Nonprobability and probability-based sampling strategies in sexual science

Analyzing Reddit Forums Specific to Abortion That Yield Diverse Dialogues Pertaining to Medical Information Seeking and Personal Worldviews: Data Mining and Natural Language Processing Comparative Study

BACKGROUND

Attitudes toward abortion have historically been characterized via dichotomized labels, yet research suggests that these labels do not appropriately encapsulate beliefs on abortion. Rather, contexts, circumstances, and lived experiences often shape views on abortion into more nuanced and complex perspectives. Qualitative data have also been shown to underpin belief systems regarding abortion. Social media, as a form of qualitative data, could reveal how attitudes toward abortion are communicated publicly in web-based spaces. Furthermore, in some cases, social media can also be leveraged to seek health information.

OBJECTIVE

This study applies natural language processing and social media mining to analyze Reddit (Reddit, Inc) forums specific to abortion, including r/Abortion (the largest subreddit about abortion) and r/AbortionDebate (a subreddit designed to discuss and debate worldviews on abortion). Our analytical pipeline intends to identify potential themes within the data and the affect from each post.

METHODS

We applied a neural network-based topic modeling pipeline (BERTopic) to uncover themes in the r/Abortion (n=2151) and r/AbortionDebate (n=2815) subreddits. After deriving the optimal number of topics per subreddit using an iterative coherence score calculation, we performed a sentiment analysis using the Valence Aware Dictionary and Sentiment Reasoner to assess positive, neutral, and negative affect and an emotion analysis using the Text2Emotion lexicon to identify potential emotionality per post. Differences in affect and emotion by subreddit were compared.

RESULTS

The iterative coherence score calculation revealed 10 topics for both r/Abortion (coherence=0.42) and r/AbortionDebate (coherence=0.35). Topics in the r/Abortion subreddit primarily centered on information sharing or offering a source of social support; in contrast, topics in the r/AbortionDebate subreddit centered on contextualizing shifting or evolving views on abortion across various ethical, moral, and legal domains. The average compound Valence Aware Dictionary and Sentiment Reasoner scores for the r/Abortion and r/AbortionDebate subreddits were 0.01 (SD 0.44) and -0.06 (SD 0.41), respectively. Emotionality scores were consistent across the r/Abortion and r/AbortionDebate subreddits; however, r/Abortion had a marginally higher average fear score of 0.36 (SD 0.39).

CONCLUSIONS

Our findings suggest that people posting on abortion forums on Reddit are willing to share their beliefs, which manifested in diverse ways, such as sharing abortion stories including how their worldview changed, which critiques the value of dichotomized abortion identity labels, and information seeking. Notably, the style of discourse varied significantly by subreddit. r/Abortion was principally leveraged as an information and outreach source; r/AbortionDebate largely centered on debating across various legal, ethical, and moral abortion domains. Collectively, our findings suggest that abortion remains an opaque yet politically charged issue for people and that social media can be leveraged to understand views and circumstances surrounding abortion.

Do pornography use and masturbation play a role in erectile dysfunction and relationship satisfaction in men?

Both masturbation frequency and pornography use during masturbation have been hypothesized to interfere with sexual response during partnered sex as well as overall relationship satisfaction. However, results from prior studies have been inconsistent and frequently based on case studies, clinical reports, and simple binary analyses. The current study investigated the relationships among masturbation frequency, pornography use, and erectile functioning and dysfunction in 3586 men (mean age = 40.8 yrs, SE = 0.22) within a multivariate context that assessed sexual dysfunctions using standardized instruments and that included other covariates known to affect erectile functioning. Results indicated that frequency of pornography use was unrelated to either erectile functioning or erectile dysfunction (ED) severity in samples that included ED men with and without various sexual comorbidities or in a subset of men 30 years or younger (p = 0.28-0.79). Masturbation frequency was also only weakly and inconsistently related to erectile functioning or ED severity in the multivariate analyses (p = 0.11-0.39). In contrast, variables long known to affect erectile response emerged as the most consistent and salient predictors of erectile functioning and/or ED severity, including age (p < 0.001), having anxiety/depression (p < 0.001 except for a subset of men ≤ 30 years), having a chronic medical condition known to affect erectile functioning (p < 0.001 except for a subset of men ≤ 30 years), low sexual interest (p < 0.001), and low relationship satisfaction (p ≤ 0.04). Regarding sexual and relationship satisfaction, poorer erectile functioning (p < 0.001), lower sexual interest (p < 0.001), anxiety/depression (p < 0.001), and higher frequency of masturbation (p < 0.001) were associated with lower sexual and lower overall relationship satisfaction. In contrast, frequency of pornography use did not predict either sexual or relationship satisfaction (p ≥ 0.748). Findings of this study reiterate the relevance of long-known risk factors for understanding diminished erectile functioning while concomitantly indicating that masturbation frequency and pornography use show weak or no association with erectile functioning, ED severity, and relationship satisfaction. At the same time, although verification is needed, we do not dismiss the idea that heavy reliance on pornography use coupled with a high frequency of masturbation may represent a risk factor for diminished sexual performance during partnered sex and/or relationship satisfaction in subsets of particularly vulnerable men (e.g., younger, less experienced).

Why Men Masturbate: Reasons and Correlates in Men with and without Sexual Dysfunction

Men purportedly masturbate for a variety of reasons, but systematic investigation of men's reasons has been lacking. We analyzed reasons why men masturbate (n = 2967, mean age = 37.7, SD = 12.9), whether men with and without sexual problems differ in their reasons, and whether those reasons vary with the frequency of masturbation and partnered sex. Results indicated that deriving pleasure, decreasing sexual tension, and reducing anxiety/stress were among the top motives, whereas partner issues were cited less frequently. Men with sexual dysfunctions showed only minor differences from men without sexual dysfunctions, the former more often citing anxiety/stress reduction as a motive. In addition, samples tapping participants from two world regions showed only minor differences in their patterns of responding. Motives for masturbation were also related to both the frequency of masturbation and the frequency of partnered sex. Overall, these findings indicate that men, like women, masturbate primarily for the positive reinforcing effects of pleasure, but in contrast with women, men are also more likely to use masturbation for the negatively reinforcing effects of reducing anxiety/distress. Unsatisfying sex with the partner and/or relationship issues were cited as a reason for masturbation in only a minority of men.

Reliability and validity of an innovative high performing healthcare system assessment tool

BACKGROUND

Universal Health coverage (UHC) is the mantra of the twenty-first century yet knowing when it has been achieved or how to best influence its progression remains elusive. An innovative framework for High Performing Healthcare (HPHC) attempts to address these issues. It focuses on measuring four constructs of Accountable, Affordable, Accessible, and Reliable (AAAR) healthcare that contribute to better health outcomes and impact. The HPHC tool collects information on the perceived functionality of health system processes and provides real-time data analysis on the AAAR constructs, and on processes for health system resilience, responsiveness, and quality, that include roles of community, private sector, as well as both demand, and supply factors affecting health system performance. The tool attempts to capture the multidimensionality of UHC measurement and evidence that links health system strengthening activities to outcomes. This paper provides evidence on the reliability and validity of the tool.

METHODS

Internet survey with non-probability sampling was used for testing reliability and validity of the HPHC tool. The volunteers were recruited using international networks and listservs. Two hundred and thirteen people from public, private, civil society and international organizations volunteered from 35 low-and-middle-income countries. Analyses involved testing reliability and validity and validation from other international sources of information as well as applicability in different setting and contexts.

RESULTS

The HPHC tool's AAAR constructs, and their sub-domains showed high internal consistency (Cronbach alpha >.80) and construct validity. The tool scores normal distribution displayed variations among respondents. In addition, the tool demonstrated its precision and relevance in different contexts/countries. The triangulation of HPHC findings with other international data sources further confirmed the tool's validity.

CONCLUSIONS

Besides being reliable and valid, the HPHC tool adds value to the state of health system measurement by focusing on linkages between AAAR processes and health outcomes. It ensures that health system stakeholders take responsibility and are accountable for better system performance, and the community is empowered to participate in decision-making process. The HPHC tool collects and analyzes data in real time with minimum costs, supports monitoring, and promotes adaptive management, policy, and program development for better health outcomes.

Characteristics of men who report symptoms of delayed ejaculation: providing support for empirically derived diagnostic criteria

BACKGROUND

Little is known regarding the demographic, sexual, and relationship characteristics of men with symptoms of delayed ejaculation (DE).

AIM

To identify differences between men with and without DE symptomology to validate face-valid diagnostic criteria and to identify various functional correlates of DE.

METHODS

A total of 2679 men meeting inclusion criteria were partitioned into groups with and without DE symptomology on the basis of their self-reported "difficulty reaching ejaculation/orgasm during partnered sex." Men were then compared on a broad array of demographic and relationship variables, as well as sexual response variables assessed during partnered sex and masturbation.

OUTCOMES

Outcomes included the identified differences between men with and without DE symptomology.

RESULTS

Men with DE-whether having comorbid erectile dysfunction or not-differed from men without DE on 5 face-valid variables related to previously proposed diagnostic criteria for DE, including ones related to ejaculation latency (P < .001); self-efficacy related to reaching ejaculation, as assessed by the percentage of episodes reaching ejaculation during partnered sex (P < .001); and negative consequences of the impairment, including "bother/distress" and (lack of) "orgasmic pleasure/sexual satisfaction" (P < .001). All such differences were associated with medium to large effect sizes. In addition, men showed differences on a number of functional correlates of DE, including anxiety, relationship satisfaction, frequency of partnered sex and masturbation, and level of symptomology during partnered sex vs masturbation (P < .001).

CLINICAL IMPLICATIONS

Face-valid criteria for the diagnosis of DE were statistically verified, and functional correlates of DE relevant to guiding and focusing treatment were identified.

STRENGTHS AND LIMITATIONS

In this first comprehensive analysis of its kind, we have demonstrated widespread differences on sexual and relationship variables relevant to the diagnosis of DE and to its functional correlates between men with and without DE symptomology during partnered sex. Limitations include participant recruitment through social media, which likely biased the sample; the use of estimated rather than clocked ejaculation latencies; and the fact that differences between men with acquired and lifelong DE were not investigated.

CONCLUSION

This well-powered multinational study provides strong empirical support for several face-valid measures for the diagnosis of DE, with a number of explanatory and control covariates that may help shed light on the lived experiences of men with DE and suggest focus areas for treatment. Whether or not the DE men had comorbid erectile dysfunction had little impact on the differences with men having normal ejaculatory functioning.

Description of and Relationships among Potential Variables Supported for the Diagnosis of Delayed Ejaculation

The lack of empirically based diagnostic criteria for delayed ejaculation (DE) not only undermines confidence in the reported prevalence rates for this sexual dysfunction, but it has also resulted in a lack of validated patient reported outcomes (PROs) for assessing this condition. The current study was designed to describe and evaluate six face-valid variables previously shown to discriminate between men with and without DE for their utility as diagnostic measures for DE. A sample of 1285 men (mean age = 37.8, SD = 12.7) free of erectile problems and premature ejaculation completed an online sexual health survey that included potential questions intended for use in the diagnosis of DE. Questionnaire items included ones reflective of previously proposed diagnostic constructs related to DE: ejaculation timing/latency, ejaculation efficacy/control, and negative effects of DE. Results indicated that five of the six proposed items showed moderate intercorrelations, suggesting that each constituted a distinct (i.e., non-redundant) though relevant criterion related to the diagnosis of DE. Based on the level of interrelatedness, the better items representing each construct were included in commonality analysis to assess their unique contributions to the diagnosis of DE. Perceived lack of ejaculatory efficacy/control contributed the largest portion of the variance to the diagnosis of DE (58%), with bother/distress (an index of the negative effects of DE) contributing the second largest portion (25%), and ejaculation timing/latency contributing only a small portion of the variance (6%) to the diagnosis of DE. The relevance of these findings to developing a patient report outcome (PRO) for diagnosing DE that considers both empirically supported questions/items and an appropriate balance of items regarding the three constructs was discussed.

Motives that Mediate the Associations Between Relationship Satisfaction, Orgasmic Difficulty, and the Frequency of Faking Orgasm

INTRODUCTION

Faking orgasm by women reportedly occurs quite frequently, with both relationship characteristics and orgasmic difficulty being significant predictors.

AIM

We explored women's motives that might mediate the associations between orgasmic difficulty and relationship satisfaction on the one hand, with the frequency of faking orgasm on the other.

METHODS

In a study of 360 Hungarian women who reported "ever" faking orgasm during partnered sex, we assessed the direct and indirect (mediated) associations between orgasmic difficulty, relationship satisfaction, and the frequency of faking orgasm.

OUTCOMES

Determination of motives that mediate the association between orgasmic difficulty and the frequency of faking orgasm, and the association between relationship satisfaction and the frequency of faking orgasm.

RESULTS

Increased orgasmic difficulty was directly related to increased frequency of faking orgasm (β = 0.37; P < .001), and each variable itself was related to a number of motives for faking orgasm. However, the only motive assessed in our study that mediated the relationship between orgasmic difficulty and the frequency of faking orgasm was insecurity about being perceived as abnormal or dysfunctional (indirect effect: β = 0.13; P < .001). A similar pattern emerged with relationship satisfaction and frequency of faking orgasm. These two variables were directly related in that lower relationship satisfaction predicted higher frequency of faking orgasm (β = -0.15; P = .008). Furthermore, while each variable itself was related to a number of motives for faking orgasm, the only motive assessed in our study that mediated the relationship between the 2 variables was insecurity about being perceived as abnormal or dysfunctional (indirect effect: β = -0.06; P = .008).

CLINICAL TRANSLATION

Insecurity related to being perceived as abnormal or deficient, along with sexual communication, should be addressed in women with a history of faking orgasm but who want to cease doing so.

STRENGTHS AND LIMITATIONS

The sample was relatively large and the online survey adhered to best practices. Nevertheless, bias may result in sample characteristics when recruitment is achieved primarily through social media. In addition, the cross-sectional sample prevented causal determination and represented Western-based values.

CONCLUSIONS

The associations between orgasmic difficulty and faking orgasm, and between relationship satisfaction and faking orgasm, are both direct and indirect (mediated). The primary motive for mediating the indirect association between the predictor variables and the frequency of faking orgasm was the insecurity about being perceived as deficient or abnormal. Hevesi K, Horvath Z, Miklos E, et al. Motives that Mediate the Associations Between Relationship Satisfaction, Orgasmic Difficulty, and the Frequency of Faking Orgasm. Sex Med 2022;10:100568.

Does Bother/Distress Contribute to the Diagnosis of Premature Ejaculation?

Introduction

The role of bother/distress in the diagnosis of premature ejaculation (PE) has received minimal investigation compared with the 2 other diagnostic criteria, ejaculatory control and ejaculatory latency (EL).

Aim

This study assessed (i) the added variance explained by bother/distress to the diagnostic accuracy of PE and (ii) determined its overall contribution to a PE diagnosis.

Methods

The 3 diagnostic criteria for PE were assessed in 2,589 men (mean age = 38.2 years, SD = 13.5) in order to determine the contribution of each factor to a dysfunctional diagnosis. A series of regression and discriminant analyses were used to assess the value of bother/distress in explaining ejaculatory control and in predicting accuracy of PE group status. Commonality analysis was used to determine the relative contribution of each of these factors to the diagnosis of PE.

Main Outcome Measure

The major outcome was the quantified contribution of “bother/distress” to a PE diagnosis.

Results

Bother/distress accounted for about 3–4% of the variation in ejaculatory control and added only minimally to the prediction accuracy of PE group status (no, probable, definite PE). Commonality analysis indicated that bother/distress comprised about 3.6% of the unique explained variation in the PE diagnosis, compared with ejaculatory control and EL which contributed 54.5% and 26.7%, respectively. Common variance among factors contributed the remaining 15.5% to the PE diagnosis.

Clinical Translation

Bother/distress contributes least to the determination of a PE diagnosis. Its contribution is largely redundant with the unique and combined contributions of ejaculatory control and EL.

Strengths and Limitations

Using a well-powered and multivariate analysis, this study parsed out the relative contributions of the 3 diagnostic criteria to a PE diagnosis. The study is limited by its use of estimated EL, a single item assessment of bother/distress, and the lack of differentiation of PE subtypes, lifelong and acquired.

Conclusion

Bother/distress contributes minimally to the PE diagnosis, yet its assessment may be key to understanding the experiences of the patient/couple and to developing an effective treatment strategy.

Rowland DL, McNabney SM, Hevesi K. Does Bother/Distress Contribute to the Diagnosis of Premature Ejaculation?. Sex Med 2022;10:100548.

Assessing rigid modes of thinking in self-declared abortion ideology: natural language processing insights from an online pilot qualitative study on abortion attitudes

Introduction

Although much work has been done on US abortion ideology, less is known relative to the psychological processes that distinguish personal abortion beliefs or how those beliefs are communicated to others. As part of a forthcoming probability-based sampling designed study on US abortion climate, we piloted a study with a controlled sample to determine whether psychological indicators guiding abortion beliefs can be meaningfully extracted from qualitative interviews using natural language processing (NLP) substring matching. Of particular interest to this study is the presence of cognitive distortions—markers of rigid thinking—spoken during interviews and how cognitive distortion frequency may be tied to rigid, or firm, abortion beliefs.

Methods

We ran qualitative interview transcripts against two lexicons. The first lexicon, the cognitive distortion schemata (CDS), was applied to identify cognitive distortion n-grams (a series of words) embedded within the qualitative interviews. The second lexicon, the Linguistic Inquiry Word Count (LIWC), was applied to extract other psychological indicators, including the degrees of (1) analytic thinking, (2) emotional reasoning, (3) authenticity, and (4) clout.

Results

People with polarized abortion views (i.e., strongly supportive of or opposed to abortion) had the highest observed usage of CDS n-grams, scored highest on authenticity, and lowest on analytic thinking. By contrast, people with moderate or uncertain abortion views (i.e., people holding more complex or nuanced views of abortion) spoke with the least CDS n-grams and scored slightly higher on analytic thinking.

Discussion and conclusion

Our findings suggest people communicate about abortion differently depending on their personal abortion ideology. Those with strong abortion views may be more likely to communicate with authoritative words and patterns of words indicative of cognitive distortions—or limited complexity in belief systems. Those with moderate views are more likely to speak in conflicting terms and patterns of words that are flexible and open to change—or high complexity in belief systems. These findings suggest it is possible to extract psychological indicators with NLP from qualitative interviews about abortion. Findings from this study will help refine our protocol ahead of full-study launch.

Are the Criteria for the Diagnosis of Premature Ejaculation Applicable to Gay Men or Sexual Activities Other than Penile-Vaginal Intercourse?

Introduction

The criteria for premature ejaculation (PE) have generally been limited to the diagnosis of heterosexual men engaging in penile-vaginal intercourse and therefore the applicability of PE diagnostic criteria to gay men and to activities beyond penile-vaginal intercourse has yet to be explored in depth.

Aim

To compare the prevalence of PE in gay and straight men and to assess whether PE-related diagnostic measures (ejaculatory control, ejaculation latency [EL], and bother/distress) can be applied with confidence to gay men or to men engaging in sexual activities other than penile-vaginal intercourse.

Methods

Gay and straight participants (n = 3878) were recruited to take an online survey assessing sexual orientation, sexual function/dysfunction (including specific PE-related measures), sexual relationship satisfaction, and various other sexual behaviors during partnered sex or masturbation.

Outcomes

Comparison of ejaculatory control, EL, and bother/distress across gay and straight men, as well as across different types of sexual activities.

Results

A slightly lower PE prevalence among gay men became undetectable when other predictors of prevalence were included in a multivariate analysis (aOR = 0.87 [95% CI: 0.60–1.22]). Gay men with PE reported longer typical ELs (z_U = -3.35, P < .001) and lower distress (z_U = 3.68, P < .001) relative to straight men, but longer ELs and lower distress were also associated with anal sex.

Clinical Translation

Clinicians can feel confident about using existing criteria for the diagnosis of PE in gay men but should be aware of potentially longer ELs and lower PE-related bother/distress—probably related to the practice of anal sex—compared with straight men.

Strengths and Limitations

Although well-powered and international in scope, this study was limited by biases inherent to online surveys, the lack of a sizable sample of bisexual men, and a lack of differentiation between men with acquired vs lifelong PE.

Conclusions

Irrespective of sexual orientation, gay and straight men with PE reported shorter ELs, lower satisfaction, and greater bother/distress than functional counterparts. While PE-related diagnostic criteria (ejaculatory control, EL, and bother/distress) are applicable to gay men, accommodation for longer ELs and lower bother/distress in gay men should be considered.

McNabney SM, Weseman CE, Hevesi K, et al. Are the Criteria for the Diagnosis of Premature Ejaculation Applicable to Gay Men or Sexual Activities Other than Penile-Vaginal Intercourse?. Sex Med 2022;10:100516.

Changes in Penile-Vaginal Intercourse Frequency and Sexual Repertoire from 2009 to 2018: Findings from the National Survey of Sexual Health and Behavior

Solo and partnered sexual behaviors are relevant to health, well-being, and relationships. Recent research shows that sexual frequency has declined in the U.S. and in other countries; however, measurement has been imprecise. We used data from 14- to 49-year-old participants in the 2009 and 2018 waves of the National Survey of Sexual Health and Behavior (NSSHB), a confidential U.S. nationally representative survey that is conducted online. We aimed to: (1) assess changes in frequency of past-year penile-vaginal intercourse and (2) examine combinations of past-year sexual behaviors for each of the two waves. We hypothesized that we would observe lower frequency of penile-vaginal intercourse (PVI) from 2009 to 2018 and that we would observe greater engagement in sexual repertoires involving non-coital partnered behaviors (e.g., partnered masturbation, oral sex) in 2018 as compared to 2009. Participants were 4155 individuals from the 2009 NSSHB (Adolescents: 406 females, 414 males; Adults: 1591 women, 1744 men) and 4547 individuals from the 2018 NSSHB (Adolescents: 416 females, 411 males; Adults: 2007 women, 1713 men). Compared to adult participants in the 2009 NSSHB, adults in the 2018 NSSHB were significantly more likely to report no PVI in the prior year (28% in 2018 vs. 24% in 2009). A similar difference in proportions reporting no PVI in the prior year was observed among 14-17-year-old adolescents (89% in 2018 vs. 79% in 2009). Additionally, for both adolescents and adults, we observed decreases in all modes of partnered sex queried and, for adolescents, decreases in solo masturbation.

Do Pornography Use and Masturbation Frequency Play a Role in Delayed/Inhibited Ejaculation during Partnered Sex? A Comprehensive and Detailed Analysis

The role of masturbation frequency and pornography use on sexual response during partnered sex has been controversial, the result of mixed and inconsistent findings. However, studies investigating this relationship have often suffered from methodological shortcomings. We investigated the role of masturbation frequency and pornography use on both the occurrence and severity of delayed/inhibited ejaculation (DE), an increasingly common sexual problem among men. We did so in a large (nonclinical) multinational sample of cisgender men (N = 2332; mean age = 40.3, SE = 0.31) within a multivariate context that relied on multiple (and, when possible, standardized) assessments of sexual dysfunctions while controlling for possible confounding variables. Results indicated a weak, inconsistent, and sometimes absent association between the frequency of pornography use and DE symptomology and/or severity. In contrast, both poorer erectile functioning and anxiety/depression represented consistent and strong predictors of DE and, to a lesser extent, DE severity. Other factors, including relationship satisfaction, sexual interest, and masturbation frequency, were significantly though moderately to weakly associated with DE. In conclusion, associations (or sometimes lack thereof) between masturbation frequency, pornography use, and delayed ejaculation are more clearly understood when analyzed in a multivariate context that controls for possible confounding effects.

Peer- and community-led responses to HIV: A scoping review

INTRODUCTION

In June 2021, United Nations (UN) Member States committed to ambitious targets for scaling up community-led responses by 2025 toward meeting the goals of ending the AIDS epidemic by 2030. These targets build on UN Member States 2016 commitments to ensure that 30% of HIV testing and treatment programmes are community-led by 2030. At its current pace, the world is not likely to meet these nor other global HIV targets, as evidenced by current epidemiologic trends. The COVID-19 pandemic threatens to further slow momentum made to date. The purpose of this paper is to review available evidence on the comparative advantages of community-led HIV responses that can better inform policy making towards getting the world back on track.

METHODS

We conducted a scoping review to gather available evidence on peer- and community-led HIV responses. Using UNAIDS' definition of 'community-led' and following PRISMA guidelines, we searched peer-reviewed literature published from January 1982 through September 2020. We limited our search to articles reporting findings from randomized controlled trials as well as from quasi-experimental, prospective, pre/post-test evaluation, and cross-sectional study designs. The overall goals of this scoping review were to gather available evidence on community-led responses and their impact on HIV outcomes, and to identify key concepts that can be used to quickly inform policy, practice, and research.

FINDINGS

Our initial search yielded 279 records. After screening for relevance and conducting cross-validation, 48 articles were selected. Most studies took place in the global south (n = 27) and a third (n = 17) involved youth. Sixty-five percent of articles (n = 31) described the comparative advantage of peer- and community-led direct services, e.g., prevention and education (n = 23) testing, care, and treatment programs (n = 8). We identified more than 40 beneficial outcomes linked to a range of peer- and community-led HIV activities. They include improved HIV-related knowledge, attitudes, intentions, self-efficacy, risk behaviours, risk appraisals, health literacy, adherence, and viral suppression. Ten studies reported improvements in HIV service access, quality, linkage, utilization, and retention resulting from peer- or community-led programs or initiatives. Three studies reported structural level changes, including positive influences on clinic wait times, treatment stockouts, service coverage, and exclusionary practices.

CONCLUSIONS AND RECOMMENDATIONS

Findings from our scoping review underscore the comparative advantage of peer- and community-led HIV responses. Specifically, the evidence from the published literature leads us to recommend, where possible, that prevention programs, especially those intended for people living with and disproportionately affected by HIV, be peer- and community-led. In addition, treatment services should strive to integrate specific peer- and community-led components informed by differentiated care models. Future research is needed and should focus on generating additional quantitative evidence on cost effectiveness and on the synergistic effects of bundling two or more peer- and community-led interventions.

Faking Orgasm: Relationship to Orgasmic Problems and Relationship Type in Heterosexual Women

Introduction

Although faking orgasm among women appears quite common, the roles of orgasmic problems and relationship type in partnered sex and masturbation have not been fully explored.

Aim

We assessed the relationship between orgasmic problems (separately in partnered sex and masturbation) and faking orgasm across various types of relationships while also considering the role of demographic and sexual function related covariates.

Methods

In this study of 1,168 Hungarian women, we assessed orgasmic problems, sexual functioning, and the prevalence and frequency of faking orgasm in 3 relationship types: romantic relationships, one-night stands, and continuing sexual relationships of more than one night.

Main Outcome Measure

Differences in faking orgasm across 3 types of relationships; the association between faking orgasm in 1 type of relationship with faking orgasm in other types of relationships; and the relationship of “orgasmic problems” in partnered sex and masturbation to the presence and frequency of faking orgasm in various relationship types.

Results

A subset of women who faked orgasm in 1 relationship type were more likely to fake orgasm in other relationship types. Orgasmic problems predicted the occurrence and frequency of faking orgasm in all 3 relationship types, though to different degrees. Other factors, including orgasmic difficulty during masturbation, the frequencies of masturbation and partnered sex, and the self-rated importance of sex were also related to the frequency of faking orgasm.

Conclusion

Our findings suggest that faking orgasm has both dispositional and situational elements. “Orgasmic problems” in partnered sex was a consistent and robust predictor of the occurrence and frequency of faking orgasm in different relationship types.

Hevesi K, Horvath Z, Sal D, et al. Faking Orgasm: Relationship to Orgasmic Problems and Relationship Type in Heterosexual Women. Sex Med 2021;9:100419.

Preliminary Insights from a U.S. Probability Sample on Adolescents' Pornography Exposure, Media Psychology, and Sexual Aggression

Sexual aggression is now widely recognized as a public health crisis. Using the sexual script acquisition, activation, application model (₃AM) as a guide, this paper reports findings on U.S. teenagers' exposure to pornography, motivation for viewing pornography, perceptions of pornography's realism, identification with pornographic actors, and sexual aggression risk from the National Survey of Porn Use, Relationships, and Sexual Socialization (NSPRSS), a U.S. population-based probability study. Sexual aggression was operationalized as pressuring another person into having sex despite their explicit declaration of nonconsent. Having been exposed to pornography and perceiving pornography as realistic were associated with increased sexual aggression risk. A stronger level of identification with pornographic actors was associated with an increased probability of sexual aggression for males, but not females. A motivation to learn about others' sexual expectations from pornography was unrelated to sexual aggression. Results interpretation and discussion focus on the need for additional theoretical nuance and measurement specificity in the media psychology literature on pornography and sexual aggression.

Diagnostic Criteria for Premature Ejaculation: Clarifying the Role of “Ejaculatory Control” and “Bother/Distress”

“Ejaculatory control” and “bother/distress” are key criteria for diagnosing men with premature ejaculation (PE), yet compared with ejaculatory latency (EL), these constructs have received only minimal attention. In addition, they have not been characterized in men having different sexual orientations or subtypes of PE. This study aimed to characterize relationships among ejaculatory control, bother/distress, and EL; to assess differences across men having different sexual orientations, PE status, and PE subtypes (i.e., lifelong vs. acquired); and to determine the importance of ejaculatory control to men’s sexual partners. In total, 1071 men and sexual partners of men rated their ejaculatory control and bother/distress and estimated their EL; these measures were compared across sexual orientation, PE status, PE subtype, and male and female partners of men. Results revealed a monotonic though slightly curvilinear relationship between ejaculatory control and bother/distress. These PE criteria differed significantly between PE and non-PE men, to a lesser extent between gay and straight men, and not at all between men having lifelong vs. acquired PE. Female and male partners of men affirmed the importance of ejaculatory control during partnered sex, indicating lack of control as a potential reason for ending a relationship.

Body Image, Orgasmic Response, and Sexual Relationship Satisfaction: Understanding Relationships and Establishing Typologies Based on Body Image Satisfaction

Introduction

This study explored the role of body image dissatisfaction on orgasmic response during partnered sex and masturbation and on sexual relationship satisfaction. The study also described typologies of women having different levels of body image satisfaction.

Methods

A sample of 257 Norwegian women responded to an online survey assessing body image dissatisfaction, problems with orgasm, and sexual relationship satisfaction. Using structural equation modeling and factor mixture modeling, the relationship between body image dissatisfaction and orgasmic response was assessed, and clusters of sexual response characteristics associated with varying levels of body image dissatisfaction were identified.

Main Outcome Measure

Orgasmic function during partnered sex and masturbation, along with sexual relationship satisfaction, were assessed as a function of body image.

Results

Body image dissatisfaction, along with a number of covariates, predicted higher levels of “problems with orgasm” during both partnered sex and masturbation, with no significant difference in the association depending on the type of sexual activity. Varying levels of body image dissatisfaction/satisfaction were associated with differences in orgasmic incidence, difficulty, and pleasure during partnered sex; with one orgasmic parameter during masturbation; and with sexual relationship satisfaction.

Conclusion

Body image dissatisfaction and likely concomitant psychological distress are related to impaired orgasmic response during both partnered sex and masturbation and may diminish sexual relationship satisfaction. Women with high body image dissatisfaction can be characterized by specific sexual response patterns.

Horvath Z, Smith BH, Sal D, et al. Body Image, Orgasmic Response, and Sexual Relationship Satisfaction: Understanding Relationships and Establishing Typologies Based on Body Image Satisfaction. Sex Med 2020;8:740–751.

Self-reported reasons for having difficulty reaching orgasm during partnered sex: relation to orgasmic pleasure

Purpose: This study investigated women's perceived causes for orgasmic difficulty during partnered sex and their relation to orgasmic pleasure.Method: From a community sample of 1843 women, we investigated 814 women's attributions for their orgasmic difficulty during partnered sex. Frequencies of 18 attributions were generated and subsequently reduced to eight principal variables through dimension reduction. Women with and without distress were compared across these eight principal variables. These variables, along with relevant covariates, were then used to predict orgasmic pleasure through regression analysis.Results: The most frequently endorsed reasons for orgasmic difficulty were, in descending order, general stress/anxiety, arousal difficulty, sex-specific anxiety and issues with the partner. Women reporting high distress were more likely to cite partner issues and less likely to report general stress/anxiety as reasons for their difficulty. Regression analysis, however, indicated that the reasons most frequently endorsed by women were not necessarily those accounting for the greater variance in orgasmic pleasure, such reasons including inhibition/lack of interest, insufficient experience and partner-related issues. Difficulty reaching orgasm during masturbation as well as relationship satisfaction also explained differences in orgasmic pleasure.Conclusion: Women cite various reasons for orgasmic difficulty, most commonly general anxiety/stress, inadequate arousal, sex-specific stress and partner issues. Women who were distressed by their condition more frequently cited partner issues. Variance in orgasmic pleasure was most related to partner issues, sexual inhibition/lack of interest and insufficient experience. Overall, partner issues and relationship satisfaction played important roles in attributions for both orgasmic difficulty and orgasmic pleasure.

Effects of Pornography Use and Demographic Parameters on Sexual Response during Masturbation and Partnered Sex in Women

The effect of pornography on sexual response is understudied, particularly among women. A multinational, community-based sample of 2433 women at least 18 years of age completed a 42-item, opt-in questionnaire collecting information on demographic and sexual history characteristics, use of pornography during masturbation, frequency of pornography use, and sexual response parameters. Pornography use and average frequency were compared across demographic variables. We also examined how pornography frequency predicted differences in self-reported arousal difficulty; orgasmic difficulty, latency, and pleasure; and the percent of sexual activities ending in orgasm during both masturbation and partnered sex. On average, women using pornography were younger, and reported more interest in sex. Pornography frequency differed significantly by menopausal status, sexual orientation, anxiety/depression status, number of sexual partners, and origin of data collection. During masturbation, more frequent pornography use predicted lower arousal difficulty and orgasmic difficulty, greater pleasure, and a higher percentage of masturbatory events leading to orgasm. Frequency of pornography use predicted only lower arousal difficulty and longer orgasmic latencies during partnered sex, having no effect on the other outcome variables. Pornography use frequency did not predict overall relationship satisfaction or sexual relationship satisfaction. Overall, more frequent pornography use was generally associated with more favorable sexual response outcomes during masturbation, while not affecting most partnered sex parameters. Several demographic and relationship covariates appear to more consistently and strongly predict orgasmic problems during partnered sexual activity than pornography use.

Sex Differences in Attributions to Positive and Negative Sexual Scenarios in Men and Women With and Without Sexual Problems: Reconsidering Stereotypes

People with sexual problems are more likely to attribute negative sexual experiences to themselves, in contrast to sexually functional individuals who attribute negative sexual experiences to external factors such as the circumstance or partner. We investigated attribution patterns in 820 men and 753 women, some of whom reported an orgasmic problem, to assess differences between the sexes and those with and without an orgasmic difficulty. Specifically, using an Internet-based approach, we compared attribution responses to four sexual scenarios, one representing a positive sexual experience and three representing negative sexual experiences. Women were more likely to attribute positive outcomes to their partner than men. Women were also more likely to attribute negative outcomes to themselves than men, but they more readily blamed their partner and circumstances for negative outcomes than men as well. Those with orgasmic problems were less willing to take credit for positive outcomes and more willing to accept blame for negative outcomes. Interaction effects between sex and orgasmic problems further highlighted differences between men's and women's attribution patterns. These results are interpreted in the context of traditional notions that men's attributions tend to be more self-serving and women's attributions more self-derogatory.

The Experience of Orgasmic Pleasure during Partnered and Masturbatory Sex in Women with and without Orgasmic Difficulty

Pleasure is critically important to the experience of sexual behavior, yet few studies have examined factors that influence it. We explored orgasmic pleasure during masturbation and partnered sex in women with and without orgasmic difficulty, as well as the mutual influence of each type of activity on the other. Data were collected from 2059 women through online surveys and paper-and-pencil tests in both the USA and Hungary. Among women who both masturbated and had partnered sex, orgasmic pleasure was higher during partnered sex. Although women with orgasmic difficulty exhibited a similar pattern of greater pleasure during partnered sex, they reported lower pleasure during partnered sex than women without orgasmic difficulty. Women struggling most to reach orgasm were likely to view masturbation as equally or more satisfying than partnered sex. Several covariates were relevant to pleasure during partnered sex, including the importance of sex, the frequency of partnered sex, and the relationship quality, affirming the idea that relational factors play a critical role in orgasmic pleasure in women. Pleasure during masturbation was associated with higher age, frequency of masturbation, and shorter latencies to orgasm, suggesting that pleasure during masturbation was related to greater experience with masturbation and greater efficiency in reaching orgasm.

Attribution Patterns in Women With and Without Orgasmic Difficulties

People with sexual problems are more likely to attribute negative sexual experiences to themselves, in contrast with sexually functional individuals who attribute negative sexual experiences to external factors such as the circumstance or situation. We investigated attribution patterns in women reporting difficult or absent orgasm-a group only minimally investigated in this regard-to determine whether they differed from women without orgasmic problems. Using an internet-based approach, we compared attribution responses of 376 women with orgasmic difficulty with 367 women without orgasmic difficulty to five sexual scenarios, two presenting positive sexual experiences and three presenting negative sexual experiences. Women with orgasmic difficulty were more likely to take blame for any negative sexual experience, including ones not related to orgasmic difficulty. They were also more likely to attribute responsibility to their partner's lack of skill, whereas orgasmic women attributed negative outcomes more to circumstance. Women with orgasmic difficulty were also less likely to assume credit or responsibility for positive sexual experiences. Differences between orgasmic and non-orgasmic groups persisted or were augmented when age and arousal difficulty were controlled. These results emphasize the stark contrast in the way women with and without orgasmic problems approach sexual situations and suggest several therapeutic strategies.

Women's Attributions Regarding Why They Have Difficulty Reaching Orgasm

Difficulty reaching orgasm during partnered sex is relatively common among women. Yet the reasons, likely multivariate, are not fully understood. This study identified perceived causes for orgasmic difficulty in 452 women during partnered sex. The most commonly endorsed reasons were stress/anxiety, insufficient arousal, and lack of time during sex; body image, pain, inadequate lubrication, and medical/medication issues were endorsed less frequently. Distressed and nondistressed women differed on several attributions, including sexual interest, partner perceptions, stress, and adequate time during sex. These findings implicate greater internalization of attributions among distressed women compared with nondistressed women and suggest possible avenues for remediation.