Sexology as a challenge to the health care system: the Norwegian version

Medical doctors and psychologist represent the largest groups of professionals working with sexological problems in Norway, with one third each. The last third consists of different health and educational professionals. Forty-three percent reported that they have undergone some training programs in sexology. This is the lowest educational level in all the countries surveyed in the context of the “Euro-Sexo” study. Seventy-one percent declared that they have had individual supervision and 49% had group supervision in sexology. 93.2% are in clinical practice, but for most of them, this is a minor part of their professional activity. Seventy-one percent reported that sexological activity represents less than 25% of their professional time. Gender differences are minor. Three percent work with sexology full time, all of these are women, and none are medical doctors. Not surprisingly, problems with orgasm (42.95) and sexual desire (60.7%) are among the most frequent problems presented among female clients, while erectile dysfunction (47.3%) is the most frequent problem among male clients. Emotional problems in the couple relationship is among the most frequent problem reported, 35% among male and 63% among female clients. The respondents also reported problems related to sexual violence or abuse, 18.1% among male and 42.9% among female clients. Thirty percent reported genital pain among their female clients. Sexological problems represent a substantial area of the clinical work for many therapists. Medical doctors represent an important part of the therapeutic field, while sexology is a less than a minor part of medical education, both pre and post graduate. Psychotherapy was reported as the most frequent treatment used by sexologists.     

Effect of sildenafil on subjective and physiologic parameters of the female sexual response in women with sexual arousal disorder

Sexual dysfunction is a complaint of 30-50% of American women. Aside from hormone replacement therapy, there are no current FDA-approved medical treatments for female sexual complaints. The goal of this pilot study was to determine safety and efficacy of sildenafil for use in women with sexual arousal disorder (SAD). Evaluations were completed on 48 women with complaints of SAD. Physiologic measurements, including genital blood flow, vaginal lubrication, intravaginal pressure-volume changes, and genital sensation were recorded pre- and postsexual stimulation at baseline and following 100 mg sildenafil. Subjective sexual function was assessed using a validated sexual function inventory at baseline and following 6 weeks of home use of sildenafil. At termination of the study patients also completed an intervention efficacy index (FIEI). Following sildenafil, poststimulation physiologic measurements improved significantly compared to baseline. Baseline subjective sexual function complaints, including low arousal, low desire, low sexual satisfaction, difficulty achieving orgasm, decreased vaginal lubrication, and dyspareunia also improved significantly following 6 weeks home use of sildenafil. Sildenafil appears to significantly improve both subjective and physiologic parameters of the female sexual response. Double-blind, placebo-controlled studies are currently in progress to further determine efficacy of this medication for treatment of female sexual dysfunction complaints in different populations of women.     

Prevalence and comorbidity of sexual dysfunctions in a Portuguese clinical sample

We investigated the prevalence and comorbidity of sexual dysfunction in a clinical Portuguese sample. A total of 96 participants (47 females and 49 males with a diagnosis of sexual dysfunction (DSM-IV; American Psychological Association, 1994) assigned by a group of trained sex therapists) answered the Female Sexual Function Index (FSFI; Rosen et al., 2000) and the International Index of Erectile Function (IIEF; Rosen et al., 1997). Results indicated erectile dysfunction (70%) and female hypoactive sexual desire disorders (40.4%) as the most prevalent complaints, with premature ejaculation (22.4%), vaginismus (25.5%), and female orgasmic disorder (21.3%) also showing relevant prevalences. Comorbidity studies indicated higher levels of overlapping among female sexual difficulties with strong associations between desire, subjective arousal, and orgasmic disorders, as well as between dyspareunia and vaginismus.     

Sexualität und Pharmakotherapie

This contribution addresses two different areas of the complex relationship between pharmacotherapy and sexual function and dysfunction in men and women. As many impairments of sexual function are caused by side effects of medications, particularly psychotropic drugs, the first part of the paper describes substances and mechanisms often related to sexual dysfunction with a special focus on antidepressants and neuroleptics. While serotonin reuptake inhibitors entail a high risk of sexual dysfunction, it is often difficult to differentiate the negative impact of the drug from the impairment caused by the mental disorder itself. Ways to deal with these dysfunctions and remedial measures are discussed. In the second section, current pharmacological treatments for female and male sexual dysfunctions are reviewed. While there is no approved pharmacotherapy with established efficacy for female sexual dysfunction with the possible exception of the transdermal testosterone patch for surgically menopausal women, effective pharmacological therapies are available for male erectile disorders. In addition, testosterone substitution is the treatment of choice for hypoactive sexual desire disorders caused by hypogonadism. As sexual dysfunctions are often caused by a mixture of psychological and organic factors, treatment strategies combining pharmacological options and sex therapy are advocated.     

Intimacy revealed: sexual experimentation and the construction of risk among young people in Mozambique

The expanding AIDS epidemic in Mozambique is fuelled principally by heterosexual transmission, with young people identified as a key group for prevention efforts. However, little is known about the sexual behaviour of young people in Mozambique and the protective practices they adopt. This paper seeks to identify the contexts and rules governing sexual risk-taking among young people in Maputo. In doing so, the paper affirms the importance of context in understanding risk practices, but highlights the fluidity of practice as an important limitation for the use of contextual analysis in prevention interventions. By focusing on one innovation, the saca cena one-night stand, this paper shows how a subgroup of young people in Maputo has redefined a "risky" sexual practice to include exclusive condom use. As a risk context, the saca cena dictates a set of implicit rules emphasizing anonymity, discretion, verbal and non-verbal cues, and for a set of select innovators, condom use. The saca cena challenges the hegemonic gender roles found among many young people in Maputo of male dominance through sexual conquest and female acquiescence. Instead, the practice allows young people to be both adventurous and responsible. The discourse demonstrates how sexual identities have been redefined to combine risk reduction with sexual experimentation and the satiation of desire.     

Sexual function in women with hypothalamo-pituitary disorders

The extent to which hypothalamo-pituitary disorders in women affect sexual desire and sexual functions was investigated. Sexual functions and sexual appreciation were assessed in a comprehensive interview of 48 women with well-defined hypothalamo-pituitary disorders. Data about sex life were correlated to blood hormone levels and diagnosis. In most of the women (64.8%), the first clinical symptom indicating a hypothalamo-pituitary dysfunction began in the age group 16 to 35. In 43 patients (89.6%), the initial symptom was menstrual irregularities. Altogether 45 (93.8%) of the women declared that they had or had had significant sexual problems. Two of the three women who did not report sexual problems had never had intercourse. Thirty-eight (79.2%) of the women had developed a lack of or a considerable decrease in sexual desire. Problems with lubrication or orgasm were reported by 31 (64.6%) and 33 (68.7%) of the women, respectively. Normal menstrual pattern, young age, and intrasellar tumor growth correlated better with normal sexual desire and sexual functions than did normal prolactin levels and normal testosterone levels. However, at the time of interview, only 7 women had hyperprolactinemia. Serum testosterone values correlated significantly only with masturbation.     

Sex Guilt Mediates the Relationship Between Religiosity and Sexual Desire in East Asian and Euro-Canadian College-Aged Women

Research has examined the relationship between religiosity and sexuality but few studies have explored the mechanisms by which sexual variables are influenced by religiosity. The purpose of the present study was to investigate the role of sex guilt in the relationship between religiosity and sexual desire in women. Euro-Canadian (n = 178) and East Asian (n = 361) female university students completed a battery of questionnaires. Higher levels of religious fundamentalism, intrinsic religiosity and spirituality were associated with higher levels of sex guilt in both ethnic groups. Paranormal belief was not associated with sex guilt in either ethnic group. The Euro-Canadian women reported significantly higher levels of sexual desire and significantly less sex guilt than the East Asian women. Among the Euro-Canadian women, sex guilt mediated the relationships between spirituality and sexual desire, and fundamentalism and sexual desire; among the East Asian women, sex guilt mediated the relationships between spirituality and sexual desire, fundamentalism and sexual desire, and intrinsic religiosity and sexual desire. These findings suggest that sex guilt may be one mechanism by which religiosity affects sexual desire among women.     

Comparing Subjective Ratings of Sexual Arousal and Desire in Partnered Sexual Activities from Women of Different Sexual Orientations

Little is known about non-monosexual women’s sexual arousal and desire. Typically, bisexual women have been excluded from research on sexual arousal and desire, whereas mostly heterosexual and mostly lesbian women have been placed into monosexual categories. This research (1) compared the subjective sexual arousal and desire of self-identified heterosexual, mostly heterosexual, bisexual, mostly lesbian, and lesbian women in partnered sexual activities with men and with women, and (2) compared within-group differences for subjective sexual arousal and desire with men versus women for the five groups. Participants included 388 women (M age = 24.40, SD = 6.40, 188 heterosexual, 53 mostly heterosexual, 64 bisexual, 32 mostly lesbian, 51 lesbian) who filled out the Sexual Arousal and Desire Inventory (SADI). Sexual orientation was associated with sexual arousal and desire in sexual activities with both men and with women. Bisexuals reported higher sexual arousal and desire for women than heterosexuals and lesbians, while lesbians reported lower sexual arousal and desire with men than the other groups. Heterosexuals and mostly heterosexuals scored higher on the male than on the female motivational dimension of the SADI, while the reverse was found for lesbians and mostly lesbians. Findings indicate that non-monosexuals have higher sexual arousal and desire in sexual activities with women than monosexuals. Further, bisexual women did not differentiate their sexual arousal with men versus women, while the other sexual orientation groups differentiated in terms of their motivation to engage in sexual activity. These findings may have implications for how female sexual orientation is conceptualized.     

Sexuality and Well-Being Among Couples Living with Acquired Deafblindness

Sexuality among couples living with acquired deafblindness (ADB) is an untouched research area, although recent research has reported an association between couples’ sexual activity and vision and hearing loss, respectively. The aim of the current study was to investigate sexuality among couples living with ADB in Denmark and its association with psychological well-being. Deafblind individuals and their partners (n = 45) were recruited from the national institute providing services for the deafblind in Denmark. Partners were asked about sexual activity, reductions in sexual desire and sexual satisfaction over the past year. Both individuals and their partners completed the WHO-5 measure of psychological well-being. Further, information about degree of hearing and vision loss and use of hearing aids was also obtained. Compared to other population based studies, level of sexual activity was low and more participants reported poor psychological well-being. Sexual activity significantly predicted psychological well-being among partners but not individuals with deafblindness. Gender differences were found indicating that sexual activity was important for male partner’s well-being but satisfaction with sex life was important for female partner’s well-being. Degree of hearing loss and use of hearing aids were also associated with sexual activity and desire among couples where the deafblind individual-partner gender distribution was male–female.     

Sexual dysfunction among female patients of reproductive age in a hospital setting in Nigeria

Although sexual dysfunction is an important public-health problem in Nigeria, little research has been conducted on this topic in Nigeria. This cross-sectional study was conducted to determine the prevalence of sexual dysfunction and their correlates among female patients of reproductive age using a questionnaire. Respondents were recruited from the out-patients clinics of a teaching hospital setting in Ile-Ife/ Ijesa administrative health zone, Osun State, Nigeria. Of 384 female patients interviewed, 242 (63%) were sexually dysfunctional. Types of sexual dysfunction included disorder of desire (n=20; 8.3%), disorder of arousal (n=l 3; 5.4%), disorder of orgasm (n=154; 63.6%), and painful coitus (dyspareunia) (n=55; 22.7%). The peak age of sexual dysfunction was observed among the age-group of 26-30 years. Women with higher educational status were mostly affected. The reasons for unsatisfactory sexual life mainly included psychosexual factors and medical illnesses, among which included uncaring partners, present illness, excessive domestic duties, lack of adequate foreplay, present medication, competition among wives in a polygamous family setting, previous sexual abuse, and guilt-feeling of previous pregnancy termination among infertile women. The culture of male dominance in the local environment which makes women afraid of rejection and threats of divorce if they ever complain about sexually-related matters might perpetrate sexual dysfunction among the affected individuals. Sexual dysfunction is a real social and psychological problem in the local environment demanding urgent attention. It is imperative to carry out further research in society at large so that the health and lifestyles of affected women and their partners could be improved.     

Sexuality and STD/AIDS prevention: social representations by rural men in a county in the Zona da Mata region in Pernambuco, Brazil

This study analyzes the concepts displayed by rural men in the Zona da Mata region in the State of Pernambuco, Brazil, concerning their sexual practices and STD/AIDS prevention. The study adopts a qualitative methodology, having interviewed 22 men According to the interviews, their first sexual intercourse is characterized as a learning experience and is sometimes marked by violence. They make a distinction between the "woman at home" and "street women"; they acknowledge women's sexual desire and value reciprocity in sexual relations, differentiating between the kinds of sex they have with different categories of women. Seven men report homoerotic experiences during adolescence, which they ascribe to immaturity, not affecting their heterosexual identity. Condom use, perceived in a negative light, is inconstant and irregular, inversely proportional to knowing the female partner. STDs in general inspire little fear, while AIDS is associated with death; the interviewees do not see themselves at risk of acquiring HIV. Ambiguities in the men's discourse, together with a basically ineffective approach by health services and preventive campaigns, reveal a high level of exposure to the risk of contracting STDs/AIDS among the interviewees and their female or male partners.     

Modèles précliniques du désir sexuel

Within the context of preclinical models of sexual behavior we suggest that the human concept of sexual desire is equivalent to the concept of sexual motivation as used in the experimental literature. Many tests of sexual motivation in non-human animals have been described. Most of these are based on the speed or rate of execution of learned responses, particularly learned operants. For several reasons outlined in this article, such procedures are not ideal for the determination of the intensity of sexual motivation. We describe here a simple test for sexual motivation that has been employed both in male and female rats. It has the advantage of being rather insensible to variations in motor activity or general arousal, it does not employ measures of response speed and it does not require learning. The absence of established treatments for human sexual desire disorders makes it difficult to determine the predictive or correlational validity of any preclinical model. Nevertheless, the model proposed here may be both isomorph and homologous to human sexual desire.     

Attitudes toward management of decreased sexual desire in premenopausal women: a national survey of nurse practitioners and physician assistants

Recent studies have determined that low sexual desire affects between one quarter to one third of adult premenopausal women, leading to distress. The prevalence of distress from low desire may suggest management gaps in the clinicians managing these patients, as recent studies have shown a reluctance to discuss sexual concerns. A survey based on the Theory of Planned Behavior, a predictive model linking attitudes and behavior, was designed to determine what factors influenced behavioral intent and behavior of nurse practitioners and physician assistants when managing decreased sexual desire and sexual concerns in premenopausal women. A path analysis found that attitudes and subjective norms were associated with behavioral intent in both groups and explained roughly one third of the intent to initiate a discussion about sexual health. In general, nurse practitioners and physician assistants had positive attitudes toward managing sexual concerns in female patients but were still at times reluctant to initiate sexual health discussions. This study shows that increased education is needed on female sexual dysfunction in the allied health professional community, as well as techniques for communicating with patients about their sexual concerns.     

The Role of Sex Guilt in the Relationship Between Culture and Women’s Sexual Desire

A large body of literature demonstrates that East Asian women report lower sexual desire than Caucasian women. Although most studies have explained these differences by referring to general culture-linked differences in sexual conservatism, none have examined the potential role of specific constructs such as sex guilt. The goals of the current study were to examine the supposition that sexual conservatism mediates the relationship between culture and sexual desire, and to explore the potential mediating role of sex guilt in the link between culture and sexual desire. Caucasian (n = 105) and East Asian (n = 137) female university students completed questionnaires online. Caucasian women reported significantly higher levels of sexual desire, significantly lower levels of sexual conservatism, and significantly less sex guilt. In the entire sample, sexual conservatism and sex guilt separately mediated the relationship between ethnicity and sexual desire such that women with more sex guilt and those who were more sexually conservative reported lower sexual desire. Among the East Asian women, sex guilt, but not sexual conservatism, mediated the relationship between mainstream acculturation (degree of westernization) and sexual desire such that women with more sex guilt reported lower sexual desire. These findings suggest that sex guilt may be one mechanism by which ethnic groups differ in sexual desire.     

Sexual fantasy and activity patterns of females with inhibited sexual desire versus normal controls

Until recent years, female sexual fantasy was generally associated with psychopathology or negative qualities. Sexual fantasy is now regarded by the cognitive-behavioral schools as a normal occurrence serving adaptive functions. No investigation has been made comparing the sexual fantasy and activity patterns of women with a specific sexual dysfunction and women with a satisfactory sexual adjustment. This study compared responses to a fantasy questionnaire completed by 30 women reporting a satisfying sex life and 25 women who came to a sexual dysfunction clinic with a complaint of inhibited sexual desire. This study confirms that females with inhibited sexual desire fantasize less during foreplay, coitus, masturbation and general daydreaming than the controls. The content of fantasies in both groups is similar. The females with inhibited sexual desire do not masturbate less often and do not have fewer orgasms through masturbation than the controls. The females with inhibited sexual desire have fewer orgasms through intercourse alone.     

Prevalence of Women’s Sexual Desire Problems: What Criteria Do We Use?

Problems of sexual desire are often cited as the most prevalent of the female sexual dysfunctions. Despite this finding, considerable variability exists when comparing prevalence figures across studies, highlighting the inconsistency in how these problems are defined and therefore measured. The current study was designed to determine how the prevalence estimates of women’s sexual desire problems varied according to the diagnostic criteria adopted to define such problems. The sample consisted of 741 women from Australia, the Americas, Europe, and Asia. Participants were between 18 and 71 years of age and were involved in a heterosexual relationship spanning between 3 months and 49 years duration. Sexual desire problems were defined using a variety of criteria, including (1) meeting DSM-IV-TR criteria for Hypoactive Sexual Desire Disorder (HSDD), (2) meeting DSM-IV-TR criteria for HSDD, removing the sexual thoughts/fantasy requirement, (3) self-identified “lack of sexual interest,” and (4) low average ratings of sexual desire levels, as assessed using the Female Sexual Desire Questionnaire. The prevalence of sexual desire problems varied from 3.0 to 31.0 % depending upon the criteria used to define such problems. It is important to reach a consensus with regard to the criteria used to define sexual desire problems, in order to standardize and compare studies investigating these problems. How women’s sexual desire problems are conceptualized has implications for their treatment. Therapists may or may not need to address absent sexual thoughts/fantasies and may be working with low normative levels of desire versus subjective evaluations of low desire.     

‘As prostitutes,we control our bodies’: perceptions of health and body in the lives of establishment-based female sex workers in Tijuana,Mexico

Many studies of female sex work focus on HIV and other sexually transmitted infections because sex workers are considered bridges between high-risk and low-risk populations. The voices of female sex workers as they pertain to health issues are often lacking in the literature. This paper offers a feminist constructivist grounded theory study with establishment-based female sex workers in Tijuana, Mexico. Analyses of interviews with 20 women reveal that they are aware of the impact of their work on their bodies, but conceptualise their health holistically and not just in terms of HIV. They emphasise that working in the sex industry has implications for sexual health, non-sexual physical health and mental health. The paper concludes that in order for public health interventions to have more sustainable impact on the lives of female sex workers, they should take into account the voices of the women, including how they define their health. The findings suggest that public health professionals need to be more aware that female sex workers have agency and a desire to control their health and their bodies.     

Dyadic Sexual Desire in Romantic Relationships: The Dyadic Interactions Affecting Dyadic Sexual Desire Model

In most theoretical models, sexual desire for one’s partner is predominantly conceptualized from an individual perspective. There is, however, a growing body of empirical evidence on the dyadic aspects of sexual desire. That evidence is as yet not well-integrated into theoretical conceptualizations of sexual desire. Aiming to fill this gap, we present the Dyadic Interactions Affecting DyadIC Sexual desire model (DIADICS), a new conceptual model inspired by systems theory that describes how dyadic interactions between partners influence dyadic sexual desire in romantic relationships. After defining dyadic sexual desire, we discuss (1) the structure of dyadic interactions, (2) their content, and (3) the process through which they affect dyadic sexual desire in a romantic relationship. Thereafter, we review theoretical, clinical, and empirical insights underscoring the relation between dyadic interactions and (dyadic) sexual desire, use DIADICS as a framework for understanding fluctuations in dyadic sexual desire in long-term relationships, and conclude by discussing implications of DIADICS for research and clinical practice.

     

Latent Structures of Female Sexual Functioning

For the last three decades, male and female sexual responses have been conceptualized as similar, based on separated and sequential phases as proposed by the models of Masters and Johnson (1966) and Kaplan (1979) model. However, there is a growing debate around the need to conceptualize female sexual response and the classification of sexual dysfunction in women, in view of the upcoming editions of the DSM and ICD. The aim of this study was to test, using structural equation modeling, five conceptual, alternative models of female sexual function, using a sample of women with sexual difficulties and a sample of women without sexual problems. A total of 1993 Portuguese women participated in the study and completed a modified version of the Female Sexual Function Index. Findings suggested a four-factor solution as the model that best fit the data regarding women presenting sexual difficulties: (1) desire/arousal; (2) lubrication; (3) orgasm; (4) pain/vaginismus. In relation to sexually healthy women, the best model was a five-factor solution comprising of (1) desire; (2) arousal; (3) lubrication; (4) orgasm; and (5) pain/vaginismus. Discriminant validity between factors was supported, suggesting that these dimensions measure distinct phenomena. Model fit to the data significantly decreased in both samples, as models began to successively consider greater levels of overlap among phases of sexual function, towards a single-factor solution. By suggesting the overlap between pain and vaginismus, results partially support the new classification that is currently being discussed regarding DSM-5. Additionally, results on the relationship between sexual desire and arousal were inconclusive as sexually healthy women were better characterized by a five-factor model that considered the structural independence among these factors, whereas women with sexual difficulties better fit with a four-factor model merging sexual desire and subjective sexual arousal.