Anal Sex

High prevalence, incidence and clearance of anal high-grade squamous intraepithelial lesions (HSIL) in homosexual men: early evidence from the Study of the Prevention of Anal Cancer (SPANC)

Homosexual men are at increased risk of anal cancer. Screening and treatment of the precursor, HSIL, has been advocated by some, but screening is not recommended in widely-accepted guidelines. We aimed to describe the prevalence, incidence, and clearance rates of anal HSIL, and association with human papillomavirus (HPV) status, in a community-recruited cohort of homosexual men.

High Resolution Anoscopy - Practice makes perfect

Background: Liquid based anal Papanicolaou smears, followed by High Resolution Anoscopy (HRA) guided biopsies are increasingly being advocated to identify areas of High Grade Anal Intraepithelial Neoplasia (HGAIN). We hypothesized that the ability to identify HGAIN would increase with experience of the anoscopist, and that comparison with contemporary Papanicolaou smears might yield insights into technical abilities.

Behavioural trends among Australian gay men pose increasing challenges for HIV prevention: findings from the Gay Community Periodic Surveys, 2003-1

Gay men remain the primary population affected by HIV in Australia. While recent attention has been focused on increasing HIV testing and the use of antiretroviral-based prevention to reduce infections, it is equally important to sustain safe sex and other risk reduction practices. Increases in unprotected anal intercourse (UAI), for example, may counteract any beneficial changes in testing and treatment. 

Undetectable viral load is associated with increased unprotected anal intercourse in gay serodiscordant couples

In serodiscordant heterosexual couples, undetectable viral load (VL) is associated with a substantially reduced HIV transmission risk. No studies in gay male serodiscordant couples (SDCs) have been reported. 'Opposites Attract' is an ongoing cohort study of gay SDCs recruited via clinics and community-based advertising. HIV-Positive Partners (HPPs) have VL tested at baseline; HIV- Negative Partners (HNPs) have HIV antibody tests and report sexual behaviour and partner’s perceived VL. Associations between unprotected anal intercourse (UAI) and VL were examined with logistic regression and Wilcoxon rank-sum test.

Practicalities of screening for anal cancer.

Digital rectal examination to screen for anal cancer in HIV positive men having sex with men (MSM)

Anal cancer is more common in MSM and even more common if they have HIV. Anal intra-epithelial neoplasia (AIN) appears to be the precursor and considerable effort is being directed toward evaluating the effectiveness of screening for and treating AIN to prevent anal cancer. This is analogous to the cervical screening programs in wealthy countries. But AIN screening and treatment differs from cervical screening and treatment in several key ways that may delay its introduction into routine clinical care.

Impact of depression on sexual activity and risk taking among french gay men seeking sex on internet

The objective of this study was to analyse how depression influences sexual desires and activities of gay men to understand the co-occurrence of depressed mood, high sex drive and unprotected anal intercourse with casual partners (UAIC) among some individuals.  In 2004, French gay men visiting a major gay Internet site participated in an online survey assessing serological status, numbers of casual partners, sex drive and control over sex drive, UAIC, depression and its impact on sexual desire. 1932 men who had casual partners in the previous year were included in the analysis. HIV-negative men on average had 22 casual partners per annum, and 28% reported UAIC. 

The types of sexual activity of women and their sexual satisfaction, mental health and quality of relationships: A literature review

Penile-vaginal intercourse, masturbation, anal sex and oral sex may influence women’s sexual satisfaction, mental health and quality of relationships. This article is a review of the literature that critically investigates how the type of sexual activity affects these aspects of women’s lives. 

Androgen

Ejaculation disorders - Diagnosis & Treatment.

The commonest male ejaculation disorder is Premature Ejaculation (PE). Inhibited or Delayed Ejaculation can be a more challenging condition to assess and treat. This discussion will focus on the diagnosis, investigations and management of ejaculation problems including an overview of the first medication specifically approved for the treatment of PE, dapoxetine, released under the trade name of Priligy™. 

Love and Lust among the 'Rusty'

The objectives are to present solutions to achieving sexual pleasure after "a dry spell."  Discuss

Literature review & pathophysiology of the role of testosterone in psychiatric illnesses

Treatment with testosterone

Pharmacotherapy of Ed ... the future

Male population with low sexual desire treated with an association of testosterone (intramuscular) and transdermal testosterone gel

Replacement treatment with Testosterone has been a controversial issue along the last 5 years. Despite the average good response to treatment many scientist disagree with the  proposal of giving Testosterone on the bases of clinical evidence of Low Sexual Desire without dosage of Testosterone blood level. Our objectives were to treat an adult male population (n=200) which presented Low Sexual Desire with intramuscular (Duratestone, Lilly) and transdermal fixed doses of Testosterone (Androlone gel, Beta).

Ethnic variations in the prevalence of male sexual dysfunction

An epidemiological study was carried out in a cohort of 923 male patients presenting with sexual dysfunction (SD) at the Andrology clinic, NUH to evaluate the community prevalence of erectile dysfunction (ED) among the different races in Singapore and how it varied with the marital status, medical illnesses and lifestyle derangements.

Long term androgen therapy restores erection in Sildenafil non-responders on demand

Debate about the role of androgens in erection still exists. The aim of this study  was to assess the efficacy of long term taking  androgen in  patients who were previously sildenafil non-responder on demand regime.  In a propective controlled trial 17 patients  with ED more than 1 year non-responder on sildenafil taking  on demand were included. Average age of patients was  53.4 All patients had late onset hypogonadism (AMS score  37±6, testosterone 7,4±2,3).  All  patients were treated with Androgel 25 mg.

Late Onset Hypogonadism (LOH) and sexual Health

It is well established that there is an age-related decline in testosterone production of men, which might play a role in the age-related decline in sexual desire and erections. Such a causal relationship is still debated since few studies found significant relationships between serum testosterone and sexual parameters of aging men that persist after adjustment of the data for age. In addition although 2 meta-analyses of randomized controlled trials confirmed a significant effect of testosterone therapy on sexual desire and erections of men of any age when baseline testosterone is below 12 nmol/l, the effect of this therapy is rather disappointing when it is used in the specific and prevalent population of the men presenting with erectile dysfunction (ED), and who are subsequently diagnosed with LOH.

Ejaculation disorders - Diagnosis & Treatment.

The commonest male ejaculation disorder is Premature Ejaculation (PE). Inhibited or Delayed Ejaculation can be a more challenging condition to assess and treat. This discussion will focus on the diagnosis, investigations and management of ejaculation problems including an overview of the first medication specifically approved for the treatment of PE, dapoxetine, released under the trade name of Priligy™. 

Androgen Therapy

Ejaculation disorders - Diagnosis & Treatment.

The commonest male ejaculation disorder is Premature Ejaculation (PE). Inhibited or Delayed Ejaculation can be a more challenging condition to assess and treat. This discussion will focus on the diagnosis, investigations and management of ejaculation problems including an overview of the first medication specifically approved for the treatment of PE, dapoxetine, released under the trade name of Priligy™. 

Androlife Campaign: andrologists and psychosexologists in team- premature ejaculation, the main sexual dysfunction diagnosed in young men

Androlife is the first Italian national campaign, supported by Italian Society of Andrology and Medical Sexology (SIAMS) aimed to: promote the primary prevention of the reproductive male tract pathologies, inform boys about the importance of controlling risk factors for male infertility, sensitize public awareness about male reproductive health, collect data on lifestyle, habits, and general health status in young males aged 18 to 35, and diagnose possible andrological pathologies.

Obesity, Smoking and ED in Sexual Health Medicine

Obesity and Cigarette Smoking are risk factors related to accelerate degenerative diseases in man which enhance precocious aging process. This condition states the heightened Oxidative Stress which is indicative for the changes made at the genetic materials level. Obesity and smoking increase the rate of telomere erosion per replication and occurring of inflammation which enhance leukocytes turn-over and shortened telomere arm length of leukocyte cells. Oxidative Stress induced extensive vascular endothelial cells dysfunction causing Vascular Diseases and other Degenerative Morbidities.

What is Driving Sexual Desire?

The total number of sexual activities for an individual varies greatly across the lifespan. The driving forces for sexual behaviour remain contentious with the role of androgens, other hormones, neurotransmitters and physiological factors often considered to be key components. Increasingly, scientific advances have attempted to provided explanations for understanding differences that have been attributed to factors such as genetic variations in CAG repeat polymorphisms or brain neuronal networks and these will be explored. However, emotional and relational problems may have equal or greater impact and there are concerns about the limitations of the medical model to explain sexual ‘differences’ and diversity.

Aphrodisiacs in sexual medicine arena

A significant advancement in plant derived medicines in the last two centuries in such areas as central nervous system, anti-tumor and anti-inflammatory activities has led to the development and identification of active chemicals and understanding of their modes of action. As for man’s health related to sexuality, numerous age-old natural products have been historically claimed as ‘aphrodisiacs’ – a collective meaning, which describes improvement of arousal, libido and/or sexual energy and activity.  It would appear that most natural herbal preparations considered as aphrodisiacs are acting like synthetic anabolic hormones. Sometimes, they are considered as a form of testosterone replacement therapy (TRT) since some of them are shown to stimulate the body to produce natural testosterone and even DHEA. 

The Sexual Life of Prostate Cancer Patients Treated with ADT

Medical or surgical castration for palliative treatment of prostate cancer gives rise to significant negative impacts on quality of life (QoL) for patients. This is because of adverse effects including decreased libido and erectile function, in addition to other conditions such as osteoporosis, vasomotor flushing, fatigue, anaemia, diabetes mellitus, metabolic syndrome, and altered body composition.

Unexplored Problems of PCOS Patients

Aim: Studies have shown sexual dysfunctionality in 20-25% of infertile couples. Polycystic Ovarian Syndrome (PCOS) is the most common hormonal disorder among women of reproductive age and is a leading cause of infertility. Infertility may alter a woman’s sexual expression by causing or exacerbating sexual problems as a consequence of the diagnosis, investigation and treatment of infertility. Adequate sexual function can contribute to the success of fertility treatments. This study aims to assess sexual function in infertile and PCOS women in relation to their age, body mass index and duration of infertility. The prevalence of Female Sexual Dysfunction (FSD) and PCOS in infertile women and its correlation with infertility was also evaluated. And to find the relationship between Female Sexual Dysfunction and testosterone levels in women with Polycystic Ovary Syndrome (PCOS).

Comprehensive Treatment of Male Psychogenic Sexual Dysfunction by Sex Therapy and Psychotropic Drugs (Without 5PDEIS)

The aim of this presentation is to explain the curative treatment of male psychogenic sexual dysfunction by sex therapy and psychotropic drugs (without PDE5 inhibitors). Normal sexual response is restored and patient remains pill free after 10 to 12 weeks of treatment with weekly or fortnightly session of sex therapy and psychotropic drugs. This reduces the PDE 5 inh dependency and non-responsiveness later on. My experience as sex therapist treating male psychogenic sexual dysfunction since 1996 in Muslim society like Pakistan will be shared. Sexual dysfunctions are either predominantly psychogenic or predominantly organic.

Significance to maintain morning erection in even over 60 year-old men for active well aging

The ultimate aim of Andrological medicine is the study of the maleness, creating the health and well-being of human male. So that, even though the fundamental study of andrology is very essential, we should finally reach to clinical andrology.

Protodioscin a Herbal Extract Enhance Recovery of Erectile Dysfunction

The age-related reduction in blood serum testosterone (T) level is well known as hypogonadism. Laboratory biochemical reports in healthy male youth has been reported to contain total-T ranging 250 - 800 mg/L. 60% are tightly bound to SHBG (sex-hormone-binding-globulin), 38% to albumin and in small fraction (2%) only is unbound and known as “free-T”. Consequently, only albumin-bound and free-T constitute the bio-available form of T, which are accessible to target tissues and carry out the actions of essential sex hormone, which also care for sexual function such as libido and mechanism of penile erection. This bioavailability of T concentration is influenced by SHBG levels. Aging men experience increase in aromatase activity and an elevation in SHBG production. The net result is an increase in the ratio of estrogen to T and decrease in total-T and Free-T. Free-T is essential for De-Hydro-Testosterone (DHT) production needed to cross the blood-brain- barrier to stimulate the TARGET aggressive-centre in the brain which provokes libido. Our former studies have shown that Tribulus terrestris L extracts containing the active agent PROTODIOSCIN can be converted to bioidentical DHEA, which may activate the conversion of albumin-bound-T to active Free-T and total-T presence of 5-alpha-dehydrogenase. Experiment with Protodioscin on Hypogonadic men with ED

Anti RetroViral Therapy

Art in the Shadows: Art that Reveals, Transforms and Restores

This visual presentation explores the relationship between creative arts practice and trauma, loss and grief, including the shadowy world of sexual abuse. It is an examination of what art and the artist, through collaborative creative processes, contributes to wellbeing in the aftermath of such experiences. I will speak of my recently completed PhD and the creative research projects I conducted with communities of women who had experienced trauma and loss and who carried the pain of these experiences for years afterwards.

Clinical factors associated with suboptimal adherence to antiretroviral therapy in Asia

Adherence to combination antiretroviral therapy (cART ) plays an important role on treatment outcomes. The TREAT Asia Studies to Evaluate Resistance – Monitoring Cohort Study (TASER-M) collects patients’ adherence based on a Visual Analogue Scale. The aim of this analysis was to assess the rates of, and factors associated with, suboptimal adherence in the first 24 months of initial cART in Asian patients.

The impact of immune activation on natural killer cells in the setting of HIV infection

HIV disease is associated with chronic inflammation and activation of the innate immune system. This state, as measured using plasma markers of inflammation, persists following suppression of HIV viremia using antiretroviral therapy, and may increase risk of non-AIDS co-morbidities. The causes of innate immune activation in the setting of virological suppression are unclear. Natural killer (NK) cells are innate immune cells that kill virus-infected and transformed cells without prior sensitization. We have shown that NK cells are activated both phenotypically (elevated expression of HLA-DR) and functionally (increased spontaneous degranulation measured by CD107a surface expression) in virologically suppressed (VS) HIV+ individuals. NK cells also lose expression of CD16, the receptor which mediates antibody-dependent cellular cytotoxicity.

Prevalence and predictors of multimorbidity among people living with HIV in regional New South Wales, Australia

In contrast to co-morbidity, multimorbidity among people living with HIV has not been well studied. Multimorbidity is the co-occurrence of more than one chronic health condition in addition to HIV. Higher multimorbidity increases mortality, complexity of care and health care costs while decreasing quality of life. Our aim was to describe the prevalence of and factors associated with multimorbidity among HIV positive patients attending a regional sexual health service.

'I left my lifeline': Understanding use and refusal of alternative therapies among people living with HIV in the Pacific Islands

Antiretroviral therapy (ART) became available in the Pacific Islands in the early 2000s, yet many people living with HIV (PLHIV) continue to turn to alternative therapies. ART is used to treat HIV infection, whereas for many people alternative therapies offer the hope of a cure or less harmful side effects. Use of alternative therapies in some cases leads people to forgo ART. This paper explores the use of alternative therapies among Pacific PLHIV including the types used, reasons for using them and why some respondents refused them.

HIV infection is associated with the aberrant expression of B cell receptors for cytokines that regulate B cell activation and differentiation

HIV infection causes B cell activation and dysfunction that deplete memory B cells and impair isotype diversification of IgG antibodies. Cytokines are critical for B cell activation (e.g. interleukin (IL)-6, interferon (IFN)-γ, IFN-α) and immunoglobulin isotype diversification (e.g. IL-21). As aberrant expression of cytokine receptors, such as the IL-7 receptor, is a characteristic abnormality of CD4+ T cells in HIV patients, we have examined cytokine receptor expression on B cells to gain further insights into B cell dysfunction.

Prevalence of CSF Alzheimer's disease-like in middle-aged HIV+ individuals

The study aimed at determining the prevalence of Alzheimer’s disease (AD) risk in ageing and chronically HIV-infected (HIV+) persons who are successfully treated with combination antiretroviral therapy (cART). 43 adult males and 1 female with stable chronic HIV disease [aged 57 ± 8 years, HIV duration 20 (5-25) years, undetectable plasma and CSF HIV RNA] were enrolled under a prospective observational study. All underwent standard neuropsychological testing, APOE genotyping and a CSFlumbar puncture to assess CSF Aβ1-42, h-tau and p-tau concentrations.

Undetectable viral load is associated with increased unprotected anal intercourse in gay serodiscordant couples

In serodiscordant heterosexual couples, undetectable viral load (VL) is associated with a substantially reduced HIV transmission risk. No studies in gay male serodiscordant couples (SDCs) have been reported. 'Opposites Attract' is an ongoing cohort study of gay SDCs recruited via clinics and community-based advertising. HIV-Positive Partners (HPPs) have VL tested at baseline; HIV- Negative Partners (HNPs) have HIV antibody tests and report sexual behaviour and partner’s perceived VL. Associations between unprotected anal intercourse (UAI) and VL were examined with logistic regression and Wilcoxon rank-sum test.

Trends in first-line antiretroviral therapy in Asia

Antiretroviral therapy (ART) has evolved in response to research findings, drug availability and experience in HIV management. The aim of this analysis was to describe the trends in first-line ART use in Asia over the past decade and evaluate whether these trends have contributed to reduced treatment modification and failure.

Sexuality in Australia's Unworried Unwell: Confounding Factors in the Management of HIV

Advances in antiretroviral medications over the last two decades have greatly improved the quality of life for people living with the human immunodeficiency virus (HIV). Acknowledgment of HIV status improves adherence to antiretroviral medication regimes that aim to reduce the viral load to be undetectable, reducing virus transmission and delaying immune system deterioration and associated symptoms. This state of wellness supports a person’s ability to engage in healthy sexual relationships.

Arousal

Is there Influence of Age, Number of Children in the Sexual Arousal of Women?

Do Women Get Confused When Describing Sexual Desire and Sexual Arousal? Responding Quantitatively with a Survey of 1140 Women

Sexual Pleasure: A Gendered, Embodied Affair

The neuroscience of psychotherapy : Simple and Complex PTSD

This eight part seminar explores psychotherapy and the social brain with a special emphasis on the causes and consequences of trauma. As a foundation, the evolution, development, and neuroanatomy of the brain with the goal of highlighting its vulnerability to dysregulation and dissociation are discussed. In it we recognise and better understand the neural networks responsible for stress and trauma and the challenge of keeping the government of systems which comprise our brains integrated and functioning smoothly. Then how psychotherapy, in its multiple forms, attempts to reshape the brain in the service of mental health is discussed. And finally,the process of healthy aging, especially for therapists who are confronted with trauma on a day-to-day basis is explored.

Menopause: a discussion

Aphrodisiacs in sexual medicine arena

A significant advancement in plant derived medicines in the last two centuries in such areas as central nervous system, anti-tumor and anti-inflammatory activities has led to the development and identification of active chemicals and understanding of their modes of action. As for man’s health related to sexuality, numerous age-old natural products have been historically claimed as ‘aphrodisiacs’ – a collective meaning, which describes improvement of arousal, libido and/or sexual energy and activity.  It would appear that most natural herbal preparations considered as aphrodisiacs are acting like synthetic anabolic hormones. Sometimes, they are considered as a form of testosterone replacement therapy (TRT) since some of them are shown to stimulate the body to produce natural testosterone and even DHEA. 

Love and Lust among the 'Rusty'

The objectives are to present solutions to achieving sexual pleasure after "a dry spell."  Discuss

Subjective Sexual Experiences at Most Recent Sexual Event among American Adolescents

This paper summarizes the subjective sexual experiences associated with the most recent partnered sexual event: sexual arousal, pleasure, orgasm, erectile (males) or lubrication (females) difficulties, and sexual intercourse pain. Data were obtained from a population-based cross-sectional survey of 5,865 adolescents and adults in the U.S. A total of 2,172 parents (or legal guardians) reviewed a description of the study, including the study instrument, and 62% (n = 1,347) subsequently consented to allow their child to be invited via e-mail to participate. Of 1,347 adolescents contacted via e-mail, 831 responded, with 99.0% (n = 820) consenting to participate. Of these, 242 (29.5%; 114 males and 128 females) reported at least one partnered sexual behavior in the past year and are the focus of subsequent analyses.

Group therapy for women with orgasm disorders

One woman in four will reach the age of 20 and one in ten even 35 without ever having experienced an orgasm, by which time the interest and joy arising from sexuality is greatly reduced. This results in questioning of the self, insecurities and a lack of self confidence all strongly affect ones view of being a woman in the ‘proper sense’. 


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