Adherence to phosphodiesterase type 5 inhibitors in the treatment of erectile dysfunction in long-term users: how do men use the inhibitors?

INTRODUCTION: The high effectiveness of phosphodiesterase type 5 inhibitors (PDE5-i) in the treatment of erectile dysfunction (ED) has been demonstrated. However, previous research shows that PDE5-i treatments have high discontinuation rates. AIM: The main goals of this study were to (i) characterize the way men use PDE5-i and (ii) analyze the adherence to treatment, identifying the factors that influence PDE5-i use. METHODS: A total of 148 men with clinical diagnosis for ED who maintained the treatment with PDE5-i for over 3 years were interviewed. Interviews concerning their ongoing treatment were carried out using a standardized questionnaire with quantitative and qualitative items. MAIN OUTCOME MEASURES: Physiological measures included the intracavernous alprostadil injection test, associated with penile rigidometry and penile Doppler ultrasound. The qualitative measure included two questions: "Do you use the drug in every sexual intercourse?" and "How do you use the inhibitor?" RESULTS: ED causes were classified as venogenic (31%), arteriogenic (23%), psychogenic (18%), iatrogenic (13%), neurogenic (8%), and diabetic (7%). Participation rate was 71.8%. Of the 148 patients studied, 75% claimed not to use PDE5-i in every intercourse. Most used tadalafil (66%), followed by sildenafil (20%), vardenafil (10%), and 4% alternated the type of medicine. Four main categories emerged concerning the factors that determine the intake of PDE5-i in some intercourse situations and not in others: (i) psychological factors; (ii) medication-related factors; (iii) circumstantial factors; and (iv) relational factors. CONCLUSION: The analysis of men's narratives revealed a combination of factors that influence the adherence to PDE5-i. The psychological and medication-related factors were the most prevalent. This study highlighted the importance of taking these factors into account, both at the time of prescription and during the follow-up in order to improve adherence. Carvalheira A, Forjaz V, and Pereira NM. Adherence to phosphodiesterase type 5 inhibitors in the treatment of erectile dysfunction in long-term users: How do men use the inhibitors? Sex Med 2014;2:96-102.

What is sexual satisfaction? Thematic analysis of lay people's definitions.

Sexual satisfaction is an important indicator of sexual health and is strongly associated with relationship satisfaction. However, research exploring lay definitions of sexual satisfaction has been scarce. We present thematic analysis of written responses of 449 women and 311 men to the question "How would you define sexual satisfaction?" The participants were heterosexual individuals with a mean age of 36.05 years (SD = 8.34) involved in a committed exclusive relationship. In this exploratory study, two main themes were identified: personal sexual well-being and dyadic processes. The first theme focuses on the positive aspects of individual sexual experience, such as pleasure, positive feelings, arousal, sexual openness, and orgasm. The second theme emphasizes relational dimensions, such as mutuality, romance, expression of feelings, creativity, acting out desires, and frequency of sexual activity. Our results highlight that mutual pleasure is a crucial component of sexual satisfaction and that sexual satisfaction derives from positive sexual experiences and not from the absence of conflict or dysfunction. The findings support definitions and models of sexual satisfaction that focus on positive sexual outcomes and the use of measures that incorporate items linked to personal and dyadic sexual rewards for both men and women.

Processo de validação da Global Measure of Sexual Satisfaction em três amostras da população portuguesa / Validation process of the Global Measure of Sexual Satisfaction in three samples of the portuguese population

A satisfação sexual é um indicador importante da saúde sexual, contudo, a sua definição não é consensual. A Global Measure of Sexual Satisfaction (GMSEX) é um instrumento que avalia a satisfação sexual global no contexto de uma relação íntima. Pretendeu-se avaliar o comportamento psicométrico deste instrumento em três amostras distintas da população portuguesa, constituídas por participantes comprometidos em relações de coabitação: duas amostras presenciais designadas por "grupo normativo" sem diagnóstico e percepção de problemas sexuais (n = 291), "grupo clínico" com problemas sexuais (n =84), e uma amostra online (n = 760). Confirmou-se a estrutura unifactorial da escala, verificando-se uma adequada fiabilidade e validade do instrumento.(AU)

Sexual satisfaction is an important indicator of sexual health, however, its definition is not consensual. Lawrence and Byers (1995) developed a conceptual model of sexual satisfaction for people in committed relationships and, within this model, the authors developed the Global Measure of Sexual Satisfaction (GMSEX) which assesses global sexual satisfaction in the context of an intimate relationship. In the present study we aimed to adapt and assess the psychometric properties of this scale with three distinct samples from the Portuguese population in cohabitation relationships. One was designated as "normative group" with no diagnosis and perception of sexual problems (n = 291), another called "clinical group", whose participants presented sexual problems (n = 84), and an "online" sample of participants with and without perception of sexual problems (n = 760). The scale proved to have a single factor structure as well as good reliability and validity.(AU)

Processo de validação da Global Measure of Sexual Satisfaction em três amostras da população portuguesa / Validation process of the Global Measure of Sexual Satisfaction in three samples of the portuguese population

A satisfação sexual é um indicador importante da saúde sexual, contudo, a sua definição não é consensual. A Global Measure of Sexual Satisfaction (GMSEX) é um instrumento que avalia a satisfação sexual global no contexto de uma relação íntima. Pretendeu-se avaliar o comportamento psicométrico deste instrumento em três amostras distintas da população portuguesa, constituídas por participantes comprometidos em relações de coabitação: duas amostras presenciais designadas por "grupo normativo" sem diagnóstico e percepção de problemas sexuais (n = 291), "grupo clínico" com problemas sexuais (n =84), e uma amostra online (n = 760). Confirmou-se a estrutura unifactorial da escala, verificando-se uma adequada fiabilidade e validade do instrumento...

Sexual satisfaction is an important indicator of sexual health, however, its definition is not consensual. Lawrence and Byers (1995) developed a conceptual model of sexual satisfaction for people in committed relationships and, within this model, the authors developed the Global Measure of Sexual Satisfaction (GMSEX) which assesses global sexual satisfaction in the context of an intimate relationship. In the present study we aimed to adapt and assess the psychometric properties of this scale with three distinct samples from the Portuguese population in cohabitation relationships. One was designated as "normative group" with no diagnosis and perception of sexual problems (n = 291), another called "clinical group", whose participants presented sexual problems (n = 84), and an "online" sample of participants with and without perception of sexual problems (n = 760). The scale proved to have a single factor structure as well as good reliability and validity...

Predictors of body appearance cognitive distraction during sexual activity in men and women.

INTRODUCTION: Cognitive distraction is a core concept in cognitive models of sexual dysfunction. Body appearance cognitive distraction during sexual activity (BACDSA) has been mainly studied among female college samples. However, the relative contribution of different indicators of body dissatisfaction among men and women from community samples, including the contribution of relationship variables to BACDSA, has yet to be examined. AIM: The aim of this study was to examine the extent to which aspects of body dissatisfaction and relationship variables predict BACDSA. METHODS: A total of 669 cohabitating, heterosexual, Portuguese participants (390 women and 279 men) with no sexual problems completed an anonymous online survey. The survey included a sociodemographic questionnaire and a set of questionnaires assessing body- and relationship-related variables. MAIN OUTCOME MEASURES: We used a single item measure of the participant's satisfaction with the opinion that they perceive their partner has about the participant's body (PPO); the Global Body Dissatisfaction Subscale of the Body Attitudes Test (GBD); a version of the Contour Drawing Rating Scale; the Global Measure of Relationship Satisfaction; and the Inclusion of Other in Self Scale. Focus on specific body parts during sexual activity (FBP) and relationship length were assessed with an open-ended question. RESULTS: Hierarchical multiple regression indicated that GBD and FBP were the only body dissatisfaction variables that significantly predicted BACDSA in both men and women. The relationship variables significantly increased the amount of variance explained in BACDSA for both men and women. However, PPO was the only significant relationship variable that predicted BACDSA and only in women. CONCLUSIONS: Body and relationship variables are significant factors in body appearance cognitive distraction. They require further research and assessment, particularly for clinical intervention.

Dropout in the treatment of erectile dysfunction with PDE5: a study on predictors and a qualitative analysis of reasons for discontinuation.

INTRODUCTION: Phosphodiesterase type 5 inhibitors (PDE5) are currently the first line treatment for erectile dysfunction (ED). However, previous research shows that PDE5 treatments have high discontinuation rates. Understanding the reasons for discontinuing PDE5 will be necessary to optimize the response to treatment. AIM: The main goals were: (i) to analyze discontinuation rate of PDE5; (ii) to identify the discontinuation predictors; and (iii) to study the reasons for discontinuation using a qualitative methodology. MAIN OUTCOME MEASURES: The PDE5 discontinuation rates, predictors, and reasons for discontinuation treatment. METHODS: A total of 327 men with clinical diagnosis for ED who had been treated with PDE5 were successfully interviewed by telephone, after giving their informed consent by snail mail. Telephone interviews, concerning their ongoing treatment, were carried out using a standardized questionnaire form with quantitative and qualitative items. Participation rate was 71.8%. RESULTS: Of the total sample, 160 men (48.9%) had discontinued PDE5 treatment. The discontinuation rate was higher among men with diabetes (73%) and in iatrogenic group (65%), and lower in venogenic etiology (38.7%). We differentiated three groups of men who discontinued treatment (i) during the first 3 months (55.1%); (ii) between 4 and 12 months (26.9%); and (iii) after a period of 12 months (18%). Qualitative analyses revealed diverse reasons for discontinuation: non-effectiveness of PDE5 (36.8%), psychological factors (e.g., anxiety, negative emotions, fears, concerns, dysfunctional beliefs) (17.5%), erection recovery (14.4%), and concerns about the cardiovascular safety of PDE5 (8.7%) were the most common. Older men and men whose partners were involved in the treatment, were less likely to discontinue treatment. CONCLUSION: Half the subjects discontinued medication. Mostly, there was a combination of factors that led to discontinuation: non-effectiveness and psychosocial factors appear to be the main reasons. Addressing those factors will allow following up with appropriate focus on relevant topics in order to improve compliance.

Sexuality during pregnancy.

INTRODUCTION: Sexuality is an important part of health and well-being. Sexual behavior modifies as pregnancy progresses, influenced by biological, psychological, and social factors. AIM: To evaluate changes in sexual perceptions and activities during pregnancy and to determine sexual dysfunctions in that period. MAIN OUTCOME MEASURES: Sexual perceptions (desire from the partner, feelings of attractiveness, and fear of sexual intercourse), sexual activities during pregnancy (sexual intercourse frequency, the most frequent sexual intercourse trimester, sexual activity during the birth week, type(s) of sexual intercourse, changes in sexual satisfaction and desire compared with the pre-pregnancy period, and changes in sexual intercourse frequency during each trimester compared with the pre-pregnancy period), and sexual dysfunctions. METHODS: Puerperal women were asked to anonymously complete a self-administered and structured questionnaire at the day of discharge from hospital. RESULTS: One hundred and eighty-eight women, aged between 17 years and 40 years with a mean age of 28.9 years, were analyzed. The first trimester was considered the most frequent period of sexual intercourse (44.7%), followed by the second trimester (35.6%). Fifty-five percent reported a decrease of sexual activity during the third trimester. Fear of sexual intercourse was referred by 23.4% of the women questioned. Sexual satisfaction was unchanged in 48.4% of the subjects and decreased in 27.7% (P < 0.0001); sexual desire is reported to be unchanged in 38.8% and decreased in 32.5% (P = 0.196) of the population. Vaginal, oral, anal sex, and masturbation were performed by 98.3%, 38.1%, 6.6%, and 20.4% of the women, respectively. CONCLUSIONS: We determined in our study that sexual satisfaction do not change in pregnancy compared with the pre-pregnancy patterns despite a decline of sexual activity during the third trimester. A discussion of expected changes in sexuality should be routinely done by the doctor in order to improve couples' perception of possible sexual modifications induced by pregnancy.