[Sexual satisfaction of women--development and results of a questionnaire]

Sexual Satisfaction and Frequency of Orgasm in Women With Chronic Pelvic Pain due to Endometriosis

BACKGROUND

Dyspareunia, one of the main symptoms of the chronic gynecological pelvic pain disorder endometriosis, may interfere with the likelihood of reaching an orgasm, yet for women with dyspareunia, no data on orgasm rates in different sexual activities are available.

AIM

The aim of this study was to evaluate the ability to reach an orgasm and its association with sexual satisfaction during different sexual activities in women with a chronic pelvic pain disorder and in healthy control women.

METHODS

A set of questionnaires including the brief index of sexual functioning and global sexual functioning was used to evaluate sexuality in women affected with endometriosis (n = 434) and a nonaffected control group (n = 434) recruited in German-speaking countries.

OUTCOMES

The primary outcome measure of this study was the orgasm rate during different types of sexual activities.

RESULTS

Only the ability to have an orgasm during sexual intercourse (P = .002) but not during masturbation (P = .509) or partnered noncoital sexual activities (P = .229) is affected by endometriosis. Dyspareunia was associated with a reduced ability to experience an orgasm during intercourse for endometriosis patients (P = .020) and control women (P = .006). The ability to orgasm during noncoital sexual activities (P = .006) and sexual intercourse (P = .038) was associated with a higher sexual satisfaction in women with endometriosis. For controls, only the ability to achieve an orgasm with sexual intercourse was associated with sexual satisfaction (P = .038).

CLINICAL IMPLICATIONS

Sexual counselling as part of medical support could help couples living with chronic pelvic pain of the female partner integrate noncoital sexual activities in their sex lives, leading to fewer sex-related problems and higher sexual desire and satisfaction.

STRENGTHS AND LIMITATIONS

This study is the first to examine different ways of achieving an orgasm and sexual satisfaction in a large group of women with endometriosis and a matched control group. The breadth of the questionnaire allowed a differentiated analysis of factors influencing the likelihood of achieving an orgasm and overall sexual satisfaction. The one limitation is that the length and the intimate nature of the questionnaire possibly resulted in reluctance to answer this part of the questionnaire.

CONCLUSION

Partnered noncoital sexual activities may represent an alternative to reach orgasm for women with endometriosis-related chronic pelvic pain or anorgasmia during sexual intercourse. Hämmerli S, Kohl-Schwartz A, Imesch P, et al. Sexual Satisfaction and Frequency of Orgasm in Women With Chronic Pelvic Pain due to Endometriosis. J Sex Med 2020;17:2417-2426.

The construct of sexual openness for females in steady intimate relationships

The analysis of open-minded attitudes towards sexuality in general requires a construct based on attitudinal dimensions. Although several existing studies involve sexual attitudes, they differ substantially and standardized conceptual work is missing. Thus, the authors introduce the latent variable sexual openness to develop a construct based on self-oriented attitudes towards different sexual topics. Available survey data of female German students in a steady relationship allowed providing a first empirical test for the applicability of this construct. Five subdimensions are acknowledged central for sexual openness: sexual practices, masturbation, bisexuality, permissiveness, and pornography consumption. Confirmatory factor analysis and correlations confirmed the idea of an underlying mechanism with an impact on all five variables. Though further validation of the construct of sexual openness is required, the findings strongly support the notion of an overarching latent attitude variable, which influences the individual relation to everything sexual. The results were compared to other studies and potential approaches for future analyses were proposed.

The role of psychopathological and personality covariates in orgasmic difficulties: a prospective longitudinal evaluation in a cohort of women from age 30 to 50

INTRODUCTION

There are little published data on the prevalence of orgasmic difficulties in representative samples and no longitudinal data on the subject. In addition, our knowledge of the factors, which increase or protect against the risk of orgasmic difficulties, is still rudimentary.

AIM

The aim of this study was to evaluate the cumulative incidence rate and longitudinal course of orgasmic difficulties from age 30 to age 50, and the role of psychopathological and personality covariates in a representative population cohort of women.

METHODS

Semi-structured interviews with single-item questions on sexual problems in general as well as on orgasmic difficulties were conducted. Psychopathological covariates were from the Symptom Checklist 90 Revised and personality characteristics from the Freiburg Personality Inventory. Coping resources were measured by the scales of mastery and self-esteem.

MAIN OUTCOME MEASURES

One-year prevalences of orgasmic difficulties, associations with psychopathological and personality covariates as well as coping resources were the main outcome measures.

RESULTS

Orgasmic difficulties were reported annually by 7.4% to 13.5% of the women with a mean of 10.0% and a cumulative risk of 27.3% from age 30 to 50. No relation between age and the prevalence of orgasmic difficulties could be demonstrated. Psychopathological covariates such as depression, psychoticism, interpersonal sensitivity, obsessive-compulsive symptoms, and somatization were moderately associated with orgasmic difficulties. Also, personality traits, i.e., nervousness, aggressiveness, depressiveness, irritability, sociability, and openness, were related to orgasmic difficulties.

CONCLUSIONS

With a cumulative risk of 27.3%, orgasmic difficulties represent a frequent sexual problem. Annual prevalence rates are particularly high in women with psychopathological characteristics and modestly related to various personality traits. Our findings support the relevance of psychosocial factors in the regulation of female orgasm. More basic research is needed to better understand underlying pathophysiological mechanisms and to improve diagnostic as well as therapeutic tools for women suffering from orgasmic difficulties.

Genetic and Environmental Influences on the Frequency of Orgasm in Women

This study reports on genetic and environmental influences on the frequency of orgasm in women during sexual intercourse, during other sexual contact with a partner, and during masturbation. Participants were drawn from the Australian Twin Registry, and recruited from a large, partly longitudinal twin-family study. Three thousand and eighty women responded to the anonymous self-report questionnaire, including 667 complete monozygotic (MZ) pairs and 377 complete dizygotic (DZ) same-sex pairs, 366 women from complete DZ opposite-sex pairs, and 626 women whose co-twins did not participate. Significant twin correlations were found for both MZ and DZ twin pairs for all three items of interest. Age effects were statistically significant for some items. Models incorporating additive genetic, shared and nonshared environmental influences provided the best fit for Items 1 and 3, while a model with additive and nonadditive genetic influences along with nonshared envir-onment fitted the data from Item 2. While an independent pathway model fits the data most par-simoniously, a common pathway model incorporating additive genetic (A), shared environment (C), and unique environment (E) effects cannot be ruled out. Overall, genetic influences account for approximately 31% of the variance of frequency of orgasm during sexual intercourse, 37% of the variance of frequency of orgasm during sexual contact other than during intercourse, and 51% of the variance of frequency of orgasm during masturbation. Following Baker (1996), we speculate that this additive genetic variance might arise from frequency-dependent selection for a variety of female sexual strategies.

Sexual activity and satisfaction in healthy community-dwelling older women

BACKGROUND

Female sexual dysfunction is a focus of medical research, but few studies describe the prevalence and covariates of recent sexual activity and satisfaction in older community-dwelling women.

METHODS

A total of 1303 older women from the Rancho Bernardo Study were mailed a questionnaire on general health, recent sexual activity, sexual satisfaction, and the Female Sexual Function Index.

RESULTS

A total of 806 of 921 respondents (87.5%) aged 40 years or more answered questions about recent sexual activity. Their median age was 67 years; mean years since menopause was 25; most were upper-middle class; 57% had attended at least 1 year of college; and 90% reported good to excellent health. Half (49.8%) reported sexual activity within the past month with or without a partner, the majority of whom reported arousal (64.5%), lubrication (69%), and orgasm (67.1%) at least most of the time, although one third reported low, very low, or no sexual desire. Although frequency of arousal, lubrication, and orgasm decreased with age, the youngest (<55 years) and oldest (>80 years) women reported a higher frequency of orgasm satisfaction. Emotional closeness during sex was associated with more frequent arousal, lubrication, and orgasm; estrogen therapy was not. Overall, two thirds of sexually active women were moderately or very satisfied with their sex life, as were almost half of sexually inactive women.

CONCLUSION

Half these women were sexually active, with arousal, lubrication, and orgasm maintained into old age, despite low libido in one third. Sexual satisfaction increased with age and did not require sexual activity.

Low sexual desire in midlife and older women: personality factors, psychosocial development, present sexuality

OBJECTIVE

Recent population-based surveys indicate that the prevalence of sexual dysfunction, particularly low sexual desire and arousal disorders, is increasing with age. However, there seems to be greater variability of the sexual experience and functioning in midlife and older women, suggesting a higher dependence on basic conditions like general well-being, physical and mental health, quality of relationship, and life situation.

DESIGN

A series of studies was conducted in the authors' Female Sexual Dysfunction research group to assess differences in (1) determinants of sexual satisfaction, (2) personality factors, and (3) present sexuality between younger and older women in both patient and nonpatient populations.

RESULTS

The results of these studies highlight that in comparison with functional women, patients with hypoactive sexual desire are generally characterized by a vulnerable self-system with several rather inadequate self-regulatory mechanisms. The results of the brief sexual function questionnaire indicate that the present sexuality of women seeking professional help for low sexual desire is significantly different from the sexuality of a control group of nonpatients. These between-group effects proved to be far more important than any age effects within both groups and showed that all domains of sexuality were negatively affected and overshadowed by the sexual dysfunction.

CONCLUSIONS

These results are supportive of the growing evidence against a simple model of midlife sexuality that depicts women as victims of their bodily and hormonal changes. Instead, life stressors, contextual factors, past sexuality, and mental health problems are more significant predictors of midlife women's sexual interest than menopause status itself. Evaluation and treatment approaches require consideration of the full range of contextual factors, including relationship quality, personality factors, past experience, and mental and physical health.