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

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 We contacted experts in the field regarding unpublished material.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.

The DSM diagnostic criteria for female orgasmic disorder

This article reviews the DSM diagnostic criteria for Female Orgasmic Disorder (FOD). Following an overview of the concept of female orgasm, research on the prevalence and associated features of FOD is briefly reviewed. Specific aspects of the DSM-IV-TR criteria for FOD are critically reviewed and key issues that should be considered for DSM-V are discussed. The DSM-IV-TR text on FOD focused on the physiological changes that may (or may not) accompany orgasm in women; one of the major recommendations here is that greater emphasis be given to the subjective aspects of the experience of orgasm. Additional specific recommendations are made for revision of diagnostic criteria, including the use of minimum severity and duration criteria, and better acknowledgment of the crucial role of relationship factors in FOD.

Psychosocial factors and sexual dysfunctions: a descriptive study in Turkish males

The study of human sexuality has dramatically changed in the last decade. The conceptualization of sexual dysfunction developed in the West is now mushrooming in different parts of the world and there is a dearth of research on characteristics of patients seeking treatment for sexual dysfunction in non-Western countries. This paper describes the demographic characteristics, related factors, and clinical symptomatology of 40 male patients with various sexual dysfunctions attending the psychiatric out-patient clinic of Cukurova University, Turkey. Turkey's population is predominantly Muslim and the country unites Europe and Asia, showing the cultural characteristics of both continents. Our results suggest that the patterns of manifestation are similar to those reported elsewhere with the exception of premarital patterns of sexuality.

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.

The Holden Psychological Screening Inventory and sexual efficacy in urological patients with erectile dysfunction

This paper examined the relationship between psychological adjustment and sexual ability in a sample of 33 men with erectile dysfunction and their spouses. Indices of sexual efficacy converged and were negatively associated with self-reported depression. Data are interpreted as confirming the association between erectile dysfunction and psychological disturbance and as providing evidence of validity for the Holden Psychological Screening Inventory Depression Scale and the Sexual Self-efficacy Scale.

Erectile dysfunction in men with chronic medical illness

This study examined interrelationships of psychosocial variables found in a psychological evaluation for erectile disorder in 75 male veterans with chronic medical illness. Patients whose partners participated in the evaluation were compared with those whose partners were not involved, and agreement on measures between patients and partners was examined. Finally, a principal components analysis was performed to assess the primary dimensions underlying the variance in mental health and sexual functioning variables. Five factors were identified, accounting for 65.5% of the variance. Results of these analyses are discussed in order to obtain an understanding of the interrelationship between behavioral, psychological, and interpersonal variables in the onset and course of sexual dysfunction.

Sexuality in the elderly

Sexuality and aging are not incompatible terms. However, sexual issues are often ignored in older adults. Impacts of altered physiology and pathologic changes, such as cardiovascular disease are discussed in this article. What is clear is that many older adults are interested in remaining sexually active throughout the years.

Treatment of sexual dysfunctions by sex therapy and other approaches

BACKGROUND

The treatment of sexual dysfunctions underwent a great change when sex therapy was developed more than 25 years ago. Since then the treatment programme has been modified in various ways, the response to treatment evaluated and other treatment approaches introduced.

METHOD

A review of the literature concerning the application and outcome of sex therapy and other treatments for sexual dysfunction was conducted.

RESULTS

The format of effective conjoint sex therapy is now fairly clear and there is good understanding of the sexual dysfunctions that respond best to this treatment and the couples most likely to benefit. Less is known about the effects of treatment of individuals without partners, bibliotherapy and combining sex therapy with marital therapy and with physical methods of treatment.

CONCLUSIONS

Sex therapy is now a well-established form of treatment. It should be more widely available for patients seen in psychiatry departments.

Psychosexual functioning of partners of men with presumed non-organic erectile dysfunction: cause or consequence of the disorder?

In the treatment of couples where the male partners have erectile dysfunction (ED) it often becomes apparent that characteristics of the female partners and of the relationship in general have contributed to the problem. However, this has received little research attention. We investigated female partners of men with ED where no organic cause could be found (n = 34) and partners of men with organically based ED (n = 71) to compare their views on their relationships, sexual function, sexual attitudes, and psychological adjustment. Relationship problems and the psychosexual dysfunctions of vaginismus and dyspareunia were more common in the partners of men with nonorganic ED; they also reported higher levels of sexual interest. Female sexual dysfunctions in the nonorganic ED group had usually preceded the onset of the erectile difficulties. While belief in male sexual myths was substantial in both groups of patients, neither the presence of traditional views on sexuality nor psychological complaints distinguished partners of men experiencing nonorganic ED from those with organic ED. Relationship problems, female psychosexual dysfunction, and the possible effect of relatively high levels of female sexual interest may contribute to the onset, exacerbation, and maintenance of ED. These should be addressed during assessment and treatment of couples in which the male partners have erectile difficulties.

Psychosexual problems in people with HIV infection: controlled study of gay men and men with haemophilia

HIV infection can be associated with major psychological and social disturbance. Psychosexual problems would be expected to arise in the context of the infection, in view of the contribution that sexual behaviour can make to the acquisition and spread of HIV infection. Here the results of a study of the psychosexual consequences of HIV infection in gay men and men with haemophilia are presented, with the inclusion of data from control groups. Sixteen HIV-positive and 23 HIV-negative gay men, and 20 HIV-positive and 24 HIV-negative men with haemophilia with sexual partners were studied. HIV infection was found to be associated with the greater risk of development of sexual dysfunction in seropositives, in particular in relation to ejaculatory difficulties, both delayed ejaculation in the case of gay men and men with haemophilia, and premature ejaculation in the case of men with haemophilia. Possible aetiological mechanisms are considered, including the possibility of organic disease. The findings are of relevance to those involved in the care of people with HIV infection.

The psychosocial impact of HIV infection in gay men. A controlled investigation and factors associated with psychiatric morbidity

This study aimed to establish the prevalence of psychosocial problems in gay men with HIV infection, and to identify factors associated with psychological morbidity. The study was a cross-sectional controlled investigation, which included 24 HIV seropositive and 25 seronegative gay men. Outcome measures included current psychological status and psychiatric history; coping and health beliefs; and social and sexual functioning. Seropositive subjects had worse scores on the PSE total score, and greater sexual difficulties. There were also differences in health beliefs and coping. Psychological morbidity was associated with hopelessness, previous psychiatric illness, symptomatic HIV disease, and low self-esteem.

Low sexual desire: sex therapy results and prognostic factors

In a prospective study of 60 couples who entered sex therapy because of the female partners' low sexual desire, 38 (63.3%) completed treatment and 34 (56.7%) had a positive outcome. The principal predictor of completion of treatment was the male partners' apparent motivation at the outset. Poorer outcome was associated with younger age of the couple (especially the male partner) and a shorter duration of the sexual problem. Surprisingly, few aspects of the couples' general relationships prior to treatment were related to outcome, except for poorer outcome being associated with a history of previous separations. The apparent lack of significant contribution of general relationship factors and psychopathology to outcome probably reflects the stringency of the initial selection process. Eventual outcome was also related to couples' progress by the third treatment session. The modest outcome of treatment for low sexual desire in this and other studies emphasises the need for further understanding of factors which contribute to this problem and for the development of novel treatment strategies.