"He Helped Me in Discovering Myself." Rethinking and Exploring Sexual and Gender Identity in Trans-Inclusive Relationships.

This qualitative study explores the effects of being in a relationship with a transgender or non-binary (TGNB) person on an individual's sexual and/or gender identity. To this aim, the responses of 107 partners of TGNB individuals to the following open-ended question were collected: "What effect, if any, has having a relationship with a transgender person had on your gender and/or sexual identity?." Through thematic analysis, 4 overarching themes emerged from the participants' responses: 1) No reason to change; 2) Exploration and changes; 3) New perspective; and 4) Negative effects and confusion. Overall, this study suggests that being in a relationship with a TGNB person may prompt a reflection on the concept of sexual and gender identity, and an exploration of one's own identity, which is usually experienced as positive, but may also be a source of distress for the individual and/or the couple. Also, in many other cases, the relationship has been observed to have no effect on the partner's identity, due to a number of reasons. These findings constitute a relevant addition to the understanding of couple's dynamics in trans-including couples.

"We Faced Every Change Together". Couple's Intimacy and Sexuality Experiences from the Perspectives of Transgender and Non-Binary Individuals' Partners.

In recent years, there has been a growing interest in the study of transgender and non-binary (TGNB) individuals' romantic and sexual relationships. The present study explored, from TGNB people's partners' perspective, how the couple experiences sexuality and intimacy, the effects from gender dysphoria in these relational domains, and how dysphoria is managed. For this purpose, 99 partners of TGNB individuals were recruited for an online study. Participants were asked to answer the following open-ended questions: "In the intimacy and sexuality with your partner, are there any parts of your or your partner's body that are/were off-limits?" "How did you manage this before, during, and after transition?" The data were analyzed through thematic analysis, and four overarching themes emerged: 1) Positive Aspects of the Relationship; (2) Challenges; (3) Strategies to Manage Dysphoria; and (4) Expected Improvement through Access to Medical Affirmation. The results suggest that gender dysphoria is one of the main challenges in experiencing intimacy and sexuality, but TGNB individuals and their partners can rely on several relational and practical resources to navigate it and enjoy positive experiences with intimacy and sexuality. The findings provide valuable information about how TGNB individuals and their partners build healthy and fulfilling relationships, and they can help clinicians better understand both members' perspectives in these romantic couples in the context of couples' therapy and sexual counseling.

Narcissistic Personality Traits and Sexual Dysfunction in Women: The Role of Body Image Self-Consciousness.

BACKGROUND: Individuals with narcissistic traits, specifically vulnerable ones, are more prone to experiencing concerns related to self-worth and physical appearance and to showing heightened sensitivity to appearance evaluation. Negative body image and body image self-consciousness may, in turn, undermine sexual functioning, especially when apprehension is related to body appearance in sexual contexts. METHODS: We aimed to evaluate the associations between self-reported pathological narcissistic traits, both grandiose and vulnerable, and sexual functioning in a large sample of nonclinical women (N = 656). Furthermore, we tested the mediating role of body image self-consciousness in these associations. OUTCOMES: Sexual functioning was measured through the Female Sexual Function Index. RESULTS: The results highlight that vulnerable narcissistic traits are associated with lower sexual functioning, this association being mediated by higher levels of body image self-consciousness. Conversely, grandiose narcissistic traits are linked to lower body image self-consciousness and, consequently, higher levels of sexual functioning. CLINICAL IMPLICATIONS: Considering the link between body image self-consciousness and sexuality is of utmost importance in clinical practice with women, as well as in promoting positive body appreciation. Clinicians working with individuals presenting with pathological personality traits should consider including an assessment of their sexual functioning. S Pavanello Decaro, M Di Sarno, A Anzani, et al. Narcissistic Personality Traits and Sexual Dysfunction in Women: The Role of Body Image Self-Consciousness. J Sex Med 2021;18:1891-1898.

"Being Talked to Like I Was a Sex Toy, Like Being Transgender Was Simply for the Enjoyment of Someone Else": Fetishization and Sexualization of Transgender and Nonbinary Individuals.

Despite the growing interest in the experiences of transgender individuals, the phenomenon of fetishization of transgender bodies and identities has been overlooked. The present study was aimed at investigating the experiences of fetishization of transgender and nonbinary (TGNB) people. Participants in the current study represent a sample of 142 TGNB volunteers from the community who answered the prompt: "If you feel comfortable, could you describe your experience of being fetishized?" Using thematic analysis, we developed three overarching themes relevant to the experiences of fetishization of TGNB participants: (1) context of fetishization; (2) negative experiences of fetishization; and (3) positive or ambiguous experiences of fetishization. The results demonstrated that, in most cases, fetishization was understood by TGNB people as a negative experience of sexual objectification, although some individuals experienced fetishization as a positive experience, perceiving the sexual desire of the other person or living it as a kink. Consistent with the integrated theory of dehumanization, the results demonstrated that both sexual objectification and minority stress contributed to participants' understanding of fetishization for TGNB individuals. Implications for clinical work with TGNB individuals are discussed.

Microaggressions towards lesbian and transgender women: Biased information gathering when working alongside gender and sexual minorities.

OBJECTIVE: Microaggressions, a concept originally introduced for ethnic minorities, represent subtle day-to-day discrimination, damaging the psychological health and well-being of lesbian, gay, bisexual, and transgender individuals as well. This study aimed to assess whether microaggressions occur in psychotherapists' assessments of clients who identify as either lesbian or transgender woman when compared with those identifying as heterosexual woman. METHODS: The study included a sample of 135 licensed psychotherapists (110 cisgender women and 25 cisgender men). Participants were presented with an audio file of a woman introducing herself during her first therapy session. Three versions were presented: a transgender, a lesbian, and a heterosexual client. Participants were asked to assess the clinical relevance of 10 questions defined as neutral (N = 5) and microaggressive (N = 5), used to determine a clinical impression of the client. A repeated measure analysis of variance was conducted to understand the likelihood of clients of different gender identity and sexual orientation receiving microaggressions. RESULTS: Participants were more prone to consider microaggressive questions relevant where the client identified as either lesbian or transgender. CONCLUSIONS: The findings highlighted a bias against lesbian and trans women in evaluating the relevance and usefulness of clinical information while making a psychological assessment of a case.

Sexual Fantasy of Cisgender and Nonbinary Individuals: A Quantitative Study.

Sexual fantasies typically represent sexually arousing mental imagery and, thus, are thought to play a role in sexual activation and sexual desire. They are also related to sexual and personal satisfaction. Differences between cisgender men and women's imagery are widely reported in the literature. In contrast, research on sexual fantasies among the trans community is scarce, especially when it comes to nonbinary identified people. The aim of the present study is to explore similarities and differences in the sexual imagery of cisgender women and men and nonbinary individuals, through a checklist of sexual fantasies, the Italian version of the Sexual Fantasy Questionnaire (SFQ). Results highlight that nonbinary individuals rate almost all categories of SFQ fantasies as sexually non-exciting, unlike cisgender men and women. The differences between cisgender men and women only partially confirm the results reported in the literature. In particular, the higher tendency to fantasize about dominance in men and passivity in women is not found in the present sample. Results are discussed in the light of the sexual script theory.

Investigating sexuality in adolescents with cancer: patients talk of their experiences.

Objective. The aim of the present study is to understand which areas of sexuality were regarded as most important and/or problematic among adolescents with cancer.Methods. A questionnaire was administered to adolescent and young adult patients who had been receiving treatments at the Pediatric Oncology Unit of our Institution, for at least 2 months, and those in follow-up who had completed their treatments no more than two years previously. The questionnaire was devised to investigate patients' experiences in various areas, i.e. personal relations, sexual relations; functional aspects, body image, and communication.Results. Questionnaires were given to 70 patients and completed by 66. As main results, the survey showed that disease and treatment might negatively affect patients' way of relating with others (53% of cases) and their body image (56%), though their sexual desire remains unchanged (69.7%). Most patients (67%) reported not having the chance to talk to someone about having sex while receiving their treatments; 79% of patients felt this topic deserved more attention.Conclusion. This study promotes the discussion of an important topic for young people with cancer, which is inadequately addressed today. When establishing an age-specific model of care, aspects related to sexuality should be considered and managed.

Dimensions of Personality Organization and Sexual Life in a Community Sample of Women.

The aim of this study was to explore the relationship between dimensions of borderline personality organization (as assessed according to Kernberg's model), sexual dysfunctions, and paraphilic interest in a community sample of women. Two hundred and sixty-six healthy women were asked to complete a set of questionnaires including the Inventory of Personality Organization (IPO), the Italian version of the Female Sexual Function Index, and a checklist to assess the prevalence of paraphilic interests. Results showed that women with sexual dysfunctions and paraphilic interests are characterized by higher scores on three out of four IPO subscales: Instability of self/others, Instability of behavior, and Psychosis. The results provide evidence of a possible connection between borderline personality organization and sexual life and support the need for a thorough assessment of personality functioning in patients with sexual problems.

Adolescent Defense Style as Correlate of Problem Behavior.

OBJECTIVE: Adolescent problem behaviors are often the visible results of intrapsychic distress. Defensive reactions are the unconscious means of managing intrapsychic distress. This cross-sectional study examines the strength of defensive style as measured by self-report on the Response Evaluation Measure (REM-71) relative to age, sex, and SES, as a correlate of internalizing and externalizing problem behaviors, as assessed by the Youth Self Report (YSR). METHODS: A sample of 1,487 students from two suburban high schools completed self-report measures of defense style, self-esteem, and internalizing and externalizing problem behaviors. Demographic variables (age, sex, and SES) were included as covariates. RESULTS: Mature and immature defense style correlated as expected with problem behaviors. Demographic variables contributed minimally to the variance in the outcome variable. CONCLUSIONS: Defense style, as assessed by the REM-71, is a significant correlate of clinically elevated internalizing and externalizing problem behaviors in youth as in adults. This study adds to the convergent validity of the REM-71.

Body Dissatisfaction and Eating Disorder Symptomatology: A Latent Structural Equation Modeling Analysis of Moderating Variables in 18-to-28-Year-Old Males.

Although body dissatisfaction is recognized as the strongest risk factor for eating disturbances, a majority of young males are body dissatisfied, but do not concomitantly report severe levels of eating disorder symptomatology. The present investigation was designed to examine five theoretically relevant variables (i.e., body checking, emotional dysregulation, perfectionism, insecure-anxious attachment, and self-esteem) as potential moderators of the relationship between body dissatisfaction and two critical components of male eating disorder symptomatology: drive for muscularity and bulimic behaviors. Data collected from 551 Italian males between 18 and 28 years old were analyzed using latent structural equation modeling. The authors found that emotional dysregulation, body checking, insecure-anxious attachment and perfectionism intensified the relationship between body dissatisfaction and each criterion variable representing male eating disorder symptomatology; the interactions accounted respectively for an additional 2%, 7%, 4% and 5% of variance in drive for muscularity and for an additional 6%, 4%, 5%, and 2% of the variance in bulimic behaviors. By contrast self-esteem weakened this relationship and the interactions accounted for an additional 3% of the variance in both drive for muscularity and bulimic behaviors. Implications of these findings for prevention and treatment of male eating disturbances are discussed.

Defensive functioning and psychopathology: a study with the REM-71.

OBJECTIVES: The aim of the present study is to explore the association between defensive functioning (as assessed through the REM-71) and psychiatric symptoms in a large sample from the community, and the moderating role of age and gender on that association. Furthermore, we explored the concurrent validity of REM-71 as compared with "caseness" (SCL-90-R). METHODS: The REM-71 was administered together with SCL-90-R to a community sample of 1,060 Italian high-school and university students (mean age=19.01±3.85 years; 66.7% females). RESULTS: Factor 1 defenses were by far the primary contributors to the predictor synthetic variable (i.e. association between defenses and psychopathology). Gender proved to moderate the association between immature defenses and symptoms. Using ROC analysis, we derived a cut-off score for Factor 1 defenses. CONCLUSIONS: Our results support the adoption of the REM-71 as a useful instrument for the assessment of defensive array and psychopathological liability in adolescents and adults.

Defensive functioning in MtF and FtM transsexuals.

In spite of the potential clinical utility of defense mechanisms in the assessment of gender identity disorder patients as candidates to sex reassignment surgery, there is paucity of research in this field. The aim of the present study is therefore to ascertain whether the defensive profile of MtF and FtM transsexuals seeking sex reassignment surgery can be defined more primitive, immature and maladaptive than that of the two control groups. We compared the defensive profiles as assessed through the REM-71 (Steiner et al., 2001) of 104 MtF transsexuals, 46 FtM transsexuals and two control groups of males and females. Our results show that MtF transsexuals present an overall more primitive defensive array than that of both control groups, while FtMs show a profile not dissimilar from that of both control groups. Our results support the hypothesis that MtF transsexuals are characterized by higher proneness to psychopathology than the general population and show a more immature level of psychological functioning than FtM transsexuals.

Internalized Homonegativity and Sexual Quality of Life in Italian Lesbian and Bisexual Women.

This study investigates the relationship between sexual quality of life (SQoL) and internalized homonegativity among Italian lesbian and bisexual cisgender women, drawing on the minority stress model. The aim of this study is to compare levels of internalized homonegativity and SQoL between the two groups, exploring the association between these variables. We used a quantitative methodology based on a questionnaire. The data were collected through an online questionnaire from 686 women, including 217 lesbians and 469 bisexuals, using the Lesbian Internalized Homophobia Scale and the Female-Sexual Quality of Life Questionnaire. Statistical analyses, including t-tests and linear regression, were performed to assess group differences and predictors of SQoL. The findings support the hypothesis that bisexual women may experience higher levels of internalized homonegativity. Additionally, the study reveals disparities in SQoL, with lesbian women reporting better outcomes. The linear regression model confirmed a significant negative association between internalized homonegativity and SQoL. The results highlight the need for further research on factors influencing sexual well-being in sexual minority women, and the need to give thorough attention to specific sexual identities in clinical and research practice.

Italian women who have sex with women: prevalence and co-occurrence of sexual practices.

Background: Sexuality research on the sexual practices of women who have sex with women (WSW) has thus far mostly centered on risk factors and addressed a limited number of practices, with a focus on oral sex and insertive vaginal sex. Aim: This study arises from the need to fill such a significant gap, which prevents researchers, clinicians, and policy makers from being adequately up-to-date on the sexual habits and tendencies of this population. Methods: A multiple-choice questionnaire was completed by 723 WSW with a mean (SD) age of 29.14 (6.94) years. Outcomes: The survey included closed questions on sexual practices, including genital and oral sex, but also nongenital sexual contact (petting and intercrural sex), anal sex, and kinky practices. Results: The most common sexual practices were self-masturbation (99.03%), oral sex (performed or received, 98.20%), and insertive genital sex (performed or received, 89.07%). Half of our sample had tried kinky practices at least once in a lifetime (51.31%). Respondents tended to experiment sexually more with stable partners rather than with casual ones. Comparisons among practices in the lesbian and bisexual population are presented. Clinical Implications: Providers should be aware that sexual orientations have their own specificities, including sexuality and practices, which should increase their knowledge and comfort in working with sexual minorities. Strengths and Limitations: The novel topic of the study addresses the gap in sexuality research among WSW. Strengths include the sex-positive approach, the inclusion of an array of sexual practices, and the consideration of the specificities of the group. Limitations in the generalization of the results are the cross-sectional design and the explicit topic, which may have kept some persons from responding. Conclusion: We propose the framing of sex as going beyond genital contact, and we invite clinicians and researchers who come into contact with WSW to be aware that sexual orientation can be associated with specificities regarding sexuality and sexual practices.

"There is No One Way to Be Transgender and to Live Sex": Transgender and Non-Binary Individuals' Experiences with Pornography.

Transgender or non-binary (TGNB) people are often present as protagonists of pornographic material. This study is the first to consider TGNB people as critical consumers of sexually explicit material. The sample included 212 self-identified TGNB individuals: 47.2% trans man/transmasculine, 15.6% trans woman/transfeminine and 37.3% non-binary. The online questionnaire consisted of a sociodemographic data collection, multiple-choice questions about preferences and habits concerning pornography, and open-ended questions about the sensations experienced when watching pornography, opinions on the representation of TGNB people in pornography, and their experience in watching pornographic videos with cisgender or TGNB protagonists. The answers were analyzed using the qualitative method of thematic analysis. We identified four themes that appeared across the responses: 1) heteronormativity and cisnormativity in pornography: the need for deconstructing the current cis-het-patriarchial normative and binary system, which dominates pornography except for the ethical porn industry, 2) cisgender pornography compared to TGNB pornography, 3) pleasurable sensations (e.g., identification and empowerment) associated with TGNB pornography, and 4) negative sensations (e.g., objectification and dysphoria) associated with TGNB pornography. Results are discussed in light of the objectification framework and the minority stress model.

How the COVID-19 pandemic affects transgender health care - A cross-sectional online survey in 63 upper-middle-income and high-income countries.

Background: Due to the COVID-19 pandemic, access to medical care is restricted for nearly all non-acute conditions. Due to their status as a vulnerable social group and the inherent need for transition-related treatments, transgender people are assumed to be affected particularly severely by the restrictions caused by the COVID-19 pandemic. Methods: As an ad hoc collaboration between researchers, clinicians and 23 community organizations, we developed a web-based survey in German that was translated into 26 languages. Participants were recruited via community sources, social media channels, and snowball sampling since May 2020. The present sample is based on the data collected until August 9, 2020. We assessed demographical data, health problems, risk factors, COVID-19 data (e.g., contact history), and the influence of the COVID-19 pandemic on access to transgender health care services. To identify factors associated with the experience of restrictions, we conducted multiple logistic regression analysis. Results: 5267 transgender people from 63 upper-middle-income and high-income countries participated in the study. Over 50% of the participants had risk factors for a severe course of a COVID-19 infection and were at a high risk of avoiding COVID-19 treatment due to the fear of mistreatment or discrimination. Access to transgender health care services was restricted for 50% of the participants. Male sex assigned at birth and a lower monthly income were significant predictors for the experience of restrictions to health care. 35.0% reported at least one mental health condition and 3.2% have attempted suicide since the beginning of the COVID-19 pandemic. Discussion: Transgender people suffer under the severity of the pandemic due to the intersections between their status as a vulnerable social group, their high number of medical risk factors, and their need for ongoing medical treatment. The COVID-19 pandemic can potentiate these vulnerabilities, add new challenges for transgender people, and, therefore, can lead to devastating consequences, like severe physical or mental health issues, self-harming behavior, and suicidality.

Prevalence and comorbidity of prolonged grief disorder in a sample of caregivers of patients in a vegetative state.

Previous studies have shown that Prolonged Grief Disorder (PGD), Post-traumatic Stress Disorder (PTSD) and major depression are autonomous nosological entities. The present study aims at further analyzing the relationship among them in a sample of caregivers of patients in Vegetative State (VS) or Minimally Conscious State (MCS). We also investigated factors predicting the development of PGD. We sampled 40 Caregivers of patients in VS or MCS consecutively admitted to long-term care units. Caregivers were administered the PG-12, the Depression Questionnaire, the SCID I and the Davidson Trauma Scale. Six participants (15%) fulfilled the criteria for PGD, 25% (N = 10) for depression and 25% (N = 10) for PTSD. Although significant correlations emerged among symptom domains of the three disorders, no relevant association was found between a diagnosis of PGD, depression and PTSD. The severity of PTSD symptoms was found to be predictive of PGD. Clinical implications are discussed.

Disordered eating behaviors among Italian men: objectifying media and sexual orientation differences.

Objectification theory was tested as a suitable framework for explaining sexual orientation differences in disordered eating behaviors in college-aged Italian men. The theory's applicability to 125 homosexual and 130 heterosexual men was investigated using self-report questionnaires. Gay men scored significantly higher on exposure to sexually objectifying media, body surveillance, body shame, disordered eating behaviors, and depression than heterosexual men. Although path analyses support the theory's applicability to both groups, for gay men the path model demonstrated a better fit to the objectification theory for disordered eating and depression. Practical implications are discussed.

Desire for Genital Surgery in Trans Masculine Individuals: The Role of Internalized Transphobia, Transnormativity and Trans Positive Identity.

Some trans people experience gender dysphoria, which refers to psychological distress that results from an incongruence between one's gender assigned at birth and one's gender identity. People who are trans masculine or nonbinary assigned-female-at-birth may pursue multiple domains of gender affirmation, including surgical affirmation (e.g., masculine chest reconstruction, penile reconstruction, etc.). The present study aimed to investigate the possible factors involved in trans people's desire to undergo gender-affirming genital surgery. Trans masculine and nonbinary participants (N = 127; mean age = 26.90) were recruited through a web-based survey and completed self-report instruments (i.e., the Internalized Transphobia subscale of the Gender Minority Stress and Resilience Measure, the Trans Positive Identity Measure, the Gender Congruence and Life Satisfaction Scale, an ad hoc scale on transnormativity, and a single-item on desire to undergo genital affirmation surgery). A path analysis showed that higher levels of internalized transphobia led to more significant genital discomfort via a dual parallel mediation of transnormativity and positive identity. Moreover, this genital discomfort fueling pattern was the most significant predictor of the desire to undergo genital surgery as the effect of internalized transphobia was fully mediated by increased genital discomfort. Findings are discussed in the light of the recent strand of research on gender dysphoria as a multifaceted construct, with social components.

The Reading the Mind in the Eyes Test, Iowa Gambling Task and Interpersonal Reactivity Index: Normative Data in an Italian Population Sample.

OBJECTIVE: Social cognition and executive deficits are frequent in neurological and neuropsychiatric disorders. Yet, there is a paucity of standardized domain-specific psychometric tools for the assessment of complex decision-making, social cognition (i.e., Theory of Mind), and empathy. To this aim, this study intended at providing normative data in an Italian population sample for the Iowa Gambling Task, the Reading the Mind in the Eyes Test, and the Interpersonal Reactivity Index. METHOD: The Iowa Gambling Task, the Reading the Mind in the Eyes Test, and the Interpersonal Reactivity Index were administered to 462 healthy Italian participants aged between 18 and 91 years, considering demographic factors. A confirmatory factor analysis was run to test for unidimensionality. Normative values were derived by means of the Equivalent Scores method. RESULTS: Education predicted all tests' scores, age influenced scores at the Interpersonal Reactivity Index and the Reading the Mind in the Eyes Test, gender predicted empathic abilities only. The three tests did not underpin a unidimensional structure. CONCLUSIONS: The present work provides demographically adjusted Italian normative data for a set of tests assessing real-life decision-making, emotion recognition and empathy, filling a gap within II-level, domain-specific, neuropsychological testing. For the first time, the Interpersonal Reactivity Index is proposed as an adjuvant neuropsychological tool, while the standardization of the Iowa Gambling Task offers a new scoring system for advantageous/disadvantageous choices.