Background: Menstrual cycle has a significant impact on women's health from different perspectives, both physically and psychologically. The assessment of menstrual-related distress is of pivotal clinical interest, especially in women with chronic exposure to abnormal bleeding or pain. The Menstrual Distress Questionnaire (MEDI-Q) is a new tool originally developed in Italian that comprehensively evaluates menstrual-related distress. Objective: To validate the English version of the MEDI-Q in an English-speaking population. Methods: The study consisted of two phases: an initial translation phase of the original Italian version of the MEDI-Q, and a data collection phase to validate the new English version among 288 native English-speaking women. Results: The English version of MEDI-Q showed excellent psychometric properties, with high internal consistency (Cronbach's alpha = 0.84) and test-retest reliability (intraclass correlation coefficient = 0.95). Construct validity was supported by significant correlations between MEDI-Q scores and scores on measures of psychological distress and premenstrual symptoms. Conclusions: The English version of the MEDI-Q is a valid and reliable instrument for the assessment of menstrual distress and its impact on psychological well-being. This tool can be utilized in research and clinical settings to comprehensively investigate the impact of menstruation on various populations, identify and monitor menstruation-related disorders promptly and effectively, and to evaluate the effectiveness of targeted treatments for menstrual distress.

Introduction Sexual dysfunction is common in eating disorders (EDs), but its relevance is often overlooked. Objectives To describe different ED clinical subgroups in terms of psychopathology, putative biological correlates, and consequences of dysregulated sexuality, focusing on the role of childhood trauma. Methods Healthy controls (n=60), binge-purging (n=38), and restricting patients (n=24) were compared (age- and BMI-adjusted ANOVA; Bonferroni post-hoc tests), using total scores of Eating Disorder Examination Questionnaire (EDE-Q), Emotional Eating Scale (EES), SCL-90-R Global Severity Index (GSI), Barratt Impulsiveness Scale (BIS-11), Difficulties in Emotion Regulation Scale (DERS), Childhood Trauma Questionnaire (CTQ), Female Sexual Functioning Index (FSFI), Hypersexual Behaviour Inventory (HBI), and patients’ hormonal profiles (gonadal and pituitary hormones, ghrelin). Self-reported voluntary termination of pregnancy (VTP) and promiscuous sexual activity were recorded. For ED patients (N=62), regression analyses between significant variables and HBI were carried, applying moderation models for different CTQ scores. Results Table 1 outlines significant between-group comparisons (°: different from controls; *: different from restricting patients; p<0.05). Binge-purging patients had higher FSH, LH, and ghrelin levels, more VTPs and promiscuity. HBI showed significant correlations with EES, SCL-90-R-GSI, DERS, CTQ, and ghrelin levels. CTQ moderated interactions for DERS and EES (Figure 1). Binge-purging Restricting Controls F EDE-Q 3.86±1.20° 3.41±1.64° 0.85±0.83 67.32 EES 40.85±22.74°* 16.01±15.88 19.87±15.21 7.01 SCL-90-R GSI 1.73±0.65° 1.27±0.69° 0.68±0.44 20.32 BIS-11 62.47±9.91° 60.81±8.56 57.04±10.04 4.99 DERS 106.97±29.15°* 83.97±33.12 78.14±14.12 10.21 CTQ 55.32±21.06° 49.31±10.81° 38.02±8.32 15.24 FSFI 17.32±11.89°* 11.70±10.98° 29.32±7.45 24.02 HBI 28.75±13.89* 20.56±3.12 26.11±4.90 4.92 Conclusions Dysregulated sexuality is linked to emotion dysregulation and childhood trauma. Binge-purging patients experience adverse behavioural consequences. Disclosure No significant relationships.

The present study explored the psychopathological, behavioral, and putative biological underpinnings of dysregulated sexuality in eating disorders (EDs), focusing on the role of childhood trauma - evaluated with the Childhood Trauma Questionnaire (CTQ). The comparison between Binge-Purging and Restricting patients outlined the predominance of markers of dysregulated sexuality in the first subgroup. In the clinical sample, hypersexuality - measured through the Hypersexual Behavior Inventory (HBI) - was associated with severe psychopathology, emotion dysregulation, childhood trauma, adverse consequences, and higher ghrelin levels. Moderation analyses showed that hypersexuality was associated with emotion dysregulation and psychopathology only in those patients reporting childhood traumatic experiences.

The relationship between childhood trauma and adult sexual dysfunction is well documented; however, there is a paucity of research that examines the physiological and psychological mechanisms that may potentiate this relationship. As depression, perceived stress, and hypothalamic pituitary adrenal (HPA) axis dysregulation are correlates of childhood trauma and sexual dysfunction, the current study sought to examine the association of each of these domains with low sexual desire in a sample of (N = 275 [n = 137 women with low sexual desire; n = 138 sexually healthy women]) non-clinically depressed women. First, we assessed the relative contributions of HPA axis dysregulation (as indexed by the diurnal cortisol slope), childhood trauma, depression symptoms and perceived daily stress on low sexual desire. Next, we examined the degree to which HPA axis dysregulation, perceived stress, and depressive symptoms, respectively, mediated the relationship between childhood trauma and sexual desire. Results indicate that diurnal cortisol slope and depression symptoms contribute to low desire over and above perceived stress and childhood trauma and that childhood trauma is associated with low sexual desire predominantly through depressive symptomatology. Theoretical and clinical implications of the findings are discussed.

Critically responding to the observations provided in the commentary is not easy, because we agree on many points made by the author and, indeed, our results support such opinions and positions. To clarify our article, we will address each point sequentially. First, the author of the commentary defined our interpretations of the results of the study as "obscure." It is possible that our article is not clear in all its sections. However, in our opinion, the research in psychiatry should make the world of psychopathology less obscure, which is the world of subjectivity. Clinicians are often not familiar with the language of psychopathology, ignoring terms such as "ego-dystonic," which refers to aspects of one's behavior or attitudes viewed as inconsistent with one's fundamental beliefs and personality (contrasted with ego-syntonic). In this regard, for all disorders included in the Diagnostic and Statistical Manual of Mental Disorders (DSM), clinicians should not limit their assessment to the description of behaviors or distress related to them. For example, the simple description of a man running in a street does not say anything; indeed, he can run because he is scared by something, angry with somebody, happy for something that he is going to do. As a whole, the recent editions of the DSM are used to privilege behaviors over cognitions and emotional states when most of the mental disorder diagnoses are considered. The last edition (DSM V), with the introduction of dimensional evaluations as well as categorical ones, can help clinicians to better evaluate the subjective experiences of patients. By definition, our patients first suffer from beliefs and emotions, then they may show a variety of abnormal behaviors that are the consequence of those beliefs and emotions. This is especially true for sexual behaviors and fantasies. As extensively reported in the article, we assessed thoughts and behaviors that are usually associated with the definition of paraphilias, although we never referred to "disorders." Paraphilic thoughts and behaviors can be associated with different dimensions of psychopathology encompassing depression, compulsivity, and subjective perception of hypersexuality, or they can be a consequence of an adverse life event interfering with healthy development of sexuality.

Introduction: The actual definitions of paraphilic thoughts or behaviors and hypersexuality are still a matter of debate in the scientific community, and few studies have evaluated their psychopathological correlates in non-clinical samples of both men and women. Aim: This study aimed at shedding light on the gender differences in terms of frequency of paraphilic fantasies and behaviors, and the relationship among paraphilias, hypersexuality, and general psychopathology. Methods: A sample of 775 university students (243 men, 532 women) was recruited from 6 Italian universities using questionnaires posted in social networks. Paraphilic behaviors, fantasies, and masturbation during these fantasies were evaluated, as well as hypersexuality, psychopathological correlates, self-perceived gender identity, and a history of adverse childhood conditions. Main Outcome Measures: Participants were assessed on the presence of paraphilic fantasies, behaviors, and masturbation related to paraphilic thoughts, and evaluated by means of the Symptom Checklist 90-Revised, the Hypersexual Disorder Screening Inventory, the International Index of Erectile Function, the Female Sexual Function Index, the Gender Identity/Gender Dysphoria Questionnaire, and the Childhood Experience of Care and Abuse Questionnaire. Results: In the present survey, 50.6% of the men and 41.5% of the women reported at least 1 behavior considered paraphilic. A gender difference in the prevalence of the main paraphilic interests and behaviors was observed, with men reporting a higher prevalence of voyeurism, exhibitionism, sadism, and frotteurism, and a higher prevalence of fetishism and masochism in women. Both general psychopathology and sexual dysfunctions were associated with hypersexuality, rather than with the content of sexual fantasies. Finally, an association between childhood adversities and hypersexuality was found in women but not in men. Clinical Implications: Understanding the psychopathological correlates of paraphilic fantasies/behaviors and hypersexuality may allow clinicians to develop specific psychological and pharmacological interventions. Strengths & Limitations: This is one of the few studies assessing paraphilic phenomenology and psychopathological correlates of hypersexuality in a non-clinical sample of both men and women. Conclusion: The results seem to demonstrate that paraphilic thoughts and behaviors are not really a deviation from normalcy, rather they are quite widespread in the young population, and the distinction between healthy and pathological sexual interests may be better replaced by an all-encompassing approach considering ego-dystonic sexuality, hypersexuality, and their psychopathological correlates. Copyright (C) 2018, International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

Trauma theories suggest that childhood maltreatment (CM) may partly explain intimacy problems in romantic relationships. However, empirical studies have yielded conflicting findings, likely due to the varying conceptualizations of intimacy. Findings that support long-term negative effects of CM on sexual and relationship satisfaction are almost exclusively based on cross-sectional intra-individual data, precluding the examination of mediating pathways and of dyadic interactions between individuals reporting CM and their partners. This study used a dyadic perspective to examine the associations between CM and the different components of intimacy based on the interpersonal process model of intimacy: self-disclosure, perceived partner disclosure, and perceived partner responsiveness. We also tested the mediating role of these intimacy components at Time 1 in the relations between CM and sexual and relationship satisfaction 6 months later. A sample of 365 heterosexual couples completed self-report questionnaires. Results of path analyses within an actor–partner interdependence framework showed that women and men’s higher levels of CM did not affect self-disclosure, but was negatively associated with their own perception of partner disclosure and responsiveness. In turn, women and men’s perception of partner responsiveness at Time 1 was positively associated with their own sexual satisfaction, as well as their own and their partner’s relationship satisfaction at Time 2. Thus, perception of partner responsiveness mediated the associations between CM and poorer sexual and relationship satisfaction. The overall findings may inform the development of couple intervention that targets the enhancement of intimacy to promote sexual and relationship well-being in couples where one partner experienced CM.

Among 70 community couples who reported childhood sexual abuse (CSA) and disclosure to their partner, this study examined associations between survivors' perception of partner responses to their disclosure, and both partners' sexual and relationship satisfaction. Participants completed self-report questionnaires online. Results of path analyses within an actor-partner interdependence model indicated that survivors' perceived partner responses of emotional support to disclosure were associated with their own and their partners' higher sexual satisfaction. Survivors' perceived responses of being stigmatized/treated differently by the partner were associated with their own and their partners' poorer relationship satisfaction. Findings suggest that survivor-perceived partner responses to the disclosure of CSA can have a positive and a negative impact on the sexual and relationship satisfaction of both partners.

BACKGROUND:Several studies have suggested a relevant overlap between eating disorders and sexual dysfunction involving the emotional component of body image esteem and dissociative experiences. AIM:To evaluate the common maintaining factors of sexual dysfunction and vulnerability to pathologic eating behaviors and their relation to a physiologic stress response. METHODS:In the present cross-sectional study, we evaluated a non-clinical sample of 60 heterosexual women (25-35 years old) for dissociation during sex with a partner, body image disturbance, and tendency toward pathologic eating behaviors. We also evaluated the stress-induced hypothalamic-pituitary-adrenal axis activation in response to a sexual stimulus and its association with binge eating and dissociation. OUTCOMES:Participants completed the Clinician-Administered Dissociative States Scale, the Sexual Satisfaction Scale-Women, the Body Esteem Scale for Adolescents and Adults, and the Eating Attitudes Test Short Version. Furthermore, we assessed cortisol levels before, during, and after exposure to explicit sexual stimuli shown within a laboratory setting. RESULTS:Dysfunctional body image esteem and a tendency toward binge-eating behaviors were associated with greater sexual distress in women. In particular, body esteem was significantly associated with greater dissociation during sex with a partner. Moreover, women who reported greater dissociation during sex with a partner and a tendency toward binge-eating behaviors showed higher levels of cortisol in response to sexual stimuli. CLINICAL IMPLICATIONS:These results support further research based on trans-diagnostic treatments targeted to dissociation and body image esteem, which could lessen sexual dysfunction and vulnerability to pathologic eating behaviors. STRENGTHS AND LIMITATIONS:Despite the small sample and self-reported questionnaires, this is the first study to consider the association of the stress response during sexual stimuli with sexual distress and with pathologic eating behaviors adopting a dimensional approach. CONCLUSION:Body uneasiness and dissociation represented factors underlying pathologic eating behaviors and sexual dysfunction. Women reporting a tendency toward binge-eating episodes and dissociation during sexual experiences represented a subpopulation with a higher stress response during sexual stimuli. Castellini G, Lo Sauro C, Ricca V, Rellini AH. Body Esteem as a Common Factor of a Tendency Toward Binge Eating and Sexual Dissatisfaction Among Women: The Role of Dissociation and Stress Response During Sex. J Sex Med 2017;14:1036-1045.

Systematic reviews and some recent studies have suggested that anxiety plays a role in reducing chances of becoming pregnant1, although the literature is not yet settled. The primary goal of this study was to further explore trait anxiety as a predictor of fertility treatment outcome in patients seeking treatment at an academic reproductive clinic serving a rural population in the northeastern United States. This is a prospective cross-sectional study. Anxiety symptomology was assessed through self-report using the Brief Symptom Inventory (BSI) subscales Phobic Anxiety (PA, e.g., "Feeling uneasy in crowds, such as shopping or at a movie"), Anxiety (A, e.g., "Feeling tense or keyed up"), and Obsessive-Compulsive (OC, e.g., "Having to check and double-check what you do"). Fertility treatments are defined as ovulation induction and IVF. Fertility treatment outcomes (i.e., positive pregnancy test at two weeks following intervention) were obtained through medical chart review. Thirty-three women were recruited and assessed during their first appointment to the clinic. After controlling for age, body mass index (BMI), and insurance coverage for reproductive care, anxiety symptomology significantly predicted fertility treatment outcomes. This model explained a significant proportion of variance in outcomes, R2 = .42, F(2 , 26) = 3.17, p =.018. All three anxiety subscales - PA (β = -.75, p = .001); A (β = .79, p = .01); OC (β = -.47, p = .05) had a negative predictive value for a successful treatment. More broad analyses of clusters of symptomology underlying anxiety disorders, demonstrate that an increase in anxiety symptoms, specifically phobic and obsessive-compulsive symptomology, is related to a decrease in pregnancy rates following fertility treatment. Results of this study further support the body of research that trait anxiety plays a predictive role in the outcome of fertility treatment and suggest that identifying and treating anxiety in patients undergoing fertility treatment could improve outcomes. In addition to improving fertility treatment outcomes, early screening and intervention for anxiety could also benefit more long term outcomes such as maternal well-being and birth outcomes.

Studies suggest that sexual self-schemas are an important cognitive mechanism in the sexual development of women with a history of childhood abuse. This literature is only beginning to explore how multiple forms of abuse (i.e., physical, emotional, and sexual), rather than sexual abuse alone, can influence the development of adult sexuality. Moreover, the extant literature has not carefully considered important factors other than the severity of the abuse that may relate to sexual self-schemas, including family environment and quality of romantic relationships. Findings from this cross-sectional study conducted on 417 heterosexual women (ages 18-25 years) suggest that family dynamics and different types of childhood abuse contribute both directly and indirectly to adult sexual function and satisfaction and that part of those effects were mediated by other factors such as sexual self-schemas and romantic relationship quality. These results, including an exploration of the direct and indirect effects, were discussed in terms of the pervasive effects of abuse on people's lives and the potential treatment targets that can be addressed when trying to reduce sexual problems in women with a history of abuse.

The literature on sexual responses shows a large and not fully understood between-women variance in sexual responses and in strength of coherence between physiological and subjective sexual responses. This study investigated cognitive factors theorized to be associated with sexual responses that could explain such variance. Specifically, we investigated the predictive value of sexual excitation/inhibition and sexual schemas on sexual response and coherence. Vaginal photoplethysmography and continuous subjective sexual arousal were collected from 29 young women while they watched a control/erotic video sequence. Hierarchical linear modeling revealed that high sexual excitation and schemas related to passion and romance were related to higher coherence. These findings support the notion that cognitive factors that enhance sexual arousal contribute to the large variation seen in the coherence of sexual response as measured in the laboratory.

Purpose To compare the psychopathological characteristics of obese patients seeking bariatric surgery with those seeking a medical approach. Methods A total of 394 consecutive outpatients seeking bariatric surgery were compared with 683 outpatients seeking a medical treatment. All patients were referred to the same institution. Results Obesity surgery patients reported higher body mass index (BMI), objective/subjective binging and more severe general psychopathology, while obesity medical patients showed more eating and body shape concerns. Depression was associated with higher BMI among obesity surgery clinic patients, whereas eating-specific psychopathology was associated with higher BMI and objective binge-eating frequency among obesity medical clinic patients. Conclusions Patients seeking bariatric surgery showed different psychopathological features compared with those seeking a non-surgical approach. This suggests the importance for clinicians to consider that patients could seek bariatric surgery on the basis of the severity of the psychological distress associated with their morbid obesity, rather than criteria only based on clinical indication.

INTRODUCTION:Sexual dysfunctions that affect all aspects of sexuality are common in patients with eating disorders. However, only few studies have provided longitudinal information on sexual functioning in patients with eating disorders.AIM:To evaluate the longitudinal course of sexual functioning, and how changes in psychopathology and history of childhood abuse interact with sexual functioning in patients with anorexia nervosa (AN) and bulimia nervosa (BN).METHODS:A total of 27 patients with AN and 31 with BN were assessed at baseline and at 1-year follow-up after a standard individual cognitive behavioral therapy (CBT).MAIN OUTCOME MEASURES:Subjects were studied by means of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders IV, Female Sexual Function Index (FSFI), Eating Disorder Examination Questionnaire, Beck Depression Inventory, Spielberg's State-Trait Anxiety Inventory, Symptom Checklist-90, and Childhood Experience of Care and Abuse Questionnaire.RESULTS:After treatment, both patients with AN and BN showed a significant improvement in the FSFI total score (P < 0.01 for both AN and BN) and all FSFI subscales, without significant between groups differences. Patients reporting childhood sexual abuse did not show a significant improvement in sexual functioning (β = 0.05; P = 0.58). Reduction in eating disorder severity was directly associated with FSFI improvement, but only in those subjects with no history of sexual abuse (β = 0.28; P = 0.01).CONCLUSIONS:Eating disorder-specific psychopathology could be considered as a specific maintaining factor for sexual dysfunction in eating disorders subjects. Subjects reporting a history of childhood sexual abuse represent a subpopulation of patients with a profound uneasiness, involving body perception, as well as sexual functioning, which appeared not to be adequately challenged during standard CBT intervention. The results, though original, should be considered as preliminary, given the relatively small sample size.

INTRODUCTION:Cross-sex hormonal treatment (CHT) used for gender dysphoria (GD) could by itself affect well-being without the use of genital surgery; however, to date, there is a paucity of studies investigating the effects of CHT alone.AIMS:This study aimed to assess differences in body uneasiness and psychiatric symptoms between GD clients taking CHT and those not taking hormones (no CHT). A second aim was to assess whether length of CHT treatment and daily dose provided an explanation for levels of body uneasiness and psychiatric symptoms.METHODS:A consecutive series of 125 subjects meeting the criteria for GD who not had genital reassignment surgery were considered.MAIN OUTCOME MEASURES:Subjects were asked to complete the Body Uneasiness Test (BUT) to explore different areas of body-related psychopathology and the Symptom Checklist-90 Revised (SCL-90-R) to measure psychological state. In addition, data on daily hormone dose and length of hormonal treatment (androgens, estrogens, and/or antiandrogens) were collected through an analysis of medical records.RESULTS:Among the male-to-female (MtF) individuals, those using CHT reported less body uneasiness compared with individuals in the no-CHT group. No significant differences were observed between CHT and no-CHT groups in the female-to-male (FtM) sample. Also, no significant differences in SCL score were observed with regard to gender (MtF vs. FtM), hormone treatment (CHT vs. no-CHT), or the interaction of these two variables. Moreover, a two-step hierarchical regression showed that cumulative dose of estradiol (daily dose of estradiol times days of treatment) and cumulative dose of androgen blockers (daily dose of androgen blockers times days of treatment) predicted BUT score even after controlling for age, gender role, cosmetic surgery, and BMI.CONCLUSIONS:The differences observed between MtF and FtM individuals suggest that body-related uneasiness associated with GD may be effectively diminished with the administration of CHT even without the use of genital surgery for MtF clients. A discussion is provided on the importance of controlling both length and daily dose of treatment for the most effective impact on body uneasiness.

Introduction. Definitions and terminology for female sexual arousal disorder (FSAD) are currently being debated. While some authors have suggested that FSAD is more a subjective response rather than a genital response, others have suggested that desire and arousal disorders should be combined in one entity. Persistent genital arousal disorder (PGAD) is a new entity which is suggested to be defined as Restless Genital Syndrome. Aims. The aims of this brief review are to give definitions of the different types of FSAD, describe their aetiology, prevalence and comorbidity with somatic and psychological disorders, as well as to discuss different medical and psychological assessment and treatment modalities. Methods. The experts of the International Society for Sexual Medicine’s Standard Committee convened to provide a survey using relevant databases, journal articles, and own clinical experience. Results. Female Arousal Disorders have been defined in several ways with focus on the genital or subjective response or a combination of both. The prevalence varies and increases with increasing age, especially at the time of menopause, while distress decreases with age. Arousal disorders are often comorbid with other sexual problems and are of biopsychosocial etiology. In the assessment, a thorough sexological history as well as medical and gynecological history and examination are recommended. Treatment should be based on of the symptoms, clinical findings and, if possibly, on underlying etiology. Conclusion. Recommendations are given for assessment and treatment of FSAD and PGAD. Giraldi A, Rellini AH, Pfaus J, and Laan E. Female sexual arousal disorders. J Sex Med 2013;10:58–73.