Aleksandar Štulhofer

Development and Bicultural Validation of the New Sexual Satisfaction Scale

The development and bicultural validation of the New Sexual Satisfaction Scale (NSSS)—a 20 item, multidimensional, composite measure of sexual satisfaction—is presented. The development of the scale was based on a five-dimension, conceptual model that emphasized the importance of multiple domains of sexual behavior including sexual sensations, sexual awareness and focus, sexual exchange, emotional closeness, and sexual activity. Scale construction and validation were carried out using seven independent samples with over 2,000 participants aged 18 to 55 in Croatia and the United States. Primary data collection was completed using online survey tools. Analyses did not confirm the proposed conceptual framework but suggested a two-dimensional structure focusing on self (“ego-centered”) and the other (a “partner- and sexual activity-centered” factor) domains, each containing items representing all five conceptual dimensions. Scale reliability (k = 20) was satisfactory for all samples, and construct validity was confirmed in both cultures. The NSSS was also found to have acceptable one-month stability. It is suggested that the NSSS may be a useful tool for assessing sexual satisfaction regardless of a persons gender, sexual orientation, and relationship status.

Revisiting the Association between Pornography Use and Risky Sexual Behaviors: The Role of Early Exposure to Pornography and Sexual Sensation Seeking

Among the suggested problems and harms associated with widespread pornography use among young people, risky sexual behaviors have been frequently mentioned. To further explore this public health concern, this article analyzed sexual sensation seeking (SSS) as a potential confounder of the association between pornography use and sexual risks using data collected in 2010 from a population-based sample of young Croatian adults aged 18 to 25 (n = 1,005). Significant, but small, correlations were found between the indicators of pornography use (age at first exposure, frequency of use in the past 12 months, and personal importance of pornography) and sexual risk taking. However, in a multivariate analysis, only age at first exposure to pornography remained a significant, albeit weak, predictor of sexual risk taking among both women and men. SSS, defined as the dispositional tendency toward the impulsive pursuit of sexual arousal and stimulation, neither confounded nor moderated this association. Overall, the findings do not support the notion that pornography use is substantially associated with sexual risk taking among young adults, but suggest that early exposure to sexually explicit material and high SSS are additive risk factors for sexual risk taking.

Religiosity and Sexual Risk Behavior among Croatian College Students, 1998–2008

A substantial increase in religious identification has been observed in most European post-communist countries. As religiosity has been associated with sexually transmitted infection (STI) and HIV vulnerability among young people, this article examined the impact of religious upbringing and personal religiosity (religiousness) on sexual risks among University of Zagreb first-year undergraduate students, using data collected in 1998, 2003, and 2008. Female participants who reported strict religious upbringing were less knowledgeable about human sexuality than other women. Religiousness was negatively correlated with basic knowledge of human sexuality, but again only among women. Contrary to expectations, no significant associations were found between religious upbringing or religiousness and condom use. Both measures of religiosity, however, were related to decreased odds of sexual debut among young women. In the case of male participants, the impact of religiosity was marginal. Religious upbringing was associated (negatively) with sexual literacy and sexual debut—but only at the beginning of the observed period. Overall, religiosity does not seem to substantially reduce STI- and HIV-related risk-taking, particularly among men. Since the observed increase in the proportion of sexually active students during the 1998 through 2008 period was not matched by an increase in condom use, reducing STI and HIV vulnerability among Croatian youth remains an essential task.

Prevalence of Sexually Transmitted Infections Among Men Who Have Sex with Men in Zagreb, Croatia

We used respondent-driven sampling among men who have sex with men (MSM) in Zagreb, Croatia in 2006 to investigate the prevalence of HIV, other sexually transmitted infections and sexual behaviours. We recruited 360 MSM. HIV infection was diagnosed in 4.5%. The seroprevalence of antibodies to viral pathogens was: herpes simplex virus type-2, 9.4%; hepatitis A, 14.2%; hepatitis C, 3.0%. Eighty percent of participants were susceptible to HBV infection (HBs antigen negative, and no antibodies to HBs and HBc antigen). Syphilis seroprevalence was 10.6%. Prevalence of Chlamydia and gonorrhoea was 9.0%, and 13.2%, respectively. Results indicate the need for interventions to diagnose, treat and prevent sexually transmitted infections among this population.

Emotional intimacy, sexual desire, and sexual satisfaction among partnered heterosexual men

In spite of a mostly positive impact of emotional intimacy on sexual desire and satisfaction, emotional merging and the safety and comfort of emotional closeness have been linked with diminished sexual desire. Aiming at a better understanding of the role of intimacy in male sexuality, this paper explored (1) a likely mechanism behind the association between emotional intimacy and sexual satisfaction and (2) whether there is empirical evidence of a negative impact of intimacy on sexual desire. Among 506 heterosexual Croatian men (M = 38.2 years, SD = 8.43) currently living with their partners who participated in a large-scale online survey carried out in 2011, sexual satisfaction was dependent on both intimacy and sexual desire. Emotional intimacy was strongly associated with the partner-centered component of personal sexual satisfaction, pointing to a possible mechanism through which intimacy affects sexual well-being. Despite employing different analytical approaches and controlling for age and the length of intimate relationship, no evidence was found of a negative association between relationship intimacy and male sexual desire. Our study supports the notion that intimacy has an important and positive role in male sexuality.

Adolescent exposure to pornography and relationship intimacy in young adulthood

The hypothesis on the role of exposure to pornography during adolescence in predicting intimacy among young adults was tested using a sample of 544 Croatian college students (aged 18–25 years) who were surveyed online. Respondents provided information about pornography use at ages 14 and 17, perceived realism of pornographic depictions of sexual activities, attitudes towards recreational sex and relationship intimacy. Significant gender differences in pornography exposure, perceived realism of pornographic contents and attitudes towards recreational sex were found. No direct relationship was found between adolescent exposure to pornography and relationship intimacy in young adulthood. As hypothesised, the realism of pornography was related both to exposure and intimacy, but only among female participants. Furthermore, the association between the appraisal of pornographic realism and intimacy was shown to be mediated by attitudes towards recreational sex. In light of contemporary concerns over the normalisation of pornography use, particularly among young people, our findings do not support the view that adolescent exposure to sexually explicit materials is a determinant of relationship intimacy among young Croatian adults.

What Types of Pornography Do People Use and Do They Cluster? Assessing Types and Categories of Pornography Consumption in a Large-Scale Online Sample

Previous research on exposure to different types of pornography has primarily relied on analyses of millions of search terms and histories or on user exposure patterns within a given time period rather than the self-reported frequency of consumption. Further, previous research has almost exclusively relied on theoretical or ad hoc overarching categorizations of different types of pornography, when investigating patterns of pornography exposure, rather than latent structure analyses of these exposure patterns. In contrast, using a large sample of 18- to 40-year-old heterosexual and nonheterosexual Croatian men and women, this study investigated the self-reported frequency of using 27 different types of pornography and statistically explored their latent structures. The results showed substantial differences in consumption patterns across gender and sexual orientation. However, latent structure analyses of the 27 different types of pornography assessed suggested that although several categories of consumption were gender and sexual orientation specific, common categories across the different types of pornography could be established. Based on this finding, a five-item scale was proposed to indicate the use of nonmainstream (paraphilic) pornographic content, as this type of pornography has often been targeted in previous research. To the best of our knowledge, no similar measurement tool has been proposed before.

Urine-based testing for Chlamydia trachomatis among young adults in a population-based survey in Croatia : feasibility and prevalence

BackgroundWe assessed the feasibility of collecting urine samples for testing on genital Chlamydia trachomatis infection in a population-based survey, and prevalence of this infection among young people aged 18-25 in Croatia. In Croatia, as in the other countries of Eastern Europe, there is a lack of data on prevalence of C trachomatis in the general population, including young adults.MethodsWe sampled participants using a nationally representative, multi-stage stratified probability sample of young men and women. Detection of C trachomatis DNA in urine samples was performed by using a real-time PCR assay COBAS® TaqMan® CT Test, v2.0.ResultsOverall, 1005 young adults participated in the behavioural part of the survey, and 27.9% men and 37.5% women who were sexually experienced agreed to provide urine samples for testing on C trachomatis. Using multivariate analysis, women were significantly more likely to provide urine samples than men (aOR = 1.53, 95% CI 1.14-2.06) as were those who reported no condom use at last intercourse (aOR = 1.95, 95% CI 1.44-2.62). Prevalence of C trachomatis infection among those who were sexually experienced was 7.3% in men and 5.3% in women.ConclusionsPopulation-based surveys that use probabilistic sampling are a feasible way to obtain population estimates of C trachomatis prevalence among young adults in Croatia, but it is challenging to obtain an adequate response rate. The prevalence of C trachomatis among young adults in Croatia found in this study was higher than that found in other European countries with similar survey response rates.

Hypersexuality and High Sexual Desire: Exploring the Structure of Problematic Sexuality

INTRODUCTION The concept of hypersexuality has been accompanied by fierce debates and conflicting conclusions about its nature. One of the central questions under the discussion is a potential overlap between hypersexuality and high sexual desire. With the relevant research in its early phase, the structure of hypersexuality remains largely unknown. AIM The aim of the present study was to systematically explore the overlap between problematic sexuality and high sexual desire. METHODS A community online survey was carried out in Croatia in 2014. The data were first cluster analyzed (by gender) based on sexual desire, sexual activity, perceived lack of control over ones sexuality, and negative behavioral consequences. Participants in the meaningful clusters were then compared for psychosocial characteristics. To complement cluster analysis (CA), multigroup confirmatory factor analysis (CFA) of the same four constructs was carried out. MAIN OUTCOME MEASURES Indicators representing the proposed structure of hypersexuality were included: sexual desire, frequency of sexual activity, lack of control over ones sexuality, and negative behavioral outcomes. Psychosocial characteristics such as religiosity, attitudes toward pornography, and general psychopathology were also evaluated. RESULTS CA pointed to the existence of two meaningful clusters, one representing problematic sexuality, that is, lack of control over ones sexuality and negative outcomes (control/consequences cluster), and the other reflecting high sexual desire and frequent sexual activity (desire/activity cluster). Compared with the desire/activity cluster, individuals from the control/consequences cluster reported more psychopathology and were characterized by more traditional attitudes. Complementing the CA findings, CFA pointed to two distinct latent dimensions-problematic sexuality and high sexual desire/activity. CONCLUSION Our study supports the distinctiveness of hypersexuality and high sexual desire/activity, suggesting that problematic sexuality might be more associated with the perceived lack of personal control over sexuality and moralistic attitudes than with high levels of sexual desire and activity.

Is Early Exposure to Pornography a Risk Factor for Sexual Compulsivity? Findings from an Online Survey among Young Heterosexual Adults

ABSTRACT The aim of this retrospective study was to assess the relationship between early exposure to pornography and sexual compulsivity among Croatian young adults. Using online survey data on pornography use and sexual behavior among 1,528 heterosexual women and men aged 18–25, we tested a hypothesis that pornography use at the age of 14 is a marker for sexual compulsivity in late adolescence and young adulthood. After satisfactory reliability of a four-item subscale of the Sexual Compulsiveness Scale (Kalichman & Rompa, 1995) was confirmed in this sample, construct validity of this composite indicator focused on out of control sexual thoughts and behaviors was assessed. High sexual compulsivity was associated with sexual risk taking, though mainly among women, decreased levels of relationship intimacy and lesser sexual contentment. However, we found no significant association between early exposure to pornography and high sexual compulsivity either among men or women.