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Follow-up showed that the gains were maintained and orgasm frequency were increased [ 20 ]. Silverman, C. Nardi also suffers from post-traumatic stress disorder, Fimbianti said, telling how Nwrdi was stricken with it after his partner was shot and killed in Narxi. Buy options. Toronto: Clarke Irwin, Local News. Nardi sex, M. Riley AJ, Riley EJ: A controlled study to evaluate directed masturbation in the management Nardi sex primary orgasmic failure in women. Everaerd W, Dekker J: Treatment of secondary orgasmic dysfunction: a comparison of systematic desensitization and Nardi sex therapy.
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Metrics details. Despite its high prevalence, there are few studies that have systematically evaluated sex therapy in comparison with other interventions. Review randomized clinical trials that present psychotherapeutic interventions for female sexual dysfunctions. Through a search in three databases Medline, Web of Science and PsycInfo , references were found.
After an analysis of the abstracts, twenty-seven articles met the inclusion criteria and composed this review. There is a lack of systematic study of many female sexual dysfunctions. Masters and Johnson proposed a linear model to explain how humans respond to sexual stimuli. Their model is composed of four phases: excitement, plateau, orgasm and resolution [ 3 ].
Years later, desire was considered an important element in the human sex cycle [ 4 ]. The current model that serves as the basis for the classification and definition of sexual dysfunction is a combination of those two models and also has three phases: desire, arousal, orgasm.
Since sexual dysfunction treatment was proposed, the majority of clinical trials focused on orgasmic disorder, both primary when women had never experienced orgasm by any means of stimulation or secondary women could achieve orgasm through self-stimulation but not in coitus. Anxiety was found to have an important role in sexual dysfunctions. The anticipation and performance anxiety could negatively impact sexual function.
Based on that assumption, the main goal of sex therapy was to reduce the levels of anxiety related to sexual situations. Another goal was to improve sexual skills and repertoire [ 5 , 6 ]. Communication skills, listening exercises, emotional expression and reflection and conflict resolution are also important parts of treatment. This paper aims to review randomized clinical trials comparing psychological interventions to other forms of treatment in female population with sexual dysfunctions.
A literature search was conducted in three databases: Medline, Web of Science and PsycInfo, using the following keywords: female, sexual, dysfunction, clinical and trial. The search was conducted by two independent researchers in August A total of references were found Pubmed, ; Web of Science, ; Psycinfo, One hundred and eighty-one duplicated references were excluded, and 54 references in languages other than English or Portuguese were also excluded, leaving references to be evaluated by abstract analysis.
The inclusion criteria were as follows: 1. Randomized Clinical Trials comparing forms of treatment; 2. At least one psychotherapeutic intervention was used; and 3.
Focus on female sexual dysfunctions even when both men and women were treated. After abstract analysis, 89 eighty-nine references were selected to full text analysis.
Some articles did not meet the inclusion criteria and were excluded. The first clinical trial to evaluate behavioral treatment for sexual dysfunction compared systematic desensitization versus positive conditioning [ 7 ].
Systematic desensitization followed the model used in anxiety disorders. A hierarchy of scenes with sexual content was presented to the subjects along with techniques such muscle relaxation. Thus, the scenes were the same for all subjects, but the presentation order varied according to the patient classification. Positive conditioning consisted of the use of an unconditioned sexual stimulus paired with a neutral stimulus in order for it to become a conditioned stimulus capable of evoking the same responses as the unconditioned stimulus.
In this study, women used a vibrator to achieve sexual excitement and they received a recorder with a male voice romantically describing a coitus scene. Before the vibrator use, women were instructed to fantasize about their sexual partner. Fourteen patients related good or very good attitudes toward sex after treatment. Two physical measures were evaluated: number of attempts to engage in sexual activity and the times these attempts were considered satisfying.
For both groups, coital attempts and satisfaction increased. Classical conditioning was used in another study, for female sexual arousal disorder [ 8 ].
The objective was to create conditioned stimuli that could evoke sexual physiological and psychological responses. The subjects were presented with erotic heterosexual movies that contained explicit intercourse and oral sex scenes. After the presentation of those movies excerpts, they were paired with a neutral stimulus, which was amber light.
Classical conditioning theory proposes that smaller intervals between the two stimuli will lead to a stronger magnitude of conditioning. Each subject received 50 sessions of conditioning, always one week after the end of menstrual period. To determine if the conditioning was successful, vaginal amplitude and subjective feelings of arousal were evaluated. After the 50 sessions, the conditioned stimulus CS was presented by itself to evaluate if it was capable of evoking the same response as the erotic videos.
None of the experimental groups showed differences when compared to the control group. The CS was not capable of evoking the same responses as the unconditioned stimulus, so the study failed to demonstrate that female sexual arousal could be classically conditioned. Some studies evaluated masturbatory training. One compared directed masturbation to conventional sex therapy, with sensate focus [ 9 ]. In another study [ 10 ], masturbatory training associated with erotic stimulation was found to be effective in orgasmic dysfunction.
Another study compared systematic desensitization, Masters and Johnson treatment sensate focus and genital stimulation and a combined treatment using both models [ 12 ]. The findings reported that the Masters and Johnson treatment has a faster response compared to systematic desensitization. Several clinical trials attempted to demonstrate the efficacy of it. One study attempted to investigate if those premises were fundamental and had an impact on outcomes [ 13 ]. Forty-eight couples presenting with sexual dysfunctions were assigned to two different groups: one with a couple of therapists and one with only one therapist.
A third group was used as a comparison and had only one therapist, but the focus was on discussing marital problems. Another study compared MJ treatment to a therapy focused on communication with no sexual interventions [ 14 ]. Communication therapy focused on active and passive listening, verbalization of and reflection on feelings, conflict management and assertive behavior. Forty-eight couples were randomly assigned to each group and 42 concluded treatment.
Another study investigated whether the order in which communication skills were presented in therapy influenced treatment outcomes [ 15 ]. One group had Communication Skills plus Sexual skills; the other was the opposite. Bibliotherapy, in the form of a self-help manual, was also evaluated as a possible form of treatment. The first article evaluated three components of sex therapy: sensate focus I, sensate focus II and ban on intercourse.
All of the materials provided to the subjects were also based in the Heiman and LoPiccolo manual. The therapy focused on information about sexuality, sensate focus, sexual skills acquisition, and elimination of performance anxiety. Group therapy was divided into male and female groups.
Women in this format reported great satisfaction with foreplay, higher orgasmic responses and satisfaction with communication and affection. Still based on the Heiman and LoPiccolo manual, another clinical trial was conducted. Women in this group learned how to use a vibrator and had better orgasmic responses.
The authors believed that, once the subjects had the sense of controlling their treatment, they would engage and present with better outcomes [ 19 ]. In the treatment group, subjects had improvement in all measures. Follow-up showed that the gains were maintained and orgasm frequency were increased [ 20 ].
Using a behavioral protocol, researchers compared individual versus group intervention in primary and secondary orgasmic dysfunction.
Fifty women were divided in two groups and then assigned to group, individual or waiting-list control WLC group. Pelvic physical exercises and their impact on female sexual function were also assessed. The objective was to determine if these exercises, designed to increase tonus of pelvic muscles, could help improve orgasmic responsiveness in non-orgasmic women.
Twelve women, who could reach orgasm through masturbation but not coitus, participated in the study. The women in the relaxation group had higher rates of sexual satisfaction at the end of treatment. A study evaluated cognitive-behavioral therapy CBT for women with complaints of hypoactive sexual desire disorder HSDD [ 24 ] Seventy-four couples were separated into two groups: group CBT and waiting list control. Using techniques such as psychosexual education, sensate focus, communication skills, positive reinforcement, cognitive restructuring and sexual fantasies training, women who underwent the program had an improvement of sex life.
In comparison with the control group, couples in the CBT group reported greater satisfaction with marital and sexual life. Only three couples abandoned treatment. Sexual pain problems have received some attention from researchers. One hundred and seventeen women were distributed among the groups.
The treatment was considered successful if the women had full penile penetration after therapy. Those women also reported less fear of coitus at the end of treatment.
Another study compared CBT and supportive therapy in the treatment of vulvodynia [ 26 ]. Vulvodynia is a gynecological condition characterized by vulvar pain and is often accompanied by sexual pain disorders. Fifty women participated in the study, but only 42 finished the treatment. The CBT protocol was adapted from a chronic pain protocol and involved techniques such as relaxation; supportive therapy was non-directive, involved no behavioral intervention and focused on patients expressing their feelings.
CBT was also compared to topical treatment with cream [ 27 ]. Ninety-seven women with vestibulodynia, a common type of sexual pain, characterized by burning or cutting sensations in the entrance of the vagina, were randomized into two groups: CBT and topical treatment with a corticosteroid cream. At the end of treatment, both groups showed improvements in pain scores, but at follow-up, the CBT group continued to show improvement.
The CBT goal of reducing fear-avoidance behaviors and anxiety, promoting a better understanding of sexuality and improving a sense of self-efficacy seem to play an important role in the treatment of vestibulodynia. A cognitive behavioral bibliotherapy approach was evaluated by a Netherlands group [ 28 ]. Patients received a manual with CBT techniques and were instructed by a researcher in how to use it. They were encouraged to read the chapters they believed had some relation to their complaints.
Compared to the control group, the treatment group had greater improvements and women with vaginismus seemed to have the greatest benefits from the program.
Both men and women reported a better quality of sex life.
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A Grant Park police lieutenant let his brother's daughter move in with him so he could "straighten out" the teen, then proceeded to have sex with her on a "daily basis" when she wasn't cooking his meals, doing his laundry, or shopping for lingerie and shoes, a Will County prosecutor said. Stephen Nardi, 45, started having sex with his year-old niece within three weeks of her moving in with him in June , said Assistant State's Attorney Peter Wilkes.
Nardi, who was arrested by agents from the Illinois State Police and fired from his job with the Grant Park Police Department Tuesday , appeared in bond court Wednesday afternoon. Wilkes told how Nardi offered to "help" his brother's daughter by letting her move into his Steger home, and by helping, he apparently meant having sex with her for the next year and a half.
Nardi also took his niece out shopping for lingerie and shoes, Wilkes said, and threatened to kill her if she blabbed about how he was having sex with her. Nardi, who forbade his niece to have friends of her own, went so far as to once grab the girl by her arm and fire a gun in the air as he told her to "keep her mouth shut," Wilkes said.
Nardi faces charges of criminal sexual assault and having sexual relations within his own family. Nardi's attorney, Eugene Fimbianti, pointed out Nardi has no criminal history and a spotless record as a police officer for not only Grant Park, but also Steger and Kankakee. Nardi also suffers from post-traumatic stress disorder, Fimbianti said, telling how he was stricken with it after his partner was shot and killed in Kankakee. The former cop's firearm owner's identification card has already been revoked, Wilkes told the judge, and the state police seized all of his guns when they took him into custody.
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