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Psychometric Validation of Gender Nonspecific Sexual Confidence and Sexual Relationship Scales in Men and Women
Abstract
Introduction:
The Sexual Confidence Scale (SCS) and the Sexual Relationship Scale (SRS) are two new measures designed for use by men and women across sexual dysfunction groups. The SCS assesses how confident an individual feels as a sexual partner, while the SRS assesses feelings that an individual has about their sexual relationship with their partner.
Aim:
To conduct item reduction and psychometric validation of the SCS and SRS instruments.
Methods:
To validate the new measures, 104 men with premature ejaculation (PE), 101 men with erectile dysfunction (ED) and 106 women with female sexual arousal disorder (FSAD) took part in the study. One hundred and one males and 53 females without sexual dysfunction also completed the measures.
Main outcome measures:
The internal consistency, convergent, and discriminant validity, test-retest reliability and known-groups validity of the instruments were assessed.
Results:
The number of items in each scale was reduced following standard item reduction analyses and reference to the conceptual framework. Factor analysis confirmed a one-factor solution for the SCS and a two-factor solution for the SRS. Internal consistency was good, with cronbach's alpha >or=0.7 across the groups for both the SCS and SRS. Excellent test-retest reliability and ability to discriminate between men and women with and without sexual dysfunction were also demonstrated for both scales. Correlations with the Sexual Quality of Life Questionnaire (SQOL) ranged from 0.48 to 0.80 indicating good convergent validity.
Conclusions:
The SCS and the SRS are reliable and valid instruments in men with PE or ED and in women with FSAD. These modules may be used either as stand-alone measures or, preferably, in conjunction with the SQOL to provide a complete assessment of sexual quality of life.
... It has been widely demonstrated that sexual dysfunction is associated with decreased quality of life and life satisfaction; it is also widely believed that a good-enough level of sexual functioning is important for general quality of life (Chevret, Jaudinot, Sullivan, Marrel, & Gendre, 2004;Dunn, Croft, & Hackett, 1999;Fisher, Rosen, Eardley, Sand, & Goldstein, 2005;Rosen et al., 2004). Therefore, it has been suggested that evaluation of the effectiveness of any therapeutic approach aimed at improving sexual functioning should incorporate an assessment of quality of life as a key outcome (Abraham et al., 2009). ...
... The rationale for the development of these measures was that generic measures of quality of life were (considered) unlikely to be sensitive enough to assess changes in SQOL. Therefore, these measures were developed to address relevant psychosocial domains when evaluating changes in sexually related quality of life (Abraham et al., 2009). The basis for the generation of these measures was Spitzer's Quality of Life model (Spitzer, 1987) that involves physical, emotional, psychological, and social components. ...
... Considering this, sexual confidence and sexual relationship are both frequently included as key outcomes in the assessment of new treatments for sexual functioning. The Sexual Confidence Scale (SCS) and the Sexual Relationship Scale (SRS) were developed as extensions to the SQOL project (Abraham et al., 2009). Abraham and colleagues (2009) noted that although the two SQOL instruments examined a variety of concepts underlying SQOL (e.g. ...
We are still left with the issue of characterising what counts as successful outcome in sex therapy. The aim of this paper is to report the progress of the outcome measurement project initiated by the College of Sexual and Relationship Therapists. In this report, I have reviewed the existing literature to answer the following question: “Does there currently exist a validated evaluation tool (or a package of tools) by which the effectiveness and success of sex therapy in dealing with sexual problems can be measured and demonstrated?”. I start with discussing some of the key dilemmas in relation to measuring outcomes in sex therapy and arrive at a conceptual framework to address this. I finish with suggesting a few measurement tools that can be utilised in this regard.
... Confidence as a sexual partner was measured using the 6item Sexual Confidence Scale (Abraham et al., 2009). Participants who had ever had a sexual partner rated their level of agreement with each item (e.g., ''I have confidence in myself as a sexual partner'') on a 6-point Likert-type scale ranging from 1 (strongly disagree) to 6 (strongly agree). ...
... Higher scores indicated greater sexual confidence. Abraham et al. (2009) reported high internal consistencies for this scale (a ¼ .85 to .89). Reliability for the present sample was also high (a ¼ .88). ...
Our study investigated predictors of consideration of labiaplasty (the surgical reduction of the labia) using a sociocultural framework. A sample of 351 heterosexual adult Australian women aged 18–69 years completed measures of media exposure, peer influence, relationship quality, internalisation of the genital ideal, genital appearance comparison, genital appearance dissatisfaction, and consideration of labiaplasty. Almost all predictor variables were significantly correlated with consideration of labiaplasty. A structural equation model based on the Tripartite Influence Model focused on beauty ideals showed a good level of fit to the data: The effects of media exposure and peer influence on genital appearance dissatisfaction and consideration of labiaplasty were mediated by internalisation of the genital ideal and genital appearance comparison. We concluded that media exposure, peer influence, and relationship quality influenced consideration of labiaplasty both directly and indirectly. The results contribute to a greater understanding of the sociocultural motivations behind labiaplasty and also demonstrate an important extension of the Tripartite Influence Model beyond the explanation of disordered eating behaviours to the consideration of a specific form of cosmetic surgery. The development of media literacy programmes may be beneficial in addressing genital appearance concerns in young girls.
... [3] The 'script' metaphor emphasizes that sexual behaviors originate from socially determined norms of sexuality. Individuals acquire their sexual 'character' through a [5] Subjective sexual well-being (SSWB) (Laumann et al., 2006) [6] Sexuality scale (SS) (Snell & Papini, 1989) [7] Sexual relationship index (SRI) (Haning, 2005) [8] Sexual self schema scale (SSSS) (Andersen & Cyranowski, 1994) [9] Sexual relationship scale (Hughes & Snell, 1990) [10] Sexual interest and desire inventory-female (DIDI-F) (Clayton et al., 2006) [11] Sexual function questionnaire (Quirk et al., 2002) [12] Sexual confidence scale (Abraham et al., 2009) [13] New sexual satisfaction scale (NSSS) (Stulhofer, Busko, & Brouillard, 2010) [14] Mccoy female sexuality questionnaire (McCoy & Davidson, 1985) [15] Index of sexual satisfaction (ISS) (Hudson, Harrison, & Crosscup, 1981) [16] Female sexual well-being scale (FSWB) (R. C. Rosen et al., 2009) [17] Female sexual function index (FSFI) (R. Rosen et al., 2000) [4] Derogatis interview for sexual functioning (DISF-SR) (L. R. Derogatis, 1997) [18] Global measure of sexual satisfaction (GMSEX) (lawrance & byers, 1995) [19] Arizona sexual experience scale (ASEX) (McGahuey et al., 2006) [20] Sexual dysfunctional beliefs questionnaire (SDBQ) (P. ...
... [3] The 'script' metaphor emphasizes that sexual behaviors originate from socially determined norms of sexuality. Individuals acquire their sexual 'character' through a [5] Subjective sexual well-being (SSWB) (Laumann et al., 2006) [6] Sexuality scale (SS) (Snell & Papini, 1989) [7] Sexual relationship index (SRI) (Haning, 2005) [8] Sexual self schema scale (SSSS) (Andersen & Cyranowski, 1994) [9] Sexual relationship scale (Hughes & Snell, 1990) [10] Sexual interest and desire inventory-female (DIDI-F) (Clayton et al., 2006) [11] Sexual function questionnaire (Quirk et al., 2002) [12] Sexual confidence scale (Abraham et al., 2009) [13] New sexual satisfaction scale (NSSS) (Stulhofer, Busko, & Brouillard, 2010) [14] Mccoy female sexuality questionnaire (McCoy & Davidson, 1985) [15] Index of sexual satisfaction (ISS) (Hudson, Harrison, & Crosscup, 1981) [16] Female sexual well-being scale (FSWB) (R. C. Rosen et al., 2009) [17] Female sexual function index (FSFI) (R. Rosen et al., 2000) [4] Derogatis interview for sexual functioning (DISF-SR) (L. R. Derogatis, 1997) [18] Global measure of sexual satisfaction (GMSEX) (lawrance & byers, 1995) [19] Arizona sexual experience scale (ASEX) (McGahuey et al., 2006) [20] Sexual dysfunctional beliefs questionnaire (SDBQ) (P. ...
The cultural compatibility of sexually related instruments is problematic because the contexts from which the concepts and meanings were extracted may be significantly different from related contexts in a different society. This paper describes the instruments that have been used to assess sexual behaviors, primarily in Western contexts. Then, based on the instruments' working definition of 'sexual behavior' and their theoretical frameworks, we will (1) discuss the applicability or cultural compatibility of existing instruments targeting women's sexual behaviors within an Iranian context, and (2) suggest criteria for sexually related tools applicable in Iranian settings. Iranian women's sexual scripts may compromise the existing instruments' compatibility. Suggested criteria are as follows: understanding, language of sexuality, ethics and morality. Therefore, developing a culturally comprehensive measure that can adequately examine Iranian women's sexual behaviors is needed.
... Multiple tools have been developed to evaluate FSD [5][6][7]. Female Sexual Function Index-19 (FSFI-19) is a frequently used and valid method of measuring sexual dysfunction [8]. FSFI-19 helps safely assess female sexual function, and its effectiveness in different age groups has been demonstrated by several studies [9,10]. ...
This study aims to assess the validity and reliability of the Turkish version of the FSFI-6 questionnaire,an abbreviated version of FSFI-19,a common tool for evaluating female sexual function. The study included 120 female patients aged between 18–65 years who presented to the urology clinic between December 2019 and March 2020. The Turkish version of FSFI-6 was translated from the English version for validation. The abridged FSFI-6 questionnaire consists of questions 2, 4, 7, 11, 16, and 17 of the FSFI-19 form. We recorded the demographic data of the patients. All subjects filled out the FSFI-19 and FSFI-6 questionnaires. The patients were asked to fill out the questionnaires again after two weeks. The mean age of the subjects was 46.58 ± 9.89 years (28–63). The results of the reliability analysis indicated that the intraclass correlation coefficient of the total FSFI-6 score was 0.92 (weighted kappa coefficients of individual items, 0.868–0.975) and the Cronbach’s alpha was 0.862. The validity analysis indicated that the mean total FSFI-6 score was strongly correlated with the mean FSFI-19 score (p < 0.001, r = 0.997). In the test-retest analysis,the kappa coefficient was calculated as 0.891. The FSFI-19 and FSFI-6 scores of the patients with (n = 52) and without climacturia (n = 68) were compared, and it was observed that the scores of the patients with climacturia were significantly lower than those without climacturia (p < 0.001). The abbreviated FSFI-6 questionnaire is a valuable tool for screening women with FSD. It can be used more extensively due to being short and easy to apply. Our results approve the Turkish version of the questionnaire as a valid and reliable tool for evaluating FSD.
... Higher scores indicate better sexual quality of life [23]. ...
Purpose:
To assess sexual health and needs for sexology care of cancer patients during chemotherapy.
Methods:
We performed a 4-month cross-sectional study in cancer patients treated by chemotherapy in the digestive cancer department of a regional university hospital. Patients were asked to fill out a self-administered questionnaire about their sexual health, Sexual Quality of Life Questionnaire for Male (SQoL-M) or Female (SQoL-F), and their needs for sexology care.
Results:
The study sample was composed of 47 men and 31 women. Tumor locations were 36 colorectal (46%), 23 pancreatic (30%), and 19 other digestive cancers (24%). SQoL scores were lower in women (p < .001), in pancreatic and colorectal tumors (p = .041 and p = .033, respectively) compared to other digestive cancers, and in less-educated patients (p = .023). During chemotherapy, 40% of sexually active patients had less frequent sexual intercourse than before diagnosis, and 33% had completely stopped sexual activity. Sexuality care was desired by 44% of respondents. Among them, 83% favored a consultation with a medical sexologist and 63% with a psycho-sexologist, 54% wanted couple therapy, and 31% considered support groups. Patients with colorectal cancer had more frequent sexual intercourse without penetration at the time of survey (p = .036) and more often wanted couple therapy than patients with pancreatic cancer (p = .048).
Conclusions:
This study is the first determination of sexual health and sexual quality of life in digestive cancers. Targets for interventions during chemotherapy for digestive cancers include populations with lower sexual quality of life: women, pancreatic sites, patients with sexual troubles during chemotherapy, and less-educated patients.
... The SQoL-M has 18 items, each with a 6-point response scale (completely agree to completely disagree). The instrument has good psychometric properties [28][29][30] and had been validated in Spanish [31]. ...
Traumatic brain injury has been linked with higher incidence of sexual problems. As there have been few published reports regarding sexual functioning in men with traumatic brain injury in Latin America, this study sought to compare sexual measures in men with traumatic brain injury with healthy controls. The hypotheses that males with TBI would experience significantly lower indices of sexual functioning compared to unaffected individuals and that increased age and injury severity would predict lower sexual functioning among participants with TBI were tested. Seventy-one Spanish-speaking Colombian men with a history of moderate to severe TBI who were at least 6 months post-injury, and 71 healthy controls participated by completing the Sexual Desire Inventory, International Index of Erectile Function, Index of Premature Ejaculation, Sexual Quality of Life Questionnaire, Index of Sexual Satisfaction. SPSS 22 was used to analyze the results. When compared to matched controls, males with TBI had significantly lower overall and dyadic sexual desire, sexual satisfaction and sexual quality of life. Erectile functioning, ejaculation control, satisfaction with ejaculation control were reported to by lower in the TBI group than in the control group. Almost 44% of participants with TBI had moderate to severe erectile dysfunction, whereas nearly 10% of the control group had the same.
... In line with this, there is recognition that in assessing treatment outcome we need to shift the focus from an emphasis on sexual ''functioning" (e.g., frequency and intensity of desire and orgasms) to broader and more clinically meaningful outcomes such as sexual satisfaction (Stulhofer et al., 2010), sexual quality of life, and sexual esteem (Abraham et al., 2009). These constructs are multidimensional and hence more challenging to assess than sexual function criteria (Rowland, 2007), but often represent the targets, and measured outcomes in sex therapy settings (Meana et al., 2014). ...
Low sexual desire is the most common sexual complaint in women, with multinational studies finding that at least a third of women experience low sexual desire. No single etiology for the development of Female Sexual Interest/Arousal Disorder, the diagnosis laid out by the 5(th) edition of the Diagnostic and Statistical Manual of Mental Disorders, has been established. There has been considerable interest in pharmacological approaches to improving low desire, and agents targeting a range of neurotransmitters have been examined. To date, only flibanserin, a centrally acting medication targeting the serotonin, dopamine, and norepinephrine systems, has been approved by the Food and Drug Administration (FDA). Despite statistically significant effects on sexual desire, sexual distress, and sexually satisfying events, side-effects are significant, and flibanserin is completely contraindicated with alcohol. As such, there has been renewed interest in advancing the science of psychological approaches to low desire, including cognitive behavioral and mindfulness therapies.
... 291 There has been a shift in focus from assessing only improvement in individual sexual functioning to broader and more clinically meaningful outcome variables such as sexual satisfaction, 292 sexual quality of life, and sexual confidence. 293 Although there are validated assessments of sexual functioning and of sexual distress, 294,295 some are suitable only for sexually active individuals or for heterosexual couples 296 ; few assessments exist for sexual minority individuals. 297 When evaluating sexual function variables, what constitutes a "good" outcome is not straightforward. ...
Introduction:
Psychological, interpersonal, and sociocultural factors play a significant role in making one vulnerable to developing a sexual concern, in triggering the onset of a sexual difficulty, and in maintaining sexual dysfunction in the long term.
Aim:
To focus on psychological and interpersonal aspects of sexual functioning in women and men after a critical review of the literature from 2010 to the present.
Methods:
This report is part 1 of 2 of our collaborative work during the 2015 International Consultation on Sexual Medicine for Committee 2.
Main outcome measures:
Systematic review of the literature with a focus on publications since 2010.
Results:
Our work as sexual medicine clinicians is essentially transdisciplinary, which involves not only the collaboration of multidisciplinary professionals but also the integration and application of new knowledge and evaluation and subsequent revision of our practices to ensure the highest level of care provided. There is scant literature on gender non-conforming children and adolescents to clarify specific developmental factors that shape the development of gender identity, orientation, and sexuality. Conversely, studies consistently have demonstrated the interdependence of sexual function between partners, with dysfunction in one partner often contributing to problems in sexual functioning and/or sexual satisfaction for the other. We recommend that clinicians explore attachment styles of patients, childhood experiences (including sexual abuse), onset of sexual activity, personality, cognitive schemas, infertility concerns, and sexual expectations. Assessment of depression, anxiety, stress, substance use and post-traumatic stress (and their medical treatments) should be carried out as part of the initial evaluation. Clinicians should attempt to ascertain whether the anxiety and/or depression is a consequence or a cause of the sexual complaint, and treatment should be administered accordingly. Cognitive distraction is a significant contributor to sexual response problems in men and women and is observed more consistently for genital arousal than for subjective arousal. Assessment of physical and mental illnesses that commonly occur in later life should be included as part of the initial evaluation in middle-aged and older persons presenting with sexual complaints. Menopausal status has an independent effect on reported changes in sex life and difficulties with intercourse. There is strong support for the use of psychological treatment for sexual desire and orgasm difficulties in women (but not in men). Combination therapies should be provided to men, whenever possible.
Conclusion:
Overall, research strongly supports the routine clinical investigation of psychological factors, partner-related factors, context, and life stressors. A biopsychosocial model to understand how these factors predispose to sexual dysfunction is recommended.
... Confidence as a sexual partner was measured using the six-item Sexual Confidence Scale. 24 Participants who had ever had a sexual partner in their lifetime rated their level of agreement with each item (eg, "I have confidence in myself as a sexual partner") on a 6-point Likert scale ranging from 1 (strongly disagree) to 6 (strongly agree). Summed total scores ranged from 6 to 36, and reliability for the present sample was high (Cronbach's α = .88). ...
Background: An increasing number of women are undergoing labiaplasty procedures; however, very little is known about the psychological factors that motivate women to seek out this procedure.
Objectives: To investigate the factors that influence women’s decisions to undergo labiaplasty.
Methods: Women seeking to undergo labiaplasty (n = 35) were compared with women who were not (n = 30). Standardized measures were employed to assess the patients’ media exposure (television, the Internet, advertising, pornography), relationship quality, and psychological well-being.
Results: Women’s motivations for deciding to undergo a labiaplasty procedure were characterized as “appearance,” “functional,” “sexual,” or “psychological” motivations, with concerns about the labia’s appearance being the most commonly reported motivation. Correspondingly, women seeking labiaplasty were significantly less satisfied with the appearance of their genitals than the comparison group (P < .001). These women had also experienced greater exposure to images of female genitalia on the Internet (P = .004) and in advertisements (P = .021), and had internalized these images to a greater extent (P = .010). There were no differences between the two groups on the measures of relationship quality. However, significantly fewer of the women seeking to undergo a labiaplasty procedure were involved in a romantic relationship at the time of the study (P = .039). There were also no differences between the two groups on the measures of psychological well-being, except that women seeking to undergo labiaplasty were less satisfied with their lives overall (P = .027).
Conclusions: The findings identified media exposure and relationship status as important factors that influence women’s decisions to undergo labiaplasty.
... Confidence as a sexual partner was measured using the six-item Sexual Confidence Scale. 24 Participants who had ever had a sexual partner in their lifetime rated their level of agreement with each item (eg, "I have confidence in myself as a sexual partner") on a 6-point Likert scale ranging from 1 (strongly disagree) to 6 (strongly agree). Summed total scores ranged from 6 to 36, and reliability for the present sample was high (Cronbach's α = .88). ...
The study investigated the effectiveness of two online resources aimed at improving women's knowledge of the variation in normal female genital appearance and their attitudes towards their own genitals. The first consisted of a photographic array of normal female genitals and the second consisted of a video addressing digital airbrushing of women's genitals in media images. A sample of 136 female undergraduate students were randomly assigned to view the photographs, video, both the photographs and video, or neither. The video significantly increased women's perceptions of genital appearance diversity as well as awareness of digital airbrushing of genital images. Owing to relatively low levels of genital appearance concern, there was no effect of either resource on women's attitudes towards their own genitals; however, women who viewed the video indicated they would pass on their knowledge to help other women. Our results suggest that an educational video could be a useful tool.
... Higher scores indicate better sexual quality of life. It has good psychometric properties [27][28][29]. The SQoL had been validated in Spanish and this version was utilized [30]. ...
Traumatic brain injury (TBI) can substantially alter many areas of a person’s life and there has been little research published regarding sexual functioning in women with TBI.
Methods
. A total of 58 women (29 with TBI and 29 healthy controls) from Neiva, Colombia, participated. There were no statistically significant differences between groups in sociodemographic characteristics. All 58 women completed the Sexual Quality of Life Questionnaire (SQoL), Female Sexual Functioning Index (FSFI), Sexual Desire Inventory (SDI), and the Sexual Satisfaction Index (ISS).
Results
. Women with TBI scored statistically significantly lower on the SQoL (
p
<
0.001
), FSFI subscales of desire (
p
<
0.05
), arousal (
p
<
0.05
), lubrication (
p
<
0.05
), orgasm (
p
<
0.05
), and satisfaction (
p
<
0.05
), and the ISS (
p
<
0.001
) than healthy controls. Multiple linear regressions revealed that age was negatively associated with some sexuality measures, while months since the TBI incident were positively associated with these variables.
Conclusion
. These results disclose that women with TBI do not fare as well as controls in these measures of sexual functioning and were less sexually satisfied. Future research is required to further understand the impact of TBI on sexual function and satisfaction to inform for rehabilitation programs.
... Items are rated on a 1 (completely agree) to 6 (completely disagree) scale, with higher summed scores indicating greater sexual satisfaction and well-being (Symonds et al., 2005). The SQOL-F has demonstrated good psychometric properties, including convergent validity, discriminant validity, and test-retest reliability (Abraham et al., 2009;Symonds et al., 2005). ...
Research on psychological factors related to female sexual functioning has been growing in recent years. Our study draws on the existing sexual health literature and objectification theory to test a model of female sexual functioning. Using structural equation modeling, we examined the associations of body surveillance and internalization of cultural standards of beauty with appearance anxiety, depression, and sexual health (i.e., physical sexual functioning and subjective sexual well-being) in a sample of 426 sexually active, heterosexual, cisgender women. Further, we investigated the role of depression and appearance anxiety as mediators of the associations of body surveillance and internalization of cultural standards of beauty with sexual health. Our findings contribute to the growing body of empirical research that examines the role of sociocultural and psychological factors in female sexual functioning. Results suggest that depression and appearance anxiety fully mediated the relations of body surveillance with sexual well-being. However, internalization of cultural standards of beauty was not significant with any study outcomes. These findings expand on existing objectification theory literature by elucidating the associations of body surveillance and internalization of cultural standards of beauty with sexual functioning as well as by highlighting the importance of attending to body image, appearance anxiety, and depression when working clinically with women reporting concerns with their sexual functioning.
... This questionnaire refers to the 4 weeks prior to its application. The SQoL-M (male version) was developed by Abraham et al. (2009), and consists of 11 items. It is also a self-administered questionnaire for men, over 18 years, taking 5 min to complete. ...
Urinary incontinence (UI) is a symptom of an underlying disorder with a high prevalence, constituting an important public health problem due to its physical, psychological and social consequences. The impact it has on the individuals' quality of life is revealed in their daily activities, self-perception, socialization, emotional health and in their sexual life. The objective of this study is to analyse the impact of incontinence on the sexual quality of life, identifying the role of the variables: gender, duration and severity of incontinence, impact of incontinence on the quality of life and type of incontinence. The sample was composed by 55 patients (54·05% male and 45·5% female) from health facilities, in Lisbon, with a mean age of 55 years, who answered a set of questionnaires, which included: the Incontinence Impact Questionnaire (IIQ-7); the Urogenital Distress Inventory (UDI-6); the Questionnaire on Sexual Quality of Life, male and female versions (SQoL-F/SQoL-M) and a sociodemographic questionnaire. The results indicate that UI has a negative impact on the sexual quality of life in general, especially if the incontinence symptoms endure for a long period of time; also the impact of UI on social relationships, and the stress UI has a significant and negative impact on the sexual quality of life. In this study, UI has a negative impact on sexual life compounded by restrictions and other negative consequences of living with urinary leakage. The authors conclude that further research is required to ascertain the full impact of UI on sexual quality of life. Finally, implications for nurses are also discussed: in addressing the sexual health of their patients, nurses have an important contribution in assuring that experiencing UI should not necessarily translate into negative sexual quality of life.
... Finding the correct way to ask delicate questions and to decode answers on sexual health and disease might be difficult and even embarrassing for the inexperienced physician. Standardized, validated sexual inventories might thus become a valuable help [14][15][16][17][18][19][20][21][22]. Since 1980s, several assessment tools, specific to or inclusive of female sexual function, that are suitable for office-based use have been introduced [16]. ...
A limiting step in the evaluation of female sexual dysfunction (FSD) is the availability of a rapid screening procedure. Often, practitioners avoid investigating sexual symptoms due to concerns of insufficient time or lack of proper tools to address FSD.
The purpose of this study was to prepare and validate an abridged form of the most popular psychometric diagnostic test (Female Sexual Function Index, FSFI-19) to provide a fast screener of FSD for easy use in outpatient visits, epidemiological studies, and assessment of treatment response.
We interviewed and administered the FSFI-19 to 200 women attending outpatient clinics for sexual and reproductive medicine. Forty women were excluded because they had no sexual activity or failed to attend the retest visit. Patients were evaluated on two subsequent visits to validate the abridged form of the questionnaire. Overall, 105 were found to suffer from a FSD.
We assessed, individually, the sensibility and sensitivity of all questions of the full-length FSFI. We then estimated the performance of each item with respect to the specific sexual domain they address. By selecting the best combination of performing items in each domain, we built an abridged, 6-item form of the FSFI.
The Receiver Operating Characteristic curves of the FSFI-6 showed that women who scored <or=19 were classified as having FSD. Using the cut-off of 19, the sensitivity and specificity of the test were, 0.93 and 0.94, respectively. Reliability, internal consistency, and stability on retest were also good.
The abridged FSFI-6 is a valuable tool for screening women that are likely to suffer from FSD. In six simple questions, taking no more than 3 minutes, a score of less than 19 indicates the need for further investigations, including the full-length FSFI-19 and a dedicated interview. In conclusion, this is a novel tool that can help any doctor to disclose FSD rapidly and efficiently.
Background
Obstructive sleep apnoea syndrome (OSAS) is associated with several chronic diseases, including erectile dysfunction (ED). The association of OSAS and ED is far more common than might be found by chance; the treatment of OSAS with non‐invasive positive airway pressure therapy is associated with improvement of respiratory symptoms, and may contribute to the improvement of associated conditions, such as ED.
Objectives
To assess the effectiveness and acceptability of non‐invasive positive airway pressure therapy for improving erectile dysfunction in OSAS.
Search methods
We identified studies from the Cochrane Airways Trials Register, CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, AMED EBSCO, and LILACS, the US National Institutes of Health ongoing trials register ClinicalTrials.gov, and the World Health Organisation international clinical trials registry platform to 14 June 2021, with no restriction on date, language, or status of publication. We checked the reference lists of all primary studies, and review articles for additional references, and relevant manufacturers' websites for study information. We also searched specific conference proceedings for the British Association of Urological Surgeons; the European Association of Urology; and the American Urological Association to 14 June 2021.
Selection criteria
We considered randomised controlled trials (RCTs) with a parallel or cross‐over design, or cluster‐RCTs, which included men aged 18 years or older, with OSAS and ED. We considered RCTs comparing any non‐invasive positive airway pressure therapy (such as continuous positive airways pressure (CPAP), bilevel positive airway pressure (BiPAP), variable positive airway pressure (VPAP), or similar devices) versus sham, no treatment, waiting list, or pharmacological treatment for ED. The primary outcomes were remission of ED and serious adverse events; secondary outcome were sex‐related quality of life, health‐related quality of life, and minor adverse events.
Data collection and analysis
Two review authors independently conducted study selection, data extraction, and risk of bias assessment. A third review author solved any disagreement. We used the Cochrane RoB 1 tool to assess the risk of bias of the included RCTs. We used the GRADE approach to assess the certainty of the body of evidence. To measure the treatment effect on dichotomous outcomes, we used the risk ratio (RR); for continuous outcomes, we used the mean difference (MD). We calculated 95% confidence intervals (CI) for these measures. When possible (data availability and homogeneous studies), we used a random‐effect model to pool data with a meta‐analysis.
Main results
We included six RCTs (all assessing CPAP as the non‐invasive positive airway pressure therapy device), with a total of 315 men with OSAS and ED. All RCTs presented some important risk of bias related to selection, performance, assessment, or reporting bias. None of included RCTs assessed the ED remission rate, and we used the provided ED mean scores as a proxy.
CPAP versus no CPAP
There is uncertainty about the effect of CPAP on mean ED scores after 4 weeks, using the International index of erectile function (IIEF‐5, higher = better; MD 7.50, 95% CI 4.05 to 10.95; 1 RCT; 27 participants; very low‐certainty evidence), and after 12 weeks (IIEF‐ED, ED domain; MD 2.50, 95% CI ‐1.10 to 6.10; 1 RCT; 57 participants; very low‐certainty evidence, downgraded due to methodological limitations and imprecision). There is uncertainty about the effect of CPAP on sex‐related quality of life after 12 weeks, using the Self‐esteem and relationship test (SEAR, higher = better; MD 1.00, 95% CI ‐8.09 to 10.09; 1 RCT; 57 participants; very low‐certainty evidence, downgraded due to methodological limitations and imprecision); no serious adverse events were reported after 4 weeks (1 RCT; 27 participants; very low‐certainty evidence, downgraded due to methodological limitations and imprecision).
CPAP versus sham CPAP
One RCT assessed this comparison (61 participants), but we were unable to extract outcomes for this comparison due to the factorial design and reporting of this trial.
CPAP versus sildenafil (phosphodiesterase type 5 inhibitors)
Sildenafil may slightly improve erectile function at 12 weeks when compared to CPAP, measured with the IIEF‐ED (MD ‐4.78, 95% CI ‐6.98 to ‐2.58; 3 RCTs; 152 participants; I² = 59%; low‐certainty evidence, downgraded due to methodological limitations).
There is uncertainty about the effect of CPAP on sex‐related quality of life after 12 weeks, measured with the Erectile Dysfunction Inventory of Treatment Satisfaction questionnaire (EDITS, higher = better; MD ‐1.24, 95% CI ‐1.80 to ‐0.67; 2 RCTs; 122 participants; I² = 0%; very low‐certainty evidence, downgraded due to methodological limitations). No serious adverse events were reported for either group (2 RCTs; 70 participants; very low‐certainty evidence, downgraded due to methodological limitations and imprecision). There is uncertainty about the effects of CPAP when compared to sildenafil for the incidence of minor adverse events (RR 1.33, 95% CI 0.34 to 5.21; 1 RCT; 40 participants; very low‐certainty evidence, downgraded due to methodological limitations and imprecision). The confidence interval was wide and neither a significant increase nor reduction in the risk of minor adverse events can be ruled out with the use of CPAP (4/20 men complained of nasal dryness in the CPAP group, and 3/20 men complained of transient flushing and mild headache in the sildenafil group).
Authors' conclusions
When compared with no CPAP, we are uncertain about the effectiveness and acceptability of CPAP for improving erectile dysfunction in men with obstructive sleep apnoea. When compared with sildenafil, there is some evidence that sildenafil may slightly improve erectile function at 12 weeks.
Background
Labiaplasty (labia minora reduction) has been increasingly requested in recent years. The surgical procedures previously reported in the literature may have some complications that affect patient satisfaction.Methods
Patients who underwent a new bilateral labiaplasty procedure that combined wedge de-epithelialization on the medial side with edge resection on the lateral side were retrospectively reviewed. Satisfaction rates were assessed, and questionnaires, namely the Female Sexual Function Index (FSFI) and Genital Appearance Satisfaction (GAS) scale, were distributed and analyzed. The data from the study group were compared with data from cases who underwent traditional labiaplasty with wedge resection (control group).ResultsFrom October 2015 to February 2020, fifty-one women underwent modified labiaplasty, while 26 women underwent traditional labiaplasty. A total of 94.1% (48/51) of patients in the modified group were satisfied with the genital appearance. Compared with the 96.2% (25/26) satisfaction rate in the control group, the difference was not statistically significant. A total of 43/55 valid questionnaires were returned, including 29 in the modified labiaplasty group and 14 in the control group. There was a significant improvement in the postoperative GAS scale compared to the preoperative scale in both groups (P<0.05). The new modified method had a significant FSFI improvement after the operation compared with preoperative scores (P<0.05), while the FSFI improvement was not significant in the control group (P>0.05). There was no significant difference in the FSFI score improvement, postoperative GAS score or postoperative FSFI between the two groups (P>0.05).Conclusion
This new modified labiaplasty is a satisfying and safe method with low risks, and it may result in better sexual sensitivity for the patientsLevel of Evidence IVThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine Ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266.
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effectiveness and acceptability of continuous positive airway pressure (CPAP) for improving erectile dysfunction in OSAS.
Background:
Providing early and better care in onco-sexuality and a better understanding of the sexual health care needs of patients before they start treatment is required.
Objective:
To assess sexual quality of life and need for sexology care of patients when they are starting radiotherapy.
Design:
We performed a cross-sectional study of adult patients with cancer admitted for radiotherapy treatment in a regional comprehensive cancer center.
Methods:
We selected all consecutive adult patients scheduled to start radiotherapy within a 3-month period and excluded patients who could not complete the questionnaires. Patients were asked to complete the Sexual Quality of Life Questionnaire (SQoL) and a needs-assessment questionnaire.
Outcomes:
Total score on the SQoL and willingness (yes or no) to get help for a sexual problem.
Results:
The study sample was composed of 77 men and 123 women. The average SQoL scores were 68.4 ± 20.9 and 47.1 ± 13.0 for men and women, respectively (P < .001). Of sexually active patients, 58% had decreased frequency of intercourse or had completely stopped sexual activity after their cancer diagnosis. Half the participants wanted care for their sexual concerns. The proportion desiring specific types of care varied from 28.5% (couple counseling) to 54.5% (sexual physician) with variation by sex or type of cancer. Furthermore, 11.5% of participants declared their willingness to join support groups.
Clinical implications:
Early interventions before radiotherapy could improve sexual quality of life, particularly in women.
Strengths and limitations:
Strengths are the SQoL validated in men and women, the original window for assessment, and the study location. Limitations are the monocentric design, the potential recall bias for data before cancer diagnosis, and the fact that some patients had treatments before radiotherapy.
Conclusion:
Our data suggest the need to examine the sexual health trajectory in a prospective fashion from diagnosis to survivorship. Almont T, Delannes M, Ducasson A, et al. Sexual Quality of Life and Needs for Sexology Care of Cancer Patients Admitted for Radiotherapy: A 3-Month Cross-Sectional Study in a Regional Comprehensive Reference Cancer Center. J Sex Med 2017;14:566-576.
Background:
Although the demand for labiaplasty has increased rapidly over the past decade, little is known about the psychological outcomes of this procedure. In particular, there is a lack of prospective controlled studies to assess the effects of labiaplasty on women's psychological well-being and intimate relationship quality. Nor has research investigated whether preoperative patient characteristics predict satisfaction with surgery.
Methods:
The current study used a prospective controlled design. Participants were 29 adult Australian women who underwent labia minora reduction and 22 comparison women who did not. Both groups completed a baseline questionnaire (preoperatively for the labiaplasty group) and a follow-up questionnaire 6 months later. The questionnaires contained standardized measures of genital appearance satisfaction, relationship satisfaction, sexual confidence, psychological distress, self-esteem, and life satisfaction.
Results:
Of the 29 women who underwent labiaplasty, the vast majority reported that they were "moderately" or "extremely" satisfied with the aesthetic (82.8 percent), functional (86.2 percent), and overall (82.8 percent) outcomes. For the standardized measures, the only significant change from baseline to follow-up for the labiaplasty group relative to the comparison group was a reduction in genital appearance dissatisfaction with large effect size (p < 0.001, d = 3.26). Higher levels of psychological distress (p = 0.001) and having a romantic partner (p = 0.016) preoperatively were significantly related to lower satisfaction with surgical outcomes.
Conclusions:
Labiaplasty appears to have a positive effect on women's genital appearance satisfaction, but not their general psychological well-being or intimate relationship quality. Medical professionals should be mindful of patients with greater psychological distress, as this may compromise satisfaction with surgical outcomes.
Clinical question/level of evidence:
Therapeutic, II.
There are many methods to evaluate female sexual function and dysfunction (FSD) in clinical and research settings, including questionnaires, structured interviews, and detailed case histories. Of these, questionnaires have become an easy first choice to screen individuals into different categories of FSD.
The aim of this study was to review the strengths and weaknesses of different questionnaires currently available to assess different dimensions of women's sexual function and dysfunction, and to suggest a simple screener for FSD.
A literature search of relevant databases, books, and articles in journals was used to identify questionnaires that have been used in basic or epidemiological research, clinical trials, or in clinical settings.
Measures were grouped in four levels based on their purposes and degree of development, and were reviewed for their psychometric properties and utility in clinical or research settings. A Sexual Complaints Screener for Women (SCS-W) was then proposed based on epidemiological methods.
Although many questionnaires are adequate for their own purposes, our review revealed a serious lack of standardized, internationally (culturally) acceptable questionnaires that are truly epidemiologically validated in general populations and that can be used to assess FSD in women with or without a partner and independent of the partner's gender. The SCS-W is proposed as a 10-item screener to aid clinicians in making a preliminary assessment of FSD.
The definition of FSD continues to change and basic screening tools are essential to help advance clinical diagnosis and treatment, or to slate patients adequately into the right diagnostic categories for basic and epidemiological research or clinical trials.
The search for a remedy or a prescription that can enhance sexual function and/or treat male erectile dysfunction has been an obsession throughout known history. Whether it was an Eastern civilization or a Western one, religious or atheist, man's aspiration for a better or best "manhood" has been a history-time goal.
This review will discuss the current research done on the most popular natural aphrodisiacs and examine the weight of evidence to support or discourage the use of any of these substances to enhance sexual desire and/or function.
Review of the current evidence on the use of natural substances as aphrodisiacs.
Efficacy of natural aphrodisiacs in enhancing sexual function in men and women.
There is little evidence from literature to recommend the usage of natural aphrodisiacs for the enhancement of sexual desire and/or performance. Data on yohimbine's efficacy does not support the wide use of the drug, which has only mild effects in the treatment of psychogenic ED. Although there's a positive trend towards recommending ginseng as an effective aphrodisiac, however, more in depth studies involving large number of subjects and its mechanism of action are needed before definite conclusions could be reached. Data on the use of natural aphrodisiacs in women is limited.
The current body of objective evidence does not support the use of any natural aphrodisiac as an effective treatment for male or female sexual dysfunctions. Potent men and men with ED will continue the search for natural aphrodisiacs despite the current disappointing data on their effectiveness. Care should be taken regarding the fraud addition of sildenafil analogues to natural aphrodisiacs.
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.
Introduction:
Accurate estimates of prevalence/incidence are important in understanding the true burden of male and female sexual dysfunction and in identifying risk factors for prevention efforts.
Aim:
To provide recommendations/guidelines concerning state-of-the-art knowledge for the epidemiology/risk factors of sexual dysfunctions in men and women.
Methods:
An International Consultation in collaboration with the major urology and sexual medicine associations assembled over 200 multidisciplinary experts from 60 countries into 17 committees. Committee members established specific objectives and scopes for various male and female sexual medicine topics. The recommendations concerning state-of-the-art knowledge in the respective sexual medicine topic represent the opinion of experts from five continents developed in a process over a 2-year period. Concerning the Epidemiology/Risk Factors Committee, there were seven experts from four countries.
Main outcome measure:
Expert opinion was based on grading of evidence-based medical literature, widespread internal committee discussion, public presentation and debate.
Results:
Standard definitions of male and female sexual dysfunctions are needed. The incidence rate for erectile dysfunction is 25-30 cases per thousand person years and increases with age. There are no parallel data for women's sexual dysfunctions. The prevalence of sexual dysfunction increases as men and women age; about 40-45% of adult women and 20-30% of adult men have at least one manifest sexual dysfunction. Common risk factor categories associated with sexual dysfunction exist for men and women including: individual general health status, diabetes mellitus, cardiovascular disease, other genitourinary disease, psychiatric/psychological disorders, other chronic diseases, and socio-demographic conditions. Endothelial dysfunction is a condition present in many cases of erectile dysfunction and there are common etiological pathways for other vascular disease states. Increasing physical activity lowers incidence of ED in males who initiate follow-up in their middle ages.
Conclusions:
There is a need for more epidemiologic research in male and female sexual dysfunction.
Ten years of research that has provided data regarding the prevalence of sexual dysfunctions is reviewed. A thorough review of the literature identified 52 studies published in the 10 years since an earlier review by Spector and Carey (Arch. Sex. Behav. 19(4): 389–408, 1990). Community samples indicate a current prevalence of 0%–3% for male orgasmic disorder, 0%–5% for erectile disorder, and 0%–3% for male hypoactive sexual desire disorder. Pooling current and 1-year figures provides community prevalence estimates of 7%–10% for female orgasmic disorder and 4%–5% for premature ejaculation. Stable community estimates of the current prevalence of other sexual dysfunctions remain unavailable. Prevalence estimates obtained from primary care and sexuality clinic samples are characteristically higher. Although a relatively large number of studies has been conducted since the earlier review, the lack of methodological rigor of many studies limits the confidence that can be placed in these findings.
To identify predictors of treatment-seeking behaviour in men with erectile dysfunction (ED) and the predictors (correlates) of individual drivers and barriers to seeking treatment. Although the prevalence and epidemiology of ED have been reviewed, there is little information about the treatment-seeking behaviour of men with this disorder.
Data from the Cross-National Survey on Male Health Issues conducted between March and September 2000 were assessed by multivariate analysis. A cohort of 32 644 men aged 20-75 years was recruited during visits to their physicians. The men completed a short screening questionnaire, covering their overall health, and prostate, urinary and erectile problems. Men identified as having ED completed a detailed follow-up questionnaire. Logistic regression methods were used to identify predictors of treatment-seeking behaviour, and individual drivers and barriers to seeking treatment.
Most men with ED had not sought treatment. The analyses suggested that ED, in conjunction with a desire to have sex, was necessary for men to seek treatment. Men seeking treatment commonly identified themselves as self-motivated or that they were influenced by a spouse or sex partner. The youngest group (20-39 years) was least likely to seek treatment. Among those who did not seek treatment, younger men were likely to believe that their ED would resolve spontaneously, whereas older men resisted seeking treatment because they felt that ED was a natural part of ageing.
The data from this survey of men using the healthcare system confirmed other population-based reports that a minority of men with ED seek treatment. Subset analyses showed that treatment-seeking behaviour tended to be driven primarily by the man or by his sex partner. Common barriers to seeking treatment included the belief that ED would resolve spontaneously (younger men) and that ED was a normal part of ageing (older men).
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.
An abridged five-item version of the 15-item International Index of Erectile Function (IIEF) was developed (IIEF-5) to diagnose the presence and severity of erectile dysfunction (ED). The five items selected were based on ability to identify the presence or absence of ED and on adherence to the National Institute of Health's definition of ED. These items focused on erectile function and intercourse satisfaction. For 1152 men (1036 with ED, 116 controls) analyzed, a receiver operating characteristic curve indicated that the IIEF-5 is an excellent diagnostic test. Based on equal misclassification rates of ED and no ED, a cutoff score of 21 (range of scores, 5-25) discriminated best (sensitivity=0.98, specificity=0. 88). ED was classified into five severity levels, ranging from none (22-25) through severe (5-7). Substantial agreement existed between the predicted and 'true' ED classes (weighted kappa=0.82). These data suggest that the IIEF-5 possesses favorable properties for detecting the presence and severity of ED.
To better evaluate efficacy in clinical trials of drugs as potential treatments for female sexual dysfunctions (FSD), a brief, multidimensional measure of female sexual function was developed.
Data from semistructured interviews with 82 women with or without FSD, aged 19-65 years, generated a pool of 61 items that addressed aspects of female sexual function. On review by a panel, individual items were selected for face validity and clinical relevance. Thirty-one items were used as a sexual function questionnaire (SFQ-V1) in two multicenter, phase II clinical trials totaling 781 women with FSD. Normative data were generated from a sample of 201 women without FSD.
Factor analysis produced seven domains of female sexual function: desire, physical arousal-sensation, physical arousal-lubrication, enjoyment, orgasm, pain, and partner relationship. The internal consistency of the domains ranged from 0.65 to 0.91, and test-retest reliability ranged from 0.21 to 0.71 for Cohen's weighted kappa and 0.42 to 0.78 for Pearson's correlation coefficient. There was a significant difference between the baseline mean SFQ domain scores of patients with FSD compared with those of women without FSD (p < 0.0001). End-of-study SFQ scores were significantly different for women who reported improvement vs. women who reported no improvement (p < 0.001).
The SFQ produced seven domains of female sexual function with excellent internal consistency, moderate to good reliability, excellent discriminant validity, and sensitivity. The results suggest that the SFQ may be a valuable new tool for evaluating and diagnosing subsets of FSD and, ultimately, for evaluating treatments of these disorders.
As a consequence of the impact of Viagra on male sexual dysfunction, considerable attention is now being paid to sexual dysfunctions in women, which might respond to pharmacological treatment. Should women's sexual problems be conceptualized in the same way as men's? The objective of this study was to assess the prevalence of distress about sexuality among women, and examine the predictors of such distress, including aspects of the woman's sexual experience, as well as other aspects of hercurrent situation. A telephone survey of women used Computer Assisted Telephone Interviewing and Telephone-Audio-Computer-Assisted Self-Interviewing methodology to investigate respondents' sexual experiences in the previous month. A national probability sample was used of 987 White or Black/African American women aged 20-65 years, with English as first language, living for at least 6 months in a heterosexual relationship. The participation rate was 53.1%. Weighting was applied to increase the representativeness of the sample. A total of 24.4% of women reported marked distress about their sexual relationship and/or their own sexuality. The best predictors of sexual distress were markers of general emotional well-being and emotional relationship with the partner during sexual activity. Physical aspects of sexual response in women, including arousal, vaginal lubrication, and orgasm, were poor predictors. In general, the predictors of distress about sex did not fit well with the DSM-IV criteria for the diagnosis of sexual dysfunction in women. These findings are compared with those from other studies involving representative samples of women, and the conceptual issues involved in the use of terms such as "sexual problem" and "sexual dysfunction" are discussed.
Development and validation of a patient-reported measure of psychosocial variables in men with erectile dysfunction (ED) is described. Literature review, focus groups, and medical specialists identified 86 potential items. Redundant, ambiguous, or low item-to-total correlation items were removed. Data from 98 men reporting diagnosed ED and 94 controls assisted in final item selection and psychometric evaluation. Treatment responsiveness was evaluated in 93 men with ED in a 10-week open-label trial of sildenafil citrate (Viagra). The 14 chosen items resolved into two domains: Sexual Relationship (eight items) and Confidence (six items), the latter comprising Self-Esteem (four items) and Overall Relationship (two items) subscales. The resulting Self-Esteem And Relationship (SEAR) questionnaire demonstrated validity and reliability. The intervention study demonstrated responsiveness to beneficial treatment with significant improvement in scores (P=0.0001). The SEAR questionnaire possesses strong psychometric properties that support its validity and reliability for measuring sexual relationship, confidence, and particularly self-esteem.
The Global Study of Sexual Attitudes and Behaviors (GSSAB) is an international survey of various aspects of sex and relationships among adults aged 40-80 y. An analysis of GSSAB data was performed to estimate the prevalence and correlates of sexual problems in 13,882 women and 13,618 men from 29 countries. The overall response rate was modest; however, the estimates of prevalence of sexual problems are comparable with published values. Several factors consistently elevated the likelihood of sexual problems. Age was an important correlate of lubrication difficulties among women and of several sexual problems, including a lack of interest in sex, the inability to reach orgasm, and erectile difficulties among men. We conclude that sexual difficulties are relatively common among mature adults throughout the world. Sexual problems tend to be more associated with physical health and aging among men than women.
Premature ejaculation (PE) is a common sexual dysfunction among men which affects men and their partners. Little qualitative data are available to characterize the impact of PE on men and their partners about ejaculatory control, sexual satisfaction, emotional distress and relationships. The objective of this study was to assess the impact of PE from the perspective of men with PE and the female partners of men with PE on their sexual experience, distress and relationships.
Qualitative data were collected through 14 focus groups in the US and through one-on-one interviews in the US, UK, Italy, France, Germany, and Poland. Study participants included heterosexual men with PE and female partners of males with PE. All participants were asked about how PE affects their daily life, including emotional impacts. One-on-one interviews also included obtaining feedback on the male and female versions of 4-single item measures of PE focusing on ejaculatory control, satisfaction with intercourse, interpersonal distress, and relationship difficulty.
Participants included 172 males with PE and 67 female partners of men with PE. Lack of control over ejaculation and dissatisfaction with intercourse emerged as central themes of PE. Lack of ejaculatory control resulted in greater dissatisfaction and greater emotional distress, including feelings of inadequacy, disappointment, and anxiety. Continued PE ultimately leads to greater problems with partners and often disrupts partner relationships. Participants indicated that PE was keeping them from attaining complete intimacy in their relationships even when their partners were generally satisfied with sexual intercourse. Impacts of PE on sexual satisfaction, emotional distress and partner relationships were consistent across countries. Feedback on the single-item PE measures confirmed relevance of the item content and further confirmed major themes identified from the qualitative data.
This qualitative study provides valuable insights on the substantial psychosocial burden of PE in the US and the Europe. Lack of control over ejaculation resulted in dissatisfaction with intercourse and increased emotional distress, and wide-ranging impact for both men with PE and their partners of men with PE. Data collected in this study may help inform the content of new patient reported measures for use in PE research.
The research which has assessed the incidence and prevalence of sexual dysfunctions is reviewed. Twenty-three studies are evaluated. Studies completed with community samples indicate a current prevalence of 5-10% for inhibited female orgasm, 4-9% for male erectile disorder, 4-10% for inhibited male orgasm, and 36-38% for premature ejaculation. Stable community estimates with regard to the current prevalence of female sexual arousal disorder, vaginismus, and dyspareunia are not available. Recent studies completed with clinical samples suggest an increase in the frequency of orgasmic and erectile dysfunction and a decrease in premature ejaculation as presenting problems. Desire disorders have increased as presenting problems in sex clinics, with recent data indicating that males outnumber females. Methodological limitations of these studies are identified and suggestions for future research are offered.
Ten years of research that has provided data regarding the prevalence of sexual dysfunctions is reviewed. A thorough review of the literature identified 52 studies published in the 10 years since an earlier review by Spector and Carey (Arch. Sex. Behav. 19(4): 389–408, 1990). Community samples indicate a current prevalence of 0%–3% for male orgasmic disorder, 0%–5% for erectile disorder, and 0%–3% for male hypoactive sexual desire disorder. Pooling current and 1-year figures provides community prevalence estimates of 7%–10% for female orgasmic disorder and 4%–5% for premature ejaculation. Stable community estimates of the current prevalence of other sexual dysfunctions remain unavailable. Prevalence estimates obtained from primary care and sexuality clinic samples are characteristically higher. Although a relatively large number of studies has been conducted since the earlier review, the lack of methodological rigor of many studies limits the confidence that can be placed in these findings.
Introduction:
An instrument that can systematically capture the impact of sexual dysfunction on quality of life (QoL) in men is needed.
Aims:
To psychometrically validate a sexual QoL instrument for men (SQOL-M) with premature ejaculation (PE) or erectile dysfunction (ED).
Methods:
The main assessment populations were men participating in clinical trials of treatments for PE or ED. Men with PE had a confirmed intravaginal ejaculatory latency time of < or = 2 minutes in > or = 70% of attempts. Men with ED had a score of > 21 on the International Index of Erectile Function (IIEF). Confirmatory psychometric testing was conducted in further groups of men with PE.
Main outcome measures:
The internal consistency, convergent and discriminant validity, test-retest reliability, and known-groups validity of the instrument were assessed.
Results:
An 11-item version of the SQOL-M was produced following factor analyses on men with either PE or ED. Psychometric testing showed no overlap between items and good item-total correlations. Factor analysis confirmed a one-factor solution. Excellent internal consistency was demonstrated, with a Cronbach's alpha of > or = 0.82 in all groups. In men reporting no change in their symptoms, the SQOL-M showed excellent test-retest reliability: the intraclass correlation coefficient was 0.77 for men with PE, and 0.79 for men with ED. Convergent validity was also good. In men with PE, the SQOL-M correlated with the satisfaction and distress domains of the Index of Premature Ejaculation. In men with ED, the SQOL-M correlated with the overall satisfaction domain of the IIEF. The measure also demonstrated excellent discriminant validity between men with PE or ED and men with no sexual dysfunction (P < 0.0001).
Conclusions:
The SQOL-M instrument is a useful tool for evaluating sexual QoL in men with PE and ED.
We provide current, normative data on the prevalence of impotence, and its physiological and psychosocial correlates in a general population using results from the Massachusetts Male Aging Study. The Massachusetts Male Aging Study was a community based, random sample observational survey of noninstitutionalized men 40 to 70 years old conducted from 1987 to 1989 in cities and towns near Boston, Massachusetts. Blood samples, physiological measures, socio-demographic variables, psychological indexes, and information on health status, medications, smoking and lifestyle were collected by trained interviewers in the subject's home. A self-administered sexual activity questionnaire was used to characterize erectile potency. The combined prevalence of minimal, moderate and complete impotence was 52%. The prevalence of complete impotence tripled from 5 to 15% between subject ages 40 and 70 years. Subject age was the variable most strongly associated with impotence. After adjustment for age, a higher probability of impotence was directly correlated with heart disease, hypertension, diabetes, associated medications, and indexes of anger and depression, and inversely correlated with serum dehydroepiandrosterone, high density lipoprotein cholesterol and an index of dominant personality. Cigarette smoking was associated with a greater probability of complete impotence in men with heart disease and hypertension. We conclude that impotence is a major health concern in light of the high prevalence, is strongly associated with age, has multiple determinants, including some risk factors for vascular disease, and may be due partly to modifiable para-aging phenomena.
To develop a brief, reliable, self-administered measure of erectile function that is cross-culturally valid and psychometrically sound, with the sensitivity and specificity for detecting treatment-related changes in patients with erectile dysfunction.
Relevant domains of sexual function across various cultures were identified via a literature search of existing questionnaires and interviews of male patients with erectile dysfunction and of their partners. An initial questionnaire was administered to patients with erectile dysfunction, with results reviewed by an international panel of experts. Following linguistic validation in 10 languages, the final 15-item questionnaire, the international index of Erectile Function (IIEF), was examined for sensitivity, specificity, reliability (internal consistency and test-retest repeatability), and construct (concurrent, convergent, and discriminant) validity.
A principal components analysis identified five factors (that is, erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction) with eigenvalues greater than 1.0. A high degree of internal consistency was observed for each of the five domains and for the total scale (Cronbach's alpha values of 0.73 and higher and 0.91 and higher, respectively) in the populations studied. Test-retest repeatability correlation coefficients for the five domain scores were highly significant. The IIEF demonstrated adequate construct validity, and all five domains showed a high degree of sensitivity and specificity to the effects of treatment. Significant (P values = 0.0001) changes between baseline and post-treatment scores were observed across all five domains in the treatment responder cohort, but not in the treatment nonresponder cohort.
The IIEF addresses the relevant domains of male sexual function (that is, erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction), is psychometrically sound, and has been linguistically validated in 10 languages. This questionnaire is readily self-administered in research or clinical settings. The IIEF demonstrates the sensitivity and specificity for detecting treatment-related changes in patients with erectile dysfunction.
To investigate the association of sexual problems with social, physical, and psychological problems.
An anonymous postal questionnaire survey.
Four general practices in England.
789 men and 979 women responding to a questionnaire sent to a stratified random sample of the adult general population (n = 4000).
Strong physical, social, and psychological associations were found with sexual problems. In men, erectile problems and premature ejaculation were associated with increasing age. Erectile problems were most strongly associated with prostate trouble, with an age adjusted odds ratio of 2.6 (95% confidence intervals 1.4, 4.7), but hypertension and diabetes were also associated. Premature ejaculation was predominantly associated with anxiety (age adjusted odds ratio 3.1 (95% confidence intervals 1.7, 5.6)). In women, the predominant association with arousal, orgasmic, and enjoyment problems was martial difficulties, all with odds ratios greater than five. All female sexual problems were associated with anxiety and depression. Vaginal dryness was found to increase with age, whereas dyspareunia decreased with age.
This study indicates that sexual problems cluster with self reported physical problems in men, and with psychological and social problems in women. This has potentially important consequences for the planning of treatment for sexual problems, and implies that effective therapy could have a broad impact on health in the adult population.
To clarify the age prevalence of female sexual dysfunction and the factors that contribute to the varying frequency of sexual intercourse and satisfaction with sexual life in Japanese women.
Of 8956 participants (median age 57 years, range 17 to 88) in a Japanese female cohort study, 5042 (56.3%) responded. We evaluated 2095 women aged 30 to 69 years (median 48) who completed a questionnaire that queried about their sexual life.
When women in their 30s were compared with those in their 60s, we found that the prevalence of the symptom of orgasmic disorder, sexual desire disorder, arousal disorder, and lubrication disorder had increased significantly from 15.2% to 32.2%, 27.7% to 57.9%, 29.7% to 57.9%, and 12.5% to 51.2%, respectively. Multivariate analysis showed that the rigidity of the partner's erection, orgasm, and arousal contributed significantly to sexual frequency and foreplay and orgasm to satisfaction with sexual life.
The prevalence of female sexual dysfunction increased with age. The results of multivariate analysis indicated that favorable sexual function is important to maintain the opportunity for sexual intercourse in both men and women and that foreplay and orgasm are essential for satisfactory sexual life in women.
To study sexual activity, the prevalence of sexual dysfunction and related help-seeking behaviour among middle-aged and elderly people in Asia.
A random population survey was carried out in 2001-2002 among urban residents aged 40-80 years in China, Taiwan, South Korea, Japan, Thailand, Singapore, Malaysia, Indonesia and The Philippines, with interviews based on a standardized questionnaire covering demographic details, health, relationships, and sexual behaviours, attitudes and beliefs. An intercept method of sampling was used in all countries except Japan, where questionnaires were mailed to a sample drawn from telephone directories. Sexual dysfunction was defined as persistent sexual problems.
The questionnaire was completed by 6700 people (3350 men and 3350 women), giving a response rate of 27%. Across all countries, 82% of men and 64% of women had engaged in sexual intercourse during the year preceding the interview. Most of the respondents considered satisfactory sex an essential means of maintaining a relationship. More than 20% of men and 30% of women complained of having at least one sexual dysfunction, although there were marked variations among the countries. The sexual dysfunctions most frequently reported were early ejaculation (20%; 95% confidence interval, CI, 18-21) and erectile dysfunction (15%, 14-17) among men; and a lack of sexual interest (27%, 25-29), lubrication difficulties (24%, 22-25), and an inability to reach orgasm (23%, 22-25) among women. Of the 948 men and 992 women who were sexually active and reported sexual dysfunctions, 45% did sought no help or advice and only 21% sought medical care.
Men and women in Asian countries continue to show sexual interest and activity into middle age and beyond. Although sexual dysfunction is prevalent in this age group, several sociocultural and economic factors appear to be preventing individuals from seeking medical help for these problems.
The Sexual Quality of Life-Female (SQOL-F) questionnaire has been developed to assess the impact of female sexual dysfunction (FSD) on a woman's sexual quality of life. SQOL-F items were developed through interviews with 82 women. Three data sets from women's health surveys in the United Kingdom and the United States generated data for scale validation. The SQOL-F showed good psychometric properties: convergent validity, discriminant validity, and test-retest reliability. The SQOL-F is a valid instrument for assessing the impact of FSD on quality of life and as an adjunct in evaluating FSD in clinical trials. The SQOL-F sensitivity to changes in sexual function needs confirmation.
To determine if the validated Sexual Function Questionnaire (SFQ), developed to assess efficacy in female sexual dysfunction (FSD) clinical trials, may also have utility in identifying target populations for such studies.
Data from five clinical trials and two general population surveys were used to analyze the utility of the SFQ as a tool to discriminate between the presence of specific components of FSD (i.e., hypoactive sexual desire disorder, female sexual arousal disorder, female orgasmic disorder, and dyspareunia).
Sensitivity/specificity analysis and logistic regression analysis, using data from all five clinical studies and the general population surveys, confirmed that the SFQ domains have utility in detecting the presence of specific components of FSD and provide scores indicative of the presence of a specific sexual disorder.
The SFQ is a valuable new tool for detecting the presence of FSD and identifying the specific components of sexual functions affected (desire, arousal, orgasm, or dyspareunia).
Erectile dysfunction (ED) can significantly impact a man's relationships and well-being.
We assessed changes in self-esteem, confidence, sexual relationship satisfaction, and overall relationship satisfaction in men with ED using the validated Self-Esteem And Relationship questionnaire (SEAR).
This was a 12-week, double-blind, placebo-controlled, flexible-dose (25, 50, 100 mg, as needed) international study of sildenafil in men > or =18 years of age in Mexico, Brazil, Australia, and Japan.
The primary study outcome was change in self-esteem from baseline to the end of treatment. Secondary study measures were changes in other SEAR components, International Index of Erectile Function (IIEF) domains, percentage of intercourse attempts that were successful, and the response to a global efficacy question at the end of treatment.
Patients were well balanced for age and duration of ED (placebo = 149 and sildenafil = 151). Compared with placebo, sildenafil significantly improved self-esteem, confidence, sexual relationship satisfaction, and overall relationship satisfaction (P < 0.0001). The psychosocial measures of well-being assessed with the SEAR were positively correlated (range 0.60-0.86, P < 0.0001) with erectile function, the frequency of achieving erections that allowed satisfactory sexual intercourse, the percentage of successful sexual intercourse attempts, and global treatment efficacy.
Significant improvements in self-esteem, confidence, sexual relationship satisfaction, and overall relationship satisfaction after treatment of ED with sildenafil were consistent among countries. These data suggest a substantial cross-cultural improvement in well-being after successful treatment of ED with sildenafil.
The objective of this study was to assess the prevalence and risk factors of female sexual dysfunctions across a selection of social groups. In all, 1219 women in the community, aged 18 y or older, answered a 38-question self-applicable questionnaire. Statistical analysis was performed using multivariate logistic regression. The average age was 35.6 y (s.d.=12.31) and the average number of sexual intercourses was 2.8 (s.d.=1.94) a week. At least one sexual dysfunction was reported by 49% of the women; lack of sexual desire (LSD) by 26.7%; pain during sexual intercourse (PSI) by 23.1% and orgasmic dysfunction (OD) by 21%. Women aged over 40 y represented an LSD and OD risk factor, whereas women aged over 25 y showed less likelihood of presenting PSI. The educational level was inversely correlated with the risk of LSD, OD and PSI. Depression and cardiopathies increased PSI occurrences and women with diabetes mellitus showed a higher probability of developing LSD and OD. In conclusion, almost half the women had at least one sexual dysfunction, and prevalence increased with age and lower educational levels. Preventive medical care for the female population, mainly for patients with chronic and/or degenerative diseases, considerably reduced the chances of sexual dysfunction.
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- L Burke
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Female sexual dysfunction and sexual quality of life in the UK
- Quirk