Sexual Abuse and Sexual Functioning in a Chronic Pelvic Pain Sample

ABSTRACT

Sexual abuse, particularly childhood sexual abuse, has been linked to chronic pelvic pain and to sexual dysfunction, though the sexual functioning of survivors of sexual abuse has not been studied in a chronic pain population. Sixty-three women with chronic pelvic pain completed measures of sexual function, sexual abuse, and pain. Using an index of the extent of sexual abuse experiences in childhood and adolescence/adulthood, higher scores were related to lower rates of sexual activity, less satisfaction with orgasm and feelings of closeness with sexual partners, and greater severity of and interference from pain. Findings point to the importance of controlling for relationship status in analyses of long-term effects of sexual abuse and of assessing chronic pelvic pain patients for histories of sexual abuse using measures that address the extent or severity of abuse.     

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 abuse and sexual functioning in a chronic pelvic pain sample

Sexual abuse, particularly childhood sexual abuse, has been linked to chronic pelvic pain and to sexual dysfunction, though the sexual functioning of survivors of sexual abuse has not been studied in a chronic pain population. Sixty-three women with chronic pelvic pain completed measures of sexual function, sexual abuse, and pain. Using an index of the extent of sexual abuse experiences in childhood and adolescence/adulthood, higher scores were related to lower rates of sexual activity, less satisfaction with orgasm and feelings of closeness with sexual partners, and greater severity of and interference from pain. Findings point to the importance of controlling for relationship status in analyses of long-term effects of sexual abuse and of assessing chronic pelvic pain patients for histories of sexual abuse using measures that address the extent or severity of abuse.     

A Dyadic Approach to Understanding the Link Between Sexual Functioning and Sexual Satisfaction in Heterosexual Couples

Researchers have demonstrated that several dimensions of sexual functioning (e.g., sexual desire, arousal, orgasm) are associated with the sexual satisfaction of individuals in a committed mixed-sex (male–female) relationship. We extended this research by comparing a dyadic model that included both own (i.e., actor effect) and partner (i.e., partner effect) domains of sexual functioning to an individual model that included only actor effects. Participants were 124 mixed-sex couples who completed online measures of sexual functioning and sexual satisfaction. Data analysis using the actor–partner interdependence model (APIM) and structural equation modeling (SEM) indicated that the dyadic model had a better fit than the individual model. Women’s sexual desire and orgasm and men’s erectile functioning were significant positive predictors of both own and partner’s sexual satisfaction. These results are discussed in terms of the importance of taking a dyadic approach to research and clinical work related to sexual satisfaction.     

Sexual functioning and self-reported depressive symptoms among college women

We conducted an exploratory study comparing 47 college-aged women reporting depressive symptoms but not receiving antidepressant medication to 47 age-matched controls. We examined various dimensions of sexual functioning, including sexual desire, arousal, orgasm, pain, pleasure, and satisfaction. The women with depressive symptoms reported more inhibited sexual arousal, more inhibited orgasm, more sexual pain problems, and less sexual satisfaction and pleasure than control participants. Novel to this study, the women with depressive symptoms reported greater desire for sexual activity alone (masturbation) than the nondepressed women. The findings are discussed in terms of primary reinforcers and depressive symptomology.     

Women With Hypoactive Sexual Desire Disorder Versus Sexual Interest/Arousal Disorder: An Empirical Test of Raising the Bar

In 2013, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was published with a major revision to the sexual dysfunction categories, and the diagnosis of female hypoactive sexual desire disorder (HSDD) was replaced with female sexual interest/arousal disorder (SIAD). Since being introduced, concern has been expressed that SIAD inappropriately “raises the bar” for diagnosis. To address these concerns, we sought to evaluate the number of women with a diagnosis of HSDD who also met criteria for SIAD. In a sample of 151 women, we found that 73.5% of women with a diagnosis of HSDD met criteria for SIAD. The two groups were compared on the Sexual Interest/Desire Inventory, and women who met criteria for both HSDD and SIAD consistently scored lower on sexual desire frequency and satisfaction, satisfaction with sex, receptivity, positive sexual thoughts, reactions to erotica, arousal frequency, ease, continuation, and orgasm ease/achievement, and higher on distress. In addition, women meeting criteria for HSDD only tended to have mild symptoms across the six SIAD criteria compared to those meeting criteria for both HSDD and SIAD. These findings suggest that the SIAD criteria does not unduly raise the bar for diagnosis.     

Sexual transformations and intimate behaviors in romantic relationships

To understand the association between sexual transformations (i.e., changes in sexual behavior for the partner), intimate behaviors, and relationship quality among couples in romantic relationships, this study used Actor Partner Interdependence Models to examine frequency of sexual transformations, feelings about sexual transformations, and intimate behaviors as predictors of relationship satisfaction among 96 couples (N?=?192). Sexual transformations were also examined as a moderator of the association between intimate behavior and relationship satisfaction. Results indicated that relationship satisfaction was positively associated with partners' frequent sexual transformations, actors' positive feelings about sexual transformations, and intimate behavior from the partner. Further, in less intimate relationships, relationship satisfaction was greater when partners reported making more sexual transformations.     

Sexual Transformations and Intimate Behaviors in Romantic Relationships

To understand the association between sexual transformations (i.e., changes in sexual behavior for the partner), intimate behaviors, and relationship quality among couples in romantic relationships, this study used Actor Partner Interdependence Models to examine frequency of sexual transformations, feelings about sexual transformations, and intimate behaviors as predictors of relationship satisfaction among 96 couples (N = 192). Sexual transformations were also examined as a moderator of the association between intimate behavior and relationship satisfaction. Results indicated that relationship satisfaction was positively associated with partners’ frequent sexual transformations, actors’ positive feelings about sexual transformations, and intimate behavior from the partner. Further, in less intimate relationships, relationship satisfaction was greater when partners reported making more sexual transformations.     

Limited Role of Body Satisfaction and Body Image Self-Consciousness in Sexual Frequency and Satisfaction in Pregnant Women

This cross-sectional study examined the role of maternal body image and body image self-consciousness in sexual satisfaction and intercourse frequency during pregnancy when controlling for satisfaction with partnership. Pregnant women in their third trimester of pregnancy (N = 150) participated in the study. Body image was measured by the Body Areas Satisfaction Scale (BASS) and Body Image Self-Consciousness Scale (BISC), while relationship satisfaction was measured by different subscales of the Perceived Quality of Marital Relationship (PQMR) Scale. Sexual satisfaction was also measured by one of the subscales of the PQMR (Intimate Relationship). The sexual behavior questionnaire comprised questions about frequency of sexual intercourse, desire, and other aspects of sexual functioning as well as the reasons that might prevent women from having intercourse during pregnancy. Findings suggested that satisfaction with body image and body image self-consciousness were related to sexual satisfaction. Nevertheless, other aspects of partnership, such as communication, appeared to be much more important predictors of sexual satisfaction than body image variables. The best predictor of sexual frequency was fear that intercourse might harm the fetus. Implications for education about sexuality issues in pregnancy are discussed.     

Sexual function and the menopausal woman: The importance of age and partner's sexual functioning

The aim of this study was to investigate age, menopausal status, and the male partner's sexual function on the sexual function of the menopausal woman. Sexual functioning of 304 women (120 premenopausal, 76 perimenopausal, 108 post‐menopausal) aged between 35 and 65 years from a community sample was investigated. Multiple regression analyses found that sexual satisfaction within the relationship was better predicted by age group than by menopausal status. Younger women were more likely to be satisfied with their sexual relationship than older women. Age group was also a better predictor than menopausal status of current frequency of intercourse, with younger women being likely to have more frequent intercourse than older women. Whether a female respondent had experienced a sexual dysfunction was better predicted by menopausal status than by age. Women who were menopausal were more likely to report a sexual problem such as lack of sexual interest, poor lubrication, and failure to have an orgasm. However, age group appeared to be a better predictor of whether the male partner had experienced a sexual dysfunction. Older men were more likely to have experienced failure to have an erection, for example. The findings of this study indicate that age and the sexual function of the partner are important factors to take into consideration when investigating the sexual function of the menopausal woman.     

After Breast Cancer: Sexual Functioning of Sexual Minority Survivors

Research on sexual difficulties after cancer has neglected sexual minority women (SMW); for example, lesbian and bisexual women. Clinicians treating these women are therefore at a disadvantage as they lack information about sexual problems in this population. This study tested the hypothesis that SMW with breast cancer have poorer sexual function than SMW without breast cancer, distinguishing partnered from unpartnered women. Using convenience sample recruitment, we conducted a case-control study to compare survivors of breast cancers who are SMW, in other words, cases to controls, that is, SMW without cancer. Anonymous survey data were collected from 85 cases after they had completed active cancer treatment and 85 age- and partner-status matched controls with no history of any cancer. Participants' self-reported sexual frequency and sexual function measured by the Female Sexual Function Index were evaluated. Cases and controls did not differ in risk of sexual dysfunction or the level of overall sexual functioning; however, cases had lower sexual frequency and scored lower on desire and ability to reach orgasm, and higher on pain compared to controls. Results inform clinicians about sexual minority survivors' sexual domains affected by cancer. When discussing sexual problems and therapeutic options, sexual orientation should be ascertained.     

Emotional Satisfaction and Physical Pleasure in Sexual Unions: Time Horizon,Sexual Behavior,and Sexual Exclusivity

This paper uses data from the 1992 National Health and Social Life Survey to examine emotional satisfaction and physical pleasure from sex in intimate unions for adults in the U.S. Using perspectives from evolutionary biology and rational choice theory, we examine the effects of the following factors on emotional satisfaction and physical pleasure: time horizon expected for the relationship, sexual behavior within the relationship, and sexual exclusivity. We find a significant effect of measures for all 3 of these dimensions on emotional satisfaction with sex. For both men and women, time horizon and sexual exclusivity are more strongly tied to emotional satisfaction than they are to physical pleasure from sex, but sexual behavior has the same impact on emotional satisfaction as it does on physical pleasure.     

The Relationship Between Sexual Concordance and Orgasm Consistency in Women

Sexual concordance (the relationship between genital and self-reported sexual responses) may be associated with orgasm consistency (OC; the proportion of sexual acts leading to orgasm) during penile–vaginal intercourse (PVI) in women. We investigated the relationship between women’s sexual concordance (assessed using different stimulus modalities and self-reported sexual arousal methods) and OC during various sexual activities (assessed using different types of questions). For Study 1 (n = 51), when sexual concordance was assessed using audiovisual sexual stimuli, we did not find a statistically significant relationship between OC and poststimulus self-reports of sexual arousal or genital sensations, raw values of OC, or ranges of OC. For Study 2 (n = 44), where sexual concordance was assessed using audionarrative sexual stimuli, we did find a statistically significant relationship between PVI OC and sexual concordance using change in self-reported sexual arousal, and ranges of orgasm consistency. Two findings were inconsistent with previous research. First, OC varied significantly by activity type in both studies; masturbation yielded the highest OC. Second, PVI OC was significantly related to oral sex and masturbation OC (Study 2). We discuss the need for further research and various factors that may affect women’s orgasm consistency and sexual concordance.     

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.     

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.     

A Survey of Sexual States of Married,Healthy, Reproductive Age Women

The sexual states of 1,800 married, healthy, reproductive- age women were surveyed. Sexual dissatisfaction occurred in 10.1% of women but in 5.3% of their husbands (P < 0.01). Statistically, stepwise logistic regression analysis was used Factors that substantially influenced the wives' sexual feelings were associated with precoital caressing, the occurrence and time of orgasm, husband's sexual satisfaction, who initiated coitus, and the wife's agreement to sexual activity if the husband was the initiator. Factors that substantially influenced the husbands' sexual feelings were frequency of coitus, successful ejaculation, wife's sexual satisfaction, and the husband's attitude toward the contraceptive method the wife had adopted     

Is the Relationship Between Pornography Consumption Frequency and Lower Sexual Satisfaction Curvilinear? Results From England and Germany

Several studies using different methods have found that pornography consumption is associated with lower sexual satisfaction. The language used by media-effects scholars in discussions of this association implies an expectation that lowered satisfaction is primarily due to frequent—but not infrequent—consumption. Actual analyses, however, have assumed linearity. Linear analyses presuppose that for each increase in the frequency of pornography consumption there is a correspondingly equivalent decrease in sexual satisfaction. The present brief report explored the possibility that the association is curvilinear. Survey data from two studies of heterosexual adults, one conducted in England and the other in Germany, were employed. Results were parallel in each country and were not moderated by gender. Quadratic analysis indicated a curvilinear relationship, in the form of a predominantly negative, concave downward curve. Simple slope analyses suggested that when the frequency of consumption reaches once a month, sexual satisfaction begins to decrease, and that the magnitude of the decrease becomes larger with each increase in the frequency of consumption. The observational nature of the data employed precludes any causal inferences. However, if an effects perspective was adopted, these results would suggest that low rates of pornography consumption have no impact on sexual satisfaction and that adverse effects initiate only after consumption reaches a certain frequency.