Treatment Of Sexual Difficulties Research Articles

The impact of narcolepsy symptoms and treatment on sex life - current evidence and reports

Introduction: Narcolepsy (NT) can manifest as excessive daytime sleepiness (EDS), cataplexy, hypnagogic (HHG) and hypnopompic (HHP) hallucinations, sleep paralysis, orgasmolepsy – all of which may affect patients' functioning. The aim of the study was to determine the impact of NT, specific sexual dysfunctions and drugs used in NT on sex life. Materials and methods: A narrative review was conducted, using keywords: narcolepsy, sexual dysfunctions, medications in narcolepsy from repository inception to March 17, 2024 searching PubMed/MEDLINE, Google Scholar, Crossref, Cochrane databases. The quality of the reviewed articles was assessed using the Scale for the Assessment of Narrative Review Articles (SANRA). Results: Sexual activity and satisfaction are reduced in up to 81.1% of patients. There are often multiple co-occurring autonomic dysregulations in patients, including the genitourinary system, causing sexual dysfunction (erectile dysfunction in 48% of men; vaginal lubrication in 81% of women). Orgasmolepsy negatively affects sexual and social relationships in more than 1⁄3 of respondents. Sleep paralysis can be accompanied by HHG, which often present the impression of sexual assault and harassment. They may cause anxiety, post-traumatic stress disorder (PTSD) features, depressed mood, in extreme cases leading to suicide attempts. Of the drugs used in NT, only methylphenidate can increase libido and reduce erectile dysfunction in NT. Conclusions: Orgasmolepsy, sexual and autonomic dysfunction in NT significantly reduce patients' quality of sex life. Sleep paralysis with sexual HHG can reduce psychological well-being. A holistic intervention approach, using behavioural interventions, cognitive-behavioural therapy, education of the patient and their loved ones, is crucial in the treatment of sexual difficulties. Keywords: narcolepsy, sexual dysfunctions, medications in narcolepsy

Sparing the doctor’s blushes: the use of sexually explicit films for the purpose of Sexual Attitude Reassessment (SAR) in the training of medical practitioners in Britain during the 1970s

The general reluctance of medical practitioners in postwar Britain to ‘speak of sex’ during healthcare consultations increasingly became a matter of professional concern in the wake of legal reforms and...

Attachment and Childhood Maltreatment as Moderators of Treatment Outcome in a Randomized Clinical Trial for Provoked Vestibulodynia

Although distal developmental factors, such as attachment and childhood maltreatment (CM), are associated with the occurrence, severity, and adjustment to provoked vestibulodynia (PVD)-the most prevalent form of vulvodynia-no studies to date have examined whether these variables are related to treatment efficacy in the context of PVD. Attachment and CM may act as moderating variables when examining different treatment modalities, whereby individuals with more insecure attachment orientations (anxiety/avoidance) or a history of CM may benefit less from treatments with higher interpersonal contexts, such as sex and couple therapy-a recommended treatment for PVD. The present randomized clinical trial (RCT) examined attachment and CM as predictors and moderators of sexual satisfaction, distress, and function at post-treatment and 6-month follow-up while comparing 2 treatments for PVD: Topical lidocaine, and a novel cognitive behavioral couple therapy focused on women's pain and partners' sexuality. One hundred eight women with PVD were randomized to a 12-week treatment of either lidocaine or couple therapy. Women completed questionnaires at pretreatment, post-treatment, and at a 6-month follow-up. (1) Global Measure of Sexual Satisfaction; (2) Female Sexual Distress Scale-Revised; (3) Female Sexual Function Index. Both attachment and CM were significant moderators of treatment outcomes. At either post-treatment or 6-month follow-up, in the couple therapy condition, women with greater attachment avoidance had poorer outcomes on sexual distress, satisfaction and function, whereas women with higher levels of CM had poorer outcomes on sexual satisfaction and sexual function, compared to women in the lidocaine condition. Although these novel findings need further replication, they highlight the importance for clinicians to take into account distal factors, for instance, attachment and CM, when treating sexual difficulties such as PVD, as these variables may affect more interpersonal dimensions of treatment (eg, trust, compliance, etc.) and ultimately, treatment progress. Using a rigorous RCT study design and statistical approach, this study is the first to examine attachment and CM as moderators in the treatment of sexual difficulties. It is however limited by the use of self-report measures, and further studies are necessary to validate the generalizability of current results to other sexual difficulties. Findings support the role of interpersonal factors in the treatment of PVD and indicate that short-term psychological interventions, such as couple therapy, may be less beneficial for women with antecedents of CM and attachment insecurity.

The Development and Validation of the Sexual and Relationship Distress Scale

BackgroundSexual distress is an important factor in the etiology, maintenance, and treatment of sexual difficulties, and as such, there is a need for validated measures. A limitation in the research and treatment of distressing sexual difficulties has been the lack of validated measures, and in particular, existing measures are unable to measure the impacts at the relationship level and currently focus on intra-personal distress. AimThis study sought to develop and psychometrically evaluate a new measure of distress associated with sexual difficulties. MethodsAn initial pool of 73 items was created from the results of an earlier qualitative study and administered using an online survey to 1,381 participants (462 men, 904 women, and 14 who identified as “other”), along with measures for the purposes of psychometric evaluation including the Female Sexual Distress Scale–Revised, Couples Satisfaction Index 16-item version, Depression Anxiety and Stress Scale–Short Form, and questions relating to sexual function. Exploratory factor analysis and confirmatory factor analysis in separate split-half samples were conducted, followed by analysis of validity and reliability of the resulting measure. OutcomesThe Sexual and Relationship Distress Scale (SaRDS) was developed to meet the need for a patient-reported outcome measure of individual and relationship distress within the context of sexual dysfunction and resulted in a psychometrically sound 30-item, 14-factor measure of sexual and relationship distress. ResultsThe final 30 items explained 77.5% of the total variance and the confirmatory factor analysis showed that this model has an adequate fit (comparative fit index = .97, normed fit index = .95, root mean square error of approximation = .05). The final measure demonstrated good psychometric properties, with strong internal reliability (Cronbach alpha = .95 for the total score with individual sub-scales ranging from .70–.96), and convergent and discriminant validity when compared to current measures (Female Sexual Distress Scale–Revised, r = .82, P < .001; Couples Satisfaction Index, r = –.69, P < .001; Depression Anxiety and Stress Scale–Short Form, r = .37, P < .001). Clinical ImplicationsThe SaRDS may prove useful for researchers and clinicians interested in understanding and improving the distress experienced within the context of sexual difficulties. The new measure is brief (30 items), easy to administer and score, easily understood (Flesch-Kincaid reading level = grade 3.9), and demonstrates high internal consistency, convergent and discriminant validity. Strengths & LimitationsThe SaRDS has advantages over existing measures as it is brief yet includes sub-scales. However, it must be noted that a community sample was used for this study and it would be beneficial to include a clinical sample in future validation studies. ConclusionUnlike most measures in this field, the SaRDS is multi-dimensional and assesses 14 distinct yet related types of sexual and relationship distress experienced in the context of sexual dysfunctions. It can be administered across genders and both members of a couple. It therefore has multiple uses within both research and clinical settings.Frost R, Donovan C. The Development and Validation of the Sexual and Relationship Distress Scale. J Sex Med 2018;15:1167–1179.

109 The Development and Psychometric Properties of the Sexual and Relationship Distress Scale (SaRDS)

Distress is an important factor in the aetiology, maintenance and treatment of sexual difficulties and as such the Third International Consultation on Sexual Medicine highlighted the need for validated measures of sexual distress for use as outcome measures in future clinical trials. Most measures currently available are gender-specific or dysfunction-specific and rarely measure the impact at the level of the couple relationship. Given that relationship factors strongly predict the degree of distress experienced, it is important to learn more about the interplay between sexual dysfunction and relationship satisfaction. Objective The Sexual and Relationship Distress Scale (SaRDS) was developed to meet the need for a measure of both individual and relationship distress within the context of sexual dysfunction. Materials and Method 73 initial items were created from the results of an earlier qualitative study and administered using an online survey to 1381 participants, along with measures for the purposes of psychometric evaluation including the FSDS-R, CSI-16, DASS-21, and questions relating to sexual function. Results Multiple iterative rounds of factor analyses were conducted on the initial item pool, resulting in a 30-item, 14 factor measure. The CFA showed that this model has an adequate fit. The final measure demonstrated good psychometric properties, with strong internal reliability, and convergent and discriminant validity. Conclusions Unlike most measures in this field, the SaRDS is multi-dimensional and assesses 14 distinct yet related types of sexual and relationship distress experienced in the context of sexual dysfunctions. It can be administered across genders and both members of a couple. It therefore has multiple uses within both research and clinical settings. Disclosure Work supported by industry: no. The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

Women’s experiences of coping with the sexual side effects of antidepressant medication

A growing body of evidence has highlighted the sexual side effects of selective serotonin reuptake inhibitor (SSRI) medication. Whilst most of the research has focused on the prevalence and treatment of sexual difficulties, little is known about how patients cope with the SSRI-related sexual side effects. The objective of this study was to explore women’s experiences of coping with the sexual side effects of SSRI medication and interpretative phenomenological analysis was employed for an in-depth exploratory study of a sample of 10 women. Four broad themes emerged which are discussed under the following headings: searching, suffering in silence, trying to resolve and accepting what is. The themes provide an insight into the different strategies used by women to cope with the sexual side effects of SSRI medication and highlight the importance of contextualising these difficulties as part of an overall approach to improve the management and treatment of SSRI-related sexual side effects.

Searching for answers and validation: Australian women's experiences of coping with the adverse sexual effects of antidepressants.

Sexual difficulties relating to selective serotonin reuptake inhibitor (SSRI) medication have an impact on quality of life and are a common cause for non-adherence to medication. While most research has focussed on the prevalence and treatment of sexual difficulties, little is known about how patients cope with the adverse sexual effects of SSRIs. This qualitative study, using Interpretive Phenomenological Analysis (IPA), investigated the experiences of 10 Australian women currently coping with the adverse sexual effects ofthis antidepressant by conducting semi-structured interviews. This paper presents one major theme from the study and reports the findings related to women's self-reported experiences of interacting with GPs in their search for answers and validation of their concerns. Findings from the study add to the current literature by providing an insight into how interactions with GPs impact on women's abilities to cope with adverse sexual effects. Empathic discussions and shared decision-making between GPs and women can provide the opportunity to improve the management of the adverse sexual effects of SSRIs and may lead to improved outcomes for women.

Experience in the treatment of sexual difficulties: Strengths and limitations of the psychoanalytic approach

Theodore Jacobs grounded his Introduction in Freud’s early connection between the damming up of sexual libido and somatic symptoms. Later, anxiety and/or depressive affect would underlie inhibited ...

Low- vs High-Dose Estradiol Vaginal Ring in Treatment of Sexual Difficulties

Low- vs High-Dose Estradiol Vaginal Ring in Treatment of Sexual Difficulties

Low- vs High-Dose Estradiol Vaginal Ring in Treatment of Sexual Difficulties—Reply

Low- vs High-Dose Estradiol Vaginal Ring in Treatment of Sexual Difficulties—Reply

Fundamentals of Theory and Practice Revisited: Sex Therapy: Historical Evolution, Current Practice. Part 2

This is the second of a two-part series on the treatment of sexual difficulties. It presents a systemic approach to sex therapy and uses illustrative case histories to explore: the interrelationship between the presenting person or couple; the ‘sexual’ as part of the relationship; the symptom; the medical considerations; the cultural context; and the framework and thinking of the therapist.

Acculturation and Sexual Function in Asian Women

Cultural effects on sexuality are pervasive and potentially of great clinical importance, but have not yet received sustained empirical attention. The purpose of this study was to explore the role of acculturation on sexual permissiveness and sexual function, with a particular focus on arousal in Asian women living in Canada. We also compared questionnaire responses between Asian and Euro-Canadian groups in hopes of investigating whether acculturation captured unique information not predicted by ethnic group affiliation. Euro-Canadian (n = 173) and Asian (n = 176) female university students completed a battery of questionnaires in private. Euro-Canadian women had significantly more sexual knowledge and experiences, more liberal attitudes, and higher rates of desire, arousal, sexual receptivity, and sexual pleasure. Anxiety from anticipated sexual activity was significantly higher in Asian women, but the groups did not differ significantly on relationship satisfaction or problems with sexual function. Acculturation to Western culture, as well as maintained affiliation with traditional Asian heritage, were both significantly and independently related to sexual attitudes above and beyond length of residency in Canada, and beyond ethnic group comparisons. Overall, these data suggest that measurement of acculturation may capture information about an individual's unique acculturation pattern that is not evident when focusing solely on ethnic group comparisons or length of residency, and that such findings may be important in facilitating the assessment, classification, and treatment of sexual difficulties in Asian women.

Psychosexual Dysfunction Among Gynecological Cancer Survivors

The purpose of this paper is to summarize the empirical findings related to the assessment and treatment of sexual difficulties commonly experienced by gynecological cancer survivors and to make suggestions for future research and practice in this area. First, we describe the sexual problems that are most frequently reported by gynecological cancer patients and some of their common medical and psychological correlates. These include pain, premature ovarian failure, changes in vaginal anatomy, emotional distress, body image, and sexual self-concept. The complex interaction of physiological and psychological variables plays an important role in the development of sexual dysfunction in this patient population. Furthermore, we review the empirical studies that have examined the effects of sexual rehabilitation therapy on the sexual functioning of gynecological cancer survivors and provide relevant research and clinical recommendations. We also discuss reasons to involve patients' sexual partners in psychosocial oncology research, given the complex interplay between patients' and partners' psychosexual issues.

The treatment of sexual difficulties in a regional institute for ambulatory mental health care

Abstract This study examines ambulatory mental health care for sexual problems, as provided by one of the 58 Riaggs in the Netherlands. Mental health professionals report that for one out of three clients sexual difficulties are a major factor in their mental problems; 40% of the clients that had sexual difficulties when they first applied for help indicate that during treatment not enough attention was paid to this issue. This can be attributed to a shortage of training in the field of sexology and to a tendency among mental health professionals not to work specifically on such problems.

Training non‐psychologists in the treatment of sexual dysfunction with special reference to the training of marriage guidance counsellors

This paper describes a study in which marriage guidance counsellors were trained in the treatment of sexual difficulties. This study is discussed in the wider context of the literature concerned with training issues in the treatment of sexual function problems. The results of the training programme give clear evidence that non-professionals can be trained to produce results similar to those of a professional and it is argued that issues discussed in the literature concerning the training of professionals in the treatment of sexual difficulties are also applicable to non-professionals.

Female sexual behaviour. A study in a random sample of 40-year-old women

This is a sexological study of a random sample of 225 40-yr-old women representative of the Danish female population at the age of 40. These women were questioned by a female physician utilizing a structured interview; 94% of the women invited to participate in this study agreed to do so. The purpose of this research was to elucidate sexual behaviour, experience, knowledge and attitudes. Some of the findings were the following. Menstruation still seems to be a taboo subject; 36% of this population knew little about this topic. 96% of these women had experienced orgasm at least once in their lives and 67.6% had experienced spontaneous libido. Genuine homosexuality appears to be a rare phenomenon. A monogamous heterosexual life style is the norm, as reflected by low number of partners and low frequency of infidelity. Yet, 35% of these woman had sexual problems. There is a need for advice and treatment of sexual difficulties in this population, but these are at present, in Denmark, not generally available.