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Trauma theories suggest that childhood maltreatment (CM) may partly explain intimacy problems in romantic relationships. However, empirical studies have yielded conflicting findings, likely due to the varying conceptualizations of intimacy. Findings that support long-term negative effects of CM on sexual and relationship satisfaction are almost exclusively based on cross-sectional intra-individual data, precluding the examination of mediating pathways and of dyadic interactions between individuals reporting CM and their partners. This study used a dyadic perspective to examine the associations between CM and the different components of intimacy based on the interpersonal process model of intimacy: self-disclosure, perceived partner disclosure, and perceived partner responsiveness. We also tested the mediating role of these intimacy components at Time 1 in the relations between CM and sexual and relationship satisfaction 6 months later. A sample of 365 heterosexual couples completed self-report questionnaires. Results of path analyses within an actor-partner interdependence framework showed that women and men's higher levels of CM did not affect self-disclosure, but was negatively associated with their own perception of partner disclosure and responsiveness. In turn, women and men's perception of partner responsiveness at Time 1 was positively associated with their own sexual satisfaction, as well as their own and their partner's relationship satisfaction at Time 2. Thus, perception of partner responsiveness mediated the associations between CM and poorer sexual and relationship satisfaction. The overall findings may inform the development of couple intervention that targets the enhancement of intimacy to promote sexual and relationship well-being in couples where one partner experienced CM.

Background Several studies have suggested a relevant overlap between eating disorders and sexual dysfunction involving the emotional component of body image esteem and dissociative experiences. Aim To evaluate the common maintaining factors of sexual dysfunction and vulnerability to pathologic eating behaviors and their relation to a physiologic stress response. Methods In the present cross-sectional study, we evaluated a non-clinical sample of 60 heterosexual women (25–35 years old) for dissociation during sex with a partner, body image disturbance, and tendency toward pathologic eating behaviors. We also evaluated the stress-induced hypothalamic-pituitary-adrenal axis activation in response to a sexual stimulus and its association with binge eating and dissociation. Outcomes Participants completed the Clinician-Administered Dissociative States Scale, the Sexual Satisfaction Scale–Women, the Body Esteem Scale for Adolescents and Adults, and the Eating Attitudes Test Short Version. Furthermore, we assessed cortisol levels before, during, and after exposure to explicit sexual stimuli shown within a laboratory setting. Results Dysfunctional body image esteem and a tendency toward binge-eating behaviors were associated with greater sexual distress in women. In particular, body esteem was significantly associated with greater dissociation during sex with a partner. Moreover, women who reported greater dissociation during sex with a partner and a tendency toward binge-eating behaviors showed higher levels of cortisol in response to sexual stimuli. Clinical Implications These results support further research based on trans-diagnostic treatments targeted to dissociation and body image esteem, which could lessen sexual dysfunction and vulnerability to pathologic eating behaviors. Strengths and Limitations Despite the small sample and self-reported questionnaires, this is the first study to consider the association of the stress response during sexual stimuli with sexual distress and with pathologic eating behaviors adopting a dimensional approach. Conclusion Body uneasiness and dissociation represented factors underlying pathologic eating behaviors and sexual dysfunction. Women reporting a tendency toward binge-eating episodes and dissociation during sexual experiences represented a subpopulation with a higher stress response during sexual stimuli.

Among 70 community couples who reported childhood sexual abuse (CSA) and disclosure to their partner, this study examined associations between survivors' perception of partner responses to their disclosure, and both partners' sexual and relationship satisfaction. Participants completed self-report questionnaires online. Results of path analyses within an actor-partner interdependence model indicated that survivors' perceived partner responses of emotional support to disclosure were associated with their own and their partners' higher sexual satisfaction. Survivors' perceived responses of being stigmatized/treated differently by the partner were associated with their own and their partners' poorer relationship satisfaction. Findings suggest that survivor-perceived partner responses to the disclosure of CSA can have a positive and a negative impact on the sexual and relationship satisfaction of both partners.

To compare the psychopathological characteristics of obese patients seeking bariatric surgery with those seeking a medical approach. A total of 394 consecutive outpatients seeking bariatric surgery were compared with 683 outpatients seeking a medical treatment. All patients were referred to the same institution. Obesity surgery patients reported higher body mass index (BMI), objective/subjective binging and more severe general psychopathology, while obesity medical patients showed more eating and body shape concerns. Depression was associated with higher BMI among obesity surgery clinic patients, whereas eating-specific psychopathology was associated with higher BMI and objective binge-eating frequency among obesity medical clinic patients. Patients seeking bariatric surgery showed different psychopathological features compared with those seeking a non-surgical approach. This suggests the importance for clinicians to consider that patients could seek bariatric surgery on the basis of the severity of the psychological distress associated with their morbid obesity, rather than criteria only based on clinical indication.

Introduction Women with a history of childhood sexual abuse (CSA) exhibit higher rates of sexual dysfunction than nonabused women. Aim Because sexual responses are affected by cognitive processes, this study investigated the implicit and explicit cognitive processing of sexual stimuli in women with a history of CSA. Methods Women with (CSA; N = 34) and without (no history of abuse [NSA]; N = 22) a history of CSA participated in a quasi-experimental study. Main Outcome Measure Implicit processes, described as involuntary or unintentional responses to stimuli, were assessed using the Implicit Association Test (IAT). Explicit processes, described as intentional, voluntary, or effortful processing of sexual stimuli, were assessed through a self-reported questionnaire (Sexual Self-Schema Scale). Results Results showed initial evidence of between group differences in the cognitive processing of sexual stimuli. Regarding the implicit processes, women in the NSA group showed that sexual pictures were more strongly associated with positive valence (pleasure) than nonsexual pictures. For the CSA group, neutral and sexual pictures were similarly associated with pleasure. Conversely, for both groups, romantic pictures were more strongly associated with positive valence than sexual pictures. Moreover, sexual satisfaction was predicted by both implicit and explicit processes, suggesting that the sexuality of women is affected by both processes independently. Conclusions These results fit within the larger body of literature suggesting that implicit and explicit processes independently predict different aspects of behavior.

Introduction Past research indicates that sexual self-disclosure, or the degree to which an individual is open with his or her partner about sexual preferences, is a key aspect of sexual satisfaction and that partner's lack of knowledge about one's sexual preferences is associated with persistent sexual dysfunction. Aims To replicate and extend past research by examining (i) how one's own levels of sexual self-disclosure are related to one's own sexual health (after controlling for partner's levels of sexual self-disclosure); (ii) how one's partner's levels of sexual self-disclosure are associated with one's own sexual health (after controlling for one's own levels of sexual self-disclosure); and (iii) whether gender moderates the associations between sexual self-disclosure and sexual health. Main Outcome Measures Scores from the Golombok Rust Inventory of Sexual Satisfaction and the Sexual Communication Satisfaction Scale. Methods A cross-sectional dyadic study using a convenience sample of 91 heterosexual couples in long-term committed relationships. Data were analyzed using the Actor–Partner Interdependence Model. Results One's own level of sexual self-disclosure is positively associated with one's own sexual satisfaction, β = −0.24, t(172.85) = −3.50, P Conclusions Our results demonstrate that sexual self-disclosure is significantly associated with sexual satisfaction and functioning for both men and women, albeit in different ways. Our findings underscore the importance of sexual self-disclosure and highlight the importance of the interpersonal level of analysis in understanding human sexuality.

Women with a history of sexual abuse during childhood/adolescence experience a high rate of sexual dysfunction. Evidence also suggests that they often use avoidant coping strategies, such as substance abuse, dissociation, and emotional suppression, which are likely factors implicated with their psychopathology. There is a dearth of information on potential psychological mechanisms affecting the sexuality of these women. Therefore, it is relevant to investigate whether avoidance, an important cognitive mechanism associated with anxiety disorders, relates to sexual functioning in this population. In this study, participants with (N = 34) and without (N = 22) a history of sexual abuse prior to age 16 years completed questionnaires on severity of sexual abuse, sexual functioning, and a tendency to avoid experiences. A three-step hierarchical regression investigated the effects of childhood/adolescent sexual abuse and avoidance tendencies on different aspects of sexual functioning. A significant interaction between childhood/adolescent sexual abuse and avoidance tendencies was found for orgasm function, with the combination of sexual abuse and avoidance tendencies explaining lower orgasm function. These findings suggest that, for women with a history of early sexual abuse, the tendency to avoid interpersonal closeness and avoid emotional involvement predicts orgasm functioning.

Accumulating evidence points to the mediating effects of sexual self-schemas on the sexual difficulties of women with a history of childhood sexual abuse (CSA). The following study adds to the extant literature by investigating (1) sexual function and (2) sexual satisfaction utilizing validated measures, and reporting on the relationship between sexual self-schemas and physiological (vaginal photoplethysmography), subjective, and affective responses during laboratory exposure to sexual stimuli. In a community sample of women with (N = 48) and without (N = 48) a history of CSA, we tested (1) the mediation of negative affect on the relation between sexual self-schemas and sexual function/satisfaction, (2) the mediation of negative affect in the relation between CSA and sexual function/satisfaction, and (3) the mediation of sexual self-schemas in the relation between a history of CSA and negative affect prior to sexual stimuli. We found that more Embarrassed/Conservative and less Romantic/Passionate sexual self-schemas predicted negative affect prior to exposure to sexual stimuli which, in turn, predicted levels of sexual satisfaction. The lower sexual satisfaction of CSA survivors was partially mediated by higher reports of negative affect prior to sexual stimuli. However, negative affect prior to sexual stimuli was not mediated by the sexual self-schemas of CSA survivors. Thus, although sexual self-schemas predicted sexual satisfaction, they did not predict variance in negative affect prior to sexual videos experienced by women with a history of CSA.

Introduction. Theoretically, the physiological response to stress should inhibit the sexual response. This has been demonstrated experimentally in animal models, and correlationally in studies of human reproduction. It is reasonable to expect, then, that the stress response would be blunted during sexual arousal, and several researchers have found a pattern of decreasing cortisol during sexual arousal. Aim. In the present study, we explored individual differences in women's cortisol response to sexual arousal in a laboratory setting. We also examined how cortisol response in the laboratory related to a validated measure of sexual arousal functioning in real life. Main Outcome Measures. Cortisol levels were measured in saliva via enzyme immunoassay. Subjective arousal was measured by a self-report questionnaire, and genital arousal was measured by a vaginal photoplethysmograph. Methods. Subjective and physiological responses to an erotic film were assessed in 30 women. Saliva samples were taken at baseline and following the film. Results. The majority of women (N = 20) showed a decrease in cortisol; nine women showed an increase in response to an erotic film. The women who showed an increase in cortisol had lower scores on the Arousal, Desire, and Satisfaction domains of the Female Sexual Function Index. Genital arousal in the laboratory was not related to cortisol change. Conclusions. Women who show an increase in cortisol in response to sexual stimuli in the laboratory have lower levels of functioning in certain areas of their sexual life compared with women who show a decrease in cortisol. Stress related to sexual performance may interfere with sexual arousal. Hamilton LD, Rellini AH, and Meston CM. Cortisol, sexual arousal, and affect in response to sexual stimuli. J Sex Med 2008;5:2111-2118.

Ginkgo biloba extract (GBE) facilitates blood flow, influences nitric oxide systems, and has a relaxant effect on smooth muscle tissue. These processes are important to the sexual response in women and, hence, it is feasible that GBE may have a therapeutic effect. The present study was the first to provide an empirical examination of the effects of both short- and long-term GBE administration on subjective and physiological (vaginal photoplethysmography) measures of sexual function in women with Sexual Arousal Disorder. A single dose of 300 mg GBE had a small but significant facilitatory effect on physiological, but not subjective, sexual arousal compared to placebo in 99 sexually dysfunctional women. The long-term effects of GBE on sexual function were assessed in 68 sexually dysfunctional women who were randomly assigned to 8 weeks treatment of either (1) GBE (300 mg/daily), (2) placebo, (3) sex therapy which focused on training women to attend to genital sensations, or (4) sex therapy plus GBE. When combined with sex therapy, but not alone, long-term GBE treatment significantly increased sexual desire and contentment beyond placebo. Sex therapy alone significantly enhanced orgasm function compared with placebo. Long-term GBE administration did not significantly enhance arousal responses beyond placebo. It was concluded that (1) neither short- or long-term administration of GBE alone substantially impacts sexual function in women, (2) a substantial placebo effect on sexual function exists in women with sexual concerns, and (3) teaching women to focus on genital sensations during sex enhances certain aspects of women's sexual functioning.

Introduction Sexual problems in women with a history of child sexual abuse (CSA) are relatively common but only a few studies have attempted to explain the mechanisms of these problems. Given the potential for a variety of factors associated with sexual problems in CSA survivors, the field needs a theoretical model to explain these difficulties. Aim The main aim of this article was to illustrate a theoretical model to understand sexual problems in CSA survivors. Sexual problems are here grouped into hyposexual and hypersexual. A review of empirical studies that support this model is presented. A second aim was to discuss the definition of CSA adopted in research projects. Methods Results from studies targeting psychophysiologic, affective, and cognitive sexual responses are discussed. Main Outcome Measures Vaginal photoplethismography, sexual self-schemas, and implicit sexual associations to sexual stimuli were the focus of the studies reviewed. Results These studies showed that during the exposure to sexual stimuli, CSA survivors experienced more inhibitory responses and less excitatory responses than women in the comparison groups. On the other hand, in situations when sexual stimuli were not present, CSA survivors showed a greater excitation of sexual responses than women in the comparison groups. Additionally, CSA survivors showed a potential difficulty inhibiting intrusive sexual thoughts. Conclusions The model shows promising qualities to adequately explain the hypo- and hypersexuality of CSA survivors. The advantages of this model over others include the ability to guide the selection of cognitive and behavioral interventions for patients presenting for treatment. Rellini A. Review of the empirical evidence for a theoretical model to understand the sexual problems of women with a history of CSA.

The present study was conducted in an attempt to examine potential differences between men and women in memory for sexually relevant information. A total of 77 undergraduate students (31 men, 46 women) read a sexual story and completed memory tasks in response to the story. Based on previous research, we hypothesized that differences would exist between men and women for different types of sexual information and we hoped to understand whether specific variables (sexual experiences, sexual functioning, and reactions to the sexual story) could explain such differences. Men were more likely to remember erotic or explicit details of the story, whereas women were more likely to remember love and emotional bonding details of the story. Additionally, women were more likely to recall information referencing the characters in the story. Results from regression analyses indicated that sexual desire and satisfaction were related to differences in recall and recognition of the love and emotional bonding aspects of the story, and that frequency of sexual intercourse was related to differences in the recall of erotic or explicit details of the story. The significant results obtained in this study correspond to previously established sex differences in memory for sexual information.

In this study, the authors assessed 48 female survivors of child sexual abuse (CSA) and 71 female control participants using measures of adult sexual function, psychological function (i.e., depression and anxiety), and sexual self-schemas. The primary purpose of this study was to examine whether differences existed between women with and without a history of CSA in the way that they viewed themselves as a sexual person and, if so, whether such differences mediated the link between early unwanted sexual experiences and later adult sexuality. CSA survivors were found to view themselves as less romantic and passionate than women who were not abused. In particular, CSA survivors showed an inverse relationship between romantic/passionate sexual self-schemas and negative sexual affect during sexual arousal. The relationship between CSA and negative sexual affect was independent from symptoms of depression and anxiety, suggesting that the impact of CSA on sexual self-schemas may be independent from the impact that the abuse may have in other areas of the survivor's life.

On the basis of literature that suggests that child sexual abuse (CSA) survivors with post traumatic stress disorder (PTSD) have higher baseline sympathetic nervous system (SNS) activity than healthy controls and research that suggests that the SNS plays a critical role in female physiological sexual arousal, we examined the impact of SNS activation through intense exercise on sexual arousal in women with CSA and PTSD. We measured physiological and subjective sexual arousal in women with CSA (n = 8), women with CSA and PTSD (n = 10), and healthy controls (n = 10) during exposure to nonerotic and erotic videos. After exercise, women with CSA and women with CSA and PTSD showed no significant differences in the physiological sexual response compared with no exercise, which was different from the increased physiological sexual response after exercise observed in control women.

Previous literature presents discordant results on the relationship between physiological and subjective sexual arousal in women. In this study, the use of hierarchical linear modeling (HLM) revealed a significant concordance between continuous measures of physiological and subjective sexual arousal as assessed during exposure to erotic stimuli in a laboratory setting. We propose that past studies that have found little or no association between the two measures may have been in part limited by the methodology and statistical analyses employed.

Introduction Cross‐sex hormonal treatment (CHT) used for gender dysphoria (GD) could by itself affect well‐being without the use of genital surgery; however, to date, there is a paucity of studies investigating the effects of CHT alone. Aims This study aimed to assess differences in body uneasiness and psychiatric symptoms between GD clients taking CHT and those not taking hormones (no CHT). A second aim was to assess whether length of CHT treatment and daily dose provided an explanation for levels of body uneasiness and psychiatric symptoms. Methods A consecutive series of 125 subjects meeting the criteria for GD who not had genital reassignment surgery were considered. Main Outcome Measures Subjects were asked to complete the Body Uneasiness Test (BUT) to explore different areas of body‐related psychopathology and the Symptom Checklist‐90 Revised (SCL‐90‐R) to measure psychological state. In addition, data on daily hormone dose and length of hormonal treatment (androgens, estrogens, and/or antiandrogens) were collected through an analysis of medical records. Results Among the male‐to‐female (MtF) individuals, those using CHT reported less body uneasiness compared with individuals in the no‐CHT group. No significant differences were observed between CHT and no‐CHT groups in the female‐to‐male (FtM) sample. Also, no significant differences in SCL score were observed with regard to gender (MtF vs. FtM), hormone treatment (CHT vs. no‐CHT), or the interaction of these two variables. Moreover, a two‐step hierarchical regression showed that cumulative dose of estradiol (daily dose of estradiol times days of treatment) and cumulative dose of androgen blockers (daily dose of androgen blockers times days of treatment) predicted BUT score even after controlling for age, gender role, cosmetic surgery, and BMI. Conclusions The differences observed between MtF and FtM individuals suggest that body‐related uneasiness associated with GD may be effectively diminished with the administration of CHT even without the use of genital surgery for MtF clients. A discussion is provided on the importance of controlling both length and daily dose of treatment for the most effective impact on body uneasiness. Fisher AD, Castellini G, Bandini E, Casale H, Fanni E, Benni L, Ferruccio N, Meriggiola MC, Manieri C, Gualerzi A, Jannini E, Oppo A, Ricca V, Maggi M, and Rellini AH. Cross‐sex hormonal treatment and body uneasiness in individuals with gender dysphoria. J Sex Med 2014;11:709–719.

Introduction Sexual dysfunctions that affect all aspects of sexuality are common in patients with eating disorders. However, only few studies have provided longitudinal information on sexual functioning in patients with eating disorders. Aim To evaluate the longitudinal course of sexual functioning, and how changes in psychopathology and history of childhood abuse interact with sexual functioning in patients with anorexia nervosa (AN) and bulimia nervosa (BN). Methods A total of 27 patients with AN and 31 with BN were assessed at baseline and at 1-year follow-up after a standard individual cognitive behavioral therapy (CBT). Main Outcome Measures Subjects were studied by means of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders IV, Female Sexual Function Index (FSFI), Eating Disorder Examination Questionnaire, Beck Depression Inventory, Spielberg's State–Trait Anxiety Inventory, Symptom Checklist-90, and Childhood Experience of Care and Abuse Questionnaire. Results After treatment, both patients with AN and BN showed a significant improvement in the FSFI total score ( P P = 0.58). Reduction in eating disorder severity was directly associated with FSFI improvement, but only in those subjects with no history of sexual abuse (β = 0.28; P = 0.01). Conclusions Eating disorder-specific psychopathology could be considered as a specific maintaining factor for sexual dysfunction in eating disorders subjects. Subjects reporting a history of childhood sexual abuse represent a subpopulation of patients with a profound uneasiness, involving body perception, as well as sexual functioning, which appeared not to be adequately challenged during standard CBT intervention. The results, though original, should be considered as preliminary, given the relatively small sample size. Castellini G, Lo Sauro C, Lelli L, Godini L, Vignozzi L, Rellini AH, Faravelli C, Maggi M, and Ricca V. Childhood sexual abuse moderates the relationship between sexual functioning and eating disorder psychopathology in anorexia nervosa and bulimia nervosa: A 1-year follow-up study. J Sex Med 2013;10:2190–2200.

Introduction Charcot-Marie-Tooth (CMT) disease is one of the most frequently inherited neurological disorders, and while it is known that individuals suffering from this condition have low quality of life, little is known about their sexual function and satisfaction. Aim To describe the functioning on different domains of sexuality in a relatively large sample of women with CMT, provide comparisons between mildly and severely affected patients and between women with the two different types of CMT (demyelinating vs. axonal), and assess the relationship between sexual function and age of onset. Methods Fifty-seven women (age: 18–60 years) were approached in a CMT rehabilitation clinic by a psychologist and administered the Italian version of the McCoy Female Sexuality Questionnaire (MFSQ). Data from 40 patients who had had sexual intercourse in the previous 4 weeks were analyzed. Main Outcome Measure The main outcome measures are the factors MFSQ-SEX and MFSQ-PARTNER, which describe sexual functioning and sexual satisfaction with a partner, respectively. Results Almost 30% of women did not engage in sexual intercourse with a partner. Overall sexual problems were more prominent in younger women and tended to be lower as age increased: this pattern was different from what was reported in previous studies in comparable samples of healthy Italian women. Severity of CMT was associated with better sexual functioning in the areas of desire, arousal, orgasm, and satisfaction, with women with more severe symptoms reporting greater functioning. Women with more severe CMT symptoms reported more pain during intercourse. Age of CMT onset and type of CMT (demyelinating vs. axonal) were not associated with differences in sexual functioning. Conclusions Findings point to the importance of including assessment of sexual dysfunction in young women with mild CMT symptoms and the importance of providing sex therapy or counseling to these patients. Gargiulo P, Vinci P, Navarro-Cremades F, and Rellini AH. Sexual functioning in women with mild and severe symptoms of Charcot-Marie-Tooth Disease.

Studies suggest that sexual self-schemas are an important cognitive mechanism in the sexual development of women with a history of childhood abuse. This literature is only beginning to explore how multiple forms of abuse (i.e., physical, emotional, and sexual), rather than sexual abuse alone, can influence the development of adult sexuality. Moreover, the extant literature has not carefully considered important factors other than the severity of the abuse that may relate to sexual self-schemas, including family environment and quality of romantic relationships. Findings from this cross-sectional study conducted on 417 heterosexual women (ages 18-25 years) suggest that family dynamics and different types of childhood abuse contribute both directly and indirectly to adult sexual function and satisfaction and that part of those effects were mediated by other factors such as sexual self-schemas and romantic relationship quality. These results, including an exploration of the direct and indirect effects, were discussed in terms of the pervasive effects of abuse on people's lives and the potential treatment targets that can be addressed when trying to reduce sexual problems in women with a history of abuse.

Women with a history of childhood sexual abuse (CSA) experience dissociative symptoms and sexual difficulties with greater frequency than women without a history of CSA. Current models of sexual dysfunction for sexual abuse survivors suggest that dissociation may mediate the relationship between CSA and sexual arousal difficulties. Dissociation, however, is often conceptualized as a single construct in studies of CSA and not as separate domains as in the dissociation literature. In the present study, women with (CSA, N = 37) and without (NSA, N = 22) a history of CSA recruited from the community were asked to indicate the frequency and intensity of their experience in two dissociation subgroups, derealization and depersonalization, during sex with a partner and in their daily life. Findings showed that, in the NSA group, more depersonalization during sex with a partner was associated with lower sexual arousal functioning. However, for both the NSA and CSA groups, more derealization during sex was associated with higher sexual arousal functioning. No measure of dissociation was significantly associated with sexual responses in the laboratory. These findings highlight the importance of distinguishing between different forms of dissociation (i.e., derealization and depersonalization) in the study of sexual arousal functioning. In addition, the findings challenge the notion that dissociation is a main predictor of sexual arousal problems in survivors of CSA and suggest that a more nuanced relationship may exist.

The role androgens play in female sexual desire remains unclear. We investigated whether androgen sensitivity or elevated androgen levels contributed to sexual desire using a motivational model of sexual desire. Eighty-five women diagnosed with polycystic ovary syndrome (PCOS) were categorized depending on whether they exhibited clinical symptoms of androgen sensitivity or high biochemical androgen levels. Additionally, instead of looking at desire as a uniform construct, we divided desire based on the reasons why women experienced desire, thus distinguishing desire to have sex for relational purposes from the desire to have sex for mating selection or physical pleasure. Findings confirmed that clinical signs suggesting sensitivity to androgen levels, but not biological levels of androgens per se predicted levels of sexual desire. Moreover, in agreement with our hypothesis, we found support for a relationship between androgen sensitivity and some, but not other aspects of sexual desire. Cues that are most closely related to mating selection were significantly associated with androgen sensitivity, but not cues associated with desiring sex to feel emotionally close or create a love bonding with a partner. This study presents a new way to investigate desire and shows some preliminary findings on the importance to consider androgen sensitivity when investigating the relationship between sexual desire and hormones.

Although sexual difficulties related to a history of childhood sexual abuse (CSA) are common, there are no efficacious treatments to address sexual distress. Recent evidence for the benefits of mindfulness, which emphasizes present-moment non-judgmental awareness, in the treatment of women's sexual concerns provided the impetus for this pilot study. Twenty partnered women with sexual difficulties and significant sexual distress, and a history of CSA were randomized to two sessions of either a cognitive behavioral (CBT, n = 8) or mindfulness-based (MBT, n = 12) group treatment (age: M = 35.8 years, range: 22-54 years). Hierarchical Linear Modeling to assess changes in concordance between laboratory-based subjective and genital sexual arousal revealed a significant effect of MBT on concordance such that women in the MBT group experienced a significantly greater subjective sexual arousal response to the same level of genital arousal compared to the CBT group and to pre-treatment. Both groups also experienced a significant decrease in sexual distress. These data support the further study of mindfulness-based approaches in the treatment of sexual difficulties characterized by a disconnection between genital and subjective sexual response.

This study examined the association between cardiovascular reactivity and proactive and reactive functions of relational aggression among women with and without a history of sexual abuse. Heart rate reactivity, blood pressure reactivity, and respiratory sinus arrhythmia reactivity while recounting a relational stressor (e.g., being left out) were assessed. Participants provided self-reports of relational aggression and a history of sexual abuse prior to age 16. Results indicated that cardiovascular reactivity was only associated with relational aggression among women with a history of sexual abuse. In addition, whereas blunted reactivity was associated with proactive relational aggression, exaggerated reactivity was associated with reactive relational aggression. These findings highlight the importance of considering contextual moderators of the association between cardiovascular reactivity and aggression; moreover, results highlight distinct cardiovascular correlates of different functions of aggression. Finally, the findings underscore the need for additional research examining the physiological correlates of aggressive behavior among women.

This study examined relations among childhood maltreatment, difficulties in emotion regulation, and sexual and relationship satisfaction among young adult women reporting current involvement in committed, romantic relationships. A sample of 192 women (ages 18-25) completed self-report questionnaires as part of an Internet-based survey. It was hypothesized that severity of childhood maltreatment and difficulties in emotion regulation would each independently and negatively predict (a) sexual satisfaction, (b) relationship intimacy, and (c) expression of affection within the context of the relationship. Furthermore, it was hypothesized that greater emotion regulation difficulties would moderate the effects of childhood maltreatment on these sexual and relationship variables (i.e., sexual satisfaction, relationship intimacy, and expression of affection). Findings suggest that difficulties in emotion regulation demonstrated an incremental effect with regard to sexual satisfaction, but not with intimacy and affection expression. In contrast to predictions, no significant interactive effects were documented. Clinical implications and future directions related to this line of inquiry are discussed.

Introduction. Past findings on the diagnostic sensitivity of vaginal photoplethysmography are limited by testing among women with heterogeneous sexual dysfunctions and by the use of statistical techniques that are unable to assess how changes in subjective arousal are associated with changes in physiological arousal. Aims. The aims of this study were to: (i) test the sensitivity of vaginal photoplethysmography and continuous measures of subjective sexual arousal in differentiating between women with and without sexual arousal or orgasm dysfunction; and (ii) examine the diagnostic utility of measuring the synchrony between genital and subjective sexual responses. Methods. Sexual arousal was assessed in sexually healthy women (n = 12), women with orgasm disorder (OD; n = 12), and 38 women who met the criteria for the three subcategories of sexual arousal dysfunction described by Basson et al. (i.e., genital sexual arousal disorder (GAD; n = 9), subjective sexual arousal disorder (SAD; n = 13), and combined genital and subjective arousal disorder (CAD; n = 16)). Main Outcome Measures. Physiological sexual arousal was assessed using vaginal photoplethysmography, and subjective sexual arousal was measured continuously and using a Likert-scale in response to sexual videos. Results. Women with GAD showed the lowest and women with CAD showed the highest levels of vaginal pulse amplitude response to erotic stimuli. Women with sexual arousal disorder showed significantly lower levels of subjective sexual arousal to erotic stimuli than did sexually healthy women. Relations between subjective and physiological measures of sexual arousal were significantly weaker among women with sexual arousal disorder than sexually healthy women or women with OD. Conclusion. Preliminary support was provided for the diagnostic utility of measuring the synchrony between subjective and genital arousal in women with sexual arousal disorder. Findings do not support the sensitivity of using vaginal photoplethysmography, or continuous or Likert-scale measures of subjective arousal for differentiating between subtypes of women with sexual arousal disorder. Meston CM, Rellini AH, and McCall K. The sensitivity of continuous laboratory measures of physiological and subjective sexual arousal for diagnosing women with sexual arousal disorder. J Sex Med 2010;7:938-950.

Despite the documented association between trauma exposure and sexual problems (sexual dissatisfaction and sexual functioning), only a paucity of studies have investigated possible mechanisms underlying this association. The present study tested the role of emotion dysregulation in regard to levels of sexual dissatisfaction and functioning among a sample of 43 trauma-exposed cigarette smokers (17 women; M(age) = 20.20, SD = 10.87). When controlling for negative affectivity, type of trauma (sexual vs. nonsexual), daily smoking rate, posttraumatic stress symptoms, and anxiety sensitivity, emotion dysregulation provided an independent and unique contribution to sexual dissatisfaction but not to sexual function. These preliminary findings suggest that emotion dysregulation may be more important to understanding certain sexual problems (dissatisfaction) among cigarette-smoking trauma survivors than previously recognized, and this topic is, therefore, worthy of further investigation.

Many women with a history of childhood sexual abuse (CSA) experience difficulties becoming sexually aroused. This study measured cortisol and physiological sexual arousal during exposure to sexual stimuli in women with and without a history of CSA. Childhood sexual abuse survivors showed a smaller decrease in cortisol during sexual arousal than the nonsexually abused, control group potentially due to an increase in cortisol in some of the participants in the CSA group. Physiological sexual arousal was weaker in CSA survivors compared to women with no history of sexual abuse and posttraumatic stress disorder symptoms showed characteristics consistent with mediation for the relationship between a history of CSA and inhibited sexual arousal responses.

Introduction The literature provides a complex picture of sexual satisfaction and its predictors. To date, studies have provided a list of predictors of sexual satisfaction, including relational and psychological factors, but very little information is available on the direct effects of these predictors in midlife women, independently from the effects of sexual function on sexual satisfaction. Aim The main aim of this article is to provide empirical evidence on factors that predict sexual satisfaction in middle-aged women above and beyond the explanation provided by sexual function. Main Outcome Measures The three items on sexual satisfaction from the Female Sexual Functioning Index were used to assess different aspects of sexual satisfaction. Methods A sample of 86 women age 40–70 years recruited from a clinic completed a battery of questionnaires on sexual satisfaction and potential predictors, including, psychological well-being, body attitudes, menopausal symptoms, and relationship adjustment. Results Relationship adjustment, psychological well-being, and menopausal symptoms predicted sexual satisfaction above and beyond sexual functioning. Body attitudes did not predict sexual satisfaction in midlife women. Conclusions Data supported the hypothesis that sexual satisfaction is only partially explained by sexual function. Other factors involved in women's lives, such as psychological well-being, relationship adjustment, and, to a lesser extent, menopausal symptoms, affect sexual satisfaction independently from sexual function. Dundon CM, and Rellini AH. More than sexual function: Predictors of sexual satisfaction in a sample of women age 40–70.

Women with a history of childhood sexual abuse (CSA) are at greater risk for experiencing sexual problems in their adult lives. Yet, little is known about the possible role of cognitive and affective mechanisms in the development of sexual arousal difficulties in this population. This study investigated the role of pre-existing affect (affect prior to exposure to sexual stimuli) on genital responses, subjective sexual arousal, and affect elicited during the presentation of erotic film excerpts in a community sample of 25 women with and 25 women without a history of CSA. The CSA group showed greater pre-existing negative affect and smaller genital responses to the erotic film stimuli compared to the NSA group. Findings support a moderating effect of CSA, in that pre-existing negative affect was associated with strength of genital responses in the NSA but not in the CSA group. The results did not support a mediation model of pre-existing negative affect as an explanation for smaller physiological sexual responses in the CSA group. Taken together, the findings suggest that pre-existing affect may be more relevant for women with no history of CSA and call for more research on factors implicated in impaired sexual responses in women with a history of CSA.

Objective To investigate the sexual function of women with functional hypothalamic amenorrhea (FHA) and to test the mediating effects of depression and anxiety on the sexual functioning of women with FHA. Design In this cross-sectional study, participants completed questionnaires on sexual function, depression, and anxiety. Setting Tertiary care university hospital. Patient(s) Women with (n = 41) and without (n = 39) FHA recruited from a gynecologic endocrinology unit. Intervention(s) None. Main Outcome Measure(s) The McCoy Female Sexuality Questionnaire assessed sexual function, and the Zung Scale measured depression and anxiety. Result(s) Women with FHA experienced more sexual function problems and significantly higher depression and anxiety compared to women without menstrual dysfunction. In addition, depression offered a significant explanation for the sexual problems experienced by women with FHA. Conclusion(s) The psychologic symptoms that contribute to the onset of FHA partially mediate the relationship between FHA and sexual dysfunction.

Although studies have identified a relationship between a history of child sexual abuse (CSA) and problems with hypoactive sexual desire, little is known about the potential cognitive and affective mechanisms involved in the sexual desire of women with a history of CSA. In this study, 27 women with a history of CSA and 22 women with no history of abuse were asked to write about sexual and non sexual topics. The Linguistic Inquiry Word Count software program was used to compute the percentage of words that fell into positive emotions, negative emotions, body, and sex categories. As expected, women with a history of CSA used more negative emotions words when writing about sexual topics, but not non-sexual topics, compared to non-abused women. Women with a history of CSA also used more sex words when writing about the non-sexual topics compared to non-abused women. Frequencies of body and sex words used in the sexual texts were positively linked to levels of sexual desire function. This association was not different between women with and without a history of CSA. A history of CSA remained an independent predictor of levels of sexual desire dysfunction even when taking into consideration the language used in the sexual texts, indicating that there may be aspects of the sexual desire experienced by women with a history of CSA that differ from non-abused women that remain unexplored.

Impairments in sexual desire, arousal, and orgasm are common problems reported by women with female sexual dysfunction (FSD). Sex therapy using cognitive-behavioral therapy (CBT) is a promising method for FSD. The primary goals of CBT are to help a woman improve her sexual satisfaction and to reduce or eliminate her sexual distress. Identification of predictors of treatment response in women receiving CBT could help determine which women will benefit most from this therapy. Little information is available on predictors of treatment response. It has been suggested that low relationship satisfaction may impair the effectiveness of individual CBT for sexual dysfunction. Women reporting low relationship satisfaction before CBT could show a weaker association between changes in sexual functioning and changes in sexual satisfaction/distress. The present study assessed the degree to which pretreatment relationship satisfaction predicted treatment response to CBT. A total of 31 women with sexual dysfunction (average age = 28 years, 77.4% white) were randomized to receive CBT with or without ginkgo biloba as part of a previously published randomized clinical trial. Gingko biloba extract is hypothesized to have beneficial effects on peripheral circulation, which may facilitate genital engorgement during sexual activities. Pretreatment and posttreatment data were compared using validated self-reported measures of sexual satisfaction, sexual distress, sexual functioning, and relationship satisfaction. The level of pretreatment relationship satisfaction was predictive after CBT for changes in sexual satisfaction and distress, but not sexual functioning. Women with high relationship satisfaction before CBT experienced improvements in sexual functioning and decreasing sexual distress levels, whereas changes in sexual functioning among those with low pretreatment relationship satisfaction were associated with increased levels of sexual distress. Relationship satisfaction before therapy was a moderator of the association between changes in sexual functioning and changes in sexual distress. Improved sexual functioning was associated with decreased levels of sexual distress only among women with high pretreatment relationship satisfaction. These data show that small improvements in sexual functioning produced by CBT among women who entered therapy with low levels of relationship satisfaction were unable to alleviate their sexual distress. Low pretreatment relationship satisfaction may be predictive for poor response to CBT.

This article presents the result of a study that translated into Italian and validated the McCoy Female Sexuality Questionnaire (MFSQ) on an Italian sample. The questionnaire was first administered to a sample of 240 Italian women (age range, 18-65 years) recruited from a gynecology clinic. A principal component analysis identified 2 factors: sexuality (9 items) and partnership (5 items). Both factors showed an adequate inter-item reliability (Cronbach's alpha of .88 and .75, respectively). The validity of the Italian MFSQ was then tested by administering the questionnaire to a sample of 16 women with sexual dysfunction and 46 control women. Sexual dysfunction diagnoses were assessed through a semi-standardized interview based on the DSM-IV-TR diagnoses for Female Sexual Arousal Disorder, Female Orgasmic Disorder, Dyspareunia, and Hypoactive Sexual Desire Disorder. A discriminant validity test showed significant differences between women with and without female sexual dysfunction. These results indicate that the translated version of the MFSQ is a reliable and valid measure of sexual dysfunction among Italian women. The results also indicated a difference in factor structure between the Italian and the original version of the MFSQ, which warrants further investigation.