Sleep disturbances and sexual dysfunction are among the most prevalent and burdensome symptoms experienced during the menopausal transition. Although emerging evidence suggests these domains may be interconnected, their relationship has not previously been systematically synthesized. This systematic review examines associations between sleep disturbances and sexual dysfunction among peri- and postmenopausal women. Across the 10 included studies, insomnia symptoms, reduced sleep duration, poor sleep quality, and obstructive sleep apnea were consistently associated with worse overall sexual functioning. Findings for other sexual function domains (desire, arousal, interest, libido, and orgasm) and vaginal symptoms were more variable. Evidence supports a meaningful association between poor sleep and sexual dysfunction during and after the menopausal transition. Future longitudinal and intervention studies are needed to clarify mechanisms, establish directionality, and determine whether interventions targeting one domain may improve outcomes in the other in menopausal populations.
Heart failure (HF) is a chronic condition with a steadily increasing prevalence that significantly reduces patients’ quality of life, with women experiencing a greater psychosocial burden and poorer quality-of-life indicators than men. One of the insufficiently recognised areas of functioning in this population includes sexuality, body image perception, and partner relationships, despite the fact that these are integral components of health and overall well-being. The aim of this review was to present the current state of knowledge regarding sexual functioning, body image, and satisfaction with partner relationship in women with heart failure, as well as to identify significant research gaps and clinical implications. Sexual dysfunctions are highly prevalent among women with HF and involve reduced sexual desire, difficulties with arousal, lubrication, and orgasm, as well as pain during sexual activity. The key aspects limiting sexual activity include fatigue, dyspnoea, fear of disease exacerbation or death during intercourse, adverse effects of pharmacotherapy, and a negative body image, which may be amplified by somatic symptoms, menopause, and the presence of implantable cardiac devices. The topic of partner relationships and intimacy remains poorly explored. However, available data indicate changes in relationship roles and the importance of adaptive strategies to maintain intimacy. A significant issue is the lack of systematic sexual counselling in cardiovascular care. Sexuality and partner relationships in women with heart failure require greater clinical attention and an interdisciplinary approach that addresses both the somatic and psychosocial aspects of the disease. Sexual dysfunction is highly prevalent in women with heart failure, affecting desire, arousal, lubrication, orgasm, and satisfaction. Fear of cardiac events during intercourse and absent medical counselling are primary barriers to sexual activity in women with heart failure. Disease symptoms, pharmacotherapy side effects, and negative body image significantly impair sexual well-being. Heart failure may shift partner relationships toward caregiving dynamics, reducing intimacy and relational satisfaction. Sexual health assessment should be integrated into routine cardiovascular care for women with heart failure.
This review examines recent advances in animal models of same-sex preference, focusing on: (1) the biological factors underlying its development, (2) the experimental paradigms used to measure it, and (3) its neurobiology. Recent research has identified several developmental factors contributing to the establishment of same-sex preference, including prenatal stress, aromatase inhibition, maternal immune responses, and order of birth effects. Specific brain circuits controlling sex preference are beginning to be established. Despite these significant advances, methodological limitations remain a major challenge, particularly in how sexual preference is assessed. Sexual preference is defined as the choice of a sexual partner of a specific sex. Animal models are useful for investigating the biological bases of sexual preference. These animal models may reproduce key developmental processes that organize brain circuits controlling partner selection. However, accurately and quantitatively assessing sexual preference remains a challenge. Future progress requires paradigms that capture the multidimensional, context-dependent, and qualitative dimensions of partner preference, thus providing a more comprehensive and biologically grounded understanding of sexual diversity.
Sexual health after breast cancer has often been framed through a dysfunction-oriented lens, with survivorship commonly understood in relation to symptoms, functional impairment, and risk management. Although sexual difficulties are widely documented, sexual pleasure remains comparatively underexamined within breast cancer survivorship research. This narrative integrative review examines how sexual pleasure is shaped and renegotiated following breast cancer treatment, moving beyond symptom-based and deficit-focused models of sexuality. Across multidisciplinary literature, four interrelated processes were identified: embodied changes associated with treatment and menopausal symptoms, disruptions in body image and sexual self-concept, relational dynamics within intimate partnerships, and sociocultural conditions shaping the legitimacy and expression of pleasure. Evidence suggests that improvements in sexual functioning alone are often insufficient to restore pleasurable sexual experience. Instead, pleasure appears to be shaped by relational safety, meaning-making, emotional connection, and broader cultural context. Sexual pleasure after breast cancer is best understood as a dynamic, context-dependent process shaped by embodied, relational, and sociocultural factors. This review advances a pleasure-centred perspective on survivorship sexuality that extends beyond dysfunction-focused approaches and highlights the importance of supporting meaningful and pleasurable sexual well-being within survivorship care.
Sleep disturbances and sexual dysfunction are highly prevalent during the menopausal transition. Although traditionally both conditions are linked to hormonal decline and vasomotor symptoms, growing evidence highlights the central role of pre sleep cognitive activity (PSCA) in sleep disturbances, including rumination, worry and intrusive thoughts. Disruption of circadian rhythms further intensifies sleep fragmentation, with consequences for cognition, mood and sexual function. This review synthesizes current evidence on cognitive hyperarousal in menopausal women by integrating hormonal, circadian and psychosocial mechanisms, and examines implications for sleep and sexual health. A narrative synthesis across cognitive science, sleep medicine, neuroendocrinology and chronobiology suggests that PSCA, contributes meaningfully to insomnia during menopause. Evidence indicates that PSCA may interact with vasomotor symptoms and circadian irregularities, amplifying vulnerability to persistent sleep disruption. These sleep related mechanisms can influence sexual health through pathways involving hormonal fluctuation, fatigue and cognitive intrusiveness. Cognitive based interventions, including CBT I, mindfulness and selected cognitive techniques, such as imagery distraction, paradoxical intention and the cognitive shuffle, have shown efficacy in reducing PSCA and improving sleep continuity. Although these approaches hold promise, menopause specific adaptations and targeted evaluations remain limited in the current literature in respect of sexual health. Addressing cognitive hyperarousal and circadian disruption offers an opportunity to complement traditional pharmacological approaches for menopausal insomnia. Integrated non-pharmacological strategies may improve sleep quality, circadian alignment and sexual health in midlife women. Future research should prioritize the development of menopause specific cognitive circadian models, objective assessments of PSCA and scalable digital interventions tailored to this population.
Vaginal dryness is a common adverse effect from hormone suppression therapy in female breast cancer survivors. While vaginal estrogen cream is the first-line therapy for genitourinary syndrome of menopause (GSM), concerns about increasing recurrence risk make its use controversial among breast cancer patients. Hyaluronic acid (HA) vaginal therapy has shown comparable efficacy to topical estrogen therapy in managing GSM, but limited research exists on its use in cancer survivors. To address this lack in evidence, this review asks: among female patients who experience vaginal dryness associated with menopause, breast cancer treatment, or endometrial cancer treatment, does HA vaginal therapy alleviate vaginal dryness or improve sexual function? Studies demonstrated topical HA vaginal therapy to have comparable efficacy with estrogen therapy for managing GSM and supported HA vaginal therapy as a safe and effective treatment for vaginal dryness and dyspareunia among breast and endometrial cancer survivors. Topical HA vaginal therapy is an effective alternative to estrogen therapy for managing vaginal atrophy and dyspareunia associated with menopause, breast cancer treatment, and endometrial cancer treatment, and is an appropriate alternative treatment for patients in whom hormonal therapy is contraindicated or not preferred. These conclusions highlight the potential of HA vaginal therapy in addressing oncology treatment-related vaginal dryness and support further research on its role in survivorship care and sexual health.
To evaluate the impact of kidney transplantation on sexual function in men and women. A narrative review of the literature was conducted using PubMed in May 2025, including studies published between January 2000 and December 2024 that assessed sexual function before and after kidney transplantation using validated instruments such as the International Index of Erectile Function (IIEF) and the Female Sexual Function Index (FSFI). Of the 155 articles identified, nine studies involving 457 patients were included. Most studies reported an improvement in sexual function after transplantation, sometimes as early as three months post-transplantation. In men, IIEF-5 scores increased by an average of 5 to 7 points, with improvement reported in up to 78
Female sexual dysfunction (FSD) frequently co-occurs with urinary incontinence (UI) and substantially impacts quality of life for women. Pelvic floor muscle (PFM) dysfunction is increasingly recognized as a physical link between these conditions, yet research and clinical care often address UI and FSD in parallel rather than as connected phenomena. This narrative review synthesizes recent evidence on PFM performance in women with UI and FSD, as well as conservative interventions targeting the PFM and surrounding tissues through medical management and pelvic floor physical therapy. Most studies focus narrowly on PFM strengthening and rely on patient-reported outcomes, limiting insight into specific PFM deficits related to specific FSD or UI presentations. The authors propose a framework connecting discrete PFM performance impairments to specific FSD and UI presentations, offering a theoretical rationale that can serve to guide clinical care and research. Future studies should focus on PFM assessment of all components of performance with specific treatment related to dysfunctions to advance precision pelvic floor care.
Palliative care applies a holistic, person-centered approach to pain and symptom management for health-related suffering up to the end of life. But, it often excludes sexuality, despite its continued importance to patients and their intimate partners. This review identifies gaps and suggests future directions for research and practice. Sexuality is important for patients receiving palliative care, even toward end of life. Patients are willing to discuss sexuality but would prefer healthcare professionals to introduce the subject. Healthcare provider attitudes, discomfort, and insufficient training affect their ability to effectively discuss sexuality, which may also uniquely result in discriminatory care for sexual and gender diverse people. Research gaps include self-sexuality, kink, consensual non-monogamy, sex work, and strengths-based approaches. From the existing literature, we propose an intersectional sex-positive approach to palliative care that is person-centered and strengths-based. This requires a cultural shift in palliative care practice, where addressing sexuality is seen as important and routine, patients’ sexuality is facilitated, and palliative care teams integrate sex therapists and sexual and gender diverse community resources into their practice.
Purpose of Review: The purpose of this review was to summarize the evidence about the association between romantic love and sexual frequency. We outlined what has historically been thought about romantic love and sexual frequency as well as the latest theoretical and empirical contributions to this area of research. Recent Findings: There have been three published articles that consider sexual frequency in a sample of participants experiencing romantic love. All are drawn from the same international sample: the Romantic Love Survey 2022. A number of publicly available studies not yet published also exist using this sample. Summary: It appears that young adults in love report having sex 3.5 times per week on average, but there was substantial variation in sexual frequency in this sample. This is meaningfully higher than sexual frequency found in the married/cohabiting American population.
Transgender and gender diverse (TGD) individuals experience disproportionate mental health burdens compared to cisgender heterosexual, lesbian, gay and bisexual populations. The Gender Minority Stress and Resilience (GMSR) framework explains how systemic prejudice drives these disparities. Our narrative review synthetizes recent expansions of the model, including novel psychological mediators, integrative frameworks and criticisms. The literature underscores the complex, socially embedded relationships between GMSR factors and mental health. Moreover, the distress related to gender incongruence may be reconceptualized as emerging from dynamic transactions between the social settings and the individual. Social invalidation, rejection and non-affirmation of gender identity in the developmental age can also impact wellbeing as forms of Gender Minority Stress. Attributing mental health challenges to internal identity processes needs to shift toward systemic invalidation as a key driver, centering the diversity of TGD experiences, beyond narratives of suffering, as positive journeys of gender affirmation.
Orgasm is often associated with pleasure and is highly sought after in sexual experiences. Orgasm is also positively associated with sexual wellbeing, particularly among women. This review provides an overview of the interpersonal context of cisgender women’s orgasm experience, with a particular focus on relevant literature in the past five years. It includes an overview of the orgasm gap, key theoretical models for understanding women’s orgasm experiences, including orgasm difficulties, and relevant interpersonal and partner correlates. Research on the impacts of orgasm difficulty on cisgender women’s partners will also be discussed. Cisgender women’s orgasm is positively associated with their own sexual and relationship wellbeing. Yet, the orgasm experiences of women are quite variable between women, and across sexual encounters for the same woman. In addition, a significant orgasm gap exists between cisgender women (who have sex with cisgender men), and cisgender men (who have sex with cisgender women), where women experience orgasm less consistently than men. These differences are not biological in nature; rather, they are best explained by sociocultural and interpersonal factors. Sexual communication and sexual behaviours that stimulate a woman’s clitoris are important predictors of women’s orgasm. Women also report orgasm more frequently with partners who are more familiar to them (in part due to greater sexual communication, and greater engagement in sexual activities that include direct clitoral stimulation). Women are least likely to orgasm when partnered with cisgender men. Overall, this review highlights that sociocultural and interpersonal factors are important predictors of cisgender women’s orgasm. Despite the important role of the partner, dyadic research is scarce. Future research and treatment should include both women with orgasm difficulty and their partners.
Current definitions of premature ejaculation (PE) include three concepts: ejaculation upon minimal stimulation, commonly defined by a short ejaculation latency (EL); a lack of ability to delay or postpone ejaculation; and negative consequences related to distress, bother, or concern. However, consensus regarding the role of ejaculation latency (EL)—and more specifically, an EL threshold—in the definition and diagnosis of PE is lacking. In this paper, we consider four aspects of this diagnostic criterion: (1) the value of, but problems with, the concept of EL as a diagnostic criterion for PE; (2) the challenge of operationally defining a specific EL threshold for diagnosing men with PE; (3) the use of EL criteria in research and intervention studies; and (4) the practice and use of the EL diagnostic criterion by clinicians in their decision to treat men who presumably have PE. We examined measurement validation and highlight that neither EL nor a specific EL threshold has undergone adequate validation using standardized procedures. We then reviewed a number of studies that have used different methods to establish ELs in men with PE, noting not only the substantial variation in average ELs across studies but also how specific methodologies—some of which are more consistent with standard validation procedures than others—account for this variation. We further reviewed the use of EL criteria in research and intervention studies over the past 15 years, and conclude with a short survey that delineates clinicians’ perspectives regarding the use and value of EL in determining both their decision-to-treat men with PE and their corresponding evaluation of successful treatment. This four-pronged analysis concludes that EL is an imprecise measure of “ejaculation in response to minimal stimulation” and should be used with caution; that validating evidence supporting the use of the 1 min criterion for PE has not been adequate; that the majority of studies using accepted procedures for criterion validation supports average ELs for men with PE in the neighborhood of 0–2 min; that research and clinically-based treatment studies generally extend ELs for men with PE well beyond the purported 1-min threshold; and that clinicians tend to use EL as a guideline rather than a rigid diagnostic criterion. The paper ends with an overall conceptualization and contextualization of EL in the diagnosis and treatment of men with PE.
This article purposes to understand the socio-cultural meanings constructed around the body and the relationship between body image and constructions of gender, sexuality and identity, and to reflect on the contribution of biomedical dynamics and contexts to the representation of the body of people intersex with genital modifications. The article finds that both alternatives—modification and non-modification of bioanatomy—require further reflection on the key issues related to the body in healthcare for intersex people. Among the participants, the body image is more compromised, and they have more difficulties in constructing an identity; the negative consequences of genital interventions hinder the experience of satisfying sexuality. Internalization of the normative ideal of 'normal' physicality permeates the physical self-concept and influences the subject's affective-erotic sexual life, the integration of physical difference into identity, and the possibility of developing a positive relationship with one's own body. The body is central to human subjectivity; it is intimately linked to sexuality, gender, identity and health. The body image construction of intersex people with genital variations is poorly documented. A qualitative study based on an analytic-interpretive approach involving twenty-one intersex people aged sixteen to forty-nine, all with genital variations at birth, eighteen of whom had undergone genital surgery, while three had not. A general, sexual and health data form, an in-depth interview guide and a projective psychological test were used as data collection instruments. All ethical aspects were considered together along with a gender anthropological interpretation.
Women and men in the League of Arab States (LAS) face significant barriers in accessing comprehensive sexual and reproductive health (SRH) information due to cultural taboos, gender inequality, and structural limitations within health and education systems. Despite increasing global recognition of the importance of SRH education, interventions in the LAS remain fragmented and under-evaluated. This scoping review aims to identify, describe, and appraise existing interventions addressing SRH education-related outcomes across LAS countries, with a focus on assessing their effectiveness, limitations, and areas for future research and policy development. Fourteen studies met inclusion criteria, representing diverse interventions including school-based, community-led, peer-supported, mHealth, and clinical-provider-based approaches. While many interventions demonstrated improvements in SRH knowledge and attitudes, significant barriers such as provider stigma, lack of parental and community support, and gender-based restrictions persist. Gaps remain in addressing the needs of marginalized populations, including refugees and LGBTQ + youth, and few studies report long-term behavioral outcomes. Effective SRH education interventions in the LAS require culturally sensitive, inclusive, and sustainable models integrated within health and education systems. Future research and policy should prioritize long-term evaluations and target underserved populations to ensure equitable access to SRH education and services.
We review the methodological issues, controversies, and main findings from the sexual offense treatment program (SOTP) outcome literature through a meta-meta-analysis (MMA) of SOTP meta-analyses with sexual offense recidivism as the primary outcome variable. The results of MMA of 21 meta-analyses demonstrated a broad treatment effect for the reduction of sexual recidivism relative to comparison controls by approximately 33
This paper reviews outcomes for risks and benefits of puberty blockers and gender-affirming hormones for pediatric gender dysphoria or gender-related distress. Studies conducted over the past 15–20 years have generally reported the effects of these interventions on bone health, metabolic outcomes, and mental health outcomes. With respect to mental health outcomes, individual clinical research studies have inconsistently demonstrated benefit. Systematic evidence reviews, which provide high-level, reliable evidence according to evidence-based medicine (EBM) principles, have found the evidence in this field is comprised of studies with significant quality issues; the body of evidence is considered weak/uncertain. Clinical guidelines should be updated to reflect the reality of the limited evidence.
The aim of this narrative review is to retrieve, summarize, and synthesize qualitative and quantitative peer-reviewed research on bondage/discipline, dominance/submission, and sadism/masochism (BDSM) within technology-mediated sexual interactions (TMSI) published since 2007. Research findings suggest that TMSI, such as sexting, cybersex, and avatar sex, are relatively widespread experiences. Separate research indicates that BDSM has become more prevalent over time. People may use TMSI for BDSM, especially during an exploratory phase of sexual development. The online disinhibition effect posits that interactions via technology result in reduced inhibitions because of characteristics present in technology-mediated interactions that are not present in person-to-person interactions. As such, TMSI may provide a space for people to explore and express their sexual selves, including BDSM interests in ways they may not do in-person. We conducted a narrative review by systematically searching PsycINFO, Academic Search Complete, and Web of Science to find articles published between 2007–2024 related to BDSM and TMSI. We supplemented the findings with manual searches. We summarized study characteristics and provide a narrative overview of the extracted information. The findings indicate that most research is focused on people who identify with BDSM, and avatar sex. There is little research on people who engage in BDSM but not the community. Some findings align with the online disinhibition effect, indicating that for those who are interested in BDSM, TMSI provides a reduction in inhibition present in in-person contexts. More research is needed to improve knowledge on the dynamics between BDSM and TMSI.
