The Development and Validation of the Sexual and Relationship Distress Scale

Background

Sexual distress is an important factor in the etiology, maintenance, and treatment of sexual difficulties, and as such, there is a need for validated measures. A limitation in the research and treatment of distressing sexual difficulties has been the lack of validated measures, and in particular, existing measures are unable to measure the impacts at the relationship level and currently focus on intra-personal distress.

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.     

Typologies of Women With Orgasmic Difficulty and Their Relationship to Sexual Distress

BackgroundAbout 50% of women who report orgasmic difficulty (OD) during partnered sex are distressed by their condition, yet why some women are distressed and others are not is unclear.AimTo determine whether sexual distress is related to women's perceived causes of their OD during partnered sex.MethodsWe established homogenous subgroups of women based on their attributions for OD during partnered sex, and these groups were validated by comparing them on variables relevant to sexual response. We then predicted OD-related distress from subgroup memberships as well as from a number of sociodemographic, control, and empirically supported sexual response variables.Results3 distinct OD subgroups emerged: type 1—high psychological–high somatic reasons; type 2—partner-related reasons; and type 3—moderate psychological–low somatic reasons. These groups also differed on independent parameters related to sexual frequency and arousal. Subgroup membership, along with age, sexual relationship satisfaction, and frequency of partnered sex predicted sexual distress related to OD.Clinical ImplicationParticular perceptions regarding the causes for OD help predict women's sexual distress, and such factors might be considered in identifying sexual issues and managing them within the context of a sexual relationship.Strengths & LimitationsA large sample size drawn from a multinational population powered the study, while the cross-sectional nature of the sample could not rule out bidirectional associations between predictor covariates (including OD subgroup) and the outcome measure (sexual distress).ConclusionType 1 membership (high levels of psychological and somatic attributions) predicted greater levels of OD-related distress than type 2 (partner-related attributions) or type 3 (moderate psychological and low somatic attributions) membership, with type 1 women having a greater likelihood of internalizing (accepting responsibility/blame for) OD attributions.Hevesi K, Miklós E, Horváth Z, et al. Typologies of Women With Orgasmic Difficulty and Their Relationship to Sexual Distress. J Sex Med 2020;17:1144–1155.     

Association Between Sexual Problems and Relationship Satisfaction Among People With Cardiovascular Disease

BackgroundRelationship satisfaction is generally positively correlated with sexual satisfaction, but this relation has been poorly examined in people with cardiovascular disease who are at increased risk of sexual problems compared with the general population.AimTo document reported changes to sex after a diagnosis of cardiac disease and determine whether there is an association between sexual function and relationship satisfaction.MethodsSemistructured telephone interviews focused on relationship satisfaction and sexual problems were conducted with 201 people with cardiovascular disease who were currently in a sexual relationship with one main partner and were recruited from six hospital cardiac rehabilitation centers in Ireland. Comparisons between groups were conducted using t-tests and multivariate analysis of variance for continuous variables and χ² tests for categorical variables. Predictors of relationship satisfaction were assessed using multiple linear regression analysis.OutcomesData were gathered on demographic and clinical variables, sexual problems, and relationship satisfaction, including satisfaction with the physical, emotional, affection, and communication aspects of relationships.ResultsJust less than one third of participants (n = 61, 30.3%) reported that sex had changed for the worse since their cardiac event or diagnosis, with approximately half of these stating that this was a serious problem for them. Satisfaction with relationships was high among patients surveyed; more than 70% of the sample reported being very or extremely satisfied with the physical and emotional aspects and showing affection during sex. Satisfaction with communication about sex was lower, with only 58% reporting being very or extremely satisfied. We did not find significant associations between reporting of sexual problems or deterioration of sex as a result of disease and relationship satisfaction.Clinical ImplicationsCardiac rehabilitation programs should address these sexual problems, potentially by enhancing communication within couples about sex.Strengths and LimitationsThe strength is that data are presented on the sexual experiences and relationship satisfaction of a relatively large sample of people diagnosed with cardiac disease, a relatively underexplored research area. Limitations include the possibility of selection bias of study participants and bias associated with self-report measurement.ConclusionsSexual problems were significant in this population but were not related to relationship satisfaction in this cross-sectional survey.Byrne M, Murphy P, D’Eath M, et al. Association Between Sexual Problems and Relationship Satisfaction Among People With Cardiovascular Disease. J Sex Med 2017;14:666–674.     

Prevalence of Low Sexual Desire With Associated Distress Across the Adult Life Span: An Australian Cross-Sectional Study

BackgroundAlthough hypoactive sexual desire dysfunction (HSDD; low sexual desire with personal distress) negatively impacts well-being, contemporary life-course prevalence data for HSDD are lacking.AimTo document, in an epidemiologic study, the prevalence of low sexual desire with associated distress (epidemiological HSDD [eHSDD]), and associated psychosocial factors in Australian women.MethodsA cross-sectional study of 10,554 women, aged 18–79 years, recruited from the community was performed.Main Outcome MeasuresLow desire was determined by corresponding questions in the Profile of Female Sexual Function and Female Sexual Function Index. HSDD was defined as having a low desire and Female Sexual Distress Scale-Revised score of ≥11.Clinical TranslationClinicians need to be aware that young women often experience sexually related distress whereas low desire with associated distress is most common in women at midlife.ResultsThe majority of the participants were partnered (66.5%) and 38.9% were recently sexually inactive. Low desire prevalence increased from age 18–24 years to 75–79 years (27.4%, 95% CI 25.5–29.3 vs 91.6%, 95% CI 88.3–94.1, P < .001). Just over half of all participants aged 25–39 years had sexually related personal distress, after which the prevalence declined with age (P < .001). 10,259 participants provided sufficient information for eHSDD classification. eHSDD increased from age 18–24 years (12.2%, 95% CI 10.8–13.7) to 40–44 years (33.4%, 95% CI 28.5–38.8), remained constant until 60–64 years (33.1%, 95% CI 28.3–38.4), and progressively declined to 7.3% (95% CI 4.8–10.9) by 75–79 years. HSDD was significantly, positively associated with being partnered (P < .001), sexually inactive (P < .001), more educated (P = .001), and psychotropic medication use (P < .001), and negatively with Asian ethnicity (P < .001).Strengths & LimitationsThis study involved the assessment of desire using a single question derived from the Profile of Female Sexual Function or the Female Sexual Function Index.ConclusioneHSDD is most prevalent at midlife. Furthermore, the likelihood of eHSDD is greater for women who are partnered, sexually inactive, more educated, or taking psychotropic medications. Taken together these findings should aid health professionals in identifying women most at risk of eHSDD.Zheng J, Islam RM, Bell RJ, et al. Prevalence of Low Sexual Desire With Associated Distress Across the Adult Life Span: An Australian Cross-Sectional Study. J Sex Med 2020;17:1885–1895.     

Does Pregnancy Play a Role? Association of Body Dissatisfaction,Body Appearance Cognitive Distraction,and Sexual Distress

Introduction

Pregnancy is characterized by physical, hormonal, and psychological changes that can affect women’s sexuality, and, for those who are in a dyadic relationship, it also affects the couple’s sexual relationship. On the other hand, the pregnancy state can function as a protective factor for body dissatisfaction as women embrace a new phase of the life cycle when body changes, namely more body volume, are expected.

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.     

Are Role and Gender Related to Sexual Function and Satisfaction in Men and Women Practicing BDSM?

Background

Published studies show good psychological health of people involved in bondage-discipline, dominance-submission, and sadism-masochism (BDSM) activities; nevertheless, there are few studies on characteristics related to gender, role in the BDSM scene, sexual functioning, and satisfaction among BDSM practitioners.

Prevalence of Sexual Problems and Associated Distress in Aging Men Across 4 European Countries

BackgroundAmong older men, comparable cross-cultural investigations of sexual problems and associated distress that also include a multitude of relevant explanatory variables of these sexual problem and related distress are rare in the research literature.AimsTo investigate prevalence rates of sexual problems and associated distress among older men across 4 European countries (Norway, Denmark, Belgium, and Portugal) and assess for associated mental and physical health–related factors.MethodsMultinational cross-sectional questionnaire study using self-report measures.OutcomesPrevalence rates of sexual problems and associated distress levels.ResultsWe found a high prevalence of sexual problems persisting for months or longer across countries, but noted that many affected men experienced minimal or no distress related to these problems. We also found marked cross-cultural differences in reported distress about sexual problems, with southern European men (ie Portugal) reporting significantly more distress related to the majority of sexual problems investigated compared with northern European men (ie Denmark and Norway). Finally, we identified several relational, physical, and mental health problems associated with the reported number of sexual problems and the distress related to these problems.Clinical ImplicationsWe suggest that healthcare professionals also target distress when considering sexual problems among older men and contextualize these considerations within a multifactorial approach to general health in which (other) mental and physical health factors relevant to these patients’ sexual health and function are also jointly considered.Strengths & LimitationsStrengths of this study include the large sample size, inclusion of participants from 4 European countries, assessment of distress associated with sexual problems, and similar research design and method of data collection across the 4 included countries. Limitations of the study include the cross-sectional design, which precludes causal conclusions; the low response rate in the Portuguese sample; the lack of homosexual participants; and the lack of comprehensive assessments of dyadic factors that may be of relevance to sexual problems and associated distress.ConclusionThis study identified a high prevalence of sexual problems persisting for 3 months or longer among older men across 4 European countries, but also found that many of the men with sexual problems experienced minimal or no distress related to these problems.G.M. Hald, C. Graham, A. ?tulhofer, et al. Prevalence of Sexual Problems and Associated Distress in Aging Men Across 4 European Countries. J Sex Med 2019;16:1212–1225.     

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 in Men With and Without Disabilities: Findings From a Representative Sample of Australian Men

IntroductionStudies on sexual function in men with disabilities have mainly relied on clinical samples; population-based evidence on this topic is limited.AimThe aim of this study was to compare aspects of sexual function between disabled and nondisabled men using a representative sample.MethodsWe used data from Ten to Men, a national cohort study of Australian men aged 18?55 years. We first compared the prevalence of 15 sexual function-related difficulties in disabled vs non-disabled men. Next, we used Poisson regression to examine associations between disability and sexual function. The main analytic sample had 8,496 men. Weights and adjustments appropriate to the sampling methodology were applied. Models adjusted for potential confounders. Results were reported as prevalence ratios (PRs). P values of < .05 were considered statistically significant.Main Outcome MeasureOutcomes were 15 individual items from the National Survey of Sexual Attitudes and Lifestyles-Sexual Function, a validated measure of sexual function with items in 3 domains: physio-psychological aspect; relational aspect; and global self-rating (the 16th item on help-seeking was excluded). These were coded as binary variables denoting past-year sexual problems.ResultsDisabled men had higher prevalence of all outcomes than nondisabled men. 25.6% of men with disabilities and 15.1% of nondisabled men experienced at least 2 of 15 difficulties. The most prevalent problems were “orgasmed too early” (43.8% of disabled men, 37.1% of nondisabled men), imbalance of sexual desire between partners (47.6% of disabled men, 39.2% of nondisabled men), and overall sexual dissatisfaction (39.4% of disabled men, 26.7% of nondisabled men). All adjusted PRs were > 1.00 for disability; associations were statistically significant except “partner experienced sexual difficulties” (PR = 1.23; 95% CI = 0.99?1.53; P = .058) and “orgasmed too early” (PR = 1.16; 95% CI = 1.00?1.35; P = .050). “Presence of discomfort/pain” had the largest adjusted PR for disability (PR = 2.77; 95% CI = 1.89?4.06; P < .001).Clinical ImplicationThis population-based analysis on the relationship between disability and sexual function contextualizes evidence from clinical studies. Findings suggest that disparities between men with and without disability exist but are not uniform across different aspects of sexual function.Strengths & LimitationsTwo major strengths of this study are that the sample included a nondisabled reference group and results are generalizable to Australian men. A key limitation is that disability and sexual function measures are self-reported.ConclusionThis study provides a broad foundation of population-based evidence about sexual function in men with disabilities, relative to men without, showing positive associations between disability and 13 of 15 sexual difficulties.Bollier A-M, King T, Shakespeare T, et al. Sexual Functioning in Men With and Without Disabilities: Findings From a Representative Sample of Australian Men. J Sex Med 2019;16:1749–1757.     

A Systematic Review of Sexual Distress Measures

Background

Sexual distress is an important component of sexual dysfunction and quality of life and many different measures have been developed for its assessment.

Why Is Impaired Sexual Function Distressing to Men? Consequences of Impaired Male Sexual Function and Their Associations With Sexual Well-Being

Introduction

According to theoretical models of sexual dysfunction, the complex association between male sexual function and subjective sexual well-being (ie, sexual satisfaction and distress) may be partially mediated by specific “consequences” of impaired function, but little research has assessed the frequency of specific consequences or their association with well-being.

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.     

Relational Intimacy Mediates Sexual Outcomes Associated With Impaired Sexual Function: Examination in a Clinical Sample

BackgroundRelational intimacy is hypothesized to underlie the association between female sexual functioning and various sexual outcomes, and married women and women with sexual dysfunction have been generally absent from prior studies investigating these associations, thus restricting generalizability.AimTo investigate whether relational intimacy mediates sexual outcomes (sexual satisfaction, coital frequency, and sexual distress) in a sample of married women with and without impaired sexual functioning presenting in clinical settings.MethodsUsing a cross-sectional design, 64 heterosexual married women with (n = 44) and without (n = 20) impaired sexual functioning completed a battery of validated measurements assessing relational intimacy, sexual dysfunction, sexual frequency, satisfaction, and distress. Intimacy measurements were combined using latent factor scores before analysis. Bias-corrected mediation models of the indirect effect were used to test mediation effects. Moderated mediation models examined whether indirect effects were influenced by age and marital duration.OutcomesPatients completed the Female Sexual Function Index, the Couple’s Satisfaction Index, the Sexual Satisfaction Scale for Women, the Inclusion of the Other in the Self Scale, and the Miller Social Intimacy Test.ResultsMediation models showed that impaired sexual functioning is associated with all sexual outcomes directly and indirectly through relational intimacy. Results were predominantly independent of age and marital duration.Clinical ImplicationsFindings have important treatment implications for modifying interventions to focus on enhancing relational intimacy to improve the sexual functioning of women with impaired sexual functioning.Strengths and LimitationsThe importance of the role relational intimacy plays in broad sexual outcomes of women with impaired sexual functioning is supported in clinically referred and married women. Latent factor scores to improve estimation of study constructs and the use of contemporary mediation analysis also are strengths. The cross-sectional design precludes any causal conclusions and it is unknown whether the results generalize to male partners, partners within other relationship structures, and non-heterosexual couples.ConclusionGreater relational intimacy mitigates the adverse impact of impaired sexual functioning on sexual behavior and satisfaction in women.Witherow MP, Chandraiah S, Seals SR, et al. Relational Intimacy Mediates Sexual Outcomes Associated With Impaired Sexual Function: Examination in a Clinical Sample. J Sex Med 2017;14:843–851.     

Hormonal Treatment Effect on Sexual Distress in Transgender Persons: 2-Year Follow-Up Data

IntroductionAs far as we know, no studies to date have investigated the psychobiological correlates of sexual distress (SD) nor the impact of hormonal treatment (HT) on SD in transgender persons.AimTo evaluate the psychobiological correlates of SD and assess the effects of HT on SD in transgender persons without gender-affirming surgery.MethodsA consecutive series of 301 transgender persons (160 transwomen and 141 transmen) was considered for the cross-sectional study, and a subset of 72 subjects was studied in a 2-year follow-up. A physical examination was performed. Blood samples were drawn for determination of cortisol levels. Subjects completed psychometric measures. During 2 years of HT, the evaluation of SD was prospectively repeated.Main Outcome MeasurePsychobiological correlates of SD in transgender population. Changes in SD during gender affirming hormonal treatment.Clinical ImplicationsKnowing how hormonal treatment influence SD will help care providers when counseling transgender people.Strengths & LimitationsTo the authors’ knowledge, this is the first study prospectively evaluating the impact of gender affirming hormonal treatment on sexual distress in transgender individuals. The main limitations are represented by the small size of the sample and the use of questionnaires validated only in the cisgender population.ResultsSD showed a positive correlation with body uneasiness (P < .0001) and with dissatisfaction toward gender-related body parts or shapes (all P < .05). In addition, SD correlated positively with general psychopathology (P < .0001), alexithymia, social anxiety, and humiliation scales (all P < .05). In transmen, SD was positively associated with autism levels (P < .005), as well as with cortisol levels (P < .02). A significant correlation between SD and perceived discrimination was observed in transwomen (P < .05). In transwomen, SD was positively associated with hair density and negatively with breast growth (both P < .05). Finally, in transmen, a negative correlation was found between SD and hair density (P < .05). When the impact of HT on SD was evaluated, a significant reduction of SD was observed across time in both transwomen and transmen (P = .001 and P = .01, respectively).ConclusionsThe present results support the efficacy of HT in reducing SD in transgender persons.Ristori J, Cocchetti C, Castellini G, et al. Hormonal Treatment Effect on Sexual Distress in Transgender Persons: 2-Year Follow-Up Data. J Sex Med 2020;17:142–151.     

Associations Between Pornography Use and Sexual Dynamics Among Heterosexual Couples

BackgroundWhile links between pornography use and couple relational well-being have been the subject of multiple research studies, less attention has been paid to the associations between pornography use and specific sexual behavior within the relationship.AimThis study aimed to explore associations between each partner's pornography use, sexual desire, sexual satisfaction, and intercourse/non-intercourse sexual behavior. The confounding and moderating role of religiosity was also explored.MethodsA dyadic sample of 240 heterosexual couples was used. Measurement assessed pornography use, sexual desire, sexual satisfaction, and sexual behavior.OutcomesSexual satisfaction as well as intercourse and non-intercourse sexual behaviors were examined.ResultsResults suggested consistent gendered differences where female pornography use was directly associated with higher reports of female sexual desire, whereas male pornography use was directly associated with more male but less female partner desire and lower overall male sexual satisfaction. Male pornography use was also indirectly associated with sexual satisfaction for both partners and non-intercourse behaviors within the relationship through sexual desire. Overall, religiosity had little impact on the results of the study.Clinical TranslationThe complex associations between pornography use, sexual desire, and sexual behaviors suggested by our results highlight the importance of comprehensive and systemic assessment and education around sexuality when working with individuals and couples.Strengths & LimitationsThe main strength of this study is the use of dyadic data. The main limitation is the cross-sectional nature of the dataConclusionThe associations between pornography use and a variety of outcomes are highly nuanced. This study provides an important step forward in more fully accounting for the complications of pornography use in a relationship.Willoughby BJ, Leonhardt ND, Augustus RA. Associations Between Pornography Use and Sexual Dynamics Among Heterosexual Couples. J Sex Med 2021;18:179–192.