Review of psychological factors in low sexual desire

[Childhood sexual abuse: how important is the diagnosis to understand and manage sexual, anorectal and lower urinary tract symptoms]

OBJECTIVE

To understand and manage the sequels of childhood sexual abuse on sexual, anorectal and lower urinary tract functions.

MATERIAL AND METHODS

Review of articles published in the Medline database, selected according to their scientific relevance and published guidelines on this subject together with our own experience.

RESULTS

A history of sexual abuse is frequently found when assessing dysfunction or symptoms of the lower urinary tract. In this context, urinary stress incontinence is rarely involved but it can be linked by epidemiological factors. Dysuria with urgency is the most frequent expressed symptom. When associated with anorectal disorders and pelvic pain or a sexual disorder in particular dyspareunia, a sexual abuse should be evoked and specific questions asked to the patient. Although these symptoms are frequently encountered in 12 to 33% of women, and 8 to 16% of men, few practitioners, whatever their speciality ask about them as routine. It is important that the physician diagnose the existence of sexual abuse, in particular when the symptoms mentioned by the patient are not conclusive, in spite of thorough urological assessment. Patients finding the initial examination difficult and painful and the failure of the initial treatment should lead to questions concerning abuse, if neglected by the initial medical inquiry.

CONCLUSIONS

Clinicians involved in perineal functional pathology are able to acquire standardized modalities of inquiry about child sexual abuse for a better time management and efficacy in the therapeutic approach. The interest of a multidisciplinary diagnostic and therapeutic approach is primordial, associating psychological therapy and if necessary perineal re-education. This can avoid unnecessary tests and out-patient visits. Directing patients towards a multidisciplinary approach is highly advisable.

Preclinical models of sexual desire: conceptual and behavioral analyses

The epidemiology, etiology and proposed treatments for the sexual desire disorders are briefly reviewed before turning to an analysis of preclinical models. We suggest that the concept of sexual desire in the human is equivalent to sexual motivation as employed in the scientific literature. Many animal tests for sexual motivation have been described over the years. Most of them are based on the evaluation of the rate or speed of performing learned operant responses. These are not ideal measures for inferring the intensity of sexual motivation. We present a test for sexual incentive motivation, which has been used in male and female rats. No learning is involved, and the test is rather insensitive to variations in ambulatory activity and it does not employ rate measures. A procedure that recently has attracted much attention, paced-mating behavior in the female, does not seem to be as useful as could be expected. In fact, it does not appear to be superior to tests for sexual receptivity (lordosis). The lack of established, clinically efficient treatments for sexual desire disorders makes it difficult to evaluate if any model has predictive validity. However, the model proposed here may be isomorphic and homologous to the human condition.

Sexuality and marital life: results of a survey

This article presents the results of a telephone survey regarding the conjugal and sex life of men and women from the Montreal region. Surprising as it may seem, the relationship between sexual and marital functioning within the couple has been the focus of little study to date. In fact, relatively little is known about the relationship among sexual behavior, sexual attitudes, sexual fantasies, and marital functioning. In this survey, a questionnaire covering these four variables was administered to 996 subjects chosen at random. The results indicate that women seem to have a more positive perception of their sexual behavior, whereas men seem to have a more positive perception of their marital life. Multiple regression analyses were run to examine the relationship between marital functioning and items related to sexual functioning. The links between sexual satisfaction and other items of the questionnaire concerning sexual behavior, sexual attitudes, and sexual fantasies were also analyzed. For this purpose, we subdivided the subjects into two age groups (under 60 and 60 and over) based on the loss of interest in sexual activity that the questionnaire allowed to discern in the 60+ group. The relationship between marital functioning and items related to sexual behavior proved statistically significant. Various items pertaining to sexual functioning also proved to be related to a global assessment of sexual satisfaction. Cognitive variables (sexual attitudes and sexual fantasies) were found to influence sexual satisfaction but had a lesser impact on marital functioning. Gender and age (under 60 or 60 and over) also had an effect on these relationships.

THE ROLE OF SEXUAL DESIRE AND SEXUAL ACTIVITY IN DATING RELATIONSHIPS

Previous research indicates that adults believe that sexual desire and sexual activity play different roles in love relationships. Little research, however, has been conducted to document the presumed differences between these two aspects of human sexual response. The purpose of this study was to examine empirically (1) whether sexual desire and sexual activity co-occur in dating relationships; (2) whether desire is more strongly associated than activity with passionate love; and (3) whether desire and activity have different implications for relationship maintenance. The results revealed that sexual desire and sexual activity were moderately (but not significantly) related. In addition, and as expected, only sexual desire was related to passionate love. Sexual desire also was related to relational maintenance; the greater the desire for the partner, the less often participants thought about ending their current relationship, thought about beginning a new relationship, reported being unfaithful to their partner, and felt attracted to others.

Life-long absence of sexual drive in a woman associated with 5-dihydrotestosterone deficiency

A case of a woman who presented with life-long absence of sexual drive is reported. Although her history contained psychological factors that might have been etiologic in her presentation, she had not responded to sex therapy or cognitive-behavior psychotherapy undertaken at other clinics. When seen by the author, she was found to have poorly developed external genitalia. The only abnormality discovered on endocrinological evaluation was a reduced level of 5 dihydrotestosterone. Treatment with dihydrotestosterone gel applied to her vulva generated sexual drive and her ability to become sexually aroused.

Childhood sexual abuse as a predictor of adult female sexual dysfunction: a study of couples seeking sex therapy

The present study investigated 359 married adult women who sought sex therapy with their spouses. Discriminant function analyses indicated that childhood sexual abuse plus a college education significantly discriminated between women with and without a diagnosed sexual dysfunction. Among abused women, abuse involving sexual penetration significantly discriminated between dysfunctional and nondysfunctional women. Current findings confirm previous theory and research regarding a connection between childhood sexual abuse and adult female dysfunction. Furthermore, the findings suggest that abuse involving sexual penetration is specifically associated with adult sexual dysfunction. Between 75% to 94% of women with a sexual dysfunction could be accurately identified on the basis of prior abuse, but many nondysfunctional women were misclassified. Future research should examine additional variables that may contribute to sexual dysfunction such as levels of anxiety and depression, as well as features of the marital relationship such as marital satisfaction and communication skills.