Examination of Sex-Related Distress and Self-Medication Drinking Model in U.S. College Women

Adult sexual assault (ASA) in college remains a concern. Consequently, many college-aged women experience negative emotions surrounding sexual activity (sex-related distress). Consistent with self-medication theory, some drink to cope with sex-related distress, which may reduce distress, but lead to greater drinking quantity before sex and negative sexual consequences. How women with ASA histories navigate sexual situations and cope with sex-related distress is under researched. We examined ASA, sex-related distress, and drinking to cope motives to understand correlates of drinking before sex. First and second year college women (n = 300) reported on a recent sexual experience in the past six weeks. In the full sample, ASA severity was associated with a greater likelihood of drinking before sex, while general sex-related distress was associated with a lower likelihood. General sex-related distress was associated with event-specific sex-related distress and sexual consequences. There were no differences in number of pre-sex drinks or subjective intoxication during sexual activity based on ASA. In a subsample of women who drank before sexual activity (n = 179), drinking to cope with sex-related distress motives mediated the association between sex-related distress and sexual consequences. Interventions can draw on these findings to target self-medication drinking in consensual sexual situations.

A Longitudinal Examination of Common Dyadic Coping and Sexual Distress in New Parent Couples during the Transition to Parenthood

New parents experience significant disruption to their sexual relationships such as lower desire and sexual frequency relative to prepregnancy. Little is known about the sexual distress new parents feel related to these changes, how sexual distress evolves over time, or how coping with stress relates to this distress. New parent couples who engage in more adaptive, joint coping with mutual stressors-common dyadic coping (CDC)-may be better able to manage distress related to their sexuality and thus, experience less sexual distress at 3-months postpartum and experience more marked improvement over time. In 99 first-time parent couples, we examined the link between CDC measured at 3-months postpartum and trajectories of sexual distress across 3-, 6-, and 12-months postpartum. Analyses used dyadic latent growth curve modeling informed by the actor-partner interdependence model. Mothers' sexual distress at 3-months postpartum was clinically elevated and higher than their partner's. Mothers' sexual distress declined significantly over time, whereas partners' sexual distress remained low and stable. An individual's higher perceptions of CDC was significantly associated with their own (but not their partner's) lower sexual distress at 3-months postpartum. No significant associations were found between CDC and change in sexual distress over time. How new parents jointly cope with stressors early in the postpartum period may lessen the distress they have about their sexuality at a time when most couples have just resumed sexual activity. Results identify CDC as a possible novel target for interventions aimed at helping couples manage sexual distress during the transition to parenthood.

A Prospective Single-Arm Study Evaluating the Effects of a Multimodal Physical Therapy Intervention on Psychosexual Outcomes in Women With Dyspareunia After Gynecologic Cancer

BACKGROUND

Dyspareunia affects most women after treatment for gynecologic malignancies. However, to date, evidence-based interventions remain limited and no study has examined the effects of multimodal physical therapy on psychosexual outcomes in these patients.

AIM

To assess the effects of multimodal physical therapy on psychosexual outcomes including sexual distress, body image concerns, pain anxiety, pain catastrophizing, pain self-efficacy and depressive symptoms in women with dyspareunia after treatment for gynecologic malignancies.

METHODS

Thirty-one gynecologic cancer survivors with dyspareunia enrolled in this prospective single-arm interventional study. The participants undertook 12 weekly sessions of physical therapy incorporating education, pelvic floor muscle exercises with biofeedback, manual therapy and home exercises. Outcome measures were evaluated pre- and post-treatment. Paired t-tests were conducted to investigate the changes from pre-treatment (P-value ˂ 0.05) while effect sizes (Cohen's d) were calculated to measure the magnitude of the change.

MAIN OUTCOME MEASURES

Sexual distress (Female Sexual Distress Scale-Revised), body image concerns (Body Image Scale), pain anxiety (Pain Anxiety Symptoms Scale), pain catastrophizing (Pain Catastrophizing Scale), pain self-efficacy (Painful Intercourse Self-Efficacy Scale) and depressive symptoms (Beck Depression Inventory-II).

RESULTS

Significant changes were found from pre- to post-treatment for all psychosexual outcomes. Women reported reductions in sexual distress (P ˂ 0.001, d = 1.108), body image concerns (P ˂ 0.001, d = 0.829), pain anxiety (P ˂ 0.001, d = 0.980), pain catastrophizing (P ˂ 0.001, d = 0.968) and depression symptoms (P = 0.002, d = 0.636) with an increase in pain self-efficacy (P ˂ 0.001, d ≥ 0.938) following the intervention.

CLINICAL IMPLICATIONS

The results suggest that multimodal physical therapy significantly improves sexual distress, body image concerns, pain anxiety, pain catastrophizing, pain self-efficacy and depressive symptoms in our sample of women with dyspareunia after treatment for gynecologic malignancies. The medium to large effect sizes obtained with the high proportion of women presenting meaningful changes according to the known minimal clinically important difference or clinical cut-off underlines the significance of these effects.

STRENGTHS & LIMITATIONS

The current study used validated questionnaires to assess the psychosexual outcomes of a well-designed physical therapy intervention using multiple modalities to address the multifaceted aspect of dyspareunia in cancer survivors. This study did not include a control group, which may limit drawing definitive conclusions.

CONCLUSION

Findings showed that multimodal physical therapy yielded significant improvements in psychosexual outcomes in gynecologic cancer survivors with dyspareunia. A randomized controlled trial is indicated to confirm these results. Cyr M-P, Dumoulin C, Bessette P, et al. A Prospective Single-Arm Study Evaluating the Effects of a Multimodal Physical Therapy Intervention on Psychosexual Outcomes in Women With Dyspareunia After Gynecologic Cancer. J Sex Med 2021;18:946-954.

Characterizing Pelvic Floor Muscle Function and Morphometry in Survivors of Gynecological Cancer Who Have Dyspareunia: A Comparative Cross-Sectional Study

OBJECTIVE

More than one-half of gynecological cancer survivors are affected by pain during sexual intercourse, also known as dyspareunia. Oncological treatments may result in pelvic floor muscle (PFM) alterations, which are suspected to play a key role in dyspareunia. However, to our knowledge, no study has investigated PFM function and morphometry in this population. The aim of the study was to characterize and compare PFM function and morphometry between gynecological cancer survivors with dyspareunia and asymptomatic women.

METHODS

Twenty-four gynecological cancer survivors with dyspareunia and 32 women with a history of total hysterectomy but without pelvic pain (asymptomatic women) participated in this comparative cross-sectional study. PFM passive forces (tone), flexibility, stiffness, maximal strength, coordination, and endurance were assessed with an intra-vaginal dynamometric speculum. Bladder neck position, levator plate angle, anorectal angle, and levator hiatal dimensions were measured at rest and on maximal contraction with 3D/4D transperineal ultrasound imaging.

RESULTS

Compared with asymptomatic women, gynecological cancer survivors showed heightened PFM tone, lower flexibility, higher stiffness, and lower coordination and endurance. At rest, they had a smaller anorectal angle and smaller levator hiatal dimensions, indicating heightened PFM tone. They also presented fewer changes from rest to maximal contraction for anorectal angle and levator hiatal dimensions, suggesting an elevated tone or altered contractile properties.

CONCLUSIONS

Gynecological cancer survivors with dyspareunia present with altered PFM function and morphometry. This research therefore provides a better understanding of the underlying mechanisms of dyspareunia in cancer survivors.

IMPACT

Our study confirms alterations in PFM function and morphometry in gynecological cancer survivors with dyspareunia. These findings support the rationale for developing and assessing the efficacy of physical therapy targeting PFM alterations in this population.

The Effect of Exposure to Sexual Violence on Sexual Dysfunction and Sexual Distress in Pregnant Women

BACKGROUND

Sexual dysfunction and sexual distress are common during pregnancy, but the effects of exposure to sexual violence on sexual dysfunction and sexual distress in pregnant women is unknown.

AIM

The aim of this study was to determine the effects of sexual violence on female sexual dysfunction and sexual distress.

METHODS

This is a descriptive study. Data were collected between December 2019 and April 2020 from 605 pregnant women.

OUTCOMES

The data were collected with a Data Collection Form (The socio-demographic and obstetric characteristics and exposure to sexual violence were evaluated with questions.), Female Sexual Function Index, and Female Sexual Distress Scale-Revised.

RESULTS

In our study, sexual dysfunction was found in 72.9% of the pregnant women, and sexual distress was found in 38.2%. It was found that 11.6% of the women were exposed to sexual violence in their then-current pregnancy. While the rate of sexual distress was found to be significantly higher in women who were exposed to sexual violence during pregnancy (P < .001), no significant difference was found between sexual violence and female sexual dysfunction (P = .572). Sexual violence during pregnancy was found to be a risk factor for sexual distress (P = .006).

CLINICAL IMPLICATIONS

This study may be an opportunity for nurses and physicians to determine the effects of sexual violence experienced by pregnant women on female sexual dysfunction and sexual distress during pregnancy.

STRENGTH & LIMITATIONS

This is the first and only study that determines the effects of sexual violence on female sexual dysfunction and sexual distress. Our findings cannot be generalized to the entire population of Turkey.

CONCLUSION

The presence of female sexual dysfunction in women during pregnancy is quite high, and the rate of sexual distress is moderate. Sexual violence from partner/spouse during pregnancy is a risk factor for sexual distress. Alan Dikmen H, Çankaya S. The Effect of Exposure to Sexual Violence on Sexual Dysfunction and Sexual Distress in Pregnant Women. J Sex Med 2020;17:2394-2407.

Prevalence of Low Sexual Desire With Associated Distress Across the Adult Life Span: An Australian Cross-Sectional Study

BACKGROUND

Although hypoactive sexual desire dysfunction (HSDD; low sexual desire with personal distress) negatively impacts well-being, contemporary life-course prevalence data for HSDD are lacking.

AIM

To document, in an epidemiologic study, the prevalence of low sexual desire with associated distress (epidemiological HSDD [eHSDD]), and associated psychosocial factors in Australian women.

METHODS

A cross-sectional study of 10,554 women, aged 18-79 years, recruited from the community was performed.

MAIN OUTCOME MEASURES

Low desire was determined by corresponding questions in the Profile of Female Sexual Function and Female Sexual Function Index. HSDD was defined as having a low desire and Female Sexual Distress Scale-Revised score of ≥11.

CLINICAL TRANSLATION

Clinicians need to be aware that young women often experience sexually related distress whereas low desire with associated distress is most common in women at midlife.

RESULTS

The majority of the participants were partnered (66.5%) and 38.9% were recently sexually inactive. Low desire prevalence increased from age 18-24 years to 75-79 years (27.4%, 95% CI 25.5-29.3 vs 91.6%, 95% CI 88.3-94.1, P < .001). Just over half of all participants aged 25-39 years had sexually related personal distress, after which the prevalence declined with age (P < .001). 10,259 participants provided sufficient information for eHSDD classification. eHSDD increased from age 18-24 years (12.2%, 95% CI 10.8-13.7) to 40-44 years (33.4%, 95% CI 28.5-38.8), remained constant until 60-64 years (33.1%, 95% CI 28.3-38.4), and progressively declined to 7.3% (95% CI 4.8-10.9) by 75-79 years. HSDD was significantly, positively associated with being partnered (P < .001), sexually inactive (P < .001), more educated (P = .001), and psychotropic medication use (P < .001), and negatively with Asian ethnicity (P < .001).

STRENGTHS & LIMITATIONS

This study involved the assessment of desire using a single question derived from the Profile of Female Sexual Function or the Female Sexual Function Index.

CONCLUSION

eHSDD is most prevalent at midlife. Furthermore, the likelihood of eHSDD is greater for women who are partnered, sexually inactive, more educated, or taking psychotropic medications. Taken together these findings should aid health professionals in identifying women most at risk of eHSDD. Zheng J, Islam RM, Bell RJ, et al. Prevalence of Low Sexual Desire With Associated Distress Across the Adult Life Span: An Australian Cross-Sectional Study. J Sex Med 2020;17:1885-1895.

Typologies of Women With Orgasmic Difficulty and Their Relationship to Sexual Distress

BACKGROUND

About 50% of women who report orgasmic difficulty (OD) during partnered sex are distressed by their condition, yet why some women are distressed and others are not is unclear.

AIM

To determine whether sexual distress is related to women's perceived causes of their OD during partnered sex.

METHODS

We established homogenous subgroups of women based on their attributions for OD during partnered sex, and these groups were validated by comparing them on variables relevant to sexual response. We then predicted OD-related distress from subgroup memberships as well as from a number of sociodemographic, control, and empirically supported sexual response variables.

RESULTS

3 distinct OD subgroups emerged: type 1-high psychological-high somatic reasons; type 2-partner-related reasons; and type 3-moderate psychological-low somatic reasons. These groups also differed on independent parameters related to sexual frequency and arousal. Subgroup membership, along with age, sexual relationship satisfaction, and frequency of partnered sex predicted sexual distress related to OD.

CLINICAL IMPLICATION

Particular perceptions regarding the causes for OD help predict women's sexual distress, and such factors might be considered in identifying sexual issues and managing them within the context of a sexual relationship.

STRENGTHS & LIMITATIONS

A large sample size drawn from a multinational population powered the study, while the cross-sectional nature of the sample could not rule out bidirectional associations between predictor covariates (including OD subgroup) and the outcome measure (sexual distress).

CONCLUSION

Type 1 membership (high levels of psychological and somatic attributions) predicted greater levels of OD-related distress than type 2 (partner-related attributions) or type 3 (moderate psychological and low somatic attributions) membership, with type 1 women having a greater likelihood of internalizing (accepting responsibility/blame for) OD attributions. Hevesi K, Miklós E, Horváth Z, et al. Typologies of Women With Orgasmic Difficulty and Their Relationship to Sexual Distress. J Sex Med 2020;17:1144-1155.

Psychometric Validation of the Sexual Distress Scale in Men with Prostate Cancer

BACKGROUND

Different scales exist for the assessment of sexual distress in men with prostate cancer (PCa); however, these measures narrowly focus on distress associated with sexual function.

AIM

To validate and examine the psychometric properties of the Sexual Distress Scale (SDS) and Sexual Distress Scale-Revised (SDS-R), which were recently validated for use within men, in samples of sexually functional and sexually dysfunctional men with PCa.

METHODS

A sample of 538 men (with and without PCa and with and without sexual dysfunction) were used to examine the psychometric properties of the SDS. Confirmatory factor analysis followed by tests of measurement bias, calculations of reliability, and estimation of receiver operating characteristic (ROC) curves were used to examine the psychometric properties of the SDS and SDS-R. A subsample of 321 men completed the survey again 1 month later, and their responses were used to examine test-retest reliability.

OUTCOMES

Participants completed the SDS and SDS-R, as well as measures of sexual bother and sexual concerns, sexual function, sexual attitudes, and mood states.

RESULTS

The SDS and SDS-R assess 1 general domain of sexual distress; 1 violation of measurement invariance was found between men with and men without PCa, which limits the comparability of scores between these 2 groups. Internal consistency and test-retest reliabilities were above 0.93 and 0.82, respectively. Evidences of validity based on relations with other variables supported our predictions because sexual distress was associated with other measures of distress, sexual function, satisfaction, and mood and not correlated to sexual attitudes. Although the SDS and SDS-R discriminated between sexually functional and dysfunctional men, the accuracy of the cutoff scores was only moderate.

CLINICAL TRANSLATION

This instrument can be used by researchers and clinicians to examine sexual distress and can be used to elucidate how sexual distress relates to sexual function, well-being, and quality of life.

STRENGTHS AND LIMITATIONS

The SDS and SDS-R assess sexual distress independently of sexual function; however, with the current evidence, they should not be used to compare men with and men without PCa and to classify men with and men without sexual dysfunction.

CONCLUSION

This study provides a validation of the SDS and SDS-R that can be used in samples of men with PCa and with and without sexual dysfunction for the assessment of distress. Santos-Iglesias P, Walker LM. Psychometric Validation of the Sexual Distress Scale in Men with Prostate Cancer. J Sex Med 2018;15:1010-1020.

A Randomized Study Comparing Video-Based Mindfulness-Based Cognitive Therapy With Video-Based Traditional Cognitive Behavioral Therapy in a Sample of Women Struggling to Achieve Orgasm

INTRODUCTION

This study examines the effectiveness of integrating mindfulness-based techniques within therapy for women suffering to achieve orgasm. Although widely applied in psychotherapy, this approach has only recently been introduced in the treatment of female sexual dysfunction.

AIM

To compare the effectiveness of a video-based self-administered treatment, rooted within the cognitive behavioral treatment (CBT) framework, with a video-based self-administered mindfulness treatment applying cognitive behavioral sexual therapy (mindfulness-based cognitive therapy), the latter of which was specifically created to increase women's ability to achieve orgasm.

METHODS

A convenience sample of 65 women suffering from difficulties to achieve orgasm, aged 18 to 58 years (mean = 32.66, standard deviation = 9.48), were randomly allocated using a randomization procedure to either a mindfulness-based cognitive therapy (N = 35) or CBT (N = 30) group. Each participant completed questionnaires before and after the start of treatment and 2 months after its completion.

MAIN OUTCOME MEASURE

We applied repeated-measure general linear models to compare the 2 groups (ie, between participant factor) on each dependent variable across time (ie, the within-participant factor). Compare mean analyses for paired samples were only conducted when the interaction effect between condition and time was significant (ie, P <.05).

RESULTS

Statistical analyses show that women in both groups presented increased sexual functioning (P = .001) and decreased sexual distress (P < .001), as well as improved desire, arousal, orgasm, and sexual satisfaction (P < .05) after their respective treatments. Contrary to our hypothesis, significant reductions in sexual pain were only observed in CBT participants.

CLINICAL IMPLICATIONS

To the best of our knowledge, this is the first study to apply a randomized allocation procedure to evaluate the effectiveness of a video-based mindfulness intervention for women struggling to achieve orgasm. These results should guide clinicians' decisions with respect to evaluating the relevance and the real added value of proposing mindfulness exercises to their patients with such difficulties.

CONCLUSION

When women suffering from difficulties to achieve orgasm are randomly assigned to a mindfulness group or an active control, improvements in sexual functioning and reductions in sexual distress can be observed after both treatments. Adam F, De Sutter P, Day J, et al. A Randomized Study Comparing Video-Based Mindfulness-Based Cognitive Therapy With Video-Based Traditional Cognitive Behavioral Treatment in a Sample of Women Struggling to Achieve Orgasm. J Sex Med 2020;17:312-324.

Prevalence of Sexual Problems and Associated Distress in Aging Men Across 4 European Countries

BACKGROUND

Among older men, comparable cross-cultural investigations of sexual problems and associated distress that also include a multitude of relevant explanatory variables of these sexual problem and related distress are rare in the research literature.

AIMS

To investigate prevalence rates of sexual problems and associated distress among older men across 4 European countries (Norway, Denmark, Belgium, and Portugal) and assess for associated mental and physical health-related factors.

METHODS

Multinational cross-sectional questionnaire study using self-report measures.

OUTCOMES

Prevalence rates of sexual problems and associated distress levels.

RESULTS

We found a high prevalence of sexual problems persisting for months or longer across countries, but noted that many affected men experienced minimal or no distress related to these problems. We also found marked cross-cultural differences in reported distress about sexual problems, with southern European men (ie Portugal) reporting significantly more distress related to the majority of sexual problems investigated compared with northern European men (ie Denmark and Norway). Finally, we identified several relational, physical, and mental health problems associated with the reported number of sexual problems and the distress related to these problems.

CLINICAL IMPLICATIONS

We suggest that healthcare professionals also target distress when considering sexual problems among older men and contextualize these considerations within a multifactorial approach to general health in which (other) mental and physical health factors relevant to these patients' sexual health and function are also jointly considered.

STRENGTHS & LIMITATIONS

Strengths of this study include the large sample size, inclusion of participants from 4 European countries, assessment of distress associated with sexual problems, and similar research design and method of data collection across the 4 included countries. Limitations of the study include the cross-sectional design, which precludes causal conclusions; the low response rate in the Portuguese sample; the lack of homosexual participants; and the lack of comprehensive assessments of dyadic factors that may be of relevance to sexual problems and associated distress.

CONCLUSION

This study identified a high prevalence of sexual problems persisting for 3 months or longer among older men across 4 European countries, but also found that many of the men with sexual problems experienced minimal or no distress related to these problems. G.M. Hald, C. Graham, A. Štulhofer, et al. Prevalence of Sexual Problems and Associated Distress in Aging Men Across 4 European Countries. J Sex Med 2019;16:1212-1225.

Does Pregnancy Play a Role? Association of Body Dissatisfaction, Body Appearance Cognitive Distraction, and Sexual Distress

INTRODUCTION

Pregnancy is characterized by physical, hormonal, and psychological changes that can affect women's sexuality, and, for those who are in a dyadic relationship, it also affects the couple's sexual relationship. On the other hand, the pregnancy state can function as a protective factor for body dissatisfaction as women embrace a new phase of the life cycle when body changes, namely more body volume, are expected.

AIM

To examine whether the effect of body dissatisfaction on sexual distress is mediated by cognitive distraction with the appearance of the body and to test a moderated mediation model of the impact of body dissatisfaction on sexual distress, with pregnancy used as the moderating factor.

METHODS

In this cross-sectional study, 87 cisgender heterosexual women (50.6% pregnant; n = 44), aged between 25 and 40 years old (mean = 31.93; SD = 3.46) involved in an exclusive and committed dyadic relationship completed a web-based questionnaire.

MAIN OUTCOME MEASURES

Validated measures consisted of a validated general measure of body dissatisfaction (global body dissatisfaction scale), sexual distress (adapted from the National Survey of Sexual Attitudes and Lifestyles), and cognitive distraction based on body appearance during sexual activity (body appearance cognitive distraction scale).

RESULTS

Results indicated that body dissatisfaction and sexual distress are related, but they are fully mediated by cognitive distraction. The mediation effect of cognitive distraction did not differ significantly by pregnancy status, after controlling for the trimester of pregnancy.

CLINICAL IMPLICATIONS

This study advances our understanding of sexuality during pregnancy by evaluating sexual distress and establishing that it is a clinically relevant variable related to body dissatisfaction that deserves attention from healthcare providers.

STRENGTH & LIMITATIONS

This preliminary study uses a robust method of data analysis to test a theory-based cognitive model of sexual distress in pregnant women; however, no causality can be established.

CONCLUSION

The data highlights that pregnancy may not be a protective factor for the impact of body dissatisfaction on sexual distress. Pascoal PM, Rosa PJ, Coelho S. Does Pregnancy Play a Role? Association of Body Dissatisfaction, Body Appearance Cognitive Distraction, and Sexual Distress. J Sex Med 2019;16:551-558.

Association Between Alcohol Use and Female Sexual Dysfunction From the Data Registry on Experiences of Aging, Menopause, and Sexuality (DREAMS)

Introduction

Sexual dysfunction is a common problem in women and the nature of its association with alcohol use remains unclear.

Aim

To explore the association between alcohol use and female sexual dysfunction (FSD).

Methods

Associations between self-reported drinking and sexual function were evaluated in 2,253 women presenting for consultation to a women’s health specialty clinic. A short version of the Alcohol Use Disorders Identification Test (AUDIT-C) was used to evaluate alcohol use. Women with an AUDIT-C ≥3 were considered at risk for hazardous drinking. Multivariable regression, controlling for depression, anxiety, and abuse (childhood and recent), was used to assess the association between alcohol consumption and FSD (defined as a Female Sexual Function Index [FSFI] ≤26.55 and Female Sexual Distress Scale [FSDS] ≥11) in sexually active women.

Main Outcome Measure

The main study outcome measure was the presence of FSD as defined by a score ≤26.55 on the FSFI and ≥11 on the FSDS.

Results

57% of the 1,649 sexually active women were classified as having FSD; 80% reported any alcohol use and 38% reported drinking patterns with the potential to be hazardous. The women at risk for hazardous drinking had significantly higher FSFI domain scores indicating better sexual function (P ≤ .001). However, in multivariable analyses, there was no significant difference in the rates of FSD across alcohol use categories in women.

Conclusion

In women presenting for consultation to a women’s health specialty clinic, an association between alcohol use and FSFI scores was seen, in which greater risk of hazardous drinking was associated with better sexual function scores. However, when sexual distress was included to define sexual dysfunction, those with FSD were not at higher risk of hazardous drinking. Given the complex nature of FSD, additional study is needed to further clarify these relationships.

Kling JM, Sidhu K, Rullo J, et al. Association Between Alcohol Use and Female Sexual Dysfunction From the Data Registry on Experiences of Aging, Menopause, and Sexuality (DREAMS). Sex Med 2019;7:162–168.

The Development and Validation of the Sexual and Relationship Distress Scale

BACKGROUND

Sexual distress is an important factor in the etiology, maintenance, and treatment of sexual difficulties, and as such, there is a need for validated measures. A limitation in the research and treatment of distressing sexual difficulties has been the lack of validated measures, and in particular, existing measures are unable to measure the impacts at the relationship level and currently focus on intra-personal distress.

AIM

This study sought to develop and psychometrically evaluate a new measure of distress associated with sexual difficulties.

METHODS

An initial pool of 73 items was created from the results of an earlier qualitative study and administered using an online survey to 1,381 participants (462 men, 904 women, and 14 who identified as "other"), along with measures for the purposes of psychometric evaluation including the Female Sexual Distress Scale-Revised, Couples Satisfaction Index 16-item version, Depression Anxiety and Stress Scale-Short Form, and questions relating to sexual function. Exploratory factor analysis and confirmatory factor analysis in separate split-half samples were conducted, followed by analysis of validity and reliability of the resulting measure.

OUTCOMES

The Sexual and Relationship Distress Scale (SaRDS) was developed to meet the need for a patient-reported outcome measure of individual and relationship distress within the context of sexual dysfunction and resulted in a psychometrically sound 30-item, 14-factor measure of sexual and relationship distress.

RESULTS

The final 30 items explained 77.5% of the total variance and the confirmatory factor analysis showed that this model has an adequate fit (comparative fit index = .97, normed fit index = .95, root mean square error of approximation = .05). The final measure demonstrated good psychometric properties, with strong internal reliability (Cronbach alpha = .95 for the total score with individual sub-scales ranging from .70-.96), and convergent and discriminant validity when compared to current measures (Female Sexual Distress Scale-Revised, r = .82, P < .001; Couples Satisfaction Index, r = -.69, P < .001; Depression Anxiety and Stress Scale-Short Form, r = .37, P < .001).

CLINICAL IMPLICATIONS

The SaRDS may prove useful for researchers and clinicians interested in understanding and improving the distress experienced within the context of sexual difficulties. The new measure is brief (30 items), easy to administer and score, easily understood (Flesch-Kincaid reading level = grade 3.9), and demonstrates high internal consistency, convergent and discriminant validity.

STRENGTHS & LIMITATIONS

The SaRDS has advantages over existing measures as it is brief yet includes sub-scales. However, it must be noted that a community sample was used for this study and it would be beneficial to include a clinical sample in future validation studies.

CONCLUSION

Unlike most measures in this field, the SaRDS is multi-dimensional and assesses 14 distinct yet related types of sexual and relationship distress experienced in the context of sexual dysfunctions. It can be administered across genders and both members of a couple. It therefore has multiple uses within both research and clinical settings. Frost R, Donovan C. The Development and Validation of the Sexual and Relationship Distress Scale. J Sex Med 2018;15:1167-1179.

A Systematic Review of Sexual Distress Measures

BACKGROUND

Sexual distress is an important component of sexual dysfunction and quality of life and many different measures have been developed for its assessment.

AIM

To conduct a literature review of measures for assessing sexual distress and to list, compare, and highlight their characteristics and psychometric properties.

METHODS

A systematic review was conducted using Scopus and PubMed databases to identify studies that developed and validated measures of sexual distress. The main characteristics and psychometric properties of each measure were extracted and examined.

OUTCOMES

Psychometrically validated measures of sexual distress and a summary of relative strengths and limitations.

RESULTS

We found 17 different measures for the assessment of sexual distress. 4 were standalone questionnaires and 13 were subscales included in questionnaires that assessed broader constructs. Although 5 measures were developed to assess sexual distress in the general population, most were developed and validated in very specific clinical groups. Most followed adequate steps in the development and validation process and have strong psychometric properties; however, several limitations were identified.

CLINICAL TRANSLATION

This literature review offers researchers and clinicians a list of sexual distress measures and relevant characteristics that can be used to select the best assessment tool for their objectives.

STRENGTHS AND LIMITATIONS

A thorough search procedure was used; however, there is still a chance that relevant articles might have been missed owing to our search methodology and inclusion criteria.

CONCLUSION

This is a novel and state-of-the-art review of assessment tools for sexual distress that includes valuable information measure selection in the study of sexual distress and sexual dysfunction. Santos-Iglesias P, Mohamed B, Walker LM. A Systematic Review of Sexual Distress Measures. J Sex Med 2018;15:625-644.

Sexual Distress and Sexual Problems During Pregnancy: Associations With Sexual and Relationship Satisfaction

INTRODUCTION

Sexual problems are common during pregnancy, but the proportion of pregnant women who experience sexual distress is unknown. In non-pregnant samples, sexual distress is associated with lower sexual and relationship satisfaction.

AIM

To identify the proportion of women experiencing sexual distress during pregnancy and to compare the sexual and relationship satisfaction of women who report sexual distress during pregnancy with that of women without distress.

METHODS

Two-hundred sixty-one pregnant women completed a cross-sectional online survey.

MAIN OUTCOME MEASURES

Women completed validated measurements of sexual functioning (Female Sexual Function Index; score < 26.55 indicates a sexual problem), sexual distress (Female Sexual Distress Scale; score ≥ 15 indicates clinically significant distress), sexual satisfaction (Global Measure of Sexual Satisfaction), and relationship satisfaction (Couples Satisfaction Index).

RESULTS

Overall, 42% of women met the clinical cutoff for sexual distress. Of sexually active women (n = 230), 26% reported concurrent sexual problems and distress and 14% reported sexual distress in the absence of sexual problems. Sexual distress and/or problems in sexual functioning were linked to lower sexual and relationship satisfaction compared with pregnant women with lower sexual distress and fewer sexual problems.

CONCLUSION

Sexual distress is common during pregnancy and associated with lower sexual and relationship satisfaction. Health care providers should ask pregnant women about feelings of sexual distress. Identifying pregnant women who experience sexual distress and referring them to appropriate resources could help minimize sexual and relationship problems during pregnancy. Vannier SA, Rosen NO. Sexual Distress and Sexual Problems During Pregnancy: Associations With Sexual and Relationship Satisfaction. J Sex Med 2017;14:387-395.

Androgens and Psychosocial Factors Related to Sexual Dysfunctions in Premenopausal Women∗: ∗2016 ISSM Female Sexual Dysfunction Prize

INTRODUCTION

The female sexual response is complex and influenced by several biological, psychological, and social factors. Testosterone is believed to modulate a woman's sexual response and desire, because low levels are considered a risk factor for impaired sexual function, but previous studies have been inconclusive.

AIM

To investigate how androgen levels and psychosocial factors are associated with female sexual dysfunction (FSD), including hypoactive sexual desire disorder (HSDD).

METHODS

The cross-sectional study included 428 premenopausal women 19 to 58 years old who completed a questionnaire on psychosocial factors and had blood sampled at days 6 to 10 in their menstrual cycle. Logistic regression models were built to test the association among hormone levels, psychosocial factors, and sexual end points.

MAIN OUTCOME MEASURES

Five different sexual end points were measured using the Female Sexual Function Index and the Female Sexual Distress Scale: impaired sexual function, sexual distress, FSD, low sexual desire, and HSDD. Serum levels of total and free testosterone, androstenedione, dehydroepiandrosterone sulfate, and androsterone glucuronide were analyzed using mass spectrometry.

RESULTS

After adjusting for psychosocial factors, women with low sexual desire had significantly lower mean levels of free testosterone and androstenedione compared with women without low sexual desire. None of the androgens were associated with FSD in general or with HSDD in particular. Relationship duration longer than 2 years and mild depressive symptoms increased the risk of having all the sexual end points, including FSD in general and HSDD in particular in multivariate analyses.

CONCLUSION

In this large cross-sectional study, low sexual desire was significantly associated with levels of free testosterone and androstenedione, but FSD in general and HSDD in particular were not associated with androgen levels. Length of relationship and depression were associated with FSD including HSDD. Wåhlin-Jacobsen S, Kristensen E, Tønnes Pedersen A, et al. Androgens and Psychosocial Factors Related to Sexual Dysfunctions in Premenopausal Women. J Sex Med 2017;14:366-379.

Why is impaired sexual function distressing to women? The primacy of pleasure in female sexual dysfunction

INTRODUCTION

Recent research has highlighted a complex association between female sexual function and subjective distress regarding sexual activity. These findings are difficult to explain given limited knowledge as to the mechanisms through which impaired sexual function causes distress.

AIM

The current study assessed whether a number of specific consequences of impaired sexual function, including decreased physical pleasure, disruption of sexual activity, and negative partner responses, mediated the association between sexual function and distress.

METHODS

Eighty-seven women in sexually active relationships reporting impairments in sexual function completed validated self-report measures and daily online assessments of sexual experiences.

MAIN OUTCOME MEASURES

Participants completed the Sexual Satisfaction Scale for Women, the Female Sexual Function Index, and the Measure of Sexual Consequences.

RESULTS

Results suggested that decreased physical pleasure and disruption of sexual activity, but not partner responses, statistically mediated the association between sexual function and distress.

CONCLUSION

Sexual consequences represent potential maintaining factors of sexual dysfunction that are highly distressing to women. Results are discussed in the context of theoretical models of sexual dysfunction and related treatments.

Dyadic sexual communication in pre-menopausal women with self-reported dyspareunia and their partners: associations with sexual function, sexual distress and dyadic adjustment

INTRODUCTION

While there is increasing interest in studying aspects of communication processes in sex research, the association between dyadic sexual communication and relationship and sexuality outcomes has not yet been examined in pre-menopausal women with dyspareunia.

AIM

To examine the associations between dyadic sexual communication and pain, sexual distress, sexual function and dyadic adjustment in women with self-reported dyspareunia and their male partners.

METHODS

Pre-menopausal women (n=38; M age=24.92, SD=6.12) with self-reported dyspareunia from a community sample and their partners (n=38; M age=26.71, SD=6.59) completed an online survey. The Actor-Partner Interdependence Model was used in order to investigate both actor and partner effects.

MAIN OUTCOME MEASURES

Both members of the couple completed: (i) the Dyadic Sexual Communication Scale and (ii) the Dyadic Adjustment Scale; women also completed (iii) the Female Sexual Function Index, (iv) the Female Sexual Distress Scale, and (v) a Visual Analogue Scale on pain during intercourse; and men also completed (vi) the International Index of Erectile Functioning.

RESULTS

Controlling for relationship duration, women's better dyadic sexual communication was significantly associated with their higher levels of sexual function (P=0.028), lower levels of sexual distress (P=0.003) and higher levels of dyadic adjustment (P=0.005), but not with their pain or men's sexual function or dyadic adjustment. Controlling for relationship duration, men's better dyadic sexual communication was associated with their higher levels of dyadic adjustment (P=0.027) but not with their sexual function, nor with women's sexual function or dyadic adjustment.

CONCLUSIONS

These findings contribute to the theoretical knowledge on interaction processes in couples with dyspareunia and suggest that it may be important to enhance open and direct communication about sexual matters in couples with dyspareunia.

Age-related prevalence rates of sexual difficulties, sexual dysfunctions, and sexual distress in heterosexual women: results from an online survey in flanders

INTRODUCTION

Although age-related prevalence rates of female sexual difficulties, i.e., difficulties with sexual desire, arousal, orgasm, or pain have occasionally been studied-with mostly inconsistent results-the age-related prevalence rates of female sexual dysfunctions, i.e., sexual difficulties that are associated with sexual distress, have not. Moreover, the association of age with sexual distress, i.e., distress due to sexual difficulties, has almost completely been neglected in epidemiological research.

AIMS

The aims of the present study were to provide age-related prevalence estimates of sexual difficulties and sexual dysfunctions and to provide proportions of participants reporting sexual distress in heterosexual women.

METHODS

An online survey comprising on sexual difficulties (i.e., low sexual desire, lack of responsive sexual desire, difficulties with lubrication, lack of subjective sexual arousal, absent or delayed orgasm, and dyspareunia) and associated sexual distress that enables us to classify respondents with sexual dysfunctions.

MAIN OUTCOME MEASURE

Sexual Functioning Scale.

RESULTS

A total of 15,048 heterosexual women aged 16-74 years living in Flanders (the Nothern, Dutch-speaking part of Belgium) completed the online survey. This study revealed that all sexual difficulties and all sexual dysfunctions are significantly associated with age in women. Although most sexual difficulties and sexual dysfunctions increase with age, some display a U-shaped association with age. Furthermore, it was found that-except for lubrication difficulties-sexual distress was also significantly associated with age and that sexual distress is more common in younger women.

CONCLUSION

The association between age and sexual difficulties, sexual dysfunctions, and sexual distress in women is complex and deserves more attention from scholars.

Sexual function in the late postmenopause: a decade of follow-up in a population-based cohort of Australian women

INTRODUCTION

There is a paucity of longitudinal studies assessing sexual function of women in the late postmenopause.

AIM

This study aims to describe sexual function of women in the late postmenopause and to investigate change from early postmenopause.

METHODS

Cross-sectional analysis of 2012/13 and longitudinal analysis from 2002/04 of the population based, Australian cohort of the Women's Healthy Ageing Project, applying validated instruments: Short Personal Experience Questionnaire (SPEQ), Female Sexual Distress Scale (FSDS), Hospital Anxiety and Depression Scale, Geriatric Depression Scale, and California Verbal Learning Test.

MAIN OUTCOME MEASURES

Sexual activity, SPEQ, and FSDS.

RESULTS

Two hundred thirty women responded (follow-up rate 53%), mean age was 70 years (range 64-77), 49.8% were sexually active. FSDS scores showed more distress for sexually active women (8.3 vs. 3.2, P<0.001). For 23 (23%) sexually active and for five (7%) inactive women, the diagnosis of female sexual dysfunction could be made. After adjustment, available partner (odds ratio [OR] 4.31, P<0.001), no history of depression (OR 0.49, P=0.036), moderate compared with no alcohol consumption (OR 2.43, P=0.019), and better cognitive function score (OR1.09, P=0.050) were significantly predictive for sexual activity. Compared with early postmenopause, 18% more women had ceased sexual activity. For women maintaining their sexual activity through to late postmenopause (n=82), SPEQ and FSDS scores had not changed significantly, but frequency of sexual activity had decreased (P=0.003) and partner difficulties had increased (P=0.043). [Correction added on 10 July 2014, after first online publication: Mean age of respondents was added.]

CONCLUSIONS

In late postmenopause, half of the women were sexually active. Most important predictors were partner availability and no history of depression. However, being sexually active or having a partner were associated with higher levels of sexual distress. Compared with early postmenopause, sexual function scores had declined overall but were stable for women maintaining sexual activity. Further research into causes of sexual distress and reasons for sexual inactivity at this reproductive stage is warranted.

Sexual communication, dyadic adjustment, and psychosexual well-being in premenopausal women with self-reported dyspareunia and their partners: a controlled study

INTRODUCTION

Although research that takes into account partner and relationship factors in dyspareunia is slowly emerging, little is known about how these couples communicate about their sexuality. Additionally, partner psychosexual adjustment has not been examined in a controlled fashion.

AIM

This study aimed to compare dyadic sexual communication, dyadic adjustment, psychological adjustment, and sexual well-being of women with self-reported dyspareunia and their partners with those of pain-free control women and their partners.

METHODS

Premenopausal women (n = 38; mean [M] age = 24.92) with self-reported dyspareunia, their partners (n = 38; M age = 26.71), as well as pain-free control women (n = 44; M age = 25.86) and their partners (n = 44; M age = 27.95) completed an online survey measuring dyadic sexual communication, dyadic adjustment, anxiety, depression, sexual functioning, and sexual distress.

MAIN OUTCOME MEASURES

Assessments of women and men's (i) dyadic sexual communication; (ii) dyadic adjustment; (iii) anxiety; (iv) depression; (v) sexual functioning; and (vi) women's sexual distress were the main outcome measures.

RESULTS

Compared with pain-free controls, women with dyspareunia reported significantly poorer dyadic sexual communication, a difference not found between partners of women with dyspareunia and control partners. Compared with partners of control women, those of women with dyspareunia reported significantly more impaired sexual functioning. No differences in dyadic adjustment were found between women with dyspareunia and pain-free control women, or between their respective partners. Finally, compared with control women, those with dyspareunia reported significantly more impaired psychological and sexual well-being.

CONCLUSIONS

Findings suggest that dyspareunia impacts not only the psychosexual adjustment of affected women but also that of their partners. It seems relevant to include both members of the couple in future research and treatment for dyspareunia.

Prevalence and characteristics of sexual functioning among sexually experienced middle to late adolescents

INTRODUCTION

Little is known about problems in sexual functioning among young people, despite the high rates found in adult samples. It is unclear which problems are most prevalent or how common sexual distress is for young people experiencing problems.

AIMS

This study aims to assess the prevalence, range, and correlates of sexual problems and distress among a sample of adolescents (16-21 years).

METHODS

Participants (mean age 19.2) were recruited from community and area high schools. Male adolescents (n = 114) completed online the International Index of Erectile Function (IIEF) and Premature Ejaculation Diagnostic Tool (PEDT). Female adolescents (n = 144) completed the Female Sexual Function Index (FSFI). Both completed the Female Sexual Distress Scale (FSDS) and the measures of background, relationship characteristics, and sexual histories.

MAIN OUTCOMES MEASURES

Clinical cutoff scores on the IIEF, PEDT, FSFI, and FSDS were used to determine whether there was a significant sexual problem.

RESULTS

Adolescents reported extensive sexual experience, most in relationship contexts. Half of the sample (51.1%) reported a sexual problem; 50.0% reported clinically significant levels of distress associated with it. Similar rates of problems and distress were found among male and female adolescents. For the most part, adolescent characteristics, backgrounds, and experience were not associated with adolescents' sexual problems.

CONCLUSION

Sexual problems are clearly prevalent among adolescents, and distressing to many who experience them, emphasizing a strong need to develop programs to address this issue.