Sex-related Distress Research Articles

Impact of mindfulness versus supportive sex education on stress in women with sexual interest/arousal disorder.

Low desire in women is the most common sexual difficulty, and stress has been identified as a significant predictor of symptoms. We evaluated a mindfulness-based cognitive therapy (MBCT) group treatment versus a sex education comparison group treatment (STEP) on self-reported stress and on the physiological stress response measured via morning-to-evening cortisol slope in 148 women with a diagnosis of sexual interest/arousal disorder (SIAD). Perceived stress decreased following treatment in both groups, and significantly more after MBCT. The cortisol slope was steeper (indicative of better stress system regulation) from pre-treatment to 6-month follow-up, with no differences between the groups. As an exploratory analysis, we found that the reduction in perceived stress predicted increases in sexual desire and decreases in sex-related distress for participants after MBCT only. These findings suggest that group mindfulness targeting women with low sexual desire leads to improvements in self-reported and physiological stress, with improvements in self-reported stress partially accounting for improvements in sexual desire and distress.

(017) Use of Knowledge Translation Methodology to Incorporate Research Results into Clinical Practice: Bringing Mindfulness and Cognitive Behavioural Therapy into a local prostate cancer program

Abstract Introduction There is an unmet need for psychological therapies that address sex-related distress in couples after prostate cancer (PCa) beyond pharmaceuticals and device aids. We recently completed a clinical trial that found both mindfulness and cognitive behavioural therapy (CBT) improved couples’ sexual health after prostate cancer (PCa). Given the benefits of these therapies to patients yet the poor translation of research into routine clinical care, we sought to use evidence-informed methods of knowledge translation to make this transition. Objective This was a knowledge translation (KT) and implementation science project. We aimed to share information about the efficacy of these therapies to PCa patients and their partners in a local prostate cancer program by creating and implementing KT tools in a format that was accessible, affirming, and effective. Methods We utilized two KT frameworks: the Knowledge to Action (KTA) cycle and the Consolidated Framework for Implementation Research (CFIR), and collaborated with knowledge partners (prostate cancer program clinical leader partnerships, patient partner consultations, and a focus group of the program staff analyzed using the CFIR framework) to guide implementation. Results We used the first four stages of the KTA cycle, informed by our knowledge partners, to create our KT tools. The first stage involved clarifying the knowledge gap. We then included the evidence-based mindfulness and CBT approaches to various existing time points of patient education in the local program's context. Next, we conducted our focus group to identify potential barriers and facilitators to implementation, and modified our implementation plan accordingly. We created an information card that explained CBT and mindfulness using terminology appropriate for the patient population. The card contained a link to a patient education video we created that instructed patients on how to practice these skills at home. This link was hosted on a webpage with external CBT and mindfulness resource links. Implementation is currently underway. Eligible patients receive the information card at clinical appointments with a registered sexual health nurse and access the education video, which then guides them on how to practice these therapies at home. A questionnaire has been developed to evaluate patient use of these tools, ease of use of the tools, and whether the tools were helpful with respect to improving sexual intimacy and mental health. Data collection is in progress. Conclusions By creating three KT tools to implement mindfulness and CBT patient education materials, we incorporated research findings into routine clinic flow of a local prostate cancer program. These tools have large implications for the current patient population: we filled a gap of a lack of psychosocial education for sexual intimacy for couples after prostate cancer to practice. To the best of our knowledge, this is the first study to use KTA methodology to apply results from a clinical trial directly into clinical practice. This methodology should be incorporated into research funding mechanisms in order to encourage more widespread adoption of bringing research findings into practice. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific, Coloplast, Sustained Therapeutics, AstraZeneca, Astellas, Genetech, Lantheus Merck, Sharp & Dohme, Myovant, Menarini, Tolmar, Vaccitech, Verity

Examination of Sex-Related Distress and Self-Medication Drinking Model in U.S. College Women

ABSTRACT Adult sexual assault (ASA) in college remains a concern. Consequently, many college-aged women experience negative emotions surrounding sexual activity (sex-related distress). Consistent with self-medication theory, some drink to cope with sex-related distress, which may reduce distress, but lead to greater drinking quantity before sex and negative sexual consequences. How women with ASA histories navigate sexual situations and cope with sex-related distress is under researched. We examined ASA, sex-related distress, and drinking to cope motives to understand correlates of drinking before sex. First and second year college women (n = 300) reported on a recent sexual experience in the past six weeks. In the full sample, ASA severity was associated with a greater likelihood of drinking before sex, while general sex-related distress was associated with a lower likelihood. General sex-related distress was associated with event-specific sex-related distress and sexual consequences. There were no differences in number of pre-sex drinks or subjective intoxication during sexual activity based on ASA. In a subsample of women who drank before sexual activity (n = 179), drinking to cope with sex-related distress motives mediated the association between sex-related distress and sexual consequences. Interventions can draw on these findings to target self-medication drinking in consensual sexual situations.

Feasibility of an Online Mindfulness-Based Intervention for Women with Sexual Interest/Arousal Disorder.

ObjectivesDifficulties with sexual desire impact up to a third of women and most do not seek or receive appropriate care for these complaints, in part due to stigma, embarrassment, and limited availability of treatment. In-person mindfulness-based interventions have lasting benefits to sexual desire and sex-related distress in controlled clinical trials but are difficult to access. Online cognitive-behavioral interventions for sexual concerns have shown promising findings, but online mindfulness interventions have received little testing. The current study assessed the feasibility of an online program (called eSense-Mindfulness) adapted from an effective face-to-face intervention for women with Sexual Interest/Arousal Disorder.MethodsThirty cisgender women (M age = 35.3) with Sexual Interest/Arousal Disorder consented and completed at least one of the eight modules of eSense-Mindfulness while providing weekly feedback regarding their experience. Feasibility was assessed via attrition rates and participant self-report regarding challenges of using the program. Limited efficacy testing was based on effect sizes for changes in sexual response and sex-related distress.ResultsParticipants (n = 25 who completed all testing) reported high levels of usability and ease of understanding content and reported the mindfulness exercises as well as the information on partner communication to be the most relevant. Limited efficacy testing showed large effect sizes for reductions in sex-related distress, and improvements in sexual desire, arousal, and satisfaction whereas there were smaller effect sizes for improvements in lubrication, orgasm, and vaginal pain.ConclusionsThe findings suggest that efficacious face-to-face mindfulness interventions for sexual dysfunction in women show excellent evidence of feasibility when delivered online without personalized guidance.

Physical Activity and Female Sexual Dysfunction: A Lot Helps, But Not Too Much

Research on the relationship between physical activity (PA) and female sexual dysfunction (FSD) is lacking. To investigate the clinical, psychological, and sexual correlates of PA in women with FSD. A non-selected series of n = 322 pre- and post-menopausal patients consulting for FSD was retrospectively studied. Regular involvement in PA and its frequency (<1 hour/week: sedentary, 1-3 hours/week: active, 4-6 hours/week: very active, >6 hours/week: extremely active) were investigated with a specific question. FSDs, including HSDD (Hypoactive sexual desire disorder) and FGAD (Female genital arousal disorder), were diagnosed according to a structured and clinical interview. Participants underwent a physical examination and a clitoral Doppler ultrasound, and were asked to complete the Female Sexual Function Index, Female Sexual Distress Scale-Revised, Body Uneasiness Test, and Middlesex Hospital Questionnaire. At multivariate analysis, women engaging in PA (67.4%, n = 217) scored significantly higher in several Female Sexual Function Index domains - including desire, arousal and lubrication - and showed lower sexual distress and lower resistance of clitoral arteries, as compared to sedentary women. A significant, inverse association between PA and HSDD was observed. Mediation analysis demonstrated that the negative association between PA and HSDD was partly mediated by body image concerns (Body Uneasiness Test Global severity index), psychopathological symptoms (Middlesex Hospital Questionnaire total score) and sexual distress (Female Sexual Distress Scale-Revised score). These latter 2 factors also partly mediated the association between PA and a reduced risk of FGAD, whilst a lower BMI was a full mediator in the relationship between PA and FGAD. Finally, extreme PA was associated with significantly worse scores in several psychosexual parameters (i,e, sexual satisfaction and histrionic/hysterical symptoms), even compared to a sedentary lifestyle. Women consulting for FSD may gain benefits on desire, arousal, lubrication and sex-related distress from regular PA; however, physicians should remain alert to the downsides of excessive exercise. The main strength lies in the novelty of the findings. The main limitations are the cross-sectional nature, the clinical setting, the small sample size of the different PA groups, and the use of self-reported instruments for the evaluation of PA. In women with FSD, PA was associated with better sexual function and clitoral vascularization, lower sexual distress and reduced odds of HSDD and FGAD; the benefits of PA on sexuality were mediated by both psychological and organic determinants; excessive PA was related with a poor overall sexual function and with a low sexual satisfaction.

Mindfulness and cognitive behavior therapy for provoked vestibulodynia: Mediators of treatment outcome and long-term effects.

Provoked vestibulodynia (PVD) is a chronic vulvo-vaginal pain condition affecting 8% of premenopausal women. Cognitive-behavioral therapy (CBT) is effective in managing pain and associated sexual and psychological symptoms, and a recent study found group mindfulness-based cognitive therapy (MBCT) to be equivalent. Our goal was to examine the long-term outcomes of these treatments and to explore mediators of change. Participants were 130 women diagnosed with PVD who had participated in a clinical trial comparing 8 weeks of group CBT to 8 weeks of group MBCT. Data were collected at pretreatment, posttreatment, and at 6- and 12-month follow-up periods. Outcomes focused on (a) pain with vaginal penetration, (b) pain elicited with a vulvalgesiometer, and (c) sex-related distress. Mediators of interest included pain acceptance (both pain willingness and activities engagement), self-compassion, self-criticism, mindfulness, decentering, and pain catastrophizing. All improvements in the 3 outcomes were retained at 12-month follow-up, with no group differences. Pain catastrophizing, decentering, and chronic pain acceptance (both scales) were mediators of improvement common to both MBCT and CBT. Changes in mindfulness, self-criticism, and self-compassion mediated improvements only in the MBCT group. Both MBCT and CBT are effective for improving symptoms in women with PVD when assessed 12 months later. The findings have implications for understanding common and potentially distinct pathways by which CBT and MBCT improve pain and sex-related distress in women with PVD. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Mindfulness-based cognitive therapy for sexuality (MBCT-S) improves sexual functioning and intimacy among older women with epilepsy: A multicenter randomized controlled trial

PurposeWomen with epilepsy (WWE) frequently experience sexual problems, including sexual dysfunction and sexual distress. Therefore, this study aimed to examine the efficacy of a mindfulness-based cognitive therapy for sexuality (MBCT-S) on sexual function and intimacy among older adult WWE in Iran. MethodsA multicenter randomized controlled trial was conducted at 15 neurology clinics in three Iranian cities. WWE together with their partners and healthcare providers were randomly assigned in patient and partner (PP; n = 220), patient, partner, and healthcare provider (PPHP; n = 220), or treatment as usual (TAU; n = 220) group. WWE and their partners in both the PP and PPHP groups received eight weeks of MBCT-S sessions. In the PPHP group, three individual sessions on sexual counseling were added for healthcare providers. Self-assessment scales were used at baseline, one month and six months after completing the intervention. Mixed linear regression models were developed to determine differences among the three groups. Multilevel mediation analyses were conducted to understand the mediating effects of mindfulness, intimacy, patient-physicians relationship and sexual counseling barriers. ResultsImprovements in sexual function, sexual distress, and intimacy were found in both the PP and PPHP groups at one-month and six-month follow-ups. The PPHP group compared with the PP group had greater improvement in intimacy at both follow-ups. Regarding sexual function, the PPHP group performed better than the PP group at the six-month follow-up. ConclusionsThe MBCT-S appears efficacious in enhancing sexual function and reducing sex-related distress in Iranian older adult WWE. Future studies should examine its efficacy in other populations.

Sexual Victimization and Sex-Related Drinking Motives: How Protective is Emotion Regulation?

One in five college women experience sexual victimization (SV), and SV severity is associated with subsequent psychological distress, including sex-related distress. SV severity may also be associated with drinking motives to cope with sex-related distress and to enhance sex (sex-related drinking motives [SRDMs]), particularly if individuals suffer from emotion regulation (ER) difficulties. College women (N = 151) completed a survey assessment of ER, SV history, childhood sexual abuse (CSA), and SRDMs. Twelve regression models assessed six facets of ER as moderators between SV severity and SRDMs. Among women with no or low levels of prior SV severity, women with greater access to ER strategies were less likely to endorse drinking to cope SRDMs. At higher levels of SV severity, women at all levels of access to ER strategies were equally likely to endorse drinking to cope SRDMs, suggesting that access to ER strategies did not mitigate motivations to drink to cope with sex-related distress for these women. Women with severe SV histories may benefit from interventions that build on existing ER strengths or address other factors. However, greater access to ER strategies may serve as a protective factor against SRDMs when SV severity is low.

Psychobiological Correlates of Vaginismus: An Exploratory Analysis

BackgroundEvidence concerning the determinants of vaginismus (V), in particular medical conditions, is inconclusive. AimTo investigate, in a cohort of subjects consulting for female sexual dysfunction, whether there is a difference in medical and psychosocial parameters between women with V and women with other sexual complaints. MethodsA series of 255 women attending our clinic for female sexual dysfunction was consecutively recruited. V was diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria. Lifelong and acquired V cases were included. OutcomesPatients underwent a structured interview and physical, gynecologic, laboratory, and clitoral ultrasound examinations; they completed the Female Sexual Function Index (FSFI), the Middlesex Hospital Questionnaire, the Female Sexual Distress Scale–Revised (FSDS), and the Body Uneasiness Test. ResultsV was diagnosed in 20 patients (7.8%). Women with V were significantly younger than the rest of the sample (P < .05). No differences were found for traditional risk factors such as a history of sexual abuse, relational parameters, or gynecologic diseases or for newly investigated parameters (ie, neurologic, hormonal, and metabolic alterations). Women with V showed significantly higher histrionic-hysterical symptoms and traits (as detected by MHQ-H score; P < .05) compared with subjects with other sexual complaints. When the scores of all MHQ subscales were simultaneously introduced in a logistic model, the association between V and MHQ-H score was confirmed (P = .013). Women with V also showed higher FSFI pain and FSDS total scores, even after adjusting for age (P < .05). In an age-adjusted model, FSDS total score increased as a function of the years of duration of V (P = .032) but not as a function of its severity. All observations were confirmed in a case-control study (ratio = 1:3). Clinical ImplicationsOur data demonstrate that some novel contributors of V should be investigated, namely histrionic-hysterical traits. This psychological comorbidity could offer valuable insights for intervention and managing complications. Strengths and LimitationsThis is the first study to assess the role of many metabolic and hormonal parameters as potential determinants of V. The main limitation is its exploratory and cross-sectional nature; our data need to be confirmed in larger, more systematic analyses. ConclusionV was associated with histrionic-hysterical traits, FSFI pain domain, and sex-related distress. A history of abuse, relational parameters, gynecologic diseases, and hormonal and metabolic alterations do not seem to play a role in the development of V.Maseroli E, Scavello I, Cipriani S, et al. Psychobiological Correlates of Vaginismus: An Exploratory Analysis. J Sex Med 2017;14:1392–1402.

Integrating Quantitative and Qualitative Methods to Evaluate an Online Psychoeducational Program for Sexual Difficulties in Colorectal and Gynecologic Cancer Survivors

Sexual health is an integral component of quality of life for cancer survivors, and is often negatively impacted by treatment. Geographic limitations often prohibit survivors from accessing sexual health programs designed to address their needs. This study examined the efficacy of an online, 12-week psychoeducational program, which included elements of mindfulness meditation, for sexual difficulties in survivors of colorectal or gynecologic cancer. Complete pre- and postintervention data were available for 46 women (mean age 55.0, SD 9.6) and 15 men (mean age 59.7, SD 6.8). Women experienced significant improvements in sex-related distress (p < .001), sexual function (p < .001 and p < .01), and mood (p < .001); these results were maintained at six months follow-up. Men's improvement in desire was not significant (p = .06), whereas intercourse satisfaction was (p < .05) immediately after the program, but not at follow-up. In order to more fully explore women's experiences, interviews were carried out with six participants and analyzed using narrative inquiry. Women shared a feeling of renewed hope for regaining their sex lives, and expressed that they would have valued an interactive component to the program. These findings suggest that an online, unidirectional psychoeducational program is feasible, and may be effective for women survivors of gynecologic and colorectal cancer, but further work is needed to ensure that online interventions address the sexual health needs of male survivors.

A Pilot Study of Eight-Session Mindfulness-Based Cognitive Therapy Adapted for Women’s Sexual Interest/Arousal Disorder

While few treatment options exist for low sexual desire and arousal, the most common sexual dysfunction in women, a growing body of research supports the efficacy of mindfulness-based approaches. The mechanisms underlying improvements, and whether they are due to mindfulness practice or other treatment components, are unclear. As a result, we designed and pilot-tested an eight-session group mindfulness-based cognitive therapy for sexuality (MBCT-S) program that includes more extensive practice of mindfulness skills and closely aligns with the evidence-based MBCT program for depression and anxiety. A total of 26 women (mean age 43.9, range 25 to 63) with a diagnosis of sexual interest/arousal disorder participated in eight weekly group sessions, before and after which they completed validated questionnaires. The majority of women attended all sessions and completed the recommended at-home mindfulness exercises. Compared to baseline, women reported significant improvements in sexual desire, overall sexual function, and sex-related distress, regardless of treatment expectations, relationship duration, or low desire duration. Depressed mood and mindfulness also significantly improved and mediated increases in sexual function. These pilot data suggest that eight-session MBCT-S is feasible and significantly improves sexual function, and provide the basis for a larger randomized-controlled trial (RCT) with a longer follow-up period.

Asexuality: an extreme variant of sexual desire disorder?

Human asexuality is defined as a lack of sexual attraction to anyone or anything. Various theories have been proposed to explain how asexuality should best be classified, and some have maintained that asexuality is an extreme variant of hypoactive sexual desire disorder (HSDD)-a sexual dysfunction characterized by a lack of interest in sex and significant distress. To date, this has never been empirically examined. Using measures of sexual desire and behavior, sex-related distress, personality, and psychopathology, the aim of the current study was to compare individuals scoring above the cutoff for asexuality identification (AIS >40) (n = 192) to sexual individuals (n = 231). The sexual group was further divided into a control group (n = 122), a HSDD group (n = 50), and a group with symptoms of low desire that were nondistressing (n = 59). Analyses were controlled for age. Individuals in the AIS >40 group had a greater likelihood of never previously engaging in sexual intercourse, fantasies, or kissing and petting than all other groups and a lower likelihood of experiencing sex-related distress than those with HSDD. For women, those in the HSDD and AIS >40 groups had significantly lower desire than the subclinical HSDD and control groups. Men in the AIS >40 group had significantly lower desire than the other three groups. Symptoms of depression were highest among those with subclinical HSDD and HSDD, whereas there were no group differences on alexithymia or desirable responding. A binary logistic regression indicated that relationship status (long-term dating/married), sexual desire, sex-related distress, and lower alexithymia scores were the best predictors of group membership (HSDD vs. AIS >40). Taken together, these results challenge the speculation that asexuality should be classified as a sexual dysfunction of low desire.

Impact of a multidisciplinary vulvodynia program on sexual functioning and dyspareunia.

For many years, multidisciplinary approaches, which integrate psychological, physical, and medical treatments, have been shown to be effective for the treatment of chronic pain. To date, there has been anecdotal support, but little empirical data, to justify the application of this multidisciplinary approach toward the treatment of chronic sexual pain secondary to provoked vestibulodynia (PVD). This study aimed to evaluate a 10-week hospital-based treatment (multidisciplinary vulvodynia program [MVP]) integrating psychological skills training, pelvic floor physiotherapy, and medical management on the primary outcomes of dyspareunia and sexual functioning, including distress. A total of 132 women with a diagnosis of PVD provided baseline data and agreed to participate in the MVP. Of this group, n = 116 (mean age 28.4 years, standard deviation 7.1) provided complete data at the post-MVP assessment, and 84 women had complete data through to the 3- to 4-month follow-up period. There were high levels of avoidance of intimacy (38.1%) and activities that elicited sexual arousal (40.7%), with many women (50.4%) choosing to focus on their partner's sexual arousal and satisfaction at baseline. With treatment, over half the sample (53.8%) reported significant improvements in dyspareunia. Following the MVP, there were strong significant effects for the reduction in dyspareunia (P = 0.001) and sex-related distress (P < 0.001), and improvements in sexual arousal (P < 0.001) and overall sexual functioning (P = 0.001). More modest but still statistically significant were improvements in sexual desire, lubrication, orgasmic function, and sexual satisfaction. All improvements were retained at 2- to 3-month follow-up. This study provides strong support for the efficacy of a multidisciplinary approach (psychological, pelvic floor physiotherapy, and medical management) for improving dyspareunia and all domains of sexual functioning among women with PVD. The study also highlights the benefits of incorporating sexual health education into general pain management strategies for this population.

A Comparison of Demographic and Psychosexual Characteristics of Women With Primary Versus Secondary Provoked Vestibulodynia

Provoked vestibulodynia (PVD) is a distressing genital pain condition affecting approximately 12% of premenopausal women. It has been speculated that primary (ie, lifelong) and secondary (ie, acquired) PVD may represent 2 distinct conditions with different etiologies. There is also evidence that primary and secondary PVD subtypes may respond differently to conventional treatments. The goal of this study was to compare the demographic, clinical, and psychosexual characteristics of a large sample of premenopausal women with primary and secondary PVD. A total of 132 premenopausal women (n=42 primary; n=90 secondary) with PVD who sought treatment in a Multidisciplinary Vulvodynia Program completed demographic questions and a battery of validated self-report measures before treatment. Women with primary PVD had a longer duration of PVD as well as more time before diagnosis. Women with secondary PVD reported significantly more clitoral hood pain, higher overall vestibular pain levels, more overall sexual dysfunction and sex-related distress, and proportionately more intercourse occasions that were painful. Women with primary pain stated they had significantly more dysmenorrhea and were more likely to report that their partners were unaware of their PVD symptoms. There were no significant subtype differences on any psychological measure but a trend towards higher magnification of symptoms in women with secondary PVD. Overall the findings suggest some important differences in the characteristics of women with primary versus secondary PVD which may have management-related implications.

Group mindfulness-based therapy significantly improves sexual desire in women

At least a third of women across reproductive ages experience low sexual desire and impaired arousal. There is increasing evidence that mindfulness, defined as non-judgmental present moment awareness, may improve women's sexual functioning. The goal of this study was to test the effectiveness of mindfulness-based therapy, either immediately or after a 3-month waiting period, in women seeking treatment for low sexual desire and arousal. Women participated in four 90-min group sessions that included mindfulness meditation, cognitive therapy, and education. A total of 117 women were assigned to either the immediate treatment (n = 68, mean age 40.8 yrs) or delayed treatment (n = 49, mean age 42.2 yrs) group, in which women had two pre-treatment baseline assessments followed by treatment. A total of 95 women completed assessments through to the 6-month follow-up period. Compared to the delayed treatment control group, treatment significantly improved sexual desire, sexual arousal, lubrication, sexual satisfaction, and overall sexual functioning. Sex-related distress significantly decreased in both conditions, regardless of treatment, as did orgasmic difficulties and depressive symptoms. Increases in mindfulness and a reduction in depressive symptoms predicted improvements in sexual desire. Mindfulness-based group therapy significantly improved sexual desire and other indices of sexual response, and should be considered in the treatment of women's sexual dysfunction.

Mindfulness-based Group Therapy for Women with Provoked Vestibulodynia

Provoked vestibulodynia (PVD) is the most common cause of painful intercourse in women of reproductive age and research supports psychological approaches in the management of chronic pain. We developed a four-session group treatment for women with PVD that relied mostly on mindfulness meditation skills along with education and some discussion of cognitive theory. A total of 85 women were assigned either to immediate treatment (n = 62; mean age, 39 years) or to a 3-month wait-list condition followed by treatment (n = 23; mean age, 40 years). Questionnaires and a genital pain assessment were administered at pre- and post-treatment, and at 6 months follow-up. Women assigned to the two groups did not significantly differ on any measure at baseline. During the pretreatment wait-list period, there were significant improvements in pain self-efficacy, and non-significant improvements in feelings of helplessness, and sex-related distress. Pain self-efficacy, pain catastrophizing, genital pain induced by a cotton swab exam, pain hypervigilance, and sex-related distress all improved with treatment. There was no change in pain with intercourse. Pretreatment genital pain was the best predictor of post-treatment genital pain. Genital pain at 6-month follow-up was predicted by pretreatment genital pain, change in pain self-efficacy, and number of comorbid chronic pain conditions. Taken together, these findings support the use of a brief mindfulness-based program as a promising treatment for distressing genital pain.

Mindful sex

This commentary summarizes the evolution of the first empirically-studied mindfulness-based treatment of sexual dysfunction. Defined as present-moment, non-judgmental awareness, mindfulness skills have been incorporated into both individual and group treatment programs and found to be effective for significantly improving several domains of sexual response and decreasing sex-related distress. More recently, mindfulness has been used in the management of women with distressing genital pain. Although much remains to be studied in regards to the mechanisms by which mindfulness may be efficacious, and concerning the extent to which these skills may show parallel usefulness in the treatment of sexual dysfunction in men, there is certainly a growing momentum of both academic and clinical interest in mindful sex.

Pilot Study of Radical Hysterectomy Versus Radical Trachelectomy on Sexual Distress

Radical trachelectomy, which leaves the uterus intact, has emerged as a desirable surgical option for eligible women with early-stage cervical cancer who wish to preserve fertility. The available data suggest excellent obstetrical outcomes with radical trachelectomy, and no differences in sexual responding between radical trachelectomy and radical hysterectomy. There is a need to examine the effect of radical hysterectomy on sexual distress given that it is distinct from sexual function. Participants were 34 women diagnosed with early-stage cervical cancer. The authors report 1-month postsurgery data for 29 women (radical hysterectomy group: n = 17, M age = 41.8 years; radical trachelectomy group: n = 12, M age = 31.8 years), and 6-month follow-up data on 26 women. Whereas both groups experienced an increase in sex-related distress immediately after surgery, distress continued to increase 6 months after surgery for the radical hysterectomy group but decreased in the radical trachelectomy group. There were no between-group differences in mood, anxiety, or general measures of health. The decrease in sex-related distress in the radical trachelectomy but not in the radical hysterectomy group suggests that the preservation of fertility may have attenuated sex-related distress. Care providers should counsel women exploring surgical options for cervical cancer about potential sex distress-related sequelae.

Characterization of Hypoactive Sexual Desire Disorder (HSDD) in Men

Little is known about Hypoactive Sexual Desire Disorder (HSDD) in men. To provide the first comprehensive characterization of men diagnosed with HSDD (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision [DSM-IV-TR]) using established patient-reported outcomes (PROs) and new PROs developed in line with U.S. Food and Drug Administration (U.S. FDA) guidance. This 4-week non-treatment study recruited men (N=200) with or without symptoms of low sexual desire and related distress. Men with erectile dysfunction, serum testosterone <300 ng/dL, or depression were excluded. Men completed assessments of sexual desire and sex-related distress and underwent structured clinical interviews for the diagnosis of HSDD. Primary endpoints were scores on the Sexual Desire Inventory (SDI), Male Desire Scale (MDS), Sexual Concerns Inventory-Male (SCI-M), and Sexual Desire Relationship Distress Scale (SDRDS) on day 28, and University of California, Los Angeles (UCLA) Psychosexual Diary on days 21-27. Scores are presented as median (interquartile range). There were no clinically relevant differences in age, serum testosterone, depressive symptomatology, erectile function, concomitant illness, or medication use between men with HSDD (N=109) and men without HSDD (N=91). However, clinically meaningful differences between men with and without HSDD were observed in sexual desire according to SDI score (40.0 [21.0] vs. 65.0 [25.0]) and MDS sexual desire domain score (18.0 [8.0] vs. 31.0 [13.0]), in sex-related distress according to SCI-M score (22.0 [12.0] vs. 6.0 [12.0]) and SDRDS score (36.0 [17.0] vs. 10.0 [16.0]), and in UCLA Psychosexual Diary sexual activity domain score (2.6 [2.7] vs. 4.9 [3.9]) (P<0.0001, for all). Based on a brief structured interview, diagnosis according to DSM-IV-TR criteria for HSDD identified a population of men comparable with men without HSDD in age, serum testosterone, concomitant illness and medication use but distinct in their experience of sexual desire and distress associated with low desire. These controlled data characterize HSDD in men as a distinct sexual dysfunction.

EDiary and Female Sexual Distress Scale© in Evaluating Distress in Hypoactive Sexual Desire Disorder (HSDD)

Sex-related distress is integral to the diagnosis of hypoactive sexual desire disorder (HSDD). This article describes the results of three prospective, non-treatment validation studies (two North American and one European), each testing over 200 participants with HSDD, other types of female sexual dysfunction (FSD), or no FSD in which the 12-item Female Sexual Distress Scale© (FSDS©), the 13-item FSDS–Revised©(FSDS–R©), and a single question asked using a daily electronic diary (the eDiary For HSDD Trials©; eDiary) were used to measure sex-related distress. FSDS results with 30- and seven-day recall were equivalent. The results observed with FSDS–R Item 13 (a single question assessing concern due to low sexual desire) were comparable to the FSDS. Mean eDiary monthly distress scores were closer to the minimum possible score (equivalent to “a little bit” of distress) and were about twice as variable as FSDS or FSDS–R Item 13 scores in participants with HSDD. All three measures confirmed that there is more distress in women with HSDD compared to women with no sexual dysfunction at all time points, demonstrating discriminant validity.