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Incidence and prevalence of the sexual dysfunctions: A critical review of the empirical literature
Abstract
The research which has assessed the incidence and prevalence of sexual dysfunctions is reviewed. Twenty-three studies are evaluated. Studies completed with community samples indicate a current prevalence of 5-10% for inhibited female orgasm, 4-9% for male erectile disorder, 4-10% for inhibited male orgasm, and 36-38% for premature ejaculation. Stable community estimates with regard to the current prevalence of female sexual arousal disorder, vaginismus, and dyspareunia are not available. Recent studies completed with clinical samples suggest an increase in the frequency of orgasmic and erectile dysfunction and a decrease in premature ejaculation as presenting problems. Desire disorders have increased as presenting problems in sex clinics, with recent data indicating that males outnumber females. Methodological limitations of these studies are identified and suggestions for future research are offered.
... Determining the true incidence of LSD and HSDD are essential to prevent female sexual dysfunctions (FSD), identify associated risk factors, and to provide adequate treatment resources (Spector & Carey, 1990). According to physicians, less than half of the patients with complaints of sexual function raised this issue in their medical interviews (Parish & Hahn, 2016). ...
... A representative sample is considered to reduce bias. A non-response bias may inflate estimates of incidence or prevalence because only those who are sexually distressed will be more likely to respond to advertisements about sexuality (Spector & Carey, 1990). The incidence of HSDD in convenience samples was seen to be higher than in the probability samples in the current meta-analysis. ...
... The current study examined the incidence of LSD and HSDD. Previous systematic reviews empirically evaluated the prevalence and incidence of sexual problems that either excluded LSD and HSDD (Dunn, Jordan, Croft, & Assendelft, 2002) or focused on studies carried out in clinical settings (Spector & Carey, 1990). The available studies also did not differentiate between LSD and HSDD (McCool et al., 2016;West, Vinikoor, & Zolnoun, 2004). ...
Determining the true incidence and identifying the risk factors of low sexual desire (LSD) and hypoactive sexual desire disorder (HSDD) are essential to prevent sexual dysfunctions and provide adequate treatment resources. This systematic review and meta-analysis were performed on research articles reporting women with LSD and HSDD in PsycArticles, Scopus, MEDLINE, Web of Science databases, and reference lists till October 2021. All cross-sectional studies published in English that assessed both sexual desire and sexual distress were included. Of 891 full-text articles identified, 24 were eligible, all of which had a low risk of overall bias. We did separate random-effects meta-analyses for LSD and HSDD outcomes. The incidence of LSD and HSDD were 29% and 12%, respectively. Studies that used the convenience sampling method reported a higher incidence of HSDD than studies that used the probability sampling method. No differences were found between the assessment method and across cultures in LSD and HSDD. A majority of studies reviewed addressed demographic (e.g. age, education), physiological (e. g. menopausal status, body mass index), psychological (e.g. depression, daily internal stress), relational (e.g. relationship length, relationship satisfaction), and sexual predictors (e.g. sexual activity, sexual pleasure) between LSD and HSDD. This systematic review may inform researchers, guideline developers, and policy-makers about LSD associated with distress and help health professionals to identify women most at risk.
... Sexual dysfunction is a common sexual complaint across different countries and cultures [1][2][3]. Evidence shows that 25-63% of women and 10-52% of men [4][5][6][7][8] experienced at least one of the sexual dysfunctions and suffered negative outcomes, including depression and anxiety [9]. From an evolutionary perspective, it has been argued that disgust may be involved in sexual dysfunctions given that body fluids such as saliva and semen exchanged during sexual activity involve a contagion risk [10]. ...
... The Disgust Propensity and Sensitivity Scale-Revised (DPSS-R). The DPSS-R [45] including 16 items measures people's disgust propensity (the general tendency to respond with the emotion of disgust) via items such as "I avoid disgusting things" and disgust sensitivity (the impact of experiencing the emotion of disgust) via items such as "It scares me when I feel nauseous", respectively on a 5-point Likert scale ranging from never (1) to always (5). In the current research, the disgust propensity subscale and sensitivity subscale had good internal consistencies in Study 1 (.73 and .76) ...
Sexual stimuli provoke both sexual arousal and disgust, and the coaction between these emotions determines sexually behavioral outcomes. The current research includes two experiments to explore the bidirectional relationship between sexual arousal toward erotic stimuli and disgust induced by sexual body fluids. Study 1 presented 234 participants (117 women) with sexual body (vs. neutral) fluids followed by erotic stimuli, and Study 2 presented 235 participants (117 women) with erotic (vs. neutral) videos followed by sexual body fluids (and a non-sex-related stimulus). Study 1 showed that exposure to sexual body fluids reduced sexual arousal and the likelihood of sexual engagement toward erotic stimuli in participants with high sexual disgust sensitivity but increased sexual arousal and the likelihood of sexual engagement in participants with low sexual disgust sensitivity, while Study 2 suggested that men exposed to erotic (vs. neutral) stimuli reported lower disgust, stronger sexual arousal state, and higher willingness to interact with the sexual body fluids. There was no relationship between subjective feelings of sexual arousal and disgust in these experiments, while the balance of sexual arousal and disgust toward sexual body fluids and erotic stimuli had a positive association. Also, exposure to erotic stimuli had no effect on reactions to generally disgusting stimulus, but feelings of sexual arousal toward erotic stimuli were positively associated with disgust induced by generally disgusting fluid. These findings suggest that Behavior Immune System regulates disgust to establish a balance between benefit and cost related to sex as well as provide insight into the process underlying sexual dysfunctions.
... 7 One study reported that the prevalence of vaginismus was between 5% and 17% in clinical settings. 8 The prevalence of vaginismus was noted in a systematic review to be between 0.4% and 8%. 9 The switch-off phenomenon, which occurs when penetration pain suddenly causes the vagina to become dry, is seen in certain women with vaginismus. ...
... Five items of the Sex Fear Questionnaire are about fear of sex without penetration (score range, 5-15) and 3 items about fear of sex with penetration (score range, [3][4][5][6][7][8][9][10][11][12][13][14][15]. The higher the sum of scores, the more the fear of sex. ...
Background:
Vaginismus is known as a type of sexual pain disorder. Regarding the multifactorial nature of vaginismus, the biopsychosocial model is one of the best models to describe this sexual disorder.
Aim:
The present research was conducted to study the determinants of sexual function in women with and without vaginismus based on the biopsychosocial model.
Methods:
This case-control study was conducted in Iran on 420 women with and without primary vaginismus who met the inclusion criteria. All eligible people were included in the research once their eligibility was verified and their informed permission was acquired; convenience and purposive sampling techniques were used continually. Data collection tools included the demographic and obstetric information form and multiple published scales and questionnaires. Structural equation modeling with LISREL 9.2 software (Scientific Software International) was used to evaluate the determinants of the sexual function of vaginismus.
Outcomes:
Participants rated their determinants of sexual function based on the biopsychosocial model.
Results:
The mean ages of the case and control groups were 27.67 and 28.44 years, respectively. The direct, indirect, and total effects of the dimensions of sexual health on sexual function and the diagnostic score of vaginismus of the women with vaginismus were significant (P < .001). Furthermore, based on the results, the diagnostic score of vaginismus in women with vaginismus was significantly affected by the direct, indirect, and cumulative impacts of vaginal penetration cognition and fear of sex (P = .016, P = .005). Women with and without vaginismus were able to accept the models' excellent fit.
Clinical implications:
This study helps inform health planners and policy makers about the sexual function of women with vaginismus, the factors related to this disorder, and the multidimensional nature of this sexual problem.
Strengths and limitations:
This study attempted to offer a more comprehensive and complete view of present knowledge via surveying different aspects of sexual health and by means of valid and reliable tools and path analysis. The study's merits include the use of the biopsychosocial model to evaluate sexual function in women with vaginismus, the use of a variety of questionnaires to compare women with and without vaginismus, and the size of the sample. The research was limited by the fact that electronic sampling was conducted because of the COVID-19 epidemic.
Conclusion:
Based on the findings of the present study for the group of women with vaginismus, the direct, indirect, and overall effects of the majority of dimensions of sexual health were significantly correlated with sexual function and vaginismus.
... Vajinismus görülme sıklığı, ülkeden ülkeye hatta aynı ülke içindeki alt kültürlerde bile oldukça büyük farklılıklar gösterebilir. [1,7,8] Dünya genelindeki görülme sıklığının %1-6 arasında olduğu öngörülürken bazı orta doğu ülkelerinde yapılan çalışmalarda bu oran %17'ye kadar çıkabilmektedir. [1,7,8] İran merkezli çalışmalar genel olarak vajinismus görülme sıklığının %5-17 arasında olduğunu bildirmektedir. ...
... [1,7,8] Dünya genelindeki görülme sıklığının %1-6 arasında olduğu öngörülürken bazı orta doğu ülkelerinde yapılan çalışmalarda bu oran %17'ye kadar çıkabilmektedir. [1,7,8] İran merkezli çalışmalar genel olarak vajinismus görülme sıklığının %5-17 arasında olduğunu bildirmektedir. [9] Batı ülkelerinde yapılan çalışmalarda ise vajinismus sıklığı son 20-30 yılda oldukça düşük oranlardadır. ...
... Vaginismus, with a prevalence of 5-17%, has been reported to be more common than other female sexual dysfunctions (3). In a study from Turkey, the incidence of vaginismus in the population has been reported to be 15.3% (4). ...
Aim: Vaginismus is the most common reason for women to apply to psychiatry outpatient clinics due to sexual problems. It has been suggested that many psychological, social, and cultural factors may cause vaginismus; however, it has not been fully clarified. In this study, factors that may be associated with vaginismus were evaluated and compared with controls.
Methods: The case group was constituted of 28 females diagnosed with primary vaginismus, and the control group was constituted of 27 healthy individuals with no difficulty in vaginal penetration. All individuals participating in the study were evaluated with self-reported scales in terms of state-trait anxiety, social phobia, self-regard, childhood trauma, and sexual function. In addition, sociodemographic variables were collected for each participant.
Results: While the mean age was 25.04±2.62 in the vaginismus group, it was 26.48±2.83 in the control group. Compared to the control group, women with vaginismus were found to have significantly higher scores for age difference with their parents, state-trait anxiety, emotional neglect, physical neglect, emotional abuse, a total of childhood trauma scale, communication, satisfaction, touching, frequency, vaginismus, anorgasmia, and lower scores for self-esteem. In addition, a positive correlation was found between maternal education level, state and trait anxiety, childhood trauma, social phobia, self-esteem scale score and vaginismus.
Conclusion: It was considered that to evaluate vaginismus only as an entry difficulty would be deficient and that there may be comorbid or related conditions such as social phobia, anxiety, trauma, low selfesteem, and a holistic evaluation is necessary.
... In prevalence studies, very different results can be reported due to reasons such as study design, classification of the related disorder, assessment tools, the publication year of study, and regional differences. 29 Although meta-analysis studies provide more reliable results on prevalence rates, heterogeneity between studies is still a disadvantage. ...
INTRODUCTION: Studies on male sexual dysfunctions around the world point to high prevalence rates. Although there are studies on the prevalence of sexual dysfunctions in men in Turkey, these studies report different results due to regional and methodological differences. Therefore, more robust and consolidated data are needed on the prevalence of sexual dysfunctions in men. METHODS: For this meta-analysis study, "Google Scholar" and "ULAKBIM" databases were searched. Studies have been conducted in Turkey between January 2000 and April 2019 were included in the study. RESULTS: The prevalence of male sexual dysfunction, erectile dysfunction and premature ejaculation were found to be 28%, 18% and 24%, respectively DISCUSSION AND CONCLUSION: This study is the first meta-analysis on the prevalence of male sexual dysfunction in Turkey. Our results reveal the importance of preventive and therapeutic health services in male sexual dysfunctions.
... [7][8][9][10] The prevalence of vaginismus remains unspecific however the prevalence rate in clinical setting have been outlined to fall between 5-17%. 11 It was found that Ghana reported 68.1% cases with signs and symptoms of vaginismus. 12 An Italian women reported 9% of enquires for vaginismus over a phone call helpline for sexual problems. ...
Vaginismus is a condition that can be defined as an uncontrolled contraction of the vaginal muscles, which can lead to difficulty in coital activity.1,2 The term vaginismus was coiled in 19th century. However, vaginismus has been actualized as a inconsistent but well recognized and well managed female sexual dysfunction. In 1859 gynecologist pen down from his personal experience “I can confidently assert that I know of no disease capable of producing so much unhappiness to both parties of the marriage contract, and I am happy to state that I know of no serious trouble that can be cured so easily, so safely and so certainly”1,3. This actualization was extended by Masters and Johnson. Who clocked in a treatment and outcome success rate of 100%. 1,4. Beck stated vaginismus as “an interesting illustration of scientific neglect”1,5.
There is paucity in the evidences of epidemiological studies examining the population prevalence of vaginismus as it requires gynecological assessment and the effected will avoid it due the pain anticipation due to which there have been numerous estimation with concerns to the prevalence vaginismus1. Masters and Johnson state that it is comparatively sparse conditio1,4,6 And there are others who advocate that it is the most found female psychosexual dysfunction.7-10. The prevalence of vaginismus remains unspecific however the prevalence rate in clinical setting have been outlined to fall between 5-17%11.
It was found that Ghana reported 68.1% cases with signs and symptoms of vaginismus.12. An Italian women reported 9% of enquires for vaginismus over a phone call helpline.
... Literature from the western world has shown sexual dysfunctions are highly prevalent in both sexes, more in women (25-63%) than men (10-52%). [3][4][5][6] An epidemiological study from India has found that one in five males and one in seven females have one or more sexual disorders. 7 The common problems related to sexual health are premature ejaculation, erectile dysfunction, delayed ejaculation, nocturnal emission, Dhat syndrome, myths related to sex and sexuality, performance anxiety, guilt about masturbation, hypo-active sexual desire, anorgasmia, vaginismus, dyspareunia, sexual aversion, and infections and tumours of the reproductive system. ...
Sexual health requires a positive and respectful approach to sexuality and sexual relationships. It is one of the most neglected parts of an individual's health. Sexual health is not adequately covered in the medical education curriculum of Nepal. There is a lack of clinicians practising sexual medicine, which provides a fertile field for quacks in this arena. Sexual health needs to be included and incorporated into medical education. The policymakers and stakeholders need to address this need in sexual health urgently and effeciently. Comprehensive sexual education should be included for children, adolescents and young adults.
Keywords:
medical education; Nepal; sexual health.
... They include, among other things, premature (early) ejaculation, delayed ejaculation, and erectile disorder for men as well as arousal disorder and orgasmic disorder for women [1]. Previous research shows that sexual dysfunctions are highly prevalent globally, affecting 10% to 52% of men and 25% to 63% of women [2][3][4][5]. ...
The aim of this study was to investigate the association between masturbation frequency and sexual dysfunction among men and women, focusing on individuals with and without regular sexual partners, and to determine whether sexual compatibility (e.g., similar sexual desire levels and a match between desired behaviors and behaviors one’s partner is willing to engage in) in the relationship affects masturbation frequency. Here, 12,271 Finnish men and women completed an online survey about masturbation frequency, sexual function, and sexual compatibility with their partner for those who were in a relationship. The results indicated that masturbation frequency was positively associated with overall sexual function for women. This was moderated by relationship status, meaning that more frequent masturbation was associated with better orgasmic function and sexual satisfaction in single women, whereas the opposite was true for women who were in a relationship. For men, more frequent masturbation was associated with better erectile function for single men, and better ejaculatory latency but worse orgasmic function, intercourse satisfaction, and more symptoms of delayed ejaculation for men who were in a relationship. Lower sexual compatibility and sexual dysfunctions in the partner were associated with more frequent masturbation in both sexes. The associations between masturbation frequency and sexual function vary for single and partnered individuals, and are, for the latter group, further affected by sexual compatibility.
... According to Spector and Carey (1990), sexual dysfunction is among the most common psychological disorders in the general population, and rates of sexual dysfunction seem to be particularly high in men who have sex with men (McDonagh, Bishop, Brockman, & Morrison, 2014). According to a recent review (Peixoto, 2017), 75-98% of gay men have experienced at least one sexual problem during their lifetime; however, when the target period is limited to the past year, this rate falls to 42.5-79% (Hirshfield et al., 2010;Lau, Kim, & Tsui, 2006, 2008Rosser, Metz, Bockting, & Buroker, 1997;Seibel, Rosser, Horvath, & Evans, 2009). ...
The aim of the present study was to investigate sexuality in a sample of gay fathers and lesbian mothers with children from previous heterosexual relationships. In particular, we compared their sexual functioning in their respective homosexual and heterosexual relationships and explored possible related factors. Thirty-two self-identified lesbian women and 26 self-identified gay men (mean age 45.62 ± 8.88 years) participated. Internalized homophobia, sexual satisfaction, and sexual functioning were investigated. For women, moving from a heterosexual to a homosexual relationship decreased the prevalence of sexual problems (78.1% vs. 3.1%, respectively); however, for men, the frequencies remained unchanged, with the exception of low sexual desire (26.9% vs. 0.0%, respectively). Among gay fathers, current internalized homophobia levels were found to be associated with sexual functioning with same-sex partners, while awareness of sexual orientation at the time of marriage was associated with sexual functioning with opposite-sex partners. Among lesbian mothers, internalized homophobia at the time of marriage was associated with sexual functioning with opposite-sex partners. In general, not having revealed one’s homosexuality to one’s children was associated with worse sexual functioning. Understanding the impact of internalized homophobia on gay and lesbian parents’ sexual functioning can be useful for designing interventions for promoting sexual well-being.
Background
Female sexual dysfunction (FSD) is a term used to describe various sexual problems, such as low desire or interest, diminished arousal, orgasmic difficulties, and dyspareunia.
Objectives
The aim of the present study was to determine the effect of chronic skin disease on female sexual function among married Egyptian females as well as the prevalence of FSD among them and its effect on their husbands.
Patients and methods
The study was conducted on 300 sexually active married Egyptian women attending the Dermatology Outpatient Clinic of Minia University Hospital and Kom Elshokafa Clinic (Alexandria). All women were asked to fill out the female sexual function index sheet using the Arabic validated translated version of it. Those with FSD were asked about its effect on their husbands.
Results
We reported that 234 (78%) women with chronic skin disease had sexual dysfunction. Despite dysfunction being more common among those who had skin disease, compared with nondysfunction, it was not statistically significantly different among most skin diseases. There was a positive correlation between female’s age and percentage of dysfunction. It was found that only 15.9% of those with FSD showed an effect on their partners in the form of decreased libido.
Limitations
Limitations include the lack of a control group; the standardization of data, which may not be representative of the community, as they related to specific areas; and being a cross-sectional hospital-based study.
Conclusion
Our study revealed a high prevalence of FSD (78%) among Egyptian married women with chronic skin disease in both Minia and Kom Elshokafa (Alexandria) districts. However, it was not statistically significantly different among most skin diseases, with affection of only 15.9% of their partners.
Vaginismus is defined as condition which leads to involuntary vaginal muscle spasm leading to painful sexual Intercourse. It is also classified as sexual pain disorder. It is one of the most common conditions prevalent among females who experience pain during vaginal intercourse leading to sexual pain disorder. The main objective of the study was to rule out the effectiveness of intra-vaginal management on patient with Vaginismus. Vaginismus is a sexual pain disorder in which female have difficulties in vaginal penetration during sexual Intercourse due to number of reasons such as fear, involuntary muscle contraction, sexual abuse and pelvic pain etc. As per studies, it had been showed that vaginismus is also one of the main reasons behind Infertility among many females. Most of the females in North India are not aware regarding the pelvic floor examination or to consult the pelvic floor practitioner for their problems related to Infertility. In many cases, as per studies we had founded that most of the females are being focused to go for number of testing procedures but they are not being guided to undergo pelvic floor examination.
We propose criteria for diagnosing vaginismus based on our clinical experience and review of relevant literature (Table 1). It consists of subjective criteria, objective criteria, frequency duration criteria, and exclusion criteria
Epidemiological studies illustrate that sexual dysfunction (SD) is common among the majority of patients suffering from neurological disorders (NLDs). However, our understanding of the SD in NLDs is in its infancy. Our effort in this review article reveals how the clinical studies illustrate different phenotypes relating to SD in both men and women suffering from NLDs, with special reference to PD, and how the development of animal models will provide a fantastic opportunity to decipher mechanistic insights into the biological and molecular processes of SD, understanding of which is critical to figure out the causes of SD and to develop therapeutic strategies either by targeting molecular players or altering and/or regulating the profiles of involved genetic targets. Specific emphasis is placed on dopamine-dependent and independent mechanism(s) of SD among PD patients, which is important because certain critical dopamine-independent phenotypes are yet to be characterized and understood in order to decipher the comprehensive pathophysiology of PD. Synergic efforts of both clinicians and bench scientists in this critical direction would significantly improve the quality of life of sufferers of NLDs who are already burdened. This knowledge relating to SD will help us to make one more step in reducing the burden of disease.
Patients with cardiovascular disease are at increased risk of developing erectile dysfunction (ED). This may be a consequence of atherosclerosis of the penile arteries, a reduced cardiac output, or a side‐effect of drugs used to reduce cardiovascular risk factors (particularly β‐blockers, thiazide diuretics and, occasionally, lipid‐lowering drugs). ED is a distressing condition, which often diminishes the patient's self‐esteem, with the potential for damage to his psychological health and his relationship with his partner and family. When treating ED, the underlying aetiology should be established by careful examination and consideration of medical history and concurrent medication. Until recently, pharmacological treatment options involved intracavernous injections (alprostadil or moxisylyte) or intraurethral alprostadil. These treatments are often inconvenient and not well accepted by the patient. The recent introduction of oral sildenafil promises to revolutionise the treatment of ED. In double‐blind, placebo‐controlled trials in patients with ED, sildenafil improved erectile function and quality of life and was well tolerated. ED is a clinically important complication of cardiovascular disease and should be asked about and treated accordingly. It is important that effective treatments, including sildenafil, should be available for treating patients with cardiovascular disease and ED.
Introduction
Disorders of male sexual health and functioning are complex and can have significant deleterious effects on patients psychological wellbeing and interpersonal relationships. It is well recognised that clinicians have an overall poor understanding of the true effect that disease has on their patients and self-reported patient-reported outcome measures (PROMs) aim to better communicate these issues. PROMs are generally welcomed by patients and their use in this highly sensitive area of clinical practice is well recognised. An atlas of available PROMs for key conditions in andrology is presented in this article.
Methods
A comprehensive search of world literature was conducted from the inception of databases to June 2022, to identify male-specific PROMs relevant to four key andrological disorders: hypogonadism, erectile dysfunction, penile curvature and disorders of ejaculation. Each tool was evaluated in narrative format.
Results
35 PROMs were identified. 6 were designed for the assessment of hypogonadism, 18 for erectile dysfunction, one for penile curvature and 10 for ejaculatory disorders. In general, PROMs were brief, self-administered and user-friendly. There was sufficient scope and variety in all categories (apart from penile curvature) to give the clinician flexibility in tool selection and find an appropriate tool for different scenarios.
Conclusion
A number of PROMs exist within andrology that can be utilised in both research and clinical settings. PROMs enable subjective evaluation of difficult-to-assess aspects of the patient experience.
Introduction
Vaginismus disorder is one of the most common sexual disorders in women, which is characterized by involuntary muscle spasm of the outer third of the vagina and interferes with vaginal intercourse.
Objective
The present study aimed to assess self-esteem, sexual self-concept, and irrational beliefs in vaginismus women with other women who do not have sexual problems.
Methods
This study was a cross-sectional analytical study, conducted on 60 married women aged 18 to 35 years old (vaginismus=30, control=30) by convenient sampling in 2020. The samples were selected from a sexual disorders’ clinic. The written informed consent forms were obtained. It took 30 to 40 minutes to complete the questionnaires The Multidimensional Sex Questionnaire (MSQ), The Sexual Self-esteem Inventory for Women (SSEI-W) and Jones' Irrational Beliefs Test (IBT-40). The data were analyzed using statistical methods at the levels of descriptive and inferential statistics of chi-square, and t-test with SPSS 23.
Results
According to the calculated mean for each group, it can be said that the women with vaginismus vs. control had lower score in sexual self-concept (113.33 ± 21.66 vs. 125.26± 24.32). Further, the mean of Self-esteem and irrational belief in the vaginismus and control groups were 261.40±49 vs 223.36± 46.53 and 122.26±22.49 vs 118.333 that of the control group indicated significant statistical difference (p=0.003).
Conclusion
The present study showed that women with vaginismus have lower sexual self-concept and self-esteem but their non-sexual irrational beliefs have no difference with those of non-affected women though their non-sexual beliefs are different. Therefore, it seems that medical and educational programs must focus on changing these variables.
Vaginismus and dyspareunia were classified in DSM-V as female sexual dysfunctions in “Genito-Pelvic Pain and Penetration Disorders (GPPPD),” which describes persistent or recurrent difficulty/pain on sexual intercourse or penetration attempts. It is not easy to differentiate vaginismus, dyspareunia, and provoked vestibulodynia (PVD) because of their overlapping symptoms.Gynecological examination and detailed anamnesis are important in diagnosing, grading, and designing treatment modalities. GPPPD treatments need a multidisciplinary team’s multimodal approach, including gynecologist, psychiatrist, urologist, family consultant, sex therapist, psychologist, and physiotherapist.This chapter shares my 20 years of knowledge and experience on vaginismus and dyspareunia treatments in light of literature.KeywordsVaginismusDyspareuniaVaginismus treatmentsSexual disorderSexologyVaginismus therapyFemale sexual disorderFemale sexual dysfunctionsGenito-pelvic painSexualityVestibulodyniaSexual pain
We evaluated the treatment outcomes of the patients with primary vaginismus in a specialized clinic. Cognitive-Behavioral Therapies (CBT), finger exercises, and vaginal dilators were used. Symptom Checklist-90 Revised, Martial Adjustment Inventory, Female Sexual Function Index and Golombok-Rust Index for Sexual Satisfaction were applied pre-and post-treatment. Twenty-three patients were enrolled. All patients achieved sexual intercourse at the end of the treatment. After treatment, the results improved in the SCL-90 R test and sexual function indexes Marriage adjustment scores did not improve. With vaginismus, improvement in psychological scores emphasizes the importance of sexual therapy in couples having sexual dysfunctions.
Background:
Previous studies assessed the association of sexual dysfunction (SD) in cases of specific organic and psychiatric disorders separately as risk factors of SD, but the extent of association of various disorders in cases of SD was rarely evaluated. This study was conducted to assess almost all types of comorbidities to find out their effects on SD in male patients and to make complete diagnoses.
Materials and methods:
All male patients aged between 18 and 60 years reporting with sexual problems to the psychiatry outpatient department were evaluated with Arizona sexual experiences scale (ASEX) for males. Their assessment included detailed medical and psychiatric history including medicine intake, physical and mental status examination. Relevant biochemical investigations were done including sex hormone assessment.
Results:
Among 104 males diagnosed as cases of SD according to the ASEX scale in 1 year period only 75 patients completed all the biochemical and hormonal assessments. It was observed that 38.67% were diagnosed as SD without any comorbidity, 25.33% had biochemical or hormonal or physical comorbidities, 21.33% had psychiatric comorbidities and 14.67% had psychiatric as well as biochemical or hormonal or physical comorbidities (n = 75). The severity of SD was higher in the patients with comorbidity and the age of the patients predicted its severity.
Conclusion:
All cases of SD should be assessed in detail for physical, biochemical, hormonal, and psychiatric comorbidities to treat them holistically. Psychiatrists should play a key role in assessing, diagnosing, treating, and referring them to the appropriate treatment provider.
The objective of this study was to evaluate the content, quality, and readability of websites containing information on dyspareunia, vaginismus, and vulvodynia in Spanish. Web pages were retrieved entering the terms “dyspareunia”, “vaginismus”, and “vulvodynia” in Google, Yahoo!, and Bing search engines. Two researchers employed the DISCERN and Bermúdez-Tamayo questionnaires to analyze the content and quality of the websites, and the INFLESZ scale to evaluate their readability. IBM SPSS® version 25 statistical software was employed for data analysis. The internet search yielded 262 websites, 91 of which were included after applying the selection criteria. Websites with information on dyspareunia obtained median scores of 24 (30–21) in the DISCERN, 38 (41.0–35.5) in the Bermúdez-Tamayo, and 55.3 (57.2–50.9) in the INFLESZ tools. The results for websites on vaginismus revealed median scores of 23.5 (30–20) in the DISCERN, 37 (42–35) in the Bermúdez-Tamayo, and 52.9 (55.6–46.4) in the INFLESZ. Finally, the median scores for vulvodynia sites was 25.5 (30–20) in the DISCERN, 38 (43–33.7) in the Bermúdez-Tamayo, and 54.2 (57.3–−47.2) in the INFLESZ. These outcomes indicate that the quality of information in these websites is very low, while the overall quality of the web pages is moderate. Sites on vaginismus and vulvodynia were “somewhat difficult” to read, while readability was “normal” for websites on dyspareunia. Healthcare professionals should be aware of the shortcomings of these websites and address them through therapeutic education with resources containing updated, quality information. This raises the need for health professionals to generate these resources themselves or for experts and/or scientific societies in the field to check the quality and timeliness of the contents, regardless of whether or not the websites are endorsed with quality seals.
Background
Female sexual dysfunction (FSD) is a complex disorder of biopsychosocial etiology, and FSD symptoms affect more than 40% of adult women worldwide.
Aim
In this cross-sectional study, we sought to investigate the association between FSD and socioeconomic status (SES) in a nationally representative female adult population.
Methods
Economic and sexual data for women aged 20–59 from the 2007–2016 National Health and Nutrition Examination Survey, a United States nationwide representative database, was analyzed. Poverty income ratio (PIR), a ratio of family income to poverty threshold, was used as a measure of SES, and low sexual frequency was used as a measure of FSD. The association between FSD and SES was analyzed using survey-weighted logistic regression after adjusting for relevant social and gynecologic covariates, such as marital status and history of pregnancy, as well as significant medical comorbidities.
Outcomes
We found that FSD, as measured by low sexual frequency, was associated with lower SES.
Results
Among the 7,348 women of mean age 38.4 (IQR 29–47) included in the final analysis, 26.3% of participants reported sexual frequency of 0–11 times/year and 73.7% participants reported sexual frequency >11 times/year. Participants of PIR <2 were 92% more likely to report sexual frequency ≤11 times/year than those of PIR ≥2 after adjusting for demographics, social history, gynecologic history and significant medical conditions (OR = 1.92; 95% CI = 1.21–3.05; P < .006).
Clinical Implications
The evaluation and treatment of FSD may benefit from a comprehensive approach that takes SES into account.
Strengths & Limitations
This study is limited by its cross-sectional design, but it is strengthened by a large, nationally representative sample with extensive, standardized data ascertainment.
Conclusion
Lower SES and lower sexual frequency are directly correlated among female adults in the United States; future studies should focus on social determinants of health as risk factors for FSD.
Kim J.I., Zhu D., Davila J., et al. Female Sexual Dysfunction as Measured by Low Sexual Frequency is Associated With Lower Socioeconomic Status: An Analysis of the National Health and Nutrition Examination Survey (NHANES), 2007-2016. J Sex Med 2021;XX:XXX–XXX.
Introduction
Pelvic floor muscle (PFM) dysfunction is a sexual pain disorder characterized by involuntary spasm of pelvic floor muscles (PFMs) around the vagina that interferes with intercourse or any kind of vaginal penetration, making it impossible or extremely painful. Recently, researchers have shown increased interest in botulinum toxin (BoNTA) as an alternative option for refractory cases of PFM dysfunction, especially those that fail first-line treatments. Questions have been raised about the efficacy of BoNTA for the treatment of PFM dysfunction.
Objectives
To provide an updated and comprehensive review on the role of BoNTA in the management of refractory PFM dysfunction.
Methods
We reviewed the literature using a systematic search strategy via PubMed and Google Scholar databases, to identify articles investigating the use of BoNTA in PFM dysfunction. We included studies that explored its indications, mechanism of action, injection dosing and technique, success rate, side effects, and contraindications.
Results
We identified 20 relevant articles. Of these, 12 were original studies: 7 clinical trials, 1 retrospective cohort study and 4 case reports or case series. Doses of BoNTA that were used in these studies ranged between 20 and 500 units. The most commonly injected sites were levator ani muscles. Success rates varied between 62 and 100 %. Most studies showed no recurrence within 1 year after treatment. The majority of these studies used BoNTA after conventional first-line treatments have failed.
Conclusion
PFM dysfunction is a debilitating condition that adversely affects quality of life. There is promising evidence to support the use of BoNTA in cases of refractory PFM dysfunction. Further randomized controlled trials are warranted to standardize the use of BoNTA as a treatment option for these cases.
Gari R, Alyafi M, Gadi RU, et al. Use of Botulinum Toxin (Botox) in Cases of Refractory Pelvic Floor Muscle Dysfunction. Sex Med Rev 2021;XX:XXX–XXX.
Introduction
Male sexual dysfunction is a common problem, and there are many self‐report questionnaires for measuring sexual function among men; however, the Brief Male Sexual Function Inventory (BSFI) is a tool that has 5 subscales, which is more complete than others. a validated self‐report questionnaire, in the local language with modest expressions is required for men.
Aim
To determine the validity and reliability of the Persian version of the BSFI among men.
Methods
This cross-sectional study was conducted on 200 males. The sampling process was performed in several stages from health centers. After the accomplishment of the standard process of back-translating the questionnaire from English to Persian, its face, content, and construct validity were evaluated. The collected data were analyzed using confirmatory factor analysis, multivariate analysis of variance, and Pearson correlation coefficient. To determine the reliability of the instrument, the test-retest method was used with 2 weeks interval and the Cronbach's alpha coefficient method was applied to check the internal homogeneity.
Main Outcome Measures
Reliability (internal consistency and test-retest) and validity were assessed
Results
According to the research findings, confirmatory factor analysis had an acceptable fit. By modifying the measurement model and fitting the final model, the fitting indices were obtained as the following: Chi-square statistic = 21.63, NPAR = 36, P = .001 > 0.05; Tucker-Lewis index = 0.956; comparative fit indices = 0.976; Normed Fit Index = 0.952; and root mean square error of approximation = 0.068. These values indicated that the obtained model had a good fit for the data. Moreover, Cronbach's alpha and intra-cluster correlation coefficients of the whole questionnaire were calculated at 0.893 and 0.893, respectively (confidence interval between 0.811–0.950), showing the internal consistency of the items in the whole questionnaire and domain.
Conclusion
The BSFI questionnaire showed a 5-factor structure similar to the original structure and the 11-item Persian version of the questionnaire of male sexual function can be considered a valid and reliable tool to assess the level of male sexual function. Rezaei N, Sharifi N, Fathnezhad-Kazemi A, et al. Evaluation of Psychometric Properties of the Persian Version of Brief Male Sexual Function Inventory: A Cross-Sectional Study. Sex Med 2021;XX:XXXXXX.
Female sexual dysfunction (FSD) is a multicausal and multidimensional problem affecting between 30–50% of American women (1,2). Based on the National Health and Social Life Survey of 1749 women, 43% have complaints of sexual dysfunction. Although this study has a large sample size and minority representation, it is limited by the cross-sectional design. In addition, women over age 60 were not included, and neither menopausal nor other medical risk factors were correlated with sexual complaints. Another study, which looked at 448 women over age 60, demonstrated that two-thirds of them were sexually inactive, 12% of married women had difficulty with intercourse, and approx 14% experienced pain with intercourse. Sexual activity was strongly correlated with marital status (3). Women over age 60 were less likely to have sex if their partner was of poor health and if they had low feelings of self-worth (4). Studies of older women have failed to include specific measures of female sexual arousal, orgasm, or satisfaction.
Cinsel işlev bozuklukları birçok toplumda görülmekte olup, özellikle vajinismus Türkiye’de yaygın olarak karşılaşılan bir sağlık problemi olarak değerlendirilmektedir. Temelde eşler arasındaki cinsel birleşmenin sağlıklı olmasını olumsuz yönde etkileyen bir problem olan vajinismus, eşler arasındaki cinsel uyumsuzlukların yanında psikolojik ve sosyal açıdan da birçok sorunu beraberinde getirmektedir. Bu nedenle vajinismus üzerinde önemle durulması ve tedavi edilmesi gereken bir cinsel işlev bozukluğu olarak değerlendirilmektedir. Günümüzde erken tanı ve farklı tedavi yöntemlerinin gelişmesi ile birlikte vajinismus, tedavide başarı oranı yüksek bir sağlık sorunu olarak görülmektedir. Ancak uygulanacak olan tedavi yöntemlerinin başarılı olabilmesi için tedavi sürecinde sağlık personeline önemli görevler düşmektedir. Bu noktada özellikle hemşireler vajinismusun tanı ve tedavi sürecinde sorumluluk sahibi sağlık çalışanları arasında gösterilmektedir. Yapılan bu çalışmada da vajinismus tanı ve tedavisinde kullanılan yöntemler ile kullanılan yanlış uygulamalara ve vajinismus tedavisinde hemşirelik yaklaşımının önemine değinilmiştir.
This chapter reviews the multitude of sexual dysfunctions that men and women can be faced with. Sexual dysfunction is the umbrella term for the inability, for a variety of reasons, to participate in and enjoy sexual activities. In this chapter we examine the various dysfunctions, their biological, emotional, and psychological origins, and the treatment approaches that may be helpful in addressing them.
Abstract
Aim
In this study, we aimed to analyze the impact of a detailed anamnesis and gynecological examination findings of women with vaginismus on its treatment success in a tertiary therapy center with 18 years of experience.
Methods
The socio‐demographical factors, gynecological examination notes and the treatment results of 281 vaginismus patients were analyzed between July 2018 and July 2019. The relationship with these parameters and the number of sessions for treatment were evaluated.
Results
The women with higher vaginismus grade had a longer duration of marriage (P < 0.001) and they needed more CBT sessions (P = 0.004). On the other hand, the age of the patient, duration of the relationship, education level, and surgical intervention (hymenotomy, hymenectomy) or presence of anatomically pathological hymen did not affect the outcomes regarding the number of sessions, duration of the treatment and the rate of successful penetration.
Conclusion
Gynecological evaluation and detailed anamnesis that is taken upon the first admission has an important impact on the management of therapy and the treatment success.
Introduction: People with any psychiatric disorder tend to have difficulties in responding sexually. However, sexual dysfunction (SD) is usually under-recognized, even the tightly hormonal and neuronal common connexions through the brain-sex axis. Multiple sources of resistance to comprehensive SD assessment and intervention efforts persist to improve this situation.
Areas covered: The present review aims to underline the feasibility to introduce SD evaluation in patients with any psychiatric disorders, evaluating the potential mutual benefits of their management.
Expert opinion: Women and men living with mental disorders frequently display sexual difficulties; however, some of them consider sexuality as a relevant parameter of their quality of life. In fact, SD as a side effect is a frequent reason for stopping the intake of medication. What’s more, a holistic approach integrating sexual function could foster a better understanding of mental pathologies due to a common origin of pathogenesis. This could improve care quality, in keeping with the global tendency towards the development of personalized medicine. Consistently, the integration of SD assessment is highly recommended in mental health, all the more so when a psychotropic drug is prescribed. An expected consequence would be a reconstruction of the healthcare professional’s consideration for the sexuality of people experiencing mental disorders.
Background:
Sexual function is often affected in patients suffering from chronic diseases especially chronic obstructive pulmonary disease (COPD). However, the effect of COPD on sexual satisfaction is underappreciated in clinical practice. The aim of this study is to evaluate the impact of COPD on patient's sexuality and the explanatory variables of sexual dissatisfaction.
Methods:
Questionnaires were emailed to participants and they submitted their responses on the Santé Respiratoire France website. Data about sexual well-being (Arizona Sexual Experience Scale, ASEX), Quality of life (VQ11), anxiety, depression (Hospitalized anxiety and depression, HAD) and self-declared COPD grade were collected.
Results:
Seven hundred and fifty one subjects were included and were characterized as follows: women-51%, mean age-61 years, in a couple-62% and 70%-retired. Every grade of COPD was represented. Out of 751 participants, 301 participants (40%) had no sexual activity and 450 (60%) had sexual activity. From the 450 participants, 60% needed to change their sexual life because of their disease (rhythm, frequency and position). Subjects often used medications to improve sexual performance (43% used short-acting bronchodilator and 13% -specific erectile dysfunction drugs). ASEX questionnaire confirmed patients' dissatisfaction (diminution of sexual appetite for 68% and sexual desire for 60%) because of breathlessness and fatigue. Eighty one percent of the responders had an altered quality of life (VQ11 mean score 35) and frequent suspected anxiety or depression (HAD mean score 10.8). Ninety percent declared that sexual dysfunction had never been discussed by their doctors, while 36% of patients would have preferred to undergo a specialized consultation.
Conclusion:
Sexual dysfunction is frequent among COPD patients and leads to an altered well-being, however being a cultural taboo, it remains frequently neglected. Sexual guidance should be a part of patient's consultations improve quality of sexual life.
Objectives
This meta-analysis aimed to determine the prevalence of female sexual dysfunction (FSD) in healthy women and to investigate the related demographic factors.
Methods
Studies that were conducted in Turkey were included in the analysis.
Results
The prevalence of FSD, arousal, desire, pain/vaginismus, satisfaction, lubrication, and orgasm disorders were 39.65, 31, 31.3, 17.6, 23.8, 22.7, and 18.7%, respectively. Crude divorce rate (β= −0.478, p = 0.004), crude marriage rate (β= −0.180, p = 0.037), and age difference between partners (β = 1.08, p = 0.001) had a significant effect on the outcomes.
Conclusions
The prevalence of FSD in Turkey is similar to its prevalence in other countries.
The objective of this study is to identify factors associated with bother with rapid ejaculation in a cohort of men presenting to a sexual dysfunction clinic, independent of a diagnosis of PE. A prospective institutional database has been maintained on patients completing an 89-item intake questionnaire querying various areas of sexual dysfunction. Regarding ejaculatory dysfunction, patients are asked “Do you feel bothered, annoyed, and/or frustrated by ejaculating too quickly?” Statistical modeling was performed to identify associations. A total of 1359 men completed the intake survey, and 694 responded to the question on bother with rapid ejaculation. Overall, 42.9% (298/694) of respondents reported bother with rapid ejaculation. Men reporting bother were more likely to report lower intravaginal ejaculatory latency (IELT) time (4.2 vs 12.2 min, p < 0.0001), problems with depression (32% vs 21%, p = 0.001), negative impact on relationship (73% vs 51%, p < 0.0001), and negative impact on partner’s sexual satisfaction (26% vs 15%, p < 0.001). These results highlight the importance of asking all men presenting with sexual health concerns about their bother with rapid ejaculation for complete assessment of sexual and mental wellbeing.
In this study, we sought to determine the burden and characteristics of orgasmic dysfunction (OD) and concomitant erectile dysfunction (ED) in men with type 1 diabetes (T1D) enrolled in the Epidemiology of Diabetes Interventions and Complications (EDIC) study. In 2010, we assessed orgasmic and erectile function using the International Index of Erectile Function (IIEF). Sociodemographic, clinical, and diabetes characteristics were compared by OD status (OD only, OD and ED, no ED or OD). Age-adjusted associations between risk factors and OD status were examined. OD and ED information was available from 563 men. Eighty-three men (14.7%) reported OD of whom 21 reported OD only and 62 reported OD and ED. Age-adjusted odds ratios demonstrated that men who reported OD only had higher odds of depression, low sexual desire, and decreased alcohol use compared with men reporting no dysfunction. Men with OD concomitant with ED had greater odds of elevated hemoglobin A1C, peripheral and autonomic neuropathy, and nephropathy. Men reporting both dysfunctions were also more likely to report smoking, lower urinary tract symptoms, and had greater odds of androgen deficiency than men with no sexual dysfunction. Men with longstanding T1D suffer from an increased burden of OD. Psychogenic factors predominate in men reporting OD only while men who present with concomitant ED report increased burden of diabetes severity, characteristics previously observed with incident ED. ED may be the central impediment to sexual function in men with OD and ED. Longitudinal studies to characterize OD and ED experience over time are warranted.
Introduction:
Normal sexual functioning of both men and women, being a very complex process, is affected by numerous issues besides aging. Many factors affect the sexual function and lifestyle of the young population. In this article, we tried to review the literature to update the knowledge on benzodiazepine-related (BZD) sexual dysfunction (SD) and involved mechanisms of actions based on animal and human studies.
Methods:
Different standard websites such as PubMed were used to review the literature and keywords including benzodiazepines, sexual dysfunction, gammaaminobutyric acid A (GABAA) receptor and erectile dysfunction were used.
Results:
SD is one of the most common disorders in males and females which has recently been demonstrated to be associated with psychotropic medications such as antihypertensive agents, tranquilizers, antihistamines, appetite suppressants, antidepressants and anxiolytics. BZDs are among the most common psychotropic agents worldwide. SD including decreased libido, erectile dysfunction (ED) and other undesired sexual urges were observed in the patients receiving BZDs.
Discussion:
The mechanisms of action of BZDs to induce SD mainly relate to enhanced GABAA receptor function which reduces penile erection.
Vaginismus is the persistence of difficulties in allowing the vaginal entry of a penis, a finger or a gynecologic examination. This study aimed to compare the success rates of vaginismus therapy with exposure therapy treatment using a finger or a dilator. The finger training group (FTG) (n = 30) and the dilator training group (DTG) (n = 30) were established. Groups were trained about dilatation and desensitization. The Female Sexual Function Index (FSFI) was applied. From the baseline measurement to the post-treatment measurement, the average change in FSFI scores for both groups was statistically significant (p < 0.001). There was a significant difference between two groups in terms of patient drop-out numbers (p = 0.016); the DTG was more successful in continuing treatment than the FTG. This research revealed that DTG is more successful in treatment continuity and show more improvement in sexual functions.
Amaç: Bu çalışmada psikiyatri polikliniğine ayaktan başvuran hastalarda cinsel işlev bozukluğu (CİB) sıklığı ve CİB ile sosyodemografik veriler arasındaki ilişkinin araştırılması amaçlanmıştır.Yöntem: Çalışmaya tarama sorularını içeren formu doldurmayı kabul eden 369 kadın ve 232 erkek hasta alınmıştır. Olası bir CİB olduğu düşünülen 275 kadın ve 145 erkek hastadan görüşmeyi kabul eden 172 kadın ve 83 erkek hasta ile görüşülmüştür. DSM-V tanı kriterlerine göre klinik görüşme ile CİB tanısı konulmuştur.Bulgular: CİB sıklığı kadınlarda %67.4, erkeklerde %53 oranında tespit edilmiştir. Kadınlarda sosyodemografik verilerden 38 yaş üzerinde olanlarda, çocuk sayısı üç ve üzerinde olanlarda, evlilik süresi 15 yıl ve üzerinde olanlarda CİB anlamlı olarak daha yüksek saptanmıştır (sırasıyla; p=0.034, p=0.007, p=0.015). Erkeklerde ise sosyodemografik veriler ile CİB arasında istatistiksel olarak anlamlı bir ilişki saptanmamıştır. Sonuç: Çalışmamızda CİB’in psikiyatri polikliniğine başvuran kadın ve erkek hastalarda oldukça sık görüldüğü tespit edilmiştir. Ek olarak CİB’in kadınlarda sosyodemografik verilerden yaş, çocuk sayısı, evlilik süresi ile ilişkili olduğu tespit edilmişken, erkeklerde ise sosyodemografik verilerle ilişkisi tespit edilmemiştir.
Sexual problems are routinely dealt with in National Health Service (NHS) clinics across the UK. This is a service evaluation of the Maudsley Psychosexual Service situated in South London. It incorporates retrospective information on 609 referred patients over a three year period (2015–2017) with complex and persistent sexual problems. The majority of patients were referred from within the South London area of which 65% were male, mean age 40 with the female mean age being 34 years. Of referred individuals with varied sexual problems the greater numbers 78% came via primary care, 10% from acute medical service and 8% from acute psychological services. Of patients who were both assessed and treated 65% completed their planned treatment. These patients improved to below the cut-off point for distress and showed improvement in condition. The majority of referrals identified as white whilst those identifying as Black, Asian or Mixed Ethnic were notably under-representative of the patient community. Of those patients completing treatment 79% did so with a mean of 19 sessions supporting our treatment protocol for complex and persistent sexual problems. Given the financial challenges the NHS is experiencing it is fitting this evaluation indicates patients in this service are receiving care appropriate for their needs.
Objectives: The frequency of, and relationship between, the various manifestations of male sexual dysfunction in infertile couples have been poorly investigated, especially in Vietnam. Our study aims to assess the prevalence of premature ejaculation and erectile dysfunction in infertile couples using validated instruments, and the relationship between these disorders.
Method: Cross-sectional descriptive study, using validated questionnaires including the Premature Ejaculation Diagnostic Tool (PEDT) and the International Index of Erectile Function-15 (IIEF-15), to measure the incidence of these problems in 255 male partners of infertile couples who were examined from January through December 2017, at the Center for Reproductive Endocrinology & Infertility, Hue University Hospital.
Results: The prevalence of overt premature ejaculation was 4.7%, probable premature ejaculation was 7.1%, and erectile dysfunction was 26.3% (mild: 19.3%, mild-to-moderate: 3.9%, moderate: 2.7%, and severe: 0.4%). The PEDT total score was negatively correlated to IIEF-15-EFD and IIEF-15 total scores (r [Formula: see text]0.322 and r [Formula: see text]0.348, respectively).
Conclusions:In light of the identified prevalence of premature ejaculation and erectile dysfunction in the studied population, screening for these conditions should be included in the evaluation of infertile couples. These two disorders could negatively reciprocal effect on each other.
We conducted a systematic review and meta-analysis of published randomised controlled trials of dapoxetine for premature ejaculation. We systematically searched Embase, PubMed, Cochrane, Web of Knowledge, FDA.gov and Clinical Trials.gov for studies reporting dapoxetine in men with premature ejaculation. Efficacy endpoints included intravaginal ejaculatory latency times (IELT), personal distress related to ejaculation (PDRE) and treatment-emergent adverse events (TEAEs) was used to evaluate safety. Data were analysed using a random-effects model. Electronic search identified 276 papers. The final analysis included eight papers (n = 8422 subjects). Analysis of the pooled results indicated efficacy in both IELT (weighted mean difference (WMD) = 1.67, 95% confidence interval (CI) 1.45–1.89) and PDRE (relative risk = 1.26, 95% CI 1.18–1.35). Subgroup analysis indicated efficacy (i.e. increase in IELT) for 30- and 60-mg on-demand dapoxetine (WMD 1.38 (95% CI 1.01–1.75) and 1.62 (95% CI 1.40–1.84) respectively), as well as daily use of 60 mg dapoxetine (WMD 2.18, 95% CI 1.71–2.64). The safety profile was acceptable. Based on the different effects of magnitude of the three dosing regimens, we recommend a stepwise approach, starting with 30 mg on demand, then 60 mg on demand and finally 60 mg dapoxetine daily.
Normal male sexual function depends on the sexual response cycle, which consists of an anticipatory libidinous state (sexual motive or desire), effective vasocongestive arousal (erection), orgasm, and resolution (detumescence). Libido is defined as the biological need for sexual activity and frequently is expressed as sexseeking behavior. Its intensity is variable between individuals as well as within an individual over a given period of time. Little is known about the physiological basis of libido. Erection, however, is associated with significant psychological and physical changes. This is the ultimate response to multiple psychogenic and sensory stimuli from imaginative, visual, auditory, olfactory, gustatory, tactile, and genital reflexogenic sources, which trigger several neurological and vascular cascades that produce penile tumescence and rigidity sufficient for vaginal penetration. The sensation of orgasm is accompanied by two sequential functions: emission and ejaculation. Emission, mediated by contractions of the prostate, seminal vesicles, and urethra, produces a sensation of ejaculatory inevitability and deposition of semen in the posterior urethra. Generalized muscular tension, perineal contractions, and involuntary pelvic thrusting (every 0.8 seconds) usually follow and lead to the expulsion of semen from the urethral meatus. The resolution phase returns the penis to the flaccid state and provides a sense of general pleasure, well-being, and muscular relaxation. During this period, men are physiologically refractory to subsequent erection and orgasm for a variable amount of time. (For further information on normal male sex physiology, see Chapter 3.) Disorders of the sexual response may involve one or more of the cycle’s phases; these may be generalized or limited to certain situations or partners or may be lifelong (i.e., there has been no evidence of any effective sexual performance, generally due to persistent intrapsychic conflicts) or acquired (dysfunction arises after a period of normal function). Although there are no universally acknowledged defining criteria, a period of persistence over three months has been suggested as a reasonable guideline for clinical concern. Isolated dysfunction of the erectile mechanism is the most common problem, but generally, disturbances may occur in some or all of the subjective components of desire, arousal, and pleasure and the objective components of performance, vasocongestion, and orgasm, although any of these may be affected independently.
Introduction:
Sexual difficulties, and sexual pain in particular, represent a global health issue for women, and their prevalence has been shown to differ across countries.
Aim:
To review the existing literature on the prevalence of female sexual difficulties and sexual pain worldwide measured by the Female Sexual Function Index (FSFI).
Methods:
We conducted a systematic literature review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Included were peer-reviewed publications indicating prevalence rates of female sexual difficulties based on the FSFI and cutoff values. Studies with samples limited to a certain age group or health condition were excluded.
Main outcome measure:
The outcome measure includes cutoff values and prevalence rates for sexual difficulties and sexual pain, as well as sample characteristics.
Results:
22 studies conducted in 11 countries were included. These examined samples from the community, patient records, health care staff, or the Internet. Various prevalence cutoff values were applied. Prevalence rates of overall sexual difficulties ranged between 5.5% and 77%. For sexual pain, rates from 3% to 95.5% were found. A comparison between countries was restricted due to differences in sample size, sample type, and applied cutoffs. Representative community samples using comparable cutoffs found that 5.8-63.3% of women experience general sexual difficulty and 6-31.6% experience sexual pain.
Clinical implications:
Sexual difficulties and sexual pain are prevalent in all examined countries, and despite restrictions to interpretability, the large prevalence rates point to the necessity of further clinical research.
Strength & limitations:
Many studies had to be excluded because of missing data. The comparison of studies is descriptive, and not all regions worldwide are represented. Nevertheless, results of the review were useful to derive recommendations for reporting of future studies using the FSFI.
Conclusion:
This review is the first comparison of prevalence studies based on the FSFI. It reflects the extent of available research and limitations in comparability. Koops TU, Briken P. Prevalence of Female Sexual Function Difficulties and Sexual Pain Assessed by the Female Sexual Function Index: A Systematic Review. J Sex Med 2018;15:1591-1599.
Sexual disorders and/or problems are exceedingly common and they significantly affect a patient’s quality of life. Sexual health problems can be caused by an ongoing illness, medication use, past surgery and/or relationship issues. The WHO has defined ‘sexual health as a state of physical, emotional, mental and social well being in relation to sexuality and it is not merely the absence of disease, dysfunction or infirmity’ [1]. Good sexual health comprises an absence of sexually transmitted disease (STD), fertility problems and unwanted pregnancies and also the ability to enjoy one’s sexuality without abuse and/or oppression [1]. The topic of sex and sexuality in itself is now no longer confined to hushed discussions in the twenty-first century. Yet, there is still anxiety and abstinence when the topic of sex comes up for discussion, especially more so between the clinician and the patient [2, 3]. This leaves a tremendous void in the delivery of complete holistic healthcare.
Background
Female sexual dysfunction affects 41% of reproductive-age women worldwide, making it a highly prevalent medical issue. Predictors of female sexual dysfunction are multifaceted and vary from country to country. A synthesis of potential risk factors and protective factors may aid healthcare practitioners in identifying populations at risk, in addition to revealing modifiable factors to prevent sexual dysfunction among reproductive-age women.
Methods
Observational studies which assessed the prevalence and predictors of female sexual dysfunction in reproductive-age women were systematically sought in relevant databases (2000–2014). Significant predictors were extracted from each included publication. A qualitative analysis of predictors was performed with a focus on types of sexual regimes and level of human development.
Results
One hundred thirty-five studies from 41 countries were included in the systematic review. The types of predictors varied according to the location of the study, the type of sexual regime and the level of gender inequality in that country/region. Consistently significant risk factors of female sexual dysfunction were: poor physical health, poor mental health, stress, abortion, genitourinary problems, female genital mutilation, relationship dissatisfaction, sexual abuse, and being religious. Consistently significant protective factors included: older age at marriage, exercising, daily affection, intimate communication, having a positive body image, and sex education. Some factors however had an unclear effect: age, education, employment, parity, being in a relationship, frequency of sexual intercourse, race, alcohol consumption, smoking and masturbation.
Conclusions
The sexual and reproductive lives of women are highly impacted by female sexual dysfunction, and a number of biological, psychological and social factors play a role in the prevalence of sexual dysfunction. Healthcare professionals who work with women should be aware of the many risk factors for reproductive-age women. Future prevention strategies should aim to address modifiable factors, e.g. physical activity and access to sex education; international efforts in empowering women should continue.
• One-month prevalence results were determined from 18571 persons interviewed in the first-wave community samples of all five sites that constituted the National Institute of Mental Health Epidemilogic Catchment Area Program. US population estimates, based on combined site data, were that 15.4% of the population 18 years of age and over fulfilled criteria for at least one alcohol, drug abuse, or other mental disorder during the period one month before interview. Higher prevalence rates of most mental disorders were found among younger people (<age 45 years), with the exception of severe cognitive impairments. Men had higher rates of substance abuse and antisocial personality, whereas women had higher rates of affective, anxiety, and somatization disorders. When restricted to the diagnostic categories covered in international studies based on the Present State Examination, results fell within the range reported for European and Australian studies.
One-month prevalence results were determined from 18,571 persons interviewed in the first-wave community samples of all five sites that constituted the National Institute of Mental Health Epidemiologic Catchment Area Program. US population estimates, based on combined site data, were that 15.4% of the population 18 years of age and over fulfilled criteria for at least one alcohol, drug abuse, or other mental disorder during the period one month before interview. Higher prevalence rates of most mental disorders were found among younger people (less than age 45 years), with the exception of severe cognitive impairments. Men had higher rates of substance abuse and antisocial personality, whereas women had higher rates of affective, anxiety, and somatization disorders. When restricted to the diagnostic categories covered in international studies based on the Present State Examination, results fell within the range reported for European and Australian studies.
Lifetime rates are presented for 15 DSM-III psychiatric diagnoses evaluated in three large household samples on the basis of lay interviewers' use of the Diagnostic Interview Schedule. The most common diagnoses were alcohol abuse and dependence, phobia, major depressive episode, and drug abuse and dependence. Disorders that most clearly predominated in men were antisocial personality and alcohol abuse and dependence. Disorders that most clearly predominated in women were depressive episodes and phobias. The age group with highest rates for most disorders was found to be young adults (aged 25 to 44 years). Correlates with race, education, and urbanization are presented.
Sexual problems are a major cause of personal distress and marital breakdown, affecting as many as one in ten of the general population. This title presents a practical account of the nature, causes, assessment, and treatment of sexual problems. The various stages of treatment are described in sufficient detail for therapists who are about to start sex therapy. Experienced therapists will also find this book a source of useful advice. The treatment approach includes behavioural, psychotherapeutic, and educational techniques. In addition to the treatment of couples, the management of sexual problems of individuals without partners, and of the physically disabled, are also described. Practical guidance is backed up by research findings.
• Six-month prevalence rates for selected DSM-III psychiatric disorders are reported based on community surveys in New Haven, Conn, Baltimore, and St Louis. As part of the Epidemiologic Catchment Area program, data were gathered on more than 9,000 adults, employing the Diagnostic Interview Schedule to collect information to make a diagnosis. The most common disorders found were phobias, alcohol abuse and/or dependence, dysthymia, and major depression. The most common diagnoses for women were phobias and major depression, whereas for men, the most predominant disorder was alcohol abuse and/or dependence. Rates of psychiatric disorders dropped sharply after age 45 years.
• Lifetime rates are presented for 15 DSM-III psychiatric diagnoses evaluated in three large household samples on the basis of lay interviewers' use of the Diagnostic Interview Schedule. The most common diagnoses were alcohol abuse and dependence, phobia, major depressive episode, and drug abuse and dependence. Disorders that most clearly predominated in men were antisocial personality and alcohol abuse and dependence. Disorders that most clearly predominated in women were depressive episodes and phobias. The age group with highest rates for most disorders was found to be young adults (aged 25 to 44 years). Correlates with race, education, and urbanization are presented.
Systematic and detailed studies of the relationship between sexual behaviour and social class do not exist.We have made an analysis of the sexual behaviour, experience, knowledge and attitude in 40-yr-old Danish women, related to their social background and social status, in order to clarify the influence of social factors on sexual behaviour. A random sample of 225 40-yr-old women was investigated. The participation rate was 94.2%. The method was a personal, structured interview by a female doctor.Particular sexological variables were tested for differences between high-social and low-social class. Sexual behaviour was in several ways determined by social background and actual social status, women in the high social-status group having more sexual scope, more benefit from sexual life, more tolerance and knowledge and lower frequency of sexual problems than women from the low-status group.We conclude that it is misleading if, either generalization is not made from a socially representative random sample, or if data from each respective social group are not given.
Characterizing Sexual Desire and Its ComponentsEpidemiologyPhysiology of Desire and Drive Disorders in MenClinical Evaluation of Desire DisordersManagement of Hypoactive Sexual Desire DisorderEthical ConcernsSummary and Conclusions
In 1955 data were collected from 161 couples who had been married for approximately 20 years and who had been participants in a longitudinal study of marriage during the 20‐year period. The data concerned the expectations, perceptions, and experiences of the couples in their sexual relationships. Results indicated that both men and women had held positive anticipations about sex from the outset of the marriage and currently received significant pleasure from their sexual relations, although men were significantly higher on both measures. A majority felt they had changed their early ideas and expectations, at least to some extent. Frequency of intercourse had dropped. Husbands continued to prefer intercourse more frequently than wives. About 70% of the wives were at least usually orgasmic and 36% of the husbands were occasionally impotent. Most individuals reporting that their opinions about sex were at least somewhat different from those of their spouse felt that these differences had produced negative effects in the marriage.
sexual desire and persons with medical conditions
Sex and Disability Unit, Human Sexuality Program, University of California at San Francisco
differential diagnosis
stressors from medical conditions that may contribute to decreased sexual desire and treatment suggestions for dealing with them / biological stressors / psychological stressors / social and interpersonal stressors / case presentations (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Describes the origins, growth, and practices of a sexual dysfunction clinic established from the outset in 1972 as a training center. A 15-yr overview of 2,376 patients treated is reported, with no-show, drop-out, and diagnostic categories specified. In a 10-wk treatment program there was 80% symptom reversal for the 1,188 couples completing the program. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
incidence of low sexual desire / assessment strategies / causes
[elements in] conceptual framework for treating couples with low sexual desire or aversion to sex / experiential/sensory awareness / insight / cognitive restructuring / behavioral interventions
case[s] (PsycINFO Database Record (c) 2012 APA, all rights reserved)
"Sexual Desire Disorders" is a comprehensive guide to contemporary theory, research, and treatment. Containing contributions by foremost sex therapists in the field, the book addresses all aspects of sexual desire difficulties and provides a variety of treatment approaches. Offering a number of professional viewpoints, it includes actual case studies that illuminate this perplexing and challenging problem.
After an introductory discussion of changing perspectives on sexual desire, including problems of definition and measurements of "normalcy," the book analyzes four basic models of desire disorders and the interventions they favor.
Dr. Leiblum and Rosen have combined the fruit of their vast experience to create a compelling and enlightening volume that will be of great value to psychiatrists, psychologists, mental health and medical specialists, graduate level students, and anyone else concerned with the subject of psychosexual disorders. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This is a sexological study of a random sample of 225 40-yr-old women representative of the Danish female population at the age of 40. These women were questioned by a female physician utilizing a structured interview; 94% of the women invited to participate in this study agreed to do so. The purpose of this research was to elucidate sexual behaviour, experience, knowledge and attitudes.Some of the findings were the following. Menstruation still seems to be a taboo subject; 36% of this population knew little about this topic. 96% of these women had experienced orgasm at least once in their lives and 67.6% had experienced spontaneous libido. Genuine homosexuality appears to be a rare phenomenon. A monogamous heterosexual life style is the norm, as reflected by low number of partners and low frequency of infidelity. Yet, 35% of these woman had sexual problems.There is a need for advice and treatment of sexual difficulties in this population, but these are at present, in Denmark, not generally available.
Investigación sobre la sexualidad femenina hecha en Estados Unidos con base en una encuesta aplicada a 3 mil mujeres. Aborda los siguientes temas: masturbación, orgasmo, coito, estimulación clitórica, lesbianismo, esclavitud sexual, la revolución sexual, mujeres mayores y hacia una nueva sexualidad femenina.
A procedure for minimizing nonresponse error in a self-administered mail waterfowl harvest survey was tested on a stratified
sample of 3,360 Canada Migratory Game Bird Hunting Permit purchasers in Ontario. On the assumption that follow-ups probe deeper
into the core of nonrespondents, a linear regression model for estimating parameter values of the population while correcting
for nonresponse bias was devised using cumulated responses over three successive mailings. It was estimated that nonrespondents
who tended to have a significantly lower level of participation and involvement in the topic investigated were younger and
resided in rural areas of the province. Nonresponse bias was as high as 14.4 percent for waterfowl kill per day of hunting
and 11.1 percent for age of hunters. Results confirm the usefulness of follow-ups of nonrespondents as a means of exploring
and correcting for nonresponse error
The study aimed to identify those patients referred to a psychiatric out-patient clinic who had sexual or marital difficulties and who could be offered help with these problems, although none of the patients had been referred primarily for sexual or marital therapy. The methods of assessment formed a series of filtering devices for screening the sample, and possible reasons for discrepancies in the results are discussed. Twelve per cent of the sample had sexual or marital problems and were offered treatment, and it is suggested that this proportion may be an underestimate of the 'true' frequency of such problems in the sample. Implications of this finding for the provision of treatment resources in the psychiatric out-patient setting are considered.
Information regarding male sexual function and satisfaction was gathered from a representative sample of 58 married Swedish men studied by means of semi-structured interviews. 23 men (40% of the total sample) reported a tendency towards sexual dysfunction, 22 (39% of the total sample) of these had experienced premature ejaculation, 6 (10% of the total sample) retarted ejaculation, and 4 (7% of the total sample) impotence. Sexual dysfunction was more common in men reporting early parental relations that may predispose for inadequate masculine identification. Thus, a report of poor contact with the father and a dominating mother was over-represented in sexually-dysfunctional men. Sexual dysfunction was not significantly related to the sexual satisfaction of the couple. In contrast, man's sexual satisfaction, while related to the emotional relationship to the wife and the child, was not associated with his early parental relations.
In analyzing the responses of 100 predominantly white, well educated and happily married couples to a self-report questionnaire, this study examined the frequency of sexual problems experienced and the relations of those problems to sexual satisfaction. Although over 80 per cent of the couples reported that their marital and sexual relations were happy and satisfying, 40 per cent of the men reported erectile or ejaculatory dysfunction, and 63 per cent of the women reported arousal or orgasmic dysfunction. In addition, 50 per cent of the men and 77 per cent of the women reported difficulty that was not dysfunctional in nature (e.g., lack of interest or inability to relax). The number of "difficulties" reported was more strongly and consistently related to overall sexual dissatisfaction than the number of "dysfunctions."
Epidemiological data on female sexual functioning are presented. Fifty-nine 30- to 39-year-old Black women attending a gynecology clinic at University Hospitals of Cleveland for nonsexual complants were interviewed to determine the frequency of sexual dysfunction. Seventeen percent had difficulty achieving orgasm in partner sexual behavior. Most of these women had prior history of adequate sexual functioning; 5% had never been orgasmic. Ten of the 49 women who had no orgasmic difficulty were not satisfied with their sexual relationships. The relative risk of sexual dysfunction was 5 times greater in women who had undergone pelvic surgery.
Assessment of 29 couples seeking marital therapy and 25 seeking sexual therapy at the same institution permitted the delineation of two distinct profiles. Although the two groups were similar in the degree of their sexual and marital difficulties and in demographic characteristics, the relationships of the sex therapy couples were generally characterized by satisfaction and affection, whereas those of the marital therapy couples were often antagonistic. In addition, the sex therapy couples tended to be less conservative and more thoughtful in their approach to life and their problems.
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A program of sexual rehabilitation in a cancer center evaluated 308 men and 76 women, using a structured interview. The site of the malignancy was pelvic or genital in 79% of men and 58% of women. Most patients (73%) had one or two sessions of sexual counseling, but therapy was more intensive for about a quarter of patients. Partners were included in counseling by 28% of women and 56% of men. Although cancer patients and spouses of patients reported similar rates of sexual dysfunction before cancer diagnosis, after cancer treatment husbands and wives of patients maintained stable sexual function, while dysfunctions increased dramatically in all categories except premature ejaculation for patients. Patients who were older or had pelvic/genital tumors were more likely to develop arousal-phase sexual dysfunctions. Psychological distress was correlated with rates of low sexual desire and dyspareunia in both men and women. The success of treatment in reversing sexual dysfunction was rated by the therapist in 118 cases. Patients who were younger, who were not clinically depressed, and who had less conflicted marriages had more positive outcomes. Good outcome was also associated with a longer duration of treatment.
Seventy-six women who presented with a principal complaint of anorgasmia were compared with a matched cohort of sexually functional controls on the domains of the Derogatis Sexual Functioning Inventory (DSFI). Patients were case matched with controls on age, race, marital status, and social class. Initial comparisons revealed significant differences between patient and control groups on a number of psychosexual characteristics, consistent with prior research. Based on evidence of heterogeneity within the patient sample and earlier research by our group, the anorgasmic cohort was partitioned by a "marker variable" approach into two anorgasmic subtypes. The marker variable used to create the subtypes was the presence of homosexual fantasies. Subsequent contrasts, both between the two anorgasmic subgroups, and with functional controls, revealed highly significant differences, and provided strong evidence for at least two psychologically distinct subtypes of anorgasmia.
Six-month prevalence rates for selected DSM-III psychiatric disorders are reported based on community surveys in New Haven, Conn, Baltimore, and St Louis. As part of the Epidemiologic Catchment Area program, data were gathered on more than 9,000 adults, employing the Diagnostic Interview Schedule to collect information to make a diagnosis. The most common disorders found were phobias, alcohol abuse and/or dependence, dysthymia, and major depression. The most common diagnoses for women were phobias and major depression, whereas for men, the most predominant disorder was alcohol abuse and/or dependence. Rates of psychiatric disorders dropped sharply after age 45 years.
This is a review and chronological perspective on the development of self-report measures designed to describe an individual's sexual functioning. It includes scales that provide data on both heterosexual and homosexual behavior. Attitude scales are also included, but only those that reflect an individual's attitudes toward his own or his partner's behavior. Two classes of self-report measures are evaluated: (1) unidimensional scales that are relatively short and restricted in the information they supply; and (2) multidimensional inventories or questionnaires that elicit a wider variety of information. Available psychometric data are provided, and the measures are critically examined from both a research and a clinical point of view. It was concluded that unidimensional scales are probably more useful for research settings, while multidimensional inventories appear to have greater potential in clinical settings. All the test instruments reviewed would benefit from refinements, and recommendations are made that additional validity studies be conducted and more normative data be provided.
Ninety-eight presumably normal London men, age 20-35 and sexually active in a stable relationship, responded to an invitation at their work place to participate in a detailed sexuality interview. The interview was developed by a group of WHO collaborators to measure possible effects on sexual functioning resulting from various medical regimens (for example, a male contraceptive pill). It assessed frequency of coitus and masturbation during the previous 4 weeks, a variety of subjective ratings of sexual interest, satisfaction, and quality of relationships, as well as reports of the nature and incidence of various sexual problems. The study sample's responses displayed internal consistency and in general supported the inference that the sample was not atypical. The data appear to support Westoff's (1974) notion that the frequency of coitus has increased since the early normative reports by Kinsey et al. (1948). Most importantly, the results of principal components analyses point to the fact that overall sexual drive or "libido" (e.g., frequency of sexual behavior) is independent of several other possibly significant dimensions, including latency to orgasm, quality of sexual experience, autoeroticism, and the incidence of erectile difficulties. It is concluded that the sexuality interview provides potentially useful baseline data against which to evaluate effects of sexual therapy or drug regimens.
Discusses the prevalence of sexual dysfunction, the source and nature of referrals to a sexual dysfunction clinic, and the management of couples with sexual dysfunction. This management process is outlined with respect to assessment, treatment formulation, behavioral task assignment, counseling, education, general relationship problems, frequency of treatment sessions, and the number and orientation of the therapist(s). Assessment and determinants of outcome are briefly addressed along with the treatment of patients without partners. Adjuncts to treatment—written material, mechanical aids, and hormones—are noted. It is concluded that more research is needed in areas that involve individualized treatment, characteristics that are predictive of outcome, and the relevancy of hormonal/physical disorders. (49 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
In a multiaxial system for classifying the sexual dysfunctions, the axes specify sexual problems associated with the desire, arousal, and orgasm phases of the sexual response cycle, as well as types of coital pain, dissatisfaction with the frequency of sex, and certain other information relevant to sexual functioning. In contrast to DSM-III and other existing diagnostic systems for sexual dysfunctions, this new multiaxial system is based on highly specific empirical descriptions of sexual behavior. There are no inferences made about the cause of the dysfunctions.
The Kinsey Data: Marginal Tabulations of the 1938–1963 Interviews Conducted by the Institute for
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Epidemiologyfor the Health Sciences: A Primer on Epidemiologic Concepts and Their Uses Three years' experience in a sexual problems clinic
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Sexuality-Related Measures: A Compendium Psycho-logical subtypes of anorgasrnia: A marker variable approach
- C M Davis
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Davis, C. M., Yarber, W. L., and Davis, S. L. (eds.). (1988). Sexuality-Related Measures: A Compendium, Graphic Publishing, Lake Mills, IA. Derogatis, L. R., Fagan, P. J., Schmidt, C. W., Wise, T. N., and Gilden, K. S. (1986). Psycho-logical subtypes of anorgasrnia: A marker variable approach. J. Sex Marital Ther. 12: 197-210.
Epidemiology for the Health Sciences: A Primer on Epidemiologic Concepts and Their Uses Charles C Thomas
- D F Austin
- S B Werner
The New Sex Therapy Brunner/Mazel
- H S Kaplan
- H. S. Kaplan
The Kinsey Data: Marginal Tabulations of the
- P H Gebhard
Sexual Behavior in the 70's Playboy
- M Hunt
- M. Hunt
Sexuality Problems and Chronic Disease
- L R Schover
- S B Jensen
Practice Based Epidemiology: An Introduction Gordon and Breach Science
- S H Schuman
- S. H. Schuman
Human Sexual Inadequacy Little
- W Masters
- W. Masters
Unpublished researchSexuality Problems and Chronic Disease
- L R Schover
- L R Schover
- S B Jensen
Behaviour Therapy and the Neuroses Pergamon
- H Eysenck
- H. Eysenck
The Kinsey Data: Marginal Tabulations of the 1938?
- P H Gebhard
- P. H. Gebhard
Epidemiology for the Health Sciences: A Primer on Epidemiologic Concepts and Their
- D F Austin
- S B Werner
- D. F. Austin
Disorders of Sexual Desire Brunner/Mazel
- H S Kaplan
- H. S. Kaplan