Sildenafil and Female Sexual Dysfunction: Isn't it Time to Target the Right Candidates?

Female sexual arousal disorder (FSAD) is one of the subcategories of female sexual dysfunction (FSD). During recent years, many different chemical and herbal medicines have been introduced to the market by pharmaceutical companies targeting women who suffer sexual dysfunction. Notwithstanding, the majority of these medications failed to demonstrate their efficacy in experimental studies. Regarding the fact that men and women are increasingly becoming similar in terms of life style, familial and social responsibilities, etc, treating female sexual problems by the use of sildenafil citrate (Viagra) has become of interest to many physicians and professionals. This drug is a phosphodiesterase type 5 inhibitor and is commonly used for the treatment of erectile dysfunction. Evaluation of the effect of sildenafil on FSAD has yielded controversial results and still there is no unanimity on this issue. The focus of this review article is on the efficacy of sildenafil as a treatment for FSAD. Regarding the fact that women’s sexual dysfunction is a biopsychosocial disorder with a multifaceted etiology, it is proposed that the sole use of sildenafil may not be an effective treatment for FSAD. All aspects of female sexuality should be taken into account during evaluation of female sexual function and when therapeutic approaches for FSAD are introduced. As a matter of fact, women’s sexual problems may become worse and their self-confidence may be negatively affected if improper treatment approach is nominate

A research and evaluation capacity building model in Western Australia

Evaluation of public health programs, services and policies is increasingly required to demonstrate effectiveness. Funding constraints necessitate that existing programs, services and policies be evaluated and their findings disseminated. Evidence-informed practice and policy is also desirable to maximise investments in public health. Partnerships between public health researchers, service providers and policymakers can help address evaluation knowledge and skills gaps. The Western Australian Sexual Health and Blood-borne Virus Applied Research and Evaluation Network (SiREN) aims to build research and evaluation capacity in the sexual health and blood-borne virus sector in Western Australia (WA). Partners’ perspectives of the SiREN model after 2 years were explored. Qualitative written responses from service providers, policymakers and researchers about the SiREN model were analysed thematically. Service providers reported that participation in SiREN prompted them to consider evaluation earlier in the planning process and increased their appreciation of the value of evaluation. Policymakers noted benefits of the model in generating local evidence and highlighting local issues of importance for consideration at a national level. Researchers identified challenges communicating the services available through SiREN and the time investment needed to develop effective collaborative partnerships. Stronger engagement between public health researchers, service providers and policymakers through collaborative partnerships has the potential to improve evidence generation and evidence translation. These outcomes require long-term funding and commitment from all partners to develop and maintain partnerships. Ongoing monitoring and evaluation can ensure the partnership remains responsive to the needs of key stakeholders. The findings are applicable to many sectors

The development and validation of sexual health indicators of Canadians aged 16-24 years

Objectives: We developed and validated a set of self-administered, multidimensional indicators of sexual health among Canadians aged 16–24 years. Methods: This study used a mixed-method qualitative and quantitative approach to develop and validate indicators of sexual health. We used the four-stage Dillman method to identify, focus-test, pilot-test, and validate key metrics to measure sexual health. We collected quantitative data to validate the measures through a computer-assisted self-interviewing program among a purposive sample of 1,158 people aged 16–24 years recruited from four Canadian provinces. Results: The survey contained 75 items measuring five dimensions of sexual health: (1) physical, mental, emotional, and social well-being in relation to sexuality; (2) approach to sexuality; (3) sexual relationships; (4) sexual experiences; and (5) discrimination, coercion, and violence. Principal components analysis for composite measures found seven components with eigenvalues ≥ 1. The factor structure was stable across gender, age, size of area of residence, and language in which the survey was completed. Cronbach’s alpha coefficients ranged from 0.79 to 0.90. Indicators of condom use at last vaginal sex, protection self-efficacy, sexually transmitted infection/HIV testing self-efficacy, and sexual orientation also showed good construct validity. Conclusions: The indicators constituted a conceptually grounded survey that is easy for young adults to complete and contains valid, reliable, and psychometrically robust measures. The survey instrument provides a tool for future research to collect population-level data to measure and monitor trends in the sexual health of young people in Canada

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Childbirth in Pleasure and Ecstasy: A Fountain of Hormones and Chemicals

Birth is generally perceived as a painful event and some women prefer to undergo a Caesarean section in order to escape from labor pain. Dissimilar to childbirth, sexual activity is known as a pleasant event in which various degrees of gratification are achieved. Evidence demonstrates that both birth and orgasm are progressed through similar internal mechanisms and unique blends of hormones and chemicals, and they share some common physical characteristics. In this article the similarities between the process of childbirth and orgasm are discussed, and it is suggested that labor contractions can be augmented by having pleasure and experiencing orgasm. Childbirth may be a pleasant experience for women if they give birth in ecstasy

Assessment of Postnatal Depression Among Australian Lesbian Mothers

This cross-sectional study used a combination of three relative, reliable and standard questionnaires to evaluate symptoms of depression, sexual function and relationship satisfaction in the first year postpartum of sixteen lesbian mothers. The questionnaire was administered online. When individual scores were analyzed, there were 5 women who were depressed and 11 who were not. Those who were non-depressed had better sexual functioning and a higher level of satisfaction with relationships. This pilot study indicated that the need for further studies with lesbian mothers

A Literature Review to Determine the Impact of Sexuality and Body Image Changes Following Burn Injuries

The purpose of this study was to perform a review of the existing literature to (a) determine the impact of sexuality and body image changes following burn injuries in an adult population and (b) identify if there is a relationship between the two variables and the impact this potentially has on burns survivors’ quality of life. A total of 16 research articles; sexuality (n = 5) and body image (n = 8), sourced from online databases were reviewed. Both quantitative and qualitative studies that investigated adult burn survivors in both inpatient and outpatient settings were included in this review. The literature suggeststhere is an interaction between body image dissatisfaction, sexual satisfaction and long term psychological adjustment, particularly for female burn survivors. However, methodological limitations of the studies reviewed limits the transferability of the findings to clinical practice. Three themes were identified throughout the literature; satisfaction/dissatisfaction, adjustment issues and stigmatisation. Changes in body image and sexuality have a potential negative effect on burn survivors’ long-term quality of life. Further collaborative empirical research is required to understand the incidence and prevalence of these issues as well as intervention studies evaluating treatment programs for best practice

Sexuality, body image and relationships following burns: Analysis of BSHS-B outcome measures

BackgroundThe Burns Specific Health Scale – Brief (BSHS-B) was analyzed to investigate the longitudinal impact of burns on sexuality and body image. Four sub-domains of the BSHS-B domains were of particular interest: sexuality, body image, affect and relationships, and as such were investigated for correlation between all of the sub-scales of the BSHS-B.MethodsA total of 1846 observations from 865 Western Australian burn patient BSHS-B questionnaires were analyzed. Descriptive statistical methods included dichotomous and ordinal scale variables and medians, as well at the range for continuous variables. Inferential statistical methods used longitudinal linear mixed-effects models and random effects models with the BSHS-B total and its sub-scales as dependent variables.ResultsThe four BSHS-B domains of interest all showed no significant change over time, indicating that the psychological and psychosocial impact of burns does not significantly improve for burn survivors, regardless of good physical and functional recovery.ConclusionsBurn survivors experience sexuality, body image and relationship changes following a burn, which may affect their quality of life (QoL) over time. Rehabilitation services need to be aware of these issues and create rehabilitation programs that specifically and meaningfully address these issues for burn survivors

Searching for answers and validation Australian women's experiences of coping with the adverse sexual effects of antidepressants /

Sexual difficulties relating to selective serotonin reuptake inhibitor (SSRI) medication have an impact on quality of life and are a common cause for non-adherence to medication. While most research has focussed on the prevalence and treatment of sexual difficulties, little is known about how patients cope with the adverse sexual effects of SSRIs. This qualitative study, using Interpretive Phenomenological Analysis (IPA), investigated the experiences of 10 Australian women currently coping with the adverse sexual effects of this antidepressant by conducting semi-structured interviews. This paper presents one major theme from the study and reports the findings related to women’s self-reported experiences of interacting with GPs in their search for answers and validation of their concerns. Findings from the study add to the current literatureby providing an insight into how interactions with GPs impact on women’s abilities to cope with adverse sexual effects. Empathic discussions and shared decision-making between GPs and women can provide the opportunity to improve the management of the adverse sexual effects of SSRIs and may lead to improved outcomes for women

Engaging, practical and empowering: Sexuality and relationships education at Curtin University, Australia that supports pre-service teachers

Introduction and Objective: An audit of Western Australian universities found pre-service teachers have limited opportunity to study health-related courses (termed units in Australia), and when they are offered there is often little focus on sexuality and relationships education (SRE). Curtin University has recently established an undergraduate course for Bachelor of Education students, which focuses solely on the delivery of evidence-based SRE. Methods: Formative mixed methods research was conducted to inform the course development. It was piloted during 2014 with 20 undergraduate students and involved 36 hours of face-to-face contact during one semester. Students participated in a range of qualitative and quantitative pre- and post-evaluations to examine content, delivery, process and impact. Results: Course content was viewed positively by all students. Selfassessment of teaching competency and inclusive attitudes towards sexuality concepts increased for each student at the end of the semester. Assessment tasks were viewed positively and, in particular, a teaching resource file was viewed as a useful tool that could be utilised and added to throughout one’s teaching career. Post-course reflection papers provided rich qualitative data regarding learning experience. Students reported becoming empowered as SRE educators and intended to implement learning immediately. Conclusions: An undergraduate course dedicated specifically on school-based SRE has been successfully incorporated for pre-service teachers within the School of Education at Curtin University, Australia. Regardless of their teaching speciality (special needs, early childhood, primary and secondary), all students reported the unit content applicable to their future work as educators. This has implications for universities and/or teaching colleges that address SRE in an ad hoc manner or provide it only in specific degrees like B.Ed. (Secondary) or B.Ed. (Health and Physical Education)