Female Sexual Dysfunction

In recent years, increased attention to women's sexual health has propelled basic scientific research and clinical trials investigating treatment paradigms for improving sexual well-being. As the prevalence of female sexual dysfunction has become manifest, knowledge of the intricate pathophysiological role of androgens in maintaining sexual function has fostered a clearer understanding of the effect of age on androgen status, the role of androgens in the postmenopausal ovary, and aetiological mechanisms of androgen insufficiency in premenopausal and postmenopausal women. Understanding the long-term safety and efficacy of physiological androgen replacement and the development of sensitive testosterone assays for specific use in women, will better characterise women who are most likely to respond to androgen therapy and, thereby, optimise their quality of life.

F emale sexual dysfunction is age-related, progressive, and highly prevalent, affecting 30% to 50% of women. 1-3 Based on the National Health and Social Life Survey of 1749 women, 43% experienced sexual dysfunction. 4 U.S. population census data reveal that 9.7 million American women aged 50 to 74 years self-report complaints of diminished vaginal lubrication, pain and discomfort with intercourse, decreased arousal, and difficulty achieving orgasm. Female sexual dysfunction is clearly an important women's health issue that affects the quality of life of many of our female patients.

Objective. Th e present study aimed to investigate the psychometric properties of a Persian version of the Female Sexual Distress Scale-Revised (P-FSDS-R) among a sample of healthy Iranian women. Methods. A total of 562 healthy Iranian women completed a battery of questionnaires, including the P-FSDS-R, Depression Anxiety Stress Scales (DASS), Positive and Negative Aff ect Scales (PANAS) and Locke-Wallace-Marital Adjustment Test (LWMAT). Th e factor structure and the convergent and divergent validity of the P-FSDS-R were examined, using exploratory and confi rmatory factor analysis and Pearson product-moment correlations, respectively. To examine the discriminant validity of the P-FSDS-R, data collected from 562 healthy participants were compared with data from 108 women with sexual problems who completed the P-FSDS-R measure. Results. Th e results of exploratory and confi rma-tory factor analyses indicate that the P-FSDS-R is conceptualized within a one-factor model. Th e results also indicate that the P-FSDS-R has good internal consistency and test-retest reliability. Signifi cant correlations in the predicted directions between the P-FSDS-R scores and the scores of DASS, PANAS and LWMAT support both the convergent and divergent validity of the FSDS-R. Th e results also indicate that the scores of the P-FSDS-R tests signifi cantly diff erentiated women with and without sexual problems. Conclusions. In general, these fi ndings support the reliability and the validity of the P-FSDS-R among Iranian women.

Distress about a sexual problem is a necessary part of diagnosing female sexual dysfunction. It is an important way to distinguish between a sexual problem and normal sexual variation and has implications for treatment seeking, motivation for therapy and prognosis. The concept of distress, however, has not been clearly defined and is complex and poorly understood. Furthermore, there has been

Female sexual dysfunction is age-related, progressive, and highly prevalent, affecting 30-50% of American women. While there are emotional and relational elements to female sexual function and response, female sexual dysfunction can occur secondary to medical problems and have an organic basis. This paper addresses anatomy and physiology of normal female sexual function as well as the pathophysiology of female sexual dysfunction. Although the female sexual response is inherently difficult to evaluate in the clinical setting, a variety of instruments have been developed for assessing subjective measures of sexual arousal and function. Objective measurements used in conjunction with the subjective assessment help diagnose potential physiologic/organic abnormalities. Therapeutic options for the treatment of female sexual dysfunction, including hormonal, and pharmacological, are also addressed.

The aim of the present article is to present a new instrument, specially developed to assess beliefs about sexuality that are supposed to be closely related with the development of sexual disorders. Using a cognitive theory perspective we hypothesized that sexual behaviour and its problems are in someway related to the way we think about sexuality, our beliefs and our expectations. Although some questionnaires of sexual attitude, information and beliefs already exist, there is, until now, no specific measure oriented to assess both male and female sexual dysfunctional beliefs related to aetiology. The Sexual Dysfunctional Beliefs Questionnaire is a 40-item self-reported measure constituted by two versions (female and male) rated on a five point likert scale. Both male and female versions present satisfactory test -retest reliability (r = 0.73 and r = 0.80 respectively), and internal consistency (Cronbach's alpha = 0.93 for male and 0.81 for the female version). Studies of convergent validity show a relationship with other measures of sexual and more general beliefs, as well as with measures of sexual functioning. Discriminant validity studies support its capacity to discriminate functional from sexual dysfunctional subjects. It is expected that these measures could be useful in both clinical practice and educational programmes serving as an indicator of vulnerability to sexual dysfunction.

O objectivo principal deste estudo foi a avaliação da prevalência e caracterização das disfunções sexuais, em Portugal Continental, em indivíduos de ambos os sexos, com idades compreendidas entre os 18 e os 75 anos. Mais, pretendeu-se a caracterização dos doentes relativamente a dados demográficos, prática clínica e terapêutica.

Although yohimbine (YOH) has been available for the treatment of male erectile dysfunction (ED) for longer than Viagra 1 , there is a perception that little is known about the clinical performance of the drug. This review attempts, by comprehensive analysis of the literature, to cover the clinical, pharmacological, and therapeutic profiles of YOH, relevant to its potential utility in the management of patients with ED. Relatively few well-designed studies have been completed. From these, however, it can be concluded that YOH as monotherapy possesses only modest efficacy in ED patients. In acute and chronic (long-term) studies, YOH has been found to be relatively free of side effects over the dose range predicted to be effective in ED. At much higher doses, the most frequently observed effects, consistent with the primary pharmacological action of the drug, are elevation of blood pressure, a slight anxiogenic action, and increased frequency of urination. These side effects are all easily reversible on termination of YOH therapy. There is increasing evidence that the erectogenic action of YOH can be augmented by concomitant administration of agents that augment the release and/or action of nitric oxide in the corpus cavernosum. YOH has yet to be studied in female sexual dysfunction. Overall, the benefit risk profile of YOH would indicate that it has potential, more probably as part of a combination strategy, e.g., with a drug that enhances the nitric oxide pathway, in the treatment of ED.

Introduction. Women frequently report low sexual desire or interest. An associated lack of subjective arousal during sexual activity is clinically highly apparent but has not been the focus of traditional sexual inquiry, definitions of dysfunction, or management. The frequent poor correlation of women's subjective sexual arousal and observable increases in genital congestion in response to sexual stimulation has not been reflected in assessment, diagnosis, or management.

Objective  The aim of this study was to assess the prevalence and associated factors of female sexual dysfunction (FSD) in Lower Egypt.Design  A cross-sectional clinic-/hospital-based survey.Setting  Five district medical centres in Dakahlia Governorate: Shirbin, Bilquas, Samblawen, Dekrinis and Mansoura City.Population  One thousand married women aged between 16 and 49 years.Methods  Data were collected by personal interview in a questionnaire format in addition to physical examination (when allowed).Main outcome measures  FSD and associated risk factors.Results  The response rate was 93.6%. 68.9% of women had one or more sexual problems; however, 23% of the women with sexual problems were not distressed by these issues. 31.5% of women suffered from dyspareunia. 49.6% of the women had decreased sexual desire, 36% had difficult arousal and 16.9% had anorgasmia (primary and secondary). Marital disharmony, ‘hate’ and unfavourable socio-economic circumstances were the most common aggravating factors (28.1%) for sexual dysfunction among the participants, followed by pregnancy-related events (15.7%). Most women (84.5%) received no help for their sexual problems. 90.3% of the women were circumcised. Only 7.1% (46 of 645) of women with sexual problems had received treatment, with no real improvement reported in 58.7% (27 of the 46 women).Conclusions  FSD is a highly prevalent problem within the scope of this study. Low reporting rates and very low treatment rates were identified in the sample from Lower Egypt.

Pelvic surgeries are among the most common causes of organic sexual dysfunction in men and women. The impact of nerve-sparing surgery on potency has been well documented in radical prostatectomy. However, its impact on potency needs to be evaluated in other pelvic surgeries. Sexual dysfunction is highly prevalent even after multiple technical advances in the field of oncological surgeries. The prevalence varies from 8 to 82%, depending on the type of pelvic surgery. In females, sexual dysfunction has not been evaluated adequately using validated questionnaires. However, in subspecialized circles, treatment for female sexual dysfunction is becoming routine. Currently, physicians have several options for the treatment of erectile dysfunction (ED) in men. Since the introduction of oral PDE-5 inhibitors, oral therapy has become the first-line treatment option for ED, irrespective of etiology. Currently available treatment options for the female sexual dysfunction include estrogens, androgens, phosphodiesterase inhibitors, and dopamine receptor antagonists. Initial reports regarding the role of early rehabilitation are encouraging and may become the part of routine practice in the management of ED after pelvic surgery. In this article, we summarize the sexual dysfunction following pelvic surgeries and their management.

The purpose of this study was to evaluate sexual function in women referred to a urogynecology practice. All new patients were mailed an optional female sexual function index (FSFI) in conjunction with their history forms; other sexual function information was obtained during the physician interview. Over 6 months, four hundred fifty new patients were enrolled. Of these, 243 (54%) were not sexually active. Reasons listed for sexual inactivity included partner problems/no partner (32%), low desire (14%), prolapse (10%), and pain (10%). There were several differences between sexually active and non-sexually active participants; however, after a multivariate analysis, only age, marital status, and stage/grade 1–2 of prolapse remained significant. One hundred nine sexually active patients completed the FSFI; the majority was sexually active two to four times per month. Female sexual dysfunction was noted in 70 (64%) patients. Lowest scores were noted for the domain of desire, followed by arousal, orgasm, lubrication, satisfaction, and pain. Reduced frequency of intercourse was the only factor significantly associated with dysfunction. Ninety-four percent were not embarrassed by the survey. Overall, sexual inactivity is common in patients presenting for urogynecologic care. Those that are sexually active report low rates of sexual activity and high rates of sexual dysfunction. Most sexually active patients will accept a sexual function questionnaire as part of their routine assessment.

Female sexual dysfunction is a prevalent problem in the general community; however, it has not been studied as extensively as male sexual dysfunction. Female sexual dysfunction is a common complication after most pelvic surgeries. With the introduction of screening programs, most pelvic malignancies are detected at earlier stages and in younger patients. Sexual dysfunction is a major quality-of-life issue in these young women. Hysterectomy (simple or radical) is the most common type of pelvic surgery in women and is one of the most important causes of female sexual dysfunction. Additionally, female sexual dysfunction is an important issue after urologic (radical cystectomy) and colorectal surgeries (simple and radical proctocolectomy). Sexual dysfunction is a common problem among postmenopausal women. Modifications in the surgical technique (nerve sparing) are rapidly evolving in the field of urology and colorectal surgery, which will be soon followed by modifications in the field of gynecologic surgery. In this article we summarize the pathophysiology and classification of female sexual dysfunction, with special emphasis on the relationship between female sexual dysfunction and pelvic surgeries.

In the last few years, the concept of sexual agency has been used by many English-language studies on youth and women to describe the ability to take control of one’s own body and sexuality. While the term is rarely used in informal English, it appears even less frequently in French.

One way that young women can exercise their sexual agency is for them to take an active role by seeking answers to their questions about their own sexuality. Using an innovative "private" blog method, combined with in-depth interviews, we sought to determine how teenage girls and young women ages 17 to 21 are using the Internet to learn about sexuality. We then interviewed the participants about the situations where they exercise (or refrain to exercise) sexual agency in their lives.

In this thesis, we propose a definition of sexual agency, describe the method we have developed, and then discuss our results. We show that the participants use the Internet to gather information on a wide variety of sexual topics, but using the Internet has some limitations when a participant's situation is worrisome or taboo. Although Internet seems to serve well their needs related to "physical" matters, the participants don’t really use Internet to address their more "psychological" or "relational" concerns. They also do not grant the same credence to some Internet sources as they do to their friends, doctors or parents. We also show that the participants, in their sexual encounters, have integrated some agentic messages, such as "No means no", but show some lack of sexual agency when their partner is more experienced or insistent. Finally, we will see that our method of private blogs mixed with in-depth interviews is an ideal method for gathering qualitative data on sensitive topics such as sexuality.

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Dans les études anglophones sur les jeunes femmes, on fait de plus en plus appel à un concept relativement récent en sciences sociales : l’agentivité sexuelle (sexual agency). Terme peu usité en anglais, et encore moins en français, l’agentivité sexuelle fait référence à l’idée de « contrôle » de sa propre sexualité, c’est-à-dire à la capacité de prendre en charge son corps et sa sexualité.

L’une des façons de prendre une part active dans sa sexualité est de s’y intéresser et chercher des réponses à ses questions. Par le biais de blogues « privés » de recherche sur Internet et d’entrevues individuelles, nous avons interrogé 30 jeunes femmes âgées de 17 à 21 ans sur leurs façons d’utiliser Internet pour répondre à leurs questions sur la sexualité. Nous avons ensuite poussé plus loin la question de l’agentivité en interrogeant la façon dont les jeunes participantes manifestent de l’agentivité dans diverses situations en lien avec leur sexualité.

Ce rapport de recherche doctorale propose une définition du concept d’agentivité sexuelle, décrit la méthodologie novatrice utilisée et présente ensuite de façon qualitative les résultats. Nous avons pu observer qu’Internet constitue un moyen de choix pour répondre aux questions des participantes sur la sexualité, mais qu’en certaines situations angoissantes, Internet présente certaines limites. Bien qu’Internet leur semble une solution rapide, efficace et anonyme pour répondre à leurs questions d’ordre « physique », elles utilisent très peu le Web pour répondre à leurs besoins d’ordre plus « psychologique » ou « relationnel ». Elles n’accordent pas non plus aux sources Web le même crédit qu’à leurs parents, médecins ou amis. Nous avons également constaté que les participantes, dans leurs pratiques, ont bien intégré certaines notions de contrôle (notamment que « non », c’est « non »), mais éprouvent plus de difficulté à exercer du pouvoir quand leur partenaire est insistant ou a plus d’expérience qu’elles. Nous verrons enfin que la méthode du blogue « privé », jumelée à des entretiens individuels, présente de nombreux avantages sur les méthodes de recherche plus « traditionnelles », notamment lorsqu’il est question de sujets délicats comme la sexualité.

Medicalisation is a social phenomenon in which conditions that were once under legal, religious, personal or other jurisdictions are brought into the domain of medical authority. Low sexual desire in females has been medicalised, pathologised as a disease, and intervened upon with a range of pharmaceuticals. There are two polarised positions on the medicalisation of low female sexual desire: I call these the mainstream view and the critical view. I assess the central arguments for both positions. Dividing the two positions are opposing models of the aetiology of low female sexual desire. I conclude by suggesting that the balance of arguments supports a modest defence of the critical view regarding the medicalisation of low female sexual desire.

Several illnesses can distress sexual health and disrupt sexuality, an integral part of being human. These illnesses are not different in origin from those affecting other health areas, but, because sexuality is involved, effective communication and empathy between the physician and the patient may be severely hindered by negative feelings such as anxiety and guiltiness. A detailed general and sexual history is, however, an essential step in evaluating patients for sexual dysfunction (SD). Finding the correct way to ask questions and to decode answers on sexual health and disease might be difficult and, in some way, embarrassing. Hence, validated and standardized sexual inventories might help physicians confront SD. These case-history tools have the advantage of being standardized, easy to administer and score, relatively unobtrusive and substantially inexpensive. This review describes the main sexual inventories hitherto described and validated in different sexual areas of health and disease, and the advantages of the two main formats available to clinicians, that is, structured interviews (SIs) and self-report questionnaires (SRQs). Both types of inventories are composed of a set of standardized, written probe questions requiring a finite number of responses, driven by an interviewer (SIs) or by the patients themselves (SRQs). SRQs allow more time and intimacy to organize and develop answers to delicate questions, as are those on sexual life. In addition, SRQs could also be very useful in quantifying disease severity and treatment outcome. On the other hand, SIs help achieve a better patient-physician relationship and reduce the risk of misunderstandings.

Prevalence data suggest that more than 40% of women experience sexual problems and that 12% of these women are distressed by the problem. In the 1960s, Masters and Johnson introduced what is now considered the classic linear model of female sexual response based on a physiologic foundation. Recently, Rosemary Basson introduced a nonlinear interconnected model which emphasizes the importance of emotional intimacy and satisfaction as integral components of the female sexual response cycle. According to the Diagnostic and Statistical Manual (DSM-IV TR), there are six female sexual disorders: hypoactive sexual desire disorder, aversion disorder, sexual arousal disorder, female orgasmic disorder, vaginismus, and dyspareunia. Despite the high prevalence, few healthcare professionals take the time or feel adequately trained to assess and treat these sexual problems. Sexuality questionnaires play an integral role in the diagnosis and treatment of male and female sexual dysfunctions. They are used to (1) identify/diagnose individuals with a particular dysfunction, (2) assess the severity of the dysfunction, (3) measure improvement or satisfaction with treatment, (4) examine the impact of the dysfunction on the individual's quality of life (relationship satisfaction, mood, sexual confidence), and (5) study the impact of the dysfunction on the partner and his or her quality of life. Patient-reported outcomes (PRO) are increasingly important in both clinical practice and research settings. The instruments reviewed have played a significant role in furthering our understanding of the impact of female sexual function on the patient and partner and its treatment. It is important for the clinician and researcher to familiarize themselves with the best available measures for identifying specific dysfunctions, measuring distress due to the sexual dysfunction, assessing treatment efficacy, and objectively evaluating the quality of life issues of women with these dysfunctions. However, even the best PRO cannot replace the clinician-patient interview and the careful gathering of the patient's sexual history. PROs should always be interpreted and integrated with the woman's history.

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.

Review of literature with regard to androgen replacement therapy in women. Review of the MEDLINE database and references from articles. Androgens affect sexual function, bone health, muscle mass, body composition, mood, energy, and the sense of well-being. Androgen insufficiency clearly has been demonstrated in patients with hypopituitarism, adrenalectomy, oophorectomy, and in some women placed on oral estrogen therapy which increases sex hormone-binding globulin (SHBG) levels and lowers the free and bioavailable forms of T. Symptoms of androgen insufficiency in women may include a diminished sense of well-being, low mood, fatigue, and hypoactive sexual desire disorder with decreased libido, or decreased sexual receptivity and pleasure that causes a great deal of personal distress. The preponderance of evidence from clinical trials supports the correlation of decreased endogenous androgen levels with these symptoms and alleviation of many of the symptoms with the administration of T or, in some cases, DHEA. There are no Food and Drug Administration-approved androgen preparations on the market for treating androgen insufficiency in women. The safety profile of androgens in doses used for the treatment of hypoactive sexual desire disorder has been excellent with only mild acne and hirsutism being noted in a minority of patients.

Introduction. Women frequently report low sexual desire or interest. An associated lack of subjective arousal during sexual activity is clinically highly apparent but has not been the focus of traditional sexual inquiry, definitions of dysfunction, or management. The frequent poor correlation of women's subjective sexual arousal and observable increases in genital congestion in response to sexual stimulation has not been reflected in assessment, diagnosis, or management.

Psychiatry’s problematic framing of femininity, women’s bodies, and sexuality has attracted much condemnation (Caplan & Cosgrove, 2004; Frith, 2013; Ussher, 2011). The intersection of sanism and sexism is particularly overt in the psy- complex’s (Rose, 1979) response to violence. While psychiatry acknowledges that many of those diagnosed with ‘female sexual dysfunction’ have experienced sexual abuse, addressing the problems of violence against women is starkly absent within psychiatric discourse. The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders combined ‘vaginismus’ and ‘dyspareunia’ to produce a new diagnostic classification: ‘genito-pelvic pain/penetration disorder.’ The diagnostic criteria included difficulties, pain, or fear regarding penetrative heterosexual sex (American Psychiatric Association, 2013). Using discourse analysis (Burman, 2004; Parker, 2013) and critical intersectional analysis (Cole, 2009; Crenshaw, 1991; Hill- Collins, 1998, 2003), this paper analyzes psychiatric discourse to illuminate the violence inherent in procedures and treatments that perpetuate sanism and (hetero)sexism within psychiatry. We argue that psychiatry’s positioning of penetrative heterosexual intercourse as ‘normal,’ necessary, and ‘healthy’ pathologizes experiences of sexual violence as well as other forms of sexual identity (e.g., asexuality and homosexuality). Psychiatry needs to promote and accept sexual diversity, including the choice not to have penetrative sex at all.

The medicalization of women's sexual problems under the overall rubric of female sexual dysfunction (FSD) has been thoroughly critiqued by feminist scholars, health practitioners, and sex therapists. However, there has been much less commentary on the medicalization of women's sexual pain—currently, a subset of an official FSD diagnosis. This article critically examines interdisciplinary understandings and ways of addressing sexual pain. It analyzes these frameworks in relation to feminist theories on medicalization, heteronormativity, and the reciprocal relationship between these two processes. We argue that many women who experience sexual pain have been eager for medicalization as a path to minimizing pain during sexual activity and reinstating normative heterosexual practices and identities. These goals have been lobbied for by patient advocacy groups and noted by professionals in the field. Although there are some clear benefits to this case for medicalization, there are also theoretical, personal, and political costs. Guided by a growing body of feminist theoretical and qualitative, empirical research on this topic, as well as the first author's personal experience of sexual pain, this article highlights some alternatives to medicalization and makes suggestions for change.

To determine the changes, if any, on female sexual pathways using sildenafil (primary outcome), and to verify the safety of this drug (second outcome). Study design: Following previous research on symptomatic women, we wanted to study the effects of sildenafil on asymptomatic women. We would like to make it clear from the outset that this study is part of an ongoing line of research and this drug, and others of its type, should be used under strict medical supervision only on symptomatic patients. A randomized double-blind cross-over, placebo-controlled study was conducted at the Family Planning . Sixty-eight healthy volunteer women aged 19-38 years, asymptomatic for sexual disorders, were enrolled. The study consisted of 4 weeks sildenafil, 2 weeks washout, and 4 weeks placebo, by two possible sequences: sildenafil 50 mg, washout, placebo; or placebo, washout, sildenafil 50 mg. Efficacy of sildenafil was assessed by the Personal Experiences Questionnaire (PEQ) based on the 5-point Likert scale. The questionnaire quantified subjective sexual aspects at baseline, during washout, after treatments, and at the follow-ups. Statistical analysis was done with the Wilcoxon's rank-sum test and Student's t-test. Results: 50/68 women completed the study at the first follow-up, and 38 women reached the second follow-up. Six women withdrew because of adverse events. Sildenafil improved arousal (P < 0:001), orgasm (P < 0:05), and enjoyment (P < 0:001) with respect to placebo. Significant differences were noted during sildenafil usage with respect to the baseline for arousal (P < 0:01), orgasm (P < 0:001), and sexual enjoyment (P < 0:001). The adverse events were transient and mild or moderate. Conclusions: Our study suggests that sildenafil acts on the different sexual pathways in healthy women, improving their sexual experience. This study could help to understand the physiologic and pathophysiologic aspects of female sexuality. In comparison with current psychosexual therapies, which are long-term, compliance would be improved with use of this drug. Additional studies are required to define the use of sildenafil in a clinical setting. #

Female Orgasmic Disorder is the “delay in, marked infrequency of, or absence of orgasm” or “reduced intensity of orgasmic sensations” experienced during sexual activity for a period of 6 months or more.  Female orgasmic disorder can be lifelong or acquired; generalized or situational; primary or secondary (DSM V; Meston, Hull, Levin & Sipski, 2004).  This review highlighted the most successful non-pharmacological therapies to female orgasmic disorders.  The PICO question is ““How effective are different non-pharmacological therapies (sex therapy & communication therapy, bibliotherapy, contact vs. no - contact with therapist, group vs. individual therapy) in the treatment of female orgasmic disorder?”  The inclusion criteria applied in the review included that the studies had to be systemic reviews or randomized controlled trials published from 2005 onwards, had to directly tackle orgasmic problems in females and be written in the English language.  The exclusion criteria applied were studies that were published before 2005; were not reviews or RCTs; did not tackle orgasmic problems in females, had an organic basis for the sexual problem and were not written in the English language.  The nine studies that were included were critically appraised using the CASP tools, the SIGN guidelines and the PEDro Scale.  After thematic analysis was conducted, four major themes emerged, namely “Sex therapy and communication therapy”; “Bibliotherapy”; “Contact vs. No contact with therapist” and “Group vs. individual therapy”.  The result suggests that the first theme is the most prominent in the studies included.  The recommendations suggested are the need for further studies with larger samples so as to get a more comprehensive view of using non-pharmocological therapies. Pereira et al. (2013) underline the fact that Masters and Johnson (1970); and Heiman and LoPiccolo (1988) practices are still the most commonly used when treating sexual problems.  Thus, this questions whether enough effort and research was put into understanding FOD, as these protocols should be reviewed and updated if necessary.

There are no psychometrically validated assessment tools designed to solely and specifically evaluate satisfaction with the quality of erections. Aim. To develop and psychometrically analyze the Quality of Erection Questionnaire (QEQ), a new patientreported measure developed to evaluate men's satisfaction with the quality of their erections. Methods. The questionnaire was developed through in-depth qualitative interviews of men with erectile dysfunction (ED) in the United States and Australia. An exploratory methodology study was conducted on 65 men with ED. Subsequently, the psychometric properties were confirmed in a larger dataset of 558 men with ED from two combined clinical trials. Main Outcome Measures. Identification of potential redundancy or outliers in items (Pearson inter-item correlations); exploratory factor analysis (unrotated and varimax rotated); internal consistency (Cronbach's alpha); convergent validity (Pearson correlation coefficients between the QEQ total score and domain scores of the International Index of Erectile Function); known-groups validity (ability of the QEQ scores to differentiate between ED severity groups); test-retest reliability (Pearson correlation coefficient). Results. The QEQ demonstrated excellent convergent and known-groups validity. Additional analysis demonstrated high internal consistency (Cronbach's alpha, 0.92). Item analysis demonstrated a unidimensional structure and suggested that satisfaction with hardness may be the key driver for satisfaction with overall quality of erections ( r = 0.8). The smaller exploratory study demonstrated good test-retest reliability ( r = 0.82). Conclusions. The QEQ is a six-item, patient-reported measure with a unidimensional structure, which produces a total score that may be transformed to a 0-100 scale. Psychometric analysis confirmed reliability and validity of the QEQ, which solely and specifically evaluates satisfaction of men with the quality of their erections. The QEQ is a potentially useful measure for monitoring and evaluating treatment in those who are bothered by, or concerned about, their erectile function. Porst H, Gilbert C, Collins S, Huang X, Symonds T, Stecher V, and Hvidsten K. Development and validation of the Quality of Erection Questionnaire. J Sex Med 2007;4:372-381.

Background: A review of validated methods for assessing female sexual dysfunction and a review of male and female sexual dysfunction did not refer to any specific questionnaire for evaluating sexuality during pregnancy. A study was performed at the Obstetrics and Gynecology Department of Botucatu Medical School, São Paulo State University, Brazil to design and validate a pregnancy sexuality questionnaire, the Pregnancy Sexual Response Inventory (PSRI).

Female sexual dysfunction is a complex problem with multiple overlapping etiologies. Androgens play an important role in healthy female sexual function, especially in stimulating sexual interest and in maintaining desire. There are a multitude of reasons why women can have low androgen levels with the most common reasons being age, oophorectomy and the use of oral estrogens. Symptoms of androgen insufficiency include absent or greatly diminished sexual motivation and/or desire, that is, libido, persistent unexplainable fatigue or lack of energy, and a lack of sense of well being. Although there is no androgen preparation that has been specifically approved by the FDA for the treatment of Women's Sexual Interest/Desire Disorder or for the treatment of androgen insufficiency in women, androgen therapy has been used off-label to treat low libido and sexual dysfunction in women for over 40 y. Most clinical trials in postmenopausal women with loss of libido have demonstrated that the addition of testosterone to estrogen significantly improved multiple facets of sexual functioning including libido and sexual desire, arousal, frequency and satisfaction. In controlled clinical trials of up to 2 y duration of testosterone therapy, women receiving androgen therapy tolerated androgen administration well and demonstrated no serious side effects. The results of these trials suggest that testosterone therapy in the low-dose regimens is efficacious for the treatment of Women's Sexual Interest and Desire Disorder in postmenopausal women who are adequately estrogenized. Based on the evidence of current studies, it is reasonable to consider testosterone therapy for a symptomatic androgen-deficient woman with Women's Sexual Interest and Desire Disorder.

This paper defines female sexual dysfunction, its classification and incidence, and discusses several available treatments. ... • Causes of FSD can be psychogenic, endocrinologic, vasculogenic, neurogenic, muscular, infectious, or the result of certain medication use.

Despite the high prevalence of genital pain in healthy young adult women, limited research has addressed genital pain during intercourse using contemporary models of multidimensional sexual function. The objectives of this study were threefold: (1) to identify differences in sexual functioning in women who experience genital pain compared to pain free women; (2) to identify predictors of sexual functioning in women with and without genital pain; and (3) to identify predictors of sexual satisfaction in women with and without genital pain. Sexually active female undergraduates (n = 651) were administered the Female Sexual Function Index and the Derogatis Sexual Functioning Inventory. We evaluated the sexual factors that impact the sexual function of women with any pain (including high and low pain groups) versus women with no history of pain. Women with genital pain reported greater rates of sexual dysfunction as compared to painfree women; however, sexual functioning in the high versus low pain groups was distinguished primarily by vaginal lubrication. Women in the high pain group showed negative correlations between domains of sexual satisfaction and genital pain frequency and intensity that were not found in the low pain group. For pain-free women, intercourse played a strong role in sexual satisfaction, whereas non-intercourse sexual behavior was central to sexual satisfaction in women who reported pain. The evaluation of levels of genital pain may provide insight into the mech-anisms underlying the impairment of sexual function, sexual behavior, and sexual satisfaction.

In the present study, we introduce clitoral photoplethysmography as an instrument to assess clitoral blood volume (CBV). In research on female sexual functioning, vaginal pulse amplitude (VPA), as measured using vaginal photoplethysmography, has been used extensively as a measure of vaginal vasocongestion. Measurement of clitoral blood flow has thus far been problematic, mainly because of methodological constraints. Aim. To demonstrate that CBV is a valuable, easy to use complementary measure for the female sexual response, offering additional information to the VPA. Methods. Thirty women with and without female sexual dysfunction (FSD) watched neutral and erotic film clips. At the end of the erotic clip, the session was interrupted to induce inhibition of the sexual response. Another neutral clip followed the interruption. VPA and CBV were measured simultaneously, as well as skin conductance levels (SCLs), to assess the amount of sympathetic activity. Main Outcome Measures. VPA, CBV, SCL. Results. For both FSD and non-FSD women, VPA and CBV increased when sexually explicit material was presented. Changes in skin conductance significantly predicted changes in CBV (b = -0.61, t[27] = -3.88, P < 0.001), but not in VPA. A large increase in sympathetic activity was accompanied by a large decrease in CBV. Furthermore, a large increase in CBV at the end of the erotic film clip presentation, as compared with the neutral clip, was accompanied by a relatively small increase in VPA (b = -0.39, t[29] = -2.25, P < 0.033). Conclusion. CBV is a valid and sensitive tool to measure the female genital response. In the present study, it was particularly useful in investigating sexual inhibition, when used in combination with SCL. Furthermore, high CBV appeared to inhibit VPA, suggesting that VPA reflects an automatic preparatory response rather than genital arousal per se. Gerritsen J, van der Made F, Bloemers J, van Ham D, Kleiverda G, Everaerd W, Olivier B, Levin R, and Tuiten A. The clitoral photoplethysmograph: A new way of assessing genital arousal in women. J Sex Med 2009;6:1678-1687.

Recent attempts to medicalize women's sexual "dysfunction" are critiqued and a "New View" of women's sexual problems is introduced. The author argues for a female-centered perspective on women's sexual desires and problems, based on a review of the literature on women's sexuality and her observations of young women's sexual experiences from 25 years of teaching Human Sexuality to undergraduate women. The review suggests that a pill or a patch cannot adequately address the sexual problems commonly experienced by US women.

Introduction. Women frequently report low sexual desire or interest. An associated lack of subjective arousal during sexual activity is clinically highly apparent but has not been the focus of traditional sexual inquiry, definitions of dysfunction, or management. The frequent poor correlation of women's subjective sexual arousal and observable increases in genital congestion in response to sexual stimulation has not been reflected in assessment, diagnosis, or management.

Female sexual dysfunction (FSD) is a multifactorial condition that has anatomical, physiological, medical, psychological, and social components. Similar to erectile dysfunction in men, FSD is highly prevalent and often undertreated. Due to the development of successful treatment for male erectile dysfunction, FSD is receiving increased attention. Only a few studies dealing with epidemiology of female sexual dysfunction are available in the literature. However, research efforts in the field are increasing. This overview presents currently used classification systems, recently updated definitions, as well as prevalence data on the different entities of female sexual disorders.

Introduction and hypothesis This study aims to assess the prevalence of sexual problems in general gynecology and urogynecology clinics using a simple screening tool and to compare the prevalence between patients presenting with gynecology or urogynecology complaints. Methods Patients attending (uro)gynecology clinics completed three screening questions for sexual problems to be assessed. A fourth question was later introduced to address sexual problems which bother them. Student's t-test, chisquare test, and logistic regression were used. Results Of 1,194 women, 37% had a sexual complaint. Seventeen percent volunteered this information as part of their main complaint, while the remaining only admitted it on questioning. The last 290 questionnaires included the question on "bother." Of these, 37% had a sexual complaint and only 45% found them bothersome. Multivariate analysis showed that urogynecology complaints were significantly associated with sexual complaints. Conclusions As most women only volunteer symptoms when asked directly, clinicians should be vigilant in identifying sexual problems but always establish the question of bother to avoid over-diagnosis.

A significant number of patients undergoing treatment with selective serotonin reuptake inhibitors (SSRIs) report sexual dysfunction. SSRI-induced sexual dysfunction adversely affects quality of life and patient adherence to and compliance with treatment regimens. This trial examined the efficacy and safety of adjunctive bupropion in the treatment of SSRI-induced female sexual dysfunction. Sexual function was assessed by using the sexual function domains of the Female Sexual Function Index (primary efficacy outcome measure) and the Clinical Global Impression Scale adapted for sexual function (secondary efficacy outcome measure). End point treatment satisfaction was assessed using a Visual Analog Scale. A total of 218 women (25-45 years old) with SSRI-induced sexual dysfunction were randomized to receive 12 weeks of double-blind fixed dosed treatment with bupropion sustained release 150 mg b.i.d. (n = 109) or placebo (n = 109). The mean (SD) for Female Sexual Function Index total score was higher in the bupropion sustained release group (25.9 (5.12), 95% confidence interval (CI) 22.2-29.4) than in the placebo group (17.2 (4.9), 95% CI 15.8-20.1) (p = 0.001). Mean (SD) Clinical Global Impression Scale score for the bupropion group (2.4 (0.6), 95% CI 2.0-3.6) was significantly lower than that for the placebo group (4.2 (0.8), 95% CI 3.4-5.4) (p = 0.001). At the end of the trial the mean (SD) scores for desire (4.1 (0.7), 95% CI 3.5-4.8) (p = 0.001), arousal (4.4 (0.6), 95% CI 3.7-4.8) (p = 0.01), lubrication (4.4 (0.4), 95% CI 3.3-4.8) (p = 0.001), orgasm (4.4 (0.5), 95% CI 3.7-4.7) (p = 0.001), and satisfaction (4.2 (0.7), 95% CI 3.4-4.8) (p = 0.001) were significantly higher in the bupropion group. The highest improvement was observed in sexual desire, followed by lubrication. Compared with baseline, desire and lubrication domains increased by 86.4% (95% CI 64.9-102.2%, p = 0.001) and 69.2% (95% CI 44.7-82.6%, p = 0.001) in the bupropion group. Adjunctive treatment with bupropion sustained release during a 12-week period significantly improved key aspects of sexual function in women with SSRI-induced sexual dysfunction.