Women's Sexual Well-being Research Articles

Defining Pleasure: A Focus Group Study of Solitary and Partnered Sexual Pleasure in Queer and Heterosexual Women.

Solitary and partnered sexuality are typically depicted as fundamentally similar, but empirical evidence suggests they differ in important ways. We investigated how women's definitions of sexual pleasure overlapped and diverged when considering solitary versus partnered sexuality. Based on an interdisciplinary literature, we explored whether solitary pleasure would be characterized by eroticism (e.g., genital pleasure, orgasm) and partnered pleasure by nurturance (e.g., closeness). Via focus groups with a sexually diverse sample of women aged 18-64 (N=73), we found that women defined solitary and partnered pleasure in both convergent and divergent ways that supported expectations. Autonomy was central to definitions of solitary pleasure, whereas trust, giving pleasure, and closeness were important elements of partnered pleasure. Both solitary and partnered pleasure involved exploration for self-discovery or for growing a partnered relationship. Definitions of pleasure were largely similar across age and sexual identity; however, relative to queer women, heterosexual women (especially younger heterosexual women) expressed greater ambivalence toward solitary masturbation and partnered orgasm. Results have implications for women's sexual well-being across multiple sexual identities and ages, and for understanding solitary and partnered sexuality as overlapping but distinct constructs.

Associations Between Penetration Cognitions, Genital Pain, and Sexual Well-being in Women with Provoked Vestibulodynia.

Provoked vestibulodynia (PVD) is a common vulvovaginal pain condition that negatively impacts women's psychological and sexual well-being. Controlled studies have found that women with PVD report greater negative and less positive cognitions about penetration; however, associations between these types of cognitions and women's pain and sexual well-being remain unknown. Further, researchers have yet to examine how interpersonal variables such as sexual communication may impact the association between women's penetration cognitions and PVD outcomes. We examined associations between vaginal penetration cognitions and sexual satisfaction, sexual function, and pain in women with PVD, as well as the moderating role of sexual communication. Seventy-seven women (M age= 28.32, SD= 6.19) diagnosed with PVD completed the catastrophic and pain cognitions and positive cognitions subscales of the Vaginal Penetration Cognition Questionnaire, as well as the Dyadic Sexual Communication Scale. Participants also completed measures of sexual satisfaction, sexual function, and pain. Dependent measures were the (i) Global Measure of Sexual Satisfaction Scale; (ii)Female Sexual Function Index; and (iii) Present Pain Intensity scale of the McGill Pain Questionnaire, with reference to pain during vaginal intercourse. Women's lower catastrophic and pain cognitions, higher positive cognitions, and higher sexual communication were each uniquely associated with higher sexual satisfaction and sexual function. Lower catastrophic and pain cognitions also were associated with women's lower pain. For women who reported higher sexual communication, as positive cognitions increased, there was a significantly greater decrease inpain intensity during intercourse compared to women who reported lower levels of sexual communication. Findings may inform cognitive-behavioral interventions aimed at improving the pain and sexual well-being of women with PVD. Targeting the couple's sexual communication and women's penetration cognitions may improve women's sexual adjustment and reduce pain.

The role of anxiety sensitivity in the sexual functioning of young women

High anxiety sensitivity (AS; fear of arousal-related bodily sensations) is a known risk factor for psychopathology and medical pathology. High AS individuals tend to avoid activities that induce feared arousal-related sensations; yet, few studies have examined AS and sexual activity, those that did have produced mixed results, and no study to date has examined AS and sexual avoidance. In Study 1, 296 young adult women completed the Anxiety Sensitivity Index-3 (ASI-3) and the Female Sexual Distress Scale-Revised, which were positively correlated, r = 0.34, p < .001. Women scoring in the highest and lowest quartiles on the ASI-3 were recruited for Study 2. As predicted, high (vs. low) AS women reported significantly more sexual distress, impairments in sexual functioning (including sexual pain), and avoidance of sexual activity, and less sexual satisfaction. Results suggest that high AS can limit the frequency and quality of sexual functioning in young adult women, or lead to avoidance of sexual activity altogether. Reducing AS via empirically validated cognitive-behavioural approaches could improve women's sexual and relationship well-being.

Psychosocial/survivorship issues in breast cancer: are we doing better?

Modern breast cancer treatment offers many women greater prospects of cure or lengthier, good quality survival than was possible in the past. Advances include improved diagnostic and staging procedures, sophisticated onco-plastic surgery, enhanced radiotherapy techniques, and targeted systemic therapies. Much more attention has also been paid to cancer care delivery and access to specialist nurses, counsellors, support groups, and services provided by breast cancer charities. However, there are some concerns that these considerable improvements in treatment delivery and clinical outcomes have not led to similar benefits in the psychosocial, functional, and sexual well-being of women. The impact that non-life threatening, long-term iatrogenic harms of otherwise efficacious anticancer treatments has on patients is often overlooked; this is in part because of the emphasis given to physician-reported safety data in trials and the general exclusion of patient-reported outcomes (PROs). A failure to utilise reliable PRO measures has meant that some problems are underreported, which consequently has hampered much-needed research into ameliorative interventions. Systematic monitoring of quality of life-threatening side effects would permit early implementation of effective interventions and enhance long-term survivorship. Some examples of the pervasive difficulties that continue to affect survivors and evidence that certain interventions might help are provided in this commentary.

Assessing the association between childhood sexual abuse and adult sexual experiences in women with sexual difficulties.

Self-report instruments for assessing sexual well-being in women with sexual difficulties have not to date been explicitly validated among women with a history of childhood sexual abuse (CSA). Given an extensive literature suggesting psychological differences between women with and without a history of CSA, it is possible that sexual well-being has a different meaning for these groups. Without validated scales, it is difficult to evaluate the impact of early sexual trauma on adult sexuality. The present study assessed whether the factor structure of widely used measures of sexual well-being were consistent across women experiencing sexual difficulties, with and without an abuse history, and to estimate effect sizes for the statistical effect of CSA on sexual well-being in this population. A sample of women with and without a history of CSA (N = 238) completed the Female Sexual Function Index and the Sexual Satisfaction Scale for Women. Structural equation models indicated generally consistent factor structures across groups, suggesting good construct validity. Effect size estimates indicated medium to large (0.53-0.72) effects of CSA on sexual well-being for women with sexual difficulties. These findings support and extend research regarding the potential effects of CSA that may inform treatment for this population.

Predictors of sexual well-being after endometrial cancer: results of a national self-report survey.

We examined whether sociodemographic, physical, reproductive, psychological and clinical factors at the time of diagnosis were related to women's sexual well-being 3-5 years following treatment for endometrial cancer. Of the 1,399 women in the Australian National Endometrial Cancer Study, 644 completed a follow-up questionnaire 3-5 years after diagnosis. Of these, 395 women completed the Sexual-Function Vaginal Changes Questionnaire, which was used to assess sexual well-being. Based on two questions assessing worry and satisfaction with their sexuality, women were classified into lower and higher sexual well-being. Multivariable-adjusted logistic regression models were used to examine sexual well-being 3-5 years following cancer treatment and the factors associated with this at diagnosis and at follow-up. Of the 395 women, 46 % (n = 181) were categorized into the "higher" sexual well-being group. Women who were older (odds ratio [OR] = 1.97; 95 % confidence limit [CI], 1.23-3.17), high school educated (OR = 1.75; 95 % CI, 1.12-2.73), who reported good mental health at the time of diagnosis (OR = 2.29; 95 % CI, 1.32-3.95) and whose cancer was treated with surgery alone (OR = 1.93; 95 % CI, 1.22-3.07) were most likely to report positive sexual well-being. At 3-5 years post-diagnosis, women with few symptoms of anxiety (OR = 2.28; 95 % CI, 1.21-4.29) were also most likely to report positive sexual well-being. Psychological, sociodemographic and treatment factors are important to positive sexual well-being post-cancer. Care that focuses on maintaining physical and psychosocial aspects of women's lives will be more effective in promoting positive sexual well-being than care that focuses solely on physical function.

Sexual Communication, Dyadic Adjustment, and Psychosexual Well‐Being in Premenopausal Women with Self‐Reported Dyspareunia and Their Partners: A Controlled Study

Although research that takes into account partner and relationship factors in dyspareunia is slowly emerging, little is known about how these couples communicate about their sexuality. Additionally, partner psychosexual adjustment has not been examined in a controlled fashion. This study aimed to compare dyadic sexual communication, dyadic adjustment, psychological adjustment, and sexual well-being of women with self-reported dyspareunia and their partners with those of pain-free control women and their partners. Premenopausal women (n = 38; mean [M] age = 24.92) with self-reported dyspareunia, their partners (n = 38; M age = 26.71), as well as pain-free control women (n = 44; M age = 25.86) and their partners (n = 44; M age = 27.95) completed an online survey measuring dyadic sexual communication, dyadic adjustment, anxiety, depression, sexual functioning, and sexual distress. Assessments of women and men's (i) dyadic sexual communication; (ii) dyadic adjustment; (iii) anxiety; (iv) depression; (v) sexual functioning; and (vi) women's sexual distress were the main outcome measures. Compared with pain-free controls, women with dyspareunia reported significantly poorer dyadic sexual communication, a difference not found between partners of women with dyspareunia and control partners. Compared with partners of control women, those of women with dyspareunia reported significantly more impaired sexual functioning. No differences in dyadic adjustment were found between women with dyspareunia and pain-free control women, or between their respective partners. Finally, compared with control women, those with dyspareunia reported significantly more impaired psychological and sexual well-being. Findings suggest that dyspareunia impacts not only the psychosexual adjustment of affected women but also that of their partners. It seems relevant to include both members of the couple in future research and treatment for dyspareunia.

Psychological Factors Predicting the Distress to Female Persistent Genital Arousal Symptoms

Symptoms of persistent genital arousal are expected to negatively affect women's sexual and emotional well-being. However, not all women who experience persistent genital arousal complain about their genital condition. Against this background, this study aimed to evaluate psychological predictors of the distress associated with persistent genital arousal symptoms, as well as psychological moderators influencing the conditions under which persistent genital arousal causes distress. A total of 117 women reporting symptoms of persistent genital arousal answered to online questionnaires measuring personality traits, sexual beliefs, and dyadic adjustment. Women have also completed a checklist measuring the frequency/severity of persistent genital arousal symptoms and the distress/impairment caused by these symptoms. Results showed that neuroticism, (low) openness, sexual conservatism, and (low) dyadic adjustment significantly predicted distress associated with genital symptoms. Furthermore, sexual conservatism was found to moderate the relation between the symptoms’ severity and the distress associated with those symptoms. Overall, sexual conservatism seems to be a key differentiator factor, influencing the psychological conditions under which women may report higher levels of distress caused by persistent genital arousal. Because such findings focus on the distress to genital arousal symptoms rather than on persistent genital arousal disorder as a clinical entity, the results under consideration may or may not characterize women formally assigned to the persistent genital arousal disorder label.

EVOLUTION—Taking Charge and Growing Stronger: The Design, Acceptability, and Feasibility of a Secondary Prevention Empowerment Intervention for Young Women Living with HIV

In the United States, youth of 13-24 years account for nearly a quarter of all new HIV infections, with almost 1000 young men and women being infected per month. Young women account for 20% of those new infections.This article describes the design, feasibility, and acceptability of a secondary prevention empowerment intervention for young women living with HIV entitled Young Women Taking Charge and Growing Stronger. The nine session intervention aimed to reduce secondary transmission by enhancing social and behavioral skills and knowledge pertaining to young women's physical, social, emotional, and sexual well-being,while addressing the moderating factors such as sexual inequality and power imbalances. Process evaluation data suggest that EVOLUTION is a highly acceptable and feasible intervention for young women living with HIV. Participants reported enjoying both the structure and comprehensive nature of the intervention. Both participants and interventionists reported that the intervention was highly relevant to the lives of young women living with HIV since it not only provided opportunities for them to broaden their knowledge and risk reduction skills in HIV, but it also addressed important areas that impact their daily lives such as stressors, relationships,and their emotional and social well-being. Thus, this study demonstrates that providing a gender-specific,comprehensive group-based empowerment intervention for young women living with HIV appears to be both feasible and acceptable.

The Effectiveness of Postmodern Feminist Empowering Counseling for Abused Women: A Perspectives of Thai Abused Women

This qualitative research aimed to explore the perspectives of Thai abused women regarding the effectiveness of postmodern feminist empowering counseling (PFEC) for them. The research and data collection was done in nine months. The setting of the study was a tertiary hospital located in the lower Northern area in Thailand. The participants were six abused women. The research instruments consisted of semi-structured interviews. The findings showed that the abused women, who received counseling, achieved changes in three aspects; (a) men and women are equal, (b) being abused is not fate, and (c) feeling powerful. These findings suggested that the PFEC process proposed can be utilized by counselors to increase perceived empowerment in abused women. Positive adjustments to their lives can be explained by their perceived empowerment and developed through the counseling process. Violence against women is danger facing women in every corner of the world. It can happen to women of any age, as a fetus, toddler, girl child, teenager, adult, and elderly. (Kritaya, Kanchanachitra, Im-em, & Lerdsrisuntad, 2005). According to the report of office of women's affairs and family development (2012), the incidence of violence related to children, women, and domestic violence markedly increased in Thailand, with a total of 916 occurrences of violence reported. The violence was perpetrated by men (86.23%) more than by women (11.50%); in about 2.27% of cases, the gender of the perpetrator was not identified. Considerably more women were abused within the family (87.18%) compared to men (10.28%); the gender of the abused was not identified in around 2.54% cases. Physical and psychological violence (in some instances) was carried out repetitively, and sexual violence represented 61.29%, 27.54%, 6.22% and 4.95% of the cases, respectively. The impact of violence on women's physical, psychological, and sexual well-being has not been systematically assessed (Leslie, 2001). However, some empirical studies revealed that the consequences of violence can lead to depression, psychological breakdown, or serious injuries. More importantly, in extreme cases, it can even lead to murder or suicide (Henttonen, Watts, Roberts, Kaducu & Borchert, 2008). A previous study by Smith, Tessaro, and Earp (1995) reported that women who were abused might develop fear and powerless. Consequently, the abused women were hesitate to receive health services due to shame, lack of self-respect, and decreased self-appreciation. Based on previous study, it has been found that the feelings of raped women were powerlessness, loneliness, and inner conflicts about power issue, being controlled, and inner questioning about the meaning of how sex with their partners should be (Finkelhor & Yoll, 1983, as cited in Howard, Riger, Campbell, & Wasco, 2003).

How Does Divorce Affect Iranian Women's Sexual Well-Being?

Sexuality and divorce are two interwoven subjects with complex effects on women's sexual well-being in Iranian culture. Results of this exploratory study using focus group discussions and individual interviews revealed how the sexual well-being of women was influenced by the divorce experience through common patterns and recurring themes. A total of 26 women participated voluntarily in the study. They were approached through a selected social support group in a center in West Tehran in 2011, and all had been divorced for less than 10 years. For the majority, sexuality-related matters became complicated and jeopardized their overall well-being in postdivorce life. This finding, along with the fact that the majority were seeking financial and emotional support, implies that counseling women and providing economic support for postdivorce life might improve women's sexual well-being.

Subjective sexual well-being and sexual behavior in young women with breast cancer

The aim of this study was to systematically describe the nature and context of subjective sexual well-being and sexual behavior in young women with breast cancer. Data on sexual behavior and subjective sexual well-being were collected through an internet questionnaire. Respondents were included if they had been diagnosed with breast cancer within the past 6 years and were currently 45 years of age or younger. Results were compared with a representative sample of the general Dutch population. In comparison with the general Dutch population of women, young women still undergoing breast cancer treatment are less sexually active and have a more negative experience of sexuality. While women who had already finished their treatment had more or less the same amount of sexual activity as the general Dutch population, there were still major differences in their experience of sexuality. Particularly strong associations were found between these women's sexual well-being in relation to their relationship satisfaction, and sexual interaction competence. In the wake of breast cancer treatment, young women have difficulty enjoying sex; it is evidently hard for them to resume their sex lives after breast cancer. In particular, women who find it hard to discuss sexual wishes and the possibilities and impossibilities associated with breast cancer with their partner experience negative consequences when trying to resume their sex lives.

Bidentity: Sexual Behavior/Identity Congruence and Women's Sexual, Physical and Mental Well-Being

According to cognitive dissonance theory, the co-occurrence of inconsistent cognitions may result in psychological distress. This distress may lead to undesirable health outcomes. This study explored the role of sexual behavior/identity congruence on women's mental, physical and sexual well-being. A total of 2,578 women who reported sexual attraction, desire, affection, intentions and/or behavior involving other women completed a web-based survey about their sexual identity/orientation, sexual behavior and well-being across domains. Participants whose recent sexual partnering matched their sexual identity reported fewer mentally/physically unhealthy days and also better sexual experiences. The well-being of queer-identified women did not significantly vary as a function of the gender of their sexual partners. The importance of behavior/identity congruence is discussed.

Assessment of Sexual Satisfaction in Relation to Potential Sexual Problems in Women with Multiple Sclerosis: A Pilot Study

Changes in sexual functioning are common in Multiple Sclerosis (MS) patients, but its impact on women’s sexual satisfaction remains unclear. The study examined the level of sexual satisfaction in relation to sexual functioning changes and explored the factors associated with overall sexual wellbeing in women with MS. A cross-sectional anonymous survey was administered to 160 women during routine MS clinic visits. Sexual satisfaction was assessed using a modified version of the Female Sexual Functioning Index. One-hundred-forty-four subjects completed the entire survey with a 90% completion rate. Subject’s mean age was 42 (SD 10.2) years. Mean MS duration was 8.7 (SD 6.9) years. The majority reported Relapsing-Remitting form of MS (79%) and were walking independently (73%). Presence of at least one bladder and bowel problem was noticed in 54/144 and 69/144 subjects respectively. Generalized sexual satisfaction was demonstrated in this cohort of women (44%). Respondents reported extreme satisfaction with their partner-relationship (35%), highest satisfaction for frequency of sexual activity (48%) and highest dissatisfaction for sexual desire (33%). Frequency of sexual activity and sexual desire ranked highest for having an impact on overall sex life. Other factors in the descending order of importance were: natural wetness, sexual arousal, orgasm, partner-relationship and disease duration.

“I’ve Lost My Mojo, Baby”

Few studies have explored women’s subjective experiences with Depo-Provera, in particular its impact on their sexual selves and everyday lives. Thirty-four (34) women were interviewed about their experiences using Depo-Provera and other methods of contraception, with interviews analyzed using a thematic narrative analysis approach. A key theme emerging in interviews was decrease in libido (sexual desire) in taking Depo-Provera, which was linked with emotions, body image, and had social ramifications. Four participants’ stories serve as exemplars for exploring subjective complexity. "Lived" accounts of user experiences are essential for overcoming a reductive focus on contraceptive side effects, which elides connections and obscures user understanding. A narrative perspective provides an empirical basis for developing family planning programs and sexual health policies that acknowledge more experientially grounded conceptualizations of women's sexual and reproductive health and wellbeing.

Developing the clinical assessment of female sexual difficulties after pelvic radiotherapy

Introduction and aimsPelvic radiotherapy creates physical and psychological effects that impact negatively on the sexual well-being of women and their partners. The aim of this ethnographic study was to develop...

Corrections to: “Stephenson K, Ahrold T, Meston CM. Differentiating components of sexual well-being in women: Are sexual satisfaction and sexual distress independent constructs? J Sex Med. 2010;7:2458-68.”

Corrections to: “Stephenson K, Ahrold T, Meston CM. Differentiating components of sexual well-being in women: Are sexual satisfaction and sexual distress independent constructs? J Sex Med. 2010;7:2458-68.”

Genital Appearance Dissatisfaction: Implications for Women's Genital Image Self-Consciousness, Sexual Esteem, Sexual Satisfaction, and Sexual Risk

Findings regarding the link between body image and sexuality have been equivocal, possibly because of the insensitivity of many of body image measures to potential variability across sensory aspects of the body (e.g., appearance versus odor), individual body parts (e.g., genitalia versus thighs), and social settings (e.g., public versus intimate). The current study refined existing methods of evaluating women's body image in the context of sexuality by focusing upon two highly specified dimensions: satisfaction with the visual appearance of the genitalia and self-consciousness about the genitalia during a sexual encounter. Genital appearance dissatisfaction, genital image self-consciousness, and multiple facets of sexuality were examined with a sample of 217 undergraduate women using an online survey. Path analysis revealed that greater dissatisfaction with genital appearance was associated with higher genital image self-consciousness during physical intimacy, which, in turn, was associated with lower sexual esteem, sexual satisfaction, and motivation to avoid risky sexual behavior. These findings underscore the detrimental impact of negative genital perceptions on young women's sexual wellbeing, which is of particular concern given their vulnerability at this stage of sexual development as well as the high rates of sexually transmitted infections within this age group. Interventions that enhance satisfaction with the natural appearance of their genitalia could facilitate the development of a healthy sexual self-concept and provide long-term benefits in terms of sexual safety and satisfaction.

Differentiating Components of Sexual Well-Being in Women: Are Sexual Satisfaction and Sexual Distress Independent Constructs?

Sexual satisfaction and sexual distress are common outcome measures in studies of sexual health and well-being. However, confusion remains as to if and how the two constructs are related. While many researchers have conceptualized satisfaction and distress as polar opposites, with a lack of satisfaction indicating high distress and vice versa, there is a growing movement to view satisfaction and distress as relatively independent factors and measure them accordingly. The study aimed to assess the level of independence between sexual satisfaction and distress in female clinical and nonclinical samples. Ninety-nine women (mean age = 25.3) undergoing treatment (traditional sex therapy and/or gingko biloba) for sexual arousal disorder with or without coexistent hypoactive sexual desire disorder and/or orgasmic disorder completed surveys assessing sexual satisfaction, sexual distress, sexual functioning, and relational functioning at pretreatment, mid-treatment, posttreatment, and follow-up. Two hundred twenty sexually healthy women (mean age = 20.25) completed similar surveys at 1-month intervals. Sexually dysfunctional women completed the Sexual Satisfaction Scale for Women (SSS-W), the Female Sexual Function Index (FSFI), and the Dyadic Adjustment Scale. Sexually healthy women completed the SSS-W, the FSFI, the Relationship Assessment Scale, and the Dimensions of Relationship Quality Scale. Sexual satisfaction and distress were generally closely and inversely related; however, distress was more closely related to sexual functioning variables than was satisfaction in the clinical sample, and satisfaction was more closely related to relational variables than was distress in the nonclinical sample. Additionally, satisfaction and distress showed partially independent patterns of change over time, and scales of distress showed a larger change in response to treatment than did scales of satisfaction. Although sexual satisfaction and distress may be closely related, these findings suggest that they are, at least, partially independent constructs. Implications for research on sexual well-being and treatment outcome studies are discussed.

ORIGINAL RESEARCH – OUTCOMES ASSESSMENT: Female Sexual Well-Being Scale™ (FSWB Scale™): Development and Psychometric Validation in Sexually Functional Women

ABSTRACT Introduction No validated instrument exists for measuring female sexual well-being (FSWB™) in women without medical/psychosocial conditions. Aims To develop and psychometrically validate a self-administered Female Sexual Well-Being Scale™ (FSWB Scale™) for assessing sexual well-being in sexually functional women. Methods Important aspects of FSWB™ were identified via focus groups, debriefing interviews, and administration of an initial scale to 111 US women aged 21–72 years reporting normal sexual function (Female Sexual Function Index &amp;gt;26). Principal components analysis and psychometric validity testing of a FSWB Scale™ were conducted in a second study of 332 women. Main Outcome Measures To develop a FSWB Scale, based on qualitative input from women reporting normal sexual function, and determine its factor structure and psychometric validity. Results Four aspects of FSWB were identified from the qualitative research. Women’s preferred language to describe sexual well-being and preferred response formats were incorporated into the scale. A principle components analysis of quantitative study data from 332 women aged 21–72 years reporting normal sexual function identified 5 factors with eigenvalues &amp;gt;1: interpersonal domain (6 items), cognitive-emotional domain (5 items), physical arousal domain (3 items), orgasm-satisfaction domain (3 items), and external lubrication domain (2 items). The external lubrication domain did not demonstrate strong positive correlations with the other 4 domains, so it was not retained in the final scale. A high degree of internal consistency was demonstrated for the 4 domains (Cronbach’s alpha values: 0.84–0.92). Test-retest reliability over a 2-week period was high (r &amp;gt; 0.80) or moderately high (r &amp;gt; 0.70) for the 4 domain scores. Correlation coefficients between FSWB Scale domain scores and standardized scale scores for female sexual function, depression, and social desirability demonstrated the construct validity of the FSWB Scale. Conclusion A 17-item FSWB Scale was developed and psychometrically validated as a reliable, multidimensional, self-administered instrument for assessing sexual well-being in women of different ages.