Psychological intervention for premature ejaculation.

While psychological issues are present in most patients with premature ejaculation (PE), whether as a cause or a consequence of the disorder, the effectiveness of psychological intervention for PE is not clear. Searches of the MEDLINE, EMBASE, PsychINFO, LILACS and the Cochrane Library electronic databases find little high-quality evidence for the psychosexual and behavioral approaches to treatment of PE. Five randomized and four quasi-randomized trials were included in this Review. Little evidence was found that psychological interventions are effective in the treatment of PE. Three studies showed strong evidence in support of improved intravaginal ejaculatory latency times following psychosexual therapy combined with pharmacotherapy, compared with monotherapy. One study found that functional-sexological treatment markedly improved duration of intercourse, sexual satisfaction, and sexual function. Limitations of published studies include a lack of randomization, uncertain clinical significance of outcomes, absence of compelling follow-up data that show long-term response and lack of reproducibility. Randomized trials with large sample sizes are still needed to expand the currently available evidence on psychological intervention for treating PE. Besides examining the main effects of treatment, trials in this field should also address the complex interactions between patient characteristics, PE subtype and treatment approach.

[Cross-cultural adaptation of the Female Sexual Function Index]. / Adaptação transcultural do Female Sexual Function Index.

The epidemiology of female sexual dysfunctions is still not well known. The Female Sexual Function Index (FSFI) is a short questionnaire specially designed to assess female sexual response. This study aimed to evaluate the cross-cultural equivalence of the Portuguese version of the FSFI. The cross-cultural adaptation involved five steps: translation, back-translation, formal equivalence assessment, review by specialists in sexuality, and pre-testing. After identification of semantic problems, agreements, and disagreements, a brief version was proposed, selecting and incorporating items from one of the two Portuguese versions. Some changes were made after pre-testing the questionnaire, most of which to make the Portuguese version more readily comprehensible and acceptable for the target population, using ordinary words as options or to complement the scientific language. Comparing more than one version of the instrument in the process of cross-cultural equivalence allowed detecting problems and difficulties in adapting the language, which would not have been observed otherwise.

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.