Sexual Dysfunction and Distress Among Childhood Sexual Abuse Survivors: The Role of Post-Traumatic Stress Disorder

Childhood maltreatment, sexual desire and sexual distress in couples: the role of touch aversion

BACKGROUND

Childhood maltreatment (CM), experienced by about 40 % of adults, is associated with romantic relationship challenges like instability, sexual dissatisfaction, and dysfunction. While CM has been linked to lower sexual desire and higher distress, its impact within couples and underlying mechanisms remain underexplored. Touch aversion, where partner touch feels unpleasant, may explain how CM relates to lower sexual desire and higher sexual distress.

OBJECTIVE

This study explores the mediating role of touch aversion in the associations between CM, sexual desire and sexual distress in couples.

METHODS

A sample of 363 adult couples completed self-reported online questionnaires on CM, partner-focused sexual desire, sexual distress and touch aversion.

RESULTS

A person's CM is indirectly associated with their own lower sexual desire (b = - 0.07, 95 % bootstrap CI = [-0.08, -0.02]), their partner's higher sexual desire (b = 0.01, 95 % bootstrap CI = [0.000, 0.02]), and both their own (b = 0.06, 95 % bootstrap CI = [0.01, 0.03]) and their partner's higher sexual distress (b = 0.02, 95 % bootstrap CI = [0.003, 0.013]) through their own higher touch aversion.

CONCLUSIONS

These findings provide theoretical support for the role of touch aversion in the sexual dynamics of couples reporting CM, underscoring the interdependent nature of partners' sexual desire and distress. Clinically, understanding how individuals with a CM history respond to touch may highlight a modifiable psychological process that could help couples navigate their sexual desire and distress.

Complex PTSD and identification with the aggressor among survivors of childhood abuse

BACKGROUND

Childhood abuse (CA) is a risk factor for trauma-related disorders including posttraumatic stress disorder (PTSD) and complex posttraumatic stress disorder (CPTSD). This severe form of interpersonal trauma may result in "identification with the aggressor" (IWA), in which the individual may take on the beliefs, perspectives, and behaviors of the perpetrator. Although previous evidence suggests that IWA may be particularly related to CPTSD as compared to PTSD, there has been no study that investigated this hypothesis.

OBJECTIVE

The current study explored the relations between IWA and PTSD and CPTSD symptoms, and the contribution of IWA to the excess probability of PTSD and CPTSD classifications, as compared to no classification.

PARTICIPANTS AND SETTING

This cross-sectional study was conducted among 320 Israeli adult CA survivors aged 21-63 (M = 42.04, SD = 10.81).

METHODS

An online survey was completed by a convenience sample of adult CA survivors.

RESULTS

Replacing one's agency with that of the perpetrator as part of IWA had a significant effect on both PTSD and CPTSD symptoms (ES = 0.36 and 0.24, respectively), and served as a risk factor for both PTSD and CPTSD classifications. Moreover, analysis of the models' predicted values reveals that the predicted probability of CPTSD classification was 3 to 5 times higher than on the probability of PTSD classifications, for low to high values of the replacing one's agency scale, respectively.

CONCLUSIONS

The current findings suggest that IWA may describe some of the deep and long-lasting detriments of CA on self, and may contribute to the development of CPTSD symptoms.

Hypoactive sexual desire disorder in women: new possibilities to ensure better understanding, diagnosis, and response to treatment

BACKGROUND

Hypoactive Sexual Desire Disorder (HSDD) is a frequent sex-related problem in women; however, a specific tool to characterize HSDD subtypes based on sexual inhibitory and excitatory factors is still lacking.

AIM

(1) To find a cutoff value in Sexual Inhibition Scale (SIS)/Sexual Excitation Scale (SES) scores predicting a diagnosis of HSDD in women consulting for sexual symptoms, (2) to explore the sexual inhibitory and excitatory profiles in women referred to a clinic for female sexual dysfunction by stratifying the sample according to the newfound cutoffs, and (3) to identify biopsychosocial factors significantly associated with the 2 profiles.

METHODS

An overall 133 women consulting for sexual symptoms were retrospectively evaluated for clinical, biochemical, and psychosexologic data collected at the first visit. A subgroup of 55 women treated with transdermal testosterone was retrospectively analyzed at baseline and the 6-month visit.

OUTCOMES

Patients underwent physical and laboratory examinations and completed the SIS/SES, Female Sexual Function Index, Female Sexual Distress Scale-Revised, Emotional Eating Scale, and Middlesex Hospital Questionnaire.

RESULTS

Specific cutoffs for SIS1 (≥32.5; indicating threat of performance failure) and SES (≤46.5) predicted HSDD diagnosis with an accuracy of 66.4% (P = .002) and 68.7% (P < .0001), respectively. Patients with impaired SIS1 scores showed higher distress and psychopathologic symptoms, while those with impaired SES scores demonstrated lower desire and arousal and a negative association with some metabolic and hormonal parameters. SES score also showed a significant predictive value on testosterone treatment efficacy for HSDD.

CLINICAL TRANSLATION

A better characterization of HSDD would enable individualized treatment based on the main underlying etiologies.

STRENGTHS AND LIMITATIONS

Limitations of the study include the small sample size and cross-sectional retrospective design, with the choice of treatment for HSDD limited to transdermal testosterone. Strengths comprise the thorough and multifactorial evaluation of every aspect potentially affecting inhibitory and excitatory components of sexual desire.

CONCLUSION

Validated cutoffs of SIS/SES scores could allow deep characterization of women diagnosed with HSDD, thus ensuring better tailoring of therapy and prediction of the probability of response to specific treatments.

Patterns of Sexual Risk Behaviors and Sexuality-Related Risk Factors among Young Adults in Germany: Implications for Prevention and Therapy

Sexual risk behavior (SRB) includes behavioral (sex without contraception, sexualized substance use, sex work, sexual partner violence, other sexual activities that harm oneself or others) and affective subtypes (sexuality-related feelings of shame/guilt, relationship impairments) and leads to psychosocial and health-related consequences. Young adults comprise a vulnerable group regarding the development of SRB. The study aimed to identify SRB patterns among young adults and their relation to sexuality-related risk factors. A cross-sectional online survey measured behavioral and affective aspects of SRB with nine items. Latent class analysis was conducted to identify patterns of SRB. Gender, sexual orientation, age of first intercourse, number of sexual partners, hypersexuality, and sexual dysfunction were captured as risk factors via multinomial logistic regression. Within this convenience sample (n = 609; nfemale = 365; nmale = 245; Mage = 23.1 years), the SRB patterns unremarkable (67%; low values in all SRB subtypes), shame-ridden (17%; high values in sexual feelings of shame/guilt) and risky sexual behavior (16%; high values in all subtypes of SRB, especially sexualized drug use) were identified. The shame-ridden and risky patterns were strongly associated with higher hypersexuality values, the risky pattern moreover with being non-heterosexual, of younger age at first sexual experience, and a higher number of sexual partners. Male and sexual minority participants demonstrated SRB more often than females and heterosexuals. Within prevention and treatment of SRB, it seems beneficial to address sexuality-related feelings of shame/guilt and addictive patterns (concerning sexual behaviors/substances) via gender- and diversity-sensitive measurements.

From trauma to intimacy: Examining the link between childhood maltreatment and adult sexual functioning - The mediating role of self-criticism

BACKGROUND

Childhood maltreatment has been linked to negative sexual functioning, but the underlying mechanisms for this association are poorly understood.

OBJECTIVE

Addressing this gap, this study investigates the mediating role of self-criticism in the association between childhood maltreatment and adult sexual functioning.

PARTICIPANTS AND SETTING

Two independent studies were conducted, each utilizing a distinct dataset to enhance the robustness and generalizability of the findings. The sample in Study 1 included 914 participants, while the sample in Study 2 consisted of 451 women. Both samples completed self-report online questionnaires; however, in Study 2, we purposefully oversampled for child sexual abuse survivors.

METHODS

This study employed a mediation model using PROCESS.

RESULTS

Study 1 confirmed the negative association between childhood maltreatment and sexual functioning, as well as the positive association between childhood maltreatment and self-criticism. Self-criticism was also negatively associated with sexual functioning. The mediation analysis revealed that self-criticism significantly mediated the association between childhood maltreatment and sexual functioning. Study 2 built upon these findings by oversampling childhood sexual abuse survivors and incorporating comprehensive measures of sexual functioning. The results in Study 2 replicated the findings of Study 1, providing a more representative understanding of the link between childhood maltreatment and sexual functioning.

CONCLUSIONS

The findings highlight the importance of self-criticism as a potential mechanism underlying the negative impact of childhood maltreatment on sexual functioning in adulthood. This knowledge can inform interventions and therapeutic approaches aimed at addressing self-criticism and improving sexual well-being in individuals with a history of childhood maltreatment.

War-Time Stress and Sexual Well-Being in Israel

Objective

This study explored the relationship between war-related stressors and sexual well-being among a civilian population during the 2023 Israel-Hamas War, emphasizing a comprehensive assessment of sexual satisfaction, function, and distress. We aimed to investigate how direct exposure, media exposure, and acute stress symptoms during the war contribute to various dimensions of sexual well-being using a quasi-longitudinal online survey method.

Methods

An online survey with a convenience sample of 1033 Israeli adults, utilizing measures of direct and media exposure to war stress, acute stress symptoms, and various aspects of sexual well-being, both pre-war and present was distributed. Data analysis involved Pearson correlations and hierarchical regression.

Results

There were significant associations between stress-related variables and sexual well-being, highlighting the differential contribution of direct exposure, media exposure, and acute stress symptoms. Direct exposure to stress was uniquely associated with sexual dysfunction, while media exposure and acute stress symptoms contributed significantly to predicting various aspects of sexual well-being.

Conclusions

Recognizing the multifaceted impact of stress during wartime on sexual well-being is crucial for developing comprehensive mental health interventions that address individual and societal factors. This study contributes valuable insights into the relationships between stress-related variables and sexual well-being during wartime, emphasizing the need for holistic approaches in addressing the intimate challenges individuals face during times of conflict.

Stories of childhood sexual abuse (CSA) among older adults living with HIV (OALH) in South Carolina: a qualitative study

Childhood sexual abuse (CSA) devastatingly impacts an individual's behavioral, psychological, and social health. Childhood, a developmental stage directly influenced by the home or school environment, leaves a life-long imprint. Compared with the general population, CSA prevalence is doubled among people living with HIV. Thus, the study aimed to explore CSA circumstances among older adults living with HIV (OALH) in South Carolina (SC). We included 24 OALH aged 50 and above who reported CSA. The data were collected at an immunology center in SC. In-depth semi-structured interviews were conducted, audio-recorded, transcribed, and analyzed using a thematic analysis approach. The iterative analytic process included a discussion of initial thoughts and key concepts, identification, and reconciliation of codes, and naming of emergent themes. Six themes emerged: known perpetrators, re-victimization, "nobody believed me", "cannot live like others", lack of CSA disclosure, and interconnections with other adverse childhood experiences (ACEs). CSA experiences and non-disclosure were found to be linked with shame, embarrassment, fear, and trust issues. Hence, trauma-focused interventions are required to resolve these issues and improve the quality of life of OALH with past trauma. Counseling or therapy programs should incorporate psychological and behavioral theoretical models to best target OALH who are CSA survivors.

The Relationship Between Child Sexual Abuse and Sexual Dysfunction in Adults: A Meta-Analysis

Child sexual abuse (CSA) has been recognized as a risk factor for sexual dysfunction and has attracted increasing attention. However, controversies remain regarding related research. The aim is to calculate the pooled effect size estimate for the correlation between CSA and sexual dysfunction in adults by meta-analysis. Five bibliographic databases (PubMed, Cochrane Library, Web of Science, Embase, and PsycINFO) were comprehensively searched to clarify the association between CSA and sexual dysfunction in adults. We used a fixed-effects model to determine the total pooled effect size estimate and reported odds ratios (ORs) and the corresponding 95% confidence intervals (CIs). Subgroup analysis, publication bias analysis, and sensitivity analysis were conducted. Adults who had a history of CSA experienced a higher proportion of sexual dysfunction than adults with no history of CSA (OR = 1.68, 95% CI [1.49, 1.87]). Subgroup analysis showed that women with a history of CSA reported a higher proportion of sexual dysfunction than men with a history of CSA (men: OR = 1.45, 95% CI [1.05, 1.84]; women: OR = 1.62, 95% CI [1.42, 1.83]). The estimates of the effect sizes differed substantially depending on the CSA and sexual dysfunction instruments that were used in each study and the region of each sample. This meta-analysis provides conclusive evidence of an association between CSA and sexual dysfunction in adults. Currently known interventions for the treatment of sexual dysfunction after CSA have only been evaluated in women, so specific interventions should be designed for men CSA survivors who experience sexual impairment.

Risk and protective factor profiles predict addictive behavior among adolescents

BACKGROUND AND AIMS

Internet gaming disorder (IGD), compulsive sexual behavior (CSB), and problematic social network usage (PSNU) are prevalent disorders among adolescents. Research indicates an increase in the number of adolescents engaging in daily gaming, sex, and the use of social networks, as well as an increase in the number of adolescents diagnosed with these disorders. The current study aims to detect unique profiles of risk and protective factors and examine whether these profiles could explain the different severities of IGD, CSB, and PSNU among adolescents.

METHOD

The sample comprised 544 Jewish Israeli adolescents from the general community (age 14-18), who were asked about risk (childhood adversity, childhood trauma, depression, anxiety, stress, post-traumatic stress, self-concealment, internalized stigma) and protective (parent-adolescent communication,) factors and addictive behaviors (IGD, CSB, and PSNU).

RESULTS

Adolescents were classified into three different clusters based on their risk and protective factors: "at risk" (n = 48, 8.82%), "moderate" (n = 400, 73.53%), and "resilient" (n = 96, 17.65%). The "at risk" group had significantly greater severity of addictive behaviors (IGD, CSB, and PSNU) than did the "moderate" or "resilient" groups, and the "moderate" group had significantly greater severity of addictive behaviors than the "resilient" group.

CONCLUSIONS

The findings highlight the fact that protective and risk factor profiles are highly indicative of various addictive behaviors among adolescents. The current research expands knowledge about addictive behaviors by providing a more individualized approach to understanding addictive behaviors among adolescents.

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.

Posttraumatic Growth, Dissociation and Identification With The Aggressor Among Childhood Abuse Survivors

Childhood abuse puts individuals at risk for psychopathology and psychiatric symptoms such as posttraumatic stress disorder (PTSD) and anxiety symptoms. At the same time, research has indicated that some survivors report positive transformations in the aftermath of their trauma, known as posttraumatic growth (PTG). Yet the essence of PTG reports is questionable, and some scholars claim that it may reflect maladaptive illusory qualities. Furthermore, according to a recent theoretical model, PTG might be dissociation-based and related to survivors' bonds with their perpetrators. This study aimed to explore these claims by assessing PTG, dissociation, and identification with the aggressor (IWA), as well as PTSD and anxiety symptoms. An online survey was conducted among 597 adult childhood abuse survivors. Study variables were assessed via self-report measures. Analyses indicated positive associations between PTG, dissociation, and IWA. Three distinct profiles were found, reflecting high, medium, and low scores on PTG, dissociation, and IWA. Profile type explained PTSD and anxiety symptoms above and beyond gender, age, and abuse severity. These findings suggest that whereas some childhood abuse survivors might experience a positive transformation subsequent to their trauma, others' PTG reports might reflect dissociative mechanisms and pathological attachments to their perpetrators, and thus might be maladaptive.

Sexual Self-Concept and Psychological Functioning of Women With a History of Childhood Sexual Abuse in Hong Kong

Sexual self-concept (SSC) is an important component of health that is closely associated with the well-being of survivors of child sexual abuse (CSA). Compared with non-CSA respondents, SSC of CSA survivors was deleteriously affected, resulting in ineffective psychological functioning (negative self-evaluation, psychological ill-health, and difficulties in interpersonal relationships). Negative SSC (sexual anxiety, sexual depression, and sexual fear) played a significant role in mediating the adverse effects of CSA on psychological functioning. Future studies may recruit a sample with greater variation in CSA characteristics and use externalizing problems as outcome measures to cross-validate findings of this study.

Profiles of Sexual Disorders and Eating Disorder Symptoms: Associations With Body Image

BACKGROUND

Although the empirical evidence supporting the co-occurrence of sexual disorders and eating disorders is growing, it is not yet known how often these 2 conditions co-occur, and whether the comorbidities of sexual disorders and eating disorders differ in any specific ways.

AIM

To examine the co-occurrence of sexual disorders and eating disorders.

METHODS

In the current study, we used latent profile analysis to identify distinct profiles of sexual disorders and eating disorder symptoms among a large non-clinical sample of women (n = 985). We also examined how these profiles differed in terms of body image self-consciousness. The study was conducted as an online survey among a convenience sample of Israeli women.

MAIN OUTCOME MEASURES

For sexual disorders we used the Arizona Sexual Experience Scale, and for eating disorders we used the Eating Disorders Inventory 2.

RESULTS

Latent profile analysis revealed 4 profiles: no disorder (low levels of sexual disorders and eating disorder symptoms), eating disorder symptoms (low levels of sexual disorders and high levels of eating disorder symptoms), sexual disorders (high levels of sexual disorders and low levels of eating disorder symptoms), and comorbidity (high levels of both sexual disorders and eating disorder symptoms). Women in the comorbidity group had significantly more body image self-consciousness during sexual activity than did women in the other groups.

CONCLUSION

The 4 profiles identified in the study support the co-occurrence of sexual disorders and eating disorder symptoms, yet also raise many clinical considerations. Limitations of the study, directions for future research, and clinical implications are discussed. Gewirtz-Meydan A, Spivak-Lavi Z. Profiles of Sexual Disorders and Eating Disorder Symptoms: Associations With Body Image. J Sex Med 2021;18:1364-1373.