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Novel Research in Sexuality and Mental Health
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Novel Research in Sexuality and Mental Health

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Mental Health".

Deadline for manuscript submissions: closed (31 May 2019) | Viewed by 298000

Printed Edition Available!
A printed edition of this Special Issue is available here.

Special Issue Editor

Prof. Dr. Angel L. Montejo

E-Mail Website
Guest Editor
1. Psychiatry Service, Clinical Hospital of the University of Salamanca, 37007 Salamanca, Spain
2. Institute of Biomedical Research of Salamanca (IBSAL), Paseo San Vicente SN, 37007 Salamanca, Spain
3. Nursing School, University of Salamanca, Av. Donates de Sangre SN, 37007 Salamanca, Spain
Interests: sexuality and mental health; psychotropic-related sexual dysfunction; sexual medicine
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Sexuality is considered as a great human value related to happiness and satisfaction, but unfortunately, when affecting mental disorders, they tend to be associated with second level human functions. Nevertheless, sexual dysfunction often accompanies psychiatric disorder, intensely influencing compliance, quality of life and human relationships. Sexuality could be influenced either by a mental disorder itself, difficulties to get and maintain couple relationships or by the use of psychotropic treatments. Treatment-related adverse events are unfortunately under-recognized by clinicians, scarcely spontaneously communicated by patients, and rarely investigated in clinical trials. The most frequent psychotropic compounds that could deteriorate sexuality and quality of life include antidepressants, antipsychotics and mood regulators. There are important differences between them related to some variations in mechanisms of action including serotonin, dopamine and prolactin levels. Little is known about the relevance of sexuality and its dysfunctions in chronic and frequent mental and neurological disorders, such as psychosis, mood disorders, anxiety, phobias, eating disorders, alcohol or drug dependencies, epilepsy and childhood pathology. Poor sexual life, low satisfaction and more frequent risky sex behavior than in the general population are associated with severe mental diseases. There is a need for increasing research in this field, including epidemiological, psychological, neurophysiological, neuroanatomical and genetic variables related to sexual life to get a better understanding of the implicated mechanisms. To increase the sensibility of clinicians, the identification and management of sexual disturbances after the onset of any mental disorder should be highlighted. This would avoid unnecessary suffering and deterioration of quality of life.

Prof. Angel L. Montejo
Guest Editor

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Keywords

  • sexuality
  • mental health
  • mental disorder
  • sexual dysfunction
  • psychotropic (antidepressant, antipsychotic, antiepileptic)
  • mechanism of action
  • clinical management

Published Papers (19 papers)

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Editorial

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3 pages, 176 KiB  
Editorial
Sexuality and Mental Health: The Need for Mutual Development and Research
by Angel L. Montejo
J. Clin. Med. 2019, 8(11), 1794; https://doi.org/10.3390/jcm8111794 - 26 Oct 2019
Cited by 11 | Viewed by 4996
Abstract
Research in the field of sexuality has shown growing scientific development in recent years, although there’s a lack of well-trained professionals who could contribute to increasing its benefits. Sexuality continues to be a taboo with different interpretations and difficult delimitation of either normal [...] Read more.
Research in the field of sexuality has shown growing scientific development in recent years, although there’s a lack of well-trained professionals who could contribute to increasing its benefits. Sexuality continues to be a taboo with different interpretations and difficult delimitation of either normal or pathological behavior. More resources are needed for the understanding of new emerging pathologies, and to increase the research in new models of sexual behavior. All psychiatric diseases include symptoms affecting sexual life, such as impaired desire, arousal, or sexual satisfaction that need to be properly addressed. Health providers and prescribers must detect and prevent iatrogenic sexual dysfunction that can highly deteriorate a patient’s sexual life and satisfaction, leading to frequent drop-outs of medication. Approaching and researching aspects of sexual intimacy, life desires, frustrations, and fears undoubtedly constitutes the best mental health care. Full article
(This article belongs to the Special Issue Novel Research in Sexuality and Mental Health)

Research

Jump to: Editorial, Review

9 pages, 256 KiB  
Article
Negative Self-Perception and Self-Attitude of Sexuality Is a Risk Factor for Patient Dissatisfaction Following Penile Surgery with Small Intestinal Submucosa Grafting for the Treatment of Severe Peyronie’s Disease
by Armin Soave, Sebastian Laurich, Roland Dahlem, Malte W. Vetterlein, Oliver Engel, Timo O. Nieder, Peer Briken, Michael Rink, Margit Fisch and Philip Reiss
J. Clin. Med. 2019, 8(8), 1121; https://doi.org/10.3390/jcm8081121 - 28 Jul 2019
Cited by 7 | Viewed by 2196
Abstract
Objective: To assess patient satisfaction with surgical outcome, body related self-perceptions, self-attitudes of sexuality, and health related quality of life after penile surgery with small intestinal submucosa (SIS) grafting for the treatment of severe Peyronie’s disease (PD). Material and methods: This retrospective study [...] Read more.
Objective: To assess patient satisfaction with surgical outcome, body related self-perceptions, self-attitudes of sexuality, and health related quality of life after penile surgery with small intestinal submucosa (SIS) grafting for the treatment of severe Peyronie’s disease (PD). Material and methods: This retrospective study included 82 patients, who were treated with SIS grafting for severe PD between 2009 and 2013 at the University Medical Center Hamburg-Eppendorf. Patients were asked to complete standardized questionnaires including the International Index of Erectile Function Erectile Function domain (IIEF-EF), Short-Form (SF)-8 Health Survey, and Frankfurt Body Concept Scale-Sexuality (FKKS-SEX). Results: Follow-up was available in 58 (69.9%) patients. SIS grafting resulted in subjective straightening of the penis in 53 (91.3%) patients. After a mean follow-up of 28.9 ± 16.5 months, 24 (41.4%) patients were satisfied or very satisfied with surgical outcome. Postoperatively, the mean FKKS-SEX was 23.5 ± 5.9. In total, 36 (62.1%), 18 (31%), and four (6.9%) patients had FKKS-SEX scores corresponding to positive, neutral, and negative self-perception and self-attitude of sexuality, respectively. The mean postoperative SF-8 was 15.2 ± 6.4. Compared to the mean for German controls, patients achieved lower mean scores in the domains social functioning (50.4 ± 7.1), mental health (49.5 ± 9.2), and emotional roles (48.5 ± 6.8). Subjective shortening of the penis (Odds ratio (OR): 2.0), negative body related self-perceptions, and self-attitudes of sexuality (OR: 3.6) as well as IIEF-EF score (OR: 0.9) were risk factors for patient dissatisfaction (p-values ≤ 0.02). Conclusion: A relevant number of patients is not satisfied with surgical outcome after SIS grafting for the treatment of severe PD. Subjective shortening of the penis, negative body related self-perceptions, and self-attitudes of sexuality as well as IIEF-EF score were risk factors for patient dissatisfaction. Full article
(This article belongs to the Special Issue Novel Research in Sexuality and Mental Health)
13 pages, 255 KiB  
Article
Two Sides of One Coin: A Comparison of Clinical and Neurobiological Characteristics of Convicted and Non-Convicted Pedophilic Child Sexual Offenders
by Charlotte Gibbels, Christopher Sinke, Jonas Kneer, Till Amelung, Sebastian Mohnke, Klaus Michael Beier, Henrik Walter, Kolja Schiltz, Hannah Gerwinn, Alexander Pohl, Jorge Ponseti, Carina Foedisch, Inka Ristow, Martin Walter, Christian Kaergel, Claudia Massau, Boris Schiffer and Tillmann H.C. Kruger
J. Clin. Med. 2019, 8(7), 947; https://doi.org/10.3390/jcm8070947 - 29 Jun 2019
Cited by 7 | Viewed by 4075
Abstract
High prevalence of child sexual offending stand in contradiction to low conviction rates (one-tenth at most) of child sexual offenders (CSOs). Little is known about possible differences between convicted and non-convicted pedophilic CSOs and why only some become known to the judicial system. [...] Read more.
High prevalence of child sexual offending stand in contradiction to low conviction rates (one-tenth at most) of child sexual offenders (CSOs). Little is known about possible differences between convicted and non-convicted pedophilic CSOs and why only some become known to the judicial system. This investigation takes a closer look at the two sides of “child sexual offending” by focusing on clinical and neurobiological characteristics of convicted and non-convicted pedophilic CSOs as presented in the Neural Mechanisms Underlying Pedophilia and sexual offending against children (NeMUP)*-study. Seventy-nine male pedophilic CSOs were examined, 48 of them convicted. All participants received a thorough clinical examination including the structured clinical interview (SCID), intelligence, empathy, impulsivity, and criminal history. Sixty-one participants (38 convicted) underwent an inhibition performance task (Go/No-go paradigm) combined with functional magnetic resonance imaging (fMRI). Convicted and non-convicted pedophilic CSOs revealed similar clinical characteristics, inhibition performances, and neuronal activation. However, convicted subjects’ age preference was lower (i.e., higher interest in prepubescent children) and they had committed a significantly higher number of sexual offenses against children compared to non-convicted subjects. In conclusion, sexual age preference may represent one of the major driving forces for elevated rates of sexual offenses against children in this sample, and careful clinical assessment thereof should be incorporated in every preventive approach. Full article
(This article belongs to the Special Issue Novel Research in Sexuality and Mental Health)
18 pages, 2671 KiB  
Article
Frequency of Sexual Dysfunction in Patients Treated with Desvenlafaxine: A Prospective Naturalistic Study
by Angel L. Montejo, Joemir Becker, Gloria Bueno, Raquel Fernández-Ovejero, María T. Gallego, Nerea González, Adrián Juanes, Laura Montejo, Antonio Pérez-Urdániz, Nieves Prieto and José L. Villegas
J. Clin. Med. 2019, 8(5), 719; https://doi.org/10.3390/jcm8050719 - 21 May 2019
Cited by 8 | Viewed by 3506
Abstract
Despite being clinically underestimated, sexual dysfunction (SD) is one of the most frequent and lasting adverse effects associated with antidepressants. Desvenlafaxine is an antidepressant (AD) with noradrenergic and serotonergic action that can cause a lower SD than other serotonergic ADs although there are [...] Read more.
Despite being clinically underestimated, sexual dysfunction (SD) is one of the most frequent and lasting adverse effects associated with antidepressants. Desvenlafaxine is an antidepressant (AD) with noradrenergic and serotonergic action that can cause a lower SD than other serotonergic ADs although there are still few studies on this subject. Objective: To check the frequency of SD in two groups of depressive patients: one group was desvenlafaxine-naïve; the other was made up of patients switched to desvenlafaxine from another AD due to iatrogenic sexual dysfunction. A naturalistic, multicenter, and prospective study of patients receiving desvenlafaxine (50–100 mg/day) was carried out on 72 patients who met the inclusion criteria (>18 years old and sexually active), who had received desvenlafaxine for the first time (n = 27) or had switched to desvenlafaxine due to SD with another AD (n = 45). Patients with previous SD, receiving either drugs or presenting a concomitant pathology that interfered with their sexual life and/or patients who abused alcohol and/or drugs were excluded. We used the validated Psychotropic-Related Sexual Dysfunction Questionnaire (PRSexDQ-SALSEX) to measure AD-related sexual dysfunction and the Clinical Global Impression Scale for psychiatric disease (CGI-S) and for sexual dysfunction (CGI-SD) at two points in time: baseline and three months after the commencement of desvenlafaxine treatment. Results: In desvenlafaxine-naïve patients, 59.2% of the sample showed moderate/severe sexual dysfunction at baseline, which was reduced to 44% at follow-up. The PSexDQ-SALSEX questionnaire total score showed a significant improvement in sexual desire and sexual arousal without changes in orgasmic function at follow-up (p < 0.01). In the group switched to desvenlafaxine, the frequency of moderate/severe SD at baseline (93.3%) was reduced to 75.6% at follow-up visit. Additionally, SD significantly improved in three out of four items of the SALSEX: low desire, delayed orgasm, and anorgasmia at follow-up (p < 0.01), but there was no significant improvement in arousal difficulties. The frequency of severe SD was reduced from 73% at baseline to 35% at follow-up. The CGI for psychiatric disease and for sexual dysfunction improved significantly in both groups (p < 0.01). There was a poor tolerability with risk of treatment noncompliance in 26.7% of patients with sexual dysfunction due to another AD, this significantly reduced to 11.1% in those who switched to desvenlafaxine (p = 0.004). Conclusion: Sexual dysfunction improved significantly in depressed patients who initiated treatment with desvenlafaxine and in those who switched from another AD to desvenlafaxine, despite this, desvenlafaxine treatment is not completely devoid of sexual adverse effects. This switching strategy could be highly relevant in clinical practice due to the significant improvement in moderate/severe and poorly tolerated SD, while maintaining the AD efficacy. Full article
(This article belongs to the Special Issue Novel Research in Sexuality and Mental Health)
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12 pages, 430 KiB  
Article
(Don’t) Look at Me! How the Assumed Consensual or Non-Consensual Distribution Affects Perception and Evaluation of Sexting Images
by Arne Dekker, Frederike Wenzlaff, Anne Daubmann, Hans O. Pinnschmidt and Peer Briken
J. Clin. Med. 2019, 8(5), 706; https://doi.org/10.3390/jcm8050706 - 17 May 2019
Cited by 11 | Viewed by 5031
Abstract
The non-consensual sharing of an intimate image is a serious breach of a person’s right to privacy and can lead to severe psychosocial consequences. However, little research has been conducted on the reasons for consuming intimate pictures that have been shared non-consensually. This [...] Read more.
The non-consensual sharing of an intimate image is a serious breach of a person’s right to privacy and can lead to severe psychosocial consequences. However, little research has been conducted on the reasons for consuming intimate pictures that have been shared non-consensually. This study aims to investigate how the supposed consensual or non-consensual distribution of sexting images affects the perception and evaluation of these images. Participants were randomly assigned to one of two groups. The same intimate images were shown to all participants. However, one group assumed that the photos were shared voluntarily, whereas the other group were told that the photos were distributed non-consensually. While the participants completed several tasks such as rating the sexual attractiveness of the depicted person, their eye-movements were being tracked. The results from this study show that viewing behavior and the evaluation of sexting images are influenced by the supposed way of distribution. In line with objectification theory men who assumed that the pictures were distributed non-consensually spent more time looking at the body of the depicted person. This so-called ‘objectifying gaze’ was also more pronounced in participants with higher tendencies to accept myths about sexual aggression or general tendencies to objectify others. In conclusion, these results suggest that prevention campaigns promoting ‘sexting abstinence’ and thus attributing responsibility for non-consensual distribution of such images to the depicted persons are insufficient. Rather, it is necessary to emphasize the illegitimacy of the non-consensual distribution of sexting images, especially among male consumers of the material. Full article
(This article belongs to the Special Issue Novel Research in Sexuality and Mental Health)
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18 pages, 478 KiB  
Article
Sexual Satisfaction and Mental Health in Prison Inmates
by Rodrigo J. Carcedo, Daniel Perlman, Noelia Fernández-Rouco, Fernando Pérez and Diego Hervalejo
J. Clin. Med. 2019, 8(5), 705; https://doi.org/10.3390/jcm8050705 - 17 May 2019
Cited by 6 | Viewed by 4612
Abstract
The main goal of this study was to investigate the association between sexual satisfaction and mental health, and the combined effect of two previously found, statistically significant moderators: partner status and sexual abstinence. In-person interviews were conducted with 223 participants (49.327% males and [...] Read more.
The main goal of this study was to investigate the association between sexual satisfaction and mental health, and the combined effect of two previously found, statistically significant moderators: partner status and sexual abstinence. In-person interviews were conducted with 223 participants (49.327% males and 50.673% females). The effect of sexual satisfaction on mental health and the interactions of sexual satisfaction × partner status, sexual satisfaction × sexual abstinence, and sexual satisfaction × partner status × sexual abstinence were examined using simple moderation and moderated moderation tests after controlling for a set of sociodemographic, penitentiary, and interpersonal variables. Results revealed a direct relationship between sexual satisfaction and mental health only for the sexually abstinent group. Partner status was not significant as a moderator. It seems that the lack of sexual relationships is more powerful as a moderator than the lack of a romantic relationship. Additionally, the sexually abstinent group showed lower levels of sexual satisfaction in those with a partner outside or inside prison, and lower mental health independently of the current romantic status, than sexually active inmates. These findings point to the importance of sexual satisfaction to mental health in sexual situations of extreme disadvantage. Full article
(This article belongs to the Special Issue Novel Research in Sexuality and Mental Health)
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11 pages, 632 KiB  
Article
Sexual Distress in Patients with Hidradenitis Suppurativa: A Cross-Sectional Study
by Carlos Cuenca-Barrales, Ricardo Ruiz-Villaverde and Alejandro Molina-Leyva
J. Clin. Med. 2019, 8(4), 532; https://doi.org/10.3390/jcm8040532 - 18 Apr 2019
Cited by 27 | Viewed by 3448
Abstract
Hidradenitis suppurativa (HS) is a chronic auto-inflammatory skin disease with a great impact in quality of life. However, there is little research about the impact of HS on sex life. The aims of this study are to describe the frequency of sexual distress [...] Read more.
Hidradenitis suppurativa (HS) is a chronic auto-inflammatory skin disease with a great impact in quality of life. However, there is little research about the impact of HS on sex life. The aims of this study are to describe the frequency of sexual distress (SD) in patients with HS and to explore potentially associated epidemiological and clinical factors. We conducted a cross-sectional study by means of a crowd-sourced online questionnaire hosted by the Spanish hidradenitis suppurativa patients’ association (ASENDHI). Sexual distress (SD) was evaluated with a Numeric Rating Scale (NRS) for HS impact on sex life. A total of 393 participants answered the questionnaire. The mean NRS for HS impact on sex life was 7.24 (2.77) in women and 6.39 (3.44) in men (p < 0.05). Variables significantly associated (p < 0.05) with SD in the multiple linear regression model were sex, with a higher risk in females, the presence of active lesions in the groin and genitals and NRS for pain and unpleasant odor; being in a stable relationship was an important protector factor. Regarding these results, it seems that SD in HS patients is due, at least in part, to disease symptoms and active lesions in specific locations, emphasizing the importance of disease control with a proper treatment according to management guidelines. Women and single patients are more likely to suffer from sexual distress. Full article
(This article belongs to the Special Issue Novel Research in Sexuality and Mental Health)
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18 pages, 299 KiB  
Article
Predictors of Sexual Dysfunction in Veterans with Post-Traumatic Stress Disorder
by Marina Letica-Crepulja, Aleksandra Stevanović, Marina Protuđer, Božidar Popović, Darija Salopek-Žiha and Snježana Vondraček
J. Clin. Med. 2019, 8(4), 432; https://doi.org/10.3390/jcm8040432 - 29 Mar 2019
Cited by 25 | Viewed by 4302
Abstract
Background: The problems in sexual functioning among patients with post-traumatic stress disorder (PTSD) are often overlooked, although scientific research confirms high rates of sexual dysfunctions (SD) particularly among veterans with PTSD. The main objective of this study was to systematically identify predictors of [...] Read more.
Background: The problems in sexual functioning among patients with post-traumatic stress disorder (PTSD) are often overlooked, although scientific research confirms high rates of sexual dysfunctions (SD) particularly among veterans with PTSD. The main objective of this study was to systematically identify predictors of SD among veterans with PTSD. Methods: Three hundred veterans with PTSD were included in the cross-sectional study. The subjects were assessed by the Mini-International Neuropsychiatric Interview (MINI) and self-report questionnaires: PCL-5, i.e., PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) with Criterion A, International Index of Erectile Function (IIEF), Premature Ejaculation Diagnostic Tool (PEDT), and Relationship Assessment Scale (RAS). Several hierarchical multiple regressions were performed to test for the best prediction models for outcome variables of different types of SD. Results: 65% of participants received a provisional diagnosis of SD. All tested prediction models showed a good model fit. The significant individual predictors were cluster D (Trauma-Related Negative Alterations in Cognition and Mood) symptoms (for all types of SD) and in a relationship status/relationship satisfaction (all, except for premature ejaculation (PE)). Conclusions: The most salient implication of this study is the importance of sexual health assessment in veterans with PTSD. Therapeutic interventions should be focused on D symptoms and intended to improve relationship functioning with the aim to lessen the rates of SD. Psychotropic treatment with fewer adverse sexual effects is of utmost importance if pharmacotherapy is applied. Appropriate prevention, screening, and treatment of medical conditions could improve sexual functioning in veterans with PTSD. Full article
(This article belongs to the Special Issue Novel Research in Sexuality and Mental Health)
11 pages, 233 KiB  
Article
Sexual Dysfunctions and Their Association with the Dual Control Model of Sexual Response in Men and Women with High-Functioning Autism
by Daniel Turner, Peer Briken and Daniel Schöttle
J. Clin. Med. 2019, 8(4), 425; https://doi.org/10.3390/jcm8040425 - 28 Mar 2019
Cited by 12 | Viewed by 5672
Abstract
Adults with an Autism Spectrum Disorder (ASD) are characterized by impairments in social interaction and communication, repetitive and stereotyped interests and behaviours as well as hyper- and/or hyposensitivities. These disorder specific symptoms could be associated with the development of sexual disorders. The Dual [...] Read more.
Adults with an Autism Spectrum Disorder (ASD) are characterized by impairments in social interaction and communication, repetitive and stereotyped interests and behaviours as well as hyper- and/or hyposensitivities. These disorder specific symptoms could be associated with the development of sexual disorders. The Dual Control Model of Sexual Response presents one approach that is frequently used to explain the emergence of sexual dysfunctions. The aim of the present study was to assess the extent of symptoms of sexual dysfunctions in men and women with ASD and to evaluate their association with the individual propensity of sexual excitation and inhibition as defined by the Dual Control Model. Both men and women with ASD were more likely to report about sexual dysfunctions than individuals from the control group. In men with ASD, sexual inhibition was significantly correlated with the emergence of sexual dysfunctions, while there was no association between sexual functioning and sexual excitation. In women, the opposite pattern was found. Especially the peculiarities in sensitive perception could be responsible for the observed problems with sexual functioning in individuals with ASD. The present findings highlight the great need for specialized treatment programs addressing the frequently observed sexuality-related problems in individuals with ASD. However, up to now such treatment programs are lacking. Full article
(This article belongs to the Special Issue Novel Research in Sexuality and Mental Health)
15 pages, 765 KiB  
Article
Mental Health and Proximal Stressors in Transgender Men and Women
by Noelia Fernández-Rouco, Rodrigo J. Carcedo, Félix López and M. Begoña Orgaz
J. Clin. Med. 2019, 8(3), 413; https://doi.org/10.3390/jcm8030413 - 25 Mar 2019
Cited by 11 | Viewed by 4512
Abstract
This paper explores the subjective perception of some personal and interpersonal aspects of the lives of transgender people and the relationship they have with their mental health. One hundred and twenty transgender people (60 men and 60 women) participated in semi-structured interviews. Following [...] Read more.
This paper explores the subjective perception of some personal and interpersonal aspects of the lives of transgender people and the relationship they have with their mental health. One hundred and twenty transgender people (60 men and 60 women) participated in semi-structured interviews. Following quantitative methodology, analysis highlighted that social loneliness is the main predictor of lower levels of mental health (anxiety and depression) for both genders and recognized romantic loneliness as the strongest factor among transgender men. In both cases, higher levels of loneliness were associated with lower levels of mental health. The results have guided us to improve institutional and social responses and have provided an opportunity to promote the mental health of transgender people. Full article
(This article belongs to the Special Issue Novel Research in Sexuality and Mental Health)
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14 pages, 627 KiB  
Article
Couple Relationship and Parent-Child Relationship Quality: Factors Relevant to Parent-Child Communication on Sexuality in Romania
by Meda Veronica Pop and Alina Simona Rusu
J. Clin. Med. 2019, 8(3), 386; https://doi.org/10.3390/jcm8030386 - 19 Mar 2019
Cited by 6 | Viewed by 3469
Abstract
This study of parents in Romania explores how perceptions of their couple relationship quality and of factors associated with it (such as sexual communication anxiety and sexual perfectionism) were related to their perception of aspects describing parenting dimensions relevant to the sexual education [...] Read more.
This study of parents in Romania explores how perceptions of their couple relationship quality and of factors associated with it (such as sexual communication anxiety and sexual perfectionism) were related to their perception of aspects describing parenting dimensions relevant to the sexual education and sexual health of their children. The hypotheses tested in this study were supported by the data collected from 106 participants (aged 25 to 51 years), parents of 1 to 3 children: (1) sexual communication anxiety with one’s partner (but not sexual perfectionism) is a significant predictor for parents’ self-efficacy, outcome expectancy and communication and parenting behavior related to sexuality education; (2) parents’ self-efficacy and outcome expectancy about parent-child communication on sexual topics (including involvement in risky sexual behaviors) predict the level of parenting behavior in this respect; (3) parents’ sexual communication anxiety (but not their sexual perfectionism) together with their self-efficacy and outcome expectancy regarding parent-child communication about sexuality predict the level of parental sexuality-communication-and-education behavior. Full article
(This article belongs to the Special Issue Novel Research in Sexuality and Mental Health)
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12 pages, 1648 KiB  
Article
Sexual Dysfunction and Quality of Life in Chronic Heroin-Dependent Individuals on Methadone Maintenance Treatment
by Carlos Llanes, Ana I. Álvarez, M. Teresa Pastor, M. Ángeles Garzón, Nerea González-García and Ángel L. Montejo
J. Clin. Med. 2019, 8(3), 321; https://doi.org/10.3390/jcm8030321 - 07 Mar 2019
Cited by 17 | Viewed by 3937
Abstract
This study examined whether methadone (hereinafter referred to as MTD) maintenance treatment (MMT) is correlated with sexual dysfunction (SD) in heroin-dependent men. This was conducted to determine the prevalence of sexual dysfunction and if there is a relationship between duration and dose among [...] Read more.
This study examined whether methadone (hereinafter referred to as MTD) maintenance treatment (MMT) is correlated with sexual dysfunction (SD) in heroin-dependent men. This was conducted to determine the prevalence of sexual dysfunction and if there is a relationship between duration and dose among men on MMT and its impact on the quality of life. The study combined a retrospective and a cross-sectional survey based on the Kinsey Scale, TECVASP, and PRSexDQ-SALSEX clinical interviews of 85 patients who are currently engaged in MMT. Sexual dysfunction in all five PRSexDQ-SALSEX domains (lack of libido, delay in orgasm, inability to orgasm, erectile dysfunction, and tolerance or acceptance of changes in sexual function) was associated with dose and long-term use of heroin. All dimensions of SD were affected by the MTD intake. From the analysis of our sample, we may conclude that dose of MTD and overall score of SD were directly associated. However, no evidence was found to prove that treatment duration and severity of SD were linked. It is notable that only one tenth of the patients spontaneously reported their symptoms of the sexual sphere, but up to a third considered leaving the MMT for this reason. Full article
(This article belongs to the Special Issue Novel Research in Sexuality and Mental Health)
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17 pages, 1227 KiB  
Article
Same Same but Different: A Clinical Characterization of Men with Hypersexual Disorder in the Sex@Brain Study
by Jannis Engel, Maria Veit, Christopher Sinke, Ivo Heitland, Jonas Kneer, Thomas Hillemacher, Uwe Hartmann and Tillmann H.C. Kruger
J. Clin. Med. 2019, 8(2), 157; https://doi.org/10.3390/jcm8020157 - 30 Jan 2019
Cited by 42 | Viewed by 33805
Abstract
Problems arising from hypersexual behavior are often seen in clinical settings. We aimed to extend the knowledge about the clinical characteristics of individuals with hypersexual disorder (HD). A group of people who fulfilled the proposed diagnostic criteria for HD (men with HD, n [...] Read more.
Problems arising from hypersexual behavior are often seen in clinical settings. We aimed to extend the knowledge about the clinical characteristics of individuals with hypersexual disorder (HD). A group of people who fulfilled the proposed diagnostic criteria for HD (men with HD, n = 50) was compared to a group of healthy controls (n = 40). We investigated differences in sociodemographic, neurodevelopmental, and family factors based on self-report questionnaires and clinical interviews. Men with HD reported elevated rates of sexual activity, paraphilias, consumption of child abusive images, and sexual coercive behavior compared to healthy controls. Moreover, rates of affective disorders, attachment difficulties, impulsivity, and dysfunctional emotion regulation strategies were higher in men with HD. Men with HD seem to have experienced various forms of adverse childhood experiences, but there were no further differences in sociodemographic, neurodevelopmental factors, and family factors. Regression analyses indicated that attachment-related avoidance and early onset of masturbation differentiated between men with HD and healthy controls. In conclusion, men with HD appear to have the same neurodevelopment, intelligence levels, sociodemographic background, and family factors compared to healthy controls, but they report different and adverse experiences in childhood, problematic sexual behavior, and psychological difficulties. Full article
(This article belongs to the Special Issue Novel Research in Sexuality and Mental Health)
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17 pages, 13287 KiB  
Article
Understanding the Mechanism of Antidepressant-Related Sexual Dysfunction: Inhibition of Tyrosine Hydroxylase in Dopaminergic Neurons after Treatment with Paroxetine but Not with Agomelatine in Male Rats
by Yanira Santana, Angel L. Montejo, Javier Martín, Ginés LLorca, Gloria Bueno and Juan Luis Blázquez
J. Clin. Med. 2019, 8(2), 133; https://doi.org/10.3390/jcm8020133 - 23 Jan 2019
Cited by 14 | Viewed by 6737
Abstract
Antidepressant-related sexual dysfunction is a frequent adverse event caused by serotonergic activation that intensely affects quality of life and adherence in depressed patients. The dopamine system has multiple effects promoting sexual behavior, but no studies have been carried out to confirm dopaminergic changes [...] Read more.
Antidepressant-related sexual dysfunction is a frequent adverse event caused by serotonergic activation that intensely affects quality of life and adherence in depressed patients. The dopamine system has multiple effects promoting sexual behavior, but no studies have been carried out to confirm dopaminergic changes involved in animal models after antidepressant use. Methods: The sexual behavior-related dopaminergic system in the rat was studied by comparing two different antidepressants and placebo for 28 days. The antidepressants used were paroxetine (a serotonergic antidepressant that causes highly frequent sexual dysfunction in humans) and agomelatine (a non-serotonergic antidepressant without associated sexual dysfunction). The tyrosine hydroxylase immunoreactivity (THI) in the substantia nigra pars compacta, the ventral tegmental area, the zona incerta, and the hypothalamic arcuate nucleus, as well as the dopaminergic projections to the striatum, hippocampus, cortex, and median eminence were analyzed. Results: The THI decreased significantly in the substantia nigra and ventral tegmental area after treatment with paroxetine, and the labeling was reduced drastically in the zona incerta and mediobasal hypothalamus. The immunoreactive axons in the target regions (striatum, cortex, hippocampus, and median eminence) almost disappeared only in the paroxetine-treated rats. Conversely, after treatment with agomelatine, a moderate reduction in immunoreactivity in the substantia nigra was found without appreciable modifications in the ventral tegmental area, zona incerta, and mediobasal hypothalamus. Nevertheless, no sexual or copulatory behavior was observed in any of the experimental or control groups. Conclusion: Paroxetine but not agomelatine was associated with important decreased activity in dopaminergic areas such as the substantia nigra and ventral tegmental areas that could be associated with sexual performance impairment in humans after antidepressant treatment. Full article
(This article belongs to the Special Issue Novel Research in Sexuality and Mental Health)
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Review

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15 pages, 577 KiB  
Review
The Potential Associations of Pornography Use with Sexual Dysfunctions: An Integrative Literature Review of Observational Studies
by Aleksandra Diana Dwulit and Piotr Rzymski
J. Clin. Med. 2019, 8(7), 914; https://doi.org/10.3390/jcm8070914 - 26 Jun 2019
Cited by 55 | Viewed by 17509
Abstract
This paper reviews the associations between pornography use and sexual dysfunction based on evidence from observational studies. The existing data in this regard mostly derive from cross-sectional investigations and case reports. There is little if no evidence that pornography use may induce delayed [...] Read more.
This paper reviews the associations between pornography use and sexual dysfunction based on evidence from observational studies. The existing data in this regard mostly derive from cross-sectional investigations and case reports. There is little if no evidence that pornography use may induce delayed ejaculation and erectile dysfunction, although longitudinal studies that control for confounding variables are required for a full assessment. The associations between pornography use and sexual desire may differ between women and men although the existing data is contradictory and causal relationships cannot be established. The strongest evidence is available for the relation of pornography use with decreased sexual satisfaction, although the results of prospective studies are inconsistent. The paper outlines future research prospects beneficial in understanding the nature of associations between pornography use and sexual dysfunctions in men and women. Full article
(This article belongs to the Special Issue Novel Research in Sexuality and Mental Health)
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22 pages, 1054 KiB  
Review
Hormonal Contraceptives, Female Sexual Dysfunction, and Managing Strategies: A Review
by Nerea M. Casado-Espada, Rubén de Alarcón, Javier I. de la Iglesia-Larrad, Berta Bote-Bonaechea and Ángel L. Montejo
J. Clin. Med. 2019, 8(6), 908; https://doi.org/10.3390/jcm8060908 - 25 Jun 2019
Cited by 34 | Viewed by 14722
Abstract
In recent decades, hormonal contraceptives (HC) has made a difference in the control of female fertility, taking an unequivocal role in improving contraceptive efficacy. Some side effects of hormonal treatments have been carefully studied. However, the influence of these drugs on female sexual [...] Read more.
In recent decades, hormonal contraceptives (HC) has made a difference in the control of female fertility, taking an unequivocal role in improving contraceptive efficacy. Some side effects of hormonal treatments have been carefully studied. However, the influence of these drugs on female sexual functioning is not so clear, although variations in the plasma levels of sexual hormones could be associated with sexual dysfunction. Permanent hormonal modifications, during menopause or caused by some endocrine pathologies, could be directly related to sexual dysfunction in some cases but not in all of them. HC use seems to be responsible for a decrease of circulating androgen, estradiol, and progesterone levels, as well as for the inhibition of oxytocin functioning. Hormonal contraceptive use could alter women’s pair-bonding behavior, reduce neural response to the expectation of erotic stimuli, and increase sexual jealousy. There are contradictory results from different studies regarding the association between sexual dysfunction and hormonal contraceptives, so it could be firmly said that additional research is needed. When contraceptive-related female sexual dysfunction is suspected, the recommended therapy is the discontinuation of contraceptives with consideration of an alternative method, such as levonorgestrel-releasing intrauterine systems, copper intrauterine contraceptives, etonogestrel implants, the permanent sterilization of either partner (when future fertility is not desired), or a contraceptive ring. Full article
(This article belongs to the Special Issue Novel Research in Sexuality and Mental Health)
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11 pages, 211 KiB  
Review
Uncovering Female Child Sexual Offenders—Needs and Challenges for Practice and Research
by Safiye Tozdan, Peer Briken and Arne Dekker
J. Clin. Med. 2019, 8(3), 401; https://doi.org/10.3390/jcm8030401 - 22 Mar 2019
Cited by 26 | Viewed by 24007
Abstract
This article provides a short literature overview on female child sexual offenders (FCSO) focusing on the discrepancy between prevalence rates from different sources, characteristics of FCSO and their victims, as well as the societal “culture of denial” surrounding these women. FCSO are a [...] Read more.
This article provides a short literature overview on female child sexual offenders (FCSO) focusing on the discrepancy between prevalence rates from different sources, characteristics of FCSO and their victims, as well as the societal “culture of denial” surrounding these women. FCSO are a powerful social taboo. Even professionals in the healthcare or justice system were shown to respond inappropriately in cases of child sexual abuse committed by women. As a result, offences of FCSO may be underreported and therefore difficult to research. The lack of scientific data on FSCO lowers the quality of child protection and treatment services. We therefore deem it particularly necessary for professionals in health care to break the social taboo that is FCSO and to further stimulate research on the topic of FCSO. We provide some general implications for professionals in health care systems as well as specific recommendations for researchers. We end with an overall conclusion. Full article
(This article belongs to the Special Issue Novel Research in Sexuality and Mental Health)
14 pages, 409 KiB  
Review
Serotonergic, Dopaminergic, and Noradrenergic Modulation of Erotic Stimulus Processing in the Male Human Brain
by Heiko Graf, Kathrin Malejko, Coraline Danielle Metzger, Martin Walter, Georg Grön and Birgit Abler
J. Clin. Med. 2019, 8(3), 363; https://doi.org/10.3390/jcm8030363 - 14 Mar 2019
Cited by 11 | Viewed by 7694
Abstract
Human sexual behavior is mediated by a complex interplay of cerebral and spinal centers, as well as hormonal, peripheral, and autonomic functions. Neuroimaging studies identified central neural signatures of human sexual responses comprising neural emotional, motivational, autonomic, and cognitive components. However, empirical evidence [...] Read more.
Human sexual behavior is mediated by a complex interplay of cerebral and spinal centers, as well as hormonal, peripheral, and autonomic functions. Neuroimaging studies identified central neural signatures of human sexual responses comprising neural emotional, motivational, autonomic, and cognitive components. However, empirical evidence regarding the neuromodulation of these neural signatures of human sexual responses was scarce for decades. Pharmacological functional magnetic resonance imaging (fMRI) provides a valuable tool to examine the interaction between neuromodulator systems and functional network anatomy relevant for human sexual behavior. In addition, this approach enables the examination of potential neural mechanisms regarding treatment-related sexual dysfunction under psychopharmacological agents. In this article, we introduce common neurobiological concepts regarding cerebral sexual responses based on neuroimaging findings and we discuss challenges and findings regarding investigating the neuromodulation of neural sexual stimulus processing. In particular, we summarize findings from our research program investigating how neural correlates of sexual stimulus processing are modulated by serotonergic, dopaminergic, and noradrenergic antidepressant medication in healthy males. Full article
(This article belongs to the Special Issue Novel Research in Sexuality and Mental Health)
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20 pages, 605 KiB  
Review
Online Porn Addiction: What We Know and What We Don’t—A Systematic Review
by Rubén de Alarcón, Javier I. de la Iglesia, Nerea M. Casado and Angel L. Montejo
J. Clin. Med. 2019, 8(1), 91; https://doi.org/10.3390/jcm8010091 - 15 Jan 2019
Cited by 127 | Viewed by 142287
Abstract
In the last few years, there has been a wave of articles related to behavioral addictions; some of them have a focus on online pornography addiction. However, despite all efforts, we are still unable to profile when engaging in this behavior becomes pathological. [...] Read more.
In the last few years, there has been a wave of articles related to behavioral addictions; some of them have a focus on online pornography addiction. However, despite all efforts, we are still unable to profile when engaging in this behavior becomes pathological. Common problems include: sample bias, the search for diagnostic instrumentals, opposing approximations to the matter, and the fact that this entity may be encompassed inside a greater pathology (i.e., sex addiction) that may present itself with very diverse symptomatology. Behavioral addictions form a largely unexplored field of study, and usually exhibit a problematic consumption model: loss of control, impairment, and risky use. Hypersexual disorder fits this model and may be composed of several sexual behaviors, like problematic use of online pornography (POPU). Online pornography use is on the rise, with a potential for addiction considering the “triple A” influence (accessibility, affordability, anonymity). This problematic use might have adverse effects in sexual development and sexual functioning, especially among the young population. We aim to gather existing knowledge on problematic online pornography use as a pathological entity. Here we try to summarize what we know about this entity and outline some areas worthy of further research. Full article
(This article belongs to the Special Issue Novel Research in Sexuality and Mental Health)
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