Cindy Günzler

Efficacy of Psychosocial Interventions in Men and Women with Sexual Dysfunctions—A Systematic Review of Controlled Clinical Trials

INTRODUCTION As yet, a summary of the research evidence concerning the efficacy of psychological treatment in female sexual dysfunction is lacking. Previous reviews were often nonsystematic or explored one specific sexual dysfunction. AIM Our systematic review provides an overview of the efficacy of psychosocial interventions in all female sexual dysfunction. MAIN OUTCOME MEASURES Main outcome measures included for example psychometrically validated scales, diary notes, interviews, and vulvar algesiometer. The efficacy of psychosocial interventions was measured for example by the frequency of and satisfaction with sexual activity and sexual functioning. Safety and acceptance were evaluated on the basis of adverse events and dropout rates. METHODS The systematic literature search included electronic database search, handsearch, contact with experts, and an ancestry approach. Studies were included if the woman was given a formal diagnosis of a sexual dysfunction (International Statistical Classification of Diseases and Related Health Problems-ICD10/-9; Diagnostic and Statistical Manual of Mental Disorders-IV/-III-R) and when the intervention was psychosocial or psychotherapeutic. The control group included either another treatment or a waiting-list control group. The report of relevant outcomes was necessary for inclusion as well as the design of the study (randomized, controlled trials [RCTs] and controlled clinical trials). The assessment of methodological quality comprised aspects of randomization, blinding, incomplete outcome data, selective reporting, and allegiance. RESULTS We identified 15 RCTs that investigated efficacy in female sexual dysfunction and two further studies that examined male and female sexual dysfunction together. Most trials explored sexual pain disorders. About half of all studies in women used either a concept derived from Masters and Johnson or a cognitive-behavioral treatment program. Both approaches showed significant improvements compared with a control group. Benefit was not always maintained over the (variable) follow-up period. CONCLUSIONS Traditional sexual therapeutic concepts proved to be efficacious in the treatment of female sexual dysfunction. A shortcoming was the rather low methodological quality of included studies.

Effect of Sexual Function on Health-Related Quality of Life Mediated by Depressive Symptoms in Cardiac Rehabilitation. Findings of the SPARK Project in 493 Patients

INTRODUCTION Empirical evidence suggests associations between cardiovascular diseases, sexual functioning, depressive symptoms, and quality of life. However, to date, the interrelation of these constructs has not been examined simultaneously in a structural analysis. AIM To estimate the prevalence of sexual disorders and depressive symptoms and to examine the association between sexual disorders, depressive symptoms, and quality of life in patients in the rehabilitation of cardiovascular disorders. AIM A postal survey in five German inpatient rehabilitation centers for cardiovascular diseases was conducted. Prevalence of sexual disorders and depressive symptoms were assessed using psychometrically sound instruments. To analyze complex associations, structural equation modeling was used. MAIN OUTCOME MEASURES For epidemiological questions, proportions with 95% confidence intervals were calculated. The strength of association in structural equation models was expressed as a standardized regression coefficient. RESULTS Data from 493 patients were analyzed (response rate 22.7%). At least moderate erectile dysfunction proved to be present in 20.3% of men. The prevalence of female sexual dysfunction lay at 43.1%. At least moderate depressive symptoms were present in 14.4% of men and 16.5% of women. A considerable association between sexual functioning and quality of life was found in both sexes, which was largely mediated by depressive symptoms. Major drawbacks of the study are imprecision of the estimates due to limited sample size and questionable generalizability of the findings due to possible self-selection bias. CONCLUSIONS Considering the high prevalence of depressive symptoms and their role as a mediating factor between sexual functioning and quality of life, it is recommended to routinely screen for depression in men and women with cardiac disease.

Association of Sexual Functioning and Quality of Partnership in Patients in Cardiovascular Rehabilitation—A Gender Perspective

INTRODUCTION In the general population, studies indicate a strong association between sexual dysfunction and partnership quality. Despite a high prevalence of sexual problems in patients with cardiovascular diseases, this association has not yet been examined in this sample. AIM The central task of this paper is to determine the association between sexual dysfunction and quality of partnership under a gender-specific view. METHODS A written survey was handed out to all newly admitted patients in five participating inpatient rehabilitation centers for cardiovascular diseases in Germany. The survey included a gender-specific questionnaire to assess sexual functioning (International Index of Erectile Function for men, and Female Sexual Function Index for women), and a Partnership Questionnaire. MAIN OUTCOME MEASURES Correlations were calculated between sexual function and relationship satisfaction, and differences between groups (cardiovascular diseased men and women with and without sexual problems) were tested using covariance analyses. RESULTS Overall, 44.3% of 98 female participants and 52.7% of 395 male participants stated to have at least one sexual problem. Patients with sexual problems showed significantly more quarrelling (P = 0.001), significantly less tenderness (P < 0.001), communication (P < 0.001), as well as significantly lower overall quality of partnership (P < 0.001), compared with cardiac men and women without sexual problems. Suffering from a sexual problem impaired partnership quality for women to a significantly greater extent than for men. CONCLUSIONS Possible shortcomings of our study are selection bias, i.e., it is unknown whether all newly admitted patients received the questionnaire by their physician, as well as an overall low response rate, probably because of the private character of questions. This study suggests for the first time that men and women who suffer from cardiovascular diseases and sexual problems show a significantly decreased partnership satisfaction compared with those without sexual dysfunction. Further longitudinal studies might confirm the causal nature of found correlations.

Is One Question Enough to Detect Female Sexual Dysfunctions? A Diagnostic Accuracy Study in 6,194 Women

INTRODUCTION Literature shows that recognition of sexual dysfunctions in women is insufficient and existing instruments to aid detection are mostly too extensive to be used in routine practice. AIM To develop a brief and accurate screening instrument to detect female sexual dysfunctions in routine care. METHODS The initial item pool for the index test consisted of 15 items. In a 4-year period, a total of 12,957 persons filled out the test on a specifically designed web-site. Six thousand one hundred ninety-four complete data sets could be used for statistical analysis. The validated German version of the Female Sexual Function Index (FSFI-d) served as reference standard to estimate the accuracy of the screening test. In order to test several possible ways of combining items a multi-step procedure employing univariate analyses, multiple logistic regression, and classification and regression tree analysis was applied to a learning sample and cross-validated in a test sample. MAIN OUTCOME MEASURES Diagnostic performance (sensitivity, specificity, positive and negative predictive value, accuracy, diagnostic odds ratio as well as adjusted odds ratio) of the items and resulting models to discriminate women with sexual dysfunction from those without were calculated. RESULTS One dichotomous question for overall satisfaction proved to show high accuracy as a stand-alone instrument and played also a central role in multivariate models. It may be recommended as a one-question screening test (76.4% sensitivity and 76.5% specificity in the test sample). A hierarchical two-question test yielded higher sensitivity (93.5%) and lower specificity (60.1%). A slightly more extensive version consists of five questions (83.1% sensitivity and 81.2% specificity). CONCLUSIONS Despite some methodological limitations of our study all developed tests showed acceptable to good diagnostic performance, all are very short and could therefore be easily implemented into routine care. Further tests of psychometric properties in other settings are needed.