Compulsive sexual behavior disorder in 42 countries: Insights from the International Sex Survey and introduction of standardized assessment tools

© 2023 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC), https://creativecommons.org/licenses/by-nc/4.0/Background and aims Despite its inclusion in the 11th revision of the International Classification of Diseases, there is a virtual paucity of high-quality scientific evidence about compulsive sexual behavior disorder (CSBD), especially in underrepresented and underserved populations. Therefore, we comprehensively examined CSBD across 42 countries, genders, and sexual orientations, and validated the original (CSBD-19) and short (CSBD-7) versions of the Compulsive Sexual Behavior Disorder Scale to provide standardized, state-of-the-art screening tools for research and clinical practice. Method Using data from the International Sex Survey (N = 82,243; Mage = 32.39 years, SD = 12.52), we evaluated the psychometric properties of the CSBD-19 and CSBD-7 and compared CSBD across 42 countries, three genders, eight sexual orientations, and individuals with low vs. high risk of experiencing CSBD. Results A total of 4.8% of the participants were at high risk of experiencing CSBD. Country- and gender-based differences were observed, while no sexual-orientation-based differences were present in CSBD levels. Only 14% of individuals with CSBD have ever sought treatment for this disorder, with an additional 33% not having sought treatment because of various reasons. Both versions of the scale demonstrated excellent validity and reliability. Discussion and conclusions This study contributes to a better understanding of CSBD in underrepresented and underserved populations and facilitates its identification in diverse populations by providing freely accessible ICD-11-based screening tools in 26 languages. The findings may also serve as a crucial building block to stimulate research into evidence-based, culturally sensitive prevention and intervention strategies for CSBD that are currently missing from the literature.Peer reviewe

Psychometric properties of the Alcohol Use Disorders Identification Test (AUDIT) across cross-cultural subgroups, genders, and sexual orientations: Findings from the International Sex Survey (ISS)

Introduction. Despite being a widely used screening questionnaire, there is no consensus on the most appropriate measurement model for the Alcohol Use Disorders Identification Test (AUDIT). Furthermore, there have been limited studies on its measurement invariance across cross-cultural subgroups, genders, and sexual orientations. Aims. The present study aimed to examine the fit of different measurement models for the AUDIT and its measurement invariance across a wide range of subgroups by country, language, gender, and sexual orientation. Methods. Responses concerning past-year alcohol use from the participants of the cross-sectional International Sex Survey were considered (N = 62,943; Mage: 32.73; SD = 12.59). Confirmatory factor analysis, as well as measurement invariance tests were performed for 21 countries, 14 languages, three genders, and four sexual-orientation subgroups that met the minimum sample size requirement for inclusion in these analyses. Results. A two-factor model with factors describing ‘alcohol use’ (items 1–3) and ‘alcohol problems’ (items 4–10) showed the best model fit across countries, languages, genders, and sexual orientations. For the former two, scalar and latent mean levels of invariance were reached considering different criteria. For gender and sexual orientation, a latent mean level of invariance was reached. Conclusions. In line with the two-factor model, the calculation of separate alcohol-use and alcohol-problem scores is recommended when using the AUDIT. The high levels of measurement invariance achieved for the AUDIT support its use in cross-cultural research, capable also of meaningful comparisons among genders and sexual orientations

Cross-cultural Validation of the Arizona Sexual Experience Scale (ASEX) in 42 Countries and 26 Languages

© The Author(s) 2024. This is an Open Access article, licensed under a Creative Commons Attribution 4.0 International License. http://creativecommons.org/licenses/by/4.0/The Arizona Sexual Experiences Scale (ASEX) is a brief questionnaire that evaluates five major aspects of sexual function: sex drive, arousal, erectile function/vaginal lubrication, ability to reach orgasm, and satisfaction with orgasm. An advantage of the ASEX is its simplicity and brevity (five items), making it suitable for the screening of sexual function problems in healthcare contexts and large-scale studies. The main objective of this study was to examine the psychometric properties of the ASEX in a multi-national sample, as well as to explore sexual function according to countries, genders, and sexual orientations.Peer reviewe

Motives for pornography use and women's sexual wellbeing: Insights from a 42-country study

Background and aims Despite a growing body of research on pornography use among women, there is a lack of understanding of the problematic versus non-problematic nature. The current study aimed to investigate the relationship between women's motivations for pornography use and sexual wellbeing using a cross-sectional, self-report survey design among participants from 42 countries. Methods The total sample included 82,243 participants, of whom 46,874 (57.0%) identified as women and were analyzed. The participants' age averaged at M = 29.67 years, with a standard deviation of SD = 10.11. Participants were asked to complete a questionnaire assessing their motivations for pornography use, as well as measures of sexual functioning, sexual desire, and sexual satisfaction. Results Study results suggest that across cultures, women's motivations for pornography use are associated with their sexual wellbeing. Specifically, when women reported using pornography for their own pleasure or sexual curiosity, it was associated with fewer sexual functioning problems and higher sexual desire. Conversely, when women reported using pornography due to a lack of sexual satisfaction in their relationships, it was associated with more sexual functioning problems. Discussion and conclusions These findings highlight the need to consider the multifaceted nature of pornography use among women, including the usage motives, to fully understand associations with sexual wellbeing. Additionally, the study emphasizes the importance of conducting further research utilizing longitudinal designs, to establish the directionality between pornography use motivations and sexual wellbeing among women

Identification and comprehensive characterization of moral disapproval and behavioral dysregulation-based pornography-use profiles across 42 countries

Background and aims The Moral Incongruence Model of Pornography Use proposes that pornography-use-related problems may be present due to problematic pornography use (PPU) and/or moral disapproval (MD) of pornography use. Despite some supporting empirical evidence, no study has tested the presence of different pornography-use profiles based on individuals' behavioral dysregulation (i.e., PPU) and moral values concerning pornography use. The generalizability of previous findings to diverse populations has also been limited given the scarcity of studies conducted outside of Western countries. Methods Using data from the International Sex Survey (42 countries, N = 66,994; Mage = 32.16 years, SD = 12.27), we conducted latent profile analysis to identify pornography-use profiles based on individuals' frequency of use, MD, and PPU. The profiles were compared along a wide range of pornography-use-related, sexuality-related, and psychological correlates. Results Six pornography-use profiles were identified, including two increased risk groups (i.e., Increased risk of PPU without MD and Increased risk of PPU with some MD). Several factors differentiated between the increased risk vs. no/low risk profiles (e.g., relatedness satisfaction) as well as between the two increased risk profiles (e.g., religiosity). Apart from behavioral dysregulation, moral values concerning pornography use played an important role in distinguishing pornography-use profiles and demonstrated the importance of inquiring about MD when working with individuals with pornography-use-related problems. Conclusion Findings also support recent calls for better-integrated sex therapy and sexual medicine perspectives into pornography-use-related problems research and care

The short version of the Sexual Distress Scale (SDS-3): Measurement invariance across countries, gender identities, and sexual orientations

© 2024 The Author(s). Published by Elsevier B.V. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial 4.0 International License (CC BY-NC), https://creativecommons.org/licenses/by-nc/4.0/Background The three-item Sexual Distress Scale (SDS-3) has been frequently used to assess distress related to sexuality in public health surveys and research on sexual wellbeing. However, its psychometric properties and measurement invariance across cultural, gender and sexual subgroups have not yet been examined. This multinational study aimed to validate the SDS-3 and test its psychometric properties, including measurement invariance across language, country, gender identity, and sexual orientation groups. Methods We used global survey data from 82,243 individuals (Mean age=32.39 years; 40.3 % men, 57.0 % women, 2.8 % non-binary, and 0.6 % other genders) participating in the International Sexual Survey (ISS; https://internationalsexsurvey.org/) across 42 countries and 26 languages. Participants completed the SDS-3, as well as questions regarding sociodemographic characteristics, including gender identity and sexual orientation. Results Confirmatory factor analysis (CFA) supported a unidimensional factor structure for the SDS-3, and multi-group CFA (MGCFA) suggested that this factor structure was invariant across countries, languages, gender identities, and sexual orientations. Cronbach's α for the unidimensional score was 0.83 (range between 0.76 and 0.89), and McDonald's ω was 0.84 (range between 0.76 and 0.90). Participants who did not experience sexual problems had significantly lower SDS-3 total scores (M = 2.99; SD=2.54) compared to those who reported sexual problems (M = 5.60; SD=3.00), with a large effect size (Cohen's d = 1.01 [95 % CI=-1.03, -0.98]; p < 0.001). Conclusion The SDS-3 has a unidimensional factor structure and appears to be valid and reliable for measuring sexual distress among individuals from different countries, gender identities, and sexual orientations.Peer reviewe

Cross-cultural Validation of the Arizona Sexual Experience Scale (ASEX) in 42 Countries and 26 Languages

Introduction The Arizona Sexual Experiences Scale (ASEX) is a brief questionnaire that evaluates five major aspects of sexual function: sex drive, arousal, erectile function/vaginal lubrication, ability to reach orgasm, and satisfaction with orgasm. An advantage of the ASEX is its simplicity and brevity (five items), making it suitable for the screening of sexual function problems in healthcare contexts and large-scale studies. The main objective of this study was to examine the psychometric properties of the ASEX in a multi-national sample, as well as to explore sexual function according to countries, genders, and sexual orientations. Methods The psychometric examination of the ASEX was conducted with a sample of 82,243 participants (women = 57.02%; men = 39.59%; gender-diverse = 3.38%; Mage = 32.39 years; SD = 12.52) from 42 different countries speaking 26 languages. Results The CFA supported a one-factor solution. Multigroup CFAs supported configural, metric, partial scalar, and residual invariance across countries, languages, genders, and sexual orientations. Furthermore, the ASEX showed good internal consistency (ω = .85) and convergent validity (e.g., significant negative associations with masturbation and sexual intercourse frequency). Finally, individuals in Eastern countries, women, and asexual participants reported higher levels of sexual function issues. Conclusions and Policy Implications The findings supported the use of the ASEX as a tool to screen for sexual function problems across diverse populations in multi-cultural settings. This scale may be used to improve our knowledge on the cross-cultural differences on the expression of sexual function, serving as the basis for the development of culturally tailored interventions for the improvement of this basic aspect of well-being

Compulsive Sexual Behavior Disorder in 42 Countries: Insights from the International Sex Survey and Introduction of Standardized Assessment Tools

Background and aims: Despite its inclusion in the 11th revision of the International Classification of Diseases, there is a virtual paucity of high-quality scientific evidence about compulsive sexual behavior disorder (CSBD), especially in underrepresented and underserved populations. Therefore, we comprehensively examined CSBD across 42 countries, genders, and sexual orientations, and validated the original (CSBD-19) and short (CSBD-7) versions of the Compulsive Sexual Behavior Disorder Scale to provide stan- dardized, state-of-the-art screening tools for research and clinical practice. Method: Using data from the International Sex Survey (N 5 82,243; Mage 5 32.39 years, SD 5 12.52), we evaluated the psychometric properties of the CSBD-19 and CSBD-7 and compared CSBD across 42 countries, three genders, eight sexual orientations, and individuals with low vs. high risk of experiencing CSBD. Results: A total of 4.8% of the participants were at high risk of experiencing CSBD. Country- and gender-based differences were observed, while no sexual-orientation-based differences were pre- sent in CSBD levels. Only 14% of individuals with CSBD have ever sought treatment for this disorder, with an additional 33% not having sought treatment because of various reasons. Both versions of the scale demonstrated excellent validity and reliability. Discus- sion and conclusions: This study contributes to a better under- standing of CSBD in underrepresented and underserved populations and facilitates its identification in diverse populations by providing freely accessible ICD-11-based screening tools in 26 languages. The findings may also serve as a crucial building block to stimulate research into evidence-based, culturally sensitive pre- vention and intervention strategies for CSBD that are currently missing from the literature

Change Through Stillness: Qualitative Explorations of Heterosexual Men as They Utilise Meditation as an Intervention for Self-Perceived Problematic Pornography Use

This project fills significant research gaps in current literature related to adult heterosexual men who identify with a problematic relationship with pornography, including qualitative research examining the experiences and contexts that contributed to SPPPU, its origins, explorations of past attempts at quitting, and experiences of men as they intervene with the problematic pornography use with a meditation intervention designed specifically for this study. The aim of this study was to explore the effectiveness of meditation as an intervention and mediator of pornography viewing for adult heterosexual men who identify with Self-Perceived Problematic Pornography Use (SPPPU) utilizing Single Case Experimental Design (SCED). Additionally, the study design explored the previously undocumented qualitative accounts of men’s experiences with SPPPU, its origins, contexts for use, and experiences of these men as they intervene with their problematic pornography use. Using a multiple baseline design in accordance with the single-case reporting guidelines in behavioural interventions (SCRIBE), fifteen men (n=3 for pilot study; n=12 for intervention study) with SPPPU participated in a randomized multiple-baseline across-subjects design with one intervention condition: twice-daily guided meditations. Participants logged their daily pornography viewing (both frequency and total duration) throughout the study, and filled out the Pornography Craving Questionnaire (PCQ) and Problematic Pornography Consumption Scale (PPCS) at intake and post-study. Qualitative data provided by pre- and post-study interviews provided rich data, which served the primary function of contextualising data and adding explanatory power in support of other quantitative results. Statistical analyses alone demonstrated modest results in relation to meditation’s potential efficacy as an intervention for SPPPU. Thematic analyses helped to reveal both important themes related to how men talk about SPPPU, as well as supportive data for the perceived benefits and mechanisms of action associated with meditation as it relates to SPPPU. Lastly, the experiences of men as they engage with SPPPU revealed key considerations for researchers/clinicians working with this study population. Potential directions for future research and implications for researchers/clinicians are also discussed