Associations between recalled childhood gender nonconformity and adult sexual dysfunction in Denmark: baseline assessment in the Project SEXUS cohort study.

BACKGROUND: Sexual dysfunctions may negatively affect an individual's self-perceived womanhood or manhood, but whether gender nonconformity in childhood or adolescence can influence adult sexual functioning has not been examined so far. AIM: To explore the possible link between recalled childhood gender nonconformity and sexual dysfunctions in adulthood in a large sample. METHODS: We analyzed baseline questionnaire data from Project SEXUS, a nationally representative cohort study on sexual health among 15- to 89-year-old Danish citizens. Our sample included sexually active participants aged ≥18 years who were queried about gender nonconformity in childhood or adolescence (N = 21 390). To capture sexual dysfunctions, we assessed (1) difficulties with lubrication, orgasm, vaginal cramps precluding sexual intercourse, and/or genital pain during partnered sexual activity in women and (2) difficulties with erection, premature ejaculation, orgasm, and/or genital pain during partnered sexual activity in men. Furthermore, we assessed whether such difficulties were perceived as problematic. The 6-item Female Sexual Function Index and the 5-item International Index of Erectile Function served as standardized measures. Polytomous logistic regression analyses yielded demographically weighted adjusted odds ratios (aORs) with 95% CIs for associations between childhood gender nonconformity and sexual dysfunctions, controlling for age, sociodemographics, health-related factors, and other potential confounders. OUTCOMES: Sexual difficulties and dysfunctions, as well as scores on the Female Sexual Function Index and International Index of Erectile Function. RESULTS: Age-adjusted odds ratios indicated that sexual dysfunctions were significantly more common among childhood gender-nonconforming than conforming participants. After controlling for additional potential confounders, most sexual dysfunctions-notably, vaginal cramps in women (aOR, 2.12; 95% CI, 1.25-3.60) and genital pain dysfunction in men (aOR, 2.99; 95% CI, 1.79-4.99)-remained significantly increased among childhood gender-nonconforming respondents. CLINICAL IMPLICATIONS: Findings suggest that self-perceived gender nonconformity in childhood or adolescence may negatively affect sexual functioning in adult life. If confirmed by future studies, they may warrant a clinical emphasis on such issues in sexologic treatment and care. STRENGTHS AND LIMITATIONS: Our study is the first to report associations between childhood gender nonconformity and adult sexual dysfunction, building on data from a large-scale, nationally representative cohort study. The retrospective assessment of childhood gender nonconformity via one item might have neglected significant dimensions of this construct. CONCLUSION: The present study is the first to show that individuals who recall being gender nonconforming in childhood or adolescence may be at a greater risk of experiencing sexual dysfunctions, particularly sexual pain disorders, as adults.

Association of sexual dysfunction according to DSM-5 diagnostic criteria with avoidance of and discomfort during sex in a population-based sample.

Background: Sexual dysfunction frequencies and diagnostic indicators among older populations are relevant for public health measures, but evidence from large population-based studies is still scarce. Aim: To determine sexual dysfunction frequencies for women and men according to the Diagnostic and Statistical Manual of Mental Disorders (fifth edition; DSM-5) among 45- to 74-year-old participants of the population-based Hamburg City Health Study and the factors associated with sexual dysfunction diagnoses. Methods: We determined sexual dysfunction frequencies according to the DSM-5 and the factors associated with sexual dysfunction diagnoses (quality/avoidance of and discomfort during sex) among 45- to 74-year-olds from 7786 participants of the population-based Hamburg City Health Study. We analyzed cross-sectional self-report questionnaire data collected between 2016 and 2019 using descriptive statistics, comparative tests (Fisher test, Mann-Whitney U test), and logistic regression. Outcomes: Outcomes included sexual dysfunction frequencies - specifically, sexual difficulties experienced frequently or more often, over at least six months in the last year, causing severe or very severe distress, and not associated with physical health or relationship problems - and items on quality/avoidance of and discomfort during sex. Results: Participants' median age was 62.0 years (IQR, 14) and 51.1% were women. The frequency of sexual dysfunction according to the DSM-5 was 9.3% (95% CI, 8.3%-10.4%) in women and 6.2% (95% CI, 5.4%-7.1%) in men, with women's sexual interest/arousal and men's erectile disorder being most common. Sexual dysfunction rates increased with age: whereas complaints were more frequent among women than men in the younger groups, participants aged ≥65 years with a sexual dysfunction were more often men. Quality/avoidance of and discomfort during sex were significantly associated with a diagnosis of sexual dysfunction. Clinical Implications: Results suggest that sexual dysfunction caused by other than physical health or relationship factors is important to consider in this population. In addition, the avoidance of, perceived quality of, and discomfort during sex serve as valuable diagnostic indicators for the presence of sexual dysfunction. Strengths and Limitations: This study draws on robust data from a large sample to give valuable insight on the frequency of sexual difficulties and dysfunctions as defined by DSM-5 criteria. Limitations represent the restriction to self-report questionnaire data, the focus on participants living in a metropolitan area, and the lack of experience of sexual difficulties due to a lack of sexual activity not being taken into account. Conclusion: The study provides estimates for DSM-5 sexual dysfunction frequencies among Germans from a metropolitan area and points to the diagnostic value of age-related changes as well as the quality/avoidance of and discomfort during sex.

Sexual activities and experiences in women who underwent genital cosmetic surgery: a cross-sectional study using data from the German Health and Sexuality Survey (GeSiD).

The aim of this study was to compare women who have undergone genital cosmetic surgery (FGCS) with women who have not regarding past sexual activities and experiences. It draws on data from the German Health and Sexuality Survey (GeSiD). The subsample of women who had undergone FGCS (n = 32) was compared to a subsample of women who had not had FGCS (n = 96); the samples were matched for age, education, relationship and marital status, and whether participants had born a child. Variables concerning the present relationship, recent/lifetime sexual activities, sexual orientation, pregnancy-related experiences, health, sexual boundary violations/violence, sexual difficulties, and migration background served as main outcome measures. Women who had undergone FGCS reported more often anal intercourse during their last sexual encounter (13% vs. 1%, p = 0.021), a pregnancy ending in miscarriage (34% vs. 16%, p = 0.016), and not to be satisfied with their own appearance (41% vs. 15%, p = 0.002) than women who had not undergone FGCS. The results indicate women's motivations for FGCS beyond the desire to improve genital appearance or function, and that contributing factors might be clinically relevant regarding more general psychological wellbeing.

'I don't live in my body somehow': metaphorical talk in women's accounts of vaginismus and dyspareunia.

Vaginismus and dyspareunia are common sexual difficulties; they often take a long time to be appropriately diagnosed, and their origins remain unclear. This paper examines the metaphors used by women to describe bodily experiences associated with vaginismus and dyspareunia, and highlights the contribution this form of analysis can make to the study of sexuality and sexual difficulties. A secondary analysis was conducted on primary data from biographic interviews exploring women's experiences of sexual pain and difficulties with sexual intercourse. Metaphor analysis was used to analyse a data subset of 28 interviews translated from German into English. Metaphorical concepts lying at the basis of the metaphors used were identified and grouped into three themes: characterisation of sexual difficulties; split body and 'self'; and sexual agency and objectification. Results are discussed with in the context of literature regarding the function of metaphors and the utility of metaphor analysis for research, and healthcare research and interventions more generally.

Assessing Psychodynamic Conflicts and Level of Personality Functioning in Women Diagnosed With Vaginismus and Dyspareunia.

Knowledge on etiological and risk factors of genito-pelvic pain/penetration disorder, formerly classified as dyspareunia and vaginismus, is limited. The Operationalized Psychodynamic Diagnosis (OPD) system offers a valuable basis for developmental considerations, and has not yet been used to research sexual pain difficulties in women. We conducted an exploratory pilot study of psychodynamic motivational conflicts and level of personality functioning as defined by the OPD system by means of an anonymous online survey among 24 women who had been diagnosed with dyspareunia or vaginismus. We matched them with 24 healthy controls and compared groups using paired-samples t-tests and Wilcoxon tests. Effect sizes were calculated using Pearson's r. Large effect sizes were found for mean or median differences of several OPD Structure Questionnaire (OPD-SQ) scales (self-reflection, p = 0.002/r = 0.59; affect differentiation, p = 0.007/r = 0.53; self-perception, p = 0.002/r = 0.58; impulse control, p = 0.007/r = 0.53; self-worth regulation, p = 0.008/r = 0.52; self-regulation, p = 0.004/r = 0.56; experiencing affect, p = 0.009/r = 0.53; bodily self, p = 0.008/r = 0.54; OPD-SQ total score, p = 0.007/r = 0.52; internal communication, p = 0.001/r = 0.63) and OPD Conflict Questionnaire (OPD-CQ) scales (guilt conflict active, p = 0.004/r = 0.60; Oedipal conflict passive, p = 0.009/r = 0.51; individuation versus dependency conflict active, p = 0.01/r = 0.52; guilt conflict passive, p < 0.001/r = 0.70; self-worth conflict passive, p = 0.001/r = 0.70; passive mode, p < 0.001/r = 0.68). The problems with personality functioning and more pronounced types of conflicts participants displayed suggest proneness for self-invalidation, internalization and restricted self-perception.

"A Woman Should Still Be a Woman" - A Grounded Theory of the Origins of Sexual Pain and Difficulties with Intercourse.

The origin of women's sexual pain and difficulties with intercourse is still under-researched. The aim of this study was to examine women's constructions of origins. Twenty-eight participants previously diagnosed with vaginismus or dyspareunia were recruited via patient lists and private practices. Interviews had a semi-structured biographic-narrative format; transcripts were analyzed using Grounded Theory. Participants' narratives were constructed based on two major processes: Negotiating Womanhood and Othering the Body. They were integrated in an explanatory model. Identified processes permeated women's subjective experience and construction of the origin of their sexual difficulties, and were related to societal discourses and women's embodied experience.

Prevalence of Female Sexual Function Difficulties and Sexual Pain Assessed by the Female Sexual Function Index: A Systematic Review.

INTRODUCTION: Sexual difficulties, and sexual pain in particular, represent a global health issue for women, and their prevalence has been shown to differ across countries. AIM: To review the existing literature on the prevalence of female sexual difficulties and sexual pain worldwide measured by the Female Sexual Function Index (FSFI). METHODS: We conducted a systematic literature review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Included were peer-reviewed publications indicating prevalence rates of female sexual difficulties based on the FSFI and cutoff values. Studies with samples limited to a certain age group or health condition were excluded. MAIN OUTCOME MEASURE: The outcome measure includes cutoff values and prevalence rates for sexual difficulties and sexual pain, as well as sample characteristics. RESULTS: 22 studies conducted in 11 countries were included. These examined samples from the community, patient records, health care staff, or the Internet. Various prevalence cutoff values were applied. Prevalence rates of overall sexual difficulties ranged between 5.5% and 77%. For sexual pain, rates from 3% to 95.5% were found. A comparison between countries was restricted due to differences in sample size, sample type, and applied cutoffs. Representative community samples using comparable cutoffs found that 5.8-63.3% of women experience general sexual difficulty and 6-31.6% experience sexual pain. CLINICAL IMPLICATIONS: Sexual difficulties and sexual pain are prevalent in all examined countries, and despite restrictions to interpretability, the large prevalence rates point to the necessity of further clinical research. STRENGTH & LIMITATIONS: Many studies had to be excluded because of missing data. The comparison of studies is descriptive, and not all regions worldwide are represented. Nevertheless, results of the review were useful to derive recommendations for reporting of future studies using the FSFI. CONCLUSION: This review is the first comparison of prevalence studies based on the FSFI. It reflects the extent of available research and limitations in comparability. Koops TU, Briken P. Prevalence of Female Sexual Function Difficulties and Sexual Pain Assessed by the Female Sexual Function Index: A Systematic Review. J Sex Med 2018;15:1591-1599.

Online sexual activity involving webcams-An overview of existing literature and implications for sexual boundary violations of children and adolescents.

Despite the relevance of the Internet and its increasing use for sexual purposes, research into online sexual activity (OSA) involving webcams is limited. Aside from positive experiences, OSA may implicate violations of sexual boundaries, reaching from minor issues to serious forms of sexual abuse. To provide a basis for a classification of sexual boundary violations online and a conceptualization of preventive measures, a systematic review of the literature on OSA involving webcams was conducted, resulting in publications from four thematic categories: webcam use in common OSA, psychopathological phenomena, sex work, and crime and indecency (commercial sexual exploitation, trafficking, and sexual boundary violations). The discussion addresses the implications of different types of sexual boundary violation of children and adolescents on the Internet. The study's Internet findings could promote prevention and law enforcement strategies tailored to these types of offense as well as different target groups.

[In-patient hospital care of selected sexual disorders : An analysis of data from the German Federal Statistical Office from 2000 to 2014]. / Stationäre Krankenhausbehandlungen ausgewählter sexueller Störungen : Eine Analyse der Daten des Statistischen Bundesamts von 2000 bis 2014.

BACKGROUND: Patients with the ICD-10 sexual disorders F52, F64, F65, and F66 are treated by a variety of medical disciplines. Until now, there has been a paucity of data regarding which sexual disorders are treated by means of in-patient hospital care and whether changes have occurred over time. OBJECTIVES: The aim of this study is to examine how many patients with sexual disorders that are classified by ICD-10 chapter V (F) as "mental" are treated as in-patients. METHODS: Diagnosis data regarding German hospital care, which have been published annually since 2000 by the German Federal Statistical Office (Destatis), are analysed. RESULTS: Since 2000, the number of in-patients with disorders of gender identity (F64) has increased 2.6-fold. Hospital treatment of sexual dysfunctions (F52) as a primary diagnosis is decreasing, whereas a significantly higher number of in-patients are treated with F52 as a secondary diagnosis. In-patients with F64 are mostly treated in urology and gynaecology departments or by surgeons, and 76.0-81.1% of F52 cases in urology. In-patients with paraphilic disorders (F65) or psychological and behavioral disorders associated with sexual development and orientation (F66) are rarely but almost exclusively treated in psychiatric or psychotherapeutic departments. DISCUSSION: The data indicate that most in-patient hospital treatment for primary diagnoses of sexual disorders are somatic treatments for erectile dysfunction (F52.2) and transsexualism (F64.0). Owing to a steady increase in cases with F64.0 diagnoses, a growth in demand for competence in sexual medicine can be noted, especially in the surgical disciplines. Causes of the distribution and the increase in in-patient numbers are discussed. Further research is required, particularly concerning the treatment of in-patients with F52 and F64 secondary diagnoses.

Child sex tourism - prevalence of and risk factors for its use in a German community sample.

BACKGROUND: To investigate the prevalence of child sex tourism (CST) in a large German community sample, and to compare those who made use of CST with other child sexual abusers regarding established characteristics and risk factors for child sexual abuse. METHODS: Adult German men were recruited through a German market research panel and questioned by means of an anonymous online survey. Group assignment was accomplished based on information on previous sexual contacts with children and previous use of CST. Characteristics and risk factors were compared between the groups using t- and Chi-square tests. Binary logistic regression analysis was performed to predict CST. Data collection was conducted in 2013, data analysis in January 2015. RESULTS: Out of 8718 men, 36 (0.4%) reported CST use. The CST group differed from the nonCST group (n = 96; 1.1%) with regard to pedophilic sexual and antisocial behaviors as well as own experiences of sexual abuse. Social difficulties, pedophilic sexual interests, and hypersexuality were not distinct features in the CST group. Own experiences of sexual abuse, child prostitution use, and previous conviction for a violent offense predicted CST in a logistic regression model. CONCLUSIONS: This study is a first step to gain insight into the prevalence and characteristics of men using CST. Findings could help to augment prevention strategies against commercial forms of sexual abuse in developed as well as in developing countries by fostering the knowledge about the characteristics of perpetrators.