The phenomena of regret and detransition in individuals undergoing gender-affirming treatments raise significant medical and bioethical challenges for professionals working in this area.

This work aimed to gather the most current evidence regarding the approach to the issues of regret and detransition, characterizing the main factors involved and reflecting on possible prevention strategies.

A literature review was conducted through research on PubMed, using the keywords “gender dysphoria,” “regret,” and “detransition”. Only articles in English were included. Additional bibliography was selected by consulting the references of the initially included articles.

Regret and detransition are distinct concepts. In fact, there can be regret without detransition and detransition without regret, with the narratives and experiences of these individuals being very diverse. Detransition may be motivated by external or internal factors, depending on whether transgender identity is preserved or lost. Originally thought to be rare, it has been challenging to assess the actual prevalence of these phenomena, whose increase is expected in the future. In an effort to counter this trend, the literature emphasizes the importance of a multidisciplinary and comprehensive approach to individuals with gender dysphoria, based on effective and assertive communication, ensuring responsible and informed decision-making. Regular follow-up combined with psychosocial support throughout the entire transition process is also crucial. Therapeutic approach should be individualized and integrated into a continuing care plan, grounded in an empathetic and non-judgmental attitude.

Regret and detransition are not necessarily synonymous with medical error. Considering the complex spectrum of experiences involving these phenomena, a comprehensive approach that allows for an integrated view of each person and their needs is essential. Further research and development of guidelines regarding the approach and support for this group of individuals are needed.

None Declared

Serotonergic antidepressants, particularly Selective Serotonin Reuptake Inhibitors (SSRIs), have been known to cause relevant sexual adverse effects, which were originally thought to disappear after treatment course. In later years, an emergent condition concerning the persistence of sexual impairment following SSRI discontinuation has gathered increasing social and scientific interest. Post-SSRI sexual dysfunction (PSSD) is still underrecognized and understudied.

Our aim was to gather available evidence regarding the pathophysiological mechanisms and contributing factors to PSSD, as well as current management options.

A literature review was conducted using PubMed, through research of the following MESH terms: “Selective Serotonin Reuptake Inhibitors”, “Antidepressive Agents”, “Sexual Dysfunction, Physiological” and “Sexual Dysfunctions, Psychological”. Only papers published in English were included.

PSSD has been described as an iatrogenic condition whose symptoms could persist indefinitely. Despite clinical heterogeneity and lack of robust literature surrounding PSSD, there is growing evidence of this concern. In order to diagnose PSSD, sexual dysfunction due to reemergence of depressive illness must be ruled out. Accurate incidence and prevalence rates of this condition are unknown, though it appears to be a rare phenomenon. Several potential etiological explanations for PSSD have been proposed. Some have highlighted a dysregulation in serotonergic activity induced by SSRIs, while others have tested the role of neuroregulatory agents and bioelectric circuits. Another theory involves a possible link between PSSD and other post-discontinuation syndromes. In contrast, some authors have theorized that sexual impairment induced by a long course of SSRIs could induce a negative conditioning effect towards sexual activity in some patients. Despite abovementioned hypotheses, sexual dysfunction is usually complex in nature and thus multifactorial. There is no established treatment to PSSD. Pharmacological and psychotherapeutic approaches have been tested and proposed to ameliorate symptoms of PSSD, but further investigation is warranted.

PSSD is a heterogenous and idiosyncratic syndrome that needs further characterization. It remains unclear why only certain individuals develop PSSD and treatment options are limited. Current evidence is still incipient and insufficient to justify adjusting current SSRI prescription patterns. However, clinicians must be aware of this condition and should monitor and address these issues with patients. Future research should provide further insights into underlying pathophysiological mechanisms, which in turn could help acknowledge possible preventive and therapeutic interventions.

None Declared

In Spain, erectile dysfunction (ED) affects around 19% of men aged 25 to 70, with higher prevalence in older age groups. Family doctors are key for early ED detection, yet it is often underdiagnosed due to limited sexual health training and poor communication. Many patients hesitate to discuss sexual issues, and short consultation times worsen this problem. Early diagnosis is crucial for effective intervention, improving both quality of life and health outcomes.

To evaluate the effects of chronic diseases and medications on ED and identify commonly used treatments.

This retrospective review focused on patients with late-diagnosed ED. We assessed the delay in reporting symptoms and contributing factors such as embarrassment and consultation constraints. The study also explored the impact of chronic conditions like diabetes and hypertension, and the role of psychotropic medications. Data were gathered from the Sexology Patient Database at Vallirana Primary Care Centre (CAP), covering 255 sexual dysfunction cases. The review aimed to understand diagnostic delays and the influence of chronic conditions and medications on ED.

Of 255 sexual dysfunction diagnoses, 193 were ED, making up 75.69%. The average patient age was about 62, with an average delay of 1.95 years before seeking help. ED comorbidities included Cardiovascular and Metabolic Diseases: 33.3%, Musculoskeletal and Articular Diseases: 31.25%, Psychiatric and Sleep Disorders: 29.2%, Digestive Diseases: 20.83%, Respiratory Diseases: 18.75%, Urogenital Disorders: 18.75%, Dermatological Disorders: 12.5%, Neurological Disorders: 10.42%, Endocrine Disorders: 8.33%, and Harmful Habits: 8.33%. Common medications were Antihypertensives: 16.7%, SSRIs: 14.6%, Proton Pump Inhibitors: 12.5%, Benzodiazepines: 10.4%, Antidiabetics: 10.4%, Statins and Fibrates: 10.4%, Bronchodilators and Inhaled Corticosteroids: 10.4%, Antiplatelets: 8.3%, and Other Medications.

The high ED prevalence of 75.69% underscores major issues with timely diagnosis. The average 1.95-year delay highlights barriers to early treatment. Chronic conditions, especially cardiovascular and metabolic disorders, are closely linked to ED. The presence of psychiatric and sleep disorders indicates a complex interaction with sexual dysfunction. The variety of medications used, particularly antihypertensives and SSRIs, necessitates careful management to avoid adverse effects. Family doctors are crucial for diagnosing, managing ED, and referring to specialists. However, time limitations and lack of sexology training often result in underdiagnosis. Enhancing awareness can improve early detection and management, leading to better patient outcomes and timely specialist care.

None Declared

Gender dysphoria (GD) refers to the marked incongruity between the experience of one’s gender and the sex at birth.

Psychiatric illness is one of the major negative prognostic features for the outcome of GD. In particular, much controversy exists regarding whether individuals with psychotic symptoms should receive gender affirmative treatment.

The present review aims to provide an overview of the current literature of the occurrence of gender dysphoria symptoms during psychotic episodes and identify challenges in differential diagnosis and treatment and offering recommendations to overcome them.

Articles published on the last five years were searched on Medline, PubMed, Web of Science and Springer Link using the following keywords: gender identity, psychosis, gender dysphoria.

Delusions about one’s physical appearance and the desire to change the body can be observed in patients with schizophrenia or other psychotic disorders. Therefore, the differential diagnosis is critical for therapeutic planning and effort is required to carry out the necessary diagnostics when articulation of gender dysphoric feelings coincides with the onset of psychosis. It is crucial to evaluate the chronology and dynamics of the individual symptoms, their constancy, patient’s criticism, and response to antipsychotic treatment.

Some presentations of GD can be created by life experience in individuals who have underlying mental or neurophysiological abnormalities. The experiences of practitioners indicate that coincidence of schizophrenia and gender identity disorder is possible, that is why the differential diagnosis needs time, careful observation, examination and cooperation of psychiatrist and sexologist.

This review addresses the significance of understanding each patient’s individual circumstances, focusing specifically on proper physician training and direct patient care.

None Declared

Pedophilic disorder is characterised by a sustained, focused, and intense pattern of sexual arousal involving pre-pubertal children. In addition, the individual must have acted on these thoughts, fantasies or urges or be markedly distressed by them (ICD - 11).

Beyond its obvious ethical and legal implications, this disorder is often associated with substantial mental health comorbidities, including depression, anxiety, and substance abuse. One particularly alarming yet understudied aspect is the elevated risk of suicidal ideation and behavior among individuals diagnosed with pedophilic disorder. The intersection between pedophilic disorder and suicide risk is critical to understand, as it can inform the development of more effective intervention strategies and support systems.

The present review aims to explore the intersection between pedophilic disorder and suicide risk, shedding light on the psychological factors that contribute to suicidal ideation and behavior among individuals with this disorder, including those who have never sexually engaged with children.

PubMed, Web of Science and Google Scholar were searched using the following keywords “pedophilic disorder”, “suicide risk”, “suicidal ideation”, and “stigma”. Articles published within the last decade were included.

The review showed several risk factors, perhaps the most significant being the psychosocial effects of the intense stigma, social isolation, and internalized shame. Other risk factors are prior mental health treatment, weaker attraction to adult women, history of sexual abuse, young age, less education, and additionally, the lack of access to appropriate mental health services.

The relationship between these individuals’ emotional distress and their likelihood of sexually engaging with a child is not known, but there is evidence that impulse control is compromised by negative affect. Moreover, literature posits that stigma raises the risk of sexual activity with children via disturbances in emotional, social, cognitive, and health service utilization domains.

It is evident that this population faces unique challenges that require specialized attention and addressing this intersection necessitates a comprehensive approach.

Strategies aimed at reducing stigma, promoting social support, enhancing access to mental health services and fostering supportive environments have the potential to mitigate suicidal risk factors and enhance overall well-being. Furthermore, efforts to destigmatize help-seeking behaviors and improve access to confidential and non-judgmental support services are crucial in reducing the incidence of suicide and promote mental health among this population.

None Declared

The perinatal period, encompassing pregnancy and the first postpartum year, is a transformative phase in a woman’s life. It involves profound physical, psychological, social, and emotional changes that can significantly impact sexual experiences.

The purpose of this work is to address the challenges of experiencing sexuality during the perinatal period.

Evidence-based review, through research conducted on PubMed and selection of the most relevant studies, published in the last decade, using the keywords: “Sexuality” and “Perinatal period”.

Hormonal fluctuations, physical discomfort, and body image changes during pregnancy can significantly affect sexual desire and satisfaction. By the third trimester, between 83 to 100% of first-time mothers report a decrease in sexual activity. Recent studies indicate that this trend continues into the first postpartum year, with over 60% reporting decreased sexual activity. Postpartum challenges, such as physical recovery, breastfeeding, and fatigue further complicate sexual intimacy. The anticipation of parenthood and shifts in relationship dynamics also play a significant role. Societal pressures and cultural norms regarding sexuality in the perinatal period can influence personal experiences and expectations, and contribute to communication barriers between partners regarding sexual needs and concerns.

The perinatal period presents unique challenges to sexual health and intimacy. A holistic perinatal care, incorporating comprehensive sexual health education and promoting open communication between partners are crucial for addressing these challenges effectively.

None Declared

Sexuality, although an essential component of human health, remains a controversial topic, shrouded in stigma, particularly in the context of dementia, where the expression of sexuality presents unique challenges.

The main objective of this work is to address the complexity of the biopsychosocial components of sexuality in patients with dementia, promoting a change in medical perspective and social attitudes.

Evidence-based review, through research conducted on PubMed and selection of the most relevant studies on this topic, published in the last decade, using the keywords: “Sexuality” and “Dementia”.

Cognitive impairment can affect the frequency and satisfaction with sexual activity. Most studies focuses exclusively on the biological (and dysfunctional) component of sexuality, devaluing the challenges and barriers to the expression of this sexuality. The deterioration of cognitive processes, with emphasis on the involvement of the prefrontal cortex, can influence the ability to make decisions, setting boundaries and providing consent. Inappropriate sexual behaviors, such as disinhibition and hypersexuality, have an incidence of 7-25% in patients with dementia, and may require intervention psychopharmacological. These vulnerabilities result in an enormous challenge in terms of establishing a balance between autonomy and safety of these patients, sometimes resulting in neglect of sexual health in treatment environments.

A comprehensive understanding of the sexuality of older adults with dementia is essential to improve the quality of life and clinical care of this population, highlighting the importance of accurate education and inclusive sexual orientation, creating safe spaces for dementia patients to explore and express their sexuality.

None Declared

Sexuality is a central aspect of human life, encompassing its complexities and diversities. In the field of Psychiatry, Paraphilic Disorders remain a subject of ongoing controversy, including debates over the definition of paraphilia itself.

The present work aims to present a review of the current state of the art regarding the evolution of Paraphilic Disorders, analyzing the evidence that supports this diagnosis, and promote the importance of evolution, understanding and non-stigmatization of sexualities.

Evidence-based review, using a PubMed research and selection of the most relevant studies on this topic, published in the last decade.

An evolution was evident in the classification systems, where initially a pathologization of non-normative sexual practices predominated. Homosexuality and masturbation were understood as diseases, and as such susceptible medical and social control.

In DSM III, the concept of paraphilia, sexual arousal outside normal activity patterns, was introduced in an attempt to reduce stigmatization. But only in DSM V was the distinction made between Paraphilia and Paraphilic Disorder, the latter as causing suffering or dysfunction to the individual or others. This distinction marked a change in paradigm.

The definition and categorization of Paraphilic Disorders in the main classification systems has been influenced by changes in sexual and social norms over time, highlighting their influence on the recognition and treatment of paraphilias.

The view of human sexuality continues to be deeply marked by heteronormativity and reproduction as a social and cultural model, causing sexual practices outside this standard to be labeled as pathological. These diagnoses tend to focus on specific behaviors rather than considering the complexity of each person’s sexual experiences, and to be based on prejudices and stereotypes rather than robust scientific evidence.

None Declared

We represent a case report of a female patient with schizophrenia and gender identity disorder, shedding light on the complexity of her medical condition. The patient gave the informed consent for anonymous presentation of her case.

We want to highlight the unique vulnerability of schizophrenia patients with comorbid gender identity issues. The diagnostic and treatment processes of these patients should be insightful, careful and interdisciplinary.

Descriptive report of a case report based on the regular examination of the patient, review of patients clinical file and a non-systematic literate review.

The 23-year-old female patient, diagnosed with undifferentiated schizophrenia at the age of 18, has been receiving regular one-monthly therapy with aripiprazole long-acting injection since 2019. The psychosis has been in stable remission since 2019. Due to comorbid mixed anxiety and depressive disorder, she was receiving sertraline. In 2021, the patient identified as a transgender male. He was admitted to outpatient clinic for sexual health, where he was diagnosed with gender identity disorder. In February 2023, the patient started receiving testosterone transdermal gel due to the recommendation letter of the Slovenian interdisciplinary team for gender identity confirmation. Three months later, he reported insomnia and strong intrapsychic tension; intense hands tremor was also observed. He was voluntarily admitted to the psychiatric clinic due to suspected psychotic symptoms.

Before prescribing hormone therapy to the patient in our case, the psychotic background of his desire for gender reassignement was excluded by multidisciplinary team. Due to suspected relaps of schizophrenia, which appeared three months after the patient had started receiving testosterone treatment, the Slovenian interdisciplinary team for gender identity confirmation reconsidered the patient’s case and decided to temporarly discontinue his testosterone hormone therapy. The patient continues with his psychiatric treatment.

It is important to notice that exacerbation of psychotic symptoms in the course of schizophrenia may prevent implementation of various stages of treatment of gender dysphoria. Hormonal pharmacotherapy can affect the patients emotional state. The use of pharmacological and surgical methods used for gender reassignment should be precluded in the case of current psychotic process. Treatment of gender dysphoria should be conducted in accordance with current version of the World Professional Association of Transgender Health standards.

None Declared

Sexual function is essential to women’s health, impacting psychological well-being and relationships. In Tunisia, cultural norms may influence how sexual dysfunction is reported and perceived. This study examines the prevalence of sexual dysfunction and its psychological consequences.

To evaluate sexual function in Tunisian women and assess its correlation with psychological distress.

This cross-sectional descriptive study was conducted in March 2023 with 80 Tunisian women, aged 24-50, using a self-administered online questionnaire. Data collection involved the Female Sexual Function Index (FSFI) to assess sexual dysfunction and the Depression Anxiety and Stress Scale (DASS-21) for psychological well-being. Key sociodemographic variables, including marital status, number of children, and socio environmental context were also collected.

We gathered data from 80 women out of 500 distributed questionnaires (16%).

Participants had a mean age of 33.35 years. A majority (63.7%) had children, and 93.8% resided in urban areas. Notably, the majority of women who responded to the questionnaire (74%) were married.

Among the study population, the median FSFI score was 23.65, with 61.3% scoring below the threshold of 26.55, indicating sexual dysfunction. For married women (n=59), the mean FSFI score was 23.7 ± 7.9. The detailed FSFI scores for the entire population and married women are presented in Table I, indicating that the most affected domains of sexual function were excitation and desire. Severe depression, anxiety, and stress were reported by 6.3%, 12.5%, and 6.3% of participants, respectively.

Sexual dysfunction was significantly associated with depression (p=0.02). However, no statistically significant associations were found between anxiety, stress, and sexual dysfunction.

Table I: FSFI Scores among the Study Population

The study shows a high prevalence of sexual dysfunction among Tunisian women, tied to psychological distress, mainly depression. Enhancing sexual health and mental well-being is key to improving overall quality of life and addressing marital issues. Future research should explore culturally sensitive interventions to enhance sexual health and support women’s mental well-being.

None Declared

The postpartum period can significantly affect sexual life, particularly for women who have undergone an episiotomy. This study examines the impact of episiotomy on sexual activity during the postpartum period.

To evaluate the sexual life of Tunisian women following episiotomy in the postpartum period.

We conducted a prospective cohort study at the Gynecology and Obstetrics Department of Farhat Hached University Hospital in Sousse. The study included women who delivered vaginally with an episiotomy in 2020. Data were collected from medical records and delivery reports. Nine months postpartum, participants were contacted by phone to complete a questionnaire assessing their experiences with episiotomy and sexual satisfaction.

The final sample comprised 66 women with a mean age of 27 ± 2.8 years (range: 20-34 years).

Regarding sexual function, 84% of women were very or moderately satisfied with their sexual life before pregnancy, and 74% were satisfied during pregnancy. Most women resumed sexual activity between 7 and 8 weeks postpartum (78%), with 22% resuming before 8 weeks. Compared to pre-birth satisfaction, 54% of women reported no change in sexual satisfaction after childbirth, while 29% reported a decrease and 17% an increase.

Sexual satisfaction was statistically related to the mode of delivery, with 55% of women who had forceps delivery being dissatisfied or equally satisfied as dissatisfied (p=0.01).

Factors affecting postpartum sexual activity included fear of pain (32%), fear of another pregnancy (13%), perceived loss of body desirability (37%), body changes (31%), and excessive fatigue (24%).

This study demonstrates that episiotomy can have a notable impact on postpartum sexual life. Several factors, including the type of suture used during delivery and the mode of delivery, influence women’s sexual satisfaction. These findings underline the importance of considering both physical and emotional aspects of postpartum recovery to improve the overall sexual health and well-being of women after childbirth.

None Declared

Infertility can have a profound impact on couples, causing emotional distress and negatively affecting sexual well-being. In Tunisia, it contributes to over 20% of divorce cases due to relationship strain. Despite its significance, research on the influence of infertility on sexual experiences, particularly gender differences, remains limited.

This study aims to evaluate the effects of infertility on sexual health of Tunisian infertile couples and to compare these effects between men and women.

We conducted a cross-sectional study involving sexually active infertile couples who had been under follow-up for at least one year at a specialized Assisted Reproductive Technology center in Tunis. Each participant completed closed-ended questions regarding their sexual experiences following the infertility diagnosis, including the frequency of sexual intercourse, preferred types of sexual activities, sexual positions believed to enhance conception, and overall sexual rhythm. The Arizona Sexual Experiences Scale (ASEX) was used in Arabic to assess sexual function.

A total of 60 infertile couples participated in the study. The average age of women was 35.07 ± 4 years while the average age of men 41.1 ± 6 years. Regarding sexual intercourse frequency, 35% of women (n=21) and 27% of men (n=16) reported a decrease, with no significant gender difference (p=0.426).

Infertility did not significantly alter preferences for sexual practices, as 78% of women (n=47) and 85% of men (n=51) reported no changes. Vaginal penetration was the predominant activity for both sexes (100%), while mutual masturbation was engaged in by 68% of women and 72% of men. Oral sex was reported by 57% of women and 53% of men, with no significant gender differences (p>0.05).

In terms of sexual positions, 48% of women and 50% of men favored specific positions to enhance conception, with no significant differences (p=0.995). However, 48% of women and 64% of men adhered to a calendar-based rhythm, with women perceiving this regimen as more detrimental to spontaneity (p=0.038 and p=0.041).

Sexual dysfunctions were significantly more common in women, with a prevalence of 28% compared to only 5% in men. Desire disorders were the most commonly reported sexual dysfunction for both genders. Women exhibited significantly higher rates of physical and psychological arousal problems, as well as orgasmic disorders (p<0.05).

Screening for sexual dysfunction in infertile couples is essential not only for improving sexual health but also for providing tailored psychological support that considers gender differences. By identifying and addressing these issues, healthcare providers can enhance the overall well-being of couples dealing with infertility challenges.

None Declared

Reproduction in mammals relies on complex interactions involving the genital and olfactory systems, which can be influenced by environmental factors, such as manganese (Mn). Although essential for survival, Mn is potentially toxic over long periods, potentially affecting sexual and reproductive behaviors.

This study aims to assess the long-term effects of Mn exposure on sexual and reproductive functions in male Wistar rats, focusing on Mn-induced neuroaffective and olfactory dysfunctions.

Male Wistar rats received intraperitoneal injections of Mn at doses of 6 mg/kg, 25 mg/kg, and 30 mg/kg for 12 weeks. Each experimental group consisted of one Mn-intoxicated male and four non-intoxicated females. After six days of cohabitation, the females were isolated to evaluate fertility outcomes. The study also monitored weight changes and conducted behavioral assessments for anxiety, depression, and olfactory functions in males.

Higher Mn doses (25 mg/kg and 30 mg/kg) resulted in significant behavioral changes in males, including anxiety, depression, and olfactory dysfunctions, which were associated with decreased reproductive success. Specifically, pregnancy rates were 33% (4 out of 12) at 25 mg/kg and zero at 30 mg/kg. In contrast, males treated with 6 mg/kg Mn exhibited no significant neuroaffective or olfactory impairments, maintaining fertility rates comparable to those of the control groups.

Chronic Mn exposure adversely affects sexual behavior and reproductive success in male Wistar rats, probably due to olfactory and neuroaffective disruptions. Further research is recommended to elucidate the mechanisms underlying these effects.

None Declared

The COVID-19 pandemic has significantly altered daily life and affected the sexual dynamics of couples across various contexts. Enforced lockdowns and pervasive social isolation, coupled with heightened anxiety associated with the pandemic, have profoundly affected mental health and intimate relationships, affecting sexual satisfaction among couples. This narrative review examines the psychosocial effects of these changes on couples’ sexuality, focusing on the challenges and coping strategies adopted by couples to mitigate the adverse effects and enhance intimate relationship quality.

This review systematically analyzes the psychosocial impacts of the pandemic on couples’ sexuality, using post-2020 literature to better understand these dynamics and enhance psychosexual support.

An extensive literature review was conducted across PubMed, Scopus, and Google Scholar, focusing on keywords such as “COVID-19,” “sexual health,” “intimacy,” “divorce,” and “coping strategies.” Ten high-quality studies published after 2020 were selected based on their methodological rigor and relevance to couples’ dynamics. These studies include a mix of quantitative and qualitative research and systematic reviews, providing a broad yet detailed perspective on the topic.

The findings reveal that the pandemic has significantly diminished couples’ sexual desire and relationship satisfaction. Notable psychosocial effects include increased anxiety, stress, depression, and relational conflicts. Modifications in sexual frequency and quality were noted, yet many couples have adopted effective coping strategies such as enhanced communication, couples therapy, shared stress management activities, and the utilization of online psychological support resources, which have helped strengthen relationships during the pandemic.

The pandemic has profoundly influenced couples’ sexual and relational health, introducing psychosocial stressors. Despite these challenges, the resilience displayed by couples through diverse coping strategies highlights their adaptive capacity. This review emphasizes the need for mental health professionals to integrate targeted interventions to support couples’ well-being and prepare them for potential future crises.

None Declared

The use of recreational drugs for sexual intercourse (chemsex) is a widespread practice in certain subgroups of the population in recent years. There is documentation of chemsex in men who have sex with men (MSM) but less data on its use in other populations (men who have sex with women, women, transgender women, transgender men) and its effects on mental health.

Evaluate the use of chemsex in the population attended in a sexually transmitted infection (STI) consultation.

To evaluate the use of chemsex in the population attended in a sexually transmitted infection (STI) consultation, a survey was carried out on all patients who attended the STI consultation of the U. Ramón y Cajal Hospital between January and April 2022. The degree of anxiety and depression was assessed using the HADS scale.

A total of 148 surveys were distributed, with 82 being completed. Among those surveyed, 56% had used drugs at some time in their lives, the vast majority of times associated with sexual relations. The most consumed drugs were alcohol, cannabis and poppers. There were no differences between MSM and non-MSM in this consumption (p= 0.073), but there were in the substances consumed: MSM consumed more gamma hydroxy-butyrate acid (GHB/GBL) (p= 0.031), mephedrone (p= 0.031) and poppers (p= 0.019). Using the HADS Scale, 34 patients suffered from anxious (41%) and 11 depressive symptoms (13%), with no significant differences between MSM and non-MSM.

Chemsex is a frequent phenomenon among patients attending in an STI consultation, both in the MSM and non-MSM population. It negatively impacts mental health, being associated with anxiety and depression. It is necessary to improve information to reduce drug use in this context.

None Declared

Sexual functioning is an essential aspect of human existence. Sexual dysfunctions are prevalent and negatively affect the quality of life in the general population. Little attention has been paid to the sexual function of health workers.

The aim of our work was to evaluate sexual dysfunction among Tunisian doctors and to determine associated underlying factors.

A cross-sectional study was conducted online, from January to March 2024, via a pre-established questionnaire. Tunisian doctors, who had finished their medical studies, working in the public or private sector and who agreed to anonymously respond to the questionnaire were included. Sociodemographic, economic, clinical data and those related to the medical profession were collected. Sexual function was evaluated with the Arizona Sexual Experience Scale (ASEX).

A total of 80 individuals had fully responded to the questionnaire. The mean age of participants was 36.81 ± 7.49 years and 68,7 % (n=55) of them were male. Ninety five percent (n=76) were married and 77.5 % (n=62) had children. The mean working hours per week was 34.32 ± 5.32. A regular physical activity was practiced by 35 % (n=28) of individuals. The mean monthly income was 3592.5 ± 596 Tunisian Dinars. The results of the ASEX showed that 23,8 % (n=19) of participants, 23,6 % (n=13) of male participants and 24 % of female (n=6) participants had sexual dysfunction. Ten per cent of individuals (n=8) have previously consulted a sexologist. Longer working hours, lower monthly income, less physical exercise were significantly associated with increased risk for sexual dysfunction.

Sexual dysfunctions seem to be common among Tunisian doctors. Knowledge about their sexual functioning is important to promote their physical and mental health and to improve the care delivered.

None Declared

This study explores sleep health disparities among adults with depressive episodes, focusing specifically on sexual and gender minorities (SGM). Given the high prevalence of sleep disturbances in this population, we aim to understand the influence of sexual orientation, alongside sociodemographic factors, on sleep health.

• - To determine the prevalence of sleep difficulties among sexual minorities with depressive episodes.

• - To assess how sociodemographic factors, including education and ethnicity, relate to sleep health in this population.

Using data from the 2020-2021 National Survey on Drug Use and Health (NSDUH), we analyzed a sample of 15,244 individuals who experienced depressive episodes. The study employed weighted estimates to accommodate the survey’s multistage sampling design. Descriptive statistics were used to assess the prevalence of various factors, including tobacco and nicotine use, age, gender, ethnicity, income, marital status, and education. To evaluate the relationships between these factors and sleep difficulties, we utilized generalized linear models with Poisson distribution and log-link function to estimate adjusted prevalence ratios for each covariate.

The study identified notable disparities in sleep health among individuals with depressive episodes based on sexual orientation and sociodemographic factors. Gay/lesbian individuals and bisexual individuals were both found to have a higher likelihood of reporting sleep difficulties compared to heterosexuals, with an increased prevalence of 1.06 times (p = 0.038 for gay/lesbian and p = 0.009 for bisexual). Educational attainment appeared to play a significant protective role; those with a college degree or higher were 0.89 times less likely to report sleep difficulties than individuals without a high school diploma (p < 0.001). Additionally, ethnicity influenced sleep health, with Hispanic individuals being 1.05 times more likely to report sleep issues than non-Hispanic Whites (p = 0.015).

Image 1:

The findings emphasize the presence of sleep health disparities among sexual and gender minorities experiencing depressive episodes. Gay/lesbian and bisexual individuals face a higher risk of sleep difficulties, highlighting the need for mental health interventions that are sensitive to sexual orientation. The protective effect of higher educational attainment suggests that enhancing access to education and related resources may improve sleep health outcomes. The increased prevalence of sleep difficulties among Hispanic individuals points to the need for culturally tailored approaches in mental health care. Addressing these disparities through individualized and culturally sensitive therapeutic strategies can contribute to better sleep health and overall well-being for these populations, underlining the importance of integrated, comprehensive care in managing depressive disorders.

None Declared

Epilepsy is a common disease that is mostly treated with antiepileptic drugs (AEDs). The sexual dysfunction (SD) side effects related to the use of AEDs have not received sufficient attention.

The aims of this study were to assess the prevalence of SD and to study the role played by the AEDs among patients with epilepsy.

A cross-sectional and analytic study was conducted from September to December 2023, among patients with epilepsy follow up in the neurology outpatients of the University Hospital in Gabes (Tunisia), received AEDs, married for at least six months and sexually active. We collected the therapeutics data including type and number of prescribed AEDs and medication adherence, using pre-established form. SD was measured using the Arizona Sexual Experience Scale (ASEX) questionnaire.

Forty-five patients were enrolled (68.9% male and 31.1% female). The average age was 46.76 years (SD=12.39). The majority of patients had a low socio-economic status (64.4%). Carbamazepine and phenobarbital were the most commonly AEDs prescribed (57.8% and 53.3% respectively), especially as monotherapy (62.3%). Poor medication adherence was observed in 13 patients (28.9%). The frequency of SD among patients, based on ASEX questionnaire, was 44.4%. The factors associated with SD included carbamazepine and phenobarbital prescription (p=0.036 and p=0.045 respectively), double or multiple drug therapies (p=0.006) and poor medication adherence (p=0.033).

SD is very common in patients with epilepsy. This seems to be related to AEDs such as using of carbamazepine and phenobarbital, polytherapy and poor medication adherence.

None Declared

The month of Ramadan, a sacred period in the Islamic calendar, is a time of fasting, prayer, and reflection for millions of Muslims worldwide. While the effects of fasting on physical and mental health have been extensively studied, there has been little focus on its specific impact on sexual life, particularly in the Tunisian context.

The aim of our research was to study the opinions of Tunisians regarding their sexual behavior during the month of Ramadan.

This was a retrospective, descriptive, and comparative study conducted through an online survey among Tunisian adults. Data collection was carried out via a self-administered online questionnaire during Ramadan 2024, from March 21 to April 4, 2024. Two reminders were sent and the anonymity of the responses was guaranteed.

Our study included 130 Tunisian adults with a mean age of 28.69 years. The majority of our population resided in urban areas (98.5%), 43.8% were single where 29.2% were in a relationship and both genders were equally represented (53.1% female, 46.9% male). The majority of participants identified as heterosexual (89.2%). During Ramadan, 78.5% of participants fasted, and 77.7% believed sexual activity was permissible during this period. Overall, 44.6% of participants felt that fasting had a negative impact on sexual behavior, 30.7% on sexual desire, and 26% on sexual performance. More than 70% reported that fasting influenced their sexual behavior, primarily in a negative way (44.6%). Among those who perceived an impact (n=93), changes were mostly noted in the timing (77.7%) and frequency of sexual activities (75.5%). Furthermore, 72.3% of participants reported that fasting influenced their sexual desire, with 40.9% perceiving this influence positively. Behavioral factors were identified as the most common cause of these changes (52.1%), followed by religious reasons (27.7%) and societal factors (11.7%). Significant gender differences were observed, with women being more affected by religious factors (p=0.02), while men were more influenced by behavioral factors (p=0.03). Women also reported a significantly greater impact on the frequency of sexual activity compared to men (p=0.012) and perceived a more significant negative impact of fasting on sexual performance compared to men (p=0.06).

Our study indicates that Ramadan fasting significantly affects the sexual lives of Tunisians, driven by sociocultural, religious, and physiological factors. This highlights the need for culturally sensitive sexual education and targeted health policies to ensure accessible and inclusive care during Ramadan.

None Declared

Gender dysphoria (GD) is a rare entity which involves significant distress experienced by an individual due to a perceived discrepancy between his gender identity and his sex assigned at birth. In the current literature, there is little research on medical students’ knowledge and attitudes towards this entity.

The objectives of our study were to estimate the prevalence of gender dysphoria within young medical trainees and to explore their knowledge and beliefs about this entity.

It was a cross-sectional and descriptive study, carried out on GOOGLE FORMS in the period of time from October 1, 2023, to January 31, 2024, and relating to a population of Tunisian young medical trainees. We used a questionnaire including an information sheet and the gender identity/gender dysphoria questionnaire for adolescents and adults (GIDYQ-AA).

Our study involved 111 participants with a sex ratio (M/F) of 0.56. Their median age was 28 years.

The overall prevalence of gender dysphoria was 0.9%. It was 2.5% among participants assigned male at birth (95% CI=[0.06%–13.2%]) and 0% among those assigned female at birth.

Among the participants, 21.6% had received training on GD or sexual identity disorders during their medical education while 3.6% of reported being aware of specialized services for the management and support of GD.

Four-fifths of the participants (80.2%) believed that the development of GD would be due to organic factors, while 70.3% described the contribution of socio-cultural factors and 58.6% attributed it to early family interactions.

More than a third of the participants (40.6%) considered GD as an entity related to sexual development disorders, 28.8% equated it with a symptom of a more general mental pathology, while 30.6% regarded it as a distinct entity.

Regarding the suffering associated with GD, it was attributed to the internal experience of gender incongruence by 42.3% of the participants, social stigma in 29.8% of cases, and to psychiatric pathology by 27.9% of the participants. GD was mentioned as a risk factor for suicide by 84.7% of the participants.

Our study revealed a low prevalence of GD among young medical trainees, similar to that observed in the general population, which could be explained by reluctance and fear of stigma in our society where sexuality remains a taboo subject. The knowledge of young doctors about this issue, still insufficient, could be improved through sexuality training dedicated to specialists, as well as through the teaching of sexology during the medical education.

None Declared