A Survey on the Experience of Singaporean Trainees in Obstetrics/Gynecology and Family Medicine of Sexual Problems and Views on Training in Sexual Medicine

Introduction

Asian patients may have more difficulty seeking help for their sexual problems because of a largely conservative culture. Residents from both obstetrics and gynecology (OBGYN) and family medicine (FM) departments are ideally placed to address sexual problems.

Aim

This survey explored the experience of residents from OBGYN and FM in managing sexual problems and their views on training in sexual medicine (SM).

Method

An anonymized questionnaire collecting data on trainee characteristics, exposure to male and female sexual problems, and training in SM was sent to all FM and OBGYN residents in Singapore. These residents had completed their medical registration with the Singapore Medical Council and were at various stages of specialty training in both FM and OBGYN residency programs in Singapore.

Main Outcome Measure

Trainees’ exposure to male and female sexual problems and their views on training in Sexual Medicine.

Results

The overall response from the survey was 63.5% (122/192)—54% (70/129) and 69% (52/75) of FM and OBGYN residents responded, respectively. 63% were female, with 22% being senior residents, and 55% attended Singaporean medical schools. About one quarter (30/122) of the respondents encountered patients with sexual problems at least monthly. Most would refer these patients directly to specialists, psychologists, and sex therapists. More than 80% of residents were not confident in managing sexual problems in either sex (89% for male problems; 83% for female problems). Among the recognized categories, only 30% felt confident to manage erectile dysfunction, 26% for vaginismus, while less than 10% felt confident to manage libido, arousal, or orgasm disorders. 95% of the residents agreed that SM should be part of both training curricula, with 70% and 25% suggesting at junior and senior residency, respectively. 93% of them were interested to obtain further knowledge and skills in SM through their core training curriculum and from seminars.

Conclusions

This survey reported a significant number of residents in OBGYN and FM departments are regularly exposed to patients with sexual problems but lack the skills to manage them. OBGYN residents were more familiar with managing female sexual problems while FM residents tend to have more experience in male sexual problems. Almost universally, the residents in FM and OBGYN were very keen to acquire skills in SM, and the results support the incorporation of appropriate knowledge and skills into both national residency program curricula.

Huang Z, Choong DS, Ganesan AP, et al. A Survey on the Experience of Singaporean Trainees in Obstetrics/Gynecology and Family Medicine of Sexual Problems and Views on Training in Sexual Medicine. J Sex Med 2019;8:107–113.

Sexual Dysfunction in Menopausal Women

INTRODUCTION

Hormone-related changes in menopause may negatively affect sexual function.

AIM

The primary aim of this study was to evaluate sexual functioning in Polish women with the Female Sexual Function Index (FSFI). The secondary aim was to evaluate the major factors affecting sexual functions in middle-aged Polish women.

METHODS

The Menopause Rating Scale was used to assess the menopausal symptoms. The Polish translation of the FSFI was used to assess sexual function.

OUTCOMES

69.73% of respondents had sexual dysfunction according to FSFI (FSFI score ≤ 26.55).

RESULTS

80.61% of women experienced menopausal symptoms during the 4-week period of study. Psychological and urogenital symptoms were the most frequently reported among all the women enrolled in the study (78.23% and 77.21%). Sexual problems were observed in women who did not use hormone therapy (β = 0.09, t = -1.97, P = .048) and showed no somatic symptoms (β = 0.03, t = 2.95, P = .002).

CLINICAL IMPLICATIONS

It is important for health care providers to ask women about this problem and understand the factors that may influence sexual problems in menopause.

STRENGTHS & LIMITATIONS

A validated survey tool was used. The limitation was selection of participants in the clinical setting and sample population size.

CONCLUSION

Sexual problems were much more common in women who did not use hormone therapy and showed no somatic symptoms. Dąbrowska-Galas M, Dąbrowska J, Michalski B. Prevalence and Associated Risk Factors of Sexual Problems Among Polish Middle-Aged Women. Sex Med 2019;7:472-479.

Prevalence of Sexual Problems and Associated Distress in Aging Men Across 4 European Countries

BACKGROUND

Among older men, comparable cross-cultural investigations of sexual problems and associated distress that also include a multitude of relevant explanatory variables of these sexual problem and related distress are rare in the research literature.

AIMS

To investigate prevalence rates of sexual problems and associated distress among older men across 4 European countries (Norway, Denmark, Belgium, and Portugal) and assess for associated mental and physical health-related factors.

METHODS

Multinational cross-sectional questionnaire study using self-report measures.

OUTCOMES

Prevalence rates of sexual problems and associated distress levels.

RESULTS

We found a high prevalence of sexual problems persisting for months or longer across countries, but noted that many affected men experienced minimal or no distress related to these problems. We also found marked cross-cultural differences in reported distress about sexual problems, with southern European men (ie Portugal) reporting significantly more distress related to the majority of sexual problems investigated compared with northern European men (ie Denmark and Norway). Finally, we identified several relational, physical, and mental health problems associated with the reported number of sexual problems and the distress related to these problems.

CLINICAL IMPLICATIONS

We suggest that healthcare professionals also target distress when considering sexual problems among older men and contextualize these considerations within a multifactorial approach to general health in which (other) mental and physical health factors relevant to these patients' sexual health and function are also jointly considered.

STRENGTHS & LIMITATIONS

Strengths of this study include the large sample size, inclusion of participants from 4 European countries, assessment of distress associated with sexual problems, and similar research design and method of data collection across the 4 included countries. Limitations of the study include the cross-sectional design, which precludes causal conclusions; the low response rate in the Portuguese sample; the lack of homosexual participants; and the lack of comprehensive assessments of dyadic factors that may be of relevance to sexual problems and associated distress.

CONCLUSION

This study identified a high prevalence of sexual problems persisting for 3 months or longer among older men across 4 European countries, but also found that many of the men with sexual problems experienced minimal or no distress related to these problems. G.M. Hald, C. Graham, A. Štulhofer, et al. Prevalence of Sexual Problems and Associated Distress in Aging Men Across 4 European Countries. J Sex Med 2019;16:1212-1225.

A Descriptive Analysis of Sexual Problems in Long-Term Heterosexual Relationships

BACKGROUND

Although much research has described individual sexual dysfunctions, few studies to date have examined the types of problems that couples consider most significant in their sexual relationships.

AIM

To clarify the types of relational sexual problems that are most common and most severe in the sexual lives of individuals in long-term romantic relationships.

METHODS

A community sample of 117 mixed-sex couples completed this in-lab study. Members of each couple separately completed a demographics questionnaire and a measure of their relational sexual problems, the Sexual Problems Questionnaire (SPQ). Descriptive analyses (eg, examination of means, frequency counts) were conducted to determine the most common and severe sexual problems reported by participants. t-Tests were performed to examine gender differences in mean severity ratings for each SPQ item. Qualitative data were examined by conducting a frequency count on the SPQ items that participants reported to be most important in their sexual relationships. Results of all frequency counts were divided by the total sample size and are reported as percentages.

MAIN OUTCOME MEASURES

Participants reported on the severity of their sexual problems using the 25-item SPQ.

RESULTS

Quantitative analyses revealed that the most common and problematic sexual problems endorsed by both sexes were frequency of sex, sexual initiation, and showing interest. A frequency count of participants' qualitative reports also revealed that frequency of sex (women = 36%; men = 39%), sexual initiation (women = 33%; men = 32%), and showing interest (women and men = 25%) were the most important sexual issues for most individuals.

CLINICAL IMPLICATION

The most pressing relational sexual problems for couples in long-term romantic relationships are consistent between sexes and pertain to the domain of sexual desire.

STRENGTH & LIMITATIONS

The current study used an expanded measure of sexual problems, which allowed participants to report on a broad range of issues in their sexual relationships. The direction of such relational sexual problems (eg, desiring more or less sexual frequency) was not explored.

CONCLUSION

The key problems in sexual relationships center on the theme of sexual desire, and men and women consider these issues to be problematic to a similar extent. Sutherland SE, Rehman US, Fallis EE. A Descriptive Analysis of Sexual Problems in Long-Term Heterosexual Relationships. J Sex Med 2019;16:701-710.

Prevalence and Predictors of Sexual Problems Among Midlife Canadian Adults: Results from a National Survey

BACKGROUND

Sexual problems are common among midlife men and women, and studies have identified a range of demographic, health, and relational correlates. Research on prevalence of these sexual problems within Canada is sparse and is warranted given the unique context related to provision of health care services in contrast to other countries.

AIM

We investigated sexual problems (women's low desire, orgasm difficulties, and vaginal pain, as well as men's low desire, erection difficulties, and ejaculation difficulties) and their correlates among a large sample of Canadian men and women aged 40-59 years.

METHODS

A national sample of Canadians was recruited (N = 2,400). Prevalence statistics for the sexual problems, and odds ratios for correlates were computed using logistic regression to identify demographic, health, and behavioral correlates of men' and women's sexual problems.

OUTCOMES

Self-reported experiences in the last 6-months of low desire, vaginal dryness, vaginal pain, and orgasm difficulties for women, and low desire, erectile difficulties, and ejaculation problems for men.

RESULTS

Sexual problems were relatively common; low desire was the most common sexual problem, particularly for women, with 40% reporting low sexual desire in the last 6 months. Women who were post-menopausal were much more likely to report low desire, vaginal pain, and vaginal dryness. Low desire and erectile difficulties for men, and low desire and orgasm difficulties for women were significant predictors of overall happiness with sexual life.

CLINICAL TRANSLATION

Given the prevalence and impact of sexual problems indicated in our study, physicians are encouraged to routinely assess for and treat these concerns.

CONCLUSIONS

Strengths include a national sample of an understudied demographic category, midlife adults, and items consistent with other national studies of sexual problems. Causal or directional associations cannot be determined with these cross-sectional data. Results are largely consistent with previous national samples in the United States and the United Kingdom. Sexual problems are common among Canadian men and women, with many being associated with self-reported sexual happiness. Quinn-Nilas C, Milhausen RR, McKay A, et al. Prevalence and Predictors of Sexual Problems Among Midlife Canadian Adults: Results from a National Survey. J Sex Med 2018;15:873-879.

Sexual Sensation Seeking, Sexual Compulsivity, and Gender Identity and Its Relationship With Sexual Functioning in a Population Sample of Men and Women

INTRODUCTION

Despite awareness of the importance of psycho-affective factors in the development of sexual problems, there is a lack of studies exploring the relation of sexual sensation seeking (SSS) and sexual compulsivity (SC) to sexual functioning. Because sex differences in SSS and SC have been reported, gender identity (GI; an individual's own experience of his or her gender that is unrelated to the actual biological sex) might act as a moderator in this relation.

AIM

To understand the role of SSS and SC for men and women's sexual functioning and to explore whether these potential associations are moderated by GI.

METHODS

A population-based cross-sectional online survey targeted 279 individuals (69.2% women, 30.8% men; mean age = 32 years). Validated questionnaires, including the Sexual Sensation Seeking Scale, the Sexual Compulsivity Scale, the Female Sexual Function Index, the Premature Ejaculation Diagnostic Tool, and the International Index of Erectile Function, were applied.

MAIN OUTCOME MEASURES

Variations in SSS and SC and their association with sexual functioning were investigated using Spearman rank correlation. Moderation analyses were conducted using regression models in which the interaction terms between SSS and GI and between SCS and GI as predictors of sexual functioning were included.

RESULTS

A statistically significant correlation between SSS and SC could be detected in men and women (r = 0.41 and 0.33, respectively; P < .001 for the two comparisons). In women, higher levels of SSS were associated with higher levels of desire, arousal, lubrication, and orgasm and less sexual pain (P < .05 for all comparisons). No moderating effect of GI could be detected. In men, GI was a significant moderator in the relation between SC and erectile function (β = 0.47; P < .001) and between SSS and erectile and ejaculatory function (β = -0.41 and 0.30; P < .001 for the two comparisons).

CONCLUSION

The present study is the first to show a link between SSS and SC and sexual functioning. The results might have important clinical implications and can provide useful information for programs aimed at sexual health enhancement.

Postcoital Dysphoria: Prevalence and Psychological Correlates

Introduction

While problems related to desire, arousal, and orgasm have been subject to extensive epidemiologic research, women's postcoital reactions and feelings, and postcoital dysphoria (PCD) remains under‐researched.

Aim

The study examined the association between women's attachment anxiety and avoidance, differentiation of self, and the experience of PCD symptoms.

Methods

Two hundred and thirty female university students completed an online survey.

Main Outcome Measures

The Female Sexual Function Index, the Experiences in Close Relationships Scale, the Differentiation of Self Inventory‐Revised, and study specific questions.

Results

Forty‐six percent of respondents reported experiencing PCD symptoms at least once in their lifetime with 5.1% experiencing PCD symptoms a few times within the past 4 weeks. A small but significant inverse correlation was found between lifetime prevalence of PCD and sexual functioning (r = −0.16). While the regression model accounted for 22% of variance in lifetime prevalence of PCD, attachment and differentiation of self variables did not account for significant variance.

Conclusions

The findings confirm that PCD is under‐recognized and under‐researched. There appears to be no relationship between PCD and intimacy in close relationships. Further research is necessary to understand the subjective experience of PCD and to inform the development of a reliable measure. Schweitzer RD, O'Brien J, and Burri A. Postcoital dysphoria: Prevalence and psychological correlates. Sex Med 2015;3:229–237.

Dysfunctional sexual beliefs: a comparative study of heterosexual men and women, gay men, and lesbian women with and without sexual problems

INTRODUCTION

Conservative and dysfunctional sexual beliefs are commonly associated with sexual problems among heterosexual men and women. However, little is known about the role of sexual beliefs in sexual problems in gay men and lesbians.

AIM

The present study aimed at analyzing the role of sexual beliefs in sexual dysfunction in a sample of heterosexual and homosexual men and women.

MAIN OUTCOME MEASURES

Participants answered questions about self-perceived sexual problems and completed the Sexual Dysfunctional Beliefs Questionnaire.

METHODS

Two hundred twelve men (106 gay) and 192 women (96 lesbian) completed a Web survey.

RESULTS

Findings indicated that men with sexual dysfunction (regardless of sexual orientation) reported significantly more conservative beliefs and more erroneous beliefs related to partner's sexual satisfaction compared with sexually healthy men. Also, gay men with sexual dysfunction (but not heterosexual men) scored higher on belief in sex as an abuse of men's power compared with healthy controls. In addition, heterosexual men scored higher on "macho" beliefs, beliefs regarding partner's sexual satisfaction, and partner's power, compared with gay men. For women, a main effect was found for sexual orientation, with lesbian women scoring higher on sexual desire as a sin, age-related beliefs, and affection primacy and lower on beliefs related to motherhood primacy.

CONCLUSIONS

Overall, findings suggest that dysfunctional sexual beliefs may play a role as vulnerability factors for sexual dysfunction regardless of sexual orientation, particularly in men.

Sexual problems among women with multiple sclerosis

BACKGROUND

Sexual problems are prevalently experienced by women with multiple sclerosis (MS) and have been investigated in several studies. The nature of sexual changes in MS is best defined as primary, secondary, and tertiary.

OBJECTIVES

The aim of this study was to investigate three levels of sexual problems (SP) in female patients with MS and to examine their relationship with various clinical and demographic variables.

METHODS

A total of 132 women with MS completed two questionnaires; demographic and clinical history, and Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19). Fatigue was evaluated by Fatigue (energy) sub-scale of Multiple Sclerosis Quality of Life-54 (MSQOL-54) questionnaire. General physical ability and frequency of sexual intercourse were also evaluated.

RESULTS

One hundred and fifteen patients (87.1%) reported primary SP. The most frequent symptoms of primary, secondary and tertiary sexual problems were delayed orgasm, spasticity and concern about partner's sexual satisfaction, respectively. The MSISQ-19 total score was correlated with age(p=0.002), disease duration(p=0.010), marriage duration(p=0.001), fatigue(p<0.001), number of children(p=0.006), physical ability(p<0.001), education(p=0.006), economic status(p=0.002), number of times having sexual intercourse(p=0.007) and number of times approached by spouse for intercourse(p=0.012) in the last 30 days.

CONCLUSIONS

Sexual problems were prevalent among our participants. Appropriate management of SP depends on understanding the disturbed level.