Prevalence and Risk Factors for Dyspareunia and Unsatisfying Sexual Relationships in a Cohort of Primiparous and Secondiparous Women After 12 Months Postpartum

ABSTRACT

Dyspareunia is a common short-term pregnancy complication, rarely lasting longer than 1 year after delivery. Our study aims to determine postpartum dyspareunia prevalence and its impact on women's sexual health. In this retrospective study, we asked 602 women about dyspareunia and the quality of sexual intercourse through telephone interviews. The influence of dyspareunia on the quality of sexual intercourse and couple relationship is scored on a 4-point verbal scale according to its severity. Data were analyzed by R (version 2.8.0), considering significant p < .05. Nearly 100% of women (99.9%) resumed their sexual activity; 16.2% of them reported dyspareunia significantly compromising their sexual intercourse and couple relationships. In univariate analysis, severe perineal tears are associated with persistent dyspareunia (p < .05). By multivariate analysis, postpartum dyspareunia results independently influenced by operative delivery, previous dyspareunia, recurrent urogenital infections and urge incontinence (p < .05), as well as by the Kristeller maneuver and partoanalgesia (p = .084) in the case of women who had a vaginal delivery. Dyspareunia significantly compromises women's sexual health postpartum, mostly caused by perineal trauma by means of delivery management and recurrent urogenital infections.     

Heterosexual Women’s and Men’s Labeling of Anal Behaviors as Having “Had Sex”

This study explored labeling of penile–anal intercourse (PAI), manual–anal (MA), and oral–anal (OA) behaviors as having “had sex” among heterosexual men and women with such experience residing in the United States (n = 3,218). Adult men and women completed an online questionnaire assessing sexual behaviors and whether each counted as having had sex. With the exception of anal intercourse, there was high variation in whether a behavior was labeled having had sex. There was not consensus on which anal sexual behaviors constituted having had sex, with attitudes varying across age, gender, and behavioral experience. Those who were older, male, and had the specific behavioral experience were more likely to label it as having had sex. Behaviorally specific assessments of the various anal behaviors as part of the sexual repertoire is critical to more accurate evaluation of sexual histories and assessment of risks to sexual health.     

Weight-related issues and high-risk sexual behaviors among college students

Individuals with high body mass index (BMI), negative body image, and unhealthy weight control behaviors may be more likely to engage in high-risk sexual behaviors than others. Researchers have not fully investigated these relationships in a sample of college students. The authors collected data regarding several weight-related issues and high-risk sexual behaviors (response rate = 39%) from 1,168 college students. Over half reported at least 1 high-risk sexual behavior. After the authors controlled for several demographic characteristics, they found that higher BMIs were associated with increased odds of having a casual sexual partner (odds ratio [OR] = 2.70) and being intoxicated at last intercourse (OR = 2.25). Among women, unhealthy weight control behaviors were associated with having a casual partner (OR = 2.12), using no or unreliable contraception (OR = 1.98), and being intoxicated at last intercourse (OR = 2.31). Weight-related issues were not associated with sexual behaviors among college men. The authors describe their findings within two health behavior frameworks, and they discuss implications for research and health education.     

College Women's Sexual Decision Making: Cognitive Mediation of Alcohol Expectancy Effects

Abstract

Objective: Alcohol has been linked to a variety of risky sexual practices, including inconsistent condom use. Due to the high rates of alcohol consumption among underage college women, greater understanding of the role of alcohol in young women's sexual decision making is warranted. Participants and Methods: Female underage (18- to 20-year-old) social drinkers (N = 94) participated in an experiment in which they projected themselves into a written hypothetical sexual situation with a new partner. One half of the situations portrayed alcohol consumption; one half did not involve alcohol consumption. Their appraisals of the situation's sexual potential, impelling and inhibiting cognitions, and sexual behavior intentions were assessed. Results: Results revealed that alcohol's expectancy effects on young women's unprotected sexual intentions were mediated by their cognitive appraisals of the situation. Conclusions: These findings indicate that alcohol expectancies and their influence on women's sexual decisions should be incorporated into sexual risk reduction efforts.     

Individual Differences in Women's Salivary Testosterone and Estradiol Following Sexual Activity in a Nonlaboratory Setting

Objectives: The current study evaluated women's salivary testosterone and estradiol levels before and after exposure to sexual stimuli in a U.S. sex club. Methods: Behavioral data and salivary samples were collected from 19 women during semistructured interviews. Results: Findings demonstrate substantial individual differences in the magnitude and direction of women's hormonal changes following sexual activity. Conclusions: In an age of individualized medicine, these findings highlight the need to better understand factors shaping variation in physiological responses to sexual activity. Findings contribute to a relatively small and contradictory literature on women's hormonal responses to sexual stimuli.     

A Dyadic Perspective on Childhood Maltreatment for Women With Provoked Vestibulodynia and Their Partners: Associations With Pain and Sexual and Psychosocial Functioning

Childhood maltreatment is robustly associated with adult-onset vulvodynia, a common form of female genito-pelvic pain/penetration disorder. However, little is known about the impact of childhood maltreatment on current sexual, psychological, and relationship adaptation for couples with provoked vestibulodynia (PVD). This study examined the associations between childhood maltreatment and sexual and psychosocial functioning and pain in women with PVD, the most common subtype of vulvodynia, and their partners. A total of 49 couples (M_age women = 27.80, SD = 6.05; M_age men = 30.04; SD = 6.48) with PVD completed the Childhood Trauma Questionnaire (CTQ), as well as measures of sexual functioning, couple satisfaction, and anxiety. Women also reported on their pain during intercourse. Analyses were guided by the actor–partner interdependence model. Women’s higher reports of childhood maltreatment were associated with their lower sexual functioning and higher anxiety. Partners’ higher reports of childhood maltreatment were associated with their lower sexual functioning, lower couple satisfaction, and higher anxiety, as well as women’s lower couple satisfaction and higher anxiety. Both women’s and partners’ higher reports of childhood maltreatment were associated with higher affective pain for women. Findings suggest childhood maltreatment experienced by women with PVD and their partners should be considered as part of treatment planning.     

‘Pain on Top of Pain,Hurtness on Top of Hurtness’: Social Discrimination,Psychological Well-Being,and Sexual Risk Among Women Living With HIV/AIDS

ABSTRACT

This qualitative study explored how a subsample (n = 26) of participants in Protect and Respect (N = 184), a safer-sex intervention for women living with HIV/AIDS (WLH/A), discussed their experiences of social discrimination and the impact of discrimination on their lives, psychological well-being, and risk behaviors during group intervention sessions. The majority of participants was Black (83%), earned less than $10,000 per year (80%), and acquired HIV through heterosexual sex (58%). Analyses demonstrated that social discrimination manifested in the women's lives as poverty, HIV/AIDS-related stigma, and gender inequality. These experiences caused intense psychological distress and limited WLH/A's ability to implement the safer-sex skills that they learned during the intervention. We discuss the applied and theoretical implications of our findings, advocating for HIV and sexual risk-reduction interventions that are based on an ecological framework that addresses holistically the individual, relational, and sociostructural factors that affect women's sexual risk behaviors.     

The Influence of Consent on College Students’ Perceptions of the Quality of Sexual Intercourse at Last Event

ABSTRACT. The current study assessed consent's relation to quality of sexual intercourse. College students (n = 640) participated in a survey assessing their most recent intercourse. Hierarchical regression was conducted: alcohol consumption, relationship status, and age were entered in Step 1; the Internal and External Consent Scale factors were entered in Step 2. For women, three internal consent factors explained a significant proportion of variance in quality of intercourse beyond Step 1 (ΔR² = .17, p < .001). For men, one internal and two external consent factors were significant predictors beyond Step 1 (ΔR² = .24, p < .001). Preliminary findings suggest consent is associated with quality of intercourse.     

Frequency and Types of Partner Violence Among Mexican American College Women

Objective and Participants: The authors studied the prevalence of partner violence, by type, among Mexican American college women aged 18 to 35 years (N = 149; response rate = 85%). Results: Twelve percent of women who reported a dating partner in the past year were physically or sexually assaulted, 12.1% were stalked, and 9.1% scored as psychologically abused. Among those experiencing partner violence, almost half experienced stalking and 89% reported psychological abuse. Few women (25%) who experienced physical violence believed violence was a problem in their relationship. Conclusions: Partner violence was prevalent in this population, and participants experienced many forms of violence. Because few women experiencing physical violence report that violence is a problem in their relationship, interventions must address perceptions of violence and its impact on women's mental and physical health in college populations.     

The Relationship Between College Women’s Sexual Attitudes and Sexual Activity: The Mediating Role of Body Image

ABSTRACT. This study examined the relationship between sexual attitudes and engagement in sexual activity among a sample of 401 college women. In addition, we investigated the potential role of body image as a mediator of this relationship. Online surveys included self-report measures of sexual attitudes ranging from liberal to conservative, body image satisfaction, and frequency of sexual activity. Results indicated that more liberal sexual attitudes were directly linked with more frequent sexual activity. Whereas mediation was not evident, indirect effects existed such that more liberal sexual attitudes were associated with higher body image satisfaction, which, in turn, was associated with increased sexual activity. Clearly, sexual attitudes and body image are important cognitive factors that affect women's sexual activity, yet each influence alone is not enough to explain the complex process that leads to sexual behavior. Although cross-sectional in nature, our findings suggest that body image and sexual attitudes may work together as a process to affect women's sexual activity.     

Development and Assessment of Measures of Adolescents' Attitudes about Sexual Relationship Rights

Objective: Develop and validate measures of adolescents' attitudes about sexual relationship rights. Methods: Items were completed by students in a large U.S. city (N = 655). The authors conducted an exploratory factor analysis, evaluated internal consistency, and assessed construct validity, including ability to predict sexual behavior at 1-year follow-up. Results: Factor analysis identified 2 distinct factors, comprising attitudes about rights to refuse unwanted sexual activity (5 items) and express sexual engagement needs (5 items) in a sexual relationship. The measures showed sound evidence of reliability and construct validity. Conclusions: The psychometric evidence supports the use of these measures in adolescent sexual health research.     

Multiple sex partners among college women and men: Sexual behaviors and sexual satisfaction revisited

The purpose of this investigation was to examine the effects of number of lifetime sex partners on sexual behaviors, sexual attitudes, and sexual satisfaction for never‐married college women and men. An anonymous questionnaire was administered in select classes at a midwestern state university. One‐partner group (one sex partner) women, in comparison to few‐partner (two to five sex partners) and many‐partner (six or more sex partners) group women, were more likely to have been older at first intercourse and to report psychological sexual satisfaction, mastur‐batory guilt, and commitment and love as conditions for sexual intercourse. For men, one‐partner group respondents were also more likely than few‐partner and many‐partner group respondents to report older age at first intercourse, masturbatory guilt, and commitment and love as conditions for sexual intercourse. In an era in which early sexual fulfillment clashes with concerns over unsafe sexual practices, these data provide insights into the influence of multiple partner experience on the sexual behavior patterns of young adults.     

More Than Just Sex

Abstract

The purpose of this research was to identify behaviors in addition to those of an explicitly sexual or romantic nature that men and women define as unfaithful acts in the context of committed dating relationships. We also sought to identify possible gender differences in the proportions of men and women who have engaged in these unfaithful behaviors while in dating relationships. We examined 219 college men's and women's reported involvement in sexual behaviors, romantic attachments, sexual and nonsexual fantasies, sexual attraction, romantic attraction, flirting, and social participation in dyads and groups with someone other than their current or past dating partner. A sizable proportion of both men and women reported engaging in one or more of the behaviors at some point in their dating history. Proportionately more men than women indicated having engaged in sexual fantasies of various types about someone other than their primary partner and reported “hitting on” someone else while in a dating relationship. No other gender differences emerged. A unique aspect of this study is that we asked young men and women to determine what kinds of behaviors they considered to be unfaithful rather than only examining sexual and emotional behaviors as has been the case in past research. Further, the few significant gender differences we found indicates that the convergence of men's and women's attitudes about sexuality may now be show in their behavior.     

The Role of Attachment Behaviors in the Link between Relationship Satisfaction and Depression in Clinical Couples: Implications for Clinical Practice

Using dyadic, clinical data from 104 couples in committed relationships, the purpose of this study was to determine whether relationship satisfaction was associated with depression through perceived partner attachment behaviors—accessibility, responsiveness, and engagement—for both men and women. We found that one's satisfaction in the relationship was the lens through which they viewed their partner's attachment behaviors and—women's relationship satisfaction was the lens through which her male partner viewed her attachment behaviors. Finally, women's relationship satisfaction is associated with both individuals' depression through her perceived partner's accessibility, responsiveness, and engagement. The findings from this study are important because they provide clinically relevant and mutable constructs in which clinicians can intervene at an attachment level in distressed marriages with depressed partners.     

The pinney sexual satisfaction inventory

The purpose of the present investigation was to (a) develop a reliable self‐report questionnaire that assesses women's sexual satisfaction and (b) investigate the correlates of sexual satisfaction in women. A total of 275 college‐aged women completed the Pinney Sexual Satisfaction Inventory (PSSI) and were also assessed on a variety of sexual behaviors, experiences, and attitudes. The results supported the internal reliability of the PSSI, and evidence of covergent validity was provided by strong positive correlations between the PSSI and other measures of sexual satisfaction. A factor analysis revealed two underlying dimensions of the PSSI: General Sexual Satisfaction and Satisfaction with Partner. The variables that were most highly correlated with the PSSI were relationship commitment, orgasm consistency, frequency of intercourse, and effectiveness of contraceptive device. These findings have implications for further use of the PSSI in research and clinical practice.     

Associations between Young Adults' Use of Sexually Explicit Materials and Their Sexual Preferences,Behaviors, and Satisfaction

This study examined how levels of sexually explicit material (SEM) use during adolescence and young adulthood were associated with sexual preferences, sexual behaviors, and sexual and relationship satisfaction. Participants included 782 heterosexual college students (326 men and 456 women; M_age = 19.9) who completed a questionnaire online. Results revealed high frequencies and multiple types and contexts of SEM use, with men's usage rates systematically higher than women's. Regression analyses revealed that both the frequency of SEM use and number of SEM types viewed were uniquely associated with more sexual experience (a higher number of overall and casual sexual intercourse partners, as well as a lower age at first intercourse). Higher frequencies of SEM use were associated with less sexual and relationship satisfaction. The frequency of SEM use and number of SEM types viewed were both associated with higher sexual preferences for the types of sexual practices typically presented in SEM. These findings suggest that SEM use can play a significant role in a variety of aspects of young adults’ sexual development processes.     

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.     

Facial emotion identification and sexual assault risk detection among college student sexual assault victims and nonvictims

Objective: High rates of sexual victimization among college students necessitate further study of factors associated with sexual assault risk detection. The present study examined how social information processing relates to sexual assault risk detection as a function of sexual assault victimization history. Participants: 225 undergraduates (M_age = 19.12, SD = 1.44; 66% women). Methods: Participants completed an online questionnaire assessing victimization history, an emotion identification task, and a sexual assault risk detection task between June 2013 and May 2014. Results: Emotion identification moderated the association between victimization history and risk detection such that sexual assault survivors with lower emotion identification accuracy also reported the least risk in a sexual assault vignette. Conclusions: Findings suggest that differences in social information processing, specifically recognition of others' emotions, are associated with sexual assault risk detection. College prevention programs could incorporate emotional awareness strategies, particularly for men and women who are sexual assault survivors.     

Internet-based Cognitive Behavioral Therapy for DSM-IV Sexual Dysfunctions in Breast Cancer Survivors: Predictors of Treatment Response

Abstract

Objectives: We evaluated factors predictive of the effect of internet-based cognitive behavioral therapy (CBT) in breast cancer survivors with a sexual dysfunction. Methods: Fifty-five women completed questionnaires assessing sexual functioning and distress at baseline and post-CBT. Results: Higher therapy compliance and better partner baseline sexual functioning predicted better post-CBT sexual functioning. Higher therapy compliance and higher partner relationship satisfaction predicted lower sexual distress. Therapy compliance, in turn, was predicted by active partner involvement in therapy and a stronger therapeutic relationship. Conclusions: To increase the effect of internet-based CBT, we recommend partner involvement in therapy and establishing a strong therapeutic relationship.