University Medical Center Freiburg, Department of Psychiatry and Psychotherapy, Freiburg, Germany Rhein-Jura-Clinic for Psychiatry, Psychosomatic Medicine and Psychotherapy, Bad Säckingen, Germany Section for Sexual Medicine, German Society for Psychiatry and Psychotherapy (DGPPN), Berlin, Germany.
Introduction. As yet, a summary of the research evidence concerning the efficacy of psychological treatment in female sexual dysfunction is lacking. Previous reviews were often nonsystematic or explored one specific sexual dysfunction.
Aim. Our systematic review provides an overview of the efficacy of psychosocial interventions in all female sexual dysfunction.
Main Outcome Measures. Main outcome measures included for example psychometrically validated scales, diary notes, interviews, and vulvar algesiometer. The efficacy of psychosocial interventions was measured for example by the frequency of and satisfaction with sexual activity and sexual functioning. Safety and acceptance were evaluated on the basis of adverse events and dropout rates.
Methods. The systematic literature search included electronic database search, handsearch, contact with experts, and an ancestry approach. Studies were included if the woman was given a formal diagnosis of a sexual dysfunction (International Statistical Classification of Diseases and Related Health Problems—ICD10/-9; Diagnostic and Statistical Manual of Mental Disorders-IV/-III-R) and when the intervention was psychosocial or psychotherapeutic. The control group included either another treatment or a waiting-list control group. The report of relevant outcomes was necessary for inclusion as well as the design of the study (randomized, controlled trials [RCTs] and controlled clinical trials). The assessment of methodological quality comprised aspects of randomization, blinding, incomplete outcome data, selective reporting, and allegiance.
Results. We identified 15 RCTs that investigated efficacy in female sexual dysfunction and two further studies that examined male and female sexual dysfunction together. Most trials explored sexual pain disorders. About half of all studies in women used either a concept derived from Masters and Johnson or a cognitive-behavioral treatment program. Both approaches showed significant improvements compared with a control group. Benefit was not always maintained over the (variable) follow-up period.
Conclusions. Traditional sexual therapeutic concepts proved to be efficacious in the treatment of female sexual dysfunction. A shortcoming was the rather low methodological quality of included studies. Günzler C, and Berner MM. Efficacy of psychosocial interventions in men and women with sexual dysfunctions—A systematic review of controlled clinical trials. J Sex Med 2012;9:3108–3125.
[Show abstract][Hide abstract] ABSTRACT: Sexual dysfunction is common among women with schizophrenia treated with antipsychotic medication. Multiple factors influence sexual function and reproductive health in this patient population, including the effects of medications on prolactin secretion and the complexities of making contraceptive decisions in the context of a serious mental illness. The author explores the causes and management of loss of libido as illustrated by a case vignette and describes the course and outcome of a clinical intervention that was implemented to alleviate the sexual dysfunction. Possible approaches and potential pitfalls of the intervention are described. Clinicians must be open to discussions regarding sexual concerns, relationships with sexual partners, and reproductive issues with women suffering from schizophrenia. Both patients and clinicians need to be aware of unintended effects of intervention. Opportunities exist for improved education among clinicians to achieve a more proactive approach to sexual health in women receiving antipsychotic medication.
American Journal of Psychiatry 05/2013; 170(5):471-5. DOI:10.1176/appi.ajp.2012.12111475 · 12.30 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Female sexual dysfunctions (FSDs) range from short-term aggravations to major emotional disturbances adversely affecting family and workplace. This review highlights diagnosis and management of the four most widely diagnosed FSDs. It initially focuses on hypoactive sexual desire disorder (HSDD) as a driving force at the heart of all other FSDs; nothing happens without sexual desire. Successful resolution of HSDD frequently facilitates resolution of other disorders. Central to understanding HSDD is the impact of aging female sexual endocrinology and its effect on both prevalence and expression patterns of FSD. Advances in this field have enabled introduction of some the most effective treatments yet described for HSDD. Sexual arousal disorder, though commonly affected by the same factors as HSDD, is heavily associated with psychotropic drugs and mood elevators. Orgasmic disorder is frequently the downstream result of other sexual dysfunctions, particularly HSDD, or the result of a major psychosexual trauma. Successful management of the underlying disorder often resolves orgasmic disorder. Sexual pain disorder is frequently the result of a gynecologic disorder, such as endometriosis, that can be substantially managed through successful treatment of that disorder. This article ends with the article's most important note: how to initiate the conversation. (Fertil Steril (R) 2013; 100: 905-15. (C) 2013 by American Society for Reproductive Medicine.)
Fertility and Sterility 10/2013; 100(4):905-915. DOI:10.1016/j.fertnstert.2013.08.026 · 4.59 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The objective of this study was to explore changes in the sexual function of women who attended a rural nurse-led female sexual dysfunction clinic.
This exploratory study was designed as a one-group pre-test/post-test design from a convenience sample of women attending the clinic.
The setting was a women's health centre located in regional Western Australia.
One hundred eleven women aged between 18 and 65 years were recruited from clinic attendees.
The Australian version of the validated McCoy Female Sexuality Questionnaire was completed before the first appointment (T0), and 1 (T1) and 6 months (T2) after the last appointment.
Women attending the clinic reported significant increases in sexual desire, satisfaction and orgasm quality and achievement at 1 and 6 months after their last appointment. There was also a significant increase in satisfaction with their main sexual partner at 6 months.
This study confirmed the value of an innovative approach to managing female sexual dysfunction in a rural area with workforce shortages and limited health services. It is recommended that care by a nurse-led multidisciplinary team be used in the management of sexual dysfunction. Further research is needed to see if this model of care would be effective in other settings.
Australian Journal of Rural Health 02/2014; 22(1):33-9. DOI:10.1111/ajr.12076 · 1.23 Impact Factor
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