Opportunities and pitfalls of e-health have been described and assessed in various health domains, but in the field of sexual health, the respective literature is limited.
The aim of this document is ...to present the European Society of Sexual Medicine's (ESSM) current position statement on e-sexual health.
This statement article is an expert opinion-based proposal that was developed under the auspices of the ESSM with input from the e-sexual health subcommittee of the ESSM Scientific Committee.
ESSM statements were provided on four domains: health information for patients, e-learning for professionals, health interventions, and health research.
e-Sexual health is the use of information and communication technologies for sexual health including sexual health care, surveillance, education, knowledge, and research. Quality indicators have to be applied on Web pages that provide sexual health information, e-learning can increase educational opportunities for professionals, online treatment interventions can be effective but needs to be available to the public, and online health research can provide access to difficult to reach populations.
The ESSM acknowledges the necessity for the use of information and communication technologies to meet the sexual health needs of citizens and patients and also the professional needs of sexual healthcare providers, in an evidence-based manner.
ESSM statements on this topic were provided based on expert opinion and summarize the ESSM position in this field.
The ESSM believes that e-sexual health can provide opportunities for the improvement of the sexual health of the population. Kirana PS, Gudeloglu A, Sansone A, et al. E-Sexual Health: A Position Statement of the European Society for Sexual Medicine. J Sex Med 2020;17;1246-1253.
The International Society for the Study of Women's Sexual Health process of care (POC) for management of hypoactive sexual desire disorder (HSDD) algorithm was developed to provide evidence-based ...guidelines for diagnosis and treatment of HSDD in women by health care professionals. Affecting 10% of adult females, HSDD is associated with negative emotional and psychological states and medical conditions including depression. The algorithm was developed using a modified Delphi method to reach consensus among the 17 international panelists representing multiple disciplines. The POC starts with the health care professional asking about sexual concerns, focusing on issues related to low sexual desire/interest. Diagnosis includes distinguishing between generalized acquired HSDD and other forms of low sexual interest. Biopsychosocial assessment of potentially modifiable factors facilitates initiation of treatment with education, modification of potentially modifiable factors, and, if needed, additional therapeutic intervention: sex therapy, central nervous system agents, and hormonal therapy, guided in part by menopausal status. Sex therapy includes behavior therapy, cognitive behavior therapy, and mindfulness. The only central nervous system agent currently approved by the US Food and Drug Administration (FDA) for HSDD is flibanserin in premenopausal women; use of flibanserin in postmenopausal women with HSDD is supported by data but is not FDA approved. Hormonal therapy includes off-label use of testosterone in postmenopausal women with HSDD, which is supported by data but not FDA approved. The POC incorporates monitoring the progress of therapy. In conclusion, the International Society for the Study of Women's Sexual Health POC for the management of women with HSDD provides a rational, evidence-based guideline for health care professionals to manage patients with appropriate assessments and individualized treatments.
A detailed sexual history is the cornerstone for all sexual problem assessments and sexual dysfunction diagnoses. Diagnostic evaluation is based on an in-depth sexual history, including sexual and ...gender identity and orientation, sexual activity and function, current level of sexual function, overall health and comorbidities, partner relationship and interpersonal factors, and the role of cultural and personal expectations and attitudes.
To propose key steps in the diagnostic evaluation of sexual dysfunctions, with special focus on the use of symptom scales and questionnaires.
Critical assessment of the current literature by the International Consultation on Sexual Medicine committee.
A revised algorithm for the management of sexual dysfunctions, level of evidence, and recommendation for scales and questionnaires.
The International Consultation on Sexual Medicine proposes an updated algorithm for diagnostic evaluation of sexual dysfunction in men and women, with specific recommendations for sexual history taking and diagnostic evaluation. Standardized scales, checklists, and validated questionnaires are additional adjuncts that should be used routinely in sexual problem evaluation. Scales developed for specific patient groups are included. Results of this evaluation are presented with recommendations for clinical and research uses.
Defined principles, an algorithm and a range of scales may provide coherent and evidence based management for sexual dysfunctions.
Highlights • Inpatients expect to be informed, but not equally involved in the decision-making process. • Weaker spiritual faith in healing was negatively associated with patient-centered attitudes. ...• Inpatients’ higher desire for information was associated with worse subjective health status. • Higher expectations for caring physicians were correlated with higher perceived social support.
Recent research suggests that none of the current theoretical models can sufficiently describe women's sexual response, because several factors and situations can influence this.
To explore ...individual variations of a sexual model that describes women's sexual responses and to assess the association of endorsement of that model with sexual dysfunctions and reasons to engage in sexual activity.
A sample of 157 randomly selected hospital employees completed self-administered questionnaires.
Two models were developed: one merged the Master and Johnson model with the Kaplan model (linear) and the other was the Basson model (circular). Sexual function was evaluated by the Female Sexual Function Index and the Brief Sexual Symptom Checklist for Women. The Reasons for Having Sex Questionnaire was administered to investigate the reasons for which women have sex.
Women reported that their current sexual experiences were at times consistent with the linear and circular models (66.9%), only the linear model (27%), only the circular model (5.4%), and neither model (0.7%). When the groups were reconfigured to the group that endorsed more than 5 of 10 sexual experiences, 64.3% of women endorsed the linear model, 20.4% chose the linear and circular models, 14.6% chose the circular model, and 0.7% selected neither. The Female Sexual Function Index, demographic factors, having sex for insecurity reasons, and sexual satisfaction correlated with the endorsement of a sexual response model. When these factors were entered in a stepwise logistic regression analysis, only the Female Sexual Function Index and having sex for insecurity reasons maintained a significant association with the sexual response model.
The present study emphasizes the heterogeneity of female sexuality, with most of the sample reporting alternating between the linear and circular models. Sexual dysfunctions and having sex for insecurity reasons were associated with the Basson model.
Despite its importance for epidemiological and clinical reasons, relatively few studies investigated determinants of bother or distress associated with sexual problems.
To assess perception of bother ...from sexual concerns and examine its role in predicting treatment-seeking.
The Brief Sexual Symptom Checklist and two single-item questions were used to assess type of sexual problems, level of bother, and treatment-seeking behavior.
Participants were recruited by selecting all sequentially eligible patients in each of the hospital's clinics. The scales used were drawn from the Hospitalized and Outpatients' Profile and Expectations Study survey instrument. Data were analyzed using chi-square, Fisher's exact tests, and multivariate logistic regression models.
In total 415 inpatients (48% men and 52% women) participated in the study. A high prevalence of male and female sexual problems was obtained (more than 50%) with a high degree of overlap among the various sexual problems. Common profiles included lack of desire and arousal or orgasmic problems in the women (8–9%); erectile dysfunction (ED) and low desire in the men (21.7%). Forty-five percent and 34% of our male and female participants, respectively, reported moderate or severe bother with its level declining with aging only in women (P<0.001). Degree of bother was strongly associated with ED (P=0.005) and curved penis (P=0.02) in men, and with difficulties reaching orgasm (P=0.01) in women. In both genders, bother increased the likelihood of willingness to discuss the sexual problem with a physician (odds ratio OR 10.66 for men and OR 4.35 for women); only in women, bother was associated with treatment seeking (OR 2.81).
Sexual dysfunctions are not always associated with increased bother or dissatisfaction, a condition that influences treatment-seeking behavior. Such findings are of clinical importance as they aid physicians in establishing a diagnosis of a sexual disorder. Evangelia N, Kirana P-S, Chiu G, Link C, Rosen R, and Hatzichristou D. Level of bother and treatment-seeking predictors among male and female in-patients with sexual problems: A hospital-based study. J Sex Med 2010;7:700–711.
To describe the development and assess the outcome of a workshop on erectile dysfunction (ED) management based on participating physicians evaluations.
The study involved physicians who attended a ...workshop offered throughout the country, during a 3‐year period. The workshop included tutorials, video‐based dramatizations, and role‐play sessions. A pilot study investigated the workshop's impact on physicians’ attitudes toward patient‐centeredness and sexual behavior issues; Patient–Practitioner Orientation Scale (PPOS) and Cross Cultural Attitude Scale (CCAS) were administered before and after the course. New knowledge acquisition, quality of presentation, and workshop's usefulness in their clinical practice were the dimensions used for workshop's evaluation. Analysis used quantitative and qualitative methods.
A total of 194 questionnaires were administered during the pilot study and the response rate was 53.6%. A shift in attitudes toward patient‐centeredness and less judgmental attitude toward patients’ sexual attitudes were revealed (total PPOS score and Sharing subscale: P < 0.05, CCAS: P < 0.001). Six hundred physicians were asked to evaluate the workshops and the response rate was 62.3%. The tutorial session for “medical treatment of ED” (P < 0.001) and the role‐play on sexual history taking (P < 0.05) received higher evaluation scores. Qualitative analysis showed that the most frequently reported category referred to the appropriateness of role‐play as a teaching and awareness‐raising technique (31.25%); a need for changes in clinical practice and communication patterns was identified by 20% of the participants who stressed the necessity for multidisciplinary approach, as well as the adoption of a nonjudgmental attitude toward patients.
Training courses on ED management, using a combination of tutorial and interactive sessions, constitute an effective way of providing knowledge, enhancing physicians’ communication skills with ED patients, and influencing attitudes toward patient‐centeredness in sexual issues. Such results strongly support the establishment of sexual medicine courses at continuing medical education curricula. Athanasiadis L, Papaharitou S, Salpiggidis G, Tsimtsiou Z, Nakopoulou E, Kirana P‐S, Moisidis K, and Hatzichristou D. Educating physicians to treat erectile dysfunction patients: development and evaluation of a course on communication and management strategies. J Sex Med 2006;3:47–55.
Sexual health services are limited and inadequate to reduce factors that hinder treatment and adequate care, despite the growing interest for public awareness and prevention strategies.
The aim of ...this study was to present an integrative conceptual framework, which led to the development of a model of alternative sexual health services and the 10-year experience of the practice of the service.
Multiple-level needs assessments.
The conceptual framework is composed of four distinct elements: (i) it adopts a social/ecological perspective; (ii) it assumes that results are optimal when multiple interventions are used; (iii) interventions are influenced by behavioral theories; and (iv) sexual health is conceptualized through the biopsychosocial model. Based on this model, a Sexual and Reproductive Health Center was developed, dedicated to research, education, and public awareness.
Over 10 years of experience show that the present approach constitutes a process which: (i) facilitates our understanding of the needs at individual, community, and system level; and (ii) increases the individuals', community and systems' capacity to control sexual health.
Alternative models for sexual and reproductive health services should be encouraged, in order for best practices to be explored and identified. In addition, future research in the effectiveness of such interventions shall be beneficial in order for evidence-based interventions to be designed. Paraskevi-Sofia K, Stamatis P, Loukas A, Evangelia N, George S, Kyriakos M, Chryssa P, Konstantinos H, Vassilios T, Aleka P, Maria I, Apostolos A, Athanasios B, and Dimitrios H. A conceptual framework for the evolution of sexual medicine and a model for the development of alternative sexual health services: 10-year experience of the Center for Sexual and Reproductive Health. J Sex Med 2009;6:2405–2416.
To explore the life satisfaction of patients with erectile dysfunction (ED) and to examine the relation between severity of ED and life satisfaction.
The study sample was recruited from patients who ...presented in an andrologic outpatient clinic complaining of ED. All patients underwent the basic clinical evaluation and were assessed by the International Index of Erectile Dysfunction (IIEF) and the Life Satisfaction Inventory (LSI).
The study included 69 patients with ED (age range 22-71 years, mean 49.5, SD 13.7). The LSI appeared to have satisfactory internal consistency (Cronbach's alpha = 0.82). Men with ED had significantly lower satisfaction with their sexual life (t = -13.756, d.f. = 68, P = 0.000), but also significantly lower total score of satisfaction with their life (t = -2.793, d.f. = 68, P = 0.007) compared with available normative data from healthy population. However, when compared with controls, men with ED showed significantly higher satisfaction scores on their financial status (t = 5.075, d.f. = 68, P = 0.000) and on their leisure time activities (t = 4.029, d.f. = 68, P = 0.000). Regarding ED severity, mild ED affects patients' satisfaction with sexual life less than do moderate and severe ED. Interestingly, no difference was identified between moderate and severe ED groups.
Men who seek help for ED have lower satisfaction with sexual life and lower satisfaction with their overall life compared with healthy people. Severity of ED seems to be an important factor, as men with moderate ED perceive the impact of ED on their life satisfaction equally with those with severe ED. ED patients gain more satisfaction from other domains of their life, provided they adopt coping behaviors that help compensate for their low overall life satisfaction. Furthermore, as ED patients do not differ from healthy people in their expressed subjective rating of quality of life (QoL), life satisfaction may be more sensitive than QoL assessment in the evaluation of the impact of ED on our patients' life.
Although the use of the Web has brought major advances in every step of the research process, this also comes with several methodological challenges.
The article presents the European Society for ...Sexual Medicine's position statements on key methodological concerns relative to Web-based research in sexual medicine.
The authors conducted a systematic scoping review of articles using Web-based research methods in sexual medicine. For the creation of the statements, the authors processed the data from the methodology of the studies and formulated the final statements reaching 100% agreement in the group.
European Society for Sexual Medicine statements were provided on the following domains: definition of the population of interest, selection of the population of interest, data collection quality, response rate, self-reported questionnaire, consent, and legal obligations.
Researchers should justify the relevance of the Internet population to the population of interest; should clearly describe how they identified study participants; should select and employ specific measures to avoid hoax; should explicitly describe the process of calculation of response and completion rates as well as the relative implications; should validate traditional sexual health questionnaires for online and, if possible, multilingual use; should not ignore consent in Web-based research; and need to be knowledgeable of the technical measures and legal obligations to protect anonymity.
Researchers are advised to include trained computer scientists in their group, have a good understanding of their legal obligations as to collecting, storing and disseminating personal data, and design their studies by taking into account the challenges of Web-based research.
The heterogeneity of the included studies and methodological low quality of most of them was a limitation, which also shows the importance of this study and the need for guidelines regarding Web-based research.
Large uncontrolled samples could be a threat to the quality of the studies and increase bias if researchers are not mindful of the methodological challenges they would need to account for.
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