Does Size Matter? Genital Self-Image,Genital Size,Pornography Use and Openness Toward Cosmetic Genital Surgery in 3503 Swedish Men and Women

BackgroundDissatisfaction with the appearance and size of one's genitalia is a common issue, and the use of cosmetic genital surgery is increasing among people with normal genitalia.AimThis cross-sectional study aimed to investigate the distribution of genital self-image in a large sample of males and females, and whether selected factors could predict genital self-image.MethodsThree thousand five hundred three anonymous participants completed online questionnaires. Multiple linear regressions were used to identify the association between genital self-image and genital size (length of penis or protrusion of labia minora), consumption of sexually explicit material (SEM), sexual activity, avoidance and safety seeking behaviors, openness toward genital cosmetic surgery and age.OutcomesTotal scores on the Female and Male Genital Self Image Scale were used as the main outcome measures.ResultsOverall, 3.6% of females and 5.5% of males had a severely low genital self-image (defined as 2 SD below the mean) and 33.8% of all individuals reported dissatisfaction with the appearance of their genitalia, with 13.7% of females and 11.3% of males considering undergoing cosmetic genital surgery. Mean protrusion of labia minora and stretched flaccid penis length in the population was estimated to 0.76 cm (95% CI 0.63–0.89 cm) and 12.5 cm (95% CI 12.33–12.76 cm), respectively. A higher genital self-image score was predicted by having a larger penis or less protruding labia minora, but not by the degree of SEM consumption, although 93.6% of males and 57.5% of females had consumed SEM in the past three months. The degree of avoidance and safety seeking behaviors, sexual activity, and openness toward genital cosmetic surgery predicted a low genital self-image. Being older was associated with a better genital self-image in females.Clinical ImplicationsThe results show that a psychological intervention may be needed as an alternative to cosmetic genital surgery for people who are dissatisfied with the appearance of their genitals.Strengths and LimitationsThis is one of few available studies investigating the association between actual genital size and genital dissatisfaction. The vast sample size and high response rate are also strengths. Limitations include the cross-sectional design, and possible bias in the study sample due to self-selection.ConclusionOverall, a low genital self-image and dissatisfaction with one's genitalia is relatively common and is influenced not only by genital size, but also behaviors performed to alleviate worry about one's genitals.Hustad IB, Malmqvist K, Ivanova E, et al. Does Size Matter? Genital Self-Image, Genital Size, Pornography Use and Openness Toward Cosmetic Genital Surgery in 3503 Swedish Men and Women. J Sex Med 2022;19:1378–1386.     

Which U.S. States’ Medicaid Programs Provide Coverage for Gender-Affirming Hormone Therapy and Gender-Affirming Genital Surgery for Transgender Patients?: A State-by-State Review,and a Study Detailing the Patient Experience to Confirm Coverage of Services

BackgroundTo date, a comprehensive state-by-state assessment of transgender transition-related health care coverage for gender-affirming hormone therapy (GAHT) and genital gender-affirming surgery (GAS) has not been reported.AimsThe aims of this study were 1) to verify which U.S. states’ Medicaid systems do/do not cover GAHT and GAS; 2) to assess the ease/difficulty for patients to determine whether GAHT and GAS are Medicaid-covered benefits; and 3) to understand possible state-related predictors of Medicaid coverage for gender-affirming care.MethodsWe reviewed the official Medicaid Handbook and website for all 51 states (+D.C.) and 5 territories to confirm whether GAHT and GAS are covered benefits. When indeterminate, we called the Medicaid office in each state, and for many, Medicaid managed care organizations (MCOs), and individual in-state providers, to confirm coverage. We recorded our experiences, number of, and duration of phone calls to confirm coverage.OutcomesThe main outcome was a definitive answer from the state/territory's Medicaid program or MCOs regarding whether GAHT and GAS are/are not covered benefits. Secondary outcome measures included responses we received and the total number/duration of phone calls necessary to confirm coverage.ResultsOnly 12 of 51 states and 0 of 5 territories featured their policy regarding coverage for GAHT in their Medicaid Handbook/webpages. We confirmed that 34 of 51 state Medicaid programs do cover GAHT, whereas 9 of 51 states' and 2 of 5 territories’ do not. We could not confirm coverage of GAHT in 8 of 51 states and 3 of 5 territories.Only 26 of 51 states and 0 of 5 territories featured their policy regarding coverage for GAS in their Medicaid Handbook/webpages. We confirmed that 25 of 51 state Medicaid programs do cover GAS, whereas 22 of 51 states' and 3 of 5 territories’ do not. We could not confirm coverage of GAS in 4 of 51 states and 2 of 5 territories. Up to 12 calls, lasting up to 125 minutes, were required to confirm coverage for GAHT/GAS.Clinical ImplicationsOur findings indicate that important health care access barriers/disparities exist today and warrant improvement.Strengths & LimitationsTo our knowledge, this is the most comprehensive assessment of transgender transition-related health care coverage. Limitations include possible bias, as it could be that we were more persistent than actual patients would be to determine service coverage, and a lack of specificity regarding which specific hormone formulations or procedures are/are not covered.ConclusionOur findings show that only 34 of 51 (67%) states’ Medicaid programs include GAHT and 25 of 51 (49%) include GAS as covered benefits. Our experience suggests that the process to confirm coverage can be especially time-consuming and frustrating for patients.Zaliznyak M, Jung EE, Bresee C, et al. Which U.S. States’ Medicaid Programs Provide Coverage for Gender-Affirming Hormone Therapy and Genital Gender-Affirming Surgery for Transgender Patients?: A State-by-State Review, and a Study Detailing the Patient Experience to Confirm Coverage of Service. J Sex Med 2021;18:410–422.     

Does Health-Related Quality of Life Improve in Women Following Gynaecological Surgery?

ObjectivesTo measure the change in health-related quality of life (HRQOL) before and after gynaecologic surgery and to compare HRQOL to age-matched Canadian normative data.MethodsThis prospective observational cohort study consisted of a convenience sample of 460 women scheduled for elective gynaecologic surgery. Women underwent surgery for a variety of reasons, including cancer, menorrhagia/dysfunctional uterine bleeding, benign uterine masses, prolapse or urinary incontinence, and chronic pelvic pain syndromes Women were recruited preoperatively and followed for six months after surgery. HRQOL questionnaires were completed preoperatively and at six weeks and six months postoperatively, using the SF-36, and compared between time points and against normative data Analysis included univariate statistics, repeated measures ANOVA, paired t tests, and independent samples t testsResultsThe mean age of women in the study cohort was 49 years (± 11); the majority were married, employed, had an education beyond high school, were overweight or obese, had a hysterectomy, and had an abdominal incision Twenty-eight percent underwent surgery for cancer General and mental health domains showed significant improvement between the preoperative and six-week postoperative assessments, while the remaining domains showed statistically significant declines. All but one (general health) of 10 outcomes saw significant improvements from the preoperative to the six-month follow-up assessment. Preoperatively, the surgical sample scored worse on all but one (role emotional) outcome than the normative data. By six months, domain scores were much closer to normative values.ConclusionHealth-related quality of life improved considerably from the preoperative period to six months postoperative in women who underwent gynaecologic surgery When compared with normative data from age-matched women, the surgical sample reported significantly reduced HRQOL preoperatively and at six weeks following surgery, but by six months after surgery HRQOL had rebounded to the point of being comparable to age-matched peers.     

The Urinary Protein-to-Creatinine Ratio in Canadian Women at Risk of Preeclampsia: Does the Time of Day of Testing Matter?

ObjectivesTo determine the performance of a protein-to-creatinine ratio threshold of 30 mg/mmol in pregnant women investigated for hypertension according to the time of day of the sampleMethodsThis prospective study included ambulatory pregnant women investigated for hypertensive disorders. A single voided random urine specimen was obtained to determine the protein-to-creatinine ratio, followed immediately by a 24-hour urine collection. Statistical analyses included Spearman correlation, sensitivity, specificity, predictive values, likelihood ratios, and receiver-operator characteristic curves with 95% confidence intervals. A P value < 0.05 was considered statistically significant.ResultsAmong the 91 specimens analyzed, 47.3% showed significant proteinuria in the 24-hour collection and 33% were first morning samples. The protein-to-creatinine ratio and 24-hour urinary protein excretion were highly correlated (r = 0.92, P < 0.001). The diagnostic accuracy of the protein-to-creatinine ratio threshold of 30 mg/mmol was lower in first morning samples than in samples obtained during the rest of the day, with sensitivity 58% and 90%, specificity 93% and 100%, positive predictive value 88% and 100%, negative predictive value 72% and 92%, positive likelihood ratio 8 and not calculable, and negative likelihood ratio 0.45 and 0.1, respectively. The receiver-operator characteristic area under the curve was 0.94 (95% CI 0.86 to 1) for first morning samples and 1.0 (95% CI 0.99 to 1) for other samples.ConclusionA protein-to-creatinine ratio threshold of 30 mg/mmol reliably identifies significant proteinuria, but its reliability is reduced in first morning samples. Consequently, such samples should not be used for this purpose.     

Does Testosterone Treatment Increase Anger Expression in a Population of Transgender Men?

Background

The acquisition of phenotypic male features in transmen with gender dysphoria requires testosterone treatment. The suppression of menses is 1 of the most desired effects. The relation between testosterone levels and human aggressive behavior has been described. However, the effects of testosterone on anger expression have been poorly investigated in trans-persons.

Adolescent Self-Reported Use of Highly Effective Contraception: Does Provider Counseling Matter?

Study ObjectiveTo examine associations between provider counseling about specific contraceptive methods and method choices reported by adolescents.DesignA cross-sectional, secondary analysis of the local 2015 Youth Risk Behavior Survey, to which we added 2 new/modified questions about long-acting reversible contraception (LARC).SettingRochester, New York.ParticipantsFemale students in 9th-12th grade in the Rochester City School District.InterventionsAn anonymous, standardized survey was administered to collect data.Main Outcome MeasuresWe studied associations between students’ reported contraceptive use and counseling (LARC, short-acting contraception [SAC], neither), health care factors, and potential risk/protective factors. Data were analyzed using bivariate and multivariate methods.ResultsAmong 730 sexually active female respondents, 353/730 (49%) were African American and 182/730 (25%) were Other/Mixed race. 416/730 (57%) used no hormonal method at last sex, and 95/730 (13%) used LARC. 210/730 (29%) of participants recalled any LARC-specific counseling, and 265/730 (36%) any counseling on SAC. Recall of LARC and SAC counseling and use were significantly associated with speaking privately with a provider, but were not related to personal risk/protective factors. Multivariate analyses showed that recollection of LARC counseling was significantly associated with higher odds of using either LARC (adjusted odds ratio, 14.3; P < .001) or SAC (adjusted odds ratio, 2.1; P = .007). Recollection of either LARC or SAC counseling was associated with significantly lower odds of using no contraception.ConclusionAdolescents’ use of LARC was only 13%, but those who recalled contraceptive counseling had higher odds of using some hormonal method. Efforts are needed to improve provider counseling, maintain confidentiality, and identify effective methods to engage adolescents in meaningful, memorable discussions of LARC.     

Risk Factors of Peyronie's Disease. What Does Our Clinical Experience Show?

IntroductionPeyronie's disease (PD) is a localized fibrosis that affects the tunica albuginea of the penis. Its origin can be associated with coital penile trauma in men with autoimmune hypersensitivity and a presumed genetic predisposition.AimTo identify clinical and traumatic risk factors in a patient population with PD, when compared to a control group.MethodsFrom November 2007 to March 2010, 317 patients sought medical attention for PD. As control group, 147 consecutive patients, who came for a prostate exam, were studied. Clinical, traumatic, and sexual history of these patients was gathered. Risks factors were considered only if they had been present before the onset of PD symptoms.Main Outcome MeasureThe International Index of Erectile Function and the International Prostate Symptoms Score. A univariate logistic regression model (chi‐square) (odds ratios [ORs] and 95% confidence intervals [CI] ) was used to estimate the association of risk factors with PD; and the Student's t‐test was implemented for age.ResultsThe mean age of patients with PD and control group was 56.7 and 58.8, respectively (P < 0.923). The mean evolution time of the disease was 17.7 months (2–48). Erectile dysfunction (ED) and coital trauma constituted the only two independent risk factors for PD compared to the control group (P < 0.05 and 0.002, respectively) with an OR of 1.5 (95% CI 1.0–2.3) and 2.69 (95% CI 1.41–5.21), respectively. Patients with ED and diabetes mellitus and with a mild‐to‐moderate ED also presented a higher predisposition (P = 0.008 and 0.00001), with an OR of 3.64 (95% CI 1.33–10.79) and 5.58 (95% CI 3.03–10.42), respectively.ConclusionErectile dysfunction and coital trauma have proven to be independent risk factors for the development of PD. Casabé A, Bechara A, Cheliz G, De Bonis W, and Rey H. Risk factors of Peyronie's disease. What does our clinical experience show? J Sex Med 2011;8:518–523.     

The Effect of Maternal Age on Adverse Birth Outcomes: Does Parity Matter?

ObjectivesTo examine the effect of parity on the association between older maternal age and adverse birth outcomes, specifically stillbirth, neonatal death, preterm birth, small for gestational age, and neonatal intensive care unit admission.MethodsWe conducted a retrospective cohort study of singleton births in British Columbia between 1999 and 2004. In the cohort, 69 023 women were aged 20 to 29, 25 058 were aged 35 to 39, and 4816 were aged 40 and over. Perinatal risk factors, obstetric history, and birth outcomes were abstracted from the British Columbia Perinatal Database Registry. Logistic regression was used to calculate adjusted odds ratios (aOR) and 95% confidence intervals for adverse outcomes in the two older age groups compared with the young control subjects.ResultsCompared with younger control subjects, women aged 35 to 39 years had an aOR of stillbirth of 1.5 (95% CI 1.2 to 1.9) and women aged ≥ 40 years also had an aOR of 1.5 (95% CI 1.0 to 2.4). The aOR for NICU admission was 1.2 (95% CI 1.0 to 1.3) in women aged 35 to 39 years and 1.4 (95% CI 1.1 to 17) in women aged ≥ 40 years compared with younger control subjects. The risk of preterm birth and SGA differed by parity. The aOR for preterm birth compared with younger primiparas was 1.5 (95% CI 1.4 to 1.7) for women aged 35 to 39 years and 1.6 (95% CI 1.3 to 2.0) for women aged ≥ 40 years. In multiparas the aOR for preterm birth was 1.1 (95% CI 1.1 to 1.2) in women aged 35 to 39 and 1.3 (95% CI 1.1 to 1.5) in women > 40 years. The aOR for SGA in primiparas was 1.2 (95% CI 1.1 to 1.4) for women aged 35 to 39 and 1.4 (95% CI 1.1 to 1.7) for women aged ≥ 40 years. The risk of neonatal death was not significantly different between groups.ConclusionOlder women were at elevated risk of stillbirth, preterm birth, and NICU admission regardless of parity. Parity modified the effect of maternal age on preterm birth and SGA. Older primiparas were at elevated risk for SGA, but no association between age and SGA was found in multiparas. Older primiparas were at higher risk of preterm birth than older multiparas compared with younger women.     

Does Cost Influence the Choice of Disposable Versus Reusable Instruments? Mailed Survey of Obstetrician/Gynaecologists

ObjectiveA “cost-awareness” campaign was undertaken at a tertiary hospital from 2015 to 2016 to raise awareness about costs of disposable versus reusable instruments in laparoscopic procedures. We undertook a before and after survey of obstetrician/gynecologists (Ob/Gyns) to find out if the campaign had affected their attitudes about choosing disposable versus less expensive reusable instruments.MethodsIn 2015 (before the cost-awareness campaign) and 2017 (after the cost-awareness campaign), all full-time university-associated Ob/Gyns were mailed a cover letter, questionnaire, and coffee card ($5) with a postage-paid return envelope. Responses (with unique identification) from Ob/Gyns who perform laparoscopic procedures were entered into a password-protected REDCap database on a secure server. All statistical analyses were performed using SAS software version 9.4 (SAS Institute Inc, Cary, NC) (Canadian Task Force Classification II-3).ResultsA total of 35 of 42 eligible Ob/Gyns (85%) with a median 10 years in practice completed questionnaires before and after the intervention. The majority had undertaken minimally invasive surgery training, mainly during residency (80%) and conferences (71%). Before the intervention, the three most important qualities influencing their decision to use a particular instrument were safety (66%), effectiveness (57%), and personal experience (49%). After the intervention, the three most important qualities were effectiveness (57%), safety (57%), and ease of use (46%). Device cost was ranked sixth (26%) before and seventh (17%) after the intervention. The majority (57%) of participants did not change their choice of disposable or reusable instruments, or they would make the choice according to the specific procedure.ConclusionGiven the current economy, operative costs are constantly under review. Knowledge about Ob/Gyns’ attitudes provides information to design more effective awareness campaigns to encourage use of less costly instruments. To change practice, a campaign increasing Ob/Gyns’ exposure to less expensive but safe and effective instruments may help to increase uptake and potentially lead to cost reduction. Cost awareness alone is unlikely to change practice.     

Depth of invasion for appendiceal metastasis of ovarian cancers: does it have any clinical significance?

Aim:  Depth of appendiceal metastasis in patients with epithelial ovarian carcinoma (EOC) has not been previously analyzed for a possible relationship with clinico-pathological variables.
Methods:  Sixty-nine patients with EOC treated at Hacettepe University were retrospectively analyzed. All of the patients had appendiceal metastasis. Pathological slides were re-reviewed by the same pathologist. Appendiceal metastases were defined as serosal (if tumoral spread involved only serosa of the appendix) or sero-mucosal (if tumoral spread also involved either muscular or mucosal surfaces of the appendix). Univariate and multivariate analysis did not reveal a significant difference with respect to the prognostic variables between the groups.
Results:  Thirty-nine patients had serosal appendiceal metastasis (56.5%), while the remaining 30 patients (43.5%) had appendiceal metastasis extending toward the muscular layer (seromucosal metastasis: 16 within muscularis mucosa, 14 within the mucosa of the appendix). The mean age at the time of diagnosis was 54.58 years (range, 26-88 years), with no significant difference between the groups ( P  = 0.9). Comparison of the survival rates between the two groups did not reveal a significant difference. Three-year survival rates were 23.3% in the serosal metastasis and 27.9% in the seromucosal metastasis group ( P  = 0.9). This figure was 25% for patients with only muscular metastasis and 41.6% for patients with appendiceal metastasis extending to the mucosal layer ( P  = 0.2).
Conclusion:  This is the first report to analyze the metastatic pattern of EOC on the appendix with respect to depth of invasion which could not reveal a significant difference.     

Role of Genital Mycoplasmas in Bacteremia: Should We Be Routinely Culturing for These Organisms?

Objective: The purpose of this study was to examine the role of the genital mycoplasmas Mycoplasma hominis and Ureaplasma urealyticum as causes of bacteremia in a tertiary referral obstetrical, gynecological, and neonatal intensive care facility, over a period of 12 years from 1983 to 1994 inclusively.Methods: All clinically significant blood cultures were reviewed and the percentage of septicemic episodes for genital mycoplasmas was compared to the total isolation rate, including conventional bacteria.Results: The overall positivity rate for all pathogenic organisms isolated from the blood cultures of infants ranged from 4.5% to 7.7% per annum. U. urealyticum represented 0.8% of these positive isolates and M. hominis 0.4%. For adults, the overall positivity rate from blood cultures ranged from 6.5% to 13.5%, with U. urealyticum representing 9.6% of these positive isolates and M. hominis 9.9%.Conclusions: With M. hominis having an established role in such clinical entities as postabortal and postpartum fever and U. urealyticum strongly implicated with chronic lung disease in low birth weight infants, it is appropriate to examine blood cultures for genital mycoplasmas in an obstetric institution.     

Do Women Get Posttraumatic Stress Disorder as a Result of Childbirth? A Prospective Study of Incidence

Background: Recent research suggests that a proportion of women may develop posttraumatic stress disorder after birth. Research has not yet addressed the possibility that postpartum symptoms could be a continuation of the disorder in pregnancy. This study aimed to test the idea that some women develop posttraumatic stress disorder as a result of childbirth, and to provide an estimate of the incidence using a prospective design, which controls for the disorder in pregnancy. Method: This prospective study assessed 289 women at three time points: 36 weeks gestation and 6 weeks and 6 months postpartum. The prevalence of posttraumatic stress disorder was assessed by questionnaire at each time point, and the incidence was examined after removing women who had severe symptoms of posttraumatic stress disorder or clinical depression in pregnancy. Results: After removing women at the first time point, 2.8 percent of women fulfilled criteria for the disorder at 6 weeks postpartum and this decreased to 1.5 percent at 6 months postpartum. Conclusions: The results suggest that at least 1.5 percent of women may develop chronic posttraumatic stress disorder as a result of childbirth. It is important to increase awareness about the disorder and to give health professionals access to simple screening tools. Intervention is possible at several levels, but further research is needed to guide this intervention.     

Should Caesarian Section Be Offered to Women With Recurrent Genital Herpes Simplex Lesions After >4 Hours of Ruptured Membranes?

Background

Neonatal herpes simplex virus (HSV) infection and its implications have been well defined. Several methods are recommended to mitigate the risk of maternal transmission of HSV to the neonate, including CS, suppressive antiviral therapy for the mother, and prophylaxis for the infant. The utility of CS in women who present with a duration of rupture of membranes greater than 4 hours remains a question.

Does the Female Sexual Distress Scale‐Revised Cover the Feelings of Women with HSDD?

IntroductionDistress associated with low sexual desire is a key feature of hypoactive sexual desire disorder (HSDD). Accurate, reliable, and easy‐to‐use diagnostic tools to measure such distress are required. The Female Sexual Distress Scale‐Revised (FSDS‐R) has been shown to have good discriminant validity, test–retest reliability, and internal consistency in measuring sex‐related personal distress in women with HSDD. However, the content validity (relevance, clarity, comprehensiveness) of the scale must also be established.AimThe aim of this study was to assess the content validity of the FSDS‐R and to examine the potential of Item 13 as a stand‐alone measure of distress associated with decreased sexual desire.MethodsA single‐visit content validation study was conducted in three centers in the United States. Women were screened for HSDD; those with HSDD completed the FSDS‐R and then underwent debriefing to capture information on their perceptions of the instrument. Participants also rated the relevancy of every FSDS‐R item, from 0 (“not at all relevant”) to 4 (“extremely relevant”).Main Outcome MeasuresFemale HSDD patients' ratings of the relevance and ease of understanding of the 13 items of the FSDS‐R.ResultsTwenty‐five women with HSDD were interviewed. Mean relevancy ratings ranged from 1.96 (Item 9) to 3.33 (Item 13). Most participants (76–100%) found every item clear and easy to understand. Item 13 alone demonstrated good content validity, and 56% of participants felt that it covered all of their feelings about their low sexual desire.ConclusionsThis study established the content validity of the FSDS‐R and demonstrated that the FSDS‐R total score is a relevant endpoint for women with HSDD. The tool's one item specific to low sexual desire (Item 13) was given the highest score and highest relevancy of all items, and over half the sample felt that it covered all of their feelings about their low sexual desire. DeRogatis L, Pyke R, McCormack J, Hunter A, and Harding G. Does the female sexual distress scale‐revised© (FSDS‐R©) cover the feelings of women with HSDD? J Sex Med 2011;8:2810–2815.     

Does Body Mass Index of Infertile Women Have an Impact on IVF Procedure and Outcome?

Purpose: The objective was to explore whether body mass index (BMI) of women related to the different parameters of the in vitro fertilization (IVF) procedure and outcome. Methods: This retrospective study on 398 couples analyzed epidemiological features, characteristics of ovarian stimulation, number and quality of retrieved oocytes, as well as pregnancy outcome according to three groups of BMI values: BMI < 20, 20 BMI < 25 and BMI 25 kg/m². Results: The prevalence of underweight and overweight women was 21.8% and 22.3%, respectively. The mean ratio follicle-stimulating hormone–luteinizing hormone increased significantly according to BMI. An increase in the mean number of consummated gonadotropin ampoules together with a decrease in the number of collected oocytes was observed in long stimulation protocol cycles when BMI 25 kg/m². The same observations were made in short stimulation protocol cycles for BMI < 20 and 25 kg/m². No significant difference could be found in clinical pregnancy and miscarriage rates between underweight, normal weight, and overweight patients. Conclusions: Both underweight and overweight have negative effects on IVF parameters and outcome leading to decreased chances of pregnancy.     

How Do Psychological Risk Factors Predict Sexual Outcomes? A Comparison of Four Models of Young Women’s Sexual Outcomes

BackgroundRecent research findings suggest that women who report high anxiety sensitivity (AS; the fear of physiologic sensations associated with anxiety) also report increased sexual dysfunction and decreased sexual satisfaction. Moreover, findings suggest that maladaptive emotion regulation (ER) can contribute to the relation between AS and psychological distress, thereby indirectly influencing sexual outcomes. Identifying relations among these variables and how they specifically relate to sexual outcomes could be vital for diagnostic and therapeutic purposes. As such, a comparison of different models of sexual outcomes that encompass psychological and sexual risk factors is needed.AimTo compare four psychological models of women’s sexual outcomes in a cross-sectional sample and specifically to investigate whether psychological factors (ie, AS, ER, psychological distress) uniquely or jointly predict related, but distinct, sexual outcomes in women: sexual functioning, sexual quality of life, and frequency of sexual activity.MethodsWomen (N = 316) completed an online survey that included the Anxiety Sensitivity Index–3, Difficulties with Emotion Regulation Scale, Depression Anxiety Stress Scales, Sexual Quality of Life Scale–Female, Female Sexual Function Index, and Sexual Experiences Questionnaire–Female.OutcomesOutcome variables included women’s self-reported sexual functioning, sexual quality of life, and frequency of sexual activity.ResultsPath analysis models demonstrated that psychological factors predicted orgasm, sexual pain, sexual quality of life, and frequency of partnered sexual activity in women but predicted sexual desire, arousal, lubrication, and frequency of solitary sexual activity to a lesser degree. We found that ER significantly accounted for the relation between AS and psychological distress through mediation and moderation pathways.Clinical TranslationClinicians would benefit from incorporating psychological risk factors in their assessment and interventions of women’s sexual concerns.Strengths and LimitationsThis is the first study to compare models of women’s sexual lives using indicators of mental and sexual health. However, our study was limited to a cross-sectional sample of young women in one university setting.ConclusionsAS, ER, and psychological distress are related to sexual functioning, sexual quality of life, and frequency of partnered sexual activity in young women. Psychological risk factors should be taken into consideration to better understand women’s sexual lives.Tutino JS, Ouimet AJ, Shaughnessy K. How Do Psychological Risk Factors Predict Sexual Outcomes? A Comparison of Four Models of Young Women’s Sexual Outcomes. J Sex Med 2017;14:1232–1240.     

When Are Sexual Difficulties Distressing for Women? The Selective Protective Value of Intimate Relationships

IntroductionRecent studies have shown that sexual functioning and sexually related personal distress are weakly related in women, with only a minority of sexual difficulties resulting in significant levels of distress. However, there has been little systematic research to date on which factors moderate the relationship between sexual functioning and sexual distress.AimTo assess the degree to which relational intimacy and attachment anxiety moderate the association between sexual functioning and sexual distress in college-age women.MethodsTwo hundred women (mean age = 20.25) completed surveys assessing sexual functioning, relational intimacy, attachment anxiety, and sexual distress.Main Outcome MeasuresParticipants completed the Sexual Satisfaction Scale for Women, the Female Sexual Function Index, the Dimensions of Relationship Quality Scale, and the Revised Experiences in Close Relationships Measure of Adult Romantic Attachment.ResultsRelational intimacy and attachment anxiety moderated the association between multiple aspects of sexual functioning and sexual distress. For lubrication and sexual pain, functioning was more strongly associated with distress in low-intimacy vs. high-intimacy relationships, but only for women with high levels of attachment anxiety. Results regarding desire were mixed and neither intimacy nor attachment anxiety interacted with subjective arousal or orgasm in predicting distress.ConclusionBoth relational intimacy and attachment anxiety are important moderators of the association between sexual functioning and subjective sexual distress in women. Theoretical and practical implications are discussed. Stephenson KR, and Meston CM. When are sexual difficulties distressing for women? The selective protective value of intimate relationships.