Functional cortical and subcortical abnormalities in pedophilia: a combined study using a choice reaction time task and fMRI

IntroductionPedophiles show sexual interest in prepubescent children but not in adults. Research into the neurofunctional mechanisms of paraphilias has gathered momentum over the last years.AimTo elucidate the underlying neural processing of sexual interest among pedophiles and to highlight the differences in comparison with nonparaphilic sexual interest in adults.MethodsNine pedophilic patients and 11 nonpedophilic control subjects underwent functional magnetic resonance imaging (fMRI) while viewing pictures of nude (prepubescents, pubescents, and adults) and neutral content, as well as performing a concomitant choice reaction time task (CRTT).Main Outcome MeasuresBrain blood oxygen level-dependent (BOLD) signals and response latencies in the CRTT during exposure to each picture category.ResultsAnalysis of behavioral data showed group differences in reaction times regarding prepubescent and adult but not pubescent stimuli. During stimulation with pictures displaying nude prepubescents, pedophiles showed increased BOLD response in brain areas known to be involved in processing of visual sexual stimuli. Comparison of pedophilic patients with the control group discovered differences in BOLD responses with respect to prepubescent and adult but not to pubescent stimuli. Differential effects in particular occurred in the cingulate gyrus and insular region.ConclusionsThe brain response of pedophiles to visual sexual stimulation by images of nude prepubescents is comparable with previously described neural patterns of sexual processing in nonpedophilic human males evoked by visual stimuli depicting nude adults. Nevertheless, group differences found in the cingulate gyrus and the insular region suggest an important role of these brain areas in pedophilic sexual interest. Furthermore, combining attention-based methods like CRTT with fMRI may be a viable option for future diagnostic procedures regarding pedophilia. Poeppl TB, Nitschke J, Dombert B, Santtila P, Greenlee MW, Osterheider M, and Mokros A. Functional cortical and subcortical abnormalities in pedophilia: A combined study using a choice reaction time task and fMRI.     

Diminished Functional Connectivity on the Road to Child Sexual Abuse in Pedophilia

BackgroundPedophilia is a disorder recognized for its impairment to the individual and for the harm it may cause to others. However, the neurobiology of pedophilia and a possible propensity to sexually abuse children are not well understood. In this study, we thus aimed at providing new insights in how functional integration of brain regions may relate to pedophilia or child sexual abuse (CSA).MethodBy using functional magnetic resonance imaging (fMRI) technique, we compared functional connectivity at rest (RSFC) between pedophiles who engaged (P+CSA; N = 12) or did not engage (P–CSA; N = 14) in CSA and healthy controls (HCs; N = 14) within two networks: (i) the default mode network and (ii) the limbic network that has been linked to pedophilia before.ResultsPedophiles who engaged in CSA show diminished RSFC in both networks compared with HC and P–CSA. Most importantly, they showed diminished RSFC between the left amygdala and orbitofrontal as well as anterior prefrontal regions. Though significant age differences between groups could not be avoided, correlation control analysis did not provide evidence for the assumption that the RSFC effects were related to age differences.ConclusionWe found significantly diminished RSFC in brain networks critically involved in widespread motivational and socio‐emotional processes. These results extend existing models of the functional neuroanatomy of pedophilia and CSA as altered RSFC between these regions were related to CSA rather than pedophilia and thus may account for an increased propensity to engage in CSA in people suffering from pedophilia. Kärgel C, Massau C, Weiß S, Walter M, Kruger THC, and Schiffer B. Diminished functional connectivity on the road to child sexual abuse in pedophilia. J Sex Med 2015;12:783–795.     

Diagnostic Accuracy of Eye Movements in Assessing Pedophilia

IntroductionGiven that recurrent sexual interest in prepubescent children is one of the strongest single predictors for pedosexual offense recidivism, valid and reliable diagnosis of pedophilia is of particular importance. Nevertheless, current assessment methods still fail to fulfill psychometric quality criteria.AimsThe aim of the study was to evaluate the diagnostic accuracy of eye‐movement parameters in regard to pedophilic sexual preferences.MethodEye movements were measured while 22 pedophiles (according to ICD‐10 F65.4 diagnosis), 8 non‐pedophilic forensic controls, and 52 healthy controls simultaneously viewed the picture of a child and the picture of an adult. Fixation latency was assessed as a parameter for automatic attentional processes and relative fixation time to account for controlled attentional processes.Main Outcome MeasuresReceiver operating characteristic (ROC) analyses, which are based on calculated age‐preference indices, were carried out to determine the classifier performance. Cross‐validation using the leave‐one‐out method was used to test the validity of classifiers.ResultsPedophiles showed significantly shorter fixation latencies and significantly longer relative fixation times for child stimuli than either of the control groups. Classifier performance analysis revealed an area under the curve (AUC) = 0.902 for fixation latency and an AUC = 0.828 for relative fixation time. The eye‐tracking method based on fixation latency discriminated between pedophiles and non‐pedophiles with a sensitivity of 86.4% and a specificity of 90.0%. Cross‐validation demonstrated good validity of eye‐movement parameters.ConclusionsDespite some methodological limitations, measuring eye movements seems to be a promising approach to assess deviant pedophilic interests. Eye movements, which represent automatic attentional processes, demonstrated high diagnostic accuracy. Fromberger P, Jordan K, Steinkrauss H, von Herder J, Witzel J, Stolpmann G, Kröner‐Herwig B, and Müller JL. Diagnostic accuracy of eye movements in assessing pedophilia. J Sex Med 2012;9:1885–1899.     

The German Dunkelfeld Project: A Pilot Study to Prevent Child Sexual Abuse and the Use of Child Abusive Images

IntroductionSexual interest toward prepubescents and pubescents (pedophilia and hebephilia) constitutes a major risk factor for child sexual abuse (CSA) and viewing of child abusive images, i.e., child pornography offenses (CPO). Most child sexual exploitation involving CSA and CPO are undetected and unprosecuted in the “Dunkelfeld” (German: “dark field”).AimThis study assesses a treatment program to enhance behavioral control and reduce associated dynamic risk factors (DRF) in self‐motivated pedophiles/hebephiles in the Dunkelfeld.MethodsBetween 2005 and 2011, 319 undetected help‐seeking pedophiles and hebephiles expressed interest in taking part in an anonymous and confidential 1‐year‐treatment program using broad cognitive behavioral methodology in the Prevention Project Dunkelfeld. Therapy was assessed using nonrandomized waiting list control design (n = 53 treated group [TG]; n = 22 untreated control group [CG]).Main Outcome MeasuresSelf‐reported pre‐/posttreatment DRF changes were assessed and compared with CG. Offending behavior characteristics were also assessed via self‐reporting.ResultsNo pre‐/postassessment changes occurred in the control group. Emotional deficits and offense‐supportive cognitions decreased in the TG; posttherapy sexual self‐regulation increased. Treatment‐related changes were distributed unequally across offender groups. None of the offending behavior reported for the TG was identified as such by the legal authorities. However, five of 25 CSA offenders and 29 of 32 CPO offenders reported ongoing behaviors under therapy.ConclusionsTherapy for pedophiles/hebephiles in the Dunkelfeld can alter child sexual offending DRF and reduce‐related behaviors. Unidentified, unlawful child sexual exploitative behaviors are more prevalent in this population than in officially reported recidivism. Further research into factors predictive of problematic sexual behaviors in the Dunkelfeld is warranted. Beier KM, Grundmann D, Kuhle LF, Scherner G, Konrad A, and Amelung T. The German Dunkelfeld Project: A pilot study to prevent child sexual abuse and the use of child abusive images. J Sex Med 2015;12:529–542.     

Executive dysfunctions in pedophilic and nonpedophilic child molesters

IntroductionThere is some evidence that child molesters show neuropsychological abnormalities which might reflect specific structural and/or functional brain alterations, but there are also inconsistencies in the existing findings which need to be clarified. Most of the different outcomes can either be explained by the fact that different types of child molesters were examined or by not having accounted for basically confounding factors such as age, education/intelligence, or criminality.AimThe present study therefore sought to determine whether pedophilic and nonpedophilic child molesters, compared to relevant control groups, show different profiles of executive dysfunction when accounting for potentially confounding factors.MethodsThe performance of 30 child molesters (15 pedophilic and 15 nonpedophilic) and 33 age‐ and education‐matched controls (16 nonsexual offenders and 17 healthy controls) was assessed regarding several neuropsychological functions.Main Outcome MeasuresScores on different neurocognitive tests and semistructured diagnostical interviews.ResultsResults indicate that pedophilic child molesters exhibited less performance deficits in cognitive functioning than nonpedophilic child molesters. Compared to healthy controls and nonsexual offenders, the pedophilic child molesters only showed executive dysfunction concerning response inhibition, whereas the nonpedophilic child molesters revealed more severe dysfunction, especially on tasks associated with cognitive flexibility and verbal memory.ConclusionsThese results enhance our knowledge about executive dysfunction associated with criminality and/or pedophilia, as they suggest different profiles of impairment between groups. In summary, data suggest that nonpedophilic child molesters showed more severe cognitive deficits than pedophilic child molesters. However, as response inhibition is associated with prefrontal (i.e., orbitofrontal) functioning, the deficits observed in both child molester groups indicate dysfunction in the orbitofrontal cortex. This has to be further examined with functional imaging approaches in larger samples and a full‐factorial approach which allows for a clear distinction between criminality and pedophilia in a factorial manner. Schiffer B and Vonlaufen C. Executive dysfunctions in pedophilic and nonpedophilic child molesters. J Sex Med 2011;8:1975–1984.     

Dysfunctional Sexual Beliefs: A Comparative Study of Heterosexual Men and Women,Gay Men,and Lesbian Women With and Without Sexual Problems

IntroductionConservative and dysfunctional sexual beliefs are commonly associated with sexual problems among heterosexual men and women. However, little is known about the role of sexual beliefs in sexual problems in gay men and lesbians.AimThe present study aimed at analyzing the role of sexual beliefs in sexual dysfunction in a sample of heterosexual and homosexual men and women.Main Outcome MeasuresParticipants answered questions about self-perceived sexual problems and completed the Sexual Dysfunctional Beliefs Questionnaire.MethodsTwo hundred twelve men (106 gay) and 192 women (96 lesbian) completed a Web survey.ResultsFindings indicated that men with sexual dysfunction (regardless of sexual orientation) reported significantly more conservative beliefs and more erroneous beliefs related to partner's sexual satisfaction compared with sexually healthy men. Also, gay men with sexual dysfunction (but not heterosexual men) scored higher on belief in sex as an abuse of men's power compared with healthy controls. In addition, heterosexual men scored higher on “macho” beliefs, beliefs regarding partner's sexual satisfaction, and partner's power, compared with gay men. For women, a main effect was found for sexual orientation, with lesbian women scoring higher on sexual desire as a sin, age-related beliefs, and affection primacy and lower on beliefs related to motherhood primacy.ConclusionsOverall, findings suggest that dysfunctional sexual beliefs may play a role as vulnerability factors for sexual dysfunction regardless of sexual orientation, particularly in men. Peixoto MM and Nobre P. Dysfunctional sexual beliefs: A comparative study of heterosexual men and women, gay men, and lesbian women with and without sexual problems. J Sex Med 2014;11:2690–2700.     

Development and psychometric properties of the Female Sexual Desire Questionnaire (FSDQ)

IntroductionSexual desire is often evaluated as part of a global assessment of female sexual function, which may not comprehensively evaluate the various facets of this experience. There currently exists a need to develop a psychometrically robust desire‐specific measure for women.AimThe aim of this study was to develop and validate a desire‐specific, self‐administered instrument that evaluates the multiple facets of sexual desire and factors influencing this experience for partnered heterosexual women, with or without sexual dysfunction.MethodsPreliminary items for inclusion in the Female Sexual Desire Questionnaire (FSDQ) were identified through a literature review and individual interviews with partnered heterosexual women, mostly from Australia. The resulting instrument was completed by a validation sample of 741 women, aged between 18 and 71 years, who were involved in a heterosexual relationship of between 3 months' and 49 years' duration.Main Outcome MeasuresExploratory factor analysis was used to refine the FSDQ item content and identify the underlying domain structure. The reliability (internal consistency) and validity (convergent validity) of the FSDQ were also evaluated.ResultsThe final version of the FSDQ consisted of 50 items organized into six domains that characterized the experience of, and factors influencing, sexual desire for heterosexual partnered women: Dyadic Desire, Solitary Desire, Resistance, Positive Relationship, Sexual Self‐Image, and Concern. Each domain demonstrated high reliability, as did the overall measure. Evidence of construct validity was ascertained through convergence with the Sexual Desire Inventory and the Hurlbert Index of Sexual Desire. A short‐form of the FSDQ, consisting of six items, was also developed.ConclusionsThe FSDQ is a new reliable and valid multidimensional measure designed specifically for evaluating the facets of, and factors influencing, sexual desire among sexually functional and dysfunctional women who are involved in a heterosexual relationship. Goldhammer DL and McCabe MP. Development and Psychometric Properties of the Female Sexual Desire Questionnaire (FSDQ). J Sex Med 2011;8:2512–2521.     

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.     

Male and Female Sexual Function After Surgical Repair of Female Organ Prolapse

IntroductionFew data are available referring to male and female sexual function after prolapse repair of symptomatic pelvic organ.AimPrimary aim of this study is to determine the male and female sexual function before and after surgery for pelvic organ prolapse.Main Outcome MeasuresWe used the Female Sexual Function Index (FSFI) questionnaire for female patients and for their male partners the Brief Male Sexual Inventory (BMSI) as measurement of sexual function.MethodsWe included sexually active heterosexual couples that were referred to the Department of Urogynaecology because of symptomatic cystocele, rectocele or vault descent. For cystoceles, anterior repair was performed, for rectoceles posterior repair, and for vault descent sacrospinous ligament fixation. FSFI and BMSI questionnaires were distributed before and after pelvic organ surgery and 4 months after. Female clinical examination assessing the degree of prolapse was performed before and 6 weeks after surgery.ResultsA full data set of 70 female questionnaires and 64 male questionnaires could be evaluated. Two cases of female de novo dyspareunia occurred. In women, FSFI scores improved significantly in the domains desire, arousal, lubrication, overall satisfaction, and particularly pain. Orgasm remained unchanged. In men, interest, sexual drive, and overall satisfaction improved significantly. Erection, ejaculatory function, and orgasm remained unchanged. Despite remaining unchanged, erection, strength of erection, ejaculation, and orgasm were not considered problems anymore compared to preoperative BMSI scores.ConclusionSurgery for pelvic organ prolapse improves male and female sexual function in some domains but not in all. Kuhn A, Brunnmayr G, Stadlmayr W, Kuhn P, and Mueller MD. Male and female sexual function after surgical repair of female organ prolapse. J Sex Med 2009;6:1324–1334.     

Changes in Sexual Arousal as Measured by Penile Plethysmography in Men with Pedophilic Sexual Interest

IntroductionAlthough pedophilia is defined by a recurrent sexual interest in prepubescent children, little attention has been paid to the stability or fluidity of this sexual interest over time.AimThe aim of the current study was to investigate if patterns of penile tumescence (as a proxy for sexual interest) measured by penile plethysmography testing (PPT) can change.MethodsIn this retrospective chart review study, PPT results of 43 men diagnosed with pedophilia were collected and analyzed. All participants displayed a pedophilic sexual arousal pattern at the time of their first PPT. To test for change, we compared initial PPT results with subsequent PPT results measured at least 6 months later.Main Outcome MeasureSexual arousal was assessed using PPT by measuring change in penile circumference induced by the presentation of standardized sexual audio stimuli.ResultsApproximately half of the sample (n = 21) displayed a change in PPT results. This change was characterized by a significant decrease of sexual arousal in response to pedophilic (child) stimuli and a significant increase of sexual arousal in response to nonpedophilic (adult) stimuli. No differences between sexual interest changers (ICs) and nonchangers (NC) were found for demographic data or for length of time between assessments. However, between-group comparisons revealed that ICs had significantly lower pedophilic indices at the initial assessment than NCs.ConclusionsResults from the current study indicate that relative pedophilic interest, as defined by increase in penile circumference in response to nonpedophilic stimuli as measured by PPT, changed in about 50% of men diagnosed with pedophilia who also had initial pedophilic PPT sexual responses. This represents a significant challenge to the hypothesis that sexual interest in men with pedophilia is unchangeable and should be the focus of future studies.Müller K, Curry S, Ranger R, Briken P, Bradford J, and Fedoroff JP. Changes in sexual arousal as measured by penile plethysmography in men with pedophilic sexual interest. J Sex Med 2014;11:1221–1229.     

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.     

The Revised Screening Scale for Pedophilic Interests (SSPI-2) May Be a Measure of Pedohebephilia

IntroductionThe Revised Screening Scale for Pedophilic Interests (SSPI-2) was developed as a screening measure for pedophilia (sexual interest in prepubescent children), but the SSPI-2 items reflect offending against both prepubescent and pubescent children, roughly corresponding to victims under age 15.AimWe examined whether the SSPI-2 is better interpreted as a measure of pedohebephilia (sexual interest in both prepubescent and pubescent children) by reanalyzing the original SSPI-2 data and reporting its new psychometric properties.MethodsThe sample was comprised of 1,900 men whose clinical assessment data were entered into an archival database. All men in the sample had at least 1 child victim. Phallometric indices based on sexual responses to children relative to adults were used to classify individuals as having pedophilia only, hebephilia only (sexual interest in pubescent children), or pedohebephilia.Main Outcome MeasureThe 5 SSPI-2 items were scored based on official file information sent by the referral source and self-disclosures about offending history made during the assessment.ResultsThe phallometric indices revealed that pedohebephilia was most frequently observed (24%), followed by hebephilia only (16%) and pedophilia only (1%). Classification accuracy analyses suggest that the SSPI-2 may be more appropriately interpreted as a measure of pedohebephilia than hebephilia only; there were too few cases of pedophilia only for classification analysis. Sensitivity, specificity, and positive and negative predictive values are presented to assist users in selecting appropriate SSPI-2 cut-offs.Clinical ImplicationsThe SSPI-2 should be interpreted as a measure of pedohebephilia when used in clinical practice or research, and test users should select the most appropriate cut-off score based on their assessment context. Classification accuracy results are modest, and the scale may be most appropriately used in research or as a screening measure.Strengths & LimitationsThe study used a comprehensive clinical database with well-validated measures. A limitation is that the dataset did not contain other assessment measures of sexual interest in children, and we were unable to examine if the SSPI-2 could detect pedophilia only due to its low base rate.ConclusionThe SSPI-2 may be best conceptualized as a measure of pedohebephilia. Further, there was significant overlap between pedophilia and hebephilia; pedophilia only was rarely observed.Stephens S, Seto MC, Cantor JM, et al. The Revised Screening Scale for Pedophilic Interests (SSPI-2) May Be a Measure of Pedohebephilia. J Sex Med 2019;16:1655–1663.     

Cognitive-Affective Dimensions of Female Orgasm: The Role of Automatic Thoughts and Affect During Sexual Activity

BackgroundCognitive-affective factors contribute to female sexual dysfunctions, defined as clinically significant difficulties in the ability to respond sexually or to experience sexual pleasure. Automatic thoughts and affect presented during sexual activity are acknowledged as maintenance factors for these difficulties. However, there is a lack of studies on the influence of these cognitive-affective dimensions regarding female orgasm.AimTo assess the role of automatic thoughts and affect during sexual activity in predicting female orgasm occurrence and to investigate the mediator role of these variables in the relation between sexual activity and orgasm occurrence.MethodsNine hundred twenty-six sexually active heterosexual premenopausal women reported on frequency of sexual activities and frequency of orgasm occurrence, cognitive factors, and social desirability. Participants completed the Sexual Modes Questionnaire–Automatic Thoughts Subscale, the Positive and Negative Affect Schedule, and the Socially Desirable Response Set. Multiple linear regressions and mediation analyses were performed, controlling for the effect of covariates such as social desirability, sociodemographic and medical characteristics, and relationship factors.OutcomesThe main outcome measurement was orgasm frequency as predicted and mediated by automatic thoughts and affect experienced during sexual activities.ResultsThe presence of failure thoughts and lack of erotic thoughts during sexual activity significantly and negatively predicted female orgasm, whereas positive affect experienced during sexual activity significantly and positively predicted female orgasm. Moreover, negative automatic thoughts and positive affect during sexual activity were found to mediate the relation between sexual activity and female orgasm occurrence.Clinical ImplicationsThese data suggest that the cognitive aspects of sexual involvement are critical to enhancing female orgasm experience and can aid the development of strategies that contemplate the central role of automatic thoughts and of positive emotions experienced during sexual activity.Strengths and LimitationsData were not collected face to face, which constitutes a strength of this study, because it is known that social desirability is lower in self-administered online questionnaires compared with traditional paper-and-pencil questionnaires, particularly for more sensitive sexual issues. The fact that the sample was composed of heterosexual, premenopausal, and relatively young women demands some caution regarding generalization of the present results.ConclusionThe findings support the contribution of cognitive and affective factors to female orgasmic functioning. It is recommended that future research confirm these findings with other samples, particularly clinical samples of women with orgasmic difficulties.Tavares IM, Laan ETM, Nobre PJ. Cognitive-Affective Dimensions of Female Orgasm: The Role of Automatic Thoughts and Affect During Sexual Activity. J Sex Med 2017;14:818–828.     

Sensitivity and Specificity of the Phallometric Test for Hebephilia

IntroductionThe phallometric test has been examined most widely in the literature with regard to its ability to detect pedophilia; however, it has become of increasing interest to clinicians and researchers to ascertain to what extent the test accurately detects hebephilia: Whereas pedophilia refers to an adult's sexual interest in prepubescent children (age 10 or younger, on average), hebephilia refers to an adult's sexual interest in pubescent children (ages 11–14, on average).AimThe aim of this study was to estimate the accuracy of volumetric phallometry in distinguishing pedophilic men and hebephilic men from men who are teleiophilic (primarily sexually interested in adults, age 17 or older).MethodsA retrospective chart review was conducted on the cumulate database of a large phallometric laboratory and clinic to identify a group of 239 men who committed sexual offenses against extrafamilial adults age 17 or older and a group of 996 men who committed sexual offenses against extrafamilial children age 14 or younger, all of whom professed a greater sexual interest in adults over children.Main Outcome MeasuresThe sensitivity and specificity of the phallometric test is calculated for its accuracy in distinguishing sexual preferences for children spanning various age ranges.ResultsReceiver operator characteristic curves were highly significant for each classification decision: Using its previously established cut‐point of +0.25 standard deviation (SD) units, the phallometric test detected hebephilia with a sensitivity and specificity of 70.0% and 90.7%, detected pedophilia with 46.9% and 100%, and detected pedohebephilia with 75.3% and 90.7%. At a new cut‐point of +0.0 SD units, the sensitivity and specificity of the test for pedophilia was 71.9% and 95.3%.ConclusionsVolumetric phallometry significantly distinguishes teleiophilic sex offenders from each of pedophilic, hebephilic, and pedohebephilic sex offenders and can serve as a reliable diagnostic test of sexual age preference among men who deny sexual interest in children. Cantor JM, and McPhail IV. Sensitivity and specificity of the phallometric test for hebephilia. J Sex Med 2015;12:1940–1950.     

Substance use and mental health disparities among sexual minority girls: results from the Pittsburgh girls study

PurposeTo examine substance use and mental health disparities between sexual minority girls and heterosexual girls.MethodsData from the Pittsburgh Girls Study were analyzed. All girls were 17 years old. Girls were included if they were not missing self-reported sexual orientation and mental health data (N = 527). Thirty-one girls (6%) endorsed same-sex romantic orientation/identity or current same-sex attraction. Bivariate analyses were conducted to test group differences in the prevalence of substance use and suicidal behavior, and group differences in depression, anxiety, borderline personality disorder (BPD), oppositional defiant disorder (ODD), and conduct disorder (CD) symptoms.ResultsCompared with heterosexual girls, sexual minority girls reported higher past-year rates of cigarette, alcohol, and heavy alcohol use, higher rates of suicidal ideation and self-harm, and higher average depression, anxiety, BPD, ODD, and CD symptoms.ConclusionsSexual minority girls are an underrepresented group in the health disparities literature, and compared with heterosexual girls, they are at higher risk for mental health problems, most likely because of minority stress experiences such as discrimination and victimization. The disparities found in this report highlight the importance of discussing sexual orientation as part of a comprehensive preventive care visit.     

Sexual Inhibition is a Vulnerability Factor for Orgasm Problems in Women

Background

The differential role of psychological traits in the etiology and maintenance of female orgasm difficulties is yet to be consistently established.

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.     

ORIGINAL RESEARCH—PAIN: Sexual Functioning in Women with Chronic Pelvic Pain: The Role of Anxiety and Depression

IntroductionChronic pelvic pain (CPP) in women is a long lasting and often disabling condition. It seems reasonable to expect that as a result of the pain, extreme fatigue and/or emotional problems, women with CPP may report a variety of sexual problems.AimThe present study investigated differences in the report of sexual problems in women with CPP compared with healthy controls, and whether the association of CPP with sexual problems was moderated or mediated by somatic and psychological factors as manifested in women suffering from CPP.MethodOne hundred fifty-four women with CPP and 58 age-matched controls completed self-report measures for sexual functioning, pain, physical impairment, anxiety, depression, and sexual and physical abuse.Main Outcome MeasureGolombok Rust Inventory of Sexual Satisfaction.ResultsWomen with CPP reported higher levels of vaginistic complaints, sexual avoidance, nonsensuality and sexual dissatisfaction than healthy controls. Sexual problems were associated with anxiety, depression, and sexual abuse history but not with somatic factors as pain and physical impairment. Anxiety as well as depression, irrespective of the report of sexual abuse experiences, mediated the effect of CPP on sexual problems. Sexual abuse was a general predictor of sexual problems in both women with CPP and controls.ConclusionsAnxiety and depression constitute important factors in the evaluation of sexual problems in women with CPP. ter Kuile MM, Weijenborg PTM, and Spinhoven P. Sexual functioning in women with chronic pelvic pain: The role of anxiety and depression.     

Common Genetic Factors among Sexual Orientation,Gender Nonconformity,and Number of Sex Partners in Female Twins: Implications for the Evolution of Homosexuality

IntroductionHomosexuality is a stable population‐level trait in humans that lowers direct fitness and yet is substantially heritable, resulting in a so‐called Darwinian “paradox.” Evolutionary models have proposed that polymorphic genes influencing homosexuality confer a reproductive benefit to heterosexual carriers, thus offsetting the fitness costs associated with persistent homosexuality. This benefit may consist of a “sex typicality” intermediate phenotype. However, there are few empirical tests of this hypothesis using genetically informative data in humans.AimThis study aimed to test the hypothesis that common genetic factors can explain the association between measures of sex typicality, mating success, and homosexuality in a Western (British) sample of female twins.MethodsHere, we used data from 996 female twins (498 twin pairs) comprising 242 full dizygotic pairs and 256 full monozygotic pairs (mean age 56.8) and 1,555 individuals whose co‐twin did not participate. Measures of sexual orientation, sex typicality (recalled childhood gender nonconformity), and mating success (number of lifetime sexual partners) were completed.Main Outcome MeasureVariables were subject to multivariate variance component analysis.ResultsWe found that masculine women are more likely to be nonheterosexual, report more sexual partners, and, when heterosexual, also report more sexual partners. Multivariate twin modeling showed that common genetic factors explained the relationship between sexual orientation, sex typicality, and mating success through a shared latent factor.ConclusionsOur findings suggest that genetic factors responsible for nonheterosexuality are shared with genetic factors responsible for the number of lifetime sexual partners via a latent sex typicality phenotype in human females. These results may have implications for evolutionary models of homosexuality but are limited by potential mediating variables (such as personality traits) and measurement issues. Burri A, Spector T, and Rahman Q. Common Genetic Factors among Sexual Orientation, Gender Nonconformity, and Number of Sex Partners in Female Twins: Implications for the Evolution of Homosexuality. J Sex Med 2015;12:1004–1011.