A Dyadic Approach to Understanding the Link Between Sexual Functioning and Sexual Satisfaction in Heterosexual Couples

A Dyadic Analysis of Sexual Assertiveness and Sexual Outcomes in Adolescent Romantic Relationships

Amid adolescence, youth are developing the relational skills necessary to form and maintain positive intimate relationships. Sexual assertiveness is a key skill that could be related to couples' sexual outcomes (i.e. sexual satisfaction, sexual concerns, and sexual function). However, dyadic studies are lacking, and associations between sexual assertiveness and adolescents' sexual health and well-being remain underexplored. This cross-sectional dyadic study examined associations between dimensions of sexual assertiveness and sexual outcomes in adolescent romantic relationships. The Actor-Partner Interdependence Model guided analyses of self-reported questionnaires from 110 romantic dyads (aged 14-19 years; M = 16.51). Participants' gender was considered in the models, and gender differences emerged in the associations between study variables. Path analyses revealed that sexual needs and desires communication, refusal of unwanted sex, sexual intimacy initiation, and comfort talking about sex have significant actor and partner effects on adolescents' sexual outcomes in mixed-gender dyads. These findings suggest that authentically expressing one's own sexual needs, desires, and limits in adolescence may influence not only one's own sexual satisfaction, sexual concerns, and sexual function, but also their partner's. The aforementioned dimensions of sexual assertiveness could be important targets for research-based interventions to promote sexual health and well-being in adolescent romantic relationships.

Perception of orgasmic intensity changes between clitorally and vaginally activated orgasm: a psychometric analysis using the Orgasmometer scale

Female orgasmic experience and intensity depend on several biological, anatomical, cultural, psychological and relational factors, yet studies have not explored how receptiveness to different stimulations (clitoral, vaginal, or both) affects subjectively perceived orgasmic intensity. Using data from sexually active, heterosexual women in two Italian nationwide surveys from 2021 and 2023, we evaluated orgasmic experience, sexual and psychological well-being using validated psychometric tools (FSFI, Orgasmometer, GAD-7, PHQ-9), also considering several socio-demographic factors, aiming to identify changes in terms of subjectively perceived orgasmic intensity according to different stimulations. The two surveys (Sex@COVID study, from April 7th to May 4th, 2020, n = 6821; and the FATHER Study, from May 12th to June 12th, 2023, n = 1845) were hosted on a dedicated website and were advertised through social media, radio broadcast, and interviews on national newspapers. Among 1,799 women meeting inclusion criteria, 40.7% primarily experienced clitorally activated orgasms (CAO, n = 733), 18% vaginally activated orgasms (VAO, n = 324), and 41.2% both types (Clitorally and Vaginally Activated Orgasms, CaVAO, n = 742). Significant psycho-sexological differences between the two studies were observed, with additional evidence suggesting the impact of lockdown and social distancing on sexual outcomes. Women experiencing CaVAO attained the highest FSFI and Orgasmometer scores, followed by those with VAO, and lastly, those with CAO (p < 0.001 for both). Regression analysis confirmed the same trend for Orgasmometer scores (R2 = 0.247, p < 0.001), also highlighting the relevance of sexual dysfunction (according to FSFI, β = -1.34 ± 0.08, p < 0.001) for orgasmic intensity. Lastly, women preferring masturbation to partnered sexual activity had lower orgasmic intensity (β = -0.41 ± 0.07, p < 0.001). Age, psychological status and relationship status had no significant effect on the model. Despite some limitations, this is the first study addressing the association between receptiveness to different stimulations and orgasmic intensity on a large sample using validated psychometric instruments.

Update on cannabis in human sexuality

RATIONALE

Sexuality is a central aspect of being human that encompasses many facets. Cannabis, a widely used psychoactive substance, has been associated with various effects on sexuality. The relationship between cannabis and sexuality is complex and multifaceted, involving physiological, psychological, and social factors.

OBJECTIVES

This review aims to provide an overview of the current literature on the effects of cannabis on several sexual functions, including sexual desire, arousal, orgasm, and sexual satisfaction. It also discusses the potential mechanisms underlying these effects, as well as the impact of dose and frequency of use.

RESULTS

This review has revealed a complex relationship between cannabis dosage and its influence on sexuality. It appears that the frequency of cannabis use in humans has been associated with the frequency of sexual activities. Individuals who use cannabis more frequently tend to report higher levels of sexual activity. Moreover, there is a notable gender difference in how cannabis affects sexuality. In addition, we found lower doses of cannabis to be linked to heightened sexual desire and enjoyment, whereas higher doses may lead to a decrease in sexual desire and performance.

CONCLUSIONS

Overall, the association between cannabis and sexuality is complex and warrants further research to better understand the psychological and neurological mechanisms that underlie the effect of cannabis on these sexuality functions and its implications for sexual health. To advance in this endeavor, a crucial step is establishing a precise measurement of dosage in human studies.

The Interplay of Worry and Relationship Satisfaction to Understand Sexual Distress: An APIM Study with Heterosexual Couples Using Cross-Sectional Data

The current study takes an integrative approach, considering individual transdiagnostic processes and relationship outcomes. It assumes an interdependence approach and aims to test a dyadic model to analyze the impact of worry and relationship satisfaction on heterosexual couples' sexual -distress, an essential factor for diagnosing sexual dysfunction. The current study recruited 103 couples from the community to complete an online survey containing the Female Sexual Distress Scale-Revised, the Penn State Worry Questionnaire - Abbreviated, and the Global Measure of Relationship Satisfaction. The results show that women's and men's worries are associated with their own sexual distress, and men's relationship satisfaction has an effect on their own and their partner's sexual distress. These results highlight the critical role of cognitive processes in shaping the experience of sexual distress and reinforce the importance of taking an integrative perspective that considers relationship (satisfaction), individual (worry) and social factors (gender) in interventions to treat sexual distress.

(Dis)Similarities in Attitudes Between Partners About Women's Solo Masturbation: A Dyadic Approach to Solo Masturbation and Its Associations with Sexual Satisfaction

Attitudes among couples about women's solo masturbation are not well understood. The primary aim of this study was to assess (dis)similarities in attitudes between partners about women's solo masturbation and associations of each partner's attitudes with women's and their partners' sexual satisfaction. One hundred and four mixed-sex couples (M = 27.43 years), recruited through social networking websites and Prolific (an online research participant platform), completed an online survey about demographics, their experiences of solo masturbation, and validated measures of attitudes about women's masturbation and sexual satisfaction. Dyadic data were analyzed using correlational methods and the Actor-Partner Interdependence Model. Women and their partners reported similar and positive attitudes about women's solo masturbation. For women, reports of positive attitudes toward women's solo masturbation were associated with both their own and their partner's sexual satisfaction; there were no associations for men. The role of solo masturbation within romantic relationships is complex but our results support the idea that women's masturbation is now less stigmatized than commonly thought. Normalizing and including masturbation in the sexual script for individuals in relationships may help maximize their, and their partners,' sexual satisfaction.

From couplepause to doublepause: the impact of midlife physical, psychological, and social changes on the sexual life of aging couples

INTRODUCTION

Midlife men and women are facing frequent sexual problems that affect not only individuals' sexual health but also the sexual health of aging couples.

OBJECTIVES

To review the main sexual life challenges faced by midlife couples, to present the concepts of couplepause and doublepause as 2 new paradigms to address the sexual health needs of aging couples, and to discuss key aspects in couple-focused care.

METHODS

An online meeting attended by 5 European experts in sexual health was carried out in June 2023 to discuss the topic. The conversation centered on their clinical experience and expert opinion. Additionally, the indexed literature was reviewed to endorse and complement the expert opinions obtained in the aforementioned meeting.

RESULTS

Midlife men and women face physical, psychological, and sociocultural changes that affect their sexual activity. These changes may be experienced differently between genders. Both members of a couple may experience age-related changes concurrently or in an unsynchronized manner affecting their sexual health. Communication, sharing expectations, defining sexual dynamics, and couple goals are determinant for the sexual health of a midlife couple. Couplepause and doublepause are 2 new complementary paradigms that effectively address the sexual health needs of aging couples as a unit, considering physical, psychological, cultural, social, and dyadic-related factors. Couple-centered strategies should promote open communication about couple intimacy issues, understanding the diverse expectations according to gender and orientation, communication styles, and goals. The following are identified as crucial aspects to promote couple-focused care: education and training of health care professionals, the provision of information to aging couples, physician involvement in addressing sexual problems, the need for collaboration across medical specialties, and the development of effective tools and strategies.

CONCLUSIONS

The sexual problems of aging couples should be managed following couple-centered strategies that effectively address their sexual health needs as a couple.

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

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

Sexual pleasure during college students' most recent partnered sexual experiences

ObjectiveWe explored college students' sexual pleasure using a new self-report measure, the Body, Emotions, Sensations, Touch/Trust (B.E.S.T.) Scale of Sexual Pleasure. Participants: Data were from 3997 randomly sampled students with a partnered sexual experience. Methods: Students completed an online survey about their most recent partnered sexual experience. Data was collected in January 2020. Results: Students find the nonphysical aspects of partnered sex (e.g., emotions, trust, connection with partners) as pleasurable as physical aspects (e.g., behaviors engaged and received, bodily sensations). Self-reported arousal, wantedness, and emotional intimacy were the strongest correlates of male, female, and transgender/gender non-binary students' sexual pleasure. Few sexual behaviors were associated with sexual pleasure and only one - cuddling for women - was associated with greater sexual pleasure. Conclusions: Students find their partnered sexual experiences pleasurable. Students' sex may be more pleasurable when they feel ready for sex, desire sex, and feel close to their partners.

The complexity of female orgasm and ejaculation

The anatomy and physiology of the female orgasm are often neglected. The female orgasm is a normal psychophysiological function to all women, and some even can achieve ejaculation as part of the normal physiological response at the height of sexual arousal. The complexity of female sexuality requires a deep understanding of genital anatomy. The clitoris is the principal organ for female pleasure. The vaginal stimulation of the anterior vaginal wall led women to orgasm due to the stimulation of the clitourethrovaginal complex and not due to stimulation of a particular organ called the G spot in the anterior distal vaginal wall. Female ejaculation follows orgasm. It consists of the orgasmic expulsion of a smaller quantity of whitish fluid produced by the female prostate. Squirting can be differentiated from female ejaculation because it is the orgasmic transurethral expulsion of a substantial amount of diluted urine during sexual activity, and it is not considered pathological. The female orgasm is influenced by many aspects such as communication, emotional intimacy, long-standing relationship, adequate body image and self-esteem, proper touching and knowledge of the female body, regular masturbation, male sexual performance, male and female fertility, chronic pain, and capacity to engage in new sexual acts. Stronger orgasms could be achieved when clitoral stimulation, anterior vaginal wall stimulation, and oral sex is involved in the same sexual act.

"It happens to everyone" vs. "You're not a real man": The relationship between intimate communication and men's sexual difficulties

Sexual difficulties can have negative intrapersonal and interpersonal consequences on both members of a couple, but little is known about how communication in a relationship relates to men's experience of sexual difficulties. We explored the associations among components of intimate communication, men's sexual difficulties, relationship satisfaction, and sexual satisfaction in a sample of men in mixed-gender and same-gender relationships (n = 341). Among all components of intimate communication, sexual communication was most consistently related to indicators of sexual difficulties, relationship satisfaction, and sexual satisfaction. Results generally remained consistent across mixed-gender and same-gender couples, with some exceptions relevant to sexual difficulties.

Why Do Women with Disordered Eating Engage in Sex? The Mediating Role of Sexual Motivations in the Association Between Disordered Eating Behaviors and Attitudes and Sexual Dysfunction

Although there is growing evidence of an association between disordered eating and sexual dysfunction, the mechanism underlying this association is still unclear. In the current study, we sought to examine the mediating role of sexual motivation between disordered eating and sexual dysfunction. We used a multi-path mediation model to examine the mediating role of sexual motivation between disordered eating and sexual functioning among a sample of 341 non-clinical women in a steady relationship. Analysis revealed two significant mediation paths associating disordered eating with sexual functioning: (1) a high level of disordered eating was significantly linked with higher motivation for partner approval via sex and sexuality which, in turn, was associated with lower sexual functioning and (2) a high level of disordered eating was significantly linked with lower enhancement sexual motivation which, in turn, was associated with lower sexual functioning. This study extends the existing knowledge by offering an explanation for the relation between disordered eating and sexual dysfunction via sexual motives. Findings from the current study suggest women with disordered eating utilized sex for self-affirmation, for coping with negative emotions, for partner approval, and to increase intimacy. Also, these women were not likely to engage in sex for enhancement reasons.

What Is the Mediating Role of Communication Skills and Sexual Satisfaction between Job and Life Satisfaction of Healthcare Employees?

There are three areas of harmony in human life that are related to each other: "work environment", "love-to be loved-sexual area" and "social environment". Incompatibility and dissatisfaction in one area can also affect other areas. Therefore, the aim of this study is to examine the relationship between job satisfaction, life satisfaction, communication, and sexual satisfaction of healthcare employees. The data collected by questionnaires from 394 employees working in university hospitals in Turkey were analysed using SPSS and AMOS programs. The findings show that there is a positive relationship between the job and life satisfaction of employees of healthcare organizations. Additionally, the findings revealed that communication skills and sexual satisfaction have a mediating role between job satisfaction and life satisfaction of employees in healthcare organizations. Life satisfaction, sexual satisfaction, and relationships are some of the factors that should be considered by healthcare organizations. It would be beneficial to employees and the public if health policy makers implemented programmes to enhance job satisfaction.

Sexual functioning beliefs, sexual satisfaction, and sexual functioning in women: a cross-sectional mediation analysis

BACKGROUND

Sexual dysfunctional beliefs are known to be negative predictors of women's sexual functioning and sexual satisfaction, but little is known about the role that beliefs about sexual functioning play in women's sexual functioning and sexual satisfaction.

AIM

The purpose of the present study was to examine the mediating role of sexual functioning in the relationship between women's beliefs about sexual functioning and sexual satisfaction.

METHODS

A sample of 301 women was invited to participate in a web survey about female sexuality in May 2020.

OUTCOMES

Participants completed the sociodemographic questionnaire, the Beliefs About Sexual Functioning Scale, the Sexual Satisfaction Scale for Women, and the Female Sexual Functioning Index.

RESULTS

Sexual functioning was a significant mediator in the relationship between beliefs about sexual functioning and sexual satisfaction in women. When the dimensions of sexual functioning were considered as mediators, only sexual desire and absence of sexual pain were significant mediators in the relationship between beliefs about sexual functioning and sexual satisfaction in women.

CLINICAL IMPLICATIONS

Negative beliefs about sexual functioning in women are associated with poor sexual functioning and lack of sexual satisfaction. Therefore, beliefs about sexual functioning should be assessed during the intervention for women's sexual difficulties and to increase sexual pleasure and satisfaction. In addition, special attention should be paid to women with problems with sexual desire and sexual pain when beliefs about sexual functioning are being assessed.

STRENGTHS AND LIMITATIONS

This study is one of the first attempts to explore the role of beliefs about sexual functioning in women's sexual satisfaction and to examine the mediating role of sexual functioning. Limitations include the small sample size, the lack of a clinical sample, and the nonlongitudinal methodological approach.

CONCLUSION

Beliefs about sexual functioning are a negative predictor of sexual functioning and sexual satisfaction in women. In addition, women with sexual pain and lack of sexual desire are more likely to have lower sexual satisfaction if they have more negative beliefs about sexual functioning.

The influence of cannabis on sexual functioning and satisfaction

BACKGROUND

The purpose of this study was to examine the perceived influence of cannabis on sexual functioning and satisfaction. This study used Kaplan's and Masters and Johnson's sexual response cycle (desire, excitement, orgasm, plateau, resolution) and included satisfaction to complete the sexual response cycle. Given increased attention in the research literature to the potential benefits of cannabis and the lack of research on the sexual benefits of cannabis use, the current study was completed.

METHODS

Data were collected using the online survey tool "Qualtrics" from a self-selected, convenience sample of adults over the age of 18 who reported previous cannabis use. The survey, developed by the researchers based on previous literature, included demographic questions followed by a scale to measure sexual functioning and satisfaction in relation to cannabis use (α = 0.897).

RESULTS

The final sample was 811 participants ranging in age from 18 to 85 years old (M = 32.11). The majority of participants were identified as female (n = 536, 64.9%), White/Caucasian (n = 640, 78.9%), and college educated (n = 650, 80.1%). Almost 25% of the participants were identified as LGBTQIA+ (n = 187, 23.1%). Most of the participants reported being in a monogamous sexual relationship (n = 598, 73.7%). Data were analyzed using descriptive statistics, t-tests, one-way ANOVA, and multiple regression. Age and gender were not found to have significant effects on cannabis use and sexual functioning and satisfaction. Over 70% of participants reported increased desire (M = 4.05, SD = 0.962) and orgasm intensity (M = 4.05, SD = 0.884). Participants who reported masturbating indicated that cannabis enhanced their pleasure while masturbating (n = 620, 62.5%). Participants also stated that cannabis enhanced their sense of taste (n = 583, 71.9%) and touch (n = 576, 71.0%).

DISCUSSION

The results of this study contrast and establish new evidence within the literature. Demographic results indicate that the people who use cannabis are of a wide range of ages, from a variety of occupations, and have differing cannabis use preferences. The inclusion of LGBTQIA + respondents is a strength of this study. Overall, results indicated that both men and women perceived that cannabis use increased their sexual functioning and satisfaction, particularly increased desire and orgasm intensity.

CONCLUSION

This study updates the current literature on cannabis and sexuality and provides implications for improving sexual quality. Medical implications of this study include the possible use of cannabis for treating sexual dysfunctions, especially within women.

Exploring the Relationship between Early Adaptive Schemas and Sexual Satisfaction

Rationale

Early maladaptive schemas (EMS) develop from unmet core emotional needs during childhood and adolescence. EMS influence the way individuals perceive themselves and others, while also sharing associations with various sexual difficulties. Contrastingly, Early Adaptive Schemas (EAS) develop when core emotional needs are met. Yet, the potential influence of EAS on sexual wellbeing remains underinvestigated.

Objective

The current study assessed the relationship between EAS and sexual satisfaction as a primary component of sexual wellbeing.

Method

The study design was an online, cross-sectional survey. Participants included 732 adults (Mage = 32.05, SDage = 9.30), who completed self-report questionnaires assessing sexual satisfaction and EAS.

Results

Two, three-step hierarchical regressions evaluated the effect of EAS on sexual satisfaction, controlling for several potentially confounding variables. Results indicated that the only EAS that was associated with sexual satisfaction in both men and women was Realistic Expectations. EAS of Social Belonging and Success were associated with sexual satisfaction for women alone, whereas Self-Compassion was for men.

Conclusion

Findings provide preliminary evidence that EAS are associated with sexual satisfaction. As such, schema therapy may be a useful therapeutic framework for improving sexual satisfaction, when indicated.

Mating in Captivity: The Influence of Social Location on Sexual Satisfaction through Phases of the COVID-19 Pandemic

The recent global pandemic provides a natural experiment "intervention" to examine how differing baseline social dynamics such as gender, education, and politics shaped diverging patterns of well-being during rapidly shifting societal conditions. Using married adults from a nationally representative panel study in the United States from August 2019 to August 2021, discontinuous growth curves reveal a large drop in average married sexual satisfaction in both quality and frequency directly following the pandemic onset. Moreover, sexual satisfaction remained largely suppressed for the subsequent 18 months, apart from a brief "optimism blip" in the fall of 2020. Race, age, income, employment, parenthood, education, and political affiliation all appear as meaningful predictors, but these differ across various phases of the pandemic and by gender. These results reveal evidence of lingering changes in subjective sexual well-being as well as patterns of catastrophe risk and resilience moderated by social location factors.

Solitary and Dyadic Sexual Desire and Sexual Satisfaction in Women With and Without Sexual Concerns

Women's sexual difficulties have been associated with sexual-related dimensions. The present study aims to analyze the differences between women with and without sexual concerns, according to the Female Sexual Functioning Index cutoff score, on dyadic and solitary sexual desire and sexual satisfaction dimensions. A total of 314 women participated in the study and answered to a sociodemographic screening, to the Sexual Desire Inventory - 2, to the Female Sexual Functioning Index, and to the Sexual Satisfaction Scale for Women. Main findings showed that women with sexual concerns revealed lower levels of global sexual desire and partner-related sexual desire, experienced lower levels of communication and compatibility with sexual partner, and have more personal and relational sexual concerns. Overall, results enhance the role of dyadic and relational dimensions that allow to differentiate between women with and without sexual concerns. Clinical implications are discussed.

COVID-19 and Sexual Desire: Perceived Fear Is Associated with Enhanced Relationship Functioning

Lifestyle changes caused by the COVID-19 pandemic had mostly negative consequences for individual, relationship, and sexual functioning. However, some individuals have reported increases in sexual desire and made new additions to their sex lives. Given that stress-provoking situations can sometimes make mortality more salient and heighten sexual desire, it is possible that lifestyle changes and fear of COVID-19 infection may have benefited some relationships. We conducted a cross-sectional study with 303 romantically involved adults (58.1% men) and found that lifestyle changes were associated with negative changes in one's sex life, unrelated to wanting to spend time with one's partner, and positively associated with relationship quality. Lifestyle changes were also positively associated with sexual desire, but only for participants with high (vs. low) fear of COVID-19 infection. For these participants, sexual desire was associated with positive changes in one's sex life and wanting to spend time with one's partner, but not with overall relationship quality. Results were consistent after controlling for pandemic-related anxiety and demographic variables. This study advances literature focused on the importance of romantic relationships in stress-provoking situations such as the COVID-19 pandemic by shedding light on the association between sexual desire and personal and relational well-being.

A behavioral approach to sexual function: testing a moderation mediation model with expression of feelings, sexual self-disclosure and gender

Little is known about specific intimacy dimensions' role in sexual function. In the current study, we aimed to gain more insight into how expression of feelings and sexual self-disclosure (a mediator) might potentially affect sexual functioning testing a theoretically based moderated mediation model, that uses gender as a moderator. A total of 661 participants, of which 211 were men (31,90%) and 450 were women (68,10%) aged 18-74 years involved in a monogamous committed relationship participated in the study. We used macro PROCESS 3.2 for IBM - SPSS to test simple mediation and moderated mediation models. The data revealed a significant overall effect of expression of feelings on sexual function, supporting that sexual self-disclosure mediates this relationship. We found that gender does not moderate either the relationship between expression of feelings and sexual self-disclosure nor the trajectory between sexual self-disclosure and sexual function. Our results highlight the importance of taking an interpersonal behavioral approach to sexual function, namely one that focuses on communication behaviors. However, these results need to be explored with clinical samples to understand their full potential for clinical interventions within a behavioral paradigm to partnered people's sexual problems.

Female Sexual Assertiveness and Sexual Satisfaction Among Chinese Couples in Hong Kong: A Dyadic Approach

Western studies have demonstrated that female sexual assertiveness is positively associated with sexual satisfaction in a committed heterosexual relationship. Furthermore, the ability of women to refuse sex has been shown to protect them from unwanted sexual contact and to lead to fewer sexual victimization experiences and less risky sexual behavior. However, there is little research on female sexual assertiveness that included both the own (actor effect) and partner (partner effect) impact of female sexual assertiveness on sexual satisfaction from a dyadic approach, involving both members of a couple. The data for the present study came from a representative sample of Chinese couples collected by the Hong Kong Family Planning Association in 2017. Using the actor-partner interdependence model, the results indicated that female sexual initiation was positively associated with both their own and their partner's sexual satisfaction. However, female sexual refusal was not associated with the sexual satisfaction of either party. These findings suggest the importance of adopting a dyadic approach in sex research to capture the mutual influences between partners. Couples should be encouraged to express their sexual desires and refuse unwanted sex requests honestly to improve their and their partner's sexual satisfaction.

Single and Multiple Orgasm Experience Among Women in Heterosexual Partnerships. Results of the German Health and Sexuality Survey (GeSiD)

BACKGROUND

Orgasm occurrence plays an important role in general sexual satisfaction for women. Until now, only few studies have focused on examining a broad spectrum of sexuality- and relationship-specific factors associated with orgasm in heterosexual women currently in a long-term relationship or on differences between the overall experience of orgasm and multiple orgasms.

AIM

The present study aims to understand how various sexuality- and relationship-associated factors are related to experiencing partnered orgasm among heterosexual women having stable relationships in Germany. Moreover, the study aims to differentiate between the overall experience of orgasm and the experience of multiple orgasms and shed light on their impact on general sexual satisfaction.

METHODS

Within the nationwide representative survey GeSiD (German Health and Sexuality Survey), n = 1,641 sexually active women aged between 18 and 75 years in heterosexual relationships reported their experience of orgasm during the latest sexual encounter. Data on the type of sexual practices, frequency of sexual activity and of masturbation, relationship satisfaction, feelings of love, closeness, and general sexual satisfaction were analyzed.

OUTCOMES

The overall experience of orgasm, the experience of multiple orgasms, and associations between experiencing orgasm and sexual satisfaction.

RESULTS

Frequency of sexual activity, relationship satisfaction, feelings of love and closeness were moderately to strongly positively correlated with each other and each showed positive associations with the likelihood of orgasm. Greater number of sexual practices and frequency of sexual activity were associated with an increased likelihood of experiencing multiple orgasms, which in turn was correlated with higher sexual satisfaction.

CLINICAL IMPLICATIONS

In clinical and therapeutic work with women who have difficulty achieving orgasm, central issues should be the perceived relationship quality as well as regular sexual activity with the partner.

STRENGTHS & LIMITATIONS

The present population-representative study is the first in Germany to identify significant factors associated with the experience of orgasm among heterosexual women in relationships. Further studies ought to include the frequency of orgasms in partnered sex over a longer period of time as well as the experience of orgasm during masturbation.

CONCLUSION

The experience of orgasm for women is related to a variety of complex interpersonal mechanisms and to be associated with sexual satisfaction. Cerwenka S, Dekker A, Pietras L, et al. Single and Multiple Orgasm Experience Among Women in Heterosexual Partnerships. Results of the German Health and Sexuality Survey (GeSiD). J Sex Med 2021;XX:XXX-XXX.

The Health Benefits of Sexual Expression

Objective

Sexual activity is a fundamental human function with short-term and long-term emotional, social, and physical benefits. Yet within healthcare, sexuality has been marginalized and many HCPs are unaware of its beneficial implications for immediate and long-term health.

Methods

To challenge this assumption we combined the data that already had been collected by the authors with an extensive search of articles on the various health benefits of sexual activity. The results of this process are displayed according to short-term, intermediate-term, and long-term benefits with some explanation about potential causal relationships.

Results

For the time being, it cannot yet be proved that "good sex promotes good health" since good health also favors good sex.

Conclusions

Despite lacking such convincing evidence, the article concludes with recommendations for the relevant professions. The balance of research supports that sexuality anyhow deserves greater attention among HCPs and that sexuality research needs better integration within health research.

Psychological Distress in Erectile Dysfunction: The Moderating Role of Attachment

Introduction

In clinical consultations, men with erectile dysfunction do not always express personal, sexual, and interpersonal concerns.

Aim

We explore whether the attenuated impact of erectile dysfunction may be explained by a regulation of negative affect that causes activation of the attachment system.

Methods

The study sample consisted of 69 men diagnosed with erectile dysfunction, mean (SD) age 56 (10.83) years. Participants completed self-reported questionnaires to assess erectile dysfunction severity, attachment style, sexual satisfaction, relationship satisfaction, and psychological symptoms.

Main Outcome Measure

The moderating role of attachment between erectile dysfunction and sexual satisfaction, relationship satisfaction, and psychological distress was evaluated using multiple linear regression and moderation analysis.

Results

All men in the sample had high attachment avoidance, distributed between the dismissive-avoidant (69.6%) and fearful-avoidant (30.4%) substyles, but low levels of psychological symptoms. Despite their erectile dysfunction, 27 patients (39.1%) rated their sexual life as satisfactory, and 46 (66.7%) rated their relationship with their partner as satisfactory. Men with fearful-avoidant attachment reported feeling more sexual desire and less sexual satisfaction than men with dismissive-avoidant attachment. Multiple linear regression analysis showed that sexual satisfaction variance was explained by erectile dysfunction severity, attachment anxiety, and relationship satisfaction scores. Moderation analysis showed that attachment anxiety, but not relationship satisfaction, moderated the impact of erectile dysfunction on sexual satisfaction.

Conclusion

The avoidance dimension of attachment, which tends to be high in patients with erectile dysfunction, involves deactivation of the sexual system in an effort to minimize the emotional distress associated with erectile dysfunction, which damages sexual and relationship intimacy and delays the decision to obtain professional help. The presence of high attachment avoidance and the moderating value of attachment anxiety allow us to propose specific treatments for these men.

Maestre-Lorén F, Castillo-Garayoa JA, López-i-Martín X, et al. Psychological Distress in Erectile Dysfunction: The Moderating Role of Attachment. Sex Med 2021;9:100436.

Erotic Pleasure and Pleasure-Seeking Associated with Implicit and Explicit Sexual Motives

Two studies examined the proposal that implicit and explicit sexual motives are associated with the experience of pleasure in sexual situations, as well as with seeking out sexual pleasure. In Study 1, implicit and explicit motive scores of 145 heterosexually identified women and 152 heterosexually identified men were demonstrated to be independently associated with the experience of pleasure in response to videos of female-male sexual behavior, more consistently so for women than men. The implicit and explicit motive scales were also associated with the frequency of viewing erotic materials in daily life. The experience of pleasure within sexual relationships was additionally shown to be associated with sexual motives, although primarily implicit motives. In Study 2 involving 139 women and 65 men, implicit motive scales were associated with ratings of interest in a potential romantic partner. The results support the conceptualization of the two instruments as measures of sexual motivation. The difference between implicit versus explicit measures in the pattern of correlations involving acquainted versus non-acquainted individuals is consistent with research on ideal partner preference.

Bullying Victimization and Sexual Wellbeing in Sexually Active Heterosexual, Cisgender and Sexual/Gender Minority Adolescents: The Mediating Role of Emotion Regulation

Bullying victimization is prevalent in adolescence and associated with adverse consequences on physical and psychological wellbeing, paricularly in sexual and gender minority youth. However, little is known about its associations with sexual wellbeing and the underlying mechanisms that could explain this association. The present study assessed the associations between bullying victimization and sexual wellbeing (sexual satisfaction, sexual desire/arousal and orgasmic function difficulties, sexual distress) via the mediating role of emotion regulation difficulties, considering potential sexual/gender minority status-based differences. Self-report online surveys were completed by 1036 sexually active (49.7% were girls) high school students (M_age = 14.6 years, SD_age = 0.6). Bullying victimization was directly and negatively associated with sexual desire/arousal difficulties and positively with sexual distress. Higher emotion regulation difficulties mediated the associations between higher bullying victimization and higher orgasmic function difficulties, as well as higher bullying victimization and higher sexual distress. No significant association was observed between bullying victimization and sexual satisfaction. No significant differences were observed between heterosexual, cisgender and sexual and gender minority youth in any of the associations. The findings suggest that bullying victimization is associated with adolescents' sexual wellbeing. The cross-sectional design and small effect sizes support the need for further prospective cohort studies.

Predictors of Sexual Satisfaction in Women: A Systematic Review

INTRODUCTION

The increasing research interest in sexual satisfaction corresponds to a large amount of studies which focus on different singular determinants without establishing a common model for its explanation.

OBJECTIVES

The purpose of this review is to systematically identify and evaluate the structure and results of the current research about sexual satisfaction in heterosexual women in a long-term relationship.

METHODS

A systematic literature search using Web of Knowledge, ProQuest and PSYNDEX was conducted from January 2004 to October 2019. In total, 1,649 studies published in the last 15 years were extracted from the databases with a systematic keyword search. Through a multistage evaluation process 204 studies met the inclusion criteria and described findings about sexual satisfaction as dependent variable.

RESULTS

Research interest in sexual satisfaction increased notably in the last 5 years. Empirical analyses were predominantly based on data from North America whereas a considerably smaller share of research analyzed samples from Europe or Asia. Relationship variables were the most frequently analyzed predictors and included in more than half of the identified studies. Sexual behavior was most often analyzed in the form of frequency of sexual interactions. Contrariwise, sexual practices, communication about sexuality and sexual desire, and sexual thoughts received limited attention. Demographics were considered in one third of all studies. The inclusion of control variables was rare. Some important studies considered variables closely related to sexual satisfaction such as sexual dysfunction.

CONCLUSION

Relationship satisfaction and the frequency of sexual interactions are identified as the most frequently confirmed predictors of sexual satisfaction across all evaluated studies. Results about the effects of pornography consumption, religion, and relationship duration showed the greatest inconsistency. In general, identified effects were often believed to result from mediator variables like sexual desire or distracting thoughts. Rausch D, Rettenberger M. Predictors of Sexual Satisfaction in Women: A Systematic Review. Sex Med Rev 2021;9:365-380.

The stepwise development of an interactive web-based sex education programme for subfertile couples: the Pleasure & Pregnancy programme

STUDY QUESTION

Can we develop a web-based sex education programme (programme running in a web browser) that addresses the needs of subfertile couples who are advised expectant management for at least 6 months?

SUMMARY ANSWER

The 'Pleasure & Pregnancy' programme addresses couples' needs, is likely to improve couples' sexual functioning, and is subsequently hypothesised to improve the chance of natural pregnancy.

WHAT IS KNOWN ALREADY

According to professional guidelines (e.g. the Netherlands and UK) couples with unexplained subfertility and a good chance of natural pregnancy, should be advised at least 6 months of expectant management. Adherence to expectant management is challenging as couples and gynaecologist prefer a more active approach. Targeting sexuality may be useful as subfertility is a risk factor for decreased sexual functioning.

STUDY DESIGN, SIZE, DURATION

A novel programme was developed according to the three steps of the Medical Research Councils' (MRC) framework. First, relevant literature was explored. Second, an interdisciplinary expert panel developed a theory (based on a systematic literature review and patient interviews) on how the chance of natural conception can be improved. Third, the expected process and outcomes were modelled.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Two licenced clinical sexologists, two gynaecologists, a clinical embryologist and two midwife-researchers, all from Belgium and the Netherlands, proposed components for the sex education programme. PubMed was searched systematically for randomised controlled trials (RCTs) evaluating the proposed components in different patient populations. The needs of 12 heterosexual Dutch or Belgian couples who were advised expectant management were explored with in-depth interviews. The content and delivery characteristics of the novel programme were described in detail with the aid of 'Intervention Taxonomy'. To model the outcomes, a protocol for an RCT was designed, registered and submitted for publication.

MAIN RESULTS AND THE ROLE OF CHANCE

To help maintain or improve sexual functioning, mainly pleasure, and hence increase pregnancy rates, the web-based Pleasure & Pregnancy programme contains a combination of psychosexual education and couple communication, mindfulness and sensate focus exercises. Information on the biology of conception and interaction with fertility clinic staff and peers were added based on couples' needs to increase potential acceptability.

LIMITATIONS AND REASON FOR CAUTION

This paper outlines the development phase of a sex education programme according to the MRC-framework. Whether the Pleasure & Pregnancy programme actually is acceptable, improves sexual functioning, increases pregnancy rates and is cost-effective remains to be determined.

WIDER IMPLICATIONS OF THE FINDINGS

No previous interactive web-based sex education programme has aimed to increase the natural pregnancy rate of subfertile couples by targeting their sexual pleasure. The Pleasure & Pregnancy programme addresses couples' needs and its effect on sexual functioning and pregnancy rate is plausible but remains to be demonstrated by an RCT which is currently ongoing.

STUDY FUNDING/COMPETING INTEREST(S)

Funding was provided by The Netherlands Organisation for Health Research and Development (ZonMw), Flanders Research Foundation and the University of Amsterdam. C.B.L. is editor-in-chief of Human Reproductionbut was blinded to all parts of the peer review process. The remaining authors have no conflict of interest to report.

TRIAL REGISTRATION NUMBER

Not applicable.

I Want You to Want Me: A Qualitative Analysis of Heterosexual Men's Desire to Feel Desired in Intimate Relationships

Current sexual scripts for heterosexual relationships in the Western world stipulate that men should be the ones to initiate sexual activity, push to the next level of physical intimacy, and to desire women (and not be desirable themselves). However, there is building evidence that sexual scripts and gender roles are not only limited, they may be evolving and shifting over time. The purpose of the current study was to explore the degree to which feeling desired is considered important to heterosexual men in intimate relationships as well as how heterosexual men feel desired by their partners. Three hundred men between the ages of 18 and 65 were recruited from the online platform Reddit. Using Thematic Analysis, we determined that the vast majority of men in this study felt that feeling desired was very important to their sexual experiences. Men in this study listed several ways they felt desired, many that fell outside of traditional gender roles such as romantic, non-sexual touch and having women initiate sexual activity. The findings add to a growing body of literature which suggests traditional sexual scripts for heterosexual men may be limiting and not accurate for all men's sexual experiences.

Development and validation of a short version of the Female Sexual Function Index in the Spanish population

Background

The Female Sexual Function Index (FSFI) is a commonly used scale for the assessment of female sexual function. Our aim was to develop and validate a Spanish short version of the FSFI.

Methods

A parallel exploratory, sequential mixed-methods approach was used, involving 2 sites. The process consisted of 2 steps: (1) cognitive and content validation of the previously translated FSFI in the Spanish population, both through a focus group; and item selection based on the difficulty and discrimination parameters using item response theory (IRT), thereby obtaining a short version of the scale (sFSFI-sv); (2) assessment of test–retest reliability (intraclass correlation coefficient, ICC) of the sFSFI-sv. The presence or absence of a sexual disorder variable based on clinical interview was used on the Receiver Operating Characteristic (ROC) to establish the cut off point whose Area Under the Curve (AUC) based on sensibility and specificity was maximum.

Results

Specific modifications of the FSFI were made according to the focus group results. 114 women were included for IRT analysis. The initial IRT model pointed to the exclusion of items 1, 2, 5, 11, 18, and 19 (S-χ² p < 0.001). Items 3, 9, 11, and 14 showed the best discrimination and difficulty parameters. On the basis of the IRT and focus group results, items 1, 3, 9, 12, 16, and 17 were included in the final sFSFI-sv. sFSFI-sv showed good reliability (ICC 0.91) in a group of 93 women. A total score ≤ 18 could indicate a higher risk of sexual disorder (sensitivity: 81.0%, specificity: 73.3%).

Conclusion

A focus group and the IRT analysis allowed the development of a 6-item Spanish version of the FSFI, which showed good reliability in a group of Spanish women.

Dyadic Association between Sexual Dysfunction and Sexual Satisfaction: A Cross-Sectional Survey of Heterosexual Couples in Hong Kong

Substantial evidence has demonstrated that sexual dysfunction is negatively associated with the sexual satisfaction of individuals in a committed heterosexual relationship. However, little is known about their relationship based on couple data, especially in non-Western societies. We extended this study to examine the extent to which men's and women's sexual dysfunction were associated with their own as well as their partners' sexual satisfaction. Participants were 1,014 heterosexual couples who participated in a community-based survey in Hong Kong in 2017. Using the actor-partner interdependence model and structural equation modeling, our results indicated that the dyadic model fit the data better than the individual model. Women's orgasm and men's sexual desire functioning were significant predictors of both own and partner's sexual satisfaction, and these two domains had similar effects on the sexual satisfaction of both men and women. These findings are discussed in terms of the importance of taking a dyadic approach to research and enhance sexual health and well-being of heterosexual couples.

Posttraumatic Stress and Sexual Satisfaction in Husbands and Wives: A Dyadic Analysis

Trauma survivors who suffer from posttraumatic stress symptoms (PTSS) are known to experience impairments in sexual satisfaction. However, the negative effects of PTSS are not limited to the primary survivors, as they can lead to secondary PTSS in their spouses as well. The implications of secondary PTSS in the sexuality of couples remain unknown. This study aimed to investigate whether specific symptom clusters of PTSS (i.e., intrusions, hyperarousal, and avoidance) are implicated in the sexual satisfaction of couples. We assessed a sample of primarily exposed Israeli veterans from the Yom Kippur War and their wives who had been secondarily exposed (N = 191). The dyadic data were analyzed in an Actor-Partner Independence Model. When scrutinizing specific PTSS clusters, the husbands' avoidance related to their own sexual satisfaction. The wives' hyperarousal related to their own and their spouses' sexual satisfaction, whereas their intrusions were associated only with their husbands' sexual satisfaction. In conclusion, PTSS in one spouse is related to both spouses' sexual satisfaction; it is therefore recommended that clinicians adopt a dyadic approach when delivering interventions.

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

Introduction

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

Aim

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

Methods

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

Main Outcome Measure

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

Results

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

Conclusion

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

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

Partners' Daily Love and Desire as Predictors of Engagement in and Enjoyment of Sexual Activity

Romantic love and sexual desire have often been seen as two distinct constructs and studied separately. However, in most romantic relationships love, desire, and sex are intertwined. The purpose of the present study was to examine whether daily feelings of love and desire influence engagement in and enjoyment of sexual activity. Ninety mixed-sex couples (N = 180) completed a 30-day daily diary. The results were analyzed using hierarchical linear modeling and showed that both love and desire significantly predicted engagement in and enjoyment of sexual activity with desire being a stronger predictor. Clinical implications and future directions are discussed.

A dyadic approach to understanding safer sex behavior in intimate heterosexual relationships

This study applied a dyadic approach to condom-use research. Partners from 124 heterosexual couples independently completed a questionnaire assessing condom-related attitudes, subjective norms, perceived behavioral control, and intentions to use condoms. Results demonstrate the superiority of a dyadic approach to understanding couples’ condom-use intentions and behavior over traditional, individual-level approaches. The addition of partner effects to the model, via the actor–partner interdependence model, resulted in an increase in the variance accounted for in condom-use intentions and this dyadic model showed better fit compared to the individual-level model. The results suggest that consideration of relationship partners plays an important role in the prediction of safer sex intentions.