Feasibility and preliminary effectiveness of a novel cognitive-behavioral couple therapy for provoked vestibulodynia: a pilot study.

Introduction Provoked vestibulodynia (PVD), a recurrent, localized vulvovaginal pain problem, carries a significant psychosexual burden for afflicted women, who report impoverished sexual function and decreased frequency of sexual activity and pleasure. Interpersonal factors such as partner responses to pain, partner distress, and attachment style are associated with pain outcomes for women and with sexuality outcomes for both women and partners. Despite these findings, no treatment for PVD has systematically included the partner. Aims This study pilot‐tested the feasibility and potential efficacy of a novel cognitive–behavioral couple therapy (CBCT) for couples coping with PVD. Methods Couples (women and their partners) in which the woman was diagnosed with PVD (N = 9) took part in a 12‐session manualized CBCT intervention and completed outcome measures pre‐ and post‐treatment. Main Outcome Measures The primary outcome measure was women's pain intensity during intercourse as measured on a numerical rating scale. Secondary outcomes included sexual functioning and satisfaction for both partners. Exploratory outcomes included pain‐related cognitions; psychological outcomes; and treatment satisfaction, feasibility, and reliability. Results One couple separated before the end of therapy. Paired t‐test comparisons involving the remaining eight couples demonstrated significant improvements in women's pain and sexuality outcomes for both women and partners. Exploratory analyses indicated improvements in pain‐related cognitions, as well as anxiety and depression symptoms, for both members of the couple. Therapists' reported high treatment reliability and participating couples' high participation rates and reported treatment satisfaction indicate adequate feasibility. Conclusions Treatment outcomes, along with treatment satisfaction ratings, confirm the preliminary success of CBCT in reducing pain and psychosexual burden for women with PVD and their partners. Further large‐scale randomized controlled trials are necessary to examine the efficacy of CBCT compared with and in conjunction with first‐line biomedical interventions for PVD.

Evaluation of a cognitive behavior therapy program for people with sexual dysfunction

This article reports on an evaluation of a cognitive behavioral program for the treatment of sexual dysfunction. Frequency data are provided on the sexual dysfunction of 95 males (mean age = 41.6 years) and 105 females (mean age = 36.4 years). The effectiveness of a cognitive behavioral program among 45 sexually dysfunctional males (mean age = 39.9 years) and 54 sexually dysfunctional females (mean age = 36.2 years) was assessed. The results demonstrated that, after therapy, respondents experienced lower levels of sexual dysfunction, more positive attitudes toward sex, perceptions that sex was more enjoyable, fewer affected aspects of sexual dysfunction in their relationship, and a lower likelihood of perceiving themselves as a sexual failure. The implications of these findings for the treatment of sexual dysfunction are discussed.

Are primary and secondary provoked vestibulodynia two different entities? A comparison of pain, psychosocial and sexual characteristics.

Introduction Provoked vestibulodynia (PVD) is suspected to be the most frequent cause of vulvodynia in premenopausal women. Based on the onset of PVD relative to the start of sexual experience, PVD can be divided into primary (PVD1) and secondary PVD (PVD2). Studies comparing these PVD subgroups are inconclusive as to whether differences exist in sexual and psychosocial functioning. Aim The aim of this study was to compare the pain, sexual and psychosocial functioning of a large clinical and community-based sample of premenopausal women with PVD1 and PVD2. Methods A total of 269 women (n = 94 PVD1; n = 175 PVD2) completed measures on sociodemographics, pain, sexual, and psychosocial functioning. Main Outcome Measures Dependent variables were the 0–10 pain numerical rating scale, McGill–Melzack Pain Questionnaire, Female Sexual Function Index, Global Measure of Sexual Satisfaction, Beck Depression Inventory-II, Painful Intercourse Self-Efficacy Scale, Pain Catastrophizing Scale, State-Trait Anxiety Inventory Trait Subscale, Ambivalence over Emotional Expression Questionnaire, Hurlbert Index of Sexual Assertiveness, Experiences in Close Relationships Scale—Revised, and Dyadic Adjustment Scale-Revised. Results At first sexual relationship, women with PVD2 were significantly younger than women with PVD1 (P < 0.01). The average relationship duration was significantly longer in women with PVD2 compared with women with PVD1 (P < 0.01). Although women with PVD1 described a significantly longer duration of pain compared with women with PVD2 (P < 0.01), no significant subtype differences were found in pain intensity during intercourse. When controlling for the sociodemographics mentioned earlier, no significant differences were found in sexual, psychological, and relational functioning between the PVD subgroups. Nevertheless, on average, both groups were in the clinical range of sexual dysfunction and reported impaired psychological functioning. Conclusions The findings show that there are no significant differences in the sexual and psychosocial profiles of women with PVD1 and PVD2. Results suggest that similar psychosocial and sex therapy interventions should be offered to both subgroups of PVD.

Are married couples happier in their relationships than cohabiting couples? Intimacy and relationship factors

This study was designed to examine the relationship between dyadic adjustment and intimacy, and to determine how this varies for different types of relationships between males and females, and for relationships of different duration. Eighty-seven heterosexual couples (10 dating, 21 living together, 56 married) participated in the study. The results demonstrated that there was a strong interrelationship between intimacy and dyadic adjustment for both males and females. Those in relationships of longer duration and married couples experienced higher levels of intimacy and relationship satisfaction than other couples. There was a general trend for married couples and those who were living together to have a higher level of agreement on their levels of intimacy and relationship adjustment than couples who were dating. The implication of these findings for obtaining a better understanding of the lifecycle of relationships is discussed.

Do we need a new classification system for female sexual dysfunction? A comment on the 1999 consensus classification system.

This Article does not have an abstract.

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.

Relationships, sexuality and adjustment among people with physical disability.

The current study investigated the association between relationship status and the psychological adjustment, sexual esteem and sexual behaviour of people with and without physical disability. A total of 1196 participants completed the study, 748 participants (367 men, 381 women) had a physical disability and 448 participants (171 men, 277 women) were able-bodied. The age range of participants was 18 to 69 years, with a mean age of 36.39 years (SD=10.41). The results demonstrated that physical disability and its severity were related to an increased likelihood of being single. Men with physical disabilities were more likely than women to be single. In terms of psychological adjustment, single people with physical disabilities were more depressed than those who had a partner they did not live with. However, they were not significantly disadvantaged in this area when compared to married people and those in de facto relationships. Relationship status was strongly related to sexual wellbeing in people with and without physical disability, with single people reporting lower levels of sexual satisfaction and sexual esteem as well as less frequent mutual sexual activity. However, married people with physical disabilities reported lower levels of sexual wellbeing than the people who had partners they did not live with. This suggests that among couples where a partner has a physical disability, marriage and live-in relationships may add burdens that do not exist in more casual relationships.

The impact of stigma on couples managing a sexually transmitted infection

Recent research has indicated that the stigma surrounding sexually transmitted infections (STIs) creates a psychological and emotional burden for individuals with these conditions. It would be expected that the stigma of having a STI would also alter the dynamics of an intimate relationship. This paper reviews the literature on the impact of STIs on intimate relationships, and considers the relevance of this research to both clinicians and researchers. In particular, the types of relationships in which the presence of a STI may have a varying degree of impact are examined. Since disclosure of a STI would also be expected to impact on a relationship, an overview of the factors involved in the disclosure of a STI to a partner is also considered. Finally, the implications of this research for both clinicians and researchers are discussed.

Psychological and interpersonal dimensions of sexual function and dysfunction.

To highlight the salient psychological and interpersonal issues contributing to sexual health and dysfunction; to offer a four-tiered paradigm for understanding the evolution and maintenance of sexual symptoms; and to offer recommendations for clinical management and research.

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.

Psychological and interpersonal dimensions of sexual function and dysfunction

Introduction. There are limited outcome data on the etiology and efficacy of psychological interventions for male and female sexual dysfunction as well as the role of innovative combined treatment paradigms.
Aim. This study aimed to highlight the salient psychological and interpersonal issues contributing to sexual health and dysfunction, to offer an etiological model for understanding the evolution and maintenance of sexual symptoms, and to offer recommendations for clinical management and research.
Methods. This study reviewed the current literature on the psychological and interpersonal issues contributing to male and female sexual dysfunction.
Main Outcome Measure. This study provides expert opinion based on a comprehensive review of the medical and psychological literature, widespread internal committee discussion, public presentation, and debate.
Results. Medical and psychological therapies for sexual dysfunctions should address the intricate biopsychosocial influences of the patient, the partner, and the couple. The biopsychosocial model provides an integrated paradigm for understanding and treating sexual dysfunction.
Conclusions. There is need for collaboration between healthcare practitioners from different disciplines in the evaluation, treatment, and education issues surrounding sexual dysfunction. In many cases, neither psychotherapy alone nor medical intervention alone is sufficient for the lasting resolution of sexual problems. The assessment of male, female, and couples’ sexual dysfunction should ideally include inquiry about predisposing, precipitating, maintaining, and contextual factors. Research is needed to identify efficacious combined and/or integrated treatments for sexual dysfunction.

Sexualidade e deficiência física: reabilitação e terapia sexual de lesados medulares

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Age-specific and sex-specific weight gain norms to monitor antiretroviral therapy in children in low-income and middle-income countries.

BACKGROUND Viral load and CD4% are often not available in resource-limited settings for monitoring children's responses to antiretroviral therapy (ART). We aimed to construct normative curves for weight gain at 6, 12, 18, and 24 months following initiation of ART in children, and to assess the association between poor weight gain and subsequent responses to ART. DESIGN Analysis of data from HIV-infected children younger than 10 years old from African and Asian clinics participating in the International epidemiologic Databases to Evaluate AIDS. METHODS The generalized additive model for location, scale, and shape was used to construct normative percentile curves for weight gain at 6, 12, 18, and 24 months following ART initiation. Cox proportional models were used to assess the association between lower percentiles (< 50th) of weight gain distribution at the different time points and subsequent death, virological suppression, and virological failure. RESULTS Among 7173 children from five regions of the world, 45% were underweight at baseline. Weight gain below the 50th percentile at 6, 12, 18, and 24 months of ART was associated with increased risk of death, independent of baseline characteristics. Poor weight gain was not associated with increased hazards of virological suppression or virological failure. CONCLUSION Monitoring weight gain on ART using age-specific and sex-specific normative curves specifically developed for HIV-infected children on ART is a simple, rapid, sustainable tool that can aid in the identification of children who are at increased risk of death in the first year of ART.