Chiara Simonelli

International Society for Sexual Medicine's guidelines for the diagnosis and treatment of premature ejaculation.

INTRODUCTION Over the past 20 years our knowledge of premature ejaculation (PE) has significantly advanced. Specifically, we have witnessed substantial progress in understanding the physiology of ejaculation, clarifying the real prevalence of PE in population-based studies, reconceptualizing the definition and diagnostic criterion of the disorder, assessing the psychosocial impact on patients and partners, designing validated diagnostic and outcome measures, proposing new pharmacologic strategies and examining the efficacy, safety and satisfaction of these new and established therapies. Given the abundance of high level research it seemed like an opportune time for the International Society for Sexual Medicine (ISSM) to promulgate an evidenced-based, comprehensive and practical set of clinical guidelines for the diagnosis and treatment of PE. AIM Develop clearly worded, practical, evidenced-based recommendations for the diagnosis and treatment of PE for family practice clinicians as well as sexual medicine experts. Method.  Review of the literature. RESULTS This article contains the report of the ISSM PE Guidelines Committee. It affirms the ISSM definition of PE and suggests that the prevalence is considerably lower than previously thought. Evidence-based data regarding biological and psychological etiology of PE are presented, as is population-based statistics on normal ejaculatory latency. Brief assessment procedures are delineated and validated diagnostic and treatment questionnaires are reviewed. Finally, the best practices treatment recommendations are presented to guide clinicians, both familiar and unfamiliar with PE, in facilitating treatment of their patients. CONCLUSION Development of guidelines is an evolutionary process that continually reviews data and incorporates the best new research. We expect that ongoing research will lead to a more complete understanding of the pathophysiology as well as new efficacious and safe treatments for this sexual dysfunction. Therefore, it is strongly recommended that these guidelines be re-evaluated and updated by the ISSM every 4 years.

The influence of caregiver burden on sexual intimacy and marital satisfaction in couples with an Alzheimer spouse.

Objective:  This study investigates affective and sexual dimensions in partners involved as caregivers of Alzheimer dementia (AD) subjects. A negative correlation between burden of the caregiver and sexual‐affective quality of life was assumed.

Health-Related Characteristics and Unmet Needs of Men with Erectile Dysfunction: A Survey in Five European Countries

INTRODUCTION Data suggest that ED is still an underdiagnosed and undertreated condition. In addition, it seems that men with ED are unsatisfied about their relationship with their physician and with the available drugs. AIM The study aims to identify health-related characteristics and unmet needs of patients suffering from erectile dysfunction (ED) in big 5 European Union (EU) nations (France, Germany, Italy, Spain, and UK). METHODS Data were collected from the 2011 5EU National Health and Wellness-Survey on a population of 28,511 adult men (mean age: 47.18; SD 16.07) and was focused on men (5,184) who self-reported ED in the past 6 months. In addition, the quality of life (QoL) and work productivity/activity were explored. MAIN OUTCOME MEASURES Health-related QoL (HRQoL) and work productivity were measured with SF-12v2 and WPAI validated psychometric tools. RESULTS One in every 20 young men (age 18-39) across 5EU experienced ED in the past 6 months. About half of men (2,702/5,184; [52%]) with ED across all ages did not discuss their condition with their physician. Interestingly, among those men who did discuss their condition with their physician, 68% (1,668/2,465) do not currently use medication. These findings were more evident in the age group of 18-39 years. Only 48% (2,465/5,184) had a closer relationship with their physician, suggesting that this quality of relationship may be unsatisfactory. Compared with controls, ED patients have a significantly higher intrapsychic and relational psychopathological comorbid burden and relevant decreasing in HRQoL, with a significantly higher impairment on work productivity/activity. CONCLUSION Data suggest that there is a need for a new therapeutic paradigm in ED treatment which images the achievement of a new alliance between physician and patient. Hence, alternative drug delivery strategies may reduce the psychological and social impact of this disease.

Male sexuality and regulation of emotions: a study on the association between alexithymia and erectile dysfunction (ED)

Alexithymia is a multidimensional construct that describes a constellation of personality features characterised by difficulties in differentiating, identifying and communicating emotions. The purpose of the present study was to investigate prevalence of alexithymia in outpatients with erectile dysfunction (ED), both in the psychogenic lifelong type (PLED) and in the acquired one (PAED). ED severity was evaluated with the International Index of Erectile Function (IIEF) and alexithymia was measured using the Italian version of the 20-item Toronto Alexithymia Scale (TAS-20). The results suggest a high incidence of alexithymic characteristics in patients with psychogenic ED, a positive correlation between the alexithymia level and ED severity in patients with PAED and statistically significant differences in the alexithymia level between the two subgroups PLED and PAED. We assumed that alexithymia contributes to the origin of the PLED, and to a more severe manifestation of ED, once it appears in the acquired form.

Intimate Partner Violence: Relationships Between Alexithymia, Depression, Attachment Styles, and Coping Strategies of Battered Women

INTRODUCTION One of the most common forms of violence against women is the intimate partner violence (IPV). This term includes physical, sexual, and emotional abuse and controlling behaviors by an intimate partner. AIM This exploratory study investigates the relationship between alexithymia, adult attachment styles, depression, and coping strategies in a group of female victims of IPV and a control group. METHODS Participants were 80 female victims of IPV with an age range from 18 years to 54 years (mean 31.62; standard deviation 9.81). The control group included 80 women with no history of IPV with an age range from 19 years to 37 years (mean 25.05; standard deviation 3.67). MAIN OUTCOME MEASURES We administered the following self-report questionnaires: (i) 20-Item Toronto Alexithymia Scale (TAS-20); (ii) Coping Orientation Problems Experienced; (iii) Beck Depression Inventory (BDI)-II; and (iv) Attachment Style Questionnaire (ASQ). RESULTS Compared with control group, the IPV group showed higher mean scores on TAS-20 (52.9 vs. 41.1, P < 0.001) and BDI-II (19.50 vs. 9.95, P < 0.001). In both groups, we found significant correlations between BDI-II and TAS-20 total scores (P < 0.001) and between BDI-II and the following dimensions of ASQ: confidence (P < 0.001), discomfort with closeness (P = 0.002), relationships as secondary (P < 0.001), need for approval (P < 0.001), and preoccupation with relationships (P < 0.001). Differently from the control group, in the IPV group, social support correlated significantly and positively (P < 0.001) with the dimension preoccupation with relationships on ASQ, but not with the secure attachment style. CONCLUSIONS In comparison to the control group, alexithymia, depressive symptoms, and an insecure attachment style were negatively correlated with the ability to cope with stress for women in the IPV group.

What do men and women ask a helpline on sexual concerns? Results of an Italian telephone counselling service

Introduction:  In Europe, helplines have become a common counselling service for men and women who are seeking advice for sexual problems. Despite this, relatively few peer‐reviewed reports on this subject have been published in the last decade.

Questionnaires and scales for the evaluation of the online sexual activities: A review of 20 years of research

An increasing number of people use the Internet for Online Sexual Activities (OSA). This sexual revolution has resulted in both positive and negative aspects, enriching sexual functioning but also providing other risks for criminal, negative and harmful sexual conducts, or Online Sexual Problems (OSP). A deeper understanding of Internet sexuality is therefore important for practitioners who work in the psychological and sexological fields. Current studies on Internet sexuality span a broad spectrum with respect to data collection: interviews, questionnaires, observations, content analyses and Internet log file recordings have all been used. The aim of this paper is to offer the most complete overview of these instruments focusing on the strengths and weaknesses of different tools currently available to assess different dimensions of OSA, and to suggest a simple screener for OSP. A systematic search of published online sexual activities inventories was performed using PsychInfo and Pubmed (1993 to July 2013). Although many of them are adequate for their own purposes, our review revealed a lack of standardized, internationally (culturally) accepted tools that are epidemiologically validated in general populations and that can be used to investigate OSA and to assess OSP. The definitions of OSA and OSP continue to change and basic tools are essential to have a broader idea of the phenomenon and of the challenges and possibilities emerging from the double link between the Internet and sexuality. More accurate instruments are also necessary to help advanced clinical diagnosis and treatment for OSP.

Female sexual pain disorders: dyspareunia and vaginismus.

Purpose of review To analyze literature on sexual pain disorders and to review and summarize the articles published throughout 2013 which contribute to the current knowledge on this subject. Recent findings By age 40, 7.8% of women reported vulvar pain. Diagnostic and Statistical Manual of Mental Disorders, fifth edition, has combined vaginismus and dyspareunia into the same diagnostic label. The research reviewed in this article seems to differently point toward two conditions, focusing on different aspects both on the etiological and on the treatment area. Higher levels of partner-perceived self-efficacy and lower levels of partner catastrophizing were associated with less pain intensity in women with entry dyspareunia, independent of womens pain perception and self-efficacy. Alexithymia and fear were found to be important etiological factors in vaginismus. Summary The present findings did not provide clear evidence in support of the superiority of any treatment and highlight the need for randomized, placebo-controlled trials that compare treatments in the future. A lot of work remained to be done to understand such a complex and multifaceted disturbance as genital sexual pain, but the articles examined showed that we are slowly adding more knowledge on the etiological cause and treatment models for such conditions.

Unconsummated marriage: can it still be considered a consequence of vaginismus?

Unconsummated marriage (UM) is the failure to perform successful sexual intercourse at the beginning of the marriage. Vaginismus has been traditionally reported as the leading cause. ED is also a leading cause for UM. This appears to be a significant problem in the conservative middle-Eastern societies and in the developing countries, where couples are strongly prevented by religious rules and cultural taboos from sexual experiences before wedding. One could think that according to major sexual freedom and information, in Western countries UM is now disappearing, but the number of observed cases by the authors in 2008–2012 was relevant. The aim of this study is to compare the literature data from non-Western countries with the features of UM in Western ones, focusing on cases observed by the authors, and to verify whether the etiology of UM proposed in the ’70s is still relevant, outlining any changes that occur in current reality. In our series, traditional appearance of UM is no more effective, while the role of man is undervalued, because of his frailty, lack of self-confidence and ignorance, expressing a social and cultural change of man’s role in the couple.

Moral Disengagement Strategies in Sex Offenders

Sexual abuse is a heterogeneous phenomenon. The literature on sexual offenders considers risk factors in the individual and familial history as well as precursors such as cognitive distortions, defence mechanisms and moral disengagement (MD) mechanisms. This study investigates the MD in sex offenders and non-sex offenders in a sample of 362 males comprising a control group of 268 non-offenders, a group of 42 detained sex offenders and a group of 52 detained non-sex offenders. Participants were administered a semi-structured interview and the Moral Disengagement Scale (MDS). The results show a significant difference between the jailed participants (non-sex offenders and sex offenders) and controls; offenders were found to generally display overall higher levels of MD. Among the jailed participants, sex offenders seem to make more use of MD mechanisms than non-sex offenders.