Sexuality in Older Adults (65+)—An Overview of The Recent Literature,Part 2: Body Image and Sexual Satisfaction

Objectives: the aim of the paper is to provide an overview of the literature published 2005-2015 on sexual satisfaction and body image in older adults. Method: A narrative literature search using the PsycINFO database was conducted. Results: Although women in general seem less satisfied with their bodies than men, particularly in sexual contexts, older women appear to be less vulnerable to body-related dissatisfaction than younger women. Despite the age-specific dynamics of sexual satisfaction and sexual well-being, which parallel age-related decrease in the frequency of sexual activity, research findings from different countries show that substantial proportions of aging men and women are satisfied with their sex life. There is some limited evidence that this proportion may be increasing across cohorts. Gender differences in factors that influence sexual satisfaction among older adults appear marginal. Conclusion: Older age can affect sexual satisfaction on individual, interpersonal, and culture-related levels. Future research in older adults' sexuality should focus on sexual well-being in women who are without partners, sexual satisfaction among aging lesbian, gay, bisexual, and transgender individuals and couples, the relationship between religiosity and sexual satisfaction, and employ a comparative, cross-cultural approach.     

Improving body image and sexual health behaviors among college women

ABSTRACT

Objective: To conduct a pilot test to determine if the Body Project, an eating disorder prevention program, was able to reduce risky sexual behaviors. Participants: Twenty college-age women ages 18–21 (in March, 2015) who endorsed both body image dissatisfaction and previous or current sexual activity. Methods: Participants were randomized to the Body Project or psychoeducational control group, and completed baseline, post-test, and 6-month follow-up measures assessing body image concerns, eating behaviors, and sexual behaviors and attitudes. Results: An intervention manipulation check demonstrated that body image variables were in expected directions, though were not significant by group. There was a significant interaction across group and time for “unanticipated sexual encounters,” which decreased in the Body Project group. Conclusions: This pilot study supports the feasibility of using an eating disorder prevention program to reduce other risky behaviors, specifically risky sexual behaviors.     

Brief Report: Sexual Wellbeing in Heterosexual,Mostly Heterosexual,and Bisexually Attracted Men and Women

Abstract

Objective: To assess differences in sexual wellbeing among men and women with exclusively heterosexual, mostly heterosexual, and bisexual attractions. Method: An anonymous online survey in a convenience sample of 597 young adults (394 women, 203 men; average age = 20.04) assessed patterns of sexual attraction, desire, sexual functioning, and sexual satisfaction using validated questionnaires. Results: Individuals with mostly heterosexual attractions reported significantly higher solitary sexual desire than exclusively heterosexual individuals (women: d?=?0.64; men: d?=?0.68). Partnered sexual desire did not differ between groups. Women with exclusively heterosexual attractions reported significantly higher sexual functioning and satisfaction than either mostly heterosexual or bisexually attracted women (functioning: d?=?0.29; satisfaction: d?=?0.47). Men with mostly heterosexual attractions reported significantly lower sexual functioning than either exclusively heterosexual or bisexually attracted men (d?=?0.40). Conclusions: There were significant differences between exclusively vs. mostly heterosexual individuals in several aspects of sexual wellbeing, supporting the assertion that mostly heterosexual may constitute a distinct orientation. Taken together with prior research showing higher rates of sexual dysfunction in bisexual women, these findings highlight sexual health disparities among nonmonosexual women. Efforts to support the sexual wellbeing of sexual minority individuals should include consideration of mostly heterosexual individuals, as this population may have unique sexual health needs.     

Changes in Sexual Distress,Depression and Sexual Function after Clitoral Reconstruction in Women with Female Genital Mutilation/Cutting

Abstract

Background: Female genital mutilation/cutting (FGM/C) links health complications and psychological distress. However, there is scarce literature on how women with FGM/C respond to treatment interventions. Objective: In this study, we aimed to assess changes in depression symptomatology, sexual function, and distress following clitoral reconstructive surgery combined with a psychoeducational intervention. Methods: The reconstructive surgery consisted of recovering the remaining clitoris and placing it externally and as close to the vagina as possible. FGM/C patients (n?=?27) received psychological support and sexual counseling upon undergoing the surgical intervention and were further assessed at 6-month follow-up. Moreover, they completed the Beck Depression Inventory and the Female Sexual Distress Scale Revised at these two time points. Patients’ sexual dysfunction was assessed according to DSM-5 criteria. Results: Statistically significant clinical changes after FGM/C were reported. Overall, patients presented reduced depression and sexual distress levels, and decreased female sexual interest/arousal disorder prevalence. Results also revealed that sexual distress improvements were more significant in Type I FGM/C patients. Conclusions: Significant improvements in sexual distress, psychopathology, and sexual function were observed in our sample following reconstructive surgery, suggesting that combined interventions are effective for treatment.     

Body Size and Sexual Behavior in a Community-Based Sample of Women

ABSTRACT. Women's body size is closely related to their social and sexual experiences. Clinical research has found that women's lifetime sexual behaviors may vary based on body mass index (BMI). Objectives: This study examined the relationship between BMI and recent solo and partnered sexual repertoire in a community-based, non-clinical sample of women. Methods: Two hundred thirty-eight sexually active women completed an online survey measuring age, sexual relationship status, BMI, gender of sexual partners, and engagement in sexual behaviors in the previous 4 weeks. Logistic regression analyses were conducted to determine whether BMI predicted engagement in behaviors after controlling for age and sexual relationship variables. Results: Participant age ranged from 18 to 56 years (M = 30.4, SD = 7.8). Participants were predominantly in exclusive sexual relationships (62.9%, n = 146) with men (82.8%, n = 197). Mean BMI for the sample was 29.33 (SD = 9.28). Participation in self-masturbation, masturbating a partner, performing oral sex on a partner, receiving oral sex from a partner, and penile–vaginal intercourse were not predicted by BMI after controlling for age and partner variables. Conclusions: BMI did not impact sexual repertoire during the previous 4 weeks, with the exception of an increased odds ratio for penile–anal intercourse (OR = 1.06; 95% CI [1.02, 1.10]). Researchers and practitioners working with women should not assume limitations on women's sexual repertoires because of larger body size.     

College Women's Experiences with Physically Forced,Alcohol- or Other Drug-Enabled,and Drug-Facilitated Sexual Assault Before and Since Entering College

Objective: Research has shown associations between college women's alcohol and/or drug consumption and the risk of sexual assault, but few studies have measured the various means by which sexual assault is achieved.

Participants: The authors' Campus Sexual Assault Study obtained self-report data from a random sample of undergraduate women (N = 5,446).

Methods: The authors collected data on sexual assault victimization by using a cross-sectional, Web-based survey, and they conducted analyses assessing the role of substance use. The authors also compared victimizations before and during college, and across years of study.

Results: Findings indicate that almost 20% of undergraduate women experienced some type of completed sexual assault since entering college. Most sexual assaults occurred after women voluntarily consumed alcohol, whereas few occurred after women had been given a drug without their knowledge or consent.

Conclusions: The authors discuss implications for campus sexual assault prevention programs, including the need for integrated substance use and sexual victimization prevention programming.     

Efficacy of group therapy for problems with postmastectomy self‐perception,body image,and sexuality

Until very recently, the sexual and body image problems of women treated for breast cancer by surgical removal of the breast were ignored by physicians and therapists. Postmastectomy women (N = 62) and non‐mastectomy women (N = 51) were compared on self‐image and sexuality, positive affect, autonomy, self‐sacrifice, and body touching. Additionally, mastectomees were tested three times over 12 months to evaluate the efficacy of group therapy for postmastectomy women. Prior to group therapy, baseline data indicated that, compared to nonmastec‐tomy women, mastectomees had a significantly different body image and lower sexual adjustment. Specifically there was marked dislike for the amputated breast region and diminished pleasure in self‐touching of the remaining breast. Positive affect and sexual receptivity for both the mastectomee and her partner were perceived to be adversely affected. These effects were not related to age, marital status, or elapsed time since mastectomy. Treatment significantly improved positive affect and sexual adjustment but did not improve attitude toward the amputated breast region or increase the range or frequency of sexual activity and sexual receptivity.     

Body Appreciation and Contraceptive Use Among College Women: A Brief Report

Research suggests that body image and sexual behaviors are related, with poor body image associated with risky behaviors and positive body image related to protective behaviors. However, few studies explore the relationships between positive body image and contraceptive use. Accordingly, the current study investigated the relationship between body appreciation and barrier and hormonal contraceptive use among college women (N = 399). Body appreciation was significantly related to male condom use and to the use of both male condoms and a hormonal contraceptive. These findings are promising as dual contraceptive use is the best way to prevent unintended pregnancy and sexually transmitted infections (STIs).     

Sexuality in Older Adults (65+)—An Overview of the Literature,Part 1: Sexual Function and its Difficulties

Objectives: The aim of the current article was to provide an overview of literature on sexual function and sexual difficulties in older adults. Method: The authors conducted a narrative review of papers published in English between January 2005 and July 2015 based on an extensive search in PsycINFO. Results: The review showed that although common biological changes may adversely affect sexual function in old age, sexual experience seems to also be affected by psychological and interpersonal factors. Conclusions: Greater life expectancy and better medical care will result in older individuals with chronic diseases living longer. The need for help to cope with changes in sexual health is likely to increase in older adults, as sexuality may be negatively affected through several pathways.     

Sexual Life of Women with Multiple Sclerosis: A Qualitative Study

Objectives: To define the thoughts, emotions, experiences and perceptions of women with multiple sclerosis (MS) and to determine sexual, physical, and emotional effects of MS on patients. Methods: Twenty-one women were included into this qualitatively designed study. Results: Three baseline themes were defined as “uncertainty” arising from complaints due to numbness in extremities and loss of sense, balance or vision, “alterations in sexual life,” and “inability” as a result of deformities in marital status and gender role. Conclusion: Healthcare providers should evaluate MS patients meticulously as to sexual life and refer such patients to appropriate health centers.     

Sexual Body Image and Its Correlates: A Population-Based Study of Finnish Women and Men

ABSTRACT

Sexual body image was examined in a population-based sample of 9,532 Finnish men and women, age 18 to 49 years. More than one half of women and men were satisfied with their genitals, one half of the women were satisfied with their breasts. Higher levels of genital satisfaction were related to higher frequencies of sexual behavior and better sexual function for both genders. For men, penis size satisfaction was associated with lower levels of premature ejaculation and better erectile function. Sexual body image was related to overall perceived attractiveness, for women a higher body mass index was related to satisfaction with breast size. Having children was negatively related to women's sexual body image, abortions and miscarriages likewise. Limitations of the study and clinical implications of the findings are discussed.     

Femininity Ideology and Sexual Health in Young Women: A focus on Sexual Knowledge,Embodiment, and Agency

ABSTRACT

Traditional femininity ideology is associated with diminished sexual agency in women; yet we know little about its connection to sexual knowledge or experiences of one's body during sex. This study examined how femininity ideology related to sexual health knowledge, body comfort during sex, condom self-efficacy, and sexual assertiveness in college-age women. Femininity ideologies were related to decreased sexual-risk knowledge and lowered body esteem during sex. Femininity ideologies were also related to decreased sexual assertiveness and condom use self-efficacy. Results highlight the importance of understanding the association between femininity ideologies and sexual knowledge acquisition as an aspect of sexual agency, as well as sexual embodiment, in addition to the more commonly studied sexual self-efficacy and assertiveness.     

Experiences of Discrimination and Sexual Behaviors: An Examination of Motives as Potential Psychological Mediators

Objectives: We investigated three psychological mechanisms that may underlie the associations between discrimination and sexual activity: emotion regulation, autonomy restoration, and intimacy building. Methods: An online survey was administered to a diverse sample of 565 undergraduate students at a large public university. Results: Having sex to mitigate negative emotions mediated the associations between self-reported discrimination and lifetime number of sexual partners, and between discrimination and the frequency of sexual intercourse while intoxicated. Conclusions: Sexual activity may serve as a coping strategy in response to the experiences of negative emotions and human core needs thwarted by the experiences of discrimination.     

Condom Use Completeness,Perceptions, and Sexual Quality at Most Recent Sexual Event: Results from a U.S. Nationally Representative Probability Sample

Abstract

Objectives: To explore perceptions of condoms associated with complete use and evaluate relationships between condom perceptions, condom use, and sexual quality.

Methods: Using data from a U. S. nationally representative probability sample, we assessed individuals’ condom use perceptions and related characteristics of their most recent sexual event through bivariate and regression analyses (n?=?234).

Results: Most participants reported complete condom use and neutral or positive perceptions of condoms. Though incomplete use was associated with orgasm among women, arousal and pleasure did not differ by gender or duration of condom use.

Conclusions: We found no evidence that delayed application or early condom removal increased sexual arousal or pleasure, which may help sexual health promotion interventions address negative cultural ideas about condoms.     

Internet Pornography use and Sexual Body Image in a Dutch Sample

Objectives: A commonly attributed cause of sexual body image dissatisfaction is pornography use. This relationship has received little verification. Methods: The relationship between sexual body image dissatisfaction and Internet pornography use was tested using a large-N sample of Dutch respondents. Results/Conclusion: Penis-size dissatisfaction is associated with pornography use. The relationship between pornography use and breast-size dissatisfaction is null. These results support prior speculation and self-reports about the relationship between pornography use and sexual body image among men. These results also support a prior null finding of the relationship between breast-size satisfaction for women and pornography use.     

Effect of a Web-Based Sexual Health Enhancement Program for Women with Gynecologic Cancer and Their Husbands

Objectives: This study examined the effects of a web-based sexual health enhancement program on of women with gynecologic cancer and their husbands. Methods: Twenty-one couples attended the program for 4 weeks and 22 couples were assigned to a control group. Results: The experimental group reported significant improvements in the sexual function of the women with gynecologic cancer (effect size [ES] = .75; p?p?=?.015). Conclusions: Therefore, our results can help provide interventions for patients and their husbands to identify and resolve sexual problems after gynecologic cancer treatment.     

Chronic Avoidance Helps Explain the Relationship Between Severity of Childhood Sexual Abuse and Psychological Distress in Adulthood

ABSTRACT

Recent studies have found that chronic avoidance of unpleasant internal experiences (e.g., thoughts, emotions, memories) is a maladaptive means of affect regulation often adopted by women with a history of sexual victimization in childhood. The primary aim of this study was to replicate and extend previous findings suggesting that higher levels of experiential avoidance may account for the relationship between childhood sexual abuse (CSA) and psychological distress in adulthood. It was hypothesized that, in a sample of undergraduate females (n = 151), the relationship between severity of CSA (e.g., frequency, nature of victimization) and trauma-related psychological distress would be mediated by avoidance. Results supported this hypothesis. Findings are consistent with previous studies, and further suggest that the general tendency to avoid or escape from unpleasant internal experiences may be a specific factor that exacerbates psychological distress among women with a history of sexual victimization in childhood.     

Seventy-Five Years Old and Still Going Strong: Stability and Change in Sexual Interest and Sexual Enjoyment in Elderly Men and Women Across Europe

Abstract

Objective: The aim of this study was to test a conceptual model of retrospectively assessed change in sexual interest and sexual enjoyment in the past 10 years among coupled older adults in Norway, Denmark, Belgium and Portugal. To which degree do structural influences, personal characteristics, and interpersonal factors predict the dynamics of sexual interest and enjoyment in partnered persons? Methods: Data were collected as a cross-sectional postal survey, with national probability-based samples of the population aged 60-75 years recruited by phone registers in Norway (676 men and 594 women), Denmark (530 men and 515 women), Belgium ( 318 men and 672 women), and Portugal (236 men and 273 women). Results: Across countries, personal characteristics—primarily general health status—were the most important predictors of change in sexual interest and sexual enjoyment in men. Change in sexual interest and enjoyment among women (except for Portuguese women) was best predicted by interpersonal factors. Conclusions: Good health, an active sex life throughout the lifespan, direction of relationship, and feeling emotionally close to partner during sex are important factors in maintaining sexual interest and enjoyment among partnered older adults in Europe.     

Regional Prevalence,Patterns and Correlates of Sexual Coercion Among Women in Sub-Saharan Africa: A Multi-Country Population-Based Study

Abstract

Objective: This study investigates the prevalence, perpetrators, and factors associated with forced sexual acts. Methods: Pooled secondary data from the most recent Demographic and Health Survey (DHS) in 22 sub-Saharan African countries was used in this study. The individual woman components of the questionnaire involving 148,720 women of reproductive age (15-49?years) were analyzed. Percentages and graphs were used to present distribution of study variables. Multivariable logistic regression was used to examine factors associated with sexual coercion. Results: Forced sexual acts were prominent in Rwanda (15.7%), Gabon (12.3%) and Democratic Republic of Congo (10.9%). The lowest mean age at first forced sexual acts was recorded in Gabon (14.1?years), Comoros and Mali (14.9?years each), whereas the maximum was recorded in Namibia (25.9?years). Results from adjusted logistic regression models identified that factors such as high women decision making power, large spousal age difference, rural residence, Islamic religious beliefs and listening to radio were significantly associated with reduction in the odds of forced sexual acts. Conversely, high-risk partner’s behavior, older age at start of first marriage, early age at sexual debut, most disadvantaged community, education, and the use of newspapers were significantly associated with higher odds of forced sexual acts. Conclusion: Based on the findings of this study, policies should be reinforced to handle perpetrators of sexual violence especially non-intimate partners. Population-based preventive measures of sexual coercion are essential to complement justice system responses. Our findings also showed the importance of building gender equity as part of sexual violence prevention approach.     

Sexual Practices Among a Sample of Young Lesbian and Bisexual Women from Mexico: An Exploratory Study

Objective: To describe sexual practices in Mexican lesbian and bisexual women. Materials and method: An online survey was conducted with a nonprobabilistic sample of self-identified lesbian (n?=?768) and bisexual (n?=?371) women from the 32 states of Mexico. Results: Lesbians less frequently reported having had sex with a man than bisexual women. Preferred sexual practices with other women were external genital stimulation with fingers, internal genital stimulation with fingers, and oral genital stimulation. Most (～80%) participants did not use protection to prevent sexually transmitted infections. Conclusions: Our results can inform the design of promotion and prevention programs in sexual health aimed at sexual minority women.