Lori A. Brotto

A lack of interest in sexual activity that is associated with clinically significant personal distress is a common experience for women. The Diagnostic and Statistical Manual of Mental Disorders (D...

Advances in cancer treatments are increasingly extending the life expectancy of cancer survivors (Michaeli et al., 2023). However, these treatments often result in distressing post-treatment sympto...

Sexual aversion is defined as extreme aversion to partnered genital sexual contact. Sexual aversion may share features with asexuality (e.g., avoidance of sexual behaviors and sexual disgust), but the former provokes distress whereas the latter does not. It may also share symptoms with low sexual desire (avoidance of sexual behaviors and distress), but the link between sexual aversion and reduced sexual desire has not been established. The extent to which sexual aversion overlaps with asexuality and low sexual desire has not been studied. Based on the dual control model, we hypothesized that sexual aversion is distinct because it is accompanied by distress and predicted by heightened sexual inhibition, whereas low desire and non-distressing aversion (as seen in asexuality) are predicted by diminished sexual excitation. A total of 2065 participants completed self-report questionnaires assessing sexual aversion, desire, asexuality, distress, and sexual excitation and inhibition. We used Pearson correlations to test relationships between variables. Multiple regressions evaluated which inhibition and excitation factors predicted sexual aversion, desire, and asexuality. Secondary analyses investigated gender differences. Sexual aversion, asexuality, and low desire were correlated but only the positive correlation of sexual aversion with sexual distress reached moderate strength. Sexual inhibition, particularly inhibitory cognitions, was a significant predictor of sexual aversion. Asexuality was predicted by reduced sexual excitation and weakly by increased sexual inhibition, whereas sexual desire was predicted by high sexual excitation and weakly by reduced sexual inhibition. These results demonstrate that different mechanisms of sexual response predict aversion compared to desire and asexuality. These findings suggest that targeting sexual inhibition, specifically inhibitory cognitions, may be a promising focus for treatment of sexual aversion.

Background: Pelvic organ prolapse (POP) is common and can affect sexual health and body image. Sexual concerns of non-sexually active (NSA) females with POP have been poorly described. Aim: To describe the burden of POP and explore associations between sexual function and body image in all patients seeking surgery. Methods: Secondary analysis of a baseline patient cohort, randomized controlled trial (RCT) of 2 POP reconstructive surgeries at 5 urogynecology tertiary centers. We present baseline sexual activity, function, and sex-related affect and body image. Patients scheduled for POP surgery completed validated condition-specific questionnaires of sexual function, body image, demographics, POP burden, and medical comorbidities. We used descriptive statistics and appropriate tests of significance. Outcomes: Differences between sexually active (SA) and NSA patients in POP-specific sexual function and body image; associations between body image and impaired sexual function. Results: Of 181 patients, 86 (47.5%) were SA, with a mean (SD) of age 62 (11.1). SA patients were younger, with fewer comorbidities. 30/86 (35%) had clinically significant sexual function impairment. Reasons for being NSA included pelvic symptoms (69.1%), lack of interest (53.8%), and lack of partner (40.5%). Frustration, sexual inferiority, and anger were similar between NSA and SA patients. NSA patients have 5 times the odds of avoiding sexual activity because of fear of pelvic symptoms; twice the odds of being more dissatisfied and twice the odds of feeling more inadequate in their sex life than SA patients. (P < .05, unadjusted and adjusted analyses). A total of 171 patients (80% partnered) had similar body image scores between SA and NSA patients. Partnered NSA patients were more likely than SA to avoid sexual intimacy because of POP, aOR 2.35 (95% CI, 1.03-5.33). Patients who had clinically significant POP-related impairment of sexual function had significantly worse body image (P < .001). Clinical Implications: Patients with clinically bothersome POP have significant sexual concerns. Body image was similarly affected regardless of sexual activity. Perceived partner avoidance of intimacy was a common barrier. This is an opportunity for tailored sexual health individual and couples counseling. Strengths and Limitations: Our findings apply to many surgical POP patients regardless of partner or sexual activity status. Limitations include missing data, no validated measure of sexual distress, and no evaluation of partner sexual function. Conclusion: The burden of POP-related sexual dysfunction and corresponding poor body image is substantial in both SA and NSA patients awaiting POP surgery. In the preoperative assessment of POP, sexual health and body image questions should be routinely included.

Mindfulness-based cognitive therapy (MBCT) has been demonstrated to be highly effective for improving sexual desire and reducing sex-related distress among women with sexual interest/arousal disorder (SIAD). The extent to which MBCT efficacy is impacted by relationship factors has not been studied to date and has implications for recommending MBCT to individual treatment seekers based upon their particular relationship characteristics. The goal of this study was to examine relationship status, relationship duration, self-reported relationship closeness, and relationship satisfaction as moderators of MBCT outcomes on sexual desire and sexual distress in 70 women with SIAD (Mean age 39.3 years). Multilevel modeling examined the effects of these four moderators on outcomes at immediate posttreatment, and 6- and 12-month follow-up. Women who were single, those who self-reported not being emotionally close in their relationship, and those who had lower relationship satisfaction scores had significantly greater improvements in sexual desire after MBCT (d ranging from 0.49 to 0.99), and there was no effect of these relationship variables on sex-related distress. Years in relationship did not moderate either outcome. These preliminary findings suggest that single and relationally dissatisfied partnered women may benefit more from MBCT in terms of improvements to sexual desire compared to partnered and relationally satisfied women with SIAD.