Predictors of Sexual Satisfaction in Women: A Systematic Review

Discrimination, Internalized Sexual Prejudice and the Post-Sex Experience Among Members of Sexual Minorities

Postcoital dysphoria (PCD) refers to a counter-intuitive experience of sadness, tearfulness, irritability or dysphoria following an otherwise satisfactory and consensual sexual experience. Research to date has primarily focused on heteronormative samples. The current study explored the prevalence of PCD, and potential correlates of internalized sexual prejudice, perceived discrimination, and sex life satisfaction within a LGBTQIA+ population. One hundred and seventy-two adults identifying as LGBTQIA+ completed an online survey. Main outcome measures included the Post Sex Experience Scale (p-SES), Everyday Discrimination Scale (EDS), Internalized Homophobia Scale (IHS), Satisfaction with Sex Life Scale (SWSLS), and study specific questions. Prevalence of PCD was 42% of males attracted to other males and 81% of participants identifying as bisexual/sexual fluid. A significant and a moderate inverse correlation was found between sex life satisfaction and PCD (r = -.75) for individuals identifying as bisexual/fluid sexual orientation. Significant correlations were found between perceived discrimination and PCD (weak positive correlation, r = .28), and sex life satisfaction and PCD (moderate negative correlation, r = -.59) in men attracted to men. This research suggests being a member of a sexual minority is associated with sex-related dysphoria and dissatisfaction. Further research is needed to further elucidate PCD.

Positive sexuality, relationship satisfaction, and health: a network analysis

Introduction

Positive sexuality, defined as the happiness and fulfillment individuals derive from their sexual experiences, expressions, and behaviors, has been linked to relationship satisfaction and health. However, the intricate associations between positive sexuality and relationship functioning and health indicators have rarely been explored from a network perspective. This approach, by analyzing the interconnections among these factors within a broader system, can offer insights into complex dynamics and identify key variables for targeted interventions.

Methods

The present study applied network analysis to uncover interconnections between positive sexuality, relationship satisfaction, and health indicators, highlight the most relevant variables and explore potential gender-based differences in a sample of 992 partnered individuals (51% women, aged 18-71 years). Networks were estimated via Gaussian Graphical Models, and network comparison test was used to compare men and women.

Results

Results indicated that variables related to positive sexuality were more highly interconnected than the rest of the network. There were small-to-negligible connections between positive sexuality and relationship satisfaction variables, both of which had negligible or no connections with health. The network was globally invariant across gender, though a few connections were gender-specific. The most important variables, regardless of gender, related to pleasurable feelings during sexual intercourse.

Discussion

The findings underscore the importance of enhancing positive sexual experiences within intimate relationships and have implications for research and clinical practice in positive sexuality.

Cracking the code to female sexual satisfaction: the serial mediation of sexual behavior and the perceived importance of healthy sexuality from sexual self-efficacy

Introduction

Sexual satisfaction has been shown to have a strong association with many aspects of sexual health and wellbeing. It is further considered a robust indicator of an individual's health status and general wellbeing, revealing that a person can enjoy pleasurable and healthy sexual experiences, beyond the mere absence of sexual and reproductive health issues.

Objectives

This study aimed to analyze the relationship between sexual satisfaction, sexual behaviors, sexual self-efficacy, and the importance personally attributed to maintaining an active and satisfying sexual life among young and middle-aged women aged 18-50.

Design

A descriptive correlational study with a cross-sectional design was conducted.

Methods

Participants (N = 1,076 women) completed self-reports on sexual self-efficacy beliefs, frequency of sexual behaviors, the importance attributed to active and healthy sexuality, and multidimensional sexual satisfaction.

Results

The supported mediation model indicated that sexual self-efficacy was related to sexual satisfaction directly and indirectly through sexual behavior and a serial path through sexual behavior and the perceived importance of healthy sexuality. The total effect was significant, and the full model explained 7.3% of the global sexual satisfaction variance (F = 17.218, p = 0.000), with the mediated effect accounting for 44.3%.

Conclusion

This study confirms a partial serial mediation model by which sexual self-efficacy significantly predicts sexual satisfaction through sexual behaviors and the importance attributed to a healthy sexuality. Due to its significant contribution, the perceived importance of sexuality should be considered when studying correlates of sexual satisfaction. These findings have interesting implications for the development of strategies aimed at sexual health promotion and sexual education among women in early and middle adulthood.

Predictors of sexual satisfaction among patients with chronic pain

Objectives

Sexual satisfaction is an important aspect of quality of life. Chronic pain, depression and anxiety, and relational problems correspond with higher risk for sexual difficulties. Less is known about how risk factors for sexual dysfunction and other problems-such as medical conditions, pain severity, and medication side effects-affect the sexual satisfaction of people with chronic pain. Using a biopsychosocial framework, this study explored factors related to sexual satisfaction among patients presenting for evaluation of chronic pain.

Methods

Researchers used a hierarchical multiple regression analysis to model potential predictors of sexual satisfaction. Variables analyzed were demographic features, medical history, average pain severity, depressed mood, anxiety, and perceived significant other support. Data collection involved administration of retrospective questionnaires and chart review. The sample included male and female participants (N = 134) presenting for evaluation at a multidisciplinary pain rehabilitation clinic.

Results

Medical history (i.e., medical conditions, surgical history, and medications) and clinical self-report variables (i.e., pain severity, depressed mood, anxiety, and perceived significant other support) were associated with sexual satisfaction. In this sample, antidepressant use and higher pain severity were unique predictors of lower sexual satisfaction. Married marital status and higher levels of perceived significant other support were predictive of greater sexual satisfaction.

Discussion

Findings highlight the importance of understanding the unique impact of biopsychosocial variables on the sexual satisfaction of patients presenting for evaluation at a multidisciplinary pain rehabilitation clinic. Further exploration of protective factors that account for sexual satisfaction among individuals with chronic pain may help inform screening, referrals, and treatment.

Dyadic associations and prediction of maternal and paternal sexual satisfaction in couples-Findings from an 18-year longitudinal study

Background

: Sexual satisfaction is one of many crucial factors for the long-term success of romantic relationships. Longitudinal studies examining the dyadic associations between maternal and paternal factors in middle adulthood for predicting sexual satisfaction in later adulthood are scarce.

Method

The German longitudinal intervention study "Future Family" followed families with at least one child over 18-years (Pre: N = 477, mothers: M = 35.2 years, fathers: M = 38.8 years, children: M = 4.1 years). At the time of the 18-year follow-up, N = 150 mothers (M = 54.1 years) were still living together with the biological fathers (M = 56.1 years; mean relationship duration: 32 years). Dyadic associations between individual and dyadic factors at Pre were analyzed with Actor-Partner Interdependence models to predict sexual satisfaction 18 years later.

Results

Higher relationship quality was significantly associated with higher levels of one's own sexual satisfaction 18 years later. Higher levels of maternal and paternal mental health problems were linked to lower levels of sexual satisfaction in both the individual themselves and their partner. General life satisfaction of mothers and fathers only predicted their own sexual satisfaction. The model for dysfunctional parenting yielded no significant effects.

Conclusions

The results indicate that relationship quality, mental health problems, and general life satisfaction of both parents could be starting points for preventive and therapeutic interventions to achieve long-term effects in sexual satisfaction in married couples.

Influence of pelvic floor disorders on sexuality in women

OBJECTIVE

To determine the association between different pelvic floor disorders and the presence of sexual dysfunction in women.

METHOD

An observational study of non-pregnant women was carried out in Spain in 2021 and 2022. To assess the presence of pelvic floor problems, the Pelvic Floor Distress Inventory (PFDI-20) was used, consisting of the subscales Pelvic Organ Prolapse Distress Inventory-6 (POPDI-6; prolapse symptoms), Colorectal-Anal Distress Inventory (CRADI-8; colorectal symptoms), and Urinary Distress Inventory-6 (UDI-6; urinary symptoms). The validated tool, Female Sexual Function (FSF), was used to evaluate female sexual function.

RESULTS

In total, 1008 women participated. Of these, 288 (28.6%) had some type of sexual dysfunction. Regarding symptoms, 52 (5.2%) stated that they do not reach orgasm and 172 (17.1%) said they had never or occasionally felt sexual desire in the last month. Women with sexual dysfunctions had higher mean scores on the POPDI-6, CRADI-8, and UDI-6 subscales than those who did not have sexual dysfunction (P ≤ 0.005). Risk factors identified included being postmenopausal, with an adjusted odds ratio (aOR) of 2.98 (95% confidence interval [CI] 2.12-4.18), and a greater impact of the symptoms of pelvic floor problems as assessed by the PFDI-20 scale, in such a way that for each point increase the probability of sexual dysfunction increases with an aOR of 1.008 (95% CI 1.005-1.011).

CONCLUSION

Women with pelvic floor disorders and postmenopausal women present sexual dysfunction more frequently.

The Development and Psychometric Evaluation of the Sexual Fantasy Experience Scale

Clinicians and researchers consider sexual fantasies to be a central aspect of human sexuality. Although these are subjective experiences, most studies have assessed only their frequency and content. A measure that assesses individuals' subjective experience of sexual fantasies is therefore needed. The aim of this study was to evaluate the psychometric properties of a new measure, the Sexual Fantasy Experience Scale (SFES). In Study 1, the SFES was administered to 391 participants (240 defined themselves as women, 149 as men, and 2 as other). In Study 2, the SFES was administered to 426 participants (255 defined themselves as women, 167 as men, and 4 as other), along with a battery of questionnaires including the New Sexual Satisfaction Scale Short Form and the Global Measure of Sexual Satisfaction, both of which measure sexual satisfaction, as well as the Sexual Fantasy Checklist, which evaluates the content of sexual fantasies and their frequency. Five reliable SFES subscales emerged from Study 1: playfulness, limitlessness, functionality, intrusiveness, and shame. In Study 2, a confirmatory factor analysis confirmed the scale's underlying factor structure, which was obtained in Study 1. The subscales of the SFES contributed to the explained variance of the assessments of sexual satisfaction, beyond the contribution of the fantasies' content and frequency, demonstrating the incremental validity of the subscales. The results of the present analyses suggest that the SFES has good psychometric properties, making it useful as an assessment tool for future research, clinical practice, and sex education.

Predictors of social intermediate factors associated with sexual quality of life of women: systematic review and meta-analysis

BACKGROUND

Sexual problems and diminished sexual quality of life can adversely affect the physical, psychological, and emotional health of women. The present study was done to determine the social intermediate factors of health associated with sexual quality of life in women of reproductive age.

DESIGN

Systematic review and Meta-analysis.

DATA SOURCES

Embase, Web of Science, PubMed/Medline (NLM), ProQuest, and CENTRAL.

ELIGIBILITY CRITERIA

Observational studies (cross-sectional, case-control, cohort) from 2010 to 2022 with no language constraints were included. The sexual quality of life, as the main variable of the study, has been evaluated using Symonds women's sexual quality of life scale (SQOL-F). The health social determinants intermediate factors based on WHO model were considered as exposure variables.

DATA EXTRACTION AND SYNTHESIS

The data of included studies were extracted by two independent persons through a researcher-made checklist according to the study aims. Quality assessment of studies was done using Newcastle-Ottawa instrument. R software (Version R-4.2.1) were used for meta-analysis. Publication bias was evaluated by Egger & Begg tests. Sensitivity analysis was done through one-out remove approach.

RESULTS

Eventually, 15 studies were eligible to be included in this systematic review and meta-analysis. Variables of depression, quality of marital relation, body image, self-esteem, physical activity, and sexual function were among the health social intermediate factors associated with sexual quality of life. Publication bias had no effect on the obtained results; no study affecting the results was found through sensitivity analysis.

CONCLUSION

Considering the relationship between modifiable factors and sexual quality of life, it seems that identification of these factors can be an important step towards designing interventional studies to help women experience enhanced sexual quality of life.

Sexual Rewards and Costs in Heterosexual and Gay Hispanic Adults

The Interpersonal Exchange Model of Sexual Satisfaction proposes that sexual satisfaction can be explained by the balance of sexual rewards or costs exchange. The Interpersonal Exchange Model of Sexual Satisfaction Questionnaire (IEMSSQ) was developed from this model. The IEMSSQ includes the Reward/Costs Checklist (RCC). The RCC assesses different sexual exchanges that are categorized into sexual rewards and/or costs. Analyses and comparisons of sexual rewards and costs in the Hispanic cisgender population based on gender (man or woman) and sexual orientation (heterosexual and homosexual) with this measure have not been conducted. The main goal was to analyze and rank the sexual rewards, costs, and both, indicated by a sample of 1996 Hispanic partnered participants (heterosexual men, gay men, heterosexual women, and lesbians). The predominant sexual exchanges that were reported involved emotional aspects, both as rewards and costs. When participants indicated that the exchange was both a reward and a cost, they were referring to aspects specifically related to the sexual relationship itself. Heterosexual men and women had greater rewards and higher costs, respectively. Gay men obtained a greater number of items reported as rewards and costs. The results provide further insight into sexual satisfaction related to gender and sexual orientation.

Sexual Satisfaction among Lesbian and Heterosexual Cisgender Women: A Systematic Review and Meta-Analysis

BACKGROUND

Sexual satisfaction is a complex, multifaceted, and broad concept that is influenced by several factors. The minority stress theory posits that sexual and gender minorities are at a particular risk for stress due to stigma and discrimination at the structural, interpersonal, and individual levels. The aim of this systematic review and meta-analysis was to evaluate and compare the sexual satisfaction between lesbian (LW) and heterosexual (HSW) cisgender women.

METHODS

A systematic review and meta-analysis were conducted. We searched the PubMed, Scopus, Science Direct, Websci, Proquest, and Wiley online databases from 1 January 2013 to 10 March 2023 to identify the published observational studies on sexual satisfaction in women according to their sexual orientation. The risk of bias in the selected studies was assessed using the JBI critical appraisal checklist for the analytical cross-sectional studies.

RESULTS

A total of 11 studies and 44,939 women were included. LW reported having orgasms during a sexual relationship more frequently than HSW, OR = 1.98 (95% CI 1.73, 2.27). In the same direction, the frequency of women reporting "no or rarely" for having orgasms during their sexual relationships was significantly lower in the LW than the HSW, OR = 0.55 (95% CI 0.45, 0.66). The percentage of the LW who reported having sexual intercourse at least once a week was significantly lower than that of the HSW, OR = 0.57 for LW (95% CI 0.49, 0.67).

CONCLUSIONS

Our review showed that cisgender lesbian women reached orgasm during sexual relations more often than cisgender heterosexual women. These findings have implications for gender and sexual minority health and healthcare optimization.

Early Adaptive Schemas and Sexual Wellbeing in Women: Exploring Differences in Menopausal Status

There is limited research concerning the relationship between early adaptive schema, from Young's Schema Theory, and women's sexual wellbeing. Schema Theory posits that early adaptive schema start forming in early childhood from core emotional needs being met, and positively influence individuals' concept of self, relationships with others, and their behaviours. Building on this theory, the current study explored the relationship of early adaptive schema and adult women's sexual wellbeing at pre-, peri-, and post-menopause. Four hundred and sixty-seven women, mostly partnered and heterosexual, from over ten countries, participated in an online survey measuring relationships between early adaptive schema and sexual wellbeing, measured by sexual functioning and sexual satisfaction. The strength of association of early adaptive schema and sexual well-being were evaluated in addition to known predictors. The results showed higher early adaptive schema were associated with higher sexual wellbeing, measured by sexual satisfaction and sexual functioning,with medium-to-large effect sizes, at pre and peri-menopause, and produced a non-significant result for post-menopause. The association of early adaptive schema continued after known factors were accounted for. The results support the use of early adaptive schema to promote sexual wellbeing for women at pre- and peri-menopause.

Going beyond "With a Partner" and "Intercourse": Does Anything Else Influence Sexual Satisfaction among Women? The Sexual Satisfaction Comprehensive Index

The validated tools for measuring sexual satisfaction (SS) assess in fact other phenomena such as sexual functioning, assess SS within the context of a romantic heterosexual relationship and intercourse-type activity or were designed to be applied only in therapeutic or rehabilitation contexts. Consequently, they offer an incomplete understanding of SS, particularly among women. We thus developed an alternative measure of SS, the Sexual Satisfaction Comprehensive Index (SSCI), considering both the individual and with-a-partner dimensions, as well as the actual and desired experiences of satisfaction, along with other dimensions affecting SS, and explored its psychometric properties. A total of 1080 young to mid-aged women with different sociodemographic, relationship and sexual identity backgrounds voluntarily completed several measures of SS, including the SSCI. Results showed that the SSCI is a reliable measure for assessing SS. An exploratory and a confirmatory factor analysis confirmed the latent multidimensional structure of the SSCI, supporting its factorial validity. In addition, the SSCI showed appropriate convergent validity with other measures commonly used to assess SS. In sum, the SSCI was revealed to be a useful multidimensional index of SS for research and practice contexts which allows the practitioner or the researcher to make decisions on which dimension(s) are to be evaluated. This study focused on women's SS, and future research with other gender, sexual and cultural identities is necessary to support its utility in multi-identity and multi-sexuality scenarios.

Do oral combined contraceptive pills modify body image and sexual function?

BACKGROUND

The effect of hormonal contraceptives on sexual function and body image is still controversial. Existing studies have not come to definite conclusions on the association between hormonal contraceptive use and sexual function/presence of sexual dysfunction or changes in body image perception. Thus, this study aimed to evaluate the prevalence of sexual problems/dysfunction in Polish women of reproductive age (18-45 years) and to assess to what extent oral combined contraceptive pills (OCCP) impact body image, sexual function and the prevalence of female sexual dysfunction (FSD).

METHODS

A total of 495 women were included in this cross-sectional questionnaire-based study. Sexual function was assessed by the Changes in Sexual Function Questionnaire (CSFQ), the prevalence of FSD was assessed by DSM-5 criteria, and body image was assessed by the Body Exposure during Sexual Activity Questionnaire (BESAQ). A total of 237 women using OCCP were the study group (HC), and the rest were controls (CG). A regression model was used to evaluate the influence of the selected variables on sexual function and the presence of FSD.

RESULTS

The prevalence of FSD was 7.5% in HC and 2.6% in CG, and 22% compared to 14% of women in HC and CG, respectively, reported sexual problems (CSFQ). The demographic characteristics of those using other contraception methods or not using any contraception (control group) were similar. The contraceptive group was characterized by significantly higher importance of sex (4.03 vs. 3.79), worse partner's attitude toward sex (4.35 vs. 4.47), worse self-attitude toward sex (4.35 vs. 4.47), and worse body image (BESAQ) compared to controls. Among all of the variables, a lower level of anxiety (t = -1.99), positive attitudes toward sex (t = 2.05), watching erotic videos (t = 5.58) and a higher importance of sex (t = 5.66) were predictive of better sexual function (R2-0.38, F = 28.9, p = 0.0001).

CONCLUSION

Sexual behaviors and function are different in those using OCCP compared to nonusers. The prevalence of sexual problems and dysfunction was higher in those using this hormonal method of contraception; however, using OCCP was not a risk factor for either worse sexual function or sexual dysfunction. Partners' attitudes toward sex and general anxiety level were factors contributing to sexual function and the risk of sexual dysfunction in the population of women of reproductive age and should be routinely evaluated in clinical practice, especially before prescribing hormonal contraceptives.

Effects of Stigma on the Relationship Between Perceived Social Support and Sexual Satisfaction Among Breast Cancer Survivors

BACKGROUND

Sexual satisfaction is one of the issues faced by breast cancer survivors (BCSs).

AIM

This study aims to explore the mediation of stigma in the relationship between perceived social support (PSS) and sexual satisfaction among breast cancer survivors.

METHODS

A cross-sectional study was conducted among 918 BCSs in Shanghai Cancer Rehabilitation Club. Data were collected using an online questionnaire including questions on sociodemographic characteristics, health status, PSS, stigma and sexual satisfaction of participants. The bootstrap method was used to test the significance of the simple mediation model.

OUTCOMES

The simple mediation of stigma was found significant in the relationship between PSS and sexual satisfaction.

RESULTS

Stigma plays an intermediary role in the relationship between 2 dimensions of PSS (family and friends) and sexual satisfaction, but not in the relationship between the dimension of other significant people of PSS and sexual satisfaction.

CLINICAL TRANSLATION

It is important to reduce stigma when improving the sexual satisfaction of BCSs from the perspective of PSS.

STRENGTHS & LIMITATIONS

The mediating role of stigma in the relationship between PSS and sexual satisfaction among BCSs has been shown for the first time. Study limitations include limitations in the representativeness of population by the study sample and the cross-sectional study design.

CONCLUSIONS

Stigma mediates the relationship between PSS and sexual satisfaction, which needs to be eliminated in intervention practice. Yuxin Zhang, Jie Zhao, Nan Jiang, et al. Effects of Stigma on the Relationship Between Perceived Social Support and Sexual Satisfaction Among Breast Cancer Survivors. J Sex Med 2022;19:1002-1011.

Impact of Social Determinants of Health on Women's Satisfaction with Their Sexual Life and Its Relationship with the Use of Psychotropic Drugs: A Cross-Sectional Study

Sexual satisfaction (SS) is defined as an affective response arising from one’s subjective evaluation of the positive and negative dimensions associated with one’s sexual relationship. It is an important indicator of health. In women, SS has an important personal component consisting of the physical experiences of pleasure and the positive feelings and emotions that they experience in their affective-sexual relationships. The socioeconomic position is determined by income, educational level, and work, and it conditions women’s sexual health. We aimed to assess whether social determinants of health (income, education, work, and gender) are associated with women’s sexual satisfaction and to identify whether the impact of social determinants on sexual satisfaction differs with psychotropic consumption. We conducted a cross-sectional study designed to assess the association between variables related to the social determinants of health (work, education, income, and gender) and sexual satisfaction in women of reproductive age in La Rioja (Spain). The women in this study ranged in age from 17 to 52 years, with a mean age of 33.4 (Standar Deviation 8.6). Most were Spanish (82.9%), had undertaken non-compulsory specialized education (84%), and worked (72.7%). Regarding their relationships, 87% maintained monogamous relationships, 84.5% had stable relationships, and 65.7% lived with their partners. In total, 12.3% of the women were taking psychotropic drugs prescribed for the treatment of anxiety and/or depression. We observed that SS is significantly lower among women who have only undertaken compulsory education (Student-t = −4.745; p < 0.01), in those who have unstable affective-sexual relationships (Student-t = −2.553; p < 0.01), and in those who take psychotropic drugs (Student-t = −4.180, p < 0.01). We conclude that the social determinants of health such as education, not continuing to study beyond compulsory education, gender, and taking psychoactive drugs have a significant impact on women’s degree of satisfaction with their sexual life.