A Network Analysis of the Fear Avoidance Model of Genital Pain.

Using a novel data-driven network approach, this study aimed to examine the interconnection between the key elements of the Fear-Avoidance Model of female genital pain - sexual arousal, fear-avoidant cognitions, and motivational coping - and its associated factors to predict the intensity and frequency of genital pain across women over time. Network modeling allowed for a comprehensive evaluation of the Fear-Avoidance model while capturing the dynamic features of genital pain. We estimated a cross-sectional and a temporal, contemporaneous, and between-persons network model on convenience-based data of 543 female students (mean age = 23.7 years, SD = 3.6) collected at three time points. Results showed that lubrication, pain catastrophizing, pain avoidance, fear-avoidance beliefs, sexual satisfaction, anxiety, and frequency of coital and non-coital sex predicted pain, with lubrication being the most consistent predictor across estimations. The network of women with recurrent genital pain showed a similar pattern as the network of the total sample, except that pain avoidance and fear-avoidance beliefs rather than pain catastrophizing predicted pain directly, and frequency of coital and non-coital sexual activities played a more prominent role. These results suggest that the main problem of genital pain centers around women not being sufficiently aroused during intercourse and inadequate ways of pain coping, which are critical targets of cognitive-behavioral therapy treatment and should be developed further.

Hysterectomy and sexual function: a systematic review and meta-analysis.

BACKGROUND: Sexual function after hysterectomy can be a concern for patients, and research remains inconclusive about changes in sexual function associated with hysterectomy. AIM: We meta-analyzed studies on change in sexual function from pre- to posthysterectomy and the role of total vs subtotal hysterectomy and concomitant bilateral salpingo-oophorectomy (BSO) in differences in such change. METHODS: We searched PubMed, Embase, and Cochrane databases from inception to January 2022. Two reviewers screened and included studies if they were published in a peer-reviewed journal and reported on sexual function pre- and posthysterectomy for benign nonprolapse indication. Methodological quality was assessed with the STROBE checklist. We used random effects multilevel models to meta-analyze standardized mean differences in pre- to postoperative sexual function and the posthysterectomy Female Sexual Function Index mean across study groups in R (RStudio). OUTCOMES: Outcomes included overall sexual function, dyspareunia, desire, arousal, lubrication, and orgasm. RESULTS: Thirty-two articles were analyzed: 8 randomized controlled trials, 20 prospective studies, 2 retrospective studies, 1 cross-sectional study, and 1 secondary analysis, comprising a total of 4054 patients. Each study provided data for at least 1 outcome. Study quality was moderate, and effect sizes showed large between-study heterogeneity. Hysterectomy was not associated with significant change in overall sexual function irrespective of surgical route, with patients tending to report potentially remaining sexual dysfunction posthysterectomy. Cervix removal was not significantly associated with differences in magnitude of change. Hysterectomy without BSO was associated with significantly stronger improvement in lubrication and orgasm than hysterectomy with BSO, which was not the case for desire, arousal or overall sexual function. However, these significant differences were not replicated within studies that directly compared cases with and without BSO. CLINICAL IMPLICATIONS: Clinicians should address remaining sexual dysfunction posthysterectomy, and BSO should not be considered if not medically required. STRENGTHS AND LIMITATIONS: We analyzed a comprehensive number of trials and studied clinically relevant factors that might relate to differences in change in sexual function. Conclusions need to be interpreted with caution since many studies showed moderate methodological quality and large effect size heterogeneity. CONCLUSION: Subtotal and total hysterectomy was not associated with significant change in overall sexual function irrespective of surgical route, with patients tending to report potentially remaining sexual dysfunction posthysterectomy. Hysterectomy without BSO was associated with significantly stronger improvement in lubrication and orgasm than hysterectomy with BSO. Future research on hysterectomy should analyze predictors of sexual function change trajectories, such as different indications.

Sexual Pleasure Matters - and How to Define and Assess It Too. A Conceptual Framework of Sexual Pleasure and the Sexual Response.

Objective: Sexual pleasure is central to current understandings of sexual function, health, and wellbeing. In this article, we suggest that we lack a sufficiently specific, yet encompassing, definition of sexual pleasure and that we therefore lack comprehensive assessments of sexual pleasure. We introduce a definition of sexual pleasure and position it centrally in an adapted framework of the sexual response. In the framework, we include a taxonomy of rewards which can be retrieved from sex and thereby aim to capture the multifaceted nature of sexual pleasure. Methods/Results: Through narrative review, we arrive at the definition, framework, and taxonomy by integrating theories of sexual motivation and response with the literature on sexual pleasure and basic rewards. We position this literature within theories of affect and personality which allows us to differentiate between the experience of and the tendency to experience sexual pleasure (i.e., state versus trait sexual pleasure). We discuss how this conceptualization of sexual pleasure could be reflected in self-report assessments to quantitatively assess sexual pleasure. Conclusions: The framework may aid to understand the role of the diverse facets of sexual pleasure in sexual function, health, and wellbeing and contribute to giving sexual pleasure the center position it deserves in sex research and therapy.

A topography of 21 phobic fears: network analysis in an epidemiological sample of adult twins.

BACKGROUND: Few factor analyses and no network analyses have examined the structure of DSM phobic fears or tested the specificity of the relationship between panic disorder and agoraphobic fears. METHODS: Histories of 21 lifetime phobic fears, coded as four-level ordinal variables (no fear to fear with major interference) were assessed at personal interview in 7514 adults from the Virginia Twin Registry. We estimated Gaussian Graphical Models on individual phobic fears; compared network structures of women and men using the Network Comparison Test; used community detection to determine the number and nature of groups in which phobic fears hang together; and validated the anticipated specific relationship between panic disorder and agoraphobia. RESULTS: All networks were densely and positively inter-connected; networks of women and men were structurally similar. Our most frequent and stable solution identified four phobic clusters: (i) blood-injection, (ii) social-agoraphobia, (iii) situational, and (iv) animal-disease. Fear of public restrooms and of diseases clustered with animal and not, respectively, social and blood-injury phobias. When added to the network, the three strongest connections with lifetime panic disorder were all agoraphobic fears: being in crowds, going out of the house alone, and being in open spaces. CONCLUSIONS: Using network analyses applied to a large epidemiologic twin sample, we broadly validated the DSM-IV typography but did not entirely support the distinction of agoraphobic and social phobic fears or the DSM placements for fears of public restrooms and diseases. We found strong support for the specificity of the relationship between panic disorder and agoraphobic fears.

In Pursuit of Pleasure: A Biopsychosocial Perspective on Sexual Pleasure and Gender.

Objective: Various sources of evidence suggest that men and women differ in their experience of sexual pleasure. Such gender differences have been attributed to men's higher innate sex drive, supported by evolutionary psychology perspectives and gender differences in reproductive strategies. Method: This paper presents biopsychosocial evidence for gender similarities in the capacity to experience pleasure, and for substantial gender differences in opportunities for sexual pleasure. Results: We conclude that sexual activity, in most cultures, is less pleasurable and associated with greater cost for heterosexual women than for heterosexual men, even though they do not differ in the capacity for sexual pleasure. Conclusion: Since gender differences in experienced sexual pleasure are not a biological given, a more critical discourse of sexual pleasure might create awareness of current inequalities, help lift restrictions for women's opportunities for pleasure, and could reduce gender differences in the cost of sex. That would truly serve sexual justice around the globe.

A network analysis of female sexual function: comparing symptom networks in women with decreased, increased, and stable sexual desire.

Problems related to low sexual desire in women are common clinical complaints, and the aetiology is poorly understood. We investigated predictors of change in levels of sexual desire using a novel network approach, which assumes that mental disorders arise from direct interactions between symptoms. Using population-based data from 1,449 Finnish women, we compared between-subject networks of women whose sexual desire decreased, increased, or remained stable over time. Networks were estimated and analyzed at T1 (2006) and replicated at T2 (2013) using R. Domains included were, among others, sexual functions, sexual distress, anxiety, depression, body dissatisfaction, and relationship status. Overall, networks were fairly similar across groups. Sexual arousal, satisfaction, and relationship status were the most central variables, implying that they might play prominent roles in female sexual function; sexual distress mediated between general distress and sexual function; and sexual desire and arousal showed different patterns of relationships, suggesting that they represent unique sexual function aspects. Potential group-differences suggested that sex-related pain and body dissatisfaction might play roles in precipitating decreases of sexual desire. The general network structure and similarities between groups replicated well; however, the potential group-differences did not replicate. Our study sets the stage for future clinical and longitudinal network modelling of female sexual function.

A Network Approach to Hypersexuality: Insights and Clinical Implications.

BACKGROUND: In spite of a growing interest in research on hypersexuality, consensus about its etiology and best treatment strategy has not been achieved. AIM: To further the empirical and clinical understanding of hypersexuality by exploring the structure of its symptoms using a network analytic approach. METHODS: In 2014, an online survey advertised as focusing on Internet pornography, sexual health, and relationships was carried out among Croatian men and women aged 18-60 years (Mage = 31.1 years, SD = 9.67). In a sample of 3,028 participants, we applied a network analytic approach to explore the structure of hypersexuality symptoms. In the network, nodes represented hypersexuality symptoms and associated sexual behaviors, while their connections were operationalized as partial correlations. 4 Research questions were addressed: (1) does the hypersexuality network differ between genders; (2) which symptoms are centrally positioned; (3) what is the topological location of pornography use; and (4) are there distinct clusters ("communities") of symptoms in the network? OUTCOMES: We estimated and plotted hypersexuality networks by gender using items from the Hypersexual Disorder Screening Inventory and the Hypersexual Behavioral Consequences Scale, as well as indicators of sexual desire, pornography use, sexual intercourse, and masturbation frequency. RESULTS: The structure of the hypersexuality network was surprisingly similar in women and men, both in terms of symptom centrality and the clustering of symptoms. Psychological distress and negative emotions triggered by sexual fantasies and/or behaviors, together with a loss of control over sexual feelings, occupied central positions in the networks. Pornography use was located peripherally in both the men's and women's hypersexuality networks. CLINICAL TRANSLATION: Psychological distress and negative emotions triggered by sexual fantasies and/or behaviors constituted the core of the hypersexuality network, which makes them potential prime targets for clinical intervention and calls for normalization of (presumably self-stigmatized) sexual expression through affirmative therapy and interventions that enhance self-care, self-compassion, and adaptive coping mechanisms. STRENGTHS & LIMITATIONS: This is the first network analytic approach to hypersexuality. Apart from its novel insights about the structure of hypersexuality, the study employed several methods to assure reliability and robustness of findings. Considering that networks were estimated in a convenience-based community sample, the findings might not generalize to clinically distressed individuals. CONCLUSION: Our results demonstrate the usefulness of network analytics to hypersexuality in a non-clinical sample and we encourage future clinical and longitudinal explorations of hypersexuality using this novel approach. Werner M, Stulhofer A, Waldorp L, et al. A Network Approach to Hypersexuality: Insights and Clinical Implications. J Sex Med 2018;15:373-386.