Titel Deelnemers "Korte inhoud" "Dyadic Sexual Communication in Pre-Menopausal Women with Self-Reported Dyspareunia and Their Partners: Associations with Sexual Function, Sexual Distress and Dyadic Adjustment" "Elizabeth Pazmany, Johan Verhaeghe, Lukas Van Oudenhove, Paul Enzlin" "While there is increasing interest in studying aspects of communication processes in sex research, the association between dyadic sexual communication and relationship and sexuality outcomes has not yet been examined in pre-menopausal women with dyspareunia." "The Sexual Adjustment Process of Cancer Patients and Their Partners: A Qualitative Evidence Synthesis" "Charlotte Benoot, Marlies Saelaert, Karen Hannes, Johan Bilsen" "When confronted with cancer, a prominent challenge for patients and their partners is their changed sexual relationship. An empirically based theoretical model of the sexual adaptation process during cancer might be helpful in guiding the development of adequate interventions for couples who struggle with their sexual relationship. Therefore, the purpose of this study was to synthesize evidence from primary qualitative research studies and to arrive at a detailed description of the process of sexual adjustment during cancer. We conducted a qualitative evidence synthesis of a purposeful sample of 16 qualitative papers, using the meta-ethnography approach to synthesis. We found that the subsequent studies used different theoretical approaches to describe the sexual adaptation process. This led to three divergent sexual adaptation processes: (1) the pathway of grief and mourning, depicting sexual changes as a loss; (2) the pathway of restructuring, depicting the adjustment process toward sexual changes as a cognitive process with a strong focus on the social and cultural forces that shape the values and experiences of sexuality; and (3) the pathway of sexual rehabilitation, depicting sexual changes as a bodily dysfunction that needs treatment and specific behavioral strategies. All three pathways have their own opportunities and challenges. A greater awareness of these different pathways could help healthcare providers to better understand the ways a particular couple might cope with changed sexuality, offering them opportunities to discover alternative pathways for sexual adjustment." "The use of purposeful sampling in a qualitative evidence synthesis: A worked example on sexual adjustment to a cancer trajectory" "Charlotte Benoot" "Background An increasing number of qualitative evidence syntheses papers are found in health care literature. Many of these syntheses use a strictly exhaustive search strategy to collect articles, mirroring the standard template developed by major review organizations such as the Cochrane and Campbell Collaboration. The hegemonic idea behind it is that non-comprehensive samples in systematic reviews may introduce selection bias. However, exhaustive sampling in a qualitative evidence synthesis has been questioned, and a more purposeful way of sampling papers has been proposed as an alternative, although there is a lack of transparency on how these purposeful sampling strategies might be applied to a qualitative evidence synthesis. We discuss in our paper why and how we used purposeful sampling in a qualitative evidence synthesis about ‘sexual adjustment to a cancer trajectory’, by giving a worked example. Methods We have chosen a mixed purposeful sampling, combining three different strategies that we considered the most consistent with our research purpose: intensity sampling, maximum variation sampling and confirming/disconfirming case sampling. Results The concept of purposeful sampling on the meta-level could not readily been borrowed from the logic applied in basic research projects. It also demands a considerable amount of flexibility, and is labour-intensive, which goes against the argument of many authors that using purposeful sampling provides a pragmatic solution or a short cut for researchers, compared with exhaustive sampling. Opportunities of purposeful sampling were the possible inclusion of new perspectives to the line-of-argument and the enhancement of the theoretical diversity of the papers being included, which could make the results more conceptually aligned with the synthesis purpose. Conclusions This paper helps researchers to make decisions related to purposeful sampling in a more systematic and transparent way. Future research could confirm or disconfirm the hypothesis of conceptual enhancement by comparing the findings of a purposefully sampled qualitative evidence synthesis with those drawing on an exhaustive sample of the literature." "Sexual Communication, Dyadic Adjustment, and Psychosexual Well-Being in Premenopausal Women with Self-Reported Dyspareunia and Their Partners: A Controlled Study" "Elizabeth Pazmany, Johan Verhaeghe, Lukas Van Oudenhove, Paul Enzlin" "Although research that takes into account partner and relationship factors in dyspareunia is slowly emerging, little is known about how these couples communicate about their sexuality. Additionally, partner psychosexual adjustment has not been examined in a controlled fashion." "Timing of female sexual unreceptivity and male adjustment of copulatory behaviour under competition risk in the wolf spider **Schizocosa malitiosa**" "Anita Aisenberg, Natalia Estramil, Carlos Toscano-Gadea, Macarena González" "Males can change their copulatory or sperm transfer patterns in response to sperm competition risk. Schizocosa malitiosa performs long copulations, which include two consecutive patterns (Patterns 1 and 2). Virgin females are very sexually receptive, but mated females diminish their receptiveness. Female unreceptivity has been attributed to the action of receptivity-inhibiting substances, mainly transferred during Pattern 1. We tested: (1) if females who mated only with Pattern 1 were immediately unreceptive; (2) male and female behaviours when the copulating couple was exposed to another male. For (1), we interrupted mating when Pattern 1 finished and immediately exposed the female to a second male. For (2), we introduced a second male when the couple was starting (Ei) or finishing copulation (Li). Females were unreceptive immediately after finishing Pattern 1. Males from Ei and Li dismounted and approached the second males. Ei males diminished the frequencies of insertion after perceiving the presence of a second male and dismounted less frequently when copulating with heavy females. The study provides insights about the timing of sexual unreceptivity in S. malitiosa under possibilities of sperm competition, discussing male adjustment of copulatory behaviour in the presence of rival males." "Sexual dysfunctions: what's distress got to do with it? A study on sexual difficulties, sexual dysfunctions and sexual distress: prevalence and associated factors" "Lies Hendrickx" "Sexual difficulties, i.e., impairments in one or more aspects of the sexual response cycle, i.e., sexual desire, sexual arousal, orgasm or pain, are common in men and women. Epidemiological studies suggest that about 40-50% of adult women and about 20-30% of adult men have at least one sexual difficulty (Fugl-Meyer et al., 2010; Hayes & Dennerstein, 2005; Lewis et al., 2010). For a sexual difficulty to become a sexual dysfunction, the sexual difficulty has to cause marked distress or interpersonal difficulty (American Psychiatric Association (APA), 1994; 2000; 2013). Research focusing on sexual difficulties and sexual dysfunctions is characterized by two major limitations (see Chapter 1). First, most epidemiological studies were based on the traditional model of the human sexual response cycle (Masters & Johnson, 1966; Kaplan, 1979) which was also the main framework for the conceptualization of sexual dysfunctions in the Diagnostic and Statistical Manual of Mental Disorders (DSM; American Psychiatric Association). This traditional model has, however, progressively received more and more critiques during the last two decades (for reviews, Levin, 2005; Pfaus et al., 2014; Tiefer, 1991; 2012). Nevertheless, alternative diagnostic categories such as hyperactive sexual desire, a lack of responsive sexual desire, a lack of subjective arousal have not yet been empirically assessed. Second, although since the fourth edition of the Diagnostic and Statistical Manual of Mental Disorder (DSM-IV; APA, 1994), stipulated that distress is a necessary criterion for a diagnosis of a sexual dysfunction, empirical studies have typically not included a measurement of sexual distress when assessing sexual difficulties. As a consequence, epidemiological data on sexual dysfunctions as well as studies assessing factors associated with sexual distress are still relatively scarce. The fact that sexual distress has consistently been neglected in empirical studies on sexual difficulties could be partly due to the fact that the inclusion of a distress-criterion in the diagnostic criteria to define sexual dysfunctions in DSM has been disputed ever since its first inclusion in DSM-IV. Therefore, our first aim was to critically review the meaning, importance and role of distress as a criterion for a diagnosis of a sexual dysfunction according to the DSM (Chapter 2). Secondly, the present dissertation was initiated to gain empirical insight into sexual difficulties, sexual dysfunctions, and sexual distress (Chapters 3 7). Therefore, (age-related) prevalence rates of sexual difficulties (including uncommonly assessed difficulties), sexual dysfunctions, and sexual distress were generated from a representative population-based study in Flanders (Sexpert-study, N = 1,832) and from an online survey with Flemish men and women (OGOM-study, N = 30,378). Furthermore, we aimed at enhancing our understanding about factors associated with sexual distress in women with a sexual difficulty (Sexpert-study). In Chapter 2, we provided a historical review and evaluation of the arguments used in the debate about the necessity to in- or exclude sexual distress as a diagnostic criterion for a diagnosis of sexual dysfunction in the DSM. We concluded that the protagonists in the debate do not agree on the necessity of the distress criterion because they differ in their view on the essence and utility of a diagnosis. While according to the proponents of an objective approach a diagnosis should be neutral and based on objectively measurably criteria, the proponents of a functional approach stress that a diagnosis should enable us to detect clinically meaningful sexual dysfunctions and that the experience of distress is just what is helping to separate those with and without a need for treatment. We concluded that this debate cannot be solved based on empirical data only, but that it is first and foremost a philosophical matter about what a diagnosis exactly is. The debate has become and will remain probably endless, until the American Psychiatric Association will be more explicit as to what meaning they ascribe to a diagnosis of a sexual dysfunction in DSM. In Chapters 3 and 4, prevalence estimates of commonly and uncommonly assessed sexual difficulties and sexual dysfunctions were presented. In the Sexpert-study (Chapter 3), 44% of women and 35% of men had at least one sexual difficulty, while 22% of women and 12% of men were classified with at least one sexual dysfunction. In the OGOM-study (Chapter 4), 49% of women and 48% of men were classified with a sexual difficulty, and 24% of women and 21% of men were classified with a sexual dysfunction. In both studies, the most prevalent sexual difficulties/dysfunctions in women were lack of spontaneous sexual desire (16-21% for the sexual difficulty; 9-10% for the sexual dysfunction) responsive sexual desire (11-14% for the sexual difficulty, 8-9% for the sexual dysfunction), absent or delayed orgasm (17-19% and 6-7%), lubrication difficulties (13-15% for the sexual difficulty, 8-9% for the sexual dysfunction), and lack of subjective arousal (7-11% for the sexual difficulty, 5-7% for the sexual dysfunction). In men, most common sexual difficulties/dysfunctions were hyperactive sexual desire (13-27% for the sexual difficulty, 3-10% for the sexual dysfunction), erectile difficulties (8-9% for the sexual difficulty, 4-5% for the sexual dysfunction), and premature ejaculation (9-12% for the sexual difficulty, 4-6% for the sexual dysfunction). Overall, the present study revealed that prevalence estimates of sexual difficulties and sexual dysfunctions seemed to vary extensively depending on the criteria used to define them. That is also why prevalence rates vary extensively across studies and why comparison of prevalence estimates from different studies is a hazardous undertaking. Our studies revealed that especially using more stringent severity criteria to define sexual difficulties (i.e., not including mild impairment in sexual difficulties) and including an assessment of sexual distress seemed to have a pronounced impact on prevalence rates. Since it is unknown which criteria and cut-offs in questionnaire research are useful to identify real (diagnoses and clinically relevant) sexual dysfunctions, we cannot be sure whether the prevalence estimates we found here approximate real prevalence rates of real sexual dysfunctions. Future research should further explore this weakness.In Chapter 3, besides prevalence rates, also co-occurrence rates between lack of sexual desire and lack of sexual arousal in men and women were analyzed (OGOM-study). In women, co-occurrence between lack of desire and lack of arousal was generally quite high (mostly between 45% to 53% for sexual difficulties, and 29% to 49% for sexual dysfunctions). However, despite high co-occurrence rates, more women had a desire dysfunction without an arousal dysfunction than a combined desire/arousal dysfunction. In men, co-occurrence rates were somewhat lower than in women though co-occurrence between lack of subjective arousal and lack of desire was relatively high (between 30.4% to 49.5% for sexual difficulties, and 26.6% to 43.0% for sexual dysfunctions). Especially erectile difficulties/dysfunctions displayed lower co-occurrence with lack of sexual desire (between 18.5% and 19.2% for sexual difficulties and between 13.4% and 17.9% for sexual dysfunctions). Taken together, although prevalence rates suggest that desire dysfunctions and arousal dysfunctions are commonly occurring independent, the high co-occurrence rates also suggest that desire and arousal difficulties/dysfunctions in men and women are closely related. These findings challenge the traditional ideas about the differences between men´s and women´s sexuality.Chapters 5 and 6 presented an overview of the age-related prevalence rates of commonly and uncommonly assessed sexual difficulties, sexual dysfunctions and sexual distress in men and women (OGOM-study). For women, our findings indicated that while most sexual difficulties increased with age or displayed a U-shaped pattern with age, for most sexual difficulties it was found that older women were less likely to report sexual distress. For men, our findings also indicated that sexual difficulties and sexual distress could be differently related to age (e.g., erectile difficulties increased with age, while distress associated with erectile difficulties decreased with age). As demonstrated by the curvilinear associations of sexual difficulties and sexual dysfunctions with age found in the current study, it becomes clear that the link between age and sexual difficulties, sexual dysfunctions and distress is complex and yet not well-understood.The focus of chapter 7 was on the association of sexual distress with the propensity for sexual inhibition and sexual excitation in women (based on data of the Sexpert-survey). The findings suggest that sexual inhibition due to threat of performance failure is an important predictor of sexual distress in low sexual desire and arousal (apart from lubrication difficulties) above and beyond age, mental health, relationship adjustment, dyadic sexual communication, and the severity of the sexual impairment. Since this study was exploratory in nature, the present results need to be replicated in future research. Furthermore, establishing more knowledge on factors related to sexual distress due to impairments in sexual functioning is important because it might have important implications for clinical work.Finally, in Chapter 8 we concluded that the results of the current dissertation have increased our awareness of importance of a correct interpretation of prevalence rates of sexual dysfunctions. The current findings clearly indicate that prevalence rates of sexual difficulties in which distress is not taken into account should be interpreted with caution, as these will inflate our idea about the number of people for whom sexual difficulties are possibly a health concern. We also conclude that the results in the current dissertation have increased our preliminary insight into factors associated with sexual distress in women, though it is clear that research on sexual distress is in need of a theoretical framework that could guide and inspire studies focusing on possible predisposing and precipitating risk factors of sexual distress due to sexual difficulties in both men and women. In this final chapter, we further discussed several implications of the results of our studies, described the strengths and limitations of our studies and made a number of suggestions to inspire future research in this interesting but understudied and unresolved field. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.Fugl-Meyer,K. S., Lewis, R. W.,Corona, G.,Hayes,R.D., Laumann, E. O.,Moreira,E.D., . . . Segraves,T. (2010). Definitions, classification, and epidemiology of sexual dysfunction. In F.Montorsi, R. Basson, G. Adaikan, E. Becher, A. Clayton, F. Giuliano, S. Khoury, & F. Sharlip (Eds.), Sexual medicine: Sexual dysfunctions in men and women (pp. 41117). Paris, France: Health Publications.Hayes, R.D, & Dennerstein, L. (2005). The Impact of Aging on Sexual Function and Sexual Dysfunction in Women: A Review of Population‐Based Studies. The Journal of Sexual Medicine, 2, 317330.Kaplan, H. S. (1979). Disorders of sexual desire. The new sex therapy. Volume II. New York: Brunner/Mazel.Levin, R. J. (2005). Sexual arousal: Its physiological role in human production. Annual Review of Sex Research, 16, 154189.Lewis, R. W., Fugl‐Meyer, K. S., Corona, G., Hayes, R. D., Laumann, E. O., Moreira Jr, E. D., ... & Segraves, T. (2010). Original articles: definitions/epidemiology/risk factors for sexual dysfunction. The Journal of Sexual Medicine, 7, 1598-1607.Masters, W. H., & Johnson, V. E. (1966). Human sexual response. Boston: Little, Brown.Pfaus, J. G., Scepkowski, L. A., Marson, L., & Georgiadis, J. R. (2014). Biology of the sexual response. In: D. L. Tolman, & L. M. Diamond (Eds.). APA Handbook of sexuality and psychology. Volume 1: Person-based approaches (pp.145-203). Washington: American Psychological Association.Tiefer, L. (1991). Historical, scientific, clinical and feminist criticisms of the human sexual response cycle model. Annual Review of Sex Research, 2, 123.Tiefer, L. (2012).The New View campaign: A feminist critique of sex therapy and an alternative vision. In: P. K. Kleinplatz (Ed.). New directions in sex therapy (2nd ed., pp.21-35). London: Routledge." "Genetics of decayed sexual traits in a parasitoid wasp with endosymbiont-induced asexuality" "Wen-Juan Ma" "Trait decay may occur when selective pressures shift, owing to changes in environment or life style, rendering formerly adaptive traits non-functional or even maladaptive. It remains largely unknown if such decay would stem from multiple mutations with small effects or rather involve few loci with major phenotypic effects. Here, we investigate the decay of female sexual traits, and the genetic causes thereof, in a transition from haplodiploid sexual reproduction to endosymbiont-induced asexual reproduction in the parasitoid wasp Asobara japonica. We take advantage of the fact that asexual females cured of their endosymbionts produce sons instead of daughters, and that these sons can be crossed with sexual females. By combining behavioral experiments with crosses designed to introgress alleles from the asexual into the sexual genome, we found that sexual attractiveness, mating, egg fertilization and plastic adjustment of offspring sex ratio (in response to variation in local mate competition) are decayed in asexual A. japonica females. Furthermore, introgression experiments revealed that the propensity for cured asexual females to produce only sons (because of decayed sexual attractiveness, mating behavior and/or egg fertilization) is likely caused by recessive genetic effects at a single locus. Recessive effects were also found to cause decay of plastic sex-ratio adjustment under variable levels of local mate competition. Our results suggest that few recessive mutations drive decay of female sexual traits, at least in asexual species deriving from haplodiploid sexual ancestors." "Psychologic, Relational, and Sexual Functioning in Women After Surgical Treatment of Vulvar Malignancy: A Prospective Controlled Study" "Leen Aerts, Paul Enzlin, Johan Verhaeghe, Ignace Vergote, Frédéric Amant" "OBJECTIVE: Vulvectomy for vulvar malignancy can affect sexual functioning based on anatomic, physiologic, psychologic, and relational mechanisms. The aims of this study were to prospectively investigate sexual adjustment of women with vulvar malignancy during a follow-up period of 1 year after vulvectomy and to compare the results with healthy control women. METHODS: In this prospective controlled study, participants completed the Beck Depression Inventory scale, World Health Organization-5 Well-being scale, Dyadic Adjustment Scale, Short Sexual Functioning Scale, and Specific Sexual Problems Questionnaire to assess various aspects of psychosocial and sexual functioning just before surgery, 6 months, and 1 year after treatment. RESULTS: Twenty-nine women with vulvar malignancy and 29 healthy controls completed the survey. Compared with the presurgery status, no significant differences were found in psychologic, relational, and sexual functioning in women after surgery for vulvar malignancy. Compared with healthy control women, women with vulvar malignancy reported significantly lower psychologic well-being and quality of partner relationship, both before and after treatment. Moreover, significantly more patients with vulvar malignancy reported preoperative and postoperatively sexual dysfunctions than healthy controls, including entry and deep dyspareunia, abdominal pain during intercourse, reduced ability to achieve orgasm, and reduced intensity of orgasm. CONCLUSIONS: This prospective study yielded no differences in psychosocial and sexual functioning for women with vulvar malignancy before and after vulvectomy. However, when compared with healthy controls, patients with vulvar malignancy are at high risk for sexual dysfunctions, both before and after surgical treatment." "Sexual Functioning in Women Using Levonorgestrel-Releasing Intrauterine Systems as Compared to Copper Intrauterine Devices" "Paul Enzlin, Willy Poppe, Elizabeth Pazmany, Els Elaut" "Introduction.  There has been little research published on the impact of intrauterine contraceptive (IUC) methods on sexual functioning. Aims.  This study aimed: (i) to assess different aspects of sexual functioning, including the prevalence of sexual dysfunction in women using a levonorgestrel intrauterine system (LNG-IUS); (ii) to compare this prevalence with that among copper-releasing intrauterine device (Cu-IUD) users; and (iii) to identify the relationship between psychological variables and sexual functioning in women using one of the aforementioned IUCs. Methods.  In a multicenter cross-sectional study, 845 women with an IUC were invited to fill out a questionnaire. The latter was returned by 402 (48%) of them: 353 women were LNG-IUS users (88%) and 49 were Cu-IUD users (12%). The questions asked pertained to depression, well-being, marital relation quality, and sexual functioning. Main Outcome Measures.  Sexual functioning was measured with the Short Sexual Functioning Scale. Results.  One-third of LNG-IUS users (33%) reported a sexual dysfunction. Of those, 20% reported an increased sexual desire, 25% a decreased sexual desire, 5% arousal problems, and 8% orgasm problems. Women using a LNG-IUS did not differ significantly in distribution, type, or prevalence (32.9% vs. 36.7%) of sexual dysfunction, nor in depressive symptoms (Beck Depression Inventory score; 4.7 vs. 3.9; P = 0.33), general well-being (WHO-5 well-being scale score; 16.8 vs. 17.7; P = 0.170), or partner relationship quality (Dyadic Adjustment Scale score; 107 vs. 108; P = 0.74) compared to Cu-IUD users. Overall, the perceived influence of IUCs on sexual functioning was in the lower range and did not differentiate LNG-IUS greatly from Cu-IUD-users. Conclusion.  Women using a LNG-IUS do not differ from those wearing a Cu-IUD with regard to psychological and sexual functioning. The perceived impact of IUD use on sexuality should not be overestimated. Enzlin P, Weyers S, Janssens D, Poppe W, Eelen C, Pazmany E, Elaut E, and Amy J-J. Sexual functioning in women using levonorgestrel-releasing intrauterine systems as compared to copper intrauterine devices. J Sex Med **;**:**-**." "Sexual Functioning in Long-Term Survivors of Hematopoietic Cell Transplantation" "Hélène Schoemans" "This investigation characterized sexual activity and sexual function in hematopoietic cell transplantation (HCT) survivors, compared them with norms, and examined factors associated with sexual dysfunction, with the goal of identifying targets for intervention to improve sexual health. Surviving adults from a large transplantation center were asked to complete an annual survey with a core of health questions and a module on sexual activity and function. Participants completed the Sexual Function Questionnaire, Cancer and Treatment Distress form, and Revised Dyadic Adjustment Scale. Clinical data were collected from the transplantation medical database. Multivariate logistic regressions identified factors associated with sexual activity and function. Participating survivors (n = 1742) were a mean of 11.9 years (range, .4 to 43.1 years) after HCT, mean age 57.6 years, and 53% male. Women were more likely than men to report being sexually inactive in the past year (39% versus 27%) and, among those sexually active, to report low sexual function (64% versus 32%). Male and female survivors reported lower rates of sexual activity and function than comparison norms (all P < .01). In regressions, factors associated with being sexually inactive included older age, having"