Profiles of couples seeking sex therapy and marital therapy

Interventions for vaginismus

BACKGROUND

Vaginismus is an involuntary contraction of the vaginal muscles which makes sexual intercourse difficult or impossible. It is one of the more common female psychosexual problems. Various therapeutic strategies for vaginismus, such as sex therapy and desensitisation, have been proposed, and uncontrolled case series appear promising.

OBJECTIVES

To assess the effects of different interventions for vaginismus.

SEARCH METHODS

We searched the Cochrane Depression, Anxiety and Neurosis Group's Specialised Register (CCDANCTR-Studies and CCDANCTR-References) to August 2012. This register contains relevant randomised controlled trials from: The Cochrane Library (all years), EMBASE (1974 to date), MEDLINE (1950 to date) and PsycINFO (1967 to date). We searched reference lists and conference abstracts. We contacted experts in the field regarding unpublished material.

SELECTION CRITERIA

Controlled trials comparing treatments for vaginismus with another treatment, a placebo treatment, treatment as usual or waiting list control.

DATA COLLECTION AND ANALYSIS

The review authors extracted data which we verified with the trial investigator where possible.

MAIN RESULTS

Five studies were included, of which four with a total of 282 participants provided data. No meta-analysis was possible due to heterogeneity of comparisons within included studies as well as inadequate reporting of data. All studies were considered to be at either moderate or high risk of bias. The results of this systematic review indicate that there is no clinical or statistical difference between systematic desensitisation and any of the control interventions (either waiting list control, systematic desensitisation combined with group therapy or in vitro (with women under instruction by the therapist) desensitisation) for the treatment of vaginismus. The drop-out rates were higher in the waiting list groups.

AUTHORS' CONCLUSIONS

A clinically relevant effect of systematic desensitisation when compared with any of the control interventions cannot be ruled out. None of the included trials compared other behaviour therapies (e.g. cognitive behaviour therapy, sex therapy) to pharmacological interventions. The findings are limited by the evidence available and as such conclusions about the efficacy of interventions for the treatment of vaginismus should be drawn cautiously.

A critical examination of popular assumptions about the benefits and outcomes of monogamous relationships

In this article, we critically examine the social institution of monogamy. First, we discuss the lack of an adequate and consistent definition of the construct of monogamy and consider how common monogamy is. Next, we address perceived benefits of monogamy and whether those ostensible benefits are supported by empirical evidence. We conclude that evidence for the benefits of monogamy relative to other relationship styles is currently lacking, suggesting that, for those who choose it, consensual non-monogamy may be a viable alternative to monogamy. Implications for theories of close relationships are discussed.

Successful management of vaginismus: An eclectic approach

Vaginismus is defined as recurrent or persistent involuntary spasm of the musculature of the outer third of the vagina, which interferes with coitus and causes distress and interpersonal difficulty. In this report, we describe the successful treatment of vaginismus in a 25-year-old lady based on a model proposed by Keith Hawton. The eclectic approach involved education, graded insertion of fingers, Kegel's exercises and usage of local anesthesia with vaginal containment along with the prescription of Escitalopram.

Psychosexual factors that differentiate men with inhibited ejaculation from men with no dysfunction or another sexual dysfunction

AIM

Inhibited or retarded ejaculation (IE) is an uncommon male sexual dysfunction that may result in a lack of sexual fulfillment for both the man and his partner. In this study, we attempted to identify factors that differentiate men with IE from sexually functional controls or from men with other sexual dysfunctions and to specify whether such factors predict self-reported sexual arousal during psychophysiological assessment.

METHODS

Each patient underwent psychophysiological assessment and a structured clinical interview based on a standardized questionnaire that included demographic information, psychosexual and medical history, and assessment of current sexual, erectile, and ejaculatory function, including relationship quality and characteristics.

RESULTS

Men with IE resemble men with other dysfunctions but are differentiated from controls, in their lower level of relationship satisfaction, greater level of distress, and higher level of health-related problems. Men with IE were further characterized by lower levels of self-reported subjective sexual arousal, despite exhibiting strong penile response during psychophysiological testing and reporting high quality erections across a variety of situations. Also notable, however, were the many factors on which men with IE did not differ from controls.

CONCLUSIONS

Taken together, this research helps specify directions for future investigations of men with IE.

Interventions for vaginismus

BACKGROUND

Vaginismus is involuntary vaginal muscle contraction which makes sexual intercourse difficult or impossible. It is one of the more common female psychosexual problems. Various therapeutic strategies for vaginismus, such as sex therapy and desensitization, have been considered in uncontrolled studies.

OBJECTIVES

The aim of this review is to determine the clinical effectiveness of treatments for vaginismus and also to examine the role of partner participation in the effectiveness of the treatment.

SEARCH STRATEGY

The Cochrane Collaboration Depression, Anxiety & Neurosis Controlled Trials Register (Issue 3, 2000), the Cochrane Controlled Trials Register (Cochrane Library, Issue 2, 2002), MEDLINE (1966 to Nov 2002), EMBASE (1980 to Nov 2002), PsycINFO (1967 to Nov 2002) and CINAHL (1982 to Nov 2002) were searched. The Journal of Sex Research (1974 to 1999), Sexual & Marital Therapy (1986 to 1999), Sexual Dysfunction (1998 to 1999) and the Journal of Sex and Marital Therapy (1974 to 1999) were handsearched. Reference lists and conference abstracts were searched. Experts in the field were contacted regarding unpublished material.

SELECTION CRITERIA

Controlled trials comparing treatments for vaginismus with another treatment, a placebo treatment, treatment as usual or waiting list control.

DATA COLLECTION AND ANALYSIS

The reviewers extracted data which were verified with the trial investigator.

MAIN RESULTS

Two controlled trials were identified although data were only available from one trial. The second trial compared two forms of systematic desensitization and reported no discernible differences between them.

REVIEWER'S CONCLUSIONS

In spite of encouraging results reported from uncontrolled series of patients there is very limited evidence from controlled trials concerning the effectiveness treatments for vaginismus. Further trials are need to compare therapies with waiting list control and with other therapies.

Premature ejaculation: a psychophysiological approach for assessment and management

This article distinguishes several subtypes of biogenic and psychogenic premature ejaculation (PE) according to their etiologic features: the physiological PE types of (a) neurologic constitution, (b) acute physical illness, (c) physical injury, and (d) pharmacologic side effect; and the psychological PE types of (a) psychological constitution, (b) acute psychological distress, (c) relationship distress, and (d) psychosexual skills deficit. Attention is given to assessment and differential diagnosis, and to specific treatment of the types of PE, such as the pharmacologic management of difficult neurologic cases. Effective psychosexual treatment combines multiple strategies such as physiological relaxation, pubococcygeal muscle training, cognitive and behavioral pacing strategies, and the involvement of the partner in the therapy. Treatment should determine the specific type of PE and comprehensively address its particular features in order to improve long-term treatment effectiveness.

Diabetes, psychological function and male sexuality

The aim of the study was to assess psychological contributors or correlates of sexual dysfunction in diabetic men. The study was conducted on 40 diabetic men and 40 age-matched healthy volunteers. The subjects underwent a psychosexual interview with their sexual partners and had a comprehensive medical evaluation to rule out the confounding effects of other illnesses or medications. Psychiatric, psychological and marital information was obtained with the Schedule for Affective Disorders and Schizophrenia (SADS-L), the SCL-90-R, the Derogatis Sexual Function Inventory, the Locke-Wallace Marital Adjustment test and the Dyadic Adjustment Inventory. Compared to controls, diabetic patients had significantly lower levels of erotic drive, sexual arousal, enjoyment and satisfaction. Problems in these areas coexisted with alterations in sexual attitudes and body image but were not related to group differences in marital adjustment as reported separately by the patients and their partners. There was no evidence that psychological distress or psychiatric disorders are associated with diabetes or with its effects on sexual function.

Relationship conflict management patterns among sex dysfunction, sex offender, and satisfied couples

A substantial amount of research has distinguished specific behaviors of distressed from nondistressed couples. Among this evidence are differences in relationship conflict management styles. This investigation examined differences in relationship satisfaction and conflict management styles among 30 sex dysfunction, 25 sex offender, and 26 satisfied couples assessed by the Dyadic Adjustment Scale (DAS) and the Styles of Conflict Inventory (SCI). Results indicate significantly different levels of marital adjustment and distinctive conflict management patterns among the three couples groups. The two sex problem groups were significantly more distressed than the satisfied couples, and sex offender couples appeared more conflicted than sex dysfunction couples. Compared to satisfied couples, sex dysfunction couples address relationship conflict with somewhat polarized roles with an "avoid vs. engage" pattern, while sex offender couples employ a more chaotic "engage-avoid vs. engage-avoid" style. These different patterns of reactivity to conflict suggest that individualized treatment approaches to this dimension of the clinical picture is warranted.

Evaluation and treatment of premature ejaculation: a critical review

OBJECTIVE

Premature ejaculation is the most prevalent male sexual dysfunction. The present article is a comprehensive review of the literature on premature ejaculation.

METHOD

This critical discussion of the literature evaluates the definitional issues, theoretical conceptualizations, assessment strategies, and treatment alternatives for premature ejaculation.

RESULTS

The review integrates the most recent findings on the diagnosis and treatment of premature ejaculation updating an earlier review with the addition of more than fifty recent articles and adding sections on treatment generalization and maintenance, medical evaluation, pharmacological intervention, and a discussion of methodological issues in the literature.

CONCLUSIONS

The pause-squeeze technique remains the current treatment of choice for the disorder. However, this unitary treatment recommendation disguises a multidimensional disorder which has yet to evolve an operational definition, psychometrically sound assessment procedures, or clearly articulated etiology.

Couples referred to a sexual dysfunction clinic. Psychological and physical morbidity

Two hundred couples referred to a sexual problems clinic were assessed in a standardised way for their suitability for sex therapy. The assessment focused on the nature of the sexual dysfunction, motivation for treatment, marital and relationship problems, psychiatric status, and physical problems. Approximately one-third of the couples were found to have significant marital and relationship problems, and more than 30% were suffering from psychiatric disorders, although these were usually of mild to moderate intensity. A third of males and 18% of females were suffering from physical disorders likely to contribute to the sexual dysfunction. Patients who were offered sex therapy and who completed their course of treatment were more likely to show high levels of motivation and an absence of physical disorders, marital relationship problems and psychiatric disorder. There should be careful assessment of couples suffering from sexual dysfunction before specific treatment is offered.

End stage renal disease and the marital dyad: an empirical investigation

The psychological well-being of end stage renal disease (ESRD) patients and spouses was investigated from a dyadic perspective. The responses of patients and spouses from five groups of couples--illustrating different points in the progression and treatment of ESRD--were compared both across ESRD groups and between patients and spouses. Despite the fact that the ESRD groups reflected differences in illness/treatment intrusiveness, no significant differences were found between the ESRD groups, or between patients and spouses, in either marital relations or psychological well-being. However, while for all the participants marital role strain was a significant predictor of psychological well-being, the two dialysis groups evidenced significantly greater correlations between marital role strain and psychological distress than the nondialysis groups. These findings are interpreted as being consistent with a general systems theory approach to the conceptualization and treatment of chronic illness.

Motivation and resistance in sex therapy

Aspects of motivation and resistance in sex therapy as encountered in single, couples and group treatment are discussed, with emphasis on couples therapy. To a significant extent success in sex therapy depends on patients' sound motivation and minimal resistance. Keeping in mind various forms of motivation and resistance therapists are better equipped to deal with the fears and conflicts of their patients and thus promote their sexual welfare.

Comments on the use of group therapy and written instruction in treatment of sexual dysfunction

An examination is offered of recently developed therapeutic strategies for the treatment of sexual dysfunction. Treatment techniques using groups arose from the desire to increase the efficiency and decrease the cost of therapy. The characteristics and techniques of these groups are examined. These treatments seem efficacious and may possess certain advantages over individual therapy. A discussion is offered of -written programs for treating sexual dysfunction. When utilized with clients whose relationships are stable and motivation high, these methods also appear efficacious. Comments are provided regarding further use of these strategies.