Female sexual disorders: psychiatric aspects

Sexual Desire in the Time of COVID-19: How COVID-Related Stressors Are Associated with Sexual Desire in Romantic Relationships

The COVID-19 pandemic and the resulting social distancing measures have caused widespread social and economic disruptions, resulting in spikes in unemployment and financial instability, along with drastic changes to people's ability to feel socially connected. Many of the changes resulting from the COVID-19 pandemic are risk factors for depressive symptoms, which are associated with lower levels of sexual desire. The current research (N = 4,993) examined whether responses to external stressors brought on by COVID-19 (i.e., financial concern, worry, loneliness, stress) were associated with sexual desire among a multi-national sample of people in relationships (Studies 1-2), and whether this association was, in part, due to reports of depressive symptoms (Study 2). In the period immediately following the onset of the pandemic, more financial concern (Study 1) and worry (Study 2) were associated with higher sexual desire, while other factors, like stress (Studies 1-2), were associated with lower desire. We also followed a subset of participants every two weeks during the initial stages of the pandemic and at times when people reported greater stress, loneliness, financial strain, or worry than their average, they reported greater depressive symptoms, which was, in turn, associated with lower sexual desire. Results suggest that the social isolation and stress resulting from the COVID-19 pandemic have mixed associations with sexual desire at the onset of the pandemic. But over time, when people report heightened COVID-related stressors, they tend to report lower sexual desire for their partner, in part because these stressors are associated with more depressive symptoms.

Sexual Dysfunction in Women with Nonpsychotic Disorders: A Cross-sectional Hospital-based Study

Background

Sexual dysfunction among female psychiatric patients is zcommon and can be affected by various bio-psycho-social factors. The clinician's or patient's reluctance to actively inquire or spontaneously report these sexual difficulties creates a lacuna in our understanding of this association. This study aimed to assess the proportion of women with nonpsychotic psychiatric disorders reporting sexual dysfunction and evaluate its association with sociodemographic and clinical variables.

Methods

This cross-sectional study conducted over six months included 113 women attending the psychiatry outpatient department of a tertiary care hospital. Sociodemographic and clinical variables, including diagnosis based on International Classification of Diseases 10th version (ICD 10) criteria, were assessed using a specially designed proforma. Sexual functioning was measured by Female Sexual Functioning Index (FSFI) and the Change in Sexual Functioning Questionnaire-Female Version (CSFQ-FV).

Results

Sexual dysfunction was reported by 67.3% of patients. Among patients on psychotropics, 49% reported worsening of sexual dysfunction after treatment initiation. Sexual dysfunction was associated with increasing age (χ2 = 7.86, P = 0.04), lower educational qualification (χ2 =3.41, P = 0.04), skilled occupation (χ2 = 4.49, P = 0.03), lower socioeconomic status (χ2 = 4.27, P = 0.03) and presence of ongoing psychosocial stressor (χ2 = 4.49, P = 0.03).

Conclusions

Difficulties in different domains of sexual functioning are prevalent among women with nonpsychotic disorders. Sociodemographic and relational factors, along with treatment status, can influence sexual dysfunction in these patients. Clinicians should be vigilant of this association and should plan treatment to enhance compliance and outcome.

Sexual Dysfunction among Females Receiving Psychotropic Medication: A Hospital-based Cross-sectional Study

BACKGROUND

Sexual dysfunction (SD) is a known adverse effect of psychotropic medications. Even though sexual difficulties are common among women; very few studies have been carried out in India.

OBJECTIVE

To study the prevalence and nature of SD among females receiving psychotropic medications and to compare the SD among female patients receiving antipsychotics and antidepressants.

MATERIALS AND METHODS

Female investigator conducted a hospital-based cross-sectional study on female patients visiting the psychiatry outpatient department. Patients meeting inclusion criteria were assessed for SD disorder as per Diagnostic and Statistical Manual of Mental Disorders 4th Edition Text Revision. SD severity was measured using Female Sexual Function Index (FSFI) scale.

RESULTS

The prevalence of SD in this study was 68.32%. There was more than one SD in 48 (47.52%). FSFI score was significantly low in patients with SD as compared to patients not having SD (P = 0.001). SD was more common in patients who were on combination of antidepressants and benzodiazepines than antidepressant alone or antipsychotic alone.

CONCLUSION

SD was prevalent in more than 50% of female patients on psychotropic drugs. Number of patients on individual psychotropic drugs was so small that a definite conclusion could not be drawn. Study emphasizes the need to carry out similar study on larger number of patients to get better insight into this problem.

The Relationship between Sexual Cues and Sexual Desire in Women

Sexual desire is one of the most studied dimensions of sexual response. There is extensive research on bio-medical, psychosocial, and relationship predictors of desire particularly in women. Despite this accumulated knowledge, there is a lack of studies investigating the ability of sexual cues to predict sexual desire. A sample of 546 heterosexual and premenopausal Portuguese women, aged between 18 and 53 years old, completed a web survey assessing socio-demographic variables, medical conditions, psychopathology, relationship dimensions, sexual cues and sexual desire. Findings from hierarchical regression analyses indicated that sexual cues significantly predict sexual desire. In particular, explicit/arousal cues (β = .321, p < .001) were the most significant predictor of female sexual desire. Additionally, somatization (β = .188, p < .001), relationship satisfaction (β = .159, p < .001), anxiety (β = -.165, p = .006), and antidepressant medication (β = -.094, p = .014) were also significant predictors. Results emphasize the strong ability of explicit/arousal cues to predict sexual desire in women above and beyond other known factors. These findings suggest that the assessment of sexual desire problems in women as well as treatment approaches should take into consideration the role of sexual cues and particularly explicit/arousal cues.

Female sexual dysfunction: A comparative study in drug naive 1(st) episode of depression in a general hospital of South Asia

BACKGROUND

Women's sexual dysfunction is found to be highly prevalent in western and Indian literature. Limited studies are available on drug naive depression in western literature and in Indian population.

AIM

To determine the prevalence rate and symptom profile of female sexual dysfunctions in patients with untreated depression.

DESIGN

A cross-sectional study in the psychiatry out-patient department of general hospital in South India.

MATERIALS AND METHODS

Following written informed consent female sexual functioning index (FSFI) and Arizona Sexual Experience Scale (ASEX) - female version and Hamilton Depression Rating Scale (HAMD - 17 item) on 30 cases and 30 controls was administered. Sociodemographic data, pattern and type of sexual dysfunctions were enquired. Data were analyzed using descriptive statistics, contingency co-efficient analysis and stepwise multiple regression.

RESULTS

The mean score of HAMD 17 item in study group was 19.13. The study showed that female sexual dysfunction was 70.3% in study group compared to 43.3% in control FSFI scores above 16 in HAMD had dysfunction of 76% with FSFI in study group. With ASEX-F sexual dysfunction was 73.3% in study compared to 20% in control. Scores above 16 in HAMD had 80% of sexual dysfunction with ASEX-F in study group.

CONCLUSION

The study found that ASEX-F co-related better with HAMD 17 item. Following the onset of depression, the incidence of sexual dysfunction started at an early age in women.

Sexual behavior of married young women: a preliminary study from north India

BACKGROUND

There are significant gaps in the scientific literature concerning female sexual behavior and attitudes surrounding sexuality, which have definitive implications on public health and clinical work.

AIM

To study the sexual behavior of young married Indian women.

MATERIALS AND METHODS

The study group comprised 100 consecutive women attending the Department of Pediatrics for the care of noncritical children in a multispecialty, tertiary care teaching hospital setting in North India. Current levels of sexual functioning and satisfaction were assessed by using the Brief Index of Sexual Functioning for Women (BISF-W). All participants were also administered a translated and culturally adapted instrument called Sex Knowledge and Attitude Questionnaire-II (SKAQ-II).

RESULTS

Peno-vaginal sex continues to be considered the most desired and actually performed sexual activity for arousal and orgasm, followed by kissing and foreplay. Difficulties while performing sexual activity, in the form of physical problems, were faced by 17% of the participants. The participants displayed adequate sexual knowledge and favorable attitude towards sexuality as measured by SKAQ-II.

CONCLUSION

The present study is a preliminary effort to understand the contemporary female sexual behavior, knowledge and attitude by employing standard instruments. Still further studies are required in this area.

Predictors of women's sexual desire: the role of psychopathology, cognitive-emotional determinants, relationship dimensions, and medical factors

INTRODUCTION

Deficient sexual desire is a common sexual difficulty among women, often related to medical and psychiatric problems, lack of adjustment in a relationship, or age. However, the relative contribution of each one of these dimensions is not yet well establish.

AIM

The aim of this study was to evaluate the main predictive factors of female sexual desire.

METHODS

A total of 237 women from the general population answered to a set of questionnaires assessing psychopathology, cognitive-emotional factors, dyadic adjustment, presence of medical pathologies, and menopause.

MAIN OUTCOME MEASURES

Psychopathology measured by the Brief Symptom Inventory (BSI), dysfunctional sexual beliefs measured by the Sexual Dysfunctional Beliefs Questionnaire, thoughts and emotions in sexual context measured by the Sexual Modes Questionnaire, dyadic adjustment measured by the Dyadic Adjustment Scale, medical condition measured by the Medical History Formulation, and sexual desire measured by the Sexual Desire subscale of the Female Sexual Function Index.

RESULTS

Findings indicated that psychoticism was the only psychopathological dimension that significantly predicted sexual desire (beta = 0.37). Conservative beliefs (beta = -0.33) and age-related beliefs (beta = -0.25) were also significant predictors of desire. Additionally, lack of erotic thoughts (beta = -0.28), failure and disengagement sexual thoughts (beta = -0.64), and thoughts related to female passivity (beta = 0.31) during sexual activity were significant predictors of desire. Regarding relationship dimensions, dyadic cohesion (beta = 0.37), and dyadic affection (beta = 0.45) were the best predictors of sexual desire. Moreover, postmenopausal women and women with medical problems presented reduced sexual desire. A multiple regression analysis (enter method) including all these variables plus age, indicated that failure/disengagement thoughts during sexual activity was the only significant predictor of sexual desire in women (beta = -0.52).

CONCLUSIONS

Results support the role of cognitive dimensions in the maintenance of women's sexual interest, and suggest implications for assessment and treatment of sexual desire difficulties.

Sexual dysfunction associated with antidepressant therapy

Increasing numbers of patients are on psychiatric drugs, especially antidepressants. When patients complain of sexual dysfunction, it is important that the clinician take a careful history concerning psychopharmacologic agents. It is possible that simple interventions may maintain the desired effect of the psychiatric drugs while also eliminating sexual side effects caused by these agents.

Female sexual dysfunction: classification, pathophysiology, and management

Female sexual dysfunction is a prevalent problem in the general community; however, it has not been studied as extensively as male sexual dysfunction. Female sexual dysfunction is a common complication after most pelvic surgeries. With the introduction of screening programs, most pelvic malignancies are detected at earlier stages and in younger patients. Sexual dysfunction is a major quality-of-life issue in these young women. Hysterectomy (simple or radical) is the most common type of pelvic surgery in women and is one of the most important causes of female sexual dysfunction. Additionally, female sexual dysfunction is an important issue after urologic (radical cystectomy) and colorectal surgeries (simple and radical proctocolectomy). Sexual dysfunction is a common problem among postmenopausal women. Modifications in the surgical technique (nerve sparing) are rapidly evolving in the field of urology and colorectal surgery, which will be soon followed by modifications in the field of gynecologic surgery. In this article we summarize the pathophysiology and classification of female sexual dysfunction, with special emphasis on the relationship between female sexual dysfunction and pelvic surgeries.

Correlates of Lesbian Sexual Functioning

OBJECTIVE

The objectives of this descriptive study were (1) to characterize sexual functioning of lesbian women, (2) to validate the use of a modified version of the Female Sexual Function Index (FSFI) with lesbians, and (3) to evaluate correlates of sexual functioning in lesbians.

METHODS

The current study was a cross-sectional examination of correlates of sexual functioning in lesbian women. Participants were 350 self-identified lesbians, aged > or = 18 (mean age 35.5 +/- 11.4 years), who completed an anonymous, Internet-based survey. The survey instrument included measures of sociodemographics, sexual functioning, psychological symptoms, and relationship characteristics.

RESULTS

Adequate reliability was demonstrated for all domains of the FSFI, as well as for the total score. Reliability coefficients were comparable to those obtained with the normative sample of heterosexual women. In univariate analyses, age, psychological symptoms, and relationship characteristics were related to many dimensions of sexual functioning in lesbians. Older age was associated with less desire for sexual activity, greater difficulty with lubrication during sexual activity, and lower scores for overall sexual functioning. Psychological symptoms were associated with decreased arousal, pleasure (i.e., orgasm), satisfaction, overall sexual functioning, and increased difficulty with lubrication during sexual activity. Higher relationship satisfaction was associated with increased arousal during sexual activity, less difficulty with lubrication during sexual activity, greater pleasure/orgasm, greater sexual satisfaction, and better overall sexual functioning. Psychological symptoms and relationship characteristics were consistently associated with aspects of sexual functioning in multivariate models.

CONCLUSIONS

Age, psychological symptoms, and relationship characteristics were related to some but not all indices of female sexual functioning. Findings provide a solid empirical basis upon which to explore other determinants of sexual functioning in lesbians.

Pharmacologic treatment strategies for sexual dysfunction in patients with epilepsy and depression

Sexual dysfunction is a frequently encountered comorbid condition in patients with many medical and psychiatric conditions, such as epilepsy and depression. Most depressed patients experience some type of sexual dysfunction, decreased sexual desire being the most common. The association of sexual dysfunction with epilepsy is less clear. Changes in sex hormone levels are common in patients with epilepsy and may be attributable to the disease or to antiepileptic drugs (AEDs). Sexual dysfunction associated with depression or epilepsy is generally treated according to standard guidelines for the management of sexual disorders, since data from special populations are not available. The most common forms of female sexual dysfunction are lack of sexual desire and difficulty achieving orgasm. There are no approved pharmacotherapies for female hypoactive sexual desire disorder or female orgasmic disorder. Female sexual arousal disorder is treated with estrogen replacement therapy when indicated or vaginal lubricants. The most common male sexual dysfunction disorders are premature ejaculation and erectile dysfunction. Phosphodiesterase type-5 inhibitor drugs are now the first-line treatment for erectile dysfunction, and selective serotonin reuptake inhibitors and topical anesthetic creams are nonapproved but effective treatments for premature ejaculation. Testosterone and aromatase inhibitors have been used investigationally to treat sexual dysfunction in men taking AEDs. Patient education and follow-up appointments are essential to ensure optimal outcomes of pharmacologic treatments for sexual dysfunction.

Female Hypoactive Sexual Desire Disorder: History and Current Status

INTRODUCTION

Hypoactive sexual desire disorder (HSDD) is a common problem that is often treatment refractory. This refractoriness to treatment is reflective of our lack of knowledge concerning the determinants of sexual libido in women.

AIM

To review the development and current status of information concerning the diagnosis and treatment of HSDD.

METHODOLOGY

Literature on HSDD published between 1950 and 2005 was reviewed.

RESULTS

Historically, HSDD was considered to be a psychiatric disorder. Thus, the diagnostic criteria utilized in studies of interventions for this disorder are based on the Diagnostic and Statistical Manual of the American Psychiatric Association. This system was never designed to encompass organic causes of sexual dysfunction and has evolved by expert opinion. If the syndrome is poorly defined by these diagnostic criteria, this could limit progress in this field. Epidemiological studies have found that approximately 24-43% of women complain of low sexual desire in the preceding year. The percentage of the population meeting diagnostic criteria for HSDD is probably much lower. There has been considerable progress in the development of psychometrically sound instruments for the assessment of libido. The development of approaches to treatment was reviewed. Approaches to treatment have evolved in three major areas: psychological, hormonal, and use of psychopharmacological agents. There is some evidence of efficacy utilizing all three approaches. The major evidence of efficacy concerns the use of testosterone therapy. Long-term safety data concerning this treatment are absent.

CONCLUSION

There is a rapidly expanding knowledge base concerning the diagnosis and treatment of HSDD. However, the contemporary clinician is faced with the absence of an approved treatment for this disorder and the lack of clear guidelines concerning the indications and safety of the use of non-approved agents.

Sexual dysfunction in the elderly: age or disease?

Sexuality is an important component of emotional and physical intimacy that men and women experience through their lives. Male erectile dysfunction (ED) and female sexual dysfunction increase with age. About a third of the elderly population has at least one complaint with their sexual function. However, about 60% of the elderly population expresses their interest for maintaining sexual activity. Although aging and functional decline may affect sexual function, when sexual dysfunction is diagnosed, physicians should rule out disease or side effects of medications. Common disorders related to sexual dysfunction include cardiovascular disease, diabetes, lower urinary tract symptoms and depression. Early control of cardiovascular risk factors may improve endothelial function and reduce the occurrence of ED. Treating those disorders or modifying lifestyle-related risk factors (eg obesity) may help prevent sexual dysfunction in the elderly. Sexuality is important for older adults, but interest in discussing aspects of sexual life is variable. Physicians should give their patient's opportunity to voice their concerns with sexual function and offer them alternatives for evaluation and treatment.

Emerging therapies for female sexual dysfunction

Epidemiological studies in the US, the UK and Sweden indicate that approximately 40% of women aged 18 - 59 have significant complaints about their sexual lives. The majority of complaints concern low sexual desire. Other common problems include difficulty reaching orgasm, insufficient lubrication and painful coitus. A vacuum erection device which increases blood flow to the clitoris has been approved by the US Food and Drug Administration. There are no pharmacological agents with approval for the treatment of female sexual dysfunction. Phosphodiesterase inhibitors and other drugs which cause genital vasocongestion in women appear to have minimal clinical efficacy. Although many of these agents increase the vasocongestive response to sexual stimulation, there is minimal correlation between subjective and objective measures of sexual arousal in women. Trials with androgens have clearly and convincingly demonstrated that supraphysiological doses of testosterone increase libido in postmenopausal women. The long-term safety of such doses is unclear. To date, no studies have shown lower doses of androgens to be beneficial. There have been minimal studies of drugs targeting the central nervous system to date. Bupropion may have a beneficial effect on orgasm attainment in women with hypoactive sexual desire disorder.

Standards for Clinical Trials in Sexual Dysfunctions of Women: Research Designs and Outcomes Assessment

INTRODUCTION

Clinical trials on sexual dysfunctions in women are limited in spite of the fact that sexual dysfunctions are likely more common in women than in men. Currently there are no medications approved for treatment in women, and limited data on drug efficacy or psychological efficacy in well-controlled studies.

AIM

To provide recommendations/guidelines concerning state-of-the-art knowledge for the research design and outcome assessment standards for clinical trials in women's sexual dysfunctions.

METHODS

An International Consultation in collaboration with the major urology and sexual medicine associations assembled over 200 multidisciplinary experts from 60 countries into 17 committees. Committee members established specific objectives and scopes for various male and female sexual medicine topics. The recommendations concerning state-of-the-art knowledge in the respective sexual medicine topic represent the opinion of experts from five continents developed in a process over a 2-year period. Concerning the Standards for Clinical Trials in Women's Sexual Dysfunctions Committee, there were seven experts from two countries.

MAIN OUTCOME MEASURE

Expert opinion was based on grading of evidence-based medical literature, widespread internal committee discussion, public presentation and debate.

RESULTS

A comprehensive update was created which included references and recommended guidelines for rationale and design of clinical trials, study populations, outcome assessments, protocol design and implementation, data analysis and reporting, as well as ethical and clinical issues related to sexual dysfunction research.

CONCLUSIONS

There is a need for more research in developing standards to be used when performing clinical trials and outcomes assessment research in sexual dysfunctions of women.

Bupropion sustained release for the treatment of hypoactive sexual desire disorder in premenopausal women

Premenopausal women meeting operational criteria for idiopathic, acquired, global hypoactive sexual desire disorder were studied in a randomized, double-blind, placebo-controlled, multiple-site escalating dose 112-day trial of bupropion sustained release. Outcome was measured by investigator-rating and self-administered questionnaires. All measures indicated greater sexual responsiveness in women receiving bupropion. The Changes in Sexual Functioning Questionnaire indicated that bupropion had significant effects on increasing measures of sexual arousal, orgasm completion, and sexual satisfaction.

Pharmacologic management of sexual dysfunction: benefits and limitations

What is the current knowledge concerning the pharmacologic treatment of human sexual dysfunction? A number of interventions, including oral phophodiesterase inhibitors and intracorporeal agents with vasodilatory effects, are available to treat male erectile disorder. Serotonergic drugs have been shown to be effective in the treatment of rapid ejaculation. Various lines of research suggest that high dosages of androgenic agents may eventually have a role in the treatment of decreased libido in females. There may be a role for phophodiesterase inhibitors in the treatment of a subgroup of women with arousal disorders. Normal sexual function involves successful integration of biological, psychological, and interpersonal influences. Clinical psychiatry with its biopsychosocial model should incorporate the treatment of human sexual dysfunction within its purview.