Koops Thula U, Uhlenbusch Natalie, Löwe Bernd, Härter Martin, Harth Volker, Briken Peer
Institute for Sex Research, Sexual Medicine, and Forensic Psychiatry, University Medical Centre Hamburg-Eppendorf, Hamburg 20246, Germany.
Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre Hamburg-Eppendorf, Hamburg 20246, Germany.
J Sex Med. 2024 Dec 1;21(12):1144-1151. doi: 10.1093/jsxmed/qdae113.
Symptoms of sexual dysfunction and somatic symptom disorder may resemble each other in their presentation as lasting and distressing alterations of expected bodily "functioning"; their co-occurrence has not yet been studied in nonclinical settings or by DSM-5 criteria (Diagnostic and Statistical Manual of Mental Disorders, fifth edition).
To investigate (1) the association of indicators consistent with DSM-5 sexual dysfunction and somatic symptom disorder diagnoses, (2) whether individuals with different sexual dysfunction diagnoses differ in somatic symptoms and their perception, and (3) whether distress from sexual difficulties is related to somatic symptoms and symptom perception.
We examined links among sexual dysfunctions/distress from sexual difficulties (Brief Questionnaire on Sexuality), somatic symptom severity (Patient Health Questionnaire-15 [PHQ-15]), and symptom perception (Somatic Symptom Disorder-B Criteria Scale) in 9333 participants of the Hamburg City Health Study aged 45 to 74 years. For a sensitivity analysis, we repeated all analyses after excluding an item on sexual difficulties from the PHQ-15 score.
Outcomes included scores on the Brief Questionnaire on Sexuality indicating sexual difficulties and dysfunction according to DSM-5, PHQ-15 for somatic symptom severity, and Somatic Symptom Disorder-B Criteria Scale for symptom perception.
Indicators consistent with DSM-5 sexual dysfunction and somatic symptom disorder diagnoses were linked (P = .24) before the sensitivity analysis but not after. Individuals with different sexual dysfunction diagnoses did not differ in their somatic symptom severity or their symptom perception. Distress from sexual difficulties was weakly correlated with somatic symptom severity (after sensitivity analysis: ρ = .19, P = .01) and symptom perception (ρ = .21, P = .01). Both correlations were stronger for men than for women.
Our results convey that it is worth exploring sexual difficulties and somatic symptom disorder in patients presenting with either complaint but also that sexual difficulties should still be regarded as an independent phenomenon.
Our sample consisted of participants from one metropolitan region who were >45 years of age and thus does not demographically represent the general population. Assessing via self-report questionnaires may have influenced the reporting of symptoms, as may have prevailing shame around experiencing sexual dysfunction. The final sample size was reduced by missing values from some questionnaires. Despite these limitations, sample sizes for all analyses were large and offer meaningful new observations on the subject.
Our data suggest that indicators for sexual dysfunction and somatic symptom disorder somewhat overlap but still represent distinct phenomena and should be treated accordingly in research and clinical practice.
性功能障碍和躯体症状障碍的症状在表现上可能相似，均为预期身体“功能”的持续且令人痛苦的改变；它们的共现情况尚未在非临床环境中或根据《精神疾病诊断与统计手册》第五版（DSM - 5）标准进行研究。
调查（1）与DSM - 5性功能障碍和躯体症状障碍诊断一致的指标之间的关联；（2）不同性功能障碍诊断的个体在躯体症状及其认知方面是否存在差异；（3）性困难带来的痛苦是否与躯体症状及症状认知相关。
我们在汉堡市健康研究的9333名年龄在45至74岁的参与者中，研究了性功能障碍/性困难带来的痛苦（性简短问卷）、躯体症状严重程度（患者健康问卷 - 15 [PHQ - 15]）和症状认知（躯体症状障碍 - B标准量表）之间的联系。为进行敏感性分析，我们在从PHQ - 15评分中排除一项性困难项目后，重复了所有分析。
在敏感性分析之前，与DSM - 5性功能障碍和躯体症状障碍诊断一致的指标存在关联（P = 0.24），但之后则无关联。不同性功能障碍诊断的个体在躯体症状严重程度或症状认知方面没有差异。性困难带来的痛苦与躯体症状严重程度（敏感性分析后：ρ = 0.19，P = 0.01）和症状认知（ρ = 0.21，P = 0.01）呈弱相关。两种相关性在男性中均比女性更强。
我们的结果表明，对于出现这两种主诉之一的患者，探索性困难和躯体症状障碍是值得的，但性困难仍应被视为一种独立现象。
我们的样本由来自一个大都市地区、年龄大于45岁的参与者组成，因此在人口统计学上不能代表一般人群。通过自我报告问卷进行评估可能影响了症状报告，经历性功能障碍时普遍存在的羞耻感也可能有影响。一些问卷的缺失值减少了最终样本量。尽管有这些局限性，但所有分析的样本量都很大，并提供了关于该主题有意义的新观察结果。
我们的数据表明，性功能障碍和躯体症状障碍的指标有所重叠，但仍代表不同现象，在研究和临床实践中应相应地进行处理。
