Women's sexual function: Revised and expanded definitions

Department of Psychiatry, University of British Columbia and B.C. Centre for Sexual Medicine, Vancouver General Hospital, Vancouver, BC.
Canadian Medical Association Journal (Impact Factor: 5.96). 06/2005; 172(10):1327-33. DOI: 10.1503/cmaj.1020174
Source: PubMed


Acceptance of an evidence-based conceptualization of women's sexual response combining interpersonal, contextual, personal psychological and biological factors has led to recently published recommendations for revision of definitions of women's sexual disorders found in the American Psychiatric Association's Diagnostic and Statistical Manual (DSM-IV-TR). DSM-IV definitions have focused on absence of sexual fantasies and sexual desire prior to sexual activity and arousal, even though the frequency of this type of desire is known to vary greatly among women without sexual complaints. DSM-IV definitions also focus on genital swelling and lubrication, entities known to correlate poorly with subjective sexual arousal and pleasure. The revised definitions consider the many reasons women agree to or instigate sexual activity, and reflect the importance of subjective sexual arousal. The underlying conceptualization of a circular sex-response cycle of overlapping phases in a variable order may facilitate not only the assessment but also the management of dysfunction, the principles of which are briefly recounted.

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Available from: Rosemary Basson, Aug 14, 2014
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    • "Similarly, female respondents were asked whether they had trouble lubricating (Waite, Laumann, Das, & Schumm, 2009). Note that we do not conceptualize both of these as sexual dysfunction, since women may have difficulty lubricating even if they experience sexual arousal (Basson, 2005). "
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    ABSTRACT: Sexuality is a key component of health and functioning that changes with age. Although most sexual activity takes place with a partner, the majority of research on sexuality has focused on individuals. In this paper, we focused on the sexual dyad. We proposed and tested a conceptual model of the predictors of partnered sexual activity in older adulthood. This model began with the personality of each of the partners, which affects individuals' views of sex and characteristics of the partnership, which in turn affected sexual expression in the couple. We measured a key feature of personality, Positivity, which reflected the individual's tendency to present his or herself positively in social situations. This trait, we posited, increased frequency of sex through increased desire for sex, and the subjective importance of sex to each member of the couple. In this model, Positivity also impacted characteristics of the relationship that promoted dyadic sexual behavior. These processes differed for men and women in the model. We tested this model with data from the National Social Life, Health and Aging Project, which conducted personal interviews with both partners in 940 American dyads (average male age 72; average female age 69). We found that couples in which the husbands' (but not wives') were high in Positivity show higher levels of sexual activity, and that this association was partially mediated by dimensions of relationship quality, but more so by individual factors such as thinking about sex and believing sex is important.
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    • "These factors were included but were not limited to genetics (Dawood et al. 2005), mental health status (Azar et al. 2007; Khajehei and Hadzic 2012), symptoms of depression and anxiety (Shindel et al. 2011; Khajehei et al. 2012a, b, c), quality of relationships (Papaharitou et al. 2008), menopause, hormonal imbalance, hysterectomy, ovariectomy, sexual abuse, negative sexual attitude , negative body image, drug and alcohol abuse (Burri et al. 2009), sexual orientation (Breyer et al. 2010; Khajehei et al. 2012a, b, c), childbirth and its outcomes (Thompson et al. 2002), mode of delivery (Chang et al. 2011), number of childbirths (East et al. 2012), breastfeeding (Khajehei et al. 2009a, b, c), and fears of pregnancy or sexually transmitted diseases (Crooks and Baur 2011). Previous literature (Rosen 2000; Basson 2005; Ponholzer et al. 2005) has discussed the role of some of these factors in the occurrence of female M. Khajehei et al. "
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    ABSTRACT: Sexual function of women can be affected by many factors resulting in female sexual dysfunction (FSD). Sexual dysfunction is a common problem among women of all ages and has negative effects not only on their quality of lives but also on the sexual function and quality of life of their partners. It can also affect mental health of the entire family and society. Regarding the multidimensional nature of female sexual dysfunction and considering its consequences, this condition needs to be recognised in its early stages in order to prevent future consequences and impacts. This article discusses biopsychosocial aspect of female sexual function, classifications and risk factors of female sexual dysfunction and investigates current approaches to identify and treat this problem.
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    • "Additionally , when administering the FSFI to women diagnosed with breast cancer, practitioners should consider removing item 14 (regarding emotional closeness with one's partner), as the CFA model fit significantly improved when this was excluded from the scale. Item 14 contributed to more than one subscale, as the level of emotional intimacy impacts on aspects of sexual functioning other than satisfaction[41]. The final caveat relates to the use of the FSFI with women not reporting recent sexual activity. "
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    ABSTRACT: Sexual dysfunction commonly arises for women following diagnosis and treatment of breast cancer. The aim of this study was to systematically evaluate the acceptability, reliability, and validity of the Female Sexual Functioning Index (FSFI) when used with these women. Sexually active women previously diagnosed with breast cancer (N = 399) completed an online questionnaire including the FSFI and measures of acceptability (ease of use, relevance), sexual functioning, body image, fatigue, impact of cancer, physical and mental health, and relationship adjustment. Reliability and validity were evaluated using standard scale validation techniques. Participants indicated a high degree of acceptability. Excellent internal consistency (α = 0.83-0.96) and test-retest reliability (r = 0.74-0.86) of the FSFI were evident. According to the confirmatory factor analysis, the best fit was achieved with removal of item 14 (regarding the extent of emotional closeness with the partner) and six subscales (desire, arousal, lubrication, orgasm, satisfaction, pain), without a total score (TLI = 0.96, CFI = 0.97, RMSEA = 0.07). Correlations with measures of sexual functioning and related constructs provided evidence for convergent and divergent validities, respectively. All but one subscale (orgasm) discriminated between women who are, and are not, currently receiving treatment for breast cancer (discriminant validity). These findings indicate that not only is the FSFI psychometrically sound when used with women with breast cancer, but it is perceived as being easy to use and relevant. It is recommended that the FSFI subscale scores can be used in both clinical and research settings as a screening tool to identify women experiencing sexual dysfunction following breast cancer.
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