The sexual responses of women with a history of child sexual abuse
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Theoretical and epidemiological studies indicate that women with a history of child sexual abuse (CSA) experience more sexual problems during adulthood compared to non-abused women. Despite the abundance of research conducted on prevalence and incidence of sexual difficulties associated with a history of CSA, very little is known on the psychophysiological sexual response of CSA survivors. A study was conducted to examine whether women with and without a history of CSA differed in their physiological and subjective sexual responses when exposed to erotic videos. A second study was conducted to explore potential predictors of the physiological and subjective sexual responses of women with a history of CSA. Overall, the physiological sexual arousal of CSA survivors was not significantly weaker than the response of women with no history of CSA. However, when controlling for levels of sexual distress and sexual function those CSA survivors with higher levels of sexual distress showed lower physiological sexual arousal compared to CSA survivors with less sexual distress. In agreement with prior studies, for women with no history of CSA the relationship between levels of distress and physiological sexual arousal was not significant. Similarly, levels of subjective sexual arousal reported in the laboratory were associated with sexual distress in CSA survivors but not in women with no history of CSA. Women who reported more re-experiencing symptoms and more negative affect before the erotic video showed a significantly lower increase in subjective sexual arousal in the presence of an increase in physiological sexual arousal. Cortisol levels measured before and after exposure to the erotic video indicated that higher dissociation experienced during the sexual interaction with a partner is associated with a cortisol secretion during exposure to sexual stimuli. This finding suggests a potentially learned stress response to erotic stimuli which may negatively affect the physiological sexual arousal for a subgroup of CSA survivors. Findings from the two studies suggest that the psychophysiological assessment of the sexual response of CSA survivors captures some important aspects of the sexual difficulties experienced by these women. A number of potential predictors of the physiological and the subjective sexual responses of CSA survivors were identified. Future studies will need to examine whether interventions that target these predictors can help CSA survivors to increase their physiological and subjective sexual arousal to sexual cues and whether this provides some relief to their sexual distress.