Psychophysiological sexual arousal in women with a history of child sexual abuse

Investigating trait mindfulness in women with a history of unwanted sexual contact

Unwanted sexual contact (USC) is common in women, and may contribute to sexual dysfunction via avoidance coping techniques. Mindfulness-based treatments, which directly challenge avoidance, have been shown to be effective in treating sexual dysfunction, however, it is not yet clear whether there are differences in trait mindfulness between women with and without a history of USC. We used data from four previous studies and compared trait mindfulness on the Five Facet Mindfulness Questionnaire (FFMQ) in women with and without a history of USC. There were no significant differences between the USC and no-USC groups on total FFMQ score, nor on most individual domain scores; however, significant group differences were found on observe and acting with awareness subscales. We speculate on the possible meaning of the USC group having higher observe scores and lower acting with awareness scores compared to the no-USC group.

Affective neuroscience: applications for sexual medicine research and clinical practice

INTRODUCTION

Affective neuroscience is the study of the brain substrates of emotional, embodied experiences. Affective neuroscience theory (ANT) is based on experimental evidence that all mammals are hardwired with 7 primary subcortical emotional operating systems, or "core emotions," that have overlapping but distinct circuits buried in the deep, ancient parts of the brain. Imbalances in the 7 core emotions can affect multiple aspects of the individual's psychosocial well-being (eg, depression, anxiety, substance abuse). Here, we propose that core emotions can also influence sexual function and, specifically, that imbalances in core emotions are the bridge connecting psychiatric symptoms (eg, anhedonia) to sexual dysfunction (eg, anorgasmia).

OBJECTIVES

In this targeted review and commentary, we outline potential connections between ANT and sexual medicine research and clinical practice. We summarize ANT by defining the 3-level BrainMind and core emotions; examining how they relate to personality, behavior, and mental health; and determining the implications for sexual health research and clinical practice.

METHODS

A targeted literature review was conducted. Case studies were adapted from client files and clinician interviews and then anonymized.

RESULTS

We propose a novel organizational schema for implementing affective balance therapies for sexual dysfunction, which integrate psychoeducational, somatic, and cognitive therapeutic approaches under the ANT framework. We provide 3 patient case studies (anorgasmia, hypersexuality, spinal cord injury) outlining the implementation of this approach and patient outcomes.

CONCLUSION

ANT has practical translational applications in sexual health research and clinical practice. By integrating our understanding of the role of core emotions in human sexuality, clinicians can better tailor treatments to address sexual dysfunction.

Childhood Sexual Abuse and Relationship Satisfaction: The Moderating Role of PTSD and Sexual-Related Posttraumatic Stress Symptoms

Research on childhood sexual abuse (CSA) has consistently demonstrated the long-term effects of such abuse, not only on survivors' development, but also on the nature and quality of their adult relationships, particularly romantic ones. In this study we examined the moderating role of posttraumatic stress disorder (PTSD) and sexual-related posttraumatic stress symptoms (sexual-related PTSS) between CSA and relationship satisfaction. Survey data from 529 individuals who reported being currently in a romantic relationship were analyzed. In the first set of analyses, results demonstrated that participants with CSA reported significantly lower relationship satisfaction and significantly greater severity of PTSD and sexual-related PTSS than participants without CSA. Sexual-related PTSS but not PTSD moderated the association between CSA and participants' relationship satisfaction, with the model of sexual-related PTSS explaining 20.8% of the variance in relationship satisfaction and the model of PTSD explaining 11.3% of this variance. In the second set of analyses conducted among survivors of CSA only, higher sexual-related PTSS severity was linked with ongoing abuse and with abuse by a non-family member. This study points to the potential contribution made by sexual-related PTSS to relationship satisfaction among survivors of CSA.

Sex in the Shadow of Child Sexual Abuse: The Development and Psychometric Evaluation of the Post-Traumatic Sexuality (PT-SEX) Scale

Sexual-related post-traumatic stress symptoms (sexual-related PTSS) refers to the traumatic reactions that are replicated during sexual activity among survivors of child sexual abuse (CSA). However, the construct of sexual-related PTSS have been adapted from clinical work with survivors, and research with limited examination of the scales themselves. Given this gap, the current study offers the development of a new measure (PT-SEX) that examines sexual-related PTSS. The study was conducted online, among two convenience samples of women survivors of CSA (study 1 included 451 women and study 2 included 330 women). Six reliable PT-SEX factors emerged from Study 1: Dissociation during sex, intrusiveness during sex, shame and guilt in regard to sexual aspects, pleasing the other during sex, interpersonal distress, and hypervigilance during sex. Study 2 revealed survivors of CSA had significantly higher sexual-related PTSS levels as compared to participants without such a history. Also, post-traumatic stress disorder and sexual-related PTSS made unique and unshared contributions to the observed data, including sexual self-esteem, sexual motives, relationship satisfaction, compulsive sexual behavior, and mental health. CSA significantly moderated the associations between sexual-related PTSS and sexual self-esteem, sexual motivations of self-affirmation and coping, and depression and anxiety. Findings from the current study show that over time, the trauma of CSA seems to be implicated in survivors' sexual experience. As sexual difficulties are accompanied by sexual-related PTSS, these symptoms are unlikely to resolve by trauma-focused therapy and must be actively targeted in therapy.

Treating Sexual Dysfunctions Among Survivors of Child Sexual Abuse: An Overview of Empirical Research

Sexual problems are very prevalent among survivors of child sexual abuse (CSA). Yet, various approaches to therapy do not seem to address this issue when treating these individuals. Traditional sex therapy may also not suit the experiences of CSA survivors, as CSA was not considered when the most well-known and frequently used techniques were developed. The present review sought to identify (1) theory-based therapeutic approaches that address sexual problems among CSA survivors and offer treatment protocols (including an outline of specific therapy stages, sessions, or techniques) to treat these sexual problems and (2) identify therapeutic approaches that include a protocol for treating sexual problems among CSA survivors that was empirically tested and validated. In total, six approaches for treating sexual dysfunctions among CSA survivors that provide detailed guidelines for implementing the approach within sex therapy for CSA survivors were identified in the literature. Only two of the studies conducted a randomized controlled trial to test the intervention. This overview concludes with important issues to address when treating sexual problems among CSA survivors and a call for additional evidence-based practices for treating sexual problems among survivors of CSA.

The Impact of Child Sexual Abuse on Men's Sexual Function: A Systematic Review

Child sexual abuse (CSA) is strongly associated with sexual dysfunction. However, research about male survivors' sexual functioning after CSA is lacking. The current systematic review searched for all studies that reported on CSA and sexual function among male survivors to answer the following questions: Do male survivors of CSA experience sexual dysfunctions, and if so, to what extent? Does CSA increase the risk of developing sexual dysfunctions in adulthood among men? Studies were identified by searching seven databases and sources of gray literature. The selection criteria included empirical studies involving a population of adult men who experienced CSA before the age of 18. Studies focused on sexual functioning and sexual development after the abuse. Twelve studies met the selection criteria. While some studies confirmed that CSA is a risk factor for sexual dysfunction in adult male survivors, including low sexual drive, problems with arousal, and difficulties with orgasm and pain, other studies failed to find a correlation between sexual dysfunction and CSA. The wide range in quality, methodology, and definitions of CSA and sexual function presented challenges to consistent analysis of the studies and to determine the impact of CSA. Further research is required to fully understand the effect of CSA on adult men's sexual function.

Using Latent Variable Mixture Modeling to Understand Trauma-Related Outcomes in Undergraduate Women

Posttraumatic stress disorder (PTSD) and sexual functioning problems often co-occur after trauma. Researchers have linked certain factors (e.g., depression, relationship satisfaction) to PTSD and sexual functioning, but it is unclear how these variables interact. Adult undergraduate female trauma survivors (N = 280) completed self-report measures via an online survey. Latent variable mixture modeling generated four groups that differed in terms of their PTSD symptom severity, sexual functioning, sexual pain, relationship status, and relationship functioning. ANOVAs explored group differences. Classes were not differentiated by trauma, relationship satisfaction, or drug use. Results highlight the complex relations between sexual functioning and post-trauma symptomology.

Sexual vs. Nonsexual Currently Most Upsetting Trauma: A Fresh Look at Attenuation of Sexual Response, Alcohol Intoxication, and Post-Traumatic Stress

This study examined the dependence of sexual response (vaginal pulse amplitude [VPA] and subjective sexual arousal) on alcohol intoxication (.10% breath alcohol concentration [BrAC] versus no alcohol) and the nature of a woman's currently most upsetting traumatic event (C-MUTE), whether it was sexual (e.g., rape) or nonsexual (e.g., combat). Self-reported sexual outcomes were also compared by C-MUTE type. A total of 117 women completed background measures and either drank alcoholic or nonalcoholic beverages. They were shown erotic films and their VPA was assessed. A two (sexual versus nonsexual C-MUTE) by two (.10% BrAC versus no alcohol) analysis of variance (ANOVA) showed that, controlling for post-traumatic stress (PTS) symptoms, women with a sexual C-MUTE showed lower percent VPA change than women with a nonsexual C-MUTE. No significant effects were found for subjective sexual arousal. A multivariate analysis of variance (MANOVA) showed that women with a sexual C-MUTE reported more frequent anxiety and inhibition during partnered sex and more frequent lack of vaginal lubrication versus women with a nonsexual C-MUTE. There was no significant interaction between C-MUTE and alcohol intoxication. Whether a woman is currently upset by past sexual victimization may influence current sexual difficulties. Attenuated VPA may be attributable to the sexual nature of a C-MUTE as opposed to general trauma exposure.

Body Esteem as a Common Factor of a Tendency Toward Binge Eating and Sexual Dissatisfaction Among Women: The Role of Dissociation and Stress Response During Sex

BACKGROUND

Several studies have suggested a relevant overlap between eating disorders and sexual dysfunction involving the emotional component of body image esteem and dissociative experiences.

AIM

To evaluate the common maintaining factors of sexual dysfunction and vulnerability to pathologic eating behaviors and their relation to a physiologic stress response.

METHODS

In the present cross-sectional study, we evaluated a non-clinical sample of 60 heterosexual women (25-35 years old) for dissociation during sex with a partner, body image disturbance, and tendency toward pathologic eating behaviors. We also evaluated the stress-induced hypothalamic-pituitary-adrenal axis activation in response to a sexual stimulus and its association with binge eating and dissociation.

OUTCOMES

Participants completed the Clinician-Administered Dissociative States Scale, the Sexual Satisfaction Scale-Women, the Body Esteem Scale for Adolescents and Adults, and the Eating Attitudes Test Short Version. Furthermore, we assessed cortisol levels before, during, and after exposure to explicit sexual stimuli shown within a laboratory setting.

RESULTS

Dysfunctional body image esteem and a tendency toward binge-eating behaviors were associated with greater sexual distress in women. In particular, body esteem was significantly associated with greater dissociation during sex with a partner. Moreover, women who reported greater dissociation during sex with a partner and a tendency toward binge-eating behaviors showed higher levels of cortisol in response to sexual stimuli.

CLINICAL IMPLICATIONS

These results support further research based on trans-diagnostic treatments targeted to dissociation and body image esteem, which could lessen sexual dysfunction and vulnerability to pathologic eating behaviors.

STRENGTHS AND LIMITATIONS

Despite the small sample and self-reported questionnaires, this is the first study to consider the association of the stress response during sexual stimuli with sexual distress and with pathologic eating behaviors adopting a dimensional approach.

CONCLUSION

Body uneasiness and dissociation represented factors underlying pathologic eating behaviors and sexual dysfunction. Women reporting a tendency toward binge-eating episodes and dissociation during sexual experiences represented a subpopulation with a higher stress response during sexual stimuli. Castellini G, Lo Sauro C, Ricca V, Rellini AH. Body Esteem as a Common Factor of a Tendency Toward Binge Eating and Sexual Dissatisfaction Among Women: The Role of Dissociation and Stress Response During Sex. J Sex Med 2017;14:1036-1045.

The Physiology of Female Sexual Function and the Pathophysiology of Female Sexual Dysfunction (Committee 13A)

INTRODUCTION

The article consists of six sections written by separate authors that review female genital anatomy, the physiology of female sexual function, and the pathophysiology of female sexual dysfunction but excluding hormonal aspects.

AIM

To review the physiology of female sexual function and the pathophysiology of female sexual dysfunction especially since 2010 and to make specific recommendations according to the Oxford Centre for evidence based medicine (2009) "levels of evidence" wherever relevant.

CONCLUSION

Recommendations were made for particular studies to be undertaken especially in controversial aspects in all six sections of the reviewed topics. Despite numerous laboratory assessments of female sexual function, genital assessments alone appear insufficient to characterise fully the complete sexual response.

Sexual Dysfunction Problems in Female College Students: Sexual Victimization, Substance Use, and Personality Factors

Little empirical information is available on sexual dysfunction (SD) among college women even though college years represent a critical period in the development of sexuality. The current study aimed to identify factors associated with the presence, number, and type of SD problems among 547 female college students in the United States. Racial minority status, problematic drinking behaviors, and past sexual victimization were positively related to the presence of SD problems, whereas hormonal contraceptive use and past sexual victimization were associated with a greater number of SD problems. These findings highlight the importance of assessment, treatment, and prevention of sexual health issues on college campuses.

Sexuality in eating disorders patients: etiological factors, sexual dysfunction and identity issues. A systematic review

The scientific community appears to be less interested in sexuality of eating disorders (EDs) as compared to other psychiatric or medical comorbidities. However, a clear association between sexual problems and ED psychopathology was reported from different perspectives. The overarching goal of this systematic review was to evaluate the general approach of the scientific literature toward the topic of sexuality and EDs. In particular, four different categories of research have been individuated, encompassing the role of puberty, and sexual abuse in the pathogenesis of the disorders, sexual dysfunctions, and the association between sexual orientation and EDs psychopathology. Timing of puberty with its hormonal consequences and the changes in the way persons perceive their own body represent a crucial period of life for the onset of the disorder. Sexual abuse, and especially childhood sexual abuse are well-recognized risk factors for the development of ED, determining a worse long-term outcome. Recent research overcome the approach that considers sexual activity of EDs patients, in terms of hypersexuality and dangerous sexual behaviors, considering the sexuality of EDs persons in terms of sexual desire, satisfaction, orgasm and pain. Results from this line of research are promising, and describe a clear relationship between sexual dysfunction and the core psychopathological features of EDs, such as body image disturbances. Finally, the analysis of the literature showed an association between sexual orientation and gender dysphoria with EDs psychopathology and pathological eating behaviors, confirming the validity of research developing new models of maintaining factors of EDs related to the topic of self-identity.

Changes in Autonomic Nervous System Activity are Associated with Changes in Sexual Function in Women with a History of Childhood Sexual Abuse

INTRODUCTION

Women with histories of childhood sexual abuse (CSA) have higher rates of sexual difficulties, as well as high sympathetic nervous system response to sexual stimuli.

AIM

The study aims to examine whether treatment-related changes in autonomic balance, as indexed by heart rate variability (HRV), were associated with changes in sexual arousal and orgasm function.

METHODS

In study 1, we measured HRV while writing a sexual essay in 42 healthy, sexually functional women without any history of sexual trauma. These data, along with demographics, were used to develop HRV norms equations. In study 2, 136 women with a history of CSA were randomized to one of three active expressive writing treatments that focused on their trauma, sexuality, or daily life (control condition). We recorded HRV while writing a sexual essay at pretreatment, posttreatment, and 2-week, and 1- and 6-month follow-ups; we also calculated the expected HRV for each participant based on the norms equations from study 1.

MAIN OUTCOME MEASURES

The main outcome measures used were HRV, Female Sexual Function Index, Sexual Satisfaction Scale--Women.

RESULTS

The difference between expected and observed HRV decreased over time, indicating that, posttreatment, CSA survivors displayed HRV closer to the expected HRV of a demographics-matched woman with no history of sexual trauma. Also, over time, participants whose HRV became less dysregulated showed the biggest gains in sexual arousal and orgasm function. These effects were consistent across condition.

CONCLUSIONS

Treatments that reduce autonomic imbalance may improve sexual well-being among CSA populations.

Dissociation during sex and sexual arousal in women with and without a history of childhood sexual abuse

Women with a history of childhood sexual abuse (CSA) experience dissociative symptoms and sexual difficulties with greater frequency than women without a history of CSA. Current models of sexual dysfunction for sexual abuse survivors suggest that dissociation may mediate the relationship between CSA and sexual arousal difficulties. Dissociation, however, is often conceptualized as a single construct in studies of CSA and not as separate domains as in the dissociation literature. In the present study, women with (CSA, N = 37) and without (NSA, N = 22) a history of CSA recruited from the community were asked to indicate the frequency and intensity of their experience in two dissociation subgroups, derealization and depersonalization, during sex with a partner and in their daily life. Findings showed that, in the NSA group, more depersonalization during sex with a partner was associated with lower sexual arousal functioning. However, for both the NSA and CSA groups, more derealization during sex was associated with higher sexual arousal functioning. No measure of dissociation was significantly associated with sexual responses in the laboratory. These findings highlight the importance of distinguishing between different forms of dissociation (i.e., derealization and depersonalization) in the study of sexual arousal functioning. In addition, the findings challenge the notion that dissociation is a main predictor of sexual arousal problems in survivors of CSA and suggest that a more nuanced relationship may exist.

Sexual victimization, alcohol intoxication, sexual-emotional responding, and sexual risk in heavy episodic drinking women

This study used an experimental paradigm to investigate the roles of sexual victimization history and alcohol intoxication in young women's sexual-emotional responding and sexual risk taking. A nonclinical community sample of 436 young women, with both an instance of heavy episodic drinking and some HIV/STI risk exposure in the past year, completed childhood sexual abuse (CSA) and adolescent/adult sexual assault (ASA) measures. A majority of them reported CSA and/or ASA, including rape and attempted rape. After random assignment to a high alcohol dose (.10 %) or control condition, participants read and projected themselves into an eroticized scenario of a sexual encounter involving a new partner. As the story protagonist, each participant rated her positive mood and her sexual arousal, sensation, and desire, and then indicated her likelihood of engaging in unprotected sex. Structural equation modeling analyses revealed that ASA and alcohol were directly associated with heightened risk taking, and alcohol's effects were partially mediated by positive mood and sexual desire. ASA was associated with attenuated sexual-emotional responding and resulted in diminished risk taking via this suppression. These are the first findings indicating that, compared to non-victimized counterparts, sexually victimized women respond differently in alcohol-involved sexual encounters in terms of sexual-emotional responding and risk-taking intentions. Implications include assessing victimization history and drinking among women seeking treatment for either concern, particularly women at risk for HIV, and alerting them to ways their histories and behavior may combine to exacerbate their sexual risks.

Factors associated with sexual function in Iranian women with type 2 diabetes mellitus: partner relationship as the most important predictor

Background:

No comprehensive study has been conducted on risk factors of sexual dysfunction in women with diabetes mellitus.

Objectives:

The aim of this study was to consider all possible influencing variables including hormonal, physical and, psychological status, socioeconomic status, and dietary intake to get more accurate and reliable results.

Patients and Methods:

Sexual function was assessed by Iranian validated female sexual function index (FSFI).The variables of the study were demographic and diabetes-related factors, stress-depression, physical activity, blood pressure, anthropometric measurements, lipid profile, cortisol, sex and thyroid hormones, 25-hydroxy vitamin D, and dietary intake.

Results:

Among all investigated variables, partner relationship showed a strong positive association with FSFI (β = 1.93 ± 0.41, P < 0.0001). In addition, not considering partner relationship, FSFI showed a significant negative association with age (β = -0.19 ± 0.20, P = 0.04), stress-depression score (β = -0.08 ± 0.04, P = 0.04), DD (β = -0.03 ± 0.01, P = 0.04), and systolic blood pressure (β = -0.14 ± 0.06, P = 0.03). Significant associations between FSFI and serum sex hormones and other biochemical were found in neither postmenopausal nor non-menopausal women. The means of SFSI in postmenopausal women were greater than non-menopausal (P = 0.02).

Conclusions:

It seems that in our population, female sexual function was much more than just a hormonal or physical problem and psychological factors, especially partner relationship and stress-depression, are the most determinants. In addition, age, duration of challenging with disease, and the lack of controlling systolic blood pressure were common factors that decreased sexual function.

Physiological stress responses predict sexual functioning and satisfaction differently in women who have and have not been sexually abused in childhood

Physiological responses to sexual stimuli may contribute to the increased rate of sexual problems seen in women with childhood sexual abuse (CSA) histories. We compared two physiological stress responses as predictors of sexual function and satisfaction, sympathetic nervous system (SNS) activation and cortisol in women with (CSA, N = 136) and without CSA histories (NSA, N = 102). In CSA survivors, cortisol response to sexual stimuli did not significantly predict sexual functioning; however, in NSA women, cortisol increases were associated with poorer sexual functioning, and decreases with higher functioning. For women with CSA histories, lower SNS activity was associated with poorer sexual functioning. For CSA survivors with low lifetime trauma, lower SNS activity was associated with higher sexual satisfaction; for women with high lifetime trauma, the reverse was true. Decreased SNS activity during sexual stimuli predicted higher sexual functioning in NSA women with low lifetime exposure to traumatic events, but lower sexual functioning in those with high exposure. Differences between women with and without CSA histories in the association between cortisol and SNS response and sexual functioning and satisfaction suggests that CSA causes disruptions in both short and long-term stress responses to sexual stimuli that perpetuate into adulthood.

The mediating effect of daily stress on the sexual arousal function of women with a history of childhood sexual abuse

Psychopathologies such as posttraumatic stress disorder are often proposed as mediators of the sexual arousal dysfunction experienced by women with a history of childhood maltreatment. However, posttraumatic stress disorder symptoms are only part of the difficulties experienced by these women. Other factors to consider include negative affectivity and perceived daily stress. To assess the mediating role of posttraumatic stress disorder symptoms, negative affectivity, and perceived daily stress, we collected data from 62 women with and without a history of childhood maltreatment (sexual, physical and emotional abuse). A comprehensive assessment of sexual arousal functioning and sexual responses was obtained using self-reported measures and psychophysiological measures of vaginal engorgement and subjective sexual arousal during exposure to sexual visual stimuli. The model assessed the simultaneous mediating effect of posttraumatic stress disorder symptoms, negative affectivity and perceived daily stress on the relation between childhood maltreatment and sexual variables. Daily stress, showed a significant and stronger mediation effect on sexual arousal functioning as compared to posttraumatic stress disorder and negative affectivity. These findings suggest that daily stress may be an important mechanism to consider when treating sexual arousal functioning in women who have a history of childhood maltreatment.

The effect of pre-existing affect on the sexual responses of women with and without a history of childhood sexual abuse

Women with a history of childhood sexual abuse (CSA) are at greater risk for experiencing sexual problems in their adult lives. Yet, little is known about the possible role of cognitive and affective mechanisms in the development of sexual arousal difficulties in this population. This study investigated the role of pre-existing affect (affect prior to exposure to sexual stimuli) on genital responses, subjective sexual arousal, and affect elicited during the presentation of erotic film excerpts in a community sample of 25 women with and 25 women without a history of CSA. The CSA group showed greater pre-existing negative affect and smaller genital responses to the erotic film stimuli compared to the NSA group. Findings support a moderating effect of CSA, in that pre-existing negative affect was associated with strength of genital responses in the NSA but not in the CSA group. The results did not support a mediation model of pre-existing negative affect as an explanation for smaller physiological sexual responses in the CSA group. Taken together, the findings suggest that pre-existing affect may be more relevant for women with no history of CSA and call for more research on factors implicated in impaired sexual responses in women with a history of CSA.

Biopsychosocial factors associated with dyspareunia in a community sample of adolescent girls

Although various biopsychosocial factors have been associated with dyspareunia, research to date has focused on retrospective reports of adult women, and lack of consensus regarding etiology remains. By targeting girls at the beginning of their reproductive life, this study aimed to examine the biomedical, behavioral, and psychosocial correlates of chronic painful intercourse in sexually active adolescents compared to pain-free girls. With written informed consent, data were obtained from 1425 girls (12-19 year olds) from seven metropolitan high schools using self-report questionnaires pertaining to gynaecologic/biomedical history, physical/psychological/sexual abuse, anxiety, depression, attitudes towards sexuality, and social support. While the chronic painful intercourse (n = 51) and pain-free comparison group (n = 167) did not differ significantly on biomedical variables, painful intercourse was associated with significantly more pain during tampon insertion, and avoidance of tampons was linked to a fourfold risk of experiencing pain during sex. Cases also reported engaging in significantly more detrimental vulvar hygiene habits than pain-free girls, whereas no significant group differences were observed for self-treatment using over-the-counter antifungal preparations. Sexual abuse, fear of physical abuse, and trait anxiety were identified as significant psychosocial correlates of chronic painful intercourse. A logistic regression further identified pain during first tampon insertion and trait anxiety as statistical predictors of adolescent pain during intercourse. In addition to a possible intrinsic dysfunction in central pain processing, findings suggest that psychological variables, such as anxiety, play a significant role in painful intercourse's very first manifestations in adolescent girls.

Sexual self-schemas, sexual dysfunction, and the sexual responses of women with a history of childhood sexual abuse

Accumulating evidence points to the mediating effects of sexual self-schemas on the sexual difficulties of women with a history of childhood sexual abuse (CSA). The following study adds to the extant literature by investigating (1) sexual function and (2) sexual satisfaction utilizing validated measures, and reporting on the relationship between sexual self-schemas and physiological (vaginal photoplethysmography), subjective, and affective responses during laboratory exposure to sexual stimuli. In a community sample of women with (N = 48) and without (N = 48) a history of CSA, we tested (1) the mediation of negative affect on the relation between sexual self-schemas and sexual function/satisfaction, (2) the mediation of negative affect in the relation between CSA and sexual function/satisfaction, and (3) the mediation of sexual self-schemas in the relation between a history of CSA and negative affect prior to sexual stimuli. We found that more Embarrassed/Conservative and less Romantic/Passionate sexual self-schemas predicted negative affect prior to exposure to sexual stimuli which, in turn, predicted levels of sexual satisfaction. The lower sexual satisfaction of CSA survivors was partially mediated by higher reports of negative affect prior to sexual stimuli. However, negative affect prior to sexual stimuli was not mediated by the sexual self-schemas of CSA survivors. Thus, although sexual self-schemas predicted sexual satisfaction, they did not predict variance in negative affect prior to sexual videos experienced by women with a history of CSA.

Sexual abuse history, alcohol intoxication, and women's sexual risk behavior

We examined potential differences in women's likelihood of sexual risk taking in a laboratory setting based on alcohol intoxication and sexual abuse history. Participants (n = 64) were classified as non-sexually abused (NSA) or as having experienced sexual abuse in childhood only (CSA) or adulthood only (ASA) and randomly assigned to consume alcoholic (.06, .08, or .10% target blood alcohol content) or non-alcoholic drinks, after which participants read and responded to a risky sex vignette. Dependent measures included vaginal pulse amplitude, self-reported sexual arousal, likelihood of engaging in condom use and risky sexual behaviors described in the vignette, and mood. NSA and ASA women did not differ significantly on any dependent measures. CSA women reported significantly lower likelihood of condom use and unprotected intercourse relative to NSA and ASA women. Intoxicated women reported significantly greater sexual arousal, positive mood, and likelihood of risky sex relative to sober women. Intoxicated CSA women reported significantly more likelihood of unprotected oral sex and less likelihood of condom use relative to intoxicated NSA and ASA and sober CSA women. CSA women's increased risk of sexually transmitted infections (STIs) may be driven by non-condom use and behavioral changes while intoxicated. These findings provide preliminary insight into situational influences affecting CSA women's increased STI risk.

Assessing women's sexual arousal in the context of sexual assault history and acute alcohol intoxication

INTRODUCTION

Few studies have examined differences in women's sexual arousal based on sexual assault history (SAH) or in-the-moment alcohol intoxication. Only one has examined combined effects. Findings regarding the relationship between SAH and arousal are contradictory.

AIM

We aimed to determine the relationship between SAH, alcohol intoxication, and sexual arousal.

METHODS

Women were randomly assigned to an alcohol (target blood alcohol level = 0.10%) or control condition and categorized as having an SAH or not. After beverage administration, all women watched erotic films while genital arousal (vaginal pulse amplitude; VPA) was measured. Afterward, self-reported sexual arousal was measured.

MAIN OUTCOME MEASURES

Genital response was measured by VPA using vaginal photoplethysmography while watching erotic films. Self-reported sexual arousal was assessed after watching erotic films.

RESULTS

Women with an SAH had smaller increases in genital arousal in response to the films than women without an SAH. Intoxicated women had smaller increases in genital arousal than sober women. However, no differences for SAH or intoxication were found in self-reported arousal.

CONCLUSION

SAH and alcohol intoxication are associated with smaller increases in genital arousal compared to women without an SAH and sober women, suggesting that these co-occurring factors impact sexual arousal.

Agreement of self-reported and genital measures of sexual arousal in men and women: a meta-analysis

The assessment of sexual arousal in men and women informs theoretical studies of human sexuality and provides a method to assess and evaluate the treatment of sexual dysfunctions and paraphilias. Understanding measures of arousal is, therefore, paramount to further theoretical and practical advances in the study of human sexuality. In this meta-analysis, we review research to quantify the extent of agreement between self-reported and genital measures of sexual arousal, to determine if there is a gender difference in this agreement, and to identify theoretical and methodological moderators of subjective-genital agreement. We identified 132 peer- or academically-reviewed laboratory studies published between 1969 and 2007 reporting a correlation between self-reported and genital measures of sexual arousal, with total sample sizes of 2,505 women and 1,918 men. There was a statistically significant gender difference in the agreement between self-reported and genital measures, with men (r = .66) showing a greater degree of agreement than women (r = .26). Two methodological moderators of the gender difference in subjective-genital agreement were identified: stimulus variability and timing of the assessment of self-reported sexual arousal. The results have implications for assessment of sexual arousal, the nature of gender differences in sexual arousal, and models of sexual response.

The cortisol response during physiological sexual arousal in adult women with a history of childhood sexual abuse

Many women with a history of childhood sexual abuse (CSA) experience difficulties becoming sexually aroused. This study measured cortisol and physiological sexual arousal during exposure to sexual stimuli in women with and without a history of CSA. Childhood sexual abuse survivors showed a smaller decrease in cortisol during sexual arousal than the nonsexually abused, control group potentially due to an increase in cortisol in some of the participants in the CSA group. Physiological sexual arousal was weaker in CSA survivors compared to women with no history of sexual abuse and posttraumatic stress disorder symptoms showed characteristics consistent with mediation for the relationship between a history of CSA and inhibited sexual arousal responses.

Impaired sexual function in patients with borderline personality disorder is determined by history of sexual abuse

INTRODUCTION

Patients suffering from a Borderline Personality Disorder (BPD) display altered sexual behavior, such as sexual avoidance or sexual impulsivity, which has repeatedly been linked to the sexual traumatization that occurs in a high percentage of BPD patients. Until now, no empirical data exists on whether these patients concomitantly suffer from sexual dysfunction.

AIM

This study investigates sexual function and the impact of sexual traumatization on this issue in women with BPD as compared to healthy women.

MAIN OUTCOME MEASURES

Sexual function was measured using the Female Sexual Function Index. Additionally, diagnoses were made with SCID II Interviews for Axis II and with the Mini International Neuropsychiatric Interview for Axis I disorders. The Post-traumatic Stress Diagnostic Scale for trauma evaluation was used. Sexual orientation was assessed by self-evaluation.

METHODS

Forty-five women with BPD as diagnosed according to DSM-IV criteria and 30 healthy women completed questionnaires on sexual function and sexual abuse history, as well as interviews on axis I and II disorders and psychotropic medication.

RESULTS

The BPD group showed a significantly higher prevalence of sexual dysfunction. Subgroup analyses revealed that BPD with concomitant sexual traumatization, and not BPD alone, best explains impaired sexual function. Sexual inactivity was mainly related to current major depression or use of SSRI medication. In sexually active participants, medication and symptoms of depression had no significant impact on sexual function.

CONCLUSIONS

Not BPD alone, but concomitant sexual traumatization, predicts significantly impaired sexual function. This may have a therapeutic impact on BPD patients reporting sexual traumatization.

Indirect effects of acute alcohol intoxication on sexual risk-taking: The roles of subjective and physiological sexual arousal

Three experiments supported the idea that alcohol fosters sexual risk-taking in men and women, in part, through its effects on sexual arousal. In Experiment 1, increasing alcohol dosage (target blood alcohol levels of .00, .04, .08%) heightened men's and women's risk-taking intentions. Alcohol's effect was indirect via increased subjective sexual arousal; also, men exhibited greater risk-taking than women. In Experiment 2, an extended dosage range (target blood alcohol levels of .00, .06, .08, .10%) heightened men's risk-taking intentions. Alcohol's effect again was indirect via subjective arousal. Physiological sexual arousal, which was unaffected by alcohol, increased risk-taking via increased subjective arousal. In Experiment 3, alcohol increased women's risk-taking indirectly via subjective arousal, but alcohol-attenuated physiological arousal had no effect on risk-taking. Implications for alcohol myopia theory and prevention interventions are discussed.

Evaluation of the female sexual function index in a population based sample from Finland

The factor structure and reliability of the Female Sexual Function Index (FSFI) was evaluated in a Finnish population based sample of 2,081 women, age 33-43 years. In addition, associations between female sexual function and age, psychological distress, alcohol use, hormone based contraceptives, child sexual abuse (CSA), and adult sexual abuse were examined. The results supported a six factor solution for the FSFI with high internal consistencies, in line with earlier research in clinical populations. Psychological distress was positively associated with every dimension of the FSFI except desire problems. Age was associated with fewer pain problems. Alcohol use was associated with every dimension of the FSFI, but the direction of the association depended on if it was drinking in general or in connection to intercourse. More drinking in general was related to fewer sexual function problems while drinking in connection to intercourse was related to more sexual function problems. No significant correlation was found between adult sexual abuse and sexual function but between CSA and lubrication, satisfaction, and pain problems. Usage of oral contraceptive pill was not significantly associated with sexual function. The use of hormone based intrauterine systems was significantly associated with less pain and more desire, arousal, and satisfaction. In conclusion, the study supports use of the FSFI for assessing sexual function not only in clinical samples but also in population based samples. The associations found between sexual function and other important variables showed the complexity of sexual function.

Effects of alcohol intoxication and instructional set on women's sexual arousal vary based on sexual abuse history

The influence of alcohol intoxication and arousal instructional set on psychophysiological measures of sexual responding was examined in a non-clinical sample of sexually abused (SA) and non-sexually abused (NSA) women. Participants (n=42) were randomly assigned to consume alcoholic (target blood alcohol level = .08%) or non-alcoholic drinks and to receive instructions to maximize or suppress their sexual response to erotic films. Measures included vaginal pulse amplitude (VPA), self-reported sexual arousal, and mood. SA classification interacted with instruction condition such that NSA women's VPA scores were higher under maximize than suppress instructions, but this did not occur for SA women. SA classification interacted with alcohol such that, compared to their sober counterparts, intoxicated NSA women reported less sexual arousal, whereas intoxicated SA women reported more sexual arousal than their sober counterparts. Moreover, positive mood ratings were highest among intoxicated SA women. Findings indicate that alcohol may affect women differently based on SA history and imply that SA history may be associated with differences in response to subsequent sexual situations.