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False beliefs about sexual risk, poor physician-patient communication impede STD screening in young women

A study found that one in four clinicians surveyed will disregard screening guidelines for chlamydia and/or gonorrhea if a patient is asymptomatic.

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Despite record high rates of new cases of sexually transmitted diseases (STDs), young women who are sexually active often don’t talk to their clinicians about sex and STD risk, and many aren’t being tested for infection or disease as guidelines recommend, according to new research from Quest Diagnostics, a provider of diagnostic information services.

The findings from a new survey -“Young Women and STDs: Are Physicians Doing Enough to Empower their Patients and Protect their Health?” – suggest that lack of direct communication between clinicians and patients – and false beliefs about STD risk held by both groups — may contribute to STD prevalence.

The survey examined the perceptions of young women 15-24 years of age, mothers of young women in this age group, and primary care, OB/GYN, and other specialty physicians regarding sexual activity, sexual health, and knowledge of and screening for STDs (also known as sexually transmitted infections or STIs). The results of the 2017 survey were also compared to those of previous research by Quest in 2015 involving similar populations.

Medical guidelines from the Centers for Disease Control and Prevention recommend annual laboratory testing for chlamydia and gonorrhea for all sexually active women under the age of 25. According to the Centers for Disease Control and Prevention (CDC), cases of sexually transmitted disease are at an all-time high, with more than two million cases of chlamydia, gonorrhea and syphilis reported in the United States in 2016. Young adults make up about half of STD cases.

“We know that people often think of STDs as something that happens ‘to others’ and, frequently, health care providers have similar beliefs and don’t view their patients as being at risk,” said Lynn Barclay, president and CEO, American Sexual Health Association. “Testing is crucial in young women because STDs are very common, often without symptoms, and undetected infections like chlamydia can lead to problems including infertility.”

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Among the key findings:

  • Young women may not understand their STD risk: A little more than half of young women (56%) say they are sexually active and of those who are, 56 percent say they have been tested for an STD. Young sexually active women cite “not feeling at risk” (62%) and “being asymptomatic” (55%) as reasons for not testing, although STDs often lack symptoms. Of women who are sexually active, 86 percent and 88 percent said they aren’t at risk for chlamydia or gonorrhea, respectively.
  • Many young women are uncomfortable talking to their clinician about sex and STDs: Fifty-one percent of young women say they don’t want to bring up for discussion the topics of sex or STDs with their clinicians.
  • Young women may fail to be truthful with their clinician: Twenty seven percent of sexually active young women admit they don’t always tell the truth about their sexual history to their clinician. For the youngest sexually active women (15-17 years of age), forty-three percent aren’t always truthful.
  • Women don’t recall having a clinician ask about STD screening: 49 percent of young women claim their clinician has never asked if they want STD testing, and less than one in four sexually active women has asked their healthcare professional for an STD test.

In addition, the survey responses of young women suggest rates of STD screening by clinicians have declined, particularly among those 15-17 years of age. Based on the comparison of responses of sexually active women 15-17 between 2015 and 2017, STD testing by clinicians for chlamydia and gonorrhea has decreased by 9 percent and 11 percent, respectively.

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The survey also found gaps in care by some physicians.

Clinicians may also be uncomfortable discussing STDs, with one in four (24%) primary care physicians agreed with the statement, “I am very uncomfortable discussing STI risk with my female patients.”

One in three primary care physicians rely on symptoms to diagnose an STD: Twenty-seven percent reported that they could accurately diagnose STD patients “based on their symptoms,” even though CDC notes, “STDs do not always cause symptoms, so it is possible to have an infection and not know it.”

Undiagnosed women are much more likely than men to suffer long-term health impacts from STDs, including infertility and pelvic inflammatory disease.
Photo by Olla Ky from Unsplash.com

Also, one in four physicians will disregard screening guidelines if a patient is asymptomatic: Only seventy-four percent of primary care doctors said they would order chlamydia testing of an asymptomatic, sexually active female patient. Only seventy-two percent would order testing for gonorrhea for such an asymptomatic patient.

Annual screening for chlamydia and gonorrhea for men who do not have sex with other men is not currently guideline recommended, although, like women, they may not have symptoms and can unknowingly transmit infection to a partner. Undiagnosed women are much more likely than men to suffer long-term health impacts from STDs, including infertility and pelvic inflammatory disease.

“Our findings suggest that discomfort with frank conversations about sexual activity and false beliefs about risk are key barriers to STD testing, and could be driving some of the increase in STD cases of young women,” said Damian P. Alagia, III, MD, FACOG, FACS, medical director of woman’s health, Quest Diagnostics. “Half of all new STD cases are acquired by young people between the ages of 15-24, and one in four sexually active adolescents has a sexually transmitted disease. Our hope in sharing this survey’s findings with clinicians and the general public is that it prompts open dialogue about reproductive health and STD risk, which is absolutely critical to reversing the trajectory of high STD rates in the US.”

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The research was conducted by Aurora Research & Consulting on behalf of Quest Diagnostics in December, 2017. A total of 4,742 study respondents, comprised of 3,414 young women between the ages of 15-24, of whom 1,500 self-identified as sexually active; 1,016 mothers of young women in that age group; and 312 primary care, OB/GYN and specialty physicians were surveyed. Most clinician survey data presented in this report was of responses of 100 primary care physicians. Each respondent completed 15-30 minute online surveys regarding perceptions and knowledge of STDs and chlamydia and gonorrhea testing. Strengths of the research include the large number of respondents and the research’s national scale, while limitations include self-reported data and a lack of direct comparability between study populations. The 2017 research was complemented by results of a survey of similar cohort of patients and healthcare practitioners performed in 2015.

Health & Wellness

First case of sexually transmitted dengue confirmed in Spain

Health authorities confirmed a case of a man spreading dengue through sex. This is a world first for a virus which – until recently – was largely thought to be transmitted only by mosquitos.

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No, getting bitten by mosquitos isn’t the only way you can get dengue.

In Spain, health authorities confirmed a case of a man spreading dengue through sex. This is a world first for a virus which – until recently – was largely thought to be transmitted only by mosquitos.

The case involves a 41-year-old man from Madrid who contracted dengue after having sex with his male partner, who got the virus from a mosquito bite during a trip to Cuba and the Dominican Republic.

When the man’s dengue infection was confirmed in September, it puzzled doctors because he had not traveled to a country where the disease is common. An analysis of the sperm of the two men was carried out and it revealed that not only did they have dengue, but that it was exactly the same virus which circulates in Cuba.

Dengue is transmitted mainly by the Aedes Aegypti mosquito, which grows in number in densely-populated tropical climates, such as the Philippines.

Though it kills 10,000 people a year and infects over 100 million, the disease is fatal only in extreme cases, though symptoms are extremely unpleasant, including high fever, severe headaches and vomiting. It is particularly serious – and deadly – in children.

In the Philippines, the Department of Health reported a total of 271,480 dengue cases from January to August 31 this year, prompting it to declare a national dengue epidemic. As of end-August, an estimated 1,107 people have died of dengue in the country.

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Improved support after self-harm needed to reduce suicide risk

To reduce the high risk of suicide after hospital attendance for self-harm, improved clinical management is needed for all patients – including comprehensive assessment of the patients’ mental state, needs, and risks, as well as implementation of risk reduction strategies, including safety planning.

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Risk of suicide following hospital presentation for self-harm is very high immediately following hospital discharge, emphasising the need for provision of early follow-up care and attention to risk reduction strategies

To reduce the high risk of suicide after hospital attendance for self-harm, improved clinical management is needed for all patients – including comprehensive assessment of the patients’ mental state, needs, and risks, as well as implementation of risk reduction strategies, including safety planning.

The results are from an observational study spanning 16 years and including almost 50,000 people from five English hospitals, published in The Lancet Psychiatry journal.

“The peak in risk of suicide which follows immediately after discharge from hospital underscores the need for provision of early and effective follow-up care. Presentation to hospital for self-harm offers an opportunity for intervention, yet people in are often discharged from hospital having not received a formal assessment of their problems and needs, and without specific aftercare arrangements. As specified in national guidance, a comprehensive assessment of the patients’ mental state, needs, and risks is essential to devise an effective plan for their follow-up care,” says study author Dr. Galit Geulayov, Centre for Suicide Research, Department of Psychiatry, University of Oxford, UK.

It has been estimated that every year there are approximately 200,000 presentations to emergency departments in hospitals across England following acts of non-fatal self-harm. Self-harm is associated with increased mortality, especially by suicide. Approximately 50% of individuals who die by suicide have a history of self-harm, with hospital presentation for self-harm often occurring shortly before suicide.

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The new study compared the risk of suicide following hospital presentation for self-harm according to patient characteristics, method of self-harm, and socioeconomic deprivation. It also estimated the incidence of suicide by time after hospital attendance, adjusting for gender, age, previous self-harm, and psychiatric treatment.

The study included 49,783 people aged over 15 years who presented to hospital after non-fatal self-harm a total of 90,614 times between 2000-2013. The authors followed these patients for 16 years (until the end of 2015), and the study included five hospitals (one in Oxford, three in Manchester and one in Derby).

Within the 16 year follow up, 703 out of 49,783 people died by suicide – with the incidence of suicide being 163 per 100,000 people per year.

Around a third of these deaths occurred within a year of the patient attending hospital for non-fatal self-harm (36%, 252/703 deaths), and the study confirmed the high risk of suicide in the first year after presentation to hospital for self-harm (the incidence of suicide in the year following discharge from hospital was 511 suicides per 100,000 people per year – 55.5 times higher than that of the general population).

The authors found that risk was particularly elevated in the first month (the incidence of suicide in the month following discharge from hospital was 1,787 per 100,000 people per year – close to 200 times higher than in the general population) – with 74 out of 703 people in the study dying by suicide within a month.

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The authors note that men were more likely to die by suicide following hospital presentation of self-harm than women, people who attended hospital more than once for non-fatal self-harm were more likely to die by suicide than those with a single presentation, and age was associated with risk (with risk increasing 3% with each year of age).

In addition, those who lived in less deprived areas had a higher risk of death by suicide than those who lived in the most deprived areas, but this contrasts with a large body of evidence and might be explained by higher rates of psychiatric disorders in this group in this study – more research is needed. The authors also note that some forms of self-harm were more strongly linked to subsequent suicide, but advise against including detail of this kind in media reporting.

Suicide is a big issue in the LGBTQIA community. In 2018, for instance, a study found that a total of 37% of trans respondents reported having seriously considered suicide during the past 12 months and 32% had ever attempted a suicide. Offensive treatment during the past three months and lifetime exposure to trans-related violence were significantly associated with suicidality.

A study published in LGBT Health in 2016, meanwhile, emphasized the importance of strengthening family support and acceptance as part of a positive intervention.

The authors of this newer study note that holistic assessment of risk factors is required, and warn that no single characteristic will help predict later suicide.

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“While awareness of characteristics which increase the risk of subsequent suicide can assist as part of this assessment, previous studies indicate that individual factors related to self-harm are a poor means to evaluate the risk of future suicide. These factors need to be considered together, followed by risk reduction strategies, including safety planning, for all patients,” says Professor Hawton, Centre for Suicide Research, Department of Psychiatry, University of Oxford, UK.

The authors note that their study focuses on three cities in England and the findings may not necessarily apply to the whole of the country.

Writing in a linked comment, Dr. Annette Erlangsen, Danish Research Institute for Suicide Prevention, Denmark, notes that there is a range of treatment options available following presentation of self-harm in emergency departments (including referrals to psychiatric wards after psychosocial assessments, outpatient treatment for patients not under immediate risk of self-harming, and – in some countries – specialized suicide prevention clinics) but many countries send patients home with a referral to their GP or do not refer at all.

She says: “The bottom line is–while the body of evidence of effective intervention is growing, we need to help people who present with self-harm. Operating in such a scenario is challenging but the numbers are clear; we need to ensure that patients receive support immediately when presenting and implement a continuation of care after discharge.”

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Health & Wellness

Trouble sleeping? Insomnia symptoms linked to increased risk of stroke, heart attack

The results suggest that if we can target people who are having trouble sleeping with behavioral therapies, it’s possible that we could reduce the number of cases of stroke, heart attack and other diseases later down the line.

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People who have trouble sleeping may be more likely to have a stroke, heart attack or other cerebrovascular or cardiovascular diseases, according to a study published in the November 6, 2019, online issue of Neurology, the medical journal of the American Academy of Neurology.

“These results suggest that if we can target people who are having trouble sleeping with behavioral therapies, it’s possible that we could reduce the number of cases of stroke, heart attack and other diseases later down the line,” said study author Liming Li, MD, of Peking University in Beijing, China.

The study involved 487,200 people in China with an average age of 51. Participants had no history of stroke or heart disease at the beginning of the study.

Participants were asked if they had any of three symptoms of insomnia at least three days per week: trouble falling asleep or staying asleep; waking up too early in the morning; or trouble staying focused during the day due to poor sleep. A total of 11 percent of the people had difficulty falling asleep or staying asleep; 10 percent reported waking up too early; and 2 percent had trouble staying focused during the day due to poor sleep. The researchers did not determine if the people met the full definition of insomnia.

The people were then followed for an average of about 10 years. During that time, there were 130,032 cases of stroke, heart attack and other similar diseases.

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People who had all three symptoms of insomnia were 18 percent more likely to develop these diseases than people who did not have any symptoms. The researchers adjusted for other factors that could affect the risk of stroke or heart disease including alcohol use, smoking, and level of physical activity.

People who had trouble falling asleep or staying asleep were 9 percent more likely to develop stroke or heart disease than people who did not have this trouble. Of the 55,127 people who had this symptom, 17,650, or 32 percent, had a stroke or heart disease, compared to 112,382, or 26 percent, of the 432,073 people who did not have this symptom of insomnia.

People who woke up too early in the morning and could not get back to sleep were 7 percent more likely to develop these diseases than people who did not have that problem. And people who reported that they had trouble staying focused during the day due to poor sleep were 13 percent more likely to develop these diseases than people who did not have that symptom.

“The link between insomnia symptoms and these diseases was even stronger in younger adults and people who did not have high blood pressure at the start of the study, so future research should look especially at early detection and interventions aimed at these groups,” Li said.

Li noted that the study does not show cause and effect between the insomnia symptoms and stroke and heart disease. It only shows an association.

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A limitation of the study was that people reported their own symptoms of insomnia, so the information may not have been accurate.

Also, the researchers did not ask participants about having sleep that was not refreshing; this is another common symptom of insomnia.

The question that needs to be asked: How is this relevant particularly to the LGBTQIA community?

Sleep may be fundamental to health, but a study found that lesbian, gay and bisexual adults reported more sleep problems than their heterosexual counterparts. This suggests that sleep difficulties may underlie a number of mental and physical health problems experienced by sexual minorities.

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Study finds normal body weight can hide eating disorder in teens

In 2013, a new category of eating disorder was formally recognized: atypical anorexia nervosa. Individuals with this condition meet all other diagnostic criteria for anorexia nervosa but have a normal body weight.

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Teens and young adults with atypical anorexia nervosa can have normal body weights and still be dangerously ill, according to a new study led by researchers at the Stanford University School of Medicine and the University of California-San Francisco.

The research is the largest, most comprehensive assessment to date of normal-weight adolescents with atypical anorexia.

Traditionally, individuals had to be below 85% of their ideal body weight to receive a diagnosis of anorexia nervosa, a disorder characterized by restrictive eating, over-exercising, distorted body image and intense fear of weight gain. But in 2013, a new category of eating disorder was formally recognized: atypical anorexia nervosa. Individuals with this condition meet all other diagnostic criteria for anorexia nervosa but have a normal body weight.

“This group of patients is underrecognized and undertreated,” said the study’s senior author, Neville Golden, MD, professor of pediatrics at the Stanford School of Medicine. “Our study showed that they can be just as sick medically and psychologically as anorexia nervosa patients who are underweight.”

The study, publishing online Nov. 5 in Pediatrics, shows that large, rapid weight loss is the best predictor of medical and psychological problems in patients with atypical anorexia, not their body weight at diagnosis. Dangerously low heart rate and blood pressure, as well as serious electrolyte imbalances and psychological problems, are common in patients with atypical anorexia whose weight is within a normal range, the study found.

The study’s lead author is registered dietitian Andrea Garber, PhD, adjunct professor of pediatrics at UCSF.

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“The bigger context is that, over the past 30 years, the prevalence of adolescent obesity has quadrupled, and teens are being told to lose weight without being given tools to do so in a healthy way,” Golden said. Obese teens who adopt unhealthy behaviors — such as severe food restriction and extreme exercise — may initially be praised for weight loss or told not to worry about eating-disorder concerns because they aren’t underweight.

“By the time they get to see us, they’ve lost a tremendous amount of weight, their vital signs are unstable and they need to be hospitalized,” Golden said.

The study compared 50 patients with atypical anorexia nervosa with 66 patients who met traditional diagnostic criteria, including being underweight. Participants were 12-24 years old, and 91% were female. All participants received eating-disorder treatment as part of the study, the results of which will be reported in a future publication.

Before developing an eating disorder, patients with atypical anorexia had higher weight-to-height ratios than typical patients. During their illness, patients in both groups lost the same amount of weight, an average of 30 pounds over 15.9 months. The two groups had equally poor vital signs, including low heart rate and low electrolytes. Cessation of menstruation, a side effect of the disease, was equally common in the two groups. Some members of both groups also had very low blood pressure, although this was more common in the patients with typical anorexia. Atypical patients had worse psychological symptoms, on average.

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The researchers used statistical modeling to determine which factors best predicted illness severity. The amount, speed and duration of weight loss were linked with worse illness; body weight at the time of diagnosis was not, they found.

More research is needed to identify what constitutes healthy weight for adolescents recovering from atypical anorexia nervosa, Golden said.

“If a patient was obese, the goal is not to have them regain all the lost weight,” Golden said, adding that a mixture of metabolic, hormonal and psychological measures may be needed to define a healthy weight instead.

“If someone gains a bit of weight, regains menses, and is doing well socially, emotionally and cognitively, that might indicate that they are in a place of recovery,” he said.

Other Stanford co-authors on the study are Cynthia Kapphahn, MD, clinical professor of pediatrics; research coordinators Anna Kreiter and Kristina Saffran; and clinical dietitian Allyson Sy. Scientists at UCSF, UCLA and the University of Chicago also contributed to the study.

Weight issues also affect the LGBTQIA community, with 44% to 70% of LGBTQ teens reported weight-based teasing from family members, 41% to 57% reported weight-based teasing from peers, and as many as 44% reported weight-based teasing from both family members and peers.

Meanwhile, specific to the gay community, a study found that Grindr, the most popular dating app for gay, bisexual, two-spirit and queer men, had a negative effect on men’s body image, especially when it came to weight. The study also found that apart from weight stigma, body dissatisfaction stemmed from sexual objectification and appearance comparison. With three out of four gay men reported to have used Grindr, this issue affects a big chunk of the gay population.

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How too much porn causes erectile dysfunction

Here we list the ways watching too much porn causes erectile dysfunction (ED) and the spill-over effects it can have on everyday sexual interactions.

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It’s a slippery slope. At the beginning, it might not take much to get aroused. However over-consumption of pornography may lead the user to seek out more extreme content as they become desensitised to the things that once turned them on. Not only can this have an impact on erectile function, but it can also have unintended consequences when it comes to real-world sexual relationships.

Here we list the ways watching too much porn causes erectile dysfunction (ED) and the spill-over effects it can have on everyday sexual interactions. 

Desensitisation 

Watching too much hardocre porn can make it harder to get an erection because repeated viewing of extreme content may render normal, everyday sexual encounters unfulfilling. 

This is because as people watch more porn, their viewing habits tend to change. As porn users watch more x-rated flicks, they begin to develop a tolerance to the things that used to excite them. As a result, they branch out to more extreme content to fulfil their sexual desires and fantasies. 

However, this kind of extreme content is rarely replicated in real life. After being desensitised by porn, people may find it difficult to become aroused by real life – and comparatively “mundane” – sexual experiences. 

This was certainly the case for Alexander Rhodes, the founder of NoFap – a movement that supports men who have experienced relationship difficulties, erectile dysfunction, and other conditions as a result of their porn consumption. He began watching porn at the age of 11 or 12, and by the time he started having sex at 19 he “couldn’t maintain an erection without imagining porn”. 

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The desensitising effect porn can have is compounded by the fact that it is highly addictive. Research has shown that out of all the varieties of online entertainment (e.g. gambling, gaming, and social networking) “adult entertainment” is the most common reason for compulsive internet use.

Porn triggers the same reward centre in the brain that other addictive substances (such as sugar and drugs) do. This, in turn, floods the brain with dopamine and makes the brain crave the source of the pleasure more. 

The brain attempts to combat this dopamine overload with another chemical called CREB (cyclic adenosine monophosphate response element binding protein). CREB helps to limit the pleasure response generated by dopamine. However if the brain is repeatedly exposed to dopamine (and thus excessive amounts of CREB), the user can become desensitised to the stimulus that initially gave them pleasure. 

In fact, it can make the user desensitised to other things in life that once gave them pleasure – such as socialising with friends or even sex. This may make it harder for the affected person to get an erection because they do not get the same feelings of pleasure they once did from real-life sexual interactions. 

Performance anxiety isn’t always caused by porn. Sometimes it can be caused by general feelings of nervousness, or the fear of not being able to get an erection before sexual intercourse. However, porn can exacerbate feelings of anxiety by making regular porn watchers insecure about their bodies and/or performance.

Unrealistic expectations

Some people may experience erectile dysfunction (ED) after being over-exposed to porn because it gives them unrealistic expectations about what sex “should be like” in real life. The immaculately shaven bodies, exaggerated moans, and extreme positions exhibited in porn portray sex in way that is rarely recreated in everyday life. 

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If a person is repeatedly exposed to porn – particularly at a young, impressionable age – then they may begin to believe that the depiction of sex in porn is representative of sex in real life. When their expectations are not met, it may be hard for them to get aroused because real sex doen’t normally involve the same extreme positions, ear-splitting shrieks, and surgically enhanced bodies as porn does. 

Further, watching porn is a very individual experience. If a person is used to deriving their sexual pleasure from porn, they could find it difficult (and nerve-wracking) to make the transition over to a real-life sexual relationship in which two people need sexual satisfaction. The anxiety this could cause may result in the inability to achieve an erection. This is known as performance anxiety, and it is very common.  

Performance anxiety 

The infinite stamina and notoriously large appendages displayed in porn videos make many men feel anxious about their ability to please their sexual partners in the real world. Many men see sex as a performance and put themselves under immense pressure to “get it right”. 

But by putting themselves under such stress, men can experience anxiety-induced erectile dysfunction. The nervousness, worry, and fear that arises from feeling as though they need to perform “like a pornstar” can induce a “fight or flight” response and kick the sympathetic nervous system (SNS) into action. 

When this happens, the heart beats faster and pumps blood to the areas of the body that need them most in a “fight or flight” situation (such as the muscles). As a result, less blood is supplied to the penis – making it harder to achieve an erection. 

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Performance anxiety is relatively common. A survey by men’s wellness brand Numan revealed that 79% of men who had experienced ED had also suffered from anxiety. Performance anxiety isn’t always caused by porn. Sometimes it can be caused by general feelings of nervousness, or the fear of not being able to get an erection before sexual intercourse. However, porn can exacerbate feelings of anxiety by making regular porn watchers insecure about their bodies and/or performance. 

There is evidence to suggest that sildenafil (the active ingredient in Viagra) can indirectly help to alleviate performance anxiety by improving confidence. Erectile dysfunction can have a profoundly negative effect on a man’s self confidence. However, sildenafil may help to improve confidence in men affected by ED because it allows them to generate harder erections. This, in turn, may help to relieve performance anxiety, as men treated with sildenafil might be less likely to worry about their ability to perform in the bedroom.  Like most other medicines, though, sildenafil does have its side effects (although not everyone gets them). Therefore, it’s best to consult a doctor before taking sildenafil to ensure it is safe to take and does not conflict with any medication you are on. 

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Long-term mental health benefits of gender-affirming surgery for transgender individuals

A study found that among transgender individuals with gender incongruence, undergoing gender-affirming surgery was significantly associated with a decrease in mental health treatment over time.

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For transgender individuals, gender-affirming surgery can lead to long-term mental health benefits, according to new research published in the American Journal of Psychiatry. The study found that among transgender individuals with gender incongruence, undergoing gender-affirming surgery was significantly associated with a decrease in mental health treatment over time.

Researchers Richard Branstrom, Ph.D., and John E. Pachankis, Ph.D., with the Yale School of Public Health, New Haven, Connecticut, used the Swedish Total Population Register to identify more than 2.500 individuals who received a diagnosis of gender incongruence (i.e., transsexualism or gender identity disorder) between 2005 and 2015. Among individuals with gender incongruence, just more than 70% had received hormone treatment and nearly half (48%) had undergone gender-affirming surgical treatment during the 10-year follow-up period. Nearly all (97%) of those who had undergone surgery also received hormone treatment. Less than one-third had received neither treatment.

They analyzed mental health treatment in 2015 in relation to the length of time since gender-affirming hormone and surgical treatment, including distinguishing the potentially interrelated effects of the two treatments. The mental health measures included health care visits for mood and anxiety disorder, antidepressant and anti-anxiety prescriptions, and hospitalization after a suicide attempt.

Increased time since last gender-affirming surgery was associated with reduced likelihood of use of mental health treatment. The study found the odds of receiving mental health treatment were reduced by 8% for every year since receiving gender-affirming surgery over the 10-year follow-up period. They did not find the same association for hormone treatment.

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The study also found that compared with the general population, transgender individuals with a gender incongruence were

  • about six times as likely to have had a mood or anxiety disorder health care visit;
  • more than three times as likely to have received prescriptions for antidepressants and anti-anxiety medication; and
  • more than six times as likely to have been hospitalized after a suicide attempt.

Despite the reduced mental health treatment use after gender-affirming surgery, treatment use among transgender individuals continued to exceed that of the general population.

The authors conclude that “in this first total population study of transgender individuals with a gender incongruence diagnosis, the longitudinal association between gender-affirming surgery and reduced likelihood of mental health treatment lends support to the decision to provide gender-affirming surgeries to transgender individuals who seek them.”

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