1
|
Lazar A, Gewirtz-Meydan A, Rosenbaum TY. War-Time Stress and Sexual Well-Being in Israel. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2024; 36:1-14. [PMID: 38596811 PMCID: PMC10903651 DOI: 10.1080/19317611.2024.2317169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 02/03/2024] [Indexed: 04/11/2024]
Abstract
Objective This study explored the relationship between war-related stressors and sexual well-being among a civilian population during the 2023 Israel-Hamas War, emphasizing a comprehensive assessment of sexual satisfaction, function, and distress. We aimed to investigate how direct exposure, media exposure, and acute stress symptoms during the war contribute to various dimensions of sexual well-being using a quasi-longitudinal online survey method. Methods An online survey with a convenience sample of 1033 Israeli adults, utilizing measures of direct and media exposure to war stress, acute stress symptoms, and various aspects of sexual well-being, both pre-war and present was distributed. Data analysis involved Pearson correlations and hierarchical regression. Results There were significant associations between stress-related variables and sexual well-being, highlighting the differential contribution of direct exposure, media exposure, and acute stress symptoms. Direct exposure to stress was uniquely associated with sexual dysfunction, while media exposure and acute stress symptoms contributed significantly to predicting various aspects of sexual well-being. Conclusions Recognizing the multifaceted impact of stress during wartime on sexual well-being is crucial for developing comprehensive mental health interventions that address individual and societal factors. This study contributes valuable insights into the relationships between stress-related variables and sexual well-being during wartime, emphasizing the need for holistic approaches in addressing the intimate challenges individuals face during times of conflict.
Collapse
Affiliation(s)
- Aryeh Lazar
- Department of Psychology, Faculty of Humanities and Social Sciences, Ariel University, Ariel, Israel
| | - Ateret Gewirtz-Meydan
- School of Social Work, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | | |
Collapse
|
2
|
Steil R, Weiss J, Bornefeld-Ettmann P, Priebe K, Kleindienst N, Müller-Engelmann M. A preliminary study on the effect of trauma-focused therapies on sexual dysfunctions in women with PTSD after childhood abuse. J Psychiatr Res 2024; 170:340-347. [PMID: 38211457 DOI: 10.1016/j.jpsychires.2024.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 01/02/2024] [Accepted: 01/06/2024] [Indexed: 01/13/2024]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is often associated with female sexual dysfunctions (FSD). However, little is known about the impact of therapies for PTSD on FSD according to DSM-5 criteria. AIM/OBJECTIVE To examine if sexual functioning diagnosed according to DSM-5 criteria improves after treatment for PTSD in women with a PTSD diagnosis after interpersonal child abuse. METHOD FSD according to DSM-5 criteria were assessed with the structured clinical interview SISEX in N = 152 female participants (mean age = 36.5 years) of a large randomized controlled trial three months into treatment and after 15 months of receiving either dialectical behavior therapy for PTSD or cognitive processing therapy. Number of fulfilled FSD criteria and diagnostic status were compared from pre-to post-treatment using Poisson and negative binomial regression analyses and the McNemar test. The effect of treatment type on reduction of FSD symptoms and the association between reduction in PTSD symptoms and reduction in FSD symptoms were assessed. RESULTS From pre-to post-treatment, the number of fulfilled criteria for each FSD decreased (Incident rate ratios between 0.60 and 0.71, p between <. 001 and <0 .05). Less women met criteria for genito-pelvic pain/penetration disorder at post-treatment compared to pre-treatment (11.8 % vs. 6.6 %, p < .05). No difference was found between treatments in reduction of FSD symptoms. Reduction of PTSD symptoms was associated with greater decrease in FSD symptoms. CONCLUSIONS Our results suggest a positive association between effective PTSD treatments and improvements in sexual functioning of women with PTSD after child abuse.
Collapse
Affiliation(s)
- Regina Steil
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt am Main, Germany.
| | - Judith Weiss
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt am Main, Germany
| | - Pia Bornefeld-Ettmann
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt am Main, Germany
| | - Kathlen Priebe
- Faculty of Life Sciences, Department of Psychology, Humboldt-University of Berlin, Berlin, Germany; Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Nikolaus Kleindienst
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Meike Müller-Engelmann
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt am Main, Germany; Faculty of Human Sciences, Department of Psychology, Medical School Hamburg, Germany
| |
Collapse
|
3
|
Way BM, Griffin KR, Kraus SW, Tsai J, Pietrzak RH. Erectile Dysfunction in a U.S. National Sample of Male Military Veterans. Mil Med 2023; 188:2837-2843. [PMID: 35792506 DOI: 10.1093/milmed/usac187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 06/06/2022] [Accepted: 06/15/2022] [Indexed: 06/15/2023] Open
Abstract
INTRODUCTION Erectile dysfunction (ED) is one of the most prevalent sexual dysfunctions in men and often co-occurs with physical and mental health issues. Military veterans are at elevated risk for many comorbid physical and mental health issues, including ED, although little research has examined the prevalence and health burden of ED in the general U.S. veteran population. The present study calculated the weighted lifetime prevalence of ED and its association with physical and mental health conditions in a nationally representative sample of U.S. veterans. MATERIALS AND METHODS Using data from a nationally representative sample of 921 male U.S. veterans, self-report assessments assessed major depressive disorder (MDD), generalized anxiety disorder, probable post-traumatic stress disorder (PTSD), at-risk/problem gambling, and past two-week suicidal ideation and attempts, as well as 22 physical health conditions. RESULTS The weighted lifetime prevalence of ED among veterans was 14.2% (95% CI = 12.0%-16.0%). Veterans with ED were more likely to be older than 60, unemployed, to have served less than four years in the military, and to have served in combat roles and in the Vietnam War. Relative to veterans without ED, veterans with ED had higher rates of sleep disorders (adjusted odds ratio [aOR] = 3.23), arthritis (aOR = 2.60), high cholesterol (aOR = 2.30), diabetes (aOR = 2.29), high blood pressure (aOR = 2.14), obesity (aOR = 2.12), heart disease (aOR = 2.10), cancer (aOR = 2.07), respiratory illness (aOR = 2.02), and chronic pain (aOR = 1.86). After adjusting for sociodemographic characteristics and physical health conditions, ED was associated with increased odds of MDD (aOR = 2.88), at-risk/problem gambling (aOR = 2.45), and suicidal ideation (aOR = 1.91) but not for generalized anxiety disorder (aOR = 1.69) or probable PTSD (aOR = 1.63). When considered in the context of all mental health variables, MDD was independently associated with ED (aOR = 3.39). CONCLUSION This study examined both mental and physical health conditions associated with ED in a U.S. nationally representative sample of veterans. ED is prevalent in veterans and associated with elevated physical and mental health burden. Results highlight the importance of considering ED in disease prevention and treatment efforts in this population. These findings may help inform prevention approaches as well as clinical targets for early screening and treatment in vulnerable subgroups of this population. Notably, data collected relied on self-report assessments; data on race and socioeconomic status were not collected.
Collapse
Affiliation(s)
- Bailey M Way
- Department of Psychology, University of Nevada, Las Vegas, NV 89154, USA
| | - Kaelyn R Griffin
- Department of Psychology, University of Nevada, Las Vegas, NV 89154, USA
| | - Shane W Kraus
- Department of Psychology, University of Nevada, Las Vegas, NV 89154, USA
- Department of Psychiatry, UNLV School of Medicine, Las Vegas, NV 89154, USA
| | - Jack Tsai
- U.S. Department of Veterans Affairs, National Center on Homelessness Among Veterans, Tampa, FL, USA
- University of Texas Health Science Center at Houston, School of Public Health, San Antonio Campus, TX 78229, USA
| | - Robert H Pietrzak
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT 06516, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06511, USA
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT 06511, USA
| |
Collapse
|
4
|
van Woudenberg C, Voorendonk EM, Tunissen B, van Beek VHF, Rozendael L, Van Minnen A, De Jongh A. The impact of intensive trauma-focused treatment on sexual functioning in individuals with PTSD. Front Psychol 2023; 14:1191916. [PMID: 37614489 PMCID: PMC10442952 DOI: 10.3389/fpsyg.2023.1191916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 07/24/2023] [Indexed: 08/25/2023] Open
Abstract
Background Individuals with posttraumatic stress disorder (PTSD) often experience sexual disturbances. Objective To determine whether intensive trauma-focused treatment is associated with an improvement in sexual functioning (i.e., sexual satisfaction and sexual desire) in individuals with PTSD. Method In total, 227 patients with PTSD (68.7% women, mean age = 40.97) participated in an intensive eight-day trauma-focused treatment program consisting of prolonged exposure, eye movement and desensitization and reprocessing (EMDR) therapy, physical activity, and psychoeducation. Patients were assessed (i.e., Clinician Administered PTSD Scale and Sexual Functioning Questionnaire) pre- and post-treatment and at 6-months follow-up. Results Sexual satisfaction and sexual desire increased significantly associated with trauma-focused treatment from pre-treatment to 6-months follow-up, albeit the effect sizes were small (Cohen's d = 0.39 and 0.17, respectively). Although men reported greater overall sexual desire than women, sexual functioning improved after treatment in both men and women. Furthermore, those with remission of PTSD reported greater sexual functioning post-treatment and at 6-months follow-up, than those without remission. However, changes in PTSD symptoms associated with treatment were not predictive of the level of sexual satisfaction or sexual desire 6 months after treatment. Conclusion The results of this uncontrolled study suggest that intensive treatment for PTSD can have beneficial effects on sexual satisfaction and desire in both men and women; however, this may not necessarily be due to a decrease in PTSD symptoms.
Collapse
Affiliation(s)
| | - Eline M. Voorendonk
- Research Department, PSYTREC, Bilthoven, Netherlands
- Behavioural Science Institute (BSI), Radboud University Nijmegen, Nijmegen, Netherlands
| | - Bo Tunissen
- Research Department, PSYTREC, Weert, Netherlands
| | | | | | - Agnes Van Minnen
- Research Department, PSYTREC, Bilthoven, Netherlands
- Behavioural Science Institute (BSI), Radboud University Nijmegen, Nijmegen, Netherlands
| | - Ad De Jongh
- Research Department, PSYTREC, Bilthoven, Netherlands
- Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, Netherlands
- School of Psychology, Queen’s University, Belfast, United Kingdom
- Institute of Health and Society, University of Worcester, Worcester, United Kingdom
| |
Collapse
|
5
|
Protuđer M, Stevanović A, Letica-Crepulja M. Sexual Dysfunctions among Veterans with and without PTSD. Healthcare (Basel) 2023; 11:1861. [PMID: 37444696 PMCID: PMC10340479 DOI: 10.3390/healthcare11131861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 06/17/2023] [Accepted: 06/22/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Research on the relationship between posttraumatic stress disorder (PTSD) and sexual dysfunctions (SD) has clearly recognized the association among these conditions. The main objective of this research was to compare the levels of the overall and the level of certain domains of sexual functioning among veterans with and those without PTSD. METHODS Two hundred and fifty veterans with PTSD and 187 veterans without PTSD were included in the comparative study. The following assessments were conducted: LEC-5, PCL-5, ITQ, IIEF, PEDT, and MINI. RESULTS Veterans with PTSD had significantly higher levels of all types of SD in the PTSD group compared with the non-PTSD veterans. Veterans with PTSD more frequently experienced psychiatric and somatic comorbidities and use of medication that may contribute to the occurrence and severity of SD. CONCLUSIONS The present study emphasized that SDs are an important issue among patients with PTSD. The study comprehensively accounted for conditions that may contribute to the occurrence and severity of SD among veterans with PTSD. Future directions of the research that could further improve the healthcare of the patients were indicated.
Collapse
Affiliation(s)
- Marina Protuđer
- Department of Psychiatry and Psychological Medicine, Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia; (M.P.); (A.S.)
| | - Aleksandra Stevanović
- Department of Psychiatry and Psychological Medicine, Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia; (M.P.); (A.S.)
- Department of Psychiatry, Clinical Hospital Center Rijeka, Referral Center for PTSD of the Ministry of Health of the Republic of Croatia, 51000 Rijeka, Croatia
- Department of Basic Medical Sciences, Faculty of Health Studies, University of Rijeka, 51000 Rijeka, Croatia
| | - Marina Letica-Crepulja
- Department of Psychiatry and Psychological Medicine, Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia; (M.P.); (A.S.)
- Department of Psychiatry, Clinical Hospital Center Rijeka, Referral Center for PTSD of the Ministry of Health of the Republic of Croatia, 51000 Rijeka, Croatia
| |
Collapse
|
6
|
Levinson DB, Halverson TF, Wilson SM, Fu R. Less dropout from prolonged exposure sessions prescribed at least twice weekly: A meta-analysis and systematic review of randomized controlled trials. J Trauma Stress 2022; 35:1047-1059. [PMID: 35278229 DOI: 10.1002/jts.22822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 11/29/2021] [Accepted: 12/01/2021] [Indexed: 11/06/2022]
Abstract
Trauma-focused psychotherapies, such as prolonged exposure (PE), are strongly recommended to treat posttraumatic stress disorder due to their effects in reducing symptoms. However, such therapies may also suffer from high dropout rates. To investigate how clients might benefit from trauma-focused therapy while minimizing dropout, we conducted a meta-analysis of 1,508 adults from 35 randomized controlled trials (RCTs) of outpatient PE programs to evaluate treatment frequency as a predictor of dropout. When an RCT prescribed PE sessions at least twice weekly compared to less frequently, the dropout rate was significantly lower at 21.0%, 95% CI [13.9%, 30.4%], compared to 34.0%, 95% CI [28.9%, 39.4%], OR = 0.52, 95% CI [0.30, 0.89], p = .018. It was not possible to draw causal conclusions, as only one RCT compared two PE treatment frequencies head-to-head. Nonetheless, the findings remained significant after controlling for study characteristics. These data invite reconsideration of the common practice of weekly psychotherapy in favor of twice-weekly sessions in standard outpatient treatment.
Collapse
Affiliation(s)
| | - Tate F Halverson
- Durham VA Health Care System, Durham, North Carolina, USA
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, North Carolina, USA
| | - Sarah M Wilson
- Durham VA Health Care System, Durham, North Carolina, USA
- Division of Behavioral Medicine and Neurosciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Rongwei Fu
- School of Public Health, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA
| |
Collapse
|
7
|
K Blais R, K Zalta A, S Livingston W. Interpersonal Trauma and Sexual Function and Satisfaction: The Mediating Role of Negative Affect Among Survivors of Military Sexual Trauma. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP5517-NP5537. [PMID: 32990170 DOI: 10.1177/0886260520957693] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Healthy sexual function among women service members/veterans (SM/Vs) is associated with higher quality of life, lower incidence and severity of mental health diagnoses, higher relationship satisfaction, and less frequent suicidal ideation. Although trauma exposure has been established as a predictor of poor sexual function and satisfaction in women SM/Vs, no study to date has examined whether specific trauma types, such as military sexual trauma (MST), increase risk for sexual issues. Moreover, the possible mechanisms of this association have not been explored. The current study examined whether posttraumatic stress disorder (PTSD) and depression symptom clusters mediated the association of trauma type and sexual function and satisfaction in 426 trauma-exposed women SM/Vs. Two hundred seventy participants (63.4%) identified MST as their index trauma. Path analyses demonstrated that MST was related to poorer sexual function and lower satisfaction relative to the other traumas (χ2[28, N = 426] = 43.3, p = 0.03, CFI = 1.00, TLI = 0.99, and RMSEA = 0.04), and this association was mediated by higher non-somatic depressive symptoms and PTSD symptom clusters of anhedonia and negative alterations in cognition and mood (NACM). Causality cannot be inferred due to the cross-sectional nature of the data. However, our findings suggest that interventions aimed at decreasing sexual issues among female SM/Vs with MST should target depressogenic symptoms, whether the origin is depression or PTSD. Longitudinal research exploring the etiological processes that contribute to sexual dysfunction among those with MST is needed.
Collapse
|
8
|
Mechanisms of the association between PTSD and sexual arousal and lubrication functioning among trauma-exposed female service members/veterans. J Affect Disord 2022; 301:352-359. [PMID: 34965403 DOI: 10.1016/j.jad.2021.12.106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 12/22/2021] [Accepted: 12/24/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND The presence of a post-traumatic stress disorder (PTSD) diagnosis or higher PTSD severity is associated with higher overall sexual dysfunction in female service members/veterans. However, the mechanisms linking PTSD to specific components of women's sexual arousal function, like lubrication and mental arousal, are unknown. METHODS We conducted a survey among 464 women who reported probable Criterion A exposure for PTSD. Path analysis examined (1) the association of PTSD with sexual arousal, (2) whether specific PTSD symptom clusters were uniquely associated with sexual arousal, and (3) whether this association is indirect, through the effects of higher depression severity and lower romantic relationship satisfaction. Arousal was operationalized to measure both mental (subjective arousal) and physical (lubrication) experiences. RESULTS Higher PTSD severity was associated with lower lubrication and arousal function. The association of PTSD severity with arousal was indirect, through lower romantic relationship satisfaction (estimate: -0.12; 95% CI: [-0.014, -0.007]) and higher depression (estimate: -0.08, 95% CI: [-0.012, -0.002]). The association of PTSD severity with lubrication was also indirect, but only through lower relationship satisfaction (estimate: -0.10, 95% CI: [-0.013, -0.006]). PTSD symptom clusters were not uniquely associated with arousal and lubrication through mediated pathways. LIMITATIONS Data were from a cross-sectional study using a convenience sample. Criterion A exposure could not be confirmed. CONCLUSIONS PTSD may lead to arousal and lubrication dysfunction by contributing to higher depression severity and strained romantic relationships. Interventions targeting reductions in depressive symptoms and bolstering relationship satisfaction may minimize the burden of PTSD on sexual arousal concerns.
Collapse
|
9
|
Sexual Habits and Sexual Dysfunctions in a Sample of Patients with Psychotic Disorders Compared to a Group of Healthy Adults. J Clin Med 2022; 11:jcm11030505. [PMID: 35159957 PMCID: PMC8836347 DOI: 10.3390/jcm11030505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/11/2022] [Accepted: 01/17/2022] [Indexed: 11/17/2022] Open
Abstract
Background: There is a growing body of literature on the association between psychosis and sexual dysfunction. However, most studies have focused on sexual dysfunction and have not investigated the sexual lives of patients with psychosis across a broader range. Material and Methods: Consecutive patients with a diagnosis of acute psychosis or schizophrenia were recruited to the study after obtaining informed consent (n = 46). In addition, healthy control subjects were recruited (n = 52). Sociodemographic and clinical data, psychopathology, and sexual functioning were assessed. Independent sample t-test to determine group differences was obtained. Results: In both the male and female groups, there are significant differences between psychotic individuals and healthy controls in several areas of their sexual functioning: the control group seemed to better perceive Couple sexuality, Self-eroticism, and overall appeared to have a higher Quality of sexual life; on the other hand, the group of patients with psychosis displayed higher scores in Sexual dysfunction. Conclusions: A poor sexual quality of life may be found in patients with psychotic disorders. Assessment of sexual function in these patients is necessary to identify and manage issues and provide support and help to patients in this important area of life.
Collapse
|
10
|
Blais RK. The Association of Exposure to Military Sexual Trauma and Romantic Relationship Satisfaction Among Partnered Men Service Members/Veterans: The Influence of Compulsive Sexual Behavior. FAMILY PROCESS 2021; 60:1295-1306. [PMID: 33400283 DOI: 10.1111/famp.12623] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Civilian literature shows a strong, consistent association between exposure to sexual violence and poor romantic relationship satisfaction. The impact of sexual violence that occurred during military service, or military sexual trauma (MST), on romantic relationship satisfaction among partnered men service members/veterans (SM/Vs) is understudied. However, a recent study conducted in women observed that MST that involved an assault was associated with poorer relationship satisfaction through higher sexual dysfunction and lower sexual satisfaction. The current study extended the literature by examining sexual function as a mediator of the association of exposure to MST and romantic relationship satisfaction among partnered men SM/Vs (N = 499). Participants completed self-report measures of MST exposure, romantic relationship satisfaction, erectile dysfunction, and compulsive sexual behavior, as well as a demographic inventory. The average score on relationship satisfaction was in the distressed range. Sixty-four participants (12.83%) reported MST exposure. MST exposure was related to lower relationship satisfaction through higher compulsive sexual behavior. The model explained 16% of the variance in relationship satisfaction. The indirect effect of erectile dysfunction was nonsignificant. Current findings are consistent with research in women SM/Vs: the association of MST and romantic relationship satisfaction appears to be indirect, through the effects of sexual function. Couples' therapy may be most effective if it addresses sexual health concerns among men MST survivors, particularly engagement in compulsive sexual behaviors. Due to low endorsement of MST that involved assault, the impact of MST severity could not be examined.
Collapse
Affiliation(s)
- Rebecca K Blais
- Department of Psychology, Utah State University, Logan, UT, USA
| |
Collapse
|
11
|
Pulverman CS, Creech SK. The Impact of Sexual Trauma on the Sexual Health of Women Veterans: A Comprehensive Review. TRAUMA, VIOLENCE & ABUSE 2021; 22:656-671. [PMID: 31438778 DOI: 10.1177/1524838019870912] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Sexual trauma, particularly childhood sexual trauma, is a potent risk factor for sexual health difficulties among civilian women. Women veterans report elevated rates of sexual trauma compared to their civilian peers, including sexual trauma during military service, perhaps making women veterans even more vulnerable to sexual health difficulties. A comprehensive review of the peer-reviewed literature on the relationship between sexual trauma and sexual health in women veterans was conducted. Inclusion criteria were measurement of sexual trauma and sexual health (i.e., sexual function or sexual satisfaction), a U.S. veteran sample including women veterans, and written in English. This process identified 18 articles. Results indicated that similar to the pattern observed among civilian women, sexual trauma was associated with an increased risk of sexual dysfunction and low sexual satisfaction among women veterans. Sexual pain was the most common sexual dysfunction among women veterans. Comorbid post-traumatic stress disorder and depression were identified as correlates of sexual dysfunction. Gaps in the literature included limited use of validated measures of sexual health and inconsistencies in the assessment of sexual trauma history. Future research is needed on the interrelationships between sexual trauma, sexual health, and mental health to inform treatment recommendations for improving sexual health among women veterans.
Collapse
Affiliation(s)
- Carey S Pulverman
- VHA VISN 17 Center of Excellence for Research on Returning War Veterans, The Central Texas Veterans Health Care System, Waco, TX, USA
- Dell Medical School, 441903University of Texas at Austin, Austin, TX, USA
| | - Suzannah K Creech
- VHA VISN 17 Center of Excellence for Research on Returning War Veterans, The Central Texas Veterans Health Care System, Waco, TX, USA
- Dell Medical School, 441903University of Texas at Austin, Austin, TX, USA
| |
Collapse
|
12
|
Bird ER, Piccirillo M, Garcia N, Blais R, Campbell S. Relationship Between Posttraumatic Stress Disorder and Sexual Difficulties: A Systematic Review of Veterans and Military Personnel. J Sex Med 2021; 18:1398-1426. [PMID: 37057456 DOI: 10.1016/j.jsxm.2021.05.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 04/26/2021] [Accepted: 05/15/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is associated with sexual difficulties but the nuances of this relationship remain elusive. Research has increased in recent years, most notably following publication of several reviews in 2015. AIM This systematic review examines the relationship between PTSD and sexual difficulties in veterans/military personnel. METHODS A systematic review was conducted using PRISMA guidelines in PsycINFO and PubMed databases for studies examining a diagnosis of PTSD or PTSD severity in relation to a range of sexual difficulties. Forty-three studies were identified that met inclusion and exclusion criteria for this review. RESULTS PTSD was associated with increased risk of experiencing at least one sexual difficulty. PTSD was most clearly associated with overall sexual function, sexual desire, sexual satisfaction, and sexual distress. Results were mixed for sexual arousal, orgasm function, erectile dysfunction, premature ejaculation, sexual pain, and frequency of sexual activity. PTSD symptom clusters of avoidance and negative alterations in cognition/mood were most commonly associated sexual difficulties. Few studies compared results by gender and trauma type. CLINICAL IMPLICATIONS Clinicians should inquire about sexual health in relation to PTSD symptoms and target avoidance and negative mood symptoms by incorporating sexual exposure assignments and sexual activation exercises when appropriate. STRENGTHS & LIMITATIONS This systematic review synthesizes an extensive literature that has grown substantially in the past 5 years and includes studies with low to moderate risk of bias. Limitations of the existing literature include challenges differentiating between PTSD and depression, inconsistent measurement of PTSD and trauma histories, inconsistent operationalization and measurement of sexual outcomes, and largely cross-sectional study designs. CONCLUSION PTSD is linked to a range of sexual outcomes. The current literature suggests that PTSD is associated with sexual difficulties related to both the sexual response cycle (ie, sexual desire) and one's emotional relationship to sexual activity (eg, sexual distress). More research is needed to increase confidence in findings. Bird ER, Piccirillo M, Garcia N, et al. Relationship Between Posttraumatic Stress Disorder and Sexual Difficulties: A Systematic Review of Veterans and Military Personnel. J Sex Med 2021;18:1398-1426.
Collapse
Affiliation(s)
- Elizabeth R Bird
- VA Puget Sound Healthcare System, Seattle Division, Seattle, WA.
| | - Marilyn Piccirillo
- VA Puget Sound Healthcare System, Seattle Division, Seattle, WA; University of Washington, Department of Psychology, Seattle, WA
| | - Natalia Garcia
- VA Puget Sound Healthcare System, Seattle Division, Seattle, WA
| | - Rebecca Blais
- Utah State University, Department of Psychology, Logan, UT
| | - Sarah Campbell
- Seattle-Denver Center of Innovation in Veteran-Centered and Value-Driven Care, Health Services Research and Development, VA Puget Sound Health Care System, Seattle, WA; Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
| |
Collapse
|
13
|
Szuster E, Kostrzewska P, Pawlikowska A, Mandera A, Biernikiewicz M, Kałka D. Mental and Sexual Health of Polish Women of Reproductive Age During the COVID-19 Pandemic - An Online Survey. Sex Med 2021; 9:100367. [PMID: 34146832 PMCID: PMC8360924 DOI: 10.1016/j.esxm.2021.100367] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 03/20/2021] [Accepted: 03/29/2021] [Indexed: 01/22/2023] Open
Abstract
Introduction The COVID-19 pandemic can cause emotional distress, which can in turn lead to the development of mental and physical symptoms. Aim We examined the association of the COVID-19 outbreak and the mental, physical and sexual health of the female Polish population. Methods Data were collected in an online survey distributed on social media from April 22, 2020 through to May 7, 2020. The data collection began one month after the start of lockdown in Poland. Main Outcome Measure Women were asked to complete the Beck Depression Inventory (BDI) and the Female Sexual Function Index (FSFI) questionnaires. Results Overall, 1644 women (median age 23 years) took part in the survey. They reported a lower frequency of sexual activity (P < .001) and a lower libido level (P < .001) during the pandemic then before it. 57.5% of the study group (n = 944) strongly agreed or agreed that fear of the health condition of loved ones was a source of stress and depressed mood. The average BDI-II total score was 11 (range 0-51; IQR 5-18), which corresponds to minimal depression. The average FSFI total score was 27.01 ± 7.61 (range 2-36). The FSFI and BDI scores were significantly correlated (P < .001). The FSFI score was significantly correlated with the presence of any comorbid chronic disease, the intensity of the fear of infection and fear of health conditions, perceived loneliness, and the being up to date with media news. The BDI score was significantly correlated with age, the intensity of the fear of infection and fear of health conditions, perceived loneliness, being up to date with media news, and the more frequent use of stimulants. Conclusions The COVID-19 lockdown setting was associated with a high occurrence of depressive symptoms and increased risk of sexual dysfunction with decreased libido and lower sexual frequency the most commonly reported issues. Szuster E, Kostrzewska P, Pawlikowska A, et al. Mental and Sexual Health of Polish Women of Reproductive Age During the COVID-19 Pandemic – An Online Survey. Sex Med 2021;9:100367.
Collapse
Affiliation(s)
- Ewa Szuster
- Cardiosexology Students Club, Wrocław Medical University, Wrocław, Poland
| | | | - Anna Pawlikowska
- Cardiosexology Students Club, Wrocław Medical University, Wrocław, Poland
| | - Amanda Mandera
- Cardiosexology Students Club, Wrocław Medical University, Wrocław, Poland
| | | | - Dariusz Kałka
- Cardiosexology Unit, Department of Pathophysiology, Wrocław Medical University, Wrocław, Poland; Men's Health Centre in Wrocław, Wrocław, Poland
| |
Collapse
|
14
|
Kiss MJ, McDonagh LK, Sparks B, Hamp T, Morrison TG. Accurately Assessing Gay Men's Erectile Functioning: A Critique of the International Index of Erectile Function (IIEF) Use with Gay Men. JOURNAL OF SEX RESEARCH 2021; 58:589-598. [PMID: 33044087 DOI: 10.1080/00224499.2020.1811195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The International Index of Erectile Functioning (IIEF) has been widely used to measure gay men's erectile functioning. However, the IIEF was initially developed using a sample of men whose sexual orientation was unspecified. Using scales not validated for specific populations can result in inaccurate assessments. The purpose of the current study was to evaluate the dimensionality, reliability, and validity of the IIEF with a large sample of gay men. One thousand and eighteen men self-identifying as "exclusively gay" completed an online survey consisting of demographics, the IIEF, the Hospital Anxiety and Depression Scale (HADS), the Perceived Stress Scale 4 (PSS4), and the Gay Male Sexual Difficulties (GMSD) erectile difficulties sub-scale. The replicability of the IIEF factor structure with a gay male sample was determined using exploratory and confirmatory factor analyses. Additionally, the HADS, PSS4, and GMSD were used to determine the validity of the IIEF. The current study was unable to replicate the IIEF factor structure. Four items required deletion and the factor solution differed from the original. Thus, reinterpretation of the latent variables was deemed necessary. Although the resultant 12-item IIEF evidenced model fit, validity, and reliability, it is not recommended for use with gay men. The revised IIEF is unable to accurately measure gay men's erectile functioning as the content of the items fail to capture their sexual behaviors (i.e., insertive and receptive anal sex).
Collapse
Affiliation(s)
- Mark J Kiss
- Department of Psychology, University of Saskatchewan
| | - Lorraine K McDonagh
- Research Department of Primary Care and Population Health, University College London
| | | | - Thomas Hamp
- Department of Psychology, University of Saskatchewan
| | | |
Collapse
|
15
|
Carbone MG, Campo G, Papaleo E, Marazziti D, Maremmani I. The Importance of a Multi-Disciplinary Approach to the Endometriotic Patients: The Relationship between Endometriosis and Psychic Vulnerability. J Clin Med 2021; 10:jcm10081616. [PMID: 33920306 PMCID: PMC8069439 DOI: 10.3390/jcm10081616] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 04/04/2021] [Accepted: 04/06/2021] [Indexed: 12/24/2022] Open
Abstract
Endometriosis is a chronic inflammatory condition, which is distinguished by the presence of the endometrial-like glands and stroma outside the uterine cavity. Pain and infertility are the most commonly expressed symptoms, occurring in 60% and 40% of cases, respectively. Women with endometriosis, especially those with pelvic pain, also have a greater vulnerability to several psychiatric disorders. There is, in particular, a tendency to contract affective or anxiety disorders as well as panic-agoraphobic and substance use disorders. Endometriosis with pelvic pain, infertility and psychic vulnerability usually leads to disability and a markedly lower quality of life for women of reproductive age. Thus, the burden of endometriosis is not limited to the symptoms and dysfunctions of the disease; it extends to the social, working and emotional spheres, leading to a severe impairment of global functioning. An analysis of scientific literature revealed a close relationship between specific temperamental traits, the expression of several psychiatric symptoms, chronicity of pain, risk of substance use and lower probability of a positive outcome. Endometriosis symptoms and the impact of related psychological consequences, increased vulnerability and the possible onset of psychiatric symptoms may influence coping strategies and weaken resilience, so triggering a vicious cycle leading to a marked deterioration in the quality of life. A multidisciplinary approach consisting of a medical team composed of gynecologists, psychologists, psychiatrists, experts in Dual Disorder, algologists and sexologists, would guarantee the setting of a target and taking the best decision on a personalized treatment plan. That approach would allow the prompt detection of any psychopathological symptoms and improve the endometriosis-related physical symptoms, bringing a healthier quality of life and a greater likelihood of a positive outcome.
Collapse
Affiliation(s)
- Manuel Glauco Carbone
- PISA-School of Experimental and Clinical Psychiatry, 56100 Pisa, Italy;
- Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, 21100 Varese, Italy
| | - Giovanni Campo
- Obstetrics and Gynecology Department, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy; (G.C.); (E.P.)
| | - Enrico Papaleo
- Obstetrics and Gynecology Department, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy; (G.C.); (E.P.)
- Reproductive Sciences Laboratory, Division of Genetics and Cell Biology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Donatella Marazziti
- 1st Psychiatric Unit, Department of Clinical and Experimental Medicine, Santa Chiara University Hospital, University of Pisa, 56100 Pisa, Italy;
- Saint Camillus International University of Health and Medical Sciences-UniCamillus, 00131 Rome, Italy
| | - Icro Maremmani
- Saint Camillus International University of Health and Medical Sciences-UniCamillus, 00131 Rome, Italy
- Association for the Application of Neuroscientific Knowledge to Social Aims (AU-CNS), 55045 Pietrasanta, Lucca, Italy
- Vincent P. Dole Dual Disorder Unit, 2nd Psychiatric Unit, Santa Chiara University Hospital, University of Pisa, 56100 Pisa, Italy
- G. De Lisio Institute of Behavioral Sciences, 56100 Pisa, Italy
- Correspondence: ; Tel.: +39-050-993045
| |
Collapse
|
16
|
Bachem R, Levin Y, Solomon Z. Posttraumatic Stress and Sexual Satisfaction in Husbands and Wives: A Dyadic Analysis. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:1533-1543. [PMID: 32246223 DOI: 10.1007/s10508-020-01680-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 03/04/2020] [Accepted: 03/04/2020] [Indexed: 06/11/2023]
Abstract
Trauma survivors who suffer from posttraumatic stress symptoms (PTSS) are known to experience impairments in sexual satisfaction. However, the negative effects of PTSS are not limited to the primary survivors, as they can lead to secondary PTSS in their spouses as well. The implications of secondary PTSS in the sexuality of couples remain unknown. This study aimed to investigate whether specific symptom clusters of PTSS (i.e., intrusions, hyperarousal, and avoidance) are implicated in the sexual satisfaction of couples. We assessed a sample of primarily exposed Israeli veterans from the Yom Kippur War and their wives who had been secondarily exposed (N = 191). The dyadic data were analyzed in an Actor-Partner Independence Model. When scrutinizing specific PTSS clusters, the husbands' avoidance related to their own sexual satisfaction. The wives' hyperarousal related to their own and their spouses' sexual satisfaction, whereas their intrusions were associated only with their husbands' sexual satisfaction. In conclusion, PTSS in one spouse is related to both spouses' sexual satisfaction; it is therefore recommended that clinicians adopt a dyadic approach when delivering interventions.
Collapse
Affiliation(s)
- Rahel Bachem
- I-Core Research Center for Mass Trauma, Tel Aviv University, Chaim Levanon 30, 6997801, Tel Aviv, Israel.
- Bob Shapell School of Social Work, Tel-Aviv University, Tel Aviv, Israel.
| | - Yafit Levin
- I-Core Research Center for Mass Trauma, Tel Aviv University, Chaim Levanon 30, 6997801, Tel Aviv, Israel
- Bob Shapell School of Social Work, Tel-Aviv University, Tel Aviv, Israel
| | - Zahava Solomon
- I-Core Research Center for Mass Trauma, Tel Aviv University, Chaim Levanon 30, 6997801, Tel Aviv, Israel
- Bob Shapell School of Social Work, Tel-Aviv University, Tel Aviv, Israel
| |
Collapse
|
17
|
Richardson JD, Ketcheson F, King L, Forchuk CA, Hunt R, St Cyr K, Nazarov A, Shnaider P, McIntyre-Smith A, Elhai JD. Sexual Dysfunction in Male Canadian Armed Forces Members and Veterans Seeking Mental Health Treatment. Mil Med 2020; 185:68-74. [PMID: 31268528 DOI: 10.1093/milmed/usz163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/07/2019] [Accepted: 06/13/2019] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION There is mixed evidence regarding how posttraumatic stress disorder (PTSD) symptom clusters are associated with sexual dysfunction (SD), and most studies to date have failed to account for potentially confounding variables. Our study sought to explore the unique contribution of PTSD symptom clusters on (a) lack of sexual desire or pleasure, and (b) pain or problems during sexual intercourse, after adjusting for comorbidities and medication usage. MATERIALS AND METHODS Participants included 543 male treatment-seeking veterans and Canadian Armed Forces (CAF) personnel (aged <65 years), referred for treatment between September 2006 and September 2014. Each participant completed self-report measures of demographic variables, depressive symptom severity, chronic pain, alcohol misuse, and psychotropic medication usage as part of a standard clinical intake protocol. Hierarchical ordinal logistic regression analyses were used to determine the incremental contribution of PTSD symptom clusters on sexual dysfunction. RESULTS Nearly three-quarters (71.5%) of participants reported a lack of sexual desire or pleasure and 40.0% reported pain or problems during intercourse. Regression analyses suggested that avoidant/numbing symptoms were the only symptoms to be independently associated with lacking sexual desire or pleasure (AOR = 1.10; 95% CI 1.05-1.15). None of the PTSD symptom clusters were independently associated with pain or problems during intercourse. CONCLUSIONS Sexual dysfunction is prevalent among male treatment-seeking CAF personnel and veterans. Results suggest that PTSD symptoms are differentially associated with sexual desire or pleasure concerns. Assessing sexual function among CAF personnel and veterans seeking treatment for PTSD is critical in order to treat both conditions and improve overall functioning.
Collapse
Affiliation(s)
- J Don Richardson
- Operational Stress Injury Clinic, Parkwood Institute, 550 Wellington Rd, London, ON, N6C 5J1 Canada.,MacDonald/Franklin OSI Research Centre, Parkwood Institute, 550 Wellington Rd, London, ON, N6C 5J1, Canada.,Department of Psychiatry, Western University, 1151 Richmond St, London, ON, N6A 3K7, Canada.,Department of Psychiatry, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8 Canada
| | - Felicia Ketcheson
- Operational Stress Injury Clinic, Parkwood Institute, 550 Wellington Rd, London, ON, N6C 5J1 Canada
| | - Lisa King
- Operational Stress Injury Clinic, Parkwood Institute, 550 Wellington Rd, London, ON, N6C 5J1 Canada
| | - Callista A Forchuk
- MacDonald/Franklin OSI Research Centre, Parkwood Institute, 550 Wellington Rd, London, ON, N6C 5J1, Canada
| | - Renée Hunt
- MacDonald/Franklin OSI Research Centre, Parkwood Institute, 550 Wellington Rd, London, ON, N6C 5J1, Canada.,Department of Psychiatry, Western University, 1151 Richmond St, London, ON, N6A 3K7, Canada
| | - Kate St Cyr
- Operational Stress Injury Clinic, Parkwood Institute, 550 Wellington Rd, London, ON, N6C 5J1 Canada.,MacDonald/Franklin OSI Research Centre, Parkwood Institute, 550 Wellington Rd, London, ON, N6C 5J1, Canada.,Dalla Lana School of Public Health, University of Toronto, 155 College St. Rm 500, Toronto, ON, M5T 3M7, Canada
| | - Anthony Nazarov
- MacDonald/Franklin OSI Research Centre, Parkwood Institute, 550 Wellington Rd, London, ON, N6C 5J1, Canada.,Department of Psychiatry, Western University, 1151 Richmond St, London, ON, N6A 3K7, Canada.,Department of Psychiatry, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8 Canada
| | - Philippe Shnaider
- St. Joseph's Healthcare Hamilton, 50 Charlton Ave E, Hamilton, ON, L8N 4A6, Canada
| | | | - Jon D Elhai
- Department of Psychology, and Department of Psychiatry, University of Toledo, 2801 Bancroft St, Toledo, OH, 43606
| |
Collapse
|
18
|
Badour CL, Cox KS, Goodnight JR, Flores J, Tuerk PW, Rauch SA. Sexual Desire among Veterans Receiving Prolonged Exposure Therapy for PTSD: Does Successful PTSD Treatment Also Yield Improvements in Sexual Desire? Psychiatry 2020; 83:70-83. [PMID: 31577915 PMCID: PMC7083685 DOI: 10.1080/00332747.2019.1672439] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: People with posttraumatic stress disorder (PTSD) commonly report difficulties with sexual desire and other aspects of sexual functioning, but it is currently unknown if people who respond to psychotherapy for PTSD also report improvements in sexual desire. Method: One hundred and eighty-seven veterans with PTSD received prolonged exposure (PE) therapy at two outpatient PTSD specialty clinics and completed measures of PTSD symptoms (the PTSD Checklist - Military Version) and sexual desire (item 21 of the Beck Depression Inventory - Second Edition) repeatedly throughout the course of treatment. Results: The results of a conditional generalized mixed ordinal regression model showed a significant interaction between weeks in treatment and PTSD treatment response in predicting change in sexual desire across the course of treatment. Specifically, PTSD treatment responders reported improvement in sexual desire over the course of treatment, whereas nonresponders did not show changes in sexual desire over time. However, the effect of PTSD treatment response was no longer significant when accounting for severity of depression at the start of treatment. Participants reporting more severe depression at the start of treatment reported less improvement in sexual desire, regardless of PTSD symptom response. Conclusions: People with PTSD who respond to PE also report improvements in sexual desire over time, indicating that response to PE is associated with improved sexual desire, but the effect is complicated by the presence of co-occurring depression symptomatology.
Collapse
Affiliation(s)
| | - Keith S. Cox
- University of North Carolina, Asheville, Department of Psychology
| | | | | | | | - Sheila A.M. Rauch
- Emory University, Department of Psychiatry and Behavioral Sciences,VA Atlanta Healthcare System, Mental Health Service Line
| |
Collapse
|
19
|
Sexual Assault in the Military and Increased Odds of Sexual Pain Among Female Veterans. Obstet Gynecol 2019; 134:63-71. [DOI: 10.1097/aog.0000000000003273] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
20
|
Gawron LM, Mohanty AF, Kaiser JE, Gundlapalli AV. Impact of Deployment on Reproductive Health in U.S. Active-Duty Servicewomen and Veterans. Semin Reprod Med 2019; 36:361-370. [PMID: 31003251 DOI: 10.1055/s-0039-1678749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Reproductive-age women are a fast-growing component of active-duty military personnel who experience deployment and combat more frequently than previous service-era women Veterans. With the expansion of the number of women and their roles, the United States Departments of Defense and Veterans Affairs have prioritized development and integration of reproductive services into their health systems. Thus, understanding associations between deployments or combat exposures and short- or long-term adverse reproductive health outcomes is imperative for policy and programmatic development. Servicewomen and women Veterans may access reproductive services across civilian and military or Veteran systems and providers, increasing the need for awareness and communication regarding deployment experiences with a broad array of providers. An example is the high prevalence of military sexual trauma reported by women Veterans and the associated mental health diagnoses that may lead to a lifetime of high risk-coping behaviors that increase reproductive health risks, such as sexually transmitted infections, unintended pregnancies, and others. Care coordination models that integrate reproductive healthcare needs, especially during vulnerable times such as at the time of military separation and in the immediate postdeployment phase, may identify risk factors for early intervention with the potential to mitigate lifelong risks.
Collapse
Affiliation(s)
- Lori M Gawron
- Informatics, Decision Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, Utah.,Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, Utah
| | - April F Mohanty
- Informatics, Decision Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, Utah.,Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Jennifer E Kaiser
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, Utah
| | - Adi V Gundlapalli
- Informatics, Decision Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, Utah.,Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah.,Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, Utah
| |
Collapse
|
21
|
Examining Changes in Sexual Functioning after Cognitive Processing Therapy in a Sample of Women Trauma Survivors. Womens Health Issues 2019; 29:72-79. [DOI: 10.1016/j.whi.2018.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 09/21/2018] [Accepted: 10/08/2018] [Indexed: 01/23/2023]
|
22
|
Bhalla A, Allen E, Renshaw K, Kenny J, Litz B. Emotional numbing symptoms partially mediate the association between exposure to potentially morally injurious experiences and sexual anxiety for male service members. J Trauma Dissociation 2018; 19:417-430. [PMID: 29601288 DOI: 10.1080/15299732.2018.1451976] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Service members (SMs) returning from deployment are at risk of a range of sexual problems, some of which are thought to be related to psychological issues that may arise during deployment or combat. The current study sought to examine whether exposure to potentially morally injurious events (PMIEs) was associated with sexual anxiety (SA) above and beyond combat exposure and whether any such association was mediated by post-traumatic stress disorder (PTSD) symptom clusters. These questions were tested using data from self-report surveys collected from 221 partnered male Army (Active Duty, National Guard, or Reserve) SMs at three separate time points. Findings showed that exposure to PMIEs was significantly related to greater SA, with transgressions by self and perceived betrayal demonstrating unique associations when controlling for all factors of PMIEs. Moreover, total exposure to PMIEs was associated with SA above and beyond general combat exposure. PTSD symptoms partially mediated the association between exposure to PMIEs and SA, with emotional numbing accounting for significant unique indirect effects after controlling for other PTSD symptom clusters. The findings suggest that exposure to PMIEs is associated with SA, even when accounting for either combat exposure or PTSD symptoms, emphasizing the importance of this issue in understanding post-deployment problems in sexual intimacy.
Collapse
Affiliation(s)
- Arjun Bhalla
- a Department of Psychology , University of Colorado Denver , Denver , CO , USA
| | - Elizabeth Allen
- a Department of Psychology , University of Colorado Denver , Denver , CO , USA
| | - Keith Renshaw
- b Department of Psychology , George Mason University , Fairfax , VA , USA
| | - Jessica Kenny
- a Department of Psychology , University of Colorado Denver , Denver , CO , USA
| | - Brett Litz
- c Massachusetts Veterans Epidemiological Research and Information Center , Boston VA Healthcare System , Boston , MA , USA
| |
Collapse
|
23
|
Blais RK, Monteith LL, Kugler J. Sexual dysfunction is associated with suicidal ideation in female service members and veterans. J Affect Disord 2018; 226:52-57. [PMID: 28961442 DOI: 10.1016/j.jad.2017.08.079] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 08/15/2017] [Accepted: 08/27/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Suicide is a leading cause of premature death among military service members/veterans (SM/Vs). The Interpersonal Theory of Suicide (Joiner, 2007) proposes that higher thwarted belonging, perceived burdensomeness, and acquired capability confer increased risk for suicide. However, no studies have examined the association of sexual dysfunction, a possible component of thwarted belonging and perceived burdensomeness, with suicidal ideation. The present study explored whether sexual dysfunction was associated with suicidal ideation when accounting for mental health, demographic, and military characteristics among female SM/Vs. METHOD Female SM/Vs (n = 710) completed an anonymous online survey assessing demographics, mental health, military characteristics, sexual dysfunction, and suicidal ideation. RESULTS One hundred fifty-nine participants (22.39%) reported suicidal ideation during the preceding two weeks. A multivariable ordinal regression adjusted for age, marital status, probable posttraumatic stress disorder (PTSD), probable depression, race/ethnicity, Army service, and deployment history. Lower sexual functioning (adjusted odds ratio [AOR] = 0.98, 95% confidence interval[CI] = 0.95-0.99), probable PTSD (AOR = 2.54, 95% CI = 1.61-4.01), and probable depression (AOR = 5.28, 95% CI = 3.34-8.34) were associated with suicidal ideation. Post-hoc analyses examined the association of suicidal ideation with specific components of sexual functioning: difficulties with sexual arousal (AOR = 0.87, 95% CI = 0.79-0.97) and sexual satisfaction (AOR = 0.85, 95% CI = 0.75-0.96) were associated with suicidal ideation. LIMITATIONS Data were cross-sectional and limited to self-report. DISCUSSION Sexual dysfunction is associated with suicidal ideation, accounting for established mental health, military, and demographic characteristics among female SM/Vs. Efforts to prevent suicidal ideation in female SM/Vs may be enhanced by screening for and treating sexual dysfunction, particularly sexual arousal and satisfaction.
Collapse
Affiliation(s)
- Rebecca K Blais
- Department of Psychology, Utah State University, United States.
| | - Lindsey L Monteith
- Denver Veterans Affairs Medical Center, Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC), United States; Department of Psychiatry, University of Colorado Anschutz Medical Campus, United States
| | - Jordan Kugler
- Department of Psychology, Utah State University, United States
| |
Collapse
|
24
|
Bornefeld-Ettmann P, Steil R, Höfling V, Weßlau C, Lieberz KA, Rausch S, Priebe K, Fydrich T, Müller-Engelmann M. Validation of the German Version of the Sexual Self-Esteem Inventory for Women and its Application in a Sample of Sexually and Physically Abused Women. SEX ROLES 2017. [DOI: 10.1007/s11199-017-0849-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
|
25
|
Petri-Kelvasa M, Schulte-Herbrüggen O. Disinhibited Exposing Behavior, Hypersexuality, and Erectile Dysfunction as a Consequence of Posttraumatic Stress in a 42-Year-Old Male Patient. ARCHIVES OF SEXUAL BEHAVIOR 2017; 46:2197-2205. [PMID: 28484862 DOI: 10.1007/s10508-017-0985-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 03/25/2017] [Accepted: 03/26/2017] [Indexed: 06/07/2023]
Abstract
Research into sexual dysfunction and its explanations within a cognitive behavioral framework in patients with posttraumatic stress is sparse. In this report, we present the case of a 42-year-old male with severe posttraumatic stress symptoms who displayed apparent exhibitionistic behavior, hypersexual behavior in the form of excessive masturbation, and erectile dysfunction. Differential diagnostics showed that the presented exhibitionistic behavior could be more accurately classified as non-paraphilic disinhibited exposing behavior. Functional behavioral analysis of his sexual behavior suggested that disinhibited exposing and hypersexual behavior served as dysfunctional coping strategies for trauma-associated negative emotions. Erectile dysfunction seemed to be the result of trauma-associated hyperarousal and excessive masturbation. Within the context of operant learning processes, we propose that his sexual behaviors became highly automated and were used as the main strategies to regulate trauma-associated negative emotions. Implications for the diagnoses and suggestions for the conceptualization and incorporation into a cognitive behavioral therapy treatment of posttraumatic stress disorder are made.
Collapse
Affiliation(s)
- Mirja Petri-Kelvasa
- Department of Psychiatry and Psychotherapy, Charité-University Medicine, Charité Campus Mitte, Große Hamburger Straße 5-11, 10115, Berlin, Germany.
| | - Olaf Schulte-Herbrüggen
- Department of Psychiatry and Psychotherapy, Charité-University Medicine, Charité Campus Mitte, Große Hamburger Straße 5-11, 10115, Berlin, Germany
| |
Collapse
|
26
|
O'Driscoll C, Flanagan E. Sexual problems and post-traumatic stress disorder following sexual trauma: A meta-analytic review. Psychol Psychother 2016; 89:351-67. [PMID: 26449962 DOI: 10.1111/papt.12077] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 07/31/2015] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Difficulties with sex often develop following sexual trauma, yet are rarely targeted within treatment of post-traumatic stress disorder (PTSD). Where outcomes of sexual function are included, they are secondary to other measures. This review aimed to assess whether psychological treatment for PTSD (from sexual trauma) has an effect on sexual functioning. METHODS Systematic searches of MEDLINE, PsycINFO, EMBASE, and trial registers were performed. Five studies met inclusion criteria. Pre-post treatment effect sizes were also calculated. RESULTS Data from four good-quality RCTs were included in the meta-analyses. These examined females (n = 799) who had experienced adult sexual trauma or child sexual abuse. Studies compared psychological treatment to control conditions, but no effect on outcomes of sexual concerns, standardized mean difference (SMD) = 0.03 and dysfunctional sexual behaviour, SMD = 0.02, was found. Pre-post treatment effect sizes were small to medium (SMD = 0.36 and 0.47, respectively). CONCLUSIONS While firm conclusions cannot be drawn, the available evidence suggests that psychological treatment for PTSD has no effect on sexual problems. Pre-post effects indicate some improvement over the course of treatment, which may be strengthened if treatment actively targeted sexual problems. The paucity of evidence in this area suggests that there is substantial need for further research in order to establish a set of evidence-based guidelines for practitioners implementing treatment in this area. PRACTITIONER POINTS The measurement of sexual problems is overlooked in psychological treatment RCTs for sexual trauma. Current treatments for post-traumatic stress disorder (PTSD) from sexual trauma do not appear to be addressing sexual problems. Integrated treatments for comorbid sexual problems and PTSD treatment may be warranted. It is imperative that in future, RCTs that examine people with PTSD from sexual trauma use outcomes of sexual problems.
Collapse
Affiliation(s)
- Ciarán O'Driscoll
- Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Esther Flanagan
- Research Department of Clinical, Educational and Health Psychology, University College London, UK
| |
Collapse
|