Julia Heiman

<h3 class="gsh_h3">Purpose: </h3>Female sexual dysfunction is highly prevalent but not well defined or understood. We evaluated and revised existing definitions and classifications of female sexual dysfunction.<h3 class="gsh_h3">Materials and Methods: </h3>An interdisciplinary consensus conference panel consisting of 19 experts in female sexual dysfunction selected from 5 countries was convened by the Sexual Function Health Council of the American Foundation for Urologic Disease. A modified Delphi method was used to develop consensus definitions and classifications, and build on the existing framework of the International Classification of Diseases-10 and DSM-IV: Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association, which were limited to consideration of psychiatric disorders.<h3 class="gsh_h3">Results: </h3>Classifications were expanded to include psychogenic and organic causes of desire, arousal, orgasm and sexual pain disorders …

In light of various shortcomings of the traditional nosology of women's sexual disorders for both clinical practice and research, an international multi-disciplinary group has reviewed the evidence for traditional assumptions about women's 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 women's sexual dysfunctions are recommended. There is a new definition of sexual interest/desire disorder, sexual arousal disorders are separated into genital and …

<h3 class="gsh_h3">ABSTRACT</h3> Introduction.  Existing definitions of women's sexual disorders are based mainly on genitally focused events in a linear sequence model (desire, arousal and orgasm). Aim.  To revise definitions based on an alternative model reflecting women's reasons/incentives for sexual activity beyond any initial awareness of sexual desire. Methods.  An International Definitions Committee of 13 experts from seven countries repeatedly communicated, proposed new definitions and presented at the 2nd International Consultation on Sexual Medicine in Paris July 2003. Main Outcome Measure.  Expert opinions/recommendations are based on a process that involved review of evidence‐based medical literature, extensive internal committee discussion, informal testing and re‐testing of drafted definitions in various clinical settings, public presentation and deliberation. Results.  Women have many reasons …

Recent consensus-based characterizations of female sexual dysfunction have emphasized personal distress as an essential component of their definition. To assist researchers and clinicians, we developed a new scale, the Female Sexual Distress Scale, to measure sexually related personal distress in women. In this article, we describe the initial stages in the development and validation of this instrument. Three studies involving a total of approximately 500 women were performed to evaluate the reliability and validity of the scale in different samples of sexually functional and dysfunctional women. Results indicated a unidimensional factor structure in both the original 20-item version and in a "polished" 12-item version. We observed a high degree of internal consistency and test-retest reliability in both versions across all three studies. Additionally, the scale showed a high degree of discriminative ability to …

Advises women how to reassess their sexual backgrounds, explore their sensual feelings, and improve their sexual relationships, and discusses how to recover from sexual traumas.

<h3 class="gsh_h3">Purpose: </h3>There is evidence that many patients experiencing chronic idiopathic prostatitis or prostadynia not only have recurrent physical symptoms but also display a range of psychological symptoms, such as depression or anxiety, suggesting that the symptoms of chronic prostatitis may seriously impact on quality of life and functioning. We investigated the degree of sickness impact of chronic prostatis, and the differential importance of physical and psychological symptoms in predicting sickness impact.<h3 class="gsh_h3">Materials and Methods: </h3>The sickness impact profile as well as several symptom measures were administered to 39 patients with chronic prostatitis. Multiple regression analyses were performed to evaluate what proportion of the variance in quality of life or functional status was explained by physical and psychological symptoms.<h3 class="gsh_h3">Results: </h3>The sickness impact profile mean total score of chronic prostatitis patients was …

<h3 class="gsh_h3">OBJECTIVE:</h3> To update for both clinicians and the lay public the evidence-based position statement published by The North American Menopause Society (NAMS) in July 2008 regarding its recommendations for menopausal hormone therapy (HT) for postmenopausal women, with consideration for the therapeutic benefit-risk ratio at various times through menopause and beyond. <h3 class="gsh_h3">METHODS:</h3> An Advisory Panel of clinicians and researchers expert in the field of women's health was enlisted to review the July 2008 NAMS position statement, evaluate new evidence through an evidence-based analysis, and reach consensus on recommendations. The Panel's recommendations were reviewed and approved by the NAMS Board of Trustees as an official NAMS position statement. Also participating in the review process were other interested organizations who then endorsed the document. <h3 class="gsh_h3">RESULTS:</h3> Current evidence …

Fifty‐nine female and 39 male undergraduates completed 3 sessions of a psychophysiological study on sexual arousal. Subjects were assigned to one of six experimental groups. Subjects within each group were exposed to a series of four audio‐tapes, and were asked to fantasize before and after the tape series. Tapes varied in their erotic and romantic content, and two sex role dimensions were also varied across tapes. Dependent measures included scaled subjective reports, genital pulse amplitude and blood volume responses, heart rate, and finger pulse amplitude. Erotic contents were significantly more sexually arousing than nonerotic contents for both sexes. Romantic content did not significantly enhance the facilitation of sexual arousal. Nontraditional sex roles were significantly more arousing for females, with a similar nonsignificant trend for males. There were significant correlations between genital …

The importance of androgens in establishing and maintaining sexual function in males of most species is well recognized. Estrogens also stimulate male sexual function in some species. In men, most studies of androgen effects on behavior have used hypogonadal men as an experimental model; much less is known about the role of endogenous testosterone (T) or estradiol (E2) in the regulation of behavior in healthy, eugonadal men. In a randomized, double-blind study, we used a GnRH antagonist, Nal-Glu, without T replacement, to induce acute, profound, reversible gonadal steroid deficiency in 9 normal men for 6 weeks (Nal-Glu alone). We also studied the effects of partial androgen replacement by administering Nal-Glu together with T enanthate, 50 mg im weekly, to 10 other men. A third group of 10 men received Nal-Glu plus T, 100 mg im weekly. We studied the role of endogenous E2 by administering …

Sexual dysfunctions and sexual problems are reviewed from the perspective of prevalence, broad etiological factors, and available treatments. Although a large percentage of individuals experience sexual problems, with estimates between 10% and 52% of men and 25% and 63% of women, the prevalence of sexual dysfunctions that meet diagnostic criteria is lower and less well established by large scale population‐based studies. Sexual problems and dysfunctions are correlated with other health conditions, including cardiovascular disorders, common diseases such as diabetes, health habits, and mental health. Adequate sexual functioning also appears to be associated with personal well‐being and relationship stability, although this may be more accurate for men than women. Efficacious and effective treatments exist for some of the sexual disorders, and there is an increasing focus on medical (particularly …

We assessed the impact of two distinct forms of socially desirable responding—self‐deceptive enhancement and impression management—on sexuality self‐reports (n = 504) under anonymous testing conditions. Results revealed significant positive relationships between self‐deceptive enhancement and sexual adjustment variables for both sexes. Impression management was significantly negatively related to a number of intrapersonal (e.g., unrestricted sexual fantasies, sexual drive) and interpersonal (e.g., sexual experience, virginity status) sexual behaviors for females, and to unrestricted sexual attitudes and fantasies for males. We calculated correlations were first calculated between self‐deceptive enhancement, impression management, and personality and conservatism scores. Self‐deceptive enhancement and impression management were significantly associated with personality for males and females …

In addition to their use as replacement therapy for hypogonadal males, androgens, particularly testosterone (T), are being explored as potential hormonal male contraceptive agents, alone or in combination with other compounds. Androgens have regulatory effects on a variety of physiological systems in addition to gonadotropin secretion and spermatogenesis. Therefore, as hormonal contraceptive regiments that alter serum T levels are explored, it is important to evaluate their effects on these aspects of normal male physiology. The effects of exogenous T on suppression of spermatogenesis in 19 healthy men were recently compared, using a T dosage of 200 mg im/week for 20 weeks. Before treatment, the men were evaluated during a 3-month pretreatment period, and after treatment, they were followed for 4-6 months or until their sperm counts normalized. Because of the lack of information regarding the …

Although recent changes in health care management in the United States have increased professional interest in identifying psychotherapies of proven utility, the concern about validated and effective psy chotherapy treatments is several decades old (Lambert &amp; Bergin, 1994; Paul, 1967). Compared to treatments for other mental health diagnoses, such as depression and anxiety, sexual dysfunction treat ment efficacy has received less critical attention. Sexual disorders have often attracted entrepreneurial and exploratory interventions, with clinical examples, that are often encouraging, but which rarely meet conditions for a well-designed single-case or group-studies series. Our purpose in reviewing validated treatments is to under score the importance of developing standards of care for sexual dys functions.Overview: Empirical Validation of Sexual Dysfunction Treatments

Sexuality research focuses almost exclusively on individuals rather than couples, though ongoing relationships are very important for most people and cultures. The present study was the first to examine sexual and relationship parameters of middle-aged and older couples in committed relationships of 1–51 years duration. Survey research was conducted in Brazil, Germany, Japan, Spain, and the U.S. targeting 200 men aged 40–70 and their female partners in each country, with 1,009 couples in the final sample. Key demographic, health, physical intimacy, sexual behavior, sexual function, and sexual history variables were used to model relationship happiness and sexual satisfaction. The median ages were 55 for men and 52 for women; median relationship duration was 25 years. Relationship satisfaction in men depended on health, physical intimacy, and sexual functioning, while in women only sexual …

An orgasm in the human female is a variable, transient peak sensation of intense pleasure, creating an altered state of consciousness, usually with an initiation accompanied by involuntary, rhythmic contractions of the pelvic striated circumvaginal musculature, often with concomitant uterine and anal contractions, and myotonia that resolves the sexually induced vasocongestion and myotonia, generally with an induction of well-being and contentment. Women's orgasms can be induced by erotic stimulation of a variety of genital and nongenital sites. As of yet, no definitive explanations for what triggers orgasm have emerged. Studies of brain imaging indicate increased activation at orgasm, compared to pre-orgasm, in the paraventricular nucleus of the hypothalamus, periaqueductal gray of the midbrain, hippocampus, and the cerebellum. Psychosocial factors commonly discussed in relation to female orgasmic ability …