Authorship and Publication

  • Author: M. Bonierbale, MD

  • Affiliation: Service de psychiatrie et de psychologie médicale, CHU Sainte-Marguerite, Marseille, France

  • Published in: Sexologies, 2009, Volume 18, Pages 10-13

  • Available Online: February 7, 2009

  • DOI: 10.1016/j.sexol.2008.07.004

  • Presentation: Paper presented at the First "Assises françaises de sexologie et de santé sexuelle" - French Congress on Sexology and Sexual Health, Strasbourg, 2007.

Keywords

  • Effectiveness

  • Efficacy

  • Assessment

  • Difficulty

  • Dysfunction

Abstract

  • Literature Overview: The review of sexual dysfunctions (SD) literature from the past decade suggests that standardized assessment methods are primarily focused on dysfunctional aspects, neglecting variations that occur due to psychological and social contexts.

  • Cognitive Aspects in Assessments: Typically reflect satisfaction levels but lack measures for intimacy or relationship quality. Indicators of psychological vulnerability are missing.

  • Drug Assessments vs. Real-Life Treatement: Current research often measures drug efficacy rather than the efficiency of real-life treatments.

  • Erectile Dysfunction (ED) Findings: A study noted a 35% spontaneous remission rate of ED, suggesting it may not only worsen with age, but can also be a temporary symptom impacted by lifestyle changes.

  • Clinical Practice Implications: Sexual issues should be examined from physiological and relational perspectives, highlighting the importance of psychosocial factors.

Importance of Distinction Between Difficulties and Dysfunctions

  • Central to Assessment: Differentiating between sexual difficulties and dysfunctions is crucial for tailoring management strategies.

  • Research Gaps: There is insufficient research on how psychosocial factors intertwine with sexual problems.

Challenges in Current Assessments

  • Standardized Assessments: Often provide limited insights, focusing mainly on dysfunction, without considering subjective psychological and relational factors.

  • Self-questionnaires: Have limitations and may not reflect true patient experiences. They measure specific dysfunction elements without addressing emotional and psychological contexts.

  • Diagnostic Underestimation: There is a trend where the specialty of the assessor can lead to underestimating certain diagnoses (Lee et al., 2000).

Psychological and Social Contexts of Sexual Dysfunction

  • Cognitive Aspects of Sexual Health: The role of psychological factors like depression, anxiety, and self-esteem is often minimized compared to physiological aspects (Araujo et al., 2000; Latini et al., 2002).

  • Influence of Relationships: Studies find that relationship dynamics and partner perceptions significantly impact sexual functioning, and such aspects must be incorporated into assessments.

Statistical Findings on Erectile Dysfunction (ED)

  • Epidemiological Insight: Research highlights the significant occurrence of spontaneous remission in ED cases and disputes the belief that age deterioration is inevitable.

  • Clinical Indicators: Clinicians should value the importance of lifestyle changes and psychosocial history when evaluating sexual dysfunctions.

Recommendations for Clinical Practice

  • Assessment Framework: Sexual problems should be evaluated at two levels: physiological functions and interpersonal relationships.

  • Psychosocial History: Essential for identifying situations or relationships negatively influencing sexual performance. Factors to analyze include:

    • Comorbidities and associated risk factors.

    • Contextual analysis of sexual difficulties before any medical treatment is prescribed.

    • Patient’s level of distress concerning sexual problems, differentiating real dysfunction from anxiety stemming from societal or relational pressures.

  • Clinical Engagement: Practitioners should facilitate conversations about sexual difficulties, considering psychosocial dimensions to devise personalized therapeutic strategies.

References

  • Akerman, M.D., D’Attilio, J.P. Sexual Dysfunction: a Neuro-Medical Approach. Futura Publishing Company, Inc.

  • Althof, S.E. et al. Psychological and interpersonal dimensions of sexual function and dysfunction. J Sex Med (2005).

  • Araujo, A.B. et al. Relation between psychosocial risk factors and incident erectile dysfunction. Am J Epidemiol (2000).

  • Bonierbale, M. Plaidoyer pour une sexualité ordinaire. Sexologies (2006).

  • Brock, G. Oral agents; First-line therapy for erectile dysfunction. Eur Urol Suppl (2002).

  • Laumann, E.O. et al. Sexual dysfunction in the United States: prevalence and predictors. JAMA (1999).

  • Lee, J.C. et al. Prevalence and influence of significant psychiatric abnomalities in men. IJIR (2000).

  • Mathias, S.D. et al. A comparison of patient and partner responses to a brief sexual function questionnaire. J Urol (1999).

  • Moynihan, R. The marketing of a disease: female sexual dysfunction. BMJ (2005).

  • Tiefer, L. New view approach to men’s sexual problems. (2006).

  • Travison, T.G. et al. The natural progression and remission of erectile dysfunction. J Urol (2007).

  • Warot, D. Interêt des autoquestionnaires dans l’évaluation des troubles sexuels liés aux médicaments. Thérapie (1993).