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.     

An evolutionary analysis of psychological pain following human (Homo sapiens) rape: IV. The effect of the nature of the sexual assault

Mental pain is hypothesized to manifest an adaptation for analyzing and coping with social problems that would have reduced inclusive fitness in human (Homo sapiens) evolutionary history. We examined this hypothesis in the psychological pain of 790 rape victims. Reproductive-aged and postreproductive-aged victims were more likely than prereproductive-aged victims to have experienced vaginal intercourse and to have had sperm present in the reproductive tract. As predicted, vaginal intercourse constituted the most psychologically devastating form of sexual assault for reproductive-aged women. Nonreproductive-aged victims were not more traumatized by vaginal rapes. When rapes included ejaculation in the victim's reproductive tract, reproductive-aged victims may have been more traumatized. These results suggest that the psychology that regulates mental pain processes information about the nature of the sexual act in the event of a woman's rape.     

Improving Young Male Couples’ Sexual and Relationship Health in the 2GETHER Program: Intervention Techniques,Environments of Care,and Societal Considerations

Young male couples are at high risk for acquiring human immunodeficiency virus (HIV). However, few HIV prevention programs meet the needs of young male couples that express an interest in how to maintain healthy relationships. As such, we developed 2GETHER, a couple-based program that integrates HIV risk reduction and sexual health information into a relationship education program specific to young male couples. 2GETHER was guided by cognitive-behavioral theories of HIV risk reduction and relationship functioning and was informed by a social–ecological perspective to address factors within and outside the couple that can impact sexual and relationship health. As a micro-level intervention, 2GETHER intervenes directly with couples via psychoeducation and cognitive-behavioral strategies to change couples’ communication patterns, sexual health behaviors, and relationship satisfaction. Successful implementation of 2GETHER requires mezzo-level interventions that create an affirming environment of care for sexual minority individuals and facilitators who are culturally competent in working with young male couples. Although macro-level interventions to change societal acceptance of and policies germane to sexual minority couples are beyond the scope of 2GETHER, we discuss how clinicians can advocate for systemic changes to improve sexual minority couples’ health, and how 2GETHER addresses the impact of such macro-level factors on the couple’s relationship. Our experience developing and testing 2GETHER indicates that HIV prevention programs for young male couples should reflect the unique contexts shaping sexual minority individuals’ relationships and lives, and that programs should intervene within and across multiple levels when possible to improve health for sexual minority men.     

Couple-based interventions for medical problems

The current paper discusses general principles, therapeutic strategies, common factors, and domains commonly addressed in the treatment of couples who have a partner with a medical condition. Couple-based interventions for medical problems are contrasted with couple therapy and relationship education in that the emphasis is on assisting the patient in addressing the medical disorder, along with being attentive to the patient's partner and their relationship. Guidelines are provided showing how knowledge and understanding of medical disorders and couple functioning are integrated in order to conduct such interventions. Five common domains addressed during intervention are elaborated upon: (a) psychoeducation about the disorder, (b) sharing thoughts and feeling regarding the disorder, (c) making decisions focal to the medical disorder, (d) implementing relationship changes that are nonmedical but that result from the disorder, and (e) addressing relationship functioning unrelated to the disorder. The importance of empirically demonstrating the utility of each domain in future investigations is noted.     

Structural couple therapy in the treatment of inhibited sexual drive

Abstract

This paper presents a study of a structural couple therapy approach to the treatment of inhibited sexual desire (ISD). ISD is first conceptualized as a relational phenomenon that may be most effectively treated in a couple context. Structural couple therapy is advanced and applied to the treatment of a clinical sample of couples presenting with ISD. Results of the study suggest that a structural couple therapy approach to ISD is effective in reducing symptoms of the sexual disorder and in increasing couple satisfaction.     

Women's perceptions of female contraceptive behavior: experimental evidence of the sexual double standard

A social perception study was conducted to examine the effect of the sexual double standard on impressions of a female target. As part of a "social memory" study, 57 female undergraduates read a fictitious woman's diary describing a sexual encounter where the woman provided a condom, the man provided a condom, or the couple had unprotected intercourse. Participants made behavioral judgments and interpersonal judgments about the couple, and rated the female target on several personality traits. Women rated the target's behavior more negatively, and as more inappropriate, when she provided a condom, than when her partner provided a condom. Participants also assumed that the target's partner would feel less positive about her when she provided a condom than if he provided a condom or if they had unprotected intercourse. These results are discussed with respect to the continued existence of the sexual double standard, and its impact on women's contraceptive behavior.     

SIMILARITIES AND DIFFERENCES IN WOMEN'S SEXUAL ASSAULT EXPERIENCES BASED ON TACTICS USED BY THE PERPETRATOR

Only a few studies have examined the characteristics of sexual assault based on the tactics used by the perpetrator. In this study we compared the experiences of women who were forced to engage in vaginal, anal, or oral intercourse due to verbal coercion, physical force, or intoxication. Random-digit dialing was used to obtain a sample of 272 single African American and Caucasian women between the ages of 18 and 49 from the Detroit metropolitan area. Participants completed a computer-assisted self-interview that asked detailed questions about a past sexual assault and their reactions to it. Among the 139 women who were forced to engage in vaginal, anal, or oral intercourse, sexual assaults that involved physical force produced the most severe negative outcomes. Situations that involved the woman being too intoxicated to resist differed from others primarily in terms of how much alcohol the man and woman consumed. Although all types of sexual assault were perceived as being at least moderately serious, verbally coerced assaults were on average perceived as being least serious. These findings suggest that the perpetrators' tactics affect women's responses to sexual assault.     

Couples and Diabetes: A 30-Year Narrative Review of Dyadic Relational Research

Diabetes is a chronic condition that affects both members of a couple. However, relatively few studies have focused on the entire couple system as the unit of observation when examining the psychosocial impact of this disease. This narrative review examines the literature between 1980 and 2010 that uses the couple as the unit of observation. A total of 49 articles were identified for review. Articles were grouped by their central themes or outcomes: (1) sexual functioning, (2) relationship adjustment and support, (3) culture and spirituality, (4) treatment/education programs, and (5) diabetes as a risk factor. Research and clinical implications such as increasing the utilization of dyadic analytical strategies and the importance of assessing illness burden from each partners’ perspective are discussed. Identified benefits of incorporating the couple dyad for future research and clinical practice included: (1) understanding the influence of variables such as a non-diabetic partner and gender have on diabetes adjustment and management, (2) the role disease severity and management of diabetes by the partner living with diabetes has on spousal support and non-diabetic partner emotional wellbeing, (3) the interdependent nature of couple outcomes in the areas of adjustment to sexual dysfunction, perceived illness burden, and couple satisfaction, as well as, (4) disease as both an individual and a shared experience among couples.     

The pleasures of sex: An empirical investigation

This study examined associations between the pleasurability of various sexual activities and behavioural experience with these activities. Participants were 145 female and 78 male undergraduates. Participants rated the pleasurability of various sexual activities (vaginal intercourse, anal intercourse, receiving oral sex, performing oral sex, masturbation by a partner, and self-masturbation) and answered questions about their experience with these sexual activities. Vaginal intercourse, receiving oral sex, and being masturbated by a partner received the highest,pleasure ratings. For behaviours other than vaginal intercourse and receiving oral sex, pleasure ratings were significantly higher among respondents who had engaged in the activity. Pleasure ratings for several different sexual behaviours were intercorrelated. Participants who scored high on a pleasure index were more sexually experienced, engaged in more frequent sexual activity, and reported having more sex partners. Results are interpreted within the context of an evolutionary theory which suggests that pleasure motivates sexual behaviour.     

Same-sex couple perceptions of family support: a consensual qualitative study

Few studies have examined the family context in which same-sex couples negotiate their lives and relationships. Consensual qualitative research methods (Hill, Thompson, & Williams, 1997) were used to analyze 14 same-sex couples' conversations about family support. Couples perceived that their families are positively supportive, non-supportive, or ambivalent in their support. These perceptions led to positive or negative emotional reactions in the couple members and to specific coping. The majority of couples perceived that family support (or lack of support) had an effect on the quality of their couple relationship. No general or typical response strategies to lack of family of origin support emerged, suggesting a lack of models or norms for same-sex couples. The implications for psychotherapeutic interventions with same-sex couples are discussed.     

Hysterical Again: The Gastrointestinal Woman in Medical Discourse

This article suggests increased attention to how medical discourses of gastrointestinal (GI) disorder and distress are fraught with social assumptions and consequences by examining nineteenth-century and contemporary medical texts focused on chronic constipation and Irritable Bowel Syndrome (IBS). I suggest that these medical discourses present what I call the “gastrointestinal woman,” who is characterized as having unjustified anxiety and is to blame for her condition. My approach to understanding, and ultimately revising, the representation of the gastrointestinal woman is shaped by disability studies scholarship, which encourages intervention in problematic medical discourses and more active shaping of discourses of chronic pain and illness by those who have these conditions.     

Couples’ Negative Interaction Behaviors and Borderline Personality Disorder

Borderline personality disorder (BPD) is a severe mental health problem predisposing to dysfunctional interaction behaviors and negative couple outcomes. This study aimed to assess, through direct observation, the quality of relationships of couples in which women were diagnosed with BPD. The sample consisted of 28 couples in which the woman had BPD, and 82 community couples. Couples’ interactions were coded using three scales—withdrawal/ avoidance, dominance, and criticism/attack/conflict—from the Global Couple Interaction Coding System. Couples in which the women had BPD evidenced significantly more negative behaviors, particularly dominance behaviors, than community couples. Moreover, in BPD couples, women adopted Criticism/Attack/Conflict behaviors more frequently than men.     

Body Image Satisfaction and Involvement in Risky Sexual Behaviors Among University Students

This study examined the impact of body image satisfaction on university students’ (N = 465) involvement in risky sexual behaviors. A valid and reliable survey instrument was designed and administered to students in their classrooms at a Midwestern university. Of 465 participants, 53.8 % reported having low levels of body image satisfaction and 78.9 % indicated they had engaged in sexual intercourse during their lifetime. Of the sexually active students, 80 % have had sexual intercourse without the use of a condom, 76 % have had sexual intercourse while intoxicated, and 21 % have had sexual intercourse following illegal drug use. Students who had high body image satisfaction were significantly more likely to have ever engaged in sexual intercourse. These results should be considered when developing and implementing sexual education efforts for university students. Future studies should seek to identify specific strategies to increase body image satisfaction and decrease risky sexual behaviors among this high-risk population.     

An Infertility Primer for Family Therapists: II. Working with Couples Who Struggle with Infertility

The distress of infertility and its medical treatments are profound, and the effects reverberate in each partner, the couple dyad, and the couple's relationships with family, friends, and medical systems. Yet family therapists, like others in our society, are often uninformed or misinformed about the experience of infertility. While the legacies of infertility may be painful and enduring, they often remain unspoken, and hence may be overlooked in standard interviews. This article describes the experiences of couples struggling with infertility, most of whom have sought medical intervention, and it provides treatment interventions for guiding couples through this difficult and often uncharted terrain. Case vignettes derived from 2 years of this clinical research study are included.     

Providing Relationship Interventions to Same-Sex Couples: Clinical Considerations,Program Adaptations,and Continuing Education

Despite remarkable similarities to different-sex couples in terms of core relationship processes and outcomes, same-sex couples differ from different-sex couples in important ways, including relational strengths (e.g., more egalitarian) and challenges associated with their sexual minority identity (e.g., discrimination). Given that most cognitive-behavioral relationship interventions have been designed for and tested on different-sex couples, clinicians wishing to serve same-sex couples will need to make appropriate adaptations to these interventions in order to remove heterosexist bias and sensitively meet the unique needs of same-sex couples. Further, clinicians should strive to be culturally competent in serving this population by developing knowledge of same-sex couple dynamics and issues, and by building a sense of comfort working with these families, which may involve addressing personal biases. The current paper seeks to provide an introduction to same-sex couple relational processes, and offers clinical recommendations and intervention adaptations to better serve this population. Some examples will refer to the development of the Strengthening Same-Sex Relationships programs, culturally sensitive relationship education programs specifically designed for and successfully piloted with male and female same-sex couples.     

Altered states of consciousness are related to higher sexual responsiveness

Altered states of consciousness lead to profound changes in the sense of self, time and space. We assessed how these changes were related to sexual responsiveness during sex. 116 subjects reported (a) intensity of awareness concerning body, space and time, and (b) satisfaction, desire, arousal, and orgasm occurrence. We differentiated vaginal intercourse orgasm from noncoital orgasm. Female vaginal intercourse orgasm was further differentiated as with or without concurrent clitoral masturbation. Overall, sexual responsiveness was related to greater body awareness and lesser time and space awareness. Satisfaction, desire, and arousal were especially associated with less time awareness in women. Female orgasms during vaginal intercourse were related to greater body awareness and lesser time awareness, but noncoital orgasms were unrelated. Our findings provide empirical support for the hypotheses that altered states of consciousness with attentional absorption are strongly related to sexual responsiveness in women, and to a lesser extent in men.     

Men and women's acceptance of coercive sexual strategies varied by initiator gender and couple intimacy

Seventy-two men and 86 women read vignettes describing five coercive strategies for obtaining sexual intercourse on a date. Subjects rated the acceptability of strategies used by male and female initiators for couples who were or were not sexually intimate. Subjects generally rejected all tactics. Results revealed a continuum of increasing rejection from verbal pressure and sexual stimulation, followed by mock force, followed by intoxication and physical force. Although women were more rejecting of any strategy than were men, women were slightly less opposed to verbal pressure and stimulation for “more sex” rather than for “first-time sex.” Women equally rejected most male- and female-initiated strategies, but men were more accepting of female-initiated strategies. Results are explained in terms of sex role norms prescribing that men be initiators and women be gatekeepers in sexual interaction.