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Genital pain (GP) is a common symptom in women of reproductive age. The prevalence of GP is difficult to gauge as it has been underreported by both patients and clinicians and neglected in clinical studies despite wide recognition of the adverse effects to women's health. The purpose of the present study was 3-fold: (i) to explore the self-reported presence and perception of GP and its association with sexual functioning, sexual distress, emotions, psychopathology, and quality of life (QoL); (ii) to explore if, controlling for the pain effect, women with Female Sexual Function Index (FSFI) scores indicating sexual dysfunction also reported worse outcomes regarding sexual distress, emotions, psychological health, and QoL than GP women with higher FSFI scores; and (iii) to evaluate the effects of GP duration, comparing women with GP with shorter (<6 months) duration of symptoms with women with longer (≥6 months) duration of symptom of GP on sexual functioning, distress, emotions, psychopathology and QoL. A total of 1,034 women (age ranges between 18 and 40 years) from the Italian general population completed a web survey on sexual health. 6 self-report questionnaires exploring different biopsychosocial factors were assessed: the FSFI, the Female Sexual Distress Scale, the Positive and Negative Affect Schedule, the Short Form McGill Pain Questionnaire adapted for GP, the Short Form 36, and the Symptom Check List-90-Revised. Women who reported GP (n = 319) indicated generally lower sexual function than women without GP (n = 648; P =.036). They reported a higher level of sexual distress (P <.001), more negative emotions related to sexual experiences (P =.001), lower scores in all QoL domains (P <.001), and higher levels of psychopathological symptoms (P <.001). Controlling for pain effects, women whose FSFI scores indicated sexual dysfunction (n = 150) reported higher rates of sexual distress than women whose FSFI scores indicated normal sexual function (n = 169; P <.001). The scores also indicated fewer positive (P <.001) and more negative emotions (P <.001) related to sexuality, lower QoL (P <.001) and significantly higher psychological burden (P <.001). Moreover, women experiencing GP for ≥6 months reported significantly lower means on the FSFI total score (P <.05; especially in the desire, satisfaction, and pain domains), distress (P <.001), and emotions (P <.05) than women experiencing GP duration <6 months. No significant differences were found on the QoL and the psychopathological symptoms. GP is significantly pervasive, but a high percentage of sexual problems and related emotional suffering is overlooked. Raising awareness about this issue is critical, both among clinicians and the general public. The present study highlighted important characteristics of GP from a community sample; the results indicate problems related to pain experiences and their repercussions on sexual, psychological, affective health, and QoL. Major limitations are related to the use of self-report measures via a web-based study. The results provide evidence of a lack of awareness regarding pain experiences as they relate to sexual functioning in women; clinicians would be advised to more fully investigate sexual functioning and psychosocial variables associated with GP during routine consultation beginning with the first onset of the symptoms. Nimbi FM, Rossi V, Tripodi F, et al. Genital Pain and Sexual Functioning: Effects on Sexual Experience, Psychological Health, and Quality of Life. J Sex Med 2020; 17:771–783. [ABSTRACT FROM AUTHOR]

Abstract Introduction Literature lacks biopsychosocial models of men's sexuality. Regarding sexual desire, Carvalho and Nobre (J Sex Med 2011;8:754-763.) presented a cognitive-affective model including age, medical factors, dyadic adjustment, psychopathology, restrictive attitudes toward sexual activity, erection concerns, lack of erotic thoughts (LET), sadness, and shame as predictors. In particular, automatic thoughts were highlighted as the main predictors of sexual desire in men. Aim To test a conceptual model (confronting full and partial mediation) considering the interrelated role of automatic thoughts, emotional factors, sexual function, and sexism in influencing the levels of men's sexual desire. Methods Selected variables were the best predictors of men's sexual desire in a previous study on 450 heterosexual Italian men (age 31.36 ± 10.73 years). Path diagrams were built including "orgasmic function," "LET," "erection concerns thoughts" (ECT), "hostile sexism," and "positive affect" as predictors of sexual desire. The 2 versions of the model were designed as a "partial" and a "full mediation" from automatic thoughts toward desire. ECT and LET were selected as main predictors, with direct paths going from ECT to positive affect and sexual desire, and from LET to positive affect, orgasmic function, and sexual desire. Direct paths were also drawn from emotions and orgasm to sexual desire. Moreover, in the partial mediation model, part of ECT and LET effect was mediated by emotions and orgasm, and part directly influenced sexual desire. Hostile sexism and sociodemographic variables were considered as exogenous variables influencing sexual desire. Path analyses were performed through structural equation modeling approach. Main Outcome Measure Results from 4 standardized questionnaires and sociodemographic information were considered for this study: International Index of Erectile Function, Positive and Negative Affect Schedule, Ambivalent Sexism Inventory, and Sexual Modes Questionnaire. Results Results showed a satisfactory data fit for both versions, but the partial mediation model was retained (χ2 = 35.312, degree of freedom = 34, P =.406; goodness of fit =.987; normed fit index =.945; comparative fit index =.998; root mean square error of approximation =.009 [95% CI.000–.036]). All the endogenous paths and hostile sexism were found to be significant. Clinical Implications The model selected could suggest the need to operate under an biopsychosocial approach, considering cognitive, emotional, and sexual aspects all together to elicit an effective arise of sexual desire level. Strength & Limitations The study can claim a good methodology and the proposal of an interesting model, even if the results should be carefully interpreted due to the use of no representative sample, self-report measures, and the limited number of variables involved. Conclusion Our findings suggest that cognitive, emotional, sexual functioning, and cultural variables interplay affecting men's sexual interest. Nimbi FM, Tripodi F, Rossi R, et al. Testing a Conceptual Model for Men's Sexual Desire Referring to Automatic Thoughts, Emotions, Sexual Function, and Sexism. J Sex Med 2018;15:1518–1526. [ABSTRACT FROM AUTHOR]

Background The literature lacks studies of the male sex drive. Most existing studies have focused on hypoactive sexual desire disorder in coupled heterosexual men, highlighting some of the main related biological, psychological, and social factors. Aim To evaluate the role of selected psychological and social variables affecting male sexual desire such as quality of life, sexual function, distress, satisfaction, psychological symptoms, emotions, alexithymia, couple adjustment, sexism, cognitive schemas activated in a sexual context, sexual dysfunctional beliefs, and different classes of cognitions triggered during sexual activity about failure anticipation, erection concerns, age- and body-related thoughts, erotic fantasies, and negative attitudes toward sexuality. Methods A wide self-administered survey used snowball sampling to reach 298 heterosexual Italian men (age = 32.66 ± 11.52 years) from the general population. Outcomes 13 questionnaires exploring psychological and social elements involved in sexual response were administrated: International Index of Erectile Function, Short Form 36 for Quality of Life, Beck Depression Inventory–II, Symptom Check List–90–Revised, Toronto Alexithymia Scale, Premature Ejaculation Severity Index, Sexual Distress Scale, Sexual Satisfaction Scale, Dyadic Adjustment Scale, Ambivalent Sexism Inventory, Sexual Modes Questionnaire, Sexual Dysfunctional Belief Questionnaire, and Questionnaire of Cognitive Schema Activation in Sexual Context. Results Results showed lack of erotic thoughts (β = −0.328), fear (β = −0.259) and desire to have a baby (β = −0.259) as the main predictors of the level of sexual desire in this group. Energy-fatigue, depression, premature ejaculation severity, sexual distress, compatibility, subjective sexual response, and sexual conservatism had a weaker effect on sexual desire. Sexual functioning (13.80%), emotional response (12.70%), dysfunctional sexual beliefs (12.10%), and negative automatic thoughts (12.00%) had more variable effects on sexual drive. Clinical Translation Analyzed variables could represent important factors that should be considered in the assessment of desire concerns and discussed in therapy. Strengths and Limitations The strength of this study is the analysis of novel psychological and social factors on male sexual desire. Recruitment and sample size do not allow generalization of the results, but some crucial points for future research and clinical practice are discussed. Conclusion Our findings showed that male sexual desire could be affected by many psychological and social elements. Other factors remain to be explored, in their direct and interactive effects, aiming to better explain male sexual desire functioning. Nimbi FM, Tripodi F, Rossi R, Simonelli C. Expanding the Analysis of Psychosocial Factors of Sexual Desire in Men. J Sex Med 2018;15:230–244. [ABSTRACT FROM AUTHOR]

The article discusses role of some biopsychosocial variables affects male sexual desire such as Quality of Life, psychological symptoms, and alexithymia. Topics discussed include preliminary study shows lack of desire in men due to lack of erotic thoughts; level of sexual desire connected with many factors such as depression, premature ejaculation severity, and sexual response and sexual desires in men could be characterized as interaction between biological, psychological, and social elements.