[HORROR, SHAME AND GUILT IN THE BEDROOM: THE EFFECTS OF EXPOSURE TO TRAUMA ON SEXUAL FUNCTION].

INTRODUCTION: Since the brutal October 7, 2023 attacks on Israel, the encroachment of the battlefield into the daily lives of all Israelis has impacted both civilians and combatants in various ways. The development of post-traumatic stress reactions has far-reaching effects across numerous aspects of life. One of the lesser-discussed consequences is the onset of sexual dysfunction. Reactions to such distressing events can adversely affect sexual desire, arousal, orgasm, the frequency of sexual activities, and satisfaction derived from them. These issues may present directly in clinical settings, or indirectly through other symptoms. The impact of trauma on sexual function can be attributed to disruptions in biological mechanisms, cognitive impairments, mood changes, and diminished motivation. This review explores how responses to post-traumatic stress relate to sexual function. We present case studies of patients recovering from such events, describe the underlying mechanisms that trigger these adverse reactions, and discuss interventions that can enhance sexual health, which can be implemented in primary care settings. It is advisable for assessments of sexual function to be included in routine evaluations by primary care physicians. Early identification of sexual dysfunction can help prevent the progression of more persistent issues and enhance overall quality of life for patients.

Prostate Cancer Related Sexual Dysfunction and Barriers to Help Seeking: A Scoping Review.

OBJECTIVE: Despite available support, sexuality needs are the most frequently reported unmet need among men with prostate cancer, which may be due to low help-seeking rates. Using the Ecological Systems Framework as a theoretical foundation, we conducted a scoping review of the available literature to understand what factors impact help-seeking behaviour for sexual issues after prostate cancer treatment among men who had received treatment. METHODS: Following PRISMA guidelines, a systematic search on Medline, PsychInfo, Embase, Emcare, and Scopus was conducted to identify studies of adult prostate cancer patients post-treatment, which reported barriers and/or facilitators to help-seeking for sexual health issues. Quality appraisals were conducted using Joanna Briggs Institute appraisal tools, and results were qualitatively synthesised. RESULTS: Of the 3870 unique results, only 30 studies met inclusion criteria. In general, studies were considered moderate to good quality, though only six used standardised measures to assess help-seeking behaviour. Barriers and facilitators for sexual help-seeking were identified across all five levels of the Ecological Systems Framework, including age, treatment type, and previous help seeking experience (individual level), healthcare professional communication and partner support (microsystem), financial cost and accessibility of support (meso/exosystem), and finally embarrassment, masculinity, cultural norms, and sexuality minority (macrosystem). CONCLUSIONS: Addressing commonly reported barriers (and inversely, enhancing facilitators) to help-seeking for sexual issues is essential to ensure patients are appropriately supported. Based on our results, we recommend healthcare professionals include sexual wellbeing discussions as standard care for all prostate cancer patients, regardless of treatment received, age, sexual orientation, and partnership status/involvement.

[Compulsive Sexual Behaviour Disorder and Sexual Motivations]. / A kompulzív szexuális viselkedési zavar és a szexuális motivációk összefüggései.

INTRODUCTION: Compulsive sexual behaviour or hypersexuality has been the subject of growing interest among academic circles. However, relatively few reliable predictors have been identified. The aim of the present study was to examine whether different types of sexual motivations based on Self-Determination Theory can account for compulsive sexual behaviour. METHOD: The study was conducted on a non-clinical sample of nearly 1000 participants. Sexual motivation was assessed using the Sexual Motivation Scale and compulsive sexual behaviour was assessed using the Hypersexual Behaviour Inventory. Both measures showed adequate reliability. Multiple linear regression was performed to analyse the relationship between the variables. RESULTS: In the regression, controlling for gender, of the six motivational factors, integrated (ß = 0.167), introjected (ß = 0.074) and amotivation (ß = 0.128) were found significant (p <0.001), and identified was nearly significant (ß = 0.53; p = 0.065). The intrinsic (ß = -0.032; p = 0.366) and extrinsic (ß = -0.027; p = 0.168) forms of motivation had no impact on hypersexuality. The total explained variance of the model was 18% (p <0.001). Results indicated that three of the six motivational factors positively and weakly predicted hypersexuality. CONCLUSION: The original hypothesis of the study, that less self-determined motivated sexual behaviour would be a better predictor of compulsive sexual behaviour, was not confirmed. In practice, positively related variables, especially amotivation, may play an important role in psychotherapeutic processes. However, in order to better understand compulsive sexual behaviour, additional factors still need to be explored.

Sexual Disorders in Men: The Main Factors of Occurrence and Their Correction.

ABSTRACT: The aim is to identify the causes of physical and emotional health disorders in men in terms of intimate interaction with partners, as well as how they can be prevented. The research used comparison, analysis, statistical methods, and surveys. The need for people to discover and study sexual health issues in the modern world in order to support not only the physical, but also the psychological aspects of their body, as well as the impact of lifestyle on this process, is shown. The research was conducted to better understand all diseases that are based on the deterioration of the psycho-emotional state of men, which leads to sexual disorders. A more detailed study of this topic will allow to better select treatment for patients and find different approaches to the problem in the future.

Sexual anxiety mediate relationship between sexual schemas and body image with sexual function in Iranian women.

BACKGROUND: Sexual function is one of the most critical challenges in human society, especially among women. The problems associated with sexual function are significantly ambiguous in a society like Iran. This study investigated the mediating role of sexual anxiety in relationship between sexual schemas and body image with female sexual function. METHOD: The research method was correlational and specifically path analysis. The statistical population included women aged 25-45 in Rasht, Iran, 2021. 365 women were selected using Cochran's formula and the convenience sampling method. The Female Sexual Function Index (FSFI), Sexual Self-Schema Scale for Women (SSSS), Body Image Scale (BIS), and Multidimensional Sexual Self-Concept Questionnaire (MSQ) were used for data collection. For data analysis, SPSS-26 and LISREL 10.2 software were used. RESULTS: Descriptive data analysis showed that mean and standard deviation were for further passionate-romantic schema 22.96 and 4.83, open-direct schema 27.64 and 5.09, embarrassed-conservative 20.93 and 4.61, body image 128.96 and 27.35, sexual anxiety 13.13 and 3.91 and sexual function 49.83 and 8.67. According to the results of path analysis, passionate-romantic (ß = 0.51), explicit-comfortable (ß = 0.27), shy-conservative (ß = -0.59), and body image (ß = -0.62) schemas showed a significant relationship with sexual function. Sexual function anxiety as a mediating variable also had a significant role (ß = -0.41) in female sexual function. CONCLUSION: Sexual function anxiety, negative body image, and negative sexual schema negatively affect women's sexual function, and positive sexual schemas and body image positively affect sexual function anxiety.

"Sexual sacrifice": a qualitative exploration of husbands' experience of living with survivors of breast cancer-sexual dysfunction in Malaysia.

PURPOSE: Experiencing sexual dysfunction (SD) alongside a breast cancer (BC) diagnosis has significant consequences, not only for wives but also for their husbands. Therefore, we explored husbands' perspectives on sexuality and their encounters in dealing with wives' SD following a BC diagnosis. METHODS: This qualitative study, conducted within the phenomenological framework, focused on sexually active husbands whose wives faced SD after being diagnosed with BC in Kelantan. Husbands with an International Index of Erectile Function (IIEF-5) score above 11, indicating the absence of erectile dysfunction, were invited to participate in in-depth interviews conducted between September 2019 and March 2021. The interviews were recorded and transcribed verbatim, and the transcriptions were then managed and analyzed using the NVivo® analytic computer software. Thematic analyses were performed, taking into account the meaning-making theory. RESULTS: To grasp husbands' experiences, three themes emerged. "Sex, a calming act," delves into their understanding of sexuality and its impact severity. "Distressing sequelae yet provide better tolerance" underscores that husbands experienced adverse consequences due to their wives' imperfections and sexual challenges, but they exhibited improved tolerance in dealing with these difficulties. Lastly, "Improving lives with multiple strategies" highlights how husbands sought alternative activities in response. CONCLUSION: This study illuminates the experiences of husbands coping with their wives' SD following a BC diagnosis. Husbands had to reconsider their understanding of sexuality and sexual needs and employed various response and coping strategies. These strategies included emphasizing influences of culture (husbands' roles and rights), religious beliefs, and self-distraction, redirecting the focus to health concerns, and engaging in alternative activities.

Asking women with diabetes about sexual problems: An exploratory study of NHS professionals' attitudes and practice: A survey of healthcare professionals regarding communication and silences about sexual problems during the routine care of women with diabetes.

AIMS: To explore UK healthcare professionals' practice and attitudes towards asking women with diabetes about sexual health problems, including symptoms of female sexual dysfunction (FSD). METHODS: An online questionnaire to address the study aims was developed, piloted by ten healthcare professionals (HCPs) and completed by 111 eligible HCPs, recruited via professional networks and social media. Free text data were analysed and reported thematically. Two questions were analysed to test the hypothesis of differences between men's and women's responses. RESULTS: The majority of respondents did not ask women with diabetes about sexual problems. Multiple barriers to inquiry were reported, including inadequate training, time constraints, competing priorities, the perceived likelihood that questions will cause surprise or distress (especially for certain groups of women), the belief that sexual problems are to be expected as women age, and the belief that FSD is complex or untreatable, with unclear management pathways. Exploratory findings indicated significant differences in men and women's responses (men disagreed more strongly with prioritisation, and fewer reported routine inquiry about sexual problems in their usual practice). CONCLUSIONS: HCPs reported not asking women with diabetes about sexual problems during routine care. They described multiple factors reinforcing the silence about sexual health, including inadequate education and perceived social risk for individual HCPs who deviate from the patterns of topics usually discussed in diabetes consultations.

Let's talk about sex! Why should healthcare professionals address sexual distress in breast cancer patients and survivors?

PURPOSE: Sexual distress impacts the quality of life (QoL) of breast cancer patients but is often overlooked in standard care pathways. This study evaluated the prevalence and factors of sexual distress among Dutch breast cancer patients, compared them to the general population, and explored how sexual distress is discussed in clinical settings from the perspectives of patients and healthcare professionals (HCPs). METHODS: Questionnaires containing the Female Sexual Distress Scale (FSDS) and demographic variables were distributed to women with breast cancer. The effect of breast cancer on sexual distress was assessed with a Mann-Whitney U test. Multivariable linear regression was used to analyze variables associated with FSDS. The Sexuality Attitudes and Beliefs Survey (SABS) was sent to HCPs. RESULTS: Breast cancer patients reported significantly higher sexual distress compared to a Dutch non-breast cancer cohort, respectively 16.38 (SD 11.81) and 23.35 (SD 11.39). Factors associated with higher sexual distress were psychological comorbidities, the body image scale, and being diagnosed >10 years ago. Sexual distress was not discussed as often as patients needed. Barriers to addressing sexual distress were time constraints, HCPs' confidence in their ability to address sexual distress, and uncertainty about who is responsible for initiation. CONCLUSIONS: Breast cancer patients showed significantly higher sexual distress compared to the Dutch population. However, it was not frequently addressed in the consultation room. While some barriers have been identified, this study highlights the importance of further exploring obstacles to integrating discussions about sexual distress into routine care to improve QoL of breast cancer patients.

The Effectiveness of Online Sensate Focus Exercises in Enhancing Sexual Function and Intimacy Among Chinese Heterosexual Couples: A Randomized Controlled Trial.

We investigated the effectiveness of online Sensate Focus exercises, delivered online as a series of 11 animation videos, in improving participants' sexual functioning and enhancing intimacy, relationship and sexual satisfaction. We studied 35 Chinese heterosexual couples, assessed them at pretest, post-test, and a three-month follow-up. Compared to the waitlist control group, the experimental group showed improvement in orgasm in women, and this was maintained at follow-up. Also, for those with a lower function at pretest, the intervention was possibly effective in improving erectile function among men, as well as overall sexual function and pain among women. These improvements were maintained at follow-up as well. Findings from the current study suggest that online Sensate Focus intervention has potential in treating sexual dysfunction of Chinese heterosexual couples. It may also serve as the first part of a stepped care approach or be integrated with other medication or cognitive behavioral therapy treatment.

The Impact of Atopic Dermatitis on Sexual Function and Reproductive Desires in Women.

Atopic dermatitis is a prevalent skin condition that affects up to 17% of adult population. It can lead to itching, pain, and other symptoms such as sleep disturbance, anxiety, and depression. Due to its high prevalence and limiting symptoms, atopic dermatitis often has a great impact on patients' quality of life but there is scarce information regarding how atopic dermatitis affects women's sexual health and reproductive desires. The purpose of this article was to assess the impact of atopic dermatitis on sexual function and reproductive wishes in women. A cross-sectional study was conducted from February to March 2022. A total of 102 women with atopic dermatitis were recruited through online questionnaires sent through the Spanish Atopic Dermatitis Association; 68.6% of the patients acknowledged impairment in sexual function, especially those with more severe disease and those with genital and gluteal involvement. In addition, 51% of the women considered that atopic dermatitis may have an influence on their gestational desire, particularly those with gluteal involvement. In conclusion, atopic dermatitis has a great impact on sexual function and reproductive desires in women.

Polycystic ovarian syndrome elevates the distress of sexual pain in Iranian women with infertility.

BACKGROUND: Sexual dysfunction may lead to sexual distress in women with infertility, while polycystic ovarian syndrome (PCOS) may escalate this distress. This study aimed to investigate the role of PCOS in the relationship between sexual dysfunction and sexual distress in Iranian women with infertility. METHODS: The Female Sexual Function Index (FSFI), Female Sexual Distress Scale-Revised (FSDS-R), and Depression and Anxiety modules of the DASS-21 were cross-sectionally investigated in 190 women with infertility (103 women with PCOS and 87 women without PCOS). RESULTS: There were negative correlations between sexual function domains and sexual distress (P < .001) in the total sample. Moderation analysis revealed that higher levels of impaired desire, arousal, and pain elevated sexual distress in the PCOS group. After adjusting for depression and anxiety, only the association between sexual pain and sexual distress was moderated by PCOS condition (P = .008). CONCLUSIONS: The findings suggest that impaired sexual function is associated with increased levels of sexual distress in infertile female patients. Importantly, comorbid PCOS renders patients susceptible to sexual distress where sexual pain is increased. Further research may shed light on the physiological, psychological, and relational aspects of sexual pain and associated distress in infertile female patients with comorbid PCOS.

Women's Safety Behaviors before and during Sexual Activity: Psychometric Properties of Its Self-Report Questionnaire in German Women.

Sexual safety behaviors (SSB) may constitute a relevant factor for the development and maintenance of sexual dysfunctions. The present study aims to improve the understanding of SSB in women. A total of N = 923 women completed an online survey consisting of the Questionnaire on Behaviors Before and During Sexual Activities, a measure of SSB, and a set of other questionnaires that assessed sexual dysfunctions, anxiety, depression, and other clinically relevant variables. Exploratory and confirmatory factor analyses of the QBSA revealed a robust three-factor solution with 1) cognitive and behavioral avoidance, 2) use of lubricants, and 3) thought and body control. While some SSB were generally common in women, others discriminated well between women with sexual dysfunctions, women with sexual problems, and women without impairment. SSB was significantly negatively associated with women's level of sexual functioning and positively with repetitive and negative thought processes, depression, and anxiety. Overall, the concept of SSB can be reliably measured and SSBs correlate meaningfully with variables measuring women's mental health. We argue that the concept of SSB should be further developed as it can enrich present sexual therapeutic treatment approaches, especially in the context of cognitive-behavioral therapy.

Hypersexuality in neurological disorders: A systematic review.

BACKGROUND: Hypersexuality (HS) accompanying neurological conditions remains poorly characterized despite profound psychosocial impacts. Objective We aimed to systematically review the literature on HS in patients with neurological disorders. Study selection and analysis We conducted a systematic review to identify studies that reported HS in neurological disorders. HS was defined as a condition characterized by excessive and persistent preoccupation with sexual thoughts, urges, and behaviors that cause significant distress or impairment in personal, social, or occupational functioning. Data on demographics, assessment techniques, associated elements, phenotypic manifestations, and management strategies were also extracted. Findings The final analysis included 79 studies on HS, encompassing 32 662 patients across 81 cohorts with neurological disorders. Parkinson's disease was the most frequently studied condition (55.6%), followed by various types of dementia (12.7%). Questionnaires were the most common assessment approach for evaluating HS, although the techniques varied substantially. Alterations in the dopaminergic pathways have emerged as contributing mechanisms based on the effects of medication cessation. However, standardized treatment protocols still need to be improved, with significant heterogeneity in documented approaches. Critical deficiencies include risks of selection bias in participant sampling, uncontrolled residual confounding factors, and lack of blinded evaluations of reported outcomes. Conclusions and clinical implications Despite growth in the last decade, research on HS remains limited across neurological conditions, with lingering quality and methodological standardization deficits. Key priorities include advancing assessment tools, elucidating the underlying neurobiology, and formulating management guidelines. PROSPERO REGISTRATION NUMBER: CRD42017036478.

Profiles of University Students in Terms of Sexual Dysfunction: The Role of Anxiety, Depression, Eating Attitudes, and Mindfulness.

Objective: Sexual dysfunction (SD) can interfere with sexual desire and satisfaction and is associated with an impairment in one's emotional, mental, physical, and social function. Despite its importance, SD remains understudied in Lebanon, possibly due to its sensitive nature. Therefore, this research aimed to address this gap by examining the relationship between SD and certain psychological and behavioral factors. The objective was to investigate the relationship between SD and eating attitudes, depression, anxiety, and mindfulness among university students in Lebanon using a cluster analysis approach.Methods: This cross-sectional study was carried out between July and September 2021. Using the snowball technique, a sample of 363 Lebanese university students was recruited. SD was measured using the Sexual Dysfunction Questionnaire, with higher scores indicating higher sexual arousal/desire. Eating attitudes, anxiety, depression, and mindfulness were measured using the Eating Attitude Test, Lebanese Anxiety Scale, Patient Health Questionnaire, and Freiburg Mindfulness Inventory, respectively.Results: Participants were divided into 3 clusters: cluster 1 "moderate well being" (n = 109, 30.0%) was characterized by moderate eating attitudes, anxiety, depression, and mindfulness; cluster 2 "positive well-being" (n = 186, 51.2%) was characterized by having the lowest mean eating attitude, anxiety, and depression scores, while having the highest mean mindfulness score; and cluster 3 "negative well-being" (n = 68, 18.7%) was characterized by the highest mean eating attitude, anxiety, and depression scores, while having the lowest mean mindfulness score. Females compared to males (ß = -0.87) and belonging to cluster 2 (ß = -1.32) or cluster 3 (ß = -1.32) were significantly associated with less sexual arousal.Conclusion: The results align with previous findings suggesting that mindfulness has a role in SD. The current study highlights the importance of taking into consideration factors that interplay with SD. Mental health providers should consider integrating aspects of mindfulness into their practice when working with patients with SD. Additionally, addressing the taboo surrounding sexual health will be crucial to destigmatize this topic. The findings emphasize the need for accessible campaigns by sexual health organizations to raise awareness.Prim Care Companion CNS Disord 2024;26(3):23m03682. Author affiliations are listed at the end of this article.

Evidence for the Impact of Stress and Trauma on Sexual Function in Women: Review and Clinical Recommendations.

Stressors occur in a spectrum, ranging from daily hassles to life-threatening experiences, and can significantly impact sexual functioning. Thus, this review summarizes the intricate relationship between trauma spectrum experiences and women's sexual functioning. Biological mechanisms are described to elucidate the physiologic complexity that manifests because of trauma-related experiences. Additionally, both psychological and social implications are discussed. Treatment recommendations for practitioners working with women are discussed, underscoring the importance of adopting a trauma-informed care model.

Sexuality and Infertility.

Infertility diagnoses and treatment can lead to psychological distress and relationship strain. Infertility is commonly associated with disruptions in sexual function and satisfaction among women, in part due to overlapping etiologic factors (eg, comorbid medical conditions). Women and couples with infertility should be screened for sexual problems and provided education on the relationship between infertility and sexuality. Sexual dysfunction in the context of infertility is often best addressed using an interdisciplinary approach. This article provides a summary on the relationship between sexuality and infertility and recommendations for the assessment and management of sexual dysfunction in women with infertility.