Sexual dysfunctions and sex therapy: The role of a general practitioner.

BACKGROUND: Medical management is undeniably an important therapeutic intervention for selected sexual dysfunctions, but it does not serve as a stand-alone approach to treat many common sexual dysfunctions such as lack of interest in sex, sexual performance anxiety, inability to reach orgasm or too quick an orgasm. OBJECTIVE: The aim of this article is to highlight the role of general practitioners (GPs) in recognising sexual problems, encourage initiation of conversation about sexual dysfunction with patients and raise awareness of sex therapy and presentations that may benefit from referral to sex therapists. DISCUSSION: GPs in Australia have a significant role in addressing sexual health concerns despite practice-related and doctor-patient-related barriers, thereby promoting the healthy sexuality of Australians. Sex therapy is a specialty comprised of various medical, cognitive, emotional and behavioural interventions. Sex therapists, who are healthcare professionals with tertiary training in human sexuality, can share care with GPs to help individuals and/or couples understand, improve and resolve their sexual dysfunctions.

Sexual difficulties for persons with multiple sclerosis in New South Wales, Australia.

This 1992 study was conducted to ascertain the incidence of sexual difficulties in individuals diagnosed with multiple sclerosis (MS) living in New South Wales, Australia. New South Wales is a state lying roughly 29-36 degrees south of the equator. This is currently the largest study conducted. The anonymous questionnaire completed by 283 respondents included questions on sexual difficulties, relationship satisfaction and the ability to communicate about and seek help for the sexual difficulties. In this study, 30% of respondents claimed to have sexual difficulties attributable to MS. Sexual difficulties were experienced by 51% of female and 74% of male respondents. For females, the most frequently occurring sexual symptoms were difficulty with achieving orgasm, lowered libido, dissatisfaction with sexual performance, dissatisfaction with frequency of intercourse, arousal difficulties and decreased vaginal lubrication. For males, by far the most common problem was decreased frequency of intercourse, followed by dissatisfaction with sexual performance, masturbation difficulties, difficulty with achieving vaginal orgasms, erectile dysfunctions, retarded ejaculation and premature ejaculation. Overall, females rated their sexual difficulties as 10th in order of importance of disabilities from MS and males ranked sexual difficulties as fourth in importance. For both males and females, sexual disability increased with age, relationship unhappiness and disease disability. Communicating about sexual difficulties was an issue for both males and females. Fifty five percent of males and 39% of females had been able to talk about their sexual difficulties and of these, only 29% of males and 36% of females had been able to access help for their sexual difficulty. Educational level did not predict ability to talk about, or ability to access help. There was a very low satisfaction rate for the sexual help received. The study highlights areas of need for the MS population.

Is there a place for sexuality in the holistic care of patients in the palliative care phase of life?

Being diagnosed with a life-limiting condition is a traumatic event. The journey to the moment of death is usually only done once--so it is a time of fears and uncertainty. Sexuality is particularly vulnerable at this time. It may be difficult for both patient and partner to deal with the changes in sexuality without professional assistance. It is "sexuality" rather than "sex" that defines the meaningful relationships people have with themselves and significant others. When sexuality is lost or changed, important benefits may be lost. Studies show that many patients do value sexuality and want assistance in making the best of their sexual potential during the palliative care phase. Health professionals regularly acknowledge the importance of sexuality for their patients but have difficulties acting on their beliefs. Sexuality, within the patient's functional ability and desire for it, must be acknowledged and included in holistic management. It is the health professional's responsibility to raise this issue.

Safety and efficacy of a testosterone metered-dose transdermal spray for treating decreased sexual satisfaction in premenopausal women: a randomized trial.

BACKGROUND: It is not known whether premenopausal women who report low sexual satisfaction and have low circulating testosterone levels will benefit from testosterone therapy. OBJECTIVE: To evaluate the effects of exogenous testosterone in premenopausal women reporting diminished sexual function. DESIGN: Randomized, double-blind, placebo-controlled, dose-ranging trial. SETTING: 6 Australian medical centers. PATIENTS: 261 women age 35 to 46 years who reported a decrease in satisfying sexual activity relative to their younger years and had a morning serum free testosterone level less than 3.8 pmol/L (<1.1 pg/mL). INTERVENTION: 3 different doses of testosterone administered by a metered-dose transdermal spray for 16 weeks or placebo. MEASUREMENTS: The primary outcome was the mean number of self-reported satisfactory sexual events (SSEs) over 28 days at week 16. The frequency of SSEs, total number of sexual events (every 4 weeks), scores from the modified Sabbatsberg Sexual Self-Rating Scale and the Psychological General Well-Being Index, and safety variables were also measured. RESULTS: The number of SSEs increased during the treatment period in the active treatment groups and the placebo group. The mean number of SSEs over 28 days at week 16 was statistically significantly greater for women treated with the intermediate dose of testosterone therapy (one 90-microL spray) than for women treated with placebo. The least-squares mean was 2.48 versus 1.70 SSEs, respectively (event rate ratio, 1.49 [95% CI, 1.01 to 2.18]; P = 0.04). The frequency of SSEs in women treated with low and high doses of testosterone did not differ from that in women who took placebo. The rate ratios based on the least-squares mean rates of SSEs during weeks 4 to 16 for each treatment group showed statistically significant or borderline significant increases in all testosterone groups compared with the placebo group. The rate ratios for the one 56-microL spray, one 90-microL spray, and two 90-microL sprays treatment groups were 1.34 (CI, 0.97 to 1.85; P = 0.081), 1.48 (CI, 1.07 to 2.06; P = 0.018), and 1.38 (CI, 1.00 to 1.92; P = 0.052), respectively. At week 16, 95% of women treated with the one 90-microL dose had a free testosterone level less than the upper limit of the reference range for women. The most frequently reported adverse event was hypertrichosis, which was dose-related and mostly confined to the application site. No clinically relevant changes in blood test values, serum biochemical variables, or vital signs occurred. LIMITATION: The study duration was short, and the placebo effect was strong. CONCLUSION: A daily 90-microL dose of transdermal testosterone improves self-reported sexual satisfaction for premenopausal women with reduced libido and low serum-free testosterone levels by a mean of 0.8 SSE per month. The rate of SSEs with higher and lower testosterone doses did not differ from that with placebo.

A general look at female orgasm and anorgasmia.

Male and female genital anatomy evolves from the same embryonic tissue. Is it therefore possible that males and females have the same potential for orgasmic response? Have forces external to a woman's biology influenced her potential enjoyment of this bodily function, or is female orgasm a by-product of that early sameness and variable because it has no or very little functional or evolutionary benefit? In modern times, we continue to study the anatomy and physiology of female sexual responses. The journey now is to understand the similarities and differences between the male and female sexual responses and be respectful of both. Female sexual response models and the classification of female sexual dysfunctions direct the thoughts and treatments of sexual and relationship therapists. The ultimate aim is to allow each woman to have the best possible sex life and orgasm, namely the one she wants. The psychophysiological treatments for female orgasmic dysfunction are on the whole successful. However, in anorgasmia proven to be biological in aetiology, following menopause for example, physiological changes occur that cannot be resolved by these strategies alone. We need to be supportive of the pharmaceutical industry finding medication that we can appropriately and responsibly use for the good of women with sexual difficulties, because good sexuality is a very important quality of life issue for very many women.