Self-report assessment of female sexual function: psychometric evaluation of the Brief Index of Sexual Functioning for Women

A randomized, placebo-controlled, crossover study of ephedrine for SSRI-induced female sexual dysfunction

The objective of this study was to determine whether ephedrine, an alpha- and beta-adrenergic agonist previously shown to enhance genital blood flow in women, has beneficial effects in reversing antidepressant-induced sexual dysfunction. Nineteen sexually dysfunctional women receiving either fluoxetine, sertraline, or paroxetine participated in an eight-week, double-blind, placebo-controlled, cross-over study of the effects of ephedrine (50 mg) on self-report measures of sexual desire, arousal, orgasm, and sexual satisfaction. Although there were significant improvements relative to baseline in sexual desire and orgasm intensity/pleasure on 50 mg ephedrine 1-hr prior to sexual activity, significant improvements in these measures, as well as in sexual arousal and orgasmic ability also were noted with placebo. These findings highlight the importance of conducting placebo-controlled trials for this condition.

Medicine or Surgery (Ms): a randomized clinical trial comparing hysterectomy and medical treatment in premenopausal women with abnormal uterine bleeding

Hysterectomy may be overused as treatment for abnormal uterine bleeding due to benign causes in reproductive women. Medical therapies are an alternative, and there is a need for randomized trials comparing the outcomes of these approaches. Women of reproductive age who continued to have bothersome abnormal uterine bleeding after cyclic hormonal treatment with medroxyprogesterone acetate (MPA; 10-20 mg for 10-14 days/month) for 3-5 months were invited to participate in a randomized trial of hysterectomy versus other medical therapies. Participating gynecologists were free to choose the particular surgical (transabdominal or transvaginal) or medical (generally oral contraceptives and/or a prostaglandin synthetase inhibitor) approaches. Outcomes during 2 years of follow-up include quality of life (primary), sexual function, clinical effectiveness and cost. We screened 1557 women to find 413 who began 3-5 months of MPA; 215 completed this treatment, of whom 102 still had bothersome symptoms, and of these 38 consented to be randomized. Another 25 women with bothersome symptoms after a documented history of 3 months of cyclic MPA were also randomized, for a total of 63. The average age of randomized women was 41; 54% were African-American, and they reported uterine bleeding 12 days/month on average, heavy bleeding 6 days/month. Anemia (hematocrit<32) was present in 38% of African-Americans and 15% of Caucasians (p=0.05). Two thirds of the women had fibroids and 80% reported pelvic pain. Obesity was common (45% had a body mass index (BMI)>30), and associated with a longer duration of symptoms (12 vs. 4 years for BMI<25; p=0.02) and a greater prevalence of incontinence (44% vs. 16%; p=0.046). Although recruitment was difficult, we have completed enrollment in a randomized clinical trial comparing surgical and medical treatments for abnormal uterine bleeding.

Impact of infertility on quality of life, marital adjustment, and sexual function

OBJECTIVES

To evaluate the hypothesis that infertility may result in a decrease in quality of life and an increase in marital discord and sexual dysfunction. The burden of infertility is physical, psychological, emotional, and financial.

METHODS

Couples seeking treatment for infertility were asked to complete standardized validated questionnaires assessing quality of life (Quality of Well-Being Scale-Self Administered, version 1.04), marital adjustment (Locke-Wallace Marital Adjustment Test), and sexual function (Brief Index of Sexual Functioning for Women and International Index of Erectile Function for men). Couples seeking elective sterilization served as the control subjects.

RESULTS

Eighteen infertile couples and 12 couples seeking elective sterilization participated in the study. The mean age, years together, and household income were comparable. Infertile couples had made a mean of 14.5 office visits for infertility, and 83% of couples reported feeling societal pressures to conceive. The Marital Adjustment Test scores for the women of the infertile couples were significantly lower than the scores of the controls (P = 0.01); however no difference was noted in the men. A trend toward lower quality-of-life scores was noted in women (P = 0.09) but not in the men of infertile couples. No statistically significant impact on sexual functioning in women was noted; however, the men in the infertile couples had lower total International Index of Erectile Function scores (P = 0.05) and intercourse satisfaction scores (P = 0.03).

CONCLUSIONS

Women in infertile couples reported poor marital adjustment and quality of life compared with controls. Men may experience less intercourse satisfaction, perhaps because of the psychological pressure to try to conceive or because of the forced timing of intercourse around the woman's ovulatory cycle.

Female sexuality

Female sexuality is an extraordinarily complex process. The physician needs to be aware of the patient's sexuality and whether or not there are sexual concerns. Physiologic changes over the lifespan can interact with sexual performance as can a variety of disease processes. Partner and relationship issues must also be taken into account. Physicians need to include a sexual history as part of their general history and should not be judgmental of their patients' sexual practices. Sexual disorders in women are defined and delineated by those issues causing personal distress. Again, one person's distress may be quite normal to another. The important aspects of care consist of listening, educating, and providing support to the patient. There is increasing interest but a continued need for data in the use of testosterone in women with decreased libido. The use of sildenafil for female sexual dysfunction remains controversial as a benefit. Overall, there is a need for the development of well-organized, randomized, controlled studies on appropriate assessment and intervention for sexual dysfunction in women.

Problems with sexual function in people attending London general practitioners: cross sectional study

OBJECTIVES

To assess sexual behaviour, prevalence of ICD-10 diagnosed sexual dysfunction, associations between sexual and psychological problems, and help seeking for sexual problems in people attending general practice; to assess predictors of ICD-10 diagnosis of sexual dysfunction.

DESIGN

Cross sectional study.

SETTING

13 general practices in London.

PARTICIPANTS

1065 women and 447 men attending general practices.

MAIN OUTCOME MEASURE

Prevalence and predictors of ICD-10 diagnoses of sexual dysfunction.

RESULTS

97 (22%, 95% confidence interval 18% to 25%) men and 422 (40%, 37% to 43%) women received at least one ICD-10 diagnosis, but only 3-4% had an entry relating to sexual problems in their general practice notes. The most common problems were erectile failure and lack or loss of sexual desire in men and lack or loss of sexual desire and failure of orgasmic response in women. Increasing age and being unemployed predicted sexual problems in women, and bisexual orientation, being non-white, and being unemployed were demographic predictors in men. No practice note factors predicted sexual problems in women, but high consulting rate predicted problems in men. The main clinical predictors were poor physical function and dissatisfaction with current sex life in both sexes and higher psychological morbidity in women. When all factors were considered, increasing age (odds ratio 1.01, 1.00 to 1.02), physical subscale score on the SF-12 (0.98, 0.97 to 0.99), sexual dissatisfaction (1.9, 1.5 to 2.4), and scoring over a 3/4 threshold score on the general health questionnaire (1.5, 1.1 to 1.9) independently predicted an ICD-10 sexual dysfunction diagnosis in women. Being bisexual (4.1, 1.3 to 12.8) was the only independent predictor of an ICD-10 diagnosis in men.

CONCLUSIONS

Sexual difficulties are common in people attending general practitioners, and many people are prepared to talk about them with their doctors.

Comparative effects of oral esterified estrogens with and without methyltestosterone on endocrine profiles and dimensions of sexual function in postmenopausal women with hypoactive sexual desire

OBJECTIVE

In some women, a decline in sexual interest accompanies a relative androgen insufficiency after menopause. We sought to characterize the hormonal effects of the combination of oral esterified estrogens and methyltestosterone and to investigate whether this regimen improves hypoactive sexual desire.

DESIGN

Double-blind randomized trial.

SETTING

Healthy volunteers in a multicenter research environment.

PATIENT(S)

Postmenopausal women taking estrogen therapy who were experiencing hypoactive sexual desire.

INTERVENTION(S)

4 months of treatment with 0.625 mg of esterified estrogens (n = 111) or the combination of 0.625 mg of esterified estrogens and 1.25 mg of methyltestosterone (n = 107).

MAIN OUTCOME MEASURES

Baseline and end-of-study measurements of total and bioavailable testosterone and sex hormone-binding globulin (SHBG), and mean change in level of sexual interest or desire as rated on the Sexual Interest Questionnaire.

RESULT(S)

Treatment with the combination of esterified estrogens and methyltestosterone significantly increased the concentration of bioavailable testosterone and suppressed SHBG. Scores measuring sexual interest or desire and frequency of desire increased from baseline with combination treatment and were significantly greater than those achieved with esterified estrogens alone. Treatment with the combination was well tolerated.

CONCLUSION(S)

Increased circulating levels of unbound testosterone and suppression of SHBG provide a plausible hormonal explanation for the significantly improved sexual functioning in women receiving the combination of esterified estrogen and methyltestosterone.

Quality of life in women at risk for ovarian cancer who have undergone risk-reducing oophorectomy

OBJECTIVES

Women at risk for ovarian cancer may consider risk-reducing salpingo-oophorectomy (RRSO), and desire information regarding the health consequences of the procedure. We studied women who had undergone RRSO to assess quality of life after the procedure.

METHODS

Women (n = 59) undergoing RRSO between 1 January 1997 and 31 July 2000 completed a questionnaire composed of the Symptom Checklist (SCL), the Medical Outcomes Study SF-36 Health Survey, the Center for Epidemiological Studies Depression Scale, the Impact of Events Scale, and the Sexual Functioning Questionnaire-Female.

RESULTS

At a mean of 23.8 months after RRSO, overall quality of life was similar to that reported for the general population and for breast cancer survivors. Estrogen deprivation symptoms, particularly vaginal dryness (35.2%) and dyspareunia (27.7%), were commonly bothersome. Genital symptoms resulting in sexual dysfunction were the most significant predictors of satisfaction with surgery. The prevalence of depression (20.4%) was similar to that of the general population, but a significant proportion of the group (20.7%) continued to report significant ovarian cancer-specific worries despite surgery.

CONCLUSION

Vaginal symptoms are bothersome to women who have undergone RRSO, but overall health and psychological outcomes are not impaired. Although coital symptoms may not be a direct consequence of RRSO, they are the most important predictors of satisfaction. A proportion of women continue to report worries about ovarian cancer after surgery, and these women are at risk for psychological distress.

Sexual functioning and self-reported depressive symptoms among college women

We conducted an exploratory study comparing 47 college-aged women reporting depressive symptoms but not receiving antidepressant medication to 47 age-matched controls. We examined various dimensions of sexual functioning, including sexual desire, arousal, orgasm, pain, pleasure, and satisfaction. The women with depressive symptoms reported more inhibited sexual arousal, more inhibited orgasm, more sexual pain problems, and less sexual satisfaction and pleasure than control participants. Novel to this study, the women with depressive symptoms reported greater desire for sexual activity alone (masturbation) than the nondepressed women. The findings are discussed in terms of primary reinforcers and depressive symptomology.

Reliability of retrospective self-reports of sexual and nonsexual health behaviors among women

The accuracy of self-reports regarding sexual health behavior has been questioned. To investigate whether sexual health behaviors are uniquely difficult to report, we asked 185 college women to answer behavioral frequency questions about sexual and nonsexual health behaviors for an 8-week interval. Women either took part in a face-to-face interview or completed a self-administered questionnaire. One week later, the women returned and responded to the same questions in the same mode of assessment conditions. The test-retest intraclass correlations showed that all health behaviors, sexual and nonsexual, were reported reliably. There was a trend for lower-frequency reports to yield more-stable estimates of behavioral frequency. These findings converge with other methodological investigations to indicate that socially sensitive health behaviors are not more difficult to assess reliably.

Differential effects of oral estrogen versus oral estrogen-androgen replacement therapy on body composition in postmenopausal women

Menopause is associated with decreased lean body mass and increased fat due to aging and declining hormone secretion. Estrogens or estrogen-progestins have been used to alleviate vasomotor symptoms. However, estrogen-androgen (E/A) therapy is also used for vasomotor symptom relief and has been shown to increase lean body mass while decreasing fat mass. The objective of this 16-wk, double-blind, randomized, parallel group clinical trial was to compare esterified estrogen plus methyltestosterone (1.25 mg estrogen + 2.5 mg methyltestosterone/d; E/A group) vs. esterified estrogen alone (1.25 mg/d; E group) on body composition. Forty postmenopausal women (mean age, 57 yr) participated. Compared with estrogen treatment alone, women in the E/A group increased their total lean body mass and reduced their percentage fat for all body parts (P < 0.05). After E/A treatment, there were statistically significant increases in lean body mass by 1.232 kg [0.181 +/- 0.004, 0.81 +/- 0.057, and 0.24 +/- 0.009 kg in the upper body (P = 0.021), trunk (P = 0.001), and lower body (P = 0.047), respectively]. In the E group, the increase was 0.31 +/- 0.004, 0.021 +/- 0.03, and 0.056 +/- 0.05 kg in the upper body, trunk, and lower body, respectively. In the E/A group, body fat was reduced by 0.90 kg (P = 0.18 for the trunk only), and percentage body fat declined by 7.4% (P < or = 0.05 for all body parts). Lower body strength increased by 23.1 kg (51 lb) in the E/A group vs. only 11 kg (24.25 lb) in the E group (P = 0.002 between groups). A statistically significant increase in weight (2.7 +/- 5.1 vs. 0.1 +/- 4.6 lb; P < 0.05) was observed in the E/A group compared with the E group. When subjects were given self-reporting questionnaires, more improvement was noted in sexual functioning and quality of life in the E/A group when compared with patients receiving E alone. There were no noteworthy side effects. In conclusion, E/A replacement therapy can improve body composition, lower-body muscle strength, quality of life, and sexual functioning in postmenopausal women.

Assessment of female sexual dysfunction: review of validated methods

OBJECTIVE

To review validated methods for the assessment of female sexual function in clinical trials.

DESIGN

Evaluation of recent peer-review literature on sexual function assessment in women.

SETTING

International conference on androgen insufficiency in women.

PATIENT(S)

Women with sexual dysfunction due to androgen insufficiency or other causes.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

Measures of sexual function in women.

RESULT(S)

Design and measurement problems in the assessment of sexual functioning in women have limited clinical trials in female sexual dysfunction. Objective measures, such as vaginal photoplethysmography or Duplex ultrasound, have been used in some studies but lack standardization and are unsuitable for use in large-scale clinical trials. A variety of interview methods, validated questionnaires, and event log measures have been used for assessing sexual function in recent trials of androgen replacement therapy. Each of these methods has distinct advantages and disadvantages, although validated questionnaires have provided the most reliable findings to date. Recent Food and Drug Administration guidelines on assessment of female sexual function in clinical trials are critically reviewed.

CONCLUSION(S)

Despite their prevalence and clinical significance, sexual problems in women have often been neglected in clinical trials. A major obstacle in the design of clinical trials in this area has been the need for sensitive and reliable measures of outcome. Of the currently available measures, self-reported event logs or questionnaires are best suited for research or clinical assessment of female sexual function.

Validated instruments for assessing female sexual function

In this article, we review five instruments for assessing female sexual dysfunction (FSD): the Brief Index of Sexual Functioning for Women (BISF-W; Taylor, Rosen, & Leiblum, 1994), the Changes in Sexual Functioning Questionnaire (CSFQ; Clayton, McGarvy, & Clavet, 1997), the Derogatis Interview for Sexual Functioning (DISF/DISF-SR; Derogatis, 1997), the Female Sexual Function Index (FSFI; Rosen et al., 2000), and the Golombok Rust Inventory of Sexual Satisfaction (GRISS; Rust & Golombok, 1986). The purpose of this article is to highlight the psychometric properties of these questionnaires in an effort to assist researchers in selecting effective measurement tools for FSD.

Measurement of male and female sexual dysfunction

Measurement approaches for male and female sexual dysfunction have proliferated in recent years, spurred in large part by the development of new treatments for male and female dysfunction. In the past, physiologic measures of penile tumescence and rigidity in males, and vaginal blood flow in females, played an important role in clinical and research studies. More recently, a variety of brief, self-report measures have been developed for assessing male and female function across a variety of sexual domains (eg, desire, arousal, orgasm, satisfaction). These self-report measures have been shown to have a high degree of reliability and validity, and are sensitive to treatment interventions. Accordingly, they are widely employed in clinical trials. Daily diary or sexual event logs have similarly been developed for this purpose. Self-report measures have been used for clinical screening purposes and for diagnostic assessment of sexual function in a number of studies. Finally, several disease-specific quality of life and treatment satisfaction measures have been developed, which are currently in widespread use in clinical trials of sexual dysfunction.

Prevalence of and recent developments in female sexual dysfunction

In the past few years, female sexual dysfunction (FSD) has attracted significant attention. The main reason for this was the successful introduction of oral pharmacotherapy for the treatment of male erectile dysfunction. This raised the question of whether a vascular medication such as sildenafil would be efficacious for female sexual dysfunction. Once triggered, female sexual dysfunction research went even further and raised more questions. This article addresses the prevalence of FSD and the most recent developments in this field.

Episodic hyperlibidinism in multiple sclerosis

BACKGROUND

Changes in sexual function are commonly associated with MS and occur in many forms. Hypersexual thoughts or behavior are rare, but can present on the background of persistent cognitive impairment or psychiatric conditions such as mania, whereas isolated hypersexuality is still rarer.

CASE REPORT

We describe the clinical, neuropsychological, electrodiagnostic, neuroimaging and endocrine findings in a MS patient with episodes of greatly increased libido. Imaging and neuropsychologicol studies indicated frontal lobe dysfunction; hormone studies showed no significant changes.

CONCLUSION

Episodic hypersexuality can be a recurrent transient manifestation of MS.

Transdermal testosterone treatment in women with impaired sexual function after oophorectomy

BACKGROUND

The ovaries provide approximately half the circulating testosterone in premenopausal women. After bilateral oophorectomy, many women report impaired sexual functioning despite estrogen replacement. We evaluated the effects of transdermal testosterone in women who had impaired sexual function after surgically induced menopause.

METHODS

Seventy-five women, 31 to 56 years old, who had undergone oophorectomy and hysterectomy received conjugated equine estrogens (at least 0.625 mg per day orally) and, in random order, placebo, 150 microg of testosterone, and 300 microg of testosterone per day transdermally for 12 weeks each. Outcome measures included scores on the Brief Index of Sexual Functioning for Women, the Psychological General Well-Being Index, and a sexual-function diary completed over the telephone.

RESULTS

The mean (+/-SD) serum free testosterone concentration increased from 1.2+/-0.8 pg per milliliter (4.2+/-2.8 pmol per liter) during placebo treatment to 3.9+/-2.4 pg per milliliter (13.5+/-8.3 pmol per liter) and 5.9+/-4.8 pg per milliliter (20.5+/-16.6 pmol per liter) during treatment with 150 and 300 microg of testosterone per day, respectively (normal range, 1.3 to 6.8 pg per milliliter [4.5 to 23.6 pmol per liter]). Despite an appreciable placebo response, the higher testosterone dose resulted in further increases in scores for frequency of sexual activity and pleasure-orgasm in the Brief index of Sexual Functioning for Women (P=0.03 for both comparisons with placebo). At the higher dose the percentages of women who had sexual fantasies, masturbated, or engaged in sexual intercourse at least once a week increased two to three times from base line. The positive-well-being, depressed-mood, and composite scores of the Psychological General Well-Being Index also improved at the higher dose (P=0.04, P=0.03, and P=0.04, respectively, for the comparison with placebo), but the scores on the telephone-based diary did not increase significantly.

CONCLUSIONS

In women who have undergone oophorectomy and hysterectomy, transdermal testosterone improves sexual function and psychological well-being.

Controlled studies on women presenting with sexual drive disorder: I. Endocrine status

A single mid-cycle blood sample was obtained from 15 premenopausal female patients presenting with lifelong absence of sexual drive and from a control group of women with intact sexual drive. Serum levels of testosterone, 5-dihydrotestosterone (5-DHT), 17 beta oestradiol, sex hormone binding globulin, and prolactin were measured and indices of free testosterone and 5-DHT were derived. During the menstrual cycle in which the blood samples were obtained, the study subjects kept a diary of their sexual desire and activities. The only endocrine parameter that is significantly different between the two groups is free testosterone, which is lower in the patients than in the control women. Associations between endocrine parameters and indices of sexual behavior were examined. In the control group, average daily sexual thoughts correlates positively with total testosterone, free testosterone index, and free 5-DHT. Feeling of "need for sex" correlates positively with free 5-DHT index and free testosterone index. Experience of sexual thoughts correlates with need for sex, and average frequency of masturbation correlates negatively with age. In both groups, average coital frequency correlates with free testosterone index.

Does hypertension and its pharmacotherapy affect the quality of sexual function in women?

Considerable research has been conducted into the effects of antihypertensive drugs on male sexual functioning. This remains underexplored in women, even though almost half of treated hypertensives are women. An ambulatory medical record-based, case-control study was designed to study sexual function in treated and untreated hypertensive women and healthy controls. We conducted this study at a teaching hospital with satellite clinics in upstate New York. Of 3312 medical records reviewed, 640 premenopausal white women with or without mild hypertension (defined as blood pressure [BP] > or = 140/90 and < 160/110 mmHg), in heterosexual relationships, with no other significant medical history, were eligible. Of these, 241 women agreed to participate, and 224 (35%) completed both a self-administered questionnaire and a telephone interview. Analysis was conducted on 211 women (107 healthy controls, and 104 mild hypertensives, of whom 37 were unmedicated and 67 medicated). Questions on sexuality were classified into seven composite variables and later further divided. There were no demographic differences between participants and nonparticipants. Cases and controls differed only by age (P < .01); therefore, subsequent analysis was age-adjusted. Current smokers reported a significantly lower mean score for orgasm than did nonsmokers (P = .04). Women with unmedicated and medicated hypertension did not differ significantly on sexuality scores and were subsequently combined. Using age-adjusted ANOVA, women with hypertension reported significantly decreased lubrication and orgasm and increased pain compared to nonhypertensive women. There were no significant differences by ANOVA in the quality of sexual functioning between six treatment groups. In conclusion, the quality of female sexual functioning was quantified in an ambulatory outpatient setting. Hypertensive women, regardless of type of treatment, reported age-adjusted decrease in vaginal lubrication, less frequent orgasm, and more frequent pain when compared to nonhypertensive women. Emotional aspects of sexual functioning in hypertensive women do not appear to be impaired. These areas require further investigation. An incidental finding indicated diminished orgasm reported in current smokers, compared to nonsmokers, which was not associated with age or hypertension.

The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function

This article presents the development of a brief, self-report measure of female sexual function. Initial face validity testing of questionnaire items, identified by an expert panel, was followed by a study aimed at further refining the questionnaire. It was administered to 131 normal controls and 128 age-matched subjects with female sexual arousal disorder (FSAD) at five research centers. Based on clinical interpretations of a principal components analysis, a 6-domain structure was identified, which included desire, subjective arousal, lubrication, orgasm, satisfaction, and pain. Overall test-retest reliability coefficients were high for each of the individual domains (r = 0.79 to 0.86) and a high degree of internal consistency was observed (Cronbach's alpha values of 0.82 and higher) Good construct validity was demonstrated by highly significant mean difference scores between the FSAD and control groups for each of the domains (p < or = 0.001). Additionally, divergent validity with a scale of marital satisfaction was observed. These results support the reliability and psychometric (as well as clinical) validity of the Female Sexual Function Index (FSFI) in the assessment of key dimensions of female sexual function in clinical and nonclinical samples. Our findings also suggest important gender differences in the patterning of female sexual function in comparison with similar questionnaire studies in males.

The Arizona Sexual Experience Scale (ASEX): reliability and validity

Although sexual dysfunction is common in psychiatric patients, quantification of sexual dysfunction is limited by the paucity of validated, user-friendly scales. In order to address this problem, the authors have developed the Arizona Sexual Experiences Scale (ASEX), a five-item rating scale that quantifies sex drive, arousal, vaginal lubrication/penile erection, ability to reach orgasm, and satisfaction from orgasm. Possible total scores range from 5 to 30, with the higher scores indicating more sexual dysfunction. This study assesses the internal consistency, test-retest reliability, and convergent and discriminant validity of the ASEX.

Prevalence of sexual dysfunction in women seeking services at family planning centers in Tehran

In the present study, a modified standardized sexual function questionnaire, along with a test of knowledge about and attitude toward sexuality, was administered to 300 healthy women, ages 16 through 53, who sought services at family planing centers in Tehran, Iran. All participants were married. The greatest percentages had two children (35%) and were housewives (69%). Some 72% were well educated, and 1% were illiterate; 74% of the women had moderate knowledge about sexuality, and 53% had a conservative attitude toward sexuality. The study revealed the prevalence of inhibited desire (15%), inhibited orgasm (26%), lack of lubrication (15%), vaginismus (8%), and dyspareunia (10%); 38% of the women had at least one sexual dysfunction. The most common sexual difficulties reported were "too little foreplay before intercourse" and "partner chooses inconvenient time" (8% each). Despite these difficulties, 51% of the sample reported that their overall sexual relationship was satisfactory. Knowledge about sexuality was significantly correlated with orgasm experience, higher knowledge being associated with more orgasm experience. There were significant correlations between attitude toward sexuality and sexual function (orgasm, desire, lubrication); a conservative attitude was associated with more sexual dysfunction. Spousal sexual dysfunction had a significant negative correlation with sexual function in the woman.

Relating body image to psychological and sexual functioning in child sexual abuse survivors

Cognitive-affective body image variables and their relation to long-term psychological and sexual functioning were investigated in a community sample of 57 female adult child sexual abuse (CSA) survivors and 47 comparison subjects. The Body-Self Relations Questionnaire and the Body Esteem Scale were administered to assess cognitive-affective body image. Group comparisons indicated that, after controlling for actual weight status, survivors evaluated their health more negatively and reported less body esteem regarding their sexual attractiveness than comparison subjects. Body image variables related to health and sexual attractiveness significantly explained variance on symptom measures that reflect the diverse CSA long-term sequelae. Results suggest the need for careful assessment of body image disturbances and the development of effective interventions targeting body image in the treatment of CSA survivors.

Sexuality in women with Parkinson's disease

There is a renewed interest in sexuality in chronic disease states. Whereas there is some literature on male sexuality in Parkinson's disease (PD), no study has been devoted exclusively to women. We compared 27 women who had PD with community controls matched for age and marital status by using the Brief Index of Sexual Functioning in Women. Approximately 50% of both samples were sexually active. The women with PD were more likely to be dissatisfied with the quality of the sexual experiences. There were significant differences in the two groups with respect to anxiety or inhibition, vaginal tightness, and involuntary urination. Preoccupation with health problems interfering with sex and dissatisfaction with body appearance were also more prevalent in parkinsonian women, but not statistically different from controls. The PD patients were less satisfied with their sexual relationships and with their partners, and were more depressed as a group when compared with controls (Beck Depression Inventory of 11.8 vs 6.3). In both groups, age was associated with significant changes in satisfaction and activity. In summary, qualitative differences exist in the sexual experiences of women with PD compared with controls.

Sexual functioning in women with breast cancer after treatment with adjuvant therapy

The purpose of this research was to describe current sexual functioning in women with breast cancer comparing women treated with chemotherapy or endocrine therapy to women treated without pharmacological manipulation. Sixty-seven women diagnosed with stage I, II, or III breast cancer responded to a two-part mailed questionnaire. The first part of the questionnaire asked about menopausal symptoms (weight changes, hot flashes, mood swings, and anxiety attacks) the women might currently be experiencing and about various symptoms that might be currently interfering with sexual functioning (vaginal dryness, decreased libido, dyspareunia, and difficulty achieving orgasm). The second part of the questionnaire was the Derogatis Sexual Functioning Inventory (DSFI) designed to measure current sexual functioning in ten areas. The women who participated in this study were primarily middle class, white, and married. Controlling for endocrine therapy, the 25 women treated with chemotherapy were 6.5 times more likely than women not treated with chemotherapy to report weight changes (p = 0.001), 3.6 times more likely to report hot flashes (p = 0.02), and 6.5 times more likely to report mood swings (p = 0.001). Additionally, still controlling for endocrine therapy, the women treated with chemotherapy were 5.7 times more likely than women not treated with chemotherapy to report vaginal dryness (p = 0.001), 3.0 times more likely to report decreased libido (p = 0.04), 5.5 times more likely to report dyspareunia (p = 0.003), and 7.1 times more likely to report difficulty achieving orgasm (p = 0.004). Controlling for chemotherapy, the 20 women treated with endocrine therapy did not experience either menopausal or sexual dysfunction symptoms significantly differently from women not treated with endocrine therapy. Controlling for endocrine therapy, there was a significant negative effect of chemotherapy on body image (p = 0.01), affects (p = 0.001), psychological symptoms (p = 0.001), and overall sexual functioning (p = 0.02). However, controlling for chemotherapy, there was no significant effect of endocrine therapy on any of the DSFI subscales. This study indicates that women who have received chemotherapy are especially susceptible to adverse changes in their current sexual functioning.