Psychological and interpersonal dimensions of sexual function and dysfunction: recommendations from the fifth international consultation on sexual medicine (ICSM 2024)

INTRODUCTION

Sexual health concerns are common and significantly impact quality of life, but many people do not seek treatment due to embarrassment and other barriers. A biopsychosocial model of assessment and treatment acknowledges the biological, psychological, and social contributors to sexual difficulties and suggests that all these domains should be evaluated.

OBJECTIVES

This paper provides an overview of the major psychological factors contributing to sexual difficulties and offer an evidence-based approach for primary care clinicians to assess and treat these issues.

METHODS

A comprehensive literature review was undertaken focusing on articles published since the last consultation in 2016. The study findings were synthesized, critiqued, authors assigned a Grading of Recommendation as Weak or Strong following a year-long process of discussions among the committee. When a particular well-established psychological practice was not evaluated in the literature, we assigned an expert opinion recommendation.

RESULTS

Since the 2015 ICSM, there have been a number of high-quality trials of psychological treatments addressing sexual dysfunctions, as well as meta-analyses and systematic reviews. In some domains, there is strong evidence of psychological treatment, and primary care providers should be aware of such approaches and refer when appropriate.

CONCLUSIONS

This paper offers a practical guide for primary care clinicians to understand the psychological factors underlying sexual dysfunction and outlining what approaches may be appropriate for this clinician, and when the patient should be referred to a specialist. We emphasize an evidence-based approach to managing sexual dysfunctions in primary care, allowing for timely interventions. A comprehensive evaluation of biopsychosocial factors is recommended to personalize psychological interventions to overall context, including chronic diseases, mental health issues, and relationship conflicts. The initial assessment is key to developing an individualized intervention plan, which may include psychoeducation, referral for cognitive-behavioral therapy, mindfulness, or couple therapy, and consideration of medical or digital health interventions.

The Effects of Sleep Hygiene Education on Sleep Quality, Pain, and Depression in Individuals With Fibromyalgia

BACKGROUND

Sleep problems, pain, and depression are common issues in fibromyalgia. However, studies on sleep hygiene education to address these problems are limited in the literature. Therefore, there is a need to investigate the effects of sleep hygiene education given to individuals with fibromyalgia on their sleep quality, pain, and depression levels.

PURPOSE

This experimental study was conducted to determine the effects of sleep hygiene education on sleep quality, pain, and depression in individuals with fibromyalgia.

DESIGN

This study was carried out using an experimental pretest-posttest design with a control group.

METHODS

Seventy individuals with fibromyalgia (35 experimental, 35 control) were included in the study. Data were collected using the Pittsburgh Sleep Quality Index (PSQI), the Visual Analog Scale (VAS), and the Beck Depression Inventory (BDI). The experimental group received sleep hygiene education, while the control group did not undergo any intervention.

RESULTS

The participants in the experimental group had lower PSQI, VAS, and BDI scores after the intervention. In the inter-group comparisons, there were statistically significant differences between sleep quality and pain scores of the groups after the intervention.

CONCLUSIONS

Sleep hygiene education was found to be effective in improving sleep quality and alleviating pain and depression in individuals with fibromyalgia.

CLINICAL IMPLICATIONS

Sleep hygiene education, which has been neglected in improving sleep quality and pain in the care of fibromyalgia, should be used in clinical settings.

The effect of face-to-face and online education provided to individuals with atrial fibrillation on medication adherence and satisfaction

This randomized controlled study was conducted to investigate effects of face-to-face education and tele-education given to individuals with atrial fibrillation (AF) taking oral anticoagulants on their medication compliance and satisfaction levels. The study sample comprised 150 individuals. Of them, 50 were assigned to the control group, 50 to experimental Group 1, and 50 to experimental Group 2. Data were collected with the Descriptive Information Form, Medication Compliance Notification Scale, and Duke Anticoagulation Satisfaction Scale (DASS). Intervention Group 1 was given face-to-face education. Intervention Group 2 was given tele-education. The control group underwent no intervention. The scales were administered to all the groups twice. Intragroup analysis demonstrated that the Medication Compliance Notification Scale score of the face-to-face education group increased significantly in the final measurement compared to those of the control group and tele-education group. Intergroup analysis demonstrated that the DASS scores of the three groups significantly differed. The difference stemmed from intervention Group 1. Face-to-face education given to individuals with AF on oral anticoagulants improved their medication compliance and medication satisfaction levels. Nurses should primarily use face-to-face education in the care and education programs of individuals with AF.

Treatment of Sexual Dysfunction in Women with Systemic Autoimmune Rheumatic Disorders: A Systematic Review

Introduction

Female sexual dysfunction (SD) is an under-recognized and undertreated problem in patients with systemic autoimmune rheumatic disorders (SARDs).

Objectives

To summarize and evaluate the existing treatment modalities for SD in females with SARDs.

Methods

A systematic review was conducted following the PRISMA guidelines. Electronic databases were searched up to April 2022 for studies that assessed the use of pharmacological and non-pharmacological treatment modalities for the management of SD in females with SARDs. Randomized and observational studies were included. (PROSPERO: CRD42022296381).

Results

Seven studies with 426 females with SD were included. Seven different treatment modalities belonging to 5 different classes (androgen therapy, phosphodiesterase-5 inhibitors, exercise, education and local creams) were evaluated in patients with systemic lupus erythematosus, rheumatoid arthritis and systemic sclerosis. The majority of the studies were of low methodological quality. Standardized patient education and 8-week aerobic walking programs were successful in improving female SD. Local creams improved dyspareunia in females with systemic sclerosis. Testosterone did not significantly improve SD in patients with systemic lupus erythematosus. Accordingly, tadalafil did not result in a significant improvement of SD in females with systemic sclerosis, based on the Female Sexual Function Index.

Conclusion

There is a lack of sufficient evidence to recommend a certain management strategy for SD in females with SARDs. Nonpharmacological therapy and lubricant creams may be beneficial in females with SARDs. No benefit was demonstrated after androgen therapy or tadalafil. Still, no definite conclusions can be drawn due to the important limitations of the available literature. Overall, our results may be considered preliminary and further research in the field is mandatory.

Sexual Dysfunction and Quality of Life in Patients with Rheumatoid Arthritis

Background: Sexual health is a major component of human well-being. As repeatedly shown in research, satisfaction with sex life and sexual fulfillment correlate positively with quality of life (QoL) in most of its aspects. It is thus true that a reduced quality of one’s sex life and lack of sexual fulfillment can contribute to poorer QoL overall. The aim of this study is to describe an assessment of sexual dysfunction and factors affecting sexual dysfunctions of patients with rheumatoid arthritis (RA). Material and methods: 171 consecutive RA patients (mean age 48.3 ± 14.6) attending the rheumatology outpatient clinic. Standardized questionnaires used in the study were the sexological questionnaire, WHOQOL-BREF to assess QoL level, Disease Acceptance Scale, and VAS scale to assess pain intensity. Results: The mean duration of the disease in the study group was 13 ± 9 years, mean score of subjective assessment of mobility was 6.2 ± 1.6, and the mean score of the DAS-28 was 4.0 ± 1.9. The study group presented a mean level of disease acceptance (AIS 29.6 ± 11.6). The comparative analysis showed significant differences in reaching orgasm and declared sexual dysfunctions. These problems occurred more often in women than in men (34.2% vs. 18% and 43% vs. 40%, respectively). In univariate analysis, factors correlating positively with the frequency of declaring sexual dysfunction were subjective motor score less < 6 points, AIS < 36 points, WHOQOL-BREF < 59 points, disease activity ≥3.5 points, and VAS > 3. In multivariate logistic regression analysis, independent factors positively correlating with frequency of sexual dysfunction declaration were general QoL (β = 1.255; p = 0.035) and pain limiting social life (β = 1.564; p = 0.030). The absence of comorbidities correlated negatively and reduced the prevalence of sexual dysfunction (β = −1.030; p = 0.043). Patients with reduced QoL and patients with pain limiting social life had 3.5 and 4.8 times higher risk of sexual dysfunction than other patients, respectively. In contrast, those without comorbidities were 2.8 times more likely to be free of sexual dysfunction than those diagnosed with other chronic diseases besides RA. Conclusions: Sexual dysfunction is an emerging problem in both men and women with RA. The absence of comorbidities is an independent determinant of sexual dysfunction, whereas poor QoL and pain limiting social life are independent determinants that exacerbate sexual dysfunction in both genders.

A longitudinal study of educational needs among patients with inflammatory arthritis

INTRODUCTION

Patient education is important in the follow-up and disease management for patients with chronic inflammatory arthritis. Patients' needs for education and information varies, and it is important that the education is tailored to the individual patient. Hence, the aim of this study is to investigate whether patients' educational needs change over time, and which demographic, disease-related or self-management characteristics that are associated with patients' educational needs.

METHODS

The Mann-Whitney U-test was used to study patients' longitudinal educational needs and whether their needs change over time, while multivariable linear regression analyses were used to investigate associations between patients' educational needs and demographic variables, disease-related and self-management characteristics.

RESULTS

There were no changes in patients' educational needs in the domains of managing pain, movement, feelings, arthritis process and treatment from health professionals during the study period of seven years. A small decrease in educational needs in the domains self-help measures (p-value 0.047) and support from others (p-value 0.010) was detected. The regression analyses showed that higher educational needs were associated with being female, lower educational level, shorter disease duration, and a lower level of patient activation.

CONCLUSIONS

Patients with chronic inflammatory arthritis have continual needs for patient education throughout their disease trajectory. Nurses and health care professionals must therefore ask their patients what kind of education they need at every follow-up throughout the disease course.