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 **;**:**–**.     

Sexual Functioning Among Childhood Sexual Abuse Survivors From an Attachment Perspective

BackgroundDespite the fact that childhood sexual abuse can affect a survivor's sexual functioning in adulthood, few studies have examined survivors' adult sexual functioning from the perspective of attachment theory.AimThe present study sought to examine how sexual abuse in childhood might shape the associations between attachment insecurities and sexual functioning among adults.MethodsThe study sample consisted of 265 participants (166 women and 99 men), 45 (16.9%) of whom were classified as survivors of childhood sexual abuse. Participants completed an online questionnaire about their history of childhood sexual abuse, attachment insecurities, and sexual functioning over the past 6 months.OutcomesThe findings of the present study suggest that attachment insecurities may have unique implications for sexual functioning among survivors of childhood sexual abuse.ResultsFindings indicated that a history of childhood sexual abuse significantly moderated the associations between attachment insecurities and sexual functioning. Whereas the effect of attachment avoidance in predicting sexual desire was not significant among nonabused participants, it was significant among survivors; specifically, higher levels of attachment avoidance predicted lower levels of sexual desire. A different pattern was found for attachment anxiety. Although attachment anxiety did not predict vaginal lubrication/penile erection among nonabused participants, it had significant effects among survivors; specifically, higher levels of attachment anxiety predicted higher levels of vaginal lubrication/penile erection.Clinical TranslationFindings from the present study may help facilitate sex therapy interventions for childhood sexual abuse survivors, from an attachment theory perspective.Strengths & LimitationsThe study included a nonclinical, convenience sample and used self-report measures, which are highly subjective and increase the possibility of social-desirability biases. However, on the plus side, it relied on simple, short, self-report questionnaires that are accessible and can be easily used by professionals to examine a survivor's current condition relative to any of the variables, establish intervention goals, and evaluate treatment.ConclusionA history of childhood sexual abuse is related to 2 opposite patterns of association between attachment insecurity (depending on type) and sexual functioning.Gewirtz-Meydan A, Lahav Y. Sexual Functioning Among Childhood Sexual Abuse Survivors From an Attachment Perspective. J Sex Med 2020;17:1370–1382.     

Stability of Genetic and Environmental Influences on Female Sexual Functioning

Background

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

Psychosexual Development and Sexual Functioning in Young Adult Survivors of Childhood Cancer

BackgroundChildhood cancer and its treatment can impair survivors’ development throughout life, particularly psychosexual development, which can be affected in complex ways and is crucial for survivors’ well-being. Yet, research is scarce.AimThis study assessed psychosexual development (milestone attainment, age at attainment, perceived timing) in young adult survivors of childhood cancer. It further examined sexual satisfaction and sexual functioning, and whether survivors’ perceived timing of sexual debut was related to satisfaction or functioning.MethodsA registry-based nationwide survey was completed by N = 492 German survivors of childhood cancer (age 21–26 years, 6–26 years postdiagnosis). They completed standardized measures of psychosexual milestones (eg, first kiss, sexual debut), sexual satisfaction, and sexual functioning. Psychosexual development was compared to normative data (N = 1,533).OutcomesPsychosexual development, sexual satisfaction, and sexual functioning were the primary outcome measures. Psychosexual development was characterized in three ways: milestone attainment (yes/no), age at attainment, perceived timing (“right” time, too early/late).ResultsMilestone attainment was comparable to normative data, except for sexual debut: Survivors were less often experienced (82.5% vs 88%; P = .002) and older at sexual debut (17.4 vs 16.2 years; g = 0.55), but most survivors (58.3%) perceived their timing as “right.” Survivors of brain tumors were least likely to have had their sexual debut, but if experienced age at sexual debut was similar to other survivors. Female survivors were somewhat more experienced than males (eg, first kiss, first relationship; <10% difference), but they were somewhat older when they first kissed (g = 0.26). Age at diagnosis was unrelated to milestone attainment. Perceived early/late sexual debut was related to lower satisfaction in female survivors (P = .026), but unrelated to sexual dysfunction. Instead, partnered men reported particularly low dysfunction whereas women reported similar levels of sexual dysfunction irrespective of their relationship status (P = .049). Overall, sexual functioning was favorable (60.2%: not/barely problematic).Clinical implicationsMost survivors reported favorable sexual satisfaction and functioning, but a minority of survivors may need supportive services.Strengths & LimitationsThis project represents one of few large-scale studies on psychosexual development in childhood cancer survivors relative to normative data, and is the first to link development to sexual satisfaction/functioning. Assessing satisfaction/functioning with validated, but brief measures limits detailed insights, but was inclusive of any sexual orientation. Medical background information based on registry data was limited.ConclusionResults showed normative psychosexual development (except for sexual debut) in most survivors. A self-determined attitude toward sexuality (ie, engaging in sexual activities at the “right” time) may generally determine positive sexual experiences.Lehmann V, Gerhardt CA, Baust K, et al. Psychosexual Development and Sexual Functioning in Young Adult Survivors of Childhood Cancer. J Sex Med 2022;19:1645–1654.     

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.     

A Survey of Female Sexual Functioning in the General Dutch Population

BackgroundAfter the diagnosis and treatment of disease, a major barrier to research on psychosexual functioning is the lack of a consistent estimate for the prevalence of female sexual dysfunction in the general population.AimTo clarify the prevalence of age-related female sexual functioning in the general population.MethodsA sample was compiled by random selection of women from the general population in the northern part of the Netherlands and was categorized by age. Women completed the Female Sexual Function Index (FSFI), personal medical items and daily activities, the Body Image Scale, the SF-36 Health Survey, the Hospital Anxiety and Depression Scale, and the Multidimensional Fatigue Inventory. Participants' representativeness was assessed by comparing their characteristics with data from the Dutch Central Agency for Statistics and the Dutch Health Monitor. General health, fatigue, and well-being were compared with national or international data.OutcomesAge-related total and domain scores of the FSFI.ResultsWe evaluated female sexual functioning of 521 sexually active women. For women 20 to 80 years old, sexual functioning showed wide variance and was poor in 28% of all sexually active women, with FSFI scores being below the defined clinical cutoff (FSFI score < 26.55). Although sexual activity and functioning significantly decreased with increasing age, sexual satisfaction decreased only non-significantly.Clinical ImplicationsThis study provides valuable age-specific ranges for female sexual functioning in the general population and can inform upcoming clinical studies.Strengths and LimitationsThis is the largest study on female sexual function in a representative Dutch population using internationally validated tools and described by age categories, providing valuable information that can help in the understanding of how female sexual function changes with age. The FSFI has been criticized for not assessing personal distress related to sexual problems, so the lack of the Female Sexual Distress Scale in our study is an unfortunate shortcoming. The high rate of sexual inactivity (31%) resulted in fewer women being available to evaluate sexual functioning, but this could reflect the actual level of sexual (in)activity among women in a general population.ConclusionFSFI total and domain scores showed wide variation across all age categories, but overall, one in four sexually active women scored below the diagnostic cutoff score. Sexual activity and functioning also decreased with age, whereas sexual satisfaction decreased only slightly.Lammerink EAG, de Bock GH, Pascal A, et al. A Survey of Female Sexual Functioning in the General Dutch Population. J Sex Med 2017;42:937–949.     

Correlates of Sexual Function in Male and Female Patients with Multiple Sclerosis

IntroductionMany factors have been suggested to contribute to sexual dysfunction (SD) in multiple sclerosis (MS) patients, but the research on their impact on sexual functioning (SF) and sexual quality of life (SQoL) remains scant.AimThe aim of this study was to investigate correlates of SF and SQoL in MS patients, as well as possible gender differences.Methods204 MS patients were interviewed, completed the questionnaires, and underwent neurological assessment.Main Outcome MeasurePrimary outcome measures included the International Index of Erectile Function, the Female Sexual Function Questionnaire, the Sexual Quality of Life Questionnaire, the Beck Depression Inventory, and the Expanded Disability Status Scale.ResultsThe course and duration of the disease did not predict patients' SF. Negative correlations were found for brainstem symptoms with orgasmic function and overall satisfaction in men and between cognitive functioning and the partner domain in women. Interestingly, brainstem symptoms correlated positively with the arousal domain in women. More than half (52.1%) of patients fulfilled Beck Depression Inventory criteria for depression, and these patients showed more SD than nondepressive individuals. The strongest negative correlations with depressive symptoms were found for desire, erectile function, and overall satisfaction with sexual life in men and for orgasm and sexual enjoyment in women. Deterioration in particular domains of SF was clearly related with diminished SQoL. The main gender difference was a strong influence of decreased desire on SQoL in women and no such correlation in men. Negative assessment of the relationship with partner significantly affected all domains of SF and SQoL in MS women and the desire domain in MS men.ConclusionsSeveral correlates of SF in MS patients were found. The role of brainstem symptoms needs further investigation. Clinicians should pay close attention to depressive symptoms and relationship factors in MS patients who suffer from SD. Lew‐Starowicz M and Rola R. Correlates of sexual function in male and female patients with multiple sclerosis. J Sex Med 2014;11:2172–2180.     

Differential DNA Methylation in Monozygotic Twins Discordant for Female Sexual Functioning

BackgroundResearch has repeatedly suggested genetic and environmental factors in the etiology underlying female sexual dysfunction (FSD). Because sexual functioning is a highly variable trait, epigenetics could provide a promising approach to tackle the origins of FSD and consequently offer a step-change in our understanding of these problems.AimTo identify differentially methylated CpG positions for sexual functioning in a sample of monozygotic twin pairs discordant for sexual functioning.MethodsThe sample consisted of 33 trait-discordant monozygotic twin pairs (mean age = 54.1 years, SD = 9.05) from the Twins UK Registry. Phenotypic data on sexual desire, arousal, lubrication, orgasm, satisfaction, and pain were collected using the Female Sexual Function Index–Lifelong (FSFI-LL). The Illumina Infinium HumanMethylation 450 DNA BeadChip was used for epigenome-wide analyses of DNA methylation in whole-blood samples.OutcomesComparison of DNA methylation patterns associated with the FSFI-LL total score and its six subdomains.ResultsTwo differentially methylated CpG positions (cg09580409 and cg14734994) reaching experiment-wide statistical significance were found for overall sexual functioning, mapping to MGC45800 and the threonine synthase-like 2 gene (THNSL2), respectively. Furthermore, potential biologically relevant candidates for sexual desire (CUB and zona pellucida-like domains 1, CUZD1) and satisfaction (solute carrier family 6 member 19, SLC6A19) were identified.Clinical TranslationTHNSL2 and SLC6A19, which have been linked to weight and adiposity, might represent novel candidates for sexual problems in women.Strengths and LimitationsThis is the first study to investigate epigenetic mechanisms underlying FSD. The study used a relative small sample of monozygotic female twins. The cutoff to determine discordance in sexual problems was chosen based on a 10% FSFI score difference. Therefore, the results have to be interpreted with caution and need replication in larger clinical samples.ConclusionUnderstanding how genes and environment interact to influence our sexuality might inform clinical practice and lead to new treatments for women experiencing FSD.Burri A, Leupin M, Spector T, Marinova Z. Differential DNA Methylation in Monozygotic Twins Discordant for Female Sexual Functioning. J Sex Med 2017;14:1357–1364.     

Evaluation of Indicators of Female Sexual Dysfunction in Adult Entertainers

IntroductionFemale sexual dysfunction (FSD) incorporates a wide range of sexual issues within the female population; however, it has not been evaluated among female adult entertainers.AimTo evaluate the prevalence of FSD in women working in the adult entertainment industry.MethodsA 53-question online survey was distributed to female adult entertainers via e-mail through collaboration with the Free Speech Coalition, the North American Trade Association of the Adult Industry. Surveys were sent by the Free Speech Coalition to those within the Performer Availability Screening Services database who met the criteria of having biological vaginas and having experience as adult entertainers. The surveys were answered anonymously. Statistical analysis was performed with Stata/IC 15.1.Main Outcome MeasuresThe survey acquired baseline characteristics, use of contraceptives, sexual activity, work vs home sexual satisfaction, and orgasm, in addition to evaluation of female sexual function using the Female Sexual Function Index survey, with a total score <26.55 indicative of FSD.ResultsOf the 147 respondents, 96 (65%) met inclusion criteria of adequately completing the survey, having a biological vagina, and working in the adult entertainment industry. The mean age was 34.1 ± 10.3 years (range 20–66). The average Female Sexual Function Index score was 28.7 ± 5.6, and 24.0% (23 of 96) of entertainers had scores indicative of FSD. Overall, women found their personal sex lives more satisfying when compared with their professional sex lives (3.99 ± 1.40 vs 3.08 ± 1.52, P < .01). When comparing women with FSD to those without FSD, women with FSD had less sexual satisfaction at home (2.8 ± 1.7 vs 4.4 ± 1.0, P < .01), fewer overall sexual events (7.0 ± 6.7 FSD vs 12.9 ± 10.0 non-FSD, P < .01), and fewer satisfying sexual events overall (3.3 ± 4.2 vs 10.7 ± 8.7, P < .01).Clinical ImplicationsFSD is prevalent among all women, including those within the adult entertainment industry, and must be addressed during patient interactions.Strength & LimitationThis is the first study to evaluate the novel group of female adult entertainers. Despite this novel population, the study size is rather small and is susceptible to response bias.ConclusionFSD appeared to be less prevalent among female adult entertainers than rates commonly quoted for the general population and was more often seen in the women with less satisfying personal sex lives.Dubin JM, Greer AB, Valentine C, et al. Evaluation of Indicators of Female Sexual Dysfunction in Adult Entertainers. J Sex Med 2019;16:621–623.     

Genital Pain and Numbness and Female Sexual Dysfunction in Adult Bicyclists

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

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

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

Reconstructive Surgery for Female Genital Mutilation Starts Sexual Functioning in Sudanese Woman: A Case Report

IntroductionFemale genital mutilation (FGM) involves the partial or complete removal of the external female genitalia and/or other injury to the female genital organs whether for cultural or other nontherapeutic reasons.AimsThe study aims to describe the method of and findings from reconstructive surgery for FGM victims.MethodsWe present a case of a 24-year-old Sudanese female, who had undergone ritual FGM type III as a young girl. She had suffered from a large, vulval mass for the last 6 years and came to the clinic because of apareunia. We performed mass excision and reconstructive surgery of the mutilated genital tissue.ResultsThe giant mass was successfully removed. Remaining genital tissues were approximated and sutured, with hemostasis assured for the reconstructed organs on each side.ConclusionReconstructive surgery for women who suffer sexual consequences from FGM is feasible, with a high degree of client acceptance and satisfaction. It restores some of women's natural genital anatomy, and offers the potential for improved female sexuality. Fazari ABE, Berg RC, Mohammed WA, Gailii EB, and Elmusharaf K. Reconstructive surgery for female genital mutilation starts sexual functioning in S udanese woman: A case report. J Sex Med 2013;10:2861–2865.     

Psychological Correlates of Sexual Dysfunction in Female Rectal and Anal Cancer Survivors: Analysis of Baseline Intervention Data

IntroductionSexual dysfunction represents a complex and multifactorial construct that can affect both men and women and has been noted to often deteriorate significantly after treatment for rectal and anal cancer. Despite this, it remains an understudied, underreported, and undertreated issue in the field of cancer survivorship.AimThis study examined the characteristics of women enrolled in an intervention trial to treat sexual dysfunction, and explored the relationship between sexual functioning and psychological well‐being.MethodsThere were 70 female posttreatment anal or rectal cancer survivors assessed as part of the current study. Participants were enrolled in a randomized intervention trial to treat sexual dysfunction and completed outcome measures prior to randomization.Main Outcomes MeasuresThe main outcome measures are quality of life (QOL) (European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire [EORTC‐QLQ‐C30] and Colorectal Cancer‐Specific Module [QLQ‐CR38]), sexual functioning (Female Sexual Functioning Index), and psychological well‐being (Brief Symptom Inventory Depression/Anxiety, Impact of Events Scale‐Revised, CR‐38 Body Image).ResultsWomen enrolled in the study intervention were on average 55 years old, predominantly Caucasian (79%), married (57%), and a median of 4 years postprimary treatment. For those reporting sexual activity at baseline (N = 41), sexual dysfunction was associated with a range of specific measures of psychological well‐being, all in the hypothesized direction. The Sexual/Relationship Satisfaction subscale was associated with all measures of psychological well‐being (r = ?0.45 to ?0.70, all P < 0.01). Body image, anxiety, and cancer‐specific posttraumatic distress were notable in their association with subscales of sexual functioning, while a global QOL measure was largely unrelated.ConclusionsFor sexually active female rectal and anal cancer survivors enrolled in a sexual health intervention, sexual dysfunction was significantly and consistently associated with specific measures of psychological well‐being, most notably Sexual/Relationship Satisfaction. These results suggest that sexual functioning may require focused assessment by providers, beyond broad QOL assessments, and that attention to Sexual/Relationship Satisfaction may be critical in the development and implementation of interventions for this cohort of patients. Philip EJ, Nelson C, Temple L, Carter J, Schover L, Jennings S, Jandorf L, Starr T, Baser R, and DuHamel K. Psychological correlates of sexual dysfunction in female rectal and anal cancer survivors: Analysis of baseline intervention data. J Sex Med 2013;10:2539–2548.     

Female Sexual Arousal Disorder with and without a Distress Criterion: Prevalence and Correlates in a Representative Czech Sample

IntroductionSexual medicine would benefit from large representative surveys examining the prevalence of genital female sexual arousal disorder (FSAD) symptoms (with and without the increasingly controversial distress criterion), as well as novel FSAD correlates and potential “protective” factors.AimsTo examine the extent to which genital FSAD symptoms, with and without a distress criterion, are associated with both historical and current aspects of sexual behavior.MethodsIn a representative sample of the Czech population (aged 15–88), 1,000 women were asked whether they currently have impaired lubrication and vaginal swelling (and if so, if this produces marked distress or interpersonal difficulty). They provided details of vaginal orgasm (induced by penile–vaginal intercourse [PVI] without clitoral masturbation) consistency, feelings during their first PVI, estimates of their typical foreplay and PVI durations, their degree of mental focus on vaginal sensations during PVI, among other factors.Main Outcome MeasuresThe current prevalence of FSAD with and without a distress criterion and their associations with current and antecedent sexual behaviors and responses.ResultsThe current prevalence of FSAD was 10.3% without, plus 7.5% with a distress criterion (which tended to be associated with more impairments than without distress). History of vaginal orgasm (odds ratio = 2.78), never masturbating (odds ratio = 2.4), not having felt pain and discomfort on first PVI (odds ratio = 2.27), and not having frequent anal intercourse are protective against FSAD with distress, but not without distress. Age (especially over 50) and inadequate focusing of mental attention on vaginal sensations during PVI are associated with increased FSAD risk both with and without distress.ConclusionsFSAD with and without distress appear to be different entities to some extent, with the distressed group showing more long‐term signs of psychosexual impairment. We suggest that FSAD with and without distress be considered two different disorders. Weiss P, and Brody S. Female sexual arousal disorder with and without a distress criterion: Prevalence and correlates in a representative Czech sample.     

Sexual and Cardiovascular Correlates of Male Unfaithfulness

IntroductionDefinitions of unfaithfulness and its consequences vary across different cultures, religions, and legal jurisdictions; however, having extramarital affairs is associated in most societies with a stigma. Therefore, the study of this sensitive topic is extremely complex, and its prevalence is often underestimated.AimTo offer a summary of available data in literature about unfaithfulness.MethodAn extensive Medline search was performed including the following words “unfaithfulness,”“extramarital affairs,”“infidelity,”“men.” The search, up to December 4, 2011, was restricted to English-language articles.Main Outcome MeasuresWe reported literature data on the prevalence of unfaithfulness and on related psychobiological, sexual, and risk factors.ResultsSome surveys reported that 1.5–4% of married men had extramarital coitus in any given year, others that 23.2% of men have cheated during their current relationship. Different studies reported a lifetime prevalence of unfaithfulness between 15% and 50%. With respect to factors related to unfaithfulness, several authors reported that men with extramarital affairs more frequently have a dysfunctional primary relationship, in both relational and sexual terms. In addition, parenthood, as well as conflicts within the family, seem to be associated with a higher risk of having an affair. Furthermore, unfaithful men display a higher androgenization, larger testis volume, lower prevalence of hypoactive sexual desire, and better sexual functioning. Only few studies have evaluated the correlation between infidelity and cardiovascular risk, reporting that having an extramarital affair could have a negative impact on cardiac morbidity and mortality.ConclusionsSeveral interpersonal, sexual, and biological factors are associated with having extramarital affairs. Unfaithfulness in men seems to be associated with a higher risk of major cardiovascular events. Fisher AD, Bandini E, Rastrelli G, Corona G, Monami M, Mannucci E, and Maggi M. Sexual and cardiovascular correlates of male unfaithfulness. J Sex Med 2012;9:1508–1518.     

Psychosexual Correlates of Unwanted Sexual Experiences in Women Consulting for Female Sexual Dysfunction According to Their Timing Across the Life Span

Background

Comparative data on the psychopathologic and sexual correlates of unwanted sexual experiences (USEs) occurring during childhood, adolescence, or adult life are lacking.

Sexual Functioning in Military Personnel: Preliminary Estimates and Predictors

IntroductionAlthough the military is a young and vigorous force, service members and veterans may experience sexual functioning problems (SFPs) as a result of military service. Sexual functioning can be impaired by physical, psychological, and social factors and can impact quality of life (QOL) and happiness.AimsThis study aims to estimate rates and correlates of SFPs in male military personnel across demographic and psychosocial characteristics, to examine the QOL concomitants, and to evaluate barriers for treatment seeking.MethodsThis exploratory cross‐sectional study was conducted using data from a larger nationwide study conducted between October 2013 and November 2013. This sample consists of 367 male active duty service members and recent veterans (military personnel) age 40 or younger.Main Outcome MeasuresErectile dysfunction (ED) was determined using the five‐item International Index of Erectile Function, sexual dysfunction (SD) was determined using the Arizona Sexual Experiences Scale, Male, and QOL was determined using the World Health Organization Quality of Life, Brief.ResultsSFPs were associated with various demographic, physical, and psychosocial risk factors. The rates of SD and ED were 8.45% and 33.24%, respectively, for male military personnel aged 21–40. Those who were 36–40, nonmarried, nonwhite, and of lower educational attainment reported the highest rates of SFPs. Male military personnel with poor physical and psychosocial health presented the greatest risk for ED and SD. SFPs were associated with reduced QOL and lower happiness, and barriers for treatment were generally related to social barriers.ConclusionsSFPs in young male military personnel are an important public health concern that can severely impact QOL and happiness. Wilcox SL, Redmond S, and Hassan AM. Sexual functioning in military personnel: Preliminary estimates and predictors. J Sex Med 2014;11:2537–2545.     

Correlates of Men's Sexual Interest: A Cross-Cultural Study

IntroductionLow sexual desire has been studied more extensively in women than in men.AimThe study aims to analyze the correlates of distressing lack of sexual interest and the self-assessed reasons for the lack of sexual interest among heterosexual men from three countries.MethodsA web-based survey was completed by 5,255 men aged 18–75 years from Portugal, Croatia, and Norway.Main Outcome MeasuresWe used an item that assesses lack of sexual interest from the British NATSAL 2000. Anxiety and depression were measured with the SCL-ANX4 and SCL-DEP6. Relationship intimacy was measured using a five-item version of the Emotional Intimacy Scale. A shortened version of the Sexual Boredom Scale was used to assess proneness to sexual boredom in relation to the duration of relationship, and personal distress was evaluated using an item created for this study.ResultsDistressing lack of sexual interest lasting at least 2 months in the previous year was reported by 14.4% of the participants. The most prevalent comorbidity among these men was erectile difficulty (48.7%). Men with low confidence levels in erectile function, not feeling attracted to the partner, and those in long-term relationships were more likely to have experienced lack of sexual interest than were men with high confidence levels and those who felt attracted to their partner and those in shorter-term relationships. Professional stress was the most frequently reported reason for lack of sexual interest. Sexual boredom as a result of a long-term relationship was significantly and negatively correlated with the level of intimacy (r = −0.351, P < 0.001) and sexual satisfaction (r = −0.497, P < 0.001).ConclusionsDistressing lack of sexual interest in heterosexual men was associated with a number of intrapersonal (self-confidence in erectile function, stress), interpersonal (relationship duration, partner attractiveness), and sociocultural variables. Carvalheira A, Træen B, and Štulhofer A. Correlates of men's sexual interest: A cross-cultural study. J Sex Med 2014;11:154–164.