Lori Brotto1, Sandrine Atallah2, Crista Johnson-Agbakwu3, Talli Rosenbaum4, Carmita Abdo5, E Sandra Byers6, Cynthia Graham7, Pedro Nobre8, Kevan Wylie9. 1. Department of Obstetrics/Gynaecology, University of British Columbia, Vancouver, BC, Canada. Electronic address: Lori.Brotto@vch.ca. 2. Clinique du Levant, Beirut, Lebanon. 3. Obstetrics and Gynecology, Maricopa Integrated Health System, Phoenix, AZ, USA. 4. Haziporen 10bet, Bet Shemesh, Israel. 5. Department of Psychiatry, University of Sao Paulo Medical School, Sao Paulo, Brazil. 6. Department of Psychology, University of New Brunswick, Fredericton, NB, Canada. 7. Department of Psychology, University of Southampton, Southampton, UK. 8. Departamento de Ciências da Educação, Universidade de Aveiro, Senhora da Hora, Portugal. 9. Sexual Medicine, Porterbrook Clinic, Sheffield, UK.
Abstract
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.
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.
Authors: Nana Ernst Toldam; Christian Graugaard; Rikke Meyer; Louise Thomsen; Sabine Dreier; Emmanuele A Jannini; Annamaria Giraldi Journal: Sex Med Rev Date: 2022-06-30
Authors: Stephanie S Faubion; Flavia Fairbanks; Carol L Kuhle; Richa Sood; Juliana M Kling; Jennifer A Vencill; Kristin C Mara; Ekta Kapoor Journal: J Sex Med Date: 2020-08-06 Impact factor: 3.802
Authors: Geoffrey M Reed; Jack Drescher; Richard B Krueger; Elham Atalla; Susan D Cochran; Michael B First; Peggy T Cohen-Kettenis; Iván Arango-de Montis; Sharon J Parish; Sara Cottler; Peer Briken; Shekhar Saxena Journal: World Psychiatry Date: 2016-10 Impact factor: 49.548