Showing papers in "Journal of Sex & Marital Therapy in 1998"
TL;DR: The article includes a discussion of presumed pharmacologic mechanisms, including effects on platelet activating factor, prostaglandins, peripheral vasodilatation, and central serotonin and norepinephrine receptor factor modulation.
Abstract: In an open trial ginkgo biloba, an extract derived from the leaf of the Chinese ginkgo tree and noted for its cerebral enhancing effects, was found to be 84% effective in treating antidepressant-induced sexual dysfunction predominately caused by selective serotonin reuptake inhibitors (SSRIs, N = 63). Women (n = 33) were more responsive to the sexually enhancing effects of ginkgo biloba than men (N = 30), with relative success rates of 91% versus 76%. Ginkgo biloba generally had a positive effect on all 4 phases of the sexual response cycle: desire, excitement (erection and lubrication), orgasm, and resolution (afterglow). This study originated from the observation that a geriatric patient on ginkgo biloba for memory enhancement noted improved erections. Patients exhibited sexual dysfunction secondary to a variety of antidepressant medications including selective serotonin reuptake inhibitor (SSRIs), serotonin and nonrepinephrine reuptake inhibitor (SNRIs) monoamine oxidase inhibitor (MAOIs), and tricyclics. Dosages of ginkgo biloba extract ranged from 60 mg qd to 120 mg bid (average = 209mg/d). The common side effects were gastrointestinal disturbances, headache, and general central nervous system activation. The article includes a discussion of presumed pharmacologic mechanisms, including effects on platelet activating factor, prostaglandins, peripheral vasodilatation, and central serotonin and norepinephrine receptor factor modulation.
151 citations
TL;DR: It was found that the best premarital predictors of husband's marital sexual satisfaction were wives' self-esteem, wives' open communication, and wives' relationship stability.
Abstract: This study examined select premarital factors from the ecosystemic perspective hypothesized to influence marital sexual satisfaction in the first year of marriage. A sample of 70 couples was administered by the Preparation of Marriage Questionnaire (PREP-M) a few months prior to marriage to measure premarital levels of empathy, self-disclosure, open communication, relationship stability, and self-esteem. At 1 year of marriage, their sexual satisfaction was assessed using the Index of Sexual Satisfaction (ISS). Using multiple regression analyses it was found that the best premarital predictors of husband's marital sexual satisfaction were wives' self-esteem, wives' open communication, and wives' relationship stability. The best predictors for wives' marital sexual satisfaction were wives' self-esteem, wives' open communication, and husbands' empathic communication. Conclusions and implications for premarital counselling and family life education are discussed.
127 citations
TL;DR: Orgasm appears to be a primary sexual function affected by SRIs, and erection scores were lower over time, and lubrication, libido, and sexual frequency were not appreciably changed over 3 months.
Abstract: Serotonin reuptake inhibitor (SRI) antidepressants have been associated with sexual dysfunction, though there have been few prospective reports specifically examining this problem. The purpose of this study was to determine if three SRIs affected sexual function in patients with an anxiety disorder or major depressive disorder over a 3-month period. Sixty-one patients were evaluated for at least 2 months in a prospective study of the effects of fluoxetine, sertraline, and paroxetine on five aspects of sexual function: libido, erection/lubrication, orgasm quality, orgasm delay, and sexual frequency. Measurements were made at baseline and at each month on visual analog scales. For men and women, orgasm quality was lower and orgasm delay longer at Months 1, 2, and 3 compared with baseline (p < .001). Erection scores were lower over time (p < .02) but this change was less dramatic. Lubrication, libido, and sexual frequency were not appreciably changed over 3 months. Anorgasmia was significantly more common in women than men at Months 1 and 2. Orgasm appears to be a primary sexual function affected by SRIs.
109 citations
TL;DR: Women who were sexually abused in adulthood were more sexually dissatisfied and nonsensual than women who had no history of sexual abuse and had higher numbers of unsafe sexual partners.
Abstract: The differential effects of child and adult sexual abuse on adult sexual functioning were examined. The Golombok Rust Inventory of Sexual Satisfaction (GRISS) and a sexual experiences questionnaire were administered to 201 psychology students at the University of South Florida, 175 of whom were retained in the study. GRISS variables that were analyzed consisted of anorgasmia, sexual avoidance, sexual dissatisfaction, sexual noncommunication, nonsensuality, and vaginismus. Women who were sexually abused in adulthood were more sexually dissatisfied and nonsensual than women who had no history of sexual abuse. In addition, women who had a history of sexual abuse in childhood or adulthood were less satisfied with the overall quality of their most recent sexual relationship than non-abused women and had higher numbers of unsafe sexual partners.
100 citations
TL;DR: Results indicated that for low drinking students, those with high self-esteem reported greater condom use, and low rates of alcohol use were associated with greater frequency of past condom use.
Abstract: The present study examined the confluence of alcohol use and self-esteem on risky sexual behavior and perceptions of risk for female and male college students. It was predicted that higher levels of self-esteem, female gender, and lower alcohol consumption would be associated with greater condom use and lower perceptions of risk for self and partner. Results indicated that for low drinking students, those with high self-esteem reported greater condom use. In addition, low rates of alcohol use were associated with greater frequency of past condom use. Women and students low in self-esteem indicated greater perceptions of risk for themselves and their partners. These findings are discussed in terms of their implications for developing interventions aimed at reducing risky sexual behavior.
82 citations
TL;DR: Factors associated with a greater amount of pain experienced in anal intercourse were depth and rate of thrusting, lack of social comfort with gay men, being more "closeted," and less concern over becoming old or unattractive as a gay or bisexual man.
Abstract: This study examines the frequency and duration of pain in same-sex anal intercourse in a sample of 277 adult men who have engaged in, or attempted to engage in, anal intercourse during their lifetime. Whereas estimates of frequency of pain appeared blocked distributed across a 7-point Likert scale, severity of pain appeared positively skewed, with 12% rating it as too painful to continue. Participants rated inadequate lubrication, psychological factors such as not feeling relaxed, and lack of digitoproctic stimulation prior to penetration as the three most important psychophysiological factors predicting pain. Factors associated with a greater amount of pain experienced in anal intercourse were depth and rate of thrusting, lack of social comfort with gay men, being more "closeted," and less concern over becoming old or unattractive as a gay or bisexual man. Pain was also positively related to anxiety. The use of condoms was not rated highly as a factor in receptive anal pain. Based on these findings, the authors define anodyspareunia to denote painful receptive anal intercourse, and suggest clinical criteria similar to that used for other sexual pain disorders.
56 citations
TL;DR: Improvements in a number of parameters of sexuality in postmenopausal women treated with exogenous testosterone are shown, indicating that androgens play a key role in female sexuality.
Abstract: Sexual health is an important component of overall health and well-being Multiple factors clearly influence an individual's sexuality; however, there is a general trend in Western societies to blame psychosocial factors for diminished sexuality in women Sex steroid hormones are important determinants of sexual function in women and men, and there is increasing agreement that androgens play a key role in female sexuality Androgen levels in women decline substantially during the reproductive years, with little change subsequent to spontaneous menopause The most common complaint of women experiencing androgen deficiency is loss of sexual desire, and several studies have now shown improvements in a number of parameters of sexuality in postmenopausal women treated with exogenous testosterone
47 citations
TL;DR: This article critically reviews the literature concerning differences among gay, lesbian, and heterosexual couples and presents the therapeutic implications of these differences.
Abstract: Gay and lesbian couples differ from heterosexual couples in ways that may have implications for therapy. Until recently, research in homosexuality dealt only with "curing" it. Since the 1980s, however, psychotherapy with gay and lesbian couples has received more attention. The literature in this area is seldom criticized or questioned; thus, much of the most recent research in the area is founded on assumptions about gay and lesbian couples that have never been tested empirically. This article critically reviews the literature concerning differences among gay, lesbian, and heterosexual couples and presents the therapeutic implications of these differences.
36 citations
TL;DR: A study of 132 medication trials in 97 patients found that 9.8% of the trials demonstrated accommodation to SRI-induced sexual dysfunction, which appears to be an uncommon phenomenon.
Abstract: Sexual dysfunction from serotonin reuptake inhibitors is a common occurrence. It is thought that this side effect might diminish over time. Our study of 132 medication trials in 97 patients found that 9.8% of the trials demonstrated accommodation to SRI-induced sexual dysfunction. Practitioners who utilize the strategy of waiting for spontaneous remission of this side effect should be aware that accommodation appears to be an uncommon phenomenon.
33 citations
TL;DR: Many attempts have been made to find an effective safe, and easy to administer treatment for erectile problems, ranging from herbal remedies used by native healers, mostly in Eastern countries, to the more sophisticated designer drugs, which are based on a better understanding of the physiological mechanism of erection.
Abstract: The erect penis has always been a symbol of power, virility, and fertility. Inability to obtain or maintain an erection, known clinically as erectile dysfunction, is a major health problem. It can cause considerable distress, unhappiness, and relationship problems. The search has therefore continued from time immemorial to find an effective safe, and easy to administer treatment for erectile problems. Although a number of these treatments became available in the last two decades, they all had problems with efficacy, safety, or ease of administration. Clinicians in this field often are told at the end of an assessment interview, "I wish you have a magic pill". An effective and safe oral treatment is, no doubt, the most acceptable and easy to use option. Finding such a treatment has always been the dream of many scientists, and many attempts have been made over the years. These ranged from herbal remedies used by native healers, mostly in Eastern countries, to the more sophisticated designer drugs, which are based on a better understanding of the physiological mechanism of erection. This article describes some of these attempts.
28 citations
TL;DR: The author connects sexual instinctual gratification with religious affiliation on the basis of an analysis of the sexual behavior of Germans and finds that religiously most active men feel more inclined to use aggression to reach sexual goals than religiously indifferent ones.
Abstract: After discussing the origin of religion, functions of religion, and the construction of meaning by religion, the author focuses on the connection between religion and anxiety. The permanent anxiety in religion is determined by guilt feelings that arise for example from the violation of norms in the area of sexuality. In a religion at enmity with sexuality, such as Christianity, the satisfaction of sexual desires is considered bad and sinful; the permanent production of anxiety and a guilty conscience are the result of it. Christian sexual suppression leads to the propagation of asceticism as the taming of corrupt sensuality that only religious virtuosi can maintain. One result of asceticism is celibacy, although passages from the Bible demand monogamy for bishops without prohibiting celibacy. In Catholicism, celibacy institutionalizes the enmity with sexuality and causes a permanent depreciation of real sexuality in favor of one projected onto the mother church and the Virgin Mary. A further consequence of asceticism is the reduction of sexuality to reproduction. In the section about the factual consequences of Christian sexual morality, the author connects sexual instinctual gratification with religious affiliation on the basis of an analysis of the sexual behavior of Germans. The weekly frequency rate of sexual intercourse amounts to 3.1 with male and female nondenominationals, 2.6 with Protestants, and 2.3 with Catholics; 39% of nondenominational men, 20% of Protestant men, and 12% of Catholic men in Germany use condoms. The connection of religion and aggression is empirically significant as well. The religiously most active men feel more inclined to use aggression to reach sexual goals than religiously indifferent ones.
TL;DR: This case report describes the successful use of sildenafil in fluvoxamine-induced erectile dysfunction, a common sexual side effect of various antidepressants.
Abstract: Sildenafil, a peripherally acting inhibitor of cyclic guanosine monophosphate((cGMP), has been reported highly effective in treating erectile dysfunction of various etiology. Erectile dysfunction is a common sexual side effect of various antidepressants. Various agents have been used in the treatment of antidepressant-induced erectile dysfunction; however, there are no reports on the use of sildenafil for this indication. This case report describes the successful use of sildenafil in fluvoxamine-induced erectile dysfunction. A possible mechanism of action of sildenafil in this type of erectile dysfunction is discussed.
TL;DR: Overall, gender differences followed gender-oriented stereotypes: Women have greater sexual guilt than men, women are less sexually arousable or more "erotophobic," and women are more comfortable answering questions about their sexuality and rating words.
Abstract: The present study investigated whether gender-based differences in the rating of sexual words still exist in the late 1990s. Men and women evaluated 400 English-language words on the characteristics of sexual charge and sexual ambiguity. Data gathered from these ratings were compared with other factors such as religious involvement, sexual experience, sex guilt, and social desirability. Men and women dad not differ in their sexual ratings of the list. However, because the list contained a large number of words that had no sexual content at all, gender differences were examined for ratings of a sample of 30 sexually ambiguous words. As hypothesized, men rated these words as significantly mre sexual than women. Significant gender differences were found on a number of sexuality and personality measures. Women were more religious than men, and religiosity was significantly correlated with must of the other measures. Women also had higher social desirability scores, which implies that they may have be...
TL;DR: Low plasma concentrations of 3-methoxy-4-hydroxyphenylglycol and the alpha 2-adrenergic response to yohimbine appeared within normal ranges in women with hypoactive sexual desire, with no therapeutic response to the drug.
Abstract: The use of yohimbine to treat impotence has suggested that decreased male sexual desire may relate to decreased activity of central noradrenergic neurons. Previous trials of yohimbine to treat female sexual problems are not available. Yohimbine is an alpha 2-adrenergic antagonist that stimulates norepinephrine (NE) release. In the present study, plasma concentrations of 3-methoxy-4-hydroxyphenylglycol (MHPG), the major central nervous system metabolite of NE, were measured in 9 women diagnosed with hypoactive sexual desire. Daily logs of mood and sexual activity, and trimonthly MHPG blood drawings, were obtained over an initial baseline menstrual cycle followed by two subsequent treatment cycles (yohimbine or placebo), in randomized order. Blood samples were obtained at 9:00 a.m. during (a) the early follicular phase of each cycle (24 hr after the onset of each cycle), (b) the ovulatory phase (i.e., within 1 day of an oral temperature rise), and (c) the midluteal phase (i.e., 20-25 days into each cycle). Comparisons were made with a group of 7 healthy female controls. Women with hypoactive sexual desire had slightly lower plasma MHPG values than controls at baseline, although there was only a trend toward significance during the early follicular phase (p = .09). Yohimbine (5.4 mg orally, 3 times daily, beginning at menses) caused a sustained rise in plasma MHPG of similar magnitude to that reported in men. However, in terms of improved sexual desire, yohimbine had no obvious therapeutic effect. Thus, plasma MHPG and the alpha 2-adrenergic response to yohimbine appeared within normal ranges in women with hypoactive sexual desire, with no therapeutic response to yohimbine.
TL;DR: The final focus of the article is on the etiologic theories of paraphilias and some practical advice for the pharmacotherapy and management of paraphilia.
Abstract: This article reviews the advances in pharmacotherapy of paraphilias. Antiandrogen hormones, phenothiazines, and lithium therapy of paraphilias is briefly reviewed. Pharmacotherapy of paraphilias with serotonergic drugs such as fluoxetine, clomipramine, sertraline, and fluvoxamine is reviewed in detail. In addition, the use of buspirone hydrochloride in paraphilias is discussed. The final focus of the article is on the etiologic theories of paraphilias and some practical advice for the pharmacotherapy and management of paraphilias.
TL;DR: Wives' marital satisfaction was evaluated as a function of a premarital counseling typology in an analysis of data from several thousand military couples surveyed in 1992, and results indicated that both having premarITAL counseling and reporting higher satisfaction with the counseling experience were associated with higher levels of marital satisfaction.
Abstract: Wives' marital satisfaction was evaluated as a function of a premarital counseling typology in an analysis of data from several thousand military couples surveyed in 1992. Among couples who jointly reported participation in premarital counseling, results indicated that both having premarital counseling and reporting higher satisfaction with the counseling experience were associated with higher levels of marital satisfaction. Among couples who disagreed about having had premarital counseling, results were still favorable but less consistent. Implications for clinical practice are discussed.
TL;DR: Findings and retrospective considerations for this patient suggest the need for careful differential activities in diagnostic workup, approaches to sex assignment and possible reassignment, and the clinical management of patients and families.
Abstract: This article discusses general issues with regard to gender-identity problems, sex reassignment, and clinical management in patients with ambiguous genitalia, based on a detailed case history of a patient with penile agenesis who has been followed more than 20 years. After initial uncertainty, the patient began to grow up as a boy, lived from the fourth year of life as a girl and young woman, and lived from late puberty on as a man. Over his lifetime he experienced extensive corrective surgery plus hormonal substitution therapy. Pre- and perinatal hormonal conditions, phenomenology of the genitalia, sex of rearing, timing of sex reassignment and corrective surgery, for example, appear to be important components for the development of gender-role behavior, gender identity, and sexual orientation of intersex patients. Findings and retrospective considerations for this patient suggest the need for careful differential activities in diagnostic workup, approaches to sex assignment and possible reassignment, and the clinical management of patients and families.
TL;DR: Some pitfalls in marital therapy with infidelity, including biases and identifications with one or the other spouse, moralism, and feelings of anger, helplessness, and hopelessness often surface, are discussed.
Abstract: Marital therapy for infidelity may bring up intense countertransference feelings in the therapist. Biases and identifications with one or the other spouse, moralism, and feelings of anger, helplessness, and hopelessness often surface while working with clients dealing with extramarital affairs. When the reactions are conscious they are less likely to interfere in the couple therapy, but when unconscious the work may be negatively affected. This article discusses some pitfalls in marital therapy with infidelity.
TL;DR: Sexual acting out is subdivided into four forms in order to better define their separate meanings to the unfaithful spouse, the partner, and the therapist: affairs, just-sex, making-do sex, imaginary partner sex.
Abstract: In this essay, sexual acting out is subdivided into four forms in order to better define their separate meanings to the unfaithful spouse, the partner, and the therapist: affairs, just-sex, making-do sex, imaginary partner sex. The conventional justifications for considering any sexual acting out a form of psychopathology are presented. These justifications are more compelling in some forms of acting out than others. Love affairs, the major subject of this paper, can also be understood as an existential choice that arises within a large array of social and Psychological situations. The conscious experience of the betrayed and the betrayer is explored. Guidelines for the therapist's role in dealing with individuals and couples involved in these life-changing experiences are offered .
TL;DR: A previously unreported pattern of atypical masturbatory behavior, which presents as either an erectile or orgasmic disorder in men, is described, which is suggested that the primary care physician or specialist screen for this problematic style when presented with male sexual dysfunction.
Abstract: This article describes a previously unreported pattern of atypical masturbatory behavior, which presents as either a n erectile or orgasmic disorder in men. Four case histories are described of men who masturbated in an idiosyncratic manner. The distinguishing features of the masturbatory style include a prone position and daily masturbation over a period of years. It is suggested that the primary care physician or specialist (urologist or neurologist) screen for this problematic style when presented with male sexual dysfunction. Further, and more controversially, it is suggested that a primary prevention model would argue for masturbatory instruction in the home, classroom, orpediatric clinical setting.
TL;DR: The divorced couples differed from the nondivorced couples in age difference, complaint at intake, positive regard, and empathy at the start of therapy.
Abstract: This exploratory study provides data about couples that divorced following couple therapy and compares them with couples that remained together. The divorced couples differed from the nondivorced couples in age difference, complaint at intake, positive regard, and empathy at the start of therapy. Most of the couples found couple therapy useful and viewed their divorce as a positive result of therapy.
TL;DR: Gender differences that were replicated included women's stronger preferences for romantic foreplay and men's greater erotophilia and preferences for using erotica and combining alcohol and drug use with sex.
Abstract: This study extends prior research on gender differences in sexual behavior preferences. The authors administered the 6-factor Inventory of Dyadic Heterosexual Preferences (IDHP)1 to 76 married or cohabiting couples (mean age = 35 years). Their preference patterns were compared to similar data obtained previously2 from younger (mean age = 21 years), single respondents. Gender differences that were replicated included women's stronger preferences for romantic foreplay and men's greater erotophilia and preferences for using erotica and combining alcohol and drug use with sex. Women's stronger conventionality was not replicated among older partners, both of whom were less conventional than their younger counterparts. Older men and women were also more inclined toward the use of erotica. Unlike younger men, older men were more negative toward the use of contraception. Implications for sexual safety, adjustment, communication, and therapy are discussed.
TL;DR: Psychophysiological screening was carried out on 384 consecutive patients with erectile dysfunction of psychogenic or psychogenic-organic origin, and a first intracavernous injection was most effective when combined with visual and vibrotactile stimulation.
Abstract: Psychophysiological screening was carried out on 384 consecutive patients with erectile dysfunction of psychogenic or psychogenic-organic origin. Visual sexual stimulation with penile vibration caused a satisfactory erection in roughly 50% of patients. Nonresponders subsequently produced a good penile response with intracavernous injection of vasoactive substance. Orgasm-ejaculation can occur in the absence of a full erection. In such cases subsequent intracavernous injection brought about a (near) full erection. A first intracavernous injection was most effective when combined with visual and vibrotactile stimulation. The magnitude of the response to such stimulation is useful to enable the doctor to prescribe the lowest dose of a vasoactive substance, thus minimizing the risk of priapism. Preferably, drug treatment of men with erectile dysfunction should be combined with sexual counseling or therapy.
TL;DR: A reenergized campaign for school-based sexuality education is needed to overcome obstacles and explore new directions and devise new strategies for SBSE programs.
Abstract: School-based sexuality education (SBSE) has been controversial and has faced numerous challenges to its survival. However, as the 21st century approaches, new and more intense threats are surfacing. A reenergized campaign for SBSE is needed to overcome these obstacles. Part of this campaign is to explore new directions and devise new strategies for SBSE programs.
TL;DR: How all four phases of the Human Sexual Response (HSR) cycle are affected by sildenafil is summarized.
Abstract: Public interest following the approval of sildenafil (Viagra™), for the treatment of erectile dysfunction (ED), provides sex therapists with an unprecedented opportunity to educate both lay and professional audiences about the importance of psychosocial factors in the evaluation and treatment of sexual dysfunction. My commentary here briefly summarizes how all four phases of the Human Sexual Response (HSR) cycle are affected by sildenafil.
TL;DR: The change-plan concept derives from lifestyle theory and deviates from the traditional treatment plan in its delineation of roles, point of focus, and attention to process.
Abstract: This article describes how a change plan can be helpful in defining intervention goals and objectives. The change-plan concept derives from lifestyle theory and deviates from the traditional treatment plan in its delineation of roles, point of focus, and attention to process. A case example is used to illustrate how the change plan can be implemented with sexually offending clients. Several potential limitations of the change-plan concept are also discussed .
TL;DR: In this paper, the effects of sexual trauma on adult sexuality were investigated in the context of Sex & Marital Therapy (SMT), and they found that sexual trauma has a profound effect on adult sexual health.
Abstract: (1998) Commentary: Effects of sexual trauma on adult sexuality Journal of Sex & Marital Therapy: Vol 24, No 2, pp 91-92
TL;DR: A masochist patient who received sexual gratification from being burnt or crushed is described, which indicates antiandrogen medication, serotonin uptake inhibitor, and psychodynamic psychotherapy along with sexual education and social-skills training and aversive behavior therapy may be the most effective treatments for such cases.
Abstract: Masochistic sexual activity is potentially dangerous, rarely reported voluntarily, and hard to treat. This article describes a masochist patient who received sexual gratification from being burnt or crushed. Antiandrogen medication, serotonin uptake inhibitor, and psychodynamic psychotherapy along with sexual education and social-skills training and aversive behavior therapy were all tried over a period of 9 months. The response was measured by effects of treatments on the frequency of erotic fantasies and masturbation. Antiandrogens and aversive behavior therapies may be the most effective treatments for such cases, at least in the short term, although the underlying social deficits and the need to reshape the sexual behavior ought to be addressed in the long term.