The Complex Interplay between BDSM and Childhood Sexual Abuse: A Form of Repetition and Dissociation or a Path Toward Processing and Healing?

In this theoretical paper the authors explore the connections between BDSM (i.e., practices involving bondage, discipline, dominance, submission, sadism, masochism) and CSA (childhood sexual abuse) in order to investigate the potential unconscious mechanisms at play and the therapeutic functions of BDSM practices among CSA victims. Drawing on the embodiment framework, the authors address how BDSM may serve as a form of unconscious repetition of traumatic experiences for certain CSA victims, with the aim of processing trauma and healing. A review of the empirical evidence regarding the links between BDSM and CSA trauma, along with the potential of BDSM to trigger trauma and elicit dissociation, guilt, or shame, is conducted. Finally, BDSM practices are reviewed through the concept of trauma-play, which involves deliberate rescripting. In short, the complex relationship between BDSM and CSA is highlighted, as well as its implications for understanding and potentially addressing trauma experiences in therapy.

Is Sexual Aversion a Distinct Disorder or a Trans-Diagnostic Symptom across Sexual Dysfunctions? A Latent Class Analysis.

Sexual aversion disorder (SAD) is a chronic condition that impacts sexual and psychological well-being. However, the relevance of SAD as a discrete disorder remains highly debated. This study aimed to clarify the status of SAD as either a distinct disorder or a trans-diagnostic symptom shared among sexual dysfunctions. This cross-sectional study used a latent class analysis approach among a Canadian community sample (n = 1,363) to identify how patterns of SAD symptoms (i.e., sexual fear, disgust, and avoidance) emerge across different spheres of sexual functioning (i.e., desire and arousal, erection or lubrication, genito-pelvic pain, and orgasm) and examine sociodemographic and psychosexual correlates of the identified classes. Examination of fit indices suggested four classes: Sexually functional, Impaired desire and responsiveness, Sexual aversion, and Comorbid sexual dysfunctions. Sexual aversion class members were more likely to be single, had experienced sexual assault in adulthood, and report lower levels of sexual satisfaction and psychological well-being, compared to Sexually functional class members. Results suggest that SAD is a distinct clinical syndrome, while its symptoms may co-occur with other sexual dysfunctions. To ensure that the needs of people with SAD are met with tailored treatment options, future nosography might consider reclassifying SAD as a specific disorder.

Who seeks sex therapy? Sexual dysfunction prevalence and correlates, and help-seeking among clinical and community samples.

Sexual dysfunctions (SD; e.g., female sexual interest/arousal disorder, erectile disorder, female orgasmic disorder, delayed ejaculation, genito-pelvic pain/penetration disorder, etc.) affect up to a third of individuals, impairing sexuality, intimate relationships, and mental health. This study aimed to compare the prevalence of SDs and their sexual, relational, and psychological correlates between a sample of adults consulting in sex therapy (n = 963) and a community-based sample (n = 1,891), as well as examine barriers to sexual health services for SD and the characteristics of individuals seeking such services. Participants completed an online survey. Analyses showed that participants in the clinical sample reported lower levels of sexual functioning and sexual satisfaction and higher levels of psychological distress than participants in the community-based sample. Moreover, higher SD rates were related to lower relational satisfaction and higher psychological distress in the community sample, and to lower sexual satisfaction in both samples. Among participants in the community sample who sought professional services for SD, 39.6% reported that they were unable to access services, and 58.7% reported at least one barrier to receiving help. This study provides important data regarding the prevalence of SD and the link between SD and psychosexual health in clinical and nonclinical samples, as well as barriers to treatment access.

Prevalence and Correlates of Sexual Aversion: A Canadian Community-Based Study.

BACKGROUND: Sexual aversion (SA) is a chronic difficulty impacting sexual, relational and psychological wellbeing. Yet, there is a dearth of studies exploring its prevalence and associated factors. AIM: To estimate the prevalence of SA and examine its correlates among a community sample of Canadian adults. METHODS: A large web-based sample of the Quebec (Canada) adult population (n = 1,935) completed an online survey on sexual wellbeing. Prevalence rates were estimated for SA and other sexual difficulties. Multivariate logistic regression analyses were used to identify correlates of SA. OUTCOMES: Demographics (eg, gender, employment status), self-reported experiences of sexual difficulties (low sexual desire and arousal, vaginal dryness, pain during sexual intercourse, erectile difficulties, premature or delayed ejaculation, and orgasm difficulties), and markers of psychosexual wellbeing (eg, psychological distress, performance anxiety) according to the presence or absence of SA were assessed. RESULTS: The prevalence of SA was 9.7% (95% CI: 8.5-11.2) in the present sample (6.9% [95% CI: 5.1-8.9] in men, 11.3% [95% CI: 9.4-13.4] in women and 17.1% [95% CI: 9.4-27.4] in nonbinary and/or trans individuals). The multivariate logistic regression model explained 31% of the likelihood of experiencing SA. SA was related to psychological distress (aOR: 1.77, 95% CI: 1.33-2.38), sexual satisfaction (aOR: .59, 95% CI:.49-0.70), sexual performance anxiety (aOR: 2.08, 95% CI: 1.45-2.98), and discomfort with sex-related information (aOR: 1.02, 95% CI: 1.01-1.04) CLINICAL IMPLICATIONS: Several psychosexual correlates of SA were documented and could be targeted by practitioners during the assessment and treatment of individuals living with SA. STRENGTHS AND LIMITATIONS: The study's strengths include its large, gender diverse sample and use of comprehensive diagnostic criteria for SA. Probability-based sampling methods and longitudinal studies should be conducted to address the current study's limitations. CONCLUSION: SA research is critical to document its prevalence in different sociodemographic groups, explore additional intrapersonal and interpersonal mechanisms involved in SA etiology, and ensure that the needs of people living with SA are met with tailored interventions. David Lafortune, Éliane Dussault, Mathieu Philibert, Natacha Godbout. Prevalence and Correlates of Sexual Aversion: A Canadian Community-Based Study. J Sex Med 2022;19:1269-1280.

Insecure Attachment and Sexual Satisfaction: A Path Analysis Model Integrating Sexual Mindfulness, Sexual Anxiety, and Sexual Self-Esteem.

This study examines the intermediary role of three variables (sexual mindfulness, sexual anxiety, and sexual self-esteem) in a path analysis model to explain the association between insecure attachment and sexual satisfaction. A community sample of 543 adults completed an online survey. Results supported our hypothesized integrative model, which explained 44.1% of the variance in sexual satisfaction and presented satisfactory fit indices. This study suggests that the association between attachment insecurities and lower sexual satisfaction could be partially explained by a proximal association with lower sexual mindfulness, which emphasizes the relevance of examining sexual mindfulness during the screening and treatment of people presenting low sexual satisfaction.Supplemental data for this article is available online at https://doi.org/10.1080/0092623X.2021.2011808 .

Psychological and Interpersonal Factors Associated with Sexualized Drug Use Among Men Who Have Sex with Men: A Mixed-Methods Systematic Review.

Chemsex-the use of specific drugs during planned sexual activity to sustain or enhance sexual functioning (Bourne et al., 2015)-is widely reported as a major public health issue among gay, bisexual, and other men who have sex with men (GBM) in Western countries. Considering current evidence surrounding Chemsex, we conducted a mixed-methods systematic review regarding psychological and interpersonal factors associated with Chemsex behaviors among GBM. Publications covering Chemsex and psychological or social variables were eligible. Theoretical papers and studies solely presenting physical health outcomes were excluded. 35 English papers published between January 2008 and June 2019 were identified through PubMed, Scopus, and PsycINFO. We performed a parallel-results convergent synthesis (Hong, Pluye, Bujold, & Wassef, 2017) on results extracted from qualitative and quantitative studies comprising the final corpus. Qualitative data suggest that six mechanisms promote Chemsex-related behaviors: dealing with painful emotions or stressful events; normalization and risk minimization of sexualized drug use; giving into interpersonal pressure or fulfilling desire for community belonging; increasing intimacy or connectedness; enhancing sexual performance and functioning; lessening interpersonal and sexual inhibitions. In quantitative reports, six variable categories emerged: sexual control and self-efficacy; sexual functioning; mental health; attitudes toward substance use; life stressors and internalized stressors; and identification with sexual identities or scenes. This review summarizes key psychological and interpersonal correlates of Chemsex among GBM. Further research is needed to replicate current findings and explore new hypotheses across multiple GBM sociodemographic groups and cultural contexts, following best practices in sampling for hard-to-reach populations.

Virtual Reality and Sex Therapy: Future Directions for Clinical Research.

Rapidly growing new technologies are revolutionizing the field of mental health, in terms of both understanding and treating mental disorders. Among these, virtual reality (VR) is a powerful tool providing clients with new learning experiences benefiting their psychological well-being. This article offers an overview of the current literature on VR in psychotherapy, highlighting its relevance to sexual dysfunction (SD) treatment.A literature review of PubMed and Google Scholar databases was used to provide a description of the theoretical frameworks and clinical indications associated with VR use in psychotherapy and SD treatment. The effectiveness of VR exposure-based therapy has been empirically validated for several mental disorders, notably anxiety disorders. The emerging combined use of VR and mindfulness tends to focus on chronic pain treatment. Experimental research examining the use of immersive technologies in the treatment of SDs is lacking.Given the shortcomings of conventional SD treatments, exploring and developing specialized VR interventions may prove beneficial. VR offers promising avenues in sex therapy, particularly for the treatment of genital pain disorders or SDs in which anxiety plays a significant etiological role.

[Barriers to treatment access reported by people with anxiety disorders]. / Obstacles de l'accès au traitement rapportés par des personnes aux prises avec un trouble anxieux.

OBJECTIVES: Our study examined the barriers to treatment experienced by people with anxiety disorders (ADs) who had not received services for their problems. Recommendations to improve treatment access made by participants are reported. METHOD: A web-based questionnaire on treatment accessibility for anxiety disorders was completed by 610 people living in Quebec reporting an anxiety problem. Chi-square tests were used to compare answers from people who received services (n = 151) with answers from people who had not (n = 434 ). RESULTS: Treatment wait times that were too long (X2 = 29.66, df = 1, P < 0.001 ), difficulties reaching a professional by phone (X2 = 13. 75, df = 1, P < 0.001 ), and geographical distance from service sites (X2 = 4.34, df = 1, P = 0.04) were obstacles that hindered participants who had not received the services they were seeking, more than those who had received services. CONCLUSIONS: Participant-reported barriers and recommendations highlight the need to increase access to health care professionals in terms of wait times, to train and inform primary care professionals about screening and treating ADs, and to develop psychotherapeutic services availability in the public health network.

Objective: Our study examined the barriers to treatment experienced by people with anxiety disorders (ADs) who had not received services for their problems. Recommendations to improve treatment access made by participants are reported. Method: A web-based questionnaire on treatment accessibility for anxiety disorders was completed by 610 people living in Quebec reporting an anxiety problem. Chi-square tests were used to compare answers from people who received services (n = 151) with answers from people who had not (n = 434). Results: Treatment wait times that were too long (χ2 = 29.66, df = 1, P < 0.001), difficulties reaching a professional by phone (χ2 = 13.75, df = 1, P < 0.001), and geographical distance from service sites (χ2 = 4.34, df = 1, P = 0.04) were obstacles that hindered participants who had not received the services they were seeking, more than those who had received services. Conclusions: Participant-reported barriers and recommendations highlight the need to increase access to health care professionals in terms of wait times, to train and inform primary care professionals about screening and treating ADs, and to develop psychotherapeutic services availability in the public health network.

[Taking care of outreach workers who intervene with marginal youths : Part 2]. / Des rencontres de proximité : le prendre soin de soi des intervenants au coeur de l'intervention solidaire pour joindre les jeunes en marge : Deuxième partie.

Outreach work with youths in a precarious situation raises emotions and questions in workers while confronting them with their own suffering and fragility. In order to help them help as well as counter the risk of vicarious traumatisation, spaces for talking and exchanging with a third party have been created in various intervention settings. The objective is to allow them to elaborate on what their work makes them feel and thus preserve their stability and their ability to think. Through group or individual clinical discussions, these exchanges favor distancing and allow new perspectives on their work. That is why peer support appeared as an essential element for psychologists and therapists who support not only youths but the workers who help them. The setting up of our outreach meetings-a result of our observation, allows keeping the flame alive without risking being burned. In this article, the issue of marginality in professionals working with homeless youths-as well as our own-is raised. It sometimes translates in the absence of a fixed location for a meeting symbolizing traditional stability, sometimes in the necessary flexibility of a framework to reach this population, sometimes in the openness to otherness and more precisely to a difference that disturbs when anxiety that this disaffiliated being raises, could well be our very self! Is it really marginality or a particular positioning aiming at constructive denunciation of stigmatization, unjust exclusion that youths with mental health and addiction problems sustain that place them at risk of homelessness? Neither missionaries, nor saviors are needed, but only hopeful facilitators working alongside people who want to stand up and take their place in society.

[Close team work: sharing knowledge, solidarity and hope]. / Des rencontres de proximité: apprendre de l'autre, pour tisser de la solidarité et de l'espoir. Première partie.

A proximity team was created more than eight years ago by a group of health professionals working with disaffiliated and homeless youth in the most precarious of situations. Proximity meetings have continued since that time, despite many changes within the team, including departures and new arrivals. The proximity team is a partnership project which revolves around common values and principles aimed at improving services for youth who find themselves marginalized or at risk of exclusion. Health professionals from various backgrounds explain why they believe in this approach to proximity work.