Sociodemographic Profile and Co-morbid Symptoms among Individuals with Semen Loss

Background: Semen loss and associated problems, sometimes known as ‘Dhat syndrome’ or ‘Semen loss anxiety’, are found specially in the cultures of South Asian region including Bangladesh. The aim of this study was to assess the physical, psychological and sexual problems in the patients complaining semen loss. Methods: This cross-sectional study was conducted at the outpatient department of National Institute of Mental Health, Dhaka, Bangladesh. All the male patients (aged 18-60 years) with self-reported complaints of semen loss were included in the study. Within three months, data were collected from 95 respondents through face to face interview with a semistructured questionnaire. Data analysis was performed using Statistical Package for Social Sciences (SPSS) version 24. Results: Mean age of the respondents was 23.7 (±5.1) years. Almost half (47.4%) of the respondents belonged to the age group of 21-30 years. Majority of them was Muslim (94.7%), married (54.7%), completed primary education (42.1%), currently unemployed (46.3%) and resided in urban area (87.4%), Most of the respondents complained of semen loss through urine (57.9%), followed by through night emission (18.9%) and masturbation (16.8%). All respondents complained more than one other symptom. Common physical symptoms were physical weakness (89.8%) and vertigo (50.5%), psychological symptoms were anxiety (49.8%) and depression (38.9%) and sexual symptoms were premature ejaculation (42.1%) and erectile dysfunction (31.6%). Conclusion: There were various other physical, psychological and sexual problems among the patients with the complaints of semen loss. So, other symptoms should be considered and managed when dealing with these patients. Bangladesh J Medicine July 2022; 33(1) : 64-69

The prevalence of premature ejaculation and its relationship with polygamous men: a cross-sectional observational study at a tertiary hospital in Somalia

Background Premature ejaculation (PE) is the most common and prevalent sexual disorder among men. To the best of our knowledge, this is the first study aimed at evaluating the relationship of PE among polygamous men. Method Over a 1-year period, a cross-sectional observational study was carried out among 202 married men who visited the urology polyclinic due to different clinical conditions and contributed by completing a standardized structured questionnaire regarding their sociodemographic data, as well as sexual and past medical history. Results In our study, the prevalence of PE was 37.1%; half of the monogamous men (50%) complained of PE, while 22% of men with two wives, 20% of men with three wives, and 12% of men with four wives complained of PE (p < 0.0001, 95% CI 0.122–1.920). Seventy percent of erectile dysfunction (ED) patients had PE concurrence (p < 0.0001, 95% CI 0.057–5.543). Regarding frequency of sexual intercourse, 48% of patients who complained of PE performed sexual intercourse less than two times/week, while two-thirds of the participants who did not complain of PE had sexual intercourse two to four times/week (p < 0.0001, 95% CI 0.203–0.568). Among the men who reported ED, 42% had one wife, 21.5% had two wives, 40% had three wives, and 12.5% had four wives (p < 0.029, 95% CI 0.417–0.962). Conclusions We report that polygamous men have a lower incidence of premature ejaculation and higher sexual satisfaction than monogamous men. There is a significant association between ED and PE, showing a complex and bidirectional relationship between the two conditions. The new taxonomic entity called loss of control of erection and ejaculation (LCEE) views the two sexual symptoms as deeply interrelated. The study results indicate that a sexual intercourse frequency of two or more times per week significantly lowers the risk of PE.

Association between psychosocial distress, sexual disorders, self-esteem and quality of life with male androgenetic alopecia: a population-based study with men at age 46

ObjectivesTo study the association between androgenetic alopecia (AGA) and its severity with psychosocial well-being in male subjects aged 46 years at the population level.DesignCross-sectional study.SettingThe Northern Finland Birth Cohort 1966 (NFBC1966).ParticipantsData were available for 892 male subjects aged 46 years.InterventionsStudy subjects underwent comprehensive health examinations including a skin evaluation by dermatologists and determination of AGA according to the Norwood classification. They also filled in a questionnaire battery that included previously validated questionnaires: the Hopkins Symptom Checklist-25, the Beck Depression Inventory–II; the Generalised Anxiety Disorder Screener; a 15-dimensional measure of health-related quality of life; a 12-Item General Health Questionnaire. The battery also included questions about self-esteem and sexual health.Main outcome measurementsThe presence of AGA and its severity, psychosocial well-being.ResultsAGA was found in 68.5% of subjects, 27.8% of the cases were severe, 33.2% moderate and 39.0% mild. There was no significant association between the presence of AGA or its severity with depression, anxiety, quality of life, self-esteem or sexual symptoms. Those with severe AGA reported lower sexual activity when compared with those without AGA; however, the difference was not statistically significant.ConclusionsMiddle-aged men with AGA did not differ from men without AGA in terms of psychosocial well-being.

Effect of Nigella sativa on Estradiol Levels and Menopausal Symptoms in Post-Menopausal Females

Introduction: Menopause is the permanent cessation of menses, typically occurs in women of 45-55 years. Menopause is associated with a number of somatic, psychological and sexual symptoms due to decline in estradiol levels resulting in poor quality of life of postmenopausal females. Aims & Objectives: The purpose of the current study was to determine the effect of Nigella sativa on menopausal symptoms and estradiol levels in postmenopausal females. Place and duration of study: Department of Physiology PGMI, Lahore for 8 weeks. Material & Methods: It was an interventional study conducted on 30 postmenopausal females. Nigella sativa was administered in the dose of 1g/day after breakfast for a period of 8 weeks. Menopausal Rating Scale (MRS) was filled and blood sample was taken before and after giving Nigella sativa for estradiol and testosterone levels. Data was analyzed by paired t-test using SPSS-21 and p- value less than 0.05 was considered significant. Results: The result of the study showed that there was statistically significant reduction in the overall score of MRS (p = 0.001) and in all its domains, somatic (p=0.001), psychological (p=0.001) and urogenital (p=0.017). There was also significant improvement in blood estradiol level after 8 weeks of Nigella sativa administration (p= 0.021). Conclusion: Nigella sativa supplementation increases estradiol level and decreases menopausal symptoms severity as indicted by significant reduction in the 3 domains of MRS and may be used by postmenopausal females on regular basis to improve their quality of life.

Diagnostic criteria for enduring sexual dysfunction after treatment with antidepressants, finasteride and isotretinoin

BACKGROUND: A set of enduring conditions have been reported in the literature involving persistent sexual dysfunction after discontinuation of serotonin reuptake inhibiting antidepressants, 5 alpha-reductase inhibitors and isotretinoin. OBJECTIVE: To develop diagnostic criteria for post-SSRI sexual dysfunction (PSSD), persistent genital arousal disorder (PGAD) following serotonin reuptake inhibitors, post-finasteride syndrome (PFS) and post-retinoid sexual dysfunction (PRSD). METHODS: The original draft was designed using data from two published case series (Hogan et al., 2014 and Healy et al., 2018), which represent the largest public collections of data on these enduring conditions. It was further developed with the involvement of a multidisciplinary panel of experts. RESULTS: A set of criteria were agreed upon for each of the above conditions. Features of PSSD, PFS and PRSD commonly include decreased genital and orgasmic sensation, decreased sexual desire and erectile dysfunction. Ancillary non-sexual symptoms vary depending on the specific condition but can include emotional blunting and cognitive impairment. PGAD presents with an almost mirror image of unwanted sensations of genital arousal or irritability in the absence of sexual desire. A new term, post-SSRI asexuality, is introduced to describe a dampening of sexual interest and pleasure resulting from a pre-natal or pre-teen exposure to a serotonin reuptake inhibitor. CONCLUSIONS: These criteria will help in both clinical and research settings. As with all criteria, they will likely need modification in the light of developments.

Clinical symptoms of androgen deficiency in men with migraine or cluster headache: a cross-sectional cohort study

Background To compare symptoms of clinical androgen deficiency between men with migraine, men with cluster headache and non-headache male controls. Methods We performed a cross-sectional study using two validated questionnaires to assess symptoms of androgen deficiency in males with migraine, cluster headache, and non-headache controls. Primary outcome was the mean difference in androgen deficiency scores. Generalized linear models were used adjusting for age, BMI, smoking and lifetime depression. As secondary outcome we assessed the percentage of patients reporting to score below average on four sexual symptoms (beard growth, morning erections, libido and sexual potency) as these items were previously shown to more specifically differentiate androgen deficiency symptoms from (comorbid) anxiety and depression. Results The questionnaires were completed by n = 534/853 (63%) men with migraine, n = 437/694 (63%) men with cluster headache and n = 152/209 (73%) controls. Responders were older compared to non-responders and more likely to suffer from lifetime depression. Patients reported more severe symptoms of clinical androgen deficiency compared with controls, with higher AMS scores (Aging Males Symptoms; mean difference ± SE: migraine 5.44 ± 0.90, p < 0.001; cluster headache 5.62 ± 0.99, p < 0.001) and lower qADAM scores (quantitative Androgen Deficiency in the Aging Male; migraine: − 3.16 ± 0.50, p < 0.001; cluster headache: − 5.25 ± 0.56, p < 0.001). Additionally, both patient groups more often reported to suffer from any of the specific sexual symptoms compared to controls (18.4% migraine, 20.6% cluster headache, 7.2% controls, p = 0.001). Conclusion Men with migraine and cluster headache more often suffer from symptoms consistent with clinical androgen deficiency than males without a primary headache disorder.

Vaginal Dilator Use to Promote Sexual Wellbeing After Radiotherapy in Gynaecological Cancer Survivors: A Prospective Observational Study

Background: Since continuing advances in radiotherapy technology broaden the role of radiotherapy in the treatment of gynaecologic malignancies, the use of vaginal dilators has been introduced in order to mitigate the risk of vaginal stenosis. The main aims of this study were to investigate the vaginal dilator use efficacy in the treatment of radiation-induced vaginal stenosis and the vaginal dilator effect on sexual quality of life. Methods: We studied fifty-three patients with endometrial or cervical cancer. The participants were treated with radical or adjuvant external beam radiotherapy and/or brachytherapy. They were routinely examined at four time points post-radiotherapy when also they were asked to fill in a validated sexual function-vaginal changes questionnaire. A p-value less than 0.05 was considered statistically significant. Results: The vaginal stenosis grading score was decreased and the size of the vaginal dilator comfortably insertable was gradually increased throughout the year of vaginal dilator use while radiation-induced vaginal and sexual symptoms were improved throughout the year of VD use. All patients with initial grade 3 showed vaginal stenosis of grade 2 after 12 months of vaginal dilator use and 65.8% of the patients with grade 2 initial vaginal stenosis demonstrated final vaginal stenosis grade 1 while 77.8% of the participants with initial 1st size of vaginal dilators reached the 3rd vaginal dilator size after 12 months. Starting time of dilator therapy <= 3 months after the end of radiotherapy was associated with a significant decrease in vaginal stenosis. Additionally, there was an overall upward trend regarding patients’ satisfaction with their sexual life. Conclusion: Endometrial and cervical cancer survivors should be encouraged to use vaginal dilators for the treatment of vaginal stenosis and sexual rehabilitation after radiotherapy.

Vaginal Dilator Use to Promote Sexual Wellbeing After Radiotherapy in Gynaecological Cancer Survivors: A Prospective Observational Study

Background: Since continuing advances in radiotherapy technology broaden the role of radiotherapy in the treatment of gynaecologic malignancies, the use of vaginal dilators has been introduced in order to mitigate the risk of vaginal stenosis. The main aims of this study were to investigate the vaginal dilator use efficacy in the treatment of radiation-induced vaginal stenosis and the vaginal dilator effect on sexual quality of life. Methods: We studied fifty-three patients with endometrial or cervical cancer. The participants were treated with radical or adjuvant external beam radiotherapy and/or brachytherapy. They were routinely examined at four time points post-radiotherapy when also they were asked to fill in a validated sexual function-vaginal changes questionnaire. A p-value less than 0.05 was considered statistically significant. Results: The vaginal stenosis grading score was decreased and the size of the vaginal dilator comfortably insertable was gradually increased throughout the year of vaginal dilator use while radiation-induced vaginal and sexual symptoms were improved throughout the year of VD use. All patients with initial grade 3 showed vaginal stenosis of grade 2 after 12 months of vaginal dilator use and 65.8% of the patients with grade 2 initial vaginal stenosis demonstrated final vaginal stenosis grade 1 while 77.8% of the participants with initial 1st size of vaginal dilators reached the 3rd vaginal dilator size after 12 months. Starting time of dilator therapy <= 3 months after the end of radiotherapy was associated with a significant decrease in vaginal stenosis. Additionally, there was an overall upward trend regarding patients’ satisfaction with their sexual life. Conclusion: Endometrial and cervical cancer survivors should be encouraged to use vaginal dilators for the treatment of vaginal stenosis and sexual rehabilitation after radiotherapy.

Evaluation of quality of life and postmenopausal symptoms of postsmenopausal women – a prospective observational study

Background: Menopause is a phase of transformation from the reproductive to the non-reproductive period in a woman’s life. In the aging population it is nature’s defensive event against reproductive morbidity and mortality.“An individual’s insight of their position in conditions such as the value and culture systems in which they survive and in relation to their goals, expectations, standards and concerns” in life is defined as QOL. A negative effect on the common health and quality of life (QOL) as well as the contentment of middle-aged women may occur due to Menopause and associated biologicals. Objective: To evaluate the quality of life and postmenopausal symptoms in postmenopausal women. Methods: In this present study 100 patients were recruited and studied for their demographic details and their postmenopausal qualityof life related aspects. The obtained data was analysed using the SPSS software. Results: The mean menopausal age was found to be 45.6 years. The maximum and minimum menopausal ages were 37 and 60 respectively in this study. On analysis, MSQOL revealed that 89% women suffered sexual symptoms, followed by 78% women who suffered physical symptoms like decrease in physical strength and stamina, aches in back of neck and head, aching muscles and joints. Approximately half of the women experienced vasomotor and psychological symptoms. UQOL revealed lower or poor QOL of the postmenopausal women. The overall average scores for occupational, health, emotional, sexual and total QOL for 100 participants was found to be 11.37, 21.03, 17.84, 3.67 and 53.34 respectively