Socio-demographic determinants of low sexual desire and hypoactive sexual desire disorder: a population-based study in Iran.

BACKGROUND: Various socio-demographic factors have been introduced as the determinants of Low Sexual Desire (LSD), but whether these variables can also contribute to the Hypoactive Sexual Desire Disorder (HSDD), remains uncertain. In this study, we sought to identify the socio-demographic determinants of LSD and HSDD in Iranian women of reproductive age. METHODS: This was a population-based, cross-sectional study of 1000 married Iranian women of reproductive age (16-49 years) who met the inclusion criteria. The participants were chosen using the systematic random sampling method from all the healthcare centres in the city of Sari, Iran. LSD was defined as a score no higher than 33 on the Sexual Interest and Desire Inventory-Female (SIDI-F). The sexually-related personal distress was considered as a score of at least 11.0 on the Female Sexual Distress Scale-Revised (FSDS-R), and HSDD was determined based on the sum of those scores. Descriptive statistics were used to describe the socio-demographic characteristics and a chi-square test was run for data analysis using grouping variables. Multivariate logistic regression test was also employed to adjust the effect of confounding variables. RESULTS: The mean score of sexual interest/desire among women was 30.6 ± 10.5. After adjusting the effect of confounding variables, logistic regression showed that socio-demographic variables including age at first intercourse, length of marriage and the level of satisfaction with income were significantly associated with both LSD and HSDD (P < 0.01). While advancing age (P < 0.001) and body mass index (P < 0.01) were just predictors of LSD. CONCLUSION: Some socio-demographic factors could predict LSD in women, while they were not associated with HSDD. In other words, some factors associated with LSD do not instigate sexually-related personal distress, which is one of the criteria necessary for the diagnosis of HSDD.

Sexuality and marital adjustment in women with hypertension in Turkey: how culture affects sex.

This study examined the relationship between sexual dysfunction and marital adjustment in women with hypertension and the effect of the cultures on the sexual problems of women. Mixed method was used in this study. The study was conducted as quantitative (in descriptive type) to examine sexual dysfunction and marital adjustment in women with hypertension and as qualitative to examine the effect of culture on the views of individuals on sexual problems. The study included 102 women who met inclusion criteria (who were on medication and had active sexual life for 1 year). Patient information form, Arizona Sexual Experience Scale (Female), and Marital Adjustment Test (MAT) were used to collect the data. The mean age of the subjects was found to be 55.10 ± 9.13, the mean duration of hypertension diagnosis was 8.66 ± 6.43, and the mean time to start was 7.87 ± 6.30. The mean duration of marriage for the women with hypertension was 34.08 ± 12.507. There was a negative correlation between sexual orientation, orgasm and sexual satisfaction from the subscales of ASEX and the overall scale (p < 0.05). Accordingly, as the adaptation in marriage diminished, sexual problems increased in women. As a result of the study, it was determined that HT had a negative effect on sexual functioning problems and marital adjustment, but women accepted this situation because of their culture, "women do not have the right to sexuality" and naturally accept the absence of sexuality after a certain age.

Female Sexual Dysfunction Among Muslim Women: Increasing Awareness to Improve Overall Evaluation and Treatment.

INTRODUCTION: Muslim women are an increasingly underserved population in the United States and worldwide. Diagnosis and treatment of female sexual dysfunction bring unique challenges because of the conservative nature of those practicing the religion. Several cultural and religious codes of conduct affect sexual behavior and the dysfunction that can ensue. AIM: To assess and describe the types of sexual dysfunction that have been found in Muslim women internationally and encourage a better understanding of their issues to enhance health care delivery. METHODS: A comprehensive review of the literature through Ovid and PubMed was performed in search of articles reviewing female sexual dysfunction, Muslim women, and Islam. MAIN OUTCOME MEASURES: A brief explanation and review of the interpretations of sexuality within Islam are discussed. The link is made between conservative sexual relations and interpretations and the types of sexual dysfunction experienced. Female sexual dysfunction is explored in relation to how female chastity is extolled and how cultural procedures continue despite the ethical and health concerns related to them. RESULTS: Most Muslim women experience sexual dysfunction similar to other women, including arousal, desire, and orgasmic disorders related to organic and psychologic factors. Sexual pain disorders might be more prevalent in this population, particularly concerning unconsummated marriage. There are special concerns related to maintaining virginity and preserving the hymen until marriage. Female genital cutting, practiced by some Muslim countries, has potential sexual consequences. CONCLUSION: Understanding Islamic views on sexuality and how they can affect sexual dysfunction in Muslim women is critical in opening lines of communication with patients and approaching female sexual dysfunction impartially. Although some issues that arise might introduce ethical dilemmas for the provider, having the cultural competence to address these issues will facilitate improved health care delivery. Rahman S. Female Sexual Dysfunction Among Muslim Women: Increasing Awareness to Improve Overall Evaluation and Treatment. Sex Med Rev 2018;6:535-547.

Culture and Sexuality: Cognitive-Emotional Determinants of Sexual Dissatisfaction Among Iranian and New Zealand Women.

BACKGROUND: Several studies have demonstrated that culture plays a fundamental role in individuals' beliefs, attitudes, and values toward sexuality, and influences their ability to enjoy sex. It follows that culture may influence sexual satisfaction or dissatisfaction. AIM: To examine and compare cognitive-emotional variables related to women's sexual dissatisfaction in Iran and New Zealand. METHODS: In total, 196 Iranian women and 207 New Zealand women participated in the study, answering questionnaires evaluating dysfunctional sexual beliefs, automatic thoughts, emotional and sexual response during sexual activity, as well as sexual satisfaction. OUTCOMES: Sexual beliefs were measured by the Sexual Dysfunctional Beliefs Questionnaire, thoughts and emotional responses were measured by the Sexual Modes Questionnaire, and sexual satisfaction was measured by the Sexual Satisfaction Index. RESULTS: Findings indicated that in both Iranian and New Zealand women, failure and disengagement thoughts, lack of erotic thoughts, and emotions of fear during sexual activity were significant predictors of sexual dissatisfaction. Besides these common predictors, results also indicated that sexual conservatism and women's sexual passivity beliefs, sexual abuse thoughts, and fear during sexual activity were significant predictors of sexual dissatisfaction in Iranian women. Beliefs of sexual desire and pleasure as a sin; age-related beliefs; and emotions such as sadness, disillusion, and hurt were significant predictors of sexual dissatisfaction in New Zealand women. CLINICAL TRANSLATION: The present findings could facilitate a better understanding of cultural differences in the roles played by dysfunctional sexual beliefs, negative automatic thoughts, and negative emotions during sexual activity, and the value of these beliefs, thoughts, and emotions in predicting sexual dissatisfaction. CONCLUSIONS: The strength of this study is in providing an examination of the role of culturally bound beliefs in predicting sexual dissatisfaction in women from different cultural backgrounds. Limitations include the lack of evaluation of psychological and interpersonal variables that may impact on women's sexual dissatisfaction. These findings suggest that there may be a role of culture in shaping beliefs, attitudes, and values toward sexuality; and provide evidence for the effect of cognitive-emotional variables in predicting women's sexual dissatisfaction. Abdolmanafi A, Nobre P, Winter S, et al. Culture and Sexuality: Cognitive-Emotional Determinants of Sexual Dissatisfaction Among Iranian and New Zealand Women. J Sex Med 2018;15:687-697.

The morbidity of sexual dysfunction of 125 Chinese women following different types of radical hysterectomy for gynaecological malignancies.

PURPOSE: Due to early detection and effective treatment, quality of sexual life of patients with gynaecological malignancies has become an important issue. However, the morbidity of sexual dysfunction and the proportion of different kinds of sexual dysfunction after radical hysterectomy are unclear. The aim of the current study was to assess the morbidity of sexual dysfunction and to conduct multivariate logistic regression analysis of patients' sexual dysfunction. METHODS: Between July 2007 and December 2012, 125 women underwent radical hysterectomy, modified radical hysterectomy, and nerve-sparing radical hysterectomy were administered a self-reported sexual function questionnaire. RESULTS: The preoperative, and 1- and 2-year postoperative sexual dysfunction rates were 50.5% (50/99), 86.9% (93/107), and 92.3% (72/78), respectively. The incidence rates of sexual desire disorders before operation, at postoperative year 1, and at postoperative year 2 were 14.7% (14/95), 42.1% (45/107), and 51.9% (40/77), respectively. The preoperative incidence rates of sexual arousal disorders, orgasmic disorders, and sexual pain disorders were 18.4% (18/98), 51.1% (48/94), and 10.9% (11/101), respectively. At postoperative years 1 and 2, these were 38.8% (31/80), 81.0% (64/79), and 24.4% (20/82), and 49.1% (26/53), 84.6% (44/52), and 30.2% (16/53), respectively. Multivariable regression analysis revealed that age, preserved ovary, preserved posterior vaginal wall length, preoperative stage, radiotherapy, and education background were risk factors associated with sexual dysfunction. CONCLUSION: The patients following radical hysterectomy had a high incidence of sexual dysfunction, which plateaued in postoperative years 1 and 2.

Weight gain, body image and sexual function in young patients treated with contraceptive vaginal ring. A prospective pilot study.

INTRODUCTION: Oral contraceptives could induce mood changes. As far as our knowledge, there are no studies in literature that have examined the role of vaginal contraception in self-perceived body image. AIM: To evaluate the effects of intravaginal contraception on weight gain and perceived body image in relation with the Beck's Depression Inventory questionnaire (BDI) and the McCoy Female Sexuality Questionnaire (MFSQ). METHODS: Twenty-one adult (18-35 years old) eumenorrheic (menstrual cycle of 25-35 days), lean (body mass index - BMI - of 19-25 kg/m2) women who were referred for hormonal contraception were administered the Stunkard Figure Rating Scale (FRS), BDI and MFSQ. Subjects were studied in basal condition and after 6 months of therapy with vaginal contraception (NuvaRing®; Organon-Schering-Plough Italia, Milan, Italy). MAIN OUTCOME MEASURES: BMI, FRS, MFSQ and BDI. RESULTS: After 6 months of therapy with NuvaRing®, both body weight (60.0 ± 8.3; p = 0.050) and BMI (22.1 ± 3.1; p = 0.028) slightly, but statistically, increased. FRS and BDI showed no differences after the vaginal contraception. Hormonal contraception was associated with a significant decrease in the two-factor Italian MFSQ score. CONCLUSIONS: Vaginal ring seems a good alternative to other hormonal contraceptive not significantly altering the female sexuality and not influencing the FRS and BDI.

Ethical and Sociocultural Aspects of Sexual Function and Dysfunction in Both Sexes.

AIMS: This study aimed to highlight the salient sociocultural factors contributing to sexual health and dysfunction and to offer recommendations for culturally sensitive clinical management and research as well for an ethically sound sexual health care, counseling and medical decision-making. BACKGROUND: There are limited data on the impact of sociocultural factors on male and female sexual function as well as on ethical principles to follow when clinical care falls outside of traditional realms of medically indicated interventions. METHODS: This study reviewed the current literature on sociocultural and ethical considerations with regard to male and female sexual dysfunction as well as cultural and cosmetic female and male genital modification procedures. RESULTS: It is recommended that clinicians evaluate their patients and their partners in the context of culture and assess distressing sexual symptoms regardless of whether they are a recognized dysfunction. Both clinicians and researchers should develop culturally sensitive assessment skills and instruments. There are a number of practices with complex ethical issues (eg, female genital cutting, female and male cosmetic genital surgery). Future International Committee of Sexual Medicine meetings should seek to develop guidelines and associated recommendations for a separate, broader chapter on ethics.

The SAD-MEN questionnaire: a new and reliable questionnaire for assessing sexual dysfunction in Asians with diabetes.

AIM: The aim of this study is to construct a new tool for the assessment of sexual dysfunction among men with diabetes that is valid and reliable across different ethnicities, languages and socio-economic backgrounds in South East Asia. METHODS: Focus group interviews were conducted to determine the construct of the questionnaire. Content and face validity were assessed by a panel of experts. A pilot study was conducted to validate the Sexual Dysfunction in Asian Men with Diabetes (SAD-MEN) questionnaire in English and Malay. The International Index of Erectile Function-5 (IIEF-5) was used for comparison. Construct validity was assessed using exploratory factor analysis, reliability was determined using Cronbach's α (> 0.700), and test-retest reliability using Spearman's rank correlation coefficient. RESULTS: The SAD-MEN questionnaire yielded moderate face and content validity, with high reliability as shown by Cronbach's α values of 0.949 for sexual performance and 0.775 for sexual desire for the English version. The Malay language questionnaire had a Cronbach's α value of 0.945 for sexual performance and 0.750 for sexual desire. Test-retest reliability using Spearman's test gave correlation coefficients of r = 0.853, P = 0.000 for the English language questionnaire and r = 0.908, P = 0.000 for the Malay language questionnaire. CONCLUSION: The SAD-MEN questionnaire is a valid and reliable tool by which to assess sexual dysfunction in English- and Malay-speaking Malaysian and South East Asian men with diabetes.

Screening of sexual dysfunction in Saudi women before and after the age of 40 years.

OBJECTIVE: The aim was to assess sexual performance by screening Saudi women before and after the age of 40 years. MATERIALS AND METHODS: A cross-sectional study (March-May 2013), conducted at King Abdulaziz University Hospital (KAUH), with two groups of women under 40 years of age and aged 40 or more years, were randomly selected from OPD. Ethical committee approved the study. After verbal consent, one-paper self-administered questionnaire was distributed, and filled in anonymously and privately. Questionnaire included demographic data, the six-item version of female sexual function index (FSFI) to assess desire, lubricants, orgasm, satisfaction, and pain. If score was 19 or less, it meant that women needed further investigations (full assessment using FSFI- 19). RESULTS: Out of 194, 49.5% (96) were over 40 years of age and 50.5% (98) were under 40 years of age. Answering the six questions regarding sexual dysfunction in- dicated that women > 40 years had sexual dysfunction more than women <40 (statistically significant). A scored of less than 19 was found to be statistically significant in women > 40 years. Post-menopausal women, diabetics, women with urogynecological symptoms and/or psychological disorder required further evaluation. DISCUSSION: Using the six-item version of FSFI and calculating a score less than 19 for screening, women aged more than 40 years, reduction in estrogen, diabetes, urogynecological symptoms, and psychological disorder were all found to be important factors affecting female sexual dysfunction.

Symptoms of depressed mood, disturbed sleep, and sexual problems in midlife women: cross-sectional data from the Study of Women's Health Across the Nation.

BACKGROUND: Women report many nonvasomotor symptoms across the menopausal transition, including sleep disturbances, depressed mood, and sexual problems. The co-occurrence of these three symptoms may represent a specific menopausal symptom triad. We sought to evaluate the interrelatedness of disturbed sleep, depressed mood, and sexual problems in the Study of Women's Health Across the Nation (SWAN) and determine the characteristics of women exhibiting this symptom triad. METHODS: SWAN is a multisite, multiethnic observational cohort study of the menopausal transition in the United States. Sleep disturbance, sexual problems, and depressed mood were determined based on self-report. Women who reported all three symptoms simultaneously were compared to those who did not. Logistic regression models estimated the association of demographic, psychosocial, and clinical characteristics with the symptom triad. RESULTS: Study participants (n=1716) were 49.8 years old on average and primarily in very good or excellent health. Sixteen and a half percent had depressed mood, 36.6% had a sleep problem, and 42.2% had any sexual problem. Five percent of women (n=90) experienced all three symptoms. Women with the symptom triad compared with those without had lower household incomes, less education, were surgically postmenopausal or late perimenopausal, rated their general health as fair or poor, and had more stressful life events and lower social support. CONCLUSIONS: The symptom triad of sleep disturbance, depressed mood, and sexual problems occurred in only 5% of women, and occurred most often among women with lower socioeconomic status, greater psychosocial distress, and who were surgically menopausal or in the late perimenopause.

Prevalence of female sexual dysfunction during pregnancy among Egyptian women.

AIM: The aim of this study was to assess the prevalence of female sexual dysfunction (FSD) during pregnancy in a sample of women from Egypt. MATERIALS AND METHODS: This prospective cohort study was conducted among pregnant women who presented to the Obstetrics Outpatient Clinic - Suez Canal University Hospital for routine antenatal care between February 2012 and February 2013. The 451 women who completed the study attended during their first trimester with a singleton pregnancy and were in a stable relationship with their partners for the last 6 months. Sexual function was assessed using the Female Sexual Function Index (FSFI) questionnaire during the 4 weeks preceding pregnancy and then in each trimester during the antenatal visits. RESULTS: Prevalence of FSD during pregnancy was estimated to be 68.8%. According to the FSFI, scores of all domains and total score were significantly reduced during the whole period of pregnancy (average 22.5 ± 3.7) compared to the pre-conception period (30.5 ± 5.6). However, there was significant increase of all domains and total score during the second trimester (26.6 ± 3.9) in comparison to the first and third trimesters (22.4 ± 4.1 and 18.6 ± 3.8, respectively). Total FSFI score was found to be positively correlated to pre-conception total FSFI score. However, age, parity and duration of marriage were negatively correlated. CONCLUSION: FSD is a prevalent problem during pregnancy among Egyptian women. The magnitude of the problem is highest during the third trimester while the second trimester represents the peak of sexual function during pregnancy.

Psychometric properties of the Iranian version of the female sexual distress scale-revised in women.

INTRODUCTION: Several tools for the assessment of sexuality-related distress are now available. The Female Sexual Distress Scale (FSDS) and its revised version (FSDS-R) are extensively validated and among the most widely used tools to measure sexually related personal distress. AIM: The aim of the study was to determine the psychometric properties of the Iranian version of the FSDS-R in a population sample of Iranian women. METHODS: A total of 2,400 married and potentially sexually active women were recruited and categorized into three groups including (i) a healthy control group; (ii) a group of women with hypoactive sexual desire disorder (HSDD); and (iii) a group of women suffering from other female sexual dysfunction (FSD). Participants were asked to complete a set of questionnaires including the Iranian version of the Female Sexual Function Index (FSFI-IV), the FSDS-R, and the Hospital Anxiety and Depression Scale. MAIN OUTCOME MEASURES: Sexuality-related distress and FSD as assessed by the Iranian version of the FSDS-R and the FSFI-IV are the main outcome measures. RESULTS: Internal consistencies and test-retest reliability of the FSDS-R across the three assessments points for the three groups were >0.70. The FSDS-R correlated significantly with anxiety, depression, and the FSFI total score. Significant differences in the FSDS-R scores were found between healthy women, women with HSDD, and women with other types of FSD. Factor analysis of the FSDS-R yielded a single-factor model with an acceptable fit. CONCLUSIONS: The Persian version of the FSDS-R is a valid and reliable instrument for the assessment of sexuality-related distress in Iranian women and can be used to screen patients with HSDD.

Sexual behavior and symptoms among reproductive age Chinese women in Hong Kong.

INTRODUCTION: As sexual medicine evolves, much advancement has been achieved in understanding male sexuality and treating male sexual dysfunction. Less is known about female sexual pattern, the prevalence of sexual problems, and their correlation with confounding factors. AIM: To enhance our understanding of female sexuality and the risk factors that contributed to sexual problems in reproductive age women. METHOD: A cross-sectional survey was conducted in family planning and prepregnancy checkup clinics from December 2007 to December 2009, with 2,146 sexually active Chinese women aged 21 to 40 years completed the entire questionnaire. MAIN OUTCOME MEASURES: Prevalence of sexual symptoms, coital frequency, and other sexual behavior-related activities were measured. RESULTS: Overall, 59.0% of respondents had at least one sexual problem. In this sample, 31.8% of respondents reported no desire; 31.7% had arousal problems; 40% had anorgasmia, and 33.8% experienced coital pain for at least 3 months within the past 1 year. Chi-square test showed significant correlation among the four types of sexual problems(P < 0.001). Univariate regression model showed that all sexual symptoms were significantly correlated with unidirectional coitus initiation, low coital frequency, and low foreplay enjoyment. Loglinear model revealed that desire, arousal, and orgasmic problems were correlated with low foreplay enjoyment. Arousal problem was correlated with high acceptance toward pornography and history of medical disease. Coital pain was correlated with secondary education and planning to have more children. Both unidirectional coitus initiation and low coital frequency were major contributors to all four sexual symptoms. CONCLUSIONS: Sexual problem is a prevalent health issue among reproductive age women. A number of risk factors are identified, which provide useful direction to the design of counseling and education materials that might help to enhance sexual performance in women.

Sexual disorders in Asians: a review.

Sex is an integral part of the basic needs of an individual. However, Asian populations have had a conservative attitude towards discussing and expressing their sexual concerns to the clinician. Consequently, very limited research on sexuality-related issues has been done on these populations. Many of the biological and socio-cultural factors are different for Asians and Asian migrants to the West, when compared to the native Western population, and this requires dedicated research. The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders 5th Edition) has made the classification of sexual dysfunctions gender-specific and has introduced the concepts of 'gender dysphoria' and 'paraphilic disorders' (distinct from paraphilias); it has removed subtypes based on sexual orientation. These changes will have a definite impact on our understanding of sexual dysfunctions and related disorders in the Asian populations.

Understanding the role of shame and its consequences in female hypersexual behaviours: a pilot study.

BACKGROUND AND AIMS: Hypersexuality and sexual addiction among females is a little understudied phenomenon. Shame is thought to be intrinsic to hypersexual behaviours, especially in women. Therefore, the aim of this study was to understand both hypersexual behaviours and consequences of hypersexual behaviours and their respective contributions to shame in a British sample of females (n = 102). METHODS: Data were collected online via Survey Monkey. RESULTS: Results showed the Sexual Behaviour History (SBH) and the Hypersexual Disorder Questionnaire (HDQ) had significant positive correlation with scores on the Shame Inventory. The results indicated that hypersexual behaviours were able to predict a small percentage of the variability in shame once sexual orientation (heterosexual vs. non-heterosexual) and religious beliefs (belief vs. no belief) were controlled for. Results also showed there was no evidence that religious affiliation and/or religious beliefs had an influence on the levels of hypersexuality and consequences of sexual behaviours as predictors of shame. CONCLUSIONS: While women in the UK are rapidly shifting to a feminist way of thinking with or without technology, hypersexual disorder may often be misdiagnosed and misunderstood because of the lack of understanding and how it is conceptualised. The implications of these findings are discussed.

Correlates of men's sexual interest: a cross-cultural study.

INTRODUCTION: Low sexual desire has been studied more extensively in women than in men. AIM: The study aims to analyze the correlates of distressing lack of sexual interest and the self-assessed reasons for the lack of sexual interest among heterosexual men from three countries. METHODS: A web-based survey was completed by 5,255 men aged 18-75 years from Portugal, Croatia, and Norway. MAIN OUTCOME MEASURES: We used an item that assesses lack of sexual interest from the British NATSAL 2000. Anxiety and depression were measured with the SCL-ANX4 and SCL-DEP6. Relationship intimacy was measured using a five-item version of the Emotional Intimacy Scale. A shortened version of the Sexual Boredom Scale was used to assess proneness to sexual boredom in relation to the duration of relationship, and personal distress was evaluated using an item created for this study. RESULTS: Distressing lack of sexual interest lasting at least 2 months in the previous year was reported by 14.4% of the participants. The most prevalent comorbidity among these men was erectile difficulty (48.7%). Men with low confidence levels in erectile function, not feeling attracted to the partner, and those in long-term relationships were more likely to have experienced lack of sexual interest than were men with high confidence levels and those who felt attracted to their partner and those in shorter-term relationships. Professional stress was the most frequently reported reason for lack of sexual interest. Sexual boredom as a result of a long-term relationship was significantly and negatively correlated with the level of intimacy (r = -0.351, P < 0.001) and sexual satisfaction (r = -0.497, P < 0.001). CONCLUSIONS: Distressing lack of sexual interest in heterosexual men was associated with a number of intrapersonal (self-confidence in erectile function, stress), interpersonal (relationship duration, partner attractiveness), and sociocultural variables.

Sexual dysfunction among Chinese married men aged 30-60 years: a population-based study in Hong Kong.

OBJECTIVE: To estimate the prevalence of, and risk factors associated with, sexual dysfunction among Hong Kong Chinese married men aged 30-60 years. MATERIALS AND METHODS: The present study was a part of the Ninth Knowledge, Attitude, and Practice survey conducted in 2007 by the Family Planning Association of Hong Kong. The data set consisted of 728 face-to-face interviews with Hong Kong Chinese married men aged 30-60 years living in the community. The classification of sexual dysfunction in the "Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition" was used to measure male sexual dysfunction (MSD). RESULTS: Regarding MSD prevalence, approximately 15% of men reported ≥ 1 form of MSD, with a lack of sexual interest, erectile dysfunction, and premature ejaculation present in 11.1%, 4.3%, and 4.7%, respectively. Multivariate analysis showed that age (odds ratio 2.39), employment status (odds ratio 3.62), having a wife who sought medical help for sexual problems (odds ratio 4.47), liberal attitudes toward female sexual initiation (odds ratio 2.07), and marital dissatisfaction (odds ratio 2.35) were all statistically significant risk factors for MSD and its specific components among the sample. However, having traditional attitudes toward female sexual refusal was a protective factor for MSD (odds ratio 0.51) and lack of sexual interest (odds ratio 0.51). CONCLUSION: The prevalence of MSD was low among young and middle-age married men in Hong Kong. Factors contributing to the risk of MSD spanned the domains of socioeconomic status, attitudes toward sex, and relationship factors. These findings suggest future directions for public health policies and the delivery of services that address the prevention and treatment of MSD.

Racial differences in sexual dysfunction among postdeployed Iraq and Afghanistan veterans.

This study examined the racial/ethnic differences in prevalence and risk factors of sexual dysfunction among postdeployed Iraqi/Afghanistan veterans. A total of 3,962 recently deployed veterans were recruited from Houston Veterans Affairs medical center. The authors examined sociodemographic, medical, mental-health, and lifestyle-related variables. Sexual dysfunction was diagnosed by ICD9-CM code and/or medicines prescribed for sexual dysfunction. Analyses included chi-square, analysis of variance, and multivariate logistic regression. Sexual dysfunction was observed 4.7% in Whites, 7.9% in African Americans, and 6.3% in Hispanics. Age, marital status, smoking, and hypertension were risk factors for Whites, whereas age, marital status, posttraumatic stress disorder and hypertension were significant for African Americans. For Hispanics, only age and posttraumatic stress disorder were significant. This study identified that risk factors of sexual dysfunction varied by race/ethnicity. All postdeployed veterans should be screened; and psychosocial support and educational materials should address race/ethnicity-specific risk factors.

Dhat syndrome, an emergent condition within urology in Spain.

BACKGROUND: Dhat syndrome (DS) consists of vague somatic symptoms and at times sexual dysfunction which the patient falsely attributes to involuntary emissions of semen outside of sexual relations. OBJECTIVE: Describe and analyse the occurrences of DS in patients attending the clinic and clarify the existence of this condition within the Spanish Urological service. MATERIALS AND METHODS: Patients reporting semen loss in urine or involuntarily outside of sexual relations were studied during a period from May 2006 to December 2007. Variables of age, nationality, marital status, family situation, medical history, reasons for the consultation, physical condition and additional tests were studied. All treatments and its effectiveness were also recorded. RESULTS: DS affected predominantly southern Asian continent citizens (n = 32). The average age was 35.44. Seventeen patients reported semen loss during urination; 20 at the end of urination; 11 spontaneously; 5 while sleeping; 4 during defecation; 1 while showering; 1 while eating meat; and 3 produced by noticing stained clothing. In 28 cases, the supposed loss of semen was linked to sex-related symptoms. All examinations and tests ruled out the existence of actual loss of semen. CONCLUSIONS: In urology consultations, we have been witnessing the unusual appearance of DS, a condition known by psychologists and psychiatrists and practically unheard of by urologists. A previously unknown condition in Spain, immigration from Asia, is causing the appearance of this syndrome. Its rapid identification will prevent patients from paying costly and unnecessary tests and provide alternative therapies, within a multidisciplinary approach involving psychologists and psychiatrists.