Erectile Dysfunction, Boredom, and Hypersexuality among Coupled Men from Two European Countries

Effect of internet pornography use frequency on psychogenic erectile dysfunction severity in young Turkish men: the mediating role of dyadic adjustment

This cross-sectional study aimed to investigate the effect of the frequency of using pornography on psychogenic erectile dysfunction severity after controlling for other psychological factors. It then evaluated the mediating role of dyadic adjustment regarding this. This study included 66 young married heterosexual male patients who were diagnosed with psychogenic erectile dysfunction after organic causes were excluded. The patients filled out the form about demographics, the age of onset of pornography use, and the frequency of pornography use. All participants were evaluated using a comprehensive data form, the International Index of Erectile Function, the Dyadic Adjustment Scale, the Patient Health Questionnaire-Somatic, Anxiety, and Depressive Symptoms, the Perceived Stress Scale, and the Rosenberg Self-Esteem Scale. A significant strong negative correlation was determined between the International Index of Erectile Function scores and pornography use frequency (r = -0.535 and p < 0.001). Pornography use frequency and Dyadic Adjustment Scale scores were found to have a significant predictive effect on erectile dysfunction scores in hierarchical regression analysis after controlling for somatization, depression, and perceived stress, which are typically correlated with erectile dysfunction scores (Beta = -0.28, and 0.34 respectively, p = 0.02, and 0.01 respectively). The Sobel test conducted to evaluate the mediating effect of dyadic adjustment revealed that dyadic adjustment played a mediating role in the correlation between pornography use frequency and erectile dysfunction scores (z = -1.988 and p = 0.047, respectively). The most significant observation of this study was the specific causative effect of pornography use frequency on erectile dysfunction severity through dyadic adjustment, especially considering that the frequency of using pornography is a modifiable factor.

Early traumatic experiences are linked to hypersexual behavior and erectile dysfunction in men through the mediation of body uneasiness and general psychopathology

BACKGROUND

Childhood traumatic experiences have been associated with hypersexuality and sexual dysfunctions. However, the mediators of the interactions between these variables should be clarified in men.

AIM

This study aimed to investigate the interaction of early traumatic experiences, psychopathology, and sexuality with respect to erectile dysfunction (ED) and hypersexual behavior. The hypothesized model expected that traumatic experiences would be associated with hypersexual behavior and reduced sexual functioning through the mediation of body uneasiness and psychological distress.

METHODS

The study was cross-sectional and observational. A total of 317 men were enrolled. Male patients with a primary complaint of ED and an indication for psychiatry referral represented the clinical sample (n = 116; mean ± SD age, 42.82 ± 16.89 years). Clinical classification was assessed with the Structured Interview on Erectile Dysfunction. The second sample (n = 201, 30.82 ± 11.94 years) was recruited from the general population. All participants were administered the following questionnaires: Brief Symptom Inventory, Childhood Trauma Questionnaire-Short Form, Hypersexual Behavior Inventory, Body Uneasiness Test-A, and 5-item International Index of Erectile Function.

OUTCOMES

Psychopathology and sexual functioning were assessed by a dimensional approach, and a multivariate model was computed by structural equation model analysis.

RESULTS

When compared with the sample from the general population, the clinical sample exhibited a higher prevalence of early traumatic experiences, as measured by scores on the Childhood Trauma Questionnaire-Short Form (45.08 ± 14.25 vs 39.03 ± 10.22, F = 17.63, P < .001), and a higher tendency to engage in hypersexual behaviors (34.63 ± 13.55 vs 30.79 ± 12.44, F = 6.97, P < .01). Structural equation model analysis showed excellent fit indices indicating that early traumatic experiences predicted hypersexual behaviors and ED through the exacerbating mediating effect of body uneasiness and psychopathology.

CLINICAL IMPLICATIONS

Clinicians should not limit their attention to the behavioral level when assessing sexual dysfunction in men; rather, they should also consider the complex psychopathologic consequences of childhood trauma. Integrated treatments that address the potential presence of childhood trauma with its wider psychological correlates (eg, emotion dysregulation, body uneasiness) might improve treatment response.

STRENGTHS AND LIMITATIONS

The study reports novel data on the relationship among childhood maltreatment, male sexuality, and psychopathologic mediators with a dimensional assessment. However, the assessment was cross-sectional, and causality was mainly derived from previous studies.

CONCLUSION

The present study enriches the current literature, strengthening the hypothesis that childhood traumatic experiences significantly shape development and sexuality. Body uneasiness and psychopathology can both tax sexual functioning, as assessed by erectile functioning or hypersexuality.

The Dual Control Model of Sexual Response: A Scoping Review, 2009-2022

The Dual Control Model proposes that sexual arousal and related processes are dependent on the balance between sexual excitation and sexual inhibition, and that individuals vary in their propensity for these processes. This scoping review provides an overview and discussion of the questionnaires used to measure the propensities for sexual excitation and inhibition, their translation and validation in other languages, and their application in empirical research on topics ranging from sexual desire and arousal, sexual (dys)function, sexual risk taking, asexuality, hypersexuality, and sexual aggression. A total of 152 papers, published between 2009 and 2022 and identified using online databases, were included in this review. The findings, consistent with those reviewed by Bancroft et al. (2009), suggest that sexual excitation is particularly relevant to sexual desire and responsivity and predictive of asexuality and hypersexuality. Sexual inhibition plays a role in sexual dysfunction. sexual risk taking, and sexual aggression, although often in interaction with sexual excitation. Suggestions for the further development of the model and for future studies are discussed.

Hypo- or hyperfunction? Differential relationships between compulsive sexual behavior disorder facets and sexual health

BACKGROUND

Previous studies linking compulsive sexual behavior disorder (CSBD) and sexual health have shown mixed results, which could be due to the fact that different CSBD facets may have differential relationships with sexual functioning.

AIM

As CSBD is a multidimensional disorder, we wanted to investigate whether distinct CSBD domains are differentially related to sexual health.

METHODS

Two online studies were conducted-the first on a convenience sample (812 Polish participants; mean [SD] age, 22.07 [5.91] years) and a replication study on a representative sample of Polish adults (n = 1526; 43.02 [14.37]). Hierarchical regression was employed with sexual functioning as a predicted variable and CSBD symptoms as predictors.

OUTCOMES

The Compulsive Sexual Behavior Disorder Scale was used to assess CSBD symptoms, and the Arizona Sexual Experience Scale was used to measure sexual dysfunction.

RESULTS

In study 1, CSBD salience (β = -.20, P < .001) predicted hyperfunction (ie, stronger sex drive, easier sexual arousal, easier vaginal lubrication/penile erection, easier ability to reach an orgasm, and more satisfying orgasms). Yet, CSBD negative consequences (β = .15, P = .001) and dissatisfaction (β = .22, P < .001) predicted hypofunction (ie, weaker sex drive, more difficulties in sexual arousal, greater difficulties in vaginal lubrication/penile erection, less ability to reach an orgasm, and less satisfying orgasms). Similar results were found in study 2: salience (β = -.26, P < .001) and relapse (β = -.11, P = .004) predicted hyperfunction, while negative consequences (β = .12, P < .001) and dissatisfaction (β = .12, P < .001) predicted hypofunction.

CLINICAL IMPLICATIONS

Our results stress the importance of assessing the severity of each group of symptoms in patients with CSBD to better understand possible difficulties in their sexual functioning.

STRENGTHS AND LIMITATIONS

Our studies are the first to evaluate the effects of each CSBD domain on sexual health. We also replicated results obtained from a convenience sample on a representative sample. The cross-sectional design of the current studies does not allow causal relations to be tested, so future longitudinal research should be carried out. We also gathered data from a general population-thus, it is important to replicate these results on patients diagnosed with CSBD.

CONCLUSION

Our research points out the differential impact of CSBD domains on sexual health: salience and relapse are related to sexual hyperfunction, while negative consequences and dissatisfaction to hypofunction.

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.

Hypersexuality as a tip of the iceberg of a primary psychopathology: a joined position statement of the Italian Society of Andrology and Sexual Medicine (SIAMS) and of the Italian Society of Psychopathology (SOPSI)

In the last years, hypersexual behavior has been broadly scientifically studied. The interest in this topic, belonging to psycho-sexology and sexual medicine, has been due to its still unclear aetiology, nature, and its manifestation in relationship with several organic and psychopathological conditions. So, the specialist (the psychologist, psychiatrist, endocrinologist, neurologist) may encounter some difficulties in diagnosing and managing this symptom. The first main objective of this position statement, which has been developed in collaboration between the Italian Society of Andrology and Sexual Medicine (SIAMS) and the Italian Society of Psychopathology (SOPSI) is to give to the reader evidence about the necessity to consider hypersexuality as a symptom related to another underlying condition. Following this consideration, the second main objective is to give specific statements, for the biopsychosocial assessment and the diagnosis of hypersexual behavior, developed on the basis of the most recent literature evidence. To develop a psycho-pharmacological treatment tailored on patients' needs, our suggestion is to assess the presence of specific comorbid psychopathological and organic conditions, and the impact of pharmacological treatments on the presence of an excess of sexual behavior. Finally, a suggestion of a standardized psychometric evaluation of hypersexuality will be given.

The Relationship between Boredom Proneness, Attachment Styles and Compulsive Sexual Behavior

Affect regulation is associated with compulsive sexual behavior (CSB) despite ongoing debate about its inclusion in diagnostic criteria. Previous studies on two specific affect regulation constructs - boredom proneness and attachment styles - suggest that affect regulation is associated with CSB. We tested a moderation model of the effects of attachment anxiety and attachment avoidance on the relationship between boredom proneness and CSB. Results indicate that the relationship between boredom proneness and CSB is stronger at higher levels of attachment anxiety, with no interaction between boredom proneness and attachment avoidance. Overall findings support the importance of affect regulation in conceptualizing and treating CSB.

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.

Online Sex Addiction: A Qualitative Analysis of Symptoms in Treatment-Seeking Men

BACKGROUND

Problematic sexual internet use has been attracting increasing research attention in recent years. However, there is a paucity of qualitative studies about how this problem manifests on a daily basis in the clinical population and whether the phenomenon should fall within the hypersexual, compulsive-impulsive, or addictive spectrums of disorders.

METHODS

Twenty-three semi-structured interviews, including AICA-C clinical interviews, were conducted with men who were in treatment for problematic internet sex use (aged 22-53; Mage = 35.82). The interview structure focused on the patterns of sexual behavior in question, their development, the manifestation of symptoms, and other associated psychosocial problems. A thematic analysis was applied as the main analytical strategy.

RESULTS

Typical problematic patterns included pornography use and cybersex, together with continuous masturbation for several hours several times a week. This pattern emerged relatively early in young adulthood and became persistent for years. The majority of participants fulfilled the criteria for behavioral addiction (as defined, e.g., by the components model of addiction), with loss of control and preoccupation being the most pronounced and withdrawal symptoms being the least. Together with the onset of erectile dysfunction, negative consequences were reported as being slowly built up over years and typically in the form of deep life dissatisfaction, regret, and feelings of unfulfilled potential.

DISCUSSION AND CONCLUSION

The Addiction model is relevant for describing the difficulties in treatment-seeking men who suffer from problematic sexual internet use. However, the manifestations of the additional criteria are nuanced. In the case of negative consequences, their onset might be very slow and not easily reflected. While there was evidence of several forms of tolerance, potential withdrawal symptoms in online sex addiction need further attention to be verified.

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.

The development of the Compulsive Sexual Behavior Disorder Scale (CSBD-19): An ICD-11 based screening measure across three languages

BACKGROUND

Compulsive Sexual Behavior Disorder (CSBD) is included in the eleventh edition of The International Classification of Diseases (ICD-11) as an impulse-control disorder.

AIMS

The aim of the present work was to develop a scale (Compulsive Sexual Behavior Disorder Scale-CSBD-19) that can reliably and validly assess CSBD based on ICD-11 diagnostic guidelines.

METHOD

Four independent samples of 9,325 individuals completed self-reported measures from three countries (the United States, Hungary, and Germany). The psychometric properties of the CSBD-19 were examined in terms of factor structure, reliability, measurement invariance, and theoretically relevant correlates. A potential threshold was determined to identify individuals with an elevated risk of CSBD.

RESULTS

The five-factor model of the CSBD-19 (i.e., control, salience, relapse, dissatisfaction, and negative consequences) had an excellent fit to the data and demonstrated appropriate associations with the correlates. Measurement invariance suggested that the CSBD-19 functions similarly across languages. Men had higher means than women. A score of 50 points was found as an optimal threshold to identify individuals at high-risk of CSBD.

CONCLUSIONS

The CSBD-19 is a short, valid, and reliable measure of potential CSBD based on ICD-11 diagnostic guidelines. Its use in large-scale, cross-cultural studies may promote the identification and understanding of individuals with a high risk of CSBD.

Psychometric Instruments for Problematic Pornography Use: A Systematic Review

Despite a lack of consensus in the field about how best to conceptualize problematic pornography use, psychometric instruments have nonetheless been developed to assess the construct. The present systematic review aimed to (i) identify psychometric tools that have been developed to assess problematic pornography use; (ii) summarize key characteristics, psychometric properties, and strengths and limitations of instruments for problematic pornography use; (iii) compare the instruments' theoretical conceptualizations of problematic pornography use; and (iv) evaluate each instrument on their ability to assess various core components of addiction. In this article, 22 instruments assessing problematic pornography use were reviewed. Results indicated that while the instruments had different conceptualizations of problematic pornography use, addiction still emerged as the most common theoretical framework used by the instruments. Five of the most commonly assessed addiction components across the different instruments were (1) impaired control, (2) salience, (3) mood modification, (4) interpersonal conflict, and (5) general life conflict. Contextual factors that may potentially affect the assessment of problematic pornography use and recommendations for researchers and clinicians are discussed.

The Potential Associations of Pornography Use with Sexual Dysfunctions: An Integrative Literature Review of Observational Studies

This paper reviews the associations between pornography use and sexual dysfunction based on evidence from observational studies. The existing data in this regard mostly derive from cross-sectional investigations and case reports. There is little if no evidence that pornography use may induce delayed ejaculation and erectile dysfunction, although longitudinal studies that control for confounding variables are required for a full assessment. The associations between pornography use and sexual desire may differ between women and men although the existing data is contradictory and causal relationships cannot be established. The strongest evidence is available for the relation of pornography use with decreased sexual satisfaction, although the results of prospective studies are inconsistent. The paper outlines future research prospects beneficial in understanding the nature of associations between pornography use and sexual dysfunctions in men and women.

Erectile Dysfunction Symptoms in Polydrug Dependents Seeking Treatment

OBJECTIVE

To assess erectile dysfunction (ED) symptom prevalence, sexual behavior conditions, and risk factors associated to ED in a male polydrug dependent sample.

METHODS

A cross-sectional design study was conducted with 102 substance-dependent male polydrug users who sought outpatient treatment in São Paulo, Brazil. Sociodemographic data, drug of choice, chronic disease questions, sexually transmitted infections, International Index of Erectile Function (IIEF) scale, Sexual Addiction Screening Test (SAST), and WHOQOL-Bref instrument were used.

RESULTS

The erectile dysfunction prevalence was 32.3% and it was related to the marital status (single) (p < 0.001), occupational status (fully unemployed) (p < 0.001), presenting a chronic disease (p = 0.027), and with types of sexual partnerships (occasional partner) (p < 0.001). Alcohol (73.5%), tobacco (79.4%), cannabis (83.3%), and cocaine (snorted 78.4% and smoked 42.2%) were the drugs of choice. The ED risk decreased when marital status was married (odds ratio = 3.2 CI95% 1.411-7.518) and with chronic disease (odds ratio 0.06 CI95% 0.00-0.97), while having occasional sexual partners increased 14 times ED risk (OR 14.0 CI95%1.62-122.18). There were no significant associations between quality of life, DOC and ED.

CONCLUSION

Approximately one third of the substance dependents in this sample presented ED. There is a need to integrate psychiatric and clinical care in substance treatment services, and to improve the provision of sexual health care and support available for this population.

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.