause; the remaining 329 were postmenopausal.

Twice, participants filled out a questionnaire called the Female Sexual Function Index (FSFI). This assessment tool evaluates a woman’s overall sexual function along with her function in six specific categories: desire, arousal, lubrication, orgasm, satisfaction, and pain.

The first assessment was completed by the 507 women. Four years later, 241 of them completed the FSFI again.

As expected, the researchers found that postmenopausal women were more likely to report sexual problems. However, the rates of developing a sexual problem over the four year period were about the same for premenopausal and postmenopausal women. And 7% of the women in both groups resolved a sexual problem during those four years.


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Testosterone Patches and Gels Safer Than Injections, Study Says

Jun 30, 2015

Testosterone injections, gels, and patches are three of the most common ways to take the hormone. Injections may be given in a doctor’s office or by the patient at home. Gels and patches may be applied directly to the skin, usually on the shoulder or upper arm.

The three methods provide sufficient amounts of testosterone. However, injections cause testosterone levels to spike and then gradually decrease. Gels and patches administer testosterone more evenly.

The researchers analyzed health records of 544,115 men in the United States and United Kingdom. All of the men had been on testosterone replacement therapy at some point. Approximately 37% used injections. Seven percent used patches and 56% used gels. Generally, the men were over 50 years old, although one group of U.S. Medicare recipients were in their 70s, on average. The men had not used testosterone for at least 180 days before the study began.

Next, the scientists looked at the men’s medical records for the next year to find out how frequently they had cardiovascular events, like heart attack or stroke. They also compared hospitalization and death rates by dosage type.

They found that the men who took testosterone by injection tended to have higher rates of such events, along with higher rates of hospitalization and death.


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Accepting Pain of Provoked Vestibulodynia Might Improve Sexual Satisfaction for Both Partners

Jun 23, 2015

Scientists investigating chronic pain have discovered that sometimes, pain is decreased when people can accept it and work through it. In other words, people who continue a valuable activity in spite of pain might start to feel less pain.

A Canadian research team questioned whether this line of thinking could apply to PVD. To learn more, they recruited 61 heterosexual couples for a study. All of the women had PVD. The average age for the woman was 28 years; for men, it was 30 years.

Both partners completed surveys designed to evaluate pain, sexual function and satisfaction, anxiety, and depression.

The researchers discovered that when women accepted the pain, it was less intense. They also felt less anxiety and depression. Both partners felt more sexually satisfied. Men tended to feel less depressed when they accepted their partner’s pain as well.

Why did the women feel less pain, anxiety, and depression? One theory is that accepting the pain helped women focus on what they enjoyed about sex – closeness to their partner and emotional intimacy, for example.


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Flibanserin Update

Jun 16, 2015

How flibanserin works

Taken once a day at bedtime, flibanserin works on chemicals in the brain that are involved with sexual desire.

The drug is sometimes called the “female Viagra” in the media, but this comparison to the male erectile dysfunction (ED) drug is not exactly accurate.

Flibanserin targets a woman’s brain, while Viagra targets a man’s genitals. Men with ED still feel a desire for sex, but have trouble with the physical process of erection.  

Conditions of the panel’s recommendation

The panel’s recommendations do come with some caveats, as there are still some safety issues with flibanserin.

Drug labeling should include warnings about side effects like dizziness, fainting, sleepiness, and low blood pressure, the panel suggested.

They also proposed that physicians be certified to prescribe flibanserin and that pharmacists verify that a prescribing doctor is, indeed, certified.


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Experts: Testosterone Therapy Has More Benefits than Risks

Jun 09, 2015

Currently, testosterone replacement therapy is FDA-approved only for men with hypogonadism – low testosterone that results when men’s bodies can’t make enough testosterone on their own. This can happen if there are problems with the testes, glands that produce testosterone. It may also occur if the pituitary gland in the brain can’t send signals to trigger testosterone production.

Men’s testosterone levels naturally decline as they age, leading to low libido, weakness, and mood changes.

Some doctors prescribe testosterone therapy to these men as well, even though it has not been approved for this use.

“Any patient being considered for testosterone replacement therapy should undergo a thorough diagnostic work-up. The decision to replace testosterone therapy should be guided by the signs, symptoms and testosterone concentrations rather than the underlying cause,” said endocrinologist Sandeep Dhindsa, MD, in an AACE press release.


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Recommendation on Flibanserin Announced

Jun 05, 2015

On Thursday, June 4, an advisory panel to the U.S. Food and Drug Administration recommended approval of flibanserin, a drug intended to treat hypoactive sexual desire disorder (HSDD) in women. 
HSDD is a chronic lack of sexual desire accompanied by distress. It is estimated to affect one in ten women. 
Approval of flibanserin has been rejected by the FDA twice already because of safety concerns.  The panel's recommendation does not mean the drug is approved. However, the FDA usually follows advisory panel decisions.
The committee recommended certain provisions for approval.  Only certified doctors would be able to prescribe flibanserin and pharmacies would need to confirm certification. The panel also suggested that safety studies continue. 


Metabolic Syndrome More than Doubles ED Risk

Jun 04, 2015

Criteria for diagnosing metabolic syndrome vary among medical organizations. According to American Heart Association guidelines, a patient must have three of these five factors to be diagnosed.

Erectile dysfunction is the inability to get or keep an erection firm enough for sex.

While all of these metabolic factors have been associated with ED in the past, researchers wanted to get a better sense of the connection based on recent research.

Turkish researchers examined eight studies that included over 12,000 participants. The studies were published in medical journals between 2006 and 2013.

They found that overall, men with metabolic syndrome had a 2.6 higher risk for ED. But individual factors also increased risk. For example, men with high blood sugar were at double the risk. The risk for men with high blood pressure increased 1.5 times.

The components of metabolic syndrome can damage blood vessels in all parts of the body, including the penis. Since blood flow is essential for a good erection, keeping those blood vessels healthy may prevent ED, or at least keep it from getting worse.


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FDA Meeting June 4th to Discuss Female Libido Drug

May 27, 2015

Flibanserin has been controversial. Advocates say that it’s time for a drug to treat HSDD, pointing out that there are a number of drugs approved to address men’s sexual issues, but none for women.

But opponents note that sometimes female sexual arousal happens before sexual desire. This is still a normal pattern, they say, and not something that needs to be treated with a pill.

Others point out that many factors can interfere with a woman’s libido, including stress, depression, and hormonal changes.

It is unclear whether the FDA will follow the recommendations of the two advisory panels.


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Study Examines Efficacy, Side-Effects of PDE5 Inhibitors

May 19, 2015

Some of the studies compared one ED drug to another. Other studies compared a drug to a placebo (a pill that has no active ingredients, often used in medical research.)

The research team found that the ED drugs worked better than the placebos. Generally, they were well-tolerated, too.

When the researchers looked at different ED drugs and doses, they discovered the following:

·         50 mg of sildenafil (Viagra) seemed to work best, but it had the highest rate of side effects.

·         10 mg of tadalafil (Cialis) had the lowest rate of side effects, but wasn’t as effective as sildenafil.

·         10 mg of vardenafil (Levitra, Staxyn) and 100 mg of avanafil (Stendra) had lower effectiveness rates and higher side effect rates.


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PTSD and Sexual Problems are Linked, Study Says

May 12, 2015

In this study, the researchers wanted to learn more about the connection between PTSD and sexual problems. They looked at past research on the subject, focusing on the biological and psychological processes involved with PTSD and sexual function and how those systems might interact.

Biologically, they found that the hormonal and neurological circuitry needed for good sexual function are similar to those affected by PTSD. A person will have trouble becoming interested in sex and physically aroused if those networks are already damaged.

Physiological arousal plays a role in both PTSD and sex. But the body may interpret sexual arousal as a threat and the resulting fear may be stronger than any sexual feelings or bodily response.

Psychology is another important consideration. PTSD patients often have trouble with intimacy and trust. They may not feel safe enough to let themselves enjoy a sexual experience. The idea of “letting go” and reaching orgasm may be frightening for them. They may feel that they’re not worthy of their partner’s attention or angry with partners for initiating sex. Or they may be so numbed by trauma that they don’t feel anything at all.


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Gene Therapy Could Shine Light on Erectile Dysfunction

May 06, 2015

In this case, the material would be injected directly into the penis. When this material is exposed to blue light, a chemical process begins that triggers an erection.

Blue light is usually associated with electronics, such as computer screens and smartphones. But lamps that emit blue light are widely available.

The technique is still just a prototype, tested in male rats. In those trials, exposure to blue light after injections triggered erections in most of the animals. Some of the rats ejaculated.

The research team does not expect any serious side effects in humans and injecting material into the penis may not be as unpleasant as it sounds.

“Injection of a gene construct should not be a barrier to potential users, as injections in the erectile tissue are already a standard treatment for erectile dysfunction these days,” said lead researcher Martin Fussenegger in a press release. Mr. Fussenegger is a professor of Biotechnology and Bioengineering at the Department of Biosystems in Basel, Switzerland.


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Viewing Sexually Explicit Material May Be Good For Men’s Erections

Apr 29, 2015

The men completed questionnaires about their sexual function and shared how many hours per week they spent watching sexually-explicit films and videos.

Next, the men watched a series of short videos depicting consensual male-female vaginal sex. Each man watched the videos alone in a private room in a laboratory. After each film, the men reported how aroused they felt. In between each film, a neutral film was shown so that the aroused feelings could wear off before the next film began.

The researchers discovered that the more hours men watched sexually-explicit content at home, the more aroused they felt after the films in the lab. More viewing hours at home was also associated with greater desire for sex with a partner and for solo masturbation.

The men’s home viewing habits did not appear to influence the men’s ability to have erections with a partner.


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Women’s Desire, Arousal Improved by Sleep

Apr 21, 2015

The daily reports also included information on the women’s sexual activity in the past 24 hours, such as whether they masturbated or if they had sex with a partner (vaginal, hand, oral, and anal sex were all considered “sex” for this purpose). They described how much desire and arousal they felt and indicated whether they were menstruating.

After analyzing the data, the researchers discovered that the longer the women slept, the more sexual desire they felt the next day. Women with regular partners were also more likely to have partnered sex the next day if they slept longer the night before. In fact, sleeping one extra hour increased their chances of partnered sex by 14%.

Genital arousal encompasses the physical changes that happen as women’s bodies get ready for sex. Vaginal lubrication is one example.

How did sleep affect arousal? The results were a bit tricky. If women slept longer on average, they became more aroused during sex in general. But if they slept longer than usual on one particular night, they were less aroused the next day.


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Testosterone Coupons Not Always a Good Idea

Apr 15, 2015

Testosterone is aggressively marketed to these men, so it’s not unusual for them to ask their doctors for a prescription. Unfortunately, testosterone therapy can be costly, and it isn’t covered by all insurance plans. Manufacturers’ coupons can help, but this might not be the best option.

Much depends on the man’s ability to continue paying for therapy once the coupon expires. If he cannot afford it, he will have to stop taking testosterone and that’s where the trouble lies.

Why? Once a man goes on testosterone, his body loses its ability to produce the hormone on its own. This can take weeks, sometimes months, to come back. In the meantime, the fatigue, lower sex drive, and other symptoms he had before therapy will likely return.


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New Studies Show No Link Between Testosterone Therapy and Heart Problems

Apr 08, 2015

Men’s testosterone levels naturally decline as they get older, which can make them feel fatigued, moody, and less interested in sex. Some doctors prescribe testosterone for these men, too, but the U.S. Food and Drug Administration (FDA) has not approved this use.

Lately, the safety of testosterone therapy has been under much scrutiny. In late 2013 and early 2014, studies published in medical journals reported increased risks for heart attack and stroke among men taking testosterone.

The research methods and data used in these studies were called into question, however. And other experts have found that testosterone does not increase risk of heart problems. In fact, it might even protect against heart attack and stroke.

Still, the FDA changed its labeling requirements for testosterone products last month. Manufacturers must now provide information on possible heart risks in product packaging.


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