Dissociation during sex and sexual arousal in women with and without a history of childhood sexual abuse

Dissociation and Sexual Concerns in Male Survivors of Childhood Sexual Abuse: The Role of Identity Cohesion

Research on male survivors of childhood sexual abuse is notably deficient when it comes to addressing their sexual concerns, such as experiences of sexual distress, negative thoughts, and feelings related to their sexuality. Dissociation, a known consequence of childhood sexual abuse, could be associated with higher sexual concerns through identity cohesion. Precisely, dissociation can potentially be related to lower identity cohesion (e.g., not knowing what you want or need). In return, lower identity cohesion may be related to higher sexual concerns by impeding the capacity to know and accept oneself, which tends to promote a positive and healthy sexuality. This study aimed to examine the role of identity cohesion in the link between dissociation and sexual concerns in 105 men consulting for their history of childhood sexual abuse. Men completed questionnaires assessing dissociation, sexual concerns, and identity cohesion at admission in a community setting. Results of a path analysis revealed an indirect association between dissociation and higher sexual concerns through lower identity cohesion. The model explained 27.6% of the variance in sexual concerns. This study highlights the relevance of interventions targeting dissociative symptoms to improve identity cohesion and sexual health in male survivors of childhood sexual abuse.

Borderline personality disorder and sexuality: causes and consequences of dissociative symptoms

BACKGROUND

Sexual risk behavior in patients diagnosed with borderline personality disorder (BPD) is supposed to be associated with traumatic experiences and dissociative symptoms. Nevertheless, scientific research thereon is scarce which might be due to the high prevalence of sexual trauma and fear of overwhelming patients with explicit sexual content.

METHODS

We investigated a clinical sample of patients diagnosed with BPD (n = 114) and compared them to a sample of matched healthy controls (HC) (n = 114) concerning the dissociative symptoms derealization, depersonalization, and conversion in sexual situations. In a subgroup of patients with BPD (n = 41) and matched HC (n = 40) dissociative symptoms after exposure to an acoustically presented erotic narrative were assessed in the lab. Regression analyses were used to examine the associations between sexual trauma, post-traumatic stress disorder (PTSD), dissociation in sexual situations, and risky sexual behavior.

RESULTS

Patients diagnosed with BPD endorsed higher dissociative symptoms in sexual situations retrospectively and in the lab compared to HC. Regression analyses revealed that depersonalization and conversion symptoms in sexual situations were explained by severity of BPD, while derealization was explained by PTSD symptomatology. Impulsive and sexual behavior with an uncommitted partner were higher in the BPD group and explained by derealization, while conversion showed an inverse association.

CONCLUSION

Our findings highlight the importance of addressing distinct dissociative symptoms in sexual situations when counselling and treating women with BPD. In the long term, this could contribute to a reduction in sexual risk behavior in patients with BPD.

TRIAL REGISTRATION

This analysis is part of a larger ongoing study and was registered prior to accessing the data (Registration trial DRKS00029716).

A Network Comparison of Sexual Dysfunction, Psychological Factors, and Body Dissociation between Individuals with and without Sexual Trauma Histories

Sexual dysfunction is associated with psychological symptoms, including depression and anxiety. Sexual dysfunctions are often attributed to dissociation symptoms in individuals who reported sexual trauma histories. This study utilized a network approach to analyze relationships between sexual and psychological symptoms and examine whether the identified network structures differed between individuals who reported a history of sexual trauma and those who did not. Sexual dysfunction, history of sexual trauma, internalizing symptoms, dissociation symptoms, sex-related shame, and negative body image were assessed in 1,937 United States college students (women = 69.5%). Nearly half (46.8%) of the participants reported a sexual trauma history in their lifetime. Using regularized partial correlation networks, the relationships between sexual and psychological symptoms were analyzed and compared between groups with and without trauma histories. Internalizing symptoms were positively correlated with sexual dysfunction regardless of the presence of sexual trauma history. Anxiety had a stronger influence in the trauma network than in the no-trauma network. Feeling separated from the body during sexual activity was a central symptom and was related to difficulties relaxing and enjoying sex only in the trauma network. Sex-related shame appeared to play a more important role in men compared to women. To improve clinical practice of assessing and treating sexual dysfunction, researchers and clinicians should consider core symptoms that connect different aspects of sexual and psychological functioning while being aware of the unique role of dissociation in the context of traumatic stress.

"Finding My Worth as a Sexual Being": A Qualitative Gender Analysis of Sexual Self-Concept and Coping in Survivors of Childhood Sexual Abuse

Childhood sexual abuse (CSA) is likely to have impacts on adult survivors' sexuality, particularly on their sexual self-concept. However, little is known about how survivors cope with CSA-related sexual impacts, including sexual self-concept impairments. Thus, this study aimed to examine the interplay between sexual self-concept and coping strategies in CSA survivors by (1) documenting the manifestations of their impaired sexual self-concepts; (2) identifying their strategies to cope with the sexual impacts of CSA; and (3) examining gender differences on sexual self-concept impairments and coping strategies. Content analysis was conducted on semi-structured interviews with 25 women and 26 men adult survivors of CSA recruited via social networks and victim support organizations. Analyses yielded three conceptual categories: (1) Developing an unconsolidated and unfavorable sexual self-concept following CSA; (2) Avoiding CSA-related sexual impacts and impaired sexual self-concept; (3) Approaching CSA-related sexual impacts with more authenticity. Men often managed their suffering and compensated for their impaired sexual self-concept by engaging in sexual dominance and over-investment, by accepting their sexual difficulties and relying on medication to overcome them. Women tended to restrict themselves and disconnect sexually to avoid suffering, complied with their partners' sexual demands out of a sense of duty, prioritized sexual intimacy over orgasm, and seek professional help. Interventions with survivors should promote the development of approach strategies to cope with sexual difficulties, including self-concept impairments, and foster sexual authenticity.

Reduction in genital sexual arousal varies by type of oral contraceptive pill

BACKGROUND

Although oral contraceptive pills (OCPs) have been associated with decrements in self-reported genital arousal and vaginal lubrication, 1,2 little is known about how these outcomes vary across types of OCPs.

AIM

The present study examined differences in physiological lubrication and vaginal blood flow, as well as rates of self-reported vulvovaginal atrophy and female sexual arousal disorder, among women using OCPs with varying androgenic properties.

METHODS

Participants in this study were 130 women: 59 naturally cycling control women, 50 women taking androgenic OCPs, and 21 women taking antiandrogenic OCPs. Participants watched sexual films while their sexual arousal responses were measured, completed questionnaires, and participated in a clinical interview.

OUTCOMES

Vaginal blood flow, vaginal lubrication, self-reported vulvovaginal atrophy, and female sexual arousal disorder were assessed.

RESULTS

Results indicated deficits in vaginal pulse amplitude and lubrication for women taking either form of OCP, with marked inhibitory effects found in women taking antiandrogenic OCPs. Rates of self-reported vulvovaginal atrophy and female sexual arousal disorder were also significantly greater in the antiandrogenic group compared with the control group.

CLINICAL IMPLICATIONS

It is recommended that prescribing clinicians consult patients on such physiological effects of OCPs.

STRENGTHS AND LIMITATIONS

To our knowledge, this was the first study to compare multiple measures of physiological sexual arousal across groups of women taking OCPs with varying hormonal profiles. Because all OCPs included in this study contained low doses of ethinylestradiol, we were able to identify the specific effects of the androgenic properties on women's sexual arousal responses. However, the self-administered lubrication test strip was subject to user error. Additionally, the generalizability of findings is limited by the largely heterosexual and college-aged sample.

CONCLUSION

Compared with naturally cycling women, women taking OCPs that contain antiandrogenic progestins experienced decreased vaginal blood flow and lubrication as well as higher rates of self-reported vaginal bleeding and female sexual arousal disorder.

Childhood Sexual Abuse and Relationship Satisfaction: The Moderating Role of PTSD and Sexual-Related Posttraumatic Stress Symptoms

Research on childhood sexual abuse (CSA) has consistently demonstrated the long-term effects of such abuse, not only on survivors' development, but also on the nature and quality of their adult relationships, particularly romantic ones. In this study we examined the moderating role of posttraumatic stress disorder (PTSD) and sexual-related posttraumatic stress symptoms (sexual-related PTSS) between CSA and relationship satisfaction. Survey data from 529 individuals who reported being currently in a romantic relationship were analyzed. In the first set of analyses, results demonstrated that participants with CSA reported significantly lower relationship satisfaction and significantly greater severity of PTSD and sexual-related PTSS than participants without CSA. Sexual-related PTSS but not PTSD moderated the association between CSA and participants' relationship satisfaction, with the model of sexual-related PTSS explaining 20.8% of the variance in relationship satisfaction and the model of PTSD explaining 11.3% of this variance. In the second set of analyses conducted among survivors of CSA only, higher sexual-related PTSS severity was linked with ongoing abuse and with abuse by a non-family member. This study points to the potential contribution made by sexual-related PTSS to relationship satisfaction among survivors of CSA.

Between pleasure, guilt, and dissociation: How trauma unfolds in the sexuality of childhood sexual abuse survivors

BACKGROUND

Childhood sexual abuse (CSA) is a significant risk factor for sexual difficulties in adulthood.

OBJECTIVE

In the current study we aimed to expand the understanding of the association between CSA and sexual difficulties by examining the moderating role of traumatic sexuality in the association between CSA and sexual difficulties among a sample of CSA survivors.

PARTICIPANTS AND SETTING

The hypothesized moderation model was examined among a sample of 393 CSA survivors.

METHODS

Significant interactions were probed using simple slopes tests using the interactions R package.

RESULTS

The results indicated main effects of traumatic sexuality on survivors' sexual difficulties: Greater severity of dissociation during sex was linked with greater sexual dysfunction and higher compulsive sexual behavior disorder (CSBD), and greater intrusiveness during sex and pleasing the other during sex were linked with higher CSBD. Experiencing higher sex-related guilt and/or shame and hypervigilance with regard to sex were associated with greater sexual dysfunction. As for the moderations, intrusiveness during sex and pleasing the other during sex moderated the association between CSA and sexual dysfunction. Intrusiveness during sex and sex-related guilt and/or shame moderated the association between CSA and CSBD. Intrusiveness during sex, pleasing the other during sex, and/or hypervigilance with regard to sex moderated the association between CSA and problematic pornography use.

CONCLUSION

This study points to the potential contribution of traumatic sexuality symptoms to sexual difficulties among survivors of CSA and lends support to the idea of offering trauma-focused therapy when treating the sexual difficulties of CSA survivors.

Who am I as a Sexual Being? The Role of Sexual Self-Concept Between Dispositional Mindfulness and Sexual Satisfaction among Child Sexual Abuse Survivors

Childhood sexual abuse (CSA) is associated with long-lasting and pervasive impacts on survivors' sexual health, particularly on their sexual satisfaction. Dispositional mindfulness has been found to be associated with greater sexual satisfaction among adult CSA survivors. However, the mechanisms involved in this association remain understudied. The present study examined the role of sexual self-concept (i.e., sexual esteem, sexual preoccupation, and sexual depression) in the relationship between dispositional mindfulness and sexual satisfaction among CSA survivors. A total of 176 adult CSA survivors (60.6% women, 39.4% men) completed an online survey assessing dispositional mindfulness, sexual self-concept, and sexual satisfaction. Path analyses revealed that dispositional mindfulness was positively related to sexual satisfaction through a significant indirect effect of higher sexual esteem and lower sexual depression. The integrative model explained 66.5% of the variance in sexual satisfaction. These findings highlight the key roles that dispositional mindfulness and sexual self-concept play in CSA survivors' sexual satisfaction. Implications for interventions based on trauma-sensitive mindfulness targeting the sexual self-concept are discussed, as they may promote sexual satisfaction in adult CSA survivors.

Sex in the Shadow of Child Sexual Abuse: The Development and Psychometric Evaluation of the Post-Traumatic Sexuality (PT-SEX) Scale

Sexual-related post-traumatic stress symptoms (sexual-related PTSS) refers to the traumatic reactions that are replicated during sexual activity among survivors of child sexual abuse (CSA). However, the construct of sexual-related PTSS have been adapted from clinical work with survivors, and research with limited examination of the scales themselves. Given this gap, the current study offers the development of a new measure (PT-SEX) that examines sexual-related PTSS. The study was conducted online, among two convenience samples of women survivors of CSA (study 1 included 451 women and study 2 included 330 women). Six reliable PT-SEX factors emerged from Study 1: Dissociation during sex, intrusiveness during sex, shame and guilt in regard to sexual aspects, pleasing the other during sex, interpersonal distress, and hypervigilance during sex. Study 2 revealed survivors of CSA had significantly higher sexual-related PTSS levels as compared to participants without such a history. Also, post-traumatic stress disorder and sexual-related PTSS made unique and unshared contributions to the observed data, including sexual self-esteem, sexual motives, relationship satisfaction, compulsive sexual behavior, and mental health. CSA significantly moderated the associations between sexual-related PTSS and sexual self-esteem, sexual motivations of self-affirmation and coping, and depression and anxiety. Findings from the current study show that over time, the trauma of CSA seems to be implicated in survivors' sexual experience. As sexual difficulties are accompanied by sexual-related PTSS, these symptoms are unlikely to resolve by trauma-focused therapy and must be actively targeted in therapy.

Sexual Dysfunction Among Childhood Sexual Abuse Survivors: The "Functional" Dysfunction?

Various studies have established the association between child sexual abuse and sexual dysfunction. Although sexual dysfunction can be a distressing and undesirable condition for survivors of child sexual abuse, the current article suggests viewing sexual dysfunction not solely as a negative outcome but as a condition with a potent psychological function in regulating various psychological and relational needs among survivors. The main question addressed in the current paper is: What are the functional aspects of sexual dysfunction among child sexual abuse survivors? Four main protective purposes for sexual dysfunction among survivors of child sexual abuse are proposed: avoiding re-traumatization, regulating closeness within the relationship, gaining a sense of power and control and avoiding vulnerability, and restoring a positive sense of self. Although healthy sexual functioning is a desirable long-term goal for survivors, therapists need to view sexual dysfunction within the context of trauma, and to understand the protective functions of dysfunctions, before attempting to restore sexual function.

Eating Disorders and Sexual Satisfaction: The Mediating Role of Body Image Self-consciousness during Physical Intimacy and Dissociation

Women with eating disorders experience difficulties related to sexual activity, yet little is known about the indirect association between eating disorders and sexual satisfaction. This study examined the indirect association between eating disorders and sexual satisfaction using body image self-consciousness during physical intimacy and dissociation as mediators. Online questionnaires were answered by 985 Israeli women. Of them, 98 were identified as likely to have eating disorders (study group). A matching control group (n = 98) was selected from the remaining respondents. Participants in the study group had significantly higher body image self-consciousness and dissociation than the matched controls, as well as significantly lower sexual satisfaction. The research model revealed that body image self-consciousness during physical intimacy mediates the link between eating disorders and sexual satisfaction, while dissociation does not. Women with eating disorders have higher levels of self-consciousness about their body during sexual activity, which may distract them from their own sexual needs and desires and those of their partners, and this, in turn, is associated with sexual dissatisfaction. Findings highlight the need for improved evidenced-based assessment and management of the sexual satisfaction of women with eating disorders.Abbreviations: ED: eating disorders; AN: anorexia nervosa; BN: bulimia nervosa; BED: binge eating disorder.

The Impact of Child Sexual Abuse on Men's Sexual Function: A Systematic Review

Child sexual abuse (CSA) is strongly associated with sexual dysfunction. However, research about male survivors' sexual functioning after CSA is lacking. The current systematic review searched for all studies that reported on CSA and sexual function among male survivors to answer the following questions: Do male survivors of CSA experience sexual dysfunctions, and if so, to what extent? Does CSA increase the risk of developing sexual dysfunctions in adulthood among men? Studies were identified by searching seven databases and sources of gray literature. The selection criteria included empirical studies involving a population of adult men who experienced CSA before the age of 18. Studies focused on sexual functioning and sexual development after the abuse. Twelve studies met the selection criteria. While some studies confirmed that CSA is a risk factor for sexual dysfunction in adult male survivors, including low sexual drive, problems with arousal, and difficulties with orgasm and pain, other studies failed to find a correlation between sexual dysfunction and CSA. The wide range in quality, methodology, and definitions of CSA and sexual function presented challenges to consistent analysis of the studies and to determine the impact of CSA. Further research is required to fully understand the effect of CSA on adult men's sexual function.

Childhood Sexual Abuse and Sexual Motivations - The Role of Dissociation

The present study sought to examine the relations between a history of childhood sexual abuse (CSA) and sexual motivations and to explore the moderating role of dissociation within these relations. The study was conducted among 889 men and women (ages 18-70). Results indicated a history of CSA was significantly related to higher scores on self-affirmation, coping, partner approval and peer pressure sexual motivations. Interactions between CSA and gender in explaining sexual motivations, were not significant. Among participants with a history of CSA (n = 365), dissociation was significantly related to sexual motivations, so that participants who had dissociation scores above the cutoff (reporting high levels of dissociation) scored higher on intimacy, self-affirmation, coping, and partner approval than did those with a history of CSA who reported low levels of dissociation. Analyzes revealed significant moderating effects for dissociation within the relations between CSA and intimacy, coping, and partner approval sexual motivations. The present study suggests CSA survivors and those who report high levels of dissociation in particular, utilize sex for intimacy, for coping with negative emotions, and for partner approval. Therapists working with CSA survivors should be aware of the potential effects the abuse has on the survivor's reasons to engage in sex.

Developmental Pathways from Childhood Maltreatment to Young Adult Romantic Relationship Functioning

Childhood abuse has been suggested to potentiate a maladaptive developmental trajectory, leaving adolescents and young adults at risk for mental health and romantic relationship problems. It has been suggested that mental health problems mediate the relationship between childhood abuse and young adult romantic relationship functioning; however, there are few prospective studies. The objective of the current study was to examine the effects of childhood physical, sexual, and emotional abuse on posttraumatic stress symptoms in adolescence, and relationship quality, intimacy, companionship, and conflict in young adult's romantic relationships. Using data from the Longitudinal Studies of Childhood Abuse and Neglect (LONGSCAN), a sample of 313 racially diverse adolescents were used. Using structural equation modeling, it was found that dissociation mediated the relationship between physical abuse and relationship quality, but in the opposite direction of what was expected. Additionally, anger mediated the relationship from both physical and sexual abuse to conflict. Childhood abuse appears to influence young adult relationship functioning through mental health problems in mid-adolescence, particularly anger and dissociation. These results are consistent with the notion that children who were abused may struggle in romantic relationships in young adulthood and addressing mental health problems in adolescence may a point of intervention.

Trauma-Informed Sex Positive Approaches to Sexual Pleasure

This paper develops a trauma-informed sex-positive framework as a public health, clinical, and research approach to sexual experience over the life course. The framework centers trauma-informed sex positivity as the linkage for sexual pleasure (along with sexual wellbeing and sexual health) to the social, cultural, and legal concepts of sexual justice. By providing a conceptual distinction of sexual pleasure from sexual wellbeing and sexual health, the framework improves clarity about how these constructs are related as well as provides possibilities for detailed operationalization in public health surveillance and in the new research.

What is sexual wellbeing and why does it matter for public health?

Sexual health has provided a guiding framework for addressing sexuality in public health for several decades. Although the WHO definition of sexual health is revolutionary in acknowledging positive sexuality, public health approaches remain focused on risk and adverse outcomes. The long-standing conflation of sexual health and sexual wellbeing has affected our ability to address everyday sexual issues. This Viewpoint provides a way forward to resolve this impasse. We propose sexual wellbeing as a distinct and revolutionary concept that can be operationalised as a seven-domain model. We situate sexual wellbeing alongside sexual health, sexual justice, and sexual pleasure as one of four pillars of public health enquiry. We argue that sexual wellbeing is imperative to public health as a marker of health equity, a meaningful population indicator of wellbeing, a means to capture population trends distinct from sexual health, and an opportunity to refocus the ethics, form, and practices of public health.

Addressing Sexual Dysfunction After Childhood Sexual Abuse: A Clinical Approach from an Attachment Perspective

Sexual dysfunctions are very prevalent among survivors of childhood sexual abuse. While the relationship between sexual abuse and sexual dysfunction is well-established, understanding of the mechanisms explaining this relationship is still limited and has not been studied thoroughly. The current article presents a preliminary, theoretical model of the association between childhood sexual abuse, and sexual dysfunctions in adulthood from an attachment-trauma perspective. This model is based on previous literature and hours of clinical work in sex therapy and attachment theory-based therapy, and identifies important factors that have not been adequately accounted for in the literature.

Women's Cortisol Stress Responsivity, Sexual Arousability, and Sexual History

Life history theory and the adaptive calibration model state that characteristics of one's early environment influence individual differences in both neuroendocrine reactivity to stress and sexual risk-taking behavior. However, few studies have directly examined the relationship between neuroendocrine reactivity to stress and risky sexual behavior. This study used multilevel modeling to test whether cortisol reactivity and recovery in response to laboratory stress were associated with women's history of sexual behavior and their sexual arousability in response to laboratory sexual stimuli. Participants were 65 women (35% heterosexual, 44% bisexual, and 21% lesbian) who completed two laboratory sessions, two weeks apart. Women's self-reported sexual arousability to sexual stimuli interacted with their sexual abuse history to predict their trajectories of cortisol stress reactivity and recovery. Cortisol reactivity and recovery were not associated with women's sexual risk taking, such as the age of sexual debut, sociosexuality, or lifetime number of sexual partners.

A Brief Report on the Association between Dissociation During Sex and Condom Use Self-Efficacy Among Women Residing in Domestic Violence Shelters

OBJECTIVE

Female survivors of intimate partner violence have greater risk for contracting HIV/STI's and experiencing dissociation. However, no studies have examined the association between dissociation and condom use self-efficacy in this population. This study explored whether dissociation during sex was negatively associated with condom use self-efficacy.

METHODS

Thirty-five women (88% African American) who were residing in domestic violence shelters in the United States completed questionnaires.

RESULTS

There was a negative correlation between dissociative experiences during sex and condom use self-efficacy, r = -.62, n=35, p< .01.

CONCLUSIONS

Findings suggest that dissociation during sex interferes with abused women's condom use self-efficacy.

Relationships between eating disorder psychopathology, sexual hormones and sexual behaviours

A growing body of evidences demonstrated that sexuality is an important topic in the clinical research of eating disorders (EDs), due to its association with specific psychopathological features, and etiological factors. The present review took into consideration the complex relationship between sexual behaviours, hormonal alterations and EDs psychopathology. Studies pertaining sexual behaviours in EDs were divided into those focusing on sexual dysfunctions, and those related to risky sexual behaviours. The limited number of studies on sexual dysfunctions, reported a controversial association with weight status and hormonal alterations, and a clear relationship with severity of specific psychopathology (e.g. body image disturbance). Risky sexual behaviours have been associated with impulsivity and dissociation, as well as with abnormal stress response. Finally, both restriction and uncontrolled eating have been found to be responsible for several complex metabolic alterations, determining varied sexual and gynecologic problems, such as amenorrhea, hypogonadism, genital vascular problems, infertility, and miscarriage, although it is also possible that alterations in feeding and stress hormones contribute to altered eating behaviour.

Sexual vs. Nonsexual Currently Most Upsetting Trauma: A Fresh Look at Attenuation of Sexual Response, Alcohol Intoxication, and Post-Traumatic Stress

This study examined the dependence of sexual response (vaginal pulse amplitude [VPA] and subjective sexual arousal) on alcohol intoxication (.10% breath alcohol concentration [BrAC] versus no alcohol) and the nature of a woman's currently most upsetting traumatic event (C-MUTE), whether it was sexual (e.g., rape) or nonsexual (e.g., combat). Self-reported sexual outcomes were also compared by C-MUTE type. A total of 117 women completed background measures and either drank alcoholic or nonalcoholic beverages. They were shown erotic films and their VPA was assessed. A two (sexual versus nonsexual C-MUTE) by two (.10% BrAC versus no alcohol) analysis of variance (ANOVA) showed that, controlling for post-traumatic stress (PTS) symptoms, women with a sexual C-MUTE showed lower percent VPA change than women with a nonsexual C-MUTE. No significant effects were found for subjective sexual arousal. A multivariate analysis of variance (MANOVA) showed that women with a sexual C-MUTE reported more frequent anxiety and inhibition during partnered sex and more frequent lack of vaginal lubrication versus women with a nonsexual C-MUTE. There was no significant interaction between C-MUTE and alcohol intoxication. Whether a woman is currently upset by past sexual victimization may influence current sexual difficulties. Attenuated VPA may be attributable to the sexual nature of a C-MUTE as opposed to general trauma exposure.

Women's Sex-Related Dissociation: The Effects of Alcohol Intoxication, Attentional Control Instructions, and History of Childhood Sexual Abuse

This study examined influences of alcohol intoxication, attentional control, and childhood sexual abuse (CSA) severity on sex-related dissociation. Sex-related dissociation is defined here as dissociation (e.g., feeling as if the world is unreal and feeling disconnected from one's body) during sexual activity or in the presence of sexual stimuli. Women (N = 70) were randomized to a 2 (alcohol condition: none,.10% peak breath alcohol concentration) X 2 (attentional control instructions: none, "relax and maximize" sexual arousal) experiment and exposed to sexual stimuli. Alcohol intoxication was positively associated with sex-related dissociation. CSA severity and sex-related dissociation were positively associated in the no-instruction condition but not in the "relax and maximize" condition. For some women, efforts to relax and maximize sexual arousal may buffer the association between CSA and sex-related dissociation.

Sexual problems and post-traumatic stress disorder following sexual trauma: A meta-analytic review

OBJECTIVE

Difficulties with sex often develop following sexual trauma, yet are rarely targeted within treatment of post-traumatic stress disorder (PTSD). Where outcomes of sexual function are included, they are secondary to other measures. This review aimed to assess whether psychological treatment for PTSD (from sexual trauma) has an effect on sexual functioning.

METHODS

Systematic searches of MEDLINE, PsycINFO, EMBASE, and trial registers were performed. Five studies met inclusion criteria. Pre-post treatment effect sizes were also calculated.

RESULTS

Data from four good-quality RCTs were included in the meta-analyses. These examined females (n = 799) who had experienced adult sexual trauma or child sexual abuse. Studies compared psychological treatment to control conditions, but no effect on outcomes of sexual concerns, standardized mean difference (SMD) = 0.03 and dysfunctional sexual behaviour, SMD = 0.02, was found. Pre-post treatment effect sizes were small to medium (SMD = 0.36 and 0.47, respectively).

CONCLUSIONS

While firm conclusions cannot be drawn, the available evidence suggests that psychological treatment for PTSD has no effect on sexual problems. Pre-post effects indicate some improvement over the course of treatment, which may be strengthened if treatment actively targeted sexual problems. The paucity of evidence in this area suggests that there is substantial need for further research in order to establish a set of evidence-based guidelines for practitioners implementing treatment in this area.

PRACTITIONER POINTS

The measurement of sexual problems is overlooked in psychological treatment RCTs for sexual trauma. Current treatments for post-traumatic stress disorder (PTSD) from sexual trauma do not appear to be addressing sexual problems. Integrated treatments for comorbid sexual problems and PTSD treatment may be warranted. It is imperative that in future, RCTs that examine people with PTSD from sexual trauma use outcomes of sexual problems.