Recent research suggests that, while up to 58% of women may experience significant difficulties with sexual function, only a third of these difficulties are associated with clinically relevant levels of subjective distress, suggesting a complex relationship between these two factors. We have relatively little understanding as to when sexual difficulties are distressing to women and why some difficulties are distressing while others are not. The current project aimed to begin answering these questions in a number of ways. First, I attempted to replicate previous findings regarding moderators of the association between sexual function and subjective distress. Second, I attempted identify the behavioral and cognitive mechanisms through which sexual impairments cause distress. Participants were 87 adult women from the local community who reported recurrent impairments in sexual function in the past month, and who were currently in sexually-active heterosexual relationships. Participants completed in-person diagnostic interviews and validated self-report measures before completing four weeks of daily online questionnaires assessing their sexual and relational experiences. Results provided additional support for previously identified moderators including relational satisfaction, age, and history of childhood sexual abuse. Additionally, a number of factors mediated the association between sexual function and distress within individuals over time. Specifically, a majority of the statistical effect of sexual function on subjective distress was accounted for by the degree to which impaired sexual function decreased the physical pleasure experienced by the individual during sexual activity. Other consequences of impaired sexual function such as decreased frequency of sexual activity and negative emotional reactions by the partner did not mediate this association. These findings add to theories of sexual dysfunction by taking into account the important ways in which sexual impairments play out in the context of romantic relationships. The results also may explain mechanisms through which current treatments for sexual dysfunction decrease sexual distress, potentially improving our ability to focus interventions on the factors that are of greatest importance to patients. / text

Thesis (MSc (Clinical Psychology)) -- University of Limpopo, 2010.

京都大学 / 0048 / 新制・課程博士 / 博士(人間健康科学) / 甲第21702号 / 人健博第68号 / 新制||人健||5(附属図書館) / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 古田 真里枝, 教授 天谷 真奈美, 教授 小川 修 / 学位規則第4条第1項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM

Student Number : 9809910J - MA research report - School of Human and Community Development - Faculty of Humanities / This study explores the perceptions of women suffering from vaginismus regarding their condition, themselves and their significant relationships. The subjective world of women suffering from vaginismus was therefore focused upon, within the context of a qualitative paradigm. Four volunteers who were diagnosed with the condition by a sexologist at the DISA health clinic, and were at the time seeking treatment for the condition, participated in the research. The research was conducted in the form of a semi-structured interview. Various psychological, emotional and social themes were explored. The participants’ responses were recorded and then analysed utilising content analysis. Within the analysis, a lack of constancy was noted amongst the participants. Differences with regard to etiological themes, personality profiles, emotions as well as relationships with intimate partners and parents were found. This is coherent with findings in the literature, which are also inconsistent. However, it should be noted that that whilst few aspects were found to be universal, most shared some commonality. Thus, various trends were established. The experience of vaginismus appears to be stressful, impacting on one’s emotions, selfesteem and intimate relationships. Trends were identified with regard to choice of partner. However, different relationship dynamics were found suggesting that couples react differently to the experience of vaginismus. All of the participants gave vague descriptions of their parental figures and relationships. Thus, it is difficult to make assertions regarding these relationships. Patterns of interaction and behaviour were experienced during the interviews. Avoidance of emotion was prevalent. The tendency to idealise relationships was found with all of the participants. The participants also appeared to make contradictory statements throughout the interviews.

Made available in DSpace on 2015-07-22T20:49:11Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-02-27. Added 1 bitstream(s) on 2015-08-11T03:25:33Z : No. of bitstreams: 1 Publico-008.pdf: 1147299 bytes, checksum: c53fe718c40d4278be6155456942dfbe (MD5) / Contexto: a disfunção sexual é frequente entre pacientes com esquizofrenia, sendo relatada como um dos mais incômodos efeitos adversos dos antipsicóticos e esta diretamente relacionada com adesão ao tratamento. Objetivo: a) avaliar a frequência da disfunção sexual em uma amostra de pacientes do espectro da esquizofrenia em tratamento com antipsicóticos; b) investigar 0 efeito dos diferentes antipsicóticos na função sexual; e c) avaliar a acurácia da Escala de Experiência Sexual do Arizona (AS EX) para identificar disfunção sexual. Método: pacientes ambulatoriais com esquizofrenia ou transtorno esquizoafetivo foram entrevistados através de questionários: ASEX e Escala Dickson-Glazer (DGSFi) para avaliação do funcionamento sexual, em uma única entrevista. Resultados: 137 pacientes foram entrevistados. A sensibilidade e especificidade da ASEX em relação a DGSFi foram: 80.8% ( 95% IC= 70.0%-88.5%) e 88.1 % (95% IC=76.5%-94.7%), e a taxa de classificação incorreta foi 9.5%. A curva ROC comparando a pontuação da ASEX e DGSFi revelou valor de 0.93 (IC=0.879¬0.970) com 0 ponto de corte da ASEX encontrando sendo 14/15. A disfunção sexual foi mais alta entre as mulheres (79.2%) do que nos homens (33.3%) (X2=27.41, gl=1, p<0.001). Conclusão: pacientes em tratamento com antipsicóticos mostraram alta frequência de queixas sexuais e ASEX provou ser um instrumento eficaz para identificar disfunção sexual em amostra de pacientes ambulatoriais do espectro da esquizofrenia. Mulheres mostraram frequência mais alta de disfunção, e desejo sexual e habilidade para alcançar orgasmo foram áreas mais afetadas. 0 uso de antipsicóticos, principal mente 0 uso de combinações, foi associado com piora do funcionamento sexual.. / Background: sexual dysfunction is frequent in patients with schizophrenia, it is reported as one of the most distressing antipsychotic’s adverse effects and it is directly related to treatment compliance. Objective: a) to assess the frequency of sexual dysfunction in a sample of outpatients with schizophrenia and schizoaffective disorder under antipsychotic therapy; b) to investigate the effect of different antipsychotics on sexual function; and c) to evaluate the accuracy of the Arizona Sexual Experience Scale (ASEX) to identify sexual dysfunction. Method: Outpatients with schizophrenia or schizoaffective disorder were asked to fulfill both the ASEX and the Dickson Glazer Scale for the Assessment of Sexual Functioning Inventory (DGSFi) at a single interview. Results: 137 patients were interwied. The sensitivity and specificity of the ASEX in relation to DGSFi were: 80.8%, (95% CI= 70.0%-88.5%) and 88.1% (95% CI= 76.5%-94.7%), and the misclassification rate was 9.5%. The ROC curve comparing the ASEX and the DGSFi scores revealed a value of 0.93 (CI= 0.879-0.970), with the optimum cut-off point of ASEX being 14/15. Sexual dysfunction measured was higher in females (79.2%) than in males (33.3%) (2 = 27.41, d.f.=1, p<0.001). Discussion: Patients under antipsychotic treatment showed a high level of sexual complaints, and the ASEX proved to be an accurate instrument to identify sexual dysfunction in an outpatient sample of patients with schizophrenia spectrum. Females showed a higher frequency of sexual dysfunctions and sexual drive and ability to reach orgasm were the most affected areas. The use of antipsychotics, especially the combinations, was more likely to impair sexual functioning. / TEDE / BV UNIFESP: Teses e dissertações

Male sexual dysfunction is considered to be a problematic discursive site due to the diverse ways in which it is constructed and therapeutically conceptualised. Under-researched within the discipline of counselling psychology to date, this diagnostic category needs to be explored to identify ways in which counselling psychologists construct this presenting problem. Therefore the aim of this research was to interrogate how a volunteer group of counselling psychologists understood and worked with male sexual dysfunction in order to make visible some of the masked discursive practices related to its diverse constructions. Ten counselling psychologists were interviewed and a Foucauldian discourse analysis conducted, which interrogated the discursive power games implicated in these participants' accounts. The findings produced firstly identified the wider contextual cultural norms that seemed to regulate male sexuality within gendered masculinity discourses. Secondly, three distinct discursive therapeutic subject positions and their related power games were identified as talked about by these participants. Overall, it is argued that these findings indicate that for these counselling psychologists, male sexual dysfunction is a mutable, diversely power-laden, and thereby problematic, construct. Furthermore this analysis may be understood as a contribution to counselling psychology in raising practitioners' awareness to the power games in their talk about working with male sexual dysfunction.

The aim of this study was to make an assessment of the role of the cognitive component in the development of sexual dysfunction. Past studies have largely focused on the impact of particular events on sexual dysfunction and have not assessed the role of the perception of these events. A number of theories on sexual dysfunction have been developed to explain the influence of cognitions, but these have not been empirically tested. This study investigated the role of the cognitive evaluation of sexual experiences among 30 sexually dysfunctional participants and 30 control participants who were matched on age, marital status and biological sex. The Cognitive Aspects of Sexual Dysfunction Measure (CASDM) was constructed to evaluate sexual dysfunction. This measure was designed to tap into the major events in participants’ lives and, more importantly, the participants’ perceptions of these events. The components assessed were the intergenerational (family of origin), individual, current life and relationship aspects of the person’s life. These factors were measured from the responses to questions regarding the participant's cognitions about past experiences, the effect of the past experience on the participant at the lime it occurred and the influence this experience had on the participant's sense of self now, their relationship now and sexual functioning now. The main findings in the intergenerational area were that past experiences were perceived by the sexually dysfunctional group to be having an impact on the self, relationships and their sexual functioning although there were no actual differences between the sexually functional and the sexual dysfunctional participants in the occurrence of the event. For the individual factors, there were differences between the sexually functional and sexually dysfunctional participants in both values and lifestyle, although these were not perceived to be having an impact on the self, relationship and sexual functioning. In the relationship area, anger was the major factor separating the sexually functional and sexually dysfunctional groups. Anger was high among the sexually dysfunctional participants and was perceived to be having an impact on self, the couple’s relationship and their sexual functioning. The importance of all these variables in providing a better understanding of the cognitive factors in sexual dysfunction was discussed. The findings demonstrate the importance of cognitions in influencing sexual functioning. Clinicians should not simply deal with the life experiences of sexually dysfunctional people when attempting to change their behaviour, but should focus on changing cognitions about the behaviours in relation to sexual functioning.

Research on aging indicates that older adults do not, as a group, report decreased health-related quality of life (HRQOL) despite age-related declines in physical health status. Several cognitive adaptation strategies have been suggested to underlie HRQOL stability in this population. Studies of older cancer patients nevertheless show substantial variance in post-treatment HRQOL outcomes, although cognitive mechanisms for individual differences have received little attention. The current study expanded on a developmental adaptation of self-regulation theory in which aging influences both self-vulnerability and perceptions of disease. A model was tested in which older age was hypothesized to predict better HRQOL via less severe illness perceptions in men treated for localized (Stage I and II) PC. Results indicated that age was not directly associated with HRQOL. However, older age was indirectly associated with better HRQOL via less severe PC perceptions. Further, this indirection association helped account for the positive association between age and HRQOL that three risk factors (income, comorbid disease burden, and sexual function) were shown to suppress. Perceptions of PC may promote HRQOL stability by mitigating age-related declines in health and income status. Disease perceptions thus represent critical components of health assessments and interventions for PC survivors of all ages, but particularly for men facing difficulties adapting to complex health profiles or normative lifespan challenges.

In clinical trials of drug treatments for women’s sexual dysfunction, placebo responses have often been substantial. Little is known about the nature and time course of symptom reduction with placebo treatment. It is also unknown to what extent placebo responses might be associated with individual characteristics, such as demographic variables, that influence responsiveness to treatment. Finally, it is unknown how sexual behavior during placebo treatment changes and whether changes in sexual behavior account for variability in outcomes. In the present work I investigated potential between-trial, between-person, and within-person variables that might explain variability in response to placebo treatment of sexual dysfunction in women. Study 1 consisted of a systematic review of the clinical trial literature to estimate the magnitude and predictors of placebo response across previous trials. Study 2 was an analysis of a small sample of women who were randomized to receive placebo in a recent clinical trial. These preliminary studies provided evidence of a relatively large clinical response among women randomized to placebo in controlled clinical trials of sexual dysfunction treatments. In addition, I found evidence of a possible effect of psychosocial variables on placebo response. In Study 3, I further tested the nature and correlates of placebo response in a sample of 50 women with sexual arousal and desire problems. These data were drawn from a 12-week double-blind randomized controlled trial in which measurement of symptom severity took place at baseline, 4 weeks, 8 weeks, and 12 weeks, allowing for longitudinal analysis. Change in sexual function during placebo treatment peaked at 4 weeks and remained relatively stable through post-treatment. Furthermore, change in sexual function was clinically meaningful in approximately one-third of the sample. Symptom improvement appeared to be in part a function of increased frequency of satisfying sexual encounters during treatment, although there remained additional variability in outcomes that could not be explained by the available data. The findings are discussed with reference to enhancing both clinical trial design and psychological therapies in the treatment of sexual dysfunction in women. / text

CoordenaÃÃo de AperfeiÃoamento de NÃvel Superior / O Jambu (Spilanthes oleracea ou Spilanthes acmella var oleracea ou Acnella oleracea) à uma planta tÃpica da regiÃo norte do Brasil, mais precisamente do ParÃ. à utilizado na culinÃria paraense, fazendo parte do prato de peixes como o TacacÃ, o Pato no Tucupi. AlÃm da utilizaÃÃo na culinÃria, tem tido outras aplicaÃÃes, principalmente como analgÃsica, anti-inflamatÃria e antifÃngica. Recentemente, tem sido utilizado como estimulante sexual em mulheres. Segundo a cultura popular, o aumento da excitaÃÃo feminina decorreria de uma atividade contrÃtil (aumento do peristaltismo) na vulva. Entretanto, nenhum estudo bem conduzido foi publicado na literatura mÃdica para confirmar se isso à realmente verdade. O presente estudo teve como objetivo avaliar se a pomada de Jambu realmente aumenta a excitaÃÃo e o desejo sexual feminino; se ocasiona algum impacto sobre o desejo e a satisfaÃÃo sexual masculina e, por fim, observar a sua seguranÃa e tolerabilidade. Dois ensaios clÃnicos randomizados, cruzados e placebo-controlados, foram realizados ao mesmo tempo: um para avaliar os homens que utilizaram o creme e o placebo e outro para avaliar as mulheres. Vinte e dois casais participaram do estudo. Utilizaram, durante as relaÃÃes sexuais, o creme de JAMBU e o placebo. Foram avaliados separadamente, por questionÃrios auto-aplicÃveis, antes e apÃs a utilizaÃÃo de cada pomada. Os questionÃrios utilizados foram o Ãndice Internacional de FunÃÃo ErÃtil (IIEF) e o Ãndice de Funcionamento Sexual Feminino (FSFI). A mÃdia de idade foi de 43,3 anos para os homens e de 40,5 anos para as mulheres. Verificou-se que, apÃs o tratamento, o desejo e a satisfaÃÃo sexual mensurados no grupo Jambu foram significantemente maiores que o observado no grupo Placebo, nos homens (P = 0,0008 e P = 0,0006, respectivamente). O desejo e a excitaÃÃo sexual na mulher mensurados no grupo Jambu tambÃm foram significantemente maiores que o observado no grupo Placebo (P = 0,0006 e P = 0,0005, respectivamente). Igualmente, apenas no grupo Jambu, houve um aumento significante sobre o desejo e a satisfaÃÃo sexual nos homens e sobre o desejo e a excitaÃÃo nas mulheres, apÃs o tratamento quando comparado aos valores basais (P = 0,0002 e P = 0,0003) e (P = 0,0001 e P = 0,0008, respectivamente). O mesmo nÃo ocorreu com o placebo. NÃo foi constatada diferenÃa estatisticamente significante em relaÃÃo à alteraÃÃo no tempo ejaculatÃrio (P = 0,7768) entre os grupos placebo e Jambu. TambÃm nÃo foi constatada diferenÃa estatisticamente significante em relaÃÃo à dor ou desconforto apÃs a utilizaÃÃo das pomadas, tanto no grupo masculino quanto no grupo feminino, (P = 0,7728 e P = 1,0000) entre os dois grupos. Conclui-se que o creme de Jambu (Acmella oleracea) aumentou a excitaÃÃo e o desejo sexual feminino e o desejo e a satisfaÃÃo sexual masculina durante atividade sexual, quando comparada ao placebo. NÃo houve alteraÃÃo no tempo ejaculatÃrio dos pacientes que utilizaram o creme. Os efeitos colaterais foram discretos e cessaram apÃs a sua remoÃÃo. / The toothache plant (Spilanthes oleracea or Spilanthes acmella oleracea or simply Acmella oleracea) is a well-known herb in Northern Brazil, especially in ParÃ, where it is referred to as jambu. Though commonly used in the local cuisine in dishes such as tacacà and pato-no-tucupi, it is also widely used to prepare analgesic, antiinflammatory and antifungal medications. Extracts of this plant have recently become popular as a topical sexual stimulant for women. The active substance in the herb, spilanthol, is believed to contract the vulva, but so far no medical study has been published confirming this. In the present randomized, double-blind, placebo-controlled crossover clinical study a cream was prepared from extracts of the toothache plant and tested with regard to its effect on female sexual desire and excitation and male sexual desire and satisfaction and ejaculation time, along with safety and tolerability. Twenty-two blinded couples used cream with and without extract of A. oleracea during two periods of 4 weeks. The participants were aged 43.3 years (men) and 40.5 years (women) on the average and were evaluated individually using self-reported questionnaires (the International Index of Erectile Function and The Female Sexual Function Index) before and after the use of each cream. Compared to placebo, male sexual desire and satisfaction (p=0.0008 and p=0.0006, respectively) and female sexual desire and excitation (p=0.0006 and p=0.0005, respectively) were significantly greater when couples were using the extract. Likewise, male sexual desire and satisfaction (p=0.0002 and p=0.0003, respectively) and female sexual desire and excitation (p=0.0001 and p=0.0008, respectively) only increased in relation to baseline values when couples were using extract. No significant differences were observed between extract and placebo with regard to ejaculation time (p=0.7768), nor with regard to pain and discomfort after intercourse, as reported by both genders (p=0.7728 and p=1.0000, respectively). It may be concluded that cream prepared from extracts of the toothache plant increased female sexual desire and excitation and male sexual desire and satisfaction during intercourse compared to placebo and baseline, without affecting ejaculation time. Side effects were negligible and subsided after completion of treatment.