An Integrative Biopsychosocial and Sex Positive Model of Understanding and Treatment of Impulsive/Compulsive Sexual Behavior

Understanding How Religiousness Shapes Perceptions of Compulsive Sexual Behavior

In the present study, we test the model of moral incongruence by examining whether moral disapproval of pornography mediates the relationship between organizational religious activity and self-reported CSB and whether the frequency of viewing pornography moderates the relationship between moral disapproval and self-reported CSB in two samples: a general population sample and a sample of members of the Church of Jesus Christ of Latter-day Saints ("Mormons"). Analyses revealed that, among both samples, frequency of pornography viewing moderated the indirect effect of organizational religious activity on perceived CSB via morally disapproving of pornography. Specifically, moral disapproval of pornography mediated the relationship between organizational religious activity and compulsive sexual behavior when participants viewed pornography approximately monthly or more (mean and +1 SD among the general population sample, +1 SD among the Latter-day Saint sample). Findings suggest that individuals who attend worship services more frequently are more likely to perceive their pornography viewing as compulsive at higher frequencies of usage - even when their frequency of pornography viewing is unlikely to be associated with actual functional impairment - and that this distress is better understood in relation to experiences of moral incongruence.

Assessment and treatment of compulsive sexual behavior disorder: a sexual medicine perspective

INTRODUCTION

The addition of compulsive sexual behavior disorder (CSBD) into the ICD-11 chapter on mental, behavioral, or neurodevelopmental disorders has greatly stimulated research and controversy around compulsive sexual behavior, or what has been termed "hypersexual disorder," "sexual addiction," "porn addiction," "sexual compulsivity," and "out-of-control sexual behavior."

OBJECTIVES

To identify where concerns exist from the perspective of sexual medicine and what can be done to resolve them.

METHODS

A scientific review committee convened by the International Society for Sexual Medicine reviewed pertinent literature and discussed clinical research and experience related to CSBD diagnoses and misdiagnoses, pathologizing nonheteronormative sexual behavior, basic research on potential underlying causes of CSBD, its relationship to paraphilic disorder, and its potential sexual health consequences. The panel used a modified Delphi method to reach consensus on these issues.

RESULTS

CSBD was differentiated from other sexual activity on the basis of the ICD-11 diagnostic criteria, and issues regarding sexual medicine and sexual health were identified. Concerns were raised about self-labeling processes, attitudes hostile to sexual pleasure, pathologizing of nonheteronormative sexual behavior and high sexual desire, mixing of normative attitudes with clinical distress, and the belief that masturbation and pornography use represent "unhealthy" sexual behavior. A guide to CSBD case formulation and care/treatment recommendations was proposed.

CONCLUSIONS

Clinical sexologic and sexual medicine expertise for the diagnosis and treatment of CSBD in the psychiatric-psychotherapeutic context is imperative to differentiate and understand the determinants and impact of CSBD and related "out-of-control sexual behaviors" on mental and sexual well-being, to detect forensically relevant and nonrelevant forms, and to refine best practices in care and treatment. Evidence-based, sexual medicine-informed therapies should be offered to achieve a positive and respectful approach to sexuality and the possibility of having pleasurable and safe sexual experiences.

Confirming and Expanding the Moral Incongruence Model of Compulsive Sexual Behavior

Compulsive sexual behavior (CSB) is a clinical syndrome in which repetitive sexual behaviors, urges, or thoughts cause significant distress and impairment. Moral incongruence (MI), or conflict between an individual's sexual behaviors and moral beliefs, is highly associated with self-reported problematic pornography use, a common behavioral manifestation of CSB. However, it is currently unknown whether MI is associated with other self-reported compulsive sexual behaviors, such as masturbation, sexual fantasy, and sex with multiple partners. Additionally, research on MI has not explored whether emotional responses to sexual cues (i.e., erotophilia-erotophobia) may serve as a moderating variable in the MI model. To address these gaps in the literature, this study administered an online survey to a sample of 804 American participants. Results confirmed previous research on MI indicating frequency of pornography use is more strongly associated with self-reported CSB at high levels of moral disapproval. This moderation was also replicated with frequency of sexual fantasy and number of sex partners, but not with frequency of masturbation. Results also indicated that self-reported CSB was modestly associated with positive emotional response to sexual cues (i.e., erotophilia) but offered limited support for erotophilia as a moderator in the MI model. Collectively, these findings suggest the MI model can be expanded to several behavioral manifestations of CSB, but that emotional responses to sexual cues may play a limited or more nuanced role in MI.

Identifying Relationships Between Difficulties with Emotion Regulation and Compulsive Sexual Behavior

Emotion dysregulation is an associated feature of compulsive sexual behavior disorder (CSBD), now recognized by the World Health Organization. Previous studies have identified associations between trait emotion dysregulation and CSBD. Given that difficulties with emotion regulation (DERS) is comprised of several facets (e.g., difficulty with impulse control and lacking awareness of one's feelings when upset), and that these facets differentially relate to other mental health concerns, the present study aimed to examine how DERS facets relate to compulsive sexual behavior (CSB). The present study also considered interpersonal emotion regulation via attachment avoidance and attachment anxiety. Hierarchical regression was conducted, first accounting for demographic covariates, then adding attachment styles, and finally all DERS subscales. Results indicated that, among a large, diverse, online U.S. sample (N = 915; Mage = 39.21, SD = 0.81; 54.3% men), difficulty controlling impulses when upset, difficulty with clarity of emotions, and non-acceptance of emotions were significantly positively associated with CSB (small to moderate effects). Attachment anxiety and avoidance were also significantly positively associated with CSB, although their effects were minimal when adding DERS facets. Overall, this study supports the theorized impact of emotion dysregulation on CSB. Assessment of individual differences in DERS and intervening on these concerns are important for treating CSB.

Compulsive Sexual Behavior and Changes in Solitary Sexual Behaviors During the COVID-19 Pandemic

The aim of with this brief report is to examine how the COVID-19 pandemic differentially impacted solitary sexual behaviors in those with and without clinically significant compulsive sexual behavior (CSB). A total of 944 individuals in the United States completed an online cross-sectional survey in October 2020. Participants were asked to retrospectively report their frequency of masturbation and pornography use during the pandemic and prior to the pandemic. Participants also completed assessments of CSB, depression symptoms, and experiences of financial stress caused by the pandemic. Individuals who screened positive for clinically significant CSB reported statistically significant increases in masturbation and pornography use during the pandemic. Those who screened negative for CSB reported no significant increase in masturbation and a very small, statistically significant increase in pornography use. Those screening positive for CSB also reported significantly higher levels of depression symptoms but did not report increased likelihood of experiencing financial distress due to the pandemic. This suggests that increases in masturbation and pornography use reported by some, but not all, recent studies on sexual behaviors during the COVID-19 pandemic may be driven by individuals with CSB. Future research on sexual behaviors during the pandemic should assess CSB to further clarify its relationship with sexual behavior changes.

Sexual Violence in Military Service Members/Veterans Individual and Interpersonal Outcomes Associated with Single and Multiple Exposures to Civilian and Military Sexual Violence

Sexual harassment and violence is a grave public health concern and risk for revictimization increases following initial exposure. Studies of sexual revictimization in military samples are generally limited to women and are focused on rates of posttraumatic stress disorder (PTSD), with no examination of how revictimization relates to interpersonal outcomes, such as relationship or sexual satisfaction. The current study addressed these gaps in a sample of 833 women and 556 men service members/veterans. Self-reported outcomes of PTSD, depression, suicidal ideation, sexual function, and relationship satisfaction were compared across those reporting exposure to sexual harassment and violence before the military only (i.e., pre-military), during the military only (i.e., military sexual harassment and violence [MSV]), before and during the military (i.e., revictimization), and to no exposure. More than half of women (51.14%, n = 426) reported revictimization and only 5.79% (n = 28) of men reported revictimization. Among women, those reporting MSV or revictimization tended to report higher PTSD, depression, and suicidal ideation relative to pre-military sexual violence and no sexual violence exposure. No interpersonal outcomes were significantly different among these sexual violence groups. Among men, revictimization was associated with higher PTSD, depression, and sexual compulsivity. PTSD and depression were also higher among those reporting MSV only. No effects were found for premilitary sexual trauma exposure only or relationship satisfaction for either group. Findings highlight the particularly bothersome nature of MSV, whether it occurred alone or in tandem with premilitary sexual violence. Findings also show unique gender differences across outcomes, suggesting interventions following sexual harassment and violence may differ for men and women.

The Relationship Between Alcohol and Drug Use, Compulsive Sexual Behavior, and Condomless Anal Sex in Men Who have Sex with Men: Analysis of Retrospectively-Reported Sexual Behavior

Men who have sex with men (MSM) are disproportionately impacted by HIV in the United States, and substance use and compulsive sexual behavior (CSB) are contributors to HIV risk behavior. This study sought to examine the direct and interactive effects of concurrent substance use and CSB on condomless anal sex (CAS) in a community sample of MSM (N = 200) utilizing a 90-day timeline follow-back assessment. Results indicated CSB did not directly increase risk for CAS when controlling for substance use and age. There was limited evidence for a direct effect of concurrent alcohol use on CAS, and no evidence for an interaction effect with CSB. The relationship between concurrent drug use and CAS was moderated by CSB, such that concurrent drug use was positively associated with CAS for those who screened positive for CSB, while the association was non-significant for those who screened negative. Implications and limitations of these findings are discussed.

Coming Together: Synthesizing Sex Therapy with Integrative Behavioral Couple Therapy

The fields of couple therapy and sex therapy have historically been divided, with sex therapists focusing on sexual problems as fuel for relationship distress and couple therapists conceptualizing relationship distress as the root of sexual problems. Various researchers and clinicians have worked to integrate the two worlds by offering strategies for integrating sex therapy interventions into couple therapy, either by providing just the information necessary to address the sexual difficulty or by articulating how to utilize a sex therapy intervention within a specific couple therapy modality. However, limited literature exists that truly integrates sex therapy with specific couple therapies, actively accounting for the theoretical lenses held by both. This paper explores the conceptual fit between Integrative Behavioral Couple Therapy (IBCT; Christensen, Doss, & Jacobson, Integrative behavioral couple therapy: A therapist's guide to creating acceptance and change. Norton Professional Books, 2020) and modern sex therapy. To highlight this fit, we first review IBCT's theory, process, and primary interventions and then summarize the current trends in the field of sex therapy. We outline the conceptual fit between IBCT and modern sex therapy, then provide a pragmatic model for how a therapist might integrate the two in practice, highlighted with a case example.

The Relationship between Compulsive Sexual Behavior, Religiosity, and Moral Disapproval

Compulsive sexual behavior (CSB) is associated with religiosity and moral disapproval for sexual behaviors, and religiosity and moral disapproval are often used interchangeably in understanding moral incongruence. The present study expands prior research by examining relationships between several religious orientations and CSB and testing how moral disapproval contributes to these relationships via mediation analysis. Results indicated that religious orientations reflecting commitment to beliefs and rigidity in adhering to beliefs predicted greater CSB. Additionally, moral disapproval mediated relationships between several religiosity orientations and CSB. Overall, findings suggest that religiosity and moral disapproval are related constructs that aid in understanding CSB presentations.

Mental and sexual health perspectives of the International Classification of Diseases (ICD-11) Compulsive Sexual Behavior Disorder •

After introduction of compulsive sexual behavior disorder (CSBD) in the ICD-11, many questions regarding etiology, classification and diagnostic criteria remain unanswered, providing rationale for further research. In this commentary, we critically review the ongoing discussion reflected in some relevant articles, and try to point out the risks of oversimplification of the broad clinical phenomenon, as well as attract attention to the neglected aspects, such as psychosexual development, intimacy disorder and the role of sexological expertise in the assessment and treatment of individuals presenting with out-of-control sexual behaviors. We also advocate for multimodal, transtheoretical approach and suggest that CSBD may be reconsidered as a condition related to sexual health.

Religiosity, Perceived Effects of Pornography Use on Personal Sex Life, and Moral Incongruence: Insights from the German Health and Sexuality Survey (GeSiD)

Although online pornography use appears to be a mainstream activity, there is little information, particularly outside of the USA, about how consumers perceive its impact on their sexuality. Considering increasing concerns about pornography use, this lack of evidence has sociocultural and clinical ramifications - especially because the recently proposed Moral Incongruence model (MI) suggests that some individuals may see their pornography use as problematic independently of the frequency of use. Using data from 4,177 adults from the 2018-2019 national probability-based German Health and Sexuality Survey, we explored self-perceived impact of pornography use on personal sex life and the role of MI. Most participants (61.7%) reported no impact of pornography. Women were characterized by significantly higher odds of reporting positive relative to no impact, while men had higher odds of reporting mixed/negative compared to no impact. Participants in both the positive and the mixed impact group reported a significantly higher frequency of pornography use than participants in the no impact group. In line with the MI model, we observed a significant relationship between participants' religious upbringing and self-perceived negative (relative to mixed) impact of pornography use. Social relevance and clinical implications of the findings are discussed.

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.

Compulsive sexual behavior, religiosity, and spirituality: A systematic review

BACKGROUND AND AIMS

In recent years, increasing attention has been given to the relationship between compulsive sexual behavior (CSB), religiosity, and spirituality. This review summarizes research examining the relationship CSB has with religiosity and spirituality, clarifying how these constructs inform the assessment and treatment of this syndrome.

METHODS

The present paper reviews research published through August 1, 2021, using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Only studies providing quantitative analyses were included.

RESULTS

This review identified 46 articles, subsuming 59 studies, analyzing the relationship between CSB and religiosity or spirituality. Most studies used cross-sectional designs with samples primarily composed of heterosexual White men and women. Generally, the studies found small to moderate positive relationships between religiosity and CSB. Studies considering the mediating or moderating role of moral incongruence identified stronger, indirect relationships between religiosity and problematic pornography use (PPU), a manifestation of CSB. Few studies examined the association between spirituality and CSB, but those that did either reported negative relationships between indicators of spiritual well-being and CSB or positive relationships between CSB and aspects of spiritual struggles.

DISCUSSION AND CONCLUSIONS

Although research examining CSB and religiosity has flourished, such growth is hampered by cross-sectional samples lacking in diversity. Moral incongruence assists in explaining the relationship between religiosity and PPU, but future research should consider other manifestations of CSB beyond PPU. Attention should also be given to examining other religiosity and spirituality constructs and obtaining more diverse samples in research on CSB, religiosity, and spirituality.

The Association of Exposure to Military Sexual Trauma and Romantic Relationship Satisfaction Among Partnered Men Service Members/Veterans: The Influence of Compulsive Sexual Behavior

Civilian literature shows a strong, consistent association between exposure to sexual violence and poor romantic relationship satisfaction. The impact of sexual violence that occurred during military service, or military sexual trauma (MST), on romantic relationship satisfaction among partnered men service members/veterans (SM/Vs) is understudied. However, a recent study conducted in women observed that MST that involved an assault was associated with poorer relationship satisfaction through higher sexual dysfunction and lower sexual satisfaction. The current study extended the literature by examining sexual function as a mediator of the association of exposure to MST and romantic relationship satisfaction among partnered men SM/Vs (N = 499). Participants completed self-report measures of MST exposure, romantic relationship satisfaction, erectile dysfunction, and compulsive sexual behavior, as well as a demographic inventory. The average score on relationship satisfaction was in the distressed range. Sixty-four participants (12.83%) reported MST exposure. MST exposure was related to lower relationship satisfaction through higher compulsive sexual behavior. The model explained 16% of the variance in relationship satisfaction. The indirect effect of erectile dysfunction was nonsignificant. Current findings are consistent with research in women SM/Vs: the association of MST and romantic relationship satisfaction appears to be indirect, through the effects of sexual function. Couples' therapy may be most effective if it addresses sexual health concerns among men MST survivors, particularly engagement in compulsive sexual behaviors. Due to low endorsement of MST that involved assault, the impact of MST severity could not be examined.

What's in a Name? A Phenomenological Exploration of Hypersexuality Narratives

Objective

We explored men's subjective experiences of hypersexuality, including the underlying factors they believed contributed to their sexuality. Methods: We interviewed 32 Canadian men with self-reported concerns related to hypersexuality. Interviews were analyzed using Interpretative Phenomenological Analysis and narrative analysis.

Results

Participants' (hyper)sexual experiences revealed complex histories of desire, life disruptions, and hopes to re-story their sexual lives. Similar (sexual and non-sexual) desires were often attributed to different expressions of hypersexuality.

Conclusion

Assessment and treatment protocols for hypersexuality should account for the social and cultural factors that shape sexuality, and the broader field of desire extending beyond just sexual forms.

Estimated Prevalence and Demographic Correlates of Compulsive Sexual Behavior Among Gay Men in the United States

BACKGROUND

Compulsive sexual behavior (CSB) is a clinical syndrome that causes significant distress and impairment for many individuals in the United States. Gay men are thought to have a higher prevalence of CSB, and it is associated with many relevant health outcomes including HIV risk behavior.

AIM

To estimate the prevalence and examine demographic correlates of CSB among gay men in the United States.

METHODS

A U.S. national probability sample of 227 gay-identified men were collected as part of the 2015 National Survey of Sexual Health and Behavior (NSSHB).

OUTCOMES

Participants completed the Compulsive Sexual Behavior Inventory (CSBI-13) and demographic measures.

RESULTS

Eighteen participants (7.93%) scored above the CSBI-13 clinical cut point, indicating they would likely meet criteria for clinically significant compulsive sexual behavior. To assess demographic correlates of CSB, demographic variables were entered into a logistic regression. Results of the logistic regression indicated that participant age, education, and religious affiliation were significant predictors of CSB status. Individuals scoring above the cut point were younger on average (M = 39.17; SD = 14.84) than those scoring below the cut point (M = 47.52; SD = 14.62; P = .02). Odds of scoring above the cut point were about six times greater for religiously affiliated participants compared to non-religiously affiliated participants (P = .005), and four times greater for those who had attended college compared to those who had not (P = .03).

CLINICAL IMPLICATIONS

These results indicate the prevalence of CSB in gay men is more modest than previously estimated, and is similar to the general population prevalence estimated in a previous study. The strongest predictor of CSB in this sample was religious affiliation, which underscores the importance of evaluating the role of religiosity in the etiology and/or identification of this clinical syndrome.

STRENGTHS AND LIMITATIONS

These findings are strengthened by the national probability sampling methodology and the use of the empirically validated CSBI-13 cut point. However, this sample was also older and had higher income and educational attainment than the larger population of gay men in the U.S.

CONCLUSION

These results indicate gay men may have a CSB prevalence rate similar to the general population, which contradicts previous research suggesting they are at greater risk for CSB. Gleason N, Finotelli I, Miner MH, et al. Estimated Prevalence and Demographic Correlates of Compulsive Sexual Behavior Among Gay Men in the United States. J Sex Med 2021;18:1545-1554.

Relationship Between Posttraumatic Stress Disorder and Sexual Difficulties: A Systematic Review of Veterans and Military Personnel

BACKGROUND

Posttraumatic stress disorder (PTSD) is associated with sexual difficulties but the nuances of this relationship remain elusive. Research has increased in recent years, most notably following publication of several reviews in 2015.

AIM

This systematic review examines the relationship between PTSD and sexual difficulties in veterans/military personnel.

METHODS

A systematic review was conducted using PRISMA guidelines in PsycINFO and PubMed databases for studies examining a diagnosis of PTSD or PTSD severity in relation to a range of sexual difficulties. Forty-three studies were identified that met inclusion and exclusion criteria for this review.

RESULTS

PTSD was associated with increased risk of experiencing at least one sexual difficulty. PTSD was most clearly associated with overall sexual function, sexual desire, sexual satisfaction, and sexual distress. Results were mixed for sexual arousal, orgasm function, erectile dysfunction, premature ejaculation, sexual pain, and frequency of sexual activity. PTSD symptom clusters of avoidance and negative alterations in cognition/mood were most commonly associated sexual difficulties. Few studies compared results by gender and trauma type.

CLINICAL IMPLICATIONS

Clinicians should inquire about sexual health in relation to PTSD symptoms and target avoidance and negative mood symptoms by incorporating sexual exposure assignments and sexual activation exercises when appropriate.

STRENGTHS & LIMITATIONS

This systematic review synthesizes an extensive literature that has grown substantially in the past 5 years and includes studies with low to moderate risk of bias. Limitations of the existing literature include challenges differentiating between PTSD and depression, inconsistent measurement of PTSD and trauma histories, inconsistent operationalization and measurement of sexual outcomes, and largely cross-sectional study designs.

CONCLUSION

PTSD is linked to a range of sexual outcomes. The current literature suggests that PTSD is associated with sexual difficulties related to both the sexual response cycle (ie, sexual desire) and one's emotional relationship to sexual activity (eg, sexual distress). More research is needed to increase confidence in findings. Bird ER, Piccirillo M, Garcia N, et al. Relationship Between Posttraumatic Stress Disorder and Sexual Difficulties: A Systematic Review of Veterans and Military Personnel. J Sex Med 2021;18:1398-1426.

Screening Positive for Military Sexual Harassment or Assault Is Associated With Higher Compulsive Sexual Behavior in Men Military Service Members/Veterans

INTRODUCTION

Compulsive sexual behavior (CSB) is understudied in military service members/veterans despite elevated risk for psychological disorders that are associated with CSB, including posttraumatic stress disorder (PTSD), depression, and alcohol misuse. Civilian research shows that sexual trauma is associated with higher CSB. Among military service members/veterans, sexual trauma that occurred before military service is identified as a risk factor for CSB, but the impact of screening positive for sexual trauma that occurred during military service (military sexual harassment[MSH]/military sexual assault[MSA]) on CSB is unknown. Moreover, screening positive for MSH/A confers a higher risk for distress relative to sexual trauma that occurred before or after military service, suggesting that MSH/A may be a robust predictor of CSB. The current study examined whether screening positive for MSH/A was associated with higher CSB after accounting for mental health and demographic characteristics. The current study specifically focused on men service members/veterans given that men show higher engagement and distress associated with CSB relative to women.

MATERIALS AND METHOD

Male service member/veterans (n = 508) completed self-report measures of CSB, MSH/A, PTSD and depression severity, hazardous drinking, and age. CSB was regressed on MSH/A, PTSD and depression severity, hazardous drinking, and age to determine if MSH/A was uniquely associated with CSB after accounting for other risk factors.

RESULTS

A total of 9.25% to 12.01% of the sample reported scores suggestive of high levels of CSB. The regression of CSB on MSH/A screen status, PTSD, depression, alcohol use, and age explained 22.3% of the variance. Screening positive for MSH/A, higher PTSD symptoms, and higher depression symptoms were associated with higher CSB, but age or alcohol use were not.

CONCLUSION

Screening positive for MSH/A appears to be a unique risk factor for higher CSB above and beyond the effects of depression and PTSD. Since screening for CSB is not part of routine mental health care, clinicians may consider a positive screen for MSH/A as a possible indicator that CSB may be of clinical concern. Previous research on MSH/A and individual and sexual health outcomes suggest that distinguishing between MSH/A severities (harassment only vs. assault) is critical as the most dysfunction is observed with sexual trauma that involves assault. Owing to low endorsement of MSA, this study did not examine differences between MSA and MSH. Future research in this area would be strengthened by exploring MSH/A severities as a correlate of CSB.

Sexual Responsivity and the Effects of Negative Mood on Sexual Arousal in Hypersexual Men Who Have Sex With Men (MSM)

BACKGROUND

A number of studies have found that hypersexuality is associated with a high propensity for sexual excitation. In comparison, less is known about the relationship between hypersexuality and sexual arousal at the state level. Also, previous research has revealed a relationship between hypersexuality and negative mood. However, the possibility that sexual response might not be as negatively impacted by negative mood in hypersexual individuals has, as yet, not been tested.

AIM

The purpose of this study was to investigate sexual responsivity and the effects of negative mood on sexual arousal in hypersexual men who have sex with men (MSM).

METHODS

A total of 211 MSM were assigned to a hypersexuality (N = 81) or a control (N = 130) group using an interview patterned with a semi-structured Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders format. Participants filled out questionnaires and were shown neutral, sexual, and anxiety- and sadness-inducing films.

OUTCOMES

Changes in penile circumference and self-reported sexual arousal were the primary outcomes analyzed in this study.

RESULTS

Controlling for age and HIV status, no differences were found in genital response between hypersexual and non-hypersexual men. Also, the 2 groups did not differ in subjective sexual arousal. Moreover, no effects of negative mood were found. Time series clustering analyses revealed 3 groups-low responders and slow and fast high responders. Sexual excitation, but not sexual compulsivity or pornography use, predicted cluster membership.

CLINICAL TRANSLATION

Hypersexual MSM may benefit more from an exploration of motivational and behavioral, as compared to psychophysiological, mechanisms underlying possible links between (negative) mood and sexual behavior.

STRENGTHS & LIMITATIONS

Strengths of the study include its sample size, making it one of the larger psychophysiological sex studies; the use of clinical interviews for group assignment; the inclusion of genital response measures; and the application of time series clustering to examine differences among participants. Limitations include possible sample heterogeneity and the reliance on researcher-selected stimuli.

CONCLUSION

Given the lack of any effects of negative mood on sexual response in hypersexual MSM, future studies could explore in more depth possible motivational and behavioral effects, including, for example, the impact of negative mood on the tendency to seek out sex as a form of distraction or for validation or emotional support. Janssen E, Prause N, Romine RS, et al. Sexual Responsivity and the Effects of Negative Mood on Sexual Arousal in Hypersexual Men Who Have Sex With Men (MSM). J Sex Med 2020;17:1751-1760.

Effects of Emotions on Sexual Behavior in Men with and without Hypersexuality

The association between positive and negative affect and sexual behavior in 39 MSM with and without hypersexuality (HS) was explored using ecological momentary assessment. Participants reported their current positive and negative affect three times per day and their sexual behavior each morning and evening. The relationship between affect and sexual behavior differed between men with or without HS. In those with HS, the timing of and interactions between experienced affect differentially predicted types of sexual behavior, indicating differing mechanisms driving partnered sexual behavior and masturbation. These findings lend support to conceptualizing HS behavior as a coping strategy for affective arousal.