Individual and dyadic barriers to a pharmacotherapeutic treatment of hypoactive sexual desire disorders: results and implications from a small-scale study with bupropion.

This article describes the results of an independent small-scale trial with the centrally acting agent bupropion for female hypoactive sexual desire disorder. The main goals were to gain insight into the intrapsychic and interpersonal barriers to improvement associated with the pharmacological treatment of this common disorder. Eligible subjects entered a 2-week run-in period and a 4-week placebo phase, followed by a 20-week treatment phase. In addition to semi-structured clinical interviews and a set of standardized questionnaires, we used 2 self-developed questionnaires, addressing the period between visits and the week preceding each visit. Participants were 16 women who entered the placebo phase and 10 who completed the medication period. Analyses of pre-post scores and of the questionnaire addressing the time between visits yielded no significant changes. The questionnaire focusing on the week preceding each visit indicated improvements in sexual desire, arousability, and orgasmic ease after Week 8. In the clinical interviews, half of the women reported subjective improvements of sexual desire and arousability that could not be transferred to the sexual relationship as a result of individual and dyadic barriers. Overall, a centrally acting agent such as bupropion may be a viable option for female sexual dysfunction, but it seems mandatory to embed it in a psychotherapeutic approach.

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.

Female sexual desire disorders: subtypes, classification, personality factors and new directions for treatment.

Lack of sexual interest is highly prevalent in the general female population and, for more than two decades, low sexual desire has been the most common presenting problem in clinical institutions. The renewed interest in female sexual dysfunction has recently focused on biological and classification aspects whilst personality- and partner-related factors, as well as theoretical concepts, have largely been neglected. After critically reviewing the current diagnostic systems for female desire disorders, this paper specifically addresses the issues of personality and life history factors. In two empirical studies, 50 patients with low sexual desire were compared to a group of 100 sexually functional women by employing both semi-structured clinical interviews and a set of self-developed and standardised questionnaires. The results of these studies indicate that women seeking help for desire disorders exhibit marked signs of mood instability and a low and fragile self-regulation and self-esteem. In addition, they tend to be more worried, anxious, introverted and conventional when compared to sexually functional women. Interestingly, no significant differences in the variables relating to partnership quality in general could be detected. Although caution is needed due to sample size and methodological limitations, our results suggest a substantial level of at least subclinical psychiatric symptoms like mood-disorders, low self-esteem and feelings of guilt in women with sexual desire disorders. These problems seem to be rather deep-rooted and particularly affect the self-regulation and the inner balance of the personality. Overall, female sexual dysfunctions and low desire, in particular, cannot be conceptualised as discrete phase disorders, but rather as a global inhibition of sexual response together with a history of mood disorder, specific personality factors and an elevated level of psychological stress. This combination calls for broad-band treatment approaches where individual and interpersonal aspects can be taken into account simultaneously. In addition, the ubiquitous comorbidity, both with other sexual dysfunctions and with various personality and psychological problems, and the developmental sequence of the sexual problems must be adequately considered.