Luring the Elusive: Narratives about Sexual Desire for One's Partner by Women and Men in Heterosexual Romantic Relationships.

In this qualitative study, we explored women's and men's experience of sexual desire for their romantic partner and its link to dyadic interactions. During interviews and focus group discussions, our participants described sexual desire as 'elusive', 'conditional', 'responsive' and 'malleable'. The subtheme 'elusive' refers to sexual desire having a will of its own, while the remaining three refer to prerequisites for, triggers of, and strategies for enhancing sexual desire respectively. These subthemes come together in the overarching narrative 'luring the elusive', which articulates one's responsibility to accommodate sexual desire for one's partner, but also the necessity to acknowledge its elusiveness.

Prevalence of and risk factors for sexual dysfunctions in adults with type 1 or type 2 diabetes: Results from Diabetes MILES - Flanders.

BACKGROUND AND AIMS: The prevalence of sexual dysfunctions in people with diabetes is still debated and understudied in women. This study examines the prevalence of sexual dysfunction in men and women with type 1 or type 2 diabetes (T1D or T2D) and the associations with clinical and psychological variables. METHODS: Adults with diabetes (n = 756) completed an online survey including questions on sexual functioning (adapted Short Sexual Functional Scale), general emotional well-being (WHO-5), symptoms of anxiety (GAD-7) and diabetes distress (PAID-20). RESULTS: One third of participants reported a sexual dysfunction. Men reported erectile dysfunction (T1D: 20%; T2D: 33%), and orgasmic dysfunction (T1D: 22%; T2D: 27%). In men, sexual dysfunction was independently associated with, older age (OR = 1.05, p = 0.022), higher waist circumference (OR = 1.04; p < 0.001) and longer duration of diabetes (OR = 1.04; p = 0.007). More men with sexual dysfunction reported diabetes distress (20% vs. 12%, p = 0.026). Women reported decreased desire (T1D: 22%; T2D: 15%) and decreased arousal (T1D: 9%; T2D: 11%). More women with sexual dysfunction reported diabetes distress (36% vs. 21%, p = 0.003), impaired emotional well-being (36% vs. 25%, p = 0.036) and anxiety symptoms (20% vs. 11%, p = 0.026). CONCLUSION: Sexual dysfunctions are common in both men and women with diabetes. In men, sexual dysfunctions were associated with clinical factors. More women with sexual dysfunction reported low emotional well-being and anxiety symptoms compared to women without sexual dysfunction. For both men and women, sexual dysfunctions were associated with diabetes distress.

Dyadic Sexual Desire in Romantic Relationships: The Dyadic Interactions Affecting Dyadic Sexual Desire Model.

In most theoretical models, sexual desire for one's partner is predominantly conceptualized from an individual perspective. There is, however, a growing body of empirical evidence on the dyadic aspects of sexual desire. That evidence is as yet not well-integrated into theoretical conceptualizations of sexual desire. Aiming to fill this gap, we present the Dyadic Interactions Affecting DyadIC Sexual desire model (DIADICS), a new conceptual model inspired by systems theory that describes how dyadic interactions between partners influence dyadic sexual desire in romantic relationships. After defining dyadic sexual desire, we discuss (1) the structure of dyadic interactions, (2) their content, and (3) the process through which they affect dyadic sexual desire in a romantic relationship. Thereafter, we review theoretical, clinical, and empirical insights underscoring the relation between dyadic interactions and (dyadic) sexual desire, use DIADICS as a framework for understanding fluctuations in dyadic sexual desire in long-term relationships, and conclude by discussing implications of DIADICS for research and clinical practice.

Erectile dysfunction and mining-related jobs: an explorative study in Lubumbashi, Democratic Republic of Congo.

INTRODUCTION: The African Copperbelt is a site of intense artisanal and industrial mining and refining of copper and cobalt. Anecdotal reports of erectile dysfunction (ED) among mineworkers in the area led us to conduct an explorative study to investigate the possible association between ED and working in mining-related jobs. METHODS: We included 42 consecutive men (18-40 years) buying sildenafil (the active substance of Viagra) from a pharmacy located in a popular neighbourhood in Lubumbashi, and 42 age-matched (±2 years) men buying painkillers. All participants replied to questionnaires administered face-to-face to obtain sociodemographic data, including information on occupation, and a score of erectile function using the International Index of Erectile Function (IIEF6). RESULTS: The IIEF6 score (maximum 30) was lower among sildenafil-buyers (median 17, range 8-30) than among painkiller-buyers (median 30, range 17-30). The proportion of mining-related jobs was higher among sildenafil-buyers (19/42, 45%) than among painkiller-buyers (7/42, 17%), yielding an OR of 4.1 (95% CI 1.5 to 11.3; p=0.009). The proportion of mining-related jobs was higher among men with ED (defined as IIEF6 <26) (24/45, 54%) than among men without ED (2/39, 5%) (OR 21.1; 95% CI 4.5 to 98.4; p<0.001). Using a more stringent definition of ED (IIEF6 <22) gave similar results: 55% (20/36) of men with ED had a mining-related job versus 13% (6/48) of men without ED (OR 8.7; 95% CI 2.9 to 25.7; p=0.001). DISCUSSION: The findings of this preliminary study justify further epidemiological studies of the possible role of occupational exposures in the pathogenesis of male sexual dysfunction among miners and workers in the copper and cobalt industry.

Prevalence and Predictors of Sexual Difficulties and Associated Distress Among Partnered, Sexually Active Older Women in Norway, Denmark, Belgium, and Portugal.

There has been little comparative, cross-cultural research on sexual difficulties and associated distress, and factors associated with these, among older women. Therefore, the aim of this study was to investigate prevalence rates of sexual difficulties, distress related to these difficulties, and associated sociodemographic, relational, and health factors, among sexually active older women (60-75 years) in committed relationships across four European countries (Norway, Denmark, Belgium, and Portugal). These data could inform us about what differentiates women who do and do not experience distressing sexual difficulties and facilitate the identification of older women who might benefit from clinical interventions as well as the development of new interventions. In total, 1057 women (357 Norwegian; 322 Danish; 237 Belgian; 141 Portuguese) completed a cross-sectional questionnaire assessing six sexual difficulties-vaginal dryness, orgasmic difficulties, lacking interest in sex, lacking enjoyment in sex, pain during sex, and no excitement/arousal during sex-and associated distress. We found a high prevalence of sexual difficulties lasting 3 months or longer in the past year (between 23.5 and 50.2%, depending on the specific difficulty). With the exception of vaginal dryness and pain during sex, however, the majority of women reporting sexual difficulties (50.0% to 86.1%, depending on the specific difficulty) reported no or mild distress. There were relatively few cross-country differences, either in the prevalence of sexual difficulties or related distress. Few sociodemographic or health variables were associated with distressing sexual difficulties, but higher sexual intimacy, higher emotional intimacy, and better mental health were associated with less distress about some sexual difficulties. The findings underline the importance of healthcare professionals asking older women about sexual function and especially associated distress, and suggest that careful attention to the psychological and relationship context of these sexual difficulties is needed, as these could be important targets in the treatment process.

Ambiguous Loss in Transnational Families' Adolescents: An Exploratory Study in Ecuador.

In psychosocial migration literature, the perspective of ambiguous loss has been relevant to articulate personal and relational experiences in the context of transnational families and ongoing separation. Most studies have focused on adult members' experiences of transnational families, but research exploring ambiguous loss in adolescents whose parents have migrated is still lacking. The present study aimed to explore adolescents' lived experiences of parental migration. In a pilot explorative study, 14 adolescents with at least one parent who migrated were interviewed about their lived experiences of transnational parent-child relationships and ongoing parent-child separation. Data analysis identified four themes in participants' accounts: practices of separation creating confusion; current relationship with migrant parents permeated by ambiguity; distrustful representations of migrant parents; and family and social dynamics reactivating the pain of loss. The findings reveal how in the context of parental migration, patterns of separation and ongoing relational processes, compounded by the uncertainty of reunification and an exclusionary social fabric, constitute core elements that shape adolescents' lived experiences of parent-child relationships characterized by ambiguity.

En la bibliografía sobre las consecuencias psicosociales de la migración, la perspectiva de la pérdida ambigua ha sido relevante para expresar las experiencias personales y relacionales en el contexto de las familias transnacionales y la separación constante. La mayoría de los estudios se han centrado en las experiencias de los miembros adultos de las familias transnacionales, pero aun faltan investigaciones que analicen la pérdida ambigua en los adolescentes cuyos padres han emigrado. El presente estudio tiene como finalidad analizar las vivencias de los adolescentes de padres migrantes. En un estudio piloto exploratorio, se entrevistó a 14 adolescentes con al menos un padre que emigró acerca de sus vivencias con respecto a las relaciones transnacionales entre padre e hijo y la separación constante entre padre e hijo. Los análisis de datos identificaron cuatro temas en los informes de los participantes: las prácticas de separación que generan confusión; la relación actual con los padres emigrantes impregnada por la ambigüedad; las representaciones desconfiadas de los padres emigrantes; y la dinámica familiar y social que reactiva el dolor de la pérdida. Los resultados revelan cómo, en el contexto de la migración parental, los patrones de separación y los procesos relacionales constantes, agravados por la incertidumbre de la reunificación y una estructura social exclusivista, constituyen elementos fundamentales que moldean las vivencias de los adolescentes en las relaciones entre padres e hijos caracterizadas por la ambigüedad.

A Qualitative Study About How Nurses in Belgium Offer Relationship Support to Couples in Palliative Care.

Although palliative care nurses are identified as key players in supporting couples during advanced illness, there is a lack of evidence about their knowledge and experiences with this particular role. The aim of the study was to explore palliative care nurses' attitudes, roles, and experiences in addressing relationship functioning of couples in daily practice. A qualitative study was conducted using in-depth interviews, observational research, and peer debriefing groups with palliative care nurses in Flanders, Belgium. Nurses support relationship functioning by creating a couple-positive care environment, by being present/acknowledging feelings, and by rectifying imbalances between couples. They do so in a proactive way, backed up by team support. Nurses hesitate toward explicitly unraveling and intervening in relationship problems, in favor of providing comfort or offering a strengths-based approach. The findings offer an urgent call to enhance the educational programs for palliative care nurses by integrating the theories and practice frameworks that guide relational assessment and intervention, which are being used in family nursing.

"To Shave or Not to Shave": Pubic Hair Removal and Its Association with Relational and Sexual Satisfaction in Women and Men.

BACKGROUND: Pubic hair removal (PHR) is a widespread practice that entails certain health risks; however, there remains a lack of scientific information on the prevalence and antecedents of PHR, as well as on its association with sexual behavior and relational satisfaction. AIMS: To explore women's and men's attitudes regarding PHR and their PHR practices and the associations with demographic, relational, and sexual characteristics. METHODS: A total of 2,687 men and 1,735 women living in Flanders (the Northern part of Belgium) completed an online survey. Participants ranged in age from 15 to 60+ years; they self-identified as heterosexual, bisexual, or homosexual and reported various relationship statuses. MAIN OUTCOME MEASURES: Demographic items (ie, age, religion, partner relationship status), sexuality-related items (ie, sexual activity, sexual orientation, age at first intercourse, number of sexual partners), PHR items (ie, reasons, inclination to have or not have sex after PHR, perceived partner preferences, partner's PHR), and relationship satisfaction, assessed with the Maudsley Marital Questionnaire. RESULTS: Fewer men (39.1%) than women (80.3%) reported (partially) removing their pubic hair. In both men and women, the practice was associated with age, sexual activity, relationship status, and partner's PHR practice and expectations. In men, sexual and relationship satisfaction were correlated with their partner's PHR practices and whether these were in line with the men's expectations. In women, sexual and relationship satisfaction were mostly correlated with whether both partner's expectations were met. Although both men and women reported that the reasons for PHR were related to their sexual experiences and to their partner's preference, only women reported that PHR was a way to enhance feelings of femininity. Finally, the reasons for not engaging in PHR were related to partner preferences and side effects. CONCLUSION: PHR is a widespread practice and seems strongly associated with personal, partner-related, sexual, and relational factors. Strategies to prevent men and women from being confronted with health risks should take all these factors into account. Enzlin P, Bollen K, Prekatsounaki S, et al. "To Shave or Not to Shave": Pubic Hair Removal and Its Association with Relational and Sexual Satisfaction in Women and Men. J Sex Med 2019;16:954-962.

In Search of Desire: The Role of Intimacy, Celebrated Otherness, and Object-of-Desire Affirmation in Sexual Desire in Women.

While the interactive nature of sexual desire in women is increasingly recognized, dyadic factors affecting it, including partner interactions, have as yet received little research attention. In this cross-sectional study, we examined the associations among intimacy, celebrated otherness, and object-of-desire affirmation and explored how they complement each other in the prediction of sexual desire in women. Based on the reports of 662 participants, positive correlations were found among all factors. However, in a multiple regression analysis, object-of-desire affirmation emerged as the only positive predictor of sexual desire.

Addressing sexual issues in palliative care: A qualitative study on nurses' attitudes, roles and experiences.

AIM: To explore palliative care nurses' attitudes, roles and concrete experience with regard to addressing sexual issues in their daily practice. BACKGROUND: Patients and their partners in palliative care might experience dramatic changes in their sexuality and want nurses to provide the opportunity to address them. Moreover, it is argued that the holistic philosophy of palliative care encourages nurses working in this area to include sexual issues in their daily care. It is, however, unknown how palliative care nurses address sexual issues. DESIGN: A generic qualitative study was performed. METHODS: In total, 21 in-depth interviews were done with nurses from different facilities of palliative care networks in Flanders. Data were collected between September 2014 - September 2016 and thematic analysis was used to analyse the data. RESULTS: It was found that the way palliative care nurses addressed sexual issues was clearly influenced by their own interpretation of the philosophical principles underlying palliative care. The different interpretations of these basic principles create tensions for nurses about how to address sexual issues in the daily practice of palliative care and nurses vary in their reactions to these tensions. The present findings show that palliative care nurses - when they were able to overcome these tensions - use a "sex-positive approach" that fits with their tendency to focus on quality of life. CONCLUSION: Out of the results of this study, we made a list of good practices for palliative care nurses addressing sexual issues. This list can be used in nursing educational programs.

Sexual Difficulties and Associated Sexual Distress in Flanders (Belgium): A Representative Population-Based Survey Study.

INTRODUCTION: Because severity and duration of sexual impairment and any distress caused by the sexual impairment are not assessed in most epidemiologic studies on sexual dysfunction, the available prevalence rates are probably an overestimation. AIMS: To provide prevalence estimates of severe and persistent sexual difficulties that cause personal distress and to explore the association between personal sexual distress and avoidance of sex, help-seeking behavior, and sexual satisfaction. METHODS: This study used home-based computer-assisted personal interviewing and computer-assisted self-interviewing of a representative, randomly selected, population-based cross-sectional sample of 651 Flemish men and 695 women 14 to 80 years old. MAIN OUTCOME MEASURES: Prevalence of sexual difficulties, prevalence of sexual dysfunctions (ie, sexual difficulties causing personal distress), and association of sexual distress with avoidance of sex, help-seeking behavior, and sexual satisfaction. RESULTS: In this sample, 43.5% of women (95% CI =39.7-47.3) and 34.8% of men (95% CI =31.3-38.3) reported a moderate to severe sexual difficulty. When considering the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (ie, minimum duration of 6 months and presence of personal sexual distress), prevalence rates decreased to 19.0% in women (95% CI =16.0-22.0) and to 15.1% in men (95% CI =12.4-17.8). Sexual distress was associated with more sexual dissatisfaction and greater sexual avoidance. Sexual distress also was associated with help-seeking behavior, although most individuals with distressing sexual difficulties had not sought help. CONCLUSION: Although sexual difficulties per se are quite prevalent, severe and persistent sexual difficulties causing sexual distress are far less common. Despite sexual distress being associated with avoidance of sex and lower sexual satisfaction, most people tend not to seek help for their sexual problem, even when being distressed by the problem.

Predictors of Sexual Distress in Women With Desire and Arousal Difficulties: Distinguishing Between Personal, Partner, and Interpersonal Distress.

INTRODUCTION: Although impaired sexual function is relatively common, not all sexual impairments are associated with distress. To date, most studies on protective and risk factors for sexual distress have asked about distress in a more general manner and have failed to distinguish different dimensions of sexual distress. AIM: To examine the association of several intra- and interpersonal factors with personal, perceived partner, and interpersonal distress due to an impairment in sexual functioning in women. METHODS: This study is a cross-sectional representative population-based survey with a two-level random selection of Flemish women 14 to 80 years old from the Belgian National Register. The data of 520 sexually active heterosexual women with a partner (weighted N) and impairment in sexual desire (n = 291) and/or sexual arousal (n = 273) were used for analysis. MAIN OUTCOME MEASURES: Demographic information was obtained, and the five-item Mental Health Inventory, the Marital Adjustment subscale of the Maudsley Marital Questionnaire, and the four-item Dyadic Sexual Communication Questionnaire were used. Presence and severity of sexual impairments and associated sexual distress were assessed using the Sexual Functioning Scale. RESULTS: Severity and number of sexual impairments were predictive of all types of sexual distress. Also, for desire and arousal impairments, lower mental well-being predicted personal distress, and lower relationship satisfaction predicted perceived partner distress. For desire impairments, lower relationship satisfaction and less communication about sexual needs were predictive of interpersonal distress. For impairments in sexual arousal, lower mental well-being and lower relationship satisfaction were predictive of interpersonal distress. CONCLUSION: Personal, perceived partner, and interpersonal distress due to sexual impairments have different types of predictors. Clinical assessment and treatment could benefit from differentiating between different types of distress and the intra- and interpersonal factors that are associated with them.

Type 2 Diabetes Patients' Needs and Preferences for Care Concerning Sexual Problems: A Cross-Sectional Survey and Qualitative Interviews.

Sexual dysfunction is highly prevalent among patients with type 2 diabetes; however, little is known regarding these patients' needs and preferences for care for sexual problems. A cross-sectional survey and 25 semistructured interviews were therefore conducted among 40- to 75-year-old type 2 diabetes patients to explore this. We learned from the survey and interviews that most participants were unaware of the association between type 2 diabetes and sexual problems. Although certain barriers for discussing sexual problems with a care provider were identified (e.g., feelings of embarrassment), patients still reported a need for discussing their problems, because sex was viewed as an important part of their relationship. Some patients had sought help, but were dissatisfied with the offered care. Patients experienced a lack of attention and information from diabetes care providers. Improving this, together with a care provider-initiated conversation, was suggested to lower the threshold for discussion. Moreover, patients preferred a care provider with whom they have a close relationship, whereas age, gender, and medical specialty were regarded to be less important. An important recommendation was to make care for sexual problems an integral part of routine diabetes care. Future research should look into these recommendations.

Age-related prevalence rates of sexual difficulties, sexual dysfunctions, and sexual distress in heterosexual women: results from an online survey in flanders.

INTRODUCTION: Although age-related prevalence rates of female sexual difficulties, i.e., difficulties with sexual desire, arousal, orgasm, or pain have occasionally been studied-with mostly inconsistent results-the age-related prevalence rates of female sexual dysfunctions, i.e., sexual difficulties that are associated with sexual distress, have not. Moreover, the association of age with sexual distress, i.e., distress due to sexual difficulties, has almost completely been neglected in epidemiological research. AIMS: The aims of the present study were to provide age-related prevalence estimates of sexual difficulties and sexual dysfunctions and to provide proportions of participants reporting sexual distress in heterosexual women. METHODS: An online survey comprising on sexual difficulties (i.e., low sexual desire, lack of responsive sexual desire, difficulties with lubrication, lack of subjective sexual arousal, absent or delayed orgasm, and dyspareunia) and associated sexual distress that enables us to classify respondents with sexual dysfunctions. MAIN OUTCOME MEASURE: Sexual Functioning Scale. RESULTS: A total of 15,048 heterosexual women aged 16-74 years living in Flanders (the Nothern, Dutch-speaking part of Belgium) completed the online survey. This study revealed that all sexual difficulties and all sexual dysfunctions are significantly associated with age in women. Although most sexual difficulties and sexual dysfunctions increase with age, some display a U-shaped association with age. Furthermore, it was found that-except for lubrication difficulties-sexual distress was also significantly associated with age and that sexual distress is more common in younger women. CONCLUSION: The association between age and sexual difficulties, sexual dysfunctions, and sexual distress in women is complex and deserves more attention from scholars.

Sexual functioning in women after surgical treatment for endometrial cancer: a prospective controlled study.

INTRODUCTION: Endometrial cancer (EC) can affect sexual functioning based on anatomical, physiological, psychological, and relational mechanisms. AIM: The aim of this study was to prospectively investigate sexual adjustment of women with EC during a follow-up period of 2 years after surgical treatment and to compare the results with women who underwent a hysterectomy for a benign gynecological condition and healthy control women. METHODS/MAIN OUTCOME MEASURES: In this prospective controlled study, participants completed the Short Sexual Functioning Scale, Specific Sexual Problems Questionnaire, Beck Depression Inventory Scale, World Health Organization-5 Well-being Scale, and Dyadic Adjustment Scale to assess various aspects of sexual and psychosocial functioning before undergoing a hysterectomy and 6 months, 1 year, and 2 years after surgery. RESULTS: Eighty-four women with EC, 84 women with a benign gynecological condition, and 84 healthy controls completed the survey. In EC survivors, no differences were found in sexual functioning during prospective analyses. In comparison with women with a benign gynecological condition, significantly more EC patients reported entry dyspareunia 1 year after surgical treatment. Moreover, compared with healthy women, pre- and postoperatively, significantly more EC patients reported sexual dysfunctions, including sexual desire dysfunction, arousal dysfunction, entry dyspareunia, and a reduced intensity of orgasm. Furthermore, compared with healthy controls, EC patients reported significantly lower overall well-being 1 year after surgical treatment. Nevertheless, consensus in the partner relationship was significantly higher in EC patients compared with healthy controls. Moreover, before treatment, quality of partner relationship was negatively associated with sexual arousal dysfunction and orgasm dysfunction. CONCLUSIONS: In EC patients, no differences were found in sexual functioning when prospectively comparing the situation before surgery with the situation after surgery. However, when compared with healthy controls, EC patients are at high risk for sexual dysfunctions, both before and after surgical treatment.

Dyadic sexual communication in pre-menopausal women with self-reported dyspareunia and their partners: associations with sexual function, sexual distress and dyadic adjustment.

INTRODUCTION: While there is increasing interest in studying aspects of communication processes in sex research, the association between dyadic sexual communication and relationship and sexuality outcomes has not yet been examined in pre-menopausal women with dyspareunia. AIM: To examine the associations between dyadic sexual communication and pain, sexual distress, sexual function and dyadic adjustment in women with self-reported dyspareunia and their male partners. METHODS: Pre-menopausal women (n=38; M age=24.92, SD=6.12) with self-reported dyspareunia from a community sample and their partners (n=38; M age=26.71, SD=6.59) completed an online survey. The Actor-Partner Interdependence Model was used in order to investigate both actor and partner effects. MAIN OUTCOME MEASURES: Both members of the couple completed: (i) the Dyadic Sexual Communication Scale and (ii) the Dyadic Adjustment Scale; women also completed (iii) the Female Sexual Function Index, (iv) the Female Sexual Distress Scale, and (v) a Visual Analogue Scale on pain during intercourse; and men also completed (vi) the International Index of Erectile Functioning. RESULTS: Controlling for relationship duration, women's better dyadic sexual communication was significantly associated with their higher levels of sexual function (P=0.028), lower levels of sexual distress (P=0.003) and higher levels of dyadic adjustment (P=0.005), but not with their pain or men's sexual function or dyadic adjustment. Controlling for relationship duration, men's better dyadic sexual communication was associated with their higher levels of dyadic adjustment (P=0.027) but not with their sexual function, nor with women's sexual function or dyadic adjustment. CONCLUSIONS: These findings contribute to the theoretical knowledge on interaction processes in couples with dyspareunia and suggest that it may be important to enhance open and direct communication about sexual matters in couples with dyspareunia.

Stories about asexuality: a qualitative study on asexual women.

This study aimed to explore how asexual women experience their asexual identity, sexuality, and relationships. The authors recruited participants through the Asexuality Visibility and Education Network's website and posts on several health- and lifestyle-related websites. Interviewees were 9 women between 20 and 42 years of age. Data were collected through semi-structured interviews and analyzed using interpretative phenomenological analysis. The authors discuss 3 main themes that arose from the data: coming to an (a)sexual identity, experiencing physical intimacy and sexuality, and experiencing love and relationships. Participants described how they have always felt different and how they experienced their process of coming out. The authors found a great variation in the experience of (a) sex and physical intimacy and (b) love and relationships. Engaging in sexual behavior was mainly based on a willingness to comply with partner wishes. Whereas some longed for a relationship, aromantic asexual women did not. Some participants separated love from sex. Theoretical and clinical implications of these findings are discussed.

Prevalence and Correlates of Sexual Dysfunction in Men and Women With Type 2 Diabetes.

This study aimed to assess the prevalence and correlates of sexual dysfunction in a sample of Dutch men and women with type 2 diabetes. Patients with type 2 diabetes who were between the ages of 40 and 75 years from 4 Dutch diabetes centers were asked to complete self-report questionnaires covering sociodemographic characteristics, medical characteristics, clinical depression (Center for Epidemiological Studies), and sexual dysfunction (in men: International Index of Erectile Function; in women: Female Sexual Function Index). In total, 158 type 2 diabetes patients (68% men) completed the cross-sectional survey. On the basis of predefined criteria, 69% of men and 70% of women were classified with some degree of sexual dysfunction. Univariable logistic regression analyses revealed that sexual dysfunctions were associated with higher age, clinical depression (Center for Epidemiological Studies score ≥16), and one or more diabetes-related complications in both men and women. Multivariable logistic regression analyses revealed that clinical depression was most strongly associated with both male (OR = 6.87, 95% CI [1.77, 26.63]) and female (OR = 9.33, 95% CI [1.03, 84.87]) sexual dysfunction. In conclusion, sexual dysfunction is highly prevalent in men and women with type 2 diabetes and is associated with higher age, clinical depression, and diabetes-related complications. These results suggest that addressing sexual dysfunction in diabetes care is important.

Sexual Response in Women with Type 1 Diabetes Mellitus: A Controlled Laboratory Study Measuring Vaginal Blood Flow and Subjective Sexual Arousal.

Previous studies have indicated that women with diabetes mellitus are at higher risk to develop sexual dysfunctions. In the current study, we hypothesized that lower genital arousal response-as a consequence of diabetes-related damage to nerves and blood vessels-might play a part in these higher prevalence rates. Vaginal blood flow, subjective sexual response, and clitoral sensitivity were compared between women with diabetes and healthy controls, and associations with diabetes complications were investigated. In pre- and postmenopausal women with type 1 diabetes (n = 42) and healthy controls (n = 46), vaginal blood flow was measured as vaginal pulse amplitude (VPA). VPA was assessed at rest, during erotic film viewing, and during vibrotactile clitoral stimulation. Subjective sexual arousal was measured using a questionnaire. Clitoral sensitivity was assessed by a vibration perception test. Data on diabetes complications were obtained from medical records, and neuropathy was assessed by quantitative sensory testing. VPA, subjective sexual arousal, and clitoral sensitivity were not significantly different between women with diabetes and controls. Nevertheless, women with diabetes who had retinopathy showed significantly lower VPA than women without retinopathy, and women with diabetes who had neuropathy showed significantly higher sensation thresholds for vibrotactile clitoral stimulation. The results do not support the hypothesis of a disrupted genital arousal response in women with diabetes. However, the observed associations between retinopathy and vaginal blood flow, and between neuropathy and clitoral sensitivity, suggest that diabetes-related complications might adversely affect the physiological basis of female sexual response.

Effectiveness of a PLISSIT model intervention in patients with type 2 diabetes mellitus in primary care: design of a cluster-randomised controlled trial.

BACKGROUND: Sexual dysfunction is prevalent in patients with type 2 diabetes mellitus, but remains one of the most frequently neglected complications in diabetes care. Both patients and care providers appear to have difficulty with discussing sexual problems in diabetes care. A sexual counselling model for care providers, such as the PLISSIT model, might be a useful tool to improve the discussion of sexual issues in patients with type 2 diabetes mellitus. PLISSIT stands for Permission, Limited Information, Specific Suggestions, and Intensive Therapy. Even though the use of the PLISSIT model has often been recommended in diabetes care, no evidence with regards to its effectiveness in patients with type 2 diabetes mellitus exists. This study describes the design of a cluster-randomised controlled trial evaluating the effectiveness of a PLISSIT-model intervention in men and women with type 2 diabetes mellitus in primary care. METHODS/DESIGN: Patients with type 2 diabetes mellitus, aged 40-75 years, who indicate to be dissatisfied about their sexual functioning and that they would like to talk about their sexual problem(s) with their general practitioner are recruited. All participants receive an information leaflet from the practice nurse. In the intervention group, each participant will also receive sexual counselling based on the PLISSIT model from their general practitioner. In the control group, usual care will be provided to those participants requesting an appointment with their general practitioner when the information leaflet was not deemed sufficient. Primary outcomes include sexual functioning, satisfaction about sexual function, and quality of life. Secondary outcomes are depressive symptoms, sexual distress, emotional well-being, and treatment satisfaction. Outcomes will be measured by means of self-report questionnaires at baseline, and after 3 and 12 months post-baseline. Treatment satisfaction will be assessed in telephone interviews. DISCUSSION: This paper describes the design of a cluster-randomised controlled trial that will investigate the effectiveness of a PLISSIT-model intervention in patients with type 2 diabetes mellitus in primary care. Our study will add important and currently missing insight into the effectiveness of PLISSIT on important patient-reported outcomes of men and women with type 2 diabetes mellitus. TRIAL REGISTRATION: Dutch Trial Registry NTR4807 .