Human sex-response cycles

Psychobiological correlates of women's sexual interest as perceived by patients with erectile dysfunction

INTRODUCTION

We have recently reported that the perceived loss of a partner's sexual desire is independently associated with an increased incidence of major cardiovascular events in patients with erectile dysfunction (ED). No study has ever evaluated the specific impact of men's perception of women's sexual desire on male sexual function and lifestyle attitudes in ED subjects.

AIM

To evaluate the clinical correlates of the perception of a partner's sexual desire [hypoactive sexual desire (HSD)] in a consecutive series of subjects seeking medical care for ED.

METHODS

A consecutive series of 2,303 heterosexual male patients (mean age 58.1 ± 10.5) was studied.

MAIN OUTCOME MEASURES

Patients were interviewed with the Structured Interview on Erectile Dysfunction (SIEDY) structured interview. They also completed the Middlesex Hospital Questionnaire, a brief questionnaire for the screening of the symptoms of mental disorders.

RESULTS

Among the patients studied, 458 (19.9%) reported a mild loss of their partner's desire, 302 (13.1%) a moderate reduction of libido, while 118 (5.1%) complained of a complete absence of sexual interest on the part of their partner. After adjustment for confounding factors, the perceived women's HSD was associated with different sexual, lifestyle, and relational factors. In particular, more extra-marital affairs, a longer and more hostile couple relationship, as well as a stressful job and both alcohol and smoking abuse were all significantly associated with perceived women's HSD. In addition, the perceived women's moderate to severe HSD was significantly associated with severe ED and less frequent sexual intercourse. Finally, partner HSD was significantly associated with a stepwise increase of free-floating anxiety and depressive symptoms (adj. r = 0.081, P < 0.05 and 0.158, P < 0.0001, respectively).

CONCLUSIONS

Perceived sexual interest (éros) on the part of the woman can be seen for men not only as a fun and enjoyable behavior, but also a safe strategy for improving a man's overall health and life expectancy.

The DSM diagnostic criteria for hypoactive sexual desire disorder in women

Hypoactive Sexual Desire Disorder (HSDD) is one of two sexual desire disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and is defined by the monosymptomatic criterion "persistently or recurrently deficient (or absent) sexual fantasies and desire for sexual activity" that causes "marked distress or interpersonal difficulty." This article reviews the diagnosis of HSDD in prior and current (DSM-IV-TR) editions of the DSM, critiques the existing criteria, and proposes criteria for consideration in DSM-V. Problems in coming to a clear operational definition of desire, the fact that sexual activity often occurs in the absence of desire for women, conceptual issues in understanding untriggered versus responsive desire, the relative infrequency of unprovoked sexual fantasies in women, and the significant overlap between desire and arousal are reviewed and highlight the need for revised DSM criteria for HSDD that accurately reflect women's experiences. The article concludes with the recommendation that desire and arousal be combined into one disorder with polythetic criteria.

Predictors of women's sexual desire: the role of psychopathology, cognitive-emotional determinants, relationship dimensions, and medical factors

INTRODUCTION

Deficient sexual desire is a common sexual difficulty among women, often related to medical and psychiatric problems, lack of adjustment in a relationship, or age. However, the relative contribution of each one of these dimensions is not yet well establish.

AIM

The aim of this study was to evaluate the main predictive factors of female sexual desire.

METHODS

A total of 237 women from the general population answered to a set of questionnaires assessing psychopathology, cognitive-emotional factors, dyadic adjustment, presence of medical pathologies, and menopause.

MAIN OUTCOME MEASURES

Psychopathology measured by the Brief Symptom Inventory (BSI), dysfunctional sexual beliefs measured by the Sexual Dysfunctional Beliefs Questionnaire, thoughts and emotions in sexual context measured by the Sexual Modes Questionnaire, dyadic adjustment measured by the Dyadic Adjustment Scale, medical condition measured by the Medical History Formulation, and sexual desire measured by the Sexual Desire subscale of the Female Sexual Function Index.

RESULTS

Findings indicated that psychoticism was the only psychopathological dimension that significantly predicted sexual desire (beta = 0.37). Conservative beliefs (beta = -0.33) and age-related beliefs (beta = -0.25) were also significant predictors of desire. Additionally, lack of erotic thoughts (beta = -0.28), failure and disengagement sexual thoughts (beta = -0.64), and thoughts related to female passivity (beta = 0.31) during sexual activity were significant predictors of desire. Regarding relationship dimensions, dyadic cohesion (beta = 0.37), and dyadic affection (beta = 0.45) were the best predictors of sexual desire. Moreover, postmenopausal women and women with medical problems presented reduced sexual desire. A multiple regression analysis (enter method) including all these variables plus age, indicated that failure/disengagement thoughts during sexual activity was the only significant predictor of sexual desire in women (beta = -0.52).

CONCLUSIONS

Results support the role of cognitive dimensions in the maintenance of women's sexual interest, and suggest implications for assessment and treatment of sexual desire difficulties.

Sexual dysfunction in women with type 1 diabetes: long-term findings from the DCCT/ EDIC study cohort

OBJECTIVE

This study aimed to investigate the prevalence and risk factors associated with sexual dysfunction in a well-characterized cohort of women with type 1 diabetes.

RESEARCH DESIGN AND METHODS

The study was conducted in women enrolled in the long-term Epidemiology of Diabetes Interventions and Complications (EDIC) study, a North American study of men and women with type 1 diabetes. At year 10 of the EDIC study, 652 female participants were invited to complete a validated self-report measure of sexual function, standardized history and physical examinations, laboratory testing, and mood assessment.

RESULTS

Of the sexually active women with type 1 diabetes in the EDIC study, 35% met criteria for female sexual dysfunction (FSD). Women with FSD reported loss of libido (57%); problems with orgasm (51%), lubrication (47%), and arousal (38%); and pain (21%). Univariate analyses revealed a positive association between FSD and age (P = 0.0041), marital status (P = 0.0016), menopausal status (P = 0.0019), microvasculopathy (P = 0.0092), and depression (P = 0.0022). However, in a multivariate analysis, only depression (P = 0.004) and marital status (P = 0.003) were significant predictors of FSD.

CONCLUSIONS

FSD is common in women with type 1 diabetes and affects all aspects of sexual function and satisfaction. Depression is the major predictor of sexual dysfunction in women with type 1 diabetes. These findings suggest that women with type 1 diabetes should be routinely queried about the presence of sexual dysfunction and possible co-association with depression.

Bed death and other Lesbian sexual problems unraveled: a qualitative study of the sexual health of Lesbian women involved in a relationship

OBJECTIVES

To shed light on lesbian "bed death" among lesbian women. To explore the wishes and expectations of lesbian women with respect to healthcare professionals.

METHODS

Semi-structured interviews with 30 self-identified lesbian women. The interviews were audio recorded. Three researchers classified and analyzed the most important themes.

RESULTS

The women indicated few sexual problems except for "bed death," a quasi-complete cessation of sexual activity. Twenty-three women experienced "bed death: during the current relationship or a previous one. The factors felt by the women to contribute to "bed death: were environmental influences, the existence of a symbiotic relationship, hormonal factors, and reduced sexual initiative. The women indicated that they would like family doctors to adopt a neutral attitude, be knowledgeable about homosexuality, and be able to recognize homosexuality in their patients.

DISCUSSION

A careful examination of the potential causes of "bed death" suggests that the phenomenon is more closely linked to a patient's gender than to her sexual orientation. Lesbian women would also like general practitioners to possess at least some basic knowledge about homosexuality.

Not so great expectations: sex and housewives in Hong Kong

The study explores the life of married women who are being described as having "good," "normal," "blessed" sexuality. The case of si-nais (housewives) in Hong Kong shows that we can never assume that married women (or any social category) are privileged by virtue of their status on the sexual hierarchy. The blessings of social respectability apparently enjoyed by these women may work to enable or hinder women's expression of their erotic desires and sexual fulfillment, depending on their special social circumstances. These women's imagination and experience of good sex is composed of a multitude of components. Women may feel good because they can achieve other psychological and social aims that are important in their lives (which could be related to the maintenance of marriage or the peace of the family). Women may feel good because of the erotic satisfaction that they derive from different pursuits including interests, leisure or other intimate relationships, rather than sexual fulfillment in terms of orgasm or physical pleasure. Women may reformulate their pleasure variously at different stages of their lives. Social respectability, orgasm, emotional intimacy, or any other specific element, may all enter or leave the formula for good sex.

Effects of visual erotic stimulation on vibrotactile detection thresholds in men

This study examined the effects of sexual arousal on vibration detection thresholds in the right index finger of 30 healthy, heterosexual males who reported no sexual dysfunction. Vibrotactile detection thresholds at frequencies of 30, 60, and 100 Hz were assessed before and after watching erotic and control videos using a forced-choice, staircase method. A mechanical stimulator was used to produce the vibratory stimulus. Results were analyzed using repeated measures analysis of variance. After watching the erotic video, the vibrotactile detection thresholds at 30, 60, and 100 Hz were significantly reduced (p < .01). No changes in thresholds were detected at any frequency following exposure to the non-erotic stimulus. The results show that sexual arousal resulted in an increase in vibrotactile sensitivity to low frequency stimuli in the index finger of sexually functional men.

REVIEWS: Proposal for Changes in Diagnostic Criteria for Sexual Dysfunctions

INTRODUCTION

Officially sanctioned diagnostic criteria have a major influence on treatment decisions and on how populations are defined for clinical research. The Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric Association has had a major influence on research concerning the treatment of sexual disorders and has been criticized on numerous grounds.

AIM

The purpose of this article is to describe the evolution of criteria sets in the DSM and to critically evaluate suggestions for modification of this system.

METHOD

All living members of the DSM work groups on sexual dysfunction were contacted regarding their recollections of the evolution of criteria sets. Literature concerning diagnostic criteria for the sexual dysfunctions in the DSM, as well as literature suggesting modification of this system, was reviewed.

MAIN OUTCOME MEASURE

Recommendations for changes in the DSM-V system were based upon a review of the evidence concerning optimal criteria for each diagnostic entity.

RESULTS

The original diagnostic system from sexual disorders in the DSM was developed by expert opinion, literature searches, and solicitation of feedback for other experts in the field. There have been minimal changes in the DSM criteria for sexual dysfunctions because of the requirement that there be substantial empirical data before modification of the system would be considered. An international consensus group has suggested major modification in criteria concerning female sexual dysfunctions. There is a growing database that documents the need to change criteria for premature ejaculation.

CONCLUSIONS

It is recommended that some of the suggested modifications to the criteria sets for sexual dysfunctions be adopted by the DSM-V committee. It is also recommended that specific criteria related to duration and severity be adopted, in order to clearly distinguish sexual disorders from transient alterations in sexual function related to life stress and relationship discord.

Sexual sequelae of general medical disorders

That sexual symptoms can signal serious underlying disease confirms the importance of sexual enquiry as an integral component of medical assessment. Data on sexual function are sparse in some medical specialties. However, increased scientific understanding of the central and peripheral physiology of sexual response could help to identify the pathophysiology of sexual dysfunction from disease and medical interventions, and also to ameliorate or prevent some dysfunctions. Many common general medical disorders have negative effects on desire, arousal, orgasm, ejaculation, and freedom from pain during sex. Chronic disease also interferes indirectly with sexual function, by altering relationships and self-image and causing fatigue, pain, disfigurement, and dependency. Current approaches to assessment of sexual dysfunction are based on models that combine psychological and biological aspects.

Use of Sildenafil for Female Sexual Dysfunction

Objective:

To review the pathophysiology of female sexual dysfunction (FSD) and the literature regarding the use of sildenafil in its treatment.

Data Sources:

Literature was accessed through MEDLINE (1966—April 2006), Iowa Drug Information Service (1966—April 2006), EMBASE (1966—April 2006), and bibliographies of pertinent articles. Search terms included female sexual dysfunction; sexual dysfunction, psychological; phosphodiesterase inhibitors; and sildenafil.

Data Synthesis:

The lack of a clear understanding of FSD contributes to the limited treatment options available. Studies regarding the safety and efficacy of the phosphodiesterase 5 inhibitor sildenafil in the management of FSD were evaluated. Many trials have been of poor quality, making clinical application of their results difficult. The current literature does not show sildenafil to be an effective treatment option for FSD.

Conclusions:

Treatment of FSD should include both physical and psychological components. Based on the limited data available, it appears that sildenafil, while well tolerated, offers little or no benefit to most patients with FSD.

Revised definitions of women's sexual dysfunction

INTRODUCTION

Existing definitions of women's sexual disorders are based mainly on genitally focused events in a linear sequence model (desire, arousal and orgasm).

AIM

To revise definitions based on an alternative model reflecting women's reasons/incentives for sexual activity beyond any initial awareness of sexual desire.

METHODS

An International Definitions Committee of 13 experts from seven countries repeatedly communicated, proposed new definitions and presented at the 2nd International Consultation on Sexual Medicine in Paris July 2003.

MAIN OUTCOME MEASURE

Expert opinions/recommendations are based on a process that involved review of evidence-based medical literature, extensive internal committee discussion, informal testing and re-testing of drafted definitions in various clinical settings, public presentation and deliberation.

RESULTS

Women have many reasons/incentives for sexual activity. Desire may be experienced once sexual stimuli have triggered arousal. Arousal and desire co-occur and reinforce each other. Women's subjective arousal may be minimally influenced by genital congestion. An absence of desire any time during the sexual experience designates disorder. Arousal disorder subtypes are proposed that separate an absence of subjective arousal from all types of sexual stimulation, from an absence of subjective arousal when the only stimulus is genital. A new arousal disorder has provisionally been suggested, namely that of persistent genital arousal. Orgasm disorder is limited to absence of orgasm despite high subjective arousal. Dyspareunia includes partial painful vaginal entry attempts as well as pain with intercourse. Variable reflex muscle tightening around the vagina and an absence of abnormal physical findings are noted in the definition of vaginismus. Women's sexuality is highly contextual and descriptors are recommended re past psychosexual development, current context, as well as medical status. Diagnosing sexual disorders need not imply intrinsic dysfunction of the woman's own sex response system.

CONCLUSIONS

The International Definitions Committee has recommended a number of fundamental changes to the existing definitions of women's sexual disorders.

Integrating medication, realistic expectations, and therapeutic interventions in the treatment of male sexual dysfunction

Male sexuality in adolescence and early adulthood is characterized by autonomous, predictable erections. As males age, however, their arousal becomes less predictable and more dependent on partner interaction. This transition can produce anxiety. Many males view this change as a medical dysfunction requiring pharmacologic treatment or specialist intervention. New medical interventions, including Viagra, have been developed promising to return males to their automatic erections. A medical approach, however, fails to address the multidimensional nature of male sexuality and reinforces sex as intercourse performance. This article outlines a biopsychosocial approach to the assessment, treatment, and relapse prevention of male sexual dysfunction.

What is love anyway?

This essay explores seven interlocking meanings of the term love. These meanings are the author's synthesis based on years of trying to understand what people mean by the word and why they are not more explicit in explaining themselves during psychotherapy. The meanings may help clinicians better grasp what seems to be the most basic context for understanding a person's sexual life. Love may be: a complex emotion--it is never a single feeling; an ambition; moral commitment; a private dynamic struggle; a deal; a stop sign to psychological inquiry. Many forces in culture and within individuals resist careful scrutiny of what we mean by love.

On categorization and quantification of women's sexual dysfunctions: An epidemiological approach

The objectives of this study are to compare the two definitions of female sexual dysfunction, namely dysfunction per se (A category) and personal distress caused by dysfunction (B category), and to gauge their associations with some sociodemographic aspects and level of sexual well-being. The subjects were a nationally representative sample of sexually active Swedish women (n: 1056) aged 18-65 y, who participated in a combined structured interview/questionnaire investigation. The functions analysed were: self-reported sexual desire, interest, lubrication, orgasm, genital pain and vaginism, which were subclassified for the A and B categories into no, mild (sporadically occurring) and manifest dysfunction. Sexual well-being was reported along a six-grade scale ranging from very satisfied to very dissatisfied. The sociodemographic items registered were: education, occupation, financial situation, social group, immigrant status, location of domicile and church-going. Aggregated mild and manifest dysfunction per se of sexual interest, orgasm and vaginal lubrication were reported by about 60-90%. More than one-third had dyspareunia, but few reported vaginism. Mild dysfunctions were clearly more common than manifest dysfunctions. Not fully 45% of those with manifest low interest and orgasm perceived these dysfunctions as manifestly distressing, while in 60-70% lubricational insufficiency of dyspareunia led to manifest distress. Age and the included sociodemographic variables had marginal or no influence on sexual functions. A four-factor sexual function pattern was identified, closely linking A and B categories in a pairwise manner. Three factors, labelled sexual desire, orgasm and genital function were powerful classifiers (discriminant analysis) of level of sexual well-being. Hence, it is a matter of taste whether to use the A or the B category. Together, they can explain the gross level of satisfaction with sexual life to an adequate extent.

Couple therapy for low sexual desire: a systemic approach

This article will illustrate how marital therapists and their supervisors can instructively use the Basson Sexual Response Cycle (BSRC) as a teaching and therapeutic tool to enable students to move their clients toward improved sexual relationships. Second, it will illustrate that the Basson model can be integrated into Emotionally Focused Martial Therapy (EFT) to track and shift the couple's habitual attachment pattern or circular fight. Third, it will show that by working the triangle of emotion and the triangle of conflict described in the Brief Psychodynamic Model during the second step of stages 4-6 of EFT, the couple therapist has a working methodology to create change at a deeper emotional level, when the couple's intimacy issues are complex. Two case examples will be used.

Sexual dysfunction is common and overlooked in female patients with hypertension

Our objective was to investigate sexual activity, behavior, dysfunction, and satisfaction in hypertensive women. Sixty-seven patients with a mean age of 60.4 years completed a detailed questionnaire. Of these women, 81.3% had a sex partner; 42.6% had untreated sexual dysfunction with a duration of more than 5 years in 70.9% and a duration of more than 10 years in 41.7%; 5.3% initiated sexual activity; 36.6% reported less sexual activity than desired; and 54.8% reported sexual activity as important. Our study revealed highly prevalent untreated sexual dysfunction of long duration. It also showed low frequency of sexual activity in spite of the high availability of partners. There was low frequency of initiation of sexual activity. In spite of the high prevalence of sexual dysfunction, more than a third of patients reported sexual activity to be less than desired, and more than half of patients reported sexual activity as important.