Sexual Arousal Disorder Research Articles

MEASUREMENT OF VAGINAL AND MINOR LABIAL OXYGEN TENSION FOR THE EVALUATION OF FEMALE SEXUAL FUNCTION

Female sexual dysfunction is a new, rapidly expanding area of sexual medicine. Female sexual arousal disorder may, in part, be due to decreased pelvic blood flow. Therefore, we developed a simple noninvasive reproducible technique to measure vaginal and minor labial blood flow. The study included 12 healthy young women able to have orgasm through self-stimulation. Observations at orgasm were recorded in the 12 subjects after self-stimulation. Measurements were obtained intravaginally and on the minor labia using a modified Clark oxygen electrode to obtain partial oxygen pressure (pO(2)). Mean basal vaginal value was 3.8 +/- 0.9 mm Hg and mean basal pO(2) on the minor labia was 18.3 +/- 3.7 mm. Hg. As soon as self-stimulation was initiated an increase in oxygen tension occurred and continued during sexual stimulation. Just before orgasm a further increase was noted with peak values measured immediately after the orgasm began (pO(2) 28.6 +/- 3.1 mm Hg intravaginally and 47.3 +/- 4.1 labial). Labial pO(2) measurement decreased relatively rapidly soon after orgasm. The time to return to basal vaginal values after orgasm varied from 20 to 30 minutes. Previously, changes in female sexual arousal responses have been difficult to evaluate and quantify clinically. We developed a simple noninvasive reproducible technique to measure vaginal and minor labial blood flow. Age based and cycle dependent normograms now can be produced for vaginal and labial blood flow using this method.

Decreased circulating levels of estrogen alter vaginal and clitoral blood flow and structure in the rabbit.

Aging and menopause related decline in circulating levels of estrogen has been shown to adversely affect female sexual arousal function. Our aim was to study the effects of circulating levels of estrogen on the hemodynamic mechanism of vaginal and clitoral engorgement and on the structure of the vaginal and clitoral cavernosal tissue in the rabbit. New Zealand White female rabbits (3.5-4 kg) were randomly divided into three groups with five rabbits in each group: control; bilateral oophorectomy; bilateral oophorectomy undergoing subcutaneous injection of estrogen (40 microg/kg/day). After 6 weeks, the serum levels of 17 beta-estradiol were measured and systemic blood pressure was monitored. Vaginal and clitoral cavernosal blood flows were measured with laser Doppler flowmeter before and after pelvic nerve stimulation. Cross sections of the clitoris and vagina were processed for histologic examination and histomorphometric image analysis. Serum level of 17 beta-estradiol (pg/ml; mean+/-s.d.) revealed a significant decrease in the oophorectomy group (25.4+/-5.1) compared with the control (38.5+/-7.6) and estrogen replacement (115.9+/-57.3) groups (P<0.05). Nerve stimulation-induced peak vaginal and clitoral intracavernosal blood flows in the oophorectomy group (28.9+/-16.3 and 6.1+/-1.4, respectively) were significantly less than those recorded in the control (48.9+/-6.5 and 11.0+/-2.4, respectively) or estrogen replacement (48.7+/-12.2 and 10.1+/-2.8, respectively) group (P<0.05). In histology, marked thinning of the vaginal epithelial layers, decreased vaginal submucosal microvasculature, and diffuse clitoral cavernosal fibrosis were evident in the oophorectomy group but not in the estrogen supplement and control groups. In histomorphometry, the percentage of clitoral cavernosal smooth muscle in the oophorectomy group (49.6+/-6.2) was significantly decreased compared with the control (56.8+/-2.6) and estrogen replacement (58+/-3.0) groups (P<0.05). Our studies show that decline in circulating levels of estrogen impairs the hemodynamic mechanism of vaginal and clitoral engorgement and leads to histopathologic changes in the vagina and clitoral cavernosal tissue. These observations suggest that decreased circulating levels of estrogen, a physiologic change in the menopausal state, may play a role in the development of female sexual arousal dysfunction.

Female sexuality and its disorders from the psychological viewpoint

Female sexuality is determined to a far greater extent by the woman's emotional receptiveness to sexual feelings than by her physiological reactions. Concerning sexual symptoms, female patients suffer much more from a lack of sexual desire and from a deficit in sexually stimulating feelings and sexual pleasure than from insufficient genital functions. The following sexual symptoms are presented: sexual arousal disorders, orgasm disorders, vaginismus, dyspareunia, sexual desire disorders, sexual aversion/sexual phobia. Sex consultation and sex therapy are recommended as preferential treatment options.

Female sexual arousal disorder: new insights.

Epidemiologic investigations of women with female sexual dysfunction (FSD) from well-designed, random-sample, community-based populations are limited. Based on available information, FSD is common and estimated to occur in 22-43% of women. There are limited data on age-related and para-aging risk factors, which are critical to understand when planning treatment and prevention efforts. Based on correlates of FSD, associated risk factors include age, education, history of sexual abuse or sexually transmitted disease, overall state general happiness and physical health. This brief overview attempts to review what is known about the female sexual anatomy, describes factors that may affect female sexual responsiveness, and identifies several areas where additional research is needed to promote understanding of this complex physiological and psychosocial phenomenon. International Journal of Impotence Research (2000) 12, Suppl 4, S152-S157.

Effect of Bupropion-SR on Orgasmic Dysfunction in Nondepressed Subjects: A Pilot Study

The objective of this study was to determine whether the aminoketone antidepressant bupropion has beneficial effects in orgasmic dysfunction. Design: Single-blind, sequential treatment order of three weeks each: placebo, bupropion-SR 150 mg/day, bupropion-SR 300 mg/ day Subjects: Nondepressed women ( n = 20) and men ( n = 10) having nonphysiologic orgasmic delay or inhibition Main Outcome Measures: Reported difficulty or delay in achieving orgasm, satisfaction with orgasm and erectile function, and subjective impressions of drug effect Results: In the women, there were significant improvements relative to baseline ( p < .01) on both doses of bupropion-SR in all measured aspects of sexual function, and significant improvements relative to placebo ( p < .05) in overall sexual satisfaction on both doses and satisfaction with intensity of orgasm on 150 mg/day (300 mg/day, p = .10). In the men, significant improvements over baseline ( p < .01) were observed with both doses in overall sexual satisfaction, ability to achieve an erection, and delay in reaching orgasm/ejaculation; significant improvements relative to placebo ( p < .05) were observed in overall sexual satisfaction on both doses, ability to achieve erection on 150 mg/ day, and delay in orgasm/ejaculation on 150 mg/day. Seventy percent of subjects reported improvement in libido, arousal, or orgasmic function during bupropion administration. relative to placebo ( p < .05) were observed in overall sexual satisfaction on both doses, ability to achieve erection on 150 mg/ day, and delay in orgasm/ejaculation on 150 mg/day. Seventy percent of subjects reported improvement in libido, arousal, or orgasmic function during bupropion administration. Conclusions: Bupropion-SR may be a useful agent for treating orgasmic delay and inhibition, and possibly disorders of sexual arousal. The results argue against bupropion’s apparent prosexual effect in depressed patients being simply a result of its antidepressant activity.

Prevalence and risk factors of sexual dysfunction in men and women.

Sexual dysfunctions are highly prevalent, affecting about 43% of women and 31% of men. Hypoactive sexual desire disorder has been reported in approximately 30% of women and 15% of men in population-based studies, and is associated with a wide variety of medical and psychologic causes. Sexual arousal disorders, including erectile dysfunction in men and female sexual arousal disorder in women, are found in 10% to 20% of men and women, and is strongly age-related in men. Orgasmic disorder is relatively common in women, affecting about 10% to 15% in community-based studies. In contrast, premature ejaculation is the most common sexual complaint of men, with a reporting rate of approximately 30% in most studies. Finally, sexual pain disorders have been reported in 10% to 15% of women and less than 5% of men. In addition to their widespread prevalence, sexual dysfunctions have been found to impact significantly on interpersonal functioning and overall quality of life in both men and women.

Recent advances in female sexual dysfunction.

Female sexuality has received little scientific study. Recently, increased interest in this field has generated new research in the epidemiology, pathophysiology, and pharmacotherapy of female sexual dysfunction (FSD). A new FSD classification system has been proposed. Although sexual difficulties are highly prevalent among women, the degree of associated distress is unknown. Risk factors for FSD are probably both psychologic and physiologic. Aging or menopause is associated with lubrication difficulties, which can be treated with hormone replacement. Hysterectomy seems more likely to result in improvement rather then deterioration of sexual functioning. Depression may be a predictor of sexual dysfunction after hysterectomy. Vasoactive agents are currently being evaluated as treatment for female sexual arousal disorder. The most important advance in the study of female sexual function is the recent surge of interest in this relatively unexplored field.

Sexual Dysfunction Following Vulvectomy

Objective. This is a pilot study to evaluate sexual dysfunction in women after vulvectomy.Methods. An 88-question survey was used to assess body image and the DSM IV criteria for sexual dysfunction on women who had undergone vulvectomy.Results. Forty-seven women agreed to participate in the study and 41 women (87%) returned the survey. There was a significant alteration of body image in these women after vulvectomy (P = 0.004). Sexual frequency significantly decreased after surgery (P = 0.001) and there was significant sexual dysfunction in the categories of sexual aversion disorder (P = 0.01), arousal disorder (P = 0.02), and hypoactive sexual disorder (P = 0.001). The extent of surgery did not correlate with degree of sexual dysfunction in any category. Women who were depressed at the time of survey (as determined by the PRIME-MD scale) were more likely to suffer sexual aversion disorder (P = 0.05) and trended to have more body image disturbance (P = 0.1) and global sexual dysfunction (P = 0.06).Conclusions. Women experience significant sexual dysfunction after vulvectomy and the extent of surgery or type of vulvectomy did not correlate with degree of sexual dysfunction. There is a significant need to address sexual problems with all women after any vulvectomy. Age, depression, worsening GOG performance status, and preoperative hypoactive sexual dysfunction were risk factors for sexual dysfunction after vulvar surgery. Appropriate counseling and treatment of depression may be of benefit to this patient population.

Atherosclerosis-induced chronic arterial insufficiency causes clitoral cavernosal fibrosis in the rabbit.

In our previous studies we found that aging-associated fibrosis of clitoral cavernosal tissue correlated with the prevalence of cardiovascular disease in elderly women. The aim of this study was to determine specifically, arterial insufficiency-related structural changes of clitoral cavernosal tissue in a rabbit model. New Zealand white female rabbits were divided into clitoral cavernosal ischemia (CCI, n = 5) and control (n = 5) groups. The CCI group underwent balloon endothelial injury of the iliac arteries and received 0.5% cholesterol diet. The control group received a regular diet. After 16 weeks, arteriography was performed then the animals were sacrificed. The iliac arteries and the entire clitoris were removed. Cross-sections of the iliac arteries and clitoris were processed for histologic evaluation The percentage of smooth muscle and connective tissue in trichrome stained sections of clitoral cavernosal tissue was determined by computer-assisted histomorphometry. Arteriography revealed diffused occlusive disease in the common iliac, internal iliac and pudendal arteries in the CCI group. Histology showed that arterial occlusive disease spreads from the site of balloon injury to the smaller branches involving the clitoral cavernosal arteries. Diffuse fibrosis was observed in the clitoral cross-sections of the CCI group. The percentage of clitoral cavernosal smooth muscle (mean +/- standard error) in the CCI group (53% +/- 0.9%) was significantly decreased compared with the control group (62% +/- 0.8%) (P = 0.0001). Chronic clitoral cavernosal ischemia causes significant fibrosis and loss of smooth muscle in the clitoral cavernosal tissue. These findings suggest that chronic clitoral cavernosal arterial insufficiency may play a role in the pathophysiology of female sexual arousal disorders.

The Female Sexual Function Index (FSFI): A Multidimensional Self-Report Instrument for the Assessment of Female Sexual Function

This article presents the development of a brief, self-report measure of female sexual function. Initial face validity testing of questionnaire items, identified by an expert panel, was followed by a study aimed at further refining the questionnaire. It was administered to 131 normal controls and 128 age-matched subjects with female sexual arousal disorder (FSAD) at five research centers. Based on clinical interpretations of a principal components analysis, a 6- domain structure was identified, which included desire, subjective arousal, lubrication, orgasm, satisfaction, and pain. Overall test-retest reliability coefficients were high for each of the individual domains (r=0.79 to 0.86) and a high degree of internal consistency was observed (Cronbach’s alpha values of 0.82 and higher) Good construct validity was demonstrated by highly significant mean difference scores between the FSAD and control groups for each of the domains (p<0.001). Additionally, divergent validity with a scale of marital satisfaction was observed. These results support the reliability and psychometric(as well as clinical) validity of the Female Sexual Function Index (FSFI) in the assessment of key dimensions of female sexual function in clinical and nonclinical samples. Our findings also suggest important gender differences in the patterning of female sexual function in comparison with similar questionnaire studies in males.

Efficacy and safety of sildenafil in estrogenized women with sexual dysfunction associated with female sexual arousal disorder

Background: Sildenafil is indicated for the treatment of erectile dysfunction. The nitric oxide–cyclic guanosine monophosphate pathway involved in penile erection also may be important in some components of the female sexual arousal response during sexual stimulation.Objective: To evaluate efficacy and safety of sildenafil in estrogenized women with sexual dysfunction that included female sexual arousal disorder (FSAD).Methods: Patients received sildenafil (10, 50, or 100 mg) or placebo, to be taken as needed about 1 hour before sexual activity but not more than once daily for 12 weeks. Patients completed a global efficacy questionnaire, a sexual function questionnaire, the Life Satisfaction Checklist, and an event log of sexual activity. An optional partner questionnaire was included. Adverse event data were recorded.Results: There were 583 women randomized to treatment; FSAD was diagnosed in all the women, but it was the primary presenting symptom in only 46%. Hypoactive sexual desire disorder, female orgasmic disorder, and dyspareunia were the primary symptoms in 28%, 17%, and 9%, respectively. Differences between the two treatment groups were not significant for all patient and partner endpoints. The main adverse events were headache, flushing, rhinitis, nausea, abnormal vision, and dyspepsia, which were generally mild or moderate. There was one serious treatment-related adverse event (menorrhagia).Conclusions: Any genital physiologic effect of sildenafil administered as needed for 12 weeks was not perceived as improving the sexual response in estrogenized women with sexual dysfunction that included FSAD. Treatment with sildenafil was well tolerated in this patient population.

REPORT OF THE INTERNATIONAL CONSENSUS DEVELOPMENT CONFERENCE ON FEMALE SEXUAL DYSFUNCTION: DEFINITIONS AND CLASSIFICATIONS

Female sexual dysfunction is highly prevalent but not well defined or understood. We evaluated and revised existing definitions and classifications of female sexual dysfunction. An interdisciplinary consensus conference panel consisting of 19 experts in female sexual dysfunction selected from 5 countries was convened by the Sexual Function Health Council of the American Foundation for Urologic Disease. A modified Delphi method was used to develop consensus definitions and classifications, and build on the existing framework of the International Classification of Diseases-10 and DSM-IV: Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association, which were limited to consideration of psychiatric disorders. Classifications were expanded to include psychogenic and organic causes of desire, arousal, orgasm and sexual pain disorders. An essential element of the new diagnostic system is the "personal distress" criterion. In particular, new definitions of sexual arousal and hypoactive sexual desire disorders were developed, and a new category of noncoital sexual pain disorder was added. In addition, a new subtyping system for clinical diagnosis was devised. Guidelines for clinical end points and outcomes were proposed, and important research goals and priorities were identified. We recommend use of the new female sexual dysfunction diagnostic and classification system based on physiological as well as psychological pathophysiologies, and a personal distress criterion for most diagnostic categories.

Efficacy & safety of viagra® in estrogenized women with sexual dysfunction associated with female sexual arousal disorder (FSAD)

International Journal of Gynecology & ObstetricsVolume 70, Issue S5 p. E23-E23 Free communication Human sexuality Efficacy & safety of viagra® in estrogenized women with sexual dysfunction associated with female sexual arousal disorder (FSAD) Rosemary Basson, Search for more papers by this authorRosemary McInnes, Search for more papers by this authorMike D. Smith, Search for more papers by this authorGemma Hodgson, Search for more papers by this author Rosemary Basson, Search for more papers by this authorRosemary McInnes, Search for more papers by this authorMike D. Smith, Search for more papers by this authorGemma Hodgson, Search for more papers by this author First published: 11 December 2003 https://doi.org/10.1016/S0020-7292(00)82403-0Citations: 1AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume70, IssueS52000Pages E23-E23 RelatedInformation

Surgery Experienced as Sexual Abuse: A Case of Pre-Pubescent Sexual Offending and Hypospadias

A substantial minority of sexual offences against children are carried out by children. This article examines a case of pre-pubescent sexual offending associated with repeated reconstructive surgery to the penis, in the treatment of the congenital deformity hypospadias. Although the surgery involved was appropriate, the patient appeared to experience it as a form of recurrent sexual abuse. Subsequently the patient escalated from exhibitionism to contact sexual offences which cognitive-behavioural treatment failed to modify. We discuss the case with reference to concepts of trauma-organized systems, with a particular focus on the timing and context of surgery. We suggest that this case demonstrates that repeated genital surgery in a child may be experienced as childhood sexual abuse even with sensitive management. It emphasizes the roles of aggression and social validation in sexual offending, and it supports the proposed inclusion of ‘Sexual Arousal Disorder of Childhood’ in DSM-IV and ICD-10.

Oral phentolamine and female sexual arousal disorder: A pilot study

Female sexual arousal disorder (FSAD) is a highly prevalent problem, although little is known about pathophysiology or treatment of the disorder. Given the potential role of vascular mechanisms, a small pilot study was conducted on the effects of oral phentolamine in menopausal women with FSAD. Six postmenopausal women with a lack of lubrication and with sexual arousal difficulties of at least 6 months duration participated in the study. All subjects received a single dose of oral phentolamine (40 mg) and placebo in a single-blind, dose-escalation design. Dependent variables for the study included vaginal pulse amplitude (WA), as measured by vaginal photoplethysmo-graphy, self-report measures of sexual response, and patient- and physician-based assessments of adverse events. Results indicated a mild, positive effect of phentolamine across all measures of arousal, with significant changes (p <.05) in self-reported lubrication and pleasurable sensations in the vagina. The drug was well tolerated, overall, with few reports of adverse side effects. Further studies are needed to assess the potential value of phentolamine and other vase active agents in the treatment of female sexual dysfunction.

HISTOMORPHOMETRIC ANALYSIS OF AGE-RELATED STRUCTURAL CHANGES IN HUMAN CLITORAL CAVERNOSAL TISSUE

Purpose To characterize age-associated histological changes of human clitoral cavernosal tissue and to determine whether age-related histological changes of clitorial cavernosal tissue correlate with vascular disease-related mortality. Materials and Methods Human clitorises were obtained from 15 fresh cadavers (age: 11 to 90 years) and from 3 patients undergoing clitoral surgery (age: 6 months to 15 years). Cross sections of the clitorises were stained with Masson's trichrome and utilized for computer assisted histomorphometric image analysis to determine the clitoral cavernosal content of smooth muscle and connective tissue. Results These studies revealed a strong link between increase in age and decreased clitoral cavernosal smooth muscle fibers. In histomorphometry, the percentage of clitoral cavernosal smooth muscle (mean +/− standard error) in an age group of 6 months to 15 years (n = 4) was 65 +/− 1.5, in 44 to 54 years (n = 7) was 50 +/− 1.2, and in 55 to 90 years (n = 7) was 37 +/− 1.3 (ANOVA, p = 0.0001). In the 18 tissues studied, decrease in the percentage of clitoral cavernosal smooth muscle significantly correlated with increase in age (simple regression, r = 0.61). In the age group of 44 to 90 years, clitoral cavernosal fibrosis was significantly greater in the presence of cardiovascular disease-related mortality compared with those without cardiovascular disease-related mortality. Conclusion This study shows that aging women undergo histological changes in clitoral cavernosal erectile tissue. Vascular risk factors may adversely affect the structure of clitoral cavernosal tissue. These findings may be of importance in the pathophysiology of age-associated female sexual arousal disorders.

Sexual Dysfunction (Sex, Drugs, and Women's Issues)

Sexual dysfunction is one of the most common and curable problems presented in medicine. Still, women often suffer silently with their sexual problems despite their pain, unhappiness, and the great cost to their relationships. This review presents simple techniques for taking a sexual history and understanding sexual dysfunctions, both physiologically and psychologically. The stages ofthe sexual response cycle are slightly different for women and men, as are the types of dysfunctions. Sexual desire disorders, sexual arousal disorders, orgasmic disorders, and sexual pain disorders are described. Many medications can profoundly alter sexual function. Antidepressant medication affecting sexual function is discussed. Sexual function and dysfunction in pregnancy and menopause is explored. Finally, a summary is presented for the obstetrician/gynecologist to deal effectively with patients' sexual concerns.

Randomized, double-blind comparison of venlafaxine and fluoxetine in hospitalized patients with major depression and melancholia

Background: Many antidepressants are associated with sexual dysfunction, a side effect that may lead to patients' dissatisfaction and noncompliance with treatment.Objective: This study compared the efficacy, tolerability, and effects on sexual functioning of bupropion sustained release (bupropion SR) and the selective serotonin reuptake inhibitor fluoxetine.Methods: In this multicenter, randomized, double-blind, double-dummy, parallel-group study, patients with recurrent major depression were treated with bupropion SR 150 to 400 mg/d, fluoxetine 20 to 60 mg/d, or placebo for up to 8 weeks. Depression and sexual-functioning status were assessed by site-specific trained investigators at weekly clinic visits; tolerability was assessed primarily by monitoring adverse events.Results: Four hundred fifty-six patients participated in the study, 150 receiving bupropion SR, 154 fluoxetine, and 152 placebo. The majority of patients in each group completed the study (63% each, bupropion SR [n = 94] and fluoxetine [n = 97]; 67%, placebo [n = 102]). Bupropion SR and fluoxetine were similarly effective in the treatment of depressive symptoms. Beginning at week 2 and continuing throughout the study, significantly more fluoxetine-treated patients experienced orgasm dysfunction than did patients receiving bupropion SR or placebo (P < 0.001); similar results were seen in patients defined as clinical responders (≥50% decrease from baseline in 21-item Hamilton Rating Scale for Depression [HAM-D] total score) (P < 0.001) and in those experiencing remission of depression (HAM-D total score <8) (P < 0.05). At various time points, worsened sexual functioning, sexual desire disorder, sexual arousal disorder, and dissatisfaction with sexual functioning in those satisfied at baseline were more frequently associated with fluoxetine treatment than with bupropion SR or placebo. Both active treatments were well tolerated.Conclusions: Bupropion SR and fluoxetine were similarly effective and well tolerated in the treatment of depression. Fluoxetine, however, was more frequently associated with sexual dysfunction compared with bupropion SR. Bupropion SR may be an appropriate initial choice for the treatment of depression in patients concerned about sexual functioning.

Vacuum and constriction devices for erectile disorder—an integrative view

The fundamental need for psychodynamic clinical interventions in most cases of sexual dysfunction has never been denied. Equally, specific clinical interventions of a physiodynamic nature are a fundamental part of the richness of treatment resources in most cases of erectile dysfunction. In recent years, in the presence of uncertainties about the long-lasting therapeutic effects of exclusive methodology, advocacy for a professional approach in favour of the use of integrative systems in the treatment of sexual dysfunction has been strong. The practitioner of sexual and relationship psychotherapy, whatever his or her base discipline, is required in the name of therapeutic effectiveness to consider the psychological and the organic when establishing a plan of treatment. This is particularly true in the case of male erectile dysfunction, the most common of all sexual arousal disorders. This paper considers the role of Vacuum Constriction Devices (VCDs) in terms of their biopsychosocial cause and effect, the literature analysis, and the role of the non-medical practitioner in the use of the device.

Chronic renal failure and sexual functioning: clinical status versus objectively assessed sexual response.

Sexual dysfunctions are common among patients with chronic renal failure. The prevalence was assessed in a population of 281 patients (20-60 years), and it was attempted to determine whether their mode of treatment (haemodialysis, peritoneal dialysis, or kidney transplantation), or biochemical and endocrine variables and neuropathy affect sexual functioning. Patients with rheumatoid arthritis served as a comparison group. Assessment included clinical history, physical and laboratory examinations, questionnaires measuring erotosexual dysfunctions, and a psychophysiological test procedure. The latter is a laboratory method which measures, in a waking state, subjective and physiological sexual arousal. Men on haemodialysis or peritoneal dialysis suffered significantly more often from 'Hypoactive Sexual Desire Disorder', 'Sexual Aversion Disorder' and 'Inhibited Male Orgasm' than men with kidney transplantation or rheumatoid arthritis. Interestingly, the prevalence of 'Male Erectile Disorder' did not differ significantly between the four groups and ranged between 17 and 43%. Of the women, transplanted patients suffered significantly less from 'Hypoactive Sexual Desire Disorder' than the other three groups; the prevalence of other sexual dysfunctions did not differ between the groups. Although 'Male Erectile Disorder' and 'Female Sexual Arousal Disorder' had a relatively high prevalence there were no differences in the four groups of patients in genital responses during psychophysiological testing. Genital responses during psychophysiological assessment had no relationship to the duration of renal replacement treatment, biochemical/endocrine variables, or the presence/ absence of neuropathy. The prevalence of sexual dysfunction was high. Sexual dysfunction in men on haemodialysis or peritoneal dialysis was not so much due to erectile failure but largely to loss of sexual interest, subjectively ascribed to fatigue. The latter was also found in women on haemodialysis or peritoneal dialysis.