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Relatively few studies have measured sexual functioning in women using a large, diverse, community-based sample with measures that allow for direct comparisons with previous findings. In this article, we: (1) describe prevalence of sexual activity in women by key sociodemographic characteristics, including age, race/ethnicity, marital status, and socioeconomic status; and (2) estimate the influence of key correlates on sexual problems. Data were analyzed from the Boston Area Community Health (BACH) Survey, a 2002–2005 community-based epidemiologic study of urologic and gynecologic symptoms, sociodemographics, health status, and psychosocial characteristics in a diverse sample of Boston area residents ( N  = 3,205 women aged 30–79 years). Analyses of sexual activity prevalence and reasons for inactivity were conducted on the full sample, while analyses of sexual problems and their correlates were conducted for the subset of women who engaged in sexual activity with a partner in the previous 4 weeks. A total of 49% of participants were not sexually active, citing lack of interest (51.5%) and lack of a partner (60.8%) as the most common reasons. Data pertaining to five dimensions of sexual functioning were gathered through a self-administered questionnaire adapted from the Female Sexual Function Index, measuring desire among all women and arousal, lubrication, orgasm, and pain among those who were sexually active. Among the sexually active, we obtained a 38.4% prevalence rate of sexual problems and 34.9% of those participants reported that they were also dissatisfied with their sex lives. Therefore, only 13.7% of the sexually active sample exhibited both sexual problems and dissatisfaction with their overall sex lives. Age was strongly and positively associated with sexual problems. In terms of psychosocial factors, depression, sexual and physical abuse in adulthood, global mental health functioning, and alcohol were associated with sexual problems, with variation across racial/ethnic groups.

OBJECTIVE: This study aimed to investigate the prevalence and risk factors associated with sexual dysfunction in a well-characterized cohort of women with type 1 diabetes. RESEARCH DESIGN AND METHODS: The study was conducted in women enrolled in the long-term Epidemiology of Diabetes Interventions and Complications (EDIC) study, a North American study of men and women with type 1 diabetes. At year 10 of the EDIC study, 652 female participants were invited to complete a validated self-report measure of sexual function, standardized history and physical examinations, laboratory testing, and mood assessment. RESULTS: Of the sexually active women with type 1 diabetes in the EDIC study, 35% met criteria for female sexual dysfunction (FSD). Women with FSD reported loss of libido (57%); problems with orgasm (51%), lubrication (47%), and arousal (38%); and pain (21%). Univariate analyses revealed a positive association between FSD and age (P = 0.0041), marital status (P = 0.0016), menopausal status (P = 0.0019), microvasculopathy (P = 0.0092), and depression (P = 0.0022). However, in a multivariate analysis, only depression (P = 0.004) and marital status (P = 0.003) were significant predictors of FSD. CONCLUSIONS: FSD is common in women with type 1 diabetes and affects all aspects of sexual function and satisfaction. Depression is the major predictor of sexual dysfunction in women with type 1 diabetes. These findings suggest that women with type 1 diabetes should be routinely queried about the presence of sexual dysfunction and possible co-association with depression.

Sexual Dysfunction in Women With Type 1 Diabetes Long-term findings from the DCCT/ EDIC study cohort Paul Enzlin , PHD 1 , 2 , Raymond Rosen , PHD 3 , 4 , Markus Wiegel , PHD 3 , 4 , Jeanette Brown , MD 5 , Hunter Wessells , MD 6 , Patricia Gatcomb , RN, CDE 7 , Brandy Rutledge , PHD 8 , Ka-Ling Chan , MS 8 , Patricia A. Cleary , MS 8 and the DCCT/EDIC Research Group * 1 Department of Psychiatry, Katholieke Universiteit Leuven & University Hospitals Gasthuisberg, Leuven, Belgium; 2 Department of Obstetrics and Gynaecology, Institute for Family and Sexuality Studies, Katholieke Universiteit Leuven & University Hospitals Gasthuisberg, Leuven, Belgium; 3 New England Research Institutes, Watertown, Massachusetts; 4 Robert Wood Johnson Medical School, University of Medicine & Dentistry, Piscataway, New Jersey; 5 Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco Women's Health Clinical Research Center, San Francisco, California; 6 Department of Urology, University of Washington, Seattle, Washington; 7 Yale University School of Medicine, New Haven, Connecticut; 8 The Biostatistics Center, The George Washington University, Rockville, Maryland. Corresponding author: Paul Enzlin, paul.enzlin{at}uz.kuleuven.ac.be Abstract OBJECTIVE This study aimed to investigate the prevalence and risk factors associated with sexual dysfunction in a well-characterized cohort of women with type 1 diabetes. RESEARCH DESIGN AND METHODS The study was conducted in women enrolled in the long-term Epidemiology of Diabetes Interventions and Complications (EDIC) study, a North American study of men and women with type 1 diabetes. At year 10 of the EDIC study, 652 female participants were invited to complete a validated self-report measure of sexual function, standardized history and physical examinations, laboratory testing, and mood assessment. RESULTS Of the sexually active women with type 1 diabetes in the EDIC study, 35% met criteria for female sexual dysfunction (FSD). Women with FSD reported loss of libido (57%); problems with orgasm (51%), lubrication (47%), and arousal (38%); and pain (21%). Univariate analyses revealed a positive association between FSD and age ( P = 0.0041), marital status ( P = 0.0016), menopausal status ( P = 0.0019), microvasculopathy ( P = 0.0092), and depression ( P = 0.0022). However, in a multivariate analysis, only depression ( P = 0.004) and marital status ( P = 0.003) were significant predictors of FSD. CONCLUSIONS FSD is common in women with type 1 diabetes and affects all aspects of sexual function and satisfaction. Depression is the major predictor of sexual dysfunction in women with type 1 diabetes. These findings suggest that women with type 1 diabetes should be routinely queried about the presence of sexual dysfunction and possible co-association with depression. Footnotes ↵ *A complete list of participants in the DCCT/EDIC Research Group can be found in Arch Ophthalmol 2008;126:1707–1715. The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact. Received August 15, 2008. Accepted February 2, 2009. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details. © 2009 by the American Diabetes Association.

Men with and without sexual dysfunction present with varying patterns of agreement between subjective estimates of sexual arousal and more objective psychophysiological measures of the same construct. This relative accuracy seems to be associated with sexual function, with men who have sexual dysfunction presenting less accurate estimations (mostly reporting below measured arousal levels). The purpose of this study is to clarify the processes underlying sexual arousal and the accuracy of its self-estimation. We looked at potential predictors of sexual arousal (subjective and physiological) and accuracy in estimating objective sexual arousal in a sample of 60 sexually functional males. Predictors included pre-existing sexual attitudes (erotophobia), both trait and state positive and negative affect, self-focused attention, and interoceptive awareness. Results indicate that this sexually functional sample generally reported below their own erection level. Interestingly, trait negative affect was associated with somewhat lower levels of subjective arousal and higher levels of physiological arousal. On the other hand, state positive affect facilitated both subjective and objective arousal and increased somewhat the accuracy of estimates of erectile responding. Pre-existing sexual attitudes as well as variations in self-focused attention and interoceptive awareness evidenced little effect on sexual arousal or the accuracy of its estimation.

A review of the current approach to the assessment and treatment of female sexual disorders from a sex therapy perspective is described. The importance of a comprehensive evaluation of both the woman and her partner, prior to formalizing a treatment plan, is stressed. Certain interventions are common in the treatment of all female sexual difficulties, for example, education and information about female sexuality generally, communication training, non-demand pleasuring, and permission to engage in self-pleasuring. Specific interventions are also described for such issues as past sexual or physical trauma. The overall goal of treatment is increased pleasure and satisfaction, rather than perfect genital response. Finally, the factors associated with treatment success are noted along with the observation that these factors are the same factors that contribute to a successful outcome in any psychotherapeutic endeavor.

The present study analyzed data from women who completed the Abel Assessment for sexual interest™. The sample included 81 women who admitted sexually abusing children, 94 women who admitted sexually abusing adolescents, 204 women denying-dissimulating sexually abusing children, and 202 women evaluated for non-child related sexual misconduct. The study addressed four topic areas related to women who sexually abuse minors. First, the study described the basic characteristics of the women who admitted sexually abusing children. The results found that the women reported first sexually touching a child in their early twenties, sexually abusing an average of 3.3 children, and committing an average of 40 lifetime sexually abusive acts. The women who admitted sexually abusing children reported sexually abusing girls and boys in approximately equal numbers, with one-third sexually abusing children within their family, 46% abusing children outside of the family, and 21% abusing both. Half of the women who admitted sexually abusing children self-reported sexual attraction to children. Two thirds of the women who admitted sexually abusing minors reported a history of childhood sexual abuse themselves. Second, the study examined the relationship between the frequency of perpetrated child sexual abuse and factors theorized to contribute to the sexual abuse of minors. Endorsing a greater number of problematic sexual behaviors and self-reported sexual attraction to children predicted the frequency of perpetrated sexual abuse. Third, the study used stimulus viewing time, an objective measure of sexual interest, to investigate the women's sexual interest patterns. The women who admitted sexually abusing children evidenced objectively measured sexual interest in children, whereas the women who admitted sexually abusing adolescents and the women evaluated for non-child related sexual misconduct did not. The last portion of the study developed classification models for women denying-dissimulating sexually abusing children, based on logistic regression equations. The classification model had a cross-validated area under the ROC curve of 0.67, which resulted in a sensitivity of 0.44 and a specificity of 0.80 for correctly identifying women who had sexually abused children but denied this.

This study examined the point prevalence of smoking in patients with anxiety disorders who do not have comorbid alcohol or substance abuse or dependence (ASAD). In a retrospective chart review, the smoking status of 581 patients with anxiety disorders was assessed. Patients, ages 18-65, were seeking treatment for anxiety disorders at an outpatient clinic that specialized in anxiety and related disorders. All participants were interviewed using the Anxiety Disorders Interview Schedule--IV, during which their smoking status was assessed. The prevalence of smoking across all anxiety disorders was 14.8%, which is much lower than found in the general population (23.3%; CDC, 2002) and even lower than previous estimates in individuals with comorbid anxiety and ASAD. Individuals with panic disorder and generalized anxiety disorder had the highest prevalence of smoking, although these rates were still considerably lower than those found in previous studies of smokers with anxiety disorders. Reasons for lower prevalence estimates are discussed.[PUBLICATION ABSTRACT]

This study investigated the attributional styles of men with and without sexual dysfunction for both positive and negative sexual and general events using a sex-specific version of the Attributional Style Questionnaire (Sex-ASQ), and ascertained the preliminary psychometric properties of the measure. The Sex-ASQ was created by embedding 8 hypothetical sexual events (4 positive, 4 negative) among the original 12 events in the Attributional Style Questionnaire (ASQ; C. Peterson, A. Semmel, C. von Baeyer, L. Y. Abramson, G. I. Metalsky, & M. E. Seligman, 1982). The Sex-ASQ was completed by 21 men with a principal DSM-IV diagnosis of Male Erectile Disorder (MED) and 32 male control participants. The psychometrics of the Sex-ASQ were satisfactory, but with the positive sexual event scales found to be less stable and internally consistent than the negative sexual event scales. Reasons for modest reliability of the positive event scales are discussed in terms of the original ASQ. As expected, men with MED did not differ significantly from men without sexual dysfunction in their causal attributions for general events, indicating that both groups exhibited an optimistic attributional style in general. Also as predicted, men with MED made more internal and stable causal attributions for negative sexual events than men without sexual dysfunction, and also rated negative sexual events as more important. For positive sexual events, the 2 groups did not differ in attributional style, with both groups making more external/unstable/specific causal attributions than for positive general events. Differences between explanatory style for sexual versus nonsexual events found in both sexually functional and dysfunctional men lend support for explanatory style models that propose both cross-situational consistency and situational specificity.

Results of three randomized clinical trials (RCTs) comparing adjuvant radiotherapy (ART) and early salvage radiotherapy (eSRT) of prostate carcinoma and a subsequent meta-analysis of the individual patient data from these RCTs were recently published. The results suggest that early eSRT is as effective and potentially less toxic than ART. Therefore, eSRT should be considered the standard of care. However, due to limitations in the RCTs, ART remains a valid treatment option in patients with the combination of high-risk features such as Gleason Score (GS) 8–10, positive surgical margins (R1) and pathological T-stage 3 or 4 (pT3/4). This article provides a critical appraisal of the RCTs and the rationale for recommendations adopted in the current national guidelines regarding patients with high-risk features after radical prostatectomy (RP): ART should be offered in case of pT3/pT4 and R1 and Gleason Score 8–10; ART can be offered in case of pT3/pT4 and R0 and Gleason Score 8–10 as well as in case of multifocal R1 (including pT2) and Gleason Score 8–10. In any case, the alternative treatment option of eSRT in case of rising PSA should be discussed with the patient.

Background: Salvage radiotherapy (SRT) improves oncologic outcomes in prostate cancer (PCa) patients who develop biochemical recurrence (BCR) after radical prostatectomy (RP). However, evidence on hard clinical endpoints is scarce. We compare long-term oncologic outcomes of SRT versus no radiotherapy (noRT) in patients with BCR after RP. Patients and methods: Within a multi-institutional database, we identified patients with BCR after RP between 1989 and 2016 for PCa. Patients with lymph node invasion, with adjuvant radiotherapy, or with additional androgen deprivation therapy at BCR were excluded. In all patients with SRT, SRT was delivered to the prostatic bed only. Propensity score matching (PSM) was performed to account for differences in pathologic tumor characteristics. Kaplan–Meier analyses and Cox regression models tested the effect of SRT versus no RT on metastasis-free (MFS) and overall survival (OS). Results: Of 1832 patients with BCR, 32.9% (n = 603) received SRT without ADT. The median follow-up was 95.9 months. Median total SRT dose was 70.2 Gy. After 1:1 PSM, at 15 years after RP, MFS and OS rates were 84.3 versus 76.9% (p < 0.001) and 85.3 versus 74.4% (p = 0.04) for SRT and noRT, respectively. In multivariable Cox regression models, SRT was an independent predictor for metastasis (HR: 0.37, p < 0.001) and OS (HR: 0.64, p = 0.03). Conclusion: This is the first matched-pair analysis investigating the impact of SRT versus observation only in post-RP recurrent PCa. After compensating for established risk factors, SRT was associated with better long-term MFS and OS. These results on clinical endpoints underline the curative potential of SRT.