Effectiveness of interventions aimed at improving the sexuality of women with multiple sclerosis: a systematic review

Objective: To evaluate the effectiveness of interventions aimed at improving the sexuality of women with multiple sclerosis. Data sources: MEDLINE, CINAHL, PsycINFO, Web of Science, Scopus, Embase and the Cochrane Library, as well as doctoral thesis databases Teseo and ProQuest Dissertations & Theses Global and the grey literature database Opengrey were searched, last on 15 October 2019. Journals related to the topic were also consulted. The bibliographic references of the articles included were reviewed. Method: Studies were selected if they included women with multiple sclerosis in whom interventions aimed at reducing sexual dysfunction were applied. Data extraction was carried out by two independent reviewers. The Jadad scale was used to evaluate the methodological quality of the studies included. Results: In total, 12 clinical trials were selected, and 611 patients were examined. Studies were classified into six interventions: sexual therapy (4), pharmaceutical drugs (3), pelvic floor exercises (2), yoga (1), mindfulness (1) and vaginal devices (1). Most of them improved some primary outcomes of sexual dysfunction such as lubrication, arousal, desire or orgasm. Pain was the most common secondary outcome evaluated and it became better in two studies including sexual therapy and in one intervention with pelvic floor exercises. Tertiary outcomes such as anxiety or depression were rarely examined, and they improved with sexual therapy and with OnabotulinumtoxinA. Conclusion: Sexual therapy, administration of OnabotulinumtoxinA, pelvic floor muscles exercises alone or combined with electrostimulation and the use of clitoral devices could be the most recommended interventions to improve the sexuality in women with multiple sclerosis.

The Attitudes of Therapists and Physicians on the Use of Sex Robots in Sexual Therapy: Online Survey and Interview Study

Background Various types of robots have already been successfully used in medical care, and the use of new technologies is also playing an increasing role in the area of sexuality. Sex robots are marketed as advanced sex toys and sex dolls with artificial intelligence. Only a few considerations about the therapeutic use of sex robots in sexual therapy are debated in expert discussions. Objective The aim of this study was to conduct a first exploratory survey on the attitudes of sex therapists and physicians toward the therapeutic benefits of sex robots. Methods This study comprised a quantitative online survey and a qualitative interview study. A self-constructed questionnaire was used to survey the general attitudes of sex therapists and physicians regarding the benefits of sex robots in therapy. The qualitative study was designed to gain in-depth insight into the participants’ beliefs and attitudes. Therefore, semistructured interviews were conducted. The quantitative data were evaluated by statistical analysis, and the interviews were transcribed and analyzed by using a grounded theory approach. Results A total of 72 sex therapists and physicians completed our self-constructed questionnaire (response rate 15%, 72/480). Only a few respondents (11%, 8/72) said that the use of sex robots was not conceivable for them, and almost half of all therapists and physicians could imagine recommending sex robots in therapy (45%, 33/72). The attitude toward sex robots as a therapeutic tool was very heterogeneous, with gender (P=.006), age (P=.03), and occupational differences (P=.05); female therapists, older therapists, and psychologists (in contrast to physicians) were more critical toward the therapeutic use of sex robots. The analysis of the 5 interviews identified 3 high-level core themes that were representative of the participants’ responses: (1) the importance of the personal definition of sex robots for the assessment of their therapeutic benefits, (2) therapeutic benefits and dangers of sex robots, and (3) considerations on the quality of human-robot sexuality. Initial insights into the possible therapeutic use of sex robots in different disorders (eg, sexual dysfunction or pedophilia) and situations were gained from the perspective of sex therapists. Conclusions The results of this study provide a first overview of the potential therapeutic use of sex robots. Moral, ethical, and treatment-related issues in this context are still unresolved and need to be further researched. We suggest integrating the topic into the training of sex therapists to form opinions beyond media images and to show therapy possibilities. Scientists engaged in sexual research should be involved in the development of sex robots to design robots with positive effects on sexual education, sexual therapy, sexual counseling, and sexual well-being for interested groups.

‘You Can’t Dismiss that as Being Less Happy, You See it is Different’. Sexual Counselling in 1950s England

This article uses the audio recordings of sexual counselling sessions carried out by Dr Joan Malleson, a birth control activist and committed family planning doctor in the early 1950s, which are held at the Wellcome Library in London as a case study to explore the ways Malleson and the patients mobilised emotions for respectively managing sexual problems and expressing what they understood as constituting a ‘good sexuality’ in postwar Britain. The article contains two interrelated arguments. First, it argues that Malleson used a psychological framework to inform her clinical work. She resorted to an emotion-based therapy that linked sexual difficulties with unconscious, repressed feelings rooted in past events. In so doing, Malleson actively helped to produce a new form of sexual subjectivity where individuals were encouraged to express their feelings and emotions, breaking with the traditional culture of emotional control and restraint that characterized British society up until the fifties. Second, I argue that not only Malleson but also her patients relied on emotions. The performance of mainly negative emotions reveals what they perceived as the ‘normal’ and sexual ‘ideal’. Sexual therapy sessions reflected the seemingly changing nature of the self towards a more emotionally aware and open one that adopted both the language of emotions and that of popular psychology to articulate his or her sexual difficulties.

The Attitudes of Therapists and Physicians on the Use of Sex Robots in Sexual Therapy: Online Survey and Interview Study (Preprint)

BACKGROUND Various types of robots have already been successfully used in medical care, and the use of new technologies is also playing an increasing role in the area of sexuality. Sex robots are marketed as advanced sex toys and sex dolls with artificial intelligence. Only a few considerations about the therapeutic use of sex robots in sexual therapy are debated in expert discussions. OBJECTIVE The aim of this study was to conduct a first explorative survey on the attitudes of sex therapists and physicians toward the therapeutic benefits of sex robots. METHODS This study comprised a quantitative online survey and a qualitative interview study. A self-constructed questionnaire was used to survey the general attitudes of sex therapists and physicians regarding the benefits of sex robots in therapy. The qualitative study was designed to gain in-depth insight into the participants’ beliefs and attitudes. Therefore, semistructured interviews were conducted. The quantitative data were evaluated by statistical analysis, and the interviews were transcribed and analyzed by using a grounded theory approach. RESULTS A total of 72 sex therapists and physicians completed our self-constructed questionnaire (response rate 15%, 72/480). Only a few respondents (11%, 8/72) said that the use of sex robots was not conceivable for them, and almost half of all therapists and physicians could imagine recommending sex robots in therapy (45%, 33/72). The attitude toward sex robots as a therapeutic tool was very heterogeneous, with gender (P=.006), age (P=.03), and occupational differences (P=.05); female therapists, older therapists, and psychologists (in contrast to physicians) were more critical toward the therapeutic use of sex robots. The analysis of the 5 interviews identified 3 high-level core themes that were representative of the participants’ responses: (1) the importance of the personal definition of sex robots for the assessment of their therapeutic benefits, (2) therapeutic benefits and dangers of sex robots, and (3) considerations on the quality of human-robot sexuality. Initial insights into the possible therapeutic use of sex robots in different disorders (eg, sexual dysfunction or pedophilia) and situations were gained from the perspective of sex therapists. CONCLUSIONS The results of this study provide a first overview of the potential therapeutic use of sex robots. Moral, ethical, and treatment-related issues in this context are still unresolved and need to be further researched. We suggest integrating the topic into the training of sex therapists to form opinions beyond media images and to show therapy possibilities. Scientists engaged in sexual research should be involved in the development of sex robots to design robots with positive effects on sexual education, sexual therapy, sexual counseling, and sexual well-being for interested groups.

Epicureans on Marriage as Sexual Therapy

This paper argues that although Epicureans will never marry for love, they may find it therapeutic to marry for sex: Epicureans may marry in order to limit anxiety about securing a sexual partner if they are prone to such anxiety and if they believe their prospective partner will satisfy them sexually. The paper shows that Epicureans believe that the process of obtaining sex can be a major source of anxiety, that it is acceptable for the sage to marry under certain circumstances, and that the desire for sex alone is free of the groundless assumptions that fuel love. Epicureans would therefore approve of marrying to alleviate sexual anxiety.

Realizacja potrzeb seksualnych przez osoby niepełnosprawne: rzeczywistość — perspektywy — kontrowersje

The aim of this article is to examine how the sexuality of disabled persons is perceived by persons in their immediate surroundings (parents, caretakers, health professionals). The latter’s understanding of the question is one of the factors affecting how disabled persons define their needs and what possibility they will have of fulfilling them. On the basis of the literature on the subject, the author presents the findings of research concerning the satisfaction of sexual needs by persons with a physical or mental disability. She also indicates various ‘alternative’ methods of fulfilling these needs, such as sexual assistance, sexual therapy with a substitute partner (on the basis of the literature on the subject), and prostitution (on the basis of her own research). Consideration of the scientific and popular perspectives and the socially accepted or unaccepted manners by which disabled persons can satisfy their sexual needs makes it possible to determine to what degree these persons’ right to fulfill their sexual needs is realized in practice.

The Male Sexual Pain: Issues and Treatments

Objective: There are several kinds of male genital pain which can cause mental suffering. Usually, they emerge during ordinary urological or andrological examinations. These distresses, sine materia, can be divided into different groups. Design and Method: The first group, which is the most frequent one, mainly affects the testicles; usually, this kind of distress last all life and it is often associated with surgery and/or frequent examinations to the genitals during childhood. The second group encompasses cases of real penodinia: the patients express their discomfort especially uncovering the glan and, for this reason, this action is never done. This distress is not always referred to as pain, but more often as bothersome. Sexual intercourses are permitted. Often the patients undergo a circumcision that usually has a complicated postoperative course. The males of the third group correspond to the women suffering from vaginismus. The patients do not even tolerate the approach of the hand to the penis and they make the same actions and the same movements as the vaginismic women. The patients are unable to have sex. This phenomenon is rare. In a perspective of multi-disciplinary and integrated methodology, the patients were treated with traditional surgery and/or with administration of drugs and/or with sexual therapy according with the integrated Kaplan method and/or with techniques for the rehabilitation of the pelvic floor. Results: Some clinical cases will be presented and discussed. Conclusions: The Authors describe new categories of male genital pain, never defined before, similar to Vulvodynia or Vaginism in women.