Exploring the effects of sexual desire discrepancy among married couples

"It's an ongoing discussion about desire": Adults' strategies for managing sexual and affectionate desire discrepancies in romantic relationships

Desire discrepancies are a common source of relationship conflict and one reason adults may seek couples counseling. Within romantic relationships, adults individually experience sexual and affectionate desire, but also experience desire relative to their partner. If desire discrepancies exist, partners may attempt to resolve these discrepancies. Thus, we examined adults' strategies for managing sexual and affectionate desire discrepancies. Our sample consisted of 300 adults (45% women; Mage = 29.5; 86.3% LGBTQ+) who were in a romantic relationship and reported a desire discrepancy. Thematic analysis revealed five strategies for managing desire discrepancies: alternative behaviors, communication, doing nothing, engaging in behaviors anyway, and giving control to a specific partner. Adults reported similar strategies for resolving sexual and affectionate desire discrepancies. Perceived effectiveness and strategies varied by whether adults thought that their discrepancies were problematic. Our findings hold implications for clinicians approaching problematic desire discrepancies, and suggest strategies that may promote effective resolutions.

Call me maybe? In-person vs. teletherapy outcomes among married couples

Objective: The objective of this study was to investigate the effectiveness of teletherapy compared to in-person couple therapy in outcomes such as couple satisfaction, sexual satisfaction, and the therapeutic alliance.Method: Data from 1157 married clients seeking couple therapy were examined. Individual growth curve models were used to analyze changes in the aforementioned outcomes, with teletherapy as a predictor. The study also examined client age and clinic type as moderators.Results: The results indicated that overall, teletherapy is as effective as in-person therapy in improving outcomes. However, there were notable differences in the development of the therapeutic alliance. The alliance improved at twice the rate in in-person therapy as in teletherapy. Clinic type was also found to be a moderator of changes in sexual satisfaction. Clients in group and private practices reported improvements in sexual satisfaction; whereas clients seen in training clinics reported decreases in sexual satisfaction.Conclusion: The study concludes that although teletherapy may be a viable alternative to in-person couple therapy, there are nevertheless differences in the development of the therapeutic alliance that warrant care and further investigation. The setting of the therapy also plays a role in the effectiveness of therapy, although not specific to therapy modality.

Interplay between sexual excitation and inhibition: impact on sexual function and neural correlates of erotic stimulus processing in women

Background

As outlined by the dual control model (DCM), individual differences in the regulation of sexual arousal following sexual stimulation depend on two distinct neurophysiological processes: sexual excitation (SE) and sexual inhibition (SI). Although associations with sexual function, behavior, and cue processing have been demonstrated in previous research, underlying neural correlates remain insufficiently explored. Moreover, interactive effects of SE/SI as proposed by the DCM, as well as factors impacting SE/SI properties, such as the use of oral contraceptives (OCs), have not received adequate attention in existing research.

Methods

90 healthy, sexually active women (n = 51 using OCs, n = 39 naturally cycling) completed an Emotional-Picture-Stroop-Paradigm (EPSP) while a 64-channel EEG was recorded. LPP amplitudes toward erotic and neutral stimuli were consecutively computed as a marker of motivational salience and approach motivation. Additionally, women provided self-reports of SE/SI and sexual function. Moderation analyses were performed to assess interactive effects of SE/SI in predicting LPP amplitudes and sexual function.

Results

Sexual function was negatively associated with SI levels but unrelated to SE. Higher SI was associated with reduced LPP amplitudes in response to erotic stimuli. This negative association was, however, attenuated for women high in SE, suggesting interactive effects of SE/SI. Furthermore, women using OCs reported lower SE compared to naturally cycling women.

Conclusion

The observed findings provide additional psychophysiological evidence supporting the DCM and underscore the relevance of interactive SE/SI effects in stimulus processing and approach motivation. They also highlight the possible impact of OCs on psychosexual variables that warrants further research.

Effect of l-arginine compared to placebo on sexual function in women with major depressive disorder: a randomized controlled trial

BACKGROUND

While some evidence suggests that l-arginine may improve sexual function and alleviate depression, it has not been investigated in women with depression to assess both its effects on the depression and sexual function concurrently.

METHODS

Patients who had received a diagnosis of major depressive disorder, as determined by predetermined inclusion and exclusion criteria, were enrolled in this triple-blind clinical trial. Patients were divided into two groups: group A, received L-arginine 1 gram twice daily, and group B, received a placebo for four weeks. They were evaluated at baseline, after four and eight weeks with the Hamilton Depression Rating Scale (HDRS), and Rosen's questionnaire or Female Sexual Function Index (FSFI).

RESULTS

A decrease in the severity of depression was observed in all patients, which was determined due to Hamilton's questionnaire (P-value < 0.001). During the time in group A, FSFI increased. Based on the FSFI questionnaire, they had improvement in some domains, including the lubrication index and orgasm index, which significantly changed in the eighth week compared to the baseline (P-value < 0.05). However, these two indicators did not change statistically significantly compared to the placebo group.

CONCLUSION

L-arginine supplementation can improve sexual function, particularly lubrication and orgasm, and mood in women with depression, with minimal side effects observed. Additional research is necessary to validate these results by examining the effects of higher dosages, extended durations, and larger populations of depressed patients.

TRIAL REGISTRATION

Iranian Registry of Clinical Trial: IRCT20100127003210N26.

Small Effects, Questionable Outcomes: Bremelanotide for Hypoactive Sexual Desire Disorder

Efficacy outcomes are only informative to the extent that they are validated. We examined the measurement properties of efficacy measures from the phase III ("RECONNECT") bremelanotide trials for hypoactive sexual desire disorder (HSDD) in women. Continuous efficacy outcomes, including a) the Female Sexual Function Index (FSFI) and its Desire domain (FSFI-D) and b) the Female Sexual Distress Scale-Desire/Arousal/Orgasm (FSDS-DAO) and its item assessing distress due to low desire (FSDS-DAO #13) have questionable, at best, validity evidence for women with HSDD. We found no validity evidence for previously published categorical treatment response outcomes from the RECONNECT trials. All efficacy results should be reported, but results on 8 of the 11 clinicaltrials.gov-specified efficacy outcomes were heretofore unpublished (including FSDS-DAO total score, FSFI total score, FSFI arousal domain, and items from the Female Sexual Encounter Profile-Revised). We analyzed these outcomes, upon which effect sizes ranged from nil to small. Several other continuous and categorical outcomes generated modest apparent benefits, though nearly all of these outcomes were likely derived post-hoc. Across RECONNECT trial data from two prior publications and the current study, bremelanotide's benefits are statistically modest and limited to outcomes for which scant evidence of validity among women with HSDD exists.

The Role of Dyadic Sexual Desire Similarity in Predicting Sexual Behaviors in Cohabitating Couples: An Ecological Momentary Assessment Study

Although researchers are increasingly paying attention to the dyadic nature of sexual desire and its relevance to sexual and relational outcomes, our understanding of how sexual desire operates on a couple level and how it may influence the occurrence of sexual activity in relationships remains limited. This study used ecological momentary assessments to explore to what extent similarity in levels of desire for sex with one's sexual partner, or dyadic sexual desire, was associated with sexual initiations, receptivity to one's partner's initiations, and partnered sexual activity, and how these associations were moderated by perceived partner support. Ninety-four cohabitating couples (M age = 26.30, SD = 7.60) provided six reports a day for 10 consecutive days. We used response surface analysis to examine the associations among both the degree and direction of (dis)similarity in partners' dyadic desire and each of the three outcome variables. Our results revealed that although partners tended to experience similar levels of desire on a moment-to-moment basis, similarity in desire levels was not associated with the three outcome variables. Rather, higher desire within couples predicted each partner's behavioral outcomes. At lower levels of perceived partner support, dyadic sexual desire was negatively associated with women's receptivity to sexual initiations by their partners, indicating high context-sensitivity of women's sexual responding. These findings offer new insights into the links between the similarity in partners' levels of dyadic desire and sexual behaviors in couples, suggesting the need for increased focus on maintaining desire and promoting perceived partner support in clinical practice.

Effects of Subjective Orgasm Experience in Sexual Satisfaction: A Dyadic Analysis in Same-Sex Hispanic Couples

Subjective orgasm experience (SOE) is a component of sexual health that refers to the perception, sensation and/or appraisal of orgasm at a psychological level. This construct has scarcely been studied in non-heterosexual individuals and couples, and never before from a dyadic perspective. In this study, in which 104 same-sex Hispanic couples participated (48 male-male and 56 female-female), we explored the dyadic influence of SOE dimensions on sexual satisfaction, the mediating role of relationship satisfaction on the association of both phases of sexual response, as well as the explanatory capacity that discrepancies in these dimensions had on sexual satisfaction. The results indicated that the orgasmic dimensions that gained more prominence were Affective and Sensory. A dyadic influence of both on sexual satisfaction was observed only in male couples, as well as a detriment of sexual satisfaction when there were discrepancies in them, especially in women. Moreover, relationship satisfaction was a significant mediator between all dimensions of SOE and sexual satisfaction in both types of couples. This work highlights the need to take into account the SOE of both partners and how this individual experience can affect other dimensions of a more interpersonal nature, such as sexual or relationship satisfaction.

Attitudes toward Mothers as Sexual Beings (ATMSB): Scale Development and Associations with Satisfaction and Desire among Parents with Young Children

Societal messages about mothers indicate an incompatibility between motherhood and sexuality and women report not feeling like sexual beings after transitioning into parenthood. Research shows that negative sexual attitudes are associated with worse sexual function, indicating that negative attitudes toward mothers as sexual beings may negatively impact the sexual health of mothers and their partners. However, there is no existing tool to measure sexual attitudes about mothers. The aim of this study was to develop a tool to measure attitudes toward mothers as sexual beings (ATMSB) and examine associations with sexual satisfaction, relationship satisfaction, and desire among men and women with small children. Men and women with their first child no older than 5 (N = 481) were recruited from Qualtrics Panels. Results indicated that the ATMSB scale is a reliable and valid 11-item tool for measuring attitudes about mothers as sexual beings. The scale has two subscales, one on sexuality and quality of mothering and another on mothers' sexual interests and behaviors. ATMSB scores were associated with sexual satisfaction, relationship satisfaction and desire for men and women with young children. This scale has implications for sex research and clinical practice addressing issues that are relevant to mothers and their partners.

Sexual function among women with vaginismus: a biopsychosocial approach

BACKGROUND

Vaginismus is known as a type of sexual pain disorder. Regarding the multifactorial nature of vaginismus, the biopsychosocial model is one of the best models to describe this sexual disorder.

AIM

The present research was conducted to study the determinants of sexual function in women with and without vaginismus based on the biopsychosocial model.

METHODS

This case-control study was conducted in Iran on 420 women with and without primary vaginismus who met the inclusion criteria. All eligible people were included in the research once their eligibility was verified and their informed permission was acquired; convenience and purposive sampling techniques were used continually. Data collection tools included the demographic and obstetric information form and multiple published scales and questionnaires. Structural equation modeling with LISREL 9.2 software (Scientific Software International) was used to evaluate the determinants of the sexual function of vaginismus.

OUTCOMES

Participants rated their determinants of sexual function based on the biopsychosocial model.

RESULTS

The mean ages of the case and control groups were 27.67 and 28.44 years, respectively. The direct, indirect, and total effects of the dimensions of sexual health on sexual function and the diagnostic score of vaginismus of the women with vaginismus were significant (P < .001). Furthermore, based on the results, the diagnostic score of vaginismus in women with vaginismus was significantly affected by the direct, indirect, and cumulative impacts of vaginal penetration cognition and fear of sex (P = .016, P = .005). Women with and without vaginismus were able to accept the models' excellent fit.

CLINICAL IMPLICATIONS

This study helps inform health planners and policy makers about the sexual function of women with vaginismus, the factors related to this disorder, and the multidimensional nature of this sexual problem.

STRENGTHS AND LIMITATIONS

This study attempted to offer a more comprehensive and complete view of present knowledge via surveying different aspects of sexual health and by means of valid and reliable tools and path analysis. The study's merits include the use of the biopsychosocial model to evaluate sexual function in women with vaginismus, the use of a variety of questionnaires to compare women with and without vaginismus, and the size of the sample. The research was limited by the fact that electronic sampling was conducted because of the COVID-19 epidemic.

CONCLUSION

Based on the findings of the present study for the group of women with vaginismus, the direct, indirect, and overall effects of the majority of dimensions of sexual health were significantly correlated with sexual function and vaginismus.

Sexual Satisfaction Mediates the Effects of the Quality of Dyadic Sexual Communication on the Degree of Perceived Sexual Desire Discrepancy

Difficulties related to sexual desire discrepancy are among the most common complaints in people seeking help in therapy. The aims of the current study were to test a mediation model using a bootstrapping procedure where the quality of the dyadic sexual communication plays a key role in increasing or diminishing the degree of perceived sexual desire discrepancy through sexual satisfaction. An online survey was administered through social media to N = 369 participants involved in a romantic relationship, measuring the quality of dyadic sexual communication, sexual satisfaction, the degree of the perceived sexual desire discrepancy, and a series of relevant covariates. As expected, the mediation model showed that a better quality of dyadic sexual communication is related to a lower degree of perceived sexual desire discrepancy through increased sexual satisfaction (β = -0.17, SE = 0.05, [95% CI = -0.27, -0.07]). The effect held over and above the effect of the relevant covariates. The theoretical and practical implications of the present study are discussed.

Economic distress and perceptions of sexual intimacy in remarriage

Introduction

Economic distress and the relationship stability of remarried couples has been subject to some exploration, but less emphasis has been placed on how economic distress among remarried couples impacts other relationship domains, particularly sexual intimacy.

Methods

Through the lens of multidimensional family development theory (MFDT), this study utilizes longitudinal data over a three-year period to examine the links between economic distress, couple engagement, relationship satisfaction, and perceptions of sexual intimacy among remarried couples (n = 1,161 couples; 97% White).

Results

Through a dyadic structural equation model, results showed that wives' report of economic distress was directly related to their self-rejection of a partner's sexual advances. Findings also revealed gender differences in how both relationship satisfaction and couple engagement influenced one to accept or reject their partner's sexual advances, with couple engagement acting as a significant predictor for wives. Relationship satisfaction was also found to explain (i.e., mediate) the relation between economic distress and sexual intimacy, but only for husbands.

Discussion

Implications for further research and interventions designed to strengthen the relationships of remarried couples dealing with economic distress and intimacy issues are offered.

Relational Instability in Couples Seeking Therapy: The Contribution of Attachment, Caregiving and Sex

Attachment theory postulates that three behavioral systems-attachment, caregiving, and sex-are essential for optimal relationship functioning in couples. We examined the contribution of attachment insecurities, perceived partner support, and sexual satisfaction to relational instability in 274 couples seeking relationship therapy. The results underscore the importance of all three systems for relationship stability, showing that for both men and women, avoidance of intimacy, low perceived partner support, and low sexual satisfaction were significant and concurrent predictors of relational instability. As such, intervening on factors associated with all three behavioral systems might help reduce relationship instability in couples experiencing relationship distress.

Sexual Difficulties, Problems, and Help-Seeking in a National Representative Sample: The Second Australian Study of Health and Relationships

The Australian Study of Health and Relationships is a large national population-representative survey of sexual behavior and attitudes conducted every decade. We describe experiences of sexual difficulties lasting at least a month among Australians surveyed in 2012-2013 and identify changes since the previous survey in 2001-2002. Computer-assisted telephone interviews were completed by 20,091 people aged 16-69 years (participation rate 66%) of whom 16,897 people had had sex with a partner in the previous year. We asked how long each difficulty lasted, whether it was a problem, and whether they sought treatment. Half (48%) the men and 68% of women reported at least one difficulty. Lack of interest in having sex was common (28% men, 52% women); 21% of men reported coming to orgasm "too quickly" and women reported inability to reach orgasm (25%) and trouble with vaginal dryness (22%). Women were more likely than men not to find sex pleasurable and to have physical pain during intercourse. Some differences by age group were also apparent. Many difficulties were not seen as problems, especially lacking interest and reaching orgasm too quickly. People with erection/dryness problems, or with pain in intercourse, were more likely to seek treatment, as were people with multiple difficulties. Between 2001-2002 and 2012-2013, there was little change for men, but among women rates of all sexual difficulties fell by 4-10 percentage points. This change accompanied a drop in frequency of sex among people in ongoing relationships and an increase in masturbation and use of pornography. One explanation might be that, over time, fewer women were agreeing to "service sex" when they were not in the mood. Overall, the drop in prevalence of women's sexual difficulties since a decade earlier suggests a change towards more egalitarian sexual relations.

A Mixed Methods Study of Sexual Communication in Various Couple Typologies Part I: Cluster Analysis

This study presents the first part of a mixed-methods exploration of couple sexual communication. Typologies of heterosexual couples in committed, sexual relationships were created for further exploration of group differences in sexual communication. A cluster analysis categorized couples into four different couple typologies: mutually satisfied, satisfied men/dissatisfied women, satisfied women/dissatisfied men, and mutually dissatisfied. Using a MANOVA approach, the couple typologies were used to identify differences in how the couple types communicated about sex. The results revealed significant differences among the differing couple types, which will be explored qualitatively in part two of this analysis.

Expectations and Sexual Desire in Romantic Relationships: An Experimental Investigation of Pleasure and Emotional Closeness Expectancies among Young Adults

Drawing from expectancy-value theory, the current study documented expected likelihoods (i.e., expectancies) of orgasm, non-orgasmic sexual pleasure, and emotional closeness during sex with a romantic partner, then tested their causal roles in sexual desire. Participants (N = 582, 50.3% women) were drawn from college student and online samples of young adults in the US. Expectancies were high overall; men reported much higher orgasm expectancies than women and this gender difference was larger in the college sample. Using a within-subjects, factorial experimental design, hypothetical vignettes manipulated participants' expectancies (high/low) pertaining to sex with a romantic partner. Multilevel models indicated emotional closeness expectancies had the strongest effects on men's and women's desire. Orgasm expectancies had stronger effects among the online sample, yet had the weakest effects on desire overall. Both emotional closeness and non-orgasmic pleasure expectancies had stronger effects on women's desire than on men's. Findings indicate young adults' expectations for their romantic sexual experiences may play strong roles in stimulating or stifling their sexual desire, suggesting some desire differences may be partially explained by differences in expectancies, and underscore sex as an important mechanism for fostering intimacy and experiencing pleasure for both young men and young women. Implications for clinical practice are discussed.

Childhood Maltreatment and Mid-Life Adult Sexuality: A 10-Year Longitudinal Study

One important long-term outcome of childhood maltreatment is thought to be impairments in intimate relationships. However, the specific nature of these impairments is not well understood. To address this gap, we examined the long-term relation of sexual, emotional, and physical abuse/neglect to four key aspects of sexuality in women and men: importance of sex, intimacy in sex, pain during sex, and pleasure during sex. As part of the U.S. longitudinal National Survey of Midlife Development, 807 participants in their mid-life (410 women, 397 men) completed measures of recollected childhood maltreatment and current aspects of adult sexuality. These measures were obtained at baseline (at which time the mean age was 53.28 years (SD = 10.97) and again 10 years later. For women at baseline, emotional abuse was positively associated with pleasure, emotional neglect was negatively associated with intimacy and with pleasure, physical abuse was positively associated with pain, and physical neglect was associated with importance of sex. For men, no significant associations were found. Prospectively, for women, sexual abuse predicted increases in pleasure during sex, and physical abuse significantly predicted increases in pain during sex. For men, physical neglect significantly predicted increases in pain. We discuss these sex differences and the role these results may play in the detrimental long-term effects of childhood maltreatment.

Sexual Communication Discrepancies in Married Individuals

Sexual communication brings numerous relational and sexual benefits. However, individuals often do not communicate sexually with their partners, resulting in the potential for sexual communication discrepancies (SCD). Guided by uncertainty reduction theory, the purpose of this exploratory study was to examine SCD in married relationships. Results of a cross-sectional survey conducted with 398 married individuals revealed a significant relationship between relational uncertainty and SCD, as well as significant associations between SCD and relational and sexual outcomes. The implications of this study are discussed in the context of sexual communication research and clinical settings.

The Sexual Communication Discrepancy Index: A Multidimensional Self-Report Instrument for the Assessment of Sexual Communication Discrepancies

Sexual communication offers relational and sexual benefits. However, the sexual communication occurring in an individual's relationship may be incongruent with their expectations for such communication. Such discrepancies can affect partners' relationships and are important to examine. This study presents a new instrument for assessing discrepancies in sexual communication, the Sexual Communication Discrepancy Index (SCDI). Results of two studies examining SCDI's dimensionality, factor structure, and reliability revealed a promising 24-item, 4-factor scale instrument. The index offers a brief, easily scored, and reliable measure of sexual communication discrepancies. It may prove useful for researchers and clinicians who focus on sexual communication.

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.

Attachment Orientation Moderates the Sexual and Relational Implications of Sexual Desire Discrepancies

We examined the degree and direction of sexual desire discrepancies (SDD) between partners and how this relates to sexual function, sexual satisfaction, relationship satisfaction in 100 Saudi Arabian couples, taking into account both partners' attachment orientation. Men and women reported better outcomes when they matched on higher levels of sexual desire. In case of a mismatch, women reported higher sexual satisfaction when their partner's level of sexual desire was higher than their own. Attachment anxiety and avoidance moderated the associations between SDD and the outcome variables. This study offers unique information on SDD in couples with strong gender role expectations and cultural restrictions regarding sexuality. Therapeutic interventions should be directed at understanding the attachment meaning of sexual desire.

A sexual and reproductive empowerment framework to explore volitional sex in sub-Saharan Africa

Volitional sex is central to the sexual health and well-being of women and girls globally. To date, few studies have examined women's empowerment and its application to sexual health outcomes, including volitional sex. The aim of this study was to explore the relevance of a sexual and reproductive empowerment framework to volitional sex across four geographically and culturally diverse contexts in sub-Saharan Africa. Qualitative data were collected between July and August 2017 in four sites: Ethiopia, Nigeria (Anambra and Kano states) and Uganda. A total of 352 women aged 15-49 and 88 men aged 18 and older were interviewed through 120 in-depth interviews and 38 focus group discussions (n = 440 total participants). Results describe the substantial barriers restraining women's sexual choices, particularly norms that stigmatise women's requests for sex, even within marriage. Results further highlight women's internal sexual motivations, particularly related to the enjoyment of sex and the role of sex in strengthening partner relationships. Future empowerment research and measurement should focus not only on sexual constraints, but also integrate internal motivations, in order to fully understand the factors that shape women's sexual health outcomes.

Sexual Health Implications of COVID-19 Pandemic

INTRODUCTION

A novel coronavirus (COVID-19) reached pandemic levels by March 11th, 2020, with a destructive impact across socioeconomic domains and all facets of global health, but little is known of its impact on sexual health.

OBJECTIVE

To review current knowledge on sexual health-related containment measures during pandemics, specifically COVID-19, and focus on 2 main areas: intimacy and relational dynamics and clinical effects on sexual health.

METHODS

We carried out a literature search encompassing sexual health and pandemic issues using Entrez-PubMed and Google Scholar. We reviewed the implications of the COVID-19 pandemic on sexual health regarding transmission and safe sex practices, pregnancy, dating and intimacy amid the pandemic, benefits of sex, and impact on sexual dysfunctions.

RESULTS

Coronavirus transmission occurs via inhalation and touching infected surfaces. Currently, there is no evidence it is sexually transmitted, but there are sexual behaviors that pose a higher risk of infectivity due to asymptomatic carriers. Nonmonogamy plays a key role in transmission hubs. New dating possibilities and intimacy issues are highlighted. Sexual activity has a positive impact on the immune response, psychological health, and cognitive function and could mitigate psychosocial stressors. COVID-19 pandemic affects indirectly the sexual function with implications on overall health.

CONCLUSION

Increased awareness of health-care providers on sexual health implications related to the COVID-19 pandemic is needed. Telemedicine has an imperative role in allowing continued support at times of lockdown and preventing worsening of the sexual, mental, and physical health after the pandemic. This is a broad overview addressing sexual issues related to the COVID-19 pandemic. As this is an unprecedented global situation, little is known on sexuality related to pandemics. Original research is needed on the topic to increase the understanding of the impact the current pandemic may have on sexual health and function. Pennanen-Iire C, Prereira-Lourenço M, Padoa A, et al. Sexual Health Implications of COVID-19 Pandemic. Sex Med Rev 2021;9:3-14.

Sexual Satisfaction in Older Heterosexual Couples From Four European Countries: Exploring the Roles of Actual and Perceived Discrepancy in Sexual Interest

Even though sexual activity frequently takes place with another person, research rarely focuses on how partners influence each other's sexual lives. This study used the sexual dyad to compare the concept of actual versus perceived discrepancy in sexual interest and explored how each is related to older partnered individuals' sexual satisfaction. Further, the study assessed the robustness of the association between sexual interest discrepancy and sexual satisfaction, if any, by controlling for emotional intimacy. The actor-partner interdependence model (APIM) using structural equation modeling (SEM) was applied to examine 677 heterosexual couples ages 60 to 75 in Norway, Denmark, Belgium, and Portugal. Although a couple's actual discrepancy in sexual interest was not predictive of female and male partners' sexual satisfaction, perceived discrepancy was negatively associated with sexual satisfaction in both partners after controlling for emotional intimacy. This indicates that the subjective feelings of being sexually dissimilar seem to be more important to sexual satisfaction than the actual mismatch among partners in older heterosexual couples. Moreover, the finding that emotional intimacy is linked with sexual satisfaction underscores the importance of a broader perspective on sexuality among older adults.

Mechanisms underlying the association between perceived discrepancy in sexual interest and sexual satisfaction among partnered older adults in four European countries

The ways in which the discrepancy between one's own interest in sex and that of one's partner may affect personal sexual satisfaction has rarely been systematically studied, especially among older adults. Previous research among younger adults indicates that a discrepancy in sexual desire can be detrimental in terms of several relationship outcomes, including sexual satisfaction. This study aimed to investigate a conceptual model of sexual satisfaction among coupled older adults which posits that the association between perceived discrepancy in sexual interest and sexual satisfaction is mediated by the frequency of sexual activity and emotional closeness during sex. Data from a probability-based postal survey that included 2695 partnered heterosexual adults aged 60-75 years from four European countries (Norway, Denmark, Belgium, and Portugal) were used to test the mediation model. Due to expected gender differences in the two mediators, all analyses were carried out separately for men and women. The findings supported the proposed model, suggesting that as an individual's perception of a discrepancy in sexual interest increases, his or her levels of sexual frequency and perceived closeness during sex decrease-which in turn diminishes sexual satisfaction. The results of this study provide insights into links among sexual interest, sexual frequency, emotional closeness, and sexual satisfaction in older adults, and point to substantial similarities in the sexuality of aging men and women in this regard.

Sexual Desire Discrepancy: A Position Statement of the European Society for Sexual Medicine

Introduction

There is a lack of theoretical and empirical knowledge on how sexual desire functions and interacts in a relationship.

Aim

To present an overview of the current conceptualization and operationalization of sexual desire discrepancy (SDD), providing clinical recommendations on behalf of the European Society of Sexual Medicine.

Methods

A comprehensive Pubmed, Web of Science, Medline, and Cochrane search was performed. Consensus was guided by a critical reflection on selected literature on SDD and by interactive discussions between expert psychologists, both clinicians and researchers.

Main Outcome Measure

Several aspects have been investigated including the definition and operationalization of SDD and the conditions under which treatment is required.

Results

Because the literature on SDD is scarce and complicated, it is precocious to make solid statements on SDD. Hence, no recommendations as per the Oxford 2011 Levels of Evidence criteria were possible. However, specific statements on this topic, summarizing the ESSM position, were provided. This resulted in an opnion-based rather than evidence-based position statement. Following suggestions were made on how to treat couples who are distressed by SDD: (i) normalize and depathologize variation in sexual desire; (ii) educate about the natural course of sexual desire; (iii) emphasize the dyadic, age-related, and relative nature of SDD; (iv) challenge the myth of spontaneous sexual desire; (v) promote open sexual communication; (vi) assist in developing joint sexual scripts that are mutually satisfying in addition to search for personal sexual needs; (vii) deal with relationship issues and unmet relationship needs; and (viii) stimulate self-differentiation.

Conclusion

More research is needed on the conceptualization and underlying mechanisms of SDD to develop clinical guidelines to treat couples with SDD.

Marieke D, Joana G, Giovanni C, et al. Sexual Desire Discrepancy: A Position Statement of the European Society for Sexual Medicine. J Sex Med 2020;8:121–131.

Positive Communication and Partner Appraisals Among Mothers and Their Long-Term Male Partners: Impact on Sexual and Relationship Satisfaction

Parents in the USA struggle to maintain their sexual and relational health over time. The current study aimed to investigate the impact of positive communication and partner appraisals on sexual and relationship satisfaction in a sample of 93 mixed sex couples (N = 186) with children living in the home on a full-time basis. Results indicated that for men and women, positive communication scores predicted higher levels of sexual and relationship satisfaction and more positive partner appraisals predicted higher levels of relationship satisfaction. Significant results were also found at the couple-level. Findings have clinical and educational implications for parents.

Sexual practices and risk behaviors of Israeli adult heterosexual men

The knowledge of sexual practices of heterosexual males (HM) in Israel is limited despite the increase inthe incidence of sexually transmitted diseases (STI). This study assessed sexual practices among Israeli HM and the associations between demographic characteristics and sexual risk behaviors. The Cross-sectional study included a representative sample of 913 Jewish HM aged 18-44, which completed a questionnaire including their demographics, sexual practices, and risky sexual behavior. Of all participants, 66.8% had monogamous sex with their steady partner. These participants were more likely to be older, religious, involved ina limited repertoire of sexual practices, and less likely to engage in risky sexual behavior. Of the participants, 9.6% were in steady relationships but had concomitant sexual casual partner/s. They were more likely to be secular, paid for sex, and had more lifetime sexual partners. Of all the participants, 23.6% were singles and had sex with casual partner/s. They were more likely to be younger and engage in risky sexual behavior. Of all participants, 10.3% were involved in risky sexual behavior. These men were more likely to be singles, pay for sex and have more lifetime sexual partners. We conclude that preventive interventions aimed to prevent STI-infections should target HM who are in singles and those in steady relationships and have concomitant sex partners.

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.

Who's Distressed by Sexual Difficulties? Exploring Associations Between Personal, Perceived Partner, and Relational Distress and Sexual Difficulties in Heterosexual Men and Women

While not all sexual difficulties cause distress, research and clinical experience suggest that, apart from personal distress, partner and relational sexual distress are also often an important reason to seek professional help. The current study explored the associations between personal, perceived partner, and relational distress that men and women experience as a result of sexual difficulties. Data from heterosexual Flemish individuals ages 16 to 74 who were in a relationship (13,800 men and 13,242 women, mean age of 43.69, SD = 14.94) were collected via an online survey. Presence and severity of sexual difficulties and associated personal, perceived partner, and relational sexual distress were assessed. Among men and women with desire difficulties, either the three types of sexual distress were almost equally common or partner distress was most common. Arousal, orgasm, and sexual pain difficulties were most often associated with personal distress, particularly in men. Both men and women, however, most commonly reported that they experienced all three types of distress. These results are discussed in relation to Western gender-specific sexual scripts. Clinical implications and the importance of couples therapy and suggestions for clinically useful diagnostic criteria are presented.

Male Sexual Desire: An Overview of Biological, Psychological, Sexual, Relational, and Cultural Factors Influencing Desire

INTRODUCTION

The literature showed the need for a better understanding of the male sexual response, which has historically been considered as simpler and more mechanistic compared with that in women.

AIM

To examine the literature on biopsychosocial factors associated with the level of sexual desire in men and discuss some interesting directions for future research.

METHODS

A systematic literature review was conducted.

MAIN OUTCOME MEASURES

169 articles published in Google Scholar, Web of Science, Scopus, EBSCO, and Cochrane Library about male sexual desire and related biopsychosocial factors.

RESULTS

We found a lack of multidimensional studies on male sexual desire. Most existing research has focused on hypoactive sexual desire disorder in coupled heterosexual men. Biological factors play important roles in the level of sexual desire, but they are insufficient to explain the male sexual response. Psychological, relational, and sexual factors (eg depression, anxiety, emotions, attraction, conflicts, communication, sexual functioning, distress, satisfaction) are involved in the development/maintenance of lack of sexual interest in men. Cultural influence is also relevant, with cognitive factors linked to gender roles and sexual scripts of masculinity identified as important predictors of low sexual desire.

CONCLUSION

Male sexual desire is characterized by an interplay among biological, psychological, sexual, relational, and cultural elements. This interplay merits further study to better understand how sexual desire works and how treatments for low sexual interest could be improved. Nimbi FM,Tripodi F, Rossi R, et al. Male Sexual Desire: An Overview of Biological, Psychological, Sexual, Relational, and Cultural Factors Influencing Desire. Sex Med Rev 2020;8:59-91.

Sex in Midlife: Women's Sexual Experiences in Lesbian and Straight Marriages

OBJECTIVE

This study examines how married straight and lesbian women understand sexual changes in midlife.

BACKGROUND

Sexual satisfaction is key to marital quality, yet marital sex typically diminishes in midlife. Little is known, however, about how married straight and lesbian women make sense of midlife sexuality. Comparing the narratives of lesbian and straight women can reveal how midlife events, relational contexts, and gender norms drive women's experiences of and responses to diminishing sex.

METHOD

Inductive and deductive analyses were performed on interviews with a convenience sample of 16 straight and 16 lesbian mostly high-status married couples in Massachusetts.

RESULTS

Lesbian and straight women suggest that sexual activity and desire diminish over time due to health, aging, and caregiving events, yet lesbian women additionally emphasize the importance of weight gain, caregiving for adult parents, and shared experiences of menopause. Women further describe distress when their sex lives diverge from norms specific to marriage and their sexual identities. Moreover, women report relationship work designed to maintain or reignite sex; when compared with straight women, lesbians describe more work and a stronger sense of duty to keep sex alive and uniquely describe medical providers as unhelpful in addressing sexual challenges.

CONCLUSION

The results suggest that relational contexts and cultural discourses shape straight and lesbian women's experiences of distress and comfort about diminishing sex in marriage.

Maintaining Sexual Desire in Long-Term Relationships: A Systematic Review and Conceptual Model

The most universally experienced sexual response is sexual desire. Though research on this topic has increased in recent years, low and high desire are still problematized in clinical settings and the broader culture. However, despite knowledge that sexual desire ebbs and flows both within and between individuals, and that problems with sexual desire are strongly linked to problems with relationships, there is a critical gap in understanding the factors that contribute to maintaining sexual desire in the context of relationships. This article offers a systematic review of the literature to provide researchers, educators, clinicians, and the broader public with an overview and a conceptual model of nonclinical sexual desire in long-term relationships. First, we systematically identified peer-reviewed, English-language articles that focused on the maintenance of sexual desire in the context of nonclinical romantic relationships. Second, we reviewed a total of 64 articles that met inclusion criteria and synthesized them into factors using a socioecological framework categorized as individual, interpersonal, and societal in nature. These findings are used to build a conceptual model of maintaining sexual desire in long-term relationships. Finally, we discuss the limitations of the existing research and suggest clear directions for future research.

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.

Sexual Preoccupation Behavior in Parkinson's Disease

People with Parkinson's disease (PD) present with problematic sexual behaviors that are often misunderstood or ignored. Sexual problems in PD are part of a non-motor syndrome, and they play a  prominent role in the life of affected individuals and their partners. Based on our considerable clinical experience, we describe four common types of sexual preoccupation behaviors in people with PD: (1) sexual behavior with underlying sexual dysfunction, (2) sexual desire discrepancy with partner after restored desire, (3) hypersexuality and compulsive sexual behavior, and (4) sexual behavior with underlying restless genital syndrome. We also suggest methods of assessing and diagnosing these sexual behaviors, and propose alternative possible treatments for people with PD and their partners/caregivers. Understanding these four behavioral types will assist healthcare professionals in explaining and educating people with PD and their partners, contribute to decreased stress and tension between them, and help them manage these sexual issues.

What factors are associated with reporting lacking interest in sex and how do these vary by gender? Findings from the third British national survey of sexual attitudes and lifestyles

OBJECTIVES

To investigate factors associated with reporting lacking interest in sex and how these vary by gender.

SETTING

British general population.

DESIGN

Complex survey analyses of data collected for a cross-sectional probability sample survey, undertaken 2010-2012, specifically logistic regression to calculate age-adjusted OR (AOR) to identify associated factors.

PARTICIPANTS

4839 men and 6669 women aged 16-74 years who reported ≥1 sexual partner (opposite-sex or same-sex) in the past year for the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3).

MAIN OUTCOME MEASURE

Lacking interest in sex for ≥3 months in the past year.

RESULTS

Overall, 15.0% (13.9-16.2) of men and 34.2% (32.8-35.5) of women reported lacking interest in sex. This was associated with age and physical and mental health for both men and women, including self-reported general health and current depression. Lacking interest in sex was more prevalent among men and women reporting sexually transmitted infection diagnoses (ever), non-volitional sex (ever) and holding sexual attitudes related to normative expectations about sex. Some gender similarities in associated relationship and family-related factors were evident, including partner having had sexual difficulties in the last year (men: AOR 1.41 (1.07-1.86); women: AOR 1.60 (1.32-1.94)), not feeling emotionally close to partner during sex (men: 3.74 (1.76-7.93); women: 4.80 (2.99-7.69) and ease of talking about sex (men: 1.53 (1.23-1.90);women: 2.06 (1.77-2.39)). Among women only, lack of interest in sex was higher among those in a relationship of >1 year in duration and those not sharing the same level of interest (4.57 (3.87-5.38)) or preferences (2.91 (2.22-3.83)) with a partner.

CONCLUSIONS

Both gender similarities and differences were found in factors associated with lacking interest in sex, with the most marked differences in relation to some relationship variables. Findings highlight the need to assess, and if appropriate, treat lacking interest in sex in a holistic and relationship-specific way.

Correlates of Sex Frequency and Sexual Satisfaction Among Partnered Older Adults

This study examines behaviors associated with sex frequency and sexual satisfaction in a national sample of partnered older adults, age 50 to 85 (N = 9,164), together for over one year. The results indicate that older adults with active and satisfying sex lives engage more frequently in open sexual communication and setting the mood for sexual activity. Additionally, synchronicity in sexual desire and activities is related to a high-frequency and highly satisfying sex life in older adulthood. An expansive sexual repertoire, as measured by the number of sexual activities used during the last sexual encounter and the incorporation of sexual variety, is also associated with greater sex frequency and sexual satisfaction.

Satisfaction guaranteed? How individual, partner, and relationship factors impact sexual satisfaction within partnerships

Within committed relationships, a wide range of factors may challenge or facilitate sexual satisfaction. The aim of this study was to clarify which individual, partner-, and partnership-related aspects of a sexual relationship are crucial for the prediction of sexual satisfaction. The study included data of a representative sample of 964 couples from the general population. The actor-partner interdependence model was used to estimate actor and partner effects. Overall, predictors explained 57% of outcome variance. Actor effects were found for sexual function, sexual distress, frequency of sexual activity, desire discrepancy, sexual initiative, sexual communication, sociosexual orientation, masturbation, and life satisfaction. Gender-specific partner effects were found for sexual function and sexual distress. Neither age, nor relationship duration were significant predictors. To deepen our understanding of sexual satisfaction, it is necessary to take quantitative and qualitative aspects of sexual relationships into account and to consider actor-, partner-, and relationship-related predictors.

A New Baby in the Bedroom: Frequency and Severity of Postpartum Sexual Concerns and Their Associations With Relationship Satisfaction in New Parent Couples

INTRODUCTION

New parents are faced with many novel stressors, including possible changes to their sexual relationships. Although postpartum sexual concerns appear to be pervasive in new parents, little is known about the severity of these concerns or how they relate to new mothers' and fathers' relationship satisfaction.

AIM

To describe the frequency and severity of postpartum sexual concerns and examine associations between frequency and severity of postpartum sexual concerns and relationship satisfaction in new-parent couples.

METHODS

Participants were 239 new-parent couples of a healthy infant 3 to 12 months old. Both members of the parenting couple completed an online survey within 1 month of each other.

MAIN OUTCOME MEASURES

Frequency and severity of postpartum sexual concerns were assessed using a 20-item Likert-type questionnaire adapted from a previously validated measurement. Relationship satisfaction was assessed with the Couples Satisfaction Index.

RESULTS

A wide range of postpartum sexuality concerns was highly prevalent and moderately distressing in new mothers and fathers alike. New fathers' greater severity of postpartum sexual concerns was associated with their own and new mothers' decreased relationship satisfaction, whereas new mothers' greater severity of postpartum sexual concerns was associated only with lower relationship satisfaction in new fathers. In addition, new mothers' greater frequency of postpartum sexual concerns was associated with their own and new fathers' lower relationship satisfaction, whereas new fathers' frequency of postpartum sexual concerns was unrelated to the couples' relationship satisfaction.

CONCLUSION

Postpartum sexual concerns are pervasive and moderately distressing in new parents. The increased frequency and severity of these concerns were associated with decreased relationship well-being in both members of the couple. New mothers might need more assistance adjusting to the number of sexual concerns that they are experiencing, whereas new fathers might need more help adjusting to distress related to sexual issues.

Differences in Pornography Use Among Couples: Associations with Satisfaction, Stability, and Relationship Processes

The present study utilized a sample of 1755 adult couples in heterosexual romantic relationships to examine how different patterns of pornography use between romantic partners may be associated with relationship outcomes. While pornography use has been generally associated with some negative and some positive couple outcomes, no study has yet explored how differences between partners may uniquely be associated with relationship well-being. Results suggested that greater discrepancies between partners in pornography use were related to less relationship satisfaction, less stability, less positive communication, and more relational aggression. Mediation analyses suggested that greater pornography use discrepancies were primarily associated with elevated levels of male relational aggression, lower female sexual desire, and less positive communication for both partners which then predicted lower relational satisfaction and stability for both partners. Results generally suggest that discrepancies in pornography use at the couple level are related to negative couple outcomes. Specifically, pornography differences may alter specific couple interaction processes which, in turn, may influence relationship satisfaction and stability. Implications for scholars and clinicians interested in how pornography use is associated with couple process are discussed.

Sex drive and sexual desire

PURPOSE OF REVIEW

Loss of sexual desire is increasingly recognized as a consequence of many disease processes, and one that can have a significant negative impact on quality of life. This review explores the biological and psychological aspects of desire, as well as the aetiology and therapeutic options for loss of desire.

RECENT FINDINGS

Discoveries have been made in terms of the physiology of desire in men, in that it is affected by estradiol as well as testosterone. It has also been shown that desire is less gender specific in androphilic women than in androphilic men and gynaephilic men and women. Fatigue has been described as the most common self-reported cause of loss of desire, with communication as the most common method for addressing this. In men, a clear distinction has been shown between disorders of arousal and disorders of desire, suggesting that they should remain as separate conditions in the Diagnostic and Statistical Manual of Mental Disorders criteria. Loss of desire has been proven to be a significant consequence of diabetes, multiple sclerosis and polycystic ovary syndrome and can occur as a side-effect of statins and 5α-reductase inhibitors. Testosterone therapy may be an effective treatment for loss of desire in both men and women, and is safe in the treatment of men who have been treated for prostate cancer. It also has a significant impact on desire when used in the treatment of individuals with gender dysphoria. Nonhormonal treatments including flibanserin and new methods of therapy may also be effective.

SUMMARY

Loss of desire is underrecognized as a symptom of disease or as a complaint in its own right. As further developments in treatment options, both therapies based and pharmacological, are made, it is increasingly important that clinicians enquire about sexual dysfunction, including loss of desire, at every consultation.