Scientific Program - Sunday, February 28, 2016

033

Sexual Diversity in the United States: Results from a Nationally Representative Survey
Herbenick, D¹; Dodge, B¹; Bowling, J¹; Sayegh, MA¹; Sanders, SA¹
1: Indiana University

Objectives: To document, among a nationally representative sample of adult women and men, a broader range of adults’ sexual behaviors and interests.

Methods: A cross-sectional, Internet-based, US nationally representative probability survey of 2,021 adult women (n = 1046) and men (n = 975). Participants reported on demographic items, lifetime and recent sexual behaviors, and rated the appeal of 50+ sexual behaviors.

Results: Most participants (>80%) reported lifetime masturbation, vaginal sex, and oral sex. Lifetime anal sex was reported by 43% of men (insertive) and 37% of women (receptive). Common lifetime sexual behaviors included wearing sexy lingerie/underwear (75% women, 26% men), sending/receiving digital nude/semi-nude photos (54% women, 65% men), reading erotic stories (57% of participants), public sex (≥43%), role-playing (≥22%), tying/being tied up (≥20%), spanking (≥30%), and watching sexually explicit videos/DVDs (60% women, 82% men). Threesomes (10% women, 18% men) and playful whipping (≥13%) were less common. Lifetime group sex, sex parties, taking a sexuality class/workshop, and going to BDSM parties were uncommon (<8%). More Americans identified many behaviors as “appealing” than had engaged in them. Romantic/affectionate behaviors were among those most commonly identified as appealing.

Conclusions: Findings add to our understanding of more diverse U.S. adult sexual behaviors and the appeal of a range of sexual behaviors. For practitioners and providers, this information may assist in meeting the needs of diverse populations including improved information exchange and educational efforts.

Disclosure:

Work supported by industry: no.

028

Sexual Cognitions in the Real World: Quantifying and Comparing Sexual Self-Schemas in a Large Online Sample
Stanton, A¹; Boyd, R²; Meston, C¹
1: The University of Texas at Austin, USA; 2: The University of Texas at Austin, USA

Introduction: In a recent study, the meaning extraction method (MEM; Chung & Pennebaker, 2008), an advanced computerized text analysis technique that extracts themes from natural language, was used to analyze women’s sexual self-schemas (Stanton, Boyd, Pulverman, & Meston, 2015). Participants completed open-ended essays about their personal feelings associated with sex and sexuality in the laboratory. Seven unique themes relevant to sexual self-schemas were extracted from these essays: family and development, virginity, abuse, relationship, sexual activity, attraction, and existentialism. The present study compares the themes extracted from the expressive essays written in the laboratory with themes that were extracted from posts on sex-related boards of a large online forum. Furthermore, Stanton and colleagues (2015) observed significant differences in sexual self-schemas based on sexual abuse history; non-sexually abused (NSA) women were more likely than women with histories of childhood sexual abuse (CSA) to invoke the virginity and the relationship themes in their sexual self-schemas, while CSA women were more likely to invoke themes of abuse and attraction than their non-abused counterparts. The present study also compares the differences in sexual self-schemas between NSA women and women with a history of CSA that emerged in the laboratory setting with those that emerged in the online forum.

Objectives: (1) To compare sexual self-schemas extracted from real-world online forums to sexual self-schemas that were extracted from expressive writing samples in a laboratory study; (2) to compare the differences in sexual self-schemas between NSA and CSA in the laboratory study to differences in sexual self-schemas in the online forum.

Materials and Methods: Sexual self-schemas were assessed via the MEM in 6,089 online posts across four different sex or sexual-abuse relevant online forums.

Results: The seven original sexual self-schema themes determined by Stanton and colleagues (2015) were validated, and several new themes emerged. As in the laboratory study, posters in non-abuse specific forums were more likely than posters in the abuse-specific forums to invoke the virginity theme (F = 20.947, p < .000, η² = .003). Similarly, posters in the abuse-specific forum were more likely than posters in the non-abuse specific forums to invoke the theme of abuse (F = 2833.272, p <.001, η² = .318) and the theme of attraction (F = 8.579, p = .003, η² = .001). Effect sizes ranged from small to large.

Conclusions: Sexual self-schemas have been studied extensively in the laboratory, but they have never been studied in a large online sample. To our knowledge, these results provide the first empirical examination of sexual cognitions in the real world.

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.

029

Prevalence of Sexual Difficulties among Premenopausal Women: A Systematic Literature Review and Meta-Analysis
McCool, M¹; Zuelke, A²; Theurich, M³; Knuettel, H⁴; Ricci, C⁵; Apfelbacher, C¹
1: University of Regensburg, Germany; 2: Friedrich Schiller University of Jena, Germany; 3: Ludwig Maximilian University of Munich, Germany; 4: University Library of Regensburg, Germany; 5: Internationa Agency for Research on Cancer, France

Objective(s): To provide an estimate of the prevalence of sexual difficulties among premenopausal women worldwide

Material and Method(s): Observational studies which assessed the prevalence of sexual difficulties among premenopausal women in the general population were systematically sought in relevant databases (Jan 2000-July 2014). Publications which reported the prevalence rate for at least one sexual difficulty were included. A meta-analysis of prevalence rates was performed as well as stratification by factors of study design.

Result(s): After screening 9292 results, 440 publications were retrieved for full text review. Of these, 135 studies were included in the systematic review. Wide ranges of prevalence were found in the literature: sexual desire difficulties 6% to 70%, sexual aversion 5% to 24%, sexual arousal difficulties 1% to 60%, lubrication difficulties 1% to 53%, orgasm difficulties 8% to 72%, and coital pain 1% to 72%. The meta-analytical estimate of included studies showed that 40.9% of premenopausal women report sexual difficulties (95% CI: 37.1;44.7, I²=99.0%). Prevalence estimates of the individual sexual difficulties ranged between 20.6% (lubrication difficulties) and 28.2% (sexual desire difficulties). Further subgroup analyses showed significantly higher prevalence rates of sexual difficulties in Africa; studies performed in countries with gender-equal sexual regimes had significantly lower rates of sexual difficulties. Higher rates of sexual dysfunction were reported in studies which used interviews and questionnaires together to collect data. The validity of the assessment tool was examined, resulting in significantly higher prevalence rates in studies using non-validated tools. Prevalence rates in studies with pharmaceutical funding were lower in all domains – in some cases, significantly lower. No evidence for publication bias could be indicated through Begg’s rank correlation test and Egger’s correlation test.

Conclusion(s): Individual prevalence rates of female sexual difficulties vary substantially, worldwide. Meta-analytical estimates show that 2 out of 5 premenopausal women report sexual difficulties, posing a substantial public health problem. Still, more research and improved standardization are needed in this field.

Disclosure:

Work supported by industry: no.

030

Which are the Male Factors Associated with Female Sexual Dysfunction (FSD)?
Maseroli, E¹; Fanni, E¹; Mannucci, E¹; Fambrini, M¹; Jannini, EA²; Maggi, M¹; Vignozzi, L¹
1: University of Florence, Italy; 2: Tor Vergata University of Rome, Italy

Objectives: It has been generally assumed that partner’s erectile dysfunction (ED), premature (PE) and delayed ejaculation (DE) play a significant role in determining Female sexual dysfunction (FSD). The present study aimed to evaluate the role of perceived male partner’s sexual function in determining FSD.

Material and Methods: A consecutive series of 156 women consulting our clinic for FSD between January and December 2014 was retrospectively studied. All patients underwent a structured interview and filled out the Female Sexual Function Index (FSFI).

Results: No significant association was observed between FSFI total score and cardiovascular risk factors or investigated metabolic parameters. When relational parameters were evaluated, FSFI total score decreased as a function of partner’s age, conflicts within the couple, a relationship without cohabitation and the habit of engaging in intercourse to please the partner (p<0.05); FSFI total score increased as a function of frequency of intercourse, attempts to conceive and fertility-focused intercourse (p<0.05). FSFI total score showed a negative, stepwise correlation with partner’s perceived hypoactive sexual desire (HSD) (r=-0.327; p<0.0001), whereas no significant correlation was found between FSFI and ED, PE or DE. In an age-adjusted model, partner’s HSD was negatively related to FSFI total score (Wald=9.196, p=0.002), and arousal (Wald=7.893, p=0.005), lubrication (Wald=5.042, p=0.025), orgasm (Wald=9.293, p=0.002), satisfaction (Wald=12.764, p<0.0001) and pain (Wald=6.492, p=0.011) domains. Partner’s HSD was also significantly associated with somatized anxiety, low frequency of intercourse, low partner’s care for the patient’s sexual pleasure and with a higher frequency of masturbation, even after adjusting for age (p<0.05). In patients not reporting any HSD, FSFI total score was significantly lower when their partner’s libido was low (p=0.041); the correlation disappeared if the patient also experienced HSD.

Conclusions: Partner’s performance during sexual intercourse is not a main determinant of FSD; conversely, women’s sexuality is mostly impaired by the perceived reduction of their partner’s sexual interest.

Disclosure:

Work supported by industry: no.

031

The Impact of Mastectomy Type on the Female Sexual Function Index (FSFI) and Parameters of Intimacy such as Appearance, Satisfaction, and the Breast’s Role in Intimacy
Rojas, K¹; Raker, C¹; Onstad, M ²; Kunkel, E³; Clark, M ⁴; Stuckey, A¹; Gass, J ¹
1: Women & Infants' Hospital/Brown University, USA; 2: MD Anderson Cancer Center; 3: Perelmen School of Medicine at the University of Pennsylvania; 4: Warren Alpert Brown School of Medicine

Objective: We have previously demonstrated that parameters of intimacy such as appearance, satisfaction, and the preservation of the breast’s role in intimacy in breast cancer patients were significantly positively associated with a higher median Female Sexual Function Index (FSFI). In this study, we sought to explore the impact of mastectomy type on these parameters and FSFI.

Material and Methods: A cross-sectional survey with a retrospective chart review included patients at least one year from primary breast cancer surgery. The survey included the FSFI, seven investigator generated questions focusing on the operated breast during intimacy, and seven demographic questions. Sexual dysfunction was identified as an FSFI score <26.55. The survey questions were compared using Chi-square and Kruskal-Wallis tests. Demographic information, tumor type, treatment course, and survey responses between three mastectomy groups: simple/modified radical (TM), skin-sparing (SSM), and nipple-sparing (NSM) were compared.

Results: Two hundred sixty-eight patients participated. Median age was 57 (range 30-93); 77.2% of respondents were post-menopausal. Thirty eight patients (46.3%) had TM, 36 (44.4%) had SSM, and 8 (9.8%) had NSM. Satisfaction with appearance of the chest postoperatively was not significantly different between groups. Sixteen of the 38 TM patients (42.1%) and all SSM and NSM patients were reconstructed. Those who underwent SSM had significantly greater FSFI satisfaction domain scores (median 5.20) than women who underwent TM with reconstruction (median 4.40) or NSM (median 4.80) (p=0.005). There was a decrease in the importance of the role of the chest in sex and intimacy in surgical groups pre- and postoperatively; and this was more dramatic in the TM group (89.2% to 58.8%) when compared to SSM and NSM combined (93.3% to 77.8%) (p=0.09).

Conclusions: Patients who underwent SSM did have significantly higher satisfaction domain scores of the FSFI. Interestingly, there was no significant difference in patient satisfaction with appearance of the chest between mastectomy groups. TM patients did have a more dramatic decrease in the importance of the chest pre- and postoperatively but this did not reach significance. Surgeons may consider these outcomes when setting expectations with patients regarding surgical treatment. However, given our small numbers, the impact of the preservation of the nipple specifically remains to be further investigated.

Disclosure:

Work supported by industry: no.

032

Effects of Pornography Use on the Couple Relationship: Results of “Bottom-Up,” Participant-Informed, Qualitative Research
Fisher, W¹; Kohut, T¹; Campbell, L¹; Montgomery Graham, S¹
1: Western University, Canada

Objective: Considerable research has emerged concerning effects of pornography on couple relationships. “Top-down” close-ended quantitative investigations have targeted a limited number of primarily harm-focused effects for study. A small body of qualitative research offers tantalizing glimpses of potential effects that have been overlooked in “top-down” close-ended quantitative research. The aim of the current “bottom-up” participant-informed, qualitative research was to identify a range of participant reported effects of pornography use on couple relationships that have been overlooked in “top-down,” close-ended, quantitative studies.

Materials and Methods: An online survey recruited men (n = 219) and women (n = 211) who were currently in a heterosexual relationship where at least one partner had experience with pornography use. Open-ended questions probed participants’ perceptions of the impacts that their solitary pornography use, their partners’ solitary pornography use, and/or their shared pornography use, has had on their relationships. Responses were analyzed using Thematic Analysis (Braun & Clarke, 2006).

Results: Thematic Analysis identified 66 distinct themes related to impact of pornography use on the couple relationship. The most common reported effect of pornography on the couple relationship was “no negative effect,” and reported positive effects including “source of sexual information,” “increased sexual experimentation,” “improved sexual communication,” and “enhanced couple intimacy” predominated, together with less frequently reported negative effects of pornography, including “created unrealistic expectations” and “sexual insecurity.”

Conclusions: In “bottom-up” participant-informed, qualitative research pornography consumers and their partners reported a broad range of perceived effects of pornography use on their relationships including, modally, “no negative effects,” and predominantly positive effects. These salient reported effects may contribute to shaping the direction and focus of research in this area.

Disclosure:

Work supported by industry: no.

034

FC2 Dual Protection Non-Hormonal, Latex Free Female Condom
Faught, B¹; Goldstein, I²; Martens, M³; Rodriguez, K⁴; Ostrowski, S⁴; Levin, L⁴
1: Women’s Institute for Sexual Health; 2: Alvarado Hospital; 3: Jersey Shore University Medical Center, Rutgers-Robert Wood Johnson School of Medicine; 4: The Female Health Company

Objectives: Use of male condoms for contraception and STI protection can be associated with a lack of control for women, decreased pleasure for women and their sexual partners, and negative reactions to latex. The objective of this study was to survey and interview women with regard to use of the only FDA and WHO approved class III medical device, the FC2 Female Condom. The FC2 has the dual indication for preventing pregnancy and HIV/AIDS and other STIs.

Materials and Methods: This study involved an online survey and was conducted on two all women audiences. The first audience were condoms/short term hormonal contraceptive users who volunteered to switch to FC2 during a 6-month trial period. The second audience was independent online purchasers of the FC2. Fifteen responses came from the independent purchasers and 19 came from the focus group participants.

Results: Respondents identified as 67% Caucasian, 9% Hispanic or Latino, 9% Black, 6% American Indian or Alaskan Native, 6% Asian and 3% did not want to identify. Independent purchasers were age 25-64, and focus group respondents were age 22-45. Thirty-two percent were single, 59% were in a long term relationship, and 9% were married. Of the questions asked, women responded positively to, “Overall how well did you like the FC2 female condom?” (71 %); positively or neutrally to, “How easy was it to use the FC2 female condom?” (82%). Among attributes respondents agreed with were: “Is an effective form of contraception” (85%); “Allowed me to take control of my own protection” (79%); “Made me feel protected” (71%); “Made me feel good about my contraceptive choice”(65%); “Stays in during sex” (62% positive and 29% were neutral); “Improved the feeling/pleasure of sex” (21% with 32% neutral); “Felt more natural for my partner than male condom” (41%); and “Allowed spontaneity” (47%). Forty-seven percent of survey respondents reported purchasing FC2 multiple times, 47% would buy it again within 6 months, and 82% would recommend it to others.

Conclusions: While barrier contraceptives are most often used by males, the FC2 Female Condom offers an internal female condom that provides a non-hormonal, latex free option for dual protection against HIV/STI’s and unplanned pregnancy. This study indicated a positive acceptance by a majority of women, and counseling regarding its indications and availability should be provided in discussions with female patients.

Disclosure:

Work supported by industry: no.