ArticlePDF Available

Abstract

Difficulties in sexual desire and function often occur in persons with posttraumatic stress disorder (PTSD), but many questions remain regarding the mechanisms underlying the occurrence of sexual problems in PTSD. The aim of this review was to present a model of sexual dysfunction in PTSD underpinned by an inability to regulate and redirect the physiological arousal needed for healthy sexual function away from aversive hyperarousal and intrusive memories. A literature review pertaining to PTSD and sexual function was conducted. Evidence for the comorbidity of sexual dysfunction and PTSD is presented, and biological and psychological mechanisms that may underlie this co-occurrence are proposed. This manuscript presents evidence of sexual dysfunction in conjunction with PTSD, and of the neurobiology and neuroendocrinology of PTSD and sexual function. Sexual dysfunction following trauma exposure may be mediated by PTSD-related biological, cognitive, and affective processes. The treatment of PTSD must include attention to sexual dysfunction and vice versa. Yehuda R, Lehrner A, and Rosenbaum TY. PTSD and sexual dysfunction in men and women. J Sex Med **;**:**-**. © 2015 International Society for Sexual Medicine.
... p=0.585 and p=0.002 respectively) ( Table 2). The median IIEF-5 score was 23 (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) in the before BPS/IC-Group 1, and it was 23 (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) in Group 2 (p=0.750). While the median PEDT score was 4 (2-17) in (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18) in Group 2 (p=0.955). ...
... p=0.585 and p=0.002 respectively) ( Table 2). The median IIEF-5 score was 23 (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) in the before BPS/IC-Group 1, and it was 23 (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) in Group 2 (p=0.750). While the median PEDT score was 4 (2-17) in (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18) in Group 2 (p=0.955). ...
... The median IIEF-5 score was 23 (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) in the before BPS/IC-Group 1, and it was 23 (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) in Group 2 (p=0.750). While the median PEDT score was 4 (2-17) in (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18) in Group 2 (p=0.955). Similarly no significant difference was found in terms of orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction scores between the before BPS/IC-Group 1 and Group 2 (p=0.825, ...
... Generally, the current understanding of PTSD is hyperactivity of deeper structures and hypoactivity of the prefrontal cortex. These deeper structures include the amygdala and hippocampus and are involved in memory consolidation and fear circuitry (2,11,38). The prefrontal cortex can be subdivided into regions and the ventromedial prefrontal cortex (VMPFC) and DLPFC have been implicated in PTSD. ...
... The stress response is comprised of the HPA axis and sympathetic nervous system. The HPA axis is regulated by negative feedback, however, in PTSD this feedback loop is altered due to the presence of low basal cortisol levels and raised catecholamine levels (38). There is ongoing research attempting to explain the cause of the HPA axis derangements including the existence of genetic variants of glucocorticoid receptors (36). ...
Article
Full-text available
Post-traumatic stress disorder (PTSD) is a psychiatric disorder that causes significant functional impairment and is related to altered stress response and reinforced learned fear behavior. PTSD has been found to impact three functional networks in the brain: default mode, executive control, and salience. The executive control network includes the dorsolateral prefrontal cortex (DLPFC) and lateral PPC. The salience network involves the anterior cingulate cortex, anterior insula, and amygdala. This latter network has been found to have increased functional connectivity in PTSD. Transcranial Magnetic Stimulation (TMS) is a technique used in treating PTSD and involves stimulating specific portions of the brain through electromagnetic induction. Currently, high-frequency TMS applied to the left dorsolateral prefrontal cortex (DLPFC) is approved for use in treating major depressive disorder (MDD) in patients who have failed at least one medication trial. In current studies, high-frequency stimulation has been shown to be more effective in PTSD rating scales posttreatment than low-frequency stimulation. The most common side effect is headache and scalp pain treated by mild analgesics. Seizures are a rare side effect and are usually due to predisposing factors. Studies have been done to assess the overall efficacy of TMS. However, results have been conflicting, and sample sizes were small. More research should be done with larger sample sizes to test the efficacy of TMS in the treatment of PTSD. Overall, TMS is a relatively safe treatment. Currently, the only FDA- approved to treat refractory depression, but with the potential to treat many other conditions.
... For example, a model of sexual dysfunction in PTSD was established by Yehuda et al It was developed by an inability to regulate and redirect the physiological arousal that are needed for healthy sexual function. [58] Similarly, it reported that sexual dysfunction was also associated with other negative moods including depression, anxiety, and fear. [59] ...
Article
Full-text available
Since SARS-CoV-2 infection was first discovered in December 2019 in Wuhan City in China, it spread rapidly and a global pandemic of COVID-19 has occurred. According to several recent studies on SARS-CoV-2, the virus primarily infects the respiratory system but may cause damage to other systems. ACE-2, the main receptor for entry into the target cells by SARS-CoV-2, was reported to abundantly express in testes, including spermatogonia, Leydig and Sertoli cells. Nevertheless, there is no clinical evidence in the literature about whether SARS-CoV-2 infection has an impact on male reproductive health. Therefore, this review highlights the effect of SARA-CoV-2 infection on male reproductive health, including the reproductive system and its functioning, as well as gamete and male gonadal function that might be affected by the virus itself or secondary to immunological and inflammatory response, as well as drug treatments and the psychological stress related to panic during the COVID-19 outbreak.
... En la serie que presentamos, 9 de cada 10 mujeres afectadas por algún tipo de disfuncionalidad sexual cursaban con comorbilidades en salud mental, donde la más frecuente es el TEPT (presente en 7 de las 10) seguida por el TD. No son frecuentes los estudios sobre víctimas del conflicto armado que exploren diagnósticos de SM tomando en cuenta la disfuncionalidad sexual, ni los que abordan la SSR en este tipo de población considerando sus correlatos de SM y funcionamiento sexual, pese a que se ha encontrado que muchos de los trastornos mentales más frecuentemente diagnosticados entre víctimas de CAI, como el TEPT y TD, cursan con síntomas de alteración del funcionamiento sexual cuando se han explorado en otras poblaciones (58,59), y a que la violencia sexual contra mujeres es muy frecuente en tales contextos (60,61), lo que puede generar tanto disfunciones sexuales como algún otro trastorno mental de origen postraumático. ...
Article
Full-text available
Objetivos: explorar la salud sexual y reproductiva, en interfaz con la salud mental, en las mujeres supervivientes de la masacre de Bojayá, considerando los aspectos físicos y psicológicos involucrados en el pleno ejercicio de la sexualidad y en la reproducción a partir del análisis de registros de valoraciones clínicas recolectados en 2018. Materiales y métodos: estudio descriptivo mixto, cuantitativo tipo serie de casos y cualitativo tipo narrativo de tópicos. En el componente cuantitativo participaron 44 mujeres supervivientes directas de un artefacto explosivo; en el componente cualitativo participaron 10 de ellas, que presentaban disfunción sexual. El muestreo fue por conveniencia. Las fuentes de información fueron los registros de atención. Se midieron variables sociodemográficas, antecedentes, ginecobstétricos, síntomas, signos y diagnósticos de disfunción sexual y de salud mental a partir del CIE X. Análisis epidemiológico descriptivo y análisis narrativo cualitativo, en los que se identificaron temáticas emergentes sobre problemáticas vivenciadas y priorizadas, así como eventos significativos relacionados. Resultados: la edad promedio fue 45 años; 54% presentaba sintomatología ginecológica; 32 % dificultades para acceder a planificación familiar; 23 % disfunciones sexuales; 13,63 % antecedente de violencia sexual; y 34 % violencia intrafamiliar; 61,36 % con trastorno de estrés postraumático; el componente cualitativo evidenció frecuentes vivencias de violencia de pareja, problemas familiares, y sufrimiento por sintomatología no tratada. Conclusiones: en mujeres supervivientes del conflicto armado, deben evaluarse rutinariamente posibles disfunciones sexuales, trastornos postraumáticos, y antecedentes de poli victimización. Son necesarios nuevos estudios descriptivos y analíticos, explorando estos aspectos y sus relaciones.
... 94 Evidence also points to higher levels of sexual dissatisfaction and dysfunction in PTSD patients. 95,96 It is possible that when the traumatic PTSD event is of a sexual nature, this association is even more prevalent, considering that intrusive memories, flashbacks, negative cognitions are causally related to the event, harming future relationships. 97 Behavioral changes associated with eating occur in many disorders, most of the time causing higher rates of obesity or overweight. ...
Article
Full-text available
Introduction: Although Post-Traumatic Stress Disorder and Obsessive-Compulsive Disorder have distinct diagnostic criteria, some psychopathological phenomena seem to be shared, what may lead to misdiagnosis and to wrong therapeutical decisions. This scoping review explores the psychopathological similitudes and differences of both disorders. Methods: It followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations and included articles published in Portuguese, English or Spanish in the last 50 years in the PubMed database. Case-reports were excluded. Results: Fifty-three studies with different designs were included (30(56.5%) were cross-sectional; 8 (15.1%) were case control; 1 (1.9%) was cohort; 3 (5.7%) were clinical trials; 9 (17.0%) were reviews/systematic reviews; and 2 (3.8%) were meta-analysis.). The main described interfaced psychopathological aspects by the included studies were flashbacks x obsessions; avoidant behavior; depressive, anxious, and somatic symptoms; sexuality, sleep, and appetite; psychiatric comorbidities; and suicidality. The intersection of clinical features seems to be on the extrinsic psychopathological dimension. Conclusions: The psychopathological symptoms core (intrinsic characteristics) is distinctly different, since flashbacks and obsessions are consequences of predominant diverse defective mental function: the former from memory, the last from thought. In the same way, the avoidant behaviors are derived from different purposes and inner necessities.
... Other patients may still socialize with others, but unfortunately, their problem lies in their reduced ability to deal with emotional situations. This could affect their sexual interaction with their partners, and psychiatrists must investigate the possibility of sexual dysfunction [11]. These patients are irritable and emotional, with sudden bursts of anger or anguish. ...
Article
Background Physical and mental health are important to sexual function and wellbeing. Yet, associations of ill-health with sexual inactivity and dysfunctions are scarcely researched at population level. Aim To explore and document associations of self-rated health and physical and mental health problems with inter-personal sexual inactivity and sexual dysfunctions. Methods We used data from a probability-based, nationally representative sample of 60,958 sexually experienced Danes aged 15–89 years who participated in the 2017–18 Project SEXUS cohort study. Logistic regression analyses provided demographically weighted odds ratios for associations between health measures and sexual outcomes adjusted for partner status and other potential confounders. Outcomes Inter-personal sexual inactivity and a range of male and female sexual dysfunctions. Results Inter-personal sexual inactivity was more common among individuals with bad or very bad self-rated health compared to peers rating their health as good or very good (men: adjusted odds ratio 1.93, 95% confidence interval 1.66–2.25; women: 1.66, 1.42–1.94). Individuals rating their health as bad or very bad were also consistently more likely to report sexual dysfunctions, with associated statistically significant adjusted odds ratios ranging from 1.66 to 6.38 in men and from 2.25 to 3.20 in women. Patient groups at high risk of sexual dysfunctions comprised individuals afflicted by cardiovascular diseases, pain conditions, diabetes, gastrointestinal and liver diseases, cancer, skin diseases, nervous system diseases, gynecological diseases, benign prostatic hyperplasia, other physical health problems, stress, anxiety, affective disorders, self-injury or suicide ideation and attempts, posttraumatic stress disorder, personality disorders, eating disorders, psychoses and other mental health problems. Clinical Implications These findings warrant heightened awareness among healthcare professionals, public health promoters and researchers concerning insufficiently appreciated sexual challenges among individuals with poor health. Strengths & Limitations The major strengths of our investigation include the large size of the study cohort, the detailed assessment of health-related variables, potential confounders and sexual outcomes, and the fact that we provide new population-based knowledge about less common and sparsely researched sexual dysfunctions and diseases. Limitations of our study include its cross-sectional nature and its modest response rate (35%). Conclusion Findings from our large and nationally representative cohort study provide evidence that poor self-rated health and a range of specific physical and mental health problems are associated with statistically significantly increased rates of inter-personal sexual inactivity and sexual dysfunctions. Bahnsen MK, Graugaard C, Andersson M, et al. Physical and Mental Health Problems and Their Associations With Inter-Personal Sexual Inactivity and Sexual Dysfunctions in Denmark: Baseline Assessment in a National Cohort Study. J Sex Med 2022;XX:XXX–XXX.
Article
Background The presence of a post-traumatic stress disorder (PTSD) diagnosis or higher PTSD severity is associated with higher overall sexual dysfunction in female service members/veterans. However, the mechanisms linking PTSD to specific components of women's sexual arousal function, like lubrication and mental arousal, are unknown. Methods We conducted a survey among 464 women who reported probable Criterion A exposure for PTSD. Path analysis examined (1) the association of PTSD with sexual arousal, (2) whether specific PTSD symptom clusters were uniquely associated with sexual arousal, and (3) whether this association is indirect, through the effects of higher depression severity and lower romantic relationship satisfaction. Arousal was operationalized to measure both mental (subjective arousal) and physical (lubrication) experiences. Results Higher PTSD severity was associated with lower lubrication and arousal function. The association of PTSD severity with arousal was indirect, through lower romantic relationship satisfaction (estimate: -0.12; 95% CI: [-0.014, -0.007]) and higher depression (estimate: -0.08, 95% CI: [-0.012, -0.002]). The association of PTSD severity with lubrication was also indirect, but only through lower relationship satisfaction (estimate: -0.10, 95% CI: [-0.013, -0.006]). PTSD symptom clusters were not uniquely associated with arousal and lubrication through mediated pathways. Limitations Data were from a cross-sectional study using a convenience sample. Criterion A exposure could not be confirmed. Conclusions PTSD may lead to arousal and lubrication dysfunction by contributing to higher depression severity and strained romantic relationships. Interventions targeting reductions in depressive symptoms and bolstering relationship satisfaction may minimize the burden of PTSD on sexual arousal concerns.
Article
Full-text available
A review of 2,647 studies of posttraumatic stress disorder (PTSD) yielded 476 potential candidates for a meta-analysis of predictors of PTSD or of its symptoms. From these, 68 studies met criteria for inclusion in a meta-analysis of 7 predictors: (a) prior trauma, (b) prior psychological adjustment, (c) family history of psychopathology, (d) perceived life threat during the trauma, (e) posttrauma social support, (f) peritraumatic emotional responses, and (g) peritraumatic dissociation. All yielded significant effect sizes, with family history, prior trauma, and prior adjustment the smallest (weighted r = .17) and peritraumatic dissociation the largest (weighted r = .35). The results suggest that peritraumatic psychological processes, not prior characteristics, are the strongest predictors of PTSD.
Article
Full-text available
We have demonstrated that sexual activity produces transient sympathoadrenal activation and a pronounced, long-lasting increase in prolactin in men and women. However, by analyzing endocrine alterations at 10-min intervals, a precise assignment of these changes to the pre-, peri-and postorgasmic periods was not possible. Thus, the current study aimed to accurately differentiate the endocrine response to sexual arousal and orgasm in men using an automatic blood collection technique with 2-min sampling intervals. Blood was drawn continuously before, during and after orgasm over a total period of 40 min in 10 healthy subjects and were compared with samples obtained under a control condition. Sexual activity induced transient increases of plasma epinephrine and norepinephrine levels during orgasm with a rapid decline thereafter. In contrast, prolactin levels increased immediately after orgasm and remained elevated throughout the experiment. Although oxytocin was acutely increased after orgasm, these changes were not consistent and did not reach statistical significance. Vasopressin, LH, FSH and testosterone plasma concentrations remained unaltered during sexual arousal and orgasm. These data confirm that prolactin is secreted after orgasm and, compared with oxytocin, seems to represent a more reliable and sustained marker for orgasm in man. The results further reinforce a role for prolactin either as a neuroendocrine reproductive reflex or as a feedback mechanism modulating dopaminergic systems in the central nervous system that are responsible for appetitive behavior.
Article
Full-text available
http://onlinelibrary.wiley.com/doi/10.1111/jsm.12643/abstract Introduction. While the military is a young and vigorous force, service members and veterans may experience sexual functioning problems (SFPs) as a result of military service. Sexual functioning can be impaired by physical, psychological, and social factors and can impact quality of life (QOL) and happiness. Aims. To estimate rates and correlates of SFPs in male military personnel across demographic and psychosocial characteristics, examine the QOL concomitants, and evaluate barriers for treatment seeking. Methods. This exploratory cross-sectional study was conducted using data from a larger nation-wide study conducted between October 2013 - November 2013. This sample consists of 367 male active duty service members and recent veterans (military personnel) age 40 or younger. Main Outcome Measures. Erectile dysfunction (ED) was determined using the IIEF-5, sexual dysfunction (SD) was determined using the ASEX-M, and QOL was determined using the WHOQOL-BREF. Results. SFPs were associated with various demographic, physical, and psychosocial risk factors. The rates of SD and ED were 8.45% and 33.24%, respectively, for male military personnel aged 21-40. Those who were 36-40, non-married, non-white, and of lower educational attainment reported the highest rates of SFPs. Male veterans with poor physical and psychosocial health presented the greatest risk for ED and SD. SFPs were associated with reduced quality of life and lower happiness, and barriers for treatment were generally related to social barriers. Conclusions. SFPs in young male military personnel are an important public health concern that can severely impact quality of life and happiness.
Article
Full-text available
Patient: Male, 25 Final Diagnosis: Post Traumatic Stress Disorder Symptoms: Insomnia • nightmares • spontaneous ejaculation Medication: Paroxentine Clinical Procedure: - Specialty: Psychiatry. Unusual clinical course. Sexual dysfunction is reported to occur more frequently in posttraumatic stress disorder (PTSD) patients than in the general population. Herein, we present the case of a patient with spontaneous ejaculation that developed when severity of PTSD symptoms increased. Our patient was a 25-year-old single man admitted to a psychiatric polyclinic because of PTSD symptoms and concurrent spontaneous ejaculations. He was diagnosed with PTSD after clinical interviews. Organic pathology to explain spontaneous ejaculations was not detected. Paroxetine treatment was initiated and PTSD symptoms and frequency of spontaneous ejaculations were decreased at the clinical follow-up. Assessment of the presented case in the light of the literature indicates that his re-experiencing (flashbacks, nightmare) and hyperarousal (symptoms of anxiety specific to PTSD) led to an increase in adrenergic system activation and, consequently, spontaneous ejaculation without sexual stimulus. The effect of Paroxetine in decreasing the frequency of spontaneous erection and ejaculation in the presented case is thought to have occurred via control of PTSD symptoms and their adverse effects on ejaculation. Treatment based on a consideration of PTSD symptoms and autonomic instability might increase the positive outcome rate in such patients.
Article
"Combat addiction" is discussed as a concept central to understanding the chronicity and treatment-resistant quality of post-traumatic stress disorder in Vietnam combat survivors. Possible neurophysiologic, neurochemical, neuroelectrical, and behavioral parameters are addressed with regard to these mutually reinforcing excitatory states beginning with multiple combat experiences. Interviews with 100 such veterans revealed the remarkably frequent (94%) description of intrusive realistic reexperiencing of combat, particularly nightmares, as feeling powerful, exciting - a "high" or "rush" - with intervening states being experienced as unpleasant. Other findings are also presented which tend to support this concept. Implications for treatment planning are outlined.
Article
Posttraumatic stress disorder (PTSD) is a psychiatric condition that is directly precipitated by an event that threatens a person's life or physical integrity and that invokes a response of fear, helplessness, or horror. In recent years it has become clear that only a proportion of those exposed to fear-producing events develop or sustain PTSD. Thus, it seems that an important challenge is to elucidate aberrations in the normal fear response that might precipitate trauma-related psychiatric disorder. This paper summarizes the findings from recent studies that examined the acute and longer term biological response to traumatic stress in people appearing to the emergency room immediately following trauma exposure. In the aggregate, these studies have demonstrated increased heart rate and lower cortisol levels at the time of the traumatic event in those who have PTSD at a follow-up time compared to those who do not. In contrast, certain features associated with PTSD, such as intrusive symptoms and exaggerated startle responses, are only manifest weeks after the trauma. The findings suggest that the development of PTSD may be facilitated by an atypical biological response in the immediate aftermath of a traumatic event, which in turn leads to a maladaptive psychological state.
The aim of this article is to present an integrative review of the mental health of veteran partners living with veterans with combat-related posttraumatic stress disorder (PTSD). Living with a veteran with PTSD affects the psychological well-being and health outcomes of a veteran partner. Fourteen research articles that focused on the mental health of military partners, which directly influence the psychological well-being of veteran partners, were reviewed. Findings indicate that a range of mental health concerns exist among veteran partners living with veterans with PTSD. The mental well-being of veteran partners is affected by the emotional strain of living and caring for veterans with PTSD. For years, the partner's presence has been overlooked in the PTSD treatment. However, to promote the comprehensive health of veterans with PTSD, it is paramount to understand the mental health state of veteran partners. Understanding the mental health state of veteran partners will provide a broader perspective to the plight of veteran partners.