Violeta Alarcão

Prevalence, Severity, and Risk Factors for Erectile Dysfunction in a Representative Sample of 3,548 Portuguese Men Aged 40 to 69 Years Attending Primary Healthcare Centers: Results of the Portuguese Erectile Dysfunction Study

INTRODUCTION Many studies of the prevalence of erectile dysfunction have been conducted in several countries. This is the first Portuguese study that provides current and comparative data on the prevalence of erectile dysfunction. AIM The main objective was to estimate the prevalence of erectile dysfunction in men aged 40 to 69 years and correlate erectile dysfunction to certain risk factors. MAIN OUTCOME MEASURES Evaluation of erectile dysfunction was achieved using the International Index of Erectile Function (IIEF), a 15-item questionnaire that has been developed and validated as a brief and reliable self-administered scale for accessing erectile function. METHODS The Portuguese Erectile Dysfunction Study was based on a questionnaire that included socio-demographic variables, information on lifestyle and risk factors, and the IIEF. In total, 3,548 questionnaires were administered to men aged 40 to 69 years in 50 primary healthcare centers between July 2004 and January 2005 in a combination of both self-administration and interviews. Erectile dysfunction was defined as the inability to achieve and maintain an erection sufficient to permit satisfactory sexual intercourse. RESULTS The response rate was 81.3%. The total prevalence of erectile dysfunction was 48.1% (age-adjusted). Prevalence increases with age: 29%, 50%, and 74% in men aged 40 to 49 years, 50 to 59 years, and 60 to 69 years, respectively. Severity of erectile dysfunction also increases with age: 1%, 2%, and 10% of complete erectile dysfunction in men aged 40 to 49 years, 50 to 59 years, and 60 to 69 years, respectively. CONCLUSIONS The prevalence of erectile dysfunction is strongly related to age. There is also a correlation with the health status of participants.

Sexology as a profession in Portugal : sociographical composition and self-nomination of portuguese sexologists

ABSTRACT Objectives: The objective of this study was to describe the socio-demographic characteristics, the initial profession and training in sexology, sex therapy and psychotherapeutic techniques of Portuguese sexologists. Methods: As part of an European survey on sexology as a profession (Euro-Sexo), a questionnaire was mailed to all Portuguese sexologists. Results: Portuguese sexologist is in average 43 years old, is mainly female, a non-physician, and has training in sexology. Age, gender, profession, clinical practice and educational background in sexology, research practice in sexology and sexual education made a significant contribution to the prediction of self-nomination as a sexologist. Conclusions: An interesting diversity of sexology professions, from medical to non-medical fields was identified, and its influence on the practice of sexual medicine was discussed.

Traditions and contradictions of sexual function definitions for Portuguese heterosexual men and women: medicalization and socially constructed gender effects

ABSTRACT Research on how sexual changes are understood as dysfunctions versus normal change remains scarce, namely in societies where traditional gender roles persist among the growing diversity of sexual relationships and practices. This article discusses controversies on sexual function definitions through sociology of diagnosis and sexual scripting theoretical frameworks, drawing on 313 structured interviews with primary healthcare users of the Greater Lisbon area, followed by in-depth interviews with a subsample of 25 heterosexual men and women. The low level of agreement found between the scores of the most widely used instruments for sexual function evaluation in epidemiology studies and self-diagnosis may be understood as a challenge for the predominant biomedical model and a need to re-conceptualize sexual dysfunctions other than as organic dysfunctions, with implications for both research and practice. Results show that individuals not only challenge illness concepts and sexual dysfunction diagnoses and their treatments, as they also construct sexual problems based on their impacts in daily life. Demonstrating the permanence of traditional social scripts that operate in the definitions of sexual function is one way to understand gender as an embodied social structure and get adequate practice to the problem, particularly in the Portuguese society where sexuality remains highly gendered.

Sexology in Portugal: Narratives by Portuguese Sexologists

This article presents the emergence and development of modern sexology in Portugal through the analysis of Portuguese sexologists’ narratives, to explore how they commit to a professional identity as sexologists, and to discuss how they integrate their professional role into the vast multidisciplinary field of sexology. In-depth interviews were conducted with 44 key professionals, purposefully recruited to guarantee heterogeneity concerning generation, gender, training, and practice. Content analysis focused on highlighting differences and articulations among the main professionals making up the field. The findings indicate that sexology is not seen as a full-fledged profession but rather as a specialization or a secondary field of action. The sexual medicine perspective is prevalent and more visible among physicians, thus reflecting the gap between psychosocial and biomedical approaches. A close link between clinical work and research and a gap between clinical work and health promotion were found. Despite the multidisciplinary nature of sexology being acknowledged, it is not fully implemented by the experts in the field. However, it is this characteristic that permitted sexology to institutionalize and to legitimate itself as a discourse of truth about sex, in Portugal as in other countries.

Exploring gender in portuguese bedrooms: men’s and women’s narratives of their sexuality through a mixed methods approach

The nature of intimacy and self-identity changed profoundly over the past century. The disruption between sex and procreation enabled the emergence of new forms of relationships and contributed towards the legitimacy of a sexuality focused on pleasure, as a mean of self-realization and an expression of intimacy. Despite the evidence that most individuals now approach close relations with expectations of mutual emotional support and romantic love, intimate relationships remain highly gendered, particularly in societies where traditional roles of men and women persist in the growing diversity of sexual relationships. To address this topic, an empirical research was conducted in the Greater Lisbon area using a mixed methods approach. First, a quantitative study, with 323 primary healthcare users, intended to explain how gender influences self-constructions of sexuality and intimacy. Then, a qualitative study, with a subsample of 10 heterosexual men and 15 heterosexual women, employed in-depth interviews to explore how individuals construct their etiquette of sexual behavior. Building upon Gagnon and Simons scripting theory and Giddens’ transformations of intimacy, along with feminist criticisms concerning male dominance in hetero-relationships, we have reached an explanatory typology that focuses on Portuguese specificity in terms of the subjective experience of sexuality and intimate relationships. Sexuality and intimacy are complex and multifaceted phenomena that are affected by sexual and non-sexual factors, both in and out of the bedroom. Key findings reveal a coexistence of highly gendered sexual scripts with increasingly more egalitarian sexual roles, namely among the youngest and the most educated generations in Portuguese society.

Understanding the relationship between BMI and sexual dysfunction: Can DSM-5 shed light into this topic?

INTRODUCTION The links between body weight and sexuality, notably sexual dysfunction (SD), are intricate and not yet fully understood. A more individual-focused evaluation of sexual difficulties, as recently provided by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), contributes to improve precision in SD diagnosis and has the potential to advance our knowledge on the association between body weight and SD. OBJECTIVES To identify gender differences in sexual behaviors and SD among Portuguese men and women within different classes of body mass index (BMI); and to explore the association between BMI and SD by using the new DSM-5 criteria. MATERIAL AND METHODS Face-to-face interviews followed by self-completed questionnaires of primary healthcare users in Portugal (n=323). Data on sociodemographic variables, BMI, sexual behaviors and SD were collected. DSM-5 criteria were used to assess sexual dysfunction. The International Index of Erectile Function (IIEF) and the Female Sexual Function Index (FSFI) for men and women, respectively, were used for comparison purposes. RESULTS Overweight and obese women reported less sexual partners, less satisfaction with sexual frequency and rated sexual life as less important. These differences were not found among men. Normal weight men and women had a higher score of IIEF and FSFI, respectively, than those overweight and obese. No significant effects of BMI scale on SD following DMS-5 were detected. CONCLUSIONS Womens sexual function is more impacted by BMI than mens. Individual-orientated approaches, as proposed in DSM-5, may allow a better understanding on the relation between body size and sexuality in both genders.

Gender differences in psychosocial determinants of self-perceived health among Portuguese older adults in nursing homes

ABSTRACT Objectives: Self-perceived health declines with age, varies by gender and is a predictor of mortality, morbidity, physical and psychological functioning. However, gender differences in health and illness perception are complex and not yet fully understood. This study aimed to explore gender-related differences in psychosocial determinants of self-perceived health among older adults living in nursing homes. Method: Nationwide face-to-face survey of the Portuguese population aged 65 and over. A representative sample of nursing homes residents was obtained through a multistage cluster random sampling of nursing homes, stratified by main Portuguese administrative regions (NUTS II). Results: Overall, 1186 nursing homes residents voluntarily enrolled in this study (participation rate, 93%) and a total of 515 participants (70.1% women) were considered to have adequate cognitive functioning to answer all questionnaires. A significant association between self-rated health and gender was found: 90.6% of all women (95% CI: 85.7—93.9) and 82.3% of all men (95% CI: 72.9—88.9) rated their health as less than good (p = 0.023). Gender-stratified analyses showed differences in psychosocial determinants of self-perceived health. While symptoms of depression and loneliness feelings were the major psychosocial determinants of poor self-perceived health among women, age and subjective financial well-being were the only determinants among men. Conclusion: Factors associated with perceived health, as representative of healthy ageing, were identified by gender, leading to future avenues for fruitful investigation. The acknowledgement of interpersonal and socioeconomic factors that determine the experience of ageing at a national level is crucial to improve the health of elders.

Facilitators and Barriers in Sexual History Taking

Sexuality is a central part of human life and overall wellbeing. As awareness on issues of sexuality has been increasing, sexual health history is ever more thought of as an indispensable part of the general health assessment. The main purpose of taking a sexual history is to assess a patient’s sexual background and current functioning. The biopsychosocial model provides a comprehensive framework for this evaluation that takes into account medical, psychological, intrapsychic, interpersonal, social, cultural and ethnic variables. Although several strategies and skills can be used to enhance the efficiency and effectiveness of the process of sexual history taking, a number of barriers still impede the communication about sexual topics. The main objective of this work is to explore, integrate and summarize current knowledge on the perceived obstacles and facilitators for taking a sexual history encountered by health professionals in their clinical practice. A narrative review was conducted through a database search of scientific documents. Fifty six articles were included and analysed, being grouped into main research areas: sexual health education and promotion, sexual transmitted diseases, sexuality and disease, sexual dysfunction, lesbian, gay, bisexual, transgender, queer or questioning (LGBTQ), and sexual violence. Deficiencies in sexual history taking education and training, reticence to take a history related to concerns about the acceptability of discussing sexuality with the patient and stigma and society’s attitudes towards sex came out as major cross-cutting themes. Barriers and facilitators operate at the individual, institutional and societal levels. Sexual history taking holds the key to the practice of sexual health and provides the basis for treatment, prevention, education and sexual health promotion.

A construção da sexologia como profissão em Portugal: composição de um grupo profissional e tipos de sexólogos

This study sets out to discuss the emergence of the profession of sexologist in Portugal, comparing its development with international trends. This research also seeks to understand the self-identification of sexologists and the significances they attribute to it. The empirical information presented derives from a survey conducted with 91 Portuguese sexologists identified through the leading professional associations and from 44 in-depth interviews with experts selected by intentional sampling to ensure the diversity of Portuguese sexologists. The results of the survey indicate that the Portuguese sexologist is on average 43 years old, mainly female, non-physician, and has training in sexology. Considering the qualifications of the interviewees, their professional trajectories and the activities they develop in the field, and the discourses related to their ideals of the profession, a typology was found with five types: sexologists by vocation, sexologist by clinical practice, sexologists by certification, social scientist-sexologists and sexologists by media coverage. The survey identified an interesting diversity of practices and professional conceptions in the field of sexology in Portugal. Being a sexologist appears to be more associated with the ideals of the profession than the time devoted to same.This study sets out to discuss the emergence of the profession of sexologist in Portugal, comparing its development with international trends. This research also seeks to understand the self-identification of sexologists and the significances they attribute to it. The empirical information presented derives from a survey conducted with 91 Portuguese sexologists identified through the leading professional associations and from 44 in-depth interviews with experts selected by intentional sampling to ensure the diversity of Portuguese sexologists. The results of the survey indicate that the Portuguese sexologist is on average 43 years old, mainly female, non-physician, and has training in sexology. Considering the qualifications of the interviewees, their professional trajectories and the activities they develop in the field, and the discourses related to their ideals of the profession, a typology was found with five types: sexologists by vocation, sexologist by clinical practice, sexologists by certification, social scientist-sexologists and sexologists by media coverage. The survey identified an interesting diversity of practices and professional conceptions in the field of sexology in Portugal. Being a sexologist appears to be more associated with the ideals of the profession than the time devoted to same.

Emergencia e institucionalización de la sexología en Portugal: procesos, actores y especificidades

Based on Bourdieus field theory, this article analyzes the emergence and institutionalization of sexology as a science and profession in Portugal, identifying relevant institutions, actors, and professional practices and discussing its relations and specificities. The analysis begins by contextualizing the emergence of modern Western sexology in order to comprehend the Portuguese case in the international sexology context. The second section describes the social, cultural, and institutional factors that have driven the professionalization of sexology. The third section describes the emergence of Portuguese sexology and its principal historical milestones, institutions, and actors. Finally, the article discusses some implications of this process for the role of sexology as a science and profession. The study reveals the dynamics of national and international processes in the field, in the transition from a holistic perspective of sexology to the hegemony of sexual medicine, and sheds light on its mechanisms of legitimation as a transdisciplinary science of sexuality, suggesting future perspectives.