No feeling during intercourse

Dear Mrs Salisbury: I can’t feel anything during sex

Supplied ‘Casual sex is just another chore and I end up just giving up.’

Psychologist Robyn Salisbury helps a reader with a relationship dilemma.

QUESTION: Why can’t I feel anything during sex? Of course I can feel that there’s something inside me, and I feel arousal and pleasure during foreplay, but when it comes to the full frontal intercourse with any man, I don’t feel any pleasure or excitement, I just feel uncomfortable.

Trying unique positions doesn’t help and being on top makes no difference to being on the bottom. This really takes a toll on my intimacy, I feel like I’m doing all the work and it makes the person I’m with insecure.

Casual sex is just another chore and I end up just giving up on it and going home by myself because I know that it’ll be the same – I’ll just feel uncomfortable and I won’t get anything from it.

* Dear Mrs Salisbury: What do people mean by ‘good sex’?
* Dear Mrs Salisbury: I can’t orgasm with a partner
* Dear Mrs Salisbury: Why is sex so painful for me?
* Dear Mrs Salisbury: I get too wet during sex

ANSWER: There are several possible explanations for this, let’s clear away the physiological side first. I’m taking it from the with which name you signed your letter that you’re female.

Your success in getting aroused suggests hormonally you’re OK – are you reaching orgasm OK through clitoral stimulation of some sort?

Your clitoris, the centre of pleasurable genital sensation, has nerve endings that spread through your vulva and abdomen, so if you’re not orgasmic it’s worth checking with your GP or a gynaecologist to ensure your medical (surgery or drugs) and sporting history has not caused any lower spinal nerve impairment.

We need also to look at your expectations. Vaginas don’t have much sensation; for women who do enjoy intercourse (and that’s not everyone) the pleasure comes from wanting to feel their partner inside them, relational closeness and the friction on the clitoris and its nerve endings.

Some prefer bumping pressure that comes from thrusting in and out intercourse movements, some far prefer the rocking motion of intercourse that maintains body closeness and pelvic pressure rubbing on the clitoris (see CAT, or coital alignment technique).

Who’s on top and in what placement varies according to body shape, so casual sex with different partners would require you shifting yourself or your partner’s hips up or down to find the right place to maximise friction.

Many women don’t reach orgasm during intercourse – instead they prefer manual or oral stimulation before, during or after penetration, if that occurs at all.

Keep in mind your task is not to perform to make your man think he’s a stud, it’s to have pleasure. And check in with yourself to confirm if you really want these strangers inside your body.

Robyn Salisbury is a clinical psychologist. Email questions to [email protected]

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Sex Talk: Why do I feel nothing during sex?

Q: My problem is that I don’t have any feeling during sex. I don’t enjoy sex. I am scared of talking about my problem as I feel embarrassed.

A: As much as sexual pleasure may be derived from kissing, touching, masturbating and from stimulating areas other than the genitals, most people suffer incredible distress if they fail to derive pleasure from penetrative sexual activity.

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Any disturbance in the sexual response cycle, which is made up of the excitement, plateau, orgasm and resolution stages, can result in sexual dysfunction. Causes may be physical, for example hormonal imbalance, chronic kidney disease or menopause.

Unsatisfactory sex can also be a side effect of taking anti-depressants or the result of fatigue or psychological issues such as guilt, anxiety, past trauma or depression. Conflict in relationships, infidelity, lack of technique and intimacy may also contribute to people not enjoying sex.

Painful sex, inability to become aroused, poor lubrication, inhibited desire and lack of orgasm may be present alone or in combination. It is important to determine whether you are able to derive pleasure from masturbation, and to check if the problem is a symptom of a psychological condition, or is caused by recent stress, possibly as a result of financial issues.

To start with, please see a doctor who will take your detailed history and conduct a physical examination, including appropriate blood analysis.

You may require several sessions with a therapist to understand the cause and get appropriate help.

• Dr Tlaleng Mofokeng (MBChB), sexual and reproductive health practice, DISA Clinic, 011-886-2286, visit safersex.co.za

DO YOU HAVE A QUESTION ABOUT SEX?

E-mail your questions to [email protected] with SEX TALK as the subject. Anonymity assured.

Causes of Decreased Sensation During Intercourse

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Sexual intimacy and intercourse should provide some of life’s greatest pleasures. But because the female urogenital and reproductive organs are very susceptible to adhesions, intercourse can become painful, dissatisfying, and embarrassing. Many women still believe the old misconception that “there isn’t anything that can be done,” or “it’s just the way it is,” or “my mother didn’t enjoy sexual intimacy and neither did hers, therefore I won’t be able to either.”

If you are not satisfied with sexual intercourse, you are not alone. Did you know:

  • approximately 50% of all US women and 43% of women aged 18-59 experience female sexual dysfunction (FSD) according to data from Urology and the Journal of the American Medical Association?
  • in 2000, the Journal of Sex & Marital Therapy classified female sexual dysfunction into six measurable domains: desire, arousal, lubrication, orgasm, satisfaction, and pain.
  • intercourse pain affects between 46% and 60% of all US women, according to reports in American Family Physician (2001) and Obstetrics & Gynecology (1996).

Although sexual dysfunction and intercourse pain are prevalent among women, these conditions should not be considered “normal” or “untreatable.” A study published by the Journal of Sexual Medicine (2006)1 found that many female competitive bicyclists experienced decreased genital sensation. The researchers found that external genital nerves and arteries were negatively affected by being directly compressed in women who consistently cycled an average of at least 10 miles a week, four weeks per month. The results of their study can also be applied to other physical activities such as horseback riding.


Other known causes of sexual dysfunction and intercourse pain include bladder infections, yeast infection, inflammatory disorders, sexually transmitted diseases, pelvic surgeries, physical or sexual abuse, etc. All of these conditions can cause adhesions to form within in the reproductive tract. Adhesions can restrict and blanket the delicate structures of the reproductive system, causing decreased sensation (such as in the bicyclists) or painful intercourse.

So what can a woman do once she experiences sexual dysfunction or painful intercourse? First, she should speak with her doctor to make sure there is not a greater problem at hand, such as endometriosis or a sexually transmitted disease. The doctor can then ascertain if the vulva has been damaged in any way and determine the proper treatment.

Our therapists have helped many women overcome pelvic pain and dysfunction. Request a free phone consultation with an expert therapist to learn more about our treatment.

Our results: sexual function and pain level improvements

  • 93% of women in the natural fertility study reported decreased pain 2
  • 96% of sexual function study participants reported reduced sexual intercourse pain 3
  • 56% had improved or first-time orgasms 3
  • 65% had increased satisfaction 3
  • 70% had increased lubrication 3
  • 74% had increases in their arousal 3
  • 78% had greater or renewed desire (libido) 3
  • 91% had overall increased sexual function 3

1. Marsha K. Guess, Kathleen Connell, Steven Schrader, Susan Reutman, Andrea Wang, Julie LaCombe, Christine Toennis, Brian Lowe, Arnold Melman, Magdy Mikhail “Genital Sensation and Sexual Function in Women Bicyclists and Runners: Are Your Feet Safer than Your Seat?” Journal of Sexual Medicine. Vol 3, No 6.

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5 Signs of Sexual Dysfunction in Women

Sexual dysfunction — which includes problems with desire, arousal, orgasm, and resolution — is common in both women and men. In fact, 43 percent of women, and 31 percent of men, report some degree of sexual dysfunction, according to the Cleveland Clinic.

And while both genders may deal with issues during intercourse, it’s often easier to pinpoint the problem in men, says Brett Worly, MD, an ob/gyn at The Ohio State University Wexner Medical Center in Columbus. Plus, “male sexual problems have become more socially acceptable to discuss with a doctor in ways that female sexual dysfunction has not,” he notes.

If you’re dealing with problems in the bedroom, it’s crucial to talk to your doctor, since sexual issues can be a sign that something else is going on with your health. Read on to learn about five common sexual problems in women — and what you can do to resolve them.

1. Vaginal Dryness

Why It’s Happening: Vaginal dryness can result from hormonal changes that occur during breast-feeding or menopause. In fact, a study of 1,000 postmenopausal women published in January 2010 in the journal Menopause found that half of postmenopausal women experience vaginal dryness.

What You Can Do: Reach for an OTC lubricant before and during intercourse, such as K-Y Jelly, Aqua Lube, or Astroglide, suggests Dr. Worly. Also consider vaginal moisturizers like Replens. “Both lubricants and moisturizers can be used in tandem,” says Worly. “I tell my patients to use ‘lubricants for lovemaking’ and ‘moisturizers for maintenance.’” If your body needs a little extra assistance, ask your doctor about Osphena, a non-estrogen oral pill available by prescription that helps alleviate dryness and pain attributed to menopause.

2. Low Desire

Why It’s Happening: As hormones decline in the years leading up to menopause, your libido can go south, too. But low desire isn’t just a problem for older women: Half of females ages 30 to 50 have also suffered from a lack of lust, according to a national survey of 1,000 women. Low libido can result from a number of issues, including medical problems like diabetes and low blood pressure, and psychological issues like depression or simply being unhappy in your relationship. Certain medications, like antidepressants, can also be libido killers, as can hormonal contraceptives, according to a study published in June 2010 in The Journal of Sexual Medicine.

What You Can Do: There’s no one-stop solution to boost libido, so talk to your doctor, who can help you get to the root of the problem. If the issue is emotional or psychological, they may recommend seeing a therapist. “A traditional or sexual therapist can help couples evolve from having the same old conversation patterns, life habits, and sexual habits to having a sexual relationship that’s fulfilling, invigorating, and romantic,” says Worly.

3. Painful Sex

Why It’s Happening: As many as 30 percent of women report pain during sex, according to a study published in April 2015 in The Journal of Sexual Medicine. Pain can be caused by vaginal dryness, or it may be an indication of a medical problem, like ovarian cysts or endometriosis, according to The American Congress of Obstetricians and Gynecologists. Painful sex can also be related to vaginismus, a condition in which the vagina tightens involuntarily when penetrated.

What You Can Do: Talk to your healthcare provider to rule out medical issues like ovarian cysts, endometriosis, or vaginismus. If those aren’t the problem, your doctor may recommend pelvic floor physical therapy, medication, or surgery to treat the cause of pain, says Worly. “It’s important to understand that the first treatment doesn’t always work, and sometimes multiple attempts at treatment are needed before you find success,” he says.

4. Arousal Problems

Why It’s Happening: The inability to become aroused may be due to a number of reasons, such as anxiety or inadequate stimulation (aka, you need more foreplay). If you experience dryness or pain during sex, it can also be harder to become turned on. Hormonal changes due to menopause or a partner’s sexual issues (like erectile dysfunction or premature ejaculation) can also make it more difficult to get in the mood.

What You Can Do: Work with your healthcare provider to ID the underlying reason you can’t become aroused, recommends Worly. He or she can help connect you with the right form of treatment to correct the problem, whether that’s seeking out sexual therapy, a medication (like hormones), or treatment for your partner’s problem, he says.

5. Trouble Reaching Orgasm

Why It’s Happening: “About 5 percent of perimenopausal women experience orgasm problems,” says Worly. Aside from hormone changes, an inability to reach orgasm may also be due to anxiety, insufficient foreplay, certain medications, and chronic diseases.

What You Can Do: Just like other forms of sexual dysfunction, it’s key to talk to your doctor to address the underlying problem before trying to treat it. In the meantime, try being more mindful while you’re getting it on by paying attention to the sensations as they happen. Research published in June 2015 in the Journal of Sex Research suggests that being mindful during sex can make it easier to achieve orgasm. It may also be useful to add a vibrator to your sexual repertoire, says Worly. “Vibrators are now sold at most pharmacies, both in the store and online, so it’s possible to buy them discreetly from the comfort of your home,” he notes.

Is Female Impotence A Thing? Yes, & Here Are 9 Causes

When it comes to bedroom performance, many people think that an inability to perform is a condition that affects only men. But is female impotence a thing? Turns out, the answer is yes, and, according to Mayo Clinic, it’s medically diagnosed as female sexual dysfunction. Medically speaking, sexuality incorporates neurologic, vascular and endocrine systems — i.e. the brain, the heart and hormones — so it makes sense that there’s a possibility for something to go awry in the sack, regardless of gender.

Add psychological factors, lifestyle habits, religious beliefs, interpersonal relationships, and self-esteem — which anyone who has ever gotten naked and intimate with another person can attest to — and it’s a wonder people are doing it at all. But you do it because it’s natural, it’s fun, it feels great, and sex has scientifically proven health benefits. This makes female impotence all the more troublesome for women affected by it. But if you do suffer, it’s important to know you’re not alone.

Approximately 12 percent of women in the United States report distressing sexual health concerns and as many as 40 percent report baseline sexual concerns, according to a 2015 study published in American Family Physician. There’s help out there for women who are affected by female impotence, but in order to get effective treatment, you have to pinpoint the cause of your sexual dysfunction, which may be caused by any of the following.

1. Low Sexual Desire

Mayo Clinic reported that low sexual desire is the most common of female sexual dysfunctions. So if you’re experiencing unwillingness to be sexual and that poses a problem for you, make an appointment with your physician or mental health counselor.

2. Deep Penetration

You know how some guys think the deeper the better? Not always the case. In fact, deep penetration can cause pain, fear, and anxiety about sex, according to MedicineNet.com. Something to consider when evaluating your sex life.

3. Sexual Arousal Disorder

According to Mayo Clinic, sexual arousal disorder is when you have the desire to do it, but can’t get aroused or maintain arousal during sex. American Family Physician suggested that women who have trouble with sexual arousal use directed masturbation in order to hone in on what does get you aroused.

4. Painful Intercourse

If it hurts, you’re not going to want to have sex. But what’s causing the pain? There can be a couple of factors. MedicineNet.com notes that sexual stimulation or vaginal contact may be painful if you suffer endometriosis, a pelvic mass, ovarian cysts, vaginitis, or the presence of scar tissue from surgery. There’s also a possibility that you might have an STD or STI, so pay a visit to your doctor STAT.

5. Genito-Pelvic Pain/Penetration Disorder

A study published in American Family Physician reported on genito-pelvic pain/penetration disorder, which is when anxiety about penetration makes you tense your abdominal and pelvic muscles so much so that penetration becomes impossible. Sure, tensing up may happen from time to time to any woman, but as the study noted, the condition must persist for six months in order to be diagnosed with genito-pelvic pain/penetration disorder.

6. Orgasmic Disorder

Orgasmic disorder is self-explanatory: it’s when you get all hot and bothered and can’t finish, according to Mayo Clinic. Thus, you want to avoid sex. Again, American Family Physician suggested directed masturbation to help you climax.

7. Age

Age is nothin’ but a number, but it can affect you in the bedroom. According to American Family Physician the older you get, the slower the blood flow to your genitals, which dulls arousal. But I also know 70-year-old women who run marathons, so take everything in stride.

8. Antidepressants

Huffington Post reported women taking antidepressants suffer from low libido, meaning you may have a decreased sex drive. Each medication comes with side effects, and often you don’t know how your body is going to react until you’ve been taking them. The best solution is to be open with your doctor about whatever symptoms your medications cause, and go through a process of trial-and-error. You should, however, never go off your antidepressants, “cold turkey,” without consulting your physician beforehand.

9. Alcoholism

It’s not only men who can’t perform because of too much booze. According to Medical Daily, alcoholism can kill your sex drive regardless of your gender.

On measure after measure, Baumeister found, women were more sexually adaptable than men. Lesbians, for instance, are more likely to sleep with men than gay men are with women. Reports indicate that women’s attitudes to sex change more readily than men’s do. For instance, in one study, researchers compared the attitudes toward sex of people who came of age before and after the sexual revolution of the 1960s; they found that women’s attitudes changed more than men’s.

The sexual patterns of couples also indicate that women are sexually adaptable. The female libido fluctuates throughout the month, based on ovulation and the menstrual cycle. But couples do not appear to have sex more or less frequently based on what time of the month it is. Rather, couples have sex in weekly and daily patterns–in the evenings and/or on weekends. A 1991 survey looked at how the gap between how frequently men and women desire sex and how often they actually have sex; the gap is bigger for women, 82 percent of whom had sex when they did not desire it, compared to 60 percent of men.

What could explain this flexibility? Baumeister proposed that “Women might be more willing to adapt their sexuality to local norms and contexts and different situations, because they aren’t quite so driven by strong urges and cravings as men are.”

When Baumeister set out to compare the male and the female sex drive about a decade ago, the four leading psychology textbooks of the time either did not address the fact that the male and female sex drive were different, or they suggested that they were the same. When he presented his hypothesis–that the male sex drive is stronger than the female drive–to peers in his field, they were skeptical. They believed, as Baumeister puts it, that “the idea that men have a stronger sex drive than women was probably some obsolete, wrong, and possibly offensive stereotype.”

So Baumeister and two (female) colleagues set to work reviewing hundreds of studies about human sexuality and found consistently that women are less motivated by sex than men are.

For men, they found, the goal of sex is sex itself. One 1996 study found that seven in ten men–compared to four in ten women–said the goal of sexual desire was simply having sex. In the same study, 35 percent of women said that love and intimacy were important goals of sex compared to 13 percent of men. Men also think about sex more, according to studies. When men and women monitor their sexual urges over a seven-day period, men report having twice as many sexual urges as women do.

Bergner and others might chalk these findings up to society’s sexual double standard: Men are allowed to be more sexual than women and, therefore, they are more forthcoming about their sexual urges. But this doesn’t seem to be the case.

Men feel guiltier about sex. They feel guiltier about masturbating than women do (13 percent versus 10 percent) and they feel guiltier about thinking about sex than women do. For instance, men report having more unwanted and uncontrollable thoughts about sex. In one survey, men responded more affirmatively to the following statements than women did: “I think about sex more than I would like” and “I must fight to keep my sexual thoughts and behavior under control.”

Women who feel distressed by a lack of sexual desire may have some help on the way. Recently the FDA approved bremelanotide (Vyleesi), a new medication for premenopausal women with hypoactive sexual desire disorder (HSDD). HSDD is a term coined to describe low sexual desire without a clear cause. So, women who might like to try this new drug need to know that it is not intended to help in situations where desire diminishes due to

  • a medical or psychiatric illness
  • interpersonal or relationship problems
  • side effects from another treatment or medication.

What does research tell us?

The physiology of sexual arousal and desire is complex in women. Yet there’s not a lot of research in this area. An estimated 40% of women are affected by a lack of desire for sex. The numbers vary depending on what age women are, where they live, and whether they have recently given birth, but there’s no doubt that it is a significant problem for some women.

In research funded by a licensing partner of the drug manufacturer, bremelanotide was studied for both effectiveness and safety. According to information released by the FDA, more than 1,200 women randomly received either bremelanotide or a placebo (sham treatment) for up to 24 weeks.

About 25% of the women who took bremelanotide reported some increase in sexual desire compared with 17% of those who took a placebo. The research also looked at the women’s distress over low sexual desire. About 35% of the patients treated with bremelanotide experienced some improvement in their distress compared with 31% of those who took a placebo. However, bremelanotide did not change or improve the number of satisfying sexual events.

How is the drug given?

At least 45 minutes before anticipated sexual activity, a woman injects the medication into a thigh or her abdomen (or her partner can do this). No one knows precisely how bremelanotide works, but it does activate melanocortin receptors, which seem to be involved in a host of brain activities, including possible links to appetite and cardiovascular health. Experts do not know how long the effect will last after each dose, so only one dose a day is recommended, and women should not take more than eight doses in a month. Additionally, those who experience no improvement in sexual desire or related distress within eight weeks should stop using the medicine.

What are the possible side effects?

As with any medication, side effects may occur. The most common ones are nausea and vomiting, experienced by about 40% of participants in the studies. Nausea is more likely the first time the medication is used, and becomes less of an issue with subsequent doses. Still, as many as 13% of those who felt nauseated actually needed some treatment for their nausea. Other possible side effects include flushing and headache.

What else should I know?

Bremelanotide is approved for use only if a woman’s sexual desire has diminished — not if a woman has always had struggles with sexual desire. Also, bremelanotide is for generalized HSDD, which means decreased sexual desire regardless of the kind of sexual activity involved (including masturbation), the environment, or who the partner might be.

More research is needed on side effects. There are also some safety precautions. Women with high blood pressure should avoid bremelanotide because it can temporarily raise blood pressure. Nor is it recommended for women at risk for cardiovascular disease. Women who use naltrexone to treat alcohol dependence should not use bremelanotide because of drug interactions. Also, some women in the studies experienced darkening of skin and gums. Although rare, such changes are permanent.

The bottom line

For women, low sexual desire and distress linked with it are complex and challenging to treat. It’s encouraging that the FDA has identified female sexual dysfunction as one of 20 disease areas that deserve attention. Bremelanotide modestly increases sexual desire in some women, and may slightly lessen distress over a lack of desire. While current research suggests it doesn’t improve sexual satisfaction or affect how often a woman engages in sex, the availability of this potentially helpful medication could be a step in the right direction for some women.

Sexual dysfunction in women: Can we talk about it?

Many women experience some form of sexual dysfunction, be it lack of desire, lack of arousal, failure to achieve orgasm, or pain during sexual activity.

Sexual health may be difficult to discuss, for both the patient and the provider. Here, we describe how primary care physicians can approach this topic, assess potential problems, and begin treatment.

A COMMON PROBLEM

The age-adjusted prevalence of sexual dysfunction in US women was reported at 44% in the Prevalence of Female Sexual Problems Associated With Distress and Determinants of Treatment Seeking (PRESIDE) study,1 but the prevalence of distress associated with sexual dysfunction was 12%. The most common type of sexual dysfunction reported by women was low sexual desire, a finding consistent with that of another large population-based study.2

While the prevalence of any type of sexual dysfunction was highest in women over age 65,1 the prevalence of distress was lowest in this age group and highest in midlife between the ages of 45 and 65. The diagnostic criteria require both a problem and distress over the problem.

Sexual dysfunction negatively affects quality of life and emotional health, regardless of age.3

LIFESTYLE AND SEXUAL FUNCTION

Various lifestyle factors have been linked to either more or less sexual activity. For example, a Mediterranean diet was associated with increased sexual activity, as were social activity, social support, psychological well-being, self-reported good quality of life, moderate alcohol intake, absence of tobacco use, a normal body mass index, and exercise.4–6 A higher sense of purpose in life has been associated with greater sexual enjoyment.7

Conversely, sexual inactivity has been associated with alcohol misuse, an elevated body mass index, and somatization.4–6

SEXUAL RESPONSE: LINEAR OR CIRCULAR?

Masters and Johnson8 initially proposed a linear model of human sexual response, which Kaplan later modified to include desire and applied to both men and women.9,10 This model presumed that sexual response begins with spontaneous sexual desire, followed by arousal, and then (sometimes) orgasm and resolution.

Adapted with permission from Basson R. Human sex-response cycles. J Sex Marital Ther 2001; 27:33–43.

Figure 1. The intimacy-based female sexual response model suggests that while a woman may experience spontaneous sexual desire, a desire for emotional closeness or intimacy may also predispose her to engage in sexual activity. Biological, psychological, and sociocultural factors may adversely affect female sexual response.

In 2000, Basson11 proposed a circular, intimacy-based model of sexual response in women that acknowledged the complexities involved in a woman’s motivation to be sexual (Figure 1). While a woman may enter the cycle with spontaneous sexual desire, she may also enter it as sexually neutral, with arousal in response to a sexual stimulus. Emotional intimacy is an important part of the cycle, and emotional closeness and bonding with the partner may provide motivation for a woman to enter into the cycle again in the future.

In a Danish survey,12 more people of both sexes said the 2 linear models described their experiences better than the circular model, but more women than men endorsed the circular model, and more men than women endorsed a linear model.

In evaluating women who complain of low sexual desire, clinicians should be aware that women, particularly those who are postmenopausal, may not enter the cycle with spontaneous sexual desire, but instead may experience arousal in response to a sexual stimulus followed by desire—ie, responsive rather than spontaneous sexual desire. Sexual arousal may precede desire, especially for women in long-term relationships, and emotional intimacy is a key driver for sexual engagement in women.11

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