Women With Hypoactive Sexual Desire Disorder Versus Sexual Interest/Arousal Disorder: An Empirical Test of Raising the Bar

In 2013, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was published with a major revision to the sexual dysfunction categories, and the diagnosis of female hypoactive sexual desire disorder (HSDD) was replaced with female sexual interest/arousal disorder (SIAD). Since being introduced, concern has been expressed that SIAD inappropriately “raises the bar” for diagnosis. To address these concerns, we sought to evaluate the number of women with a diagnosis of HSDD who also met criteria for SIAD. In a sample of 151 women, we found that 73.5% of women with a diagnosis of HSDD met criteria for SIAD. The two groups were compared on the Sexual Interest/Desire Inventory, and women who met criteria for both HSDD and SIAD consistently scored lower on sexual desire frequency and satisfaction, satisfaction with sex, receptivity, positive sexual thoughts, reactions to erotica, arousal frequency, ease, continuation, and orgasm ease/achievement, and higher on distress. In addition, women meeting criteria for HSDD only tended to have mild symptoms across the six SIAD criteria compared to those meeting criteria for both HSDD and SIAD. These findings suggest that the SIAD criteria does not unduly raise the bar for diagnosis.     

Actor and Partner Effects of Attachment on Relationship Satisfaction and Sexual Satisfaction Across the Genders: An APIM Approach

Previous studies found gender differences in relationship satisfaction and sexuality. We tested gender differences in associations between attachment, a lasting relationship determinant, and two outcomes, relationship and sexual satisfaction. This study improves on earlier research by examining these associations in one Actor‐Partner‐Interdependence‐Model, making direct statistical testing between outcomes possible. Furthermore, a community and a distressed sample (N = 113 heterosexual couples each) were included to attempt replication across samples and to examine clinical implications. In both genders, actor attachment avoidance negatively affected relationship satisfaction and (with one exception) sexual satisfaction. Also in both genders, partner attachment avoidance negatively affected sexual satisfaction. However, whereas partner attachment avoidance influenced female relationship satisfaction, it did not affect male relationship satisfaction. The findings replicated across samples. Clinical implications are discussed.     

Transgender,Hysteria, and the Other Sexual Difference: An Ettingerian Approach

This article uses the feminist-psychoanalytic scholarship of Bracha L. Ettinger to consider a relationship between the discourse of the hysteric and the discourse of transgender (trans*). Both discourses struggle to articulate a dimension of being that lacks symbolization in the socio-Symbolic. My contention is that trans* subjectivity is metonymically linked to the discourse of the hysteric, and that both demographics are attuned to what Ettinger calls an Other Sexual Difference. Moreover, they are both writing something in excess of the phallic signifier that can, in Lacanian terms, circumscribe the man (as one) but not the woman (as not whole).     

Child Sexual Abuse Intervention: An Exploratory Study of Policy Concerns and Implications for Program Development

ABSTRACT

This exploratory study was designed to determine public opinion regarding intervention options for intrafamilial child sexual abuse offenders, victims, and families. The study investigated the public's willingness to support strategies of victim protection, offender control, and treatment services in various types of child sexual abuse intervention strategies. The respondents to the statewide survey generally supported established, adversarial intervention strategies, and had mixed reactions lo several of the diversion program strategies. The findings suggest that policy makers may have to compromise lo obtain public support when designing and implementing intervention programs for intrafamilial child sexual abuse. The article addresses policy issues and concludes with implications for program development.     

Social Justice and the Capabilities Approach: Seeking a Global Blueprint for the EPAS

The concept of social justice shapes several of the competencies and practice behaviors of the Council of Social Work Education’s Educational Policy and Accreditation Standards (EPAS). Furthermore, a global perspective guides the social work profession and influences its educational programs. A number of social work scholars have adopted the capabilities approach, as defined by economist Amartya Sen and political scientist Martha Nussbaum, as a globally relevant social justice framework. This article builds on this scholarship, suggesting that the capabilities approach provides a blueprint to rethink and conceptualize the EPAS social justice pedagogy in the global context. Teaching illustrations integrating the capabilities approach in an EPAS curriculum are offered.     

Sexual Behavior,Sexual Knowledge,and Sexual Attitudes of Emerging Adult Women: Implications for Working With Families

The purpose of this study was twofold: first, to examine the sexual behavior of emerging adult women in relation to their sexual knowledge, sexual attitudes, and perceptions of their parents' sexual attitudes; and second, to discuss the implications of this research in working with young adult women. Three hundred and sixty-four college-age women were administered the Sexual Experiences Inventory, Miller-Fisk Sexual Knowledge Questionnaire, and the Hendrick Sexual Attitude Scale. Ninety-six percent of the sample reported primarily heterosexual behavior. Sexual knowledge of participants was not related to their reports of sexual behavior. The sexual attitudes of college-age women and their perceptions of their parents' attitudes toward sexual behavior were found to relate positively to participant sexual permissiveness and sexual practice. The implications of these findings were discussed in relation to working with families and providing effective interventions to reduce unsafe sexual practices among emerging adult women.     

Young and Sexual in Norway and Croatia: Revisiting the Scandinavian Versus Mediterranean Gendered Pattern of Sexual Initiation

ABSTRACT

This article describes and analyzes patterns of first sexual intercourse and contraception use from a bicultural perspective. Study results are based on a 2009–2010 large-scale national probability survey of young adults aged 18 to 24 years in Croatia (n = 1,005) and Norway (n = 871). The findings corroborated the persistence of the dual model of sexual initiation in Europe (Scandinavian vs. Mediterranean), in which Norwegian women and Croatian men reported coital debut at an earlier age than their gender counterparts. Age difference between partners and the prevalence of condom use at first coitus were similar in both countries, with differences in contraceptive choices emerging with time. Young Norwegian men and women switched from using condoms to hormonal contraception when having been coitally active for some time. Interestingly, “the pill” remains rather unpopular among young Croatian women. Controlling for selected variables, using a condom at most recent sexual intercourse was significantly associated with condom use at first intercourse in all groups except Norwegian men, as well as with years of coital activity (except among Croatian men). Additionally, the odds of a condom being used at most recent intercourse were significantly correlated with same-sex sexual experience (only among Norwegian men) and with reporting the most recent intercourse with a casual partner (only among Norwegian participants). Country-specific patterns of contraceptive use are discussed in the context of public health and prevention.     

Latent Classes of Adolescent Sexual and Romantic Relationship Experiences: Implications for Adult Sexual Health and Relationship Outcomes

Adolescents’ sexual and romantic relationship experiences are multidimensional but often studied as single constructs. Thus, it is not clear how different patterns of sexual and relationship experience may interact to differentially predict later outcomes. In this study we used latent class analysis to model patterns (latent classes) of adolescent sexual and romantic experiences, and then examined how these classes were associated with young adult sexual health and relationship outcomes in data from the National Longitudinal Study of Adolescent to Adult Health (Add Health). We identified six adolescent relationship classes: No Relationship (33%), Waiting (22%), Intimate (38%), Private (3%), Low Involvement (3%), and Physical (2%). Adolescents in the Waiting and Intimate classes were more likely to have married by young adulthood than those in other classes, and those in the Physical class had a greater number of sexual partners and higher rates of sexually transmitted infections (STIs). Some gender differences were found; for example, women in the Low-Involvement and Physical classes in adolescence had average or high odds of marriage, whereas men in these classes had relatively low odds of marriage. Our findings identify more and less normative patterns of romantic and sexual experiences in late adolescence and elucidate associations between adolescent experiences and adult outcomes.     

The Use of Peer Support for Parents and Youth Living with the Trauma of Child Sexual Abuse: An Innovative Approach

ABSTRACT

This article describes and reports on an innovative intervention program for parents of sexually abused children and youth. Peer support provided by non-professional staff and volunteers, who have been personally affected by the trauma of child sexual abuse, is an approach with unique advantages. Many of these consumers have not been able to benefit from traditional service delivery approaches. Goals and objectives of the Peer Support Program (PSP) have been developed through inter-agency collaboration initiatives comprised of a coalition of existing social service agencies. This report examines characteristics of service delivery and level of consumer satisfaction of parents and youth who have participated in the peer support program. Implications for interventions with sexually abused youth and parents of sexually abused children are discussed.     

An fMRI Study of Responses to Sexual Stimuli as a Function of Gender and Sensation Seeking: A Preliminary Analysis

Although sexual cues produce stronger neural activation in men than in women, mechanisms underlying this differential response are unclear. We examined the relationship of sensation seeking and the brain’s response to sexual stimuli across gender in 27 subjects (14 men, M = 25.2 years, SD = 3.6, 85.2% Caucasian) who underwent functional magnetic resonance imaging (fMRI) while viewing sexual and nonsexual images. Whole-brain corrected significant clusters of regional activation were extracted and associated with gender, sensation seeking, and sexual behaviors. Men responded more to sexual than nonsexual images in the anterior cingulate/medial prefrontal cortex (ACC/mPFC), anterior insula/lateral orbitofrontal cortex, bilateral amygdala, and occipital regions. Sensation seeking related positively to ACC/mPFC (r = 0.65, p = 0.01) and left amygdala (r = 0.66, p = 0.01) response in men alone, with both of these correlations being significantly larger in men than in women (ps < 0.03). The relationship between brain responses and self-reported high-risk and low-risk sexual behaviors showed interesting, albeit nonsignificant, gender-specific trends. These findings suggest the relationship between sexual responsivity, sensation seeking, and sexual behavior is gender specific. This study indicates a need to identify the gender-specific mechanisms that underlie sexual responsivity and behaviors. In addition, it demonstrates that the nature of stimuli used to induce positive mood in imaging and other studies should be carefully considered.     

Men Sexually Interested in Transwomen (MSTW): Gendered Embodiment and the Construction of Sexual Desire

Unreliable self‐reporting of sexual behavior has been suggested as a major cause of variance in survey research. In addition, differing gender‐related biases are thought to account for discrepancies in reports of oral and anal sex. Insufficient attention, however, has been given to assessing the reliability of the sexual partner's reports. Data obtained from 70 couples concerning 68 sexual behaviors was reviewed. Four different reliability indices yielded moderate to substantial agreement. These included a simple percentage criterion of 87%, a Kappa of .67, and conditional probabilities of .77 and.91. Previously reported discrepancies in the reporting of oral and anal sex were not found. Kappa was found to be superior to simple percentage agreement, but produced overly conservative reliability estimates when derived from behaviors that occur at either high or low base‐rates. The two conditional probability indices are proposed for use in conjunction with Kappa to evaluate the reliability of partner data.     

Revisiting the Association between Pornography Use and Risky Sexual Behaviors: The Role of Early Exposure to Pornography and Sexual Sensation Seeking

Among the suggested problems and harms associated with widespread pornography use among young people, risky sexual behaviors have been frequently mentioned. To further explore this public health concern, this article analyzed sexual sensation seeking (SSS) as a potential confounder of the association between pornography use and sexual risks using data collected in 2010 from a population-based sample of young Croatian adults aged 18 to 25 (n = 1,005). Significant, but small, correlations were found between the indicators of pornography use (age at first exposure, frequency of use in the past 12 months, and personal importance of pornography) and sexual risk taking. However, in a multivariate analysis, only age at first exposure to pornography remained a significant, albeit weak, predictor of sexual risk taking among both women and men. SSS, defined as the dispositional tendency toward the impulsive pursuit of sexual arousal and stimulation, neither confounded nor moderated this association. Overall, the findings do not support the notion that pornography use is substantially associated with sexual risk taking among young adults, but suggest that early exposure to sexually explicit material and high SSS are additive risk factors for sexual risk taking.     

The Role of Rape-Supportive Attitudes,Alcohol, and Sexual Arousal in Sexual (Mis)Perception: An Experimental Study

While sexual misperception does not irrevocably lead to sexual aggression, it remains a significant risk factor. The present study investigated the effects of rape-supportive attitudes, alcohol, and sexual arousal on sexual perception. We used a 2 × 2 between-participants factorial design to randomly assign 135 men from the general population to a condition with or without alcohol (blood alcohol concentration target of .08%) and to a condition with or without sexual arousal. Participants were asked to listen to an audiotape depicting a sexual interaction between a man and woman and to indicate if and when they believed the woman was no longer interested in having sex. Results, obtained through survival analyses, indicate that the effects of rape-supportive attitudes on sexual misperception are moderated by alcohol consumption. Alcohol appears to be an important situational factor for activating men’s implicit theories. Our study sheds new light on the role of knowledge structures in sexual perception: It identifies when, as well as suggesting how, rape-supportive attitudes may disturb sexual perception and ultimately lead to sexual misperception.     

Gender Differences in Heterosexual College Students' Conceptualizations and Indicators of Sexual Consent: Implications for Contemporary Sexual Assault Prevention Education

Because sexual assault is often defined in terms of nonconsent, many prevention efforts focus on promoting the clear communication of consent as a mechanism to reduce assault. Yet little research has specifically examined how sexual consent is being conceptualized by heterosexual college students. In this study, 185 Midwestern U.S. college students provided responses to open-ended questions addressing how they define, communicate, and interpret sexual consent and nonconsent. The study aimed to assess how college students define and communicate consent, with particular attention to gender differences in consent. Results indicated no gender differences in defining consent. However, there were significant differences in how men and women indicated their own consent and nonconsent, with women reporting more verbal strategies than men and men reporting more nonverbal strategies than women, and in how they interpreted their partner's consent and nonconsent, with men relying more on nonverbal indicators of consent than women. Such gender differences may help to explain some misunderstandings or misinterpretations of consent or agreement to engage in sexual activity, which could partially contribute to the occurrence of acquaintance rape; thus, a better understanding of consent has important implications for developing sexual assault prevention initiatives.     

Supporting the Sexual Rights of Women Living With HIV: A Critical Analysis of Sexual Satisfaction and Pleasure Across Five Relationship Types

In the context of human immunodeficiency virus (HIV), a focus on protecting others has overridden concern about women’s own sexual well-being. Drawing on feminist theories, we measured sexual satisfaction and pleasure across five relationship types among women living with HIV in Canada. Of the 1,230 women surveyed, 38.1% were completely or very satisfied with their sexual lives, while 31.0% and 30.9% were reasonably or not very/not at all satisfied, respectively. Among those reporting recent sexual experiences (n = 675), 41.3% always felt pleasure, with the rest reporting usually/sometimes (38.7%) or seldom/not at all (20.0%). Sex did not equate with satisfaction or pleasure, as some women were completely satisfied without sex, while others were having sex without reporting pleasure. After adjusting for confounding factors, such as education, violence, depression, sex work, antiretroviral therapy, and provider discussions about transmission risk, women in long-term/happy relationships (characterized by higher levels of love, greater physical and emotional intimacy, more equitable relationship power, and mainly HIV-negative partners) had increased odds of sexual satisfaction and pleasure relative to women in all other relational contexts. Those in relationships without sex also reported higher satisfaction ratings than women in some sexual relationships. Findings put focus on women’s rights, which are critical to overall well-being.     

Sexuality Examined Through the Lens of Attachment Theory: Attachment,Caregiving, and Sexual Satisfaction

Attachment researchers have proposed that the attachment, caregiving, and sexual behavioral systems are interrelated in adult love relationships (Mikulincer &; Shaver, 2007 Mikulincer , M. , &; Shaver , P. R. ( 2007 ). Attachment in adulthood: Structure, dynamics, and change . New York , NY : Guilford . [Google Scholar]). This study examined whether aspects of partners’ caregiving (proximity, sensitivity, control, compulsive caregiving) mediated the association between their attachment insecurities (anxiety and avoidance) and each other's sexual satisfaction in two samples of committed couples (Study 1: 126 cohabiting or married couples from the general community; Study 2: 55 clinically distressed couples). Partners completed the Experiences in Close Relationships measure (Brennan, Clark, &; Shaver, 1998 Brennan , K. A. , Clark , C. L. , &; Shaver , P. R. ( 1998 ). Self-report measurement of adult attachment: An integrative overview . In J. A. Simpson &; W. W. Rholes (Eds.), Attachment theory and close relationships (pp. 46 – 76 ). New York : Guilford .[Crossref] , [Google Scholar]), the Caregiving Questionnaire (Kunce &; Shaver, 1994 Kunce , L. J. , &; Shaver , P. R. ( 1994 ). An attachment-theoretical approach to caregiving in romantic relationships . In K. Bartholomew &; D. Perlman (Eds.), Advances in personal relationships (pp. 205 – 237 ). London : Kingsley . [Google Scholar]), and the Global Measure of Sexual Satisfaction (Lawrance &; Byers, 1998 Lawrance , K. , &; Byers , E. S. ( 1998 ). Interpersonal Exchange Model of Sexual Satisfaction Questionnaire . In C. M. Davis , W. L. Yarber , R. Bauserman , G. Schreer &; S. L. Davis (Eds.), Sexuality-related measures: A compendium (pp. 514 – 519 ). Thousand Oaks , CA : Sage . [Google Scholar]). Path analyses based on the actor-partner interdependence model (APIM) revealed that caregiving proximity mediated the association between low attachment avoidance and partners’ sexual satisfaction in distressed and nondistressed couples. Sensitivity mediated this association in nondistressed couples only. Control mediated the association between men's insecurities (attachment-related avoidance and anxiety) and their partners’ low sexual satisfaction in nondistressed couples. Attachment anxiety predicted compulsive caregiving, but this caregiving dimension was not a significant mediator. These results are discussed in light of attachment theory and their implications for treating distressed couples.     

The Dynamics,Implications and Treatment of Extramarital Sexual Relationships for the Family Therapist*

This article presents the dynamics, implications and treatment of extramarital sex. Historical and cultural perspectives, various types of infidelity experiences and family therapy implications will be discussed. Marital styles will be outlined as a frame of reference in understanding the topic and the importance of symptom generation vis-a-vis infidelity. Finally, specific recommendations for treatment and a brief consideration of extramarital relationships as a healthy alternative marital style will be offered.     

Understanding the Decision to Marry Versus Cohabit: The Role of Interpersonal Dedication and Constraints and the Impact on Life Satisfaction

The current study explored men's and women's reasons for choosing to marry rather than to cohabit using a national data set (n = 786) of adults who were currently married or had been married previously. Using commitment theory participant's open-ended reasons for choosing to marry were coded into categories of either interpersonal dedication or constraint commitment. A variety of demographic, attitudinal, and relationship history variables were then used to predict commitment type. The influence of commitment type during the decision to marry on life satisfaction was also explored. Results indicate that current marital status (being married vs. being divorced or separated) and cohabiting before marriage were the strongest predictors of interpersonal dedication reasons for marriage for both men and women. Level of conventionality and parents' marital status also emerged as significant predictors of constraint commitment. Finally, marrying for reasons related to interpersonal dedication significantly predicted higher life satisfaction for men but not for women.     

Danger Talk: Sexual Error and the Limits of Thought: An Introduction

This article introduces a set of essays on the theme “Danger Talk: Sexual Error and the Limits of Thought.” To situate the essays, the author explains the original context for the essays: a 2016 forum at New York University (NYU) co-sponsored by NYU’s Center for the Study of Gender and Sexuality and the journal Studies in Gender and Sexuality.