Sexual satisfaction is an important indicator of sexual health and is strongly associated with relationship satisfaction. However, research exploring lay definitions of sexual satisfaction has been scarce. We present thematic analysis of written responses of 449 women and 311 men to the question "How would you define sexual satisfaction?" The participants were heterosexual individuals with a mean age of 36.05 years (SD = 8.34) involved in a committed exclusive relationship. In this exploratory study, two main themes were identified: personal sexual well-being and dyadic processes. The first theme focuses on the positive aspects of individual sexual experience, such as pleasure, positive feelings, arousal, sexual openness, and orgasm. The second theme emphasizes relational dimensions, such as mutuality, romance, expression of feelings, creativity, acting out desires, and frequency of sexual activity. Our results highlight that mutual pleasure is a crucial component of sexual satisfaction and that sexual satisfaction derives from positive sexual experiences and not from the absence of conflict or dysfunction. The findings support definitions and models of sexual satisfaction that focus on positive sexual outcomes and the use of measures that incorporate items linked to personal and dyadic sexual rewards for both men and women.

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Introduction In recent months, some attempts were made to understand the impact of COVID-19 on sexual health. Despite recent research that suggests COVID-19 and lockdown measures may eventually impact sexual response and sexually related behaviors, we are missing clinical sexologists’ perspectives on the impact of COVID-19 in sexual health. Such perspectives could inform a preliminary framework aimed at guiding future research and clinical approaches in the context of COVID-19. Aim To explore the perspectives of clinical sexologists about the impact of COVID-19 on their patients’ sexual health, as well as the professional challenges they have faced during the current pandemic. Findings are expected to inform a preliminary framework aimed at understanding the impact of COVID-19 on sexual health. Methods We conducted an online qualitative exploratory survey with 4 open-ended questions with 39 clinical sexologists aged between 32 and 73 years old. The survey was advertised among professional associations’ newsletters. We performed a Thematic Analysis using an inductive, semantic, and (critical) realist approach, leading to a final thematic map. Main Outcome Measures The outcome is the thematic map and the corresponding table that aggregates the main themes, subthemes, and codes derived from participants’ answers and that can serve as a preliminary framework to understand the impact of COVID-19 on sexual health. Results The final thematic map, expected to serve as a preliminary framework on the impact of COVID-19 in sexual health, revealed 3 main themes: Clinical Focus, Remapping Relationships, and Reframing Technology Use. These themes aggregate important interrelated issues, such as worsening of sexual problems and dysfunctions, mental health, relationship management, the rise of conservatism, and the use of new technology that influences sexuality and sexual health-related services. Conclusion The current study allowed us to develop a preliminary framework to understand the impact of COVID-19 on sexual health. This framework highlights the role of mental health, as well as the contextual nature of sexual problems, and subsequently, their relational nature. Also, it demonstrates that the current pandemic has brought into light the debate of e-Health delivery within clinical sexology.

Introduction: Although erectile dysfunction (ED) involves an interaction between physiological and psychological pathways, the psychosocial aspects of ED have received considerably less attention so far. Aim: To review the available evidence on the psychosocial aspects of ED in order to develop a position statement and clinical practice recommendations on behalf of the European Society of Sexual Medicine (ESSM). Method: A comprehensive, narrative review of the literature was performed.Main outcome measures: Specific statements and recommendations according to the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence criteria were provided. Results: A multidisciplinary treatment, in which medical treatment is combined with a psychological approach, is preferred over unimodal treatment. There is increasing evidence that psychological treatments of ED can improve medical treatments, the patient's adherence to treatment, and the quality of the sexual relationship. The main components of psychological treatment of ED involve cognitive and behavioral techniques aimed at reducing anxiety, challenging dysfunctional beliefs, increasing sexual stimulation, disrupting sexual avoidance, and increasing intimacy and communication skills in a relational context. When applicable and possible, it is strongly recommended to include the partner in the assessment and treatment of ED and to actively work on interpartner agreement and shared decision-making regarding possible treatment options. To ensure a better integration of the biopsychosocial model into clinical practice, developing concrete treatment protocols and training programs are desirable. Conclusion: Because the psychosocial approach to ED has been underexposed so far, this position statement provides valuable information for clinicians treating ED. Psychological interventions on ED are based on existing theoretical models that are grounded in empirical evidence. However, the quality of available studies is low, which calls for further research. The sexual medicine field would benefit from pursuing more diversity, inclusivity, and integration when setting up treatments and evaluating their effect.

Introduction Little attention has been paid to distress in sexual functioning or the sexual satisfaction of people who practice BDSM (Bondage and Discipline, Domination and Submission, Sadism and Masochism). Aim The purpose of this study was to describe sociodemographic characteristics and BDSM practices and compare BDSM practitioners' sexual outcomes (in BDSM and non-BDSM contexts). Methods A convenience sample of 68 respondents completed an online survey that used a participatory research framework. Cronbach's alpha and average inter-item correlations assessed scale reliability, and the Wilcoxon paired samples test compared the total scores between BDSM and non-BDSM contexts separately for men and women. Open-ended questions about BDSM sexual practices were coded using a preexisting thematic tree. Main Outcome Measures We used self-reported demographic factors, including age at the onset of BDSM interest, age at first BDSM experience, and favorite and most frequent BDSM practices. The Global Measure of Sexual Satisfaction measured the amount of sexual distress, including low desire, arousal, maintaining arousal, premature orgasm, and anorgasmia. Results The participants had an average age of 33.15 years old and were highly educated and waited 6 years after becoming interested in BDSM to act on their interests. The practices in which the participants most frequently engaged did not coincide with the practices in which they were most interested and were overwhelmingly conducted at home. Comparisons between genders in terms of distress in sexual functioning in BDSM and non-BDSM contexts demonstrate that, with the exception of maintaining arousal, we found distress in sexual functioning to be statistically the same in BDSM and non-BDSM contexts for women. For men, we found that distress in sexual functioning, with the exception of premature orgasm and anorgasmia, was statistically significantly lower in the BDSM context. There were no differences in sexual satisfaction between BDSM and non-BDSM contexts for men or women. Conclusion Our findings suggest that BDSM sexual activity should be addressed in clinical settings that account for BDSM identities, practices, relationships, preferences, sexual satisfaction, and distress in sexual function for men and women. Additional research needs are identified, such as the need to define distressful sexual functioning experiences and expand our understanding of the development of BDSM sexual identities.

Introduction: There is a lack of theoretical and empirical knowledge on how sexual desire functions and interacts in a relationship. Aim: To present an overview of the current conceptualization and operationalization of sexual desire discrepancy (SDD), providing clinical recommendations on behalf of the European Society of Sexual Medicine. Methods: A comprehensive Pubmed, Web of Science, Medline, and Cochrane search was performed. Consensus was guided by a critical reflection on selected literature on SDD and by interactive discussions between expert psychologists, both clinicians and researchers. Main Outcome Measure: Several aspects have been investigated including the definition and operationalization of SDD and the conditions under which treatment is required. Results: Because the literature on SDD is scarce and complicated, it is precocious to make solid statements on SDD. Hence, no recommendations as per the Oxford 2011 Levels of Evidence criteria were possible. However, specific statements on this topic, summarizing the ESSM position, were provided. This resulted in an opnion-based rather than evidence-based position statement. Following suggestions were made on how to treat couples who are distressed by SDD: (i) normalize and depathologize variation in sexual desire; (ii) educate about the natural course of sexual desire; (iii) emphasize the dyadic, age-related, and relative nature of SDD; (iv) challenge the myth of spontaneous sexual desire; (v) promote open sexual communication; (vi) assist in developing joint sexual scripts that are mutually satisfying in addition to search for personal sexual needs; (vii) deal with relationship issues and unmet relationship needs; and (viii) stimulate selfdifferentiation. Conclusion: More research is needed on the conceptualization and underlying mechanisms of SDD to develop clinical guidelines to treat couples with SDD.

Introduction Pregnancy is characterized by physical, hormonal, and psychological changes that can affect women’s sexuality, and, for those who are in a dyadic relationship, it also affects the couple’s sexual relationship. On the other hand, the pregnancy state can function as a protective factor for body dissatisfaction as women embrace a new phase of the life cycle when body changes, namely more body volume, are expected. Aim To examine whether the effect of body dissatisfaction on sexual distress is mediated by cognitive distraction with the appearance of the body and to test a moderated mediation model of the impact of body dissatisfaction on sexual distress, with pregnancy used as the moderating factor. Methods In this cross-sectional study, 87 cisgender heterosexual women (50.6% pregnant; n = 44), aged between 25 and 40 years old (mean = 31.93; SD = 3.46) involved in an exclusive and committed dyadic relationship completed a web-based questionnaire. Main Outcome Measures Validated measures consisted of a validated general measure of body dissatisfaction (global body dissatisfaction scale), sexual distress (adapted from the National Survey of Sexual Attitudes and Lifestyles), and cognitive distraction based on body appearance during sexual activity (body appearance cognitive distraction scale). Results Results indicated that body dissatisfaction and sexual distress are related, but they are fully mediated by cognitive distraction. The mediation effect of cognitive distraction did not differ significantly by pregnancy status, after controlling for the trimester of pregnancy. Clinical Implications This study advances our understanding of sexuality during pregnancy by evaluating sexual distress and establishing that it is a clinically relevant variable related to body dissatisfaction that deserves attention from healthcare providers. Strength & Limitations This preliminary study uses a robust method of data analysis to test a theory-based cognitive model of sexual distress in pregnant women; however, no causality can be established. Conclusion The data highlights that pregnancy may not be a protective factor for the impact of body dissatisfaction on sexual distress.

Researchers have demonstrated that several dimensions of sexual functioning (e.g., sexual desire, arousal, orgasm) are associated with the sexual satisfaction of individuals in a committed mixed-sex (male-female) relationship. We extended this research by comparing a dyadic model that included both own (i.e., actor effect) and partner (i.e., partner effect) domains of sexual functioning to an individual model that included only actor effects. Participants were 124 mixed-sex couples who completed online measures of sexual functioning and sexual satisfaction. Data analysis using the actor-partner interdependence model (APIM) and structural equation modeling (SEM) indicated that the dyadic model had a better fit than the individual model. Women's sexual desire and orgasm and men's erectile functioning were significant positive predictors of both own and partner's sexual satisfaction. These results are discussed in terms of the importance of taking a dyadic approach to research and clinical work related to sexual satisfaction.