The menstrual distress questionnaire (MEDI-Q): reliability and validity of the English version.

BACKGROUND: Menstrual cycle has a significant impact on women's health from different perspectives, both physically and psychologically. The assessment of menstrual-related distress is of pivotal clinical interest, especially in women with chronic exposure to abnormal bleeding or pain. The Menstrual Distress Questionnaire (MEDI-Q) is a new tool originally developed in Italian that comprehensively evaluates menstrual-related distress. OBJECTIVE: To validate the English version of the MEDI-Q in an English-speaking population. METHODS: The study consisted of two phases: an initial translation phase of the original Italian version of the MEDI-Q, and a data collection phase to validate the new English version among 288 native English-speaking women. RESULTS: The English version of MEDI-Q showed excellent psychometric properties, with high internal consistency (Cronbach's alpha = 0.84) and test-retest reliability (intraclass correlation coefficient = 0.95). Construct validity was supported by significant correlations between MEDI-Q scores and scores on measures of psychological distress and premenstrual symptoms. CONCLUSIONS: The English version of the MEDI-Q is a valid and reliable instrument for the assessment of menstrual distress and its impact on psychological well-being. This tool can be utilized in research and clinical settings to comprehensively investigate the impact of menstruation on various populations, identify and monitor menstruation-related disorders promptly and effectively, and to evaluate the effectiveness of targeted treatments for menstrual distress.

Dysregulated Sexuality in Women with Eating Disorders: The Role of Childhood Traumatic Experiences.

The present study explored the psychopathological, behavioral, and putative biological underpinnings of dysregulated sexuality in eating disorders (EDs), focusing on the role of childhood trauma - evaluated with the Childhood Trauma Questionnaire (CTQ). The comparison between Binge-Purging and Restricting patients outlined the predominance of markers of dysregulated sexuality in the first subgroup. In the clinical sample, hypersexuality - measured through the Hypersexual Behavior Inventory (HBI) - was associated with severe psychopathology, emotion dysregulation, childhood trauma, adverse consequences, and higher ghrelin levels. Moderation analyses showed that hypersexuality was associated with emotion dysregulation and psychopathology only in those patients reporting childhood traumatic experiences.

How Does Childhood Trauma Impact Women's Sexual Desire? Role of Depression, Stress, and Cortisol.

The relationship between childhood trauma and adult sexual dysfunction is well documented; however, there is a paucity of research that examines the physiological and psychological mechanisms that may potentiate this relationship. As depression, perceived stress, and hypothalamic pituitary adrenal (HPA) axis dysregulation are correlates of childhood trauma and sexual dysfunction, the current study sought to examine the association of each of these domains with low sexual desire in a sample of (N = 275 [n = 137 women with low sexual desire; n = 138 sexually healthy women]) non-clinically depressed women. First, we assessed the relative contributions of HPA axis dysregulation (as indexed by the diurnal cortisol slope), childhood trauma, depression symptoms and perceived daily stress on low sexual desire. Next, we examined the degree to which HPA axis dysregulation, perceived stress, and depressive symptoms, respectively, mediated the relationship between childhood trauma and sexual desire. Results indicate that diurnal cortisol slope and depression symptoms contribute to low desire over and above perceived stress and childhood trauma and that childhood trauma is associated with low sexual desire predominantly through depressive symptomatology. Theoretical and clinical implications of the findings are discussed.

Intimacy Mediates the Relation Between Maltreatment in Childhood and Sexual and Relationship Satisfaction in Adulthood: A Dyadic Longitudinal Analysis.

Trauma theories suggest that childhood maltreatment (CM) may partly explain intimacy problems in romantic relationships. However, empirical studies have yielded conflicting findings, likely due to the varying conceptualizations of intimacy. Findings that support long-term negative effects of CM on sexual and relationship satisfaction are almost exclusively based on cross-sectional intra-individual data, precluding the examination of mediating pathways and of dyadic interactions between individuals reporting CM and their partners. This study used a dyadic perspective to examine the associations between CM and the different components of intimacy based on the interpersonal process model of intimacy: self-disclosure, perceived partner disclosure, and perceived partner responsiveness. We also tested the mediating role of these intimacy components at Time 1 in the relations between CM and sexual and relationship satisfaction 6 months later. A sample of 365 heterosexual couples completed self-report questionnaires. Results of path analyses within an actor-partner interdependence framework showed that women and men's higher levels of CM did not affect self-disclosure, but was negatively associated with their own perception of partner disclosure and responsiveness. In turn, women and men's perception of partner responsiveness at Time 1 was positively associated with their own sexual satisfaction, as well as their own and their partner's relationship satisfaction at Time 2. Thus, perception of partner responsiveness mediated the associations between CM and poorer sexual and relationship satisfaction. The overall findings may inform the development of couple intervention that targets the enhancement of intimacy to promote sexual and relationship well-being in couples where one partner experienced CM.

Deviance or Normalcy? The Relationship Among Paraphilic Thoughts and Behaviors, Hypersexuality, and Psychopathology in a Sample of University Students.

INTRODUCTION: The actual definitions of paraphilic thoughts or behaviors and hypersexuality are still a matter of debate in the scientific community, and few studies have evaluated their psychopathological correlates in non-clinical samples of both men and women. AIM: This study aimed at shedding light on the gender differences in terms of frequency of paraphilic fantasies and behaviors, and the relationship among paraphilias, hypersexuality, and general psychopathology. METHODS: A sample of 775 university students (243 men, 532 women) was recruited from 6 Italian universities using questionnaires posted in social networks. Paraphilic behaviors, fantasies, and masturbation during these fantasies were evaluated, as well as hypersexuality, psychopathological correlates, self-perceived gender identity, and a history of adverse childhood conditions. MAIN OUTCOME MEASURES: Participants were assessed on the presence of paraphilic fantasies, behaviors, and masturbation related to paraphilic thoughts, and evaluated by means of the Symptom Checklist 90-Revised, the Hypersexual Disorder Screening Inventory, the International Index of Erectile Function, the Female Sexual Function Index, the Gender Identity/Gender Dysphoria Questionnaire, and the Childhood Experience of Care and Abuse Questionnaire. RESULTS: In the present survey, 50.6% of the men and 41.5% of the women reported at least 1 behavior considered paraphilic. A gender difference in the prevalence of the main paraphilic interests and behaviors was observed, with men reporting a higher prevalence of voyeurism, exhibitionism, sadism, and frotteurism, and a higher prevalence of fetishism and masochism in women. Both general psychopathology and sexual dysfunctions were associated with hypersexuality, rather than with the content of sexual fantasies. Finally, an association between childhood adversities and hypersexuality was found in women but not in men. CLINICAL IMPLICATIONS: Understanding the psychopathological correlates of paraphilic fantasies/behaviors and hypersexuality may allow clinicians to develop specific psychological and pharmacological interventions. STRENGTHS & LIMITATIONS: This is one of the few studies assessing paraphilic phenomenology and psychopathological correlates of hypersexuality in a non-clinical sample of both men and women. CONCLUSION: The results seem to demonstrate that paraphilic thoughts and behaviors are not really a deviation from normalcy, rather they are quite widespread in the young population, and the distinction between healthy and pathological sexual interests may be better replaced by an all-encompassing approach considering ego-dystonic sexuality, hypersexuality, and their psychopathological correlates. Castellini G, Rellini AH, Appignanesi C, et al. Deviance or Normalcy? The Relationship Among Paraphilic Thoughts and Behaviors, Hypersexuality, and Psychopathology in a Sample of University Students. J Sex Med 2018;15:1322-1335.

Body Esteem as a Common Factor of a Tendency Toward Binge Eating and Sexual Dissatisfaction Among Women: The Role of Dissociation and Stress Response During Sex.

BACKGROUND: Several studies have suggested a relevant overlap between eating disorders and sexual dysfunction involving the emotional component of body image esteem and dissociative experiences. AIM: To evaluate the common maintaining factors of sexual dysfunction and vulnerability to pathologic eating behaviors and their relation to a physiologic stress response. METHODS: In the present cross-sectional study, we evaluated a non-clinical sample of 60 heterosexual women (25-35 years old) for dissociation during sex with a partner, body image disturbance, and tendency toward pathologic eating behaviors. We also evaluated the stress-induced hypothalamic-pituitary-adrenal axis activation in response to a sexual stimulus and its association with binge eating and dissociation. OUTCOMES: Participants completed the Clinician-Administered Dissociative States Scale, the Sexual Satisfaction Scale-Women, the Body Esteem Scale for Adolescents and Adults, and the Eating Attitudes Test Short Version. Furthermore, we assessed cortisol levels before, during, and after exposure to explicit sexual stimuli shown within a laboratory setting. RESULTS: Dysfunctional body image esteem and a tendency toward binge-eating behaviors were associated with greater sexual distress in women. In particular, body esteem was significantly associated with greater dissociation during sex with a partner. Moreover, women who reported greater dissociation during sex with a partner and a tendency toward binge-eating behaviors showed higher levels of cortisol in response to sexual stimuli. CLINICAL IMPLICATIONS: These results support further research based on trans-diagnostic treatments targeted to dissociation and body image esteem, which could lessen sexual dysfunction and vulnerability to pathologic eating behaviors. STRENGTHS AND LIMITATIONS: Despite the small sample and self-reported questionnaires, this is the first study to consider the association of the stress response during sexual stimuli with sexual distress and with pathologic eating behaviors adopting a dimensional approach. CONCLUSION: Body uneasiness and dissociation represented factors underlying pathologic eating behaviors and sexual dysfunction. Women reporting a tendency toward binge-eating episodes and dissociation during sexual experiences represented a subpopulation with a higher stress response during sexual stimuli. Castellini G, Lo Sauro C, Ricca V, Rellini AH. Body Esteem as a Common Factor of a Tendency Toward Binge Eating and Sexual Dissatisfaction Among Women: The Role of Dissociation and Stress Response During Sex. J Sex Med 2017;14:1036-1045.

Testing cognitive predictors of individual differences in the sexual psychophysiological responses of sexually functional women.

The literature on sexual responses shows a large and not fully understood between-women variance in sexual responses and in strength of coherence between physiological and subjective sexual responses. This study investigated cognitive factors theorized to be associated with sexual responses that could explain such variance. Specifically, we investigated the predictive value of sexual excitation/inhibition and sexual schemas on sexual response and coherence. Vaginal photoplethysmography and continuous subjective sexual arousal were collected from 29 young women while they watched a control/erotic video sequence. Hierarchical linear modeling revealed that high sexual excitation and schemas related to passion and romance were related to higher coherence. These findings support the notion that cognitive factors that enhance sexual arousal contribute to the large variation seen in the coherence of sexual response as measured in the laboratory.

The Role of Family Environment and Multiple Forms of Childhood Abuse in the Shaping of Sexual Function and Satisfaction in Women.

Studies suggest that sexual self-schemas are an important cognitive mechanism in the sexual development of women with a history of childhood abuse. This literature is only beginning to explore how multiple forms of abuse (i.e., physical, emotional, and sexual), rather than sexual abuse alone, can influence the development of adult sexuality. Moreover, the extant literature has not carefully considered important factors other than the severity of the abuse that may relate to sexual self-schemas, including family environment and quality of romantic relationships. Findings from this cross-sectional study conducted on 417 heterosexual women (ages 18-25 years) suggest that family dynamics and different types of childhood abuse contribute both directly and indirectly to adult sexual function and satisfaction and that part of those effects were mediated by other factors such as sexual self-schemas and romantic relationship quality. These results, including an exploration of the direct and indirect effects, were discussed in terms of the pervasive effects of abuse on people's lives and the potential treatment targets that can be addressed when trying to reduce sexual problems in women with a history of abuse.

Dissociation during sex and sexual arousal in women with and without a history of childhood sexual abuse.

Women with a history of childhood sexual abuse (CSA) experience dissociative symptoms and sexual difficulties with greater frequency than women without a history of CSA. Current models of sexual dysfunction for sexual abuse survivors suggest that dissociation may mediate the relationship between CSA and sexual arousal difficulties. Dissociation, however, is often conceptualized as a single construct in studies of CSA and not as separate domains as in the dissociation literature. In the present study, women with (CSA, N = 37) and without (NSA, N = 22) a history of CSA recruited from the community were asked to indicate the frequency and intensity of their experience in two dissociation subgroups, derealization and depersonalization, during sex with a partner and in their daily life. Findings showed that, in the NSA group, more depersonalization during sex with a partner was associated with lower sexual arousal functioning. However, for both the NSA and CSA groups, more derealization during sex was associated with higher sexual arousal functioning. No measure of dissociation was significantly associated with sexual responses in the laboratory. These findings highlight the importance of distinguishing between different forms of dissociation (i.e., derealization and depersonalization) in the study of sexual arousal functioning. In addition, the findings challenge the notion that dissociation is a main predictor of sexual arousal problems in survivors of CSA and suggest that a more nuanced relationship may exist.

Psychopathological similarities and differences between obese patients seeking surgical and non-surgical overweight treatments.

PURPOSE: To compare the psychopathological characteristics of obese patients seeking bariatric surgery with those seeking a medical approach. METHODS: A total of 394 consecutive outpatients seeking bariatric surgery were compared with 683 outpatients seeking a medical treatment. All patients were referred to the same institution. RESULTS: Obesity surgery patients reported higher body mass index (BMI), objective/subjective binging and more severe general psychopathology, while obesity medical patients showed more eating and body shape concerns. Depression was associated with higher BMI among obesity surgery clinic patients, whereas eating-specific psychopathology was associated with higher BMI and objective binge-eating frequency among obesity medical clinic patients. CONCLUSIONS: Patients seeking bariatric surgery showed different psychopathological features compared with those seeking a non-surgical approach. This suggests the importance for clinicians to consider that patients could seek bariatric surgery on the basis of the severity of the psychological distress associated with their morbid obesity, rather than criteria only based on clinical indication.

Cross-sex hormonal treatment and body uneasiness in individuals with gender dysphoria.

INTRODUCTION: Cross-sex hormonal treatment (CHT) used for gender dysphoria (GD) could by itself affect well-being without the use of genital surgery; however, to date, there is a paucity of studies investigating the effects of CHT alone. AIMS: This study aimed to assess differences in body uneasiness and psychiatric symptoms between GD clients taking CHT and those not taking hormones (no CHT). A second aim was to assess whether length of CHT treatment and daily dose provided an explanation for levels of body uneasiness and psychiatric symptoms. METHODS: A consecutive series of 125 subjects meeting the criteria for GD who not had genital reassignment surgery were considered. MAIN OUTCOME MEASURES: Subjects were asked to complete the Body Uneasiness Test (BUT) to explore different areas of body-related psychopathology and the Symptom Checklist-90 Revised (SCL-90-R) to measure psychological state. In addition, data on daily hormone dose and length of hormonal treatment (androgens, estrogens, and/or antiandrogens) were collected through an analysis of medical records. RESULTS: Among the male-to-female (MtF) individuals, those using CHT reported less body uneasiness compared with individuals in the no-CHT group. No significant differences were observed between CHT and no-CHT groups in the female-to-male (FtM) sample. Also, no significant differences in SCL score were observed with regard to gender (MtF vs. FtM), hormone treatment (CHT vs. no-CHT), or the interaction of these two variables. Moreover, a two-step hierarchical regression showed that cumulative dose of estradiol (daily dose of estradiol times days of treatment) and cumulative dose of androgen blockers (daily dose of androgen blockers times days of treatment) predicted BUT score even after controlling for age, gender role, cosmetic surgery, and BMI. CONCLUSIONS: The differences observed between MtF and FtM individuals suggest that body-related uneasiness associated with GD may be effectively diminished with the administration of CHT even without the use of genital surgery for MtF clients. A discussion is provided on the importance of controlling both length and daily dose of treatment for the most effective impact on body uneasiness.

Childhood sexual abuse moderates the relationship between sexual functioning and eating disorder psychopathology in anorexia nervosa and bulimia nervosa: a 1-year follow-up study.

INTRODUCTION: Sexual dysfunctions that affect all aspects of sexuality are common in patients with eating disorders. However, only few studies have provided longitudinal information on sexual functioning in patients with eating disorders. AIM: To evaluate the longitudinal course of sexual functioning, and how changes in psychopathology and history of childhood abuse interact with sexual functioning in patients with anorexia nervosa (AN) and bulimia nervosa (BN). METHODS: A total of 27 patients with AN and 31 with BN were assessed at baseline and at 1-year follow-up after a standard individual cognitive behavioral therapy (CBT). MAIN OUTCOME MEASURES: Subjects were studied by means of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders IV, Female Sexual Function Index (FSFI), Eating Disorder Examination Questionnaire, Beck Depression Inventory, Spielberg's State-Trait Anxiety Inventory, Symptom Checklist-90, and Childhood Experience of Care and Abuse Questionnaire. RESULTS: After treatment, both patients with AN and BN showed a significant improvement in the FSFI total score (P < 0.01 for both AN and BN) and all FSFI subscales, without significant between groups differences. Patients reporting childhood sexual abuse did not show a significant improvement in sexual functioning (ß = 0.05; P = 0.58). Reduction in eating disorder severity was directly associated with FSFI improvement, but only in those subjects with no history of sexual abuse (ß = 0.28; P = 0.01). CONCLUSIONS: Eating disorder-specific psychopathology could be considered as a specific maintaining factor for sexual dysfunction in eating disorders subjects. Subjects reporting a history of childhood sexual abuse represent a subpopulation of patients with a profound uneasiness, involving body perception, as well as sexual functioning, which appeared not to be adequately challenged during standard CBT intervention. The results, though original, should be considered as preliminary, given the relatively small sample size.

Sexual functioning in women with mild and severe symptoms of Charcot-Marie-Tooth disease.

INTRODUCTION: Charcot-Marie-Tooth (CMT) disease is one of the most frequently inherited neurological disorders, and while it is known that individuals suffering from this condition have low quality of life, little is known about their sexual function and satisfaction. AIM: To describe the functioning on different domains of sexuality in a relatively large sample of women with CMT, provide comparisons between mildly and severely affected patients and between women with the two different types of CMT (demyelinating vs. axonal), and assess the relationship between sexual function and age of onset. METHODS: Fifty-seven women (age: 18-60 years) were approached in a CMT rehabilitation clinic by a psychologist and administered the Italian version of the McCoy Female Sexuality Questionnaire (MFSQ). Data from 40 patients who had had sexual intercourse in the previous 4 weeks were analyzed. MAIN OUTCOME MEASURE: The main outcome measures are the factors MFSQ-SEX and MFSQ-PARTNER, which describe sexual functioning and sexual satisfaction with a partner, respectively. RESULTS: Almost 30% of women did not engage in sexual intercourse with a partner. Overall sexual problems were more prominent in younger women and tended to be lower as age increased: this pattern was different from what was reported in previous studies in comparable samples of healthy Italian women. Severity of CMT was associated with better sexual functioning in the areas of desire, arousal, orgasm, and satisfaction, with women with more severe symptoms reporting greater functioning. Women with more severe CMT symptoms reported more pain during intercourse. Age of CMT onset and type of CMT (demyelinating vs. axonal) were not associated with differences in sexual functioning. CONCLUSIONS: Findings point to the importance of including assessment of sexual dysfunction in young women with mild CMT symptoms and the importance of providing sex therapy or counseling to these patients.

Standard operating procedures for female orgasmic disorder: consensus of the International Society for Sexual Medicine.

INTRODUCTION: As the field of sexual medicine evolves, it is important to continually improve patient care by developing contemporary "standard operating procedures" (SOPs), reflecting the consensus view of experts in sexual medicine. Few, if any, consensus SOPs have been developed for the diagnosis and treatment of Female Orgasmic Disorder (FOD). AIM: The objective is to provide standard operating procedures for FOD. METHODS: The SOP Committee was composed of a chair, selected by the International Society for the Study of Sexual Medicine, and two additional experts. To inform its key recommendations, the Committee used systematic reviews of available evidence and discussions during a group meeting, conference calls and e-mail communications. The Committee received no corporate funding or remuneration. RESULTS: A total of 12 recommendations for the assessment and treatment of FOD were generated, including suggestions for further research. CONCLUSIONS: Evidence-based, practice recommendations for the treatment of FOD are provided that will hopefully inform clinical decision making for those treating this common condition.

Female sexual arousal disorders.

INTRODUCTION: Definitions and terminology for female sexual arousal disorder (FSAD) are currently being debated. While some authors have suggested that FSAD is more a subjective response rather than a genital response, others have suggested that desire and arousal disorders should be combined in one entity. Persistent genital arousal disorder (PGAD) is a new entity which is suggested to be defined as Restless Genital Syndrome. Aims. The aims of this brief review are to give definitions of the different types of FSAD, describe their aetiology, prevalence and comorbidity with somatic and psychological disorders, as well as to discuss different medical and psychological assessment and treatment modalities. METHODS: The experts of the International Society for Sexual Medicine's Standard Committee convened to provide a survey using relevant databases, journal articles, and own clinical experience. RESULTS: Female Arousal Disorders have been defined in several ways with focus on the genital or subjective response or a combination of both. The prevalence varies and increases with increasing age, especially at the time of menopause, while distress decreases with age. Arousal disorders are often comorbid with other sexual problems and are of biopsychosocial etiology. In the assessment, a thorough sexological history as well as medical and gynecological history and examination are recommended. Treatment should be based on of the symptoms, clinical findings and, if possibly, on underlying etiology. CONCLUSION: Recommendations are given for assessment and treatment of FSAD and PGAD.

Relationship satisfaction as a predictor of treatment response during cognitive behavioral sex therapy.

Although recent research suggests that individual cognitive behavioral therapy (CBT) may be an effective treatment for female sexual dysfunctions, we have little information regarding predictors of treatment response. The goal of the current study was to assess the degree to which pre-treatment relationship satisfaction predicted treatment response to cognitive behavioral sex therapy. Women with sexual dysfunction (n = 31, M age = 28 years, 77.4 % Caucasian) receiving cognitive-behavioral sex therapy with or without ginkgo biloba, as part of a wider randomized clinical trial, were assessed pre- and post-treatment using validated self-report measures of sexual satisfaction, sexual distress, sexual functioning, and relationship satisfaction. Pre-treatment relationship satisfaction predicted changes in sexual satisfaction and distress, but not sexual functioning. Women with higher relationship satisfaction at intake experienced larger gains in sexual satisfaction and distress over the course of treatment. Pre-treatment relationship satisfaction also moderated the association between changes in sexual functioning and changes in sexual distress, such that improved functioning was associated with decreased distress only for women entering therapy with high relationship satisfaction. These findings suggest that, for women with low relationship satisfaction before entering treatment, improvement in sexual functioning may not be enough to alleviate their sexual distress.

Emotional states of love moderate the association between catecholamines and female sexual responses in the laboratory.

INTRODUCTION: Research suggests that there are three interrelated, yet distinct, emotion-motivation brain systems for human love (lust, romantic love, and attachment), each associated with a unique catecholaminergic and hormonal profile. Of interest for the current study are norepinephrine (NE) and dopamine (DA), which have a hypothesized connection with romantic love. As NE and DA are also known to facilitate sexual arousal, it is plausible that NE and DA may have a greater positive association with the sexual arousal responses of women in romantic love compared with women in lust. AIM: This study investigated if the effects of NE and DA activity on sexual arousal responses would differ depending on emotion-motivation state (Lust or Romantic). MAIN OUTCOME MEASURES: Physiological sexual arousal was assessed by photoplethysmography and subjective sexual arousal was assessed with a participant-controlled lever. METHODS: Seventeen women were included in the Lust group and 29 in the Romantic group. All participants provided a urine sample (to assess NE and DA) and completed a psychophysiological assessment. RESULTS: Elevated NE was positively and significantly associated with greater subjective and physiological sexual arousal for the Lust group, but not for the Romantic group. Similarly, elevated DA was positively and significantly associated with greater subjective sexual arousal for the Lust group, but not for the Romantic group. CONCLUSIONS: The sexual arousal responses of women in the Lust group, but not in the Romantic group, were positively and significantly associated with elevated NE and DA. It is feasible that, when women are seeking a partner (Lust), NE and DA may facilitate attention toward sexually relevant stimuli.

Cardiovascular reactivity and proactive and reactive relational aggression among women with and without a history of sexual abuse.

This study examined the association between cardiovascular reactivity and proactive and reactive functions of relational aggression among women with and without a history of sexual abuse. Heart rate reactivity, blood pressure reactivity, and respiratory sinus arrhythmia reactivity while recounting a relational stressor (e.g., being left out) were assessed. Participants provided self-reports of relational aggression and a history of sexual abuse prior to age 16. Results indicated that cardiovascular reactivity was only associated with relational aggression among women with a history of sexual abuse. In addition, whereas blunted reactivity was associated with proactive relational aggression, exaggerated reactivity was associated with reactive relational aggression. These findings highlight the importance of considering contextual moderators of the association between cardiovascular reactivity and aggression; moreover, results highlight distinct cardiovascular correlates of different functions of aggression. Finally, the findings underscore the need for additional research examining the physiological correlates of aggressive behavior among women.

Avoiding experiences: sexual dysfunction in women with a history of sexual abuse in childhood and adolescence.

Women with a history of sexual abuse during childhood/adolescence experience a high rate of sexual dysfunction. Evidence also suggests that they often use avoidant coping strategies, such as substance abuse, dissociation, and emotional suppression, which are likely factors implicated with their psychopathology. There is a dearth of information on potential psychological mechanisms affecting the sexuality of these women. Therefore, it is relevant to investigate whether avoidance, an important cognitive mechanism associated with anxiety disorders, relates to sexual functioning in this population. In this study, participants with (N = 34) and without (N = 22) a history of sexual abuse prior to age 16 years completed questionnaires on severity of sexual abuse, sexual functioning, and a tendency to avoid experiences. A three-step hierarchical regression investigated the effects of childhood/adolescent sexual abuse and avoidance tendencies on different aspects of sexual functioning. A significant interaction between childhood/adolescent sexual abuse and avoidance tendencies was found for orgasm function, with the combination of sexual abuse and avoidance tendencies explaining lower orgasm function. These findings suggest that, for women with a history of early sexual abuse, the tendency to avoid interpersonal closeness and avoid emotional involvement predicts orgasm functioning.