Andrea Bradford

The Association Between Body Esteem and Sexual Desire Among College Women

Relationships between body image variables and sexuality have been found among several groups of women. However, research has largely focused on generalized experiences of sexuality. With the exception of two studies which focused on specific medical populations, to our knowledge there has been no investigation of the relationship between body image and acute measures of sexual response. In the current study, we investigated the relationships between body esteem, sexual response to erotica in a laboratory-setting, and self-reported sexual functioning in a non-clinical sample of 85 college women. Women participated in one study session, during which mental sexual arousal, perceptions of physical arousal, and sexual desire were assessed. Results showed that higher body esteem was significantly positively related to sexual desire in response to erotica in the laboratory setting. Similarly, higher body esteem was positively related to self-reported measures of sexual desire, as assessed by a validated measure of sexual function. The sexual attractiveness and weight concern subscales of the Body Esteem Scale, which relate to body characteristics that are most likely to be under public scrutiny, were particularly linked to sexual desire. This is the first study to show that body esteem is related to sexual responses to a standardized erotic stimulus in a laboratory setting.

ORIGINAL RESEARCH—WOMEN'S SEXUAL HEALTH: Sexual Outcomes and Satisfaction with Hysterectomy: Influence of Patient Education

INTRODUCTION Many women experience improved sexual function after hysterectomy. However, a sizeable minority of women report worsened sexual function after the surgery, and concerns about the effect of surgery on sexual function are common among women planning to undergo hysterectomy. AIM The present study examined the role of education about the potential sexual consequences of hysterectomy in predicting self-reported outcomes and satisfaction with the procedure. METHODS We conducted a cross-sectional survey of 204 women who had undergone simple hysterectomy in the preceding 3-12 months. Participants volunteered in response to a Web-based advertisement. MAIN OUTCOME MEASURES Participants indicated their current sexual function using the Female Sexual Function Index (FSFI), and reported positive and negative sexual outcomes experienced after hysterectomy using a checklist. Participants also completed questionnaire items regarding satisfaction with hysterectomy and education from their physicians about sexual risks and benefits prior to surgery. RESULTS Current sexual function scores were related to self-reports of positive and negative sexual outcomes following hysterectomy and overall satisfaction with hysterectomy. Education from a physician about possible adverse sexual outcomes was largely unrelated to self-reports of having experienced those outcomes. However, education about possible negative sexual outcomes predicted overall satisfaction with hysterectomy when controlling for self-reports of positive and negative sexual outcomes. CONCLUSION Education about potential negative sexual outcomes after surgery may enhance satisfaction with hysterectomy, independent of whether negative sexual outcomes were experienced. Including a discussion of potential sexual changes after surgery may enhance the benefits of presurgical counseling prior to hysterectomy.

Placebo Response in the Treatment of Women's Sexual Dysfunctions: A Review and Commentary

We reviewed the literature to determine the nature and magnitude of therapeutic response associated with placebo treatment in clinical trials for womens sexual dysfunction. We abstracted data from 16 articles to record the effect size associated with placebo treatment. In most of these studies, placebo recipients reported statistically significant improvements on one or more major endpoints relative to baseline. Although placebo responses varied across study populations and methodologies, within-group effect sizes were predominantly in the moderate range. Our findings suggest that post-menopausal women and women with hypoactive sexual desire disorder may be more likely to respond to placebo treatment.

Behavior and Symptom Change Among Women Treated with Placebo for Sexual Dysfunction

INTRODUCTION In clinical trials of drug treatments for womens sexual dysfunction, placebo responses have often been substantial. However, little is known about the clinical significance, specificity, predictors, and potential mechanisms of placebo response in sexual dysfunction. AIM We aimed to determine the nature and predictors of sexual function outcomes in women treated with placebo for female sexual arousal disorder (FSAD). METHODS We conducted a secondary analysis of data from the placebo arm of a 12-week, multisite, randomized controlled pharmaceutical trial for FSAD (N=50). We analyzed the magnitude, domain specificity, and clinical significance of sexual function scores at baseline, 4, 8, and 12 weeks (post-treatment). We examined longitudinal change in sexual function outcomes as a function of several baseline variables (e.g., age, symptom-related distress) and in relation to changes in sexual behavior frequency during the trial. MAIN OUTCOME MEASURE Female Sexual Function Index total score. RESULTS The magnitude of change at post-treatment was clinically significant in approximately one-third of placebo recipients. Effect sizes were similar across multiple aspects of sexual function. Symptom improvement was strongly related to the frequency of satisfying sexual encounters during treatment. However, the relationship between sexual encounter frequency and outcome varied significantly between participants. CONCLUSIONS A substantial number of women experienced clinically significant improvement in sexual function during treatment with placebo. Changes in sexual behavior during the trial, more so than participant age or symptom severity at baseline, appeared to be an important determinant of outcome. Contextual and procedural aspects of the clinical trial may have influenced outcomes in the absence of an active drug treatment.

ORIGINAL RESEARCH—WOMEN'S SEXUAL HEALTHORIGINAL RESEARCH—WOMEN'S SEXUAL HEALTH: Sexual Outcomes and Satisfaction with Hysterectomy: Influence of Patient Education

INTRODUCTION Many women experience improved sexual function after hysterectomy. However, a sizeable minority of women report worsened sexual function after the surgery, and concerns about the effect of surgery on sexual function are common among women planning to undergo hysterectomy. AIM The present study examined the role of education about the potential sexual consequences of hysterectomy in predicting self-reported outcomes and satisfaction with the procedure. METHODS We conducted a cross-sectional survey of 204 women who had undergone simple hysterectomy in the preceding 3-12 months. Participants volunteered in response to a Web-based advertisement. MAIN OUTCOME MEASURES Participants indicated their current sexual function using the Female Sexual Function Index (FSFI), and reported positive and negative sexual outcomes experienced after hysterectomy using a checklist. Participants also completed questionnaire items regarding satisfaction with hysterectomy and education from their physicians about sexual risks and benefits prior to surgery. RESULTS Current sexual function scores were related to self-reports of positive and negative sexual outcomes following hysterectomy and overall satisfaction with hysterectomy. Education from a physician about possible adverse sexual outcomes was largely unrelated to self-reports of having experienced those outcomes. However, education about possible negative sexual outcomes predicted overall satisfaction with hysterectomy when controlling for self-reports of positive and negative sexual outcomes. CONCLUSION Education about potential negative sexual outcomes after surgery may enhance satisfaction with hysterectomy, independent of whether negative sexual outcomes were experienced. Including a discussion of potential sexual changes after surgery may enhance the benefits of presurgical counseling prior to hysterectomy.

Knowledge of documented dementia diagnosis and treatment in veterans and their caregivers

We studied perceptions of dementia diagnosis and treatment in patient-caregiver dyads enrolled in a care coordination intervention trial for veterans with dementia. We compared patient and caregiver perceptions of diagnosis and treatment to information in the medical record and assessed concordance between patient and caregiver perceptions. Data were derived from medical record abstraction and structured interviews with 132 patients and 183 caregivers. Most caregivers, but only about one fourth of patients, reported having received information about a diagnosis related to memory loss. Caregivers were more accurate than patients in recalling the patient’s use of memory-enhancing medications. Within dyads there was poor agreement regarding a diagnosis of dementia. Our findings suggest that there is substantial room for improvement in disclosure and education of dementia diagnosis, especially at the level of the patient-caregiver dyad.

Early Response to Psychotherapy and Long-Term Change in Worry Symptoms in Older Adults With Generalized Anxiety Disorder

OBJECTIVES To determine the association of early and long-term reductions in worry symptoms after cognitive behavior therapy (CBT) for generalized anxiety disorder (GAD) in older adults. DESIGN Substudy of larger randomized controlled trial. SETTING Family medicine clinic and large multispecialty health organization in Houston, TX, between March 2004 and August 2006. PARTICIPANTS Patients (N = 76) aged 60 years or older with a principal or coprincipal diagnosis of GAD, excluding those with significant cognitive impairment, bipolar disorder, psychosis, or active substance abuse. INTERVENTION CBT, up to 10 sessions for 12 weeks, or enhanced usual care (regular, brief telephone calls, and referrals to primary care provider as needed). MEASUREMENTS Penn State Worry Questionnaire (PSWQ) administered by telephone at baseline, 1 month (mid treatment), 3 months (posttreatment), and at 3-month intervals through 15 months (1-year follow-up). The authors used binary logistic regression analysis to determine the association between early (1 month) response and treatment responder status (reduction of more than 8.5 points on the PSWQ) at 3 and 15 months. The authors also used hierarchical linear modeling to determine the relationship of early response to the trajectory of score change after posttreatment. RESULTS Reduction in PSWQ scores after the first month predicted treatment response at posttreatment and follow-up, controlling for treatment arm and baseline PSWQ score. The magnitude of early reduction also predicted the slope of score change from posttreatment through the 15-month assessment. CONCLUSION Early symptom reduction is associated with long-term outcomes after psychotherapy in older adults with GAD.

How to ask and what to do: A guide for clinical inquiry and intervention regarding female sexual health after cancer

Purpose of reviewAs the number of female cancer survivors continues to grow, there is a growing need to bridge the gap between the high rate of womens cancer-related sexual dysfunction and the lack of attention and intervention available to the majority of survivors who suffer from sexual problems. Previously identified barriers that hinder communication for providers include limited time, lack of preparation, and a lack of patient resources and access to appropriate referral sources. Recent findingsThis study brings together a recently developed model for approaching clinical inquiry about sexual health with a brief problem checklist that has been adapted for use for female cancer survivors, as well as practical evidence-based strategies on how to address concerns identified on the checklist. Examples of patient education sheets are provided as well as strategies for building a referral network. SummaryBy providing access to a concise and efficient tool for clinical inquiry, as well as targeted material resources and practical health-promoting strategies based on recent evidence-based findings, we hope to begin eliminating the barriers that hamper oncology providers from addressing the topic of sexual/vaginal health after cancer.

A brief review of the factors influencing sexuality after hysterectomy

The extent to which hysterectomy impacts sexual function is unclear. The estimated prevalence of sexual dysfunction among women who have undergone hysterectomy varies widely among studies and is influenced by methodological factors and characteristics of the study samples. Because pre-operative sexual dysfunction is a strong predictor of post-operative sexual dysfunction (Helström et al., 1993; Rhodes et al., 1999), it is perhaps more useful to examine the numbers of hysterectomized women who report an onset of new sexual problems post-hysterectomy. Few studies have made this distinction in evaluating sexual outcomes after hysterectomy. Among women who had not experienced symptoms prior to hysterectomy, estimated postoperative rates of new sexual dysfunction are 2 – 7% for dyspareunia, 9 – 21% for vaginal dryness, 5 – 11% for decreased sexual desire, and 2 – 11% for problems with orgasm (Carlson et al., 1994; Rhodes et al., 1999; Roovers et al., 2003; Schofield et al., 1991; Weber et al., 1999). Several prospective studies have found either no change or improvements in mean scores on measures of sexual function after hysterectomy (Bernhard, 1992; Farquhar et al., 2002; Gütl et al., 2002). Others have shown that mean frequencies of negative sexual symptoms are either unchanged or reduced one year or more after hysterectomy (Carlson et al., 1994; Rhodes et al., 1999; Virtanen et al., 1993). Prospective studies of this nature are confounded by the fact that sexual behaviour is likely to be altered just prior to any major surgery, particularly one that is associated with sexual consequences. Reports on the numbers of women who show improvements or declines in sexual function after hysterectomy have also been published. It is estimated that, retrospectively, 20 – 37% of women who have undergone hysterectomy report a deterioration in some qualitative aspect of their sexuality, while 22 – 52% report improvements (Dennerstein et al., 1977; Helström, 1994; Nathorst-Böös & von Schoultz, 1992; Weber et al., 1999). These data are not associated with features particular to hysterectomy, however, and may more generally reflect the patterns of sexual outcomes after any major surgery. Two studies using non-gynaecological surgery comparison groups have reported similar sexual outcomes among women Sexual and Relationship Therapy Vol 19, No. 1, February 2004

Novel Psychological Intervention for Decision Support in Women Considering Fertility Preservation Before Cancer Treatment

Decisions about fertility preservation in young adults with cancer are often made under conditions of high subjective stress and time pressure. In women, these decisions are further complicated by the invasiveness of fertility preservation procedures, concerns about health risks of these procedures, and financial barriers. This article describes the rationale for and development of a brief decision support and stress management intervention for women aged 18-40 who are considering fertility preservation before cancer treatment. Case examples from participants are provided to illustrate the potential applicability of the intervention to survivors in a variety of circumstances.