اختلال عملکرد جنسی

Peyronie's disease is a relatively rare urological disorder that can cause pain during erection, penile angle deviation, and sexual dysfunction due to the formation of plaque in the tunica albuginea part of the male penis. Extracorporeal shock wave therapy (ESWT) for the management of Peyronie's disease is one of the emerging interventions. In this study, we aim to explore the effects of ESWT on Peyronie's disease.

We studied patients with the acute phase of Peyronie's who were treated with ESWT during the past two years, from 2021 to 2023. All patients were referred to the urology clinic of Imam Reza Hospital. Information including age, characteristics of fibrotic plaques, concurrent treatments other than ESWT, International Erectile Dysfunction Index (IIEF-5), and the severity of pain was extracted and documented from the patients' records by the urologist before and after the treatment.

The average age of the studied patients was 54.1 years. Eight percent of patients had a history of trauma to the penis, 30% suffered from diabetes, and 36% had high blood pressure. According to the statistical analysis, ESWT reduced pain and elevated the IIEF-5 score. However, this treatment had no impact on the length of the plaque.

ESWT, as a non-invasive intervention, can lessen pain sooner than the normal progression of the disease and improve the sexual performance of the individual. However, this approach had no significant effect on the length of Peyronie's plaque.

Female circumcision can be associated with unfavorable health outcomes, including physical, psychological, social, and sexual consequences. The present study was conducted to investigate the effect of circumcision and its predictor factors on sexual performance, life, and satisfaction of women.

The present study was a cross-sectional (descriptive-analytical) study of 320 women referred to the childbirth ward in 2019-2020. It was done using the available sampling method. Information was collected through questionnaires and interviews. The data collection tool was a 4-part questionnaire that included a researcher-made questionnaire, sexual questionnaires, and sexual quality of life. After collecting the data, they were analyzed using ANCOVA, a simple and multiple linear regression.

The mean score of sexual satisfaction, sexual function, and quality of sexual life in two groups (circumcised and uncircumcised women) showed a statistically significant difference (P < 0.001). Also, the mean score in all dimensions of sexual function was significant in two groups (desire (P < 0.001), stimulation (P < 0.001), humidity (P < 0.001), orgasm (P = 0.002), satisfaction (P < 0.001), pain (P = 0.049), respectively). The rate of sexual dysfunction in circumcised women was 83.9%, and in uncircumcised women was 71.6%. According to the coefficient effect in covariance analysis, 5, 7, and 13% changes in sexual satisfaction, sexual quality of life, and sexual function in women were related to circumcision, respectively. Also, the age of circumcision has the most outstanding effect and is a significant predictor of sexual satisfaction (β: 1.51; P: 0.018; CI95%: 2.77 to 0.26) and quality of sexual life (P: 0.027; CI95%: 0.12 to 2.06). The degree of circumcision 2 compared to 1 has the most distinguished effect and predictor on the overall sexual function score (β: 2.87; P: 0.018; CI95%: -0.22 to -5.52) and its dimensions.

The findings of the present study showed a decrease in the sexual satisfaction action and quality of life scores in circumcised women, and by emphasizing the negative consequences of circumcised women's sexual health, it tried to inform healthcare providers about counseling to change the views of families to improve women's sexual health.

Aging is a sensitive period of human life, and sexual health is an important part of the life of the elderly, which is usually ignored.

In this study, we examined the sexual health of retired old men.

In this cross-sectional analytical study, the research sample included 369 retired men aged 60 and over in Rrasht. Sampling was done in a stratified random way. In this study, the demographic questionnaire and Male Sexual Health Questionnaire (MSHQ) were used. Data were analyzed using Spearman’s correlation coefficient, Mann–Whitney test, Kruskal-Wallis test, and IBM SPSS Statistics software version 21 software.

The mean age of the participants was 66.5±4.7 years. The mean total sexual health score was 92.22±12.95, the maen ejaculation score was 26.87 (76.9% of the maximum score), the maen erection score was 10.88 (72.7% of the maximum score), and the mean sexual satisfaction score was 84.22 (76% compared to the maximum score). 54.6% of people were moderately satisfied with their sex life. The mean score of ejaculation and erection had a positive and significant correlation with the maen score of sexual satisfaction (respectively, r=0.189 P<0.001 and r=0.231 P<0.001). 17.1% of the elderly had erectile dysfunction. Age, length of married life and age gap with spouse were related to the mean score of erection and ejaculation (P<0.001). Place of residence and occupation had a significant relationship with the mean erection score (P<0.001). Occupation, income and length of married life had a significant relationship with sexual satisfaction (P<0.001). Physical and medical illness and drug use had a significant relationship with the mean erection score (P<0.001), but it had no relationship with the mean ejaculation score and sexual satisfaction.

The erection and ejaculation score of the old participants was more than 70% of the maximum possible score and more than half of them were moderately satisfied with their sex life. The better the participants perform in erection and ejaculation, the greater their sexual satisfaction.

One of the common problems of menopause is the decrease in sexual ability and sexual dysfunction, which can reduce the quality of life of women. Therefore, the present study was conducted with the aim of determining the effectiveness of “Behavioral Activation Therapy” on sexual self-concept and intimacy in relationships of postmenopausal women with sexual dysfunction.

The current research was of semi-experimental type with pre-test-post-test with control group and 45 days’ follow-up. The statistical population of the present study included all postmenopausal women with sexual dysfunction who referred to specialized treatment centers in the field of sexual dysfunction located in Isfahan city in 2023. A statistical sample of specialized treatment centers in the field of sexual disorders in the city of Isfahan according to the convenience method, the number of 30 postmenopausal women over 50 years of age with sexual dysfunction diagnosed by a clinical psychologist's diagnostic interview and scoring less than 28 out of 36 points "Female Sexual Function Index" were selected by purposeful sampling. Then they were randomly assigned to “Behavioral Activation Therapy” and control groups (15 people in each group). Data collection was done with demographic questionnaire, "Multidimensional Sexual Self-Concept Questionnaire" and "Personal Assessment of Intimacy in Relationships". For the intervention group, 8 sessions 90-minute of “Behavioral Activation Therapy (2 sessions per week) were performed. After the completion of the intervention, a post-test and follow-up was conducted 45 days later. Data were analyzed in SPSS. 23.

There was a significant difference between the intervention group and the control group in the two variables of sexual self-concept and intimacy in relationships, in the post-test and follow-up stages. Therefore, the intervention was effective in improving sexual self-concept and intimacy in relationships of postmenopausal women with sexual dysfunction (P<0.05).

“Behavioral Activation Therapy" improves sexual self-concept and intimacy in relationships in postmenopausal women with sexual dysfunction. It is suggested to use “Behavioral Activation Therapy" in health care centers and counseling centers to improve the psychological variables related to the sexual performance of postmenopausal women.

Type 2 diabetes is associated with a multitude of physical and psychological complications, significantly impacting the quality of life for individuals afflicted with the condition. This study aimed to explore the effectiveness of Time Perspective Therapy (TPT) on enhancing sexual function, emotional self-efficacy, and reducing marital conflicts among patients with Type 2 diabetes experiencing sexual dysfunction.

This study used a semi-experimental design involving a pre-test and post-test control group. The research included 30 individuals diagnosed with sexual dysfunction who were recruited from the Persian Diabetes Clinic in Mashhad in 2024. Participants were randomly divided into two groups: the experimental group, which received eight 90-minute TPT sessions, and the control group. Various assessment tools such as the Marital Conflicts Scale, Emotional Self-Efficacy Scale, and Marital Sexual Performance Scale were used. The data were analyzed using multivariate and single analysis of covariance through SPSS 24 software.

The results indicated statistically significant improvements in sexual function and emotional self-efficacy, along with a reduction in marital conflicts among participants in the experimental group compared to the control group. After controlling for pre-test scores, notable differences between the post-test scores of both groups were observed, affirming the potential of TPT to foster better sexual health and enhance emotional resilience.

Time Perspective Therapy significantly enhances sexual function, emotional self-efficacy, and reduces marital conflicts in patients with Type 2 diabetes facing sexual dysfunction. This study underscores the importance of psychological interventions in managing the complex needs of diabetic patients, suggesting that TPT can be an effective adjunct to traditional medical treatments.

 Sertraline is one of the most commonly used selective serotonin-reuptake inhibitors for patients with major depressive disorder. The prevalence of sexual dysfunction among patients who use selective serotonin-reuptake inhibitors is 40%–45% for women and 20%–30% for men. A strategy to prevent this side effect is combination therapy with medications such as buspiron and Ritalin. The aim of this study was to compare the effects of bupropion and Ritalin on sexual dysfunction among patients who use sertraline.

 This single-blind randomized controlled trial was conducted in 2018. Fifty eligible women aged 20–45 years old were purposefully selected from the psychiatric clinics of Yahyanejad and Ruhani hospitals, Babol, Iran. Structured interview was used to screen participants for major depressive disorder, sertraline use, and sexual dysfunction. All participants completed the Arizona Sexual Experience Scale and were randomly allocated to the bupropion and the Ritalin group through block randomization. All participants re-completed the Scale one month after the intervention. Data were analyzed through SPSS software by repeated measure analysis of variance.

 All fifty participants (25 in each group) completed the study. The mean of participants’ age was 36.38±5.64 years and the mean score of their sexual dysfunction was 23.44±3.14 at pretest and 19.52±4.92 at posttest. Between-group differences respecting the mean scores of sexual dysfunction and all its items were insignificant both at pretest (P= 0.886) and posttest (P= 0.872). However, within-group comparisons revealed that the mean score of sexual dysfunction significantly decreased in both groups (P<0.001).

 This study concludes the same efficacy of sustained release bupropion and Ritalin in significantly reducing sexual dysfunction among patients who used sertraline.

Practical Implications: 

 According to the results of the present study and the similar efficacy of slow-release bupropion and Ritalin in improving sexual dysfunction caused by sertraline, it seems that Ritalin, due to its effectiveness in treatment, is an easier drug to use. It is more cost-effective and a better alternative to bupropion in improving sexual dysfunction in patients who are candidates for treatment with serotonin- reuptake inhibitors.

Inadequate information and false sexual beliefs are common psychological factors in sexual disorders. This study aimed to determine the effect of counseling on the sexual knowledge, attitude, and performance of women with sexual dysfunction.

This randomized controlled clinical trial was conducted on 80 women aged 18 to 30 years with sexual dysfunction. Samples were randomly assigned to two test and control groups. The required data were collected using a demographic form, the Sex Knowledge and Attitude Test, and Female Sexual Function Index. The intervention was performed in 4 counseling sessions of 45-90 minutes weekly based on the rapport building, exploring, decision making, and implementing the decision (REDI) model. Data were gathered before and 4 weeks after the intervention and analyzed using Stata-13 software. The significance level was considered less than 5%.

After the intervention, the mean scores of sexual knowledge, sexual attitude, and sexual knowledge and attitude, as well as the total score of sexual function in the test group were obtained at 47.13±1.74, 51.16±2.34, 98.30± 3.73, and 26.29±2.46, respectively. These resultsshowed a statistically significant increase compared to before the intervention and also compared to the control group (P<0.001). After the intervention, the mean scores of sexual desire, orgasm, and pain domains showed a significant difference between the two test and control groups (P<0.05).

It was found that REDI model-based counseling was effective in improving the sexual knowledge, attitude, and function of young women with sexual dysfunction. Considering the simplicity and effectiveness of this method, it is recommended to use it in sexual counseling.

Sexual performance is among the most important aspects of postmenopausal women's life. The long-term side effects of hormone replacement therapy during menopause have led women towards the use of complementary therapies to improve sexual performance. This systematic review was conducted to investigate the effectiveness of complementary therapies in improving the sexual performance of postmenopausal women.

In this systematic review, studies in English and Persian languages were searched in national (SID, Magiran, and IranMedex) and international databases (PubMed, Science Direct, Embase, Cochrane Library, and Google Scholar) until 2023. The search keywords were selected based on the Medical Subject Heading (MeSH) and included "Sexual Dysfunctions", "Menopause", "Complementary medicine", "Alternative medicine" combined with Boolean operators (OR and AND). Finally, quality assessment and data extraction were performed independently by two researchers using Cochran's standard tool.

Finally, 22 articles with a total sample size of 1617 participants were selected. The types of the articles were randomized and non-randomized clinical trials. Studies showed that aroma therapy, combined inhalation aromatherapy, and herbal compounds, including combined herbal capsules containing red ginseng extract, saffron, red clover and black cohosh, date palm pollen and Althaea officinalis improved sexual performance in menopausal women. Furthermore, performing activities, including yoga, Benson relaxation and CBT had the greatest effect on sexual performance.

Based on the results of the present study, most complementary medicine treatments were effective in improving the sexual performance of postmenopausal women.

Although pregnancy is a pleasant period for most women, it is often a stressful period with physiological and psychological changes. Physical health and mental health are two general dimensions of quality of life. It seems that the quality of life has an effect on the sexual function of pregnant women. Therefore, this study was conducted with aim to compare the relationship between sexual function and the quality of life of pregnant women in different trimesters of pregnancy.

This cross-sectional study was conducted in 2019 on 360 pregnant women (120 pregnant women in each trimester) referring to the pregnancy care clinic of Rasht public Hospitals. The tools were questionnaires of demographic characteristics, FSFI sexual function, and quality of life SF-36. Data analysis was done using SPSS statistical software (version 23) and t-test, Chi-square, ANOVA and Pearson's correlation coefficient. P<0.05 was considered statistically significant.

The mean score of the total sexual function of the studied subjects was 18.64 ± 10.05. Sexual dysfunction was seen in 86.4% of the samples. The scores of sexual functions in the first to third trimester of pregnancy were 23.92 ± 7.79, 18.84 ± 8.84, and 13.17 ± 10.37, respectively. It showed a statistically significant difference between the total score and the scores of the dimensions of sexual function with trimesters of pregnancy (p<0.001). The quality of life of the groups with and without sexual dysfunction had statistically significant differences in the two main dimensions of physical health and mental health (p<0.001). The mean scores of physical health and mental health were 54.82 ± 18.73 and 60.18 ± 17.59, respectively. Also, satisfaction (r=0.162, p=0.002) and pain (r=0.108, p=0.041) had a positive correlation with physical health. The total score of sexual function (r=0.158 and p=0.003) had a positive correlation with mental health. Lubrication (r=0.126, p=0.017), orgasm (r=0.146, p=0.006), satisfaction (r=0.247, p=0.0001), pain (r=0.165, p=0.002) and the total score of sexual function (r=0.158, p=0.003) were positively correlated with mental health.

The rate of sexual dysfunction increases with increasing gestational age. Also, quality of life with the highest mean score of mental health was related to the first trimester and the highest mean score of physical health was in the third trimester of pregnancy. Sexual function had a positive correlation with the mental health dimension of quality of life.

The quality of sexual function, especially orgasm, is one of the most important issues related to sexual health and fertility. The present study aims to investigate the effect of mindfulness-based sex therapy on orgasm quality and sexual function of women with orgasm disorder.

This is a clinical trial. Participants were 25 Iranian married women referred to clinics of family therapy, sex therapy, and psychiatry in Tehran, Iran who were selected by a convenience sampling method. After obtaining informed consent, they completed the sexual function questionnaire and a researcher-made questionnaire on orgasm quality. Then, education in about the structure and performance of sexual system and sexual response processes were given to them and received the mindfulness-based sex therapy at 8 sessions before, immediately after, and three months after the intervention. The data were compared using multivariate analysis of covariance (MANOVA).

The interventions improved orgasm quality and sexual function, and the interaction effect of treatment and time was significant. Results of MANOVA showed a significant difference in sexual function (F(2,22)=195.95, P<0.0001), orgasm quality (F(2,22)=330.97, P<0.0001), number of orgasms per month (F(2,22)=352.28, P<0.0001) and number of sexual intercourses per month (F(2,22)=183.15, P<0.0001) over time. 

It seems that mindfulness-based sex therapy is effective in improving sexual function and treating orgasmic disorders in women.

Sexual dysfunction is a common complication of methadone maintenance therapy (MMT) and buprenorphine maintenance therapy (BMT). The aim of this study was to evaluate of sexual function in addicted men under treatment with methadone and buprenorphine.

In this cross-sectional study, 30 men undergoing methadone maintenance treatment (n=15) and buprenorphine (n=15) were included in the study in Kashan addiction treatment centers. The Golombok-Rust Inventory of Sexual Satisfaction (GRISS) questionnaire was used to collect data. The collected data were analyzed using SPSS version 22 software and using Fisher's exact tests, independent t test and linear regression.

There was no significant difference in the mean total score of sexual performance between the methadone (38.40±13.58) and buprenorphine (38.33±14.56) groups (P=0.733).

The results showed that in both groups, sexual performance was at an unfavorable level, and therefore, it is recommended that future studies focus on providing strategies to improve sexual performance and satisfaction in patients undergoing maintenance treatment with methadone and buprenorphine.

The present study was performed to evaluate carboxytherapy as an outpatient and non-hormonal strategy for the treatment of a number of pelvic floor disorders.

This randomized block controlled clinical trial study was performed on 60 women aged 35-65 years in 1399-1400 to evaluate the effect of carboxytherapy on the treatment of stress urinary incontinence and sexual dysfunction in comparison with the control group. At the beginning of the study, vaginal examination, cough test and POP-Q test were performed for all patients. Eligible individuals were randomly assigned to either carboxytherapy or control groups. Stress urinary incontinence was assessed using the ICIQ-UI SF questionnaire and sexual dysfunction was assessed using the PISQ-12 questionnaire. In the intervention group, 30 cc of CO2 gas with a 90-degree angle was injected in three areas of the bladder neck with the help of a needle gauge 30 with a length of 12 mm, so that each person underwent carboxytherapy twice a week for one month. The control group received the same protocol but without CO2 injection. The results were assessed both at the beginning of the study and one month and three months after the intervention through physical examination and two questionnaires.

The results of the present study showed that the mean of general sexual function index and also the mean index of sexual function of patients in the physical dimension and in the dimension related to sexual partner in the intervention group was significantly different during the two stages of measurement but no significant difference was observed in the control group. The overall score of urinary function, frequency of leakage and the effect of leakage on the quality of life of women in both control and intervention groups were significantly different between the three stages of measurement. While the rate of urine leakage in the intervention group was significantly different between times, no difference was observed in the control group.

Carboxytherapy is a safe, effective, acceptable, inexpensive, affordable, and accessible treatment option compared to other treatments for urinary incontinence, and better results can probably be achieved by increasing treatment sessions.

Pelvic organ prolapse (POP) is the descent of pelvic organs beyond the vaginal walls which is associated with bothersome urinary, defecatory, sexual and vaginal mass protrusion symptoms. The present study was performed aimed to investigate the correlation of the symptoms and POP-Q stage.

This cross-sectional study was performed on 335 women with pop symptoms referred to the pelvic floor clinic of Tehran Imam Khomeini hospital in 2018-2019. A checklist of detailed medical history which contains urinary, defecatory, sexual and bulging symptoms due to pelvic organ prolapse was completed by a gynecologist (fellowship of pelvic floor disorders) and the stage of POP was evaluated according to pelvic organ prolapse quantification (POPQ) system. The relationship between clinical symptoms and the stage of POP was assessed. Data were analyzed by SPSS software (version 23) and Chi-square, Fisher's exact test and multivariate regression. P<0.05 was considered statistically significant.

Among women with pelvic organ prolapse symptoms, there was significant correlation between stress and urgency urinary incontinence and lower stage of anterior compartment prolapse (p=0.002, p=0.043, respectively). Also, significant correlation was observed between urgency urinary incontinence and lower stage of posterior compartment prolapse (P=0.04), but there was no correlation between defecatory symptoms and stage of anterior, posterior or apical compartment prolapse (P>0.05). There was significant correlation between vaginal noise and sexual dissatisfaction with lower stage of anterior compartment prolapse (p=0.014, p=0.025, respectively).

Urinary symptoms especially stress and urgency urinary incontinence and sexual dissatisfaction were correlated with lower stage of POP. Also, due to the lack of relationship between defecation symptoms and prolapse stage, complaints of pelvic organ prolapse symptoms may not be related to the severity and stage of prolapse in clinical examination.

Regarding to the relationship between depression and sexual dysfunction and its negative effects on quality of life, this study was performed aimed to investigate the effect of wormwood vaginal gel on depression in women of reproductive age with sexual dysfunction.

This two-group, triple- blinds randomized clinical trial study was performed in 2021 on 76 women referred to the gynecological clinic of Ghaem Hospital in Mashhad. The study tools included: Demographic Information, Female Sexual function Index (FSFI), and the DASS-21 Depression questionnaires. At first, the subjects were randomly divided into the intervention and placebo groups and used vaginal gel for 4 weeks. Sexual Function and DASS-21 questionnaires were assessed in two groups before and 4 weeks after the intervention. Data were analyzed by SPSS software) version 25) and Independent t, Mann-Whitney, Paired t, Wilcoxon and chi-square tests.  P< 0.05 was considered statistically significant.

Before the intervention, there was no statistically significant difference between the mean score of total sexual function (P=0.562) and depression (P=0.140) in the intervention and placebo groups. Four weeks after the intervention, the mean score of sexual function significantly increased in the intervention group compared to the placebo group and the mean score of depression significantly decreased in the intervention group compared to the placebo group (P<0.001). The women with moderate or mild depression before the intervention had mild or no depression after the intervention.

Wormwood gel effectively improves depression in women with mild to moderate depression and sexual dysfunction.

Sexual dysfunction affects quality of life, and many social problems; therefore, the aim of this study was to determine the prevalence of sexual dysfunction and some related demographic factors in women of reproductive age in Bushehr.

The present study is a cross-sectional study that was conducted online on 548 married women aged 15 to 49 living in Bushehr. Sampling was based on random stratification among all ten health centers of Bushehr city. Data were collected using a demographics checklist and the Female Sexual Function Index for assessing the participants’ sexual performance in six domains. Data analysis was done by SPSS software version 22 using Chi-square and logistic regression. The significance level for all tests was less than 0.05.

In this study 267 persons of 548 participants (48.7%) experienced sexual dysfunction. The results showed that 48.7% of women. Among the demographic variables, level of education (p<0.001), level of family income (p=0.014), dissatisfaction with the spouse (p=0.005), history of sexual dysfunction (p<0.001) and sexual function status (p<0.001) were the predictors of sexual dysfunction.

Prevalence of sexual dysfunction in married women in Bushehr is relatively high. Since sexual function status is a strong predictor of sexual dysfunction, it can be used to identify people with sexual dysfunction. The diagnosis and treatment of female sexual disorders should be facilitated in order to prevent such disorders. It is necessary that interventions be designed and implemented to improve sexual function in women who have disputes with their husbands or have an insufficient income.

Sexual dysfunction is considered a common sexual problem affecting different aspects of life, and it seems to be rooted in individual's personality.

This paper aims to compare prevalence of sexual dysfunctions between those with narcissistic personality disorder (NPD) and healthy persons.

This is a causal – comparative research. To do so, 700 males and females from Tehran City were screened in 2021, among them 120 persons were diagnosed with NPD and 41 persons were selected through convenience sampling as individuals with disorder. Data of 40 healthy persons were analyzed for comparative purposes. Millon Clinical Multiaxial Inventory (MCMI3), Female Sexual Functions Index (FSFI) and International Index of Erectile Function (ILEF) were used. Data were analyzed by comparing two independent groups in SPSS, Version 26.

In females, there were no significant differences in sexual function (t=1.011, P=0.320), moisture (t=0.537, P=0.595), orgasm (t=-0.539, P=0.594), sexual pleasure (t=0.164, P=0.871) and pain (t=0.999, P=0.327) between narcissists and healthy persons. Difference in sexuality (t=2.289, P<0.05) and arousal (t=2.107, P<0.05) in healthy persons was more significant than narcissists. Moreover, in males, the difference in sexual function (t=7.545, P<0.001), sexuality (t=12.871, P<0.001) and erection (t=4.832, P<0.001) in healthy persons was more significant than narcissists, and orgasm (t=-3.426, P<0. 01) in narcissists was less than in healthy persons. However, there was no significant difference between sexual pleasure in both groups (t=-0.866, P=0.393).

The results show that prevalence of sexual dysfunctions in narcissists is more than healthy persons. Therefore, it is recommended that counselors and psychologists consider personality traits in diagnosis and treatment of sexual disorders.