OBJECTIVE: To identify atypical masturbatory behaviors (AMB) and to reveal their effects on both sexual and masturbational erection hardness in men with erectile dysfunction (ED).
METHODS: Patients with ED and healthy controls were questioned about their masturbation habits. Accordingly, \"rubbing in a prone position,\" \"pressure on penis,\" and \"masturbation through clothes\" were included in the traumatic masturbation syndrome (TMS) group. Erection hardness score (EHS) is used to measure the erectile functions during masturbation (mast), foreplay (presex), and sexual intercourse (sex), separately.
RESULTS: The data of 448 participants, 266 (59%) from the patient group, and 182 (41%) from the control group were analyzed. The mean ages were 30 years in both groups (p = 0.734). The rate of \"rubbing in a prone position\" and \"penile pressure\" while masturbating was higher in patients than the controls (10.2% vs. 6%, p = 0.024 and 8.6% vs. 3.3%, p = 0.0002, respectively). Patients had 2.2-fold (odds ratio, 2.21; 95% confidence interval, 1.40-3.47; p = 0.001) increased risks of having at least one AMB, compared with controls. In the secondary analysis, the patient group was divided into 2 subgroups according to having TMS (ED + TMS) or not (ED). The percentage of patients with EHS≥3 during masturbation was higher than those during sex and presex in the \"ED + TMS\" group (60.2%, 38.8%, and 37.2%, respectively, p = 0.0001; n = 98). Comparing the percentage of patients with EHS≥3 during mast, presex, and, sex was found to be similar in the \"ED\" group (58.9%, 56.5%, and 56%, respectively, p = 0.753; n = 168).
CONCLUSIONS: Atypical masturbatory behaviors are more common in young men presenting with erectile dysfunction. These patients have higher erection hardness scores during masturbation compared to partnered sex.

UNASSIGNED: Mindfulness facets can be trained with structured mindfulness interventions, but little is known regarding application on a broader level within sex therapy (e.g. men, partners and different sexual dysfunctions).
UNASSIGNED: To evaluate the feasibility and preliminary efficacy of an 8-week intervention-specifically, mindfulness for sex and intimacy in relationships (MSIR)-as a supplement to treatment as usual (TAU) as compared with only TAU in a clinical sample of men and women referred for sexual difficulties with or without a partner.
UNASSIGNED: In this randomized controlled feasibility pilot study, 34 participants were randomized to MSIR + TAU (n = 15) or TAU (n = 19). Six healthy partners were also included in the study. MSIR was administered as 2 individual evaluations and six 2-hour group sessions of mixed gender and different types of sexual dysfunction.
UNASSIGNED: The primary outcome measures were as follows: (1) feasibility, defined as the implementation of recruitment, acceptance, and attendance of intervention in daily clinical practice and the MSIR completion rate; (2) sexual functioning, as measured on a visual analog scale (\"bothered by problem\") and by validated questionnaires (Changes in Sexual Function Questionnaire for Females and Males, Female Sexual Function Index, Female Sexual Distress Scale, International Index of Erectile Function).
UNASSIGNED: MSIR was feasible and well received by patients, with high rates of acceptance and intervention completion. As compared with pretreatment, the MSIR + TAU group and TAU control group were significantly less bothered by their sexual problems at the end of treatment, but the change was significantly larger in the MSIR + TAU group (P = .04). Participants in the MSIR + TAU group did not receive fewer TAU sessions than the TAU group (MSIR + TAU mean, 6 sessions; TAU mean, 8 sessions).
UNASSIGNED: MSIR could be effectively used in a clinical setting as an add-on to TAU in the treatment of female and male sexual dysfunction and healthy partners.
UNASSIGNED: The major strength of the study is that it is a randomized controlled study. This study is novel in the sense that it included men and women with different types of sexual dysfunction in the same mindfulness group. Limitations include the pilot nature of the study (e.g. a small sample size), and statistical conclusions should be made with caution. More accurate results may be found in a larger sample.
UNASSIGNED: Results from this study support already existing evidence that mindfulness-based interventions are feasible and effective for targeting sexual dysfunctions in men and women.

BACKGROUND: For men, early ejaculation is a serious health concern. Here, we tested the influence of modafinil (Profinil®) on early ejaculation. To this end, we performed a double-blind randomized clinical trial among men with early ejaculation.
METHODS: A total of 46 men with early ejaculation (mean age: 37.35 years) and in stable marital relationships with regular weekly penile-vaginal intercourse were randomly assigned either to the modafinil (100 mg) or to the placebo condition. Compounds were taken about 4-6h before intended penile-vaginal intercourse. At baseline and four weeks later at the end of the study, participants completed a series of self-rating questionnaires covering early ejaculation. Female partners also rated their male partners\' early ejaculation profile.
RESULTS: Dimensions of early ejaculation improved over time, but only so in the modafinil condition, while no improvements were observed in the placebo condition.
CONCLUSIONS: Among male adults in stable marital relationships with regular weekly penile-vaginal intercourse modafinil improved dimensions of early ejaculation, always compared to placebo. Given the strong effect of modafinil on cognitive-executive processes, it is conceivable, that modafinil acted both via physiological and cognitive-executive pathways.

BACKGROUND: Among male sexual dysfunctions, erectile dysfunction and early ejaculation have the highest prevalence rates. Here, we tested the influence of lisdexamfetamine dimesylate (Vyas®) on early ejaculation. To this end, we performed a double-blind randomized clinical trial among males with early ejaculation.
METHODS: A total of 46 males with early ejaculation (mean age: 35.23 years) and in stable marital relationships with regular weekly penile-vaginal intercourse were randomly assigned either to the lisdexamfetamine dimesylate condition (30 mg) or to the placebo condition. Compounds were taken about six hours before intended penile-vaginal intercourse. At baseline and four weeks later at the end of the study, participants completed a series of self-rating questionnaires covering early ejaculation. Female partners also rated participants\' early ejaculation profile.
RESULTS: Compared to the placebo condition, dimensions of early ejaculation improved over time in the lisdexamfetamine condition, though improvements were also observed in the placebo condition.
CONCLUSIONS: Among male adults in stable marital relationships with regular weekly penile-vaginal intercourse, lisdexamfetamine dimesylate improved dimensions of early ejaculation. Given that improvements were also observed in the placebo condition, psychological factors such as increased attention to early ejaculation and favorable expectations of the compound should be considered.

Couples undergoing assisted reproductive technologies (ART) are prone to sexual dysfunction and lower quality of life (QoL), but whether the incidence of these problems differs with the type of ART is unknown. As such, we conducted this cross-sectional survey to compare the sexual function and QoL of 75 couples undergoing intrauterine insemination (IUI), and 160 couples undergoing in vitro fertilization (IVF). They completed an anonymous questionnaire which included: (i) demographic characteristics; (ii) female sexual function index (FSFI) or (iii) international index of erectile function-5 (IIEF-5); and (iv) fertility QoL questionnaire (FertiQoL). Overall, 22.6% of wives and 39.1% of husbands were at risk for sexual dysfunction, and the risk was similar in IUI and IVF groups. Mean core/treatment/total FertiQoL scores of husbands were higher than wives: 74.98 vs. 68.24/70.02 vs. 65.87/73.52 vs. 67.54 (all p < 0.001). FertiQoL scores were similar in IUI and IVF groups except wives\' treatment FertiQoL score was significantly higher in the IUI group (68.93 vs. 64.44; p = 0.009). This study confirms that risks for sexual dysfunction were similar in IUI and IVF couples. Wives undergoing IVF had significantly lower treatment FertiQoL score. In both IUI and IVF groups, husbands\' QoL was better than wives\' QoL.

OBJECTIVE: To describe and understand the experiences of sexuality amongst heterosexual men diagnosed with morbid obesity (MO) who are in a bariatric surgery programme.
BACKGROUND: Morbid obesity is a chronic metabolic disease that affects men\'s physical, psychological and sexual health. Evidence suggests that MO could be linked to anxiety, depression, low self-esteem, sexual life and social disorders. Bariatric surgery is a reliable method for weight loss in patients with MO.
METHODS: This is a qualitative study based on Merleau-Ponty\'s phenomenology, and the COREQ checklist was employed to report on the current study.
METHODS: Convenience and purposive sampling was carried out and included 24 in-depth interviews with heterosexual men with MO in a bariatric surgery programme between October 2018-March 2019 in Spain.
RESULTS: Two main themes emerged from the analysis: (a) a corporality which is judged and condemned; and (b) adapting sexual practices to bariatric surgery.
CONCLUSIONS: Men with MO reject a body that limits their physical, social and sexual life. A negative body image and low self-esteem, which do not respond to the traditional masculine role or new masculinities, reduce men\'s self-concept. Men with MO feel rejection, stigma and isolation. Support from their partner is fundamental to adapt.
CONCLUSIONS: The results of the study draw attention to how heterosexual men with MO experience their sexuality in a bariatric surgery programme and the challenges nurses face. Recognising the problem, helping to develop coping strategies or referring to specialists in sexuality could improve the quality of life in patients and their partners.

Recent advances in sexual health research support the benefits of mindfulness-based therapy (non-judgmental present-moment awareness) for the treatment of women\'s sexual dysfunction.
To determine whether it is feasible to implement an adapted, empirically supported treatment protocol for female sexual dysfunction to the specific needs of men with situational erectile dysfunction (ED).
A mixed-methods approach was taken for this feasibility pilot study. A total of 10 men (Mage = 40.3, SD = 14.01, Range = 20-67) with a diagnosis of situational ED were recruited to participate in a 4-week mindfulness-based treatment group. The group was adapted from protocols shown to be effective for women with sexual dysfunction and edited to include content specific to situational ED. Sessions were 2.25 hours in length, included daily home-practice activities, and integrated elements of psychoeducation, sex therapy, and mindfulness skills. Men completed questionnaires (International Index of Erectile Functioning, Relationship Assessment Scale, Five Facets of Mindfulness Questionnaire, a treatment expectation questionnaire) at 3 time points (prior to treatment, immediately after treatment, and 6 months after treatment). 5 men (Mage = 44.4, SD = 15.76, Range = 30-67) participated in qualitative exit interviews.
Findings support the feasibility of adapting a mindfulness-based group treatment for situational ED.
With respect to feasibility, the dropout rate was 10%, with 1 participant who did not complete the treatment. Comparisons between Time 1 and Time 3 self-reports suggested that this treatment protocol holds promise as a novel means of impacting erectile functioning (Cohen\'s d = 0.63), overall sexual satisfaction (Cohen\'s d = 1.02), and non-judgmental observation of one\'s experience (Cohen\'s d = 0.52). Participants\' expectations for the treatment were generally positive and correlated to self-reported outcomes (r = .68-.73). Qualitative analyses revealed 6 themes: normalization, group magic, identification of effective treatment targets, increased self-efficacy, relationship factors, and treatment barriers.
In a shift toward a biopsychosocial framework for the treatment of men\'s sexual dysfunction, clinicians may consider incorporating mindfulness to address psychosocial and psychosexual components of dysfunction.
This is the first study-to our knowledge-to adapt mindfulness protocols for use with men\'s sexual dysfunction. Because this is a pilot study aimed at feasibility, the sample size is small and no control group was included, thus conclusions about efficacy and generalizability cannot be made.
The current study suggests that a mindfulness group therapy framework offers a feasible and potentially promising treatment avenue for men with situational ED. Bossio JA, Basson R, Driscoll M, et al. Mindfulness-based group therapy for men with situational erectile dysfunction: A mixed-methods feasibility analysis and pilot study. J Sex Med 2018;15:1478-1490.

This series of articles outlines standards for clinical trials of treatments for male and female sexual dysfunctions, with a focus on research design and patient-reported outcome assessment. These articles consist of revision, updating, and integration of articles on standards for clinical trials in male and female sexual dysfunction from the 2010 International Consultation on Sexual Medicine developed by the authors as part of the 2015 International Consultation on Sexual Medicine. We are guided in this effort by several principles. In contrast to previous versions of these guidelines, we merge discussion of standards for clinical trials in male and female sexual dysfunction in an integrated approach that emphasizes the common foundational practices that underlie clinical trials in the two settings. We present a common expected standard for clinical trial design in male and female sexual dysfunction, a common rationale for the design of phase I to IV clinical trials, and common considerations for selection of study population and study duration in male and female sexual dysfunction. We present a focused discussion of fundamental principles in patient- (and partner-) reported outcome assessment and complete this series of articles with specific discussions of selected aspects of clinical trials that are unique to male and to female sexual dysfunction. Our consideration of standards for clinical trials in male and female sexual dysfunction attempts to embody sensitivity to existing and new regulatory guidance and to address implications of the evolution of the diagnosis of sexual dysfunction that have been brought forward in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. The first article in this series focuses on phase I to phase IV clinical trial design considerations. Subsequent articles in this series focus on the measurement of patient-reported outcomes, unique aspects of clinical trial design for men, and unique aspects of clinical trial design for women.

BACKGROUND: Premature ejaculation is a common sexual disorder, which is usually underreported. Multiple treatment methodologies are in use due to the absence of an effective, universally acceptable treatment modality. The most common drug used is dapoxetine, which has adverse effects limiting its long-term use. Hence, we decided to evaluate the effectiveness of \'on demand\' silidosin 4 mg in patients with premature ejaculation, who were dissatisfied with dapoxetine 30 mg.
METHODS: The study included 64 patients who reported premature ejaculation who were unhappy with the treatment with \'on demand\' dapoxetine 30 mg, either due to its adverse effects or because of its overall inefficacy. They were divided into two groups of 33 and 31 respectively by simple randomization, with Group A treated with \'on demand\' silodosin 4 mg three hours prior to intercourse, whereas Group B was treated with placebo. Pre- and post-treatment intravaginal ejaculatory latency time (IELT), premature ejaculation profile (PEP) and clinical global impression of change (CGIC) for premature ejaculation were evaluated.
RESULTS: Patients in Group A (silodosin 4 mg) reported statistically significant improvement (p <0.005) in intravaginal ejaculatory latency time (IELT), premature ejaculation profile (PEP) and clinical global impression of change (CGIC) for premature ejaculation, with four patients reporting uncomfortably-delayed ejaculation.
CONCLUSIONS: \'On demand\' silodosin 4 mg is an effective treatment option with very few adverse events in those patients suffering from premature ejaculation, who are dissatisfied with dapoxetine 30 mg due to its adverse effects or inefficacy.

Rates of sexual dysfunctions are high among adults, but little is known about problems in sexual functioning among adolescents. We completed a comprehensive assessment of problems in sexual functioning and related distress over a 2-year period among adolescents (16-21 years).
A sample of 405 adolescents completed five online surveys over 2 years. The main outcome measures were clinical cutoff scores on the International Index of Erectile Function and Premature Ejaculation Diagnostic Tool for male adolescents and the Female Sexual Function Index for female adolescents. A secondary outcome was clinical levels of distress.
The majority of sexually active adolescents (78.6% of the male and 84.4% of the female) reported a sexual problem over the course; rates did not differ significantly by gender. Common problems for males were low sexual satisfaction (47.9%), low desire (46.2%), and problems in erectile function (45.3%). Common problems for females were inability to reach orgasm (59.2%), low satisfaction (48.3%), and pain (46.9%). Models predicting problems over time showed increased odds among those not in a sexual relationship. Odds of reporting a distressing sexual problem decreased over time for female but not male adolescents.
Problems in sexual functioning emerge early in individuals\' sexual lives, are often distressing, and appear not to fluctuate over time. Additional efforts to identify key factors linked to onset will help elucidate possible mechanisms.