Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, 50100, Italy.
Andrology, Women's Endocrinology and Gender Incongruence Unit, "Mario Serio" Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, 50100, Italy.
J Sex Med. 2024 Jun 27;21(7):635-647. doi: 10.1093/jsxmed/qdae058.
Childhood traumatic experiences have been associated with hypersexuality and sexual dysfunctions. However, the mediators of the interactions between these variables should be clarified in men.
This study aimed to investigate the interaction of early traumatic experiences, psychopathology, and sexuality with respect to erectile dysfunction (ED) and hypersexual behavior. The hypothesized model expected that traumatic experiences would be associated with hypersexual behavior and reduced sexual functioning through the mediation of body uneasiness and psychological distress.
The study was cross-sectional and observational. A total of 317 men were enrolled. Male patients with a primary complaint of ED and an indication for psychiatry referral represented the clinical sample (n = 116; mean ± SD age, 42.82 ± 16.89 years). Clinical classification was assessed with the Structured Interview on Erectile Dysfunction. The second sample (n = 201, 30.82 ± 11.94 years) was recruited from the general population. All participants were administered the following questionnaires: Brief Symptom Inventory, Childhood Trauma Questionnaire-Short Form, Hypersexual Behavior Inventory, Body Uneasiness Test-A, and 5-item International Index of Erectile Function.
Psychopathology and sexual functioning were assessed by a dimensional approach, and a multivariate model was computed by structural equation model analysis.
When compared with the sample from the general population, the clinical sample exhibited a higher prevalence of early traumatic experiences, as measured by scores on the Childhood Trauma Questionnaire-Short Form (45.08 ± 14.25 vs 39.03 ± 10.22, F = 17.63, P < .001), and a higher tendency to engage in hypersexual behaviors (34.63 ± 13.55 vs 30.79 ± 12.44, F = 6.97, P < .01). Structural equation model analysis showed excellent fit indices indicating that early traumatic experiences predicted hypersexual behaviors and ED through the exacerbating mediating effect of body uneasiness and psychopathology.
Clinicians should not limit their attention to the behavioral level when assessing sexual dysfunction in men; rather, they should also consider the complex psychopathologic consequences of childhood trauma. Integrated treatments that address the potential presence of childhood trauma with its wider psychological correlates (eg, emotion dysregulation, body uneasiness) might improve treatment response.
The study reports novel data on the relationship among childhood maltreatment, male sexuality, and psychopathologic mediators with a dimensional assessment. However, the assessment was cross-sectional, and causality was mainly derived from previous studies.
The present study enriches the current literature, strengthening the hypothesis that childhood traumatic experiences significantly shape development and sexuality. Body uneasiness and psychopathology can both tax sexual functioning, as assessed by erectile functioning or hypersexuality.
童年创伤经历与性欲亢进和性功能障碍有关。然而，在男性中，这些变量之间相互作用的中介因素仍需阐明。
本研究旨在探讨早期创伤经历、精神病理学和性与勃起功能障碍（ED）和性欲亢进行为之间的相互作用。假设模型预期创伤经历会通过身体不适和心理困扰的中介作用与性欲亢进行为和性功能降低相关。
本研究为横断面和观察性研究。共纳入 317 名男性。以勃起功能障碍为主要主诉和精神科转诊指征的男性患者代表临床样本（n=116；平均年龄±标准差，42.82±16.89 岁）。临床分类采用勃起功能障碍结构化访谈进行评估。第二组样本（n=201，30.82±11.94 岁）从普通人群中招募。所有参与者均接受以下问卷评估：简明症状量表、儿童期创伤问卷-短式、性欲亢进行为量表、身体不适测试-A 和 5 项国际勃起功能指数。
与普通人群样本相比，临床样本的儿童期创伤问卷-短式评分（45.08±14.25 分比 39.03±10.22 分，F=17.63，P<.001）更高，且更倾向于发生性欲亢进行为（34.63±13.55 分比 30.79±12.44 分，F=6.97，P<.01）。结构方程模型分析显示，模型拟合指数良好，表明早期创伤经历通过加剧身体不适和精神病理学的中介作用预测性欲亢进行为和 ED。
当评估男性性功能障碍时，临床医生不应仅关注行为层面；还应考虑童年创伤的复杂心理后果。针对潜在的儿童期创伤及其更广泛的心理相关因素（如情绪调节、身体不适）的综合治疗可能会改善治疗反应。
本研究报告了关于童年期虐待、男性性行为和精神病理中介因素之间关系的新数据，采用了维度评估。然而，评估是横断面的，主要来源于既往研究。
本研究丰富了当前文献，加强了童年创伤经历对性发展和性行为具有重要影响的假设。身体不适和精神病理学都可能对勃起功能或性欲亢进行为评估的性功能产生影响。
