Presence of a sexual problem may not affect women's satisfaction from their sexual function

Acupuncture modification treatment for female sexual dysfunction: A meta-analysis

BACKGROUND

Acupuncture has potential in the treatment of female sexual dysfunction (FSD), but its effectiveness needs to be verified.

AIM

A meta-analysis to provide a summary of studies that had investigated the efficacy of acupuncture as a treatment for FSD.

METHODS

A systematic screening was conducted on electronic databases such as Pubmed, Embase, Cochrane Library, CNKI, and CBM to select studies that met the criteria before April 2023. We only included those studies assessing women's sexual functioning by the Female Sexual Function Index (FSFI).

OUTCOMES

By calculating the relative risk (RR) using the standardized mean difference (SMD) and 95% confidence interval (CI), these data were combined to generate a summary of the findings. The pooled results were calculated using a random-effects model.

RESULTS

A total of 4 studies involving 178 participants were included, and the comprehensive results indicated a significant difference in FSFI scores between the acupuncture group and the control group. In the desire and arousal scale, there was a statistically significant difference between the acupuncture group and the control group. But in the scale of lubrication, orgasm, satisfaction, and pain, there was no statistically significant difference between the two groups.

CONCLUSION

A comparison of overall FSFI scores, sexual desire, and sexual arousal revealed that acupuncture treatment can improve female sexual dysfunction to some extent. However, in terms of vaginal lubrication, orgasm, sexual satisfaction, and sexual pain, acupuncture treatment did not significantly improve female sexual dysfunction. In the future, it is necessary to include more RCT trials and expand the number of patients analyzed to make the conclusions more reliable.

Sexual function after energy-based treatments of women with urinary incontinence. A systematic review and meta-analysis

INTRODUCTION AND HYPOTHESIS

Urinary incontinence (UI) affects approximately 50% of adult women worldwide and is associated with declining sexual function (SF). Energy-based devices emerged as a minimally invasive alternative treatment. Nevertheless, their effect on sexuality is uncertain. We hypothesize that the UI energy treatment can lead to sexual function improvement.

METHODS

A search was performed in PubMed, Cochrane Library, Web of Science, Embase, and Scopus for randomized clinical trials (RCTs) and nonrandomized studies of intervention, which treated incontinent women using energy, with UI and sexual function (SF) as outcomes. Severe comorbidities, pelvic organ prolapse (POP)> grade 2, and use of medication to treat UI or that affects SF were excluded. Quality assessment and meta-analysis were performed.

RESULTS

From 322 articles, 11 RCTs were included for qualitative analysis. UI symptoms improved in all studies. Regarding SF, RCT with premenopausal women showed improvement in SF in the Er:Yag group (Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12 and Female Sexual Function Index). A prospective study showed improvement in SF independent of the grade of SUI. RF showed benefits for SF but was not superior to pelvic floor muscle training. One nonrandomized study of intervention with a High-Intensity Focused Electromagnetic Field showed significant improvement of SF in the Golombok Rust Inventory of Sexual Satisfaction total score, a decline in pain and dissatisfaction domains. Meta-analysis with 4 RCTs and 2 nonrandomized studies found no difference between groups (0.26 (95% CI -0.67 to 1.20, and -0.74 (95% CI -3.78 to 2.30) respectively).

CONCLUSIONS

This meta-analysis did not confirm that energy equipment improved the SF of women with UI.

Who am I as a Sexual Being? The Role of Sexual Self-Concept Between Dispositional Mindfulness and Sexual Satisfaction among Child Sexual Abuse Survivors

Childhood sexual abuse (CSA) is associated with long-lasting and pervasive impacts on survivors' sexual health, particularly on their sexual satisfaction. Dispositional mindfulness has been found to be associated with greater sexual satisfaction among adult CSA survivors. However, the mechanisms involved in this association remain understudied. The present study examined the role of sexual self-concept (i.e., sexual esteem, sexual preoccupation, and sexual depression) in the relationship between dispositional mindfulness and sexual satisfaction among CSA survivors. A total of 176 adult CSA survivors (60.6% women, 39.4% men) completed an online survey assessing dispositional mindfulness, sexual self-concept, and sexual satisfaction. Path analyses revealed that dispositional mindfulness was positively related to sexual satisfaction through a significant indirect effect of higher sexual esteem and lower sexual depression. The integrative model explained 66.5% of the variance in sexual satisfaction. These findings highlight the key roles that dispositional mindfulness and sexual self-concept play in CSA survivors' sexual satisfaction. Implications for interventions based on trauma-sensitive mindfulness targeting the sexual self-concept are discussed, as they may promote sexual satisfaction in adult CSA survivors.

Positive body perception and its link to sexual satisfaction in aging women - findings from the Women 40+ Healthy Aging Study

Research on the relation between physical appearance and sexual satisfaction in aging women is scarce. This study uniquely links attractiveness, body perception, and sexual satisfaction in 124 healthy aging women. Two-thirds reported being highly sexually satisfied. BMI and fat mass correlated significantly with sexual satisfaction. Weight and shape concerns moderated this relationship, affecting sexual satisfaction beyond the effect of body size and composition. Given the "unattractive stereotype" of older women related to the enduring social beauty ideal of a youthful and thin body, positive body perceptions in light of age-associated bodily changes should be promoted.

The Impact of the COVID-19 Pandemic on Female Sexual Function in Jordan: Cross-sectional Study

BACKGROUND

Sexual function is a complex physiological process controlled by neurovascular and endocrine mechanisms that are affected by stressful events. The sexual response cycle consists of four main phases, which are sexual desire or libido, arousal or excitement, orgasm, and resolution. The COVID-19 outbreak is one of the most stressful events historically, causing several unpleasant consequences, including major physical and mental disorders, and sexual dysfunction and alteration in sexual behavior are possible anticipated consequences of the pandemic. Moreover, there are social taboos related to sexual behavior in Jordan, and the current knowledge on changes in Jordanian female sexual function during COVID-19 pandemic is limited.

OBJECTIVE

This study aims to evaluate the impact of COVID-19 on women's sexual function during the early COVID-19 pandemic in Jordan.

METHODS

This is a cross-sectional study that employed a web-based survey to follow 200 female individuals from the general population in Jordan. The survey evaluated sexual function both during COVID-19 and 6 months prior to the pandemic. The primary outcomes investigated in this study were the changes in sexual intercourse frequency and sexual function aspects, including desire, arousal, satisfaction, orgasm, lubrication, and pain during sexual activity. Data were analyzed using paired t test, McNemar test, Pearson correlations, and multiple linear regression using SPSS 25.

RESULTS

During the COVID-19 pandemic, the participants' sexual intercourse frequency increased while their sexual satisfaction was significantly changed. The proportion of participants who had 0-2 times per week of sexual intercourse was decreased during the COVID-19 pandemic compared with that before the pandemic (n=90, 45% vs n=103, 51.5%; P=.02). Conversely, the number of female individuals with 3-7 times per week of sexual intercourse increased after the pandemic compared with the prepandemic state (n=103, 51.5% vs n=91, 45.5%; P=.04). Female sexual satisfaction was significantly reduced after the COVID-19 pandemic compared with that before the pandemic (3.39 vs 3.30; P=.049). The other categories of sexual function, including desire, arousal, satisfaction, orgasm, lubrication, and dyspareunia showed no significant changes during the COVID-19 pandemic compared with the previous 6 months. There were no significant differences between the total sexual function mean scores during COVID-19 (15.73) compared with the prepandemic scores (15.85; P=.41). The total score of female sexual function during the pandemic was negatively associated with the participants' age and education level. Correlations between various demographics and sexual function categories during the COVID-19 pandemic were identified.

CONCLUSIONS

This is the first study exploring female sexual function during the COVID-19 outbreak in Jordan. The results suggest that COVID-19-associated stress is influencing women's sexual function, necessitating the provision of adequate emotional and physiological well-being support for women during similar crises.

Sexual health and sexual well-being of women with Mayer-Rokitansky-Kuester-Hauser syndrome after vaginal reconstruction: a qualitative analysis

BACKGROUND

Contradictory findings on sexual health in women with Mayer-Rokitansky-Kuester-Hauser syndrome (MRKHS) after vaginal reconstruction point toward the need for more profound assessment of this subject, particularly as it is still unclear what constitutes sexual well-being, especially genital self-image or sexual self-esteem, in women with MRKHS and neovagina.

AIM

The aim of this qualitative study was to assess individual sexual health and sexual well-being in the context of MRKHS after vaginal reconstruction, with an emphasis on genital self-image, sexual self-esteem, sexual satisfaction, and coping with MRKHS.

METHODS

Qualitative semistructured interviews were conducted with women with MRKHS after vaginal reconstruction (n = 10) with the Wharton-Sheares-George surgical method and a matched control group without MRKHS (n = 20). Women were surveyed about their previous and current sexual activities, perception of and attitudes toward their genitals, disclosure to others, coping with the diagnosis, and perception of surgery. Data were analyzed through qualitative content analysis and compared with the control group.

OUTCOMES

The primary outcomes of the study were major categories, such as sexual satisfaction, sexual self-esteem, genital self-image, and dealing with MRKHS, as well as subcategories related to the content analysis.

RESULTS

Although half the women in the present study indicated that they were coping well with their condition and were satisfied with sexual intercourse, most felt insecure about their neovagina, were cognitively distracted during intercourse, and showed low levels of sexual self-esteem.

CLINICAL IMPLICATIONS

A better understanding of expectations and uncertainties regarding the neovagina might help professionals to support women with MRKHS after vaginal reconstruction to increase sexual well-being.

STRENGTHS AND LIMITATIONS

This is the first qualitative study focusing on individual aspects of sexual well-being, especially sexual self-esteem and genital self-image, in women with MRKHS and neovagina. The qualitative study indicates good interrater reliability and data saturation. The limitations of this study include the inherent lack of objectivity resulting from the method but also the fact that all the patients had a particular surgical technique, consequently resulting in limited generalizability of these findings.

CONCLUSIONS

Our data indicate that integrating the neovagina into the genital self-image is a prolonged process that is essential for sexual well-being and should thus be the focus of sexual counseling.

Sexual dysfunction and quality of life in female patients with major depression disorder

Background

Major depression can negatively affect different domains in patients’ psychosexual life. Many females with depression have sexual dysfunction which goes under diagnosed leading to reduced sexual and overall health quality of life. The aim of this study is to evaluate the risk of sexual dysfunction, sexual quality of life, and general health quality of life in a sample of Egyptian females diagnosed with major depression compared to a control group.

Results

The sample consisted of 100 participants recruited by convenience sampling, divided into a case group (50 female patients diagnosed with major depression enrolled from our institute’s outpatient clinic) and a control group (50 apparently healthy matched females enrolled from employees working in the university hospitals). Patients answered The Structured Clinical Interview for DSM-IV Axis I Disorders, the Female Sexual Function Index, the Sexual Quality Of Life-Female, and the WHO Quality of Life. Descriptive data analysis showed that all patients with major depression had a higher risk of sexual dysfunction compared to 36% in the control group, with higher rates of marital conflicts, unemployment, positive psychiatric family history and lower monthly income than those in controls. Correlation analysis showed a positive correlation between the sexual quality of life in the case group and the psychosexual feelings (emotional intimacy), self-worthlessness and the total score domains of the FSFI, and a positive correlation with psychosexual feelings, sexual relationship satisfaction, and self-worthlessness domains in the control group. Female sexual functioning scores were positively correlated with most of the WHO quality of life domains in the case group.

Conclusions

Female patients with major depression are distinctly prone to sexual dysfunction and marital problems that can lead to both defective sexual and overall health quality of life. This mandates thorough screening of the psychosocial risks of sexual dysfunction in patients with depression for early management and more satisfactory quality of life.

Examining Associations Among Sexual Health, Unmet Care Needs, and Distress in Breast and Gynecologic Cancer Survivors

OBJECTIVES

This study evaluated breast and gynecologic cancer patients' sexual function, unmet needs related to sexuality, and distress.

DATA SOURCES

Secondary analyses of a cross-sectional survey study evaluated measures of sexual function (Female Sexual Function Index [FSFI]), unmet needs (Supportive Care Needs Scale), and distress (Patient Health Questionnaire). χ² test, t tests, and analysis of variances (ANOVAs) tested bivariate relationships. Subgroup comparisons were made based on the Female Sexual Function Index sexual dysfunction diagnostic cut-off score (<26.55; lower scores indicate greater dysfunction). A regression model tested associations between sexual function and unmet needs with distress as the outcome variable.

CONCLUSION

Clinically significant sexual dysfunction was common in this cohort of women. In multivariate modeling, worse sexual function and greater unmet sexuality needs related to greater distress. Future work should explore reasons behind the high levels of sexual dysfunction and unmet needs in female survivors.

IMPLICATIONS FOR NURSING PRACTICE

It is important to routinely screen for sexual health concerns among female cancer survivors at all phases of the cancer trajectory including years posttreatment.

Impact of Social Determinants of Health on Women's Satisfaction with Their Sexual Life and Its Relationship with the Use of Psychotropic Drugs: A Cross-Sectional Study

Sexual satisfaction (SS) is defined as an affective response arising from one’s subjective evaluation of the positive and negative dimensions associated with one’s sexual relationship. It is an important indicator of health. In women, SS has an important personal component consisting of the physical experiences of pleasure and the positive feelings and emotions that they experience in their affective-sexual relationships. The socioeconomic position is determined by income, educational level, and work, and it conditions women’s sexual health. We aimed to assess whether social determinants of health (income, education, work, and gender) are associated with women’s sexual satisfaction and to identify whether the impact of social determinants on sexual satisfaction differs with psychotropic consumption. We conducted a cross-sectional study designed to assess the association between variables related to the social determinants of health (work, education, income, and gender) and sexual satisfaction in women of reproductive age in La Rioja (Spain). The women in this study ranged in age from 17 to 52 years, with a mean age of 33.4 (Standar Deviation 8.6). Most were Spanish (82.9%), had undertaken non-compulsory specialized education (84%), and worked (72.7%). Regarding their relationships, 87% maintained monogamous relationships, 84.5% had stable relationships, and 65.7% lived with their partners. In total, 12.3% of the women were taking psychotropic drugs prescribed for the treatment of anxiety and/or depression. We observed that SS is significantly lower among women who have only undertaken compulsory education (Student-t = −4.745; p < 0.01), in those who have unstable affective-sexual relationships (Student-t = −2.553; p < 0.01), and in those who take psychotropic drugs (Student-t = −4.180, p < 0.01). We conclude that the social determinants of health such as education, not continuing to study beyond compulsory education, gender, and taking psychoactive drugs have a significant impact on women’s degree of satisfaction with their sexual life.

The prevalence and severity of mental health problems and sexual dysfunction in hemodialysis patients before and during the COVID-19 pandemic

INTRODUCTION

This study aimed to investigate the prevalence and severity of mental health problems and sexual dysfunction in hemodialysis patients before and during the COVID-19 pandemic.

METHODS

A total of 84 hemodialysis patients were evaluated in terms of Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory (BDI), International Index of Erectile Function (IIEF-5) and Female Sexual Function Index (FSFI).

RESULTS

Poor sleep quality (79.8%) and poor mental health status (62.7%) and higher likelihood of having depression (31.0 vs. 61.9%, p < 0.001) were noted. The IIEF-5 (10.5(5-25) vs. 7.5(5-23), p < 0.001) and FSFI (12(4-78) vs. 6(4-66), p < 0.001) scores were significantly decreased during the pandemic with an increase in the likelihood of having erectile dysfunction (p < 0.001).

CONCLUSION

Our findings indicate high prevalence of mental health issues, an impaired quality of life and an increase in prevalence and severity of suspected depression during pandemic in hemodialysis patients along with deterioration in erectile dysfunction among males.

Lower sexual satisfaction in women with polycystic ovary syndrome and metabolic syndrome

BACKGROUND

Polycystic ovary syndrome (PCOS) is a multi-symptom disorder linked with a range of metabolic and hormonal disturbances. Psychological and sexual aspects of PCOS also need to be considered.

OBJECTIVE OF THE STUDY

This study aimed to assess sexual satisfaction (SS) in PCOS patients and eumenorrheic controls (CON). The relationships between SS, depressive symptoms, health-related quality of life (HRQoL), and hormonal and metabolic profiles were evaluated.

METHODS

In this study, 190 patients with PCOS (mean age 26.34 ± 5.47 years) and 197 age-matched CON (mean age 27.12 ± 4.97 years) were enrolled. All subjects completed Polish version of the Sexual Satisfaction Questionnaire (SSQ), WHO Quality of Life-BREF (WHOQOL-BREF), and the Center for Epidemiologic Studies Depression Scale-Revised (CESD-R) questionnaire. Fasting blood samples were collected to assess hormonal, lipid, and glucose profiles. Anthropometric measures were collected. Metabolic syndrome (MS) was evaluated according to the IDF-AHA/NHLBI criteria.

RESULTS

Patients with PCOS and MS had lower SS vs non-MS-PCOS. There were no significant differences in the level of SS, presence of depressive symptoms, or HRQoL between PCOS and CON (P > 0.05). Negative correlations were found between the SS level and BMI, waist circumference, and waist-to-height ratio in PCOS women. However, overweight or obese PCOS women did not differ in SS levels vs normal-weight PCOS patients. The social dimension of WHOQOL-BREF was the only significant predictor of SS in PCOS patients.

CONCLUSIONS

SS in PCOS women appears to be undisturbed. However, MS in PCOS patients could negatively influence SS. The level of SS should be assessed in PCOS women, especially if MS is present.

Appearance Satisfaction as a Predictor of Specific Sexual Problems and Associated Distress

INTRODUCTION

Appearance dissatisfaction is a sensitive issue and has been tied to depression, dissatisfaction in romantic relationships, and reduced sexual satisfaction.

AIM

This study sought to examine associations between appearance satisfaction and specific sexual problems and related distress, testing also the moderating role of relationship satisfaction.

METHODS

A large web-sample of Norwegians in romantic relationships (N = 2,903) completed a one-time survey.

OUTCOMES

Participants reported on their experience of five different sexual problems and associated level of distress.

RESULTS

We found that appearance satisfaction was associated with reporting fewer sexual problems, and specifically, with a smaller likelihood of experiencing problems with lack of enjoyment, lack of excitement, and lack of climax. Furthermore, appearance satisfaction was unrelated to overall sexual problem-related distress, but was associated with feeling less distress about lack of excitement and lack of climax. Relationship satisfaction did not serve as a moderator of the associations.

CLINICAL TRANSLATION

These findings suggest the importance of attending to appearance satisfaction when working with clients with multiple sexual problems, particularly those related to excitement and enjoyment.

STRENGTHS AND LIMITATIONS

Strengths of the study include a large sample of partnered adults and assessment of specific sexual problems and associated distress. A limitation is that outcomes were assessed using single items, rather than multi-item scales.

CONCLUSION

The study highlights the importance of examining the presence of sexual problems and associated distress separately, and to consider appearance satisfaction as a predictor of sexual functioning. Øverup CS, Strizzi JM, Cipric A, et al. Appearance Satisfaction as a Predictor of Specific Sexual Problems and Associated Distress. J Sex Med 2021;XX:XXX-XXX.

Multifaceted Sexual Dysfunction in Dialyzing Men and Women: Pathophysiology, Diagnostics, and Therapeutics

Patient survival continues to increase with the growing quality of dialysis and management of chronic kidney disease (CKD). As such, chronic therapy must include considerations of quality of life (QOL), and this includes the disproportionate prevalence of sexual dysfunction (SD) in this patient population. This review aims to describe the pathophysiological and the psychosocial causes of SD with regard to renal replacement therapy, particularly hemo- and peritoneal dialysis. The differences in its manifestation in men and women are compared, including hormonal imbalances—and therefore fertility, libido, and sexual satisfaction—the experience of depression and anxiety, and QOL. The impact of comorbidities and the iatrogenic causes of SD are described. This review also presents validated scales for screening and diagnosis of SD in CKD patients and outlines novel therapies and strategies for the effective management of SD. Increased prevalence of CKD invariably increases the number of patients with SD, and it is crucial for health care professional teams to become familiar with the clinical tools used to manage this sensitive and under-quantified field. As a known predictor of QOL, sexual function should become a point of focus in the pursuit of patient-centered care, particularly as we seek to achieve as “normal” a life as possible for individuals who receive dialysis.

Sexual function in women with androgen excess disorders: classic forms of congenital adrenal hyperplasia and polycystic ovary syndrome

PURPOSE

We compared the sexual function in women with classic forms of congenital adrenal hyperplasia (CAH) and polycystic ovary syndrome (PCOS) to find if the cause of androgen excess determines sexual functioning.

METHODS

Hundred and four women (21 with CAH, 63 with PCOS and 20 healthy controls) aged 18-40 years were included into the study. All participants completed a questionnaire regarding their sociodemographic background and underwent anthropometric and basic biochemical measurements. Plasma levels of total testosterone, androstenedione, and 17-hydroxyprogesterone were measured with immunoassay. To assess the sexual functions, the Female Sexual Function Index (FSFI) questionnaire was applied.

RESULTS

Apart from the higher physical activity in PCOS patients (P = 0.017), we found no significant sociodemographic differences between the studied groups. In clinical assessment, women with CAH had a lower incidence of acne (P = 0.006). Their plasma levels of 17OHP (P = 0.005) and insulin resistance index (P = 0.0248) were higher, while total testosterone (P = 0.0495) and glucose (P = 0.0061) was lower compared to the PCOS group. Significantly more women with CAH were homosexual (P = 0.003) and bisexual (P = 0.006). CAH group showed a lower total FSFI score (P = 0.0043) and lower scores in three domains: lubrication (P = 0.0131), sexual satisfaction (P = 0.0006), and dyspareunia (P < 0.0001). Higher physical activity was associated in all women with higher total FSFI score (P = 0.009) and scores in the domain of desire (P = 0.034) and sexual satisfaction (P = 0.01), while in CAH women apart from the total score (P = 0.03) and sexual satisfaction (P = 0.002) also in the domains of orgasm (P = 0.005), and pain (P = 0.03).

CONCLUSIONS

CAH women present more often homosexual and bisexual orientation, while their sexual functions are impaired compared to PCOS patients.

The Role of Sexual Desire, Sexual Satisfaction, and Relationship Satisfaction in the Sexual Function of Arab Couples Living in Saudi Arabia

INTRODUCTION

This study is one of the first to examine the association between relationship and sexual variables as approached from a dyadic perspective in Saudi Arabian couples. Theoretical models assign an important role to relationship factors in women's sexuality.

AIM

We examined the role of sexual and relationship satisfaction relative to sexual desire in explaining sexual function in a sample of clinical versus nonclinical couples.

METHODS

This is a cross-sectional, observational study in a sample of 50 heterosexual couples with sexual problems and 50 control couples without problems (N = 100 couples; 200 men and women).

MAIN OUTCOME MEASURE

All participants completed an Arabic version of measures of relationship satisfaction, sexual satisfaction, sexual desire, sexual distress, and sexual function.

RESULTS

Results showed that in the clinical group, sexual function of women was predicted by their own and their partner's level of sexual satisfaction, and their own level of solitary and dyadic sexual desire. Men's sexual function was predicted by their own sexual satisfaction and their partner's relationship satisfaction. In the control group, the sexual function of women was predicted only by their level of sexual satisfaction. In men, sexual function was predicted by their own sexual satisfaction and their level of dyadic sexual desire.

CONCLUSION

These results suggest that sexual desire rather than relationship satisfaction plays an important role in women's sexual dysfunction. Being the most consistent determinant of male and female sexual functioning, sexual satisfaction is an important target of intervention in Arabian couples. A Attaky, J Schepers, G Kok, et al. The Role of Sexual Desire, Sexual Satisfaction, and Relationship Satisfaction in the Sexual Function of Arab Couples Living in Saudi Arabia. Sex Med 2021;9:100303.

Comparison of Sexual Function in Pregnant Women with Different Gestational Age

Objectives: To evaluate sexual function in Iranian pregnant women in different trimesters. Materials and methods: This cross sectional study was conducted in a women's hospital between August 2013 and August 2014. Four hundred pregnant women were asked to answer the valid and reliable Persian version of Beck depression inventory (BDI) and valid FSFI (Female sexual function index) questionnaires. Results: Forty five subjects were in the first trimester of pregnancy, 170 in the second trimester and 185 in the third trimester. Except BDI and desire subscale of FSFI, all scores were significantly different between the three groups. By considering 26.55 as the cut off point for FSFI, 38 (84.4%) women in the first trimester, 138 (81.2%) in the second trimester, and 156 (84.3%) in the third trimester had sexual dysfunction. Logistic regression analysis showed that BDI was an independent predictor of sexual dysfunction among participants. Conclusions: As sexual life is an important aspect of marital life, physicians should pay more attention to it in pregnant women.

A Typology of Women with Low Sexual Desire

Low sexual desire is the most common sexual issue reported by women and research suggests that the presentation and experience of low sexual desire may vary considerably between women. This study explored whether women with low desire differ qualitatively from one another based on several key contextual factors theoretically associated with low desire. We collected data from women in long-term relationships (N = 508) using an online platform. Using latent profile analysis, we explored whether women could be distinguished from one another based on several contextual variables (sexual and relationship satisfaction, life stress, sexual communication). Results supported a 3-profile solution, with two distinct profiles emerging for women with low sexual desire. The first profile consisted of women with low desire who were dissatisfied with the sexual and nonsexual aspects of their relationships (Globally Distressed Group: 8%). The second profile consisted of women with low desire who were sexually, but not relationally, dissatisfied (Sexually Dissatisfied Group: 24%). In addition, a third profile emerged that consisted of generally satisfied women with average desire (Average Desire Group: 67%). t-tests revealed that the two low desire groups shared similar mean levels of sexual desire, but that their overall presentations were conceptually distinct. This research supports a categorical conceptualization of low sexual desire in women and suggests that evaluating category membership for women with low desire can provide valuable information about women's sexual experiences beyond assessing mean levels of sexual desire alone.

Sexual Satisfaction in Fully Ambulatory People with Multiple Sclerosis: Does Disability Matter?

Primary sexual dysfunctions (SD) are a direct result of neurological changes that affect the sexual response. Secondary SD result from the symptoms that do not directly involve nervous pathways to the genital system, such as bladder and bowel problems, fatigue, spasticity, or muscle weakness. Tertiary SD are the result of disability-related psychosocial and cultural issues that can interfere with sexual feelings and experiences. The aim of this study was to assess the sexual satisfaction (SS) in people with multiple sclerosis (PwMS) without significant mobility impairment and to estimate the influence of SD, the score on the Kurtzke Expanded Disability Status Scale (EDSS), lowered mood, and stress coping strategies on SS. Methods. 76 PwMS with the EDSS score < 5.0 points were enrolled in the study. The subjects completed the Montgomery-Asberg Depression Scale (MADRS), the Coping Inventory for Stressful Situations (CISS), the Multiple Sclerosis Intimacy and Sexuality Questionnaire (MSISQ-19), and the Sexual Satisfaction Questionnaire (SSQ). Results. The level of SS in PwMS was not significantly lower compared to that of the general population. It correlated with the primary, secondary, and tertiary SD and lowered mood. However, it did not correlate with disability measured by the EDSS. Conclusions. The level of SS in PwMS with the EDSS score below 5.0 points was not significantly lower. SS depended on SD, lowered mood, and stress coping style, and it was not significantly related to the level of disability in patients with the EDDS score below 5.0.

Factors Associated with Sexual Satisfaction among Veterans Who Have Experienced Military Sexual Trauma

Veterans who have experienced military sexual trauma (MST) report lower sexual satisfaction than veterans without a history of MST. The current study examined the relationship between demographic, physical health, mental health, and trauma variables and sexual satisfaction among a national sample of U.S. veterans who endorsed MST. Results demonstrated that lower sexual satisfaction was associated with uncoupled relationship status, poor physical health, and symptoms of depression, post-traumatic stress disorder, and sexual dysfunction among male and female veterans. Several additional factors were related to lower sexual satisfaction among female veterans. Findings highlight the importance of gender-targeted assessment, prevention, and treatment of sexual satisfaction problems.

Validation and translation of the Hungarian version of the Female Sexual Function Index (FSFI-H)

INTRODUCTION AND HYPOTHESIS

The Female Sexual Function Index (FSFI) has been used for clinical and research purposes in many countries. The aim of this study was to translate, adapt and perform a psychometric validation of a Hungarian version of the FSFI.

METHODS

The FSFI was translated into Hungarian, and its precision was ascertained through reverse translation by an expert team. As a first step, 40 volunteers participated in an evaluation of the test-retest reliability of the Hungarian version over a 2-week period. After that, 418 (331 control and 87 with pelvic organ prolapse) women who had been in a stable sexual relationship in the previous 4 weeks participated in the study. The data were summarized using descriptive statistics. The structure validity was examined by confirmatory factor analysis, with which we tested the hypothesized original factor structure, using maximum likelihood model estimation. We calculated the Comparative Fit Index (CFI), root mean square error of approximation (RMSEA), standardized root mean residual and Akaike information criterion (AIC). To test the internal consistency, Cronbach's alpha coefficients of the full scale were determined. Spearman's rank correlation was used for testing divergent validity and Mann-Whitney U-test for examining discriminant validity.

RESULTS

The FSFI was easily understandable and acceptable as well as capable of adequately evaluating and measuring various aspects of female sexual functioning. A high degree of internal consistency was demonstrated by the Cronbach's alpha value (0.963).

CONCLUSION

The FSFI Hungarian version is a valid tool that measures the same functioning as the original English questionnaire.

Predictors of female sexual dysfunction: a systematic review and qualitative analysis through gender inequality paradigms

Background

Female sexual dysfunction affects 41% of reproductive-age women worldwide, making it a highly prevalent medical issue. Predictors of female sexual dysfunction are multifaceted and vary from country to country. A synthesis of potential risk factors and protective factors may aid healthcare practitioners in identifying populations at risk, in addition to revealing modifiable factors to prevent sexual dysfunction among reproductive-age women.

Methods

Observational studies which assessed the prevalence and predictors of female sexual dysfunction in reproductive-age women were systematically sought in relevant databases (2000–2014). Significant predictors were extracted from each included publication. A qualitative analysis of predictors was performed with a focus on types of sexual regimes and level of human development.

Results

One hundred thirty-five studies from 41 countries were included in the systematic review. The types of predictors varied according to the location of the study, the type of sexual regime and the level of gender inequality in that country/region. Consistently significant risk factors of female sexual dysfunction were: poor physical health, poor mental health, stress, abortion, genitourinary problems, female genital mutilation, relationship dissatisfaction, sexual abuse, and being religious. Consistently significant protective factors included: older age at marriage, exercising, daily affection, intimate communication, having a positive body image, and sex education. Some factors however had an unclear effect: age, education, employment, parity, being in a relationship, frequency of sexual intercourse, race, alcohol consumption, smoking and masturbation.

Conclusions

The sexual and reproductive lives of women are highly impacted by female sexual dysfunction, and a number of biological, psychological and social factors play a role in the prevalence of sexual dysfunction. Healthcare professionals who work with women should be aware of the many risk factors for reproductive-age women. Future prevention strategies should aim to address modifiable factors, e.g. physical activity and access to sex education; international efforts in empowering women should continue.

Electronic supplementary material

The online version of this article (10.1186/s12905-018-0602-4) contains supplementary material, which is available to authorized users.

Does Type 1 Diabetes Modify Sexuality and Mood of Women and Men?

Background: Sexual disorders occurring in women and men with type 1 diabetes have not been sufficiently investigated and described until now. This study attempts to evaluate sexuality in women and men. Methods: Altogether, the study comprised 115 patients with type 1 diabetes and 105 healthy people constituting the control group. All the studied persons underwent survey studies determining sexuality using the Female Sexual Function Index (FSFI-19) in women and the International Index of Erectile Function (IIEF-15) in men, and the occurrence of depression using the Beck Depression Inventory. The acceptance of illness among patients with diabetes was examined using the Acceptance of Illness Scale questionnaire. Results: In 35% of the examined women with diabetes, the study demonstrated sexual dysfunction as determined by total FSFI. The point values of all the investigated FSFI domains were significantly lower in women with diabetes than in healthy ones (p < 0.001). Erectile dysfunction occurred in 50% of the studied men with diabetes and in 23% of the control group of men (p = 0.0017). Conclusions: Type 1 diabetes leads to sexual disorders which occur in 1/3 of women and in 1/2 of men. Sexual disorders in patients with diabetes more frequently occur in men, persons with coexisting complications of diabetes, and in those with a concentration of glycated hemoglobin higher than 6.5%.

Relationships of Sexual Dysfunction with Depression and Acceptance of Illness in Women and Men with Type 2 Diabetes Mellitus

An increased prevalence of sexual disorders has been reported in patients with type 2 diabetes. The aim of this study is the assessment of the influence of the psychical condition, the concentration of glycated hemoglobin, the duration of diabetes, the body mass index, the age, and the subjective acceptance of the illness on sexual disorders occurring in women and men with type 2 diabetes. The study enrolled 215 patients (114 women and 101 men) with type 2 diabetes and 183 controls. Sexuality was determined in all of the studied subjects using: the Female Sexual Function Index (FSFI) in women and the International Index of Erectile Function (IIEF) in men. The occurrence of depression symptoms was determined using the Beck Depression Inventory (BDI), whereas the acceptance of the illness in diabetic patients using the Acceptance of Illness Scale (AIS). A sexual dysfunction was found in 68% of the studied diabetic women and 17% of controls. The point values of all the examined FSFI domains were significantly lower in women with diabetes than in controls (p < 0.001). Erectile disorders occurred in 82% of the studied men with diabetes and in 41% of the controls (p < 0.001). The point values of all the domains of FSFI and IIEF demonstrated a significantly negative correlation with the total BDI score, which was higher in patients with diabetes than in patients without diabetes, and a positive correlation with the total AIS score (p < 0.001). The occurrence of sexual dysfunction in patients with diabetes correlated with the age and the duration of diabetes. We conclude that sexual disorders in patients with type 2 diabetes demonstrate the correlation with the occurrence of depression and the acceptance of their illness. Sexual disorders in diabetic patients occur more frequently in older patients and in those with a longer duration of diabetes.

Evidence-based treatments for low sexual desire in women

Low sexual desire is the most common sexual complaint in women, with multinational studies finding that at least a third of women experience low sexual desire. No single etiology for the development of Female Sexual Interest/Arousal Disorder, the diagnosis laid out by the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders, has been established. There has been considerable interest in pharmacological approaches to improving low desire, and agents targeting a range of neurotransmitters have been examined. To date, only flibanserin, a centrally acting medication targeting the serotonin, dopamine, and norepinephrine systems, has been approved by the Food and Drug Administration (FDA). Despite statistically significant effects on sexual desire, sexual distress, and sexually satisfying events, side-effects are significant, and flibanserin is completely contraindicated with alcohol. As such, there has been renewed interest in advancing the science of psychological approaches to low desire, including cognitive behavioral and mindfulness therapies.

Sexual function and depressive symptoms in young women with thyroid autoimmunity and subclinical hypothyroidism

OBJECTIVE

The results of few studies conducted to date suggest an increased prevalence of sexual dysfunction in patients with thyroid disorders.

DESIGN

The aim of this study was to compare female sexual function and depressive symptoms between women with autoimmune thyroid disease and with mild thyroid failure.

PATIENTS

The study included four groups of young women: euthyroid women with Hashimoto's thyroiditis (Group 1), women with nonautoimmune subclinical hypothyroidism (Group 2), women with autoimmune subclinical hypothyroidism (Group 3) and healthy euthyroid females without thyroid autoimmunity (Group 4).

MEASUREMENTS

Beyond measuring serum hormone levels and thyroid antibody titres, all enrolled women completed questionnaires evaluating female sexual function (Female Sexual Function Index - FSFI) and the presence and severity of depressive symptoms (Beck Depression Inventory-Second Edition - BDI-II).

RESULTS

The mean total FSFI score was lower in women with autoimmune hypothyroidism than in the remaining groups of women, as well as lower in Groups 1 and 2 than in Group 4. Compared to Group 4, three domains (sexual desire, lubrication and sexual satisfaction) were lower in Group 1, four domains (desire, arousal, lubrication and dyspareunia) in Group 2 and all FSFI domain scores in Group 3. The total BDI-II score was higher in Groups 1 and 2 than in Group 4, as well as higher in Group 3 than in the other groups of women.

CONCLUSIONS

The obtained results suggest that both thyroid autoimmunity and mild thyroid failure, particularly if they occur together, may negatively affect female sexual function and depressive symptoms.

Sexual Health of Polish Athletes with Disabilities

The purpose of this study was to determine sexual functioning of Polish athletes with disabilities (including paralympians). The study encompassed 218 people with physical disabilities, aged between 18 and 45 (149 men and 69 women). The entire research population was divided into three groups: Polish paralympians (n = 45), athletes with disabilities (n = 126) and non-athletes with disabilities (n = 47). The quality of sexual life of Polish paralympians was measured by using the Polish version of Female Sexual Function Index and International Index of Erectile Function. Clinically significant erectile dysfunctions were most often diagnosed in non-athletes (83.33%) with 50% result of severe erectile dysfunctions, followed by athletes and paralympians with comparable results of 56.98% and 54.17% respectively (p = 0.00388). Statistically significant clinical sexual dysfunctions concerned lubrication, orgasm as well as pain domains, and prevailed among female non-athletes (68.42%, 68.42% and 57.89%). Practising sports at the highest level has a favourable effect on the sexuality of men and women with physical disabilities. Men with physical disabilities manifest more sexual disorders than women, an aspect which should be considered by health-care professionals working with people with disabilities.

Sexuality of Disabled Athletes Depending on the Form of Locomotion

The main purpose of this study was to determine sexuality of disabled athletes depending on the form of locomotion. The study included 170 disabled athletes, aged between 18 and 45. The entire population was divided into 3 research groups depending on the form of locomotion: moving on wheelchairs (n=52), on crutches (n=29) and unaided (n=89). The research tool was a questionnaire voluntarily and anonymously completed by the respondents of the research groups. The questionnaire was composed of a general part concerning the socio-demographic conditions, medical history, health problems, a part dedicated to physical disability as well as the Polish version of the International Index of Erectile Function (IIEF) and the Female Sexual Function Index (FSFI) evaluating sexual life. STATISTICA 10.0 for Windows was used in the statistical analysis. Subjects moving on crutches were significantly older than ones moving on wheelchairs and unaided (34.41 ±11.00 vs. 30.49 ±10.44 and 27.99 ±10.51 years, respectively) (p=0.018). Clinically significant erectile dysfunctions were most often diagnosed in athletes moving on wheelchairs (70.27%), followed by athletes moving on crutches and moving unaided (60% and 35.42%, respectively; p=0.048). Clinical sexual dysfunctions were diagnosed on a similar level among all female athletes. It was concluded that the form of locomotion may determine sexuality of disabled men. Males on wheelchair revealed the worst sexual functioning. Female athletes moving on wheelchairs, on crutches and moving unaided were comparable in the aspect of their sexual life.

Sexual function, activity, and satisfaction among women receiving maintenance hemodialysis

BACKGROUND AND OBJECTIVES

Past studies that demonstrated that sexual dysfunction is common among women receiving chronic hemodialysis did not distinguish sexual dysfunction/difficulty from sexual inactivity. This study sought to differentiate these in order to elucidate the prevalence of true "sexual dysfunction" in this population.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

As part of a clinical trial of symptom management strategies in patients receiving chronic hemodialysis, female sexual function was prospectively assessed monthly for 6 months and quarterly thereafter using the Female Sexual Function Index, to which questions were added differentiating sexual dysfunction/difficulty from sexual inactivity. Beginning in month 7, patients were asked three questions about sexual activity, difficulty, and satisfaction monthly.

RESULTS

Of the women enrolled in the clinical trial,125 participants completed 1721 assessments between 2009 and 2011. Scores on 574 of 643 (89%) quarterly Female Sexual Function Index assessments were consistent with sexual dysfunction, due largely to sexual inactivity, which was reported on 525 (82%) quarterly assessments. When reported (n=1663), the most frequently described reasons for sexual inactivity were lack of interest in sex (n=715; 43%) and lack of a partner (n=647; 39%), but rarely sexual difficulty (n=36; 2%). When reported (n=1582), women were moderately to very satisfied with their sexual life on 1020 (64%) assessments and on 513 of 671 (76%) assessments in which lack of interest was cited as a reason for sexual inactivity. Women indicated an interest in learning about the causes of and treatment for sexual dysfunction on just 5% of all assessments.

CONCLUSIONS

Although many women receiving chronic hemodialysis are sexually inactive, few describe sexual difficulty. Most, including those with a lack of interest in sex, are satisfied with their sexual life and few wish to learn about treatment options. These findings suggest that true sexual dysfunction is uncommon in this population and that treatment opportunities are rare.

Survey of the prevalence of sexual dysfunctions in Kurdish women

This study evaluates the prevalence of female sexual dysfunctions among Kurdish women. Participants in the study were 196 women between 15 and 55 years of age who attended the gynecological clinic of Be'sat Hospital in Sanandaj Province, Iran. The authors collected relevant data using the Female Sexual Function Index. The mean score was 22.71 (SD = 5). Using a cutoff score of 26.55, the authors found that 151 women (77%) had some sexual dysfunction. Scores declined as patients' age increased; further, an older age at marriage was associated with a higher score. This study, the first about sexual dysfunctions in Kurdish society, shows that sexual dysfunctions are prevalent among women of this ethnicity. Clinicians should complete further studies to assess the factors contributing to this phenomenon.

Sexual dysfunction and distress--development of a Polish version of the female sexual distress scale-revised

INTRODUCTION

The concept of sexually related personal distress, central to the diagnosis of all female sexual dysfunction (FSD), is currently a subject of scientific debate. Several psychometric instruments have been used to measure sexually related personal distress in women, including the Female Sexual Distress Scale (FSDS) and its revised version (FSDS-R).

AIM

To develop a Polish version of the FSDS-R (PL-FSDS-R).

METHODS

In total, 210 women aged 18-55 years were included in the study. Seventy-five were diagnosed with hypoactive sexual desire disorder (HSDD), 31 were diagnosed with another FSD, and 104 were control. All subjects completed the PL-FSDS-R at baseline (day 0), day 7, and day 28. Internal consistencies were evaluated by Cronbach's α. Intraclass correlation coefficient was used to assess test-retest reliability. Discriminant validity was assessed by comparing mean scores of the FSD and control groups in a between-groups analysis of variance. Receiver operating characteristic (ROC) analysis was performed to determine optimal cutoff values of the PL-FSDS-R.

MAIN OUTCOME MEASURES

To measure the validity and reliability of the PL-FSDS-R and to determine optimal cutoff values.

RESULTS

Mean total PL-FSDS-R score was statistically higher in women with HSDD and other FSD compared to healthy individuals, showing the test had discriminant validity. The frequency of sexual intercourse and quality of relationship with sexual partner but not other sexual behaviors were statistically correlated with the PL-FSDS-R score. ROC analysis confirmed these findings. All domains of the PL-FSDS-R demonstrated satisfactory internal consistencies, with a Cronbach's α-value of >0.70 for the entire sample. Test-retest coefficients were between 0.86-0.92, with the best reliability for a 7-day recall period.

CONCLUSIONS

The PL-FSDS-R is a reliable questionnaire with good psychometric and discriminative validity, and can be used to measure sexually related personal distress in Polish women with FSD with a cutoff score of ≥13.

Relationship satisfaction as a predictor of treatment response during cognitive behavioral sex therapy

Although recent research suggests that individual cognitive behavioral therapy (CBT) may be an effective treatment for female sexual dysfunctions, we have little information regarding predictors of treatment response. The goal of the current study was to assess the degree to which pre-treatment relationship satisfaction predicted treatment response to cognitive behavioral sex therapy. Women with sexual dysfunction (n = 31, M age = 28 years, 77.4 % Caucasian) receiving cognitive-behavioral sex therapy with or without ginkgo biloba, as part of a wider randomized clinical trial, were assessed pre- and post-treatment using validated self-report measures of sexual satisfaction, sexual distress, sexual functioning, and relationship satisfaction. Pre-treatment relationship satisfaction predicted changes in sexual satisfaction and distress, but not sexual functioning. Women with higher relationship satisfaction at intake experienced larger gains in sexual satisfaction and distress over the course of treatment. Pre-treatment relationship satisfaction also moderated the association between changes in sexual functioning and changes in sexual distress, such that improved functioning was associated with decreased distress only for women entering therapy with high relationship satisfaction. These findings suggest that, for women with low relationship satisfaction before entering treatment, improvement in sexual functioning may not be enough to alleviate their sexual distress.

Development and validation of the Polish version of the Female Sexual Function Index in the Polish population of females

INTRODUCTION

Unlike male sexual function, which is relatively easy to assess, female sexual function is still a diagnostic challenge. Although numerous new measurements for female sexual dysfunction (FSD) have recently been developed, the Female Sexual Function Index (FSFI) remains the gold standard for screening. It has been validated in more than 30 countries. The FSFI has been used in several studies conducted in Poland, but it has never been standardized for Polish women.

AIM

The aim of this study was to develop a Polish version of the FSFI (PL-FSFI).

MATERIALS AND METHODS

In total, 189 women aged 18-55 years were included in the study. Eighty-five were diagnosed with FSD as per the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM IV-TR) criteria; 104 women did not have FSD. All subjects completed the PL-FSFI at baseline (day 0), day 7, and day 28.

MAIN OUTCOME MEASURES

Test-retest reliability was determined by Pearson's product-moment correlations. Reliability was tested using Cronbach's α coefficient. Construct validity was evaluated by principal component analysis using varimax rotation and factor analysis. Discriminant validity was assessed with between-groups analysis of variance.

RESULTS

All domains of the PL-FSFI demonstrated satisfactory internal consistencies, with Cronbach's α value of >0.70 for the entire sample. The test-retest reliability demonstrated good-to-excellent agreement between the assessment points. Based on principal component analysis, a 5-factor model was established that explained 83.62% of the total variance. Domain intercorrelations of the PL-FSFI ranged from 0.37-0.77. The optimal PL-FSFI cutoff score was 27.50, with 87.1% sensitivity and 83.1% specificity.

CONCLUSION

The PL-FSFI is a reliable questionnaire with good psychometric and discriminative validity. Therefore, it can be used as a tool for preliminary screening for FSD among Polish women.

Mediators of sexual functions in women with diabetes

INTRODUCTION

Sexual disorders in women with diabetes mellitus (DM) may not necessarily have only the biological etiology.

AIMS

To establish the mediators of sexual functions in the population of women with DM.

METHODS

Five hundred seventeen females, aged 18-55 years old, were included in a questionnaire-based, cross-sectional study. This is the second part of the study on sexual functions in females with DM where only females with DM (n=242) were analyzed. Sexual functions were compared between women with type 1 (n=109) and type 2 DM (N=133).

MAIN OUTCOME MEASURES

To assess reported female sexual functions by using the Female Sexual Function Index (FSFI) in women with type 1 and type 2 DM. To establish the risk factors of female sexual dysfunction (FSD) in women with DM by using multivariate logistic regression model.

RESULTS

Sexual dysfunction was diagnosed in 32.65% (n=64) of women with DM. Women with type 2 DM had a significantly lower number of points scored in all FSFI domains except pain compared to type 1 respondents. The only variables associated with DM significantly influencing sexual functioning were: type 2 diabetes in desire, arousal, as well as in global FSD (odds ratio [OR]=1.40; 2.70 and 3.31, respectively), the presence of retinopathy in lubrication (OR=7.8), and treatment with insulin in satisfaction domain (OR=0.29). Neither the presence of comorbidities, the duration of diabetes, the presence of diabetes complications nor the glycemic control was a moderator of FSD. The strongest significant predictors of FSD were: the presence of depressive symptoms, the importance of sex to the respondent, and satisfaction with the partner as a lover.

CONCLUSIONS

Women with DM, especially type 2, are at risk of sexual dysfunctions. Diabetes-related factors have little impact on sexual functions in women with DM. Depressive symptoms, partner-related factors, and individual perception of sexuality should be evaluated when counseling females with DM.

The association between sexual motives and sexual satisfaction: gender differences and categorical comparisons

Past research suggests that sexual satisfaction may be partially dependent on sexual motives (the reasons people have sex). The primary goal of this study was to determine which of a wide range of empirically derived sexual motives were related to sexual satisfaction, and whether gender differences existed in these relationships. Examining data from 544 undergraduate participants (93 men, 451 women), we found that certain types of motives predicted levels of sexual satisfaction for both genders. However, a greater number of motive categories were related to satisfaction for women than for men, and sexual motives were a more consistent predictor of satisfaction in general for women than for men. We also found that empirical categories of motives predicted more variance in satisfaction ratings than did previously used theoretical categories. These findings suggest that a wide range of sexual motives are related to sexual satisfaction, that these connections may be moderated by gender, and that empirically-constructed categories of motives may be the most effective tool for studying this link.

Prevalence, risk factors, and predictors of female sexual dysfunction in a primary care setting: a survey finding

INTRODUCTION

Female sexual dysfunction (FSD) is a highly prevalent sexual health problem but poorly investigated at the primary care level.

AIM

This article examines the prevalence of sexual dysfunction and its possible risk factors associated with women at high risk of FSD in a hospital-based primary practice.

METHODS

A validated Malay version of the Female Sexual Function Index (MVFSFI) was utilized to determine FSD in a cross-sectional study design, involving 163 married women, aged 18-65 years, in a tertiary hospital-based primary care clinic in Kuala Lumpur, Malaysia. Sociodemographic, marital profile, health, and lifestyle for women at high risk of FSD and those who were not at high risk were compared and their risk factors were determined.

MAIN OUTCOME MEASURES

Prevalence of FSD in Malaysian women based on the MVFSFI, and its risk factors for developing FSD.

RESULTS

Some 42 (25.8%) out of 163 women had sexual dysfunction. Prevalence of sexual dysfunction increased significantly with age. Sexual dysfunctions were detected as desire problem (39.3%), arousal problem (25.8%), lubrication problem (21.5%), orgasm problem (16.6%), satisfaction problem (21.5%) and pain problems (16.6%). Women at high risk of FSD were significantly associated with age (OR 4.1, 95% CI 1.9 to 9.0), husband's age (OR 4.3 95% C.I 1.9 to 9.3), duration of marriage (OR 3.3, 95% CI 1.6 to 6.8), medical problems (OR 8.5, 95% CI 3.3 to 21.7), menopausal status (OR 6.6, 95% CI 3.1 to 14.3), and frequency of sexual intercourse (OR 10.7, 95% CI 3.6 to 31.7). Multivariate analysis showed that medical problem (adjusted OR 4.6, 95% CI 1.6 to 14.0) and frequency of sexual intercourse (adjusted OR 7.2, 95% CI 2.1 to 24.0) were associated with increased risk of having FSD. Those who practiced contraception were less likely to have FSD.

CONCLUSION

Sexual health problems are prevalent in women attending primary care clinic where one in four women were at high risk of FSD. Thus, primary care physician should be trained and prepared to address this issue.

When are sexual difficulties distressing for women? The selective protective value of intimate relationships

INTRODUCTION

Recent studies have shown that sexual functioning and sexually related personal distress are weakly related in women, with only a minority of sexual difficulties resulting in significant levels of distress. However, there has been little systematic research to date on which factors moderate the relationship between sexual functioning and sexual distress.

AIM

To assess the degree to which relational intimacy and attachment anxiety moderate the association between sexual functioning and sexual distress in college-age women.

METHODS

Two hundred women (mean age=20.25) completed surveys assessing sexual functioning, relational intimacy, attachment anxiety, and sexual distress.

MAIN OUTCOME MEASURES

Participants completed the Sexual Satisfaction Scale for Women, the Female Sexual Function Index, the Dimensions of Relationship Quality Scale, and the Revised Experiences in Close Relationships Measure of Adult Romantic Attachment.

RESULTS

Relational intimacy and attachment anxiety moderated the association between multiple aspects of sexual functioning and sexual distress. For lubrication and sexual pain, functioning was more strongly associated with distress in low-intimacy vs. high-intimacy relationships, but only for women with high levels of attachment anxiety. Results regarding desire were mixed and neither intimacy nor attachment anxiety interacted with subjective arousal or orgasm in predicting distress.

CONCLUSION

Both relational intimacy and attachment anxiety are important moderators of the association between sexual functioning and subjective sexual distress in women. Theoretical and practical implications are discussed.

Sexual function and depressive symptoms among female North American medical students

INTRODUCTION

Depression and sexual dysfunction are often comorbid.

AIM

We explored the relationship between sexuality, sexual dysfunction, and depressive symptoms in female medical students in North America.

MAIN OUTCOME MEASURE

Female North American medical students were invited to participate in an internet survey. The CES-D was utilized to screen for depressive symptoms and an abbreviated Spielberger State-Trait Anxiety Index (STAI) was used to quantify anxiety symptoms.

METHODS

Subjects completed an ethnodemographic survey, a sexuality survey, and modified instruments for the quantification of sexual function (the Female Sexual Function Index [FSFI] and the Index of Sexual Life [ISL]). Multivariable logistic regression was used to explore the relationship between sexuality and depressive symptoms.

RESULTS

There were 1,241 female subjects with complete data on CES-D and STAI. Mean age was 25.4 years. Depressive symptoms (CES-D>16) were present in 46% of respondents and were more common in subjects with anxiety symptoms. Subjects who were Caucasian, younger than 28, heterosexual, and in a relationship were least likely to report depressive symptoms. High risk of female sexual dysfunction (HRFSD) was significantly associated with greater likelihood of depressive symptoms (odds ratio [OR] 2.25, P<0.001). After adjusting for ethnodemographic and sexual history factors, HRFSD remained significantly positively associated with depressive symptoms (OR 1.85, P<0.001). Analysis of FSFI and ISL domains indicated that depressive symptoms were most directly associated with worse orgasmic function, interference in sex life from stress and lack of partner, and lower general life satisfaction (P<0.05). Interestingly, greater ISL-sexual satisfaction was associated with greater odds of depressive symptoms (OR 1.40, P=0.01).

CONCLUSION

Depressive symptoms are common in female medical students. HRFSD is associated with depressive symptoms, although the relationship is complex when psychosocial factors are included in the multivariate model. Attention to sexuality factors from student health providers may enhance quality-of-life, academic achievement, and patient care.