Abstract: Passion and sexual satisfaction typically diminish in longer-term relationships, but this decline is not inevitable. We identified the attitudes and behaviors that most strongly differentiated sexually satisfied from dissatisfied men and women who had been together for at least three years (N = 38,747). Data were collected in 2006 from cohabiting and married men (M) and women (W) via an online survey on a major national U.S. news Web site. The vast majority of these participants reported being satisfied with their sex lives during their first six months together (83% W; 83% M). Satisfaction with their current sex lives was more variable, with approximately half of participants reporting overall satisfaction (55% W; 43% M) and the rest feeling neutral (18% W; 16% M) or dissatisfied (27% W; 41% M). More than one in three respondents (38% W; 32% M) claimed their sex lives were as passionate now as in the beginning. Sexual satisfaction and maintenance of passion were higher among people who had sex most frequ...

Abstract: The study purpose was to assess, in a U.S. probability sample of women, experiences related to orgasm, sexual pleasure, and genital touching. In June 2015, 1,055 women ages 18 to 94 from the nationally representative GfK KnowledgePanel® completed a confidential, Internet-based survey. While 18.4% of women reported that intercourse alone was sufficient for orgasm, 36.6% reported clitoral stimulation was necessary for orgasm during intercourse, and an additional 36% indicated that, while clitoral stimulation was not needed, their orgasms feel better if their clitoris is stimulated during intercourse. Women reported diverse preferences for genital touch location, pressure, shape, and pattern. Clinical, therapeutic, and educational implications are discussed.

Abstract: Sexual functioning is a complex bio-psycho-social process, coordinated by the neurological, vascular and endocrine systems. In addition to the biological factors, the psychosocial factors like societal and religious beliefs, health status, personal experience, ethnicity and socio-demographic conditions, and psychological status of the person/couple play an important role in adequate sexual functioning of a person. In addition, sexual activity incorporates interpersonal relationships, each partner bringing unique attitudes, needs and responses into the coupling. A breakdown in any of these areas may lead to sexual dysfunction. Prevalence of sexual dysfunction in general population is very high. It is suggested that about 43% of women and 31% of men have one or other kind of sexual dysfunction. Among men, premature ejaculation is the most common male sexual dysfunction. There is lack of consensus with regards to the most common sexual dysfunction in women with some studies reporting hypoactive sexual desire disorder to be the most common entity, followed by orgasmic and arousal disorders; whereas other studies suggest that difficulty achieving orgasm and vaginal dryness to be the most common type of sexual dysfunction in women. Problems of sexual dysfunction may be lifelong or acquired, general or situational. Although sexual problems are highly prevalent, these are frequently under-recognized and under-diagnosed in clinical practice. It is also noted that clinicians also have lack of understanding about the approach for identification and evaluation of sexual problem. It is often recommended that the treating psychiatrists and collaborating specialists need to possess broad knowledge and appropriate attitude towards human sexuality. The essential concepts underlying the management of sexual problems are adoption of a patient-centered framework for evaluation and treatment. Principles of evidence-based medicine may be followed in both men and women in diagnostic and treatment planning and adoption of common management approaches for sexual dysfunction. The purpose of these guidelines is to present a framework for the evaluation, treatment, and follow-up of the patient/couple, who presents with sexual dysfunction. We hope that these guidelines would help in facilitating proper management of patients presenting with various types of sexual dysfunction. These guidelines are to be read along with the earlier version of Indian Psychiatric Society Guidelines.

Abstract: Orgasms have been promoted as symbols of sexual fulfillment for women, and have perhaps become the symbol of a woman’s healthy sex life. However, some research has suggested that this focus on women’s orgasms, though ostensibly for women, may actually serve men; but the mechanisms of this are unclear. In the present experiment, we hypothesized that women’s orgasms specifically function as a masculinity achievement for men. To test this, we randomly assigned 810 men (M age = 25.44, SD = 8.31) to read a vignette where they imagined that an attractive woman either did or did not orgasm during a sexual encounter with them. Participants then rated their sexual esteem and the extent to which they would feel masculine after experiencing the given situation. Our results showed that men felt more masculine and reported higher sexual esteem when they imagined that a woman orgasmed during sexual encounters with them, and that this effect was exacerbated for men with high masculine gender role stress. These results s...

Abstract: Introduction Urinary incontinence (UI) and sexual dysfunction are common conditions often undiagnosed and untreated in women and are associated with decreased quality of life. Aim To evaluate the relation between UI and female sexual dysfunction (FSD), considering incontinence type and the psychosocial and physiologic aspects of sexual function. Methods PubMed search of terms related to UI and FSD from 1979 to 2016 generated 603 published references, of which 26 were included. Nine additional studies came from bibliographic review. Main Outcome Measure Rates and types of sexual dysfunction. Results In cross-sectional and case-control studies, UI was associated with increased rates and severity of FSD. Coital UI occurred in 24% to 66% of women with UI. Impaired body image, fear of coital UI, avoidance of sex, and complete abstinence were more common in women with UI. Deficits in desire, lubrication, satisfaction, and increased pain were found across numerous studies. Mixed UI was associated with more FSD than urgency UI and stress UI. Multiple studies suggest urgent UI is more bothersome than stress UI. Coital UI was associated with a urodynamic diagnosis other than genuine stress incontinence in 25% to 50%. Leakage at penetration was associated with stress UI; leakage at orgasm was associated more often with detrusor overactivity. Conclusion Women's UI is associated with increased rates of sexual dysfunction, suggesting concurrent screening is warranted. Clarifying timing of coital leakage would facilitate targeted treatment. Standardization of FSD measurements could better elucidate the relation between UI and FSD. Duralde ER, Rowen TS. Urinary Incontinence and Associated Female Sexual Dysfunction. Sex Med Rev 2017;5:470–485.

Abstract: Objective: To present the current understanding of normal anatomy, physiology, sexual physiology, pathophysiology and the consequential sexual changes and dysfunctions following a spinal cord injury (SCI). Methods: Narrative review of the latest literature. Results: Peripheral innervations of the pelvis involve 3 sets of efferent neurons coordinated though the pelvic plexus (somatic, thoracolumbar sympathetic, and sacral parasympathetic), and these are under cerebral descending excitatory and inhibitory control. SCI, depending on the level of lesion and completeness, can alter this cerebral control, affecting the psychological and reflexogenic potential for genital arousal and also ejaculation and orgasm. During arousal, nitric oxide is the main neurotransmitter for smooth muscle relaxation in both male and female erectile tissue. In men, erection, ejaculation, and orgasm are under separate neurological control and can be individually affected by SCI. Conclusions: Since sexual function is rated amongst th...

Abstract: Objective:Sleep disturbance and sexual dysfunction are common in menopause; however, the nature of their association is unclear. The present study aimed to determine whether sleep characteristics were associated with sexual activity and sexual satisfaction.Methods:Sexual function in the last

Abstract: Erectile dysfunction (ED), the most commonly reported sexual problem for men, reduces the quality of life for both patients and their partners Even when physiologically effective, long-term adherence to ED treatments is poor We review here the implication of having patients' partners involved in ED treatment, starting with treatment selection We suggest that having partners engaged from the outset may promote an erotic association of the treatment with the partner, ie, conceptually linking the aid to the sexual pleasure that the partner provides We hypothesize that this erotic association should enhance the sexual aid's effectiveness and might potentially help improve long-term adherence The primary focus of this review, though, is non-pharmacological and non-surgical options for maintaining sexual activity for men with ED Though not ED treatments per se, anecdotal data suggest that these options may be effective for some patients and their partners in regaining a satisfying sex life The aids discussed include external penile prostheses, penile sleeves, and penile support devices These devices can allow men to participate in penetrative sexual intercourse despite moderate to severe ED External penile prostheses can be personalized so they match in size and shape a man's normal full erection Penile sleeves can similarly be customized with a lumen that fits best a patient's penis for optimal tactile stimulation We review how multi-sensory integration can enhance sexual arousal for men who use such devices, allowing them to achieve orgasm despite intractable ED Patients are not always advised within ED clinics about these options nor why and how they can facilitate non-erection dependent sexual recovery Clinicians need to be aware of these devices and their positive attributes, so they can objectively counsel and encourage couples to explore their use as an alternative to more invasive treatments The most commonly promoted non-medical ED aid offered to patients is the vacuum erection device We discuss how erections achieved with the vacuum erection device have a "hinge effect", that is an underappreciated barrier to the effectiveness of the erection With a hinged erection, the penis points downward rather than upward We show how the normal kinematics of the penis during coitus is not strictly linear (ie, not uniaxial; not just in-and-out), and is impeded by hinging Positional adjustment, such as the receptive partner being on top, may help overcome this problem for some couples Lastly, we suggest that, in the case where ED can be anticipated from a pending medical treatment, such as a prostatectomy, pre-habilitative approaches may potentially improve adherence to sexual aid use in the long-term In conclusion, non-pharmacological and non-surgical options for sexual recovery are available Scientific studies on the effectiveness of these interventions in restoring satisfying sex are warranted

Abstract: Couples in committed relationships encounter a multitude of issues. According to Metz and McCarthy (2010), when couples report high sexual satisfaction, it accounts for 15% to 20% of their overall relationship satisfaction. However, when couples report low sexual satisfaction, it contributes 50% to 70% of their overall satisfaction with their partner. Issues of sexual desire, currently referred to as sexual desire discrepancy, are among the most difficult to treat. Although there are many factors contributing to the issue of sexual desire discrepancy, current literature highlights the importance of emotional intimacy as an outcome and predictor of increased sexual desire. Given the complex nature of sexual desire, clinicians often lack the understanding and treatment options that are systemic. By viewing sexual desire discrepancy as a relational problem that can be treated using emotionally focused therapy, clinicians are better equipped to work with emotional and sexual factors that impact desire and couple distress.

Abstract: Perineal tears may have a negative impact on female sexual function (FSF). The aim of the study was to assess the effect of different degrees of perineal tears sustained during delivery on subsequent FSF. This prospective cohort study assessed women with third- or fourth-degree perineal tears following vaginal delivery (study group) and compared them with women who underwent episiotomy or had minor lacerations (control group). Sexual function of postpartum women meeting inclusion criteria was assessed using the validated Arabic version of the Female Sexual Function Index (FSFI) questionnaire at 6 and 12 months postpartum. One hundred and fifty-six women completed the study: 56 and 100 in the study and control groups, respectively. Mean total FSFI scores were significantly different between groups at 6 months postpartum [28.1 ± 4.1 vs. 18 ± 2.4 (p < 0.002)]. After 12 months, and despite slight improvement, sexual function was significantly lower in the repaired compared with the control group (21.8 ± 2.9 vs. 29.2 ± 4.1). Women in the study group showed significant decreases in the scores of desire, arousal, lubrication, orgasm, satisfaction, and pain domains 12 months postdelivery. Higher-degree perineal tears negatively affect FSF up to 1 year after delivery. Evaluation of FSF and appropriate counseling are necessary for women with perineal tears, especially the higher degree tears.

Abstract: Background Spinal Cord Injury (SCI) causes neurological impairment with resultant neurogenic sexual dysfunction which can compound preexisting psychological and medical sexual concerns. Understanding these concerns is important in managing the lifelong needs of persons with SCIs. Objectives To provide an overview of the impact of SCI on sexuality along with a framework for treatment of sexual concerns. To briefly review male infertility and its treatments and pregnancy in females after SCI. Methods Interdisciplinary literature review and synthesis of information. Results The average age at SCI is increased, thus persons with SCIs may have preexisting sexual concerns. Sexual activity and satisfaction are decreased after SCI. Psychogenic sexual arousal is related to remaining sensation in the T11-L2 dermatomes. Orgasm occurs in approximately 50% of persons with SCIs with all injuries except subjects with complete lower motor neuron (LMN) injuries affecting the lowest sacral segments A structured approach to treatment including assessing preinjury function, determining the impact of injury, education, assessing and treating iatrogenic sexual dysfunction and treatment of concomitant problems is recommended. Basic and advanced methods to improve sexual arousal and orgasm are discussed and treatment of anejaculation and issues associated with pregnancy and SCI are reviewed. Conclusions Sexual satisfaction is impaired after SCI; however, education and new therapies can improve responsiveness. Future research is warranted to improve sexual function and fertility potential in persons with SCIs.

Abstract: Sexual dysfunction may affect 80% of women in hemodialysis. However the specific patterns and clinical correlates of sexual functioning remain poorly described. The aim of this study was to assess prevalence and correlates of the individual domains of sexual functioning in women treated with hemodialysis. We recruited, into this multinational cross-sectional study, women treated with long-term hemodialysis (Collaborative Working Group on Depression and Sexual dysfunction in Hemodialysis study). Self-reported domains of sexual functioning were assessed by the Female Sexual Function Index, which is routinely administered within the network of dialysis patients followed by the working group. Lower scores represented lower sexual functioning. Socio-demographic and clinical correlates of each domain of sexual functioning were identified by stepwise multivariable linear regression. Sensitivity analyses were restricted to women who reported being sexually active. We found that of 1309 enrolled women, 659 (50.3%) provided complete responses to FSFI survey questions and 232 (35%) reported being sexually active. Overall, most respondents reported either no sexual activity or low sexual functioning in all measured domains (orgasm 75.1%; arousal 64.0%; lubrication 63.3%; pain 60.7%; satisfaction 60.1%; sexual desire 58.0%). Respondents who were waitlisted for a kidney transplant reported scores with higher sexual functioning, while older respondents reported scores with lower functioning. The presence of depression was associated with worse lubrication and pain scores [mean difference for depressed versus non-depressed women (95% CI) -0.42 (-0.73 to -0.11), -0.53 (-0.89 to -0.16), respectively] while women who had experienced a previous cardiovascular event reported higher pain scores [-0.77 (-1.40- to -0.13)]. In conclusion, women in hemodialysis reported scores consistent with marked low sexual functioning across a range of domains; the low functioning appeared to be associated with comorbidity.

Abstract: Background: Female genital mutilation is an intentional inhumane procedure that threatens girls and women's health. It is especially widespread in developing countries due to cultural, traditional and religious preferences. The aim of the current study was to investigate how circumcision affects women's sexual function. Methods: This cross-sectional study was conducted in the urban and rural area of Piranshahr County, Iran, in 2015 among convenience samples of 200 women, 15-49 yr old, who were applying to health care centers for receiving routine health care services. Data collection was conducted with the use of a self-administered written questionnaire to assess female sexual function, mental well-being, and quality of life. Results: Significant differences were found between circumcised and non-circumcised women in total score of female sexual function index (FSFI) in domains of desire, arousal, vaginal moisture, orgasm, satisfaction, and pain [( P <0.001), MD(95%CI)=5.64(3.64 to 7.64)] and based on Hotelling's T-square, significant differences were found in dimensions of quality of life and FSFI. Conclusion: The revealed sexual dysfunction among mutilated women gives ground to require that public health systems take actions aimed at implementing special sexual education program to improve sexual functions of mutilated women and changing beliefs and social norms in the community level.

Abstract: Sexual function and to a lesser extent reproduction are often disrupted in women with spinal cord injuries (SCI), who must be educated to better understand their sexual and reproductive health. Women with SCI are sexually active; they can use psychogenic or reflexogenic stimulation to obtain sexual pleasure and orgasm. Treatment should consider a holistic approach using autonomic standards to describe remaining sexual function and to assess both genital function and psychosocial factors. Assessment of genital function should include thoracolumbar dermatomes, vulvar sensitivity (touch, pressure, vibration), and sacral reflexes. Self-exploration should include not only clitoral stimulation, but also stimulation of the vagina (G spot), cervix, and nipples conveyed by different innervation sources. Treatments may consider PDE5 inhibitors and flibanserin on an individual basis, and secondary consequences of SCI should address concerns with spasticity, pain, incontinence, and side effects of medications. Psycho...

Abstract: Existing studies of women’s sexual happiness and pleasure most often centre on sexual satisfaction, orgasm, and sexual dysfunction, largely failing to allow women to narrate their own experiences. With the recent release of the first drug to ‘treat’ women’s waning libidos a qualitative examination of women’s notion of ‘good sex’ is more pressing and urgent than ever. We need to extend feminist critiques of power, control, patriarchy and agency to the study of women’s sexuality and sexual happiness. Using semi-structured interviews with 20 women from a 2014 community sample collected in a large southwestern US city, we analyse women’s descriptions of and definitions of ‘good sex’ (as defined by respondents), as well as their experiences of sexual encounters that felt joyous and happy. Analysis revealed four themes in women’s descriptions of good, happy and joyous sex: (1) Physical pleasure, wanting and orgasm; (2) Emotional connection and relationship satisfaction; (3) Comfort and naturalness; (4) ...

Abstract: Sexuality is an important part of life, and it is necessary for clinicians to have a specific format in which to address sexual issues with their patients. A systematic approach to working with patients with spinal cord injury (SCI) to improve their sexual functioning and response is presented. Nonjudgmental communication about sexual concerns is followed by a detailed pre- and postinjury medical, psychosocial, and sexual history. If preexisting sexual issues are present, it is recommended that the patient be referred for assessment and treatment of these separate from the patient's SCI-related concerns. Physical examination, with special attention to issues that could impact the patient's sexuality, is followed by a detailed neurologic assessment with specific attention to the T11-L2 and S3-5 spinal segments. Education of the patient with regard to his or her sexual potential and the need to be flexible in his or her sexual repertoire is followed by self-exploration and practice. Routine follow-up is suggested after patient's initial sexual exploration. Treatment of confounding and iatrogenic factors related to SCI is followed by more sexual experience. Afterwards the clinician is encouraged to use simple techniques to treat sexual issues and follow-up with the patient to assess the outcome. A structured program utilizing vibratory stimulation with or without midodrine is described as a way to achieve ejaculation and potentially orgasm, and techniques for treating severe autonomic dysreflexia are discussed. If these interventions do not alleviate the patient's sexual concerns, the clinician should refer the patient for more specialized consultation.

Abstract: In addition to urinary incontinence and erectile dysfunction, several other impairments of sexual function potentially occurring after radical prostatectomy (RP) have been described; as a whole, these less frequently assessed disorders are referred to as neglected side effects. In particular, orgasmic dysfunctions (ODs) have been reported in a non-negligible number of cases, with detrimental impacts on patients' overall sexual life. This review aimed to comprehensively discuss the prevalence and physiopathology of post-RP ODs, as well as potential treatment options. Orgasm-associated incontinence (climacturia) has been reported to occur in between 20% and 93% of patients after RP. Similarly, up to 19% of patients complain of postoperative orgasm-associated pain, mainly referred pain at the level of the penis. Moreover, impairment in the sensation of orgasm or even complete anorgasmia has been reported in 33% to 77% of patients after surgery. Clinical and surgical factors including age, the use of a nerve-sparing technique, and robotic surgery have been variably associated with the risk of ODs after RP, although robust and reliable data allowing for a proper estimation of the risk of postoperative orgasmic function impairment are still lacking. Likewise, little evidence regarding the management of postoperative ODs is currently available. In general, physicians should be aware of the prevalence of ODs after RP, in order to properly counsel all patients both preoperatively and immediately post-RP about the potential occurrence of bothersome and distressful changes in their overall sexual function.

Abstract: Purpose Epileptic women are faced with many sexual challenges in their life due to medical and non-medical factors. The present study was conducted to assess sexual function in epileptic women and its related factors. Method The present cross-sectional study was conducted on 196 epileptic married women of reproductive age who were members of the Iranian Epilepsy Association and were selected continuously over six months through convenience sampling. The data collection tools included the Female Sexual Function Index (FSFI) and questions about the causes of sexual dysfunction. The statistical tests including: Chi-square, t -test, one-way ANOVA, linear and logistic regression. Results According to the results, 74.5% of the participants suffered from sexual dysfunction and scored the lowest in terms of the orgasm and sexual satisfaction dimensions. The factors associated with sexual dysfunction included age over 40, poor education, more than 15 years of marriage, poor economic status, history of infertility and irregular menstruation, several seizures per month, nocturnal seizures, triple or multiple drug therapies and not using anticonvulsant drugs that have no effect on the liver enzymes. From participants' perspective, the most common causes of sexual dysfunction include anxiety and stress, emotional problems with the spouse, dissatisfaction with the experience of unwanted sex and the type of drugs used. Conclusions Since the incidence of sexual dysfunction in epileptic women is high and multifactorial, it is recommended for experts and health service providers to not only seek to better control the patients' seizures, but also assess them in terms sexual function.

Abstract: The objective of this study was to examine the prevalence and factors associated with sexual problems and their relationship to health-related quality of life (HRQOL) in male and female non-Hodgkin lymphoma (NHL) survivors. In this cross-sectional study, 738 NHL survivors (425 men and 313 women; mean time since diagnosis, 6.2 years) in South Korea completed the six-item instrument of adult sexual behavior used by the National Health and Social Life Survey in the United States. HRQOL was measured by two subscales of the EORTC QLQ-C30. Sexual problems were reported by a greater proportion of women (range, 31.9 to 64.4%) than men (range, 23.3 to 49.1%). Among four items common to both sexes, three (lacking interest in sex, unable to achieve orgasm, sex not pleasurable) were significantly more prevalent in women. Significant factors associated with multiple sexual problems in men were older age and being unemployed; in women, they were marital status and comorbidity. Lastly, more significant associations between sexual problems and HRQOL were observed in men than in women. Male and female NHL survivors differ in the prevalence of sexual problems and the factors associated with them as well as their associations with HRQOL. These findings can be used to develop sex-specific interventions to improve sexual function in this population.