Sexual dysfunction, social maladjustment, and psychiatric disorders in women seeking treatment in a premenstrual syndrome clinic

Association between Generalized Anxiety Disorder and Premenstrual Dysphoric Disorder in a Diagnostic Interviewing Study

Background: Premenstrual dysphoric disorder (PMDD) demonstrates predictable, cyclic, affective and somatic symptoms that are aggravated in the late luteal phase and are resolved by menstruation. Generalized anxiety disorder (GAD) is characterized by excessive and persistant worry. The present study aims to evaluate the association between PMDD and GAD. The fluctuations of behavior inhibition, anxiety, depression, and irritability were also evaluated during the menstrual cycle among women with PMDD and healthy women. Methods: There were 100 women diagnosed with PMDD based on a psychiatric interview and on a prospective evaluation in three menstrual cycles. A total of 96 healthy women were recruited as controls. Each individual’s GAD diagnosis, behavior inhibition, behavior activation, depression, anxiety, and irritability were assessed in both luteal and follicular phases. Results: The odds ratio of women with GAD having PMDD was 7.65 (95% CI: 1.69–34.63) in relation to those without it. This association was partially mediated by behavior inhibition and irritability and was completely mediated by depression. Women with PMDD and GAD had higher anxiety during the luteal phase and higher PMDD severity, depression, and irritability than those without GAD in the follicular phase. There is no difference in anxiety, depression, or irritability between the luteal and follicular phases among women with PMDD and GAD. Conclusions: Women with GAD were more likely to have PMDD. Anxiety, depression, and irritability symptoms in women with PMDD and GAD were not relieved in the follicular phase. Thus, GAD should be assessed for women with PMDD. Their anxiety, depression, and irritability should be intervened not only in the luteal phase, but also in the follicular phase. Depression, irritability and behavior inhibition mediated the association between PMDD and GAD. Intervening with these mediators to attenuate GAD and PMDD comorbidity should be researched in the future.

Evaluation of sexual dysfunction in female patients presenting with faecal incontinence or defecation disorder

PURPOSE

Female patients with pelvic floor diseases may suffer from several sexual disorders and sexual life impairments. The aim of this manuscript was to evaluate sexual dysfunction in female patients presenting with faecal incontinence (FI) and defecation disorder (DD).

METHODS

A retrospective review was performed of a prospectively collected database of sexually active women referred to the pelvic floor clinic, who completed the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire-12 (PISQ-12) at first visit. Statistical analysis was performed to evaluate and compare sexual dysfunction between patients with FI and DD and with published data on the general population. Regression analysis was used to identify predictors of sexual dysfunction and surgery.

RESULTS

Three hundred thirteen patients were included, 192 (61%) with FI and 121 (39%) with DD. The patients with DD received more non-gynaecological surgical procedures (p = 0.023). More patients with DD received surgery for their current pelvic floor disease (p < 0.001). Major sexual impairment (PISQ-12 < 30) was found in 100 patients (31.9%). The mean PISQ-12 (33.2 ± 7.2) score was by 5 points lower than those reported in the general population from PISQ-validating studies. Prior anorectal surgery (odds ratio (OR) = 15.4), partner ejaculation problems (PISQ item 11, OR = 2.5), reduced sexual arousal (item 2, OR = 2.1), and orgasm perception (item 13, OR = 2.1) were the strongest predictors of worse sexual function in patients with FI. Patients with DD were almost 15 times more likely to receive subsequent surgery (OR = 14.6, p < 0.001), whereas fear of urine leakage almost doubled the risk.

CONCLUSIONS

Sexual dysfunction is prevalent among patients suffering from FI and DD, and questionnaires are useful in recognizing these patients. Subsequent surgery is more common for patients with DD compared to those with FI.

The role of psychopathological and personality covariates in orgasmic difficulties: a prospective longitudinal evaluation in a cohort of women from age 30 to 50

INTRODUCTION

There are little published data on the prevalence of orgasmic difficulties in representative samples and no longitudinal data on the subject. In addition, our knowledge of the factors, which increase or protect against the risk of orgasmic difficulties, is still rudimentary.

AIM

The aim of this study was to evaluate the cumulative incidence rate and longitudinal course of orgasmic difficulties from age 30 to age 50, and the role of psychopathological and personality covariates in a representative population cohort of women.

METHODS

Semi-structured interviews with single-item questions on sexual problems in general as well as on orgasmic difficulties were conducted. Psychopathological covariates were from the Symptom Checklist 90 Revised and personality characteristics from the Freiburg Personality Inventory. Coping resources were measured by the scales of mastery and self-esteem.

MAIN OUTCOME MEASURES

One-year prevalences of orgasmic difficulties, associations with psychopathological and personality covariates as well as coping resources were the main outcome measures.

RESULTS

Orgasmic difficulties were reported annually by 7.4% to 13.5% of the women with a mean of 10.0% and a cumulative risk of 27.3% from age 30 to 50. No relation between age and the prevalence of orgasmic difficulties could be demonstrated. Psychopathological covariates such as depression, psychoticism, interpersonal sensitivity, obsessive-compulsive symptoms, and somatization were moderately associated with orgasmic difficulties. Also, personality traits, i.e., nervousness, aggressiveness, depressiveness, irritability, sociability, and openness, were related to orgasmic difficulties.

CONCLUSIONS

With a cumulative risk of 27.3%, orgasmic difficulties represent a frequent sexual problem. Annual prevalence rates are particularly high in women with psychopathological characteristics and modestly related to various personality traits. Our findings support the relevance of psychosocial factors in the regulation of female orgasm. More basic research is needed to better understand underlying pathophysiological mechanisms and to improve diagnostic as well as therapeutic tools for women suffering from orgasmic difficulties.

The premenstrual tension syndrome rating scales: an updated version

BACKGROUND

The Premenstrual Tension Syndrome (PMTS) Rating Scales have been widely used as inclusion criteria and/or outcome measures in clinical trials of treatment of Premenstrual Syndromes (PMS). However, both the PMTS Observer Rating Scale (PMTS-O) and the PMTS Self Rating Scale (PMTS-SR) are outdated. We propose to bring them in line with the DSM-IV criteria for Premenstrual Dysphoric Disorder (PMDD) by updating the PMTS-O and replacing the PMTS-SR with a Multiple Visual Analogue Scale (PMTS-VAS).

METHODS

A convenience sample of 23 Caucasian, English-speaking women in their reproductive years with regular menstrual cycles was recruited. Participants were administered the revised PMTS-O (PMTS-OR) by a trained clinician and then instructed to complete the PMTS-SR and the new PMTS-VAS, both of which were timed. The participants were also asked which of the instruments they preferred.

RESULTS

The PMTS-OR and the new PMTS-VAS were sensitive to the variation in severity of premenstrual symptoms among the study participants. All 3 questionnaires showed very high inter-correlations. The PMTS-VAS took less time to complete, and most women preferred the PMTS-VAS to the original PMTS-SR, especially those with PMDD and severe PMS.

CONCLUSIONS

By making minor modifications to the PMTS-O we have ensured that all criteria for the DSM-IV definition of PMDD are now represented in the PMTS-OR. The new PMTS-VAS mirrors the PMTS-OR but now also captures the severity of self rated symptoms. These scales are simple to complete for both clinicians and clients, and are reliable, valid and sensitive to change.

Effects of experimentally adopted sexual schemas on vaginal response and subjective sexual arousal: a comparison between women with sexual arousal disorder and sexually healthy women

The present study evaluated and compared the effects of experimentally adopted sexual schemas on vaginal response, subjective sexual arousal, and affect in 17 women with Female Sexual Arousal Disorder (FSAD) and 17 sexually healthy women. Positive and negative cognitive schemas were presented to participants before viewing sexually explicit video segments. They were asked to temporarily adopt both schemas, and vaginal response, subjective sexual arousal, and affect were measured in each schema condition. Participants in both groups had significantly greater vaginal response and reported more subjective sexual arousal in the positive schema condition than in the negative schema condition. Sexually healthy women demonstrated significantly higher subjective sexual arousal than women with FSAD, but there were no significant group differences in vaginal response. Moreover, participants in both groups reported higher levels of Positive Affect and Vigor in the positive schema condition than in the negative schema condition but higher levels of Negative Affect, Tension-Anxiety, and Anger-Hostility in the negative schema condition than in the positive schema condition. These findings demonstrate the impact of cognitions on sexual arousal, which has important implications for addressing cognitions in the treatment of FSAD. Moreover, these findings have implications for the conceptualization of FSAD, which may be best characterized as a complex, heterogeneous cluster of symptoms.

What is worse for your sex life: starving, being depressed, or a new baby?

OBJECTIVE

To compare the current sexual functioning of women in an intimate relationship with anorexia nervosa, with major depression, and in the postpartum period.

METHOD

Complete data were available for 76 women who reported being in an intimate relationship (anorexia = 10; depression = 24; postpartum = 42). Sexual functioning was assessed using the Social Adjustment Scale (Weissman and Bothwell, Arch Gen Psychiatry, 33, 1111-1115, 1976).

RESULTS

Significant differences were found among groups for the frequency of sex (p =.03) and problems with sex (p < .001), but not for enjoyment of sex (p = .55). In the previous 2 weeks, women with anorexia nervosa or major depression were more likely to have had sex than postpartum women, but were also more likely to have had sexual problems than postpartum women. Most women with anorexia nervosa, women with major depression, and postpartum women reported enjoying sex.

CONCLUSION

Women with anorexia nervosa and women with major depression who are in an intimate relationship report a similar profile of current sexual functioning that is different from postpartum women both in the frequency of sexual encounters and in reported problems with sex.

Relationship Between Female Sexual Difficulties and Mental Health in Patients Referred to Two Public and Private Settings in Tehran, Iran

INTRODUCTION

Sexual difficulty has various effects on patients suffering from this condition that can impact on interpersonal and marital relationships. Sexual function may be adversely affected by stress of any kind and emotional disorders. There have been limited studies focusing on the mental health of those suffering from this problem.

AIM

To determine the relationship between sexual difficulties and mental health in female patients seeking help in psychiatric clinics.

METHODS

The study was based on the case-control design methodology in which the case group consisted of 165 outpatients of two psychiatric clinics, who were diagnosed with different mental disorders such as depression, anxiety, phobia, aggression, and somatic complaints (33 subjects for each type of disorder). The 33 subjects in the control group were chosen among the patients' relatives and visitors who had no history of either seeking psychiatric help or taking psychiatric drugs. The subjects of both case and control groups were selected based on a convenience sampling method. Moreover, the data were collected based on two techniques of "interview" and "questionnaire;" the latter was of three different subcategories, each dealt with demographic characteristics, sexual difficulties, and a Symptom Check-List-90-Revised.

MAIN OUTCOME MEASURE

Assessing female sexual difficulties associated with mental health and differences between women with and without psychiatric problems.

RESULTS

The obtained results indicated that there was a significant difference between the prevalence of sexual difficulties (e.g., sexual desire and orgasm disorders) in the case group and that of the control group. It was also revealed that there was a significant difference between the depressed, aggressive, as well as those with somatic complaints, and their control group counterparts.

CONCLUSIONS

In Iran, sexual difficulties seem to be more frequent in those seeking psychiatric help in clinics than in those within the normal population.

Cues resulting in desire for sexual activity in women

INTRODUCTION

A number of questionnaires have been created to assess levels of sexual desire in women, but to our knowledge, there are currently no validated measures for assessing cues that result in sexual desire. A questionnaire of this nature could be useful for both clinicians and researchers, because it considers the contextual nature of sexual desire and it draws attention to individual differences in factors that can contribute to sexual desire.

AIM

The aim of the present study was to create a multidimensional assessment tool of cues for sexual desire in women that is validated in women with and without hypoactive sexual desire disorder (HSDD).

METHODS

Factor analyses conducted on both an initial sample (N = 874) and a community sample (N = 138) resulted in the Cues for Sexual Desire Scale (CSDS) which included four factors: (i) Emotional Bonding Cues; (ii) Erotic/Explicit Cues; (iii) Visual/Proximity Cues; and (iv) Implicit/Romantic Cues.

MAIN OUTCOME MEASURES

Scale construction of cues associated with sexual desire and differences between women with and without sexual dysfunction.

RESULTS

The CSDS demonstrated good reliability and validity and was able to detect significant differences between women with and without HSDD. Results from regression analyses indicated that both marital status and level of sexual functioning predicted scores on the CSDS. The CSDS provided predictive validity for the Female Sexual Function Index desire and arousal domain scores, and increased cues were related to a higher reported frequency of sexual activity in women.

CONCLUSIONS

The findings from the present study provide valuable information regarding both internal and external triggers that can result in sexual desire for women. We believe that the CSDS could be beneficial in therapeutic settings to help identify cues that do and do not facilitate sexual desire in women with clinically diagnosed desire difficulties.

Sexual function and dysfunction in women

Multiple factors may affect sexual functioning in women, requiring a thorough assessment of all possible etiologies to guide appropriate treatment. Interventions may also be multifaceted, ranging from sex education to psychotherapy to medical treatment. Restoration of sexual functioning is the goal of treatment, but more research is needed for true success to be realized.

Relationships of premenstrual dysphoric disorder to major depression and anxiety disorders: a re-examination

Clarifying the relationships of premenstrual dysphoric disorder (PMDD) to depressive and anxiety disorders may contribute to the understanding of risk factors and etiologies associated with the disorders. A current belief is that women with PMDD have a higher percentage of past psychiatric disorders than women without the disorder, an assumption that may be premature. This review carefully examines existing literature on the nature of the relationships between PMDD and major depression and anxiety disorders. A re-evaluation of the literature and the resulting implications for risk factors and etiology, as well as for obstetric and gynecological practice, are provided.

Prevalence of mood and anxiety disorders in women who seek treatment for premenstrual syndrome

Many women experience symptoms of premenstrual irritability, reactivity of mood, anxiety, and change in appetite and sleep. Whereas some women experience these symptoms exclusively during the premenstrual phase of the menstrual cycle, others may have premenstrual complaints but actually suffer from mood and anxiety symptoms across the entire menstrual cycle. We sought to determine the extent to which women who seek treatment for premenstrual syndrome (PMS) actually suffer from symptoms of sufficient severity and duration to meet formal criteria for mood or anxiety disorders. Two hundred six women who responded to advertisements for a treatment study of premenstrual dysphoric disorder (PMDD) and who were screened by telephone for study eligibility were included in the current investigation. A telephone questionnaire keyed to the Structured Clinical Interview for Diagnosis (SCID-I/P) was used to screen for the presence of current mood and anxiety disorders. Approximately 39% (n = 80) of respondents met criteria for mood or anxiety disorders or both. Mood disorders were noted almost twice as commonly as anxiety disorders. The high prevalence of mood disorders in the sample underscores the need for clinicians to be aware of the overlap between reported PMS symptoms and underlying depressive disorder. Given that early identification and treatment of mood disorder can increase the likelihood of recovery and lower risk for recurrent illness, clinicians should have a low threshold for ruling out mood and anxiety disorders in women with complaints of premenstrual symptoms.

Intermenstrual affect in women with symptomatic premenstrual change

To determine whether women seeking treatment for symptomatic premenstrual change have ongoing psychological disturbance, we undertook a cross-sectional, comparative study across four groups of reproductive-age women. Subjects were 35 patients with symptomatic premenstrual change and no psychiatric history, 35 women without symptomatic premenstrual change, 35 patients with affective disorders, and 35 women from the community at large. All women except those in the community sample were tested in the intermenstrual phase (after menses but before the 12th cycle day). Psychological tests administered were Profile of Mood States, State-Trait Anxiety Inventory, Institute for Personality and Ability Testing (IPAT) Anxiety Scale, IPAT Depression Scale, General Health Questionnaire and the Family Inventory of Life Events (FILE). Demographic data and information concerning present and past stresses were also collected. Women with symptomatic premenstrual change were distinguishable from psychiatric patients on assessment of intermenstrual mood state. They were no different from women within the community at large or from non-symptomatic women. When symptomatic women reported on time periods, which include the premenstrual phase of the cycle, we found results at variance with those obtained in relation to current state mood. While not unlike the women from the community at large in longer term affective characteristics, they were consistently different from non-symptomatic women and sometimes indistinguishable from psychiatric patients. Women with symptomatic premenstrual change also reported higher levels of past external stresses than women taken from the community at large.