Sexual health and emotion regulation: investigating a reciprocal relationship

Sexual disorders are characterized by difficulties in the ability to respond sexually or to obtain sexual pleasure. Epidemiological data indicate that about 40-45% of adult women and 20-30% of adult men have at least one manifest sexual disorder during their lifetime.
The etiology of sexual disorders is multifactorial, encompassing physiological, affective, interpersonal, and psychological, context-dependent-factors, which may predispose, precipitate, or maintain the sexual dysfunction. Psychological and emotional factors may either contribute to the development of sexual problems or be a consequence thereof.
Emotional reactions and thoughts during sexual activity can also affect sexual functionality. With respect to emotions, different patterns for individuals with and without sexual dysfunction have been reported.
Similarly, the difficulty or inability to face experiences or process emotions adequately, also termed emotion dysregulation, has been associated with coping strategies detrimental to health and with a variety of mental disorders. Such context suggest that emotion regulation may be important for sexual health and most likely also in the treatment of sexual problems.
By deepen our knowledge of the role of emotion regulation for sexual health it would be possible to have an impact in both sexuality research and in a clinical level by providing evidence to base future of therapy programmes for people with sexual concerns.
The overall objectives of the SHER project are: a) to determine the associations between emotion
regulation and sexual health and; b) to develop and evaluate an internet-based intervention protocol designed to improve emotion regulation skills for people with sexual disorders.
The project employed different methods, namely a literature scoping review, a cross-sectional online survey and a randomized controlled trial intervention with a three months follow-up.
The dissertation presents three studies (four manuscripts) from the SHER project. The first study aimed at reviewing the existing literature on the effects of emotion regulation on sexual function and satisfaction. After searching in different databases and applying the inclusion and exclusion criteria, twenty-seven articles were analyzed. As a conclusion, was identified that emotion regulation was associated with poorer sexual health outcomes, difficulties in the sexual response cycle and overall lower sexual satisfaction. In addition, the few experimental studies (either in laboratory settings or in intervention trials) found positive effects of promoting emotion regulation change on sexual function and satisfaction.
The aim of the second study was to determine whether distinct profiles in terms of preferred emotion regulation strategies are differentially associated with sexual and mental health. The sample consisted of 5436 participants aged between 18 and 77 years (M= 25.80, SD= 6.96). A gender stratified cluster analysis was performed to classify individuals according to their scores on scales measuring emotion regulation strategies (cognitive reappraisal and emotional suppression), sexual health (assessed using gender-specific self-report questionnaires), anxiety and depression symptoms. For both men and women, the results showed a four-cluster solution: low reappraisal and high suppression, n=1243; high reappraisal and low suppression, n=1695; high reappraisal and high suppression, n=1425; low reappraisal and low suppression, n=1073. Better sexual and mental health scores were found for participants with high cognitive reappraisal and low expressive suppression scores. High expressive suppression was associated with higher anxiety and depression scores and worse sexual health. We concluded by suggesting that provision of care for sexological patients should include an assessment of their emotion regulation abilities and emotion regulation training interventions fostering reappraisal should be offered when appropriate.
The third study, aimed at developing and testing an internet-based emotion regulation training for sexual health (TREpS). First, an intervention protocol was established and published indicating the objectives, procedures and expected outcomes of the intervention. Later, a second manuscript reported the findings of the intervention. The intervention was composed of eight modules, delivered weekly. The module contents encompassed psychoeducation on sexual health and emotion regulation, a set of different strategies to deal with emotions (relaxation techniques, cognitive flexibility, non-judgmental awareness, self-acceptance and compassion, emotion analysis) and sexual emotional exposures. Participants were assessed in three different time points: baseline, end of the intervention and at three months after the intervention ending.
Initially 60 participants met the inclusion criteria and were allocated in two groups. Nonetheless, differently than what was expected, the intervention yielded a very large dropout rate (83.4 %). In this circumstance, some changes to the study protocol have been performed, e.g., the reduction of the follow-up interval period and the complete assessment of the initially waitlist-control group in the three different time points. Since the adherence rate was very low the gathered data was insufficient to investigate treatment effects. Among the participants who completed the intervention larger and moderate effect sizes were observed between assessments for emotion regulation, depression, lubrication, orgasm and thoughts of sexual failure and abuse during sexual activity.