Stuart Brody

Sexual satisfaction, sexual compatibility, and relationship adjustment in couples: the role of sexual behaviors, orgasm, and men's discernment of women's intercourse orgasm.

INTRODUCTIONnResearch indicated that (i) vaginal orgasm consistency is associated with indices of psychological, intimate relationship, and physiological functioning, and (ii) masturbation is adversely associated with some such measures.nnnAIMnThe aim of this study was to examine the association of various dyadic and masturbation behavior frequencies and percentage of female orgasms during these activities with: (i) measures of dyadic adjustment; (ii) sexual satisfaction; and (iii) compatibility perceived by both partners.nnnMETHODSnIn a sample of 85 Czech long-term couples (aged 20-40; mean relationship length 5.4 years), both partners provided details of recent sexual behaviors and completed sexual satisfaction, Spanier dyadic adjustment, and Hurlbert sexual compatibility measures. Multiple regression analyses were used.nnnMAIN OUTCOME MEASUREnThe association of sexual behaviors with dyadic adjustment, sexual compatibility, and satisfaction was analyzed.nnnRESULTSnIn multivariate analyses, womens dyadic adjustment is independently predicted by greater vaginal orgasm consistency and lower frequency of womens masturbation. For both sexes, sexual compatibility was independently predicted by higher frequency of penile-vaginal intercourse and greater vaginal orgasm consistency. Womens sexual satisfaction score was significantly predicted by greater vaginal orgasm consistency, frequency of partner genital stimulation, and negatively with masturbation. Mens sexual satisfaction score was significantly predicted by greater intercourse frequency and any vaginal orgasm of their female partners. Concordance of partner vaginal orgasm consistency estimates was associated with greater dyadic adjustment.nnnCONCLUSIONSnThe findings suggest that specifically penile-vaginal intercourse frequency and vaginal orgasm consistency are associated with indices of greater intimate relationship adjustment, satisfaction, and compatibility of both partners, and that womens masturbation is independently inversely associated with measures of dyadic and personal function. Results are discussed in light of previous research and an evolutionary theory of vaginal orgasm.

An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female anorectal dysfunction

Introduction and hypothesisThe terminology for anorectal dysfunction in women has long been in need of a specific clinically-based Consensus Report.MethodsThis Report combines the input of members of the Standardization and Terminology Committees of two International Organizations, the International Urogynecological Association (IUGA) and the International Continence Society (ICS), assisted on Committee by experts in their fields to form a Joint IUGA/ICS Working Group on Female Anorectal Terminology. Appropriate core clinical categories and sub classifications were developed to give an alphanumeric coding to each definition. An extensive process of twenty rounds of internal and external review was developed to exhaustively examine each definition, with decision-making by collective opinion (consensus).ResultsA Terminology Report for anorectal dysfunction, encompassing over 130 separate definitions, has been developed. It is clinically based with the most common diagnoses defined. Clarity and user-friendliness have been key aims to make it interpretable by practitioners and trainees in all the different specialty groups involved in female pelvic floor dysfunction. Female-specific anorectal investigations and imaging (ultrasound, radiology and MRI) has been included whilst appropriate figures have been included to supplement and help clarify the text. Interval review (5–10xa0years) is anticipated to keep the document updated and as widely acceptable as possible.ConclusionsA consensus-based Terminology Report for female anorectal dysfunction terminology has been produced aimed at being a significant aid to clinical practice and a stimulus for research.

Erectile Dysfunction and Premature Ejaculation: Interrelationships and Psychosexual Factors

INTRODUCTIONnBoth erectile dysfunction (ED) and premature ejaculation (PE) impair the quality of sexual intercourse for both men and their female partners.nnnAIMSnThis study aims to examine with a large representative sample the interrelationships of measures of ED, PE, typical intravaginal ejaculatory latency time (IELT), mens perceived relationship quality with their mother, and age of first being in love.nnnMETHODSnIn this cross-sectional study, a nationally representative sample of 960 Czech coitally experienced men (aged 15-84), provided age, International Index of Erectile Function 5-item (IIEF-5), Index of Premature Ejaculation (IPE) scores, IELT, rating of relationship with their mother, and age at first being in love.nnnMAIN OUTCOME MEASURESnCorrelations, partial correlations adjusting for age, analysis of covariance (ANCOVA), and multiple regression statistical methods were used.nnnRESULTSnIIEF-5, IPE, and IELT were significantly intercorrelated (IIEF-5 and IPE: r=0.64). Better IIEF-5 scores were associated with younger age at first (and ever) being in love. Poorer IPE score, shorter IELT, and mild-moderate ED were associated with poorer perceived mother relationship (which was also associated with first being in love at an older age). Multiple regression analyses revealed that: (i) greater IELT was associated with better erectile function and better mother relationship, but not with age; and (ii) IELT of <1 minute was associated with poorer perceived mother relationship and poorer IIEF-5, but marginally with age. History of homosexual activity was unrelated to IIEF-5, IPE, IELT, and perceived mother relationship scores.nnnCONCLUSIONSnThe findings suggest that degrees of ED and PE are often comorbid, and both ED and PE are associated with less favorable early experiences with women. Brody S and Weiss P. Erectile dysfunction and premature ejaculation: Interrelationships and psychosexual factors. J Sex Med 2015;12:398-404.

Orgasm and women's waist circumference

OBJECTIVEnGiven that adiposity is related to poorer female sexual function, among many other health problems, the present study aimed at testing the hypothesis that larger waist circumference, an index of subcutaneous and abdominal fat mass, is associated with lack of specifically vaginal orgasm. Study design One hundred and twenty Portuguese women of reproductive age had their waist measured and reported their past month frequency of penile-vaginal intercourse (PVI), vaginal orgasm, orgasm from clitoral masturbation during PVI, non-coital partnered sex (in the absence of same-day PVI), non-coital partnered sex orgasm (regardless of same-day PVI), masturbation, and masturbation orgasm.nnnRESULTSnIn both simple and partial correlations (controlling for age, social desirability responding, relationship status, and cohabitation status), larger waist circumference was associated with lack of any vaginal orgasm and with having masturbated in the past month. In a multiple regression, larger waist circumference was independently predicted by lesser frequency of vaginal orgasm, greater frequency of masturbation, and older age.nnnCONCLUSIONnAbdominal fat mass appears to be adversely associated with lesser capacity for vaginal orgasm, but not for orgasms from other sexual activities. Results are discussed in the context of vaginal orgasm being relatively more contingent on situations of increased fitness in both partners.

Specifically Penile-Vaginal Intercourse Frequency Is Associated With Better Relationship Satisfaction: A Commentary on Hicks, McNulty, Meltzer, and Olson (2016)

In a recent Psychological Science article, Hicks, McNulty, Meltzer, and Olson (2016) asserted that previous research on the association between sexual frequency and relationship satisfaction led to inconclusive results. However, Hicks et al. overlooked good evidence that there is a consistent relationship between penile-vaginal intercourse frequency and measures of relationship satisfaction (among other dimensions of satisfaction and indices of psychological and physical health and function; Brody, 2010; Brody & Costa, 2009; Brody, Costa, Hess, & Weiss, 2011; Costa & Brody, 2007; Maunder, Schoemaker, & Pruessner, 2017; Santtila et al., 2008; Smith, Nezlek, Webster, & Paddock, 2007). Other sexual behaviors (e.g., masturbation, anal sex, cunnilingus) are generally uncorrelated or even adversely associated with relationship satisfaction and other satisfaction measures (Brody, 2010). The significance of the associations between penile-vaginal intercourse and relationship satisfaction remains consistent in studies using large representative population samples or multivariate methods to control for the frequency of all measured sexual behaviors (Brody & Costa, 2009; Santtila et al., 2008). Space limitations preclude presenting a metaanalysis of the correlations between penile-vaginal intercourse frequency and relationship satisfaction, but examples include effect sizes (Cohen’s ds) such as 0.72 for men and 0.63 for women in a nationally representative Swedish sample (N = 2,810; Brody & Costa, 2009), 0.21 for men and 0.32 for women in a Finnish study of twins (N = 3,604; Santtila et al., 2008), and 1.04 for women in a convenience sample from Portugal (N = 30; Costa & Brody, 2007). Unfortunately, many studies fail to differentiate between penile-vaginal intercourse and other sexual behaviors, which thereby precludes the ability to detect essential differences between sexual behaviors. Various studies have found that when sexual behaviors are not very clearly defined, some individuals even exclude certain categories of sexual activities from their definition of sex (Byers, Henderson, & Hobson, 2009; Gute, Eshbaugh, & Wiersma, 2008; Peterson & Muehlenhard, 2007). Hicks et al. noted that in their own study results, there might have been a biasing effect due to not being sufficiently specific regarding definitions of sex. The two studies that Hicks et al. cited as not finding an association between sexual frequency and relationship satisfaction actually measured “any sexual engagement between spouses in which at least one of the spouses experienced an orgasm” (Hurlbert & Apt, 1994, p. 491) and “any mutually voluntary activity that involves genital contact and/or stimulation, even if intercourse or orgasm did not occur” (Heiman et al., 2011, p. 744). It has been noted that sexual pleasure is an evolutionary adaptation that ultimately motivates people to engage in penile-vaginal intercourse in the service of reproduction; however, sexual pleasure can be diverted to other functions, and people can engage in sexual behaviors other than penile-vaginal intercourse for the 691547 PSSXXX10.1177/0956797617691547Brody et al.Penile-Vaginal Intercourse and Relationship Satisfaction research-article2017

Evaluation of Female Orgasmic Disorder

The issues to be considered and approaches to be used in the evaluation of female orgasmic disorder are presented in the context of research evidence and best clinical practice. The sections in this chapter include epidemiology, etiology, pathophysiology, DSM-5 and ICD-10 diagnostic criteria, and approach to diagnosis (including diagnostic scales and issues to be considered during the clinical interview). Psychological, behavioral, interpersonal, pharmacological, and physiological factors related to female orgasmic disorder are reviewed. The psychological and behavioral issues include family and other developmental and experiential factors, exercise, personality traits, attachment, psychopathology, intimate relationship function, specifics of sexual behaviors, mental focus during sexual activity, specifics of sex education, and partner characteristics including partner sexual function. The physiological factors reviewed include prenatal factors, age, nutrition and substance use, medical conditions and treatments, hormonal influences, autonomic tone, muscle tone, and both peripheral and central neurophysiological pathways. The problem of fluctuating diagnostic criteria is addressed, and the issue of whether a distress criterion scientifically or clinically merits being a requirement for the diagnosis of female orgasmic disorder is evaluated. The evidence for differences between orgasm triggers (including the special psychological, physiological, and interpersonal aspects of vaginal orgasm) is presented. The implications of the process of evaluation of female orgasmic disorder for its treatment formulation are also presented.

Obesity, Overweight, Female Sexual Function, and Penile-Vaginal Intercourse Frequency.

In a recent study, Lara and colleagues found, in a convenience Brazilian sample of women in their thirties, that obese women had greater coital frequency than slimmer women (Lara, Lima, Romao, Ferriani, & Navarro, 2015). Although the terms coitus and intercourse usually mean penile-vaginal intercourse (PVI) in the English language, modern usage by some persons leaves confusion with other partnered sexual behaviors, including in translations of more inclusive terms of other languages. This could be a limitation of the study by Lara et al. with possible confounding effects on their findings, as there is no information on how coitus was defined (indeed, they also implied that simply sexual activity was queried rather than PVI specifically); this is relevant, because studies that examined the relationships of body fat indices and sexual satisfaction with different sexual behaviors found that satisfaction was specifically related to greater PVI frequency and greater PVI orgasm frequency (Brody & Costa, 2009; Philippsohn & Hartmann, 2009; Tao & Brody, 2011). In contrast, greater body fat was specifically related to lesser frequency of PVI or lesser frequency of orgasms from PVI without clitoral masturbation (Brody, 2004; Costa & Brody, 2014). The finding by Lara and colleagues (2015) is in contradiction to many research studies conducted in a variety of countries, of which we give some examples without trying to be exhaustive. Greater PVI frequency was related to slimmer hips in a German sample (Brody, 2004) and with a slimmer waist in a large nationally representative Czech sample (Brody & Weiss, 2013). In Italian samples, intercourse frequency was lower for overweight and obese women than for lean women (Castellini et al., 2010; Morotti et al., 2013). Among Portuguese

Female Sexual Function and Heart Rate Variability

Few studies have examined the associations of resting heart rate variability (HRV) with female sexual function and behavior. Therefore, we welcome the recent study finding that women with below average resting HRV (as assessed by the standard deviation of NN intervals; SDNN) had lower sexual arousal and lower global sexual function than women with average or above average SDNN (while viewing a neutral film) (Stanton et al. 2015). The SDNN reflects relatively lower sympathetic activity and/or relatively higher parasympathetic activity. Those authors noted the lack of studies on female sexuality and HRV, but missed citing an important study which explored the associations of HRV with women’s frequency of orgasm produced by several different sexual behaviors (Costa and Brody 2012). In that study, it was found that women who had any orgasm triggered by penile-vaginal intercourse (PVI) without simultaneous clitoral masturbation (henceforth, vaginal orgasm) in the past month had higher resting HRV (as assessed by the standard deviation of heart rate, a relatively similar index of HRV) than women who did not have a vaginal orgasm in the past month (Costa and Brody 2012). Of note, orgasm produced by other sexual behaviors including PVI with concurrent clitoral masturbation for the orgasm, clitorally-focused partnered masturbation, oral sex, solitary masturbation, and anal sex were unrelated to resting HRV. Orgasm from vaginally-focused masturbation by the woman’s partner was nearly significantly associated with higher HRV, but this marginal association disappeared in multivariate analyses controlling for the other orgasm trigger frequencies, resulting in only vaginal orgasm being associated with women’s greater resting HRV. These findings were discussed in terms of lower HRV being a reflection of pathophysiological processes that can impair female orgasmic responsiveness specifically during PVI (Costa and Brody 2012). This raises the possibility that vaginal responsiveness is more easily adversely affected by psychological and physiological dysfunctional processes than responding to direct clitoral masturbation. The vagus nerve (the main driver of the parasympathetic nervous system influences on HRV) transmits afferent sensory information from the proximal vagina and cervix to the brain, but is not stimulated by the clitoris (Komisaruk and Whipple 1998; Komisaruk et al. 2004). Given that appropriate afferent vagal stimulation might increase (or ‘‘tune’’) efferent vagal activity on a relatively long-term basis (Gellhorn 1967), it is plausible that PVI may enhance HRV with concomitant health benefits (Costa and Brody 2012). These findings are congruent with another study finding that greater resting HRV (standard deviation of heart rate) was associated with greater PVI frequency in a sample of both sexes, and the sex of the research participant was not a significant confounding variable (Brody and Preut 2003). Unlike in the study by Stanton and colleagues, in these two studies, resting HRV was measured without an inserted vaginal probe (Brody and Preut 2003; Costa and Brody 2012), which Stanton and colleagues listed as a potential confounder in their own study. In a large nationally representative Czech sample, female sexual arousal disorder was related to lack of history of vaginal orgasm and difficulties in focusing on & Rui M. Costa rmscosta@gmail.com