title: Psychological and Interpersonal Dimensions of Sexual Function and Dysfunction.
abstract: BACKGROUND
  Psychological, interpersonal, and sociocultural factors play a significant role in making one vulnerable to developing a sexual concern, in triggering the onset of a sexual difficulty, and in maintaining sexual dysfunction in the long term.
  
  
  OBJECTIVE
  To focus on psychological and interpersonal aspects of sexual functioning in women and men after a critical review of the literature from 2010 to the present.
  
  
  METHODS
  This report is part 1 of 2 of our collaborative work during the 2015 International Consultation on Sexual Medicine for Committee 2.
  
  
  METHODS
  Systematic review of the literature with a focus on publications since 2010.
  
  
  RESULTS
  Our work as sexual medicine clinicians is essentially transdisciplinary, which involves not only the collaboration of multidisciplinary professionals but also the integration and application of new knowledge and evaluation and subsequent revision of our practices to ensure the highest level of care provided. There is scant literature on gender non-conforming children and adolescents to clarify specific developmental factors that shape the development of gender identity, orientation, and sexuality. Conversely, studies consistently have demonstrated the interdependence of sexual function between partners, with dysfunction in one partner often contributing to problems in sexual functioning and/or sexual satisfaction for the other. We recommend that clinicians explore attachment styles of patients, childhood experiences (including sexual abuse), onset of sexual activity, personality, cognitive schemas, infertility concerns, and sexual expectations. Assessment of depression, anxiety, stress, substance use and post-traumatic stress (and their medical treatments) should be carried out as part of the initial evaluation. Clinicians should attempt to ascertain whether the anxiety and/or depression is a consequence or a cause of the sexual complaint, and treatment should be administered accordingly. Cognitive distraction is a significant contributor to sexual response problems in men and women and is observed more consistently for genital arousal than for subjective arousal. Assessment of physical and mental illnesses that commonly occur in later life should be included as part of the initial evaluation in middle-aged and older persons presenting with sexual complaints. Menopausal status has an independent effect on reported changes in sex life and difficulties with intercourse. There is strong support for the use of psychological treatment for sexual desire and orgasm difficulties in women (but not in men). Combination therapies should be provided to men, whenever possible.
  
  
  CONCLUSIONS
  Overall, research strongly supports the routine clinical investigation of psychological factors, partner-related factors, context, and life stressors. A biopsychosocial model to understand how these factors predispose to sexual dysfunction is recommended.
authors.affiliation: Department of Obstetrics/Gynaecology, University of British Columbia, Vancouver, BC, Canada. Electronic address: Lori.Brotto@vch.ca.
authors.forename: Lori
authors.initials: L
authors.lastname: Brotto
authors.affiliation: Clinique du Levant, Beirut, Lebanon.
authors.forename: Sandrine
authors.initials: S
authors.lastname: Atallah
authors.affiliation: Obstetrics and Gynecology, Maricopa Integrated Health System, Phoenix, AZ, USA.
authors.forename: Crista
authors.initials: C
authors.lastname: Johnson-Agbakwu
authors.affiliation: Haziporen 10bet, Bet Shemesh, Israel.
authors.forename: Talli
authors.initials: T
authors.lastname: Rosenbaum
authors.affiliation: Department of Psychiatry, University of Sao Paulo Medical School, Sao Paulo, Brazil.
authors.forename: Carmita
authors.initials: C
authors.lastname: Abdo
authors.affiliation: Department of Psychology, University of New Brunswick, Fredericton, NB, Canada.
authors.forename: E Sandra
authors.initials: ES
authors.lastname: Byers
authors.affiliation: Department of Psychology, University of Southampton, Southampton, UK.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Graham
authors.affiliation: Departamento de Ciências da Educação, Universidade de Aveiro, Senhora da Hora, Portugal.
authors.forename: Pedro
authors.initials: P
authors.lastname: Nobre
authors.affiliation: Sexual Medicine, Porterbrook Clinic, Sheffield, UK.
authors.forename: Kevan
authors.initials: K
authors.lastname: Wylie
mesh_terms: D000328:Adult; D000367:Age Factors; D001007:Anxiety / Q000150:complications* / Q000175:diagnosis / Q000523:psychology; D001143:Arousal; D003863:Depression / Q000150:complications* / Q000175:diagnosis / Q000523:psychology; D005260:Female; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012725:Sexual Behavior / Q000523:psychology*; D020018:Sexual Dysfunctions, Psychological / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D012747:Sexual Partners / Q000523:psychology*; D013313:Stress Disorders, Post-Traumatic / Q000150:complications* / Q000175:diagnosis; D019966:Substance-Related Disorders / Q000150:complications* / Q000175:diagnosis / Q000523:psychology
keywords: Contextual Factors; Interpersonal; Partner Factors; Psychological; Treatment Outcome