Willibrordus Weijmar Schultz

Definitions of women's sexual dysfunction reconsidered: Advocating expansion and revision

In light of various shortcomings of the traditional nosology of womens sexual disorders for both clinical practice and research, an international multi-disciplinary group has reviewed the evidence for traditional assumptions about womens sexual response. It is apparent that fullfillment of sexual desire is an uncommon reason/incentive for sexual activity for many women and, in fact, sexual desire is frequently experienced only after sexual stimuli have elicited subjective sexual arousal. The latter is often poorly correlated with genital vasocongestion. Complaints of lack of subjective arousal despite apparently normal genital vasocongestion are common. Based on the review of existing evidence-based research, many modifications to the definitions of womens sexual dysfunctions are recommended. There is a new definition of sexual interest/desire disorder, sexual arousal disorders are separated into genital and subjective subtypes and the recently recognized condition of persistent sexual arousal is included. The definition of dyspareunia reflects the possibility of the pain precluding intercourse. The anticipation and fear of pain characteristic of vaginismus is noted while the assumed muscular spasm is omitted given the lack of evidence. Finally, a recommendation is made that all diagnoses be accompanied by descriptors relating to associated contextual factors and to the degree of distress.

Sexual sequelae of general medical disorders

That sexual symptoms can signal serious underlying disease confirms the importance of sexual enquiry as an integral component of medical assessment. Data on sexual function are sparse in some medical specialties. However, increased scientific understanding of the central and peripheral physiology of sexual response could help to identify the pathophysiology of sexual dysfunction from disease and medical interventions, and also to ameliorate or prevent some dysfunctions. Many common general medical disorders have negative effects on desire, arousal, orgasm, ejaculation, and freedom from pain during sex. Chronic disease also interferes indirectly with sexual function, by altering relationships and self-image and causing fatigue, pain, disfigurement, and dependency. Current approaches to assessment of sexual dysfunction are based on models that combine psychological and biological aspects.

What Importance Do Women Attribute to the Size of the Penis

OBJECTIVEnA great deal of men consider that the size of the penis is directly proportional to its sexual power. Some men, who are worried that their penis is too small, wish to be considered for surgical lengthening or thickening procedures. The argumentation for this chiefly points in the direction of women. However, have women actually been asked about the extent to which they consider the size of the penis to be of importance from a sexual point of view? Or asked what they think about ideas surrounding the size of the penis in relation with actual sexual functioning?nnnPATIENTS AND METHODSnTo address these questions, 375 sexually active women who had recently given birth at the University Hospital Groningen were asked a number of questions about sexual functioning and the importance they attach to the size of their partners penis.nnnRESULTSnA total of 170 questionnaires were returned (response rate 45%); 20% of the women found the length of the penis important and 1% very important; 55% and 22% of the women found the length of the penis unimportant and totally unimportant, respectively. Opinions about the girth of the penis followed the same trend. Length was less important than girth: 21% and 32%, respectively. The women who found the girth of the penis important had the same opinion about the length of the penis (correlation 0.71, p=-0.001). Median division into two subgroups (girth important/unimportant; t-test) did not reveal any significant differences in relation with demographic data. Correlation analysis did not reveal any significant correlation between sexual functioning (measured with the NSF) and opinions about the girth of the penis.nnnCONCLUSIONnAlthough clearly in the minority, a nevertheless considerable percentage of the women respondents attached substantial importance to the size of the male sexual organ.

Sexual rehabilitation of radical vulvectomy patients

Ten women, who had undergone radical vulvectomy for cancer of the vulva, and their partners were interviewed on average nearly 2 years after the operation. In spite of many problems 8 out of 10 couples accomplished complete or partial sexual rehabilitation. For two couples only there seemed to be no return to sexual activity. The authors conclude that sexual rehabilitation after radical vulvectomy may be expected. But, sufficient information, sufficient coping, and sufficient communication does not guarantee complete sexual rehabilitation. It is suggested that motivation for sexual expression and mutual affection might be more important for sexual rehabilitation than any physical restrictions imposed by the surgery.

Vaginal sensitivity to electric stimuli. theoretical and practical implications

Vaginal sensitivity was investigated in a group of 60 volunteers by means of an electric stimulus and under nonerotic conditions. In comparison to the dorsum of the hand, the genital area has a low sensitivity for electric stimuli (p <0.001). Of the genital area, the vaginal wall measured 2 to 4 cm from the vaginal introitus was found to be very insensitive (p <0.05). Within the vaginal wall a relatively sensitive position to electric stimuli could be detected at the “12-hr position” (the anterior vaginal wall) (p <0.001). The study provides data underscoring previous anatomical and clinical research findings regarding the sensitivity of the anterior vaginal wall. The inefficiency of coitus for inducing female orgasm is discussed.

Vulvar Vestibulitis Syndrome: Care Made to Measure

In 2001, Bergeron and colleagues published a randomized comparison of group cognitivebehavioral therapy, surface electromyographic biofeedback, and vestibulectomy in the treatment of dyspareunia resulting from vulvar vestibulitis. The study compared group cognitive-behavioural therapy (12 week trial) with surface electromyographic biofeedback (12 week trial) and with vestibulectomy for the treatment of dyspareunia resulting from vulvar vestibulitis syndrome ( W S ) . Seventy-eight women were randomly assigned to one of three treatment conditions and assessed a t preand posttreatment and six-month follow-up via gynecological examinations, structured interviews and standard questionnaires pertaining to current pain levels compared with pretreatment levels. Subjects in all three treatment groups who completed the study reported statistically significant reductions i n pain at posttreatment and six-month follow-up, although the vestibulectomy group was significantly more successful than the other two groups. Nevertheless the authors stated that the apparent superiority of vestibulectomy needs to be interpreted with caution, because seven women who had been assigned to this condition did not go ahead with the intervention. All three groups also improved significantly on measures of psychological adjustment and sexual functioning from pretreatment to six-month follow-up. Intentto-treat analysis supported the general pattern of results of analysis by treatment received. Findings suggest that women with dyspareunia can benefit from both medical and behavioural interventions. In 1996 Weijmar Schultz and co-workers2 compared partly randomized and partly nonrandomized cognitive-behavioral therapy (individual, multidisciplinary design), whether or not preceded by surgical intervention (modified Woodruff perineoplasty). It should be mentioned that, by-and-large, the duration of the individual cognitive-behavioral therapy was 1-1.5years. which is in sharp contrast with the 12 weeks in the study by Bergeron. Followup data were gathered 2.5-3 years after the completion of treatment. In the randomized part of the study, they did not find any differences in effectiveness between treatments. In the non-randomized part, the women were given the choice of whether or not to undergo surgery prior to cognitive-behavioural therapy; 82% chose not to undergo surgery; 79% of the women benefited from the treatment, irrespective of the type received. In the non-randomized cases who did not benefit from cognitivebehavioral therapy and later opted to undergo surgery, the success rate rose to 89%. The conclusion drawn after this study, closed in 1995, was: a cognitive-behavioural approach correlated best with the multidimensional nature of WS and offered a good chance of recovery. Although their approach was very timeconsuming, it saved a large proportion of women with dyspareunia from surgical intervention. However, the option to undergo surgery should not be removed or excluded from such an integrated approach. Sometimes, surgery can help women to break the vicious circle of pain. The authors formulated strict criteria for surgery. Surgery was considered: