Gert Martin Hald

Does Viewing Explain Doing? Assessing the Association Between Sexually Explicit Materials Use and Sexual Behaviors in a Large Sample of Dutch Adolescents and Young Adults

INTRODUCTION Concerns have been voiced that the use of sexually explicit materials (SEMs) may adversely affect sexual behaviors, particularly in young people. Previous studies have generally found significant associations between SEM consumption and the sexual behaviors investigated. However, most of these studies have focused on sexual behaviors related to sexually transmitted infections or sexual aggression and/or failed to adequately control for relevant covariates. Thus, research more thoroughly investigating the association between SEM consumption and a broader range of sexual behaviors is needed. AIMS The study aims to investigate SEM consumption patterns of young people, and to assess the strength of the association between SEM consumption and a range of sexual behaviors, controlling for a comprehensive array of variables previously shown to affect these relationships. METHODS Online cross-sectional survey study of 4,600 young people, 15-25 years of age, in The Netherlands was performed. MAIN OUTCOMES MEASURES The main outcome measures were self-reported SEM consumption and sexual practices. RESULTS The study found that 88% of men and 45% of women had consumed SEM in the past 12 months. Using hierarchical multiple regression analyses to control for other factors, the association between SEM consumption and a variety of sexual behaviors was found to be significant, accounting for between 0.3% and 4% of the total explained variance in investigated sexual behaviors. CONCLUSIONS This study suggests that, when controlling for important other factors, SEM consumption influences sexual behaviors. The small to moderate associations that emerged between SEM consumption and sexual behavior after controlling for other variables suggest that SEM is just one factor among many that may influence youth sexual behaviors. These findings contribute novel information to the ongoing debates on the role of SEM consumption in sexual behaviors and risk, and provide appropriate guidance to policy makers and program developers concerned with sexual education and sexual health promotion for young people.

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.

Pornography consumption and non-marital sexual behaviour in a sample of young Indonesian university students

Using a sample of Indonesian university students and a cross sectional design, this study investigated prevalence rates and patterns of pornography consumption in Indonesia, a religious, sexually conservative, Muslim-majority nation with strict anti-pornography laws. Further, the association between pornography consumption and common non-marital sexual behaviours was explored. The study found that in this sample, pornography is as widely and readily consumed as in comparable international studies predominantly utilising Western background samples from more sexually liberal and less religious countries with very few laws on pornography. Gender differences in patterns of pornography consumption were pronounced and comparable with findings in international counterpart studies. For men only, pornography consumption was found to significantly predict common sexual behaviours in non-marital relations. The study is the first to provide insights into prevalence rates and patterns of pornography consumption and its association with common non-marital sexual behaviours in a sexually conservative, Muslim-majority nation with strict anti-pornography laws.

Does Sexually Explicit Media (SEM) affect me? Assessing first-person effects of SEM consumption among Norwegian men who have sex with men

Using a self-selected online sample of 448 Norwegian men who have sex with men (MSM) and a cross-sectional design, the present study investigated first-person effects of sexually explicit media (SEM) consumption on sexual knowledge, enjoyment of and interest in sex, attitudes towards sex and understanding of one’s sexual orientation. First-person effects refer to self-perceived and self-reported effects of SEM consumption as experienced by the consumer. In addition, the study examined and provided a thorough validation of the psychometric properties of the seven-item Pornography Consumption Effect Scale (PCES). The study found that 93% of MSM reported small-to-large positive effects from their SEM consumption on their sexual knowledge, enjoyment of and interest in sex, attitudes towards sex and understanding of their sexual orientation. Only 7% reported any negative effects from their SEM consumption on these outcomes. Furthermore, the psychometric properties of the revised version of the PCES were found to be very satisfactory. The results of the study indicate that SEM consumption among MSM may play a positive role in MSM’s sexuality by enhancing their sex life, being a major source of sexual information, providing a recreational sexual outlet and offering confirmation of one’s sexual orientation.

Sexuality in Older Adults (65+)—An Overview of the Literature, Part 1: Sexual Function and its Difficulties

ABSTRACT Objectives: The aim of the current article was to provide an overview of literature on sexual function and sexual difficulties in older adults. Method: The authors conducted a narrative review of papers published in English between January 2005 and July 2015 based on an extensive search in PsycINFO. Results: The review showed that although common biological changes may adversely affect sexual function in old age, sexual experience seems to also be affected by psychological and interpersonal factors. Conclusions: Greater life expectancy and better medical care will result in older individuals with chronic diseases living longer. The need for help to cope with changes in sexual health is likely to increase in older adults, as sexuality may be negatively affected through several pathways.

Comment on: Is Pornography Use Associated with Sexual Difficulties and Dysfunctions among Younger Heterosexual Men?

Surprisingly, given its potential clinical relevance, very few studies have attempted to investigate relationships between pornography consumption and common sexual dysfunctions and problems (in the following referred to as “sexual difficulties”). When having done so, the designs employed have predominantly been case study designs or focus group designs and the method of data collection qualitative. Alternatively, personal or clinical experiences have been utilized. Although important, such studies and experience alone may not be brought to bear on effects of the consumption of pornography. Consequently, the study by Landripet and Stulhofer offers a long and valuable cross-cultural beginning to the quantitative exploration of associations between pornography consumption and sexual difficulties. More generally, elements of the study by Landripet and Stulhofer reflect critical issues in research on pornography. First, the sample most likely constitutes a non-probability sample. This is characteristic of much of the available research on pornography today [1]. This problem may somewhat be offset by including short, valid, and reliable measures of pornography consumption in future large population based national studies on sexuality and sexual behaviors. Considering the prevalence rates of pornography consumption and the frequency by which pornography is consumed, in particular among men, this seems both highly relevant and high time. Second, the study finds only one significant association between pornography consumption and the outcomes studied (i.e., erectile dysfunction) and emphasizes that the size (magnitude) of this relationship is small. However, in pornography research, the interpretation of “size” may depend as much on the nature of the outcome studied as the magnitude of the relationship found. Accordingly, if the outcome is to be considered “sufficiently adverse” (e.g., sexual aggressive behaviors), even small effect sizes may carry considerable social and practical significance [2]. Third, the study does not address possible moderators or mediators of the relationships studied nor is it able to determine causality. Increasingly, in research on pornography, attention is given to factors that may influence the magnitude or direction of the relationships studied (i.e., moderators) as well as the pathways through which such influence may come about (i.e., mediators) [1,3]. Future studies on pornography consumption and sexual difficulties may also benefit from an inclusion of such focuses. Fourth, in their concluding statement, the authors suggest that a number of factors are more likely related to sexual difficulties than pornography consumption. To better assess this, as well as the relative contribution of each of these variables, the use of comprehensive models able to encompass both direct and indirect relationships between variables known or hypothesized to influence the outcome may be advised [3]. Overall, the study by Landripet and Stulhofer provides first and an interesting cross-cultural and quantitative insights into possible associations between pornography consumption and sexual difficulties. Hopefully comparable future studies may use this as a stepping stone to further advance the research on relationships between pornography consumption and sexual difficulties among both men and women.

Long-term follow-up of individuals undergoing sex reassignment surgery: Psychiatric morbidity and mortality

Abstract Background: There is a lack of long-term register-based follow-up studies of sex-reassigned individuals concerning mortality and psychiatric morbidity. Accordingly, the present study investigated both mortality and psychiatric morbidity using a sample of individuals with transsexualism which comprised 98% (n = 104) of all individuals in Denmark. Aims: (1) To investigate psychiatric morbidity before and after sex reassignment surgery (SRS) among Danish individuals who underwent SRS during the period of 1978–2010. (2) To investigate mortality among Danish individuals who underwent SRS during the period of 1978–2010. Method: Psychiatric morbidity and mortality were identified by data from the Danish Psychiatric Central Research Register and the Cause of Death Register through a retrospective register study of 104 sex-reassigned individuals. Results: Overall, 27.9% of the sample were registered with psychiatric morbidity before SRS and 22.1% after SRS (p = not significant). A total of 6.7% of the sample were registered with psychiatric morbidity both before and after SRS. Significantly more psychiatric diagnoses were found before SRS for those assigned as female at birth. Ten individuals were registered as deceased post-SRS with an average age of death of 53.5 years. Conclusions: No significant difference in psychiatric morbidity or mortality was found between male to female and female to male (FtM) save for the total number of psychiatric diagnoses where FtM held a significantly higher number of psychiatric diagnoses overall. Despite the over-representation of psychiatric diagnoses both pre- and post-SRS the study found that only a relatively limited number of individuals had received diagnoses both prior to and after SRS. This suggests that generally SRS may reduce psychological morbidity for some individuals while increasing it for others.

Sexually explicit media use and relationship satisfaction: a moderating role of emotional intimacy?

ABSTRACT Using a cross-sectional questionnaire design and a sample of 2284 coupled Croatian adults, this study investigated the association between Sexually Explicit Media (SEM) use and relationship satisfaction. Further, possible moderation of emotional intimacy on the relationship between SEM use and relationship satisfaction was investigated. Controlling for sociodemographic, psychosexual and relationship variables, no significant association between SEM use and relationship satisfaction was found. However, among men, a moderating effect of emotional intimacy was found. Thus, higher SEM use was found to be significantly associated with lower relationship satisfaction only among men who reported lower levels of emotional intimacy with their partner.

Successful Aging and Changes in Sexual Interest and Enjoyment Among Older European Men and Women

INTRODUCTION Despite the popularity and analytical relevance of the concept of successful aging, little efforts have been made to address its relationship to sexuality in older individuals. AIM To explore the relationship between successful aging and the (retrospectively assessed) change in sexual interest and enjoyment in the past 10 years, using a new multidimensional model of successful aging. METHODS The data for this study was collected in 2016 using national probability-based surveys in four European countries (Norway, Denmark, Belgium and Portugal). In total, information from 2,461 sexually active and inactive participants aged 60-75 years was used for analyses. Multigroup structural equation analysis was employed to address the associations between key constructs. MAIN OUTCOME MEASURE The dependent variable was a composite (two-item) indicator of change in sexual interest and enjoyment in the past 10 years; a multifaceted model of successful aging predicted the change by country and gender. RESULTS Tested cross-culturally, the proposed model of successful aging demonstrated a good fit to the data. Furthermore, its metric characteristics enabled direct comparisons across gender and national cultures. Controlling for sociodemographic characteristics, higher successful aging scores were consistently related to lower reduction in sexual interest/enjoyment among men and women across the 4 countries. CLINICAL IMPLICATIONS Given an increased life-expectancy and focus on healthy aging in many countries, the findings about the associations between sexual expression, quality of life and aging well are valuable to professionals working in the area of healthy sexual aging. STRENGTH & LIMITATIONS This is the first study to systematically address the relationship between successful aging and sexuality. Furthermore, it provides a multidimensional measure of successful aging for a wide range of sexologic studies. Among limitations, possible self-selection bias (toward more sexually permissive and sexually active participants) and the fact that the findings are restricted to older heterosexual individuals, should be considered. CONCLUSION Without stigmatizing the absence of sexual expression in aging individuals, the findings from this cross-cultural study point out that sustained sexual interest and sexual enjoyment are linked to successful aging in both genders. Štulhofer A, Hinchliff S, Jurin T, Hald GM, Træen B. Successful Aging and Changes in Sexual Interest and Enjoyment Among Older European Men and Women. J Sex Med 2018;15:1393-1402.

Long-Term Follow-Up of Individuals Undergoing Sex-Reassignment Surgery: Somatic Morbidity and Cause of Death.

Introduction Studies of mortality and somatic well-being after sex-reassignment surgery (SRS) of transsexual individuals are equivocal. Accordingly, the present study investigated mortality and somatic morbidity using a sample of transsexual individuals who comprised 98% (n = 104) of all surgically reassigned transsexual individuals in Denmark. Aims To investigate somatic morbidity before and after SRS and cause of death and its relation to somatic morbidity after SRS in Danish individuals who underwent SRS from 1978 through 2010. Methods Somatic morbidity and mortality in 104 sex-reassigned individuals were identified retrospectively by data from the Danish National Health Register and the Cause of Death Register. Main Outcome Measures Somatic morbidity and cause of death. Results Overall, 19.2% of the sample were registered with somatic morbidity before SRS and 23.1% after SRS (P = not significant). In total, 8.6% had somatic morbidity before and after SRS. The most common diagnostic category was cardiovascular disease, affecting 18 individuals, 9 before and 14 after SRS, and 5 of those 14 who were affected after SRS had cardiovascular disease before and after SRS. Ten individuals died after SRS at an average age of 53.5 ± 7.9 years (male to female) and 53.5 ± 7.3 years (female to male). Conclusion Of 98% of all Danish transsexuals who officially underwent SRS from 1978 through 2010, one in three had somatic morbidity and approximately 1 in 10 had died. No significant differences in somatic morbidity or mortality were found between male-to-female and female-to-male individuals. Despite the young average age at death and the relatively larger number of individuals with somatic morbidity, the present study design does not allow for determination of casual relations between, for example, specific types of hormonal or surgical treatment received and somatic morbidity and mortality.