Advances in Sexual Medicine

Published by Scientific Research Publishing
Online ISSN: 2164-5205
Percentage distribution of selected background characteristics according to the sample population: Nairobi, Kenya, 2010 (N = 1119).
Differentials in contraceptive use by perception variables, Nairobi, Kenya, 2010 (N = 1119).
Differentials in contraceptive use by perception variables and by sex, Nairobi, Kenya, 2010 (N = 1119).
As in other developing countries, contraceptive use among adolescents is low and only one in twenty adolescents is reported to use contraceptives in Kenya. Pregnancies early in life expose adolescents to health complications. Establishing perceptions that affect contraception and factors that influence those perceptions is important in developing appropriate programs and policies to increase contraceptive use prevalence among adolescents. We used primary data from a household survey using a systematic random sampling in eight administrative divisions in Nairobi County in 2010. The study utilized information collected using structured interviews, focus group discussions (FGDs) and in-depth interviews (IDIs). The findings revealed that perceptions on parental approval, adolescent approval, ability to get contraceptives for self, knowledge of how to use contraceptives and sexual partner communication had significant effect on contraception. The narratives showed that parents, teachers and service providers had negative perceptions and discouraged contraception among adolescents thereby influencing use. Parents and teachers had inadequate knowledge and skills to communicate sexuality messages creating potential environment likely to have indirect negative influence on adolescents' perceptions on contraception.
Article selection process.  
General characteristics of the studies (N = 22).
Frequency of studies based on the conducted place.  
Introduction: While the prevalence of HIV/AIDS is shown to be decreasing in the last few decades, it still remains a serious public health issue in Pacific countries. This study is aimed to review the common barriers and also preventive strategies for HIV/AIDS among Pacific Islanders. Methodology: This systematic review study on HIV/AIDS was developed based on the Cochrane Library Guideline. Seven online databases which were more frequently used in finding relevant studies were used to search literatures. Using relevant key words, all studies found in the search were reviewed by two independent reviewers and their quality and relevance were assessed. All previous qualitative and quantitative published articles included in the study were published from 2000 to 2016 and in the English language. A data extraction sheet was developed and a descriptive statistic was used to analyze the data. Results: Twenty-two studies met the study inclusion and exclusion criteria. Many of the studies were conducted in American Pacific countries (50%). Community-based studies were the most common type of studies (72.7%). In quantitative studies, the most common barriers were lack of accessibility to health services and lack of knowledge, while in the qualitative studies they were cultural barriers and access to health services. Educational trainings on sexual health topics were identified as the main preventive strategy. Conclusion: This study highlights the main barriers of HIV/AIDS among Pacific Islanders. It also provides a guide for decision makers to develop and implement new strategies which are sensitive and based on Pacific cultures and beliefs.
Effect of manganese on the fertility of male rats.
Introduction: Several substances were likely to cause the decline in male fertility which could go up to the complete sterility. The aim of this study was to assess the effects of Syzygium aromaticum essential oil on fertility in male rats exposed to manganese. Materials and Methods: Twenty four male rats, 6 months old, were divided into 2 groups; 12 rats in one group received, by oral route, a water containing manganese chloride tetrahydrate (MnCl2·4H2O) is at the dose of 4.79 mg·ml-1 for 12 weeks. The group of control male rats received a distilled water in the same conditions. After a period of experimentation, each group was divided into two subgroups of 6 rats which received daily, by intraperitoneal way, a 0.1 mg/kg body weight, of Syzygium aromaticum essential oil. Results: After a chronic exposure, microscopic examination of the testes showed degeneration of the seminiferous tubules and the gremlin cell. Seminal parameters indicated a decrease in the sperm levels (21.3 × 106 cells/ml) and a rise of morphological abnormalities (66.1%). However, intraperitoneal administration of essential oil extracted from the flower buds of Syzygium aromaticum, during 3 weeks, to the rats previously intoxicated with Mn, showed a significant rising of sperm concentration (61.2 × 106 cells/ml) and a reduction of morphological abnormalities (10.8%). These changes were associated with a significant regeneration of seminiferous tubules and interstitial cells. Conclusion: This study revealed an ameliorative effect of essential oil Syzygium aromaticum in testicular tissue and the sperm quality.
Hormonal regulation of spermatogenesis.
Chemical structure of testosterone enanthate.
Chemical structure of cyproterone acetate.  
Chemical structure of levonorgestrel.  
Chemical structure of norethisterone enanthate.  
Male contraception by means of hormonal approach was initiated more than 60 years ago when men became azoo-spermic with administration of testosterone. The basic principle of male hormonal contraception is suppression of spermatogenesis. Exogenous testosterone/testosterone analogs alone or in combination with progestin have been tested for contraceptive efficacy by inhibiting gonadotropins release from pituitary gland. In this review article, advancement in different testosterone preparation tested alone or in combination for contraceptive efficacy has been focused. Administration of testosterone or testosterone analogs alone failed to provide uniform azoospermia or severe oligospermia (<1 million/ml sperm count) at lower doses regimens whereas higher doses causes side effects. Newer, androgen-pro-gestin combination has proved better contraceptive efficacy than testosterone alone. Further, long term studies with hormonal regimens and other alternative approaches are required with fewer side effects for development of safe and reversible contraceptive.
Socio-demographic characteristics of the respondents. 
Respondents' source of information on Pap smear. 
Respondents' reasons for doing a Pap smear. 
Respondents' reasons for not doing a pap smear. 
Respondents' awareness of cervical cancer and Pap smear screening test. 
Introduction: Cervical cancer is one of the commonest cancers of the female genital tract and accounts for about a hundred and ninety thousand deaths each year, most of which occur in developing countries. Early cervical screening methods have contributed to the fall of cervical cancer deaths in the developed world. This is different in developing countries where people have limited knowledge about this disease condition and the screening methods for prevention. This study determined the knowledge and practice of cervical cancer screening among female secondary school teachers in Nnewi North Local Government Area of Anambra State. Method: This was a cross-sectional descriptive study in which self-administered questionnaires were returned by 142 respondents and results were analyzed using Statistical Package for Social Sciences version 17. Results: The mean age of the respondents was 35.6 ± 1.76 years. A high proportion of the respondents were aware of cervical cancer 106 (74.6%). About 44 (41.5%) knew of cervical cancer screening by Pap smear, out of which only 20.5% had done a pap smear. The most common reasons given for not doing the test were; not deeming the test necessary, not knowing where the test could be done and feeling of not being at risk of developing cervical cancer. Conclusion/Recommendation: Though the level of awareness of cervical cancer screening was high, the level of uptake of Pap smear was still very low. A national cervical cancer Pap smear campaign should be intensified to change the negative perception towards Pap smear test.
Sperm cell count before and after antibiotic treatment.
Sperm cell count before and after antibiotic treat- ment.  
Introduction: Antibiotics are the principal treatment of seminal tract infections Our objective is to determine the effi-cacy of levofloxacin in the eradication of genital tract patogens in infertile patients comparing 28 with 56 days of treat-ment and to elucidate different seminal parameters availables as markers of antibiotic efficacy in seminal improvement. Materials and Methods: We studied prospectively 50 males patients with seminal tract infections. All patients were treated with levofloxacin 500 mg orally along 28 or 56 days. Two seminal analysis were performed before and after treat-ment an seminal parameters included TUNEL and nitric oxide levels in seminal plasma were measured. Results: We observed significative differences between both diagrams of treatment. Sperm count and motility increased sig-nifica-tively after treatment. But, sperm morphology do not improve after antibiotic. Necrospermy index but not leu-cocitospermy had been reduced after levofloxacin. Nitric oxide levels have a direct correlation with sperm count but inverse with motility. The rate of apoptosis determined by TUNEL technique in the study population was 30.46%. There was no correlation between apoptosis parameters and necrozoospermy and there was no correlation between sperm cell apoptosis and NO levels. Conclutions: Bacteriologic cure in seminal infection is higher with a scheme of 56 days than 28 days. Treatment with levofloxacin improves seminal parameters in infertile patients with spermatic tract infection. Nitric oxide but not TUNEL is a good predictive factor of antibiotic efficacy.
Linear and Stereochemical formula of D-aspartic and L-aspartic acid. Chemical structure of D-aspartic acid and L-aspartic acid by using a linear formula (panel A) and a carbonium presentation based on the tetrahedral configuration (panel B). 
Sperm concentration in oligo-asthenozoospermic and asthenozoospermic patients treated with sodium D- aspartate.
Sperm motility in oligo-asthenozoospermic and asthenozoospermic patients treated with sodium D-aspar- tate.
Number of pregnancies occurring to the partners of oligo-asthenozoospermic patients and asthenozoospermic patients before and after treatment with sodium D-aspar- tate.
D-Aspartic acid concentration in seminal plasma of patients before and after treatment with sodium D-Asp- artate (nmole/ml).
Introduction: D-Aspartate is an endogenous amino acid involved in LH and testosterone release in humans. In this study we investigate the impact of nutritional supplementation of sodium D-aspartate on the improvement of sperm quality in sub-fertile patients and the rate of pregnancies that occurred with their partners. Materials and Methods: A group of 30 patients affected by oligo-asthenozoospermia and a group of 30 patients affected by asthenozoospermia were treated with a daily dose of sodium D-aspartate for 90 days. After which, the change in spermatozoa concentration and their motility and the pregnancies that occurred with their partners were recorded. Results: We found that the supplementation of D-aspartate significantly increased the concentration and the motility of spermatozoa. In oligo- asthenozoospermic patients the increase of sperm concentration was found to be 2.0-fold, P Conclusions:Treatment of sub-fertile patients with sodium D-aspartate improved the number and the motility of the spermatozoa and consequently improved the rate of pregnancies of their partners.
Infertility rise in India from 1950-2020 based on the fertility rate and population growth rate.
Intra ovarian PRP.
Endometrium thickness before and after PRP in IUI.
Comparison study for PRP instillaion in ovary.
Comparison Study for PRP instillaion in Endometrium.
In India, the problem of infertility is growing and in the last 5 years, it has gone up to 20% - 30%. This ongoing prospective clinical study brings forth a novel, innovative, effective, simple, affordable, easily performed outpatient procedure (OP) and a promising therapeutic method in rejuvenating the Ageing Ovaries and Thin Endometrium, with autologous Platelet Rich Plasma (PRP). This clinical study proves to give a better result in rejuvenating Ovary and treating the Thin Endometrium. This pilot study included five women (28 - 44 years) with Poor Ovarian Response (POR), Premature Ovarian Insufficiency (POI) and Perimenopause and Thirty-nine women (22 - 43 years.) with recurrent implantation failure due to Thin Endometrium were subjected to autologous PRP instillation under Ultrasound Guidance, and Hysteroscopic guided PRP. After PRP, a significant output was obtained, with improved Anti Mullerian Hormone (AMH) and Antral Follicle Count (AFC) and out of five women three women conceived by Intra Cytoplasmic Sperm Injection (ICSI). PRP injected in women with Poor Ovarian Response found successful ovarian rejuvenation within 1 - 3 months and had a 60% of pregnancy rate, PRP into the endometrium had 53.8% successful pregnancies. We have not encountered any complications.
Information about the informants.
Description of meaning bearing units, interpretation of sentence, Category, Subteam and Essence from the data analyze of the transcribed interviews.
Reoccurring symptoms and persistent problems that continue post treatment can be characteristic of the vaginal infections Bacterial Vaginosis (BV) and recurrent vulvovaginal candidiasis (RVVC). The purpose of this study was to describe women’s life experiences in managing the symptoms of bacterial vaginosis and Candida. Sixteen women were recruited and participated in an interview study when they contacted a Swedish gynecology clinic with vaginal complaints that ranged from and included abnormal discharge, irritation itching along with serious malodor. An interpretive phenomenological approach was used with an individual interview to get a more intimate understanding of the women experiencing these problems. The finding of this study shows that managing the recurrent symptoms of the infections remains to be a challenge for women as it has a clearly negative impact on the quality of their lives. Four themes developed: frustration and mood disorders, intimacy changes in the relationship, exposure, hope and relief. The women had high hopes of eliminating the symptoms within the six-month study period. The treatment program, with its well-developed guidelines and continuity of care within the context of the study greatly improved the quality of life of these women. Women had feelings of frustration and anxiety when nothing could cure their problem while they had also a great hope to get rid of the symptoms with a long striking treatment. Well-developed guidelines and continuity of care can help these women to have an improved quality of life.
Weekly mean of rate of sexual intercourse subjects living or no in a repartnered couple.
Introduction: Although many epidemiological studies on sexuality have been published, none have specifically addressed male and female sexuality in repartnered couples. Aim: To investigate men and women's sexual behaviors, perceptions and expectations, and the frequency of their sexual dysfunctions, with a focus on repartnered couples, i.e, subjects living with a partner in a stable relationship after divorce or widowhood (including both remarried couples and cohabitating unmarried couples). Methods: Analysis of telephone survey data collected from 1002 French subjects (483 men, 519 women) ≥35years. Of these, 748 were living with their partner as part of a heterosexual couple. For these subjects, the sexuality of 149 repartnered subjects was compared to that of the other 599 subjects. Main Outcome: Measures: A 39-item questionnaire assessing subjects' perceptions, expectations, sexual behaviors and dysfunctions. Results: Compared with other subjects, men and women in repartnered couples had more active sexuality and more interest in sexuality (men 93% vs 80%, P < 0.01, women 73% vs 65%, P < 0.05). They were generally more sensitive to feelings and emotions linked to their sexuality, and these feelings seemed to increase steadily with age. Their sexuality was more attuned to their partner's pleasure (men 79% vs 59% P < 0.001, women 50% vs 34%, P < 0.01). Concern for the future of the relationship and for sexuality was equally present for both groups, although repartnered couples were more often concerned about potential inadequacy and conflicts between the two partners. Although repartnered men seemed to be less affected by diminished desire, they had slightly higher rates of premature ejaculation and erectile dysfunction, and considered their quality of life to be more affected by these problems. Conclusion: The sexuality of repartnered couples remains poorly studied, but seems to differ from that of non-repartnered couples. Our findings open interesting avenues of research on the diagnosis and management of repartnered couples.
Introduction: Provoked vestibulodynia affects 12% of the general female population and more specifically, 21% of women aged less than 30 years. Primary and secondary vestibulodynia are hypothesized to represent the endpoints of different etiologic pathways, although there is still little research addressing potential distinctions between these two groups, particularly with regard to sexuality. Aims: To compare sexual activity and behavior of women with provoked primary vestibulodynia (PVD1) and secondary vestibulodynia (PVD2) against age-matched controls. Methods: Fifty-seven participants (N = 57), mean age 25.72 (18-41) recruited from a gynecology clinic underwent a gynaecological examination and completed a self-report questionnaire: 20 (N = 20) were diagnosed with primary provoked vestibulodynia (PVD1), 19 (N = 19) with secondary provoked vestibulodynia (PVD2), and 18 (N = 18) were medically confirmed as no-pain controls. Main outcome: To verify any differences in the sexual behavior between primary, secondary vestibulodynias and controls. Results: Mean pain duration differed significantly in participants with PVD1 at 73.8 months against those with PVD2 at 37.4 months (p = 0.003). Frequency of sexual activity also differed significantly between the three groups (p = 0.012): the controls were at 27.8% against 0% in primary and secondary vestibulodynias for once or more a day. No significant difference was observed for the sexual arousal time and masturbation frequency. Vaginal penetration was overrepresented in controls (p 0.001) contrary to fellatio frequency (p = 0.016). Pain digital test was significantly different between the three groups in one finger (3.85 vs 0.08), two fingers (4.39 vs 0.06) or three fingers (5.39 vs 0.56) (PVD1 against controls), lubricated inserted fingers for pain verification (p 0.001). Conclusions: Provoked vestibulodynia generates problems in the sexual response and coital activity, this syndrome reflecting absence of pre-existing sexual problems, notably in the masturbatory activity and oral receptive female sex.
Changes in body weights and reproductive organs ( x ± s.e.m).
Objective: To evaluate the effects of bisphenol A (BPA) on testosterone levels and sexual behaviors of male mice. Methods: Forty 12-week-old male mice, 22 - 25 g, were randomly allocated into four equal groups (n = 10 per group): the control group and three BPA exposure groups including low concentration group (10 mg/kg), middle concentration group (50 mg/kg) and high concentration group (100 mg/kg). Each mouse received BPA intraperitoneally injected for 21 consecutive days. Sexual behaviors and testosterone levels in serum and interstitial tissue of testis were measured after the last administration of BPA. Furthermore, we also observed the weights of sexual organs of each group, including testis, epididymis and seminal vesicle. Results: The mount latency in the high concentration group, the intromission latency in the middle and the high concentration group were 11.64 ± 2.67 min, 20.28 ± 3.40 min and 20.13 ± 2.06 min respectively. All of them were longer than the control group (all P < 0.05). The mount frequency, intromission frequency and copulatory efficacy in the high concentration group were 0.52 ± 0.15 numbers/min, 0.37 ± 0.12 numbers/min and 0.40 ± 0.03, which were all statistically lower than the control group (all P < 0.05). The average testis weights in the low, middle and high concentration group were 0.198 ± 0.032 g, 0.203 ± 0.037g and 0.183 ± 0.032 g, and the relative testis weight in the high concentration group was 0.637 ± 0.106. All of these data were lower than the control group (P < 0.05, P < 0.05, P < 0.01 and P < 0.05, respectively). The epididymis weight and the relative epididymis weight, the weight of seminal vesicle and the relative weight of seminal vesicle were 0.069 ± 0.010 g, 0.242 ± 0.040, 0.219 ± 0.042 g and 0.760 ± 0.143, and all of them were lower than the control group (all P < 0.05). The serum testosterone levels in the high concentration group, the intratesticular testosterone levels in the middle and the high concentration group were 7.88 ± 1.62 ng/ml, 75.5 ± 7.18 ng/g and 73.00 ± 9.57 ng/g, which were all lower than the control group (all P < 0.05). Conclusions: BPA can decline the testosterone levels in mice and inhibit their sexual behaviors.
Do you think that a satisfying sex life is possible only in a deep love relationship?
Aim: Until the 1980s, due largely to prejudice, post-menopausal women were believed to experience sig-nificantly less sexual desire and thus to have sexual intercourse less often than before menopause. Since the 1990s, this type of prejudices seems to have decreased. The aim of our study is to examine the sexuality of post-menopausal women by comparing it to same aged men's sexual behaviour and the importance of sexu-ality in their life. Methods: A sample of 1526 women and 1151 men aged 55 and over. Results: Female subjects reported having sexual intercourse as often as women in the general population (once a week for 64% of them). The same proportion of women as men consider that a successful sexual life: is essential for a successful couple life (90%), needs continuous creativity (80%), has a deep positive impact on their well-being (87%). For most of them (82%), a satisfying sex life is possible only if there is a deep love rela-tionship. 55% say they have never met sexual problems. The main complaints cited are vaginal dryness (45%) and a lack of desire (42%). Only 20% of those who had sexual problems report that age and time passing by are responsible for their troubles. In second place, they mention stress (19%), followed by relationship prob-lems, and nervous breakdown (13%). Conclusion: Our study suggests that nowadays, there is no marked difference between post-menopausal women and men's sexuality either in terms of frequency, or in terms of its importance in their life. Whenever physical problems linked to sexuality arise, they are more often attrib-uted to stress added to relationship problems rather than to ageing. This study shows once again how sexual-ity is influenced by prejudices.
Summary of "very relevant" studies identified in the literature search.
Medical male circumcision has been adopted by the WHO, and other professional public health and medical bodies, as a vital weapon in the fight against HIV. This has prompted a large body of research into the acceptability of the procedure, attitudes to it, and barriers to it. A systematic review of these studies found that satisfaction with circumcision is strongly associated with having accurate knowledge about it. A survey-based paper by Earp, Sardi and Jellison entitled “False beliefs predict increased circumcision satisfaction in a sample of US American men” is the only one to find the opposite. It therefore merits scrutiny. The present article presents the results of a critical examination of the study. Serious flaws were discovered. Half of the small number of 10 “true/false” statements used in its survey are questionable. All the large body of literature that contradicts the findings of Earp and co-workers is ignored. Importantly, the crucial question about whether dissatisfied circumcised males hold false beliefs about circumcision is not considered. Unlike most of the research on the acceptability of circumcision, the study is not motivated by a desire to evaluate the likely effectiveness of a public health measure, or how best to implement it. Rather it appears to be an attempt by a prominent anti-circumcision activist and his associates to generate a body of literature that they can then cite to further their cause. Considering this, and the serious flaws it contains, the study should be dismissed as misleading, biased and undermining public health.
Non-painful mass inferior to the scrotum with normal skin. 
A case of “biker’s nodule” in an 80 year-old cyclist is reported. The “biker’s nodule” is caused by repeated microtrauma to the subcutaneous fatty tissue or collageneous tissue on the perineal region resulting in a perineal nodular induration.
Background: Some evidence has shown that the prevalence of hypoactive sexual desire and erectile dysfunction (ED) is associated with testosterone levels whilst higher levels of testosterone have been reported to increase the frequency of intercourse. Available evidence points towards an etiologic role for hypogonadism in the causation of diabetes, metabolic syndrome (Mets) and sexual dysfunction (SD) even though the exact pathophysiological linkage is yet to be fully elucidated. This study therefore sought to evaluate the impact of testosterone as well as its bioactive components on both the MetS and SD. Method: Diabetic men engaged in a stable heterosexual relationship for at least 2 years were recruited for this study. Participants were at least 18 years and provided an informed and signed consent to partake in this study. Fasting blood samples were taken from the participants for biochemical and hormonal assay. The participants were then evaluated using the Golombok Rust Inventory of Sexual Satisfaction for males (GRISS-M). Metabolic syndrome was assessed using the NCEP-ATP III, IDF and WHO criteria. All data analyses were performed using the SPSS software, version 11.0 systat, Inc. Germany and GraphPad Prism, version 5.0, San Diego California, USA. Results: The mean total, free and bioavailable testosterone as well as SHBG recorded among the participants was 7.10 ± 1.23 ng/ml, 0.10 ± 0.01 ng/ml, 7.01 ± 1.41 ng/ml and 4.33 ± 1.12 nmol/l respectively. Subjects with the MetS showed significantly lower SHBG levels in comparison with subjects without the MetS. Participants with raised triglyceride levels showed significantly lower levels of total, free and bioavailable testosterone when compared to participant without raised triglycerides. Participants with problems of avoidance and infrequency of sexual activity showed significantly lower levels of total, free and bioavailable testosterone when compared to participants without avoidance or infrequency problems. The +SD/+MetS group recorded the lowest SHBG levels. Conclusion: Testosterone and its bioactive components are associated with male libido as well as the metabolic syndrome. Low levels of free and bioavailable testosterone are true determinants of the MetS in men.
Top-cited authors
Christina Chuck Mtuya
  • Kilimanjaro Christian Medical College
Sia Emmanueli Msuya
  • Kilimanjaro Christian Medical University College (KCMUCo) & KCMC Hospital
Michael Johnson Mahande
  • Kilimanjaro Christian Medical Centre
Paulo Lino Kidayi
  • Kilimanjaro Christian Medical College
Jim Todd
  • London School of Hygiene and Tropical Medicine