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Cassioli E, Tarchi L, Rossi E, Faldi M, Dani C, Giuranno G, Siviglia S, Baroncelli A, Maggi M, Vignozzi L, Giraldi A, Ricca V, Castellini G. Early traumatic experiences are linked to hypersexual behavior and erectile dysfunction in men through the mediation of body uneasiness and general psychopathology. J Sex Med 2024:qdae058. [PMID: 38778740 DOI: 10.1093/jsxmed/qdae058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 04/11/2024] [Accepted: 05/03/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Childhood traumatic experiences have been associated with hypersexuality and sexual dysfunctions. However, the mediators of the interactions between these variables should be clarified in men. AIM This study aimed to investigate the interaction of early traumatic experiences, psychopathology, and sexuality with respect to erectile dysfunction (ED) and hypersexual behavior. The hypothesized model expected that traumatic experiences would be associated with hypersexual behavior and reduced sexual functioning through the mediation of body uneasiness and psychological distress. METHODS The study was cross-sectional and observational. A total of 317 men were enrolled. Male patients with a primary complaint of ED and an indication for psychiatry referral represented the clinical sample (n = 116; mean ± SD age, 42.82 ± 16.89 years). Clinical classification was assessed with the Structured Interview on Erectile Dysfunction. The second sample (n = 201, 30.82 ± 11.94 years) was recruited from the general population. All participants were administered the following questionnaires: Brief Symptom Inventory, Childhood Trauma Questionnaire-Short Form, Hypersexual Behavior Inventory, Body Uneasiness Test-A, and 5-item International Index of Erectile Function. OUTCOMES Psychopathology and sexual functioning were assessed by a dimensional approach, and a multivariate model was computed by structural equation model analysis. RESULTS When compared with the sample from the general population, the clinical sample exhibited a higher prevalence of early traumatic experiences, as measured by scores on the Childhood Trauma Questionnaire-Short Form (45.08 ± 14.25 vs 39.03 ± 10.22, F = 17.63, P < .001), and a higher tendency to engage in hypersexual behaviors (34.63 ± 13.55 vs 30.79 ± 12.44, F = 6.97, P < .01). Structural equation model analysis showed excellent fit indices indicating that early traumatic experiences predicted hypersexual behaviors and ED through the exacerbating mediating effect of body uneasiness and psychopathology. CLINICAL IMPLICATIONS Clinicians should not limit their attention to the behavioral level when assessing sexual dysfunction in men; rather, they should also consider the complex psychopathologic consequences of childhood trauma. Integrated treatments that address the potential presence of childhood trauma with its wider psychological correlates (eg, emotion dysregulation, body uneasiness) might improve treatment response. STRENGTHS AND LIMITATIONS The study reports novel data on the relationship among childhood maltreatment, male sexuality, and psychopathologic mediators with a dimensional assessment. However, the assessment was cross-sectional, and causality was mainly derived from previous studies. CONCLUSION The present study enriches the current literature, strengthening the hypothesis that childhood traumatic experiences significantly shape development and sexuality. Body uneasiness and psychopathology can both tax sexual functioning, as assessed by erectile functioning or hypersexuality.
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Affiliation(s)
- Emanuele Cassioli
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, 50100, Italy
| | - Livio Tarchi
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, 50100, Italy
| | - Eleonora Rossi
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, 50100, Italy
| | - Marco Faldi
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, 50100, Italy
| | - Cristiano Dani
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, 50100, Italy
| | - Gabriele Giuranno
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, 50100, Italy
| | - Serena Siviglia
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, 50100, Italy
| | - Andrea Baroncelli
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, 50100, Italy
| | - Mario Maggi
- Andrology, Women's Endocrinology and Gender Incongruence Unit, "Mario Serio" Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, 50100, Italy
| | - Linda Vignozzi
- Andrology, Women's Endocrinology and Gender Incongruence Unit, "Mario Serio" Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, 50100, Italy
| | - Annamaria Giraldi
- Sexological Clinic, Mental Health Center Copenhagen, Copenhagen University Hospital-Mental Health Services CPH, Copenhagen, 2200, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, 2200, Denmark
| | - Valdo Ricca
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, 50100, Italy
| | - Giovanni Castellini
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, 50100, Italy
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Gewirtz-Meydan A. Sexual Dysfunction Among Childhood Sexual Abuse Survivors: The "Functional" Dysfunction? JOURNAL OF SEX & MARITAL THERAPY 2022; 48:694-705. [PMID: 35287565 DOI: 10.1080/0092623x.2022.2044944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Various studies have established the association between child sexual abuse and sexual dysfunction. Although sexual dysfunction can be a distressing and undesirable condition for survivors of child sexual abuse, the current article suggests viewing sexual dysfunction not solely as a negative outcome but as a condition with a potent psychological function in regulating various psychological and relational needs among survivors. The main question addressed in the current paper is: What are the functional aspects of sexual dysfunction among child sexual abuse survivors? Four main protective purposes for sexual dysfunction among survivors of child sexual abuse are proposed: avoiding re-traumatization, regulating closeness within the relationship, gaining a sense of power and control and avoiding vulnerability, and restoring a positive sense of self. Although healthy sexual functioning is a desirable long-term goal for survivors, therapists need to view sexual dysfunction within the context of trauma, and to understand the protective functions of dysfunctions, before attempting to restore sexual function.
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Affiliation(s)
- Ateret Gewirtz-Meydan
- School of Social Work, Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa, Israel
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Barbara G, Buggio L, Micci L, Spinelli G, Paiocchi C, Dridi D, Cetera GE, Facchin F, Donati A, Vercellini P, Kustermann A. Sexual violence in adult women and adolescents: a narrative review. Minerva Obstet Gynecol 2022; 74:261-269. [PMID: 35147019 DOI: 10.23736/s2724-606x.22.05071-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Sexual violence is a widespread phenomenon, as it has been estimated that about 35.6% of women have experienced some forms of sexual abuse, with variable prevalence estimates worldwide. Sexual violence has remarkable negative consequences on women's health and quality of life, with a specific harmful impact on women's psychological well-being and sexuality. In this narrative review, we provide an overview on the phenomenon of sexual violence against adult women and adolescents, discussing its associated multiple negative consequences with a specific focus on clinical and sexological aspects. ''Women centered care'' and a multidisciplinary approach appear of pivotal importance when working with sexual violence survivors. Woman should be engaged in all the clinical activities as equal partners in the decision-making process, and should be supported by multiple and different professional figures (i.e. gynecologists, psychologists, sexologists, forensic medical doctors, lawyers) working within the framework of a cooperative integrated model.
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Affiliation(s)
- Giussy Barbara
- Gynecological Unit and SVSeD, Service for Sexual and Domestic Violence, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy - .,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy -
| | - Laura Buggio
- Gynecological Unit and SVSeD, Service for Sexual and Domestic Violence, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Laila Micci
- Gynecological Emergency Unit and SVSeD, Service for Sexual and Domestic Violence, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gaia Spinelli
- Gynecological Emergency Unit and SVSeD, Service for Sexual and Domestic Violence, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Cristina Paiocchi
- Gynecological Emergency Unit and SVSeD, Service for Sexual and Domestic Violence, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Dhouha Dridi
- Gynecological Unit and SVSeD, Service for Sexual and Domestic Violence, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giulia E Cetera
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Federica Facchin
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
| | - Agnese Donati
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Paolo Vercellini
- Gynecological Unit and SVSeD, Service for Sexual and Domestic Violence, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Alessandra Kustermann
- Gynecological Emergency Unit and SVSeD, Service for Sexual and Domestic Violence, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Gewirtz-Meydan A, Opuda E. The Impact of Child Sexual Abuse on Men's Sexual Function: A Systematic Review. TRAUMA, VIOLENCE & ABUSE 2022; 23:265-277. [PMID: 32691693 DOI: 10.1177/1524838020939134] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
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.
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Affiliation(s)
- Ateret Gewirtz-Meydan
- Sex and Couple Therapy Unit, Meir Medical Center, Kfar-Saba, Israel
- Crimes Against Children Research Center, University of New Hampshire, Durham, NH, USA
| | - Eugenia Opuda
- Health and Human Services Librarian, University of New Hampshire, Durham, NH, USA
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Sexual Dysfunction and Distress Among Childhood Sexual Abuse Survivors: The Role of Post-Traumatic Stress Disorder. J Sex Med 2020; 17:2267-2278. [DOI: 10.1016/j.jsxm.2020.07.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/14/2020] [Accepted: 07/20/2020] [Indexed: 12/21/2022]
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O'Loughlin JI, Rellini AH, Brotto LA. How Does Childhood Trauma Impact Women's Sexual Desire? Role of Depression, Stress, and Cortisol. JOURNAL OF SEX RESEARCH 2020; 57:836-847. [PMID: 31809591 DOI: 10.1080/00224499.2019.1693490] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The relationship between childhood trauma and adult sexual dysfunction is well documented; however, there is a paucity of research that examines the physiological and psychological mechanisms that may potentiate this relationship. As depression, perceived stress, and hypothalamic pituitary adrenal (HPA) axis dysregulation are correlates of childhood trauma and sexual dysfunction, the current study sought to examine the association of each of these domains with low sexual desire in a sample of (N = 275 [n = 137 women with low sexual desire; n = 138 sexually healthy women]) non-clinically depressed women. First, we assessed the relative contributions of HPA axis dysregulation (as indexed by the diurnal cortisol slope), childhood trauma, depression symptoms and perceived daily stress on low sexual desire. Next, we examined the degree to which HPA axis dysregulation, perceived stress, and depressive symptoms, respectively, mediated the relationship between childhood trauma and sexual desire. Results indicate that diurnal cortisol slope and depression symptoms contribute to low desire over and above perceived stress and childhood trauma and that childhood trauma is associated with low sexual desire predominantly through depressive symptomatology. Theoretical and clinical implications of the findings are discussed.
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Affiliation(s)
| | | | - Lori A Brotto
- Department of Obstetrics and Gynaecology, University of British Columbia
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Gewirtz-Meydan A, Ofir-Lavee S. Addressing Sexual Dysfunction After Childhood Sexual Abuse: A Clinical Approach from an Attachment Perspective. JOURNAL OF SEX & MARITAL THERAPY 2020; 47:43-59. [PMID: 32783606 DOI: 10.1080/0092623x.2020.1801543] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Sexual dysfunctions are very prevalent among survivors of childhood sexual abuse. While the relationship between sexual abuse and sexual dysfunction is well-established, understanding of the mechanisms explaining this relationship is still limited and has not been studied thoroughly. The current article presents a preliminary, theoretical model of the association between childhood sexual abuse, and sexual dysfunctions in adulthood from an attachment-trauma perspective. This model is based on previous literature and hours of clinical work in sex therapy and attachment theory-based therapy, and identifies important factors that have not been adequately accounted for in the literature.
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Affiliation(s)
- Ateret Gewirtz-Meydan
- School of Social Work, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
- The Sex and Couple Therapy Unit, Meir Medical Hospital, Kfar-Saba, Israel
| | - Sari Ofir-Lavee
- Certified Sex and Couple Therapist, and Certified EFT Therapist, Tel-Aviv, Israel
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Gewirtz-Meydan A, Lahav Y. Sexual Functioning Among Childhood Sexual Abuse Survivors From an Attachment Perspective. J Sex Med 2020; 17:1370-1382. [DOI: 10.1016/j.jsxm.2020.03.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/25/2020] [Accepted: 03/28/2020] [Indexed: 10/24/2022]
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Wan W, Sun J, Liu J, Yang S, Liu M, Xue J, Jiao D, Liu X. Using social media to explore the linguistic features in female adults with childhood sexual abuse by Linguistic Inquiry and Word Count. HUMAN BEHAVIOR AND EMERGING TECHNOLOGIES 2019. [DOI: 10.1002/hbe2.162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Wenyu Wan
- Department of Psychology, University of Chinese Academy of SciencesCAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences Beijing China
| | - Jiumo Sun
- Department of Psychology, University of Chinese Academy of SciencesCAS Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences Beijing China
| | - Jiehan Liu
- Department of Psychology, University of Chinese Academy of SciencesCAS Key Laboratory of Cognition and Development Psychology, Institute of Psychology, Chinese Academy of Sciences Beijing China
| | - Shu‐Wen Yang
- Department of Psychology, University of Chinese Academy of SciencesCAS Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences Beijing China
| | - Mingming Liu
- Department of Psychology, University of Chinese Academy of SciencesCAS Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences Beijing China
| | - Jia Xue
- Factor‐Inwentash Faculty of Social Work & Faculty of InformationUniversity of Toronto Toronto Ontario Canada
| | - Dongdong Jiao
- Engineer in Basic Technology LaboratoryNational Computer System Engineering Research Institute of China Beijing China
| | - Xiaoqian Liu
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences Beijing China
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Bird ER, Seehuus M, Heiman JR, Davis KC, Norris J, George WH. Sexual vs. Nonsexual Currently Most Upsetting Trauma: A Fresh Look at Attenuation of Sexual Response, Alcohol Intoxication, and Post-Traumatic Stress. JOURNAL OF SEX RESEARCH 2018; 55:915-926. [PMID: 29023137 PMCID: PMC6195219 DOI: 10.1080/00224499.2017.1380159] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
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.
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Affiliation(s)
| | | | - Julia R Heiman
- c Psychological and Brain Sciences , Indiana University
- d The Kinsey Institute , Indiana University
| | | | - Jeanette Norris
- f Alcohol and Drug Abuse Institute , University of Washington
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Kingsberg SA, Althof S, Simon JA, Bradford A, Bitzer J, Carvalho J, Flynn KE, Nappi RE, Reese JB, Rezaee RL, Schover L, Shifrin JL. Female Sexual Dysfunction-Medical and Psychological Treatments, Committee 14. J Sex Med 2018; 14:1463-1491. [PMID: 29198504 DOI: 10.1016/j.jsxm.2017.05.018] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 05/15/2017] [Accepted: 05/17/2017] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Since the millennium we have witnessed significant strides in the science and treatment of female sexual dysfunction (FSD). This forward progress has included (i) the development of new theoretical models to describe healthy and dysfunctional sexual responses in women; (ii) alternative classification strategies of female sexual disorders; (iii) major advances in brain, hormonal, psychological, and interpersonal research focusing on etiologic factors and treatment approaches; (iv) strong and effective public advocacy for FSD; and (v) greater educational awareness of the impact of FSD on the woman and her partner. AIMS To review the literature and describe the best practices for assessing and treating women with hypoactive sexual desire disorder, female sexual arousal disorder, and female orgasmic disorders. METHODS The committee undertook a comprehensive review of the literature and discussion among themselves to determine the best assessment and treatment methods. RESULTS Using a biopsychosocial lens, the committee presents recommendations (with levels of evidence) for assessment and treatment of hypoactive sexual desire disorder, female sexual arousal disorder, and female orgasmic disorders. CONCLUSION The numerous significant strides in FSD that have occurred since the previous International Consultation of Sexual Medicine publications are reviewed in this article. Although evidence supports an integrated biopsychosocial approach to assessment and treatment of these disorders, the biological and psychological factors are artificially separated for review purposes. We recognize that best outcomes are achieved when all relevant factors are identified and addressed by the clinician and patient working together in concert (the sum is greater than the whole of its parts). Kingsberg SA, Althof S, Simon JA, et al. Female Sexual Dysfunction-Medical and Psychological Treatments, Committee 14. J Sex Med 2017;14:1463-1491.
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Affiliation(s)
| | - Stanley Althof
- Case Western Reserve University Medical School, Cleveland, OH, USA.
| | - James A Simon
- George Washington University School of Medicine, Washington, DC, USA
| | | | | | | | | | | | | | - Roya L Rezaee
- Case Western Reserve University Medical School, Cleveland, OH, USA
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Ciocca G, Ochoa S, Jannini EA. Epidemiology of Sexual Dysfunctions in Persons Suffering from Psychiatric Disorders. TRENDS IN ANDROLOGY AND SEXUAL MEDICINE 2018. [DOI: 10.1007/978-3-319-68306-5_4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Inter-relationships between sexual abuse, female sexual function and childbirth. Midwifery 2015; 31:1087-95. [DOI: 10.1016/j.midw.2015.07.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 06/13/2015] [Accepted: 07/20/2015] [Indexed: 12/31/2022]
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14
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Johnson L. Suggestions for further understanding of mediating factors of sexual arousal dysfunction among women with a history of childhood maltreatment. JOURNAL OF SEX & MARITAL THERAPY 2013; 39:300-302. [PMID: 23470229 DOI: 10.1080/0092623x.2013.776654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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