Dissertations / Theses on the topic 'Sexual dysfunctions, psychological – therapy'

Os objetivos do presente estudo foram: (1) avaliar a função sexual feminina e a presença de depressão e ansiedade; (2) verificar a associação entre disfunção sexual feminina (DSF), depressão e ansiedade e (3) identificar as variáveis relacionadas com os domínios: desejo, excitação, orgasmo e dor durante a relação sexual Participaram do estudo 110 pacientes saudáveis (idade: 18-61, média:38,5 anos) que aguardavam consulta ambulatorial de prevenção ginecológica no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP). A avaliação foi realizada com questionários específicos desenvolvidos para a pesquisa, juntamente com o Quociente Sexual Feminino (QS-F), Inventário Beck de Depressão (BDI-II) e Inventário Beck de Ansiedade (BAI). A análise das respostas mostrou que do total da amostra, 36 (32,7%) mulheres apresentavam inibição de desejo; 16 (14,5%), problemas de excitação; 35 (31,8%), dificuldades de orgasmo; 31 (28,2%) queixavam-se de dor durante a relação; e 39 (35,5%) atingiram pontuação inferior a 60 no QS-F, indicando DSF em geral. Depressão e ansiedade acometeram 26 (23,6%) e 37 (33,6%) pacientes, respectivamente. Os dados também revelaram uma relação significante entre DSF, depressão e ansiedade, além de identificar fatores de risco para os domínios sexuais. Diminuição do desejo sexual foi associada à depressão, ansiedade, escolaridade, incômodo com próprio o corpo, masturbação e educação sexual; problemas de excitação foram ligados à depressão, ansiedade, idade, escolaridade, incômodo com o próprio corpo, medo relacionado a sexo e educação sexual; orgasmo foi impactado por depressão, ansiedade, escolaridade, incômodo com o próprio corpo, medo relacionado a sexo, vergonha durante o ato sexual, masturbação e educação sexual; queixas de dor durante a relação sexual foram associadas à depressão, renda, escolaridade e educação sexual; por fim, fatores relevantes para a presença de DSF em geral foram depressão, ansiedade, escolaridade, incômodo com o próprio corpo, medo relacionado ao sexo, vergonha durante o ato sexual e educação sexual. Modelos de regressão foram utilizados para identificar as variáveis mais significantes para cada domínio da atividade sexaul. Com efeito, desejo sexual é inibido pela presença de depressão; o nível de excitação é negativamente impactado por depressão e pelo aumento da idade; a capacidade de atingir o orgasmo é reduzida pela baixa escolaridade, pela ansiedade e por medos relacionados ao sexo; e tanto dor durante o intercurso quanto DSF em geral estão diretamente ligadas à baixa escolaridade e à depressão. Conclui-se que inúmeras variáveis interferem na resposta sexual feminina, sendo depressão e ansiedade especialmente nocivas à função sexual. Ademais, enquanto depressão é mais prejudicial nas primeiras fases da resposta sexual (desejo e excitação), ansiedade influencia principalmente a fase de orgasmo.
The present work proposes to (1) assess female sexual functioning, depression, and anxiety; (2) verify the association between female sexual dysfunction (FSD), depression, and anxiety; and (3) identify the variables associated with the sexual domains: desire, arousal, orgasm, and pain during intercourse. A group of 110 healthy women (age: 18-61, mean: 38.5 years) among those waiting for gynecological routine consultations at the Clinics Hospital of the Faculty of Medicine of the University of São Paulo (HCFMUSP) was randomly selected for this research. The patients were asked to fill questionnaires specifically developed for this work and validated instruments, such as the Female Sexual Quotient (FSQ), the Beck Depression Inventory (BDI-II), and the Beck Anxiety Inventory (BAI). The analysis of the responses show that 36 (32.7%) women present sexual desire inhibitions; 16 (14.5%) have arousal problems; 35 (31.8%) have orgasm difficulties; 31 (28.2%) report pain during intercourse; and 39 (35.5%) exhibit overall FSD. Depression and anxiety are present in 26 (23.6%) and 37 (33.6%) patients respectively. The data also reveal a significant relation between FSD, depression, and anxiety, in addition to identifying risk factors for the sexual domains. More specifically, sexual desire inhibition is associated to depression, anxiety, education level, body issues, masturbation, and sexual education; arousal is connected to depression, anxiety, age, education level, body issues, sex-related fears, and sexual education; orgasm difficulties is related to depression, anxiety, education level, body issues, sex-related fears, sex-related shame, masturbation, and sexual education; pain during intercourse is associated with depression, monetary income, education level, and sex education; and finally, the factors relevant to overall FSD are depression, anxiety, education level, body issues, sex-related fears, sex-related shame, and sexual education. Regression models were then used to identify the most significant variables for each domain, resulting in sexual desire being inhibited by the presence of depression; excitation levels being impaired by low education levels and the increase of age; ability to achieve orgasm being hindered by low education levels, anxiety, and sex-related fears; and pain during intercourse and overall FSD increasing with lower education levels and depression. In conclusion, numerous variables influence female sexual response, depression and anxiety being especially detrimental to sexual functioning. What is more, while depression is more harmful in the early stages of sexual response (desire and arousal), anxiety is the main influence on the orgasm phase

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CAPES
Além das perdas motoras e sensitivas, o trato urinário e a função sexual são também afetados pela lesão medular, sendo a disfunção sexual um dos problemas mais comuns nestes pacientes e sua gravidade depende no nível e da complexidade da lesão. A alteração da função sexual acontece devido às mudanças no processo neurofisiológico, mas fatores psicossociais podem estar associados à disfunção. A perda da realização sexual, quando comparada à perda de autonomia, pode parecer uma consequência minoritária da lesão medular. No entanto, a função sexual é um importante componente de saúde, com evidências de que a redução da função e satisfação sexual resultam em baixa qualidade de vida, além de um fator fundamental na motivação, bem estar e satisfação. Apesar da relevância, o desempenho sexual após lesão medular ainda é um tema pouco abordado e bastante negligenciado durante o processo de reabilitação, além de serem escassos os estudos que verificam associações mais aprofundadas sobre a função erétil e os demais componentes da função sexual, fatores explicativos e preditivos de disfunção. OBJETIVO: avaliar a função sexual de homens com lesão medular traumática e analisar a associação da disfunção com fatores fisiológicos e não fisiológicos. MATERIAIS E MÉTODOS: Estudo observacional (CCAE 41221414.5.0000.5208) realizado com 45 homens, faixa etária entre 18 a 60 anos, com lesão medular traumática e vida sexual ativa. A função sexual foi avaliada pelo Índice Internacional de Função Erétil (IIFE) e nível e grau da lesão foram determinados seguindo as diretrizes da International Standards for Neurological Examination and Functional Classification of Spinal Cord Injury. Os dados foram coletados após seis meses da lesão, em hospitais de referência. Foram aplicadas técnicas de estatística descritiva e análise bivariada e multivariada, através de regressão logística ajustada para observar a associação entre a função sexual e fatores explicativos de disfunção, com nível de significância de 0,05. RESULTADOS: Participaram do estudo 45 indivíduos com idades entre 18 e 56 anos (média 34,0; IC 31,5 – 37,1) e tempo de lesão médio de 7,5 anos (IC 5,2 – 9,9). Lesões incompletas acima do segmento medular L2 foram as mais frequentes (66,7%). Ao analisar os domínios do IIFE, não foi observada associação entre disfunção sexual e complexidade da lesão, porém, os pacientes com lesões completas foram os que apresentaram mais grave disfunção orgástica (86,7%) e de satisfação (86,7%). Ao analisar a associação entre fatores explicativos para disfunção, percebeu-se que a presença parceira fixa é um fator protetor (OR: 0,22; IC95%:0,05-0,92) para disfunção erétil. Desejo sexual tem associação com parceira fixa (OR: 0,20; IC95%:0,04-0,84), masturbação (OR: 0,16; IC95%:0,04-0,67) e relação sexual no último mês (OR: 0,13; IC95%:0,01-0,92). Ejaculação presente (OR: 0,01; IC95%:0,00-0,15) foi considerado um fator protetor para disfunção orgástica, enquanto disfunção erétil (OR: 15,7; IC95%:1,38-178,58), um fator de risco. Ereção psicogênica (OR: 0,07; IC95%:0,01-0,69), frequência mensal de relação sexual (OR: 11,3; IC95%:2,0-62,8) e disfunção orgástica (OR: 7,1; IC95%:1,1-44,8) tem associação com satisfação. CONCLUSÃO: a resposta sexual altera-se após a lesão medular, tendo a função orgástica como a mais acometida, caracterizando o domínio que apresentou maior e mais grave disfunção. Fatores como presença de parceira fixa, ejaculação e masturbação são fatores de proteção para disfunção sexual. Disfunção erétil, orgástica e relações sexuais infrequentes são preditores de disfunção.
In addition to the motor and sensory loss, urinary tract and sexual function are also affected by spinal cord injury, and sexual dysfunction one of the most common problems in these patients and its severity depends on the level and complexity of the injury. The change in sexual function occurs due to changes in neurophysiological process, but psychosocial factors may be associated with dysfunction. The loss of sexual fulfillment, compared to a loss of autonomy, it may seem a minor consequence of spinal cord injury. However, sexual function is a major health component, with evidence that the reduction of sexual function and satisfaction resulting in lower quality of life, and a key factor in motivation and satisfaction welfare. Despite the relevance, sexual performance after spinal cord injury is still somewhat topic and largely neglected during the rehabilitation process, and few studies that verify deeper associations of erectile function and other sexual function, explanatory factors and predictive dysfunction. AIMS: To evaluate the sexual function of men with spinal cord injury and to analyze the association of the disorder with physiological and non-physiological factors. MATERIALS AND METHODS: Observational study (CEAC 41221414.5.0000.5208) conducted with 45 men, aged 18 to 60 years, with spinal cord injury and active sex life. Sexual function was assessed by the International Index of Erectile Function (IIEF) and level and degree of injury were determined following the guidelines of the International Standards for Neurological and Functional Examination Classi fi cation of Spinal Cord Injury. Data were collected after six months of injury in referral hospitals. Descriptive statistical techniques were applied and bivariate and multivariate analysis using logistic regression adjusted to observe the association between sexual function and explanatory factors of dysfunction, with a 0.05 significance level. RESULTS: The study included 45 subjects aged between 18 and 56 years, mean 34.0 (CI 31.5 to 37.1) and average injury time in years 7.5 (CI 5.2 to 9.9). incomplete lesions above the spinal segment L2 were the most common (66.7%). By analyzing the domains of IIEF, there was no association between sexual dysfunction and complexity of the injury, however, patients with complete injuries were those with more severe orgasmic dysfunction (86.7%) and satisfaction (86.7%). When analyzing the association between explanatory factors for dysfunction, it was realized that a primary partner presence is a protective factor (OR: 0.22; 95% CI: .05-.92) for erectile dysfunction. sexual desire is associated with a steady partner (OR: 0.20; 95% CI: 0.04 to 0.84), masturbation (OR: 0.16; 95% CI: 0.04 to 0.67) and sexual intercourse in the last month (OR: 0.13; 95% CI: 0.01 to 0.92). This ejaculation (OR: 0.01; 95% CI: .00-.15) was considered a protective factor for orgasmic dysfunction as erectile dysfunction (OR: 15.7; 95% CI: 1.38 to 178.58), a risk factor. psychogenic erection (OR: 0.07; 95% CI: 0.01 to 0.69), monthly frequency of intercourse (OR: 11.3; 95% CI: 2.0 to 62.8) and orgasmic dysfunction (OR: 7.1; 95% CI: 1.1 to 44.8) is associated with satisfaction. CONCLUSION: the sexual response changes after spinal cord injury, and orgasmic function as the most affected, featuring the area with the highest and most severe dysfunction. Factors such as the presence of fixed partner, ejaculation and masturbation are protective factors for sexual dysfunction. erectile dysfunction, orgasmic and infrequent sex dysfunction are predictors.

The extensive amount of research conducted in the field of family violence internationally indicates that child abuse has a detrimental effect on both the physical and emotional development of children as well as having a profound effect on an individual’s psychological development and functioning in adult life. The aim of this research study was to describe the therapeutic process that unfolded with a seven year old allegedly abused female client within the framework of non-directive play therapy. The case was further contextualised utilising Erik Erikson’s theory of psychosocial development. This study served to broaden the body of psychotherapeutic knowledge by means of meaningful qualitative enquiry. The client was referred for therapy because of severe emotional and behavioural problems following the alleged sexual abuse. The client was seen over a period of eight months and this included 11 sessions of non-directive play therapy, three parent interviews and psychometric assessments conducted by a colleague. The case study method was utilised in this study. To achieve the aim of the research, the methodology of choice was the descriptive dialogic case study. A purposive sampling technique was used in the selection of the research subject for this study. The data collection and analysis were conducted according to Yin’s (1994) analytical generalisation, which consists of two main strategies: (a) using a theoretical framework as a guide to determine what data is relevant; and (b) developing a matrix as a descriptive framework for organising and integrating the data. Furthermore, the process of data analysis was aided by the use of guidelines proposed by Irving Alexander (1988) with Axline’s non-directive play therapy and Erikson’s theory of psychosocial development as the theoretical frameworks. The findings of this study suggest that plotting the play therapy sessions according to the framework of the four stages of play therapy was a particularly useful tool to monitor Michelle’s progression through the therapeutic process. This can be seen as a valuable application of a tool which can be used within the non-directive play therapy approach. Contextualising Michelle’s development according to the stages of Erikson’s theory of psychosocial development was also found to be a valuable endeavour. According to her chronological age, Michelle should have been in the fourth stage of industry versus inferiority, but in reality Michelle was still struggling to strike a healthy balance between the terms of conflict of trust versus mistrust issues of the first stage. From a therapeutic point, this was an important exercise as it helped to inform the therapist and consequently, the therapeutic process. This research undertaking can be recognised as a positive demonstration of the value of non-directive play therapy (Virginia Axline) and Erik Erikson’s theory of psychosocial development in the therapeutic process. In addition, this study has served to facilitate a more holistic understanding of the case study approach to research. Recommendations regarding future research undertakings that utilise the case study approach and methodology have been made. Key concepts: child abuse; family violence; non-directive play therapy; Erik Erikson’s theory of psychosocial development; analytical generalisation; case study research.

This study was designed to test the clinical effectiveness of an Acceptance and Commitment Therapy (ACT) group intervention for individuals reporting distress related to conflict between sexual and religious identity. There were 24 participants in the study, 12 of whom took part in the therapy group, 12 of whom were in a comparison group and did not participate in the intervention. Outcome measures included the Acceptance and Action Questionnaire-2 (AAQ-2), Components of Attitudes Towards Homosexuality (CAH), Outcome Questionnaire-45 (OQ-45), the World Health Organization Quality of Life Questionnaire (WHO-QOL), Dimensions of Latter-Day Saint Religiosity (DLDSR), and the Three-Factor Scale of Authoritarianism (3-FSA). Participants from both the intervention and the comparison groups completed an initial battery of these self-report measures and an additional follow-up battery, given after the intervention group had completed the six-session intervention and after a similar 6-week period had passed for the comparison group. Repeated-measure ANOVA of the collected data indicates that, relative to the comparison group, the intervention group showed statistically significant (p < .05) changes in symptom distress (partial &brkbar;Ç2 = .36), attitudes towards homosexuality (partial &brkbar;Ç2 = .461), and quality of life (partial &brkbar;Ç2 = .85). While preliminary, results of this study indicate that an ACT therapy group is an effective clinical intervention for individuals experiencing distress as a result of conflict between sexual and religious identity.

Abstract This qualitative research explores creative movement processes such as dance/movement therapy (DMT), authentic movement (AM), and creative dance (CD) as possible tools for transforming sexual trauma for women. Eleven movement professionals were interviewed in a semi-structured research format. My direct experience and knowledge of sexual abuse, sexual trauma, and creative movement processes are interwoven with the research question: do creative dance/movement therapy processes contribute to the dynamic of healing for women transforming sexual trauma? These findings are inconclusive for the greater population of survivors of sexual abuse and sexual trauma. However, there are indications that DMT, AM, and CD may be potential tools for recovery. This research contributes to a dialogue about sexual abuse and recovery from sexual trauma.

Aims: The experience of abuse in childhood can lead to psychological distress later in life. In particular the impact of trauma on the development of the self can render survivors more vulnerable to chronic feelings of shame and guilt. The aims of this research portfolio are twofold. First, a systematic review examines the impact of therapeutic interventions on depression outcomes for survivors of Childhood Sexual Abuse. Second, a research study explores experiences of shame and guilt for this population. More specifically, the study examines those factors in the therapeutic process which survivors find helpful in their changing relationship with these emotions. Method: To address the first aim a systematic review of the literature was carried out. The methodology employed strict inclusion criteria and ten Randomised Control Studies were identified and included in the review. A prospective longitudinal qualitative study was conducted to explore the experiences of shame and guilt for survivors of childhood abuse. Participants (n=10) were interviewed at two different time intervals whilst accessing psychological therapy. Data was analysed using the Framework Method. Results: Findings from the systematic review show existing studies are mostly of poor to medium methodological quality; but that therapeutic interventions do improve depression outcomes for survivors of Childhood Sexual Abuse. Results from the empirical study suggest feelings of shame more so than guilt are core emotions in the experience of psychological distress for survivors. Conclusion: Evidence-based therapeutic interventions for the range of complexities experienced by survivors of CSA are still to be established and more strong methodological trials are required. Shame is a core emotion in psychological distress for survivors and requires to be assessed and addressed routinely in therapeutic interventions.

Introdução: Vários são os fatores que alteram a atividade sexual de homens e mulheres. Com o envelhecimento observa-se aumento das queixas de desejo hipoativo feminino e de disfunção erétil. Visto que o homem e sua parceira constituem um sistema dinâmico, antes do advento dos inibidores da fosfodiesterase eles se adaptavam às condições disfuncionais do casal. A eficácia aliada a poucos efeitos colaterais e à facilidade de administração da sildenafila e, posteriormente, da vardenafila e tadalafila, revolucionou o tratamento da disfunção erétil. Por outro lado, até a presente data, a terapêutica medicamentosa com testosterona para o desejo sexual hipoativo de mulheres, ainda gera controvérsias. Objetivo: Avaliar o uso de androgênio, utilizado para tratamento das queixas de desejo sexual hipoativo em mulheres, comparando dois períodos, ou seja, pré e após o aparecimento iPDE 5. Os efeitos colaterais e as divergências em relação a este tratamento também serão analisados. Método: Foram selecionados estudos em inglês, português e espanhol, publicados entre 1988 e os dias atuais, ou seja, na década pré-advento dos inibidores da fosfodiesterase 5 e após. A busca dos artigos foi feita em periódicos indexados nas bases Lilacs, Cochrane, Embase e Medline/PubMed, utilizando-se os seguintes descritores e suas combinações: sexualidade (sexuality), desejo sexual hipoativo em mulheres (female hypoactive sexual desire disorder), testosterona (testosterone), terapia androgênica em mulheres (androgen therapy in women). Discussão: Embora haja evidência sobre a efetividade do tratamento com testosterona para desejo hipoativo em mulheres, este uso ainda gera muitas controvérsias. Resultados: O número de estudos randomizados sobre uso de testosterona para tratamento de DSH feminino aumentou de 10%, comparando o período compreendido entre 1988 e 1998, para 90% entre 1999 e 2012. Todos os estudos randomizados analisados demonstraram benefícios sobre a resposta sexual, melhorando a libido, a excitação e/ou o orgasmo. Porém, como tiveram seguimento por um período máximo de 24 semanas, os riscos dessa administração não foram esclarecidos. Conclusão: A partir de 1988, ou seja, após a liberação comercial dos inibidores da fosfodiesterase do tipo 5, para tratamento da disfunção erétil, houve um aumento significativo do número de pesquisas com a finalidade de avaliar o uso de testosterona em mulheres com desejo hipoativo. Porém, ainda são necessários estudos de longo prazo para que os riscos e os benefícios, desta administração, sejam esclarecidos
Introduction: There are several factors that alter the sexual activity of both men and women. With age, an increase in complaints about hypoactive feminine desire and erectile dysfunction can be observed. Since the man and his partner constitute a dynamic system, before the advent of phosphodiesterase inhibitors, they would adapt to the dysfunctional conditions of the couple. The efficacy with few collateral effects and the easy administration of sildenafil and later, vardenafil and tadalafil, has revolutionized the treatment of erectile dysfunction. On the other hand, until now, the drug therapy with testosterone for hypoactive sexual desire of women still generates controversies. Objective: Assess the use of androgen, used for treating complaints of hypoactive sexual desire in women, comparing two periods, that is, before and after the emergence of iPDE 5. Side effects and divergences regarding this treatment are also analyzed. Method: Studies in English, Portuguese and Spanish were selected, published between 1988 and the present, that is, in the decade before the advent of phosphodieterase 5 inhibitors and after this fact. The search for papers was made in indexed journals on Lilacs, Cochrane, Embase and Medline/PubMed data bases, using the following descriptors and their combinations: sexuality, female hypoactive sexual desire disorder, testosterone or androgen therapy in women. Discussion: Although there is evidence on the effectiveness of treatment with testosterone for hypoactive desire in women, this use still generates many controversies. Results: The number of randomized studies on the use of testosterone for the treatment of female HSD has increased 10%, comparing the period between 1988 and 1998, to 90% between 1999 and 2012. All randomized studies analyzed showed benefits on the sexual response, improving libido, excitation and/or orgasm. However, since they were followed for a maximum of 24 weeks, the risks of this dosage were not clarified. Conclusion: From 1988, that is, after the commercial release of phosphodiesterase type 5 inhibitors, for the treatment of erectile dysfunction, there was a significant increase in the number of papers with the purpose of evaluating the use of testosterone in women with hypoactive desire. However, there is the need of long-term studies in order to clarify the risks and benefits of this use

As disfunções urinárias ou sexuais do idoso são subnotificadas. Porém, são de alta prevalência e associadas a diversos prejuízos psicossociais. O presente estudo visa à identificação da prevalência dessas condições por meio de questionários. Utilizou-se o Androgen Deficiency in Aging Male (ADAM) para avaliação de função sexual do homem, questões sobre função sexual feminina e masculina e, o International Prostate Symptom Score (IPSS) para avaliação de função urinária masculina e feminina. Temos o objetivo de realizar uma investigação nos indivíduos não institucionalizados, acima de 60 anos de idade, para obtermos dados referentes à sua saúde sexual e urinária nas cidades: São Paulo, Campinas, Santo André, São Bernardo do Campo, São Caetano e Londrina. Foram distribuídos cerca de 6000 questionários, sendo utilizados para estudo 3425, com 1575 homens e 1850 mulheres. Em relação ao ADAM, obtivemos 92,49% dos 1385 avaliados com suspeita de apresentarem distúrbio androgênico do envelhecimento masculino (DAEM). Quanto à função sexual masculina, evidenciamos que 383 (32,19%) apresentavam queixas eretivas, 458 (37,54%) de ejaculação precoce e 790 (59,13%) admitiram a necessidade de tratamento para melhorar o desempenho sexual. Quanto à função sexual feminina, 1300 (74,07%) não praticam relação sexual e os principais motivos foram: falta de parceiro, falta de desejo sexual e problema de saúde do parceiro. Além disso, 988 (78,41%) das mulheres que não têm relação sexual admitem estar bem assim e não querem sexo e mais importante: aproximadamente 21% dessas gostariam de ter relação sexual. Quanto à qualidade da relação sexual feminina, 272 (64,92%) acham a relação boa para ambos, 105 (25,06%) boa só para o parceiro e 33 (7,88%) ruim para ambos. Em relação ao IPSS masculino, observamos piora gradual no padrão miccional com o aumento da idade, dos sintomas moderados e graves, principalmente após os 75 anos, sendo os mais prevalentes: nictúria, urgência miccional e aumento da frequência urinária. Quanto ao IPSS feminino, notamos que, mesmo após os 80 anos, a maioria das mulheres (53,37%) apresenta sintomas leves relacionados à disfunção miccional; com o aumento da idade, ocorre um aumento gradual do resultado do IPSS, relacionado com os sintomas moderados e graves, sendo que o pico ocorre após os oitenta anos. Sendo assim, devido ao grande número de distúrbios sexuais e urinários encontrados, deixamos um alerta para que um maior número de medidas de Saúde Pública sejam implantadas, melhorando promover uma melhor qualidade de vida nessa população idosa
Urinary or sexual dysfunction in the elderly are underreported. However, are highly prevalent and associated with various psychosocial damage. This study aims to identify the prevalence of these conditions. We used the Androgen Deficiency in Aging Male (ADAM) to assess sexual function of men, questions of male and female sexual function, and the International Prostate Symptom Score (IPSS) for evaluation the urinary function. The aim is to carry out an investigation in non-institutionalized individuals over 60 years of age, to obtain data on its sexual and urinary health in: São Paulo, Campinas, Santo André, São Bernardo do Campo, São Caetano and Londrina. They were distributed about 6,000 questionnaires being used to study 3425, with 1575 men and 1850 women. Compared to ADAM, obtained 92.49% of the 1385 evaluated suspected of presenting androgen disorder of aging male (ADAM). As for the male sexual function, we showed that 383 (32.19%) had erective complaints, 458 (37.54%) of premature ejaculation and 790 (59.13%) admitted the need for treatment to improve sexual performance. As for the female sexual function, 1300 (74.07%) did not practice sexual intercourse and the main reasons were: lack of partner, lack of sexual desire and partner health problem. In addition, 988 (78.41%) of women who haven\'t sexual intercourse admit to being like that and not want sex and, more importantly, about 21% of them would like to have sexual intercourse. As for the quality of the female sex, 272 (64.92%) think the relation is good for both, 105 (25.06%) only good for the partner and 33 (7.88%) bad for both. IPSS when compared to males, we see gradual worsening of urinary pattern with increasing age, related with the moderate and severe symptoms, especially after 75 years, being the most prevalents: nocturia, urinary urgency and urinary frequency. As for the female IPSS, we note that even after 80 years, the majority of women (53.37%) have mild symptoms related to voiding dysfunction; with increasing age there is a gradual increase in the result of the IPSS, associated with moderate and severe symptoms, where the peak occurs after the age of eighty. Thus, due to the large number of sexual and urinary disorders found, left a warning to a greater number of public health measures are implemented, improving promote a better quality of life in this elderly population

Thesis (MPhil)--Stellenbosch University, 2014.
ENGLISH ABSTRACT: There have been new infections of HIV despite campaigns aimed at arresting the further spread of the epidemic particularly the new infections. This study sought to investigate whether HIV positive individuals disclose their status to their sexual partners. The study looked at both longtime partners and casual partners. The overall aim was to find the factors that contribute to non-disclosure or to disclosure to sexual partners by HIV positive individuals. The specific objectives were to identify prevailing levels of HIV sero-status disclosure among people living with HIV who were attending the ARV clinic; to identify people living with HIV’s attitude towards HIV status disclosure; to establish factors contributing to disclosure or non-disclosure among people living with HIV; to establish if there is a difference between disclosure rates between ‘long time’ sex partners and casual/’once-off’ sex partners and to provide guidelines to counsellors on how to educate HIV positive people on disclosure. The objectives were achieved by using a quantitative research design through the use of questionnaires targeting 50 HIV positive individuals attending the ARV clinic at Katutura Hospital in Windhoek Namibia. The questionnaire was self-administered and consisted of close-ended questions and one open-ended question which helped collect the quantitative data. The quantitative data was then analyzed using statistical tools (graphs, tables and charts). Results showed that HIV positive individuals are aware of the importance of disclosure. The results showed that majority of the participants did not disclose for fear of abandonment. Some did not disclose because they thought that their partner was also already infected. As for casual sex partners, some did not disclose because they wanted ‘to infect someone since they were also infected by someone’. Some said that they were drunk and hence did not disclose. Participants disclosed because they wanted moral support, they did not want to infect their partners and that they wanted their partners to get tested as well. One of the recommendations was that there is a need to encourage couple counselling in cases of married couples or ‘live-in’ couples to reduce the need for disclosure. It was also recommended that HIV/AIDS health workers need special training to enhance their skills on how to educate HIV positive individuals about disclosure. The link between risky sexual behavior and alcohol abuse was highlighted and it was recommended that there is a need to educate people, particular teenagers, the link between the two.
AFRIKAANSE OPSOMMING: Die doel van hierdie studie was die bepaling van die mate waartoe persone wat MIV-positief is en klinieke bywoon hulle MIV-status bekendmaak. Die studie is by die Katutura hospitaal in Windhoek, Namibië gedoen en 50 MIV-positiewe pasiënte is as steekproef gebruik. ‘n Vraelys wat die pasiënte self ingevul het is in die studie gebruik en data is op ‘n beskrywende wyse ontleed. Resultate het aangetoon dat MIV-positiewe pasiënte wel bewus is van die belangrikheid om hulle MIV-status bekend te maak. Laasgenoemde pasiënte doen dit egter nie, hoofsaaklik uit vrees vir stigma, diskriminasie en verwerping. Sommige pasiënte maak ook nie hulle status bekend nie omdat hulle bloot aanvaar dat die persoon met wie hulle saambly ook MIV-positief is en die bekendmaking van status dus onbelangrik is. Een van die belangrikste aanbevelings wat in die studie gemaak word is dat getroude paartjies aangemoedig moet word om MIV-voorligting by te woon, hulle te laat toets en hulle status bekend te maak. Dit word ook verder aanbeveel dat MIV/Vigs-gesondheidswerkers spesiale opleiding moet kry in hoe om persone wat MIV-positief is te oorreed om hulle MIV-status bekend te maak. Die studie sluit af deur te wys op die belangrike verwantskap tussen seksuele risikogedrag en die misbruik van alkohol. Daar word sterk gepleit dat die gemeenskap, en veral tienderjariges, bewus gemaak moet word van hierdie gevaar.

Introdução: A gravidez é uma fase de transição na qual pode surgir disfunção sexual e consequente compromisso da qualidade de vida do casal. O diagnóstico de problemas sexuais é dificultado pela multiplicidade de fatores subjacentes e pela sua forma de expressão. Os enfermeiros especialistas em saúde materna e obstetrícia têm, pela sua proximidade, a oportunidade de abordar esta temática e de a diagnosticar. Como tal, torna-se necessário estimar os indicadores clínicos que favoreçam o raciocínio clínico. Objetivos: Traduzir o diagnóstico de enfermagem sexual dysfunction, identificar os indicadores clínicos da disfunção sexual na amostra de grávidas, calcular a sua prevalência nos diferentes trimestres e estimar a sensibilidade, especificidade e valor preditivo das características definidoras do diagnóstico. Método: Estudo de natureza quantitativa, observacional, exploratório-descritivo e transversal. Iniciou-se com a tradução do diagnóstico para português europeu, seguida de uma revisão integrativa da literatura para identificação de indicadores clínicos do diagnóstico e, por fim, a validação clínica numa amostra de grávidas, através do modelo de Richard Fehring (1987, 1994). Integraram o estudo 306 grávidas acompanhadas na consulta de enfermagem de dois agrupamentos de centros de saúde, Lisboa Norte e Oeste Sul que preencheram um questionário constituído por dados demográficos e de saúde, o Female Sexual Function Index e as características definidoras e fatores relacionados do diagnóstico. O estudo foi aprovado pela Comissão de Ética para a Saúde da Administração Regional de Saúde de Lisboa e Vale do Tejo. Resultados: Obteve-se uma versão em português europeu do diagnóstico. Na revisão integrativa da literatura foram identificadas quatro novas características definidoras e 12 novos fatores relacionados do diagnóstico disfunção sexual na grávida em 58 estudos analisados. Na validação clínica a prevalência do diagnóstico foi de 49%, mantendo-se similar ao longo dos trimestres. Foram validadas 14 características definidoras, sete principais e sete secundárias. A característica definidora procura de confirmação de desejabilidade foi a mais sensível e a diminuição do desejo sexual foi a mais específica. O score total do diagnóstico foi 0,79. Conclusões: Novos elementos do diagnóstico foram identificados na revisão da literatura e validados na fase de validação clínica. A prevalência do diagnóstico nesta amostra confirma a disfunção sexual como um diagnóstico possível na consulta de enfermagem de saúde materna. Dos resultados emergiu uma proposta de mudança do enunciado do diagnóstico e de inclusão do diagnóstico de risco correspondente. Mais estudos de validação clínica noutros contextos, com amostras probabilísticas, poderão aumentar a evidência do diagnóstico, identificar particularidades e contribuir para o desenvolvimento da taxonomia da NANDA-I.
Introduction: Pregnancy is a transitional period and sexual dysfunction may occur compromising the couple’s quality of life. The diagnosis of sexual needs during this time is difficult to find due to a multiplicity of underlying factors and how they are present. Nurses and midwives have the opportunity to assess this subject and to diagnose, due to their proximity to the pregnant and couple. Thus, it seems necessary to evaluate the clinical indicators that may facilitate the clinical reasoning. Objectives: To translate the nursing diagnosis sexual dysfunction, to identify the clinical indicators in a sample of pregnant women, to calculate the prevalence in each trimester, to calculate the specificity, sensitivity and predictive value of the defining characteristics. Methods: Quantitative, observational, cross-sectional, exploratory-descriptive study. First, the diagnosis was translated into European Portuguese. In the second phase, an integrative literature review was performed to identify the clinical diagnostic indicators of the diagnosis. Third phase consisted in the clinical validation in a sample of pregnant using the Richard Fehring model (1987, 1994). The sample was composed of 306 pregnant women in nursing consultation in two health centers of the Regional Health Administration of Lisbon and Tagus Valley, who filled out questionnaires about their health and demographics data, the Female Sexual Function Index (FSFI), and the defining characteristics and related factors of the diagnosis. The study was approved by the Ethics Committee of Regional Health Administration of Lisbon and Tagus Valley. Results: An european portuguese version of the diagnosis was obtained. Four new defining characteristics and 12 new related factors were identified in the integrative literature review, which included 58 papers. In clinical validation the prevalence of the diagnosis was 49%, similar in all trimesters. A total of 14 defined characteristics were validated, seven major and seven minor. The defining characteristic seeks confirmation of desirability was the most sensitive, and decrease in sexual desire the most specific. The total diagnostic score was 0.79. Conclusion: New elements of the diagnosis were identified in the integrative literature review and were validated in the clinical validation. The prevalence of the diagnosis sexual dysfunction in this sample confirms the possibility of its occurrence during the maternal nursing consultation. An update in the label of the diagnosis is proposed and the integration of the related risk diagnosis to be included in NANDAI. Future studies of clinical validation in other contexts using probabilistic samples could be important in increasing the evidence of the diagnosis and the development of the taxonomy of NANDA-I.

Orientação: Jorge Manuel dos Santos Cardoso
Estima-se que 10% da população mundial sofra de insuficiência renal crónica (IRC). Esta altera a qualidade de vida e a sobrevida dos doentes, sobretudo no período terminal da doença pela necessidade de utilização de uma técnica de substituição da função renal. A transplantação renal é a terapêutica que oferece uma qualidade de vida que mais se aproxima da dos indivíduos sem IRC terminal. A sexualidade é uma componente significativa da qualidade de vida global (QoL) e da qualidade de vida associada à saúde (HRQoL), sendo no doente transplantado renal influenciada por diversos factores biopsicossociais. A disfunção sexual é muito prevalente no transplantado renal, apresentando uma etiologia multifactorial e exercendo um impacto negativo sobre a satisfação sexual e sobre a QoL e a HRQoL. Nos transplantados, a integração de um novo órgão no organismo implica um reajustamento da imagem corporal, com a probabilidade de desencadear efeitos psicológicos negativos, bem como repercussões na intimidade e na resposta sexual. Este estudo teve como objectivo avaliar a função sexual masculina, a satisfação sexual e a satisfação com a imagem corporal após transplantação, numa amostra de conveniência obtida na Unidade de Transplantação Renal do Centro Hospitalar de Lisboa Ocidental. Foi realizado um estudo transversal unicêntrico com recurso aos seguintes instrumentos: International Index of Erectile Satisfaction, New Scale of Sexual Satisfaction, Brief Symtom Inventory e Body Image Scale. A taxa de resposta foi de 27.2% diagnosticando-se disfunção eréctil em 66.1% da amostra. Identificou-se a presença de pelo menos um factor de risco para doença cardiovascular em 97.3% dos inquiridos e de 3 ou mais factores em 27.7%. Encontrou-se uma correlação entre o funcionamento sexual e a satisfação sexual (r=.598; p<.01; n =112) e entre satisfação com a imagem corporal e a função sexual (r =-.193; p<.05; n =112). O tempo decorrido após a transplantação (36meses) não evidenciou diferença na função sexual e na satisfação sexual ainda que a idade, o consumo de psicofármacos, a imagem corporal e a existência de parceira/o sexual tenham moderado a variância entre esses grupos de transplantados.  Estes resultados apontam para uma elevada taxa de disfunção sexual, nomeadamente de disfunção eréctil, face à prevalência conhecida para a população geral. Verificou-se uma relação entre a função sexual e a satisfação sexual. A imagem corporal mais satisfatória associou-se a um melhor funcionamento sexual mas não a maior satisfação sexual reflectindo provavelmente os mecanismos de ajustamento que a satisfação sexual tende a manter ao longo da vida de um indivíduo. Permanece por determinar de modo longitudinal o efeito da transplantação renal sobre a sexualidade e a imagem corporal.
Ten per cent of the worldwide population suffer from chronic kidney disease (CKD). This can impact survival and quality of life, namely in the terminal period of illness that implies the use of kidney function substitution. Kidney transplant is the technique that provides a quality of life (QoL) comparable with the one of an individual without terminal CKD. Sexuality is an important domain of the health-related quality of life (HRQoL) and of the global quality of QoL and is influenced by several biopsychossocial factors in the kidney transplant recipient. Sexual dysfunction is prevalent after kidney transplantation and its aetiology is presumed to be multifactorial. Sexual dysfunction exerts a negative impact on sexual satisfaction, HRQoL and global QoL. The integration of a new organ in the body can imply an adjustment of the body image perception, which eventually may have a negative influence on intimacy and sexual response. This study purposes to evaluate male sexual function, sexual satisfaction and body image in a convenience sample collected in the Department of Kidney Transplantation of the Centro Hospitalar de Lisboa Ocidental. This is a single centre cross-sectional study using the International Index of Erectile Satisfaction, the New Scale of Sexual Satisfaction, the Brief Symtom Inventory and the Body Image Scale. The response rate was 27.2% and erectile dysfunction was identified in 66.1% of the sample. Presence of at least one risk factor for cardiovascular disease was identified in 97.3% and 27.7% had 3 or more cardiovascular risk factors. A correlation was identified between sexual function and sexual satisfaction (r=.598; p<.01; n =112) and between body image satisfaction and sexual function (r =-.193; p<.05; n =112). The time after transplantation (< or >36meses) did not demonstrate a difference in sexual functioning or sexual satisfaction, although age, psycothropic drugs, body image perception and sexual partner availability accounts for the variations between the influences that time exerts in sexual function and satisfaction. These results showed high sexual dysfunction rates in the sample, namely erectile dysfunction, compared to those exhibited by the general population. A relation between sexual function and sexual satisfaction was established although it is not possible to evaluate if it was already evident before kidney transplant. The greater satisfaction with body image was associated with better sexual function but not with sexual satisfaction. This probably evidences the adjustment mechanisms developed to maintain sexual satisfaction throughout the life. Longitudinal evaluation is still required for the effects that kidney transplantation exerts in sexuality and the body image.

A menopausa é uma fase essencial no percurso de vida da mulher, uma vez que acarreta consigo alterações ao nível físico, emocional, relacional e sexual. Este estudo tem como objectivos avaliar as diferenças nas variáveis em estudo (satisfação sexual, satisfação conjugal, bem-estar psicológico e imagem corporal) entre mulheres nos diferentes estados da menopausa; a relação entre as variáveis (satisfação conjugal, bem-estar psicológico, imagem corporal, idade, duração do relacionamento conjugal e TRH) e a satisfação sexual e, os preditores da satisfação sexual. A amostra por conveniência é de 181 mulheres que se encontram nos diferentes estados da menopausa, em que os instrumentos a aplicados foram: Questionário Sociodemográfico e Clínico, Escala de Avaliação da Satisfação em Áreas da Vida Conjugal (EASAVIC), Escala de Bem-Estar Psicológico (EBEP), Global Measure of Sexual Satisfaction (GMSEX) e Body Shape Questionnaire (BSQ). Os resultados obtidos neste estudo revelam que se verificam diferenças significativas entre mulheres nos diferentes estados da menopausa ao nível da satisfação sexual, satisfação conjugal, bem-estar psicológico e imagem corporal. Verificou-se que mulheres que se encontram na prémenopausa e peri-menopausa revelam maior satisfação sexual, satisfação conjugal e melhor bem-estar psicológico do que as mulheres que se encontram na pós-menopausa. Contrariamente, as mulheres que se encontram na pós-menopausa revelam uma melhor imagem corporal. Verificou-se também que a satisfação conjugal, bem-estar psicológico e imagem corporal estão positivamente associadas à satisfação sexual, comparativamente à idade e duração do relacionamento conjugal. Adicionalmente, verificou-se que a idade, a satisfação conjugal e a TRH predizem uma maior satisfação sexual, com o modelo a explicar 60.1% da variância da satisfação sexual na mulher na menopausa.
Menopause is an essential phase in the life course of a woman, since it causes physical, emotional, relational and sexual changes. This study aims to evaluate the differences in the variables under study (sexual satisfaction, marital satisfaction, psychological well-being and body image) among women in different states of menopause; the relationship between the variables (marital satisfaction, psychological well-being, body image, age, duration of the conjugal relationship and HRT) and sexual satisfaction and predictors of sexual satisfaction. The sample for convenience is of 181 women who are in different states of menopause, in which the instruments applied were: Sociodemographic and Clinical Questionnaire, Satisfaction Scale in Areas of Conjugal Life (EASAVIC), Psychological Well-Being Scale (EBEP), Global Measure of Sexual Satisfaction (GMSEX) and Body Shape Questionnaire (BSQ). The results obtained in this study reveal that there are significant differences between women in different states of menopause in terms of sexual satisfaction, marital satisfaction, psychological well-being and body image. It has been found that premenopausal and perimenopausal women show greater sexual satisfaction, marital satisfaction, and better psychological well-being than postmenopausal women. Conversely, postmenopausal women show a better body image. It was also verified that marital satisfaction, psychological wellbeing and body image are positively associated with sexual satisfaction, compared to the age and duration of the marital relationship. In addition, it was verified that age, marital satisfaction and HRT predict a higher sexual satisfaction, with the model explaining 60.1% of the variance of sexual satisfaction in the woman during menopause.

The aim of this study was to explore and describe the use of music therapy during intervention with primary school girls who have been sexually abused. An empirical study of limited extent was undertaken, which was qualitative in nature and conducted from the interpretivist paradigm. In depth case study was used as research design, whilst educational psychological assessments, intervention and re-assessments, observation, interviews, analysis of documentation, field notes and a reflective diary were employed as data gathering methods. Two primary school girls in a place of safety were selected as participants in the study. Despite the fact that these girls had to cope with the trauma of sexual abuse, they had to deal with emotions and behaviour closely related to such trauma, including depression, aggression, fear, hate, inappropriate interpersonal relationships, sleeping disorders, low self-concept and behavioural difficulties. The findings of the empirical study are supported by literature, namely that music therapy can provide a safe setting to children for revealing their emotions, fears and needs related to trauma, such as sexual abuse. Music therapy had a positive effect on both cases, who illustrated positive change during the process of intervention and were able to replace negative experiences with positive emotions. Further findings of this nature include an improvement of both girls’ ability to express themselves on an emotional level, self-confidence, assertiveness, self-concepts, social skills and interpersonal relationships, as well as a decline in negative behavioural patterns and symptoms. Subsequently, both girls could perform on a higher level on all various domains of functioning.
Dissertation (MEd (Educational Psychology))--University of Pretoria, 2005.
Educational Psychology
unrestricted

Advances in breast cancer detection and oncology treatment modalities have prolonged the survival time for the cancer population, which is officially the largest group of cancer survivors among women in the western world, including South Africa (Brem & Kumar, 2011; Fisher, Dolbeault, Sultan & Bredart, 2014; Herbst, 2011; Reyes-Gibby, et al., 2012). In the light of shocking statistics and ever rising numbers of cancer, especially breast cancer, the time is ripe for further research in the domain of psycho-oncology and has motivated the researcher, due to her interest and involvement in breast cancer, to make this her field of research. Despite the need for a bio-psycho-social approach when treating cancer patients there is little literature available on the psychological interventions in South Africa where the majority of research studies previously conducted in South Africa have generally focused on the bio-medical aspects of cancer (Albrecht, 2009; Venter, 2014). To comprehend the paradigm of psycho-oncology, which is the backbone of this study, a theoretical framework was attained from Engel’s humanistic or psychological model (caring) and Pasteur’s biomedical model (curing) (Borrel-Carrio, Suchman, & Epstein, 2004). The primary aim of this study was to explore the lived experiences of breast cancer patients concerning their diagnosis, treatment and survivorship and unique needs for psycho-oncological interventions through their own “voices”. The research was conducted within a qualitative framework with a case study method of inquiry employing open-ended style interviews and psychotherapeutic sessions with five purposely sampled breast cancer patients. Two qualitative questionnaires were also used for triangulation purposes. Transcripts of all the therapeutic sessions were analysed using interpretive analysis where categories and themes were developed and described in full. Findings indicated that in spite the extensive proof that breast cancer causes numerous sexual and psychological complications during active treatment and afterwards, patients still feel that they have no “platform” to express their emotions and sexual issues within the oncology framework, or that there is enough and sufficient assistance to attend to their needs. e The researcher hopes that this study will make a valuable contribution to research in the field of psycho-oncology in South Africa and to indicate new realities of the chronicity of breast cancer and treatment complications that demand psychotherapeutic interventions in cancer care and that the study will initiate new ways of understanding the role of psychology and the psychologist in the medical world of cancer. The researcher hopes that by offering an understanding of participants’ unique experiences of this process, practitioners will have insight when working therapeutically with this population and empower them to have a quality of life, even within the boundaries of their illness.
Psychology
D. Litt. et Phil. (Psychology)

This study aimed at exploring the impact of emotional and physical abuse that a male partner experiences “at the hands” of his female partner within a marriage or cohabitating relationship. This is accomplished by giving each respondent a “voice” with which he shares his victimisation experiences. Each case is individually analysed and interpreted according to an integrated systems model of abuse of the male victim of domestic violence which forms the theoretical foundation for this study. Through a process of in-depth personal interviews with the participants, researcher was able to compile a qualitative study, using the purposive snow ball sampling method. This information was used in collaboration with supportive literature to assist researcher in gaining a deep understanding of this form of domestic violence. It is hoped that this study will contribute to further research initiatives with regards to the male victim of domestic violence in South Africa. It is also researcher’s aim to inform victimology students and the helping professions about male battering and the unique circumstances surrounding it.
Criminology
Thesis (D. Litt. et Phil. (Criminology)

This research project arose from my journeys with Protestant Christian women who were living in sexually unhappy marriages. In South African Protestant faith communities there is the expectation that Christian marriages will experience sexual fulfilment. For many Christian women however, sexual unhappiness becomes their reality. Sexuality is cocooned in silence not only within the church, but also in many Christian marriages. This leaves many Christian women (and men) with little or no recourse to address sexually unhappy marriages. My research journey briefly explored the social construction of sexuality within the history of Christianity to see which discourses underpin current constructions of White Christian female sexuality. This participatory feminist action research journey centralised the voices of present-day contexts: Protestant Christian women, as well as clergy, were invited to share their understandings and interpretations of matrimony and sexual practices in relation to their faith. With the help of narrative therapeutic practices, some of the dominant social and religious discourses that constitute White Christian female sexuality were explored, deconstructed and challenged. This research journey aimed to penetrate this silence and to invite Christian women, who are living in sexually unhappy marriages, to share their experiences. This exploration included the faith predicaments and relational complexities, challenges and dilemmas Protestant Christian women experience when living in sexually unhappy marriages. This feminist-grounded action research explored the effects and consequences which living in sexually unhappy marriages held for the cosearchers.
Practical Theology
D.Th. (Specialisation in Pastoral Therapy)