Longitudinal associations between relational and sexual well-being in couples transitioning to parenthood

There is limited understanding of the dynamic between relational and sexual well-being as couples adjust to new parenthood, despite this being a vulnerable period for couples' relationships. This study was aimed at examining the bidirectional links between relationship quality and sexual well-being (i.e., sexual satisfaction, sexual distress) across the transition to parenthood. We assessed new parent couples (N = 257) across four time points (two prenatal) from mid-pregnancy through 6 months postpartum. Parallel dyadic latent growth curve modeling was employed to examine the associations between trajectories of perceived relationship quality, sexual satisfaction, and sexual distress. New parents' declines in relationship quality were associated with declines in own and partners' sexual satisfaction and with increases in own sexual distress. Mothers' prenatal relationship quality and sexual distress predicted subsequent changes in own sexual distress and fathers' relationship quality, respectively. Results indicate that changes to new parents' relational and sexual well-being mutually influence each other over time. Current results indicate that the impact of the transition on couples' relationships is partly determined by own and partners' prenatal factors, to which clinicians and researchers can attend to early on. Cross-domain links between relational and sexual well-being should be considered in research and clinical practice.

Few Differences in Sexual Talk by Gender/Sex and Dyad Type: A Retrospective and Daily Diary Study with Couples

Sexual talk is a type of verbal communication that occurs exclusively during sexual activity and that is specific to the sexual activity itself. Previous research has identified two types of sexual talk: individualistic (i.e., self-focused) and mutualistic (i.e., sharing/partner-focused), which have generally been linked to greater sexual and relationship well-being. Whether sexual talk use varies by gender/sex (i.e., men, women, gender/sex diverse individuals; GSD) or dyad type (i.e., same- vs. mixed-gender/sex) has not been examined. Given initial evidence that the types of sexual talk may contribute differently to sexual and relationship well-being, it is important to identify factors (e.g., gender/sex) that may be associated with the amount of sexual talk used. We examined differences by gender/sex and dyad type in the average sexual talk use among long-term couples (N = 229; 69 same-gender/sex) using retrospective cross-sectional dyadic data. We also examined these differences in the same sample (N = 217) using a 35-day dyadic daily diary study. Retrospectively, but not daily, women reported using more mutualistic talk than men, especially when partnered with a woman. There were no significant gender/sex or dyad type differences in use of individualistic talk retrospectively or daily. Exploratory analyses with the GSD couples suggested that there may be gender/sex and dyad type differences retrospectively and daily, for individualistic and not mutualistic talk; however, these analyses must be interpreted with caution due to the small subsample size of GSD couples.

Sexual communication mediates cognitive-behavioral couple therapy outcomes: A randomized clinical trial for provoked vestibulodynia

Provoked vestibulodynia (PVD) is a chronic vulvovaginal pain condition affecting 8%-10% of women and is associated with negative sexual sequalae. Our randomized clinical trial comparing cognitive-behavioral couple therapy (CBCT) to a medical intervention (lidocaine) found that both treatments improved affected women's pain and both affected women's and partners' sexual outcomes, with CBCT demonstrating more benefits (Bergeron et al., 2021). The goal of this study was to examine two putative mediators of CBCT's treatment effects: collaborative and negative sexual communication patterns (SCPs). Women with PVD and their partners were randomly assigned to 12 weeks of CBCT (N = 53) or lidocaine (N = 55). Outcome measures (sexual satisfaction, function, and distress) were collected at pre-treatment, post-treatment, and 6-month follow-up, and in-treatment measures of the mediators were taken at Weeks 1, 4, 8, and 12 of treatment. Results showed that affected women's reports of improving collaborative communication mediated the effect of CBCT, but not lidocaine, on post-treatment sexual satisfaction (women with PVD and partners), sexual function (women with PVD), and sexual distress (women with PVD). For partners, collaborative communication improved equally in both treatments. Given that there were no differences in negative SCPs between the CBCT and lidocaine conditions, it was not possible to examine negative communication as a potential mediator. From the perspective of women with PVD, CBCT helped couples communicate about their sexual problems in more collaborative ways, which was in turn beneficial for improving the sexual well-being of both members of the couple. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Will you be happy for me? Associations between self-reported, perceived, and observed responses to positive events and sexual well-being in cohabiting couples

Whereas greater levels of intimacy have been shown to promote couples' sexual well-being, recent theories suggest that satisfying sex is maintained via the capacity to encourage the partner's individuality, while remaining intimately connected. Responses to capitalization attempts (i.e., the disclosure of a positive personal event) provide an opportunity to strengthen both the couple's intimacy and each partner's autonomy. Although responses to capitalization attempts are linked to couples' greater relationship adjustment, very little is known about their relation to couples' sexual well-being. The aim of this study was to examine the associations between self-reported, perceived, and observed responses to capitalization attempts and sexual satisfaction, sexual distress, and sexual function in 151 cohabiting couples who participated in a filmed discussion in the laboratory. They also completed self-report questionnaires pertaining to their responsiveness and to that of the partner during the discussion, as well as their sexual well-being. Results indicated that one's higher levels of self-reported and partner-perceived active-constructive responses (enthusiasm/elaboration) during the discussion were associated with one's own greater sexual satisfaction. Higher levels of perceived passive-constructive responses (quiet but interested) from one's partner were associated with one's own lower sexual satisfaction, and one's higher levels of self-reported and perceived passive-destructive responses (lack of interest/self-focus) were associated with one's own greater sexual distress. Finally, higher levels of observed active-destructive responses (undermines/denies the positive nature of the event) were associated with one's own lower sexual function, while in women, they were associated with their lower sexual satisfaction. Findings contribute to a growing body of literature underscoring the importance of intimacy for sexual well-being in long-term relationships.

A Longitudinal Investigation of Couples' Sexual Growth and Destiny Beliefs in the Transition to Parenthood

Beliefs about sexuality tend to become more salient during sexual challenges and are associated with how individuals respond to these difficulties and, in turn, their sexual well-being. The transition to parenthood is marked by significant changes to couples' sexuality. As such, this period of vulnerability may be an important context in which these beliefs impact how couples manage sexual stressors and may have implications for their sexual well-being. In a longitudinal dyadic study, we examined whether couples' sexual growth beliefs (e.g., beliefs that sexual problems can be resolved through effort) and sexual destiny beliefs (e.g., beliefs that sexual problems reflect incompatibility with their partner) correspond with changes to various facets of couples' sexual well-being over time. First-time parent couples (N = 203) completed online surveys assessing these beliefs in pregnancy (32 weeks) and measures of sexual well-being (satisfaction, desire, and distress) in pregnancy (20 and 32 weeks) and across the postpartum period (3, 6, 9, 12 months). Dyadic latent growth curve models showed that expectant mothers who reported stronger sexual destiny beliefs in pregnancy reported higher sexual distress and lower sexual satisfaction at 3 months postpartum. When partners reported stronger sexual destiny beliefs in pregnancy, both they and new mothers reported greater sexual desire at 3 months postpartum. Unexpectedly, partners' higher sexual growth beliefs in pregnancy predicted mothers' lower sexual desire at 3 months postpartum. Sexual growth and destiny beliefs were not associated with change in couples' sexual well-being beyond 3 months postpartum. Findings shed light on the potential benefits and costs of sexual growth and destiny beliefs for couples' sexual well-being early in the postpartum period, but not over time.

Attachment and Childhood Maltreatment as Moderators of Treatment Outcome in a Randomized Clinical Trial for Provoked Vestibulodynia

BACKGROUND

Although distal developmental factors, such as attachment and childhood maltreatment (CM), are associated with the occurrence, severity, and adjustment to provoked vestibulodynia (PVD)-the most prevalent form of vulvodynia-no studies to date have examined whether these variables are related to treatment efficacy in the context of PVD. Attachment and CM may act as moderating variables when examining different treatment modalities, whereby individuals with more insecure attachment orientations (anxiety/avoidance) or a history of CM may benefit less from treatments with higher interpersonal contexts, such as sex and couple therapy-a recommended treatment for PVD.

AIM

The present randomized clinical trial (RCT) examined attachment and CM as predictors and moderators of sexual satisfaction, distress, and function at post-treatment and 6-month follow-up while comparing 2 treatments for PVD: Topical lidocaine, and a novel cognitive behavioral couple therapy focused on women's pain and partners' sexuality.

METHODS

One hundred eight women with PVD were randomized to a 12-week treatment of either lidocaine or couple therapy. Women completed questionnaires at pretreatment, post-treatment, and at a 6-month follow-up.

OUTCOMES

(1) Global Measure of Sexual Satisfaction; (2) Female Sexual Distress Scale-Revised; (3) Female Sexual Function Index.

RESULTS

Both attachment and CM were significant moderators of treatment outcomes. At either post-treatment or 6-month follow-up, in the couple therapy condition, women with greater attachment avoidance had poorer outcomes on sexual distress, satisfaction and function, whereas women with higher levels of CM had poorer outcomes on sexual satisfaction and sexual function, compared to women in the lidocaine condition.

CLINICAL IMPLICATIONS

Although these novel findings need further replication, they highlight the importance for clinicians to take into account distal factors, for instance, attachment and CM, when treating sexual difficulties such as PVD, as these variables may affect more interpersonal dimensions of treatment (eg, trust, compliance, etc.) and ultimately, treatment progress.

STRENGTHS & LIMITATIONS

Using a rigorous RCT study design and statistical approach, this study is the first to examine attachment and CM as moderators in the treatment of sexual difficulties. It is however limited by the use of self-report measures, and further studies are necessary to validate the generalizability of current results to other sexual difficulties.

CONCLUSION

Findings support the role of interpersonal factors in the treatment of PVD and indicate that short-term psychological interventions, such as couple therapy, may be less beneficial for women with antecedents of CM and attachment insecurity. V Charbonneau-Lefebvre, M-P Vaillancourt-Morel, NO Rosen, et al. Attachment and Childhood Maltreatment as Moderators of Treatment Outcome in a Randomized Clinical Trial for Provoked Vestibulodynia. J Sex Med 2022;19:479-495.

A Longitudinal Examination of Common Dyadic Coping and Sexual Distress in New Parent Couples during the Transition to Parenthood

New parents experience significant disruption to their sexual relationships such as lower desire and sexual frequency relative to prepregnancy. Little is known about the sexual distress new parents feel related to these changes, how sexual distress evolves over time, or how coping with stress relates to this distress. New parent couples who engage in more adaptive, joint coping with mutual stressors-common dyadic coping (CDC)-may be better able to manage distress related to their sexuality and thus, experience less sexual distress at 3-months postpartum and experience more marked improvement over time. In 99 first-time parent couples, we examined the link between CDC measured at 3-months postpartum and trajectories of sexual distress across 3-, 6-, and 12-months postpartum. Analyses used dyadic latent growth curve modeling informed by the actor-partner interdependence model. Mothers' sexual distress at 3-months postpartum was clinically elevated and higher than their partner's. Mothers' sexual distress declined significantly over time, whereas partners' sexual distress remained low and stable. An individual's higher perceptions of CDC was significantly associated with their own (but not their partner's) lower sexual distress at 3-months postpartum. No significant associations were found between CDC and change in sexual distress over time. How new parents jointly cope with stressors early in the postpartum period may lessen the distress they have about their sexuality at a time when most couples have just resumed sexual activity. Results identify CDC as a possible novel target for interventions aimed at helping couples manage sexual distress during the transition to parenthood.

Is Expectant Couples' Similarity in Attitudes to Sex during Pregnancy Linked to Their Sexual Well-being? A Dyadic Study with Response Surface Analysis

Despite sexual activity being safe for the majority of expectant couples (i.e., the pregnant individual and their partner), negative attitudes toward having sex during pregnancy are common and are related to lower sexual well-being across this vulnerable life period. Using dyadic response surface analysis in a sample of 254 first-time expectant couples, we examined the degree to which expectant partners demonstrated similar versus dissimilar attitudes to sex during pregnancy and whether specific patterns of couples' similarity in attitudes may uniquely contribute to their sexual satisfaction and sexual distress. Couples' more positive attitudes (i.e., the more both partners perceived sexual activity as non-threatening to their pregnancy), rather than partners' similarity in attitudes, were associated with lower sexual distress for both partners and higher sexual satisfaction for male partners. In couples where partners held more dissimilar attitudes, men demonstrated greater distress when their female partner's attitudes were more positive than their own. To promote sexual well-being during pregnancy, interventions should assist couples to attain stronger positive attitudes to sex during pregnancy by targeting concerns about sex in both expectant partners.

Longitudinal Associations between Depressive Symptoms and Postpartum Sexual Concerns Among First-time Parent Couples

Most first-time parents experience novel concerns about their sexuality such as worries about the effects of labor and delivery on their sex lives. The link between postpartum depressive symptoms and problems with sexual function is bidirectional; however, associations with postpartum sexual concerns (i.e., worries about one's sexuality that are not necessarily related to sexual function) have not been examined. First-time parent couples (N = 99) completed measures assessing their postpartum sexual concerns and depressive symptoms at 3, 6, and 12 months postpartum. Dyadic latent growth curve modeling revealed that mothers' and partners' initial frequencies of postpartum sexual concerns were positively associated, with significant declines in the frequency of these concerns over time for both partners. Mothers' and partners' initial depressive symptoms were also positively associated; however, mothers' depressive symptoms did not change over time whereas partner's depressive symptoms worsened. Mothers' and partners' higher initial depressive symptoms were associated with partners' higher frequency of postpartum sexual concerns. Mothers' depressive symptoms at 3 months postpartum and the degree to which these symptoms changed over time were associated with a steeper decline in partners' postpartum sexual concerns over time. Results provide preliminary support for depressive symptoms as a risk factor for partners' postpartum sexual concerns.

Comparing Self-Reported Pain During Intercourse and Pain During a Standardized Gynecological Exam at 12- and 24-Month Postpartum

BACKGROUND

There is limited information about the physical indicators and biopsychosocial predictors of self-reported pain during intercourse and pain during a gynecological examination at 12- and 24-month following childbirth.

AIM

This longitudinal study aimed to (i) Compare the findings from gynecological exams at 12- and 24-month postpartum for women with minimal vs clinically significant pain during intercourse; (ii) Assess the biomedical and psychosocial correlates of self-reported pain during intercourse and the vestibular pain index (VPI) from the cotton-swab test at 12- and 24-month postpartum; (iii) Establish the relationship between self-reported pain during intercourse and the cotton-swab test.

METHODS

Women (N = 97 at 12 months postpartum and N = 44 at 24-month postpartum) recruited from a local women's hospital completed online surveys in their first trimester of pregnancy and at 12- and 24-month postpartum to assess pain during intercourse and biopsychosocial variables. Those with clinically significant (pain ≥4/10 on a visual analogue scale) were matched with those reporting minimal pain (pain <3/10) and underwent a gynecological exam including a cotton-swab test. Descriptive analyses, multiple regressions, and bivariate correlations were conducted to address each of the study aims, respectively.

MAIN OUTCOME MEASURES

(i) Findings from the gynecological examination (ii) Numerical rating scale for the VPI; (iii) Visual analogue scale of pain during intercourse.

RESULTS

The majority of women in both pain groups had normal physical findings in the gynecological exam. Greater sexual distress and pain catastrophizing at 12- and 24-month postpartum were significantly associated with greater pain during intercourse at each time-point, respectively. Greater pain catastrophizing at 12 months postpartum was significantly associated with greater pain during the cotton-swab test at that time-point. Lower relationship satisfaction at 12 months postpartum was associated with greater VPI ratings at 24 months postpartum. Pain during intercourse and the VPI were moderately and positively correlated.

CLINICAL IMPLICATIONS

Addressing psychosocial variables may interrupt the maintenance of postpartum pain. Following an initial assessment, self-reported pain intensity may be a suitable proxy for repeated examinations.

STRENGTHS & LIMITATIONS

This study is the first to describe the physical findings and psychosocial predictors of pain during intercourse and the VPI at 12- and 24-month postpartum. The homogenous and small sample may limit generalizability.

CONCLUSION

There were no observable physical indicators of clinically significant postpartum pain during intercourse. Psychosocial variables were linked to women's greater postpartum pain during intercourse and VPI ratings.

Navigating Women's Low Desire: Sexual Growth and Destiny Beliefs and Couples' Well-Being

People's beliefs about how to maintain sexual satisfaction have been associated with how they navigate sexual differences, but research has yet to explore the consequences of these beliefs for couples facing a distressing sexual issue. The current research extends past work on sexual growth beliefs (i.e., the view that sexual satisfaction requires continuous effort to maintain) and sexual destiny beliefs (i.e., the view that sexual satisfaction is the result of natural sexual compatibility with a partner) to couples for whom these beliefs might be especially consequential - those coping with sexual dysfunction. In a dyadic longitudinal study of 97 couples coping with women's clinically significant low desire and arousal, we tested how sexual growth and destiny beliefs are associated with sexual, relationship, and personal well-being. We found that endorsing greater sexual growth beliefs was associated with higher sexual desire for both partners, whereas, with some exceptions, endorsing greater sexual destiny beliefs was linked to lower sexual desire and relationship satisfaction, more conflict, and more depressive and anxious symptoms. However, these effects did not persist one year later. Our findings highlight the implications of sexual growth and destiny beliefs for both couple members when navigating a chronic sexual difficulty.

Discrepancy in Dyadic Sexual Desire Predicts Sexual Distress over Time in a Community Sample of Committed Couples: A Daily Diary and Longitudinal Study

In long-term relationships, sexual desire discrepancy (SDD) occurs frequently between partners. For many, this discrepancy is persistent and significant, and a source of distress. However, the dynamics of SDD in couples and, specifically, its implications for sexual distress have received scant empirical attention. This study examined the associations between SDD and sexual distress from one day to the next and over a 12-month span, in a community sample of 229 same-sex/gender and mixed-sex/gender couples. Two datasets were collected: A 35-day daily diary and a 12-month longitudinal survey. In both, dyadic sexual desire and sexual distress were measured, and SDD was calculated as the absolute value of the difference in sexual desire between partners. Directional associations between SDD at one time point and sexual distress at the next time point were assessed using multilevel, 2-pane autoregressive cross-lagged models, controlling for within-variable changes, dependencies between partners, and partner age. Results were consistent with the study's hypotheses: Couples' SDD on one day predicted sexual distress on the next day. Similarly, SDD at baseline predicted sexual distress 12 months later. Participant gender, partner gender, and couple type did not significantly moderate these associations, nor did differentiating partners based on higher and lower average sexual desire. The reverse associations (i.e., sexual distress predicting SDD) were non-significant. The associations' directionality and the fact that they remained significant over days and months were consistent with the proposal that SDD is a precursor of sexual distress. The present study provides support for dyadic conceptualizations of sexual desire. Clinically, findings suggest that therapeutic approaches should address issues with sexual desire and sexual distress by focusing not on the individual, but on the couple.

Predictors and Moderators of Provoked Vestibulodynia Treatment Outcome Following a Randomized Trial Comparing Cognitive-Behavioral Couple Therapy to Overnight Lidocaine

Provoked vestibulodynia is a vulvar pain condition causing sexual dysfunction, affecting 8% to 10% of women. Our recently published randomized clinical trial (N = 108 couples) found that cognitive behavioral couple therapy (CBCT) and topical lidocaine reduced women's pain and associated sexual symptoms, with CBCT showing more benefits. Little is known about pretreatment predictors of treatment outcomes in couples sex therapy. In the current study, we examined women and their partners' pretreatment demographic (age, relationship length), clinical (pain duration, anxiety) and interpersonal (partner responses to pain, sexual goals) predictors/moderators of women's pain intensity, pain unpleasantness, and sexual function at posttreatment and 6-month follow-up. Longer relationship duration, lower anxiety in women, partner higher solicitousness and partner higher approach sexual goals predicted better pain outcomes for women with PVD irrespective of treatment condition. CBCT was more effective than lidocaine for improving women's sexual function at posttreatment when, at pretreatment, women had partners with higher anxiety and women reported lower approach sexual goals, whereas lidocaine was more effective for improving women's sexual function at follow-up when partners had higher approach sexual goals. Findings can assist clinicians in determining what treatment will be most beneficial for whom.

Sexual Function and Satisfaction in Couples with Infertility: A Closer Look at the Role of Personal and Relational Characteristics

BACKGROUND

Research to date suggests that couples undergoing assisted reproductive technology (ART) are at a high risk of experiencing sexual difficulties.

AIM

This dyadic cross-sectional study aimed to provide a better understanding of the infertility-specific personal (ie, emotional, mind-body) and relational stressors associated with the sexual desire, orgasm, arousal, and sexual satisfaction of infertile couples seeking ART.

METHODS

The sample included 185 mixed-sex infertile couples seeking ART. Participants completed online the Fertility Quality of Life tool and either the Female Sexual Function Index or the International Index of Erectile Function. Data were analyzed using path analyses based on the Actor-Partner Interdependence Model.

OUTCOMES

Individuals' own and their partners' sexual function (desire, orgasm, arousal domains) and sexual satisfaction.

RESULTS

For men and women, infertility-related emotional stressors were associated with their own and their partner's lower sexual desire. For women, experiencing greater infertility-related emotional stressors was also associated with their partner's lower sexual satisfaction. While experiencing greater infertility-related mind-body stressors was not associated with men and women's own sexual desire, arousal, orgasm, and satisfaction, for women, it was associated with their partner's lower sexual arousal. Lastly, for men and women, infertility-related relational stressors were associated with their own lower sexual arousal, as well as with their own and their partner's lower sexual satisfaction. For women, experiencing greater relational stressors was also associated with their own lower sexual desire and orgasm.

CLINICAL IMPLICATIONS

Interventions addressing the emotional, mind-body, and relational spheres of infertile couples seeking ART may help facilitate improvements in sexual function and satisfaction and better serve their needs.

STRENGTHS & LIMITATIONS

This study included a large sample of couples. Our sample was heterogeneous with regards to couples' cause of infertility and treatment stage. The use of an infertility-related measure allowed us to better capture personal and relational stressors specific to couples seeking ART. Given the cross-sectional design of our study, causality between infertility-related stressors and sexual function and satisfaction cannot be inferred. Our sample included predominantly White, mixed-sex individuals with a high level of education, which may reduce the generalizability of our findings.

CONCLUSION

Couples' subjective experience of infertility and treatment (personal and relational stressors) seems to be strongly associated with their sexual health, allowing us to identify potential targets of intervention with couples seeking ART. S.E. Amiri, A Brassard, N.O. Rosen, et al. Sexual Function and Satisfaction in Couples with Infertility: A Closer Look at the Role of Personal and Relational Characteristics. J Sex Med 2021;18:1984-1997.

Associations Between Postpartum Depressive Symptoms and Couples' Sexual Function and Sexual Distress Trajectories Across the Transition to Parenthood

BACKGROUND

The transition to parenthood is associated with changes to new parents' mood and sexual health. Sexual dysfunction-problems with sexual function accompanied by sexual distress (i.e., worries and concerns about one's sex life)-is linked to poorer overall health, yet few studies have examined how sexual dysfunction unfolds for couples during this transition. Postpartum depression is a risk factor for sexual dysfunction; however, the association between depressive symptoms and how postpartum sexual dysfunction evolves has not been examined.

PURPOSE

To establish trajectories of sexual function and sexual distress for mothers and partners and to examine if postpartum depressive symptoms were associated with these trajectories.

METHODS

Data were collected from 203 first-time parent couples from midpregnancy until 12-months postpartum. Sexual function and sexual distress were assessed at six time points (two prenatal) and depressive symptoms were assessed at 3-months postpartum.

RESULTS

Dyadic latent piece-wise growth curve models revealed significant declines in mothers' and partners' sexual function between pregnancy and 3-months postpartum and significant improvements from 3- to 12-months postpartum. Mothers' sexual distress increased between pregnancy and 3-months postpartum and decreased thereafter, whereas partner's sexual distress remained stable. Depressive symptoms were associated with poorer sexual function and higher sexual distress at 3-months postpartum for both partners but did not predict change over time.

CONCLUSIONS

Mothers and their partners experience changes to their sexual function during the transition to parenthood; however, mothers are at greater risk of sexual dysfunction. Depressive symptoms are a risk factor for poorer sexual health at 3-months postpartum for both parents.

Perceived partner responsiveness is associated with sexual well-being in couples with genito-pelvic pain

Intimacy is vital to romantic relationships, yet is often thwarted by relational challenges, such as sexual difficulties. With prevalence estimates ranging from 10% to 28%, genito-pelvic pain/penetration disorder (GPPPD) is an important sexual problem resulting in negative consequences for affected women and their partners, including significant sexual dysfunction and dissatisfaction. Findings from cross-sectional studies indicate that higher levels of intimacy are associated with better sexuality outcomes in couples coping with GPPPD. However, single-occasion measurements may not capture the daily variations in intimacy that could have important implications for couples' sexual well-being. The present study focused on a key intimacy-building component-perceived partner responsiveness (PPR)-and its daily associations with women's pain and both partners' sexual function and satisfaction. Using daily diaries over an 8-week period, 160 women (M_age = 26.23, SD = 6.26) with GPPPD and their partners (M_age = 27.73, SD = 7.35) reported on PPR, sexual function and satisfaction, as well as women's pain, on days when sexual activity occurred (M = 8.87, SD = 5.87). Drawing on the Actor-Partner Interdependence Model, a multivariate multilevel modeling approach was adopted. Controlling for trait-level PPR, when women and partners reported greater PPR, women reported greater sexual function and satisfaction and partners reported greater sexual function. When partners reported greater PPR, they reported greater sexual satisfaction. No association was found between PPR and women's pain. PPR may facilitate better sexual function and satisfaction and could be an important target in sex and couple therapy for GPPPD. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Cognitive-behavioral couple therapy versus lidocaine for provoked vestibulodynia: A randomized clinical trial

OBJECTIVE

This randomized clinical trial compared a novel cognitive-behavioral couple therapy (CBCT) and topical lidocaine for provoked vestibulodynia.

METHOD

Participants were 108 women (M age = 27.06) and their partners randomized to one of two treatments and assessed at pre- and post-treatment and 6-month follow-up via questionnaires pertaining to the primary outcomes of women's pain (numerical rating scales of pain intensity and unpleasantness), and secondary outcomes of pain anxiety (Pain Anxiety Symptoms Scale), both partners' sexual function (Female Sexual Function Index; International Index of Erectile Function), sexual distress (Female Sexual Distress Scale Revised), pain-related psychological distress (Pain Catastrophizing Scale), treatment satisfaction, and global ratings of improvements in pain and sexuality.

RESULTS

Intent-to-treat multilevel analyses showed that for women, CBCT yielded significantly more improvements than lidocaine in pain unpleasantness at 6-month follow-up, pain anxiety and pain catastrophizing at post-treatment and 6-month follow-up, and sexual distress at post-treatment, and resulted in better treatment satisfaction and global sexuality improvements at both time points. Partners significantly improved in their sexual function, sexual distress, and pain catastrophizing from pre- to post-treatment and pre-treatment to 6-month follow-up, with no significant group differences. Partners in the CBCT condition reported significantly greater treatment satisfaction at both time points, and greater sexuality improvements at post-treatment.

CONCLUSIONS

CBCT yielded better outcomes on more dimensions of provoked vestibulodynia than lidocaine. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Trajectories of sexual well-being among couples in the transition to parenthood

Sexual well-being is an important contributor to romantic relationship quality, health, and quality of life, yet couples face significant disruptions to their sexuality during the transition to parenthood. While there is evidence of variability in the sexual well-being of new parents, distinct classes of dyadic trajectories have not been established. Sexual frequency, desire, satisfaction, and distress are each unique components of sexual well-being and may follow different patterns of change within couples. We sought to establish classes of trajectories of four aspects of sexual well-being for couples in the transition to parenthood as well as the associations among identified classes. Couples (N = 203) expecting their first child completed online standardized measures of sexual well-being at 20 and 32 weeks in pregnancy and at 3, 6, 9, and 12 months postpartum. Dyadic latent class growth analyses were conducted to identify classes of trajectories for each facet of sexual well-being, and dual trajectory analyses examined the probability of group membership across classes. Couples' sexual well-being over time was heterogeneous. Sexual frequency had two classes: high (33%) and low (67%); sexual desire had three classes: moderate (36%), high (25%), and discrepant (39%); sexual satisfaction had two classes: high (64%) and low (36%); and sexual distress had two classes: low (76%) and discrepant (24%). Overlap in classes of sexual well-being was variable such that high and low or discrepant (between partners) classes did not always co-occur. Findings provide more nuanced information about new parents' postpartum sexual health, which may facilitate early assessment and intervention. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The association between labour epidural analgesia and postpartum depressive symptoms: a longitudinal cohort study

BACKGROUND

Pain is a risk factor for postpartum depression (PPD) and labour epidural analgesia (LEA) may lower the incidence of PPD. We evaluated depressive symptoms risk at three, six, and 12 months postpartum in women with LEA compared with women without LEA.

METHODS

With ethics approval, hypotheses were tested using data from a longitudinal prospective observational cohort study between January 2015 and January 2019 in nulliparous women aged ≥ 18 yr with uncomplicated, singleton pregnancies. Email surveys were completed at baseline (18-20 weeks' gestation) and at three-, six- and 12 months postpartum, including the Edinburgh Postpartum Depression Scale (EPDS). Maternal, infant, and anesthesia characteristics were abstracted from electronic databases. The EPDS scores at three, six, and 12 months postpartum were analyzed using generalized estimating equations with and without covariates.

RESULTS

Of the 909 women who consented to participate, 709 women were included in the study. Antenatal EPDS scores, not LEA, predicted postpartum depressive symptom risk (P < 0.001). The adjusted 95% confidence intervals suggest mean EPDS scores differ from 1.0 point lower in the LEA group at 12 months to 1.5 points higher in the no LEA group at three months on its 0-30 scale. All the confidence intervals included zero at three, six, and 12 months, so were considered non-significant (P > 0.05).

CONCLUSION

This study did not identify an association between LEA and risk of depressive symptoms postpartum, although small mean differences between groups cannot be ruled out. Future studies should focus on other modifiable variables that influence the development of PPD.

Validation of the Maternal and Partner Sex During Pregnancy Scales (MSP/PSP) in Portugal: Assessing Dyadic Interdependence and Associations with Sexual Behaviors

BACKGROUND

The Maternal and Partner Sex During Pregnancy Scales (MSP/PSP) are self-report measures of expectant couples' attitudes towards sex during pregnancy.

AIM

This study aimed to examine dyadic non-independence of MSP/PSP scores in a sample of expectant couples, while providing an evaluation of factor structure, validity, and reliability of the Portuguese versions of the MSP/PSP. The association between partners' attitudes and frequency of sexual behaviors was also examined.

METHODS

A total of 189 expectant couples completed a survey that included a sociodemographic questionnaire, the MSP/PSP, frequency of sexual behaviors, as well as validated measures of attitudes to sex, sexual function, sexual satisfaction, depression, and perceived social support.

OUTCOMES

Dyadic interdependence was tested via Pearson correlation between MSP/PSP scores; between-dyads variability was tested via intraclass correlation of the unconditional model including only MSP/PSP scores using a multi-level model. Associations between attitudes and sexual behavior were tested using regression analysis (between-dyads outcomes) or APIM (mixed outcomes). Factor structure, internal consistency, and validity (convergent, discriminant, and concurrent) of the Portuguese versions of the scales were assessed.

RESULTS

MSP/PSP scores were interdependent within-dyads. Male partners presented significantly more positive attitudes towards sex during pregnancy than pregnant women. Attitudes were linked to indices of sexual well-being for both partners (sexual functioning, sexual satisfaction) and, for both partners, more positive attitudes were associated with higher frequencies of most partnered sexual behaviors. The Portuguese MSP/PSP scales showed good factor structure, and good to excellent indices of reliability and validity.

CLINICAL IMPLICATIONS

The Portuguese MSP/PSP is adequate for use in couples. The scales can be used to screen partners with negative attitudes towards sex during pregnancy and evaluate how these attitudes relate to intra- and inter-individual sexual well-being during pregnancy.

STRENGTHS & LIMITATIONS

A strength of this study is the inclusion of both expectant partners and the use of dyadic analysis. Couples who participated in the study were all in mixed-gender/sex relationships, although this was not defined as an inclusion criterion. Future studies should use the MSP/PSP in more diverse samples in order to further determine how the scale performs for couples with different characteristics.

CONCLUSION

Scores in the MSP/PSP are interdependent between mixed-sex/gender expectant couple members. More positive attitudes towards sex during pregnancy are linked to higher frequencies of partnered sexual behaviors and to both partners' greater sexual well-being. Tavares Inês M., Heiman Julia R., Rosen Natalie O., et al. Validation of the Maternal and Partner Sex During Pregnancy Scales (MSP/PSP) in Portugal: Assessing Dyadic Interdependence and Associations with Sexual Behaviors. J Sex Med Rev 2021;18:789-799.

A Mixed-Method Analysis of Women's Attributions about Their Partner's Pornography Use

We used a mixed-method design to examine the attributions women in mixed-gender/sex relationships make for their partner's perceived pornography use and whether such attributions covary with women's relationship and sexual satisfaction. A final sample of 199 women completed measures of relationship satisfaction, sexual satisfaction, and their perceptions of partner's pornography use. Participants also completed three open-ended questions assessing their attributions of their partner's perceived pornography use. Qualitative analyses revealed 11 themes in women's attributions of their partner's perceived pornography use; some of the themes reflected on women themselves (e.g., being open-minded and accepting), whereas other themes reflected on the partner (e.g., partner is sexually bored) or the relationship (e.g., strong and trusting relationship). Furthermore, the women made positive, negative, and neutral attributions. Quantitative analyses showed that positive attributions were significantly more frequent than neutral or negative attributions and the latter two categories did not differ significantly from each other. Also, greater frequency of positive and neutral attributions and lower frequency of negative attributions were associated with higher relationship satisfaction and sexual satisfaction. Our results suggest that women make a range of attributions about their partner's pornography use and that this variation relates meaningfully to indices of relationship functioning.

An Attachment Perspective on Partner Responses to Genito-pelvic Pain and Their Associations with Relationship and Sexual Outcomes

Although facilitative and negative partner responses are known to impact couples' adaptation to provoked vestibulodynia (PVD), a chronic genito-pelvic pain condition, it is still unknown what leads individuals to adopt or perceive such adaptative or detrimental behaviors. Attachment influences sexual and relationship adjustment, emotional reactivity and perceived support in romantic relationships, and as such could be associated with partner responses. This study aimed at examining the mediating role of facilitative and negative partner responses in the associations between attachment and relationship and sexual adjustment in 125 couples coping with PVD. Couples completed self-report questionnaires on attachment, partner responses, sexual satisfaction and distress, and relationship satisfaction. Results indicated that partners' attachment avoidance was negatively associated with facilitative partner-reported responses, which in turn was associated with partners' sexual and relationship satisfaction. Attachment anxiety in women and partners was associated with greater women-perceived negative partner responses, which in turn was associated with women's and partners' greater sexual distress and lower sexual satisfaction, and women's lower relationship satisfaction. Partners' greater attachment anxiety was also associated with greater partner-reported facilitative responses, which was associated with partners' lower and women's greater relationship satisfaction. Assessing attachment orientations may help clinicians better understand couples' dyadic coping.

Pornography Use and Sexual Health among Same-Sex and Mixed-Sex Couples: An Event-Level Dyadic Analysis

A large number of partnered individuals regularly use or are in a relationship with someone who uses pornography. However, knowledge concerning the association between pornography use and partnered sexual health-sexual satisfaction, distress, and function-is fragmentary. The current study used an event-level dyadic design to examine the associations between pornography use and sexual satisfaction, distress, and function on days when partnered sexual activity occurred. A convenience sample of 217 couples (M_age = 30.2; SD = 8.3; 72 same-sex couples) completed a short survey on days of sexual activity with their partner, over a 35-day period. Self-report measures included questions about daily pornography use and masturbation as well as daily sexual satisfaction, distress, and function. Using pornography on days of partnered sexual activity was reported by half of the couples. An individual's solitary pornography use on days of partnered sexual activity was related to their partner's higher sexual distress and, for women's use only, to their own higher quality of lubrication, compared to sex days without solitary pornography use. There was no evidence of an association between pornography use on sex days, whether alone or with the partner, and all other aspects of sexual health including sexual satisfaction. Our findings capture the complexity of the associations between pornography and sexual health. Men and women's pornography use may create idealized fantasies around appearance and performance, which may lead the partner to feel distressed about their sex life. Women's pornography use might facilitate their sexual responsiveness during partnered sexual activity.