Sexual Dysfunction Management and Expectations Assessment in Multiple Sclerosis-Female (SEA-MS-F): creation and validation of a specific questionnaire.

INTRODUCTION: Until now, no questionnaire has been developed to study specific expectations concerning sexual dysfunction management and the availability of information on sexuality in the female population affected by multiple sclerosis (MS). Understanding and meeting the patient's expectations is an issue of considerable importance in the evaluation of medical care. AIM AND MAIN OUTCOME MEASURE: We present the development and validation of a specific questionnaire designed for women with MS in order to assess their expectations in terms of sexual dysfunction management: the SEA-MS-F (Sexual Dysfunction Management and Expectations Assessment in Multiple Sclerosis-Female). METHODS: This questionnaire was created and validated by an expert panel, using the Delphi method. The psychometric evaluation was obtained with a sample of 40 female MS patients. Cronbach's alpha index and principal component analysis were used to measure the questionnaire's internal consistency. RESULTS: A consensus on the questionnaire was reached with the Delphi method. The SEA-MS-F is fully compliant with the criteria for psychometric validation among female MS patients, and its internal consistency is excellent (Cronbach's alpha 0.948). CONCLUSION: The SEA-MS-F appears to be a useful tool that could be used either in routine medical situations or in prospective studies of MS in order to ascertain women's expectations concerning the management of their sexual dysfunction.

[Importance of patient's choice in the treatment of erectile dysfunction]. / Importance du choix du patient dans le traitement de la dysfonction érectile.

Erectile dysfunction (ED) affects nearly one out of two men over age 45. ED is known to alter the quality of life of patients, and to affect significantly their sexual life and relations, as well as those of their female partners. Phosphodiesterase 5 inhibitors (PDE5) inhibitors currently represent the reference treatment for ED, because of their efficacy and good tolerability. The presence of erectile disorders capable of altering considerably the life of a couple makes it necessary to find ways for patients and their partners to get more involved in the treatment choices. A "customized" solution responding to patient's needs and resulting from a decision shared with the patient and his partner will allow a better compliance and efficacy of the treatment.

Sexuality after sigmoid vaginoplasty in patients with Mayer-Rokitansky-Küster-Hauser syndrome.

OBJECTIVE: To investigate the functional and sexual outcome of sigmoid vaginoplasty in patients with Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome. DESIGN: Prospective study. SETTING: University hospital. PATIENT(S): Fifty-nine consecutive patients with MRKH syndrome. INTERVENTION(S): Forty-eight patients underwent sigmoid vaginoplasty, and 11 were treated using the Frank method of dilatation. MAIN OUTCOME MEASURE(S): Functional results and sexuality were evaluated with the use of two standardized questionnaires: the Female Sexual Function Index (FSFI) and the revised Female Sexual Distress Scale (FSDS-R). Questions were added to analyze depression, body image perception, and desire of motherhood. RESULT(S): Out of the 68% of patients who answered the questionnaire, 73% had regular sexual intercourse. The mean total FSFI score was 28 ± 3.1 in the operated group and 30 ± 5.3 in the group treated with the Frank method. Their mean FSDS-R scores were 21 ± 12.1 and 18 ± 13.8, respectively. CONCLUSION(S): Sigmoid vaginoplasty is an effective technique providing a nearly normal sexual function to patients with vaginal aplasia. Despite this, psychologic distress related to sexuality persists in most patients, demonstrating the need for a multidisciplinary support.

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.

Improvement in quality of sexual life in female partners of men with erectile dysfunction treated with sildenafil citrate: findings of the Index of Sexual Life (ISL) in a couple study.

INTRODUCTION: Women's quality of sexual life is strongly impaired by erectile dysfunction (ED). Women's involvement in ED treatment is important for compliance and long-term efficacy but remains difficult. The Index of Sexual Life (ISL), specific of the quality of sexual life of women with ED partners, is used here to assess the impact of ED treatment on female partners. AIM: The study explored in a context close to routine clinical practice the effect of sildenafil citrate (Viagra(R); Pfizer, New York, NY, USA) treatment on women's quality of sexual life, in parallel with men's ED evaluations. METHODS: This prospective, open-labeled clinical trial was performed in France in 2006. Sexologists and andrologists recruited 67 volunteer couples for a 14-week sildenafil citrate treatment of male partners, without sex therapy in parallel. MAIN OUTCOME MEASURES: Women's quality of sexual life using ISL, and men's ED using International Index of Erectile Function (IIEF) and Self-Esteem And Relationship (SEAR) were assessed at baseline and at the end of the study. Satisfaction for treatment was measured using Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) and EDITS Partner. RESULTS: The ISL sexual life satisfaction score was low at baseline (12.3), and increased by 8.3 during the study (P < 0.0001). Women were 79.0% to be responders according to ISL assessment. The other ISL dimensions also improved. The final ISL sexual life satisfaction score was dependant on women's age and final IIEF scores. The observed correlations between the ISL sexual life satisfaction dimension and the IIEF erectile function dimension, and the SEAR confidence dimension confirmed our assumptions. Both partners were highly satisfied with the treatment. CONCLUSION: Women satisfaction with their sex life was improved by ED treatment (sildenafil citrate). Couple global caring seemed to amplify the well-known effect of ED treatment for men. The ISL could be a useful tool to help women in their partner's treatment and to integrate ED treatment in a couple approach.

Psychological and interpersonal dimensions of sexual function and dysfunction.

INTRODUCTION: There are limited outcome data on the efficacy of psychological interventions for male and female sexual dysfunction and the role of innovative combined treatment paradigms. AIM: 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. METHODS: An International Consultation assembled over 200 multidisciplinary experts from 60 countries into 17 committees. The recommendations of committee members represent state-of-the-art knowledge and opinions of experts from five continents were developed in a process over a 2-year period. Concerning the Psychological and Interpersonal Committee of Sexual Function and Dysfunction, there were nine experts from five countries. MAIN OUTCOME MEASURE: Expert opinion was based on grading of evidence-based medical 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 a compelling reason for skepticism that any single intervention (i.e., a phosphodiesterase type 5 inhibitor, supraphysiological doses of a hormone, processing of childhood victimization, marital therapy, pharmacotherapy of depression, etc.) will be sufficient for most patients or couples experiencing sexual dysfunction. CONCLUSIONS: There is need for collaboration between healthcare practitioners from different disciplines in 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. Assessment of male, female, and couples' sexual dysfunction should ideally include inquiry about: predisposing, precipitating, maintaining, and contextual factors. Treatment of lifelong and/or chronic dysfunction will be different from acquired or recent dysfunction. Research is needed to identify efficacious combined and/or integrated treatments for sexual dysfunction.

Sexuality after sigmoid colpopoiesis in patients with Mayer-Rokitansky-Kuster-Hauser Syndrome.

OBJECTIVE: To assess the functional outcome and sexuality of patients after creation of a sigmoid neovagina. DESIGN: Clinical study performed between 1992 and 2002, with a mean follow-up of 3.3 years (range, 6 months to 9 years). SETTING: Tertiary care center. PATIENT(S): Sixteen consecutive patients with Rokitansky syndrome. INTERVENTION(S): Creation of a neovagina with an antiperistaltic (n = 13) or isoperistaltic (n = 3) sigmoid graft and colovestibular anastomosis by interrupted suture (n = 11) or PCEEA forceps (n = 5). All patients had a neovaginal vault suspension (n = 16). MAIN OUTCOME MEASURE(S): Functional results were evaluated in patients 6 or more months after the operation (n = 12) by using the standardized Female Sexual Function Index (FSFI). This index assesses four domains of sexual dysfunction: desire disorder, arousal disorder, orgasm disorder, and sexual pain disorder. Lubrification and "sexual" quality of life was also evaluated. Normal patients had a mean full FSFI score of 30 +/- 5 of 36. RESULT(S): The mean full FSFI score was 28 +/- 5 (range: 22-34). Seventy-two percent of patients had vaginal intercourse at least once a week; in this subset, the mean full FSFI score was 30 +/- 3 (range: 25-34). CONCLUSION(S): Sigmoid neovagina allowed a normal sexual life in patients who had sexual relations.

Prevalence of erectile dysfunction in France: results of an epidemiological survey of a representative sample of 1004 men.

OBJECTIVE: Several recent studies have reported prevalence rates for erectile dysfunction (ED) displaying considerable variation from country to country. We report here the results of a survey carried out in France in 2001. METHODS: This study was carried out by means of telephone interviews, on a representative sample of 1004 men aged 40 years or over. The prevalence of ED was determined from the patient's self-evaluation and International Index of Erectile Dysfunction 5 (IIEF-5) score. RESULTS: We found that in France in men aged 40 years and over, one man in three (31.6%) presented ED, of essentially mild or moderate severity (according to IIEF-5 score). We also found that the majority of men suffering from ED expressed dissatisfaction with their relations with their partner. Finally, a large proportion of men stated that they were ready to consult a doctor. CONCLUSION: This survey confirms that the prevalence of ED is high in France. This condition, which represents a source of distress that remains difficult to express and to assess, should be evaluated more effectively by rigorous and standardised methods, particularly as oral and effective treatments are now available.

[Prevalence of erectile dysfunction in France: results of an epidemiological survey conducted on a representative sample of 1004 men]. / Prévalence de l'insuffisance érectile en France: résultats d'une enquête épidémiologique menée auprès d'un échantillon représentatif de 1004 hommes.

OBJECTIVE: Several studies have recently reported the prevalence rates of erectile dysfunction (ED) that vary according to the country. The authors report the results of a survey conducted in France in 2001. MATERIAL AND METHODS: This study was conducted by telephone conversation with a representative sample of 1,004 men over the age of 40. The prevalence of ED was measured by the patient's self-assessment and by the IIEF-5 index. RESULTS: The results show that about 1 man in 3 (31.6%) suffers from ED in France, which is essentially mild to moderate (according to IIEF-5). The majority of men reporting ED declared to be dissatisfied with their relationship with their partner. Finally, a large proportion of men declared that they would be willing to consult a practitioner. CONCLUSION: This survey confirms the high prevalence of erectile dysfunction in France. It is responsible for a distress that is still difficult to express and assess. This disease needs to be more accurately evaluated by rigorous and standardized methods, especially as simple and effective treatments are now available.