"That's Kind of One of Our Jobs": Sexual Activity as a Form of Care Work Among Women with Sexual Difficulties

The scarlet V: how women with dyspareunia negotiate postfeminist discourses of sexual agency

Young women must often contend with cultural scripts dictating neoliberal/postfeminist ideals of female sexual agency, including the ability to act in accord with one's personal sexual self-interest. The aim of this study was to explore how young women (n = 26) living with dyspareunia (pain experienced during penetrative sexual activity) negotiate these ideals. We found that in addition to discussing traditional discourses that assign value to women in accordance with their perceived sexual virtue, women judged themselves according to the degree to which their behaviour reflected sexual agency. Women perceived to be sexually agentic were, for the most part, lauded, while those perceived to lack sexual agency were either denigrated (in the case of high sexual activity) or seen as deficient (in the case of low sexual activity). The inability to be penetrated without pain significantly limited women's sexual repertoires. Contrasting their sexual agency with that of other women and of their past selves, women expressed feelings of disempowerment. Conceptualising agency as a spectrum rather than something that one has or lacks, as well as actively cultivating the potentialities of sexual 'transgression', may allow young women to resist heteronormative sexual hierarchies - including those rooted in a a postfeminist ethos.

Reduced Sexual Desire in Young Norwegian Women: A Mixed-Methods Study

Sexuality has become an area of social competence in which individuals strive to be recognized as sexually competent performers. However, a large proportion of young women experience reduced sexual desire. In this study, both quantitative and qualitative methods were applied. Using data from a questionnaire, the aim of this study was to explore the prevalence of, and the factors associated with, lack of sexual interest and desire among young women in Norway. Further, with the help of in-depth interviews, we investigated how young women with reduced sexual desire experience living with their desire problems and what they experience as the cause of their problems. The sample in the quantitative study consisted of 505 Norwegian women between the ages of 18 and 29 years. ANOVA was employed to explore differences in scores on psychological factors and relational factors, as well as between participants who experienced a lack of sexual interest and desire, and those who did not. The results indicate a high prevalence of lack of sexual interest and desire among women (37.1%), while low appearance satisfaction and low relationship satisfaction were central predictors of lack of sexual interest and desire. The sample in the qualitative study consisted of ten Norwegian women with reduced sexual desire between the ages of 18 and 29 years. Through thematic analysis, four themes emerged as experiences of living with reduced sexual desire: (1) physical and mental health, (2) being a young woman in today's society, (3) relational factors, (4) negative experiences, personal expectations toward sexuality, and sexual trauma.

"A Woman Should Still Be a Woman" - A Grounded Theory of the Origins of Sexual Pain and Difficulties with Intercourse

The origin of women's sexual pain and difficulties with intercourse is still under-researched. The aim of this study was to examine women's constructions of origins. Twenty-eight participants previously diagnosed with vaginismus or dyspareunia were recruited via patient lists and private practices. Interviews had a semi-structured biographic-narrative format; transcripts were analyzed using Grounded Theory. Participants' narratives were constructed based on two major processes: Negotiating Womanhood and Othering the Body. They were integrated in an explanatory model. Identified processes permeated women's subjective experience and construction of the origin of their sexual difficulties, and were related to societal discourses and women's embodied experience.

The Tampon Test as a Primary Outcome Measure in Provoked Vestibulodynia: A Mixed Methods Study

BACKGROUND

Provoked vestibulodynia (PVD) is characterized by severe pain, often induced by penetrative sex. This may lead to women abstaining from sexual intercourse, hence the recording of pain intensity levels in PVD research is often challenging. The standardized tampon test was designed as an alternative outcome measure to sexual intercourse pain and has frequently been used in clinical studies.

AIM

The aim of this mixed methods study is to evaluate the tampon test as a primary outcome measure for an upcoming randomized clinical trial for women with PVD.

METHODS

An explanatory sequential design was applied, integrating quantitative and qualitative methods. In phase one, pain intensity levels were evaluated with the tampon test amongst 10 women, aged 18-33, with PVD. The test was repeated on day 1, 7 and 14. Pain intensity was rated on the Numerical Rating Scale (NRS), (0-10), 10 being worst possible pain. In phase two, the participants' experiences with the test were explored with semi-structured interviews using a descriptive and inductive qualitative design. All participants were recruited from the Vulva Clinic, Oslo University Hospital, Norway.

OUTCOMES

The tampon test data and interviews were brought together to see how the interviews could refine and help to explain the quantitative findings.

RESULTS

The tampon test data demonstrated large intra- and inter-individual variability. Median tampon pain intensity was 4.5 (min=1.7; max=10; Q1=2.5; Q3=6). Many experienced the test as an inadequate representation of pain during intercourse as it was less painful, different in nature and conducted in an entirely different context. Four participants had a mean score of four or lower on the NRS, whilst concurrently reporting high levels of pain during sexual intercourse.

CLINICAL IMPLICATIONS

The findings indicate that the tampon test may underestimate severity of pain among some women with PVD. Participants with low pain scores would be excluded from studies where the tampon test is part of the trial eligibility criteria, even though severe pain was experienced during sexual intercourse. Large intra-individual variability in pain scores also reduces the test's ability to register clinical meaningful changes and hence necessitates repeated measurements per assessment time point.

CONCLUSION

Although the tampon test has many advantages, this study indicates several potential problems with the application of the test as a primary outcome measure in PVD. In our opinion the test is most useful as a secondary outcome, preferably undertaken repeatedly in order to increase precision of the pain estimation. Kaarbø MB, Danielsen KG, Haugstad GK, et al. The Tampon Test as a Primary Outcome Measure in Provoked Vestibulodynia: A Mixed Methods Study. J Sex Med 2021;18:1083-1091.

When Desire Fades: Women Talk About Their Subjective Experience of Declining Sexual Desire in Loving Long-term Relationships

Women's sexual desire has been shown to decline over the course of loving long-term relationships. Yet, accounts of partnered women's subjective experience of this occurrence are rather limited. In order to broaden the examination of this topic, the present exploratory qualitative study extended it cross-culturally to explore how women in Israel are impacted by, perceive, and experience this decline in their sexual desire, with the objective of sketching an account of the experiences of women who share this reality. Semi-structured interviews were conducted with 15 women, aged 25 and over, in fulfilling long-term heterosexual relationships. The participants reported a sharp decline in sexual desire in comparison to the early stages of the relationship, experiencing it as quite perplexing given their love and affection for their partner. All also described their intimate connection as based on much more than sex. Additionally, while the reduction in desire did not result from difficulties in the relationship it did create some. These included frustration, conflict, and pressure from partner, which often led to sexual compliance on the women's part. Suggested solutions included open and honest dialogue, thoughtfulness, and mutual respect. A critical discussion of the findings outlines implications for partnered women's and couples' wellbeing.

Romantic Relationship Conflict Due to the COVID-19 Pandemic and Changes in Intimate and Sexual Behaviors in a Nationally Representative Sample of American Adults

In early 2020, the novel coronavirus 2019 (COVID-19) spread across the United States and mitigation measures drastically affected the daily lives of Americans. In this study, we assessed the association between COVID-related relationship conflict and changes in intimate and sexual behaviors and experiences. Using data from an online nationally representative probability survey of 1,010 American adults in April 2020, we estimated the impact of coronavirus-related relationship conflict on changes in intimate and sexual behaviors among those in any type of romantic or sexual relationship (N_weighted=742). Further, we assessed the association between conflict and experience of orgasm and feeling emotionally close to partner. Among individuals in relationships, 34% reported some degree of conflict with their romantic partners due to the spread of COVID-19 and its related restrictions. Those experiencing frequent coronavirus-related conflict with their partner were significantly more likely to report decreased frequency of several solo and partnered intimate and sexual behaviors compared to those not experiencing any such conflict, exhibiting a dose-response trend among partnered sexual behaviors. Since the spread of coronavirus and associated social distancing measures in the United States, Americans have experienced escalations in conflict in their romantic partnerships, which was associated with changes to their intimate and sexual lives.