Silhouette Hall - Marinela

Advances in sex research: Etiology, diagnosis, and treatment of sexual dysfunctions

Anna-Carlotta Zarksi, Mehmet Sungur, Jürgen Hoyer Speaker

Convenor: Dr. Julia Velten, Ruhr-Universität Bochum, Germany
Chair: Dr. Julia Velten, Ruhr-Universität Bochum, Germany
Discussant: Anna-Carlotta Zarski, University Erlangen-Nürnberg, Germany Presenters: Dr. Julia Velten, Ruhr-Universität Bochum, Germany Anna-Carlotta Zarski, University Erlangen-Nürnberg, Germany Prof. Dr. Mehmet Sungur, Psychiatry Dept of Marmara University Hospital, Istanbul, Turkey Prof. Dr. Jürgen Hoyer, TU Dresden, Germany
Subject Tracks: Adult mental health  

The speakers of this symposium will present new data on the etiology, diagnosis, and psychological treatment of sexual dysfunctions. Over the last decade, mindfulness-based therapy has been found effective in treating sexual dysfunctions in women. The mechanisms by which these treatments help to improve women’s sexual function are, however, still unclear. Dr. Velten will present findings of two in-laboratory studies investigating the relevance of mindfulness-exercises for sexual response in women. Understanding the mechanisms by which mindfulness can improve women’s sexual response can help to further improve psychological treatments. Ms. Zarski will present results of a randomized-controlled trial investigating the efficacy of an online-treatment program for women with genito-pelvic pain/penetration disorder. This common sexual pain condition negatively affects the sexual health of women worldwide. User-friendly Internet-based treatments can improve women’s sexual function whenever no specialized treatment providers are available. Diagnostic criteria for sexual dysfunctions in women and men have been under constant change over the last decades. Dr. Sungur’s talk will focus on critiques and challenges to the old and new DSM diagnostic criteria for sexual disorders. His presentation will also include implications of these revised criteria for research and clinical practice. Dr. Hoyer will present findings of two studies, a large online survey and a clinical investigation, on safety behavior in the context of sexual dysfunction. His talk will include an estimation of the frequency of these behaviors and an evaluation of the clinical use of this concept.

1)    Understanding processes of mindfulness-based sex-therapy: Does mindfulness enhance women’s sexual arousal?

Julia Velten & Jürgen Margraf

Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Germany

Mindfulness-based sex-therapy is an effective treatment for sexual dysfunctions (e.g., low sexual desire, genito-pelvic pain) in women. The mechanisms, however, through which mindfulness fosters women’s sexual well-being are unclear. The goal of our studies was to investigate the influence of in-session mindfulness-exercises on women’s sexual response. In two psychophysiological studies (N = 42, N = 49), women’s subjective and genital sexual responses were assessed during the presentation of neutral and erotic videos. Women were invited to listen to a series of audio-recordings that included mindfulness-based or other relaxation exercises which were presented in randomized order. In addition, body responsiveness and state mindfulness were assessed between exercises. Our studies suggest that mindfulness-based exercises that encourage women to mindfully focus on bodily sensations (i.e., whole body or genitals) can increase their subjective sexual arousal. Sexual concordance, the association between genital and subjective sexual arousal, was also greater after mindfulness-exercises. Our findings suggest that mindfulness-based treatments may improve women’s sexual function by increasing their subjective sense of arousal during sexual activity.

2) Internet-based Guided Self-Help for Genito-Pelvic Pain/Penetration Disorder: Preliminary Results of a Randomized Controlled Trial

Anna-Carlotta Zarski, Matthias Berking, David D. Ebert

Friedrich-Alexander Universität Erlangen-Nürnberg

Background: Genito-pelvic pain/penetration disorder (GPPPD) not only adversely affects women’s sexuality but is also associated with reduced quality of life and well-being, mental health comorbidities, and relationship distress. Evidence for effective treatment options is scarce. Approximately two-thirds of women with sexual dysfunction do not seek professional help due to individual barriers such as feelings of shame or structural barriers such as limited availability of specialized treatment. The aim of this study is to evaluate the efficacy of an internet-based guided self-help intervention for GPPPD. Method: A total of 200 women with GPPPD were randomly allocated to the intervention or the waiting control group. The intervention is comprised of 8 modules consisting of psychoeducation, relaxation exercises, sensate focus, and systematic desensitization via dilator insertion exercises. Participants have the opportunity to request automatic text messages on their mobile phone along with the intervention and to receive written feedback on every completed session from an eCoach. The primary outcome is sexual intercourse. Secondary outcomes are e.g. fear of coitus, negative penetration cognitions, sexual functioning, and general well-being. Web-based self-report assessments for both groups are scheduled at baseline, 10 weeks, and 6 months. Findings: in progress

3) Critiques & Challenges to old and new DSM-Criteria for sexual dysfunction

Mehmet Sungur

Psychiatry Dept of Marmara University Hospital, Istanbul, Turkey

All the DSM classifications until present time based definitions of sexual dysfunctions on expert opinions that were not supported by sufficient clinical or epidemiological data. Additionally, definitions included vague terms such as satisfactory, soon after satisfactory, rapid, short, minimal, recurrent, persistent which were difficult to interpret. The DSM 5 attempted to operationalize the diagnostic criteria and avoided these vague terms. It also used specific duration and severity criteria to identify more homogeneous groups for purposes of good clinical epidemiological research and better treatment decisions. All of the DSM classifications until DSM 5 classified male and female SD on the same continuum based on unified sexual response cycles. DSM 5 made a major conceptual change and emphasized that different genders’ sexual disorders are no longer required to be analogous. DSM 5 also merged female desire and arousal diagnosis into one entity defined as female sexual interest and arousal disorders. This presentation aims to compare and contrast DSM 5 definitions of sexual dysfunctions with that of DSM IV TR and explains the rationale for making these changes. It subsequently challenges the suggested DSM 5 criteria and addresses some issues to be considered further for future diagnostic criteria.

4) Safety behaviour in the context of sexual dysfunction: Preliminary data on its frequency and on the validity of the concept

Jürgen Hoyer, Corinna Klitzke & Verena Wuellhorst

Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Germany

Safety behaviours in order to avoid embarrassing experiences are common and well researched, especially in social anxiety disorder. The study aimed to investigate whether safety behaviour also occurs in the context of sexual dysfunction and whether it co-varies with indicators of sexual functioning. In an online survey, we applied the Questionnaire on Behaviour during Sexual Activities (BSA; Frank, Noyon, Höfling, & Heidenreich, 2010) which contains items on typical (sexual) safety behaviours that patients attending sex therapy presented with. Furthermore, a short screener for sexual dysfunction, validated measures of sexual functioning (such as the Female Sexual Functioning Index) and the Sexual Motives Scale were applied. In preliminary clinical study, we applied the same set of measures in reliably diagnosed patients with anxiety and/or depressive disorders, who also had indicated to suffer from sexual problems during the diagnostic intake interview. Results of the online survey and the clinical study allow a first estimation of the frequency of these safety behaviours and make an evaluation of the clinical use of the concept possible.