Report of spontaneous and persistent genital arousal in women attending a sexual health clinic.

The frequency of spontaneous genital arousal (GA) and persistent genital arousal disorder (PGAD) in women is unknown. The aim of this study was to conduct an anonymous survey to assess the frequency and nature of spontaneous GA and PGAD in women attending a walk-in sexual health clinic in London. Female patients completed a questionnaire, which included demographic information, medical, psychiatric and gynaecology history, the hospital anxiety and depression scale, and a somatization scale. Patients were then asked to complete three questions regarding spontaneous and persistent GA. Any patient with one or more symptoms then answered questions about the distress, intensity and duration of sensations. Ninety-six subjects participated. The mean age was 28.97 years. Thirty-two women (33.3%) answered 'yes' to at least one question regarding spontaneous or persistent GA and six women (6.3%) women answered 'yes' to all three questions. Only one subject fulfilled all five diagnostic criteria for PGAD. In conclusion, women report a high rate of spontaneous GA in the absence of desire or excitement. This has not been well described previously. A small proportion of women report multiple features of spontaneous and persistent GA, with chronicity over years, but without distress in most cases. Larger studies are needed.

Definitions of women's sexual dysfunction reconsidered: advocating expansion and revision.

In light of various shortcomings of the traditional nosology of women's sexual disorders for both clinical practice and research, an international multi-disciplinary group has reviewed the evidence for traditional assumptions about women's sexual response. It is apparent that fullfilment of sexual desire is an uncommon reason/incentive for sexual activity for many women and, in fact, sexual desire is frequently experienced only after sexual stimuli have elicited subjective sexual arousal. The latter is often poorly correlated with genital vasocongestion. Complaints of lack of subjective arousal despite apparently normal genital vasocongestion are common. Based on the review of existing evidence-based research, many modifications to the definitions of women's sexual dysfunctions are recommended. There is a new definition of sexual interest/desire disorder, sexual arousal disorders are separated into genital and subjective subtypes and the recently recognized condition of persistent sexual arousal is included. The definition of dyspareunia reflects the possibility of the pain precluding intercourse. The anticipation and fear of pain characteristic of vaginismus is noted while the assumed muscular spasm is omitted given the lack of evidence. Finally, a recommendation is made that all diagnoses be accompanied by descriptors relating to associated contextual factors and to the degree of distress.

Persistent sexual arousal syndrome: a newly discovered pattern of female sexuality.

This article describes a phenomenon, persistent sexual arousal syndrome (PSAS), which heretofore has not been noted or described in the sexuality, psychiatric or medical literature. The syndrome is precisely the opposite of female sexual arousal disorder (FSAD), in that the woman's complaint is of excessive and often unremitting arousal rather than of deficient or absent arousal. Five case descriptions are reported, highlighting the essential feature of the syndrome--persistent physiological arousal in the absence of conscious feelings of sexual desire. To date, no obvious hormonal, vascular, neurological, or psychological causes have been identified as underlying the symptoms of any of these patients. The cases are presented in the hope that they will stimulate efforts to investigate the prevalence, etiology, course, and management of PSAS.

The brief index of sexual functioning for women (BISF-W): a new scoring algorithm and comparison of normative and surgically menopausal populations.

OBJECTIVE: To develop a new scoring algorithm for the Brief Index of Sexual Functioning for Women (BISF-W) and to compare results from a normative population with those from a clinical sample of surgically menopausal women with impaired sexual function. DESIGN: The scoring algorithm provided an overall composite score and seven dimension scores: D1 (thoughts/desires), D2 (arousal), D3 (frequency of sexual activity), D4 (receptivity/initiation), D5 (pleasure/orgasm), D6 (relationship satisfaction), and D7 (problems affecting sexual function). The normative population consisted of 225 healthy women between the ages of 20 and 55 years; 187 had regular sexual partners and 38 did not. The clinical sample comprised 104 women in the same age range (with partners), who reported that their sex lives had become less active or less satisfying after surgery (bilateral oophorectomy and hysterectomy), despite standard estrogen replacement therapy. RESULTS: The BISF-W composite and dimension scores for healthy women with partners were significantly greater (p < 0.001) than for women without partners, except for D1, which was comparable in both groups. For healthy women with partners, the composite and dimension scores (D1, D3, and D5) decreased significantly with increasing age (p < 0.05). In comparison, surgically menopausal women had significantly lower composite and dimension scores (p < 0.001), with the exception of D7, which was significantly higher (more problems). As a percent of the normative means for healthy women with partners, the dimension scores for surgically menopausal women were lowest for D1--47.2%, D3--46.9%, and D5--46.1%. CONCLUSIONS: This research provides further validation of the BISF-W as an instrument for evaluating female sexual function and quantifies the nature and degree of impaired sexual function in surgically menopausal women.

Transdermal testosterone treatment in women with impaired sexual function after oophorectomy.

BACKGROUND: The ovaries provide approximately half the circulating testosterone in premenopausal women. After bilateral oophorectomy, many women report impaired sexual functioning despite estrogen replacement. We evaluated the effects of transdermal testosterone in women who had impaired sexual function after surgically induced menopause. METHODS: Seventy-five women, 31 to 56 years old, who had undergone oophorectomy and hysterectomy received conjugated equine estrogens (at least 0.625 mg per day orally) and, in random order, placebo, 150 microg of testosterone, and 300 microg of testosterone per day transdermally for 12 weeks each. Outcome measures included scores on the Brief Index of Sexual Functioning for Women, the Psychological General Well-Being Index, and a sexual-function diary completed over the telephone. RESULTS: The mean (+/-SD) serum free testosterone concentration increased from 1.2+/-0.8 pg per milliliter (4.2+/-2.8 pmol per liter) during placebo treatment to 3.9+/-2.4 pg per milliliter (13.5+/-8.3 pmol per liter) and 5.9+/-4.8 pg per milliliter (20.5+/-16.6 pmol per liter) during treatment with 150 and 300 microg of testosterone per day, respectively (normal range, 1.3 to 6.8 pg per milliliter [4.5 to 23.6 pmol per liter]). Despite an appreciable placebo response, the higher testosterone dose resulted in further increases in scores for frequency of sexual activity and pleasure-orgasm in the Brief index of Sexual Functioning for Women (P=0.03 for both comparisons with placebo). At the higher dose the percentages of women who had sexual fantasies, masturbated, or engaged in sexual intercourse at least once a week increased two to three times from base line. The positive-well-being, depressed-mood, and composite scores of the Psychological General Well-Being Index also improved at the higher dose (P=0.04, P=0.03, and P=0.04, respectively, for the comparison with placebo), but the scores on the telephone-based diary did not increase significantly. CONCLUSIONS: In women who have undergone oophorectomy and hysterectomy, transdermal testosterone improves sexual function and psychological well-being.

The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function.

This article presents the development of a brief, self-report measure of female sexual function. Initial face validity testing of questionnaire items, identified by an expert panel, was followed by a study aimed at further refining the questionnaire. It was administered to 131 normal controls and 128 age-matched subjects with female sexual arousal disorder (FSAD) at five research centers. Based on clinical interpretations of a principal components analysis, a 6-domain structure was identified, which included desire, subjective arousal, lubrication, orgasm, satisfaction, and pain. Overall test-retest reliability coefficients were high for each of the individual domains (r = 0.79 to 0.86) and a high degree of internal consistency was observed (Cronbach's alpha values of 0.82 and higher) Good construct validity was demonstrated by highly significant mean difference scores between the FSAD and control groups for each of the domains (p < or = 0.001). Additionally, divergent validity with a scale of marital satisfaction was observed. These results support the reliability and psychometric (as well as clinical) validity of the Female Sexual Function Index (FSFI) in the assessment of key dimensions of female sexual function in clinical and nonclinical samples. Our findings also suggest important gender differences in the patterning of female sexual function in comparison with similar questionnaire studies in males.

Report of the international consensus development conference on female sexual dysfunction: definitions and classifications.

PURPOSE: Female sexual dysfunction is highly prevalent but not well defined or understood. We evaluated and revised existing definitions and classifications of female sexual dysfunction. MATERIALS AND METHODS: An interdisciplinary consensus conference panel consisting of 19 experts in female sexual dysfunction selected from 5 countries was convened by the Sexual Function Health Council of the American Foundation for Urologic Disease. A modified Delphi method was used to develop consensus definitions and classifications, and build on the existing framework of the International Classification of Diseases-10 and DSM-IV: Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association, which were limited to consideration of psychiatric disorders. RESULTS: Classifications were expanded to include psychogenic and organic causes of desire, arousal, orgasm and sexual pain disorders. An essential element of the new diagnostic system is the "personal distress" criterion. In particular, new definitions of sexual arousal and hypoactive sexual desire disorders were developed, and a new category of noncoital sexual pain disorder was added. In addition, a new subtyping system for clinical diagnosis was devised. Guidelines for clinical end points and outcomes were proposed, and important research goals and priorities were identified. CONCLUSIONS: We recommend use of the new female sexual dysfunction diagnostic and classification system based on physiological as well as psychological pathophysiologies, and a personal distress criterion for most diagnostic categories.

Sexual problems and dysfunction: epidemiology, classification, and risk factors.

Sexual difficulties are extremely prevalent among both men and women, occurring in about 43% of women and 31% of men. They are associated with a number of biological, medical, and psychological risk factors and increase markedly with aging. Sexual difficulties are also a significant source of emotional and relationship dissatisfaction. This article reviews and critiques the current classification system of sexual disorders and highlights the most common risk factors for sexual problems.

Definition and classification of female sexual disorders.

The diagnosis and classification of female sexual disorders has undergone significant changes over the last fifty years as a function of changing societal expectations for female sexual conduct, available knowledge about sexual psychophysiology and actual clinical practice. Currently, female sexual disorders are conceptualized as disturbances in desire, arousal, or orgasm as well as sexual pain disorders which include dyspareunia and vaginismus. The lack of objective, empirically-grounded criteria for diagnosis as well as the comorbidity of female sexual disorders contributes to the lack of reliability in the diagnosis of female sexual complaints. At the present time, hypoactive sexual desire disorder is the most commonly diagnosed female sexual disorder followed by female orgasmic disorder. Nevertheless, the major clinical complaints among women center on their dissatisfaction with such non-genital behaviors as affection, communication, and non-genital touching as well as issues of attraction and passion. These factors should be assessed as well as genital response for greater validity in evaluating female sexual disorders in both research and clinical practice.

A comparative survey of beliefs about "normal" childhood sexual behaviors.

OBJECTIVE: This study sought to collect data on what adults believe constitutes normal childhood sexual behaviors, and how variables, such as role, gender, and life experience might contribute to the formation of one's beliefs. METHODS: A survey describing 20 different scenarios of children under the age of 13 interacting with themselves or other children in a sexual manner was administered to four groups of adults: sexual abuse experts; therapists involved in a sexual abuse training program; medical students attending a human sexuality program; and group facilitators of the human sexuality program. RESULTS: Behaviors that involved oral, vaginal, or anal penetration were judged by a majority of adults to be abnormal sexual behaviors in children under 13 years of age. Professionals working with sexually abused children rated certain sexual behaviors as more abnormal than adults participating in a human sexuality course. Both sexual abuse trainees and facilitators of the human sexuality course showed more directional biases than other groups, with trainees always rating behaviors in the direction of abnormal and facilitators always rating behaviors in the direction of normal. Females also judged many of the sexual behaviors to be more abnormal than males. CONCLUSIONS: Role and gender significantly influence what adults believe constitutes normal and abnormal childhood sexual behavior.

Life after infertility treatment: a long-term investigation of marital and sexual function.

After leaving in-vitro fertilization (IVF) treatment, both successful and unsuccessful women are generally lost to follow-up. In order to assess overall life satisfaction as well as marital and sexual adjustment after the completion of infertility treatment, three groups of women were studied: group 1 (n = 41), successful IVF women; group 2 (n = 16), unsuccessful IVF women who adopted; and group 3 (n = 18), unsuccessful IVF women who remained childless. All women who had completed a minimum of three IVF cycles between the years 1982 and 1993 were invited to participate in a 'life after infertility' follow-up study. Those who agreed were mailed a lengthy questionnaire which included questions about their reproductive history and infertility treatment, the impact of infertility on their marital and sexual relationship and their final thoughts about treatment. Four standardized questionnaires were also administered. Results revealed that women who became biological mothers through IVF were significantly more satisfied with their lives than women who were unsuccessful in IVF and remained childless (F = 8.62, P < 0.001). Childless women reported that infertility had exerted a significantly greater negative impact on their marriages than that reported by the other two groups. There were no significant differences, however, between the three groups on the standardized measures of marital and sexual satisfaction.

Disclosure issues and decisions of couples who conceived via donor insemination.

Disclosing the use of donor insemination (DI) to family, friends, and offspring poses a quandary for many DI patients. A cross-sectional survey was conducted to determine whether couples opted to share information about conception via donor sperm with their children, as well as the issues and concerns that arose for parents once infertility treatment was completed. Twenty-seven married heterosexual infertile husbands and wives who had used DI to conceive completed a follow-up questionnaire asking them about disclosure decisions as well as thoughts about DI as a reproductive option. Results revealed that nearly three-quarters of the sample had not disclosed to their child and did not plan to, although 85% had told at least one other person about conception via DI. With few exceptions, husbands and wives agreed about how to handle disclosure. Notably, 32% of the mothers reported not knowing when or how to disclose. However, the majority of couples were not offered psychological counseling prior or subsequent to DI. It is suggested that mental health professionals should be aware of the divergence of opinion between what they believe about the benefits of disclosure/counseling, the beliefs of infertile couples about disclosure and what is actually known about the benefits of full disclosure among all involved parties.

Treatment of sexual disorders in the 1990s: an integrated approach.

Marked changes have occurred in the formulation and treatment of sexual disorders in the past 2 decades. Emphasis has shifted to the role of biomedical and organic factors in the etiology of sexual dysfunction, along with the growing use of medical and surgical treatment interventions. Multidimensional assessment models are widely used, particularly in the evaluation of male erectile dysfunction and sexual pain disorders. Integrated treatment approaches have also been developed, as cognitive-behavioral and couples' therapy procedures are increasingly combined with traditional sex therapy techniques. This article reviews existing data regarding the etiology and treatment of male and female sexual dysfunctions. Despite the conceptual and technological sophistication of current approaches, treatment outcome is less than satisfactory in several areas. Further research is needed on the etiology and treatment of sexual disorders.

Hypoactive sexual desire.

Hypoactive sexual desire is an ubiquitous and challenging disorder that is often associated with other psychiatric or medical conditions. Multiple etiologic determinants have been associated with the disorder, and the role of systemic and interpersonal factors have been emphasized. Treatment interventions have varied widely, including hormonal, pharmacologic, and psychological interventions. There is a paucity of controlled outcome research, and it is uncertain which patients are most likely to benefit from treatment.

Non-traditional mothers: single heterosexual/lesbian women and lesbian couples electing motherhood via donor insemination.

The purpose of the project was to explore the motivation, reproductive and postdelivery experiences, and future concerns of single heterosexual and lesbian women and lesbian couples who attempted conception via donor insemination (DI). All women who had completed at least one cycle of DI between 1987 and 1992 at a large medical school infertility program were mailed a comprehensive 'Motherhood' questionnaire. Forty-five women completed the survey (response rate = 88%) of whom 14 were lesbians, 28 were heterosexuals, two were bisexual and one was celibate. The only major differences between the heterosexual women and the lesbian women were that the heterosexual women were older and had started DI attempts at an older age than the lesbian women. The majority of women reported that four major considerations prompted their decision to initiate DI when they did: feeling secure in their employment, the sense that time was running out, feeling that they had 'worked through' concerns about parenting, and that they had sufficient social support. Three characteristics were deemed moderately or very important in their selection of sperm donors: ethnicity, education and height. After achieving a pregnancy, most women wished to know more detailed information about their donor. Unlike heterosexual couples, all single and lesbian women planned to disclose the fact of DI to their offspring but were uncertain of when or how to accomplish this. The greatest worry reported by respondents was how their child would deal with the absence of a known designated father. Overall, the women were gratified with their experience of DI, and the majority would 'absolutely' recommend it to a friend.