Couples' Sexual Communication and Dimensions of Sexual Function: A Meta-Analysis

The Effect of Sexual Counseling Based on PLISSIT and EX-PLISSIT Models on Sexual Function, Satisfaction, and Quality of Life: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis study aimed to investigate the effect of sexual counseling based on PLISSIT (Permission, Limited Information, Specific Suggestions, and Intensive Therapy) and EX-PLISSIT models on sexual function, satisfaction, and quality of sexual life. We searched seven electronic databases (MEDLINE, CINAHL, Web of Science, Cochrane Library, ProQuest, Scopus, and PubMed). Studies published between January 1, 2010, and August 16, 2022, were included in the search. Eighteen articles were eligible for inclusion in the analysis. There was a significant difference in the sexual function scores of the PLISSIT and EX-PLISSIT groups and the comparison groups (standardized mean difference (SMD): 1.677; 95% CI 0.668, 2.686; p < 0.05) and "sexual and communication satisfaction" sub-dimension of sexual life quality (SMD: 0.748; 95% CI 0.022, 1.475; p < 0.05). There was no difference in the sexual satisfaction (SMD: 0.425; 95% CI - 0.335, 1.184; p > 0.05) and quality of sexual life scores of the PLISSIT and EX-PLISSIT groups and the comparison groups (SMD: - 0.09; 95% CI - 0.211, 0.032; p > 0.05). PLISSIT and EX-PLISSIT models-based sexual counseling on sexual function was affected by the moderator variables of the time of evaluation of the results after the intervention, type of comparison group, the study population, and by whom the intervention was applied. Sexual counseling based on the PLISSIT and EX-PLISSIT models improved sexual function scores and "sexual and communication satisfaction" sub-dimension of sexual life quality.

My Catastrophizing and Your Catastrophizing: Dyadic Associations of Pain Catastrophizing and the Physical, Psychological, and Relational Well-being of Persons With Endometriosis and Their Partners

OBJECTIVES

Endometriosis, a painful chronic gynecologic condition, contributes to disruptions in multiple areas of life for both those affected and their partner. Pain catastrophizing has been associated with worse pain outcomes and quality of life for women with endometriosis and with more cognitive load for partners. Examining both partners' pain catastrophizing dyadically with our variables of interest will enhance understanding of its associations with the distressing nature of experiencing and responding to pain during sex for couples with endometriosis.

METHODS

Persons with endometriosis experiencing pain during sex and their partners (n=52 couples; 104 individuals) completed online self-report measures of pain catastrophizing, depressive symptoms, sexual satisfaction, and partner responses to pain. Persons with endometriosis reported on pain during sexual activity. Analyses were guided by the Actor-Partner Interdependence Model.

RESULTS

Persons with endometriosis' pain catastrophizing was associated with their higher pain intensity and unpleasantness during sex. When persons with endometriosis reported more pain catastrophizing, they were less sexually satisfied and reported their partners responded more negatively to their pain. When partners reported higher catastrophizing, they were more depressed and responded more negatively to the pain.

DISCUSSION

Consistent with the Communal Coping Model of pain catastrophizing, although meant to elicit support from the environment, the often-deleterious cognitive process of magnifying, ruminating, and feeling helpless about one's pain (or one's partner's pain) is associated with poorer outcomes for the individual with pain and their romantic partner. Implications for pain management include the relevance of involving the partner and attending to the pain cognitions of both members of the couple.

Patterns of Verbal and Nonverbal Communication During Sex

Sexual communication functions as an important relational process expediating satisfying sexual experiences (Sprecher & Hendrick, 2004). Much of the existing literature on sexual communication concerning sexual pleasure biases verbal communication (Babin, 2012). This study adds to the existing research regarding patterns of communication surrounding sex and during sex through qualitative analysis. Further, this inquiry focused on participants' full histories, rather than their tendencies within any current relationship. We analyzed 78 qualitative interview transcripts from participants between the ages of 18 and 69. Participants reported a reluctance to communicate anything but pleasure, discomfort, or dislike during sex to avoid discouraging their partners. Though participants reported a perception that communicating pleasure served as encouragement and affirmation to their partners, most preferred to communicate pleasure nonverbally. Some participants reported a tendency to communicate pain or dislike verbally. Some preferred communication about sexual topics only before or after sexual activities. Participants shared that a high level of comfort with their partner increased sexual communication. How sexual partners communicate sex not only affects pleasure but can only affect intimacy between partners and health. This adds to the scant literature on nonverbal communication during sex and some people's preference for that style (Blunt-Vinti et al., 2019).

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.

Does loneliness mediate the association between social media use disorder and sexual function in Lebanese university students?

Research on the association between social media use disorder (SMUD) and face-to-face sexual function remains controversial, surprisingly scarce and even non-existing in certain vulnerable populations such as university students. We aimed to explore the mediating role of loneliness between SMUD and two dimensions of sexual function (sexual arousal and desire) in a sample of Lebanese university students. A total of 363 university students participated in a cross-sectional survey. Sexual Dysfunction Questionnaire, Jong-Gierveld Loneliness Scale and Social Media Use Disorder scale were used to measure sexual function (desire and arousal), loneliness and SMUD respectively. The mediation analysis results showed that loneliness mediated the association between SMUD and sexual arousal (but not sexual desire). Higher SMUD was significantly associated with more loneliness, whereas more loneliness was significantly associated with less sexual arousal. Subsequently, higher SMUD was significantly associated with less sexual arousal. The present findings edge the university staff, clinicians, and researchers towards the psychological mechanisms that may help university students improve their sexual function, and calls for additional research in this area. Attention should be given to the possible potential role of moderating social media use in tackling loneliness and improving students' sexual function. In addition, routine sexual counseling should be considered when assessing and intervening with students having SMUD.

"I've Learned to Convert My Sensations into Sounds": Understanding During-Sex Sexual Communication

Research generally supports the idea that sexual communication is beneficial to partners in committed relationships. However, much existing sexual communication research has a verbal communication bias and has examined sexual communication in non-sexual contexts, neglecting a wide variability of other forms of communication that occur during sex. Thus, from a sexual scripts theoretical framework, the purpose of the present study was to: (1) explore how individuals communicate needs, desires, pleasure, and displeasure to their partners during sex; (2) investigate perceptions of during-sex sexual communication's purposes; and (3) document individuals' perceived barriers and facilitators to during-sex sexual communication. Data from 27 interviews conducted among individuals in committed different-gender relationships (15 women, 11 men, 1 queer person; 21-68 years old), were analyzed using thematic analysis. Participants reported communicating using a combination of verbal, vocal, and bodily forms of communication. Most participants indicated that communicating during sex increased sexual pleasure and emotional intimacy and was useful for clarifying doubts and reducing insecurities. Many individuals nonetheless reported avoiding verbal communication during sex to preserve the mood, protect a partner's feelings, and avoid experiencing negative emotions and a partner's judgment. Sexual communication was also described as a skill that is developed over time and through the development of sexual subjectivity. Implications for sexual script theory and future sexual communication research are discussed.

Sexual counseling for female sexual interest/arousal disorders: a randomized controlled trial based on the "good enough sex" model

BACKGROUND

Female sexual interest/arousal disorder (FSIAD) is the most common female sexual disorder with adverse effects on women's health and interpersonal relationships.

AIM

This survey evaluated the effects of sexual counseling based on the "good enough sex" (GES) model on the sexual health variables of women with FSIAD.

METHODS

A randomized clinical trial with a 1:1 allocation ratio was conducted among 80 women with FSIAD in Iran in 2021. Eligible participants were randomly assigned to group A (women) and group B (couples). Women attended 4 weekly online group sexual counseling sessions based on the GES model, each lasting 120 minutes. In group B, husbands participated in sessions 2 and 3.

OUTCOMES

Women's sexual health parameters-including sexual desire, sexual satisfaction, sexual function, sexual distress, sexual communication, frequency of sexual intercourse, and dysfunctional beliefs-were evaluated before and 3 months after counseling. The significance threshold considered P < .007 due to Bonferroni correction.

RESULTS

After the intervention, all sexual parameters except sexual dysfunctional beliefs showed significant improvement (P < .001) in both groups. During the follow-up period, the average scores for all sexual variables were slightly higher in group B vs group A. The between-group difference was significant only for frequency of sexual intercourse (P < .01).

CLINICAL IMPLICATIONS

This study reaffirms the impact of the GES model as biopsychosocial therapy in managing female sexual problems. Considering men's reluctance to accompany their wives to sex clinics, counseling for women alone can play a significant role in solving sexual problems, especially in the case of FSIAD. Online sexual consultation offers cost and time savings, provides a secure space for discussing sensitive topics, and facilitates group program coordination. It ensures universal access to counseling, thereby addressing gender incompatibility issues. It is a powerful, interactive, and acceptable alternative to in-person visits, providing convenience and confidentiality for clients seeking sexual health support.

STRENGTHS AND LIMITATIONS

The following were among the survey strengths: conducting a randomized controlled trial on women with FSIAD by applying an appropriate model and scales, involving spouses, and evaluating online group sexual counseling. However, the results of this study may not be generalizable to women without partners.

CONCLUSION

The GES model, emphasizing intimacy and sexual dialogue, reduces unrealistic sexual expectations and improves women's sexual desire and overall health. Our results showed that instead of insisting on the physical presence of husbands in counseling sessions, clinicians should emphasize their emotional support and companionship during the treatment process.

The Brazilian Portuguese version of the ICIQ-FLUTSsex: cross-cultural adaptation and measurement property analysis

INTRODUCTION AND HYPOTHESIS

The worldwide prevalence of sexual dysfunction in women is high; therefore, an adequate assessment of this condition is necessary, with instruments validated for the Brazilian population. The aim was to translate and adapt the International Consultation on Incontinence Questionnaire Female Sexual Matters Associated with Lower Urinary Tract Symptoms into Brazilian Portuguese (ICIQ-FLUTSsex-Br) and analyze its measurement properties.

METHODS

We recruited Brazilian women, literate, over 18 years old, who had had sexual intercourse in the last 4 weeks and had urinary loss. The translation and cross-cultural adaptation were performed following five stages: translation, synthesis, back translation, expert committee review, and pre-test. Measurement properties were analyzed using SPSS software, as follows: test-retest reliability using the intraclass correlation coefficient (ICC); construct validity using Pearson's correlation coefficient, by correlating the ICIQ-FLUTSsex-Br with the Female Sexual Function Index (FSFI) and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12).

RESULTS

A total of 328 women participated in the study. The reproducibility was 0.88, the standard error of measurement was 0.29, and the minimal detectable change was 0.80 (95% CI). Moderate correlations were found between the total scores of the ICIQ-FLUTSsex and PISQ-12 questionnaires (0.54, p<0.01), confirming the hypotheses outlined. Weak correlations were also found for comparisons between the FSFI and ICIQ-FLUTSsex total scores (-0.56, p<0.01) and the PISQ-12 question about fear of incontinence hindering sexual intercourse (0.26, p<0.01).

CONCLUSION

The Portuguese-language version of the ICIQ-FLUTSsex-Br showed validity and reproducibility, making it a tool to be used in research and clinical practice by health professionals in Brazil.

A qualitative exploration of internet forum discussions surrounding female sexual function for individuals with Sjögren's syndrome

Sexual dysfunction is a common experience for women with the autoimmune rheumatic disease, Sjögren's syndrome (SS); however, the lived experience of how the disease affects sexual functioning and the sexual environment remains unexplored. This qualitative study explores the conversations pertaining to female sexual function and the sexual environment that individuals with SS have on an internet forum. Qualitative data posted on one publicly accessible, worldwide, internet forum was extracted using an automated web scraping tool. A total of 247,694 posts across 23,382 threads were scraped from the forum in July 2019 and June 2022 (from the United Kingdom). A predetermined and theoretically informed keyword search strategy was used to screen the captured data for content relevant to the study aim. The dataset was cleaned to remove duplication and identifying information and screened for topic relevance. The Computer-Assisted Qualitative Data Analysis software tool, ATLAS.ti, was used to facilitate the data analysis process. Thematic analysis was conducted on 1443 female-oriented posts, and four key themes were identified: the symptoms of SS and their impact on the sexual environment; the emotional responses that are commonly evoked in response to sexual difficulties; the strategies that users have implemented to manage sexual problems; and the impact that a partner's behavior may have on the sexual environment. Together these themes provide an insight into the nature of sexual difficulties for females with SS. Our findings provide novel insights to inform clinical discussions between practitioners and patients whilst further outlining the importance of undertaking qualitative research with this population.

Comparing the self-awareness and problem-solving skills training on sexual desire of newly married women: A field trial study

BACKGROUND

Sexual desire of women is one of the most important factors affecting marital and sexual satisfaction. Regarding the association of life skills level with sexual dissatisfaction and sexual desire, the present study aims to compare the effect of self-awareness and problem-solving skills training on the sexual desire of newly married women.

MATERIALS AND METHODS

This was an experimental field trial study conducted since October 2019 to September 2020. The participants included 105 married women with a history of up to 5 years of cohabitation assigned randomly to either of the two intervention or control groups. The data collection tools include a demographic form, Hulbert index of sexual desire (HISD), and ENRICH couple scale that were completed by the participants before (T1), immediately (T2), and one month after the intervention (T3). The first intervention group received self-awareness skills training, whereas the second one received problem-solving skills training (four sessions of 90 min) weekly. On the other hand, the control group received no training. Statistical analyses were performed using SPSS 16 software and descriptive-analytical statistical tests including one-way ANOVA, Kruskal-Wallis, Bonferroni test, tests of within-subjects effects, and analysis test with repeated measures. P value < 0.05 was considered significant.

RESULTS

The effect of time (statistic test: 51.24, P-value < 0.001) and the interaction effects of Time and Group on sexual desire (statistic test: 2.87, P-value: 0.03) were statistically significant. The mean score of sexual desire both in interventions and control groups showed statistically significant improvement. The mean score of sexual desire in the self-awareness group was 44.31 ± 9.08 (T1), 51.34 ± 10.92 (T2), and 59.48 ± 13.76 (T3) (P < 0.001); in the problem-solving group was 48.74 ± 10.21 (T1), 52.08 ± 10.59 (T2), and 57.40 ± 12.40 (T3) (P < 0.001); and in the control group was 47.74 ± 11.60 (T1), 50.08 ± 10.04 (T2), and 54.94 ± 12.15 (T3) (P = 0.02).

CONCLUSION

The present study showed the effectiveness of both self-awareness and problem-solving skills training on newly married women's sexual desire. Moreover, this study showed simply participating in a study related to sexual desire as a control group could be effective on women's sexual desire.

The Role of Mutual Masturbation within Relationships: Associations with Sexual Satisfaction and Sexual Self-Esteem

Objectives

We explored mutual masturbation among women and men and investigated associations with sexual satisfaction and sexual self-esteem.

Methods

117 women and 151 men (Mage = 29.7 years), mostly heterosexual, all in current relationships, completed an online survey covering experiences of solo and partnered sexual activities, feelings about mutual masturbation, sexual self-esteem, and sexual satisfaction.

Results

Mutual masturbation was common among both genders. Men reported significantly higher positive feelings about mutual masturbation than women. Recent mutual masturbation was positively associated with sexual satisfaction but not with sexual self-esteem.

Conclusions

These findings have implications for sex and couple therapy and research.

Subjective effects and perceived mechanisms of change of cognitive behavioral and mindfulness-based online interventions for low sexual desire in women

Cognitive-behavioral (CBT) and mindfulness-based therapy (MBT) are effective treatments for Hypoactive Sexual Desire Dysfunction (HSDD) in women. To date, evidence regarding the mechanisms of these treatments for improving low sexual desire is still lacking. To gain comprehensive information on the subjective effects and perceived mechanisms of change of CBT and MBT for HSDD, semi-structured qualitative interviews were conducted with 51 cis-women who participated in a trial investigating internet-based CBT and MBT for HSDD. Data were analyzed with deductive and inductive content analysis. Subjective treatment effects included increased desire, improved communication, and greater self-acceptance. Different mechanisms of change for CBT and MBT were endorsed by participants. This study provides tangible evidence of the different pathways through which CBT and MBT can improve women's sexual desire.

"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.

Sexual Satisfaction Mediates the Effects of the Quality of Dyadic Sexual Communication on the Degree of Perceived Sexual Desire Discrepancy

Difficulties related to sexual desire discrepancy are among the most common complaints in people seeking help in therapy. The aims of the current study were to test a mediation model using a bootstrapping procedure where the quality of the dyadic sexual communication plays a key role in increasing or diminishing the degree of perceived sexual desire discrepancy through sexual satisfaction. An online survey was administered through social media to N = 369 participants involved in a romantic relationship, measuring the quality of dyadic sexual communication, sexual satisfaction, the degree of the perceived sexual desire discrepancy, and a series of relevant covariates. As expected, the mediation model showed that a better quality of dyadic sexual communication is related to a lower degree of perceived sexual desire discrepancy through increased sexual satisfaction (β = -0.17, SE = 0.05, [95% CI = -0.27, -0.07]). The effect held over and above the effect of the relevant covariates. The theoretical and practical implications of the present study are discussed.

Effect of depression and anxiety on sexual functioning in couples trying to conceive with and without an infertility diagnosis

OBJECTIVE

This study examined the effects of anxiety and depression on sexual functioning in couples trying to conceive, and tested the moderating role of infertility diagnosis on this association.

DESIGN

An online questionnaire was completed by 1453 individuals in a heterosexual relationship for more than one year. The final sample had 107 couples who were actively attempting a pregnancy (63 had an infertility diagnosis; 44 were presumably fertile). Data was analyzed with the Actor-Partner Interdependence Model (APIM).

MAIN OUTCOME MEASURES

Depression and anxiety symptoms were assessed by the Hospital Anxiety and Depression Scale (HADS), and male and female sexual functioning were assessed through the International Index of Erectile Function (IIEF) and the Female Sexual Function Index (FSFI), respectively.

RESULTS

Actor effects were found between depression and sexual functioning in both men (β= -.28, p= .003) and women (β= -.43, p < .001), with no significant partner effects. The moderation analysis showed that the relationship between depression and sexual functioning is stronger in infertile men than in presumably fertile men (β= -.29; p= .002).

CONCLUSION

Psychological interventions with couples trying to conceive should address the role of depression in sexual functioning, particularly in infertile men.

Vil NM, Bond KT, Mitchell JW, Juarez AC, Lambert F, Muheriwa SR, McMahon J. Dimensions of Sexual Health Conversations among U.S. Black Heterosexual Couples

Sexual health communication is an important feature of healthy intimate relationships; however, some couples may avoid discussing difficult matters (e.g., HIV/STI testing, sexual satisfaction) to minimize interpersonal conflict. From October 2018 to May 2019 in New York State, we conducted a multi-method descriptive pilot study to characterize Black heterosexual couples' (N = 28) sexual health conversations. Partners individually completed an online sexual health/relationship survey before engaging in-person for a joint dyadic qualitative in-depth interview. Quantitative descriptive statistics demonstrated that most absolute score differences among couple's preferences for sexual health outcomes, communal coping and sexual relationship power were mainly small, but greatest regarding extra-dyadic sexual behaviors. A qualitative descriptive approach discerned, motivation and norms for sexual health conversations, and communication patterns. Thematic and content analysis revealed two central themes: initiating and sustaining sexual health conversations, and leveraging features of the couples to promote sexual health. Integrated findings indicate that couples possess varied communication patterns that operate with motivations for sexual health conversations toward subsequent sexual health promotion. Equitable and skewed communication patterns emerged as relationship assets that can be leveraged to optimize sexual health. There is also opportunity for future work to address communication regarding extra-dyadic behavior and preferences. Asset-based considerations are discussed.

Few Differences in Sexual Talk by Gender/Sex and Dyad Type: A Retrospective and Daily Diary Study with Couples

Sexual talk is a type of verbal communication that occurs exclusively during sexual activity and that is specific to the sexual activity itself. Previous research has identified two types of sexual talk: individualistic (i.e., self-focused) and mutualistic (i.e., sharing/partner-focused), which have generally been linked to greater sexual and relationship well-being. Whether sexual talk use varies by gender/sex (i.e., men, women, gender/sex diverse individuals; GSD) or dyad type (i.e., same- vs. mixed-gender/sex) has not been examined. Given initial evidence that the types of sexual talk may contribute differently to sexual and relationship well-being, it is important to identify factors (e.g., gender/sex) that may be associated with the amount of sexual talk used. We examined differences by gender/sex and dyad type in the average sexual talk use among long-term couples (N = 229; 69 same-gender/sex) using retrospective cross-sectional dyadic data. We also examined these differences in the same sample (N = 217) using a 35-day dyadic daily diary study. Retrospectively, but not daily, women reported using more mutualistic talk than men, especially when partnered with a woman. There were no significant gender/sex or dyad type differences in use of individualistic talk retrospectively or daily. Exploratory analyses with the GSD couples suggested that there may be gender/sex and dyad type differences retrospectively and daily, for individualistic and not mutualistic talk; however, these analyses must be interpreted with caution due to the small subsample size of GSD couples.

A Qualitative Examination of Withdrawing Sexual Consent, Sexual Compliance, and Young Women's Role as Sexual Gatekeepers

Introduction: Withdrawing consent for sex may be difficult for young women due to gendered sexual scripts and male persistence. Method: 40 students from Canadian universities (31 women; Mean age = 20.20 years; 75% heterosexual) were asked open-ended questions about sexual experiences and consent; data were analyzed using thematic analysis. Results: Women perceived that: (1) women were responsible for communicating consent, (2) they were unaware it was acceptable to withdraw consent or did not know how to, (3) male partners often persisted in response to withdrawal of consent, and (4) these experiences factored into compliance. Conclusion: Sexual consent education, at least in North America, should increase emphasis on withdrawing consent.

Heterosexual Young Adults’ Experience With and Perceptions of the Orgasm Gap: A Mixed Methods Approach

The “orgasm gap” refers to the finding that cisgender men, on average, have more orgasms than cisgender women during heterosexual partnered sex. In the current research, we replicated evidence for several orgasm discrepancies across sexual contexts and assessed men’s and women’s perceptions of the orgasm gap. Our sample consisted of 276 heterosexual, cisgender, sexually active undergraduate students (56.52% women; M age = 18.84). We assessed participants’ self-reported orgasm frequencies with a familiar partner, with a new partner, and during masturbation, as well as participants’ perceptions of their partners’ orgasm frequencies. We found evidence for orgasm discrepancies between young men and women within contexts and for women across contexts. Additionally, men perceived the size of the orgasm gap to be smaller than women perceived it to be. We used qualitative analyses to assess participants’ perceptions of driving forces behind the orgasm gap and their responses could be grouped into five overarching themes: Sociocultural Influence, Women’s Orgasm Difficulty, Biology, Men’s Fault, and Interpersonal Communication. This qualitative data can inform education and advocacy efforts focused on improving orgasm outcomes for young women, particularly by disproving prominent biological justifications for orgasm difference and addressing relevant sociocultural concerns. Additional online materials for this article are available on PWQ’s website at http://journals.sagepub.com/doi/suppl/10.1177/03616843221076410 .

Dimensions of couples' sexual communication, relationship satisfaction, and sexual satisfaction: A meta-analysis

Despite consistent evidence that sexual communication positively correlates with relationship and sexual satisfaction, there has been empirical murkiness regarding which aspects of sexual communication matter more or less for relationship and sexual satisfaction. A systematic meta-analysis was conducted to investigate if the strength of the association between sexual communication and relationship and sexual satisfaction varied by dimensions of sexual communication and individual, interpersonal, and cultural factors. The meta-analysis included 93 studies with 209 unique effect sizes, which represented 38,499 unique individuals in a current relationship. The multilevel meta-analysis evidenced a positive association between sexual communication and both relationship (r = .37) and sexual satisfaction (r = .43). For relationship satisfaction and sexual satisfaction, the effect size for quality of sexual communication (r = .43; .52) was larger compared to the frequency of sexual communication (r = .31; .31) and sexual self-disclosure (r = .28; .39). After controlling for the average age and relationship length of the sample, samples with married participants (r = .49) had larger effect sizes compared to samples with mixed relationship statuses (r = .35). Higher levels of individualism (b = .003) strengthened, and higher levels of gender inequality (b = -.06) weakened, the association between sexual communication and sexual satisfaction. Finally, when sociosexuality was low, sexual communication had a large association with relationship satisfaction for men (r = .69) and a small association for women (r = .16). Measurement, sample characteristics, and cultural factors have an important role in understanding the link between partners' sexual communication and their relationship and sexual satisfaction. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A Mixed Methods Study of Sexual Communication in Various Couple Typologies Part I: Cluster Analysis

This study presents the first part of a mixed-methods exploration of couple sexual communication. Typologies of heterosexual couples in committed, sexual relationships were created for further exploration of group differences in sexual communication. A cluster analysis categorized couples into four different couple typologies: mutually satisfied, satisfied men/dissatisfied women, satisfied women/dissatisfied men, and mutually dissatisfied. Using a MANOVA approach, the couple typologies were used to identify differences in how the couple types communicated about sex. The results revealed significant differences among the differing couple types, which will be explored qualitatively in part two of this analysis.

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.

Dyadic Sexual Desire in Romantic Relationships: The Dyadic Interactions Affecting Dyadic Sexual Desire Model

In most theoretical models, sexual desire for one's partner is predominantly conceptualized from an individual perspective. There is, however, a growing body of empirical evidence on the dyadic aspects of sexual desire. That evidence is as yet not well-integrated into theoretical conceptualizations of sexual desire. Aiming to fill this gap, we present the Dyadic Interactions Affecting DyadIC Sexual desire model (DIADICS), a new conceptual model inspired by systems theory that describes how dyadic interactions between partners influence dyadic sexual desire in romantic relationships. After defining dyadic sexual desire, we discuss (1) the structure of dyadic interactions, (2) their content, and (3) the process through which they affect dyadic sexual desire in a romantic relationship. Thereafter, we review theoretical, clinical, and empirical insights underscoring the relation between dyadic interactions and (dyadic) sexual desire, use DIADICS as a framework for understanding fluctuations in dyadic sexual desire in long-term relationships, and conclude by discussing implications of DIADICS for research and clinical practice.

The Effect of Mindfulness-Based Cognitive-Behavioral Sex Therapy on Improving Sexual Desire Disorder, Sexual Distress, Sexual Self-Disclosure and Sexual Function in Women: A Randomized Controlled Clinical Trial

Sexual desire disorder is the most common form of sexual dysfunction among women and is associated with problems like sexual distress and reduced sexual self-disclosure. As a result, this RCT study was conducted with 70 reproductive-age women in the form of 4 weekly group educational sessions. Compared to the control group, the mindfulness-based cognitive-behavioral sex therapy (MBCST) intervention significantly improved sexual -desire, -distress, self-disclosure and -function immediately, 4 and 12 weeks after the educational sessions were completed in the intervention group (p < 0.001). Overall, our findings underscore the significance of the MBCST intervention on improving sexual dysfunction among women.Trial registration number: Iranian registry of clinical trials. IRCT Id: IRCT20160808029255N4.Trial registration date: 17th September 2018.Date of first patient's enrollment: 19th September 2018.Supplemental data for this article is available online at https://doi.org/10.1080/0092623X.2021.2008075.

Becoming what you are seeking: Building Relational Self-Awareness in emerging adults

Emerging adults are attempting to navigate a rapidly shifting and immensely complicated landscape of modern love, often without meaningful sex and relationship education. Although individually oriented relationship education programs for emerging adults make a difference in the knowledge, attitudes, and beliefs of the recipients (Simpson et al., Journal of Youth and Adolescence, 2018, 47, 477) and most emerging adults report they yearn for relationship education (Weissbourd et al., The talk: How adults can promote young people's healthy relationships and prevent misogyny and sexual harassment, 2017), these programs are not widely available. Educators who are working with emerging adults in a classroom or psychoeducational setting are well-positioned to help emerging adults identify and enact healthy and purposeful relational and sexual choices. The first part of the paper orients readers to the "topography" of the modern love landscape by describing four macro cultural themes that impact the intimate lives of emerging adults. The second part of the paper introduces relationship educators to Relational Self-Awareness (Solomon, Loving Bravely: 20 lessons of self-discovery to help you get the love you want, New Harbinger, 2017), an integrative approach to helping emerging adults understand the self-in-relationship. Each of the five pillars of Relational Self-Awareness is defined and operationalized, and specific recommendations are provided for how educators can integrate these pillars into their existing curricula. Clinical implications and future directions are offered.

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.

Transcultural Adaptation and Validation of the Spanish Version of the Sexual Satisfaction Scale for Women (SSS-W-E)

Background: Sexual satisfaction is a complex and multidimensional concept. It encompasses physical, emotional, relational and cultural dimensions, and constitutes an essential component of sexual health, as well as an indicator of quality of life and wellbeing. The Sexual Satisfaction Scale for Women (SSS-W) was designed in the United States, and it is a valid and reliable tool to measure women’s sexual satisfaction. Aim: The aim of this study was to culturally adapt and translate the SSS-W into Spanish and analyze its psychometric properties. Methods: First, the original instrument was culturally adapted and translated from English to Spanish. Then, we tested the psychometric properties of the instrument in its Spanish version in a sample of 316 women who attended a family planning clinic in Logroño, Spain. Internal consistency reliability of the whole scale and each subscale separately was measured using Cronbach’s alpha. Factorial validity of the SSS-W in its Spanish version was analyzed using exploratory factor analysis through the Kaiser–Meyer–Olkin measure of sample adequacy and Bartlett’s Sphericity test. Results: The Cronbach’s alpha coefficients of the total scale and each subscale were satisfactory (>0.7). Exploratory factor analysis confirmed the five hypothetical dimensions of the scale in its Spanish version. The five dimensions (contentment, communication, compatibility, relational concern, and personal concern) explained 60% of the total variance of the scale; factor analysis using varimax rotation revealed strong loads in each of the five components. Conclusions: The SSS-W in its Spanish version is a valid and reliable tool to assess sexual satisfaction in Spanish women of reproductive age and, therefore, can be used both in clinical practice and for the investigation of sexual health.

Couples' Use of Online Stress Management and Resiliency Training for Sexual Health Concerns: A Randomized Controlled Trial

Introduction

Mindfulness is a promising intervention for female sexual dysfunction (FSD); however, of the mindfulness interventions studied, few treat the woman and her partner.

Aim

We developed a brief online mindfulness, resilience, and psychoeducation intervention, Stress Management and Resiliency Training for Sexuality (Sex SMART), for women with sexual health concerns and their partners.

Methods

Women with female sexual interest/arousal disorder and their partners were recruited between February 24, 2015, and October 6, 2016, and randomized to treatment or control groups (received educational pamphlets). The treatment intervention comprised of an online SMART and sexual health psychoeducation module.

Main Outcome Measures

The Female Sexual Function Index (FSFI), Female Sexual Distress Scale-Revised (FSDS-R), Sexual Desire Inventory-2 (SDI-2), Revised Dyadic Adjustment Scale (RDAS), International Index of Erectile Function (IIEF), and other subjective measures were used to assess sexual function and sexual distress at baseline and 12 weeks.

Results

The study included 60 women and their partners (30 couples in each group). In both groups, sexual function by total FSFI scores and sexual distress scores significantly improved at 12 weeks compared with baseline, with no significant between-group differences (FSFI effect estimate for Sex SMART vs control = +1.4 (90% CI [–0.6 to +3.4]; P=.13). Both participants and partners randomized to the intervention reported significantly improved attitude and feelings, comfort as a sexual person, and subjective sexual functioning at 12 weeks. The findings provide preliminary evidence for efficacy of an online intervention for couples with sexual health problems.

Conclusions

A brief online mindfulness, resilience, and psychoeducation–based intervention showed no significant improvement in many outcomes (FSFI, FSDS-R, SDI-2, RDAS) of sexual health versus controls. Although this is the first online randomized controlled trial to evaluate a mindfulness-based therapy intervention, it was limited by its lack of population diversity and high attrition rate. Significant improvements in subjective sexual health and partner sexual function by the International Index of Erectile Function were reported only in the intervention group.

Rullo JE, Sood R, Fokken SC, et al. Couples’ Use of Online Stress Management and Resiliency Training for Sexual Health Concerns: A Randomized Controlled Trial. Sex Med 2021;9:100404.

Sexual Practices and Satisfaction among Gay and Heterosexual Men in Romantic Relationships: A Comparison Using Coarsened Exact Matching in a U.S. National Sample

Gay men are underrepresented in research on sexual satisfaction. We examined sexual satisfaction and over 50 sexual practices in an online U.S. national survey of men in relationships. Coarsened exact matching created comparable samples of heterosexual (n = 3527) and gay (n = 452) men on six demographic factors, including relationship length. Results identified many similarities between the groups, including sexual frequency, orgasm frequency, duration of sex, and sexual satisfaction. The majority of heterosexual and gay men expressed physical or emotional affection during their last sexual encounter, reporting that they or their partner said "I love you" (66%; 57%) and engaged in deep kissing (69%; 75%) or gentle kissing (82%; 72%). Heterosexual men were less likely than gay men to usually-always receive (27%; 61%) or give (37%; 68%) oral sex when intimate in the past month; were less likely to view pornography with their partner (35%; 61%); but were more likely to give their partner massages in the past year to improve their sex lives (71%; 58%). Number of sexual communication behaviors was a strong predictor of sexual satisfaction, particularly for gay men (β =.36). These findings enhance our understanding of heterosexual and gay men's sexual lives.

Women in Relationships and Their Pornography Use: A Systematic Review and Thematic Synthesis

A systematic review and thematic synthesis were conducted on the motivations, purposes, and influence of pornography use among women who are in committed relationships. Pornography use was identified as having both positive and negative outcomes for women's sexual and relationship lives. Women watched pornography for diverse reasons: to feel sexually empowered, to enhance sexual arousal, and for masturbation purposes. Shared use of pornography with partners provided variety in sexual activities, could aid communication about sexual issues and helped improve intimacy. Pornography use can help some women feel sexually empowered, relaxed and better able to enjoy their sexual lives.

Fantasies About Consensual Nonmonogamy Among Persons in Monogamous Romantic Relationships

The present research explored fantasies about consensual nonmonogamous relationships (CNMRs) and the factors that predict such fantasies in a large and diverse online sample (N = 822) of persons currently involved in monogamous relationships. Nearly one-third (32.6%) of participants reported that being in some type of sexually open relationship was part of their favorite sexual fantasy of all time, of whom most (80.0%) said that they want to act on this fantasy in the future. Those who had shared and/or acted on CNMR fantasies previously generally reported positive outcomes (i.e., meeting or exceeding their expectations and improving their relationships). In addition, a majority of participants reported having fantasized about being in a CNMR at least once before, with open relationships being the most popular variety. Those who identified as male or non-binary reported more CNMR fantasies than those who identified as female. CNMR fantasies were also more common among persons who identified as anything other than heterosexual and among older adults. Erotophilia and sociosexual orientation were uniquely and positively associated with CNMR fantasies of all types; however, other individual difference factors (e.g., Big Five personality traits, attachment style) had less consistent associations. Unique predictors of infidelity fantasies differed from CNMR fantasies, suggesting that they are propelled by different psychological factors. Overall, these results suggest that CNMRs are a popular fantasy and desire among persons in monogamous romantic relationships. Clinical implications and implications for sexual fantasy research more broadly are discussed.

"I Tell Them What I Can Feel and How Far My Legs Can Bend": Optimizing Sexual Satisfaction for Women With Spina Bifida

BACKGROUND

There is a high reported rate of sexual dysfunction among women with spina bifida, but little is known about the etiology of this or how sexual satisfaction could be improved.

AIM

To identify, through the words of women with spina bifida, perceived causes of diminished sexual satisfaction and recommendations to optimize partnered sexual encounters.

METHODS

In this qualitative study, we conducted semi-structured individual interviews with 22 women with spina bifida (median age 26.5 years, range 16-52 years) who have had a romantic partner. Using Grounded Theory, interviews were independently coded by 3 reviewers. Disagreements were resolved by consensus.

OUTCOMES

We identified overlapping themes of issues women experienced during sexual intimacy and strategies they learned to improve sexual encounters.

RESULTS

7 salient themes emerged from the data: (i) fear of rejection with resulting difficulty setting boundaries and the risk of coercion; (ii) conflict between spontaneity and self-care in sexual encounters; (iii) worry about incontinence during sex; (iv) trial and error in learning optimal sexual positions; (v) decreased genital sensation; (vi) safety considerations; and (vii) sharing advice with other women with spina bifida.

CLINICAL IMPLICATIONS

As sexual satisfaction is influenced by physical features as well as psychological, interpersonal, and sociocultural factors, optimizing sexual satisfaction of women with spina bifida is best managed with a holistic approach utilizing a biopsychosocial model.

STRENGTHS & LIMITATIONS

The sample included women with a diverse range of functional impairments. Women were forthright with their comments and thematic saturation was reached. Recruitment was primarily from a single Midwestern institution, which may have limited sampled perspectives.

CONCLUSION

While women with spina bifida encounter challenges during sexual encounters, strategies focused on improving communication with partners and addressing specific physical considerations can potentially enhance their sexual experiences. Streur CS, Schafer CL, Garcia VP, et al. "I Tell Them What I Can Feel and How Far My Legs Can Bend": Optimizing Sexual Satisfaction for Women With Spina Bifida. J Sex Med 2020;17;1694-1704.

Gratitude Increases the Motivation to Fulfill a Partner’s Sexual Needs

Maintaining sexual satisfaction is a critical, yet challenging, aspect of most romantic relationships. Although prior research has established that sexual communal strength (SCS)—i.e., the extent to which people are motivated to be responsive to their partner’s sexual needs—benefits romantic relationships, research has yet to identify factors that promote SCS. We predicted that gratitude would increase SCS because gratitude motivates partners to maintain close relationships. These predictions were supported in three studies with cross-sectional, longitudinal, and experimental methods. Specifically, experiencing and receiving expressions of gratitude were associated with greater SCS. These studies are the first to investigate the benefits of gratitude in the sexual domain and identify factors that promote SCS. Together, these results have important implications for relationship and sexual satisfaction in romantic relationships.