Introduction Erectile dysfunction (ED), premature ejaculation (PE), and reduced libido are common yet poorly investigated complications of diabetes especially among South Asians (SA). Aim To determine possible variations in prevalence and interassociations of ED, PE, and reduced libido among SA and Europids with and without diabetes. Method Men with diabetes and a randomly selected sample of age-matched nondiabetic men from 25 general practitioners in eight primary care trusts in the United Kingdom were invited to participate in a linguistically validated questionnaire-based study in English, Hindi, Urdu, Panjabi, Tamil, and Sinhala languages. Main Outcome Measures ED, assessed by International Index of Erectile Function (IIEF-5), PE, evaluated using the Premature Ejaculation Diagnostic Tool, and libido, assessed by asking participants to grade their desire for sexual activity. Results Sample size was 510 (SA: 184, Europid: 326). Mean age was 56.9 ± 9.7 years. There was no difference in erectile function when assessed by IIEF between SA and Europids with diabetes (84.8% and 84.1%, respectively). The overall prevalence of PE was 28.8% (32.6% and 25.8% in those with and without diabetes, respectively, P = NS). Among men with diabetes, the prevalence of PE was 45.8% and 22.4% for SA and Europids, respectively (P < 0.001). In those without diabetes, this figure was 41.9% in SA and 20.2% in Europids (P < 0.001). There was a significant trend of increasing prevalence of PE with increasing severity grade of ED (P < 0.001). Reduced libido was reported by 26.9% men (32.8% and 22.0% in those with and without diabetes, respectively, P < 0.01), with no significant ethnic difference. The association between reduced libido and increasing severity grades of ED was also significant (P < 0.001). Conclusions No significant difference was observed in the prevalence of ED between SA and Europid men with diabetes. PE was significantly more common in the SA men irrespective of their diabetes status.

BackgroundThe purpose of the linguistic validation of the Sexual Inhibition and Sexual Excitation Scales (SIS/SES) was to produce translated versions in five South Asian languages (Hindi, Urdu, Panjabi, Tamil and Sinhalese) that was “conceptually equivalent” to the original U.S. English version, for use in the Oxford Sexual Dysfunction Study (OSDS).MethodsInitially an expert committee was appointed to carry out the task of linguistic validation. This committee included the principal investigator, project coordinator and the associate project manager of the OSDS and a language consultant for each of the South Asian languages. The process of translation and validation was conducted in the following order; a) production of two independent forward translations, b) comparison and reconciliation of the translations, c) backward translation of the first reconciled version, d) comparison of the original version of SIS/SES and the backward version leading to the production of the second reconciled version and e) pilot testing and finalization.ResultsSeveral linguistic and conceptual issues arose during the process of translating the instrument. Problems were also encountered with cultural differences in acceptability of certain concepts, and with semantic difficulties in finding an appropriate translation. In addition, the researchers had to find culturally acceptable equivalents for some terms and idiomatic phrases. The problems encountered in pilot testing, during cognitive debriefing and clinicians’ review, were categorized as cultural or conceptual/semantic. Cultural issues describe the acceptability of using certain terms and phrases in a particular socio-cultural milieu. The conceptual and semantic difficulties reflect the inability to deliver the idea/meaning of a source statement in the target language. The current paper describes a selection of these issues.ConclusionsWe applied a rigorous translation method to ensure conceptual equivalence and acceptability of SIS/SES in the five different South Asian languages prior to its utilization in the OSDS. However, to complete the cultural adaptation process, future psychometric validation of the translated versions is required among the different language speakers.

BackgroundThe present study aims to evaluate the relationship between physical activity and sexual dysfunction amongst an ethnic South Asian population living in the United Kingdom and compare the association with that of the native Caucasian population.MethodsTwenty-five general practitioner clinics from eight primary care trusts in the United Kingdom collaborated in the Oxford Sexual Dysfunction Study. In each practice, a sample of diabetic and non-diabetic patients of European/Europid and South Asian origin were invited for the study. Erectile dysfunction (ED) was assessed using a five-item version of the International Index of Erectile Function. Premature ejaculation (PE) was diagnosed using the premature ejaculation diagnostic tool. Libido was assessed by asking participants to grade their desire for sexual activity. Physical activity during the past week was assessed using the short version of the International Physical Activity Questionnaire (IPAQ). A binary logistic regression analysis was performed in all adults, Europids and South Asians with ‘presence of ED’ as the dichotomous dependent variable (0 = ED absent; 1 = ED present) and age, diabetes status, physical activity, ethnicity, current smoking and use of antihypertensive medications as the independent variables.ResultsSample size was 510, and mean age was 56.9 ± 9.7 years. There were 63.9 % (n = 326) Europid males in the study population. The prevalence of ED was 64.5 % and it was significantly higher in men with diabetes than in those without diabetes (84.4 vs. 49.0 %, p < 0.001). The overall prevalence of PE was 28.8 %, (with diabetes 32.6 %, without diabetes 25.8 %; p = 0.109). Reduced libido was reported by 26.9 % of study participants (with diabetes 32.8 %, without diabetes 22.0 %; p < 0.01). The median (IQR) total physical activity of the study population was 2373 (3612) MET-min/week. In the IPAQ categorical score, 36.8 % (n = 184/434) males were ‘highly active’, and 17.8 % (n = 89/434) were ‘inactive’. In all adults, age (OR: 1.06), South Asian ethnicity (OR: 1.40), physical inactivity (OR: 1.62) and presence of diabetes (OR: 3.90) all were associated with significantly increased risk of developing ED. A similar result was observed in Europids but not in South Asians.ConclusionsErectile dysfunction was associated with physical inactivity, mainly in Europid males, irrespective of diabetes status. This association was not observed in South Asian males with or without diabetes.

BackgroundSelf-administered questionnaires provide a better alternative to disclose sensitive information in sexual health research. We describe the factors that determine the positive response (initial recruitment) to an initial invitation and subsequent completion of study to a postal questionnaire on sexual dysfunction.MethodsSouth Asians (SA) and Europids with and without diabetes (DM) were recruited from GP clinics in UK. Men who returned the properly filled consent form (‘recruited-group’) were sent the questionnaire and those who returned it were considered as the ‘completed-group’. Index of Multiple Deprivation Scores (IMDs) were generated using UK postcodes. We calculated the recruitment rate and completion rate of the recruited and the study-completed groups respectively.ResultsTotal approached sample was 9100 [DM: 2914 (32 %), SA: 4563 (50.1 %)]. Recruitment rate was 8.8 % and was higher in Europids and in patients with DM. Mean IMDs for the recruited group was 20.9 ± 11.9, and it was higher among recruited SA compared to Europids (p < 0.001). Mean IMDs was higher in the recruited group compared to non-recruited (p < 0.01). All four recruited groups (SA/Europid and DM/non-DM) had lower IMDs compared to non-recruited. Completion rate was 71.5 % (n 544) (SA: 62.3 %, Europids: 77.4 %; p < 0.05).ConclusionRecruitment for postal sexual health surveys is positively influenced by presence of investigated disease, older age, being from lesser deprived areas and Europid ethnicity. Furthermore, Europids were more likely to complete survey than South Asians irrespective of disease status.

BackgroundUnderstanding youth sexuality involves more than describing their sexual behaviour. Aims To describe the influence of gender roles in intimate relationships among undergraduates and to describe the attitudes of female undergraduates on sexual relationships. Methods Information was obtained from unmarried female undergraduates (n=283) in the faculties of Arts, Science and Law in a Sri Lankan university through qualitative inquiries and self-administered questionnaires. ResultsIn the sample studied, 52% were engaged in romantic relationships. On inquiring whether they knew of instances where girls were forced to commence a romantic relationship, 36% responded positively while 73% knew of instances where girls were forced to continue relationships. A fear of being physically harassed by males and a fear of social unacceptability if the relationship was discontinued were the most cited reasons for being coerced into commencing or contituing a relationship. Sexual relationships within romantic relationships were known to 81% of students. Verbal abuse in romantic relationships was known to 57% of students while 23% were aware of physical violence in such relationships. Furthermore, 64% reported knowing females who unwillingly agreed to sexual relationships due to the fear of losing the relationship and 21% knew of instances where violence was used by male partners to coerce females in to sexual activities. On exploring attitudes it was shown that females did not accept the use of violence by males within romantic or sexual relationships. Female undergraduates did not accept premarital sex and were unsure of the responsibilities of males in this practice. ConclusionsMale dominance within relationships resulting in coercion seems to be common in undergraduate relationships though such behaviour was unacceptable to females. Continuation of such behaviour might endanger the establishment of healthy sexual attitudes and practices in both genders. SL J Psychiatry 2011; 2 (2):54-59