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      Sexual life satisfaction of methadone-maintained Chinese patients: individuals with pain are dissatisfied with their sex lives

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          Abstract

          Purpose

          Pain is potentially associated with sexual dysfunction. Both sexual dysfunction and pain are common in methadone-maintained patients, but the association of pain with sexual dysfunction in methadone-maintained patients is rarely studied. This study examined the association between pain and sexual life satisfaction (SLS) in Chinese patients receiving methadone maintenance treatment (MMT).

          Patients and methods

          A total of 477 methadone-maintained patients who recently had sex with their sex partners were recruited from three MMT clinics in Wuhan, China. SLS was assessed with a single question, and the sociodemographic, psychological, and clinical data were collected with standardized questionnaires. Pain intensity was assessed with the 5-point verbal rating scale. Multiple ordinary logistic regression was used to control for potential confounders that may bias the pain–SLS relationship.

          Results

          The prevalence of self-reported dissatisfaction with one’s sexual life was significantly higher in patients with clinically significant pain (CSP) than those without CSP (41.5% vs 19.4%, χ 2 =23.567, P<0.001). After controlling for potential sociodemographic, psychological, and clinical confounders, CSP was still significantly and independently associated with an increase in sexual life dissatisfaction (OR =1.89, P=0.011).

          Conclusion

          Pain is significantly associated with low SLS in methadone-maintained patients. Appropriate pain management might improve SLS of patients receiving MMT.

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          Most cited references 40

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          The relative health benefits of different sexual activities.

           Stuart Brody (2010)
          Although many studies examine purported risks associated with sexual activities, few examine potential physical and mental health benefits, and even fewer incorporate the scientifically essential differentiation of specific sexual behaviors. This review provides an overview of studies examining potential health benefits of various sexual activities, with a focus on the effects of different sexual activities. Review of peer-reviewed literature. Findings on the associations between distinct sexual activities and various indices of psychological and physical function. A wide range of better psychological and physiological health indices are associated specifically with penile-vaginal intercourse. Other sexual activities have weaker, no, or (in the cases of masturbation and anal intercourse) inverse associations with health indices. Condom use appears to impair some benefits of penile-vaginal intercourse. Only a few of the research designs allow for causal inferences. The health benefits associated with specifically penile-vaginal intercourse should inform a new evidence-based approach to sexual medicine, sex education, and a broad range of medical and psychological consultations.
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            Plasma testosterone and sexual function in men receiving buprenorphine maintenance for opioid dependence.

            High-dose methadone is well known to cause testosterone deficiency and sexual dysfunction in opioid-dependent men. Buprenorphine is a new drug for the pharmacotherapy of opioid dependence. Its influence on the gonadal axis has not been investigated to date. We therefore assayed testosterone, free testosterone, estradiol, SHBG, LH, FSH, and prolactin in 17 men treated with buprenorphine. Thirty-seven men treated with high-dose methadone and 51 healthy blood donors served as controls. Sexual function and depression were assessed using a self-rating sexual function questionnaire and the Beck Depression Inventory. Patients treated with buprenorphine had a significantly higher testosterone level [5.1 +/- 1.2 ng/ml (17.7 +/- 4.2 nmol/liter) vs. 2.8 +/- 1.2 ng/ml (9.7 +/- 4.2 nmol/liter); P < 0.0001] and a significantly lower frequency of sexual dysfunction (P < 0.0001) compared with patients treated with methadone. The testosterone level of buprenorphine-treated patients did not differ from that of healthy controls. In conclusion, we demonstrated for the first time that buprenorphine, in contrast with high-dose methadone, seems not to suppress plasma testosterone in heroin-addicted men. To this effect, buprenorphine was less frequently related to sexual side effects. Buprenorphine might therefore be favored in the treatment of opioid dependence to prevent patients from the clinical consequences of methadone-induced hypogonadism.
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              Methadone Maintenance Treatment Participant Retention and Behavioural Effectiveness in China: A Systematic Review and Meta-Analysis

              Background Methadone maintenance treatment (MMT) has been scaled up by the Chinese government alongside persistent compulsory drug user detention, but the extent to which detention interferes with MMT is unknown. The study systematically reviews Chinese MMT retention rates, reasons for drop out, and behavioural changes. Method Chinese and English databases of literature are searched for studies reporting retention rates, drug use and sexual behaviours among MMT participants in China between 2004 and 2013. The estimates are summarized through a systematic review and meta-analysis. Results A total of 74 studies representing 43,263 individuals are included in this analysis. About a third of MMT participants drop out during the first three months of treatment (retention rate 69.0% (95% CI 57.7-78.4%)). Police arrest and detention in compulsory rehabilitation was the most common cause of drop out, accounting for 22.2% of all those not retained. Among retained participants, changing unsafe drug use behaviours was more effective than changing unsafe sexual behaviours. At 12 months following MMT initiation, 24.6% (15.7-33.5%) of MMT participants had a positive urine test, 9.3% (4.7-17.8%) injected drugs and only 1.1% (0.4-3.0%) sold sex for drugs. These correspond to 0.002 (<0.001-0.011), 0.045 (0.004-0.114) and 0.209 (0.076-0.580) times lower odds than baseline. However, MMT participants did not have substantial changes in condom use rates. Conclusion MMT is effective in drug users in China but participant retention is poor, substantially related to compulsory detention. Reforming the compulsory drug user detention system may improve MMT retention and effectiveness.
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                Author and article information

                Journal
                J Pain Res
                J Pain Res
                Journal of Pain Research
                Journal of Pain Research
                Dove Medical Press
                1178-7090
                2018
                10 September 2018
                : 11
                : 1789-1794
                Affiliations
                [1 ]Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, Hubei Province, China
                [2 ]Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan, Hubei Province, China, 52901543@ 123456QQ.com
                Author notes
                Correspondence: Hong-Jie Li, Department of Psychiatry, Wuhan Mental Health Center, No. 89 Gongnongbing Rd., Jiang’an District, Wuhan 430012, Hubei Province, China, Tel +86 1 387 107 1707, Fax +86 275 933 8111, Email 52901543@ 123456QQ.com
                Article
                jpr-11-1789
                10.2147/JPR.S177564
                6137950
                © 2018 Zhong et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

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