Morag A. Yule

Psychological interventions for the sexual sequelae of cancer: A review of the literature

IntroductionDespite the frequency of sexual side effects of cancer, treatment outcome studies focus almost exclusively on pharmacologic agents, most of which are completely ineffective for women. We conducted a systematic review of the literature on psychological interventions for sexual difficulties following cancer.MethodsWe searched eight research databases using the terms “sexual dysfunction,” “cancer,” and “psychological therapy” for empirical studies (not case illustrations). Three independent raters evaluated studies using a modified version of the Oxford Centre for Evidence-Based Medicine System to rate the level of evidence for every retrieved study.ResultsWe identified 27 papers ranging in level of evidence from 1b (randomized controlled trial) to 4 (expert committee report or clinical experience). Youth showed positive outcomes on sexual knowledge, body image, and sexual functioning, and treatments administered by paraprofessionals were equally effective. Thematic counseling, addressing mental health, social functioning, and sexual functioning, significantly improved quality of sexual relationships, independent partner presence, whereas other studies revealed more pronounced benefits if the partner participated. Despite the importance of talking to a cancer care provider about sexual difficulties, interventions designed to empower patients to do so were ineffective. Treatments addressing sex education were more effective if they also addressed motivation and self-efficacy. Only three treatment outcome studies focused on ethnic minority (African-American or Hispanic) sexual concerns and one focused on sexual minority (Lesbian) issues.DiscussionThere was moderate support for the effectiveness and feasibility of psychological interventions targeting sexual dysfunction following cancer but attrition rates are high, placebo response is notable, and there are often barriers impeding survivors from seeking out psychological interventions for sexual concerns.Implications for cancer survivorsDespite the prevalence of sexual difficulties following cancer treatment, psychological interventions are a viable, but not often sought after option to help improve sexual functioning, intimacy, and quality of life for cancer survivors and their partners.

Associations Among Physiological and Subjective Sexual Response, Sexual Desire, and Salivary Steroid Hormones in Healthy Premenopausal Women

INTRODUCTION Few studies have examined how sexual arousal influences healthy premenopausal womens hormones, limiting our understanding of basic physiology and our ability to transfer knowledge from clinical and nonhuman populations. AIM To examine how sexual arousal and steroid hormones (testosterone [T], cortisol [C], estradiol [E]) were linked, to see whether hormone levels influenced and/or changed in response to sexual arousal elicited via visual erotic stimuli in healthy women. METHODS Participants included 40 healthy premenopausal women not using exogenous hormones. MAIN OUTCOME MEASURES Change in genital sexual arousal (vaginal pulse amplitude), change in subjective sexual arousal, sexual desire (via the Sexual Desire Inventory and Female Sexual Function Index scales), as well as T, C, and E via saliva samples taken before and following viewing of erotic stimuli as genital arousal was recorded via a vaginal photoplethysmograph. RESULTS E increased in response to sexual stimuli but this was not statistically associated with genital sexual arousal, whereas C decreased in association with genital sexual arousal, and T showed no statistically significant change. Relationship status was linked to genital but not subjective sexual arousal such that dating women exhibited higher genital sexual arousal than single or partnered women. Results indicated that all three hormones were associated with self-reported genital arousal (via the Detailed Assessment of Sexual Arousal scales) and sexual desire in different domains, and both T and E were associated with self-reported orgasms. CONCLUSION Findings point to the need to examine multiple hormones in multiple ways (e.g., baseline, changes, stimulated) and question using erotic stimuli-induced arousal as a model for womens endocrine responses to sexuality.

Asexuality: Sexual Orientation, Paraphilia, Sexual Dysfunction, or None of the Above?

Although lack of sexual attraction was first quantified by Kinsey, large-scale and systematic research on the prevalence and correlates of asexuality has only emerged over the past decade. Several theories have been posited to account for the nature of asexuality. The goal of this review was to consider the evidence for whether asexuality is best classified as a psychiatric syndrome (or a symptom of one), a sexual dysfunction, or a paraphilia. Based on the available science, we believe there is not sufficient evidence to support the categorization of asexuality as a psychiatric condition (or symptom of one) or as a disorder of sexual desire. There is some evidence that a subset of self-identified asexuals have a paraphilia. We also considered evidence supporting the classification of asexuality as a unique sexual orientation. We conclude that asexuality is a heterogeneous entity that likely meets conditions for a sexual orientation, and that researchers should further explore evidence for such a categorization.

Asexuality: An Extreme Variant of Sexual Desire Disorder?

INTRODUCTION Human asexuality is defined as a lack of sexual attraction to anyone or anything. Various theories have been proposed to explain how asexuality should best be classified, and some have maintained that asexuality is an extreme variant of hypoactive sexual desire disorder (HSDD)-a sexual dysfunction characterized by a lack of interest in sex and significant distress. To date, this has never been empirically examined. AIM AND METHOD Using measures of sexual desire and behavior, sex-related distress, personality, and psychopathology, the aim of the current study was to compare individuals scoring above the cutoff for asexuality identification (AIS >40) (n = 192) to sexual individuals (n = 231). The sexual group was further divided into a control group (n = 122), a HSDD group (n = 50), and a group with symptoms of low desire that were nondistressing (n = 59). RESULTS Analyses were controlled for age. Individuals in the AIS >40 group had a greater likelihood of never previously engaging in sexual intercourse, fantasies, or kissing and petting than all other groups and a lower likelihood of experiencing sex-related distress than those with HSDD. For women, those in the HSDD and AIS >40 groups had significantly lower desire than the subclinical HSDD and control groups. Men in the AIS >40 group had significantly lower desire than the other three groups. Symptoms of depression were highest among those with subclinical HSDD and HSDD, whereas there were no group differences on alexithymia or desirable responding. A binary logistic regression indicated that relationship status (long-term dating/married), sexual desire, sex-related distress, and lower alexithymia scores were the best predictors of group membership (HSDD vs. AIS >40). CONCLUSION Taken together, these results challenge the speculation that asexuality should be classified as a sexual dysfunction of low desire.

Mental health and interpersonal functioning in self-identified asexual men and women

Human asexuality is defined as a lack of sexual attraction to anyone or anything, and preliminary evidence suggests that it may best be defined as a sexual orientation. As asexual individuals may face the same social stigma experienced by gay, lesbian and bisexual persons, it follows that asexual individuals may experience higher rates of psychiatric disturbance that have been observed among these non-heterosexual individuals. This study explored mental health correlates and interpersonal functioning and compared asexual, non-heterosexual and heterosexual individuals on these aspects of mental health. Analyses were limited to Caucasian participants only. There were significant differences among groups on several measures, including depression, anxiety, psychoticism, suicidality and interpersonal problems, and this study provided evidence that asexuality may be associated with higher prevalence of mental health and interpersonal problems. Clinical implications are indicated, in that asexual individuals should be adequately assessed for mental health difficulties and provided with appropriate interventions that are sensitive to their asexual identity.

The International Index of Erectile Function: A Methodological Critique and Suggestions for Improvement

The International Index of Erectile Function is a well-worded and psychometrically valid self-report questionnaire widely used as the standard for the evaluation of male sexual function. However, some conceptual and statistical problems arise when using the measure with men who are not sexually active. These problems are illustrated using 2 empirical examples, and the authors provide recommended solutions to further strengthen the efficacy and validity of this measure.

A validated measure of no sexual attraction: the Asexuality Identification Scale

Human asexuality has been described as a lack of sexual attraction toward anyone or anything. One percent of the adult population is thought to be asexual, and research suggests that asexuality is best conceptualized as a sexual orientation. A serious limitation in past research on asexuality has been the complete lack of a validated tool to measure asexuality. Due to limitations in recruiting sufficiently powered local samples, most studies have relied on recruiting via online web-based asexual communities. This is problematic because it limits the sample to individuals who have been recruited through established asexuality networks/communities. The present study aimed to develop and validate a self-report questionnaire to assess asexuality. The questionnaire was intended to provide a valid measure independent of whether the individual self-identified as asexual and was developed in several stages, including: development and administration of open-ended questions (209 participants: 139 asexual and 70 sexual); administration and analysis of resulting 111 items (917 participants: 165 asexual and 752 sexual); administration and analysis of 37 retained items (1,242 participants: 316 asexual and 926 sexual); and validity analysis of the final items. The resulting Asexuality Identification Scale (AIS), a 12-item questionnaire, is a brief, valid, and reliable self-report instrument for assessing asexuality. It is psychometrically sound, easy to administer, and has demonstrated ability to discriminate between sexual and asexual individuals. It should prove useful to allow researchers to recruit more representative samples of the asexual population, permitting for an increased understanding of asexuality.

Do East Asian and Euro-Canadian women differ in sexual psychophysiology research participation?

Evidence from studies of ethnic differences in sexual conservativeness and Papanicolaou (Pap) testing behaviors suggests that there may be culture-linked differences in rates of participation in physically invasive sexuality studies, resulting in volunteer bias. The effects of ethnicity and acculturation on participation in female psychophysiological sexual arousal research were investigated in a sample of Euro-Canadian (n = 50) and East Asian (n = 58) women. Participants completed a battery of questionnaires and were given either course credits or

Sexual Fantasy and Masturbation Among Asexual Individuals: An In-Depth Exploration

10 for their participation. Participants were then informed about the opportunity to participate in a second phase of the study, which involved psychophysiological sexual arousal testing and which was completely optional. Contrary to expectations, the results showed that the East Asian women were more likely to participate in Phase 2 than the Euro-Canadian women. Among the East Asian women, greater heritage acculturation and lower mainstream acculturation predicted a lower likelihood of Phase 2 participation. The findings suggest the need to be wary of overgeneralizing female psychophysiological sexual arousal research results and may have implications for improving Pap testing behaviors in East Asian women.

Sexual arousal in East Asian and Euro-Canadian women: a psychophysiological study.

Human asexuality is generally defined as a lack of sexual attraction. We used online questionnaires to investigate reasons for masturbation, and explored and compared the contents of sexual fantasies of asexual individuals (identified using the Asexual Identification Scale) with those of sexual individuals. A total of 351 asexual participants (292 women, 59 men) and 388 sexual participants (221 women, 167 men) participated. Asexual women were significantly less likely to masturbate than sexual women, sexual men, and asexual men. Asexual women were less likely to report masturbating for sexual pleasure or fun than their sexual counterparts, and asexual men were less likely to report masturbating for sexual pleasure than sexual men. Both asexual women and men were significantly more likely than sexual women and men to report that they had never had a sexual fantasy. Of those who have had a sexual fantasy, asexual women and men were significantly more likely to endorse the response “my fantasies do not involve other people” compared to sexual participants, and consistently scored each sexual fantasy on a questionnaire as being less sexually exciting than did sexual participants. When using an open-ended format, asexual participants were more likely to report having fantasies about sexual activities that did not involve themselves, and were less likely to fantasize about topics such as group sex, public sex, and having an affair. Interestingly, there was a large amount of overlap between sexual fantasies of asexual and sexual participants. Notably, both asexual and sexual participants (both men and women) were equally likely to fantasize about topics such as fetishes and BDSM.