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

INTRODUCTION

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

An analysis of placental chorionic villous and decidual basalis tissue immunoreactivity in patients after cesarean section due to a placenta accreta spectrum disorder and elective cesarean section followed by the depressed mood

An analysis of placental chorionic villous and decidual basalis tissue immunoreactivity in patients after cesarean section due to a placenta accreta spectrum disorder and elective cesarean section followed by a depressed mood.

RESEARCH BACKGROUND

Over the past few years, interest in investigating immune dysfunction in patients with psychiatric disorders has increased. B7-H4 is a molecule with immunosuppressive properties that seems to play a key role in establishing maternal tolerance against fetal antigens. The aim of this study was to compare the B7-H4 immunoreactivity levels in patients after cesarean section.

METHODS

Placental and decidual tissue samples were obtained from 49 women who delivered at Bielański Hospital in Warsaw between 2009 and 2015. Fifteen of the patients developed postpartum depression and 14 had a diagnosis of placenta accreta spectrum. The control group consisted of 20 healthy patients on whom cesarean section was performed due to breech presentation at term.

RESULTS

The highest levels of B7-H4 immunoreactivity were found in the placental chorionic villous and decidual basalis tissue samples of the patients who later developed postpartum depression, while the lowest levels were found in the samples of those patients with a placenta accreta spectrum disorder. The difference between the B7-H4 immunoreactivity levels of these two groups was statistically significant. The B7-H4 expression levels were statistically significantly higher in the women in the postpartum depression group than in the control group.

CONCLUSION

Postpartum depression follows a disturbance of the suppressive milieu responsible for rebalancing the maternal immune system after the initial cytotoxic activation during labor.

Assessment of the effect of mindfulness monotherapy on sexual dysfunction symptoms and sex-related quality of life in women

Background

Mindfulness-based therapies (MBTs) are frequently used in the treatment of sexual dysfunctions. So far, there has not been sufficient evidence for the effectiveness of interventions based on mindfulness monotherapy.

Aim

The aim of the study was to assess the effect of mindfulness monotherapy on the reduction of sexual dysfunction symptoms and sex-related quality of life.

Methods

We conducted 4 weeks of MBT for 2 groups of heterosexual females: 1 with psychogenic sexual dysfunction (WSD) and 1 with no sexual dysfunction (NSD). Overall 93 women were recruited for the study. We collected data via an online survey regarding sexual satisfaction, sexual dysfunctions, and mindfulness-related features at baseline, 1 week after MBT, and follow-up 12 weeks after MBT. Research tools included the Female Sexual Function Index, Five Facet Mindfulness Questionnaire, and Sexual Satisfaction Questionnaire.

Outcomes

Participating in the mindfulness program had a positive effect on women with and without sexual dysfunction.

Results

The overall risk for sexual dysfunction decreased from 90.6% at baseline to 46.7% at follow-up in the WSD group and from 32.5% at baseline to 6.9% at follow-up in the NSD group. Participants in the WSD group reported a significant increase in levels of sexual desire, arousal, lubrication, and orgasm between measurements, although not in the pain domain. Participants in the NSD group reported a significant increase in the level of sexual desire between measurements but not in levels of arousal, lubrication, orgasm, and pain. A significant increase in sex-related quality of life was observed in both groups.

Clinical Implications

The results of the study have a chance to translate into an introduction of a new therapeutic program for specialists and more effective help offered to women experiencing sexual dysfunctions.

Strengths and Limitations

This mindfulness monotherapy research project, which included assessment of meditation "homework," is the first to verify the potential of MBT in reducing symptoms of psychogenic sexual dysfunctions among heterosexual females. Major limitations include the lack of randomization, an adequate control group, and a validated measure of sexual distress.

Conclusion

The applied training was beneficial in the treatment of sexual dysfunctions in terms of increasing desire and arousal as well as the ability to reach orgasm. However, this approach needs more investigation before it can be recommended in the treatment of sexual dysfunction. The study should be replicated under a more rigorous research design, including adequate control groups and random allocation of participants to study conditions.

Withdrawal and tolerance as related to compulsive sexual behavior disorder and problematic pornography use - Preregistered study based on a nationally representative sample in Poland

Background

The addiction model of compulsive sexual behavior disorder (CSBD) and problematic pornography use (PPU) predicts the presence of withdrawal symptoms and increased tolerance for sexual stimuli in the disorder phenotype. However, clear empirical evidence supporting this claim has largely been lacking.

Methods

In the preregistered, nationally representative survey (n = 1,541, 51.2% women, age: M = 42.99, SD = 14.38), we investigated the role of self-reported withdrawal symptoms and tolerance with respect to CSBD and PPU severity.

Results

Both withdrawal and tolerance were significantly associated with the severities of CSBD (β = 0.34; P < 0.001 and β = 0.38; P < 0.001, respectively) and PPU (β = 0.24; P < 0.001 and β = 0.27; P < 0.001, respectively). Of the 21 withdrawal symptom types investigated, the most often reported symptoms were frequent sexual thoughts that were difficult to stop (for participants with CSBD: 65.2% and with PPU: 43.3%), increased overall arousal (37.9%; 29.2%), difficult to control level of sexual desire (57.6%; 31.0%), irritability (37.9%; 25.4%), frequent mood changes (33.3%; 22.6%), and sleep problems (36.4%; 24.5%).

Conclusions

Changes related to mood and general arousal noted in the current study were similar to the cluster of symptoms in a withdrawal syndrome proposed for gambling disorder and internet gaming disorder in DSM-5. The study provides preliminary evidence on an understudied topic, and present findings can have significant implications for understanding the etiology and classification of CSBD and PPU. Simultaneously, drawing conclusions about clinical importance, diagnostic utility and detailed characteristics of withdrawal symptoms and tolerance as a part of CSBD and PPU, as well as other behavioral addictions, requires further research efforts.

Psychological Characteristics of Sex Offenders

Introduction

A significant problem for clinical judicial experts when issuing court opinions is the possibility that the assessed person may be simulating, as well as lack of examination tools that would increase the objectivity and reliability of the assessment. This presentation covers studies on psychological characteristics of perpetrators of crimes against sexual freedom.

Objectives

The participants were asked to complete psychological tools - Rosenberg Self-Esteem Scale, Satisfaction with Life Scale, Emotion Understanding Test, Revised NEO Personality Inventory, Attachment Style Questionnaire.

Methods

The participants of the study consisted of 225 men serving sentences of imprisonment in a dozen of Polish prisons. Two clinical populations were compared: of perpetrators diagnosed and not diagnosed with sexual preference disorders. The control group consisted of offenders of crimes other than against sexual freedom.

Results

no personality and psychosocial variables were identified that would significantly differentiate offenders diagnosed and not diagnosed with parapaphilic disorder.

Conclusions

The results of this study justify the use of selected tools to complement the clinical diagnosis, allowing for obtaining additional data, independent from case files and interview, that would increase the probability of sexual preference disorders.

Disclosure

The study was approved by the ethical committee at the Institute of Psychiatry and Neurology in Warsaw and the Director General of the Prison Service. Scientific work was financed from the budget for science in the years 2017-2021, as a research project D

Diagnostic criteria for enduring sexual dysfunction after treatment with antidepressants, finasteride and isotretinoin

BACKGROUND:

A set of enduring conditions have been reported in the literature involving persistent sexual dysfunction after discontinuation of serotonin reuptake inhibiting antidepressants, 5 alpha-reductase inhibitors and isotretinoin.

OBJECTIVE:

To develop diagnostic criteria for post-SSRI sexual dysfunction (PSSD), persistent genital arousal disorder (PGAD) following serotonin reuptake inhibitors, post-finasteride syndrome (PFS) and post-retinoid sexual dysfunction (PRSD).

METHODS:

The original draft was designed using data from two published case series (Hogan et al., 2014 and Healy et al., 2018), which represent the largest public collections of data on these enduring conditions. It was further developed with the involvement of a multidisciplinary panel of experts.

RESULTS:

A set of criteria were agreed upon for each of the above conditions. Features of PSSD, PFS and PRSD commonly include decreased genital and orgasmic sensation, decreased sexual desire and erectile dysfunction. Ancillary non-sexual symptoms vary depending on the specific condition but can include emotional blunting and cognitive impairment. PGAD presents with an almost mirror image of unwanted sensations of genital arousal or irritability in the absence of sexual desire. A new term, post-SSRI asexuality, is introduced to describe a dampening of sexual interest and pleasure resulting from a pre-natal or pre-teen exposure to a serotonin reuptake inhibitor.

CONCLUSIONS:

These criteria will help in both clinical and research settings. As with all criteria, they will likely need modification in the light of developments.

Sexual Inhibition and Sexual Excitation Scales in Men: Psychometric Properties of a Polish Adaptation

The present study aimed to develop a Polish version of the Sexual Inhibition/Sexual Excitation Scale (SIS/SES-PL) and explore its psychometric validity in a sample of 498 men aged between 18 and 55 years. We used exploratory and confirmatory factor analyses to obtain the best model fit. Out of the 45 items in the original scale, 32 items with eight subscales and three higher-order factors: (sexual excitation [SES], sexual inhibition due to performance failure [SIS1], and sexual inhibition due to performance consequences [SIS2]) were included in the SIS/SES-PL. The SIS/SES-PL was found to have a good and satisfactory fit (comparative fit index = .87; Tucker-Lewis Index = .85; root mean square error of approximation = .054; χ² = 1108.7; p < .001; test-retest reliability Cronbach's alpha = .93). A small correlation between age and the SIS1 and SIS2 scores was detected. However, forward multiple regression analysis revealed a significant correlation only between age and SIS1 [β = .23, p < .001, R² for model = .05; F(1, 494) = 27.52, p < .001]. Furthermore, a moderate correlation between SIS1 and SES2, as well as SIS1 and general inhibition properties (measured using the Behavioral Inhibition Scale), was noted. In the case of SIS2, only small effects were observed, with the highest values for engaging in risky sexual behavior. Out of the total number of 42 variables, a moderate correlation between SES and the following was described: importance of sex, hypersexual behaviors, frequency of masturbation, frequency of sexual activities per month, sexual risk-taking, high promiscuity (measured using the Sociosexual Orientation Inventory Revised-Drive), general activation properties (measured using the Behavioral Activation Scale), neuroticism, and erotophilic tendencies (measured using the Sexual Opinion Survey-Short Form). The results of the study allowed us to conclude that the SIS/SES-PL might be a useful tool for tailoring therapy for men with sexual problems, as well as in the field of clinical research on sexual inhibition and excitation. Furthermore, it is a reliable and useful tool for measuring propensities for sexual excitement and inhibition.

Personality variables among sexual offenders with and without diagnosis of paraphilic disorders

Introduction

Sexual offenders are classified in terms of the act they have committed, diagnosis of sexual preference disorder (paraphilic disorder), and the potential motives behind the act. The typology that is often used in forensic-sexological practice is the division into preferential and non-preferential perpetrators, i.e. perpetrators showing or not showing a sexual preference disorder.

Objectives

The aim of the study was to assess whether psychosocial and personality variables significantly differ between the group of preferential and non-preferential sexual offenders.

Methods

The study involved 120 persons, including 60 preferential and 60 non-preferential sexual offenders. The participants were presented with selected, standardized psychological tools to personality traits, self-esteem, life satisfaction, capacity to understand emotions, attachment style.

Results

The study involved 120 persons, including 60 preferential and 60 non-preferential sexual offenders. The participants were presented with selected, standardized psychological tools to personality traits, self-esteem, life satisfaction, capacity to understand emotions, attachment style.

Conclusions

Differences between the both study groups and the male standardization sample suggest worse psychosocial functioning of sexual offenders. A critical analysis of the methodological limitations of this study have been presented.

Conflict of interest

Scientific work was financed from the budget for science in the years 2017-2021, as a research project DI 16/003046 under the programme „Diamond Grant”.

Polish adaptation of emotional Stroop test in assessment of pedophilia - a pilot study

OBJECTIVES

A pilot study was conducted in order to construct a Polish adaptation of emotional Stroop test in assessment of pedophilia.

METHODS

The study consisted of two stages. The first stage involved creating test material by ranking words in adequate lists by competent experts. The second stage consisted of empirical verification of the principle of emotional Stroop test in a non-clinical population.

RESULTS

Based on the assessment of five competent experts, words were ordered from the most to the least sexually arousing (Kendall's W from 0.368 to 0.693). Six ranked lists were obtained, and the competent experts were subsequently asked to assess whether these lists were suitable for the study (Lawshe's Content Validity Ratio from 0.6 to 1.0). Two categories of words were merged. Five ranked lists were obtained, and the competent experts were subsequently asked again to assess whether these lists were suitable for the study (Lawshe's Content Validity Ratio 1.0). The created lists of words were approved by allcompetent experts. Based on the experimental study conducted on a non-clinical population, it was shown that, in accordance with the principle of the test, the mean response time for sexually related words was longer that for neutral words. The mean response time for children-related words did not differ significantly from response time for neutral words.

CONCLUSIONS

Based on the study with competent experts and conducted experiments, an initial Polish adaptation of the emotional Stroop test for diagnosis of pedophilia has been created. Further studies with persons with pedophilia are needed to implement the test in clinical setting.

Validation of a Brief Pornography Screen across multiple samples

BACKGROUND AND AIMS

To address current gaps around screening for problematic pornography use (PPU), we initially developed and tested a six-item Brief Pornography Screen (BPS) that asked about PPU in the past six months.

METHODS AND PARTICIPANTS

We recruited five independent samples from the U.S. and Poland to evaluate the psychometric properties of the BPS. In Study 1, we evaluated the factor structure, reliability, and elements of validity using a sample of 224 U.S. veterans. One item from the BPS was dropped in Study 1 due to low item endorsement. In Studies 2 and 3, we further investigated the five-item the factor structure of the BPS and evaluated its reliability and validity in two national U.S. representative samples (N = 1,466, N = 1,063, respectively). In Study 4, we confirmed the factor structure and evaluated its validity and reliability using a sample of 703 Polish adults. In Study 5, we calculated the suggested cut-off score for the screen using a sample of 105 male patients seeking treatment for compulsive sexual behavior disorder (CSBD).

RESULTS

Findings from a principal components analysis and confirmatory factor analysis supported a one-factor solution which yielded high internal consistency (α = 0.89-0.90), and analyses further supported elements of construct, convergent, criterion, and discriminant validity of the newly developed screen. Results from a Receiver Operating Characteristic (ROC) curve suggested a cut-off score of four or higher for detecting possible PPU.

CONCLUSIONS

The BPS appears to be psychometrically sound, short, and easy to use in various settings with high potential for use in populations across international jurisdictions.

Which Dimensions of Human Sexuality Are Related to Compulsive Sexual Behavior Disorder (CSBD)? Study Using a Multidimensional Sexuality Questionnaire on a Sample of Polish Males

INTRODUCTION

Human sexuality is a multidimensional phenomenon related to several factors, such as self-esteem, awareness of sexual needs, and ability to communicate them to others.

AIM

To examine the sexual characteristics of patients seeking treatment for compulsive sexual behavior disorder (CSBD)-a clinical diagnosis recently included in the 11th edition of the International Classification of Diseases classification.

METHODS

We have investigated the sexual characteristics of 72 Polish men seeking treatment for CSBD compared with 208 men from the Polish general population.

MAIN OUTCOME MEASURES

The Multidimensional Sexual Questionnaire-PL was used to examine 12 sexual aspects of human sexuality. The severity of CSBD symptoms was assessed using Sexual Addiction Screening Test-PL, and the severity of problematic pornography use was measured by Brief Pornography Screener.

RESULTS

Results show that CSBD patients (when compared with the general population) exhibit higher sexual anxiety, sexual depression, external sexual control, and fear of sexual relationship. Furthermore, CSBD severity is negatively related to sexual esteem, internal sexual control, sexual consciousness, sexual assertiveness, and sexual satisfaction.

CLINICAL IMPLICATIONS

Our findings suggest that the impairment of the abovementioned dimensions warrant attention during clinical work and future studies on CSBD.

STRENGTHS & LIMITATIONS

This study was limited to men, most of whom self-identified as heterosexual. Future research should include women and non-heterosexual identified individuals.

CONCLUSION

Sexual esteem, consciousness, assertiveness, satisfaction and internal sexual control are commonly affected among CSBD individuals and should be properly addressed during the clinical interview and treatment intervention. Kowalewska E, Kraus SW, Lew-Starowicz M, et al. Which Dimensions of Human Sexuality Are Related to Compulsive Sexual Behavior Disorder (CSBD)? Study Using a Multidimensional Sexuality Questionnaire on a Sample of Polish Males. J Sex Med 2019;16:1264-1273.

Thrombocytopenia in Patients Hospitalized for Alcohol Withdrawal Syndrome and Its Associations to Clinical Complications

BACKGROUND

The aim of this study was to assess the predictive value of thrombocytopenia (TP) in alcohol withdrawal syndrome (AWS) as a marker of evolution of non-complicated AWS (nAWS) to severe, complicated AWS (cAWS): delirium tremens (DTs) and withdrawal seizures (wS), and to broaden knowledge about differences between nAWS and cAWS groups in relation to severity of TP.

METHODS

This study involved 300 people (236 males and 64 females), aged 19-65 years (M = 44.64, SD = 11.32), hospitalized in the detoxification ward with ICD-10 diagnosis of F10.3 (AWS) or F10.4 (DTs), divided into nAWS and cAWS groups, 150 cases each. AWS severity was measured by CIWA-Ar. Available clinical and laboratory data were analyzed.

RESULTS

TP was found in 139 (46%) of all subjects (nAWS = 32, cAWS = 107). nAWS and cAWS did not differ according to age, gender, length and severity of the last binge. A relationship between the occurrence of TP and cAWS was found (P < 0.001). The lower was the number of PLT, the more AWS incidence was observed. In CIWA-Ar, TP subjects had at least moderate AWS (P < 0.001). nAWS had higher PLT values than cAWS cases (Mrang = 195.96 vs. 105.04, P < 0.001). The predictive value of TP in cAWS was confirmed.

CONCLUSIONS

The study demonstrates that patients with AWS and TP (in particular <119k/mL) are at higher risk of developing cAWS.

Nonpharmacological Interventions for the Treatment of Cardiometabolic Risk Factors in People With Schizophrenia-A Systematic Review

Background: People suffering from schizophrenia are notably vulnerable to cardiometabolic risk factors (CMRF), such as obesity, high blood pressure, hyperglycemia and insulin resistance, high serum triglycerides, and low serum high-density lipoprotein (HDL), which are related to increased mortality and decreased quality of life. The increased risk of "metabolic syndrome" (MS) is related to low physical activity, an unhealthy diet, and side effects of antipsychotic drugs. Nonpharmacological interventions seem to be important in the prevention and therapy of MS. Aim: This paper provides an overview of published studies and a critical analysis of pilot programs involving nonpharmacological measures aimed at prevention and treatment of CMRF in patients with schizophrenia. Material and Method: We searched the PubMed, PsycARTICLES, and Cochrane Library databases to identify clinical trials. We included full-text studies that met the following criteria: age > 18 years, a diagnosis of schizophrenia or schizoaffective disorder, and monitored parameters associated with MS. Results: All 1,555 references were evaluated for inclusion in the review, and 20 met the inclusion criteria. Nonpharmacological interventions led to improvement in physical health and showed a promising potential for implementation in treatment programs dedicated to this particular group of patients. However, a critical analysis revealed limitations, which have implications for the direction of future research. Conclusions: Patients suffering from schizophrenia can benefit from nonpharmacological interventions aimed at counteracting CMRF, improving either metabolic parameters, cardiovascular fitness, or their health perception. Notwithstanding, to achieve long-term effects, future studies should comprise appropriate follow-up procedures.

Gender dysphoria symptoms in schizophrenia

Gender dysphoria in individuals with schizophrenia may result from the delusionally changed gender identity or appear regardless of psychotic process. Distinguishing between these situations is not only a diagnostic challenge, but also affects the therapeutic decisionmaking. The review of the literature shows that different delusional beliefs regarding belonging to another gender, anatomy or changes within the genitals affect about one-fourth of patients with schizophrenia. Contemporary classifications of disorders are moving towards the elimination of psychotic disorders as a disqualifying criterion in diagnosing gender dysphoria. It is also established that schizophrenia may change the picture of gender dysphoria, e.g., by giving meaning and delusional interpretations of the fact of the incompatibility of phenotypic sex with the sense of gender. At the same time, before making a therapeutic decision (especially aimed at gender reassignment), it is necessary to exclude the psychotic background of the desire for gender reassignment. In case of co-occurrence of both disorders, it is crucial to evaluate the chronology and dynamics of the individual symptoms, their constancy (prolonged observation), patient's criticism and response to antipsychotic treatment.

Can Pornography be Addictive? An fMRI Study of Men Seeking Treatment for Problematic Pornography Use

Pornography consumption is highly prevalent, particularly among young adult males. For some individuals, problematic pornography use (PPU) is a reason for seeking treatment. Despite the pervasiveness of pornography, PPU appears under-investigated, including with respect to the underlying neural mechanisms. Using functional magnetic resonance imaging (fMRI), we examined ventral striatal responses to erotic and monetary stimuli, disentangling cue-related 'wanting' from reward-related 'liking' among 28 heterosexual males seeking treatment for PPU and 24 heterosexual males without PPU. Subjects engaged in an incentive delay task in the scanner, in which they received erotic or monetary rewards preceded by predictive cues. Blood-oxygen-level-dependent responses to erotic and monetary cues were analyzed and examined with respect to self-reported data on sexual activity collected over the 2 preceding months. Men with and without PPU differed in their striatal responses to cues predicting erotic pictures but not in their responses to erotic pictures. PPU subjects when compared with control subjects showed increased activation of ventral striatum specifically for cues predicting erotic pictures but not for cues predicting monetary gains. Relative sensitivity to cues predicting erotic pictures vs monetary gains was significantly related to the increased behavioral motivation to view erotic images (suggestive of higher 'wanting'), severity of PPU, amount of pornography use per week, and number of weekly masturbations. Our findings suggest that, similar to what is observed in substance and gambling addictions, the neural and behavioral mechanisms associated with the anticipatory processing of cues specifically predicting erotic rewards relate importantly to clinically relevant features of PPU. These findings suggest that PPU may represent a behavioral addiction and that interventions helpful in targeting behavioral and substance addictions warrant consideration for adaptation and use in helping men with PPU.

Female sexuality in the context of dual control model

Introduction

Dual Control Model (DCM) is one of the contemporary concepts of mechanisms rooted in the central nervous system that control human sexual behaviors. The DCM holds promise for application both in scientific settings and, although at the moment limited, clinical practice. A number of psychometric tools, i.e. the SIS/SES, SES II-W and SES II-W/M questionnaires based on the DCM theoretical assumptions have been developed.

Methods

A total of 309 women aged 18–45 were eligible for the study. Inclusion criteria were met by 214 individuals who were included in the further analysis. Sexual excitation/sexual inhibition inventory for women (SESII-W) was used to evaluate sexual inhibition and sexual excitation. Semi-structure interview was used to evaluate sexual function in investigated individuals. Correlation between risky sexual behaviors, FSD and SE/SE was measured.

Results

Among the women, 28.5% were diagnosed with FSD, with orgasmic dysfunction being the most common, 11.2%. Engaging in risky sexual behavior (having multiple sexual partners and one-night-stand sexual relationships, sexual intercourse with persons known to be HIV-positive, drug users or prostitutes, unprotected vaginal, oral and anal sex, sex for money or drugs and sexual activity while using alcohol and/or psychoactive substances) was associated with higher sexual excitation scores and lower sexual excitation scores of SESII-W. In contrast, the presence of FSD were negatively correlated with SE and positively with SI.

Conclusions

Dual control model might be a good model describing different sexual behaviors in the population of women.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Motivation of sexual relationship with animal–Study of a multinational group of 345 zoophiles

Introduction

We explore relationship-seeking behaviour of zoophiles (zoos), using Francoeur's (1991) definition of sexual orientation (as consisting of affection orientation, sexual fantasy orientation, and erotic orientation).

Objectives

This study intends to be the largest in recent decades’ comprehensive analysis of self-identified zoophiles, living on all five continents. It describes similarities and differences between normative sexual orientations (hetero- and homo-) and zoophilic sexuality, using Francoeur's (1991) framework.

Method

A qualitative observational study of user activity (n = 958) on discussion forums, combined with brief demographic survey. Data were analyzed according to principles of grounded theory. Next, surveys of own design (demographic, discreet + open ended questions) were received by n = 350 participants. Presented data show aggregate conclusions from mixed methods qualitative and quantitative analysis.

Results

Trend analysis yielded four main discussions among zoophiles – worldview, personal space, sex life, and online space. Within worldview category, zoos overwhelmingly discuss bad press (55%), as well as social (41%) and legal (22%) ostracism. In personal space, the primary concern is coming at easy with own sexuality (>60%) and forming lasting relationship with either human, animal, or both partners simultaneously. In terms of sex life, zoos are concerned with improving sex play (>40%) and figuring out legality of sexual encounters with animals (22%). Concerning online space, the biggest concern here is networking (40%) and meeting other zoos for dating (15%).

Conclusions

Modern zoophiles have a wide array of personal, social, legal, and sex life challenges that can be approximated using qualitative studies.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Rethinking classification of zoophilia

Introduction

In 2011, Anil Aggrawal proposed ten-point classification system of zoophilia, based on forensic literature review.

Objectives

(1) Allow for conceptualization and improved management of zoophilic patients in clinical practice or forensic examinations, (2) describe identity of modern-day zoophiles, including demographics and psycho-social profile, and (3) determine normative and pathologic traits and behaviours.

Methods

A qualitative observational study of user activity (n = 958) on discussion forums, combined with brief demographic survey. Data were analyzed according to principles of grounded theory. Surveys of own design (demographic, discreet + open ended questions) were answered by 350 participants. Presented data show aggregate conclusions from mixed methods qualitative and quantitative analysis.

Results

Proposed classification system categorizes zoos as either classic, sexual, romantic, or platonic. Relationship goals of classic and romantic zoos are reminiscent of those typical of human partnership, differentiated by the commitment and psychological distress level (romantic zoos, affectionate relationship goals outweigh sexual pursuit; classic zoos, romantic and sexual urges cause distress rather than pleasure). Sexual zoos show high prevalence of hypersexuality traits. Platonic zoos are typically confused about the roots of their sexuality. Contrary to common perceptions, prevalence of sexual sadism is extremely low (<1% in our study). Sociopathic traits determine propensity for animal cruelty, which is not synonymous with typical zoophilia. Half of respondents were in committed relationship with human partner, whom they frequently attempted to “convert” into practicing zoophile.

Conclusions

We can categorize zoophiles into four sub-types. Emotional attachment and sexual urges play equal role in bonding with animal partner.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Personality traits, gender roles and sexual behaviours of young adult males

BACKGROUND

Previous studies have shown that personality characteristics affect sexual functioning. The aim of this exploratory study was to assess and describe the relationship between global personality traits and the stereotypical femininity and masculinity levels with the broad aspects of sexual behaviours and attitudes in the group of 97 heterosexual young adult men aged 19-39 and living in Poland.

METHODS

The 'Big Five' personality traits were measured with the NEO-FFI questionnaire; stereotypical femininity and masculinity with the Bem sex role inventory (BSRI); sexual disorders with the International index of erectile function (IIEF); socio-epidemiological data, sexual behaviours and attitudes towards sexuality with a self-constructed questionnaire.

RESULTS

We identified weak to moderate associations with particular sexual behaviours and attitudes. Neuroticism correlated positively with lower sexual satisfaction, self-acceptance and more negative attitudes towards sexuality; extraversion with higher desire, frequency of sexual intercourses, their diversity, sexual satisfaction, masculinity level and lower report of erectile problems; openness to experience with better quality of partnership, more positive attitudes towards sexual activity and masculinity level; conscientiousness with later sexual initiation age, more frequent and diverse sexual behaviours (but lower interest in masturbation and coitus interruptus), overall sexual satisfaction, satisfaction with one's body and femininity level; agreeableness with a better quality of relationship with a partner, satisfaction from body, lower number of previous partners and more frequent sexual encounters (but less masturbation). Stereotypical masculinity, more so than femininity, was related to a wide range of positive aspects of sexuality.

CONCLUSIONS

The Big Five personality traits and stereotypical femininity/masculinity dimensions were found to have a noticeable, but weak to moderate influence on sexual behaviour in young adult males.

[Children sexual abuse in Poland--study of 257 sexual offenders against minors]

INTRODUCTION

Obtaining objective data on sexual offenders against minors is difficult. In order to enhance the possibilities to prevent such crimes it is essential to determine factors that condition this kind of sexual behavior.

AIM

The aim of the study was to prepare a multidimensional analysis of a profile of sexual offenders against minors.

MATERIAL AND METHOD

A detailed analysis of documentation from forensic sexological, psychiatric and psychological examinations and information from the records of the proceedings concerning 257 perpetrators was performed by the authors. Information analyzed included demographic data, psychosocial background, psychosexual development, recent sexual activity, physical and mental health issues and information concerning accused sexual crime.

RESULTS

The majority of the offenders had undisturbed family relations. However, subjects with sexual preference disorders perceived their parents' relationship as worse, reported more difficulties in educational process and in relation to teachers and peers. 5.4% of subjects experienced sexual abuse and 23.3% physical violence in their childhood. The majority reported no sexual dysfunction and had regular but rare sexual activity. 20.6% were diagnosed as having mental disorder and 36.8% were alcohol abusers. Almost 30% were under influence of alcohol or another substance during the crime. The majority had no sexual preference disorder. Definite pedophilia was found in 27% and traits of psychosexual immaturity in 23.1% of cases. There was no relationship between sexual preference disorders and psychiatric comorbidity, alcohol or substance abuse. The acts of sexual abuse comprised genital touching, vaginal or oral intercourse as well as exposing offender's or victim's body. These acts were typically against one child, planned, being aware of victim's age and using physical violence.

CONCLUSIONS

The data from our research should be taken into account when planning therapeutic and preventive interventions.