Pornography consumption is highly prevalent, particularly among young adult males. For some individuals, problematic pornography use (PPU) is a reason for seeking treatment. Despite the pervasiveness of pornography, PPU appears under-investigated, including with respect to the underlying neural mechanisms. Using functional magnetic resonance imaging (fMRI), we examined ventral striatal responses to erotic and monetary stimuli, disentangling cue-related 'wanting' from reward-related 'liking' among 28 heterosexual males seeking treatment for PPU and 24 heterosexual males without PPU. Subjects engaged in an incentive delay task in the scanner, in which they received erotic or monetary rewards preceded by predictive cues. Blood-oxygen-level-dependent responses to erotic and monetary cues were analyzed and examined with respect to self-reported data on sexual activity collected over the 2 preceding months. Men with and without PPU differed in their striatal responses to cues predicting erotic pictures but not in their responses to erotic pictures. PPU subjects when compared with control subjects showed increased activation of ventral striatum specifically for cues predicting erotic pictures but not for cues predicting monetary gains. Relative sensitivity to cues predicting erotic pictures vs monetary gains was significantly related to the increased behavioral motivation to view erotic images (suggestive of higher 'wanting'), severity of PPU, amount of pornography use per week, and number of weekly masturbations. Our findings suggest that, similar to what is observed in substance and gambling addictions, the neural and behavioral mechanisms associated with the anticipatory processing of cues specifically predicting erotic rewards relate importantly to clinically relevant features of PPU. These findings suggest that PPU may represent a behavioral addiction and that interventions helpful in targeting behavioral and substance addictions warrant consideration for adaptation and use in helping men with PPU.

Dysregulation of emotion (DE) is commonly seen in individuals suffering from compulsive sexual behavior (CSB), as well as represents a crucial element of its common comorbidities like mood, anxiety, and substance use disorders. To investigate the links between CSB and DE. A review of pertinent literature on CSB and DE was performed using EBSCO, PubMed, and Google Scholar databases. Patterns of DE were evaluated as a common clinical feature, underlying mechanisms, as well as a target for psychological and pharmacological interventions in CSB. Across different conceptualizations of CSB, DE represents the core element of a failure to cope with sexual impulses, thoughts, urges, or resulting uncontrolled sexual behaviors. DE may contribute to the occurrence of CSB while for individuals affected by this condition, sexual arousal and release act as an easier/learned (yet uncontrolled and leading to negative consequences) way of coping with negative mood states. CSB may represent a delusive form of self-regulation. Experience of child sexual abuse and insecure attachment patterns are considered risk factors for CSB (likely to be mediated by DE) but require further investigation. DE is also positively associated with CSB symptom severity. Pharmacological treatments affecting mood regulation, anxiety, impulsivity, and regulation within the brain reward system have been reported to help people with CSB achieve better control over their sexual urges and behavior. However, the available data are scarce and well-powered randomized controlled trials are needed to support these observations. Although improvement in one's emotional self-regulation is considered as an important healing factor in treatment, its benefit in psychological therapies specific to CSB requires further investigation. DE represents a core symptom of compulsive sexual behavior disorder and related comorbidities as well as a predisposing factor to the development of compulsive sexual behavior disorder. Addressing DE may facilitate better treatment outcomes for patients with CSB. Lew-Starowicz M, Lewczuk K, Nowakowska I, et al. Compulsive Sexual Behavior and Dysregulation of Emotion. J Sex Med 2020;8:191-205.

Sexual concerns are known to be common in women suffering from multiple sclerosis (MS) but definite data on the prevalence of particular sexual dysfunctions (SD) remain unclear. Previous studies brought inconsistent findings and rely on small groups of patients or use of unvalidated assessment methods. The aim of this research was to evaluate the prevalence of SD in women with MS using validated clinimetric scales. 137 female inpatients with MS diagnosis were interviewed, completed The Female Sexual Function Questionnaire SFQ28 and underwent neurological assessment. Only 2.2 % of patients had ever discussed their sexual concerns with a physician. 70.1 % reported sexual activity. At least one SD could be found in 82.5 % of patients, hypoactive sexual desire (57.7 %), arousal dysfunction (decreased genital sensation in 47.3 %, decreased lubrication in 48.4 %, decreased subjective arousal in 45.2 %) and orgasmic dysfunction (39.8 %) being the most probable. SD were less likely in women who assessed their relationship positively but more common in older patients and those who had a positive history of depression. The prevalence of SD was higher comparing to the majority of studies by other authors. In conclusion, SD are very common in female patients with MS and permanently overlooked by medical professionals. Therefore, the assessment of sexual function should be implemented in all patients after the diagnosis of MS. Further research is needed for better understanding of the sexuality of this particular population in order to establish targets for therapeutic intervention.

Introduction: Hormonal contraception is available worldwide in many different forms. Fear of side effects and health concerns are among the main reasons for not using contraceptives or discontinuing their use. Although the safety and efficacy of contraceptives have been extensively examined, little is known about their impact on female sexual function, and the evidence on the topic is controversial.Aim: To review the available evidence about the effects of hormonal contraceptives on female sexuality in order to provide a position statement and clinical practice recommendations on behalf of the European Society of Sexual Medicine.Methods: A comprehensive review of the literature was performed.Main Outcome Measure: Several aspects of female sexuality have been investigated, including desire, orgasmic function, lubrication and vulvovaginal symptoms, pelvic floor and urological symptoms, partner preference, and relationship and sexual satisfaction. For each topic, data were analyzed according to the different types of hormonal contraceptives (combined estrogen-progestin methods, progestin-only methods, and oral or non-oral options).Results: Recommendations according to the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence criteria and specific statements on this topic, summarizing the European Society of Sexual Medicine position, were developed.Clinical Implications: There is not enough evidence to draw a clear algorithm for the management of hormonal contraception-induced sexual dysfunction, and further studies are warranted before conclusions can be drawn. A careful baseline psychological, sexual, and relational assessment is necessary for the health care provider to evaluate eventual effects of hormonal contraceptives at follow-up.Strengths & Limitations: All studies have been evaluated by a panel of experts who have provided recommendations for clinical practice.Conclusion: The effects of hormonal contraceptives on sexual function have not been well studied and remain controversial. Available evidence indicates that a minority of women experience a change in sexual functioning with regard to general sexual response, desire, lubrication, orgasm, and relationship satisfaction. The pathophysiological mechanisms leading to reported sexual difficulties such as reduced desire and vulvovaginal atrophy remain unclear. Insufficient evidence is available on the correlation between hormonal contraceptives and pelvic floor function and urological symptoms.

Purpose of Review: World Health Organization recently included compulsive sexual behavior disorder (CSBD) to the upcoming 11th edition of International Classification of Diseases (6C72). Despite the potential benefits of this decision (eg, the acceleration of research in the field will allow the development of effective treatments), previous research focused mainly on men, and as a result, we do not have an accurate clinical picture of compulsive sexual behavior (CSB) among women. Therefore, in this systematic review, we aim to present available knowledge on this topical subject. Literature search was conducted in the guideline of PRISMA methodology. Studies were identified from multiple databases including Academic Search Ultimate, SocINDEX, PsycARTICLES, PsycINFO, PubMed, and MEDLINE. Out of a total of 10,531 articles identified and screened, 58 were included in this review. Included studies covered the following topics: prevalence and etiology of CSB, behavioral and cognitive processes involved, comorbidities, personality traits, psychosocial and interpersonal difficulties, traumatic experiences, and treatments. Recent Findings: Available studies indicate that CSB symptom severity is lower in women than in men. Overall, women reported consuming pornography less often than men and exhibit lower rates of feeling urges to these materials. CSB symptoms (including problematic pornography use) have been found to be positively related to trait psychopathy, impulsivity, sensation seeking, attention-deficit/hyperactivity disorder symptoms, obsessive-compulsive disorder, pathological buying, sexual dysfunctions, general psychopathology, child sexual abuse, while negatively related to dispositional mindfulness. Summary: Conclusions that can be drawn from prior studies are considerably limited. There are no accurate estimates of the CSB prevalence or severity among women, and studies have been mostly conducted on non-clinical populations, which has limited application for women diagnosed with CSBD.

Introduction: Mindfulness-based therapies (MBT) are more and more frequently used in the treatment of sexual dysfunctions; therefore, it seems very important to assess evidence-based data on the clinical efficacy of these interventions. Aim: To provide a systematic review of published studies into the efficacy of MBT in the treatment of sexual dysfunctions. Methods: The material for the analysis was obtained by searching 3 internet databases: EBSCO, PubMed, and ResearchGate. Articles describing therapeutic interventions on the basis of mindfulness and their efficiency in reducing sexual dysfunction symptoms in men and women were sought. Main Outcome Measures: 15 original research articles were included to the review: 4 articles were devoted to the analysis of the efficiency of the mindfulness-based therapy in the reduction of sexual dysfunction related to pain in the genital-pelvic area, 10 to desire or sexual arousal disorders or both in women, and 1 to erectile dysfunction in men. Results: Studies indicate that MBT led to improvement in subjectively evaluated arousal and desire, sexual satisfaction, and a reduction of fear linked with sexual activity, as well as improving the consistency between the subjectively perceived arousal and genital response in women. The research indicated that MBT did not make a significant change in a reduction of pain during sexual activities. Evidence-based data were found on the efficacy of MBT in the treatment of male erectile dysfunction in 1 study. Clinical Implications: MBT could be effectively used in the treatment of female sexual dysfunction, specifically to improve sexual arousal/desire and satisfaction and to reduce sexual dysfunction associated with anxiety and negative cognitive schemas. Strengths & Limitations: The few studies available are affected by several methodologic limitations, including small numbers of participants, patient selection, application of complex therapeutic interventions, and a lack of homework assessment, which makes definite conclusions difficult to draw. Conclusion: The effects of MBT in female sexual dysfunctions are promising. In future studies, the mindfulness-based monotherapies should be implemented to verify their potential in reducing symptoms of sexual dysfunction. More research is needed to explore the potential of MBT in the treatment of male sexual dysfunction.