Journal of Sexual Medicine最新文献

{"title":"Relationship between sexual dysfunction and burnout among physicians in primary hospital: a cross-sectional study.","authors":"Xing Tan, Yu Tian, Ting-Ting Zhu, Peng-Peng Ge, Quan-Jie Wang, Rong Chen, Rong-Hui Xu, Xiao-Juan Meng, Tong-Tong Zhang","doi":"10.1093/jsxmed/qdae147","DOIUrl":"10.1093/jsxmed/qdae147","url":null,"abstract":"<p><strong>Background: </strong>The relationship between sexual dysfunction and burnout among physicians remains unclear.</p><p><strong>Aim: </strong>To investigate the frequency of sexual dysfunction among physicians in primary hospital and explore the association between sexual dysfunction and burnout.</p><p><strong>Methods: </strong>This study was a cross-sectional survey conducted through a questionnaire. We used the Arizona Sexual Experience Scale and the Chinese version of the Maslach Burnout Inventory-Human Service Survey to assess sexual function and burnout among physicians in primary hospital. Considering the working environment of physicians, we also evaluated the doctor-patient relationship and sleep quality.</p><p><strong>Outcomes: </strong>Over one-third of physicians experience sexual dysfunction. Burnout is a significant factor to sexual dysfunction among medical professionals.</p><p><strong>Results: </strong>A total of 382 doctors participated in this survey, and the prevalence of sexual dysfunction was 33.51%. Sexual arousal and orgasm were the main sexual dysfunctions faced by male and female doctors, respectively. The prevalence of burnout among physicians was 43.72%. The prevalence of sexual dysfunction among physicians experiencing burnout (45.51%) was higher than that observed in physicians without burnout (24.19%). Physicians with burnout exhibited significantly higher total and individual scores on the Arizona Sexual Experience Scale as compared with physicians without burnout (all P values <.05). There was a significant positive correlation between depersonalization and sexual drive (r = 0.508, P < .001), sexual arousal (r = 0.521, P < .001), lubrication (r = 0.432, P < .001), orgasm/erection (r = 0.420, P < .001), and sexual satisfaction (r = 0.434, P < .001). Logistic regression analysis confirmed that-in addition to burnout-older age, dissatisfaction with income, a poor doctor-patient relationship, and poor sleep were significant contributors to sexual dysfunction among physicians in primary hospitals.</p><p><strong>Clinical implications: </strong>Sexual health is an integral aspect of well-being. Prioritizing the sexual health of medical professionals can significantly contribute to improving their productivity.</p><p><strong>Strengths and limitations: </strong>First, our sample size was small, and the impact of different specialties on sexual functioning was somewhat overlooked. Second, we lacked laboratory data (eg, testosterone and prolactin levels) that could provide substantial support to sexual identification. Finally, although we used logistic regression to establish causality, the relationship between sexual dysfunction and certain factors may be bidirectional.</p><p><strong>Conclusions: </strong>The issue of sexual dysfunction among doctors needs more attention. We should make targeted efforts to improve the quality of physicians' sexual lives.</p>","PeriodicalId":51100,"journal":{"name":"Journal of Sexual Medicine","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142592122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Penile inversion vulvo-vaginoplasty with scrotal graft for trans women: surgical technique and results of initial experience.","authors":"Paul Sabbagh, Claire Richard, Alice Bourillon, Jean-Nicolas Cornu, Thierry Lebret, Nicolas Morel-Journel, Benoît Peyronnet, Aurélie Schirmann, Lucas Freton, François-Xavier Madec","doi":"10.1093/jsxmed/qdae135","DOIUrl":"10.1093/jsxmed/qdae135","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;A significant proportion of trans women is demanding for a genital gender-affirming surgery, with vulvo-vaginoplasty being the most frequently requested procedure. The gold standard for primary vaginoplasty in trans women is the penile skin inversion technique with scrotal skin graft, which allows for increased depth of the vaginal cavity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims: &lt;/strong&gt;The assessment of vulvo-vaginoplasty outcomes utilizing penile skin inversion and scrotal skin graft in individuals assigned male at birth in the surgeon's learning curve involves evaluating aesthetics, functionality, and sexual aspects.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A total of 76 individuals assigned male at birth were included in 2 French university hospitals from 2020 to 2022. They underwent vulvo-vaginoplasty following 8 key steps: scrotal skin excision; bilateral orchiectomy; dissection between the rectum, bladder, and prostate; penile dissection; clitoroplasty; urethroplasty; penile skin inversion with scrotal skin graft; labioplasty. The average follow-up period was 12.4 months, with participants averaging 35.7 years of age. Each patient was invited to complete a questionnaire during follow-up.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes: &lt;/strong&gt;The study's outcomes encompassed the assessment of both early and late surgical complications, postoperative sexuality, aesthetic results, and voiding satisfaction.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of the total patients, 15.8% experienced major early postoperative complications, while 3% encountered major late postoperative complications. No complication was classified 4 or 5 in Clavien-Dindo scale. Most early complications were related to issues in vulvar healing, which did not compromise long-term aesthetic results. Patients-reported satisfaction was 82% after the procedure.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Clinical implications: &lt;/strong&gt;Vulvo-vaginoplasty utilizing penile skin inversion and scrotal skin graft for individuals assigned male at birth is a reproductive surgery procedure that can be successfully performed by experienced urologist. It achieves high patient-reported satisfaction even during the learning curve.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Strengths and limitations: &lt;/strong&gt;The surgical procedures were consistent, and the sizable cohort of patients accurately reflects the learning curve of both surgeons. However, extrapolating long-term complications is challenging due to the relatively brief follow-up period. Additionally, there is a lack of self-reported sexual function data, and the scales used to assess patient-reported quality of life and urinary satisfaction are not specifically validated for transgender patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Vulvo-vaginoplasty utilizing penile skin inversion and scrotal skin graft for individuals assigned male at birth is a complex surgical procedure. It appears to be achievable by experienced urologists during their learning curve, resulting in similar functional and surgical outcomes, along w","PeriodicalId":51100,"journal":{"name":"Journal of Sexual Medicine","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142592120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Timing of puberty suppression in transgender adolescents and sexual functioning after vaginoplasty.","authors":"Isabelle S van der Meulen, Sara L Bungener, Anna I R van der Miesen, Sabine E Hannema, Baudewijntje P C Kreukels, Thomas D Steensma, Mark-Bram Bouman, Annelou L C de Vries","doi":"10.1093/jsxmed/qdae152","DOIUrl":"https://doi.org/10.1093/jsxmed/qdae152","url":null,"abstract":"<p><strong>Background: </strong>Sexual function in transgender adolescents after puberty suppression has been a topic of recent clinical and scientific questions.</p><p><strong>Aim: </strong>This study aimed to explore the long-term effects of early treatment with puberty suppression on sexual functioning of transfeminine individuals after vaginoplasty.</p><p><strong>Methods: </strong>This retrospective cohort study included 37 transfeminine individuals treated with a gonadotropin-releasing hormone agonist (puberty suppression), estrogen, and vaginoplasty (penile inversion technique or intestinal vaginoplasty) at the Center of Expertise on Gender Dysphoria in Amsterdam, the Netherlands, between 2000 and 2016.</p><p><strong>Outcomes: </strong>Experiences regarding sexual functioning and difficulties were assessed with a self-developed questionnaire ~1.5 years after genital gender-affirming surgery and compared between early (Tanner stage G2-3) and late (Tanner stage G4-5) treatment with puberty suppression.</p><p><strong>Results: </strong>Following surgery, 91% of transfeminine individuals was able to experience sexual desire, 86% experienced arousal, and 78% could attain an orgasm. Seventy-five percent of transfeminine individuals who had not experienced an orgasm pre-surgery were able to experience one post-surgery. Of all participants, 62% reported having tried penile-vaginal intercourse post-surgery. The majority reported the presence of one or multiple sexual challenges. There were no significant differences in postoperative sexual function or sexual difficulties between groups treated with early versus late puberty suppression.</p><p><strong>Clinical implications: </strong>With these findings, more adequate and tailored information on the expected effects of early endocrine gender-affirming treatment (including puberty suppression) can be given by healthcare professionals.</p><p><strong>Strengths and limitations: </strong>This is the first study that has assessed sexual functioning of transgender individuals treated with puberty suppression, and has differentiated between the pubertal stage at treatment initiation. Limitations were the small cohort size and retrospective study design. This study focuses on sexual functioning, however, it is important to realize sexual wellbeing is multifactorial and encompasses more than genital functioning or the ability to have certain sexual experiences.</p><p><strong>Conclusion: </strong>This study found that post-vaginoplasty transfeminine individuals after both early and late suppression of puberty have the ability to experience sexual desire and arousal, and to achieve orgasms. Outcomes are comparable to previous findings in those who started treatment in adulthood.</p>","PeriodicalId":51100,"journal":{"name":"Journal of Sexual Medicine","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142592123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of radiofrequency ablation of the vaginal canal for genitourinary syndrome of menopause.","authors":"Rodger Rothenberger, Elaine Kopinga, Jeffrey Dell, Robert D Moore, John R Miklos, Mickey Karram","doi":"10.1093/jsxmed/qdae133","DOIUrl":"https://doi.org/10.1093/jsxmed/qdae133","url":null,"abstract":"<p><strong>Background: </strong>Genitourinary syndrome of menopause (GSM) is a prevalent condition with a constellation of symptoms including burning, dryness, dyspareunia, and irritative lower urinary tract symptoms that result from vulvovaginal atrophic changes. Though hormonal therapy is a mainstay of treatment in GSM, some patients may pursue nonhormonal therapies.</p><p><strong>Aim: </strong>To determine the efficacy of radiofrequency ablation of the vaginal canal with the MorpheusV applicator in reducing the symptoms of GSM.</p><p><strong>Methods: </strong>We conducted a multicenter prospective case series of women with GSM as confirmed by Vaginal Health Index Score (VHIS). Subjects received 3 treatments of radiofrequency ablation ~4 weeks apart with follow-up to 6-month posttreatment.</p><p><strong>Outcomes: </strong>The primary endpoint was VHIS at 6-month posttreatment. Secondary endpoints were VHIS at 3 months, Visual analog scale (VAS) pain with each treatment, 3- and 6-month measurements of urogenital distress inventory-6 (UDI-6), and female sexual function index (FSFI) questionnaires.</p><p><strong>Results: </strong>From 2021 to 2023, 71 women were enrolled in the study with 51 followed to the 6-month follow-up time point. Treatments were found to be low in VAS pain score with mean values of 2.13 ± 2.1, 2.55 ± 2.38, and 2.18 ± 2.14 at treatments 1, 2, and 3 respectively. An improvement in VHIS score was seen from baseline to 3 months after the last treatment (15.00 ± 5.37 vs. 19.62 ± 4.44) and sustained at 6 months (20.23 ± 4.12) (P < .001). Significant improvements in both UDI-6 and FSFI were also noted. Between baseline and 6 months after treatment (FSFI: 18.81 ± 9.57 vs. 22.81 ± 10.34, P < 0.001; UDI-6: 39.58 ± 15.98 vs. 22.42 ± 14.03, P < 0.001). No adverse events were encountered by any subject during this study.</p><p><strong>Clinical implications: </strong>A therapy that is safe and effective in the treatment of both GSM and lower urinary tract symptoms without the use of hormonal methods is clinically impactful for the many patients who cannot receive or do not desire to receive these medications.</p><p><strong>Strengths and limitations: </strong>Strengths of this study include the utilization of 3 treatment sessions, with follow-up of subjects to 6-month posttreatment with a comprehensive assessment of patient symptoms. Limitations include the unblinded nature of the study and the lack of a comparator group.</p><p><strong>Conclusion: </strong>The data from this study suggests that radiofrequency ablation of the vaginal canal by the MorpheusV applicator is a safe and effective intervention for GSM. It also shows subjective improvements in stress urinary incontinence, urge urinary incontinence, and sexual function.</p>","PeriodicalId":51100,"journal":{"name":"Journal of Sexual Medicine","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142577225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modified calculation of the IIEF6-a more accurate assessment of erectile function in middle-aged men.","authors":"Florian P Kirchhoff, Rebekka D Hübner, Martina Kron, Stefan Schiele, Helga Schulwitz, Cornelia Peter, Valentin H Meissner, Matthias Jahnen, Jürgen E Gschwend, Kathleen Herkommer","doi":"10.1093/jsxmed/qdae136","DOIUrl":"https://doi.org/10.1093/jsxmed/qdae136","url":null,"abstract":"<p><strong>Background: </strong>The Erectile Function Domain of the International Index of Erectile Function (IIEF6) is inaccurate in assessing erectile function in men who are not practicing sexual intercourse. Improvement through a modification was recently tested on patients after radical prostatectomy. This study examines the application of this modification in a population-based cohort of middle-aged men.</p><p><strong>Aim: </strong>To assess the feasibility of a modified IIEF6 in a population-based random sample of 50-year old men in Germany.</p><p><strong>Methods: </strong>4924 men were included. IIEF6, Erection Hardness Score (EHS), and causes for the absence of sexual intercourse within the previous 4 weeks were assessed. Modified calculation (double weighting of non-intercourse IIEF6 questions) was applied in case of absence due to external circumstances.</p><p><strong>Outcomes: </strong>Impact of the modification on erectile dysfunction (ED) prevalence and agreement between IIEF6 and EHS in ED classification.</p><p><strong>Results: </strong>As a result of the modified calculation, ED prevalence in the overall study sample decreased by 6.2% to a rate of 27.2%. Agreement between IIEF6 and EHS was increased from 2.7% to 73.4% in men with no sexual intercourse due to external circumstances.</p><p><strong>Clinical implications: </strong>An additional inquiry into the reason for the absence of sexual intercourse and modified calculation enhances the accuracy of IIEF6 in evaluating erectile function of the individual man.</p><p><strong>Strengths and limitations: </strong>This study comprises a large population-based sample. As the study population was exclusively 50-year-old men, results may not be representative of the population average.</p><p><strong>Conclusion: </strong>A more accurate evaluation of an individual man's erectile function may be achieved by using a modified version of the IIEF6.</p>","PeriodicalId":51100,"journal":{"name":"Journal of Sexual Medicine","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142577221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to Editor on \"Unresolved questions in the recovery of spontaneous erectile function in young men treated with daily tadalafil\".","authors":"Wei-Zhen Tang, Jia-Zheng Li, Tai-Hang Liu","doi":"10.1093/jsxmed/qdae141","DOIUrl":"https://doi.org/10.1093/jsxmed/qdae141","url":null,"abstract":"","PeriodicalId":51100,"journal":{"name":"Journal of Sexual Medicine","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of duty sex frequency in women.","authors":"Kate B Metcalfe, Chelsea D Kilimnik, Cindy M Meston","doi":"10.1093/jsxmed/qdae137","DOIUrl":"https://doi.org/10.1093/jsxmed/qdae137","url":null,"abstract":"<p><strong>Background: </strong>Duty Sex-the act of engaging in sex out of a sense of duty or obligation to a partner-is a commonly reported reason why women have sex, with studies indicating associations between Duty Sex and sexual dysfunction, as well as nonconsensual sexual experiences (NSEs).</p><p><strong>Aim: </strong>This study sought to examine the associations between Duty Sex frequency, sexual function, and NSEs using comprehensive, validated measures of sexual function and NSE histories in a large community sample of women.</p><p><strong>Methods: </strong>Six hundred and fifty-eight women with (n = 293) and without (n = 365) NSE histories completed measures of sexual function and sexual motivations.</p><p><strong>Results: </strong>Women with NSE histories reported more sexual pain, lower sexual satisfaction, and more frequent Duty Sex. The relation between NSE history and Duty Sex remained after controlling for the variance in sexual function. The type of NSE behavior, but not the timing of the first NSE nor the perceived impact of the experience, predicted Duty Sex frequency.</p><p><strong>Clinical implications: </strong>Clinicians should consider sexual motivations, particularly Duty Sex, when treating women with NSE histories or who experience sexual dysfunction.</p><p><strong>Strengths and limitations: </strong>To our knowledge, this was the first study to examine how NSEs relate to all domains of sexual function and sexual motives, revealing a link between NSEs, sexual function, and Duty Sex. However, we were unable to account for what percentage of sexual encounters are considered Duty Sex. Therefore, our measurement of Duty Sex lacks specificity, which may explain the relatively low variance accounted for by the models in our analyses.</p><p><strong>Conclusions: </strong>There are consequences of NSEs, including difficulties with communicating sexual boundaries and impairment of sexual function, that may contribute to the increased likelihood of engaging in Duty Sex.</p>","PeriodicalId":51100,"journal":{"name":"Journal of Sexual Medicine","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of testosterone replacement therapy with atrial fibrillation and acute kidney injury.","authors":"Daniel R Greenberg, Taylor P Kohn, Kian Asanad, Robert E Brannigan, Joshua A Halpern","doi":"10.1093/jsxmed/qdae138","DOIUrl":"https://doi.org/10.1093/jsxmed/qdae138","url":null,"abstract":"<p><strong>Background: </strong>Secondary analyses of the Testosterone Replacement Therapy for Assessment of Long-Term Vascular Events and Efficacy Response in Hypogonadal Men (TRAVERSE) trial revealed significantly higher rates of new-onset atrial fibrillation (AF) and acute kidney injury (AKI) in the testosterone replacement therapy (TRT) cohort.</p><p><strong>Aim: </strong>To validate the secondary findings of the TRAVERSE trial.</p><p><strong>Methods: </strong>We utilized the TriNetX Research Network to identify a cohort of men ages 45-80 years old who met similar inclusion criteria to the TRAVERSE trial. We compared hypogonadal men (testosterone 100-300 ng/dL) who had a prescription for topical testosterone therapy and men who did not. Propensity score matching was used to match patient populations. Kaplan Meier survival analysis was used to determine the relative risk of new-onset AF and AKI within 3 years.</p><p><strong>Outcomes: </strong>New-onset AF and AKI within 3 years.</p><p><strong>Results: </strong>There were 2134 men included in each cohort after propensity score matching. Men on TRT had significantly lower testosterone (T) at the time of diagnosis compared to men not prescribed TRT (207 ± 66 ng/dL vs 246 ± 140 ng/dL, P < 0.001). Kaplan-Meier survival analysis showed a significantly increased risk of AKI among men on TRT (RR 1.53, 95% CI 1.07-2.18). However, TRT was not associated with a significantly increased risk of new-onset AF (RR 1.48, 95% CI 0.93-2.37).</p><p><strong>Clinical implications: </strong>Hypogonadal men with underlying cardiovascular risk factors or pre-existing cardiovascular disease who receive TRT may be at increased risk of AKI after starting therapy.</p><p><strong>Strengths and limitations: </strong>We evaluated a large global research database and utilized similar inclusion and exclusion to the TRAVERSE trial. However, our results are limited by the retrospective study design and reliance on documented claims data.</p><p><strong>Conclusion: </strong>Similar to the TRAVERSE trial, our study demonstrated an increased risk of AKI among men on TRT, but did not find increased risk of AF. However, further studies are required to validate these results.</p>","PeriodicalId":51100,"journal":{"name":"Journal of Sexual Medicine","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142565179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mistrust and missed opportunities: BDSM practitioner experiences in healthcare.","authors":"Kate L Jansen, Adam L Fried, Christianna Goetz, Saleenjit Kang","doi":"10.1093/jsxmed/qdae125","DOIUrl":"10.1093/jsxmed/qdae125","url":null,"abstract":"<p><strong>Background: </strong>Stigma and discrimination have been shown to be significant barriers to healthcare utilization and provider trust among sexual minority groups including BDSM and kink communities.</p><p><strong>Aim: </strong>This exploratory study sought to better understand medical mistrust and experiences of discrimination in primary care settings and how these factors predict hiding kink-related injuries from healthcare providers.</p><p><strong>Methods: </strong>A total of 301 individuals who self-identified as being a member of the BDSM community and engaged in BDSM-play activities completed an online survey.</p><p><strong>Outcomes: </strong>Participants completed measures including experiences with BDSM-play-related injuries, disclosure of BDSM activity to healthcare providers, measures addressing mistrust in in healthcare providers (such as avoidance of questions about sexual health or STI testing), and experiences with discrimination in healthcare settings because of BDSM group membership (such as perceptions of being insulted or receiving poor care).</p><p><strong>Results: </strong>Nearly, 40% of participants indicated at least one experience with discrimination in the healthcare system because they identified as a member of the kink community. Over 20% of participants indicated there were BDSM-related concerns they would have liked to discuss with their primary care provider but did not. Participants who hid injuries from their primary care provider had higher levels of medical mistrust and more experiences with medical discrimination than those who disclosed their injuries. A stepwise logistic regression determined that medical mistrust served as a significant predictor of hiding injuries from healthcare providers.</p><p><strong>Clinical implications: </strong>Patients who are members of the BDSM community are likely to have had negative healthcare experiences, and these experiences impact their communication with and trust in future medical encounters.</p><p><strong>Strengths and limitations: </strong>Strengths of the study include addressing diverse components of stigma in healthcare including both experiences with discrimination as well as perceptions of the medical field. Furthermore, potential direct consequences of past negative experiences such as hiding injuries from healthcare providers were examined. Given the likely impact of race, gender, and BDSM group membership on experiences with discrimination, a limitation includes the limited representations of BDSM participants from minoritized racial and ethnic groups. Furthermore, in addressing injuries, the survey did not differentiate intended or expected injuries obtained in BDSM play from unintentional or unwanted injuries.</p><p><strong>Conclusion: </strong>Mistrust in the medical system impacts members of the BDSM community's willingness to disclose injuries to their healthcare provider.</p>","PeriodicalId":51100,"journal":{"name":"Journal of Sexual Medicine","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Homework adherence in mindfulness-based cognitive interventions for female sexual dysfunction: a scoping review.","authors":"Fernanda Rafaela Cabral Bonato, Nicolas de Oliveira Cardoso, Lori A Brotto","doi":"10.1093/jsxmed/qdae108","DOIUrl":"10.1093/jsxmed/qdae108","url":null,"abstract":"<p><strong>Background: </strong>Mindfulness-based cognitive therapy (MBCT) includes regular home practice of mindfulness exercises as a key means of cultivating mindfulness. Although there are instruments available for measuring homework adherence following cognitive behavioral therapy (CBT), little is known about measuring homework practice in MBCT studies for sexual dysfunction.</p><p><strong>Aim: </strong>In this review we sought to investigate which items and instruments are the most used for the assessment of homework adherence in studies evaluating MBCT for the treatment of female sexual dysfunction (FSD). We also investigated the types of homework used in these interventions.</p><p><strong>Methods: </strong>Five databases (PubMed, Scopus, PsycINFO, Embase, and Web of Science) were searched and a total of 30 articles were included in this review.</p><p><strong>Outcomes: </strong>Our main findings revealed that there was no gold standard instrument used to assess homework adherence in patients using MBCT interventions for FSD, and that most of the reported studies did not provide information on how they assess homework adherence.</p><p><strong>Results: </strong>Six of the 9 studies for which the articles reported how homework was assessed used only ad hoc measures. Only 3 studies used psychometrically validated instruments. We also found that mindfulness, psychoeducation, and CBT exercises were the most prescribed homework.</p><p><strong>Strengths and limitations: </strong>This review uniquely integrates homework adherence measures with studies on FSD that evaluate mindfulness, finding no gold standard for assessing adherence. However, limitations including both MBCT and CBT interventions, limiting generalization to MBCT alone, the predominance of Western-based studies, and the lack of reporting on instruments used to assess adherence, indicating a gap in the field.</p><p><strong>Conclusion: </strong>Further studies should consider adapting existing instruments that assess homework adherence in studies of CBT for other psychopathologies or seek to develop new psychometrically validated instruments for MBCT interventions that assess homework adherence.</p>","PeriodicalId":51100,"journal":{"name":"Journal of Sexual Medicine","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11534372/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}