When sexual distress shares the bed: the role of sexual self-esteem in the relationship between dispositional mindfulness and sexual distress in sex therapy patients.

BACKGROUND: Sexual distress (eg, feeling distressed, unhappy, frustrated, stressed, dissatisfied, or bothered about their sexuality) is a central concern reported by patients seeking sex therapy, and might be related to sexual self-esteem and mindfulness disposition, yet research is needed to examine the links among those variables within the specific population of patients seeking therapy. AIM: This study aimed to examine the indirect role of sexual self-esteem in the relationship between dispositional mindfulness and sexual distress. METHODS: The study was conducted among 696 patients undergoing sexual therapy (mean age 34.19 ± 11.21 years, age range 18-78 years). Participants identified as women (57.3%), men (38.5%), or nonbinary (4.2%). They completed self-report questionnaires assessing dispositional mindfulness (Five Facet Mindfulness Questionnaire), sexual self-esteem (Multidimensional Sexuality Questionnaire), and sexual distress (Sexual Distress Scale-Revised), during their first few sessions (ie, first to third sessions [the assessment phase]). OUTCOMES: Sexual distress was the main outcome, as measured with the Sexual Distress Scale-Revised. RESULTS: Results indicated that 54% (n = 376) of patients reported elevated sexual distress based on the questionnaire threshold score. Path analyses indicated an indirect effect in which higher dispositional mindfulness was associated with higher levels of sexual self-esteem, which in turn was associated with lower sexual distress. Results also highlighted that specific facets of mindfulness were related to higher sexual self-esteem (ie, describing, and nonreacting) and lower sexual distress (ie, nonjudgment and acting with awareness). The integrative model explained 23% of the variance of sexual distress scores. CLINICAL IMPLICATION: Findings suggest that addressing specifically sexual self-esteem and mindfulness may represent relevant clinical avenues to reduce sexual distress among sex therapy patients. STRENGTHS AND LIMITATIONS: Strengths of this study include the novel examination of the role of sexual self-esteem in the link between mindfulness disposition and sexual distress in a large clinical sample of patients seeking sex therapy. Limitations includes reliance on patient self-report and a cross-sectional design that limit conclusion regarding causality. CONCLUSION: This study makes a valuable contribution to the existing body of research highlighting the pivotal roles of sexual self-esteem in the link between dispositional mindfulness and reduced sexual distress among adults undergoing sex therapy, allowing us to identify potential targets of intervention.

Being a Surrogate Partner: The Challenges of Fragile Boundaries.

Surrogate partner therapy is a type of treatment in which the surrogate partner (SP) works in a triadic setting with a sex therapist and a patient. At the same time, the SP acts as an intimate surrogate partner to the patient. The SP treatment includes a range of therapeutic experiences such as relaxation, intimate communication, sensual and sexual contact, and training for the acquisition of social skills. In the current study, we ask what and how SPs experience, understand, and construct boundaries in their work. We used Winnicott's therapeutic conceptualization of psychotherapy as a mode of playing and Goffman's dramaturgical role theory as the theoretical framework for our exploration. Applying a phenomenological and empathic approach, we analyzed 13 in-depth interviews with Israeli SP. It appears that SP's transitions from one performance to another are dramatic, in that their role requires the involvement of sexual and emotional helping relations with their patients. Moreover, SPs are obliged to have secrecy at all levels and in various relationships in their lives. We uncovered various complexities that SPs experience, such as a lack of clarity about their role, which creates challenges for building their professional and personal identity and affects their family and social relationships.

[Sex therapy and support for women and couples]. / Sexothérapie et accompagnement de la femme et du couple.

Sexuality is shaped by experience and by what has been passed down. Body image and sex influence desire and pleasure. In the case of endometriosis, suffering and pain can lead to shame and guilt. Encouraging people to talk to each other helps to create a free eroticism that resembles the couple.

Affective neuroscience: applications for sexual medicine research and clinical practice.

INTRODUCTION: Affective neuroscience is the study of the brain substrates of emotional, embodied experiences. Affective neuroscience theory (ANT) is based on experimental evidence that all mammals are hardwired with 7 primary subcortical emotional operating systems, or "core emotions," that have overlapping but distinct circuits buried in the deep, ancient parts of the brain. Imbalances in the 7 core emotions can affect multiple aspects of the individual's psychosocial well-being (eg, depression, anxiety, substance abuse). Here, we propose that core emotions can also influence sexual function and, specifically, that imbalances in core emotions are the bridge connecting psychiatric symptoms (eg, anhedonia) to sexual dysfunction (eg, anorgasmia). OBJECTIVES: In this targeted review and commentary, we outline potential connections between ANT and sexual medicine research and clinical practice. We summarize ANT by defining the 3-level BrainMind and core emotions; examining how they relate to personality, behavior, and mental health; and determining the implications for sexual health research and clinical practice. METHODS: A targeted literature review was conducted. Case studies were adapted from client files and clinician interviews and then anonymized. RESULTS: We propose a novel organizational schema for implementing affective balance therapies for sexual dysfunction, which integrate psychoeducational, somatic, and cognitive therapeutic approaches under the ANT framework. We provide 3 patient case studies (anorgasmia, hypersexuality, spinal cord injury) outlining the implementation of this approach and patient outcomes. CONCLUSION: ANT has practical translational applications in sexual health research and clinical practice. By integrating our understanding of the role of core emotions in human sexuality, clinicians can better tailor treatments to address sexual dysfunction.

Clitoral Therapy Device for Alleviating Sexual Dysfunction After Female Genital Mutilation: Randomized Controlled Trial.

BACKGROUND: Female genital mutilation is considered a crime but is still practiced today in Africa and the Middle East, despite all the laws that make this procedure illegal due to the long-term physical and psychological harm it causes to women. Millions of girls and women living today have undergone genital mutilation, which involves removing the external female genitalia either partially or totally, based on the belief that it restricts feminine sexuality, thereby "saving" a girl for marriage. For girls and women, the surgery offers no health advantages. Girls' right to control critical decisions regarding their sexual and reproductive health is violated because genital mutilation is frequently done against their will and frequently without their consent, leading to lifelong psychic trauma in addition to sexual dysfunction and lack of satisfaction due to distortion of the genitalia that threatens marital stability. OBJECTIVE: To determine the effect of a clitoral therapy device on improving sexual domains in women suffering from sexual dysfunction after female genital mutilation. METHODS: This study examined 80 married women aged from 20 to 45 years who were referred from the gynecology outpatient clinic of the Faculty of Medicine, Suez University, for sexual dysfunction resulting from female genital mutilation. The women were divided into 2 equal groups: the study group received a clitoral therapy device and traditional psychosexual education and were closely followed for 3 months, while the control group received only traditional psychosexual education for 3 months. The Arabic version of the Female Sexual Function Index (FSFI) questionnaire was used to assess sexual outcomes pre- and posttreatment in the 2 groups. RESULTS: Our findings revealed a significant increase in the 6 domains of the FSFI pretreatment in both groups compared to posttreatment (P>.001), except the orgasm domain in the control group, which showed only a nonsignificant increase (P=.16). CONCLUSIONS: Clitoral therapy devices may be an effective, safe, noninvasive rehabilitation method for sexual dysfunction following female genital mutilation. TRIAL REGISTRATION: ClinicalTrials.gov NCT05039775; https://clinicaltrials.gov/ct2/show/NCT05039775.

Web-Based Digital Storytelling for Endometriosis and Pain: Qualitative Pilot Study.

BACKGROUND: Endometriosis is a complex chronic disease characterized by pain, including painful sex, that can contribute to considerable sexual function, self-esteem, and relationship challenges. Digital storytelling is an arts-based, participatory methodology wherein individuals create and share their illness experiences in detailing their lived experiences. OBJECTIVE: The study objective was to pilot-test a web-based digital storytelling workshop focused on endometriosis to understand storytellers' experiences of workshop participation. We assessed the feasibility of story cocreation and sharing, including the emotional impact of workshop participation, the acceptability of the workshop for the subject matter, and the storytellers' willingness to share their stories with broader audiences as a method for knowledge translation. METHODS: This study used a community-based participatory methodology supplemented with patient-oriented research and integrated knowledge translation. Study participants, referred to as storytellers, cocreated 3- to 5-minute individual digital stories about their lived experiences of endometriosis during a web-based workshop (comprising five 2-hour sessions over 6 weeks) facilitated by The Center for Digital Storytelling. Data were collected through participant observations at the workshop, storyteller weekly reflective journals, and an end-of-workshop focus group interview with storytellers. These data were analyzed using a qualitative interpretive description approach. RESULTS: A total of 5 women and 1 nonbinary storyteller aged 19 to 39 years who had experienced endometriosis for 4 to 22 years participated in the study. We characterized storytelling workshop participation and the acceptability of story cocreation by describing participants' experiences of opportunity, commitment, and connection; complex emotions that were healing; and a desire to share. Feasibility was demonstrated through 100% engagement in the workshops. All 6 storytellers reported feeling empowered by publicly sharing their cocreated digital stories through social media and the Sex, Pain & Endometriosis website. CONCLUSIONS: Despite the complexities of the story-building process, the workshop and the cocreation and sharing of digital stories were feasible. The storytellers found that this process allowed for emotional healing and personal empowerment by offering a unique way to talk about painful sex, which also facilitated a connection among those in the workshop. The use of digital storytelling as a knowledge translation tool shows promise, and this approach also has potential as a therapeutic intervention.

Beliefs and Attitudes Held Toward Sex Therapy and Sex Therapists.

There is a growing recognition that sexual problems can adversely impact health, well-being, and quality of life. Sex therapy provides individuals with an effective means of understanding, improving, and resolving their sexual difficulties. Yet, few individuals access a sex therapist when experiencing sexual difficulties and research on perceptions toward this service remains limited. The current study aimed to explore attitudes and beliefs held by a sample with a current or previous history of sexual problems toward sex therapy and therapists. A total of 27 individuals aged 19-53 participated in unmoderated structured interviews that were analyzed using reflexive thematic analysis. The results were organized into five categories, (1) overall perceptions of sex therapy, (2) when and for whom is sex therapy, (3) expectations, (4) beliefs about sex therapists, and (5) sources of beliefs. While the results indicated that participants held positive attitudes toward the service and about others seeking sex therapy, none had accessed sex therapy for their previous or current sexual problems. Numerous barriers relating to stigma, cost, and accessibility appeared to hinder the utilization of the service. The inaccurate and unrealistic beliefs about sex therapy and sex therapists highlight the need for increased education regarding the profession, which could reduce barriers and increase accessibility.

Ignored Components of Sexuality: The Need for Competent Clinical Practice with Child Survivors of Sexual Abuse.

Child sexual abuse (CSA) is a complex and often traumatic experience that can impact youth's emotional and psychological well-being. Many clinicians do not feel adequately prepared to work with youth around topics of sexuality. In this qualitative study, we examine how licensed therapists treat youth between ages 5 and 16 who have experienced CSA. We asked participants how they incorporate sexuality into trauma work with this population. Although all participants discussed themes commonly reported in clinical work with survivors (i.e., working on trust, self-image challenges, the brain-body connection, confusion around touch and boundaries) additional themes arose that could impede the provision of sexually-competent treatment for the survivor including: considerations for gender identity and sexual orientation, youth being sexually invisible until puberty, and an inaccurate/narrow use of the term "sexuality." We discuss the need for further training on youth sexual development and the ways youth experience the many topics within the concept of sexuality in their therapeutic treatment.

Development of an indigenous manual of cognitive behavior sex therapy for young men.

Some studies with Western men have shown promising results for the efficacy of cognitive behavior sex therapy (CBST) in the treatment of erectile dysfunction. The two randomized controlled trials were conducted to assess the efficacy of CBST as a treatment of choice for young men with non-organic erectile dysfunction (NOED). The two randomized controlled trials were run to assess the efficacy of CBST and integrated treatment approaches for the treatment of NOED in young Pakistani men. The two studies were registered with ClinicalTrials.gov vide No. NCT04179747 and NCT04126252. The sex therapy techniques were combined with cognitive behavior therapy and mindfulness to develop an indigenous approach for the treatment of NOED in young Pakistani men. The CBST significantly improved International Index of Erectile Functioning-5 scores in two studies. The CBST also decreased depression scores associated with NOED. The CBST is a treatment of choice for young Pakistani men with NOED. The CBST is also significant in improving the mental health conditions associated with NOED.

Management of Sexual Dysfunction in Gastrointestinal Disorders.

Patients with gastrointestinal (GI) disorders are at increased risk of sexual dysfunction (SD) due to a combination of biomedical, psychological, social, and interpersonal factors. While most patients desire information on the impact of their GI disorder on sexual function, few providers initiate this conversation. GI providers should routinely assess their patients for SD, validate these concerns, and provide brief education and a referral for evaluation and/or treatment. Treatment of sexual concerns is often multidisciplinary and may involve a sexual medicine physician, pelvic floor physical therapists, and sex therapists.

Psycho, Pharmaco and Sex therapy for the treatment of Premature Ejaculation.

Pakistani's men with Premature ejaculation (PE) hardly prefer to go for treatment due to cultural barriers (men dominating society). This research objective is the gives knowledge about the effective treatment of premature ejaculation, how it can be effectively treated with the help of different techniques. Premature ejaculation (PE) is happened when a man has an orgasm and ejaculated earlier at the time of intercourse then he or his spouse would like. PE is a men sexual dysfunction that creates a significant anguish for men, partner and their relationships'. Premature ejaculation is not only one illness; it contains 4 subtypes with a unique psychological concern and problems (longtime, acquired, organic and subjective). PE men and couples are treated psychologically for sexual ability but also for self-esteem, performance anxiety and interpersonal disputes. Psychotherapy outcomes alone are hard to compare and to appreciate due to insufficient methodology (lacking control groups, limited sample sizes, poor results and insufficient monitoring). Rare researches, however, which overcome these methodological barriers, indicate that psychological intervention provides a promising treatment choice for men and partners. A detail literature review was done via an electronic database, "Cochrane library databases", "PsychInfo", and "PubMed" from June to July 2021. The most effective procedure for lifetime and acquired PE is pharmaco- and psychotherapy combination. Men and partners develop sexual abilities and resolve the intra-psychological, interpersonal and cognitive problems that trigger and sustain dysfunction.

Successful Multidisciplinary Management of Foot Pain With Orgasm: A Case Report.

INTRODUCTION: There is very little literature on referred pain syndromes with orgasm. Referred foot pain with orgasm is rare and evidence based diagnosis and management is not defined. Dysorgasmia is a pain condition that can severely affect sexual health and quality of life. AIM: To add to the understanding and scant literature on referred orgasmic pain with pelvic floor and myofascial etiology. METHODS: A 34-year-old cis-female presented to a Physiotherapist, Sexual Medicine Physician, and Sex Therapist with a rare case of new insidious onset right foot pain with orgasm. RESULTS: Femoral nerve entrapment was diagnosed at the level of the inguinal ligament, referring pain to the right terminal sensory branch of the saphenous nerve along the medial aspect of the foot. Physiotherapy management resolved the patient's pain, while medical assessment was important to rule out numerous potential pathologies and to facilitate multidisciplinary management. Psychological therapy via sex therapy was integral in the highly successful and improved sexual outcome for this patient and her husband. CONCLUSION: This case report details the successful multi-disciplinary assessment and management of a rare dysorgasmia and the importance of addressing sexual sequelae to add to the small amount of literature on difficult referred pain syndromes during sexual arousal and orgasm. Meddings K , Klein C, Elliott S, Successful Multidisciplinary Management of Foot Pain With Orgasm: A Case Report. Sex Med 2022;10:100499.

The Biopsychosocial Puzzle of Painful Sex.

Genital pain associated with sex is a prevalent and distressing problem with a complex research and clinical profile. This article reviews the historical context of the "sexual pain disorders" and the circuitous trajectory that has led from the first mention of painful sex in ancient documents to the latest diagnostic category of genito-pelvic pain penetration disorder in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders as well as in other existing and proposed nomenclatures. Prominent etiologic research and emergent theoretical models are critically assessed, as is the latest treatment outcome research of note. Finally, the review points to a number of extant needs in the research and clinical effort, including an integrated biopsychosocial and multidisciplinary approach, randomized clinical trials, targeting of treatment barriers, and expansion of the entire enterprise to include populations that have not been considered.

Randomized Placebo Controlled Trial of Sildenafil Citrate, Cognitive Behavior Sex Therapy and Integrated Treatment in Men Diagnosed With Non Organic Erectile Dysfunction.

INTRODUCTION: The integrated treatment combining phosphodiesterase-type 5 inhibitors (PDE5i) and Cognitive Behavior Sex Therapy (CBST) has been shown to yield promising results in the treatment of Non Organic Erectile Dysfunction (NOED) in young men. AIM: The current study aimed to establish the efficacy of integrated treatment combining Sildenafil Citrate (SC) 50mg and CBST as a treatment of choice in young Pakistani men with NOED. METHODS: One hundred thirty-seven young men were recruited to participate in the study out of 164 men referred from sexual health clinics in Pakistan. They were randomized sequentially into 4 treatment groups namely SC = 35, CBST = 34, integrated treatment = 35, and placebo = 33. 7, 4, 6, and 4 men were dropped out of each treatment group respectively. The data of 116 men were analyzed. The on demand SC 50 mg, twice weekly 50 minutes sessions and home assignments, a combination of SC and 50 minutes sessions, and placebo were administered to firsst, second, third, and fourth group respectively for a period of 12 weeks. The follow-up assessment was done after 12 weeks of post-treatment for all groups. MAIN OUTCOME MEASURES: The Urdu standardized versions of International Index of Erectile Functoning-5 (IIEF-5) and Depression Anxiety Stress Scale-21 (DASS-21) were the main outcome measures. RESULTS: The mixed repeated measures analysis of co-variance yielded significant impact of both CBST and integrated treatment groups in improving IIEF-5 scores at post treatment as compared to placebo. The CBST group experienced reduction in depression scores at post treatment as compared to both SC and integrated treatment. Only the integrated treatment brought reduction in anxiety scores at post treatment as compared to SC. The covariates age and NOED duration did not significantly impact the treatment outcome for all treatment groups. CLINICAL IMPLICATIONS: The efficacy of integrated treatment approach for improving symptoms of NOED and associated depression and anxiety is strong clinical implication of the study. STRENGTHS & LIMITATIONS: The effectiveness of integrated treatment approach in the improvement of NOED symptoms and associated depression and anxiety scores is the main strength of the study. The improvement in depression scores is the added strength of CBST component of integrated treatment approach. The study should have included other PDE5i to compare their effects with the CBST or placebo groups. CONCLUSION: The study concludes that the CBST and integrated treatments are treatment of choice for NOED and associated depression and anxiety in young men. Bilal A, Abbasi NH. Randomized Placebo Controlled Trial of Sildenafil Citrate, Cognitive Behavior Sex Therapy and Integrated Treatment in Men Diagnosed With Non Organic Erectile Dysfunction. Sex Med 2022;10:100464.

Treating Sexual Dysfunctions Among Survivors of Child Sexual Abuse: An Overview of Empirical Research.

Sexual problems are very prevalent among survivors of child sexual abuse (CSA). Yet, various approaches to therapy do not seem to address this issue when treating these individuals. Traditional sex therapy may also not suit the experiences of CSA survivors, as CSA was not considered when the most well-known and frequently used techniques were developed. The present review sought to identify (1) theory-based therapeutic approaches that address sexual problems among CSA survivors and offer treatment protocols (including an outline of specific therapy stages, sessions, or techniques) to treat these sexual problems and (2) identify therapeutic approaches that include a protocol for treating sexual problems among CSA survivors that was empirically tested and validated. In total, six approaches for treating sexual dysfunctions among CSA survivors that provide detailed guidelines for implementing the approach within sex therapy for CSA survivors were identified in the literature. Only two of the studies conducted a randomized controlled trial to test the intervention. This overview concludes with important issues to address when treating sexual problems among CSA survivors and a call for additional evidence-based practices for treating sexual problems among survivors of CSA.

Incorporating the Principles of Sex Therapy into Urologic Care.

Urologic conditions and their treatments can have a significant impact on patients' sexual functioning and sexual health. Although urologists address sexual dysfunction within their scope of practice, sexual health conversations occur rarely and focus narrowly on physiologic sexual function. The sex therapy perspective considers biologic, psychological, relationship, and cultural aspects of sexuality. We propose that urologists benefit from taking this perspective when performing sexual health assessment. Urologists are not required to provide sex therapy but can optimize their patient's sexual well-being by taking a holistic perspective on sex and offering informational resources and referral to colleagues with complementary sexual health expertise.

A Conceptual Approach to Understanding and Managing Men's Orgasmic Difficulties.

Premature ejaculation (PE) and delayed/inhibited ejaculation (DE) are 2 ejaculatory problems that may negatively affect the sexual relationship and cause distress. Although no specific cause explains these problems when they have been lifelong conditions, understanding both biological and psychological factors may be relevant to treatment choices, with options ranging from pharmacologic to psychobehavioral. Integrating treatment modalities may lead to better outcomes but may also require greater psychological and resource investment from the patient or couple.

A Multimethod Investigation of Sex, Romantic Relationships, and Interpersonal Dependency.

An individual's level of interpersonal dependency influences the way they engage with others, and researchers have achieved a comprehensive understanding of the interplay between dependency and interpersonal relationships across an array of social situations. This knowledge has improved the efficacy of medical and psychotherapeutic work with dependent clients and has informed approaches taken to reduce the societal costs of dependent personality disorder (e.g., increased risk for suicide and self-harm, perpetration of child abuse, perpetration of domestic violence, victimization by a partner, and physical illness). Relatively little research, however, has explored dependency's links to sexual activity and sexual functioning, the findings of which stand to offer knowledge valuable to sex counseling, couples therapy, sexual health, and our overall understanding of sexuality. The current study utilized a multimethod research design to explore dependency as it relates to sexual and romantic relationships and sexual activity. Multiple associations emerged between dependency, both interpersonal dependency and a healthy variant of dependency, and sexual activity. Based upon these findings and contemporary literature, an initial discussion of some of the therapeutic implications of this knowledge and suggestions for working with dependent clients are offered.