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Sexual problems can be classified as related to (1) desire, (2) arousal and penetration, (3) orgasm, and (4) subjective assessment. The usual cause of sexual dysfunction is psychosocial, eg, past conditioning, inadequate communication and cooperation between sexual partners. Possible organic or psychiatric causes should be ruled out, however.
The neurohormone oxytocin is responsible for initiating childbirth and the let-down reflex in lactating women and is released during sexual orgasm. Oxytocin has been thought of as an affiliation hormone because research on nonhuman mammals has demonstrated that it plays a key role in the initiation of maternal behavior and the formation of adult pair bonds. It has been speculated that social stimuli may induce oxytocin release and that oxytocin may make positive social contact more rewarding. Data are presented from an initial study to examine change in plasma oxytocin in response to a standard imagery task that elicits emotion related to attachment. Twenty-five normal cycling, healthy women underwent imagery tasks and completed questionnaires on attachment and interpersonal problems. Blood draws (5 ml) were bone via an indwelling catheter before, during, and after three interventions (massage, positive emotion, and negative emotion) and to establish baselines. Overall, the data showed a tendency for oxytocin levels to be elevated in response to relaxation massage and decreased in response to sad emotion. There were individual differences in response to the interventions. Those who showed evidence of increased oxytocin levels for positive emotion and massage and who maintained oxytocin levels during negative emotion were less likely to report interpersonal problems associated with intrusiveness. Maintaining oxytocin levels during sadness was also correlated with lower anxiety in close relationships. Women who were in a couple relationship had greater increases in oxytocin in response to positive emotion. In contrast, higher basal levels of oxytocin were associated with greater interpersonal distress. These data suggest that peripheral secretion of oxytocin in response to emotional stimuli is associated with the individual's interpersonal characteristics.
This article presents the development of a brief, self-report measure of female sexual function. Initial face validity testing of questionnaire items, identified by an expert panel, was followed by a study aimed at further refining the questionnaire. It was administered to 131 normal controls and 128 age-matched subjects with female sexual arousal disorder (FSAD) at five research centers. Based on clinical interpretations of a principal components analysis, a 6-domain structure was identified, which included desire, subjective arousal, lubrication, orgasm, satisfaction, and pain. Overall test-retest reliability coefficients were high for each of the individual domains (r = 0.79 to 0.86) and a high degree of internal consistency was observed (Cronbach's alpha values of 0.82 and higher) Good construct validity was demonstrated by highly significant mean difference scores between the FSAD and control groups for each of the domains (p < or = 0.001). Additionally, divergent validity with a scale of marital satisfaction was observed. These results support the reliability and psychometric (as well as clinical) validity of the Female Sexual Function Index (FSFI) in the assessment of key dimensions of female sexual function in clinical and nonclinical samples. Our findings also suggest important gender differences in the patterning of female sexual function in comparison with similar questionnaire studies in males.
The purpose of this study is to examine male and female sexual dysfunctions present in the Journal of Sex & Marital Therapy. The Journal of Sex Research, the Journal of Sex Education and Therapy, and the Archives of Sexual Behavior also are briefly discussed. The types of dysfunctions investigated include female orgasmic disorder, female sexual arousal disorder, male erectile disorder, and premature ejaculation. The results indicate that the focus has shifted to male sexual dysfunctions. Specifically, there is greater attention paid to erectile dysfunction. The implications of these findings are discussed.
This article examines sex-questionnaire data using the Personal Experiences Questionnaire (PEQ; Dennerstein, Hopper, & Burger, 1997). We used data from a population-based sample of 354 Australian mid-aged women and an optimization procedure in order to reduce the length of the PEQ while retaining items measuring the components of female sexual functioning and key determinants. Eight items were selected. We recommend retaining the item related to orgasm (rejected for parsimony only). Eight of the nine items were from the McCoy Female Sexuality Questionnaire, confirming the validity of this source scale. The original wording in the McCoy scale is recommended as considerable data has now become available on reliability and validity.
Sexual dysfunction has been reported as an unwanted effect associated with selective serotonin reuptake inhibitors therapy, but the nature and frequency of such effects have not been characterized systematically. Sexual function was assessed in depressed patients participating in a multicenter trial of acute and continuation fluoxetine therapy using a 4-item self-rated scale. Patients were evaluated at study entry, after 13 weeks of fluoxetine 20 mg daily, and during 25 weeks of continuation therapy with fluoxetine 20 mg daily, fluoxetine 90 mg weekly, or placebo. In a 13-week open-label trial, among 501 patients who met Diagnostic and Statistical Manual of Mental Disorders criteria for depression, 51.6% of women and 40.6% of men reported improvement, 35.0% of women and 41.9% of men reported no change, and 13.4% of women and 17.4% of men reported worsening in overall sexual function. During double-blind continuation therapy, there were no statistically significant differences in change in sexual function between treatments. Worsened sexual function that occurred during continuation treatment was strongly associated with worsened depressive symptoms. Depression is associated with sexual dysfunction, and improvement in sexual functioning related to the antidepressant effects of fluoxetine may be more common than drug-associated deterioration in sexual function. Among patients who report worsening, effects may be most pronounced on orgasm. Deterioration in sexual function does not appear to be a late-onset drug-specific event, but is strongly related to worsening depressive symptoms.
Diabetes Mellitus (DM) is considered to play a principle role in the etiopathogenesis of sexual dysfunction both in men and women. The aim of this study is to evaluate sexual function in Type II diabetic women. A total of 72 young diabetic women (mean age: 38.8 years) with no other systemic diseases and 60 age-matched healthy women were enrolled in our study. We sought from them a detailed medical and sexual history and used the Index of Female Sexual function (IFSF) questionnaire (Kaplan et al., 1999). The mean IFSF score of diabetic women was 29.3 +/- 6.4 and was 37.7 +/- 3.5 in normal cases (p < 0.05). Lack of libido was the most common symptom in diabetics and was observed in 77% of the women. Diminished clitoral sensation was observed in 62.5% of the women, 37.5% complained of vaginal dryness and 41.6% had vaginal discomfort. Orgasmic dysfunction was found in 49% of the women. The incidence of all these related symptoms were significantly higher when compared to controls. We concluded that significant percentage of diabetic women that we observed experience sexual dysfunction of varying degrees that diminishes their quality of life.
Perineal trauma can occur in both genders, however, data supporting the relationship between sexual dysfunction and blunt perineal trauma in women is lacking. This study reviewed the patient characteristics of women with sexual dysfunction who also had a history of blunt perineal trauma. A neurogenic form of sexual dysfunction has been implicated, with primary complaints of orgasm disorder and abnormalities noted on genital sensory testing. Further research in this area is needed.
There have been limited literature reports concerning the epidemiological characteristics of female patients who present for initial evaluation of sexual health problems to an outpatient sexual health clinic. This study is a single-institution, retrospective, IRB-approved, observational assessment of 250 female patients undergoing management for sexual dysfunction. In our clinic, women with sexual dysfunction were, in general, young, healthy, and free of vascular risk factors; complained of an acquired multidimensional combination of decreased desire, arousal, and orgasm; and had significantly low serum androgen levels. More research in the management of women with sexual health problems is needed.
The objective of this study was to demonstrate the applicability of laser doppler flowmetry to pre- and posthysterectomy vaginal blood flow assessment. We used laser Doppler flowmetry to measure pre-and postoperational vaginal blood flow in 8 premenopausal women undergoing benign hysterectomies; we also measured serum E2, FSH, FT and administered a brief sexual function questionnaire. We analyzed data using two tailed t-test for paired samples. We found no significant differences at the P <.05 level of significance for vaginal blood flow. Accompanying values of estradiol, FSH, and free testosterone remained unchanged as well. A brief sexual function assessment revealed improvement or stability of libido, arousal, orgasm, and partner relatedness. Laser doppler flowmetry is an objective, reproducible measure of vaginal blood flow and may be used to investigate posthysterectomy sexual function.
The Profile of Female Sexual Function (PFSF) is a patient-based instrument for the measuring of loss of sexual function in menopausal women with low libido (hypoactive female sexual desire disorder). The instrument, which contains 37 items in seven domains (sexual desire, arousal, orgasm, sexual pleasure, sexual concerns, sexual responsiveness, and sexual self-image) and a single-item measure of overall satisfaction with sexuality, has been extensively developed and initially validated in over 500 oophorectomized women with low libido in North America, Europe, and Australia. Initial validation results showed the PFSF is capable of discriminating these patients from age-matched controls and produced consistent responses and sensitivity across geographies. The objective of this nonrandomized, parallel-group study was to examine the psychometric properties of the final PFSF in an independent group of surgically menopausal women with low libido and to extend validation to naturally menopausal women with low libido. Participants from 16 study centers in North America included surgically (n = 59) and naturally (n = 88) menopausal women with low libido and their age-matched control subjects, both premenopausal (n = 57) and naturally menopausal (n = 47), who reported no problems with libido. Subjects completed the PFSF at baseline and again 4 weeks later. Adjusted mean scores for each of the seven domains were statistically significantly lower (P < 0.0001) in surgically menopausal women with low libido compared with age-matched control women, and in naturally menopausal women with low libido compared with naturally menopausal control women, demonstrating excellent discriminant validity. Test-retest reliability ranged from 0.57 to 0.91 for the seven domain scores, whereas internal-consistency reliability ranged from 0.74 to 0.95. Results of this research support the conclusion that the PFSF is a valid and reliable instrument for measurement of loss of sexual function in both naturally and surgically menopausal women with low libido.
The Changes in Sexual Functioning Questionnaire (CSFQ) is a 36-item clinical and research instrument identifying five scales of sexual functioning. This study documents the internal consistency and factor structure of a 14-item version of the CSFQ (CSFQ-14), which yields scores for three scales corresponding to the phases of the sexual response cycle (i.e., desire, arousal, and orgasm) as well as the five scales of the original CSFQ. Factor analysis confirms the construct validity of the CSFQ-14 as a global measure of sexual dysfunction. The CSFQ-14 and the individual scales exhibit strong internal reliability.
The Sexual Interest and Desire Inventory-Female (SIDI-F) is a 13-item scale developed as a clinician-administered assessment tool to quantify the severity of symptoms in women diagnosed with hypoactive sexual desire disorder (HSDD). The present investigation assessed the reliability and validity of the SIDI-F as a measure of HSDD severity. Results show that the SIDI-F exhibits excellent internal consistency, with Cronbach's alpha of 0.9. The validity of the SIDI-F as a measure of HSDD severity was confirmed by a number of observations. Women with a clinical diagnosis (Diagnostic and Statistical Manual of Mental Disorders [DSM-IV-TR; American Psychiatric Association, 2000]) of HSDD had significantly lower SIDI-F scores than women not meeting diagnostic criteria for any subtype of female sexual dysfunction and women diagnosed with female orgasmic disorder. There was a high correlation between scores on the SIDI-F and scores on the Female Sexual Function Index (FSFI; Rosen et al., 2000) and an interactive voice response version of the Changes in Sexual Functioning Questionnaire (CSFQ; Clayton, McGarvey, & Clavet, 1997; Clayton, McGarvey, Clavet, & Piazza, 1997), two validated measures that assess general female sexual dysfunction. In contrast, there was a poor correlation between SIDI-F scores and scores on a slightly modified Marital Adjustment Scale (Locke, Wallace, 1959; MAS), an assessment of general (nonsexual) relationship satisfaction. Taken together, the results of the present investigation indicate that the SIDI-F is a reliable and valid measure of HSDD severity, independent of relationship issues.
Symptoms of male hypogonadism such as low libido and erectile dysfunction (ED) respond to testosterone (T) replacement. In hypogonadal men with major depressive disorder (MDD), the extent to which T replacement alleviates sexual symptoms of hypogonadism is not known. We conducted 6 week double-blind placebo-controlled clinical trial in men with low and low-normal T levels (i.e., total T <or= 350 ng/dl) and MDD. Men were randomized to receive weekly intramuscular injections of either T enanthate 200 mg or sesame-seed oil (placebo). The primary outcome measure was self-reported sexual functioning. We randomized 30 patients. The mean age was 52(SD +/- 8) years, mean T level 262.5(SD +/- 8) ng/dl, and mean baseline Hamilton Rating Scale for Depression (HAM-D) score 21(SD +/- 8). At baseline, sexual function was low, with the majority reporting having had normal erectile and orgasmic functioning 0-1 time in the preceding month. All patients who received T achieved normalization of their T levels. The HAM-D scores decreased significantly in both T and placebo groups, and there were no significant between-group differences: reduction in mean HAM-D score from baseline to endpoint was 10.1 in patients who received T and 10.5 in those who received placebo. Self-reported sexual functioning improved slightly in both groups; a between-group difference was not detected. Both T replacement and placebo were associated with improvement in sexual function and mood, but differences between T and placebo were not distinguishable.
This paper reports a 2-year experience in treating sexual dysfunction in 22 gay male couples. The full range of arousal, orgasmic and desire phase disorders as well as case examples and variations in treatment techniques are discussed. To date, this comparative neglected area of research and treatment has yielded encouraging results.
This paper makes two basic conceptual suggestions that may encourage more meaningful studies of the effectiveness of sex therapy: (1) Dysfunctions consist of deficits of one or more of the basic components of sexual life: desire, arousal, orgasm, emotional satisfaction. (2) There are three distinct perspectives for determining therapeutic success--(a) reversal of the target component deficit, (b) absence of all of an individual's component deficits, and (c) absence of all component deficits in both partners. Follow-up data should be classified according to each perspective and presented separately. The "cure" rates diminish as the criteria for success become more stringent--i.e., moving from the first to the third perspective. The use of these perspectives highlights the strengths and limitations of current treatment techniques.
Five measures were used in this study to assess preorgasmic group treatment: Gambill-Richey Assertiveness Scale, Dyadic Adjustment Scale, Sexual Arousal Inventory, Survey of Sexual Activity, and General Information Questionnaire. The total sample (N = 70) was made up of two groups: a control group of 32 women and a treatment group of 38 women who had completed preorgasmic group treatment. Analysis of the data showed that the treatment group women were having orgasms more frequently, had developed significantly more positive feelings about themselves, and established better communication with their partners. In assertiveness, the treatment group was somewhat higher, while no significant differences were found on the Dyadic Adjustment Scale. Of most significance for future research was the finding of increased sexual arousal for treatment group women.
This paper challenges the need in sex therapy to routinely proscribe or forbid intercourse, viewing it as an excessive restriction for many couples, with side effects frequently causing a flight from treatment and other treatment failures. An alternative, more moderate proposal is presented which emphasizes the couple's doing sensate focus not as a prelude to orgasm or intercourse and not explicitly forbidding spontaneously occurring sexual activity. Cases illustrate how it retains the original purposes of the former total prohibition with fewer side effects. Additional advantages arising from the gentler "proscription" are elucidated. Factors influencing selection of proscription are cited.