Grief and Sexual Intimacy: Exploring Therapists' Views of Bereaved Clients.

The interaction between sexual intimacy and grief remains unexplored despite its potential to offer valuable insights into how individuals, couples, and society perspectives shape bereaved individuals' sexual intimacy. Through semi-structured interviews with ten clinical psychologists and psychotherapists specialized in grief therapy, this study explores the impact of grief on sexual intimacy, the challenges faced by bereaved individuals, and the role of sexual intimacy in the grieving process. The study also investigates therapists' approaches to addressing sexual intimacy within grief therapy sessions. Findings reveal that grief often disrupts sexual intimacy, affecting individuals' ability to engage emotionally and physically with their partners. Factors such as secondary loss, emotional availability, traumatic experiences, and the nature of the loss contribute to difficulties in resuming sexual intimacy. Nevertheless, the helpful role of sexual intimacy in grief was also highlighted. Therapists note the significance of communication, mutual empathy, and understanding in overcoming these challenges, advocating for therapy to address these issues comprehensively. Moreover, therapist-related, client-related, and shared factors hindering the exploration of sexual intimacy in grief therapy were identified. Strategies for managing these challenges include normalizing discussions around sexual intimacy and death, integrating systemic approaches into therapy, and providing training in sexuality or sexual therapy for grief therapists. Overall, this study underscores the importance of recognizing and addressing the interplay between sexual intimacy and grief to support bereaved individuals effectively. Insights from therapists shed light on potential avenues for enhancing clinical interventions and fostering awareness of the complex dynamics surrounding bereavement and sexuality.

Does Web-Based Relationship Education Improve Sexual Intimacy? Initial Examination, Replication, and Exploration of Moderation in a Low-Income Sample.

Sexual intimacy, characterized as the experience between individuals of sharing general affection and sexual activity with one another within the Personal Assessment of Intimacy in Relationships inventory, is positively related to relationship satisfaction and stability. However, many studies of couple therapy have shown that it only results in small-sized (and often non-significant) improvements in sexual intimacy. Furthermore, there are numerous financial, logistical, and psychological barriers to couple therapy. Thus, the current study sought to examine whether two brief online relationship education programs (OurRelationship and ePREP) could overcome these barriers and yield similar-sized effects to more intensive couple therapy. In two independently collected samples of low-income couples (NSample 1 = 742 Couples; M AgeSample 1 = 33.19; NSample 2 = 671 Couples; M AgeSample 2 = 33.48), the current study found that: OurRelationship (d = 0.24-0.28) and ePREP (d = 0.26-0.34) produced small-sized changes in sexual intimacy relative to a waitlist control condition in both samples, the magnitude of the effect size replicated in a second sample and, with rare exception, these changes were generally not moderated by key variables of interest. Given that web-based relationship education is significantly shorter, less expensive, and more accessible than in-person couple interventions, web-based relationship education could be considered a viable candidate for couples experiencing concerns with sexual intimacy.

Maternal caregiving stress and metabolic health: Sexual activity as a potential buffer.

Chronic stress lead to dysregulation of metabolic hormones, creating risk for obesity and type 2 diabetes. Based on previous work suggesting the potential for sexual activity to relieve psychological stress and reduce stress-related neuroendocrine activity, the present research explored sexual activity as a protective factor. We focused on chronic stress in the form of caregiving stress, comparing premenopausal mothers of a child with an autism spectrum disorder vs. a neurotypical child, in relation to metabolic hormones - insulin (and insulin resistance as assessed by HOMA), leptin, and ghrelin. Then, we explored the moderating role of sexual activity. Our results showed that high-stress mothers showed higher levels of insulin, insulin resistance, and lower levels of ghrelin compared to low-stress mothers. However, sexual activity modulated these associations such that among mothers who were sexually active (as coded from their daily diaries), no significant differences in these outcomes were observed between groups. This buffering effect of sexual activity was distinguishable from the buffering effect of physical activity and independent of global relationship satisfaction. Together, our findings provide novel evidence supporting the potential protective effects of sexual activity from chronic stress-related metabolic disease risk.

"Not Now, I Am Too Stressed": Stress and Physical Intimacy in Early Marriage.

Stressful events can disrupt couples' emotional connection, yet prior research is mixed regarding whether stress also disrupts couples' physical intimacy. This study considered whether stress must reach a critical threshold before hindering couples' sexual activity and physical affection (i.e., a curvilinear association). Couples (N = 144 couples plus four additional wives) completed two 14-day daily diary tasks during the early years of marriage. Multilevel modeling revealed a within-person curvilinear association between daily stress and sexual activity. Contrary to expectations, the likelihood of sexual activity declined as stress increased from low to moderate, then leveled off as stress continued to increase. For physical affection, a linear effect emerged. On days of greater stress, women, but not men, reported less affection. Further analyses suggested that women's stress is more influential than men's stress for couple's physical intimacy. Findings highlight the nuanced ways in which stress is linked to a vital component of satisfying relationships.

The relationship between coping strategies with sexual satisfaction and sexual intimacy in women with multiple sclerosis.

BACKGROUND: Multiple sclerosis profoundly affects the sexual aspects of patients' life, especially in women. Various coping strategies are used by women with multiple sclerosis to overcome, tolerate, or minimize these sexual effects. The present study aimed to assess the relationship between sexual satisfaction, sexual intimacy, and coping strategies in women with multiple sclerosis. METHODS: This cross-sectional study was performed on a sample of 122 married women who were members of Iran's MS society in Tehran, Iran. The study was conducted from December 2018 to September 2019. Data were collected using the Index of Sexual Satisfaction (ISS), the Sexual Intimacy Questionnaire (SIQ), and the Folkman and Lazarus Coping Strategies Questionnaire. Frequency, percentage, mean and standard deviation were used to explore the observations. Independent t-test and logistic regression were applied to analyze the data using the SPSS-23. RESULTS: The majority (n = 71, 58.2%) used an emotion-focused coping strategy with the highest score for the escape-avoidance subscale [mean (SD): 13.29 (5.40)]. However, 41.8% of the patients (n = 51) used a problem-focused coping strategy with the highest score for the positive reappraisal strategy subscale [mean (SD): 10.50 (4.96)]. The sexual satisfaction in women with problem-focused coping strategies was significantly higher than women who used emotion-focused coping strategies (95.6 vs. 84.71, P-value = 0.001). There was a negative association between sexual intimacy and higher emotion-focused coping strategy (OR = 0.919, 95% CI 0.872-0.968, P = 0.001). CONCLUSIONS: Problem-focused coping strategy in women with multiple sclerosis increases sexual satisfaction, while the emotion-focused coping strategy has a significant negative relationship with sexual intimacy.

When things go wrong: experiences of vaginal mesh complications.

INTRODUCTION: Previous research has suggested that complications stemming from vaginal mesh can lead to life-changing negative physical consequences including erosion and chronic pain. However, there has been little research on the experiences of women who have had complications. This study was aimed at exploring the individual experiences of women who have had vaginal mesh complications and how this has impacted them. METHODS: An explorative qualitative design was followed. Eighteen semi-structured interviews were conducted with women who had experienced complications with vaginal mesh due to stress urinary incontinence and pelvic organ prolapse. The mean age was 52 and the mean time since the mesh was fitted was 8 years (6 had since had it removed and a further 6 had had partial removal), and the mean time since first mesh-related symptom was 10 months. Data were analysed using thematic analysis. RESULTS: Four main themes were identified: perceived impact of mesh complications, attitudes of medical professionals, social support and positive growth. Results showed that participant experiences of their mesh complication were psychologically traumatic, including feelings of increased anxiety and fears relating to suicidal thoughts. Intimate relationships were also affected, with reduced sexual functioning and intimacy stemming from mesh complications. Negative experiences with medical professionals included feeling dismissed, a lack of recognition of their symptoms, and anger towards the profession. CONCLUSIONS: The impacts of vaginal mesh complications were found to be wide-reaching and life-changing, affecting numerous aspects of participants' lives. Greater awareness in this area is needed to provide further support for women experiencing vaginal mesh complications.

Top Ten Tips Palliative Care Clinicians Should Know About Urological Care.

Patients receiving palliative care (PC) can present with or develop a host of urological needs or complications. These needs can include attention to sexual health, urinary incontinence, genitourinary bleeding, and urinary tract obstruction by benign, malignant, or urinary stone diseases. These varied conditions require that PC clinicians understand invasive and noninvasive medical, surgical, and radiation options for treatment. This article, written by a team of urologists, geriatricians, and PC specialists, offers information and guidance to PC teams in an accessible "Top Ten Tips" format to increase comfort with and skills around assessment, evaluation, and specialist referral for urological conditions common in the PC setting.

'Like ships in the night': A qualitative investigation of the impact of childhood cancer on parents' emotional and sexual intimacy.

BACKGROUND: Childhood cancer is highly distressing for families and can place strain on parents' relationships. Parental functioning and cohesiveness are important predictors of family functioning and adaptation to stress. This qualitative study investigated the perceived impact of childhood cancer on parents' relationship with their partner, with a focus on emotional and sexual intimacy. METHODS: We conducted semi-structured interviews with 48 parents (42 mothers, six fathers) of children under the age of 18 who had completed curative cancer treatment. We analysed the interviews using thematic analysis. RESULTS: At interview, parents were on average 40.7 years old (SD = 5.5, range: 29-55 years), and had a child who had completed cancer treatment between 3 months and 10.8 years previously (M = 22.1 months). All participants were living with their partner in a married/de facto relationship. Most parents reported that their child's cancer treatment had a negative impact on emotional and sexual intimacy with their partner, with some impacts extending to the post-treatment period. Reasons for compromised intimacy included exhaustion and physical constraints, having a shifted focus, and discord arising from different coping styles. Some parents reported that their relationship strengthened. Parents also discussed the impact of additional stressors unrelated to the child's cancer experience. CONCLUSIONS: Parents reported that childhood cancer had a negative impact on aspects of emotional and sexual intimacy, although relationship strengthening was also evident. It is important to identify and offer support to couples who experience ongoing relationship stress, which may have adverse effects on family functioning and psychological wellbeing into survivorship.

Aging, sexual intimacy, and challenges in contemporary India: A qualitative study.

An individual's life is shaped by age norms practiced in a particular society. In most societies, there is a deadline for every life event. Sexual intimacy is an essential part of every individual. However, sexual intimacy seems appropriate for young individuals, and middle-aged and older are considered asexual. Those who share sexual intimacy at a later age have to face the consequences for this age-inappropriate behavior in society. This study analyses "Badhaai Ho" film to explore the consequences of sharing sexual intimacy by middle-aged heterosexual couples in their 50s as it is forbidden by prevalent social norms. This study also explores the role of family in dealing with the repercussions of actions against the prescribed social norms. Thematic analysis suggests that society has a predefined age-bound box for individuals with different age categories. The middle-aged couple suffers various consequences for breaking the prescribed age-bound box. The role of the family is found to be crucial in mending the box by replacing it with an updated version. There are also gender differences in attitude toward sexual intimacy. Implications of this study can be utilized to explore the pathway of social change in existing social (age) norms in any society.

The effect of virtual cognitive-behavioral sexual counseling on sexual function and sexual intimacy in pregnant women: a randomized controlled clinical trial.

BACKGROUND & AIM: Pregnancy is associated with numerous physical and psychological changes and affects the sexual function of couples. Since the root of many marital problems lies in the quality of the relationship and sexual function, the present study investigates the effect of virtual cognitive-behavioral sexual counseling on pregnant women's sexual function and intimacy. METHODS & MATERIALS: This study is a randomized clinical trial, and 80 pregnant women aged 18 to 35 years and in 16-24 weeks of pregnancy were assigned to two intervention and control groups based on randomized blocks from June 2021 to July 2021. The control group received routine prenatal care, but the intervention group, in addition to routine prenatal care, underwent virtual counseling with a cognitive-behavioral approach during eight sessions of 90 minutes. Data were collected using the Female Sexual Function Index (FSFI) and sexual intimacy questionnaire. SPSS software was used for statistical analysis. RESULTS: The comparison of mean scores of sexual function and intimacy in the two groups before the intervention was not statistically significant with each other. However, after the intervention, the mean scores of sexual function and intimacy in the intervention group were significantly increased compared to the control group (p < 0.001). The effect size of the intervention was 0.52 for sexual function and 0.272 for sexual intimacy. CONCLUSION: Virtual cognitive-behavioral counseling can be used as an effective treatment to promote sexual function and intimacy of women during pregnancy. TRIAL REGISTRATION: IRCT20161230031662N10. Registry date: 21/06/2021.

Young Single Widow, Dynamics of In-Laws Interference and Coping Mechanisms: Simplicity-Parsimony Approach.

The incidence of short marital duration due to the demise of a husband that often exposes young widows to in-laws' exploitation of the asset of the deceased spouses, without regard for negative health consequences and potential vulnerability to poverty has not been exhaustively investigated, especially in sub-Saharan Africa where 16% of adult women are widows. The study examined the coping mechanisms among the young widow (aged ≤ 40) who have experienced short conjugal relationships (≤5 years) and burdensome from in-laws. The research design followed a qualitative approach with the aid of semi-structured in-depth interviews among 13 young widows selected through snowballing and informant-led approaches in the purposively selected communities. Data collected were analysed using descriptive statistics and a thematic approach. The findings, among others, shows the median age of young widow as 29 years. All participants, except one, have faced exploitation from their in-laws over their husbands' assets. All the participants desired to re-marry in order to: have a father figure for their children, have their own children or have more children. There is an absence of government support, but a few have received support from religious organisations. The author proposed attitudinal-change campaigns targeting the in-laws through accessible media and legislature that could challenge the exploitation of widows and unhealthy widowhood rites.

Comprehensive Perspectives for Erectile Dysfunction Pharmacotherapy: From Mechanism to Application.

In recent years, the incidence of erectile dysfunction (ED) has continued to rise worldwide. Since pharmacotherapy is still the most common and effective method for the treatment of ED at present, many methods and drugs have been designed or developed for the treatment of ED. Oral phosphodiesterase-5 inhibitors and androgen supplement therapy are currently the common therapeutics for ED; however, some patients have poor responses to these drugs because of the multiple pathogenic mechanisms of ED. Researchers are trying to find other treatment ways. On the one hand, many new strategies and concepts, such as targeted therapy, are also integrated into clinical or preclinical research; on the other hand, some combined therapies that have synergistic effects with a reduced dose of a single drug and less adverse effects are also developed. This review article summarized the efficacy of the latest first-line, second-line drugs and adjuvant therapies for the treatment of ED, as well as the application of comprehensive treatments, which will help doctors not only deeply understand the mechanism of ED but select the suitable therapeutics for those patients.

Sexual intimacy and aging: An integrative framework to promote intimacy resilience in couple therapy.

In our work at the Intimacies Project at The Ackerman Institute for the Family we became aware of a gap in attention about sexuality and aging in the couple and family therapy field. In this article, we provide an integrative framework to guide therapists on how to address problems of sexuality and aging in the therapy room. Starting from considerations about the social context of aging and the self of the therapist, we contend that when normative sexual challenges become entangled with stigma, misconceptions about sexuality, limiting gender narratives, vulnerabilities, and defensive postures, they often result in emotional and sexual shutdowns. Through a combination of the vulnerability cycle with an expansive definition of sexuality, we demonstrate how we deconstruct impasses, disentangle normative quandaries from reactive dynamics, and help couples transform their sexual narratives. We outline how we conduct individual sessions to obtain relational sexual histories, utilize Sensate Focus as a mindful touch exercise, and help partners expand their sexual menus beyond penetration and orgasms. We also describe relational skills that may need to be strengthened to help aging couples deal with the ebb and flow of intimacy, sustaining resilience over time.

Midlife financial strain and later-life health and wellbeing of husbands and wives: Linking and moderating roles of couple intimacy trajectories.

This study investigates (a) heterogeneous trajectories of couple intimacy over the mid-later years (average ages of 40-65) and (b) how these intimacy classes are differentially associated with spouses' midlife financial strain as well as their later-life health and wellbeing outcomes. The sample was comprised of white couples in long-term marriages from the rural Mid-west who experienced the economic downturn of the farm crisis in late 1980s. Couple-level measures of emotional intimacy and sexual intimacy were created by summing husbands' and wives' reports. Using growth mixture modeling with a sample of 304 couples, conjoint intimacy classes were identified from trajectories of couple emotional intimacy and sexual intimacy. Three qualitatively different latent intimacy classes of couples were identified: Consistently High, Moderate and Increasing, and Chronically Low. Intimacy classes were differentially associated with midlife financial strain and later-life health and wellbeing. Spouses with consistently high and moderate and increasing intimacy in their mid-later years averaged lower financial strain in early midlife and better health and wellbeing outcomes in later years (>67 years) compared to those with consistently low intimacy after controlling for lagged health measures. The identification of couple intimacy trajectory groups provides a potentially useful prognostic tool for counseling efforts that can promote and develop resiliency factors to aid in the redirection of adverse couple intimacy trajectories.

En el presente estudio se investigan las a) trayectorias heterogéneas de la intimidad de la pareja durante los años de la mediana edad y la vejez (edades promedio de 40 a 65 años) y b) cómo estas clases de intimidad se asocian diferencialmente con la presión económica de la mediana edad de los cónyuges, así como con los resultados en la salud y el bienestar en la vejez. La muestra estuvo compuesta de parejas blancas en matrimonios duraderos de zonas rurales del centro de los Estados Unidos que sufrieron la recesión económica de la crisis agrícola a fines de la década de los ochenta. Las medidas a nivel de la pareja de la intimidad emocional y la intimidad sexual se crearon sumando los informes de los esposos y las esposas. Utilizando un modelo de combinación de crecimiento con una muestra de 304 parejas, se identificaron clases de intimidad conjunta a partir de las trayectorias de la intimidad emocional y la intimidad sexual de la pareja. Se identificaron tres clases de parejas cualitativamente diferentes según su intimidad latente: constantemente alta, moderada y en aumento, y crónicamente baja. Las clases de intimidad estuvieron asociadas diferencialmente con la presión económica en la mediana edad y la salud y el bienestar en la vejez. Los cónyuges con intimidad constantemente alta, y moderada y en aumento entre la mediana edad y la vejez promediaron una menor presión económica a principios de la mediana edad y mejores resultados en la salud y el bienestar durante la vejez (más de 67 años) en comparación con aquellos que tenían una intimidad constantemente baja después de tener en cuenta las medidas de salud retardadas. La identificación de los grupos de trayectorias de la intimidad de la pareja ofrece una herramienta de pronóstico que puede ser útil para el trabajo de terapia orientado a personas y a parejas, ya que puede promover y desarrollar factores de resiliencia que ayuden a redirigir las trayectorias desfavorables de la intimidad de la pareja.

Economic distress and perceptions of sexual intimacy in remarriage.

Introduction: Economic distress and the relationship stability of remarried couples has been subject to some exploration, but less emphasis has been placed on how economic distress among remarried couples impacts other relationship domains, particularly sexual intimacy. Methods: Through the lens of multidimensional family development theory (MFDT), this study utilizes longitudinal data over a three-year period to examine the links between economic distress, couple engagement, relationship satisfaction, and perceptions of sexual intimacy among remarried couples (n = 1,161 couples; 97% White). Results: Through a dyadic structural equation model, results showed that wives' report of economic distress was directly related to their self-rejection of a partner's sexual advances. Findings also revealed gender differences in how both relationship satisfaction and couple engagement influenced one to accept or reject their partner's sexual advances, with couple engagement acting as a significant predictor for wives. Relationship satisfaction was also found to explain (i.e., mediate) the relation between economic distress and sexual intimacy, but only for husbands. Discussion: Implications for further research and interventions designed to strengthen the relationships of remarried couples dealing with economic distress and intimacy issues are offered.

The interaction between BMI, weight criticism, weight bias, and psychological and relational outcomes within marriage.

PURPOSE: To examine (1) whether a wife's BMI interacts with either her husband's weight stigma or (2) her perceived weight criticisms from her husband predict husbands' and wives' psychological and relational outcomes. METHODS: The study sample consisted of 209 currently married men and women in a heterosexual relationship. Participants were drawn from an online survey platform (Qualtrics, Inc. Provo, UT) designed to approximate the US population on age, race, and region of the country. Online measures assessed husbands' weight stigma, wives' perceived weight criticisms from husband, and husbands' and wives': (1) relationship satisfaction, (2) sexual intimacy, (3) self-esteem, (4) depressive symptoms, and (5) perceptions of a desirable or ideal mate. RESULTS: Wives' BMI interacted with husbands' weight stigma to predict (1) mate value for husbands and wives and (2) marital satisfaction for husbands. The same pattern was noted with interaction of wives' BMI and perceptions of husbands' weight related criticisms. The interaction reflected that higher wife BMI and higher husband weight stigma or wife perceived weight-related criticism predicted lower marital satisfaction, greater depression, and lower perceptions of a desirable or an ideal mate. Lower BMI was not associated with outcomes regardless of the husbands' weight stigma or wives' perceived weight-related criticisms. CONCLUSION: To understand the impact of weight stigma and weight related criticisms on perceptions of a desirable or ideal mate and marital outcomes, it is important to examine the interaction with partner's BMI. LEVEL OF EVIDENCE: III: Evidence obtained from cohort or case-control analytic studies.

Experimental Induction of Emotional and Sexual Intimacy: Exploring the Validity of the German Fast Friends Procedure in Individuals with and without Childhood Maltreatment.

The Fast Friends Procedure (FFP) is a widely used experimental paradigm to induce emotional intimacy. Besides exploring the validity of a German translation of the paradigm (n = 46), we developed an extension of the FFP that induces sexual intimacy and assessed heart rate, high-frequency heart rate variability, and electrodermal activity responses to the FFP and its extension. Furthermore, we examined its applicability to individuals with childhood maltreatment (n = 56), who frequently suffer from intimacy-related difficulties. Intimacy, positive affect, liking, and attraction increased during the FFP and partly during the sexual intimacy extension in both study groups. Moreover, both groups showed physiological responses consistent with positive social interactions. The use of the German FFP and its sexual intimacy extension can thus be recommended for research in the general population and in individuals with childhood maltreatment, although more studies are needed to further validate the paradigms.

Sildenafil and suicide in Sweden.

Much theory asserts that sexual intimacy sustains mental health. Experimental tests of such theory remain rare and have not provided compelling evidence because ethical, practical, and cultural constraints bias samples and results. An epidemiologic approach would, therefore, seem indicated given the rigor the discipline brings to quasi-experimental research. For reasons that remain unclear, however, epidemiologist have largely ignored such theory despite the plausibility of the processes implicated, which engender, for example, happiness, feelings of belonging and self-worth, and protection against depression. We use an intent-to-treat design, implemented via interrupted time-series methods, to test the hypothesis that the monthly incidence of suicide, a societally important distal measure of mental health in a population, decreased among Swedish men aged 50-59 after July 2013 when patent rights to sildenafil (i.e., Viagra) ceased, prices fell, and its use increased dramatically. The test uses 102 pre, and 18 post, price-drop months. 65 fewer suicides than expected occurred among men aged 50-59 over test months following the lowering of sildenafil prices. Our findings could not arise from shared trends or seasonality, biased samples, or reverse causation. Our results would appear by chance fewer than once in 10,000 experiments. Our findings align with theory indicating that sexual intimacy reinforces mental health. Using suicide as our distal measure of mental health further implies that public health programming intended to address the drivers of self-destructive behavior should reduce barriers to intimacy in the middle-aged populations.

Preliminary Development of a Mindfulness-Based Group Therapy to Expand Couples' Sexual Intimacy after Prostate Cancer: A Mixed Methods Approach.

INTRODUCTION: Sexual health and intimacy are consistently reported among the top unmet supportive care needs of prostate cancer (PC) survivors. With an aging population and advances in PC detection and treatment, the need for better PC sexual health interventions is acute. AIM: Examine the feasibility of a mindfulness-based therapy group aimed at improving sexual intimacy for couples following PC treatments. METHODS: A 4-session mindfulness-based group intervention was developed for PC survivors (mean age 65.6 yrs) and their partners (mean age 61.4 yrs). A mixed-methods approach was adopted to account for small sample sizes (N = 14 couples). Findings will guide future treatment refinement via participants' lived experiences. MAIN OUTCOME MEASURES: Quantitative outcomes assessed pretreatment, immediately after treatment, and 6 months later included relationship adjustment, sexual satisfaction, sexual function, depression, anxiety, and mindfulness. Qualitative outcomes used Grounded Theory Approach following posttreatment exit interviews. RESULTS: Effect sizes 6 months posttreatment indicated moderate improvements in overall sexual satisfaction and large increases in mindfulness in PC survivors, small decreases in sexual intimacy reported by partners, and small increases in anxiety in PC survivors and partners. Qualitative outcomes revealed 6 themes: (i) PC treatments must view PC as a couple's disease; (ii) PC treatments must consider the impact of illness on individuals and the couple; (iii) Mindfulness was a valued treatment modality; (iv) Individual factors contribute to outcomes, and therefore, must be considered; (v) Multiple perceived mechanisms for change exist; (vi) Group format is a therapeutic element of the process. CONCLUSION: An acceptance-based approach to sexual intimacy needs among PC survivors and their partners is feasible. While this small-scale preliminary study suggests that mindfulness may address some currently unmet needs among this population, randomized clinical trials are needed. JA Bossio, CS Higano, LA Brotto. Preliminary Development of a Mindfulness-Based Group Therapy to Expand Couples' Sexual Intimacy after Prostate Cancer: A Mixed Methods Approach. Sex Med 2021;9:100310.

Rape Crisis Counseling: Trauma Contagion and Supervision.

This study of rape crisis counselors considers whether increased exposure to victims' trauma is associated with increased supervision-believed necessary to combat trauma contagion-and whether such supervision will reduce the negative impact of such exposure. One hundred six women counselors in seven of nine rape crisis centers in Israel completed anonymous questionnaires documenting their work and trauma exposure. Trauma exposure was defined by counselors' number of victim-contact hours per week and their assessment of the trauma severity they experienced. Supervision was measured by the number of hours received. Counselors trauma outcome indicators included sexual intimacy, secondary traumatization (evidenced in posttraumatic stress disorder [PTSD]-type symptomology), and vicarious traumatization (expressed as a disturbance in cognitive schemes that undermine the self and others). Hypotheses were evaluated in fully recursive path analyses via ordinary least squares (OLS) regression. Participants' mean age was 43.4 years; 58% were married, 26% single, 13% divorced, and 3% widowed; 81% had a college degree or more; 18.9% reported being exposed to victims-trauma at a minimal level, 54.7% moderate and 26.4% extreme; and 43.4% were abused at some time in their lives. Job exposure to victims' trauma was significantly associated with increases in supervision time (ß = .33, p = .002). Supervision time fully mediated the relationship between duration of exposure to victims' trauma and counselors' secondary traumatization reports such that increased supervision was associated with degrading sexual intimacy (ß = .22; p = .032) and increased Secondary Trauma Scale scores (ß = .44; p = .004) after taking into account counselors' education level, history of abuse, anger management in intimate relationship, and posttraumatic growth scores. The study results raise concern about counselors' mental health in that the supervision effect exacerbated the trauma contagion impacts. The study suggests a need for documenting the nature of the supervision and considering different types of supervision methods.