Sexual-related post-traumatic stress symptoms (sexual-related PTSS) refers to the traumatic reactions that are replicated during sexual activity among survivors of child sexual abuse (CSA). However, the construct of sexual-related PTSS have been adapted from clinical work with survivors, and research with limited examination of the scales themselves. Given this gap, the current study offers the development of a new measure (PT-SEX) that examines sexual-related PTSS. The study was conducted online, among two convenience samples of women survivors of CSA (study 1 included 451 women and study 2 included 330 women). Six reliable PT-SEX factors emerged from Study 1: Dissociation during sex, intrusiveness during sex, shame and guilt in regard to sexual aspects, pleasing the other during sex, interpersonal distress, and hypervigilance during sex. Study 2 revealed survivors of CSA had significantly higher sexual-related PTSS levels as compared to participants without such a history. Also, post-traumatic stress disorder and sexual-related PTSS made unique and unshared contributions to the observed data, including sexual self-esteem, sexual motives, relationship satisfaction, compulsive sexual behavior, and mental health. CSA significantly moderated the associations between sexual-related PTSS and sexual self-esteem, sexual motivations of self-affirmation and coping, and depression and anxiety. Findings from the current study show that over time, the trauma of CSA seems to be implicated in survivors’ sexual experience. As sexual difficulties are accompanied by sexual-related PTSS, these symptoms are unlikely to resolve by trauma-focused therapy and must be actively targeted in therapy.
AbajobirA. A.KiselyS.MaravillaJ. C.WilliamsG.NajmanJ. M. (2017). Gender differences in the association between childhood sexual abuse and risky sexual behaviours: A systematic review and meta-analysis. Child Abuse & Neglect, 63(63), 249–260. https://doi.org/10.1016/J.CHIABU.2016.11.023
2.
BernsteinD. P.SteinJ. A.NewcombM. D.WalkerE.PoggeD.AhluvaliaT.StokesJ.HandelsmanL.MedranoM.DesmondD.ZuleW. (2003). Development and validation of a brief screening version of the Childhood Trauma Questionnaire. Child Abuse and Neglect, 27(2), 169–190. https://doi.org/10.1016/S0145-2134(02)00541-0
3.
BigrasN.Vaillancourt-MorelM. P.NolinM. C.BergeronS. (2021). Associations between childhood sexual abuse and sexual well-being in adulthood: A systematic literature review. Journal of Child Sexual Abuse, 30(3), 332–352. https://doi.org/10.1080/10538712.2020.1825148
4.
BirdE. R.SeehuusM.CliftonJ.RelliniA. H. (2014). Dissociation during sex and sexual arousal in women with and without a history of childhood sexual abuse. Archives of Sexual Behavior, 43(5), 953–964. https://doi.org/10.1007/s10508-013-0191-0
5.
Bornefeld-EttmannP.SteilR.LieberzK. A.BohusM.RauschS.HerzogJ.PriebeK.FydrichT.Müller-EngelmannM. (2018). Sexual functioning after childhood abuse: The influence of post-traumatic stress disorder and trauma exposure. The Journal of Sexual Medicine, 15(4), 529–538. https://doi.org/10.1016/J.JSXM.2018.02.016
6.
BőtheB.PotenzaM. N.GriffithsM. D.KrausS. W.KleinV.FussJ.DemetrovicsZ. (2020). The development of the compulsive sexual behavior disorder scale (CSBD-19): An ICD-11 based screening measure across three languages. Journal of Behavioral Addictions, 9(2), 247–258. https://doi.org/10.1556/2006.2020.00034
7.
BrottoL. A.SealB. N.RelliniA. (2012). Pilot study of a brief cognitive behavioral versus mindfulness-based intervention for women with sexual distress and a history of childhood sexual abuse. Journal of Sex & Marital Therapy, 38(1), 1–27. https://doi.org/10.1080/0092623X.2011.569636
8.
BuehlerS. (2008). Childhood sexual abuse: Effects on female sexual function and its treatment. Current Sexual Health Reports, 5, 154–158. https://doi.org/10.1007/s11930-008-0027-4
CooperM. L.ShapiroC. M.PowersA. M. (1998). Motivations for sex and risky sexual behavior among adolescents and adults: A functional perspective. Journal of Personality and Social Psychology, 75(6), 1528–1558. https://doi.org/10.1037//0022-3514.75.6.1528
DerogatisL. R.MelisaratosN. (2004). The SCL-90-R, the Brief Symptom Inventory (BSI), and the BSI-18. In MaruishM. E. (Ed.), The use of psychological testing for treatment planning and outcomes assessment: Instruments for adults (pp. 1–41). Lawrence Erlbaum Associates Publishers.
13.
EastonS. D.CooheyC.O’learyP.ZhangY.HuaL. (2011). The effect of childhood sexual abuse on psychosexual functioning during adulthood. Journal of Family Violence, 26(1), 41–50. https://doi.org/10.1007/s10896-010-9340-6
14.
EnsinkK.BerthelotN.BiberdzicM.NormandinL. (2016). The mirror paradigm: Assessing the embodied self in the context of abuse. Psychoanalytic Psychology, 33(3), 389–405. https://doi.org/10.1037/pap0000018
FrankeG. H.JaegerS.GlaesmerH.BarkmannC.PetrowskiK.BraehlerE. (2017). Psychometric analysis of the brief symptom inventory 18 (BSI-18) in a representative German sample. BMC Medical Research Methodology, 17(1), 1–7. https://doi.org/10.1186/s12874-016-0283-3
17.
Gewirtz-MeydanA. (2020). Treating sexual dysfunctions among survivors of child sexual abuse: An overview of empirical research. Trauma, Violence, & Abuse, 23, 840–853.
18.
Gewirtz-MeydanA.LahavY. (2020). Sexual dysfunction and distress among childhood sexual abuse survivors: The role of post-traumatic stress disorder. Journal of Sexual Medicine, 17, 2267–2278.
19.
Gewirtz-MeydanA.LahavY. (2021). Childhood sexual abuse and sexual motivations – the role of dissociation. Journal of Sex Research, 58(9), 1151–1160. https://doi.org/10.1080/00224499.2020.1808564
20.
Gewirtz-MeydanA.Ofir-LaveeS. (2020). Addressing sexual dysfunction after childhood sexual abuse: A clinical approach from an attachment perspective. Journal of Sex & Marital Therapy, 47(1), 43–59.
21.
Gewirtz-MeydanA.OpudaE. (2021). The sexual fantasies of childhood sexual abuse survivors: A rapid review. Trauma, Violence, and Abuse. Advance online publication. https://doi.org/10.1177/15248380211030487
22.
Gewirtz-MeydanA.OpudaE. (2022). The impact of CSA on men’s sexual function: A systematic review. Trauma, Violence & Abuse, 23(1), 265–277. https://doi.org/10.1177/1524838020939134
23.
HallK. S. K. (2017). Treating sexual problems in survivors of sexual trauma. In PetersonZ. D. (Ed.), The wiley handbook of sex therapy (pp. 389–406). Wiley-Blackwell.
24.
HansenN. B.BrownL. J.TsatkinE.ZelgowskiB.NightingaleV. (2012). Dissociative experiences during sexual behavior among a sample of adults living with HIV infection and a history of childhood sexual abuse. Journal of Trauma and Dissociation, 13(3), 345–360. https://doi.org/10.1080/15299732.2011.641710
25.
HarlowB. L.StewartE. G. (2005). Adult-onset vulvodynia in relation to childhood violence victimization. American Journal of Epidemiology, 161(9), 871–880. https://doi.org/10.1093/aje/kwi108
26.
HendrickS. S. (1988). A generic measure of relationship satisfaction. Journal of Marriage and Family, 50(1), 93–98.
27.
HughesM. M. (1994). Using the couple relationship to address childhood sexual abuse. The Family Journal, 2(2), 114–121. https://doi.org/10.1177/1066480794022004
28.
KatzS.MarshallB. (2003). New sex for old: Lifestyle, consumerism, and the ethics of aging well. Journal of Aging Studies, 17(1), 3–16. https://doi.org/10.1016/S0890-4065(02)00086-5
29.
KilimnikC. D.MestonC. M. (2021). Sexual shame in the sexual excitation and inhibition propensities of men with and without nonconsensual sexual experiences. Journal of Sex Research, 58, 261–272. https://doi.org/10.1080/00224499.2020.1718585
30.
KratzerL.HeinzP.SchennachR.KnefelM.SchiepekG.BiedermannS. V.BüttnerM. (2022). Sexual symptoms in post-traumatic stress disorder following childhood sexual abuse: A network analysis. Psychological Medicine, 52(1), 90–101. https://doi.org/10.1017/S0033291720001750
31.
KristensenE.LauM. (2011). Sexual function in women with a history of intrafamilial childhood sexual abuse. Sexual and Relationship Therapy, 26(3), 229–241. https://doi.org/10.1080/14681994.2011.622264
32.
KristensenE.LauM. (2013). 1485 – Evaluation of the effect of specialized group therapy on sexual problems in women with a history of child sexual abuse. European Psychiatry, 28(3), 1. https://doi.org/10.1016/S0924-9338(13)76510-6
33.
LeclercB.BergeronS.BinikY. M.KhaliféS. (2010). History of sexual and physical abuse in women with dyspareunia: Association with pain, psychosocial adjustment, and sexual functioning. The Journal of Sexual Medicine, 7(2), 971–980. https://doi.org/10.1111/j.1743-6109.2009.01581.x
34.
LemieuxS. R.ByersE. S. (2008). The sexual well-being of women who have experienced child sexual abuse. Psychology of Women Quarterly, 32(2), 126–144. https://doi.org/10.1111/j.1471-6402.2008.00418.x
35.
LeonardL. M.FolletteV. M. (2002). Sexual functioning in women reporting a history of child sexual abuse: Review of the empirical literature and clinical implications. Annual Review of Sex Research, 13(1), 346–388. https://doi.org/10.1080/10532528.2002.10559809
36.
LorenzT. A.HarteC. B.HamiltonL. D.MestonC. M. (2012). Evidence for a curvilinear relationship between sympathetic nervous system activation and women’s physiological sexual arousal. Psychophysiology, 49(1), 111–117. https://doi.org/10.1111/j.1469-8986.2011.01285.x
37.
LorenzT. K.HarteC. B.MestonC. M. (2015). Changes in autonomic nervous system activity are associated with changes in sexual function in women with a history of childhood sexual abuse. Journal of Sexual Medicine, 12(7), 1545–1554. https://doi.org/10.1111/jsm.12908
38.
MaltzW. (1988). Identifying and treating the sexual repercussions of incest: A couples therapy approach. Journal of Sex and Marital Therapy, 14(2), 142–170. https://doi.org/10.1080/00926238808403914
39.
MaltzW. (2002). Treating the sexual intimacy concerns of sexual abuse survivors. Sexual and Relationship Therapy, 17(4), 321–327. https://doi.org/10.1080/1468199021000017173
40.
MatorinA. I.LynnS. J. (1998). The development of a measure of correlates of child sexual abuse: The traumatic sexualization survey. Journal of Traumatic Stress, 11(2), 261–280. https://doi.org/10.1023/A:1024499019860
41.
MestonC. M.LorenzT. A. (2013). Physiological stress responses predict sexual functioning and satisfaction differently in women who have and have not been sexually abused in childhood. Psychological Trauma: Theory, Research, Practice, and Policy, 5(4), 350–358. https://doi.org/10.1037/a0027706
42.
MestonC. M.LorenzT. A.StephensonK. R. (2013). Effects of expressive writing on sexual dysfunction, depression, and PTSD in women with a history of childhood sexual abuse: Results from a randomized clinical trial. Journal of Sexual Medicine, 10(9), 2177–2189. https://doi.org/10.1111/jsm.12247
43.
MestonC. M.RelliniA. H.HeimanJ. R. (2006). Women’s history of sexual abuse, their sexuality, and sexual self-schemas. Journal of Consulting and Clinical Psychology, 74(2), 229–236. https://doi.org/10.1037/0022-006X.74.2.229
44.
NajmanJ. M.DunneM. P.PurdieD. M.BoyleF. M.CoxeterP. D. (2005). Sexual abuse in childhood and sexual dysfunction in adulthood: An Australian population-based study. Archives of Sexual Behavior, 34(5), 517–526. https://doi.org/10.1007/s10508-005-6277-6
45.
O’DriscollC.FlanaganE. (2016). Sexual problems and post-traumatic stress disorder following sexual trauma: A meta-analytic review. Psychology and Psychotherapy: Theory, Research and Practice, 89(3), 351–367. https://doi.org/10.1111/papt.12077
46.
PayneK. A.BinikY. M.AmselR.KhaliféS. (2005). When sex hurts, anxiety and fear orient attention towards pain. European Journal of Pain, 9, 427–436. https://doi.org/10.1016/j.ejpain.2004.10.003
47.
PulvermanC. S.KilimnikC. D.MestonC. M. (2018). The impact of childhood sexual abuse on women’s sexual health: A comprehensive review. Sexual Medicine Reviews, 6(2), 188–200. https://doi.org/10.1016/j.sxmr.2017.12.002
48.
PulvermanC. S.MestonC. M. (2019). Sexual dysfunction in women with a history of childhood sexual abuse: The role of sexual shame. Psychological Trauma: Theory, Research, Practice, and Policy, 12(3), 291–299. https://doi.org/10.1037/tra0000506
49.
RelliniA.MestonC. (2007). Sexual function and satisfaction in adults based on the definition of child sexual abuse. The Journal of Sexual Medicine, 4(5), 1312–1321. https://doi.org/10.1111/j.1743-6109.2007.00573.x
50.
RelliniA. H.IngA. D.MestonC. M. (2011). Implicit and explicit cognitive sexual processes in survivors of childhood sexual abuse. The Journal of Sexual Medicine, 8(11), 3098–3107. https://doi.org/10.1111/j.1743-6109.2011.02356.x
51.
RelliniA. H.MestonC. M. (2006). Psychophysiological sexual arousal in women with a history of child sexual abuse. Journal of Sex & Marital Therapy, 32(1), 5–22. https://doi.org/10.1080/00926230500229145
52.
RelliniA. H.MestonC. M. (2011). Sexual self-chemas, sexual dysfunction, and the sexual responses of women with a history of childhood sexual abuse. Archives of Sexual Behavior, 40(2), 351–362. https://doi.org/10.1007/s10508-010-9694-0
53.
RosenR. C.RileyA.WagnerG.OsterlohI. H.KirkpatrickJ.MishraA. (1997). The international index of erectile function (IIEF): A multidimensional scale for assessment erectile dysfunction. Urology, 49(6), 822–830.
54.
SlavinM. N.ScoglioA. A. J.BlyckerG. R.PotenzaM. N.KrausS. W. (2020). Child sexual abuse and compulsive sexual behavior: A systematic literature review. Current Addiction Reports, 7(1), 76–88. https://doi.org/10.1007/s40429-020-00298-9
55.
SnellW. E.FisherT. D.WaltersA. S. (1993). The multidimensional sexuality questionnaire: An objective self-report measure of psychological tendencies associated with human sexuality. Annals of Sex Research, 6, 27–55.
56.
StaplesJ.RelliniA. H.RobertsS. P. (2012). Avoiding experiences: Sexual dysfunction in women with a history of sexual abuse in childhood and adolescence. Archives of Sexual Behavior, 41(2), 341–350. https://doi.org/10.1007/s10508-011-9773-x
57.
SwabyA. N.MorganK. A. D. (2009). The relationship between childhood sexual abuse and sexual dysfunction in Jamaican adults. Journal of Child Sexual Abuse, 18(3), 247–266. https://doi.org/10.1080/10538710902902679
58.
TheunissenC. J. (2018). Reports of traumatic sexualisation in a group of female survivors of childhood sexual abuse. North West University.
59.
TietjenG. E.BrandesJ. L.PeterlinB. L.EloffA.DaferR. M.SteinM. R.DrexlerE.MartinV. T.HutchinsonS.AuroraS. K.RecoberA.HerialN. A.UtleyC.WhiteL.KhuderS. A. (2010). Childhood maltreatment and migraine (part I). Prevalence and adult revictimization: A multicenter headache clinic survey. Headache, 50(1), 20–31. https://doi.org/10.1111/j.1526-4610.2009.01556.x
60.
TsurN. (2020). Chronic pain personification following child abuse: The imprinted experience of child abuse in later chronic pain. Journal of Interpersonal Violence, 37, 1–22. https://doi.org/10.1177/0886260520944529
61.
van der KolkB. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. Viking.
62.
WeathersF.LitzB.KeaneT.PalmieriT.MarxB. P.SchnurrP. (2013). The PTSD checklist for DSM-5 (PCL-5). Scale available from the National Center for PTSD at www.ptsd.va.gov
63.
YehudaR.LehrnerA.RosenbaumT. Y. (2015). PTSD and sexual dysfunction in men and women. Journal of Sexual Medicine, 12(5), 1107–1119. https://doi.org/10.1111/jsm.12856
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