Jacques van Lankveld

Women's sexual pain disorders

INTRODUCTION Womens sexual pain disorders include dyspareunia and vaginismus and there is need for state-of-the-art information in this area. AIM To update the scientific evidence published in 2004, from the 2nd International Consultation on Sexual Medicine pertaining to the diagnosis and treatment of womens sexual pain disorders. METHODS An expert committee, invited from six countries by the 3rd International Consultation, was comprised of eight researchers and clinicians from biological and social science disciplines, for the purpose of reviewing and grading the scientific evidence on nosology, etiology, diagnosis, and treatment of womens sexual pain disorders. MAIN OUTCOME MEASURE Expert opinion was based on grading of evidence-based medical literature, extensive internal committee discussion, public presentation, and debate. Results. A comprehensive assessment of medical, sexual, and psychosocial history is recommended for diagnosis and management. Indications for general and focused pelvic genital examination are identified. Evidence-based recommendations for assessment of womens sexual pain disorders are reviewed. An evidence-based approach to management of these disorders is provided. CONCLUSIONS Continued efforts are warranted to conduct research and scientific reporting on the optimal assessment and management of womens sexual pain disorders, including multidisciplinary approaches.

REPORTS: Summary of the Recommendations on Sexual Dysfunctions in Women

INTRODUCTION Womens sexual dysfunction includes reduced interest/incentives for sexual engagement, difficulties with becoming subjectively and/or genitally aroused, difficulties in triggering desire during sexual engagement, orgasm disorder, and sexual pain. AIM To update the recommendations published in 2004, from the 2nd International Consultation on Sexual Medicine (ICSM) pertaining to the diagnosis and treatment of womens sexual dysfunctions. METHODS A third international consultation in collaboration with the major sexual medicine associations assembled over 186 multidisciplinary experts from 33 countries into 25 committees. Twenty one experts from six countries contributed to the Recommendations on Sexual Dysfunctions in Women. MAIN OUTCOME MEASURE Expert opinion was based on grading of evidence-based medical literature, widespread internal committee discussion, public presentation, and debate. RESULTS A comprehensive assessment of medical, sexual, and psychosocial history is recommended for diagnosis and management. Indications for general and focused pelvic genital examination are identified. Evidence based recommendations for further revisions of definitions for sexual disorders are given. An evidence based approach to management is provided. Extensive references are provided in the full ICSM reports. CONCLUSIONS There remains a need for more research and scientific reporting on the optimal management of womens sexual dysfunctions including multidisciplinary approaches.

Early and Late Components of Error Monitoring in Violent Offenders with Psychopathy

BACKGROUND One of the most recognizable features of psychopathy is the reduced ability to successfully learn and adapt overt behavior. This might be due to deficient processing of error information indicating the need to adapt controlled behavior. METHODS Event-related potentials (ERPs) and behavioral components of error-monitoring processes were investigated in 16 individuals with psychopathy and in 18 healthy subjects. A letter version of the Eriksen flanker task was used in two conditions. The first condition (normal condition) required participants to press one of two buttons depending on the identity of the target stimulus. The second condition (signaling condition) required them to signal each time they had committed an error by making a second press on a signaling button. Early stages of error monitoring were investigated by using the error-related negativity (ERN/Ne) and post-error slowing as indexes. Later stages were explored by examining the error positivity (Pe) and signaling rates. RESULTS Both groups showed similar ERN amplitudes and amounts of post-error slowing. The psychopathic group exhibited both reduced Pe amplitudes and diminished error-signaling rates compared with the control group. CONCLUSIONS Individuals with psychopathy show intact early error processing and automatic behavioral adaptation but have deficits in later stages of error processing and controlled behavioral adaptation. This is an indication that individuals with psychopathy are unable to effectively use error information to change their behavior adequately.

Cognitive Behavioral Therapy for Sexual Dysfunctions in Women

Sexual dysfunctions in women are classified into disorders of desire, arousal, orgasm, and pain (including dyspareunia and vaginismus). As the cognitive behavioral treatment (CBT) procedures differ among these sexual disorders, the treatments for each disorder are reviewed separately. The efficacy of CBT differs depending on the specific sexual dysfunction to be treated. It is concluded that only a few CBT treatments for womens sexual dysfunction have yet been empirically investigated in a methodologically sound way and little is known about which of the treatment components are most effective.

Hypoactive sexual desire disorder: An underestimated condition in men.

HSDD is associated with a wide variety of biological and psychological causes [1]. At present, no single instrument for diagnostically assessing HSDD prevails [3]. Sexual healthcare providers who wish to be alert to a diagnosis of HSDD are advised to pose direct and unambiguous questions to their patients, to probe for aspects of sexual desire and motivation. Patients often will not reveal sexual problems unless explicitly invited [4]. Collateral information may be obtained through questionnaires, completed before or after the consultation. Several reliable and valid questionnaires are available for assessing sexual desire problems, with easy-to-follow instructions. The Sexual Desire Inventory [5] was designed specifically to measure level of sexual desire, the International Index of Erectile Function [6] provides a subscale to measure sexual desire, and the Golombok Rust Inventory of Sexual Satisfaction [7–9] provides subscales of sexual avoidance, and of infrequency of sexual contact.

Cognitive‐behavioral bibliotherapy for sexual dysfunctions in heterosexual couples: A randomized waiting‐list controlled clinical trial in the Netherlands

In a randomized waiting‐list controlled clinical trial cognitive‐behavioral bibliotherapy was investigated in heterosexual couples with sexual dysfunctions. After a 10‐week treatment participants (N = 199 couples) reported fewer complaints of low frequency of sexual interaction and general improvement of their sexual problem, and lower male posttreatment ratings of problem‐associated distress. At follow‐up gains with respect to frequency of sex and problem‐associated distress had eroded. Female participants with vaginismus posttreatment reported less complaints of vaginismus. However, female participants with dyspareunia reported more complaints of vaginal discomfort. These differences were maintained at follow‐up. An “intention‐to‐treat” analysis showed that the effects were robust to participant attrition. Treatment compliance was positively associated with outcome in females at posttreatment.In a randomized waiting‐list controlled clinical trial cognitive‐behavioral bibliotherapy was investigated in heterosexual couples with sexual dysfunctions. After a 10‐week treatment participants (N = 199 couples) reported fewer complaints of low frequency of sexual interaction and general improvement of their sexual problem, and lower male posttreatment ratings of problem‐associated distress. At follow‐up gains with respect to frequency of sex and problem‐associated distress had eroded. Female participants with vaginismus posttreatment reported less complaints of vaginismus. However, female participants with dyspareunia reported more complaints of vaginal discomfort. These differences were maintained at follow‐up. An “intention‐to‐treat” analysis showed that the effects were robust to participant attrition. Treatment compliance was positively associated with outcome in females at posttreatment.

Internet-Based Brief Sex Therapy for Heterosexual Men with Sexual Dysfunctions: A Randomized Controlled Pilot Trial

INTRODUCTION Internet-based sex therapy for men with erectile dysfunction has been advocated as an easily accessible and cost-effective treatment. AIM To test whether Internet-based sex therapy is superior to waiting list. METHODS Internet-based therapy was administered to heterosexual men with erectile dysfunction or premature ejaculation, without face-to-face contact, in a waiting-list controlled design, with pre-, post-, and follow-up measurements at 3 and 6 months posttreatment. Treatment was based on the sensate-focus model of Masters and Johnson, and supplemented with cognitive restructuring techniques. MAIN OUTCOME MEASURES Self-reported improvement of sexual functioning, erectile functioning (men with ED), premature ejaculation (men with PE), sexual desire, overall sexual satisfaction, and sexual self-confidence. RESULTS Ninety-eight men participated (58 ED, 40 PE). Sexual functioning was much or somewhat improved in 40 participants (48%). In participants with ED, a near significant effect of treatment was found (P = 0.065), with higher levels of sexual desire (P < 0.05) and sexual self-confidence (P = 0.05) in treated men, in addition to improved erectile functioning (P = 0.01) and overall sexual satisfaction (P < 0.001) in both groups. In participants with PE, treatment was not superior to waiting list. In participants with ED, erectile functioning (P < 0.05) and overall sexual satisfaction (P = 0.002) improved significantly. In participants with PE, latency to ejaculation (P < 0.001), sexual desire (P < 0.05), and overall sexual satisfaction (P < 0.05) improved significantly from baseline to posttreatment, with no further changes at both follow-ups. Sexual self-confidence in men with PE remained unchanged during treatment until follow-up at 3 months posttreatment, and then was found to be improved at 6-months follow-up (P < 0.05). CONCLUSION Internet-based sex therapy for male erectile dysfunction was efficacious for male erectile disorder. For men with premature ejaculation, however, treatment was not superior to waiting list.

Psychiatric Comorbidity in Heterosexual Couples with Sexual Dysfunction Assessed with the Composite International Diagnostic Interview

Psychiatric comorbidity of sexual dysfunction (SD) in heterosexual couples was investigated with the Composite International Diagnostic Interview, version 1.1 (CIDI; WHO, 1992). Demographic data, diagnoses of sexual dysfunction according to DSM-IV criteria, CIDI data, and scores on the Golombok Rust Inventory of Sexual Satisfaction (GRISS7colon; Rust and Golombok, 1986) were collected for 382 men and women with SD who applied for participation in a study of bibliotherapy. The prevalence of psychiatric disorder in the study sample was compared with the general population as documented in the NEMESIS epidemiological study in the Netherlands (Bijl et al., 1998). GRISS scores corroborated the diagnoses of SD. An increased prevalence of current anxiety disorder was found in sexually dysfunctional men (11.6%; χ2(df = 1) = 7.753; p = .005). An increased rate of lifetime diagnoses of affective (21.5%; χ2(df = 1) = 9.728; p = .002) and a near significant increased rate of lifetime anxiety disorders (19.9%; χ2(df = 1) = 5.642; p = .018) was found in men with SD. In the sexually dysfunctional female participants, a higher prevalence of current anxiety disorder was found (20.4%; χ2(df = 1) = 10.057; p = .002). Lifetime affective disorders (38.3%; χ2(df = 1) = 20.719; p > .001) as well as lifetime anxiety disorders (37.3%; χ2(df = 1) = 16.254; p > .001) were more prevalent than in the general female population. Psychiatric comorbidity in men and women with SD was significantly higher than that found in the general population. The increased comorbidity of psychiatric disorders in men and women with SD warrants adding efficient psychiatric screening to the standard intake assessment procedure of patients with SD.

The effect of visual sexual content on the event-related potential

In the present study we investigated the effect of emotional valence and arousal value of non-erotic visual stimuli on event-related potentials. We also directly compared the effects of erotic and non-erotic stimuli of comparable valence and arousal levels. Sixteen sexually functional heterosexual males rated 150 computer screen pictures, selected from the International Affective Picture System, representing five stimulus types differing along dimensions of emotional valence and arousal, and erotic vs. non-erotic content. A positive deflection of the ERP between 300 and 500 ms after stimulus onset (P300) was found to be sensitive to stimulus differences, with positive valence and high arousal resulting in larger P300. Furthermore, the positive slow wave (PSW) between 500 and 750 ms revealed additive effects of valence and arousal value. High arousal and positive valence of the stimuli resulted in larger PSW. Importantly, an interaction effect was absent here. In addition, sexual content led to a larger P300 and PSW than expected on the basis of a mere additive contribution of high arousal and positive valence.

Sex Therapy through the Internet for Men with Sexual Dysfunctions: A Pilot Study

Results are described of a pilot study of the efficacy of sex therapy through the Internet for thirty-nine men with erectile dysfunction or rapid ejaculation. Treatment consisted of sex therapy (Masters & Johnson, 1970), had a duration of three months, and was conducted entirely through e-mail. Forty-six percent of the participants dropped out. Fourteen (67%) participants reported an improvement of their sexual functioning. Seven (47%) participants reported the improvement had sustained one month after termination, eight (53%) participants reported no further change. We conclude that sex therapy through the Internet may yield positive results and that further controlled studies are warranted.