We referred to the DSM‐IV‐TR and specifically defined “sexual aversion” as the persistent or recurrent extreme fear and aversion to and avoidance of, all or almost all, genital sexual contact with a sexual partner and “low sexual desire” as a deficiency of sexual desire or decreased libido without any aversion toward sexual intimacy or genitalia. From the detailed information gathered, each complaints and issues was categorized and classified. Although the survey contained only a single open‐ended question in connection with their intimate relationship, most participants replied with great details describing the onset, chronological course of the sexual problems, and presence of children, and even speculated on possible causes such as marital/couple relationship issues, lifestyle, and coexisting health problems. Each category and reply was separately reviewed by an expert physician (K.N.) before it was sent to the respondent. Then, a urologist with postgraduate training in sexual medicine (Y.O.) assessed, defined, and categorized the presenting complaints from each participant e‐mail. Participants were asked to provide information regarding their age (teens, 20s, 30s, 40s, 50s, or over), area of residence, presence of sexual partners, and marital status, and were also given the opportunity to answer an open‐ended question which specifically related to their sexual problems ( Appendix 1). Access to the database was password protected. Data were transferred directly to a database, where they were anonymized. Respondents were required to give informed consent before they could respond to the questions. On the sexual counseling website, participants were informed that their responses would form part of an investigation into Japanese women's sexual health. To our knowledge, our institution is the first in Japan to establish an online helpline for women with sexual problems, and 1 year after the helpline was set up, it constantly appeared on the first page of any major internet search engine whenever the key words “female sexual dysfunction” were entered in the Japanese language. Traditionally, there is a pronounced scarcity of data regarding Japanese women's sexual problems as Japanese women rarely seek advice from their physicians. This was an observational web‐based pilot study, and hence, no exclusion criteria were established. We offered an absolute anonymity and free counseling. The helpline addressed Japanese women with sexual problems living either in Japan or abroad. It provided reliable information about sexual problems such as causes, available treatments, and also a recommended treatment for the specific type of sexual problems. From the online data, we conducted a cross‐sectional study in order to raise the awareness of Japanese women's sexual problems and further investigate the yet unexplored field of women sexuality and its problems within Japan. Īn online‐based helpline service ( ‐u.ac.jp/med/omori/repro/patient/sexual_impairment/female_trouble.html) was established in January 2010 at the reproduction center internet website at the Toho University School of Medicine, Japan. Nevertheless, for many people suffering from sexual problems, helplines services represent an important first step. On the other hand, there are several inherent shortcomings, such as a lack of visual cues and the impossibility of physical exams. An online helpline can also remove the barriers of geographical isolation and time restriction. Previous studies indicated that helplines were advantageous for patients with sexual problems as their anonymity could make consultations less stressful and embarrassing. One of the reasons is that the topic is treated as taboo among most Asian women, making it difficult to seek medical advice. However, little is known about women's sexual problems in Japan. Furthermore, in the global study, Japanese couples reported the lowest levels of sexual satisfaction. Women in East Asia and Southeast Asia were more likely to report sexual problems than women in other areas of the world. A global survey reported that the most common sexual problems among women worldwide were a lack of sexual desire and inability to reach orgasm. Several studies have demonstrated that 38–63% of women worldwide had sexual problems. They can lead to stress, depression, anxiety, and infertility. Women's sexual problems are common and can affect quality of life at any age.
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