Journal of Sex & Marital Therapy最新文献

This meta-analysis aims to systematically evaluate the effects of male circumcision on sexual function, providing insights that may inform clinical practice and future research. A comprehensive literature search was conducted in eight databases until January 30, 2025, with no language restrictions. Data analysis was performed using Review Manager 5.4.1, and the certainty of the evidence was assessed using the GRADE approach. This meta-analysis included 15 studies with a total of 14,737 participants. Although circumcision was associated with higher sexual satisfaction levels compared to noncircumcised men (OR: 2.48, 95% CI: 1.62-3.79, p < 0.00001), the findings should be interpreted with caution due to significant heterogeneity among the studies. Additionally, circumcised men reported a small but statistically significant improvement in erectile function (MD: 0.28, 95% CI: 0.11-0.46, p = 0.002) and a reduced likelihood of dyspareunia (OR: 0.38, 95% CI: 0.16-0.88, p = 0.03), suggesting possible improvements in comfort during intercourse. Furthermore, circumcision was linked to a lower risk of orgasm difficulties (OR: 0.26, 95% CI: 0.10-0.73, p = 0.01). However, the impact on premature ejaculation remains inconclusive, indicating a need for further research. Overall, this meta-analysis suggests that male circumcision may have potential positive effects on certain aspects of sexual function, particularly sexual satisfaction and erectile function. Nonetheless, the clinical significance of these findings is uncertain, and further investigation is warranted given the heterogeneity observed.

It is thought that anxiety sensitivity and temperament characteristics in women diagnosed with vaginismus may be determinant on the development, persistence and treatment processes of the condition. This study aims to examine anxiety sensitivity and temperament characteristics in women diagnosed with vaginismus. The study included 40 female participant diagnosed with vaginismus and 40 women without sexual dysfunction as control group. All participants were administered the Structured Clinical Interview for DSM-IV Axis-I Disorders, followed by the Golombok-Rust Sexual Satisfaction Scale, Anxiety Sensitivity Index-3, and Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire. Anxiety sensitivity levels were significantly higher in the vaginismus group compared to the control group. It was determined that depressive, irritable and anxious temperament subscale scores were significantly higher in the vaginismus group compared to the control group. While anxiety sensitivity, depressive temperament and anxious temperament traits, which showed significant differences between the groups, maintained their significant differences after controlling for covariates the significant difference in irritable temperament disappeared. Vaginismus is not only an obstacle to sexual intercourse, but also a multidimensional clinical picture that affects couples in different areas and in its etiology individual factors such as anxiety sensitivity and temperamental characteristics may play a role.

Childhood sexual abuse (CSA) is a significant public health issue with profound and long-lasting effects on survivors' emotional, psychological, and sexual well-being. While extensive research has examined the interpersonal sexual challenges associated with CSA, less is known about its association with solitary sexual behaviors such as masturbation, particularly the underlying motives or reasons. This study examined the mediating role of post-traumatic stress disorder (PTSD) symptoms in the relationship between CSA and three specific masturbation motives: mood improvement, relaxation/stress relief, and sexual arousal decrease. A sample of 624 adults (M = 29.51 years, SD = 10.23) completed an online survey assessing CSA history, PTSD symptoms, masturbation frequency, and motives for masturbation. Structural equation modeling (SEM) revealed that PTSD fully mediated the associations between CSA and the three masturbation motives. Specifically, CSA was associated with higher PTSD symptoms, which, in turn, were linked to higher levels of masturbation motives related to mood improvement, relaxation, and sexual arousal decrease. Notably, the direct associations between CSA and masturbation motives were not statistically significant. These findings suggest that masturbation may serve as a coping mechanism-either as adaptive emotional regulation or, at times, as a maladaptive response involving avoidance or distress.

This paper critically examines the scientific and ethical underpinnings of gender-affirming care, particularly for minors. While major medical organizations endorse such interventions as medically necessary, the evidence supporting their long-term safety and efficacy remains limited. Research into hormonal, neuroanatomic, and genetic influences reveals a strong biological basis for gender identity, challenging social constructionist arguments. There is a lack of robust, long-term studies that definitively demonstrate the outcomes of gender-affirming medical treatments, such as puberty blockers or hormone therapy, for minors. Questions remain about how these interventions affect physical health (e.g., bone density, fertility) and mental well-being over decades. These gaps in the evidence, particularly for adolescents, raise ethical concerns about the appropriateness of irreversible medical treatments. This analysis highlights the tension between the social constructivist framework of gender and the medicalization of gender dysphoria. It explores the implications of rising desistance rates, co-occurring mental health conditions, and increasing non-binary identities within current clinical paradigms. Drawing on evidence from cases involving gender detransitioning, the impact of hormones, and neurological development in both straight, gay, and trans individuals, the paper underscores the importance of cautious, evidence-based approaches that prioritize psychological maturity and comprehensive mental health assessments. Ultimately, the paper advocates for rigorous longitudinal research, enhanced mental health evaluations, and the development of noninvasive therapeutic options in particular anda reevaluation of treatment models to ensure ethically sound and scientifically supported care for individuals experiencing gender dysphoria.

Sexual pressure, coercion, and violence are prevalent globally and disproportionately affect girls, women, sexual minorities, and gender minorities. Using quantitative data and open-ended responses from a cross-sectional campus-representative online survey of undergraduate students, we aimed to (1) assess the percentage of students, by gender, who reported having had a scary partnered sexual experience since age 14 and (2) characterize the kinds of sexual experiences that participants described as scary. A weighted total of 721 college student participants who reported ever engaging in oral, vaginal, or anal sex during their lifetime were included in the analytic sample. Of these, 225 reported experiencing at least one scary sexual experience (31.2%). Women and gender non-conforming students were significantly more likely to have experienced a scary sexual situation (47.2% women, 13.6% men, 60.1% TGNB+ students, p < .001). Those who reported having experienced a scary sexual experience were also more likely to report a non-heterosexual identity and more likely to live in an off-campus apartment. In examining open-ended responses from 174 participants, the scary sexual experiences were categorized as: wouldn't stop or accept a no; lack of power/control; pressure, coercion, or manipulation; unwanted roughness; explicit sexual assault; force; drunk, drugged, or unconscious; anxiety, panic attack, or PTSD; restrained or difficulty leaving; escalated quickly; condom/contraception-related; isolated or tricked; demeaning language; incest or child abuse; miscellaneous. Findings from the study have implications for sexual violence prevention professionals, as experiences that are scary but that don't meet legal definitions of sexual assault or campus definitions of sexual misconduct may be underreported. Additionally, study findings have implications for sexuality educators, who are well-positioned to describe to college students the kinds of sexual situations that are problematic and ways to mitigate harm.

This cross-sectional study examined the psychometric properties of the Brief Sexual Attitudes Scale (BSAS) in Dutch heterosexual (N = 1129) and non-heterosexual (N = 200) samples. The study confirmed the previously reported factor structure and assessed the scale's reliability and construct validity. To evaluate construct validity, participants also completed the Sexual Opinion Survey, Sexual Disgust Questionnaire, International Index of Erectile Functioning or Female Sexual Function Index, Sexual Distress Scale, and Hospital Anxiety and Depression Scale. Confirmatory Factor Analyses supported a 17-item model with satisfactory fit indices. The four subscales-birth control, communion, and instrumentality (3 items each), and permissiveness (8 items)-were confirmed. Factorial invariance across gender (male vs. female) and sexual orientation (heterosexual vs. non-heterosexual) was established. The BSAS demonstrated adequate internal consistency and test-retest reliability over a four-week interval. Construct validity was supported by strong evidence for convergent validity with related measures of sexual opinions and sexual disgust, as well as for discriminant validity with respect to conceptually distinct constructs, including sexual functioning, sexual distress, and symptoms of anxiety and depression. While replication is needed, the BSAS appears suitable for use in research. Further investigation is recommended to determine its appropriateness in clinical contexts.

Sex therapy is recommended for a range of male sexual dysfunction-including erectile dysfunction, ejaculatory disorders, and low libido-but utilization remains low even when men are referred by their urologist. Here we aimed to identify patient-reported barriers and facilitators to sex therapy attendance and predictors of both compliance and perceived benefit. Men referred to sex therapy by their urologist for sexual dysfunction were surveyed. The cohort comprised 106 cisgender males (median age 43), of whom 49% were commercially insured, and 52% had ≥1 psychiatric diagnosis, especially anxiety and mood disorders. Overall, 59% attended their initial consultation. Patients with psychiatric comorbidities were more likely to attend (p < 0.001), whereas commercially insured individuals were less likely than Medicaid recipients (p = 0.002). Of the 23 patients who completed a follow-up survey, 17 attended their consultation, and most (71%) found sex therapy helpful and would recommend it to others. Barriers included shame, embarrassment, perceived dismissal by providers, scheduling conflicts, and low expected benefit; facilitators included provider credibility, personal motivation, partner support, and ease of scheduling. While stigma remains a significant barrier, patient motivation, provider expertise, and streamlined referral processes may improve attendance and integration of sex therapy into sexual health management.

The etiology of gender dysphoria (GD) involves both biological and psychosocial factors and may have a neurodevelopmental aspect. We aimed to compare individuals with GD with each other and with cisgender individuals based on minor physical anomalies (MPAs). The case group comprised 108 individuals with GD (60 GD assigned female at birth [AFAB]; 48 GD assigned male at birth [AMAB]), most with same-biological-sex attraction. The control group consisted of 117 cisgender individuals with opposite-biological-sex attraction. Participants completed a sociodemographic-clinical-data form. Waldrop MPA Scale was used to assess MPAs. The total, craniofacial, and peripheral MPA scores of the AFAB-GD group were significantly higher than those of the cisgender controls. In the AMAB-GD group, the total and craniofacial MPA scores were significantly higher than those of the cisgender controls. Peripheral MPA scores were similar between AMAB and AFAB-GD groups, and both were higher than cisgender controls. Our findings reveal elevated MPA scores in individuals with GD, enhancing our understanding of the biological mechanisms, including early genetic and environmental factors, that may contribute to GD, at least in one group of individuals, although these findings may not be entirely attributable to gender identity and the potential influence of sexual orientation should be considered.

Sex toys are widely used in both solitary and partnered sexual activities, yet the sociodemographic characteristics and sexual wellbeing of users remain under-researched. This study examined solo and partnered sex toy users' sociodemographic characteristics and levels of erotophobia and sexual satisfaction in a Canadian community sample (n = 1,959). Participants completed an online survey, including a sociodemographic questionnaire, an inventory of sex toy usage, and validated measures of erotophobia and sexual satisfaction. Comparative analyses (i.e., t-tests, chi-squared) examined the differences in characteristics between individuals who use sex toys and those who do not, while binomial logistic regressions tested the main factors associated with solitary and partnered sex toy usage. Women, younger adults, self-identified virgins, homosexual or bi/pansexual individuals, and those with a history of childhood sexual victimization were more likely to report sex toy use. Sex toy users reported higher sexual satisfaction and lower erotophobia in both solo and partnered contexts than those who had not used sex toys. These findings offer important insights into the characteristics of sex toy users and suggest that further research is needed to understand how individual and sociocultural factors contribute to the relationship between sex toy usage and sexual wellbeing.

The aim of this qualitative study is to describe the experiences of Turkish women with abnormal uterine bleeding (AUB). The study was conducted with 15 women with AUB. The experiences of the women with AUB were categorized into four themes: physical effects, psychological effects, effects on daily life, and effects on marriage relationships and sexual life. It was determined that the women participating the study faced numerous physical, psychological, social issues. The findings highlight the need for treatment and care to go beyond physical symptoms, adopting a holistic approach that considers all aspects of a woman's life affected by AUB.