Scientific Program - Thursday, February 25, 2016

005

Sexual Dysfunction among Women with a History of Childhood Sexual Abuse: The Role of Negative Appraisal of Genital Sexual Arousal and Sexual Shame
Pulverman, C¹; Meston, C¹
1: University of Texas at Austin, USA

Objective: Women with a history of childhood sexual abuse (CSA) are at a higher risk of sexual dysfunction and do not respond to existing treatments as well as non-abused women, suggesting there may be something unique about the presentation of sexual dysfunction in this population. For abused women, genital sensations may become paired with negative affect during the abuse. Therefore the genital arousal that arises during consensual sexual activity might remind a woman of her abuse, impairing her overall sexual response in the present. This study examined women’s appraisal of their genital sexual arousal as a potential mechanism underlying the relationship between history of CSA and sexual dysfunction.

Materials and Methods: Women with (n = 60) and without (n = 46) a history of CSA viewed a 6-minute erotic film and completed an adapted version of the Film Scale (Heiman & Rowland, 1983) by rating their genital arousal sensations on a series of affective words. Sexual function was assessed with the Female Sexual Function Index (FSFI; Rosen et al., 2000) and sexual shame was assessed with the Kyle Inventory of Sexual Shame (Kyle, 2013). A range of sexual function was reported across both groups of women (FSFI abused M = 23.84, SD = 6.21, range 7.60-34.20; FSFI non-abused M = 26.11, SD = 5.07, range 16-35.40).

Results: Negative appraisal of genital sexual arousal was significantly higher in abused women (M = 7.30) than in non-abused women (M = 5.83). In a structural equation model using abuse status as a dichotomous independent variable, negative appraisal of genital sexual arousal partially mediated the relationship between a history of abuse and FSFI total scores (X²(1) = 4.24, RMSEA = .18). Sexual shame was significantly higher in abused women (M = 71.73) than non-abused women (M = 49.64). In a structural equation model, sexual shame fully mediated the relationship between a history of abuse and FSFI total scores (X² (1) = 1.11, RMSEA = .03).

Conclusions: Both negative appraisal of genital sexual arousal and sexual shame help to explain the relationship between a history of CSA and sexual dysfunction. Mindfulness-based sex therapy has been more effective for treating sexual dysfunction in abused women than non-abused women (Brotto et al., 2012), yet the mechanisms underlying this therapy remains unclear. The current results suggest examining appraisal of genital sexual arousal as a potential mechanism of action in mindfulness-based sex therapy treatments for abused women.

Disclosure:

Work supported by industry: no. The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

006

Predictors of Vaginal Sex during Vaginal Pain among Adolescent Women
Hensel, DJ¹; Fortenberry, JD¹
1: Indiana University School of Medicine, USA

Objectives: Vaginal pain is associated with decreased frequency of vaginal sex in adults, yet little research examines this relationship in adolescents. We used daily diaries to prospectively evaluate the emotional and behavioral factors young women’s day-to-day engagement in vaginal sex when they also report vaginal pain.

Material and Methods: Adolescent women (N=385, 14-17 years) completed prospective, partner-specific daily diaries. Two diary measures – any vaginal pain and any vaginal sex (both no/yes) – were used to construct the primary outcome variable: any vaginal sex during vaginal pain (no/yes). Emotional variables were: positive mood and negative mood [both 3-item scales], feeling in love and sexual interest (both single-item), partner support and partner negativity (both 3-item scales). Behavioural factors were: vaginal bleeding (no/yes) and recent vaginal sex during vaginal pain (past week: no/yes). Sequential logistic regression modelled the influence of daily factors on the odds (OR) of vaginal sex during vaginal pain; robust standard errors adjusted estimates for multiple within-subject diaries (Stata; all p<.05). All models controlled for age and relationship length.

Results: Participants reported vaginal pain on 2.1% (N=3422/166,781) of all diary days; 13% (439/3422) jointly involved a report of vaginal sex. Higher sexual interest (OR=2.09), higher partner support (OR=1.79) and recently having vaginal sex during vaginal pain (OR=2.19) predicted higher odds of vaginal sex with pain. Feelings of love for a partner (OR=0.82), higher positive mood (OR=0.86) and vaginal bleeding (OR=0.09) were associated with lower odds of vaginal sex and pain. Age, relationship length, negative mood and partner negativity did not predict vaginal sex.

Conclusions: Adolescent women’s decisions to participate in vaginal sex during vaginal pain are organized in conjunction with different emotional and behavioral factors. The relationships of these factors to developing sexuality has implications for ongoing support of healthy relationship development during adolescence.

Disclosure:

Work supported by industry: no.

007

Medical Student Attitudes, Knowledge, and Comfort Level Related to Patients’ Sexual Health
Ivanova, DK¹; Jones, EA¹; Clayton, AH¹
1: University of Virginia

Introduction and Objective: A crucial aspect of thorough patient care is a sexual health evaluation. A clinician’s knowledge and attitudes towards sexual health topics can limit the collection of relevant sexual history, and impact the outcome of patient care. While it is crucial that medical students are taught how to take an adequate sexual history early in their training, also important is awareness of their attitudes and comfort level discussing sexual health topics with their patients, and identification of areas for improvement. These assessments measured changes in attitudes, comfort level, and sense of knowledge related to human sexuality/sexual medicine across a longitudinal 15-month medical school experience, and informed quality improvements in the curriculum.

Materials and Methods: On-line administration of a sexual health topics assessment prior to initiation of classes (August 2014) in the first year of medical school and following the 15-month systems-based curriculum (December 2015) which includes pre-recorded lectures, in-class role-playing experiences, case-based discussions, patient panels, and senior student/provider dialogues. Aggregate change in medical students’ responses reflecting the role of physicians, attitudes regarding sexual behaviors, opinions about sexual and reproductive situations, level of comfort with sexual issues, knowledge about sexual medicine, and demographics were evaluated to determine programmatic quality and potential modifications/improvements.

Results: The majority of survey participants were white Protestant single individuals who consider themselves as somewhat liberal; half were female. The demographics of the group completing the second survey did not differ from the first group. The students’ comfort level discussing sexual topics generally improved over the interval; however, the most significant increase was in the students’ knowledge in areas such as taking a sexual history, types of birth control, sexually transmitted infections, and explaining sexual health problems. The students’ attitudes towards a variety of sexual topics varied widely, and were relatively unchanged over the interval.

Conclusion: The second sample was representative of the completers of the first survey. A longitudinal educational experience in sexuality/sexual medicine in the pre-clerkship curriculum effects medical students’ comfort level and knowledge, but not their attitudes and opinions.

Disclosure:

Work supported by industry: no. The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

008

Female Pleasure and Orgasm: Results from a U.S. Nationally Representative Survey
Herbenick, D¹; Fu, TJ¹; Dodge, B¹; Baldwin, A¹
1: Indiana University

Objectives: To document, among a nationally representative sample of adult women in the United States, specific techniques related to female sexual pleasure and orgasm.

Methods: A cross-sectional, Internet-based, US nationally representative probability survey of 1,055 adult women. Participants reported on demographic items, specific genital touching techniques perceived as pleasurable, and genital stimulation as it relates to orgasm during intercourse.

Results: Consistent with other nationally representative surveys of American women, about two-thirds of participants reported engaging in vaginal intercourse during the previous year; a similar proportion reported partnered vagina/vulva touching in the past year. About 1 in 5 women reported that vaginal penetration alone is sufficient for their orgasm and 1 in 3 women reported that they need their clitoris to be stimulated in order to experience orgasm during intercourse. Women varied in terms of the type of pressure their preferred for vulva/vagina touching (e.g., about one-third preferred very light touch, another third preferred medium pressure, ~10% preferred firm pressure). There was also noticeable variability in terms of preferred touching techniques with most preferring up and down movements (63%) or circular movements (52%). The clitoris, the skin around the clitoris, and the labia were preferred areas of genital stimulation by a partner. The top sources from which women reported learning pleasuring techniques through self-exploration, replication of partner techniques, or reading erotica/sexy books, watching sexy movies, and watching porn.

Conclusions: There is significant variation in terms of where on their genitals women prefer to be touched, with what kind of pressure, and what motion. These data are relevant to sexual pleasure and orgasm as well as to a growing body of knowledge related to genital sensation and sexuality.

Disclosure:

Work supported by industry: yes, by For Goodness Sake, LLC.

009

An Aggressive Treatment Paradigm for the Treatment of Genito Urinary Syndrome of Menopause (GSM): A Case Series Presentation
Krychman, ML¹; Dweck, A²
1: Southern California Center for Sexual Health and Survivorship Medicine Inc.; 2: Mount Kisco Medical Group, Assistant Clinical Professor Mount Sinai School of Medicine

Introduction: GSM consists of a constellation of symptomatology that encompasses the former term vulvovaginal atrophy. This syndrome which affects the majority of menopausal woman can present with a multitude of symptoms including vaginal and vulvar burning, dysuria, itchiness, bleeding after intercourse or painful sex (dyspareunia).

Methods: A twenty-five subject case-series with diverse medical backgrounds were used from a single site for a prospective study, which implemented an aggressive treatment paradigm to treat genito urinary syndrome of menopause. Moisturizers, lubricants, minimally absorbed local estrogens, intensive dilator programs were all used in tandem to aggressively treat atrophic changes. All patients were evaluated with a detailed history, physical examination and psychosexual assessment by a sexual medicine gynecologist. Patients received either a moisturizer, lubricant or a hybrid product coupled with a detailed 1 on 1 instructional educational counseling session by a trained sexual medical assistant.

Results: 25 women were evaluated and assessed. The average age was  53 (Range  37 to 71). 21 were married, 3 single and 1 divorced.  All women presented with GSM by diagnostic criteria including an abnormal examination and confirmatory elevated PH.  The women had a diverse medical history including 20 with menopause, seven with breast cancer, five with hypothyroidism, 4 with vulvar vestibulitis and 3 with Lichen sclerosis. Fifteen women used a hybrid product including Lubrigyn Cream ® (Hybrid) or Luvena ®. All women used Lubrigyn lotion ® an external wash and mostly all used a lubricant (13 water based users; 4 silicone based products). 11 patients used a vulvar soothing cream (Neogyn ®) and 10 used a moisturizer only (Replens ® or Rephresh®). Seventeen women used a miminally absorbed local hormonal product and one woman was on an oral SERM for moderate to severe dyspareunia a symptom of VVA due to menopause.

92% or 23/25 women were able to achieve pain free intercourse within 3-4 weeks of starting this aggressive vaginal rehabilitation program

Conclusion: Aggressive vaginal rehabilitation includes multiple treatment options including hybrids, moisturizers, lubricants, dilators and vulvar cleansers, and soothing creams. Aggressive use of multiple products while tailoring to the individuals needs can help those women suffering from GSM regain sexual intercourse in a quick and efficient time frame.

Disclosure:

Work supported by industry: no. The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

004

Hymen Protection among Female University Students from Lebanon: Temporary or Chronic Sexual Schizophrenia
El Kak, F¹; Yasmine, R¹; El Salibi, N¹; Ghandour, L¹
1: American University of Beirut, Lebanon

Objectives: Investigate how sexual practices, and values vary among females who were never concerned about hymen protection and those who still are, as compared to females who were initially concerned but then had vaginal sex.

Methods: A cross-sectional online survey was conducted among 1161 female university students (aged 18-30) from Lebanon. 

Results: 416 female students have engaged in oral and/or anal sex, of whom 61% had sexual activity with no intention of protecting their hymen, 21% only engaged in oral and/or anal sex to protect their hymen and 18% were initially concerned about hymen protection but then had vaginal sex. Females who were never concerned about hymen protection were 5 times more likely to be foreign non-Arabs compared to those who were initially concerned but then had vaginal sex (p-value=0.028). Among females who expressed concern in hymen protection, those who had later vaginal sex were 4 times more likely to report being not religious or spiritual (p-value=0.003) and 3 times more likely to be living independently compared to those who were still concerned (p-value=0.025). Adjusting for socio-demographic characteristics, females who eventually had vaginal sex were 3 times more likely to feel they engaged in sexual activities they hadn’t wished for (p-value=0.001) and ever been in a relationship where they felt things were moving too fast physically (p-value<0.0001), compared to females who were concerned about hymen protection. They were also less likely to communicate with their mother/female guardian on sexual matters (p-value=0.046) (versus never concerned). Females who expressed concern in hymen protection were twice more likely to agree that once you have had sex it is harder to say no the next time (p-value=0.011) and 3 times more likely to perceive oral sex as not as big of a deal as sexual intercourse compared to those who were never concerned (p-value=0.001). Besides, females who engaged solely in non-vaginal sex expressed more conservative attitudes related to premarital sex (p-value=0.002) and were twice more likely to feel sometimes guilty about having sexual feeling compared to those who were never concerned (p-value=0.034).

Conclusions: Within the control of the existing patriarchal societies, women, trapped in between their desire to express their sexuality and the pressure to keep family values, still managed to express their sexuality via engaging in alternative sexual practices. Further research is needed to understand the negotiation process in relation to hymen protection among females and how it shapes their sexual practices and health.

Disclosure:

Work supported by industry: yes, by Ford Foundation (industry funding only - investigator initiated and executed study).

003

A Culturally Informed Educational Program to Promote Sexual Health and Well-being Among Refugee Women
Howard, H¹; Johnson-Agbakwu, C²; Michlig, G³; Sisterna, N⁴; Nizigiyimana, J²
1: The Center for Sexual Health and Rehabilitation, USA; 2: Maricopa Integrated Health System, USA; 3: Johns Hopkins University, USA; 4: University of Arizona College of Medicine-Phoenix, USA

Objective: Refugee women may possess unique sexual health vulnerabilities as a result of experiencing cultural practices such as Female Genital Mutilation/Cutting (FGM/C) or sexual violence endemic to war and conflict. Extant sexual health educational programs do not reflect their specific educational and cultural needs. A linguistically appropriate sexual health education initiative was designed to provide information to refugee women and assess their unique needs to inform future culturally grounded interventions.

Material and Methods: A multi-phased mixed-method approach comprising a pilot session, the educational intervention, and a two-month follow-up session were conducted to assess changes in knowledge, attitudes, and sexual behaviour. Educational content was delivered in the respective languages with oral consecutive translation and visual aids. Private quantitative responses to sensitive questions were captured via an Audience Response System (ARS). Statistical analyses were performed in STATA and qualitative content analyses in Nvivo.

Results: Forty-seven adult refugee women comprising 21 Somali speakers and 26 Swahili speakers participated in a sexual health pilot session (n=21; 9 Somali, 12 Swahili), the educational intervention (n=26; 12 Somali, 14 Swahili), and the two-month follow-up session (n=19; 10 Somali, 9 Swahili). Both Somali and Swahili-speaking women requested information regarding infection prevention, low sexual desire, pain and socially undesirable reproductive outcomes. The Somali women reported primary sexual concerns of dyspareunia at first coitus (100%), forceful sex (50%), and difficulty feeling satisfied (33%), possibly as a result of FGM/C. The Swahili-speaking women reported sexual pain (73%), low desire (67%), and sex for survival (56%), against a backdrop of war-related sexual violence. At follow-up they reported positive changes, with Somali women reporting increased self-pleasuring. There was no worsening in reported sexual concerns.

Conclusion: This culturally tailored sexual health educational intervention facilitated greater women’s empowerment, health literacy, and self-efficacy around sexual health concerns. This unique approach supports community capacity-building and has the potential to be adapted for broader use to promote greater cultural competency around sexual health among providers caring for vulnerable populations with limited health literacy.

Disclosure:

Work supported by industry: yes, by Patty Brisben Foundation for Women's Sexual Health (industry funding only - investigator initiated and executed study).

002

Sexual Health and Identity-Related Interactions between Sexual Minority Women and their Healthcare Providers
Baldwin, A¹; Dodge, B²; Schick, V³; Herbenick, D²; Sanders, SA²; Fortenberry, JD⁴
1: California State University Stanislaus, USA; 2: Indiana University, USA; 3: University of Texas Health Science Center at Houston, USA; 4: Indiana University Medical School, USA

Objectives: Previous research suggests that sexual minority women (SMW) are more likely to disclose identity when seeking sexual or reproductive healthcare, and that disclosure of identity to healthcare providers is related to better outcomes and improved quality of care. Little distinction is made between identity groups (e.g. lesbian, bisexual, queer), despite the different barriers, stigma, and health outcomes that exist between them. This research examines the interactions that SMW have with their healthcare providers around sexual identity and health.

Material and Methods: Using a mixed-methods approach through an online survey tool, we gathered both qualitative and quantitative data on clinician-patient interactions around identity, sexuality and health among a sample of (N=354) lesbian, bisexual, queer and pansexual women in the United States. The qualitative and quantitative data were analyzed concurrently, and qualitative themes were quantified and explored through bivariate and regression analysis.

Results: Having to correct the assumption of heterosexuality through identity disclosure was a common negative experience among participants, who described being presumed irresponsible about pregnancy and birth control. Participants also described practitioners who fundamentally misunderstand the myriad possibilities for what “sex” might mean for sexual minority women.

Conclusion: Lesbian, bisexual, pansexual and queer women have different interpretations of their interactions with healthcare providers, different reasons for disclosing identity to providers, and different likelihoods of disclosure. The results of this study speak to ways in which improved clinician-patient interactions can enhance healthcare utilization among SMW. The findings from this study demonstrate the necessity of reprioritizing collecting information on patients’ sexual identities and histories, in order to provide them care as “whole human beings.”

Disclosure:

Work supported by industry: no. The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

001

Mindfulness Facilitates Sexual Arousal among Lesbian, Bisexual, and Heterosexual Women
Dickenson, JA¹; Diamond, LM¹
1: University of Utah, USA

Objectives: Mindfulness has been shown to facilitate sexual arousal among women. Yet, given the dearth of research examining this association among sexual minority women, it remains unclear whether mindfulness facilitates all sexual arousal, or strictly arousal to the preferred gender. Because mindfulness enables awareness of physiological sensations without judgment, mindfulness may facilitate awareness of physiological arousal to both preferred and non-preferred sexual stimuli (Hypothesis 1). How might mindfulness facilitate all forms of sexual arousal? Mindfulness augments parasympathetic activity, which is indicative of greater emotional and physiological regulation (“relax and digest”) and is heightened during sexual arousal. Thus, mindfulness may facilitate sexual arousal through increasing parasympathetic activity (Hypothesis 2).

Materials and Methods: Lesbian, bisexual, and heterosexual women (N=79) completed the Five Facet Mindfulness Questionnaire. Total and subscale scores were calculated. Participants engaged in a 10-minute mindfulness meditation and listened to erotic stories depicting activity with a man or a woman, while their respiratory sinus arrhythmia (RSA) was measured. Participants rated their arousal to each story (preferred and non-preferred sexual arousal) and subsequently reported their sexual arousal over 14 days (trait sexual arousal).

Results: Assessment of Hypothesis 1 indicated that the observe subscale was associated with sexual arousal, regardless of women’s sexual orientation. Individuals with a greater tendency to notice internal and external sensations showed higher levels of trait sexual arousal and preferred and non-preferred sexual arousal. Assessment of Hypothesis 2 examined whether the relation between the tendency to observe internal and external sensations and experiencing greater sexual arousal over the 14-day period was mediated by greater RSA reactivity. Coefficients of regression analyses (using SPSS 20.0) were entered into a Sobel Test online calculation tool (quantpsy.org). Results indicated that RSA during mindfulness meditation significantly mediated the relation between the observe subscale and trait sexual arousal.

Conclusions: Results suggest that for lesbian, heterosexual, and bisexual women, mindfulness, particularly the tendency to observe sensations, augments various forms of arousal through parasympathetic activity. These have important implications for basic understanding and clinical application of female sexual arousal.

Disclosure:

Work supported by industry: no.