Mindfulness in sex therapy and intimate relationships: a feasibility and randomized controlled pilot study in a cross-diagnostic group.

Background: Mindfulness facets can be trained with structured mindfulness interventions, but little is known regarding application on a broader level within sex therapy (e.g. men, partners and different sexual dysfunctions). Aim: To evaluate the feasibility and preliminary efficacy of an 8-week intervention-specifically, mindfulness for sex and intimacy in relationships (MSIR)-as a supplement to treatment as usual (TAU) as compared with only TAU in a clinical sample of men and women referred for sexual difficulties with or without a partner. Methods: In this randomized controlled feasibility pilot study, 34 participants were randomized to MSIR + TAU (n = 15) or TAU (n = 19). Six healthy partners were also included in the study. MSIR was administered as 2 individual evaluations and six 2-hour group sessions of mixed gender and different types of sexual dysfunction. Outcomes: The primary outcome measures were as follows: (1) feasibility, defined as the implementation of recruitment, acceptance, and attendance of intervention in daily clinical practice and the MSIR completion rate; (2) sexual functioning, as measured on a visual analog scale ("bothered by problem") and by validated questionnaires (Changes in Sexual Function Questionnaire for Females and Males, Female Sexual Function Index, Female Sexual Distress Scale, International Index of Erectile Function). Results: MSIR was feasible and well received by patients, with high rates of acceptance and intervention completion. As compared with pretreatment, the MSIR + TAU group and TAU control group were significantly less bothered by their sexual problems at the end of treatment, but the change was significantly larger in the MSIR + TAU group (P = .04). Participants in the MSIR + TAU group did not receive fewer TAU sessions than the TAU group (MSIR + TAU mean, 6 sessions; TAU mean, 8 sessions). Clinical Implications: MSIR could be effectively used in a clinical setting as an add-on to TAU in the treatment of female and male sexual dysfunction and healthy partners. Strengths and Limitations: The major strength of the study is that it is a randomized controlled study. This study is novel in the sense that it included men and women with different types of sexual dysfunction in the same mindfulness group. Limitations include the pilot nature of the study (e.g. a small sample size), and statistical conclusions should be made with caution. More accurate results may be found in a larger sample. Conclusion: Results from this study support already existing evidence that mindfulness-based interventions are feasible and effective for targeting sexual dysfunctions in men and women.

[Therapy of sex offenders].

Outcomes of reviews of the effect of interventions for sexual offenders vary and are inconclusive. The lack of consensus reflects the inherent ethic and methodological difficulties related to the evaluation of treatment effect for sexual offenders. In this overview, we examined seven reviews of treatment outcome studies for adult sexual offenders. Three of seven reviews reported a significant positive post-treatment effect on sexual re-offending risk. However, the evidence for successful treatment seems far from robust given the lack of controlled and methodological strong primary studies.

Psychodynamic and systemic group treatment for women with a history of childhood sexual abuse: five-year follow-up of a randomized controlled trial.

Background: Childhood sexual abuse (CSA) is a significant trauma that may have lifelong impact. Due to the long-term negative personal and societal consequences of CSA, it is crucial to find treatments with enduring outcomes. Objective: The aim of this study was to determine the relative long-term efficacy of psychodynamic and systemic group therapy for adult women exposed to CSA. Method: A prospective randomized controlled trial was conducted with outcomes assessed at pre- and post-treatment, and 1 and 5 years post-treatment. All analyses were intention-to-treat. One hundred and six women with sequelae from childhood sexual abuse were treated with psychodynamic or systemic group therapy. Primary outcome was Global Severity Index (GSI) of SCL-90-R. Secondary outcomes included symptoms of PTSD and depression and psycho-social functioning. Results: Treatment was completed by 81% of participants; 64% completed the 1-year follow-up and 60% completed the 5-year follow-up. Completion rates did not differ between treatments. Significant reduction in symptoms measured on GSI and improvement of psychosocial functioning was found for both interventions at all measurement points after treatment (ES range = 0.68-1.19). However, different trajectories were observed: while outcome at end of treatment was significantly better in the systemic group, no differences in gains were observed at the 1- and 5-year follow-ups when controlling for baseline differences. Conclusions: The findings add to the evidence base for psychodynamic and systemic group therapy, but the result also underscores the importance of taking post-treatment trajectories into account in evidence-based research, in the continued efforts to improve treatment for this population.

Antecedentes: El abuso sexual en la infancia (ASI) es un trauma significativo que puede tener un impacto para toda la vida. Dadas las consecuencias negativas personales y sociales del ASI, es crucial encontrar tratamientos con resultados sostenidamente positivos.Objetivo: El objetivo de este estudio fue determinar la eficacia relativa a largo plazo de la terapia grupal psicodinámica y sistémica para mujeres adultas expuestas a ASI.Método: Se realizó un ensayo controlado aleatorizado prospectivo, con evaluaciones pre y post tratamiento, y luego de 1 y 5 años post-tratamiento. Todos los análisis fueron por intención de tratar. Ciento seis mujeres con secuelas derivadas de abuso sexual en la infancia fueron tratadas con terapia grupal psicodinámica o sistémica. El resultado principal fue el índice global de severidad (IGS) del SCL-90-R. Los resultados secundarios incluyeron síntomas de TEPT y depresión, y funcionamiento psicosocial.Resultados: El tratamiento fue completado por 81% de los participantes; 64% de ellos completó el seguimiento luego de un año, y 60% completó el seguimiento luego de cinco años. Se encontró una reducción significativa de síntomas medidos a través del IGS, además de un mejoramiento del funcionamiento psicosocial, en ambas intervenciones y en todo momento de evaluación post-tratamiento (ES rango = 0.68-1.19). No obstante, se observaron diferentes trayectorias: aunque el resultado al final del tratamiento era significativamente mejor en el grupo sistémico, no se observaron diferencias de ganancias en los seguimientos de 1 y 5 años, controlando las diferencias base.Conclusiones: Los hallazgos contribuyen a la evidencia basal para terapia grupal psicodinámica y sistémica, pero los resultados también resaltan la relevancia de considerar las trayectorias post-tratamiento en la investigación basada en evidencia, como parte de los esfuerzos para mejorar los tratamientos para esta población.

Sexual dysfunction and mental health in patients with multiple sclerosis and epilepsy.

BACKGROUND: Epilepsy and multiple sclerosis (MS) are two neurological diseases known to greatly influence a patient's life. The primary aim of this study was to describe the prevalence of sexual dysfunction in patients with epilepsy and MS and investigate whether there is an association between disease, sexual function, and physical and mental health. A secondary aim was to investigate whether there is a difference in sexual function between patients with MS and epilepsy. METHODS: A total of 414 patients were included in this descriptive cross-sectional study. Three patient report questionnaires were used for measurements: the Changes in Sexual Function Questionnaire (CSFQ) cut-off score; the Short Form 36 Health Survey (SF-36) divided into the Physical Component Summary (PCS) and Mental Component Summary (MCS), and the Life Satisfaction-11 (LiSat-11). RESULTS: Patients with MS constituted 62% (n = 258) of the participants and patients with epilepsy 38% (n = 156). The prevalence of sexual dysfunction was 68% in women and 77% in men. No differences were found between patients with MS and epilepsy (p = 0.184), except for the CSFQ desire domain, as patients with epilepsy more often had a desire problem (p = 0.029). On the SF-36, patients with MS scored significantly worse on the PCS (p = 0.000). Patients with epilepsy scored significantly worse on the MCS (p = 0.002). No significant differences were found on the LiSat-11. Regression analysis with CSFQ as the dependent variable showed an association with the PCS in men and an association with both PCS and MCS in women. CONCLUSIONS: In this study, the cohort of patients with MS and epilepsy had negatively affected sexual function. The only significant difference between patients with MS and epilepsy in sexual function measured by the CSFQ-14, was found in the frequency of desire, in which a larger number of patients with epilepsy reported sexual dysfunction. In the studied cohort, sexual function in women is associated with both physical and mental health, and in men with physical health. These results should be considered when caring for patients with epilepsy and MS.

[Diagnosing and treating paedophilia].

In this review, we discuss paedophilia, which is a persistent and intense sexual interest in prepuberty children. Paedophilia is related to but not identical to sexual offending. Valid and reliable identification of paedophilia is complicated. In Denmark there is a need for intensifying primary and secondary preventive interventions aimed at increasing the number of individuals with paedophilia seeking treatment. Paedophilia has the same or a higher prevalence than other severe psychiatric disorders. Yet, in Denmark, this research field is delayed in comparison to research into other psychiatric disorders.

[Mindfulness in the treatment of sexual difficulties].

In this review, we present the status of mindfulness in the treatment of sexual difficulties in men and women. The prevalence of sexual difficulties is high among both men and women. Sexual difficulties are often associated with somatic and mental disorders, and therefore effective treatments are needed. Growing evidence shows, that standardised mindfulness programmes are effective in the treatment of stress, anxiety, depression and chronic pain. Evidence for mindfulness therapy in sexology is sparse, but results so far suggest, that mindfulness can be effective in sex therapy.

Androgen Receptor Polymorphism and Female Sexual Function and Desire.

INTRODUCTION: The effect of testosterone depends on the exposure of and the sensitivity of the androgen receptor (AR). It has been shown that a cytosine-adenine-guanine (CAG) trinucleotide repeat polymorphism in the AR gene has an impact on AR functional capacity in men. However, large studies are lacking on the impact of this polymorphism on female sexual function. AIM: To determine whether the CAG repeat length was associated with different aspects of women's sexual function and dysfunction, including desire, arousal, lubrication, orgasm, satisfaction, sexual pain, and sexually related personal distress. METHODS: This cross-sectional study included 529 healthy women, aged 19-65 years. Participants completed a questionnaire to provide demographic and sexual data. The CAG repeat length was analyzed in a blood sample. The correlations between CAG repeat lengths and different aspects of sexual function were calculated. Independent Student t-tests were performed to evaluate differences in the mean number of CAG repeats in the short and long allele and of the biallelic mean length determined by simple calculation and X-inactivation analysis, respectively, between women with sexual problems and women without sexual problems. P values <.05 were considered statistically significant. MAIN OUTCOME MEASURE: We used the Female Sexual Function Index, with 6 subdomains, to distinguish between women without and women with impaired sexual function; low sexual desire; impaired arousal, lubrication, or orgasm; diminished satisfaction; or pain during sex. The Female Sexual Distress Scale was used to measure sexually related personal distress. RESULTS: Overall, we found that increasing numbers of CAG repeats were correlated to increased sexual function. We found that women with problems achieving orgasm had a significantly lower number of CAG repeats than women that reported no problems reaching orgasm. We found no associations between CAG repeat lengths and other aspects of female sexual dysfunction, including hypoactive sexual desire disorder. CLINICAL IMPLICATIONS: The results could indicate an impact of the AR on women's sexual function, including the ability to reach orgasm. STRENGTH & LIMITATIONS: This is a large study using validated sexual questionnaires. A limitation is the cross-sectional design. Owing to the study design, this study is explorative and hypothesis generating. CONCLUSION: In this large cross-sectional study, we demonstrated that CAG repeat length is positively correlated to sexual function and that women with a reduced ability to reach orgasm had smaller numbers of CAG repeats in the AR gene than women with no orgasmic problems. These findings indicated that androgens and ARs might play a role in women's sexual function. Wåhlin-Jacobsen S, Flanagan JN, Pedersen AT, Kristensen E, Arver S, Giraldi A. Androgen Receptor Polymorphism and Female Sexual Function and Desire. J Sex Med 2018;15:1537-1546.

Androgens and Psychosocial Factors Related to Sexual Dysfunctions in Premenopausal Women∗: ∗2016 ISSM Female Sexual Dysfunction Prize.

INTRODUCTION: The female sexual response is complex and influenced by several biological, psychological, and social factors. Testosterone is believed to modulate a woman's sexual response and desire, because low levels are considered a risk factor for impaired sexual function, but previous studies have been inconclusive. AIM: To investigate how androgen levels and psychosocial factors are associated with female sexual dysfunction (FSD), including hypoactive sexual desire disorder (HSDD). METHODS: The cross-sectional study included 428 premenopausal women 19 to 58 years old who completed a questionnaire on psychosocial factors and had blood sampled at days 6 to 10 in their menstrual cycle. Logistic regression models were built to test the association among hormone levels, psychosocial factors, and sexual end points. MAIN OUTCOME MEASURES: Five different sexual end points were measured using the Female Sexual Function Index and the Female Sexual Distress Scale: impaired sexual function, sexual distress, FSD, low sexual desire, and HSDD. Serum levels of total and free testosterone, androstenedione, dehydroepiandrosterone sulfate, and androsterone glucuronide were analyzed using mass spectrometry. RESULTS: After adjusting for psychosocial factors, women with low sexual desire had significantly lower mean levels of free testosterone and androstenedione compared with women without low sexual desire. None of the androgens were associated with FSD in general or with HSDD in particular. Relationship duration longer than 2 years and mild depressive symptoms increased the risk of having all the sexual end points, including FSD in general and HSDD in particular in multivariate analyses. CONCLUSION: In this large cross-sectional study, low sexual desire was significantly associated with levels of free testosterone and androstenedione, but FSD in general and HSDD in particular were not associated with androgen levels. Length of relationship and depression were associated with FSD including HSDD. Wåhlin-Jacobsen S, Kristensen E, Tønnes Pedersen A, et al. Androgens and Psychosocial Factors Related to Sexual Dysfunctions in Premenopausal Women. J Sex Med 2017;14:366-379.

Long-Term Follow-Up of Individuals Undergoing Sex-Reassignment Surgery: Somatic Morbidity and Cause of Death.

INTRODUCTION: Studies of mortality and somatic well-being after sex-reassignment surgery (SRS) of transsexual individuals are equivocal. Accordingly, the present study investigated mortality and somatic morbidity using a sample of transsexual individuals who comprised 98% (n = 104) of all surgically reassigned transsexual individuals in Denmark. AIMS: To investigate somatic morbidity before and after SRS and cause of death and its relation to somatic morbidity after SRS in Danish individuals who underwent SRS from 1978 through 2010. METHODS: Somatic morbidity and mortality in 104 sex-reassigned individuals were identified retrospectively by data from the Danish National Health Register and the Cause of Death Register. MAIN OUTCOME MEASURES: Somatic morbidity and cause of death. RESULTS: Overall, 19.2% of the sample were registered with somatic morbidity before SRS and 23.1% after SRS (P = not significant). In total, 8.6% had somatic morbidity before and after SRS. The most common diagnostic category was cardiovascular disease, affecting 18 individuals, 9 before and 14 after SRS, and 5 of those 14 who were affected after SRS had cardiovascular disease before and after SRS. Ten individuals died after SRS at an average age of 53.5 ± 7.9 years (male to female) and 53.5 ± 7.3 years (female to male). CONCLUSION: Of 98% of all Danish transsexuals who officially underwent SRS from 1978 through 2010, one in three had somatic morbidity and approximately 1 in 10 had died. No significant differences in somatic morbidity or mortality were found between male-to-female and female-to-male individuals. Despite the young average age at death and the relatively larger number of individuals with somatic morbidity, the present study design does not allow for determination of casual relations between, for example, specific types of hormonal or surgical treatment received and somatic morbidity and mortality.

Long-term follow-up of individuals undergoing sex reassignment surgery: Psychiatric morbidity and mortality.

BACKGROUND: There is a lack of long-term register-based follow-up studies of sex-reassigned individuals concerning mortality and psychiatric morbidity. Accordingly, the present study investigated both mortality and psychiatric morbidity using a sample of individuals with transsexualism which comprised 98% (n = 104) of all individuals in Denmark. AIMS: (1) To investigate psychiatric morbidity before and after sex reassignment surgery (SRS) among Danish individuals who underwent SRS during the period of 1978-2010. (2) To investigate mortality among Danish individuals who underwent SRS during the period of 1978-2010. METHOD: Psychiatric morbidity and mortality were identified by data from the Danish Psychiatric Central Research Register and the Cause of Death Register through a retrospective register study of 104 sex-reassigned individuals. RESULTS: Overall, 27.9% of the sample were registered with psychiatric morbidity before SRS and 22.1% after SRS (p = not significant). A total of 6.7% of the sample were registered with psychiatric morbidity both before and after SRS. Significantly more psychiatric diagnoses were found before SRS for those assigned as female at birth. Ten individuals were registered as deceased post-SRS with an average age of death of 53.5 years. CONCLUSIONS: No significant difference in psychiatric morbidity or mortality was found between male to female and female to male (FtM) save for the total number of psychiatric diagnoses where FtM held a significantly higher number of psychiatric diagnoses overall. Despite the over-representation of psychiatric diagnoses both pre- and post-SRS the study found that only a relatively limited number of individuals had received diagnoses both prior to and after SRS. This suggests that generally SRS may reduce psychological morbidity for some individuals while increasing it for others.

Sociodemographic Study of Danish Individuals Diagnosed with Transsexualism.

INTRODUCTION: Male-to-female (MtF) and female-to-male (FtM) individuals with transsexualism (International Classification of Diseases-10) may differ in core clinical and sociodemographic variables such as age, sexual orientation, marriage and parenthood, school, educational level, and employment. Assessing and understanding the implication of such differences may be a key to developing appropriate and effective treatment and intervention strategies for this group. However, research in the area remains sparse and is often on small populations, making the generalization of results from current studies on individuals diagnosed with transsexualism difficult. AIMS: (i) To describe and assess key sociodemographic and treatment-related differences between MtF and FtM individuals in a Danish population of individuals diagnosed with transsexualism; (ii) to assess possible implications of such difference, if any, for clinical treatment initiatives for individuals diagnosed with transsexualism. METHODS: Follow-up of 108 individuals who had permission to undergo sex reassignment surgery (SRS, meaning castration and genital plastic surgery) over a 30-year period from 1978 to 2008 through the Gender Identity Unit in Copenhagen, Denmark. The individuals were identified through Social Security numbers. Clinical and sociodemographic data from medical records were collected. RESULTS: The sex ratio was 1.16:1 (MtF : FtM). Mean age at first referral was 26.9 (standard deviation [SD] 8.8) years for FtM and 30.2 (SD 9.7) for MtF individuals. Compared with MtF, FtM had a significantly lower onset age (before 12 years of age) and lower age when permission for SRS was granted. Further, FtM individuals were significantly more often gynephilic (sexually attracted to females) during research period and less likely to start self-initiated hormonal sex reassignment (SR) (treatment with cross-sex hormones). The MtF and FtM groups did not differ in years of school, educational level, employment, or engagement in marriage and cohabitation. CONCLUSIONS: As approximately half of MtF started cross-sex hormonal SR without attending a gender unit, future treatment needs to focus on this group of MtF individuals in order to accommodate the medical risks of self-initiated hormonal treatment.Earlier intervention with adolescents appears necessary since three-quarters of FtM individuals before age 12 had problems with their assigned sex. For both MtF and FtM, we found problems in areas of school, education, and employment and recommend further help in these core areas.

Systematic Review of Sexual Dysfunction Among Veterans with Post-Traumatic Stress Disorder.

INTRODUCTION: The clinical observations that many Vietnam veterans complained of sexual problems after returning from active duty have led to the question of a correlation between post-traumatic stress disorder (PTSD) and sexual dysfunction (SD). AIM: The purpose of this review is to systematically review the current literature regarding SD in male veterans with PTSD. METHODS: A systematic literature search, primarily in PubMed, the Cochrane database, and PsycINFO, was conducted. The keywords Sexual Dysfunction, Psychological OR Sexual Dysfunction, Physiological AND Stress Disorders, and Post-Traumatic were used. All manuscripts with relevance to the aim of the review were reviewed and considered. MAIN OUTCOME MEASURE: A total of 123 results were generated from the search. There were 11 publications regarding SD in veterans with PTSD included in the review. RESULTS: The included studies are described in detail in the Results section. All but one study found an increased and significant prevalence of SD among male veterans with PTSD, especially erectile dysfunction and decreased sexual desire. SD increased in patients with PTSD, with a prevalence between 8.4% and 88.6%; the large prevalence range were partly the result of methodological differences. Only two studies have examined the correlation between the severity of PTSD symptoms and SD, with conflicting results. Samples were of relatively moderate size. Only a few confounding factors were accounted for in the included studies. CONCLUSION: Increasing evidence suggests a correlation between PTSD and SD, but still, relatively few studies have addressed these questions. Further investigation is needed into the correlation between PTSD and SD, preferably taking severity of PTSD symptoms into account, along with confounders such as use of psychotropic medication, somatic illness, drug and alcohol abuse, and comorbid psychiatric illness. Bentsen IL, Giraldi AGE, Kristensen E, and Andersen HS. Systematic review of sexual dysfunction among veterans with post-traumatic stress disorder. Sex Med Rev 2015;3:78-87.

Prevalence of sexual desire and satisfaction among patients with screen-detected diabetes and impact of intensive multifactorial treatment: results from the ADDITION-Denmark study.

OBJECTIVE: Sexual problems are common in people with diabetes. It is unknown whether early detection of diabetes and subsequent intensive multifactorial treatment (IT) are associated with sexual health. We report the prevalence of low sexual desire and low sexual satisfaction among people with screen-detected diabetes and compare the impact of intensive multifactorial treatment with the impact of routine care (RC) on these measures. DESIGN: A cross-sectional analysis of the ADDITION-Denmark trial cohort six years post-diagnosis. SETTING: 190 general practices around Denmark. SUBJECTS: A total of 968 patients with screen-detected type 2 diabetes. MAIN OUTCOME MEASURES: Low sexual desire and low sexual satisfaction. RESULTS: Mean (standard deviation, SD) age was 64.9 (6.9) years. The prevalence of low sexual desire was 53% (RC) and 54% (IT) among women, and 24% (RC) and 25% (IT) among men. The prevalence of low sexual satisfaction was 23% (RC) and 18% (IT) among women, and 27% (RC) and 37% (IT) among men. Among men, the prevalence of low sexual satisfaction was significantly higher in the IT group than in the RC group, p = 0.01. CONCLUSION: Low sexual desire and low satisfaction are frequent among men and women with screen-detected diabetes, and IT may negatively impact men's sexual satisfaction.

Prevalence of Sexual Concerns and Sexual Dysfunction among Sexually Active and Inactive Men and Women with Screen-Detected Type 2 Diabetes.

INTRODUCTION: Type 2 diabetes negatively impacts sexual health. Only limited information is available regarding sexual health among sexually inactive patients with type 2 diabetes. AIM: The aim of this study was to examine the prevalence of sexual concerns among sexually active and sexually inactive men and women with type 2 diabetes and of sexual dysfunction (SD) among sexually active. METHODS: Data from the Anglo-Danish-Dutch Study of Intensive Treatment in People with Screen-Detected Diabetes in Primary Care-Denmark study was used. A total of 1,170 Danish patients with screen-detected type 2 diabetes attended a health examination, including assessment of sexual concerns using self-report questionnaires and of SD using the Female Sexual Function Index (FSFI-R) and the International Index of Erectile Function (IIEF-5) instruments. MAIN OUTCOME MEASURES: The main outcome measures used regarding sexual concerns are the following: prevalence of failure to fill sexual needs, of experiencing sexual distress, finding it important to have a good sexual life, and additionally, prevalence of SD. RESULTS: Data regarding sexual activity status during the last 12 months were available among 583 men and 377 women. Seventeen percent of men and 47% of women reported to be sexually inactive, among whom 57% of men and 42% of women reported failure to fill sexual needs; 31% of men and 10% of women that it was important to have a good sexual life, and 32% of men and 11% of women that they were experiencing sexual distress. Around half of men and women were excluded from the SD analysis, mainly because of reporting lack of sexual intercourse during the last 4 weeks. Among those included, 54% of men and 12% of women were found to have SD. CONCLUSIONS: Sexual inactivity is highly prevalent among middle-aged and older men and women with early type 2 diabetes and these patients often have sexual concerns. The high exclusion rates when assessing SD using the FSFI-R and IIEF-5 instruments makes it difficult to draw conclusions regarding the prevalence. Sexual health should be broadly assessed in both sexually active and sexually inactive people with type 2 diabetes. Bjerggaard M, Charles M, Kristensen E, Lauritzen T, Sandbæk A, and Giraldi A. Prevalence of sexual concerns and sexual dysfunction among sexually active and inactive men and women with screen-detected type 2 diabetes. Sex Med 2015;3:302-310.

Endorsement of models describing sexual response of men and women with a sexual partner: an online survey in a population sample of Danish adults ages 20-65 years.

INTRODUCTION: Several models have been used to describe men's and women's sexual responses. These models have been conceptualized as linear or circular models. The circular models were proposed to describe women's sexual function best. AIM: This study aims to determine whether men and women thought that current theoretical models of sexual responses accurately reflected their own sexual experience and to what extent this was influenced by sexual dysfunction. METHODS: A cross-sectional study of a large, broadly sampled, nonclinical population, cohort of Danish men and women. The Female Sexual Function Index, Female Sexual Distress Scale, and the International Index of Erectile Function were used to describe sexual function. Also, participants completed questionnaires with written descriptions of different sexual responses to describe their most experienced sexual response. MAIN OUTCOME MEASURE: For women, we measured desire, arousal, lubrication, orgasm, sexual satisfaction, pain during sexual activity, sexual distress, and satisfaction with sexual life. For men, we measured erectile function, orgasm, desire, intercourse satisfaction, overall satisfaction, and satisfaction with sexual life. RESULTS: A total of 499 men and 573 women participated. We only analyzed responses from sexually active participants with a partner (401 men and 429 women). The majority of men endorsed the Masters & Johnson model (48.5%) or the Kaplan model (38.3%); only 5.4% endorsed the Basson model, and 7.3% endorsed none of the models. Among women, 34% endorsed the Kaplan model, 28% the Masters & Johnson model, 25.6% the Basson model, and 12.5% none of the models. Among women, sexual dysfunction and distress were significantly (P = 0.01) related to endorsement of the Basson model or none of the models. Among men, erectile dysfunction and dissatisfaction with sexual life were significantly related to endorsement of the Basson model or none of the models (P = 0.01). CONCLUSIONS: No single model of sexual response could describe men's and women's sexual responses. The majority of men and women with no sexual dysfunction that were satisfied with their sexual life endorsed the linear models.

Is there a correlation between androgens and sexual desire in women?

INTRODUCTION: For women, the correlation between circulating androgens and sexual desire is inconclusive. Substitution with androgens at physiological levels improves sexual function in women who experience decreased sexual desire and androgen deficiency from surgical menopause, pituitary disease, and age-related decline in androgen production in the ovaries. Measuring bioactive testosterone is difficult and new methods have been proposed, including measuring the primary androgen metabolite androsterone glucuronide (ADT-G). AIM: The aim of this study was to investigate a possible correlation between serum levels of androgens and sexual desire in women and whether the level of ADT-G is better correlated than the level of circulating androgens with sexual desire. METHODS: This was a cross-sectional study including 560 healthy women aged 19-65 years divided into three age groups. Correlations were considered to be statistically significant at P<0.05. MAIN OUTCOME MEASURE: Sexual desire was determined as the total score of the sexual desire domain of the Female Sexual Function Index. Total testosterone (TT), calculated free testosterone (FT), androstenedione, dehydroepiandrosterone sulfate (DHEAS), and ADT-G were analyzed using mass spectrometry. RESULTS: Sexual desire correlated overall with FT and androstenedione in the total cohort of women. In a subgroup of women aged 25-44 years with no use of systemic hormonal contraception, sexual desire correlated with TT, FT, androstenedione, and DHEAS. In women aged 45-65 years, androstenedione correlated with sexual desire. No correlations between ADT-G and sexual desire were identified. CONCLUSIONS: In the present study, FT and androstenedione were statistically significantly correlated with sexual desire in the total cohort of women. ADT-G did not correlate more strongly than circulating androgens with sexual desire and is therefore not superior to measuring circulating androgens by mass spectrometry.

[Multidisciplinary treatment on vulvodynia--where is the evidence?]. / Vulvodyni.

Vulvodynia is a chronic pain syndrome in vulva with a prevalence of nearly 15%. Due to poorly understood pathophysiology and lack of efficient treatment frustration is vastly spread among affected women and their physicians. Behavioural, medical and surgical interventions are widely used, but hardly any of them show significance compared to placebo effect. A multidisciplinary treatment is considered to be the new state of the art treatment, but evidence for such a model is hard to find. This article is a review and evaluation of the many treatment models and their evidence.

Analytic versus systemic group therapy for women with a history of child sexual abuse: 1-year follow-up of a randomized controlled trial.

OBJECTIVE: This randomized prospective study examines durability of improvement in general symptomatology, psychosocial functioning and interpersonal problems, and compares the long-term efficacy of analytic and systemic group psychotherapy in women 1 year after completion of treatment for childhood sexual abuse. DESIGN AND METHODS: Women (n = 106) randomly assigned to analytic or systemic psychotherapy completed the Symptom Checklist-90-R, Global Assessment of Functioning, Global Life Quality, Registration Chart Questionnaire, and Flashback Registration at pre-treatment, post-treatment, and at a 1-year follow-up. RESULTS: Post-treatment gains were significant for both treatment modalities on all measures, but significantly larger after systemic therapy. Significant treatment response was maintained 1-year post-treatment, but different trajectories were observed: 1 year after treatment completion, improvements for analytic therapy were maintained, whereas they decreased after systemic therapy, resulting in no statistically significant difference in gains between the groups at the 1-year follow-up. Despite maintaining significant gains, more than half of the patients remained above cut-off for caseness concerning general symptomatology at post-treatment and at 1-year follow-up. CONCLUSION: The findings stress the importance of long-term follow-up data in effect studies. Different trajectories were associated with the two treatments, but improvement in the two treatment groups did not differ significantly at the 1-year follow-up. Implications of the difference in trajectories for treatment planning are discussed. PRACTITIONER POINTS: Both analytic and systemic group therapy proved efficient in improving general symptomatology, psychosocial functioning, and interpersonal problems in women with a history of CSA and gains were maintained at a 1-year follow-up. Despite maintaining statistically significant gains at the 1-year follow-up, 54% of the patients remained above the cut-off for caseness with respect to general symptomatology, which may indicate a need for further treatment. Different pre-post follow-up treatment trajectories were observed between the two treatment modalities. Thus, while systemic group therapy showed a significantly better outcome immediately after termination, gains in the systemic treatment group decreased during follow-up, while gains were maintained during follow-up in analytic group therapy.

Sexual function in male patients with obstructive sleep apnoea after 1 year of CPAP treatment.

OBJECTIVE: Our objective was to investigate what impact 1 year of effective nocturnal continuous positive airway pressure (CPAP) treatment had on general and functional aspects of sexuality in male patients with a confirmed diagnosis of obstructive sleep apnoea (OSA). METHODS: Before and after 1 year of CPAP treatment, a total of 207 CPAP-compliant male patients (age 26­77) received a survey with questions drawn from two self-administered questionnaires on sexuality ­ Life Satisfaction 11 (LiSat-11) and brief sexual function inventory (BSFI). For assessment of daytime sleepiness, we used the Epworth sleepiness scale (ESS). RESULTS: Response rate was 76%. We found no significant changes in satisfaction with relation to partner or life as a whole, but satisfaction with sexual life (LiSat-11) and both general and functional aspects of sexuality (BSFI) were significantly improved after 1 year of CPAP treatment. ESS score decreased significantly after 1 year of CPAP treatment. CONCLUSION: One year of CPAP treatment improves all aspects of sexual function in male patients with OSA. Our data indirectly suggest that organic factors are the most likely explanation to these improvements.