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Bravo C.S.,Instituto Nacional Of Perinatologia Isidro Espinosa Of Los Reyes Inperier | Ayala N.P.C.,National Autonomous University of Mexico | Melendez J.C.,Instituto Nacional Of Perinatologia Isidro Espinosa Of Los Reyes Inperier | Almaraz C.H.,Instituto Nacional Of Perinatologia Isidro Espinosa Of Los Reyes Inperier
Salud Mental | Year: 2010

The systematic study of sexuality is relatively recent if we consider the works of Freud and Kinsey and the studies performed during the first half of the XXth century. The fact of undertaking the sex problem has allowed an even deeper understanding of this phenomenon, by all means complex. Later on, Masters, Johnson and Kolodny created the model of human sexual response and its alterations. Kaplan's works as well as Labrador and Crespo's are directed to conceptualize the etiology of sexual dysfunctions as phenomena evolving from both recent and remote causes, i.e., they can be explained as multi-causal events. At the Department of Psychology of the National Institute of Perinatology (INPerIER), we have detected a high proportion of couples with problems in their sexual lives. The prevalence of sexual dysfunction found was 52% in women and 38.8% in men. Therefore, we decided to initiate a line of investigation on human sexuality, to which this work belongs. The aim was to identify the frequency, difference, relation and combination of three sexual dysfunctions: erectile dysfunction, male orgasmic disorder and precocious ejaculation, as well as some intervening factors that were divided in two types. a) Personality factors, including gender role: prescriptions, norms and expectations according to rules set by the society which are introjected by the individual. When the expression of masculinity and femininity polarizes reaching machisms and submissive behavior, this can result in a negative influence for the development of sexuality. Another personality factor is the level of selfesteem, which greatly determines the conduct of individuals and is defined as the personal judgment of value towards oneself; it is expressed in the form of attitudes of the individual towards himself. b) The existence of some sexual background such as the report of having suffered child traumatic experience of sexual abuse; availability of sex information; presence or absence of sex fears; masturbation during adolescence and absence or presence of conjugal problems. It must be said that the division of intervening factors into types allowed us to propose profiles for the indicators related with the presence of the aforementioned male sexual dysfunctions. These dysfunctions are described in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). Material and Methods: This was a non-experimental, one-sample, retrospective, transversal, multivariate-correlational field study of independent observations, with samples allocated in two groups. Samples: We got non-probabilistic samples from couples of patients recently accepted for service at the institution, according to pre-established quotas. Sample size consisted of 200 men, with 100 men showing no sexual dysfunction (group 1) and 100 men with evidence of sexual dysfunction (group 2). Results of erectile dysfunction, male orgasmic disorder and precocious ejaculation are presented here; they were compared with the same number of participants showing no sexual dysfunction. Participants were limited to individuals who met the following criteria: age range, 22 to 45 years old; elementary school as the minimum schooling; no history of mental illness or chronic disease that could condition the presence of male sexual dysfunctions. Socio-demographic factors controlled in this study included age, civil status and schooling; the classification variable was set to be the presence of male sexual dysfunctions. Instruments: For the classification of groups, in order to detect the type of dysfunction present, and for the sake of capturing sexual background data, we used the male version of the questionnaire of sexuality, based on the codified clinical history for female sexuality. For the measurement of gender role, we used the Inventory of Masculinity- Femininity (IMAFE), which measures four orientations: male, female, machismo and submission. For the measurement of self-esteem we used Coopersmith Self-Esteem Inventory, and the validation technique suggested by Lara, Verduzco, Acevedo and Cortés. Participants were approached at the external consultation area at the INPerIER. Instruments described above were applied as well as clinical histories obtained in one single session, individually, once the participant had signed the informed consent letter required by the Committee of Ethics of the INPerIER. Results: The most frequent dysfunction detected was precocious ejaculation, which was present in 48 participants. Thirty four men were reported with erectile dysfunction and 15 men showed male orgasmic disorders. In a previous article, we presented the results of hypoactive sexual disorder, the sexual dysfunction more frequently found (55 male participants reported it). In this case we observed that out of 100 participants studied, the overall number of dysfunctions found was 152, including hypoactive sexual disorder, which can be interpreted as one and a half dysfunctions per man. For the sake of establishing the relationship of each sexual dysfunction with personality factors, we estimated the ETA coefficient. In the case of the relation between sexual dysfunctions and sexual background we calculated Cramer's V. Once we established the relations between the personality factors and the background that were used to develop profiles, we performed a discriminant analysis, which included all variables we found related and we came out with the following results: For erectile dysfunction we found a relation with three variables: negative relation with femininity and self-esteem, and positive relation with conjugal problems. In the case of the male orgasmic disorder, we found a relation with five variables: negative relation with femininity and self-esteem, and positive relation with child sexual traumatic experience, masturbation and conjugal problems. In the case of precocious ejaculation, we detected a relation with four variables: negative relation with masculinity, femininity and self-esteem, and positive relation with conjugal problems. The relations that became evident in every dysfunction showed that in this proportion, the discriminant variables provided us with an approximate explanation. DISCUSSION: The frequency of sexual dysfunctions can be described as high. The analysis of the results made evident that two factors are always present in these sexual dysfunctions: a tendency to show low self-esteem and the presence of conjugal problems. Alongside the different dimensions of gender roles, there is a decrease of the masculinity features in the case of precocious ejaculation; the reduction of femininity features is found in the three dysfunctions under study. There is a tendency to inhibition of both the sexual expressions and the affective expressions (femininity features), which are found combined in the case of precocious ejaculation, combined as well with a decrease of the masculinity features. When it comes to the sexual background, we observed that the history of child sexual traumatic experience is a risk indicator for the orgasmic disorder, as well as the report of practicing masturbation during adolescence. We can infer from this that this can be due to the type of masturbation limited to a biological discharge and not to the exploration addressed to a self-knowledge of the body. Another indicator present only in the orgasmic disorder is the fear of sexuality. It can be observed that the sexual dysfunction that presents more indicators is the male orgasmic disorder. For what we explained here, it becomes relevant to develop integral intervention plans for the adequate exploration of indicators related to these dysfunctions. Source


Bravo C.S.,Instituto Nacional Of Perinatologia Isidro Espinosa Of Los Reyes Inperier | Melendez J.C.,Instituto Nacional Of Perinatologia Isidro Espinosa Of Los Reyes Inperier | Ayala N.P.C.,National Autonomous University of Mexico | Almaraz C.H.,Instituto Nacional Of Perinatologia Isidro Espinosa Of Los Reyes Inperier
Salud Mental | Year: 2010

Background At the Department of Psychology of the National Institute of Perinatology Isidro Espinosa de los Reyes (INPerIER) -a medical unit specialized in reproductive problems-, a line of investigation on human sexuality was opened due to the high numbers of patients with some kind of problem in their sexual lives. We have been performing exploratory studies where we have found a high prevalence of sexual disorders, i.e. 52% in women and 38.8% in men, in addition to other comparative studies. These studies revealed that people with disturbances in their sexual life were in a disadvantageous position when considering factors such as self-concept, assertivity, levels of anxiety, marital satisfaction, style of communication and marital communication, when compared to population not showing sexual problems. This brought us to the conclusion that the presentation of one or more sexual disorders is a risk factor that deserves exhaustive studies from the psychological point of view. Our studies, made in groups of men and women showing sexual disorders, lead to the need of studying risk factors related with every sexual disorder. We have a hypothesis that not all disorders show in a similar manner and that it is in the different combination of factors where the specificity to provide elements that can help improve intervention plans lies. Objective The general objective of this work was to identify the frequency, differences, relationships and combinations between the feminine sexual dysfunctions known as sexual pain disorders: dyspareunia and vaginismus, and some intervening variables. These were gender role and self-esteem (psychological factors) and background (child sexual traumatic experience, sexual information, sexual fears, masturbation and conjugal problems), in order to create a profile of each one of these sexual disorders so that it provides elements for intervention plans. Material and methods This was a non-experimental, transversal, retrospective field study with a correlational-multivariate design and an independent sample divided into three groups with individuals selected by intentional sampling according to pre-established quotas. This work belongs to a wider research study of some risk factors found in male and female sexual dysfunctions, whose original sample consisted of 400 participants; out of this group we selected only participants with dyspareunia and vaginismus and they were compared with the same number of participants who showed no sexual disorder. So, the sample classification remained as follows: Group 1, no sexual dysfunctions; group 2, with dyspareunia, and group 3 with vaginismus. Women participating are frequent attendees of the National Institute of Perinatology (INPerIER) and had to meet all the inclusion criteria. For the allocation into groups and the collection of sexual background data we used the codified clinical history for female sexuality (CCHFS). Measurement of personality factors was performed with the Masculinity and Femininity Inventory (MFI) and with Coppersmith's self-esteem inventory. A questionnaire on sexuality and the other instruments was provided and filled in one single session at the outpatient room. For the analysis of results, we used central tendency measurements to describe controlled socio-demographic factors such as age, civil status and schooling. The statistical analysis consisted on determining the frequency of the presence of sexual dysfunctions within the group of women with sexual dysfunctions, out of which we got the patients presenting dyspareunia and vaginismus for group allocation. Then we made an analysis to compare the groups. The first group was set to be the one with no dysfunctions, the second one with dyspareunia and the third one with vaginismus, in order to get the significative differences and the relationship between groups and personality factors under study (gender role and self-esteem); for these we used the t-Student test and ETA coefficient. For the analysis of sexual background (child sexual traumatic experience, sexual information, sexual fears, masturbation and conjugal problems) and their relationship with dysfunctions, we used X2 and Cramer's V. Factors resulting related were used to perform a discriminant analysis so as to propose explanational profiles; all variables found to be related, psychological factors and sexual background were included in the analysis. Statistical data analysis was made with the software SPSS version 11. Results The description of the samples shows a normal distribution with an average for groups of age and schooling as follows: for group 1, age 31.9±5.32, years in school 10.9±3.17; for group 2, age 32.7±5.54, years in school 10.2±2.8; and for group 3, age 33.7±3.1, years in school, 9.9±2.5. From every statistical analysis variables were isolated and personality factors studied, indicating women with dyspareunia showed a decrease in masculinity features and in their levels of selfesteem, and an increase in submissive features, when compared to women with no sexual dysfunctions. As to the analysis of the results of sexual background, in the dyspaurenia group we found a relationship with conjugal problems, suggesting these variables have a significant intervention in the presence of dyspaurenia during women's adult life. The discriminant analysis launched a factor out of four variables, with 75.9% of the cases correctly classified, demonstrating that women with dyspaurenia within this percentage have related indicators, discriminating variables constituting an explanational approximation. Results of the group of women with vaginismus indicate a decrease in the self-esteem feature and an increase in the submissive features. Analysis of sexual background showed a relation between women with vaginismus and sexual fears, a decrease in sexual information and presence of conjugal problems. Described background data have a significant intervention in these women's adult life. The discriminant analysis launched a factor out of five variables, with 84.1% of the cases correctly classified, demonstrating that women with vaginismus within this percentage have these related indicators, discriminating variables constituting an explanational approximation. Conclusion The isolation of variables with the purpose of detecting the factors related to the presence of the two sexual disorders, dyspareunia and vaginismus, has as its main target to provide indicators of risk that facilitate the creation of intervention plans, in order to avoid making generalizations for the handling of sexual disorders. Source


Bravo C.S.,Instituto Nacional Of Perinatologia Isidro Espinosa Of Los Reyes Inperier | Melendez J.C.,Instituto Nacional Of Perinatologia Isidro Espinosa Of Los Reyes Inperier | Ayala N.P.C.,National Autonomous University of Mexico | Ruiz B.E.T.,National Autonomous University of Mexico
Salud Mental | Year: 2010

One target of psychology of health is the quest for specificity when detecting factors related to psychological disorders, among which there are female sexual dysfunctions showing associated pain: dyspareunia and vaginismus (not caused by medical disease). Dyspareunia is the presence of genital pain during sexual intercourse and is related to psychological or relational factors. Vaginismus is characterized by spasms in the muscles of the vaginal entrance, making it difficult or impossible to perform coitus; the woman can be sexually aroused, responsive and enjoying sexual games, she can even reach her orgasm, as long as there is no penetration. Of all the causes mentioned, the following are recognized: incapacity to let go to the erotic experience, fear to failure, cultural influence predisposing sexual conflict, anxiety and shame, as well as couple problems. However, specificity is lacking in the factors related to each one of these sexual dysfunctions in order to provide elements generating intervention strategies. Objective: The objective is to detect new indicators with the purpose of having a better understanding of why an individual exercises sexuality in such a way that it makes her have a proper sexual response and why, in other situations, the sexual response shows alterations leading to dyspareunia or vaginismus. Four are the specific objectives: 1. Identification of current indicators that have an influence in sexual dysfunctions of the participants. 2. Identification of indicators that have had an influence in the unsatisfactory development of sexuality of the participants. 3. Identification of elements of perception of the participants in the couple life of their parents that may have had an impact on their sexuality. 4. Identification of indicators that, within the sexual management provided by the family, had an impact in the sexual life of the participants. Material and methods: The qualitative-interpretative method was used, in the form of an exploratory case-study. The institution where the study took place was the Department of Psychology of the National Institute of Perinatology (INPerIER). The sample was constituted by three participants, all of them patients from the institution; they had to comply with certain inclusion criteria of the study. Any physical problem that could have caused the sexual dysfunction was discarded. The first participant did not show any sexual dysfunction (NSD), the second one showed dyspareunia (D) and the third one showed vaginismus (V). We used a semi-structured, focalized, in-depth interview. Interviews took place after having signed a letter of informed consent, accordingly to the ethical institutional requirements, and we also got an approval of recording the interview. We used the analysis of content with an empiric, exploratory orientation. Categories were organized accordingly with the specific objectives. Results: The three participants were: NSD: 32 years old, five years of marriage. No sexual dysfunction. V: 36 years old, six years of marriage. Diagnosis: vaginismus. D: 33 years old, one year in free union. Diagnosis: dyspareunia. Data systematization was performed dividing the units of analysis by every participant and the parts of the most significative stories of every specific objective within its respective categories. In the analysis of categories we detected two conditions: internal and relational, as well as two types of indicators: risk indicators and protective indicators. What marked the difference was the dominium of the protective indicators over the risk indicators in the NSD participant. Among the more important risk indicators, we found feelings of disadvantage, uselessness and devaluating feelings, linked to a tendency to submissive behavior, as a consequence of remote causes such as having faced a double moral in the family: on the one hand erotized family bonds during infancy and, on the other hand, prohibitions and stiffness towards any sexual curiosity or manifestation, apart from a poor socialization. The conflict between desire and sexual prohibition generates confusion in the identification of sensations, setting a painful, fearful association to sexuality, even more so if this landscape is complicated with other elements such as violence and carelessness. Other elements found as a consequence of the aforementioned include self-inflicted violence, annulment of desire, lack of self-care and interacting problems with the opposite sex in everyday life. All of this leads to an incapacity of exerting a satisfactory sexual life, drifting towards secondary fears when feeling disadvantageous while interacting with the couple; this, in great extent, determines the conflicts, which may be either a cause or a consequence of the sexual problem. Confusion also arises when trying to identify whether problems are internal or external, thence conductual responses tend to complicate the relationship. In both sexual dysfunctions we find a specific type of frustration, since desire, excitement and orgasm are present, but coitus cannot be performed in a satisfactory way. The following are the more important protective indicators: conductual assertive responses, clarity in the affections, situation of the problems, search for sexual information, openness to family communication and with the couple, a couple's differential place, plus the search of satisfaction of sexuality and self care. Among the indicators shared we found: limited or null sexual education, poor communication in the family nucleus, and gender stereotypes highly polarized between parents, among others. Conclusions: We corroborate in this study that it is the combination of specific elements which contributes to the presence of these two sexual dysfunctions, since the psychological world has many intertwined streams, intervention models cannot be centered only in sexual techniques, but they should also consider the indicators related to such alterations. Finally, it must be pointed out that the results of this phase are the product of an exploratory study, opening the gates to new lines of research. Source

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