Childhood Sexual Abuse Moderates the Relationship Between Sexual Functioning and Eating Disorder Psychopathology in Anorexia Nervosa and Bulimia Nervosa: A 1-Year Follow-Up Study

IntroductionSexual dysfunctions that affect all aspects of sexuality are common in patients with eating disorders. However, only few studies have provided longitudinal information on sexual functioning in patients with eating disorders.AimTo evaluate the longitudinal course of sexual functioning, and how changes in psychopathology and history of childhood abuse interact with sexual functioning in patients with anorexia nervosa (AN) and bulimia nervosa (BN).MethodsA total of 27 patients with AN and 31 with BN were assessed at baseline and at 1-year follow-up after a standard individual cognitive behavioral therapy (CBT).Main Outcome MeasuresSubjects were studied by means of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders IV, Female Sexual Function Index (FSFI), Eating Disorder Examination Questionnaire, Beck Depression Inventory, Spielberg's State–Trait Anxiety Inventory, Symptom Checklist-90, and Childhood Experience of Care and Abuse Questionnaire.ResultsAfter treatment, both patients with AN and BN showed a significant improvement in the FSFI total score (P < 0.01 for both AN and BN) and all FSFI subscales, without significant between groups differences. Patients reporting childhood sexual abuse did not show a significant improvement in sexual functioning (β = 0.05; P = 0.58). Reduction in eating disorder severity was directly associated with FSFI improvement, but only in those subjects with no history of sexual abuse (β = 0.28; P = 0.01).ConclusionsEating disorder-specific psychopathology could be considered as a specific maintaining factor for sexual dysfunction in eating disorders subjects. Subjects reporting a history of childhood sexual abuse represent a subpopulation of patients with a profound uneasiness, involving body perception, as well as sexual functioning, which appeared not to be adequately challenged during standard CBT intervention. The results, though original, should be considered as preliminary, given the relatively small sample size. Castellini G, Lo Sauro C, Lelli L, Godini L, Vignozzi L, Rellini AH, Faravelli C, Maggi M, and Ricca V. Childhood sexual abuse moderates the relationship between sexual functioning and eating disorder psychopathology in anorexia nervosa and bulimia nervosa: A 1-year follow-up study. J Sex Med 2013;10:2190–2200.     

The role of total body fat mass and trunk fat mass,combined with other endocrine factors,in menstrual recovery and psychopathology of adolescents with Anorexia Nervosa

Objective: To determine the threshold of total body and trunk fat mass required for menstrual recovery and to assess the impact of body composition in psychopathology of adolescents with Anorexia Nervosa (AN).

Methods: Prospective study of 60 adolescents presented with secondary amenorrhea and diagnosed with AN. Anthropometrics, body composition by dual-energy X-ray absorptiometry, hormonal studies and responses to mental health screens (EAT-26), were obtained at the beginning and at complete weight restoration, in all adolescents, independently of menstrual recovery (Group A) or not (Group B).

Results: At weight restoration, Group A total body fat mass, trunk fat mass, and trunk/extremities fat ratio were significantly higher (p?r?=??0.363, p?=?.032) and (r?=??0.416, p?=?.013), respectively, while an increase of 0.40% of trunk fat mass (%) lowers EAT-26 by one unit.

Discussion: Trunk fat mass distribution can positively influence psychopathology of adolescents with AN.     

Anxious and avoidant attachment, vibrator use, anal sex, and impaired vaginal orgasm

IntroductionDisturbances in intimate relationships are among the risk factors for female sexual dysfunction. Insecure styles of anxious attachment (preoccupations about abandonment) and avoidant attachment (avoidance of closeness in relationships) are robustly associated with sexual problems, relationship difficulties, and several indices of poorer physical and mental health. Similar indices of poorer sexual, relationship, and health functioning are associated with impairment of orgasm triggered by penile‐vaginal stimulation (vaginal orgasm), but unrelated or related to greater frequency of other sexual behaviors. However, research examining the differential association of sexual activities with insecure attachment styles has been lacking.AimsThe aim of this study was to test the hypotheses that insecure attachment styles are associated with lesser vaginal orgasm consistency, and are unrelated or directly related to greater frequency of other sexual behaviors.MethodSeventy coitally experienced women recruited at a Scottish university completed the Revised Experience in Close Relationships scale, and reported their frequency of various sexual behaviors (and corresponding orgasms) in a recent representative month.Main Outcome MeasuresThe main outcome measures for this study are multivariate correlations of various sexual activities with insecure attachment styles, age, and social desirability response bias.ResultsAnxious attachment was associated with lesser vaginal orgasm consistency, but with higher frequency of vibrator and anal sex orgasms. Avoidant attachment was associated with higher frequency of vibrator orgasms. Neither anxious nor avoidant attachment was associated with lifetime number of penile‐vaginal intercourse partners.ConclusionsThe results provide evidence that inability to attain a vaginal orgasm is associated with anxious attachment, among other indices of poorer mental health and relatedness. Vaginal orgasm might be the relevant sexual activity for the maintenance of a secure attachment style with a sexual partner and/or more insecurely attached women might have difficulties in attaining vaginal orgasms and be more inclined to sexual activities characterized by more emotional and physical detachment, as part of a characterological discomfort with intimacy. Costa RM and Brody S. Anxious and avoidant attachment, vibrator use, anal sex, and impaired vaginal orgasm. J Sex Med 2011;8:2493–2500.     

Attachment and Sexual Functioning: Understanding the Mediating Role of Body Image Among LGB and Non-LGB Women

IntroductionDespite studies showing that individuals with insecure attachment suffer from poor body image, and that poor body image is a main risk factor for sexual dysfunction, the mediating role of body image between attachment insecurities and sexual functioning has not been assessed. Moreover, differences in body self-consciousness among sexual minority women have not been examined, even though LGB individuals have been found to be more conscious of stigma and the disapproval of others.AimTo fill this gap, the current study examines the mediating role of body image self-consciousness between insecure attachment and sexual functioning among LGB and non-LGB women.MethodsThe study sample consisted of 1,001 women; of them, 808 defined themselves as heterosexual (80.7%), and 193 (19.3%) identified as LGB. The sample was a convenience sample of women who responded to ads on social media. Participants completed an online questionnaire (via Qualtrics) about their attachment orientation, body-image self-consciousness, and sexual functioning.Main OutcomeBody image self-consciousness mediated the relationship between insecure attachment and sexual dysfunction among women in general and LGB women in particular.ResultsResults indicated that among LGB women, the relationship between attachment and sexual functioning was fully mediated by body image self-consciousness. For non-LGB women, a full model with statistically significant direct and indirect effects was revealed. Both avoidant attachment and anxious attachment were related to body image self-consciousness which was, in turn, related to sexual functioning. A statistically significant direct path from avoidant attachment to sexual functioning was also revealed.ConclusionThe study findings contribute to the literature by revealing the mediating role that body image self-consciousness plays between insecure attachment and sexual dysfunction among women in general and LGB women in particular.Clinical ImplicationsThis study provides support for the negative relationship between body image self-consciousness and sexual functioning of women regardless of sexual orientation, and suggests that women affected by body image concerns might be prone to more sexual dysfunction. Therefore, body image self-consciousness should be brought up in sex therapy sessions and future interventions. Clinicians should also be cognizant of differences between LGB and non-LGB women in terms of this effect, taking into account the history of stigma that LGB women may have endured and how this history affects their body image.Gewirtz-Meydan A, Mitchell KJ, Spivak-Lavi Z. Attachment and Sexual Functioning: Understanding the Mediating Role of Body Image Among LGB and Non-LGB Women. J Sex Med 2021;18:1245–1257.     

Sexual Function,Sexual Dysfunctions,and ADHD: A Systematic Literature Review

BackgroundThe scientific literature on sexuality among mentally ill patients clearly shows a higher prevalence of sexual disorders for many mental disorders, but little is known about sexuality in individuals suffering from ADHD. Clinicians will often assume that specific difficulties of ADHD are bound to affect sexual functioning.AimThe aim of this study was to provide a review of the literature to gain better knowledge about sexuality in subjects with ADHD and to discuss screening and management of their potential sexual problems.MethodsA systematic review of the literature was performed in Pubmed, PsychInfo, and Embase databases.Main Outcome MeasuresThe main outcome measures were sexual function and sexual dysfunctions.ResultsThe studies indicated that subjects with ADHD report more sexual desire, more masturbation frequency, less sexual satisfaction, and more sexual dysfunctions than the general population.Clinical ImplicationsClinicians working with subjects with ADHD should explore the quality of their sexual life.Strengths & LimitationsThis is the first systematic review of the sexuality of individuals with ADHD. However, the results are limited by the small number of studies, by the small sample size of many studies, and the potential for bias.ConclusionsADHD is a mental disorder affecting sexual health. Further studies are warranted to learn more about sexuality in subjects with ADHD.Soldati L, Bianchi-Demicheli F, Schockaert P, et al. Sexual Function, Sexual Dysfunctions, and ADHD: A Systematic Literature Review. J Sex Med 2020;17:1653–1664.     

Anorectic and Bulimic Patients Suffer from Relevant Sexual Dysfunctions

IntroductionSexual life is often impaired in anorexia nervosa (AN) and bulimia nervosa (BN), and few studies have evaluated the possible relationships between body image concerns, eating disorder psychopathology, and sexual functioning in these syndromes.AimTo evaluate sexual functioning in AN patients, BN patients, and healthy controls, and to define the predictors of sexual dysfunction in the AN and BN groups.MethodsEighty‐eight eating disorders patients (44 AN, 44 BN) referring to the Outpatient Clinic for Eating Disorders of the University of Florence, and 72 healthy females were evaluated.Main Outcome MeasuresThe subjects were studied by means of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders IV, the Female Sexual Function Index (FSFI), the Eating Disorder Examination Questionnaire, the Emotional Eating Scale, the Beck Depression Inventory, the Spielberg's State–Trait Anxiety Inventory, the Barratt Impulsiveness Scale, and the Symptom Checklist 90.ResultsAN restricting/type patients had lower FSFI total scores (median; quartiles: 4.8; 2.1–15.4), compared with AN binge/purging type (28.3; 20.6–30.7) and BN patients (20.1; 3.8–30.3). Multiple linear regression analysis showed that shape concern was associated with sexual dysfunction in AN restricting type patients (β = ?0.61, P < 0.01), whereas emotional eating (β = ?0.42, P < 0.01), and subjective binge eating (β = ?0.55, P < 0.01) were significantly associated with FSFI scores in AN binge/purging type and BN patients.ConclusionsConsidering the sample size, the present results must be considered as preliminary. Sexual dysfunction was found to be a relevant concern in both AN and BN patients and was associated with different pathological eating behaviors. Sexual functioning should be carefully investigated in eating disorders patients, and treatments focused on shape concern, emotional eating, and binge eating could improve the sexual life of AN and BN patients. Castellini G, Lelli L, Lo Sauro C, Fioravanti G, Vignozzi L, Maggi M, Faravelli C, and Ricca V. Anorectic and bulimic patients suffer from relevant sexual dysfunctions. J Sex Med **;**:**–**.     

Do Gynecologists Talk About Sexual Dysfunction With Their Patients?

IntroductionFemale sexual problems and dysfunctions have a high prevalence, ranging from 12% to 80%, depending on the definition being used, underlying comorbidities, and age. Despite the high prevalence, there are only scarce data about the approach gynecologists use to address female sexual dysfunction.AimThe aim of this study is to evaluate the approach of Swiss gynecologists to addressing sexual problems among their outpatients.MethodsAfter a pilot study including 56 physicians, a modified 19‐item self‐administered questionnaire was sent to 856 Swiss gynecologists to evaluate their methods of management of patients with sexual issues and their attitudes regarding the integration of sexual health issues into the gynecological consultation.Main Outcome MeasuresBesides demographic information, the self‐administered questionnaire included questions about addressing sexual health as part of consultation routine, estimated frequency of symptoms, reasons for not addressing sexuality, clinical conditions in which sexuality was addressed, and methods of management of sexual problems.ResultsOf the 341 responding gynecologists (39.8% response rate), 40.4% reported having at least brief (at least 1–2 days) of training in sexual medicine, 7.9% of the respondents routinely explored sexual issues with more than 80% of their patients, 28.2% of the respondents offered appointments specifically for sexual issues, and 85% proposed referrals to specialized colleagues. Lack of motivation for therapy on the part of the patient was mentioned as the most common cause for persisting symptoms (63.3%). Dyspareunia was quoted as the most/second most prevalent type of female sexual dysfunction by 77.1% of the respondents.ConclusionWe conclude that among Swiss gynecologists, sexual problems are regarded as an important issue in gynecological outpatient care, but addressing patients' sexuality is not yet part of routine practice. Swiss gynecologists seem to be most likely to consider hormonal changes (although not so much those due to oral contraceptives) to necessitate discussion of sexual health issues, while psychosocial transitions or stress seem to be considered less important. Kottmel A, Ruether‐Wolf KV, and Bitzer J. Do gynecologists talk about sexual dysfunction with their patients? J Sex Med 2014;11;2048–2054.     

Hypersexuality and High Sexual Desire: Exploring the Structure of Problematic Sexuality

IntroductionThe concept of hypersexuality has been accompanied by fierce debates and conflicting conclusions about its nature. One of the central questions under the discussion is a potential overlap between hypersexuality and high sexual desire. With the relevant research in its early phase, the structure of hypersexuality remains largely unknown.AimThe aim of the present study was to systematically explore the overlap between problematic sexuality and high sexual desire.MethodsA community online survey was carried out in Croatia in 2014. The data were first cluster analyzed (by gender) based on sexual desire, sexual activity, perceived lack of control over one's sexuality, and negative behavioral consequences. Participants in the meaningful clusters were then compared for psychosocial characteristics. To complement cluster analysis (CA), multigroup confirmatory factor analysis (CFA) of the same four constructs was carried out.Main Outcome MeasuresIndicators representing the proposed structure of hypersexuality were included: sexual desire, frequency of sexual activity, lack of control over one's sexuality, and negative behavioral outcomes. Psychosocial characteristics such as religiosity, attitudes toward pornography, and general psychopathology were also evaluated.ResultsCA pointed to the existence of two meaningful clusters, one representing problematic sexuality, that is, lack of control over one's sexuality and negative outcomes (control/consequences cluster), and the other reflecting high sexual desire and frequent sexual activity (desire/activity cluster). Compared with the desire/activity cluster, individuals from the control/consequences cluster reported more psychopathology and were characterized by more traditional attitudes. Complementing the CA findings, CFA pointed to two distinct latent dimensions—problematic sexuality and high sexual desire/activity.ConclusionOur study supports the distinctiveness of hypersexuality and high sexual desire/activity, suggesting that problematic sexuality might be more associated with the perceived lack of personal control over sexuality and moralistic attitudes than with high levels of sexual desire and activity. Carvalho J, Štulhofer A, Vieira AL, and Jurin T. Hypersexuality and high sexual desire: Exploring the structure of problematic sexuality. J Sex Med 2015;12:1356–1367.     

Attachment and Childhood Maltreatment as Moderators of Treatment Outcome in a Randomized Clinical Trial for Provoked Vestibulodynia

BackgroundAlthough distal developmental factors, such as attachment and childhood maltreatment (CM), are associated with the occurrence, severity, and adjustment to provoked vestibulodynia (PVD)—the most prevalent form of vulvodynia—no studies to date have examined whether these variables are related to treatment efficacy in the context of PVD. Attachment and CM may act as moderating variables when examining different treatment modalities, whereby individuals with more insecure attachment orientations (anxiety/avoidance) or a history of CM may benefit less from treatments with higher interpersonal contexts, such as sex and couple therapy—a recommended treatment for PVD.AimThe present randomized clinical trial (RCT) examined attachment and CM as predictors and moderators of sexual satisfaction, distress, and function at post-treatment and 6-month follow-up while comparing 2 treatments for PVD: Topical lidocaine, and a novel cognitive behavioral couple therapy focused on women's pain and partners’ sexuality.MethodsOne hundred eight women with PVD were randomized to a 12-week treatment of either lidocaine or couple therapy. Women completed questionnaires at pretreatment, post-treatment, and at a 6-month follow-up.Outcomes(1) Global Measure of Sexual Satisfaction; (2) Female Sexual Distress Scale-Revised; (3) Female Sexual Function Index.ResultsBoth attachment and CM were significant moderators of treatment outcomes. At either post-treatment or 6-month follow-up, in the couple therapy condition, women with greater attachment avoidance had poorer outcomes on sexual distress, satisfaction and function, whereas women with higher levels of CM had poorer outcomes on sexual satisfaction and sexual function, compared to women in the lidocaine condition.Clinical ImplicationsAlthough these novel findings need further replication, they highlight the importance for clinicians to take into account distal factors, for instance, attachment and CM, when treating sexual difficulties such as PVD, as these variables may affect more interpersonal dimensions of treatment (eg, trust, compliance, etc.) and ultimately, treatment progress.Strengths & LimitationsUsing a rigorous RCT study design and statistical approach, this study is the first to examine attachment and CM as moderators in the treatment of sexual difficulties. It is however limited by the use of self-report measures, and further studies are necessary to validate the generalizability of current results to other sexual difficulties.ConclusionFindings support the role of interpersonal factors in the treatment of PVD and indicate that short-term psychological interventions, such as couple therapy, may be less beneficial for women with antecedents of CM and attachment insecurity.V Charbonneau-Lefebvre, M-P Vaillancourt-Morel, NO Rosen, et al. Attachment and Childhood Maltreatment as Moderators of Treatment Outcome in a Randomized Clinical Trial for Provoked Vestibulodynia. J Sex Med 2022;19:479–495.     

Maternal–foetal attachment independently predicts the quality of maternal–infant bonding and post-partum psychopathology

Purpose: The aim of this study was to evaluate the association of maternal antenatal attachment and post-partum psychopathology, maternal–infant bonding, while checking for antenatal psychopathology, for lifetime psychiatric diagnosis and for the known risk factors for peripartum depression.

Methods: One hundred and six women recruited at the first month of pregnancy (T0) were evaluated with the structured interview for DSM-IV TR (SCID-I) to assess the presence of lifetime psychiatric diagnosis and with the Perinatal Depression Predictor Inventory-Revised (PDPI-R), the Edinburgh Postnatal Depression Scale (EPDS), and the State–Trait Anxiety Inventory (STAI). At the sixth month of pregnancy (T1) and at the first month post-partum (T2), all patients were evaluated with the PDPI-R, the EPDS, the STAI, at T1, with the Maternal Antenatal Attachment Scale (MAAS), and at T2 with the Maternal Postnatal Attachment Scale (MPAS).

Results: Multivariate regression analyses showed that maternal–foetal attachment was the variable most significantly associated with postnatal symptoms of depression and anxiety and with quality of maternal-infant attachment. The logistic regression analyses showed that antenatal attachment may predict postnatal depressive and anxiety symptoms (respectively, OR: 0.83 – IC [0.74???0.95], p?=?.005, OR: 0.88 – IC [0.79???0.98], p?=?.02), and the quality of maternal postnatal attachment (OR: 1.17 – IC [1.08???1.27], p?Conclusion: The quality of maternal–foetal bonding may independently predict the quality of maternal–infant attachment and post-partum depressive and anxiety symptoms. A comprehensive assessment of maternal risk factors for perinatal psychopathology during pregnancy should include the evaluation of antenatal attachment that could be modifiable by specific interventions promoting the quality of maternal bonding.     

ORIGINAL RESEARCH—COUPLES' SEXUAL DYSFUNCTIONS: Sexual Disorders in Infertile Couples

IntroductionSexuality and the desire for a child are strongly interconnected. The same applies to sexual disorders and the unfulfilled desire for a child.AimThis article indicates the relations between sexual disorders and the unfulfilled desire for a child and outlines the potential effects of diagnostics and treatment in the context of reproductive medicine on the couples' sexuality.MethodsA research drive was undertaken in well-established medical and psychological literature database with the keywords “infertile” or “infertility” and “sexual dysfunction” or “sexual satisfaction.”ResultsSexual dysfunctions (of organic or of psychic origin) as a cause of involuntary childlessness are relatively unusual. By contrast (temporary) sexual disorders resulting from diagnosis and medical therapy are common in couples with fertility problems, with women more frequently affected than men.ConclusionsCounseling for couples with the unfulfilled desire for a child should invariably include explicit and appropriately tactful reference to sexuality and (functional) sexual disorders by the therapist. Wischmann TH. Sexual disorders in infertile couples.     

Cognitive and Emotional Determinants Characterizing Women with Persistent Genital Arousal Disorder

IntroductionPersistent genital arousal disorder (PGAD) is a relatively unknown clinical condition affecting several women. Moral standards, as well as conservative beliefs regarding sexuality, are believed to be involved in the etiology and maintenance of this syndrome. Nevertheless, there are no consistent data on the content of the beliefs system presented by these women.AimThe aim of this study was to characterize the cognitive and emotional style of women reporting PGAD. More precisely, the content of sexual beliefs, thoughts, and emotions during sexual intercourse was explored.MethodsForty‐three women presenting PGAD and 42 controls responded to a web survey. This study was cross‐cultural in nature and women worldwide (over 18 years old) were asked to participate.Main Outcome MeasuresParticipants answered the following online questionnaires: Sexual Dysfunctional Beliefs Questionnaire, Sexual Modes Questionnaire, Positive and Negative Affect Schedule, and Brief Symptom Inventory. Additionally, participants responded to a checklist assessing the presence and frequency of PGAD symptoms.ResultsAfter controlling for sociodemographic characteristics and psychopathology, findings showed that women reporting PGAD symptoms presented significantly more dysfunctional sexual beliefs (e.g., sexual conservatism, sexual desire as a sin), as well as more negative thoughts (e.g., thoughts of sexual abuse and of lack of partner's affection) and dysfunctional affective states (more negative and less positive affect) during sexual activity than non‐PGAD women.ConclusionsNotwithstanding the impact of neurophysiological determinants in the etiology of this syndrome, results support the psychological conceptualization of PGAD and highlight the role of cognitive–behavioral therapy (CBT) for PGAD symptomatology. More specifically, cognitive and behavioral strategies would be aimed at targeting maladaptive sexual beliefs and thoughts, as well as regulating negative affective states resulting from a dysfunctional cognitive style regarding sexuality. In all, CBT in association with a medical/pharmacological approach, could be clinically relevant in the management of PGAD.     

Attachment Insecurity and Sexual and Relational Experiences in Saudi Arabian Women: The Role of Perceived Partner Responsiveness and Sexual Assertiveness

BackgroundAttachment and intimacy play an important role in shaping sexual and relational experiences. Yet, their interrelation has rarely been investigated in the context of sexual problems and never been tested in Saudi Arabian women.AimThe present study examined the interrelations of attachment orientation and sexual function, distress, satisfaction, and relational satisfaction in a sample of Saudi Arabian women and explored whether this link can be explained by 2 important aspects of (sexual) intimacy, namely perceived partner responsiveness (PPR) and sexual assertiveness.MethodThis is a cross-sectional, observational study in a sample of 50 heterosexual women with sexual problems and 50 control women without problems, who completed an Arabic version of questionnaires on attachment orientation, sexual assertiveness, PPR, relationship satisfaction, sexual satisfaction, sexual distress, and sexual function.ResultsWe found that both attachment anxiety and sexual refusal showed a significant association with the level of sexual function, sexual distress, and sexual satisfaction (P < .01) in the clinical group. No mediating effects of sexual refusal were found. In the control group, sexual function, sexual distress, and sexual satisfaction were predicted by attachment avoidance (P < .01). Level of sexual function was also predicted by sexual initiation (P < .05). PPR fully mediated the association between attachment anxiety and relational satisfaction in the clinical group (P < .01), while in the control group the link between attachment avoidance and relational satisfaction was only partially mediated by PPR (P < .01).Strengths & LimitationsThis study offers unique information on relational and sexual functioning in a culture in which sexual expression and intimate behavior are restricted, particularly in women.Clinical ImplicationsPerceiving the partner as being more responsive is an important target of intervention to increase satisfaction with the relationship.ConclusionsOur results suggest that attachment anxiety and low sexual assertiveness, as indicated by lower tendencies to refuse sex when not desired, play a significant role in predicting negative sexual experiences in women who cope with sexual difficulties.Attaky A, Kok G, Dewitte M. Attachment Insecurity and Sexual and Relational Experiences in Saudi Arabian Women: The Role of Perceived Partner Responsiveness and Sexual Assertiveness. J Sex Med 2020;17:1383–1394.     

Relationship Between Adult Separation Anxiety and Attachment Styles and Vaginismus

BackgroundVaginismus has an unknown etiology, is comorbid with anxiety, and is the most common sexual dysfunction in sexual dysfunction outpatient clinics in Turkey.AimThis study aimed to determine the frequency of adult separation anxiety disorder (ASAD) and styles of attachment in patients with vaginismus and to investigate its relationship with female sexual dysfunction.MethodsSixty women with vaginismus and 60 healthy controls were compared using the Relationship Scales Questionnaire, Female Sexual Function Index (FSFI), and Adult Separation Anxiety Questionnaire (ASA-27).OutcomesWe report the results of the questionnaires with their implication on the etiology of vaginismus.ResultsSeparation anxiety and fearful and dismissive avoidance attachment style in the vaginismus group were significantly higher than in the control group. Both total FSFI scores and arousal, pain, and satisfaction subscale scores were higher in the control group.Clinical ImplicationsASAD should be evaluated and addressed separately, when necessary, in the treatment of vaginismus.Strengths & LimitationsThe relationship between ASAD and vaginismus has been shown for the first time. Study limitations included the assessment of factors influencing the study results based on self-reporting and possible recall bias.ConclusionAttachment and comorbidity research in vaginismus needs to shift from just reporting disturbances, to identify various clinical variables, such as the severity of the vaginismus, response to therapy, and differences in therapeutic modalities, in terms of outcome. Unlubilgin E, Tetik S, Aksoy I, et al. Relationship Between Adult Separation Anxiety and Attachment Styles and Vaginismus. J Sex Med 2021;18:1752–1758.     

Adult Attachment and Sexual Functioning: A Review of Past Research

IntroductionThe association between adult attachment and sexual functioning is an important area of research. However, there has been no previous attempt to systematically review the available literature between these dimensions, and how their interrelationships may vary within different populations.AimTo provide an in‐depth critical investigation of the literature on the association between adult attachment and sexual functioning (satisfaction, dysfunction, and behaviors).MethodsA systematic literature review of research reported in PsychINFO, Scopus, PubMed, and Psychology and Behavioral Sciences Collection from January 1, 1990 to November 8, 2011.ResultsThe results demonstrated that higher levels of anxious and avoidant attachment were related to less satisfying sexual relationships, higher levels of sexual dysfunction, and different sexual intercourse frequencies and motivations for sex.ConclusionsThere is a need for further research to target the sexual functioning of males and to incorporate representative samples (ethnicity, sexual orientation, and relationship status) into the analyses. Moreover, measurement of sexual behavior needs to encompass a range of sexual functioning variables. Stefanou C and McCabe MP. Adult attachment and sexual functioning: A review of past research. J Sex Med **;**:**–**.     

The Relationship Between the FFM Personality Traits,State Psychopathology,and Sexual Compulsivity in a Sample of Male College Students

IntroductionSeveral studies have advocated a relationship between psychopathological features and sexual compulsivity. Such relationship is often found among individuals seeking help for out of control sexual behavior, suggesting that the association between psychological adjustment and sexual compulsivity may have a significant clinical value. However, a more complete approach to the topic of sexual compulsivity would also include the analysis of nonclinical samples as healthy individuals may be at risk of developing some features of hypersexuality in the future.AimThe aim of this study was to explore the relationship between stable traits of personality, state psychopathology, and sexual compulsivity in a sample of male college students. Furthermore, the potential mediating role of state psychopathology in the relationship between personality traits and sexual compulsivity was tested.Main Outcome MeasuresParticipants completed the following measures: the NEO Five‐Factor Inventory, the Brief Symptom Inventory, and the Compulsive Sexual Behavior Inventory‐22.MethodsThe sample included 152 male college students recruited in a Portuguese university using nonrandom methods. The measures were completed individually and anonymously.ResultsFindings on state psychopathology suggested that psychoticism may be one of the key dimensions associated with sexual compulsivity in male students. The personality traits of Neuroticism and Agreeableness were also significant predictors of sexual compulsivity. Findings on the mediating effects suggested that state psychopathology mediated the relationship between Neuroticism and sexual compulsivity but not between Agreeableness and sexual compulsivity.ConclusionsA psychopathological path (encompassing Neuroticism and state psychopathology) and a behavioral path (encompassing Agreeableness features) may be involved in sexual compulsivity as reported by a nonclinical sample of male students. Pinto J, Carvalho J, and Nobre PJ. The relationship between the FFM personality traits, state psychopathology, and sexual compulsivity in a sample of male college students. J Sex Med 2013;10:1773–1782.     

Solo and Partnered Sexual Behavior Among an International Sample of Adults With Spina Bifida

BackgroundSpina bifida (SB) may differentially impact adults’ participation in solo and partnered sexual behaviors, but little research investigates this topic.AimDescribe solo and partnered sexual behaviors among an international sample of adult men and women with SB.Main Outcome MeasuresEver participated (no/yes) and recent participation (>1 year ago/within last year) in solo masturbation, cuddled with a partner, held hands with a partner, kissed a partner, touched a partner's genital, had genitals touched by a partner, gave a partner oral sex, received oral sex from a partner, vaginal sex, anal sex, and sex toy use.MethodsData were drawn from a larger cross-sectional, internet-based survey assessing the sexual behaviors of an international sample of men and women with SB. We used logistic regression to examine the impact of background (gender, age, independent living, and relationship status) and health (shunt status, ambulation, and genital sensation) factors on each outcome.ResultsThe sample consisted of 345 respondents aged 18–73 years from 26 nations. Very few (<3%) had no lifetime experience with any solo or partnered behaviors; 25.0% reported participating in all behaviors at some point in their lives. The median number of past year sexual behaviors (of 16 total) was 7. Lifetime and recent participation were associated with demographic and health factors.Clinical ImplicationsDespite impairment, adults with spina bifida do participate in solo and partnered sexual behaviors. Medical personnel who work with this population should include discussions about sexuality as part of routine care.Strengths & LimitationsAlthough this research measured solo and partnered sexual behavior in large international sample of adults with spina bifida, it is limited by its cross-sectional retrospective design and non-clinical convenience sample.ConclusionDespite disability, many adults with SB participate in solo and partnered sexual behavior. Medical and psychosocial supports are needed to help adults in this population enjoy sexuality in a healthy and safe manner.Hensel DJ, Misseri R, Wiener JS, et al. Solo and Partnered Sexual Behavior Among an International Sample of Adults With Spina Bifida. J Sex Med 2022;19:1766–1777.     

Couple empathy – the mediator of attachment styles for partners adjusting to parenthood

Objective and Background: Attachment styles and empathy with respect to couples’ functioning during the period of transition to parenthood have rarely been studied. The aim of the present study was to examine the link between attachment security and perceived empathy as well as their role in the adjustment to parenthood. It was hypothesised that secure parents, as opposed to insecure ones, would perceive themselves and their partners as more empathic after the child’s birth and, as a consequence, more effectively adapt to parenthood. Methods: Sixty-seven couples experiencing their first transition to parenthood participated in the study. Their attachment styles were measured before the birth of the child. Empathy (as perceived in oneself and in a partner) and adjustment to parenthood were measured when the child was a few months old. Results: The results indicated that new parents with more secure, less anxious–ambivalent, and less avoidant attachment styles expressed and perceived more empathy in their relationships, and they were better adjusted to parenthood. A partner’s perceived empathy was found to be a mediator between one’s attachment styles and their adjustment to parenthood. In particular, men’s self-assessed empathy and men’s empathy as perceived by their wives was a significant mediator of the relationship between one’s attachment styles and adjustment to parenthood. Conclusion: Attachment styles are associated with the empathy of partners (both declared and perceived), which in turn predicts their better adjustment to parenthood.     

Considering Attachment and Partner Perceptions in the Prediction of Physical and Emotional Sexual Satisfaction

IntroductionAttachment theory provides a framework for understanding sexual satisfaction; in general, research suggests that attachment anxiety and avoidance are associated with decreased sexual satisfaction. Given their different working models of self and other, perceptions of the partner's level of satisfaction might differentially influence people's own perceptions of satisfaction based on their attachment avoidance and anxiety.AimTo examine the predictive value of attachment anxiety and avoidance and perceptions of partner satisfaction in predicting physical and emotional satisfaction after sexual interactions in two studies.MethodsParticipants (study 1, n = 52; study 2, n = 144) completed a one-time survey containing a measurement of attachment and then reported on their physical and emotional sexual satisfaction after each sexual interaction over the course of 2 to 3 weeks.Main Outcome MeasuresThe Experiences in Close Relationships Scale–Revised was completed during the one-time survey, and ratings of personal physical and emotional sexual satisfaction (studies 1 and 2) and perceptions of partner's physical and emotional satisfaction were completed after sexual interactions (study 2).ResultsGreater attachment avoidance was associated with lesser physical and emotional satisfaction. Moreover, when perceiving the partner to be emotionally satisfied, people with more attachment avoidance reported less emotional satisfaction for themselves. For greater attachment anxiety, greater perceived partner satisfaction (physical and emotional) predicted greater personal satisfaction of the two types.ConclusionThe findings support attachment theory as a valuable lens through which to study sexual satisfaction. Moreover, the results suggest that it is important to consider perceptions of partner sexual satisfaction in understanding the sexual satisfaction of people who demonstrate attachment anxiety and avoidance.     

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.