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Drian A, Goldstein SW, Kim NN, Goldstein AS, Hartzell-Cushanick R, Yee A, Goldstein I. Immunohistochemical staining with CD117 and PGP9.5 of excised vestibular tissue from patients with neuroproliferative vestibulodynia. J Sex Med 2024; 21:479-493. [PMID: 38521973 DOI: 10.1093/jsxmed/qdae030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 01/16/2024] [Accepted: 02/14/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Neuroproliferative vestibulodynia (NPV), a provoked genital pain characterized by severe allodynia and hyperalgesia, is confirmed in excised vestibular tissue by immunohistochemical staining (>8 CD117-positive immunostained cells/100× microscopic field) rather than by hematoxylin and eosin staining. AIM In this study we sought to assess immunostaining of tissue samples obtained during vestibulectomy surgery and to correlate results with patient outcomes. METHODS Patients (n = 65) meeting criteria for NPV who underwent vestibulectomy during the period from June 2019 through December 2022 formed the study cohort. We performed assessment of pathology of vestibular tissues by use of immunohistochemical staining, including quantitation of mast cells by CD117 (mast cell marker) and nerve fibers by protein gene product (PGP) 9.5 (neuronal marker). We analyzed 725 photomicrographs of immunostained tissue sections (100× and 200×) by manual counting and computer-assisted histometry and correlated these data to clinical assessments. OUTCOMES Outcomes included density of CD117 and PGP9.5 immunostaining in the 1:00-11:00 o'clock and 12:00 o'clock vestibular regions, and patient-reported outcomes assessing sexual function, pain, distress, and symptom improvement. RESULTS All 65 NPV patients (median age 26 years), 45 with lifelong and 20 with acquired NPV, had severe pain documented by PROs and vulvoscopy and had >8 CD117-immunopositive cells/100× microscopic field. Median cell count values were similar in the 1:00-11:00 o'clock and 12:00 vestibular regions (28.5 and 29.5/100× field, respectively). Likewise, the marker) and nerve fibers by protein gene product (PGP) 9.5 (neuronal marker). We analyzed 725 photomicrographs of immunostained tissue sections (100× and 200×) by manual counting and computer-assisted histometry and correlated these data to clinical assessments. OUTCOMES Outcomes included density of CD117 and PGP9.5 immunostaining in the 1:00-11:00 o'clock and 12:00 o'clock vestibular regions, and patient-reported outcomes assessing sexual function, pain, distress, and symptom improvement. RESULTS All 65 NPV patients (median age 26 years), 45 with lifelong and 20 with acquired NPV, had severe pain documented by PROs and vulvoscopy and had >8 CD117-immunopositive cells/100× microscopic field. Median cell count values were similar in the 1:00-11:00 o'clock and 12:00 vestibular regions (28.5 and 29.5/100× field, respectively). Likewise, the median area of CD117 immunostaining was similar in both regions (0.69% and 0.73%). The median area of PGP9.5 immunostaining was 0.47% and 0.31% in these same regions. Pain scores determined with cotton-tipped swab testing were nominally higher in lifelong vs acquired NPV patients, reaching statistical significance in the 1:00-11:00 o'clock region (P < .001). The median score for the McGill Pain Questionnaire affective subscale dimension was also significantly higher in lifelong vs acquired NPV patients (P = .011). No correlations were observed between hematoxylin and eosin results and density of mast cells or neuronal markers. Of note, 63% of the patient cohort reported having additional conditions associated with aberrant mast cell activity. CLINICAL IMPLICATIONS The pathology of NPV is primarily localized to the vestibular epithelial basement membrane and subepithelial stroma with no visible vulvoscopic findings, making clinical diagnosis challenging. STRENGTHS AND LIMITATIONS Strengths of this study include the large number of tissues examined with what is to our knowledge the first-ever assessment of the 12:00 vestibule. Major limitations are specimens from a single timepoint within the disease state and lack of control tissues. CONCLUSIONS Performing immunohistochemical staining of excised vestibular tissue with CD117 and PGP9.5 led to histometric confirmation of NPV, indications that NPV is a field disease involving all vestibular regions, validation for patients whose pain had been ignored and who had experienced negative psychosocial impact, and appreciation that such staining can advance knowledge.
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Affiliation(s)
- Alexandra Drian
- San Diego Sexual Medicine, San Diego, CA 92120, United States
| | - Sue W Goldstein
- San Diego Sexual Medicine, San Diego, CA 92120, United States
| | - Noel N Kim
- Institute for Sexual Medicine, San Diego, CA 92120, United States
| | - Andrew S Goldstein
- Department of Molecular, Cell and Developmental Biology, University of California, Los Angeles, Los Angeles, CA 90095, United States
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, United States
| | | | - Alyssa Yee
- San Diego Sexual Medicine, San Diego, CA 92120, United States
| | - Irwin Goldstein
- San Diego Sexual Medicine, San Diego, CA 92120, United States
- Sexual Medicine, University of California San Diego East Campus, San Diego, CA 92120, United States
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Touraille P, Ågmo A. Sex Differences in Sexual Motivation in Humans and Other Mammals: The Role of Conscious and Unconscious Processes. Behav Sci (Basel) 2024; 14:277. [PMID: 38667073 PMCID: PMC11047354 DOI: 10.3390/bs14040277] [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: 02/13/2024] [Revised: 03/20/2024] [Accepted: 03/24/2024] [Indexed: 04/29/2024] Open
Abstract
In self-report questionnaires, men report higher scores than women on variables such as desire for sex, frequency of sexual thoughts, number of sex partners, etc. Based on this, men are considered to have a higher level of sexual motivation than women. However, retrospective self-reports may be unsuitable for estimations of the inherent level of sexual motivation. We review data on automatic (unconsciously controlled) responses and measures of implicit motivation during exposure to sexual stimuli. These responses and measures are inaccessible to willful manipulations and make it possible to determine whether the sex difference in answers to questionnaires is replicated when volitional response manipulations are unlikely. We complement the human data with observations from some rodent and non-human primate species. The attentional resources allotted to stimuli with sexual relevance as well as genital responses to such stimuli are similar in men and women. Measures of implicit motivation also fail to detect any sex difference. Finally, the frequency of masturbation is superior in female infants before the age at which social expectations begin to determine behavior. Neither in rodents nor in non-human primates is there any clear-cut evidence for sex differences in motivation. It seems that males and females are similar with regard to the intensity of sexual motivation. The responses to questionnaires may be affected by social learning of sexual scripts and/or the inferior quality of sexual experiences in women, among other things.
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Affiliation(s)
- Priscille Touraille
- Centre National de la Recherche Scientifique (UMR 7206), Muséum National d’Histoire Naturelle, 75116 Paris, France;
| | - Anders Ågmo
- Department of Psychology, University of Tromsø, 9037 Tromsø, Norway
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3
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Abdulai AF, Naghdali H, Noga H, Yong PJ. Patient-Centered Approaches for Designing Destigmatizing Sexual Pain-Related Web-Based Platforms: Qualitative Study. JMIR Form Res 2024; 8:e53742. [PMID: 38488844 PMCID: PMC10980992 DOI: 10.2196/53742] [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: 10/17/2023] [Revised: 02/06/2024] [Accepted: 02/07/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Sexual pain is a common but neglected disorder that affects approximately 3% to 18% of women and an unmeasured number of gender-diverse people worldwide. Despite its wide prevalence, many people feel reluctant to visit conventional health care services or disclose their symptoms due to the fear of stigmatization. To alleviate this stigma, various web-based interventions have been developed to complement and, in some cases, replace conventional sexual health interventions. However, the way these web-based interventions are developed could inadvertently reproduce, perpetuate, or exacerbate stigma among end user patients. OBJECTIVE The purpose of this study was to understand patients' perspectives on how sexual pain-related web platforms can be designed to alleviate stigma or prevent the unintended effects of stigma among patients who use web-based interventions. METHODS Individual semistructured interviews were conducted among 16 participants with lived experiences of painful sex in a large urban city in Western Canada. Participants were recruited via social media platforms, newsletters, and a provincial health volunteer website. Using a sample sexual pain website to provide context, participants were interviewed about their experiences of stigma and how they think web platforms could be designed to address stigma. The interviews were conducted via Zoom (Zoom Technologies Inc) and analyzed using thematic analysis. RESULTS The findings revealed 4 overarching themes that represented participants' perspectives on designing web platforms that may alleviate or prevent the unintended effects of stigma. These findings suggested the design of inclusive web platforms, having a nonprovocative and calming user interface, having features that facilitate connections among users and between users and providers, and displaying personal testimonials and experiences of sexual pain. CONCLUSIONS This study highlighted patient-centered design approaches that could serve as a reference guide in developing web platforms that alleviate or prevent the unintended effects of stigma, particularly among nonheterosexual and gender-diverse people. While this study was conducted in the context of sexual pain, the results might also apply to web platforms on other potentially stigmatizing health-related disorders or conditions.
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Affiliation(s)
| | - Hasti Naghdali
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Heather Noga
- Women's Health Research Institute, Vancouver, BC, Canada
| | - Paul J Yong
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
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4
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Connor JJ, Abdi C, Chen M, Salad M, Pergament S, Afey F, Hussein I, Robinson BBE. Our Body Our Health (Jirkeena, Caafimaadkeena): Somali Women's Narratives on Sexual Health. JOURNAL OF SEX RESEARCH 2023:1-15. [PMID: 38047877 PMCID: PMC11147957 DOI: 10.1080/00224499.2023.2288077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Women across the globe have been subject to female genital cutting (FGC), with the highest rates in Somalia. FGC can result in sexual concerns, especially sexual pain and lower pleasure. Due to ongoing civil war and climate disasters, there is a large number of Somali immigrants and refugees living in countries where healthcare providers may be unfamiliar with the impact of FGC. In this qualitative study, sixty Somali women between the ages 20 and 45 and living in the U.S. shared their perspectives on how FGC has affected their sexual lives, including how they have coped with any complications attributed to FGC. Participants were recruited through convenience sampling and interviewed by a bilingual community researcher in either Somali or English. Data were analyzed through a participatory analysis process by academic and community researchers. Themes included sexual desire, arousal, and pleasure; sexual satisfaction; sexual pain at first intercourse; coping with sexual pain at first intercourse; long-term sexual pain, coping with long-term sexual pain. Results are discussed with a focus on agency of the participants, role of partners, and implications for healthcare professionals.
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Affiliation(s)
- Jennifer Jo Connor
- Eli Coleman Institute for Sexual and Gender Health; Department of Family Medicine and Community Health, University of Minnesota Medical School
| | - Cawo Abdi
- Department of Sociology, University of Minnesota
| | - Muzi Chen
- Eli Coleman Institute for Sexual and Gender Health; Department of Family Medicine and Community Health, University of Minnesota Medical School
| | - Munira Salad
- Eli Coleman Institute for Sexual and Gender Health; Department of Family Medicine and Community Health, University of Minnesota Medical School
| | - Shannon Pergament
- SoLaHmo, Community-University Health Care Center (CUHCC), University of Minnesota
| | - Foos Afey
- SoLaHmo, Community-University Health Care Center (CUHCC), University of Minnesota
| | - Intisar Hussein
- SoLaHmo, Community-University Health Care Center (CUHCC), University of Minnesota
| | - Beatrice Bean E Robinson
- Eli Coleman Institute for Sexual and Gender Health; Department of Family Medicine and Community Health, University of Minnesota Medical School
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Mooney KM, Mulroy M, Poirier É, Pukall CF. Interpersonal Experiences with Persistent Genital Arousal: Connections between Symptom Disclosure, Partner Responses, and Catastrophizing on Relationship Adjustment and Symptom Severity. JOURNAL OF SEX & MARITAL THERAPY 2023; 50:182-196. [PMID: 37878759 DOI: 10.1080/0092623x.2023.2269931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
Increased research attention to interpersonal factors in genitopelvic pain conditions, such as vulvodynia, have led to more comprehensive understanding of couple dynamics in pain, sexual, and relationship outcomes. There has been very little examination of interpersonal factors in Persistent Genital Arousal Disorder/Genitopelvic Dysesthesia (PGAD/GPD), a distressing condition involving persistent sensations of arousal and often pain. The aims of the present study were to examine whether individuals disclose their symptoms to intimate partners and whether interpersonal variables (e.g., partner responses, symptom disclosure, and catastrophizing) are related to relationship adjustment and symptom severity. Seventy-six individuals with symptoms of PGAD/GPD participated in a one-time anonymous online survey. Over three-quarters (85.5%) of the sample disclosed their symptoms to their partners in some way. Greater supportive partner responses and lower symptom catastrophizing were related to better relationship adjustment among participants with PGAD/GPD symptoms. Greater symptom catastrophizing also predicted greater PGAD/GPD symptom severity. Partner responses were not related to PGAD/GPD symptom severity. Although interpersonal factors have been linked to symptom severity in chronic pain and genitopelvic pain conditions, the results of the current study suggest that interpersonal factors may play a slightly different role in PGAD/GPD symptom experiences and in the conceptualization of PGAD/GPD more broadly.
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Affiliation(s)
- Kayla M Mooney
- Department of Psychology, Queen's University, Kingston, Canada
| | - Maeve Mulroy
- Department of Psychology, Queen's University, Kingston, Canada
| | - Évéline Poirier
- Department of Psychology, Queen's University, Kingston, Canada
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Nercessian TR, Banbury S, Chandler C. A Systematic Review Looking at Anodyspareunia Among Cisgender Men and Women. JOURNAL OF SEX & MARITAL THERAPY 2023; 49:829-841. [PMID: 37089031 DOI: 10.1080/0092623x.2023.2196265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
This systematic review aims to provide an up-to-date evaluation of the available literature on anodyspareunia and treatment interventions. It aims to identify research gaps and to evaluate treatment methods in psychosexual healthcare services. Electronic searches including PubMed, PsycINFO, Web of Science, and registered clinical trials yielded 8 studies. Research centered on men who have sex with men (MSM) and cisgender women with a 3:1 ratio. In terms of causes of anodyspareunia, correlates among both MSM and cisgender women included generalized anxiety, performance anxiety, compromised well-being, lack of stimulation, lack of lubrication, and lack of sexual arousal. While research has focused on anodyspareunia among cisgender gay men, limited research has targeted other genders or sexualities including heterosexual men and lesbian and bisexual women. No research was found on intersex, transgender, and gender nonconforming people. Similarly, there were no articles that discussed or evaluated treatment strategies. The findings of this review demonstrate the paucity of research on both the condition of anodyspareunia and its treatment across genders and sexually diverse groups. Both quantitative and qualitative research would not only develop our understanding of anodyspareunia but also contribute to public health through the development of suitable treatment interventions.
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Affiliation(s)
| | - Samantha Banbury
- Department of Psychology, School of Social Sciences and Professions, London Metropolitan University, London, UK
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7
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Yessick LR, Gauvin S, Salomons TV, Pukall CF. Pain Characteristics, Sexual Script Flexibility, and Penetration Control Cognitions in Those Experiencing Anodyspareunia. PSYCHOLOGY & SEXUALITY 2022. [DOI: 10.1080/19419899.2022.2118069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Affiliation(s)
| | - Stéphanie Gauvin
- Department of Psychology, Queen’s University, Kingston, Ontario, Canada
| | - Tim V. Salomons
- Department of Psychology, Queen’s University, Kingston, Ontario, Canada
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8
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Horne RM, Raposo S, Muise A, Harasymchuk C, Impett EA. Dialing up desire and dampening disinterest: regulating sexual desire in the bedroom and sexual and relationship well-being. JOURNAL OF SOCIAL AND PERSONAL RELATIONSHIPS 2022; 39:1551-1573. [PMID: 35574184 PMCID: PMC9092913 DOI: 10.1177/02654075211054781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Romantic partners often regulate their emotions and affection to achieve certain goals, but research has yet to explore how partners regulate their expression of sexual desire during sex and its implications for couples' well-being. In two multi-part dyadic diary studies of primarily mixed-gender couples in longer-term relationships residing in North America, we examined three questions. First, is amplifying desire and suppressing disinterest during sex associated with both partners' daily sexual and relationship satisfaction? Second, do these associations differ by level of sexual desire and gender? Third, tested in our second sample, can these associations be explained by feelings of sexual inauthenticity? Across both samples (Ntotal = 225 couples, 450 participants), amplifying desire was associated with lower sexual satisfaction, while suppressing disinterest was not associated with daily satisfaction. Importantly, sexual desire played a role in the links between desire regulation during sex and satisfaction: on days when people were low in sexual desire, amplification was associated with both partners' lower sexual satisfaction, while suppression was associated with a partner's higher relationship satisfaction. In addition, amplification (on low desire days) and suppression (regardless of desire level) were associated with lower sexual authenticity which, in turn, was linked to lower relationship satisfaction. The findings suggest that desire regulation during sex plays an important role in couples' daily sexual satisfaction and relationship satisfaction-in part because it feels sexually inauthentic-with the implications of this regulation being particularly strong when people feel low sexual desire.
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Affiliation(s)
| | | | - Amy Muise
- York University, Toronto, ON, Canada
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9
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Herbenick D, Rosenberg M, Golzarri-Arroyo L, Fortenberry JD, Fu TC. Changes in Penile-Vaginal Intercourse Frequency and Sexual Repertoire from 2009 to 2018: Findings from the National Survey of Sexual Health and Behavior. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:1419-1433. [PMID: 34799832 PMCID: PMC8604196 DOI: 10.1007/s10508-021-02125-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 07/30/2021] [Accepted: 08/02/2021] [Indexed: 05/22/2023]
Abstract
Solo and partnered sexual behaviors are relevant to health, well-being, and relationships. Recent research shows that sexual frequency has declined in the U.S. and in other countries; however, measurement has been imprecise. We used data from 14- to 49-year-old participants in the 2009 and 2018 waves of the National Survey of Sexual Health and Behavior (NSSHB), a confidential U.S. nationally representative survey that is conducted online. We aimed to: (1) assess changes in frequency of past-year penile-vaginal intercourse and (2) examine combinations of past-year sexual behaviors for each of the two waves. We hypothesized that we would observe lower frequency of penile-vaginal intercourse (PVI) from 2009 to 2018 and that we would observe greater engagement in sexual repertoires involving non-coital partnered behaviors (e.g., partnered masturbation, oral sex) in 2018 as compared to 2009. Participants were 4155 individuals from the 2009 NSSHB (Adolescents: 406 females, 414 males; Adults: 1591 women, 1744 men) and 4547 individuals from the 2018 NSSHB (Adolescents: 416 females, 411 males; Adults: 2007 women, 1713 men). Compared to adult participants in the 2009 NSSHB, adults in the 2018 NSSHB were significantly more likely to report no PVI in the prior year (28% in 2018 vs. 24% in 2009). A similar difference in proportions reporting no PVI in the prior year was observed among 14-17-year-old adolescents (89% in 2018 vs. 79% in 2009). Additionally, for both adolescents and adults, we observed decreases in all modes of partnered sex queried and, for adolescents, decreases in solo masturbation.
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Affiliation(s)
- Debby Herbenick
- The Center for Sexual Health Promotion, Indiana University School of Public Health, Room 116, Indiana University, Bloomington, IN, 47405, USA.
| | - Molly Rosenberg
- The Center for Sexual Health Promotion, Indiana University School of Public Health, Room 116, Indiana University, Bloomington, IN, 47405, USA
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health Indiana University, Bloomington, IN, USA
| | - Lilian Golzarri-Arroyo
- Biostatistics Consulting Center, Indiana University School of Public Health Indiana University, Bloomington, IN, USA
| | - J Dennis Fortenberry
- The Center for Sexual Health Promotion, Indiana University School of Public Health, Room 116, Indiana University, Bloomington, IN, 47405, USA
- Division of Adolescent Medicine, Indiana University School of Medicine, Indiana University, Indianapolis, IN, USA
| | - Tsung-Chieh Fu
- The Center for Sexual Health Promotion, Indiana University School of Public Health, Room 116, Indiana University, Bloomington, IN, 47405, USA
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Conley TD, Klein V. Women Get Worse Sex: A Confound in the Explanation of Gender Differences in Sexuality. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2022; 17:960-978. [PMID: 35171743 DOI: 10.1177/17456916211041598] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Gender differences in sexuality have gained considerable attention both within and outside of the scientific community. We argue that one of the main unacknowledged reasons for these differences is simply that women experience substantially worse sex than men do. Thus, in examinations of the etiology of gender differences in sexuality, a confound has largely been unacknowledged: Women and men are treated to different experiences of what is called "sexuality" and "having sex." We discuss four arenas in which women's experience of sexuality may often be worse than men's: (a) anatomical differences, (b) sexual violence, (c) stigma, and (d) masculine cultures of sexuality. Then we consider how each disparity might explain well-known gender differences in sexuality.
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Affiliation(s)
| | - Verena Klein
- Department of Psychology, University of Michigan
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11
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Faustino MJ, Gavey N. "You Feel Like Normal Sex is not Enough Anymore": Women's Experiences of Coercive and Unwanted Anal Sex with Men. Violence Against Women 2021; 28:2624-2648. [PMID: 34913380 DOI: 10.1177/10778012211045716] [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] [Indexed: 11/16/2022]
Abstract
In this article, we explore the gendered dynamics of coercion described by 18 women we interviewed about their experiences of unwanted and nonconsensual heterosexual anal sex. Several women referred to what they believed to be the normative status of heterosexual anal sex. In many cases, the socially coercive effects of perceived norms intertwined with threads of interpersonal coercion, leaving women feeling pressured to agree to, or little room to refuse, anal sex they did not want. We discuss the ways that new sexual norms can translate into new pressures for women within the gendered framework of heterosexual relationships.
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Affiliation(s)
- Maria João Faustino
- Te Kura Mātai Hinengaro, School of Psychology, Te Whare Wānanga o Tāmaki Makaurau, 1415The University of Auckland, Auckland, New Zealand
| | - Nicola Gavey
- Te Kura Mātai Hinengaro, School of Psychology, Te Whare Wānanga o Tāmaki Makaurau, 1415The University of Auckland, Auckland, New Zealand
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12
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Stewart J, Douglas G, O'Rourke T, Gammel C. Promoting safer sex in the context of heterosexual anal intercourse: A scoping review. J Clin Nurs 2021; 30:2111-2130. [PMID: 33377555 DOI: 10.1111/jocn.15628] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 11/28/2020] [Accepted: 12/10/2020] [Indexed: 01/08/2023]
Abstract
AIMS AND OBJECTIVES To locate and summarise existing literature regarding safer sex practices specific to heterosexual anal intercourse and identify promising health promotion strategies. BACKGROUND Much of the literature regarding anal intercourse and safer sex is related to men who have sex with men. However, some studies suggest there are more women than men engaging in unprotected receptive anal intercourse. The risks associated with this sexual practice have been well documented, although many healthcare providers fail to ask about anal intercourse while addressing safer sex in the heterosexual population. DESIGN The study was based on Arksey and O'Malley's 2005 five-step methodology. METHODS A search was conducted of MEDLINE; CINAHL; PsycInfo; Cochrane; and PubMed. Databases were searched from 1990-2020. The 72 studies selected were classified according to their main area of focus. A grey literature search was also included. This scientific submission has been assessed for accuracy and completeness using the PRISMA-ScR guideline criteria (File S1). RESULTS The literature in this area is heterogeneous in terms of method and topic. Prevalence and incidence (n = 26) in addition to sexually transmitted infection risks (n = 26) related to heterosexual anal intercourse are well understood. However, there is limited information on condom use (n = 6), factors that influence heterosexual anal intercourse (n = 10) and health promotion strategies for this population and practice (n = 4). Two websites that mentioned heterosexual anal intercourse risk reduction activities were included. CONCLUSIONS Although heterosexual anal intercourse appears to be an increasingly common sexual practice, very little is known about health promotion strategies nurses might use for encouraging safer sex in this population. RELEVANCE TO CLINICAL PRACTICE Increased awareness of the prevalence and risks of heterosexual anal intercourse could enhance nurses' harm reduction strategies. Screening for sexually transmitted infections may be based on incorrect assumptions about sexual practices or due to stigma linked with anal intercourse. Reducing unprotected heterosexual anal intercourse will reduce sexually transmitted infections and their long-term sequelae.
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Affiliation(s)
- Joanne Stewart
- College and Community Health Centre, Alberta Health Services, Grande Prairie, AB, Canada
| | - Gillian Douglas
- Beaverlodge Community Health Services, Alberta Health Services, Beaverlodge, AB, Canada
| | - Tammy O'Rourke
- Faculty of Health Disciplines, Athabasca University, Athabasca, AB, Canada
| | - Carolyn Gammel
- Grande Prairie College & Community Health Centre, Alberta Health Services, Grande Prairie, AB, Canada
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Exploring Relationships Between Genito-Pelvic Pain/Penetration Disorder, Sex Guilt, and Religiosity Among College Women in the U.S. J Sex Med 2021; 18:770-782. [PMID: 33757773 DOI: 10.1016/j.jsxm.2021.02.003] [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: 09/06/2020] [Revised: 01/25/2021] [Accepted: 02/03/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Despite a growing body of research on psychosocial factors in Genito-Pelvic Pain/Penetration Disorder (GPPPD) during sexual intercourse, there are few studies examining adolescent and young adult women's experiences with painful sex and the effects of religiosity, sexual education, and sex guilt. AIM The purpose of the study was to examine the occurrence of GPPPD among sexually active female college students, including psychosocial factors of religiosity and religious practice, sexual education, sex guilt, and sexual distress. METHODS Data were collected from 974 college women from a university in the Northeastern U.S. We limited our sample to sexually active women (n = 593, 60.9%; mean age: 18.96) who responded to the questionnaire item, "In general, do you feel pain with sexual intercourse?" Participants completed the Female Sexual Function Index (FSFI), Female Sexual Distress Scale (FSDS), Revised Mosher Sex Guilt Scale, Abbreviated Santa Clara Strength of Religious Faith Questionnaire, 10-item Gender Role Beliefs Scale, and measures on sexual wellness and practice and sexual education experiences. Data were analyzed using standard bivariate and regression analyses as well as path analysis. MAIN OUTCOME MEASURES Women were asked, "In general, do you feel pain with sexual intercourse?" and categorized into one of three pain groups: occasional (10%-25% of the time), frequent (50% or more), and no pain (less than 10%). RESULTS GPPPD with sex was prevalent among young college women, with 113 (19.1%) reporting frequent pain and 143 (24.1%) occasional pain (control n = 337, 56.8%). Numerous statistically significant factors were identified, including frequency of sex, ability to orgasm, sensations during intercourse, presence of a steady sexual partner, expectations of painful sex, sex guilt, and sexual distress. Sex guilt acted as full mediator between religiosity and painful sex. IMPLICATIONS Healthcare providers should proactively initiate conversations with young female patients about painful intercourse to identify issues and normalize language on pain with sex. Educators are urged to teach evidence-based information on pain-free and guilt-free sexual experiences inside and outside religious contexts. CONCLUSION Painful sex affects adolescent and young adult women at a similar rate as non-college adult women and while religiosity does not directly impact young women's GPPPD, religiosity does lead to painful sex if it causes sex guilt. Further research is needed into the mechanisms of religion-based sexual shaming and among religiously conservative women who practice abstinence until marriage. Azim KA, Happel-Parkins A, Moses A, et al. Exploring Relationships Between Genito-Pelvic Pain/Penetration Disorder, Sex Guilt, and Religiosity Among College Women in the U.S. J Sex Med 2021;18:770-782.
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McBride KR. Examining Heterosexual Women's Anal Sexual Health Knowledge and Product Use. JOURNAL OF SEX RESEARCH 2019; 56:1070-1082. [PMID: 29746181 DOI: 10.1080/00224499.2018.1467368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Prevalence rates indicate that receptive anal sex is increasingly part of heterosexual women's sexual repertoire. However, there is a body of literature linking this behavior to risk for adverse sexual health outcomes. Women's anal sexual health knowledge and awareness of behaviors associated with elevated risk have received less attention in the research literature. The aim of the current study was to examine anal sexual health knowledge and product use among heterosexual women aged 18 to 30 years. A total of 33 self-identified heterosexual women recruited from the general population participated in one of six focus groups. The results suggest that knowledge was variable. Salient sexual health themes centered on risks of human immunodeficiency virus/sexually transmitted infections (HIV/STIs), other infections, and physical harm/damage. Product-use themes included cleanliness/hygiene, comfort, and product safety. Participants expressed the desire for anal sexual health education. The results have implications for sexual health research, education, and clinical practice.
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Affiliation(s)
- Kimberly R McBride
- School of Population Health
- Health Disparities Research Collaborative, University of Toledo
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Carter A, Ford JV, Luetke M, Fu TCJ, Townes A, Hensel DJ, Dodge B, Herbenick D. "Fulfilling His Needs, Not Mine": Reasons for Not Talking About Painful Sex and Associations with Lack of Pleasure in a Nationally Representative Sample of Women in the United States. J Sex Med 2019; 16:1953-1965. [PMID: 31551190 DOI: 10.1016/j.jsxm.2019.08.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 08/13/2019] [Accepted: 08/21/2019] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Although much research has examined correlates of pain during sex, far less research has examined why women have sex despite having pain and why they avoid telling their partner. AIM The purpose of our study was to examine women's reports of painful sex, including location of pain, whether they told their partner, factors associated with not disclosing their pain, and their reasons for not disclosing. METHODS We used data from the 2018 National Survey of Sexual Health and Behavior, a probability-based online survey of 2,007 individuals ages 14 to 49 years. We limited our sample to adult women who reported a sexual experience that was painful in the past year (n = 382; 23.2%). The primary outcome in quantitative analyses was whether women told their partner they experienced pain during sex. Associations with social identities and sexual health were explored via logistic regression. Those who did not tell their partner about painful sex were asked why; their accounts were coded and analyzed qualitatively. MAIN OUTCOME MEASURE Women were asked, "To what extent was this sexual experience physically painful for you?" Those who reported any pain were asked, "Did you tell your partner that you were in pain during sex?" and, if applicable, "Why didn't you tell your partner that you were in pain during sex?" RESULTS Of those reporting pain during sex, most said it was "a little painful" (81.6%) and occurred at the vaginal entrance (31.5%), inside the vagina (34.4%), or at or around the cervix (17.4%). Overall, 51.0% (n = 193/382) told their partner about their pain. Adjusting for age and wantedness, women who reported little or no event-level sexual pleasure had nearly 3-fold greater odds of not telling a partner about painful sex (adjusted odds ratio = 3.24; 95% CI, 1.43-7.37). Normalizing painful sex, considering pain to be inconsequential, prioritizing the partner's enjoyment, and gendered interactional pressures were the predominant themes in women's narratives. CLINICAL IMPLICATIONS Providers should ask about painful sex, if the woman continues intercourse despite pain, and how she feels about this as a means of assessing any sexual and social pressures. STRENGTHS & LIMITATIONS Strengths include the use of social theory in nationally representative survey research to examine how contextual factors influence sexual health, but experiences were largely limited to heterosexual interactions. CONCLUSION Many women do not discuss painful sex with their partners, lack of pleasure is significantly more likely among this group, and gender norms and cultural scripts are critical to understanding why. Carter A, Ford JV, Luetke M, et al. "Fulfilling His Needs, Not Mine": Reasons for Not Talking About Painful Sex and Associations with Lack of Pleasure in a Nationally Representative Sample of Women in the United States. J Sex Med 2019; 16:1953-1965.
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Affiliation(s)
- Allison Carter
- Kirby Institute, University of New South Wales Sydney, Sydney, Australia.
| | - Jessie V Ford
- School of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Maya Luetke
- Center for Sexual Health Promotion, School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
| | - Tsung-Chieh Jane Fu
- Center for Sexual Health Promotion, School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
| | - Ashley Townes
- Center for Sexual Health Promotion, School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
| | - Devon J Hensel
- Division of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Sociology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Brian Dodge
- Center for Sexual Health Promotion, School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
| | - Debby Herbenick
- Center for Sexual Health Promotion, School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
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McBride KR. Heterosexual Women's Anal Sex Attitudes and Motivations: A Focus Group Study. JOURNAL OF SEX RESEARCH 2019; 56:367-377. [PMID: 28796537 DOI: 10.1080/00224499.2017.1355437] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Focus group methods were used to explore heterosexual women's receptive anal sex attitudes and motivations. Behaviors under investigation included penile-anal intercourse (PAI), manual-anal stimulation, oral-anal contact, and the use of sex toys. A total of 33 self-identified heterosexual women ages 18 to 30 recruited from two metropolitan areas in the Midwestern United States participated in one of six focus groups. The findings suggest that women viewed heterosexual anal sex as an emerging norm. Attitudes and motivations were complex and varied by behavior. Dominant themes included curiosity, pain, pleasure, and stigma. Relational factors, including acquiescence, coercion, and consent, were also salient among participants. Factors that influence anal sexual behaviors may not be entirely distinct from those that influence other sexual behaviors; however, factors that influence anal intercourse may be distinct from those that influence nonintercourse anal sex. Improved understanding will allow scientists to better understand the integration of anal sex behaviors into the broader sexual repertoire.
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Affiliation(s)
- Kimberly R McBride
- a School of Population Health , University of Toledo
- b Health Disparities Research Collaborative , University of Toledo
- c Department of Women's and Gender Studies , University of Toledo
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Herbenick D, Bartelt E, Fu TCJ, Paul B, Gradus R, Bauer J, Jones R. Feeling Scared During Sex: Findings From a U.S. Probability Sample of Women and Men Ages 14 to 60. JOURNAL OF SEX & MARITAL THERAPY 2019; 45:424-439. [PMID: 30946623 DOI: 10.1080/0092623x.2018.1549634] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Using data from a U.S. probability survey of individuals aged 14 to 60, we aimed (1) to assess the proportion of respondents who ever reported scary sexual situations and (2) to examine descriptions of sexual experiences reported as scary. Data were cross-sectional and collected via the GfK KnowledgePanel®. Scary sexual situations were reported by 23.9% of adult women, 10.3% of adult men, 12.5% of adolescent women, and 3.8% of adolescent men who had ever engaged in oral, vaginal, or anal sex. Themes included sexual assault/rape, incest, being held down, anal sex, choking, threats, multiple people, novelty/learning, among others.
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Affiliation(s)
- Debby Herbenick
- a Center for Sexual Health Promotion, School of Public Health , Indiana University , Bloomington , IN , USA
| | - Elizabeth Bartelt
- a Center for Sexual Health Promotion, School of Public Health , Indiana University , Bloomington , IN , USA
| | - Tsung-Chieh Jane Fu
- a Center for Sexual Health Promotion, School of Public Health , Indiana University , Bloomington , IN , USA
| | - Bryant Paul
- b Media School , Indiana University , Bloomington , IN , USA
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Herbenick D, Fu TCJ, Owens C, Bartelt E, Dodge B, Reece M, Fortenberry JD. Kissing, Cuddling, and Massage at Most Recent Sexual Event: Findings From a U.S. Nationally Representative Probability Sample. JOURNAL OF SEX & MARITAL THERAPY 2019; 45:159-172. [PMID: 30040548 DOI: 10.1080/0092623x.2018.1494648] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Using data from the 2014 National Survey of Sexual Health and Behavior, a probability survey of Americans aged 14+, we assessed the prevalence and correlates of kissing, cuddling, and massage during 1,493 individuals' most recent sexual event from the past year. Most respondents reported kissing (87%) and cuddling (70%); fewer (23%) reported massage. Each was significantly associated with age, education, and relationship structure. Respondents younger than 30 were significantly more likely to indicate they did not kiss because kissing would have been too intimate with their partner. Only cuddling was significantly associated with event-level emotional intimacy and sexual pleasure.
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Affiliation(s)
- Debby Herbenick
- a School of Public Health-Bloomington, Department of Applied Health Sciences , Indiana University , Bloomington , Indiana , USA
- b Center for Sexual Health Promotion, School of Public Health-Bloomington , Indiana University , Bloomington , Indiana , USA
| | - Tsung-Chieh Jane Fu
- a School of Public Health-Bloomington, Department of Applied Health Sciences , Indiana University , Bloomington , Indiana , USA
- b Center for Sexual Health Promotion, School of Public Health-Bloomington , Indiana University , Bloomington , Indiana , USA
| | - Christopher Owens
- a School of Public Health-Bloomington, Department of Applied Health Sciences , Indiana University , Bloomington , Indiana , USA
- b Center for Sexual Health Promotion, School of Public Health-Bloomington , Indiana University , Bloomington , Indiana , USA
| | - Elizabeth Bartelt
- a School of Public Health-Bloomington, Department of Applied Health Sciences , Indiana University , Bloomington , Indiana , USA
- b Center for Sexual Health Promotion, School of Public Health-Bloomington , Indiana University , Bloomington , Indiana , USA
| | - Brian Dodge
- a School of Public Health-Bloomington, Department of Applied Health Sciences , Indiana University , Bloomington , Indiana , USA
- b Center for Sexual Health Promotion, School of Public Health-Bloomington , Indiana University , Bloomington , Indiana , USA
| | - Michael Reece
- a School of Public Health-Bloomington, Department of Applied Health Sciences , Indiana University , Bloomington , Indiana , USA
- b Center for Sexual Health Promotion, School of Public Health-Bloomington , Indiana University , Bloomington , Indiana , USA
| | - J Dennis Fortenberry
- c Indiana University School of Medicine, Indiana University , Indianapolis , Indiana , USA
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Guerra-Reyes L, Rush B, Herbenick D, Dodge B, Reece M, Schick V, Sanders SA, Fortenberry JD. Sexual Health and Language Dominance Among Hispanic/Latino Women and Men: Analysis of a Nationally Representative Sample. J Immigr Minor Health 2018; 19:1059-1072. [PMID: 27351894 DOI: 10.1007/s10903-016-0446-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study assessed the prevalence of sexual behaviors among a nationally representative sample of Latino men and women in the United States (US) (N = 432) including Spanish language data collection. Prior studies of sexual health among US Latinos have consisted of convenience samples, and focused mainly on assessing risk behaviors. We consider a broader range of sexual behaviors, subjective sexual experiences (e.g. pleasure and arousal), and STI testing behaviors. Analyses by language dominance and gender indicate a higher variability in sexual behaviors for English-dominant participants and a link between overall STI testing to regular medical examinations, especially women. Higher rates of pleasure, orgasms and arousal was reported by Spanish-dominant men and women, relative to the English-dominant group. Results represent a nuanced examination of internal differentiation among US Latinos and provides applicable data for reducing sexual health disparities in this population.
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Affiliation(s)
- Lucia Guerra-Reyes
- Department of Applied Health Science, Indiana University Bloomington, 1025 East 7th Street, Suite 116, Bloomington, IN, 47405, USA.
| | - Benjamin Rush
- Department of Epidemiology and Biostatistics, Indiana University Bloomington, 1025 East 7th Street, Suite 116, Bloomington, IN, 47405, USA
| | - Debby Herbenick
- Center for Sexual Health Promotion, Indiana University, Bloomington, IN, USA
| | - Brian Dodge
- Center for Sexual Health Promotion, Indiana University, Bloomington, IN, USA
| | - Michael Reece
- Center for Sexual Health Promotion, Indiana University, Bloomington, IN, USA
| | | | | | - J Dennis Fortenberry
- Division of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
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Pinsky HT, Shepard ME, Bird ER, Gilmore AK, Norris J, Davis KC, George WH. Differences in Mental Health and Sexual Outcomes Based on Type of Nonconsensual Sexual Penetration. Violence Against Women 2016; 23:1039-1054. [PMID: 27486127 DOI: 10.1177/1077801216655624] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Little is known based on the stratification and localization of penetration type of rape: oral, vaginal, and/or anal. The current study examined associations between type of rape and mental and sexual health symptoms in 865 community women. All penetration types were positively associated with negative mental and sexual health symptoms. Oral and/or anal rape accounted for additional variance in anxiety, depression, some trauma-related symptoms, and dysfunctional sexual behavior than the association with vaginal rape alone. Findings suggest that penetration type can be an important facet of a rape experience and may be useful to assess in research and clinical settings.
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Affiliation(s)
- Hanna T Pinsky
- 1 Department of Psychology, University of Washington, Seattle, WA, USA.,2 University of Massachusetts, Amherst, MA, USA
| | - Molly E Shepard
- 1 Department of Psychology, University of Washington, Seattle, WA, USA.,3 Palo Alto University, Palo Alto, CA, USA
| | - Elizabeth R Bird
- 1 Department of Psychology, University of Washington, Seattle, WA, USA
| | - Amanda K Gilmore
- 1 Department of Psychology, University of Washington, Seattle, WA, USA.,4 Medical University of South Carolina, Charleston, SC, USA
| | - Jeanette Norris
- 1 Department of Psychology, University of Washington, Seattle, WA, USA.,5 Alcohol and Drug Abuse Institute, University of Washington, Seattle, WA, USA
| | - Kelly Cue Davis
- 6 School of Social Work, University of Washington, Seattle, WA, USA
| | - William H George
- 1 Department of Psychology, University of Washington, Seattle, WA, USA
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Fode M, Atallah S. Sexual Medicine in the Social Media. J Sex Med 2015; 12:2221-2. [DOI: 10.1111/jsm.13046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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