Brotto Lori A, Basson Rosemary, Luria Mijal
University of British Columbia, Vancouver, British Columbia, Canada.
J Sex Med. 2008 Jul;5(7):1646-59. doi: 10.1111/j.1743-6109.2008.00850.x.
Despite their widespread prevalence, there are no existing evidence-based psychological treatments for women with sexual desire and arousal disorder. Mindfulness, the practice of relaxed wakefulness, is an ancient eastern practice with roots in Buddhist meditation which has been found to be an effective component of psychological treatments for numerous psychiatric and medical illnesses. In recent years, mindfulness has been incorporated into sex therapy and has been found effective for genital arousal disorder among women with acquired sexual complaints secondary to gynecologic cancer.
The aim of this study was to adapt an existing mindfulness-based psychoeducation (PED) to a group format for women with sexual desire/interest disorder and/or sexual arousal disorders unrelated to cancer.
Twenty-six women participated in three 90-minute sessions, spaced 2 weeks apart, with four to six other women. Group PED was administered by one mental health trained provider and one gynecologist with post graduate training and experience in sexual medicine.
Prior to and following the group, women viewed audiovisual erotic stimuli and had both physiological (vaginal pulse amplitude) and subjective sexual arousal assessed. Additionally, they completed self-report questionnaires of sexual response, sexual distress, mood, and relationship satisfaction.
There was a significant beneficial effect of the group PED on sexual desire and sexual distress. Also, we found a positive effect on self-assessed genital wetness despite little or no change in actual physiological arousal, and a marginally significant improvement in subjective and self-reported physical arousal during an erotic stimulus. A follow-up comparison of women with and without a sexual abuse history revealed that women with a sexual abuse history improved significantly more than those without such history on mental sexual excitement, genital tingling/throbbing, arousal, overall sexual function, sexual distress, and on negative affect while viewing the erotic film. Moreover, there was a trend for greater improvement on depression scores among those with a sexual abuse history.
These data provide preliminary support for a brief, three-session group psychoeducational intervention for women with sexual desire and arousal complaints. Specifically, women with a history of sexual abuse improved more than women without such a history. Participant feedback indicated that mindfulness was the most effective component of the treatment, in line with prior findings. However, future compartmentalization trials are necessary in order to conclude this more definitively.
尽管性欲和性唤起障碍在女性中普遍存在，但目前尚无基于证据的心理治疗方法。正念，即放松清醒状态的练习，是一种源于佛教冥想的古老东方修行方式，已被发现是多种精神疾病和医学疾病心理治疗的有效组成部分。近年来，正念已被纳入性治疗，并被发现对继发于妇科癌症的后天性性问题的女性的生殖器唤起障碍有效。
本研究的目的是将现有的基于正念的心理教育（PED）调整为针对患有性欲/兴趣障碍和/或与癌症无关的性唤起障碍的女性的团体形式。
26名女性与另外四至六名女性一起参加了三次90分钟的课程，课程间隔为两周。团体PED由一名接受过心理健康培训的提供者和一名具有性医学研究生培训和经验的妇科医生进行。
在团体课程之前和之后，女性观看视听色情刺激，并对生理（阴道脉搏幅度）和主观性唤起进行评估。此外，她们还完成了关于性反应、性困扰、情绪和关系满意度的自我报告问卷。
团体PED对性欲和性困扰有显著的有益影响。此外，我们发现尽管实际生理唤起几乎没有变化，但对自我评估的生殖器湿润有积极影响，并且在色情刺激期间主观和自我报告的身体唤起有轻微显著改善。对有和没有性虐待史的女性的随访比较显示，有性虐待史的女性在精神性兴奋、生殖器刺痛/悸动、唤起、总体性功能、性困扰以及观看色情电影时的负面影响方面的改善明显超过没有此类病史的女性。此外，有性虐待史的女性在抑郁评分上有更大改善的趋势。
这些数据为针对患有性欲和性唤起问题的女性的简短的、三节课的团体心理教育干预提供了初步支持。具体而言，有性虐待史的女性比没有此类病史的女性改善更多。参与者反馈表明，正念是治疗中最有效的组成部分，这与先前的研究结果一致。然而，未来需要进行更多的分组试验才能更明确地得出结论。
