sexual function

性功能
  • 文章类型: Journal Article
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  • 文章类型: Journal Article
    背景:伊朗的郊区人口越来越多。人们在郊区通常有有限的性信息和有有限的研究他们的性问题。这项研究旨在研究基于性健康模型(SHM)的性教育(SE)对居住在郊区的女性性功能的影响。
    方法:这是一项随机对照试验,有两个平行组。将通过简单随机抽样从郊区的医疗保健中心选出76名妇女,并将其分配到对照组(n=38)和干预组(n=38),随机比例为1:1。干预组的参与者将在每周120分钟的课程中接受基于SHM的SE,这些课程将使用讲座进行,问答,小组讨论,和教育小册子的方法。数据将通过人口统计和助产特征问卷收集,女性性功能指数,抑郁焦虑压力量表,和性生活质量-女性,并将通过协方差分析以及独立样本t进行分析,配对样本t,和卡方检验。
    结论:我们希望这项研究为决策者和医疗保健提供者提供一个明确的框架,为SE提供适当的政策和干预措施,从而改善郊区妇女的性健康。
    背景:该研究于2024.03.05在伊朗临床试验注册中心注册(代码:IRCT20231121060133N1)。
    BACKGROUND: Suburban population is increasingly growing in Iran. People in the suburbs usually have limited sexual information and there are limited studies into their sexual issues. This study aims the effect of sexual education (SE) based on the Sexual Health Model (SHM) on sexual functioning among women living in the suburbs.
    METHODS: This is a randomized controlled trial with two parallel groups. Seventy-six women will be selected through simple random sampling from healthcare centers in suburban areas and will be allocated to a control group (n = 38) and an intervention group (n = 38) with a randomization ratio of 1:1. Participants in the intervention group will receive SHM-based SE in three120 min weekly sessions which will be held using the lecture, question-and-answer, group discussion, and educational booklet methods. Data will be collected through a demographic and midwifery characteristics questionnaire, the Female Sexual Function Index, the Depression Anxiety Stress Scale, and the Sexual Quality of Life-Female, and will be analyzed through the analysis of covariance as well as the independent-sample t, the paired-sample t, and the Chi-square tests.
    CONCLUSIONS: We hope this study provides a clear framework for decision-makers and healthcare providers to provide appropriate policies and interventions for SE and thereby improve the sexual health of women in the suburbs.
    BACKGROUND: This study was registered in the Iranian Registry of Clinical Trials on 2024.03.05 (code: IRCT20231121060133N1).
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  • 文章类型: Journal Article
    目的:该研究的目的是在一项随机对照试验中确定基于WhatsApp的BETTER性咨询对乳腺癌幸存者性功能和性生活质量的影响。
    方法:这是一项随机对照试验,其中使用便利抽样招募了90名乳腺癌幸存者,然后随机分配到两组基于WhatsApp的BETTER模型咨询和常规护理。数据收集工具包括人口调查问卷,女性性生活质量(SQOL-F)和性功能指数(FSFI-BC)。干预组的参与者获得了为期6周的计划。该计划包括六个咨询和分配包,涵盖了BETTER模型的所有六个步骤。使用SPSS软件版本20分析数据。卡方检验,采用独立样本t检验和重复测量方差分析。显著性水平(P值)被认为小于0.05。
    结果:在对照组中,SQL量表的平均得分由35.16±10.71变为35.16±12.97(P>0.05),从34.76±10.13上升到68.20±20.48(P<0.001)。同样,对照组FSF均值从58.13±7.11到58.35±6.11无明显变化(P>0.05),在干预组中,从59.49±6.10显著提高到120.73±25.54(P<0.001)。rANOVA的结果表明,从干预前后,两组之间的SQL和SFS平均得分存在显着差异。然后在干预组的1个月随访期间(p<0.001)。考虑到部分eta平方,干预效果对性功能指数(η2=0.73)和性生活质量(η2=0.41)这两个变量的交互效应最高。
    结论:干预计划是改善乳腺癌幸存者女性性生活质量和性功能的成功模式。
    背景:IRCT20210926052601N1,7-11-2021。
    OBJECTIVE: The aim of the study was to determine the effect of WhatsApp-based BETTER sex counselling on sexual function and sexual quality of life in breast cancer survivors in a randomized control trial.
    METHODS: This is a randomized controlled trial in which a total of 90 breast cancer survivors were recruited using convenience sampling and then randomly assigned to two groups of WhatsApp-based BETTER model counselling and routine care. Data collection tools consisted of a demographic questionnaire, the Sexual Quality of Life-Female (SQOL-F) and the Sexual Function Index (FSFI-BC). Participants in the intervention group were given access to the 6-week program. The program consisted of six consultation and assignment packages covering all six steps of the BETTER model. Data were analyzed using SPSS software version 20. Chi-square test, independent samples t-test and repeated measures analysis of variance were used. The significance level (p-value) was considered to be less than 0.05.
    RESULTS: In the control group, the mean score of SQL scale changed from 35.16 ± 10.71 to 35.16 ± 12.97 (P > 0.05) and in the intervention group, it significantly increased from 34.76 ± 10.13 to 68.20 ± 20.48 (P < 0.001). Similarly, the comparison of mean of FSF in the control group showed a none-significant change from 58.13 ± 7.11 to 58.35 ± 6.11 (P > 0.05), and in the intervention group, it significantly improved from 59.49 ± 6.10 to 120.73 ± 25.54 (P < 0.001). The results of rANOVA indicated that there was a significant difference in the mean scores of the SQL and SFS between the two groups from pre- to post-intervention, and then over the 1-month follow-up period in the intervention group (p < 0.001). Considering partial eta squared, the effect of the intervention had the highest interaction effect on both variables of the sexual function index (η2 = 0.73) and sexual quality of life (η2 = 0.41).
    CONCLUSIONS: The intervention program was a successful model for improving female sexual quality of life and female sexual function in breast cancer survivors.
    BACKGROUND: IRCT20210926052601N1, 7-11-2021.
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  • 文章类型: Journal Article
    背景:肺动脉高压(PAH)可能对性功能产生多种影响,这会导致生活质量恶化。
    目的:本研究旨在评估PAH女性的性功能及其与健康功能和生活质量的关系。
    方法:于2022年1月至2023年3月在肺循环门诊中对诊断为肺动脉高压的女性进行了描述性横断面研究。通过应用女性性功能指数进行评估,世界卫生组织36项残疾评估时间表,和医学结果研究36项简短形式调查。
    结果:使用SPSS版本22.0和JASP分析数据,和Spearman的相关性测试被应用在仪器之间,P值<.05被认为是显著的。
    结果:共评估了91名女性。发现90.1%的女性有性功能障碍,在满意度方面有性功能障碍的女性得分更差,唤醒,和欲望,具有平均的健康功能和生活质量。移动性域之间存在显着相关性,相处,生命活动,以及一些性功能领域的整体功能评分,尤其是唤醒和满足。我们发现生活质量评估的某些领域与欲望领域之间存在显着相关性,唤醒,和满意,随着性功能评估的总体得分,以及健康功能和生活质量之间的强相关性。
    结论:数据加强了该人群对康复计划和社会支持的需求。
    这是为数不多的评估性功能的研究之一,生活质量,和PAH女性的健康功能。由于数据收集的局限性,我们无法评估某些因素,如激素水平和性虐待史。
    结论:我们发现,在患有轻度功能损害的PAH女性中,性功能障碍的患病率很高,生活质量评分中等,性功能之间存在相关性,健康功能,和生活质量。
    BACKGROUND: Pulmonary arterial hypertension (PAH) can have several consequences on sexual function, which can lead to worsened quality of life.
    OBJECTIVE: The study sought to assess sexual function and its association with health functionality and quality of life in females with PAH.
    METHODS: A descriptive cross-sectional study was carried out in pulmonary circulation outpatient clinics from January 2022 to March 2023 in females diagnosed with pulmonary hypertension. Assessment was carried out through the application of the Female Sexual Function Index, the 36-item World Health Organization Disability Assessment Schedule, and the Medical Outcome Study 36-Item Short Form Survey.
    RESULTS: Data were analyzed using SPSS version 22.0 and JASP, and Spearman\'s correlation tests were applied between the instruments, with a P value <.05 considered significant.
    RESULTS: A total of 91 females were assessed. It was identified that 90.1% of females had sexual dysfunction, with worse scores in females with sexual dysfunction in the domains of satisfaction, arousal, and desire, with average health functionality and quality of life. There were significant correlations between the domains of mobility, getting along, life activities, and the overall functionality score with some domains of sexual function, especially arousal and satisfaction. We found significant correlations between some domains of quality-of-life assessment with the domains of desire, arousal, and satisfaction, and with the overall score of sexual function assessment, as well as strong correlations between health functionality and quality of life.
    CONCLUSIONS: The data reinforce the need for rehabilitation programs and social support for this population.
    UNASSIGNED: This is one of the few studies to evaluate sexual function, quality of life, and health functionality in women with PAH. Due to limitations in data collection, we were unable to assess certain factors such as hormone levels and a history of sexual abuse.
    CONCLUSIONS: We identified a high prevalence of sexual dysfunction in females with PAH with mild functional impairment and a moderate quality-of-life score with correlations between sexual function, health functionality, and quality of life.
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  • 文章类型: Journal Article
    目的:本研究旨在调查健康相关生活质量(HRQoL),性功能,心理健康,生殖问题,和生育结果的育龄妇女进行生育保留手术(FSS)治疗卵巢癌(OC)或交界性卵巢肿瘤(BOT),在2年期间。
    方法:前瞻性纵向多中心研究,包括2016年至2018年在瑞典接受FSS的18-40岁女性。诊断时的临床数据,我们收集了有关肿瘤和生殖结局的组织病理学结果和2年随访.参与者完成了EORTCQLQ-C30和OV-28,FSFI,诊断时以及FSS后一年和两年的HADS和研究特异性项目。使用重复测量模型分析数据,以调查随时间的变化。
    结果:在68名符合条件的女性中,由于良性病理或随后的根治性手术而排除后,包括49例。在平均20.5个月的随访中,两名女性出现复发,82%报告有规律月经.大多数(94%)有强烈的愿望成为亲生母亲,随着时间的推移而保持或增加。受孕率为76%。HRQoL,随着时间的推移,心理健康和性功能得到改善,性功能障碍女性比例下降.在一年的随访中,50%的未产妇女的得分表明性功能障碍,而手术前或手术后分娩的妇女的得分为0%(p=0.008)。
    结论:HRQoL,出现OC或BOT的年轻女性在FSS后的两年随访中,心理健康和性功能得到改善。与未分娩妇女相比,在FSS之前或之后分娩的妇女报告性功能改善。
    OBJECTIVE: This study aimed to investigate health-related quality of life (HRQoL), sexual function, psychological-health, reproductive concerns, and fertility outcomes of women of reproductive age undergoing Fertility-Sparing Surgery (FSS) for treatment of ovarian cancer (OC) or borderline ovarian tumor (BOT), over a 2-year period.
    METHODS: Prospective longitudinal multicentre study including women 18-40 years undergoing FSS between 2016 and 2018 in Sweden. Clinical data at diagnosis, histopathological findings and 2-year follow-up regarding oncological and reproductive outcomes were collected. Participants completed the EORTC QLQ-C30 and OV-28, FSFI, HADS and study-specific items at time of diagnosis and at one- and two-years following FSS. Data were analysed using a model for repeated measures to investigate changes over time.
    RESULTS: Of 68 eligible women, 49 were included following exclusions due to benign pathology or subsequent radical surgery. During a mean follow-up of 20.5 months, two women experienced a recurrence and 82% reported regular menstruations. The majority (94%) had a strong desire to become biological mothers, which remained or increased over time. The conception-rate was 76%. HRQoL, psychological-health and sexual function improved over time and the proportion of women with sexual dysfunction decreased. At one-year follow-up 50% of nulliparous women had scores indicating sexual dysfunction compared to 0% of the women who had given birth either before or after surgery (p = 0.008).
    CONCLUSIONS: HRQoL, psychological-health and sexual function improved during two-year follow-up after FSS in young women presenting with OC or BOT. Women who had given birth prior to or after FSS reported improved sexual function compared to nulliparous women.
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  • 文章类型: Journal Article
    背景:双相情感障碍(BD)是一种慢性病理,与患者一生中的多种损伤有关,包括性功能下降。尽管生活质量(QoL)很重要,功能和药物依从性,对这些患者的调查还很少。
    目的:比较I型双相情感障碍(BD-I)患者的性功能,在缓解期,与健康对照(HC),并调查与这些个体的性功能相关的临床和社会人口统计学特征。此外,评估有和没有性功能障碍(SD)的患者的QoL。
    方法:横断面研究,132例BD-I患者处于正常状态,61例患者来自门诊。通过亚利桑那州性量表(ASEX)和世界卫生组织生活质量评估(WHOQoL-BREF)的简短版本对所有参与者进行了评估。将BD-I患者与HC患者进行比较。患者分为两组:诊断为SD的患者和没有SD的患者。
    结果:BD-I患者的SD(42.4%)高于HC(16.4%)(OR3.67,95%CI1.55-8.67;p=0.003)。患者的SD与女性相关(p=0.001),年龄较大(p=0.003),未治疗的疾病持续时间较长(p=0.010)。与没有SD的患者相比,SD患者的QoL评分较差。
    结论:BD-I患者的SD患病率较高,这与所有领域的QoL评分较差有关。
    BACKGROUND: Bipolar disorder (BD) is a chronic pathology that is associated with several impairments throughout a patient\'s life, including decreased sexual function. Despite the importance in quality of life (QoL), functionality and medication adherence, it is still little investigated in these patients.
    OBJECTIVE: To compare the sexual function of patients with Bipolar Disorder type I (BD-I), in remission, with healthy controls (HC) and to investigate the clinical and socio-demographic characteristics associated with sexual function in these individuals. Also, to assess the QoL in patients with and without sexual dysfunction (SD).
    METHODS: Cross-sectional study with 132 patients with BD-I in euthymic phase and 61 HCs from an outpatient clinic. All the participants were evaluated through the Arizona Sexual Scale (ASEX) and the brief version of the World Health Organization Quality of Life Assessment (WHOQoL-BREF). The patients with BD-I were compared with the HCs. The patients were divided into two groups: the ones diagnosed with SD and the ones without it.
    RESULTS: The patients with BD-I had higher rates of SD (42.4%) compared to the HCs (16.4%) (OR 3.67, 95% CI 1.55 - 8.67; p=0.003). SD in patients was associated with being women (p=0.001), older age (p=0.003) and having a longer duration of untreated illness (p=0.010). Patients with SD had worse QoL scores compared to those without SD.
    CONCLUSIONS: Patients with BD-I have a high prevalence of SD and this was associated with worse QoL scores in all domains.
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  • 文章类型: Journal Article
    与性功能相关的性困扰(SDRSF)在诊断性功能障碍方面至关重要。然而,缺乏对其理解的理论模型以及有关如何在临床实践中解决该问题的知识。
    通过收集临床医生的账目,为SDRSF的理论建设和临床实践做出贡献,旨在为研究和干预SDRSF的初步框架提供信息。
    使用自反性主题分析来分析来自与临床性学家进行的16次半结构化访谈的数据。结果:创造了三个主要主题:(1)从内部燃烧,(2)邪恶的游戏,(3)跑上那座山。参与者揭示了在临床环境中对SDRSF的多维理解,整合了个体,社会文化,人际和情境因素。这强调了SDRSF的相互联系的性质,揭示其与临床环境中整体痛苦的不同方面的联系。我们提出了一个初步的框架,可以在分析上进行概括,以增强对SDRSF特异性的理解。
    这些见解在临床环境中构建了SDRSF的全面概念,超越了性活动,并暗示在该领域的研究和干预中需要考虑人际关系和社会因素。
    UNASSIGNED: Sexual distress related to sexual function (SDRSF) is pivotal in diagnosing sexual dysfunction. However, there is a lack of theoretical models for its comprehension and of knowledge concerning how to address it in clinical practice.
    UNASSIGNED: To contribute to theory building and clinical practice about SDRSF by collecting clinicians\' accounts, aiming to inform a preliminary framework to study and intervene in SDRSF.
    UNASSIGNED: Reflexive thematic analysis was used to analyze the data from 16 semi-structured interviews with clinical sexologists. Results: Three main themes were created: (1) Burning from the inside, (2) Wicked games, and (3) Running up that hill. Participants revealed a multidimensional understanding of SDRSF in clinical settings that integrates individual, sociocultural, interpersonal and situational factors. This underscores the interconnected nature of SDRSF, revealing its links to different facets of overall distress in clinical settings. We present a preliminary framework that may be analytically generalized to enhance the comprehension of the specificities of SDRSF.
    UNASSIGNED: These insights frame a comprehensive conceptualization of SDRSF in clinical settings that goes beyond sexual activity and implies that interpersonal and societal factors need to be considered in research and intervention in this field.
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  • 文章类型: Journal Article
    背景:联合使用α1-肾上腺素能受体阻滞剂(α1-阻滞剂)和β3-肾上腺素受体激动剂vibegron治疗与良性前列腺增生(BPH)相关的持续性膀胱过度活动症(OAB)症状对性功能的影响尚不确定。因此,我们旨在评估vibegron作为α1受体阻滞剂治疗的附加药物对OAB和性功能的影响.方法:这项前瞻性开放标签研究包括43例BPH患者,这些患者的OAB症状通过α1受体阻滞剂治疗未得到充分控制。OAB症状评分(OABSS)国际前列腺症状评分(IPSS)15项国际勃起功能指数(IIEF-15),和安装硬度评分(EHS),以及残余尿量和血清游离睾酮(FT)和C反应蛋白(CRP)水平,在每天服用50mgvibegron/α1-受体阻滞剂联合治疗之前和之后8周进行评估。结果:Vibegron/α1受体阻滞剂联合治疗可显着改善OABSS(从6.9±2.6提高到5.1±2.9,p<0.0001)和IIEF性交满意度领域(从1.1±2.3提高到1.9±2.6,p=0.02)。IPSS没有观察到显著差异,EHS,IIEF-15总分,残余尿量,和血清FT和CRP水平。结论:研究结果表明,vibegron/α1-受体阻滞剂联合治疗可改善OAB和性满意度。
    Background: The effect of combining an α1-adrenergic receptor blocker (α1-blocker) and the β3-adrenoceptor agonist vibegron for treating persistent overactive bladder (OAB) symptoms associated with benign prostatic hyperplasia (BPH) on sexual function remains uncertain. Therefore, we aimed to evaluate the effects of vibegron as an add-on to α1-blocker therapy on both OAB and sexual function. Methods: Forty-three patients with BPH in whom OAB symptoms were inadequately controlled by α1-blocker treatment were included in this prospective open-label study. The OAB Symptom Score (OABSS), International Prostate Symptom Score (IPSS), 15-item International Index of Erectile Function (IIEF-15), and Erection Hardness Score (EHS), as well as the residual urine volume and serum-free testosterone (FT) and C-reactive protein (CRP) levels, were evaluated before and 8 weeks after the daily administration of 50 mg vibegron/α1-blocker combination therapy. Results: Vibegron/α1-blocker combination therapy significantly improved the OABSS (from 6.9 ± 2.6 to 5.1 ± 2.9, p < 0.0001) and IIEF intercourse satisfaction domain (from 1.1 ± 2.3 to 1.9 ± 2.6, p = 0.02). No significant differences were observed for the IPSS, EHS, total IIEF-15 score, residual urine volume, and serum FT and CRP levels. Conclusions: The study findings suggest that vibegron/α1-blocker combination therapy improves OAB and sexual satisfaction.
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  • 文章类型: Journal Article
    背景:有限的基于性别的研究比较了色情使用者(PU)和非使用者的性健康,包括无问题色情用户(非PPU)和有问题色情用户(PPU),特别是在非西方文化中。
    方法:2022年一项涉及450名伊朗大学生的横断面研究根据使用12个月将参与者分为PU或非用户。使用“有问题的色情使用量表”截止点将PU进一步分类为非PPU或PPU,比较了这些群体之间的人口统计学和性变量。
    结果:据报道,39.6%的学生使用色情制品,包括51.7%的男性和33.6%的女性。总的来说,9.5%的参与者是PPU,包括17.4%的男性和5.6%的女性。主要是男性,孩子少了,较短的婚姻,较低的宗教信仰,和较低的教育水平。与非用户相比,PU报告了较早的性关系,对性生活频率和沟通的满意度较低,和更高的婚外情率,手淫,性欲,和性困扰。PPU报告了更多的性欲,色情使用,手淫,和婚外情比非PPU。人口统计学中的类似模式,性史,在不同性别的色情使用中观察到健康。回归显示为男性(OR:2.42,95%CI:1.44-4.06),受教育程度较低(OR:0.89,95%CI:0.81-0.97),儿童较少(OR:0.64,95%CI:0.48-0.86),较高的手淫(OR:1.31,95%CI:1.14-1.49),更多的婚外情(OR:1.69,95%CI:1.07-2.67),宗教信仰较少(OR:0.87,95%CI:0.82-0.93),更多的性兴奋(OR:0.79,95%CI:0.62-1),和更多的性困扰(OR:1.20,95%CI:1.02-1.32)与色情使用相关。双向方差分析发现,性别或色情使用对性满意度没有显着影响。妇女的性功能更差,无论使用。色情用户,不分性别,经历了更高的性困扰。
    BACKGROUND: Limited gender-based research has compared sexual health among pornography users (PUs) and non-users, including non-problematic pornography users (non-PPUs) and problematic pornography users (PPUs), particularly in non-Western cultures.
    METHODS: A 2022 cross-sectional study involving 450 Iranian university students categorized participants as PUs or non-users based on 12 months of use. PUs were further classified as non-PPUs or PPUs using the \'Problematic Pornography Use Scale\' cutoff point, with comparisons of demographic and sexual variables made between these groups.
    RESULTS: Pornography use was reported among 39.6% of students, including 51.7% of men and 33.6% of women. In general, 9.5% of participants were PPUs, including 17.4% of men and 5.6% of women. PUs were mainly men, had fewer children, shorter marriages, lower religiosity, and lower levels of education. Compared with non-users, PUs reported earlier sexual relationships, lower satisfaction with sex frequency and communication, and greater rates of extramarital relationships, masturbation, sexual desire, and sexual distress. PPUs reported more sexual desire, pornography use, masturbation, and extramarital affairs than non-PPUs. Similar patterns in demographics, sexual history, and health were observed in pornography use across genders. The regression indicated being male (OR: 2.42, 95% CI: 1.44-4.06), having lower education (OR: 0.89, 95% CI: 0.81-0.97), fewer children (OR: 0.64, 95% CI: 0.48-0.86), higher masturbation (OR: 1.31, 95% CI: 1.14-1.49), more extramarital relationship (OR: 1.69, 95% CI: 1.07-2.67), less religiosity (OR: 0.87, 95% CI: 0.82-0.93), more sexual excitement (OR: 0.79, 95% CI:0.62-1), and more sexual distress (OR: 1.20, 95% CI: 1.02-1.32) were associated with pornography use. Two-way ANOVA found no significant effects of gender or pornography use on sexual satisfaction. Women had worse sexual function regardless of usage. Pornography users, regardless of gender, experienced higher sexual distress.
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  • 文章类型: Journal Article
    我们旨在确定普通人群中非典型手淫的患病率,并探讨异性恋男性中非典型手淫与男性性功能障碍之间的关系。非典型手淫是指与伴侣性活动中遇到的刺激明显不同的刺激。我们在中国的社交媒体上发布了包含简化的国际勃起功能指数(IIEF-6)和早泄诊断工具的问卷。我们从2020年12月9日至2021年4月18日收集了2743份有效问卷。我们发现普通人群中非典型手淫的患病率为10.97%。与典型手淫的男性相比,非典型手淫的男性的IIEF-6评分较低,勃起功能障碍(ED)的发生率较高。不同自慰方式的男性早泄发生率和估计阴道内射精潜伏期无显著差异。我们的研究表明,非典型手淫与ED有关,处理性问题的临床医生应该比迄今为止更全面地询问手淫模式。
    We aimed to establish the prevalence of atypical masturbation in the general population and explore the association between atypical masturbation and male sexual dysfunction in heterosexual males. Atypical masturbation refers to stimulation significantly distinct from that encountered during partnered sexual activity. We posted questionnaires that contained the abridged International Index of Erectile Function (IIEF-6) and the premature ejaculation diagnostic tool on social media in China. We collected 2743 valid questionnaires from December 9, 2020, to April 18, 2021. We found that the prevalence of atypical masturbation in the general population was 10.97%. Men with atypical masturbation had lower IIEF-6 scores and higher rates of erectile dysfunction (ED) than men with typical masturbation. The prevalence of premature ejaculation and estimated intravaginal ejaculatory latency time were not significantly different among men with different patterns of masturbation. Our study demonstrated that atypical masturbation is associated with ED, and a clinician dealing with sexual issues should inquire more fully about masturbation patterns than has been done to date.
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