Feasibility of a Cognitive-Behavioral Couple Therapy Intervention for Sexual Interest/Arousal Disorder

Female sexual interest/arousal disorder (SIAD) is strongly influenced by interpersonal factors; however, there are no empirically-supported, couple-based sex therapy interventions for this disorder. This pre-registered study tested the feasibility of a cognitive-behavioral couple therapy (CBCT) intervention for SIAD. A sample of 19 couples in which a female partner was diagnosed with SIAD completed a 16-session CBCT intervention delivered online by therapists with PhD-level training in clinical psychology. Women with SIAD (Mage = 43.47, SD = 12.76) and their partners (Mage = 43.74, SD = 11.68) were in long-term relationships (M = 13.86, SD = 9.15). The CBCT sessions were video recorded and independently coded for treatment manual adherence and therapists reported on the completion of in-session and homework exercises. Participants completed measures of treatment satisfaction following the intervention as well as dyadic sexual desire (women with SIAD only) and sexual distress prior to treatment, post-treatment, and at 6 months follow-up. The therapists exhibited a high level of adherence to the treatment manual and couples had high rates of homework completion. Moreover, couples had low dropout rates, high attendance rates, and reported moderately high global treatment satisfaction and high satisfaction with virtual care. Women with SIAD reported large improvements in dyadic sexual desire and sexual distress from pre-treatment to post-treatment and pre-treatment to 6-month follow-up. Partners reported moderate and small improvements in sexual distress for post-treatment and 6-month follow-up, respectively. Results support the feasibility of an evidence-based CBCT intervention for SIAD and the need for a randomized clinical trial of the intervention.

The short version of the Sexual Distress Scale (SDS-3): Measurement invariance across countries, gender identities, and sexual orientations

Background

The three-item Sexual Distress Scale (SDS-3) has been frequently used to assess distress related to sexuality in public health surveys and research on sexual wellbeing. However, its psychometric properties and measurement invariance across cultural, gender and sexual subgroups have not yet been examined. This multinational study aimed to validate the SDS-3 and test its psychometric properties, including measurement invariance across language, country, gender identity, and sexual orientation groups.

Methods

We used global survey data from 82,243 individuals (Mean age=32.39 years; 40.3 % men, 57.0 % women, 2.8 % non-binary, and 0.6 % other genders) participating in the International Sexual Survey (ISS; https://internationalsexsurvey.org/) across 42 countries and 26 languages. Participants completed the SDS-3, as well as questions regarding sociodemographic characteristics, including gender identity and sexual orientation.

Results

Confirmatory factor analysis (CFA) supported a unidimensional factor structure for the SDS-3, and multi-group CFA (MGCFA) suggested that this factor structure was invariant across countries, languages, gender identities, and sexual orientations. Cronbach's α for the unidimensional score was 0.83 (range between 0.76 and 0.89), and McDonald's ω was 0.84 (range between 0.76 and 0.90). Participants who did not experience sexual problems had significantly lower SDS-3 total scores (M = 2.99; SD=2.54) compared to those who reported sexual problems (M = 5.60; SD=3.00), with a large effect size (Cohen's d = 1.01 [95 % CI=-1.03, -0.98]; p < 0.001).

Conclusion

The SDS-3 has a unidimensional factor structure and appears to be valid and reliable for measuring sexual distress among individuals from different countries, gender identities, and sexual orientations.

Cross-cultural validation and measurement invariance of anxiety and depression symptoms: A study of the Brief Symptom Inventory (BSI) in 42 countries

BACKGROUND

Depression and anxiety are among the most prevalent mental health issues experienced worldwide. However, whereas cross-cultural studies utilize psychometrically valid and reliable scales, fewer can meaningfully compare these conditions across different groups. To address this gap, the current study aimed to psychometrically assess the Brief Symptomatology Index (BSI) in 42 countries.

METHODS

Using data from the International Sex Survey (N = 82,243; Mage = 32.39; SDage = 12.52; women: n = 46,874; 57 %), we examined the reliability of depression and anxiety symptom scores of the BSI-18, as well as evaluated evidence of construct, invariance, and criterion-related validity in predicting clinically relevant variables across countries, languages, genders, and sexual orientations.

RESULTS

Results corroborated an invariant, two-factor structure across all groups tested, exhibiting excellent reliability estimates for both subscales. The 'caseness' criterion effectively discriminated among those at low and high risk of depression and anxiety, yielding differential effects on the clinical criteria examined.

LIMITATIONS

The predictive validation was not made against a clinical diagnosis, and the full BSI-18 scale was not examined (excluding the somatization sub-dimension), limiting the validation scope of the BSI-18. Finally, the study was conducted online, mainly by advertisements through social media, ultimately skewing our sample towards women, younger, and highly educated populations.

CONCLUSIONS

The results support that the BSI-12 is a valid and reliable assessment tool for assessing depression and anxiety symptoms across countries, languages, genders, and sexual orientations. Further, its caseness criterion can discriminate well between participants at high and low risk of depression and anxiety.

Global cross-cultural validation of a brief measure for identifying potential suicide risk in 42 countries

OBJECTIVES

This study aimed to examine the psychometric properties of the P4 suicide screener in a multinational sample. The primary goal was to evaluate the reliability and validity of the scale and investigate its convergent validity by analyzing its correlation with depression, anxiety, and substance use.

STUDY DESIGN

The study design is a cross-sectional self-report study conducted across 42 countries.

METHODS

A cross-sectional, self-report study was conducted in 42 countries, with a total of 82,243 participants included in the final data set.

RESULTS

The study provides an overview of suicide ideation rates across 42 countries and confirms the structural validity of the P4 screener. The findings indicated that sexual and gender minority individuals exhibited higher rates of suicidal ideation. The P4 screener showed adequate reliability, convergence, and discriminant validity, and a cutoff score of 1 is recommended to identify individuals at risk of suicidal behavior.

CONCLUSIONS

The study supports the reliability and validity of the P4 suicide screener across 42 diverse countries, highlighting the importance of using a cross-cultural suicide risk assessment to standardize the identification of high-risk individuals and tailoring culturally sensitive suicide prevention strategies.

Do perfectionism, body image concerns, and intimacy predict genitopelvic pain in the postpartum? A prospective study of new mothers

BACKGROUND

Genitopelvic pain following childbirth is common and likely to challenge the psychological, relational, and sexual well-being of new mothers. While genitopelvic pain generally decreases during the postpartum period, personal and interpersonal characteristics may explain why genitopelvic pain persists beyond the period of physical recovery in some mothers. Body image concerns, increased stress, and relationship challenges would be particularly salient during pregnancy and the postpartum period, which could put new mothers at greater risk of sexual difficulties. Also, mothers may display a negative appraisal regarding genitopelvic pain and doubt their ability to cope with it, which may contribute to the pain.

AIM

The current study aimed to examine the role of perfectionism, body image concerns, and perceived intimacy in the occurrence and change in genitopelvic pain in new mothers in postpartum.

METHODS

A total of 211 new mothers and their partners were recruited for a larger prospective dyadic study on the transition to parenthood.

OUTCOMES

Mothers completed a single item assessing genitopelvic pain, in addition to brief validated questionnaires measuring perfectionism, body image concerns, and perceived couple intimacy during pregnancy and at 4, 8, and 12 months postpartum.

RESULTS

Five multilevel modeling analyses revealed that adaptive perfectionism, maladaptive perfectionism, and body image concerns were associated with a higher occurrence of genitopelvic pain from 4 to 12 months postpartum. Mothers' and partners' perceived intimacy was not significantly related to new mothers' genitopelvic pain. None of the predictors modified the trajectory of genitopelvic pain over time.

CLINICAL IMPLICATIONS

Raising awareness among health care professionals regarding the role of perfectionism and body image concerns in genitopelvic pain may help them identify new mothers at risk of chronic genitopelvic pain, while offering a new avenue of intervention.

STRENGTHS AND LIMITATIONS

There has been little research examining the role of perfectionism, body image concerns, and intimacy in postpartum genitopelvic pain. Based on a longitudinal prospective approach, this study identified perfectionism and body image concerns as significant predictors of postpartum genitopelvic pain. However, prepregnancy genitopelvic pain, genitopelvic pain intensity, and sexual distress were not measured.

CONCLUSION

Adaptive and maladaptive perfectionism and body image concerns are associated with new mothers' genitopelvic pain up to 12 months postpartum.

Cross-Cultural Adult ADHD Assessment in 42 Countries Using the Adult ADHD Self-Report Scale Screener

OBJECTIVE

We analyzed adult ADHD symptoms in a cross-cultural context, including investigating the occurrence and potential correlates of adult ADHD and psychometric examination of the Adult ADHD Self-Report Scale (ASRS) Screener.

METHOD

Our analysis is based on a large-scale research project involving 42 countries (International Sex Survey, N=72,627, 57% women, Mage=32.84; SDage=12.57).

RESULTS

The ASRS Screener demonstrated good reliability and validity, along with partial invariance across different languages, countries, and genders. The occurrence of being at risk for adult ADHD was relatively high (21.4% for women, 18.1% for men). The highest scores were obtained in the US, Canada, and other English-speaking Western countries, with significantly lower scores among East Asian and non-English-speaking European countries. Moreover, ADHD symptom severity and occurrence were especially high among gender-diverse individuals. Significant associations between adult ADHD symptoms and age, mental and sexual health, and socioeconomic status were observed.

CONCLUSIONS

Present results show significant cross-cultural variability in adult ADHD occurrence as well as highlight important factors related to adult ADHD. Moreover, the importance of further research on adult ADHD in previously understudied populations (non-Western countries) and minority groups (gender-diverse individuals) is stressed. Lastly, the present analysis is consistent with previous evidence showing low specificity of adult ADHD screening instruments and contributes to the current discussion on accurate adult ADHD screening and diagnosis.

Hooked on a feeling: Downregulation of negative emotion during sexual conflict is associated with sexual well-being among long-term couples

Intimate partners experience more negative emotion in response to sexual versus nonsexual conflicts in their relationship. Negative emotions hinder communication and sexual well-being. In a laboratory-based observational study, we tested the prediction that couples who took longer to downregulate negative emotion during a sexual conflict discussion would report lower sexual well-being. Long-term couples (N = 150) were video recorded while they discussed the most contentious problem within their sexual relationship. Participants subsequently viewed their filmed discussion and used a joystick to continuously report on their emotional experience during their disagreement. Trained coders continuously coded the valence of participants' emotional behavior. Downregulation of negative emotion was assessed by calculating how quickly, on average, an individual's negative emotional experience and behavior returned to neutral during their discussion. Participants also completed measures assessing sexual distress, satisfaction, and desire prior to the discussion and 1 year later. Analyses were conducted per the Actor-Partner Interdependence Model. For both women and men, we found that a person's slower downregulation of negative emotional experience was concurrently associated with their own greater sexual distress and lower sexual desire and with their partner's lower sexual satisfaction. Downregulation of negative emotional experience also predicted one's own lower sexual satisfaction and, surprisingly, higher sexual desire for both members of the couple 1 year later. People who took longer to downregulate their negative emotional behavior during the conflict also reported higher sexual desire 1 year later. Findings suggest that greater difficulty shifting out negative emotional states during sexual conflict is concurrently linked with poorer sexual well-being for long-term couples. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

How Does Sexual Subjectivity Vary on the Basis of Gender and Sexual Orientation? Validation of the Short Sexual Subjectivity Inventory (SSSI-11) in Cisgender, Heterosexual and Sexual and Gender Minority Adolescents

Through sexual exploration, adolescents learn that they are sexual beings with choices, desires, and are deserving of pleasure, which corresponds to sexual subjectivity. However, the two measures of this construct (i.e., Female Sexual Subjectivity Inventory and Male Sexual Subjectivity Inventory) have not been validated with younger adolescents and have different items for boys and girls (with no scale available for gender diverse individuals), limiting gender comparisons. This study examined (1) the factor structure of the adapted Short Sexual Subjectivity Inventory-11 items (SSSI-11) in a large sample of young cisgender, heterosexual and sexual and gender minority adolescents, (2) measurement invariance across language (English and French), gender, and sexual orientation, (3) validity with sexuality-related outcomes, and (4) one-year temporal stability. Results of a confirmatory factor analysis among 2001 adolescents (Mage = 15.5 years, SD = 0.60) revealed a multidimensional factor structure. The SSSI-11, in both English and French, showed adequate reliability and one-year temporal stability, and was invariant across genders, sexual orientations, and languages. Girls had lower scores on the entitlement to self-pleasure and self-efficacy in achieving pleasure factors, and higher scores on the entitlement to pleasure from a partner factor. No significant differences were observed on the basis of language or between heterosexual and sexual minority adolescents. The SSSI-11 correlated positively with sexuality-related variables. Findings support the strong psychometric properties of the SSSI-11, rendering it of considerable use in clinical, education, and research applications.

Comparing Responses to Sexual Rejection and Sexual and Relationship Well-Being in Couples Coping with Sexual Interest/Arousal Disorder and Community Couples

Four distinct partner responses to sexual rejection - sexual advances that are declined by a partner - have been identified. This study assessed the frequency of these responses between and within North American couples coping with Sexual Interest/Arousal Disorder (SIAD) and community couples and - in line with the Interpersonal Emotion Regulation Model - compared the associations between responses to sexual rejection and sexual and relationship well-being across the two samples. Individuals with SIAD and their partners (n = 241) and community couples (n = 105) completed online measures of sexual rejection responses, sexual satisfaction, sexual desire, sexual distress, sexual frequency, and relationship satisfaction. Results showed that after accounting for sexual rejection frequency, individuals with SIAD and their partners reported greater resentful and insecure partner responses to sexual rejection than individuals in the community sample, and individuals with SIAD perceived less understanding responses than their own partners reported. For both groups, more understanding and less resentful and insecure responses were associated with greater sexual and relationship well-being. Clinicians might encourage couples to reflect on their rejection responses and to shift to more helpful ways of responding to sexual rejection.

Can I Love My Body Even if It Doesn't Look Like the Porn Stars'? Longitudinal Associations Between Pornography Use Frequency and Body Appreciation in a Diverse Sample of Adolescents

Online technologies could play an important role in the sexual development of adolescents as they watch more pornography than before. Pornography may relate to adolescents' perceptions of their bodies, especially among those identifying as a sexual and/or gender minority (SGM) as they have an increased risk of body image concerns compared to their heterosexual, cisgender (HC) peers. The present study examined the cross-sectional and longitudinal associations over 3 years between adolescents' pornography use frequency and body appreciation, considering potential gender and sexual orientation-based differences. Results from linear univariate and parallel processes latent growth curve models with a multi-group approach among 2904 adolescents (MageT1 = 14.5 years, SD = 0.61; 51.4% girls, 16.3% sexual minority) demonstrated that HC and SGM girls' body appreciation slightly decreased over time. Moreover, HC boys, HC girls and SGM girls' pornography use frequency slightly increased over time. Cross-sectionally, greater pornography use frequency was associated with lower levels of body appreciation in HC girls and SGM boys, with a small effect size. However, longitudinally, pornography use frequency and body appreciation were not related to each other in either group. Our findings support that pornography use, in the short term, is negatively associated with adolescents' body appreciation, although these associations might not hold in the long term. Adolescents may be more critical of body ideals represented in pornography as they learn to think with more discernment about the pornographic depictions of bodies and sexuality.

Psychometric properties of the Alcohol Use Disorders Identification Test (AUDIT) across cross-cultural subgroups, genders, and sexual orientations: Findings from the International Sex Survey (ISS)

INTRODUCTION

Despite being a widely used screening questionnaire, there is no consensus on the most appropriate measurement model for the Alcohol Use Disorders Identification Test (AUDIT). Furthermore, there have been limited studies on its measurement invariance across cross-cultural subgroups, genders, and sexual orientations.

AIMS

The present study aimed to examine the fit of different measurement models for the AUDIT and its measurement invariance across a wide range of subgroups by country, language, gender, and sexual orientation.

METHODS

Responses concerning past-year alcohol use from the participants of the cross-sectional International Sex Survey were considered (N = 62,943; Mage: 32.73; SD = 12.59). Confirmatory factor analysis, as well as measurement invariance tests were performed for 21 countries, 14 languages, three genders, and four sexual-orientation subgroups that met the minimum sample size requirement for inclusion in these analyses.

RESULTS

A two-factor model with factors describing 'alcohol use' (items 1-3) and 'alcohol problems' (items 4-10) showed the best model fit across countries, languages, genders, and sexual orientations. For the former two, scalar and latent mean levels of invariance were reached considering different criteria. For gender and sexual orientation, a latent mean level of invariance was reached.

CONCLUSIONS

In line with the two-factor model, the calculation of separate alcohol-use and alcohol-problem scores is recommended when using the AUDIT. The high levels of measurement invariance achieved for the AUDIT support its use in cross-cultural research, capable also of meaningful comparisons among genders and sexual orientations.

Sexual growth and destiny beliefs: Longitudinal associations with dyadic coping among couples seeking medically assisted reproduction

BACKGROUND

Medically assisted reproduction is a vulnerable time for couples' sexual health. Believing that sexual challenges can be worked through (i.e., sexual growth beliefs) or that these challenges indicate incompatibility (i.e., sexual destiny beliefs) may be related to dyadic coping-the strategies couples use to cope-with the physical and psychological stressors of medically assisted reproduction.

AIM

In the current study we aimed to examine the longitudinal associations between typical (i.e., average) levels of sexual growth and destiny beliefs and positive and negative facets of dyadic coping and how greater than typical levels of these constructs predicted each other across time.

METHODS

Couples (n = 219) seeking medically assisted reproduction were recruited for an online longitudinal, dyadic study.

OUTCOMES

Couples completed online measures of sexual growth and destiny beliefs and positive and negative dyadic coping at baseline, 6-and 12-months.

RESULTS

Random intercept cross-lagged panel models demonstrated that at the within-person level, reporting higher sexual growth beliefs at baseline, relative to their average across time points, was associated with lower negative dyadic coping at 6 months. Higher negative dyadic coping at 6 months, relative to their average, was linked to lower sexual growth beliefs at 12-months. When individuals reported higher sexual destiny beliefs at 6-months, relative to their average, they and their partners reported higher negative dyadic coping at 12 -months. At the between-person level, higher overall levels of sexual destiny beliefs were related to higher overall levels of negative dyadic coping. No associations with positive dyadic coping were identified.

CLINICAL IMPLICATIONS

Couples may benefit from identifying and reducing unhelpful beliefs about sex and negative dyadic coping.

STRENGTHS AND LIMITATIONS

Strengths of this study include our large, inclusive sample, engagement of community partners, and novel analytical approach to assess change over time. However, following couples in 6-month increments and not using questionnaires specific to medically assisted reproduction may have limited our ability to detect nuanced changes that couples experience during this time.

CONCLUSION

Lower sexual growth and higher sexual destiny beliefs may promote couples' engagement in less adaptive coping behaviors as they seek medically assisted reproduction.

Dating Violence Trajectories in Adolescence: How Do They Relate to Sexual Outcomes in Canada?

Dating violence during adolescence is a major public health issue: it is highly prevalent and extensive research has documented its physical and psychological consequences, yet very little has focused on its sexual consequences. The present study investigated the longitudinal associations between dating violence victimization (psychological, sexual or physical) and sexual well-being (sexual satisfaction and sexual distress) among 1442 sexually active adolescents aged between 14 and 17 years who completed at least one of three data waves (51.1% girls; 45.7% boys; 0.3% non-binary; 3.0% varying gender identity). The study also examined whether these associations differed by gender identity and sexual minority status. Adolescents completed online questionnaires on electronic tablets during class. The results indicated that psychological, physical (except for boys), and sexual dating violence victimization were all associated with lower sexual satisfaction and greater sexual distress over time. Moreover, the between-level associations between dating violence and poorer sexual outcomes were stronger among girls and gender varying adolescents than among boys. The within-level association between physical dating violence and sexual satisfaction was significant among adolescents with a nonvarying sexual minority status, but not among those with a nonvarying heterosexual status or that varied in sexual minority status. Findings offer cues for dating violence prevention and intervention programs by suggesting the need to examine sexual well-being over time.

Toward an Integrative Model of Intimacy, Sexual Satisfaction, and Relationship Satisfaction: A Prospective Study in Long-Term Couples

Sexual and relationship well-being are strongly intertwined in couple relationships. However, relationship quality is generally examined through relationship satisfaction only, neglecting the importance of sexual satisfaction as an aspect of relationship quality for many couples. Moreover, considering the role of interpersonal processes, such as intimacy, in relationship quality seems essential to better understand couples' optimal functioning. Although the Vulnerability-Stress-Adaptation Model posits bidirectional associations between interpersonal processes and relationship quality, few studies have tested such models. This dyadic study examined the longitudinal associations between the process of intimacy and sexual and relationship satisfaction in 145 long-term mixed-gender/sex couples. Participants completed online questionnaires three times over 13 months. A cross-lagged panel model revealed bidirectional associations between intimacy behaviors and both sexual and relationship satisfaction. Findings suggest that intimacy behaviors could foster both sexual and relationship satisfaction in couples, and that higher sexual and relationship satisfaction could also promote intimacy behaviors over time. These results highlight that satisfaction may not only be an outcome of positive interpersonal processes, but also a facilitator of these interpersonal processes over time. This study underscores the need to consider the complex interplay of interpersonal processes and satisfaction to foster relationship quality in long-term couples over time.

The eleven-item Alcohol, Smoking and Substance Involvement Screening Test (ASSIST-11): Cross-cultural psychometric evaluation across 42 countries

The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) is an instrument to screen substance-use-related health risks. However, little is known whether the ASSIST could be further shortened while remaining psychometrically sound across different countries, languages, gender identities, and sexual-orientation-based groups. The study aimed to validate a shortened 11-item ASSIST (ASSIST-11). Using the International Sex Survey data, 82,243 participants (M age = 32.39 years) across 42 countries and 26 languages completed questions from the ASSIST-11 regarding gender identity, sexual orientation, and other information. Confirmatory factor analysis (CFA) and multigroup CFA (MGCFA) evaluated the ASSIST-11's structure and tested measurement invariance across groups. Cronbach's α and McDonald's ω were used to examine the internal consistency. Cohen's d and independent t-tests were used to examine known-group validity. The ASSIST-11 was unidimensional across countries, languages, age groups, gender identities (i.e., men, women, and gender-diverse individuals), and sexual orientations (i.e., heterosexual and sexual minority individuals). Cronbach's α was 0.63 and McDonald's ω was 0.68 for the ASSIST-11. Known-group validity was supported by Cohen's d (range between 0.23 and 0.40) with significant differences (p-values<0.001). The ASSIST-11 is a modified instrument with a unidimensional factor structure across different languages, age groups, countries, gender identities, and sexual orientations. The low internal consistency of the ASSIST-11 might be acceptable as it assesses a broad concept (i.e., use of several different substances). Healthcare providers and researchers may use the ASSIST-11 to quickly assess substance-use information from general populations and evaluate the need to follow up with more detailed questions about substance use.

Compulsive sexual behavior disorder in 42 countries: Insights from the International Sex Survey and introduction of standardized assessment tools

Background and aims

Despite its inclusion in the 11th revision of the International Classification of Diseases, there is a virtual paucity of high-quality scientific evidence about compulsive sexual behavior disorder (CSBD), especially in underrepresented and underserved populations. Therefore, we comprehensively examined CSBD across 42 countries, genders, and sexual orientations, and validated the original (CSBD-19) and short (CSBD-7) versions of the Compulsive Sexual Behavior Disorder Scale to provide standardized, state-of-the-art screening tools for research and clinical practice.

Method

Using data from the International Sex Survey (N = 82,243; Mage = 32.39 years, SD = 12.52), we evaluated the psychometric properties of the CSBD-19 and CSBD-7 and compared CSBD across 42 countries, three genders, eight sexual orientations, and individuals with low vs. high risk of experiencing CSBD.

Results

A total of 4.8% of the participants were at high risk of experiencing CSBD. Country- and gender-based differences were observed, while no sexual-orientation-based differences were present in CSBD levels. Only 14% of individuals with CSBD have ever sought treatment for this disorder, with an additional 33% not having sought treatment because of various reasons. Both versions of the scale demonstrated excellent validity and reliability.

Discussion and conclusions

This study contributes to a better understanding of CSBD in underrepresented and underserved populations and facilitates its identification in diverse populations by providing freely accessible ICD-11-based screening tools in 26 languages. The findings may also serve as a crucial building block to stimulate research into evidence-based, culturally sensitive prevention and intervention strategies for CSBD that are currently missing from the literature.

Partner Knowledge of Solitary Pornography Use: Daily and Longitudinal Associations with Relationship Quality

Pornography use is a common sexual activity engaged in mostly alone, including for partnered individuals. Evidence concerning the benefits and costs of solitary pornography use for romantic relationship quality is mixed and may vary depending on the circumstances of pornography use, including partner knowledge of one's solitary use. Adopting a dyadic daily diary and longitudinal design, we examined the associations between knowledge of a partner's solitary pornography use and one's own and the partner's relationship satisfaction and intimacy on the same day, and trajectories over one year. A convenience sample of 217 couples completed daily surveys over 35 days and self-reported measures three times over one year. Each participant reported if they used pornography today and whether their use was known by their partner. Findings showed that when an individual's solitary pornography use was unknown by their partner, they reported lower same-day relationship satisfaction and intimacy as well as a lower initial level of relationship satisfaction. When an individual's solitary pornography use was known, they reported higher intimacy over one year and their partner reported lower intimacy over one year. Findings underscore the complexity of the relational context surrounding solitary pornography use in couples, in particular the partner's knowledge of pornography use.

Mediators of change in cognitive-behavioral couple therapy for genito-pelvic pain: Results of a randomized clinical trial

OBJECTIVE

A novel cognitive-behavioral couple therapy (CBCT) has shown efficacy for treating provoked vestibulodynia (PVD), the most common type of genito-pelvic pain, in comparison to topical lidocaine. However, mechanisms of therapeutic change have not been determined. We examined women's and partners' pain self-efficacy and pain catastrophizing as mediators of change in CBCT, using topical lidocaine as a control group.

METHOD

108 couples coping with PVD were randomized to 12-week CBCT or topical lidocaine and assessed at pre-treatment, post-treatment, and six-month follow-up. Dyadic mediation analyses were conducted.

RESULTS

CBCT was not more effective in increasing pain self-efficacy than topical lidocaine, so this mediator was discarded. In women, decreases in pain catastrophizing at post-treatment mediated improvement in pain intensity, sexual distress, and sexual function. In partners, decreases in pain catastrophizing at post-treatment mediated improvement in sexual function. Partners' decreases in pain catastrophizing also mediated reductions in women's sexual distress.

CONCLUSIONS

Pain catastrophizing may be a mediator specific to CBCT for PVD, explaining improvements in pain and sexuality. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Maltreatment in Childhood and Perceived Partner Responsiveness in Adult Romantic Relationships: A Dyadic Daily Diary and Longitudinal Study

This study examined the associations between childhood maltreatment (CM) and the mean-level of perceived partner responsiveness (PPR; the extent to which individuals feel cared for, understood, and validated by their partner) over 35 days, the day-to-day variability in PPR, and the initial levels and trajectories of PPR over 1 year in community couples. Both members of 228 couples completed a self-reported measure of CM and provided daily reports of PPR over 35 days and retrospective reports of PPR at three time points over 1 year. A person's greater CM was related to a lower mean level of PPR over 35 days and to a lower initial level of their own PPR. A person's sexual abuse, physical neglect, and emotional neglect had an effect over and above other forms of CM in these associations. A person's greater CM was also related to higher day-to-day variability in their own and their partner's PPR, and a person's greater emotional neglect was associated with a sharper decrease over time in their own PPR. These findings provide a more fine-grained understanding of how CM may affect the perceptions of being cared about, accepted, and validated by a partner on a daily basis and over time.

A Validation Study of the Global Measure of Sexual Satisfaction in Sexually Active Adolescents

Positive views of adolescents' sexuality have only begun to garner interest in the last two decades. Despite great strides in this emerging area, progress is limited by the paucity of valid and reliable measures among this population. The goal of this study was to validate the widely used adult five-item Global Measure of Sexual Satisfaction (GMSEX) in a large sample of sexually active adolescents. A total of 1,036 adolescents (516 girls, 49.8%) aged between 14 and 17 years (M_age = 14.62; SD = 0.66) were recruited to investigate the reliability and validity of the GMSEX. The GMSEX yielded strong psychometric properties in adolescents, including factor structure, measurement invariance, and reliability. Results showed that the scale works similarly for boys and girls as well as for heterosexual, cisgender, and sexual minority adolescents. The GMSEX is a short, reliable, and valid measure of sexual satisfaction that can be used in future studies focusing on adolescents' sexuality and relationships.

Why do you have sex and does it make you feel better? Integrating attachment theory, sexual motives, and sexual well-being in long-term couples

Attachment theory postulates that three behavioral systems are central to optimal couple functioning: attachment, caregiving, and sex. However, few studies have examined the concurrent contribution of these systems to understand sexual well-being. This daily diary study examined the intermediary role of attachment- and caregiving-related sexual motives in the associations linking attachment insecurities and positive and negative emotions during sexual activity in 149 long-term mixed-gender/sex couples. Multilevel analyses revealed that individuals higher in attachment avoidance endorsed less caregiving sexual motives, which was associated with their own more negative emotional experience during sexual activity. Individuals higher in attachment anxiety endorsed more attachment sexual motives, which was associated with their own and their partner's more negative emotional experience during sex. However, individuals higher in attachment anxiety also concurrently endorsed more caregiving sexual motives, which predicted their own and their partner's more positive emotional experience during sex. Overall, the findings support the associations between the attachment, caregiving, and sexual behavioral systems and suggest that engaging in sex as a way to care for one's partner might foster sexual well-being in long-term couples.

Few Differences in Sexual Talk by Gender/Sex and Dyad Type: A Retrospective and Daily Diary Study with Couples

Sexual talk is a type of verbal communication that occurs exclusively during sexual activity and that is specific to the sexual activity itself. Previous research has identified two types of sexual talk: individualistic (i.e., self-focused) and mutualistic (i.e., sharing/partner-focused), which have generally been linked to greater sexual and relationship well-being. Whether sexual talk use varies by gender/sex (i.e., men, women, gender/sex diverse individuals; GSD) or dyad type (i.e., same- vs. mixed-gender/sex) has not been examined. Given initial evidence that the types of sexual talk may contribute differently to sexual and relationship well-being, it is important to identify factors (e.g., gender/sex) that may be associated with the amount of sexual talk used. We examined differences by gender/sex and dyad type in the average sexual talk use among long-term couples (N = 229; 69 same-gender/sex) using retrospective cross-sectional dyadic data. We also examined these differences in the same sample (N = 217) using a 35-day dyadic daily diary study. Retrospectively, but not daily, women reported using more mutualistic talk than men, especially when partnered with a woman. There were no significant gender/sex or dyad type differences in use of individualistic talk retrospectively or daily. Exploratory analyses with the GSD couples suggested that there may be gender/sex and dyad type differences retrospectively and daily, for individualistic and not mutualistic talk; however, these analyses must be interpreted with caution due to the small subsample size of GSD couples.

Sexual communication mediates cognitive-behavioral couple therapy outcomes: A randomized clinical trial for provoked vestibulodynia

Provoked vestibulodynia (PVD) is a chronic vulvovaginal pain condition affecting 8%-10% of women and is associated with negative sexual sequalae. Our randomized clinical trial comparing cognitive-behavioral couple therapy (CBCT) to a medical intervention (lidocaine) found that both treatments improved affected women's pain and both affected women's and partners' sexual outcomes, with CBCT demonstrating more benefits (Bergeron et al., 2021). The goal of this study was to examine two putative mediators of CBCT's treatment effects: collaborative and negative sexual communication patterns (SCPs). Women with PVD and their partners were randomly assigned to 12 weeks of CBCT (N = 53) or lidocaine (N = 55). Outcome measures (sexual satisfaction, function, and distress) were collected at pre-treatment, post-treatment, and 6-month follow-up, and in-treatment measures of the mediators were taken at Weeks 1, 4, 8, and 12 of treatment. Results showed that affected women's reports of improving collaborative communication mediated the effect of CBCT, but not lidocaine, on post-treatment sexual satisfaction (women with PVD and partners), sexual function (women with PVD), and sexual distress (women with PVD). For partners, collaborative communication improved equally in both treatments. Given that there were no differences in negative SCPs between the CBCT and lidocaine conditions, it was not possible to examine negative communication as a potential mediator. From the perspective of women with PVD, CBCT helped couples communicate about their sexual problems in more collaborative ways, which was in turn beneficial for improving the sexual well-being of both members of the couple. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Changes in Canadian Adolescent Well-Being since the COVID-19 Pandemic: The Role of Prior Child Maltreatment

Adolescents may be particularly vulnerable to the negative impact of the coronavirus disease 2019 (COVID-19) pandemic, given their increased socialization needs during this developmental period. This prospective study examined the potential changes in adolescents' well-being from before to during the pandemic, and the moderating role of a history of child maltreatment (CM), COVID-19-related distress, and gender among 1,802 adolescents (55.5% participants identified as boy, 42.2% as girl, and 1.5% as nonbinary; M_age 14.74 years). Another aim was to determine whether COVID-19-related distress mediated the relationship between CM and well-being. Results revealed that COVID-19-related distress was associated with lower well-being (i.e., higher levels of internalized and externalized behaviors, and lower levels of self-esteem and life satisfaction). Boys experienced a greater decrease in life satisfaction and self-esteem than girls. A history of CM had a moderation effect, with the pandemic having a lesser impact on the outcomes of adolescents with such a history. However, it was also associated with more COVID-19-related distress, which in turn was associated with lower levels of internalized and externalized behaviors, self-esteem, and life satisfaction. These unexpected results with regard to CM might indicate that the social restrictions during the pandemic could have had a relieving effect on adolescents with particular challenges associated with CM.

Will you be happy for me? Associations between self-reported, perceived, and observed responses to positive events and sexual well-being in cohabiting couples

Whereas greater levels of intimacy have been shown to promote couples' sexual well-being, recent theories suggest that satisfying sex is maintained via the capacity to encourage the partner's individuality, while remaining intimately connected. Responses to capitalization attempts (i.e., the disclosure of a positive personal event) provide an opportunity to strengthen both the couple's intimacy and each partner's autonomy. Although responses to capitalization attempts are linked to couples' greater relationship adjustment, very little is known about their relation to couples' sexual well-being. The aim of this study was to examine the associations between self-reported, perceived, and observed responses to capitalization attempts and sexual satisfaction, sexual distress, and sexual function in 151 cohabiting couples who participated in a filmed discussion in the laboratory. They also completed self-report questionnaires pertaining to their responsiveness and to that of the partner during the discussion, as well as their sexual well-being. Results indicated that one's higher levels of self-reported and partner-perceived active-constructive responses (enthusiasm/elaboration) during the discussion were associated with one's own greater sexual satisfaction. Higher levels of perceived passive-constructive responses (quiet but interested) from one's partner were associated with one's own lower sexual satisfaction, and one's higher levels of self-reported and perceived passive-destructive responses (lack of interest/self-focus) were associated with one's own greater sexual distress. Finally, higher levels of observed active-destructive responses (undermines/denies the positive nature of the event) were associated with one's own lower sexual function, while in women, they were associated with their lower sexual satisfaction. Findings contribute to a growing body of literature underscoring the importance of intimacy for sexual well-being in long-term relationships.

Social Reactions to Disclosure of Sexual Violence in Adulthood and Women's Sexuality: The Mediating Role of Shame and Guilt

This study examined the mediating role of emotions related to sexual violence in adulthood in the associations between social reactions to sexual violence disclosure and sexual outcomes. Self-reported data were collected from 324 women reporting sexual violence and path analyses were conducted among the 264 women (81.5%) who disclosed their most recent sexual violence experience. Results showed that emotional support was associated with higher sexual satisfaction. Victim blame was associated with greater guilt related to the sexual violence, which, in turn, was associated with higher sexual compulsivity. Stigmatization was associated with greater shame related to the sexual violence, which, in turn, was associated with higher sexual distress and avoidance, and lower sexual satisfaction and function. Our findings highlight the importance of social reactions to sexual violence disclosure in women's sexuality.

Cumulative childhood interpersonal trauma and parenting stress: The role of self-capacities disturbances among couples welcoming a newborn

BACKGROUND

The birth of a child is a life-defining event which tends to widen the gap between parents' resources and the demands they face, generating parenting stress. In this regard, individuals who experienced childhood trauma, particularly cumulative childhood interpersonal trauma (CCIT), appear more vulnerable, with higher rates of parenting stress. However, dyadic studies are lacking and the mechanisms explaining the association between CCIT and parenting stress remain unknown, limiting the promotion of resilience in parental couples.

OBJECTIVE

Based on the Self-Trauma Model and the Actor-Partner Interdependence Model, this study examined the role of self-capacities disturbances (i.e., affect dysregulation, identity impairment and interpersonal conflicts) in the association uniting CCIT and parenting stress.

PARTICIPANTS AND SETTINGS

A randomly selected sample of 421 parental couples of an infant.

METHODS

Participants completed self-reported measures online.

RESULTS

Path analyses revealed that CCIT was associated to greater parenting stress through affect dysregulation and identity impairment, in both mothers and fathers (R² = 22.4%; 20.7%). APIM modeling revealed a dyadic association between mothers' proneness to interpersonal conflicts and fathers' parenting stress, in addition to indirect effects involving all three self-capacities in the associations between one parent's CCIT and their partner's parenting stress.

CONCLUSIONS

CCIT-exposed individuals may experience parenting stress through difficulties with self-capacities at the individual and dyadic level, highlighting these capacities as promising intervention targets during the postpartum period, and emphasizing the need to involve both parents since intricate dyadic patterns may be at play.

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.

Pain Characteristics, Fear-avoidance Variables, and Pelvic Floor Function as Predictors of Treatment Response to Physical Therapy in Women With Provoked Vestibulodynia

OBJECTIVE

The aim was to investigate whether pretreatment pain characteristics, psychological variables, and pelvic floor muscle (PFM) function predict the response to physical therapy (PT) in women with provoked vestibulodynia (PVD).

MATERIALS AND METHODS

One hundred-five women diagnosed with PVD underwent 10 weekly sessions of individual PT comprising education, PFM exercises with biofeedback, manual therapy, and dilators. Treatment outcomes were evaluated at pretreatment, post-treatment, and 6-month follow-up and included pain intensity (numerical rating scale 0 to 10) and sexual function (Female Sexual Function Scale). Multilevel analyses were used to examine the potential predictors of response over time including pain characteristics (PVD subtype, pain duration), psychological variables (fear of pain, pain catastrophizing), and PFM function assessed with a dynamometric speculum (tone, flexibility, and strength).

RESULTS

PVD subtype and PFM tone were significant predictors of greater treatment response for pain intensity reduction. Secondary PVD (ie, pain developed after a period of pain-free intercourse) and lower PFM tone at baseline were both associated with greater reduction in pain intensity after PT and at follow-up. Among the psychological variables, fear of pain was the only significant predictor of better treatment response when assessed through improvement in sexual function, where higher fear of pain at baseline was associated with greater improvement after PT.

DISCUSSION

This study identified PVD secondary subtype, lower PFM tone, and higher fear of pain as significant predictors of better treatment response to PT in women with PVD.

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

BACKGROUND

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

AIM

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

METHODS

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

OUTCOMES

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

RESULTS

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

CLINICAL IMPLICATIONS

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

STRENGTHS & LIMITATIONS

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

CONCLUSION

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

Cumulative interpersonal childhood adversity and post-traumatic stress symptoms across heterosexual, cisgender and gender and sexually diverse adolescents: The mediating role of emotion regulation

BACKGROUND

Emotion regulation has been identified as an explanatory factor in the association between interpersonal childhood adversity and post-traumatic stress symptoms (PTSS). However, most studies focused on adults or older adolescents, neglecting youth from the community, especially gender and sexually diverse (GSD) adolescents, who have a higher risk for exposure to adverse events and psychological difficulties, compared to their heterosexual, cisgender (HC) peers.

OBJECTIVE

The present cross-sectional study aimed to examine the mediating role of emotion regulation difficulties in the association between cumulative interpersonal childhood adversity and PTSS across HC and GSD adolescents.

METHODS

A sample of 2904 ninth grade students (M_age = 14.53, SD = 0.61) completed a self-report survey. Multigroup path analyses were conducted to examine the proposed mediation model in all groups, and comparisons were made using chi-square difference tests.

RESULTS

Greater difficulties in emotion regulation mediated the association between greater cumulative interpersonal childhood adversity (β = 0.36, p < .001) and greater PTSS (β = 0.35, p < .001) - regardless of HC or GSD status - although the direct association between cumulative interpersonal childhood adversity and PTSS was significantly stronger among GSD boys (β = 0.36, p < .001) and GSD girls (β = 0.35, p < .001) than among HC boys (β = 0.21, p < .001) and HC girls (β = 0.25, p < .001).

CONCLUSIONS

Findings offer a modifiable target for prevention and/or intervention among middle adolescents, as emotion regulation difficulties may partially explain the presence of PTSS following cumulative interpersonal childhood adversity.

A Longitudinal Study of Adolescents' Pornography Use Frequency, Motivations, and Problematic Use Before and During the COVID-19 Pandemic

Since the beginning of the COVID-19 pandemic, an increase in pornography use has been reported based on cross-sectional findings, raising concerns about associated adverse outcomes, such as problematic pornography use (PPU). The aims of the present study were to document potential changes in adolescents' pornography use frequency, motivations, and PPU before and during the COVID-19 pandemic. As part of an ongoing study on adolescents' sexual health, we used a large sample (N_{Time 1} = 1771; 47.6% girls, M_age = 15.42 years, SD = 0.59) to examine changes from baseline (before the COVID-19 pandemic) to one year later (during the COVID-19 pandemic) in adolescents' self-reported pornography use frequency, motivations, and PPU, using latent change models and examining potential gender differences. No significant changes were observed in adolescents' pornography use frequency and pornography use motivations, and no gender differences were present in these trends. Although statistically significant, slight decrease was observed in boys' PPU levels, and a statistically significant, slight increase was observed in girls' PPU levels, these changes were very small, providing no practical or clinical relevance. In sum, despite previous propositions, concerns, and cross-sectional findings, longitudinal results suggest that adolescents' pornography use characteristics were rather stable between November 2019 and June 2021, and the COVID-19 pandemic and related lockdowns might not have led to general increases in adolescents' pornography use as it was expected.

Discrepancy in Dyadic Sexual Desire Predicts Sexual Distress over Time in a Community Sample of Committed Couples: A Daily Diary and Longitudinal Study

In long-term relationships, sexual desire discrepancy (SDD) occurs frequently between partners. For many, this discrepancy is persistent and significant, and a source of distress. However, the dynamics of SDD in couples and, specifically, its implications for sexual distress have received scant empirical attention. This study examined the associations between SDD and sexual distress from one day to the next and over a 12-month span, in a community sample of 229 same-sex/gender and mixed-sex/gender couples. Two datasets were collected: A 35-day daily diary and a 12-month longitudinal survey. In both, dyadic sexual desire and sexual distress were measured, and SDD was calculated as the absolute value of the difference in sexual desire between partners. Directional associations between SDD at one time point and sexual distress at the next time point were assessed using multilevel, 2-pane autoregressive cross-lagged models, controlling for within-variable changes, dependencies between partners, and partner age. Results were consistent with the study's hypotheses: Couples' SDD on one day predicted sexual distress on the next day. Similarly, SDD at baseline predicted sexual distress 12 months later. Participant gender, partner gender, and couple type did not significantly moderate these associations, nor did differentiating partners based on higher and lower average sexual desire. The reverse associations (i.e., sexual distress predicting SDD) were non-significant. The associations' directionality and the fact that they remained significant over days and months were consistent with the proposal that SDD is a precursor of sexual distress. The present study provides support for dyadic conceptualizations of sexual desire. Clinically, findings suggest that therapeutic approaches should address issues with sexual desire and sexual distress by focusing not on the individual, but on the couple.

Predictors and Moderators of Provoked Vestibulodynia Treatment Outcome Following a Randomized Trial Comparing Cognitive-Behavioral Couple Therapy to Overnight Lidocaine

Provoked vestibulodynia is a vulvar pain condition causing sexual dysfunction, affecting 8% to 10% of women. Our recently published randomized clinical trial (N = 108 couples) found that cognitive behavioral couple therapy (CBCT) and topical lidocaine reduced women's pain and associated sexual symptoms, with CBCT showing more benefits. Little is known about pretreatment predictors of treatment outcomes in couples sex therapy. In the current study, we examined women and their partners' pretreatment demographic (age, relationship length), clinical (pain duration, anxiety) and interpersonal (partner responses to pain, sexual goals) predictors/moderators of women's pain intensity, pain unpleasantness, and sexual function at posttreatment and 6-month follow-up. Longer relationship duration, lower anxiety in women, partner higher solicitousness and partner higher approach sexual goals predicted better pain outcomes for women with PVD irrespective of treatment condition. CBCT was more effective than lidocaine for improving women's sexual function at posttreatment when, at pretreatment, women had partners with higher anxiety and women reported lower approach sexual goals, whereas lidocaine was more effective for improving women's sexual function at follow-up when partners had higher approach sexual goals. Findings can assist clinicians in determining what treatment will be most beneficial for whom.

Sexual Function and Satisfaction in Couples with Infertility: A Closer Look at the Role of Personal and Relational Characteristics

BACKGROUND

Research to date suggests that couples undergoing assisted reproductive technology (ART) are at a high risk of experiencing sexual difficulties.

AIM

This dyadic cross-sectional study aimed to provide a better understanding of the infertility-specific personal (ie, emotional, mind-body) and relational stressors associated with the sexual desire, orgasm, arousal, and sexual satisfaction of infertile couples seeking ART.

METHODS

The sample included 185 mixed-sex infertile couples seeking ART. Participants completed online the Fertility Quality of Life tool and either the Female Sexual Function Index or the International Index of Erectile Function. Data were analyzed using path analyses based on the Actor-Partner Interdependence Model.

OUTCOMES

Individuals' own and their partners' sexual function (desire, orgasm, arousal domains) and sexual satisfaction.

RESULTS

For men and women, infertility-related emotional stressors were associated with their own and their partner's lower sexual desire. For women, experiencing greater infertility-related emotional stressors was also associated with their partner's lower sexual satisfaction. While experiencing greater infertility-related mind-body stressors was not associated with men and women's own sexual desire, arousal, orgasm, and satisfaction, for women, it was associated with their partner's lower sexual arousal. Lastly, for men and women, infertility-related relational stressors were associated with their own lower sexual arousal, as well as with their own and their partner's lower sexual satisfaction. For women, experiencing greater relational stressors was also associated with their own lower sexual desire and orgasm.

CLINICAL IMPLICATIONS

Interventions addressing the emotional, mind-body, and relational spheres of infertile couples seeking ART may help facilitate improvements in sexual function and satisfaction and better serve their needs.

STRENGTHS & LIMITATIONS

This study included a large sample of couples. Our sample was heterogeneous with regards to couples' cause of infertility and treatment stage. The use of an infertility-related measure allowed us to better capture personal and relational stressors specific to couples seeking ART. Given the cross-sectional design of our study, causality between infertility-related stressors and sexual function and satisfaction cannot be inferred. Our sample included predominantly White, mixed-sex individuals with a high level of education, which may reduce the generalizability of our findings.

CONCLUSION

Couples' subjective experience of infertility and treatment (personal and relational stressors) seems to be strongly associated with their sexual health, allowing us to identify potential targets of intervention with couples seeking ART. S.E. Amiri, A Brassard, N.O. Rosen, et al. Sexual Function and Satisfaction in Couples with Infertility: A Closer Look at the Role of Personal and Relational Characteristics. J Sex Med 2021;18:1984-1997.

Perceived partner responsiveness is associated with sexual well-being in couples with genito-pelvic pain

Intimacy is vital to romantic relationships, yet is often thwarted by relational challenges, such as sexual difficulties. With prevalence estimates ranging from 10% to 28%, genito-pelvic pain/penetration disorder (GPPPD) is an important sexual problem resulting in negative consequences for affected women and their partners, including significant sexual dysfunction and dissatisfaction. Findings from cross-sectional studies indicate that higher levels of intimacy are associated with better sexuality outcomes in couples coping with GPPPD. However, single-occasion measurements may not capture the daily variations in intimacy that could have important implications for couples' sexual well-being. The present study focused on a key intimacy-building component-perceived partner responsiveness (PPR)-and its daily associations with women's pain and both partners' sexual function and satisfaction. Using daily diaries over an 8-week period, 160 women (M_age = 26.23, SD = 6.26) with GPPPD and their partners (M_age = 27.73, SD = 7.35) reported on PPR, sexual function and satisfaction, as well as women's pain, on days when sexual activity occurred (M = 8.87, SD = 5.87). Drawing on the Actor-Partner Interdependence Model, a multivariate multilevel modeling approach was adopted. Controlling for trait-level PPR, when women and partners reported greater PPR, women reported greater sexual function and satisfaction and partners reported greater sexual function. When partners reported greater PPR, they reported greater sexual satisfaction. No association was found between PPR and women's pain. PPR may facilitate better sexual function and satisfaction and could be an important target in sex and couple therapy for GPPPD. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Romantic relationship group intervention for men with early psychosis: A feasibility, acceptability and potential impact pilot study

AIM

To assess the feasibility, acceptability and potential impact of a cognitive behavioural group intervention occurring over 12 sessions and focusing on romantic relationships for single men with early psychosis.

METHODS

Recruitment, drop-out and participation rates were collected. An A-B-A within-subject design (n = 7), where each participant acted as his own control, was used to determine potential impact (on social functioning, romantic relationship functioning, self-esteem, theory of mind [ToM] and self-stigma) across time (six time points).

RESULTS

Feasibility and acceptability were established. As for the potential impact of the intervention, participants did not all evolve the same way. Improvements were found on social functioning ("behaviours" subscale), romantic relationship functioning and ToM ("mentalizing" subscale).

CONCLUSIONS

More studies are warranted to expand on these results and to further help men with early psychosis in their social and romantic development.

Cognitive-behavioral couple therapy versus lidocaine for provoked vestibulodynia: A randomized clinical trial

OBJECTIVE

This randomized clinical trial compared a novel cognitive-behavioral couple therapy (CBCT) and topical lidocaine for provoked vestibulodynia.

METHOD

Participants were 108 women (M age = 27.06) and their partners randomized to one of two treatments and assessed at pre- and post-treatment and 6-month follow-up via questionnaires pertaining to the primary outcomes of women's pain (numerical rating scales of pain intensity and unpleasantness), and secondary outcomes of pain anxiety (Pain Anxiety Symptoms Scale), both partners' sexual function (Female Sexual Function Index; International Index of Erectile Function), sexual distress (Female Sexual Distress Scale Revised), pain-related psychological distress (Pain Catastrophizing Scale), treatment satisfaction, and global ratings of improvements in pain and sexuality.

RESULTS

Intent-to-treat multilevel analyses showed that for women, CBCT yielded significantly more improvements than lidocaine in pain unpleasantness at 6-month follow-up, pain anxiety and pain catastrophizing at post-treatment and 6-month follow-up, and sexual distress at post-treatment, and resulted in better treatment satisfaction and global sexuality improvements at both time points. Partners significantly improved in their sexual function, sexual distress, and pain catastrophizing from pre- to post-treatment and pre-treatment to 6-month follow-up, with no significant group differences. Partners in the CBCT condition reported significantly greater treatment satisfaction at both time points, and greater sexuality improvements at post-treatment.

CONCLUSIONS

CBCT yielded better outcomes on more dimensions of provoked vestibulodynia than lidocaine. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Hypersexuality in Mixed-Sex Couples: A Dyadic Longitudinal Study

Emotion dysregulation and intimacy problems are theoretically underpinned correlates of hypersexuality (i.e., uncontrollable sexual urges, fantasies, and behaviors resulting in distress and impairment in different areas of functioning), but the directionality of these associations has not been established, as work in this area has relied on cross-sectional designs. Moreover, although hypersexuality may have significant adverse effects on romantic relationships and approximately half of treatment-seeking individuals are in a relationship, prior studies almost exclusively involved samples of men, regardless of their relationship status. The aim of the present study was to examine the directionality of associations between both partners' emotion dysregulation, physical (i.e., partnered sexual frequency) and relationship intimacy, and hypersexuality using a longitudinal, dyadic framework. Self-reported data of 267 mixed-sex couples (M_{age_men} = 29.9 years, SD = 8.2; M_{age_women} = 27.7 years, SD = 6.7) at baseline (T1) and six-month follow-up (T2) were analyzed using a crossed-lagged model within an actor-partner interdependence framework. Prior greater emotion dysregulation (T1) in both men and women was associated with their own later greater hypersexuality (T2). Women's prior greater hypersexuality (T1) was associated with their later lower relationship intimacy (T2). Lower levels of intimacy were not significantly associated with later hypersexuality. No partner effects were found in relation to hypersexuality. Findings suggest that men and women may use sexual behaviors to cope with negative emotions, which could, in turn, lead to hypersexuality. Intimacy problems did not precede hypersexuality, although women's hypersexuality may reduce their own relationship intimacy over time.

Validation of the French-Canadian Version of the Sexual Inhibition and Sexual Excitation Scales-Short Form (SIS/SES-SF): Associations With Sexual Functioning, Sociosexual Orientation, and Sexual Compulsivity

Introduction

The Dual control model proposes that both excitatory and inhibitory processes are responsible for the human sexual response.

Aim

To validate the French-Canadian translation of the Sexual Inhibition and Excitation Scales-Short Form (SIS/SES-SF) by exploring its factor structure and by investigating its capacity to retrospectively predict sexual functioning and behaviors, namely, sociosexual orientation and sexual compulsivity.

Methods

A French-Canadian translation of the SIS/SES-SF was created using forward-backward translation. A community sample of 362 men and 420 women completed an online survey. The factor structure and the measurement invariance between men and women was explored using Exploratory Structural Equation Modeling. Predictive power of the scales was tested using Multiple Linear Regression models using a corrected threshold (P< .008).

Main outcome measures

Sexual functioning was assessed using the International Index of Erectile Function and the Female Sexual Function Index while sexual compulsion and sociosexual orientation were measured using the Sexual Compulsion Scale and the Revised Sociosexual Orientation Inventory, respectively.

Results

The original three-factor solution of the SIS/SES-SF was replicated. All three scales showed acceptable internal consistency and good temporal stability. Yet, results only supported configural measurement invariance between men and women, suggesting that their scores cannot be directly compared. Overall, for both men and women, higher sexual excitation (SES) was significantly predictive of better sexual functioning, while higher sexual inhibition due to threat of performance failure (SIS1) was a significant predictor of lower sexual functioning. Both sexual compulsivity and sociosexual orientation were significantly predicted by higher SES and lower sexual inhibition due to threat of performance consequences (SIS2).

Conclusion

These results support the cross-cultural transferability of the SIS/SIS-SF and the Dual control model to French-Canadian men and women, higlighting the utility for clinicians to evaluate both excitatory and inhibitory factors associated with sexual dysfunction and sexual behaviors. Nolet K, Guay JP, Bergeron S. Validation of the French-Canadian Version of the Sexual Inhibition and Sexual Excitation Scales-Short Form (SIS/SES-SF): Associations With Sexual Functioning, Sociosexual Orientation, and Sexual Compulsivity. Sex Med 2021;9:100374.

Validity and reliability of the short version of the Problematic Pornography Consumption Scale (PPCS-6-A) in adolescents

OBJECTIVE

Despite the high prevalence of adolescents' pornography use and increasing societal concerns about it, the examination of problematic pornography use (PPU) among this population is still scarce, potentially due to the lack of well-validated, reliable measures. The aims of the present study were to validate a short, theory-based measure of PPU in a diverse sample of adolescents and identify a potentially at-risk problematic pornography user group.

METHOD

We used a sample of 802 adolescents (35% girls; 14% sexual minority; M_age = 15.4 years, SD = 0.6) who reported lifetime pornography use, collected as part of an ongoing longitudinal study on adolescents' sexual health. To examine the psychometric properties of the short, six-item version of the Problematic Pornography Consumption Scale for adolescents (PPCS-6-A), we conducted confirmatory factor analysis, gender and sexual orientation measurement invariance testing, and assessed theoretically relevant correlates (e.g., masturbation frequency). We conducted latent profile analysis to identify adolescents at risk of PPU.

RESULTS

The PPCS-6-A demonstrated strong psychometric properties in terms of factor structure, measurement invariance (i.e., boys vs. girls, and heterosexual vs. sexual minority adolescents), and reliability, and correlated reasonably with the assessed variables. Ten percent of participants were identified as being at-risk of PPU.

CONCLUSIONS

The PPCS-6-A can be considered a short, reliable, and valid scale to assess PPU in adolescents, and may distinguish between low-risk and at-risk problematic users. Its use in future studies could lead to a better understanding of the prevalence and characteristics of adolescents' PPU. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

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

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

An Attachment Perspective on Partner Responses to Genito-pelvic Pain and Their Associations with Relationship and Sexual Outcomes

Although facilitative and negative partner responses are known to impact couples' adaptation to provoked vestibulodynia (PVD), a chronic genito-pelvic pain condition, it is still unknown what leads individuals to adopt or perceive such adaptative or detrimental behaviors. Attachment influences sexual and relationship adjustment, emotional reactivity and perceived support in romantic relationships, and as such could be associated with partner responses. This study aimed at examining the mediating role of facilitative and negative partner responses in the associations between attachment and relationship and sexual adjustment in 125 couples coping with PVD. Couples completed self-report questionnaires on attachment, partner responses, sexual satisfaction and distress, and relationship satisfaction. Results indicated that partners' attachment avoidance was negatively associated with facilitative partner-reported responses, which in turn was associated with partners' sexual and relationship satisfaction. Attachment anxiety in women and partners was associated with greater women-perceived negative partner responses, which in turn was associated with women's and partners' greater sexual distress and lower sexual satisfaction, and women's lower relationship satisfaction. Partners' greater attachment anxiety was also associated with greater partner-reported facilitative responses, which was associated with partners' lower and women's greater relationship satisfaction. Assessing attachment orientations may help clinicians better understand couples' dyadic coping.

Pornography Use and Sexual Health among Same-Sex and Mixed-Sex Couples: An Event-Level Dyadic Analysis

A large number of partnered individuals regularly use or are in a relationship with someone who uses pornography. However, knowledge concerning the association between pornography use and partnered sexual health-sexual satisfaction, distress, and function-is fragmentary. The current study used an event-level dyadic design to examine the associations between pornography use and sexual satisfaction, distress, and function on days when partnered sexual activity occurred. A convenience sample of 217 couples (M_age = 30.2; SD = 8.3; 72 same-sex couples) completed a short survey on days of sexual activity with their partner, over a 35-day period. Self-report measures included questions about daily pornography use and masturbation as well as daily sexual satisfaction, distress, and function. Using pornography on days of partnered sexual activity was reported by half of the couples. An individual's solitary pornography use on days of partnered sexual activity was related to their partner's higher sexual distress and, for women's use only, to their own higher quality of lubrication, compared to sex days without solitary pornography use. There was no evidence of an association between pornography use on sex days, whether alone or with the partner, and all other aspects of sexual health including sexual satisfaction. Our findings capture the complexity of the associations between pornography and sexual health. Men and women's pornography use may create idealized fantasies around appearance and performance, which may lead the partner to feel distressed about their sex life. Women's pornography use might facilitate their sexual responsiveness during partnered sexual activity.

A Dyadic Longitudinal Study of Child Maltreatment and Sexual Well-Being in Adult Couples: The Buffering Effect of a Satisfying Relationship

This study examined the contribution of child maltreatment (CM) to trajectories of couples' sexual well-being, and whether relationship satisfaction moderates these associations. Using a sample of 269 mixed-sex couples followed over one year, dyadic latent growth curve models showed both actor and partner effects. In terms of actor effects, women's emotional neglect was associated with lower initial levels of sexual satisfaction, and most types of women's CM were related to a sharper decrease over time in sexual satisfaction. Men and women's emotional abuse and neglect, and women's sexual abuse, were associated with lower initial levels of sexual function. Men and women's emotional neglect and women's emotional abuse were related to higher initial levels of sexual distress. Women's sexual abuse was associated with a steeper increase in sexual distress. In terms of partner effects, women's emotional neglect was associated with lower initial levels of partner sexual satisfaction, and women's emotional abuse and neglect, with lower initial levels of partner sexual function. Greater relationship satisfaction buffered some of these negative effects. Given that sexual well-being requires a context in which the individual feels safe, all forms of CM may affect sexual well-being, although a satisfying relationship may buffer some of these effects.

Multimodal physical therapy versus topical lidocaine for provoked vestibulodynia: a multicenter, randomized trial

BACKGROUND

Provoked vestibulodynia is the most common subtype of chronic vulvar pain. This highly prevalent and debilitating condition is characterized by acute recurrent pain located at the entry of the vagina in response to pressure application or attempted vaginal penetration. Although physical therapy is advocated as a first-line treatment for provoked vestibulodynia, evidence supporting its efficacy is scarce.

OBJECTIVE

The purpose of this study was to establish the efficacy of multimodal physical therapy compared with topical lidocaine, a frequently used first-line treatment.

STUDY DESIGN

We conducted a multicenter, parallel-group, randomized clinical trial in women diagnosed as having provoked vestibulodynia recruited from the community and 4 Canadian university hospitals. Women were randomly assigned (1:1) to receive either weekly sessions of physical therapy or overnight topical lidocaine (5% ointment) for 10 weeks. Randomization was stratified by center using random permuted blocks from a computer-generated list managed by an independent individual. Physical therapy entailed education, pelvic floor muscle exercises with biofeedback, manual therapy, and dilation. Assessments were conducted at baseline, posttreatment, and 6-month follow-up. Outcome assessors, investigators, and data analysts were masked to allocation. The primary outcome was pain intensity during intercourse evaluated with the numeric rating scale (0-10). Secondary outcomes included pain quality (McGill-Melzack Pain Questionnaire), sexual function (Female Sexual Function Index), sexual distress (Female Sexual Distress Scale), satisfaction (numeric rating scale of 0-10), and participants' impression of change (Patient Global Impression of Change). Intention-to-treat analyses were conducted using piecewise linear-growth models.

RESULTS

Among 212 women who were recruited and randomized, 201 (95%) completed the posttreatment assessment and 195 (92%) completed the 6-month follow-up. Multimodal physical therapy was more effective than lidocaine for reducing pain intensity during intercourse (between-group pre-post slope difference, P<.001; mean group postdifference, 1.8; 95% confidence interval, 1.2-2.3), and results were maintained at 6-month follow-up (mean group difference, 1.8; 95% confidence interval, 1.2-2.5). The physical therapy group also performed better than the lidocaine group in all secondary outcomes (pain quality, sexual function, sexual distress, satisfaction, and participants' impression of change) at posttreatment and 6-month follow-up. Moreover, the changes observed after physical therapy were shown to be clinically meaningful. Regarding participants' impression of change, 79% of women in the physical therapy group reported being very much or much improved compared with 39% in the lidocaine group (P<.001).

CONCLUSION

The findings provide strong evidence that physical therapy is effective for pain, sexual function, and sexual distress and support its recommendation as the first-line treatment of choice for provoked vestibulodynia.

Childhood sexual abuse, girls' genitourinary diseases, and psychiatric comorbidity: A matched-cohort study

Objective: The present study aimed to determine whether psychiatric comorbidity (i.e., diagnostic comorbidity in eight categories of mental and behavioral disorders) mediates the relationship between childhood sexual abuse (CSA) and diseases of the genitourinary system (International Statistical Classification of Diseases and Related Health Problems, 10th revision) among girls. Method: Using a prospective matched-cohort design, we documented diagnoses given by a physician after a medical consultation or hospitalization for diseases of the genitourinary system, for 661 sexually abused girls and 661 matched controls via administrative databases covering the period between January 1996 and March 2013. Path analyses using negative binomial regressions with CSA as independent variable, psychiatric comorbidity as mediator and genitourinary diseases diagnoses as dependent variables were performed. Results: After controlling for socioeconomic level, prior genitourinary diseases and number of years of medical data, the mediation effect for the path from CSA to genitourinary diseases through psychiatric comorbidity was significant for the urinary system (b = .125, 95% confidence interval [0.057, 0.192]) as well as for the genital system (b = .213, 95% confidence interval [0.141, 0.285]). Psychiatric comorbidity carried 62% of the sexual abuse total effect on the number of diagnoses received for genital diseases, whereas it carried 23% of the sexual abuse total effect on the number of diagnoses received for urinary diseases. Conclusions: Findings suggest that CSA may have an indirect effect on girls' diagnosed genitourinary diseases during a medical consultation or hospitalization through the increased risk for psychiatric comorbidity. Early interventions aimed at addressing psychological distress among sexually abused girls might prevent the emergence of genitourinary diseases years after the abuse. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Efficiency and Cost: E-Recruitment Is a Promising Method in Gynecological Trials

BACKGROUND

Recruitment of participants is crucial to the success of any trial as it can have a major impact on study costs, the duration of the study itself, and, more critically, trial failure. Given that vulvodynia particularly affects young women, the use of social media and e-recruitment could prove efficient for enrollment.

AIM

To compare the efficiency, effectiveness, and cost-effectiveness of three different recruitment methods.

METHODS

The comparison data were collected as part of a bicentric randomized controlled trial evaluating the efficacy of physiotherapy in comparison with topical lidocaine in 212 women suffering from provoked vestibulodynia. The recruitment methods included: (i) conventional methods (eg, posters, leaflets, business cards, newspaper ads); (ii) health professional referrals, and (iii) e-recruitment (eg, Facebook ads and web initiatives). Women interested in participating were screened by telephone for eligibility criteria and were assessed by a gynecologist to confirm their diagnosis. Once included, structured interviews were undertaken to describe their baseline characteristics.

MAIN OUTCOME MEASURES

The outcomes of this study were the recruitment efficiency (the number of patients screened/enrolled), recruitment effectiveness (the number of participants enrolled), cost-effectiveness (cost per enrolled participant), and retention rate, and baseline characteristics of participants were monitored for each method.

RESULTS

The conventional methods (n = 101, 48%) were more effective as they allowed for greater enrollment of participants, followed by e-recruitment (n = 60, 28%) and health professional referrals (n = 33, 16%) (P < 0.007). Recruitment efficiency was found to be similar for e-recruitment and referrals (60/122 and 33/67, 49%, P = 0.055) but lower for conventional methods (101/314, 32%, P < 0.011). Nonsignificant differences were found between the three groups for baseline characteristics (P ≥ 0.189) and retention rate (91%, P ≥ 0.588). The average cost per enrolled participant was fairly similar for e-recruitment ($117) and conventional methods ($110) and lower for referrals ($60).

CLINICAL IMPLICATIONS

Our results suggest that having a variety of recruitment methods is beneficial in promoting clinical trial recruitment without affecting participant characteristics and retention rates.

STRENGTH & LIMITATIONS

Although recruitment methods were used concomitantly, this study gives an excellent insight into the advantages and limitations of recruitment methods owing to a large sample size.

CONCLUSION

The study findings revealed that e-recruitment is a valuable recruitment method because of its comparable efficiency and cost-effectiveness to health professional referrals and conventional methods, respectively.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov, number NCT01455350. Benoit-Piau J, Dumoulin C, Carroll MS, et al. Efficiency and Cost: E-Recruitment Is a Promising Method in Gynecological Trials. J Sex Med 2020;17:1304-1311.

Preliminary validation of the Sexual Distress Scale-Short Form: Applications to Women, Men, and Prostate Cancer Survivors

The Sexual Distress Scale (SDS) can be used to assess sexual distress in women, men, and prostate cancer (PCa) survivors. Despite its strong psychometric properties, researchers and clinicians could benefit from a short form of the scale. Two studies were conducted to develop (Study 1) and validate (Study 2) a short form of the SDS (SDS-SF) using samples of women, men, and PCa survivors from previous studies. Results of Study 1 suggested a 5-item SDS-SF. Study 2 showed that the SDS-SF items clustered in one factor with good fit across the three samples and excellent reliability. Sexual distress was associated with higher sexual bother, and poorer sexual satisfaction, sexual function, and relationship quality. The SDS-SF discriminated participants with and without distressing sexual problems. The SDS-SF facilitates the assessment of sexual distress in clinical settings by providing a quick way of screening patients with high levels of sexual distress.