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Sexual desire has often been conceptualized and studied as an individual trait. However, empirical evidence suggests that there is also value in studying it as a state and dyadic construct. Through a daily diary study with a randomized controlled experimental design, we aimed to explore (i) how the roles that partners fulfill in dyadic interactions are associated with daily fluctuations in dyadic sexual desire, (ii) whether these roles can be leveraged to affect sexual desire for one's partner, and (iii) whether effects of partner interactions on dyadic sexual desire vary by gender. In total, 163 mixed-gender couples ( N  = 326), with a mean age of 30.3 years ( SD  = 7.95), participated. During 22 consecutive days, participants reported daily on their dyadic sexual desire, as well as on several aspects of their interactions. Couples in the experimental condition additionally received assignments that manipulated their partner interactions. Analyzing our data using Multilevel Modelling techniques for longitudinal dyadic data, we found that daily dyadic sexual desire was associated with what each partner takes, gives, and receives in relation with their affiliation, sexuality and exploration needs. Additionally, women's sexual desire was associated with what their partner reported taking, giving, and receiving during affiliative interactions, and with perceived but not enacted responsiveness to their sexuality and exploration needs. Our results suggest that daily ebbs and flows of sexual desire may be partly explained by temporal changes in interactions between partners, making them possible valuable targets for clinical interventions.

Background: The African Copperbelt is a site of intense artisanal and industrial mining and refining of copper and cobalt., Aim: We aimed to investigate factors that are possibly associated with erectile dysfunction (ED) in metal miners in the former Katanga province of the Democratic Republic of the Congo., Methods: In a cross-sectional study of 138 miners and 139 controls (bakers), we administered questionnaires to obtain sociodemographic and occupational data and to assess male sexual function (International Index of Erectile Function [IIEF]) and marital relation quality (Revised Dyadic Adjustment Scale). Furthermore, we measured trace metals in blood and urine, as well as testosterone and thyroid hormones in serum., Outcomes: Outcomes included the prevalence of questionnaire-derived ED and the relation of ED with individual characteristics, serum testosterone, and environmental factors., Results: Miners were on average 4 years older than bakers (mean ± SD, 37.5 ± 6.9 vs 33.3 ± 5.7 years). Miners had significantly lower scores than bakers on the IIEF (median [IQR], 66 [49-73] vs 73 [66-74]) and the 3 domains of the Revised Dyadic Adjustment Scale (consensus, satisfaction, cohesion). Free testosterone was significantly lower in miners than bakers (ng/dL; 8.11 [6.90-10.10] vs 10.52 [8.83-12.58]; P ˂ .001). In miners, sex hormone-binding globulin correlated positively with blood Pb and urinary Cd. In a multivariable analysis, mild to moderate ED or moderate ED (IIEF-erectile function score ≤18) was significantly associated with having a mining-related job (adjusted odds ratio [aOR], 2.6; 95% CI, 1.3-5.3), work seniority ˃5 years (aOR, 2.3; 95% CI, 1.1-4.6), alcohol consumption (aOR, 2.8; 95% CI, 1.2-6.7), and aphrodisiacs use (aOR, 4.2; 95% CI, 2.2-8.0). Mediation analysis showed that marital relationship partially mediated the relation between work seniority >5 years in mining and ED., Clinical Implications: The high prevalence of ED found in artisanal mine workers indicates that work-related factors should be considered as possibly contributing, directly or indirectly, to sexual dysfunction in men., Strengths and Limitations: Strengths include being the first epidemiologic study documenting ED with validated questionnaires and its possible determinants, including exposure to toxic metals, among young artisanal miners vs a suitable control group. Limitations are the cross-sectional design with convenience sampling and absence of objective confirmation of ED., Conclusion: As compared with controls, miners reported poorer sexual function and lower quality of their marital relationship, and they had lower free testosterone levels, which may be due to their high exposure to trace metals., Competing Interests: The authors declare that they have no conflicts of interest., (© The Author(s) 2023. Published by Oxford University Press on behalf of The International Society of Sexual Medicine.)

This article presents a new conceptual framework that shows how dementia may affect the sexual relationship between partners, and how different actors become progressively more involved in "managing" the sexual relationship during consecutive phases of dementia, that is, the premorbid, preclinical, and clinical phases. Each phase challenges couples in different ways and these challenges may affect the expression of sexuality in their relationship. The person living with dementia and/or the partner's desire to continue to be sexually active may result in conflicts with health care professionals and family members who want to protect the person living with dementia from becoming the perpetrator and/or the victim of "inappropriate" or "harming" sexual behavior. The framework posits that a diagnosis of dementia instigates a journey of renegotiating sexuality in which gradually more actors-who often approach sexuality from a sex-negative point of view-become involved. Therefore, the new framework starts from a sex-positive perspective and is presented together with a new research agenda that ensues from this framework. Research based on this framework that starts from the experience of both people living with dementia and their partners will help us to better understand the relational and sexual effects of a dementia diagnosis. This knowledge will enable health care professionals to provide tailored care with respect for the sexual needs of couples living with dementia. Hence, clinical implications arising from the framework are presented., (© The Author(s) 2022. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

In this qualitative study, we explored women's and men's experience of sexual desire for their romantic partner and its link to dyadic interactions. During interviews and focus group discussions, our participants described sexual desire as 'elusive', 'conditional', 'responsive' and 'malleable'. The subtheme 'elusive' refers to sexual desire having a will of its own, while the remaining three refer to prerequisites for, triggers of, and strategies for enhancing sexual desire respectively. These subthemes come together in the overarching narrative 'luring the elusive', which articulates one's responsibility to accommodate sexual desire for one's partner, but also the necessity to acknowledge its elusiveness.

Objective: Sexual assertiveness (SA), i.e., the ability to communicate thoughts and desires that may be translated into satisfying sexual activity within an intimate relationship, is important for safe and satisfying sexual behavior. In an attempt to unravel which cultural, relational, and individual variables are related to the development of SA in emerging adults, an exploratory study was conducted in Cuenca, Ecuador. Methods: Five hundred and thirty-eight participants completed scales that measured their levels of SA, endorsement of the sexual double standard, relationship satisfaction, and mental well-being. Results: This study showed a negative effect of the sexual double standard on SA in both men and women and this effect was slightly tempered by the level of education. Women reported higher levels of SA than men. In women, SA was associated with general mental well-being and relationship satisfaction; but not in men. For both women and men, no association was found with relationship status or duration. Conclusions: These findings corroborate evidence highlighting the importance of SA for healthy sexual relationships and emphasize the importance of (sex) education for SA for lower educated women and men. The results are discussed in relation to findings on SA in other contexts., Competing Interests: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper., (© 2022 Taylor & Francis Group, LLC.)

Background: While sexuality and intimacy are suggested to contribute to quality of life (QoL), it is striking that the sexual problems of head and neck cancer patients have not been adequately studied., Objectives: Our aim was to prospectively assess the impact of head and neck cancer and its treatment on sexuality and intimacy., Material and Methods: A questionnaire study with a 6-month follow-up period was conducted at the University Hospitals Leuven, Belgium, using the Maudsley marital questionnaire (MMQ), the sexual adjustment questionnaire (SAQ) and the short sexual functioning scale (SSFS) to prospectively assess the impact of head and neck cancer and its treatment on sexuality and intimacy., Results: Twelve patients (67%) reported a negative impact on their sexuality and/or intimacy. There were significant declines in marital, sexual and general life satisfaction (p < 0.000) at the 6-month follow-up as compared to baseline. There was a significant increase in frustration after sexual activity (p = 0.031). Sexual desire was also impacted, with a near doubling of patients reporting a decline. The perceived importance of discussing sexual issues with one's physician significantly increased from 7 to 16 patients (p = 0.004)., Conclusions: Sexual problems are common after head and neck cancer treatment. Using a screening instrument can help to identify patients that need intervention. Discussing sexuality and intimacy issues that patients may face before, during and after treatment can have a positive impact on QoL.

Background and Aims: The prevalence of sexual dysfunctions in people with diabetes is still debated and understudied in women. This study examines the prevalence of sexual dysfunction in men and women with type 1 or type 2 diabetes (T1D or T2D) and the associations with clinical and psychological variables., Methods: Adults with diabetes (n = 756) completed an online survey including questions on sexual functioning (adapted Short Sexual Functional Scale), general emotional well-being (WHO-5), symptoms of anxiety (GAD-7) and diabetes distress (PAID-20)., Results: One third of participants reported a sexual dysfunction. Men reported erectile dysfunction (T1D: 20%; T2D: 33%), and orgasmic dysfunction (T1D: 22%; T2D: 27%). In men, sexual dysfunction was independently associated with, older age (OR = 1.05, p = 0.022), higher waist circumference (OR = 1.04; p < 0.001) and longer duration of diabetes (OR = 1.04; p = 0.007). More men with sexual dysfunction reported diabetes distress (20% vs. 12%, p = 0.026). Women reported decreased desire (T1D: 22%; T2D: 15%) and decreased arousal (T1D: 9%; T2D: 11%). More women with sexual dysfunction reported diabetes distress (36% vs. 21%, p = 0.003), impaired emotional well-being (36% vs. 25%, p = 0.036) and anxiety symptoms (20% vs. 11%, p = 0.026)., Conclusion: Sexual dysfunctions are common in both men and women with diabetes. In men, sexual dysfunctions were associated with clinical factors. More women with sexual dysfunction reported low emotional well-being and anxiety symptoms compared to women without sexual dysfunction. For both men and women, sexual dysfunctions were associated with diabetes distress., (© 2021 Diabetes UK.)

In most theoretical models, sexual desire for one's partner is predominantly conceptualized from an individual perspective. There is, however, a growing body of empirical evidence on the dyadic aspects of sexual desire. That evidence is as yet not well-integrated into theoretical conceptualizations of sexual desire. Aiming to fill this gap, we present the Dyadic Interactions Affecting DyadIC Sexual desire model (DIADICS), a new conceptual model inspired by systems theory that describes how dyadic interactions between partners influence dyadic sexual desire in romantic relationships. After defining dyadic sexual desire, we discuss (1) the structure of dyadic interactions, (2) their content, and (3) the process through which they affect dyadic sexual desire in a romantic relationship. Thereafter, we review theoretical, clinical, and empirical insights underscoring the relation between dyadic interactions and (dyadic) sexual desire, use DIADICS as a framework for understanding fluctuations in dyadic sexual desire in long-term relationships, and conclude by discussing implications of DIADICS for research and clinical practice., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objective: To compare adnexectomy by vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) versus laparoscopy., Design: Parallel group, 1:1 single-centre single-blinded randomised trial, designed as non-inferiority study with a margin of 15%., Setting: Belgian teaching hospital., Population: Non-pregnant non-virgin women with an intact uterus and without obliteration of the pouch of Douglas scheduled to undergo removal of an adnexal mass assessed to be benign on ultrasound by IOTA criteria., Methods: Randomisation to laparoscopy (control group) or vNOTES (experimental group). Stratification according to adnexal size. Blinding of participants and outcome assessors by sham incisions., Main Outcome Measures: The primary outcome measure was adnexectomy by the allocated technique. Secondary outcomes included duration of surgery, pain scores and analgesics used, quality of life and adverse events., Results: We randomly assigned 67 participants (34 to the vNOTES group and 33 to the laparoscopy group). The primary end point was always reached in both groups: there were no conversions. We performed a sensitivity analysis for the primary outcome, assuming one conversion in the vNOTES group and no conversions in the laparoscopy group: the one-sided 95% upper limit for the differences in proportions of conversion was estimated as 13%, which is below the predefined non-inferiority margin of 15%. The secondary outcomes demonstrated a shorter duration of surgery, lower pain scores, lower total dose of analgesics and a trend for more adverse events in the vNOTES group., Conclusions: vNOTES is non-inferior to laparoscopy for a successful adnexectomy without conversion. vNOTES allowed shorter operating times and less postoperative pain but there was a trend for more adverse events., (© 2021 John Wiley & Sons Ltd.)

Different pain types may be encoded in different brain circuits. Here, we examine similarities and differences in brain processing of visceral and somatic pain. We analyze data from seven fMRI studies (N = 165) and five types of pain and discomfort (esophageal, gastric, and rectal distension, cutaneous thermal stimulation, and vulvar pressure) to establish and validate generalizable pain representations. We first evaluate an established multivariate brain measure, the Neurologic Pain Signature (NPS), as a common nociceptive pain system across pain types. Then, we develop a multivariate classifier to distinguish visceral from somatic pain. The NPS responds robustly in 98% of participants across pain types, correlates with perceived intensity of visceral pain and discomfort, and shows specificity to pain when compared with cognitive and affective conditions from twelve additional studies (N = 180). Pre-defined signatures for non-pain negative affect do not respond to visceral pain. The visceral versus the somatic classifier reliably distinguishes somatic (thermal) from visceral (rectal) stimulation in both cross-validation and independent cohorts. Other pain types reflect mixtures of somatic and visceral patterns. These results validate the NPS as measuring a common core nociceptive pain system across pain types, and provide a new classifier for visceral versus somatic pain.

There has been little comparative, cross-cultural research on sexual difficulties and associated distress, and factors associated with these, among older women. Therefore, the aim of this study was to investigate prevalence rates of sexual difficulties, distress related to these difficulties, and associated sociodemographic, relational, and health factors, among sexually active older women (60-75 years) in committed relationships across four European countries (Norway, Denmark, Belgium, and Portugal). These data could inform us about what differentiates women who do and do not experience distressing sexual difficulties and facilitate the identification of older women who might benefit from clinical interventions as well as the development of new interventions. In total, 1057 women (357 Norwegian; 322 Danish; 237 Belgian; 141 Portuguese) completed a cross-sectional questionnaire assessing six sexual difficulties-vaginal dryness, orgasmic difficulties, lacking interest in sex, lacking enjoyment in sex, pain during sex, and no excitement/arousal during sex-and associated distress. We found a high prevalence of sexual difficulties lasting 3 months or longer in the past year (between 23.5 and 50.2%, depending on the specific difficulty). With the exception of vaginal dryness and pain during sex, however, the majority of women reporting sexual difficulties (50.0% to 86.1%, depending on the specific difficulty) reported no or mild distress. There were relatively few cross-country differences, either in the prevalence of sexual difficulties or related distress. Few sociodemographic or health variables were associated with distressing sexual difficulties, but higher sexual intimacy, higher emotional intimacy, and better mental health were associated with less distress about some sexual difficulties. The findings underline the importance of healthcare professionals asking older women about sexual function and especially associated distress, and suggest that careful attention to the psychological and relationship context of these sexual difficulties is needed, as these could be important targets in the treatment process.

In psychosocial migration literature, the perspective of ambiguous loss has been relevant to articulate personal and relational experiences in the context of transnational families and ongoing separation. Most studies have focused on adult members' experiences of transnational families, but research exploring ambiguous loss in adolescents whose parents have migrated is still lacking. The present study aimed to explore adolescents' lived experiences of parental migration. In a pilot explorative study, 14 adolescents with at least one parent who migrated were interviewed about their lived experiences of transnational parent-child relationships and ongoing parent-child separation. Data analysis identified four themes in participants' accounts: practices of separation creating confusion; current relationship with migrant parents permeated by ambiguity; distrustful representations of migrant parents; and family and social dynamics reactivating the pain of loss. The findings reveal how in the context of parental migration, patterns of separation and ongoing relational processes, compounded by the uncertainty of reunification and an exclusionary social fabric, constitute core elements that shape adolescents' lived experiences of parent-child relationships characterized by ambiguity., (© 2019 Family Process Institute.)

In an attempt to extend our understanding of how social contexts co-create female sexuality in Latin America, the aim of the current study was to explore the beliefs, views, and ideas about sexual assertiveness in Latino emerging adult women. Seventeen women between 22 and 30 years old living in Cuenca, Ecuador, participated in focus groups. A constructivist grounded theory approach was used to analyze the data. Findings suggest that the overall views about sexual assertiveness in emerging adult women can be grouped into five categories: (1) gender role schemata; (2) concerns about the partner's thoughts and reactions; (3) gendered attitudes towards the use of specific methods of contraception; (4) talking about sexual histories as a challenging task; and (5) replication of family patterns. The findings of this study are discussed within existing literature that highlights the influence of gender role schemata on sexual assertiveness. Finally, a plea for more culturally sensitive research is formulated as well as some educational - the need to reinforce sex education programs - and clinical - highlighting the ability to be sexually assertive from the start of a relationship - implications are mentioned.

Although palliative care nurses are identified as key players in supporting couples during advanced illness, there is a lack of evidence about their knowledge and experiences with this particular role. The aim of the study was to explore palliative care nurses' attitudes, roles, and experiences in addressing relationship functioning of couples in daily practice. A qualitative study was conducted using in-depth interviews, observational research, and peer debriefing groups with palliative care nurses in Flanders, Belgium. Nurses support relationship functioning by creating a couple-positive care environment, by being present/acknowledging feelings, and by rectifying imbalances between couples. They do so in a proactive way, backed up by team support. Nurses hesitate toward explicitly unraveling and intervening in relationship problems, in favor of providing comfort or offering a strengths-based approach. The findings offer an urgent call to enhance the educational programs for palliative care nurses by integrating the theories and practice frameworks that guide relational assessment and intervention, which are being used in family nursing.

Introduction: The African Copperbelt is a site of intense artisanal and industrial mining and refining of copper and cobalt. Anecdotal reports of erectile dysfunction (ED) among mineworkers in the area led us to conduct an explorative study to investigate the possible association between ED and working in mining-related jobs., Methods: We included 42 consecutive men (18-40 years) buying sildenafil (the active substance of Viagra) from a pharmacy located in a popular neighbourhood in Lubumbashi, and 42 age-matched (±2 years) men buying painkillers. All participants replied to questionnaires administered face-to-face to obtain sociodemographic data, including information on occupation, and a score of erectile function using the International Index of Erectile Function (IIEF6)., Results: The IIEF6 score (maximum 30) was lower among sildenafil-buyers (median 17, range 8-30) than among painkiller-buyers (median 30, range 17-30). The proportion of mining-related jobs was higher among sildenafil-buyers (19/42, 45%) than among painkiller-buyers (7/42, 17%), yielding an OR of 4.1 (95% CI 1.5 to 11.3; p=0.009). The proportion of mining-related jobs was higher among men with ED (defined as IIEF6 <26) (24/45, 54%) than among men without ED (2/39, 5%) (OR 21.1; 95% CI 4.5 to 98.4; p<0.001). Using a more stringent definition of ED (IIEF6 <22) gave similar results: 55% (20/36) of men with ED had a mining-related job versus 13% (6/48) of men without ED (OR 8.7; 95% CI 2.9 to 25.7; p=0.001)., Discussion: The findings of this preliminary study justify further epidemiological studies of the possible role of occupational exposures in the pathogenesis of male sexual dysfunction among miners and workers in the copper and cobalt industry., Competing Interests: Competing interests: PMO owns the pharmacy where the study took place., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Multimodal neuroimaging studies provide support for a role of alterations in sensory processing circuits and endogenous pain modulatory systems in provoked vestibulodynia (PVD). In this study, we tested the hypotheses that PVD compared with healthy controls (HCs) would demonstrate gray matter volume (GMV) alterations in regions associated with sensorimotor, corticothalamic, and basal ganglia circuits. We also tested the replicability of previously reported gray matter increases in basal ganglia and hippocampal volumes in PVD vs HCs. In addition, disease specificity of GMV alterations were examined by comparing PVD with another chronic pain disorder. Finally, we examine whether GMV alterations are correlated with symptom measures. Structural magnetic resonance imaging was obtained in 119 premenopausal women (45 PVD, 45 HCs, and 29 irritable bowel syndrome [IBS]). A voxel-based morphometry analysis was applied to determine group differences in the hypothesized regions of interest. Compared with HCs, PVD women exhibited greater GMV in the basal ganglia, hippocampus, and sensorimotor cortices. Compared to patients with IBS, women with PVD had greater GMV in the hippocampus, and sensorimotor network, but lower GMV in the thalamus and precentral gyrus. Regional GMV alterations were associated with patient reports of pain during intercourse and muscle tenderness. The current findings provide further evidence that GMV is increased in PVD compared with HCs in several regions of the sensorimotor network and the hippocampus in patients with PVD. In addition, GMV distinct alterations in the sensorimotor network were identified between 2 pelvic pain disorders, PVD compared with IBS.

Background: Pubic hair removal (PHR) is a widespread practice that entails certain health risks; however, there remains a lack of scientific information on the prevalence and antecedents of PHR, as well as on its association with sexual behavior and relational satisfaction., Aims: To explore women's and men's attitudes regarding PHR and their PHR practices and the associations with demographic, relational, and sexual characteristics., Methods: A total of 2,687 men and 1,735 women living in Flanders (the Northern part of Belgium) completed an online survey. Participants ranged in age from 15 to 60+ years; they self-identified as heterosexual, bisexual, or homosexual and reported various relationship statuses., Main Outcome Measures: Demographic items (ie, age, religion, partner relationship status), sexuality-related items (ie, sexual activity, sexual orientation, age at first intercourse, number of sexual partners), PHR items (ie, reasons, inclination to have or not have sex after PHR, perceived partner preferences, partner's PHR), and relationship satisfaction, assessed with the Maudsley Marital Questionnaire., Results: Fewer men (39.1%) than women (80.3%) reported (partially) removing their pubic hair. In both men and women, the practice was associated with age, sexual activity, relationship status, and partner's PHR practice and expectations. In men, sexual and relationship satisfaction were correlated with their partner's PHR practices and whether these were in line with the men's expectations. In women, sexual and relationship satisfaction were mostly correlated with whether both partner's expectations were met. Although both men and women reported that the reasons for PHR were related to their sexual experiences and to their partner's preference, only women reported that PHR was a way to enhance feelings of femininity. Finally, the reasons for not engaging in PHR were related to partner preferences and side effects., Conclusion: PHR is a widespread practice and seems strongly associated with personal, partner-related, sexual, and relational factors. Strategies to prevent men and women from being confronted with health risks should take all these factors into account. Enzlin P, Bollen K, Prekatsounaki S, et al. "To Shave or Not to Shave": Pubic Hair Removal and Its Association with Relational and Sexual Satisfaction in Women and Men. J Sex Med 2019;16:954-962., (Copyright © 2019 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.)

While not all sexual difficulties cause distress, research and clinical experience suggest that, apart from personal distress, partner and relational sexual distress are also often an important reason to seek professional help. The current study explored the associations between personal, perceived partner, and relational distress that men and women experience as a result of sexual difficulties. Data from heterosexual Flemish individuals ages 16 to 74 who were in a relationship (13,800 men and 13,242 women, mean age of 43.69, SD = 14.94) were collected via an online survey. Presence and severity of sexual difficulties and associated personal, perceived partner, and relational sexual distress were assessed. Among men and women with desire difficulties, either the three types of sexual distress were almost equally common or partner distress was most common. Arousal, orgasm, and sexual pain difficulties were most often associated with personal distress, particularly in men. Both men and women, however, most commonly reported that they experienced all three types of distress. These results are discussed in relation to Western gender-specific sexual scripts. Clinical implications and the importance of couples therapy and suggestions for clinically useful diagnostic criteria are presented.

Objective: To compare hysterectomy by transvaginal natural orifice transluminal endoscopic surgery (vNOTES) versus total laparoscopic hysterectomy (TLH) as a day-care procedure., Design: Parallel group, 1:1 randomised single-centre single-blinded trial, designed as a non-inferiority study with a margin of 15%., Setting: Belgian teaching hospital., Population: Women aged 18-70 years scheduled to undergo hysterectomy for benign indications., Methods: Randomisation to TLH (control group) or vNOTES (experimental group). Stratification according to uterine volume. Blinding of participants and outcome assessors., Main Outcome Measures: The primary outcome was hysterectomy by the allocated technique. We measured the proportion of women leaving within 12 hours after hysterectomy and the length of hospital stay as secondary outcomes., Results: We randomly assigned 70 women to vNOTES (n = 35) or TLH (n = 35). The primary endpoint was always reached in both groups: there were no conversions. We performed a sensitivity analysis for the primary outcome, assuming one conversion in the vNOTES group and no conversions in the TLH group: the one-sided 95% upper limit for the differences in proportions of conversion was estimated as 7.5%, which is below the predefined non-inferiority margin. More women left the hospital within 12 hours after surgery after vNOTES: 77 versus 43%, difference 34% (95% CI 13-56%), P = 0.007. The hospital stay was shorter after vNOTES: 0.8 versus 1.3 days, mean difference -0.5 days, (95% CI -0.98 to -0.02), P = 0.004., Conclusions: vNOTES is non-inferior to TLH for successfully performing hysterectomy without conversion. Compared with TLH, vNOTES may allow more women to be treated in a day-care setting., Tweetable Abstract: RCT: vNOTES is just as good as laparoscopy for successful hysterectomy without conversion but allows more day-care surgery., (© 2018 Royal College of Obstetricians and Gynaecologists.)

While the interactive nature of sexual desire in women is increasingly recognized, dyadic factors affecting it, including partner interactions, have as yet received little research attention. In this cross-sectional study, we examined the associations among intimacy, celebrated otherness, and object-of-desire affirmation and explored how they complement each other in the prediction of sexual desire in women. Based on the reports of 662 participants, positive correlations were found among all factors. However, in a multiple regression analysis, object-of-desire affirmation emerged as the only positive predictor of sexual desire.

Aim: To explore palliative care nurses' attitudes, roles and concrete experience with regard to addressing sexual issues in their daily practice., Background: Patients and their partners in palliative care might experience dramatic changes in their sexuality and want nurses to provide the opportunity to address them. Moreover, it is argued that the holistic philosophy of palliative care encourages nurses working in this area to include sexual issues in their daily care. It is, however, unknown how palliative care nurses address sexual issues., Design: A generic qualitative study was performed., Methods: In total, 21 in-depth interviews were done with nurses from different facilities of palliative care networks in Flanders. Data were collected between September 2014 - September 2016 and thematic analysis was used to analyse the data., Results: It was found that the way palliative care nurses addressed sexual issues was clearly influenced by their own interpretation of the philosophical principles underlying palliative care. The different interpretations of these basic principles create tensions for nurses about how to address sexual issues in the daily practice of palliative care and nurses vary in their reactions to these tensions. The present findings show that palliative care nurses - when they were able to overcome these tensions - use a "sex-positive approach" that fits with their tendency to focus on quality of life., Conclusion: Out of the results of this study, we made a list of good practices for palliative care nurses addressing sexual issues. This list can be used in nursing educational programs., (© 2018 John Wiley & Sons Ltd.)

Introduction: Natural orifice transluminal endoscopic surgery (NOTES) uses natural orifices to access the cavities of the human body to perform surgical interventions. NOTES limits the magnitude of surgical trauma and potentially reduces postoperative pain. Our group published a protocol on a randomised study comparing transvaginal NOTES (vNOTES) versus laparoscopy for hysterectomy (HALON). We simultaneously designed a similar randomised controlled trial (RCT) comparing vNOTES with laparoscopy for adnexectomy. To the best of our knowledge, this is the first RCT comparing vNOTES with laparoscopy for adnexal surgery., Methods and Analysis: The methodology of the Notes Adnexectomy for Benign Indication versus Laparoscopic Excision (NOTABLE) study is similar to that of the HALON trial. Women aged 18-70 years with an indication for benign adnexal surgery will be eligible. We will use stratification according to adnexal size. Entrants will be randomised to the laparoscopic treatment (control) or vNOTES (intervention). Participants will be evaluated on days 0-7 and at 3 and 6 months. The primary outcome will be the proportion of women successfully treated by removing an adnexa by the allocated technique without conversion. We will collect the following data (secondary outcomes): proportion of women hospitalised on the day of surgery, postoperative pain scores measured two times per day from day 1 to 7, total dosage of pain killers used from day 1 to 7, hospital readmission during the first 6 weeks, dyspareunia and sexual well-being at baseline, 3 and 6 months using a validated questionnaire (Short Sexual Functioning Scale), health-related quality of life at baseline, 3 and 6 months after surgery using a validated questionnaire (EQ-5D-3L), duration of surgical intervention, infection or other surgical complications and direct costs up to 6 weeks following surgery. For the primary outcome measure, a one-sided 95% CI of the difference in the proportions of women with a successful removal of the uterus by the randomised technique will be estimated. Non-inferiority will be concluded when 15% lies above the upper limit of this 95% CI., Ethics and Dissemination: The study was approved on 1 December 2015 by the EthicsCommitteeof the Imelda Hospital (registration no: 689), Bonheiden, Belgium. We aim to present the final results of the NOTABLE trial in peer-reviewed journals and at scientific meetings within 4 years after the start of the recruitment., Trial Registration Number: NCT02630329., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Aims: The identification and discussion of sexual care needs in people with type 2 diabetes mellitus (T2DM) in primary care is currently insufficient. The objective of this study was to determine the prevalence of sexual dissatisfaction, sexual problems and need for help by using a screening instrument among people with T2DM in primary care., Methods: Data were collected in 45 general practices in the Netherlands from January 2015 to February 2016. The Brief Sexual Symptom Checklist (BSSC) was used to screen among 40-75 year old men and women., Results: In total, 786 people with T2DM (66.5% men) were screened. The prevalence of sexual dissatisfaction was 36.6%, significantly higher among men than among women (41.1% vs. 27.8%). Sexually dissatisfied men most often reported erectile dysfunction (71.6%); for sexually dissatisfied women, low sexual desire (52.8%) and lubrication problems (45.8%) were most common. More than half of all dissatisfied people had a need for care (61.8%), significantly more men than women (66.8% vs. 47.2%)., Conclusions: One third of people with T2DM is sexually dissatisfied and more than half of these people report a need for help. The BSSC could be used a tool to proactively identify sexually dissatisfied people in primary care., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Objective: In DSM-5, pain-related fear during anticipation of vaginal penetration is a diagnostic criterion of Genito-Pelvic Pain/Penetration Disorder (GPPPD). We aimed to investigate subjective and brain responses during anticipatory fear and subsequent induction of vestibular pain in women with GPPPD., Methods: Women with GPPPD (n = 18) and age-matched healthy controls (HC) (n = 15) underwent fMRI scanning during vestibular pain induction at individually titrated pain threshold after a cued anticipation period. (Pain-related) fear and anxiety traits were measured with questionnaires prior to scanning, and anticipatory fear and pain intensity were rated during scanning using visual analog scales., Results: Women with GPPPD reported significantly higher levels of anticipatory fear and pain intensity. During anticipation and pain induction they had stronger and more extensive brain responses in regions involved in cognitive and affective aspects of pain perception, but the group difference did not reach significance for the anticipation condition. Pain-related fear and anxiety traits as well as anticipatory fear ratings were positively associated with pain ratings in GPPPD, but not in HC. Further, in HC, a negative association was found between anticipatory fear ratings and brain responses in regions involved in cognitive and affective aspects of pain perception, but not in women with GPPPD., Conclusions: Women with GPPPD are characterized by increased subjective and brain responses to vestibular pain and, to a lesser extent, its anticipation, with fear and anxiety associated with responses to pain, supporting the introduction of anticipatory fear as a criterion of GPPPD in DSM-5.

Objective: To critically appraise studies comparing benefits and harms in women with benign disease without prolapse undergoing hysterectomy by natural orifice transluminal endoscopic surgery (NOTES) versus laparoscopy., Study Design: We followed the PRISMA guidelines. We searched MEDLINE, EMBASE and CENTRAL for randomised controlled trials (RCTs), controlled clinical trials (CCTs) and cohort studies comparing NOTES with laparoscopy assisted vaginal hysterectomy (LAVH) or total laparoscopic hysterectomy (TLH) in women bound to undergo removal of a non-prolapsed uterus for benign disease. Two authors searched and selected studies, extracted data and assessed the risk of bias independently. Any disagreement was resolved by discussion or arbitration., Results: We did not find RCTs but retrieved two retrospective cohort studies comparing NOTES with LAVH. The study quality as assessed by the Newcastle-Ottawa scale was acceptable. Both studies reported no conversions. The operative time in women treated by NOTES was shorter compared to LAVH: the mean difference (MD) was -22.04min (95% CI -28.00min to -16.08min; 342 women; 2 studies). There were no differences for complications in women treated by NOTES compared to LAVH: the risk ratio (RR) was 0.57 (95% CI 0.17-1.91; 342 women; 2 studies). The length of stay was shorter in women treated by NOTES versus LAVH: the MD was -0.42days (95% CI -0.59days to -0.25days; 342 women; 2 studies). There were no differences for the median VAS scores at 12h between women treated by NOTES (median 2, range 0-6) or by LAVH (median 2, range 0-6) (48 women, 1 study). There were no differences in the median additional analgesic dose request in women treated by NOTES (median 0, range 0-6) or by LAVH (median 1, range 0-5) (48 women, 1 study). The hospital charges for treatment by NOTES were higher compared to LAVH: the mean difference was 137.00 € (95% CI 88.95-185.05 €; 294 women; 1 study)., Conclusions: At the present NOTES should be considered as a technique under evaluation for use in gynaecological surgery. RCTs are needed to demonstrate its effectiveness., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Introduction: Although impaired sexual function is relatively common, not all sexual impairments are associated with distress. To date, most studies on protective and risk factors for sexual distress have asked about distress in a more general manner and have failed to distinguish different dimensions of sexual distress., Aim: To examine the association of several intra- and interpersonal factors with personal, perceived partner, and interpersonal distress due to an impairment in sexual functioning in women., Methods: This study is a cross-sectional representative population-based survey with a two-level random selection of Flemish women 14 to 80 years old from the Belgian National Register. The data of 520 sexually active heterosexual women with a partner (weighted N) and impairment in sexual desire (n = 291) and/or sexual arousal (n = 273) were used for analysis., Main Outcome Measures: Demographic information was obtained, and the five-item Mental Health Inventory, the Marital Adjustment subscale of the Maudsley Marital Questionnaire, and the four-item Dyadic Sexual Communication Questionnaire were used. Presence and severity of sexual impairments and associated sexual distress were assessed using the Sexual Functioning Scale., Results: Severity and number of sexual impairments were predictive of all types of sexual distress. Also, for desire and arousal impairments, lower mental well-being predicted personal distress, and lower relationship satisfaction predicted perceived partner distress. For desire impairments, lower relationship satisfaction and less communication about sexual needs were predictive of interpersonal distress. For impairments in sexual arousal, lower mental well-being and lower relationship satisfaction were predictive of interpersonal distress., Conclusion: Personal, perceived partner, and interpersonal distress due to sexual impairments have different types of predictors. Clinical assessment and treatment could benefit from differentiating between different types of distress and the intra- and interpersonal factors that are associated with them., (Copyright © 2016 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.)

Introduction: Natural orifice transluminal endoscopic surgery (NOTES) uses natural body orifices to access the cavities of the human body to perform surgery. NOTES limits the magnitude of surgical trauma and has the potential to reduce postoperative pain. This is the first randomised study in women bound to undergo hysterectomy for benign gynaecological disease comparing NOTES with classical laparoscopy., Methods and Analysis: All women aged 18-70 years, regardless of parity, consulting at our practice with an indication for hysterectomy due to benign gynaecological disease will be eligible. After stratification according to uterine size on clinical examination, participants will be randomised to be treated by laparoscopy or by transvaginal NOTES. Participants will be evaluated on day 0, days 1-7 and at 3 and 6 months. The following data will be collected: the proportion of women successfully treated by removing the uterus by the intended approach as randomised; the proportion of women admitted to the inpatient hospital; postoperative pain scores measured twice daily by the women from day 1 to 7; the total amount of analgesics used from day 1 to 7; readmission during the first 6 weeks; presence and intensity of dyspareunia and sexual well-being at baseline, 3 and 6 months (Short Sexual Functioning Scale (SSFS) scale); duration of surgery; postoperative infection or other surgical complications; direct and indirect costs incurred up to 6 weeks following surgery. The primary outcome will be the proportion of women successfully treated by the intended technique; all other outcomes are secondary., Ethics and Dissemination: The study was approved on 1 December 2015 by the Ethics Committee of the Imelda Hospital, Bonheiden, Belgium. The first patient was randomised on 17 December 2015. The last participant randomised should be treated before 30 November 2017. The results will be presented in peer-reviewed journals and at scientific meetings within 4 years after starting recruitment., Trial Registration Number: NCT02631837; Pre-results., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Sexual dysfunction is highly prevalent among patients with type 2 diabetes; however, little is known regarding these patients' needs and preferences for care for sexual problems. A cross-sectional survey and 25 semistructured interviews were therefore conducted among 40- to 75-year-old type 2 diabetes patients to explore this. We learned from the survey and interviews that most participants were unaware of the association between type 2 diabetes and sexual problems. Although certain barriers for discussing sexual problems with a care provider were identified (e.g., feelings of embarrassment), patients still reported a need for discussing their problems, because sex was viewed as an important part of their relationship. Some patients had sought help, but were dissatisfied with the offered care. Patients experienced a lack of attention and information from diabetes care providers. Improving this, together with a care provider-initiated conversation, was suggested to lower the threshold for discussion. Moreover, patients preferred a care provider with whom they have a close relationship, whereas age, gender, and medical specialty were regarded to be less important. An important recommendation was to make care for sexual problems an integral part of routine diabetes care. Future research should look into these recommendations.

Introduction: Because severity and duration of sexual impairment and any distress caused by the sexual impairment are not assessed in most epidemiologic studies on sexual dysfunction, the available prevalence rates are probably an overestimation., Aims: To provide prevalence estimates of severe and persistent sexual difficulties that cause personal distress and to explore the association between personal sexual distress and avoidance of sex, help-seeking behavior, and sexual satisfaction., Methods: This study used home-based computer-assisted personal interviewing and computer-assisted self-interviewing of a representative, randomly selected, population-based cross-sectional sample of 651 Flemish men and 695 women 14 to 80 years old., Main Outcome Measures: Prevalence of sexual difficulties, prevalence of sexual dysfunctions (ie, sexual difficulties causing personal distress), and association of sexual distress with avoidance of sex, help-seeking behavior, and sexual satisfaction., Results: In this sample, 43.5% of women (95% CI =39.7-47.3) and 34.8% of men (95% CI =31.3-38.3) reported a moderate to severe sexual difficulty. When considering the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (ie, minimum duration of 6 months and presence of personal sexual distress), prevalence rates decreased to 19.0% in women (95% CI =16.0-22.0) and to 15.1% in men (95% CI =12.4-17.8). Sexual distress was associated with more sexual dissatisfaction and greater sexual avoidance. Sexual distress also was associated with help-seeking behavior, although most individuals with distressing sexual difficulties had not sought help., Conclusion: Although sexual difficulties per se are quite prevalent, severe and persistent sexual difficulties causing sexual distress are far less common. Despite sexual distress being associated with avoidance of sex and lower sexual satisfaction, most people tend not to seek help for their sexual problem, even when being distressed by the problem., (Copyright © 2016 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.)

Purpose: This study aimed to: (a) investigate whether, and if so which, sexual problems are present in people with a limb amputation; (b) analyze how they experience their sexuality; and (c) investigate whether sexuality was discussed with them during their rehabilitation process., Method: In total, 301 participants completed a survey consisting of a questionnaire on participant characteristics, the Hospital Anxiety and Depression Scale (HADS), the Maudsley Marital Questionnaire (MMQ), the Amputee Body Image Scale (ABIS), the Questionnaire about Sexual Counselling, the Questionnaire about Sexuality and the Short Sexual Functioning Scale (SSFS)., Results: Overall, 20% of the participants experienced one or more sexual dysfunction(s). Participants who had at least one sexual dysfunction were more likely to be male, had an amputation more recently, and had a more negative body image. Moreover, sexuality was only scantly discussed by rehabilitation professionals., Conclusions: Sexual problems and sexual dysfunctions do occur in people with a limb amputation, but these problems are not discussed during the rehabilitation process. Justice for a person's "whole body" can only be served when sexuality is taken seriously in rehabilitation care in order to avoid cutting sexuality out of an amputee's life. Implications for Rehabilitation People with a limb amputation may be confronted with sexual problems and/or sexual dysfunctions. It is therefore important that sexuality is taken seriously as a part of standard rehabilitation care and that professionals bring up the issue of sexuality during the rehabilitation process.

Previous studies have indicated that women with diabetes mellitus are at higher risk to develop sexual dysfunctions. In the current study, we hypothesized that lower genital arousal response-as a consequence of diabetes-related damage to nerves and blood vessels-might play a part in these higher prevalence rates. Vaginal blood flow, subjective sexual response, and clitoral sensitivity were compared between women with diabetes and healthy controls, and associations with diabetes complications were investigated. In pre- and postmenopausal women with type 1 diabetes (n = 42) and healthy controls (n = 46), vaginal blood flow was measured as vaginal pulse amplitude (VPA). VPA was assessed at rest, during erotic film viewing, and during vibrotactile clitoral stimulation. Subjective sexual arousal was measured using a questionnaire. Clitoral sensitivity was assessed by a vibration perception test. Data on diabetes complications were obtained from medical records, and neuropathy was assessed by quantitative sensory testing. VPA, subjective sexual arousal, and clitoral sensitivity were not significantly different between women with diabetes and controls. Nevertheless, women with diabetes who had retinopathy showed significantly lower VPA than women without retinopathy, and women with diabetes who had neuropathy showed significantly higher sensation thresholds for vibrotactile clitoral stimulation. The results do not support the hypothesis of a disrupted genital arousal response in women with diabetes. However, the observed associations between retinopathy and vaginal blood flow, and between neuropathy and clitoral sensitivity, suggest that diabetes-related complications might adversely affect the physiological basis of female sexual response.

Background: Sexual dysfunction is prevalent in patients with type 2 diabetes mellitus, but remains one of the most frequently neglected complications in diabetes care. Both patients and care providers appear to have difficulty with discussing sexual problems in diabetes care. A sexual counselling model for care providers, such as the PLISSIT model, might be a useful tool to improve the discussion of sexual issues in patients with type 2 diabetes mellitus. PLISSIT stands for Permission, Limited Information, Specific Suggestions, and Intensive Therapy. Even though the use of the PLISSIT model has often been recommended in diabetes care, no evidence with regards to its effectiveness in patients with type 2 diabetes mellitus exists. This study describes the design of a cluster-randomised controlled trial evaluating the effectiveness of a PLISSIT-model intervention in men and women with type 2 diabetes mellitus in primary care., Methods/design: Patients with type 2 diabetes mellitus, aged 40-75 years, who indicate to be dissatisfied about their sexual functioning and that they would like to talk about their sexual problem(s) with their general practitioner are recruited. All participants receive an information leaflet from the practice nurse. In the intervention group, each participant will also receive sexual counselling based on the PLISSIT model from their general practitioner. In the control group, usual care will be provided to those participants requesting an appointment with their general practitioner when the information leaflet was not deemed sufficient. Primary outcomes include sexual functioning, satisfaction about sexual function, and quality of life. Secondary outcomes are depressive symptoms, sexual distress, emotional well-being, and treatment satisfaction. Outcomes will be measured by means of self-report questionnaires at baseline, and after 3 and 12 months post-baseline. Treatment satisfaction will be assessed in telephone interviews., Discussion: This paper describes the design of a cluster-randomised controlled trial that will investigate the effectiveness of a PLISSIT-model intervention in patients with type 2 diabetes mellitus in primary care. Our study will add important and currently missing insight into the effectiveness of PLISSIT on important patient-reported outcomes of men and women with type 2 diabetes mellitus., Trial Registration: Dutch Trial Registry NTR4807 .

While there has been considerable inquiry into how religion may help Christians deal with stressful life events (SLEs), only limited research has been conducted on the impact SLEs might have on religion. This study's purpose was to provide an in-depth analysis of this relationship in a sample of highly religious Christians of Chinese origin. In-depth qualitative interviews were conducted with 11 Chinese couples residing in Belgium, and a conceptual model was created to describe how SLEs impact religiosity and how religion influences people's coping processes. Results indicated that for highly religious Chinese Christians, an SLE may represent a faith-growth opportunity.

Introduction: While there is increasing interest in studying aspects of communication processes in sex research, the association between dyadic sexual communication and relationship and sexuality outcomes has not yet been examined in pre-menopausal women with dyspareunia., Aim: To examine the associations between dyadic sexual communication and pain, sexual distress, sexual function and dyadic adjustment in women with self-reported dyspareunia and their male partners., Methods: Pre-menopausal women (n=38; M age=24.92, SD=6.12) with self-reported dyspareunia from a community sample and their partners (n=38; M age=26.71, SD=6.59) completed an online survey. The Actor-Partner Interdependence Model was used in order to investigate both actor and partner effects., Main Outcome Measures: Both members of the couple completed: (i) the Dyadic Sexual Communication Scale and (ii) the Dyadic Adjustment Scale; women also completed (iii) the Female Sexual Function Index, (iv) the Female Sexual Distress Scale, and (v) a Visual Analogue Scale on pain during intercourse; and men also completed (vi) the International Index of Erectile Functioning., Results: Controlling for relationship duration, women's better dyadic sexual communication was significantly associated with their higher levels of sexual function (P=0.028), lower levels of sexual distress (P=0.003) and higher levels of dyadic adjustment (P=0.005), but not with their pain or men's sexual function or dyadic adjustment. Controlling for relationship duration, men's better dyadic sexual communication was associated with their higher levels of dyadic adjustment (P=0.027) but not with their sexual function, nor with women's sexual function or dyadic adjustment., Conclusions: These findings contribute to the theoretical knowledge on interaction processes in couples with dyspareunia and suggest that it may be important to enhance open and direct communication about sexual matters in couples with dyspareunia., (© 2014 International Society for Sexual Medicine.)

Introduction: Although age-related prevalence rates of female sexual difficulties, i.e., difficulties with sexual desire, arousal, orgasm, or pain have occasionally been studied-with mostly inconsistent results-the age-related prevalence rates of female sexual dysfunctions, i.e., sexual difficulties that are associated with sexual distress, have not. Moreover, the association of age with sexual distress, i.e., distress due to sexual difficulties, has almost completely been neglected in epidemiological research., Aims: The aims of the present study were to provide age-related prevalence estimates of sexual difficulties and sexual dysfunctions and to provide proportions of participants reporting sexual distress in heterosexual women., Methods: An online survey comprising on sexual difficulties (i.e., low sexual desire, lack of responsive sexual desire, difficulties with lubrication, lack of subjective sexual arousal, absent or delayed orgasm, and dyspareunia) and associated sexual distress that enables us to classify respondents with sexual dysfunctions., Main Outcome Measure: Sexual Functioning Scale., Results: A total of 15,048 heterosexual women aged 16-74 years living in Flanders (the Nothern, Dutch-speaking part of Belgium) completed the online survey. This study revealed that all sexual difficulties and all sexual dysfunctions are significantly associated with age in women. Although most sexual difficulties and sexual dysfunctions increase with age, some display a U-shaped association with age. Furthermore, it was found that-except for lubrication difficulties-sexual distress was also significantly associated with age and that sexual distress is more common in younger women., Conclusion: The association between age and sexual difficulties, sexual dysfunctions, and sexual distress in women is complex and deserves more attention from scholars., (© 2014 International Society for Sexual Medicine.)

This study aimed to explore how asexual women experience their asexual identity, sexuality, and relationships. The authors recruited participants through the Asexuality Visibility and Education Network's website and posts on several health- and lifestyle-related websites. Interviewees were 9 women between 20 and 42 years of age. Data were collected through semi-structured interviews and analyzed using interpretative phenomenological analysis. The authors discuss 3 main themes that arose from the data: coming to an (a)sexual identity, experiencing physical intimacy and sexuality, and experiencing love and relationships. Participants described how they have always felt different and how they experienced their process of coming out. The authors found a great variation in the experience of (a) sex and physical intimacy and (b) love and relationships. Engaging in sexual behavior was mainly based on a willingness to comply with partner wishes. Whereas some longed for a relationship, aromantic asexual women did not. Some participants separated love from sex. Theoretical and clinical implications of these findings are discussed.

This study aimed to assess the prevalence and correlates of sexual dysfunction in a sample of Dutch men and women with type 2 diabetes. Patients with type 2 diabetes who were between the ages of 40 and 75 years from 4 Dutch diabetes centers were asked to complete self-report questionnaires covering sociodemographic characteristics, medical characteristics, clinical depression (Center for Epidemiological Studies), and sexual dysfunction (in men: International Index of Erectile Function; in women: Female Sexual Function Index). In total, 158 type 2 diabetes patients (68% men) completed the cross-sectional survey. On the basis of predefined criteria, 69% of men and 70% of women were classified with some degree of sexual dysfunction. Univariable logistic regression analyses revealed that sexual dysfunctions were associated with higher age, clinical depression (Center for Epidemiological Studies score ≥16), and one or more diabetes-related complications in both men and women. Multivariable logistic regression analyses revealed that clinical depression was most strongly associated with both male (OR = 6.87, 95% CI [1.77, 26.63]) and female (OR = 9.33, 95% CI [1.03, 84.87]) sexual dysfunction. In conclusion, sexual dysfunction is highly prevalent in men and women with type 2 diabetes and is associated with higher age, clinical depression, and diabetes-related complications. These results suggest that addressing sexual dysfunction in diabetes care is important.

Introduction: Endometrial cancer (EC) can affect sexual functioning based on anatomical, physiological, psychological, and relational mechanisms., Aim: The aim of this study was to prospectively investigate sexual adjustment of women with EC during a follow-up period of 2 years after surgical treatment and to compare the results with women who underwent a hysterectomy for a benign gynecological condition and healthy control women., Methods/main Outcome Measures: In this prospective controlled study, participants completed the Short Sexual Functioning Scale, Specific Sexual Problems Questionnaire, Beck Depression Inventory Scale, World Health Organization-5 Well-being Scale, and Dyadic Adjustment Scale to assess various aspects of sexual and psychosocial functioning before undergoing a hysterectomy and 6 months, 1 year, and 2 years after surgery., Results: Eighty-four women with EC, 84 women with a benign gynecological condition, and 84 healthy controls completed the survey. In EC survivors, no differences were found in sexual functioning during prospective analyses. In comparison with women with a benign gynecological condition, significantly more EC patients reported entry dyspareunia 1 year after surgical treatment. Moreover, compared with healthy women, pre- and postoperatively, significantly more EC patients reported sexual dysfunctions, including sexual desire dysfunction, arousal dysfunction, entry dyspareunia, and a reduced intensity of orgasm. Furthermore, compared with healthy controls, EC patients reported significantly lower overall well-being 1 year after surgical treatment. Nevertheless, consensus in the partner relationship was significantly higher in EC patients compared with healthy controls. Moreover, before treatment, quality of partner relationship was negatively associated with sexual arousal dysfunction and orgasm dysfunction., Conclusions: In EC patients, no differences were found in sexual functioning when prospectively comparing the situation before surgery with the situation after surgery. However, when compared with healthy controls, EC patients are at high risk for sexual dysfunctions, both before and after surgical treatment., (© 2014 International Society for Sexual Medicine.)

Purpose: Following a lower limb amputation, people may experience limitations in performing sexual activities. However, only little research efforts have been devoted to unravel how people experience their sexuality after such an amputation. Therefore, the purpose of the current study is to describe how people with a lower limb amputation experience (changes in) their sexual functioning and sexual well-being., Methods: A qualitative approach with semi-structured interviews was used., Results: In total 26 interviews with persons with a lower limb amputation were performed. Thematic analysis of the data resulted in eight themes derived from the interviews: importance and description of sexuality; changes in sexual functioning; changes in sexual well-being; practical problems concerning sexuality; self-image; feelings of shame; role of the partner; communication about sexuality with professionals., Conclusions: Participants in this study indicated some problems concerning sexual functioning and/or sexual well-being. Some of these problems were of practical nature, and participants would have appreciated some information about how to handle this kind of practical sexual problems. However, such information should not be given at the beginning of the rehabilitation process, as at that time sexuality is not a priority for all patients.

While lack of sexual attraction, lack of sexual behavior, and self-identification as asexual have been used as criteria to define asexuality, it is not known how much they overlap in describing the same group of people. This study aimed to assess how many individuals could be identified as asexual based on each of these criteria and on combinations of these criteria. Participants were recruited through the Asexuality Visibility and Education Network, social media, and posts on several health- and lifestyle-related websites. In total, 566 participants between 18 and 72 years old (M = 27.86, SD = 10.53) completed an online survey (24% male, 68.9% female, 7.1% "other"). Based on self-identification or lack of sexual attraction, 71.3% and 69.2%, respectively, of participants were categorized as asexual, while based on lack of sexual behavior only 48.5% were categorized as asexual. Gender differences were found only for those participants who indicated that they did not experience sexual attraction, with more women (72.8%) than men (58.8%) indicating a lack of sexual attraction. Given that self-identification as asexual implies familiarity with the term asexual, we argue for the use of lack of sexual attraction as the primary criterion to define asexuality.

Objective: Women with cervical cancer (CC) may be faced with changes in sexual functioning resulting from the cancer itself and/or its surgical treatment. The aims of this study were to prospectively investigate sexual adjustment of CC patients during a follow-up period of 2 years after radical hysterectomy without adjuvant treatment and to compare the results with women who underwent a hysterectomy for a benign gynecological condition and with healthy control women., Methods: In this prospective controlled study, participants completed the Short Sexual Functioning Scale, Specific Sexual Problems Questionnaire, Beck Depression Inventory Scale, World Health Organization-5 Well-Being Scale, and Dyadic Adjustment Scale to assess various aspects of sexual and psychosocial functioning at certain time intervals, namely, before surgery and 6 months, 1 year, and 2 years after surgical treatment., Results: Thirty-one women with CC, 93 women with a benign gynecological condition, and 93 healthy controls completed the survey. In CC survivors, no differences were found in sexual functioning during prospective analyses and in comparison with women with a benign gynecological condition. However, compared with healthy women, preoperatively and postoperatively, significantly more CC patients reported sexual dysfunctions, including sexual arousal dysfunction, entry dyspareunia, deep dyspareunia, abdominal pain during intercourse, and reduced intensity of the orgasm. Furthermore, compared with healthy controls, CC patients reported worse psychological functioning before surgery and at 6 months after surgery. Finally, before surgery, quality of partner relationship was rated significantly better by CC patients compared with healthy controls; however, quality of the partner relationship declined during the first year of follow-up compared with the situation before surgery., Conclusions: In CC patients, no differences were found in sexual functioning when prospectively comparing the situation before and after surgery. However, when compared with healthy controls, CC patients are at high risk for sexual dysfunctions, both before and after surgical treatment.

Introduction: Breast cancer (BC) and/or its treatments may affect sexual functioning based on physiological and psychosocial mechanisms. The aim of this study was to prospectively investigate sexual adjustment of BC patients during a follow-up period of one year after mastectomy (ME) or breast conserving therapy (BCT)., Methods: In this prospective controlled study, women with BC and an age-matched control group of healthy women completed the Beck Depression Inventory Scale, World Health Organization 5 Well-being scale, Body Image Scale, EORTC QLQ questionnaire, Dyadic Adjustment Scale, Short Sexual Functioning Scale and Specific Sexual Problems Questionnaire to assess various aspects of sexual and psychosocial functioning before surgery, six months and one year after surgical treatment., Results: In total, 149 women with BC and 149 age-matched healthy controls completed the survey. Compared to the situation before surgery, significantly more BCT women reported problems with sexual arousal six months after surgery and significantly more women of the ME group reported problems with sexual desire, arousal and the ability to achieve an orgasm six months and one year after surgery. While in comparison with healthy controls, no significant differences in sexual functioning were found after BCT surgery, significantly more women who underwent ME reported problems with sexual desire, arousal, the ability to achieve an orgasm and intensity of the orgasm., Conclusions: Although little differences were seen in sexual functioning in the BCT group during prospective analyses and in comparison with healthy controls, analyses revealed that women who underwent a ME were at risk for post-operative sexual dysfunctions., (Copyright © 2014. Published by Elsevier Ltd.)

Introduction: Although research that takes into account partner and relationship factors in dyspareunia is slowly emerging, little is known about how these couples communicate about their sexuality. Additionally, partner psychosexual adjustment has not been examined in a controlled fashion., Aim: This study aimed to compare dyadic sexual communication, dyadic adjustment, psychological adjustment, and sexual well-being of women with self-reported dyspareunia and their partners with those of pain-free control women and their partners., Methods: Premenopausal women (n = 38; mean [M] age = 24.92) with self-reported dyspareunia, their partners (n = 38; M age = 26.71), as well as pain-free control women (n = 44; M age = 25.86) and their partners (n = 44; M age = 27.95) completed an online survey measuring dyadic sexual communication, dyadic adjustment, anxiety, depression, sexual functioning, and sexual distress., Main Outcome Measures: Assessments of women and men's (i) dyadic sexual communication; (ii) dyadic adjustment; (iii) anxiety; (iv) depression; (v) sexual functioning; and (vi) women's sexual distress were the main outcome measures., Results: Compared with pain-free controls, women with dyspareunia reported significantly poorer dyadic sexual communication, a difference not found between partners of women with dyspareunia and control partners. Compared with partners of control women, those of women with dyspareunia reported significantly more impaired sexual functioning. No differences in dyadic adjustment were found between women with dyspareunia and pain-free control women, or between their respective partners. Finally, compared with control women, those with dyspareunia reported significantly more impaired psychological and sexual well-being., Conclusions: Findings suggest that dyspareunia impacts not only the psychosexual adjustment of affected women but also that of their partners. It seems relevant to include both members of the couple in future research and treatment for dyspareunia., (© 2014 International Society for Sexual Medicine.)

Objective: Vulvectomy for vulvar malignancy can affect sexual functioning based on anatomic, physiologic, psychologic, and relational mechanisms. The aims of this study were to prospectively investigate sexual adjustment of women with vulvar malignancy during a follow-up period of 1 year after vulvectomy and to compare the results with healthy control women., Methods: In this prospective controlled study, participants completed the Beck Depression Inventory scale, World Health Organization-5 Well-being scale, Dyadic Adjustment Scale, Short Sexual Functioning Scale, and Specific Sexual Problems Questionnaire to assess various aspects of psychosocial and sexual functioning just before surgery, 6 months, and 1 year after treatment., Results: Twenty-nine women with vulvar malignancy and 29 healthy controls completed the survey. Compared with the presurgery status, no significant differences were found in psychologic, relational, and sexual functioning in women after surgery for vulvar malignancy. Compared with healthy control women, women with vulvar malignancy reported significantly lower psychologic well-being and quality of partner relationship, both before and after treatment. Moreover, significantly more patients with vulvar malignancy reported preoperative and postoperatively sexual dysfunctions than healthy controls, including entry and deep dyspareunia, abdominal pain during intercourse, reduced ability to achieve orgasm, and reduced intensity of orgasm., Conclusions: This prospective study yielded no differences in psychosocial and sexual functioning for women with vulvar malignancy before and after vulvectomy. However, when compared with healthy controls, patients with vulvar malignancy are at high risk for sexual dysfunctions, both before and after surgical treatment.

As most epidemiological surveys on sexual problems have not included assessment of associated distress, the principal aim of this study was to provide prevalence estimates of both DSM-IV-TR-defined (American Psychiatric Association [APA], 2000 ) and less commonly assessed sexual difficulties and dysfunction (e.g., lack of responsive sexual desire, lack of subjective arousal). A secondary aim was to obtain information about comorbidity between sexual desire and sexual arousal difficulties/dysfunction. This study comprised an online survey completed by 35,132 heterosexual Flemish men and women (aged 16 to 74 years). Results indicated that sexual dysfunctions were far less common than sexual difficulties, and some uncommonly assessed sexual problems (e.g., "lack of responsive desire" in women; "hyperactive sexual desire" in men) were quite prevalent. In women, there was a high comorbidity between "lack of spontaneous sexual desire" and "lack of responsive sexual desire"; between "lack of genital arousal" and "lack of subjective sexual arousal"; and between sexual desire and sexual arousal difficulties/dysfunctions. The implications of these findings for epidemiological research on sexual dysfunction and for the newly defined DSM-5 Female Sexual Interest/Arousal Disorder (APA, 2013 ) are discussed.

Although there has been increasing interest in asexuality during the past decade, still little is known on this topic. To define asexuality, three different approaches have been proposed: a definition that is based on sexual behavior, one on sexual desire/sexual attraction, one on self-identification, and one on a combination of these. Depending on the definition used, reported prevalence rates range from 0.6% to 5.5%. In this article, the authors present characteristics of asexuality and review biological, psychological, and sociodemographic factors associated with asexuality. Given the suggestion of existing overlap with hypoactive sexual desire disorder, special attention is paid to similarities and differences between this condition and asexuality. It is further noted that theoretical models to understand (the etiology) of asexuality are underdeveloped.

Aims and Objectives: To describe the impact of patients' lower limb amputations on their partners' sexual functioning and well-being., Background: Annually, about 3300 major lower limb amputations are performed in the Netherlands. An amputation may induce limitations in performing marital activities, including expression of sexual feelings between partners. However, up until now, little attention has been paid towards this aspect in both research and clinical practice. The lack of studies on sexual activities and lower limb amputation is even more apparent with respect to partners of patients with such an amputation. Previous studies have shown, however, that the presence of a disease or disability may have a large impact not only on the patient's but also on the partner's sexual activities., Design: Qualitative thematic analysis., Methods: Semi-structured interviews. The questions used in the interview were inspired by a generic framework about chronic disease and sexual functioning and well-being. In total, 16 partners of patients with a lower limb amputation who were at least 18 years old were recruited in different rehabilitation centres., Results: Seven major themes (i.e. importance of sexuality, thoughts about sexuality before the amputation, changes in sexual functioning and sexual well-being, amputation as the main cause of these changes, acceptance of the amputation, role confusion and communication about sexuality) were derived from the interviews. Minor changes in sexual functioning and sexual well-being were reported by the participants. Problems participants did encounter were solved by the couples themselves. For some participants, their sexual well-being improved after the amputation., Conclusion and Relevance to Clinical Practice: Participants in our study reported minor changes in their sexual well-being. Most of them indicated that communication about the changes expected and how to cope with these would have been helpful. It is therefore important that professionals address sexuality during the rehabilitation process with patients and partners., (© 2013 John Wiley & Sons Ltd.)

Study Question: Is there a difference between women with endometriosis who underwent laparoscopic surgery with bowel resection or without bowel resection regarding depressive symptoms, relational adjustment and sexual functioning?, Summary Answer: Radical surgery for endometriosis in both groups improved the levels of depression and sexual functioning, but only the bowel resection patients showed improvements in relationship satisfaction. WHAT IS KNOWN ALREADY?: The frequent pain symptoms in endometriosis patients can have an impact on psychological issues, relationships and sexual functioning. There are no data available on depression and relationship adjustment after endometriosis surgery. Sexual dysfunction problems have been described after bowel resection for rectal cancer, but no data are available for endometriosis surgery., Study Design, Size, Duration: This prospective cohort study included 203 consecutive women operated at the Leuven University Fertility Center (LUFC) between 1 September 2006 and 30 September 2008 for moderate (n = 67) or severe (n = 136) endometriosis. The preoperative response rate was respectively 84% in the bowel resection group and 79% in the no bowel resection group., Participants, Setting, Methods: The beck depression inventory (BDI) measured depression, the dyadic adjustment scale (DAS) measured relationship satisfaction and the short sexual functioning scale (SSFS) measured sexual functioning before and 6, 12 and 18 months after women had laparoscopic surgery at the LUFC, a tertiary referral centre for fertility exploration, treatment and surgery., Main Results and the Role of Chance: Both groups had better post-operative outcomes when compared with the preoperative assessments. Mean BDI and DAS levels were comparable with the normal population. Overall assessment points, the bowel resection patients had better outcomes for DAS (P < 0.05) and SSFS 'arousal' (P < 0.05) than the no bowel resection patients. At 6 months after the operation, when compared with the no bowel resection group, the bowel resection group reported lower mean levels of BDI (P < 0.05), a lower incidence of SSFS 'pain during intercourse' and 'orgasm problems' (P < 0.05), and a lower proportion of patients with severe orgasm problems (P < 0.05). The data show that radical but fertility sparing surgery, with or without bowel resection, for the treatment of endometriosis results in comparable and good psychological outcomes concerning depression levels, relationship satisfaction and sexual functioning., Limitations, Reasons for Caution: Although the initial response rate was good, response dropped over time and was significantly higher for bowel resection patients compared with the no bowel resection patients (P = 0.05). A responder/non-responder analysis for the whole study population showed no significant differences concerning pain problems. This reduces the possible risk of (positive) bias in the results., Wider Implications of the Findings: Endometriosis is a complex condition and the focus should not be on a one-dimensional end-organ gynaecological outcome, but should take into account the role of psychological factors in pain-related outcome. To this end, more prospective data are needed on sexual functioning and psychological outcomes.