The relationship between self-reported sexual satisfaction and general well-being in women

Sexual Satisfaction and Mental Health in Prison Inmates

The main goal of this study was to investigate the association between sexual satisfaction and mental health, and the combined effect of two previously found, statistically significant moderators: partner status and sexual abstinence. In-person interviews were conducted with 223 participants (49.327% males and 50.673% females). The effect of sexual satisfaction on mental health and the interactions of sexual satisfaction × partner status, sexual satisfaction × sexual abstinence, and sexual satisfaction × partner status × sexual abstinence were examined using simple moderation and moderated moderation tests after controlling for a set of sociodemographic, penitentiary, and interpersonal variables. Results revealed a direct relationship between sexual satisfaction and mental health only for the sexually abstinent group. Partner status was not significant as a moderator. It seems that the lack of sexual relationships is more powerful as a moderator than the lack of a romantic relationship. Additionally, the sexually abstinent group showed lower levels of sexual satisfaction in those with a partner outside or inside prison, and lower mental health independently of the current romantic status, than sexually active inmates. These findings point to the importance of sexual satisfaction to mental health in sexual situations of extreme disadvantage.

Psychobiological Factors of Sexual Functioning in Aging Women - Findings From the Women 40+ Healthy Aging Study

Background: A variety of biological and psychosocial factors are associated with women’s sexual health in midlife and older age. Evidence suggests a decline in sexual functioning in the context of aging and the menopausal transition, including changes in sexual desire, arousal, lubrication, orgasm, pain, and/or contentment. However, not all women in midlife and older age experience such a decline, and it remains unclear how the endocrine environment and psychosocial aspects contribute to the maintenance of healthy sexual functioning. Therefore, the aim of this study was to examine psychobiological predictors of sexual functioning in healthy middle-aged and elderly females.

Methods: A total of 93 healthy, sexually active women aged 40–73 years completed a battery of validated psychosocial questionnaires, including measures of sexual functioning (Female Sexual Function Index) and of protective psychological traits and interpersonal variables. The steroid hormones estrogen, testosterone, progesterone and dehydroepiandrosterone sulfate were determined in saliva samples, while follicle-stimulating hormone, luteinizing hormone and sex hormone-binding globulin were determined in dried blood spots. The findings were statistically adjusted for multiple testing.

Results: Age and postmenopausal status were negatively associated with overall sexual functioning, arousal, and lubrication. Regression analyses revealed that relationship satisfaction, emotional support, self-esteem, optimism, and life satisfaction each significantly predicted overall sexual functioning or specific aspects of sexual functioning, including arousal, contentment, orgasm, and pain (all p < 0.029). For desire and lubrication, no associations were found with the tested psychosocial factors. In terms of steroid hormones, testosterone was positively linked to orgasm (p = 0.012). In this sample, 79.6% reported to have healthy sexual functioning according to the questionnaires’ cutoff. Younger age (OR = 0.911, 95% CI 0.854–0.970, p = 0.004) and a higher level of emotional support (OR = 1.376, 95% CI 1.033–1.833, p = 0.029) were associated with the presence of healthy sexual functioning.

Discussion: Although aging and menopause negatively affected aspects of sexual functioning, the accompanying endocrine correlates were not predictive for sexual functioning in this healthy sample of middle-aged and older females. Instead, our findings suggest that sexual functioning is highly dependent on psychosocial aspects related to well-being. Accordingly, personality traits such as optimism, and interpersonal aspects such as emotional support and relationship satisfaction were identified as important predictors of sexual functioning.

Exploring the Impact of Personal and Partner Traits on Sexuality: Sexual Excitation, Sexual Inhibition, and Big Five Predict Sexual Function in Couples

Sexual difficulties are common among women and men and are associated with various mental and physical health problems. Although psychological traits are known to impact sexual attitudes and behavior, sexuality- and personality-related traits have not been jointly investigated to assess their relevance for sexual functioning in couples. The aim of this study was to investigate how psychological traits of two partners influence women's and men's sexual function. Data from 964 couples, representative of the adult population in Germany, were analyzed. Sexual function was assessed with the Female Sexual Function Index (FSFI) and the International Index of Erectile Function (IIEF). Sexuality-related traits were measured with the Sexual Excitation/Sexual Inhibition Inventory for Women and Men (SESII-W/M). Personality was measured with self-report and partner-rating versions of the Big Five Inventory (BFI). Sexual excitation was a positive and sexual inhibition was a negative predictor of sexual function in both genders. Women whose partners were sexually inhibited reported lower sexual function. Conscientious individuals reported better sexual function. Women whose partners were more conscientious also had better sexual function. Assessing partner-related factors may be helpful to identify predisposing and maintaining factors of sexual dysfunctions, especially in women.

Sexual Portrait of Couples Seeking Relationship Therapy

This study sought to provide information about the sexual well-being of 298 mixed-sex couples seeking relationship therapy and determined the extent to which problems with sexual functioning and dyadic adjustment of both partners are associated with sexual satisfaction. Partners completed measures of dyadic adjustment, sexual satisfaction, and sexual functioning. Thirty percent of couples reported a clinically significant sexual problem. Compared to their male partners, the women were more likely to report a sexual problem as well as lower dyadic adjustment, sexual satisfaction, and overall sexual functioning. Path analysis indicated that relationship adjustment uniquely predicted individuals' own sexual satisfaction; problems in sexual functioning uniquely predicted own and partner sexual satisfaction. Findings underscore the need to address sexual problems in relationship therapy.

The Relationship Between the Sexual Self and the Experience of Pregnancy

Studies reveal that prenatal health-care providers and educators often refrain from discussing sexuality with their patients. The present study explored the relationship between sexuality and pregnancy by considering whether the way in which women view themselves sexually is associated with their experience of pregnancy. Findings revealed that a positive sexual self was significantly related to a positive experience of pregnancy and that particular experiences of pregnancy were more significantly related to how women viewed themselves sexually than others. The findings encourage further discussion regarding the role that comprehensive sex education and training of prenatal health-care providers might play in ultimately establishing open, honest, and nonjudgmental discussions about sexuality between providers and their pregnant patients and partners.

Genotype scores predict drug efficacy in subtypes of female sexual interest/arousal disorder: A double-blind, randomized, placebo-controlled cross-over trial

Attempts to develop a drug treatment for female sexual interest/arousal disorder have so far been guided by the principle of ‘one size fits all’, and have failed to acknowledge the complexity of female sexuality. Guided by personalized medicine, we designed two on-demand drugs targeting two distinct hypothesized causal mechanisms for this sexual disorder. The objective of this study was to design and test a novel procedure, based on genotyping, that predicts which of the two on-demand drugs will yield a positive treatment response. In a double-blind, randomized, placebo-controlled cross-over experiment, 139 women with female sexual interest/arousal disorder received three different on-demand drug-combination treatments during three 2-week periods: testosterone 0.5 mg + sildenafil 50 mg, testosterone 0.5 mg + buspirone 10 mg, and matching placebo. The primary endpoint was change in satisfactory sexual events. Subjects’ genetic profile was assessed using a microarray chip that measures 300,000 single-nucleotide polymorphisms. A preselection of single-nucleotide polymorphisms associated with genes that are shown to be involved in sexual behaviour were combined into a Phenotype Prediction Score. The Phenotype Prediction Score demarcation formula was developed and subsequently validated on separate data sets. Prediction of drug-responders with the Phenotype Prediction Score demarcation formula gave large effect sizes (d = 0.66 through 1.06) in the true drug-responders, and medium effect sizes (d = 0.51 and d = 0.47) in all patients (including identified double, and non-responders). Accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of the Phenotype Prediction Score demarcation formula were all between 0.78 and 0.79, and thus sufficient. The resulting Phenotype Prediction Score was validated and shown to effectively and reliably predict which women would benefit from which on-demand drug, and could therefore also be useful in clinical practice, as a companion diagnostic establishing the way to a true personalized medicine approach.

Sexual vs. Non-sexual trauma, sexual satisfaction and function, and mental health in female veterans

Trauma in general, and sexual assault in particular, is associated with serious mental health and functional problems. The quality of sexual satisfaction/function may be particularly impacted by sexual assault, and such sexual problems may account for some of the broader mental health and functioning impairments in sexual assault survivors. Accordingly, we examined self-reports of sexual health and mental health in a sample of 255 female veterans in committed, monogamous relationships who provided data regarding sexual assault (n = 153) or nonsexual trauma (n = 102). Trauma type was not associated with differences in sexual function, but sexual trauma was associated with significantly lower sexual satisfaction, greater posttraumatic stress disorder (PTSD) and depressive symptoms, and higher suicidal ideation. Furthermore, the indirect effect of trauma type on all mental health outcomes was significant via sexual satisfaction but not via sexual function. Finally, trauma type moderated the association of sexual function with suicidality, such that the association was significantly positive in those with a history of sexual assault but nonsignificant in those with nonsexual trauma. These results suggest that (1) female veterans' experience of sexual assault is related to sexual satisfaction, which in turn is related to mental health outcomes, and (2) a history of sexual assault may increase the importance of sexual functioning with regard to suicidality.

Holistic sexuality post gynaecological cancer treatment: A review of recent literature

Background: Sexual difficulties post gynaecological cancer treatment are commonplace and can impact multiple aspects of a woman’s life. Yet, health care practitioners remain reluctant to discuss sexuality from a holistic perspective with their patients.Aim: This article reviewed the literature on sexuality post gynaecological cancer treatment from the last 10 years. The aim was to understand research trends as well as identify gaps in the field.Methods: The review was framed using the neo-theoretical framework of sexuality. A comprehensive literature search, using the electronic databases EBSCOHost, Ovid, Clinical Key and PubMed, was conducted for articles concentrating on sexuality after gynaecological cancer treatment, published from 2007 to 2017 in English.Results: The results showed that the majority of the literature still approaches sexuality post treatment from a biomedical perspective with a focus on physical sexual functioning. However, there has been a slight shift towards understanding sexuality from a comprehensive standpoint, although there is a dearth of research relating to the psychological and relational aspects of sexuality.Conclusion: Comprehensive sexuality post treatment should be given further consideration in South Africa, and our unique socio-cultural context ought to be taken into consideration. Additionally, interventions at multiple levels should be explored, such as broadening sexual health training within the medical curriculum, considering the development of holistic cancer clinics and widening the scope of research relating to gynaecological cancer care.

Ethics and sexual health: Exploration of the ethical code of conduct for physiotherapists concerning sexual health in clinical practice

Physiotherapists have an important role in sexual health, but there are specific ethical considerations regarding sexuality and the practice of physiotherapy which require serious consideration. This article aims to illustrate how the professional ethical code of physiotherapy can serve as a tool for ethical clinical reasoning regarding sexual health in clinical physiotherapy practice. We analyse the ethical codes for physical therapy, in relation to a definition of sexual health and the declaration of sexual rights. The analysis outlines several ethical considerations crucial in dealing with sexual health, while also acknowledging the critical role of cultural context in any ethical analysis. We conclude that physiotherapists need to practise ethical reasoning and that the ethical code of physiotherapy can act as a point of departure for reflection on thought-provoking ethical dilemmas to improve the practice of physiotherapy and support clients' overall health.

Sexual Satisfaction Among Older Australian Heterosexual Men and Women: Findings from the Sex, Age & Me Study

This study explored sexual satisfaction in older heterosexual Australians using data from a national sample of 1,583 men and women aged 60+ who hoped or planned to have sex in the future. Data collection took place in 2015; participants were recruited using a variety of online and offline advertisements. Less than half the sample (46%) reported they were very or extremely satisfied with their sexual lives. Those who had sex more often and were more interested in sex were more likely to be satisfied, while those who wanted sex more often in the future were less likely to be satisfied, as were men who had experienced sexual difficulties. Sexual satisfaction was also associated with life satisfaction in men and positive mental health in women. Factors associated with satisfaction in this study will help guide strategies to support older people in realizing the sexual lives they desire.

Sexual Satisfaction Among Couples: The Role of Attachment Orientation and Sexual Motives

The mediating effect of sexual motives between attachment orientation and sexual satisfaction and functioning was investigated among 128 couples (N = 256) using the actor-partner interdependence model (Campbell & Kashy, 2002). Actor effects between attachment orientation and sexual satisfaction and functioning, mediated by sexual motives, were found regarding men's sexual satisfaction, sexual intimacy, and orgasmic responsivity. Partner effect revealed two significant paths in which the greater the women's attachment avoidance, the lower the partners' intimacy motivation, which in turn was linked with lower partners' sexual satisfaction and increased lack of sexual intimacy. The analyses did not reveal significant mediation paths affecting women's sexual satisfaction and functioning. These findings emphasize the importance of implementing a dyadic perspective on sexuality within practice. Recommendations for further research and additional clinical implications are discussed.

Flibanserin: A controversial drug for female hypoactive sexual desire disorder

Sexual functioning is an integral part of human life. Female sexual dysfunction (FSD) adversely affects quality of life and general well-being. The Food and Drug Administration recently approved flibanserin, for treatment of female hypoactive sexual desire disorder (HSDD), regarded as the most common FSD, amid great controversy. A novel multifunctional serotonin agonist and antagonist, flibanserin, has been shown to be efficacious in treating HSDD but with a rather tenacious side effect profile. We review this interesting drug in its entirety. Data for the article were collected by reviewing articles on PubMed, the drug (Addyi) website, and related websites on the internet.

Psychosocial Syndemic Correlates of Sexual Compulsivity Among Men Who Have Sex with Men: A Meta-Analysis

Efforts have been made to better understand sexual compulsivity by examining salient psychosocial syndemic correlates, though examination of such factors has yielded inconclusive results. Given that research on sexual compulsivity has predominately involved men who have sex with men (MSM), the aims of the current study were to establish the mean effect sizes of seven psychosocial syndemic indicators with sexual compulsivity, to determine if the effect varied as a function of the type of psychosocial syndemic, and investigate the potential moderating effects using MSM samples. A total of 95 studies were included for analyses among the psychosocial syndemic indicators of interest (i.e., depression, anxiety, alcohol use, drug use, intimate partner violence, childhood sexual abuse, and sexual risk behavior). Results revealed a medium mean effect size of sexual compulsivity, the strength of which was significantly moderated by type of psychosocial syndemic indicator. Significant mean effect sizes for all syndemic indicators on sexual compulsivity were found, with depression and anxiety having the strongest relationships; significant moderating effects were found and are discussed. Findings highlight clinical considerations regarding sexual compulsivity and its role within the HIV syndemic framework among MSM.

Implications of no recent sexual activity, casual sex, or exclusive sex for college women's sexual well-being depend on sexual attitudes

OBJECTIVE

We examine how sexual activity relates to sexual well-being within the context of sexual attitudes, sexual agency, and sexual desire.

PARTICIPANTS/METHODS

We surveyed 471 college women in 2012-2014 who had ever had sex.

RESULTS

Sexual agency and sexual desire consistently predicted well-being, regardless of recent sexual activity. There was a significant interaction between recent sexual activity (none, casual, or exclusive relationship) and sexual attitudes. Exclusive sex was associated with higher than average sexual well-being, especially for women with permissive attitudes. Women who had casual sex and held permissive to average attitudes had the next highest levels of well-being, but those with non-permissive attitudes fell substantially below the overall mean. Women who had no recent sex were consistently below the mean, especially for women with more permissive attitudes.

CONCLUSIONS

A disconnect between sexual attitudes and recent sexual activity may lower women's sexual well-being.

Female condom acceptability in urban India: Examining the role of sexual pleasure

This qualitative study examined the acceptability of female condoms in urban India, with a focus on sexual pleasure. We conducted focus group discussions with 50 women and 19 men, as well as a small number of individual interviews with women ( n = 3), in Chennai and New Delhi. Perceived benefits of female condoms included protection against unintended pregnancy and sexually transmitted infections, increased sense of empowerment for women, and simple clean up. The most common drawback was reduced sensation. Participants suggested structural changes to the female condom to ease insertion and use. Consent and privacy were discussed as increasing sexual pleasure. Pleasure should be acknowledged in design and education efforts to increase female condom use.

Using Emotionally Focused Therapy to Treat Sexual Desire Discrepancy in Couples

Couples in committed relationships encounter a multitude of issues. According to Metz and McCarthy (2010), when couples report high sexual satisfaction, it accounts for 15% to 20% of their overall relationship satisfaction. However, when couples report low sexual satisfaction, it contributes 50% to 70% of their overall satisfaction with their partner. Issues of sexual desire, currently referred to as sexual desire discrepancy, are among the most difficult to treat. Although there are many factors contributing to the issue of sexual desire discrepancy, current literature highlights the importance of emotional intimacy as an outcome and predictor of increased sexual desire. Given the complex nature of sexual desire, clinicians often lack the understanding and treatment options that are systemic. By viewing sexual desire discrepancy as a relational problem that can be treated using emotionally focused therapy, clinicians are better equipped to work with emotional and sexual factors that impact desire and couple distress.

Repercussões da Menopausa para a Sexualidade de Idosas: Revisão Integrativa da Literatura

Resumo A menopausa representa transformações hormonais significativas que podem ser acompanhadas de mudanças sociais e emocionais. Além disso, a população idosa feminina tem apresentado maiores comprometimentos em relação à sexualidade do que os homens. Este estudo teve por objetivo apresentar uma revisão integrativa da literatura científica nacional e internacional sobre as possíveis repercussões da menopausa para a sexualidade de idosas. As buscas foram realizadas nas bases Lilacs, SciELO, PePSIC e PsycINFO com análise da produção científica nacional e internacional relativa ao período de janeiro de 2006 a março de 2016. Foram analisadas 36 produções na íntegra cujo perfil predominante é de estudos quantitativos, descritivos e transversais, desenvolvidos com mulheres de diferentes faixas etárias na pós-menopausa, incluindo idosas. Todavia, estudos com amostras compostas exclusivamente por idosas são minoria. Entre os resultados houve predominância de pesquisas voltadas para a avaliação e quantificação das possíveis patologias e sintomas biológicos que afetam a sexualidade (redução da libido, de lubrificação e de orgasmos, por exemplo). A maioria das pesquisas aponta para a importância da análise conjunta de aspectos biológicos, psicológicos, sociais, culturais e individuais para a compreensão das suas distintas influências na sexualidade das idosas. Destaca-se a necessidade de realização de pesquisas com abordagem mista e voltadas apenas para mulheres idosas a fim de ampliar a compreensão acerca das suas perspectivas sobre as repercussões da menopausa para a sexualidade pretendendo respaldar práticas clínicas e políticas sociais destinadas a essa população.

Effects of Mindfulness-Based Therapies for Female Sexual Dysfunction: A Meta-Analytic Review

Mindfulness-based therapy (MBT) represents a potentially efficacious treatment for female sexual dysfunction (FSD). A number of recent trials assessing MBT for FSD have been published, but we are aware of no existing meta-analysis synthesizing these results. We conducted a literature review to identify all published trials of MBT for FSD. References of retrieved studies were searched and key authors were contacted with requests for complete but unpublished trials. Eleven trials, including a total of 449 participants, were identified. Two of these studies were under review at the time of the current analyses. Four trials utilized wait-list controls. All aspects of sexual function and subjective sexual well-being exhibited significant improvement during MBT, with effect sizes generally moderate. Controlled effect sizes versus wait list were of similar magnitude in most cases; however, they did not reach statistical significance for multiple outcome measures. Results for some outcomes were consistent with possible publication bias. For some outcomes, larger effect sizes tended to be reported in studies requiring participants to be in a romantic relationship or studies providing individual (versus group) therapy. MBT may be an efficacious intervention for FSD. However, important limitations of the current literature and future directions for research are discussed.

Satisfaction and Condomless Anal Sex at Sexual Debut and Sexual Risk Among Young Black Same-Sex Attracted Men

First sex may be a sentinel event crucial to understanding sexual health trajectories of young Black same-sex attracted men (YBSSAM). We sought to understand whether satisfaction, condomless anal sex, and contextual factors during first sex were associated with sexual risk and recent condom use in YBSSAM. A total of 201 YBSSAM aged 15-24 years completed an Internet survey exploring first sex, current condom use, and sexual risk. High risk was defined as ≥3 of the following: new/concurrent sex partners, STI history, and no/inconsistent condom use. Multivariate logistic regression assessed the association between predictor (satisfaction and first condomless anal sex) and outcome (sexual risk and condomless sex in the past 3 months) variables. Mean age at first sex was 15.2 (SD = 2.9) years, and emotional satisfaction (51.7 %), physical satisfaction (63.7 %), and condomless first anal sex (55.2 %) were common. YBSSAM describing high levels of satisfaction were no more likely to be at high risk or engage in recent condomless sex. Condomless first sex (AOR = 4.57, p = .001), younger age (AOR = 3.43, p = .02), and having a partner >5 years older (AOR = 2.78, p = .03) at first sex were significantly associated with increased risk. Only condomless first sex (AOR = 4.28, p < .001) was associated with condomless recent sex. Satisfaction at first sex may not influence later sexual risk in YBSSAM. However, context of first sex, including condom use at first sex, may play an important role in subsequent risk. Prevention strategies on condom negotiation prior to first sex may help to mitigate HIV burden in YBSSAM.

Parenting Stress and Sexual Satisfaction Among First-time Parents: A Dyadic Approach

The present paper reports on longitudinal associations between parenting stress and sexual satisfaction among 169 heterosexual couples in the first year after the birth of a first child. Actor Partner Interdependence Modeling (APIM) was used to model the effects of the mother's and father's parenting stress at 6 months after birth on sexual satisfaction at one year after birth. Based on social constructivist theory and scarcity theory, two hypotheses were posed: (a) mothers' parenting stress will predict their own later sexual satisfaction whereas fathers' parenting stress will not predict their own later sexual satisfaction (actor effects) and (b) mothers' parenting stress will predict fathers' later sexual satisfaction but fathers' parenting stress will not predict mothers' later sexual satisfaction (partner effects). On average, parents were only somewhat satisfied with their sex life. The first hypothesis was supported as greater parenting stress significantly predicted lower sexual satisfaction for mothers but not for fathers. The second hypothesis was also supported as mothers' greater parenting stress significantly predicted less sexual satisfaction in fathers, whereas fathers' parenting stress did not significantly predict mothers' sexual satisfaction. We discuss how our results may be interpreted considering the social construction of gendered family roles.

Sexual Excitation and Sexual Inhibition as Predictors of Sexual Function in Women: A Cross-Sectional and Longitudinal Study

To date, no longitudinal studies have evaluated the predictive value of the two factors of the dual control model-sexual excitation (SE) and sexual inhibition (SI)-for future sexual function. The aims of the present study were to investigate the associations between SE/SI and sexual function and estimate their predictive value for future sexual function in a sample of women. Overall, 2,214 women participated in a web-based survey that assessed SE, SI, and sexual function as well as symptoms of depression. The one- and two-year follow-up surveys included 396 and 382 participants, respectively. Correlational analyses and hierarchical regression analyses were conducted to analyze the relationships between predictor and outcome variables. Four factors of SE (Arousability, Partner Characteristics, Sexual Power Dynamics, and Setting) and two factors of SI (Concerns about Sexual Function and Arousal Contingency), as well as symptoms of depression and partnership status, were significant predictors of concurrent and future sexual function. Several subscales of SE and SI contributed to the prediction of future sexual function above and beyond prior sexual function levels. Our study provides the first supportive evidence for the assumptions of the dual control model that propensities for low SE and high SI influence future sexual function.

The More or the Better? How Sex Contributes to Life Satisfaction

Much cross-sectional research documented associations between sexuality and life satisfaction, but very little longitudinal research on the topic has considered whether changes in sexuality and life satisfaction unfold together over time. Using data from 5582 individuals in partnerships surveyed across 5786 intimate relationships (providing 18,712 observations for analysis) during five waves of the German Family Panel (pairfam), this study examined whether intraindividual changes in sexual frequency and satisfaction were associated with corresponding intraindividual changes in life satisfaction. Fixed effects regression modeling results showed that individuals reported a greater increase (decrease) in life satisfaction when they also experienced a more substantial increase (decrease) in sexual frequency and satisfaction. This finding was consistent for men and women. This study contributes to the literature by documenting that naturally occurring increases in sexual frequency and satisfaction over time predicted corresponding increases in life satisfaction.

Sexual Quality of Life and Aging: A Prospective Study of a Nationally Representative Sample

Unlike other life domains, sexual quality of life (SQoL) has a negative relationship with age. This study disentangled the effect of age in this relationship from confounding sociocultural influences (e.g., the period of time in which data were collected, and cohort differences) and aimed to understand the roles of other sexual domains (i.e., frequency, perceived control, thought and effort invested in sex, and number of sexual partners). We analyzed data from the longitudinal Midlife in the United States study (n = 6,278; age range 20-93), which were collected between 1995 and 2013. Repeated measures linear mixed-effects models showed that age was the most robust time-related predictor of declining SQoL. However, after the sexual domains were included in the model, age had a positive relationship with SQoL and older adults' SQoL was differentially influenced by the quality-not quantity-of sex. When partnership characteristics were included in the model, age was no longer related to SQoL. These findings suggest that aging may be associated with the acquisition of skills and strategies that can buffer age-related declines in SQoL, particularly in the context of a positive relationship. We summarize these findings as sexual wisdom.

Validation of the Interpersonal Exchange Model of Sexual Satisfaction With Women in a Same-Sex Relationship

We examined the validity of the interpersonal exchange model of sexual satisfaction for sexual-minority women (SMW) with a range of sexual identities (lesbian, bisexual, queer, unlabeled, questioning). Participants, 898 (192 who were dating, 439 who were cohabitating) SMW in a romantic relationship of at least 3 months, completed an online survey that included the Interpersonal Exchange Model of Sexual Satisfaction Questionnaire. The results provide support for the validity of the model for SMW in that all the model components (relationship satisfaction, balance of sexual rewards and costs, balance of relative sexual rewards and costs, equality of rewards, equality of costs) were significantly associated with sexual satisfaction. All of the components, except equality of sexual costs, contributed uniquely to the prediction of sexual satisfaction. Neither relationship stage (dating vs. cohabiting) nor sexual identity (lesbian vs. other sexual-minority identity) moderated these associations. Women daters reported a significantly higher level of sexual rewards, sexual costs, and sexual satisfaction than did women cohabiters. The interpersonal exchange model may be used by clinicians as a framework for exploring experiences of low sexual satisfaction with a couple. The results also add to an emerging positive picture of the sexual relationships of SMW at both stages; this information can be used to counter negative stereotypes. Online supplemental files are available at http://journals.sagepub.com/doi/suppl/10.1177/0361684316679655 .

Multidimensional Sexual Perfectionism and Female Sexual Function: A Longitudinal Investigation

Research on multidimensional sexual perfectionism differentiates four forms: self-oriented, partner-oriented, partner-prescribed, and socially prescribed. Self-oriented sexual perfectionism reflects perfectionistic standards people apply to themselves as sexual partners; partner-oriented sexual perfectionism reflects perfectionistic standards people apply to their sexual partner; partner-prescribed sexual perfectionism reflects people's beliefs that their sexual partner imposes perfectionistic standards on them; and socially prescribed sexual perfectionism reflects people's beliefs that society imposes such standards on them. Previous studies found partner-prescribed and socially prescribed sexual perfectionism to be maladaptive forms of sexual perfectionism associated with a negative sexual self-concept and problematic sexual behaviors, but only examined cross-sectional relationships. The present article presents the first longitudinal study examining whether multidimensional sexual perfectionism predicts changes in sexual self-concept and sexual function over time. A total of 366 women aged 17-69 years completed measures of multidimensional sexual perfectionism, sexual esteem, sexual anxiety, sexual problem self-blame, and sexual function (cross-sectional data). Three to six months later, 164 of the women completed the same measures again (longitudinal data). Across analyses, partner-prescribed sexual perfectionism emerged as the most maladaptive form of sexual perfectionism. In the cross-sectional data, partner-prescribed sexual perfectionism showed positive relationships with sexual anxiety, sexual problem self-blame, and intercourse pain, and negative relationships with sexual esteem, desire, arousal, lubrication, and orgasmic function. In the longitudinal data, partner-prescribed sexual perfectionism predicted increases in sexual anxiety and decreases in sexual esteem, arousal, and lubrication over time. The findings suggest that partner-prescribed sexual perfectionism contributes to women's negative sexual self-concept and female sexual dysfunction.

Evaluation of Body Image and Sexual Satisfaction in Women Undergoing Female Genital Plastic/Cosmetic Surgery

BACKGROUND

Little prospective data exists regarding the procedures constituting female genital plastic/cosmetic surgery (FGPS).

OBJECTIVES

To evaluate whether the procedures of labiaplasty and vaginoperineoplasty improve genital self image, and evaluate effects on sexual satisfaction.

METHODS

Prospective cohort case-controlled study of 120 subjects evaluated at baseline, 6, 12, and 24 months postoperative, paired with a demographically similar control group. Interventions include labiaplasty, clitoral hood reduction, and/or aesthetic vaginal tightening, defined as perineoplasty + "vaginoplasty" (aka "vaginal rejuvenation."). Outcome measures include body image, genital self-image, sexual satisfaction, and body esteem.

RESULTS

As a group, study patients tested at baseline showing body dissatisfaction, negative genital self-image, and poorer indices of sexual satisfaction. Preoperative body image of study patients were in a range considered to be mild to moderately dysmorphic, but matched controls at one and two years; genital self-image scores at entry were considerably lower than controls, but by 2-year follow-up had surpassed control value at entry. Similarly, sexual satisfaction values, significantly lower at entry, equaled at one, and surpassed control values, at 2 years. Postoperatively, at all points in time, these differences in body image and genital self-image disappeared, and sexual satisfaction markedly improved. Overall body esteem did not differ between study and control groups, with the exception of the genital esteem quotient, which improved after surgery.

CONCLUSIONS

Women requesting and completing FGPS, when tested by validated instruments, at entry report sexual dissatisfaction and negative genital self-image. When tested at several points in time after surgery up to two years, these findings were no longer present. When performed by an experienced surgeon, FGPS appears to provide sexual and genital self-image improvement.

LEVEL OF EVIDENCE

2 Therapeutic.

Mindfulness, cognitive distraction, and sexual well-being in women

Mindfulness involves intentional, non-judgmental and accepting awareness of the present moment. People differ in terms of their level of dispositional mindfulness and can also engage in formal training to cultivate greater mindfulness. Despite a recent proliferation in research on mindfulness and its association with numerous aspects of psychological well-being, researchers have only recently investigated mindfulness in relation to sexual well-being. Existing research has primarily focused on small clinical samples and formal mindfulness intervention and the mechanisms by which mindfulness relates to sexual well-being are poorly understood. In the current study, mindfulness and sexual satisfaction were measured in an online sample of adult women (n=355) who were in relationships. Cognitive distraction during sexual activity was examined as a potential mediator as cognitive distraction has been associated with sexual well-being in women and mindfulness is associated with lower levels of rumination. Women who reported higher levels of mindfulness reported experiencing significantly less frequent cognitive distraction during partnered sexual activity and significantly higher levels of sexual satisfaction. Mindfulness was associated with all measured aspects of cognitive distraction (i.e., cognitive distraction due to appearance concerns, performance concerns, and everyday distractors). Bootstrapping mediational analysis revealed a significant indirect effect; that is, cognitive distraction mediated the association between mindfulness and sexual satisfaction. Mindfulness interventions may be particularly beneficial for women who experience frequent cognitive distraction during sexual activity. Additional clinical implications and potential directions for future research are discussed.

A Sex-Positive Framework for Research on Adolescent Sexuality

In this article, I propose a sex-positive framework for research on adolescent sexuality in which I consider consensual sexual activities in adolescence as developmentally normative and potentially healthy. The sex-positive framework is contrasted with the predominant "risk" perspective that presumes that abstinence from sexual activity is the ideal behavioral outcome for teenagers. Evidence from longitudinal and behavioral genetic studies indicates that engaging in sexual intercourse in adolescence does not typically cause worse psychological functioning. The relationship context of sexual experience may be a critical moderator of its psychological impact. Moreover, cross-cultural data on adolescents' contraception usage, unintended pregnancy, and sexually transmitted infections suggest that, despite the unacceptably high rate of negative health consequences among U.S. teenagers, adolescents can have the developmental capacity to regulate the health risks inherent in sexual activity. Understanding adolescent sexuality can be fostered by considering sexual well-being, a multidimensional construct that incorporates an adolescent's sexual self-efficacy, sexual self-esteem, feelings of sexual pleasure and satisfaction, and freedom from pain and negative affect regarding sexuality. New research is necessary to understand the development of adolescent sexual well-being, including its normative age trends, its reciprocal links with sexual behavior, and its impact on psychological and physical health.

Single dose sublingual testosterone and oral sildenafil vs. a dual route/dual release fixed dose combination tablet: a pharmacokinetic comparison

AIM

The aim was to compare the pharmacokinetic profiles of two formulations of a combination drug product containing 0.5 mg testosterone and 50 mg sildenafil for female sexual interest/arousal disorder. The prototype (formulation 1) consists of a testosterone solution for sublingual administration and a sildenafil tablet that is administered 2.5 h later. The dual route/dual release fixed dose combination tablet (formulation 2) employs a sublingual and an oral route for systemic uptake. This tablet has an inner core of sildenafil with a polymeric time delay coating and an outer polymeric coating containing testosterone. It was designed to increase dosing practicality and decrease potential temporal non-adherence through circumventing the relatively complex temporal dosing scheme.

METHODS

Twelve healthy premenopausal subjects received both formulations randomly on separate days. Blood was sampled frequently to determine the pharmacokinetics of free testosterone, total testosterone, dihydrotestosterone, sildenafil and N-desmethyl-sildenafil.

RESULTS

Formulation 2 had a higher maximum concentration (Cmax ) for testosterone, 8.06 ng ml(-1) (95% confidence interval [CI] 6.84, 9.28) and higher area under the plasma concentration-time curve (AUC), 7.69 ng ml(-1)  h (95% CI 6.22, 9.16) than formulation 1, 5.66 ng ml(-1) (95% CI 4.63, 6.69) and 5.12 ng ml(-1)  h (95% CI 4.51, 5.73), respectively. Formulation 2 had a lower Cmax for sildenafil, 173 ng ml(-1) (95% CI 126, 220) and a lower AUC, 476 ng ml(-1)  h (95% CI 401, 551) than formulation 1, 268 ng ml(-1) (95% CI 188, 348) and 577 ng ml(-1)  h (95% CI 462, 692), respectively. Formulation 2 released sildenafil after 2.75 h (95% CI 2.40, 3.10).

CONCLUSIONS

The dual route/dual release fixed dose combination tablet fulfilled its design criteria and is considered suitable for further clinical testing.

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT

Female sexual interest/arousal disorder (FSIAD) is a significant problem impacting psychological well-being, but the pharmacotherapeutic options for this problem are lacking. The combined, on-demand, sublingual administration of low dose sublingual testosterone and oral administration of sildenafil is a novel pharmacotherapeutic option under development for FSIAD. In proof-of-concept trials, these compounds were successfully administered via different dosage forms (sublingual and oral) at different time points (separated by 2.5 h) because of their markedly different pharmacokinetic-pharmacodynamic profiles. For future larger scale studies and the clinical practice, this raises obvious adherence issues.

WHAT THIS STUDY ADDS

A newly developed dual route/dual release fixed dose combination tablet containing testosterone and sildenafil mimics the pharmacokinetic profile of these components when they are administered as different dosage forms, 2.5 h apart. This combination tablet is a suitable final pharmaceutical drug product that will be used in future studies.