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Brotto LA, Altas M. New management approaches for female sexual dysfunction. Curr Opin Obstet Gynecol 2024; 36:372-377. [PMID: 39109594 DOI: 10.1097/gco.0000000000000984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2024]
Abstract
PURPOSE OF REVIEW The goal of this paper is to review the most recent studies evaluating treatments for female sexual dysfunction (FSD), including distressing symptoms of desire, arousal, and orgasm disorder. We divide the sections into psychological and pharmacological. RECENT FINDINGS There is excellent evidence in favour of mindfulness, cognitive behavioural therapy, and psychoeducation for improving low sexual desire in women, and less evidence in support of these approaches to address other sexual dysfunctions in women. There are two US Food and Drug Administration (FDA) approved pharmacological treatments for low desire in premenopausal women that have modest benefits above placebo, and a significant proportion of users will experience side effects. Evidence also supports the use of transdermal testosterone for low desire in postmenopausal women. SUMMARY Sexual dysfunction in women is common and distressing, and there are a variety of psychological and pharmacological treatments. More research is needed to better understand the predictors of a positive treatment response in order to deliver more personalized care.
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Affiliation(s)
- Lori A Brotto
- Department of Obstetrics and Gynaecology, University of British Columbia
| | - Melanie Altas
- BC Centre for Vulvar Health, Vancouver, British Columbia, Canada
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Godbout N, Martel NW, Gewirtz-Meydan A, Girard M, Hébert M. When sexual distress shares the bed: the role of sexual self-esteem in the relationship between dispositional mindfulness and sexual distress in sex therapy patients. J Sex Med 2024:qdae095. [PMID: 39167770 DOI: 10.1093/jsxmed/qdae095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 07/03/2024] [Accepted: 07/23/2024] [Indexed: 08/23/2024]
Abstract
BACKGROUND Sexual distress (eg, feeling distressed, unhappy, frustrated, stressed, dissatisfied, or bothered about their sexuality) is a central concern reported by patients seeking sex therapy, and might be related to sexual self-esteem and mindfulness disposition, yet research is needed to examine the links among those variables within the specific population of patients seeking therapy. AIM This study aimed to examine the indirect role of sexual self-esteem in the relationship between dispositional mindfulness and sexual distress. METHODS The study was conducted among 696 patients undergoing sexual therapy (mean age 34.19 ± 11.21 years, age range 18-78 years). Participants identified as women (57.3%), men (38.5%), or nonbinary (4.2%). They completed self-report questionnaires assessing dispositional mindfulness (Five Facet Mindfulness Questionnaire), sexual self-esteem (Multidimensional Sexuality Questionnaire), and sexual distress (Sexual Distress Scale-Revised), during their first few sessions (ie, first to third sessions [the assessment phase]). OUTCOMES Sexual distress was the main outcome, as measured with the Sexual Distress Scale-Revised. RESULTS Results indicated that 54% (n = 376) of patients reported elevated sexual distress based on the questionnaire threshold score. Path analyses indicated an indirect effect in which higher dispositional mindfulness was associated with higher levels of sexual self-esteem, which in turn was associated with lower sexual distress. Results also highlighted that specific facets of mindfulness were related to higher sexual self-esteem (ie, describing, and nonreacting) and lower sexual distress (ie, nonjudgment and acting with awareness). The integrative model explained 23% of the variance of sexual distress scores. CLINICAL IMPLICATION Findings suggest that addressing specifically sexual self-esteem and mindfulness may represent relevant clinical avenues to reduce sexual distress among sex therapy patients. STRENGTHS AND LIMITATIONS Strengths of this study include the novel examination of the role of sexual self-esteem in the link between mindfulness disposition and sexual distress in a large clinical sample of patients seeking sex therapy. Limitations includes reliance on patient self-report and a cross-sectional design that limit conclusion regarding causality. CONCLUSION This study makes a valuable contribution to the existing body of research highlighting the pivotal roles of sexual self-esteem in the link between dispositional mindfulness and reduced sexual distress among adults undergoing sex therapy, allowing us to identify potential targets of intervention.
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Affiliation(s)
- Natacha Godbout
- Department of Sexology, Faculty of Social Sciences, Université du Québec à Montréal, Montréal, H2L 2C4, Québec, Canada
| | - Nadia Willard Martel
- Department of Sexology, Faculty of Social Sciences, Université du Québec à Montréal, Montréal, H2L 2C4, Québec, Canada
| | - Ateret Gewirtz-Meydan
- School of Social Work, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, 3498838, Israel
| | - Marianne Girard
- Department of Sexology, Faculty of Social Sciences, Université du Québec à Montréal, Montréal, H2L 2C4, Québec, Canada
| | - Martine Hébert
- Department of Sexology, Faculty of Social Sciences, Université du Québec à Montréal, Montréal, H2L 2C4, Québec, Canada
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Brotto LA, Basson R, Grabovac A, Chivers ML, Zdaniuk B, Bodnar TS, Weinberg J. Impact of mindfulness versus supportive sex education on stress in women with sexual interest/arousal disorder. J Behav Med 2024; 47:721-733. [PMID: 38668816 DOI: 10.1007/s10865-024-00491-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 04/09/2024] [Indexed: 08/02/2024]
Abstract
Low desire in women is the most common sexual difficulty, and stress has been identified as a significant predictor of symptoms. We evaluated a mindfulness-based cognitive therapy (MBCT) group treatment versus a sex education comparison group treatment (STEP) on self-reported stress and on the physiological stress response measured via morning-to-evening cortisol slope in 148 women with a diagnosis of sexual interest/arousal disorder (SIAD). Perceived stress decreased following treatment in both groups, and significantly more after MBCT. The cortisol slope was steeper (indicative of better stress system regulation) from pre-treatment to 6-month follow-up, with no differences between the groups. As an exploratory analysis, we found that the reduction in perceived stress predicted increases in sexual desire and decreases in sex-related distress for participants after MBCT only. These findings suggest that group mindfulness targeting women with low sexual desire leads to improvements in self-reported and physiological stress, with improvements in self-reported stress partially accounting for improvements in sexual desire and distress.
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Affiliation(s)
- Lori A Brotto
- Department of Obstetrics and Gynaecology, University of British Columbia, 2775 Laurel Street, 6th Floor, Vancouver, BC, V5Z 1M9, Canada.
| | - Rosemary Basson
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Andrea Grabovac
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | | | - Bozena Zdaniuk
- Department of Obstetrics and Gynaecology, University of British Columbia, 2775 Laurel Street, 6th Floor, Vancouver, BC, V5Z 1M9, Canada
| | - Tamara S Bodnar
- Department of Cellular and Physiological Sciences, University of British Columbia, Vancouver, Canada
| | - Joanne Weinberg
- Department of Cellular and Physiological Sciences, University of British Columbia, Vancouver, Canada
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Kolbuszewska MT, Tavares IM, Nobre PJ, Dawson SJ. Using network analysis to model associations between psychological symptoms, sexual function, and sexual distress in women. Int J Clin Health Psychol 2024; 24:100479. [PMID: 39040481 PMCID: PMC11262177 DOI: 10.1016/j.ijchp.2024.100479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 06/19/2024] [Indexed: 07/24/2024] Open
Abstract
Background Psychological difficulties, including depression, anxiety, and somatization, are among the most important predictors for women's sexual function (i.e., arousal, desire, lubrication, pain, and satisfaction) and sexual distress. These associations have largely been studied at the construct level, with little research examining which specific symptoms might be most important for maintaining links between psychological difficulties and domains of sexual function. The present research sought to establish and characterize networks of women's psychological symptoms, sexual function, and sexual distress, and identify potential bridge symptoms that connect them. Methods In a cross-sectional study, 725 women reported on their sexual function, sexual distress, and depressive, anxiety, and somatization symptoms. A series of network analyses was used to identify central symptoms and connections between psychological symptoms, sexual function domains, and sexual distress. Results Across the modeled networks, sexual distress and pain during sex were consistent bridges between other sexual function domains and psychological symptoms. Discussion Overall, our models revealed sexual distress as an important potential mediator between sexual function problems and psychological symptoms that might contribute to the development and maintenance of comorbid sexual function and psychological problems.
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Affiliation(s)
- Marta T. Kolbuszewska
- Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver, BC V6T 1Z4, Canada
| | - Inês M. Tavares
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Pedro J. Nobre
- Faculty of Psychology and Educational Sciences, University of Porto, Porto, Portugal
| | - Samantha J. Dawson
- Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver, BC V6T 1Z4, Canada
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Luz do Nascimento BH, Figueira JR, Rosa-E-Silva ACJDS, Reis RM, Andrade MCR, Brito LGO, Lara LADS. Management of hypoactive sexual desire dysfunction at a specialized service in women's sexual health. JOURNAL OF SEX & MARITAL THERAPY 2024; 50:542-553. [PMID: 38482856 DOI: 10.1080/0092623x.2024.2329081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Hypoactive sexual desire dysfunction (HSDD) is prevalent among women. This retrospective cohort study aimed to verify the results of the strategies used by Gynecologists and Obstetricians (Ob-gyn) residents in the management of female HSDD. For this, we conducted a data collection of patient medical records of women with HSDD from the Human Sexuality Studies outpatient clinic of the Human Reproduction Center, Department of Gynecology and Obstetrics of FMRP-USP, from 2005 to 2019. Among the 437 women included, 361 (82.6%) answered the question concerning the effect of the protocol to which they were submitted, whereas 234 (64.8%) reported improvements in sexual desire. The univariate model showed that patients without chronic pelvic pain were 19.0% less likely to report improvements in HSDD than those with chronic pelvic pain (p = 0.03). Patients without depression and without orgasmic dysfunction were, respectively 32% and 23% more likely to show improvements in their HSDD than those who had depression or orgasmic dysfunction (respectively p = 0.001, p = 0.008). However, the multivariate model did not identify any associations. The assistance regarding HSDD by the Ob-gyn resident in training to deal with female sexual complaints may be effective in improving sexual complaints.
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Affiliation(s)
| | | | | | - Rosana Maria Reis
- Ribeirão Preto Medical School, São Paulo University, Ribeirão Preto, SP, Brazil
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Merwin KE, Brotto LA. Psychological Treatment of Persistent Genital Arousal Disorder/Genitopelvic Dysesthesia Using an Integrative Approach. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:2249-2260. [PMID: 37253921 PMCID: PMC10228892 DOI: 10.1007/s10508-023-02617-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 05/03/2023] [Accepted: 05/04/2023] [Indexed: 06/01/2023]
Abstract
Persistent genital arousal disorder/genitopelvic dysesthesia (PGAD/GPD) is characterized by persistent, unwanted physiological genital arousal (i.e., sensitivity, fullness, and/or swelling) in the absence of sexual excitement or desire which can persist for hours to days and causes significant impairment in psychosocial well-being (e.g., distress) and daily functioning. The etiology and course of PGAD/GPD is still relatively unknown and, unsurprisingly, there are not yet clear evidence-based treatment recommendations for those suffering from PGAD/GPD. We present the case of a 58-year-old woman with acquired persistent genital arousal disorder, which began in March 2020; she believed she developed PGAD/GPD due to a period of significant distress and anxiety related to the COVID-19 pandemic. After seeking medical diagnosis and treatment from multiple healthcare providers and trying a combination of pharmacological and medical treatment modalities, she presented for psychological treatment. An integrative therapy approach (3 assessment sessions, 11 treatment sessions), which included cognitive behavior therapy, distress tolerance and emotion regulation skills from dialectical behavior therapy, and mindfulness practice, was utilized. The patient reported improvements anecdotally (e.g., decreased impact on occupational and social functioning, greater self-compassion, less frequent and shorter duration of PGAD/GPD flare-ups, improved ability to cope with PGAD/GPD symptoms, and decreased need for sleeping medication) and on self-report measures (e.g., lower PGAD/GPD catastrophizing, lower anxiety and depression, and greater overall quality of life).We report the use of an integrative (i.e., psychoeducational, cognitive behavioral, dialectical behavioral, and mindfulness-based) intervention, which may be an effective psychological treatment for PGAD/GPD.
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Affiliation(s)
- Kathleen E Merwin
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
- Borderline Personality Disorder Treatment Program, Mental Health and Addictions Program, Nova Scotia Health Authority, Dartmouth, NS, Canada
| | - Lori A Brotto
- Department of Obstetrics and Gynaecology, Faculty of Medicine, UBC Sexual Health Research, University of British Columbia, 2775 Laurel Street, 6th Floor Gordon & Leslie Diamond Health Care Centre, Vancouver, BC, V5Z 1M9, Canada.
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Aldahadha B. Self-disclosure, mindfulness, and their relationships with happiness and well-being. MIDDLE EAST CURRENT PSYCHIATRY 2023. [DOI: 10.1186/s43045-023-00278-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Abstract
Background
This study aims to test how self-disclosure relates to mindfulness, whether self-disclosure or mindfulness best predicts happiness and well-being, and whether there are significant differences between happiness and well-being levels due to self-disclosure and mindfulness. Data from a public sample was collected using e-mails and social media platforms (N = 486).
Results
The findings demonstrated a weak relationship between mindfulness and self-disclosure (r = 0.16) and acting with awareness but a strong relationship between happiness, wellness, mindfulness, and its factors. The results revealed four values that predict the differentiation between happy and unhappy people, and these values are statistically significant, namely, mindfulness, description, acceptance without judgment, and self-disclosure, as well as four values that predict the distinction between being well and unwell, namely mindfulness, observation, description, and self-disclosure. Additionally, results showed significant differences in the means of each of the mindfulness predictor variables in favor of happiness, wellness, and females. For the self-disclosure variable, the results showed differences in its means favoring females, happiness, and wellness. Finally, when controlling for gender and age, regression analyses found mindfulness to be an important predictor for happiness and well-being at 59% and 48% of the variance, respectively, while self-disclosure was a weak predictor at 12% and 15%, respectively.
Conclusions
In general, the results indicate that mindfulness is more effective and beneficial for living a happy and healthy life than self-disclosure
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