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Postcoital Dysphoria: Prevalence and Psychological Correlates

Authors:
  • Private Institute for Sex Counselling and Sexual Sciences

Abstract

IntroductionWhile problems related to desire, arousal, and orgasm have been subject to extensive epidemiologic research, women's postcoital reactions and feelings, and postcoital dysphoria (PCD) remains under-researched.AimThe study examined the association between women's attachment anxiety and avoidance, differentiation of self, and the experience of PCD symptoms.Methods Two hundred and thirty female university students completed an online survey.Main Outcome MeasuresThe Female Sexual Function Index, the Experiences in Close Relationships Scale, the Differentiation of Self Inventory-Revised, and study specific questions.ResultsForty-six percent of respondents reported experiencing PCD symptoms at least once in their lifetime with 5.1% experiencing PCD symptoms a few times within the past 4 weeks. A small but significant inverse correlation was found between lifetime prevalence of PCD and sexual functioning (r = −0.16). While the regression model accounted for 22% of variance in lifetime prevalence of PCD, attachment and differentiation of self variables did not account for significant variance.Conclusions The findings confirm that PCD is under-recognized and under-researched. There appears to be no relationship between PCD and intimacy in close relationships. Further research is necessary to understand the subjective experience of PCD and to inform the development of a reliable measure. Schweitzer RD, O'Brien J, and Burri A. Postcoital dysphoria: Prevalence and psychological correlates. Sex Med **;**:**–**.
Running head: POSTCOITAL DYSPHORIA
Postcoital Dysphoria: Prevalence and Psychological Correlates
Robert D Schweitzer PhD1, Jessica O’Brien MA (Clin Psy)1, Andrea Burri PhD2
1 School of Psychology and Counselling, Queensland University of Technology, Australia
2 Department of Psychology, University of Zurich, Switzerland
Submission: Sexual Medicine
Corresponding author:
Robert Schweitzer
School of Psychology and Counselling
Queensland University of Technology
Victoria Park Road
Kelvin Grove
Qld 4059, Australia
Phone: 07 3870 9596
Email: r.schweitzer@qut.edu.au
ACKNOWLEDGMENT
AB reports an Ambizione personal career fellowship from the Swiss National Science
Foundation.
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Abstract
Introduction
While problems related to desire, arousal and orgasm have been subject to extensive
epidemiologic research, women’s post-coital reactions and feelings, and postcoital dysphoria
(PCD) remains under-researched.
Aim
The study examined the association between women’s attachment anxiety and avoidance,
differentiation of self and the experience of postcoital dysphoria (PCD) symptoms.
Methods.
Two hundred and thirty female university students completed an online survey.
Main Outcome Measures
The Female Sexual Function Index (FSFI), the Experiences in Close Relationships Scale
(ECRS), the Differentiation of Self Inventory – Revised, and study specific questions.
Results
Forty-six percent of respondents reported experiencing PCD symptoms at least once in their
lifetime with 5.1% experiencing PCD symptoms a few times within the past four weeks. A
small but significant inverse correlation was found between lifetime prevalence of PCD and
sexual functioning (r=-.16). While the regression model accounted for 22% of variance in
lifetime prevalence of PCD, attachment and differentiation of self variables did not account
for significant variance.
Conclusions
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The findings confirm that PCD is under recognized and under researched. There appears to
be no relationship between PCD and intimacy in close relationships. Further research is
necessary to understand the subjective experience of PCD and to inform the development of a
reliable measure.
Key words: Postcoital dysphoria, sexual problems, FSD, attachment, anxiety,
differentiation of self
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Postcoital Dysphoria: Prevalence and Psychological Correlates
Introduction
The umbrella term of female sexual dysfunctions (FSD) primarily relates to desire,
arousal, orgasm, and pain and, as such, describes feelings and functions occurring prior to or
during sexual activities [1]. Little attention has been given to physiological or emotional
expressions and disturbances occurring post-coitally [2]. A very limited number of recent
studies have drawn attention to a previously poorly recognized phenomenon known as
postcoital dysphoria (PCD), or ‘post-sex blues’ [3]. PCD is the experience of negative affect
characterized by tearfulness, a sense of melancholy or depression, anxiety, agitation or
aggression following sexual intercourse [4].
Research on the occurrence of PCD symptoms is severely lacking. Bird et al. [2]
reported that 32.9% of the women in their sample had experienced PCD symptoms in their
lifetime. A study by Burri and Spector [4] investigated the experience of post-coital
psychological symptoms such as irritability and motiveless crying after sexual intercourse
and/or orgasm in a sample of 1489 female twins in the United Kingdom. They report 7.7%
of women reported experiencing these symptoms persistently and 3.7% of women reported
recent experience of these symptoms. The underlying causes of PCD remain unknown,
although it is speculated that the etiology is multifactorial, with psychological and affective
factors accounting for a large proportion of PCD expression. The genesis of PCD symptoms
may be understood within a broader non-linear model of female sexual functioning provided
by Basson [5]. The model incorporates emotional intimacy, sexual stimuli, and relationship
satisfaction. Basson [5] suggests that, for most women, their motivation to engage in sexual
activity stems from desire to enhance intimacy with their partner [6-9] as well as to
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experience physical pleasure [5]. Therefore, according to Basson [5] there are two primary
goals of sex: to enhance intimacy with one’s partner and achieve sexual satisfaction.
In seeking to gain a better understanding of the post coital experience in women, is
crucial to gain further understanding on how and to what extent women’s sexual motivation
and therefore functioning is influenced by the need to develop, maintain or enhance intimacy
with one’s partner. Two components of intimacy relate to the role of attachment, and to
differentiation of self, in women’s sexual functioning [4,10]. Attachment and differentiation
of self are postulated to dictate how women manage intimacy in significant relationships
[11]. Differentiation of self relates to one’s ability to balance intimacy and autonomy in
relationships, as well as the ability to separate emotions from rational thinking [12]. Each of
these constructs may be expressed intra-personally and inter-personally. Burri and colleagues
[10], for example, found the relational variables of attachment avoidance and, to a lesser
degree, attachment anxiety to be associated with FSD, with the inability to maintain a sense
of self in the presence of intimate others being the strongest predictors of sexual problems
[10]. Similarly, attachment avoidance and insecurity, and fear of loss of sense of self may
contribute to post coital dysphoria.
Aims
The first objective of this study was to assess the prevalence of PCD in a sample of female
university students and to determine whether PCD is related to overall sexual functioning.
We hypothesized that lifelong PCD would be fairly common and related to respondents’
overall sexual functioning. The second objective of the study was to identify potential
relational factors associated with PCD by examining the association between respondents’
attachment anxiety and avoidance, and the degree of differentiation of self, and the
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experience of PCD symptoms. Here, we hypothesized that respondents with higher degrees
of attachment avoidance and anxiety and with lower levels of differentiation would show
more PCD.
Methods
Study Sample
Study data was collected using a cross-sectional online questionnaire. A convenience
sample of female students was recruited by an advertisement that was circulated via email at
Australian universities and on Facebook. To be included in the study women had to be over
the age of 18 and have reported being sexually active. Data collection was conducted over
approximately 6 months from May to November, 2012. Compensation was not provided to
participants. Of the n=300 women who began the questionnaire, only n=231 completed it
resulting in a completion rate of 77%. Furthermore, previous research has reported
significant differences in the prevalence of sexual difficulties between women in same-sex
relationships and women in opposite-sex relationships [13]. Therefore, individuals
identifying as bi- or homosexual were excluded from correlation and regression analyses
(resulting in a total sample of n=195).
Procedure
The questionnaire was constructed using online survey software, Key Survey, and
data was hosted by a secure University-based server. Participants were notified that their
consent to participate would be inferred by their decision to click the ‘Next’ button. No
identifying information was obtained. Ethics approval was obtained from the University
Human Research Ethics Committee (Approval Number 1100001497).
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Main Outcome Measures
Demographic and background information such as age, level of education, sexual orientation,
current relationship status, relationship duration, and number of children was collected using
study-specific, self-constructed questions.
The Female Sexual Function Index (FSFI) [14] was used to assess female sexual
functioning. The FSFI consists of 19 items tapping into the six domains of desire, arousal,
lubrication, orgasm, pain, and sexual satisfaction. Responses were recorded on a Likert-type
rating scale which included an option to indicate that no sexual activity was attempted. The
total FSFI score is indicative of overall sexual functioning with lower scores indicating lower
sexual functioning.
Two additional items that address the lifetime and four-week prevalence of PCD were
included following the FSFI. These items were adapted from Bird et al.’s study [2]. Items
were: “Have there been any times in your life where inexplicable tearfulness or sadness
following consensual sexual intercourse was a problem for you?” and “Have there been any
times in the past four weeks where inexplicable tearfulness or sadness following consensual
sexual intercourse was a problem for you?”. Responses were coded similarly to the FSFI.
The short form of the Experiences in Close Relationships Scale (ECR-SF) [15,16] is a
12-item self-report measure of adult attachment. The scale is composed of two dimensions:
attachment anxiety and attachment avoidance. The anxiety subscale reflects fear of
abandonment and the intense desire to merge with the other. The avoidance subscale reflects
discomfort with intimacy in close relationships. Responses to all items were recorded on a
seven-point Likert-type rating scale that ranges from “1 = Disagree strongly” to “7 = Agree
8
strongly”. Across six studies, Wei et al. [16] found internal reliability coefficients ranging
from .77 to .86 and for the anxiety subscale from .78 to .88.
The Differentiation of Self Inventory – Revised (DSI-R) [17,18] is a measure of the
degree to which an individual is able to balance autonomy and intimacy in close
relationships, as well as the ability to balance rational and emotional reasoning. The
inventory contains 46 items and yields four subscale scores as well as an overall score. The
four subscales include emotional reactivity (i.e., tendency to respond too emotionally to one’s
environment), ‘I’ position (i.e., the ability to maintain a clearly defined sense of self),
emotional cutoff, (i.e., fear of intimacy) and fusion with others (i.e., the tendency to be over-
involved in significant relationships). Responses to all items were coded on a six-point
Likert-type scale ranging from “1 = Not very true of me” to “6 = Very true of me” [17].
Subscale scores were then summed to provide a total score. Higher scores indicate greater
differentiation whereas lower scores indicate poor differentiation. Skowron and Schmitt [18]
found adequate internal reliability for the full scale and each subscale: DSI-R = .92,
emotional reactivity = .89, ‘I’ position = .81, emotional cutoff = .82, and fusion with others
= .85.
Psychological Distress. The K6 [19] was used to screen for mental illness among
participants. The K6 consists of 6 items that assess cognitive, behavioral, emotional, and
physical symptoms of mood and anxiety disorders. Responses were coded on a five-point
Likert-type scale ranging from “1 = None of the time” to “5 = All of the time”. A
Cronbach’s α of .89 has been found previously for the K6 [19].
To control for the association between sexual functioning and sexual abuse (e.g.,
[20]), two items adapted from Bird et al. [2] were included to identify individuals with a
history of sexual abuse. Responses were coded as either “Yes” or “No”.
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Statistical Analysis
Data handling and all statistical analyses were carried out using SPSS and Predictive
Analysis Software (PASW) Statistics Version 17.0 for PC. For all analyses, a P value less
than .05 was considered statistically significant. Assumptions of normality were assessed
with the Kolmogorov–Smirnov test. Internal reliability of each scale was calculated using
Cronbach’s α. All scales were found to have good internal reliability; however, both PCD
items and the attachment avoidance subscale of the ECR-SF were found to be skewed and
were subsequently transformed using a logarithmic transformation.
Sample characteristics and variables of interest were reported on the basis of means
and standard deviations or numbers and percentages, as appropriate. To investigate the
relationship between the variables, a set of correlation and regression analyses were used,
including Spearman correlation (rho) between categorical and continuous variables [21],
Pearson correlation (r), and linear regression for continuous variables.
Two hierarchical multiple regression analyses were conducted to assess whether
attachment anxiety, attachment avoidance, and differentiation of self predict prevalence of
PCD symptoms. The data were analyzed using the Predictive Analysis Software (PASW)
Statistics Version 17.0 for PC. Since only a small percentage (5.1%) of women indicated that
they experienced PCD symptoms within the past four weeks, only lifetime prevalence of
PCD symptoms was used in multiple regression analyses. Also, differentiation of self,
attachment, as well as previous experience of abuse represent more enduring factors and it is
therefore reasonable to investigate their association with lifelong PCD symptoms as opposed
to short-term symptoms, where other factors might contribute to symptom expression. As a
precaution, history of sexual abuse and psychological distress were entered into the first
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block of the hierarchical multiple regression models as confounders. Although age was not
correlated with lifetime prevalence of PCD symptoms, it was possible that age remained a
potential confound due to its previously demonstrated association with sexual difficulties [4].
As a check, the multiple regression analyses were run with and without age included at block
one. The inclusion of age did not significantly affect the output and therefore was left out of
the analysis. FSFI was entered in the first block; the two primary predictors of attachment
and differentiation of self were entered in two separate blocks. As differentiation of self has
a broader theoretical scope than attachment, it was entered in the final block within the
following multiple regression analyses to determine whether it accounted for more variance
than attachment.
Results
A breakdown of the sample demographics is provided in Table 1. The mean age of women
was 25.9 (SD 8.15). Key differences were noted between the heterosexual and the non-
heterosexual group, particularly in the association between a history of sexual abuse, either as
a child or an adult, and the experience of PCD, both across the lifetime and within the past
four weeks. Therefore, individuals identifying as bi- or homosexual were excluded from
correlation and regression analyses (resulting in a total sample of n=195). Table 2 shows the
descriptive statistics and the internal reliability of each scale used to assess sexuality-related
and psychological variables of interest.
Prevalence of PCD and Correlation with Psychological and Sexuality-Related Variables
Table 3 presents the prevalence of PCD symptoms in the sample. Symptoms of PCD
in the past four weeks were reported by around 5% of women, whereas lifetime PCD
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symptoms were more common, being reported by 46.2% of women (figures relating to a “few
times” to “almost always or always”). Only 2% of women reported experiencing symptoms
of PCD “always” or “most of the time”.
To determine which variables needed to be included in the regression model, analysis
of correlations between all key variables was conducted (see Table 4). There was a weak
albeit statistically significant correlation (r = - .16, p = .02) between the total FSFI score and
lifetime prevalence of PCD (but not recent PCD) symptoms, suggesting that sexual
difficulties are mildly associated with higher incidence of lifetime PCD symptoms.
Age and relationship duration was not correlated with female sexual functioning or
PCD symptoms. Sexual abuse as a child and an adult positively correlated with PCD
symptoms (r=23, p<0.01 for childhood and r=0.15, p<0.05 for adulthood abuse). Only sexual
abuse as an adult was associated with FSFI such that those who experienced abuse were more
likely to report overall sexual difficulties. Psychological distress as measured by the K6 was
associated with both sexual functioning (r=0.25, p<0.01) and PCD (r=0.33 and r=0.16,
respectively). Table 4 also shows significant correlations between the predictors. This was
expected given that they are similar constructs.
Hierarchical Multiple Regression Analyses
Table 5 contains the statistics for the hierarchical regression model with PCD
symptoms as the criterion. The overall model was significant and accounted for 22% of the
variance. At block one, all predictors accounted for approximately 17% of the variance, with
childhood sexual abuse accounting for 4% of unique variance, β=0.20, t=3.04, p=0.003, sr² =
0.04. At block two, there was a non-significant increase in accounted variance with the
addition of attachment anxiety and attachment avoidance into the model. None of the factors,
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however, contributed significantly to the overall accounted variance. At block three, an
additional 4% of variance was accounted for, with a statistically significant effect of
emotional reactivity, accounting for approximately 2% unique variance in the final model.
Overall, there was 16% shared variance.
Discussion
Overall, women’s experience of the resolution phase, and PCD in particular, remains under-
recognized and under-researched. The present study reports occurrence of lifelong and
current PCD symptoms and is, to the best of our knowledge, the first to investigate
attachment and differentiation of self as potential risk factors in the etiology of PCD.
Approximately 46.2% of the current sample reported that they had experienced PCD
symptoms at least once in their lifetime. In regards to the past four weeks, 5.1% of the
sample reported experiencing PCD symptoms. Although the rates are somewhat comparable
to the estimates reported by Bird and colleagues (32.9% at least once in their lifetime and
9.5% within the past four weeks) [2], they are much higher than those found in Burri and
Spector’s study (3.7% in the past four weeks and 7.7% lifetime) [4]. Dissimilar assessment
methods, as well as differing sample characteristics (i.e. mean age) might be the reason for
these huge discrepancies in prevalence rates. Nevertheless, these and Bird’s [2] relatively
high rates highlight the crucial need for further research into PCD and post-coital phase,
particularly for women.
The study further examined PCD by investigating whether women’s experience of
PCD symptoms was related to their self-reported overall sexual functioning. Based on
previous research [2] it was hypothesized that PCD symptoms would mildly correlate with
overall sexual functioning. This hypothesis was partially supported as a weak link was found
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between lifelong PCD symptoms and overall sexual functioning. Contrary to Bird’s study
[2], however, no significant relationship could be detected between the experience of PCD in
the past 4 weeks and overall sexual functioning. Insufficient power might provide an
explanation for these findings, as only 5.1% of the sample reported experiencing PCD four
weeks prior to completing the questionnaire. Alternatively, it could also mean that PCD
symptoms might not necessarily be related to overall sexual functioning and could occur
despite or following ‘normal’ physiological functioning. This potential explanation provides
further support to Burri and Spector’s [4] supposition that the underlying cause of PCD
symptoms may be due to multiple biopsychosocial factors. In their twin study, genetics were
found to account for approximately 26% to 28% of variance in the experience of post-coital
psychological symptoms such as irritability and motiveless crying [4]. While these results
suggest there is a genetic component to post-coital psychological symptoms, a large
proportion of variance remained unaccounted for. Burri and Spector [4] therefore proposed
that factors such as relationship satisfaction and history of sexual abuse may be more
predictive of post-coital symptoms. In accordance with this conclusion, a history of
childhood sexual abuse appeared to be the most important predictor of PCD accounting for
5% unique variance in the present study. This finding is also consistent with Bird et al.’s [2]
multiple regression analyses where history of childhood abuse explained approximately 4.1%
of the unique variance [2]. The results are further in line with findings from Burri and
Spector [4] who reported significant associations not only between sexual abuse and
symptoms of PCD but also of physical and emotional abuse. Several possible explanations
regarding these associations are feasible. Previous experience of abuse can lead to the
development of emotional and/or psychological problems including anxiety about sexual
contacts which again might impact on women’s long-term sexual functioning and behavior.
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It is further plausible that women with an abusive history may be more prone to enter
relationships in which they do not always feel in control of their experience, or assertive
about their wants/needs, and perhaps may be prone to resentment [4]. Accordingly, we also
found a significant association between adulthood sexual abuse and attachment avoidance.
Other previously reported risk factors of sexual problems, such as age, were also
investigated. Although age is commonly seen as a predictor for sexual problems, evidence
suggests that age cannot be regarded a global risk factor for impaired sexual functioning [22].
Although several studies have consistently reported a decrease in libido and subjective and
genital arousal, other domains such as overall sexual satisfaction may even improve.
Accordingly, we did not find any significant association between age and PCD or overall
sexual functioning in our study.
Statistically significant, albeit small to moderate, correlations provided some evidence
for an association between attachment, differentiation of self and experience of PCD, with
higher levels of attachment anxiety and attachment avoidance, greater emotional reactivity,
and greater difficulty maintaining an ‘I’ position being associated with the experience of PCD
symptoms. When assessing the four-week prevalence, however, only emotional reactivity,
‘I’ Position and fusion with others were significantly correlated with PCD symptoms.
Results could only partially be replicated in the hierarchical regression analyses. While
attachment anxiety and attachment avoidance did not predict experience of PCD symptoms
across lifetime, a significant contribution of emotional reactivity could be detected. As this is
the first study to investigate differentiation of self and the experience of PCD symptoms,
potential explanations of significant correlations are based solely on Bowen’s theoretical
framework [12] and should be treated tentatively. According to Bowen [12], differentiation
of self represents a critical determinant of well-being, as poor differentiation is thought to
15
lead to psychological and physical distress. A number of studies have demonstrated the
association between differentiation of self and psychological distress and found that
differentiation of self was highly predictive of self-reported life satisfaction [17,23]. There is
little evidence available in the literature which assessed the relationship between
differentiation of self and sexual functioning. This is intriguing as a large part of marital and
sex therapy draws on Bowen theory as a foundation for its practice [24]. Schnarch [25], for
example, argues that greater differentiation of self in intimate relationships leads to increased
intimacy and greater sexual satisfaction by allowing for greater sexual communication
without being overwhelmed by anxiety. Those with lower differentiation may be more
anxious about ‘losing one’s self’ or control during sexual intercourse, thus resulting in sexual
problems. Schnarch [26] further argues that if partners can increase their differentiation by
developing an intimate connection without fear of losing their sense of self, their relationship
and sexual satisfaction will be enhanced.
In our study, individuals who have difficulty maintaining an ‘I’ position and are more
emotionally reactive were more likely to report symptoms of PCD. In the period following
sexual intercourse, individuals who are emotionally reactive may be more sensitive or
vulnerable to negative emotions, resulting in an acute period of depression or irritability.
Those who have a tendency to become fused with others may perceive the resolution phase of
sexual intercourse as a separation from their partner, which may be overwhelming. However,
differentiation of self did not account for significant variance in the overall regression model
which suggests that the explanation for PCD symptoms may lie elsewhere. Therefore, further
exploration of PCD and the potential biopsychosocial risk factors is greatly needed.
Limitations
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Several limitations are noted. Firstly, this study utilized a non-clinical convenience
sample of heterosexual and mostly Caucasian women attending university thus restricting the
generalizability of the study’s findings. Studies using general populations are needed for
greater generalizability of the findings to women. Additionally, the inclusion of non-
heterosexual women is needed to contribute to greater external validity. Secondly, due to the
lack of reliable and validated measures of PCD, the prevalence rates established in this study
need to be treated with caution. To assist future research in sexual functioning, a reliable
measure of the resolution phase with a particular focus on the psychological symptoms of
PCD needs to be developed. Reference may also be made to a broader definition of PCD, as
suggested by Sadock and Sadock [3] which includes anxiety and agitation in their description
of PCD. However, the question used to assess PCD occurrence in the present study is
comparable to the one used by Bird and colleagues [2] and Burri and Spector [4]. Third, due
to the retrospective nature of self-report measures, data can be inaccurate due to poor recall or
socially desirable answers [27]. Finally, no information on clinical and sub-clinical
depressive status of the women was available. Mental illness, including depressive
symptoms, were, however, assessed with the K6 and taken into account in all analyses.
Future research may extend upon the current study by taking account of the duration and
quality of relationships.
Conclusions
Overall, our results support the notion that PCD symptoms are prevalent in the general
population and that they can occur in spite of an otherwise physiologically functional sexual
experience. Lifetime prevalence of PCD suggest that differentiation of self is a stronger
predictor of PCD symptoms than attachment. The significant bivariate correlations warrant
17
the need for further exploration of the concepts which could have clinical implications and
may inform future prevention and educational strategies aiming at promoting sexual health.
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Table 1
Demographics and Background Information of the overall sample (n = 230)
Variable M SD Range
Age in years 25.88 8.15 18-55
Percentage (%)
Ethnic background
Caucasian 90.9
Asian 5.7
Middle Eastern 0.4
Aboriginal or Torres Strait Islander 0.4
Other 2.6
Country of residence
Australia 95.2
Other 3.5
Did not respond 1.3
Highest level of education
High school 30.4
Tertiary qualification 53.0
Post graduate qualification 16.5
Sexual orientation
Heterosexual 84.8
Homosexual 2.2
Bisexual 13
Relationship status
Single 15.7
Dating 32.6
Living together 33.9
Married 17.4
Divorced 0.4
Relationship length
Not currently in a relationship 17.0
Less than 3 months 4.3
Less than 6 months 4.3
Less than 1 year 8.7
Less than 2 years 14.8
Less than 5 years 24.8
Greater than 5 years 26.1
Children
None 87.0
1+ 13.0
Experienced childhood sexual abuse 20.4
21
Experienced adult sexual abuse 20.4
Table 2
Descriptive statistics and internal reliability of sexuality-related and psychological variables
(n = 195)
Variable Mean (SD) Score Range Skewness Cronbach’s α
PCD 4 weeks - - 2.27 -
PCD Lifetime - - 1.44 -
Total FSFI 23.28 (5.11) 2.80 – 32.00 -1.35 0.91
ECR-SF
Anxiety 21.00 (7.54) 8.00 – 42.00 .56 0.81
Avoidance 13.33 (6.70) 6.00 - 37.00 1.10 0.85
DSI-R
Emotional Reactivity 3.21 (1.01) 1.00 – 5.64 .02 0.89
I Position 4.01 (.80) 1.73 – 5.82 -.36 0.82
Emotional Cut-off 4.58 (.91) 2.00 – 6.00 -.55 0.86
Fusion 3.39 (.80) 1.50 – 5.67 .27 0.77
K6 6.45 (4.30) 0.00 - 21.00 .95 0.85
22
Table 3
Prevalence of Postcoital Dysphoria (PCD) (n = 195)
Percentage (%) of sample experiencing PCD
Frequency of PCD after intercourse Over four weeks Over lifetime
Did not attempt intercourse 7.2 -
Almost never or never 87.7 53.8
A few times (less than half) 3.1 37.9
Sometimes (about half the time) 1.5 6.2
Most times (more than half the time) 0.5 1.5
Almost always or always 0.0 0.5
Table 4
Correlation matrix of sexuality-related and psychological variables
Variable Age
Relationshi
p Duration
Sexual
Abuse (C)
Sexual
Abuse
(A) K6
PCD
Life
PCD
4weeks FSFI
Attach
Avoid
Attach
Anx ER IP EC FO
Age - .37** .17* .19** -.04 .13 .05 -.06 -.11 -.19** .13 .13 .08 .30**
Relationship
Duration - .11 .01 -.11 -.01 .07 .14 -.56** -.37** .10 -.04 .36** .16*
Sexual Abuse (C) - .13 .07 .23** -.01 .05 -.04 .01 -.04 .05 -.11 -.01
Sexual Abuse (A) - .14 .15* -.01 -.15* .15* .021 -.06 -.05 -.27** -.04
K6 - .33** .16* -.25** .33** .44** -.57** -.47** -.48**
-.34*
*
PCD Life - .35** -.16* .19** .24** -.35** -.27** -.24**
-.19*
*
PCD 4weeks - .12 .05 .06 -.18* -.21** -.03 -.16*
FSFI - -.36** -.22** -.11 .29** .40** .21**
Attach Avoid - .33** -.14 -.14 -.74** -.101
Attach Anx - -.65** -.48** -.35**
-.50*
*
ER - .68** .30** .61**
IP - .25** .51**
EC - .28**
FO -
*p < .05, **p < .01, ***p ≤ .001
Abbreviations FSFI = Female Sexual Function Index, PCD = Post Coital Dysphoria, Differentiation of Self Inventory comprises four
subscales: ER = Emotional Reactivity, IP= ‘I’ Position, EC = Emotional Cutoff, FO = Fusion with Others subscale.
POSTCOITAL DYSPHORIA
Table 5
Hierarchical multiple regression model with PCD lifetime as the criterion
Predictors R² R²ch Fch df β sr²
Block 1 0.17*** 0.17 9.39 4, 190
Childhood
Sexual Abuse 0.22*** 0.04
Adult Sexual
Abuse 0.07 0.01
Psychological
Distress 0.12 0.01
FSFI -0.08 0.00
Block 2 0.18*** 0.01 1.56 2, 188
Attachment
Anxiety -0.04 0.00
Attachment
Avoidance 0.14 0.01
Block 3 0.22*** 0.04 2.19 4, 184
Emotional
Reactivity -0.27* 0.02
I Position -0.05 0.00
Emotional
Cut-off 0.07 0.00
Fusion 0.04 0.00
*p < .05, **p < .01, ***p ≤ .001
POSTCOITAL DYSPHORIA
26
... It is also called postcoital tristesse or "post-sex blues," which refers to feelings of deep sadness or agitation after consensual sex, even if the encounter was satisfactory and pleasurable. It is a paradoxical or counterintuitive occurrence where generally satisfying sexual activity is followed by unexplainable sensations of tearfulness, melancholy, or irritation [2]. Although Masters and Johnson's model intentionally focused on physiological changes, it was criticized for being too narrow in its conceptualization [1]. ...
... Existing literature has reported that PCD affects women more than men [6]. A study reported that about 46.2% of their sample of 195 female students had experienced PCD symptoms at least once in their lifetime [2]. Maczkowiack and Schweitzer studied the prevalence and correlates of PCD among males, and reported that about 41% of 1208 male participants experienced PCD at some point in their lifetime [6]. ...
... The scale has a Cronbach's alpha of .65 [5]. This questionnaire provides a simple, quick, and easy-to-use approach to diagnose PCD, and has been used in other studies such as the one by Schweitzer et al. [2]. ...
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Sexual engagement usually leads to positive and satisfactory feelings under typical circumstances. However, studies conducted in recent years have revealed that some people experience feelings of depression, anxiety, agitation, or aggression following sexual activity or masturbation. This condition, known as postcoital dysphoria (PCD), is a rare psychiatric disorder that has been reported more in women than in men. We present a rare case of a 24-year-old male who suffers from PCD. This provides clinical insight for studies further attempting to investigate PCD among males.
... Sexual dysfunctions among women relate to desire, arousal, orgasm, or pain, which occur before or during sexual activities [1]. They may have existed for their entire adult life or have occurred after a period of normal functioning. ...
... Postcoital dysphoria (PCD) is the experience of negative affect after sexual intercourse. Specifically speaking, tearfulness, a sense of melancholy or depression, anxiety or aggression can appear [1]. The dysphoria can last for over an hour, and it is hard for a partner or individual to control or minimalize [3]. ...
... The causes of this phenomenon are unknown, but probably they are multifactorial, mostly with a contribution of psychological factors. According to Basson's model [2], not only physical pleasure is important for women, but also intimacy with their partner, so it is possible that also attachment plays a great role in those symptoms [1]. Postcoital dysphoria can be associated with distress, sexual abuse, or sexual dysfunctions [4]. ...
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A phenomenon of postcoital dysphoria is the experience of negative effect after sexual intercourse, specifically tearfulness, a sense of melancholy or depression, anxiety, or aggression, which is hard to control or minimalize. The causes of this phenomenon are unknown. This article presents a content analysis of personal descriptions published on online forums from women suffering from postcoital dysphoria. The study aimed to determine the problem of this phenomenon in personal experiences, to exhibit if psychological description coincides with women’s descriptions, and to check how often women write on forums about their problem. The study was qualitative research: the content analysis of posts appearing on online forums. The study included six online forums related to mental health, relationship and sexuality. All descriptions have been divided into three groups connected with emotions, behaviour, and partner’s response. Due to the qualitative research, the most popular PCD symptoms are crying and sobbing what might result from both positive and negative emotions. Based on the theoretical description of PCD symptoms do not coincide with personal experiences. Furthermore, the partner’s response is relevant for understanding and coping with sexual difficulties symptoms. The postcoital dysphoria causes remain multifactorial.
... 2e7 One explanation for the paucity of research concerning the phenomenological experience of the phase following arousal and satisfaction phases of the sexual experience is the fact that researchers may assume the answers are obvious that people feel relaxed, calm, sleepy, a sense of intimacy or a range of other positive emotions following sex, suggesting a coherence in the postsex experience. However, recent research has instead found considerable variation in the psychological and emotional responses people experience following sexual activity, 7,8 suggesting the need to develop a more fine-grained understanding of the postsex experience. ...
... 13 However, the presence of negative emotions following sexual activity has also been a subject of recent investigation. 7 Negative emotional experiences following sexual activity have been found to be common, with over 80% of college students experiencing one or more negative emotion(s) following sexual activity. 4 Sex differences are observed in the types of negative emotions experienced, with males more likely to experience negative emotions associated with avoidance of bonding (irritability, anger, disgust for partner), while females are more likely to experience negative emotions associated with a need for bonding (lonely, insecure, need to be comforted). ...
... PCD has been found to occur in up to 46% of females and 40% of males, with between 3% and 4% of participants experiencing PCD on a regular basis. 2,7 Females are more likely to experiences postsex dysphoria than males. 8 Female and male differences are significant in the variation of postsex experience, which is consistent with the work of Basson. ...
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Introduction There is little systematized research on the postsex phase of the sexual cycle, due in part to the absence of literature on the period immediately following sexual activity. Aim The paper describes the development and validation of the Postsex Experience Scale (P-SES), an instrument designed to measure the psychological dimensions of the postsex period of the human sexual response cycle. Methods Scale development involved (a) item construction, selection, and subsequent validation through item analysis, and (b) a factor analysis of the item intercorrelations of the P-SES and the establishment of its factorial validity, based upon an online survey of 4,217 respondents. Results In the exploratory factor analysis of the psychometric structure of the scale, structures for males and females differed. 3 factors emerged, which captured the male postsex experience. These factors were labeled Sense of Sexual Alienation, Positive Connection with Self, and Feeling Connected with Partner. 4 factors best captured the female postsex experience and were labeled Self-Loathing, Positive Connection with Self, Sense of Being Emotionally Overwhelmed, and Feeling Connected with Partner. Clinical Implications There is strong evidence for acknowledging a wide variation in postsex experience in both men and women across sexual orientations. Strengths & Limitations Strengths include a large heterogeneous sample leading to the provision of a metric to investigate novel aspects of human sexuality. Limitations include the potential underreporting of experiences due to the structure of the scale and its reference to “general experiences” and presentation bias. Conclusions The P-SES provides a framework for assessing the postsex experience in women and men, providing opportunities to gain a better understanding of the variations in postsex experience. RD Schweitzer, G du Plessis, J Maczkowiack, et al. Development and Validation of the Post Sex Experience (P-SES) Scale. Sex Med 2020; XX:XXX–XXX.
... Many other non-hedonic feelings or emotions have been reported after sexual activity, e.g. fear of pregnancy in women and postcoital dysphoria in men and women (Maczkowiack & Schweitzer, 2019;Schweitzer et al., 2015). ...
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Sexual motivation (desire) requires the simultaneous presence of an active central motive state and a stimulus with sexual significance. Once activated, sexual motivation leads to visceral responses and approach behaviors directed toward the emitter of the sexual stimulus. In humans, such behaviors follow cognitive evaluation of the context, including predictions of the approached individual’s response. After successful approach and establishment of physical contact, manifest sexual activities may be initiated. Sexual interaction is associated with and followed by a state of positive affect in most animals, whereas aversive consequences may be experienced by humans. The affective reactions may become associated with stimuli present during sexual interaction, and these stimuli may thereby alter their incentive properties. Here we show how the incentive motivation model can be used to explain the origins and possible treatments of sexual dysfunctions, notably disorders of desire. We propose that associations formed between negative outcomes of sexual interaction and the salient stimuli, for example, the partner, underlies hypoactive desire disorder. Highly positive outcomes of sexual interaction enhance the incentive value of the stimuli present, and eventually lead to hyperactive sexual desire. Treatments aim to alter the impact of sexual incentives, mainly by modifying cognitive processes.
... e factors reported in our study for low sexual desire and activity, such as vaginal dryness and dyspareunia, loss of sexual interest due to painful experience during the intercourse, and absence of a partner, were in line with previous reports [3]. In our study, 15.4% of women reported postcoital dysphoria (PCD), whereas in another study, the presence of PCD symptoms showed an inverse relation with sexual activity [46]. Fibromyalgia, considered as another important factor for lower sexual desire [47], was reported in 0.9% of our study population. ...
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Objective: This survey was designed and conducted with an aim to present data on sexual desire and activity in Chinese women. Methods: Between October 2013 and December 2013, we surveyed 3000 women (aged 40-65 years) at Beijing No. 2 Hospital and the Yuetan Community Health Service Center using a questionnaire. The primary outcomes included determination of sexual desire in the past 4 weeks, reasons for stopping sexual activity, and postmenopausal syndrome. The secondary outcome was determination of factors for low sexual desire. Results: A total of 2400 women (mean age 54.33 ± 6.25 years; mean menopausal age 50.11 ± 3.31 years) returned the questionnaire, with 58% of women reporting lowered sexual desire and 39.3% reporting stoppage of sexual activity. Compared with the postmenopausal group, the incidence of anxiety, depressive, somatic, and vasomotor symptoms was higher in the perimenopausal group. Muscle and joint pain (45.8%) and vaginal pruritus (21.5%) were the most commonly reported menopausal and vulvovaginal symptoms, respectively. The odds of decrease in sexual desire were significantly higher with older age, menopause, presence of gynecological disease, menopausal depression symptoms, menopausal vasomotor symptoms, and vulvovaginal atrophy; only cesarean delivery (odds ratio = 0.887, P=0.018) was associated with lesser reduction in sexual desire compared with the aforementioned factors. Conclusion: This survey showed that a high proportion of Chinese middle-aged and old women have lowered sexual desire and activity. Lack of sexual desire is associated with multiple factors and affects the quality of life of women.
... Attachment and emotional processing can aff ect sex uality. Attachment fears are associated with problems in orgasm, postcoital dysphoria, and low sexual satisfaction ( Burri et al., 2014 ;Schnarch, 2011 ;Schweitzer et al., 2015 ). Wymbs et al. (2017 ) showed that substance abuse in students with pronounced ADHD symptoms was associated with an increased rate of intimate part ner violence. ...
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Attention deficit hyperactivity disorder (ADHD) symptomatology, comorbid diseases, and pharmacological treatment with antidepressants can have a negative impact on sexual function, which in turn increases the likelihood of sexual dysfunction in people with ADHD. The objective of this pilot study was to differentiate and delineate possible sexual dysfunction in adults with ADHD. Adult ADHD patients (n = 32, cisgender / heterosexual) and healthy controls (n = 32, cisgender / heterosexual) filled out the DÄS-Zuf questionnaire with 59 items (Krieger, 2013). This questionnaire is divided into the scales “general contentment with life,” “anxiety/depression,” “sexual dysfunction” and “sexual satisfaction.” Patients with ADHD had significantly higher scores on single items measuring various aspects of sexual dysfunction as well as higher scores on the “anxiety/depression” scale and lower scores on the “general contentment with life” scale. Following repeated measures analyses of covariance in which the scale “anxiety/depression” was controlled as covariate, none of the previously differences for single items between ADHD patients and controls remained significant. ADHD patients with methylphenidate showed stronger physical sexual arousal compared to those without methylphenidate. The results of this pilot study suggest several explanations for sexual dysfunction among adults with ADHD and offer tentative routes for practical treatment approaches.
... Crying, depression and dysphoria despite satisfactory sexual intercourse have been reported to occur with and without orgasm and therefore cannot be considered as a true post-orgasmic phenomenon. PCD can include tearfulness and feelings of melancholy, depression, anxiety, agitation, or aggression which can mimic the psychological burden of POIS; this is why we mentioned it in our review, although symptoms last only up to an hour after sexual intercourse [19]. ...
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