published_or_final_version / Social Work and Social Administration / Doctoral / Doctor of Philosophy

Since the 2011 revolution, the media has given much attention to the problem of sexual harassment and assault in Egypt. Attacks against female journalists and protestors have thrust the issue into the international spotlight, but it is a problem that has plagued Egypt for years. The majority of women in Egypt face some kind of sexual harassment everyday. This report is about the men and women who are working to stop sexual harassment and assault in Egypt. / text

This study examined sexual frequency, sexual satisfaction, and marital satisfaction in connection with the emotional climate within which it exists, using data from a 13-year longitudinal study about marriage. First, affection and negativity were used to predict sexual frequency. Second, affection, negativity and sexual frequency were used to predict spouses' sexual satisfaction. Third, sexual frequency and spouses' sexual satisfaction were used to predict marital satisfaction. A positive association was found between affection and sexual frequency, whereas no association was found between negativity and sexual frequency. Affection was found to be associated with higher sexual satisfaction for husbands in the early years of marriage and negativity was associated with lower sexual satisfaction for both spouses. An association was also found between one's own sexual satisfaction and marital satisfaction. No association was found between sexual frequency and marital satisfaction when the emotional climate was considered. / text

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In clinical trials of drug treatments for women’s sexual dysfunction, placebo responses have often been substantial. Little is known about the nature and time course of symptom reduction with placebo treatment. It is also unknown to what extent placebo responses might be associated with individual characteristics, such as demographic variables, that influence responsiveness to treatment. Finally, it is unknown how sexual behavior during placebo treatment changes and whether changes in sexual behavior account for variability in outcomes. In the present work I investigated potential between-trial, between-person, and within-person variables that might explain variability in response to placebo treatment of sexual dysfunction in women. Study 1 consisted of a systematic review of the clinical trial literature to estimate the magnitude and predictors of placebo response across previous trials. Study 2 was an analysis of a small sample of women who were randomized to receive placebo in a recent clinical trial. These preliminary studies provided evidence of a relatively large clinical response among women randomized to placebo in controlled clinical trials of sexual dysfunction treatments. In addition, I found evidence of a possible effect of psychosocial variables on placebo response. In Study 3, I further tested the nature and correlates of placebo response in a sample of 50 women with sexual arousal and desire problems. These data were drawn from a 12-week double-blind randomized controlled trial in which measurement of symptom severity took place at baseline, 4 weeks, 8 weeks, and 12 weeks, allowing for longitudinal analysis. Change in sexual function during placebo treatment peaked at 4 weeks and remained relatively stable through post-treatment. Furthermore, change in sexual function was clinically meaningful in approximately one-third of the sample. Symptom improvement appeared to be in part a function of increased frequency of satisfying sexual encounters during treatment, although there remained additional variability in outcomes that could not be explained by the available data. The findings are discussed with reference to enhancing both clinical trial design and psychological therapies in the treatment of sexual dysfunction in women. / text

More than 20 million people in the United States have survived a completed or attempted rape in their lifetimes, and approximately 22.5 million people have problematic substance use. The interplay between these two issues is complex: a history of sexual assault predicts substance abuse and, conversely, substance abuse increases sexual assault risk. This secondary analysis of the Virginia Twin Study of Psychiatric and Substance Use Disorders data for White female-female twins (n=1,497) examines the role of multiple traumas in the sexual assault/substance abuse association. Structural models were used to examine pathways between child sexual abuse (CSA), other traumas, familial factors, social support, psychiatric disorders, and substance abuse. The models also integrate the ACE twin design to estimate genetic, shared environment, and individual-specific environment contributions to liability for psychiatric disorders and substance abuse. Study findings support an interplay between childhood trauma, development of substance abuse and psychiatric disorders, and risks for adult victimization. The findings also support assertions that multiple traumas may increase likelihood for substance abuse and psychiatric disorders, and that these disorders predict risk of adult sexual assault. Across all ACE models, both genetics and common environment produced consistently large estimates of influence on liability for substance abuse. Individual-specific environment played a smaller role but was also often significant, and the pathways from trauma variables to both psychiatric disorders and substance abuse tended to be strong. This supports an interaction between genes and environment/experience in which genetic predisposition, though present, may or may not be activated depending on life experiences. Study findings underscore the need for integrated services for clients with history of multiple traumas and for clients with trauma history and substance abuse or psychiatric disorders. / text

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Recent studies have shown that sexual functioning and sexually related personal distress are weakly related in women, with only a minority of sexual difficulties resulting in significant levels of distress. However, there has been little systematic research to date on which factors moderate the relationship between sexual functioning and sexual distress. Our aim was to assess the degree to which relational intimacy and attachment anxiety moderate the association between sexual functioning and sexual distress in college-age women. Two hundred women (mean age = 20.25) completed surveys assessing sexual functioning, relational intimacy, attachment anxiety, and sexual distress. Relational intimacy and attachment anxiety moderated the association between multiple aspects of sexual functioning and sexual distress. For lubrication and sexual pain, functioning was more strongly associated with distress in low-intimacy vs. high-intimacy relationships, but only for women with high levels of attachment anxiety. Results regarding desire were mixed and neither intimacy nor attachment anxiety interacted with subjective arousal or orgasm in predicting distress. We conclude that both relational intimacy and attachment anxiety are important moderators of the association between sexual functioning and subjective sexual distress in women. Theoretical and practical implications are discussed. / text

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