Article

Ongoing Pain, Sexual Desire, and Frequency of Sexual Intercourses in Females with Different Chronic Pain Syndromes

Authors:
To read the full-text of this research, you can request a copy directly from the authors.

Abstract

The aim of this study was to assess the importance of an active sex life, the ability to feel sexual desire, and the frequency of sexual intercourses in females suffering from four different chronic pain syndromes. Forty female pain patients and forty-one healthy control subjects participated. The following parameters were assessed: pain intensity, pain duration, the importance of an active sex life, the ability to feel sexual desire, and the frequency of sexual intercourses. The patients found an active sex life less important than the healthy control subjects. A total of 23 (58%) of the females with chronic non-malignant pain experienced no ability to feel sexual desire at all. The pain patients had a significantly lower frequency of sexual intercourses than the control subjects (2 per month versus 9 per month) (p<0.01). Chronic non-malignant pain of different aetiologies was shown to have a significant influence on the rating of the importance of an active sex life, the ability to feel sexual desire, and the frequency of sexual intercourses. This may be an important aspect to include when counseling pain patients and their partners.

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the authors.

... For example, regarding physical symptoms, low levels of sexual desire and functioning have been associated with tension-type and migraine headaches, [20][21][22] as well as a variety of chronic pain conditions. [23][24][25][26] Regarding psychological symptoms, experimental manipulations of negative mood, 27,28 as well as clinical and nonclinical observational studies, [29][30][31][32] have found negative emotions to be associated with lower levels of sexual desire and functioning. Notably, Kalmbach et al 33 reported that daily reports of anhedonia, anxiety, and general distress were associated with decrements in same-day reports of sexual desire and functioning (eg, desire, arousal, lubrication, orgasm, and pain). ...
... This finding adds to previous reports of moderate to high rates of sexual difficulties among patients with diverse types of chronic pain. 23,24,26 Moreover, actual physical pain and the fear of exacerbating that pain during sex have been implicated as negatively influencing sexual activity. 23,26 To explain these associations, Sjogren and Fugl-Meyer 26 suggested that physical pain and fear of pain may produce a shift of attention away from pleasurable genital sensations, thus resulting in a cognitive interference in sexual desire or response (see Barlow 58 and Cuntim and Nobre 59 for relevant work on cognitive interference in sexual response). ...
Article
Full-text available
Background Past research on the association between sexual desire and the menstrual cycle has provided inconclusive results and has not considered the potential influence of psychological and physical changes that are frequently associated with the menstrual cycle. Aim To test the strength of association between the menstrual cycle (and associated symptoms) and changes in sexual desire. Methods Prospective daily reports across 2 full menstrual cycles (2 months) from a sample of female university students (n = 213), were analysed. Analyses tested for average effects of the menstrual cycle on sexual desire, individual differences in these effects, and cyclical and noncyclical associations between sexual desire and the 9 menstrual cycle–related changes. Note that data presented in the current article come from a larger study from which other reports have been published. Outcomes Target variables were (1) daily change in sexual desire and (2) daily reports of 5 psychological changes and 4 physical changes that are commonly associated with the menstrual cycle. Results Results showed that when considering average effects across participants, the menstrual cycle was associated with a small midcycle increase in sexual desire. However, multilevel analyses showed large individual differences in how the menstrual cycle influences sexual desire. Specifically, some participants showed a midcycle increase, others a perimenstrual increase, and others no change across the menstrual cycle. Moreover, results demonstrated that psychological changes were more important for predicting sexual desire as compared with physical changes. Clinical Implications These results suggest that daily measurement of sexual desire across multiple menstrual cycles may be an important tool in the assessment of sexual desire among some females. Strengths and Limitations Strengths of this study are the daily assessment of sexual desire and all symptoms for 2 menstrual cycles and multilevel analyses that allow the study of individual differences. Limitations include limited measurement of sexual desire based on only 2 questions and the lack of measures of relationship status and sexual orientation. Conclusion Emphasis is placed on the need to apply more rigorous research methods and to abandon simplistic average-effects models that are based on outdated theories and stereotypes.
... For example, regarding physical symptoms, low levels of sexual desire and functioning have been associated with tension-type and migraine headaches, [20][21][22] as well as a variety of chronic pain conditions. [23][24][25][26] Regarding psychological symptoms, experimental manipulations of negative mood, 27,28 as well as clinical and nonclinical observational studies, [29][30][31][32] have found negative emotions to be associated with lower levels of sexual desire and functioning. Notably, Kalmbach et al 33 reported that daily reports of anhedonia, anxiety, and general distress were associated with decrements in same-day reports of sexual desire and functioning (eg, desire, arousal, lubrication, orgasm, and pain). ...
... This finding adds to previous reports of moderate to high rates of sexual difficulties among patients with diverse types of chronic pain. 23,24,26 Moreover, actual physical pain and the fear of exacerbating that pain during sex have been implicated as negatively influencing sexual activity. 23,26 To explain these associations, Sjogren and Fugl-Meyer 26 suggested that physical pain and fear of pain may produce a shift of attention away from pleasurable genital sensations, thus resulting in a cognitive interference in sexual desire or response (see Barlow 58 and Cuntim and Nobre 59 for relevant work on cognitive interference in sexual response). ...
Article
Introduction Although research has attempted to quantify the effects of the menstrual cycle on sexual desire, we lack a clear understanding of how the menstrual cycle, and the many physical and psychological changes of the menstrual cycle, are related to changes in sexual desire. For example, whereas evolutionary theories predict that women should converge on increased sexual interest around ovulation, methodologically strong tests of this idea are lacking, and there is reason to hypothesize that there are significant individual differences in these associations. Objective This study has three main objectives. First, to quantify the contributions of (a) mean-level differences across individuals, (b) average effects of the menstrual cycle, and (c) individual differences in the effects of the menstrual cycle, to sexual desire. Second, to test for the influence of day-to-day changes in physical and psychological symptoms on day-to-day changes in sexual desire, independent of the menstrual cycle. Third, to test for associations between cyclical changes in physical and psychological symptoms attributable to the menstrual cycle and cyclical changes in sexual desire attributable to the menstrual cycle. Methods A sample of n = 213 university-aged women with regular menstrual cycles, who were not using hormonal birth control, completed daily questionnaires for two full menstrual cycles (M = 58 daily reports per participant). Measurement included changes in sexual desire (increase and decrease), as well as physical (headaches, back and joint pain, cramps, breast changes) and psychological changes (anxiety, depression, happiness, mood swings, low energy) that are commonly associated with the menstrual cycle. Multilevel modeling with random intercepts and slopes, as well as linear regression of cosine coefficients of all physical and psychological symptom scores, were used to test these hypotheses. Results Relative to the three objectives described above, results showed that: mean-level differences across participants accounted for 21.5% of the overall variance in changes in sexual desire; the average/fixed effects of the menstrual cycle accounted for 1.6% of the variance; and random effects of the menstrual cycle (e.g., individual differences in menstrual cycle effects) accounted for 7.8% of the variance. Only day-to-day changes in psychological symptoms, but not day-to-day changes in physical symptoms, were associated with day-to-day changes in sexual desire (independent of the menstrual cycle). Finally, only menstrual cycle-related cyclical changes in depression were associated with menstrual cycle-related changes in sexual desire. Conclusions Results from the present study demonstrate that average effects of the menstrual cycle play a very small role in influencing changes in sexual desire (see left panel of Figure 1). Most variance in changes in sexual desire, instead, is explained by individual differences in mean levels, and in individual differences in the effects of the menstrual cycle (see right panel in Figure 1). Thus, women differ significantly in their average levels of desire and how the menstrual cycle influences changes in their desire. Moreover, only psychological symptoms, and not physical symptoms, are associated with changes in sexual desire. Of the psychological symptoms, happiness is the most strongly associated with changes in sexual desire. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: ApexNeuro
... If sex is a basic human right and ova-having individuals deserve the right to their sexuality even with an autoimmune disorder, sexual pleasure becomes pertinent and sexual pain becomes dire to address. Desire for sexual activity often becomes diminished due to pain, pain avoidance, neurological rewiring, neuro sensitivity, pain sensitivity, and the potential impacts on the relational dynamic where the sexual activity takes place (Basson, 2012;Laursen et al., 2006). This becomes relevant to therapists because diminished normative functioning, sexual pain, and disrupted sexual activity within relational dynamics can all contribute to psychological distress (Meana et al., 2015;Wylie et al., 2015). ...
... Mobility typically associated with sexual activity, whether partnered or solo, can become difficult in many ways depending on the manifestation of the autoimmune disorder. For example, as joints swell and stiffen with rheumatoid arthritis, patients experience limited mobility with activities such as partnered and/or penetrative sex, as well as with day-to-day living (Laursen et al., 2006;Zhang et al., 2018). With Behçet's syndrome, painful sores can form on the mouth, skin, and genitals, making any sort of rubbing extremely painful (Yetki et al., 2012). ...
Article
This article proposes a connection between autoimmune disorders and pain with sexual activity in ova-having individuals. The authors focus on accumulating research from psychology data, medical data, the field of psychoneuroimmunology (PNI), and the field of sex therapy. Current research supports a connection between the mind-body bidirectionality and effects on the immune system, and effects of the mind-body bidirectionality and pain with sexual activity. Content analysis will first discuss the occurrence of autoimmune disorders in ova-having individuals from a PNI perspective followed by a discussion of the occurrence of sexual pain in ova-having individuals. Finally, the authors discuss the overlap in what is happening based upon psychoneuroimmunology and pain during sexual activity in ova-having individuals, as well as clinical implication and a call-to-action for further study of the link between autoimmune disorders and sexual pain.
... Studies on psychological distress in endometriosis are scarce, and those that do exist focus mainly on identifying depression, anxiety, and lessened quality of life [9][10][11][12]. Research into sexual function in endometriosis has been increasing [5,[13][14][15], mainly looking at infertility, which is significantly related to depression and anxiety [16][17][18], and dyspareunia, which is present in around 50% of patients. ...
... Previous studies have reported the lower frequency of sexual intercourses in pain patients than healthy controls. 43,44 In our study, pain may interfere with patients' sexuality because of the pain itself (ie, dyspareunia), or other factors related to pain. There is evidence that pain has negative effects on patients' relationship with their partners -both mentally and physically. ...
Article
Full-text available
Purpose Pain is potentially associated with sexual dysfunction. Both sexual dysfunction and pain are common in methadone-maintained patients, but the association of pain with sexual dysfunction in methadone-maintained patients is rarely studied. This study examined the association between pain and sexual life satisfaction (SLS) in Chinese patients receiving methadone maintenance treatment (MMT). Patients and methods A total of 477 methadone-maintained patients who recently had sex with their sex partners were recruited from three MMT clinics in Wuhan, China. SLS was assessed with a single question, and the sociodemographic, psychological, and clinical data were collected with standardized questionnaires. Pain intensity was assessed with the 5-point verbal rating scale. Multiple ordinary logistic regression was used to control for potential confounders that may bias the pain–SLS relationship. Results The prevalence of self-reported dissatisfaction with one’s sexual life was significantly higher in patients with clinically significant pain (CSP) than those without CSP (41.5% vs 19.4%, χ² =23.567, P<0.001). After controlling for potential sociodemographic, psychological, and clinical confounders, CSP was still significantly and independently associated with an increase in sexual life dissatisfaction (OR =1.89, P=0.011). Conclusion Pain is significantly associated with low SLS in methadone-maintained patients. Appropriate pain management might improve SLS of patients receiving MMT.
... All participants reported an increase in fatigue and issues with physical impairments as a result of the caregiving duties. Consistent with the literature on caregivers of individuals with a variety of disabilities, the participants reported that the identified physical ailments greatly influenced their levels of sexual desire (Froud et al., 2014;Laursen, Overvad, Olesen, Delmar, & Arendt-Nielsen, 2006). Of the identified physical impairments, back pain was the most prevalent among the participants. ...
Article
Date Presented 3/31/2017 The purpose of this research is to identify the experiences of intimate partners of individuals with SCI and to identify resource needs. Interviews were completed and themes identified. The information gained can be used to inform future development of resources for this population. Primary Author and Speaker: Kate Eglseder
... The recommended coital frequency among couples seeking conception by natu- This may be due to the fact that the same age group is most likely to be affected by the medical conditions that indirectly contribute to erectile dysfunction (Table 2) such as diabetes mellitus (DM), high blood pressure (HBP), chronic renal failure and low back pain, which leads to physical difficulties in the act of having coitus ( [17]. ...
... All participants reported an increase in fatigue and issues with physical impairments as a result of the caregiving duties. Consistent with the literature on caregivers of individuals with a variety of disabilities, the participants reported that the identified physical ailments greatly influenced their levels of sexual desire (Froud et al., 2014;Laursen, Overvad, Olesen, Delmar, & Arendt-Nielsen, 2006). Of the identified physical impairments, back pain was the most prevalent among the participants. ...
Article
Although sexuality is an integral aspect of the human experience, individuals who sustain a spinal cord injury (SCI) often receive inadequate education to facilitate successful participation in sexual activities. Intimate partners are often not included in discussions related to sexuality during the rehabilitative process. The purpose of this study was to identify the lived experiences of intimate partners of individuals with SCI related to sexuality. Four intimate partners were selected to participate in semistructured interviews related to their lived experiences of sexuality. Participants identified aspects of SCI, extreme discomfort due to self-perceived sexual norms, and a lack of education as contributors to unsuccessful participation in sexual activity. Coupled sexual activity is a complex phenomenon which includes factors that influence both the injured individuals as well as their intimate partners. To provide effective interventions in addressing sexuality, practitioners should consider the entire issue, the couple.
... erectile dysfunctions, dyspareunia, reduced subjective arousal, and orgasm problems [10][11][12]. Numerous studies have shown that problems in sexual response often have an effect on sexual satisfaction, sexual anxiety, as well as sexual self-esteem, and body esteem [13][14][15][16][17][18][19][20]. However, epidemiological studies on the prevalence of sexual dysfunctions among the rehabilitation population are lacking. ...
Article
Background: Sexual health problems are more prevalent among people with a chronic illness or physical disability than among the general population. Although sexual health care in the rehabilitation setting in the Netherlands is a growing field of interest, integrating sexual health in the overall care for rehabilitation patients has proven to be a challenge. Methods: This article describes a training designed for rehabilitation professionals working in operational multidisciplinary teams. The main objective of this training is to help create a professional environment in which sexual health problems can be discussed, if possible prevented and when needed treated. A pretest-posttest design was used to measure the impact of this educational program given to six teams in the Netherlands. Results: The results demonstrated that the staff's knowledge, comfort levels and approach levels significantly increased. Team members were more active concerning sexual health and patient care. Conclusion: These findings clearly indicate that rehabilitation workers can benefit from a custom fit design team training on sexual health care. Strategically working with the modus operandi of a multidisciplinary team, such as task definition, determining pro- and reactive roles and formal agreements, appears to be of importance in integrating sexual health in the overall care for patients. Implications for Rehabilitation Sexuality and intimacy are important aspects of quality of life and difficult to integrate in rehabilitation treatment. A multidisciplinary Team Training Sexual Health Care (TTSHC) has been developed with core themes: talking about sex, using a biopsychosocial approach, identifying and understanding sexual health issues, applying the existing expertise of the MDT for sexual health care. After the TTSHC all the participants of the MDTs show significantly more active behavior concerning sexual health and patient care. Defining roles and responsibilities in the MDT is important for integrating sexual health care in rehabilitation treatment.
... Spinal cord injuries, Parkinson's disease, diabetes, and multiple sclerosis are examples of conditions that often lead to erectile dysfunctions, dyspareunia, reduced subjective arousal, and orgasm problems (Basson & Weijmar Schulz, 2007;Rees, Fowler, & Maas, 2007;Sipski & Alexander, 1997). Numerous studies have shown that these problems in sexual response may have an effect on sexual behaviour, sexual esteem, and sexual satisfaction, which in turn may lead to sexual anxiety as well as decreased sexual satisfaction, sexual esteem, and body esteem (e.g., DeHaan & Wallander, 1988;McCabe & Taleporos, 2003;Laursen, Overvad, Olesen, Delmar, & Arendt-Nielsen, 2006;Mendes, Cardoso, & Savall, 2008;Nosek et al., 1996;Taleporos & McCabe, 2001, 2002a. On the basis of the current literature, it can be concluded that people with physical impairments and chronic diseases score negatively in nearly all assessed sexual health areas; at the same time, they indicate that sexuality has the same importance to them, comparable with the general, able-bodied population (Summerville & McKenna, 1998). ...
Article
Full-text available
The purpose of this study was to determine whether participation in a short and well-structured psychosexual therapy was effective for people with a broad range of physical impairments and chronic diseases. Data were collected from 37 men and 10 women (between 30 and 70 years of age). The results demonstrated that psychosexual therapy has a positive effect on several areas of sexual well-being: less relational stress and sexual stress and an increase in sexual satisfaction, sexual esteem, sexual interaction competence, and a higher frequency in sexual contact. Although based on a relatively small sample, these findings clearly indicate that people with physical impairments can benefit from psychosexual therapy.
... Bringing together women with different pain sites seemed to enhance women's understanding of pain, its effects and its management. Interestingly, Laursen et al (32) found no difference in frequency of intercourse between the patient groups of low back pain, fibromyalgia and whiplash, endometriosis, and arthritis. ...
Article
Full-text available
Chronic pain significantly impacts women's quality of life in the domain of sexual function. Treatment aimed at improving the sexual function of women living with chronic pain is minimal or absent within an interdisciplinary rehabilitation pain program. To evaluate a cognitive-behavioural treatment group designed to improve the sexual function of women with chronic pelvic pain, daily headache pain and neuromusculoskeletal pain within an interdisciplinary rehabilitation pain program. Participants were 47 women who attended the treatment group. A physical therapist and a psychologist facilitated the group. The participants completed a modified version of the Sexual Activity Questionnaire pregroup and at one month postgroup, and a Treatment Helpfulness Questionnaire at the final group session. All 47 women found the treatment group helpful. Sexual function improved as evidenced by significant differences (Wilcoxon signed-rank test, P<0.05) from pregroup to postgroup on measures of enjoyment, lubrication, satisfaction after sexual activity and satisfaction with frequency. Improvements occurred despite no change in pain level during penetration or fatigue level from pregroup to postgroup. Treatment helpfulness results showed that women valued the knowledge and skills gained in the group. Qualitative findings suggest that a cognitive shift, and communication and partner involvement may be mechanisms of change for improved sexual function. The sexual function of women with chronic pain can be significantly enhanced by a cognitive-behavioural treatment group delivered within an interdisciplinary rehabilitation pain program.
Thesis
Full-text available
Over the last decades, women’s sexual life has recorded some noticeable changes, along with new light-shedding perspectives on the understanding of women’s sexuality. A relevant set of studies highlight the importance of different biological, psychological and social dimensions as determinants of sexual functioning and satisfaction, although only a few of them consider those dimensions in an integrated and interdependent way, in order to ascertain each dimension’s significance. Furthermore, and despite the close relation between sexual functioning and sexual satisfaction, the existing literature tends to show some confusion and overlapping between both concepts. Considering this, the present study is intended to analyse the main relational, psychological, contextual and biomedical predictors of women’s sexual functioning and satisfaction, as well as to explore the relation between these two dimensions of women’s sexuality. In this light, using a sample of 497 women, ten empirical studies were conducted, based on queries aimed at assessing the participants’ social and demographic characteristics, medical history and lifestyle, psychopathology, well-being, cognitive and affective variables, relational aspects, sexual context, sexual activity, sexual functioning and sexual satisfaction. Results suggested significant differences between women with high and low levels of sexual functioning, and between high and low levels of sexual satisfaction regarding the various dimensions analysed. On the other hand, the combined analysis of all the biopsychosocial dimensions confirmed the unequivocal contribution of the psychological variables to explain women’s sexual functioning, particularly the role of self-awareness of one’s pleasure during sexual activity, the satisfaction and contentment that derive from meaningful sexual experiences, as well as sexual self-esteem, that is, the image that the woman has of herself as a sexual being. As to the other dimensions considered, only the use of cardiotonic drugs significantly predicted reduced sexual functioning, whereas age, or other social and demographic variables, diseases and the perception of one’s health, menopausal state, lifestyle, psychopathology, general concerns during sexual activity or other contextual variables have shown no predictive value. Regarding sexual satisfaction, the best predictors were the emotional variables, especially the specific responses of joy and absence of guilt during sexual activity, as well as relational aspects, particularly the relationship’s quality, but also the presence of a sensitive partner to the woman’s needs and sexual preferences. Furthermore, cognitive variables have also shown a significant role, such as women resorting to sexual fantasies and minding their behaviour during sexual activity, contributing to an increased sexual satisfaction. Besides that, sexual self-esteem and the ability to achieve orgasm during sexual encounters were also significant predictors of satisfactory sexual experiences. Conversely, no medical, sociodemographical, lifestyle or psychopathological variables have shown any predictive value for sexual satisfaction. In a simultaneous analysis of the different biopsychosocial predictors of women’s sexual functioning, cognitive and emotional determinants stand out. Concerning satisfactory sexual experiences, besides those, relational aspects also played a central role, all the more important given the close relation and circularity between sexual functioning and sexual satisfaction. However, these two dimensions of women’s sexual experience seem to have different predictors, thus supporting the need for a differentiated and specific approach, whether in empirical studies or in interventions. In general, this study was intended to fill a void in the research field regarding women’s sexual experiences, in a positive perspective (both sexual functioning and satisfaction), enabling a deeper knowledge on its determinants, with repercussions for clinical intervention and for the promotion of a more gratifying women’s sexual life.
Article
Full-text available
To describe sexual well-being among non-Hodgkin lymphoma (NHL) survivors. Descriptive, correlational, cross-sectional study. NHL survivors identified via the Los Angeles County Cancer Surveillance Program. 222 NHL survivors two- to five-years postdiagnosis. Data were collected via mailed questionnaire. Multivariate models were used to examine sexual well-being. Three indices of sexual well-being were examined in relation to sociodemographic and medical variables: participation in sexual activity, satisfaction with sex life, and sexual function. Most NHL survivors were participating in sexual activity; however, more than half were dissatisfied with their sex life. A substantial minority "usually or always" experienced problems with sexual function. Associations between study variables and outcomes differed across indices of sexual well-being and by gender; older age was associated with decreased participation, decreased satisfaction, and impaired sexual function for men as well as with decreased participation for women. Poorer physical functioning was associated with decreased participation for men and women as well as poorer sexual function for women. Finally, poorer mental functioning was associated with less satisfaction and poorer sexual function for men and women; shorter times since diagnosis were associated with poorer sexual function for women. Most NHL survivors were sexually active, but many reported difficulties with satisfaction and function. Sexual well-being is a multifaceted construct that requires continued attention throughout survivorship. Oncology nurses are in an excellent position to ensure that survivors' sexual concerns are addressed. Survivorship care plans may help to facilitate communication about survivors' sexual well-being.
Article
Pain is the most common symptom in the world for which patients seek professional help. Opioids offer an appropriate and safe treatment for some but not all patients with nonmalignant chronic pain. Potential risks, including drug abuse and intolerable side effects, appear to be manageable or even preventable in most cases. Patients with persistent rheumatic pain who have failed traditional treatments should be considered for long-acting opioids. Opioids are best administered in the framework of weighing the good against the bad in each patient, recognizing the potential morbidity and sometimes mortality in untreated patients who have severe and disabling pain daily.
Article
Full-text available
Context While recent pharmacological advances have generated increased public interest and demand for clinical services regarding erectile dysfunction, epidemiologic data on sexual dysfunction are relatively scant for both women and men. Objective To assess the prevalence and risk of experiencing sexual dysfunction across various social groups and examine the determinants and health consequences of these disorders. Design Analysis of data from the National Health and Social Life Survey, a probability sample study of sexual behavior in a demographically representative, 1992 cohort of US adults. Participants A national probability sample of 1749 women and 1410 men aged 18 to 59 years at the time of the survey. Main Outcome Measures Risk of experiencing sexual dysfunction as well as negative concomitant outcomes. Results Sexual dysfunction is more prevalent for women (43%) than men (31%) and is associated with various demographic characteristics, including age and educational attainment. Women of different racial groups demonstrate different patterns of sexual dysfunction. Differences among men are not as marked but generally consistent with women. Experience of sexual dysfunction is more likely among women and men with poor physical and emotional health. Moreover, sexual dysfunction is highly associated with negative experiences in sexual relationships and overall wellbeing. Conclusions The results indicate that sexual dysfunction is an important public health concern, and emotional problems likely contribute to the experience of these problems.
Article
Full-text available
While recent pharmacological advances have generated increased public interest and demand for clinical services regarding erectile dysfunction, epidemiologic data on sexual dysfunction are relatively scant for both women and men. To assess the prevalence and risk of experiencing sexual dysfunction across various social groups and examine the determinants and health consequences of these disorders. Analysis of data from the National Health and Social Life Survey, a probability sample study of sexual behavior in a demographically representative, 1992 cohort of US adults. A national probability sample of 1749 women and 1410 men aged 18 to 59 years at the time of the survey. Risk of experiencing sexual dysfunction as well as negative concomitant outcomes. Sexual dysfunction is more prevalent for women (43%) than men (31%) and is associated with various demographic characteristics, including age and educational attainment. Women of different racial groups demonstrate different patterns of sexual dysfunction. Differences among men are not as marked but generally consistent with women. Experience of sexual dysfunction is more likely among women and men with poor physical and emotional health. Moreover, sexual dysfunction is highly associated with negative experiences in sexual relationships and overall well-being. The results indicate that sexual dysfunction is an important public health concern, and emotional problems likely contribute to the experience of these problems.
Article
Article
Retrospective, self-reported frequencies of pre- and post-injury sexual intercourse were compared in four back injury diagnostic groups. Comparisons were made among groups, and the relation of self-reported pain was compared to the frequency of self-reported sexual intercourse. One hundred subjects were interviewed and their medical records reviewed two years, on average, post-injury. All subjects reported a reduction in sexual frequency post-injury. The surgery group was found to experience a greater reduction in sexual frequency than non-surgery back injured patients. In addition, all subjects reported experiencing some level of pain, and the degree of reported pain was significantly correlated with reduced frequency of sexual intercourse. However, this relationship was considered clinically insignificant. The implications of these findings for individuals with chronic back pain are discussed.
Article
The objectives of this study were to describe (1) coital positions adopted by chronic back pain patients, (2) and to describe sexual function as assessed by Derogatis Inventory of Sexual Functioning (DISF). In addition, patients were asked questions regarding effects of sexual intercourse on severity of pain, influence of pain over sexual functioning, and perceived factors causing sexual problems. This is a subset (45 patients) of a larger study (70 patients) describing sexual functioning. These 45 patients responded to additional questions as described above. Mean age of the patients was 55.7 years (range 36–74 years). There were 40 male patients. Twenty-five patients (56%) were married. Mean duration of pain was 145.2 months. Thirty-two patients (27 male and 5 female) were sexually active. Eighty-one percent of male and 100% of female patients, who were sexually active, preferred male superior position. Of those sexually active, 41% performed sexual intercourse while sitting on a chair. A majority of patients were experiencing problems in all domains of sexual functioning except for fantasy. Thirty-nine patients (87%) reported that pain extremely interfered in performing sexual intercourse. Twenty-nine patients (64%) reported worsening of pain due to sexual intercourse. Majority (n = 34) of the patients (76%) had fear of failure to perform and 25 patients (56%) reported fear of aggravating pain due to sexual activity. There is need for further research in this area.
Article
Pain is a perceived threat or damage to one's biological integrity. Suffering is the perception of serious threat or damage to the self, and it emerges when a discrepancy develops between what one expected of one's self and what one does or is. Some patients who experience sustained unrelieved pain suffer because pain changes who they are. At a physiological level, chronic pain promotes an extended and destructive stress response characterised by neuroendocrine dysregulation, fatigue, dysphoria, myalgia, and impaired mental and physical performance. This constellation of discomforts and functional limitations can foster negative thinking and create a vicious cycle of stress and disability. The idea that one's pain is uncontrollable in itself leads to stress. Patients suffer when this cycle renders them incapable of sustaining productive work, a normal family life, and supportive social interactions. Although patients suffer for many reasons, the physician can contribute substantially to the prevention or relief of suffering by controlling pain. Suffering is a nebulous concept for most physicians, and its relation to pain is unclear. This review offers a medically useful concept of suffering that distinguishes it from pain, accounts for the contributory relation of pain to suffering by describing pain as a stressor, and explores the implications of these ideas for the care of patients.
Article
This is a sexological study of a random sample of 225 40-yr-old women representative of the Danish female population at the age of 40. These women were questioned by a female physician utilizing a structured interview; 94% of the women invited to participate in this study agreed to do so. The purpose of this research was to elucidate sexual behaviour, experience, knowledge and attitudes.Some of the findings were the following. Menstruation still seems to be a taboo subject; 36% of this population knew little about this topic. 96% of these women had experienced orgasm at least once in their lives and 67.6% had experienced spontaneous libido. Genuine homosexuality appears to be a rare phenomenon. A monogamous heterosexual life style is the norm, as reflected by low number of partners and low frequency of infidelity. Yet, 35% of these woman had sexual problems.There is a need for advice and treatment of sexual difficulties in this population, but these are at present, in Denmark, not generally available.
Article
Investigación sobre la sexualidad femenina hecha en Estados Unidos con base en una encuesta aplicada a 3 mil mujeres. Aborda los siguientes temas: masturbación, orgasmo, coito, estimulación clitórica, lesbianismo, esclavitud sexual, la revolución sexual, mujeres mayores y hacia una nueva sexualidad femenina.
Article
In a study of the sexual activity of 66 married patients referred to a pain management center, almost two thirds reported deterioration in sexual adjustment, with decreased frequency and quality, and more than one third reported deterioration of the marriage itself. These sexual changes represent additional problems for the patient. In order to make a comprehensive diagnosis and a recommendation for treatment, physicians must include sexual function in their medical review of patients with chronic pain.
Article
This paper reviews the literature on chronic pain patients and their families. The review focuses on family and marital variables correlated with pain, conceptualizations of the family's role in maintaining pain, reports of family treatment and follow-up studies of the family's impact on treatment. Although research in this field is generally weak methodologically, and the mechanisms whereby the family affects chronic pain are still little understood, the authors conclude that family characteristics and behaviors contribute strongly to a chronic pain problem and they have a significant influence on treatment outcome.
Article
Sexuality was investigated in 35 males and 25 females with chronic back pain. Prior to onset of pain orgasmic dysfunction was common in 60 per cent of the females with relatively lower level of sexual frustration. Markedly less sexual dysfunction characterized the males. With back pain sexual dysfunction increased in both sexes. Frequency of coitus was reduced in half the subjects and about 50 per cent also had altered coital positions. Fatigue and pain were common and sexual enjoyment was reduced for most subjects. In many females back pain may serve to legalize previously latent sexual dysfunction. However, for both sexes back pain per se causes sexual maladaptation. Therefore, sexual counselling should be part of the rehabilitation of the back pain sufferer.
Article
Fifty married patients who were referred to a pain-management program and their spouses were interviewed independently concerning marital-sexual adjustment. The effect of pain on frequency and quality of sexual activity, and the effect of sexual activity on pain, showed a consistent trend toward deterioration in sexual activity after the onset of pain complaints in both patient and spouse groups. Ratings of overall sexual adjustments and adjustment in marriage were essentially the same for both groups before the onset of pain; but after pain onset a significantly large number of spouses rated their marriage below average, whereas most patients rated it average or above average. For the pain patient and his or her spouse, it seems very important that open and candid communication exist about the constant problem of adjusting to chronic pain, and the spouse should participate in the treatment program.
Article
To describe sexual functioning and its relationship with psychological measures in chronic pain patients. It is a self report survey with a convenience sample. Seventy consenting chronic pain patients responded to a questionnaire. Mean age was 49.9 years (range 29-74); mean pain duration was 146.7 months (range 6-624). Participants endorsed a wide variety of pain conditions. INSTRUMENTS USED: (1) Derogatis Inventory of Sexual Functioning; (2) Multidimensional Pain Inventory; (3) Center for Epidemiological Studies Depression Scale: (4) Multidimensional Health Locus of Control; (5) Hopkins Symptom Check List; (6) Vanderbilt Pain Management Inventory; (7) Coping Strategies Questionnaire. Sixty-six per cent of patients were interested in sex, 50% were satisfied with current sexual partner and 20% considered current sexual life to be adequate. Over 70% fantasized at least once a month. Only 44% experienced normal arousal during intercourse; 33% practiced masturbation and 47% were involved in sexual intercourse or oral sex at least once a month. The majority were dissatisfied with orgasmic activities. No relationship was found between pain severity, duration, frequency and sexual functioning. A relationship was found between disability status, age and several psychological variables and various domains of sexual functioning. CONCLUSIONS; Sexual problems are common in chronic pain patients. Patients who reported symptoms of depression and distress had more sexual problems.
Article
Clarification of women's sexual response during long-term relationships is needed. I have presented a model that more accurately depicts the responsive component of women's desire and the underlying motivational forces that trigger it. The variety of arousal/orgasm responses is also acknowledged. The purpose is both to prevent diagnosing dysfunction when the response is simply different from the traditional human sex-response cycle and to more clearly define subgroups of dysfunction. The latter would appear to be necessary before progress in newer treatment modalities, including pharmacological, can be made.
Article
Description of the specific physical and psychological problems associated with sexual activity in patients with chronic pain. Self-completion questionnaire on extent and nature of sexual difficulties related to pain; data on psychological and physical function in respondents; personal and medical data for respondents and nonrespondents. Three hundred twenty-seven patients with chronic pain in inpatient and outpatient pain programs; 237 (72%) completed the questionnaire. Extent of general and specific sexual problems; anxiety and depression (Hospital Anxiety and Depression Scale [HAD]); pain self-efficacy; pain-related disability (Sickness Impact Profile); drug use. Respondents were younger and had less depressed mood than nonrespondents, but there were no other major differences. Seventy-three percent of respondents had pain-related difficulty with sexual activity; most had several, in various combinations of problems with arousal, position, exacerbating pain, low confidence, performance worries, and relationship problems. All except position difficulties were associated with less frequent sexual activity. There were few differences between men and women, and only weak relations emerged between specific problems and mood and disability. There is a high prevalence of sexual difficulties in patients with chronic pain attending treatment, nearly double that of a general UK survey. These difficulties are not simply related to mood or disability. The range of problems and patients' expressed preferences for help suggest that multidisciplinary intervention is required.
Article
An analysis is reported of the variety of understandings available in British culture to understand acceptance of chronic pain. Q-factor analysis is used within a critical framework as Q-methodology. Thirty participants completed the procedure. Eight factors or accounts of accepting chronic pain were derived. These are reported as taking control, living day to day, acknowledging limitations, empowerment, accepting loss of self, more to life than pain, don't fight battles that cannot be won, and spiritual strength. Common features of accepting chronic pain are (1) the acknowledgement that a cure for pain is unlikely, (2) a shift of focus away from pain to non-pain aspects of life, and (3) a resistance to any suggestion that pain is a sign of personal weakness. Where accounts of chronic pain differ is in the extent to which acceptance of pain means a change in core aspects of self. Implications of this study for the study of chronic pain are discussed. In particular, how identity is managed in the context of threatening chronic pain is suggested as a fruitful area of future investigation.
Article
A number of psychosocial factors have been associated with the onset, exacerbation and/or maintenance of chronic pain in adolescents. The present study was conducted to evaluate the relative importance of vulnerability, reinforcement, and modeling. We compared 222 adolescents with chronic pain and no documented physiological etiology (headache, back, limb and abdominal pain) with 148 controls and their (respectively 183 vs. 127) parents. Analyses showed that adolescents with chronic pain are more vulnerable in terms of neuroticism, negative fear of failure, and (less) experienced social acceptance. Contrary to our expectations, the chronic pain group experienced less reinforcement for their pain behavior by both parents and peers than the control group. While the number of pain models was higher in the chronic pain group, no differences were found between their parents and those of the adolescents without chronic pain in pain experience, pain parameters, and pain coping. Regression analyses on the contribution of psychosocial factors to chronic pain and its parameters sustained the positive relation between vulnerability, (less) pain reinforcement, pain models and coping with pain. Furthermore, we also found evidence that gender differences have to be taken into account.
Article
Persistent pain is a complex mix of physical and psychological symptoms and is ideally managed by a biopsychosocial approach. Often the relative contributions of family and personal relationships, finances, work, past pain experiences and personality outweigh those of the nociceptive or neuropathic processes from which most pain originates. Recent advances in our understanding of the pathophysiology of pain may lead to improved drug treatments; however, non-drug treatments--education, lifestyle modification, exercise and reassurance--should be used routinely to improve patients' quality of life. Patients with persistent pain that is difficult to control or has complex psychosocial influences, or who have a history of medication misuse, should be referred to a multidisciplinary pain centre. Selected patients may be offered invasive options such as nerve blocks or spinal-cord stimulation. The best outcomes are achieved in patients treated in group-based pain-management programs using cognitive-behavioural therapy to improve physical function, change unhelpful thinking and improve patients' understanding of their situation.
Klassifikation af sygdomme Alfabetisk del. 1. udg. København: Munksgaard
  • Sundhedsstyrelsen
Sundhedsstyrelsen: Klassifikation af sygdomme. Alfabetisk del. 1. udg. København: Munksgaard, 1993.
Chronic Pain Patients and Spouses, Marital and Sexual Adjustment Sexual Intercourses in Females with Different Chronic Pain Syndrome 37 8. Sj ogren K, Fugl-Meyer AR: Chronic back pain and sexuality
  • T Maruta
  • D Osborne
  • Swanson Dw
  • Halling
  • Jm
Maruta T, Osborne D, Swanson DW, Halling JM: Chronic Pain Patients and Spouses, Marital and Sexual Adjustment. Mayo Clin Proc 56:307–310, 1981. Sexual Intercourses in Females with Different Chronic Pain Syndrome 37 8. Sj ogren K, Fugl-Meyer AR: Chronic back pain and sexuality. Int Rehabil Med 3:19–25, 1981.
A National Study of Female Sexuality
  • S Hite
  • Hite Report The
Hite S: The Hite Report. A National Study of Female Sexuality. New York: Dell Pub-lishing Co, 1976.
Klassifikation af sygdomme. Alfabetisk del. 1. udg
  • Sundhedsstyrelsen
Human Sexual Response
  • W Masters
  • V Johnson