Reliable and valid self-report outcome measures in sexual (dys)function: a systematic review

Sexual Disability in Low Back Pain: Diagnostic and Therapeutic Framework for Physical Therapists

BACKGROUND

The literature shows a relationship between sexual activity and low back pain (LBP). The aim of this work is to provide a theoretical framework and practical proposal for the management of sexual disability in individuals with LBP.

METHODS

Based on a literature review, a team of specialized physical therapists developed a pattern for the management of LBP-related sexual disability.

RESULTS

A patient reporting LBP-related sexual disability may be included in one of four clinical decision-making pathways corresponding to one of the following: #1 standard physical therapy (PT); #2 psychologically informed physical therapy (PIPT); #3 PIPT with referral; or #4 immediate referral. Standard PT concerns the management of LBP-related sexual disability in the absence of psychosocial or pathological issues. It includes strategies for pain modulation, stiffness management, motor control, stabilization, functional training, pacing activities comprising education, and stay-active advice. PIPT refers to patients with yellow flags or concerns about their relationship with partners; this treatment is oriented towards a specific psychological approach. "PIPT with referral" and "Immediate referral" pathways concern patients needing to be referred to specialists in other fields due to relationship problems or conditions requiring medical management or pelvic floor or sexual rehabilitation.

CONCLUSIONS

The proposed framework can help clinicians properly manage patients with LBP-related sexual disability.

Sexual dysfunction in male childhood cancer survivors and adolescent and young adult survivors of hematologic malignancies

Sexual Health is an important aspect of overall health and quality of life (QoL) among adolescent and young adult (AYA) as well as childhood cancer survivors (CCS). Sexual health encompasses psychosocial, physical, developmental, emotional and relationship factors that impact sexual function. Cancer and its associated treatments are associated with negative effects on sexual health, body image, relationships, as well as overall physical and mental health. Data shows that CCS are known to experience diminished QoL compared to their peers. However, limited information is available to guide the assessment and treatment of sexual dysfunction in AYA and CCS. Further, exploration into specific cancer types, treatment methods and their resultant effects on sexual function within these populations is far more limited. We conducted an extensive review of the literature that focused on sexual dysfunction in male survivors of hematologic malignancies (HM). Our review identified an increased incidence of sexual dysfunction within male AYA and CCS of HM, and the negative impact this has on overall QoL. Our results show the degree to which survivors of HM experience increased sexual dysfunction, and the therapies and pathophysiologic mechanisms that may contribute to the development of sexual dysfunction within this population. These findings highlight the lack of research on this topic and need for further exploration into AYA and CCS sexual health to improve patient care and close the knowledge gaps to better assess and treat sexual dysfunction in this patient population.

Empirical Analysis of Health Assessment Objective and Subjective Methods on the Determinants of Health

Background

There are several methods for assessing health status. The aims of this study were to investigate the empirical differences between health assessment objective and subjective methods, to identify a possible long-term relationship between methods and health determinants and the influence of these methods on the perceived level of risk according to health determinants.

Methods

Using data from 1970 to 2018 in the United States, health status was assessed by perception of health, absence from work due to self-reported illness, life expectancy at birth and mortality rate. Health determinants were tobacco and alcohol consumptions, number of physicians per 1,000 persons, stay in hospitalization unit, curative care, release of greenhouse gases, per capita gross domestic product (GDP) and urbanization. The differences between health objective and subjective assessment methods were investigated through a Generalized linear model, a structural break date of health methods was investigated by Chow test and the long-term relationship between health assessment methods and health determinants by Engle and Granger cointegration test.

Results

Tobacco consumption was associated with a decrease of life expectancy while no long-term causal relationship was found between them. There was a positive correlation between alcohol consumption and perception of good health with a long-term causal relationship. Although per capita GDP positively influenced life expectancy, there was no cointegration between them. The release of greenhouse gases was positively correlated with both the absence from work due to self-reported illness and the perception of good health. Finally, curative care was associated with a decrease of mortality and absence from work due to self-reported illness and an increase of life expectancy and perception of good health while hospitalization is positively correlated with mortality and negatively correlated with life expectancy with a long-term causal relationship. Finally, the number of physicians per 1,000 persons was not correlated with health assessment methods used.

Conclusion

Our results highlight the influence of health assessment methods on the determinants of health and the fact that the perceived risk of health determinants changes according to the method used. Thus, the impact of health assessment methods must be considered in order to prioritize the determinants of health.

The Sexual Function Evaluation Questionnaire (SFEQ) to Evaluate Effectiveness of Treatment for Sexual Difficulties: Development and Validation in a Clinical Sample

Progress toward establishing the effectiveness of biopsychosocial treatment for patients with sexual problems is limited by the lack of brief measurement tools assessing change across various domains of the treatment model. We developed and psychometrically validated a new clinical evaluation tool, the Sexual Function Evaluation Questionnaire (SFEQ) to meet this gap. The SFEQ combines into a single scale the best performing items from two instruments that were piloted in a UK sexual problems clinic (n = 486): the Natsal-SF Clinical Version and the National Sexual Outcomes Group 1 measure. Internal construct validity evidence from exploratory and confirmatory factor analyses supported a 16-item measure consisting of one overarching dimension of overall sexual function distributed along four subscales: problem distress, partner relationship, sex life, and sexual confidence. The measure had satisfactory configural, metric, and scalar invariance over time and across groups based on gender, ethnicity, and age. Correlations with patient depression and anxiety demonstrated external validity. Change in scores over the course of therapy varied as predicted, with greater improvement in younger patients and in areas more amenable to change via therapy (sexual confidence and problem distress). The SFEQ is a brief clinical tool with the potential to assess sexual function and evaluate the effectiveness of biopsychosocial treatment programs.

Pain Characteristics, Fear-avoidance Variables, and Pelvic Floor Function as Predictors of Treatment Response to Physical Therapy in Women With Provoked Vestibulodynia

OBJECTIVE

The aim was to investigate whether pretreatment pain characteristics, psychological variables, and pelvic floor muscle (PFM) function predict the response to physical therapy (PT) in women with provoked vestibulodynia (PVD).

MATERIALS AND METHODS

One hundred-five women diagnosed with PVD underwent 10 weekly sessions of individual PT comprising education, PFM exercises with biofeedback, manual therapy, and dilators. Treatment outcomes were evaluated at pretreatment, post-treatment, and 6-month follow-up and included pain intensity (numerical rating scale 0 to 10) and sexual function (Female Sexual Function Scale). Multilevel analyses were used to examine the potential predictors of response over time including pain characteristics (PVD subtype, pain duration), psychological variables (fear of pain, pain catastrophizing), and PFM function assessed with a dynamometric speculum (tone, flexibility, and strength).

RESULTS

PVD subtype and PFM tone were significant predictors of greater treatment response for pain intensity reduction. Secondary PVD (ie, pain developed after a period of pain-free intercourse) and lower PFM tone at baseline were both associated with greater reduction in pain intensity after PT and at follow-up. Among the psychological variables, fear of pain was the only significant predictor of better treatment response when assessed through improvement in sexual function, where higher fear of pain at baseline was associated with greater improvement after PT.

DISCUSSION

This study identified PVD secondary subtype, lower PFM tone, and higher fear of pain as significant predictors of better treatment response to PT in women with PVD.

A new grading system for female sexual dysfunction based on the female sexual function index in Egyptian women: a cross-sectional study

Objective

To provide a grading system that accurately reflects the grades of female sexual dysfunction (FSD) severity.

Patients and methods

A cross-sectional study was conducted in Assiut University Hospital. It included 500 women who answered the Arabic version of the Female Sexual Function Index (FSFI) after getting their consent. A gradient of FSD severity was created, classifying FSD into five grades: severe, moderate, mild to moderate, mild, and no FSD.

Results

According to our grading system, FSD was detected in 339 women (67.8 %); Mild FSD in 20.4%, mild to moderate in 41.6%, moderate in 15.3%, and severe in 22.7%. Mean scores of desire show a linear trend of reduction from 3.8 in mild to 3.36 in mild to moderate to 2.25 in moderate and markedly reduced to 2.1 in severe grade. This difference was highly statistically significant (p= 0.002). The same was reported in arousal, orgasm, and satisfaction domains, while in lubrication and pain domains, the difference was not statistically significant.

Conclusion

In this study, our grading system was complementary to the FSFI. Moreover, it seems to be more practical and useful in grading the severity of FSD.

Comparison of erectile function in patients with end-stage renal disease receiving haemodialysis and kidney transplantation

To investigate the frequency and risk factors of ED in haemodialysis patients (HDps) and kidney transplantation (KTx) recipients (KTxRs). HDps and KTxRs between the ages of 18-65 were compared in terms of ED. IEFF-15 (International Index of Erectile Function) score was used to evaluation of ED. Fifty-seven male HDps and 52 male KTxRs with a mean age of 45.6 ± 10.4 years were included in our study. DM, CAD, hyperlipidaemia, smoking and beta blocker use were higher HDps (p = 0.037, p < 0.001, p = 0.001, p = 0.001 and p = 0.031 respectively). There was no ED in five (8.8%) HDps and 27(51.9%) KTxRx. Severity of ED was significantly higher in HDps (p < 0.001). In multiple logistic regression analysis, KTx was found the most relevant associated factor with ED. KTxRs had decreased risk for ED (OR = 0.09, 95% CI 0.02-0.30, p < 0.001). ED is significantly more common in HDps than KTxRs. Known risk factors for ED, HT, DM, CAD, HL, smoking, obesity and beta-blocker use were not related to ED in the HDps and KTxRs, and the KTx was positively effective for ED in patients undergoing renal replacement therapy.

Sexual Dysfunction Among Young Adults in Sweden-A Population-Based Observational Study

INTRODUCTION

There is a lack of studies using validated instruments to investigate prevalence and predictors of sexual dysfunction among young adults.

AIM

This population-based observational study aimed to determine the prevalence and predictors of sexual dysfunction in young adults in Sweden and to compare sexual function in women and men.

METHODS

A random sample of the general population aged 19-40 years, identified via the Swedish population registry, was approached with a postal survey. A total of 819 individuals participated, 493 women (51% response) and 326 men (34% response). Predictors of sexual dysfunction were identified by multivariable logistic binary regression analyses.

MAIN OUTCOME MEASURE

Sexual function and satisfaction were assessed using the Patient-Reported Outcomes Measurement Information System Sexual Function and Satisfaction measure, version 2.0.

RESULTS

Among the women, 53% reported at least one sexual dysfunction; the corresponding figure for men was 31%. The most common sexual dysfunction in women was low sexual interest (reported by 32%), whereas low satisfaction with sex life was the most common dysfunction in men (reported by 17%). Men reported a higher level of sexual interest and orgasm ability than women, whereas women reported a higher level of orgasm pleasure than men. Regression models showed that in both women and men, having a partner was related to lower risk of dysfunction in the domains satisfaction with sex life and orgasm pleasure. Having children was related to low interest in sex in women, whereas it was related to dissatisfaction with sex life in men. Being born outside of Sweden predicted sexual dysfunction in both women and men, as did experiencing symptoms of anxiety and depression.

CONCLUSION

Sexual dysfunction is common in young adults, particularly in women. Risk factors of sexual dysfunction include not having a partner, having children, being an immigrant, and reporting symptoms of anxiety and depression. Ljungman L, Lampic C, Wettergren L, et al. Sexual Dysfunction Among Young Adults in Sweden-A Population-Based Observational Study. Sex Med 2020;8:631-642.

Sexual Morbidity Assessment in Gyne-Oncology Follow-Up: Development of the Sexual Well-Being After Cervical or Endometrial Cancer (SWELL-CE) Patient-Reported Outcome Measure

BACKGROUND

Clinical assessment and management of sexual difficulties after gynecological cancer remain a neglected aspect of women's rehabilitation.

AIM

To develop and validate a patient-reported outcome measure of sexual well-being for women experiencing sexual consequences of cervical and endometrial cancer treatment for use in routine follow-up.

METHODS

This is a sequential mixed method study comprising (i) in-depth qualitative interviews (n=21 of 118) to generate items regarding sexual consequences of cervical or endometrial cancer and treatment; (ii) questionnaire construction with 51 core items (all respondents) and 4 subsections (18-58 items), depending on the relationship status and whether or not participants were sexually active (SA/NSA); (iii) item refinement following cognitive debriefing (n=13 of 21); (iv) validation of resultant items via postal survey (n=788 women) and Rasch analysis; and (v) creation of brief (14-item) clinical screener. Women attending routine follow-up (3 months to 5 years) at 6 English cancer centers and members of 3 UK cancer patient websites, who met the study inclusion criteria, were invited to participate.

OUTCOMES

The primary outcome of this study was the construction and initial psychometric testing of SWELL-CE short and long form versions.

RESULTS

21 women participated in interviews and 250 of 788 (32%) returned the postal survey (T1). 110 draft items were evaluated using cognitive testing (n=13) to refine instrument design and test face validity, comprehension, and acceptability. Exploratory factor analysis of survey data (n=250) produced an initial 6 domain structure as a guidance for the Rasch analysis. Subsequent Rasch analysis yielded a 3 domain structure: physical sexual function, sexual and relationship concerns, and sexual desire and sexual self-esteem, each satisfying Rasch model requirements within their respective SA (item pool =59) and NSA (item pool =53) categories, including the absence of local response dependency and all showing strict unidimensionality. The 3 subscales demonstrated good psychometric properties, external validity, and test-retest reliability. A valid Rasch short form of 14 items was created from the larger item pool.

CLINICAL IMPLICATIONS

This PROM may assist clinicians to improve identification, discussion, and management of women who could benefit from sexual rehabilitation.

STRENGTHS & LIMITATIONS

Initial evaluation supports psychometric validity and reliability in the assessment of physical sexual function, sexual interest and sexual self-esteem, and sexual and relationship concerns in this study sample. However, given this study's modest response rate (32%, n=250), findings should be interpreted with caution. This PROM identifies sexual concerns in women who are sexually active or sexually non-active due to illness or treatment-associated sexual difficulties.

CONCLUSION

Sexual Well-being after Cervical or Endometrial Cancer is a novel and psychometrically valid sexual well-being measure for clinical assessment of female sexual difficulties after cervical or endometrial cancer treatment. White ID, Tennant A, Taylor C, Sexual Morbidity Assessment in Gyne-Oncology Follow-Up: Development of the Sexual Well-Being After Cervical or Endometrial Cancer (SWELL-CE) Patient-Reported Outcome Measure. J Sex Med 2020;17:2005-2015.

Is There an Association Between Contraception and Sexual Dysfunction in Women? A Systematic Review and Meta-analysis Based on Female Sexual Function Index

BACKGROUND

A growing body of research investigates the sexual functioning status in women with contraceptives use; however, the evidence is still inconclusive.

AIM

To examine whether contraceptives use is associated with a higher risk of female sexual dysfunction (FSD).

METHODS

The electronic databases MEDLINE, Embase, Cochrane Library databases, and PsychINFO were systematically screened for eligible studies before December 2019. We only included those studies assessing women's sexual functioning by the Female Sexual Function Index (FSFI). This study was registered on the PROSPERO (ID: CRD42020167723, http://www.crd.york.ac.uk/PROSPERO).

OUTCOMES

The strength of the association between contraceptives use and risk of FSD was presented by calculating the standard mean dierences (SMDs) and the relative risk (RR) with a 95% confidence interval (CI). The pooled results were calculated using a random-effects model.

RESULTS

A total of 12 studies (7 cross-sectional studies, 3 cohorts, and 1 case-control study) involving 9,427 participants were included. The mean age in the contraceptive users ranged from 22.5 ± 2.4 years to 38.2 ± 4.6 years, while the mean age in the nonusers was 22.5 ± 2.4 years to 36.0 ± 1.0 years. Pooled results showed that no significant difference in the total FSFI scores was observed between contraceptives use and noncontraception (SMD = -1.03, 95% CI: -2.08 to 0.01, P = .053; heterogeneity: I² = 98.2%, P < .001). In line with this finding, the pooled RR also yielded no association between contraception use and the risk of FSD (RR = 1.29, 95% CI: 0.72-2.28, P = .392; heterogeneity: I² = 76.0%, P = .0015). However, the subscale sexual desire showed a significant reduction in women who received contraceptives than those did not use contraception (SMD = -1.17, 95% CI: -2.09 to -0.24, P = .014; heterogeneity: I² = 97.7%, P < .001), while no significant differences were found in sexual arousal, lubrication, orgasm, satisfaction, and pain domain.

CLINICAL IMPLICATIONS

Though evidence from this meta-analysis did not support an association between contraceptives use and the risk of FSD, the sexual desire could be significantly impaired by contraceptives use.

STRENGTHS & LIMITATIONS

This is the first meta-analysis quantifying the relationship between contraceptives use and the risks of FSD. However, substantial heterogeneities were presented across the included studies.

CONCLUSION

No direct association between contraceptives use and the risk of FSD was found. Nevertheless, declining sexual desire was significantly associated with contraceptives use. Additional double-blind, randomized, placebo-controlled trials are still warranted. Huang M, Li G, Liu J, et al. Is There an Association Between Contraception and Sexual Dysfunction in Women? A Systematic Review and Meta-analysis Based on Female Sexual Function Index. J Sex Med 2020;17:1942-1955.

Insight into Informant Discrepancies Regarding Psychosexual Functioning of Adolescents with and without Autism Spectrum Disorder

The private nature of psychosexual functioning leads adolescents and their parents to have different perspectives, which highlights studying parent-child informant discrepancies in this domain. We investigated informant discrepancy in psychosexual functioning, using the self-report and parent report versions of the Teen Transition Inventory (TTI), of adolescents with autism spectrum disorder (ASD; 136 parent-child dyads) compared to adolescents from the general population (GP; 70 parent-child dyads). Significantly larger informant discrepancies exist in ASD dyads than GP dyads in most domains of psychosexual functioning, except for Body image, Sexual behavior, and Confidence in the future. It is important to use and pay attention to both informants, as discrepancies are relevant for both research and clinical practice regarding psychosexual functioning.

Systematic review of the psychometric properties of instruments to measure sexual desire

Background

Sexual desire is one of the domains of sexual function with multiple dimensions, which commonly affects men and women around the world. Classically, its assessment has been applied through self-report tools; however, an issue is related to the evidence level of these questionnaires and their validity. Therefore, a systematic review addressing the available questionnaires is really relevant, since it will be able to show their psychometric properties and evidence levels.

Method

A systematic review was carried out in the PubMed, EMBASE, PsycINFO, Science Direct, and Web of Science databases. The search strategy was developed according to the following research question and combination of descriptors and keywords, including original studies with no limit of publication date and in Portuguese, English, and Spanish. Two reviewers carried out the selection of articles by abstracts and full texts as well as the analysis of the studies independently. The methodological quality of the instruments was evaluated by the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) checklist.

Results

The search resulted in 1203 articles, of which 15 were included in the review. It identified 10 instruments originally developed in the English language. Unsatisfactory results on methodological quality were evidenced in cultural adaptation studies with no description of the steps of the processes and inadequacy of techniques and parameters of adequacy for models. The Principal Component Analysis with Varimax rotation predominated in the studies.

Conclusions

The limitation of the techniques applied in the validation process of the reviewed instruments was evident. A limitation was observed in the number of adaptations conducted and contexts to which the instruments were applied, making it impossible to reach a better understanding of the functioning of instruments. In future studies, the use of robust techniques can ensure the quality of the psychometric properties and the accuracy and stability of instruments. A detailed description of procedures and results in validation studies may facilitate the selection and use of instruments in the academic and/or clinical settings.

Systematic review registration

PROSPERO CRD42018085706.

Electronic supplementary material

The online version of this article (10.1186/s12874-018-0570-2) contains supplementary material, which is available to authorized users.

Sexual problems and post-traumatic stress disorder following sexual trauma: A meta-analytic review

OBJECTIVE

Difficulties with sex often develop following sexual trauma, yet are rarely targeted within treatment of post-traumatic stress disorder (PTSD). Where outcomes of sexual function are included, they are secondary to other measures. This review aimed to assess whether psychological treatment for PTSD (from sexual trauma) has an effect on sexual functioning.

METHODS

Systematic searches of MEDLINE, PsycINFO, EMBASE, and trial registers were performed. Five studies met inclusion criteria. Pre-post treatment effect sizes were also calculated.

RESULTS

Data from four good-quality RCTs were included in the meta-analyses. These examined females (n = 799) who had experienced adult sexual trauma or child sexual abuse. Studies compared psychological treatment to control conditions, but no effect on outcomes of sexual concerns, standardized mean difference (SMD) = 0.03 and dysfunctional sexual behaviour, SMD = 0.02, was found. Pre-post treatment effect sizes were small to medium (SMD = 0.36 and 0.47, respectively).

CONCLUSIONS

While firm conclusions cannot be drawn, the available evidence suggests that psychological treatment for PTSD has no effect on sexual problems. Pre-post effects indicate some improvement over the course of treatment, which may be strengthened if treatment actively targeted sexual problems. The paucity of evidence in this area suggests that there is substantial need for further research in order to establish a set of evidence-based guidelines for practitioners implementing treatment in this area.

PRACTITIONER POINTS

The measurement of sexual problems is overlooked in psychological treatment RCTs for sexual trauma. Current treatments for post-traumatic stress disorder (PTSD) from sexual trauma do not appear to be addressing sexual problems. Integrated treatments for comorbid sexual problems and PTSD treatment may be warranted. It is imperative that in future, RCTs that examine people with PTSD from sexual trauma use outcomes of sexual problems.

Sexual dysfunction related to antiepileptic drugs in patients with epilepsy

INTRODUCTION

Epilepsy is a common disease that is mostly treated with antiepileptic drugs (AEDs). However, the sexual dysfunction (SD) side effects related to the use of AEDs have not received sufficient attention.

AREAS COVERED

The purpose of this review is to examine the current evidence on SD-related side effects of AEDs. The incidence, clinical features and major types of SD are summarized. Furthermore, various AEDs that may cause SDs are addressed in detail. Finally, we briefly summarize the treatments for SD related to AEDs.

EXPERT OPINION

SD related to AEDs is common. Symptoms include erectile dysfunction (ED), hyposexuality, hypersexuality and ejaculatory dysfunction. Traditional AEDs such as valproate and enzyme-inducing AEDs (EIAEDs) may produce high incidences of decreased libido. Recently, sexual function changes related to new AEDs have been reported. Topiramate, pregabalin and gabapentin may cause SD, whereas oxcarbazepine, lamotrigine and levetiracetam may improve sexual function. Although the treatment for SD related to AEDs remains unclear, switching to another AED may be an option. Further studies are necessary to better understand and treat SD related to AEDs.

Sexual function of women suffering from anorexia nervosa and bulimia nervosa

The cross-sectional study aimed at examining the sexual function of young adult women suffering from eating disorders. The authors interviewed 53 women (26 with anorexia nervosa and 27 with bulimia nervosa) and 58 female students. Each participant was administered the Female Sexual Function Index, the Eating Attitudes Test, the Body Shape Questionnaire, and the Beck Depression Inventory. Comparisons among the 3 groups showed that patients with anorexia nervosa scored lower in each Female Sexual Function Index subscale than did healthy controls. There was no significant difference between bulimia nervosa and healthy controls. Sexual functionality of patients with anorexia nervosa was correlated only with body mass index (r = 0.5, p =.01). Sexual functionality of patients with bulimia nervosa was correlated only with the Beck Depression Inventory (r = -0.4, p =.03) Patients with anorexia nervosa had more disturbed sexual function than did controls. Sexual function can be related to the level of starvation and symptoms of depression.

A comparison of cognitive-behavioral couple therapy and lidocaine in the treatment of provoked vestibulodynia: study protocol for a randomized clinical trial

Background

Provoked vestibulodynia (PVD), a frequent form of chronic genital pain, is associated with decreased sexual function for afflicted women, as well as impoverished sexual satisfaction for women and their partners. Pain and sexuality outcomes for couples with PVD are influenced by interpersonal factors, such as pain catastrophizing, partner responses to pain, ambivalence over emotional expression, attachment style and perceived relationship and sexual intimacy. Despite recommendations in the literature to include the partner in cognitive-behavioral therapy targeted at improving pain and sexuality outcomes, no randomized clinical trial has tested the efficacy of this type of intervention and compared it to a first-line medical intervention.

Methods

This bi-center, randomized clinical trial is designed to examine the efficacy of cognitive-behavioral couple therapy compared to topical lidocaine. It is conducted across two Canadian university-hospital centers. Eligible women diagnosed with PVD and their partners are randomized to one of the two interventions. Evaluations are conducted using structured interviews and validated self-report measures at three time points: Pre-treatment (T1: prior to randomization), post-treatment (T2), and 6-month follow-up (T3). The primary outcome is the change in reported pain during intercourse between T1 and T2. Secondary outcomes focus on whether there are significant differences between the two treatments at T2 and T3 on (a) the multidimensional aspects of women’s pain and (b) women and partners’ sexuality (sexual function and satisfaction), psychological adjustment (anxiety, depression, catastrophizing, self-efficacy, and quality of life), relationship factors (partner responses and dyadic adjustment) and self-reported improvement and treatment satisfaction. In order to detect an effect size as small as 0.32 for secondary outcomes, a sample of 170 couples is being recruited (27% dropout expected). A clinically significant decrease in pain is defined as a 30% reduction.

Discussion

The randomized clinical trial design is the most appropriate to examine the efficacy of cognitive-behavioral couple therapy, a recently developed and pilot-tested psychosocial intervention for couples coping with PVD, in comparison to a frequent first-line treatment option, topical lidocaine. Findings from this study will provide important information about empirically supported treatment options for PVD, and inform future treatment development and research for this patient population.

Trial registration

Clinicaltrials.gov NCT01935063; registration date: 27 August 27 2013.

Dyadic sexual communication in pre-menopausal women with self-reported dyspareunia and their partners: associations with sexual function, sexual distress and dyadic adjustment

INTRODUCTION

While there is increasing interest in studying aspects of communication processes in sex research, the association between dyadic sexual communication and relationship and sexuality outcomes has not yet been examined in pre-menopausal women with dyspareunia.

AIM

To examine the associations between dyadic sexual communication and pain, sexual distress, sexual function and dyadic adjustment in women with self-reported dyspareunia and their male partners.

METHODS

Pre-menopausal women (n=38; M age=24.92, SD=6.12) with self-reported dyspareunia from a community sample and their partners (n=38; M age=26.71, SD=6.59) completed an online survey. The Actor-Partner Interdependence Model was used in order to investigate both actor and partner effects.

MAIN OUTCOME MEASURES

Both members of the couple completed: (i) the Dyadic Sexual Communication Scale and (ii) the Dyadic Adjustment Scale; women also completed (iii) the Female Sexual Function Index, (iv) the Female Sexual Distress Scale, and (v) a Visual Analogue Scale on pain during intercourse; and men also completed (vi) the International Index of Erectile Functioning.

RESULTS

Controlling for relationship duration, women's better dyadic sexual communication was significantly associated with their higher levels of sexual function (P=0.028), lower levels of sexual distress (P=0.003) and higher levels of dyadic adjustment (P=0.005), but not with their pain or men's sexual function or dyadic adjustment. Controlling for relationship duration, men's better dyadic sexual communication was associated with their higher levels of dyadic adjustment (P=0.027) but not with their sexual function, nor with women's sexual function or dyadic adjustment.

CONCLUSIONS

These findings contribute to the theoretical knowledge on interaction processes in couples with dyspareunia and suggest that it may be important to enhance open and direct communication about sexual matters in couples with dyspareunia.

Sexual communication, dyadic adjustment, and psychosexual well-being in premenopausal women with self-reported dyspareunia and their partners: a controlled study

INTRODUCTION

Although research that takes into account partner and relationship factors in dyspareunia is slowly emerging, little is known about how these couples communicate about their sexuality. Additionally, partner psychosexual adjustment has not been examined in a controlled fashion.

AIM

This study aimed to compare dyadic sexual communication, dyadic adjustment, psychological adjustment, and sexual well-being of women with self-reported dyspareunia and their partners with those of pain-free control women and their partners.

METHODS

Premenopausal women (n = 38; mean [M] age = 24.92) with self-reported dyspareunia, their partners (n = 38; M age = 26.71), as well as pain-free control women (n = 44; M age = 25.86) and their partners (n = 44; M age = 27.95) completed an online survey measuring dyadic sexual communication, dyadic adjustment, anxiety, depression, sexual functioning, and sexual distress.

MAIN OUTCOME MEASURES

Assessments of women and men's (i) dyadic sexual communication; (ii) dyadic adjustment; (iii) anxiety; (iv) depression; (v) sexual functioning; and (vi) women's sexual distress were the main outcome measures.

RESULTS

Compared with pain-free controls, women with dyspareunia reported significantly poorer dyadic sexual communication, a difference not found between partners of women with dyspareunia and control partners. Compared with partners of control women, those of women with dyspareunia reported significantly more impaired sexual functioning. No differences in dyadic adjustment were found between women with dyspareunia and pain-free control women, or between their respective partners. Finally, compared with control women, those with dyspareunia reported significantly more impaired psychological and sexual well-being.

CONCLUSIONS

Findings suggest that dyspareunia impacts not only the psychosexual adjustment of affected women but also that of their partners. It seems relevant to include both members of the couple in future research and treatment for dyspareunia.

A systematic review of sexual dysfunction measures for gay men: how do current measures measure up?

The measurement of subjective components of sexual functioning is of increasing importance in clinical research and practice. Differences have been reported in prevalence rates and experiences of sexual difficulties between heterosexual and gay men. The aim of this article is to identify reliable and valid measures of sexual dysfunction suitable for use with gay men. Seven measures were reviewed; details about item development, dimensionality, reliability, and validity are provided. Heteronormative and heterosexist wording were evident throughout. Several areas of concern emerged in relation to psychometric properties (e.g., questionable validity). No psychometrically robust sexual function measure was identified for use with gay populations.

Screening for sexual dysfunction in women diagnosed with breast cancer: systematic review and recommendations

Breast cancer patients are at increased risk of sexual dysfunction. Despite this, both patients and practitioners are reluctant to initiate a conversation about sexuality. A sexual dysfunction screening tool would be helpful in clinical practice and research, however, no scale has yet been identified as a "gold standard" for this purpose. The present review aimed at evaluating the scales used in breast cancer research in respect to their psychometric properties and the extent to which they measure the DSM-5/ICD-10 aspects of sexual dysfunction. A comprehensive search of the literature was conducted for the period 1992-2013, yielding 129 studies using 30 different scales measuring sexual functioning, that were evaluated in the present review. Three scales (Arizona Sexual Experience Scale, Female Sexual Functioning Index, and Sexual Problems Scale) were identified as most closely meeting criteria for acceptable psychometric properties and incorporation of the DSM-5/ICD-10 areas of sexual dysfunction. Clinical implications for implementation of these measures are discussed as well as directions for further research.

Body image and genital self-image in pre-menopausal women with dyspareunia

With a prevalence of 15-21%, dyspareunia is one of the most commonly reported sexual dysfunctions in pre-menopausal women under the age of 40. Studies to date have focused primarily on clinical samples, showing that women with dyspareunia report overall sexual impairment, anxiety, and feelings of sexual inadequacy. However, little is known about their body image and genital self-image and few studies have sampled women exclusively from the general population. The aim of the present, controlled study was to investigate body image and genital self-image in a community sample of pre-menopausal women with self-reported dyspareunia. In total, 330 women completed an online survey, of which 192 (58%) had dyspareunia and 138 (42%) were pain-free control women. In comparison to pain-free control women, women with dyspareunia reported significantly more distress about their body image and a more negative genital self-image. Moreover, findings from a logistic regression, in which trait anxiety was controlled for, showed that a more negative genital self-image was strongly and independently associated with an increased likelihood of reporting dyspareunia. These results suggest that, in women with dyspareunia, body image and genital self-image are significantly poorer and would benefit from more attention from both clinicians and researchers.

Do romantic partners' responses to entry dyspareunia affect women's experience of pain? The roles of catastrophizing and self-efficacy

INTRODUCTION

Entry dyspareunia is a sexual health concern which affects about 21% of women in the general population. Characterized by pain provoked during vaginal penetration, introital dyspareunia has been shown by controlled studies to have a negative impact on the psychological well-being, sexual function, sexual satisfaction, and quality of life of afflicted women. Many cognitive and affective variables may influence the experience of pain and associated psychosexual problems. However, the role of the partner's cognitive responses has been studied very little.

AIM

The aim of the present study was to examine the associations between partners' catastrophizing and their perceptions of women's self-efficacy at managing pain on one side and women's pain intensity, sexual function, and sexual satisfaction on the other.

METHODS

One hundred seventy-nine heterosexual couples (mean age for women = 31, SD = 10.0; mean age for men = 33, SD = 10.6) in which the woman suffered from entry dyspareunia participated in the study. Both partners completed quantitative measures. Women completed the Pain Catastrophizing Scale and the Painful Intercourse Self-Efficacy Scale. Men completed the significant-other versions of these measures.

MAIN OUTCOME MEASURES

Dependent measures were women's responses to (i) the Pain Numeric Visual Analog Scale; (ii) the Female Sexual Function Index; and (iii) the Global Measure of Sexual Satisfaction scale.

RESULTS

Controlled for women's pain catastrophizing and self-efficacy, results indicate that higher levels of partner-perceived self-efficacy and lower levels of partner catastrophizing are associated with decreased pain intensity in women with entry dyspareunia, although only partner catastrophizing contributed unique variance. Partner-perceived self-efficacy and catastrophizing were not significantly associated with sexual function or satisfaction in women.

CONCLUSIONS

The findings suggest that partners' cognitive responses may influence the experience of entry dyspareunia for women, pointing toward the importance of considering the partner when treating this sexual health problem.

Provoked vestibulodynia: mediators of the associations between partner responses, pain, and sexual satisfaction

Provoked vestibulodynia (PVD) is a chronic, recurrent vulvo-vaginal pain condition affecting 12% of the general population, and is associated with sexual dysfunction, psychological distress, and reduced quality of life. There is growing interest in the role of interpersonal variables in PVD, which have been widely neglected. In a sample of 175 couples, the present study examined the mediating roles of partner and participant catastrophizing and self-efficacy in the association between solicitous partner responses and pain intensity, and that of dyadic adjustment in the association between solicitous and negative partner responses and sexual satisfaction. Couples completed measures of partner responses, catastrophizing, self-efficacy, dyadic adjustment, and depression. Women also completed measures of pain, sexual satisfaction, and sexual function. Controlling for depression and solicitousness perceived by the other member of the couple, catastrophizing and self-efficacy partially mediated the association between higher solicitous responses and higher pain during intercourse, accounting for 26 and 25% of the variance in this association for participant and partner-perceived responses, respectively. For both participant and partners, only pain catastrophizing was a unique mediator. Controlling for depression, sexual function and partner-perceived responses, dyadic adjustment partially mediated the association between higher participant-perceived solicitous responses and higher sexual satisfaction, and between higher participant-perceived negative responses and lower sexual satisfaction, accounting for 26% of the variance in each association. The current findings suggest that catastrophizing and dyadic adjustment may constitute a route by which partner responses exacerbate pain and increase or decrease sexual satisfaction in PVD couples.

Measuring outcomes in urogynecological surgery: "perspective is everything"

Over 10 years have passed since the first US National Institutes of Health consensus panel considered the standardization of definitions of pelvic floor conditions and the criteria utilized for reporting pelvic floor research study outcomes. The literature is replete with pelvic floor outcome studies; however, a consistent standardized approach to the evaluation of patients and characterization of outcomes is still needed. The purpose of this overview is to describe how the use of outcome measures has evolved over time and to attempt to help readers utilize the best measures for their clinical and research needs.

Harmful or helpful: perceived solicitous and facilitative partner responses are differentially associated with pain and sexual satisfaction in women with provoked vestibulodynia

INTRODUCTION

Provoked vestibulodynia (PVD) is a highly prevalent vulvovaginal pain condition that negatively affects women's emotional, sexual, and relationship well-being. Recent studies have investigated the role of interpersonal variables, including partner responses.

AIM

We examined whether solicitous and facilitative partner responses were differentially associated with vulvovaginal pain and sexual satisfaction in women with PVD by examining each predictor while controlling for the other.

METHODS

One hundred twenty-one women (M age = 30.60, SD = 10.53) with PVD or self-reported symptoms of PVD completed the solicitous subscale of the spouse response scale of the Multidimensional Pain Inventory, and the facilitative subscale of the Spouse Response Inventory. Participants also completed measures of pain, sexual function, sexual satisfaction, trait anxiety, and avoidance of pain and sexual behaviors (referred to as "avoidance").

MAIN OUTCOME MEASURES

Dependent measures were the (i) Pain Rating Index of the McGill Pain Questionnaire with reference to pain during vaginal intercourse and (ii) Global Measure of Sexual Satisfaction Scale.

RESULTS

Controlling for trait anxiety and avoidance, higher solicitous partner responses were associated with higher vulvovaginal pain intensity (β = 0.20, P = 0.03), and higher facilitative partner responses were associated with lower pain intensity (β = -0.20, P = 0.04). Controlling for sexual function, trait anxiety, and avoidance, higher facilitative partner responses were associated with higher sexual satisfaction (β = 0.15, P = 0.05).

CONCLUSIONS

Findings suggest that facilitative partner responses may aid in alleviating vulvovaginal pain and improving sexual satisfaction, whereas solicitous partner responses may contribute to greater pain.

The Natsal-SF: a validated measure of sexual function for use in community surveys

Sexual dysfunction often features as an outcome variable in community health surveys and epidemiological surveys. Key design imperatives for measures included in large scale, population-based surveys are acceptability, brevity and relevance to diverse sexual lifestyles. None of the available measures of sexual dysfunction are entirely suited to this task. We developed a new measure of sexual function for the third British National Survey of Sexual Attitudes and Lifestyles (Natsal 3). Items for the measure were derived from qualitative work from patients and community members. The draft measure was developed and validated using a general population sample (internet panel survey (n = 1,262)) and a clinical sample (patients attending sexual problems clinics (n = 100). Confirmatory factor analysis established that a ‘general-specific model’ had the best fit and was equivalent between general population and clinical samples (Comparative Fit Index = 0.963 Tucker Lewis Index = 0.951; Root Mean Square Error of Approximation = 0.064). The 17-item Natsal-SF is positively associated with the Female Sexual Function Index-6 (B = 0.572) and Brief Sexual Function Questionnaire for men (B = 0.705); it can discriminate between clinical and general population groups (OR = 2.667); and it has good test–retest reliability (r = 0.72). The Natsal-SF provides an estimate of the level of sexual function in the last year. By including items on distress about sex and sexual relationships, and by being relevant to all regardless of sexual lifestyle, it addresses some of the gaps in current measurement design.

Sexual desire discrepancy: the effect of individual differences in desired and actual sexual frequency on dating couples

The present study used a sample of 8,096 dating couples from the United States to explore how sexual desire discrepancy was associated with relationship satisfaction and stability. Sexual desire discrepancy was the difference between an individual's desired level of sexual intercourse and the actual frequency of sexual intercourse within a given relationship. Actor and partner effects were explored. Results suggested that higher discrepancy between sexual desire and frequency was associated with higher relationship satisfaction and lower relationship stability but that these associations were moderated by gender and relationship length. Female sexual desire discrepancy had a particularly strong effect on relationship satisfaction. It was also found that high discrepancies tended to be associated with negative outcomes in relationships with longer relationship length.

Scripting sexual function: a qualitative investigation

The biomedical model assumes universal agreement in what it means to have a functioning sex life. In reality there is significant variation in the criteria that individuals employ in assessing their sex lives. We use a scripting approach to understand the meaning of sexual function from a lay perspective. Based on the accounts of 32 individuals representing a range of sexual function experience, we identified three scripts employed by participants to describe their sexual experiences: the biomedical script emphasised genital function and physical release (orgasm), the relational script focused on relational aspects of encounters and valued emotional intimacy and security; and the erotic script focused on pleasure and valued novelty and excitement. Respondent accounts usually contained elements of more than one script, but often one of these was prominent. At the intra-psychic level each script serves as a schema, comprising priorities, expectations and evaluative criteria. In the context of sex therapy, this scripting approach may help shed light on the sources of sexual difficulties. Our findings also challenge the current domination of the biomedical script in measuring, diagnosing and treating sexual dysfunction, since the construct does not adequately reflect the priorities of those who prioritise alternative scripts.

Sexual functioning in male survivors of lymphoma: a systematic review (CME)

INTRODUCTION

The lymphomas (Hodgkin's lymphoma [HL] and non-Hodgkin's lymphoma [NHL]) are among the most common cancers affecting men under 45 years. Survival rates are now excellent, but treatment is associated with a number of side effects including sexual dysfunction with potential implications for compromised quality of life (QoL).

AIMS

To address the (i) prevalence of sexual dysfunction among lymphoma survivors relative to the general population, survivors of other cancers, and in survivors of HL and NHL; and (ii) relationships between sexual functioning and disease and treatment, demographic, and psychological variables.

METHODS

Inclusion criteria were quantitative studies that focused on adult male survivors of lymphoma and included a comparison group and presented results separately for HL and NHL. Standardized systematic searches were used. Information about design, sample size, age, time since diagnosis, type of treatment, comparison group, measures, and findings were extracted from eligible studies.

RESULTS

Ten articles met the inclusion criteria, of which, nine included patients with HL only, and one included patients with HL or NHL. Sexual function was compromised relative to the general population, better than testicular cancer survivors, and worse than leukemia survivors. Depression was consistently associated with sexual dysfunction. There was evidence that chemotherapy, relapse, reduced testosterone levels, older age at survey, and worse physical QoL were associated with worse sexual function.

CONCLUSIONS

Conclusions are limited by methodological issues including lack of utilization of standardized measures of sexual function and longitudinal research. Even so, there is evidence of sexual dysfunction among lymphoma survivors. Clinicians need to be sensitive to these issues. Future longitudinal work is necessary to determine the likelihood of recovery.

Attributions about pain as predictors of psychological symptomatology, sexual function, and dyadic adjustment in women with vestibulodynia

The present study examined whether attributions for vulvo-vaginal pain predicted pain intensity, sexual function, as well as psychological and dyadic adjustment in women with vestibulodynia. Women with vestibulodynia (N = 77) completed measures of attributions, pain, psychological distress, sexual functioning, and dyadic adjustment. They also took part in a structured interview and a gynaecological examination for diagnostic purposes. Attributions are represented by: (1) internality (personal responsibility) or externality (cause lies in an external situation); (2) globality (entire life affected by the problem) or specificity (problem affecting only a specific situation); (3) stability (problem will still remain in the future) or instability (weak probability that the problem will be maintained with time); and (4) partner responsibility (partner responsible or not for the problem). Results indicated that attributions were not significantly correlated with pain outcomes. However, after controlling for pain intensity and relationship duration, internal attributions predicted higher dyadic adjustment, both global and stable attributions predicted lower dyadic adjustment and higher psychological distress, whereas global attributions also predicted increased sexual impairment. Findings suggest that cognitive factors, such as attributions, may be related to psychological distress, sexual functioning, and dyadic adjustment in women with vestibulodynia. Results also highlight the importance of adhering to a biopsychosocial perspective focusing on pain reduction, sexual rehabilitation, and relationship enhancement in the treatment of dyspareunia.

A self-report instrument that describes urogenital atrophy symptoms in breast cancer survivors

Urogenital atrophy affects the lower urinary and genital tracts and is responsible for urinary, genital, and sexual symptoms. The accurate identification, measurement, and documentation of symptoms are limited by the absence of reliable and valid instruments. The Urogenital Atrophy Questionnaire was developed to allow self-reporting of symptoms and to provide clinicians and researchers an instrument to identify, measure, and document indicators of urogenital atrophy. A pilot study (n = 30) measured test-retest reliability (p < .05) of the instrument. Subsequently, a survey of women with (n = 168) and without breast cancer (n = 166) was conducted using the Urogenital Atrophy Questionnaire, Female Sexual Function Instrument, and Functional Assessment of Cancer Therapy, Breast, Endocrine Scale. Exploratory factor analysis (KMO 0.774; Bartlett's test of sphericity 0.000) indicated moderate-high relatedness of items. Concurrent (p > .01) and divergent validity (p < .000) were established. A questionnaire resulted that enables women, regardless of sexual orientation, partner status, and levels of sexual activity to accurately report symptoms.

Validation of the sexual excitation/sexual inhibition inventory for women and men

The purpose of the current investigation was to develop a scale that would assess propensity for sexual arousal in response to a broad range of stimuli and sexual situations in both men and women. In Study 1, data from a nonclinical sample of 481 male and female students (graduate and undergraduate) were submitted to exploratory and confirmatory factor analyses in order to develop the Sexual Excitation/Sexual Inhibition Inventory for Women and Men (SESII-W/M), and gender differences on the subscales were tested. In Study 2, construct validity and test-retest reliability of the SESII-W/M were assessed with a second sample of undergraduate students. The resultant measurement tool was comprised of six subscales: Inhibitory Cognitions, Relationship Importance, Arousability, Partner Characteristics and Behaviors, Setting (Unusual or Unconcealed), and Dyadic Elements of the Sexual Interaction. The measure demonstrated good test-retest reliability and discriminant and convergent validity. The SESII-W/M will likely be a useful measure in investigations in which sexual inhibition and sexual excitation must be assessed identically for men and women.