Personal genital satisfaction is associated with differences in perception of male and female sexual anatomy and function.

BACKGROUND: Prior studies primarily of men correlated low personal genital satisfaction (PGS) with decreased sexual activity; however, the association between PGS and genital anatomy perceptions is unknown, and there is a paucity of studies examining women. AIM: We assessed the relationship between genital satisfaction, survey respondent sexual activity, and perceptions of anatomy and function. METHODS: A 54-item REDCap survey was distributed to any-gendered volunteers ≥18 years of age through ResearchMatch from January to March 2023. Responses were split into (1) high PGS and (2) low PGS. Analysis was performed using chi-square tests on survey responses and a Mann Whitney U test on median satisfaction level. OUTCOMES: Outcomes were genital anatomy perceptions, sexual activity, and respondents' PGS. RESULTS: Of the 649 respondents who started the survey, 560 (86.3%) completed it. Median PGS was 7 of 10, forming subgroups of high (≥7 of 10) satisfaction (n = 317 of 560 [56.6%]) and low (<7 of 10) satisfaction (n = 243 of 560 [43.4%]). The mean age was 45.8 ± 16.8 years, and demographics were notable for 72.1% women (n = 404 of 560), 83.2% White (n = 466 of 560), 47.9% married (n = 268 of 560), and 75.5% bachelor's degree holders (n = 423 of 560). Comparing high- and low-PGS groups, more low-PGS respondents felt normal flaccid penis length to be <2 inches (11.1% vs 5.1%; P = .008). High-PGS respondents more often responded that it is normal for women to have orgasms over half the time (20.8% vs 13.2%; P = .0002) or to identify as being sexually active (81.1% vs 71.6%; P = .008). Women were more likely than men to report larger normal testicle sizes as 60.1 to 90 mL (24.5% vs 10.3%; P < .0001), whereas more men felt that normal testicle size was 7 to 15 mL (26.3% vs 11.4%; P < .0001). Orgasm length perceptions also differed: more women felt female orgasm length was 2.6 to 5 seconds (36.6% vs 16.7%; P < .0001), and more men believed female orgasms to be longer, at 7.6 to 10 seconds (29.5% vs 17.3%; P = .002), 10.1 to 12.5 seconds (11.5% vs 5.2%; P = .0008), and >12.5 seconds (12.2% vs 5.7%; P = .009). Respondents' views on their genitalia differed by gender, with women more likely to feel that their genitals are normal compared with men (89.4% vs 75.0%; P < .0001). CLINICAL IMPLICATIONS: PGS may be a useful screening tool given its association with sexual activity. STRENGTHS AND LIMITATIONS: Our large-scale survey assesses public perceptions of genital anatomy and function. Limitations include a lack of gender nonbinary perceptions. CONCLUSION: Gender and PGS interact with perceptions of male anatomy and female sexual activity, and the frequency of sexual activity was higher among high-PGS respondents; however, the direction of these interactions remains unclear and requires future causal analysis.

Effects of Subjective Orgasm Experience in Sexual Satisfaction: A Dyadic Analysis in Same-Sex Hispanic Couples.

Subjective orgasm experience (SOE) is a component of sexual health that refers to the perception, sensation and/or appraisal of orgasm at a psychological level. This construct has scarcely been studied in non-heterosexual individuals and couples, and never before from a dyadic perspective. In this study, in which 104 same-sex Hispanic couples participated (48 male-male and 56 female-female), we explored the dyadic influence of SOE dimensions on sexual satisfaction, the mediating role of relationship satisfaction on the association of both phases of sexual response, as well as the explanatory capacity that discrepancies in these dimensions had on sexual satisfaction. The results indicated that the orgasmic dimensions that gained more prominence were Affective and Sensory. A dyadic influence of both on sexual satisfaction was observed only in male couples, as well as a detriment of sexual satisfaction when there were discrepancies in them, especially in women. Moreover, relationship satisfaction was a significant mediator between all dimensions of SOE and sexual satisfaction in both types of couples. This work highlights the need to take into account the SOE of both partners and how this individual experience can affect other dimensions of a more interpersonal nature, such as sexual or relationship satisfaction.

Victim Sexual Arousal During Nonconsensual Sex: A Scoping Review.

Sexual arousal in male and female victims during nonconsensual sex is an understudied phenomenon with many potential psychological, clinical, and legal implications for survivors. The aim of this scoping review was to assess the literature to determine whether we could estimate the frequency and circumstances of physiological sexual arousal (e.g., erection, lubrication, ejaculation, orgasm) among victims during nonconsensual sex. Six reference database and hand searches led to the screening of 13,894 articles and other reports. Eight articles and one book published between 1977 and 2019 included relevant data from 136 male survivors and 250 female survivors. Results confirmed that physiological sexual arousal (only genital responses were mentioned) can occur in both male and female victims during nonconsensual sex. The frequency of these responses could not be determined because of the widely different methodologies used. In addition, it was not possible to determine the circumstances in which victim sexual arousal was more likely to occur although some were inferred. The results of the scoping review highlight that physiological sexual arousal during nonconsensual sex does occur for victims but has not been studied systematically. There is a clear need to properly assess the type, circumstances, consequences, and frequency of sexual arousal during nonconsensual sex in large and diverse populations of male and female survivors.

Sexual Self-Esteem and Orgasm Consistency: Exploring the Unique Roles of Body Image and Genital Image.

We explored the unique roles that body and genital image play in behavior-specific orgasm consistency, beyond overall sexual self-esteem. US adults (N = 599; 64% women) completed questionnaires online. Hierarchical regression analyses predicted orgasm consistency during receptive oral sex and penile-vaginal intercourse (PVI) with additional clitoral stimulation (WAS) and with no additional clitoral stimulation (NAS) for the woman. Body image, genital image, and gender were entered in later steps to assess model improvement above sexual self-esteem. Models accounted for age, sexual and racial minority identities, and current relationship status. Results indicated that genital image improved all models and predicted higher orgasm consistency across all behaviors for men and women. For orgasm during receptive oral sex and PVI-NAS, sexual self-esteem was no longer significant once genital image was included. Genital image was a stronger predictor of women's versus men's orgasm during PVI-NAS; no significant gender differences were found for oral sex and PVI-WAS. Body image was not significant in any models, contrary to expectations, suggesting role overlap with sexual self-esteem. Genital image appears to play a unique role in sexual pleasure beyond overall sexual self-esteem and body image.

Neuroelectric Correlates of Human Sexuality: A Review and Meta-Analysis.

Many reviews on sexual arousal in humans focus on different brain imaging methods and behavioral observations. Although neurotransmission in the brain is mainly performed through electrochemical signals, there are no systematic reviews of the electrophysiological correlates of sexual arousal. We performed a systematic search on this subject and reviewed 255 studies including various electrophysiological methods. Our results show how neuroelectric signals have been used to investigate genital somatotopy as well as basic genital physiology during sexual arousal and how cortical electric signals have been recorded during orgasm. Moreover, experiments on the interactions of cognition and sexual arousal in healthy subjects and in individuals with abnormal sexual preferences were analyzed as well as case studies on sexual disturbances associated with diseases of the nervous system. In addition, 25 studies focusing on brain potentials during the interaction of cognition and sexual arousal were eligible for meta-analysis. The results showed significant effect sizes for specific brain potentials during sexual stimulation (P3: Cohen's d = 1.82, N = 300, LPP: Cohen's d = 2.30, N = 510) with high heterogeneity between the combined studies. Taken together, our review shows how neuroelectric methods can consistently differentiate sexual arousal from other emotional states.

The Relational Nature of Gender, the Pervasiveness of Heteronormative Sexual Scripts, and the Impact on Sexual Pleasure.

This study examined how gender shapes sexual interactions and pleasure outcomes. We highlight varying expectations people have in regard to sex by combining questions about orgasm frequency and sexual pleasure. Our analysis was driven from a sample of 907 survey responses from cis women, cis men, trans women, trans men, non-binary, and intersex millennial respondents, 324 of which had gender-diverse sexual histories. The findings built upon previous literature about the orgasm gap by including those with underrepresented gender identities and expanding our conceptualization of gender's role in the gap beyond gender identity. Qualitative results indicated that individuals change their behavior based on their partner's gender and follow strong gendered scripts. Participants also relied upon heteronormative scripts and cis normative roles to set their interactions for the sexual encounter. Our findings support previous research on how gender identity impacts pleasure outcomes and has implications for how we might make gender progress in the arena of sexuality.

Not Who You Are, But Who You Are With: Re-examining Women's Less Satisfying Sexual Debuts.

Gender differences in appraisals of first intercourse are among the largest in sexuality research, with women indicating less satisfying "sexual debuts" than men. Dispositional or "actor-level" explanations for this gender gap are pervasive, yet research has largely examined heterosexual debuts in which actor gender and partner gender are confounded. We assessed whether women's less satisfying sexual debuts are better explained by actor gender or partner gender, comparing experiences of women who debuted with men (WDM) with those of men and women who debuted with women (MDW, WDW). Retrospective accounts of sexual debut were collected from 3033 adults. At first intercourse, we found that WDW had equal physical and emotional satisfaction to MDW, and more satisfaction than WDM, suggesting satisfaction gaps owing to partner gender, not actor gender. This pattern did not extend to a comparison event (first masturbation), where WDW and WDM had similar satisfaction, but less satisfaction than MDW, suggesting an actor gender gap. To identify sources of satisfaction gaps, we probed for corresponding differences in the circumstances of sexual debut. Sexual circumstances were more strongly implicated than nonsexual ones, with relative deprivation of glans stimulation explaining relative dissatisfaction at first intercourse, but not first masturbation, and orgasm explaining it at both. Findings challenge the view that the satisfaction gap at first intercourse reflects an inherent difference between genders. Indeed, they demonstrate similarities when partner gender does not differ and suggest strategies for ensuring equal sexual satisfaction-and equal sexual rights realization-at (hetero) sexual debut.

The complexity of female orgasm and ejaculation.

The anatomy and physiology of the female orgasm are often neglected. The female orgasm is a normal psychophysiological function to all women, and some even can achieve ejaculation as part of the normal physiological response at the height of sexual arousal. The complexity of female sexuality requires a deep understanding of genital anatomy. The clitoris is the principal organ for female pleasure. The vaginal stimulation of the anterior vaginal wall led women to orgasm due to the stimulation of the clitourethrovaginal complex and not due to stimulation of a particular organ called the G spot in the anterior distal vaginal wall. Female ejaculation follows orgasm. It consists of the orgasmic expulsion of a smaller quantity of whitish fluid produced by the female prostate. Squirting can be differentiated from female ejaculation because it is the orgasmic transurethral expulsion of a substantial amount of diluted urine during sexual activity, and it is not considered pathological. The female orgasm is influenced by many aspects such as communication, emotional intimacy, long-standing relationship, adequate body image and self-esteem, proper touching and knowledge of the female body, regular masturbation, male sexual performance, male and female fertility, chronic pain, and capacity to engage in new sexual acts. Stronger orgasms could be achieved when clitoral stimulation, anterior vaginal wall stimulation, and oral sex is involved in the same sexual act.

Orgasm Rating Scale and Bodily Sensations of Orgasm Scale: Validation for Use With Pre, Peri, and Post-Menopausal Women.

BACKGROUND: Orgasm, particularly in older women, remains a poorly understood aspect of female sexual response partly because of a lack of validated self-report measures. AIM: To evaluate the Orgasm Rating Scale (ORS) and Bodily Sensations of Orgasm Scale (BSOS) for use with pre, peri, and post-menopausal women and between solitary and partnered orgasm contexts. METHODS: Participants (solitary context, 252 pre, 139 peri, 190 post; partnered context, 229 pre, 136 peri, and 194 post-menopausal women, aged 18-82 years) were asked to complete an online questionnaire based on most recent solitary and partnered orgasm. Principal components analysis with Varimax rotation summarized the data into interpretable baseline models for all groups. Multi-Group Confirmatory Factor Analysis tested for multi-group measurement invariance. Adjustments to the models were made, and final model structures were presented. MAIN OUTCOME MEASURES: ORS and BSOS measuring solitary and/or masturbation and partnered orgasm. RESULTS: For the ORS, 10 factor solutions were preferred, explaining 81% (pre), 80% (peri), and 81% (post) of the variance for the solitary and 83% (pre), 86% (peri), and 84% (post) of the variance for the partnered context. Factors included pleasurable satisfaction, ecstasy, emotional intimacy, relaxation, building sensations, flooding sensations, flushing sensations, shooting sensations, throbbing sensations, and general spasms. For the BSOS, 3 factor solutions were preferred, explaining 55% (pre), 60% (peri), and 56% (post) of the variance for the solitary and 56% (pre), 61% (peri), and 60% (post) of the variance for the partnered context. Factors included extragenital sensations, genital sensations and spasms, and nociceptive sensations and sweating responses. Divergent validity was observed (solitary r = -.04; partnered r = -.11) and configural, metric and scalar invariance for the solitary and partnered versions of the ORS and BSOS were found, suggesting the measures were interpreted similarly by all women. CLINICAL IMPLICATIONS: With valid measurement tools, women's varying orgasm experiences can be investigated more systematically and compared to address gaps and conflicts in the existing literature. Ultimately, these additions may assist with improved interventions for women who are unsatisfied with their orgasm experiences. STRENGTHS AND LIMITATIONS: Strengths include gaining the ability to compare age and menopausal status groups using empirically validated measures of orgasm experience. Limitations include cross-sectional design and lack of test-retest reliability measurement. CONCLUSION: The ORS and BSOS are supported for use with women across adulthood in solitary and partnered orgasm contexts and can be used concurrently to provide a comprehensive assessment. Webb AE, Reissing ED, Huta V. Orgasm Rating Scale and Bodily Sensations of Orgasm Scale: Validation for Use With Pre, Peri, and Post-Menopausal Women. J Sex Med 2022;19:1156-1172.

Feelings of Masculinity and Accomplishment in Response to Penetrative versus Non-Penetrative Orgasms.

Research indicates that men view their women partner's orgasms as reflections of their masculinity and sexual esteem. The purpose of this study was to examine this phenomenon in more detail by exploring whether men's feelings of masculinity and sexual esteem, as well as their feelings of accomplishment, were influenced by the method by which their woman partner experienced orgasm. Specifically, 193 young adult men (primarily between the ages of 18 and 24) read one of three vignettes (a partner orgasming from intercourse, from manual/oral stimulation, or from vibrator use) and then rated their imagined feelings of masculinity, accomplishment, and sexual esteem. Findings indicated that men who imagined their partner orgasmed from intercourse or manual/oral stimulation had higher feelings of masculinity and accomplishment than those who imagined their partner orgasmed from a vibrator. We found a significant interaction between clitoral knowledge and vignette condition in predicting masculinity, with clitoral knowledge only predicting masculinity for men in the manual/oral stimulation condition. The results of this study have important implications for sex education and the prevention of sexual problems, as well as for the future study of positive sexual functioning in women and men.

Single and Partnered Individuals' Sexual Satisfaction as a Function of Sexual Desire and Activities: Results Using a Sexual Satisfaction Scale Demonstrating Measurement Invariance Across Partnership Status.

Although some evidence exists to suggest that single (i.e., unpartnered) individuals are less sexually satisfied on average than are partnered individuals, it is unclear whether the variables correlating with each group's sexual satisfaction are similar or different. This research sought to examine how desire for and actual engagement in solitary and partnered sexual activities are associated with both groups' sexual satisfaction. We first conducted a preliminary study (n = 572) to test and refine existing measures of sexual satisfaction for applicability across relationship status. In two follow-up studies (N = 1,238), measurement invariance (across relationship status and gender) of the resulting 4-item sexual satisfaction scale was established. Further, results across the studies showed that for singles dyadic sexual desire was negatively related to sexual satisfaction, whereas no significant link was found with solitary desire. For individuals in romantic relationships, having higher sexual desire involving a partner and lower solitary desire were both associated with greater sexual satisfaction. When analyzing participants' responses on the desired and actual frequency of engaging in specific sexual acts, we found that for both single and partnered individuals, frequent engagement in partnered acts was associated with greater sexual satisfaction. Wanting frequent engagement in partnered acts was associated with lower sexual satisfaction for both groups, but only if the current frequency of engaging in these acts was low. These findings suggest that at least during the COVID-19 pandemic, meeting desires for partnered sex plays an important role in maintaining a sexually satisfying life, regardless of one's relationship status.

Enhanced visualization of female squirting.

INTRODUCTION: Squirting is the involuntary expulsion of fluid from the female urethra following stimulation of the anterior vaginal wall before or during orgasm. The mechanism underlying squirting has not been established. PURPOSE: To elucidate the mechanism of squirting. METHODS: The subjects in the current study were women who were able to squirt. They were not sex workers. A urethral catheter was inserted before sexual stimulation and the bladder was emptied. Then, a mixture of indigo carmine (10 ml) and saline (40 ml) was injected into the bladder. Sexual stimulation was provided to facilitate squirting, which was videotaped and verified. The secretions were collected in sterile cups, and prostate specific antigen (PSA) and glucose levels were measured. RESULTS: Five women (2 in the 30s, 2 in the 40s, and 1 in the 50s) participated in this study. All women were able to squirt; three squirted only with manual sexual stimulation and two with penetrative sexual stimulation. The discharged fluid was blue in all cases, confirming the bladder as the source. The fluid was PSA-positive in four patients. CONCLUSIONS: The main component of squirt fluid is urine, but may also contain fluid from Skene's glands (female prostate). This is the first report in which visualization of squirting was enhanced.

The overlooked reproductive function of the human clitoris-News media responses to the published review.

A brief survey of how the news media reported and misreported on the publication of the review that revealed the overlooked empirical evidence for the reproductive function of the human clitoris.

Female ejaculation: An update on anatomy, history, and controversies.

Female ejaculation is a contentious topic. From a review of the literature, history indicates that it is not a modern concept; some females were aware of it in times past without understanding the role of the fluid or composition of the ejaculate. Over time, scholars experimented, mainly with anatomical studies, in an attempt to identify the source of the ejaculate and explore its physiological and anatomical benefits for the female sexual experience. Despite these studies, views about female ejaculation remain controversial and inconsistent, with no clear conclusion as to its function. This review discusses the history of studies of female ejaculation and presents various hypotheses from an anatomical and physiological perspective. After reviewing 44 publications from 1889 to 2019, it became apparent that clinical and anatomical studies conducted during recent decades provide substantial evidence in support of the female ejaculatory phenomenon. Anatomical studies have shown that the ejaculate originates in the paraurethral (Skene's) glands, but its composition has been debated. Female ejaculate differs from urine in its creatinine and urea concentrations. The fluid also contains prostate specific antigen (PSA) and could have antibacterial properties that serve to protect the urethra. While the specific function of female ejaculation remains a topic of debate, there is sufficient evidence to support the existence of the phenomenon.

Time to Orgasm in Women in a Monogamous Stable Heterosexual Relationship.

BACKGROUND: Orgasm in women is a complex phenomenon, and the sparse data about time to orgasm (TitOr) in women are an impediment to the research on this complex phenomenon. AIM: To evaluate the stopwatch measured TitOr in women in a monogamous stable heterosexual relationship. METHODS: The study was conducted through web-based and personal interview using a questionnaire, which addressed the issues related to TitOr. Sexually active women older than 18 years and women in a monogamous stable heterosexual relationship were included in the study. Those with comorbidities such as diabetes, hypertension, asthma, psychiatric illness, sexual dysfunction and those with partners with sexual dysfunction were excluded. The participants reported stopwatch measured TitOr after adequate sexual arousal over an 8-week period. The data analysis was performed using GraphPad software (©2018 GraphPad Software, Inc, USA). OUTCOMES: The outcomes included stopwatch measured average TitOr in women. RESULTS: The study period was from October 2017 to September 2018 with a sample size of 645. The mean age of the participants was 30.56 ± 9.36 years. The sample was drawn from 20 countries, with most participants from India, the United Kingdom, the Netherlands, and the United States of America. The mean reported TitOr was 13.41 ± 7.67 minutes (95% confidence interval: 12.76 minutes-14.06 minutes). 17% of the participants had never experienced the orgasm. Penovaginal intercourse was insufficient to reach orgasm in the majority, in whom it was facilitated by certain positions and maneuvers. CLINICAL IMPLICATIONS: The knowledge of stopwatch measured TitOr in women in real-life setting helps to define, treat, and understand female sexual function/dysfunction better and it also helps to plan treatment of male ejaculatory dysfunction, as reported ejaculatory latency in healthy men is much less than the reported TitOr here. STRENGTHS & LIMITATIONS: Use of stopwatch to measure TitOr and a large multinational sample are the strength of the study. The absence of a crosscheck mechanism to check the accuracy of the stopwatch measurement is the limitation of the study. CONCLUSION: Stopwatch measured average TitOr in the sample of women in our study, who were in a monogamous stable heterosexual relationship, is 13.41 minutes (95% confidence interval: 12.76 minutes-14.06 minutes) and certain maneuvers as well as positions during penovaginal intercourse help achieving orgasm, more often than not. Bhat GS, Shastry A. Time to Orgasm in Women in a Monogamous Stable Heterosexual Relationship. J Sex Med 2020;17:749-760.

Female Sexual Orgasmic Dysfunction and Genital Sensation Deficiency.

INTRODUCTION: Most studies on female sexual dysfunction (FSD), and female sexual orgasmic disorder (FSOD) in particular, have qualitatively examined cultural and educational factors; only few have quantitatively examined physiological factors. AIM: The aim of this study was to compare quantitative sensory testing (QST) between women for whom FSOD was their primary complaint and other women with FSD. METHODS: In this retrospective study of women who visited a sexual dysfunction clinic, the study group comprised women for whom FSOD was their primary complaint, and the control group comprised other women with FSD. Sexual dysfunction was assessed by the Female Sexual Function Index (FSFI). QST was performed with a thermal and vibration Genito-Sensory Analyzer (GSA; Medoc Ltd, Israel) aimed at the clitoral and vaginal areas. MAIN OUTCOME MEASURE: The main outcome was clitoral and vibratory sensory thresholds in accordance with the presence of FSOD. RESULTS: The study group comprised 89 (45%) women, with a mean age of 37.6 ± 1.9 years; and the control group comprised 110 (55%) women, with a mean age of 37.5 ± 11.3 years. Both mean FSFI-FSOD and total FSFI scores were significantly lower in the study group than in the control group (0.97 ± 0.94 vs 1.91 ± 1.3, P < 0.001) and (11.9 ± 3.2 vs 15.6 ± 3.6, P < 0.001), respectively. Mean clitoral vibratory sensory thresholds were higher in the study group than in the control group: 2.02 confidence interval (CI) 1.12-2.64 vs 1.55 CI 1.12-2.41, P < 0.001. No statistically significant difference was found between the groups in vaginal vibratory thresholds: 3.7 CI 2.6-6.6 vs 3.4 CI 1.9-5.4, P = 0.14. CLINICAL IMPLICATIONS: The findings support the role of the clitoris in obtaining sexual orgasm, thus inferring a possible physiologic cause of FSOD in otherwise healthy women, beyond established psychological causes. STRENGTH & LIMITATIONS: Assessments using an objective quantitative measure (QST) and a subjective tool (FSFI) in both the FSOD and control groups are strengths of this study. The retrospective design is a limitation. CONCLUSION: QST showed a direct correlation between vibratory clitoral stimulation and FSOD; Compared with the control group, women with FSOD are relatively insensitive to clitoral stimulation, but not to vaginal stimulation. Gruenwald I, Lauterbach R, Gartman I, et al. Female Sexual Orgasmic Dysfunction and Genital Sensation Deficiency. J Sex Med 2020; 17:273-278.

"Not Tonight, Honey:" Reasons Couples Do Not Engage in Sex and Their Impact on Satisfaction and Desire.

INTRODUCTION: Sexual activity is an important aspect of most romantic relationships. However, many couples report declines in sexual activity over time and report many reasons for not engaging in sexual activity on a daily basis. AIM: To investigate the reasons for not engaging in sexual activity in couples over a month and whether these reasons are associated with sexual and relationship satisfaction and sexual desire. METHODS: We collected 30-day daily electronic report data from 174 individuals (87 mixed-sex couples). The responses between men and women were analyzed using chi-squared tests, and we used multilevel modeling to examine the association between the reasons and satisfaction and desire. MAIN OUTCOME MEASURE: The main outcome measure includes daily sexual satisfaction, relationship satisfaction, and sexual desire. Daily reported reasons for not engaging in sexual activity are categorized into joint reason, self-based reason, partner-based reason, and other reasons. RESULTS: Men and women were equally likely to endorse joint reasons for not engaging in sexual activity (eg, "It just didn't happen"), whereas women were more likely to endorse self-based reasons (eg "I wasn't in the mood") and men partner-based reasons (eg "My partner was tired"). The reasons for not engaging in sexual activity were associated with daily sexual and relationship satisfaction and daily sexual desire. Higher baseline sexual desire was associated with a greater likelihood of endorsing partner-related reasons and smaller likelihood of endorsing self-related reasons. Higher baseline sexual satisfaction was associated with a decreased likelihood of reporting partner-based reasons, and higher baseline relationship satisfaction was associated with an increased likelihood of reporting joint reasons. Some of the other associations were significant only for men or women. CLINICAL IMPLICATIONS: Results inform couples' therapy and other clinical interventions and highlight the importance of addressing the reasons for not engaging in sexual activity to find ways of mitigating some of these reasons. STRENGTH & LIMITATIONS: The study was the first to date to address reasons for not engaging in sexual activity in a sample of couples in an experience-sampling study. However, our scope was limited to mixed-sex couples who were primarily white and heterosexual, and we only addressed reasons for not engaging in partnered sex (not solitary sex). CONCLUSION: The reasons for not engaging in sexual activity seem different for men and women and are associated with sexual and relationship satisfaction and sexual desire, and this link appears to be bidirectional. Mark KP, Vowels LM, Leistner CE. "Not Tonight, Honey:" Reasons Couples Do Not Engage in Sex and Their Impact on Satisfaction and Desire. J Sex Med 2020;17:431-441.

Relationship Between Masturbation and Partnered Sex in Women: Does the Former Facilitate, Inhibit, or Not Affect the Latter?

INTRODUCTION: The relationship between masturbation activities and their effect on partnered sex is understudied. AIM: The aim of this study was to assess the alignment of activities between masturbation and partnered sex, and to determine whether different levels of alignment affect orgasmic parameters during partnered sex. METHODS: 2,215 women completed an online survey about activities during masturbation and reasons for orgasmic difficulty during masturbation, and these were compared with activities and reasons for orgasmic difficulty during partnered sex. MAIN OUTCOME MEASURE: Degree of alignment between masturbation activities and partnered sex activities was used to predict sexual arousal difficulty, orgasmic probability, orgasmic pleasure, orgasmic latency, and orgasmic difficulty during partnered sex. RESULTS: Women showed only moderate alignment regarding masturbation and partnered sex activities, as well as reasons for masturbation orgasmic difficulty and reasons for partnered sex orgasmic difficulty. However, those that showed greater alignment of activities showed better orgasmic response during partnered sex and were more likely to prefer partnered sex over masturbation. CLINICAL IMPLICATIONS: Women tend to use less conventional techniques for arousal during masturbation compared with partnered sex. Increasing alignment between masturbation and partnered sexual activities may lead to better arousal and orgasmic response, and lower orgasmic difficulty. STRENGTH & LIMITATIONS: The study was well-powered and drew from a multinational population, providing perspective on a long-standing unanswered question. Major limitations were the younger age and self-selection of the sample. CONCLUSION: Women that align masturbation stimulation activities with partnered sex activities are more likely to experience orgasm and enhanced orgasmic pleasure, with sexual relationship satisfaction playing an important role in this process. Rowland DL, Hevesi K, Conway GR, et al. Relationship Between Masturbation and Partnered Sex in Women: Does the Former Facilitate, Inhibit, or Not Affect the Latter? J Sex Med 2020;17:37-47.

Bother Associated With Climacturia After Radical Prostatectomy: Prevalence and Predictors.

INTRODUCTION: Orgasm-associated incontinence, climacturia, is one of the lesser studied radical prostatectomy (RP) complications. Little is known about patient bother related to this condition, specifically, its prevalence and predictors. AIM: To ascertain the prevalence and predictors of patient bother associated with climacturia. METHODS: Patients presenting for the evaluation of sexual dysfunction after RP at a single center were queried on various domains of sexual dysfunction. This included orgasmic dysfunction and sexual incontinence (including climacturia and arousal incontinence). Patients were specifically asked about the frequency and amount of climacturia. In addition, questions addressed patient bother and the perceived bother of their partners. Descriptive statistics were used for patient characteristics. A t-test was used for comparing the frequency of patient and partner bother, and the Pearson correlation test compared relationships between bother and predictors. Multivariable analysis was conducted to define predictors of climacturia-associated bother. MAIN OUTCOME MEASURE: The main outcome measures was the prevalence and predictors of climacturia-associated patient bother and perceived partner bother. RESULTS: Climacturia was reported by 23% of 3,207 consecutive men analyzed. Bother of any degree was experienced by 45% of these patients, and 14% reported partner bother related to this condition. Patient bother was associated with perceived partner bother (P < .001) and inversely correlated with relationship duration (P < .001). The overall frequency and quantity of climacturia were also predictive (P < .001 for both). In the adjusted model, all of these factors remained significant. CLINICAL IMPLICATIONS: Given the prevalence of this condition and the bother associated with it, this complication should be discussed with patients preoperatively. STRENGTH & LIMITATIONS: Strengths include a large study population and specific questions on climacturia-associated bother. Limitations include the fact that it is a single-center study and no direct partner questioning occurred. CONCLUSION: Climacturia and its associated bother are common after RP. The predictors of patient bother include perceived partner bother, shorter relationship duration, and increasing frequency and quantity of climacturia. Salter CA, Bach PV, Miranda E, et al. Bother Associated With Climacturia After Radical Prostatectomy: Prevalence and Predictors. J Sex Med 2020;17:731-736.

Sexual health in colon cancer patients: A systematic review.

OBJECTIVE: Despite the impact that diagnosis and treatment can have on patients' sexual health, very little research has been conducted on the impact of colon cancer on sexual health. The aim of this systematic review was to assess the prevalence of sexual dysfunctions in colon cancer and describe the sociodemographic, clinical, and psychological correlates of sexual dysfunction. METHODS: Four electronic databases (PsycINFO, PubMed, AcademicSearchPremier, Cochrane Library) were searched for studies reporting sexual adjustment outcomes for colorectal cancer patients from January 1990 to July 2019. RESULTS: Of the 380 articles screened, 14 were included in this review. Sexual function is affected by colon cancer: patients' sexual satisfaction decreases significantly, as does the frequency of sexual intercourse. There is an increase in sexual problems (desire, excitement, or pleasure disorders). Male gender, advanced age, distress, and the comorbidities increase sexual disorders. In addition, it appears that partner distress negatively affects patients' sexual health. Taking such difficulties into account appears key for these patients and their partners. They could benefit from better care throughout treatment and in remission. CONCLUSION: The results of this systematic review highlight the importance of taking an interest in the sexual health of patients with colon cancer.