Childhood Interpersonal Trauma and Sexual Satisfaction in Patients Seeing Sex Therapy: Examining Mindfulness and Psychological Distress as Mediators

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.

From trauma to intimacy: Examining the link between childhood maltreatment and adult sexual functioning - The mediating role of self-criticism

BACKGROUND

Childhood maltreatment has been linked to negative sexual functioning, but the underlying mechanisms for this association are poorly understood.

OBJECTIVE

Addressing this gap, this study investigates the mediating role of self-criticism in the association between childhood maltreatment and adult sexual functioning.

PARTICIPANTS AND SETTING

Two independent studies were conducted, each utilizing a distinct dataset to enhance the robustness and generalizability of the findings. The sample in Study 1 included 914 participants, while the sample in Study 2 consisted of 451 women. Both samples completed self-report online questionnaires; however, in Study 2, we purposefully oversampled for child sexual abuse survivors.

METHODS

This study employed a mediation model using PROCESS.

RESULTS

Study 1 confirmed the negative association between childhood maltreatment and sexual functioning, as well as the positive association between childhood maltreatment and self-criticism. Self-criticism was also negatively associated with sexual functioning. The mediation analysis revealed that self-criticism significantly mediated the association between childhood maltreatment and sexual functioning. Study 2 built upon these findings by oversampling childhood sexual abuse survivors and incorporating comprehensive measures of sexual functioning. The results in Study 2 replicated the findings of Study 1, providing a more representative understanding of the link between childhood maltreatment and sexual functioning.

CONCLUSIONS

The findings highlight the importance of self-criticism as a potential mechanism underlying the negative impact of childhood maltreatment on sexual functioning in adulthood. This knowledge can inform interventions and therapeutic approaches aimed at addressing self-criticism and improving sexual well-being in individuals with a history of childhood maltreatment.

The Mediating Role of Emotion Regulation in the Relationship Between Sexual Mindfulness and Relational Quality in a Sample of Iranian Women

Mindfulness during sex has shown many positive relational and sexual outcomes. However, little is known about the ways in which sexual mindfulness works to improve an individual's experience. This study investigated the mediating role of emotion regulation strategies in the relationship between sexual mindfulness and relational quality in a sample of Iranian women. Using a multi-stage cluster sampling method, we examined data from 265 women aged 19 to 50 years (M = 31.76, SD = 8.47). Results showed a significant positive relationship between relational quality and sexual mindfulness (p < .001, β = .13), sexual mindfulness and reappraisal strategy (p < .001, β = .65), and relational quality and reappraisal strategy (p < .001, β = .78). The reduction of the path coefficient in the full mediation model compared to the direct model indicating a partial mediation role of the reappraisal strategy was confirmed in relation to sexual mindfulness and relational quality. These findings may help identify one path, emotion regulation, through which sexual mindfulness works. This study provides psychologists and counselors evidence that both sexual mindfulness and emotion regulation are positive skills that likely improve the quality of their clients' relationships.

Cumulative childhood trauma, sex motives and sexual satisfaction among emerging adults

BACKGROUND

To better understand sexual satisfaction in emerging adults, previous research has emphasized the importance of considering the role of developmental experiences, such as cumulative childhood trauma (CCT; the number of different forms of abuse and neglect sustained during childhood). However, the mechanisms by which CCT and sexual satisfaction are related remain unknown. Sex motives are suggested as an explanatory mechanism given the previously found associations between sex motives and both sexual satisfaction and CCT.

OBJECTIVE

This study examined the direct associations between CCT and sexual satisfaction, as well as indirect associations through sex motives, in emerging adults.

PARTICIPANTS AND SETTING

A sample of 437 French Canadian emerging adults (76 % women, mean age of 2.3) were recruited.

METHODS

Participants completed online self-reported validated questionnaires assessing CCT, sex motives and sexual satisfaction.

RESULTS

Results from a path analysis revealed that CCT was associated with a higher endorsement of the self-affirmation sex motive (β = 0.25, p < .001) which was linked to lower sexual satisfaction (β = -0.13, p < .001). CCT was also associated with a higher endorsement of the coping (β = 0.25, p < .001) and partner approval (β = 0.09, p < .05) sex motives. A higher endorsement of the intimacy (β = 0.28, p < .001) and pleasure (β = 0.24, p < .001) sex motives, and a lower endorsement of the partner approval sex motive (β =  -0.13, p < .001) were linked to greater sexual satisfaction.

CONCLUSIONS

Results suggest education and intervention targets to improve emerging adults' sexuality.

Between pleasure, guilt, and dissociation: How trauma unfolds in the sexuality of childhood sexual abuse survivors

BACKGROUND

Childhood sexual abuse (CSA) is a significant risk factor for sexual difficulties in adulthood.

OBJECTIVE

In the current study we aimed to expand the understanding of the association between CSA and sexual difficulties by examining the moderating role of traumatic sexuality in the association between CSA and sexual difficulties among a sample of CSA survivors.

PARTICIPANTS AND SETTING

The hypothesized moderation model was examined among a sample of 393 CSA survivors.

METHODS

Significant interactions were probed using simple slopes tests using the interactions R package.

RESULTS

The results indicated main effects of traumatic sexuality on survivors' sexual difficulties: Greater severity of dissociation during sex was linked with greater sexual dysfunction and higher compulsive sexual behavior disorder (CSBD), and greater intrusiveness during sex and pleasing the other during sex were linked with higher CSBD. Experiencing higher sex-related guilt and/or shame and hypervigilance with regard to sex were associated with greater sexual dysfunction. As for the moderations, intrusiveness during sex and pleasing the other during sex moderated the association between CSA and sexual dysfunction. Intrusiveness during sex and sex-related guilt and/or shame moderated the association between CSA and CSBD. Intrusiveness during sex, pleasing the other during sex, and/or hypervigilance with regard to sex moderated the association between CSA and problematic pornography use.

CONCLUSION

This study points to the potential contribution of traumatic sexuality symptoms to sexual difficulties among survivors of CSA and lends support to the idea of offering trauma-focused therapy when treating the sexual difficulties of CSA survivors.

Adverse childhood experiences and sexual dysfunction in midlife women: Is there a link?

BACKGROUND

One in 3 children has had at least 1 adverse childhood experience (ACE), and ACEs have been associated with multiple medical and psychiatric morbidities in women later in life, including greater menopause symptom burden.

AIM

To evaluate the association between ACEs and female sexual dysfunction (FSD) in midlife women.

METHODS

A cross-sectional analysis from DREAMS-the Data Registry on Experiences of Aging, Menopause, and Sexuality-was conducted with questionnaires completed by women aged 40 to 65 years who presented to a women's health clinic at Mayo Clinic in Rochester, Minnesota, from May 2015 to December 2016. History of ACEs was obtained with the validated ACE questionnaire. FSD was assessed by the Female Sexual Function Index and the Female Sexual Distress Scale-Revised.

OUTCOMES

The association between ACEs and FSD (defined as Female Sexual Function Index score ≤26.55 and Female Sexual Distress Scale-Revised score ≥11) was evaluated via a multivariable logistic regression model, adjusting for age, menopause status, hormone therapy use, anxiety, depression, relationship satisfaction, hot flash severity, and history of abuse in the past year.

RESULTS

Women (N = 1572) had a mean age of 53.2 years. Overall 59% reported having at least 1 ACE. When compared with no ACEs, a history of ≥4 ACEs significantly increased the odds of not being sexually active (odds ratio, 1.83; 95% CI, 1.30-2.57; P < .001). Among sexually active women, the proportion of women with FSD increased sequentially as the number of ACEs increased. In the univariate analysis, a history of ≥4 ACEs significantly increased the odds of FSD as compared with no ACEs (odds ratio, 2.12; 95% CI, 1.50-2.99; P < .001). The association remained statistically significant in the multivariable analysis after adjusting for confounders (odds ratio, 1.75; 95% CI, 1.15-2.68; P = .009).

CLINICAL IMPLICATIONS

The findings highlight an opportunity for clinicians to screen for ACEs in women with sexual dysfunction and offer appropriate treatment and counseling as indicated.

STRENGTHS AND LIMITATIONS

Strengths of the study include the large cohort, the use of validated tools for assessment of ACEs and FSD, and the adjustment for multiple potential confounding factors. Limitations include the cross-sectional study design, recall bias in reporting ACEs and recent abuse, and the low representation of racially and ethnically diverse women in the cohort.

CONCLUSION

The study demonstrates an increased risk of sexual inactivity and sexual dysfunction in midlife women who experienced childhood adversity. The sexual dysfunction in women with ACEs seems to be independent of other factors that potentially affect female sexual function in midlife.

Who am I as a Sexual Being? The Role of Sexual Self-Concept Between Dispositional Mindfulness and Sexual Satisfaction among Child Sexual Abuse Survivors

Childhood sexual abuse (CSA) is associated with long-lasting and pervasive impacts on survivors' sexual health, particularly on their sexual satisfaction. Dispositional mindfulness has been found to be associated with greater sexual satisfaction among adult CSA survivors. However, the mechanisms involved in this association remain understudied. The present study examined the role of sexual self-concept (i.e., sexual esteem, sexual preoccupation, and sexual depression) in the relationship between dispositional mindfulness and sexual satisfaction among CSA survivors. A total of 176 adult CSA survivors (60.6% women, 39.4% men) completed an online survey assessing dispositional mindfulness, sexual self-concept, and sexual satisfaction. Path analyses revealed that dispositional mindfulness was positively related to sexual satisfaction through a significant indirect effect of higher sexual esteem and lower sexual depression. The integrative model explained 66.5% of the variance in sexual satisfaction. These findings highlight the key roles that dispositional mindfulness and sexual self-concept play in CSA survivors' sexual satisfaction. Implications for interventions based on trauma-sensitive mindfulness targeting the sexual self-concept are discussed, as they may promote sexual satisfaction in adult CSA survivors.

Parents' history of childhood interpersonal trauma and postpartum depressive symptoms: The moderating role of mindfulness

Postpartum depression is the most commonly reported mental health issue among parents welcoming a new child, with long-term impacts on the well-being of their family. Survivors of childhood interpersonal trauma (CIT) appear to be more vulnerable with higher rates of postpartum depressive symptoms. Yet, studies are needed on protective mechanism that can buffer the link between CIT and postpartum depressive symptoms, to identify factors that can promote resilience in CIT survivors as they navigate this demanding period. Studies also need to include both parents to adopt a comprehensive dyadic perspective. This study examined the moderating role of mindfulness, a protective mechanism documented as key for both postpartum mental health and trauma processing, in the association between CIT and postpartum depressive symptoms in parental couples. A randomly selected sample of 843 couples who recently welcomed a new child completed self-reported measures of CIT, dispositional mindfulness and postpartum depression. Path analyses showed that more experience of CIT was associated with higher levels of postpartum depression, but this association was weaker in parents with higher dispositional mindfulness. Exploration of mindfulness facets yielded that higher disposition to act with awareness and observation acted as specific buffers, for fathers and mothers respectively. In addition, more CIT reported by one parent was linked with their partner's higher depressive symptoms. These findings shed light on the protective role of mindfulness during the postpartum period to protect against postpartum depression in parents who are CIT survivors and their partners.

A Hierarchical Cluster Analysis of Childhood Interpersonal Trauma and Dispositional Mindfulness: Heterogeneity of Sexual and Relational Outcomes in Adulthood

The current mixed-method study aimed to 1) identify different childhood interpersonal trauma (CIT) and dispositional mindfulness (DM) profiles in an adult sample; 2) illustrate these profiles with qualitative data documenting childhood sexual abuse (CSA) and CIT survivors' perceptions of their own DM; and 3) examine profile differences on sexual and relational outcomes. Participants were 292 adults who completed an online questionnaire. A subsample of participants having reported a history of CSA (n = 51) also completed semi-structured interviews. Hierarchical cluster, comparison, and content analyses were performed. Analyses yielded three profiles: 1) Lower victimization, high mindfulness; 2) Psychological victimization, low mindfulness; and 3) Multi-victimization, low mindfulness. Participants in profile 1 presented the lowest frequency of CIT experiences and the highest levels of DM and sexual and relational well-being. Profile 2 participants presented higher sexual and relational well-being (i.e., higher sexual satisfaction, lower sexual depression, and fewer interpersonal conflicts) than those in profile 3. By documenting distinct CIT and DM profiles and tying them to different levels of relational and sexual well-being, this study could guide practitioners in designing tailored interventions.

Internet- and mobile-based psychological interventions for sexual dysfunctions: a systematic review and meta-analysis

Sexual dysfunctions are highly prevalent and undertreated. Internet- and mobile-based psychological interventions (IMIs) could be a promising addition to close this treatment gap, given their accessibility, anonymity, and scalability. This systematic review and meta-analysis investigated the efficacy of IMIs for sexual dysfunctions. A comprehensive literature search was conducted in August 2021 on randomized controlled trials investigating the effects of IMIs on sexual functioning and satisfaction compared to a control condition. Twelve RCTs with 14 comparisons were reviewed with six IMIs targeting female and six IMIs targeting male sexual dysfunctions and n = 952 participants were evaluated in the meta-analysis. IMIs were significantly more effective than control conditions (k = 11 waitlist control group, k = 3 online discussion board) at post-treatment for female sexual functioning (g = 0.59, CI: 0.28–0.90, I²= 0%) and satisfaction (g = 0.90, CI: 0.02–1.79, I²= 82%), and male sexual functioning (g = 0.18, CI: 0.02–0.34, I²= 0%). No significant effect was found for male sexual satisfaction (g = 0.69, CI: −0.13–1.51, I²= 88%) with substantial heterogeneity in studies. Most studies showed high dropout, with ten studies indicating some concern of risk of bias, and two studies showing high risk of bias. The results suggest that IMIs can be an effective treatment for sexual dysfunctions, although additional high-quality research is needed. Given the limited availability of specialized treatment for sexual dysfunctions and individual preferences for discrete treatment options, IMIs seem to be a valuable addition to routine care, empowering individuals to promote their sexual health on a guided self-help basis.

Treatment of Traumatised Sexuality

Based on therapeutic meetings with individuals who have experienced sexual violence and abuse, the challenge is how do we help these couples to establish sexual relationships on their own terms, without interference of defence or coping strategies they have used to protect themselves against the overwhelming experiences of violence or abuse in the past? This article will focus on therapeutic work with such couples and how to interact with them and support their efforts to establish satisfying sexual relationships, based on sexological experience as well as experience from work with traumatisation. The basis for our treatment is a modified version of William Masters and Virginia Johnson's approach. The technique of sensate focus is central, modified by trauma theory, including the understanding of dissociation, and the need to integrate memories from different levels: somatic, emotional, and cognitive. The traumatised client needs special attention to the experiences of predictability and safety and respect due to their history of being transgressed against. The therapists must be aware of the issue of dissociation; different dissociated inner parts can play different roles in the interaction between client and therapist. While couples therapy is a necessary frame for this therapy, the therapist often needs to work with issues unique to each individual. Each partner must be able to identify their own responses and their own sexual needs and preferences. It may therefore be valuable to have a co-therapist. The central goal is for the clients to identify responses to stimulation as a here and now experience in a setting that feels safe and welcome.