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Managing Women with Sexual Dysfunction: Difficulties Experienced by Malaysian Family Physicians

Muhamad R, Horey D, Liamputtong P, Low WY

Arch Sex Behav, 2019 04;48(3):949-960.
PMID: 30238183 DOI: 10.1007/s10508-018-1236-1

Recognizing barriers to managing sexual issues makes it more likely that effective ways to overcome them will be found. In Malaysia, where discussion of sexual issues is taboo, sociocultural factors may influence how physicians manage patients with these types of problems. This article focuses on the challenges encountered by 21 Malay family physicians when women experiencing sexual problems and female sexual dysfunction (FSD) attended their clinics, an uncommon occurrence in Malaysia, despite their high prevalence. This qualitative study employed a phenomenological framework and conducted face-to-face in-depth interviews. Three main barriers to managing women with sexual problems were identified that can hinder assessment and treatment: insufficient knowledge and training; unfavorable clinic environments; and personal embarrassment. Some barriers were associated with physician characteristics but many were systemic. These were further evaluated using social cognitive theory. Professional attitudes appear important as those physicians with an interest in managing women's health seemed to make greater effort to explore issues further and work to gain trust. Physicians who appeared indifferent to the impact of FSD showed greater reluctance to find solutions. Systemic issues included unfavorable clinical settings, lack of training, and lack of local evidence. Any strategy to address FSD needs to be underpinned by appropriate policies and resources.

Matched MeSH terms: Sexual Dysfunctions, Psychological/psychology*
Female sexual dysfunction post radical cystectomy and urinary diversion

Zahran MH, Fahmy O, El-Hefnawy AS, Ali-El-Dein B

Climacteric, 2016 Dec;19(6):546-550.
PMID: 27649461

OBJECTIVES: To evaluate the impact of radical cystectomy and urinary diversion on female sexual function.
MATERIALS AND METHODS: A Medline search was conducted according to the PRISMA statement for all English full-text articles published between 1980 and 2016 and assessing female sexual function post radical cystectomy and urinary diversion. Eligible studies were subjected to critical analysis and revision. The primary outcomes were the reporting methods for female sexual dysfunction (FSD), manifestations of FSD, and factors associated with FSD, postoperative recoverability of FSD, and awareness level regarding FSD.
RESULTS: From the resulting 117 articles, 11 studies were finally included in our systematic review, with a total of 361 women. Loss of sexual desire and orgasm disorders were the most frequently reported (49% and 39%). Dyspareunia and vaginal lubrication disorders were reported in 25% and 9.5%, respectively. The incidence of sexual dysfunction was 10% in 30 patients receiving genital- or nerve-sparing cystectomy vs. 59% receiving conventional cystectomy.
CONCLUSION: Although female sexual function is an important predictor of health-related quality of life post radical cystectomy and urinary diversion, the available literature is not enough to provide proper information for surgeons and patients.

Matched MeSH terms: Sexual Dysfunctions, Psychological/epidemiology*
Fulltext The SAD-MEN questionnaire: a new and reliable questionnaire for assessing sexual dysfunction in Asians with diabetes

Chung CM, Lu MZ, Wong CY, Goh SG, Azhar MI, Lim YM, et al.

Diabet Med, 2016 May;33(5):674-80.
PMID: 26202696 DOI: 10.1111/dme.12864

AIM: The aim of this study is to construct a new tool for the assessment of sexual dysfunction among men with diabetes that is valid and reliable across different ethnicities, languages and socio-economic backgrounds in South East Asia.
METHODS: Focus group interviews were conducted to determine the construct of the questionnaire. Content and face validity were assessed by a panel of experts. A pilot study was conducted to validate the Sexual Dysfunction in Asian Men with Diabetes (SAD-MEN) questionnaire in English and Malay. The International Index of Erectile Function-5 (IIEF-5) was used for comparison. Construct validity was assessed using exploratory factor analysis, reliability was determined using Cronbach's α (> 0.700), and test-retest reliability using Spearman's rank correlation coefficient.
RESULTS: The SAD-MEN questionnaire yielded moderate face and content validity, with high reliability as shown by Cronbach's α values of 0.949 for sexual performance and 0.775 for sexual desire for the English version. The Malay language questionnaire had a Cronbach's α value of 0.945 for sexual performance and 0.750 for sexual desire. Test-retest reliability using Spearman's test gave correlation coefficients of r = 0.853, P = 0.000 for the English language questionnaire and r = 0.908, P = 0.000 for the Malay language questionnaire.
CONCLUSION: The SAD-MEN questionnaire is a valid and reliable tool by which to assess sexual dysfunction in English- and Malay-speaking Malaysian and South East Asian men with diabetes.

Matched MeSH terms: Sexual Dysfunctions, Psychological/complications; Sexual Dysfunctions, Psychological/diagnosis*; Sexual Dysfunctions, Psychological/ethnology; Sexual Dysfunctions, Psychological/physiopathology
The prevalence of sexual dysfunction among male patients on methadone and buprenorphine treatments: a meta-analysis study

Yee A, Loh HS, Hisham Hashim HM, Ng CG

J Sex Med, 2014 Jan;11(1):22-32.
PMID: 24344738 DOI: 10.1111/jsm.12352

INTRODUCTION: For many years, methadone has been recognized as an effective maintenance treatment for opioid dependence. However, of the many adverse events reported, sexual dysfunction is one of the most common side effects.
AIM: We conducted a meta-analysis to evaluate the prevalence of sexual dysfunction among male patients on methadone and buprenorphine treatments.
METHODS: Relevant studies published from inception until December 2012 were identified by searching PubMed, OVID, and Embase. Studies were selected using prior defined criteria. Heterogeneity, publication bias, and odds ratio were assessed thoroughly.
MAIN OUTCOME MEASURES: To examine the prevalence and odds ratio of sexual dysfunctions among the methadone and buprenorphine groups.
RESULTS: A total of 1,570 participants from 16 eligible studies were identified in this meta-analysis. The studies provided prevalence estimates for sexual dysfunction among methadone users with a meta-analytical pooled prevalence of 52% (95% confidence interval [CI], 0.39-0.65). Only four studies compared sexual dysfunction between the two groups, with a significantly higher combined odds ratio in the methadone group (OR = 4.01, 95% CI, 1.52-10.55, P = 0.0049).
CONCLUSIONS: Evidence showed that the prevalence of sexual dysfunction was higher among the users of methadone compared with buprenorphine. Patients with sexual difficulty while on methadone treatment were advised to switch to buprenorphine.

Matched MeSH terms: Sexual Dysfunctions, Psychological/chemically induced; Sexual Dysfunctions, Psychological/epidemiology*
Female sexual dysfunction in patients with major depressive disorder (MDD) treated with selective serotonin reuptake inhibitor (SSRI) and its association with serotonin 2A-1438 G/A single nucleotide polymorphisms

Masiran R, Sidi H, Mohamed Z, Mohd Nazree NE, Nik Jaafar NR, Midin M, et al.

J Sex Med, 2014 Apr;11(4):1047-1055.
PMID: 24533444 DOI: 10.1111/jsm.12452

INTRODUCTION: Selective serotonin reuptake inhibitors (SSRIs) are known for their sexual side effects. Different SSRIs may affect different areas of sexual function at different rates.
AIMS: The study aimed to determine the prevalence of female sexual dysfunction (FSD), its clinical correlates, and association with 5HT2A (rs6311) single nucleotide polymorphisms (SNPs) in patients with major depressive disorder (MDD) who were on SSRI therapy.
METHODS: This was a cross-sectional study on 95 female outpatients with MDD treated with SSRI. The patients were in remission as determined by Montgomery-Asberg Depression Rating Scale. Genomic DNA was isolated from buccal swabs and samples were processed using a real time polymerase chain reaction.
MAIN OUTCOME MEASURES: The presence or absence of FSD as measured by the Malay Version of Female Sexual Function Index and 5HT2A-1438 G/A (rs6311) SNP.
RESULTS: The overall prevalence of FSD was 32.6%. After controlling for age, number of children, education level, total monthly income, SSRI types, and SSRI dosing, being employed significantly enhanced FSD by 4.5 times (odds ratio [OR] = 4.51; 95% confidence interval [CI] 1.00, 20.30; P = 0.05). Those having marital problems were 6.7 times more likely to have FSD (OR = 6.67; 95% CI 1.57, 28.34). 5HT2A-1438 G/A (rs6311) SNP was not significantly associated with FSD.
CONCLUSION: There was no significant association between FSD and the 5HT2A (rs6311) SNP in patients with MDD on SSRI therapy. Employment status and marital state were significantly associated with FSD among these patients.
Study site: Psychiatry clinics, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia

Matched MeSH terms: Sexual Dysfunctions, Psychological/genetics; Sexual Dysfunctions, Psychological/psychology*
Remitted male schizophrenia patients with sexual dysfunction

Kheng Yee O, Muhd Ramli ER, Che Ismail H

J Sex Med, 2014 Apr;11(4):956-965.
PMID: 23845160 DOI: 10.1111/jsm.12246

INTRODUCTION: Despite the high prevalence of sexual dysfunction among male schizophrenia patients, there is still a paucity of research on this area.
AIMS: The study aims to determine the prevalence of sexual dysfunction and any association between male patients with schizophrenia in remission and the sociodemographic profile, medication, depression, anxiety, psychopathology of illness, body mass index, and waist circumference.
METHODS: A cross-sectional study with nonprobability sampling method was conducted in a psychiatric outpatient clinic in Taiping Hospital (Perak, Malaysia) over a 7-month period. A total of 111 remitted male schizophrenia patients were recruited. The validated Malay version of the International Index of Erectile Function (Mal-IIEF-15) was administered to the patients and assessed over 4-week duration in the domains of erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction. Logistic regression analysis was employed.
MAIN OUTCOME MEASURES: Prevalence and associated factors for sexual dysfunction in each domain are the main outcome measures.
RESULTS: All five domains of sexual functioning in patients showed a high prevalence of dysfunction ranging from 78.4% to 97.1% with orgasmic dysfunction being the least impaired and intercourse satisfaction the worst impaired. Among the domains, only orgasmic dysfunction was significantly associated with race, i.e., Chinese at lower risk for impairment than the Malays (OR = 0.23; 95% CI: 0.07, 0.76; P = 0.018); education, i.e., patients with education higher than primary level were at higher risk for dysfunction (OR = 6.49; 95% CI: 1.32, 32.05; P = 0.022); and Positive and Negative Syndrome Scale (PANSS)-positive subscale, i.e., higher PANSS-positive score was a protective factor for orgasmic dysfunction (OR = 0.54; 95% CI: 0.33, 0.89; P = 0.015).
CONCLUSIONS: The prevalence of sexual dysfunction was generally high. Malay patients and those with education higher than primary level were at higher risk for orgasmic dysfunction whereas higher PANSS-positive score was protective against the impairment. The high rate of sexual dysfunction in schizophrenia patients warrants a routine inquiry into patients' sexuality and the appropriate problems being addressed.
Study site: Psychiatric clinic, Hospital Taiping, Perak, Malaysia

Matched MeSH terms: Sexual Dysfunctions, Psychological/epidemiology*; Sexual Dysfunctions, Psychological/psychology
The prevalence of sexual dysfunction and potential risk factors that may impair sexual function in Malaysian women

Sidi H, Puteh SE, Abdullah N, Midin M

J Sex Med, 2007 Mar;4(2):311-21.
PMID: 17040486

Female sexual dysfunction (FSD) is a prevalent sexual health problem that does not spare the women in Malaysia, a nation with a conservative multiethnic society.

Matched MeSH terms: Sexual Dysfunctions, Psychological/diagnosis; Sexual Dysfunctions, Psychological/epidemiology*
Fulltext Male sexual dysfunction in Asia

Ho CC, Singam P, Hong GE, Zainuddin ZM

Asian J Androl, 2011 Jul;13(4):537-42.
PMID: 21643001 DOI: 10.1038/aja.2010.135

Sex has always been a taboo subject in Asian society. However, over the past few years, awareness in the field of men's sexual health has improved, and interest in sexual health research has recently increased. The epidemiology and prevalence of erectile dysfunction, hypogonadism and premature ejaculation in Asia are similar in the West. However, several issues are specific to Asian males, including culture and beliefs, awareness, compliance and the availability of traditional/complementary medicine. In Asia, sexual medicine is still in its infancy, and a concerted effort from the government, relevant societies, physicians and the media is required to propel sexual medicine to the forefront of health care.

Matched MeSH terms: Sexual Dysfunctions, Psychological/ethnology; Sexual Dysfunctions, Psychological/epidemiology*
Hypersexuality As a Neuropsychiatric Disorder: The Neurobiology and Treatment Options

Asiff M, Sidi H, Masiran R, Kumar J, Das S, Hatta NH, et al.

Curr Drug Targets, 2018;19(12):1391-1401.
PMID: 28325146 DOI: 10.2174/1389450118666170321144931

Hypersexuality refers to abnormally increased or extreme involvement in any sexual activity. It is clinically challenging, presents trans-diagnostically and there is extensive medical literature addressing the nosology, pathogenesis and neuropsychiatric aspects in this clinical syndrome. Classification includes deviant behaviours, diagnosable entities related to impulsivity, and obsessional phenomena. Some clinicians view an increase in sexual desire as 'normal' i.e. psychodynamic theorists consider it as egodefensive at times alleviating unconscious anxiety rooted in intrapsychic conflicts. We highlight hypersexuality as multi-dimensional involving an increase in sexual activity that is associated with distress and functional impairment. The aetiology of hypersexuality is multi-factorial with differential diagnoses that include major psychiatric disorders (e.g. bipolar disorder), adverse effects of treatments (e.g. levodopatreatment), substance-induced disorders (e.g. amphetamine substance use), neuropathological disorders (e.g. frontal lobe syndrome), among others. Numerous neurotransmitters are implicated in its pathogenesis, with dopamine and noradrenaline playing a crucial role in the neural reward pathways and emotionally- regulated limbic system neural circuits. The management of hypersexuality is determined by the principle of de causa effectu evanescent, if the causes are treated, the effect may disappear. We aim to review the role of pharmacological agents causing hypersexuality and centrally acting agents treating the associated underlying medical conditions. Bio-psycho-social determinants are pivotal in embracing the understanding and guiding management of this complex and multi-determined clinical syndrome.

Matched MeSH terms: Sexual Dysfunctions, Psychological/diagnosis; Sexual Dysfunctions, Psychological/drug therapy*
Fulltext Epidemiology of Male Sexual Dysfunction in Asian and European Regions: A Systematic Review

Irfan M, Hussain NHN, Noor NM, Mohamed M, Sidi H, Ismail SB

Am J Mens Health, 2020 7 7;14(4):1557988320937200.
PMID: 32623948 DOI: 10.1177/1557988320937200

Male sexual dysfunctions (MSDs) often remain undiagnosed and untreated in Asia compared to Europe due to conservative cultural and religious beliefs, socioeconomic conditions, and lack of awareness. There is a tendency for the use of traditional medicines and noncompliance with and reduced access to modern healthcare. The present systematic review compared the incidence and factors of MSD in European and Asian populations. English language population/community-based original articles on MSDs published in MEDLINE from 2008 to 2018 were retrieved. A total of 5392 studies were retrieved, of which 50 (25 Asian and 25 European) were finally included in this review. The prevalence of erectile dysfunction (ED) (0%-95.0% vs. 0.9%-88.8%), low satisfaction (3.2%-37.6% vs. 4.1%-28.3%), and hypoactive sexual desire disorder (HSDD) (0.7%-81.4 vs. 0%-65.5%) was higher in Asian than in European men, whereas the prevalence of anorgasmia (0.4% vs. 3%-65%) was lower in Asian than in European men. Age was an independent positive factor of MSD. In European men over 60 years old, the prevalence of premature ejaculation (PE) decreased. The prevalence of MSD was higher in questionnaires than in interviews. The significant factors were age, single status, low socioeconomic status, poor general health, less physical activity, cardiovascular diseases, diabetes, obesity, lower urinary tract symptoms, prostatitis, anxiety, depression and alcohol, tobacco, and drug use. The prevalence of MSD differed slightly in Asian and European men. There is a need to conduct large studies on the various Asian populations for the effective management of MSD.

Matched MeSH terms: Sexual Dysfunctions, Psychological/epidemiology*; Sexual Dysfunctions, Psychological/psychology
Fulltext Determinants of doctors' decisions to inquire about sexual dysfunction in Malaysian primary care settings

Tong SF, Low WY, Ismail SB, Trevena L, Wilcock S

Transl Androl Urol, 2013 Dec;2(4):281-90.
PMID: 26816741 DOI: 10.3978/j.issn.2223-4683.2013.09.14

BACKGROUND: Perceptions of how receptive men are to sexual health inquiry may affect Malaysian primary care doctors' decisions to initiate such a discussion with their male patients. This paper quantifies the impact of doctors' perceptions of men's receptivity on male sexual health inquiry. Sexual health inquiry is one of the five areas in a study on determinants of offering preventive health checks to Malaysian men.
METHODS: This was a cross sectional survey among primary care doctors in Malaysia. The questionnaire was based on an empirical model defining the determinants of primary care doctors' intention to offer health checks. The questionnaire measured: (I) perceived receptivity of male patients to sexual health inquiry; (II) doctors' attitudes towards the importance of sexual health inquiries; (III) perceived competence and, (IV) perceived external barriers. The outcome variable was doctors' intention in asking about sexual dysfunction in three different contexts (minor complaints visits, follow-up visits and health checks visits). All items were measured on the Likert scale of 1 to 5 (strongly disagree/unlikely to strongly agree/likely) and internally validated.
RESULTS: 198 doctors participated (response rate 70.4%). Female primary care doctors constituted 54.5%. 78% of respondents were unlikely to ask about sexual dysfunction in visits for minor complaints to their male patients, 43.6% in follow up visits and 28.2% in health checks visits. In ordinal regression analysis, positive perception of men's receptivity to sexual health inquiry significantly predicted the doctors' intention in asking sexual dysfunction in all three contexts; i.e., minor complaints visits (P=0.013), follow-up visits (P<0.0001) and health checks visits (P=0.002). Perceived competence in sexual health inquiry predicted their intention in the follow-up visits (P=0.006) and health checks visits (P<0.001). Lower cost to health checks only predicted their intention in the follow-up visits (P=0.010).
CONCLUSIONS: Whilst sexual health inquiry should be initiated in an appropriate context, 'perceived receptivity' to sexual health inquiry significantly affected doctors' intention in initiating sexual health inquiry to their male patients. Malaysian men's health may be substantially improved by strategies that assist doctors to identify patient 'receptivity'.

Matched MeSH terms: Sexual Dysfunctions, Psychological
Association between 5HT2A polymorphism and selective serotonin re-uptake inhibitor (SSRI)-induced sexual desire disorder (SDD) among Malaysian women

Masiran R, Sidi H, Mohamed Z, Mohamed Saini S, Nik Jaafar NR

Asia Pac Psychiatry, 2013 Apr;5 Suppl 1:41-9.
PMID: 23857836 DOI: 10.1111/appy.12043

SSRIs are known for their sexual side-effects with a variable rate of sexual dysfunction (SD). 5HT2A (rs6311) single nucleotide polymorphism (SNP) was found to have significant association with SD. The purpose of this study was to determine the prevalence of female SDD, its clinical correlates and association with 5HT2A (rs6311) SNP in patients with major depressive disorder (MDD) treated with SSRIs.

Matched MeSH terms: Sexual Dysfunctions, Psychological/chemically induced; Sexual Dysfunctions, Psychological/genetics*; Sexual Dysfunctions, Psychological/epidemiology
Citalopram (antidepressant) administration causes sexual dysfunction in male mice through RF-amide related peptide in the dorsomedial hypothalamus

Soga T, Wong DW, Clarke IJ, Parhar IS

Neuropharmacology, 2010 Jul-Aug;59(1-2):77-85.
PMID: 20381503 DOI: 10.1016/j.neuropharm.2010.03.018

Citalopram is the most potent selective serotonin reuptake inhibitor (SSRI) which is used as an antidepressant but causes sexual dysfunction. Whether citalopram induced sexual dysfunction is a result of gonadotropin-releasing hormone (GnRH), kisspeptin or RF-amide related peptide (RFRP) alteration is unknown. In this study, we tested mice for sexual behavior after vehicle (0.9% NaCl) and citalopram treatment (5 mg/kg) daily for 1 day (acute) and 21 or 28 days (chronic). Effects of acute and chronic treatments on neuronal numbers and mRNA expression of GnRH, kisspeptin and RFRP were measured. In addition, RFRP fiber projections to preoptic (POA)-GnRH neurons were analyzed using double-label immunohistochemistry. The expression of 14 different serotonin receptor types mRNA was examined in immunostained laser dissected single RFRP neurons in the dorsomedial hypothalamus (DMH), however only 11 receptors types were identified. Acute citalopram treatment did not affect sexual behavior, whereas, the total duration of intromission was reduced with chronic treatment. There was no effect in the expression of kisspeptin (neuronal numbers and mRNA) in the anteroventral periventricular nucleus and the arcuate nucleus and expression of GnRH (neuronal numbers and mRNA) in the POA after citalopram treatment. However, RFRP neuronal numbers in the DMH and fiber projections to the POA were significantly increased after chronic citalopram treatment, which suggests citalopram induced inhibition of sexual behavior involves the modulation of RFRP through serotonin receptors in the DMH.

Matched MeSH terms: Sexual Dysfunctions, Psychological/chemically induced*; Sexual Dysfunctions, Psychological/metabolism; Sexual Dysfunctions, Psychological/pathology
Fulltext Sexual function of malay women with type 2 diabetes mellitus: a preliminary study

Kamaralzaman S, Sidi H, Yau M, Budin SB, Sani A, Mohamed J

ASEAN Journal of Psychiatry, 2010;11(1):64-71.
MyJurnal

Objective: Female sexual dysfunction is a known complication of diabetes mellitus. The aims of this study is to estimate the prevalence of sexual dysfunction and the types of sexual dysfunction experienced by Malay women with type 2 diabetes mellitus.
Methods: Cross sectional study was conducted on married Malay women with type 2 diabetes mellitus, receiving treatment from two community clinics in Selangor, Malaysia. Female sexual function was assessed using Malay version of Female Sexual Function Index.
Results: This study found that sexual dysfunction was present among 18.2% women. Lack of libido was the commonest symptom among these women and was observed in 40.9% of women followed by sexual dissatisfaction (36.4%). Sexual arousal disorder was observed in 22.7%, 18.2% complained of lack of lubrication, and 22.7% had vaginal discomfort. Orgasmic dysfunction was found in only 4.5% of these women.
Conclusion: This preliminary research showed sexual desire disorder was the commonest type of sexual disorder among diabetic women.

Matched MeSH terms: Sexual Dysfunctions, Psychological
Sexual norms: its behaviour

Teoh JI

Med J Malaysia, 1974 Mar;28(3):135-42.
PMID: 4278269
Matched MeSH terms: Sexual Dysfunctions, Psychological
Prevalence and correlates of premature ejaculation in a primary care setting: a preliminary cross-sectional study

Tang WS, Khoo EM

J Sex Med, 2011 Jul;8(7):2071-8.
PMID: 21492404 DOI: 10.1111/j.1743-6109.2011.02280.x

INTRODUCTION: Premature ejaculation (PE) is common. However, it has been underreported and undertreated.
AIMS: To determine the prevalence of PE and to investigate possible associated factors of PE.
METHODS: This cross-sectional study was conducted at a primary care clinic over a 3-month period in 2008. Men aged 18-70 years attending the clinic were recruited, and they completed self-administered questionnaires that included the Premature Ejaculation Diagnostic Tool (PEDT), International Index of Erectile Function, sociodemography, lifestyle, and medical illness. The operational definition of PE included PE and probable PE based on the PEDT.
MAIN OUTCOME MEASURE: Prevalence of PE.
RESULTS: A total of 207 men were recruited with a response rate of 93.2%. There were 97 (46.9%) Malay, 57 (27.5%) Chinese, and 53 (25.6%) Indian, and their mean age was 46.0 ± 12.7 years. The prevalence of PE was 40.6% (N = 82) (PE: 20.3%, probable PE: 20.3% using PEDT). A significant association was found between ethnicity and PE (Indian 49.1%, Malay 45.4%, and Chinese 24.6%; χ(2) = 8.564, d.f. = 2, P = 0.014). No significant association was found between age and PE. Multivariate analysis showed that erectile dysfunction (adjusted odds ratio [OR] 4.907, 95% confidence interval [CI] 2.271, 10.604), circumcision (adjusted OR 4.881, 95% CI 2.346, 10.153), sexual intercourse ≤5 times in 4 weeks (adjusted OR 3.733, 95% CI 1.847, 7.544), and Indian ethnicity (adjusted OR 3.323, 95% CI 1.489, 7.417) were predictors of PE.
CONCLUSION: PE might be frequent in men attending primary care clinics. We found that erectile dysfunction, circumcision, Indian ethnicity, and frequency of sexual intercourse of ≤5 times per month were associated with PE. These associations need further confirmation.
Study site: primary care clinic at the University Malaya Medical Center (UMMC), Kuala Lumpur, Malaysia

Matched MeSH terms: Sexual Dysfunctions, Psychological/epidemiology*
The Asian Menopause Survey: knowledge, perceptions, hormone treatment and sexual function

Huang KE, Xu L, I NN, Jaisamrarn U

Maturitas, 2010 Mar;65(3):276-83.
PMID: 20018469 DOI: 10.1016/j.maturitas.2009.11.015

To provide current insights into the opinions, attitudes, and knowledge of menopausal women in Asia regarding menopause and hormone replacement therapy (HRT).

Matched MeSH terms: Sexual Dysfunctions, Psychological*
Prevalence and risk factors of female sexual dysfunction among healthcare personnel in Malaysia

Grewal GS, Gill JS, Sidi H, Gurpreet K, Jambunathan ST, Suffee NJ, et al.

Compr Psychiatry, 2014 Jan;55 Suppl 1:S17-22.
PMID: 23452905 DOI: 10.1016/j.comppsych.2013.01.009

OBJECTIVE: To determine the prevalence and risk factors of female sexual dysfunction (FSD) among healthcare personnel in selected healthcare facilities in Malaysia.
METHODS: This was a cross-sectional study carried out at three large healthcare facilities that were selected by convenience sampling. Within each facility, stratified random sampling was used to select suitable candidates to participate in the study (n=201). Validated questionnaires were used to assess depression, anxiety, sexual function in women and erectile dysfunction (ED) in their partners.
RESULTS: The prevalence of FSD was 5.5%. Women with sexual dysfunction were more likely to be married longer (OR=4.08; 95% CI; 1.15-4.50), had lower frequency of sexual intercourse (OR=5.00; 95% C; 1.05-23.76) and had a spouse with ED (OR=24.35; 95% CI; 4.55-130.37). Multivariate analysis showed that ED was the strongest predictor for FSD (AOR=27.30; 95% CI; 4.706-159.08).
CONCLUSION: One in eighteen female healthcare personnel suffered from FSD and presence of ED in the partner strongly impacted her sexual function, negatively. The findings highlight the importance of including the male partner in clinical assessment of FSD.

Matched MeSH terms: Sexual Dysfunctions, Psychological/epidemiology*
The feasibility of the Golombok-Rust Inventory of Marital State (GRIMS) in assessing marital satisfaction in a Malaysian population

Quek KF, Low WY, Razack AH, Chua CB, Loh CS

J Sex Marital Ther, 2002 Oct-Dec;28(5):423-6.
PMID: 12378843

The purpose of this study is to validate the English version of the Golombok-Rust Inventory of Marital State (GRIMS) in a Malaysian population. Using the test-retest method and Cronbach's alpha, we assessed reliability and internal consistency. Sensitivity to change was expressed as the effect size. Internal consistency was excellent (Cronbach's alpha value = 0.59 to 0.91) Test-retest correlation coefficient and intraclass correlation coefficient were highly significant in majority items (ICC = 0.62 and above), and there was a high degree of sensitivity and specificity. The GRIMS is suitable, reliable, valid, and sensitive to clinical change in a Malaysian population.

Matched MeSH terms: Sexual Dysfunctions, Psychological/psychology*
Prevalence, risk factors, and predictors of female sexual dysfunction in a primary care setting: a survey finding

Ishak IH, Low WY, Othman S

J Sex Med, 2010 Sep;7(9):3080-7.
PMID: 20584130 DOI: 10.1111/j.1743-6109.2010.01848.x

INTRODUCTION: Female sexual dysfunction (FSD) is a highly prevalent sexual health problem but poorly investigated at the primary care level.
AIM: This article examines the prevalence of sexual dysfunction and its possible risk factors associated with women at high risk of FSD in a hospital-based primary practice.
METHODS: A validated Malay version of the Female Sexual Function Index (MVFSFI) was utilized to determine FSD in a cross-sectional study design, involving 163 married women, aged 18-65 years, in a tertiary hospital-based primary care clinic in Kuala Lumpur, Malaysia. Sociodemographic, marital profile, health, and lifestyle for women at high risk of FSD and those who were not at high risk were compared and their risk factors were determined.
MAIN OUTCOME MEASURES: Prevalence of FSD in Malaysian women based on the MVFSFI, and its risk factors for developing FSD.
RESULTS: Some 42 (25.8%) out of 163 women had sexual dysfunction. Prevalence of sexual dysfunction increased significantly with age. Sexual dysfunctions were detected as desire problem (39.3%), arousal problem (25.8%), lubrication problem (21.5%), orgasm problem (16.6%), satisfaction problem (21.5%) and pain problems (16.6%). Women at high risk of FSD were significantly associated with age (OR 4.1, 95% CI 1.9 to 9.0), husband's age (OR 4.3 95% C.I 1.9 to 9.3), duration of marriage (OR 3.3, 95% CI 1.6 to 6.8), medical problems (OR 8.5, 95% CI 3.3 to 21.7), menopausal status (OR 6.6, 95% CI 3.1 to 14.3), and frequency of sexual intercourse (OR 10.7, 95% CI 3.6 to 31.7). Multivariate analysis showed that medical problem (adjusted OR 4.6, 95% CI 1.6 to 14.0) and frequency of sexual intercourse (adjusted OR 7.2, 95% CI 2.1 to 24.0) were associated with increased risk of having FSD. Those who practiced contraception were less likely to have FSD.
CONCLUSION: Sexual health problems are prevalent in women attending primary care clinic where one in four women were at high risk of FSD. Thus, primary care physician should be trained and prepared to address this issue.
Study site: Primary Care Clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia

Matched MeSH terms: Sexual Dysfunctions, Psychological/epidemiology*

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