Assessment and management of women's sexual dysfunctions: problematic desire and arousal

Measuring Sexual Intelligence for Evaluating Sexual Health

The current paper reports four consecutive studies that were conducted to link sexual health with a new construct of sexual intelligence by developing and validating a new scale to measure sexual intelligence. Sexual intelligence was defined as "the ability to perceive, understand and respond to sexual needs and desires in a personal and social context." Sexual Intelligence Scale (SIS), comprising of 8 items in English and 2 factors (sexual knowledge & sexual behavior), was developed and validated by involving 959 respondents in the process of 4 consecutive studies. The validity of SIS was tested step by step for its face, content, factorial, convergent, discriminant, and predictive validities. The reliability was measured through internal consistency and item-total & item-scale correlations. The study found significantly higher levels of sexual intelligence in men as compared to women. Sexual intelligence, moreover, had significant positive correlations with age, education, emotional intelligence, social intelligence, sexual health, and satisfaction with life. Sexual health was linked with sexual intelligence and the SIS was accepted as a reliable and valid tool to measure sexual intelligence.

Holistic Care for People Living With Chronic Musculoskeletal Pain: The Relevance and Importance of Sexual Function

People living with chronic primary or secondary musculoskeletal pain conditions such as low back pain, fibromyalgia, and inflammatory arthritis typically experience wide-ranging impacts on their physical function, activity participation, and psychosocial wellbeing. These can extend to negative impacts on a person's sexual function and their intimate relationships. While sexual function is an important component of wellbeing, it is often not considered within musculoskeletal pain care. Without awareness or targeted training, physical therapists may lack the confidence and skills to screen, assess, and manage the impacts that pain may be having on a person's sexual function and can miss the opportunity to tailor their care and optimize wellbeing. This article seeks to raise awareness among physical therapists of how living with chronic musculoskeletal pain can impact a person's sexual function and intimate relationships, and provide guidance on how to consider these issues within a person-centered approach to care. It describes why considering sexual function and intimate relationship issues as part of a person's lived musculoskeletal pain experience may be relevant, outlines the use of validated patient-reported outcome measures to assess sexual dysfunction, and suggests practical strategies for sensitively raising sexual function in consultations. Management approaches and possible referral pathways are also presented, to assist physical therapists in understanding available care options. This article seeks to support holistic care by improving physical therapists' knowledge and understanding of sexual dysfunction and its management in people living with chronic musculoskeletal pain.

IMPACT

Considering sexual function as a valued functional activity, together with other activities of daily living, will assist physical therapists to provide more holistic and person-centered care. This article covers the main considerations for raising sexual function and intimate relationship issues with people living with chronic musculoskeletal pain, as well as management options and potential referral pathways. Physical therapists are encouraged to seek targeted training to improve their confidence and skills in this area, and to use inclusive, respectful language for discussions around sexual function and intimate relationships.

Endorphins, Sexuality, and Reproduction

Beta-endorphin is secreted from the hypothalamus and pituitary in both mother and newborn. The placenta produces numerous pituitary hormones from the third month of pregnancy, one of which is βE. It has been suggested that βE has a role in the appetitive and precopulatory phase of sexual behavior in animals. An increase in endorphin levels during sexual activity in humans may contribute to attachment and bonding between partners, but contradictory reports in the literature question the association between sexuality and βE levels. The level of βE also increases during pregnancy, rises in early labor, peaks in late labor, and drops in the postpartum period. This fluctuation provides natural analgesia, raises the pain threshold, decreases the sensation of pain, or suppresses pain, and decreases fear levels during labor and birth. Beta-endorphin also protects the fetus from hypoxia during labor and birth and potential neural damage by aiding blood flow to the brain under hypoxic conditions. It has been suggested that a variety of pharmacologic and nonpharmacologic complementary therapies, when used in pregnancy, labor, and birth, activate the opioid receptors in the CNS and alter the sensation of pain during labor and birth, affect the mother-child attachment and affect sexual function. These studies report contradictory results that will be discussed in this chapter.

Sexual Function and Satisfaction in the Context of Obesity

PURPOSE OF REVIEW

Sexual dysfunction is commonly associated with overweight/obesity, but the underlying physiological and psychosocial mechanisms are not fully understood. This review contextualizes the obesity-sexual (dys)function relationship, describes recent insights from the medical and social science literature, and suggests opportunities for continued research.

RECENT FINDINGS

Although sexual dysfunction has been historically evaluated as a consequence/outcome of obesity, it is increasingly considered as a harbinger of future metabolic comorbidities, including type 2 diabetes and cardiovascular disease. Body image dissatisfaction is a consistent predictor for lower sexual satisfaction across BMI categories, likely mediated by cognitive distraction during partnered sex. To fully capture the relationship between obesity and sexual dysfunction, multidisciplinary research approaches are warranted. While clinically significant weight loss tends to improve sexual functioning for women and men, higher body image satisfaction may independently promote sexual function and satisfaction without concomitant weight loss.

Female sexual dysfunction in an outpatient andrology clinic-A therapeutic opportunity?

INTRODUCTION

The sexual life of a couple is a dynamic entity, in which the two influence each other mutually, thus the existence of female sexual dysfunction (FSD) can influence the treatment of the man who seeks clinical help. Identify sexual dysfunction in female partners of patients attending an andrology clinic may provide a therapeutic opportunity. The authors aim to assess proportion of FSD in this population by comparison with a control group.

MATERIAL AND METHODS

A longitudinal study over 12 months timespan. The female partners of patients attending the andrology clinic participating in the study (study group - SG) completed the Female Sexual Function Index (FSFI), as did the women serving as controls (control group - CG). Further data such as age, duration and quality of the relationship and previous relationships was also collected.

RESULTS

Of the 30 women included in the SG, 14 (46.6%) considered that their current sex life was worse than in previous relationships. Of the 20 women in the CG, 60% considered that their current sex life was better. In the SG, 22 (73.3%) had FSD, with a mean score in the FSFI of 20.5, whereas only 3 women in the CG (15%) had FSD, with a mean score of 30.7 (p<0.01).

CONCLUSIONS

Our study demonstrated that the proportion of FSD in female partners of patients attending an andrology clinic is significantly higher than control group. FSD treatment should be considered as a therapeutic opportunity for the couple in this setting.

Emotional and autonomic response to visual erotic stimulation in patients with functional hypothalamic amenorrhea

Introduction

Functional hypothalamic amenorrhea (FHA) is a clinical condition associated with high levels of physiological and psychological stress ranging from weight loss to maladaptive behavior and coping skills. A reliable measure of the psychophysiological response to stress and the ability to cope with stimuli is heart rate variability (HRV). Through the sympathetic (SNS) and parasympathetic nervous system (PNS), the autonomic nervous system (ANS) promotes various changes in HRV that reflect the individual's psychophysiological response to stress. FHA patients are characterized by high levels of PNS activation during psychological load, suggesting that parasympathetic hyperactivation could be a pathology marker.

Methods

In the present study, we examine changes in HRV during observation of erotic, neutral, and disgusting images in 10 patients with FHA [(mean ± S.D.) age: 26.8 ± 5.9] and in 9 controls (age: 25.4 ± 6.4; BMI: 22.47 ± 2.97) to assess the differential activation of PNS and SNS between FHA patients and controls matched for age and without other clinical conditions.

Results

Our results showed that FHA patients had significantly higher HRV activation while observing high emotional value images and not during the observation of neutral images confirming a parasympathetic hyperactivation.

Discussion

HRV and cognitive and psychological testing, could provide new insights into understanding such a clinically understudied condition and provide further tools for clinical diagnosis and treatment.

Obesity, Body Image Dissatisfaction, and Sexual Dysfunction: A Narrative Review

With approximately two-thirds of the United States adult population classified as overweight or obese, obesity remains a critical public health concern. Obesity not only contributes to several health complications including type 2 diabetes mellitus and cardiovascular disease, but the condition is also associated with sexual dysfunction in both women and men. Despite evidence linking obesity and its concomitant pathophysiology to sexual problems, the potential roles of psychosocial factors such as body image are understudied. This narrative review evaluates the research linkages between obesity and sexual dysfunction, with particular attention to the potential effects of body image dissatisfaction. A literature search of biomedical and psychological databases was used to identify research pertaining to obesity, sexual function, and/or body image constructs. The pathophysiological effects of obesity on sexual function are well-documented in mechanistic studies and animal trials, often with corroboration in human clinical samples. However, very few studies examine obesity, body image, and sexual function in tandem. Body image dissatisfaction appears to independently impinge upon the sexual response cycle and mental health outcomes, irrespective of body weight. While obesity is often associated with negative body image appraisal, it is unclear whether these constructs exert additive, synergistic, or antagonistic effects on sexual responsivity. Additionally, overweight/obese individuals who exhibit higher levels of body image satisfaction or self-confidence appear to be protected from the deleterious effects of obesity on sexual satisfaction, at least to some extent. Greater reliance upon conceptual/theoretical models from the body image literature may better clarify the relationships between these constructs.

The Heteronormativity Theory of Low Sexual Desire in Women Partnered with Men

Low sexual desire in women partnered with men is typically presumed to be a problem-one that exists in women and encourages a research agenda on causation and treatment targeting women. In this paper, we present a distinct way forward for research on low sexual desire in women partnered with men that attends to a more structural explanation: heteronormativity. A heteronormative worldview assumes that relationships and structures are heterosexual, gender (usually conflated with sex) is binary and complementary, and gender roles fit within narrow bounds including nurturant labor for women. We propose the heteronormativity theory of low sexual desire in women partnered with men, arguing that heteronormative gender inequities are contributing factors. We outline four hypotheses and their predictions related to: inequitable divisions of household labor, blurring of partner and mother roles, objectification of women, and gender norms surrounding sexual initiation. We discuss some mechanisms-social, physiological, and otherwise-for the heteronormativity theory, especially related to stress, objectification, and nurturance. We close by noting some limitations of our paper and the ways that the heteronormativity theory of low sexual desire in women partnered with men provides a rigorous, generative, and empirical way forward.

The Role of Bupropion in the Treatment of Women with Sexual Desire Disorder: A Systematic Review and Meta-Analysis

Although few clinical trials examined the efficacy of bupropion to treat sexual dysfunction among female patients, a comprehensive and objective synthesis of the best available evidence is still lacking. To date, to the best of our knowledge, there are no published systematic reviews or meta-analyses specifically focusing on the role of bupropion in the treatment of female sexual dysfunction. The main objective of the present study was to evaluate the efficacy of bupropion in the treatment of female sexual dysfunction, and we hypothesized that bupropion is efficient in treating female patients with sexual dysfunction. This review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic search for published literature was performed using Ovid, Medline, Scopus, Cochrane Library, Science Direct, and PubMed databases. In our study, we found that bupropion was almost three-fold more favorable in improving problems with sexual desire (pool estimate 2.845, 95% CI: 0.215 to 5.475, I2= 95.6%, p=0.034). A meta-regression was performed to explore heterogeneity and we found that only the dosage of bupropion was statistically significant in explaining the variance, i.e., the lower the dosage (150 mg vs. 300 mg), the better the improvement in the sexual desire of women with hypoactive sexual desire disorder (HSDD). Based on the results of this systematic review and metaanalysis, there is a potential role of bupropion as an effective treatment for women with HSDD.

Factors associated with sexual practices and positions performed by pregnant women: a cross-sectional study

OBJECTIVES

to identify factors associated with the sexual practices and positions performed by pregnant women.

METHODS

a cross-sectional, quantitative study conducted with 354 pregnant women, in the interior of Ceará, Brazil, in 2016. For data collection, a form and a Pregnancy Sexuality Questionnaire were used.

RESULTS

there was a reduction in the sexual initiative of the woman, sexual disposition of the couple, sexual practices and most of the sexual positions, while the maintenance of preliminary sexual activities and initiative to perform them was verified. Sexual practices and positions decreased (p<0.0001): preliminary sexual activities, sexual disposition, lubrication, orgasm, pain or discomfort, sexual positions, sexual practices, and sexual satisfaction. Sexual practices and positions increased (p<0.0001) as a function of: education, number of deliveries, sexual life, desire and arousal, and sexual disposition of the pregnant woman, frequency of orgasm and of sexual practices (p<0.0001).

CONCLUSIONS

sexual practices and positions of pregnant women were affected by domains of sexual function, sexual, reproductive, physical, and psychological aspects.

Treatment for vaginal atrophy using microablative fractional CO2 laser: a randomized double-blinded sham-controlled trial

OBJECTIVE

The aim of this study was to evaluate the efficacy of vaginal CO2 laser for the treatment of vaginal atrophy compared to the sham procedure.

METHODS

Between June 2016 and May 2017, postmenopausal women with moderate to severe intensity of any vaginal atrophy symptoms (VAS) were invited to participate in the study. A total of 88 women were randomized to receive treatment with either vaginal CO2 laser or sham procedures every 4 weeks for three sessions. Both the participants and the evaluators were blinded to the treatment. Vaginal Health Index (VHI) score (primary outcome), VAS score, and the item for vaginal dryness from the International Consultation on Incontinence Modular Questionnaire-Vaginal Symptoms questionnaire were compared between the two groups by intention-to-treat analysis at 12 weeks after treatment.

RESULTS

Eighty-eight women were enrolled into the study and nine women were lost to follow-up. After 12 weeks of laser treatment, the VHI, VAS, and International Consultation on Incontinence Modular Questionnaire-Vaginal Symptoms (item for vaginal dryness) scores were significantly improved. For VHI and VAS scores the mean difference between the laser group versus the sham group was 1.37 (95% CI: 0.12-2.63), P < 0.001 and -1.52 (95% CI: -2.21 to -0.82), P = 0.03, respectively.

CONCLUSIONS

This study demonstrated that the application of microablative fractional CO2 laser was effective in treating vaginal atrophy. It could be a promising alternative treatment for postmenopausal women with vaginal atrophy. : Video Summary:http://links.lww.com/MENO/A582.

Sexual Satisfaction: Exploring the Role of Flow

Sexual satisfaction plays an important role in relationship, mental, and even physical health. Activities that produce a state of flow create meaning in people's lives. Although people who report high levels of sexual satisfaction describe their sex lives as being very meaningful, there is little research on the relationship between sexual satisfaction and flow. This study sought to address this gap. One hundred participants who were in monogamous relationships completed an online survey consisting of two questionnaires-the New Sexual Satisfaction Scale and the Core Dispositional Flow State Scale. We used partial least square structural equation modeling approach to examine the association between flow and sexual satisfaction. We found that flow was a statistically significant positive predictor of both partner-focused and personal sexual satisfaction. Our results indicate that there are no statistically significant gender differences.

When Desire Fades: Women Talk About Their Subjective Experience of Declining Sexual Desire in Loving Long-term Relationships

Women's sexual desire has been shown to decline over the course of loving long-term relationships. Yet, accounts of partnered women's subjective experience of this occurrence are rather limited. In order to broaden the examination of this topic, the present exploratory qualitative study extended it cross-culturally to explore how women in Israel are impacted by, perceive, and experience this decline in their sexual desire, with the objective of sketching an account of the experiences of women who share this reality. Semi-structured interviews were conducted with 15 women, aged 25 and over, in fulfilling long-term heterosexual relationships. The participants reported a sharp decline in sexual desire in comparison to the early stages of the relationship, experiencing it as quite perplexing given their love and affection for their partner. All also described their intimate connection as based on much more than sex. Additionally, while the reduction in desire did not result from difficulties in the relationship it did create some. These included frustration, conflict, and pressure from partner, which often led to sexual compliance on the women's part. Suggested solutions included open and honest dialogue, thoughtfulness, and mutual respect. A critical discussion of the findings outlines implications for partnered women's and couples' wellbeing.

Sexuality and Associated Factors in Chronic Obstructive Pulmonary Disease (COPD) Patients Attending a Referral Hospital in Northeastern Brazil

The aim of this study was to evaluate sexual function in male and female COPD (chronic obstructive pulmonary disease) patients and identify associated factors. Methods: This is a cross-sectional study on 52 COPD patients treated at an outpatient pneumology service of a referral hospital in Northeastern Brazil. Information was collected on demographic, clinical and spirometric variables and exercise capacity. The following instruments and scores were used: modified Medical Research Council (mMRC) for dyspnea, SF-36 for quality of life (QoL), the Beck Depression and Anxiety Inventory, Male and Female Sexual Quotient. Results: Sexual function was satisfactory/excellent in 17% (9/52) and poor/absent in 82% (43/52). Patients with poor/absent sexual function tended to have lower scores on the domain mental health summary score of SF-36 (p = 0.007) and higher anxiety and depression scores than patients with satisfactory/excellent sexual function (p = 0.02 and p = 0.01). In the multivariate analysis, patients with high depression scores displayed a greater likelihood of poor/absent sexual function (OR = 1.13; 95% CI = 1.02-1.25). Conclusion: COPD patients presented a high rate of sexual dysfunction and compromised sexuality was associated with depression.

Disfunção sexual em mulheres com câncer do colo do útero submetidas à radioterapia: análise de conceito

Resumo Objetivo analisar o conceito de disfunção sexual em mulheres com câncer do colo do útero submetidas a tratamento radioterápico. Método estudo de análise de conceito fundamentado no referencial metodológico proposto por Walker e Avant, o qual é composto por oito etapas: seleção do conceito; determinação dos objetivos da análise conceitual; identificação dos possíveis usos do conceito; determinação dos atributos críticos ou essenciais; construção de um caso modelo; construção de casos adicionais; identificação dos antecedentes e consequentes do conceito; e definição das referências empíricas. Resultados a amostra final resultou em 11 artigos, que identificaram 4 atributos críticos, 18 antecedentes e 07 consequentes do conceito, os quais permitiram a construção de uma definição conceitual e elaboração de um caso-modelo, com a finalidade de exemplificar o contexto social no qual o conceito encontra-se inserido. Conclusão e implicações para prática alterações na estrutura corporal, déficit de conhecimento, diminuição da frequência das relações sexuais, dispareunia e indiferença do parceiro são alguns dos principais antecedentes e consequentes da disfunção sexual na população estudada. Entretanto, esses fatores ainda são pouco conhecidos, o que limita a realização de ações de promoção, prevenção e reabilitação sexual, sobretudo no campo da enfermagem.

Effectiveness of postpartum sexual health education programme structured according to Levine's conservation model: An interventional study

AIM

This study aimed to determine the effects of a postpartum sexual health education programme structured according to Levine's conservation model on postpartum women.

METHODS

The interventional study was completed with 67 postpartum women. The intervention group was given the postpartum sexual health education programme structured according to Levine's conservation model. The control group received routine discharge training. The data were collected using a personal information form, The Index of Female Sexual Function, Arizona Sexual Experience Scale and Golombok-Rust Inventory of Sexual Satisfaction.

RESULTS

It has been determined that the decrease in sexual arousal and desire is the first among postpartum sexual problems experienced by women. This study demonstrated that sexual function, sexual satisfaction and sexual response were higher in nonbreastfeeding women, women who had sexual intercourse one to three times a week and women who could talk to health care professionals on sexual matters. After the programme, the intervention group had more adequate sexual function, and they developed a strong, easy and satisfactory sexual response than the control group (p < 0.05).

CONCLUSION

This programme was effective in increasing the sexual functions and satisfaction of the postpartum women. Models provide guidance to nurses for provision of care in a systematic manner.

Endorphins, oxytocin, sexuality and romantic relationships: An understudied area

Endorphins are the body’s natural opioids that are created and released by the central nervous system, hypothalamus and pituitary gland. Endorphins have a reputation for pain reduction, enhancing excitement or satisfaction, boosting confidence, enabling control of emotions and generating feelings of euphoria, and are involved in the natural reward cycle. There is also evidence in the literature suggesting the role of endorphins in sexuality (including sexual function and sexual behaviours), as they may regulate the release of sex hormones, prolactin and growth hormone, which are involved in sexual function and love. Endogenous oxytocin is another intrinsic hormone whose role in inducing labour contractions, the delivery of the baby and stimulating lactation has been well studied. However, the potential impact of endorphins and oxytocin on sexuality and romantic relationships is not well understood. This article reviews the research on endorphins and endogenous oxytocin and how they relate to human sexuality and romantic relationships. Some animal studies report the effect of endorphin and oxytocin on sex hormones and mating behaviours, but these findings have not been supported by research into human behaviour, indicating many gaps in knowledge relating to the association between these hormones and human sexuality.

Identification and localization of epithelial progenitor cells in the vagina

The purpose of this study was to identify and localize mucosal epithelial progenitor cells (EPCs) in the rat vagina. Rat vagina was obtained from f77emale Sprague-Dawley rats (12 weeks old, n = 20). To identify EPCs in vagina, we followed a single-cell isolation protocol and analyzed the number of cells staining positive for EPC markers by flow cytometry. The expression of EPC-specific markers (CD44, ERα, PR) was evaluated by immunofluorescence. As shown by confocal immunofluorescence, CD44/ERα double-labeled cells were mainly expressed in the basal cell and suprabasal cell layers. Immunofluorescent staining of CD44 was expressed in the plasma membrane of the vaginal epithelium, and ERα was expressed in the cytoplasm of the vaginal epithelium. The CD44/ERα double-positive cells were noted in the rat vagina by flow cytometric analysis. PR-labeled cells were localized in the intermediate layer of the epithelial space of the vagina. The results revealed the existence of EPCs in the vagina. These findings imply that resident EPCs may have a role in the regeneration of vaginal mucosa.

For new mothers, the relationship matters: Relationship characteristics and postpartum sexuality

Postpartum sexuality has traditionally been studied using a biomedical framework, which focuses on how the physical and biological changes that occur during pregnancy and childbirth affect the resumption of pain-free intercourse. The current study sought to use a more inclusive and contextual approach by investigating how relationship characteristics are related to postpartum sexual desire and predict the resumption of a variety of sexual activities. A total of 188 new mothers who were within one year postpartum completed an online study. The Sexual Desire Inventory was used to measure solitary and dyadic sexual desire. Relationship satisfaction was measured using the Relationship Assessment Scale and perception of partner's sexual desire was measured using three modified questions from the Sexual Desire Inventory. New mothers were also asked to report when they resumed a variety of sexual activities in the postpartum period. Relationship satisfaction and perceptions of partner's desire were negatively correlated with solitary sexual desire, and relationship satisfaction was positively correlated with dyadic sexual desire. Birth-related factors were not related to postpartum sexual desire. New mothers' perception of their partner's desire predicted the resumption of most sexual activities in the postpartum (i.e., manual stimulation of new mother's and partner's genitals, oral stimulation of partner's genitals, penile-vaginal intercourse). Relationship satisfaction predicted the resumption of oral stimulation of the new mother's genitals. The results of this study support the incorporation of contextual factors, such as relationship characteristics, and the inclusion of non-penetrative sexual activities in the study of postpartum sexuality.

Spinal cord injury and women's sexual life: case-control study

Study design :This is a case-control study.

OBJECTIVE

The objective of this study was to estimate the magnitude of association between spinal cord injury (SCI) and women's quality of sexual life and sexual function.

SETTING

This study was conducted in the Brain and Spinal Cord Injury Research Center, Tehran University of Medical Sciences, Tehran, Iran.

METHODS

From the referral university-based clinics, we used simple random sampling to recruit 62 women: 31 women with SCI and 31 women without SCI. Socio-demographic and reproductive traits questionnaire, Sexual Quality of life-Female (SQOL-F), Female Sexual Function Index (FSFI) and Spinal Cord Independence Measure (SCIM) were completed using telephone and face-to-face interviews in the cases and controls. After univariate analyses, multivariate linear and proportional odds regression models were conducted to investigate the relation between SCI and women's quality of sexual life, as well as sexual function.

RESULTS

The mean age of cases and controls was 35.42±6.51 and 33.77±4.02 years. Most women were high school-educated and housewives. Adjusting for probable confounders, the proportional odds regression model showed a significant relationship between the spinal cord injury (AOR=4.2, 95% CI: 1.8-9.2), non-college-educated (AOR=3.1, 95% CI: 1.2-5.9) and employed (AOR=1.8, 95% CI: 1.1-1.8) variables and being in one of the moderate or poor quality of life classes. Scores of SQOL-F and FSFI domains, except satisfaction, were significantly worse in cases versus controls (P<0.001).

CONCLUSION

Although our participants showed low sexual dysfunction, they tended to report moderate to poor quality of sexual life. Our findings support the implication that sexual rehabilitation must be provided for women with SCI soon after injury.

Further Validation of the Female Sexual Function Index: Specificity and Associations With Clinical Interview Data

Female sexual function is a multi-faceted psychophysiological construct. The Female Sexual Function Index (FSFI) is considered a "gold standard" self-report instrument that assesses the various aspects of sexual function. However, researchers have recently proposed potential limitations of the FSFI, highlighting the need for continued validation research. The aims of the current analyses were (a) to assess the correlations between FSFI scores and information regarding specific rates of functional impairment gained via clinical interview; and (b) to assess the specificity of FSFI subscale scores in reflecting corresponding aspects of sexual function (e.g., whether the Sexual Desire subscale reflects sexual desire specifically rather than sexual arousal, orgasm, etc.). The participants were 97 sexually active women who reported impairments in sexual function. Clinical interview data exhibited moderate-to-strong correlations with FSFI scores. Additionally, FSFI subscales generally exhibited adequate specificity in terms of reflecting their corresponding aspects of sexual function more strongly than other aspects. The results generally supported the validity of the FSFI. Implications for the measurement and conceptualization of female sexual function are discussed.

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.

Loss of sexual interest and premenstrual mood change in women with postpartum versus non-postpartum depression: A nationwide community sample of Korean adults

BACKGROUND

Postpartum depression (PPD) is a type of clinical depression that can affect women after childbirth. Few previous studies have explored the association of depressive and physical symptoms among women with PPD in a nationwide community study.

METHOD

A total of 18,807 adults, randomly selected, completed a face-to-face interview using the Korean version of Composite International Diagnostic Interview (K-CIDI) (response rate 80.2%). PPD was defined as a major depressive episode that began within 4 weeks after delivery.

RESULTS

Of 679 female subjects with major depressive disorder (MDD), 14.0% (n=95) experienced PPD. Subjects with PPD were significantly more likely to have higher income, education, and reside in an urban area, compared to those with non-PPD. No significant differences were found in number of children. Multiple logistic regression revealed that the loss of sexual interest was the only symptom among 23 depressive symptoms that was significantly associated with depressive episodes among individuals with PPD (AOR=1.91, 95% CI 1.01-3.60) when compared with non-PPD. Loss of sexual interest was also significantly associated with the subjects with lifetime PPD regardless of depressive episode (AOR=1.93, 95% CI 1.12-3.31). Conversely, loss of confidence and loss of pleasure were less frequent in subjects with PPD. Premenstrual mood change (χ(2)=5.57, p=0.0036) and comorbid alcohol use disorder (χ(2)=5.11, p=0.031) showed a valid association with PPD.

CONCLUSIONS

Loss of sexual interest and premenstrual mood change were associated with women with PPD, whereas those with non-PPD were not, thereby suggesting the possible link between sexual hormones and PPD.

Review of Naturopathy of Medical Mushroom, Ophiocordyceps Sinensis, in Sexual Dysfunction

Sexual dysfunctions including desire, arousal, orgasm, and pain disorders are increasing worldwide due to etiological factors and aging. Several types of treatment are claimed in modern medicine, but they have serious side effects and higher costs. In fact, alternative approaches, such as the intake of plants, fungi, and insects, or their extracts, have also been practiced to enhance sexuality and ameliorate illness with notable successes. However, the scientific evidence related to the mechanisms and efficacy of these alternative medicines is both scarce and all too often unconvincing. Ophiocordyceps sinensis is an Ascomycetes fungus parasitic to Lepidoptera larvae, and has long been used as medicine to treat many illnesses and promote longevity in Chinese society. Previous investigations have shown that O. sinensis has many pharmacological activities. This review has focused on illustrating that O. sinensis can enhance libido and sexual performance, and can restore impaired reproductive functions, such as impotency or infertility, in both sexes.

Transition Stages in Adjustment of Wives With Their Husbands’ Erectile Dysfunction

Background:

No study has been conducted yet on the process of adjustment of wives with their husbands’ erectile dysfunction in the transitional stages, and there is lack of understanding of this process in Iran.

Objectives:

A qualitative, grounded-theory study was designed to examine the process of adjustment of wives with their husbands’ erectile dysfunction in transitional stages.

Materials and Methods:

Purposive sampling was carried out in Tehran, Iran. Data collection occurred until the theoretical saturation was reached. A total of 16 semi structured in-depth interviews were conducted with 15 woman participants. The constant comparative method of data analysis was used.

Results:

The women were 29-53 years old and duration of marriage was 2-40 years. They had different educational status ranging from Illiterate to Master’s degree. The present study showed the process of adjustment of wives with husbands’ erectile dysfunction in categories of husband broken role, ups and downs in woman’s sexual life, passing through failure, and end of transition. Following erectile dysfunction (event) and the man’s reaction, broken role occurs (change). In response to this change, reactions due to loss of intimacy occur in the ups and downs of woman’s life. Some women, unable to get through the failure, continue low quality life with sexual and communicational problems (limbo). By the end of transition, some women manage to overcome this unpleasant state of limbo, and begin to experience a new life, with increased intimacy, with or without sexual intercourse (new beginning).

Conclusions:

If the process of transitional adjustment occurs in women, it will be effective in improving the relationship and increased intimacy, even sexual intimacy. With this understanding, better counseling and therapeutic interventions can be planned for these couples.

Urogynecological effects of menopause

The menopause signifies a period after significant hormonal change that affects all estrogen-sensitive tissues. This change may result in symptoms affecting any part of the urogenital system. These changes can significantly affect women's health and quality of life. The menopause is associated with lower urinary tract symptoms, vulvovaginal symptoms and pelvic organ prolapse. In this article, we have aimed to describe the symptomatology along with pathophysiology of the effects of menopause on urogynecological problems affecting women's health. Other factors apart from menopause add to these symptoms, like parity, mode of delivery, obesity, smoking and poor psychological health.

Investigating the sexual function and its associated factors in women with chronic illnesses

AIMS AND OBJECTIVES

To evaluate sexual dysfunction and the factors that affect sexual dysfunction in women with chronic disease.

BACKGROUND

Sexual dysfunction is one of the most common problems in women with chronic disease. There is limited understanding of the related factors of sexual dysfunction in women with chronic disease, with research currently limited to other problems and problems related to chronic diseases.

DESIGN

This research was conducted as a descriptive survey.

METHODS

This study involved 100 female inpatients at clinics of internal medicine of a university hospital. Data were collected with a patients identification form and a female sexual function index (KCFI). Kruskal-Wallis test, test of significance of difference between two means and test of significance of difference between two pairs were used in the data analysis.

RESULTS

Sixty-five percentage of women in the sample were defined to have sexual dysfunction. The majority of women expressed pain during sexual intercourse, problems in orgasm and satisfaction, and reluctance to have sex. Older age, being unemployed, being in menopause, fatigue, sleep disorder, and pain and weakness in extremities were the factors that were found to significantly affect the prevalence of sexual dysfunction (p < 0.05).

CONCLUSIONS

This study concluded that sexual function of women with chronic disease is affected negatively. Chronic disease-related symptoms, experienced changes in the body and psychosocial problems are changing the lives of women. Ultimately, these changes also affect sexual activity.

RELEVANCE TO CLINICAL PRACTICE

Determination of the factors affecting sexual activity in women with chronic disease is important for women' ability to cope with sexual dysfunction and keep it under control. To be able to accomplish this, it is necessary for healthcare personnel, the partners and family to work together.

Sexual functioning in young women in the context of breast cancer treatment

Breast cancer is the most common type of cancer among women worldwide. The number of breast cancer survivors has been growing because of earlier detection and improved treatment. Young women under 50 years of age account for relatively small percentage of all newly diagnosed breast cancer patients. However, their medical and psychosocial context of the disease is unique. Breast cancer is diagnosed at the most productive time in life. Concerns about childbearing, partner rejection, sexual function, body image, sexual attractiveness and career are common. For all these reasons experience of breast cancer diagnosis and treatment among young women requires special attention. Researches indicate that oncological treatment may negatively affect female sexual functioning. Chemotherapy is one of the greatest risk factors of sexual dysfunctions, especially when it results in medication-induced menopause. The duration and severity of sexual problems depend on a wide variety of factors: medical, psychological and interpersonal. These side effects may last for many years after the end of treatment. It is known that breast cancer affects both patients and their partners. The first sexual experience after surgery may be a turning point in sexual adaptation in couples. Communication is crucial in this process. More knowledge about sexual difficulties and sexual adaptation process of young breast cancer survivors (YBCSs) and their partners is needed. Knowing protective and risk factors is necessary to identify couples at risk for sexual dysfunctions in order to professionally support them in the best way and at the right time.

Sexuality and stroke: the effects and holistic management

Since the days of the early pioneering work of authors such as Glover (1985) and Woods (1987), there has been a proliferation of research and practice guidelines related to the effects of ill health on individuals' and couples' sexuality and sexual health (Reis et al, 2010; Sadovsky et al, 2010; Royal College of Nursing, 2000). This article reviews the common difficulties experienced by individuals and couples affected by stroke regarding to their sexuality and sexual health. Furthermore, it presents and explores a possible model of care that can be used in practice to address these difficulties with people affected by stroke.

Sexual arousal difficulties in women treated with antidepressants: a comparison between escitalopram and fluoxetine

OBJECTIVE

To compare the risk of sexual arousal difficulties between two groups of depressed female patients in remission who were treated with either escitalopram or fluoxetine. Associated factors were also examined.

METHODS

This was a cross-sectional study involving 112 female patients attending the psychiatric clinic, University Kebangsaan Malaysia Medical Centre (UKMMC) with depressive disorders as assessed by using the Structured Clinical Interview for DSM-IV (SCID), who had been in remission for the previous 2 months as defined by a score of < or = 10 from an assessment using the Montgomery-Asberg Depression Rating Scale (MADRS) and were treated with either fluoxetine or escitalopram. Sexual arousal difficulties were assessed using the arousal subscale of Malay Version of the Female Sexual Function Index (MVFSFI).

RESULTS

The rate of sexual arousal difficulties was 41.1% for all subjects. Sexual arousal difficulties occurred in 50.0% of subjects treated with fluoxetine and 32.1% with escitalopram. However, this difference was not statistically significant (p = 0.055). Multivariate logistic regression analysis showed that higher dose of antidepressant (adjusted OR = 4.08, 95 CI = 1.70-9.81) was significantly associated with female sexual arousal difficulties.

CONCLUSION

The risk of sexual arousal difficulties was higher in female patients who were treated with higher doses of either fluoxetine or escitalopram.

Quantity vs. quality: an exploration of the predictors of posttreatment sexual adjustment for women affected by early stage cervical and endometrial cancer

INTRODUCTION

Women with early stage cervical and endometrial cancer may experience complex posttreatment changes to their sexual function, but clinical practice and past research have focused more on the quantity than the perceived quality of sexual life.

AIM

The aims of this prospective study were to explore the following: (i) the relative importance of quantity vs. quality of sexual life over the first year posttreatment; (ii) the psychological and sexual predictors of overall sexual function; and (iii) the relationship between sexual function and quality of life (QoL).

METHODS

Fifty-three cancer patients completed standardized measures at baseline, with follow-up at 6 and 12 months posttreatment. Analyses were based on prespecified linear mixed models with overall sexual function and QoL as outcomes, and quality and quantity of sexual life, anxiety, and depression as the main predictors of interest. Radiotherapy, age, and relationship satisfaction were controlled for as potential confounders.

MAIN OUTCOME MEASURES

Derogatis Sexual Functioning Inventory subscales to assess quantity (Drive) and quality (Satisfaction) of sexual life, and overall sexual function (Global Sexual Satisfaction Index); Functional Assessment of Cancer Therapy--General to assess QoL; Hospital Anxiety and Depression Scale to assess psychological distress; and Relationship Satisfaction Interaction Scale to assess relationship satisfaction.

RESULTS

The models demonstrated that: (i) overall sexual function was predicted more strongly by the perceived quality than the quantity of sexual interactions, (ii) a small change in perceived quality had a large impact on overall sexual function, and (iii) overall sexual function was a predictor of QoL.

CONCLUSION

This study found that quality rather than quantity of sexual life is the best predictor of overall sexual function among women treated for early stage cervical and endometrial cancer, indicating the importance of including quality indices in posttreatment sexual assessment in clinical practice and research studies.

Sexual problems in women during the first postpartum year and related conditions

AIM

The aim of this study was to evaluate the sexual problems in women during the first postpartum year and related conditions.

BACKGROUND

In the postpartum period, women encounter numerous physical, psychological and sociocultural factors. These factors negatively affect both the sexual function and the quality of life of woman.

DESIGN

A descriptive survey.

METHODS

In this study, 230 women were included. The study was conducted between September 2007 and December 2008 in Izmir, Turkey. A questionnaire form developed by authors, the Arizona Sexual Experience Scale-female version and the Beck depression inventory were applied for participants.

RESULTS

The women began to have sexual intercourse within 7·06 weeks after delivery. Of the women, 58·3% reported that they had dyspareunia in the postpartum period. According to Arizona Sexual Experience Scale, the total score was ≥ 11 in 91·3% of women and they had sexual problems in the first postpartum year. The results of the multivariate analysis revealed that the increase in age, the presence of sexual problems during pregnancy and the increase in time after delivery significantly increased the possibility of postpartum sexual problems.

CONCLUSION

This study revealed that the majority of the women had postpartum sexual problems and the possibility of postpartum sexual problems increased with the increase in age, the presence of sexual problems during pregnancy and the increase in time after delivery.

RELEVANCE TO CLINICAL PRACTICE

Healthcare professionals should evaluate women in terms of their sexual functions during both pregnancy and postpartum period. Health education, counselling, referral services for early diagnosis and treatment might contribute to the protection and improvement of the sexual health of women during the postpartum period.

The Relationship between female sexual arousal and response bias in women with and without provoked vestibulodynia

Smaller correlations have typically been found between genital and subjective sexual arousal in female versus male samples. This study evaluated the association between response bias and the relationship between genital and subjective arousal (i.e., concordance) in women with (n = 20) and without (n = 21) provoked vestibulodynia. Participants (M = 21.27 years, SD = 2.27) underwent blood flow imaging via a laser Doppler imager to assess genital responsiveness to a visual erotic stimulus; subjective arousal was assessed during and following the film. The relationships between three types of subjective arousal ratings (perceived sexual arousal, perceived genital responsiveness, and reported desire to engage in sexual activity) and two forms of socially desirable responding (impression management and self-deceptive enhancement) were examined. Concordance estimates were statistically non-significant in both groups, with the exception of the desire to engage in sexual activity, which was moderately correlated with genital arousal in the control group. Impression management was not a statistically significant moderator of the relationship between genital and subjective arousal, but was moderately negatively related to the three forms of subjective arousal ratings in the provoked vestibulodynia group. The results highlight the importance of assessing response bias in laboratory studies comparing women with and without sexual dysfunction.

Mood disorders and sexual functioning in women with functional hypothalamic amenorrhea

OBJECTIVE

To investigate the sexual function of women with functional hypothalamic amenorrhea (FHA) and to test the mediating effects of depression and anxiety on the sexual functioning of women with FHA.

DESIGN

In this cross-sectional study, participants completed questionnaires on sexual function, depression, and anxiety.

SETTING

Tertiary care university hospital.

PATIENT(S)

Women with (n=41) and without (n=39) FHA recruited from a gynecologic endocrinology unit.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

The McCoy Female Sexuality Questionnaire assessed sexual function, and the Zung Scale measured depression and anxiety.

RESULT(S)

Women with FHA experienced more sexual function problems and significantly higher depression and anxiety compared to women without menstrual dysfunction. In addition, depression offered a significant explanation for the sexual problems experienced by women with FHA.

CONCLUSION(S)

The psychologic symptoms that contribute to the onset of FHA partially mediate the relationship between FHA and sexual dysfunction.