ESSM Newsletter # 40

22 ESSM Today Have you read? Best of the best: Clinical research when their partner ejaculated during vaginal intercourse. 17.4 % reported that they defi- nitely experienced a more intensive orgasm depending on the intensity of their partner’s ejaculation, whereas for 17.8% this did not matter at all. 20.9 % of women did not feel that their orgasm was more intense depend- ing on the subjectively felt ejaculate quantity, whereas the majority (37.9 %) stated that it did not matter. 13.1 % of women regarded the quantity of expelled ejaculate as an ex- pression of their own sexual attractiveness. Women stating that they experienced more intense orgasms when the partner ejaculated, when the partner experienced a more intense ejaculation, and when he expelled a greater ejaculate quantity also reported better lifelong orgasmic function and more lifelong sexual satisfaction. Strength & Limitations: This is the very first study to explore the importance of male ejaculation volume and intensity for women’s sexual functioning. Data are of self- report nature and ejaculation characteristics were not objectively measured but by women’s self-report. Conclusion: Although male ejacu- lation and its different aspects seem to play an important role for women, the study demon- strates a considerable variability of women’s attitudes toward ejaculatory characteristics. Illiano E, Mahfouz W, Giannitsas K et al. Coital incontinence in women with urinary incon- tinence: An international study. J Sex Med 2018; 15(10): 1456-1462. Coital urinary incontinence (CUI) is not much explored during clinical history, and this could lead to an underestimation of the problem. This was a multicenter international study, conducted in Italy, Greece, the United States, and Egypt including sexually active women with UI and in a stable relationship for at least 6 months which intended to evaluate the prevalence and clinical risk factors of CUI in women with urinary incontinence (UI), and to measure the impact of CUI on women’s sexuality and quality of life. The UI was classified as stress UI (SUI), urgency UI (UUI), and mixed UI (MUI). 1.041 women (age 52.4 ± 10.7 years) were included. 53.8% of women had CUI: 8% at penetration, 35% during intercourse, 9% at orgasm, and 48% during a combination of these. Women with CUI at pen- etration had a higher prevalence of SUI, women with CUI during intercourse had higher preva- lence of MUI with predominant SUI, and women with CUI at orgasm had higher prevalence of UUI and MUI with predominant UUI component. Previous hysterectomy was a risk factor for CUI during any phase, while cesarean delivery was a protective factor. Previous failed anti-UI surgery was a risk factor for CUI during penetration and intercourse, and body mass index >25 kg/m 2 was a risk factor for CUI at intercourse. Ac- cording to International Consultation on Incon- tinence questionnaire scores, increased severity of UI positively correlated with CUI, and had a negative impact on the quality and frequency of sexual activity. Clinical Implications: This study should encourage physicians to evaluate the CUI; in fact, it is an under-estimated clinical problem, but with a negative impact on quality of life. Conclusion: CUI is a symptom that can affect sexual life and should be investigated dur- ing counseling in all patients who are referred to urogynecological centers. Sexual behavior Carvalho J, Czop O, Rocha M, Nobre P, Soares S. Gender differences in the automatic atten- tion to romantic vs. sexually explicit stimuli. J Sex Med 2018; 15(8): 1083-1092. Gender differences in sexual responses and cognitive and emotional processing to romantic and sexually explicit stimuli have been reported. However, these differences seem to depend on the automaticity of the task that is being used, thus suggesting that gen- der differences may be the result of specific mechanisms rather than a generalized effect. This study included 26 women and 30 men, heterosexual, in which romantic and sexually explicit stimuli were presented as distractors while a concurrent letter discrimination task was performed, followed by a self-report task assessing subjective sexual and emotional responses to the stimuli and aimed to investi- gate gender differences on automatic attention to sexual stimuli, and to test its relationship with sexual excitation proneness. Findings revealed that sexually explicit pictures yielded more automatic attention capture. However, this effect was superseded by pornography consumption, which likely reflects a habitua- tion mechanism. Also, data revealed gender-x type of picture interaction effects only at the self-report task, with men rating sexually ex- plicit stimuli as more sexually exciting, and women rating these stimuli as less pleasant. No relationship was found between automatic attention proxies and sexual excitation prone- ness. Clinical translation: While therapeutic strategies are used as tools to improve at- tention to sexual stimuli (and, hence, increase sexual arousal), the current findings suggest that the specific pathways by which atten- tion influences sexual response are still to be established. Also, gender differences on the subjective appraisal of sex stimuli suggest that therapeutic approaches, consisting on expo- sure techniques, must recognize gender spe- cificities. Conclusion: Whereas both genders do not seem to differ in automatic attention toward romantic and sexually explicit stimuli, their responses do differ in their subjective appraisal of the stimuli.