The relationship between affective appraisal of physiological sexual arousal and sexual dysfunction among women with a history of childhood sexual abuse
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Women with a history of childhood sexual abuse (CSA) are at a higher risk of sexual dysfunction than non-abused women and standard treatments for sexual dysfunction have been less effective in abused women. Although low desire is the sexual difficulty most commonly reported by women in general, for abused women arousal problems are most prevalent. The variation in presentation of sexual dysfunction and treatment response for abused women suggests that the sexual dysfunction of abused women may develop via unique pathways from that of their non-abused peers. The aim of this study was to identify mechanisms underlying the relationship between a history of CSA and sexual dysfunction. Prior work suggests that sexual arousal may be associated with negative affect and trauma memories for abused women, therefore I hypothesized that greater negative and shameful and less positive appraisal of genital sexual arousal would explain the relationship between a history of CSA and sexual dysfunction. I also tested a number of other candidate mechanisms to explain this relationship. Participants were 107 women from the local community: 61 abused women and 46 non-abused women. Participants completed a single laboratory session in which they viewed an erotic film and completed questionnaires on appraisal of genital sexual arousal and other candidate mechanisms. Results supported the notion that the sexual difficulties of abused women develop through distinct pathways by indicating that appraisal of genital sexual arousal and body image focused on sexual attractiveness explain the relationship between a history of CSA and sexual dysfunction. Greater negative appraisal of genital arousal and one’s own sexual attractiveness during sexual arousal could be highly distracting to abused women trying to engage in consensual sexual activity and suggest an extension of Barlow’s cognitive affective model of sexual function to abused women. Although Barlow’s model helps to explain the sexual function of women in general, the current results suggest that the content that distracts women during sexual activity may differ by abuse history. Clinically these findings call for greater attention to negative appraisals of genital arousal and the overall body when treating sexual dysfunction in women with a history of CSA.
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