Perspectives on Sexual Health and Function of Recent Male Combat Veterans of Iraq and Afghanistan.

BACKGROUND: U.S. veterans of recent wars in Iraq and Afghanistan may be at greater risk for sexual dysfunction due to injuries, mental health conditions, medications used to treat those conditions, and psychosocial factors. OBJECTIVE: To explore the perceptions of recent Veterans about sexual health and dysfunction, contributing factors, its impact and solutions. DESIGN: Qualitative study. PARTICIPANTS: Eight men who screened positive for sexual dysfunction at initial presentation to a postdeployment clinic at a Veterans Affairs medical center. APPROACH: Patients who screened positive for sexual dysfunction and indicated an interest in participating were contacted and scheduled for an in-person private interview with a researcher. Interviews were semistructured, utilizing open-ended and follow-up probe questions to elicit the individual's perspective about sexual dysfunction and its cause, impact and solutions. Interviews were recorded, transcribed and analyzed for themes. KEY RESULTS: These heterosexual men discussed a range of sexual dysfunction in their activities including lack of desire, erectile dysfunction, delayed orgasm, premature ejaculation, and distraction. They also discussed the importance of setting or context and changes over time to their sexual health and function. The men shared their ideas about contributory factors, including normal aging, medication side effects, injury and a possible role for combat deployment more generally. Reported solutions for sexual dysfunction included medications, herbal remedies, and new positions and approaches to sexual activity. Participants reported discussing sexual dysfunction with their health-care providers and what was helpful. Finally, the men expressed in their own words the significant impact of sexual dysfunction on their self-perception, their partners, and their relationships. CONCLUSIONS: Sexual dysfunction in recent combat veterans can have important negative effects on their health and relationships. Our findings elucidate perceived contributory factors and preferred solutions, which can be applied by health-care providers to improve the management of sexual dysfunction in these patients.

An Exploration of Returning Veterans' Sexual Health Issues Using a Brief Self-Report Measure.

INTRODUCTION: Sexual health is an integral aspect of quality of life with important implications for satisfaction with intimate relationships, emotional well-being, and life as a whole. Veterans returning from Iraq and Afghanistan frequently encounter a wide range of known risk factors for sexual health concerns. AIM: This article seeks to examine the overall frequency, important covariates associated with sexual difficulties, and the relevant domains of sexual dysfunction among a group of recent US veterans of Iraq and Afghanistan. METHODS: This is a retrospective chart review of 247 veterans of conflicts in Iraq and Afghanistan evaluated for an initial visit at the post-deployment clinic of a large veterans affairs medical center (VAMC). Patient demographic and medical characteristics were calculated using descriptive statistics. The prevalence and burden of sexual health issues in our patient sample were calculated using descriptive statistics from these veterans' responses to a self-report measure of sexual functioning. Item-level regression analyses were then conducted between sexual functioning responses and other patient data. MAIN OUTCOME MEASURES: The main outcome measures used were the responses to the Arizona Sexual Experience Scale (ASEX). RESULTS: Almost 18% of veterans screened positive for sexual functioning difficulties. Self-reported sexual dysfunction was most strongly associated with depression, posttraumatic stress disorder, female sex, and service connection rating. Co-occurring characteristics varied with specific areas of sexual functioning. CONCLUSIONS: Screening using an empirically validated self-report instrument indicates that there is a high prevalence of reported sexual dysfunction among recently deployed veterans. Analyses indicated that there are specific characteristics associated with both overall self-reported sexual dysfunction and specific subtypes of sexual dysfunction. Active assessment of specific aspects of sexual dysfunction concerns may allow providers to identify and implement more precise sexual functioning interventions. Beaulieu GR, Latini DM, Helmer DA, Powers-James C, Houlette C, and Kauth MR. An exploration of returning veterans sexual health issues using a brief self-report measure. Sex Med 2015;3:287-294.

Assessment and documentation of sexual health issues of recent combat veterans seeking VHA care.

INTRODUCTION: Sexual health is an important aspect of human existence associated with disease and overall health. Despite these associations and the existence of medical treatments to improve sexual function, sexual health is often overlooked in health care. Recent combat veterans may be particularly vulnerable to sexual health issues due to their deployment-related health issues such as mental health conditions, prescription medications use, and psychosocial challenges. AIM: This study assesses the sexual health issues of recent combat veterans seeking care at a Veterans Affairs Medical Center (VAMC) documented in the primary care and mental health notes from the first 6 months of care. MAIN OUTCOME MEASURES: Documentation of sexual health issues in the progress notes (coded into categories), primary care vs. mental health care visit note, initial vs. follow-up visit notes, and templated vs. non-templated text. METHODS: This is a retrospective chart review of the first 158 consecutive patients seen for an initial assessment in the VAMC post-deployment clinic. Medical records were reviewed and text of sexual health issues and relevant patient and care characteristics were abstracted and coded into variables. RESULTS: Almost 25% of patients had documented sexual health issues in the first 6 months of care. We coded 52 separate sexual health issues into 13 distinct categories. Overall, most sexual health issues were documented in mental health care notes, in non-templated text, and at follow-up visits. The use of templated text appeared to drive the documentation of low libido (the most common sexual health issue) in mental health care notes. CONCLUSIONS: Sexual health issues are prevalent in recent combat veterans seeking care at a VAMC, but patterns of documentation suggest that they may be under-reported or incompletely addressed. A more systematic and provider-initiated approach to assessment of sexual health may promote fuller discussion of sexual health issues and optimize management.

PET/CT imaging in systemic lupus erythematosus.

Systemic lupus erythematosus (SLE) is the classical immune-complex disease. Involvement of vital organs, particularly the kidneys and brain, accounts for significant morbidity and mortality. A number of imaging tools are currently available for evaluation of inflammatory conditions. By targeting the increased glucose uptake of infiltrating granulocytes and tissue macrophages, positron emission tomography with fluorine-18 fluorodeoxyglucose ([(18) F]FDG PET/CT) has been shown to delineate inflammation with high sensitivity. Because activated lymphocytes have increased glucose metabolism, [(18) F]FDG PET has been successfully used to visualize large concentrations of these cells in lymphoid organs where antigen presentation and lymphocyte activation occur. Widespread increased FDG uptake in lymph nodes of patients with active SLE, as well as increased thymic uptake, has been described. The most prevalent and dramatic PET/CT finding in neuropsychiatric SLE (NP-SLE) patients is parieto-occipital hypometabolism. In conclusion, PET/CT has become an excellent ancillary tool to assess disease activity and prognosis in SLE patients.

Intra-articular knee mass in a 51-year-old woman.

A 51-year-old woman presented with moderate knee pain refractory to conservative measures. Radiographs revealed a well-defined, but irregularly-shaped ovoid soft tissue density at the posterior superior aspect of the infrapatellar fat pad of Hoffa. On magnetic resonance imaging, the mass was mildly heterogeneous and had intermediate signal in the proton density series and mixed signal intensity on the T2-weighted images. A low-signal rim could be seen around a portion of the lesion. Arthroscopic resection was performed and a vascular stalk was encountered. The differential diagnosis included: ganglion cyst, meniscal cyst, intra-articular lipoma, villous proliferation of the synovial membrane, Hoffa disease, and intracapsular chondroma. Histologic examination revealed a fibrous capsule partially surrounding a benign lipomatous neoplasm containing an abundance of thin- and thick-walled blood vessels with periadventitial myxoid stroma. To our knowledge, this is the first reported case of an intra-articular angiomyxolipoma in the literature. At 8-month follow-up, the patient was asymptomatic with no sign of recurrence. We postulate a low recurrence rate based on the insidious growth rate and benign histological appearance of such lesions. To our knowledge, no other intra-articular lipomatous lesion of the knee has been removed solely with arthroscopic techniques. Further follow-up information is needed to better understand the natural course of these lesions.

Conditional switches for extracellular matrix patterning in Drosophila melanogaster.

An F(1) mutagenesis strategy was developed to identify conditional mutations affecting extracellular matrix (ECM) patterning. Tubulogenesis requires coordinated movement of epithelial cells and deposition of a multilayered ECM. In the Drosophila ovary, an epithelium of follicle cells creates the eggshells, including the paired tubular dorsal appendages (DAs) that act as breathing tubes for the embryo. A P-element mutagenesis strategy allowed for conditional overexpression of hundreds of genes in follicle cells. Conditional phenotypes were scored at the level of individual mutant (F(1)) female flies. ECM pattern regulators were readily identified including MAPK signaling gene ets domain lacking (fused DAs), Wnt pathway genes frizzled 3 and osa (long DAs), Hh pathway gene debra (branched DAs), and transcription factor genes sima/HIF-1alpha, ush, lilli, Tfb1, broad, and foxo. In moving cells the [Ca(2+)]/calcineurin pathway can regulate adhesion to ECM while adherens junctions link cells together. Accordingly, thin eggshell and DA phenotypes were identified for the calcineurin regulator calreticulin and the adherens junction component arc. Finally a tubulogenesis defect phenotype was identified for the gene pterodactyl, homologous to the mammalian serine/threonine receptor-associated protein (STRAP) that integrates the TGF-beta and PI3K/AKT signaling pathways. Because phenotypes can be scored in each mutant fly before and after gene induction, this F(1) conditional mutagenesis strategy should allow for increased scale in screens for mutations affecting repeated (reiterated) events in adult animals, including gametogenesis, movement, behavior, and learning.