Attachment-related anxiety is associated with poor genital satisfaction and sexual problems in women

Nikola Komlenac1, Margarethe Hochleitner2
1Gender Medicine Unit, Medical University of Innsbruck, Fritz-Pregl-Strasse 3, 6020, Innsbruck, Austria
2Gender Medicine Unit, Medical University of Innsbruck, Innrain 66, 6020, Innsbruck, Austria

Tóm tắt

Abstract Background

Genital satisfaction has been found to influence women’s sexual experience. We tested the Relational Bodily Experiences Theory (RBET) that predicts associations between women’s genital satisfaction, attachment models, and sexual desire. We extended the model by additionally considering sexual arousal, orgasmic sensation, or the experience of pain during sexual activity as outcome variables. According to the RBET, women’s attachment models are associated with their genital satisfaction and linked to women’s sexual experience.

Methods

A cross-sectional online questionnaire study was conducted at an Austrian medical university. In total 294 women (Mage = 23.7, SD = 3.4) provided full responses. Women were asked about genital satisfaction and experiences of distressing sexual problems. Attachment-related anxiety and avoidance were assessed with the Experiences in Close Relationships-Relationship Structures Questionnaire.

Results

Results partially support the RBET. Attachment-related anxiety was associated with genital satisfaction which, in turn, was linked to experiences of frequent and/or distressing diminished sexual arousal, diminished sexual desire, or pain during sexual activity.

Conclusions

These results suggest that clinicians should assess genital satisfaction when treating female sexual problems. Women with attachment-related anxiety may especially be prone to having poor genital satisfaction and may profit from body image interventions in order to improve their sexual experience.

Từ khóa


Tài liệu tham khảo

Cherkasskaya E, Rosario M. The Relational and Bodily Experiences Theory of sexual desire in women. Arch Sex Behav. 2019a;45:1659–81.

Cherkasskaya E, Rosario M. Relational and Bodily Experiences Theory: attachment and sociocultural influences in a parsimonious model of sexual desire in women. Arch Sex Behav. 2019b;48:1719–22.

Cherkasskaya E, Rosario M. A model of female sexual desire: internalized working models of parent–child relationships and sexual body self-representations. Arch Sex Behav. 2017;46:2429–44.

Komarnicky T, Skakoon-Sparling S, Milhausen RR, Breuer R. Genital self-image: associations with other domains of body image and sexual response. J Sex Marital Ther. 2019;45:524–37.

Herbenick D, Schick V, Reece M, Sanders S, Dodge B, Fortenberry JD. The Female Genital Self-Image Scale (FGSIS): results from a nationally representative probability sample of women in the United States. J Sex Med. 2011;8:158–66.

Barlow DH. Causes of sexual dysfunction: the role of anxiety and cognitive interference. J Consult Clin Psychol. 1986;54:140–8.

Silva E, Pascoal PM, Nobre P. Beliefs about appearance, cognitive distraction and sexual functioning in men and women: a mediation model based on cognitive theory. J Sex Med. 2016;13:1387–94.

American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5). London: American Psychiatric Publishing; 2013.

WHO. Internationale Klassifikation psychischer Störungen: ICD-10 Kapitel V (F) Klinisch-diagnostische Leitlinien. Dilling H, Mombour W, Schmidt MH, editors. Bern: Verlag Hans Huber, Hogrefe; 2008.

Hendrickx L, Gijs L, Enzlin P. Sexual difficulties and associated sexual distress in Flanders (Belgium): a representative population-based survey study. J Sex Med. 2016;13:650–68.

Hazan C, Shaver PR. Attachment as an organizational framework for research on close relationships. Psychol Inq. 1994;5:1–22.

Bowlby J. Attachment and loss: volume II: separation, anxiety and anger. New York: Basic Books; 1973. p. 1–429.

Fraley RC, Roisman GI. The development of adult attachment styles: four lessons. Curr Opin Psychol. 2019;25:26–30.

Doherty NA, Feeney JA. The composition of attachment networks throughout the adult years. Pers Relatsh. 2004;11:469–88.

Pinquart M, Feußner C, Ahnert L. Meta-analytic evidence for stability in attachments from infancy to early adulthood. Attach Hum Dev. 2013;15:189–218.

Fraley RC. Attachment in adulthood: recent developments, emerging debates, and future directions. Annu Rev Psychol. 2019;70:401–22.

Klohnen EC, Weller JA, Luo S, Choe M. Organization and predictive power of general and relationship-specific attachment models: one for all, and all for one? Pers Soc Psychol Bull. 2005;31:1665–82.

McConnell M, Moss E. Attachment across the life span: factors that contribute to stability and change. Austr J Educ Dev Psychol. 2011;11:60–77.

Nichols M. Expanding our understanding of women’s sexual desire. Arch Sex Behav. 2019;48:1699–701.

Zimmer-Gembeck MJ, French J. Associations of sexual subjectivity with global and sexual well-being: a new measure for young males and comparison to females. Arch Sex Behav. 2016;45:315–27.

Fredrickson BL, Roberts T-A. Objectification theory: toward understanding women’s lived experiences and mental health risks. Psychol Women Q. 1997;21:173–206.

Grogan S. Body image: understanding body dissatisfaction in men, women and children. New York: Routledge; 2016.

Bogaert AF, Brotto LA. Object of Desire self-consciousness theory. J Sex Marital Ther. 2014;40:323–38.

Mikulincer M, Shaver PR. The attachment behavioral system in adulthood: activation, psychodynamics, and interpersonal processes. Adv Exp Soc Psychol. 2003;35:56–152.

Berman LA, Berman J, Miles M, Pollets DAN, Powell JA. Genital self-image as a component of sexual health: relationship between genital self-image, female sexual function, and quality of life measures. J Sex Marital Ther. 2003;29:11–21.

Berman L, Windecker MA. The relationship between women’s genital self-image and female sexual function: a national survey. Curr Sex Health Rep. 2008;5:199–207.

Braun V. In search of (better) sexual pleasure: female genital ‘cosmetic’ surgery. Sexualities. 2005;8:407–24.

Alleva JM, Sheeran P, Webb TL, Martijn C, Miles E. A meta-analytic review of stand-alone interventions to improve body image. PLoS ONE. 2015;10:e0139177.

Velotta N, Schwartz P. Developing an integrative approach to female sexual desire: the advances and drawbacks of Relational and Bodily Experiences Theory. Arch Sex Behav. 2019;48:1715–8.

Komlenac N, Siller H, Bliem HR, Hochleitner M. Associations between gender role conflict, sexual dysfunctions, and male patients’ wish for physician–patient conversations about sexual health. Psychol Men Masc. 2019;20:337–46.

Mitchell KR, Jones KG, Wellings K, Johnson AM, Graham CA, Datta J, et al. Estimating the prevalence of sexual function problems: the impact of morbidity criteria. J Sex Res. 2016;52:955–67.

Hendrickx L, Gijs L, Enzlin P. Age-related prevalence rates of sexual difficulties, sexual dysfunctions and sexual distress in heterosexual men: results from an online survey in Flanders. Sex Relatsh Ther. 2019;34:440–61.

Petrie TA, Tripp MM, Harvey P. Factorial and construct validity of the Body Parts Satisfaction Scale-Revised: an examination of minority and nonminority women. Psychol Women Q. 2002;26:213–21.

Fraley RC, Heffernan ME, Vicary AM, Brumbaugh CC. The experiences in close relationships—Relationship Structures Questionnaire: a method for assessing attachment orientations across relationships. Psychol Assess. 2011;23:615–25.

Bollen KA, Stine R. Direct and indirect effects: classical and bootstrap estimates of variability. Sociol Methodol. 1990;20:115–40.

Muthén LK, Muthén BO. Mplus user’s guide. Los Angeles: Muthén & Muthén; 1998–2017.

Satorra A, Bentler PM. A scaled difference chi-square test statistic for moment structure analysis. Psychometrika. 2001;66:507–14.

Weston R, Gore PA. A brief guide to structural equation modeling. Couns Psychol. 2006;34:719–51.

Weiber R, Mühlhaus D. Strukturgleichungsmodellierung: Eine anwendungsorientierte Einführung in die Kausalanalyse mit Hilfe von AMOS, SmartPLS und SPSS. 2nd, extended and corrected ed. Berlin: Springer; 2014.

Browne MW, Cudeck R. Alternative ways of assessing model fit. In: Bollen KA, Long JS, editors. Testing structural equation models, vol. 154. London: Sage Publications; 1993. p. 136–62.

Cash TF, Thériault J, Annis NM. Body image in an interpersonal context: adult attachment, fear of intimacy and social anxiety. J Soc Clin Psychol. 2004;23:89–103.

DeVille DC, Ellmo FI, Horton WA, Erchull MJ. The role of romantic attachment in women’s experiences of body surveillance and body shame. Gend Issues. 2015;32:111–20.

Pascoal P, Narciso I, Pereira NM. Predictors of body appearance cognitive distraction during sexual activity in men and women. J Sex Med. 2012;9:2849–60.

Sanchez DT, Kiefer AK. Body concerns in and out of the bedroom: implications for sexual pleasure and problems. Arch Sex Behav. 2007;36:808–20.

Ramseyer Winter V, Teti M, Landor AM, Morris K. “On a journey to appreciate what my body does for me”: qualitative results from a positive body image pilot intervention study. Soc Work Public Health. 2019;34:637–45.

Ramseyer Winter V, Landor AM, Teti M, Morris K, Schliep EM, Pevehouse-Pfeiffer D, et al. Is body appreciation a mechanism of depression and anxiety? An investigation of the 3-Dimensional Body Appreciation Mapping (3D-BAM) intervention. Ment Health Prev. 2019;14:200158.

Alleva JM, Martijn C, Van Breukelen GJP, Jansen A, Karos K. Expand your horizon: a programme that improves body image and reduces self-objectification by training women to focus on body functionality. Body Image. 2015;15:81–9.

Johnson S. An emotionally focused approach to sex therapy. In: Peterson ZD, editor. The Wiley handbook of sex therapy. West Sussex: Wiley; 2017. p. 250–65.

Basson R. Are healthy parental attachments and resilience to societal objectification basic to women’s sexual health? Arch Sex Behav. 2019;48:1683–7.

Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. New York: Lawrence Erlbaum Associates Inc; 1988.

McCabe MP, Sharlip ID, Lewis R, Atalla E, Balon R, Fisher AD, et al. Risk factors for sexual dysfunction among women and men: a consensus statement from the fourth International Consultation on Sexual Medicine 2015. J Sex Med. 2016;13:153–67.

Meston CM, Bradford A. Sexual dysfunctions in women. Annu Rev Clin Psychol. 2007;3:233–56.

Sharp G, Tiggemann M, Mattiske J. Predictors of consideration of labiaplasty: an extension of the tripartite influence model of beauty ideals. Psychol Women Q. 2015;39:182–93.

Choi BCK, Pak AWP. A catalog of biases in questionnaires. Prev Chronic Dis. 2005;2:Article A13.

World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310:2191–4.

American Psychological Association. Ethical principles of psychologists and code of conduct. Am Psychol. 2002;57:1060–73.