Self-Compassion,Emotion Regulation,and Female Sexual Pain: A Comparative Exploratory Analysis

IntroductionSexual pain is a multideterminate phenomenon, resulting from the interplay between biopsychosocial dimensions. Research suggests that self-compassion plays a protective role on mental health through the enablement of adaptive emotion regulation strategies and that they both contribute to ease chronic pain experience. However, little is known about the role played by self-compassion and emotion regulation on female sexual pain.AimThe study aims to identify differences between women with self-reported sexual pain, women with other self-reported sexual dysfunctions, and women without sexual complaints regarding self-compassion and emotion regulation.MethodsA total of 220 women (M_age = 27.73 years, SD = 8.46) were divided into 3 groups based on their clinical condition – 53 women with self-reported sexual pain, 30 women with other self-reported sexual dysfunctions, and 137 women without sexual complaints – completed measures of sexual functioning (Female Sexual Function Index), self-compassion (Self-Compassion Scale), and difficulties in emotion regulation (Difficulties in Emotion Regulation Scale). Multivariate analyses of variance (MANOVAs) with post hoc analyses were performed.Main Outcome MeasureThe main outcome measures were self-compassion, measured on a 5-point Likert scale using 26-item questionnaire, and difficulties in emotion regulation, assessed on a 5-point Likert scale using a 36-item questionnaire.ResultsFindings indicated that women with self-reported sexual dysfunction and particularly women with self-reported sexual pain report lower self-compassion (P values ranging between .001 and .044) and more difficulties in emotion regulation (P values ranging between .003 and .023) than women without sexual problems.Clinical ImplicationsFindings highlight the association between lower levels of self-compassion and more difficulties in emotion regulation with self-reported sexual complaints, particularly with genito-pelvic pain–related sexual complaints.Strength & LimitationsThis is the first study to address differences between groups with different self-reported sexual dysfunctions regarding self-compassion and emotion regulation. Findings suggest that women with self-reported sexual dysfunction, particularly female sexual pain, report decreased levels of self-compassion and emotion regulation. The absence of equity on sample dimension and the correlational nature of the study are limitations to be considered.ConclusionResults indicated that self-compassion and emotion regulation are associated with sexual complaints, and particularly genito-pelvic pain complaints, suggesting the importance of conducting further investigation to address their potential positive outcomes in clinical intervention.Vasconcelos P, Oliveira C, Nobre P. Self-Compassion, Emotion Regulation, and Female Sexual Pain: A Comparative Exploratory Analysis. J Sex Med 2020;17:289–299.     

Stability of Genetic and Environmental Influences on Female Sexual Functioning

Background

Genetic factors have been implicated in the etiology of female sexual dysfunction. Yet, how much the dynamic nature of sexual functioning is influenced by changes in genetic and/or environmental factors remains unknown.

Genital Pain and Numbness and Female Sexual Dysfunction in Adult Bicyclists

IntroductionBicycle seat pressure on the perineum may impair arousal and clitoral erection, likely contributing to genital pain and numbness experienced by female cyclists.AimWe aimed to identify the association between genital pain and numbness experienced by female cyclists and female sexual dysfunction (FSD).MethodsFemale cyclists were recruited to complete an online survey using the Female Sexual Function Index (FSFI), a validated questionnaire to assess FSD. Cyclist demographics, experience, preferred riding style, use of ergonomic cycle modifications, and genital discomfort while riding were also queried. Multivariate logistic regression analysis was used to evaluate risk factors of FSD.Main Outcome MeasuresThe main outcome was FSFI score, which is used to diagnose FSD when the FSFI score is <26.55.ResultsOf the survey respondents, 178 (53.1%) completed the survey and FSFI questionnaire. Mean age was 48.1 years (±0.8 standard error [SE]), and the average riding experience was 17.1 years (±0.9 SE). Overall, 53.9% of female cyclists had FSD, 58.1% reported genital numbness, and 69.1% reported genital pain. After adjusting for age, body mass index, relationship status, smoking history, comorbidities, and average time spent cycling per week, females who reported experiencing genital numbness half the time or more were more likely to have FSD (adjusted odds ratio [aOR], 6.0; 95% CI, 1.5–23.6; P = .01), especially if localized to the clitoris (aOR, 2.5; 95% CI, 1.2–5.5; P = .02). Females that reported genital pain half the time or more while cycling also were more likely to have FSD (aOR, 3.6; 95% CI, 1.2–11.1; P = .02). Cyclists experiencing genital pain within the first hour of their ride were more likely to have FSD (aOR, 12.6; 95% CI, 2.5–63.1; P = .002). Frequency and duration of cycling were not associated with FSD. Analysis of FSFI domains found that the frequency of numbness was correlated with decreased arousal, orgasm, and satisfaction during intercourse, whereas the frequency of pain significantly reduced arousal, orgasm, and genital lubrication.Clinical ImplicationsFemale cyclists that experience numbness and/or pain have higher odds of reporting FSD.Strengths & LimitationsOur study includes a validated questionnaire to assess FSD and queries specific characteristics and symptoms of genital pain and genital numbness; however, the study is limited by its cross-sectional survey design.ConclusionThis study highlights the need for cyclists to address genital pain and numbness experienced while cycling, and future studies are required to determine if alleviating these symptoms can reduce the impact of cycling on female sexual function.Greenberg GR, Khandwala YS, Breyer BN, et al. Genital Pain and Numbness and Female Sexual Dysfunction in Adult Bicyclists. J Sex Med 2019; 16:1381–1389.     

Self-Focused Reasons for Having Sex: Associations Between Sexual Goals and Women's Pain and Sexual and Psychological Well-being for Couples Coping With Provoked Vestibulodynia

BackgroundFor couples coping with provoked vestibulodynia (PVD), interpersonal sexual goals are associated with sexual and psychological functioning as well as women’s pain during intercourse, however, self-focused sexual goals (eg, having sex for personal pleasure, having sex to avoid feeling bad about oneself) have not been studied in this clinical population.AimThe purpose of this study was to examine the associations between self-focused approach and avoidance sexual goals and women's pain during intercourse and sexual satisfaction and depressive symptoms for both women and their partners.MethodsWomen diagnosed with PVD (N = 69) and their partners completed measures of self-focused sexual goals, sexual satisfaction, and depressive symptoms. Women also reported on pain experienced during sexual intercourse.OutcomesOutcomes included the Global Measure of Sexual Satisfaction, the Beck Depression Inventory-II, and a Numerical Rating Scale of pain during sexual intercourse.ResultsWhen women reported higher self-focused approach sexual goals, they also reported lower pain intensity. Women's higher self-focused avoidance sexual goals were associated with their own higher depressive symptoms, whereas men's higher self-focused approach goals were associated with their own higher depressive symptoms. When controlling for frequency of sexual intercourse, there were no significant associations between women or partners' sexual goals and sexual satisfaction.Clinical ImplicationsWithin a clinical context where many interpersonal pressures for sex exist, interventions should target self-focused sexual goals alongside interpersonal sexual goals to improve pain and psychological adjustment.Strengths & LimitationsThis is the first study to examine self-focused sexual goals among women with PVD and their partners. This study is cross-sectional, and the direction of associations cannot be inferred. Couples were in mixed-sex relationships, and results may not generalize to same-sex couples.ConclusionFindings suggest that self-focused goals are relevant to the psychological adjustment of women with PVD and their male partners and for women's pain.Corsini-Munt S, Bergeron S, Rosen NO. Self-Focused Reasons for Having Sex: Associations Between Sexual Goals and Women's Pain and Sexual and Psychological Well-being for Couples Coping With Provoked Vestibulodynia. J Sex Med 2020;17:975–984.     

Associations Between Depressive Symptoms and Sexual Risk Behavior in a Diverse Sample of Female Adolescents

Study ObjectiveTo determine associations between depressive symptoms, locus of control, and sexual outcomes in a predominantly African-American cohort of female adolescents.DesignA computerized assessment was administered to participants as part of a larger randomized clinical trial. We assessed sexual risk behaviors (SRBs) via self-report, and we assessed depressive symptoms using the Center for Epidemiologic Studies Depression Scale. We used multivariate regression to determine associations between depressive symptoms and outcomes while controlling for covariates.SettingThis was a secondary analysis of baseline data collected during a randomized clinical trial intended to prevent unintended pregnancy and sexually transmitted infections (STIs).Participants572 adolescent females, ages 13 to 21 years, were recruited via a hospital-based adolescent clinic and community-wide advertisements.Main Outcome MeasuresParticipants reported on prior sexual intercourse, number of lifetime partners, frequency of intercourse, history of pregnancies and STIs, and locus of control.ResultsTwo thirds of the sample had been sexually active. In a model that controlled for all covariates, those with a high level of depressive symptoms had higher odds of having had intercourse (adjusted OR = 2.29; 95% CI = 1.18–4.43). High levels of depressive symptoms were also independently associated with increased numbers of lifetime sexual partners and an external locus of control. However, when depression and locus of control were included in the same model, locus of control was not independently associated with SRBs.ConclusionThese findings support other literature demonstrating an association between depression and SRBs, particularly in a largely African-American population. They further suggest that perceived control does not fully explain the relationship between depression and SRBs.     

Levels of Depression and Anxiety,Sexual Functions,and Affective Temperaments in Women With Lifelong Vaginismus and Their Male Partners

BackgroundDepression and anxiety levels, sexual dysfunctions, and affective temperament characteristics of women with lifelong vaginismus (LLV) and their male partners may have important effects on the development, maintenance, and exacerbation of LLV.AimWe aimed to investigate depression and anxiety levels, sexual dysfunctions, and affective temperament characteristics of both women with LLV and their male partners.Methods56 women with LLV, their 56 male partners, and 44 couples with no complaints of any sexual function as a control group were included in this study. Dyadic data were analyzed using the Actor-Partner Interdependence Model.OutcomesThe Beck Depression Inventory, Beck Anxiety Inventory, Golombok Rust Inventory of Sexual Satisfaction, and Temperament Evaluation of Memphis, Pisa, Paris and San Diego Auto Questionnaire Scale were completed by all participants.ResultsWomen with LLV had higher levels of anxiety and depression and had more sexual dysfunctions except for avoidance than those of female controls. Temperament Evaluation of Memphis, Pisa, Paris and San Diego Auto Questionnaire Scale scores were significantly higher in women with LLV for depressive (odds ratio [OR] = 1.27, 95% CI = 1.09–1.49), cyclothymic (OR = 1.31, 95% CI = 1.15–1.49), anxious (OR = 1.22, 95% CI = 1.09–1.38), and irritable (OR = 1.22, 95% CI = 1.04–1.42) temperament than in female controls. It was found that anxiety levels of male partners of women with LLV were higher than those of male controls and that they experienced less sexual satisfaction. Depressive (OR = 1.31, 95% CI = 1.07–1.61) and cyclothymic (OR = 1.18, 95% CI = 1.04–1.34) temperament scores were significantly higher in male partners of women with LLV than in male controls. The Actor-Partner Interdependence Model analyses show that hyperthymic temperament in male partners of women with LLV and anxious and depressive temperament in women with LLV have a negative effect on their own sexual functions. In terms of partner effect, it was found that men with hyperthymic temperament had a negative effect on the sexual functions of women with LLV and men with depressive temperament had a positive effect.Clinical ImplicationsThe individual characteristics of both the women and their male partners have an impact on LLV.Strengths & LimitationsThe sample size was relatively small to assess affective temperaments. The inclusion of male partners in the study contributed to our understanding of couples with LLV.ConclusionOur results indicate that affective temperaments detected in women with LLV (depressive, cyclothymic, anxious and irritable) and their male partners (depressive and cyclothymic) have an effect on the development, maintenance, and exacerbation of LLV, and affective temperaments have an effect on both their own and partner's sexual functions.Turan Ş, Usta Sağlam NG, Bakay H, et al. Levels of Depression and Anxiety, Sexual Functions, and Affective Temperaments in Women With Lifelong Vaginismus and Their Male Partners. J Sex Med 2020;17:2434–2445.     

Androgens and Psychosocial Factors Related to Sexual Dysfunctions in Premenopausal Women1: 12016 ISSM Female Sexual Dysfunction Prize

IntroductionThe female sexual response is complex and influenced by several biological, psychological, and social factors. Testosterone is believed to modulate a woman's sexual response and desire, because low levels are considered a risk factor for impaired sexual function, but previous studies have been inconclusive.AimTo investigate how androgen levels and psychosocial factors are associated with female sexual dysfunction (FSD), including hypoactive sexual desire disorder (HSDD).MethodsThe cross-sectional study included 428 premenopausal women 19 to 58 years old who completed a questionnaire on psychosocial factors and had blood sampled at days 6 to 10 in their menstrual cycle. Logistic regression models were built to test the association among hormone levels, psychosocial factors, and sexual end points.Main Outcome MeasuresFive different sexual end points were measured using the Female Sexual Function Index and the Female Sexual Distress Scale: impaired sexual function, sexual distress, FSD, low sexual desire, and HSDD. Serum levels of total and free testosterone, androstenedione, dehydroepiandrosterone sulfate, and androsterone glucuronide were analyzed using mass spectrometry.ResultsAfter adjusting for psychosocial factors, women with low sexual desire had significantly lower mean levels of free testosterone and androstenedione compared with women without low sexual desire. None of the androgens were associated with FSD in general or with HSDD in particular. Relationship duration longer than 2 years and mild depressive symptoms increased the risk of having all the sexual end points, including FSD in general and HSDD in particular in multivariate analyses.ConclusionIn this large cross-sectional study, low sexual desire was significantly associated with levels of free testosterone and androstenedione, but FSD in general and HSDD in particular were not associated with androgen levels. Length of relationship and depression were associated with FSD including HSDD.Wåhlin-Jacobsen S, Kristensen E, Tønnes Pedersen A, et al. Androgens and Psychosocial Factors Related to Sexual Dysfunctions in Premenopausal Women. J Sex Med 2017;14:366–379.     

The Mediating Role of Sexual Behavior in Event-Level Associations Between Sexual Difficulties and Sexual Satisfaction in Newlywed Mixed-Sex Couples

Introduction

Many sexual difficulties encountered by couples in their day-to-day lives, although of insufficient intensity and persistence to warrant a clinical diagnosis of sexual disorder, are nevertheless frequent and a source of individual and relational distress.

Genital Pain and Sexual Functioning: Effects on Sexual Experience,Psychological Health,and Quality of Life

BackgroundGenital pain (GP) is a common symptom in women of reproductive age. The prevalence of GP is difficult to gauge as it has been underreported by both patients and clinicians and neglected in clinical studies despite wide recognition of the adverse effects to women's health.AimThe purpose of the present study was 3-fold: (i) to explore the self-reported presence and perception of GP and its association with sexual functioning, sexual distress, emotions, psychopathology, and quality of life (QoL); (ii) to explore if, controlling for the pain effect, women with Female Sexual Function Index (FSFI) scores indicating sexual dysfunction also reported worse outcomes regarding sexual distress, emotions, psychological health, and QoL than GP women with higher FSFI scores; and (iii) to evaluate the effects of GP duration, comparing women with GP with shorter (<6 months) duration of symptoms with women with longer (≥6 months) duration of symptom of GP on sexual functioning, distress, emotions, psychopathology and QoL.MethodsA total of 1,034 women (age ranges between 18 and 40 years) from the Italian general population completed a web survey on sexual health.Outcomes6 self-report questionnaires exploring different biopsychosocial factors were assessed: the FSFI, the Female Sexual Distress Scale, the Positive and Negative Affect Schedule, the Short Form McGill Pain Questionnaire adapted for GP, the Short Form 36, and the Symptom Check List-90-Revised.ResultsWomen who reported GP (n = 319) indicated generally lower sexual function than women without GP (n = 648; P = .036). They reported a higher level of sexual distress (P < .001), more negative emotions related to sexual experiences (P = .001), lower scores in all QoL domains (P < .001), and higher levels of psychopathological symptoms (P < .001). Controlling for pain effects, women whose FSFI scores indicated sexual dysfunction (n = 150) reported higher rates of sexual distress than women whose FSFI scores indicated normal sexual function (n = 169; P < .001).The scores also indicated fewer positive (P < .001) and more negative emotions (P < .001) related to sexuality, lower QoL (P < .001) and significantly higher psychological burden (P < .001). Moreover, women experiencing GP for ≥6 months reported significantly lower means on the FSFI total score (P < .05; especially in the desire, satisfaction, and pain domains), distress (P < .001), and emotions (P < .05) than women experiencing GP duration <6 months. No significant differences were found on the QoL and the psychopathological symptoms.Clinical ImplicationsGP is significantly pervasive, but a high percentage of sexual problems and related emotional suffering is overlooked. Raising awareness about this issue is critical, both among clinicians and the general public.Strengths & LimitationsThe present study highlighted important characteristics of GP from a community sample; the results indicate problems related to pain experiences and their repercussions on sexual, psychological, affective health, and QoL. Major limitations are related to the use of self-report measures via a web-based study.ConclusionThe results provide evidence of a lack of awareness regarding pain experiences as they relate to sexual functioning in women; clinicians would be advised to more fully investigate sexual functioning and psychosocial variables associated with GP during routine consultation beginning with the first onset of the symptoms.Nimbi FM, Rossi V, Tripodi F, et al. Genital Pain and Sexual Functioning: Effects on Sexual Experience, Psychological Health, and Quality of Life. J Sex Med 2020; 17:771–783.     

The Association Between Female Sexual Dysfunction and Sexual Dysfunction in the Male Partner: A Systematic Review and Meta-Analysis

BackgroundThe field of study addressing the relationship between FSD and male sexual dysfunction (MSD) represents a pivotal worldwide health issue as interrelationship between FSD and MSD studies are still inconclusive.AimTo review the interrelationship between FSD and MSD and to conclude whether there is a definitive risk of men developing sexual dysfunction when his partner is suffering from FSD.MethodsThe investigation was conducted following the standard practice for conducting and reporting the findings of systematic reviews and meta-analyses comprising of 4 electronic databases, that is, Embase, PsycInfo, Cochrane Library and Ovid (Medline) from inception to December 2019. Search strategies were developed based on relevant keywords with appropriate truncation and Boolean operators’ approach. The quality of studies was employed using the McMaster Critical Review Form for Quantitative Studies and were assessed by independent reviewers. The levels of evidence of the included studies were also determined.OutcomesMSD who had been exposed to FSD.ResultsFrom more than 8,000 studies searched, 26 studies were finally included, and most included studies have reasonable quality. Meta-analysis found a significant sexual dysfunction in men who are partnered with women with FSD. It found a consistent correlation between FDS and sexual dysfunction in men with a significant 3-fold increase in MSD who are partnered with women with FSD (odds ratio = 3.011, 95% confidence interval: 1.856–4.885, P = <.001, I² = 42.26%). Among subtypes of MSD, likelihood increased 4-fold for erectile dysfunction and that of premature ejaculation doubled. The data for several other domains on their components were mixed.Clinical TranslationThese findings support the notion that clinicians should evaluate sexual function pertaining to both partners and encompassing several dimensions and needing an interdisciplinary approach.Strength & LimitationsThis review exhaustively examines data search from vast electronic databases and as the comparison of studies is extracted from English journal publications, not all regions worldwide are represented.ConclusionThis meta-analysis and systematic review found an association between sexual dysfunction in men partnered with women with FSD, especially in the domains of erectile and ejaculatory function.Chew PY, Choy CL, Sidi Hb, et al. The Association Between Female Sexual Dysfunction and Sexual Dysfunction in the Male Partner: A Systematic Review and Meta-analysis. J Sex Med 2021;18:99–112.     

Association Between Body Mass Index and Female Sexual Dysfunction: A Cross-sectional Study from the Data Registry on Experiences of Aging,Menopause, and Sexuality

BackgroundObesity and female sexual dysfunction (FSD) are prevalent conditions, and both are associated with significant adverse effects on health and well-being.AimTo investigate the association between body mass index and FSD, as well as potential moderators.MethodsThis cross-sectional study was performed by analyzing medical records of 6,688 women seeking consultation for menopause-related or sexual health–related concerns at women’s health clinics at Mayo Clinic Rochester, MN, and Scottsdale, AZ, between May 1, 2015, and September 15, 2019.OutcomesFemale sexual function was assessed by the Female Sexual Function Index, and sexual distress was assessed by the Female Sexual Distress Scale-Revised.ResultsBeing overweight or obese was associated with a lack of sexual activity. Among sexually active women, those who were overweight or obese had lower Female Sexual Function Index total scores and sexual function domain scores (indicating worse sexual function), including sexual arousal, lubrication, satisfaction, orgasm, and pain, and higher levels of sexual distress than those with normal weight. However, on multivariable analysis, these associations were found to be mediated by other factors, including age, level of education, reproductive stage, medication use, and mood disturbances, which are known to impact body weight and sexual function in women.Clinical ImplicationsOverweight and obesity were associated with sexual inactivity and greater odds of having FSD, which should prompt proactive assessment of sexual function.Strengths and LimitationsThe strengths of this study include the large cohort size and assessment of sexual problems in addition to sexual distress, a key component of the definition of sexual dysfunction. This study also took into account multiple potential moderating factors. Limitations include the cross-sectional design, which precludes determination of causality as well as lack of diversity in the cohort, potentially limiting generalizability of results. In addition, sexual function was not assessed in women reporting no recent sexual activity, which may confound results.ConclusionOverweight/obesity and FSD are highly prevalent conditions, which appear to be indirectly associated. These results highlight the need to identify and address FSD in all overweight and obese women, with particular attention to potential contributing factors.Faubion SS, Fairbanks F, Kuhle CL, et al. Association Between Body Mass Index and Female Sexual Dysfunction: A Cross-sectional Study from the Data Registry on Experiences of Aging, Menopause, and Sexuality. J Sex Med 2020;17:1971–1980.     

Partners Experience Consequences,Too: A Comparison of the Sexual,Relational, and Psychological Adjustment of Women with Sexual Interest/Arousal Disorder and Their Partners to Control Couples

Introduction

Women diagnosed with female sexual interest/arousal disorder (FSIAD) report lower health-related quality of life, more depressive symptoms, and lower sexual and relationship satisfaction compared with healthy control subjects. Despite the impact of FSIAD on women’s sexuality and the inherently interpersonal nature of the sexual problem, it remains unclear whether the partners of women with FSIAD also face negative consequences, as seen in other sexual dysfunctions.

Association Between Multiple Sclerosis and Risk of Female Sexual Dysfunction: A Systematic Review and Meta-Analysis

Introduction

It has been reported that multiple sclerosis (MS) would increase the susceptibility to female sexual dysfunction (FSD).

Psychological and Sexual Consequences of Psoriasis Vulgaris on Patients and Their Partners

IntroductionPsoriasis is a chronic, multisystem, inflammatory, disfiguring disease with a high negative impact on quality of life due to comorbid psychological, organic, and sexual consequences.AimTo evaluate the psychopathological and sexual aspects of psoriasis vulgaris in patients and their partners compared to healthy controls.MethodsIn the current comparative cross-sectional study, the sample included 220 psoriasis vulgaris patients (110 males and 110 females), their consenting partners, and 220 age- and sex-matched healthy controls. All participants were evaluated for depression and anxiety using the Hospital Anxiety and Depression Scale and for low self-esteem using the Rosenberg's Self-Esteem Questionnaire. Sexual function was assessed in females using the Female Sexual Function Index questionnaire and in males using the International Index of Erectile Function and its abbreviated 5-item version. For male patients suffering from erectile dysfunction, hormonal assessment and penile duplex ultrasound were added.Main Outcome MeasureThe main outcome measures were frequency of depression, anxiety, low self-esteem, and sexual dysfunction in psoriasis vulgaris patients, partners, and controls; the domains of sexual function affected in the studied groups; and the etiology of erectile dysfunction in affected psoriatic males.ResultsFrequency of depression, anxiety, and low self-esteem were significantly higher in psoriasis patients of both sexes compared with controls. Sexual dysfunction followed the same trend of being significantly higher in cases when compared to controls. Females had a significantly higher frequency of sexual dysfunction than males. Sexual dysfunction in both sexes involved multiple domains of the sexual response cycle, with depression and genital affection by psoriasis being risk factors in both sexes and disease severity being an additional risk factor in females. Erectile dysfunction was mainly psychogenic in origin in male patients.Clinical ImplicationsAssessment of psychopathological and sexual comorbidities in psoriasis patients and partners should be an integral part of the management plan and should be added to the guidelines of the disease.Strength & LimitationsThis study is of sufficient power to draw solid conclusions. Assessment of the partners and determination of the sexual domains affected by the disease and nature of erectile dysfunction in males are points of novelty. The cross-sectional design is a limitation of the study.ConclusionPsoriatic patients of both sexes and their partners suffer from a high burden of psychopathological and sexual consequences that are related to disease distribution and severity.Alariny AF, Farid CI, Elweshahi HM, et al. Psychological and Sexual Consequences of Psoriasis Vulgaris on Patients and Their Partners. J Sex Med 2019; 16:1900–1911.     

The Actual and Ideal Sexual Self Concept in the Context of Genital Pain Using Implicit and Explicit Measures

BackgroundThe experience of pain during sexual intercourse generates significant distress and sexual impairments, which is likely to affect sexual identity and become a threat to the sense of self.AimTo explore the role of the concept of the sexual self in the context of genital pain by measuring different states of self (ie, actual vs ideal) at different levels of responding (ie, explicit vs implicit) and examine their associations with sexual, emotional, and pain-related variables.Methods and Main OutcomesThirty young women who identified with genital pain and 29 women without pain completed (i) two versions of the Relational Responding Task as a measurement of implicit actual and ideal sexual self; (ii) explicit ratings of the actual and the ideal sexual self; and (iii) measurements of sexual self-esteem, global self-esteem, depression, sexual satisfaction, sexual distress or depression, sexual frequency, and pain experiences.ResultsWomen with genital pain scored lower on the explicit and implicit actual-self measurements than women without pain but did not differ in their ideal self. Furthermore, the pain group reported higher ideal- than actual-self scores at the explicit level. Actual- and ideal-self measurements had differential effects on sexual, emotional, and behavioral outcome variables. In general, rating the ideal self higher than the actual self was related to more negative outcomes. Pain-related variables were predicted only by the implicit measurements, showing that the high pain group reported more pain, fear of pain, and a stronger tendency to continue with sex despite the pain when perceiving themselves as sexually less competent and when this perception did not match their ideal self.Clinical ImplicationsTherapeutic interventions might benefit from discussing women's internal guides for self, decreasing potential discrepancies, and developing identity-related motivational treatments that target the emotional discomfort and maladaptive behavioral strategies that result from trying to conform with their guides of self. Setting idealistically high sexual standards, feeling pressure to perform as a sexual partner, and fearing to be sexually unqualified could be key factors in developing, maintaining, and exacerbating sexual dysfunctions.Strengths and LimitationsThis is the first study to systematically examine different components of the concept of the sexual self in the context of genital pain. Despite the small sample and the use of a non-clinical group of women, we found a theoretically and clinically interesting pattern of results.ConclusionsDifferentiating between different components of the sexual self is relevant to explain sexual, emotional, and pain-related responses.Dewitte M, De Schryver M, Heider N, De Houwer J. The Actual and Ideal Sexual Self Concept in the Context of Genital Pain Using Implicit and Explicit Measures. J Sex Med 2017;14:702–714.     

The Sexual Event Diary (SED): Development and Validation of a Standardized Questionnaire for Assessing Female Sexual Functioning During Discrete Sexual Events

BackgroundThe efficacy of on-demand drugs for hypoactive sexual desire disorder (HSDD) or female sexual interest/arousal disorder (FSIAD) should be assessed using a validated instrument that assesses the discrete sexual events during which the on-demand drug is taken.AimTo develop and validate an event log for measuring sexual satisfaction and sexual functioning of discrete sexual events.MethodsPsychometric assessment was carried out on data of 10,959 Sexual Event Diaries (SEDs) collected during three clinical trials in a total of 421 women with HSDD. Cognitive debriefing interviews were held with 16 women with HSDD.OutcomesItem scores of the SED at the event level and at the subject level, summarized item scores of women during the baseline establishment and active treatment periods, and score changes in women from baseline establishment to active treatment.ResultsSeveral items of the initial 16-item SED items showed weak validity. The 16-item SED was refined to the 11-item SED. The reliability, content, and convergent validity of the 11-item SED were confirmed. For most 11-item SED item scores, the ability to discriminate between known groups was confirmed. Larger mean score changes from the baseline establishment period were found in those with than in those without known benefit from the medication, and Guyatt effect sizes ranged from 0.73 to 1.58, thereby demonstrating the ability to detect change.Clinical TranslationThe SED is a good tool for assessing sexual function during a discrete sexual event and for assessing the sexual function of women over longer periods.Strengths and LimitationsThe validation of the SED was performed on data from nearly 11,000 sexual events, gathered as part of a drug development program for HSDD and FSIAD. This amount of data provides very robust results when related to drug use for HSDD and FSIAD, but caution is advised when generalizing the validity of the SED directly to other areas of research (eg, recreational drug use and sexual risky behaviors), because such data were not used in this validation.ConclusionsThe 11-item SED is a reliable, valid, and responsive instrument and suitable for use in evaluating the effects of on-demand drugs in women with HSDD or FSIAD.van Nes Y, Bloemers J, van der Heijden PGM, et al. The Sexual Event Diary (SED): Development and Validation of a Standardized Questionnaire for Assessing Female Sexual Functioning During Discrete Sexual Events. J Sex Med 2017;14:1438–1450.     

Partner Responses to Low Desire: Associations With Sexual,Relational, and Psychological Well-Being Among Couples Coping With Female Sexual Interest/Arousal Disorder

BackgroundThe experience of distressing low sexual interest/arousal—female sexual interest/arousal disorder (FSIAD)—is prevalent in women of all ages and is associated with poorer sexual, relationship, and psychological well-being than women without this difficulty. Women who are partnered are almost 5 times more likely to be distressed by low desire and to receive a diagnosis of FSIAD than unpartnered women, indicating that interpersonal factors are highly relevant, although largely neglected in past research.AimIn a dyadic cross-sectional and longitudinal study, we examined whether partner responses to FSIAD were associated with the sexual, relationship, and psychological well-being of couples, and whether any effects persisted 1 year later.MethodsWomen diagnosed with FSIAD (N = 89) completed a validated measure of perceived partner positive vs negative responses to their low sexual interest/arousal and their partners reported on their own responses, as well as measures of sexual desire, sexual satisfaction, relationship satisfaction, sexual distress, and anxiety. 1 year later, couples (N = 66) completed the outcome measures again. Data were analyzed according to the Actor-Partner Interdependence Model.OutcomesOutcomes included were the Sexual Desire Inventory–Solitary and Partner-Focused Subscales; Global Measure of Sexual Satisfaction; Female Sexual Distress Scale; Couple Satisfaction Index; and State-Trait Anxiety Inventory–Short-Form.ResultsWhen women with FSIAD perceived more positive partner responses (eg, warm, supportive, compassionate) than negative responses (eg, hostile, unsupportive, indifferent), they were more satisfied with the relationship and they and their partners reported lower anxiety. When partners reported more positive than negative responses, they had greater relationship and sexual satisfaction and lower sexual distress and anxiety. Exploratory analyses revealed that women's perceptions of their partners' responses accounted for the link between partners' own responses and women's relationship satisfaction and anxiety. Partner responses did not predict any change in outcomes over time.Clinical ImplicationsFindings support interpersonal conceptualizations of FSIAD and may inform the development of future couple-based interventions.Strengths & LimitationsThis study is one of the few dyadic investigations of FSIAD, as diagnosed via a clinical interview. Significant associations were only observed cross-sectionally, limiting causal conclusions. There was limited power to detect longitudinal effects.ConclusionMore positive responses to women's low sexual interest/arousal by partners is linked to better adjustment among couples affected by FSIAD.Rosen NO, Corsini-Munt S, Dubé JP, et al. Partner Responses to Low Desire: Associations With Sexual, Relational, and Psychological Well-Being Among Couples Coping With Female Sexual Interest/Arousal Disorder. J Sex Med 2020;17:2168–2180.     

Comparing Provider-Led Sexual Health Counseling of Male and Female Patients Undergoing Radical Cystectomy

BackgroundSexual dysfunction is a common quality-of-life issue among patients undergoing radical cystectomy (RC) for bladder cancer, but patients report deficiencies in sexual health counseling.AimWe sought to characterize provider-led sexual health counseling of patients undergoing RC and whether provider practice differs by patient gender.MethodsWe conducted a cross-sectional survey of members of the Society of Urologic Oncology to assess topics included in provider-led sexual health counseling and barriers to counseling.OutcomesNonroutine counseling regarding each sexual health topic was compared for female vs male patients using chi-squared tests. Modified Poisson regression was used to examine associations between provider characteristics and nonroutine counseling of female patients.ResultsAmong 140 urologists, the majority did not routinely counsel patients about sexual orientation, partner sexual dysfunction, or referral options to sexual health services. Providers were significantly more likely to not provide routine counseling to female patients compared to male patients about the following topics: baseline sexual activity (20.6% vs 9.7%, respectively, P = 0.04), baseline sexual dysfunction (60.8% vs 20.2%, respectively, P < 0.05), the risk of sexual dysfunction after RC (20.0% vs 6.5%, respectively, P = 0.006), the potential for nerve-sparing RC (70.8% vs 35.5%, respectively, P = 0.002), and postoperative sexual health and dysfunction (42.6% vs 21.1%, respectively, P = 0.01). Overall, 41.2% of providers did not routinely discuss the potential for pelvic organ-preserving RC with sexually active female patients. Provider sex, age, practice type, urologic oncology fellowship training, years in practice, or female RC volume were not predictive of nonroutine or disparate counseling of female patients. The most common barriers to counseling female patients were older patient age (50.7%), inadequate time (47.1%), and uncertainty about baseline sexual function (37.1%).Clinical ImplicationsUrologists acknowledge key deficiencies and gender disparities in sexual health counseling of patients undergoing RC.Strengths and LimitationsAlthough cross-sectional, to our knowledge, this is the first study to examine provider practice patterns regarding sexual health counseling of patients undergoing RC.ConclusionFuture efforts should be directed towards reducing barriers to sexual health counseling of patients undergoing RC to improve deficiencies and gender disparities.Gupta N, Kucirka LM, Semerjian A, et al. Comparing Provider-Led Sexual Health Counseling of Male and Female Patients Undergoing Radical Cystectomy. J Sex Med 2020;17:949–956.     

Sexual and Relationship Satisfaction in Young,Heterosexual Couples: The Role of Sexual Frequency and Sexual Communication

BackgroundAlthough their individual contributions to sexual and relational outcomes are well-established, there has been a lack of research on the importance of sexual frequency and sexual communication to sexual and relationship satisfaction.AimTo examine the contribution of sexual frequency and sexual communication to sexual and relationship satisfaction in the early stages of couple relationships.MethodsA sample of 126 young, heterosexual couples (mean age = 23.3 years, SD = 2.4; average relationship duration = 1.9 years, SD = 0.9) filled out questionnaires about sexual frequency, sexual communication, and sexual and relationship satisfaction. Analyses were guided by the actor-partner interdependence model.OutcomesMain outcome variables were sexual satisfaction and relationship satisfaction, measured by the Quality of Sex Inventory and the Couple Satisfaction Index, respectively.ResultsAnalyses revealed a significant actor effect of both sexual communication and sexual frequency for sexual satisfaction. Only sexual communication, not sexual frequency, predicted relationship satisfaction. No significant partner or gender effects were found.Clinical TranslationThese findings lend support to the notion that couples could benefit from focusing on non-behavioral processes (eg, sexual communication), rather than sexual behavior per se, when pursuing a fulfilling partnership.Strengths & LimitationsStrengths of the study include the dyadic nature of the data and analyses, allowing for the evaluation of both individual- and couple-level processes. Also, to our knowledge, this is the first study to specifically examine the importance of sexual frequency and sexual communication to both sexual and relationship satisfaction. Limitations include the reliance on self-report measures and a relatively homogeneous sample.ConclusionAlthough both sexual frequency and sexual communication were relevant to the prediction of sexual satisfaction, only sexual communication predicted relationship satisfaction in this sample of young, heterosexual couples.Roels R, Janssen E. Sexual and Relationship Satisfaction in Young, Heterosexual Couples: The Role of Sexual Frequency and Sexual Communication. J Sex Med 2020;17:1643–1652.