Changes over time in sexual and relationship functioning of people with multiple sclerosis

Relationship and sexual satisfaction among people with multiple sclerosis (MS) has received little research attention. This article reports on a longitudinal investigation of the impact of coping style and illness-related variables among people with MS and the general population on sexual and relationship functioning. Both men (n = 120) and women (n= 201) with MS and men (n = 79) and women (n = 160) from the general population participated in the study at two points in time, 6 months apart. People with MS experienced lower levels of sexual activity, sexual satisfaction, and relationship satisfaction and higher levels of sexual dysfunction. Generally speaking, the time 1 levels of the health and coping variables explained little of the variance in the time 2 sexual and relationship variables. However, sexual activity at time 1 contributed significant unique variance to relationship satisfaction at time 2 for MS men, and coping strategies at time I contributed to relationship satisfaction among general population women at time 2. Furthermore, for those respondents who had been diagnosed with MS for less than 7 years, levels of sexual activity at time 2 were predicted by levels of sexual and relationship satisfaction, as well as levels of sexual activity at time 1. These results suggest that strategies used to cope with illness may not play a major role in sexual and relationship satisfaction. However, an examination of these strategies over a longer time frame is needed.

Attrition from an internet-based psychological intervention for erectile dysfunction : who is likely to drop out?

The current study evaluated the dropout rate from an internet-based treatment program for erectile dysfunction (ED), and determined reasons for attrition from this program. Only 12 of 40 treatment group men and 19 of 20 control group men completed the post-test measures. Reasons for the men being excluded or dropping out of the study are discussed. These reasons included medical conditions that contributed to their ED, the man's partner not being interested in participating in the program, a lack of motivation from the man, or the time commitment being too demanding.

Conceptualizing women's sexual function : linear vs. circular models of sexual response

Introduction. The lack of an adequate empirical base for models of female sexual response is a critical issue within the female sexual dysfunction (FSD) literature.

Aim. The current research compared the extent to which a linear model of sexual response and Basson's circular model of female sexual response represent the sexual function of women with and without FSD.

Main Outcome Measures. Women's levels of sexual function/dysfunction were assessed with the Female Sexual Function Index and additional items measured women's endorsement of models of female sexual function as representing their own sexual experience.

Methods. An anonymous online survey assessing female sexual response and associated aetiological factors was completed by a random sample of 404 women.

Results. Although the linear model of sexual response was a good fit for women with and without sexual dysfunction, the relationship between sexual arousal and orgasm was mediated by sexual desire for women with FSD. The fit of the initial circular model of women's sexual response was poor for both groups. Following pathway modification, the modified circular model adequately represented the responses of both groups and revealed that a number of the relationships between sexual response variables were stronger for women with FSD.

Conclusions. The linear model was a more accurate representation of sexual response for women with normal sexual function than women with FSD and sexual arousal and orgasm was mediated by sexual desire for women with FSD. The modified circular model was a more accurate representation of the sexual response of women with FSD than women with normal sexual function.

The impact of erectile dysfunction on female partners : a qualitative investigation

Sexual dysfunction research has primarily focused on understanding and treating problems of erectile dysfunction (ED) in men. Research has paid little attention to the impact of ED on women. The current study reports on an investigation of women's perception of their partners' ED, what they had tried to do about the problem and the impact of ED on them and their relationship. In-depth interviews were conducted with 51 women who were currently in a heterosexual relationship with a man with ED. The findings provide detailed information on women's experience of their partners' ED. They also demonstrate the need for educational resources on sexual difficulties for both the lay public and their medical practitioners. In the clinical situation, the study demonstrated the value of involving the female partner in the treatment process in improving a couple's sexual satisfaction.

Are aspects of study design associated with the reported prevalence of female sexual difficulties?

Objective: To investigate associations between the prevalence of sexual  difficulties reported in published studies and design features of those studies to determine if differences in design contribute to variation in prevalence estimates.
Design: Systematic review, multivariate analysis.
Setting: Studies published internationally in English.
Patient(s): Not applicable.
Intervention(s): None.
Main Outcome Measure(s): Prevalence estimates of difficulty with desire, arousal, orgasm, and sexual pain reported in published studies.
Result(s): Our systematic literature search identified 1,380 publications. Fifty-five studies met our inclusion criteria (reporting prevalence, sample size and response rate, sample size greater than 100, not clinic based). Reported prevalence of sexual difficulty varied across studies (up to tenfold). Eleven aspects of research conduct in these studies were included in our multivariate analysis as explanatory variables. Five aspects of study design and conduct (data collection procedures, inclusion criteria, duration of sexual difficulty recorded, sample size, and response rate) were associated with the reported prevalence of at least one type of sexual difficulty independently of likely predictors of true variation in prevalence: study location, study year, and age range of participants.
Conclusion(s): This review provides evidence that study design may influence reported prevalence estimates of female sexual difficulties and contribute to the wide variation in published estimates.

What is the "true" prevalence of female sexual dysfunctions and does the way we assess these conditions have an impact?

Introduction. A wide range of prevalence estimates of female sexual dysfunctions (FSD) have been reported.
Aim. Compare instruments used to assess FSD to determine if differences between instruments contribute to variation in reported prevalence.
Main Outcome Measures. Sexual Function Questionnaire combined with Female Sexual Distress Scale (SFQ-FSDS) was our gold standard, validated instrument for assessing FSD. Alternatives were SFQ alone and two sets of simple questions adapted from Laumann et al. 1994.
Methods. A postal survey was administered to a random sample of 356 Australian women aged 20 to 70 years.
Results. When assessed by SFQ-FSDS, prevalence estimates (95% confidence intervals) of hypoactive sexual desire disorder, sexual arousal disorder (lubrication), orgasmic disorder, and dyspareunia were 16% (12% to 20%), 7% (5% to 11%), 8% (6% to 12%), and 1% (0.5% to 3%), respectively. Prevalence estimates varied across alternative instruments for these disorders: 32% to 58%, 16% to 32%, 16% to 33%, and 3% to 23%, respectively. Compared with SFQ-FSDS alternative instruments produced higher estimates of desire, arousal and orgasm disorders and displayed a range of sensitivities (0.25 to 1.0), specificities (0.48 to 0.99), positive predictive values (0.01 to 0.56), and negative predictive values (0.95 to 1.0) across the disorders investigated. Kappa statistics comparing SFQ-FSDS and alternative instruments ranged from 0 to 0.71 but were predominantly 0.44 or less. Changing recall from previous month to 1 month or more in the previous year produced higher estimates for all disorders investigated. Including sexual distress produced lower estimates for desire, arousal, and orgasm disorders.
Conclusions. Prevalence estimates of FSD varied substantially across instruments. Relatively low positive predictive values and kappa statistics combined with a broad range of sensitivities and specificities indicated that different instruments identified different subgroups. Consequently, the instruments researchers choose when assessing FSD may affect prevalence estimates and risk factors they report.

The psychological and relationship impact of erectile dysfunction

This thesis demonstrated that Australian men with erectile dysfunction (ED) experience poorer levels of masculinity, self-esteem, quality of life, sexual satisfaction and relationship satisfaction than do men without ED. The implications of these findings for the current medical approach to treating this sexual dysfunction were discussed. The portfolio explores grief following elective abortion and reflects on how grief responses may present in post-abortion counselling. The potential utility of grief therapy to this counselling is demonstrated in four case studies.

Circumcision in Australia : further evidence on its effects on sexual health and wellbeing

Objective: To report on the prevalence and demographic variation in circumcision in Australia and examine sexual health outcomes in comparison with earlier research.
Methods: A representative household sample of 4,290 Australian men aged 16–64 years completed a computer-assisted telephone interview including questions on circumcision status, demographic variables, reported lifetime experience of selected sexually transmissible infections (STIs), experience of sexual difficulties in the previous 12 months, masturbation, and sexual practices at last heterosexual encounter.
Results: More than half the men (58%) were circumcised. Circumcision was less common (33%) among men under 30 and more common (66%) among those born in Australia. After adjustment for age and number of partners, circumcision was unrelated to STI history except for non-specific urethritis (higher among circumcised men, OR=2.11, p<0.001) and penile candidiasis (lower among circumcised men, OR=0.49, p<0.001).
Circumcision was unrelated to any of the sexual difficulties we asked about (after adjusting for age) except that circumcised men were somewhat less likely to have worried during sex about whether their bodies looked unattractive (OR=0.77, p=0.04). No association between lack of circumcision and erection difficulties was detected. After correction for age, circumcised men were somewhat more likely to have masturbated alone in the previous 12 months (OR=1.20, p=0.02).
Conclusions: Circumcision appears to have minimal protective effects on sexual health in Australia.

Development and psychometric properties of the Female Sexual Desire Questionnaire (FSDQ)

Introduction.  Sexual desire is often evaluated as part of a global assessment of female sexual function, which may not comprehensively evaluate the various facets of this experience. There currently exists a need to develop a psychometrically robust desire-specific measure for women.

Aim.  The aim of this study was to develop and validate a desire-specific, self-administered instrument that evaluates the multiple facets of sexual desire and factors influencing this experience for partnered heterosexual women, with or without sexual dysfunction.

Methods.  Preliminary items for inclusion in the Female Sexual Desire Questionnaire (FSDQ) were identified through a literature review and individual interviews with partnered heterosexual women, mostly from Australia. The resulting instrument was completed by a validation sample of 741 women, aged between 18 and 71 years, who were involved in a heterosexual relationship of between 3 months' and 49 years' duration.

Main Outcome Measures.  Exploratory factor analysis was used to refine the FSDQ item content and identify the underlying domain structure. The reliability (internal consistency) and validity (convergent validity) of the FSDQ were also evaluated.

Results.  The final version of the FSDQ consisted of 50 items organized into six domains that characterized the experience of, and factors influencing, sexual desire for heterosexual partnered women: Dyadic Desire, Solitary Desire, Resistance, Positive Relationship, Sexual Self-Image, and Concern. Each domain demonstrated high reliability, as did the overall measure. Evidence of construct validity was ascertained through convergence with the Sexual Desire Inventory and the Hurlbert Index of Sexual Desire. A short-form of the FSDQ, consisting of six items, was also developed.

Conclusions.  The FSDQ is a new reliable and valid multidimensional measure designed specifically for evaluating the facets of, and factors influencing, sexual desire among sexually functional and dysfunctional women who are involved in a heterosexual relationship.

Demographic and psychological factors related to sexual desire among heterosexual women in a relationship

This study examined demographic, psychological, and relationship factors that are associated with the experience of sexual desire in women. The contribution of other aspects of sexual function on sexual desire was also investigated. The participants were 741 partnered heterosexual women (mean age¼45.7 years), who completed the Female Sexual Desire Questionnaire online, which evaluated their levels of sexual desire, as well as a range of individual and dyadic variables. For each of the six aspects of sexual desire assessed, the number and frequency of problems in other aspects of women’s sexual functioning were the most common predictors. The results demonstrated that sexual desire was lower among older, postmenopausal women and those who had been in their current relationship for a longer period of time. Women who reported that their partner experienced a sexual dysfunction also obtained lower sexual desire scores. These findings demonstrate the strong interrelationship between the different phases of the sexual response cycle for women. Further, they suggest that sexual dysfunction in one partner is likely to be associated with sexual dysfunction in the other partner. The clinical implications of these findings in terms of the treatment for sexual dysfunction among women (and their partners) are discussed.

Body mass index, sexual difficulties and sexual satisfaction among people in regular heterosexual relationships : a population-based study

Background/Aims:  The aims of this study were to clarify the relationship between body mass index (BMI) and sexual difficulties and to investigate if BMI influenced sexual satisfaction, over and above the effects of sexual difficulties.

Methods:  Cross-sectional analyses of a nationally representative computer-assisted telephone interview. Eight thousand, six hundred and fifty-six respondents were recruited by random digit dialling in 2004–2005. Only those in a sexually active, heterosexual relationship were included in the current analyses.

Results:  After adjustments for demographic factors, both overweight and obese male and female participants were more likely to report worrying during sex about whether their body was unattractive. Among women, associations were also found between higher BMI and lack of interest in sex. No other significant associations between BMI and sexual difficulties were evident. There was an association between BMI and extreme physical pleasure for women but not men over and above the effects of sexual difficulties, with obese women being more likely than normal weight women to report extreme physical pleasure. No associations were found for either men or women between BMI and whether or not they reported extreme emotional or sexual satisfaction with their relationship.

Conclusions:  With the exception of body image difficulties, there is little association between BMI and self-reported sexual difficulties. Furthermore, extreme sexual and emotional satisfaction appeared to be associated with the presence or absence of sexual difficulties and not overly influenced by BMI. Overall, clinicians and patients should be aware that being overweight is not necessarily detrimental to sexual functioning.

Incidence and persistence/recurrence of women’s sexual difficulties : findings from the Australian longitudinal study of health and relationships

This study presents data on the prevalence, incidence, and persistence/recurrence of 8 sexual difficulties among women. Australian women participated in 2 computer-assisted interviews approximately 12 months apart. Analyses were based on a weighted sample of 2,252 women who were 20–64 years of age, sexually active in the past 12 months, and in the same heterosexual relationship at both interviews. Upon recruitment, two-thirds of women (66%) reported having one or more sexual difficulties. At follow-up, 36% reported a new sexual difficulty. The two highest incident difficulties were “lacking interest in having sex” (26%) and “taking too long to orgasm” (11%). In addition, 68% of women with 1 or more sexual difficulties at recruitment reported having at least 1 of these again at follow-up. Lacking interest in having sex had the highest persistence/recurrence (65%). Logistic regression modeling revealed a lower incidence of sexual difficulties among women in their 40s. Age was also a predictor of the persistence/recurrence, with persistence/recurrence most likely among older women. Tobacco and alcohol use predicted the incidence, but not persistence/recurrence, of lacking interest in sex. Health professionals need to take note of the sociodemographic groups most prone to developing and having persistent/recurrent sexual difficulties.