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Sexual Dysfunction and Distress Among Childhood Sexual Abuse Survivors: The Role of Post-Traumatic Stress Disorder
Abstract
Background
Research has revealed that survivors of childhood sexual abuse (CSA) have elevated sexual dysfunction and distress. Nevertheless, a vast majority of studies examining sexual dysfunction and distress among CSA survivors were conducted among women only, and the moderating role of post-traumatic stress disorder (PTSD) symptoms between a history of CSA and sexual dysfunction and distress is yet to be investigated.
Aim
To fill this gap, the present study aimed to investigate the following: (i) are there sex differences in the relations between CSA and sexual dysfunction and distress and (ii) whether PTSD symptoms mediate the relations between CSA and sexual dysfunction and distress.
Methods
This study was conducted online among 792 Israeli men and women aged 18–70 years; among whom, 367 reported a history of CSA.
Outcomes
The findings of the present study suggest that PTSD symptoms mediate the relations between CSA and sexual dysfunction and distress.
Results
Results indicated that those who had a history of CSA reported elevated sexual dysfunction and sexual distress, as compared with non-abused participants, regardless of their sex. Furthermore, PTSD symptoms were related to sexual dysfunction and sexual distress and mediated the relations between a history of CSA and sexual dysfunction and distress. A history of CSA predicted elevated PTSD symptoms, which in turn, were related to elevated sexual dysfunction and distress. Clinical interventions for CSA survivors should incorporate various treatment approaches to alleviate both PTSD symptoms and sexual dysfunction and distress.
Clinical translation
The present findings indicate the need for clinicians to identify PTSD symptoms and to conjoin distinctive treatment approaches to relieve survivors’ PTSD symptoms, as well as their sexual dysfunction and distress.
Strengths & limitations
The study included a non-clinical, convenience sample and used self-report measures, which are highly subjective and increase the possibility of social desirability biases. However, on the plus side, it provides important information on CSA survivor’s sexual functioning and can assist in establishing intervention goals, and to evaluate treatment.
Conclusion
PTSD symptoms were found to mediate the relations between a history of CSA and sexual dysfunction and distress, implying that PTSD symptoms serve as a mechanism underlying sexual dysfunction and distress among CSA survivors.
Gewirtz-Meydan A, Lahav Y. Sexual Dysfunction and Distress Among Childhood Sexual Abuse Survivors: The Role of Post-Traumatic Stress Disorder. J Sex Med 2020;XX:XXX–XXX.
... Notwithstanding this wealth of research on sexual difficulties in the aftermath of CSA, our understanding of the mechanism explaining the association between CSA and sexual difficulties in adulthood is limited. One of the main theoretical conceptualizations of this association relies on trauma theories that posit a direct link between different aspects of sexual abuse and different traumatic reactions (e.g., Bird et al., 2014;Bornefeld-Ettmann et al., 2018;Gewirtz-Meydan & Lahav, 2020;Kratzer et al., 2022;Lorenz et al., 2015). ...
... Most of the studies investigating the association between CSA and sexual difficulties in adulthood in relation to trauma, have examined the association between sexual-related variables and various trauma-related symptoms, such as post-traumatic stress disorder (PTSD) symptoms (Bornefeld-Ettmann et al., 2018;Gewirtz-Meydan & Lahav, 2020;Kratzer et al., 2020), sympathetic nervous system activation (Lorenz et al., 2015), and dissociation (Bird et al., 2014). However, we expect that the PTSD symptoms that include intrusion (e.g., flashbacks, nightmares), avoidance (e.g., avoidance of traumarelated thoughts or feelings and reminders), alterations in cognition and mood (e.g., overly negative thoughts and assumptions about oneself or the world, negative affect), and hyperarousal symptoms (e.g., irritability and aggression, difficulty sleeping) will be manifested within the sexuality of survivors, thereby affecting their sexual self-concept , their cognitions related to sex , their dissociative experiences during sex (Bird et al., 2014;Hansen et al., 2012), and their feelings toward sex, such as guilt, and shame (Kilimnik & Meston, 2021). ...
... Despite the well-established association between CSA and sexual difficulties in adulthood (Bigras et al., 2021;Gewirtz-Meydan & Opuda, 2020;Pulverman et al., 2018;Slavin et al., 2020), there is a limited amount of research on how symptoms of PTSD interplay within this association. To date, researchers on sexuality among CSA survivors have examined the moderating or mediating role of PTSD in the relation between abuse history and adult sexuality (e.g., Bornefeld-Ettmann et al., 2018;Gewirtz-Meydan & Lahav, 2020). Currently, the sexuality of CSA survivors is measured independently of the trauma by examining the relationship between sexual dysfunction and trauma-related variables. ...
Sexual-related post-traumatic stress symptoms (sexual-related PTSS) refers to the traumatic reactions that are replicated during sexual activity among survivors of child sexual abuse (CSA). However, the construct of sexual-related PTSS have been adapted from clinical work with survivors, and research with limited examination of the scales themselves. Given this gap, the current study offers the development of a new measure (PT-SEX) that examines sexual-related PTSS. The study was conducted online, among two convenience samples of women survivors of CSA (study 1 included 451 women and study 2 included 330 women). Six reliable PT-SEX factors emerged from Study 1: Dissociation during sex, intrusiveness during sex, shame and guilt in regard to sexual aspects, pleasing the other during sex, interpersonal distress, and hypervigilance during sex. Study 2 revealed survivors of CSA had significantly higher sexual-related PTSS levels as compared to participants without such a history. Also, post-traumatic stress disorder and sexual-related PTSS made unique and unshared contributions to the observed data, including sexual self-esteem, sexual motives, relationship satisfaction, compulsive sexual behavior, and mental health. CSA significantly moderated the associations between sexual-related PTSS and sexual self-esteem, sexual motivations of self-affirmation and coping, and depression and anxiety. Findings from the current study show that over time, the trauma of CSA seems to be implicated in survivors’ sexual experience. As sexual difficulties are accompanied by sexual-related PTSS, these symptoms are unlikely to resolve by trauma-focused therapy and must be actively targeted in therapy.
... Mechanisms that have been proposed to explain the relationship between CSA and sexual dysfunction have included cognitive aspects such as negative sexual self-concept 22,23 and self-schemas, [24][25][26] low body image and self-esteem, 27 feelings of shame and guilt, 28,29 posttraumatic stress disorder levels, 30,31 and depressive symptomatology. 32 Although the aforementioned studies offer important contributions to our knowledge regarding the implications of CSA for survivors' sexual functioning, the focus has often been on the negative consequences and mechanisms explaining the association between CSA and sexual functioning. ...
... 63 The Hebrew-language version has been used in previous studies. 31,64,65 Cronbach alpha for the ASEX in the current study was good (α = 0.82). ...
Background:
The current study is based on the established association between child sexual abuse (CSA) and self-compassion, and CSA and sexual functioning, with an overall goal to better understand how self-compassion explains the association between CSA and sexual functioning.
Aim:
The current study examined the role of self-compassion as a potential mediator, and relationship satisfaction as a potential moderator, in the association between CSA and sexual functioning among a nonclinical sample of men and women.
Methods:
Participants completed an online survey assessing CSA, self-compassion, sexual functioning, and relationship satisfaction. The sample consisted of 914 individuals, of whom 582 reported currently being in a romantic relationship and were included in the current analysis. The majority of the sample was female (n = 534, 91.8%), with a mean age of 31.85 years (SD, 9.76).
Outcomes:
Self-compassion mediated the link between CSA and sexual dysfunction, and relationship satisfaction moderated this same link.
Results:
Results indicate that self-compassion mediated the association between CSA and sexual functioning. In addition, there was a significant 2-way interaction between CSA and intimate relationship satisfaction predicting sexual functioning. Specifically, CSA was negatively associated with sexual functioning only when there were low levels of relationship satisfaction, whereas in the presence of average and high intimate relationship satisfaction, the association between CSA and sexual functioning was nonsignificant.
Clinical implications:
Findings from the current study suggest that clinicians working with CSA survivors should take into account survivors' self-compassion and relational functioning when engaging in therapeutic work around their sexual dysfunction.
Strengths and limitations:
The study included a nonclinical sample of individuals and used self-report measures, which are highly subjective and increase the possibility of social desirability biases. Additional research should be conducted among clinical samples and among couples to explore this model from a dyadic perspective.
Conclusion:
Our results highlight the importance of self-compassion and relationship satisfaction when considering sexual dysfunction following CSA.
... Boden et al. state that many psychological problems will arise after children are sexually abused, such as anxiety disorder, depression, suicidal ideation, suicide attempts, et al. [6]. In addition, CSA experiences might lead victims to sexual dysfunction such as delayed ejaculation, female orgasmic disorder et al. [7], and impact victims' social function. The objectivities of this literature review are those find theories and evidence of the association between CSA and other disorders. ...
... Researchers have demonstrated that the prevalence of sexual dysfunctions among CSA survivors is higher than it is among individuals who are not suffering from abuse. These survivors also have a high risk for PTSD than normal [7,21]. Moreover, research demonstrated that nearly 45% of CSA survivors develop PTSD [22]. ...
... Childhood abuse is a pervasive, global problem that substantially hampers the well-being of millions of children around the world (Stoltenborgh et al., 2015). The long-term ramifications of childhood abuse are multifaceted and include posttraumatic stress disorder (PTSD), anxiety, dissociation, substance use disorders, eating disorders, non-suicidal self-injury, sexual dysfunction, poor physical health, and depression (Ford & Gómez, 2015;Gewirtz-Meydan & Lahav, 2020a, 2020bLindert et al., 2014;Messman-Moore & Bhuptani, 2017;Nelson et al., 2017;Vonderlin et al., 2018;Wegman & Stetler, 2009). ...
Childhood abuse puts individuals at risk for psychopathology and psychiatric symptoms such as posttraumatic stress disorder (PTSD) and anxiety symptoms. At the same time, research has indicated that some survivors report positive transformations in the aftermath of their trauma, known as posttraumatic growth (PTG). Yet the essence of PTG reports is questionable, and some scholars claim that it may reflect maladaptive illusory qualities. Furthermore, according to a recent theoretical model, PTG might be dissociation-based and related to survivors' bonds with their perpetrators. This study aimed to explore these claims by assessing PTG, dissociation, and identification with the aggressor (IWA), as well as PTSD and anxiety symptoms. An online survey was conducted among 597 adult childhood abuse survivors. Study variables were assessed via self-report measures. Analyses indicated positive associations between PTG, dissociation, and IWA. Three distinct profiles were found, reflecting high, medium, and low scores on PTG, dissociation, and IWA. Profile type explained PTSD and anxiety symptoms above and beyond gender, age, and abuse severity. These findings suggest that whereas some childhood abuse survivors might experience a positive transformation subsequent to their trauma, others' PTG reports might reflect dissociative mechanisms and pathological attachments to their perpetrators , and thus might be maladaptive. ARTICLE HISTORY
... The results of this study on the prediction of sexual dysfunction in adulthood based on sexual abuse in childhood are consistent with the results of previous research (45). Researchers believe that when explaining sexual dysfunction in people with a history of child sexual abuse, it is better to look at it from the perspective of a traumatic experience. ...
Background: Methadone maintenance treatment (MMT) is an evidence-based effective treatment for drug addiction. Psychological problems are common among drug users. However, a few studies have investigated the role of psychological factors, including depression, anxiety, and childhood trauma, on sexual dysfunction in MMT patients. Objectives: This study aimed to determine the prevalence of sexual dysfunction and the role of psychological factors, including anxiety, depression, and childhood trauma, on the sexual function of patients on MMT. Patients and Methods: In this cross-sectional study, 100 MMT patients were selected by convenience sampling among patients referring to Baharan Psychiatric Hospital, Zahedan, Iran. All participants completed self-report questionnaires, including the Beck Anxiety Inventory (BAI), Beck Depression Inventory-II (BDI-II), Childhood Trauma Questionnaire (CTQ), and International Index of Erectile Function (IIEF-15). Statistical analysis was done with Pearson correlation coefficients, and stepwise linear regression models determined the predictors of sexual function. Results: Seventeen percent of participants reported various degrees of sexual dysfunction. Child sexual abuse and depression were significant predictors of sexual dysfunction. The regression analysis showed that 12% of the variance of sexual dysfunction (R2 = 0.12; F = 6.61; P < 0.002) was predicted by an experience of childhood sexual abuse and depression. Conclusions: People on MMT suffer from psychological problems as the risk factors for sexual dysfunction. Thus, mental health care staff should consider psychological factors to prevent and treat sexual dysfunction.
... 27 The ASEX was translated using the back translation method, following the guidelines for the process of cross-cultural adaptation of self-report measures, 30 and had been used in the Hebrew form in previous studies. 31,32 Cronbach's alpha for the ASEX in the current study was good (a = 0.82). ...
Background
Although the empirical evidence supporting the co-occurrence of sexual disorders and eating disorders is growing, it is not yet known how often these 2 conditions co-occur, and whether the comorbidities of sexual disorders and eating disorders differ in any specific ways.
Aim
To examine the co-occurrence of sexual disorders and eating disorders.
Methods
In the current study, we used latent profile analysis to identify distinct profiles of sexual disorders and eating disorder symptoms among a large non-clinical sample of women (n = 985). We also examined how these profiles differed in terms of body image self-consciousness. The study was conducted as an online survey among a convenience sample of Israeli women.
Main Outcome Measures
For sexual disorders we used the Arizona Sexual Experience Scale, and for eating disorders we used the Eating Disorders Inventory 2.
Results
Latent profile analysis revealed 4 profiles: no disorder (low levels of sexual disorders and eating disorder symptoms), eating disorder symptoms (low levels of sexual disorders and high levels of eating disorder symptoms), sexual disorders (high levels of sexual disorders and low levels of eating disorder symptoms), and comorbidity (high levels of both sexual disorders and eating disorder symptoms). Women in the comorbidity group had significantly more body image self-consciousness during sexual activity than did women in the other groups.
Conclusion
The 4 profiles identified in the study support the co-occurrence of sexual disorders and eating disorder symptoms, yet also raise many clinical considerations. Limitations of the study, directions for future research, and clinical implications are discussed.
Gewirtz-Meydan A, Spivak-Lavi Z. Profiles of Sexual Disorders and Eating Disorder Symptoms: Associations With Body Image. J Sex Med 2021;XX:XXX–XXX.
Child sexual abuse (CSA) has been recognized as a risk factor for sexual dysfunction and has attracted increasing attention. However, controversies remain regarding related research. The aim is to calculate the pooled effect size estimate for the correlation between CSA and sexual dysfunction in adults by meta-analysis. Five bibliographic databases (PubMed, Cochrane Library, Web of Science, Embase, and PsycINFO) were comprehensively searched to clarify the association between CSA and sexual dysfunction in adults. We used a fixed-effects model to determine the total pooled effect size estimate and reported odds ratios (ORs) and the corresponding 95% confidence intervals (CIs). Subgroup analysis, publication bias analysis, and sensitivity analysis were conducted. Adults who had a history of CSA experienced a higher proportion of sexual dysfunction than adults with no history of CSA (OR = 1.68, 95% CI [1.49, 1.87]). Subgroup analysis showed that women with a history of CSA reported a higher proportion of sexual dysfunction than men with a history of CSA (men: OR = 1.45, 95% CI [1.05, 1.84]; women: OR = 1.62, 95% CI [1.42, 1.83]). The estimates of the effect sizes differed substantially depending on the CSA and sexual dysfunction instruments that were used in each study and the region of each sample. This meta-analysis provides conclusive evidence of an association between CSA and sexual dysfunction in adults. Currently known interventions for the treatment of sexual dysfunction after CSA have only been evaluated in women, so specific interventions should be designed for men CSA survivors who experience sexual impairment.
Sexual violence, particularly against women, is alarmingly common. Many survivors experience post-traumatic stress ( Cortina & Kubiak, 2006 ); thus, reminders of the trauma could cause flashbacks, dissociative symptoms, and intense fear ( American Psychiatric Association, 2013 ). Given that women consume media that regularly depicts sexual violence, which could cause distress, the current study examined women’s perceptions of, and emotional responses to, scenes of sexual violence. It was predicted that women would perceive scenes of sexual violence negatively and that would be particularly true for women with a sexual violence history, those who reported post-traumatic stress disorder symptoms related to sexual violence history, and those who use negative coping strategies in response to stressors. Participants were women ( n = 229) who completed an online survey. More than half (52%) of participants reported that they had experienced sexual violence. Participants generally reported negative perceptions of scenes of sexual violence, with a majority viewing them as too graphic, used for shock value/titillation, and unnecessary to the plot. Women with a history of sexual violence reported greater avoidance of media that might contain sexual violence and greater negative affect in response to scenes of sexual violence; however, women who exceeded the post-traumatic stress disorder screen cut-off did not report greater avoidance and negative affect than those who did not exceed the cut-off. Finally, those who reported a greater tendency to cope with stressors using problem avoidance reported more avoidance of, and negative affect in response to, scenes of sexual violence. Exploratory analyses, limitations, and future directions are discussed.
Sexual self-concept (SSC) is an important component of health that is closely associated with the well-being of survivors of child sexual abuse (CSA). Compared with non-CSA respondents, SSC of CSA survivors was deleteriously affected, resulting in ineffective psychological functioning (negative self-evaluation, psychological ill-health, and difficulties in interpersonal relationships). Negative SSC (sexual anxiety, sexual depression, and sexual fear) played a significant role in mediating the adverse effects of CSA on psychological functioning. Future studies may recruit a sample with greater variation in CSA characteristics and use externalizing problems as outcome measures to cross-validate findings of this study.
Background:
The problems in sexual functioning among patients with post-traumatic stress disorder (PTSD) are often overlooked, although scientific research confirms high rates of sexual dysfunctions (SD) particularly among veterans with PTSD. The main objective of this study was to systematically identify predictors of SD among veterans with PTSD.
Methods:
Three hundred veterans with PTSD were included in the cross-sectional study. The subjects were assessed by the Mini-International Neuropsychiatric Interview (MINI) and self-report questionnaires: PCL-5, i.e., PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) with Criterion A, International Index of Erectile Function (IIEF), Premature Ejaculation Diagnostic Tool (PEDT), and Relationship Assessment Scale (RAS). Several hierarchical multiple regressions were performed to test for the best prediction models for outcome variables of different types of SD.
Results:
65% of participants received a provisional diagnosis of SD. All tested prediction models showed a good model fit. The significant individual predictors were cluster D (Trauma-Related Negative Alterations in Cognition and Mood) symptoms (for all types of SD) and in a relationship status/relationship satisfaction (all, except for premature ejaculation (PE)).
Conclusions:
The most salient implication of this study is the importance of sexual health assessment in veterans with PTSD. Therapeutic interventions should be focused on D symptoms and intended to improve relationship functioning with the aim to lessen the rates of SD. Psychotropic treatment with fewer adverse sexual effects is of utmost importance if pharmacotherapy is applied. Appropriate prevention, screening, and treatment of medical conditions could improve sexual functioning in veterans with PTSD.
This manuscript is the first to examine the psychometric properties of the Female Sexual Distress Scale in samples of sexually functional and dysfunctional men, herein called the Sexual Distress Scale (SDS). A sample of 127 sexually dysfunctional men and 267 sexually functional men completed an online survey that included a sociodemographic questionnaire, a health questionnaire, the SDS, as well as measures of sexual bother and concerns, sexual function, sexual attitudes, and mood states. We also used a sample of 188 sexually dysfunctional and 155 sexually functional women from previous studies. Results showed that the SDS assesses one general domain of sexual distress. The factor structure was invariant across gender and sexual function status. The SDS also showed good content, construct, and criterion validity, as well as good internal consistency reliability (Cronbach’s alpha) and test–retest reliability. Finally, the SDS discriminated well between sexually functional and sexually dysfunctional men. These results show that the SDS is a reliable and valid tool for assessing sexual distress in men. This instrument can be used by researchers and clinicians to examine sexual distress and can be used to elucidate how sexual distress relates to sexual function, well-being and quality of life.
Introduction:
Childhood sexual abuse (CSA) has been identified as a potent risk factor for sexual dysfunction. Certain characteristics of the abuse experience, such as repeated abuse, appear to affect the risk of developing sexual dysfunction. Despite the robust findings that CSA can be detrimental to sexual function, there is little consensus on the exact mechanisms that lead to these difficulties.
Aim:
To summarize the most up-to-date research on the relation between CSA and women's sexual function.
Methods:
The published literature examining the prevalence of sexual dysfunction among women with CSA histories, various types of sexual dysfunctions, and mechanisms proposed to explain the relation between CSA and later sexual difficulties was reviewed.
Main outcome measures:
Review of peer-reviewed literature.
Results:
Women with abuse histories report higher rates of sexual dysfunction compared with their non-abused peers. The sexual concerns most commonly reported by women with abuse histories include problems with sexual desire and sexual arousal. Mechanisms that have been proposed to explain the relation between CSA and sexual dysfunction include cognitive associations with sexuality, sexual self-schemas, sympathetic nervous system activation, body image and esteem, and shame and guilt.
Conclusion:
Women with CSA histories represent a unique population in the sexual health literature. Review of mechanisms proposed to account for the relation between CSA and sexual health suggests that a lack of positive emotions related to sexuality, rather than greater negative emotions, appears to be more relevant to the sexual health of women with CSA histories. Treatment research has indicated that mindfulness-based sex therapy and expressive writing treatments are particularly effective for this group. Further research is needed to clarify the mechanisms that lead to sexual dysfunction for women with abuse histories to provide more targeted treatments for sexual dysfunction among women with abuse histories. Pulverman CS, Kilimnik CD, Meston CM. The Impact of Childhood Sexual Abuse on Women's Sexual Health: A Comprehensive Review. Sex Med Rev 2018;X:XXX-XXX.
Objective:
Sexual self-schemas are cognitive generalizations about the sexual self that influence the processing of sexually pertinent information and guide sexual behavior. Until recently sexual self-schemas were exclusively assessed with self-report instruments. Recent research using the meaning extraction method, an inductive method of topic modeling, identified 7 unique themes of sexual self-schemas: family and development, virginity, abuse, relationship, sexual activity, attraction, and existentialism from essays of 239 women (Stanton, Boyd, Pulverman, & Meston, 2015). In the current study, these themes were used to examine changes in theme prominence after an expressive writing treatment.
Method:
Women (n = 138) with a history of childhood sexual abuse completed a 5-session expressive writing treatment, and essays on sexual self-schemas written at pretreatment and posttreatment were examined for changes in themes.
Results:
Women showed a reduction in the prominence of the abuse, family and development, virginity, and attraction themes, and an increase in the existentialism theme.
Conclusions:
This study supports the validity of the 7 themes identified by Stanton and colleagues (2015) and suggests that expressive writing may aid women with a history of sexual abuse to process their abuse history such that it becomes a less salient aspect of their sexual self-schemas. (PsycINFO Database Record
Objective
Difficulties with sex often develop following sexual trauma, yet are rarely targeted within treatment of post-traumatic stress disorder (PTSD). Where outcomes of sexual function are included, they are secondary to other measures. This review aimed to assess whether psychological treatment for PTSD (from sexual trauma) has an effect on sexual functioning.Methods
Systematic searches of MEDLINE, PsycINFO, EMBASE, and trial registers were performed. Five studies met inclusion criteria. Pre-post treatment effect sizes were also calculated.ResultsData from four good-quality RCTs were included in the meta-analyses. These examined females (n = 799) who had experienced adult sexual trauma or child sexual abuse. Studies compared psychological treatment to control conditions, but no effect on outcomes of sexual concerns, standardized mean difference (SMD) = 0.03 and dysfunctional sexual behaviour, SMD = 0.02, was found. Pre-post treatment effect sizes were small to medium (SMD = 0.36 and 0.47, respectively).Conclusions
While firm conclusions cannot be drawn, the available evidence suggests that psychological treatment for PTSD has no effect on sexual problems. Pre-post effects indicate some improvement over the course of treatment, which may be strengthened if treatment actively targeted sexual problems. The paucity of evidence in this area suggests that there is substantial need for further research in order to establish a set of evidence-based guidelines for practitioners implementing treatment in this area.Practitioner pointsThe measurement of sexual problems is overlooked in psychological treatment RCTs for sexual trauma.Current treatments for post-traumatic stress disorder (PTSD) from sexual trauma do not appear to be addressing sexual problems.Integrated treatments for comorbid sexual problems and PTSD treatment may be warranted.It is imperative that in future, RCTs that examine people with PTSD from sexual trauma use outcomes of sexual problems.
Difficulties in sexual desire and function often occur in persons with posttraumatic stress disorder (PTSD), but many questions remain regarding the mechanisms underlying the occurrence of sexual problems in PTSD.
The aim of this review was to present a model of sexual dysfunction in PTSD underpinned by an inability to regulate and redirect the physiological arousal needed for healthy sexual function away from aversive hyperarousal and intrusive memories.
A literature review pertaining to PTSD and sexual function was conducted. Evidence for the comorbidity of sexual dysfunction and PTSD is presented, and biological and psychological mechanisms that may underlie this co-occurrence are proposed.
This manuscript presents evidence of sexual dysfunction in conjunction with PTSD, and of the neurobiology and neuroendocrinology of PTSD and sexual function.
Sexual dysfunction following trauma exposure may be mediated by PTSD-related biological, cognitive, and affective processes.
The treatment of PTSD must include attention to sexual dysfunction and vice versa. Yehuda R, Lehrner A, and Rosenbaum TY. PTSD and sexual dysfunction in men and women. J Sex Med **;**:**-**.
© 2015 International Society for Sexual Medicine.
Research indicates that childhood sexual abuse (CSA) produces lasting alterations in interpersonal relatedness, identity, and affect regulation, often referred to as self-capacity disturbance. CSA also has been shown to negatively impact sexual functioning. This study examined the role of altered self-capacities in mediating the relationship between CSA and sexual responses. Path analysis revealed that CSA was related to sexual anxiety and decreased sexual satisfaction through its association with reduced self-awareness and a propensity to be involved in difficult interpersonal relationships.
http://onlinelibrary.wiley.com/doi/10.1111/jsm.12643/abstract
Introduction. While the military is a young and vigorous force, service members and veterans may experience sexual functioning problems (SFPs) as a result of military service. Sexual functioning can be impaired by physical, psychological, and social factors and can impact quality of life (QOL) and happiness.
Aims. To estimate rates and correlates of SFPs in male military personnel across demographic and psychosocial characteristics, examine the QOL concomitants, and evaluate barriers for treatment seeking.
Methods. This exploratory cross-sectional study was conducted using data from a larger nation-wide study conducted between October 2013 - November 2013. This sample consists of 367 male active duty service members and recent veterans (military personnel) age 40 or younger.
Main Outcome Measures. Erectile dysfunction (ED) was determined using the IIEF-5, sexual dysfunction (SD) was determined using the ASEX-M, and QOL was determined using the WHOQOL-BREF.
Results. SFPs were associated with various demographic, physical, and psychosocial risk factors. The rates of SD and ED were 8.45% and 33.24%, respectively, for male military personnel aged 21-40. Those who were 36-40, non-married, non-white, and of lower educational attainment reported the highest rates of SFPs. Male veterans with poor physical and psychosocial health presented the greatest risk for ED and SD. SFPs were associated with reduced quality of life and lower happiness, and barriers for treatment were generally related to social barriers.
Conclusions. SFPs in young male military personnel are an important public health concern that can severely impact quality of life and happiness.
This study investigated the relationship between 10 characteristics of childhood sexual abuse and dissociation in adulthood. A structured clinical interview, the Dissociative Experiences Scale, and the Dissociation Subscale of the Symptom Checklist 90 - Revised were administered to 118 women survivors seeking psychotherapy. Separate stepwise multiple regression analyses were conducted for each dissociation scale to determine which abuse characteristics were predictive of dissociation. In both analyses, the same four variables were significantly related to dissociation: age at onset, coercive sexual acts, objectifying sexual acts, and concurrent multiple perpetrators. Implications of findings for future research and clinical practice are explored.
Self-report instruments for assessing sexual well-being in women with sexual difficulties have not, to date, been explicitly validated among women with a history of childhood sexual abuse (CSA). Given an extensive literature suggesting psychological differences between women with and without a history of CSA, it is possible that sexual well-being has a different meaning for these groups. Without validated scales, it is difficult to evaluate the impact of early sexual trauma on adult sexuality. The present study assessed whether the factor structure of widely used measures of sexual well-being were consistent across women experiencing sexual difficulties, with and without an abuse history, and to estimate effect sizes for the statistical effect of CSA on sexual well-being in this population. A sample of women with and without a history of CSA (N = 238) completed the Female Sexual Function Index and the Sexual Satisfaction Scale for Women. Structural equation models indicated generally consistent factor structures across groups, suggesting good construct validity. Effect size estimates indicated medium to large (.53-.72) effects of CSA on sexual well-being, for women with sexual difficulties. These findings support and extend research regarding the potential effects of CSA that may inform treatment for this population.
Women with a history of childhood sexual abuse (CSA) experience dissociative symptoms and sexual difficulties with greater frequency than women without a history of CSA. Current models of sexual dysfunction for sexual abuse survivors suggest that dissociation may mediate the relationship between CSA and sexual arousal difficulties. Dissociation, however, is often conceptualized as a single construct in studies of CSA and not as separate domains as in the dissociation literature. In the present study, women with (CSA, N = 37) and without (NSA, N = 22) a history of CSA recruited from the community were asked to indicate the frequency and intensity of their experience in two dissociation subgroups, derealization and depersonalization, during sex with a partner and in their daily life. Findings showed that, in the NSA group, more depersonalization during sex with a partner was associated with lower sexual arousal functioning. However, for both the NSA and CSA groups, more derealization during sex was associated with higher sexual arousal functioning. No measure of dissociation was significantly associated with sexual responses in the laboratory. These findings highlight the importance of distinguishing between different forms of dissociation (i.e., derealization and depersonalization) in the study of sexual arousal functioning. In addition, the findings challenge the notion that dissociation is a main predictor of sexual arousal problems in survivors of CSA and suggest that a more nuanced relationship may exist.
The sex drive refers to the strength of sexual motivation. Across many different studies and measures, men have been shown to have more frequent and more intense sexual desires than women, as reflected in spontaneous thoughts about sex, frequency and variety of sexual fantasies, desired frequency of intercourse, desired number of part - ners, masturbation, liking for various sexual practices, willingness to forego sex, initi - ating versus refusing sex, making sacrifices for sex, and other measures. No contrary findings (indicating stronger sexual motivation among women) were found. Hence we conclude that the male sex drive is stronger than the female sex drive. The gender dif - ference in sex drive should not be generalized to other constructs such as sexual or or - gasmic capacity, enjoyment of sex, or extrinsically motivated sex. If the world were designed for the primary goal of maximizing human happiness, the sexual tastes of men and women would match up very closely. What could be more ideal than perfect attunement with one's mate, so that both people feel sexual desire at the same times, to the same degrees, and in the same ways? Yet there is ample evidence that romantic partners are sometimes out of synchrony with each other's sexual wishes and feelings. The continuing market for sexual advice, sex therapy, couple counseling, and similar offerings is a testimony to the fact that many people are not perfectly satisfied with their sex lives even within committed re- lationships. Infidelity and divorce may also sometimes reflect sexual dissatisfaction. The focus of this article is on one potential source of
Context While recent pharmacological advances have generated increased public interest and demand for clinical services regarding erectile dysfunction, epidemiologic data on sexual dysfunction are relatively scant for both women and men. Objective To assess the prevalence and risk of experiencing sexual dysfunction across various social groups and examine the determinants and health consequences of these disorders. Design Analysis of data from the National Health and Social Life Survey, a probability sample study of sexual behavior in a demographically representative, 1992 cohort of US adults. Participants A national probability sample of 1749 women and 1410 men aged 18 to 59 years at the time of the survey. Main Outcome Measures Risk of experiencing sexual dysfunction as well as negative concomitant outcomes. Results Sexual dysfunction is more prevalent for women (43%) than men (31%) and is associated with various demographic characteristics, including age and educational attainment. Women of different racial groups demonstrate different patterns of sexual dysfunction. Differences among men are not as marked but generally consistent with women. Experience of sexual dysfunction is more likely among women and men with poor physical and emotional health. Moreover, sexual dysfunction is highly associated with negative experiences in sexual relationships and overall wellbeing. Conclusions The results indicate that sexual dysfunction is an important public health concern, and emotional problems likely contribute to the experience of these problems.
Objectives:
Systematic reviews on prevalence estimates of child sexual abuse (CSA) worldwide included studies with adult participants referring on a period of abuse of about 50 years. Therefore we aimed to describe the current prevalence of CSA, taking into account geographical region, type of abuse, level of country development and research methods.
Methods:
We included studies published between 2002 and 2009 that reported CSA in children below 18 years. We performed a random effects meta-analysis and analyzed moderator variables by meta-regression.
Results:
Fifty-five studies from 24 countries were included. According to four predefined types of sexual abuse, prevalence estimates ranged from 8 to 31 % for girls and 3 to 17 % for boys. Nine girls and 3 boys out of 100 are victims of forced intercourse. Heterogeneity between primary studies was high in all analyses.
Conclusions:
Our results based on most recent data confirm results from previous reviews with adults. Surveys in children offer most recent estimates of CSA. Reducing heterogeneity between studies might be possible by standardized measures to make data more meaningful in international comparisons.
Introduction:
The literature shows a discrepancy in the association between child sexual abuse (CSA) and adult sexual function. One of the proposed explanations for this discrepancy is the different ways in which CSA is assessed. While some studies explicitly ask potential participants whether they are sexual abuse survivors, others ask whether participants experienced specific unwanted sexual behaviors.
Aim:
This study investigated the differences between women who self-identified as CSA survivors, women who experienced similar unwanted sexual experiences but did not identify as CSA survivors (NSA), and women with no history of sexual abuse (control). CSA was defined as unwanted touching or penetration of the genitals before the age of 16.
Methods:
A sample of 699 college students anonymously completed a battery of questionnaires on sexuality and sexual abuse history.
Main outcome measures:
Sexual function was measured with the Female Sexual Function Index (FSFI), and sexual satisfaction was measured with the Sexual Satisfaction Scale-Women. History of CSA was measured with a modified version of Carlin and Ward's childhood abuse items.
Results:
Differences emerged between women who experienced sexual abuse before age 16 and women who never experienced sexual abuse (control) on the personal distress subscale of the Sexual Satisfaction Scale. The CSA group (N = 89) reported greater sexual distress compared to the NSA (N = 98) group, and the NSA group reported more distress than the control group (N = 512). No significant group differences were observed in the FSFI. Characteristics of the abuse that predicted whether women identified as CSA survivors included vaginal penetration, fear at the time of the abuse, familial relationship with the perpetrator, and chronic frequency of the abuse. These abuse characteristics were associated with sexual satisfaction but not with sexual function.
Conclusions:
Differences in levels of sexual satisfaction between women with and without a history of CSA were associated with the type of CSA definition adopted. It remains unexplained why the CSA group showed more personal distress about their sexuality but not more sexual dysfunction.
Introduction:
Accurate estimates of prevalence/incidence are important in understanding the true burden of male and female sexual dysfunction and in identifying risk factors for prevention efforts.
Aim:
To provide recommendations/guidelines concerning state-of-the-art knowledge for the epidemiology/risk factors of sexual dysfunctions in men and women.
Methods:
An International Consultation in collaboration with the major urology and sexual medicine associations assembled over 200 multidisciplinary experts from 60 countries into 17 committees. Committee members established specific objectives and scopes for various male and female sexual medicine topics. The recommendations concerning state-of-the-art knowledge in the respective sexual medicine topic represent the opinion of experts from five continents developed in a process over a 2-year period. Concerning the Epidemiology/Risk Factors Committee, there were seven experts from four countries.
Main outcome measure:
Expert opinion was based on grading of evidence-based medical literature, widespread internal committee discussion, public presentation and debate.
Results:
Standard definitions of male and female sexual dysfunctions are needed. The incidence rate for erectile dysfunction is 25-30 cases per thousand person years and increases with age. There are no parallel data for women's sexual dysfunctions. The prevalence of sexual dysfunction increases as men and women age; about 40-45% of adult women and 20-30% of adult men have at least one manifest sexual dysfunction. Common risk factor categories associated with sexual dysfunction exist for men and women including: individual general health status, diabetes mellitus, cardiovascular disease, other genitourinary disease, psychiatric/psychological disorders, other chronic diseases, and socio-demographic conditions. Endothelial dysfunction is a condition present in many cases of erectile dysfunction and there are common etiological pathways for other vascular disease states. Increasing physical activity lowers incidence of ED in males who initiate follow-up in their middle ages.
Conclusions:
There is a need for more epidemiologic research in male and female sexual dysfunction.
For many woman survivors of childhood sexual abuse, there are long-term sexual sequelae, such as hypersexual activity and
avoidance, although the trajectory to each type of response remains unclear. Female survivors of childhood sexual abuse have
problems with intimate relationships and some survivors may also complain of multiple health problems and use emergency room
services at a higher rate than women who were not sexually abused. Although the health care provider is in a position to screen
for childhood sexual abuse, care must be taken to maintain trust if referring the survivor for psychotherapy, specifically
sex therapy, which can be the treatment of choice. This article reviews the effect of childhood sexual abuse in female sexual
function and provides general treatment recommendations.
The study examined whether and how characteristics of childhood sexual abuse and disclosure influenced three dimensions of
psychosexual functioning—emotional, behavioral and evaluative—during adulthood. The sample included 165 adults who were sexually
abused as children. The General Estimating Equation was used to test the relationship among the predictors, moderators and
five binary outcomes: fear of sex and guilt during sex (emotional dimension), problems with touch and problems with sexual
arousal (behavioral), and sexual satisfaction (evaluative). Respondents who were older when they were first abused, injured,
had more than one abuser, said the abuse was incest, and told someone about the abuse were more likely to experience problems
in at least one area of psychosexual functioning. Older children who told were more likely than younger children who told
to fear sex and have problems with touch during adulthood. Researchers and practitioners should consider examining multiple
dimensions of psychosexual functioning and potential moderators, such as response to disclosure.
KeywordsSexual functioning-Child sexual abuse-Adult survivors-GEE
Studies of tobacco use and other health behaviors have reported great challenges in recruiting young adults. Social media is widely used by young adults in the United States and represents a potentially fast, affordable method of recruiting study participants for survey research.
The present study examined Facebook as a mechanism to reach and survey young adults about tobacco and other substance use.
Participants were cigarette users, age 18-25 years old, living throughout the United States and recruited through Facebook to complete a survey about tobacco and other substance use. Paid advertising using Facebook's Ad program over 13 months from 2010 Feb 28 to 2011 Apr 4 targeted by age (18-25), location (United States or California), language (English), and tobacco- and/or marijuana-related keywords. Facebook approved all ads.
The campaign used 20 ads, which generated 28,683,151 impressions, yielding 14,808 clicks (0.7% of targeted Facebook members), at an overall cost of $6,628.24. The average cost per click on an ad was $0.45. The success of individual ads varied widely. There was a rise in both clicks and impressions as the campaign grew. However, the peak for clicks was 3 months before the peak for ad impressions. Of the 69,937,080 accounts for those age 18-25 in the United States, Facebook estimated that 2.8% (n = 1,980,240) were reached through tobacco and marijuana keywords. Our campaign yielded 5237 signed consents (35.4% of clicks), of which 3093 (59%) met criteria, and 1548 (50% of those who met criteria) completed the survey. The final cost per valid completed survey was $4.28. The majority of completed surveys came from whites (69%) and males (72%). The sample averaged 8.9 cigarettes per day (SD 7.5), 3.8 years of smoking (SD 2.9), with a median of 1 lifetime quit attempts; 48% did not intend to quit smoking in the next 6 months.
Despite wide variety in the success of individual ads and potential concerns about sample representativeness, Facebook was a useful, cost-effective recruitment source for young-adult smokers to complete a survey about the use of tobacco and other substances. The current findings support Facebook as a viable recruitment option for assessment of health behavior in young adults.
Although sexual difficulties related to a history of childhood sexual abuse (CSA) are common, there are no efficacious treatments to address sexual distress. Recent evidence for the benefits of mindfulness, which emphasizes present-moment non-judgmental awareness, in the treatment of women's sexual concerns provided the impetus for this pilot study. Twenty partnered women with sexual difficulties and significant sexual distress, and a history of CSA were randomized to two sessions of either a cognitive behavioral (CBT, n = 8) or mindfulness-based (MBT, n = 12) group treatment (age: M = 35.8 years, range: 22-54 years). Hierarchical Linear Modeling to assess changes in concordance between laboratory-based subjective and genital sexual arousal revealed a significant effect of MBT on concordance such that women in the MBT group experienced a significantly greater subjective sexual arousal response to the same level of genital arousal compared to the CBT group and to pre-treatment. Both groups also experienced a significant decrease in sexual distress. These data support the further study of mindfulness-based approaches in the treatment of sexual difficulties characterized by a disconnection between genital and subjective sexual response.
For men with nonconsensual sexual experience (NSEs) histories, sexual shame may play a critical role in their sexual responses. Through online surveys, the current study examined sexual shame in the sexual excitation and inhibition responses of men with NSE histories who both do (identifiers; n = 255) and do not identify (non-identifiers; n = 239) their NSEs with sexual violence labels (e.g., rape) and men with no NSEs (n = 289). Regardless of identification, men with NSEs reported greater sexual shame than men with no NSEs and higher levels of excitatory (e.g., arousability) and inhibitory (e.g., inhibitory cognitions) domains of sexual response propensities. Sexual shame predicted inhibitory domains of sexual response for all of the men. NSE history and identification moderated the relationship between sexual shame and arousability. Sexual shame had a stronger positive association with arousability for both identifiers and those with no NSEs than non-identifiers. The results provide support for the role of sexual shame in men’s sexual response and suggest sexual shame is an important target for interventions with men with NSEs.
Introduction
There is mixed evidence regarding how posttraumatic stress disorder (PTSD) symptom clusters are associated with sexual dysfunction (SD), and most studies to date have failed to account for potentially confounding variables. Our study sought to explore the unique contribution of PTSD symptom clusters on (a) lack of sexual desire or pleasure, and (b) pain or problems during sexual intercourse, after adjusting for comorbidities and medication usage.
Materials and Methods
Participants included 543 male treatment-seeking veterans and Canadian Armed Forces (CAF) personnel (aged <65 years), referred for treatment between September 2006 and September 2014. Each participant completed self-report measures of demographic variables, depressive symptom severity, chronic pain, alcohol misuse, and psychotropic medication usage as part of a standard clinical intake protocol. Hierarchical ordinal logistic regression analyses were used to determine the incremental contribution of PTSD symptom clusters on sexual dysfunction.
Results
Nearly three-quarters (71.5%) of participants reported a lack of sexual desire or pleasure and 40.0% reported pain or problems during intercourse. Regression analyses suggested that avoidant/numbing symptoms were the only symptoms to be independently associated with lacking sexual desire or pleasure (AOR = 1.10; 95% CI 1.05–1.15). None of the PTSD symptom clusters were independently associated with pain or problems during intercourse.
Conclusions
Sexual dysfunction is prevalent among male treatment-seeking CAF personnel and veterans. Results suggest that PTSD symptoms are differentially associated with sexual desire or pleasure concerns. Assessing sexual function among CAF personnel and veterans seeking treatment for PTSD is critical in order to treat both conditions and improve overall functioning.
Sexual communication promotes sexual and relationship well-being. Previous research has frequently neglected couples’ communication that occurs exclusively during sexual activity, and that is specific to that sexual interaction (i.e., sexual talk). We examined associations between individualistic and mutualistic (i.e., self- and other-focused) sexual talk and sexual and relationship well-being, and the potential moderating role of perceived partner responsiveness to sexual talk (PPR). An MTurk community sample of 303 individuals (171 female) in committed relationships completed online measures assessing sexual satisfaction, sexual functioning, sexual distress, relationship satisfaction, sexual talk, and PPR. Greater mutualistic talk was associated with higher female sexual functioning, whereas greater individualistic talk was associated with lower relationship satisfaction. At higher levels of PPR, using more mutualistic talk was associated with less sexual distress and more individualistic talk was associated with greater sexual satisfaction. At lower levels of PPR, more mutualistic talk was associated with more sexual distress and more individualistic talk was linked to poorer sexual satisfaction. PPR may help buffer against the negative associations between self-focused (i.e., individualistic) sexual talk and sexual and relationship well-being, whereas other-focused (i.e., mutualistic) sexual talk may be beneficial for sexual and relationship well-being, unless a partner is perceived as very unresponsive.
Introduction:
Sexual trauma during military service is prevalent among women veterans and is associated with multiple negative physical and mental health sequelae. The high prevalence of military sexual trauma (MST), sexual harassment and assault during military service, has prompted the Veterans Health Administration to enact several policies to address the detrimental health impacts of this experience. MST also negatively impacts veterans' sexual health, yet the field lacks a systematic review of the relationship between MST and sexual health among women veterans.
Aim:
To systematically review the existing research on the impact of MST on sexual health in women veterans.
Methods:
The published literature examining MST and sexual health in women veterans prior to July 19, 2018, was reviewed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic reviews. Articles were abstracted and evaluated for risk of bias.
Main outcome measures:
6 articles were identified that met inclusion criteria; they generally evidenced a low risk of bias and thus a high quality of evidence. Results indicated that MST is associated with sexual dysfunction and low sexual satisfaction among women veterans. Other mental health concerns were also commonly comorbid with female sexual dysfunction in this population. This body of literature is small and methodologically limited by over-reliance on observational study design, use of non-validated and single-item measures of sexual health, and failure to comprehensively assess trauma history, including sexual and non-sexual trauma.
Conclusions:
Sexual dysfunction is a salient health issue for women veterans who experienced MST. Additional research is needed with improved designs, validated measures of sexual function, and comprehensive assessment of trauma to learn about the specific impact of MST on women veterans' sexual health. We present recommendations for future directions in terms of research, clinical practice, education, and policy. Pulverman CS, Christy AY, Kelly UA. Military Sexual Trauma and Sexual Health in Women Veterans: A Systematic Review. Sex Med Rev 2019;7:393-407.
Spouses of former prisoners-of-war (ex-POWs) are at risk for Posttraumatic Stress Symptoms (PTSS) and marital distress. This longitudinal study assessed the implications of PTSS and self-differentiation in sexual satisfaction among 90 ex-POWs' spouses and 75 matched combatants' spouses of the 1973 Yom-Kippur War. Standardized questionnaires were used. Ex-POWs' spouses had elevated PTSS and imbalanced self-differentiation. PTSS were associated with poorer self-differentiation and lower sexual satisfaction. Imbalanced self-differentiation mediated the association between PTSS and sexual satisfaction. The findings imply that PTSS and imbalanced self-differentiation contribute to low sexual satisfaction among spouses of primary trauma survivors.
Introduction:
Women diagnosed with female sexual interest/arousal disorder (FSIAD) report lower health-related quality of life, more depressive symptoms, and lower sexual and relationship satisfaction compared with healthy control subjects. Despite the impact of FSIAD on women's sexuality and the inherently interpersonal nature of the sexual problem, it remains unclear whether the partners of women with FSIAD also face negative consequences, as seen in other sexual dysfunctions.
Aim:
The aim of this study was to compare the sexual, relational, and psychological functioning of partners of women with FSIAD (as well as the women themselves) to their control counterparts. We also compared women with their partners within the FSIAD and control groups.
Methods:
Woman diagnosed with FSIAD and their partners (n = 97) and control couples (n = 108) independently completed measures of sexual desire, sexual distress, sexual function, sexual satisfaction, sexual communication, relationship satisfaction, depression, and anxiety.
Main outcome measure:
Main outcomes included: Sexual Desire Inventory-2; Female Sexual Distress Scale; Female Sexual Functioning Index; International Index of Erectile Functioning (IIEF), Global Measure of Sexual Satisfaction; Dyadic Sexual Communication Scale; Couple Satisfaction Index; Beck Depression Inventory-II; State-Trait Anxiety Inventory-Short Form.
Results:
Partners of women with FSIAD reported lower sexual satisfaction, poorer sexual communication, and higher sexual distress compared with control partners. Male partners of women with FSIAD reported more difficulties with orgasmic and erectile functioning and lower overall satisfaction and intercourse satisfaction on the IIEF compared with control partners. Women with FSIAD reported lower sexual desire and satisfaction, and higher sexual distress and depressive and anxiety symptoms, in comparison to both control women and their own partners, and they reported poorer sexual communication compared with control women. Women with FSIAD also reported lower sexual desire, arousal, lubrication, and satisfaction, and greater pain during intercourse on the Female Sexual Function Index compared with control women.
Clinical implications:
The partners of women with FSIAD also experience negative consequences-primarily in the domain of sexuality. Partners should be included in treatment and future research.
Strength & limitations:
This is the first study, to our knowledge, to document consequences for partners of women with FSIAD in comparison to control subjects. This study is cross-sectional, and causation cannot be inferred. Most couples were in mixed-sex relationships and identified as straight and cis-gendered; results may not generalize.
Conclusion:
Findings suggest that partners of women with FSIAD experience disruptions to many aspects of their sexual functioning, as well as lower overall sexual satisfaction and heightened sexual distress. Rosen NO, Dubé JP, Corsini-Munt S, et al. Partners Experience Consequences, Too: A Comparison of the Sexual, Relational, and Psychological Adjustment of Women with Sexual Interest/Arousal Disorder and Their Partners to Control Couples. J Sex Med 2019;16:83-95.
Background:
Impairments in sexual functioning and sexual satisfaction are very common in women who have experienced childhood sexual abuse (CSA). A growing body of literature suggests a high prevalence of sexual distress in patients with post-traumatic stress disorder (PTSD). However, the influence of sexual trauma exposure per se and the influence of PTSD symptoms on impairments in sexual functioning remain unclear.
Aim:
The aim of this study was to investigate the influence of sexual trauma exposure and PTSD on sexual functioning and sexual satisfaction by comparing 3 groups of women.
Methods:
Women with PTSD after CSA (N = 32), women with a history of CSA and/or physical abuse but without PTSD (trauma controls [TC]; N = 32), and healthy women (N = 32) were compared with regards to self-reported sexual functioning and sexual satisfaction. Trauma exposure was assessed with the Childhood Trauma Questionnaire, and PTSD was assessed with the Clinician-Administered PTSD Scale for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.
Outcomes:
Sexual functioning was assessed with the Sexual Experience and Behavior Questionnaire, and sexual satisfaction was assessed with the questionnaire Resources in Sexuality and Relationship.
Results:
PTSD patients had significantly lower sexual functioning in some aspects of sexual experience (sexual aversion, sexual pain, and sexual satisfaction) but did not significantly differ in sexual arousal and orgasm from the other 2 groups. TC and healthy women did not significantly differ from each other on the measures of sexual functioning or sexual satisfaction.
Clinical translation:
Results suggest that the development of PTSD has a greater impact on sexual functioning than does the experience of a traumatic event. This emphasizes the importance to address possible sexual distress and sexual satisfaction in women with PTSD by administering specific diagnostic instruments and by integrating specific interventions targeting sexual problems into a trauma-specific treatment.
Conclusions:
The study is the first comparing PTSD patients and TC with healthy women with regards to sexual functioning. Limitations are selection and size of the samples, the assessment of sexual functioning by self-report measures only, and lack of consideration of other potentially relevant factors influencing sexuality. The findings suggest that the experience of sexual abuse does not necessarily lead to sexual impairment, whereas comparably low levels of sexual functioning seem to be prominent in PTSD patients after CSA. Further research is needed on how to improve treatment for this patient group. Bornefeld-Ettmann P, Steil R, Lieberz KA, et al. Sexual Functioning After Childhood Abuse: The Influence of Post-Traumatic Stress Disorder and Trauma Exposure. J Sex Med 2018;XX:XXX-XXX.
Objective: College women are at risk for exposure to sexual victimization, which is a risk factor for posttraumatic stress (PTS) and sexual dysfunction. Contemporary models of female sexual functioning identify the role of distal (e.g., sexual abuse) and proximal (e.g., psychological) variables in contributing to female sexual response. This study examined whether and how PTS symptom clusters are related to specific domains of sexual functioning in a sample of sexually active college women who reported a history of sexual victimization. Method: A nonclinical sample of 108 women, recruited from a midsized university, completed online questionnaires assessing sexual victimization history, PTS symptom clusters (i.e., intrusion, avoidance, and hyperarousal), and difficulties with sexual functioning (i.e., desire, arousal, lubrication, orgasm, pain, and distress). Results: Regression analyses indicated that greater intrusive symptoms were associated with more difficulties with orgasm and higher sexual distress. Conclusion: Results confirm the importance of intrusive PTS symptoms in understanding subjective distress and orgasm difficulties in sexual assault survivors. Possible implications of these findings include the integration of trauma-focused therapy with treatment of sexual dysfunction among women with a history of sexual assault. Future research should examine prospective relationships between sexual assault exposure, PTS response, and female sexual dysfunction.
Background:
Suicide is a leading cause of premature death among military service members/veterans (SM/Vs). The Interpersonal Theory of Suicide (Joiner, 2007) proposes that higher thwarted belonging, perceived burdensomeness, and acquired capability confer increased risk for suicide. However, no studies have examined the association of sexual dysfunction, a possible component of thwarted belonging and perceived burdensomeness, with suicidal ideation. The present study explored whether sexual dysfunction was associated with suicidal ideation when accounting for mental health, demographic, and military characteristics among female SM/Vs.
Method:
Female SM/Vs (n = 710) completed an anonymous online survey assessing demographics, mental health, military characteristics, sexual dysfunction, and suicidal ideation.
Results:
One hundred fifty-nine participants (22.39%) reported suicidal ideation during the preceding two weeks. A multivariable ordinal regression adjusted for age, marital status, probable posttraumatic stress disorder (PTSD), probable depression, race/ethnicity, Army service, and deployment history. Lower sexual functioning (adjusted odds ratio [AOR] = 0.98, 95% confidence interval[CI] = 0.95-0.99), probable PTSD (AOR = 2.54, 95% CI = 1.61-4.01), and probable depression (AOR = 5.28, 95% CI = 3.34-8.34) were associated with suicidal ideation. Post-hoc analyses examined the association of suicidal ideation with specific components of sexual functioning: difficulties with sexual arousal (AOR = 0.87, 95% CI = 0.79-0.97) and sexual satisfaction (AOR = 0.85, 95% CI = 0.75-0.96) were associated with suicidal ideation.
Limitations:
Data were cross-sectional and limited to self-report.
Discussion:
Sexual dysfunction is associated with suicidal ideation, accounting for established mental health, military, and demographic characteristics among female SM/Vs. Efforts to prevent suicidal ideation in female SM/Vs may be enhanced by screening for and treating sexual dysfunction, particularly sexual arousal and satisfaction.
Introduction:
Women's sexuality is influenced by their perceptions of their bodies. Negative body appraisals have been implicated in the development and maintenance of sexual concerns in women with a history of childhood sexual abuse (CSA). The sexuality of these women is often expressed in extremes of approach and avoidant sexual tendencies, which have been related to the sexual inhibition and sexual excitation pathways of the dual control model.
Aim:
To test the influence of body esteem on the sexual excitation and inhibition responses of women with and without a history of CSA.
Methods:
One hundred thirty-nine women with CSA and 83 non-abused women reported on their abuse history, depressive symptomology, sexual response, and affective appraisals of their body.
Main Outcome Measures:
Validated self-report measurements of sexual excitation and inhibition responses (Sexual Excitation/Sexual Inhibition Inventory for Women) and body esteem (Body Esteem Scale) were administered.
Results:
Body esteem was significantly associated with sexual inhibition responses of women regardless of CSA history status but was significantly related only to the sexual excitation responses of women with a CSA history. Perceived sexual attractiveness was a unique predictor of sexual excitation in women with a history of CSA.
Conclusion:
Women with a history of CSA have lower body esteem than non-abused women, particularly in self-perceived sexual attractiveness, and these perceptions appear to influence their sexual responses by acting on the sexual excitation and inhibition response pathways.
Among individuals defined as having been sexually abused based on legal criteria, some will self-report having been abused and some will not. Yet, the empirical correlates of self-definition status are not well studied. Different definitions of abuse may lead to varying prevalence rates and contradictory findings regarding psychological outcomes. The present study examined whether, among legally defined sexual abuse survivors, identifying oneself as having experienced childhood sexual abuse (CSA) was associated with more severe abuse, negative emotional reactions toward the abuse, and current sexual reactions. A convenience sample of 1,021 French-speaking Canadians completed self-report questionnaires online. The prevalence of legally defined CSA was 21.3% in women and 19.6% in men, as compared to 7.1% in women and 3.8% in men for self-defined CSA. Among legally defined sexual abuse survivors, those who identified themselves as CSA survivors had been abused more frequently, were more likely to report a male aggressor, and more often described abuse by a parental figure than those who did not self-identify as abused. Further, self-defined CSA was associated with more negative postabuse reactions and sexual avoidance, whereas those not identifying as sexually abused were more likely to report sexual compulsion.
Sexual dysfunction is not a symptom of PTSD but is a common clinical complaint in trauma survivors with this disorder. In that there are biological parallels in the neuroendocrine processes underlying both PTSD and sexual behavior, we conducted an exploratory investigation of the relationship of PTSD and related neuroendocrine indicators with sexual dysfunction in armed service veterans. Major Depressive Disorder, highly comorbid with PTSD and sexual dysfunction, was also assessed. In veterans with PTSD, sexual problems were associated with plasma DHEA and cortisol, urinary catecholamines, and glucocorticoid sensitivity, even when controlling for the effects of comorbid depression. In a subsample analysis, testosterone levels did not distinguish PTSD or sexual dysfunction, suggesting that sexual problems reported by veterans in this sample were not the result of organic disorder. PTSD did predict higher dihydrotestosterone (DHT) levels, which were associated with sexual problems. More detailed assessment of sexual dysfunction in biologically informed studies of PTSD is warranted to clarify the relationships of PTSD symptomatology and related neurobiology with sexual dysfunction.
Women with histories of childhood sexual abuse (CSA) have higher rates of sexual difficulties, as well as high sympathetic nervous system response to sexual stimuli.
The study aims to examine whether treatment-related changes in autonomic balance, as indexed by heart rate variability (HRV), were associated with changes in sexual arousal and orgasm function.
In study 1, we measured HRV while writing a sexual essay in 42 healthy, sexually functional women without any history of sexual trauma. These data, along with demographics, were used to develop HRV norms equations. In study 2, 136 women with a history of CSA were randomized to one of three active expressive writing treatments that focused on their trauma, sexuality, or daily life (control condition). We recorded HRV while writing a sexual essay at pretreatment, posttreatment, and 2-week, and 1- and 6-month follow-ups; we also calculated the expected HRV for each participant based on the norms equations from study 1.
The main outcome measures used were HRV, Female Sexual Function Index, Sexual Satisfaction Scale-Women.
The difference between expected and observed HRV decreased over time, indicating that, posttreatment, CSA survivors displayed HRV closer to the expected HRV of a demographics-matched woman with no history of sexual trauma. Also, over time, participants whose HRV became less dysregulated showed the biggest gains in sexual arousal and orgasm function. These effects were consistent across condition.
Treatments that reduce autonomic imbalance may improve sexual well-being among CSA populations. Lorenz TK, Harte CB, and Meston CM. Changes in autonomic nervous system activity are associated with changes in sexual function in women with a history of childhood sexual abuse. J Sex Med **;**:**-**.
© 2015 International Society for Sexual Medicine.
Introduction:
The clinical observations that many Vietnam veterans complained of sexual problems after returning from active duty have led to the question of a correlation between post-traumatic stress disorder (PTSD) and sexual dysfunction (SD).
Aim:
The purpose of this review is to systematically review the current literature regarding SD in male veterans with PTSD.
Methods:
A systematic literature search, primarily in PubMed, the Cochrane database, and PsycINFO, was conducted. The keywords Sexual Dysfunction, Psychological OR Sexual Dysfunction, Physiological AND Stress Disorders, and Post-Traumatic were used. All manuscripts with relevance to the aim of the review were reviewed and considered.
Main outcome measure:
A total of 123 results were generated from the search. There were 11 publications regarding SD in veterans with PTSD included in the review.
Results:
The included studies are described in detail in the Results section. All but one study found an increased and significant prevalence of SD among male veterans with PTSD, especially erectile dysfunction and decreased sexual desire. SD increased in patients with PTSD, with a prevalence between 8.4% and 88.6%; the large prevalence range were partly the result of methodological differences. Only two studies have examined the correlation between the severity of PTSD symptoms and SD, with conflicting results. Samples were of relatively moderate size. Only a few confounding factors were accounted for in the included studies.
Conclusion:
Increasing evidence suggests a correlation between PTSD and SD, but still, relatively few studies have addressed these questions. Further investigation is needed into the correlation between PTSD and SD, preferably taking severity of PTSD symptoms into account, along with confounders such as use of psychotropic medication, somatic illness, drug and alcohol abuse, and comorbid psychiatric illness. Bentsen IL, Giraldi AGE, Kristensen E, and Andersen HS. Systematic review of sexual dysfunction among veterans with post-traumatic stress disorder. Sex Med Rev 2015;3:78-87.
Veterans with post-traumatic stress disorder (PTSD) experience high rates of sexual dysfunction. However, the topic of sexual dysfunction is often overlooked clinically and underexamined in the PTSD research literature. Clinician assessment and treatment of sexual dysfunction are particularly important for Veterans, who are at increased risk of exposure to trauma.
Review the literature regarding sexual dysfunction among Veterans with PTSD.
Review of the literature.
Sexual dysfunction, including erectile difficulties in males and vaginal pain in females, is common among Veterans with PTSD. Several underlying mechanisms may account for the overlap between PTSD and sexual dysfunction. Certain barriers may contribute to the reluctance of providers in addressing problems of sexual dysfunction in Veterans with PTSD.
With the high likelihood of sexual dysfunction among Veterans with PTSD, it is important to consider the integration of treatment strategies. Efforts to further the research on this important topic are needed. Tran JK, Dunckel G, and Teng EJ. Sexual dysfunction in veterans with post-traumatic stress disorder. J Sex Med **;**:**-**.
Published 2015. This article has been contributed to by US Government employees and their work is in the public domain in the USA.
Studies suggest that sexual self-schemas are an important cognitive mechanism in the sexual development of women with a history of childhood abuse. This literature is only beginning to explore how multiple forms of abuse (i.e., physical, emotional, and sexual), rather than sexual abuse alone, can influence the development of adult sexuality. Moreover, the extant literature has not carefully considered important factors other than the severity of the abuse that may relate to sexual self-schemas, including family environment and quality of romantic relationships. Findings from this cross-sectional study conducted on 417 heterosexual women (ages 18-25 years) suggest that family dynamics and different types of childhood abuse contribute both directly and indirectly to adult sexual function and satisfaction and that part of those effects were mediated by other factors such as sexual self-schemas and romantic relationship quality. These results, including an exploration of the direct and indirect effects, were discussed in terms of the pervasive effects of abuse on people's lives and the potential treatment targets that can be addressed when trying to reduce sexual problems in women with a history of abuse.
G*Power (Erdfelder, Faul, & Buchner, 1996) was designed as a general stand-alone power analysis program for statistical tests commonly used in social and behavioral research. G*Power 3 is a major extension of, and improvement over, the previous versions. It runs on widely used computer platforms (i.e., Windows XP, Windows Vista, and Mac OS X 10.4) and covers many different statistical tests of the t, F, and chi2 test families. In addition, it includes power analyses for z tests and some exact tests. G*Power 3 provides improved effect size calculators and graphic options, supports both distribution-based and design-based input modes, and offers all types of power analyses in which users might be interested. Like its predecessors, G*Power 3 is free.
The DSM-5, published in May of 2013, created new changes in the sexual dysfunctions chapter in an attempt to correct, expand and clarify the different diagnoses and their respective criteria. Although many of the changes are subtle, some are noteworthy: gender-specific sexual dysfunctions were added, and female disorders of desire and arousal were amalgamated into a single diagnosis called “female sexual interest/arousal disorder”. Many of the diagnostic criteria were updated for increased precision: for instance, almost all DSM-5 sexual dysfunction diagnoses now require a minimum duration of 6 months as well as a frequency of 75%-100%. The purpose of this article is to present and explain the changes that were introduced to the nomenclature and diagnostic criteria of sexual dysfunctions in the DSM-5.
We consider Facebook’s utility for subject recruitment in social-science survey experiments, highlighting in its potential - particularly relative to MTurk (Berinsky et al. 2012) - to spur research outside the US, and on targeted demographic groups inside the US. We then assess the external and internal validity of experiments performed on subjects from three different pools of Brazilian respondents: a national probability sample, an in-person convenience sample of university students, and an on-line convenience sample recruited via Facebook. As with US samples recruited via MTurk, our Facebook sample was more representative than a college student sample but less representative than a national sample. However, to the extent representativeness is a concern in experimental research, Facebook’s vast user base offers the possibility of post-stratification, something unlikely using MTurk. Facebook also offers the prospect of demographic targeting almost anywhere in the world, an ability to rapidly generate large samples, ease in obtaining meta-statistics, and relatively low cost per respondent. Most importantly, subjects recruited via Facebook entail little loss in terms of internal validity.
Childhood sexual abuse (CSA) has been associated with a number of long-term negative consequences, including depression, anxiety and psychosomatic symptomology. Sexual trauma has also been linked to problematic sexual functioning and sexual behaviour in adulthood. This paper critically evaluates the current literature on CSA and adult sexuality and identifies the main sexual difficulties experienced by women with a history of CSA. The authors also present a preliminary theoretical model of the association between CSA and problematic sexual outcome. This model takes into consideration literature that directly critiques previous models of association and identifies important factors that have not adequately been accounted for in the reviewed literature.
The New View recognizes that people may be dissatisfied with any emotional, physical or relational aspect of sexual experience and thus invites men and women with abuse histories to discuss sexual issues that are distressing. There are numerous pathways by which child sexual abuse (CSA) can lead to sexual dissatisfaction in adulthood. In addition to those outlined by learning theory and trauma formulations, the New View adds several important and hitherto neglected paths: anxiety about being `normal' or living up to perceived cultural standards, power imbalance in the sexual relationship, stress (because of the consequences of low socioeconomic status), and limited access to both quality health care and sexual information. Assessment of both sexual difficulties and treatment must address these kinds of economic, social and relational factors. How the New View contributes to our ability to understand and treat the sexual concerns of men and women with histories of childhood sexual abuse will be presented in this article and illustrated with clinical case material.
Psychopathologies such as posttraumatic stress disorder are often proposed as mediators of the sexual arousal dysfunction experienced by women with a history of childhood maltreatment. However, posttraumatic stress disorder symptoms are only part of the difficulties experienced by these women. Other factors to consider include negative affectivity and perceived daily stress. To assess the mediating role of posttraumatic stress disorder symptoms, negative affectivity, and perceived daily stress, we collected data from 62 women with and without a history of childhood maltreatment (sexual, physical and emotional abuse). A comprehensive assessment of sexual arousal functioning and sexual responses was obtained using self-reported measures and psychophysiological measures of vaginal engorgement and subjective sexual arousal during exposure to sexual visual stimuli. The model assessed the simultaneous mediating effect of posttraumatic stress disorder symptoms, negative affectivity and perceived daily stress on the relation between childhood maltreatment and sexual variables. Daily stress, showed a significant and stronger mediation effect on sexual arousal functioning as compared to posttraumatic stress disorder and negative affectivity. These findings suggest that daily stress may be an important mechanism to consider when treating sexual arousal functioning in women who have a history of childhood maltreatment.
Introduction. A distress criterion was added to the diagnostic criteria of sexual dysfunctions in Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV; 1994). This decision was neither based on empirical evidence, nor on an open, academic, or public debate about its necessity. As a result, this decision has been disputed ever since the publication of DSM-IV.
Aim. In this article, the necessity to include or exclude the distress criterion from the diagnostic criteria of sexual dysfunctions is critically evaluated, illustrating its consequences for both sex research and clinical practice.
Methods. Apart from careful reading of relevant sections in DSM-II, DSM-III, DSM-IV, DSM-IV Text Revision, and articles about and online proposals for DSM-5, an extensive PubMed literature search was performed including words as “sexual dysfunction”/“sexual difficulty”/“sexual disorder,”“distress”/“clinical significance,”“diagnostic criteria,” and “DSM”/“Diagnostic and statistical manual of mental disorders.” Based on analysis of the references of the retrieved works, more relevant articles were also found.
Main Outcome Measures. Arguments for or against removal of distress from the diagnostic criteria of sexual dysfunctions by former and current members of the DSM Task Force and Work Group on Sexual Disorders, as well as by other authors in the field of sex research, are reviewed and critically assessed.
Results. Proponents and opponents of including the distress criterion in the diagnostic criteria of sexual dysfunctions appear to be unresponsive to each others' arguments. To prevent the debate from becoming an endlessly repetitive discussion, it is first necessary to acknowledge that this is a philosophical debate about the nature, function, and goals of the diagnosis of a sexual dysfunction.
Conclusions. Given the current lack of data supporting either the retention or removal of the distress criterion, distress should always be taken into account in future research on sexual dysfunctions. Such forthcoming data should increase our understanding of the association between distress and sexual difficulties. Hendrickx L, Gijs L, and Enzlin P. Distress, sexual dysfunctions, and DSM: Dialogue at cross purposes? J Sex Med 2013;10:630–641.
Research studies have provided increasing evidence for the potential adverse impact of child sexual abuse on women's sexual health. The present study examined the association between child sexual abuse and sexual health while controlling for various forms of childhood victimization. Self-report questionnaires were administered to 889 young women from the province of Quebec. Results suggest that child sexual abuse survivors were more likely to report having experienced other forms of childhood victimization than were women without child sexual abuse. Women with a history of both child sexual abuse and multiple forms of victimization were at greater risk of experiencing more adverse outcomes, including risky sexual behaviors, sexual problems, and negative sexual self-concept. Regression analyses revealed that child sexual abuse was significantly related to indicators of sexual health outcomes even when controlling for the effect of single forms of victimization. Clinically, interventions optimizing sexual health may be particularly helpful for a subgroup of child sexual abuse survivors.
Introduction. The recent availability of noninvasive pharmacological remedies for male sexual function triggered an exponential increase in the number of men requesting help in the sexuality area.
Aim. The Italian Society of Andrology explored requests for help, not included in formerly established clinical categories of sexual medicine.
Methods. A central board of 67 andrologists identified new areas of requests for help, instrumental for a web-based questionnaire, forwarded to 912 members of the Italian Society of Andrology. Results were submitted to an independent consensus development panel.
Main Outcome Measures. A questionnaire response rate of 30.8% was considered acceptable according to standard response rates of medical specialist samples.
Results. The Central Board interaction identified two new domains of requests for help: sexual distress and unconventional requests for pro-erectile medications. Web-based questionnaire results suggested that such domains account for 29% and 9% respectively of all requests for help already presented by male patients at sexual medicine clinics. The Independent Consensus Development Panel issued a final consensus document; herewith, the statement defining male sexual distress: A non-transitory condition and/or feeling of inadequacy such as to impair “sexual health” (WHO working definition). Inadequacy can originate both from physiological modifications of male sexual functions, and from diseases, dysfunctions, dysfunctional symptoms and dysmorphisms, both of andrological and non-andrological origin, which do not relate to “erectile dysfunction” (NIH Consensus Development Panel definition), but that might also induce erectile dysfunction. Sexual Distress can lead to a request for help which needs to be acknowledged.
Conclusion. The Italian Society of Andrology identified two new areas of requests for help concerning male sexual issues: sexual distress and unconventional requests for pro-erectile medications. These domains, which do not represent new diseases, nonetheless induce the sufferers to seek help and, accordingly, need to be acknowledged. Pescatori ES, Giammusso B, Piubello G, Gentile V, and Pirozzi Farina F. Journey into the realm of requests for help presented to sexual medicine specialists: Introducing male sexual distress. J Sex Med 2007;4:762–770.
Little attention has been given to the occurrence of dissociative symptoms during sexual behavior in adults who have experienced childhood sexual abuse (CSA). For this study, 57 adults living with HIV infection who had experienced CSA and were entering a treatment study for traumatic stress completed study assessments and clinical interviews, including a 15-item scale of dissociative experiences during sexual behavior. Predictor variables included Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision diagnoses of posttraumatic stress disorder (PTSD) and dissociative disorders, rape by an intimate partner, duration of CSA, number of perpetrators of CSA, and current sexual satisfaction. A multiple regression analysis was conducted to identify significant associations between predictors and dissociation during sex. Mean differences by clinical diagnosis were also examined. Results indicated that PTSD, dissociative disorders, rape by an intimate partner, duration of CSA, and number of perpetrators of CSA were associated with increased dissociation during sexual behavior. Dissociation during sex likely increases vulnerability to sexual revictimization and risky sexual behavior. Standard behavioral prevention interventions may be ineffective for sexual situations when dissociation occurs, and prevention efforts should be integrated with mental health care for those who have experienced CSA.