Sleep disturbance as a clinical sign for severe hypogonadism: efficacy of testosterone replacement therapy on sleep disturbance among hypogonadal men without obstructive sleep apnea

Objective: The present subanalysis of the EARTH study investigates the effects of one year testosterone replacement therapy (TRT) on sleep disturbance among hypogonadal men without obstructive sleep apnea.

Methods: Sleep disturbance was defined as three or more points in question 4 of the aging males symptoms (AMS) questionnaire. All participants completed the AMS scale, International Prostatic Symptoms Score (IPSS), Sexual Health Inventory for Men (SHIM) and Short Form 36 (SF-36) health survey at baseline and after 12?months. Sexual symptoms were also evaluated based on three AMS subscores (Q15, 16 and 17).

Results: We identified 100 patients with sleep disturbance, of whom 48 (24 each in the TRT and control groups) were ultimately included for analysis. All SF-36 categories , AMS scale, IPSS and SHIM score subdomains were significantly worse in patients with sleep disturbance than in those without disturbance. Statistically significant differences in sleep disturbance, erectile symptoms, sexual desire and some domains of the SF-36 were observed between the TRT and control groups after 12?months.

Conclusion: Sleep disturbance may be one of the clinical signs for severe hypogonadism. Moreover, TRT improved sleep conditions, sexual function and quality of life among hypogonadal men with sleep disturbance.     

Homosexuality and Risk for Psychiatric Disorders

Abstract

Social science researchers have traditionally found it difficult to obtain representative samples of gay men and lesbians. Still, this has not prevented some from making broad conclusions about the lives and mental status of homosexuals as a group. In recent months, two separate national studies have examined sexual attitudes and behaviors of adults and adolescents. Collectively, the sample size of males and females surveyed in these studies is in the thousands. Because the subjects in both studies were randomly selected, the findings were based on persons with a wide spectrum of sexual attitudes and behaviors. In many respects, these studies confirm some of the data from smaller studies. That is, homosexual orientation can be a risk factor for psychiatric disturbance for some men and women. In addition, adolescents struggling with issues related to sexual orientation are two times more likely than their peers to consider or attempt suicide.     

THE FEMALE EXPERIENCE OF SIBLING INCEST*

The occurrence of sibling incest is underrecognized, and its impact is debated. Professionals may be inadequately sensitized to its occurrence since it is considered less traumatic to victims than other forms of incest and assigning responsibility in such contact between minors is difficult. Survivors may be unlikely to reveal such a history because of guilt and shame. Four case presentations of females who expereinced sibling incest illustrate problem areas, including issues of enforced secrecy, interpersonal power differentials, influences on sexual development, individual aftereffects, disturbance in family dynamics, and genderbased differences in relationship styles. Recommendations for identification and treatment are included.     

Rorschach Assessment in Child Custody Case

SUMMARY

This article describes the utility and limitations of the Rorschach Inkblot Test for addressing issues in child custody cases, with particular attention to identifying level of adjustment or psychological disturbance, personality characteristics that may foster or impede adequate parenting, and possible childhood experiences of trauma and sexual abuse. Data are reviewed that document the scientific respectability and widespread use of Rorschach assessment and attest the regularity with which Rorschach-based testimony is admitted into evidence in the courtroom. Also noted are ways in which Rorschach findings can lend incremental validity to forensic evaluations and circumvent efforts atmalingering or deception.     

Body Image for Women: Conceptualization, Assessment, and a Test of its Importance to Sexual Dysfunction and Medical Illness

The content and valence of women's body image attitudes, general and enduring positive or negative feelings about the body, are studied with psychometric analyses of measures and contrasted groups. Data from two frequently used measures (Body Image Scale, Derogatis & Melisaratos, 1979; Body Satisfaction Scale, Berscheid, Walster & Bohrnstedt, 1973) provided an evaluation of the construct and the assessment of body image. Two studies are provided. The construct analyses suggest two contents for body attitude measures: a general factor of body, facial, and sexual (genital and breast) items, and a second factor assessing weight and/or its body correlates-the hips, thighs, and buttocks. Also, a method factor, a response style of negativity, may be important. Body image attitudes are correlated with some conceptually relevant criteria, such as interest in engaging in sexual activity; however, these relationships do not appear sufficiently strong to predict behavior, such as the occurrence or resolution of sexual dysfunction. Generalized body image disturbance as currently conceptualized and assessed may be difficult to document, particularly when item content and response styles are considered.     

Producing change in attitudes toward abortion∗

This study examines several factors affecting reactions to persons identified as homosexual. Reactions are operationalized in terms of expressed rejection of the homosexual as indicated by responses to a social distance scale. The major variables examined are sex of homosexual, sex of reactor, and acceptance of two commonly held stereotypes. These stereotypes—perceived danger and psychological disturbance—both suggest that a sense of threat is associated with rejection of the homosexual. A particularly interesting finding was that male subjects are especially rejecting of male homosexuals. Presumably male subjects tend to view the male homosexual as a sexual failure and to perceive him as personally threatening or dangerous.     

Characteristics of difficult-to-place youth in state custody: a profile of the Exceptional Care Pilot Project population

This study examines the characteristics of Texas youth designated as 'most difficult to place' recipients of service under the "Exceptional Care Pilot Project" (N = 46). Findings include, among others, high levels of comorbid psychiatric disturbance (> 3 diagnostic groupings), physical (78.3%) and sexual (88%) maltreatment, and placement breakdowns (m = 4.8 therapeutic placements). This initial profile of the population provides a base for helping other states identify and plan for the needs of their most troubled youth.     

Body image for women: Conceptualization,assessment, and a test of its importance to sexual dysfunction and medical illness

The content and valence of women's body image attitudes, general and enduring positive or negative feelings about the body, are studied with psychometric analyses of measures and contrasted groups. Data from two frequently used measures (Body Image Scale, Derogatis & Melisaratos, 1979; Body Satisfaction Scale, Berscheid, Walster & Bohrnstedt, 1973) provided an evaluation of the construct and the assessment of body image. Two studies are provided. The construct analyses suggest two contents for body attitude measures: a general factor of body, facial, and sexual (genital and breast) items, and a second factor assessing weight and/or its body correlates—the hips, thighs, and buttocks. Also, a method factor, a response style of negativity, may be important. Body image attitudes are correlated with some conceptually relevant criteria, such as interest in engaging in sexual activity; however, these relationships do not appear sufficiently strong to predict behavior, such as the occurrence or resolution of sexual dysfunction. Generalized body image disturbance as currently conceptualized and assessed may be difficult to document, particularly when item content and response styles are considered.     

Eunuchoid sexuality in four syndromes

Using HTDM and SAM Questionnaires, heterosexual development and sexual activity were investigated in the following patients: two men with a Klinefelter syndrome associated with developmental anomalies of the penis, two patients with testicular agenesis, 14 men with hypogonadism, and three “fertile eunuchs.” Through comparison with a control group of 204 adult well‐developed, fertile, and potent men it was ascertained that the heterosexual development of the patients was distinctly retarded and that their sexual activity was lower. These insufficiencies in sex life were of the same character regardless of the diversity of etiopathogenetic mechanisms which had led to the disturbance of somatosexual development.     

Treating Serious Emotional and Behavioural Problems Using Multisystemic Therapy

Multisystemic therapy (MST) is a family‐ and community‐based treatment of serious emotional and behavioural problems presented by adolescents. The development of this model began in the late 1970s, and today MST is a leading evidence‐based treatment of serious antisocial behaviour in youths, with programs transported to more than 30 states in the United States and 12 nations, including Australia and New Zealand. This article rerviews the theoretical rationale that underlies MST and presents the central clinical features of the intervention model. In addition, the training and quality assurance protocols used to promote MST program fidelity and treatment adherence are described. Finally, findings from approximately 15 published randomised and two quasi‐experimental clinical trials with youths presenting serious clinical problems (e.g., violence, substance abuse, serious emotional disturbance, sexual offending, and chronic illness) are summarised.     

Guilty or not? A path model of women's sexual force fantasies

This study estimated a path model of women's forceful sexual fantasies. Constructs examined were childhood sexual abuse, feminist beliefs, sexual guilt, erotophilia, and sexual experience. The study clarifies how these factors mediate one another in relationship to forceful sexual fantasies, and is first to examine the effects of feminist beliefs on forceful sexual fantasy. Adult women (N = 261) participated by completing an online survey. A path from sex guilt to forceful sexual fantasy, mediated by erotophilia, was found, wherein low levels of sex guilt and high levels of erotophilia were found to predict forceful sexual fantasy. A direct path between childhood sexual abuse and forceful sexual fantasy was also found. The resulting model is discussed in relation to previously-proposed theories on the role of force in women's sexual fantasies.     

Number of sexual partners and sexual assertiveness predict sexual victimization: do more partners equal more risk?

In previous studies, number of sexual partners and sexual assertiveness were examined as independent risk factors for sexual victimization among college women. Using a sample of 335 college women, this study examined the interaction of number of sexual partners and sexual assertiveness on verbal sexual coercion and rape. Approximately 32% of the sample reported unwanted sexual intercourse, 6.9% (n = 23) experienced verbal sexual coercion, 17.9% (n = 60) experienced rape, and 7.2% (n = 24) experienced both. As number of sexual partners increased, instances of verbal sexual coercion increased for women low in relational sexual assertiveness but not for women high in relational sexual assertiveness. A similar relationship was not found for rape. Among women who experienced both verbal sexual coercion and rape, increases in number of partners in the context of low refusal and relational assertiveness were associated with increases in verbal sexual coercion and rape. Findings suggest sexual assertiveness is related to fewer experiences of sexual coercion.     

Subjective sexual arousal and involvement: Development of multiple indicators

Three measures of subjective sexual arousal were observed across four erotic conditions in a sample of 241 college men and women (a) to refine two multi‐item scales of subjective sexual arousal, (b) to determine the convergent and discriminant validity of three measures of sexual arousal, and (c) to relate these operational definitions of subjective sexual arousal to the construct of subjective sexual arousal within Mosher's (1980) involvement theory. From the perspective of involvement theory, subjective sexual arousal is conceived to be an affect‐cognition blend, consisting of awareness of physiological sexual arousal, sexual affects, and affect‐cognition blends, which is transmuted into consciousness and deepens involvement by amplifying the perception of sexual stimulation, sexual cognitions, sexual behavior, physiological sexual response, and itself. Evidence of convergent validity was strong with a median validity coefficient of .51 for the three measures across the four conditions.     

Women’s Sexual Communication with Their Peers and Its Association with Sexual Wellbeing

Abstract

Communication about sex is an important variable in sexual well-being, but sex remains a taboo topic, particularly for women. This study explores women’s peer sexual communication, and its association with their sexual well-being. A survey (N?=?617) showed that women tend to solicit expressive, rather than instrumental, sexual communication from other women. Regression analyses revealed that peer sexual communication is associated with higher sexual self-efficacy, and sexual self-esteem, but also higher risky sexual norms perceptions. Peer sexual communication appears to be a potential vehicle for disseminating sexual information, as long as women have accurate and empowering information to start with.     

Exploring a Contextual Model of Sexual Self-Disclosure and Sexual Satisfaction

Sexual self-disclosure is a critical component of relationship and sexual satisfaction, yet little is known about the mechanisms that facilitate a person’s engagement in sexual self-disclosure. Individuals (N = 265) involved in romantic relationships participated in an online study testing a contextual model of sexual self-disclosure across three contexts: relationship context, sexual self-disclosure context, and outcome of sexual self-disclosure. Results suggest that sexual satisfaction was predicted by a positive relationship context and a positive sexual self-disclosure context. In addition, the sexual self-disclosure context was predicted by the relationship context. These findings emphasize the importance of examining contextual influences that determine whether an individual will engage in or avoid sexual self-disclosure and the consequences of this engagement or avoidance on sexual satisfaction.     

What is Sexual Satisfaction? Thematic Analysis of Lay People's Definitions

Sexual satisfaction is an important indicator of sexual health and is strongly associated with relationship satisfaction. However, research exploring lay definitions of sexual satisfaction has been scarce. We present thematic analysis of written responses of 449 women and 311 men to the question “How would you define sexual satisfaction?” The participants were heterosexual individuals with a mean age of 36.05 years (SD = 8.34) involved in a committed exclusive relationship. In this exploratory study, two main themes were identified: personal sexual well-being and dyadic processes. The first theme focuses on the positive aspects of individual sexual experience, such as pleasure, positive feelings, arousal, sexual openness, and orgasm. The second theme emphasizes relational dimensions, such as mutuality, romance, expression of feelings, creativity, acting out desires, and frequency of sexual activity. Our results highlight that mutual pleasure is a crucial component of sexual satisfaction and that sexual satisfaction derives from positive sexual experiences and not from the absence of conflict or dysfunction. The findings support definitions and models of sexual satisfaction that focus on positive sexual outcomes and the use of measures that incorporate items linked to personal and dyadic sexual rewards for both men and women.     

Sexual Distress Mediates the Associations Between Sexual Contingent Self-Worth and Well-Being in Women With Genitopelvic Pain: A Dyadic Daily Experience Study

Provoked vestibulodynia (PVD), a common cause of women’s genitopelvic pain, is associated with poorer psychological and sexual well-being in affected couples. Greater sexual contingent self-worth (CSW)—defined as self-esteem that is dependent on the perceived success or failure of a sexual relationship—has been linked to poorer well-being in a cross-sectional study of couples coping with PVD. This study aimed to examine whether daily sexual distress mediated the associations between greater sexual CSW and lower sexual satisfaction and greater anxiety, depressed mood, and women’s pain in affected couples. Women (N = 125) diagnosed with PVD and their partners completed the Sexual CSW Scale and then online daily surveys for eight weeks measuring sexual distress, sexual satisfaction, anxiety, depressed mood, and women’s pain during intercourse. Multilevel analyses were based on the actor–partner interdependence model (APIM). For women who had higher sexual CSW (compared to lower sexual CSW), on sexual activity days when their sexual distress was higher, they reported lower sexual satisfaction and greater anxiety, depressed mood, and pain (compared to their average level across all sexual activity days). Findings suggest that daily sexual distress may be one pathway between greater sexual CSW and poorer day-to-day well-being in women with PVD.     

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.     

Contributions of Divergent Peer and Parent Sexual Messages to Asian American College Students' Sexual Behaviors

Receiving more parent sexual communication is generally linked to a later age of first sexual intercourse and less sexual risk taking. However, Asian American youth report minimal parent sexual communication, later sexual initiation, and fewer sexual risks than their counterparts. What contributes to this unexpected pattern of sexual communication and sexual behaviors? To answer this question, we surveyed 312 Asian American college students ages 17 to 22 on their sexual behaviors, parent sexual communication, and peer sexual communication. Assessment of parent and peer sexual communication was completed via a measure in which participants rated the frequency with which they had received each of 22 sexual messages from each source. Young women generally received more messages promoting abstinence, traditional sex roles, and sex within a relational context than their male counterparts. Young men, however, reported greater parent and peer communications that were accepting of casual sex. Exposure to peer messages that were accepting of casual sex was associated with more sexual partners, casual sex encounters, and sexual experience. Being older, being raised outside the United States, being less religious, and being homosexual was each predictive of more sexual experience. Implications regarding the role of culture and gender on sexual socialization are discussed.     

Sexual Cognition Guides Viewing Strategies to Human Figures

Gaze patterns to figure images have been proposed to reflect the observer's sexual interest, particularly for men. This eye-tracking study investigated how individual differences in sexual motivation tendencies are manifested in naturalistic gaze patterns. Heterosexual men and women (M = 21.0 years, SD = 2.1) free-viewed plain-clothed male and female figures, aged 10, 20, and 40 years old, while their eye movements were recorded. Questionnaires were used to measure sexual cognitions, including sensation seeking and sexual compulsivity, sexual inhibition and excitation, and approach and avoidance responses to sexual stimuli. Our analysis showed a clear role of sexual cognitions in influencing gaze strategies for men. Specifically, men who scored higher on sexual compulsivity dedicated more gaze to the waist–hip region when viewing figures of their preferred sexual partners than men who scored lower on sexual compulsivity. Women's sexual cognitions showed no clear effect on the gaze pattern in viewing figures of their preferred age and gender of sexual partners, suggesting women's gaze is unlikely to be a straightforward reflection of their sexual preferences. The findings further suggest that men's gaze allocation is driven by sexual preferences and supports the utility of eye tracking in the assessment of male sexual interest.