A randomized, placebo-controlled laboratory study of the effects of D-cycloserine on sexual memory consolidation in women.

RATIONALE AND OBJECTIVE: The aim of this study was to investigate the possible facilitating effect of the partial NMDA receptor agonist D-cycloserine (DCS) on memory consolidation of conditioned sexual responses and to examine the capability of DCS to reduce context-specificity of learning. METHODS: In a randomized placebo-controlled double-blind trial, 50 healthy females were exposed to a differential conditioning procedure. Two pictures of a male abdomen were used as conditional stimuli (CSs), of which one (the CS+) was followed by the unconditional stimulus (US), a genital vibrotactile stimulus. After the conditioning session on day 1, participants received either 125 mg of DCS or a placebo. The effects of DCS on affect, sexual arousal and US expectancy in response to the CS+ and CS- were examined 24 h after the conditioning procedure. RESULTS: A main effect of DCS was found on affect at the first test trials (p = 0.04, ηp2 = 0.09), and a similar non-significant but trend level effect was found for sexual arousal (p = 0.06, ηp2 = 0.07), which appeared to persist over a longer time (p = 0.07, ηp2 = 0.08). Unexpectedly, ratings of positive affect and sexual arousal in response to both the CS+ and the CS- were higher in the DCS condition compared to the control condition, possibly indicating that DCS administration reduced stimulus specificity. Since the results did not show clear evidence for context learning, we were not able to test effects on context-specificity of learning. CONCLUSION: Although largely inconclusive, the results provide tentative support for a facilitating effect of DCS on affect and sexual arousal in response to stimuli that were presented in a sexual conditioning procedure, however, no conclusions can be drawn about effects of DCS on sexual reward learning, since the design and results do not lend themselves to unambiguous interpretation.

Sexual functioning, sexual esteem, genital self-image and psychological and relational functioning in women with Mayer-Rokitansky-Küster-Hauser syndrome: a case-control study.

STUDY QUESTION: Do sexual functioning, sexual esteem, genital self-image and psychological and relational functioning in women with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome differ from a comparison group of women without the condition? SUMMARY ANSWER: In comparison to controls, women with MRKH with a non-surgically or surgically created neovagina did not differ in psychological and relational functioning but reported lower sexual esteem and more negative genital self-image, intercourse-related pain, clinically relevant sexual distress and sexual dysfunction, with sexual esteem levels strongly associated with sexual distress and sexual dysfunction. WHAT IS KNOWN ALREADY: Studies on sexual functioning measured with standardized questionnaires in women with MRKH syndrome compared with women without the condition have yielded contradictory results. Factors associated with sexual functioning in this patient population have rarely been investigated. STUDY DESIGN, SIZE, DURATION: Between November 2015 and May 2017, 54 women with MRKH syndrome with a neovagina and 79 age-matched healthy women without the condition were enrolled in this case-control study. PARTICIPANTS/MATERIALS, SETTING, METHODS: All participants had to be at least 18-years old and had to live in a steady heterosexual relationship. Women with MRKH syndrome were asked to participate by their (former) gynecologists at three university hospitals and by MRKH peer support group. Controls were recruited via advertisement in local newspapers and social media. Standardized questionnaires were administered to assess sexual functioning, sexual esteem, genital self-image and psychological and relational functioning. MAIN RESULTS AND THE ROLE OF CHANCE: Women with MRKH syndrome with a surgically or non-surgically created neovagina reported significantly more pain during intercourse (P < 0.05, d = 0.5), but did not differ in overall sexual functioning from control women. More women with MRKH syndrome reported clinically relevant sexuality-related distress (P < 0.05, odds ratio (OR): 2.756, 95% CI 1.219-6.232) and suffered a sexual dysfunction (P < 0.05, OR: 2.654, 95% CI: 1.088-6.471) in comparison with controls. MRKH women scored significantly lower on the sexual esteem scale (SES) (P < 0.01, d = 0.5) and the female genital self-image scale (FGSIS) (P < 0.01, d = 0.6) than controls. No significant differences were found between the two groups regarding psychological distress, anxiety and depression, global self-esteem and relational dissatisfaction. Sexual esteem was significantly associated with the presence of clinically relevant sexual distress (ß = 0.455, P = 0.001) and suffering a sexual dysfunction (ß = 0.554, P = 0.001) and explained, respectively, 40% and 28% of the variance. LIMITATIONS, REASONS FOR CAUTION: Given the nature of the study focusing on sexual functioning, a potential selection bias cannot be excluded. It is possible that those women with the most severe sexual and/or psychological disturbances did or did not choose to participate in our study. WIDER IMPLICATIONS OF THE FINDINGS: The study results add new data to the very limited knowledge about psychosexual functioning of women with MRKH syndrome and are of importance for more adequate counseling and treatment of these women. STUDY FUNDING/COMPETING INTEREST(S): The research was financially supported by the Dutch Scientific Society of Sexology (Nederlandse wetenschappelijke Vereniging Voor Seksuologie). The funding was unrestricted, and there was no involvement in the conduct of the research. There are no conflicts of interest to declare.

Impaired sexual function in women with systemic sclerosis: a cross-sectional study.

OBJECTIVE: To compare sexual functioning and distress in women with systemic sclerosis (SSc) with that in healthy controls and determine the association between disease characteristics and sexual function. METHODS: We conducted a cross-sectional study of 69 women with SSc (ages 18-60 years) and 58 healthy, age-matched controls. Assessment included the Female Sexual Function Index (FSFI), Female Sexual Distress Scale (FSDS), Hospital Anxiety and Depression Scale, Short Form 36 health survey, sociodemographic characteristics, and in patients only, the Health Assessment Questionnaire. RESULTS: Of 69 eligible patients with SSc, 37 (54%) responded, in addition to 37 (64%) of 58 controls. The FSFI total score and the subscale scores for lubrication, orgasm, arousal, and pain were significantly lower and the FSDS scores were significantly higher in patients with SSc. Longer disease duration and higher levels of marital dissatisfaction were significantly associated with low sexual function in patients with SSc. Longer disease duration, more depressive symptoms, and the use of antidepressants were significantly associated with sexual distress. Multivariate analyses indicated that marital distress was the only variable significantly associated with low sexual function in patients with SSc (beta = 0.40, P < 0.05), whereas depression was the only variable significantly associated with sexual distress (beta = 0.32, P < 0.05). The same pattern of associations was found in the healthy control group. CONCLUSION: Women with SSc reported significantly impaired sexual functioning and more sexual distress then healthy controls. Impaired sexual functioning and sexual distress were associated with marital distress and depressive symptoms. These results indicate that in daily practice, inquiring about sexuality and screening for depressive symptoms is indicated in every patient with SSc, irrespective of their clinical characteristics.

[Individualized obstetrical care for women with a history of sexual abuse]. / Verloskundige zorg op maat voor vrouwen die in het verleden seksueel misbruikt zijn.

The consequences of a history of sexual abuse for pregnancy and delivery are illustrated in case histories of three women, aged 28, 27 and 31 years respectively. The first woman (who had a history of sexual abuse, like the other women) reacted to labour with dissociative behaviour. This was anticipated by giving her directions for the proceedings during labour, which helped restoring contact. The second patient expressed insecurity during her prenatal check-ups, the reaction to which was inadequate. When labour started her fear had grown and led to an early plea for a caesarean section. An epidural made caesarean section redundant. The third patient had re-experiences during her prenatal check-ups. External examination or an ultrasound were a burden to her. Together with the patient a detailed treatment plan was made which gave her control over the situation. It is advised to question all women during prenatal care about a possible history of sexual abuse and if found, to discuss the consequences of these experiences in her everyday life, especially during her pregnancy. The obstetrical care-giver has to be aware of the circumstances that might provoke traumatic memories and anxious feelings. By knowing and anticipating these events--also called triggers--, the professional can give 'tailor-made' care during pregnancy and delivery.

Vaginismus and dyspareunia: is there a difference in clinical presentation?

The purpose of this exploratory study was to identify clinical similarities and differences in patients with vaginismus and dyspareunia. Thirty patients who were referred to an outpatient clinic for psychosomatic gynecology and sexology, with either of these two diagnoses, were investigated by means of a standardized interview, physical examination and self-rating questionnaires. Based on the interview, no significant differences were demonstrated between patients with vaginismus and dyspareunia, in the ability to insert a finger into the vagina or to have a gynecological examination. No differences were found in the reported level of pain during coitus (or attempted coitus), inserting one finger into the vagina, or during gynecological examination. Patients with vaginismus, however, more often reported that coitus was impossible. The physical examination and self-rating questionnaires showed no differences at all between patients with vaginismus and dyspareunia in palpated vaginal muscular tension and reported anxiety or tension during the examination. Moreover, in both groups redness and painful areas on the vulva were equally common. Redness and pain on the same location were more frequently present in the dyspareunia group. Patients with dyspareunia reported higher levels of pain during the examination. In conclusion, neither the interview nor the physical examination produced useful criteria to distinguish vaginismus from dyspareunia. A multi-axial description of these syndromes is suggested, rather than viewing them as two separate disorders.

The effect of a group programme on women with the Mayer-Rokitansky-Küster-Hauser syndrome.

OBJECTIVE: To evaluate the effect of a group programme on psychological distress in women with the Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome. SETTING: Gynaecologic outpatient clinic. SAMPLE: Seventeen women with MRKH syndrome participated in this study. METHOD: A semi-structured programme of seven sessions was offered dealing with themes of the MRKH syndrome. Psychological distress was measured at the first visit 3-6 month before the group programme was started (pre-test-0), at the first (pre-test) and then at the last group session (post-test). MAIN OUTCOME MEASURE: The Symptom Check List-90 was used to assess feelings of psychological distress. RESULTS: The post-test subscale scores for anxiety, depression, interpersonal sensitivity and the total score for psychological distress were significantly lower than the pre-test-0 and pre-test scores (P < 0.05). No significant differences were found between the pre-test-0 and pre-test subscale scores and total score. CONCLUSION: A semi-structured group programme seems valuable in helping women with the MRKH syndrome to deal with their psychological stress.

[Sexual problems and experiences with sexual and physical violence in gynecological patients]. / Seksuele klachten en ervaringen met seksueel en fysiek geweld bij gynaecologische patiënten.

OBJECTIVE: To determine the frequency of sexual difficulties and of sexual and physical abuse. DESIGN: Descriptive survey study. SETTING: Outpatient gynaecology clinic of the University Hospital of Leiden, the Netherlands. PATIENTS AND METHOD: During 3 months, December 1994-February 1995, all consecutive new female patients were questioned by the gynaecologist by means of a short standardised questionnaire. Oncology patients and non-Dutch-speaking patients were excluded. Data were analysed with descriptive statistical procedures; relationships among variables were tested with the chi 2 test with Yates' correction or Fisher's exact test. RESULTS: Of 325 patients 34.2% reported sexual difficulties, 15.4% reported sexual abuse and 7.4% physical molestation. Age of the patient and presence or absence of the partner during the consultation were not associated with differences in the patients' reports. 18.8% of the patients with these complaints answered affirmatively when asked if they needed specialised help. CONCLUSION: Sexual difficulties and sexual and physical abuse were common among gynaecology patients. Less than one-fifth of them required specialised help.

Psychologic profiles of and sexual function in women with vulvar vestibulitis and their partners.

OBJECTIVE: To compare psychologic profiles of women with vulvar vestibulitis and their partners with a normal population, and to identify sexual dysfunction in women and their partners. METHODS: Forty-three women with vulvar vestibulitis and 38 partners, recruited from a gynecology outpatient clinic, completed the Symptom Check List-90, the Short Dutch Version of the Minnesota Multiphasic Personality Inventory, the Maudsley Marital Questionnaire, and the Questionnaire for Screening Sexual Dysfunctions. RESULTS: The women with vulvar vestibulitis scored significantly higher on the somatization and shyness subscales than a normal population. They didn't differ in respect to their current level of psychologic distress, extraversion, risk of psychopathology, and marital satisfaction. Their partners had significantly lower scores for psychopathology than a normal population. They didn't differ from a normal population in respect to their level of psychologic distress, extraversion, shyness, somatization, and marital satisfaction. Women with vulvar vestibulitis reported more frequent problems and higher distress with genital pain, lubrication, sexual arousal, and negative emotions in the sexual interaction with the partner. During masturbation, however, they reported less frequent problems and distress. The partners of these women reported nearly no problems or distress in either sexual situation. CONCLUSION: Women with vulvar vestibulitis and their partners seem in general to be psychologically healthy, although vulvar vestibulitis may be associated with a situationally defined sexual dysfunction for the women.

Difficulties in the differential diagnosis of vaginismus, dyspareunia and mixed sexual pain disorder.

This retrospective study was undertaken to investigate predictors of vaginismus, dyspareunia and mixed sexual pain disorder in respect of symptom profile and treatment history variables of female patients and their partners. The study sample consisted of 147 female patients attending a university hospital outpatient clinic for Psychosomatic Gynecology and Sexology. All patients met the DSM-III-R criteria of the diagnoses of vaginismus (n = 50), dyspareunia (n = 46), or of both diagnoses (n = 51). No univariate differences were found between members of the three groups or between their partners. It was not possible to make a multivariate prediction of group membership.