Sexual Dysfunction: A Neglected Complication of Panic Disorder and Social Phobia

Little is known about sexual dysfunctions comorbid with anxiety disorder. The aim of this study is to evaluate retrospectively the sexual function of social phobic patients in comparison with a panic disorder sample. Using a semistructured interview (SCID-I), 30 patients with social phobia and 28 patients with panic disorder were examined. The DSM-IV criteria were employed to diagnose sexual dysfunctions in this sample; however, the C criterion, which states that the sexual dysfunction cannot be related to other Axis I disorders, was excluded. Panic disorder patients reported a significantly greater proportion of sexual disorders compared with social phobics: 75% (21/28) vs. 33.3% (10/30) (p = .0034). Sexual aversion disorder was the most common sexual dysfunction in both male (35.7%; 5/14) and female (50%; 7/14) panic disorder patients, and premature ejaculation was the most common sexual dysfunction in male social phobic patients: 47.4% (9/19). These results suggest that sexual dysfunctions are frequent and neglected complications of social phobia and panic disorder.     

Psychiatric Comorbidity in Heterosexual Couples with Sexual Dysfunction Assessed with the Composite International Diagnostic Interview

Psychiatric comorbidity of sexual dysfunction (SD) in heterosexual couples was investigated with the Composite International Diagnostic Interview, version 1.1 (CIDI; WHO, 1992). Demographic data, diagnoses of sexual dysfunction according to DSM-IV criteria, CIDI data, and scores on the Golombok Rust Inventory of Sexual Satisfaction (GRISS7colon; Rust and Golombok, 1986) were collected for 382 men and women with SD who applied for participation in a study of bibliotherapy. The prevalence of psychiatric disorder in the study sample was compared with the general population as documented in the NEMESIS epidemiological study in the Netherlands (Bijl et al., 1998). GRISS scores corroborated the diagnoses of SD. An increased prevalence of current anxiety disorder was found in sexually dysfunctional men (11.6%; ²(df = 1) = 7.753; p = .005). An increased rate of lifetime diagnoses of affective (21.5%; ²(df = 1) = 9.728; p = .002) and a near significant increased rate of lifetime anxiety disorders (19.9%; ²(df = 1) = 5.642; p = .018) was found in men with SD. In the sexually dysfunctional female participants, a higher prevalence of current anxiety disorder was found (20.4%; ²(df = 1) = 10.057; p = .002). Lifetime affective disorders (38.3%; ²(df = 1) = 20.719; p > .001) as well as lifetime anxiety disorders (37.3%; ²(df = 1) = 16.254; p > .001) were more prevalent than in the general female population. Psychiatric comorbidity in men and women with SD was significantly higher than that found in the general population. The increased comorbidity of psychiatric disorders in men and women with SD warrants adding efficient psychiatric screening to the standard intake assessment procedure of patients with SD.     

Sexual Risk-Taking in Gay Men: The Relevance of Sexual Arousability, Mood, and Sensation Seeking

This paper examined the relationship of three aspects of personality to sexual risk-taking in gay men: (1) sexual arousability, as propensity for sexual excitation, and propensity for inhibition of sexual arousal in the face of threat (measured by the Sexual Excitation, SES, and Sexual Inhibition, SIS1, SIS2, scales); (2) the relation between negative mood and sexuality; and (3) sensation seeking. Risk-taking was assessed for the past 6 months in relation to unprotected anal intercourse (UAI), oral sex, number of casual partners, and patterns of cruising behavior. A combination of number of partners and use of condoms was used to derive a longer-term risk grouping. Two patterns of association were identified. UAI and high risk oral sex were more likely in those with low inhibition of sexual response due to threat of performance consequences" (i.e., low SIS2) and low trait anxiety (low STAI). High numbers of casual partners and frequent cruising were associated with increased sexual interest in states of depression and high propensity for sexual excitation (SES). Higher long-term risk was also associated with low SIS2. Unexpectedly, high SIS1, which is strongly related to vulnerability to erectile failure, was also predictive of higher long-term risk. Possible reasons for this are discussed. Disinhibition from the Sensation Seeking Scales was a positive predictor of all types of sexual risk assessed. All three aspects of personality are of potential relevance to designing better interventions to reduce high risk sexual behavior and in evaluating their effectiveness.     

“Frigidity”: A critical review

Freudian theory linking emotional development with somatic correlates has not been shown to explain certain phenomena from the laboratory and from clinical experience. Comparative studies, however, suffer from problems in methodology. Population samples may be biased by an absence of women more likely to be frigid, interview methods are emotionally superficial even though apparently comprehensive, and reliability and validity studies are generally not done. However, on the basis of these studies neurotic personality appears to be associated with sexual fears. Higher social class and younger age group are associated with less inhibition. Relationship to past personal experiences is more controversial, and there is less support for this hypothesis in comparative studies. Marital happiness appears to form a motivation for adaptation between partners. Successful treatment of frigidity has been accomplished by many forms of psychotherapy, including behavior therapy. In all types, nonconsummation has been very successfully treated, while treatment of orgasmic inadequacy has been disappointing. The absence of any comparative trials and the effects of self-selection of patients (especially in retraining schemes) make it impossible to compare the efficacies of treatment. Attention should be drawn to the similarity of nonconsummation to a phobic state and orgasmic inadequacy to a state of hysterical dissociation. This similarity would lead to an expectation, theoretically, of better results with behavior therapy and methods of desensitization and retraining.This study forms part of a thesis presented to the University of London for the degree of Master of Philosophy, April 1969.     

Men's and women's reactions to sexually explicit films: A serendipitous finding

We proposed that men and women would be turned off by watching men and women like themselves engaged in sexual activity and turned on by watching someone of the opposite sex engaged in the same activity. We tested this hypothesis by showing college men and women eight films: films depicting male and female homosexuality, male and female masturbation, and males and females engaged in heterosexual intercourse. We assessed men and women's reactions via the Byrne-Sheffield (1965) Feeling Scale and Griffitt's (1975) Physiological Arousal Scale. We found support for our hypothesis. We also attempted to determine whether men and women differed in how easily they became aroused by sexually explicit films. We found that they did not.This research was supported, in part, by University of Wisconsin Graduate School funds and was conducted during the tenure of NIMH Grant MH 26681.     

Assessment of Sexual Behavior,Sexual Attitudes,and Sexual Risk in Sweden (1989–2003)

To assess changes in sexual behavior, sexual attitudes, and sexual risk related to HIV, we conducted mailed questionnaire surveys in random samples of the Swedish general population in 1989, 1994, 1997, 2000, and 2003 (total N = 13,762). Each sample consisted of 4,000–6,000 subjects aged 16–44 years, stratified by age: 16–17, 18–19, 20–24, 25–34, and 35–44 years. The overall participation rate was 63.8% (for men, 55.9%; for women, 71.9%). The prevalence of three or more sexual partners and casual sexual contacts without the use of a condom was comparatively high for men, for persons aged 16–24 years, single persons with and without a regular partner, and persons living in towns and urban areas. The prevalence of multiple sexual partners and casual sexual contacts increased significantly over time. There was a significant decrease in the proportion of participants who agreed with the statement Sexual intercourse should only take place in a stable relationship. Personal risk assessments related to HIV did not change significantly over time. The study shows that risky sexual behavior related to HIV/AIDS increased in the Swedish population between 1989 and 2003, and that attitudes concerning casual sexual relations became more permissive.     

Comprehensive pediatric primary care vs traditional care in an israeli population: Their influence on pediatric emergency room use and hospitalization

Emergency room (ER) utilization and hospitalization were studied as indicators of the impact of improvements in pediatric primary care services in an Israeli development town, Ofakim, population 12,000. One of the two pediatric services was upgraded in 1976 through the introduction of pediatric faculty, integration of preventive and curative services and conversion of the medical records to a problem-oriented format ( experimental clinic B ). The primary care system remained unchanged in the second clinic ( traditional clinic A ). During 1980, ER utilization by the B clinic population was 9.3/100 compared with 17.6/100 for the A clinic population. Fifty two percent of the B clinic population patients reaching the ER were hospitalized compared with 25% of A clinic patients.The lower ER utilization rate represents a significant saving for the health services, and educational interventions are suggested from the study. Analysis of ER utilization data seems to offer useful information for overall planning and monitoring of ambulatory services for a community.Corresponding author.     

Health-related quality of life in a rare disease: Hereditary hemorrhagic telangiectasia (HHT) or Rendu–Osler–Weber Disease

The levels of the health-related quality of life (HR-QoL) were analyzed in hereditary hemorrhagic telangiectasia (HHT) patients. The Short Form-36 Health Survey (SF-36) was administered to 50 HHT patients and scores were compared to a cohort of 2301 normal subjects. Clinical variables were patient age, illness duration, number of epistaxis episodes in the previous year and hemoglobin levels. Physical functioning, physical role limitations, bodily pain, social functioning, emotional role limitations and the physical component scores were lower among females. In multivariable analyses increasing age was related to lower physical functioning (P<0.04), physical role limitations (P<0.008), bodily pain (P<0.05) and emotional role limitations (P<0.01), while higher hemoglobin levels improved physical functioning(€P<0.03). The number of epistaxis episodes was negatively associated with physical role limitations (€P<0.009), vitality (P<0.002), social functioning (P<0.001), physical component summary (€P<0.001) and bodily pain (P<0.01). Illness duration was negatively related to the mental component summary (P<0.004). HHT patients had a lower HR-QoL with respect to normal controls in all domains except for bodily pain. Females had lower scores for several domains. Epistaxis was the most important clinical variable.     

The Sexual Interaction Inventory: A new instrument for assessment of sexual dysfunction

A paper-and-pencil self-report inventory for assessing the sexual adjustment and sexual satisfaction of heterosexual couples is described. Other sexual assessment procedures are reviewed, and the rationale for the format of the Sexual Interaction Inventory is explained. Data from four different client and normal samples are presented, detailing the reliability and validity of the inventory.     

Selecting films for sex research: gender differences in erotic film preference

The aim of this study was to explore gender differences in sexual responsiveness to erotic films that had been selected for their differential appeal for men and women. A secondary objective was to identify variables that influence sexual arousal and explore whether these variables differ for men and women. Fifteen men (M age = 26 yrs) and 17 women (M age = 24 yrs) were presented with 20 film clips depicting heterosexual interactions, half of which were female- and the other half male-selected, and were asked to rate the clips on a number of dimensions. Overall, men found the film clips more sexually arousing than did the women. Gender differences in arousal were negligible for female-selected clips but substantial for male-selected clips. Furthermore, men and women experienced higher levels of sexual arousal to clips selected for individuals of their own gender. Cluster regression analyses, explaining 77% of the variance for male and 65% for female participants, revealed that men's sexual arousal was dependent upon the attractiveness of the female actor, feeling interested, and both imagining oneself as a participant and watching as an observer. For women, with all variables entered, only imagining oneself as a participant contributed to sexual arousal ratings. The findings suggest that how films are selected in sex research is an important variable in predicting levels of sexual arousal reported by men and women.     

A suggestion on how to use measurements of cadmium in blood as a cumulative dose estimate

Summary The individual cumulative cadmium dose was estimated for 44 smelter workers in a cadmium-copper alloy plant. Two different principles were used: cumulative respiratory dose and cumulative average annual blood-cadmium dose. Out of eight workers with a cumulative respiratory dose exceeding 500 mg Cd · h/m³, two of them (25%) had signs of a cadmium-induced renal dysfunction. These two men were the only workers that had a cumulative average annual blood cadmium dose exceeding 200 g Cd · year/1. Our results suggest that measurements of cadmium in the blood can be used as an indicator of the cadmium exposure of each individual and that, in order to prevent renal dysfunction, the average blood-cadmium concentration should not exceed 10 Cd/1 over periods of many years (decades).     

A Critique of Schüklenk and Brookey: “Biomedical Research on Sexual Orientation: Researchers Taking Our Chances in Homophobic Societies”

In their paper in the previous issue of the Journal of the Gay and Lesbian Medical Association, Schüklenk and Brookey warn that research on the causes of sexual orientation may be dangerous. They develop several themes of which the most radical appear to be that research has no value of its own and that the products of research may be used for evil purposes, that we should greatly fear advances in knowledge, and (at least by implication) that we should put a stop to research and to advancing knowledge on the origins of sexual orientation. The present critique attempts to place their themes in a different context.     

An analysis of self-reported sexual behavior in a sample of normal males

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.     

In a Secular Spirit: Strategies of Clinical Pastoral Education

The Clinical Pastoral Education (CPE) model forthe provision of spiritual care represents theemergence of a secularized professionalpractice from a religiously-based theologicalpractice of chaplaincy. The transformation ofhospital chaplaincy into spiritual careservices is one means by which religioushealthcare ministry negotiates modernity, inthe particular forms of the secular realm ofbiomedicine and the pluralism of thecontemporary United States healthcaremarketplace. Spiritual is a labelstrategically deployed to extend the realm ofrelevance to any patient's belief system,regardless of his or her religious affiliation.Theological language is recast as a tool forconceptualizing the spiritual lens. Suchmoves transform chaplaincy from a peripheralservice, applicable only to the few religiouspatients, into an integral element of patientcare for all. Such a secularized professionalpractice is necessary to demonstrate therelevance and utility of spiritual care for allhospital patients in an era of cost-containmentpriorities and managed care economics.     

Sexuality,Fertility, and Danger: Twentieth-Century Images of Women with Cognitive Disabilities

Historically, women with cognitive disabilities in the United States have been portrayed as sexually and socially threatening, and in need of professional management and control. Expressions of concern over the sexual nature of this group are still present in medical, legal, and popular cultural discourse. This presentation considers five examples (four nonfiction and one fictional) where the sexual identities of women with cognitive disabilities received national scrutiny: the sterilization of Carrie Buck; the institutionalization of Deborah Kallikak the Glen Ridge sexual assault case; the sterilization of Cindy Wasiek; and the movie The Other Sister. These examples reveal that implicit cultural assumptions (modern fairy tales) about the sexuality and fertility of women with cognitive disabilities are embedded in United States history, and still very much in evidence today.     

Male and Female Differences in Reports of Women's Heterosexual Initiation and Aggression

Previous work that compared male and femalereports of women's heterosexual initiation andaggression is replicated. It was hypothesized that men'sreports of women's sexual initiation and aggressionwould be significantly greater than women'sself-report of sexual initiation and aggression in themost recent sample. Of the 24 questionnaire items, 12 ofthe 17 specifically designed to assess sexual initiation or aggression demonstrated significantreporting differences. For every questionnaire item,except mutually consenting contact, menreported women initiating sexual contact more often thanwomen self-reported. In addition, comparisons were made to determinethe level of agreement between the results of this studyand a previous study in which the same comparisons weremade with a different sample. It was hypothesized that the identical questionnaire items woulddemonstrate significant gender-based reportingdifferences in both samples. This hypothesis was mostlysupported with 11 items showing a significant difference in both samples. In both samples, malesreported receiving female initiation and aggression morefrequently than females reported giving. Logisticregression results supported a difference in perception of women's sexual initiation based on gender ofrespondent. In both samples men see women's initiationas less conforming to traditional social norms for womenand more aggressive than women do. Gender role expectations and social desirability mayinfluence male and female perceptions of femaleheterosexual initiation and aggression in a way thatcontributes to significant differences inreporting.     

Sexual interviewing,evaluation, and therapy: Psychoanalytic emphasis on the use of sexual fantasy

Sexual fantasy in initial interviews and during psychotherapy and psychoanalysis is explored for its contribution to understanding psychopathology, both sexual and nonsexual. The focus is on distinguishing between the sexual and the seemingly sexual. Sexual behavior and fantasy are regarded as having sexual pleasure and orgasm as the predominant goal. Seemingly sexual behavior and fantasy have a predominant goal that is not sexual, even though a sexual mode is used. Predominant goals in the seemingly sexual are emphasized such as coping with intense aggression and problems of self-esteem, self-definition, self-cohesion, and the maintenance of object relations. Sexual fantasy and behavior can be especially useful for repairing negative self- and object images and the associated intensely negative affects. This does not imply that all more primitive patients are incapable of experiencing intense sexual pleasure and orgasm. On the contrary, borderline patients, with extensive use of splitting mechanisms at the level of dyadic object relating, may have intact sexual functioning.     

Psychological concerns in sexual rehabilitation and mastectomy

Since the sexual functioning of the mastectomy patient is unimpaired, sexual rehabilitation primarily involves the resolution of emotional problems attendant upon the operation. The woman, deeming herself repulsive, fears rejection; her partner doubts his ability to help; and the couple drifts apart emotionally and sexually. Rehabilitation consists chiefly in allaying these fears: most women remain attractive; most men can trust their ardor. Helping professionals without psychosexual therapy training can assist the couple in avoiding these problems, by helping them confront the missing breast and establish good communication, and by providing advice on sexual activities during the recuperative period.     

Sexuality of pregnant and breastfeeding women

The effect of pregnancy and lactation on the sexual behavior of women was studied, using a retrospective questionnaire answered by a nonrandom sample of 33 women. Sexual functioning was operationally defined by four categories: desire, frequency, enjoyment, and orgasm. Five time periods were studied: the three trimesters of pregnancy, the period of breastfeeding and the period after weaning. Most of the mothers reported that their sexual behavior was about the same during pregnancy as before except for the third trimester, where desire, frequency, and enjoyment decreased. Eighty-two percent of the mothers felt that sex relations should continue throughout all of the pregnancy. Sexual functioning during breastfeeding was reported to be about the same as before pregnancy by 75% of the women. Desire returned for most women by 4 weeks after childbirth, earlier than many of them felt it safe to resume sex relations. Women who had been married longer, with more children and more breastfeeding time, reported an earlier return of sexual interest and felt it safe to resume sex relations earlier. Most women reported their sexual interest after weaning was about the same. No one reported a decrease in sexual interest after weaning. All of the women reported breastfeeding to be enjoyable. Younger marrieds were apt to rate breastfeeding even higher than older marrieds. Also, younger marrieds felt freer about breastfeeding in public. Sexual relations continue when procreatively unfruitful and even when difficult in humans. This underscores the importance of the bonding value of sex.