Sexual Dysfunction and Distress Among Childhood Sexual Abuse Survivors: The Role of Post-Traumatic Stress Disorder

BackgroundResearch has revealed that survivors of childhood sexual abuse (CSA) have elevated sexual dysfunction and distress. Nevertheless, a vast majority of studies examining sexual dysfunction and distress among CSA survivors were conducted among women only, and the moderating role of post-traumatic stress disorder (PTSD) symptoms between a history of CSA and sexual dysfunction and distress is yet to be investigated.AimTo fill this gap, the present study aimed to investigate the following: (i) are there sex differences in the relations between CSA and sexual dysfunction and distress and (ii) whether PTSD symptoms mediate the relations between CSA and sexual dysfunction and distress.MethodsThis study was conducted online among 792 Israeli men and women aged 18–70 years; among whom, 367 reported a history of CSA.OutcomesThe findings of the present study suggest that PTSD symptoms mediate the relations between CSA and sexual dysfunction and distress.ResultsResults indicated that those who had a history of CSA reported elevated sexual dysfunction and sexual distress, as compared with non-abused participants, regardless of their sex. Furthermore, PTSD symptoms were related to sexual dysfunction and sexual distress and mediated the relations between a history of CSA and sexual dysfunction and distress. A history of CSA predicted elevated PTSD symptoms, which in turn, were related to elevated sexual dysfunction and distress. Clinical interventions for CSA survivors should incorporate various treatment approaches to alleviate both PTSD symptoms and sexual dysfunction and distress.Clinical translationThe present findings indicate the need for clinicians to identify PTSD symptoms and to conjoin distinctive treatment approaches to relieve survivors’ PTSD symptoms, as well as their sexual dysfunction and distress.Strengths & limitationsThe study included a non-clinical, convenience sample and used self-report measures, which are highly subjective and increase the possibility of social desirability biases. However, on the plus side, it provides important information on CSA survivor’s sexual functioning and can assist in establishing intervention goals, and to evaluate treatment.ConclusionPTSD symptoms were found to mediate the relations between a history of CSA and sexual dysfunction and distress, implying that PTSD symptoms serve as a mechanism underlying sexual dysfunction and distress among CSA survivors.Gewirtz-Meydan A, Lahav Y. Sexual Dysfunction and Distress Among Childhood Sexual Abuse Survivors: The Role of Post-Traumatic Stress Disorder. J Sex Med 2020;17:2267–2278.     

Sexual Functioning After Childhood Abuse: The Influence of Post-Traumatic Stress Disorder and Trauma Exposure

Background

Impairments in sexual functioning and sexual satisfaction are very common in women who have experienced childhood sexual abuse (CSA). A growing body of literature suggests a high prevalence of sexual distress in patients with post-traumatic stress disorder (PTSD). However, the influence of sexual trauma exposure per se and the influence of PTSD symptoms on impairments in sexual functioning remain unclear.

Sexual function and satisfaction in adults based on the definition of child sexual abuse

IntroductionThe literature shows a discrepancy in the association between child sexual abuse (CSA) and adult sexual function. One of the proposed explanations for this discrepancy is the different ways in which CSA is assessed. While some studies explicitly ask potential participants whether they are sexual abuse survivors, others ask whether participants experienced specific unwanted sexual behaviors.AimThis study investigated the differences between women who self-identified as CSA survivors, women who experienced similar unwanted sexual experiences but did not identify as CSA survivors (NSA), and women with no history of sexual abuse (control). CSA was defined as unwanted touching or penetration of the genitals before the age of 16.MethodsA sample of 699 college students anonymously completed a battery of questionnaires on sexuality and sexual abuse history.Main Outcome MeasuresSexual function was measured with the Female Sexual Function Index (FSFI), and sexual satisfaction was measured with the Sexual Satisfaction Scale-Women. History of CSA was measured with a modified version of Carlin and Ward's childhood abuse items.ResultsDifferences emerged between women who experienced sexual abuse before age 16 and women who never experienced sexual abuse (control) on the personal distress subscale of the Sexual Satisfaction Scale. The CSA group (N = 89) reported greater sexual distress compared to the NSA (N = 98) group, and the NSA group reported more distress than the control group (N = 512). No significant group differences were observed in the FSFI. Characteristics of the abuse that predicted whether women identified as CSA survivors included vaginal penetration, fear at the time of the abuse, familial relationship with the perpetrator, and chronic frequency of the abuse. These abuse characteristics were associated with sexual satisfaction but not with sexual function.ConclusionsDifferences in levels of sexual satisfaction between women with and without a history of CSA were associated with the type of CSA definition adopted. It remains unexplained why the CSA group showed more personal distress about their sexuality but not more sexual dysfunction. Rellini A, and Meston C. Sexual function and satisfaction in adults based on the definition of child sexual abuse.     

Deviance or Normalcy? The Relationship Among Paraphilic Thoughts and Behaviors,Hypersexuality, and Psychopathology in a Sample of University Students

Introduction

The actual definitions of paraphilic thoughts or behaviors and hypersexuality are still a matter of debate in the scientific community, and few studies have evaluated their psychopathological correlates in non-clinical samples of both men and women.

The Link Between Boredom and Hypersexuality: A Systematic Review

BackgroundSome conceptualizations of hypersexuality posit boredom as a possible trigger of hypersexual behavior.AimThis work aims to review published articles addressing the link between boredom and hypersexuality to investigate if this relationship can yet be established based on current empirical data.MethodsThis systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies, published until September 2019, were retrieved from EBSCO, Scopus, Web of Science, and PubMed. A systematic search was conducted using an exhaustive list of key terms combining “boredom” with “hypersexuality,” “sexual impulsivity,” “sexual compulsivity,” and “sexual addiction.” Only articles presenting empirical results concerning the relationship between boredom and hypersexuality were considered.ResultsFrom the initial poll of 76 articles, only 19 articles were included in our final selection. Of the total studies, 16 were quantitative studies and 3 were qualitative studies. 4 studies were validation studies of hypersexuality-related measures, 11 studies concerned online sexual activity, and 3 reported sexual boredom. 7 studies with men used non-heterosexual samples. 5 studies used samples with both women and men, and 1 study used a sample of women only. Most studies indicate a positive association between boredom and hypersexuality, although 4 did not.ImplicationsFurther studies with diversified samples are still indispensable, as female samples are not portrayed and research is much focused on online sexual activity. Future research should explore the relationship between boredom and hypersexuality within specific behavioral specifiers including masturbation, pornography use, sexual behavior with consenting adults, cybersex, telephone sex, and strip clubs.Strengths and limitationsTo the authors’ knowledge, this is the first review looking at the possible link between boredom and hypersexuality. Investigation on the topic is scarce, and several of the studies included in this review correspond to anecdotal evidences of the phenomenon, as only few studies used appropriate measures of boredom.ConclusionAlthough current literature identifies a link between boredom and hypersexuality, further substantive research is still much needed to clarify the associations between the 2 constructs.de Oliveira L, Carvalho J. The Link Between Boredom and Hypersexuality: A Systematic Review. J Sex Med 2020;17:994–1004.     

Association Between Marijuana Use and Sexual Frequency in the United States: A Population-Based Study

BackgroundMarijuana use is increasingly prevalent in the United States. Effects of marijuana use on sexual function are unclear, with contradictory reports of enhancement and detriment existing.AimTo elucidate whether a relation between marijuana use and sexual frequency exists using a nationally representative sample of reproductive-age men and women.MethodsWe analyzed data from cycle 6 (2002), cycle 7 (2006–2010), and continuous survey (2011–2015) administrations of the National Survey of Family Growth, a nationally representative cross-sectional survey. We used a multivariable model, controlling for demographic, socioeconomic, and anthropographic characteristics, to evaluate whether a relationship between marijuana use and sexual frequency exists.OutcomesSexual frequency within the 4 weeks preceding survey administration related to marijuana use and frequency in the year preceding survey administration.ResultsThe results of 28,176 women (average age = 29.9 years) and 22,943 men (average age = 29.5) were analyzed. More than 60% of men and women were Caucasian, and 76.1% of men and 80.4% of women reported at least a high school education. After adjustment, female monthly (incidence rate ratio [IRR] = 1.34, 95% CI = 1.07–1.68, P = .012), weekly (IRR = 1.36, 95% CI = 1.15–1.60, P < .001), and daily (IRR = 1.16, 95% CI = 1.01–1.32, P = .035) marijuana users had significantly higher sexual frequency compared with never users. Male weekly (IRR = 1.22, 95% CI = 1.06–1.41, P = .006) and daily (IRR = 1.36, 95% CI = 1.21–1.53, P < .001) users had significantly higher sexual frequency compared with never users. An overall trend for men (IRR = 1.08, 95% CI = 1.05–1.11, P < .001) and women (IRR = 1.07, 95% CI = 1.04–1.10, P < .001) was identified showing that higher marijuana use was associated with increased coital frequency.Clinical ImplicationsMarijuana use is independently associated with increased sexual frequency and does not appear to impair sexual function.Strengths and LimitationsOur study used a large well-controlled cohort and clearly defined end points to describe a novel association between marijuana use and sexual frequency. However, survey responses were self-reported and represent participants only at a specific point in time. Participants who did not answer questions related to marijuana use and sexual frequency were excluded.ConclusionA positive association between marijuana use and sexual frequency is seen in men and women across all demographic groups. Although reassuring, the effects of marijuana use on sexual function warrant further study.Sun AJ, Eisenberg ML. Association Between Marijuana Use and Sexual Frequency in the United States: A Population-Based Study. J Sex Med 2017;14:1342–1347.     

Sexual Distress and Sexual Problems During Pregnancy: Associations With Sexual and Relationship Satisfaction

IntroductionSexual problems are common during pregnancy, but the proportion of pregnant women who experience sexual distress is unknown. In non-pregnant samples, sexual distress is associated with lower sexual and relationship satisfaction.AimTo identify the proportion of women experiencing sexual distress during pregnancy and to compare the sexual and relationship satisfaction of women who report sexual distress during pregnancy with that of women without distress.MethodsTwo-hundred sixty-one pregnant women completed a cross-sectional online survey.Main Outcome MeasuresWomen completed validated measurements of sexual functioning (Female Sexual Function Index; score < 26.55 indicates a sexual problem), sexual distress (Female Sexual Distress Scale; score ≥ 15 indicates clinically significant distress), sexual satisfaction (Global Measure of Sexual Satisfaction), and relationship satisfaction (Couples Satisfaction Index).ResultsOverall, 42% of women met the clinical cutoff for sexual distress. Of sexually active women (n = 230), 26% reported concurrent sexual problems and distress and 14% reported sexual distress in the absence of sexual problems. Sexual distress and/or problems in sexual functioning were linked to lower sexual and relationship satisfaction compared with pregnant women with lower sexual distress and fewer sexual problems.ConclusionSexual distress is common during pregnancy and associated with lower sexual and relationship satisfaction. Health care providers should ask pregnant women about feelings of sexual distress. Identifying pregnant women who experience sexual distress and referring them to appropriate resources could help minimize sexual and relationship problems during pregnancy.Vannier SA, Rosen NO. Sexual Distress and Sexual Problems During Pregnancy: Associations With Sexual and Relationship Satisfaction. J Sex Med 2017;14:387–395.     

Sexual Responsivity and the Effects of Negative Mood on Sexual Arousal in Hypersexual Men Who Have Sex With Men (MSM)

BackgroundA number of studies have found that hypersexuality is associated with a high propensity for sexual excitation. In comparison, less is known about the relationship between hypersexuality and sexual arousal at the state level. Also, previous research has revealed a relationship between hypersexuality and negative mood. However, the possibility that sexual response might not be as negatively impacted by negative mood in hypersexual individuals has, as yet, not been tested.AimThe purpose of this study was to investigate sexual responsivity and the effects of negative mood on sexual arousal in hypersexual men who have sex with men (MSM).MethodsA total of 211 MSM were assigned to a hypersexuality (N = 81) or a control (N = 130) group using an interview patterned with a semi-structured Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders format. Participants filled out questionnaires and were shown neutral, sexual, and anxiety- and sadness-inducing films.OutcomesChanges in penile circumference and self-reported sexual arousal were the primary outcomes analyzed in this study.ResultsControlling for age and HIV status, no differences were found in genital response between hypersexual and non-hypersexual men. Also, the 2 groups did not differ in subjective sexual arousal. Moreover, no effects of negative mood were found. Time series clustering analyses revealed 3 groups—low responders and slow and fast high responders. Sexual excitation, but not sexual compulsivity or pornography use, predicted cluster membership.Clinical TranslationHypersexual MSM may benefit more from an exploration of motivational and behavioral, as compared to psychophysiological, mechanisms underlying possible links between (negative) mood and sexual behavior.Strengths & LimitationsStrengths of the study include its sample size, making it one of the larger psychophysiological sex studies; the use of clinical interviews for group assignment; the inclusion of genital response measures; and the application of time series clustering to examine differences among participants. Limitations include possible sample heterogeneity and the reliance on researcher-selected stimuli.ConclusionGiven the lack of any effects of negative mood on sexual response in hypersexual MSM, future studies could explore in more depth possible motivational and behavioral effects, including, for example, the impact of negative mood on the tendency to seek out sex as a form of distraction or for validation or emotional support.Janssen E, Prause N, Romine RS, et al. Sexual Responsivity and the Effects of Negative Mood on Sexual Arousal in Hypersexual Men Who Have Sex With Men (MSM). J Sex Med 2020;17:1751–1760.     

“If Everyone Else Is Having This Talk With Their Doctor,Why Am I Not Having This Talk With Mine?”: The Experiences of Sexuality and Sexual Health Education of Young Women With Spina Bifida

IntroductionWomen with spina bifida are sexually active, but most never discuss this topic with providers.AimTo determine what women with spina bifida understand about their sexual health, how they learned about it, what questions they have, and their experiences with their sexuality.MethodsFor this qualitative study, women with spina bifida ages 16 and older without marked developmental delay were individually interviewed. 25 women with spina bifida participated (mean age 27.1 years, range 16–52). Interviews were independently coded for themes by 3 reviewers, using Grounded Theory, with disagreements resolved by consensus.Main Outcome MeasuresWe identified overlapping themes regarding the women’s perception and experience of their sexuality and sexual health education.Results17 of the 25 (68%) participants had been or were currently sexually active. 5 themes emerged regarding their understanding of their sexuality and their sexual experiences: (i) being perceived as asexual, (ii) sources for sex education, (iii) need for spina bifida–specific sex education, (iv) impact of spina bifida–specific features on sexual encounters, and (v) perceived relationship between low sexual self-confidence and risk for sexual assault.Clinical ImplicationsWomen with spina bifida are sexual beings, but they are perceived as asexual by providers, which prevents them from getting adequate sexual health education and leaves them with misconceptions and unanswered questions, as well as vulnerable to sexual abuse.Strength & LimitationsThe strengths of this study include the diversity of women interviewed, including their age, severity of disability, and experiences with their sexuality, as well as the ability to reach thematic saturation. The limitation of this study is that most women received treatment at a single Midwestern tertiary referral center in the United States.ConclusionIncluding sexual health discussions in the usual care of women with spina bifida is critical to enhancing their sexual confidence and experience and preventing sexual abuse.Streur CS, Schafer CL, Garcia VP, et al. “If Everyone Else Is Having This Talk With Their Doctor, Why Am I Not Having This Talk With Mine?”: The Experiences of Sexuality and Sexual Health Education of Young Women With Spina Bifida. J Sex Med 2019;16:853–859.     

Sexual Sensation Seeking,Sexual Compulsivity,and Gender Identity and Its Relationship With Sexual Functioning in a Population Sample of Men and Women

IntroductionDespite awareness of the importance of psycho-affective factors in the development of sexual problems, there is a lack of studies exploring the relation of sexual sensation seeking (SSS) and sexual compulsivity (SC) to sexual functioning. Because sex differences in SSS and SC have been reported, gender identity (GI; an individual’s own experience of his or her gender that is unrelated to the actual biological sex) might act as a moderator in this relation.AimTo understand the role of SSS and SC for men and women's sexual functioning and to explore whether these potential associations are moderated by GI.MethodsA population-based cross-sectional online survey targeted 279 individuals (69.2% women, 30.8% men; mean age = 32 years). Validated questionnaires, including the Sexual Sensation Seeking Scale, the Sexual Compulsivity Scale, the Female Sexual Function Index, the Premature Ejaculation Diagnostic Tool, and the International Index of Erectile Function, were applied.Main Outcome MeasuresVariations in SSS and SC and their association with sexual functioning were investigated using Spearman rank correlation. Moderation analyses were conducted using regression models in which the interaction terms between SSS and GI and between SCS and GI as predictors of sexual functioning were included.ResultsA statistically significant correlation between SSS and SC could be detected in men and women (r = 0.41 and 0.33, respectively; P < .001 for the two comparisons). In women, higher levels of SSS were associated with higher levels of desire, arousal, lubrication, and orgasm and less sexual pain (P < .05 for all comparisons). No moderating effect of GI could be detected. In men, GI was a significant moderator in the relation between SC and erectile function (β = 0.47; P < .001) and between SSS and erectile and ejaculatory function (β = −0.41 and 0.30; P < .001 for the two comparisons).ConclusionThe present study is the first to show a link between SSS and SC and sexual functioning. The results might have important clinical implications and can provide useful information for programs aimed at sexual health enhancement.     

Psychometric Properties of Common Measures of Hypersexuality in an Online Canadian Sample

BackgroundHypersexuality has been posited as the central defining feature of Compulsive Sexual Behavior Disorder, and although the acceptance and inclusion of this construct in psychiatric nosologies provides some legitimacy, concerns surrounding terminology, assessment, and diagnosis remain.AimThe present study was an independent psychometric examination of 2 of the most commonly used measures of Compulsive Sexual Behavior Disorder; specifically, the gender invariance of the latent structure, reliability (test retest, internal consistency), and external correlates (concurrent validity) of these measures.MethodsThe Sexual Compulsivity Scale and the Hypersexual Behavior Inventory were completed by 2 nonclinical online community samples of cisgender women (ns = 525 and 359), cisgender men (ns = 419 and 364), and transgender or non-binary individuals (ns = 38 and 11).OutcomesCriterion based measures of sexual history and total sexual outlet (number of orgasms per week) were gathered to validate Sexual Compulsivity Scale and Hypersexual Behavior Inventory total and factor scores.ResultsResults supported the factorial validity of both assessment measures: correlated 3 factor solutions were established through exploratory factor analysis of 1 sample, and confirmatory factor analysis in the second sample. Multiple group confirmatory factor analysis, conducted on the 2 combined samples, also supported the gender invariance of the 3-factor solutions. Additional basic psychometric indices of test-retest and internal consistency reliability and criterion-related (concurrent) validity conducted across the 2 online samples were supported.Clinical ImplicationsCommon measures of hypersexuality have potential for use in its assessment, treatment, and management.Strengths & LimitationsStudy strengths include: the inclusion of 2 fairly large and diverse online samples, thorough checks for insufficient effort/validity of responding, validity and reliability methodology (ie, measurement at multiple time points, obtaining behavioral indicators of sexual health), and a comprehensive set of psychometric analyses to inform conclusions regarding the external validity, reliability, and latent structure of hypersexuality measures across gender groups. Study limitations include: potential concerns related to validity and accuracy of responding owing to a reliance on self-report, the potential for selection bias, and limiting the examination of the latent structure of hypersexuality to cisgender men and women such that the results may not generalize to gender diverse populations.ConclusionHypersexuality is a multidimensional construct, with a common latent structure among cisgender men and women, consistency in measurement over time, and meaningful concurrent associations with behavioral criteria that have relevance for sexual health.Olver ME, Kingston DA, Laverty EK, et al. Psychometric Properties of Common Measures of Hypersexuality in an Online Canadian Sample. J Sex Med 2022;19:331–346.     

Self‐Reported Indicators of Hypersexuality and Its Correlates in a Female Online Sample

IntroductionHypersexual behavior has been a controversial and much disputed issue in the field of sexual medicine. However, only little attention has been paid to hypersexual behavior in women. Therefore, to date there is limited knowledge on the behavioral patterns of hypersexuality in women.AimsThe purpose of the present study was to examine which sexual behavioral patterns are associated with self‐reported indicators of hypersexuality in a female online sample. The second aim was to evaluate the association between hypersexuality and sexual risk behavior in women.MethodsIn total, 988 women participated in an online survey. Logistic regression analysis was conducted to examine the association between sexual behavioral patterns and hypersexuality. Furthermore, correlation analyses were calculated in order to identify the relationship between sexual risk behavior and hypersexuality.Main Outcome MeasuresIndicators of hypersexual behavior were measured by the Hypersexual Behavior Inventory (HBI). In addition, current and present impersonal sexual activities were investigated. Sexual risk behavior was assessed using the Sexual Sensation Seeking Scale (SSSS).ResultsHigh masturbation frequency, number of sexual partners, and pornography use were associated with a higher degree of hypersexual behavior in women. Furthermore, the HBI total score was positively correlated to sexual risk behavior.ConclusionThe results of the current study do not support the idea of previous research that hypersexual women are typically engaged in more passive forms of sexual behavior. Rather female hypersexuality seems to be more characterized by impersonal sexual activity. An association between hypersexual behavior and sexual risk behavior was identified. The implications of these findings for potential prevention strategies and therapeutic interventions are discussed. Klein V, Rettenberger M, and Briken P. Self‐reported indicators of hypersexuality and its correlates in a female online sample. J Sex Med 2014;11:1974–1981.     

A Systematic Review on Sexual Boredom

BackgroundEmpirical data on sexual boredom are scarce and unsystematized, contrasting with the literature on general boredom.AimThe aim of this review of literature is to verify how sexual boredom is defined in previous research and which relationships were found with sexual functioning, relationship dynamics, or gender.MethodsA systematic search was conducted in EBSCO, Scopus, Web of Science, and PubMed databases for papers published until August 2020. Search terms used were “sexual boredom” or “sexual tedium” or “sexual indifference” or “sexual monotony” or a combination of “boredom” and “sexual activity” or “intercourse”. This systematic review followed PRISMA guidelines.OutcomesArticles were grouped in general boredom and sexuality research and in sexual boredom research.ResultsThis review consists of 43 articles, of which 31 are quantitative studies, 8 are qualitative studies, and 4 are mixed-method studies. Studies concerning general boredom and sexuality include research on diverse aspects of sexual behavior, namely solitary sexual behavior, extra-dyadic sex, compulsive sexual behavior, and risky sexual behavior. Sexual boredom research included papers regarding personality, sexual response, and varied aspects of sexual behavior.Clinical ImplicationsFindings suggest sexual boredom is related with sexual response, sexual satisfaction, and hypersexuality, which renders clinical relevance. Sexual boredom impacts well-being, and further research should focus on exploring potential mechanisms underpinning this sexual problem.Strengths and limitationsTo the authors' knowledge, this is the only existing systematic review of sexual boredom and allowed identifying key features of sexual boredom and related aspects. However, because most studies are correlational, and several do not use comprehensive measures of sexual boredom, no causal relationships were identified.ConclusionThis review indicates the construct of sexual boredom includes individual, relationship, and societal aspects. However, no definition of sexual boredom includes these, and current knowledge does not allow formulating a model or a theory of sexual boredom.de Oliveira L, Carvalho J, Nobre P. A Systematic Review on Sexual Boredom. J Sex Med 2021;18:565–581.     

The invisible wounds: The occurrence of psychological abuse and anxiety compared with previous experience of physical abuse during the childbearing year

The aim of this study was to measure the prevalence, effects and character of psychological abuse in women visiting antenatal clinics. A standardized questionnaire based on four different established scales (PMWI, SVAW, TSC-33, and STAI) was used to estimate the frequency of psychological, physical and sexual abuse, anxiety and depression. in the study 207 pregnant Swedish born women married to or cohabiting with Swedish born men were consecutively chosen from three different antenatal dimes from the city of Göteborg, Sweden. Personal interviews were conducted in connection to their regular visit to the antenatal dink, ranging from the first to the third trimester. Fifty-one (24.5%) women out of 207 reported threats and/or acts of violence during the last year according to the Severity of Violence Against Women Scale (SVAW). There was 89.4% who had experienced dominance/isolation according to the Psychological Maltreatment of Women Inventory (PMWI) and 44.4% of the women reported emotional/verbal abuse. Occupational status, but not age income or education, was found to be significantly correlated to physical violence, dominance/isolation and to emotional/verbal factor according to Psychological Maltreatment of Women Inventory (PMWI). Threats of moderate violence and ‘serious violence’ were strongly correlated to physical violence (correlation coefficient 0.9433 and 0.9405, respectively). Sexual abuse demonstrated a high correlation to physical violence and emotional/verbal factor. The results indicate that sexual violence is highly represented in the abusive relationship and also that depression and anxiety in the childbearing year may be caused by domestic violence. This study emphasises the importance of incorporating screening for threats and actual acts of psychological, physical and sexual abuse into routine care for women, enabling health care providers to identify high-risk patients and improve quality of care.     

Effects of Expressive Writing on Sexual Dysfunction,Depression, and PTSD in Women with a History of Childhood Sexual Abuse: Results from a Randomized Clinical Trial

IntroductionWomen with a history of childhood sexual abuse (CSA) have high rates of depression, posttraumatic stress disorder, and sexual problems in adulthood.AimWe tested an expressive writing-based intervention for its effects on psychopathology, sexual function, satisfaction, and distress in women who have a history of CSA.MethodsSeventy women with CSA histories completed five 30-minute sessions of expressive writing, either with a trauma focus or a sexual schema focus.Main Outcome MeasuresValidated self-report measures of psychopathology and sexual function were conducted at posttreatment: 2 weeks, 1 month, and 6 months.ResultsWomen in both writing interventions exhibited improved symptoms of depression and posttraumatic stress disorder (PTSD). Women who were instructed to write about the impact of the abuse on their sexual schema were significantly more likely to recover from sexual dysfunction.ConclusionsExpressive writing may improve depressive and PTSD symptoms in women with CSA histories. Sexual schema-focused expressive writing in particular appears to improve sexual problems, especially for depressed women with CSA histories. Both treatments are accessible, cost-effective, and acceptable to patients. Meston CM, Lorenz TA, and Stephenson KR. Effects of expressive writing on sexual dysfunction, depression, and PTSD in women with a history of childhood sexual abuse: Results from a randomized clinical trial. J Sex Med 2013;10:2177–2189.     

Gender Differences in the Emotional Response and Subjective Sexual Arousal Toward Non-Consensual Sexual Intercourse: A Pupillometric Study

BackgroundGender differences in sexual response have targeted individuals' emotional appraisal of mainstream erotica. Yet, evidence reveals that men and women commonly endorse non-normative sexual interests, and no evidence has been collected on their emotional responses toward deviant sexual stimuli.AimThis study was aimed at evaluating gender differences in the emotional responses toward non-consensual sexual intercourse, thus revealing individuals' appraisal of non-normative sexual contents. In order to provide an initial background to interpret findings, this study further tested the association between individuals' emotional responses and sexual self-schemas (SSSs).Methods29 men and 45 women (all heterosexual) were voluntarily exposed to audiovisual presentations of non-consensual/physically forced sexual intercourse in a laboratory context. Markers of emotional response were collected by psychophysiological and self-report means.OutcomesPupil activation, namely pupil diameter ratio, during exposure to the video clips was captured with an eye tracker. Positive and negative emotions and subjective sexual arousal toward the clips were also collected. In addition, participants responded to the SSS scale assessing individuals' sexual self-perceptions.ResultsFindings revealed a small degree of gender differences. While men reported significantly more positive emotions toward the clip displaying a woman as recipient to non-consensual sex, no further differences were found. Also, participants revealed an increased pupil diameter ratio only in the first moments of the video clips. SSSs, including themes of aggression and power, were associated with men's emotional responses toward the clips, while no associations were found in women.Clinical TranslationDespite its preliminary nature, the current study provides evidence on the emotional mechanisms underpinning human sexual response, and may eventually translate to conceptualizing models with a focus on non-normative sexual behavior.Strengths & LimitationsTo our best knowledge, this is the first study researching gender specificities in the emotional appraisal of non-consented sex. Current findings may help to understand individuals' deviant sexual interests and establish a framework for future research in this area. However, it is worth noting that lack of previous research prevents the generalization of findings and limits our interpretation of data.ConclusionFindings revealed a small degree of gender differences in the emotional appraisal of non-consensual sexual intercourse, and suggested partial evidence in the relationship between sexual self-perceptions and emotional responses to forced sex.Carvalho J, Rosa PJ. Gender Differences in the Emotional Response and Subjective Sexual Arousal Toward Non-Consensual Sexual Intercourse: A Pupillometric Study. J Sex Med 2020;17:1865–1874.     

Are the Predictors of Sexual Violence the Same as Those of Nonsexual Violence? A Gender Analysis

IntroductionViolence manifests itself in such multifarious ways as sexual, physical, and psychological abuse. What has hitherto eluded the medical community, however, is whether sexual and nonsexual abuse share the same predictors.AimDrawing upon a representative sample of married men and women in the Iranian capital, Tehran, we aimed to determine: (i) the overlap between sexual abuse and physical and psychological violence, and (ii) the predictors that sexual violence victimization share with physical and psychological violence victimization.Main Outcome MeasuresVictimization through any type of sexual coercion by the husband in the context of the current marital relationship, as determined via the conflict tactic scales-revised (CTS-2).MethodsIn a cross-sectional survey in Tehran in 2007, 460 married Iranian men and women were selected via a multicluster sampling method from four different randomized regions. Independent variables comprised sociodemographic characteristics, subscores of psychological, and personality characteristics known to be allied with intimate abuse (personal and relationship profile), and dichotomus data on victimization history through all types of violence by the spouse including psychological aggression, physical assault, and sexual coercion (CTS-2).ResultsIn both genders, the experience of physical or psychological violence increased the likelihood of sexual violence victimization. In both genders, higher conflict was a predictor of sexual and psychological violence victimization. In addition, the common predictors of sexual and physical violence victimization were low self-control and high violent socialization in the men and women, respectively.ConclusionsSexual violence victimization shares some factors with the victimization of nonsexual types of marital abuse, but this seems to be partially gender dependent. Mohammadkhani P, Forouzan AS, Khooshabi KS, Assari S, and Moghani Lankarani M. Are the predictors of sexual violence the same as those of nonsexual violence? A gender analysis. J Sex Med 2009;6:2215–2223.     

Pregnancy and Sexual Relationships Study Involving wOmen and meN (PASSION Study)

IntroductionSexual satisfaction is believed to decrease during pregnancy; however, the effect of pregnancy on the sexual relationship in a couple is not well studied.AimTo assess for sexual dysfunction in heterosexual couples during pregnancy.MethodsWe performed a cross-sectional study of heterosexual pregnant women in the third trimester and their cohabitating partners.Main Outcome MeasuresSexual satisfaction in heterosexual couples during pregnancy was assessed with a self-reported questionnaire, the Golombok-Rust Inventory of Sexual Satisfaction (GRISS) questionnaire.ResultsA total of 53 couples met eligibility criteria, and nearly all of those approached participated (52 of 53 couples). All couples were enrolled at or after 35 weeks’ gestation. The mean age was 29.0 ± 6.4 and 31.3 ± 6.9 years for women and men, respectively. 60% of couples were married, and the remainder were cohabitating and in a committed relationship. When analyzing the results of the GRISS questionnaire for both partners, a significant difference was seen in mean avoidance of sex between women and men (3.31 vs 2.63; P = .047) and non-sensuality (3.54 vs 2.75; P = .040). Women reported more of a decrease in communication about sex when compared with their partners (3.79 vs 3.23; P = .047). Vaginismus was more problematic during pregnancy than before (mean = 4.17), and frequency of intercourse was decreased (mean = 4.93) based on calculated GRISS scores.Clinical ImplicationsPregnant couples reported decreased frequency of intercourse and more pain with intercourse in women. Women were more likely to avoid intercourse and reported more problems with communication regarding sexual needs.Strength & LimitationsThis study is the first to assess both partners in pregnancy. Due to the nature of the study, we were unable to assess other factors affecting the relationship that may result in sexual dysfunction, there was no control group, and the results are limited to heterosexual couples.ConclusionOverall sexual satisfaction and function were not problematic for these couples during pregnancy based on the GRISS scale.Dwarica DS, Garbe Collins G, Fitzgerald C, et al. Pregnancy and Sexual Relationships Study Involving WOmen and MeN (PASSION Study). J Sex Med 2019;16:975–980.     

Sexual Functioning Among Childhood Sexual Abuse Survivors From an Attachment Perspective

BackgroundDespite the fact that childhood sexual abuse can affect a survivor's sexual functioning in adulthood, few studies have examined survivors' adult sexual functioning from the perspective of attachment theory.AimThe present study sought to examine how sexual abuse in childhood might shape the associations between attachment insecurities and sexual functioning among adults.MethodsThe study sample consisted of 265 participants (166 women and 99 men), 45 (16.9%) of whom were classified as survivors of childhood sexual abuse. Participants completed an online questionnaire about their history of childhood sexual abuse, attachment insecurities, and sexual functioning over the past 6 months.OutcomesThe findings of the present study suggest that attachment insecurities may have unique implications for sexual functioning among survivors of childhood sexual abuse.ResultsFindings indicated that a history of childhood sexual abuse significantly moderated the associations between attachment insecurities and sexual functioning. Whereas the effect of attachment avoidance in predicting sexual desire was not significant among nonabused participants, it was significant among survivors; specifically, higher levels of attachment avoidance predicted lower levels of sexual desire. A different pattern was found for attachment anxiety. Although attachment anxiety did not predict vaginal lubrication/penile erection among nonabused participants, it had significant effects among survivors; specifically, higher levels of attachment anxiety predicted higher levels of vaginal lubrication/penile erection.Clinical TranslationFindings from the present study may help facilitate sex therapy interventions for childhood sexual abuse survivors, from an attachment theory perspective.Strengths & LimitationsThe study included a nonclinical, convenience sample and used self-report measures, which are highly subjective and increase the possibility of social-desirability biases. However, on the plus side, it relied on simple, short, self-report questionnaires that are accessible and can be easily used by professionals to examine a survivor's current condition relative to any of the variables, establish intervention goals, and evaluate treatment.ConclusionA history of childhood sexual abuse is related to 2 opposite patterns of association between attachment insecurity (depending on type) and sexual functioning.Gewirtz-Meydan A, Lahav Y. Sexual Functioning Among Childhood Sexual Abuse Survivors From an Attachment Perspective. J Sex Med 2020;17:1370–1382.