When and why are difficulties with sexual functioning distressing to women? : building a contextual model of sexual dysfunction



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Recent research suggests that, while up to 58% of women may experience significant difficulties with sexual function, only a third of these difficulties are associated with clinically relevant levels of subjective distress, suggesting a complex relationship between these two factors. We have relatively little understanding as to when sexual difficulties are distressing to women and why some difficulties are distressing while others are not. The current project aimed to begin answering these questions in a number of ways. First, I attempted to replicate previous findings regarding moderators of the association between sexual function and subjective distress. Second, I attempted identify the behavioral and cognitive mechanisms through which sexual impairments cause distress. Participants were 87 adult women from the local community who reported recurrent impairments in sexual function in the past month, and who were currently in sexually-active heterosexual relationships. Participants completed in-person diagnostic interviews and validated self-report measures before completing four weeks of daily online questionnaires assessing their sexual and relational experiences. Results provided additional support for previously identified moderators including relational satisfaction, age, and history of childhood sexual abuse. Additionally, a number of factors mediated the association between sexual function and distress within individuals over time. Specifically, a majority of the statistical effect of sexual function on subjective distress was accounted for by the degree to which impaired sexual function decreased the physical pleasure experienced by the individual during sexual activity. Other consequences of impaired sexual function such as decreased frequency of sexual activity and negative emotional reactions by the partner did not mediate this association. These findings add to theories of sexual dysfunction by taking into account the important ways in which sexual impairments play out in the context of romantic relationships. The results also may explain mechanisms through which current treatments for sexual dysfunction decrease sexual distress, potentially improving our ability to focus interventions on the factors that are of greatest importance to patients.