Correlates of Men's Sexual Interest: A Cross-Cultural Study

The Mediating Role of Sexual Boredom in Women's Sexual Desire and Satisfaction

Sexual boredom in women is associated with various levels and dimensions of sexual desire, as well as lower sexual and relationship satisfaction. However, the directionality of these relationships remains unclear. This study aimed to investigate whether sexual boredom mediates the relationship between partner and attractive-other sexual desire and sexual and relationship satisfaction in a sample of 1155 Portuguese women in long-term monogamous relationships. Participants, aged 18-66 years (M = 31.60, SD = 5.65), were involved in cohabiting relationships of 1 year or more. Linear regression analysis and Structural Equation Modeling were conducted, revealing that sexual boredom emerged as a stronger predictor of sexual and relationship satisfaction compared to dimensions of sexual desire. Additionally, sexual boredom partially mediated the relationship between partnered sexual desire and satisfaction and fully mediated the relationship between attractive other-related sexual desire and satisfaction variables. Notably, sexual boredom explained up to one-third of sexual satisfaction (32%) and slightly less of relationship satisfaction (27%). These findings underscore the importance of addressing sexual boredom in long-term relationships to promote women's sexual health. Furthermore, they suggest that experiencing sexual desire for attractive non-partners is not indicative of sexual and relationship dissatisfaction unless accompanied by sexual boredom.

Rights or Obligations: The Extent to Which Sexual Desire and Gender Roles Determine Sexual Intimacy in Romantic Relationships

The present study aims to investigate the relationship between traditional gender roles and the frequency of sexual intimacy within romantic relationships, considering sexual desire and societal norms and expectations. The study was conducted among a convenience sample of men and women in Israel. The survey included measures of sociodemographic information, traditional gender roles, sexual desire, perceived partner's sexual desire, and frequency of engaging in sex. Findings suggest that men who embraced less traditional gender roles exhibit a greater synchronization between their own sexual desire and their perceived partner's sexual desire, whereas women who embraced more traditional gender roles tend to rely more on their partners' sexual desire in their frequency of sex. These results imply that men's sexual desire plays a significant role in determining the frequency of sexual activity in romantic relationships, especially in relationships where traditional gender roles are more strongly embraced. Findings from the current study underscore the idea that the decision to engage in intimate acts may not solely hinge on individual sexual desire; rather, it operates within a broader context influenced by societal and cultural expectations. It is important to challenge societal norms to promote more balanced and equitable sexual dynamics in committed relationships.

The effect of short-term increase of estradiol levels on sexual desire and orgasm frequency in women and men: A double-blind, randomized, placebo-controlled trial

Estradiol (E2) has been implicated in sexual functioning in both sexes. E2 levels change distinctively over the menstrual cycle, peaking around ovulation. Data on short-term effects of fluctuating E2 levels on sexual desire are however sparse and mostly based on observational studies. To fill this gap, we ran a double-blind, randomized, placebo-controlled study (N = 126) to investigate the effects of a short-term increase in E2 on sexual desire and orgasm frequency in healthy, young men and women. Circulating E2 levels were elevated through estradiol valerate (E2V) administered over two consecutive days to simulate the rise in E2 levels around ovulation. E2V had no effect on orgasm frequency and only minor effects on sexual desire. On average, the administered E2V dampened change in sexual desire compared to untreated participants with comparable baseline sexual desire in such a way that sexual desire was slightly reduced even in those with higher baseline sexual desire. These findings suggest that short-term increases in E2 have little effect on sexual function and are unlikely to explain the increase in sexual desire around ovulation.

Is Sexual Aversion a Distinct Disorder or a Trans-Diagnostic Symptom across Sexual Dysfunctions? A Latent Class Analysis

Sexual aversion disorder (SAD) is a chronic condition that impacts sexual and psychological well-being. However, the relevance of SAD as a discrete disorder remains highly debated. This study aimed to clarify the status of SAD as either a distinct disorder or a trans-diagnostic symptom shared among sexual dysfunctions. This cross-sectional study used a latent class analysis approach among a Canadian community sample (n = 1,363) to identify how patterns of SAD symptoms (i.e., sexual fear, disgust, and avoidance) emerge across different spheres of sexual functioning (i.e., desire and arousal, erection or lubrication, genito-pelvic pain, and orgasm) and examine sociodemographic and psychosexual correlates of the identified classes. Examination of fit indices suggested four classes: Sexually functional, Impaired desire and responsiveness, Sexual aversion, and Comorbid sexual dysfunctions. Sexual aversion class members were more likely to be single, had experienced sexual assault in adulthood, and report lower levels of sexual satisfaction and psychological well-being, compared to Sexually functional class members. Results suggest that SAD is a distinct clinical syndrome, while its symptoms may co-occur with other sexual dysfunctions. To ensure that the needs of people with SAD are met with tailored treatment options, future nosography might consider reclassifying SAD as a specific disorder.

Sexual Motivation in Persons with Multiple Sclerosis: A Controlled Cross-Sectional Study

Purpose

Sexual motives are major determinants of sexual behaviour. It has been known that sexual motives may vary according to circumstances. Multiple sclerosis (MS) is a chronic disease causing a broad range of symptoms and disabilities, that often interfere with sexual activities. We aimed to investigate the sexual motives in persons with MS.

Patients and Methods

Cross-sectional study in 157 persons with MS and 157 controls matched for age, gender, relationship, duration of relationship and educational status via propensity score matching. The Reasons for Having Sex (YSEX) questionnaire assessed the proportion with which a person had engaged in sexual intercourse for each of 140 distinct motives to have sex. Estimated mean differences in scores for four primary factors (Physical, Goal attainment, Emotional, Insecurity) and 13 sub-factors, and sexual satisfaction and importance of sex were calculated as Average Treatment Effect of the Treated using 99% confidence intervals.

Results

Persons with MS reported a lower proportion of engaging in sex compared with the controls for the factors Physical (-0.29), Emotional (-0.23) and Insecurity (-0.10); and for the physical sub-factors Pleasure (-0.48), Experience seeking (-0.32), Stress reduction (-0.24), and Physical desirability (-0.16), the emotional sub-factors Love and commitment (-0.27) and Expression (-0.17), and the insecurity sub-factor Self-esteem boost (-0.23). In the control group seven of the top 10 sexual motives were physical versus five in the MS group. The importance of sex was lower in the MS group (-0.68).

Conclusion

Findings of this controlled cross-sectional study suggest a reduction in the number of sexual motives in persons with MS, especially of physical motives related to pleasure and experience seeking. Health care professionals may consider assessing sexual motivation when dealing with persons with MS who suffer from decreased sexual desire or another sexual dysfunction.

Self-reported reasons for having difficulty reaching orgasm in men with diverse etiologies

Background

Difficulty reaching orgasm/ejaculation during partnered sex, a primary characteristic of delayed or absent ejaculation, affects about 5% to 10% of men, but the reasons underlying this problem are poorly understood.

Aim

The study sought to gain insight into possible etiologies of delayed ejaculation by assessing men's self-perceptions as to why they experience difficulty reaching orgasm.

Methods

We drew 351 men reporting moderately severe to severe difficulty reaching orgasm during partnered sex from a sample of over 3000 respondents obtained through an online survey. As part of the 55-item survey, participants responded to 2 questions asking about their self-perceived reasons for having difficulty reaching orgasm and selected from a list of 14 options derived from the research literature, a series of men's focus groups, and expert opinion. The first question allowed respondents to select all the reasons that they felt contributed to the problem, the second to select only the most important reason. In addition, both men with and without comorbid erectile dysfunction were investigated and compared.

Outcomes

Hierarchical ordering of men's self-pereceived reasons for having difficulty reaching orgasm, including typal reasons established through principal component analysis.

Results

The major reasons for difficulty were related to anxiety/distress and lack of adequate stimulation, with relationship and other factors endorsed with lower frequency. Further exploration using principal components analysis identified 5 typal reasons, in descending order of frequency: anxiety/distress (41%), inadequate stimulation (23%), low arousal (18%), medical issues (9%), and partner issues (8%). Few differences emerged between men with and without comorbid ED other than ones related to erectile problems, such as higher level of endorsement of medical issues. Typal reasons showed correlations, albeit mostly weak, with a number of covariates, including sexual relationship satisfaction, frequency of partnered sex, and frequency of masturbation.

Clinical Implications

Until supplemental medical treatments for delayed ejaculation are developed and approved, a number of men's purported reasons for difficult or absent ejaculation/orgasm-anxiety/distress, inadequate stimulation, low arousal, relationship issues-fall into areas that can be addressed in couples counseling by a trained sex therapist.

Strengths and Limitations

This study is unique in scope and robust in sample size. Drawbacks include those associated with online surveys, including possible bias in sample selection, limitation to Western-based samples, and the lack of differentiation between men with lifelong and acquired difficulty.

Conclusion

Men who have difficulty reaching ejaculation/orgasm identify putative reasons for their problem, ranging from anxiety/stress, inadequate stimulation, and low arousal to partner issues and medical reasons.

Why Men Masturbate: Reasons and Correlates in Men with and without Sexual Dysfunction

Men purportedly masturbate for a variety of reasons, but systematic investigation of men's reasons has been lacking. We analyzed reasons why men masturbate (n = 2967, mean age = 37.7, SD = 12.9), whether men with and without sexual problems differ in their reasons, and whether those reasons vary with the frequency of masturbation and partnered sex. Results indicated that deriving pleasure, decreasing sexual tension, and reducing anxiety/stress were among the top motives, whereas partner issues were cited less frequently. Men with sexual dysfunctions showed only minor differences from men without sexual dysfunctions, the former more often citing anxiety/stress reduction as a motive. In addition, samples tapping participants from two world regions showed only minor differences in their patterns of responding. Motives for masturbation were also related to both the frequency of masturbation and the frequency of partnered sex. Overall, these findings indicate that men, like women, masturbate primarily for the positive reinforcing effects of pleasure, but in contrast with women, men are also more likely to use masturbation for the negatively reinforcing effects of reducing anxiety/distress. Unsatisfying sex with the partner and/or relationship issues were cited as a reason for masturbation in only a minority of men.

Regulate and Communicate: Associations between Emotion Regulation and Sexual Communication among Men with Hypoactive Sexual Desire Disorder and their Partners

Hypoactive Sexual Desire Disorder (HSDD) is characterized by a persistent and distressing lack of sexual desire. Affected men report lower sexual well-being and romantic partners may also experience consequences. According to the Interpersonal Emotion Regulation Model of sexual dysfunction, how couples manage their emotions in relation to sexual problems may promote or hinder sexual communication. In the first dyadic study to date of men with HSDD and their partners (n = 64 couples), we investigated associations between two emotion regulation strategies - reappraisal and suppression - and couples' communication about their sexual relationship. Participants completed measures assessing use of reappraisal and suppression about their sexual relationship, sexual communication, and sexual assertiveness. Men with HSDD who reported greater suppression also reported lower sexual assertiveness and both partners reported poorer sexual communication. Partners of men with HSDD who used greater suppression were less sexually assertive. In contrast, while reappraisal was only marginally associated with perceived quality of sexual communication, men with HSDD who employed more reappraisal were also more sexually assertive. While suppression may hinder sexual communication, reappraisal may allow men with HSDD to better assert their sexual needs. Findings may inform interventions to help couples navigate impactful emotional experiences associated with HSDD.

A Scoping Review of the Influence of Mindfulness on Men's Sexual Activity

Mindfulness practice and mindfulness-based interventions are widely known, especially for women's sexuality. However, it is currently unknown how this practice affects the experience of male sexuality, possibly due to the existence of pharmacological treatments that are usually the first choice of treatment for men. The objectives of this study are to explore the influence of mindfulness on different components of men's sexuality from a scoping review of relevant scientific articles existing in the literature. A literature search from 2010 to 2022 was carried out in the electronic databases MEDLINE, Embase, PsycINFO, Web of Science, Scopus, PubMed, Dialnet, SciELO Citation Index, and Redalyc. Out of the 238 studies, 12 that met the defined selection criteria were selected. The analysis of these studies seems to indicate that the practice of mindfulness favours different variables of male sexuality, such as satisfaction and sexual functioning or genital self-image. Mindfulness-based interventions represent a valuable and promising contribution. No adverse effects were detected from the review of scientific articles considered in this work. Nevertheless, more randomized studies with active control groups are necessary to establish the benefits of mindfulness-based interventions in sex therapy for men.

Sexual boredom and sexual desire in long-term relationships: a latent profile analysis

BACKGROUND

Research suggests a general link between sexual boredom and sexual desire, but its understanding is currently very limited.

AIM

To identify distinct (latent) groups of women and men in long-term relationships based on their reported levels of sexual boredom and sexual desire.

METHODS

Latent profile analysis (LPA) was conducted in an online sample of 1223 Portuguese participants aged 18 and 66 years (mean ± SD, 32.75 ± 6.11), using indicators of sexual boredom and partner-related, attractive other-related, and solitary sexual desire to categorize participants. Multinomial logistic regression analysis was carried out to explore predictors and correlates of the latent profiles.

OUTCOMES

Sexual boredom was assessed by the Sexual Boredom Scale, while sexual desire was measured with the Sexual Desire Inventory.

RESULTS

As compared with women, men reported higher levels of sexual boredom and sexual desire. LPA indicated 3 profiles in women and 2 profiles in men. Among women, P1 was characterized by above-average sexual boredom, below-average partner- and attractive other-related sexual desire, and very low solitary sexual desire; P2 by below-average sexual boredom, attractive other-related sexual desire, and solitary sexual desire and above-average partner-related sexual desire; and P3 by above-average sexual boredom, attractive other-related sexual desire, and solitary sexual desire and below-average partner-related sexual desire. In men, P1 was characterized by high sexual boredom, above-average partner-related sexual desire, and high attractive other-related and solitary sexual desire and P2 by below-average sexual boredom and above-average partner-related, attractive other-related, and solitary sexual desire. The latent profiles did not differ according to relationship duration. Overall, the sole consistent correlate of the latent categorization was sexual satisfaction.

CLINICAL IMPLICATIONS

In women, above-average levels of sexual boredom were linked to below-average levels of partner-related desire, which suggests likely benefits of helping the couple to minimize or cope better with their sexual routines. In men, participants in the 2 profiles did not differ in partner-related sexual desire, suggesting that clinical interventions dealing with male sexual boredom should investigate factors beyond the current relationship.

STRENGTHS AND LIMITATIONS

This study explored different facets of sexual desire and used LPA, rendering advantages over previous research. The male sample has lower statistical power than the female sample.

CONCLUSION

Patterns of sexual boredom and sexual desire among individuals in long-term monogamous relationships are distinct and consistently related to sexual satisfaction in women and men and to relationship satisfaction among only women, which have important clinical ramifications.

Who seeks sex therapy? Sexual dysfunction prevalence and correlates, and help-seeking among clinical and community samples

Sexual dysfunctions (SD; e.g., female sexual interest/arousal disorder, erectile disorder, female orgasmic disorder, delayed ejaculation, genito-pelvic pain/penetration disorder, etc.) affect up to a third of individuals, impairing sexuality, intimate relationships, and mental health. This study aimed to compare the prevalence of SDs and their sexual, relational, and psychological correlates between a sample of adults consulting in sex therapy (n = 963) and a community-based sample (n = 1,891), as well as examine barriers to sexual health services for SD and the characteristics of individuals seeking such services. Participants completed an online survey. Analyses showed that participants in the clinical sample reported lower levels of sexual functioning and sexual satisfaction and higher levels of psychological distress than participants in the community-based sample. Moreover, higher SD rates were related to lower relational satisfaction and higher psychological distress in the community sample, and to lower sexual satisfaction in both samples. Among participants in the community sample who sought professional services for SD, 39.6% reported that they were unable to access services, and 58.7% reported at least one barrier to receiving help. This study provides important data regarding the prevalence of SD and the link between SD and psychosexual health in clinical and nonclinical samples, as well as barriers to treatment access.

Associations Between Pornography Use Frequency, Pornography Use Motivations, and Sexual Wellbeing in Couples

Pornography use is prevalent, even among partnered individuals. Although pornography use motivations represent key predictors of sexual behaviors, prior studies only assessed the associations between pornography use frequency and sexual wellbeing, with mixed results. This cross-sectional dyadic study examined the associations between partners' individual and partnered pornography use frequency, motivations, and sexual wellbeing. Self-report data from 265 couples (M_{age_men} = 31.49 years, SD = 8.26; M_{age_women} = 29.36 years, SD = 6.74) were analyzed using an actor-partner interdependence model. Men's greater emotional avoidance motivation was related to their own lower sexual function (β = -.24, p = .004) and greater sexual distress (β = .19, p = .012), while their higher sexual curiosity motivation was related to higher partnered sexual frequency (β = .15, p = .031), their own greater sexual satisfaction (β = .13, p = .022), sexual function (β = .16, p = .009), and lower sexual distress (β = -.13, p = .043). Women's higher partnered pornography use frequency was associated with their own greater sexual function (β = .15, p = .034) and lower sexual distress (β = -.14, p = .012). Additionally, women's higher individual pornography use frequency (β = .33, p < .001) and lower sexual pleasure motivation (β = -.35, p = .002) were associated with higher partnered sexual frequency. No partner effects were observed. Findings highlight that women's pornography use frequency and each partner's motivations might play crucial roles in couples' sexual wellbeing.

Effects of Abelmoschus manihot Flower Extract on Enhancing Sexual Arousal and Reproductive Performance in Zebrafish

The flower of Abelmoschus manihot L. is mainly used for the treatment of chronic kidney diseases, and has been reported to have bioactivities such as antioxidant, anti-inflammatory, antiviral, and antidepressant activities. This study used wild-type adult zebrafish as an animal model to elucidate the potential bioactivity of A. manihot flower ethanol extract (AME) in enhancing their sexual and reproductive functions. Zebrafish were fed AME twice a day at doses of 0.2%, 1%, and 10% for 28 days, and were then given the normal feed for an additional 14 days. The hormone 17-β estradiol was used as the positive control. Sexual behavioral parameters such as the number of times males chased female fish, the production of fertilized eggs, and the hatching rate of the fertilized eggs were recorded at days 0.33, 7, 14, 21, 28, and 42. The expression levels of sex-related genes—including lhcgr, ar, cyp19a1a, and cyp19a1b—were also examined. The results showed that the chasing number, fertilized egg production, and hatching rate were all increased with the increase in the AME treatment dose and treatment time. After feeding with 1% and 10% AME for 28 days, the chasing number in the treated group as compared to the control group increased by 1.52 times and 1.64 times, respectively; the yield of fertilized eggs increased by 1.59 times and 2.31 times, respectively; and the hatching rate increased by 1.26 times and 1.69 times, respectively. All three parameters exhibited strong linear correlations with one another (p < 0.001). The expression of all four genes was also upregulated with increasing AME dose and treatment duration. When feeding with 0.2%, 1%, and 10% AME for 28 days, the four sex-related genes were upregulated at ranges of 1.79−2.08-fold, 2.74−3.73-fold, and 3.30−4.66-fold, respectively. Furthermore, the effect of AME was persistent, as the promotion effect continued after the treatment was stopped for at least two weeks. The present findings suggest that AME can enhance the endocrine system and may improve libido and reproductive performance in zebrafish.

Comparison of spermiograms of infertile men before and during the COVID-19 pandemic

OBJECTIVE

Since the start of the COVID-19 pandemic, there has been interest in the impact of both SARS-CoV-2 infection and pandemic-induced social restrictions on male reproductive health. This study aimed to evaluate the spermiogram values of men who presented for infertility during the pandemic compared with the previous 2 years.

METHODS

Patients who presented to a urology outpatient clinic for the first time due to infertility were included. The patients' age, semen volume, and spermiogram results were recorded. Based on the presentation date, the patients were divided into prepandemic group 1 (March 2018-February 2019), prepandemic group 2 (March 2019-February 2020), and pandemic group (March 2020-February 2021) for comparison.

RESULTS

A total of 594 patients were included. There was no significant difference between the three groups in terms of the number of patients who presented for infertility (207, 190, and 197 patients, respectively; p=0.691). The mean age was 36.6±7.2 in the prepandemic group 1, 35.5±7.1 in the prepandemic group 2, and 33.1±6.3 in the pandemic group. Patients who presented during the pandemic were significantly younger (p<0.001). There were no differences between the groups in terms of semen volume (p=0.910) or rates of normospermia and pathological spermiogram findings (p=0.222).

CONCLUSIONS

In the first year of the COVID-19 pandemic, there was no significant difference in the number of patients who presented for infertility or in their spermiogram results compared with 2018 and 2019. However, it is noteworthy that the patients were significantly younger during the pandemic than in the previous 2 years.

A Cluster Analysis on Sexual Boredom Profiles in A Community Sample of Men and Women

Research evidence of the attributes of sexual boredom is extremely limited. Understanding variability in the experience of sexual boredom may offer relevant insights for the field of human sexuality. This study aimed to explore the co-occurrence of sexual boredom and other sexuality-related dimensions. The sample consisted of 1021 participants aged between 18 and 75 years old (M = 32.68, SD = 8.79). A gender-stratified cluster analysis was performed to classify individuals regarding their scores on sexual boredom, general boredom, sexual sensation seeking, sexual desire, sexual excitation, sexual pleasure, and sexual satisfaction. A three-cluster solution was revealed for both men and women. Based on our findings, we put forward a profile for the sexually bored individual, who is more likely to be married or cohabiting with a partner, to have a boredom prone personality, to lack sexual sensation seeking, experience low sexual pleasure and satisfaction, and to present with sexual arousal and/or desire problems. Women dealing with sexual boredom might present low sexual desire for their partner but experience high sex desire for attractive others. Results are critically discussed and implications for sexual therapy explored.

Perceived Changes in Sexual Interest and Distress About Discrepant Sexual Interest During the First Phase of COVID-19 Pandemic: A Multi-Country Assessment in Cohabiting Partnered Individuals

Due to COVID-19 pandemic, different restrictive measures in terms of physical distancing and lockdowns have been introduced in most European countries, affecting all facets of social life. Currently, little is known about how partnered individuals perceive changes in their sexual life during this complex emergency. This study explored retrospectively assessed changes in sexual interest for one's partner and levels of distress related to perceived sexual interest discrepancy during the first phase of the pandemic in a large-scale online sample of partnered individuals (n = 4813; Mage = 38.5 years, SD = 10.74) recruited between May and July 2020 in seven European Union countries and Turkey. We also examined the possible role of approach/avoidance motives for sex in reported changes in sexual interest and associated distress. Most participants (53%) reported no change in their sexual interest during the pandemic, followed by those who reported an increase (28.5%). The pattern was similar across the eight countries. Distress about discrepant sexual interest, which was only weakly related to changes in sexual interest, was significantly associated with relationship quality and emotional closeness with a partner, coping with and worrying about the pandemic, and specific motivation for sex. In contrast to avoidant and relationship-focused approach motivation, ego-focused approach motivation was related to stable sexual interest during the pandemic. The current study contributes to the understanding of the link between sexual interest and complex emergencies. Considering that the COVID-19 pandemic continues, the reported experiences and perceptions are prone to change.

The Sexual Long COVID (SLC): Erectile Dysfunction as a Biomarker of Systemic Complications for COVID-19 Long Haulers

Introduction

Long term complications of COVID-19, the disease caused by the SARS-CoV-2, involve many organ systems, dramatically worsening the quality of life, and finally contributing to impaired physical functioning. Despite the presence of well-identified pathogenetic mechanisms, the effect of “Long COVID” on sexual health has been only marginally addressed.

Objectives

To provide coverage of the current literature on long COVID, its epidemiology, pathophysiology, and relevance for erectile function. Methods. Comprehensive review of literature pertaining to the epidemiology and pathophysiology of long COVID, and its relevance for erectile function.

Results

Symptoms of long COVID are highly prevalent and involve almost all systems of the human body, with a plethora of clinical manifestations which range from minor nuisances to life-threatening conditions. “Brain fog” and fatigue are the most common complaints, although other neuropsychiatric complications, including sensory dysfunctions, anxiety, depression, and cerebrovascular events have also been reported. The respiratory and cardiovascular systems are also affected, with dyspnea, pulmonary fibrosis, endothelial dysfunction, and myocarditis occurring in some COVID long haulers. A subset of patients might develop endocrine manifestations, including onset of diabetes, thyroid dysfunction, and hypogonadism. Overall, long COVID features many complications which can impair erectile function by multiple pathogenetic mechanisms, and which could require tailored treatment: (i) careful investigation and management from the sexual medicine expert are therefore much needed, (ii) and future research on this topic is warranted.

Conclusion

in COVID-19 long haulers, several complications can adversely affect erectile function which, upon future tailored studies, could be used as biomarker for the severity of the long COVID disease and for its follow-up.

Sansone A, Mollaioli D, Limoncin E et al. The Sexual Long COVID (SLC): Erectile Dysfunction as a Biomarker of Systemic Complications for COVID-19 Long Haulers. Sex Med Rev 2022;10:271–285.

Appearance Satisfaction as a Predictor of Specific Sexual Problems and Associated Distress

INTRODUCTION

Appearance dissatisfaction is a sensitive issue and has been tied to depression, dissatisfaction in romantic relationships, and reduced sexual satisfaction.

AIM

This study sought to examine associations between appearance satisfaction and specific sexual problems and related distress, testing also the moderating role of relationship satisfaction.

METHODS

A large web-sample of Norwegians in romantic relationships (N = 2,903) completed a one-time survey.

OUTCOMES

Participants reported on their experience of five different sexual problems and associated level of distress.

RESULTS

We found that appearance satisfaction was associated with reporting fewer sexual problems, and specifically, with a smaller likelihood of experiencing problems with lack of enjoyment, lack of excitement, and lack of climax. Furthermore, appearance satisfaction was unrelated to overall sexual problem-related distress, but was associated with feeling less distress about lack of excitement and lack of climax. Relationship satisfaction did not serve as a moderator of the associations.

CLINICAL TRANSLATION

These findings suggest the importance of attending to appearance satisfaction when working with clients with multiple sexual problems, particularly those related to excitement and enjoyment.

STRENGTHS AND LIMITATIONS

Strengths of the study include a large sample of partnered adults and assessment of specific sexual problems and associated distress. A limitation is that outcomes were assessed using single items, rather than multi-item scales.

CONCLUSION

The study highlights the importance of examining the presence of sexual problems and associated distress separately, and to consider appearance satisfaction as a predictor of sexual functioning. Øverup CS, Strizzi JM, Cipric A, et al. Appearance Satisfaction as a Predictor of Specific Sexual Problems and Associated Distress. J Sex Med 2021;XX:XXX-XXX.

Epidemiology of Male Sexual Dysfunction in Asian and European Regions: A Systematic Review

Male sexual dysfunctions (MSDs) often remain undiagnosed and untreated in Asia compared to Europe due to conservative cultural and religious beliefs, socioeconomic conditions, and lack of awareness. There is a tendency for the use of traditional medicines and noncompliance with and reduced access to modern healthcare. The present systematic review compared the incidence and factors of MSD in European and Asian populations. English language population/community-based original articles on MSDs published in MEDLINE from 2008 to 2018 were retrieved. A total of 5392 studies were retrieved, of which 50 (25 Asian and 25 European) were finally included in this review. The prevalence of erectile dysfunction (ED) (0%–95.0% vs. 0.9%–88.8%), low satisfaction (3.2%–37.6% vs. 4.1%–28.3%), and hypoactive sexual desire disorder (HSDD) (0.7%–81.4 vs. 0%–65.5%) was higher in Asian than in European men, whereas the prevalence of anorgasmia (0.4% vs. 3%–65%) was lower in Asian than in European men. Age was an independent positive factor of MSD. In European men over 60 years old, the prevalence of premature ejaculation (PE) decreased. The prevalence of MSD was higher in questionnaires than in interviews. The significant factors were age, single status, low socioeconomic status, poor general health, less physical activity, cardiovascular diseases, diabetes, obesity, lower urinary tract symptoms, prostatitis, anxiety, depression and alcohol, tobacco, and drug use. The prevalence of MSD differed slightly in Asian and European men. There is a need to conduct large studies on the various Asian populations for the effective management of MSD.

Gender Differences in Sexual Information Needs and Relating Factors in Cancer Patients: A Cross-Sectional Survey

This study aimed to identify the sexual information requirements and related factors according to gender to improve sexual health in cancer patients. In this cross-sectional study, a total of 687 cancer patients from a single cancer center in Korea completed a self-reported questionnaire. Multiple logistic regression analysis was used to compare the sexual information requirements and related factors among cancer patients. The results showed that male cancer patients had higher demands for sexual information than female cancer patients (t = 27.11, p < 0.001). Men appeared to have a greater need than women in the need for sexual information (t = 30.41, p < 0.001) and professional sexual intervention (t = 21.97, p < 0.001). Regarding sexual information needs, income (OR: 0.43, 95% CI: 0.25 to 0.73) was a significant factor in men. In women, age (OR: 0.51, 95% CI: 0.31 to 0.86), alcohol consumption (OR: 1.88, 95% CI: 1.12-3.16), and chemotherapy (OR: 1.87, 95% CI: 1.12-3.12) were significant factors. Significant differences in the overall sexual information needs and related factors were observed between male and female cancer patients. Therefore, a strategy needs to be established to improve the sexual health of cancer patients considering gender differences.

Frequency of use, moral incongruence and religiosity and their relationships with self-perceived addiction to pornography, internet use, social networking and online gaming

BACKGROUND AND AIMS

Moral incongruence involves disapproval of a behavior in which people engage despite their moral beliefs. Although considerable research has been conducted on how moral incongruence relates to pornography use, potential roles for moral incongruence in other putative behavioral addictions have not been investigated. The aim of this study was to investigate the role of moral incongruence in self-perceived addiction to: (i) pornography; (ii) internet addiction; (iii) social networking; and (iv) online gaming.

DESIGN

A cross-sectional, preregistered, online survey using multivariable regression.

SETTING

Online study conducted in Poland.

PARTICIPANTS

1036 Polish adults aged between 18 and 69 years.

MEASUREMENTS

Measures included self-perceived behavioral addiction to pornography, internet use, social networking and online gaming and their hypothesized determinants (moral incongruence, frequency of use, time of use, religiosity, age and gender).

FINDINGS

Higher moral incongruence (β = 0.20, P < 0.001) and higher religiosity (β = 0.08, P < 0.05) were independently associated with higher self-perceived addiction to pornography. Additionally, frequency of pornography use was the strongest of the analyzed predictors (β = 0.43, P < 0.001). A similar, positive relationship between high moral incongruence and self-perceived addiction was also present for internet (β = 0.16, P < 0.001), social networking (β = 0.18, P < 0.001) and gaming addictions (β = 0.16, P < 0.001). Religiosity was uniquely, although weakly, connected to pornography addiction, but not to other types of addictive behaviors.

CONCLUSIONS

Moral incongruence may be positively associated with self-perception of behavioral addictions including not only pornography viewing, but also internet use, social networking and online gaming.

The relation between sexuality and obesity: the role of psychological factors in a sample of obese men undergoing bariatric surgery

Obesity produces a significant deterioration in general and sexual health. The aim of this cross-sectional study was to investigate the impact of obesity on sexuality, illustrating the psychological constructs that may play a significant role in determining sexual functioning and satisfaction. During the psychological assessment for bariatric surgery eligibility, 171 obese men filled out a socio-demographic questionnaire, the International Index of Erectile Function (IIEF), the 20 Item-Toronto Alexithymia Scale, the Symptom Checklist-90-Revised, the Body Uneasiness Test, and the Obesity-related Disability test. A series of hierarchical multiple regression analyses highlighted how obese men sexual desire (F_(11,159) = 10.128, p < 0.001), erectile function (F_(10,160) = 63.578, p < 0.001), orgasmic function (F_(10,160) = 33.967, p < 0.001), intercourse satisfaction (F_(7,163) = 159.752, p < 0.001), and general satisfaction (F_(10,160) = 18.707, p < 0.001) were significantly associated with other IIEF sexual domains, difficulties in identifying feelings, psychopathological symptoms (such as depression and paranoid ideation), body image, and quality of life. Findings are useful for deepening understanding of obese male sexual response, and more generally, for analyzing the complex and multivariate relation between obesity and sexuality, supporting the need of a multidisciplinary approach to obesity care that includes professionals with specific training in sexology.

Perceptions of sexual boredom in a community sample

This study explored the definitions of sexual boredom in a large community sample of Portuguese individuals. A thematic analysis of written responses to the question "What is sexual boredom for you?" was conducted with 653 participants aged 18 to 75 (M = 33.14; SD = 9.01) of multiple genders, sexual orientations, and relationship types. Three main themes were identified: definitions of sexual boredom, predisposing and maintenance factors of sexual boredom, and managing of sexual boredom. Sexual monotony, sexual desire, and hedonic value stand out as defining features of sexual boredom. Findings suggest the need of a multidimensional measure of sexual boredom.

Developing a prediction model for the self-evaluation of erectile dysfunction in an adult male population

The purpose of this study was to develop an erectile dysfunction (ED) risk assessment tool suitable for the general population. Based on an ED network survey of the general adult male population in China from October to November 2019, a total of 612 cases with a mean age of 31 years (interquartile range: 28-37) with valid data were collected: 357 cases were assigned to the training set and 255 to the validation set. The ED risk prediction model was established by multifactor logistic regression analysis, and nomograms were constructed for visualisation. In the validation set, a receiver operating characteristic curve, calibration curve analysis and decision curve analysis were used to evaluate the discrimination, calibration and clinical usefulness of the ED risk prediction model. Based on multivariate logistic regression, education, smoking, chronic diseases, feelings about one's spouse, frequency of sexual intercourse, masturbation and self-reported sexual satisfaction were selected as predictors to develop the ED prediction model. The model had good discrimination, calibration and clinical applicability. The ED risk prediction model developed in this study can effectively predict ED risk in the general population.

Attenuation of Deviant Sexual Fantasy across the Lifespan in United States Adult Males

Deviant sexual fantasy is identified as a risk factor for sexual offending, yet no study has examined deviant sexual fantasy across the lifespan in nonoffending adult males. To bridge this gap, this study examined the frequencies of normative and deviant sexual fantasies among 318 nonoffending adult males in the United States. Participants were recruited via Amazon Mechanical Turk™. Participants took two inventories that assessed demographics and types of sexual fantasies. Normality tests, means tests, Kruskal-Wallis 1-way analyses of variance (ANOVAs), binary logistic regressions, and odds ratio post hoc analyses were conducted. Deviant sexual fantasies progressively declined across all three age groups, while normative sexual fantasy did not. Results suggest that deviant sexual fantasy changes across the lifespan. Applicability of the findings to applied settings, such as sexually violent predator evaluations, is discussed. Limitations and future considerations are addressed.

The dynamics of adolescents' pornography use and psychological well-being: a six-wave latent growth and latent class modeling approach

Despite increasing concerns that pornography decreases adolescents' well-being, existing empirical support for this position is largely limited to cross-sectional studies. To explore possible links between adolescent pornography use and psychological well-being more systematically, this study focused on parallel dynamics in pornography use, self-esteem and symptoms of depression and anxiety. A sample of 775 female and 514 male Croatian high school students (M_{age at baseline} 15.9 years, SD 0.52) from 14 larger secondary schools, who were surveyed 6 times at approximately 5-month intervals, was used for the analyses. The longitudinal data were analyzed using latent growth curve and latent class growth modeling. We observed no significant correspondence between growth in pornography use and changes in the two indicators of psychological well-being over time in either female or male participants. However, a significant negative association was found between female adolescents' pornography use and psychological well-being at baseline. Controlling for group-specific trajectories of pornography use (i.e., latent classes) confirmed the robustness of findings in the both female and male samples. This study's findings do not corroborate the notion that pornography use in middle to late adolescence contributes to adverse psychological well-being, but do not rule out such a link during an earlier developmental phase-particularly in female adolescents. The findings have ramifications for educational and adolescent health specialists, but also for concerned parents.

Mapping the Perceived Sexuality of Heterosexual Men and Women in Mid- and Later Life: A Mixed-Methods Study

Introduction

There is currently limited research that examines the meaning of sexuality at midlife and later life.

Aim

This study investigates how heterosexual men and women in mid- and later life perceive their sexuality and the factors that influence it.

Methods

Group concept mapping was used to produce a conceptual map of the experience of sexuality for heterosexual adults ages 45 years and above. Group concept mapping data were collected using 6 open-ended survey questions that asked about sexuality, intimacy, and desire. Thematic analysis was used to examine how participants perceived their sexuality to have changed as they aged. Thematic analysis data were collected using a single open-ended survey question.

Main Outcome Measure

Statements generated from 6 of the open-ended survey questions were rated by participants using a 5-point Likert scale for how important participants felt that each statement was to themselves personally. Participants responses to the seventh open-ended survey question were examined using thematic analysis to understand whether participants felt that their sexual experiences had changed over time and, if so, how they had changed.

Results

Eight themes were identified across the different phases of group concept mapping. These were, in order of importance, partner compatibility, intimacy and pleasure, determinants of sexual desire, sexual expression, determinants of sexual expression, barriers to intimacy, sexual urges, and barriers to sexual expression. Seven areas of change were identified in terms of perceived changes to sexuality with age. These included changes to perspective, relationship dynamics, environment, behavior, body/function, sexual interest/desire, and sexual enjoyment.

Conclusion

The results highlight the prioritization of interrelationship dynamics in mid- and later life sexuality over sexual functioning and sexual urges. These findings may facilitate the development of new perspectives on how sexuality is experienced in the later years and provide new avenues for intervention in situations where sexual problems arise.

Macleod A, Busija L, McCabe M. Mapping the Perceived Sexuality of Heterosexual Men and Women in Mid- and Later Life: A Mixed-Methods Study. Sex Med 2019; 8:84–99.

Sexual and Relationship Satisfaction: The Role of Perceived (Non)problematic Sexual Desire Discrepancy in Gay and Heterosexual Men

Sexual desire discrepancy has been associated with sexual and relationship dissatisfaction. Nonetheless, little is known regarding the role of desire discrepancy in gay men, as main research has been systematically conducted with heterosexual couples. Also, only one study has focused on problematic sexual desire discrepancies and sexual satisfaction with lesbian women. This study sought to understand if perceived sexual desire discrepancy influences sexual and relationship satisfaction in men, and to explore differences according to sexual orientation. A total of 346 men (245 heterosexual and 101 gay) completed an online survey and answered sociodemographic questions, a specific question about sexual desire discrepancy, and completed the Global Measure of Sexual Satisfaction and the Global Measure of Relationship Satisfaction. The main findings showed differences in sexual and relationship satisfaction according to sexual desire discrepancy groups, with men who experienced no desire discrepancy being more satisfied within their relationship and sex life compared to men who experienced both problematic and nonproblematic sexual desire discrepancy. Additionally, men who experienced nonproblematic sexual desire discrepancy reported being more sexually and relationship satisfied than men who experienced problematic sexual desire discrepancy. No sexual orientation differences were found. Overall, current findings emphasize the role of (non)problematic desire discrepancy in sexual and relationship satisfaction among heterosexual and gay men.

Average Associations Between Sexual Desire, Testosterone, and Stress in Women and Men Over Time

Sexual desire and testosterone are widely assumed to be directly and positively linked to each other despite the lack of supporting empirical evidence. The literature that does exist is mixed, which may result from a conflation of solitary and dyadic desire, and the exclusion of contextual variables, like stress, known to be relevant. Here, we use the Steroid/Peptide Theory of Social Bonds as a framework for examining how testosterone, solitary and partnered desire, and stress are linked over time. To do so, we collected saliva samples (for testosterone and cortisol) and measured desire as well as other variables via questionnaires over nine monthly sessions in 78 women and 79 men. Linear mixed models showed that testosterone negatively predicted partnered desire in women but not men. Stress moderated associations between testosterone and solitary desire in both women and men, but differently: At lower levels of stress, higher average testosterone corresponded to higher average solitary desire for men, but lower solitary desire on average for women. Similarly, for partnered desire, higher perceived stress predicted lower desire for women, but higher desire for men. We conclude by discussing the ways that these results both counter presumptions about testosterone and desire but fit with the existing literature and theory, and highlight the empirical importance of stress and gender norms.

What factors are associated with reporting lacking interest in sex and how do these vary by gender? Findings from the third British national survey of sexual attitudes and lifestyles

OBJECTIVES

To investigate factors associated with reporting lacking interest in sex and how these vary by gender.

SETTING

British general population.

DESIGN

Complex survey analyses of data collected for a cross-sectional probability sample survey, undertaken 2010-2012, specifically logistic regression to calculate age-adjusted OR (AOR) to identify associated factors.

PARTICIPANTS

4839 men and 6669 women aged 16-74 years who reported ≥1 sexual partner (opposite-sex or same-sex) in the past year for the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3).

MAIN OUTCOME MEASURE

Lacking interest in sex for ≥3 months in the past year.

RESULTS

Overall, 15.0% (13.9-16.2) of men and 34.2% (32.8-35.5) of women reported lacking interest in sex. This was associated with age and physical and mental health for both men and women, including self-reported general health and current depression. Lacking interest in sex was more prevalent among men and women reporting sexually transmitted infection diagnoses (ever), non-volitional sex (ever) and holding sexual attitudes related to normative expectations about sex. Some gender similarities in associated relationship and family-related factors were evident, including partner having had sexual difficulties in the last year (men: AOR 1.41 (1.07-1.86); women: AOR 1.60 (1.32-1.94)), not feeling emotionally close to partner during sex (men: 3.74 (1.76-7.93); women: 4.80 (2.99-7.69) and ease of talking about sex (men: 1.53 (1.23-1.90);women: 2.06 (1.77-2.39)). Among women only, lack of interest in sex was higher among those in a relationship of >1 year in duration and those not sharing the same level of interest (4.57 (3.87-5.38)) or preferences (2.91 (2.22-3.83)) with a partner.

CONCLUSIONS

Both gender similarities and differences were found in factors associated with lacking interest in sex, with the most marked differences in relation to some relationship variables. Findings highlight the need to assess, and if appropriate, treat lacking interest in sex in a holistic and relationship-specific way.

The Impact of Body Dissatisfaction on Distressing Sexual Difficulties Among Men and Women: the Mediator Role of Cognitive Distraction

Research has demonstrated a negative impact of cognitive distraction on sexual activity, and body dissatisfaction has been associated with less satisfying and fewer sexual activities. In the current study we examined the extent to which cognitive distraction, based on body appearance and sexual performance, mediated the impact of body dissatisfaction on sexual difficulties among women and men. A sample of 493 women (M_age = 30.61) and 595 men (M_age = 37.90) completed an online survey. Women reported significantly higher levels of distressing sexual difficulties, significantly more body dissatisfaction, and greater cognitive distraction based on appearance than men. In contrast, men reported higher cognitive distraction based on performance than women. A path analysis model indicated that, for men, only cognitive distraction based on performance mediated the effects of body dissatisfaction on distressing sexual difficulties, and the mediation was only partial as body dissatisfaction had a significant direct effect on distressing sexual difficulties. In contrast, among women, both appearance-based cognitive distraction and performance-based cognitive distraction fully mediated the effects of body dissatisfaction on distressing sexual difficulties.

Erectile Dysfunction and Low Sex Drive in Men with Type 2 DM: The Potential Role of Diabetic Pharmacotherapy

INTRODUCTION

Diabetic men with erectile dysfunction have not been widely studied. They have low testosterone levels, causing low sex drive and erectile dysfunction.

AIM

To assess the erectile dysfunction and sex drive in relation to testosterone serum levels in type 2 Diabetes Mellitus (DM) patients.

MATERIALS AND METHODS

A total of 64 patients with type 2 DM were enrolled in this cross-sectional study, according to the treatment types they were divided into three groups, group (A): 34 patients treated with metformin, group (B): 30 patients treated with sulfonylurea and group (C): 27 healthy normal non-diabetic men are taken as control. Total testosterone (TT), Free Testosterone (FT), Free Androgenic Index (FAI), Sex Hormone Binding Globulin (SHBG), lipid profile and anthropometric parameters in metformin and sulfonylurea treated patients were compared to normal healthy men along with Sexual Health Inventory for Men (SHIM).

RESULTS

Total testosterone serum levels were high in sulfonylurea treated patients as compared to metformin treated patients' p < 0.0001. Similarly, SHBG levels were significantly higher in sulfonylurea treated patients compared to metformin treated patients p < 0.0001. FT was also significantly higher in sulfonylurea treated patients compared to metformin treated patients p =0.014 and significantly low compared to the control p =0.0002. FAI was also significantly higher in sulfonylurea treated patients compared to metformin treated patients p < 0.0001. On other hand Bioavailable testosterone (BT) was low in metformin treated patients (2.75±1.12 nmol/L) compared to the control p< 0.0001. SHIM was low in metformin treated patients 10.61±3.22 which significantly differed from control and sulfonylurea treated patients p< 0.0001, intergroup differences was significant p=0.001.

CONCLUSION

Metformin leads to significant reduction in testosterone levels, sex drive and induction of low testosterone-induced erectile dysfunction, whereas; sulfonylurea leads to significant elevation in testosterone levels, sex drive and erectile function.

Is Internet Pornography Causing Sexual Dysfunctions? A Review with Clinical Reports

Traditional factors that once explained men's sexual difficulties appear insufficient to account for the sharp rise in erectile dysfunction, delayed ejaculation, decreased sexual satisfaction, and diminished libido during partnered sex in men under 40. This review (1) considers data from multiple domains, e.g., clinical, biological (addiction/urology), psychological (sexual conditioning), sociological; and (2) presents a series of clinical reports, all with the aim of proposing a possible direction for future research of this phenomenon. Alterations to the brain's motivational system are explored as a possible etiology underlying pornography-related sexual dysfunctions. This review also considers evidence that Internet pornography's unique properties (limitless novelty, potential for easy escalation to more extreme material, video format, etc.) may be potent enough to condition sexual arousal to aspects of Internet pornography use that do not readily transition to real-life partners, such that sex with desired partners may not register as meeting expectations and arousal declines. Clinical reports suggest that terminating Internet pornography use is sometimes sufficient to reverse negative effects, underscoring the need for extensive investigation using methodologies that have subjects remove the variable of Internet pornography use. In the interim, a simple diagnostic protocol for assessing patients with porn-induced sexual dysfunction is put forth.

Self-Report Measures of Boredom: An Updated Review of the Literature

A detailed review of the psychometric measures of boredom was published approximately 12 years ago (Vodanovich, 2003). Since that time, numerous studies have been conducted on existing scales, and new measures of boredom have been developed. Given these assessment advancements, an updated review of self-report boredom scales is warranted. The primary focus of the current review is research published since 2003, and it includes a total of 16 boredom scales. The measures reviewed consist of two trait assessments (Boredom Proneness Scale, Boredom Susceptibility subscale of the Sensation Seeking Scale), five context-specific trait boredom scales (Boredom Coping Scale, Leisure Boredom Scale, Free Time Boredom Scale, Sexual Boredom Scale, Relational Boredom Scale), three assessments of state boredom (Multidimensional State Boredom Scale, State Boredom Measure, Boredom Experience Scale), and six context-specific state boredom measures-Lee's Job Boredom Scale, Dutch Boredom Scale, Boredom Coping Scale (Academic), the Boredom subscale of the Achievement Emotions Questionnaire, Academic Boredom Scale, Precursors to Boredom Scale. In addition to providing a review of these measures, a brief critique of each scale is included, as well as suggestions for needed research focus.

Sex drive and sexual desire

PURPOSE OF REVIEW

Loss of sexual desire is increasingly recognized as a consequence of many disease processes, and one that can have a significant negative impact on quality of life. This review explores the biological and psychological aspects of desire, as well as the aetiology and therapeutic options for loss of desire.

RECENT FINDINGS

Discoveries have been made in terms of the physiology of desire in men, in that it is affected by estradiol as well as testosterone. It has also been shown that desire is less gender specific in androphilic women than in androphilic men and gynaephilic men and women. Fatigue has been described as the most common self-reported cause of loss of desire, with communication as the most common method for addressing this. In men, a clear distinction has been shown between disorders of arousal and disorders of desire, suggesting that they should remain as separate conditions in the Diagnostic and Statistical Manual of Mental Disorders criteria. Loss of desire has been proven to be a significant consequence of diabetes, multiple sclerosis and polycystic ovary syndrome and can occur as a side-effect of statins and 5α-reductase inhibitors. Testosterone therapy may be an effective treatment for loss of desire in both men and women, and is safe in the treatment of men who have been treated for prostate cancer. It also has a significant impact on desire when used in the treatment of individuals with gender dysphoria. Nonhormonal treatments including flibanserin and new methods of therapy may also be effective.

SUMMARY

Loss of desire is underrecognized as a symptom of disease or as a complaint in its own right. As further developments in treatment options, both therapies based and pharmacological, are made, it is increasingly important that clinicians enquire about sexual dysfunction, including loss of desire, at every consultation.

Individual and Relationship Factors Associated With the Self-Identified Inability to Experience Orgasm in a Community Sample of Heterosexual Men From Three European Countries

The inability to reach orgasm is probably the least common and least understood of all male sexual dysfunctions. The present study aims to investigate the incidence of the inability to reach orgasm, and the psychological and interpersonal factors associated with this sexual difficulty. A total of 3,672 heterosexual men from three European countries (1,937 Portuguese, 1,215 Croats, 520 Norwegians) participated in this web survey (M age = 36.6 years, SD = 18-75 years). A total of 354 (9.6%) reported the inability to reach orgasm. Among those men, 89.8% reported moderate to extreme distress regarding this sexual difficulty. A multivariate assessment revealed that men in short-term relationships and taking antidepressants were more likely to report inability to reach orgasm. Men who reported having difficulties getting or maintaining an erection were 4 times more likely to have experienced the inability to reach orgasm than were those who did not report this difficulty. Men who experienced difficulty "'letting go' and surrendering to sexual pleasure during sex" were 2.7 times more likely to have experienced the inability to reach orgasm than were those who did not report this difficulty. This difficulty of "letting go" might reflect the unwillingness to give oneself, an idea presented in previous research.

Masturbation and Pornography Use Among Coupled Heterosexual Men With Decreased Sexual Desire: How Many Roles of Masturbation?

The relation between masturbation and sexual desire has not been systematically studied. The present study assessed the association between masturbation and pornography use and the predictors and correlates of frequent masturbation (several times a week or more often) among coupled heterosexual men who reported decreased sexual desire. Analyses were carried out on a subset of 596 men with decreased sexual desire (mean age = 40.2 years) who were recruited as part of a large online study on male sexual health in 3 European countries. A majority of the participants (67%) reported masturbating at least once a week. Among men who masturbated frequently, 70% used pornography at least once a week. A multivariate assessment showed that sexual boredom, frequent pornography use, and low relationship intimacy significantly increased the odds of reporting frequent masturbation among coupled men with decreased sexual desire. These findings point to a pattern of pornography-related masturbation that can be dissociated from partnered sexual desire and can fulfill diverse purposes. Clinical implications include the importance of exploring specific patterns of masturbation and pornography use in the evaluation of coupled men with decreased sexual desire.