The brief index of sexual functioning for women (BISF-W): a new scoring algorithm and comparison of normative and surgically menopausal populations.

OBJECTIVE: To develop a new scoring algorithm for the Brief Index of Sexual Functioning for Women (BISF-W) and to compare results from a normative population with those from a clinical sample of surgically menopausal women with impaired sexual function. DESIGN: The scoring algorithm provided an overall composite score and seven dimension scores: D1 (thoughts/desires), D2 (arousal), D3 (frequency of sexual activity), D4 (receptivity/initiation), D5 (pleasure/orgasm), D6 (relationship satisfaction), and D7 (problems affecting sexual function). The normative population consisted of 225 healthy women between the ages of 20 and 55 years; 187 had regular sexual partners and 38 did not. The clinical sample comprised 104 women in the same age range (with partners), who reported that their sex lives had become less active or less satisfying after surgery (bilateral oophorectomy and hysterectomy), despite standard estrogen replacement therapy. RESULTS: The BISF-W composite and dimension scores for healthy women with partners were significantly greater (p < 0.001) than for women without partners, except for D1, which was comparable in both groups. For healthy women with partners, the composite and dimension scores (D1, D3, and D5) decreased significantly with increasing age (p < 0.05). In comparison, surgically menopausal women had significantly lower composite and dimension scores (p < 0.001), with the exception of D7, which was significantly higher (more problems). As a percent of the normative means for healthy women with partners, the dimension scores for surgically menopausal women were lowest for D1--47.2%, D3--46.9%, and D5--46.1%. CONCLUSIONS: This research provides further validation of the BISF-W as an instrument for evaluating female sexual function and quantifies the nature and degree of impaired sexual function in surgically menopausal women.

Effects of antihypertensive medications on quality of life in elderly hypertensive women.

The impact of antihypertensive medications on the quality of life of elderly hypertensive women has rarely been systematically evaluated in large clinical trials using drugs from the new generations of pharmaceutic preparations. We carried out a multicenter, randomized double-blind clinical trial with 309 hypertensive women aged 60 to 80 years to assess effects of atenolol, enalapril, and isradipine on measures of quality of life over a 22-week period. The patients had mild to moderate hypertension. Hydrochlorothiazide was added to treatment if monotherapy was inadequate in lowering blood pressure. At the conclusion of the trial the three drug groups did not differ in degree of reduction of diastolic blood pressure or in supplementation with hydrochlorothiazide. Over the 22-week trial, linear trend analysis showed no differences between the treatment groups in change from baseline on quality of life measures of well-being, physical status, emotional status, cognitive functioning, and social role participation. Regarding each of 33 physical side effects over the 22 weeks, we found no general difference between atenolol, enalapril, and isradipine groups on measures of change in distress over symptoms except for enalapril patients who worsened in distress over cough (P = .001) and atenolol patients who worsened in distress over dry mouth (P = .014). Centering on three medications that are relatively new additions to the armamentarium for blood pressure control, the findings underline the increasing opportunities for the physician to select drugs that can control blood pressure while maintaining the quality of life of elderly hypertensive women.

Brief sexual inquiry in gynecologic practice.

Eight hundred eight-seven consecutive gynecologic outpatients were screened for sexual concerns and dysfunctions by the inclusion in the medical history of two questions concerning sexual function. Only 29 women (3%) spontaneously offered sexual complaints without direct inquiry. An additional 142 women (16%) acknowledged sexual problems upon questioning. The most common sexual complaint was dyspareunia (48%), followed by decreased sexual desire (21%), partner problem(s) or dysfunction(s) (8%), vaginismus (6%), anorgasmia (4%), and other problems (13%), eg, arousal problems, decreased lubrication, sexual anxiety, etc. Sexual complaints were more prevalent in those 50 years of age or older. This brief sexual inquiry added little time to the office visit, and most of the sexual complaints could be resolved by the gynecologist.

Definition and classification of female sexual disorders.

The diagnosis and classification of female sexual disorders has undergone significant changes over the last fifty years as a function of changing societal expectations for female sexual conduct, available knowledge about sexual psychophysiology and actual clinical practice. Currently, female sexual disorders are conceptualized as disturbances in desire, arousal, or orgasm as well as sexual pain disorders which include dyspareunia and vaginismus. The lack of objective, empirically-grounded criteria for diagnosis as well as the comorbidity of female sexual disorders contributes to the lack of reliability in the diagnosis of female sexual complaints. At the present time, hypoactive sexual desire disorder is the most commonly diagnosed female sexual disorder followed by female orgasmic disorder. Nevertheless, the major clinical complaints among women center on their dissatisfaction with such non-genital behaviors as affection, communication, and non-genital touching as well as issues of attraction and passion. These factors should be assessed as well as genital response for greater validity in evaluating female sexual disorders in both research and clinical practice.

Treatment of sexual disorders in the 1990s: an integrated approach.

Marked changes have occurred in the formulation and treatment of sexual disorders in the past 2 decades. Emphasis has shifted to the role of biomedical and organic factors in the etiology of sexual dysfunction, along with the growing use of medical and surgical treatment interventions. Multidimensional assessment models are widely used, particularly in the evaluation of male erectile dysfunction and sexual pain disorders. Integrated treatment approaches have also been developed, as cognitive-behavioral and couples' therapy procedures are increasingly combined with traditional sex therapy techniques. This article reviews existing data regarding the etiology and treatment of male and female sexual dysfunctions. Despite the conceptual and technological sophistication of current approaches, treatment outcome is less than satisfactory in several areas. Further research is needed on the etiology and treatment of sexual disorders.

Hypoactive sexual desire.

Hypoactive sexual desire is an ubiquitous and challenging disorder that is often associated with other psychiatric or medical conditions. Multiple etiologic determinants have been associated with the disorder, and the role of systemic and interpersonal factors have been emphasized. Treatment interventions have varied widely, including hormonal, pharmacologic, and psychological interventions. There is a paucity of controlled outcome research, and it is uncertain which patients are most likely to benefit from treatment.

Sexuality in sexagenarian women.

Sexual behavior was examined in 59 healthy, post-menopausal women between 60 and 70 years of age. Subjects were interviewed by a psychologist, completed medical and sexual questionnaires and had a gynecologic exam and blood drawn for determination of estradiol, luteinizing hormone and total and free testosterone. Partners filled out a mail-back sexual questionnaire. Thirty-nine (66%) of the group were coitally active and twenty (34%) were abstinent. The coitally active group reported higher levels of sexual desire (P less than 0.03), greater sexual satisfaction (P less than 0.007), more comfort in expressing sexual preferences (P less than 0.009) and greater pre-menopausal sexual satisfaction (P less than 0.01) and on pelvic examination were noted to have less genital atrophy (P less than 0.0005) than the abstinent group. For the entire sample sexual complaints such as decreased desire and vaginal lubrication in the female and erectile difficulties in the male were reported frequently. Of the hormones studied, higher serum levels of free testosterone were associated with reports of increased sexual desire.

Women's attitudes toward the menopause: an update.

A sample of 244 pre-, peri-, post-menopausal and hysterectomized women were administered a 10-item Menopause Attitude Questionnaire which assessed women's agreement with several controversial menopausal issues (i.e., whether the women subscribed to a view of menopause as a normal developmental stage or as a deficiency disease; attitudes toward hormonal replacement; and whether female sexuality was perceived as compromised during and subsequent to menopause). Results revealed that even a fairly homogeneous population of well-educated women held a considerable diversity of beliefs about the menopause. Respondents were clearly divided regarding the issue of hormone replacement therapy and its associated risks, but were united in holding optimistic beliefs about maintaining their femininity and sexuality subsequent to menopause. The implications of this research are discussed in terms of the current zeitgeist regarding menopause.

Sexual expression and its determinants in the post-menopausal woman.

Anatomic, hormonal, psychosocial and psychosexual variables of sexual expression were evaluated in 69 non-patient post-menopausal women. Subjects received a 2-h individually administered interview, a gynecologic examination with subjective scoring of vaginal atrophy, and serum determinations of estrone, estradiol, and androstenedione, testosterone, FSH and LH. Sexual repertoire of the 34 coitally active (coitus greater than 3 X monthly) was compared to the 29 coitally inactive (coitus less than 10 X yearly) subjects. The majority of subjects engaged in traditional sexual activities, with emphasis on physical affection and coitus. The active and inactive women were similar on all demographic variables except family income and weight/height ratio. The inactive women were slightly more obese and had lower incomes. Post-menopausal patterns of sexual activity correlated with post-menopausal sexual expression as did partner availability and function. The active women had a significantly higher LH level. No correlation was found between current or ideal sexual frequency and androgen or estrogen levels.

Correlates of sexual desire in post-menopausal women.

Sexual desire was studied in 22 post-menopausal women (absence of menses for at least 12 mth) without complaints of sexual dysfunction, not receiving estrogen replacement therapy, and in good physical health. Psychosexual evaluation, medical history, physical and pelvic examinations, and blood samples for the determination of estradiol, androstenedione, FSH and LH were obtained. In addition, the effects of a formal exercise program on sexual desire was investigated. It was found that approximately 50% of the women in this study experienced no decline in sexual interests with menopause, and less than 20% reported a significant decrease. Results indicated a positive relationship between desire and a measure of marital adjustments which women with loss of sex desire had on the Locke-Wallace Marital Adjustment Test. There was no correlation between gonadotropins and loss of sexual desire.

Screening in or out of the new reproductive options: who decides and why.

A lively controversy exists among infertility specialists about the value and necessity of screening candidates for inclusion into infertility programs. Advocates of screening argue that there is both a child advocacy and community welfare responsibility to evaluate prospective candidates (and donors) for the new assisted reproductive techniques. Opponents of screening argue that screening is costly and superfluous, since the majority of applicants are highly motivated and well-adjusted individuals who have the 'right' to pursue parenthood, if they choose. A pilot survey was undertaken to determine whether infertility programs currently have explicit policies regarding suspension or refusal of treatment on psychological grounds and to determine what would (or should) constitute grounds for denial of infertility treatment. A Treatment Refusal Questionnaire was mailed to all members of the Psychological Special Interest Group of the American Fertility Society. Forty-two responded (response rate of 47%). Results revealed that the majority of respondents did not have a formal policy regarding suspension or refusal of treatment, although they did have informal criteria. Four criteria were significantly endorsed as constituting 'red flags' for treatment rejection: substance abuse, physical abuse, severe marital strife, and coercion of one spouse by another. Furthermore, treatment decisions were modified by the type of intervention sought, so that for example, more stringent criteria were operative if clients sought ovum donation than if they sought ovulation induction. These and other findings are presented and discussed.

Disclosure issues and decisions of couples who conceived via donor insemination.

Disclosing the use of donor insemination (DI) to family, friends, and offspring poses a quandary for many DI patients. A cross-sectional survey was conducted to determine whether couples opted to share information about conception via donor sperm with their children, as well as the issues and concerns that arose for parents once infertility treatment was completed. Twenty-seven married heterosexual infertile husbands and wives who had used DI to conceive completed a follow-up questionnaire asking them about disclosure decisions as well as thoughts about DI as a reproductive option. Results revealed that nearly three-quarters of the sample had not disclosed to their child and did not plan to, although 85% had told at least one other person about conception via DI. With few exceptions, husbands and wives agreed about how to handle disclosure. Notably, 32% of the mothers reported not knowing when or how to disclose. However, the majority of couples were not offered psychological counseling prior or subsequent to DI. It is suggested that mental health professionals should be aware of the divergence of opinion between what they believe about the benefits of disclosure/counseling, the beliefs of infertile couples about disclosure and what is actually known about the benefits of full disclosure among all involved parties.

Non-traditional mothers: single heterosexual/lesbian women and lesbian couples electing motherhood via donor insemination.

The purpose of the project was to explore the motivation, reproductive and postdelivery experiences, and future concerns of single heterosexual and lesbian women and lesbian couples who attempted conception via donor insemination (DI). All women who had completed at least one cycle of DI between 1987 and 1992 at a large medical school infertility program were mailed a comprehensive 'Motherhood' questionnaire. Forty-five women completed the survey (response rate = 88%) of whom 14 were lesbians, 28 were heterosexuals, two were bisexual and one was celibate. The only major differences between the heterosexual women and the lesbian women were that the heterosexual women were older and had started DI attempts at an older age than the lesbian women. The majority of women reported that four major considerations prompted their decision to initiate DI when they did: feeling secure in their employment, the sense that time was running out, feeling that they had 'worked through' concerns about parenting, and that they had sufficient social support. Three characteristics were deemed moderately or very important in their selection of sperm donors: ethnicity, education and height. After achieving a pregnancy, most women wished to know more detailed information about their donor. Unlike heterosexual couples, all single and lesbian women planned to disclose the fact of DI to their offspring but were uncertain of when or how to accomplish this. The greatest worry reported by respondents was how their child would deal with the absence of a known designated father. Overall, the women were gratified with their experience of DI, and the majority would 'absolutely' recommend it to a friend.

The sexual difficulties of women.

Despite the fact that women are susceptible to experiencing a wide variety of sexual difficulties and complaints during their lifetime, it is also true that women are sexually resilient and are capable of satisfactory sexual response throughout their life cycle. Often, permission and reassurance, coupled with sensible suggestions are sufficient to overcome bothersome sexual difficulties. When this is not helpful, referral to a well-trained sexual or couples' therapist is indicated.

Sexual problems and dysfunction: epidemiology, classification, and risk factors.

Sexual difficulties are extremely prevalent among both men and women, occurring in about 43% of women and 31% of men. They are associated with a number of biological, medical, and psychological risk factors and increase markedly with aging. Sexual difficulties are also a significant source of emotional and relationship dissatisfaction. This article reviews and critiques the current classification system of sexual disorders and highlights the most common risk factors for sexual problems.

Persistent sexual arousal syndrome: a newly discovered pattern of female sexuality.

This article describes a phenomenon, persistent sexual arousal syndrome (PSAS), which heretofore has not been noted or described in the sexuality, psychiatric or medical literature. The syndrome is precisely the opposite of female sexual arousal disorder (FSAD), in that the woman's complaint is of excessive and often unremitting arousal rather than of deficient or absent arousal. Five case descriptions are reported, highlighting the essential feature of the syndrome--persistent physiological arousal in the absence of conscious feelings of sexual desire. To date, no obvious hormonal, vascular, neurological, or psychological causes have been identified as underlying the symptoms of any of these patients. The cases are presented in the hope that they will stimulate efforts to investigate the prevalence, etiology, course, and management of PSAS.

The weekend workshop for dysfunctional couples: assets and limitations.

Two major new trends are emerging in the field of sexual counseling: the use of self-help programs and the increasing reliance on group therapy to overcome specific sexual complaints. The weekend sexual enhancement workshop represents a synthesis of both trends, but efficacy regarding outcome has not been well documented. In order to investigate specific changes in sexual and marital adjustment, two intensive weekend programs were conducted. Pre- and postmeasures were obtained for both groups. Based on the results of 15 couples who displayed a diversity of sexual dysfunctions, several conclusions can be drawn. The weekend workshop format appears effective in achieving three of its four major goals: (1) Couple communication improves via the stimulus of new information, group discussion, and permission to talk sexually. Marital satisfaction increases, particularly where the history of marital conflict is not chronic. (2) Attitude change occurs, and erroneous beliefs are relinquished in the face of new input. (3) The frequency of sexual interaction increases. (4) Long-standing sexual dysfunctions are not resolved as a result of group participation and information on self-help methods alone. Finally, the role of such weekend programs in sexual counseling in discussed.