Psychosexual Education Research Articles

Evaluating the Feasibility and Acceptability of a Psychosexual Intervention for Couples Post-allogeneic Hematopoietic Stem Cell Transplantation.

Allogeneic hematopoietic stem cell transplantation (HSCT) can have a long-term impact on patients' sexual functioning and consequently, their relationship satisfaction. This study aimed to examine the feasibility and acceptability of a 5-session psychosexual intervention for HSCT survivors and their partners. To be eligible patients were required to be more than 3 months post-allogeneic HSCT. The intervention comprised 2 components: (1) A psychosexual education session exploring medical/behavioral treatment options for sexual dysfunction, delivered by a specialist nurse; (2) A 4-session Emotionally-Focused Therapy-based relationship education program for couples delivered by a clinical psychologist. Measures assessing relationship quality, sexual functioning, anxiety, and depression were administered pre- and post-intervention. Feasibility was measured via participation rate, adherence and compliance with completing main measures. Acceptability of the intervention was assessed via patient/partner satisfaction surveys. Eight of 85 (9.4%) eligible patients and their partners participated in the study. Reasons for declining participation included: feeling uncomfortable due to sensitive nature of intervention; did not have any relationship/sexual function issues; and experiencing ongoing medical issues. Six of 8 couples (75%) attended at least 4 intervention sessions and 5 of 8 (62.5%) completed the main study measures post-intervention. Four couples reported that sexual satisfaction and relationship satisfaction was somewhat or much better post-intervention; 1 reported no change. Feasibility criteria were not met, with low enrolment rate, however the intervention was deemed acceptable. Couples who participated adhered to the intervention and considered it beneficial. Further strategies to identify and manage sexual concerns are required.

The complexities of delivering a home-school based comprehensive sexuality curriculum to visually impaired learners

Following the ongoing study to develop a Comprehensive Sexuality Education (CSE) curriculum for visually impaired learners in South Africa, teachers reported hesitance from parents/guardians to inform their visually impaired children about sex. As such, this study sought to explore parents/guardians’ involvement in their children’s psychosexual education. Five parents/guardians were engaged in a focus-group discussion. Data were analysed thematically, while home-school partnership theory underpinned this study. Parents felt confident that they had prepared their children with enough psychosexual education to make healthy sexual choices, and therefore blamed teachers, security guards, and hostel caretakers for their children’s early sexual debut. However, no blame or accountability was assigned to the learners for their own sexual behaviour and decision-making. Interrogating the complexities within these socio-educational spaces suggested that there was confusion in the roles and responsibilities assumed for the capacitation of visually impaired learners with CSE. More importantly, the problem was not that parents were worried that these learners were not having safe sex, but that they should not be having sex at all now or in the future. The study suggests that a supportive, non-judgemental, and collaborative home-school partnership is necessary to recognise and guide the sexual agency of visually impaired learners.

Sexual quality of life after gynaecological cancer: what young women want.

Psychosexual distress is known to be a common complication of treatment for gynaecological cancer (GC), affecting the sexual quality of life (SQoL) for an increasing number of young gynaecological cancer survivors (YGCS). The SQoL in YGCS study aimed to identify strategies that are acceptable and helpful to YGCS in protecting and improving SQoL, using a salutogenic approach. A qualitative study was undertaken with young women aged 18-45 and pre- or perimenopausal at diagnosis. Semi-structured interviews were conducted on Zoom and a thematic analysis of transcripts was completed in NVivo. Fifteen interviews with YGCS revealed three themes for strategy development: psychosexual education, psychosocial support, and healthcare policy and strategy to establish SQoL as standard care in gynaecologic oncology. The strategies put forward by YGCS showed the need for a holistic, patient-centric, and multidisciplinary approach to SQoL. A better understanding of the strategies acceptable to YGCS, including the importance of using a trauma-informed approach to communication and care, can help healthcare providers play a vital role in protecting and improving SQoL.

P-558 The importance of sexual desire for the sexual health of infertile women and men starting their fertility clinic journey

Abstract Study question Is the sexual desire of infertile women and men correlated with their intercourse frequency and sexual satisfaction? Summary answer Both partner’s sexual desire is moderately correlated to intercourse frequency and their own sexual satisfaction and weakly correlated to the sexual satisfaction of their partner. What is known already Reviews showed that infertile couples have worse sexual health than the general population. Qualitative studies explained that infertile patients feel less attractive and consider intercourse a ‘duty’, associated with failure. Fertility clinics offer diagnosis and treatments but have yet to start caring for sexual health. The Pleasure&Pregnancy-programme, combining psychosexual education with communication, mindfulness and sensate focus exercises, recently proved to increase the sexual desire of infertile women pursuing natural conception. Whether improving sexual desire can be expected to increase the intercourse frequency and sexual satisfaction of women and men about to start fertility treatment had yet to be explored. Study design, size, duration A cross-sectional cohort of 140 heterosexual couples (n = 280; response rate 51%) was surveyed between 2019 and 2022. Couples filled out a package questioning their sexual health over the past four weeks at a chosen moment between their first fertility clinic consultation and the end of their diagnostic workup. This package included a questionnaire to be filled out by each partner individually and a couple questionnaire. Non-responders received were reminded. Participants/materials, setting, methods Sexual desire and satisfaction of women and men was assessed with subscales of the following valid and reliable questionnaires: Female Sexual Function Index in women (FSFI; the higher, the better) or International Index of Erectile Function in men (IIEF; the higher, the better). Intercourse frequency of couples was assessed with a sexual activity event log. Spearman rho’s correlations assessed associations between sexual desire, sexual satisfaction and coital frequency. Main results and the role of chance Responding women and men were in their early thirties and had tried to conceive naturally for 18.2 months, on average. The sexual desire of women (and of men was not correlated (r = 0.116, p = 0.178). Couples had sexual intercourse seven times per month (7.12±4.03), on average. The sexual desire of both women and men was moderately correlated to couple’s intercourse frequency (♀: r = 0.402, p < 0.001; ♂: r = 0.426, p < 0.001). The sexual desire of women was also moderately correlated to their own sexual satisfaction (r = 0.481, p < 0.001) and weakly correlated to the sexual satisfaction of their male partner (r = 0.270, p = 0.001). The sexual desire of men was significantly but weakly correlated to their own sexual satisfaction (r = 0.361, p < 0.001) and the sexual satisfaction of their female partner (r = 0.239, p = 0.005). Limitations, reasons for caution The sexual health of the included couples is currently followed-up during fertility treatment. Linear mixed models, taking account of dyads and of multiple assessments, would allow analysing the impact over time of women’s sexual desire whilst taking account of the sexual desire of her male partner and vice-versa. Wider implications of the findings Sexual desire seems important for a couple’s coital frequency and both partner’s sexual satisfaction. Examining whether a six-month sexual health programme that improves women’s sexual desire, could in the longer term improve intercourse frequency and especially sexual satisfaction or prevent the deterioration thereof would be interesting. Trial registration number not applicable

Clitoral Therapy Device for Alleviating Sexual Dysfunction After Female Genital Mutilation: Randomized Controlled Trial

Female genital mutilation is considered a crime but is still practiced today in Africa and the Middle East, despite all the laws that make this procedure illegal due to the long-term physical and psychological harm it causes to women. Millions of girls and women living today have undergone genital mutilation, which involves removing the external female genitalia either partially or totally, based on the belief that it restricts feminine sexuality, thereby "saving" a girl for marriage. For girls and women, the surgery offers no health advantages. Girls' right to control critical decisions regarding their sexual and reproductive health is violated because genital mutilation is frequently done against their will and frequently without their consent, leading to lifelong psychic trauma in addition to sexual dysfunction and lack of satisfaction due to distortion of the genitalia that threatens marital stability. To determine the effect of a clitoral therapy device on improving sexual domains in women suffering from sexual dysfunction after female genital mutilation. This study examined 80 married women aged from 20 to 45 years who were referred from the gynecology outpatient clinic of the Faculty of Medicine, Suez University, for sexual dysfunction resulting from female genital mutilation. The women were divided into 2 equal groups: the study group received a clitoral therapy device and traditional psychosexual education and were closely followed for 3 months, while the control group received only traditional psychosexual education for 3 months. The Arabic version of the Female Sexual Function Index (FSFI) questionnaire was used to assess sexual outcomes pre- and posttreatment in the 2 groups. Our findings revealed a significant increase in the 6 domains of the FSFI pretreatment in both groups compared to posttreatment (P>.001), except the orgasm domain in the control group, which showed only a nonsignificant increase (P=.16). Clitoral therapy devices may be an effective, safe, noninvasive rehabilitation method for sexual dysfunction following female genital mutilation. ClinicalTrials.gov NCT05039775; https://clinicaltrials.gov/ct2/show/NCT05039775.

Psychosexual Education Interventions for Autistic Youth and Adults—A Systematic Review

(1) Background: The literature shows a general lack of sexual knowledge and appropriate sexual health education in persons with Autism Spectrum Disorders (ASD). Moreover, the existing interventions mainly target the neurotypical population, without addressing the specific needs of individuals with ASD. (2) Aims: The current systematic review aimed at analyzing the literature encompassing psycho-educational interventions on sexuality addressed exclusively to people with ASD, in order to report the good practices and to describe the effectiveness of the existing programs. (3) Methods: The systematic review followed the PRISMA-P method. The literature search was conducted in June 2022, examining PsycInfo, PsycArticle, PubMed, and Education Source. The search strategy generated 550 articles, of which 22 duplicates were removed, 510 papers were excluded for not matching the criteria, and 18 articles were finally included. (4) Results: Ten papers presented good practices and eight focused on intervention validation. The analysis showed that the good practices were essentially applied in the intervention studies. No intervention proved to be successful both in increasing psychosexual knowledge and in promoting appropriate sexual behaviors; thus, further research is needed. (5) Conclusions: The current review allows for critical reflection on the need for validated sexuality interventions.

İlk Koitus Sonrası Gerçekleşen Genital Yaralanmaların Sonuçları

Abstract Background: In this study, we aimed to investigate the outcomes of the first coitus injuries in newly married couples, which are common in our society. Material and Methods: This is a retrospective study involving 89 patients admitted to the obstetrics and gynecology clinic of our hospital with the complaint of bleeding secondary to postcoital vaginal discharge between January 2017 and December 2020. Results: The mean age of 89 patients admitted due to postcoital genital injury was 26 ± 8 years. All 89 of the patients had genital injury in the first coitus. The mean number of lesions was 1.4 ± 0.73 and their dimensions were 2.7 ± 0.96 cm. 65% of the patients were in primary and lower education groups. The main localizations of genital injuries were 29 in the vaginal introitus, 13 in the right lateral, 10 in the left lateral, and 10 in the posterior fourchette. Preoperative mean hemoglobin level was 11.2 ± 1.78 and postoperative hemoglobin level was 9.8 ± 1.3. The mean operation time was 21.2 ± 7 minutes and the hospital stay was 1.04 ±0.2 days. 19 of the interventions were repaired under local anesthesia under office conditions and 70 were repaired under spinal anesthesia or sedoanalgesia in the operating room. Conclusions: Vaginal injuries after coitus are considerably high. After these injuries, there is rapidly developing and life-threatening bleeding. Premarital couples receiving psychosexual education, preventing pregnancies at an early age, and conducting socio cultural-based studies may help to reduce genital injuries after the first coitus.

O-092 The ‘Pleasure&Pregnancy’ eHealth programme and its effect on the sexual functioning and ongoing pregnancy rates of couples with unexplained subfertility: a randomized controlled trial

Abstract Study question Does offering the ‘Pleasure&Pregnancy programme’ rather than expectant management affect sexual desire, pleasure and satisfaction, intercourse frequency and ongoing pregnancy rates in subfertile couples? Summary answer The ‘Pleasure&Pregnancy programme’ limits the decline in sexual desire and intercourse frequency but does not affect sexual pleasure and satisfaction and ongoing pregnancy rates. What is known already Dutch guidelines advise six months of non-interactive expectant management, in couples with unexplained subfertility and Hunault-prognosis of minimally 30%, rather than immediately starting assisted reproduction. Adherence to this advice is limited as both couples and fertility clinic staff feel an urge for action. Underpowered studies indicated that face-to-face sex-counselling may increase the pregnancy rates of these couples. Interactive eHealth programmes proved as effective as face-to-face sex counselling in other patient populations. Our group developed the interactive six months Pleasure&Pregnancy web-based programme, aiming to help couples maintain or improve sexual pleasure and activity and consequently increase chances on naturally conceived pregnancies. Study design, size, duration This multi-centre trial randomised 701 couples between six months of the Pleasure&Pregnancy programme (n = 349) or expectant management, the current standard of care (n = 353) from 2016 to 2021. The Pleasure&Pregnancy web-based programme contains eight modules combining psychosexual education with couple communication, mindfulness and sensate focus exercises and additionally enables couples to interact with professionals and peers. Sexual outcomes were assessed with a diary and reliable questionnaires at baseline, three and six months. Participants/materials, setting, methods Heterosexual couples with unexplained subfertility and a Hunault-prognosis of minimally 30% were included after their diagnostic work-up in 41 Dutch fertility clinics. All analyses were according to intention-to-treat principles. Differences between groups in ongoing pregnancy rates (naturally conceived within six months after randomization; primary outcome) were expressed as relative risks (RR). Linear mixed models assessed time, group and interactive effects on female/male sexual desire, pleasure and satisfaction, and intercourse frequency; mean differences (MD) are provided. Main results and the role of chance Response rates at baseline, three and six months for the diaries assessing sexual pleasure (Quality of Sexual Experience; QSE) were, respectively: 55.8%, 33.9% and 16.8%. For the International Index of Erectile Function (IIEF) and the Female Sexual Function Index (FSFI) questionnaires assessing intercourse frequency, sexual desire and satisfaction response rates were, respectively: 83.2%, 50.8% and 41.2%. The probability of a naturally conceived ongoing pregnancy within six months after randomization did not differ between the randomized groups, and was 22% (n = 78/349) in the Pleasure&Pregnancy-group and 24% (n = 83/353) in the control group (RR 0.94; 95% CI 0.67 to 1.32). Neither did the groups differ in time to pregnancy (log rank p = 0.46). Both female and male sexual pleasure and satisfaction was comparable in both groups and did not change over time. Male sexual desire (scale 2-10) remained over time in the Pleasure&Pregnancy-group but decreased in the control group (MD 0.47, 95%CI 0.28 to 0.67, p < 0.001) and a similar trend was observed in females (MD 0.16, 95%CI -0.02 to 0.33, p = 0.086). Intercourse frequency declined over time in both groups (MD over 6 months -1.05, 95% CI -1.47 to -0.62, p < 0.01), but less in the Pleasure&Pregnancy- group (MD 0.3, 95% CI 0-0.6; p = 0.05). Limitations, reasons for caution The intended sample size of 1164 was not reached, although the inclusion period was doubled. Web-based tracking showed limited intervention adherence, indicating the need for per protocol analysis in addition to this intention-to-treat analysis. Examining user experiences with the Pleasure&Pregnancy programme would be of interest and might explain adherence rate. Wider implications of the findings Clinics are advised to offer the Pleasure&Pregnancy or similar programme to care for the sexual health of couples with unexplained subfertility. The Pleasure&Pregnancy programme did not increase naturally conceived ongoing pregnancy rates but did help couples maintain their sexual desire and intercourse frequency, while continuing to attempt natural conception. Trial registration number NTR5709

Tocophobia

ABSTRACT Introduction Fear of childbirth is common during pregnancy and is believed to be the most common underlying reason for requesting a caesarean section without medical indication. Despite the fact that 17%-20% of all pregnant women report extreme fear of birth, named tocophobia, in ICD -10 International Classification for Disease-10 revision – ICD-10,) there is not established diagnose Tocophobia, which can also occurs in non-pregnant women and in men. Primary tocophobia may have its onset in adolescence, affecting nulliparous women to such degree that some women never bear a child. They also describe sexual dysfunction as vaginismus and non-consummation. Secondary tocophobia may be associated with a previous traumatic birth experience such as stillbirth. Tocophobia is not just associated with antenatal psychological morbidity, but also raised rates of postnatal depression, impact on the mental well-being of the baby for life, increased length of labour, lower birth weights and increased prevalence (8%) of admission to neonatal intensive care. They can have feelings of isolation, guilt and shame, difficulties to prepare for birth. They may have sleeplessness, nightmares, stomachaches and depression with anxiety that can leads to panic attacks. Women may also be concerned with pain, their own incapability, possible obstetric injuries, lack of control, lack of partner or family support, and loss of their baby. The interventions included psychosexual education, cognitive behavioural sex therapy. Therapeutic interventions reduce the number of women who go on to have caesarean birth. Tocophobia is a common condition with both acute and chronic implications for the welfare of mothers and babies. It can cause not only mental but also physical morbidity and needs a clear both plan for the care of women and her specific fears. Objective Couple has started with couple sex therapy for his problems with erection before they have children. They are married; they have already two children (5y, 3y). She has recently discovered that she is pregnant for the third time and she is in gestational week 8. As nulliparous woman, she has developed sever tocophobia. She has intensive therapy with clinical psychologist through all first pregnancy time, but she still developed minor postpartum depression but without any need for antidepressants. Methods We present a case of a 40-years old woman with sever tocophobia and the results of the treatment interventions. Results Treatments include sensitive psychosexual education about the birth process, development of problem-solving skills, teaching coping strategies for labour. Conclusions Tocophobia is a common condition with both acute and chronic implications for the welfare of mothers and babies. It can cause not only mental but also physical morbidity and needs a clear both plan for the care of women and her specific fears. Disclosure Work supported by industry: no.

The Effect of Psychosexual Education on Promoting Sexual Function, Genital Self-Image, and Sexual Distress among Women with Rokitansky Syndrome: A Randomized Controlled Clinical Trial.

To assess the effectiveness of psychosexual education on promoting sexual function and genital self-image and reducing sexual distress through e-learning among women with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome. Randomized controlled trial. Imam Khomeini Hospital "Pelvic Floor Clinic" in Tehran. Thirty-eight 15- to 49-year-old women with MRKH syndrome who had undergone surgical or nonsurgical vaginal reconstruction techniques more than 6 months before the intervention were assigned to 2 parallel intervention and control groups of 19 each. Psychosexual education was delivered through e-learning for the intervention group over an 8-week period, with no limitations of time and space. Sexual function, genital self-image, and sexual distress were evaluated at baseline, and at 4 and 8 weeks after the intervention. The data collection tools included the Persian version of the Female Sexual Function Index, Female Genital Self-Image Scale, and the Revised Female Sexual Distress Scale. The between group mean differences of sexual function, genital self-image, and sexual distress after 4 weeks (-1.2 [95% CI, -2.1 to -0.1], P=.025; -1.9 [95% CI, -2.9 to -0.9], P < .001; 4.2 [95% CI, 2.0-6.4], P < .001, respectively), as well as after 8 weeks (-1.8 [95% CI, -3.1 to -0.5], P=.009; -3.0 [95% CI, -4.5 to -1.5], P < .001; 6.7, 95% CI, 3.9-9.6], P <0.001, respectively) after baseline were significant. Psychosexual education improved sexual function and genital self-image and reduced sexual distress in women with MRKH syndrome. Therefore, using this approach, we can raise individuals' sexual knowledge and skills and correct their sexual beliefs and attitudes.

Image-Based Sexual Abuse: Social and Legal Implications

Widely referred to as either “revenge porn” or “nonconsensual sharing of sexual imagery,” image-based sexual abuse targets millions of people around the world and causes much harm. This article covers the current state of social scientific knowledge on this key variant of digitized sexual violence and suggests new directions in empirical work. A rapidly growing body of research shows that image-based sexual abuse is committed mainly by men against women and it often co-occurs with offline forms of male-to-female assaults like rape, stalking, and beatings. Additionally, to further understand the scope of factors that contribute to the problems of online image-based sexual abuse online, researchers should examine the relationship between image-based sexual abuse and pornography consumption. Future studies should be specially designed to test theories that prioritize the concepts of gender, power, control, and patriarchy. Further, despite the creation of new legislation aimed at curbing image-based sexual abuse, the criminal justice system’s response has, thus far, been woefully inadequate. Hence, additional means of prevention and control are necessary. A multidisciplinary approach may involve mental health and sexual wellness awareness campaigns that include ethical behaviors in a digital space. Also, clinical assessment and treatment may be part of creating long-term changes at individual, interpersonal, and societal levels with psychosexual education that investigates core beliefs and harmful operating systems that facilitate image-based sexual abuse. Moreover, testing and providing empirically validated treatments for those who experienced sexual trauma and those who perpetrated and consumed digitized sexual abuse are warranted.

Psychosexual knowledge and education in autism spectrum disorder individuals.

Autism spectrum disorder (ASD) is a highly prevalent neurodevelopmental condition. Autism spectrum disorder individuals are interested in sexual activity and pursuing romantic relationships, yet they often lack psychosexual knowledge and engage in risky sexual behaviors. The special learning needs of ASD individuals influence their exclusion from educational and social settings, resulting in fewer opportunities to acquire sex knowledge from reliable sources. This review aimed to explore factors influencing sexual knowledge and evaluate outcomes of comprehensive, ASD-tailored psychosexual education. PubMed, PsychINFO, and EBSCOhost databases were used to locate peer-reviewed articles in English in the 5 years between 2013 and 2018. Keywords included "autism spectrum disorder," "child abuse," "sexual," "sexual offenses," "sexual abuse," and "sexual education." Nine articles were included in the review. Compared with neurotypical adults, ASD adults had less sex-related knowledge, more victimization experiences, and obtained sexual information from more nonsocial sources. Knowledge is a partial mediator between ASD diagnosis and sexual victimization. Parents expressed having little support to educate their offspring and provided less sex education to children with intellectual disability and severe symptoms. Psychosexual education programs that are tailored to suit developmental and cognitive differences of ASD individuals increase knowledge and improve parent-child communication, especially for younger adolescents. Nurse practitioners who care for ASD individuals should assess knowledge and victimization experiences, assess parent perceptions and concerns, and provide guidance for developmentally and intellectually appropriate sex education. These should be incorporated into practice starting at a young age and continue across the lifespan.

Study protocol of a pilot study evaluating feasibility and acceptability of a psychosexual intervention for couples postallogeneic haematopoietic stem cell transplantation

IntroductionSexual dysfunction is one of the most common side effects of allogeneic haematopoietic stem cell transplantation (HSCT) for haematological cancers. Problems can persist between 5 and 10 years post-transplant and...

The stepwise development of an interactive web-based sex education programme for subfertile couples: the Pleasure & Pregnancy programme.

Can we develop a web-based sex education programme (programme running in a web browser) that addresses the needs of subfertile couples who are advised expectant management for at least 6 months? The 'Pleasure & Pregnancy' programme addresses couples' needs, is likely to improve couples' sexual functioning, and is subsequently hypothesised to improve the chance of natural pregnancy. According to professional guidelines (e.g. the Netherlands and UK) couples with unexplained subfertility and a good chance of natural pregnancy, should be advised at least 6 months of expectant management. Adherence to expectant management is challenging as couples and gynaecologist prefer a more active approach. Targeting sexuality may be useful as subfertility is a risk factor for decreased sexual functioning. A novel programme was developed according to the three steps of the Medical Research Councils' (MRC) framework. First, relevant literature was explored. Second, an interdisciplinary expert panel developed a theory (based on a systematic literature review and patient interviews) on how the chance of natural conception can be improved. Third, the expected process and outcomes were modelled. Two licenced clinical sexologists, two gynaecologists, a clinical embryologist and two midwife-researchers, all from Belgium and the Netherlands, proposed components for the sex education programme. PubMed was searched systematically for randomised controlled trials (RCTs) evaluating the proposed components in different patient populations. The needs of 12 heterosexual Dutch or Belgian couples who were advised expectant management were explored with in-depth interviews. The content and delivery characteristics of the novel programme were described in detail with the aid of 'Intervention Taxonomy'. To model the outcomes, a protocol for an RCT was designed, registered and submitted for publication. To help maintain or improve sexual functioning, mainly pleasure, and hence increase pregnancy rates, the web-based Pleasure & Pregnancy programme contains a combination of psychosexual education and couple communication, mindfulness and sensate focus exercises. Information on the biology of conception and interaction with fertility clinic staff and peers were added based on couples' needs to increase potential acceptability. This paper outlines the development phase of a sex education programme according to the MRC-framework. Whether the Pleasure & Pregnancy programme actually is acceptable, improves sexual functioning, increases pregnancy rates and is cost-effective remains to be determined. No previous interactive web-based sex education programme has aimed to increase the natural pregnancy rate of subfertile couples by targeting their sexual pleasure. The Pleasure & Pregnancy programme addresses couples' needs and its effect on sexual functioning and pregnancy rate is plausible but remains to be demonstrated by an RCT which is currently ongoing. Funding was provided by The Netherlands Organisation for Health Research and Development (ZonMw), Flanders Research Foundation and the University of Amsterdam. C.B.L. is editor-in-chief of Human Reproductionbut was blinded to all parts of the peer review process. The remaining authors have no conflict of interest to report. Not applicable.

The effectiveness of psychosexual education program on psychological dimensions of sexual function and its quality in cardiac rehabilitation patients

Objectives: The study aimed to assess the efficacy of a psychosexual education program (PSEP) on the psychological dimensions of sexual function and its quality in cardiac rehabilitation (CR) patients. Methods: In this randomized clinical trial, 43 male patients undergoing coronary artery bypass graft were selected randomly and then divided into case (n = 23) or control groups (n = 20). The research instruments consist of multidimensional sexual questionnaire and Sexual Quality of Life Questionnaire. Levin's PSEP (two 1-hour sessions) is presented as an intervention program. Data were analyzed through multivariate analysis of covariance to control the baseline scores. Results: Approximately 84% of patients (cases: 87% and controls: 80%) completed the final assessment. The results indicated that PSEP is significantly effective in the enhancement of sexual assertiveness (P = 0.034) and reduction of fear about intercourse (P = 0.007). There were no significant differences between two groups in other variables (P > 0.05). Conclusion: The results of the study indicated that PSEP is effective in the promotion of sexual assertiveness and fear of intercourse among CR patients. As the resumption of sexual function is one of the most important components in the psychosocial improvement of patients, it seems that this intervention should be included as a priority among educational programs in Iranian CRs.

Individual Psychosexual Counseling Is One of the Educational Necessities for Cardiac Rehabilitation of Patients in Iran

Cardiovascular diseases (CVDs) are debilitating conditions with long-term physical and psycho-logical consequences (1). After a cardiac event or procedure, the patient encounters several problems, two of the most important of which are psychosexual dysfunction and difficulty in resuming sexual activity (2-4). The World Health Organization (WHO) defines sexual health as a state of physical, emotional, psychological, and social well-being related to sexual interaction and sexuality (2). Resuming sexual activity is a common concern among patients, such that in nearly half of patients resuming sexual activity is associated with fear (5). In the developed countries, despite cultural constraints and shame, numerous cardiac patients frequently request information on how to resume sexual activity (2). However, the evidence suggests that information on sexual issues is not easily available to patients, which can lead to misper-ceptions among patients on how to resume sexual activity (2, 6). According to the available evidence, 37-76% of cardiac patients experience changes in their sexual activity, only in 42% of whom these issues are raised with the treating physician (7, 8). However, in the developing countries, only 11% of patients receive information about sexual life after a cardiac event (7) and Iran is no exception in this regard. Barriers to sexual activity include lack of need for patients by health professionals, lack of experience of care providers, time constraints, linguistic and cultural barriers, as well as fear and shame (6). After cardiac event or procedures, doubt about resuming sexual activity, fear of sudden death during sexual intercourse, inadequate knowledge about when and how to resume sexual activity, as well as sexual anxiety and depression are the main obstacles cardiac patients face (9, 10). Based on the repeated recommendations of professionals and researchers on this issue, psychosexual counseling and rehabilitation is one of the educational needs of this group of patients (2, 3, 6, 8, 11), and the focus of sexual counseling strategies should be on assuaging patients' anxiety and the healthy resumption of sexual activity (3). Counseling and psychosexual education can be presented to patients in the form of verbal (face to face counseling), written (books and pamphlets), and visual (photos and videos) information (2, 6). The content of sexual education and psych-osexual counseling with a focus on psychosocial homework, including cognitive behavioral therapy and social support, can be effective in reducing patient anxiety and problems (6). In addition, in relation to delivery format of psychosexual counseling to cardiac patients, various approaches were proposed and it seems that culture plays an important role in choosing the appropriate format. Based on pair, group, or one-on-one teaching methods and seminars despite being used in different parts of the world (2, 6), it seems that one-on-one approach is more appropriate for the Iranian culture. Our experience in Kermanshah center of cardiac rehabilitation showed that patients do not welcome pair and group meetings and they generally refuse to participate in meetings and ask their questions. However, creating a private and safe environment with a same-sex counselor can facilitate participation of patients. Given that the sexual problems of men and women, and consequently, their needs are different (4), content of interventions should be defined according to the needs of each sex. Therefore, we recommend providing one-on-one psychosexual counseling, as one of the educational requirements of patients, in cardiac rehabilitation centers of Iran.

Vaginal and sexual health treatment strategies within a female sexual medicine program for cancer patients and survivors.

We sought to evaluate patient adherence and response to simple vaginal and sexual health treatment strategies in female cancer patients receiving treatment at a female sexual medicine and health program and identify improvements of physical symptoms, per patient and clinical evaluation. Evaluability criteria included gynecologic exam at initial visit, at least one follow-up with gynecologic exam within 8months of initial visit, and all consecutive follow-ups <6months apart. Demographics, medical information, and clinical assessments from 175 evaluable patients with at least one follow-up from 09/12 to 10/14 were analyzed. The majority of patients were being treated for or had a history of breast (n=90, 53%), gynecologic (n=54, 32%), or colorectal/anal (n=15, 9%) cancers. An assessment form included a clinician evaluation, Vaginal Assessment Scale (VAS), Vulvar Assessment Scale (VuAS), and patient-reported outcomes. Compliance with treatment recommendations were summarized, and changes over time were compared for clinical outcomes. Mean number of visits was 3.43. Mean age was 55.4years; 92% (n=155/169) were in menopause. Treatment strategies included rationale and instruction for use of vaginal moisturizers, lubricants, pelvic floor exercises, and dilator therapy, in addition to psychosexual education regarding sexual changes (response, anatomy, and function) associated with cancer treatment and support. At last assessment, 89% had complied with the clinical recommendation (moisturize 2-5+ times/week). Vaginal pH scores >6.5 declined over time (p=0.03). VAS scores improved by last assessment (p<0.001), as did VuAS scores (p=0.001). Sexual function scores significantly improved (p<0.001), confidence about future sexual activity increased (p=0.004), and sexual/vaginal health concerns decreased (p=0.00003). Significant changes were observed in women using treatment strategies, with improvement in vulvovaginal symptoms, a decrease in elevated vaginal pH and pain with exams, enhanced sexual function, and increasedintimacy confidence. These findings have high clinical relevance for symptom management with improvement of sexual function using simple strategies and clinical tools in the oncology setting.

Evaluation of Quality of Life Therapy Effectiveness in Contrast to Psycho-Sexual Education on Sexual Self-Concept of Iranian Women

Background: Quality-of-life therapy (QOLT) is an integrative psychotherapy that was formed by adding positive psychology concepts to cognitive-behavior therapy (CBT). Objectives: The aim of the current study was to evaluate the efficacy of QOLT on the sexual self-concept of Iranian women. Patients and Methods: A double-blind randomized experimental study was done from February 2011 to January 2012. The study subjects were recruited from a mental health nongovernmental organization in Isfahan, Iran. They were assigned randomly to two groups. The first group was under ten sessions of QOLT, and the second, as a control group, was under psycho-sexual education (PSE). General Health Questionnaire-28 (GHQ-28), the Multidimentional Sexual Self-Concept Questionnaire, and the Female Sexual Function Index (FSFI) were completed for participants before and after the intervention. The ANCOVA model was used for analysis. Results: The findings revealed no significant differences between the two groups in mental health (GHQ-28 scores) and female sexual dysfunction, but sexual self-concept changed. Two subscales of sexual self-concept, sexual monitoring (QOLT group = 6.3 ± 2.7 vs PSE group = 4.7 ± 3.1 P < 0.05) and sexual-problem management (QOLT group = 15.4 ± 3.8 vs PSE group=13.7 ± 3.9 P < 0.05), increased significantly during QOLT. Conclusions: QOLT did not impact mental health, but it could change many dimensions of sexual self-concept.

Prostate cancer survivorship and psychosexual care

With increasing numbers of prostate cancer survivors, it is vital that follow-up care meets their needs. The authors propose that psychosexual education and rehabilitation should become a standard element of survivorship care.

Standard Operating Procedures in the Disorders of Orgasm and Ejaculation

Ejaculatory/orgasmic disorders are common male sexual dysfunctions and include premature ejaculation (PE), inhibited ejaculation, anejaculation, retrograde ejaculation, and anorgasmia. To provide recommendations and guidelines of the current state-of-the-art knowledge for management of ejaculation/orgasmic disorders in men as standard operating procedures (SOPs) for the treating health care professional. The International Society of Sexual Medicine Standards Committee assembled over 30 multidisciplinary experts to establish SOPs for various male and female sexual medicine topics. The SOP for the management of disorders of orgasm and ejaculation represents the opinion of four experts from four countries developed in a process over a 2-year period. Expert opinion was based on grading of evidence-based medical literature, limited expert opinion, widespread internal committee discussion, public presentation, and debate. PE management is largely dependent upon etiology. Lifelong PE is best managed with PE pharmacotherapy (selective serotonin reuptake inhibitors and/or topical anesthetics). The management of acquired PE is etiology specific and may include erectile dysfunction (ED) pharmacotherapy in men with comorbid ED. All men seeking treatment for PE should receive basic psychosexual education. Graded behavioral therapy is indicated when psychogenic or relationship factors are present and is often best combined with PE pharmacotherapy in an integrated treatment program. Delayed ejaculation, anejaculation, and/or anorgasmia may have a biogenic and/or psychogenic etiology. Men with age-related penile hypoanesthesia should be educated, reassured, and instructed in revised sexual techniques which maximize arousal. Retrograde ejaculation is managed by education, patient reassurance, and pharmacotherapy. Additional research is required to further the understanding of the disorders of ejaculation and orgasm.