Prevalence and correlates of sexual morbidity in long-term breast cancer survivors

Objective: Breast cancer survivors report adverse sexual effects (sexual morbidity) such as disrupted sexual function, sexual distress and body dissatisfaction. However, most studies have failed to evaluate the persistence of these effects in long-term survivors. The present study comprehensively assessed the prevalence and predictors of sexual/body image problems among survivors three or more years post diagnosis.

Design/outcome measures: Eighty-three breast cancer survivors completed surveys a median of seven years post diagnosis. Survey items probed demographic, diagnostic and clinical information, in addition to sexual activity, sexual function (Female Sexual Function Index [FSFI]), body image, and distress regarding body changes and sexual problems (Female Sexual Distress Scale-revised; FSDS-R).

Results: Seventy-seven percent of all participants and 60% of sexually active participants qualified for sexual dysfunction based on the FSFI. Between 37 and 51% met criteria for female sexual dysfunction, based on two FSDS-R clinical cut-offs. Body satisfaction was worse than normative values, while body change stress was mid-range. Notable sexual morbidity predictors included mastectomy, which was associated with worse sexual/body change distress, and post-treatment weight gain, which predicted greater body dissatisfaction/body change stress.

Conclusions: Breast cancer survivors report substantial sexual morbidity years after treatment, especially after mastectomy or post-treatment weight gain. Breast cancer patients and their providers should be aware of these potential sexual effects.     

Sexual quality of life in patients undergoing coronary artery bypass graft surgery

Objectives: Despite improvements in many domains of functioning, sexual quality of life often remains impaired following coronary artery bypass graft (CABG) surgery. This study examined associations among sexual quality of life, fear of sexual activity and receiving information from providers about sexual activity in CABG patients.

Methods: Participants completed a survey assessing sexual activity, mental health and physical health at baseline (3–5-day post-surgery; n?=?60) and 2-month post-surgery (n?=?42).

Results: Sexual quality of life showed moderate difficulties at baseline and did not improve by follow-up (p values ≥0.09). At follow-up, greater patient fear was associated with lower sexual quality of life in some domains; receiving information was related to lower fear (p values ≤0.03) and greater sexual satisfaction and interest (p values ≤0.04). Suggestive of mediation, there was a significant indirect effect of information on patient fear and of patient fear on sexual interest (p?=?0.05).

Conclusions: Though data were cross-sectional, findings suggest that fears of sexual activity may play a role in lowering CABG patients’ motivation for sexual activity and that receiving information from a medical provider may assist in hastening sexual rehabilitation. Prospective and intervention studies are needed to support findings.     

Sexual well-being and perceived stress in couples transitioning to parenthood: A dyadic analysis

Background/ObjectiveThe transition to parenthood encompasses several psychological and relational changes that might contribute to couples’ high levels of stress postpartum. Although common across the postpartum, couples’ sexual changes are frequently overlooked.MethodWe surveyed 255 mixed-sex new parent couples to examine the associations between sexual well-being—sexual satisfaction, desire, and postpartum sexual concerns—and perceived stress postpartum. Couples completed self-report questionnaires assessing perceived stress and sexual well-being.ResultsFor both mothers and fathers, greater sexual satisfaction was associated with their partners’ lower perceived stress and, for fathers, this was also associated with their own lower perceived stress. For mothers, greater partner-focused sexual desire was associated with their own lower perceived stress whereas, for fathers, greater partner-focused sexual desire was associated with their partners’ higher perceived stress. In addition, greater solitary sexual desire and postpartum sexual concerns were associated with both parents’ own higher perceived stress.ConclusionsThis study highlights the association between sexual well-being and couples’ postpartum stress, suggesting that more positive sexual experiences are linked to lower perceptions of stress across this vulnerable period. Couples’ sexual well-being may be an important target for interventions aimed at helping postpartum couples cope with stress.     

Study of Sexual Concordance in Men and Women with Different Typologies of Adherence to the Sexual Double Standard

Background/ObjectiveSexual concordance (i.e., relationship between genital response and subjective sexual arousal) is higher in men than in women. Among the factors that could explain this difference would be the sexual double standard (SDS). Sexual concordance is examined by SDS typologies of adherence (egalitarian, man-favorable, and woman-favorable).MethodDuring exposure to a film with sexual content, genital response (penile circumference/vaginal pulse amplitude) and self-reported sexual arousal were recorded in 104 young adults (42 men and 62 women), distributed into SDS typologies of adherence on the basis of their scores on the Sexual Double Standard Scale.ResultsSexual concordance was obtained in men and women with egalitarian and man-favorable typology. Subjective sexual arousal explained a significant percentage of the variance in genital response in the egalitarian typology (men: R² = .32, p < .01; women: R² = .19, p < .05) and man-favorable typology (men: R² = .21, p < .05; women: R² = .23, p < .05).ConclusionsAgreement between genital responsiveness and subjective sexual arousal depends on DES adherence typology.     

Personality and sexuality in older adults

Objective: This study explored cross-time associations between personality and multiple components of sexual functioning and behaviour in a large cohort of older adults (n = 5745).

Design: Participants (M_age = 65.57 ± 8.28 years) completed questionnaires in 2010 and 2012.

Main outcome measures: Outcomes explored included sexual attitudes, sexual activity, sexual satisfaction, lifetime sexual partners, sexual orientation and sexual dysfunction.

Results: We found that higher levels of openness and lower levels of agreeableness were related to more liberal attitudes toward sex, a greater number of sexual partners, a higher sex drive, more frequent sexual activity, lower levels of sexual dysfunction and (for women) a greater tendency towards homosexuality. Higher levels of conscientiousness were also related to more conservative attitudes towards sex, lower levels of sexual dysfunction and a greater tendency towards heterosexuality. For sexually active older adults, higher levels of extraversion and lower levels of neuroticism were related to greater sexual satisfaction. Higher levels of extraversion and lower levels of conscientiousness were also related to a greater number of sexual partners in men but not women.

Conclusion: These findings provide evidence that personality is an important correlate of sexual functioning and behaviour in older adults.     

The assessment of incarcerated sexual delinquents’ risk of recidivism

IntroductionThe present study examined the possibility of assessing the risk of sexual recidivism on the basis of static and dynamic factors.ObjectiveA comparison was carried out of detainees on the basis of their scores on a predictive scale of risk of recidivism, on their empathy towards the victim, on their attributive style, and on their self-esteem.MethodThree samples of detainees were compared: two samples of individuals guilty of sexual crime (one sample having committed the aggression towards adults, the second towards children under fifteen years of age) and a control group composed of non-sexual delinquents.ResultsResults showed that sexual offenders targeting children had a lower risk of recidivism than sexual offenders of adults. However, when considering only the recidivists, no difference was found in risk between the two populations.ConclusionIn conclusion, some of the dynamic factors that were analyzed could be retained to complete the static factors in predictive scales of risk of recidivism.     

Treating the Sexual Concerns of Adult Incest Survivors and Their Partners

SUMMARY

Negative attitudes about sex and sexuality and many types of sexual dysfunction are common aftereffects of sexual child abuse and incest. The traumatic sexualization and the aversive sexual conditioning resulting from childhood abuse have long gone unrecognized, however. This article presents research findings regarding the impact of incest on sexual attitudes and functioning along with treatment recommendations.     

Experiences of transgender prisoners and their knowledge,attitudes, and practices regarding sexual behaviors and HIV/STIs: A systematic review

Background: Despite transgender people being more visible in prison systems, research suggests they are at higher risk of experiencing sexual violence compared to other prisoners. Research also suggests that transgender prisoners experience harassment, and physical and sexual assault by fellow prisoners, and prison officers who lack transgender-specific health knowledge. There exist no systematic reviews on the experiences of transgender people in prisons. This review aims to fill this research gap. The following question developed in consultation with transgender, sexual health/HIV and corrective services stakeholders has guided the systematic review: What are transgender and gender-diverse prisoners’ experiences in various prison settings and what are their knowledge, attitudes and practices regarding sexual behaviors and HIV/STIs?

Methods: The review followed the PRISMA guidelines and searches were conducted in four databases for the period of January 2007 to August 2017. Studies were assessed against predetermined inclusion and exclusion criteria. Included studies were peer-reviewed, written in English with online full-text availability and reported data on transgender and gender-diverse prisoner experiences relevant to the research question.

Results: Eleven studies (nine qualitative, one quantitative, one mixed-methods; nine in USA, two in Australia) met the criteria for review. Four studies were of high quality, six were of good/acceptable quality, and one study was of modest quality. Transgender and gender-diverse prisoners reported a range of challenges which included sexual assault, discrimination, stigma, harassment, and mistreatment. Information on their sexual health and HIV/STIs knowledge, attitudes, practices is in short supply. Also, their lack of access to gender-affirming, sexual health/STIs and mental health services is commonplace.

Conclusions: The experiences of transgender prisoners as reported in this review are almost uniformly more difficult than other prisoners. Their “otherness” is used as a weapon against them by fellow prisoners through intimidation and violence (including sexual) and by prison officers through neglect and ignorance.     

Sex,Disorder and Perversion

Abstract

This paper aims to describe an objective account of sexual perversion. That is, it seeks to characterize sexual perversion as something which is not simply a deviation from a statistical norm but rather as something which violates an objective naturalistic norm. The central point is that perversion consists in the introduction of a strange and extraneous loop in the aetiology of sexual sensations, and this extraneous loop makes it possible to characterize sexual perversion as an objective disorder which is in need of therapy.     

Retrospective coping strategies during sexual identity formation and current biopsychosocial stress

Background: Lesbian, gay men, and bisexual individuals (LGBs) often experience distress related to the recognition, self-acceptance, and disclosure of their sexual orientation. Objectives and Design: Retrospectively reported coping strategies enacted during sexual identity formation among LGBs were assessed in relation to current stress indices measured using environmental (frequency of perceived daily hassles), psychological (perceived distress), and biological (allostatic load [AL] levels representing physiological dysregulations) perspectives. Methods: Forty-six healthy LGBs between the ages of 18 and 45 (M = 23.91, SE = .80) participated. Questionnaires included the Ways of Coping Checklist adapted to disclosure milestones, Daily Hassles Inventory, and Perceived Stress Scale. AL was calculated using 21 biomarkers of neuroendocrine, immune, cardiovascular, and metabolic functioning. Results: Avoidance coping during sexual identity formation was positively associated with frequency of daily hassles (β = .598, p < .001), perceived stress (β = .361, p = .015), and AL (β = .405, p = .006). By contrast, seeking social support was negatively associated with perceived stress (β = –.598, p = .048). Conclusions: Emotion-focused coping strategies during LGB sexual identity development are associated with current indices of biopsychosocial stress.     

Prospective effects of social support on internalized homonegativity and sexual identity concealment among middle-aged and older gay men: a longitudinal cohort study

Background and objectives: Middle-aged and older gay men experience higher rates of depression and anxiety compared to their heterosexual counterparts, with internalized homonegativity and sexual identity concealment known to be major stress-related contributors. This study examined the prospective effect of different types and sources of social support on internalized homonegativity and sexual identity concealment experienced among middle-aged and older gay men.

Methods: A longitudinal survey involving two waves of data collection separated by 12 months was conducted among a cohort of 186 gay-identified men aged 40 years and older.

Results: Two types of social support were found to be important. Greater baseline tangible or practical support independently predicted lower internalized homonegativity at 12-month follow-up, while greater baseline emotional or psychological support independently predicted a lower tendency toward sexual identity concealment at 12-month follow-up. Greater baseline support from community or government agencies, such as health services and support organizations, predicted higher internalized homonegativity at 12-month follow-up.

Conclusions: These findings suggest that tangible and emotional support may be beneficial in reducing internalized homonegativity and sexual identity concealment among middle-aged and older gay men. Ensuring that services provide environments that do not compound the stressful impact of stigma also appears to be important.     

Plurality and prevalence of sexual motivations in a sample of young francophone adults

IntroductionUnderstanding the motivations that lead to the adoption of sexual behaviors is of major interest to both the individual and public health.ObjectivesThis work (i) questions the reasons that lead students from two French universities to adopt sexual behaviors, (ii) examines the motivational similarities and differences between men and women, (iii) compare the results to data from north American subjects.MethodIn total, 657 subjects (526 women; 131 men, mean age: 22.6 years) were requested to take part in an online study investigating sexual behaviors. Reason for Having Sex Questionnaire (Meston & Buss, 2007), was used as a basis for the identification of sexual motivations.ResultOn average 53.05 different motivations led to the adoption of sexual behaviors. Significant differences of men/women were found between men and women (72% significant differences in p < 0.05) but mainly of small amplitude (d < 0.33: 58.33%). Men and women also differ in the structure of interrelations between motivations and by the role played by the different motivations. Overall, female motivational system is more sectorized and more organized than the male system, which seems more resilient (density of interrelations Men: 46.3%; women: 34.2%; distance between motivations: 5.44 vs. 3.86, p < 0.001, d = 2.07). Cultural comparisons showed significant differences of low to moderate amplitude between young adult students in France and those who come from North American universities. Gender differences in sexual motivations for sex were more marked in France than in the US.ConclusionOur results argue for a bio-psychosocial and systemic approach of sexual motivations. Theoretical, methodological and practical perspectives are envisaged.     

Predictors of Risky Sexual Behavior among High School Students in the United States

ABSTRACT

Risky sexual behavior among teenagers in the United States is a noted public health concern. The purpose of this study is to examine the correlates and theoretical predictors of risky sexual behavior among American teens. Data from the Youth Risk Behavioral Survey was utilized with concepts from Routine Activities Theory guiding analyzes. Bivariate regression results indicated that components of Routine Activities Theory are moderate to strong predictors of using substances before sexual activity and having multiple sexual partners.     

An interactional approach to sexual dysfunctions

Abstract

This paper offers an interactional perspective as a broad and practical conceptual framework with which to understand patterns of sexual dysfunction. The theoretical model centers on the power of the sexual interaction as a critical focus for therapeutic change. The model is developed by presenting: the basic sexual interaction cycle, the individual and interactional variables that modify the sexual interaction cycle, and the creation of a continuously changing figure/ground configuration of sexual and nonsexual patterns. At various points in the discussion of the model, initial clinical strategies are derived to illustrate the applicability and advantages of an interactional perspective on sexual relationships.     

Conjuring,Expanding, and Blurring Boundaries of Sexual Subcultures: The Grounding of the Fluid

ABSTRACT

This paper creates a fluid model with which to research the connection between sexual subcultures and online spaces, as well as, the impact of online spaces on the creation and proliferation of sexual subcultures. This model is influenced by previous models that examined sexuality, both pre-internet and post. We offer an updated model that focues on, sexual subcultures in online spaces. A discussion of how this new model can be used to accommodate research on sexual subcultures in online spaces is offered.     

THE EXPERIENCE CYCLE AND THE SEXUAL RESPONSE CYCLE: CONCEPTUALIZATION AND APPLICATION TO SEXUAL DYSFUNCTIONS

Abstract

The sexual response cycle as a heuristic for understanding sexual responding has emerged from sexuality literature. Another cyclic heuristic, the experience cycle, has been developed in Personal Construct Psychology (PCP) literature to conceptualize how persons anticipate, encounter, and then evaluate experiences in terms of validation/invalidation and potential need for construct system change. The present article maps these two cycles onto each other to offer a PCP framework for understanding sexual responding, sexual dysfunctions, and therapy targeting sexual function.     

Types of Followers

Abstract

This study examined the influence of gender and exposure to gender-stereotyped music video imagery on sexual attitudes (adversarial sexual beliefs, acceptance of rape myths, acceptance of interpersonal violence, and gender role stereotyping). A group of 44 U.S. college students were randomly assigned to 1 of 2 groups that viewed either a video portraying stereotyped sexual imagery or a video that excluded all sexual images. Exposure to traditional sexual imagery had a significant main effect on attitudes about adversarial sexual relationships, and gender had main effects on 3 of 4 sexual attitudes. There was some evidence of an interaction between gender and exposure to traditional sexual imagery on the acceptance of interpersonal violence.     

A communal approach to sexual need responsiveness in romantic relationships

ABSTRACT

Sex is a crucial factor that impacts the quality and stability of relationships, yet many couples report recurrent sexual issues – such as discrepancies in their desired sexual frequency or levels of sexual desire – that detract from their relationship quality. This article describes how applying the theory of communal motivation from relationship science to the sexual domain of relationships can shed light onto understanding how couples can maintain desire over time, remain satisfied in the face of conflicting sexual interests, and decline one another’s sexual advances in ways that protect their relationship. We integrate a decade of research on communal motivation, sexual rejection, and responses to sexual rejection to provide a better, and more holistic, understanding of how partners can successfully balance their sexual needs to ultimately reap the powerful rewards of a fulfiling sexual connection.