Socio-demographic determinants of low sexual desire and hypoactive sexual desire disorder: a population-based study in Iran.

BACKGROUND: Various socio-demographic factors have been introduced as the determinants of Low Sexual Desire (LSD), but whether these variables can also contribute to the Hypoactive Sexual Desire Disorder (HSDD), remains uncertain. In this study, we sought to identify the socio-demographic determinants of LSD and HSDD in Iranian women of reproductive age. METHODS: This was a population-based, cross-sectional study of 1000 married Iranian women of reproductive age (16-49 years) who met the inclusion criteria. The participants were chosen using the systematic random sampling method from all the healthcare centres in the city of Sari, Iran. LSD was defined as a score no higher than 33 on the Sexual Interest and Desire Inventory-Female (SIDI-F). The sexually-related personal distress was considered as a score of at least 11.0 on the Female Sexual Distress Scale-Revised (FSDS-R), and HSDD was determined based on the sum of those scores. Descriptive statistics were used to describe the socio-demographic characteristics and a chi-square test was run for data analysis using grouping variables. Multivariate logistic regression test was also employed to adjust the effect of confounding variables. RESULTS: The mean score of sexual interest/desire among women was 30.6 ± 10.5. After adjusting the effect of confounding variables, logistic regression showed that socio-demographic variables including age at first intercourse, length of marriage and the level of satisfaction with income were significantly associated with both LSD and HSDD (P < 0.01). While advancing age (P < 0.001) and body mass index (P < 0.01) were just predictors of LSD. CONCLUSION: Some socio-demographic factors could predict LSD in women, while they were not associated with HSDD. In other words, some factors associated with LSD do not instigate sexually-related personal distress, which is one of the criteria necessary for the diagnosis of HSDD.

Culture and Sexuality: Cognitive-Emotional Determinants of Sexual Dissatisfaction Among Iranian and New Zealand Women.

BACKGROUND: Several studies have demonstrated that culture plays a fundamental role in individuals' beliefs, attitudes, and values toward sexuality, and influences their ability to enjoy sex. It follows that culture may influence sexual satisfaction or dissatisfaction. AIM: To examine and compare cognitive-emotional variables related to women's sexual dissatisfaction in Iran and New Zealand. METHODS: In total, 196 Iranian women and 207 New Zealand women participated in the study, answering questionnaires evaluating dysfunctional sexual beliefs, automatic thoughts, emotional and sexual response during sexual activity, as well as sexual satisfaction. OUTCOMES: Sexual beliefs were measured by the Sexual Dysfunctional Beliefs Questionnaire, thoughts and emotional responses were measured by the Sexual Modes Questionnaire, and sexual satisfaction was measured by the Sexual Satisfaction Index. RESULTS: Findings indicated that in both Iranian and New Zealand women, failure and disengagement thoughts, lack of erotic thoughts, and emotions of fear during sexual activity were significant predictors of sexual dissatisfaction. Besides these common predictors, results also indicated that sexual conservatism and women's sexual passivity beliefs, sexual abuse thoughts, and fear during sexual activity were significant predictors of sexual dissatisfaction in Iranian women. Beliefs of sexual desire and pleasure as a sin; age-related beliefs; and emotions such as sadness, disillusion, and hurt were significant predictors of sexual dissatisfaction in New Zealand women. CLINICAL TRANSLATION: The present findings could facilitate a better understanding of cultural differences in the roles played by dysfunctional sexual beliefs, negative automatic thoughts, and negative emotions during sexual activity, and the value of these beliefs, thoughts, and emotions in predicting sexual dissatisfaction. CONCLUSIONS: The strength of this study is in providing an examination of the role of culturally bound beliefs in predicting sexual dissatisfaction in women from different cultural backgrounds. Limitations include the lack of evaluation of psychological and interpersonal variables that may impact on women's sexual dissatisfaction. These findings suggest that there may be a role of culture in shaping beliefs, attitudes, and values toward sexuality; and provide evidence for the effect of cognitive-emotional variables in predicting women's sexual dissatisfaction. Abdolmanafi A, Nobre P, Winter S, et al. Culture and Sexuality: Cognitive-Emotional Determinants of Sexual Dissatisfaction Among Iranian and New Zealand Women. J Sex Med 2018;15:687-697.

The morbidity of sexual dysfunction of 125 Chinese women following different types of radical hysterectomy for gynaecological malignancies.

PURPOSE: Due to early detection and effective treatment, quality of sexual life of patients with gynaecological malignancies has become an important issue. However, the morbidity of sexual dysfunction and the proportion of different kinds of sexual dysfunction after radical hysterectomy are unclear. The aim of the current study was to assess the morbidity of sexual dysfunction and to conduct multivariate logistic regression analysis of patients' sexual dysfunction. METHODS: Between July 2007 and December 2012, 125 women underwent radical hysterectomy, modified radical hysterectomy, and nerve-sparing radical hysterectomy were administered a self-reported sexual function questionnaire. RESULTS: The preoperative, and 1- and 2-year postoperative sexual dysfunction rates were 50.5% (50/99), 86.9% (93/107), and 92.3% (72/78), respectively. The incidence rates of sexual desire disorders before operation, at postoperative year 1, and at postoperative year 2 were 14.7% (14/95), 42.1% (45/107), and 51.9% (40/77), respectively. The preoperative incidence rates of sexual arousal disorders, orgasmic disorders, and sexual pain disorders were 18.4% (18/98), 51.1% (48/94), and 10.9% (11/101), respectively. At postoperative years 1 and 2, these were 38.8% (31/80), 81.0% (64/79), and 24.4% (20/82), and 49.1% (26/53), 84.6% (44/52), and 30.2% (16/53), respectively. Multivariable regression analysis revealed that age, preserved ovary, preserved posterior vaginal wall length, preoperative stage, radiotherapy, and education background were risk factors associated with sexual dysfunction. CONCLUSION: The patients following radical hysterectomy had a high incidence of sexual dysfunction, which plateaued in postoperative years 1 and 2.

Weight gain, body image and sexual function in young patients treated with contraceptive vaginal ring. A prospective pilot study.

INTRODUCTION: Oral contraceptives could induce mood changes. As far as our knowledge, there are no studies in literature that have examined the role of vaginal contraception in self-perceived body image. AIM: To evaluate the effects of intravaginal contraception on weight gain and perceived body image in relation with the Beck's Depression Inventory questionnaire (BDI) and the McCoy Female Sexuality Questionnaire (MFSQ). METHODS: Twenty-one adult (18-35 years old) eumenorrheic (menstrual cycle of 25-35 days), lean (body mass index - BMI - of 19-25 kg/m2) women who were referred for hormonal contraception were administered the Stunkard Figure Rating Scale (FRS), BDI and MFSQ. Subjects were studied in basal condition and after 6 months of therapy with vaginal contraception (NuvaRing®; Organon-Schering-Plough Italia, Milan, Italy). MAIN OUTCOME MEASURES: BMI, FRS, MFSQ and BDI. RESULTS: After 6 months of therapy with NuvaRing®, both body weight (60.0 ± 8.3; p = 0.050) and BMI (22.1 ± 3.1; p = 0.028) slightly, but statistically, increased. FRS and BDI showed no differences after the vaginal contraception. Hormonal contraception was associated with a significant decrease in the two-factor Italian MFSQ score. CONCLUSIONS: Vaginal ring seems a good alternative to other hormonal contraceptive not significantly altering the female sexuality and not influencing the FRS and BDI.

The SAD-MEN questionnaire: a new and reliable questionnaire for assessing sexual dysfunction in Asians with diabetes.

AIM: The aim of this study is to construct a new tool for the assessment of sexual dysfunction among men with diabetes that is valid and reliable across different ethnicities, languages and socio-economic backgrounds in South East Asia. METHODS: Focus group interviews were conducted to determine the construct of the questionnaire. Content and face validity were assessed by a panel of experts. A pilot study was conducted to validate the Sexual Dysfunction in Asian Men with Diabetes (SAD-MEN) questionnaire in English and Malay. The International Index of Erectile Function-5 (IIEF-5) was used for comparison. Construct validity was assessed using exploratory factor analysis, reliability was determined using Cronbach's α (> 0.700), and test-retest reliability using Spearman's rank correlation coefficient. RESULTS: The SAD-MEN questionnaire yielded moderate face and content validity, with high reliability as shown by Cronbach's α values of 0.949 for sexual performance and 0.775 for sexual desire for the English version. The Malay language questionnaire had a Cronbach's α value of 0.945 for sexual performance and 0.750 for sexual desire. Test-retest reliability using Spearman's test gave correlation coefficients of r = 0.853, P = 0.000 for the English language questionnaire and r = 0.908, P = 0.000 for the Malay language questionnaire. CONCLUSION: The SAD-MEN questionnaire is a valid and reliable tool by which to assess sexual dysfunction in English- and Malay-speaking Malaysian and South East Asian men with diabetes.

Ethical and Sociocultural Aspects of Sexual Function and Dysfunction in Both Sexes.

AIMS: This study aimed to highlight the salient sociocultural factors contributing to sexual health and dysfunction and to offer recommendations for culturally sensitive clinical management and research as well for an ethically sound sexual health care, counseling and medical decision-making. BACKGROUND: There are limited data on the impact of sociocultural factors on male and female sexual function as well as on ethical principles to follow when clinical care falls outside of traditional realms of medically indicated interventions. METHODS: This study reviewed the current literature on sociocultural and ethical considerations with regard to male and female sexual dysfunction as well as cultural and cosmetic female and male genital modification procedures. RESULTS: It is recommended that clinicians evaluate their patients and their partners in the context of culture and assess distressing sexual symptoms regardless of whether they are a recognized dysfunction. Both clinicians and researchers should develop culturally sensitive assessment skills and instruments. There are a number of practices with complex ethical issues (eg, female genital cutting, female and male cosmetic genital surgery). Future International Committee of Sexual Medicine meetings should seek to develop guidelines and associated recommendations for a separate, broader chapter on ethics.

Screening of sexual dysfunction in Saudi women before and after the age of 40 years.

OBJECTIVE: The aim was to assess sexual performance by screening Saudi women before and after the age of 40 years. MATERIALS AND METHODS: A cross-sectional study (March-May 2013), conducted at King Abdulaziz University Hospital (KAUH), with two groups of women under 40 years of age and aged 40 or more years, were randomly selected from OPD. Ethical committee approved the study. After verbal consent, one-paper self-administered questionnaire was distributed, and filled in anonymously and privately. Questionnaire included demographic data, the six-item version of female sexual function index (FSFI) to assess desire, lubricants, orgasm, satisfaction, and pain. If score was 19 or less, it meant that women needed further investigations (full assessment using FSFI- 19). RESULTS: Out of 194, 49.5% (96) were over 40 years of age and 50.5% (98) were under 40 years of age. Answering the six questions regarding sexual dysfunction in- dicated that women > 40 years had sexual dysfunction more than women <40 (statistically significant). A scored of less than 19 was found to be statistically significant in women > 40 years. Post-menopausal women, diabetics, women with urogynecological symptoms and/or psychological disorder required further evaluation. DISCUSSION: Using the six-item version of FSFI and calculating a score less than 19 for screening, women aged more than 40 years, reduction in estrogen, diabetes, urogynecological symptoms, and psychological disorder were all found to be important factors affecting female sexual dysfunction.

Sexual behavior and symptoms among reproductive age Chinese women in Hong Kong.

INTRODUCTION: As sexual medicine evolves, much advancement has been achieved in understanding male sexuality and treating male sexual dysfunction. Less is known about female sexual pattern, the prevalence of sexual problems, and their correlation with confounding factors. AIM: To enhance our understanding of female sexuality and the risk factors that contributed to sexual problems in reproductive age women. METHOD: A cross-sectional survey was conducted in family planning and prepregnancy checkup clinics from December 2007 to December 2009, with 2,146 sexually active Chinese women aged 21 to 40 years completed the entire questionnaire. MAIN OUTCOME MEASURES: Prevalence of sexual symptoms, coital frequency, and other sexual behavior-related activities were measured. RESULTS: Overall, 59.0% of respondents had at least one sexual problem. In this sample, 31.8% of respondents reported no desire; 31.7% had arousal problems; 40% had anorgasmia, and 33.8% experienced coital pain for at least 3 months within the past 1 year. Chi-square test showed significant correlation among the four types of sexual problems(P < 0.001). Univariate regression model showed that all sexual symptoms were significantly correlated with unidirectional coitus initiation, low coital frequency, and low foreplay enjoyment. Loglinear model revealed that desire, arousal, and orgasmic problems were correlated with low foreplay enjoyment. Arousal problem was correlated with high acceptance toward pornography and history of medical disease. Coital pain was correlated with secondary education and planning to have more children. Both unidirectional coitus initiation and low coital frequency were major contributors to all four sexual symptoms. CONCLUSIONS: Sexual problem is a prevalent health issue among reproductive age women. A number of risk factors are identified, which provide useful direction to the design of counseling and education materials that might help to enhance sexual performance in women.

Correlates of men's sexual interest: a cross-cultural study.

INTRODUCTION: Low sexual desire has been studied more extensively in women than in men. AIM: The study aims to analyze the correlates of distressing lack of sexual interest and the self-assessed reasons for the lack of sexual interest among heterosexual men from three countries. METHODS: A web-based survey was completed by 5,255 men aged 18-75 years from Portugal, Croatia, and Norway. MAIN OUTCOME MEASURES: We used an item that assesses lack of sexual interest from the British NATSAL 2000. Anxiety and depression were measured with the SCL-ANX4 and SCL-DEP6. Relationship intimacy was measured using a five-item version of the Emotional Intimacy Scale. A shortened version of the Sexual Boredom Scale was used to assess proneness to sexual boredom in relation to the duration of relationship, and personal distress was evaluated using an item created for this study. RESULTS: Distressing lack of sexual interest lasting at least 2 months in the previous year was reported by 14.4% of the participants. The most prevalent comorbidity among these men was erectile difficulty (48.7%). Men with low confidence levels in erectile function, not feeling attracted to the partner, and those in long-term relationships were more likely to have experienced lack of sexual interest than were men with high confidence levels and those who felt attracted to their partner and those in shorter-term relationships. Professional stress was the most frequently reported reason for lack of sexual interest. Sexual boredom as a result of a long-term relationship was significantly and negatively correlated with the level of intimacy (r = -0.351, P < 0.001) and sexual satisfaction (r = -0.497, P < 0.001). CONCLUSIONS: Distressing lack of sexual interest in heterosexual men was associated with a number of intrapersonal (self-confidence in erectile function, stress), interpersonal (relationship duration, partner attractiveness), and sociocultural variables.

Psychometric properties of the Iranian version of the female sexual distress scale-revised in women.

INTRODUCTION: Several tools for the assessment of sexuality-related distress are now available. The Female Sexual Distress Scale (FSDS) and its revised version (FSDS-R) are extensively validated and among the most widely used tools to measure sexually related personal distress. AIM: The aim of the study was to determine the psychometric properties of the Iranian version of the FSDS-R in a population sample of Iranian women. METHODS: A total of 2,400 married and potentially sexually active women were recruited and categorized into three groups including (i) a healthy control group; (ii) a group of women with hypoactive sexual desire disorder (HSDD); and (iii) a group of women suffering from other female sexual dysfunction (FSD). Participants were asked to complete a set of questionnaires including the Iranian version of the Female Sexual Function Index (FSFI-IV), the FSDS-R, and the Hospital Anxiety and Depression Scale. MAIN OUTCOME MEASURES: Sexuality-related distress and FSD as assessed by the Iranian version of the FSDS-R and the FSFI-IV are the main outcome measures. RESULTS: Internal consistencies and test-retest reliability of the FSDS-R across the three assessments points for the three groups were >0.70. The FSDS-R correlated significantly with anxiety, depression, and the FSFI total score. Significant differences in the FSDS-R scores were found between healthy women, women with HSDD, and women with other types of FSD. Factor analysis of the FSDS-R yielded a single-factor model with an acceptable fit. CONCLUSIONS: The Persian version of the FSDS-R is a valid and reliable instrument for the assessment of sexuality-related distress in Iranian women and can be used to screen patients with HSDD.

Prevalence of female sexual dysfunction during pregnancy among Egyptian women.

AIM: The aim of this study was to assess the prevalence of female sexual dysfunction (FSD) during pregnancy in a sample of women from Egypt. MATERIALS AND METHODS: This prospective cohort study was conducted among pregnant women who presented to the Obstetrics Outpatient Clinic - Suez Canal University Hospital for routine antenatal care between February 2012 and February 2013. The 451 women who completed the study attended during their first trimester with a singleton pregnancy and were in a stable relationship with their partners for the last 6 months. Sexual function was assessed using the Female Sexual Function Index (FSFI) questionnaire during the 4 weeks preceding pregnancy and then in each trimester during the antenatal visits. RESULTS: Prevalence of FSD during pregnancy was estimated to be 68.8%. According to the FSFI, scores of all domains and total score were significantly reduced during the whole period of pregnancy (average 22.5 ± 3.7) compared to the pre-conception period (30.5 ± 5.6). However, there was significant increase of all domains and total score during the second trimester (26.6 ± 3.9) in comparison to the first and third trimesters (22.4 ± 4.1 and 18.6 ± 3.8, respectively). Total FSFI score was found to be positively correlated to pre-conception total FSFI score. However, age, parity and duration of marriage were negatively correlated. CONCLUSION: FSD is a prevalent problem during pregnancy among Egyptian women. The magnitude of the problem is highest during the third trimester while the second trimester represents the peak of sexual function during pregnancy.

Dhat syndrome, an emergent condition within urology in Spain.

BACKGROUND: Dhat syndrome (DS) consists of vague somatic symptoms and at times sexual dysfunction which the patient falsely attributes to involuntary emissions of semen outside of sexual relations. OBJECTIVE: Describe and analyse the occurrences of DS in patients attending the clinic and clarify the existence of this condition within the Spanish Urological service. MATERIALS AND METHODS: Patients reporting semen loss in urine or involuntarily outside of sexual relations were studied during a period from May 2006 to December 2007. Variables of age, nationality, marital status, family situation, medical history, reasons for the consultation, physical condition and additional tests were studied. All treatments and its effectiveness were also recorded. RESULTS: DS affected predominantly southern Asian continent citizens (n = 32). The average age was 35.44. Seventeen patients reported semen loss during urination; 20 at the end of urination; 11 spontaneously; 5 while sleeping; 4 during defecation; 1 while showering; 1 while eating meat; and 3 produced by noticing stained clothing. In 28 cases, the supposed loss of semen was linked to sex-related symptoms. All examinations and tests ruled out the existence of actual loss of semen. CONCLUSIONS: In urology consultations, we have been witnessing the unusual appearance of DS, a condition known by psychologists and psychiatrists and practically unheard of by urologists. A previously unknown condition in Spain, immigration from Asia, is causing the appearance of this syndrome. Its rapid identification will prevent patients from paying costly and unnecessary tests and provide alternative therapies, within a multidisciplinary approach involving psychologists and psychiatrists.

Female sexual dysfunction among young and middle-aged women in Hong Kong: prevalence and risk factors.

INTRODUCTION: Sexual dysfunction is a serious public health problem that affects women's quality of life. However, there is very little epidemiological data on its incidence in Hong Kong Chinese women. AIM: To estimate the prevalence of, and risk factors associated with sexual dysfunction among young and middle-aged women in Hong Kong. METHODS: The study was part of the ninth Knowledge, Attitude, and Practice survey conducted by the Family Planning Association of Hong Kong in 2007. The dataset comprised 1,510 face-to-face interviews with Hong Kong Chinese women aged 19-49 living in the community. MAIN OUTCOME MEASURE: The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition classification of sexual dysfunction was used to measure female sexual dysfunction (FSD). RESULTS: At least one form of FSD was reported by 37.9% of the sample. Multivariate analysis showed that having sought medical help for sexual problems (odds ratio [OR] = 4.20), having a partner with erectile dysfunction (OR = 2.44) and premature ejaculation (OR = 2.56), perceiving sex as unimportant to marriage (OR = 1.57), and reporting marital dissatisfaction (OR = 1.45) were all significant risk factors for FSD and its specific components among the sample. However, having liberal attitudes to sex (OR = 0.63) was a protective factor. CONCLUSION: The prevalence of FSD is lower among Hong Kong Chinese young and middle-aged women than in the United States and some Asian countries. Factors contributing to the risk of FSD span the domains of sexual experience, attitudes to sex, and relationship factors. These findings suggest future directions for the delivery of services addressing the prevention and treatment of FSD.

Coping and chronic psychosocial consequences of female genital mutilation in The Netherlands.

OBJECTIVE: The study presented in this article explored psychosocial and relational problems of African immigrant women in The Netherlands who underwent female genital mutilation/cutting (FGM/C), the causes they attribute to these problems--in particular, their opinions about the relationship between these problems and their circumcision--and the way they cope with these health complaints. DESIGN: This mixed-methods study used standardised questionnaires as well as in-depth interviews among a purposive sample of 66 women who had migrated from Somalia, Sudan, Eritrea, Ethiopia or Sierra Leone to The Netherlands. Data were collected by ethnically similar female interviewers; interviews were coded and analysed by two independent researchers. RESULTS: One in six respondents suffered from post-traumatic stress disorder (PTSD), and one-third reported symptoms related to depression or anxiety. The negative feelings caused by FGM/C became more prominent during childbirth or when suffering from physical problems. Migration to the Netherlands led to a shift in how women perceive FGM, making them more aware of the negative consequences of FGM. Many women felt ashamed to be examined by a physician and avoided visiting doctors who did not conceal their astonishment about the FGM. CONCLUSION: FGM/C had a lifelong impact on the majority of the women participating in the study, causing chronic mental and psychosocial problems. Migration made women who underwent FGM/C more aware of their condition. Three types of women could be distinguished according to their coping style: the adaptives, the disempowered and the traumatised. Health care providers should become more aware of their problems and more sensitive in addressing them.

An e-mail and telephone helpline for sexual problems - results of a 2-year survey of men's sexual concerns.

INTRODUCTION: Sexual problems are relatively common in the community. The under-reporting of such problems calls for alternative ways of getting a true perspective of the prevalence of sexual dysfunction. AIM: To assess and investigate the concerns, ages and nationality of male users of a electronic helpline using it over 2 years (2009-2010). METHODS: Detailed records were kept of all emails and telephone calls to the helpline which included administrative and clinical queries. The clinical calls and some of the emails were answered by the administrator, while the majority of the emails were answered by a physician. This presentation will deal with the users who emailed for assistance with male sexual dysfunction. (n = 673). RESULTS: The helpline received a total of 6142 calls over the period of investigation, including administrative and press calls. Men accounted for 88% of the callers about sexual dysfunction. Erectile dysfunction accounted for 68% of the complaints by men who used the e-mail service. Premature ejaculation, loss of sex drive, genital problems and masturbation worries were other concerns that were received. A large number of men from the Middle East and the Indian sub-continent used the email service, mostly for premature ejaculation and masturbation worries, related to their arranged marriage. CONCLUSIONS: We found confirmation that the commonest sexual complaints in men were of erectile dysfunction and loss of sex drive. Significant correlations were identified between the types of sexual dysfunction and the age and ethnicity of the men who presented with them.

Depression and sexual adjustment following breast cancer in low-income Hispanic and non-Hispanic White women.

OBJECTIVE: Hispanics are the largest and fastest growing ethnic minority group in the United States and breast cancer is the most commonly diagnosed cancer in Hispanic women. However, Hispanics are underrepresented in the psychosocial breast cancer literature. METHODS: This study included 677 low-income women (425 Hispanic, 252 non-Hispanic White) enrolled in the Medi-Cal Breast and Cervical Cancer Treatment Program. Data were gathered through phone interviews conducted in English or Spanish 6 and 18 months following breast cancer diagnosis. We focus on three variables that the literature indicates are salient for breast cancer survivors: sexual function, body image and depression. RESULTS: Results of an ANCOVA indicated worse sexual function for Hispanic women, even after controlling for significant covariates. Hispanics reported significantly less sexual desire, greater difficulty relaxing and enjoying sex, and greater difficulty becoming sexually aroused and having orgasms than non-Hispanic White women. Both Hispanic and non-Hispanic White women endorsed a lack of sexual desire more frequently than problems with sexual function. Body image did not differ between Hispanic and non-Hispanic White women. In all, 38% of Hispanic and 48% of non-Hispanic White women scored above cut-off scores for depressive symptoms. While there was no ethnic difference in depressive symptoms, single women reported more depressive symptoms than partnered women. CONCLUSIONS: Findings suggest that low-income breast cancer survivors may experience symptoms of depression more than a year following diagnosis, and that sexual dysfunction may be particularly salient for low-income Hispanic women.

Sexual desire among Mexican-American older women: a qualitative study.

Although researchers have related sexual desire in older women to quality-of-life variables such as overall physical health, well-being, and life satisfaction, little is known about the socio-cultural mechanisms that shape sexual desire in minority ethnic older women. We investigated this sexual variable among Mexican-American older women in a qualitative fashion. Data were collected from 25 community-dwelling women of Mexican descent (aged 59-89 years) using a semi-structured interview protocol and a grounded theory approach. We inquired about dimensions of sexual desire including sexual fantasies and the desire to engage in sexual activity within the context of several socio-cultural and health-related factors. Using content analysis, we were able to identify key themes differentiating among respondents' levels of sexual desire and fantasies. These included the availability of a suitable partner, cultural and religious norms pertinent to women's sexuality, stigma related to sexuality in older age, and health status. Traditional socio-cultural restrictions coupled with unmarried status and physical health problems emerged as critical issues associated with limited or no sexual fantasies and desire in our sample. Many respondents indicated that their sexual needs were unmet.

Sexuality and marital adjustment in women with hypertension in Turkey: how culture affects sex.

This study examined the relationship between sexual dysfunction and marital adjustment in women with hypertension and the effect of the cultures on the sexual problems of women. Mixed method was used in this study. The study was conducted as quantitative (in descriptive type) to examine sexual dysfunction and marital adjustment in women with hypertension and as qualitative to examine the effect of culture on the views of individuals on sexual problems. The study included 102 women who met inclusion criteria (who were on medication and had active sexual life for 1 year). Patient information form, Arizona Sexual Experience Scale (Female), and Marital Adjustment Test (MAT) were used to collect the data. The mean age of the subjects was found to be 55.10 ± 9.13, the mean duration of hypertension diagnosis was 8.66 ± 6.43, and the mean time to start was 7.87 ± 6.30. The mean duration of marriage for the women with hypertension was 34.08 ± 12.507. There was a negative correlation between sexual orientation, orgasm and sexual satisfaction from the subscales of ASEX and the overall scale (p < 0.05). Accordingly, as the adaptation in marriage diminished, sexual problems increased in women. As a result of the study, it was determined that HT had a negative effect on sexual functioning problems and marital adjustment, but women accepted this situation because of their culture, "women do not have the right to sexuality" and naturally accept the absence of sexuality after a certain age.

Age of first sexual intercourse and acculturation: effects on adult sexual responding.

INTRODUCTION: Although age of first intercourse and the emotional aspects of that experience are often a target in assessment because they are thought to contribute to later sexual functioning, research to date on how sexual debut relates to adult sexual functioning has been limited and contradictory. AIM: The goal of this study was to explore the association between age of first intercourse and adult sexual function in a sample of Euro-Canadian and Asian Canadian university students. In addition, culture-based comparisons of sexual complaints were made to clarify the role of culture in sexual response. METHODS: Euro-Canadian (N = 299) and Asian Canadian (N = 329) university students completed the Golombok-Rust Inventory of Sexual Satisfaction and the Vancouver Index of Acculturation. MAIN OUTCOME MEASURES: Self-reported sexual problems and bidimensional acculturation. RESULTS: Ethnic group comparisons revealed that Asians reported more sexual complaints including sexual avoidance, dissatisfaction and non-sensuality. Among the women, Asians reported higher scores on the Vaginismus and Anorgasmia subscales whereas the ethnic groups did not differ on the male-specific measures of sexual complaints. In the overall sample, older age of first intercourse was associated with more sexual problems as an adult, including more sexual infrequency, sexual avoidance, and non-sensuality. Among the Asian Canadians, less identification with Western culture was predictive of more sexual complaints overall, more sexual noncommunication, more sexual avoidance, and more non-sensuality. For Asian women, acculturation interacted with age of first intercourse to predict Vaginismus scores. CONCLUSIONS: Overall, these data replicate prior research that found that a university sample of individuals of Asian descent have higher rates of sexual problems and that this effect can be explained by acculturation. Earlier sexual debut was associated with fewer sexual complaints in adulthood.