Summary

The aim of this study was to investigate the influence of sexual trauma exposure and PTSD on sexual functioning and sexual satisfaction by comparing 3 groups of women.

“The assumption that PTSD rather than the experience of sexual violence is crucial for impairments in sexual functioning is supported by a high prevalence of sexual dysfunctions in PTSD patients who experienced other forms of traumatic events, such as war-related trauma.”

 

 

“Considering the results of previous studies, it remains unclear whether the occurrence of PTSD symptoms or the experience of a traumatic event itself has a greater impact on the development of sexual impairments.”

Thus, the study looked at the role PTSD (Post Traumatic Stress Disorder) has in mediating sexual functioning and sexual satisfaction after CSA (Childhood Sexual Abuse) by comparing women with both PTSD and CSA (Group 1 – Trauma Group), women with CSA but no PTSD (Group 2 – Trauma Controls), and women without PTSD or CSA (Group 3 – Healthy Controls). Groups were matched for basic demographics and for abuse using the Childhood Trauma Questionnaire. The only demographic reportedly not matched evenly was sexual orientation. The Trauma Group had significantly fewer persons of heterosexual sexual orientation than the Trauma Controls and the Healthy Controls.(1)Authors made no other comment on this data point. During statistical analysis, depression was factored in as a covariate but not found to be significant.

Outcome

Researchers found no significant differences in arousal or orgasm in any of the groups. Significant difference was found in pain, aversion, and sexual satisfaction between Trauma Group and both Trauma Controls and Normal Controls. No significant differences in pain, aversion, and sexual satisfaction between Trauma Controls and Normal Controls.

“Our findings overall suggest that the presence of PTSD symptoms has a greater impact on the development of sexual dysfunction than does the experience of childhood trauma itself.”

Cohen d effect size
PAIN TC HC
TG .66† .75‡
TC ns

 

AVERSION TC HC
TG 1.48‡ 1.68‡
TC ns

 

SATISFACTION TC HC
TG 1.28‡ 1.27†
TC ns

P < .05.   ‡P < .01.

While the researchers report high (aversion) and medium (pain/satisfaction) effect sizes, traditional interpretation would suggest a large effect on pain and very large effect on aversion and satisfaction. One way to say it is that adding PTSD symptoms to CSA moves the mean for aversion score up 96% of the time. Adding PTSD symptoms moves the mean more than one standard deviation above the mean of those without PTSD symptoms. The presence of CSA alone does not significantly move the mean score.

Review

This appears to be a well done study. For the most part, assessment of PTSD, CSA, borderline, and depression seem valid (though I would have preferred validated instruments). Sexual dysfunction was assessed by self report, which is historically unreliable. We are also not given the questions used to assess arousal, orgasm, pain, and avoidance so it is unclear what was exactly assessed. Interpretation to a ICD-10 or DSM diagnosis is not appropriate since that criteria was not used.

Researchers pointed out that the high level of physical abuse (vs just sexual abuse) has the potential to confound the numbers. Testing for depression as a covariate suggested no direct impact of the depression.

Finally, researchers acknowledged symptomology for PTSD members was pretty high. This limits generalizability for individuals with a low level of PTSD symptoms.

So What? …

“Presence of childhood sexual abuse alone, does not seem to predict sexual problems.” Many couples and individuals are concerned, or believe, the problems in their marriage are a result of CSA. This study suggests the presence of Childhood Sexual Abuse alone may not be issue in sexual problems.

Great hope for those experiencing sexual dysfunction related to PTSD and CSA. While individuals (couples) cannot change the presence of CSA, treatment is available for PTSD symptoms. As this study suggests it is primarily the PTSD that is linked to the sexual dysfunction, there is hope for addressing the sexual dysfunction by decreasing the PTSD (experimental research would be needed to support this hypothesis).

Citation

Bornefeld-Ettmann, P., Steil, R., Lieberz, K. A., Bohus, M., Rausch, S., Herzog, J., . . . Müller-Engelmann, M. (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. doi:10.1016/j.jsxm.2018.02.016

References   [ + ]

1. Authors made no other comment on this data point.