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Sexual-wellbeing is recognized as an important aspect of quality-of-life. Yet, no overview exists of which aspects of sexual-wellbeing have been assessed in trans individuals seeking or undergoing medical treatment, nor is it clear what tools are used to evaluate the effect of medical treatment on sexual-wellbeing. First, to identify which topics pertaining to sexual-wellbeing have been assessed in transgender individuals in a medical context. Second, to determine which tools have been used for measuring aspects of sexual-wellbeing. A conceptual framework of sexual-wellbeing, was used as reference. A literature search (in PubMed, Embase, Cochrane Library) was performed up to March 10th, 2020. Studies that assessed aspects of sexual-wellbeing in transgender individuals' medical context were included in this review. Specific sexual topics addressed in each study were extracted by two independent reviewers. Thematic analysis was performed to identify sexual themes. Additionally, tools used to measure topics related to sexuality in transgender individuals were identified. In 172 papers, a total of 178 topics related to sexual-wellbeing were identified. Ten overarching themes were identified; sexuality, enacted sexual script, sexual activities, sexual relations, sexual response cycle, genital function, sexual function, sexual pleasure, sexual satisfaction, and quality-of-sex-life. Functional aspects of sexuality are assessed most frequently. A variety of methods was used to evaluate aspects related to sexual-wellbeing in trans individuals and over 50 different tools were identified. Self-developed questionnaires were used most frequently (n = 80), followed by chart reviews (n = 50), self-developed structured interviews (n = 37) and physical examination (n = 13). 23 previously developed questionnaires were used, all of which were developed for a cisgender population. Many studies in trans individuals touch on topics related to sexual-wellbeing, however, a comprehensive conceptualisation of (10 themes of) sexual-wellbeing is still lacking. Still, no valid tool exists for assessing sexual-wellbeing in the trans population, but is much needed.

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Studies on diagnostic subtypes of gender identity disorder (GID) or gender incongruence (GI), comorbidity and treatment outcome show considerable variability in results. Clinic/country specific factors may account for the contradictory results, but these factors have never been studied. This article is the first of a series reporting on a unique collaborative study of four European gender identity clinics (the European network for the investigation of gender incongruence [ENIGI]). Here, we present the diagnostic procedures of the four clinics (Amsterdam, Ghent, Hamburg, and Oslo), the standard battery of instruments, and the first results regarding applicants with GI who seek treatment. Applicants in the four clinics did not differ in living situation, employment status, sexual orientation, and age of onset of GI feelings. However, the Amsterdam and Ghent clinic were visited by a majority of natal males, whereas Hamburg and Oslo see more natal females. Male applicants were older than female applicants within each country, but female applicants in one country were sometimes older than male applicants in another country. Also, educational level differed between applicants of the four clinics. These data indicate that certain sociodemographic and/or cultural characteristics of applicants have to be taken into account in future studies.

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BACKGROUND: Low sexual desire is present in 1/3 of male-to-female transsexuals (post-operative male-to-female transsexual persons on estrogen replacement). Several studies report lower endogenous testosterone (T) levels in this group compared to community dwelling women. However, no relationship between T and sexual desire has been found in male-to-female transsexuals. Considering its role in androgen sensitivity, cytosine-adenine-guanine (CAG) trinucleotide repeat sequence in the androgen receptor (AR) might modify the relationship between T levels and sexual desire in male-to-female transsexuals. AIM: This study aims to assess the potential contribution of the number of CAG repeats in the association between T and sexual desire in male-to-female transsexuals. MATERIAL, SUBJECTS, AND METHODS: Thirty-four post-operative male-to-female transsexuals participated in a cross-sectional study. The Sexual Desire Inventory, a questionnaire measuring sexual desire, was completed. Serum levels of total (TT) and free T (FT), DHEA-S, SHBG, and LH were measured in morning blood samples. AR gene CAG repeat length was determined by automated DNA fragment analysis of exon 1 of the AR gene. RESULTS: The CAG repeat length ranged from 14 to 28 with a median of 21. CAG polymorphism was correlated with FT (r=0.389; p=0.023) but not with TT (r=0.191; p=0.280). The observed interaction between TT and CAG was significant only for solitary sexual desire (p=0.002). The interaction of CAG repeats and FT on sexual desire failed to reach significance. CONCLUSIONS: We could not establish that CAG repeat length is a consistent modulating factor in the relationship between TT or FT and sexual desire in male-to-female transsexuals.

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In the last decade, transsexual patients have increasingly sought sex reassignment (cross-sex hormones and sex reassignment surgery), whilst avoiding adequate diagnostic procedures. They ask non-specialized physicians to prescribe hormones or to perform sex reassignment surgery. Sometimes hormones are ordered through the Internet or obtained from other illegitimate sources. If these patients later turn to a specialized team (for instance for sex reassignment surgery), the obligatory standard diagnostic procedure is problematic: the patient does not accept having to go through a long period of assessment and objective decisionmaking, while the attending health professional feels pressured by the patient's impatience. Non-expert health professionals should draw patients' attention to the necessity of a thorough diagnostic procedure, thus avoiding wrong decisions and future regrets.

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From the files of the outpatient urology department 44 men with ED had undergone both psychophysiological diagnostic screening (PDS, VSS, VSS+VIB, ICI+VSS+VIB) and color Doppler sonography testing (CDS, including VSS). PDS was carried out by one medical physiologist, CDS by one urologist. The diagnoses reached could be compared. This study revealed that CDS in ED-patients often resulted in an incorrect diagnosis, that is a presumed vascular abnormality while many such patients demonstrated firm erections under PDS-laboratory test conditions. Thus, it was concluded that CDS as a (first) screening test in ED-patients is of limited value. It was further emphasized that PDS, although giving quite relevant information about possible etiology and therapeutic treatment, is not a necessary first screen. Good history taking, preferably of the man and his partner, is still the basic first screen and quite often offers enough information to make a treatment plan with reasonable likelihood of success.

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Psychophysiological diagnostic screening (PDS) was carried out on just over 1000 consecutive patients with erectile dysfunction (ED) during 1995 through 1999. Roughly one-third did not require an intracavernous injection (ICI) because of optimal penile response during visual and tactile penile sexual stimulation. The present article deals with those other patients (n = 609) who required an ICI and completed a 24-hour-postinvestigation questionnaire (PIQ). The two ICI preparations used, prostaglandin and papaverine + fentolamine, were virtually equally effective in the doses applied, with very low and similar percentages of unwanted side effects, for example, prolonged erection. Somatic ED patients displayed the lowest penile responses to ICI, whereas psychogenic ED patients had the highest penile responses. ED patients who also suffered from premature ejaculation (PE) ejaculated significantly more readily during PDS that those without PE. An ICI following an ejaculation/orgasm could lead to an erection presumably sufficient for intromission, which indicates ICI as a therapeutic option for rapid ejaculators. Our elaborate and lengthy PDS procedure, particularly the use of penile vibration as an addition to the visual sexual stimulation, obviates the diagnostic use of the PIQ.

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Over the past few years, polyfunctional thiols present as trace components have been found to play a major role in many food flavors, due to their exceptionally low odor thresholds. Unfortunately, their presence in minute concentration (in ng/kg to a few microg/kg) and their high reactivity make it very difficult to extract and identify them. Furthermore, most of them are not yet commercially available. The aim of this work was to characterize the chromatographic and sensorial properties of 10 synthetic mercaptoketones and mercaptoalcohols. Combinatorial chemistry proved to be a very useful way to synthesize them rapidly. Sulfur-selective sulfur chemiluminescence detection chromatograms coupled with mass spectroscopy enabled the target compounds to be identified. Flavor profiles and best estimate gas chromatography lowest amount detected by sniffing (BE-GC-LOADS) values were further determined by GC-olfactometry. As expected, new, exceptionally odorant molecules (BE-GC-LOADS < 0.1 ng) were revealed by this unusual approach.

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OBJECTIVE: To compare, in men with erectile dysfunction, the diagnosis obtained with the 'Leiden impotence questionnaire' (LIQ)--which differentiates between psychogenic and organic erectile dysfunction--with the clinical diagnosis based on psychophysiological diagnostic screening (PDS). DESIGN: Exploratory, comparative, and prospective. METHOD: The LIQ-questionnaire was administered to 320 consecutive patients with erectile dysfunction who underwent PDS (i.e. visual sexual stimulation and penile vibration) in the Department of Endocrinology and Reproduction, Erasmus University Medical Centre, Rotterdam, the Netherlands. The clinical diagnosis was based on PDS and later, retrospectively, compared to the LIQ-based diagnosis (only the first six of the 11 LIQ-questions were answered by all patients). RESULTS: The clinical diagnosis, psychogenic or somatic, corresponded well with the LIQ-diagnosis. Following PDS an organic aetiology was assumed in 30% of the patients; compared to 33% according to the LIQ. For a psychogenic aetiology the figures were 70% and 67% respectively. Overall there was a 74% correspondence between PDS-diagnosis and the LIQ-diagnosis. Age was a significant factor: younger men (< 40 years) had the highest LIQ-score (compared to men aged 40-60 and > 60 years) and the strongest penile responses. This is indicative of a more frequent psychogenic aetiology of the erectile dysfunction in younger men. CONCLUSION: Elaborate psychophysiological diagnostic screening is not necessarily the first diagnostic choice in men with erectile dysfunction; one may start by applying the LIQ. A high LIQ-score (5-7) virtually excludes a somatic aetiology. A low LIQ-score (0-2) necessitates further psychosomatic diagnostic screening, preferably with PDS.

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This study focuses on the influences of self-perceived interpersonal behavior of addicted inpatients (n = 107) on the stereotypes of their ideal male and female therapist. Based on the interpersonal model of personality patients were asked to describe their ideal male and female therapist. Perceptions of interpersonal behavior of the ideal therapist are determined by the self-perceived interpersonal behavior of the patients rather than by their gender. Ideal therapists are described as managerial-autocratic and sociable-extravert, which is in almost perfect accordance with the self-perceptions of therapists. Although most of the patients prefer a female therapist, the interpersonal behavior of a male or a female therapist does not differ significantly. The results are discussed from the viewpoint that mutual expectations and preferences between patients and therapists are thought to be of crucial importance for the outcome of therapy. In the process of matching patients and therapists, these expectations should not only be assessed, but also used to improve the final matching.

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Hop S-methylcysteine sulfoxide has previously been postulated as the precursor of dimethyl trisulfide (DMTS) in beers. The present data point to 3-methylthiopropionaldehyde, the Strecker aldehyde issued from methionine, as another potential precursor in aged beers. Spiking either fresh beer or wort before boiling leads in all cases to higher levels of DMTS after storage. Moreover, special malts with a high level of 3-methylthiopropionaldehyde also favor polysulfide synthesis. A higher pH should increase this onion-like off-flavor, whereas a low pH is unfortunately known to enhance the cardboard flavor of aged beers. 3-methylthiopropanol, issued from yeast reducing activity, can be considered as an additional DMTS source during aging.

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The odor characteristics of individual components present in a library comprised of S-methyl thioesters were determined independently by two laboratories using similar but not identical techniques. The odor potency was assessed by values of best estimate-GC-lower amount detected by sniffing (BE-GC-LOADS). For small and medium chain S-methyl thioesters, these values were found to increase from 6 ng for S-methyl thiobutanoate to 90 ng for S-methyl thiostearate. All assessors detected a "green", "floral", or "pineapple" odor for S-methyl thiohexanoate and described thioesters containing a 2-6 carbon chain length as "cheesy". The results of this preliminary analysis were confirmed by a more extensive study of selected compounds, namely S-methyl thioacetate, S-methyl thiopropionate, S-methyl thiobutanoate, and S-methyl thiohexanoate, using a trained panel of 18 subjects. The subjects confirmed the presence of the "green" and "fruity" notes in the odor of S-methyl thiohexanoate. The analysis also revealed a significant difference in the odor of S-methyl thiopropionate relative to that of S-methyl thioacetate and S-methyl thiobutanoate. When "cheesy" characteristics were mentioned, the majority of panelists clearly associated the flavor of S-methyl thiopropionate with Camembert with almost 20% of all the descriptors given referring specifically to this cheese variety as compared to about 2 and 5% in the case of S-methyl thioacetate and thiobutanoate, respectively. Prompted by this observation, two samples of Camembert prepared from unpasteurized and pasteurized milk were analyzed and relatively large amounts of S-methyl thiopropionate were found in the former but not in the latter cheese. The results obtained in the course of this work suggest that the sensory analysis of combinatorial libraries is a useful new approach in the search for new commercial flavors and/or identification of characteristic flavors in foods.

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A new method for the "one-pot" synthesis of S-methyl thioesters has been developed by reacting methyl chlorothiolformate with carboxylic acids. The resulting "flavor library" contained all the intended thioesters and a single major impurity, identified by GC-MS as S, S-dimethyldithiocarbonate. Quantification of individual compounds present in the library was performed by GC analysis using two independent methods of detection, SCD and FID. It was shown that apart from S-methyl thioacetate (0.8 mol %), molar concentrations of other thioesters varied in a relatively narrow range from 4.2 mol % for S-methyl thiopropionate to 14.1 mol % for S-methyl thiohexanoate. In general, medium chain S-methyl thioesters were present in slightly higher molar concentrations than those prepared from short or long chain carboxylic acids. This variation was attributed to partial loss of the most volatile components during extraction and the lower reactivity of higher homologues. The library was used for the characterization of some physicochemical parameters of thioesters. In particular, lipophilicity coefficients (log k(w)) and thioester retention in 10, 20, and 33% triolein (used as a model lipid phase) were determined directly by reverse-phase HPLC and extrapolated from the respective data. This analysis illustrates that substantial information can be generated using a library containing a relatively large number of compounds in effectively the same way as is necessary for the analysis of a single sample.

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This article reports on the changes in the classification of sexual dysfunctions since DSM-III, and on the results of the efforts to make these disorders compatible in DSM-IV and ICD-10. A comparison is made between the ways in which sexual dysfunctions are conceptualized in DSM-III, DSM-III-R, DSM-IV, and ICD-10. Special attention is given to the extent to which: (1) in the diagnostic criteria due weight is given to the physiological and psychological aspects, and to the different phases of the sexual response cycle; and (2) these disorders apply to people of different sexes and sexual orientations, and to problems arising while using different sexual techniques. After publication of DSM-III, the classification of sexual dysfunctions has evolved considerably. Moreover, there are still important differences between DSM-IV and ICD-10. Suggestions for DSM-V and ICD-11 are (among others): (1) introduction of excessive (hyperactive) sexual desire in addition to diminished (hypoactive) sexual desire; (2) differentiation between genital arousal disorder and sexual excitement disorder; and (3) differentiation between orgasmic disorder, anhedonic orgasm, ejaculation disorder, and premature orgasm.

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In a study of 320 men (20 to 77 years) in gay relationships, data were gathered on verbal, physical, and emotional intimacy and on sexual aspects of relationship functioning. Independent of relationship duration and partners' age, emotional intimacy predicts relationship satisfaction the best. Sexual satisfaction is best predicted by low sexual distance. Sexual frequency is best predicted by sexual satisfaction. Data analysis indicates that young gay men value emotional aspects of their relationship more than older gay men do. The attitude towards sexual encounters one partner has is related to his actual number of sexual partners and to his partner's attitude.

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