Cumulative Childhood Trauma and Adult Sexual Satisfaction: Mediation by Affect Dysregulation and Sexual Anxiety in Men and Women

An Interpretative Phenomenological Analysis of Black Women's Meaning and Experiences of Sexual Anxiety

Sexual anxiety can activate the stress response cycle during sex, compromising a woman's ability to experience sexual pleasure. Black women face additional cultural and contextual factors, such as hypersexualization, partner scarcity, and higher rates of sexual trauma that may increase the magnitude, frequency, and odds of experiencing sexual anxiety. However, limited research has explored this phenomenon among Black women. Thus, we sought to qualitatively explore how N = 25 premenopausal Black women living in the southern United States make meaning of experiences with sexual anxiety. We analyzed the interview data using an interpretive phenomenological approach. Three components of the phenomenon of sexual anxiety were gleaned: 1) causes of sexual anxiety, 2) characteristics of sexual anxiety, and 3) coping strategies. Each component included three to six elements of meaning making. For these Black women, causes of sexual anxiety included fears of sexual pain, partner unfamiliarity, previous traumas, mental health concerns, and intersecting socio-structural factors. Characteristics of sexual anxiety included mental, somatic, and emotional elements. Coping strategies included having a reassuring and supportive sex partner, supporting themselves with affirmations and mindfulness, attending therapy, and using substances. Through reflection about their perceived causes of, experienced characteristics of, and intentional coping with sexual anxiety, meanings were co-constructed through an intersectional frame. Implications for intersectionality-informed interventions and suggestions for mental health professionals and partners are discussed.

"The sound of silence" Giving voice to endometriosis-related positional dyspareunia

Deep dyspareunia is one of the main symptoms of endometriosis. It appears to be submerged by a two-way disconnection between patients and their physicians. The aim of our review is to provide clear, ready-to-use advice on how to manage deep dyspareunia overcoming the gap in communication. Sexual history should always be taken as part of routine health care in these regards, using a patient-centered approach. An educational pelvic examination, which actively includes patients in the identification of painful areas, may prove useful to improve patients' understanding of their condition. Correlating painful pelvic areas with sexual positions and inviting patients to adopt alternative positions may represent a simple but extremely effective coping strategy to mitigate pain. Revealing and explaining to partners the nature of the pain is essential to allow them to take part in shared research of coping mechanisms, empowering the couple to make choices and changes. Couples who do not feel comfortable talking about intimacy by themselves may find that including a psychotherapist or a sexual therapist, may be a good way to start communication. Investigating and managing dyspareunia during medical encounters is a medical and ethical duty all healthcare practitioners should pursue.

Romantic Attachment, Sex Motives and Sexual Difficulties in Emerging Adults: The Role of Childhood Interpersonal Victimization

A growing body of research has revealed that many emerging adults (i.e., aged 18 to 25) experience sexual difficulties. Past studies have emphasized the need to examine sexual difficulties by accounting for sex motives (i.e., reasons for engaging in sex) and by using a trauma-focused or attachment-based framework. This study examined the role of sex motives in the associations among attachment insecurities (anxiety, avoidance) and sexual difficulties in emerging adults, and assessed whether these links varied on the basis of low or high exposure to childhood interpersonal victimization (CIV) (i.e., 0-3 different types of CIV or 4 or more types of CIV). A sample of 437 French-Canadian emerging adults completed validated questionnaires online. Path analyses revealed that participants with higher attachment anxiety were more likely to endorse the partner approval sex motive, which was related to more sexual difficulties. Participants with higher attachment avoidance were less likely to endorse the pleasure sex motive, which was associated with more sexual difficulties. Results indicated a significant effect of CIV showing that some indirect effects were significant only in participants who reported high CIV exposure. Results suggest that addressing sex motives using an attachment- and trauma-focused framework might help understand, prevent and treat sexual difficulties among emerging adults.

The Impacts of Lifetime Violence on Women's Current Sexual Health

Background

Intimate partner violence (IPV), nonpartner sexual violence (SV), child sexual and physical abuse, and neglect have detrimental impacts on women's reproductive and sexual health. More empirical studies are needed to investigate the negative impacts of lifetime violence, including physical or sexual child abuse, nonpartner SV, physical, sexual, and psychological IPV on women's sexual health to better understand long-term impacts from IPV and physical or sexual child abuse.

Materials and Methods

We used data from Wellness, Health and You, an ongoing health registry. A total of 1,213 women were included in data analysis. Our aim was to investigate the associations between lifetime IPV, nonpartner SV, child abuse, and women's current sexual health defined using Patient-Reported Outcomes Measurement Information System (PROMIS) measures of sexual health (e.g., sexual satisfaction, interest, and functioning), sexual assertiveness, female sexual subjectivity, and use of online resources to address sexual needs. Multivariate analysis of covariance was used to investigate demographic factors (e.g., age and current relationship) as potential correlates of current sexual health.

Results

Women with lifetime experiences of physical, sexual, or psychological IPV, nonpartner SV, and child physical or sexual abuse reported lower sexual satisfaction compared to women with no history of lifetime violence (p < 0.0001). However, lifetime violence was not correlated with sexual interest, sexual functioning, sexual subjectivity, nor sexual assertiveness.

Conclusion

Lifetime experiences of violence (i.e., IPV, nonpartner SV, child abuse) are associated with poorer sexual health. Asking questions about past sexual and physical violence/abuse in ways that support disclosure is important toward improving women's physical and sexual health and wellbeing.

Cumulative childhood trauma, sex motives and sexual satisfaction among emerging adults

BACKGROUND

To better understand sexual satisfaction in emerging adults, previous research has emphasized the importance of considering the role of developmental experiences, such as cumulative childhood trauma (CCT; the number of different forms of abuse and neglect sustained during childhood). However, the mechanisms by which CCT and sexual satisfaction are related remain unknown. Sex motives are suggested as an explanatory mechanism given the previously found associations between sex motives and both sexual satisfaction and CCT.

OBJECTIVE

This study examined the direct associations between CCT and sexual satisfaction, as well as indirect associations through sex motives, in emerging adults.

PARTICIPANTS AND SETTING

A sample of 437 French Canadian emerging adults (76 % women, mean age of 2.3) were recruited.

METHODS

Participants completed online self-reported validated questionnaires assessing CCT, sex motives and sexual satisfaction.

RESULTS

Results from a path analysis revealed that CCT was associated with a higher endorsement of the self-affirmation sex motive (β = 0.25, p < .001) which was linked to lower sexual satisfaction (β = -0.13, p < .001). CCT was also associated with a higher endorsement of the coping (β = 0.25, p < .001) and partner approval (β = 0.09, p < .05) sex motives. A higher endorsement of the intimacy (β = 0.28, p < .001) and pleasure (β = 0.24, p < .001) sex motives, and a lower endorsement of the partner approval sex motive (β =  -0.13, p < .001) were linked to greater sexual satisfaction.

CONCLUSIONS

Results suggest education and intervention targets to improve emerging adults' sexuality.

Adolescents' Self Perceptions: Connecting Psychosocial Competencies to the Sexual Self-Concept

Adolescence is a crucial period for the development of the sexual self-concept. While existing research shows that adolescents' sexual self-concept varies, few studies have examined its relation with psychosocial competencies such as the general self-concept, interpersonal skills, and self-control capacities. The objective of this study was to examine the association between dimensions of the sexual self-concept (sexual self- and body esteem, self-efficacy, and anxiety) and psychosocial competencies among Canadian adolescents. Self-reported data from 1584 adolescents aged between 14 and 18 years (49.7% girls) were analyzed using path analysis. Results show that adolescents whose general self-concept was characterized by more internally consistent self-beliefs and greater self-worth, and who perceived their interpersonal skills as more developed, displayed higher sexual self- and body esteem, higher sexual self-efficacy, and lower sexual anxiety. Self-control capacities were positively correlated with sexual body-esteem and negatively correlated with sexual anxiety. These associations were, however, minimal and, when significant, exhibited a counterintuitive relationship with the sexual self-concept in the path model. Age, gender and sexual experience did not moderate these associations. Findings from the study highlight the need to pursue research on the interface between sexuality and psychosocial functioning to increase current understanding of adolescent development.

Cumulative Childhood Trauma, Communication Patterns, and Intimate Partner Violence Perpetrated by Men Seeking Help

Intimate partner violence (IPV) is a complex and multifactorial public health problem associated with important physical and psychological repercussions. Recent studies suggest that cumulative childhood trauma (CCT) may be related to higher IPV perpetration through dysfunctional communication patterns, but to our knowledge, no study has tested this proposition in a clinical population. This study aimed to explore the direct and indirect links between CCT and perpetrated IPV through dysfunctional communication patterns among 577 men seeking help from community centers specializing in IPV. Prior to receiving services, participants completed a battery of questionnaires including validated brief measures of CCT (sexual, physical, and psychological abuse; physical and psychological neglect; witnessing of physical and psychological parental violence; bullying), communication patterns (demand/demand, partner demands/man withdraws, man demands/partner withdraws), and IPV (psychological, physical, coercive control). Results from a path analysis reveal that having sustained a higher number of different forms of childhood trauma is directly related to men's higher risk of perpetrating psychological IPV. CCT is also indirectly related to higher perpetrated psychological and physical IPV and coercive control through a higher report of the demand/demand communication pattern and a higher report of the man demands/partner withdraws communication pattern. The tested model explains 23% of the variance in psychological IPV, 6% of the variance in physical IPV, and 12% of the variance in coercive control. Results highlight the importance of assessing, in therapy, both distal and proximal variables associated with IPV, including the accumulation of many forms of childhood interpersonal trauma, and to tailor trauma-informed interventions that promote constructive communication strategies.

Adverse childhood experiences and sexual dysfunction in midlife women: Is there a link?

BACKGROUND

One in 3 children has had at least 1 adverse childhood experience (ACE), and ACEs have been associated with multiple medical and psychiatric morbidities in women later in life, including greater menopause symptom burden.

AIM

To evaluate the association between ACEs and female sexual dysfunction (FSD) in midlife women.

METHODS

A cross-sectional analysis from DREAMS-the Data Registry on Experiences of Aging, Menopause, and Sexuality-was conducted with questionnaires completed by women aged 40 to 65 years who presented to a women's health clinic at Mayo Clinic in Rochester, Minnesota, from May 2015 to December 2016. History of ACEs was obtained with the validated ACE questionnaire. FSD was assessed by the Female Sexual Function Index and the Female Sexual Distress Scale-Revised.

OUTCOMES

The association between ACEs and FSD (defined as Female Sexual Function Index score ≤26.55 and Female Sexual Distress Scale-Revised score ≥11) was evaluated via a multivariable logistic regression model, adjusting for age, menopause status, hormone therapy use, anxiety, depression, relationship satisfaction, hot flash severity, and history of abuse in the past year.

RESULTS

Women (N = 1572) had a mean age of 53.2 years. Overall 59% reported having at least 1 ACE. When compared with no ACEs, a history of ≥4 ACEs significantly increased the odds of not being sexually active (odds ratio, 1.83; 95% CI, 1.30-2.57; P < .001). Among sexually active women, the proportion of women with FSD increased sequentially as the number of ACEs increased. In the univariate analysis, a history of ≥4 ACEs significantly increased the odds of FSD as compared with no ACEs (odds ratio, 2.12; 95% CI, 1.50-2.99; P < .001). The association remained statistically significant in the multivariable analysis after adjusting for confounders (odds ratio, 1.75; 95% CI, 1.15-2.68; P = .009).

CLINICAL IMPLICATIONS

The findings highlight an opportunity for clinicians to screen for ACEs in women with sexual dysfunction and offer appropriate treatment and counseling as indicated.

STRENGTHS AND LIMITATIONS

Strengths of the study include the large cohort, the use of validated tools for assessment of ACEs and FSD, and the adjustment for multiple potential confounding factors. Limitations include the cross-sectional study design, recall bias in reporting ACEs and recent abuse, and the low representation of racially and ethnically diverse women in the cohort.

CONCLUSION

The study demonstrates an increased risk of sexual inactivity and sexual dysfunction in midlife women who experienced childhood adversity. The sexual dysfunction in women with ACEs seems to be independent of other factors that potentially affect female sexual function in midlife.

Complex factors related to marital and sexual satisfaction among couples undergoing infertility treatment: A cross-sectional study

Objectives

This study assesses complex factors related to marital and sexual satisfaction among couples undergoing infertility treatment.

Methods

This cross-sectional study was conducted with 140 couples who visited fertility centers in Iran, between September 2015 and July 2016. Data collection was done by Marital and Sexual Satisfaction Questionnaires and were analyzed by the IBM SPSS 26 software.

Results

There was a significant difference between wives and husbands in the MSQ total scores (p = 0.027). However, there was no significant difference between wives and husbands in the SSQ total scores (p = 0.398). Sexual satisfaction and decision-maker in life among wives and husbands were significant predictors of MSQ. The kind of treatment, cause of infertility and BMI among wives and kinds of treatment, cause of infertility, and decision-maker among husbands were also significant predictors of SSQ.

Conclusion

The findings of this study showed that there is a difference between the understanding of marital and sexual satisfaction in wives and their husbands. Healthcare providers need to pay more attention to these differences.

Child Maltreatment and Couples' Sexual Health: A Systematic Review

INTRODUCTION

Childhood maltreatment (CM) is an interpersonal trauma reported by 35% to 40% of individuals in population-based studies in North America. It refers to physical, sexual, and emotional abuse, as well as physical and emotional neglect. Although there is a growing body of cross-sectional work focusing on associations between CM and sexual health, most studies have ignored the broader relationship context in which sexuality is experienced.

OBJECTIVES

The current review sought to systematically and critically appraise all studies that reported on the association between CM and couples' sexual health, to inform clinical care and recommendations for research.

METHODS

The electronic literature search was conducted using PubMed, PsycNET (PsycINFO, PsychArticles), Medline, CINAHL, and Eric for peer-reviewed journal articles published before September 2021. Eligible studies had to report on the association between any form of CM and any dimension of sexual health in couples or individuals in a romantic relationship.

RESULTS

In total, 13 studies (18 articles) were included in this systematic review: 4 studies pertained to clinical couples and 9, to community couples; 2 studies used a longitudinal design and 11, a cross-sectional design; 3 studies examined CM as a whole, 2 studies examined multiple subtypes of CM separately, 1 study examined both CM as a whole and its subtypes separately, whereas the other 7 studies focused on childhood sexual abuse. Results indicated that studies using valid measures of sexual health outcomes found significant associations between CM and worse outcomes - including declines over time - in both clinical and community samples. Mediators and moderators of these associations were also identified.

CONCLUSIONS

Findings provide preliminary support for the role of CM in couples' sexual health. There is a need for future longitudinal studies involving both members of the couple, valid and multidimensional measures of sexual health, and potential mediators and moderators. Bergeron S, Bigras N, Vaillancourt-Morel M-P. Child Maltreatment and Couples' Sexual Health: A Systematic Review. Sex Med Rev 2022;XX:XXX-XXX.

Roles of Psychological Distress and Social Support in the Relationship Between Childhood Maltreatment and Perceived Needs for Mental Health Care

Childhood maltreatment is a major public health issue worldwide. It increases a range of health-risk behaviors, psychological and physical problems, which are associated with an increased need for mental health services in adulthood. Identification of mediating factors in the relationship between maltreatment and seeking mental health care may help attenuate the negative consequences of childhood maltreatment and promote more appropriate treatment. This study aims to examine whether the relationship between childhood maltreatment and perceived need for mental health care is mediated by psychological distress and/or moderated by social support. Data from the Canadian Community Health Survey-Mental Health 2012 are analyzed. A total of 8,993 participants, who had complete information on childhood maltreatment and diagnoses of mental disorders or psychological distress, are included in this study. Structural equation modeling and the PROCESS macro were used to identify relationships among childhood maltreatment, perceived needs for mental health care, and psychological distress. Hierarchical linear regression was then used to verify the moderated mediation model. We found that psychological distress partially mediated the effect of childhood maltreatment on perceived needs for mental health care in adulthood. Social support played an important role in terms of moderating the relationship between maltreatment and perceived needs for care. For those with a history of childhood maltreatment, those who perceived a low level of social support were more likely to have higher levels of psychological distress and perceived need for mental health care. This is the first study to identify the separate and combined roles of psychological distress and social support in the relationship between childhood maltreatment and perceived need for mental health care. Selective prevention strategies should focus on social support to improve mental health services among people with a history of childhood maltreatment.

A descriptive study of adverse childhood experiences (ACEs) among female patients with sexual dysfunctions in Armenia

Background

Adverse childhood experiences (ACEs) are associated with increased risk for a wide range of negative health outcomes, in-cluding sexual dysfunctions. There is a growing interest to advance the science of ACEs to improve the lives of children and families worldwide.

Participants and procedure

The purpose of the present study was to explore the extent to which ACEs occur in patients with sexual dysfunctions in Armenia. To this end, the ACE questionnaire was used to assess the presence of adverse experiences from 85 female patients with sexual dysfunctions and 155 sex- and age-adjusted controls.

Results

More than two-thirds of the patients (74.1%) had been exposed to one or more ACEs and 27.2% had been exposed to four or more ACEs. In the control group, these numbers were 56.1% and 18.1% respectively. Patients had significantly higher ACE scores (M = 2.06, SD = 1.95) than the control group (M = 1.65, SD = 2.50). Parental divorce and witnessing mother being abused (treated violently) were the most prevalent adversities in the patients.

Conclusions

The presence of multiple adverse childhood experiences in the patient group suggests that psychogenic factors are likely involved in sexual dysfunctions. ACEs Aware initiatives in Armenia aimed at screening for childhood adversities can improve the treatment of sexual dysfunctions and ultimately improve health and wellbeing.

Attachment and Childhood Maltreatment as Moderators of Treatment Outcome in a Randomized Clinical Trial for Provoked Vestibulodynia

BACKGROUND

Although distal developmental factors, such as attachment and childhood maltreatment (CM), are associated with the occurrence, severity, and adjustment to provoked vestibulodynia (PVD)-the most prevalent form of vulvodynia-no studies to date have examined whether these variables are related to treatment efficacy in the context of PVD. Attachment and CM may act as moderating variables when examining different treatment modalities, whereby individuals with more insecure attachment orientations (anxiety/avoidance) or a history of CM may benefit less from treatments with higher interpersonal contexts, such as sex and couple therapy-a recommended treatment for PVD.

AIM

The present randomized clinical trial (RCT) examined attachment and CM as predictors and moderators of sexual satisfaction, distress, and function at post-treatment and 6-month follow-up while comparing 2 treatments for PVD: Topical lidocaine, and a novel cognitive behavioral couple therapy focused on women's pain and partners' sexuality.

METHODS

One hundred eight women with PVD were randomized to a 12-week treatment of either lidocaine or couple therapy. Women completed questionnaires at pretreatment, post-treatment, and at a 6-month follow-up.

OUTCOMES

(1) Global Measure of Sexual Satisfaction; (2) Female Sexual Distress Scale-Revised; (3) Female Sexual Function Index.

RESULTS

Both attachment and CM were significant moderators of treatment outcomes. At either post-treatment or 6-month follow-up, in the couple therapy condition, women with greater attachment avoidance had poorer outcomes on sexual distress, satisfaction and function, whereas women with higher levels of CM had poorer outcomes on sexual satisfaction and sexual function, compared to women in the lidocaine condition.

CLINICAL IMPLICATIONS

Although these novel findings need further replication, they highlight the importance for clinicians to take into account distal factors, for instance, attachment and CM, when treating sexual difficulties such as PVD, as these variables may affect more interpersonal dimensions of treatment (eg, trust, compliance, etc.) and ultimately, treatment progress.

STRENGTHS & LIMITATIONS

Using a rigorous RCT study design and statistical approach, this study is the first to examine attachment and CM as moderators in the treatment of sexual difficulties. It is however limited by the use of self-report measures, and further studies are necessary to validate the generalizability of current results to other sexual difficulties.

CONCLUSION

Findings support the role of interpersonal factors in the treatment of PVD and indicate that short-term psychological interventions, such as couple therapy, may be less beneficial for women with antecedents of CM and attachment insecurity. V Charbonneau-Lefebvre, M-P Vaillancourt-Morel, NO Rosen, et al. Attachment and Childhood Maltreatment as Moderators of Treatment Outcome in a Randomized Clinical Trial for Provoked Vestibulodynia. J Sex Med 2022;19:479-495.

Sexual symptoms in post-traumatic stress disorder following childhood sexual abuse: a network analysis

BACKGROUND

Even though recent research indicates that sexual symptoms are highly prevalent in post-traumatic stress disorder following childhood sexual abuse and cause severe distress, current treatments neither address them nor are they effective in reducing them. This might be due to a lack of understanding of sexual symptoms' specific role in the often complex and comorbid psychopathology of post-traumatic stress disorder following childhood abuse.

METHODS

Post-traumatic, dissociative, depressive, and sexual symptoms were assessed in 445 inpatients with post-traumatic stress disorder following childhood sexual abuse. Comorbidity structure was analyzed using a partial correlation network with regularization.

RESULTS

A total of 360 patients (81%) reported difficulties engaging in sexual activities and 102 patients (23%) reported to suffer from their sexual preferences. Difficulties engaging in sexual activities were linked to depressive and hyperarousal symptoms, whereas sexual preferences causing distress were linked to anger and dissociation. Dissociative amnesia, visual intrusions, and physical reactions to trauma reminders were of central importance for the network. Dissociative amnesia, depressed mood, lack of energy, and difficulties engaging in sexual activities were identified as bridge symptoms. Local clustering analysis indicated the non-redundancy of sexual symptoms.

CONCLUSIONS

Sexual symptoms are highly prevalent in survivors of childhood sexual abuse with post-traumatic stress disorder. Further research is needed regarding the link of difficulties engaging in sexual activities, depression, and post-traumatic stress disorder, as well as regarding the association of dissociation and sexual preferences causing distress. Sexual symptoms require consideration in the treatment of post-traumatic stress disorder following childhood sexual abuse.

Insecure Attachment and Sexual Satisfaction: A Path Analysis Model Integrating Sexual Mindfulness, Sexual Anxiety, and Sexual Self-Esteem

This study examines the intermediary role of three variables (sexual mindfulness, sexual anxiety, and sexual self-esteem) in a path analysis model to explain the association between insecure attachment and sexual satisfaction. A community sample of 543 adults completed an online survey. Results supported our hypothesized integrative model, which explained 44.1% of the variance in sexual satisfaction and presented satisfactory fit indices. This study suggests that the association between attachment insecurities and lower sexual satisfaction could be partially explained by a proximal association with lower sexual mindfulness, which emphasizes the relevance of examining sexual mindfulness during the screening and treatment of people presenting low sexual satisfaction.Supplemental data for this article is available online at https://doi.org/10.1080/0092623X.2021.2011808 .

Initial Validation of the Mindful Presence Scale: The Issue of the Construal Level of Scale Items

Our research has two main aims. It undertakes the validation of a six-item trait mindfulness scale called Mindful Presence Scale (MPS), which measures central aspects of mindfulness. For the first time in mindfulness literature, the construal level of scale items is also examined. Four questionnaire-based online studies were conducted. Study 1 drew three samples (n n = 391, n p = 215, and n b = 235) from the students at the University of Debrecen. It examined the factor structure, reliability, and internal consistency of the three differently worded scale versions. The positively worded scale version (MPSp) yielded a stable two-factor structure and demonstrated the best psychometric properties. Study 2 performed a confirmatory factor analysis on a sample drawn from public employees across the country (n cfa = 420). The two-factor solution in Study 1 was confirmed. χ2 tests were not significant, and fit indices were excellent. There was no significant difference between the high-level construal subscale (Fhlc) and the low-level construal subscale (Fllc) in terms of factorial stability. Participant of Study 3 were students who did not take part in Study 1. The sample (n inv = 250) was tested for measurement invariance across gender. The scaled results supported strong/threshold invariance. Study 4 tested concurrent validity with 10 concurrent instruments. A sample of secondary school teachers (n con = 128) was tested by examining Spearman's rank order correlations. There was a significant difference in how the Fhlc and Fllc subscales predicted scores of some of the concurrent instruments. Further research is warranted into how the construal level of mindfulness scale items affects the recollection of the mindful experience. Overall, MPSp proved to be a valid short mindfulness measure.

Bullying Victimization and Sexual Wellbeing in Sexually Active Heterosexual, Cisgender and Sexual/Gender Minority Adolescents: The Mediating Role of Emotion Regulation

Bullying victimization is prevalent in adolescence and associated with adverse consequences on physical and psychological wellbeing, paricularly in sexual and gender minority youth. However, little is known about its associations with sexual wellbeing and the underlying mechanisms that could explain this association. The present study assessed the associations between bullying victimization and sexual wellbeing (sexual satisfaction, sexual desire/arousal and orgasmic function difficulties, sexual distress) via the mediating role of emotion regulation difficulties, considering potential sexual/gender minority status-based differences. Self-report online surveys were completed by 1036 sexually active (49.7% were girls) high school students (M_age = 14.6 years, SD_age = 0.6). Bullying victimization was directly and negatively associated with sexual desire/arousal difficulties and positively with sexual distress. Higher emotion regulation difficulties mediated the associations between higher bullying victimization and higher orgasmic function difficulties, as well as higher bullying victimization and higher sexual distress. No significant association was observed between bullying victimization and sexual satisfaction. No significant differences were observed between heterosexual, cisgender and sexual and gender minority youth in any of the associations. The findings suggest that bullying victimization is associated with adolescents' sexual wellbeing. The cross-sectional design and small effect sizes support the need for further prospective cohort studies.

Associations between Childhood Sexual Abuse and Sexual Well-being in Adulthood: A Systematic Literature Review

Child sexual abuse (CSA) tends to occur in close relationships and involves sexual acts and betrayal. Thus, it is thought to affect sexual well-being in adulthood more so than any other form of childhood trauma. Research conducted over the last decade resulted in an impressive diversity of evidence reporting that CSA may be related to greater sexual dysfunction and lower sexual satisfaction as an adult, but also to higher levels of sexual compulsivity and sexual risk behaviors. Some studies also found no significant association between CSA and adult sexual well-being. Faced with these mixed results, understanding how CSA may affect sexual well-being in adulthood remains challenging for clinicians and researchers. The aim of this comprehensive literature review was to synthesize the empirical studies published in the last five years documenting the associations between CSA and several indicators of sexual well-being in adults excluding risky sexual behaviors. The literature search yielded 18 eligible studies which mainly examined five domains of sexual outcomes of CSA: sexual function, sexual satisfaction, sex-related cognitions, sexual behaviors and affective components of sexuality. Findings suggest that CSA is not unanimously related to all domains of sexual well-being, but rather, that associations are largely a function of the presence of other comorbidities or nature of the sample. Moreover, men are still significantly underrepresented in reviewed studies. Implications of the findings will be discussed in light of their relevance for clinicians and for researchers about gaps in current literature need to be filled.

Validation of a brief French version of the sexual anxiety scale

Although sexual anxiety (SA) is associated with significant sexual and relationship difficulties, to date, we lack brief scales to adequately assess SA. The aim of the present study was to develop a brief and reliable French version of the Sexual Anxiety Scale (SAS) that can be used to screen the manifestations of SA and their severity. A community sample ( n = 576) was recruited to investigate the reliability and validity of the brief form of the scale (SAS-BF). Confirmatory factor analysis was performed on the original three-factor model (SAS) and on the new, four-factor SAS-BF. Its convergent validity was tested with theoretically relevant correlates (e.g., anxiety, sexual satisfaction). The SAS-BF yielded strong psychometric properties in terms of factor structure and reliability, and was reasonably correlated with associated variables. SAS-BF can be considered a valid short scale to assess SA in studies where a brief form of the questionnaire is desirable or during clinical screening with patients experiencing variable levels of SA.

Polyvictimization and the Associations Between Poor Self-Perceived Health, Dissatisfaction With Life, and Sexual Dysfunction Among Women in Estonia

The severe impact of different forms of violence on health has been demonstrated in a substantial number of studies. At the same time, it has been acknowledged that different forms of violence tend to co-occur, such that many survivors of violence have been exposed to more than one violent event and/or more than one form of violence. Despite mounting evidence concerning the associations between polyvictimization and health, there are still important gaps in this knowledge concerning adult female population's sexual health, including both physical and mental aspects associated with it. The aim of this study was to evaluate the exposure to emotional, physical, and sexual violence among women and associations with poor self-perceived health, dissatisfaction with life, stress, and worry due to sex life and sexual dysfunction. The term polyvictimization is used in this article to express the exposure to more than one form of violence. We used data from a cross-sectional study carried out in Estonia in 2014 among women aged 16 to 44 years. Responses of 2,333 women were analyzed for this article. Of all the respondents, 27.9% were polyvictimized. Women who had been exposed to all three forms of violence had, after adjusting for confounding factors, the highest risk of reporting poor self-perceived health, limited daily activities due to chronic health problems, feelings of depression, dissatisfaction with life, stress, and worry due to sex life and sexual dysfunction. The results of this study demonstrate that exposure to violence is associated with poorer health outcomes and that the association is stronger among those who have been polyvictimized.

Getting to Know the Inner Self. Exploratory Study of Identity Oriented Psychotrauma Therapy-Experiences and Value From Multiple Perspectives

Early trauma and failures in attachment attunement can affect future relational patterns, health and well-being. The processing of trauma, especially complex trauma, through adequate interventions may help integrate traumatic experiences, enhance health and quality of life. Despite years of clinical practice with Identity oriented psychotrauma therapy (IoPT), there is a lack of scientific research on the subject. Objective: The study's aim was to explore the experiences and value of IoPT for persons with experiences of IoPT, whether as a therapist, client, representative and/or observer. Methods: The study has an explorative, qualitative design. Data collection through individual in-depth interviews and focus groups with 20 participants and data analysis were inspired by grounded theory. Results: The results showed an exploratory process of self-discovery and self-development, Getting to know the inner self, to which all categories were interrelated through their contribution to the process. The findings shed light on the experiences and tangible value of IoPT for the participants from the perspectives of client, therapist, representative and observer. These perspectives were intertwined and illuminated in terms of their contribution to the process. Conclusion: IoPT seems to have transformative potential in terms of a self-exploratory journey from multiple perspectives. The need for effective treatments to enhance health and prevent further ill health in persons affected by complex trauma motivates the exploration of novel treatment approaches and formats to support clients toward health enhancing strategies. Further quantitative and qualitative research is motivated to enhance our understanding of the workings and value of IoPT for self-development, health and quality of life.

Is My Sex Life Ok? The Mediating Role of Sexual Anxiety in the Association between Childhood Sexual Abuse and Sexual Coercion against Women

Empirical studies suggest that childhood sexual abuse is associated with sexual revictimization by a male romantic partner in female survivors. Yet, the potential mechanisms underlying this association remain understudied. Past studies indicated that women childhood sexual abuse survivors report more sexual anxiety, which in turn was linked to an increased risk of sustaining sexual coercion. The current study, conducted with a sample of 448 adult women from the community, aimed to examine sexual anxiety as a potential mechanism in the association between childhood sexual abuse and sexual coercion sustained by women in heterosexual romantic relationships. Results from path analyses confirmed the indirect effect of sexual anxiety in the relationship between childhood sexual abuse and sexual coercion victimization. Findings indicated that childhood sexual abuse is associated with higher levels of sexual anxiety, which in turn, was linked to a higher frequency of sexual coercion experiences perpetrated by the romantic partner. This study contributes to a better understanding of the determinants of sexual violence against women and provides an empirical basis to better inform prevention initiatives and guide future interventions.

Cumulative Childhood Trauma and Couple Satisfaction: Examining the Mediating Role of Mindfulness

Objectives

Cumulative childhood trauma (CCT) survivors are at a higher risk of suffering from interpersonal problems including couple dissatisfaction. Dispositional mindfulness is increasingly proposed as a potential explanatory mechanism of post-traumatic symptomatology and has been documented as a predictor of couple satisfaction. Most authors operationalize mindfulness as a multidimensional disposition comprised of five facets (i.e., Describing, Observing, Non-judgment of inner experiences, Non-reactivity, and Acting with awareness), but the role of these facets in the link between CCT and couple satisfaction has yet to be understood. This study aimed to assess mindfulness as a potential mediator in the relationship between CCT and couple satisfaction and to examine the distinctive contributions of mindfulness facets in this mediation.

Methods

A sample of 330 participants from the community completed measures of couple satisfaction, mindfulness, and exposure to eight types of childhood maltreatment experiences.

Results

Path analysis results revealed that mindfulness mediated the relationship between CCT and couple satisfaction. More precisely, two mindfulness facets acted as specific mediators, namely, Describing and Non-judgment of inner experiences. The final integrative model explained 14% (p < .001) of the variance in couple satisfaction.

Conclusions

Findings suggest that mindfulness may be a meaningful mechanism in the link between CCT and couple satisfaction. They also highlight that description of inner experiences and a non-judgmental attitude of these experiences may act as key components to understand the influence of CCT on adults' lower couple satisfaction.

Sexual health of women with schizophrenia: A review

Women with schizophrenia experience low rates of sexual satisfaction and high rates of sexual dysfunction. They are at high risk for adverse sexual health outcomes including unplanned pregnancies, induced abortions, and human immunodeficiency virus (HIV), and face higher rates of sexual violence and various forms of intimate partner violence. This review explores the complex and intersecting biopsychosocial risk factors that explain these outcomes among women with schizophrenia, including factors related to the illness itself, antipsychotic medications, medical and psychiatric comorbidities, stigma, childhood trauma, and social determinants of health including poverty and housing instability. Sexual health interventions designed to help women with schizophrenia achieve pleasurable and safe sexual experiences, free of coercion, discrimination and violence are few and far between, suggesting opportunities for future development in this area.

Childhood Interpersonal Trauma and Sexual Satisfaction in Patients Seeing Sex Therapy: Examining Mindfulness and Psychological Distress as Mediators

Mindful attention and awareness may promote sexual satisfaction. However, experiencing cumulative childhood interpersonal trauma (CCT; sexual abuse, neglect, etc.) is associated with distress, which might interfere with dispositional mindfulness and lead to lower sexual satisfaction. Although the concept of mindfulness emerged as an interesting variable to understand sexual difficulties, little empirical data are available on this topic. This study tested an integrative mediation model of the relation between CCT, psychological distress, dispositional mindfulness, and sexual satisfaction within a clinical sample of 410 adult patients consulting in sex therapy. Patients completed questionnaires assessing CCT, psychological distress, dispositional mindfulness, and sexual satisfaction. Results showed that the majority of patients reported experiences of childhood interpersonal trauma. Path analyses highlighted three distinct significant paths from CCT to sexual satisfaction. First, dispositional mindfulness mediated the relationship between CCT and sexual satisfaction. Second, psychological distress also mediated the relationship between CCT and sexual satisfaction. Third, the effect of CCT on sexual satisfaction was sequentially mediated through greater levels of psychological distress and lower levels of dispositional mindfulness. The model explained 19% of the variance in sexual satisfaction. Findings suggest that dispositional mindfulness and psychological distress are key processes explaining sexual satisfaction in CCT survivors.

Emotional numbing symptoms partially mediate the association between exposure to potentially morally injurious experiences and sexual anxiety for male service members

Service members (SMs) returning from deployment are at risk of a range of sexual problems, some of which are thought to be related to psychological issues that may arise during deployment or combat. The current study sought to examine whether exposure to potentially morally injurious events (PMIEs) was associated with sexual anxiety (SA) above and beyond combat exposure and whether any such association was mediated by post-traumatic stress disorder (PTSD) symptom clusters. These questions were tested using data from self-report surveys collected from 221 partnered male Army (Active Duty, National Guard, or Reserve) SMs at three separate time points. Findings showed that exposure to PMIEs was significantly related to greater SA, with transgressions by self and perceived betrayal demonstrating unique associations when controlling for all factors of PMIEs. Moreover, total exposure to PMIEs was associated with SA above and beyond general combat exposure. PTSD symptoms partially mediated the association between exposure to PMIEs and SA, with emotional numbing accounting for significant unique indirect effects after controlling for other PTSD symptom clusters. The findings suggest that exposure to PMIEs is associated with SA, even when accounting for either combat exposure or PTSD symptoms, emphasizing the importance of this issue in understanding post-deployment problems in sexual intimacy.

Adult Profiles of Child Sexual Abuse Survivors: Attachment Insecurity, Sexual Compulsivity, and Sexual Avoidance

The present study examined the possibility of different groups of child sexual abuse (CSA) survivors based on their different patterns of attachment and sexual problems. A sample of 324 CSA survivors and 484 participants who did not report any child maltreatment experiences completed online questionnaires. A cluster analysis on attachment and sexual outcomes revealed that CSA survivors formed two distinct profiles. The first profile included CSA survivors with elevated attachment anxiety and low to moderate scores on attachment avoidance, sexual compulsion, and sexual avoidance. The second profile comprised CSA survivors with high scores on attachment anxiety, attachment avoidance, sexual compulsion, and sexual avoidance. These groups were then compared on CSA severity, gender differences, and other child maltreatment experiences. As compared to CSA survivors of the first profile, survivors from the second profile reported more intrusive and extrafamilial CSA, higher rates of psychological maltreatment and witnessed parental violence, and experienced more personal and couple distress. These results suggest that CSA survivors form a heterogeneous population and that sexual abuse is differentially associated with the complex unfolding of the attachment and sexual systems within two distinct subgroups.

Cumulative Childhood Trauma and Therapeutic Alliance: The Moderator Role of Attachment in Adult Patients Consulting in Sex Therapy

While it is documented that clients consulting in sex therapy tend to report high rates of childhood interpersonal traumas (e.g., physical, psychological and sexual abuse), which are associated to insecure attachment and poorer therapeutic alliance, the interrelations of these variables have not yet been evaluated in this specific population. This study examined the associations between attachment, cumulative trauma and therapeutic alliance in 278 sex therapy patients who filled out self-report questionnaires. Results revealed that avoidant attachment acted as a moderator between cumulative trauma and the agreement on tasks dimension of therapeutic alliance. Results suggests the relevance for sex therapists to investigate past traumas and current attachment representations to guide interventions and optimize treatment benefits.

Polyvictimization and Sexual Risk Behaviors in College-Aged Women

Current research suggests a link between childhood sexual abuse and risky sexual behaviors (RSBs) in emerging adults. However, previous studies neglect evaluating the influence of high levels of cumulative childhood victimization. The present study examined the relationships among polyvictimization, six aggregate categories of childhood victimization, and RSB in college women. This study first examined the relative contributions of polyvictimization and individual categories of childhood victimization in predicting RSB and then tested whether polyvictimization contributes any unique variance, beyond that accounted for by the combination of all six aggregate categories in a sample of 321 college women in a Southern state. Regression analyses reveal that (a) polyvictimization accounts for a significant proportion of variability in scores for RSB, beyond that accounted for by any of the six categories of childhood victimization alone; (b) the categories of childhood victimization contribute little to no variability beyond that accounted for by polyvictimization; and (c) polyvictimization accounts for a significant proportion of variability in RSB, beyond that already accounted for by the simultaneous entry of all six categories as predictor variables. Results suggest treatment providers working with college students should assess polyvictimization in relation to RSB and inform their prevention efforts given this link.

Acute Stress Symptoms in Seriously Injured Patients: Precipitating Versus Cumulative Trauma and the Contribution of Peritraumatic Distress

The relationship between type of trauma exposure, cumulative trauma, peritraumatic distress, and subsequent acute stress disorder (ASD) symptoms was examined prospectively in 96 individuals presenting with acute medical injuries to a Level 1 emergency/trauma department. Common precipitating traumas included motor vehicle-related events, stabbings, shootings, and physical assaults. At 2 to 3 weeks follow-up, 22.9% of participants had developed ASD. Univariate analysis revealed no relationship between type of precipitating trauma and ASD symptoms, whereas robust path analysis indicated direct effects of gender, lifetime cumulative trauma exposure, and peritraumatic distress. Peritraumatic distress did not mediate the association between cumulative trauma and symptoms, but did mediate the association between gender and symptomatology. These results, which account for 23.1% of the variance in ASD symptoms, suggest that ASD may be more due to cumulative trauma exposure than the nature of the precipitating trauma, but that cumulative trauma does not exert its primary effect by increasing peritraumatic distress to the most recent trauma.