Self-efficacy as a relevant construct in understanding sexual response and dysfunction.

While self-efficacy has been widely used to explain and treat various biobehavioral responses, few investigations have examined this concept in the context of sexual response and dysfunction. In this study, the authors constructed a measure of sexual self-efficacy, investigated whether it differentiated men with and without sexual dysfunction, and determined the utility of this construct by exploring its relation to other variables known to be related to erectile dysfunction in a sample of 60 men with erectile dysfunction and 14 functional men visiting a urology clinic. The sexual self-efficacy index differentiated men with and without erectile dysfunction, and general linear modeling showed that the index did indeed relate to other variables known to affect sexual and emotional response during a partnered sexual experience. These findings suggest that, as a unifying construct that predicts cognitive, affective, motivational, and behavioral responses, sexual self-efficacy has the potential to play an important role in the assessment of effective treatments for sexual problems.

Role of attribution in affective responses to a partnered sexual situation among sexually dysfunctional men.

UNLABELLED: Study Type - Therapy (qualitative) Level of Evidence 4 What's known on the subject? and What does the study add? Sexually dysfunctional men report higher negative affect and lower positive affect than sexually functional men. Furthermore, men with sexual problems tend to make internal, self-blaming, attributions for negative sexual events, which can result in a diminished sense of self-efficacy and cause men to expect similar negative outcomes across future sexual situations. This pattern may sustain and actually intensify the sexual problem. This study shows that causal attributions for dysfunctional response influence emotional response to a partnered sexual situation. Specifically, sexually dysfunctional men who attribute their problem to a medical condition do better emotionally than those who attribute the problem to unknown or psychological factors - and this attribution process is a more powerful and reliable predictor of emotional response than the man's actual diagnosed somatic risk for a sexual problem. Furthermore, the study strongly suggests that those men who attribute their problem to a physical/medical issue are able to 'externalize' it - needing to assume less responsibility for and/or control over it, thereby reducing their psychological burden. These findings indicate not only that communication between physician and patient regarding the aetiology of a sexual problem may be critically important but also that, at least for some patients, pharmacological treatment should be combined with strategies that promote the development of internal positive self-serving attributions surrounding sexual activity. OBJECTIVE: To investigate factors that influence sexually dysfunctional men's emotional response within a partnered sexual situation, and, most specifically, whether they attribute their dysfunctional response to a specific biomedical cause vs a psychological or unknown cause. PATIENTS AND METHODS: Based on a sample of 59 sexually dysfunctional men visiting a urology clinic, linear regression was used to determine the relationship between patients' attributions and five global affective factors derived through principal components analysis: apprehension, insecure, arousable, affection, and pleasant. Two other covariates were included: actual (diagnosed) somatic risk as determined by the patient's medical history and clinician's notes, and the patient's self-reported importance of sexual intimacy. RESULTS: Attribution (biomedical vs psychological/unknown) had significant effects on three psycho-affective factors (insecure, arousable, affection); men who attributed their problem to a biomedical cause had higher positive affect and lower insecurity. Diagnosed somatic risk was significant for insecure and marginally for affection. Importance of sex was significant on four psycho-affective variables (insecure, arousable, pleasant, affection), with higher endorsement associated with higher insecurity and lower positive affect. CONCLUSIONS: Men who can attribute their sexual dysfunction to a medical condition do much better emotionally (higher positive affect and lower negative affect) than those who attribute the problem to unknown or psychological factors - and this factor is more predictive of their emotionality than the patient's actual somatic risk for sexual dysfunction. As demonstrated in a previous analysis, higher ratings of the importance of sex independently predicted stronger negative affect for men experiencing sexual problems.