ABSTRACT
BACKGROUND: Individuals with mental health disorders have a higher risk of sexual problems impacting intimate relations and quality of life. For individuals with bipolar disorder (BD) the mood shifts might to a particular degree affect their sexual function with possible hypersexual interest during manic episodes and low sexual interest during depressive episodes. The diagnosis is often given in late adolescence, which may impact sexual identity and development. Only a few studies have looked at BD and sexual life, with no qualitative research on the topic. We conducted a qualitative pilot study exploring sexuality in connection to mood swings in five participants with BD. RESULTS: Thematic content analysis revealed five themes: (1) sexual drive and impulses, (2) sexual behavior, (3) thoughts and feelings in relation to sexual issues, (4) intimate relationships, and (5) sexuality and identity. During manic episodes the participants described having a higher sexual drive, leading for some to more sexual interactions. During depressed episodes, the sexual drive in the three female participants was low, however, in the two men, rather than a reduced sexual drive, a more self-destructive way of engaging in sex prevailed. The sexual outgoing behavior during manic phases was described as joyful, with no feelings of shame connected to it. However, the shifts in sexual drive connected to mood shifts affected the participants' relationships negatively. Further, all the participants described having outgoing sexual behavior in their youth. CONCLUSIONS: Overall, changes in sexual drive may act as a trigger or early warning symptoms of new episodes, pinpointing the clinical relevance of addressing sexuality in individuals with BD. In general, sexual drive followed affective episodes. However, during depressive episodes sex could be, instead of reduced drive, associated with negative feelings. All participants described having an outgoing sexual behavior in their youth before the onset of BD, which might be essential to consider if there is a clinical suspension of BD in an individual.
ABSTRACT
INTRODUCTION: Few studies have investigated women's experiences with orgasm and the factors that they cite as important for their orgasmic function and sexual behavior related to foreplay and sexual stimulation. AIM: To investigate and describe overall sexual function in a cohort of North American women, with a special focus on orgasmic function, satisfaction, triggers, risk factors, and sexual behavior. METHODS: A total of 303 women aged 18-75 years completed a 100-questionnaire survey, which included the Female Sexual Function Index (FSFI) questionnaire and questions on orgasmic function, duration of sexual activity, sexual behaviors and relationship, and the partner's sexual function. Statistical analysis was performed using SPSS to illuminate factors affecting sexual function. OUTCOMES: The main outcome measures are FSFI score, satisfaction with sexual life, ability to reach orgasm, orgasm frequency, preferred sexual stimulation, and sexual habits. RESULTS: FSFI scores, which were calculated for the 230 women who reported having had a steady male sex partner in the preceding 6 months, showed that 41% of the 230 women were at risk for female sexual dysfunction (a cutoff less than 26.55) and 21% were dissatisfied with their overall sexual life. Almost 90% of the overall cohort reported good emotional contact with their partner, that their partner was willing to have sex, satisfaction with the partner's penis size (wherever applicable), and good erectile function and ejaculatory control of their partner (wherever applicable). 81% of the overall cohort claimed to be sexually active. Around 70% (70-72) did reach orgasm frequently, but around 10% never did so. Vaginal intercourse was reported by 62% of the overall cohort as the best trigger of orgasm, followed by external stimulation from the partner (48%) or themselves (37%). External stimulation was reported to be the fastest trigger to orgasm. CLINICAL IMPLICATIONS: The knowledge on how women reach orgasm and how it is related to the partners' willingness to have sex and other factors can be incorporated in the clinical work. STRENGTHS & LIMITATIONS: The use of a validated questionnaire and the relative large number of participants are strengths of the study. Limitations are the cross-sectional design, the lack of a sexual distress measure, and a possible selection bias. CONCLUSION: Most women in the overall cohort were satisfied overall with their sexual life and partner-related factors, even though 41% (of those who cited a steady sex male partner) were at risk for female sexual dysfunction. Most women did reach orgasm through different kinds of stimulation. Correlation was good between preferred and performed sexual activities and positions. Shaeer O, Skakke D, Giraldi A, et al. Female Orgasm and Overall Sexual Function and Habits: A Descriptive Study of a Cohort of U.S. Women. J Sex Med 2020;17:1133-1143.
