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Background: Aggressive sexual fantasies (ASFs) have consistently been associated with sexual aggression measures. ASF frequency has mostly been used to indicate ASF, but other ASF characteristics may be important to explain the apparent gap between alleged high lifetime prevalence rates of ASF and lower sexual aggression rates—that is, why ASFs are only sometimes put into action. Aim: The present study therefore examined whether additional ASF characteristics show associations with sexual aggression measures above and beyond ASF frequency to identify the most relevant ASF characteristics. Methods: The present study is based on cross-sectional survey data from 4 independent mostly community samples with 448, 131, 758, and 415 participants to examine whether ASF elaboration, intrusion, preoccupation, context, and consent were associated with self-reported sexual aggression measures beyond ASF frequency. Outcomes: Self-reported sexual aggression measures included presumably consensual and nonconsensual sexual sadism, self-reports on acting on ASF, sexual harassment, use of coercive strategies, and rape proclivity. Results: The results showed positive correlations among all ASF characteristics. ASF frequency was the most consistent and often strongest predictor of sexual aggression across samples and outcome measures. ASF elaboration and/or its interaction with ASF frequency added to this prediction in study 1 but not in study 2. All other ASF characteristics in studies 1 to 4 either did not add to the predictions or yielded results contrary to expectations, mostly suggesting suppressor effects. Clinical Implications: Sexual medicine and forensic sexology researchers may want to consider ASF frequency in diagnostics and develop and refine interventions to reduce it in cases of clearly elevated levels. Strengths and Limitations: The strengths of the present study include considering 4 independent samples as well as a large number of ASF characteristics and sexual aggression measures. Its limitations include the reliance on cross-sectional data and not being able to examine the potential influences of all ASF characteristics in a single model. Conclusion: ASF frequency seems the most valid and reliable indicator of ASF and the most important associate of sexual aggression. It should be considered the main indicator of ASF by future research and in prevention efforts and risk assessment. [ABSTRACT FROM AUTHOR]

Background Individuals convicted of a sexual offense (ICSO) can be treated with testosterone-lowering medication (TLM) in order to support the control of paraphilic sexual fantasies and to decrease the risk of sexual recidivism. However, due to partly severe side effects, TLM should not be a lifelong treatment. Aim The aim of the current study was to further evaluate the Change or Stop Testosterone-Lowering Medication (COSTLow)-R Scale in forensic outpatient aftercare practice. The scale was developed to assist forensic professionals in deciding on whether to change or stop TLM treatment in ICSO. Methods The COSTLow-R Scale was applied retrospectively in a forensic-psychiatric outpatient institution in Hesse, Germany, on 60 ICSO. TLM was terminated in 24 patients (40%). Moreover, 10 forensic professionals of the institution as well as an experienced working group within the institution focusing on the treatment of ICSO, qualitatively evaluated the COSTLow-R Scale by participating in an open designed survey. Outcomes The COSTLow-R Scale ratings as assessed by forensic professionals were collected. In addition, a survey was performed among these professionals about the usefulness of the scale and their practical experiences with it. Results A binary logistic regression analysis was conducted to ascertain the predictive power of the scale regarding the stopping of TLM. Three items of the COSTLow-R Scale significantly predicted stopping decisions: the possibility of psychotherapy before TLM treatment, psychopathic traits, and a substantial decrease of paraphilic severity. Thus, a decision towards stopping TLM was more likely for patients who showed greater treatment readiness before starting TLM, lower psychopathy scores, and a higher decrease of paraphilic severity. The forensic professionals described the scale as a good and structured tool that displays which aspects are important to consider during TLM treatment decisions. Clinical Implications The COSTLow-R Scale provides structure to the decision of whether to change or stop TLM and should thus be implemented in the forensic treatment process of patients with TLM more frequently. Strengths and Limitations Although the small sample size limits generalizability of the findings, the present study was conducted directly in a forensic outpatient practice and, therefore, has high external validity and a strong impact on the life and health of patients treated with TLM. Conclusion The results indicate that the COSTLow-R Scale can be a useful instrument facilitating the TLM decision-making process by providing a structured compendium of criteria. Further research is still needed to evaluate the scale and to provide additional evidence for the results of the current study. [ABSTRACT FROM AUTHOR]

Introduction: In recent years there has been a surge of research on plurisexuality (the ability to experience attraction to more than one gender). Evidence strongly suggests that plurisexual people experience desire differently, face unique stressors, and have increased risk for sexual dysfunction compared to gay and lesbian groups (Björkenstam et al., 2020). These factors may differ between plurisexual people in same-gender relationships and those in mixed-gender relationships. Fantasy and desire, two fundamental constructs of sexology theory and sex therapy, merit further research in this population. Objective: We hypothesize that plurisexual people experience fantasy and desire differently depending on their relationship type (same-gender vs. mixed-gender). Methods: Data was collected for a larger study of sexual health and behaviors in undergraduate students at a large university in the Midwestern US. The sample included participants in relationships (n=493; mean age = 20.48 years; 80% women, 16% men, 4% gender minority; 78% White). Respondents who identified as "bisexual," "pansexual," "mostly heterosexual," "mostly lesbian/gay," or a combination of these were coded as plurisexual, and other respondents (e.g., "heterosexual," "lesbian/gay," "asexual") were coded as not plurisexual. Respondents were coded as being in same-gender relationships if they identified as a man dating a man, a woman dating a woman, or any gender minority (e.g., "non-binary," "gender fluid") dating a man, woman, or other gender minority person (i.e., relationships likely to be perceived as queer). Respondents were coded as being in mixed-gender relationships if they identified as a man dating a woman or a woman dating a man. Fantasy was measured with an adapted Sex Fantasy Questionnaire (SFQ; Wilson, 1988), and desire with the Sexual Desire Inventory-2 (Spector, Carey, & Steinberg, 1996). We conducted two-way ANOVAs to evaluate the influence of plurisexual identity and relationship type on fantasy and desire. Results: There was a significant main effect of plurisexual identity on sexual fantasy (F(1, 391)=58.61, p<0.01) and desire (F(1, 469)=7.26 p<0.01), with plurisexual participants reporting higher levels of both. There was also a significant interaction effect between plurisexual identity and relationship type for fantasy (F(1, 391)=4.73, p=0.03) and sexual desire (F(1, 469)=5.78, p=0.02), such that the effect of plurisexuality was amplified for participants in mixed-gender relationships and attenuated for participants in same-gender relationships (see Figures). Conclusions: Results suggest that plurisexual people experience higher levels of fantasy and desire when in mixed-gender vs. same-gender relationships. These differences could be attributed to perceptions that plurisexual people in same-gender relationships are queer and those in mixed-gender relationships are straight (Arriaga & Parent, 2019). Additionally, the fluidity of sexual identity suggests that experiences of attraction, desire, and fantasy change substantially based on the gender of one's partner (Diamond, 2008). Clinically, our findings point to different applications of interventions on fantasy intended to stimulate desire in plurisexual patients with low desire, address desire discrepancy between partners, or separate problematic desire from behavior. As most research surrounding fantasy and its role in desire was developed in straight cisgender samples, clinicians and researchers should consider sexual orientation, relationship type, and their interaction when intervening upon fantasy. Disclosure: No. [ABSTRACT FROM AUTHOR]

Aggression-related sexual fantasies (ASF) are considered an important risk factor for sexual aggression, but empirical knowledge is limited, in part because previous research has been based on predominantly male, North-American college samples, and limited numbers of questions. The present study aimed to foster the knowledge about the frequency and correlates of ASF, while including a large sample of women and a broad range of ASF. A convenience sample of N = 664 participants from Germany including 508 (77%) women and 156 (23%) men with a median age of 25 (21–27) years answered an online questionnaire. Participants were mainly recruited via social networks (online and in person) and were mainly students. We examined the frequencies of (aggression-related) sexual fantasies and their expected factor structure (factors reflecting affective, experimental, masochistic, and aggression-related contents) via exploratory factor analysis. We investigated potential correlates (eg, psychopathic traits, attitudes towards sexual fantasies) as predictors of ASF using multiple regression analyses. Finally, we examined whether ASF would positively predict sexual aggression beyond other pertinent risk factors using multiple regression analysis. The participants rated the frequency of a broad set of 56 aggression-related and other sexual fantasies, attitudes towards sexual fantasies, the Big Five (ie, broad personality dimensions including neuroticism and extraversion), sexual aggression, and other risk factors for sexual aggression. All participants reported non-aggression-related sexual fantasies and 77% reported at least one ASF in their lives. Being male, frequent sexual fantasies, psychopathic traits, and negative attitudes towards sexual fantasies predicted more frequent ASF. ASF were the strongest predictor of sexual aggression beyond other risk factors, including general aggression, psychopathic traits, rape myth acceptance, and violent pornography consumption. ASF may be an important risk factor for sexual aggression and should be more strongly considered in prevention and intervention efforts. The strengths of the present study include using a large item pool and a large sample with a large proportion of women in order to examine ASF as a predictor of sexual aggression beyond important control variables. Its weaknesses include the reliance on cross-sectional data, that preclude causal inferences, and not continuously distinguishing between consensual and non-consensual acts. ASF are a frequent phenomenon even in in the general population and among women and show strong associations with sexual aggression. Thus, they require more attention by research on sexual aggression and its prevention. Bondü R, Birke JB, Aggression-Related Sexual Fantasies: Prevalence Rates, Sex Differences, and Links With Personality, Attitudes, and Behavior. J Sex Med 2021;18:1383–1397. [ABSTRACT FROM AUTHOR]

The use of androgen deprivation therapy (ADT) shows promising results in the treatment of paraphilic disorders. Although the side effects of ADT can be intrusive, there is no research into the experiences of patients with pedophilic disorder themselves. This research aims to explore the psychological, physical, and sexual experiences of ADT from the perspective of sex offenders diagnosed with pedophilic disorder. Twelve semistructured in-depth interviews with male adults diagnosed with pedophilic disorder were conducted using a phenomenological approach. Six of the 12 respondents were on luteinizing hormone-releasing hormone agonists and the remaining on anti-androgens. Half of each group were inpatients, and the other half outpatients. The respondents were recruited in collaboration with one psychiatric hospital. The data were analyzed with help of a qualitative software application NVivo. The respondents described experiences on the use of ADT on a physical, psychological, and sexual level. The most prominent physical side effects mentioned were bone loss, weight gain, and breast formation. The respondents generally described a positive influence of the medication on their well-being. They felt more relaxed and experienced a reduction in frequency and intensity of sexual fantasies, anger, and aggressive feelings in general. In addition, all the respondents noticed a lower frequency of sexual contact and masturbation. Most of the participants experienced the use of ADT as a mandatory decision made by the treating psychiatrist. This study recommends informing patients and their loved ones on the potential side effects of ADT. Furthermore, training forensic counselors on potential side effects of ADT and methods to alleviate them can promote the dissemination of information and will encourage the informed consent procedure. This is the first qualitative study about the experiences of ADT in men diagnosed with pedophilic disorder in Belgium. Future studies should include more than one treatment center. The majority of the participants had a positive attitude towards ADT in general. Boons L, Jeandarme I, Vervaeke G. Androgen Deprivation Therapy in Pedophilic Disorder: Exploring the Physical, Psychological, and Sexual Effects From a Patient's Perspective. J Sex Med 2021;18:353–362. [ABSTRACT FROM AUTHOR]

Introduction: Hypersexuality or Compulsive Sexual Behavior Disorder (CSBD) is characterized by a spectrum of sexual behaviors and fantasies marked by compulsion, obsession, and impulsivity. The pathophysiology of CSBD remains poorly understood despite the arousing of articles exploring the potential biomarkers associated with hypersexuality. Objective: We aimed to review the literature regarding the investigation on CSBD pathophysiology from a neuroimaging, neuroendocrine and molecular perspective. Methods: We raised papers related on neuroimaging, neuroendocrine and molecular biomarkers investigated in individuals that reached diagnosis of CSBD or similar, written in English language in the last 10 years, through PubMed, Scopus, and Web of Science with biomarkers and compulsive sexual behavior/hypersexuality key terms. Results: Neuroimaging studies revealed the activation of the anterior cingulate cortex, ventral striatum, and amygdala, in individuals with CSBD. Neuroendocrine markers revealed abnormalities in the hypothalamic-pituitary-adrenal (HPA) axis, including elevated adrenocorticotropic hormone (ACTH) levels and non-suppression of dexamethasone. Findings concerning the hypothalamic-pituitary-gonadal (HPG) axis, responsible for sexual function regulation, varied among CSBD individuals, including testosterone and luteinizing hormone (LH) levels. Oxytocin levels have been noted to rise in CSBD individuals and subsequently decrease following psychotherapy. Genetic and epigenetic markers associated with CSBD suggest involvement of addiction-related genes and epigenetic modifications near the corticotropin-releasing hormone (CRH) gene. Conclusion: Most of the findings point to HPA axis alterations. Molecular analysis is in the beginning, as well as more research on the HPG axis is needed. The exploration of CSBD biomarkers potentially will provide insights into its pathophysiology, diagnosis, and treatment. Financing: FAPESP. [ABSTRACT FROM AUTHOR]

Introduction: Although the definition of asexuality varies across previous studies, asexuality is usually defined as a lack of sexual attraction to others. Recent surveys of general populations report that 0.4–1 % of the population identifies as asexual. Previous studies on asexuality mainly focused on differences between asexual and allosexual individuals. Not surprisingly asexual individuals report fewer sexual fantasies, desire, arousal, masturbation, sex, and fewer sexual partners compared to allosexuals. But information about asexuality is still scattered. Objective: The main aim of this study was to map the prevalence of asexuality and diversity in the field of sexual milestones among asexual women and men. Methods: Participants were recruited in 2020 via sociodemographic agency using computer-assisted web interviewing software. Stratified random sampling with quotas on Czech nationality, region, size of the place of residence, sex, age, and education was applied. A representative sample of 1,616 adult men (n = 806; 21–85 years; mage = 50.65; SD = 15.52) and women (n = 810; 20–91 years; mage = 50,62; SD = 16.15) answered questions about selected dimensions of sexual and romantic relationship milestones. Results: Approximately 2.1 % (n = 17) of men and 1.6 % (n = 13) of women indicated they were asexual. Results also showed that 64.7 % of asexual men and 84.6 % of asexual women were in long-term romantic relationship and compared to sexual men and women had less sexual partners (7.1 vs. 15.2 and 3.5 vs. 9.6, respectively). Preliminary results showed that asexual women had a later onset of first desire to have a romantic relationship (17.2 vs. 16.2 years old), first masturbation (21.1 vs. 18.4), first falling in love (21.1 vs. 15.8), first interest in pornographic materials (22.4 vs. 18.4), an earlier onset of menarche (12.5 vs. 13.7), and first occurrences of sexual fantasies (17.5 vs. 18.3), compared to sexual women, respectively. Sexual women and asexual women were in same age of first passionate kissing (16.7 vs. 16.2), first sex (17.3 vs. 17.4), and first petting (16.1 vs. 16.6). Asexual men had an earlier onset of first masturbation (13.1 vs. 14.9 years old), first interest in pornographic materials (13.3 vs. 14.2), first occurrences of sexual fantasies (14.8 vs. 15.8), first falling in love (15.8 vs. 16.6), first sex (16.7 vs. 18.2 years old), compared to sexual men, respectively. Sexual and asexual men were in same age of first pollution (13.2 vs. 13.8), first passionate kissing (16.1 vs. 16.4 years old), first petting (16.1 vs. 16.6), and first desire to have a romantic relationship (16.9 vs. 17.2). Conclusions: Consistent with previous research, we found some biological and psychosocial markers that have been associated with asexuality. Asexual women experienced most of their sexual milestones later compared to sexual women. Interestingly, the opposite was found for asexual men. They experienced most of their sexual milestones earlier. Thus, our results suggest that the development of sexuality differs between asexual men and women. Disclosure: No. [ABSTRACT FROM AUTHOR]

Objectives: To measure the public opinion of different ages and sexes regarding their socio-sexual behaviors. Methods: A qualitative descriptive research carried out through the survey of the Albanian population living in Kosovo and Albania. The data were collected in September 2002 through "The revised Sociosexual Orientation Inventory", (Lars Penke). 712 people participated in the research (64.9% women and 34.1% men), of which 75.8% were aged 20-40. They were previously informed about the purpose of the research and the possibility of withdrawal. Results: The obtained results showed that 52.5% had sex with only one partner, 14.6% had sex with two partners. 38.5% did not have sexual relations without interest in a long-term committed relationship with that person, with one partner 20.8% and with two such partners 12.1%. Sex without love is OK thought 40.2% which agreed or fully agreed, while 43% of them disagreed. When they were asked for the possibility to imagine themself comfortable and enjoy "casual" sex with different partners, 54.7% disagreed, 30.1% agreed, while 18.3% are undecided. When asked about the fantasy of having sex with someone with whom they are not in a committed romantic relationship, 22.5% stated never and 37.1% rarely. In the question, how often do you spontaneously fantasize about having sex with someone you just met, 34.8% stated never, while 34.3% said rarely, while only 9.8% said a few times a week Conclusions: Based on these findings, we can conclude that even among Albanians there is a pronounced socio-sexual diversity. Conflicts of Interest: Authors declared no conflict of interest [ABSTRACT FROM AUTHOR]

Sexual imagery and fantasy are key aspects of human sexuality: they are associated with sexual arousal and are reflective of societal influences on sexuality. In addition, they are thought to play a role in sexual activation, desire and personal satisfaction. The current study aimed to depict the sexual imagery of Italian population using a paradigm similar to the pioneering American study about the same topic (Lehmiller, 2018). 5043 participants were recruited on social networks. A first collection of basic socio-demographic information was asked and then, the respondents were questioned about their sexual imagery. After descriptive analyses, a comparison was made between groups (sexual orientation, gender, age) through a one-way ANOVA and t-student test for independent samples, while correlations were investigated with Pearson correlations. Most participants (82%) think that sharing sexual fantasies with their partner improved their relationship, while the most common fantasy in the sample (60%) is seeking for "novelty or having new or exciting sexual experiences". It also emerged that men think about having sex with their partner's parents / best friends significantly more often than women, as well as having sex with younger partners, even much younger. People with a gender identity other than biological sex report the fantasy of having a different body during sexual intercourse and are more prone to having sex with transgender or cross-dressed people than respondents with congruence between gender identity and biological sex. Conversely, they report less interest in vaginal sex. This study offers a general but innovative overview of the Italian sexual imaginary. In a Country where LGBT+ rights are still underrepresented, and sex education struggles to emerge due to stigma and religious concerns, a colorful landscape of sexual fantasies and preferences has nevertheless emerged, highlighting continuity with the sexual revolution that is underway happening all over the world. Daniel Giunti, Paolo Antonelli, Andrea Olmi, Gioele Salvatori, Miriana Amoroso, Francesco Fantacci, Justin Lehmiller declare that they have no conflicts of interest. [ABSTRACT FROM AUTHOR]

To date, relatively few studies have provided an in-depth overview of approaches to treating paraphilic sexual fantasies. The different types of treatment were considered separately or some were not included or explored. The purpose of this systematic review is to provide a broad and in-depth overview of therapeutic approaches related to problematic sexual fantasies. A comprehensive search of four electronic databases (Cochrane Library, Google Scholar, Scopus, and EBSCO) was carried out to identify literature regarding the treatments of paraphilic sexual fantasies. References lists of articles were reviewed to identify additional papers. A total of 67 papers and relevant books were included. From the results of the current review, two main treatment approaches for paraphilic sexual fantasies emerged: behavioral and psychoanalytic. Behavioral strategies would appear to be the predominant approach to treating problematic sexual fantasies and behaviors. The cognitive-behavioral approach includes a range of procedures and techniques that aim to reduce inappropriate sexual arousal (e.g., covert sensitization, satiation, systematic desensitization) or to improve appropriate sexual arousal (e.g., orgasm reconditioning). However, over the years, the use of alternative treatments (e.g., cognitive imagery techniques, mindfulness-based cognitive therapy, use of drugs) have been suggested. This review would highlight the limited presence of research confirming the efficacy of behavioral strategies in the treatment of problematic sexual fantasies and behaviors. In light of the above, further studies could consider more integrated approaches to better understand how to improve treatments for problematic sexual fantasies and behaviors. We have no conflict of interest to declare. [ABSTRACT FROM AUTHOR]

Objectives: Individuals with paraphilic interests such as sexual interests in rape, masochism or violent restraint, may have difficulties establishing healthy, consensual intimate relationships. We aimed to examine whether adults with violent sexual interest have difficulties synchronizing with their partner or achieving orgasm during sexual intercourse. Methods: A nationally representative sample of 1193 Czech adults completed an online survey examining paraphilic interest and sexual functioning. Participants were asked about their experience of sexual synchrony (harmonizing rhythm during intercourse, eye contact, noticing partner's vocalization, etc.). For a variety of sexual positions, participants were asked how frequently they engaged in that position, how appealing they found that position, and the percentage of time they experienced orgasm in that position. Participants also reported the percentage of time they acheived orgasm via masturbation. Structural equation modeling with confirmatory factor analysis was then used to test associations between violent paraphilic interest, the probability of orgasm, frequency, and appeal across sexual positions, as well as sexual synchrony while controlling for age. Results: In both men and women, greater sexual synchrony was associated with a greater probability of orgasm across a range of sexual positions, controlling for the appeal of a particular position and its frequency. In women, violent paraphilic interest was not significantly associated with orgasm probability or sexual synchrony. However, men with greater violent paraphilic interest experienced fewer orgasms across a range of positions, and this effect was mediated by reduced sexual synchrony. Violent paraphilic interest was not associated with the probability of orgasm via masturbation. Conclusions: These results suggest that men with greater violent sexual interest may have difficulty experiencing pleasure in dyadic sexual activities. Difficulties experiencing orgasm or synchronizing with their partner during intercourse could lead individuals to develop more extreme sexual fantasies. Psychotherapy for individuals with violent paraphilic interests should take into consideration potential sexual problems. Conflicts of Interest: None to declare. [ABSTRACT FROM AUTHOR]

Introduction: Sexuality is an important aspect of quality of life and sexual fantasies comprise a normal part of human sexuality. However, the nature of sexuality and sexual fantasies of patients with mental illness remains an understudied area. Aim: To investigate the nature and frequency of sexual fantasies in psychiatric patients, the present study compared the frequency of four types of sexual fantasies across four different mood and psychotic diagnoses and three personality disorder clusters. Methods: Study participants included 133 psychiatric inpatients recruited from an urban hospital. Sexual fantasies were compared across patients with schizophrenia, bipolar disorder, schizoaffective disorder, major depressive disorder and three nonclinical samples from the literature and then correlated with personality cluster scores. Main Outcome Measures: Subjects were administered the Structured Clinical Interview for DSM-IV for Axis I and for Axis II Disorders. Sexual fantasies were assessed by the Wilson Sexual Fantasies Questionnaire, which measures four types of sexual fantasies (exploratory, intimate, impersonal, and sadomasochistic). Results: Within the entire sample, there were significant differences across sexual fantasy types, with subjects scoring highest on intimate sexual fantasies and then exploratory, impersonal, and sadomasochistic. There were no significant differences across mood and psychotic diagnostic groups for any of the sexual fantasy scales and the scores were within the normative range of nonclinical samples. Patients with high cluster B scores scored significantly higher on all four fantasy scales than those without. Patients with high cluster A scores scored lower on intimate fantasies, but there was no association between cluster C scores and sexual fantasies. The association between cluster B and sexual fantasies remained consistent across Structured Clinical Interview for DSM-IV for Axis I diagnoses (no interaction effect). Conclusion: Patients with severe mental illness report sexual fantasies that are largely affiliative in nature and consistent with normative patterns. This suggests that assessment and treatment of sexual issues in the mentally ill should be part of the clinical routine as it is in healthy individuals. [ABSTRACT FROM AUTHOR]

Introduction Although several theories and treatment plans use unusual sexual fantasies ( SF) as a way to identify deviancy, they seldom describe how the fantasies referred to were determined to be unusual. Aim The main goal of this study was to determine which SF are rare, unusual, common, or typical from a statistical point of view among a relatively large sample of adults recruited from the general population. A secondary goal was to provide a statistical comparison of the nature and intensity of sexual fantasies for men and women. This study also aims at demonstrating with both quantitative and qualitative analyses that certain fantasies often considered to be unusual are common. Methods An Internet survey was conducted with 1,516 adults (799 ♀; 717 ♂) who ranked 55 different SF and wrote their own favorite SF. Each SF was rated as statistically rare (2.3% or less), unusual (15.9% or less), common (more than 50%), or typical (more than 84.1% of the sample). Main Outcome Measures An extended version of the Wilson's Sex Fantasy Questionnaire with an open question. Results Only two sexual fantasies were found to be rare for women or men, while nine others were unusual. Thirty sexual fantasies were common for one or both genders, and only five were typical. These results were confirmed with qualitative analyses. Submission and domination themes were not only common for both men and women, but they were also significantly related to each other. Moreover, the presence of a single submissive fantasy was a significant predictor of overall scores for all SF in both genders. Conclusion Care should be taken before labeling an SF as unusual, let alone deviant. It suggested that the focus should be on the effect of a sexual fantasy rather than its content. Joyal CC, Cossette A, and Lapierre V. What exactly is an unusual sexual fantasy? J Sex Med 2015;12:328-340. [ABSTRACT FROM AUTHOR]

Introduction Over the past two decades, sexual desire and desire discrepancy have become more frequently studied as have potential pharmaceutical interventions to treat low sexual desire. However, the complexities of sexual desire-including what exactly is desired-remain poorly understood. Aims To understand the object of men's and women's sexual desire, evaluate gender differences and similarities in the object of desire, and examine the impact of object of desire discrepancies on overall desire for partner in men and women in the context of long-term relationships. Methods A total of 406 individuals, 203 men and 203 women in a relationship with one another, completed an online survey on sexual desire. Main Outcome Measures Reports of the object of sexual desire in addition to measures of sexual desire for current partner were collected from both members of the couple. Results There were significant gender differences in the object of sexual desire. Men were significantly more likely to endorse desire for sexual release, orgasm, and pleasing their partner than were women. Women were significantly more likely to endorse desire for intimacy, emotional closeness, love, and feeling sexually desirable than men. Discrepancies within the couple with regard to object of desire were related to their level of sexual desire for partner, accounting for 17% of variance in men's desire and 37% of variance in women's desire. Conclusions This research provides insights into the conceptualization of sexual desire in long-term relationships and the multifaceted nature of sexual desire that may aid in more focused ways to maintain desire over long-term relationships. Future research on the utility of this perspective of sexual desire and implications for clinicians working with couples struggling with low sexual desire in their relationships is discussed. Mark K, Herbenick D, Fortenberry D, Sanders S, and Reece M. The object of sexual desire: Examining the 'what' in 'what do you desire?' J Sex Med 2014;11:2709-2719. [ABSTRACT FROM AUTHOR]

Absorbed states refer to states of focused attention in which individuals get engrossed and fascinated by sensory and imaginary experiences to the point of a transient alteration in the usual awareness of self, space, and time. As such, the propensity to enter absorbed states indicates a greater tendency to experience altered states of consciousness by a variety of triggers, including sex. The personality tendency to experience absorbed states is commonly given the name absorption or self-forgetfulness. Previously, higher self-forgetfulness was found to correlate with higher desire in both sexes, and with greater coital frequency in men. A proposed explanation is that absorbed states may favor fascination and emotional engagement with partners or potential partners. Given that fantasy can be a focus of absorbed attention, people more prone to absorbed states might have richer and more intense sex fantasies. However, there is also evidence that disorganized attachment is associated with propensity to experience absorbed states. Given that insecure attachment has been related to sexual difficulties, the findings are difficult to reconcile. To test for independent associations of self-forgetfulness (absorption) with sexual function, anxious attachment, and avoidant attachment. During a laboratory study, 324 Portuguese (312 women, 112 men) reported their frequency of sexual behaviors in the past month and how satisfied they were with their sex lives. Sexual desire was assessed with the desire dimensions of the Female Sexual Function Index and the International Index of Erectile Function. Propensity for absorbed states was assessed by the self-forgetfulness subscale of the Temperament and Character Inventory – Revised. Multiple regressions were run with self-forgetfulness as dependent variable. The independent variables were anxious attachment, avoidant attachment, and in separate regressions, sexual desire, sexual satisfaction, penile-vaginal intercourse frequency, noncoital sex frequency, and solitary masturbation frequency. In women, self-forgetfulness was independently associated with: 1) higher desire (β =.15) and more attachment anxiety (β =.13), 2) more sexual satisfaction (β =.16) and more attachment anxiety (β =.17), 3) greater masturbation frequency (β =.13) and more attachment anxiety (β =.15). In men, self-forgetfulness was independently associated with: 1) higher desire (β =.23) and more attachment anxiety (β =.19), 2) greater coital frequency (β =.19) and more attachment anxiety (β =.22), 3) greater noncoital sex frequency (β =.24) and more attachment anxiety (β =.20). Propensity for absorbed states can favor sexual function, but can also be part of the psychological dynamics of insecure attachment. In the former case, the tendency to experiencing absorbed states might lead to greater fascination by attractive people and to a richer erotic fantasy. In the latter case, absorbed states might be part of psychological defenses against stressors related to intimate relationships, such as dissociation and use of fantasy as a means of "escape" of reality, which have no relevance for sexual function, or might even be detrimental. Work supported by industry: no. [ABSTRACT FROM AUTHOR]

Introduction Women are often reported to have a low coherence (often referred to as 'discordance' in sexuality literature) between their genital response and self-reported sexual arousal. Aim The purpose of this study was to determine whether differing instructions for rating sexual arousal would increase the coherence between genital response and self-reported arousal in women. Methods Genital responses were recorded, using vaginal photoplethysmography, from 32 young women while they fantasized in three different conditions. Conditions instructed women to rate their overall sexual arousal, any physical cues, and genital blood flow. Main Outcome Measures The primary outcome measure was the coherence of vaginal pulse amplitude ( VPA) and reported sexual response in the three conditions. Results Unexpectedly, both VPA response and self-reported sexual arousal were higher when women were asked to rate their genital blood flow. Examining only participants who reported at least some sexual arousal in all conditions (n = 17), coherence was highest when women were instructed to rate overall sexual arousal. Conclusion Results suggest that focusing on genital blood flow during sexual fantasy may increase women's (self-reported and genital) sexual response. Focusing on any physical arousal cues during sexual fantasy was associated with lower coherence of women's genital response and self-reported arousal compared with when they were instructed to rate their overall sexual arousal. Prause N, Barela J, Roberts V, and Graham C. Instructions to rate genital vasocongestion increases genital and self-reported sexual arousal but not coherence between genital and self-reported sexual arousal. J Sex Med 2013;10:2219-2231. [ABSTRACT FROM AUTHOR]

The article offers reviews of several articles including "Testosterone treatment and mortality in men with low testosterone levels," by MM Shores, NL Smith and others, "Qualitative analysis of heterosexual women's experience of sexual pain and discomfort" by O Sutherland and "Sexual fantasies and viewing times across the menstrual cycle: A diary study" by Samantha J. Dawson, Kelly D. Suschinsky and others.

This is a report of a cross-sectional study on paraphilia-associated sexual arousal patterns (PASAP) among men in a metropolitan city in Germany, EU. To determine the prevalence of PASAP during sexual fantasies, fantasies accompanying masturbation, and real-life sociosexual behavior. In a cross-sectional study, self-reported sexual history data were collected by questionnaire from 367 volunteers recruited from a community sample of 1,915 men aged 40-79 years. The Derogatis Symptom Checklist-Revised (SCL-90-R) and the Life Satisfaction Questionnaire (LSQ; German original, Fragebogen zur Lebenszufriedenheit, [FLZ]) were administered to obtain a general subjective health measure and a measure of general as well as sex life satisfaction. The Questionnaire on Sexual Experiences and Behaviour was administered to comprehensively assess all relevant sexo-medical data. The percent of men that reported at least one PASAP was 62.4%. In 1.7% of cases, PASAP were reported to have caused distress. The presence of PASAP was associated with a higher likelihood of being single (odds ratio [OR] 2.6; 95%; confidence interval [CI] 1.047-6.640), masturbating at least once per week (OR 4.4; 95%; CI 1.773-10.914), or having a low general subjective health score (OR 11.9; 95%; CI 2.601-54.553). Pedophilic PASAP in sexual fantasies and in real-life sociosexual behavior was reported by 9.5% and 3.8% of participants, respectively. The findings suggest that paraphilia-related experience can not be regarded as unusual from a normative perspective. At the same time, many men experience PASAP without accompanying problem awareness or distress, even when PASAP contents are associated with potentially causing harm to others. In view of the relevance for sex life and relationship satisfaction, presence of PASAP should be assessed in all sexual medicine consultations. Future research should focus on conditions in which PASAP reach clinical significance in the sense of mental disorders. [ABSTRACT FROM AUTHOR]

Introduction. Hypoactive sexual desire disorder (HSDD) is defined as persistent lack of sexual fantasies or desire marked by distress. With a prevalence of 10% it is the most common form of female sexual dysfunction. Recently, the serotonin-1A (5-HT1A) receptor agonist and the serotonin-2A (5-HT2A) receptor antagonist flibanserin were shown to be safe and efficacious in premenopausal women suffering from HSDD in phase III clinical trials. Aim. The current study aims to assess the effect of flibanserin on neurotransmitters serotonin (5-HT), norepinephrine (NE), dopamine (DA), glutamate, and γ-aminobutyric acid (GABA) in brain areas associated with sexual behavior. Methods. Flibanserin was administered to female Wistar rats (280–350 g). Microdialysis probes were stereotactically inserted into the mPFC, NAC, or MPOA, under isoflurane anesthesia. The extracellular levels of neurotransmitters were assessed in freely moving animals, 24 hours after the surgery. Main Outcome Measures. Dialysate levels of DA, NE, and serotonin from medial prefrontal cortex (mPFC), nucleus accumbens (NAC), and hypothalamic medial preoptic area (MPOA) from female rats. Results. Acute flibanserin administration decreased 5-HT and increased NE levels in all tested areas. DA was increased in mPFC and MPOA, but not in the NAC. Basal levels of NE in mPFC and NAC and of DA in mPFC were increased upon repeated flibanserin administration, when compared to vehicle-treated animals. The basal levels of 5-HT were not altered by repeated flibanserin administration, but basal DA and NE levels were increased in the mPFC. Glutamate and GABA levels remained unchanged following either repeated or acute flibanserin treatment. Conclusions. Systemic administration of flibanserin to female rats differentially affects the monoamine systems of the brain. This may be the mechanistic underpinning of flibanserin's therapeutic efficacy in HSDD, as sexual behavior is controlled by an intricate interplay between stimulatory (catecholaminergic) and inhibitory (serotonergic) systems. Allers KA, Dremencov E, Ceci A, Flik G, Ferger B, Cremers TIFH, Ittrich C, and Sommer B. Acute and repeated flibanserin administration in female rats modulates monoamines differentially across brain areas: A microdialysis study. J Sex Med 2010;7:1757–1767. [ABSTRACT FROM AUTHOR]

Introduction. There are problems with the existing definition of hypoactive sexual desire disorder (HSDD) in that desire for sex and sexual fantasy are not a universal experience. Aims. To explore: (i) women's motivations to engage in sexual activity; (ii) frequency and predictors of sexual fantasies; (iii) sexual arousal; (iv) recognition of sexual arousal; and (v) association between relationship duration and these variables. Methods. Three thousand six hundred eighty-seven women completed a web-based survey of previously pilot-tested items. Main Outcome Measures. Investigator-derived self-report questions of sexual desire and arousal, and sexual fantasies. Results. Among women who easily became aroused, 15.5% reported only engaging in sex if they felt sexual desire at the outset whereas 30.7% typically or always accessed desire only once they were aroused. Women in longer-term relationships engaged in sex with no sexual desire more often (42%) than women in short-term relationships (22.4%) ( P < 0.001). The percentage of women that reported fantasies only sometimes was 52.5%. A logistic regression revealed that religion (odds ratio [OR] = 1.45; P < 0.001), difficulty getting aroused (OR = 0.511; P < 0.001), responsive desire (OR = 0.919; P < 0.05), and frequency of orgasm (OR = 1.11; P < 0.05) were significantly associated with sexual fantasy. After controlling for age, relationship duration was negatively associated with frequency of initiating sex ( r = −0.116, P < 0.001), women's satisfaction with their own sexuality ( r = −0.173, P < 0.001) and sexual satisfaction with the partner ( r = −0.162, P < 0.001). Conclusions. Results reflect diversity in women's motivations for sex, and there is evidence that responsive desire occurs in women with and without arousal difficulties. We strongly recommend relationship duration as well as adequacy of partner sexual stimulation to be recognized in any future diagnostic framework of dysfunction. Clinical implications as well as those for future diagnostic nomenclature are considered. Carvalheira AA, Brotto LA, and Leal I. Women's motivations for sex: Exploring the Diagnostic and Statistical Manual, Fourth Edition, Text Revision criteria for hypoactive sexual desire and female sexual arousal disorders. J Sex Med 2010;7:1454–1463. [ABSTRACT FROM AUTHOR]

Introduction. Insufficient documentation exists regarding the prevalence of hypoactive sexual desire disorder (HSDD) in surgically menopausal (SM) women in European countries. Women who have undergone hysterectomy and bilateral oophorectomy experience a loss of ovarian hormones. Inclusion of these women in an epidemiological study provided the opportunity to study biological and cultural impacts on sexual function. Aim. The aim of this study was to compare the prevalence of HSDD among SM women in France, Germany, Italy, and the United Kingdom, as well as the relationship between low sexual desire and sexual activity or behavior, and sexual or partner relationship satisfaction. Methods. Cross-sectional survey of a convenience sample of 427 SM women aged 20–70 years. Main Outcome Measures. The desire domain of the Profile of Female Sexual Function (PFSF) to identify women with low sexual desire, Personal Distress Scale (PDS) to measure distress caused by low sexual desire, and a sexual activities measure. Women with low sexual desire who were distressed were classified as having HSDD. Results. SM women having low sexual desire ranged from 35% (United Kingdom) to 44% (Italy); of these women, 16% (Germany) to 56% (France) were distressed because of their low sexual desire. Overall, SM women classified with HSDD ranged from 7% (Germany) to 22% (France). A strong positive correlation was observed between sexual desire and arousal, orgasm, and sexual pleasure in all countries ( P < 0.001). Low sexual desire leads to less sexual activity, more dissatisfaction with sex life and partner relationship, and more negative emotional or psychological states, than normal desire in each country. Conclusions. A similar percentage of SM women with low sexual desire were found across countries suggesting the role of biological factors (i.e., losing ovarian hormones) in determining sexual desire. Differences in the percentage of SM women with HSDD suggest a role for cultural factors in determining how low sexual desire is perceived. Graziottin A, Koochaki PE, Rodenberg CA, and Dennerstein L. The prevalence of hypoactive sexual desire disorder in surgically menopausal women: An epidemiological study of women in four European countries. J Sex Med 2009;6:2143–2153. [ABSTRACT FROM AUTHOR]

Though hypersexuality defines the disorder, persistent arousal complaints are unusual. Conclusions KLS is a rare disorder often characterized by hypersomnia, hyperphagia, and disinhibited behavior, including hypersexuality/sexual arousal concerns. There are many sexual disorders that present with persistent, intrusive sexual arousal, but the sexual medicine clinician should consider KLS as part of the differential diagnosis. [Extracted from the article]

The article highlights the study on examining the relations among paraphilic fantasies, psychopathology and hyper sexuality. Topics discussed include the gender differences in paraphilic and hypersexual behavior; information on the paraphilic-related behaviors associated with sexual dysfunction; and the conceptualization of paraphilic-related sexual interests.

The article focuses on a study on difference between female sexual fantasies and male sexual fantasies in Italy. Topics discussed include relation between socio-cultural and socio-biological theories of female sexual tendencies and sexual fantasies, presence of themes of role reversal, dominance and submission in both sexes, and influence of the media on sexual fantasy scenarios.

The article discusses a study related to comparison of sexual fantasies among Indian heterosexual and homosexual men and their relationship with sexual satisfaction. Topics discussed include most endorsed sexual fantasies such as watching erotic picture, sex with a loving partner and passionate kissing, least common fantasies such as giving oral pleasure and homosexual erotic activity; and high sexual score of young people indicating more sexual experimentation and sexual drive.