The impact of COVID-19 and long COVID on sexual function in cisgender women.

BACKGROUND: Research suggests that COVID-19 impairs sexual function in men, but little is known about the impact of COVID-19 (or long COVID) on sexual function in women. AIM: We sought to compare the sexual function of cisgender women who had never had COVID-19, who had COVID-19 but not long COVID, and who had long COVID, and assessed whether long COVID symptoms and/or emotional distress mediate the relationship between COVID-19 history and sexual function. METHODS: In total, 2329 adult cisgender women were recruited online as study participants. Half of these women reported having had COVID-19, and the other half reported never having had COVID-19. Of those who had COVID-19, 25% (n = 170) reported having long COVID. We compared the mean Female Sexual Function Index (FSFI) scores by using t-tests for each of the primary comparison categories (never COVID vs COVID and only COVID vs long COVID). Four path models were used to test the hypotheses that (1) long COVID symptoms or (2) depression, anxiety, and/or stress assessed with the subscales of the 21-item Depression, Anxiety, and Stress Scale (DASS-21) mediated the relationship between COVID-19 and sexual function. OUTCOMES: Sexual function was measured with the FSFI, long COVID symptoms were assessed using the Centers for Disease Control working symptom set, and emotional distress was measured with the DASS-21. RESULTS: In total, 1313 participants provided data suitable for analysis. The never-COVID group (n = 645, 49.1%) had higher scores on the Desire, Arousal, Lubrication, and Satisfaction subscales of the FSFI (mean [M] [SD] FSFI total Mnever COVID = 27.98 [4.84] vs MCOVID = 27.05 [5.21]) than the combined only-COVID (n = 498, 37.9%) and long-COVID (n = 170, 12.9%) groups. The FSFI subscale scores were significantly higher in the only-COVID group than in the long-COVID group for the Arousal, Lubrication, and Orgasm and lower for the Pain subscales and higher for overall sexual function (FSFI total Monly COVID = 27.49 [5.00] vs Mlong COVID = 25.77 [5.61]. None of the proposed mediation models had adequate model fit. CLINICAL IMPLICATIONS: Clinicians treating cisgender women who have COVID-19 should consider proactively discussing sexual function with their patients and offering available resources. STRENGTHS AND LIMITATIONS: In this study we used a large and diverse sample, but this sample did not include transgender or gender-diverse persons. This study was also correlational; as such, causal conclusions cannot be drawn. Further, the mechanism of action remains unexplained. CONCLUSIONS: The study findings suggest the following: (1) COVID-19 infection is associated with impaired sexual function in cisgender women, and (2) that women with long COVID experienced incrementally more impaired sexual function than women with COVID-19 who did not develop long COVID.

Emotional responding: Integration of multiple constructs and association with psychological health.

OBJECTIVE: Numerous psychological constructs exist to describe different facets of emotional responding, but they have rarely been examined together. We empirically modeled the associations between four psychological constructs (mindfulness, emotional nonacceptance, experiential avoidance, and anxiety sensitivity) of individuals' responses to their affective experience, hypothesizing that a bifactor model would fit the data best. METHOD: We used exploratory structural equation modeling, a novel latent variable modeling framework, to compare five measurement models of emotional responding in an online community sample (N = 307). RESULTS: A bifactor model including a general emotional responding factor had substantial factor loadings from nearly all items, with mixed results for specific factors. Exploratory analyses supported the significant association of avoidant emotional responding and psychopathology/well-being. CONCLUSION: The general avoidant emotional responding factor appears to overlap most directly with experiential avoidance and may be a transtheoretical construct relevant to mental health.

On the Content of "Real-World" Sexual Fantasy: Results From an Analysis of 250,000+ Anonymous Text-Based Erotic Fantasies.

A recurring problem with the study of sexual fantasy is that of social desirability bias. Study participants may report fantasies that are consistent with general societal expectations of fantasy content, as opposed to themes characterized by their actual fantasies. The wide availability of erotic material on the Internet, however, facilitates the study of sexual fantasy narratives as they are anonymously expressed and viewed online. By extracting approximately 250,000 text-based erotic fantasies from a user-generated website, we sought to examine "real-world" sexual fantasies, determine the themes that were typical of these narratives, and explore the relationship between themes and story popularity (as assessed by story views per day). A principal components analysis identified 20 themes that commonly occurred across the massive corpus, and a path analysis revealed that these themes played a significant role in predicting the popularity of the sexual fantasy narratives. In particular, the empirically identified themes reflecting familial words (e.g., mother, father) and colloquial sexual words (e.g., cock, fuck) were predictive of story popularity. Other themes identified included those not obviously erotic, such as those consisting of words reflecting domesticity (e.g., towel, shower) and colors (e.g., brown, blue). By analyzing a sexual fantasy corpus of unprecedented size, this study offers unique insight into both the content of sexual fantasies and the popularity of that content.

Loneliness as a mediator for college students' social skills and experiences of depression and anxiety.

INTRODUCTION: Rates of anxiety and depression are increasing among college undergraduates. Existing research has demonstrated a link between social skills and mental health outcomes. This study explores the relationship between verbal social skills (encoding and decoding) and anxiety and depression by measuring the extent to which loneliness mediates these relationships. METHODS: Baseline data from a cross-sequential study exploring college student mental health was used to analyze social skills, loneliness, as well as, depression and anxiety. A diverse group of students (n = 2,054; M = 19.95; SD = 1.26) participated from two residential colleges in the United States. RESULTS: Six mediation models were estimated, separately testing whether loneliness mediated the relationship between anxiety and depression and social expressiveness, sensitivity, and control. All six found that (a) anxiety and depression were separately predicted by the verbal encoding skills of social expressivity and social control and the decoding skill of social sensitivity, and (b) all of those relationships were mediated by loneliness. These models accounted for 37-38% of the variability in scores of depression and 17-20% of the variability in scores of anxiety. CONCLUSIONS: The results of this study indicate verbal social skills play an important role in students experience of loneliness as well as depression and anxiety. Improving the social skills of students should be considered by colleges seeking to reduce the mental health burdens experienced by their students.

A house is not a home: Modeling the effects of social support and connection within resettled refugee populations.

AIM: The U.S. resettlement program currently resettles refugees in communities of similar or the same ethnic background known as like-ethnic communities. This practice provides resettled refugees with a familiar community who may be able to provide support through the difficult resettlement process. However, by associating with a like-ethnic community, resettled refugees may limit interaction with the host community, which may have subsequent adverse effects on well-being. METHODS: This study examined whether satisfaction with community support is moderated by a premigration factor (trauma history) or a postmigration factor (English fluency) in predicting depressive symptoms in a resettled refugee community (N = 179). Four moderation models were analyzed and compared. RESULTS: The model in which English fluency moderated the relationship between satisfaction with community support and depressive symptoms had the best overall model fit. In addition, trauma history was found to also be a meaningful but secondary moderator within this relationship. English fluency and trauma history within this study did not significantly interact. CONCLUSION: These results highlight the importance of early English language lessons and community support during resettlement. Further, they emphasize the need to integrate refugees with individuals from similar backgrounds, as well as with host communities throughout resettlement.

The Role of Family Environment and Multiple Forms of Childhood Abuse in the Shaping of Sexual Function and Satisfaction in Women.

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.

Dissociation during sex and sexual arousal in women with and without a history of childhood sexual 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.

Declines in social-emotional skills in college students during the COVID-19 pandemic.

Introduction: The present study investigated whether social-emotional skills in first year college students differed before and after the coronavirus disease (COVID-19) lockdowns. Methods: Participants (N = 1,685) consisted of first year college students (mean age 18.53 years) selected from a broader cohort enrolled in a longitudinal study on college mental health at liberal arts colleges in the United States. In a cohort-sequential design, participants completed an online survey assessing social-emotional skills in January of 2018, 2019, 2020, and 2022. Using analysis of covariance, we examined mean differences in social-emotional skills between students who were first years before (January 2018-2020) and after the lockdowns (January 2022), controlling for sociodemographic variables. Results: The post-lockdown group scored significantly lower on emotional control and expressivity and marginally higher on social sensitivity compared to the pre-lockdown group. No group differences in social/emotional expressivity or social control were detected. Discussion: These findings indicate that the COVID-19 lockdowns impaired some, but not all, social-emotional skills in first year college students. Addressing social-emotional skills in college may help to reduce the COVID-19 mental health burden.

Relationship of insomnia to sexual function and sexual satisfaction: Findings from the sleep and sex survey II.

OBJECTIVE: Research suggests that healthy sleep is a key component of sexual function. When evaluating sexual function, however, poor sleep is often overlooked as a contributing factor. This cross-sectional survey expands prior work by exploring relationships among insomnia severity, sexual satisfaction, and sexual function with an updated battery of measures for the Sleep and Sex Survey. METHOD: The sample (N = 1266) consisted of 618 men, 648 women recruited via Prolific, an online survey platform. The Sleep and Sex Survey II included measures addressing insomnia, fear of sleep, nightmares, sexual function, sexual satisfaction, sexual activity, depression, anxiety, posttraumatic stress, and alcohol use. RESULTS: Recent sexual activity was correlated with better sleep, lower anxiety, and lower scores on a posttraumatic stress disorder screener. Insomnia severity was negatively correlated with sexual satisfaction (r = 0.22, p < .001) and the presence of insomnia was associated with higher rates of sexual dysfunction in women (53.8% vs. 31.8%; p < .001) and men (22.7% vs. 12.5%; p = .036). In regression analyses, after accounting for depression and anxiety, insomnia had a statistically significant association with sexual function for women (ß = 0.12; p < .01) but not men (ß = 0.11; p = .60). CONCLUSION: Findings support a relationship of insomnia to sexual function and satisfaction with some gender differences. Future work may be enhanced by assessing these relationships in a gender diverse population including objective sleep measures and addressing contributing mechanisms. Clinically, findings support the assessment of sleep when evaluating patients for sexual dysfunction.

Gender effects on mental health symptoms and treatment in college students.

PURPOSE: Mental health problems are a growing concern on college campuses. Although postsecondary institutions often provide mental health services to students free of charge, it is unclear which students access such treatment and why. Methods: This study examined predictors of mental health treatment among college students. 2,280 students completed an online survey to assess demographic variables, mental health symptoms (depression, anxiety), stress and prior/current mental health treatment. Results: After accounting for symptom severity, men were less likely to receive treatment for mental health problems and LGBQ students were more likely to receive treatment. That difference was not evident at higher levels of depression and anxiety. Finally, self-reported anxiety but not depressive symptoms predicted being in mental health treatment. Conclusions: These findings can help inform efforts to target college students who could benefit from treatment but are not seeking it.

Change in the Popularity of Transgressive Content in Written Erotica between 2000 and 2016.

There is a widely held belief that the amount and intensity of transgressive content in pornography have been rising. Reliably assessing for such an increase, however, is complicated by methodological factors including hand-coding content using conflicting a priori definitions of what constitutes transgressive content. In response to those limitations, the present study used the results of a published empirical content analysis of ~250,000 erotic stories written over 16 years to determine if the amount or popularity of transgressive content (stories high in the themes of violence, family (incest), or BDSM) has changed in that timeframe. Results from the present study indicated no meaningful increase in either the amount of content with those themes or popularity (as measured by story views per day) of any of the three transgressive themes within the erotic narratives over the 16-year period of analysis. These results, in addition to recent research presenting similar findings within pornographic video, do not support popular perceptions that erotic material is becoming increasingly transgressive. Rather, such content within internet-based erotic material, and particularly erotic narratives, appears to be relatively consistent.

Impact of COVID-19 predicts perceived risk more strongly than known demographic risk factors.

OBJECTIVE: To identify the factors associated with perceived COVID-19 risk among people living in the US. METHODS: A cross-sectional representative sample of 485 US residents was collected in mid-April 2020. Participants were asked about (a) perceptions of COVID-19 risk, (b) demographic factors known to be associated with increased COVID-19 risk, and (c) the impact of COVID-19 on different life domains. We used a three-step hierarchical linear regression model to assess the differential contribution of the factors listed above on perceived COVID-19 risk. RESULTS: The final model accounted for 16% of variability in perceived risk, F(18,458) = 4.8, p < .001. Participants who were White reported twice as much perceived risk as participants of color (B = -2.1, 95% CI[-3.4,-0.8]. Higher perceived risk was observed among those who reported a negative impact of the pandemic on their sleep (B = 1.5, 95% CI[0.8,2.1]) or work (B = 0.7, 95%CI[0.1,1.3]). The number of cases per capita in their state of residence, age, or proximity to someone with a COVID-19 diagnosis were not found to meaningfully predict perceived risk. CONCLUSIONS: Perceived risk was not found to be associated with known demographic risk factors, except that the effect of race/ethnicity was in the opposite direction of existing evidence. Perception of COVID-19 risk was associated with the perceived personal impact of the pandemic.

Emotional Intelligence, Belongingness, and Mental Health in College Students.

Mental health problems are prevalent amongst today's college students and psychosocial stress has been identified as a strong contributing factor. Conversely, research has documented that emotional intelligence (EQ) is a protective factor for depression, anxiety and stress (mental health problems). However, the underlying mechanism whereby EQ may support stronger mental health is currently not well understood. This study used regression analyses to examine the hypothesis that belongingness (inclusion, rejection) partially mediates the effects of EQ (attention, clarity, repair) on psychological well-being in a large sample (N = 2,094) of undergraduate students. Results supported the mediation hypotheses for all three EQ components and highlighted that the effects of rejection on psychological well-being were particularly strong. In line with prior research, our results indicate that prevention and intervention efforts with college students could explicitly target EQ skills in an effort to reduce perceived rejection and promote student well-being.

An internet-based mind/body intervention to mitigate distress in women experiencing infertility: A randomized pilot trial.

OBJECTIVE: To determine if an internet-based mind/body program would lead to participants experiencing infertility (1) being willing to be recruited and randomized and (2) accepting and being ready to engage in a fertility-specific intervention. Secondary exploratory goals were to examine reduced distress over the course of the intervention and increased likelihood to conceive. METHODS: This was a pilot randomized controlled feasibility trial with a between-groups, repeated measure design. Seventy-one women self-identified as nulliparous and meeting criteria for infertility. Participants were randomized to the internet-based version of the Mind/Body Program for Fertility or wait-list control group and asked to complete pre-, mid- and post-assessments. Primary outcomes include retention rates, number of modules completed, and satisfaction with intervention. Secondary exploratory outcomes sought to provide preliminary data on the impact of the program on distress (anxiety and depression) and self-reported pregnancy rates relative to a quasi-control group. RESULTS: The retention, adherence, and satisfaction rates were comparable to those reported in other internet-based RCTs. Although time between pre- and post-assessment differed between groups, using intent-to-treat analyses, women in the intervention group (relative to the wait-list group) had significant reduction in distress (anxiety, p = .003; depression, p = .007; stress, p = .041 fertility-social, p = .018; fertility-sexual, p = .006), estimated as medium-to-large effect sizes (ds = 0.45 to 0.86). The odds of becoming pregnant was 4.47 times higher for the intervention group participants as compared to the wait-list group, OR 95% CI [1.56, 12.85], p = .005 and occurred earlier. The findings suggest that the research design and program specific to this population are feasible and acceptable. Replication efforts with an active control group are needed to verify distress reduction and conception promotion findings.

The Differential Role of Coping, Physical Activity, and Mindfulness in College Student Adjustment.

Research has examined the function of stress management techniques, including coping, physical activity, and mindfulness on college students' adjustment. The present study examined the differential contributions of three stress management techniques to students' maladaptation (perceived stress, depression, anxiety, and loneliness) and adaptation (self-esteem). Undergraduate students (N = 1185) responded to an online survey. Hierarchical linear regression results indicated that all three stress management techniques - coping, physical activity, and mindfulness - were related to the five outcomes as predicted. Higher levels of disengagement coping strategies were related to higher perceived stress, anxiety, and depression. Components of mindfulness emerged as a strong predictor of adaptation.

FSFI scores of women with persistent genital arousal disorder compared with published scores of women with female sexual arousal disorder and healthy controls.

INTRODUCTION: Although persistent genital arousal disorder (PGAD) has been mistaken for hypersexuality, there is no research documenting the sexual functioning of PGAD women to support or refute such an assumption. AIM: To compare the Female Sexual Function Index (FSFI) scores of PGAD women to that of women diagnosed with female sexual arousal syndrome (FSAD) and healthy controls. METHODS: The FSFI scores of heterosexual women who met all five features qualifying for a diagnosis of PGAD (N = 172) on an online questionnaire were compared with previously published FSFI scores of women diagnosed with FSAD (N = 128) and healthy controls (N = 131). MAIN OUTCOME MEASURE: Total and subscale scores on the FSFI. RESULTS: On every subscale of the FSFI with the exception of desire, the PGAD women obtained scores between that of the FSAD and the healthy control group. The FSAD women displayed the greatest problems in desire, arousal, lubrication, orgasm, and pain while women with PGAD reported somewhat more desire than the control group but did not meet the cutoff score for sexual dysfunction. PGAD women are more similar to the normal control group than women with FSAD. CONCLUSIONS: There is no evidence to support the belief that women who meet criteria for a diagnosis of PGAD are "hypersexual." In fact, their overall sexual functioning falls within the normal range and is significantly better than that of women diagnosed with FSAD.

To BATHE or not to BATHE: patient satisfaction with visits to their family physician.

BACKGROUND: BATHE is an acronym for Background, Affect, Trouble, Handling, and Empathy and refers to specific questions or comments incorporated into a standard medical interview. The BATHE technique was developed as a rapid psychosocial intervention for the assessment of psychological factors that may contribute to patients' physical complaints. The present research was designed to determine whether the use of BATHE significantly increased patient satisfaction during a visit to a family physician. METHODS: Four family physicians in a busy urban family practice center were involved in the study. Two physicians were instructed to use the BATHE protocols until data had been collected from 10 patients and then to proceed in their usual fashion with their next 10 patients. The other two physicians conducted their interview as usual with their first 10 patients and then used BATHE with the following 10 patients. All patients were asked to complete a satisfaction survey following their consultation. RESULTS: BATHEd patients responded with significantly higher ratings for 8 of the 11 satisfaction measures, including those related to information provided, perception of physician concern, and likelihood of recommending the physician to others. CONCLUSIONS: The results of this pilot study support the use of BATHE with primary care patients, as it increases patient satisfaction, possibly by helping patients sense that their physician is sympathetic and concerned.

The sleep and sex survey: Relationships between sexual function and sleep.

OBJECTIVE: Distress and dysfunction in sleep and sex are both very common, and have been found to be separately related to anxiety, depression, and stress. Even so, and despite evidence linking obstructive sleep apnea and erectile disfunction, the connections between sleep and sex are largely understudied. METHOD: A large (N = 703) survey of people in the United States between 18 and 65 years old was conducted using Mechanical Turk, an on-line crowd-sourcing platform. Approximately 30% of participants were Black, Hispanic, Asian, or Native American, 8% identified as lesbian, gay or bisexual, and the sampling structure ensured an even gender distribution in each of 5 age strata. The Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), International Index of Erectile Function (IIEF), and Female Sexual Function Index (FSFI) assessed sleep and sexual dysfunction; the Perceived Stress Scale (PSS), Patient Health Questionnaire (PHQ-9), and General Anxiety Disorder scale (GAD-7) measured stress, depression, and anxiety to measure variance. RESULTS: We found a significant connection between insomnia severity and sexual function. The relationship remained significant after accounting for the shared variability associated with depressive and anxious symptoms, and perceived stress. CONCLUSION: Given this relationship, clinicians observing dysfunction in one area should routinely assess for dysfunction in the other. Further research will be required to determine (a) if treatment of one has an effect on the other, and (b) if this connection is related to a common psychopathological factor and/or is a conditioned association related to the commonly shared context of bed.

Sexual vs. Nonsexual Currently Most Upsetting Trauma: A Fresh Look at Attenuation of Sexual Response, Alcohol Intoxication, and Post-Traumatic Stress.

This study examined the dependence of sexual response (vaginal pulse amplitude [VPA] and subjective sexual arousal) on alcohol intoxication (.10% breath alcohol concentration [BrAC] versus no alcohol) and the nature of a woman's currently most upsetting traumatic event (C-MUTE), whether it was sexual (e.g., rape) or nonsexual (e.g., combat). Self-reported sexual outcomes were also compared by C-MUTE type. A total of 117 women completed background measures and either drank alcoholic or nonalcoholic beverages. They were shown erotic films and their VPA was assessed. A two (sexual versus nonsexual C-MUTE) by two (.10% BrAC versus no alcohol) analysis of variance (ANOVA) showed that, controlling for post-traumatic stress (PTS) symptoms, women with a sexual C-MUTE showed lower percent VPA change than women with a nonsexual C-MUTE. No significant effects were found for subjective sexual arousal. A multivariate analysis of variance (MANOVA) showed that women with a sexual C-MUTE reported more frequent anxiety and inhibition during partnered sex and more frequent lack of vaginal lubrication versus women with a nonsexual C-MUTE. There was no significant interaction between C-MUTE and alcohol intoxication. Whether a woman is currently upset by past sexual victimization may influence current sexual difficulties. Attenuated VPA may be attributable to the sexual nature of a C-MUTE as opposed to general trauma exposure.

Father Participation in Child Psychopathology Research.

The purpose of the current study was two-fold: (1) To examine time trends of the inclusion of fathers in child psychopathology research from 2005 to 2015; and (2) to examine online crowdsourcing as a method to recruit and study fathers. In study 1, findings indicated that, relative to two earlier reviews of father participation from 1984 to 1991 and 1992-2004, there has been limited progress in the inclusion of fathers in child psychopathology research over the last decade. In study 2, without explicit efforts to recruit fathers, almost 40% of a sample of 564 parents recruited from online crowdsourcing (Amazon's Mechanical Turk) were fathers. Major demographic differences did not emerge between mother and father participants and data were equally reliable for mothers and fathers. Fathers were more likely to drop out over the course of a 12-month follow-up but these differences in retention between mothers and fathers were non-significant if fathers were retained at a 2-week follow-up. Finally, family process models tested across four assessments (baseline, 4, 8, and 12 month follow-ups) indicated that data from fathers are equally supportive of convergent validity as data from mothers. We concluded that online crowdsourcing is a promising recruitment methodology to increase father participation in child psychopathology research.