Management Of Sexual Problems Research Articles

RELATIONSHIP BETWEEN SEXUAL DYSFUNCTION AND SEXUAL SELF-CONCEPT IN PATIENTS WITH DIABETES MELLITUS: A SCOPING REVIEW

Background: An often-occurring complication of diabetes mellitus is sexual dysfunction, often linked to poor blood sugar control. Despite its significant impact on patients' lives, issues related to sexual desire, education, and timely detection and management of sexual problems have historically been overlooked in diabetes interventions. This neglect may affect individuals' sexual self-concept and overall well-being. The purpose of this study is to investigate the relationship between sexual dysfunction and sexual self-concept in diabetics. Design: This research employs a scoping review design. Data Sources: A comprehensive literature search was conducted using databases such as Web of Science, Open Alex, Crossref, Google Scholar, PubMed, Scopus, and Semantic Scholar. Articles published between January 2018 and October 2023 were included. Review Methods: The analysis followed the Arksey and O'Malley model and PRISMA guidelines. 26 quantitative articles were reviewed, including 24 cross-sectional studies and 2 observational studies, all using quantitative methodologies. Results: Sexual dysfunction is prevalent among diabetes type 1 and type 2 in both men and women, influenced by physiological factors and glycemic control. Men may experience issues like diminished libido, premature ejaculation, and difficulty achieving orgasm, while women may face reduced sexual desire, arousal difficulties, and dyspareunia. Factors contributing to sexual dysfunction include age, duration of diabetes, glycemic control, comorbidities, medication use, psychological factors, and lifestyle elements like physical activity and stress levels. Sexual dysfunction in people with diabetes has a significant impact on sexual self-concept, which includes feelings, views, and beliefs about sexual relationships. Conclusion: There hasn't been any specific research conducted on diabetic patients concerning the correlation between sexual dysfunction and sexual self-concept, highlighting the need for dedicated studies to address this association and raise awareness.

Sex and concepts of sexuality influence sexual problems and help-seeking behaviours of older people

In this study, we aimed to examine the prevalence, associated factors, and management of sexual problems in older people at a primary care unit. We recruited people aged 60 years old and over, who visited the Primary Care Unit of Songklanagarind Hospital, a tertiary-care and referral centre in Southern Thailand, between June and August 2021, and used a self-administered questionnaire on sexuality, sexual problems, help-seeking behaviours, and clinical consultations for sexual problems in older people. There were 190 participants in this study (120 women, 70 men, mean age = 68.3). One hundred and five (55.3%) participants reported having sexual problems. Compared to their female counterparts, males were more likely to have sexual problems (adjusted OR = 3.11; 95% CI = 1.52,6.34; p-value = 0.001). The majority (77.3%) considered non-penetrative sexual activities (outercourse) when discussing sexuality in later life, and they had lower odds of having sexual problems compared to those who relied purely on sexual intercourse (adjusted OR = 0.27 for only outercourse and 0.30 for both intercourse and outercourse; p-value = 0.016). Only 2.1% (4/190) of participants reported that a physician had asked them about sexual problems. Participants reporting sexual problems (N = 105) often consulted their partners (25.7%) and friends (10.5%) or searched information from the internet (18.1%). According to this study, sexual problems in older people are common in primary care settings, but they tend to be poorly managed. Clinical discussions and interventions that are sensitive to gender differences and acknowledge the broadened concepts of sexuality in later life, e.g., encouragement to practice outercourse, may help improve sexual problems and well-being among older people.

The management of sexual problems in cancer patients

. The management of sexual problems in cancer patients. Sexual dysfunction is one of the most common and distressing consequences of cancer treatment. Many survivors face long-term effects such as treatment-induced menopause, altered gonadal function, and significant surgical disfigurement but some treatment-related sexual adverse effects are short-term. Many survivors do not feel prepared for potential sexual changes and often do not receive adequate support to manage sexual dysfunction. A concise review of the most common sexual problems experienced by cancer ptients is presented together with the main evidence based interventions to suggest to address sexual dysfunction.

Sexual health outcomes of PLISSIT-based counseling versus grouped sexuality education among Iranian women with breast cancer: A randomized clinical trial

In-person, individual counseling using the PLISSIT model is a well-known approach to help people with sexual problems. Evidence suggests that Grouped Sexuality Education (GSE) can be as effective as in-person sexuality education. The efficacy of PLISSIT versus GSE has not previously been evaluated in women with Breast Cancer (BC). In this paper, we report on the effect of PLISSIT versus GSE on self-reported sexual behaviors experienced by women after a BC diagnosis (n = 75). The women were randomly allocated into three groups, with 25 women in each arm. Data analysis of the intention-to-treat population (n = 65) revealed efficacy of both GSE and PLISSIT in improving sexual behaviors (p < 0.0001) with a positive change in sexual capacity, motivation and performance after 6- and 12-weeks post-intervention follow ups. We found the GSE model showed a greater efficacy than the PLISSIT model. Due to the substantial needs faced by women with cancer and the cost associated with implementing the PLISST model, GSE seems to be more effective. We recommend GSE for Iranian communities where management of sexual problems is at an early stage and where the sexuality of women with cancer is routinely overlooked.

The New Avatar of Female Sexual Dysfunction in ICD-11—Will It Herald a Better Future?

Female sexual dysfunction has always had challenges related to nosological issues due to inadequate research and understanding in this area. The ICD-11 has proposed substantial changes to the classification of conditions related to sexual health. In this review, we have discussed the proposed changes, compared with other classificatory systems and discussed its implications on clinical practice and research in this field. While there have been several progressive moves in the taxonomy of sexual dysfunctions, we have expressed our views on possible changes which can help with better diagnosis and management of sexual problems in women.

Effect of Standardized Oncology Nursing Care Intervention on Reducing Sexual Dysfunction among Cervical Cancer Survivors' Women

There were great sexual challenges reported by the cervical cancer survivors' women. The assessment and management of sexual problems should become an important part of the standard care of cancer survivors' women. There over the purpose of study was to assess the severity of sexual dysfunction symptoms and determining the effect of the standardized oncology nursing care intervention on reducing sexual dysfunctions among cervical cancer survivors' women. Women's sexual dysfunctions are assessed using Female Sexual Function Index (FSFI). “Pre-posttest” questionnaires supplemented by structured interview questionnaire are administered to 50 women diagnosed with cervical cancer and treated by chemoradiotherapy in the Menoufiya University of the oncology institute of the Menoufiya Governorate-Arab Republic of Egypt. Results revealed significant decrease in sexual dysfunctions among cervical cancer survivors' women as measured by the FSFI checklist at posttesting (11. 5±0.3 versus 27±0.2). Results along with the interviews revealed that the effectiveness of standard oncology nursing care intervention on reducing sexual dysfunctions among cervical cancer survivors' women. The study recommended that the nurses should provide educational counseling on sexuality after women having cervical cancer.

Medisinstudenters intensjon om å tematisere seksualitet i behandlingsrommet [Medical students’ intention to talk about sexuality in clinical practice

The purpose of this study was to assess medical students’ intention to ask their patients about sexuality. Data was collected from a self-selected sample of 411 medical students at the universities in Tromso, Trondheim, and Bergen. The results showed that, on average, medical students reported low levels of self-perceived competence related to the management of sexual problems in clinical practice. They also exhibited low levels of self-efficacy with regard to addressing non-traditional sexual issues. In addition, the results indicated that the intention to talk about sexuality in future clinical practice was predicted by sociodemographic characteristics, attitudes, self-efficacy, and competence. The most important factor for the prediction of intention was the attitude “normalization of sexuality.” Students with more self-perceived competence and more self-efficacy had a stronger intention to talk about sexuality in their future practice.

Qualitative Exploration of Sexual Health Among Diverse Breast Cancer Survivors.

Although the physical and emotional impact of surgical removal of partial or complete removal of the breast as well as effects of breast cancer treatment on the individual have been well documented, little research is available on sexuality and sexual health of breast cancer survivors in a relationship context. Sexual health concerns of breast cancer survivors remain an unmet need for many. The present study consisted of qualitative interviews with 135 racially diverse, female breast cancer survivors who completed treatment to better understand their perspectives on sexual health and management of sexual problems in their potential and existing relationships after breast cancer. Key thematic findings include that breast cancer survivors have to (1) adapt to the physical and emotional traumas of breast cancer surgery and treatment, (2) navigate complicated sexual communications with potential and existing partners, and (3) negotiate intimacy and closeness without sexual intercourse with existing partners. This study demonstrates the need for healthcare providers to discuss sexual health after breast cancer with all of their patients as it is a concern that faces single and partnered breast cancer survivors months and years after treatment.

Knowledge and Skills in the Assessment and Management of Sexual Problems by Different Physicians in a University Hospital

Objective: We analyze the knowledge of different medical specialists in relation to knowledge of the sexual dimension of their patients, as well as the attitudes and skills to listen and treat it. Design and Method: We used a validated FSP questionnaire: F= frequency with which the subject is confronted with the problem. S = given seriousness for the professional exercises. P = problems of skills to bring a response in terms of theoretical knowledge’s. Survey done with 62 different medical specialists: 19 gynecologists, 15 general practitioners, 13 urologists, 11 general surgeons and 4 medical oncologists. Comparisons of means were performed with Student t test. Results: (number = mean) (A) Frequency: a) personal awareness: higher in urologists (1.77), medical oncologists (1.5) and gynecologists (1.33) than in general surgeons (0.64)(p=0.001); b)professional confrontation with the sexual complaint: usual for urologists and general practitioners, less in medical oncologists and gynecologists and rarely in general surgeons (p=0.00); Urologists have a more proactive attitude (1.54) than gynecologists (1.05) and general surgeons (0.64) (p=0.03). (B) Seriousness: to be listening and reactive to sexual demand is more important for urologists than the remaining specialists. (C) Problems: theoretical knowledge: good in urologists (1.54) than the other specialists (gynecologists 1.0) (p=0.026). Conclusions: Urologists believe to have greater proactive and good knowledge to treat sexual problems of their patients compared to other physicians. It should encourage and conduct continuing education specific to different medical specialists, in order to have a proactive and sufficient knowledge about the sexual quality of life of the patients.

Talking with patients about sex: results of an interprofessional simulation-based training for clinicians.

Sexuality is often a neglected topic in healthcare consultations. Several factors have been identified by clinicians as barriers to communication around sexuality, including lack of time, inadequate training, and personal discomfort. Within the Program to Enhance Relational and Communication Skills (PERCS), we developed a half-day interdisciplinary workshop that focuses on communication skills around sexuality and management of sexual problems with patients (PERCS-sexuality). This study reports on the efficacy of six PERCS-sexuality workshops enrolling 84 clinicians. Through a pre-post-questionnaire, participants rated their preparation, confidence, anxiety, communication and relational skills in talking with patients about sexual issues. Qualitative questions were also asked on their learning experience. The workshop increased participants' preparation (p=0.000), confidence (p=0.000), communication (p=0.000), and relational skills (p=0.000). Anxiety did not decrease. Qualitative comments focused on: Acquisition of communication and relational skills, Importance of patient's sexuality, Appreciation of group dynamics, and Personal insights. The findings suggest that PERCS-sexuality is a useful training experience to improve clinicians' attitudes and skills in addressing sexuality with patients.

Sexual Problems and Quality of Life in Women with Multiple Sclerosis

Sexual problems (SP) are often experienced by people with multiple sclerosis (MS) and severely affect their quality of life. The aim of this study is to investigate the relationship between sexual problems and quality of life subscales. 132 women with MS from Iranian MS Society completed demographic and medical history questionnaire. Quality of life was measured by Multiple Sclerosis Quality of Life-54 (MSQoL-54) and sexual problems were quantified by MSISQ-19 which includes items for primary, secondary and tertiary causes of sexual problems. The data was analyzed by using SPSS-18 and Pearson’s correlation coefficients were used to examine relationships between sexual problems and quality of life subscales. Statistically significant correlation was found between sexual problems and quality of life subscales. Physical and mental components of MSQoL-54 were strongly correlated with secondary level of SP (p < 0.001, r = 0.702 and p < 0.001, r = 0.470 respectively). Of primary SP items decreased libido showed highly significant correlation with physical and mental components of MSQoL-54 (p < 0.001, r = 0.629 and p < 0.001, r = 0.499 respectively). Sexual problems such as decreased libido are highly correlated with quality of life in women with MS. Secondary SP had most correlations with quality of life subscales. Evaluation and appropriate management of sexual problems in MS patients can lead to improving their quality of life.

Management of sexual problems in cancer patients and survivors

As patients with cancer are now living long lives after cancer diagnosis and treatment, there has been a growing need to address specific treatment-related side effects that affect quality of life. In particular, sexuality is one of the most fundamental and complex experiences that is often profoundly affected by cancer treatment. Over the past century, researchers have constructed several models for understanding human sexuality. Within the oncology setting, a more mechanistic model of sexuality has been predominant, with focus almost exclusively on addressing physical sequelae and disruptions in organ function. More recently, efforts have been made to raise awareness regarding the complexity of sexuality after cancer, and some integrative models have been proposed. In this section, 3 of these models are briefly reviewed. The review of these models is not exhaustive, but rather meant to provide a prologue for a more comprehensive understanding of sexuality in the context of cancer care and to further frame the content presented throughout this article.

Education in Sexual Medicine: Proceedings from the International Consultation in Sexual Medicine, 2009

Sexual problems in men and women are common; and physicians endorse many barriers to addressing these issues, including lack of knowledge about the diagnosis and management of sexual problems and inadequate training in sexual health communication and counseling. To update the recommendations published in 2004, from the International Consultation on Sexual Medicine (ICSM) relevant to the educational aspects of sexual health in undergraduate, graduate, and postgraducate medical education. A third international consultation in collaboration with the major sexual health organizations assembled over 186 multidisciplinary experts from 33 countries into 25 committees. Three experts from three countries contributed to this committee's review of Education in Sexual Medicine. Expert opinion was based on a comprehensive review of the medical literature, committee discussion, public presentation, and debate. A comprehensive review about the current state of undergraduate, graduate, and postgraduate sexual health education worldwide is provided. Recommendations about ideal sexual health curricula across training levels are provided. Best methods for achieving optimal training approaches to sexual health communication and interviewing, clinical skills and management, and counseling are described. Current sexual health education for undergraduate and practicing physicians is inadequate to meet the advancing science and technology and increasing patient demand for high-quality sexual health care. There is a need for enhanced training in medical institutions responsible for physician sexual health training worldwide. Future training programs at all levels of medical education should incorporate standardized measures of sexual health clinical skills acquisition and assessments of the impact on patient outcomes into the design of educational initiatives.

Working interactively using a systemic sex therapy model for common sexual problems within a modern health service setting

Summary Sexual and Relationship Couples Psychotherapy is a specialist form of psychotherapy and counselling within which different theoretical perspectives may be employed by clinical staff. These include psychodynamic, family-of-origin, cognitive behavioural and systemic therapies. Systemic therapy has developed from a family systems background for the management of couples with relationship difficulties and in certain instances for couples with both relationship and sexual difficulties. The history and development of systemic therapy is described followed by a more specific review and outline of systemic therapy in the management of sexual problems. We go on to describe the specific training experience of a member of staff in systemic therapy to build upon the existing clinical framework employed within the service. Inherent for systemic therapy, there is a need for a team of observers, which in our clinic incorporates both staff and our postgraduate trainees. The experience of the member of staff learning specific skills in systemic sex therapy and live supervision of the team of her work during development of her skill set is explored and discussed. Issues around clinical outcomes and clinical governance are further described as our service is provided within a national health system service where these are considered mandatory.

Psychosexual counselling training for midwives

Many women and man report sexual problems or have been subjected to sexual abuse, or are dissatisfied with their sex life. Sexual counselling does not appear to be available as readily as desirable. Sexual problems are not yet a routine part of diagnostic work up and therapeutic planning. Nowdays the midwife is seen as a figure who can offer support and can provide sexual guidance and counsel. Psycosexual courses training for midwives have the purpose to train the midwives in discussing the psychology of interpersonal relationships and sexuality, the caratteristics of sexual dysfunction, in exploring cultural, religious and education factors which may inhibit a sexual relationship. The courses in sexual behaviour and counselling have the aims to increase the midwives knowledge of sexual behaviour and ability in sexual counselling, and in reducing anticipated anxiety or embarrassment in sexual discussion. This seminaris can facilitate access to recognition and possible sex treatment. Actually a midwife must acquire sexual knowledge, comfort and counselling skills. However one part of sexual dysfunction can be improved by sexual counselling if possible including the partner. If there are indications for sex therapy has to be clarified. The midwife can play an important role in facilitating healthful sexual changes in women and couple enhancing intimacy, reinforcing the “healthy” component of the symptom, in the sense of prompting a motivation for change. Midwives have an excellent opportunity to promote sex health, establishing a practise standard by incorporating a routine sex health assessment into each woman encounter. Of course there are sex therapists when the management of sexual problems requires more than counselling and reassurance.

Assessment &amp; management of sexual problems in women

Sexual dysfunction in women is, according to many studies, a common experience. The definition of dysfunction may vary widely, and there are concerns about distinguishing sexual concerns, difficulties, disorders and dysfunctions (SCDDD). However, such a differentiation may be useful during the initial assessment.

Assessment &amp; management of sexual problems in women

This article is the sixth in a series of articles on sexuality and sexual health.

ORIGINAL RESEARCH—EDUCATION: Predictors of Physicians’ Involvement in Addressing Sexual Health Issues

Although the World Health Organization has declared that sexual health is an integral part of overall health, physicians seem to engage in taking the sexual health history less than their patients would desire. This study aimed at investigating the factors that predict physicians' involvement in addressing sexual health issues, including their attitudes toward the doctor-patient relationship, as well as sexual issues. Physicians participating in educational courses on erectile dysfunction were the study sample, and anonymously and optionally completed a battery of questionnaires. In addition to demographics and a questionnaire on their involvement in taking sexual histories, the beliefs about the doctor-patient relationship were measured by the Patient-Practitioner Orientation Scale, while the Physician Belief Scale was used as the measurement of the psychosocial aspects of patient care. Finally, participants completed the Derogatis Sexual Functioning Inventory--Attitude subscale, in order to determine the possible role of physicians' sexual attitudes. Previous training in communication skills was found to be the strongest predictor for sexual history taking. Physicians addressing patients' psychosocial concerns were found to be more likely to ask for sexual health problems and to consider their management as less difficult. Other identified predictors of their involvement in sexual history taking were their medical specialty-possibly reflecting their level of education in sexual medicine--and having liberal sexual attitudes; female physicians and general practitioners reported more difficulty in dealing with sexual problems. Physicians' training in communication skills seems to be fundamental for sexual history taking and the management of sexual problems, as it improves their level of comfort in dealing with sexual issues; exposure to sexual medicine courses, and psychosocial orientation, as well as physicians' personal sexual attitudes, are also important factors affecting their involvement in sexual medicine.

ORIGINAL RESEARCH—EDUCATION: Sexual Communication Skills in Residency Training: The Robert Wood Johnson Model

Few medical schools or residency programs offer adequate training in sexual medicine. Using the experience gained in our long-standing program in human sexuality for medical students, we have pilot tested a half-day intensive workshop curriculum for residents that focuses on sexual communication skills and management of sexual problems. Unlike our medical school program, this residency course was offered on an elective, one-day basis. The current report describes the successful implementation of our pilot program with 46 medical residents from subspecialty and primary care residency programs. Before the workshop, 22 (48%) residents indicated that they were uncomfortable with open discussion of sexual issues and would not feel comfortable in addressing the topic with their patients. A number of factors were identified as barriers to communication, including lack of time, inadequate training, and personal discomfort. After the workshop, the participants rated themselves as more comfortable with the topic and as more likely to address sexual issues with their patients. The participants evaluated the workshop positively overall and responded well to the interactive format and audience-response components. Most of the participants showed interest and willingness to participate in further training in sexual medicine skills. Our program offers a model for training of residents in communication skills and management of sexual problems. The difficulties in implementation and overcoming institutional barriers to curriculum reform are addressed.

Sexual Functioning in Cancer Patients

Controversy exists regarding the extent and nature of sexual problems in cancer patients. The incidence of sexual problems varies in published studies irrespective of the cancer site. Most of the studies are retrospective and descriptive in design and many do not take into account the preexisting physical, psychosocial, sexual, and marital problems. However, it is clear that sexual problems are common in cancer patients and may be caused by all the available treatment options. Management of sexual problems in this patient population has not been systematically studied. This article reviews prevalence of sexual problems that result from various treatment modalities (such as surgery, radiotherapy, and chemotherapy) and describes guidelines for management of sexuality related issues in cancer survivors.