Prevalence of sexual difficulties among female sex workers and clients attending a sexual health service.

The objective of this study was to determine the proportion of sex workers and non-sex workers with sexual difficulties. Consenting female sex workers (93) and non-sex worker clients (178) attending the Melbourne Sexual Health self-answered an anonymous questionnaire about demographic characteristics, sexual behaviour, prevalence of sexual difficulties with private partners, distress regarding one's sex life, and physical pleasure, emotional satisfaction with sex and overall satisfaction with life. The demographic characteristics, sexual behaviours, prevalence of painful sex (34% versus 42%), orgasmic difficulty (43% versus 40%), vaginal dryness (45% versus 36%) and performance anxiety (28% versus 37%), physical pleasure and emotional satisfaction with sex and overall life satisfaction among sex workers was similar to that of non-sex workers, respectively. Sex workers were more likely to experience sexual disinterest (odds ratio 1.9, (95% confidence interval 1.1, 3.2) and less likely to report being distressed about their sex life (P = 0.04). The prevalence of sexual difficulties, other than desire was similar to those of non-sex workers. These findings may be relevant only to sex workers operating in a highly regulated sex industry.

Couple characteristics and outcome of therapy in vaginismus.

OBJECTIVE: To describe couple characteristics and outcome of therapy in vaginismus. DESIGN: A prospective before-after intervention descriptive study. SETTING: Department of Physiology, Faculty of Medicine, Colombo, Sri Lanka. METHODS: Fifty six couples with vaginismus, mostly self referrals and referrals from gynaecologists and general practitioners, were treated with a standard cognitive behaviour therapy protocol with before-after assessments of the degree of vaginismus and individual partner self-ratings of the relationship and psychological status (GHQ-30). OUTCOME MEASURES: Success at the end of the therapy was equated to the absence of or only mild vaginismus and, improvement in the couple relationship and psychological status scores. RESULTS: Twenty seven (48%) of the 52 (93%) couples with non-consummation reported failure of coitus following previous non-surgical and surgical interventions. Love marriages (70%), frequent attempts at sex (75%, 3 or 4 times/week) and sexual arousal (women = 86%, men = 89%) characterised couples. Ten men developed sexual problems, mostly erectile failure and premature ejaculation secondarily. Couple therapy enabled penetrative sex in 45 (80.3%). The single prognostic indicator of outcome was the degree of vaginismus at first visit, those with mild and moderate vaginismus (77%) being significantly more likely to establish coitus (p<0.001) and complete the therapy (p<0.001). The couple relationship improved marginally (women p<0.01, men 0.025

0.01) but the psychological status remained unchanged. Dropouts and referrals for psychiatric and marital counselling failed to complete therapy. INTERPRETATION: Couple sex therapy is effective in the management of vaginismus. Health professionals, especially gynaecologists and general practitioners, need to be aware of the problem and the satisfactory outcome of sex therapy.