Is sexual well-being part of subjective well-being? An empirical analysis of Belgian (Flemish) survey data using an extended well-being scale

Development and Validation of a Brief Measure of Sexual Wellbeing for Population Surveys: The Natsal Sexual Wellbeing Measure (Natsal-SW)

Sexual wellbeing is an important aspect of population health. Addressing and monitoring it as a distinct issue requires valid measures. Our previous conceptual work identified seven domains of sexual wellbeing: security; respect; self-esteem; resilience; forgiveness; self-determination; and comfort. Here, we describe the development and validation of a measure of sexual wellbeing reflecting these domains. Based on the analysis of 40 semi-structured interviews, we operationalized domains into items, and refined them via cognitive interviews, workshops, and expert review. We tested the items via two web-based surveys (n = 590; n = 814). Using data from the first survey, we carried out exploratory factor analysis to assess and eliminate poor performing items. Using data from the second survey, we carried out confirmatory factor analysis to examine model fit and associations between the item reduced measure and external variables hypothesized to correlate with sexual wellbeing (external validity). A sub-sample (n = 113) repeated the second survey after 2 weeks to evaluate test-retest reliability. Confirmatory factor analysis indicated that a "general specific model" had best fit (RMSEA: 0.064; CFI: 0.975, TLI: 0.962), and functioned equivalently across age group, gender, sexual orientation, and relationship status. The final Natsal-SW measure comprised 13 items (from an initial set of 25). It was associated with external variables in the directions hypothesized (all p < .001), including mental wellbeing (0.454), self-esteem (0.564), body image (0.232), depression (-0.384), anxiety (-0.340), sexual satisfaction (0.680) and sexual distress (-0.615), and demonstrated good test-retest reliability (ICC = 0.78). The measure enables sexual wellbeing to be quantified and understood within and across populations.

Promoting sexual well-being of college students through wellness programs

Objective: Despite a growing emphasis on holistic student wellness in higher education, sexual well-being often remains neglected as part of wellness. We conducted a website content review to assess the broad utilization of wellness models and the specific integration of sexual well-being into wellness programs. Methods and results: Targeting 51 flagship and top 50 private institutions, we found that 82.35% of flagships and 64.00% of top private institutions mentioned some form of the wellness model. However, integration of the wellness model into on-campus or local resources varied considerably across institutions. Importantly, only two institutions (both private) addressed sexuality as its own unique dimension of wellness. Conclusion: The current study underscores the need for wellness programs to include a focus on sexual well-being. Skills and knowledge that college students learn through wellness programs can help them make better health decisions and improve their quality of life while in college and beyond.

A new sexual wellbeing paradigm grounded in capability approach concepts of human flourishing and social justice

Over the last twenty years, there has been a growing interest in measuring sexual wellbeing, including by a WHO/UNFPA working group in 2007, which sought clarity on key dimensions and asked for indicators of these to be devised. However, there remains a lack of conceptual clarity surrounding the concept of sexual wellbeing, which may create variation in what is being assessed and to what we are referring. This paper proposes one way in which to achieve conceptual clarity might be through the utilisation of a Capability Approach, thereby posing a new set of normative questions about what sexual wellbeing is. The central argument in this paper is for researchers, theorists and practitioners to focus more fully on a person's freedom to achieve sexual wellbeing within a particular social and cultural context. We suggest the kinds of data that might need to be captured to operationalise and measure such an understanding. By offering new critical insights, we hope to drive forward empirical and methodological development in the evaluation of sexual wellbeing.

“Sex as a way to gain some control”: Sexual subjectivity during the COVID-19 pandemic

The COVID-19 pandemic has shifted dynamics of sexual health, including sexual subjectivity, or the way in which someone thinks of themself as a sexual being and feels entitled to pleasure. This study examines how adults in the US perceive changes in their sexual subjectivity related to the pandemic. We conducted an online survey ( N = 326), and included thematic analyses related to open-ended questions. The following themes emerged: intentional self-reflection, control of change, control of perspective, control of relationships, control of communication, and control of sexual behavior. Our findings have implications for psychological and public health approaches. We find large overlap of “capacity and engagement in self-reflection” across other themes. The implications and durability of these changes are unknown.

Determinants of health-related quality of life in young adults living with perinatally acquired HIV infection in Botswana

Background

Due to the successful antiretroviral therapy (ART) programme in Botswana, large numbers of perinatally HIV-infected adolescents are emerging into young adulthood. Young adulthood is a critical period of human development. However, there is lack of information on the factors affecting the health-related quality of life (HRQOL) of young adults living with perinatally acquired HIV (YALPH) in Botswana.

Objectives

The objective of this study was to assess the HRQOL and its determinants among YALPH who were enrolled on ART at Botswana-Baylor Children’s Clinical Centre of Excellence in Gaborone, Botswana.

Method

A cross-sectional study assessed the HRQOL of 509 YALPH aged 18–30 years using the WHOQOL-HIV BREF. Data about other variables of interest were abstracted from medical records. Bivariate analyses were performed using t and Chi-square tests to determine the associations between demographic and clinical variables and general HRQOL. The variables that were associated with the general HRQOL at P-value < 0.1 were included in the multivariable analysis using the logistic regression approach.

Results

The majority of participants had good general HRQOL (78.4%). The highest mean HRQOL score was in the Physical domain (5.4 [± 2.9]) and the lowest in the Environment domain (13.8 [± 2.7]). The factors that were significantly associated with the general HRQOL included: level of education attained (P = 0.012), employment status (P = 0.069), viral load suppression (P = 0.073) and self-reported illness (P = 0.001).

Conclusion

Interventions that effectively increase educational attainment, employment opportunities, ART adherence, and prevention or management of illness are needed to promote good HRQOL among YALPH in Botswana.

Sexual Health in COPD: A Systematic Review and Meta-Analysis

COPD has a profound impact on the lives of patients and their partners, but the influence on physical, psychological and social aspects of sexual health has not been reviewed systematically. Searches for studies of the impact of COPD on sexual health were conducted independently by two authors in the databases of PubMed, PsycINFO, Embases, CINAHL, Web of Science, Scopus and The Cochrane Library. English-language quantitative and qualitative studies assessing one or more aspects of sexual health in patients diagnosed with COPD were narratively reviewed and, when possible, subjected to meta-analytic evaluation. A total of 31 studies, including 4 qualitative, were included. Twelve studies assessing erectile dysfunction with the International Index of Erectile Function were subjected to meta-analysis. The pooled prevalence of erectile dysfunction was 74% (95% CI: 68-80%) in a total of 1187 patients with COPD, compared with 56% (37-73%) in 224 age-matched, non-COPD controls. The sexual health outcomes assessed in the remaining studies varied considerably, compromising the comparability of the results. None of the qualitative studies had sexual health as their primary focus. Compared with non-COPD individuals, erectile dysfunction appears to be more prevalent among patients with COPD, but more studies including non-COPD controls are needed to confirm this finding. In addition, the impact of COPD on other physical, psychological and social aspects of sexual health remains unclear due to the lack of comparable assessment methods and study designs.

In Pursuit of Pleasure: A Biopsychosocial Perspective on Sexual Pleasure and Gender

Objective: Various sources of evidence suggest that men and women differ in their experience of sexual pleasure. Such gender differences have been attributed to men's higher innate sex drive, supported by evolutionary psychology perspectives and gender differences in reproductive strategies. Method: This paper presents biopsychosocial evidence for gender similarities in the capacity to experience pleasure, and for substantial gender differences in opportunities for sexual pleasure. Results: We conclude that sexual activity, in most cultures, is less pleasurable and associated with greater cost for heterosexual women than for heterosexual men, even though they do not differ in the capacity for sexual pleasure. Conclusion: Since gender differences in experienced sexual pleasure are not a biological given, a more critical discourse of sexual pleasure might create awareness of current inequalities, help lift restrictions for women's opportunities for pleasure, and could reduce gender differences in the cost of sex. That would truly serve sexual justice around the globe.

Psychological Distress in Erectile Dysfunction: The Moderating Role of Attachment

Introduction

In clinical consultations, men with erectile dysfunction do not always express personal, sexual, and interpersonal concerns.

Aim

We explore whether the attenuated impact of erectile dysfunction may be explained by a regulation of negative affect that causes activation of the attachment system.

Methods

The study sample consisted of 69 men diagnosed with erectile dysfunction, mean (SD) age 56 (10.83) years. Participants completed self-reported questionnaires to assess erectile dysfunction severity, attachment style, sexual satisfaction, relationship satisfaction, and psychological symptoms.

Main Outcome Measure

The moderating role of attachment between erectile dysfunction and sexual satisfaction, relationship satisfaction, and psychological distress was evaluated using multiple linear regression and moderation analysis.

Results

All men in the sample had high attachment avoidance, distributed between the dismissive-avoidant (69.6%) and fearful-avoidant (30.4%) substyles, but low levels of psychological symptoms. Despite their erectile dysfunction, 27 patients (39.1%) rated their sexual life as satisfactory, and 46 (66.7%) rated their relationship with their partner as satisfactory. Men with fearful-avoidant attachment reported feeling more sexual desire and less sexual satisfaction than men with dismissive-avoidant attachment. Multiple linear regression analysis showed that sexual satisfaction variance was explained by erectile dysfunction severity, attachment anxiety, and relationship satisfaction scores. Moderation analysis showed that attachment anxiety, but not relationship satisfaction, moderated the impact of erectile dysfunction on sexual satisfaction.

Conclusion

The avoidance dimension of attachment, which tends to be high in patients with erectile dysfunction, involves deactivation of the sexual system in an effort to minimize the emotional distress associated with erectile dysfunction, which damages sexual and relationship intimacy and delays the decision to obtain professional help. The presence of high attachment avoidance and the moderating value of attachment anxiety allow us to propose specific treatments for these men.

Maestre-Lorén F, Castillo-Garayoa JA, López-i-Martín X, et al. Psychological Distress in Erectile Dysfunction: The Moderating Role of Attachment. Sex Med 2021;9:100436.

What is sexual wellbeing and why does it matter for public health?

Sexual health has provided a guiding framework for addressing sexuality in public health for several decades. Although the WHO definition of sexual health is revolutionary in acknowledging positive sexuality, public health approaches remain focused on risk and adverse outcomes. The long-standing conflation of sexual health and sexual wellbeing has affected our ability to address everyday sexual issues. This Viewpoint provides a way forward to resolve this impasse. We propose sexual wellbeing as a distinct and revolutionary concept that can be operationalised as a seven-domain model. We situate sexual wellbeing alongside sexual health, sexual justice, and sexual pleasure as one of four pillars of public health enquiry. We argue that sexual wellbeing is imperative to public health as a marker of health equity, a meaningful population indicator of wellbeing, a means to capture population trends distinct from sexual health, and an opportunity to refocus the ethics, form, and practices of public health.

A Randomized Trial of a Relationship-Enhancement Approach in Improving Marital Intimacy in Middle-Aged Iranian Couples

The purpose of this study was to evaluate the effects of a relationship enhancement education and counseling (REEC) program on improving middle-aged couples' marital intimacy. The randomized controlled trial study was conducted in Tabriz, Iran, from May to December 2017. Thirty-two married couples, attending a public health center and meeting the inclusion criteria, were randomly assigned to the intervention (receiving REEC) and control (receiving routine care) groups. The outcome measures were marital intimacy, sexual motivation, and sexual function. Data were collected at three points in time. The Statistical Package for the Social Sciences was used for the purpose of data analysis. In all analyses, the interventional group outperformed the control group on all outcome measures. In the intervention group, results showed statistically significant improvement in all variables of interest after one week and 12 weeks in comparison with preintervention. Upon the completion of the experimentation, it can be concluded that a REEC program positively affects marital intimacy, sexual function, and sexual motivation in middle-aged couples.

Cognitive Impairment, Sexual Activity and Physical Tenderness in Community-Dwelling Older Adults: A Cross-Sectional Exploration

BACKGROUND

The ability to engage in sexual activity and better cognitive functioning are both associated with better health. However, the association between cognitive functioning and sexual activity is understudied.

OBJECTIVE

To examine the association between cognitive functioning with sexual activity and physical tenderness among community-dwelling older adults.

METHODS

From the Rotterdam Study, cognitive impairment and sexual activity were assessed in 4,201 community-dwelling, 60+ year olds between 2008 and 2014 in the Netherlands. Mild cognitive impairment (MCI) was based upon subjective complaints related to age and education-adjusted test scores. Mini-Mental State Examination (MMSE) impairment was defined by a score of < 26. Sexual activity and physical tenderness (e.g., fondling or kissing) in the last 6 months were assessed at an interview. Analyses were stratified by gender and partner status, with prevalence rates for the "no impairment" categories weighted based on age from the cognitive impairment categories. Inter-rater reliability was examined utilising 74 cohabiting couples of opposite gender.

RESULTS

It was found that 14% were categorised as having cognitive impairment, and < 1% as dementia (excluded from subsequent analyses). There was strong evidence that the odds of engaging in physical tenderness (observed through MMSE < 26, OR 2.14, 95% CI 1.32-3.48, p = 0.002) and sexual activity (MCI, OR 2.36, 95% CI 1.35-4.12, p = 0.003) among partnered females with no impairment was twice that observed among cognitively impaired partnered females. There was weak evidence that the odds of engaging in physical tenderness (MMSE < 26, OR 1.59, 95% CI 1.04-2.42, p = 0.03) and sexual activity (MMSE < 26, OR 1.51, 95% CI 1.02-2.24, p = 0.04) among partnered males with no impairment was 50% greater than observed among cognitively impaired partnered males. The associations between cognitive functioning and physical tenderness continued to remain after adjustment for physical function, diabetes, cardiovascular disease and cancer. There was no clear evidence of a difference between amnestic and non-amnestic MCI for sexual behaviour. There was moderate to substantial agreement among the coupled adults who had 1 partner categorised with MCI.

CONCLUSION

Having no cognitive impairment was associated with more engagement in sexual activity and physical tenderness among community-dwelling older adults. Sexuality is an important aspect of active aging and our findings illustrate a potential barrier to maintaining or instigating intimate relationships as we age. Longitudinal analyses are required to explore the direction of effect.

Sex Life Satisfaction in Sub-Saharan Africa: A Descriptive and Exploratory Analysis

Nearly all of the sex life satisfaction literature has dealt with developed-country settings, and nothing has been published on sex life satisfaction in sub-Saharan Africa. Not only is sub-Saharan African a substantively relevant area in its own right, but it also provides a useful point of comparison for patterns and relations found in developed-world contexts. A brief descriptive and exploratory study of sex life satisfaction in sub-Saharan Africa was conducted using the World Gallup Poll, a dataset with representative sex life satisfaction data for 31 countries and 25,483 cases. In general, there was little variation in weighted averages across countries, and most of the samples surveyed were satisfied with their sex lives, with the modal score being a perfect 10. Furthermore, what variation did exist could not be attributed to level of economic development or gender inequality. Within countries, sociodemographic associations generally comported with patterns found in other contexts: income, education, and being partnered were generally associated with sex life satisfaction, and for two of the four UN subregions (West Africa and East Africa), males were significantly more satisfied with their sex lives than women. The relationship with age demonstrated a curvilinear relationship, with the peak age of sexual satisfaction in the late 20s to early 30s depending on the geographic region. The age pattern was not due to health differences, but combining estimators after a seemingly unrelated regression suggests that 4-12% of the effect of income on sex life satisfaction was attributable to better health. In general, religiosity and perceived gravity of the HIV/AIDS problem in one's country were not significantly related to sexual satisfaction.

The More or the Better? How Sex Contributes to Life Satisfaction

Much cross-sectional research documented associations between sexuality and life satisfaction, but very little longitudinal research on the topic has considered whether changes in sexuality and life satisfaction unfold together over time. Using data from 5582 individuals in partnerships surveyed across 5786 intimate relationships (providing 18,712 observations for analysis) during five waves of the German Family Panel (pairfam), this study examined whether intraindividual changes in sexual frequency and satisfaction were associated with corresponding intraindividual changes in life satisfaction. Fixed effects regression modeling results showed that individuals reported a greater increase (decrease) in life satisfaction when they also experienced a more substantial increase (decrease) in sexual frequency and satisfaction. This finding was consistent for men and women. This study contributes to the literature by documenting that naturally occurring increases in sexual frequency and satisfaction over time predicted corresponding increases in life satisfaction.

Happiness, rather than depression, is associated with sexual behaviour in partnered older adults

Background

The relation between positive psychological well-being (PPWB) and sexual behaviour is understudied in older adult groups.

Objective

To examine the relation between PPWB (positive affect and life satisfaction) and sexual behaviour (sexual activity and physical tenderness) in older adults, and whether it is independent from depressive symptoms and uniform across older age groups.

Design

Cross-sectional.

Setting

Community-dwelling adults aged 65 years or older, Rotterdam, The Netherlands.

Methods

Sexual behaviour, the Cantril Self-Anchoring Striving Scale, the Center for Epidemiological Studies Depression (CES-D) scale and partner status were assessed in 2,373 dementia-free older adults from the Rotterdam Study.

Results

For partnered participants, greater positive affect and life satisfaction was associated with more sexual activity and physical tenderness. Although CES-D was negatively associated with sexual behaviour within partnered older adults, there was no association between the negative affect sub-scale and sexual behaviour. The relations were independent of depressive symptoms, physical health and chronic disease status and were observed for both sexes at all older ages. For unpartnered participants, greater life satisfaction and was associated with more physical tenderness. There was low prevalence of sexual behaviour in unpartnered participants, limiting further stratification.

Conclusion

Greater PPWB was associated with more sexual behaviour in partnered, community-dwelling older adults. We are the first to demonstrate that sexual behaviour is associated with PPWB, rather than lack of depressive symptoms; and that the association was present at all ages for partnered older adults. Limited conclusions can be drawn for unpartnered older adults as their sexual behaviour was infrequent.

Subjective Sexual Well-Being in Chilean Adults: Evaluation of a Predictive Model

Research on sexuality has traditionally focused on sexual satisfaction, with studies into subjective sexual well-being being a recent phenomenon. This study sought to evaluate the relationship between sexual behavior, happiness, health, and subjective sexual well-being. The data were collected from 862 people aged between 18 and 50 years in Santiago, Chile, and were analyzed by logistic regression analysis. The results showed that sexual behavioral indicators (sexual frequency, sexual caresses, and touching), happiness, and perception of health taken as a whole predicted 47.4% of subjective sexual well-being (SSWB). Analysis of the four items of subjective sexual well-being separately showed that the dimension of physical satisfaction was associated with three variables of sexual behavior indicators with a prediction percentage of 33.5%, whereas emotional satisfaction was associated with three variables of sexual behavior indicators and happiness, with a percentage of prediction of 43.3%. Satisfaction with sexual function was associated with perception of health and one sexual behavior indicator, with a prediction percentage of 29.2% of this variable. The importance of sex was associated with three sexual behavior variables that predicted 26.2% of this variable. The results confirm that subjective sexual well-being can be predicted and that its four dimensions present a different behavior compared to the study predictors.

A Sex-Positive Framework for Research on Adolescent Sexuality

In this article, I propose a sex-positive framework for research on adolescent sexuality in which I consider consensual sexual activities in adolescence as developmentally normative and potentially healthy. The sex-positive framework is contrasted with the predominant "risk" perspective that presumes that abstinence from sexual activity is the ideal behavioral outcome for teenagers. Evidence from longitudinal and behavioral genetic studies indicates that engaging in sexual intercourse in adolescence does not typically cause worse psychological functioning. The relationship context of sexual experience may be a critical moderator of its psychological impact. Moreover, cross-cultural data on adolescents' contraception usage, unintended pregnancy, and sexually transmitted infections suggest that, despite the unacceptably high rate of negative health consequences among U.S. teenagers, adolescents can have the developmental capacity to regulate the health risks inherent in sexual activity. Understanding adolescent sexuality can be fostered by considering sexual well-being, a multidimensional construct that incorporates an adolescent's sexual self-efficacy, sexual self-esteem, feelings of sexual pleasure and satisfaction, and freedom from pain and negative affect regarding sexuality. New research is necessary to understand the development of adolescent sexual well-being, including its normative age trends, its reciprocal links with sexual behavior, and its impact on psychological and physical health.

A Swiss Longitudinal Study of the Prevalence of, and Overlap Between, Sexual Problems in Men and Women Aged 20 to 50 Years Old

The aim of this study was to obtain data on the development and course of sexual problems and their interrelationships by investigating a representative sample of men and women over a period of 30 years. A representative sample of 299 women selected from the complete electoral register and 292 men selected from screening lists for military service in Zurich, Switzerland, answered questions about their sexuality as part of a series of seven interviews between ages 20 (1979) and 50 (2008). Of the initial sample of 591 participants, 43% (57% of them male) were lost to follow-up. Interviews were conducted using the Structured Psychopathological Interview and Rating of the Social Consequences of Psychological Disturbances for Epidemiology (SPIKE), a semistructured interview. Sexual problems were identified on the basis of the study participants' self-appraisal. One-year prevalence rates, lifetime risks, and overlap of functional, emotional, and sexual desire problems in men and women were evaluated. The findings confirmed higher lifetime risks in women than in men for any sexual problem (females 67.0%; males 46.0%) and for functional (39.3%; 22.1%), emotional (35.7%; 15.9%), and sexual desire problems (51.6%; 33.3%). While in general men's sexual problems increased with age, no such association was observed in women. The overlap of all three problems (functional, emotional, and sexual desire) was reported by 16.9% of women but only 5.0% of men. Although there are commonalities, the type but also the development and, in particular, the overlap of sexual problems in women and men are markedly different.