Depression and sexual functioning in minority women: current status and future directions

Sexual Desire in the Time of COVID-19: How COVID-Related Stressors Are Associated with Sexual Desire in Romantic Relationships

The COVID-19 pandemic and the resulting social distancing measures have caused widespread social and economic disruptions, resulting in spikes in unemployment and financial instability, along with drastic changes to people's ability to feel socially connected. Many of the changes resulting from the COVID-19 pandemic are risk factors for depressive symptoms, which are associated with lower levels of sexual desire. The current research (N = 4,993) examined whether responses to external stressors brought on by COVID-19 (i.e., financial concern, worry, loneliness, stress) were associated with sexual desire among a multi-national sample of people in relationships (Studies 1-2), and whether this association was, in part, due to reports of depressive symptoms (Study 2). In the period immediately following the onset of the pandemic, more financial concern (Study 1) and worry (Study 2) were associated with higher sexual desire, while other factors, like stress (Studies 1-2), were associated with lower desire. We also followed a subset of participants every two weeks during the initial stages of the pandemic and at times when people reported greater stress, loneliness, financial strain, or worry than their average, they reported greater depressive symptoms, which was, in turn, associated with lower sexual desire. Results suggest that the social isolation and stress resulting from the COVID-19 pandemic have mixed associations with sexual desire at the onset of the pandemic. But over time, when people report heightened COVID-related stressors, they tend to report lower sexual desire for their partner, in part because these stressors are associated with more depressive symptoms.

The Evolution of the Female Sexual Disorder/Dysfunction Definitions, Nomenclature, and Classifications: A Review of DSM, ICSM, ISSWSH, and ICD

INTRODUCTION

The 2 most well-known classification systems that include sexual medicine diagnoses are the International Classification of Diseases and Statistics (ICD) and the Diagnostic and Statistical Manual of Mental Disorders (DSM). Sexual medicine experts from international societies representing an array of disciplines have revised and redefined female sexual dysfunctions (FSDs) to reflect current scientific evidence and the state of the art.

AIM

To summarize the evidence and interactive and chronological process by which sexual medicine societies' consensus groups developed the current nomenclature, classifications, and definitions for FSDs.

METHODS

We review the contributions and collaborations of the Fourth International Consultation in Sexual Medicine (ICSM), the International Society for the Study of Women's Sexual Health (ISSWSH), and the World Association of Sexual Health in conjunction with the World Health Organization.

MAIN OUTCOME MEASURES

The ICSM and ISSWSH diagnostic systems are contrasted with the DSM classification. We discuss innovations and strengths; relevant evidence regarding epidemiology, etiology, and risk factors; and key differences. We describe how sexual medicine expertise informed FSD codes in the ICD-11 classification.

RESULTS

ICSM and ISSWSH published evidence-based guidelines on the definitions, nomenclature, and diagnostic criteria for FSD that diverge from the DSM psychiatric compendia. These definitions and nomenclature recommend the separation of female sexual desire and arousal disorders, elaborate on subtypes of arousal problems, broaden the scope of sexual pain definitions, and provide a greater understanding of etiologies and risk factors for FSDs.

CONCLUSIONS

These collaborations among sexual medicine experts and their role in the ICD-11 development process provide confidence that the ICD-11 Sexual Dysfunction codes are based on current scientific evidence for diagnosing and coding FSDs in clinical settings worldwide, can serve as endpoints in clinical trials, and will provide specificity for treatment outcomes for FSD therapies. Parish SJ, Cottler-Casanova S, Clayton AH, et al. The Evolution of the Female Sexual Disorder/Dysfunction Definitions, Nomenclature, and Classifications: A Review of DSM, ICSM, ISSWSH, and ICD. Sex Med 2021;9:36-56.

Evidence that Relationship Quality, Social Support, and SSRI Use Do Not Account for the Shared Underlying Relationships among Symptoms of Depression, Anxiety, and Female Sexual Dysfunction

Recent research has suggested that the shared characteristics and co-occurrence among depression, anxiety, and female sexual dysfunction may represent a shared underlying liability (i.e., the internalizing spectrum, which traditionally accounts for the overlap between depression and anxiety in psychopathology research). To date, however, whether common covariates shared by these symptom domains might instead account for the interrelationships has not been examined. Three such potential confounders include intimate relationship quality, social support, and selective serotonin reuptake inhibitor (SSRI) use. We therefore aimed to examine whether and to what extent controlling for these covariates affects the structure of an internalizing spectrum model that includes sexual problems. Participants (n = 525, mean [SD] age = 32 [11.1]) were women who participated in an online self-report survey and were in a current intimate relationship. Hierarchical exploratory structural equation models of the internalizing spectrum were compared before and after controlling for relationship quality, social support, and SSRI use and were markedly similar, indicating that the model was robust. This study provides further evidence that the internalizing spectrum can account for the relationships among depression, anxiety, and low sexual function in women, which has potential implications for diagnosis and treatment.

A Place for Sexual Dysfunctions in an Empirical Taxonomy of Psychopathology

Sexual dysfunctions commonly co-occur with various depressive and anxiety disorders. An emerging framework for understanding the classification of mental disorders suggests that such comorbidity is a manifestation of underlying dimensions of psychopathology (or "spectra"). In this review, we synthesize the evidence that sexual dysfunctions should be included in the empirical taxonomy of psychopathology as part of the internalizing spectrum, which accounts for comorbidity among the depressive and anxiety disorders. The review has four parts. Part 1 summarizes the empirical basis and utility of the empirical taxonomy of psychopathology. Part 2 reviews the prima facie evidence for the hypothesis that sexual dysfunctions are part of the internalizing spectrum (i.e., high rates of comorbidity; shared cognitive, affective, and temperament characteristics; common neural substrates and biomarkers; shared course and treatment response; and the lack of causal relationships between them). Part 3 critically analyzes and integrates the results of the eight studies that have addressed this hypothesis. Finally, Part 4 examines the implications of reconceptualizing sexual dysfunctions as part of the internalizing spectrum, and explores avenues for future research.

The Relationship between Sexual Cues and Sexual Desire in Women

Sexual desire is one of the most studied dimensions of sexual response. There is extensive research on bio-medical, psychosocial, and relationship predictors of desire particularly in women. Despite this accumulated knowledge, there is a lack of studies investigating the ability of sexual cues to predict sexual desire. A sample of 546 heterosexual and premenopausal Portuguese women, aged between 18 and 53 years old, completed a web survey assessing socio-demographic variables, medical conditions, psychopathology, relationship dimensions, sexual cues and sexual desire. Findings from hierarchical regression analyses indicated that sexual cues significantly predict sexual desire. In particular, explicit/arousal cues (β = .321, p < .001) were the most significant predictor of female sexual desire. Additionally, somatization (β = .188, p < .001), relationship satisfaction (β = .159, p < .001), anxiety (β = -.165, p = .006), and antidepressant medication (β = -.094, p = .014) were also significant predictors. Results emphasize the strong ability of explicit/arousal cues to predict sexual desire in women above and beyond other known factors. These findings suggest that the assessment of sexual desire problems in women as well as treatment approaches should take into consideration the role of sexual cues and particularly explicit/arousal cues.

BIOPSYCHOSOCIAL DETERMINANTS OF HYPOACTIVE SEXUAL DESIRE IN WOMEN: A NARRATIVE REVIEW

Background:

As a mental response to sexual stimuli, sexual desire determines human sexual behavior and represents the cognitive capacity of sexual stimulation, so that avoiding sexual activity has a very negative effect on the discharge of intimacy and joy in couple’s relationship and threatens the stability relationship, which can finally end in sexual dissatisfaction and divorce; it may even affect the reproduction. This study, reviews the literature on biopsychosocial determinants of hypoactive sexual desire disorder in women in childbearing ages.

Method:

The search was done from January to March 2015 by the use of the data bases ProQuest, Pubmed, CINAHL, Ovid and Medline and the words sexual desire, related factors and biopsychosocial determinants were used as free text words. The words reduce sexual desire, hypoactive sexual desire disorder, dyadic relationship, biopsychosocial factors and women were used as keywords in the search. Also, the articles focusing on any aspects of sexual desire such as biological, social and psychological factors and relationship factors alone or integrated, were included in the study. The articles which specifically targeted the hypoactive sexual desire disorder in pregnant and lactating women and also the articles targeting biopsychosocial factors related to other types of sexual function disorder such as arousal disorder, orgasm disorder and dyspareunia, were all excluded from this study.

Findings:

After reviewing the literature, the findings were categorized in three main class of effect of biologic factors on sexual desire and sexual hypoactivity, the effect of psychological factors on sexual desire and the effect of cultural factors and couple’s relationship on sexual desire, each of these domains cover a wide range (such as hormonal changes, chronic diseases, psychological difficulties (perceived stress, anxiety, depression). Incompatibility of couples, the spouse’s sexual function disorder) which may overlap. Because of the complexity of etiology and the difficulty of treating hypoactive sexual desire disorder, it is necessary to use biopsychosocial approaches to diagnose and treat the disorder.

Conclusion:

According to the findings of this reviewing study, the factors able to affect sexual desire and activity are not distinct and often overlap, therefore, the complicated etiology of hypoactive sexual desire disorder often needs multidimensional intervention to use biopsychosocial approach; Multi factor assessment with a combination of psychological, physical, social and hormonal intervention can be effective in making strategies to treat the symptoms of HSDD.

New roles of carboxypeptidase E in endocrine and neural function and cancer

Carboxypeptidase E (CPE) or carboxypeptidase H was first discovered in 1982 as an enkephalin-convertase that cleaved a C-terminal basic residue from enkephalin precursors to generate enkephalin. Since then, CPE has been shown to be a multifunctional protein that subserves many essential nonenzymatic roles in the endocrine and nervous systems. Here, we review the phylogeny, structure, and function of CPE in hormone and neuropeptide sorting and vesicle transport for secretion, alternative splicing of the CPE transcript, and single nucleotide polymorphisms in humans. With this and the analysis of mutant and knockout mice, the data collectively support important roles for CPE in the modulation of metabolic and glucose homeostasis, bone remodeling, obesity, fertility, neuroprotection, stress, sexual behavior, mood and emotional responses, learning, and memory. Recently, a splice variant form of CPE has been found to be an inducer of tumor growth and metastasis and a prognostic biomarker for metastasis in endocrine and nonendocrine tumors.

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.

Sexuality among patients with a colostomy: an exploration of the influences of gender, sexual orientation, and Asian heritage

A large number of patients undergoing surgery for rectal cancer experience construction of a colostomy and subsequent sexual dysfunction. However, sexual problems are easily neglected or concealed by patients, partners, and medical staff. This literature review explores sexual concerns, dysfunctions, and related factors that directly or indirectly influence sexuality after rectal cancer surgery, including gender differences, sexual orientation, sexual partners, and cultural beliefs. Results of this literature review suggest that additional research is needed that focuses on both anatomical and physiological changes after creation of a colostomy as well as psychological, gender based, and sociocultural factors affecting sexuality.

Sexual assault in the military and its impact on sexual satisfaction in women veterans: a proposed model

AIMS

Sexual assault in the military (SAIM) is associated with decreased sexual satisfaction. However, mediators of this association have not been fully described.

METHODS

Using a retrospective analysis of cross-sectional data collected for the national Veterans Affairs (VA) Women's Health Survey, we propose a mediator model to explain the association between SAIM and decreased sexual satisfaction among women veterans. Four mediators of the association between SAIM and decreased sexual satisfaction are tested: (1) emotional health-related quality of life, (2) physical health-related quality of life, (3) lack of a close partner, and (4) gynecological illness. These mediators were chosen to encompass independent domains potentially relevant to sexual satisfaction, including emotional, physical, and relational.

RESULTS

Of 3161 women (87%) who answered the sexual satisfaction question, the mean age was 45 (SD 15) years; 85% were white. Twenty-four percent reported a history of SAIM, and 39% reported sexual dissatisfaction. In age-adjusted logistic regression analyses, both SAIM and sexual dissatisfaction were strongly associated with each of the proposed mediators. However, of the four mediators, emotional health-related quality of life most strongly attenuated the association between SAIM and sexual dissatisfaction. After including all mediators, the association between SAIM and decreased sexual satisfaction was markedly attenuated.

CONCLUSIONS

SAIM's negative impact on sexual satisfaction in women veterans operates both directly and through its physical and mental health sequelae. Of the proposed mediators in this association, the most prominent is mental health-related quality of life; the other proposed mediators were minimally related.

Correlates of sexual satisfaction among sexually active postmenopausal women in the Women's Health Initiative-Observational Study

BACKGROUND

Satisfaction with sexual activity is important for health-related quality of life, but little is known about the sexual health of postmenopausal women.

OBJECTIVE

Describe factors associated with sexual satisfaction among sexually active postmenopausal women.

DESIGN

Cross-sectional analysis.

PARTICIPANTS

All members of the Women's Health Initiative-Observational Study (WHI-OS), ages 50-79, excluding women who did not respond to the sexual satisfaction question or reported no partnered sexual activity in the past year (N = 46,525).

MEASUREMENTS

PRIMARY OUTCOME

dichotomous response to the question, "How satisfied are you with your sexual activity (satisfied versus unsatisfied)?" Covariates included sociodemographic factors, measures of physical and mental health, and gynecological variables, medications, and health behaviors related to female sexual health.

RESULTS

Of the cohort, 52% reported sexual activity with a partner in the past year, and 96% of these answered the sexual satisfaction question. Nonmodifiable factors associated with sexual dissatisfaction included age, identification with certain racial or ethnic groups, marital status, parity, and smoking history. Potentially modifiable factors included lower mental health status and use of SSRIs. The final model yielded a c-statistic of 0.613, reflecting only a modest ability to discriminate between the sexually satisfied and dissatisfied.

CONCLUSIONS

Among postmenopausal women, the variables selected for examination yielded modest ability to discriminate between sexually satisfied and dissatisfied participants. Further study is necessary to better describe the cofactors associated with sexual satisfaction in postmenopausal women.

Psychosocial and behavioral correlates of depressed mood among female methamphetamine users

Female methamphetamine (meth) users report more depressive symptoms than do males. This study examined psychosocial and behavioral correlates of depressed mood in 146 heterosexual, meth-using women in San Diego, CA. Sixty percent met Beck Depression Inventory (BDI) criteria for moderate to severe depressive symptoms (i.e., higher levels of depressive symptoms); 40% had minimal to mild depressive symptoms (i.e., lower levels of depressive symptoms). The two groups were compared on background characteristics, reasons for meth use, patterns of meth use, psychosocial factors, social and sexual consequences of meth use, and sexual risk behavior. Women with higher levels of depressive symptoms were less likely to be employed, were more likely to use meth to cope with mood, used more grams of meth in a 30-day period, used meth more times per day on a greater number of consecutive days, and were more likely to be binge users of meth. They also scored lower on a measure of self-esteem and higher on measures of impulsivity, social stigma, and social network members' use of meth. In multivariate analyses, lower self-esteem and higher ratings of social network members' use of meth were significant predictors of higher levels of depressive symptoms. Psychosocial and behavioral factors are discussed in terms of treatment protocols for mood regulation and meth abatement in the target population.

Minority stress and sexual problems among African-American gay and bisexual men

Minority stress, such as racism and gay bashing, may be associated with sexual problems, but this notion has not been examined in the literature. African-American gay/bisexual men face a unique challenge in managing a double minority status, putting them at high risk for stress and sexual problems. This investigation examined ten predictors of sexual problems among 174 African-American gay/bisexual men. Covarying for age, a forward multiple regression analysis showed that the measures of self-esteem, male gender role stress, HIV prevention self-efficacy, and lifetime experiences with racial discrimination significantly added to the prediction of sexual problems. Gay bashing, psychiatric symptoms, low life satisfaction, and low social support were significantly correlated with sexual problems, but did not add to the prediction of sexual problems in the regression analysis. Mediation analyses showed that stress predicted psychiatric symptoms, which then predicted sexual problems. Sexual problems were not significantly related to HIV status, racial/ethnic identity, or gay identity. The findings from this study showed a relationship between experiences with racial and sexual discrimination and sexual problems while also providing support for mediation to illustrate how stress might cause sexual problems. Addressing minority stress in therapy may help minimize and treat sexual difficulties among minority gay/bisexual men.