Introduction to special issue on women’s sexuality and outline of assessment of sexual problems
Introduction to special issue on women’s sexuality and outline of assessment of sexual problems
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女性性特刊简介及性问题评估大纲
DOI：
10.1097/01.gme.0000138543.73541.4a
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发表时间：
2004
期刊：
影响因子：
2.7
通讯作者：
R. Basson
中科院分区：
文献类型：
--
作者：
R. Basson
鉴于普遍存在对妇女造成中度或严重痛苦的性困难，欢迎出版一期关于围绝经期和绝经后妇女性行为的特别期刊。性问题是及时的，因为目前我们对女性性反应的概念化以及对其生物学和心理学基础的研究发生了变化。通过对心理问题如何影响身体在许多其他医学领域的生理反应的理解，我们可以摒弃以前的观念，即性困难要么是生物的，要么是有机的，要么是心理的。因此，在评估和管理患者的性健康时，对这两个领域的了解是必要的。尽管研究表明，大约30%的女性几乎没有性欲，但重要的是要注意到，如果将女性未得到满足的性需求(无论是身体上的、情感上的、背景上的)项目包括在内，报告的比例相当相似。这两者联系在一起的可能性很高。目前正在评估妇女缺乏性快感和满足感，从而导致性困扰的原因。最近，一项对987名美国女性进行的全国性概率抽样研究得出结论，最能预报性苦恼的是女性的总体情绪幸福感，以及她们在性生活过程中对伴侣的情感亲密感。她的身体反应有多好或多可靠，预测价值要小得多。Hartmann等人在本期杂志上提供了更多支持老年女性这一概念的经验数据。越来越多的数据证实，女性煽动或同意与伴侣发生性行为有几个原因。在任何给定的经历开始时，意识到性欲的情况都很少见。然而，马斯特斯、约翰逊和卡普兰的传统人类性反应周期表明，女性必须从性欲望的意识开始性体验，随后是性唤起、性高潮和决心。现在，这被认为是对妇女经历的有限且往往不准确的描述。已经描述了一种不同的模式来帮助评估和管理女性的性困难。除了这一新的概念外，对女性性功能障碍的定义也在不断修订。不幸的是，无论是美国精神病学协会内负责《精神疾病诊断和统计手册》的委员会，还是国际疾病和相关健康问题统计分类委员会，都没有计划在不久的将来解决迫切需要修订其对女性性功能障碍的官方定义的问题。第一篇文章概述了对女性性反应的另一种概念化和对功能障碍的修订定义。女性的性唤醒比医疗环境中通常关注的一个组成部分要大得多，也更复杂：阴道毛细血管间质液体增加，穿过阴道上皮进入其管腔，即随性刺激而增加润滑性的现象。Van Lumsen和Laan在本期的综述中概述了在雌激素耗尽的情况下，只要有足够的刺激和主观性唤起，这种情况仍然可以以令人满意的方式发生。在过去25年的心理生理学研究中，已经证明了唤醒的主观体验的重要性。主题之间经常缺乏相关性2004年4月23日接受；2004年6月17日接受。
A special journal issue on women’s sexuality in perimenopause and postmenopause is welcome, given the prevalence of sexual difficulties that create moderate or severe distress to women. The sexuality issue is timely because of the current changes in our conceptualization of women’s sexual response and research into its biologic as well as psychologic underpinnings. An appreciation of how matters of the mind can influence the physical responses of the body in many other areas of medicine allows us to discard the former concept that sexual difficulties are either biologic and organic or psychologic. Thus, an understanding of both areas is necessary in the assessment and management of our patients’ sexual health. Although studies suggest that some 30% of women experience little sexual desire, it is important to note that when items regarding women’s unmet sexual needs (be they physical, emotional, contextual) are included, rather similar percentages are reported. That the two are connected is highly possible. The reasons underlying women’s lack of sexual enjoyment and satisfaction, leading to sexual distress, are currently being evaluated. A recent study of a national probability sample of 987 American women concluded that the best predictors of sexual distress were a woman’s general emotional well-being and her feelings of emotional closeness to her partner during their sexual experience. How well or reliably her body responded had far less predictive value. Further empirical data supporting this concept in older women is given by Hartmann et al in this journal issue. Increasing data confirm that women instigate or agree to sexual activity with their partners for several reasons. Awareness of sexual desire at the outset of any given experience is infrequent. However, the traditional human sex response cycle of Masters, Johnson, and Kaplan indicates that women necessarily begin a sexual experience with an awareness of sexual desire, which is followed by arousal and by orgasm and resolution. This is now recognized as a limited and often inaccurate portrayal of women’s experience. A different model has been described to aid the assessment and management of women’s sexual difficulties. Alongside this new conceptualization, there are ongoing revisions of the definitions of women’s sexual dysfunction. Unfortunately, neither the committee responsible for the Diagnostic and Statistical Manual of Mental Disorders within the American Psychiatric Association, nor the International Statistical Classification of Disease and Related Health Problems Committee, has plans in the near future to address the urgent need to revise their official definitions of women’s sexual dysfunction. Both the alternative conceptualization of women’s sexual response and the revised definitions of dysfunction are outlined in the first article. Women’s sexual arousal is something much larger and more complex than the one component usually focused on in medical settings: the increase in interstitial fluid from vaginal capillaries moving across the vaginal epithelium onto its lumen, ie, the phenomenon of increased lubrication with sexual stimulation. That this can occur in a satisfactory manner despite estrogen depletion, provided there is sufficient stimulation and subjective sexual arousal, is outlined in the review by Van Lunsen and Laan in this issue. The importance of the subjective experience of arousal has been documented in the psychophysiologic studies of the past 25 years. The frequent lack of correlation between subjecReceived April 23, 2004; accepted June 17, 2004.
影响因子：
120.7
作者：
Laumann, EO;Paik, A;Rosen, RC
通讯作者：
Rosen, RC