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PubMed2006

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.

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PubMed2006

Sexual function status in women with obstructive sleep apnea syndrome.

INTRODUCTION: Several co-morbid diseases have been shown to affect sexual functions in both genders. In the literature, sexual function status in men with obstructive sleep apnea syndrome (OSAS) has been studied; however, sexual functions in women with OSAS have not yet been studied. AIMS: In this prospective study, we aimed to determine sexual function status in women with OSAS and its relationship with the disease parameters of OSAS. METHODS: Women, who were diagnosed with OSAS with polysomnography performed in the sleep center of our university hospital, formed the study population. Women with any genital deformity, postmenopausal women, and women without a regular partner were excluded from the study. General demographic properties, medical histories, polysomnography parameters, and frequency of intercourse per month were noted for each patient. Patients completed the Sexual Function Questionnaire Version 2 (SFQ-V2) and Epworth Sleepiness Scale. The patients were grouped as mild, moderate, and severe OSAS according to the level of respiratory disturbance index (RDI). MAIN OUTCOME MEASURES: Scores of sexual function domains were determined from SFQ, and their relationships with parameters of polysomnography and demographics were studied. RESULTS: Twenty-five patients were included in the study. Mean age was 48.1 +/- 2.7 years. All were married with a mean marriage duration of 25.6 +/- 3.3 years. Mean frequency of intercourse per month was 3.3 +/- 1.8. All domains of sexual functions except pain and enjoyment significantly decreased with increasing severity of OSAS. When we controlled for factors of age and co-morbid diseases, correlation analyses showed significant negative correlation between levels of RDI and all domains of sexual functions except pain and enjoyment (P < 0.05). CONCLUSIONS: Obstructive sleep apnea syndrome negatively impacts sexual function in women independent of age and associated co-morbid diseases.

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PubMed2006

Premature ejaculation: on defining and quantifying a common male sexual dysfunction.

INTRODUCTION: Premature ejaculation (PE) and its individual and relationship consequences have been recognized in the literature for centuries. PE is one of the most common male sexual dysfunctions, affecting nearly one in three men worldwide between the ages of 18 and 59 years. Until recently, PE was believed to be a learned behavior predominantly managed with psychosexual therapy; however, the past few decades have seen significant advances in understanding its etiology, diagnosis, and management. There is, as yet, no one universally agreed upon definition of PE. AIM: To review five currently published definitions of PE. METHODS: The Sexual Medicine Society of North America hosted a State of the Art Conference on Premature Ejaculation on June 24-26, 2005 in collaboration with the University of South Florida. The purpose was to have an open exchange of contemporary research and clinical information on PE. There were 16 invited presenters and discussants; the group focused on several educational objectives. MAIN OUTCOME MEASURE: Data were utilized from the World Health Organization, the American Psychiatric Association, the European Association of Urology, the Second International Consultation on Sexual Dysfunctions, and the American Urological Association. RESULTS: The current published definitions of PE have many similarities; however, none of these provide a specific "time to ejaculation," in part because of the absence of normative data on this subject. While investigators agree that men with PE have a shortened intravaginal ejaculatory latency time (IELT; i.e., time from vaginal penetration to ejaculation), there is now a greater appreciation of PE as a multidimensional dysfunction encompassing several components, including time and subjective parameters such as "control,""satisfaction," and "distress." CONCLUSION: There is a recent paradigm shift away from PE as a unidimensional disorder of IELT toward a multidimensional description of PE as a biologic dysfunction with psychosocial components.

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PubMed2006

Guidelines for the diagnosis and management of premature ejaculation.

INTRODUCTION: Until recently, premature ejaculation (PE) was believed to have a psychologic etiology requiring psychosexual therapy. Recognition of a neurobiologic component to the etiology of PE has since highlighted the need for diagnostic and management guidelines for this common sexual problem. One major medical organization-the American Urological Association (AUA)--has established such guidelines. In addition, the Second International Consultation on Sexual Dysfunctions (ICSD) in 2003 developed a set of recommendations for PE, as well as for other sexual dysfunctions. AIM: To review the current guidelines for the diagnosis and treatment of PE. METHODS: The Sexual Medicine Society of North America hosted a State of the Art Conference on Premature Ejaculation on June 24-26, 2005 in collaboration with the University of South Florida. The purpose was to have an open exchange of contemporary research and clinical information on PE. There were 16 invited presenters and discussants; the group focused on several educational objectives. MAIN OUTCOME MEASURE: Data from the AUA Guideline on the Pharmacologic Management of Premature Ejaculation and the Second ICSD. RESULTS: Both documents emphasize the importance of a sexual history in diagnosing PE, and each of these two documents recognizes that diagnosis involves a shortened intravaginal latency time as well as patient reports of poor control over ejaculation and patient distress over the condition. CONCLUSIONS: Condensed guidelines for the diagnosis and treatment of PE are presented. Once diagnosis is suspected, optimal treatment regimens should be established utilizing randomized placebo-controlled trials.

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PubMed2006

Diagnosing premature ejaculation: a review.

INTRODUCTION: Premature ejaculation (PE) is one of the most prevalent male sexual dysfunctions, yet it is frequently misdiagnosed or overlooked as a result of numerous patient and physician barriers. In particular, there is no universally used definition of the condition. There are no validated assessments or laboratory assays which distinguish men with PE from men without PE, and there are no risk factors or definitive correlates identified for this condition. Patients fail to seek medical help because of the stigma and embarrassment over the condition. In addition, patients (and clinicians) often misdiagnose PE as erectile dysfunction (ED). AIM: To review the barriers to diagnosing PE, the factors to consider in diagnosing PE and how to diagnose PE. METHODS: The Sexual Medicine Society of North America hosted a State of the Art Conference on Premature Ejaculation on June 24-26, 2005 in collaboration with the University of South Florida. The purpose was to have an open exchange of contemporary research and clinical information on PE. There were 16 invited presenters and discussants; the group focused on several educational objectives. MAIN OUTCOME MEASURE: Data were utilized from the American Urological Association (AUA) Guideline on the Pharmacologic Management of Premature Ejaculation. RESULTS: The AUA recommends the diagnosis of PE be based solely upon sexual history. In addition to a shortened latency time, recent research has identified three key factors associated with--and necessary for--a diagnosis of PE: (i) patient reports of reduced control over ejaculation; (ii) patient (and/or partner) reports of reduced satisfaction with sexual intercourse; and (iii) patient (and/or partner) distress over the condition. CONCLUSIONS: The diagnosis of PE is based upon sexual history of a shortened latency time, poor control over ejaculation, low satisfaction with intercourse, and distress regarding the condition.

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PubMed2006

The psychology of premature ejaculation: therapies and consequences.

INTRODUCTION: Premature ejaculation (PE) is a common male sexual dysfunction characterized by the loss or absence of ejaculatory control, marked distress or interpersonal difficulty and by a short intravaginal ejaculatory latency time (IELT). PE can impact both the patient's and his partner's quality of life. AIM: To review evidence concerning the psychologic influences of PE on the self-esteem and self-confidence of men with PE and the impact on their partners. To review the role of psychotherapy in the management of men with PE. METHODS: The Sexual Medicine Society of North America hosted a State of the Art Conference on Premature Ejaculation on June 24-26, 2005 in collaboration with the University of South Florida. The purpose was to have an open exchange of contemporary research and clinical information on PE. There were 16 invited presenters and discussants; the group focused on several educational objectives. MAIN OUTCOME MEASURE: Peer-reviewed medical literature was reviewed concerning management of men with PE by psychologic and sexual therapy. Premature ejaculation has long been viewed as a psychological concern involving psychological interventions, although recent research also focuses on the neurobiological underpinnings of the dysfunction. Psychosexual therapies combine behavioral interventions to help the patient learn to control or delay his ejaculation and to assist him in regaining confidence and lessening performance anxiety. Psychosexual therapy can be combined with pharmacotherapies to provide an improved prognosis to the patient with PE. CONCLUSIONS: Healthcare providers do not manage the majority of patients with PE with the same consideration and attention provided men with erectile dysfunction (ED). PE has been perceived as a psychological concern, either a learned behavior or a response to a meaningful event/interaction or sexual anxiety. Primary treatment has involved psychosexual therapy. Regardless of etiology, psychological/sexual therapy can play an important role in the management of PE.

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PubMed2006

Current and future pharmacotherapies of premature ejaculation.

INTRODUCTION: There are currently no oral or topical agents approved by government regulation agencies for the management of premature ejaculation (PE). AIM: To review pharmacologic therapies for treatment of PE. METHODS: The Sexual Medicine Society of North America hosted a State of the Art Conference on Premature Ejaculation on June 24-26, 2005 in collaboration with the University of South Florida. The purpose was to have an open exchange of contemporary research and clinical information on PE. MAIN OUTCOME MEASURE: Data were obtained by extensive examination of peer-reviewed published literature. RESULTS: Chronic administration of selective serotonin reuptake inhibitors (SSRIs) is associated with an increased adverse event profile encompassing dry mouth, nausea, drowsiness, and reduced libido. Their use may also facilitate the development of other sexual dysfunctions, such as anejaculation and erectile dysfunction (ED). Phosphodiesterase-5 (PDE-5) inhibitors have also been investigated for the management of PE, as an indirect consequence of their ability to prolong erections. Trials have found PDE-5 inhibitors to be appropriate for men with PE secondary to ED, or when they are used in conjunction with other agents such as SSRIs. Trials of topical formulations that contain either anesthetic agents or other ingredients report significant increases in ejaculatory latency times; however, long-term safety and efficacy studies are lacking. New agents are being developed specifically for the management of PE. Among these are a topical formulation and numerous oral agents. Only one agent--dapoxetine hydrochloride (DPX)--has undergone Phase III trials. DPX is a serotonin transport inhibitor (STI) with a pharmacokinetic profile conducive to on-demand dosing for the management of PE. Unlike the current oral agents, DPX has a rapid onset of action and is effective from the first dose. CONCLUSIONS: Well-designed clinical trials utilizing appropriate outcome measurements are needed to provide safe and effective pharmacologic options for men with PE.

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PubMed2006

The prevalence of sexual dysfunction and potential risk factors that may impair sexual function in Malaysian women.

INTRODUCTION: Female sexual dysfunction (FSD) is a prevalent sexual health problem that does not spare the women in Malaysia, a nation with a conservative multiethnic society. AIM: To investigate the prevalence of FSD and the potential risk factors that may impair sexual function among women at a primary care setting in Malaysia. MAIN OUTCOME MEASURE: The prevalence, the risk factors, and the main predictors for FSD were measured among these women. METHODS: A validated Malay version of the Female Sexual Function Index was used to assess FSD. A total of 230 married women aged 18-70 years participated in this study. The sociodemographic and marital profiles of women who had FSD and those who did not were compared; the risk factors for FSD were determined. RESULTS: The majority of the respondents were younger than 50 years old, predominantly Malays, and had a higher academic achievement. The prevalence of FSD in the primary care population was 29.6%. The prevalence of women with lack of orgasms, low sexual arousal, lack of lubrication, sexual dissatisfaction, and sexual pain were 59.1%, 60.9%, 50.4%, 52.2%, and 67.8%, respectively. CONCLUSION: The risk factors for FSD are older age, Malays, married longer (more than 14 years), having less sexual intercourse (less than 1-2 times a week), having more children, married to an older husband (aged >42 years), and having a higher academic status. Lack of lubrication is found to be the main predictor for FSD in this study. Is lack of lubrication a cause or a complication of FSD? Prospective research is needed in the near future.

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PubMed2006

Customs, culture, and tradition--what role do they play in a woman's sexuality?

INTRODUCTION: Sexual health is an assumed right for every individual, but we know little regarding customs, culture, or tradition and the role they play on the sexual experiences for a woman. A woman's sexuality must be considered in the context of the environment in which she and her partner live. Culture, social customs of the community, and religion often determine the acceptance and achievement of sexual health for both men and women. AIM: This is a review of the available literature on the impact of culture on a woman's sexual satisfaction, with emphasis placed on information from cultures practicing female genital circumcision (FGC). RESULTS: FGC provides a spectrum of surgical excisions and outcomes. The spectrum of FGC surgical excisions can alter well-being, obstetrical outcomes, and sexual responses. The psychologic aspects of a painful procedure in a young child may also impact her future sexual responsiveness. CONCLUSION: There is a paucity of information on which to base conclusions and the effect of culture on a woman's sexual satisfaction. Preliminary data suggest the need for further research using markers specific to the culture and her satisfaction.

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PubMed2006

Development of a Korean version of the Female Sexual Distress Scale.

INTRODUCTION: This article presents data based on the responses of more than 100 women who contributed to the development of a Korean version of the Female Sexual Distress Scale (FSDS). AIM: The FSDS was developed to measure sexually related personal distress in women. This article aims to test the usefulness and analyze factors of the 20-item version of the FSDS in a Korean female sample. METHODS: The original two-item FSDS was translated with cultural modifications. A total of 104 healthy, married women were recruited through a survey. A second survey was undertaken after 2 weeks for test-retest reliability. Validity, internal consistency reliability, and test-retest reliability were evaluated. An exploratory factor analysis was also performed. MAIN OUTCOME MEASURES: A Korean version of the FSDS. RESULTS: The test-retest coefficients of stability over a 2-week period was 0.99 (P < 0.01). The 20 items of the FSDS have good internal consistency, with an alpha of 0.96. The FSDS discriminated between women with and without sexually related distress (t = -7.34, P < 0.01). The optimal cut-off score was 20 (sensitivity 71.4%, specificity 92.2%). By principal axis factoring, the Korean version of the FSDS was found to consist of two factors. A 16-item FSDS had good internal consistency with an alpha of 0.97. The test-retest reliability was good (r = 0.99, P < 0.01). The items of the 16-item FSDS were somewhat different from the original 12-item FSDS. CONCLUSIONS: The Korean version of the FSDS (20-item) might be a useful tool for screening sexually distressed women in Korea. Instead of the 12-item version of the original FSDS, the 16-item FSDS was validated in this study. These results could reflect cultural differences between Eastern Asian and Western societies.

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PubMed2006

Association of risk factors and medical comorbidities with male sexual dysfunctions.

INTRODUCTION: Conventionally, little attention has been given to the association of risk factors and medical comorbidities with male sexual dysfunctions. Although that association has been recently shown in many studies, it is not yet well investigated in the Saudi community. AIM: To investigate the association of risk factors and medical comorbidities with male sexual dysfunctions in the Saudi community. METHODS: A total of 1,464 male patients with a clinical diagnosis of sexual dysfunctions were enrolled in this study. All patients were assessed for sexual functions using different domains of the International Index for Erectile Function. Patients were also interviewed for sociodemographic data, medical history, and risk factors for erectile dysfunction (ED). Routine laboratory investigations, plus total testosterone and prolactin assessments, were offered to all patients. Assessments of penile vasculature using Doppler ultrasonography and rigidometer were performed. RESULTS: A total of 92.6% of the patients had ED, 50.8% had premature ejaculation (PE), and 7.6% had low sexual desire. There was a significant association between increased age and increased severity of ED. In total, 20% had psychogenic cause, whereas 80% had organic cause of ED. Of the patients, 10.2% had mild, 41% had moderate, and 48.8% had severe ED. There were significant associations between endocrinopathy and both low sexual desire and PE (P < 0.05). There were significant associations between increased severity of ED and presence of diabetes, hypertension, dyslipidemia, ischemic heart disease, myocardial infarction, and psychological disorders. There were significant associations between increased severity of ED and increased values of end diastolic velocity, decreased values of peak systolic velocity, resistive index, rigidometer, and decreased response to intracavernosal injection (P < 0.001). CONCLUSION: This study provides an assessment of the association of risk factors and medical comorbidities with male sexual dysfunctions in ambulatory service in this community.

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PubMed2006

Sexual outcomes and satisfaction with hysterectomy: influence of patient education.

INTRODUCTION: Many women experience improved sexual function after hysterectomy. However, a sizeable minority of women report worsened sexual function after the surgery, and concerns about the effect of surgery on sexual function are common among women planning to undergo hysterectomy. AIM: The present study examined the role of education about the potential sexual consequences of hysterectomy in predicting self-reported outcomes and satisfaction with the procedure. METHODS: We conducted a cross-sectional survey of 204 women who had undergone simple hysterectomy in the preceding 3-12 months. Participants volunteered in response to a Web-based advertisement. MAIN OUTCOME MEASURES: Participants indicated their current sexual function using the Female Sexual Function Index (FSFI), and reported positive and negative sexual outcomes experienced after hysterectomy using a checklist. Participants also completed questionnaire items regarding satisfaction with hysterectomy and education from their physicians about sexual risks and benefits prior to surgery. RESULTS: Current sexual function scores were related to self-reports of positive and negative sexual outcomes following hysterectomy and overall satisfaction with hysterectomy. Education from a physician about possible adverse sexual outcomes was largely unrelated to self-reports of having experienced those outcomes. However, education about possible negative sexual outcomes predicted overall satisfaction with hysterectomy when controlling for self-reports of positive and negative sexual outcomes. CONCLUSION: Education about potential negative sexual outcomes after surgery may enhance satisfaction with hysterectomy, independent of whether negative sexual outcomes were experienced. Including a discussion of potential sexual changes after surgery may enhance the benefits of presurgical counseling prior to hysterectomy.

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