We're currently recruiting Australians aged 60 and over to participate in a new online study at the Centre for Emotional Health. The ad is shown below, and a link to the study information and to participate is: https://mqedu.qualtrics.com/SE/?SID=SV_9popTFwXsgpAKTX
Well I’ve finally finished my PhD! Here is a photo of me just before I submitted my thesis, and a brief summary of what I did:
What was the aim?
I wanted to understand how and why low mood and stress are related to sexual problems. The most common sexual problems include: low or absent sexual desire, difficulty becoming aroused, difficulty achieving orgasm, achieving orgasm too quickly, or pain with sexual activity. Before I started my PhD, there was lots of research that showed these sexual problems are often associated with symptoms of depression and anxiety, but there wasn’t much research on how and why these symptoms are related. Understanding these relationships is really important, so we can get better at recognising and treating the symptoms of depression, anxiety, and sexual problems.
How did we do it?
You lovely people completed thousands of self-report surveys for me. The first wave of data collection was a single survey, and the big wave of data collection was over six time points – either over six weeks, or six months. We used advanced statistical modelling to look for patterns in the responses to these surveys to answer our questions about the relationships between mood and stress levels and sexual problems. For example: “Do people with low stress levels and positive moods experience less sexual problems?” or “Do people experiencing sexual problems tend to become depressed and/or anxious over time?”.
What did we find?
Over the course of five separate studies, we learned a lot about these relationships. The most important finding was that depression and anxiety share a common factor with sexual problems – they’re not categorically separate families of disorders. This was found for men and women of all ages in both studies, across studies that used different questions to measure symptoms, and across studies that used different types of statistical models -- so we’re pretty confident it's true. There were also no causal relationships between the disorders. Instead, the shared factor between the disorders explained the relationships over time. We also found that the most popular questionnaires to assess sexual problems don’t do their job very well, which was helpful to know when we were designing the big six-wave study.
What does this mean in practice?
Discovering a shared factor between depression, anxiety, and sexual problems was exciting. It tells us a lot about how and why these problems are related. It provides a direction for future research that will help us to diagnose and treat the disorders more effectively because we know they aren’t categorically separate groups of disorders, and there aren’t any clear causal relationships between them. More specifically, we now know that they share a common vulnerability. This tells us that if someone reports symptoms of depression and anxiety, we also need to ask about sexual problems, and vice versa, and also that these symptoms need to be treated together. The next steps will be to learn how we can target the underlying vulnerability through new programs that treat symptoms of depression, anxiety, and sexual problems at the same time.
I'm hoping to get funding to continue this research next year, but in the meantime I would like to thank you for your support and interest in my research. Please don't hesitate to contact me if you have any questions or comments, or if you'd like a more technical summary of my research.
Our latest article was published in the early hours of this morning by The Journal of Sex Research.
In my early research, I found that the most widely used questionnaires for sexual function (called the Female Sexual Function Index, and the International Index of Erectile Function) were giving me unexpected results that were in contrast to other studies' findings. I thought this was interesting, and potentially concerning, so did a little more digging to learn about the measures. My paper has been published with a commentary by the author of the measures -- who challenges many of our critiques -- and my reply to that commentary. If you're interested in reading the full academic text, you can read it here. Otherwise, here is a summary:
Critical Flaws in the Female Sexual Function Index and the International Index of Erectile Function
Miriam K. Forbes, Andrew J. Baillie, and Carolyn A. Schniering
JOURNAL OF SEX RESEARCH, 51(5), 485-491, 2014, doi: 10.1080/00224499.2013.876607
What was the aim?
We wanted to determine if the Female Sexual Function Index (FSFI) and the International Index of Erectile Function (IIEF) accurately measure all the dimensions of sexual dysfunction for which they are used.
The FSFI and IIEF are the most widely used self-report measures to diagnose sexual dysfunction in clinical practice and research. The FSFI, is a 19-item measure that has been cited in over 1500 articles, and measures the six key dimensions of sexual function in woman: desire, arousal, lubrication, orgasm, satisfaction and pain. However, the measure was originally designed to identify arousal disorders only. This raises questions around the validity of the measure for other domains of sexual dysfunction.
The IIEF is a 15-item measure, cited in over 2700 articles, and measures five domains of male sexual function including desire, erectile function, orgasmic function, intercourse satisfaction, and overall satisfaction. However, the IIEF was also designed to measure arousal disorders; specifically, erectile dysfunction. Again, the validity of the measure across the other domains is questioned.
How did we do it?
A total of 518 sexually active Australian adults completed an online survey, of which 65% were female. The median age group of respondents was 25 to 34 years, but the sample included adults ranging in age from 18 to 65 years. Women completed the FSFI and men completed the IIEF. We analysed their responses in the context of the existing literature to determine whether the FSFI and IIEF provided reliable and valid measurement of sexual dysfunctions.
What did we find?
Both the FSFI and IIEF had clear measurement flaws. The FSFI provided poor measurement of sexual desire in particular, because it used an over-simplified definition of female sexual desire, and only asked to broad and vague questions about how desire was experience. There were no apparent problems with the brief orgasm and pain scales, but measuring physiological sexual arousal using self-report methods for women has been shown to be inaccurate. For men, only the erectile function subscale of the IIEF provided reliable and valid information. The desire scale performed very poorly in statistical tests, and the orgasmic function scale does not provide clinically useful information.
What does this mean in practice?
We encourage researchers and clinicians to assess whether using either of these measures are appropriate on a case-by-case basis; the measures are most suitable when sexual arousal or erectile function are the outcomes of interest. Specifically, the FSFI should not be used to measure sexual desire, and clinicians and researchers should familiarise themselves with the conceptual issues surrounding self-report measurement of physiological sexual arousal for women. We also recommend that the desire and orgasmic functions subscales of the IIEF should not be used if low desire, premature ejaculation or delayed ejaculation are variables of interest; and that the Sexual Health Inventory for Men (which is comprised of the erectile function items from the IIEF) should replace the IIEF in all future research.
I've written an article on our preliminary findings for The Conversation. It has also been published on the SBS website and by the New Zealand Herald. It's great to see our ideas getting some attention!
Check out the full article here. I'd love to hear your thoughts.
We also have another (somewhat controversial) peer-reviewed paper being published next week, so check back here for details!
Yesterday a friend asked me whether my research showed any relationship between frequency of sex, and relationship quality. To be honest - I hadn't looked! I've just looked at my data, with the results shown below. It seems that women who were having sex more often reported having a better relationship with their partner. However, this relationship seems to plateau when couples are having sex 3-4 times per fortnight, with little improvement in relationship quality reported for couples having sex four or more times per fortnight.
Unfortunately, we didn't ask men how often they were having sex, because they answer a whole different set of questionnaires about sexuality. We compared men who had sex in the past month with men who hadn't, and found that the sexually active men reported better quality relationships.
The closest approximation to the results for women was a question where we asked men how often they could go without any sexual activity. These results were interesting, and are shown below. Here we see that men who could go a year or so without any sexual activity tend to report low relationship quality. Then as desire increases in frequency we see a steady incline in relationship quality. However, there are two exceptions to this notion that higher desire is related to better relationships: men who could go forever without sexual activity of any kind report above-average relationship quality, and men who can't last a day without sexual activity report very low relationship satisfaction.
Why might that be? Maybe for the men who feel no sexual desire, sex is unrelated to their perception of relationship quality, and is determined by other factors. It might also be that for men with exceptionally high levels of desire, sex is a big issue in the relationship - any differences between partners' desire levels would be amplified here, and these men might feel very dissatisfied with their relationship as a result of this mismatch.
In the context of my research, I'd suggest that these findings are much more complex than "more sex = better relationships". It's very likely that better quality relationships would actually foster more sexual activity in the relationship. It's also likely that relationship quality is related to mood and stress, and desire and sexual function are also closely related to these factors, so this is just one piece of a very busy puzzle.
What do you think about these results? Do you have any questions like this one? I'm happy to dig through my data for answers...
I've just had a look at the differences between people who had sex in the month before the study, and those who hadn't. I thought they might be interesting to some of you:
Women who had not had sex in the past four weeks had higher levels of all depression and anxiety symptoms, compared to the women who had engaged in intercourse in the past four weeks. They also felt more distressed about their sex lives, reported lower quality relationships with their partners, and less social support. Sexually, they reported lower levels of desire and less feelings of emotional sexual arousal around sexual activity (feeling excited or turned on).
There were no differences between women who had or hadn't had sex in the past four weeks in terms of stressful life events, their age, or how many children they had (or whether they had children at all). Sexually, the groups showed no differences in terms of their sensation of sexual arousal (pulsating, tingling or warmth), their vaginal lubrication, or their ability to orgasm. We could compare groups on these factors because some women had been sexually active without engaging in vaginal intercourse in the past four weeks.
Men who had not had sex in the past four weeks reported lower quality relationships with their partners, and lower levels of sexual satisfaction. Sexually, they reported lower levels of desire. Other than this, there were no difference between the groups of men who had and hadn't had sex.
These are some pretty interesting findings, don't you think? Why do you think women have so many more group differences, compared to men? I'd love to hear your thoughts.
I've just started listening to Jacqueline Hellyer's Podcasts, and they're pretty cool. The radio show is called "The Tantric Lounge" and she explores sexuality in a variety of contexts, integrating therapeutic, scientific and spiritual perspectives. I find it particularly interesting because she explores the so-called "third wave" of sexuality, following the shaming from the Victorian era and the sleaze of the 60s and 70s sexual liberation, to now. Can we have a societal view of sex as a varied, positive and empowering experience, and not necessarily "dirty"? I think so, and I think views like that would lessen the connection we see between sexual problems and depression and anxiety.
For anyone who is interested, her website is: www.jacquelinehellyer.com, and it has a variety of articles, as well as links to her Podcasts, which are released weekly.
Sorry for the lengthy delay. This period of research is a slow one; I've finished with my old data set, and have papers slowly working their way through the pipeline. I've also started on the new data set, and will have a new paper ready to submit soon!
The news that I do have to update you with is that I've just returned from a fabulous work trip to the USA. I presented my PhD thesis at Northwestern University to the Medical Social Sciences Department and the Department of Preventative Medicine, and went to the International Academy for Sex Research Conference in Chicago. The conference was a great experience, where I met a lot of leading researchers in my field, and shared new and exciting ideas with new friends and colleagues. I was lucky enough to be selected to present a poster at the conference, so I also received some great feedback on my research.
I've just had a paper accepted with revisions, so I'll be able to share those results with you soon. I also have another study under review, and one to be submitted shortly! Still early days on my final study for my PhD, but I'm very excited to share all of my findings with you here in the future.
So just another note to let you know I haven't forgotten about you. Just waiting for the academic world to catch up with my enthusiasm for research, so I can shout my findings from a mountain top.
All the best,
Time for a well overdue update! It's difficult to keep posting regularly now because we have finished data collection, and our newest research output is still in the peer review pipeline. Unfortunately, I can't publicise our results here until they are published.
We have two more papers under review at the moment on the first data set, and have nearly finished analyses on Time Point 1 of the new data set! There are some awesome findings coming to light in the new data, and it has helped enormously to have a lot of people in the data set with varying symptom levels of all those constructs we measured!
I'm off to Chicago in August to present at the International Academy of Sex Research conference. It will be a great opportunity to get feedback from other researchers in the field.
Once we've finished the current analyses on Time Point 1 of our mighty fine data set, we'll (finally) get to start looking at the longitudinal relationships in the data. Can't wait to get my claws into those analyses.
So I promise I haven't forgotten about keeping you updated on our progress, and I will post here as soon as we have new findings to share.
All the best,
I've just had a look into the differences between the groups who started time point one and went on to finish time point six, and there were some interesting results:
It won't be such a long break until I have new information this time - I just moved house (again) and got married.
We've just bought a super computer, which will help us keep making progress on the models that we were stuck on earlier, and will hopefully speed up our progress on analysing time point one so we can move onto the good stuff!
I'll keep you all posted as more stuff comes up!