The Need to Look at Transgender and Gender Diverse People's Health: A Preliminary Descriptive Report on Pain, Sexual Distress, and Health Profile of Five Transmasculine People and One Non-Binary Person with Endometriosis.

The sexual health of transgender and gender diverse (TGD) people with endometriosis has been overlooked, and important emotional experiences, such as sexual distress and its correlates, have been ignored. This has prevented a more comprehensive look at the health experiences of TGD individuals. This descriptive online survey study preliminarily explored the experiences of pain symptoms, sexual distress, and mental health of N = 6 TGD individuals diagnosed with endometriosis. Descriptive results showed a mean delay of 10 years from the onset of symptoms to the diagnosis. Endometriosis-related pain was a common symptom, although with low to moderate intensity. Results also showed higher mean levels of pain impact, powerlessness and lack of control, somatization, depression, anxiety, and sexual distress, and lower mean levels of emotional well-being, social support, and worse self-image compared to reports on cisgender women with endometriosis in the literature. These results suggested that sexual and mental health in the context of TGD people with endometriosis has specificities and may be associated with factors that need to be accounted for to provide comprehensive and socially just healthcare, such as the recognition of the impact of endometriosis treatment on symptoms of gender dysphoria. To achieve sexual health equity for TGD people, continuous and updated professional training and inclusive research with multiple informants are necessary.

The role and needs of family doctors in sexual medicine: contributions of a preliminary Portuguese qualitative study for a global action.

Sexual health is fundamental for overall well-being and quality of life, making it the focus of intervention in Sexual Medicine (SM). Within the National Health Services, Primary Care Physicians (PCPs) guarantee comprehensive care in a biopsychosocial action, including in sexual health. This exploratory study aimed to investigate PCPs' perceptions about their role in SM and how to improve it. A cross-sectional online qualitative design was used, and a sample of 73 Portuguese PCPs was collected. Data was analyzed employing a summative content analysis. Three categories were established regarding how PCPs perceive their role in SM: "Protagonist", "Antagonist", and "Circumstantial". Concerning improving PCP's practice, two categories were identified: "Legitimizing Sexual Health" and "Enhancing Professional Development". In relation to SM, PCPs recognize themselves as institutional gatekeepers and comprehensive caregivers, resorting to familiar tasks to practice in a conditioned framework. To improve their role in SM, PCPs highlighted education investment, making specific suggestions for educational content, resource expedition, detailed guidelines creation, and raising provider and patient awareness beyond the biomedical scope. The results stress the need for an institutional effort to uphold PCPs' crucial role in SM to ensure adequate resource use and consistent, comprehensive sexual healthcare provision, enhancing overall patient care and placing sexual health as an essential field in primary care.

The impact of digital media on sexuality: a descriptive and qualitative study.

The beliefs about Digital Information and Communication Media (DM) impact on sexuality by people from the community are an essential field to understanding people's sexual behaviours and their response to others' sexuality. This cross-sectional, online, descriptive, qualitative study, developed in the context of the celebration of National Sexual Health Day in Portugal, intended to identify the reasons and the activities using DM related to sexuality and explore participant's beliefs about the impact of DM on sexuality. In August 2021, a convenience sample of 167 people (M = 40.01; SD = 14.67; range 19-75 years old) completed an online survey that was disseminated through social networks and that included two closed questions about internet use and an open question about their personal beliefs about the impact of DM on sexual health. The results showed that most participants were motivated to use DM to search for erotic content (51.5%). DMs are also regularly used for educational purposes, such as seeking information about sexual pleasure and satisfaction (46.1%). Regarding qualitative data, three themes were identified concerning the impact of DM on sexuality: YES, IT'S SEX, SO WHAT?, I'M MORE VULNERABLE NOW! and SEXUAL EXPANSION. DM is an indisputable resource in sexual health, like in other dimensions of health. Still, it may facilitate exposure to contexts of aggression with a harmful impact on mental health, especially for younger people. Taken together, our results reveal that sexuality is part of DM use, and people share beliefs that indicate they may be actively involved in diminishing its hazards and benefiting from its potential.

Psychometric properties of the Interpersonal Emotion Regulation Questionnaire in a community sample of the Portuguese population.

BACKGROUND: Intrapersonal aspects of emotion regulation have been at the forefront of research, while interpersonal aspects have received less attention. The Interpersonal Emotion Regulation Questionnaire (IERQ) was developed to address this issue. However, this scale was neither adapted nor validated for European Portuguese. AIMS: The present study aims to adapt the IERQ to European Portuguese and explore the preliminary psychometric properties of the IERQ in a community sample, through confirmatory factor analysis (CFA). Construct validity was further supported by examining convergent validity with ERQ subscales. METHOD: Using a cross-sectional design, individuals were recruited online. Self-report questionnaires were used, namely the IERQ and the Emotion Regulation Questionnaire (ERQ). RESULTS: The four-factor structure was confirmed through CFA. IERQ subscales correlated positively with the dimensions of the ERQ of cognitive reappraisal and correlated negatively with experiential suppression. CONCLUSIONS: This preliminary study showed that the IERQ has adequate psychometric properties in a Portuguese sample and supports that this instrument can be used to assess interpersonal emotion regulation strategies in non-clinical samples.

Body Dissatisfaction, Cognitive Distraction, and Sexual Satisfaction in a Sample of LGB+ People: A Mediation Study Framed by Cognitive Psychology Models of Sexual Response.

Introduction: Body dissatisfaction is a well-established risk factor for emotional problems and low levels of well-being indicators, such as sexual health. Cognitive models propose that dissatisfaction with one's body can cause cognitive distraction related to physical appearance during sexual activity. This may compromise sexual response, namely, sexual satisfaction in heterosexual cis women. However, this relationship has only been studied within heterosexual samples. The present study aims to test a mediation model using cognitive distraction related to body appearance during sexual activity as a mediator between body dissatisfaction and sexual satisfaction in LGB+ cis people (lesbian, gay, bisexual, and other minority sexual orientations). Methods: This cross-sectional online study comprised 165 cisgender LGB+ participants (n = 67 cis women, 40.6%; n = 98 cis men, 59.4%). Self-report questionnaires were used: the Global Body Dissatisfaction Scale, the Body Appearance Distraction Scale, and a Single-Item Measure of Sexual Satisfaction. Results: Cis women and cis men experience similar levels of body dissatisfaction, cognitive distraction with body appearance during sexual activity, and sexual satisfaction. Body appearance cognitive distraction during sexual activity mediated the relationship between body dissatisfaction and sexual satisfaction only in the men's sample. Discussion: Overall, in terms of gender and body dissatisfaction, our results reveal a reversed pattern than those found in heterosexual samples. This may be because LGB+ cis women may conform less to societal pressure, leading to less meaning given to body dissatisfaction in relation to sexuality, which may lead to more positive sexual outcomes. Likewise, LGB+ cis men present higher body dissatisfaction and experience lower sexual satisfaction, possibly due to the emphasis on physical appearance in the gay subculture. The results confirm the validity of cognitive models of sexual response.

What Sexual Problems Does a Sample of LGB+ People Report Having, and How Do They Define Sexual Pleasure: A Qualitative Study to Inform Clinical Practice.

Introduction: Sexual pleasure is a human right and a central aspect of human sexuality that contributes significantly to people's overall well-being, making it an essential element to consider in clinical settings. This study aims to expand the understanding of sexual pleasure by examining how LGB+ people (lesbian, gay, bisexual, and other minority sexual orientations)-who perceived having a sexual problem-define solitary and partnered sexual pleasure. Methods: A cross-sectional exploratory qualitative study was conducted online. The current study included 85 people who self-identified as LGB+ and reported experiencing a sexual problem. Data analysis was performed using summative content analysis. Results: The results for solitary sexual pleasure comprised the creation of 5 categories (Enhancing the relationship with oneself, Specification of solitary pleasure, Negative experience, Unrestrained experience and A goal). For partnered sexual pleasure, 9 categories were created (The perks of being with another, Openness to experience, A result of sexual techniques, Psychophysiological experience, Misconceptions about sexual pleasure, Absence of intrapersonal constraints, Undesirable feelings, Explicit consent, and Absence of interpersonal constraints). Discussion: Despite reporting sexual problems, most participants reported having experienced sexual pleasure, and were able to define it. This study provided a deeper understanding of the perspectives on and experiences of sexuality among LGB+ people who experience sexual problems. Our findings highlight that current diagnostic criteria (e.g., DSM-5) do not seem to align with the problems reported by this sample population (the problems presented are beyond their sexual function). This reinforces the importance of viewing sexual problems from a perspective that goes beyond the categorial psychopathology model. Our study's findings may offer valuable insights for the evaluation and treatment of sexual problems, where sexual pleasure is considered a crucial aspect of sexual well-being.

The effect of emotional regulation difficulties on sexual and psychological distress using repetitive negative thinking as a mediator.

BACKGROUND: Sexual distress, a determinant factor in diagnosing sexual dysfunction, plays a significant role in individuals' sexual well-being, yet it has been overlooked in research. AIM: This exploratory study adopted a transdiagnostic approach to sexual distress and sought to examine the association between emotional regulation difficulties and sexual and psychological distress, with repetitive negative thinking as a potential mediator. METHODS: We used a quantitative cross-sectional design with a sample of 509 partnered individuals. OUTCOMES: The survey included a sociodemographic questionnaire, the Difficulties in Emotion Regulation Scale-Short Form, the Kessler Psychological Distress Scale, the Persistent and Intrusive Negative Thoughts Scale, and the Female Sexual Distress Scale-Revised. RESULTS: Correlational analysis revealed significant associations among emotional regulation difficulties, repetitive negative thinking, psychological distress, and sexual distress. Furthermore, a mediation model demonstrated that repetitive negative thinking significantly mediated emotion dysregulation and psychological and sexual distress. CLINICAL IMPLICATIONS: These findings underscore the importance of considering emotion regulation difficulties and repetitive negative thinking as a maladaptive coping strategy when evaluating sexual distress and suggest that therapeutic interventions targeting such difficulties and thoughts may yield beneficial outcomes. STRENGTHS AND LIMITATIONS: These findings reinforce the importance of considering the role of emotional regulation difficulties and, consequently, repetitive negative thinking as a dysfunctional coping strategy, when studying and intervening in sexual distress. Future research with clinical samples should be developed to establish better the significance of considering these two dimensions in assessment and therapeutic intervention. CONCLUSION: Future research should corroborate and expand upon these findings to advance our understanding of sexual distress and optimize interventions in this domain.

Clinical Sexologists' Perceptions of the Potentials, Downfalls, and Best Practices for Digitally Delivered Therapy: A Lesson from Lockdown Due to COVID-19 in Portugal.

Professionals who work in clinical sexology intervene in situations related to mental health, such as sexual dysfunctions and marital conflicts, often with vulnerable populations, e.g., people with chronic illnesses or trans people. In this work, we wanted to understand the perceptions these professionals have about using Internet interventions and how they perceive-based on their COVID-related experience and the reflections it brought about non-face-to-face interventions-the use of online interventions. During the first lockdown due to COVID-19 in Portugal, we used an online survey and collected answers from 39 Portuguese sexual health professionals to open questions about the use of Internet interventions. The data were analyzed following the summative content analysis procedures. Our results showed that sexual health professionals had several difficulties in clinical practice during the lockdown period, such as the perception that sexuality moved to the backseat in people's lives. Even so, they stated that Internet interventions have several advantages, such as easy accessibility and excellent promotion of social justice. However, disadvantages were also pointed out. The current study allowed us to understand clinicians' perception of the impact of the pandemic on sexual healthcare access and brought recommendations for good practice of sexual medicine with e-health.

Dialectical Core Schemas Mediate the Relationships Between Dissociative Experiences and Symptomatology in a Community Sample.

BACKGROUND: Maladaptive cognitions about the self and others are associated with a wide array of dysfunctional responses and psychopathological symptoms in non-clinical and clinical samples. Dissociative experiences (e.g., depersonalization and derealization) as a coping response to stressful situations lie on a continuum from healthy to unhealthy but are generally elevated in individuals experiencing mental illness. However, the extent to which Dialectical Core Schemas explain the relationship between dissociative experiences and symptomatology is unclear. Therefore, this study aimed to investigate the mediating role of Dialectical Core Schemas on the relationship between dissociative experiences and symptomatology. METHODS: A community sample of 179 participants were recruited (Mage = 21.2 years, SD = 8.2). Data were gathered through self-report questionnaires using a cross-sectional design. RESULTS: Maladaptive core schemas about self and others correlated positively with all dissociative experiences (e.g., depersonalization/derealization, amnesia), while adaptive core schemas about the self correlated negatively with depersonalization/derealization and distractibility. Maladaptive core schemas mediated the relationship between dissociative experiences and symptomatology. CONCLUSIONS: The relationships between dissociative experiences and symptomatology are bi-directional. Exploring the mediating factors may help clinicians and researchers better understand how to enhance case conceptualization and clinical decision-making.

A behavioral approach to sexual function: testing a moderation mediation model with expression of feelings, sexual self-disclosure and gender.

Little is known about specific intimacy dimensions' role in sexual function. In the current study, we aimed to gain more insight into how expression of feelings and sexual self-disclosure (a mediator) might potentially affect sexual functioning testing a theoretically based moderated mediation model, that uses gender as a moderator. A total of 661 participants, of which 211 were men (31,90%) and 450 were women (68,10%) aged 18-74 years involved in a monogamous committed relationship participated in the study. We used macro PROCESS 3.2 for IBM - SPSS to test simple mediation and moderated mediation models. The data revealed a significant overall effect of expression of feelings on sexual function, supporting that sexual self-disclosure mediates this relationship. We found that gender does not moderate either the relationship between expression of feelings and sexual self-disclosure nor the trajectory between sexual self-disclosure and sexual function. Our results highlight the importance of taking an interpersonal behavioral approach to sexual function, namely one that focuses on communication behaviors. However, these results need to be explored with clinical samples to understand their full potential for clinical interventions within a behavioral paradigm to partnered people's sexual problems.

Reducing Sexual and Reproductive Health Inequities Between Natives and Migrants: A Delphi Consensus for Sustainable Cross-Cultural Healthcare Pathways.

The increasing number of international migrants (ranging from 153 million in 1990 to ~272 million in 2019) brought to attention the wide variation of national contexts concerning the policy measures to protect migrants' rights and ensuring their equal access to basic and essential services, namely in health. Sexual and Reproductive Health (SRH) is a key component to the overall health and quality of life and is impacted by power inequities inherent to society's institutions, environment, economics, and culture. In Portugal, guidelines for intervention in SRH are insufficient, a gap that is more pronounced with migrant populations due to the absence of culturally sensitive indicators to assess and monitor SRH. The aim of this work was 2-fold: to identify good practices in the SRH field, with a particular focus, whenever possible, on migrant populations, and to identify relevant and inclusive indicators to monitor SRH in Portugal. A Delphi panel (via online survey) with 66 experts (researchers, teachers, and health professionals) and 16 stakeholders (non-governmental organizations, civil society, and governmental organizations) was implemented in two rounds. Panelists were asked to state their level of agreement (5-point Likert-type scale) regarding four different SRH areas: Sexual Health, Reproductive Health, Social-Structural Factors, and Good Practices. Items were based on literature review and a World Café with 15 experts and stakeholders. Participation rate was 68% and response rate was 97% on the first round. From the initial list of 142 items, a total of 118 (83%) items were approved by consensus. Findings may provide extended opportunities for the healthcare system to engage in better informed decisions and more inclusive and integrative strategies regarding SRH, contributing to build political measures toward sexual and reproductive justice.

Defining Polyamory: A Thematic Analysis of Lay People's Definitions.

This study aimed to analyze laypeople's definitions of polyamory and compare definitions presented by people who are not willing to engage in consensual non-monogamy (CNM) and those who are or are willing to be in a CNM relationship. This exploratory qualitative study used data collected from a convenience sample through a web survey, where people answered the question "What does polyamory mean?" We conducted thematic analysis to examine patterns in meaning and used demographic data to compare themes among groups. The final sample comprised 463 participants aged 18-66 years (M = 32.19, SD = 10.02), mostly heterosexual (60%). Of the total sample, 54% were in a monogamous relationship, followed by 21% not in a relationship, and 13% in a non-monogamous relationship. Analysis showed that people define polyamory mostly as a set of behaviors in a relationship, followed by the potential of multiple relationships or feelings for multiple people. Definitions also include emotional, sexual, and ethical aspects. People in CNM relationships are more likely to define polyamory as constituting a potential form of relating, focus more on interpersonal feelings and ethics, and include consent in their definitions than those unwilling to engage in CNM. People in CNM relationships also focus particularly on the non-central role of sex within these relationships, which might challenge assumptions about sexuality in these relationships in clinical and research settings.

The Impact of COVID-19 on Sexual Health: A Preliminary Framework Based on a Qualitative Study With Clinical Sexologists.

INTRODUCTION: In recent months, some attempts were made to understand the impact of COVID-19 on sexual health. Despite recent research that suggests COVID-19 and lockdown measures may eventually impact sexual response and sexually related behaviors, we are missing clinical sexologists' perspectives on the impact of COVID-19 in sexual health. Such perspectives could inform a preliminary framework aimed at guiding future research and clinical approaches in the context of COVID-19. AIM: To explore the perspectives of clinical sexologists about the impact of COVID-19 on their patients' sexual health, as well as the professional challenges they have faced during the current pandemic. Findings are expected to inform a preliminary framework aimed at understanding the impact of COVID-19 on sexual health. METHODS: We conducted an online qualitative exploratory survey with 4 open-ended questions with 39 clinical sexologists aged between 32 and 73 years old. The survey was advertised among professional associations' newsletters. We performed a Thematic Analysis using an inductive, semantic, and (critical) realist approach, leading to a final thematic map. MAIN OUTCOME MEASURES: The outcome is the thematic map and the corresponding table that aggregates the main themes, subthemes, and codes derived from participants' answers and that can serve as a preliminary framework to understand the impact of COVID-19 on sexual health. RESULTS: The final thematic map, expected to serve as a preliminary framework on the impact of COVID-19 in sexual health, revealed 3 main themes: Clinical Focus, Remapping Relationships, and Reframing Technology Use. These themes aggregate important interrelated issues, such as worsening of sexual problems and dysfunctions, mental health, relationship management, the rise of conservatism, and the use of new technology that influences sexuality and sexual health-related services. CONCLUSION: The current study allowed us to develop a preliminary framework to understand the impact of COVID-19 on sexual health. This framework highlights the role of mental health, as well as the contextual nature of sexual problems, and subsequently, their relational nature. Also, it demonstrates that the current pandemic has brought into light the debate of e-Health delivery within clinical sexology. Pascoal PM, Carvalho J, Raposo CF, et al. The Impact of COVID-19 on Sexual Health: A Preliminary Framework Based on a Qualitative Study With Clinical Sexologist. Sex Med 2021;9:100299.

A Transdiagnostic Approach to Sexual Distress and Sexual Pleasure: A Preliminary Mediation Study with Repetitive Negative Thinking.

Sexual distress is a core characteristic of sexual dysfunction; however, little is known about its correlates. In the current study, we aimed to contribute to the understanding of both sexual distress and its positive counterpart, sexual pleasure, by taking a transdiagnostic approach to sexual distress using two types of repetitive negative thinking: worry and rumination. Because sexual activity mostly occurs in a dyadic context, we also looked at the potential mediating effect of co-worry and co-rumination, and we used them as mediators. Our preliminary exploratory quantitative study used a cross-sectional design, with a sample of 206 partnered heterosexual people. We used path analysis with parallel mediation, with structural equation modelling being performed using lavaan designed for R environment. Overall, our results show that repetitive negative thinking is associated with both sexual distress and sexual pleasure, and that neither co-rumination nor co-worry mediates these associations. The exception is the indirect effect of rumination on sexual pleasure that is mediated by co-rumination. These results demonstrate that a transdiagnostic approach to sexual distress is a new field worth exploring, and they contribute to establishing the relevance of a cognitive approach to sexual dysfunction.

Sexuality in Emerging Adults with Type 1 Diabetes Mellitus: An Exploratory Study Using Thematic Analysis.

This qualitative cross sectional study seeks to explore the perceptions of emerging adults with Type 1 Diabetes Mellitus regarding the impact of this disease on their Sexual and Reproductive Health (SRH) using thematic analysis on the answers of 59 participants. Hypoglycemia and hyperglycemia during sexual activity, the use of insulin pump and the interconnection between an individual and the interpersonal impact of this illness were identified as crucial. This sample perceives their clinical condition as influential in their SRH and highlights the role of romantic partners in promoting their health and well-being.

Fertility, Migration and Acculturation (FEMINA): a research protocol for studying intersectional sexual and reproductive health inequalities.

BACKGROUND: The existing knowledge on the interplay between reproductive and sexual health, migration and acculturation is recent and inconsistent, particularly on the sociocultural motives and constraints regarding fertility. Therefore, sexual and reproductive health (SRH) surveys are needed to provide accurate and comparable indicators to identify and address SRH inequalities, with specific focus on under researched aspects, such as the interrelation between migration and gender. FEMINA (FErtility, MIgratioN and Acculturation) aims to investigate intersectional SRH inequalities among Cape Verdean immigrant and Portuguese native families and how they impact on fertility in Portugal. This study will use a comprehensive approach exploring simultaneously the components of SRH, namely regarding identities, perceptions and practices of both women and men among lay people and relevant experts and stakeholders. The project has three main goals: 1) to identify social determinants of SRH among Cape Verdean immigrant and Portuguese native men and women of reproductive age; 2) to gain understanding of the diversity of the sexual and reproductive experiences and expectations of Cape Verdean immigrant and Portuguese native men and women of reproductive age, considering the singularities of their migratory, social and family dynamics; and 3) to produce recommendations for policy makers, employers and service providers on how to better address the SRH needs of Portuguese-born and immigrant populations. METHODS: The study will address these goals using a mixed methods approach, including: a cross-sectional telephone survey with a probabilistic sample of 600 Cape Verdean immigrant and 600 Portuguese native women and men (women aged 18 to 49 and men aged 18 to 54), residents of the Greater Lisbon Area; a qualitative research through in-depth interviews with a subsample of 30 Cape Verdean immigrants and 30 Portuguese native men and women; and a Delphi technique for finding consensus on good practices in SRH for the entire population with a special emphasis on immigrants, namely extra-EU migrants. DISCUSSION: Data will be used to produce a comprehensive set of indicators to monitor SRH in Portugal, to foster a greater understanding of its specificities and challenges to policy and decision makers, and to provide targeted recommendations to promote inclusive and migrant sensitive SRH services.

O papel mediador da autorrevelação sexual na relação entre a expressão de sentimentos e a satisfação sexual em adultos heterossexuais / The mediating role of sexual self-disclosure satisfaction in the association between expression of feelings and sexual satisfaction in heterosexual adults

Resumo O objetivo de deste estudo foi testar um modelo de mediação da expressão de sentimentos e a satisfação sexual via autorrevelação, enquanto processo, é uma variável mediadora significativa da associação entre a expressão de sentimentos e a satisfação sexual. A amostra deste estudo foi constituída por 564 participantes (370 mulheres, 65,60%), cisgénero, heterossexuais, numa relação diádica de exclusividade e compromisso. Foram testados dois modelos: um modelo de mediação simples e um modelo de mediação moderada, sendo este último usado para testa a influência do género no modelo de mediação. Os resultados demonstraram que, globalmente, homens e mulheres apresentaram valores médios idênticos na autorrevelação sexual e satisfação sexual; se contudo, na expressão de sentimentos, as mulheres apresentaram valores significativamente superiores. A expressão de sentimentos revelou-se uma variável preditora significativa da satisfação sexual e a autorrevelação sexual como uma variável parcialmente mediadora do modelo. No entanto, o género não modera a expressão de sentimentos e a autorrevelação. O presente estudo demonstra que a expressão de sentimentos e a autorrevelação sexual são importantes aspetos da satisfação sexual de ambos os géneros.

Abstract The present study had the main goal of testing a mediation model of expression of feelings and sexual satisfaction via sexual self-disclosure, trying to understand if the process of sexual self-disclosure is a significant mediator variable of the association between expression of feelings and sexual satisfaction. The sample of this study comprised by 564 cisgender, heterosexual participants (370 women, 65.60%), who were in a dyadic and exclusive relationship of commitment. Two models were tested: a simple mediation model and a moderate mediation model in which the objective is to test the influence of gender on the of mediation. Overall, results showed that men and women had similar mean values for sexual self-disclosure and sexual satisfaction, however, a significantly higher expression of feelings was found in women compared to men. The results demonstrated that expression of feelings was a significant predictor variable of sexual satisfaction and that sexual self-disclosure is partially a mediator variable of the tested model. Gender did not moderate the association between expression of feelings and sexual self-disclosure. The present study shows that expression of feelings and sexual self-disclosure are important aspects of sexual satisfaction in both genders.