A Qualitative Content Analysis of Perceived Individual and Relational Consequences of Sexual Compliance and Their Contributors.

Sexual compliance (i.e., consensually engaging in sex despite a lack of desire for it) is common in committed intimate relationships, but the consequences of compliance for the well-being of the individual and the relationship are poorly understood. We investigated the perceived consequences of sexual compliance and perceptions of factors contributing to negative/positive consequences by applying qualitative content analysis to free-text retrospective survey responses from 107 (mostly) Finnish adults. We identified five themes of personal consequences (emotions and mood, sexual experience, sexual desire, pressure and violations, and physical pain), four of relational consequences (relationship satisfaction, partner's response, relationship interaction, and value alignment), and nine of possible factors contributing to negative/positive consequences (communication, self-esteem, motives for sex, relationship factors, agency and self-knowledge, mental health and stress, psychological flexibility, societal norms, and past negative experiences). Perceived consequences varied widely across individuals, both in terms of whether any positive or negative consequences were experienced and whether compliance was perceived as improving or worsening specific domains of well-being. We discuss the themes identified in relation to previous theories of sexuality and intimate relationships and offer hypotheses that can be tested in future quantitative studies.

Vibrator-Assisted Start-Stop Exercises Improve Premature Ejaculation Symptoms: A Randomized Controlled Trial.

Premature ejaculation (PE) is associated with decreased quality of life, lower confidence and self-esteem, and higher levels of depression, anxiety, and interpersonal difficulties. Here we investigated the effectiveness of vibrator-assisted start-stop exercises for treatment of PE, and whether the treatment effect could be enhanced by an additional psychobehavioral intervention. Fifty participants with a mean age of 41.7 years were included and randomized into two treatment groups and a waiting list control group. Participants were instructed to perform start-stop exercises while stimulating the penis with a purpose-made vibrator, 3 times a week for 6 weeks. Additionally, participants in one of the treatment groups received additional psychoeducation and performed mindfulness meditation-based body scan exercises three times a week. Data were gathered through online questionnaires before and after treatment, as well as 3 and 6 months after treatment. The interventions reduced PE symptoms with large effect sizes (partial η2 = .20 across the three groups, d [95% CI] = 1.05 [.27, 1.82] and 1.07 [.32, 1.82] for treatment groups compared to waiting list control group). The additional psychobehavioral intervention did not further reduce PE symptoms, but did decrease PE-associated negative symptoms such as levels of sexual distress, anxiety, and depression. No side effects were reported. Vibrator-assisted start-stop exercises can be offered as an adequate treatment option for PE.

A Longitudinal Assessment of Associations Between Women's Tendency to Pretend Orgasm, Orgasm Function, and Intercourse-Related Pain in Different Partner Relationship Constellations.

The aim of the present study was to investigate how women's tendency to pretend orgasm during intercourse is associated with orgasm function and intercourse-related pain, using a longitudinal design where temporal stability and possible causal relationships could be modeled. The study sample consisted of 1421 Finnish women who had participated in large-scale population-based data collections conducted at two time points 7 years apart. Pretending orgasm was assessed for the past 4 weeks, and orgasm function and pain were assessed using the Female Sexual Function Index for the past 4 weeks. Associations were also computed separately in three groups of women based on relationship status. Pretending orgasm was considerably variable over time, with 34% of the women having pretended orgasm a few times or more at least at one time point, and 11% having done so at both time points. Initial bivariate correlations revealed associations between pretending orgasm and orgasm problems within and across time, whereas associations with pain were more ambiguous. However, we found no support in the path model for the leading hypotheses that pretending orgasms would predict pain or orgasm problems over a long period of time, or that pain or orgasm problems would predict pretending orgasm. The strongest predictor of future pretending in our model was previous pretending (R 2 = .14). Relationship status did not seem to affect pretending orgasm in any major way.

Genetic Variants Associated With Male Pedophilic Sexual Interest.

INTRODUCTION: The etiology of sexual preference disorders (paraphilias) in general and pedophilia in particular remains unknown. There are some indications of biological factors related to pedophilic interest and pedophilic disorder. AIM: To examine single-nucleotide polymorphisms (SNPs) potentially associated with pedophilic sexual interest. METHODS: The sample consisted of 1,672 men 18 to 45 years old from the Genetics of Sex and Aggression sample who had submitted saliva samples. Fifty-four SNPs were genotyped and relevant SNPs were analyzed. MAIN OUTCOME MEASURES: A self-report questionnaire designed specifically for the Genetics of Sex and Aggression sample was used to measure sexual interest in and sexual behavior toward children and adolescents. DNA extraction and genotyping were used to measure possible associations between male pedophilia and SNPs. RESULTS: Before controlling for multiple testing, statistically significant associations were found for SNPs linked to androgen, estrogen, prolactin, corticotrophin, serotonin, and oxytocin. No associations remained significant after controlling for multiple testing. CONCLUSION: The results of the present study suggest a complex biological mechanism affecting adult sexual interest in children. Very small effect sizes characterized the findings, and several polymorphisms related to different hormonal functioning were initially related to the phenotype.

A study of possible associations between single nucleotide polymorphisms in the estrogen receptor 2 gene and female sexual desire.

INTRODUCTION: Female sexual desire and arousal problems have been shown to have a heritable component of moderate size. Previous molecular genetic studies on sexual desire have mainly focused on genes associated with neurotransmitters such as dopamine and serotonin. Nevertheless, there is reason to believe that hormones with more specific functions concerning sexuality could have an impact on sexual desire and arousal. AIM: The aim of the present study was to investigate the possible effects of 17 single nucleotide polymorphisms (SNPs) located in estrogen receptor genes on female sexual desire and subjective and genital arousal (lubrication). Based on previous research, we hypothesized that ESR1 and ESR2 are relevant genes that contribute to female sexual desire and arousal. MAIN OUTCOME MEASURES: The desire, arousal, and lubrication subdomains of the Female Sexual Function Index self-report questionnaire were used. METHODS: The present study involved 2,448 female twins and their sisters aged 18-49 who had submitted saliva samples for genotyping. The participants were a subset from a large-scale, population-based sample. RESULTS: We found nominally significant main effects on sexual desire for three ESR2 -linked SNPs when controlled for anxiety, suggesting that individuals homozygous for the G allele of the rs1271572 SNP, and the A allele of the rs4986938 and rs928554 SNPs had lower levels of sexual desire. The rs4986938 SNP also had a nominally significant effect on lubrication. No effects for any of the SNPs on subjective arousal could be detected. CONCLUSIONS: The number of nominally significant results for SNPs in the ESR2 gene before correcting for multiple testing suggests that further studies on the possible influence of this gene on interindividual variation in female sexual functioning are warranted. In contrast, no support for an involvement of ESR1 was obtained. Our results should be interpreted with caution until replicated in independent, large samples.

Sexual Compliance in Finnish Committed Relationships: Sexual Self-Control, Relationship Power, and Experienced Consequences.

We studied sexual compliance (i.e., consensual engagement in partnered sexual activity despite lack of sexual desire) in committed relationships using a large Finnish sample. First, we tested if previous theories on sexual self-control and partner sexual relationship power could be extended to a Finnish setting. As little is known about the personal and relational consequences of compliance, we also explored the experienced consequences and their association with the aforementioned aspects. The convenience survey sample (n = 1,496) included individuals who were or had recently been in committed intimate relationships. As 93% of the participants were women, our analyses focused on these (64.3% heterosexual, 24.5% bisexual, 11.3% other). Sixty-five percent of women reported having complied at least once in their current or most recent relationship. Women with lower sexual self-control and higher partner sexual relationship power reported more compliance, corroborating previous research. Lower age was uniquely associated with more compliance, whereas the association between more compliance and lower education diminished when including sexual self-control and partner sexual relationship power in the regression model. Experienced consequences of compliance varied greatly among women. However, roughly two-fifths reported only negative consequences for their well-being and relationships. Fewer approach motives, more avoidance motives, lower sexual self-control, and higher partner relationship control were associated with experiencing fewer positive consequences. Our results corroborate previous studies conducted in North America, suggesting that sexual compliance is common among women in committed relationships. We suggest careful consideration in instances of compliance, considering possible negative consequences.

No Signs of Inclusive Fitness or Reciprocal Altruism in Advantageous Inequity Aversion.

Advantageous inequity aversion (i.e., the tendency to respond negatively to unfairness that benefits oneself) usually develops in 6-8-year-olds. However, little is known about the selection pressures that might have shaped this phenomenon. Using data collected from 120 4-8-year-old Finnish children, we tested two evolutionary explanations for the development of advantageous inequity aversion: reciprocal altruism (i.e., benefiting from sharing when the roles are likely reversed in the future) and inclusive fitness (i.e., benefiting from sharing with biological relatives that carry the same alleles). We first successfully replicated a previous experiment, showing that 6-8-year-olds display advantageous inequity aversion by preferring to throw away a resource rather than keep it for themselves. Here, this behavior was also displayed in 5-year-olds. Using a novel experiment, we then asked children to distribute five erasers between themselves, a sibling, a peer, and a stranger. That is, an equal distribution was only possible if throwing away one eraser. We found no support for advantageous inequity aversion being shaped by either inclusive fitness or reciprocal altruism. Future studies could investigate costly signaling and adherence to social norms to avoid negative consequences as ultimate explanations for advantageous inequity aversion.

A study of possible associations between single nucleotide polymorphisms in the serotonin receptor 1A, 1B, and 2C genes and self-reported ejaculation latency time.

INTRODUCTION: Previous research has indicated that serotonergic genes may influence ejaculatory function. Attempts to investigate effects of polymorphisms in serotonergic genes have been carried out, but so far, no study has conducted exploratory genotype analyses regarding the serotonin receptor 1A, 1B, and 2C subtypes, which have been hypothesized to mediate the inhibitory effects of serotonin on ejaculation in rodents. AIM: The aim of the present study was to investigate effects of a total of six single nucleotide polymorphisms (SNPs) located in genes encoding serotonin receptor subtypes 1A, 1B, and 2C on self-reported ejaculation latency time. METHODS: A retrospective self-report measure of ejaculation latency time was used to investigate ejaculatory function in a population-based sample of 1,399 male twins. DNA was collected using self-administered saliva sampling. MAIN OUTCOME MEASURE: Calculations of allelic effects were conducted using the Generalized Estimating Equations module of PASW 18.0, which appropriately controls for between-subjects dependence. RESULTS: Out of six investigated polymorphisms, two SNPs (both serotonin receptor 5-HT(1B) linked) had a significant main effect on ejaculation latency time. Of these, one (rs11568817) remained significant after Bonferroni correction for multiple testing, indicating that individuals homozygous for the G allele had significantly shorter ejaculation latencies. CONCLUSIONS: The results of this study support the hypothesis that serotonergic genes play a role in ejaculatory function in the general population. Replication of the results of the present study is warranted.

Are early and current erectile problems associated with anxiety and depression in young men? A retrospective self-report study.

Erectile dysfunction (ED) has been extensively studied in the past few decades, and significant advances have been made in understanding its etiology. Most cases of this type of dysfunction have an organic etiology, and ED occurs primarily in older men. However, relatively little is known about erectile problems in young men or about the interconnection between psychiatric symptoms and ED etiology. In this study, the authors investigated ED symptoms in a large, population-based sample of 18-48-year-old men. Participants reported ED symptoms from their first intercourse experience as well as those occurring at present. The authors assessed the association between reported ED symptoms during early partnered sexual experiences and present ED symptoms. Furthermore, the authors investigated associations between age, symptoms of anxiety and depression, and erectile problems. Results indicated that age was a significant predictor of ED problems already in young age groups. ED problems were prevalent to a much higher extent during early sexual intercourse experiences and appeared to pass with time for most men. Anxiety and depression were significant predictors of present erectile problems. Implications of the results and potential limitations were discussed.

Mental health among sexual and gender minorities: A Finnish population-based study of anxiety and depression discrepancies between individuals of diverse sexual orientations and gender minorities and the majority population.

Substantial empirical evidence suggests that individuals who belong to sexual and gender minorities experience more anxiety and depression than heterosexual and cisgender people. Many previous studies have not, however, used population-based samples. There is also a shortage of evidence about certain sexual and gender minorities (e.g., nonbinary individuals). We examined differences in levels of anxiety and depression within sexual and gender minorities, as well as compared to the heterosexual and cisgender majority in a population-based Finnish sample (N = 8,589). We also explored if individuals who belong to both a gender and a sexual minority (double minority) reported higher rates of anxiety and depression than individuals who hold either a gender or a sexual minority status (single minority). Individuals who belonged to either a sexual or a gender minority overall experienced significantly higher rates of anxiety and depression than cisgender and heterosexual individuals. Among the different sexual and gender minorities, bisexual, emerging identity, and nonbinary individuals reported the highest rates of anxiety and depression. We found no differences in anxiety and depression between single minority and double minority individuals. Our results suggest that even though Finland is a country with an inclusive social climate, sexual and gender minorities are, nevertheless, disproportionately affected by mental health issues. The present study gives further support to the claim that individuals holding a sexual or gender minority status experience higher levels of depression and anxiety compared to cisgender and heterosexual individuals and pinpoints the need to acknowledge these issues both in the context of health care and in the society at large.

The Mother-Offspring Conflict: The Association Between Maternal Sleep, Postpartum Depression, and Interbirth Interval Length.

To test the hypothesis that infant night waking is an adaptation to increase interbirth intervals (IBIs) (i.e., the time between a mother's consecutive births) by exhausting the mother, we made an initial attempt at investigating whether maternal sleep disturbance is associated with longer IBIs. We also explored whether postpartum depression symptoms mediated the association between maternal sleep disturbance and IBI length. We used retrospective self-reports from 729 mothers living in Finland. We conducted structural regressions separately for the mother's two first children at two different age intervals (0-1 and 1-3 years). Infant night waking was associated with maternal sleep disturbance (ß = .78-.84) and maternal sleep disturbance was associated with postpartum depression symptoms (ß = .69-.81). Postpartum depression symptoms were also associated with longer IBIs for the first child (ß = .23-.28). This result supports the notion that postpartum depression in and of itself could be viewed as adaptive for the offspring's fitness, and not just as an unintentional byproduct of the mother's sleep disturbance. Contrary to our prediction, maternal sleep disturbance was, however, associated with shorter IBIs for the first child (ß = -.22 to -.30) when including postpartum depression symptoms in the model. We discuss the potential role of social support as an explanation for this unexpected result.

Postpartum depression and mother-offspring conflict over maternal investment.

BACKGROUND AND OBJECTIVES: As the mother-offspring relationship is central to human reproduction, postpartum depression symptoms are difficult to explain in evolutionary terms. We proposed that postpartum depression might arise as a result of evolutionary mother-offspring conflict over maternal investment, and investigated the association between postpartum depression symptoms, infant night waking, maternal sleep disturbance and breastfeeding frequency. METHODOLOGY: We conducted a cross-sectional analysis using survey responses at 6 months postpartum from 1598 Finnish mothers. We hypothesized that infant night waking at 6 months postpartum would be associated with postpartum depression symptoms, and that this association would be mediated by maternal sleep disturbance and a higher breastfeeding frequency. RESULTS: Infant night waking was moderately associated with postpartum depression symptoms, and this association was mediated by maternal sleep disturbance (R 2=0.09). Contrary to our prediction, we found that increased breastfeeding was associated with less postpartum depression symptoms. CONCLUSIONS AND IMPLICATIONS: We conclude that postpartum depression symptoms might partly be the result of increased maternal fatigue stemming from high offspring demands on maternal investment, but that this is not due to the metabolic strain from increased breastfeeding. Studying postpartum depression from the mother-offspring conflict perspective can potentially improve our understanding of the involved behavioral processes of both mother and offspring, and allow interventions designed to benefit the well-being of both parties. Lay Summary: We proposed that postpartum depression is due to an evolutionary conflict between mother and infant, where the infant tires the mother to delay the arrival of a sibling. We found a link between infant night waking and postpartum depression, mediated by the mother's sleep, but not by breastfeeding frequency.

A Randomized, Waiting-List-Controlled Study Shows That Brief, Mindfulness-Based Psychological Interventions Are Effective for Treatment of Women's Low Sexual Desire.

We evaluated two treatment conditions for low sexual desire in women: one where participants were administered a mindfulness-based treatment protocol and another with exercises focusing on scheduled sex and motivations for sex in addition to the aforementioned protocol. Seventy women (Mage 39.2, SD = 9.8) with complaints of low sexual desire were randomly allocated to one of these treatment conditions or a waiting-list condition. Participants attended four individual sessions and completed homework exercises. Questionnaire data were collected before and after treatment and at follow-ups three and six months later. Primary outcomes were the Female Sexual Function Index (FSFI) desire subdomain and the Sexual Interest and Desire Inventory-Female (SIDI-F). Secondary outcomes were the Female Sexual Distress Scale-Revised (FSDS-R), the Revised Dyadic Adjustment Scale (RDAS), the Perceived Relationship Quality Components Inventory (PRQC), and the Brief Symptom Inventory-18 (BSI-18). Women in both treatment conditions reported significantly higher sexual desire (FSFI desire d = 0.75 to 1.06) immediately following treatment, compared to the waiting list. Improvements were sustained at follow-up, accompanied by improvements in some secondary outcomes. We found no significant differences between the treatment conditions in terms of treatment effectiveness. Our study adds to the literature suggesting that mindfulness-based treatments are suitable options for treating low sexual desire in women.

A network analysis of female sexual function: comparing symptom networks in women with decreased, increased, and stable sexual desire.

Problems related to low sexual desire in women are common clinical complaints, and the aetiology is poorly understood. We investigated predictors of change in levels of sexual desire using a novel network approach, which assumes that mental disorders arise from direct interactions between symptoms. Using population-based data from 1,449 Finnish women, we compared between-subject networks of women whose sexual desire decreased, increased, or remained stable over time. Networks were estimated and analyzed at T1 (2006) and replicated at T2 (2013) using R. Domains included were, among others, sexual functions, sexual distress, anxiety, depression, body dissatisfaction, and relationship status. Overall, networks were fairly similar across groups. Sexual arousal, satisfaction, and relationship status were the most central variables, implying that they might play prominent roles in female sexual function; sexual distress mediated between general distress and sexual function; and sexual desire and arousal showed different patterns of relationships, suggesting that they represent unique sexual function aspects. Potential group-differences suggested that sex-related pain and body dissatisfaction might play roles in precipitating decreases of sexual desire. The general network structure and similarities between groups replicated well; however, the potential group-differences did not replicate. Our study sets the stage for future clinical and longitudinal network modelling of female sexual function.

No Evidence for Long-Term Causal Associations Between Symptoms of Premature Ejaculation and Symptoms of Anxiety, Depression, and Sexual Distress in a Large, Population-Based Longitudinal Sample.

Premature ejaculation (PE) is one of the most common male sexual complaints, but its etiology is unclear. Psychological problems, such as symptoms of anxiety and depression, have traditionally been seen as causal or maintaining etiological components of PE, and previous cross-sectional studies have found weak positive associations between them. The aim of the present study was to test possible causal pathways over time between PE and symptoms of the psychological problems anxiety, depression, and sexual distress. A sample of 985 male Finnish twins and brothers of twins completed a questionnaire in 2006 and 2012. Significant bivariate correlations were found both within and across time between PE and the psychological problems. When fitting structural equation models to test hypothesized causal pathways, symptoms of anxiety and sexual distress at the first measurement time point did not predict future PE. Likewise, PE symptoms at the first measurement did not predict increments or decrements in anxiety, sexual distress, or depression later on. These null findings regarding hypothesized associations may partly be explained by the relatively long time between measurements, or that the measures possibly did not capture the aspects of anxiety that are related to PE.

A Longitudinal Analysis of Premature Ejaculation Symptoms Raises Concern Regarding the Appropriateness of a "Lifelong" Subtype.

Premature ejaculation (PE) is divided into acquired and lifelong subtypes, with the implication that the latter is chronic. This longitudinal study included data for untreated respondents from a population-based sample (sample 1) and a sample of patients diagnosed with lifelong PE (sample 2). About half of the respondents who at time 1 fulfilled the most important diagnostic criterion for lifelong PE (≤1minute ejaculation latency) no longer did so at time 2. Standardised autoregressive coefficients for PE symptom measures were 0.58 for sample 1, 0.83 for sample 2, and 0.37 for individuals with ejaculatory latencies ≤1minute. A subjective perception of change in ejaculatory latency was reported by 47% (n=397) of sample 1 and 62% (n=10) of sample 2. PE symptoms were in general unstable over time, which raises concern regarding the appropriateness of the "lifelong" diagnosis. PATIENT SUMMARY: We looked at the stability of symptoms of premature ejaculation (PE) over time. We found that PE symptom severity varies considerably, and to a lesser but still considerable degree in patients diagnosed with lifelong PE. Our results suggest that there is reason to doubt the appropriateness of the term lifelong PE.

Associations between Salivary Testosterone Levels, Androgen-Related Genetic Polymorphisms, and Self-Estimated Ejaculation Latency Time.

INTRODUCTION: Recently, testosterone (T) has been shown to be associated with premature ejaculation (PE) symptoms in the literature. Furthermore, studies suggest that the etiology of PE is partly under genetic control. AIM: The aim of this study was to reassess findings suggesting an association between testosterone (T) and a key symptom of PE, ejaculation latency time (ELT), as well as exploratively investigating associations between six androgen-related genetic polymorphisms and ELT. MATERIALS AND METHODS: Statistical analyses were performed on a population-based sample of 1,429 Finnish men aged 18-45 years (M = 26.9, SD = 4.7). Genotype information was available for 1,345-1,429 of these (depending on the polymorphism), and salivary T samples were available from 384 men. Two androgen receptor gene-linked, two 5-alpha-reductase type 2-gene-linked, and two sex hormone-binding globuline gene-linked polymorphisms were genotyped. MAIN OUTCOME MEASURES: Ejaculatory function was assessed using self-reported ELT. RESULTS: We found no association between salivary T levels and ELT. We found a nominally significant association between a 5-alpha-reductase type 2-gene-linked polymorphism (rs2208532) and ELT, but this association did not remain significant after correction for multiple testing. One single nucleotide polymorphism in the sex hormone-binding globulin gene (rs1799941) moderated (significantly after correction for multiple testing) the association between salivary T and ELT, so that A:A genotype carriers had significantly lower salivary T levels as a function of increasing ELT compared with other genotype groups. CONCLUSIONS: We were unable to find support for the hypothesis suggesting an association between T levels and ELT, possibly because of the low number of phenotypically extreme cases (the sample used in the present study was population based). Our results concerning genetic associations should be interpreted with caution until replication studies have been conducted. Jern P, Westberg L, Ankarberg-Lindgren C, Johansson A, Gunst A, Sandnabba NK, and Santtila P. Associations between salivary testosterone levels, androgen-related genetic polymorphisms, and self-estimated ejaculation latency time. Sex Med 2014;2:107-114.