Psychological and interpersonal dimensions of sexual function and dysfunction.

INTRODUCTION: There are limited outcome data on the etiology and efficacy of psychological interventions for male and female sexual dysfunction as well as the role of innovative combined treatment paradigms. AIM: This study aimed to highlight the salient psychological and interpersonal issues contributing to sexual health and dysfunction, to offer an etiological model for understanding the evolution and maintenance of sexual symptoms, and to offer recommendations for clinical management and research. METHODS: This study reviewed the current literature on the psychological and interpersonal issues contributing to male and female sexual dysfunction. MAIN OUTCOME MEASURE: This study provides expert opinion based on a comprehensive review of the medical and psychological literature, widespread internal committee discussion, public presentation, and debate. RESULTS: Medical and psychological therapies for sexual dysfunctions should address the intricate biopsychosocial influences of the patient, the partner, and the couple. The biopsychosocial model provides an integrated paradigm for understanding and treating sexual dysfunction. CONCLUSIONS: There is need for collaboration between healthcare practitioners from different disciplines in the evaluation, treatment, and education issues surrounding sexual dysfunction. In many cases, neither psychotherapy alone nor medical intervention alone is sufficient for the lasting resolution of sexual problems. The assessment of male, female, and couples' sexual dysfunction should ideally include inquiry about predisposing, precipitating, maintaining, and contextual factors. Research is needed to identify efficacious combined and/or integrated treatments for sexual dysfunction.

Women's sexual desire and arousal disorders.

INTRODUCTION: A committee of five was convened to update the chapter on women's sexual dysfunctions from the perspective of diagnostic issues, pathophysiology, assessment, and treatment. AIM: To review the literature since 2003 and provide recommendations based on evidence. METHODS: Research databases, conference proceedings, and articles in press were read for relevant new data on these topics for hypoactive sexual desire disorder (HSDD), female sexual arousal disorder (FSAD), female orgasmic disorder (FOD), and persistent genital arousal disorder (PGAD). MAIN OUTCOME MEASURES: Recommendations by five experts from five countries were formulated with associated grades. RESULTS: The definitions of HSDD, FSAD, and FOD in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text-Revised are imperfect and have been criticized over the last decade. Proposed new criteria that take into account empirical findings and the diversity across women are recommended. There has been a flurry of new epidemiological studies on women's sexual dysfunction; studies also assessing distress consistently find a much lower prevalence of dysfunction if distress is considered. Assessment of sexual difficulties is best achieved through a biopsychosocial clinical interview of the woman and her partner (if possible); though laboratory investigations, a physical examination, psychophysiological measurement, and self-report questionnaires can often supplement the interview information. There are currently no approved pharmacological treatments for women's sexual dysfunction in North America, though a number of promising agents have been studied. Evidence for the efficacy of psychological treatments is based on limited studies. There is an urgent need for more data on the assessment, etiology, and treatment of PGAD. CONCLUSIONS: Specific recommendations for the assessment and treatment of women's desire, arousal, and orgasm disorders are forwarded; however, more research into these domains is needed.

Vaginal dryness: a comparison of prevalence and interventions in 11 countries.

INTRODUCTION: There is limited research comparing cross-cultural differences in women's experiences of vaginal dryness. AIM: To examine international differences in the prevalence of vaginal dryness, the degree to which it is experienced as problematic or bothersome, the use of lubricants to alleviate it, and women's discussion of this problem with physicians. MAIN OUTCOME MEASURES: Questionnaire measuring the level of vaginal dryness and degree to which it is perceived as bothersome. METHODS: The Global Survey of Sexual Attitudes and Practices was administered to 6,725 women from 11 countries: UK, Germany, Japan, Australia, Canada, Spain, Italy, Mexico, Argentina, Brazil and Thailand. RESULTS: Prevalence of self-reported vaginal dryness varied from a minimum of 5.8% in Italy to a maximum of 19.7% in Brazil. The proportion of women with self-reported vaginal dryness who found it very bothersome varied as well (e.g., 5.6% UK, 26.4% Germany). Pain during intercourse ranged from a reported low of 3.6% in Australia to 18.6% in Brazil. Older women (50-65 years) as compared with younger women (18-34 years) reported significantly more vaginal dryness in the UK, Australia, Canada, Italy, Spain, Argentina, and Thailand (P values <0.02). The majority of women under 50 attributed vaginal dryness to inadequate sexual arousal while women over 50 believed it was because of aging or menopause. Cross-culturally, women differed substantially in the likelihood of discussing their sexual life/concerns with a physician. CONCLUSION: Women from different countries differ substantially in their experiences, concerns, and reports of vaginal dryness/sexual pain, as well as their familiarity with personal lubricants as a treatment. Researchers should assess the prevalence and degree of the bother of vaginal dryness in order to make international comparisons of the burden of this condition.

Female sexual well-being scale (FSWB scale): development and psychometric validation in sexually functional women.

INTRODUCTION: No validated instrument exists for measuring female sexual well-being (FSWB) in women without medical/psychosocial conditions. AIMS: To develop and psychometrically validate a self-administered Female Sexual Well-Being Scale (FSWB Scale) for assessing sexual well-being in sexually functional women. METHODS: Important aspects of FSWB were identified via focus groups, debriefing interviews, and administration of an initial scale to 111 US women aged 21-72 years reporting normal sexual function (Female Sexual Function Index >26). Principal components analysis and psychometric validity testing of a FSWB Scale were conducted in a second study of 332 women. MAIN OUTCOME MEASURES: To develop a FSWB Scale, based on qualitative input from women reporting normal sexual function, and determine its factor structure and psychometric validity. RESULTS: Four aspects of FSWB were identified from the qualitative research. Women's preferred language to describe sexual well-being and preferred response formats were incorporated into the scale. A principle components analysis of quantitative study data from 332 women aged 21-72 years reporting normal sexual function identified 5 factors with eigenvalues >1: interpersonal domain (6 items), cognitive-emotional domain (5 items), physical arousal domain (3 items), orgasm-satisfaction domain (3 items), and external lubrication domain (2 items). The external lubrication domain did not demonstrate strong positive correlations with the other 4 domains, so it was not retained in the final scale. A high degree of internal consistency was demonstrated for the 4 domains (Cronbach's alpha values: 0.84-0.92). Test-retest reliability over a 2-week period was high (r > 0.80) or moderately high (r > 0.70) for the 4 domain scores. Correlation coefficients between FSWB Scale domain scores and standardized scale scores for female sexual function, depression, and social desirability demonstrated the construct validity of the FSWB Scale. CONCLUSION: A 17-item FSWB Scale was developed and psychometrically validated as a reliable, multidimensional, self-administered instrument for assessing sexual well-being in women of different ages.

FSFI scores of women with persistent genital arousal disorder compared with published scores of women with female sexual arousal disorder and healthy controls.

INTRODUCTION: Although persistent genital arousal disorder (PGAD) has been mistaken for hypersexuality, there is no research documenting the sexual functioning of PGAD women to support or refute such an assumption. AIM: To compare the Female Sexual Function Index (FSFI) scores of PGAD women to that of women diagnosed with female sexual arousal syndrome (FSAD) and healthy controls. METHODS: The FSFI scores of heterosexual women who met all five features qualifying for a diagnosis of PGAD (N = 172) on an online questionnaire were compared with previously published FSFI scores of women diagnosed with FSAD (N = 128) and healthy controls (N = 131). MAIN OUTCOME MEASURE: Total and subscale scores on the FSFI. RESULTS: On every subscale of the FSFI with the exception of desire, the PGAD women obtained scores between that of the FSAD and the healthy control group. The FSAD women displayed the greatest problems in desire, arousal, lubrication, orgasm, and pain while women with PGAD reported somewhat more desire than the control group but did not meet the cutoff score for sexual dysfunction. PGAD women are more similar to the normal control group than women with FSAD. CONCLUSIONS: There is no evidence to support the belief that women who meet criteria for a diagnosis of PGAD are "hypersexual." In fact, their overall sexual functioning falls within the normal range and is significantly better than that of women diagnosed with FSAD.

Development and evaluation of the Women's Sexual Interest Diagnostic Interview (WSID): a structured interview to diagnose hypoactive sexual desire disorder (HSDD) in standardized patients.

INTRODUCTION: Female sexual dysfunction (FSD) is a common disorder in postmenopausal women. Currently, there is no clear "gold standard" for the diagnosis of FSD. AIM: The aim of this study was to evaluate the interrater reliability of the Women's Sexual Interest Diagnostic Interview (WSID), a new structured clinical interview designed to diagnose hypoactive sexual desire disorder (HSDD). The reliability of additional interview questions focused on the diagnosis of other types of FSD was also evaluated. MAIN OUTCOME MEASURES: The main outcome measure was the level of agreement in the diagnosis of FSD among clinical experts, between clinical experts and study coordinators, and between clinical experts and patients' self-reported interactive voice response system (IVRS) version of the WSID. METHODS: Two versions of WSID were developed based on current diagnostic criteria: a clinician-administered version using a structured interview guide, and a patient self-report version using an IVRS. Three sexual medicine experts developed 20 clinical scenarios portraying cases and noncases of HSDD and other FSD diagnostic subtypes. Ten actresses with experience in standardized patient interviewing rehearsed these scenarios and performed the scripted patient roles in a standardized clinical interview with clinical experts (not the author of the script) and study coordinators, on a one-on-one basis, using the WSID interview format. In addition, all actresses completed the IVRS version of the WSID. Interviews were videotaped and viewed by the expert panel. In each instance, the diagnosis that the interview was scripted to portray was considered as the "gold standard." Kappa (kappa) coefficients were utilized to assess the level of agreement among experts, between study coordinators and the "gold standard", and between the IVRS version of the WSID and the "gold standard". RESULTS: All experts agreed with the gold standard diagnosis provided by the author of the script (kappa=1.0). Similarly, there was perfect agreement among the experts on the presence of depressive symptomatology (kappa=1.0). On the related diagnoses of arousal disorder, orgasmic disorder, and sexual pain disorder, kappas of 0.894, 0.966, and 0.946 were observed (P<0.0001 for all comparisons). When study coordinator's WSID diagnoses were compared with the "gold standard," kappa for HSDD was 0.851; sensitivity was 0.864, and specificity and positive predictive value (PPV) were 1.00 (P<0.001 for all comparisons). When diagnoses obtained via IVRS interviews were compared with the "gold standard", kappa for HSDD was 0.802, sensitivity was 0.818, and specificity and PPV were 1.00 (P<0.001 for all comparisons). CONCLUSION: Agreement as estimated by kappa coefficients was consistently high in both clinician-administered and patient self-reported IVRS versions in the diagnosis of HSDD.

To BATHE or not to BATHE: patient satisfaction with visits to their family physician.

BACKGROUND: BATHE is an acronym for Background, Affect, Trouble, Handling, and Empathy and refers to specific questions or comments incorporated into a standard medical interview. The BATHE technique was developed as a rapid psychosocial intervention for the assessment of psychological factors that may contribute to patients' physical complaints. The present research was designed to determine whether the use of BATHE significantly increased patient satisfaction during a visit to a family physician. METHODS: Four family physicians in a busy urban family practice center were involved in the study. Two physicians were instructed to use the BATHE protocols until data had been collected from 10 patients and then to proceed in their usual fashion with their next 10 patients. The other two physicians conducted their interview as usual with their first 10 patients and then used BATHE with the following 10 patients. All patients were asked to complete a satisfaction survey following their consultation. RESULTS: BATHEd patients responded with significantly higher ratings for 8 of the 11 satisfaction measures, including those related to information provided, perception of physician concern, and likelihood of recommending the physician to others. CONCLUSIONS: The results of this pilot study support the use of BATHE with primary care patients, as it increases patient satisfaction, possibly by helping patients sense that their physician is sympathetic and concerned.

Interaction of organic and psychological factors in persistent genital arousal disorder in women: a report of six cases.

There have been a number of case reports published recently describing women who complain of persistent genital arousal. Most of these papers do not report medical data or observations from genital examination. We report in such detail on six cases of persistent genital arousal disorder (PGAD) in women. We further advance the hypothesis that in many cases the objective genital component may be induced by a variety of psychophysiological and pathological factors such as anxiety, genital prolapses and dermatoses. Genital engorgement so produced may not be continuous but when present may be enhanced and perpetuated by both anxiety focussed on the genitals and masturbation used in an attempt to relieve the sensations. Premorbid affective psychological illness negatively colours the subjective perception of this genital engorgement, leading to either elicitation or maintenance of PGAD. We discuss this hypothesis in relation to our six cases.

Persistent genital arousal disorder in women: case reports of association with anti-depressant usage and withdrawal.

Little is known with certitude about the triggers of persistent genital arousal disorder (PGAD) in women, although there appears to be certain common features of the disorder. Women complain of unbidden feelings of genital arousal that are qualitatively different from sexual arousal that is preceded by sexual desire/and or subjective arousal. The majority of women find PGAD distressing and report only brief relief with orgasm. In this article, we describe five women who believe they developed PGAD either after withdrawing from selective serotonin reuptake inhibitor (SSRI) anti-depressants or while using them. We discuss these sexual symptoms in relation to what is already known about prolonged SSRI withdrawal syndromes and the possible etiologies of these conditions. While not a common cause of PGAD, it is possible that use of, and withdrawal from, pharmacological agents contributes to the development of PGAD.

Psychological, medical, and pharmacological correlates of persistent genital arousal disorder.

INTRODUCTION: Little is known about the etiology or medical/psychological correlates of persistent genital arousal disorder (PGAD). AIM: The aims of this article were (i) to replicate the findings of earlier research identifying two subtypes of women with persistent arousal-those who meet all features of the condition and are at least moderately distressed, and those who meet only some features and are less distressed; and (ii) to identify the medical, psychological and/or pharmacological correlates of the condition. METHOD: A comprehensive web-based survey of persistent genital arousal (PGA) was posted on several Internet websites. Of the 156 women who completed the survey, 76 met all five features qualifying for a persistent genital arousal disorder (PGAD) group, and 48 met only some features (non-PGAD group). MAIN OUTCOME MEASURES: The main outcome measures were endorsement of diagnostic signs of depression, anxiety, obsessive-compulsive disorder, and panic attack as well as medical illnesses and pharmacological preparations. RESULTS: Compared to non-PGA subjects, women with PGA were significantly more likely to be depressed (55% vs. 38%) and to report panic attacks (31.6% vs. 14.6%). They were more anxious and more likely to monitor their physical sensations. Both groups reported high rates of childhood and adult sexual abuse, although the PGA women reported a higher prevalence of sexual victimization. They were significantly more likely to endorse negative feelings about their genital sensations and also more likely to complain of chronic fatigue syndrome than women without the condition (10% vs. 0%). There were no significant relationships with pharmacologic agents and symptoms. CONCLUSIONS: Women who met all the criteria of PGAD were more likely than women who only met some of the criteria to report depression, anxiety, panic attacks, and certain obsessive-compulsive symptoms such as monitoring their physical sensations. It is hypothesized that for a subset of women, psychological factors, namely anxiety, reinforce exacerbate and maintain PGAD.

Normal and persistent genital arousal in women: new perspectives.

Interest in women's sexual functioning has increased in recent years although the primary emphasis has been on deficits in both genital and subjective sexual response. Female sexual psychophysiology research suggests that women are capable of greater sexual responsiveness than previously thought and can experience genital response in the absence of a subjective experience of sexual arousal. Women who report relatively persistent genital arousal, both with and without accompanying distress, provide case examples of the potential for dissociation between genital and psychological sexual response. In this article, we provide case illustrations of women reporting unprovoked genital arousal both with and without distress and suggest that what appears to be spontaneous genital arousal in some women may be the result of either subconscious processing of sexual stimuli in the environment - stimuli that are either consciously unacceptable or not noticed. Finally, we suggest that there may exist three types of genital arousal in women: 1) spontaneous sensations of genital arousal that are appraised as mildly pleasurable; 2) persistent feelings of genital arousal that are experienced as mildly distracting but not especially unwelcome or bothersome; and 3) continuous, intense, and persistent genital arousal that is extremely distracting, distressing, and worrisome. A variety of psychological, pharmacological, vascular, and neurological factors may account for these differences in women's genital arousal responsiveness. However, a full understanding of the range and variation in women's sexual experience remains to be elucidated.

Persistent genital arousal: disordered or normative aspect of female sexual response?

INTRODUCTION: Persistent genital arousal disorder (PGAD), previously known as persistent sexual arousal syndrome, is a serious and extremely distressing condition. Clinical experience suggests that there may be a subset of women who experience persistent genital arousal as a normative and not especially distressing part of their sexuality. AIM: To determine whether there are women who report unprovoked genital arousal and view it as normative, and to identify differences between women who endorse all five features of PGAD vs. those who endorse only some of features. MAIN OUTCOME MEASURES: Respondents were asked about the nature, onset, duration, and severity of their arousal, and their feelings about PGAD. Overall sexual and relationship satisfaction was assessed, as were scores on the Female Sexual Function Index (FSFI). METHODS: An on-line, anonymous survey on persistent genital arousal was conducted. Of the 388 respondents, 206 women endorsed all five features of PGAD (PGAD group) and 176 endorsed some, but not all, criteria (non-PGAD group). RESULTS: The two groups were similar in age, relationship status, and duration. More PGAD than non-PGAD women reported current symptoms and greater symptom severity. Distress ratings were significantly greater for PGAD than non-PGAD women (7.9 vs. 4.7 on a 10-point scale). Forty-eight percent of PGAD vs. 27% of non-PGAD women reported continuous feelings of arousal. Significantly more PGAD women than non-PGAD women endorsed negative feelings about their genital arousal. Women with PGAD reported lower desire, less sexual satisfaction, greater pain, and lower overall scores on the FSFI. CONCLUSIONS: There is a cohort of women who regularly, if intermittently, experience unprovoked and persistent genital arousal and find it mildly pleasurable. Their genital arousal differs from that of women who meet all five criteria for a diagnosis of PGAD. Possible explanations and etiologies for these differing reactions are discussed.

Social concerns of women undergoing infertility treatment.

OBJECTIVE: Our study was undertaken to determine [1] what women are disclosing to their employer with regard to their infertility, [2] what demographic characteristics are associated with women who are more likely to disclose, and [3] if there is an association between disclosure and lowering one's stress. We hypothesize that, in certain women, disclosure may lower stress, and therefore increase success rate of in vitro fertilization. DESIGN: Cross-sectional questionnaire. SETTING: University Infertility Treatment Center. PATIENT(S): We handed out a questionnaire to patients being evaluated and treated for infertility over a 6-month period. A total of 267 questionnaires were handed out and all were collected. MAIN OUTCOME MEASURE(S): We collected demographic data as well as information regarding privacy, disclosure, and stress. We then compared women who disclose to their employer that they are being seen by an infertility specialist to those women who do not disclose. We also measured stress and determined if higher stress level was associated with disclosure or nondisclosure. RESULT(S): Most women who did disclose did so because they needed a reason to leave work for frequent doctor visits. Among women who did not disclose, the main reason for nondisclosure was to protect their privacy. Women with a high school education were more likely to disclose compared with those with a college and postgraduate education. African American/Caribbean American women were least likely to disclose. Those who were out of work more often because of their infertility were more likely to disclose. There was not an association with disclosure and decreasing stress level. CONCLUSION(S): Women who did or did not disclose their infertility status to their employer were different with regard to level of education, race/ethnicity, and number of visits per month to the doctor. The decision to disclose does not seem to have a significant impact on stress.

A symptomatic approach to understanding women's health experiences: a cross-cultural comparison of women aged 20 to 70 years.

OBJECTIVES: To determine patterns of symptoms across age groups, identify symptom groups associated with ovarian hormonal depletion or other variables, and develop a prediction model for each symptom. DESIGN: This was a cross-sectional survey of 4,517 women ages 20 to 70 years recruited from market research panels in the United States, United Kingdom, Germany, France, and Italy using a self-report questionnaire that included general health information and a checklist of 36 symptoms. Stepwise regression was used to determine for each symptom how prevalence varied with age, indicators of menopausal hormonal changes, and the effects of other explanatory variables, including body mass index, morbidity, and country. Hierarchical clustering was used to group symptoms. RESULTS: Six groups of symptoms were found, of which two groups, with seven symptoms in total, were related to markers of menopausal hormonal change: a group consisting of hot flashes and night sweats and a second group including poor memory; difficulty sleeping; aches in the neck, head, and shoulders; vaginal dryness; and difficulty with sexual arousal. Physical and mental morbidity affected estimates of the prevalence of all symptoms. Psychological symptoms declined with age from a maximum prevalence before age 40. Certain physical symptoms increased with age and body mass index. Clustering identified three country groups: (1) US and UK women; (2) French and Italian women; and (3) German women. There were marked differences in prevalence between countries for certain physical and psychological symptoms. CONCLUSIONS: The seven symptoms most linked to menopausal hormonal change should form part of any future menopause symptom list. Physical and mental morbidity affect symptom prevalence and should be measured.

Relationship between hypoactive sexual desire disorder and aging.

OBJECTIVE: Explore the association between Hypoactive Sexual Desire Disorder (HSDD) and aging. The American Foundation of Urologic Disease and the American Psychiatric Association stipulate that HSDD is only diagnosed when both low sexual desire and sexually related personal distress are present. DESIGN: Community-based, cross-sectional study. SETTING: Europe (UK, Germany, France, Italy) and the USA. PATIENT(S): Women aged 20-70 in sexual relationships participating in the Women's International Study of Health and Sexuality (n=1998 Europe, n=1591 USA). INTERVENTION(S): No interventions were administered. MAIN OUTCOME MEASURES: Self-administered questionnaire that included two validated instruments: Profile of Female Sexual Function(c) measured sexual desire; Personal Distress Scale(c) measured sexual distress. Women with low desire and distress were considered to have HSDD. RESULTS: The proportion of European women with low desire increased from 11% amongst women aged 20-29 years to 53% amongst women aged 60-70 years. The proportion of American women with low desire displayed a trend towards an increase with age. In the 20-29 year age group 65% of European women and 67% of American women with low sexual desire were distressed by it. This decreased to 22% and 37%, respectively, in the 60-70 year age group. In Europe and the USA the prevalence of HSDD in the population did not change significantly with age (6-13% in Europe, 12-19% in the USA). CONCLUSIONS: The proportion of women with low desire increased with age while the proportion of women distressed about their low desire decreased with age. Consequently, the prevalence of HSDD remained essentially constant with age. This may explain why no association between HSDD and age is often reported in the literature.

Vulvodynia: a state-of-the-art consensus on definitions, diagnosis and management.

Vulvodynia is a chronic pain syndrome affecting up to 18% of the female population. Despite its high prevalence and associated distress, the etiology, diagnosis and clinical management of the disorder have not been clearly delineated. This "white paper" describes the findings and recommendations of a consensus conference panel based on a comprehensive review of the published literature on vulvodynia in addition to expert presentations on research findings and clinical management approaches. The consensus panel also identified key topics and issues forfurther research, including the role of inflammatory mechanisms and genetic factors and psychosexual contributors.

A methodology study to develop and validate a screener for hypoactive sexual desire disorder in postmenopausal women.

INTRODUCTION: Current methods for diagnosing hypoactive sexual desire disorder (HSDD) can be complicated and time-consuming. A previous study reported validity and reliability of a structured diagnostic method created for clinical trials that can be performed in approximately 1 hour. METHODS: A more succinct tool is needed for incorporation into busy physician practices. Therefore, a brief HSDD screening tool was developed consisting of four self-report questions with an interpretable cut-score and concise confirmatory physician interview. MAIN OUTCOME MEASURES: Accuracy of the HSDD screener cut-score alone, and in combination with physician interview, was then separately evaluated when compared with in-depth interview diagnosis. RESULTS. The results showed good agreement between the two diagnoses (kappa of 0.669 and 0.562 for cut-score alone and cut-score in combination with physician interview, respectively). CONCLUSIONS: The HSDD screener can reliably detect the likely presence of HSDD in postmenopausal women.

Hypoactive sexual desire disorder in postmenopausal women: US results from the Women's International Study of Health and Sexuality (WISHeS).

OBJECTIVE: To determine the prevalence of hypoactive sexual desire disorder (HSDD) among US women by reproductive status and age and to explore the correlates of sexually related distress. DESIGN: The Women's International Study on Health and Sexuality questionnaire was mailed to a national sample of US women in 2000. The survey included validated questionnaires: the Short Form-36, which measures overall health status; the Profile of Female Sexual Function, which assesses sexual desire; and the Personal Distress Scale, which measures distress caused by low desire. Four groups of women were studied: surgically postmenopausal, aged 20 to 49 years and 50 to 70 years; premenopausal, aged 20 to 49 years; and naturally postmenopausal, aged 50 to 70 years. Clinically derived cutoff Profile of Female Sexual Function and Personal Distress Scale scores were used to classify women with HSDD and determine its prevalence. The relations between sexual desire and frequency of sexual activity or relationship satisfaction were assessed. Overall health status of HSDD women and women with normal desire were compared. RESULTS: The prevalence of HSDD ranged from 9% in naturally postmenopausal women to 26% in younger surgically postmenopausal women. The prevalence of HSDD was significantly greater among surgically postmenopausal women, aged 20 to 49 years, than premenopausal women of similar age, whereas there were no significant differences in the prevalence between surgically postmenopausal women, aged 50 to 70 years, and naturally postmenopausal women. For many women, HSDD was associated with emotional and psychological distress as well as significantly lower sexual and partner satisfaction. HSDD was also associated with significant decrements in general health status, including aspects of mental and physical health. CONCLUSIONS: HSDD is prevalent among women at all reproductive stages, with younger surgically postmenopausal women at greater risk, and is associated with a less active sex life and decreased sexual and relationship satisfaction.

Persistent genital arousal in women -- a new syndrome entity.

The persistent sexual arousal syndrome (PSAS) is a newly described entity where women become involuntarily aroused genitally for extended periods in time in the absence of sexual desire. Genital vasoengorgement and oedema have been observed. These women are found to be usually very distressed. The cause of the syndrome in the majority of cases is unknown, although a number of women report symptoms after withdrawal from selective serotonin reuptake inhibitors (SSRI) antidepressants. There is no specific therapy at present, although electroconvulsive therapy (ECT) has resulted in clinical improvement in cases where there was concomitant severe depression.