The effect of testosterone on mood and well-being in men with erectile dysfunction in a randomized, placebo-controlled trial.

The relationship between testosterone, well-being and mood is poorly understood. We investigated the effect of testosterone supplementation on mood, well-being, and self-reported health in men with erectile dysfunction (ED) and low serum testosterone levels. This was a randomized, double-blind, placebo-controlled trial (ClinicalTrials.gov registration number NCT00512707), in which 140 men, 40-70 years, with ED and low serum testosterone levels were first optimized on sildenafil alone for 3-7 weeks and then randomized to receive either sildenafil plus testosterone gel (n = 70) or sildenafil plus placebo (n = 70) gel for 14 weeks. Using multiple imputations and generalized linear regression, we compared psychological changes in well-being, evaluated by the Psychological General Well-Being Index, and mood, evaluated by Derogatis Affects Balance Scale. Mood and well-being scores were similar between the two groups at baseline and did not substantially change during the administration of sildenafil or after randomization to testosterone. Our findings show that the addition of testosterone to sildenafil in men with ED and low serum testosterone levels was not associated with improvement in either well-being or mood.

Assessment of sexual function/dysfunction via patient reported outcomes.

The recent recognition of the high prevalence of sexual dysfunctions and disorders in our society, along with the substantial investment of the pharmaceutical industry in the field of sexual functioning, has resulted in a significant expansion in the development of valid and reliable measures of sexual function/dysfunction. The instruments tend to be brief self-report inventories, typically requiring 10-20 min of patient time for completion. Most measures were initially developed as screening and outcomes measures for use in clinical drug trials of new treatments for sexual dysfunction, but are beginning to see more widespread use in the clinic. All these instruments must adhere to recently prescribed rigorous guidelines set forth by the Food and Drug Administration, and have been demonstrated to be valid and reliable indicators of the status and quality of sexual functioning in both men and women. The constructs that form the framework of our diagnostic system for sexual dysfunctions are not amenable to direct physical measurement, so that currently they must be assessed via these self-report scales. Although not as precise as physical measures, these inventories do an admirable job of quantifying and registering sexual functioning status in a concise and reliable manner, and have become indispensable tools in our clinical and research programs.

Prevalence and consequences of androgen deficiency in young male cancer survivors in a controlled cross-sectional study.

BACKGROUND: Testosterone replacement in hypogonadal males improves body composition, sexual function, and health-related quality of life. Male cancer survivors are at risk of androgen deficiency; however, when and in whom testosterone should be replaced remain unanswered questions. OBJECTIVE: The aim of our study was to define the prevalence of androgen deficiency in this patient group through assessment of testosterone levels and related measures. DESIGN: This was a cross-sectional, observational study of cases and controls. We recruited 176 cancer survivors and 213 controls, aged 25-45 yr. RESULTS: Of cancer survivors, 97% had received chemotherapy and 40% radiotherapy. Cancer survivors had lower total testosterone (tT) levels than controls (mean difference 2.67 nmol/liter; 95% confidence interval 1.58-3.76; P = 0.003), and 24 of 176 (13.6%; 95% confidence interval 9.3-19.5) had a tT less than 10 nmol/liter, which was less than 2.5% centile for controls. Cancer survivors had a greater fat mass, higher fasting insulin and glucose levels, increased fatigue, and reduced sexual function and health-related quality of life. In both cohorts, the tT correlated negatively with insulin levels and negatively with body fat mass; however, the difference in tT between them was independent of fat mass. We measured tT and SHBG and calculated bioavailable testosterone. The changes in calculated bioavailable testosterone were similar to tT. CONCLUSIONS: A significant proportion of young male cancer survivors had a frankly low tT associated with an increased fat mass and insulin level compared with controls. These factors would be predicted to improve in response to testosterone replacement therapy and provide a powerful argument for an interventional study of testosterone therapy in young male cancer survivors.

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.

Sexual function and quality of life: endpoints and outcomes.

Quality of sexual functioning and quality of life (QOL) are implacably interwoven phenomena. Therefore, realistic clinical trials of the efficacy of potential therapeutic agents for sexual dysfunction must include endpoints that reflect both sexual functioning and QOL. A review of design parameters in clinical trials demonstrates that the selection of well-developed psychological outcomes measures to define these endpoints can be an important factor in improving the sensitivity of clinical trials. The inclusion of well-designed and validated outcomes measures increases sensitivity through reductions in measurement of error and the deflection of additional variance associated with within-subjects variability. A brief list of recommended outcomes measures for both sexual functioning and relevant QOL domains is included. The roster of measures is not intended to be comprehensive; however, the instruments cited all have been well-designed, conform to the requirements of clinical trials, and have demonstrated sensitivity to therapeutic effects in previous investigations.

A new psychosocial screening instrument for use with cancer patients.

The authors performed a principal components factor analysis on the 18-item Brief Symptom Inventory (BSI-18), a new brief screening inventory. The factor analysis, in which four factors were specified, is consistent with findings in a previous community sample. The study sample consisted of 1,543 cancer patients who completed the full BSI as part of their entry into care at a regional cancer center. The reliability of the BSI-18 was determined based on the calculation of the internal consistency, mean item scores, and correlations with the total score of the BSI. In addition, sensitivity and specificity was calculated to determine the ability of the BSI-18 to discriminate positive and negative cases. The BSI-18 is a shortened version of the BSI that can serve as a brief psychological screening instrument. The BSI-18 can be incorporated into outpatient clinics to prospectively and rapidly identify cancer patients with elevated levels of distress who are in need of clinical interventions. Early identification of distress with appropriate interventions can reduce distress, enhance quality of life, and decrease health care costs.

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.

Relation of low-severity violence to women's health.

OBJECTIVE: To determine if women who experience low-severity violence differ in numbers of physical symptoms, psychological distress, or substance abuse from women who have never been abused and from women who experience high-severity violence. DESIGN: Cross-sectional, self-administered, anonymous survey. SETTING: Four community-based, primary care, internal medicine practices. PATIENTS: Survey respondents were 1,931 women aged 18 years or older. SURVEY DESIGN: Survey included questions on violence; a checklist of 22 physical symptoms; the Symptom Checklist-22 (SCL-22) to measure depression, anxiety, somatization, and self-esteem; CAGE questions for alcohol use; and questions about past medical history. Low-severity violence patients had been "pushed or grabbed" or had someone "threaten to hurt them or someone they love" in the year prior to presentation. High-severity violence patients had been hit, slapped, kicked, burned, choked, or threatened or hurt with a weapon. MAIN RESULTS: Of the 1,931 women, 47 met criteria for current low-severity violence without prior abuse, and 79 met criteria for current high-severity violence without prior abuse, and 1,257 had never experienced violence. The remaining patients reported either childhood violence or past adult abuse. When adjusted for socioeconomic characteristics, the number of physical symptoms increased with increasing severity of violence (4.3 for no violence, 5.3 for low-severity violence, 6.4 for high-severity violence, p < .0001). Psychological distress also increased with increasing severity of violence (mean total SCL22 scores 32.6 for no violence, 35.7 for low-severity violence, 39.5 for high-severity violence, p < .0001). Women with any current violence were more likely to have a history of substance abuse (prevalence ratio [PR] 1.8 for low-severity, 1.9 for high-severity violence) and to have a substance-abusing partner (PR 2.4 for both violence groups). CONCLUSIONS: In this study, even low-severity violence was associated with physical and psychological health problems in women. The data suggest a dose-response relation between the severity of violence and the degree of physical and psychological distress.

Psychological assessment measures of human sexual functioning in clinical trials.

This current review is intended to provide a brief overview of the major design and psychometric issues inherent in the development of psychological instruments to assess human sexual functioning. Particular emphasis has been placed on those issues which derive from the implementation of psychological tests as outcomes measures in clinical trials. Cardinal psychometric parameters are identified and reviewed, as are supplementary measurement criteria. Five specific psychological instruments are recommended and discussed, and each instrument's design characteristics, psychometric evaluation, and program of validation is briefly reviewed and evaluated.

Psychological assessment measures of female sexual functioning in clinical trials.

The focus of this review is on the psychological measurement of female sexual functioning, and the particular requirements associated with the implementation of psychological instruments as outcomes measures in clinical trials. In addition to the general psychometric criteria which must be met by all psychological measures, unique confounds associated with the nosology of female sexual dysfunctions are also discussed. A rationale for the utilization of measurement models closely tied to the sexual response cycle is articulated, and five specific test instruments which reflect this rationale to varying degrees are reviewed as to their psychometric characteristics, and validity as potential outcomes measures in clinical trials.

Clinical characteristics of women with a history of childhood abuse: unhealed wounds.

OBJECTIVES: To determine the prevalence of childhood physical or sexual abuse in women seen in primary care practices; to identify physical and psychologic problems associated with that abuse; and to compare the effects of childhood physical vs sexual abuse and childhood vs adult abuse. DESIGN: Cross-sectional, self-administered, anonymous survey. SETTING: Four community-based, primary care internal medicine practices. PATIENTS: A total of 1931 women of varied age and marital, educational, and economic status examined from February through July 1993. MAIN OUTCOME MEASURES: Prevalence of physical and sexual abuse, physical symptoms, psychological symptoms (Symptom Checklist-22), alcohol abuse (CAGE questions), and street drug use. RESULTS: Of the 1931 respondents, 424 (22.0%) reported childhood or adolescent physical or sexual abuse. Compared with women who reported never having experienced abuse (n=1257), women who reported abuse as children but not adults (n=204) had more physical symptoms (mean+/-SE, 6.2+/-0.2 vs 4.0+/-0.9; P<.001) and had higher scores for depression, anxiety, somatization, and interpersonal sensitivity (low self-esteem) (P<.001); were more likely to be abusing drugs (prevalence ratio [PR], 4.7; 95% confidence interval [CI], 2.9-7.6) or to have a history of alcohol abuse (PR, 2.2; 95% CI, 1.5-3.2); were more likely to have attempted suicide (PR, 3.7; 95% CI, 2.6-5.1); and were more likely to have had a psychiatric admission (PR, 3.2; 95% CI, 2.2-4.7). Women abused only as children did not differ from women who reported current, but not childhood, abuse in number of physical symptoms, emotional distress, substance abuse, or suicide attempts. Patients who reported both childhood and adult abuse had higher levels of psychological problems and physical symptoms than those who reported childhood or adult abuse alone. CONCLUSIONS: Childhood physical or sexual abuse is associated with adult health problems including physical symptoms, psychological problems, and substance abuse; for many variables, this association is as strong as for patients experiencing current abuse.

The Derogatis Interview for Sexual Functioning (DISF/DISF-SR): an introductory report.

The current report describes a program of research designed to demonstrate the psychometric characteristics and validity of the Derogatis Interview for Sexual Functioning (DISF/DISF-SR), a set of brief, gender-keyed, multidimensional outcome measures designed to measure quality of sexual functioning. The primary goals of the development of the DISF/DISF-SR are outlined within the context of the principal measurement parameters involved in human sexual functioning. The development and rationale for both interview (DISF) and matching self-report (DISF-SR) versions of the instrument are presented, as is the rationale for developing distinct male and female forms. The studies described evaluate the reliabilities of both modalities of the DISF/DISF-SR and demonstrate confirmation for the hypothesized internal structure of the test. Research is provided that demonstrates dimensional uniqueness in subtest-total score relationships, and several studies are reviewed that show high discriminative validity for the DISF/DISF-SR in medical and community cohorts. The initial norms for the DISF/DISF-SR are also reviewed and described.

Sexual functioning following traumatic brain injury.

In this study we investigated sexual functioning in 52 outpatients with a history of traumatic brain injury to determine: (1) the prevalence of reported sexual dysfunction; and (2) the relationship between sexual functioning and age, severity and locus of injury, time since injury, and physical and cognitive function. Reports of sexual functioning indicated a reduction below levels within non-injured populations, but only to statistically significant levels on two scales of the Derogatis Interview of Sexual Function (DISF): Orgasm and Drive/Desire. Location of injury was related to sexuality in that patients with frontal lobe lesions reported an overall higher level of sexual satisfaction and functioning than those individuals without frontal lobe lesions. Time since injury was inversely related to reports of levels of sexual arousal; that is, patients with more recent injuries reported greater levels of arousal than those not recently injured. Right hemisphere injuries also correlated with higher scores on reports of sexual arousal and sexual experiences.

The "battering syndrome": prevalence and clinical characteristics of domestic violence in primary care internal medicine practices.

OBJECTIVES: To determine the prevalence of domestic violence among female patients and to identify clinical characteristics that are associated with current domestic violence. DESIGN: Cross-sectional, self-administered, anonymous survey. SETTING: 4 community-based, primary care internal medicine practices. PATIENTS: 1952 female patients of varied age and marital, educational, and economic status who were seen from February to July 1993. MEASUREMENTS: The survey instrument included previously validated questions on physical and sexual abuse, alcohol abuse, and emotional status and questions on demographic characteristics, physical symptoms, use of street drugs and prescribed medications, and medical and psychiatric history. RESULTS: 108 of the 1952 respondents (5.5%) had experienced domestic violence in the year before presentation. Four hundred eighteen (21.4%) had experienced domestic violence sometime in their adult lives, 429 (22.0%) before age 18 years, and 639 (32.7%) as either an adult or child. Compared with women who had not recently experienced domestic violence, currently abused patients were more likely to be younger than 35 years of age (prevalence ratio [PR], 4.1 [95% CI, 2.8 to 6.0]); were more likely to be single, separated, or divorced (PR, 2.5 [CI, 1.7 to 3.6]); were more likely to be receiving medical assistance or to have no insurance (PR, 4.3 [CI, 2.8 to 6.6]); had more physical symptoms (mean, 7.3 +/- 0.38 compared with 4.6 +/- 0.08; P < 0.001); had higher scores on instruments for depression, anxiety, somatization, and interpersonal sensitivity (low self-esteem) (P < 0.001); were more likely to have a partner abusing drugs or alcohol (PR, 6.3 [CI, 4.4 to 9.2]); were more likely to be abusing drugs (PR, 4.4 [CI, 1.9 to 10.4]) or alcohol (PR, 3.1 [CI, 1.5 to 6.5]); and were more likely to have attempted suicide (PR, 4.3 [CI, 2.8 to 6.5]). They visited the emergency department more frequently (PR, 1.7 [CI, 1.2 to 2.5]) but did not have more hospitalizations for psychiatric disorders. In a logistic regression model into which 9 risk factors were entered, the likelihood of current abuse increased with the number of risk factors, from 1.2% when 0 to 1 risk factors were present to 70.4% when 6 to 7 risk factors were present. CONCLUSIONS: In a large, diverse, community-based population of primary care patients, 1 of every 20 women had experienced domestic violence in the previous year; 1 of every 5 had experienced violence in their adult life; and 1 of every 3 had experienced violence as either a child or an adult. Current domestic violence is associated with single or separated status, socioeconomic status, substance abuse, specific psychological symptoms, specific physical symptoms, and the total number of physical symptoms.

PIP: This cross-sectional study determined the prevalence of domestic violence among female patients presenting to four community-based primary care internal medicine practices in Baltimore, Maryland, between February and July, 1993. Furthermore, it identified clinical characteristics associated with domestic violence. A total of 1952 female patients of diverse socioeconomic backgrounds participated in a self-administered, anonymous survey that solicited data on physical and sexual abuse, alcohol abuse, emotional status, demographic characteristics, physical symptoms, use of street drugs and prescribed medications, and medical and psychiatric history. Of the 1952 respondents, 108 (5.5%) had experienced domestic violence in the previous year, 418 (21.4%) had experienced violence sometime in their adult lives, 429 (22%) before age 18 years, and 639 (32.7%) as either an adult or a child. Current violence status is associated with single or separated status, substance abuse, specific psychological symptoms, specific physical symptoms, and the total number of physical symptoms. In a logistic regression model, the likelihood of current abuse increased with the number of risk factors. The magnitude of these associations supports the idea that domestic violence is a significant medical public health problem. Detection of domestic violence by physicians or other health care professionals might alter both the diagnostic and treatment plans for these women.

Serum androgens and psychopathology in hirsute women.

Twenty consecutive women referred for evaluation and treatment of idiopathic hirsutism were evaluated with regard to levels of serum androgens, degree of hirsutism, nature and prevalence of psychological symptoms, and mood and affects. Androgens measured were total testosterone, free testosterone, biologically active testosterone, dehydroepiandrosterone, dehydroepiandrosterone sulfate and androstenedione. Psychological symptoms were quantified via the Derogatis Symptom Inventory, and mood and affects were measured by the Affects Balance Scale. Results revealed very significant correlations between unbound fractions of testosterone (i.e. free and biologically active testosterone) and both symptom and mood measures of depression (r = 0.60; p < 0.01). Significant inverse correlations were also observed between unbound fractions of testosterone and positive affects measures (e.g. 'contentment' r = -0.51; p < 0.05). Correlations between total testosterone and psychological variables were non-significant in all instances. Measures of degree of hirsutism correlated approximately zero (o) with psychological symptom and mood measures in this sample. When psychiatric 'caseness' criteria were applied to the cohort, seven of the 20 women (35%) were found to be positive. Results are interpreted to suggest that depression among hirsute women appears more likely to have its basis in a deranged neuroendocrine mechanism than in psychosocial causes.

Serum androgens and depression in women with facial hirsutism.

BACKGROUND: Studies on the psychopathologic aspects of hirsutism are sparse. Attempts to correlate these aspects with either the extent of the facial hirsutism and/or circulating serum androgens are virtually nonexistent. This study evaluates the psychopathologic aspects of hirsutism and correlates these findings with the extent of the facial hirsutism as well as with the circulating serum androgens. OBJECTIVE: Our purpose was to assess the psychopathologic aspects of facial hirsutism and to determine whether any correlation exists between these findings and either the extent of the facial hirsutism or the circulating serum androgens. METHODS: Twenty consecutive women with facial hirsutism were studied by administration of psychologic tests (DeRogatis Symptom Inventory and the Affects Balance Scale). The results of these tests were correlated with the grade of facial hirsutism as well as serum levels of total testosterone (T), biologically active testosterone (BT), free testosterone (FT), dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulfate (DHEA-S), and androstenedione (A-dione). RESULTS: Significant levels of depression were found. No correlation was found between the psychopathologic measurements and the extent of facial hirsutism or serum levels of T, DHEA, DHEA-S, and A-dione. Significant correlations were found between depression and serum levels of FT and BT. CONCLUSION: There is an increased incidence of depression in facially hirsute women and this correlates with their circulating active testosterone levels and not with the extent of their facial hirsutism.

A randomized clinical trial of alprazolam versus progressive muscle relaxation in cancer patients with anxiety and depressive symptoms.

A randomized nonblinded study was performed in three cancer centers to test over a 10-day period the efficacy of (1) a triazolobenzodiazepine, alprazolam, 0.5 mg three times a day and (2) use of a behavioral technique in which patients were trained in progressive muscle relaxation at an initial session with a behavioral psychologist and then asked to listen at home to an audiotape of the session three times a day. Of 147 cancer patients who met entry levels of distress and completed the study, uncontrolled for site or disease stage, 70 were randomized to drug, 77 to relaxation. Four measures of anxiety and depression were used: Covi, Raskin, Affects Balance, and Symptoms Checklist-90 (SCL-90). Results showed that both treatment arms resulted in significant (P less than .001) decrease in observer and patient-reported anxious and depressed mood symptoms. Although both treatment arms were effective, patients receiving the drug showed a slightly more rapid decrease in anxiety and greater reduction of depressive symptoms. These findings confirm efficacy of both alprazolam and relaxation to reduce cancer-related anxiety and depression. As safe, inexpensive, and effective interventions, physicians should consider their use in cancer patients experiencing anxiety and depressive symptoms.

Pretreatment evaluation of sexual function in patients with adenocarcinoma of the prostate.

Forty-three patients with adenocarcinoma of the prostate and available partners were interviewed to assess qualitatively and quantitatively their levels of sexual functioning prior to radiotherapy. The mean age was 67.7 years (58-80 years). The Derogatis Interview for Sexual Functioning (DISF) was the evaluation used. The Derogatis Interview for Sexual Functioning measures five domains of sexual functioning: sexual fantasy, arousal, experience, orgasm, and drive. Twenty-seven of the 43 (62.7%) patients evaluated were considered impotent. Fifteen of the 27 patients scored low in all five domains of sexual functioning even though they could achieve erection but they were unable to maintain erection throughout the phases of the sexual response cycle. Twelve of the 27 patients had scored 0 on sexual arousal and orgasm, thus had no ability for erection. Sixteen of the 43 (37.2%) patients were considered potent. This group of patients had achieved erection throughout the phases of sexual cycle and scored adequately in all five domains of sexual functioning. Patients with DISF score less than 20 were impotent. Those with a Derogatis Interview for Sexual Functioning score of greater than 45 were potent. Only 6 of 19 patients with scores between 20 and 45 were potent. The Derogatis Interview for Sexual Functioning score was highly prognostic for impotence, (p = .002) was easy to use and could be used for follow-up of the effect of therapy on sexual function in patients with adenocarcinoma of the prostate. Patients who present for radiation therapy are older, 50% are on cardiac or antihypertensive medication, and the majority (62.7%) are already impotent prior to therapy.

Pre and posttreatment evaluation of sexual function in patients with adenocarcinoma of the prostate.

Twenty-seven patients with adenocarcinoma of the prostate, and available partners, were interviewed to qualitatively and quantitatively assess their level of sexual function prior to and 12 months after radiotherapy. Assessments were made using the Derogatis Interview for Sexual Functioning (DISF). Five domains of sexual functioning are measured: sexual fantasy, arousal, experience, orgasm, and drive. Prior to therapy 17 of 27 patients (62.9%) were considered impotent. There were eight patients with a DISF score of less than 20 who were impotent. Six patients had a DISF score of greater than 47 and were considered potent. Of the patients with DISF scores between 20-47 four were potent, and nine were impotent. Post radiation therapy three of the patients considered potent (with a score greater than 47) maintained their potent status. Four patients considered impotent prior to therapy became potent after therapy. All patients with a score less than 20 prior to radiation therapy remained impotent after therapy. Results indicate that an objective evaluation of sexual function pre treatment is necessary to determine the effect of radiotherapy. Our method of qualitative assessment of sexual function was easy to implement, was reproducible and could be used to evaluate long-term effects of radiotherapy on sexual function. Of the patients presenting for radiotherapy, 62.9% were impotent. Twelve months after radiation therapy 19 of 27 (70.3%) were impotent.

Subtypes of anorgasmia via mathematical taxonomy.

Seventy-six women who presented with a principal complaint of anorgasmia were partitioned into four distinct subtypes on the basis of psychosexual and psychological symptoms using hierarchical cluster analysis, a mathematical taxonomic method. The classification was accomplished with data from the Derogatis Sexual Functioning Inventory (DSFI) and the Brief Symptom Inventory (BSI). Comparisons involving age, race, marital status, and social class demonstrated no significant differences between the four subtypes; however, statistical analyses of psychosexual, psychological symptom, and chart-review variables (including psychiatric diagnosis) revealed very significant distinctions between the four groups. From the resulting typology, anorgasmic subtypes were presumptively identified as "low desire" (n = 21), "histrionic/marital conflict" (n = 20) "psychiatric disorder" (n = 12) and "constitutional" (n = 16). Implications of the typology for etiologic and optimal treatment decisions concerning anorgasmia are discussed.