Profile of Female Sexual Function: a patient-based, international, psychometric instrument for the assessment of hypoactive sexual desire in oophorectomized women

OBJECTIVE

The purpose of this study was to develop a self-administered, patient-based questionnaire to assess loss of sexual desire and associated symptoms in postmenopausal women with hypoactive sexual desire disorder (HSDD) experiencing distress.

DESIGN

Preliminary items and domains of sexual function were identified through individual and focus group interviews with postmenopausal women in the United States and Europe. A subset of items was selected for translation and further analysis. Cognitive interviews were conducted with women with HSDD and non-HSDD women in eight countries to ensure items would have the same meaning in seven languages. The resulting instrument was tested in 325 oophorectomized women with HSDD and 255 age-matched nonoophorectomized control women in the United States, Canada, Europe, and Australia.

RESULTS

Psychometric item reduction analyses resulted in 37 items organized into seven domains characterizing female sexual function in postmenopausal women with HSDD. Excellent reliability and validity of the domains of the Profile of Female Sexual Function (PFSF) were observed in all geographic areas tested. Statistically significant differences between oophorectomized women with low libido and control women were found for all domains and all geographic areas.

CONCLUSIONS

The PFSF is a new instrument specifically designed for measurement of sexual desire in oophorectomized women with low libido. Robust psychometric properties have been established in a large number of geographic regions and languages, making it useful for assessing therapeutic change in multinational clinical trials.

Summary of the Recommendations on Sexual Dysfunctions in Women

INTRODUCTION

Women's sexual dysfunctions include persistent or recurrent disorders of sexual interest/desire, disorders of subjective and genital arousal, orgasm disorder, pain and difficulty with attempted or completed intercourse. There are limited recommendation/guideline documents pertaining to the diagnosis and treatment of women's sexual dysfunctions.

AIM

To provide recommendations/guidelines concerning state-of-the-art knowledge for the clinical management of women's sexual dysfunctions.

METHODS

An International Consultation in collaboration with the major sexual medicine associations assembled over 200 multidisciplinary experts from 60 countries into 17 committees. Committee members established specific objectives and scopes for various sexual medicine topics. The recommendations concerning state-of-the-art knowledge in the respective sexual medicine topic represent the opinion of experts from five continents developed in a process over a 2-year period. Ten experts from four countries compiled the Recommendations on Sexual Dysfunctions in Women.

MAIN OUTCOME MEASURE

Expert opinion was based on grading of evidence-based medical literature, widespread internal committee discussion, public presentation and debate.

RESULTS

Recommendations and guidelines concerning the various sexual dysfunctions were updated. A comprehensive assessment of medical, sexual and psychosocial history is recommended for diagnosis and management planning. Indications for general and focused pelvic genital examination and laboratory testing are included. Recently revised definitions for sexual desire/interest disorder, arousal disorders (genital, subjective, combined and persistent), orgasm disorder, dyspareunia and vaginismus are presented. An evidence-based approach to management is provided.

CONCLUSIONS

There is a need for more research and scientific reporting, re-assessment, and management of women's sexual dysfunction including long-term outcome studies.

Summary of the Recommendations on Sexual Dysfunctions in Men

INTRODUCTION

There are few published guidelines for the management of sexual dysfunctions in men and women, despite the prevalence and lack of attention to these problems. Disorders of sexual function in men include erectile dysfunction, orgasm/ejaculation disorders, priapism, and Peyronie's disease.

AIM

To provide evidence-based and expert-opinion consensus guidelines for the clinical management of men's sexual dysfunctions.

METHODS

An International Consultation in collaboration with major urological and sexual medicine societies assembled over 200 multidisciplinary experts from 60 countries into 17 consultation committees. Committee members established the scope and objectives for each chapter. Following intensive review of available data and publications, committees developed evidence-based guidelines in each area.

MAIN OUTCOME MEASURE

New algorithms and guidelines for assessment and treatment of men's sexual dysfunction were developed. The Oxford system of evidence-based review was systematically applied. Expert opinion was based on systematic grading of the medical literature, in addition to cultural and ethical considerations.

RESULTS

Recommendations and guidelines for men's sexual dysfunction are presented. These guidelines were developed as evidence-based, patient-centered, and multidisciplinary in focus. For the clinical assessment and diagnosis of ED, a basic evaluation was recommended for all patients, with optional and specialized testing reserved for special cases. A new treatment algorithm is proposed. This algorithm provides a clinically relevant guideline for managing ED in the large majority of men. New treatment guidelines and algorithms are provided for men's orgasm and ejaculation disorders, including premature ejaculation, retrograde and delayed ejaculation. Finally, expert opinion-based guidelines for the clinical management of priapism and Peyronie's disease are provided.

CONCLUSIONS

Additional research is needed to validate and extend these guidelines. Nonetheless, this summary encompasses the recommendations concerning men's sexual dysfunctions presented at the 2nd International Consultation on Sexual Medicine in Paris, France, June 28-July 1, 2003.

Endocrine Aspects of Female Sexual Dysfunction

INTRODUCTION

Various endogenous hormones, including estrogen, testosterone, progesterone and prolactin, may influence female sexual function.

AIM

To provide recommendations for the diagnosis and treatment of women with endocrinologic sexual difficulties.

METHODS

The Endocrine Aspects of Female Sexual Dysfunction Committee was part of a multidisciplinary International Consultation. It included four experts from two countries and several peer reviewers.

MAIN OUTCOME MEASURE

Expert opinion was based on committee discussion, a comprehensive literature review and evidence-based grading of available publications.

RESULTS

The impact of hormones on female sexual function and their etiological roles in dysfunction is complex. Research data are limited as studies have been hampered by lack of precise hormonal assays and validated measures of sexual function in women. Sex steroid insufficiency is associated with urogenital atrophy and may also adversely affect central sexual thought processes. Systemic estrogen/estrogen progestin therapy alleviates climacteric symptoms but there is no evidence that this therapy specifically improves hypoactive sexual desire disorder (HSDD) in premenopausal or postmenopausal women. Exogenous testosterone has been shown in small randomized controlled trials (RCT) to improve sexual desire, arousal and sexual satisfaction in both premenopausal and postmenopausal women. However, as there is no biochemical measure that clearly identifies who to treat, use of exogenous testosterone should be considered only after other causes of HSDD have been excluded, such as depression, relationship problems and ill health. The clinical assessment of HSDD should include detailed medical, gynecologic, sexual and psychosocial history and physical examination including the external/internal genitalia. Hormonal therapy should be individualized and risks/benefits fully discussed, and all treated women should be carefully followed up and monitored for therapeutic side effects.

CONCLUSIONS

There is a need for prospective, multi-institutional clinical trials to define safe and effective endocrine treatments for female sexual dysfunction.

Clinical Evaluation and Management Strategy for Sexual Dysfunction in Men and Women

INTRODUCTION

The optimal approach for identification and evaluation of the sexual problems in men and women in primary care or general medicine practice has not been consensed.

AIM

To provide recommendations/guidelines concerning state-of-the-art knowledge for clinical evaluation and management strategies in the evaluation and treatment of sexual dysfunction in men and women, emphasizing evidence-based medicine and a patient-centered framework.

METHODS

An International Consultation in collaboration with the major urology and sexual medicine associations assembled over 200 multidisciplinary experts from 60 countries into 17 committees. Committee members established specific objectives and scopes for various male and female sexual medicine topics. The recommendations concerning state-of-the-art knowledge in the respective sexual medicine topic represent the opinion of experts from five continents developed in a process over a 2-year period. Concerning the Clinical Evaluation and Management Strategies Committee, there were 12 experts from five countries.

MAIN OUTCOME MEASURE

Expert opinion was based on grading of evidence-based medical literature, widespread internal committee discussion, public presentation and debate.

RESULTS

Three concepts underlie sexual medicine management: (i) adoption of a patient-centered framework for evaluation and treatment; (ii) application of the principles of evidence-based medicine in diagnostic and treatment planning; and (iii) use of a unified management approach in men and women. When taken together, these three principles provide a balanced and integrated approach to sexual dysfunction management. Common algorithms for diagnosis and management of men and women with sexual dysfunction, brief sexual symptom checklists, basics in history and physical examination, indications for specialized referral and development of a follow-up strategy are presented.

CONCLUSIONS

More research is needed in understanding the role of evidence-based and patient-centered medicine in the clinical evaluation and management strategies of men and women with sexual dysfunction.

Disorders of Orgasm in Women

INTRODUCTION

Orgasm is a sensation of intense pleasure creating an altered consciousness state accompanied by pelvic striated circumvaginal musculature and uterine/anal contractions and myotonia that resolves sexually-induced vasocongestion and induces well-being/contentment. In 1,749 randomly-sampled U.S. women, 24% reported an orgasmic dysfunction.

AIM

To provide recommendations/guidelines concerning state-of-the-art knowledge for management of orgasmic disorders in women.

METHODS

An International Consultation in collaboration with the major urology and sexual medicine associations assembled over 200 multidisciplinary experts from 60 countries into 17 committees. Committee members established specific objectives and scopes for various male and female sexual medicine topics. The recommendations concerning state-of-the-art knowledge in the respective sexual medicine topic represent the opinion of experts from five continents developed in a process over a 2-year period. Concerning the Disorders of Orgasm in Women Committee, there were four experts from two countries.

MAIN OUTCOME MEASURE

Expert opinion was based on grading of evidence-based medical literature, widespread internal committee discussion, public presentation and debate.

RESULTS

Female Orgasmic Disorder, the second most frequently reported women's sexual problem is considered to be the persistent or recurrent delay in, or absence of, orgasm following a normal sexual excitement phase that causes marked distress or interpersonal difficulty (DSM-IV). Empirical treatment outcome research is available for cognitive behavioral and pharmacological approaches. Cognitive-behavioral therapy for anorgasmia promotes attitude and sexually-relevant thought changes and anxiety reduction using behavioral exercises such as directed masturbation, sensate focus, and systematic desensitization treatments as well as sex education, communication skills training, and Kegel exercises. To date there are no pharmacological agents trials (i.e., bupropion, granisetron, and sildenafil) proven to be beneficial beyond placebo in enhancing orgasmic function in women diagnosed with Female Orgasmic Disorder.

CONCLUSIONS

More research is needed in understanding management of women with orgasmic dysfunction.

Religiosity is associated with hippocampal but not amygdala volumes in patients with refractory epilepsy

OBJECTIVE

To assess the relationship between the behavioural triad of hyper-religiosity, hypergraphia and hyposexuality in epilepsy, and volumes of the mesial temporal structures.

METHOD

Magnetic resonance images were obtained from 33 patients with refractory epilepsy and mesial temporal structure volumes assessed. Amygdala and hippocampal volumes were then compared in high and low scorers on the religiosity, writing, and sexuality sub-scales of the Neurobehavioural Inventory.

RESULTS

Patients with high ratings on the religiosity scale had significantly smaller right hippocampi. Religiosity scores rated by both patient and carer showed a significant negative correlation with right hippocampal volumes in this group. There were no other differences in amygdala or hippocampal volumes between these groups, or between high and low scorers on the writing and sexuality sub-scales.

CONCLUSIONS

These findings suggest that right hippocampal volumes are negatively correlated with religiosity in patients with refractory epilepsy.

Weibliche sexuelle Funktionsstörungen: Klassifikation, Diagnostik und Therapie

Sexual dysfunction is defined as "disturbances in sexual desire and in the psychophysiological changes that characterize the sexual response cycle and cause marked distress and interpersonal difficulty". The female sexual response cycle consists of three phases: desire, arousal, and orgasm. Various organs of the external and internal genitalia, e.g. vagina, clitoris, labia minora, vestibular bulbs, pelvic floor muscles and uterus, contribute to female sexual function. During sexual arousal, genital blood flow and sensation are increased. The vaginal canal is moistened (lubrication). During orgasm, there is rhythmical contraction of the uterus and pelvic floor muscles. Within the central nervous system, hypothalamic, limbic-hippocampal structures play a central role for sexual arousal. Sexual arousal largely depends on the sympathetic nervous system. Moreover, nonadrenergic/noncholinergic neurotransmitters (NANC), e.g. vasoactive intestinal polypeptide (VIP) and nitric oxide (NO), are involved in smooth muscle relaxation and enhancement of genital blood flow. Furthermore, various hormones may influence female sexual function. Estrogen has a significant role in maintaining vaginal mucosal epithelium as well as sensory thresholds and genital blood flow. Androgens primarily affect sexual desire, arousal, orgasm and the overall sense of well-being. The internationally accepted classification of female sexual dysfunction consists of hypoactive sexual desire disorders, sexual aversion disorders, sexual arousal disorders, orgasmic disorders and sexual pain disorders. Vascular insufficiency, e.g. due to atherosclerosis, and neurologic diseases, e.g. diabetic neuropathy, are major causes of sexual dysfunction. Additionally, sexual dysfunction may be due to changes in hormonal levels, medications with sexual side effects or of psychological origin. For the diagnosis of female sexual dysfunction, a detailed history should be taken initially, followed by a physical examination and laboratory studies. Physiologic monitoring of parameters of arousal potentially allows to diagnose organic diseases. Recordings at baseline and following sexual stimulation are recommended to determine pathologic changes that occur with arousal. Duplex Doppler sonography, photoplethysmography or the measurement of vaginal and minor labial oxygen tension may help to evaluate genital blood flow. Moreover, measurements of vaginal pH and compliance should be performed. Neurophysiological examination, e.g. measurement of the bulbocavernosus reflex and pudendal evoked potentials, genital sympathetic skin response (SSR), warm, cold and vibratory perception thresholds as well as testing of the pressure and touch sensitivity of the external genitalia, should be performed to evaluate neurogenic etiologies. Medical management of female sexual dysfunction so far is primarily based on hormone replacement therapy. Application of estrogen results in decreased pain and burning during intercourse. The efficacy of various other medications, e.g. sildenafil, L-arginine, yohimbine, phentolamine, apomorphine and prostaglandin E1, in the treatment of female sexual dysfunction is still under investigation.

Urologische Funktionsst�rungen nach sexuellem Missbrauch und Gewalt

Criminal statistics say that 300,000 children are sexually abused in the Federal Republic of Germany every year: 70-75% are abused by their own fathers or another psychological parent. Most victims are girls aged 7-12 years. Sexual abuse during childhood can lead to severe psychosomatic dysfunctions both in children and adults. Possible long-term results are depression, anxiety, emotional and cognitive problems, personal dysfunction, eating and sleeping disorders, alcohol or drug abuse, relationship problems, social maladaptation, and somatizations. Many urological dysfunctions without organic findings can be caused by sexual abuse. Among others, chronic pelvic pain (CPPS), enuresis, incontinence, and sexual dysfunction can occur. When children or adults see the urologist because of their symptoms there is always the danger of reproducing the abusive event by invasive diagnostic methods.Sometimes harming themselves the patients bring this situation about unconsciously. With the following article we want to heighten the awareness among urologists.

Vaginal spasm, pain, and behavior: an empirical investigation of the diagnosis of vaginismus

This study investigated the roles of vaginal spasm, pain, and behavior in vaginismus and the ability of psychologists, gynecologists, and physical therapists to agree on a diagnosis of vaginismus. Eighty-seven women, matched on age, relationship status, and parity, were assigned to one of three groups: vaginismus, dyspareunia resulting from vulvar vestibulitis syndrome (VVS), and no pain with intercourse. Diagnostic agreement was poor for vaginismus; vaginal spasm and pain measures did not differentiate between women in the vaginismus and dyspareunia/VVS groups; however, women in the vaginismus group demonstrated significantly higher vaginal/pelvic muscle tone and lower muscle strength. Women in the vaginismus group also displayed a significantly higher frequency of defensive/avoidant distress behaviors during pelvic examinations and recalled past attempts at intercourse with more affective distress. These data suggest that the spasm-based definition of vaginismus is not adequate as a diagnostic marker for vaginismus. Pain and fear of pain, pelvic floor dysfunction, and behavioral avoidance need to be included in a multidimensional reconceptualization of vaginismus.

The effects of hysterectomy on sexual arousal in women with a history of benign uterine fibroids

Research indicates hysterectomy surgery may adversely affect the pelvic autonomic nerves and autonomic mechanisms are integral to the sexual arousal response in women. This study explored the possibility that women who undergo hysterectomy may experience an impaired vasocongestive response to erotic stimulation. Thirty-two women with a history of benign uterine fibroids who had ( n = 15) or had not ( n = 17) undergone hysterectomy participated in two experimental sessions in which self-report and physiological (vaginal pulse amplitude; VPA) sexual responses were recorded during an erotic film presentation. In one of the sessions, the women exercised on a treadmill for 20 min prior to viewing the erotic films as a means inducing autonomic arousal. Exercise significantly increased VPA but not subjective sexual responses in both groups of women. VPA responses were marginally higher among the fibroid than hysterectomy group in the no-exercise condition. The hypothesis that physiological sexual arousal may be impaired with hysterectomy surgery was only partially supported.

A comparison of relational attitude and personality disorders in the explanation of child molestation

This study examined parental sensitivity, relational attitude (i.e., trust, friendship, adult romantic attachment), and personality disorders in the aetiology of sexual offences among a group of 84 child molesters and a matched normal control group (n = 80). The child molesters were selected from either a community-based, educational training program (n = 51), or a Belgium prison (n = 33). Analyses using structural equation modeling found that both relational attitude and personality disorders differentiated between the child molesters and the comparison group. Implications for the aetiology and treatment of child molesting is discussed.

Validation of the profile of female sexual function (PFSF) in surgically and naturally menopausal women

The Profile of Female Sexual Function (PFSF) is a patient-based instrument for the measuring of loss of sexual function in menopausal women with low libido (hypoactive female sexual desire disorder). The instrument, which contains 37 items in seven domains (sexual desire, arousal, orgasm, sexual pleasure, sexual concerns, sexual responsiveness, and sexual self-image) and a single-item measure of overall satisfaction with sexuality, has been extensively developed and initially validated in over 500 oophorectomized women with low libido in North America, Europe, and Australia. Initial validation results showed the PFSF is capable of discriminating these patients from age-matched controls and produced consistent responses and sensitivity across geographies. The objective of this nonrandomized, parallel-group study was to examine the psychometric properties of the final PFSF in an independent group of surgically menopausal women with low libido and to extend validation to naturally menopausal women with low libido. Participants from 16 study centers in North America included surgically (n = 59) and naturally (n = 88) menopausal women with low libido and their age-matched control subjects, both premenopausal (n = 57) and naturally menopausal (n = 47), who reported no problems with libido. Subjects completed the PFSF at baseline and again 4 weeks later. Adjusted mean scores for each of the seven domains were statistically significantly lower (P < 0.0001) in surgically menopausal women with low libido compared with age-matched control women, and in naturally menopausal women with low libido compared with naturally menopausal control women, demonstrating excellent discriminant validity. Test-retest reliability ranged from 0.57 to 0.91 for the seven domain scores, whereas internal-consistency reliability ranged from 0.74 to 0.95. Results of this research support the conclusion that the PFSF is a valid and reliable instrument for measurement of loss of sexual function in both naturally and surgically menopausal women with low libido.

Osteopathic approach to sexual dysfunction: holistic care to improve patient satisfaction and prevent mortality and morbidity

Erectile dysfunction has multiple causes; most commonly the causes are mixed, a combination of physical and physiologic dysfunction. Two hypothetical case presentations provide the context for a discussion of the neurologic basis of erectile dysfunction and sexual dysfunction from the perspective of osteopathic medicine's holistic approach. Both offer osteopathic physicians the challenge of correcting structural, biological, and chemical defects to restore normal function. One of the cases is representative of patients who do not tell their physicians about sexual dysfunction unless their physicians specifically ask, and even then, these patients are most likely to lie to protect their self-esteem. The second hypothetical patient is representative of those patients who consult their physicians for any reason other than sexual dysfunction, expecting their physicians to figure out the real problem. Both of the hypothetical patients require not only support, but also education and counseling to motivate them to adopt healthier lifestyles and choices. Both would benefit from osteopathic manipulative treatment to correct structural abnormalities, and an oral medication such as a phosphodiesterase type 5 inhibitor offers both patients a good and easily accepted treatment option for erectile dysfunction.

[Diagnosis and treatment of insertion obstacle(report of 32 cases)]

OBJECTIVE

To point out and define "insertion obstacle" (IO) as another sort of sexual dysfunction.

METHODS

A retrospective review was done on 32 patients with IO. They were diagnosed by self-rating insertion scale(SIS) designed by reference to the first five questions in OLeary's "Brief Male Sexual Function Inventory for Urology" (1995), involving sexual desire and erection and insertion, and treated mainly by psychological behavior therapy.

RESULTS

Of the 32 cases, 30 patients were diagnosed as IO, 29 (90.6%) were simple psychological IO, and successfully cured by psychological behavior therapy.

CONCLUSIONS

IO, as a sort of sexual dysfunction, could be diagnosed by SIS, and cured by psychological behavior therapy.

Definitions of women's sexual dysfunction reconsidered: advocating expansion and revision

In light of various shortcomings of the traditional nosology of women's sexual disorders for both clinical practice and research, an international multi-disciplinary group has reviewed the evidence for traditional assumptions about women's sexual response. It is apparent that fullfilment of sexual desire is an uncommon reason/incentive for sexual activity for many women and, in fact, sexual desire is frequently experienced only after sexual stimuli have elicited subjective sexual arousal. The latter is often poorly correlated with genital vasocongestion. Complaints of lack of subjective arousal despite apparently normal genital vasocongestion are common. Based on the review of existing evidence-based research, many modifications to the definitions of women's sexual dysfunctions are recommended. There is a new definition of sexual interest/desire disorder, sexual arousal disorders are separated into genital and subjective subtypes and the recently recognized condition of persistent sexual arousal is included. The definition of dyspareunia reflects the possibility of the pain precluding intercourse. The anticipation and fear of pain characteristic of vaginismus is noted while the assumed muscular spasm is omitted given the lack of evidence. Finally, a recommendation is made that all diagnoses be accompanied by descriptors relating to associated contextual factors and to the degree of distress.

[Premature orgasm in the male]

To date, we have no uniform definition of ejaculatio praecox. In a qualitative approach, premature ejaculation is ascribed to a failure to control excitement. As causes, organic disorders and erectile dysfunction must be excluded. The majority of cases, however, are due to psychological or partnership problems. The history-taking should aim, in particular, to uncover possible anxiety in conjunction with premature orgasm, and also to establish the reactions of the partner. As therapy, medication (local anesthetics, antidepressive agents, PDE-5 inhibitors) and sexual-therapeutic measures are available. Since few sufferers take the initiative in seeking treatment, particular importance attaches to providing the public with information about the therapeutic options for treating this common disorder.

Sexual modes questionnaire: measure to assess the interaction among cognitions, emotions, and sexual response

The goal of the present article is to present a new measure developed to assess cognitive and emotional factors of sexual function. This instrument was developed especially to test some hypotheses derived from Beck s new theoretical conceptualization (the modes theory; A. T. Beck, 1996). This model, characterized by its systemic and integrated approach, constitutes a remarkable development from a linear to a network perspective of the cognitive-emotional-behavioral processes. The new concept of mode, as a composite of schemas (cognitive, emotional, and behavioral) interacting together, is theoretically sound and supported by recent research findings from clinical and experimental sets (see A. T. Beck, 1996, for a revision). Our aim is to develop a new measure specifically created to assess these integrated and interdependent processes in the field of sexuality. The Sexual Modes Questionnaire (SMQ; male and female versions) is a combined measure constituted by three interdependent subscales: automatic thoughts, emotions, and sexual response presented during sexual activity. Psychometric studies showed good reliability and validity results in both versions, and high correlations between several dimensions of the three subscales support the concept of mode and its interactional character. Moreover, the capacity showed by the SMQ to discriminate between sexually functional and dysfunctional subjects and its high correlations with measures of sexual functioning emphasize the role of cognitive-emotional processes on sexual problems, supporting the clinical value of the measure.

[Position of sexual medicine in medical specialties]

The position of sexual medicine among the different medical subspecialities is discussed. Sexuality is seen under its socio-communicative, reproductive and lust-aspects which in turn influence specific characteristics of sexual medicine, as e.g. its biopsychosocial way of thinking, its focus on the couple, the alloying of different forms of therapy and especially the stressing of the communicative meaning of sexual behaviour as a form of non-verbal communication. Hence therapeutic interventions aim at the restoration of the sexual relationship as a means of fulfilling fundamental needs and desires as for acceptance, warmth, security and so on and thus exceed the cure of the sexual dysfunction. Sexual Medicine should be integrated into the study of medicine as a subject of its own.

Emotional loneliness in sexual murderers: a qualitative analysis

This study compared levels of emotional loneliness between sexual murderers and rapists who had not gone on to kill their victim/s. All participants were life-sentenced prisoners in the United Kingdom. Assessment consisted of a semistructured interview and was subjected to grounded theory analysis. This approach is defined as the breaking down, naming, comparing, and categorizing of data. As such, it is distinguished from other qualitative methods by the process of constant comparison. This continual sifting and comparing elements assists in promoting conceptual and theoretical development. The results of this process found that sexual murderers, compared to rapists, reported significantly higher levels of grievance towards females in childhood, significantly higher levels of peer group loneliness in adolescence, and significantly higher levels of self as victim in adulthood.

[New progress on diagnosis and treatment of female sexual dysfunction]

Female sexual dysfunction(FSD) is an age-related progressive disease and may affect up to half of adult women. It has not been paid attention to for a long time. This paper reviews the current information on the anatomy, physiology and pathophysiology of FSD. In addition the diagnosis and treatment of FSD are also described. It aims at improving the knowledge of FSD.

A simple self-report diary for assessing psychosexual function in hypogonadal men

To examine the performance of a self-report diary to assess psychosexual function in hypogonadal men, 2 groups of eugonadal men and 2 groups of hypogonadal men were asked to record and score parameters for sexual desire, sexual enjoyment, sexual performance, sexual activity, and positive and negative moods daily for 7 days before a clinic visit (data set 1 and 2). The hypogonadal men were also assessed after testosterone replacement and some of the eugonadal men were studied while they were on placebo treatment. In this retrospective analysis, sexual function parameters (sexual desire, performance, and activity score) in the diary discriminated between the hypogonadal and eugonadal men with all measures significantly lower in hypogonadal men (all parameters P <.0001). Significant improvements in sexual desire and performance as well as sexual activity scores (P <.0001 for all parameters) in hypogonadal men after testosterone treatment were readily detected within 30 days. Mood and functional parameters did not show any change over time in eugonadal men on placebo treatment. The mood parameters assessed by the diary showed an excellent correlation with those assessed by the Profile of Mood States. Mood parameters were not clearly different between eugonadal and hypogonadal men at baseline. With testosterone treatment positive mood parameters were significantly increased (P <.0028 and.0001 set in data 1 and 2, respectively), and negative mood parameters improved in hypogonadal men (P <.0003 in data set 2). We conclude that this simple self-report diary is useful in assessing the sexual function and mood profile of hypogonadal subjects in clinical research.