Female sexual dysfunction is highly prevalent but not well defined or understood. We evaluated and revised existing definitions and classifications of female sexual dysfunction.
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.
Classifications were expanded to include psychogenic and organic causes of desire, arousal, orgasm and sexual pain disorders. An essential element of the new diagnostic system is the “personal distress” criterion. In particular, new definitions of sexual arousal and hypoactive sexual desire disorders were developed, and a new category of noncoital sexual pain disorder was added. In addition, a new subtyping system for clinical diagnosis was devised. Guidelines for clinical end points and outcomes were proposed, and important research goals and priorities were identified.
We recommend use of the new female sexual dysfunction diagnostic and classification system based on physiological as well as psychological pathophysiologies, and a personal distress criterion for most diagnostic categories.
Adult smokers (
N
= 253) without clinically significant depression were randomized on a double-blind basis to receive fluoxetine (30 or 60 mg daily) or a placebo for 10 weeks in combination with ...cognitive-behavioral therapy (CBT). It was predicted that fluoxetine would selectively benefit smokers with higher baseline depression, nicotine dependence, and weight concern and lower self-efficacy about quitting smoking. Among those who completed the prescribed treatment regimen, baseline depression scores moderated the treatment response. Logistic regression analyses showed that 1 and 3 months after the quit date, fluoxetine increased the likelihood of abstinence, as compared with placebo, among smokers with minor depression but not among those with little or no depression. Results suggest that, as an adjunct to CBT, fluoxetine enhances cessation by selectively benefiting medication-compliant smokers who display even subclinical levels of depression.
Diagnostic information was examined on 258 men with male erectile disorder in a multi-site study. Of the sample, 78% was diagnosed as having difficulty both in obtaining and maintaining erections; ...20% had a secondary or tertiary diagnosis of hypoactive sexual desire disorder. There was minimal evidence that the multi-axial diagnostic system has advantages over the categorical DSM-III-R diagnosis of male erectile disorder.
Recently, researchers have suggested the possible importance of weight-related variables, particularly among women, in relapse to smoking. The present study
prospectively examined the prediction of ...success versus failure (both relapse and dropout) in a smoking-cessation program using several weight-related variables and gender. Weight-related variables accounted for a significant amount of variance in the prediction of dropout from a cessation program. The interaction of gender with Body Mass Index (BMI) and gender with concern about postcessation weight gain also accounted for a significant amount of variance in dropout. Particularly, women who were lower in weight and women who were concerned about postcessation weight gain were more likely to drop out of a cessation program before completion than the other participants in the study. Results also indicated that people who have chronic weight concern and gain weight during a cessation attempt were more likely to drop out of a cessation program before completion than individuals with chronic weight concern and little to no weight gain during the quit attempt. Prediction of relapse to smoking during the cessation program was not very revealing. One finding that did emerge was that, among those who completed the study and did not drop out, men were twice as likely to relapse as were women. These results indicate the importance of weight-related variables, particularly among women, in the prediction of success in a cessation program. Findings also suggest that dropout may be more revealing in predicting failure in a cessation program than relapse to smoking in terms of the influence of weight-related issues.
Thirty-five survivors of extremity sarcomas being followed in a University-Hospital orthopedic clinic were evaluated for current and lifetime presence of psychiatric disorders. Patients were assessed ...for cognitive abilities using the Cognitive Capacity Screening Examination and for psychiatric disorders using a structured interview format, the Schedule for Affective Disorders and Schizophrenia-Lifetime version. The criteria for psychiatric disorders were the Research Diagnostic Criteria. Two patients were excluded because of cognitive deficiencies; thirty-three patients (mean age = 37.7 yr) were formally evaluated at a mean time of 2.6 yr following cancer diagnosis and surgery. Forty-five per cent of patients were given the diagnosis of at least one lifetime psychiatric disorder. Fifteen per cent of patients reported a current episode. Affective disorders and alcoholism were the most frequently reported disorders.
Clinical trials on sexual dysfunctions in women are limited in spite of the fact that sexual dysfunctions are likely more common in women than in men. Currently there are no medications approved for ...treatment in women, and limited data on drug efficacy or psychological efficacy in well controlled studies.
To provide recommendations/guidelines concerning state of the art knowledge for the research design and outcome assessment standards for clinical trials in women's sexual dysfunctions.
An International Consultation in collaboration with the major urology and sexual medicine associations assembled over 200 multidisciplinary experts from 60 countries into 17 committees. Committee members established specific objectives and scopes for various male and female sexual medicine topics. The recommendations concerning state of the art knowledge in the respective sexual medicine topic represent the opinion of experts from five continents developed in a process over a 2 year period. Concerning the Standards for Clinical Trials in Women's Sexual Dysfunctions Committee, there were seven experts from two countries.
Expert opinion was based on grading of evidence based medical literature, widespread internal committee discussion, public presentation and debate.
A comprehensive update was created which included references and recommended guidelines for rationale and design of clinical trials, study populations, outcome assessments, protocol design and implementation, data analysis and reporting, as well as ethical and clinical issues related to sexual dysfunction research.
There is a need for more research in developing standards to be used when performing clinical trials and outcomes assessment research in sexual dysfunctions of women.
