Barriers experienced by emerging adults in discussing their sexuality with parents and health care providers: A mixed-method study.

While most parents and health care providers understand the importance of educating young people about their emerging sexuality, many report never discussing sex with the young people in their care. Using data from a survey of 1,193 emerging adults, we applied concept mapping to a corpus of over 2,350 short qualitative responses to two questions: (a) What, if anything, makes it difficult to talk to your parents about sexuality or your sexual health? and (b) What, if anything, makes it difficult to talk to your doctors, therapists, or mental health professionals about sexuality or your sexual health? Qualitative analyses revealed that while embarrassment, shame, and awkwardness were commonly reported barriers to communicating with both parents and providers, participants reported different effects across settings: Parent-related embarrassment was associated with concerns about changing the intimacy of the parental relationship, while provider-related embarrassment was associated with fears of seeming incompetent or eliciting dismissal. These observations were supported by multidimensional scaling and hierarchical cluster analyses, which we used to derive conceptual maps based on quantitative spatial analysis of single-concept statements. These analyses revealed a best-fit solution of eight conceptual groups for barriers to discussing sexuality with health care providers, but only four groups of barriers in discussing with parents. Broadly, our findings reinforce the need to tailor sexual health communication to patient characteristics and settings. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Relational and Trait Factors Mediate the Associations between Women's Intoxication-Related Unwanted Sexual Experiences, Pleasure, and Desire.

Despite documented negative sexual health sequelae of unwanted sexual contact (USC), it is unclear why individuals who have experienced USC within the context of intoxication (intoxication-related USC) are at particular risk for poor sexual functioning. Intoxication-related USC may impact relational factors like relationship satisfaction, as trauma symptoms interfere with emotional closeness during sex. Additionally, although individual traits - such as sexual excitation and sensation seeking - affect the relationship between trauma and sexual functioning, it is unknown whether these factors differentially impact those who have experienced intoxication-related USC. Finally, because presence of a partner may evoke trauma-related symptoms during partnered (dyadic) sexual activity, mediators may differ across solitary versus dyadic sexual pleasure and desire. We tested relational and individual trait mediators of the association between intoxication-related USC and solitary and dyadic sexual pleasure and desire in a sample of heterosexual and sexual minority women. Trait factors consistently mediated the association between intoxication-related USC and both dyadic and solitary desire and pleasure, while relational factors such as emotional closeness were inconsistently related to sexual wellbeing. If replicated, these findings would suggest that trait factors may be useful targets for clinical sexual wellness interventions among sexuality-diverse women who have experienced intoxication-related USC.

Lack of Evidence for a Relationship Between Salivary CRP and Women's Sexual Desire: An Investigation Across Clinical and Healthy Samples.

BACKGROUND: Inflammation has been linked to a variety of mental and physical health outcomes that disproportionately impact women, and which can impair sexual function; thus, there is reason to expect a link between inflammation and women's sexual functioning. AIM: To test the hypothesis that higher concentrations of C-reactive protein (CRP), a general biomarker of inflammation, would predict women's lower sexual desire. METHOD: As 2 independent research teams, we conducted 3 separate studies (total n = 405) that assessed salivary CRP and various measurements of sexual desire in different women populations. OUTCOMES: Female Sexual Function Index, Sexual Desire Inventory-2, Decreased Sexual Desire Screener, and Sexual Interest and Desire Inventory. RESULTS: Regardless of the way sexual desire was measured (e.g., state vs trait; general desire vs. desire functioning) and the population sampled (i.e., healthy vs. clinically diagnosed with sexual dysfunction), all the studies revealed null results. CLINICAL IMPLICATIONS: While exploratory, the convergence of these null results across studies and researchers suggests that if there is an association between inflammation and women's sexual desire, it is likely very subtle. STRENGTHS & LIMITATIONS: Across 2 independent research teams, 3 unrelated studies, and various measurements of sexual desire, results were consistent. These points lend to the generalizability of the results. However, study designs were cross-sectional. CONCLUSIONS: Future research may reveal (i) a non-linear threshold effect, such that inflammation does not begin to impact women's sexual desire until it is at a high level, (ii) inflammatory biomarkers other than CRP might be more sensitive in detecting associations between inflammation and desire, should they exist, or (iii) the mechanisms underlying sexual dysfunction may differ between sexes. Clephane K, et al. Lack of Evidence for a Relationship Between Salivary CRP and Women's Sexual Desire: An Investigation Across Clinical and Healthy Samples. J Sex Med 2022;19:745-760.

Communication changes the effects of sexual pain on sexual frequency in the pregnancy to postpartum transition.

PURPOSE: To evaluate how sexual pain influences changes in sexual frequency from the pregnancy to postpartum transition, and to examine how couple's sexual communication interacts with sexual pain during pregnancy. METHODS: We explored data following 159 mixed-sex couples across the transition from pregnancy to 6 months postpartum. Couples completed the Relationship Quality Interview and the Marital Satisfaction Inventory-Revised, which assessed their sexual communication, pain and other sexual problems during pregnancy, and frequency of intercourse at pregnancy and postpartum. RESULTS: Overall, couples reported a decline in sexual activity from pregnancy to postpartum. Women's sexual pain during pregnancy influenced changes in sexual frequency only among couples who reported poorer communication about sex. Among couples reporting sexual pain and good communication, pain did not impact changes in sexual frequency (i.e. they experienced significant declines in sexual activity into the postpartum period, as expected). In contrast, among couples with poor communication, sexual frequency did not significantly decline. CONCLUSION: Our findings suggest that sexual communication alters the effects of sexual pain on postpartum sexual activity. Future research should examine if sexual communication training during pregnancy improves postpartum sexual wellbeing.

Higher sexual excitation is associated with an increase in sex-linked substance use in women with a history of unwanted sexual contact.

Survivors of unwanted sexual contact have an increased likelihood of using substances in sexual situations, which puts them at heightened risk for intoxication-related harms. Separately, research has indicated that women may intentionally use substances in sexual situations to either enhance pleasure (i.e., increase sexual excitation) and/or reduce sexual anxiety or shame (i.e., reduce sexual inhibition), a phenomenon termed sex-linked substance use (SLSU). A predominant assumption in the literature is that women with unwanted sex histories are more likely to disengage during sex, suggesting greater inhibition-related SLSU; however, there is little prior research directly examining if women who have unwanted sex histories primarily engage in SLSU to increase sexual excitation or decrease inhibitions. We conducted exploratory analyses of an online survey in a convenience sample of 516 undergraduate women including data on their history of unwanted sex, SLSU, and sexual excitation/inhibition. Sexual excitation mediated the association between a history of unwanted sexual contact and SLSU, suggesting that women with unwanted sexual histories reported higher levels of sexual excitation, which in turn was associated with a higher likelihood of using substances to increase pleasure during sexual activity. Specifically, arousability, partner characteristics, and power dynamics subfactors were significant mediators. Sexual inhibition did not mediate the relationship between a history of unwanted sexual contact and SLSU, suggesting that women with unwanted sex histories may have been less likely to use substances to reduce sexual inhibitions. If replicated, these findings suggest that sexual excitation may be a useful target of intervention surrounding SLSU, particularly in women with histories of unwanted sexual contact. Specifically, treatments targeting cognitive and affective tendencies associated with sexual excitation may help women who engage in SLSU to have safe, pleasurable sexual activity, without increasing the risk of intoxication-related harms.

Autonomic, endocrine, and psychological stress responses to different forms of blood draw.

BACKGROUND: Although fingerstick is often favorably compared to venipuncture as a less invasive method of drawing blood for clinical labs, there is little empirical research that compares physical and psychological stress responses to fingerstick vs. venipuncture (blood draw using a needle in the arm) within the same person. METHODS AND FINDINGS: We assessed changes in cortisol (a stress hormone), heart rate variability (a marker of autonomic stress), and psychological stress in 40 healthy women who completed both venipuncture and fingerstick. Contrary to our predictions, there was a significant decline in cortisol across conditions, with greater decline from pre- to post-draw in response to venipuncture than fingerstick. There were similar patterns of rise and fall in heart rate variability in both types of blood draw, suggestive of mild vasovagal responses. Psychological measures of stress (such as negative emotion and perceived stress) were generally stronger predictors of participant's reported pain and blood draw preferences than physical stress measures. CONCLUSIONS: These findings challenge the characterization of fingerstick as necessarily "less invasive" than venipuncture, as participant's stress responses to fingerstick were equivalent to (and for some measures greater than) their response to venipuncture. Heart rate variability response to fingerstick significantly predicted that individual's vasovagal-like responses to venipuncture, suggesting that measuring heart rate variability during pre-donation hemoglobin testing may identify donors at risk for adverse events during venipuncture.

Relying on an "Other" Category Leads to Significant Misclassification of Sexual Minority Participants.

Purpose: This study assessed which sexual minority participants selected "Other" if their identity was absent. Methods: This was an online survey; 905 participants saw a limited set of sexual orientation options (bisexual, gay/lesbian, heterosexual, other), and later in the same survey, saw an expanded list. Results: Twenty-one percent of participants chose different orientation labels across questions. When not presented with a "mostly heterosexual" option, 78% of mostly heterosexual participants chose "heterosexual"; 3% chose "other." However, when not presented with an "asexual" label, 100% of asexual participants chose "other." Conclusion: These findings suggest that "other" categories could misclassify a substantial proportion of sexual minority participants.

Sexual excitation and sex-linked substance use predict overall cannabis use in mostly heterosexual and bisexual women.

Background: Bisexual and mostly heterosexual women report higher substance use than exclusively heterosexual or lesbian women. In sexual minority men, sex-linked substance use (SLSU) can increase risk for substance use problems; equivalent research in women is lacking.Objectives: To test if sexual excitation and inhibition mediate the association between sexual minority status and women's SLSU.Methods: We surveyed a convenience sample of 595 undergraduate women who identified as exclusively heterosexual (n = 499), mostly heterosexual (n = 59), or bisexual (n = 37). Participants reported on their last month use of alcohol, cannabis, and other drugs (e.g., cocaine) in sexual and non-sexual contexts, and symptoms of alcohol and non-alcohol drug use disorders (e.g., withdrawal symptoms). Drug use symptoms were collapsed across non-alcohol substances. We used structural equation modeling to test serial mediations of women's SLSU and overall drug and alcohol use.Results: Bisexual and mostly heterosexual women reported higher cannabis use (η2 = 0.030) and drug use disorder symptoms (η2 = 0.050) than heterosexual women. Mostly heterosexual women's SLSU was a stronger predictor of alcohol use (η2 = 0.019) and binge drinking frequency (η2 = 0.015) than for other orientation groups. Bisexual and mostly heterosexual women's higher sexual excitation predicted their higher SLSU, which in turn predicted higher cannabis use frequency and drug use disorder symptoms. However, sexual inhibition failed to mediate either SLSU or overall substance use.Conclusion: These findings point to SLSU as a mechanism by which sexual minority women may experience disparities in substance use related harms.

Inflammation Predicts Sexual Arousability in Healthy Women.

Background: Though many women report sexual arousal difficulties, the mechanisms driving these difficulties are unclear. Sexual response relies on a host of psychophysiological processes that have bidirectional relationships with inflammation. Additionally, chronic inflammation may impair genital blood flow, which in turn may impact sexual arousal. C-reactive protein (CRP) is an acute-phase marker of inflammation produced in response to cytokine signaling throughout the body, which makes it a useful marker of systemic inflammation. Aim: The present study examined interactions between inflammation and women's sexual arousal. Methods: CRP, self-reported frequency of partnered sexual activity, and subjective and vaginal arousal were assessed in 91 healthy, pre-menopausal women. Data were collected during a single laboratory session. Main Outcome Measures: Subjective sexual arousal and vaginal pulse amplitude (a measure of vaginal arousal) were the main outcome measures. Results: Change in subjective sexual arousal in response to a sexual film was unaffected by baseline CRP and sexual frequency. However, there were significant interactions between inflammation and sexual frequency in predicting vaginal arousal during the sexual film. Among women reporting more frequent sexual activity, higher CRP predicted lower magnitude arousal response and longer time to maximum vaginal arousal. Among women reporting less frequent sex, higher CRP predicted shorter time to maximum arousal and greater magnitude of arousal response. Controlling for cortisol strengthened the effects seen for time to maximum vaginal arousal but weakened those observed for percent change. Conclusions: Among healthy young women, higher CRP may be associated with vaginal arousal, but not subjective sexual arousal. Specifically, our results suggest that higher baseline CRP is associated with lower genital sexual arousal for women who have sex frequently, which is consistent with clinical evidence that elevated inflammation can be detrimental to sexual function.

Putative Mental, Physical, and Social Mechanisms of Hormonal Influences on Postpartum Sexuality.

Purpose of Review: Much research has documented changes in postpartum sexuality, including changes in sexual functioning and satisfaction for both the birthing parent and their partner(s). These changes are often linked to postpartum changes in hormonal and immune responses, which can have both direct and indirect effects on sexuality. Recent Findings: Here, we review how postpartum sexuality may be changed via mental, physical, and social/relationship effects of a variety of hormones, including estrogens, progestogens, androgens, cortisol, and oxytocin. We also review the ways in which inflammation may act alongside hormones to influence postpartum sexuality. Summary: We argue that, as each of these factors strongly influence the action of others, the next phase of research in postpartum sexuality must examine the bidirectional interactions of hormones and their effects on behavior, cognition, and social relationships.

Corrigendum: A Close and Supportive Interparental Bond During Pregnancy Predicts Greater Decline in Sexual Activity From Pregnancy to Postpartum: Applying an Evolutionary Perspective.

[This corrects the article DOI: 10.3389/fpsyg.2019.02974.].

Antidepressant Use During Development May Impair Women's Sexual Desire in Adulthood.

INTRODUCTION: Although antidepressants are well known to cause sexual side effects in adults, the long-term effects of antidepressant use during development on adult sexual function is unknown. AIM: To explore differences in sexual desire and sexual behavior between adults who did vs did not use antidepressants during childhood or adolescence. METHODS: An online survey of 610 young adults (66% women) assessed childhood and current mental health and use of antidepressants and other psychiatric medications before the age of 16 years and currently, partnered and solitary sexual desire, and frequency of masturbation and partnered sexual activity. Antidepressants were coded into either selective serotonin reuptake inhibitors (SSRIs) or non-SSRI antidepressants. MAIN OUTCOME MEASURE: Scores on the Sexual Desire Inventory, and self-reported frequency of masturbation and partnered sexual activity. RESULTS: For women, childhood SSRI use was associated with significantly lower solitary sexual desire, desire for an attractive other, and frequency of masturbation. This was true even when controlling for childhood mental health concerns, current mental health, and current antidepressant use. However, there was no effect of childhood SSRI use on women's partnered sexual desire or partnered sexual activity. There was no significant effect of childhood antidepressant use on men's sexual desire or masturbation. However, in men, childhood use of non-SSRI antidepressants was associated with significantly higher frequency of partnered sexual activity. Childhood use of non-SSRI antidepressants, or nonantidepressant psychiatric medication, was not associated with adult sexual desire or behavior in either women or men. CLINICAL IMPLICATIONS: It is possible that SSRI use during childhood interrupts the normal development of sexual reward systems, which may be a risk factor for sexual desire dysfunction in adult women. STRENGTHS & LIMITATIONS: Strengths include a large sample, use of attention checks and validated measures, and careful assessment of childhood mental health history; however, generalizability is limited by a predominantly white, young adult sample. These data are cross-sectional, and therefore, causal explanations for the association between childhood SSRI use and adult sexual well-being should be considered preliminary, warranting replication. CONCLUSION: These findings point to a critical need for well-controlled, prospective research on possible long-term effects of antidepressant use, particularly SSRI use, on the development of adult sexual well-being. Lorenz TK. Antidepressant Use During Development May Impair Women's Sexual Desire in Adulthood. J Sex Med 2020;17:470-476.

Neural correlates of emotion processing comparing antidepressants and exogenous oxytocin in postpartum depressed women: An exploratory study.

Despite common use of antidepressants to treat postpartum depression, little is known about the impact of antidepressant use on postpartum brain activity. Additionally, although oxytocin has been investigated as a potential treatment for postpartum depression, the interaction between antidepressants and exogenous oxytocin on brain activity is unknown. We explored postpartum depressed women's neural activation in areas identified as important to emotion and reward processing and potentially, antidepressant response: the amygdala, nucleus accumbens and ventral tegmental area. We conducted a secondary analysis of a functional imaging study of response to sexual, crying infant and smiling infant images in 23 postpartum depressed women with infants under six months (11 women taking antidepressants, 12 unmedicated). Participants were randomized to receive a single dose of oxytocin or placebo nasal spray. There was significantly higher amygdala activation to sexual stimuli than either neutral or infant-related stimuli among women taking antidepressants or receiving oxytocin nasal spray. Among unmedicated women receiving placebo, amygdala activation was similar across stimuli types. There were no significant effects of antidepressants nor oxytocin nasal spray on reward area processing (i.e., in the nucleus accumbens or ventral tegmental area). Among postpartum women who remain depressed, there may be significant interactions between the effects of antidepressant use and exogenous oxytocin on neural activity associated with processing emotional information. Observed effect sizes were moderate to large, strongly suggesting the need for further replication with a larger sample.

Brief Report: Sexual Wellbeing in Heterosexual, Mostly Heterosexual, and Bisexually Attracted Men and Women.

OBJECTIVE: To assess differences in sexual wellbeing among men and women with exclusively heterosexual, mostly heterosexual, and bisexual attractions. METHOD: An anonymous online survey in a convenience sample of 597 young adults (394 women, 203 men; average age = 20.04) assessed patterns of sexual attraction, desire, sexual functioning, and sexual satisfaction using validated questionnaires. RESULTS: Individuals with mostly heterosexual attractions reported significantly higher solitary sexual desire than exclusively heterosexual individuals (women: d = 0.64; men: d = 0.68). Partnered sexual desire did not differ between groups. Women with exclusively heterosexual attractions reported significantly higher sexual functioning and satisfaction than either mostly heterosexual or bisexually attracted women (functioning: d = 0.29; satisfaction: d = 0.47). Men with mostly heterosexual attractions reported significantly lower sexual functioning than either exclusively heterosexual or bisexually attracted men (d = 0.40). CONCLUSIONS: There were significant differences between exclusively vs. mostly heterosexual individuals in several aspects of sexual wellbeing, supporting the assertion that mostly heterosexual may constitute a distinct orientation. Taken together with prior research showing higher rates of sexual dysfunction in bisexual women, these findings highlight sexual health disparities among nonmonosexual women. Efforts to support the sexual wellbeing of sexual minority individuals should include consideration of mostly heterosexual individuals, as this population may have unique sexual health needs.

Interactions between inflammation and female sexual desire and arousal function.

PURPOSE OF REVIEW: To describe the current state of research on interactions between inflammation and female sexual function. RECENT FINDINGS: Inflammation may interfere with female sexual desire and arousal via direct (neural) and indirect (endocrine, vascular, social/behavioral) pathways. There are significant sex differences in the effect of inflammation on sexual function, arising from different evolutionary selection pressures on regulation of reproduction. A variety of inflammation-related conditions are associated with risk of female sexual dysfunction, including cardiovascular disease, metabolic syndrome, and chronic pain. SUMMARY: Clinical implications include the need for routine assessment for sexual dysfunction in patients with inflammation-related conditions, the potential for anti-inflammatory diets to improve sexual desire and arousal function, and consideration of chronic inflammation as moderator of sexual effects of hormonal treatments. Although the evidence points to a role for inflammation in the development and maintenance of female sexual dysfunction, the precise nature of these associations remains unclear.

A Close and Supportive Interparental Bond During Pregnancy Predicts Greater Decline in Sexual Activity From Pregnancy to Postpartum: Applying an Evolutionary Perspective.

A common topic for advice given to parents after childbirth - both from relationship experts and popular media - is how to "bounce back" to one's pre-pregnancy sexuality, with warnings that postpartum declines in sexual frequency will take a serious toll on one's relationship. However, these admonishments may not accurately reflect the ways in which the unique reproductive context of pregnancy and the postpartum transition alter associations between sexual frequency and relationship quality. Evolutionary perspectives on reproductive strategies would suggest that in the postpartum context, decreased sexual activity would help target parental investment in the current offspring (rather than creating new offspring); however, if the parental relationship is lacking in intimacy and support, continued sexual activity may help seal the cracks in the bond. We tested this theory in a longitudinal dyadic study of changes in relationship quality and sexual frequency from pregnancy to 6 months postpartum among 159 heterosexual couples. We found that across three different measures of relationship quality taken from interviews and behavioral observation of couple interactions, higher relationship quality (i.e., greater support, intimacy, and responsiveness) predicted greater decline in sexual frequency whereas sexual frequency remained relatively stable in lower quality relationships. These findings suggest that, during the postpartum transition, decreased sexual frequency may not be a reliable signal of poor relationship quality.

Physiological predictors of leptin vary during menses and ovulation in healthy women.

Although research has shown interactions between the reproductive system and energy homeostasis, it is not clear how environmental or behavioral factors may factor into these associations. Here we aimed to determine how changes in reproductive state (i.e., phase of the menstrual cycle) and other behavioral and physiological factors may influence leptin levels in healthy women, as well as how sexual activity may play a role in leptin modulation. We collected serum and saliva from 32 healthy women and measured leptin, estradiol, and progesterone. Participants also completed surveys of demographics, health and sexual behaviors, and physical activity. Leptin was predicted by meals per day and missed meals at both menses and ovulation. However, estradiol and physical activity were stronger predictors of leptin at menses, while sexual activity was a stronger predictor of leptin at ovulation. These findings suggest that predictors of serum leptin, and possibly energy storage and expenditure, vary across the menstrual cycle.