Italian Versions of the 12-Item Sexual Distress Scale (SDS) and the 5-Item Sexual Distress Scale-Short Form (SDS-SF): Psychometric Properties.

The study aimed to analyze the psychometric properties of the Italian versions of the 12-item Sexual Distress Scale (SDS) and the 5-item Sexual Distress Scale-Short Form (SDS-SF). A total sample of 2291 adults (1361 women, 930 men) participated through a web survey completing the SDS, the FSFI, the IIEF, the PANAS and the SCL-90-R. The results supported the adequacy of both the SDS and SDS-SF factor structures, good reliability (respectively, α = .96 and .92), discriminant validities and strong associations with satisfaction, fear, depression, and psychoticism. SDS and SDS-SF may facilitate the assessment of sexual distress for both clinical and research purposes.

COVID-19 Quarantine Dramatically Affected Male Sexual Behavior: Is There a Possibility to Go Back to Normality?

We performed a monocentric longitudinal study on sexually active male patients, from May 2021 to October 2021, with SARS-CoV-2 infection confirmed with a nasopharyngeal reverse transcriptase polymerase chain reaction (RT-PCR). The questionnaires were delivered by email. The study period was divided into the periods before getting tested (T1), during quarantine (T2), 1 month after a negative test (T3), and 3 months after a negative test (T4). All participants were invited to complete these questionnaires: 10- and 6-item questionnaires, a sexual distress schedule (SDS), and the international index of erectile function questionnaire of 15 items (IIEF-15). The primary endpoint was to evaluate the impact of quarantine on male sexual function (SF) during and after the SARS-CoV-2 infection. A total of 22 male patients met the inclusion criteria. The differences for both SDS and IIEF-15 scores, between T1−T2 (27 (IQR 24.0−32.2) vs. 37.5 (IQR 34.2−45.5), 45 (IQR 38.0−50.2) vs. 28.5 (IQR 19.5−38.0)), T2−T3 (37.5 (IQR 34.2−45.5) vs. 28 (IQR 24.0−31.0), and 28.5 (IQR 19.5−38.0) vs. 39.5 (IQR 35.5−44.2)) were statistically significant (p < 0.001), respectively. Moreover, between T1−T4, no statistically significant difference (p > 0.05) was recorded in both SDS (27 (IQR 24.0−32.2) vs. 26.5 (IQR 24−30.2)) and IIEF-15 (45 (IQR 38.0−50.2) vs. 28.5 (IQR 19.5−38.0)). In 20 patients (90.9%), SARS-CoV-2 had a huge impact on relationship and sexual life, but no patient attended a clinic for sexual difficulties. In conclusion quarantine has negatively influenced SF in infected patients; however, 3 months after the rRT-PCR negative test, a promising return to the preinfection SF values is observed.

Endometriosis and Sexual Functioning: How Much Do Cognitive and Psycho-Emotional Factors Matter?

Women with endometriosis often suffer from genito-pelvic pain. The objective of the present study was to analyze the relationship between cognitive and psycho-emotional factors and sexual functioning of women with endometriosis, comparing women with and without endometriosis. A total of 87 women with endometriosis (EG) and 100 women without endometriosis (CG) completed a socio-demographic questionnaire; the short-form of McGill Pain Questionnaire (SF-MPQ); the Female Sexual Functioning Index (FSFI); the Sexual Distress Scale (SDS); the Symptoms Checklist (SCL-90-R); the Toronto Alexithymia Scale (TAS-20); the Positive and Negative Affects Scale (PANAS); the Sexual Dysfunctional Belief Questionnaire (SDBQ); the Sexual Modes Questionnaire (SMQ); and the Questionnaire of Cognitive Schema Activation in Sexual Context (QCSASC). EG obtained worse scores than CG in SF-MPQ, Pain subscale of FSFI, and SDS. EG reached higher scores than CG on almost all scales of SCL-90-R and lower scores in the "Identifying Feelings" scale of TAS-20. Furthermore, EG reported more negative emotions toward sexuality than CG (PANAS) higher scores on the "Affection Primacy" scale of SDBQ and the "Helpless" sexual cognitive schema of QCSASC than CG. No significant differences were found in SMQ. Sexual health professionals should address psychological, emotional, and cognitive factors since they seem involved in patients' sexual experiences.

ReOpen demands as public health threat: a sociotechnical framework for understanding the stickiness of misinformation.

In the absence of a national, coordinated, response to COVID-19, state and local representatives had to create and enforce individualized plans to protect their constituents. Alongside the challenge of trying to curb the virus, public health officials also had to contend with the spread of false information. This problematic content often contradicted safeguards, like masks, while promoting unverified and potentially lethal treatments. One of the most active groups denying the threat of COVID is The Reopen the States Movement. By combining qualitative content analysis with ethnographic observations of public ReOpen groups on Facebook, this paper provides a better understanding of the central narratives circulating among ReOpen members and the information they relied on to support their arguments. Grounded in notions of individualism and self-inquiry, members sought to reinterpret datasets to downplay the threat of COVID and suggest public safety workarounds. When the platform tried to flag problematic content, lack of institutional trust had members doubting the validity of the fact-checkers, highlight the tight connection between misinformation and epistemology.

Endometriosis-associated pain: a review of quality of life, sexual health and couple relationship.

INTRODUCTION: Endometriosis is a chronic gynecological disease that affects women's quality of life, sexuality, and relationship. Endometriosis-associated pain plays an essential role in well-being impairment. The present review aimed to analyze literature about endometriosis-associated pain and quality of life, sexual health, and quality of the relationship, assessing the role of the bio-psycho-social factors involved and the women's pain experience. EVIDENCE ACQUISITION: Bibliographic research of relevant articles published from 2015 to 2020 in PubMed, Google Scholar, Web of Science, Scopus, EBSCO, and Cochrane Library. EVIDENCE SYNTHESIS: Endometriosis is associated with impairing all women's quality of life domains, and pain appears to be the most influential variable. The pain mechanism is not simple and implies several biological, psychological, and social factors. Women's sexual health is also impaired, and patients report dyspareunia, sexual dysfunctions, dissatisfaction, and distress. Partners' sexual well-being is compromised as well. Endometriosis negatively influences relationship quality, and the illness burden affects both couple members. CONCLUSIONS: A multidisciplinary team using a couple-centered and a biopsychosocial approach is crucial to provide appropriate treatment for endometriosis-associated pain. A better comprehension of all bio-psycho-social aspects implicated in women's well-being and pain experience needs more research.

CD33 and SIGLECL1 Immunoglobulin Superfamily Involved in Dementia.

Sialic acid-binding immunoglobulin-type lectins, which are predominantly expressed in immune cells, represent a family of immunomodulatory receptors with inhibitory and activating signals, in both healthy and disease states. Genetic factors are important in all forms of dementia, especially in early onset dementia. CD33 was recently recognized as a genetic risk factor for Alzheimer disease (AD). Here, we present a 2-generation family with 4 members, the father and the 3 siblings, characterized by an early form of unusual dementia exhibiting a behavioral variant close to behavioral variant frontotemporal dementia phenotype and severe forms of memory loss suggestive of AD. We analyzed the CD33 gene in this family and identified 10 single nucleotide polymorphisms (SNPs) in a linkage disequilibrium block associated with the disease. We also identified a tag SNP, rs2455069-A>G, in CD33 exon 2 that could be involved with dementia risk. Additionally, we excluded the presence of C9orf72 expansion mutations and other mutations previously associated with sporadic FTD and AD. The tag SNP association was also analyzed in selected sporadic AD patients from the same Southern Italy region. We demonstrate that CD33 and SIGLECL1 have a significantly increased level of expression in these patients.

Genital Pain and Sexual Functioning: Effects on Sexual Experience, Psychological Health, and Quality of Life.

BACKGROUND: Genital pain (GP) is a common symptom in women of reproductive age. The prevalence of GP is difficult to gauge as it has been underreported by both patients and clinicians and neglected in clinical studies despite wide recognition of the adverse effects to women's health. AIM: The purpose of the present study was 3-fold: (i) to explore the self-reported presence and perception of GP and its association with sexual functioning, sexual distress, emotions, psychopathology, and quality of life (QoL); (ii) to explore if, controlling for the pain effect, women with Female Sexual Function Index (FSFI) scores indicating sexual dysfunction also reported worse outcomes regarding sexual distress, emotions, psychological health, and QoL than GP women with higher FSFI scores; and (iii) to evaluate the effects of GP duration, comparing women with GP with shorter (<6 months) duration of symptoms with women with longer (≥6 months) duration of symptom of GP on sexual functioning, distress, emotions, psychopathology and QoL. METHODS: A total of 1,034 women (age ranges between 18 and 40 years) from the Italian general population completed a web survey on sexual health. OUTCOMES: 6 self-report questionnaires exploring different biopsychosocial factors were assessed: the FSFI, the Female Sexual Distress Scale, the Positive and Negative Affect Schedule, the Short Form McGill Pain Questionnaire adapted for GP, the Short Form 36, and the Symptom Check List-90-Revised. RESULTS: Women who reported GP (n = 319) indicated generally lower sexual function than women without GP (n = 648; P = .036). They reported a higher level of sexual distress (P < .001), more negative emotions related to sexual experiences (P = .001), lower scores in all QoL domains (P < .001), and higher levels of psychopathological symptoms (P < .001). Controlling for pain effects, women whose FSFI scores indicated sexual dysfunction (n = 150) reported higher rates of sexual distress than women whose FSFI scores indicated normal sexual function (n = 169; P < .001). The scores also indicated fewer positive (P < .001) and more negative emotions (P < .001) related to sexuality, lower QoL (P < .001) and significantly higher psychological burden (P < .001). Moreover, women experiencing GP for ≥6 months reported significantly lower means on the FSFI total score (P < .05; especially in the desire, satisfaction, and pain domains), distress (P < .001), and emotions (P < .05) than women experiencing GP duration <6 months. No significant differences were found on the QoL and the psychopathological symptoms. CLINICAL IMPLICATIONS: GP is significantly pervasive, but a high percentage of sexual problems and related emotional suffering is overlooked. Raising awareness about this issue is critical, both among clinicians and the general public. STRENGTHS & LIMITATIONS: The present study highlighted important characteristics of GP from a community sample; the results indicate problems related to pain experiences and their repercussions on sexual, psychological, affective health, and QoL. Major limitations are related to the use of self-report measures via a web-based study. CONCLUSION: The results provide evidence of a lack of awareness regarding pain experiences as they relate to sexual functioning in women; clinicians would be advised to more fully investigate sexual functioning and psychosocial variables associated with GP during routine consultation beginning with the first onset of the symptoms. Nimbi FM, Rossi V, Tripodi F, et al. Genital Pain and Sexual Functioning: Effects on Sexual Experience, Psychological Health, and Quality of Life. J Sex Med 2020; 17:771-783.

Male Sexual Desire: An Overview of Biological, Psychological, Sexual, Relational, and Cultural Factors Influencing Desire.

INTRODUCTION: The literature showed the need for a better understanding of the male sexual response, which has historically been considered as simpler and more mechanistic compared with that in women. AIM: To examine the literature on biopsychosocial factors associated with the level of sexual desire in men and discuss some interesting directions for future research. METHODS: A systematic literature review was conducted. MAIN OUTCOME MEASURES: 169 articles published in Google Scholar, Web of Science, Scopus, EBSCO, and Cochrane Library about male sexual desire and related biopsychosocial factors. RESULTS: We found a lack of multidimensional studies on male sexual desire. Most existing research has focused on hypoactive sexual desire disorder in coupled heterosexual men. Biological factors play important roles in the level of sexual desire, but they are insufficient to explain the male sexual response. Psychological, relational, and sexual factors (eg depression, anxiety, emotions, attraction, conflicts, communication, sexual functioning, distress, satisfaction) are involved in the development/maintenance of lack of sexual interest in men. Cultural influence is also relevant, with cognitive factors linked to gender roles and sexual scripts of masculinity identified as important predictors of low sexual desire. CONCLUSION: Male sexual desire is characterized by an interplay among biological, psychological, sexual, relational, and cultural elements. This interplay merits further study to better understand how sexual desire works and how treatments for low sexual interest could be improved. Nimbi FM,Tripodi F, Rossi R, et al. Male Sexual Desire: An Overview of Biological, Psychological, Sexual, Relational, and Cultural Factors Influencing Desire. Sex Med Rev 2020;8:59-91.

Hormonal Contraception and Female Sexuality: Position Statements from the European Society of Sexual Medicine (ESSM).

INTRODUCTION: Hormonal contraception is available worldwide in many different forms. Fear of side effects and health concerns are among the main reasons for not using contraceptives or discontinuing their use. Although the safety and efficacy of contraceptives have been extensively examined, little is known about their impact on female sexual function, and the evidence on the topic is controversial. AIM: To review the available evidence about the effects of hormonal contraceptives on female sexuality in order to provide a position statement and clinical practice recommendations on behalf of the European Society of Sexual Medicine. METHODS: A comprehensive review of the literature was performed. MAIN OUTCOME MEASURE: Several aspects of female sexuality have been investigated, including desire, orgasmic function, lubrication and vulvovaginal symptoms, pelvic floor and urological symptoms, partner preference, and relationship and sexual satisfaction. For each topic, data were analyzed according to the different types of hormonal contraceptives (combined estrogen-progestin methods, progestin-only methods, and oral or non-oral options). RESULTS: Recommendations according to the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence criteria and specific statements on this topic, summarizing the European Society of Sexual Medicine position, were developed. CLINICAL IMPLICATIONS: There is not enough evidence to draw a clear algorithm for the management of hormonal contraception-induced sexual dysfunction, and further studies are warranted before conclusions can be drawn. A careful baseline psychological, sexual, and relational assessment is necessary for the health care provider to evaluate eventual effects of hormonal contraceptives at follow-up. STRENGTHS & LIMITATIONS: All studies have been evaluated by a panel of experts who have provided recommendations for clinical practice. CONCLUSION: The effects of hormonal contraceptives on sexual function have not been well studied and remain controversial. Available evidence indicates that a minority of women experience a change in sexual functioning with regard to general sexual response, desire, lubrication, orgasm, and relationship satisfaction. The pathophysiological mechanisms leading to reported sexual difficulties such as reduced desire and vulvovaginal atrophy remain unclear. Insufficient evidence is available on the correlation between hormonal contraceptives and pelvic floor function and urological symptoms. Both S, Lew-Starowicz M, Luria M, et al. Hormonal Contraception and Female Sexuality: Position Statements from the European Society of Sexual Medicine (ESSM). J Sex Med 2019;16:1681-1695.

A Biopsychosocial Model for the Counseling of Hormonal Contraceptives: A Review of the Psychological, Relational, Sexual, and Cultural Elements Involved in the Choice of Contraceptive Method.

INTRODUCTION: Hormonal contraceptives are among the most popular contraceptives used by women worldwide. Long-term adherence may vary significantly among users because of fear of side effects, unhealthy habits, and lack of knowledge, despite their proven effectiveness. AIM: To analyze the psychological, relational, sexual, and cultural factors associated with choice and use of hormonal contraceptives. We highlight the importance of a biopsychosocial approach to contraceptive counseling. METHODS: A systematic literature review was conducted in September 2018. MAIN OUTCOME MEASURES: 99 articles published in Google Scholar, Web of Science, Scopus, EBSCO, and the Cochrane Library about counseling to hormonal contraception and related biopsychosocial factors were reviewed. RESULTS: In the current work, we have analyzed a broad range of factors involved in the contraceptive choice among psychological, relational, sexual, and cultural spheres under the umbrella of the biopsychosocial model. The literature has highlighted that counseling provided by a specialized health care professional may help women in selecting a contraceptive method that best suits their personal needs and lifestyles, maximizing compliance and well-being. CONCLUSION: The importance of psychological, relational, sexual and cultural aspects involved in the selection of a contraceptive should be acknowledged by health care professionals and addressed during individualized counseling to ensure that the option selected and offered is tailored to the personal preferences, lifestyle, and practices of each woman. Nimbi FM, Rossi R, Tripodi F, et al. A Biopsychosocial Model for the Counseling of Hormonal Contraceptives: A Review of the Psychological, Relational, Sexual, and Cultural Elements Involved in the Choice of Contraceptive Method. Sex Med Rev 2019;7:587-596.

[Smartphone applications : useful for sex education, counselling and therapy ?] / Applications pour smartphones - Peuvent-elles être utiles pour l'éducation sexuelle, le counseling et la thérapie ?

In recent years, the number of smartphone users has exploded worldwide and downloads of applications for these phones have increased significantly. The purpose of this article is to present a review of the literature on the use of smartphone applications to improve sexual health, suggesting how they can be used in sex education, counselling and therapy ; the use of smartphone applications to provide sexual health information, particularly to younger populations, could increase awareness of risky sexual behaviours before first sexual intercourse. This article could help sexologists use smartphone applications to facilitate their work. It is very important that clinicians have specific knowledge of online sexual issues, otherwise they may be vulnerable to stereotypes and judgments.

Ces dernières années, le nombre d'utilisateurs de smartphones a explosé dans le monde entier et les téléchargements d'applications pour ces téléphones ont considérablement augmenté. Le but de cet article est de présenter une revue de la littérature sur l'utilisation des applications des téléphones intelligents pour améliorer la santé sexuelle, suggérant comment elles peuvent être utilisées dans l'éducation sexuelle, le counseling et la thérapie. Cet article pourrait aider les sexologues à utiliser les applications des téléphones intelligents pour faciliter leur travail. Il est très important que les cliniciens aient une connaissance spécifique des questions sexuelles en ligne, sinon ils peuvent être vulnérables aux stéréotypes et aux jugements.

Are Role and Gender Related to Sexual Function and Satisfaction in Men and Women Practicing BDSM?

BACKGROUND: Published studies show good psychological health of people involved in bondage-discipline, dominance-submission, and sadism-masochism (BDSM) activities; nevertheless, there are few studies on characteristics related to gender, role in the BDSM scene, sexual functioning, and satisfaction among BDSM practitioners. AIM: The aim of this study was to explore gender and role differences, prevalence of sexual complaints, related distress, and sexual satisfaction in BDSM participants compared with the general population. METHODS: A group of 266 Italian consensual BDSM participants (141 men and 125 women) were recruited with a snowball sampling technique. An anonymous protocol, including self-reported ad hoc and validated questionnaires, was used. The control group was composed of 100 men and 100 women who were not significantly different from the BDSM group for the sociodemographic data and were randomly extracted from an Italian database on sexual functioning of the general population. MAIN OUTCOME MEASURES: Self-reported demographic factors, including favorite and most frequent BDSM practices, the Sexual Complaint Screener, and the Sexual Satisfaction Scale, were completed by the participants. RESULTS: The mean age of the BDSM group was 41.42 ± 9.61 years old (range 18-74). Data showed a varied outlook of practices, fantasies, rules, and roles. With regard to concerns about BDSM activities (fantasies and behaviors), participants reported a very low self-declared degree of distress. The dominant and switch groups appear to be more satisfied and less concerned about sexuality than the general population and the submissive group. Role in the BDSM scene was the only significant predictor of sexual satisfaction, showing a medium effect size. CLINICAL IMPLICATIONS: Results from this study could be helpful to inform sexual health care professionals and to reduce the stigma related to the BDSM population. STRENGTHS & LIMITATIONS: In general, this study may help to describe better some characteristics related to gender, role, sexual preferences, function, and satisfaction. The main limitation regards the sampling method, which does not allow us to consider the group as representative of BDSM participants in general. CONCLUSION: Data showed a varied outlook of practices, fantasies, rules, and roles in both BDSM men and women. BDSM participants (especially dominant and switch groups) appear to be more satisfied and less concerned about sexuality than the general population. This is an attempt to increase the attention of researchers and health care professionals to this important topic and to improve the care provided to people with specific preferences and behaviors. Botta D, Nimbi FM, Tripodi F, et al. Are Role and Gender Related to Sexual Function and Satisfaction in Men and Women Practicing BDSM? J Sex Med 2019;16:463-473.

Which psychosocial variables affect drive the most? Analysis of sexual desire in a group of Italian men.

Literature lacks wide studies on variables affecting sexual desire in men. Aim of this study was to explore the role of some psychosocial variables such as quality of life, sexual function, distress, sexual satisfaction, psychological symptoms, emotions, alexithymia, couple adjustment, sexism, dysfunctional beliefs, cognitive schemas, and modes. A self-administered survey reached 450 heterosexual Italian men (age 31.36 ± 10.73). Results showed "orgasmic function", "lack of erotic thoughts", "erection concerns thoughts", "hostile sexism", and "positive affect" as the main sexual desire predictors. "Depression", "premature ejaculation severity", "sexual distress", "sexual conservatism", and "helpless" predicted in minor manner sexual desire levels. Analyzed variables could represent key factors in the assessment and therapy of sexual desire problems.

Testing a Conceptual Model for Men's Sexual Desire Referring to Automatic Thoughts, Emotions, Sexual Function, and Sexism.

INTRODUCTION: Literature lacks biopsychosocial models of men's sexuality. Regarding sexual desire, Carvalho and Nobre (J Sex Med 2011;8:754-763.) presented a cognitive-affective model including age, medical factors, dyadic adjustment, psychopathology, restrictive attitudes toward sexual activity, erection concerns, lack of erotic thoughts (LET), sadness, and shame as predictors. In particular, automatic thoughts were highlighted as the main predictors of sexual desire in men. AIM: To test a conceptual model (confronting full and partial mediation) considering the interrelated role of automatic thoughts, emotional factors, sexual function, and sexism in influencing the levels of men's sexual desire. METHODS: Selected variables were the best predictors of men's sexual desire in a previous study on 450 heterosexual Italian men (age 31.36 ± 10.73 years). Path diagrams were built including "orgasmic function," "LET," "erection concerns thoughts" (ECT), "hostile sexism," and "positive affect" as predictors of sexual desire. The 2 versions of the model were designed as a "partial" and a "full mediation" from automatic thoughts toward desire. ECT and LET were selected as main predictors, with direct paths going from ECT to positive affect and sexual desire, and from LET to positive affect, orgasmic function, and sexual desire. Direct paths were also drawn from emotions and orgasm to sexual desire. Moreover, in the partial mediation model, part of ECT and LET effect was mediated by emotions and orgasm, and part directly influenced sexual desire. Hostile sexism and sociodemographic variables were considered as exogenous variables influencing sexual desire. Path analyses were performed through structural equation modeling approach. MAIN OUTCOME MEASURE: Results from 4 standardized questionnaires and sociodemographic information were considered for this study: International Index of Erectile Function, Positive and Negative Affect Schedule, Ambivalent Sexism Inventory, and Sexual Modes Questionnaire. RESULTS: Results showed a satisfactory data fit for both versions, but the partial mediation model was retained (χ2 = 35.312, degree of freedom = 34, P = .406; goodness of fit = .987; normed fit index = .945; comparative fit index = .998; root mean square error of approximation = .009 [95% CI .000-.036]). All the endogenous paths and hostile sexism were found to be significant. CLINICAL IMPLICATIONS: The model selected could suggest the need to operate under an biopsychosocial approach, considering cognitive, emotional, and sexual aspects all together to elicit an effective arise of sexual desire level. STRENGTH & LIMITATIONS: The study can claim a good methodology and the proposal of an interesting model, even if the results should be carefully interpreted due to the use of no representative sample, self-report measures, and the limited number of variables involved. CONCLUSION: Our findings suggest that cognitive, emotional, sexual functioning, and cultural variables interplay affecting men's sexual interest. Nimbi FM, Tripodi F, Rossi R, et al. Testing a Conceptual Model for Men's Sexual Desire Referring to Automatic Thoughts, Emotions, Sexual Function, and Sexism. J Sex Med 2018;15:1518-1526.

Sexual Modes Questionnaire (SMQ): Translation and Psychometric Properties of the Italian Version of the Automatic Thought Scale.

BACKGROUND: The Sexual Modes Questionnaire (SMQ) is a validated and widespread used tool to assess the association among negative automatic thoughts, emotions, and sexual response during sexual activity in men and women. AIM: To test the psychometric characteristics of the Italian version of the SMQ focusing on the Automatic Thoughts subscale (SMQ-AT). METHODS: After linguistic translation, the psychometric properties (internal consistency, construct, and discriminant validity) were evaluated. 1,051 participants (425 men and 626 women, 776 healthy and 275 clinical groups complaining about sexual problems) participated in the present study. OUTCOMES: 2 confirmatory factor analyses were conducted to test the fit of the original factor structures of the SMQ versions. In addition, 2 principal component analyses were performed to highlight 2 new factorial structures that were further validated with confirmatory factor analyses. Cronbach α and composite reliability were used as internal consistency measures and differences between clinical and control groups were run to test the discriminant validity for the male and female versions. The associations with emotions and sexual functioning measures also are reported. RESULTS: Principal component analyses identified 5 factors in the male version: erection concerns thoughts, lack of erotic thoughts, age- and body-related thoughts, negative thoughts toward sex, and worries about partner's evaluation and failure anticipation thoughts. In the female version 6 factors were found: sexual abuse thoughts, lack of erotic thoughts, low self-body image thoughts, failure and disengagement thoughts, sexual passivity and control, and partner's lack of affection. Confirmatory factor analysis supported the adequacy of the factor structure for men and women. Moreover, the SMQ showed a strong association with emotional response and sexual functioning, differentiating between clinical and control groups. CLINICAL TRANSLATION: This measure is useful to evaluate patients and design interventions focused on negative automatic thoughts during sexual activity and to develop multicultural research. STRENGTHS AND LIMITATIONS: This study reports on the translation and validation of the Italian version of a clinically useful and widely used measure (assessing automatic thoughts during sexual activity). Limits regarding sampling technique and use of the Automatic Thoughts subscale are discussed in the article. CONCLUSION: The present findings support the validity and the internal consistency of the Italian version of the SMQ-AT and allow the assessment of negative automatic thoughts during sexual activity for clinical and research purposes. Nimbi FM, Tripodi F, Simonelli C, Nobre P. Sexual Modes Questionnaire (SMQ): Translation and Psychometric Properties of the Italian Version of the Automatic Thought Scale. J Sex Med 2018;15:396-409.

Expanding the Analysis of Psychosocial Factors of Sexual Desire in Men.

BACKGROUND: The literature lacks studies of the male sex drive. Most existing studies have focused on hypoactive sexual desire disorder in coupled heterosexual men, highlighting some of the main related biological, psychological, and social factors. AIM: To evaluate the role of selected psychological and social variables affecting male sexual desire such as quality of life, sexual function, distress, satisfaction, psychological symptoms, emotions, alexithymia, couple adjustment, sexism, cognitive schemas activated in a sexual context, sexual dysfunctional beliefs, and different classes of cognitions triggered during sexual activity about failure anticipation, erection concerns, age- and body-related thoughts, erotic fantasies, and negative attitudes toward sexuality. METHODS: A wide self-administered survey used snowball sampling to reach 298 heterosexual Italian men (age = 32.66 ± 11.52 years) from the general population. OUTCOMES: 13 questionnaires exploring psychological and social elements involved in sexual response were administrated: International Index of Erectile Function, Short Form 36 for Quality of Life, Beck Depression Inventory-II, Symptom Check List-90-Revised, Toronto Alexithymia Scale, Premature Ejaculation Severity Index, Sexual Distress Scale, Sexual Satisfaction Scale, Dyadic Adjustment Scale, Ambivalent Sexism Inventory, Sexual Modes Questionnaire, Sexual Dysfunctional Belief Questionnaire, and Questionnaire of Cognitive Schema Activation in Sexual Context. RESULTS: Results showed lack of erotic thoughts (ß = -0.328), fear (ß = -0.259) and desire to have a baby (ß = -0.259) as the main predictors of the level of sexual desire in this group. Energy-fatigue, depression, premature ejaculation severity, sexual distress, compatibility, subjective sexual response, and sexual conservatism had a weaker effect on sexual desire. Sexual functioning (13.80%), emotional response (12.70%), dysfunctional sexual beliefs (12.10%), and negative automatic thoughts (12.00%) had more variable effects on sexual drive. CLINICAL TRANSLATION: Analyzed variables could represent important factors that should be considered in the assessment of desire concerns and discussed in therapy. STRENGTHS AND LIMITATIONS: The strength of this study is the analysis of novel psychological and social factors on male sexual desire. Recruitment and sample size do not allow generalization of the results, but some crucial points for future research and clinical practice are discussed. CONCLUSION: Our findings showed that male sexual desire could be affected by many psychological and social elements. Other factors remain to be explored, in their direct and interactive effects, aiming to better explain male sexual desire functioning. Nimbi FM, Tripodi F, Rossi R, Simonelli C. Expanding the Analysis of Psychosocial Factors of Sexual Desire in Men. J Sex Med 2018;15:230-244.

Oxford School of Sexual Medicine: how are we doing?

INTRODUCTION: Since 2007, the European Society of Sexual Medicine has held an annual 2-week educational residential program at Oxford. The Oxford School of Sexual Medicine provides knowledge and skills learning opportunities for healthcare professionals. AIM: The aim of the current study was to evaluate the impact of Oxford School courses on the daily practice and medical careers of fellows from different countries. METHODS: All participants in the Oxford School programs were invited to anonymously complete a self-administered questionnaire. MAIN OUTCOME MEASURES: The questionnaire comprised three sections: socio-demographic characteristics of the respondents; four Likert-scale score items inquiring about professional background; and 17 closed and two open questions to evaluate the impact of Oxford School on the respondents' practices. Differences in proportions of categorical variables between respondent subgroups were assessed using Pearson χ(2) test. RESULTS: The mean age of the 54 fellows who participated in the study was 44 years (range 28-63 years), 71% were men and 29% were women. Fifty (92%) were physicians, two (4%) psychologists, and two (4%) were sex therapists. Following participation in the Oxford School course, significantly more participants reported spending 50% or more of their clinical time practicing sexual medicine than prior to the course (59% [32] vs. 27% [15], P < 0.001, Figure 1); and significantly more reported spending 50% or more of their working time in clinical research (54% [29] vs. 33% [18], P < 0.001, Figure 2). Forty-six fellows (85%) reported current participation in teaching activities, compared with only 29 (54%) prior to participating in the Oxford School course. CONCLUSION: Educational activities in sexual medicine, such as the Oxford School, may contribute to the advancement of clinical practice, teaching activities, and clinical research of healthcare providers who are interested in sexual medicine.

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.

Blood ammonia levels in liver cirrhosis: a clue for the presence of portosystemic collateral veins.

BACKGROUND: Portal hypertension leads to the formation of portosystemic collateral veins in liver cirrhosis. The resulting shunting is responsible for the development of portosystemic encephalopathy. Although ammonia plays a certain role in determining portosystemic encephalopathy, the venous ammonia level has not been found to correlate with the presence or severity of this entity. So, it has become partially obsolete. Realizing the need for non-invasive markers mirroring the presence of esophageal varices in order to reduce the number of endoscopy screening, we came back to determine whether there was a correlation between blood ammonia concentrations and the detection of portosystemic collateral veins, also evaluating splenomegaly, hypersplenism (thrombocytopenia) and the severity of liver cirrhosis. METHODS: One hundred and fifty three consecutive patients with hepatic cirrhosis of various etiologies were recruited to participate in endoscopic and ultrasonography screening for the presence of portosystemic collaterals mostly esophageal varices, but also portal hypertensive gastropathy and large spontaneous shunts. RESULTS: Based on Child-Pugh classification, the median level of blood ammonia was 45 mcM/L in 64 patients belonging to class A, 66 mcM/L in 66 patients of class B and 108 mcM/L in 23 patients of class C respectively (p < 0.001).The grade of esophageal varices was concordant with venous ammonia levels (rho 0.43, p < 0.001). The best area under the curve was given by ammonia concentrations, i, e., 0.78, when comparing areas of ammonia levels, platelet count and spleen longitudinal diameter at ultrasonography. Ammonia levels predicted hepatic decompensation and ascites presence (Odds Ratio 1.018, p < 0.001). CONCLUSION: Identifying cirrhotic patients with high blood ammonia concentrations could be clinically useful, as high levels would lead to suspicion of being in presence of collaterals, in clinical practice of esophageal varices, and pinpoint those patients requiring closer follow-up and endoscopic screening.