UNASSIGNED: To determine individual- and country-level factors associated with self-reported changes in solo and partnered sexual behaviors in an international sample of adults during COVID-19.
UNASSIGNED: Data were from the International Sexual Health And REproductive Health during COVID-19 study (I-SHARE)-a cross-sectional, multi-country study (N = 26 countries) assessing adult (N = 19,654) sexual/reproductive health before and during the first wave of COVID-19. We examined self-reported changes (three-point scale: decreased, no change, increased) in solo masturbation, hugging/holding hands/cuddling with a partner, sex with a primary partner, sex with a casual partner, sexting with a partner, viewing sexually explicit media and partnered cybersex. Ordinal regression assessed the impact of individual (age, gender- and sexual-identity, romantic partnership status, employment and income stability, household change and content, mental well-being, changes in alcohol use, and changes in marijuana use) and country-level (e.g., Oxford Stringency Index, Human Development Index, and the Palma Ratio) factors on behavior change.
UNASSIGNED: The most common behavior to increase was hugging, kissing, or cuddling with a partner (21.5%), and the most common behavior to decrease was sex with a main partner (36.7%). Household factors like job/income instability and having children over the age of 12 years were significantly associated with decreased affectionate and sexual partnered sexual behaviors; more frequent substance use was linked to significantly increased solo, partnered, and virtual sexual behaviors.
UNASSIGNED: Understanding changes in sexual behaviors-as well as the factors that make changes more or less likely among adults around the world-are important to ensure adequate sexual health support development for future public health emergencies.

Introduction: Sexual pleasure is a human right and a central aspect of human sexuality that contributes significantly to people\'s overall well-being, making it an essential element to consider in clinical settings. This study aims to expand the understanding of sexual pleasure by examining how LGB+ people (lesbian, gay, bisexual, and other minority sexual orientations)-who perceived having a sexual problem-define solitary and partnered sexual pleasure. Methods: A cross-sectional exploratory qualitative study was conducted online. The current study included 85 people who self-identified as LGB+ and reported experiencing a sexual problem. Data analysis was performed using summative content analysis. Results: The results for solitary sexual pleasure comprised the creation of 5 categories (Enhancing the relationship with oneself, Specification of solitary pleasure, Negative experience, Unrestrained experience and A goal). For partnered sexual pleasure, 9 categories were created (The perks of being with another, Openness to experience, A result of sexual techniques, Psychophysiological experience, Misconceptions about sexual pleasure, Absence of intrapersonal constraints, Undesirable feelings, Explicit consent, and Absence of interpersonal constraints). Discussion: Despite reporting sexual problems, most participants reported having experienced sexual pleasure, and were able to define it. This study provided a deeper understanding of the perspectives on and experiences of sexuality among LGB+ people who experience sexual problems. Our findings highlight that current diagnostic criteria (e.g., DSM-5) do not seem to align with the problems reported by this sample population (the problems presented are beyond their sexual function). This reinforces the importance of viewing sexual problems from a perspective that goes beyond the categorial psychopathology model. Our study\'s findings may offer valuable insights for the evaluation and treatment of sexual problems, where sexual pleasure is considered a crucial aspect of sexual well-being.

UNASSIGNED: Difficulty reaching orgasm/ejaculation during partnered sex, a primary characteristic of delayed or absent ejaculation, affects about 5% to 10% of men, but the reasons underlying this problem are poorly understood.
UNASSIGNED: The study sought to gain insight into possible etiologies of delayed ejaculation by assessing men\'s self-perceptions as to why they experience difficulty reaching orgasm.
UNASSIGNED: We drew 351 men reporting moderately severe to severe difficulty reaching orgasm during partnered sex from a sample of over 3000 respondents obtained through an online survey. As part of the 55-item survey, participants responded to 2 questions asking about their self-perceived reasons for having difficulty reaching orgasm and selected from a list of 14 options derived from the research literature, a series of men\'s focus groups, and expert opinion. The first question allowed respondents to select all the reasons that they felt contributed to the problem, the second to select only the most important reason. In addition, both men with and without comorbid erectile dysfunction were investigated and compared.
UNASSIGNED: Hierarchical ordering of men\'s self-pereceived reasons for having difficulty reaching orgasm, including typal reasons established through principal component analysis.
UNASSIGNED: The major reasons for difficulty were related to anxiety/distress and lack of adequate stimulation, with relationship and other factors endorsed with lower frequency. Further exploration using principal components analysis identified 5 typal reasons, in descending order of frequency: anxiety/distress (41%), inadequate stimulation (23%), low arousal (18%), medical issues (9%), and partner issues (8%). Few differences emerged between men with and without comorbid ED other than ones related to erectile problems, such as higher level of endorsement of medical issues. Typal reasons showed correlations, albeit mostly weak, with a number of covariates, including sexual relationship satisfaction, frequency of partnered sex, and frequency of masturbation.
UNASSIGNED: Until supplemental medical treatments for delayed ejaculation are developed and approved, a number of men\'s purported reasons for difficult or absent ejaculation/orgasm-anxiety/distress, inadequate stimulation, low arousal, relationship issues-fall into areas that can be addressed in couples counseling by a trained sex therapist.
UNASSIGNED: This study is unique in scope and robust in sample size. Drawbacks include those associated with online surveys, including possible bias in sample selection, limitation to Western-based samples, and the lack of differentiation between men with lifelong and acquired difficulty.
UNASSIGNED: Men who have difficulty reaching ejaculation/orgasm identify putative reasons for their problem, ranging from anxiety/stress, inadequate stimulation, and low arousal to partner issues and medical reasons.

It is unclear whether men who experience sexual difficulty during partnered sex experience similar difficulty during masturbation.
To determine whether sexual functionality and dysfunctionality were similar or different during masturbation vs partnered sex.
We compared sexual responsivity during masturbation vs partnered sex in a multinational sample of 4,209 men with and without a sexual dysfunction to determine whether dysfunctionality was greater, less, or about the same during these 2 types of sexual activity.
Consistently lower impairment of sexual function was found during masturbation compared with partnered sex for all 3 sexual problems assessed: erectile dysfunction, premature ejaculation, and delayed ejaculation.
These findings reiterate the potential value of assessing sexual responsivity during masturbation as well as melding masturbation strategies with couples therapy in order to attenuate impaired response during partnered sex.
Although this study provides the first empirical evidence based on a large multinational sample indicating that sexual functionality is consistently higher during masturbation than partnered sex, it does not provide an empirically-derived explanation for this difference.
Understanding a man\'s response potential during masturbation may be important to improving sexual response during partnered sex, with the need for more targeted research that more directly evaluates the use of such strategies in the treatment of men\'s sexual problems.

Little is known regarding the demographic, sexual, and relationship characteristics of men with symptoms of delayed ejaculation (DE).
To identify differences between men with and without DE symptomology to validate face-valid diagnostic criteria and to identify various functional correlates of DE.
A total of 2679 men meeting inclusion criteria were partitioned into groups with and without DE symptomology on the basis of their self-reported \"difficulty reaching ejaculation/orgasm during partnered sex.\" Men were then compared on a broad array of demographic and relationship variables, as well as sexual response variables assessed during partnered sex and masturbation.
Outcomes included the identified differences between men with and without DE symptomology.
Men with DE-whether having comorbid erectile dysfunction or not-differed from men without DE on 5 face-valid variables related to previously proposed diagnostic criteria for DE, including ones related to ejaculation latency (P < .001); self-efficacy related to reaching ejaculation, as assessed by the percentage of episodes reaching ejaculation during partnered sex (P < .001); and negative consequences of the impairment, including \"bother/distress\" and (lack of) \"orgasmic pleasure/sexual satisfaction\" (P < .001). All such differences were associated with medium to large effect sizes. In addition, men showed differences on a number of functional correlates of DE, including anxiety, relationship satisfaction, frequency of partnered sex and masturbation, and level of symptomology during partnered sex vs masturbation (P < .001).
Face-valid criteria for the diagnosis of DE were statistically verified, and functional correlates of DE relevant to guiding and focusing treatment were identified.
In this first comprehensive analysis of its kind, we have demonstrated widespread differences on sexual and relationship variables relevant to the diagnosis of DE and to its functional correlates between men with and without DE symptomology during partnered sex. Limitations include participant recruitment through social media, which likely biased the sample; the use of estimated rather than clocked ejaculation latencies; and the fact that differences between men with acquired and lifelong DE were not investigated.
This well-powered multinational study provides strong empirical support for several face-valid measures for the diagnosis of DE, with a number of explanatory and control covariates that may help shed light on the lived experiences of men with DE and suggest focus areas for treatment. Whether or not the DE men had comorbid erectile dysfunction had little impact on the differences with men having normal ejaculatory functioning.

To understand how household context factors impacted self-reported changes in solo and sexual behaviors in U.S. adults during early stages of the COVID- 19 pandemic, we conducted an online, nationally representative, cross-sectional survey of U.S. adults (N = 1010; aged 18-94 years; 62% response rate) from April 10-20, 2020. We used weighted descriptive statistics with Wilcoxon rank sign tests to understand the population prevalence and significance of self-reported changes (five-point scale: much less to much more) in 10 solo and partnered sexual behaviors. Ordinal regression was used to assess the impact of household predictor variables-including number of children at home, number of adults in home, partnership status (unpartnered, partnered and not living together, partnered and living together) and employment status (not working, employed not as essential worker, employed as essential worker). All models were adjusted for gender, age, sexual orientation, race/ethnicity, and residence location (urban, suburban, rural).All solo and partnered sexual behaviors showed some amount of significant change-increased activity for some and decreased for others-for U.S. adults during the pandemic. Not living with a partner was broadly associated with decreased affectionate partnered sexual behaviors; unpartnered adults reported increased sexting. Individuals not employed reported increased oral sex and increased consumption of sexually explicit materials as compared to non-essential workers. Number of children at home and household size were not significantly linked to self-reported behavior change. Ongoing sexual health-focused research should continue to focus on understanding how adults manage opportunities and constraints to their sexual lives in the context of a still-going pandemic. While many aspects of social life look more \"normal\" (e.g., many people have returned to their in-person offices and children are largely back in school), new and more-infectious strains of COVID-19 have proven that the pandemic may still yet impact daily living. Lessons learned from COVID need to include sexual health planning both for any future strains of COVID, as well as for future public health emergencies.

UNASSIGNED: Masturbation is a behavior that can enhance sexual functioning. This study aims to analyze differences between men and women in different masturbation parameters, and to examine their relation with orgasm satisfaction in sexual relationships.
UNASSIGNED: One thousand three hundred and thirty-fifth men and women from the Spanish population aged 18-83 years (M = 36.91; SD = 11.86) participated in an online survey. A questionnaire was used to collect socio-demographic. Sexual history data, negative attitude toward masturbation, solitary sexual desire and orgasm subjective experience upon masturbation were assessed. Given the differences between men and women, independent regression models are proposed to explain orgasm satisfaction in the sexual relationships context.
UNASSIGNED: Men, compared to women, masturbated at a younger age (p < 0.001), and reported higher current masturbation frequency (p < 0.001) and more solitary sexual desire (p < 0.001). Women reported greater intensity in the subjective orgasm experience on its Affective (p < 0.001), Sensory (p < 0.001) and Intimacy (p < 0.001) dimensions. Regarding regression models, the Affective dimension of orgasm was a common parameter in men (β = 0.36; p < 0.001) and women (β = 0.24) to explain orgasm satisfaction during sexual relationships. In men, solitary masturbation frequency (β = -0.10; p = 0.027) acquired a significant role. In women, the model also included age (β = 0.09; p = 0.038), negative attitude toward masturbation (β = -0.12; p = 0.005) and solitary sexual desire (β = -0.19; p = 0.001).
UNASSIGNED: When dealing with men and women\'s orgasm difficulties in the sexual relationships context, it is important to consider the role of masturbation. In men and women, the Affective dimension of the orgasm experience explain the orgasm satisfaction in sexual relationship. Also, in men, the solitary masturbation frequency is negatively related with orgasm satisfaction in sexual relationship, supporting the compensatory hypothesis of masturbation. In women, in addition to the Affective dimension, the orgasm satisfaction in sexual relationship is explained, negatively, by the negative attitude toward masturbation, and positively, by the solitary sexual desire, which could be associated with more sexual self-knowledge. The relevance of masturbation in understanding sexual functioning is highlighted.

It is unclear whether men who experience sexual difficulty during partnered sex experience similar difficulty during masturbation.
To determine whether sexual functionality and dysfunctionality were similar or different during masturbation vs partnered sex.
We compared sexual responsivity during masturbation vs partnered sex in a multinational sample of 4,209 men with and without a sexual dysfunction to determine whether dysfunctionality was greater, less, or about the same during these 2 types of sexual activity.
Consistently lower impairment of sexual function was found during masturbation compared with partnered sex for all 3 sexual problems assessed: erectile dysfunction, premature ejaculation, and delayed ejaculation.
These findings reiterate the potential value of assessing sexual responsivity during masturbation as well as melding masturbation strategies with couples therapy in order to attenuate impaired response during partnered sex.
Although this study provides the first empirical evidence based on a large multinational sample indicating that sexual functionality is consistently higher during masturbation than partnered sex, it does not provide an empirically-derived explanation for this difference.
Understanding a man\'s response potential during masturbation may be important to improving sexual response during partnered sex, with the need for more targeted research that more directly evaluates the use of such strategies in the treatment of men\'s sexual problems. Rowland DL, Hamilton BD, Bacys KR et al. Sexual Response Differs during Partnered Sex and Masturbation in Men With and Without Sexual Dysfunction: Implications for Treatment. J Sex Med 2021;18:1835-1842.

BACKGROUND: This study explored the role of body image dissatisfaction on orgasmic response during partnered sex and masturbation and on sexual relationship satisfaction. The study also described typologies of women having different levels of body image satisfaction.
METHODS: A sample of 257 Norwegian women responded to an online survey assessing body image dissatisfaction, problems with orgasm, and sexual relationship satisfaction. Using structural equation modeling and factor mixture modeling, the relationship between body image dissatisfaction and orgasmic response was assessed, and clusters of sexual response characteristics associated with varying levels of body image dissatisfaction were identified.
METHODS: Orgasmic function during partnered sex and masturbation, along with sexual relationship satisfaction, were assessed as a function of body image.
RESULTS: Body image dissatisfaction, along with a number of covariates, predicted higher levels of \"problems with orgasm\" during both partnered sex and masturbation, with no significant difference in the association depending on the type of sexual activity. Varying levels of body image dissatisfaction/satisfaction were associated with differences in orgasmic incidence, difficulty, and pleasure during partnered sex; with one orgasmic parameter during masturbation; and with sexual relationship satisfaction.
CONCLUSIONS: Body image dissatisfaction and likely concomitant psychological distress are related to impaired orgasmic response during both partnered sex and masturbation and may diminish sexual relationship satisfaction. Women with high body image dissatisfaction can be characterized by specific sexual response patterns. Horvath Z, Smith BH, Sal D, et al. Body Image, Orgasmic Response, and Sexual Relationship Satisfaction: Understanding Relationships and Establishing Typologies Based on Body Image Satisfaction. Sex Med 2020;8:740-751.

The effect of pornography on sexual response is understudied, particularly among women. A multinational, community-based sample of 2433 women at least 18 years of age completed a 42-item, opt-in questionnaire collecting information on demographic and sexual history characteristics, use of pornography during masturbation, frequency of pornography use, and sexual response parameters. Pornography use and average frequency were compared across demographic variables. We also examined how pornography frequency predicted differences in self-reported arousal difficulty; orgasmic difficulty, latency, and pleasure; and the percent of sexual activities ending in orgasm during both masturbation and partnered sex. On average, women using pornography were younger, and reported more interest in sex. Pornography frequency differed significantly by menopausal status, sexual orientation, anxiety/depression status, number of sexual partners, and origin of data collection. During masturbation, more frequent pornography use predicted lower arousal difficulty and orgasmic difficulty, greater pleasure, and a higher percentage of masturbatory events leading to orgasm. Frequency of pornography use predicted only lower arousal difficulty and longer orgasmic latencies during partnered sex, having no effect on the other outcome variables. Pornography use frequency did not predict overall relationship satisfaction or sexual relationship satisfaction. Overall, more frequent pornography use was generally associated with more favorable sexual response outcomes during masturbation, while not affecting most partnered sex parameters. Several demographic and relationship covariates appear to more consistently and strongly predict orgasmic problems during partnered sexual activity than pornography use.