Lack of ‘responsive’ sexual desire in women: implications for clinical practice

Low sexual desire in women is a common occurrence in loving long-term relationships and the most challenging of all the sexual problems confronting practitioners. The seemingly widespread phenomenon calls for innovative intervention. This paper reports on the findings of a study (reported more fully elsewhere) on the subjective experience of ten heterosexual women who presented with low sexual desire in their relationships, it then focuses on the implications of the findings to suggest management strategies. Findings confirmed that a lack of spontaneous desire is inevitable with time even in satisfying relationships and that, as a result, women often made a conscious decision to engage in sex, based on reasons unrelated to sexual desire. The undesired sexual experiences were tolerated with degrees of unpleasantness. The implications of the findings are that management strategies should include the accurate diagnosis of lack of responsive desire and should consider the emotional intimacy paradox in the relationship as a prerequisite for sexual connection when encouraging differentiation. The willingness to engage in sex for reasons other than having sexual desire (and the attendant discomfort attached thereto) is an important issue for the practitioner to keep in mind when planning intervention.     

Bibliotherapy interventions for female low sexual desire: erotic fiction versus self-help

Low sexual desire is the number one complaint that women bring to their health care practitioners. Limited research demonstrates that written materials (or bibliotherapy) increase sexual desire in women. The aim of this study was to further the literature by conducting a comparative study on the efficacy of two types of written materials when read by women struggling with low sexual desire: self-help versus erotic fiction. Thirty-five women across the two conditions completed sexual functioning measures at two time points (pre-intervention and post-intervention), with 27 women completing a six-week follow-up. Participants reading both types of books made statistically significant gains on the two measures of desire, arousal, lubrication, satisfaction, orgasm, pain reduction, and overall sexual functioning. In both conditions, those participating in a six-week follow-up maintained their gains in desire, satisfaction, pain reduction, and overall sexual functioning. Findings are discussed within the context of treatment for low sexual desire in women. Implications are discussed.     

Flibanserin – the female Viagra?

This article provides a clinically relevant review of the first medication approved by the US Food and Drug Administration for hypoactive sexual desire disorder (HSDD) in premenopausal women. In this short piece, the human sexual response cycle and its relevance to HSDD will be described as well as the pharmacological mechanism of action of flibanserin. Finally, efficacy and safety data of this new medication will be summarised.     

Sexual problems in two inner city London sexual health centres: prevalence,attributions and need for psychosexual services

Sexual problems are common and psychosexual provision is recommended within sexual health services. This study aimed to explore and compare the prevalence and range of sexual problems in men and women attending two sexual health centres; explore patients' attributions for sexual problems; and establish the need for psychosexual clinics. Questionnaires were completed by 868 patients (452 men; 416 women) attending two sexual health centres in London, UK. Women reported more sexual problems than men overall (43 and 32%, respectively). Thirteen percent of men and 18% of women reported reduced interest in sex, 16% of men and 11% of women had arousal difficulties, 6% of men and 18% of women experienced painful sex and 19% of men and 24% of women reported ejaculation/orgasm problems. The majority of sexual problems interfered with patients' lives. Most sexual problems had started within the last year. However, ejaculation/orgasm problems had typically been experienced for longer. Men and women most commonly attributed their sexual problems to an emotional cause. Only a minority of patients with sexual problems were receiving help despite almost half of patients wanting it. Increased identification and treatment for sexual problems is essential in sexual health services.     

When sex isn't the answer: Examining sexual compliance,restraint, and physiological stress

Past research suggests that sexual activity has numerous health benefits; however, we argue that the association between sexual behavior and health is nuanced. More specifically, we argue that when individuals comply with their partner's sexual desire, sex may have unintended negative health consequences. As such, we evaluated how sexual desire and frequency interact to predict individuals' cortisol levels (i.e. a physiological measure of stress) in romantic relationships. Sixty-four participants (38 women, 26 men) who were in generally good health provided salivary cortisol samples and completed questionnaires assessing sexual behavior. As hypothesized, multiple regression analyses confirmed that the interaction between desired and actual sexual frequency predicted cortisol; participants who reported higher sexual frequency than desired (i.e. sexual compliance) had higher cortisol than participants whose desired and actual frequency matched. Interestingly, participants who reported lower frequency than desired (i.e. sexual restraint) had cortisol levels similar to participants whose desired and actual frequency matched. Overall, the results suggest that being sexually compliant (i.e. engaging in more frequent sex than desired) may be stressful and thus lead to negative physiological consequences.     

Some Prospects for Couples Therapy

This paper highlights two specific areas as future prospects for couples therapists. The development of couples therapy has primarily focussed on refining conceptual models for formulating and intervening with couples and on developing adequate methods of assessment. As a result, some areas have been neglected, specifically (i) an appreciation of the dyadic needs of psychiatric patients, handicapped persons and the elderly and (ii) some of the philosophical issues involved in couples therapy.     

Sex education and HIV/AIDS prevention

In reviewing intervention approaches to HIV/AIDS prevention such as mass media, school health education, clinic and service provision, outreach and community mobilization, this paper argues for educational approaches which take account of the contextual forces, in addition to the individual factors, which influence and shape sexual behaviour. The paper focuses attention on the necessity for a sociological as well as a biomedical framework for analysis, interpretation and educational intervention.     

Reduced sexual desire in a random sample of Norwegian couples

Abstract

The purpose of this study was to analyse reduced sexual desire in Norwegian heterosexual couples and to identify factors associated with loss of sexual desire in both men and women. The study comprises a sample of 399 couples (798 individuals) between 22 to 67 years of age. Data were collected by the means of self-administered postal questionnaires. The majority of the couples (59%) did not report distressing problems related to loss of sexual desire. In 26% of the couples the female partner had experienced distressing loss of sexual desire; in 8% of the couples the male partner did, and in 8% of the couples both experienced distressing problems. Most of the men and women who had sexual desire problems believed their loss of sexual desire was related to stress, disease, or “other” factors. Reduced capacity for sexual arousal was the best predictor of loss of desire in both genders. Among women, negative work-to-home interference was related to loss of sexual desire. It seems reduced sexual desire may represent a new area of public health concern in Norway.     

Self-Reported Sexual Function and Sexual Arousability in Women with Epilepsy

Summary: Purpose: Women with epilepsy are at risk for sexual dysfunction but the frequency and types of dysfunction have not been well characterized.
Methods: Self-reported sexual function was evaluated in 116 women aged 18-65 years with epilepsy and no concomitant medical or psychiatric illness, including 99 with localization-related epilepsy (LRE) and 17 with primary generalized epilepsy (PGE). Variables evaluated included seizure frequency, age of seizure onset, and antiepileptic drug (AED) exposure. Standardized inventories assessed sexual functioning, sexual arousability and anxiety, sexual behavior, and depression.
Results: Although sexual experience was not reduced, women with PGE and LRE reported significantly less sexual arousability and women with LRE reported significantly more sexual anxiety. Women with LRE experienced significantly more dyspareunia, vaginismus, arousal insufficiency, and sexual dissatisfaction, whereas women with PGE experienced an-orgasmia and sexual dissatisfaction. Sexual symptoms were not associated with seizure frequency, AED exposure, sexual experience, depression, or prepubertal seizure onset.
Conclusions: In contrast to subjects of previous research, the women in our study did not have a disorder of sexual desire, but more than one third experienced disorders of sexual arousal, implying a physiological deficit. Although the etiology for these arousal phase dysfunctions has not been defined, such conditions are treatable and warrant referral to a gynecologist versed in the treatment of sexual disorders.     

Changes,changes? Women's experience of sexuality in later life

ABSTRACT

Research employing representative samples has provided data about the sexual expression of older adults in the past decade. The results indicate that sexual activity declines with age. Most of the data are quantitative. The purpose of this research was to study the lived experience of women aged 55–80. We ask: how does women's sexuality change in later life, and how do women experience these changes? We conducted face-to-face interviews with 24 women aged 55–80; all self-identified as heterosexual. Most of the women recounted declining sexual desire in the recent past; some attributed it to feeling less attractive or “frumpy”, others to physical changes that made sexual activity uncomfortable, and others to partners’ health problems. Paradoxically, only a minority reported declining frequency of sexual activity, while others reported stable frequencies, citing the importance of sex to the relationship. A minority described increased frequency, in some cases associated with entering a new relationship. Most women reported reacting to the changes by exercising agency; they described a diverse set of behavioral changes designed to maintain or enhance sexual expression. Our results provide insights into older women's experiences of change in sexuality, and their use of agency to cope with these changes.     

Gender equitable boys in a gender inequitable world: Reflections from qualitative research and programme development in Rio de Janeiro

This paper reviews the normal patterns of sexual function in the first year after childbirth and the evidence in terms of social, physical, endocrine and psychological factors that may interact with and alter these normal patterns. Clients, as well as professionals, need to be aware that it is normal for sexual function to be reduced during pregnancy and slowly return to pre-pregnancy levels during the first postnatal year. In addition, information that interacting factors are relatively common and generally self-limiting, should allay many fears, anxieties and fantasies. Both preventative and treatment measures are discussed in a bid to reduce long-term sexual morbidity.     

Amelioration of sexual fantasies to sexual abuse cues in an adult survivor of childhood sexual abuse: a case study

Although sexual dysfunction of childhood sexual abuse survivors has received considerable attention, other sexual difficulties experienced by survivors of CSA, such as sexual fantasies to cues of sexual abuse, have received less attention. In this A–B design case study, a young adult female survivor of childhood sexual abuse presented for treatment at a Midwest rape crisis center. After successful treatment of post-traumatic stress disorder, she complained of unwanted sexual fantasies to sexual abuse cues and concomitant guilt and shame. Following baseline data collection, treatment consisted of self-applied aversion therapy to unwanted sexual arousal to sexual abuse cues. Decrease in sexual arousal to these cues was concurrent with the introduction of treatment. A concomitant decrease in guilt and shame occurred while self-ratings of control increased.     

Double Blind Trial of Yohimbine Hydrochloride in the Treatment of Erection Inadequacy

For many years yohimbine was a common treatment for disorders of potency and libido. However, yohimbine was withdrawn from use in the United Kingdom on account of inadequacy of the documentation confirming its efficiency. We report here the results of a double blind, cross over, placebo controlled trial of yohimbine hydrochloride 5.4 mg three times daily in the treatment of erectile inadequacy of mixed aetiology. Efficacy data are presented on 61 of 70 men recruited to the trial. Yohimbine was associated with a significant improvement in the quality of stimulated erections. The drug was generally well tolerated     

Human muscle-derived cell injection in a rat model of stress urinary incontinence

We investigated the use of human muscle-derived cells (hMDCs) for the treatment of stress urinary incontinence (SUI) in a nude rat model. hMDCs were isolated from adult skeletal muscle. Three groups of six animals consisting of controls, animals undergoing sciatic nerve transection (SNT) with periurethral sham-injection, and SNT with hMDCs (1 x 10(6) cells/20 microl saline) were utilized. Leak point pressure (LPP) was measured 4 weeks following injection. Bilateral SNT resulted in a significantly lower LPP that was significantly higher following hMDCs than sham injection. The results demonstrate the efficacy of human muscle cell therapy alone in improving physiologic outcomes in an animal model of SUI.     

A comparison of sexually explicit illustrations for use in psychosexual therapy

This quantitative study aimed to establish patients' preferred illustrations for educative use in psychosexual therapy by comparing their responses to photographs and line drawings both depicting sexual activity. A sample of 68 subjects, divided almost equally between the sexes and between the age groups 18-40 and 41-65, attending a sexual difficulties clinic at the Porterbrook Clinic, Sheffield were recruited. Nearly all subjects felt comfortable with both types of illustration and thought that they were helpful. Roughly 70% of subjects favoured photographs over line drawing as being the most informative and useful, and most appealing. However, preference was reversed when subjects were asked which illustrations were most acceptable for keeping at home, with 52% preferring line drawings. There were no significant differences between the age groups in their preference choices, in contrast to previous studies which have shown older subjects less accepting of sexually explicit material than younger people.     

Sexual dissatisfaction among heterosexual Norwegians in couple relationships

The purpose of this paper was to analyze sexual dissatisfaction in couple relationships in Norway. The reasons for sexual dissatisfaction and to what extent dissatisfaction is associated with thoughts of ending the relationship are also discussed. The results are based on 1001 web interviews among persons ranging from 18 to 67 years old, registered in the eBase of the poll organization ‘Synovate’. The analysis was limited to the 797 persons who were married, cohabiting or dating. Of respondents, 62% said they were sexually satisfied with their partner, 23% reported neither being satisfied nor dissatisfied and 15% were dissatisfied. Controlling for gender, age and level of education, sexual dissatisfaction was statistically significantly associated only with low frequency of sex and having children below the age of 12 in the household. Women tended to blame the dissatisfaction with their sex life on their own reduced sexual desire. Men regarded too little creativity in their sex life as the primary cause of dissatisfaction. In men, a boring sex life was the most important reason for considering breaking up with their partner. Women's main reasons for ending the relationship revolved more around arguments with the partner over the division of domestic duties and responsibilities and feeling bored in the relationship.     

The relationship between male sexual dysfunction and belief in zilbergeld' s myths: An empirical investigation

This study examined the relationship between belief in the myths described by Zilbergeld and sexual dysfunction in males. A group of men seeking treatment for sexual problems were compared with a group of non-dysfunctional men, with regard to their belief in these myths. As predicted, the results showed significantly greater belief in the myths among the dysfunctional group.