Restrictions and distress in daily, social, and sexual functioning, and intimate relationships in women with pelvic floor complaints: A mixed-method study.

Women with pelvic floor complaints experience restrictions and distress in their daily, social, and sexual functioning, and their intimate relationships. We interviewed forty-eight women to unravel differences between women receiving and not receiving pelvic physical therapy and between pregnant, parous, and nulliparous women in preparation for theory development. We analyzed data in a mixed-method design using NVivo and Leximancer. Sexual dysfunction, relationship dynamics, the nature and severity of restrictions and distress, and coping strategies appear to vary between women receiving and not receiving therapy. Specific combinations of restrictions and distress are present in pregnant, parous, and nulliparous women, and might influence women's decision to seek help.

Sexual response in patients treated with sacral neuromodulation for lower urinary tract symptoms or fecal incontinence.

OBJECTIVES: To determine whether sacral neuromodulation (SNM) for urinary symptoms or fecal incontinence gives improvement of female sexual function and whether improvement is due to physiological or psychological factors. METHODS: Between 2002 and 2008, 8 patients had an array of questionnaires before and after SNM implantation. The questionnaires were: the Questionnaire for Screening for Sexual Dysfunctions, the Golombok Rust Inventory of Sexual Satisfaction, the Symptom Checklist-90, the Maudsley Marital Questionnaire and the McGill-Mah Orgasm Questionnaire. Three of these 8 patients underwent vaginal plethysmography before and after implantation. RESULTS: No statistically significant changes were found, although there seems to be a trend toward improvement in orgasm scores. In plethysmography all 3 patients showed increased vaginal pulse amplitude with the stimulator turned on with both erotic and non-erotic stimuli. CONCLUSIONS: This study does not show a clear effect of SNM on sexual function, although there seems to be an improvement in orgasm scores. The lack of response on psychological questionnaires and the increase in vaginal pulse amplitude after SNM implantation indicate that there might be a physiological response.

Predictive validity of the Golombok Rust Inventory of Sexual Satisfaction (GRISS) for the presence of sexual dysfunctions within a Dutch urological population.

The objective of this study was to investigate the predictive validity of the Dutch translation of the Golombok Rust Inventory of Sexual Satisfaction (GRISS) for the presence of clinically relevant sexual dysfunctions and patient's need of help. A total of 57 male urological outpatients (age 50.7+/-13.2 y; range 27-77 y) completed the GRISS, a 28-item self-report questionnaire assessing sexual dysfunctions and sexual satisfaction in heterosexual relationships. GRISS subscales were found to differentiate multivariately between men with and without sexual dysfunctions. The erectile dysfunction (In the original English version of the GRISS, the term 'impotence' was used instead of 'erectile dysfunction'), dissatisfaction, and infrequency subscales also differentiated univariately between these groups. The predictive validity for the presence of sexual dysfunctions and for the patients' need for professional help was investigated. Prediction models, derived by means of logistic regression analysis, were tested in a crossvalidation sample. Sensitivity and specificity for the presence of sexual dysfunctions, as well as the predictive values positive and negative were found to be satisfactory. The predictive validity of the GRISS was found equally satisfactory for the patients' need for professional help. The discriminant and predictive validity of the GRISS in men with and without sexual dysfunctions appeared satisfactory. Routine use of the GRISS appears warranted for the screening of sexual dysfunctions in new urological patients.

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.

Psychiatric comorbidity in heterosexual couples with sexual dysfunction assessed with the composite international diagnostic interview.

Psychiatric comorbidity of sexual dysfunction (SD) in heterosexual couples was investigated with the Composite International Diagnostic Interview, version 1.1 (CIDI; WHO, 1992). Demographic data, diagnoses of sexual dysfunction according to DSM-IV criteria, CIDI data, and scores on the Golombok Rust Inventory of Sexual Satisfaction (GRISS: Rust and Golombok, 1986) were collected for 382 men and women with SD who applied for participation in a study of bibliotherapy. The prevalence of psychiatric disorder in the study sample was compared with the general population as documented in the NEMESIS epidemiological study in the Netherlands (Bijl et al., 1998). GRISS scores corroborated the diagnoses of SD. An increased prevalence of current anxiety disorder was found in sexually dysfunctional men (11.6%; chi 2 (df = 1) = 7.753; p = .005). An increased rate of lifetime diagnoses of affective (21.5%; chi 2 (df = 1) = 9.728; p = .002) and a near significant increased rate of lifetime anxiety disorders (19.9%; chi 2 (df = 1) = 5.642; p = .018) was found in men with SD. In the sexually dysfunctional female participants, a higher prevalence of current anxiety disorder was found (20.4%; chi 2 (df = 1) = 10.057; p = .002). Lifetime affective disorders (38.3%; chi 2 (df = 1) = 20.719; p < .001) as well as lifetime anxiety disorders (37.3%; chi 2 (df = 1) = 16.254; p < 0.001) were more prevalent than in the general female population. Psychiatric comorbidity in men and women with SD was significantly higher than that found in the general population. The increased comorbidity of psychiatric disorders in men and women with SD warrants adding efficient psychiatric screening to the standard intake assessment procedure of patients with SD.

Characteristics of couples applying for bibliotherapy via different recruitment strategies: a multivariate comparison.

This study compared characteristics of couples with different sexual dysfunctions who were recruited for participation in a bibliotherapy program via two routes: in response to media advertisements and through their presence on a waiting list for therapist-administered treatment in an outpatient sexology clinic. Data were collected from 492 subjects (246 couples). Male sexology patients were younger than media-recruited males. However, type of sexual dysfunction accounted for a substantially larger proportion of variance in the demographic and psychometric data. An interaction effect of recruitment strategy and sexual dysfunction type was found with respect to female anorgasmia. We conclude from the absence of differences between the two study groups that the Wills and DePaulo (1991) model of help-seeking behavior for mental problems does not apply to couples with sexual dysfunctions joining a bibliotherapy program who either primarily requested professional treatment or who responded to media advertising.

The Golombok Rust Inventory of Sexual Satisfaction (GRISS): psychometric properties within a Dutch population.

The aim of this study was to investigate the psychometric properties of the Golombok Rust Inventory of Sexual Satisfaction (GRISS) in a Dutch population. The participants in this study were 373 heterosexual couples: 305 couples with a sexual problem and 68 student couples (test-retest). Evidence for a 12-factor solution corresponding to the original 12 subscales of GRISS was found, although some of the subscales were rather highly correlated. The homogeneity of the 12 GRISS subscales, as determined by mean interitem correlations, item-rest correlations, and Cronbach's coefficient alpha, was satisfactory to good. The test-retest reliability of the GRISS scales was sufficient. The GRISS subscales were reasonably stable with respect to age, duration of the relationship, and level of education. Furthermore, a higher order factor analysis on the 12 subscales suggested a male and a female sexual dissatisfaction factor.

Bibliotherapy in the treatment of sexual dysfunctions: a meta-analysis.

This article describes the combined effect of 12 controlled studies of bibliotherapy for sexual dysfunctions, comprising data on 397 participants, who were treated in 16 bibliotherapy groups. A mean effect size of 0.68 SDs at posttreatment was found (0.50 when weighted for sample size). This effect eroded at follow-up. No influence on effect size was found for either bibliotherapy implementation characteristics or study methodology. Studies were largely limited to bibliotherapeutic administration of the directed practice approach to orgasmic disorders. The efficacy of bibliotherapy has not yet been investigated sufficiently for evaluation of its use for other sexual dysfunctions or for its comparison with other therapeutic approaches for sexual dysfunctions.

[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.