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Introduction Previous, population‐based studies investigating the risk factors for sexual distress have not drawn on longitudinal data. Aims Determine the prevalence of sexual distress and dysfunction, explore factors associated with/predictive of sexual distress, and describe changes in sexual function over a decade in a population‐based sample of mid‐aged women. Methods Eleven‐year prospective study of Australian‐born women, aged 45–55 years, and menstruating at baseline. Short Personal Experiences Questionnaire (SPEQ) was completed in years 1 to 8 and 11 of follow‐up. Female Sexual Distress Scale (FSDS) was completed in the 11th year of follow‐up. Main Outcome Measures Validated outcome measures were the SPEQ (total sex score ≤7 indicates low sexual function) and FSDS (score ≥15 indicates sexual distress). Results Two hundred fifty‐seven women were interviewed in the 11th year of follow‐up. All domains of sexual function declined significantly in the decade studied. Women using hormone therapy in year 11 had significantly greater responsivity and higher frequency of sexual activities than nonusers. Two hundred four women completed both the FSDS and SPEQ questionnaires. One hundred sixty‐six (81%) women had an SPEQ score ≤7 of whom 34 (17% of the total sample) had an FSDS score ≥15, and were classified as having female sexual dysfunction. The multiple logistic regression analysis found that female sexual distress was concurrently associated with higher depression scores (odds ratio [OR] 1.31, 95% confidence interval [CI] 1.10, 1.56) and more negative feelings for partner (OR 0.49, 95% CI 0.32, 0.76) and predicted by prior negative feelings for partner (OR 0.31, 95% CI 0.14, 0.70), and a greater decline in total sex score (OR 0.77, 95% CI 0.59, 0.99). Conclusion By the end of the sixth decade, women have low levels of sexual function. Hormone therapy may help these women maintain sexual function. A minority of these mostly postmenopausal women are significantly distressed about low sexual function. Sexual distress is associated with depression and relationship factors. Dennerstein L, Guthrie JR, Hayes RD, DeRogatis LR, and Lehert P. Sexual function, dysfunction, and sexual distress in a prospective, population‐based sample of mid‐aged, Australian‐born women. J Sex Med 2008;5:2291–2299.

Introduction No previous population-based studies have used validated instruments to measure female sexual dysfunction (FSD) in Australian women across a broad age range. Aim To estimate prevalence and explore factors associated with the components of FSD. Main Outcome Measures Sexual Function Questionnaire measured low sexual function. Female Sexual Distress Scale measured sexual distress. Methods Multivariate analysis of postal survey data from a random sample of 356 women aged 20–70 years. Results Low desire was more likely to occur in women in relationships for 20–29 years (odds ratio 3.7, 95% confidence intervals 1.1–12.8) and less likely in women reporting greater satisfaction with their partner as a lover (0.3, 0.1–0.9) or who placed greater importance on sex (0.1, 0.03–0.3). Low genital arousal was more likely among women who were perimenopausal (4.4, 1.2–15.7), postmenopausal (5.3, 1.6–17.7), or depressed (2.5, 1.1–5.3), and was less likely in women taking hormone therapy (0.2, 0.04–0.7), more educated (0.5, 0.3–0.96), in their 30s (0.2, 0.1–0.7) or 40s (0.2, 0.1–0.7), or placed greater importance on sex (0.2, 0.05–0.5). Low orgasmic function was less likely in women who were in their 30s (0.3, 0.1–0.8) or who placed greater importance on sex (0.3, 0.1–0.7). Sexual distress was positively associated with depression (3.1, 1.2–7.8) and was inversely associated with better communication of sexual needs (0.2, 0.05–0.5). Results were adjusted for other covariates including age, psychological, socioeconomic, physiological, and relationship factors. Conclusions Relationship factors were more important to low desire than age or menopause, whereas physiological and psychological factors were more important to low genital arousal and low orgasmic function than relationship factors. Sexual distress was associated with both psychological and relationship factors. Hayes RD, Dennerstein L, Bennett CM, Sidat M, Gurrin LC, and Fairley CK. Risk factors for female sexual dysfunction in the general population: Exploring factors associated with low sexual function and sexual distress.

Introduction A range of methodological inconsistencies has the potential to affect reported prevalence rates of sexual intercourse. Aims We reviewed published studies of sexual intercourse frequency reported by women and associated factors. Methods Literature search of electronic databases. Inclusion criteria for selected cross-sectional studies were population and community-based studies of frequency of intercourse in women published in English or German languages with sample size greater than 300. Longitudinal studies were selected if duration was at least 1 year and samples were not clinically based. Main Outcome Measures Frequency of sexual intercourse/activities and any associated factors. Results There was a great deal of variation in the mean frequency of intercourse across all age groups with higher rates reported by European and American women. There was a reduction in frequency of sexual intercourse from age 50 among women from Europe and the United States. Asian women reported increasing rates through the age group 20–30 followed by a decline. Change with age was not as evident among African and South American studies. Factors most often associated with the frequency of sexual intercourse were age, parity, duration of relationship, pregnancy, time, relationship status, fertility intentions, and contraception. Conclusions There is variation in reported frequency of sexual intercourse between studies, age groups, and continents. Some of the variation may be due to variation in definitions, study designs, and methods suggesting a need for greater consistency in research practice. Schneidewind-Skibbe A, Hayes RD, Koochaki PE, Meyer J, and Dennerstein L. The frequency of sexual intercourse reported by women: A review of community-based studies and factors limiting their conclusions.

Introduction Studies that address sensitive topics, such as female sexual difficulty and dysfunction, often achieve poor response rates that can bias results. Factors that affect response rates to studies in this area are not well characterized. Aim To model the response rate in studies investigating the prevalence of female sexual difficulty and dysfunction. Methods Databases were searched for English-language, prevalence studies using the search terms: sexual difficulties/dysfunction, woman/women/female, prevalence, and cross-sectional. Studies that did not report response rates or were clinic-based were excluded. A multiple linear regression model was constructed. Main Outcome Measures Published response rates. Results A total of 1,380 publications were identified, and 54 of these met our inclusion criteria. Our model explained 58% of the variance in response rates of studies investigating the prevalence of difficulty with desire, arousal, orgasm, or sexual pain ( R 2 = 0.581, P = 0.027). This model was based on study design variables, study year, location, and the reported prevalence of each type of sexual difficulty. More recent studies (β = −1.05, P = 0.037) and studies that only included women over 50 years of age (β = −31.11, P = 0.007) had lower response rates. The use of face-to-face interviews was associated with a higher response rate (β = 20.51, P = 0.036). Studies that did not include questions regarding desire difficulties achieved higher response rates than those that did include questions on desire difficulty (β = 23.70, P = 0.034). Conclusion Response rates in prevalence studies addressing female sexual difficulty and dysfunction are frequently low and have decreased by an average of just over 1% per anum since the late 60s. Participation may improve by conducting interviews in person. Studies that investigate a broad range of ages may be less representative of older women, due to a poorer response in older age groups. Lower response rates in studies that investigate desire difficulty suggest that sexual desire is a particularly sensitive topic. Hayes RD, Bennett C, Dennerstein L, Gurrin L, and Fairley C. Modeling response rates in surveys of female sexual difficulty and dysfunction.

Introduction Many recent studies have investigated the prevalence of female sexual difficulty/dysfunction. Aim Investigate female sexual difficulty/dysfunction using data from prevalence studies. Methods We reviewed published prevalence studies excluding those that had not included each category of sexual difficulty (desire, arousal, orgasm, and pain), were based on convenience sampling, or had a response rate Main Outcome Measures For each study we used the prevalence of any sexual difficulty as the denominator and calculated the proportion of women reporting each type of difficulty. For each category of sexual difficulty we used the prevalence of that difficulty lasting 1 month or more as the denominator and calculated the proportion of difficulties lasting several months or more and 6 months or more. Results Only 11 of 1,248 studies identified met our inclusion criteria. These studies used different measures of sexual dysfunction, so generating a simple summary prevalence was not possible. However, we observed consistent patterns in the published data. Among women with any sexual difficulty, on average, 64% (range 16–75%) experienced desire difficulty, 35% (range 16– 48%) experienced orgasm difficulty, 31% (range 12–64%) experienced arousal difficulty, and 26% (range 7–58%) experienced sexual pain. Of the sexual difficulties that occurred for 1 month or more in the previous year, 62–89% persisted for at least several months and 25–28% persisted for 6 months or more. Two studies investigated distress. Only a proportion of women with sexual difficulty were distressed by it (21–67%). Conclusions Desire difficulty is the most common sexual difficulty experienced by women. While the majority of difficulties last for less than 6 months, up to a third persist for 6 months or more. Sexual difficulties do not always cause distress. Consequently, prevalence estimates will vary depending on the time frame specified by researchers and whether distress is included in these estimates. Hayes RD, Bennett CM, Fairley CK, Dennerstein L. What can prevalence studies tell us about female sexual difficulty and dysfunction? J Sex Med 2006;3:589–595.

Introduction Despite rapid current and anticipated growth in the number of women who will spend a substantial portion of their life span in the postmenopausal period, the nature, incidence, and prevalence of changes in sexual function during and after the menopausal transition remain poorly characterized. Aim Challenges inherent in studying the menopausal transition and proposed additions and changes that have emerged from recent consensus conferences on female sexual dysfunction are reviewed. Methods Specific topics related to female sexual dysfunction were presented in a Postmenopausal FSD Roundtable in which multidisciplinary international experts participated. Main Outcome Measure Expert opinion was based on a review of evidence‐based medical literature, presentation, and internal discussion. Results Knowledge concerning sexual function in the menopause is limited, in part, due to the difficulty in designing and conducting studies that adequately address these changes over time, and which also permit the effects of menopause to be distinguished from more general changes associated with aging. Moreover, the study of female sexual function and dysfunction is in the midst of significant transition: a tentative definition of the stages of reproductive aging and menopause has recently been advanced, and a set of comprehensive changes to the diagnostic framework that defines female sexual dysfunction is under review. Conclusions In spite of fast‐moving changes in this field of study, it is possible to reach some tentative conclusions about how women's sexual function changes after menopause: postmenopausal women report a relatively high rate of sexual dysfunction (higher than men). There is a marked decline in sexual interest and frequency of sexual activity. This decline can be ameliorated by a number of psychosocial factors, although vaginal dryness and dyspareunia seem to be driven primarily by declining estradiol. The effects of menopause appear to be incremental and additional to those characteristic of aging. Dennerstein L, and Hayes RD. Confronting the challenges: epidemiological study of female sexual dysfunction and the menopause. J Sex Med 2005;2(suppl 3):118–132.

Introduction Scientific interest in the impact of aging on women's sexual function and dysfunction has increased in the half century since Kinsey described age‐related changes in women's sexual activities. However, a range of methodological issues limit the conclusions that can be drawn from many published studies in this area. Aim To review community‐based studies investigating changes in women's sexual function and sexual dysfunction with age, taking into account confounders to aging and methodological limitations. Methods Electronic databases were searched for published studies investigating changes in sexual function and dysfunction with age. A critical review was carried out. Main Outcome Measures Age‐related changes in sexual function and dysfunction. Results There are inconsistencies in the way sexual function and sexual dysfunction are measured. Validated scales are infrequently used. Low response rates, limited age ranges, and restrictive inclusion criteria limit the generalizability of many studies. Confounders are often either not measured or not analyzed. Longitudinal studies are rare, making it difficult to separate the effects of birth cohort and aging. The evidence indicates that a woman's sexual function declines with age. This decline begins in a woman's late 20s to late 30s. Specifically, desire, frequency of orgasm, and frequency of sexual intercourse decrease with age. However, it is not clear whether arousal decreases or remains relatively constant. In longitudinal studies, decline in women's sexual function has also been detected, but patterns of stability and improved sexual function have also been observed for short periods of time. The prevalence of most sexual difficulties or dysfunctions changes little with age, with the exception of sexual pain, which may decrease. Conclusions Age‐related changes in sexually related personal distress may help explain why the prevalence of sexual dysfunctions remains constant with age while sexual function declines. More research is needed to demonstrate this.

Introduction. The challenge of personalised medicine is to identify components of addiction that are relevant to an individual in a way that treatment and drug overdose preventions can be tailored. Opioid misusers continue to have recognised extremely high mortality but the influence of psychiatric comorbidity in excess all-cause and cause-specific mortality is questionable. Methods. Opioid-dependent (OD) patients were identified in London-based patient register, which contains records on over 220,000 cases linked to national mortality tracing. We used Cox regression to model the effect of psychiatric co-morbidity on mortality, controlling for a broad range of potential confounders. Results. We identified 4837 OD patients with 176 deaths. The presence of comorbid personality disorder (PD) and alcohol use disorder (AUD) was found to be associated with increased all-cause mortality in all models, including the fully adjusted model. AUD was associated with two-fold increased risk of fatal overdose and seven-fold risk for liver-related deaths. Individuals with OUD and comorbid PD had almost four-times greater risk of liver related deaths compared to those without PD. Conclusions. The study highlights the importance of assessment for PD and alcohol misuse among opioid addicts in order to identify individuals at substantially elevated mortality risk for a more personalised approach to their medical care. This research is part of a larger project, which focusses on electronic-based personalised medicine in drug addiction. The complete research plan as well as research October '14 research update will also be provided.