Sex Therapy Research Articles

Sex, Alchemy, and Marriage

This article bridges the field of sex and couples therapy with Jungian psychology. By linking sex therapy to the realms of play, creativity, fantasy, imagination, and spirit, it offers fresh perspectives on sexual experiences within committed relationships. It explores matters of the unconscious and transference between romantic partners and how these relate to the relationship between an analyst and a patient. Drawing inspiration from Carl Jung’s The Psychology of the Transference, this thesis examines the psychological and erotic significance of the Rosarium Philosophorum, a collection of alchemical woodprints from the 16th century, in conjunction with Jung’s concepts. The essay amplifies Jung’s perspective by comparing it to Imago Relationship Therapy, a couples counseling modality. It posits that the Rosarium Philosophorum may provide the formula for a fulfilling, vital, erotic union. The integration of Jungian psychology with sex and couples therapy reveals a novel yet ancient framework for understanding and enhancing intimate relationships.

Enhanced chronic inflammation and increased branched chain amino acids in adrenal disorders: a cross-sectional study.

Patients with adrenal hormone excess demonstrate increased cardiovascular risk and mortality. We aimed to determine the impact of adrenal disorders on the inflammation marker GlycA, total branched-chain amino acids (BCAA), ketone bodies and the gut microbiome-derived metabolites trimethylamine N-oxide (TMAO) and betaine. We conducted a single-center cross-sectional study of patients with nonfunctioning adenomas (NFA), mild autonomous cortisol secretion (MACS), primary aldosteronism (PA), Cushing syndrome (CS), pheochromocytoma/paragangliomas (PPGL), other benign or malignant adrenal masses, and adrenocortical carcinoma (ACC) between January 2015 and July 2022 (n=802). Referent subjects included participants of the PREVEND (Prevention of Renal and Vascular End-stage Disease) study (n=5241). GlycA, BCAA, ketone bodies, TMAO, and betaine were measured using nuclear magnetic resonance spectroscopy. Multivariable logistic analyses were adjusted for age, sex, BMI, smoking, hypertension, diabetes mellitus and statin therapy. In age-and sex-adjusted comparison to referent subjects, increased GlycA was noted in all patient categories, increased BCAA in NFA, MACS, CS, PA and ACC, increased TMAO in patients with other malignant adrenal masses, increased betaine in NFA and MACS, and increased ketone bodies in NFA, CS and ACC. Essentially similar findings were observed in fully adjusted analysis and after exclusion of subjects with diabetes and cardiovascular disease. Patients with functioning and non-functioning adrenal masses demonstrated increased GlycA and BCAA, biomarkers associated with adverse cardiometabolic disorders and mortality. Patients with NFA demonstrated an adverse metabolic profile similar to patients with MACS and CS.

Psychotherapeutic approaches and methods and their effectiveness in treating orgasmic dysfunction in women

Orgasmic dysfunction is a sexual disorder in which an orgasm does not occur or is delayed. The prevalence of orgasmic dysfunction ranges from 16% to 28% in Europe, America and mainland China, and from 30% to 46% in other Asian countries. The causes may be physiological, neurological and psychosocial. A literature review was conducted to examine which psychotherapeutic approaches and methods are used in the treatment of orgasmic dysfunction and to examine the results of their effectiveness. All resources linked in this paper have been taken from sources contained in the Scopus or EbscoHost research databases. Throughout this paper we have researched all relevant research papers, removed any duplicates and by applying all the necessary criteria, we have concluded with 15 research articles. The therapeutic approaches and methods with proven efficacy in the treatment of orgasmic dysfunction are: group sex therapy and couples sex therapy, behavioural approaches (Master and Johnson methods, systematic desensitisation), mindfulness-based programmes (Mindfulness-Based Cognitive Therapy - MBCT, Mindfulness-Based Behavioural and Cognitive Therapy), The Betty Dodson Method (a combination of short-term psychodynamic group therapy and self-stimulation methods) and self-help programmes based on video tracking, Cognitive Behavioural Therapy (CBT) and MBCT, and psychosexual therapy manuals. Some self-help programmes also include minimal contact with a therapist. There is an overlap between these approaches (e.g. sex therapy integrates behavioural methods). The results and the review serve as a basis for the application of effective interventions and opportunities for improvement in the treatment of orgasmic dysfunction.

Review: Smoke Sauna Sisterhood (2023): documentary by Anna Hints

This article aims to review the critically acclaimed debut documentary “Smoke Sauna Sisterhood” (2023) by Anna Hints. On the outside the movie is rather culturally specific - setting of a smoke sauna in a Võromaa region of the small country of Estonia, following the lived experiences of women growing up in the late Soviet to early post-Soviet times. However, in this context, much more universal themes of womanhood are unveiled. As the themes of womanhood, bodies, nudity, patriarchy, and violence are ever-present in the therapy rooms of sex and relationships therapists, this is a movie that holds a gentle reminder of the fragility and stories people hold. In the context of visceral smoke sauna traditions, the relevance of cultural wisdom and humanity invite therapists to reflect on the nature of our work and the spaces we create.

Effect of clinical decision support for severe hypercholesterolemia on low-density lipoprotein cholesterol levels

Severe hypercholesterolemia/possible familial hypercholesterolemia (FH) is relatively common but underdiagnosed and undertreated. We investigated whether implementing clinical decision support (CDS) was associated with lower low-density lipoprotein cholesterol (LDL-C) in patients with severe hypercholesterolemia/possible FH (LDL-C ≥ 190 mg/dL). As part of a pre-post implementation study, a CDS alert was deployed in the electronic health record (EHR) in a large health system comprising 3 main sites, 16 hospitals and 53 clinics. Data were collected for 3 months before (‘silent mode’) and after (‘active mode’) its implementation. Clinicians were only able to view the alert in the EHR during active mode. We matched individuals 1:1 in both modes, based on age, sex, and baseline lipid lowering therapy (LLT). The primary outcome was difference in LDL-C between the two groups and the secondary outcome was initiation/intensification of LLT after alert trigger. We identified 800 matched patients in each mode (mean ± SD age 56.1 ± 11.8 y vs. 55.9 ± 11.8 y; 36.0% male in both groups; mean ± SD initial LDL-C 211.3 ± 27.4 mg/dL vs. 209.8 ± 23.9 mg/dL; 11.2% on LLT at baseline in each group). LDL-C levels were 6.6 mg/dL lower (95% CI, −10.7 to −2.5; P = 0.002) in active vs. silent mode. The odds of high-intensity statin use (OR, 1.78; 95% CI, 1.41–2.23; P < 0.001) and LLT initiation/intensification (OR, 1.30, 95% CI, 1.06–1.58, P = 0.01) were higher in active vs. silent mode. Implementation of a CDS was associated with lowering of LDL-C levels in patients with severe hypercholesterolemia/possible FH, likely due to higher rates of clinician led LLT initiation/intensification.

A randomized comparison of online mindfulness-based group sex therapy vs supportive group sex education to address sexual dysfunction in breast cancer survivors.

Sexual difficulties and vaginal pain are common following treatment for breast cancer. The goal of this study was to evaluate an online mindfulness-based group sex therapy vs an online supportive sex education group therapy to address these sexual difficulties. Breast cancer survivors (n= 118) were randomized to 1 of the 2 arms; 116 provided informed consent and completed the time 1 assessment. Treatment included 8 weekly 2-hour online group sessions. Those randomized to the mindfulness group completed daily mindfulness exercises, and those in the comparison arm read and completed exercises pertaining to sex education. Assessments were repeated at posttreatment and 6 months after the completion of the group. There was a main effect of treatment on primary endpoints of sexual desire, sexual distress, and vaginal pain, with all outcomes showing significant improvements, with no differential impact by treatment arm. Secondary endpoints of interoceptive awareness, mindfulness, and rumination about sex also significantly improved with both treatments, with no group-by-time interaction. Both mindfulness-based sex therapy and supportive sex education delivered in group format online are effective for improving many facets of sexual function, vaginal pain, rumination, mindfulness, and interoceptive awareness in breast cancer survivors. We used a randomized methodology. Future studies should seek to diversify participants. These findings highlight the need to offer similar treatments to more breast cancer survivors immediately after and in the years following cancer treatment as a means of improving survivorship quality of life.

Being a Surrogate Partner: The Challenges of Fragile Boundaries.

Surrogate partner therapy is a type of treatment in which the surrogate partner (SP) works in a triadic setting with a sex therapist and a patient. At the same time, the SP acts as an intimate surrogate partner to the patient. The SP treatment includes a range of therapeutic experiences such as relaxation, intimate communication, sensual and sexual contact, and training for the acquisition of social skills. In the current study, we ask what and how SPs experience, understand, and construct boundaries in their work. We used Winnicott's therapeutic conceptualization of psychotherapy as a mode of playing and Goffman's dramaturgical role theory as the theoretical framework for our exploration. Applying a phenomenological and empathic approach, we analyzed 13 in-depth interviews with Israeli SP. It appears that SP's transitions from one performance to another are dramatic, in that their role requires the involvement of sexual and emotional helping relations with their patients. Moreover, SPs are obliged to have secrecy at all levels and in various relationships in their lives. We uncovered various complexities that SPs experience, such as a lack of clarity about their role, which creates challenges for building their professional and personal identity and affects their family and social relationships.

(229) Late Life Male Virgins: Exploring the Psycho-Social-Sexual Consequences of Sexual Inexperience in Cisgender American Males Seeking Sex Therapy

Abstract Introduction Reports on past studies about male sexuality, as it compares to women’s, indicate that men have higher sex drives, more positive attitudes toward casual or uncommitted sexual encounters, being more eager to engage in a variety of sexual activities, having more positive emotional responses to intercourse and having higher value regarding sexual experience and activity than women. Although the literature and cultural norms have perpetuated the myth of the sexual male, there is a dearth of literature regarding male virginity, specifically, late life male virginity, and its impacts on psycho-social-sexual health. Objective To investigate the experiences of later in life male virgins and the effects of their sexual status on their psycho-social-sexual health. To provide new insight into late life male virgins' assumptions, feelings, and gender role expectations and their perceptions on how those impact their attainability of sexual interactions and romantic relationships. To increase awareness among clinicians regarding the need for targeted interventions for late life male virgins in clinical practice. Methods This exploratory qualitative research was based on the case studies of five cisgender heterosexual men in the United States of America, who were late life virgins at the time of the study (defined as men 45 years and older, with no previous sexual experiences or interactions with the opposite sex) who sought Sex Therapy and Surrogate Partner Therapy to assist in their objective to acquire social and sexual skills with the goal of having their sexual debut. Results The common themes that stemmed from the case studies revealed that: 1) although the men in the study were able to achieve academic and professional status, they felt flawed and out of the norm due to their virginity status; 2) all the men hid their sexual inexperience from peers and family due to shame and fear of negative consequences to their reputation and even professional loss; and 3) made evident the challenges these men face while navigating social and sexual experiences later in life; 4) underscored the damaging effects of myths, stereotypes and societal expectations around male sexuality; and 5) highlighted the lack of information, education and therapeutic tools that could help guide late life male virgins in their pursuit to exercise their sexuality. Conclusions The study provides a greater understanding of the challenges and issues late life male virgins face in their quest to reach their sexual debut and live satisfactory sex lives that meet their particular needs. The themes offer guidance for the development and implementation of sex therapy interventions that will help this specific cohort, as well as directions for future research. Disclosure No.

(258) Some Erotic Arts and Sexual Therapies Originated from the Ancient Chinese Erotic Health Science

Abstract Introduction Chinese people have created some sexual cultural heritages in 5,000 years, such as the Combined Yin and Yang and The Classic of the Medical Goddess. I have collected more than 5,000 Chinese sexual artifacts, compiled and published The Sexual Life and Health for the Couple: Ancient Wisdom for Modern Use, and hosted the “Forum for Sexual Life and Health” in 2017, to explore ancient Chinese sexual culture, and found that many sexual concepts and sexual therapy or treatment techniques originated from ancient China. 5000, 2017. Objective Some Erotic Arts and Sexual Therapies Originated from the Ancient Chinese Erotic Health Science. Methods The Han Dynasty's Ten Questions to the Sophist recorded “relaxing one’s hip, contracting one’s pelvic floor muscles, tightening one’s anus are being Keep healthy”, all of the methods mean “A anal lifting therapy in traditional Chinese exercise”. Sun Simiao, a Chinese medicine pharmacist in Tang Dynasty, called them “massage the anus therapy”, and advocated “to do it a hundred times a day for prevention some diseases, and it could extend longevity” in his book Prescriptions for Erotic Techniques of the Couples. This is the therapy that is earlier about 2 thousand years than the Kegel movement, in 1948. In Ming dynasty, The Secret Teachings of the Taoist Nuns, it is written that “nine shallow and one deep while coitus”, and in Northern and southern Dynasties, The Record of Nurturing Life and Extending Longevity there are not only records of the “Ten Movements”, but also explanations of “slow insertion and quick extraction are good for health”, and so on. The recorded “sexual exercises of such kind” are more artistic and practical, predating the “stop-move-stop” while coitus, invented by Helen Singer Kaplan. 194812. Results In 1943, James H. Semans, the father of “premature ejaculation”, considered the dysfunction as a physical and mental disease and applied anesthetic cream to treat it, while as early as 1896, Ye Tianshi a doctor of Chinese medicine in the middle of Qing Dynasty, wrote it is, in The Secret Book of Elixir for Progeny, “liking as a cock copulating fast” 1943, 1896. Conclusions It is an important sex therapy that was used in ancient China, ie. “to therapy sexual disorders with sexual activities”. For example, The Thousand Golden Remedies is recorded also by Sun Simiao, “the sexual activity is karezza or coitus reservatus rather than administration”, that is to say, it is a form of coitus in which the man tries to avoid ejaculation. This also coincides with the “Sensate Focus Therapy” created by Masters and Johnson. Disclosure No.

Sex therapy and support for women and couples

Sexuality is shaped by experience and by what has been passed down. Body image and sex influence desire and pleasure. In the case of endometriosis, suffering and pain can lead to shame and guilt. Encouraging people to talk to each other helps to create a free eroticism that resembles the couple.

Sexuality in penile cancer survivors: A rarely discussed problem in uro‐oncology

AbstractSexuality in cancer patients is a complex area. It is estimated that 81% of patients with urological cancer develop problems in their sexual functionality, even from the moment of diagnosis and aggravated during treatment due to direct injury to the genitalia. Currently, there are few avenues of care within the field of urology that address sexual health and quality of sexual life in penile cancer survivors, which causes many of them to lose self‐esteem and have problems with their partners. To review the literature on what are the consequences on the sexual life of penile cancer survivors in terms of their performance, including risk factors associated with penile cancer and what are the alternatives they must recover their sexual life. Most penile cancer survivors develop alterations in sexual performance and functionality, such as loss of sexual interest, dysfunctional ejaculation, and loss of orgasm, increasing the risk of depression and anxiety. Sex therapy is presented as an alternative to improve the quality of life of these patients, proposing sexuality as something more than genitalia and helping to lead a better life. Sex therapy is an alternative and should be contemplated in the therapeutic plan of patients with urological cancer, especially penile cancer, since sexuality is part of an individual's life, and its loss affects the quality of life.

Relationship between sex, body size, and cardiac resynchronization therapy benefit: A patient-level meta-analysis of randomized controlled trials

BackgroundWomen might benefit more than men from cardiac resynchronization therapy (CRT) and do so at shorter QRS durations. ObjectiveThis meta-analysis was performed to determine whether sex-based differences in CRT effects are better accounted for by height, body surface area (BSA), or left ventricular end-diastolic dimension (LVEDD). MethodsWe analyzed patient-level data from CRT trials (MIRACLE, MIRACLE ICD, MIRACLE ICD II, REVERSE, RAFT, COMPANION, and MADIT-CRT) using bayesian hierarchical Weibull regression models. Relationships between QRS duration and CRT effects were examined overall and in sex-stratified cohorts; additional analyses indexed QRS duration by height, BSA, or LVEDD. End points were heart failure hospitalization (HFH) or death and all-cause mortality. ResultsCompared with men (n = 5628), women (n = 1439) were shorter (1.62 [interquartile range, 1.57–1.65] m vs 1.75 [1.70–1.80] m; P < .001), with smaller BSAs (1.76 [1.62–1.90] m2 vs 2.02 [1.89–2.16] m2; P < .001). In adjusted sex-stratified analyses, the reduction in HFH or death was greater for women (hazard ratio, 0.54; credible interval, 0.42–0.70) than for men (hazard ratio, 0.77; credible interval, 0.66–0.89; Pinteraction = .009); results were similar for all-cause mortality even after adjustment for height, BSA, and LVEDD. Sex-specific differences were observed only in nonischemic cardiomyopathy. The effect of CRT on HFH or death was observed at a shorter QRS duration for women (126 ms) than for men (145 ms). Indexing QRS duration by height, BSA, or LVEDD attenuated sex-specific QRS duration thresholds for the effects of CRT on HFH or death but not on mortality. ConclusionAlthough body size partially explains sex-specific QRS duration thresholds for CRT benefit, it is not associated with the magnitude of CRT benefit. Indexing QRS duration for body size might improve selection of patients for CRT, particularly with a “borderline” QRS duration.

BioNTech COVID-19 (BNT162b2) Vaccination and Varicella Zoster Reactivation: A Comprehensive Cross-sectional Study.

Herpes zoster (HZ) results from reactivation of latent varicella-zoster virus. Recent observations have suggested that HZ is associated with vaccination against COVID-19. To investigate the association between the vaccine and HZ severity, a single-centre, cross-sectional study of all patients diagnosed with HZ and 2 control diagnoses (cellulitis and bone fractures), between 2017 and 2021, was performed. Hospital visits and hospitalization rates were compared. All medical records of patients diagnosed with HZ in the first year after the COVID-19 vaccination campaign began were reviewed, in order to generate a retrospective cohort comparing vaccinated and unvaccinated patients with HZ. All participants had received the Pfizer-BioNTech COVID-19 (BNT162b2) vaccine. During the study period, 2,413 patients were diagnosed with HZ, and when normalized to control diagnoses the number of cases remained stable. The retrospective cohort included 365 patients. A multivariate analysis controlling for sex, age, autoimmune diseases, malignancies, and immunosuppressive therapy showed higher admission rates in vaccinated compared with unvaccinated individuals (odds ratio (OR) 2.75, 95% CI 1.27-5.96, p = 0.01). However, matching techniques and stratification by age, used to better control for confounders, invalidated these findings. No differences were observed in other variables indicative of disease severity (hospital stay length and complications). In conclusion, COVID-19 vaccination was not found to be associated with an increased risk of HZ-related admission and complications.

(357) The Importance of Assessing Adult ADHD/ADD Diagnoses in Patients Presenting with Concomitant Sexual Disorders and Sexuality Related Challenges to Both Sex Therapists and Medical Providers

Abstract Introduction A 2020 literature review in The Journal of Sexual Medicine concluded that research subjects with ADHD reported more sexual desire, more masturbation frequency, less sexual satisfaction, and more sexual dysfunctions than the general population. Another study showed that all participants with self-reported ADHD showed higher rates of avoidant attachment while males with ADHD and anxious attachment reported using a greater amount of online pornography/sexually explicit media. There are unique challenges that affect singles’ and couples’ sex lives when a partner has Adult ADHD/ADD. Many patients seek out medical treatment of sex therapy for Erectile Disorder, Delayed Ejaculation, Premature/Uncontrolled Ejaculation, Genital Pelvic Penetrative Pain Disorder, and low desire and seek out sex therapists for the above diagnoses as well as infidelity, out-of-control-sexual-behavior, orgasmic disorders or sexless relationships. These patients seek to address what they regard as exclusively a medical or a relational problem. However, only through accurate assessment and treatment by both sex therapists and doctors of an intersectionality of an adult ADHD diagnosis impacting the sexual disorder will the client or couples’ challenges fully improve. Objective Many patients show up in both sex therapists’ and doctors’ offices with sexual complaints without either having been formerly diagnosed with ADHD or by sharing with the provider that they have this disorder. The ADHD/ADD diagnosis can be a treatment blind spot for both sex therapists and medical providers that can be greatly improved upon due to the integral impact it has on both a single patient's concomitant sexual disorder and a couples’ sex life. In this talk, the presenter hopes to improve participants assessment skills to treat the co-occurring symptoms that impact both sexual functioning and health. Methods In this presentation, an overview of common sexual issues occurring in single clients and couples where one partner has ADHD/ADD, will be presented along with clinical case examples. The presenter will offer some key questions to pose when assessing a patient to yield more information regarding how their sexual functioning has been impacted over the course of various stages of their adult life. This talk will also assist in educating providers on how to provide sexuality education so clients can protect their sexual health, understand the interplay of ADHD and their sexual functioning problems, and provide referrals needed to sex therapists, ADHD-specialized psychiatrists, urologists, gynecologists, and pelvic floor therapists so the patient has a holistic treatment plan. Results Clinical experience suggests assessing and treating comorbid adult ADHD in single and coupled patients may be a key to treating a common matrix of sexual comorbidities: Erectile Disorder, Anorgasmia, Out of Control Sexual Behavior, Premature Ejaculation, Anxiety and Depression. In this group these hard-to-treat problems may become more responsive to directed treatment if the disability of ADHD can be mitigated. Addressing adult ADHD provides an opportunity to reverse demoralization and open up doors to effective sexual functioning for a portion of our patients who have struggled to get a full-spectrum treatment plan. Conclusions As a sex therapist in practice for over 25 years, I have found that many adults have not been formally be diagnosed with ADHD and that their previous experiences with medical providers and general couples counselors have missed out on the impact the disorder's symptoms has on their sexual functioning. There is still scant research on ADHD and sexual functioning in the literature and I feel that our patients would improve more quickly if this disorder were taken into account by their medical and sex therapy providers. Disclosure No.

(110) Socioeconomic Factors Impacting Density of Certified Sex Therapists in the United States

Abstract Introduction An exploratory study mapping sex therapists based on the top ten Google results in each state concluded that most sex therapists were located in larger metropolitan areas, and importantly, they found that only 18.2% of clinicians offering sex therapy services were certified by a national organization such as AASECT. Objective To map where certified sex therapists practice and what variables influence where they practice in the United States. Methods The American Association of Sexuality Educators, Counselors, and Therapists online directory was queried for certified sex therapists in each state. Univariable and multiple linear regression analyses were utilized to assess the relationship between the density of certified sex therapists in each state with various training and socioeconomic factors. Results Across all 50 states and the District of Columbia the median density of sex therapists per 500,000 people was 1.28 (IQR 0.82, 1.83). On univariable linear regression, median household income (p &amp;lt; .01, R2 = .20), percent of state population with a bachelor’s degree or higher (p &amp;lt; .01, R2 = .57), and percent of state population living in an urban setting (p &amp;lt; .01, R2 = .18) were significantly correlated with the density of certified sex therapists in each state. On multiple linear regression, percent of state population with a bachelor’s degree or higher (p &amp;lt; .01) and percent of population not in poverty (p &amp;lt; .01) remained significantly correlated with the density of certified sex therapists in each state. Conclusions Certified sex therapists are more likely to practice in urban settings with populations that have a higher median income and are more educated. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific, Coloplast.

(341) First-time Orgasm in a Man with Flibanserin Use: A Case Report

Abstract Introduction Anorgasmia is a poorly understood phenomenon defined as either a lifelong or an acquired consistent inability to achieve ejaculation. Despite the prevalence of anorgasmia, there is currently no established treatment. Objective In this abstract, we present the unique case of a patient with lifelong anorgasmia who was able to achieve his first orgasm with off-label use of flibanserin. Methods A 28-year-old male presented to our office with complaints of lifelong anejaculation and anorgasmia, without any signs of erectile dysfunction. He reported good libido and energy levels and denied any urinary symptoms or history of depression. Physical examination revealed normal genital anatomy without lesions. Testicular size was within normal limits, and a palpable varicocele was noted. Hormonal evaluations revealed total testosterone levels of 590 ng/dl and prolactin levels of 12 ng/ml. The baseline International Index of Erectile Function (IIEF) score was 41, with an orgasmic function sub-domain (IIEF-OF) score of 2. The patient had no history of major surgeries. He denied any neurological, infectious, or endocrine cause of anejaculation or anorgasmia. He was not taking medications that could cause these symptoms, except for over-the-counter allergy medications. Upon further questioning, the patient equated orgasm with ejaculation and reported having never experienced any previous orgasms. Results The patient was prescribed 150 mg of bupropion daily, which was increased to 300 mg daily after two weeks, in combination with sex therapy. Despite having received four–five sex therapy sessions over three months, the patient reported that this treatment approach was not effective. Subsequently, bupropion was tapered and discontinued. The patient was then started on bremelanotide, administered at a dose of 10 mg/mL, injecting 0.2mL (2 mg) before sexual activity. Although various forms of stimulation were attempted, the patient was unable to achieve orgasm with bremelanotide, and experienced penile pain. Flibanserin was then initiated, and after 28-32 doses over four weeks, the patient achieved his first orgasm. Notably, the patient also experienced nocturia and insomnia after initiating this medication. The follow-up IIEF score marginally improved by two points without any improvement in IIEF-OF. Conclusions This case highlights the challenges in managing anorgasmia and anejaculation in a young male patient. A stepwise approach, involving pharmacotherapy and sex therapy, was unsuccessful. However, off-label use of flibanserin ultimately resulted in the patient achieving his first orgasm, albeit with some side effects. Further studies are required to evaluate the efficacy and safety of flibanserin for this indication. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Consultant for AbbVie, Marius, Tolmar, Endo, Petros, Boston Scientific, Coloplast Investor: Sprout.

(356) Reframing The Bio-psychosocial Model. For Sexual Medicine

Abstract Introduction Most sexual medicine and sex therapy clinicians consider the biopsychosocial model the current gold standard for the diagnosis and treatment of sexual disorders. While paying lip service to that, both groups tend to focus on a couple aspects of the model overly exclusively, with insufficient awareness/attention to other contributing factors. Professionals tend to “stay in their lane,” but this can result in poorer patient care. Explicitly expanding the biopsychosocial model’s scope can help clinicians address “blind spots,” which can result in overlooking key etiological factors. Healthcare’s “medical model” perspective was upended with the publication of Engel’s (1977) “biopsychosocial model,” which emphasized multiple etiological determinants. The last decades since Engel have seen significant advances in our capacity to identify disorder’s biological causes through biomedical advances (imaging, etc.). Pharmaceutical marketing success has generated the greatest drug consumption in history, including drugs to improve sexual functioning. More people are living longer than ever with chronic disease and surviving cancer. Unfortunately, many of the ‘cures” result in iatrogenic sexual disorders because of their anti-sexual side effects. Explicitly recognizing that the prefix “bio’ represents both biological and biomedical will help enhance the re-recognition of the full range of organic factors in the diagnosis and successful treatment of sexual disorders. Doing so will lead to a greater appreciation of biomedical advances and improved recognition of iatrogenic causation for sex therapists and sexual medicine experts alike. Many sexual medicine specialists recognize psychosocial factors such as depression, anxiety, self-esteem, and satisfaction. But clinicians must also focus on specific cognitive and behavioral mechanisms and patterns (sexual scripts) that contribute to developing and maintaining sexual disorders. The need to explicitly incorporate “culture” within our sexuality model is best exemplified by current discussions surrounding gender and the continuing controversy about what constitutes “normal.” The various “identity movements’,” messaged tenants of the late 20th and early 21st century (amplified by social media), have raised international consciousness of additional psychosocial and cultural factors that should at least be considered when diagnosing and/or treating sexual disorders. There is a need for clinician sensitivity (especially in today’s world), which is enhanced by recognizing that despite culture’s complex, far-reaching constellation of factors, they must be incorporated when considering psychosocial factors. Objective Sexuality professionals need to recognize and accept an expanded view of the biopsychosocial model's scope. Methods Literature review. Results Limitations in how the biopsychosocial model is currently used may risk under-emphasizing the role of organic, behavioral, and cultural factors in sexual disorder etiology and treatment. Conclusions “Biopsychosocial” should be seen as an explicit “stand-in” for all predisposing, precipitating, and maintaining bio-medical/surgical, cognitive, behavioral, emotional, social, and cultural factors determining the etiology and treatment of sexual disorders. Such an explicit expansion of the model will provide multidimensional clarity and understanding that will help the next generation of clinicians adopt a transdisciplinary perspective, not merely a multidisciplinary one. Disclosure No.

(097) Psychosocial Factors in PGAD/GPD Patients Who Underwent Spine Surgery for Lumbosacral Annular Tear-Induced Sacral Radiculopathy

Abstract Introduction Persistent genital arousal disorder/genito-pelvic dysesthesia (PGAD/GPD) is characterized by persistent or recurrent, unwanted or intrusive, distressing sensations of genital arousal not associated with concomitant sexual interest, thoughts, or fantasies and/or other symptoms of GPD (e.g. itching, burning, throbbing, pain) that persist for ≥3 months. Multiple psychological and medical factors may contribute to the development and maintenance of PGAD/GPD. Concerning psychologic factors, women afflicted with PGAD experience more than double the rate of suicidal ideation (54%) compared to a control group, difficulty with mental health issues such as depression, high rates of negative emotions, and substantial difficulties with psychosocial adjustment. Objective This study focuses on psychosocial factors identified in a cohort of PGAD/GPD patients diagnosed with lumbosacral annular tear-induced sacral radiculopathy. Methods Using our multidisciplinary spine-sexual medicine management algorithm, 20 patients (15 cisgendered women, 5 cisgendered men, mean age 40.3 ± 16.8 years) diagnosed with PGAD/GPD fulfilled criteria for lumbosacral annular tear-induced sacral radiculopathy. A total of 22 lumbar endoscopic spine surgery (LESS) procedures were performed in these 20 patients. Validated instruments administered included the Sexual Distress Scale-Revised, Perceived Stress Scale, and Patient Health Questionnaire-9. The sex therapy evaluation performed on initial patient intake assessed psychosocial issues including effect of symptoms on quality of life, self-image, past trauma, and current relationship(s). Patients identified as having significant psychosocial issues were advised to undergo pre-op and/or post-op therapy. Results Ninety percent of patients were advised to undergo therapy. Our study cohort exhibited high levels of anxiety, depression, and/or obsessive-compulsive disorder as well as suicidal ideation. The Sexual Distress Scale–Revised revealed significant distress in 14 patients (82%). The Perceived Stress Scale showed 2 (12%) having high stress, 12 (70%) having moderate stress, and 3 patients (18%) having low stress. As assessed by item 1 of the Patient Health Questionnaire-9, 3 patients had a score consistent with warranting treatment for depression while an additional 10 had a score consistent with the possible need for treatment based on clinical judgment. As assessed by item 2 (“How difficult is it for you to do your work, take care of things at home, or get along with other people?”), 13 (65%) reported difficulties, with 3(15%) extremely difficult, 5 (25%) very, and 5 (25%) somewhat difficult. Overall, 7 (35%) showed improvement on the Patient Global Impression of Improvement after 3 months and by one year post-operatively, 80% (16/20) reported improvement. Conclusions There are many recognized triggers for PGAD/GPD. While this subgroup was diagnosed with lumbosacral annular tear-induced sacral radiculopathy and experienced long-term alleviation of symptoms by LESS, psychological factors likely contributed to the development, continuation, and consequences of PGAD/GPD. We believe that the significant mental health issues in this PGAD/GPD patient population made recovery from LESS more protracted than typically experienced after this surgery for sciatica alone. Psychological therapy would be beneficial in this population and should be continued postoperatively, as needed, to address psychological concerns and enhance quality of life. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Eliquence.

The role of person-centered psychotherapy in addressing sexual dysfunction and the role of the focusing technique on sex therapy

The work follows the positive influence of the elements/techniques present in a form of non-directive psychotherapy on the awareness of a sexual dysfunction and on the openness in therapy to work on this segment; also, the aim is to present the positive effects of focusing on clients with sexual dysfunctions. Eight clients were observed during a psychotherapeutic process that lasted over 20 sessions. All eight clients came for psychotherapy invoking elements of anxiety, wanting to more effectively manage their emotional area in couple relationships and the stress related to professional life. In the first sessions, dysfunctional elements in sexual life were not presented. After laying the foundation of an authentic therapeutic process through unconditional positive acceptance, empathy, and congruence - central elements in person-centered psychotherapy, the clients also began to explore the area of sexuality where we could observe what does not work and so, steps could be taken towards awareness and accepting the presence of elements associated with sexual dysfunction. From this point of psychotherapy, it was also possible to work with the dysfunctional elements in the sexual area through the focusing technique, the clients being able to connect at a deeper level with their body. The awareness/acceptance of a problem related to sexuality also needs a space where the person feels safe, to be able to work together with the psychotherapist also in the area of sex therapy. Focusing, through deeper bodily awareness, comes to the psychotherapist's aid when we have elements present in sexual dysfunctions.

The Association between Women’s History of Sexual Abuse, Mental Health, and Sexual Motivations in Committed Intimate Relationships

In committed intimate relationships, motivations for engaging in or avoiding sexual relations can indicate partners’ perceptions, needs, and attitudes toward sexual intimacy, and reflect sexual functioning. Sexual motivations can be positive, reflecting and advancing relational goals, such as establishing and maintaining closeness between partners and pleasure, or negative, stemming out of fear of one’s partner, pleasing them, or depriving sexual contact to punish the partner or establish relational power. In this study, we extended the current conceptualization and assessment of negative sexual motivations to explore the associations between women’s history of sexual abuse, their mental health, and their negative sexual motivations. Structural equation modeling results from 236 adult Israeli women who were in committed intimate relationships indicated that a woman’s history of sexual abuse negatively predicted her mental health which, in turn, negatively predicted her negative sexual motivations. Mental health mediated the association between a woman’s history of sexual abuse and her negative sexual motivations. These findings have theoretical and empirical contributions to research in terms of the short- and long-term effects of sexual abuse on women, mental health, and women’s sexuality. Their clinical implications for mental health professionals, sexual therapists, and clinicians working with women who experience sexual abuse are also discussed.