The Sexuality Forum

"Life is an irresistible desire to be irresistibly desired..."

More women sexually active into old age
However, one in seven women aged 65 to 79 years has hypoactive sexual desire dysfunction
November 9, 2016
The North American Menopause Society (NAMS)
Multiple studies show that older women are still sexually active beyond their seventh decade of life. A new study suggests, however, that at least one in seven women aged 65 to 79 years has hypoactive sexual desire dysfunction (HSDD).



Multiple studies show that older women are still sexually active beyond their seventh decade of life. A new study published online in Menopause, the journal of The North American Menopause Society (NAMS), suggests, however, that at least one in seven women aged 65 to 79 years has hypoactive sexual desire dysfunction (HSDD).
In the questionnaire-based, cross-sectional study, more than 1,500 Australian women were assessed for sexual function and sexual distress as defined by the Female Sexual Function Index and the Female Sexual Distress Scale-Revised. The group consisted of 52.6% partnered women, with a mean age of 71 years. Within this group, 88% were found to have low sexual desire, 15.5% had sexually related personal distress, and 13.6% had HSDD, which is defined as the presence of both low sexual desire and sexually related personal distress. This percentage was higher than what had previously been reported for women in this age group and similar to the prevalence reported for younger women.
Although HSDD was found to be more common in women with partners, the study confirmed that unpartnered older women are still sexually active and may be distressed by low sexual desire. Independent factors included vaginal dryness during intercourse in the past month, having moderate to severe depressive symptoms, and having symptomatic pelvic floor dysfunction.
"This study demonstrates that healthcare providers need to have honest and open discussions with their patients as they age with regard to desire, mood, vaginal dryness, and pelvic floor issues to determine whether these factors are affecting a woman's desire or ability to be sexual," says Dr. JoAnn Pinkerton, NAMS executive director.

Story Source:
Materials provided by The North American Menopause Society (NAMS). Note: Content may be edited for style and length.

Journal Reference:
  1. Berihun M. Zeleke, Robin J. Bell, Baki Billah, Susan R. Davis. Hypoactive sexual desire dysfunction in community-dwelling older women. Menopause, 2016; 1 DOI: 10.1097/GME.0000000000000767

Study reveals secret to a happy sex life
November 8, 2016
University of Toronto
The secret to a happy sex life in long-term relationships is the belief that it takes hard work and effort, instead of expecting sexual satisfaction to simply happen if you are true soulmates, suggests a new study.
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The secret to a happy sex life in long-term relationships is the belief that it takes hard work and effort, instead of expecting sexual satisfaction to simply happen if you are true soulmates, says a study led by a University of Toronto (U of T) social psychology researcher.
These "sexpectations" -- the need to work on sexual growth or rely on sexual destiny -- are so powerful they can either sustain otherwise healthy relationships or undermine them, says Jessica Maxwell, a PhD candidate in the Department of Psychology in the Faculty of Arts & Science at U of T.
"People who believe in sexual destiny are using their sex life as a barometer for how well their relationship is doing, and they believe problems in the bedroom equal problems in the relationship as a whole," says Maxwell.
"Whereas people who believe in sexual growth not only believe they can work on their sexual problems, but they are not letting it affect their relationship satisfaction."
The findings are based on research involving approximately 1,900 participants, and the results published online in the
Journal of Personality and Social Psychology included people from both heterosexual and same-sex relationships.
While the effect of people's so-called "implicit beliefs" have been studied in other aspects of human relationships, this is the first time they have been applied to the sexual domain.
Maxwell says there is a honeymoon phase lasting about two to three years where sexual satisfaction is high among both sexual growth and sexual destiny believers.
But the benefit of believing in sexual growth becomes apparent after this initial phase, as sexual desire begins to ebb and flow.
"We know that disagreements in the sexual domain are somewhat inevitable over time," says Maxwell. "Your sex life is like a garden, and it needs to be watered and nurtured to maintain it."
While her research did not focus on the influence of media on sex beliefs, it is clear pop culture has conditioned us to accept and understand that other aspects of relationships, such as the division of household chores, takes work and effort, Maxwell notes.
Hollywood's glamorous portrayal of sex and romance in shows like The Bachelor are less grounded in reality, however, which may fuel a "soulmate" philosophy that is not as adaptable to conflicts and problems that arise over time.
Maxwell says her research provided at least one example of the media's impact on the sexual domain. She was able to influence people's beliefs by "priming" them with phoney magazine articles that either emphasized sexual destiny philosophies, or advocated the idea that sex takes work.
Like everything else concerning human relationships, however, the study suggests the distinctions between the two schools of belief are more shades of grey than black and white.
For example, the research demonstrated there are often aspects of both sexual growth and sexual destiny beliefs in the same individual.
And while many women are avid consumers of soulmate and romantic destiny stories, the study showed they are more likely than men to believe that sex takes work in a long-term relationship.
"I think that this could be because there is some evidence that sexual satisfaction takes more work for women, so they rate higher on the sexual growth scale," Maxwell says The study showed that, while sexual-growth beliefs can buffer the impact of problems in the bedroom, they don't help as much if the problems become too substantial.
There is also some evidence that sexual-destiny believers may be open to making changes in their sex life for the sake of their partners, but only if they are convinced they are their true soulmate.
The findings underscore the importance for counsellors and clinicians trying to help couples struggling with sexual satisfaction to promote the idea that problems in the bedroom are normal, and don't mean the relationship is automatically in trouble.
"Sexual-destiny beliefs have a lot of similarities with other dysfunctional beliefs about sex, and I think it's important to recognize and address that."
The findings are reported in the study titled "How Implicit Theories of Sexuality Shape Sexual and Relationship Well-Being" published online ahead of print in the November issue of the
Journal of Personality and Social Psychology.

Story Source:
Materials provided by University of Toronto. Original written by Peter Boisseau. Note: Content may be edited for style and length.

Journal Reference:
  1. Jessica A. Maxwell, Amy Muise, Geoff MacDonald, Lisa C. Day, Natalie O. Rosen, Emily A. Impett. How Implicit Theories of Sexuality Shape Sexual and Relationship Well-Being.. Journal of Personality and Social Psychology, 2016; DOI: 10.1037/pspi0000078

Article by Dr. David Ley:

“The Sexual Dependency Inventory – An Invalid Instrument?” A tale of intimidation, lack of transparency, and suppression of criticism.
The  below post was originally published on Psychology Today. However, IITAP, and the sex addiction gurus who profit from the SDI, threatened Psych Today and forced them to take it down. I don’t blame the editors at Psychology Today. Indeed, I had predicted this would happen, and wrote the editors in advance, to warn them that they should anticipate such threats. Unfortunately, groups such as Psychology Today are quite vulnerable to such threats, and the cost/time/energy required to defend themselves against claims of libel, defamation or other such legal bullying.
I wrote this article, not to attack IITAP or any specific individuals. Instead, I wrote it due to my concerns about patient who are vulnerable to exploitation and maltreatment by clinicians using an unsupported instrument in unethical ways. Prior to publishing it, I had the piece reviewed by no fewer than 5 statistical, research and sexuality experts, several of whom have histories of much greater support of sex addiction than do I. It wasn’t an echo chamber review. I wrote it carefully, in as objective a manner as possible. I complied with ethics around test protection, and copyright, and wrote this within specific compliance with Fair Use protocol, in order to ethically criticize a clinical assessment I believe is potentially harmful.
I’m publishing this blog here, and in emails and on the blogs of other colleagues, in interest of sharing this information widely, and challenging the ways in which the sex addiction industry uses threats and intimidation to suppress criticism or challenges to their methods. I myself have been threatened with legal action by the sex addiction industry at least half a dozen times, merely for challenging them and publicly criticizing the validity and harmfulness of their methods. Multiple of my colleagues have also been threatened in similar ways, for daring to criticize the monolithic, cultlike industry of sex addiction therapists. I welcome anyone to republish this on their own blogs or websites, not to promote myself in any way, but so as to increase the chances that a patient mandated to complete the SDI by a sex addiction therapist, has the ability to learn for themselves the limitations of this instrument.
Since I first published this, IITAP has taken down the SDI Manual which was previously publicly available on their website. This has the unfortunate result of making a test which was already less than transparent, even more obscure to outside criticism, and limiting even more the degree to which a potential patient can be informed about this test.
The Sexual Dependency Inventory – An Invalid Instrument?
First published on Psychology Today – Women Who Stray blog of David J. Ley PhD. 9/1/16
Clinical and psychological assessment is a nuanced, and sophisticated area. It’s also a deeply contentious area, with many “pet” assessments which are developed by thought leaders, to evaluate or test their specific theories. Psychological instruments convey a level of science, and therapeutic value, which are sometimes deserved, and other times are used in ways which potentially violate informed consent by patients.
For example – the Myers-Briggs Type Inventory is a test with a great deal of history, often used in business settings and in relationship counseling. But, modern research largely reveals that it is a clinically
meaningless and invalid (link is external)test based on antiquated, failed theories. Ethical, informed clinicians no longer use the test, so as not to waste our patient’s time, or to give them the false idea that the test is serving a clear clinical function. The sex addiction treatment industry commonly uses similar outdated and unsupported instruments in ways which pose potentially serious ethical concerns. The Sexual Dependency Inventory (SDI) is one such measure, prominently used by many in the sex addiction industry, despite some alarming weaknesses.

Source: via Wikimedia commons
The Internet is filled with numerous online tests and screening tools which allegedly measure sex addiction. Most of these online tests are free, and appear to work as marketing tools for sex addiction therapists and treatment programs. One however, the Sexual Dependency Inventory-Revised (SDI-R) 4.0, is quite expensive, and commonly used by many sex addiction therapists who sometimes mandate their patients complete the test as a part of treatment. I recently encountered the SDI, in a
forensic matter where a therapist had used the SDI 4.0 inappropriately, making custody recommendations on the basis of this test. This case led me to take a closer look at this instrument, which in turn, led to serious concerns about its use in clinical settings. I chose to draft this this post in order to better inform patients who may encounter ill-advised use of the SDI by therapists.
The Sexual Dependency Inventory
The SDI-R 4.0 is described by authors as the only “broadband measure of potentially problematic sexual behaviors and preoccupations…” (
Green et al (link is external), p. 127). It is a very long instrument, with over five hundred items, which allegedly assess an extremely wide variety of sexual and relationships issues. I was able to find and download the “SDI R– 4.0 Therapist Manual (link is external)” from IITAP, free on their website and is not identified as restricted or copyrighted. Nevertheless, in keeping with professional ethics regarding test security, I choose not to publish any verbatim items from the test in this article. Quotes used herein are used under Fair Use doctrine, and for the protected purposes of clinical criticism.
The International Institute for
Trauma and Addiction Professionals (IITAP) is an organization, founded by Patrick Carnes, PhD. and currently run by his daughter, which established their own training and certification for sex addiction therapists, and offers the SDI-R 4.0 for a substantial fee through their website (link is external). The test is accessed by individuals through an interesting and relatively unique use of “tokens” which are purchased by clinicians, and then distributed to patients by the therapist. It’s apparently up to the clinician to set the fee for the patient to receive a token which allows them access to the test and report of test results. Most clinicians charge their patients between $85 and $250 per test. (This cost range is supported by the websites of various online therapists, as well as internal emails from IITAP staff.)
The Sexual Dependency Inventory – Revised, 4.0 is a muddled instrument which takes a “kitchen-sink” approach to testing, essentially throwing everything in, to see what sticks. It has few scientific publications describing it or its development. A very early (1998) version of the test was briefly evaluated and showed some initial potential value. However, that version was less than a fourth as long as the currently administered test. There have been no further validity
evaluations (link is external)of the SDI-R 4.0 or replications of these results. Applying these initial findings from 1998 to the current version is contrary to industry standards: For instance, each time the WAIS (IQ test) is updated, the makers must develop and publish extensive statistical modeling and conversion scores, to allow comparison of the new version to past results. There is no evidence that such comparisons have been conducted or published. Indeed, in much of what is written about the SDI, it is typically quite difficult to determine what version of the test is being described. When there are apparently substantial changes happening across versions, this is a troubling lapse.
The SDI-R 4.0 now includes within it a number of distinct instruments, such as the Sexual Addiction Screening Test (SAST), tests of
attachment, assessments of motivation for change, and numerous items and scales which allege to distinguish or identify various sexual preoccupations, predilections and tendencies. The manual offers little information regarding any over-arching theory which ties these various items and tests together, and merely states “The SDI is actually a whole battery of relevant tests organized into one cohesive report.” (page 3 of Manual). Unfortunately, many of these individual tests have limitations and problems themselves and combining them all into a single measure would require research to evaluate the degree to which these instruments may overlap or even conflict, and whether their combined use leads to increased “convergent validity” in assessment and treatment. Moreover, there could be issues with ordering effect wherein responses to some questions impact how an individual responds to subsequent items. No such research is evident in the manual, or published literature.
The SDI relies of course on the disputed, consistently rejected pop psychology concept of sex addiction, as well as makes references to more unique concepts such as “
eroticized rage,” “sexual anorexia,” and “intimacy disorders.” These concepts are used heavily in the theories of Patrick Carnes, PhD., but have not been adopted at a broader level in the mental health or addictions industry. They reflect antiquated and stigmatizing psychoanalytic theories. They are not accepted diagnoses or generally supported theories of psychological practice, mental health, or sexual development. It is also unclear how the items and structure for the SDI were deductively generated or developed. A 2015 paper indicated that during a structural analysis of the SDI, some items were retained as “critical items,” despite evidence that they had no statistical value.
The SDI-R 4.0 includes items assessing sexual behaviors related to various sexual subcultures, from the Lesbian, Gay, Bisexual and
Transgender communities, to swinging communities, and those who engage in kink-related or BDSM types of behaviors. These varied items, and issues imply that these behaviors are inherently evidence of disturbance in relationship, sexuality or mental health. There is no evidence in the manual, or in published research, that these items have been normed on members of these sexual populations who are not experiencing problems. As a result, it is quite likely that this test will inaccurately assess individuals who are struggling or questioning with their sexual orientation, kink, or interest in nonmonogamy.
In 1992, SDI author Patrick Carnes
wrote (link is external): “The giving or receiving of pain, also known as sadomasochism or S&M, is a type of sexually addictive behavior in which pain is associated with sexual pleasure. There is a blatant imbalance of power between the giver and the receiver, although both partners may be consenting. . . . Victims may perceive their feelings towards their torturer as loving, but there is no genuine trust or intimacy when a relationship is based on hurting one another.” This inaccurate and biased perception of BDSM relationships still pervades the SDI.


People who practice BDSM are often stigmatized inappropriately by sex addiction therapists.
Source: Via Wikimedia Commons
The SDI-R 4.0 Manual and test interpretation contains troubling errors regarding sexual disorders, such as this statement: “Dressing and behaving like the other
gender with a psychological preference to be the other gender (transvestitism)” (page 35 of manual) actually appears to be describing the issue of transgender or gender dysphoria. Transvestism is a paraphilia related to wearing the opposite gender’s clothing. Similar confusion regarding “cross-dressing” is noted in the manual. Errors such as these in a published clinical test, are troubling and invite a high potential for misinterpretation by both patient and therapist. They suggest a significant lack of awareness of sexological or sexual health treatment in the creation and development of this instrument. Given that it purports to assess and measure paraphilias and sexual behaviours, this is quite troubling.
Another glaring error lies in the marketing and general descriptions of the test, by the therapists who use it. It is frequently described online by clinicians who use it, as having “
96.5% accuracy (link is external).” The origin of this misstatement is in the manual, where one subtest, the SAST is described as having been “proven 96.5% accurate in identifying a clinical population.” (page 39, manual). Even this statement about the SAST is disputable, as there is no true “clinical” definition or criterion for such sexual behavior problems, and the SAST is not congruent with the most recent criteria proposed for Hypersexual Disorder. The SAST may be prone to false positives, because of its inclusion of issues related to moral and social attitudes towards sex. The fact that therapists use this statement inaccurately suggests either ignorance or deceptive advertising on their part – either of which are troubling.
Validity testing is a critical component in the development of any psychological test, and is a way to determine if a given test identifies issues that distinguish a clinical population from a nonclinical one. In other words, if there was research showing that the test misidentified a person who is having no problems related to sex, then we would be concerned that this test may more generally mistakenly pathologize normal sexual variations in people. One of the severe weaknesses of the SDI, is its lack of “clinical cutoff scores” which identify problematic users from a normative population. Thus, without these cutoff scores, there is great chance of pathologizing normal behaviors. The SDI has been
described (link is external)as limited in its reliance on self-report, with no external validation of confirmation on the patient’s affirmations. Such self-report responses can easily be influenced by feelings of shame and guilt, as opposed to actual clinical issues. As far as I am able to determine, the only validity testing done on the SDI was conducted in 1998, on an early and different version of this test. As a result, we have no current evidence regarding what this instrument actually does.
Based upon the information reviewed and described above, this writer concludes that use of the SDI R 4.0 in clinical or forensic settings is extremely questionable, unless a patient is provided with informed consent regarding the limited validity and reliability of this experimental instrument.  Results and predictions of the SDI-R 4.0 should be regarded with extreme skepticism without other corroborating information, test results or behavioural evidence. The report itself can mislead patients into a belief that the conclusions reflect a scientific or clinical evaluation that is definitive which has the potential to cause psychological harm to those taking the test. The SDI R 4.0 is an internal, “home-grown” instrument, used only within the isolated “cottage industry” of sex addiction treatment. It seems that the test has been created more for a revenue stream for its authors than as a benefit for patients. The absence of the SDI-R 4.0 in generally accepted literature and methods raises significant ethical concerns about therapists administering and charging patients for clinical use of this instrument.
People seeking help for sexual and relationship matters are extremely vulnerable, dealing with intense issues of guilt, shame,
fear and isolation. They are eager and desperate for help and reassurance. Such individuals are unfortunately highly disposed to believe and trust based on the appearance of credibility and expertise. In dealing with such problems, clinicians must be extremely careful and thoughtful to educate patients about the limitations of our tools and methods. Therapists currently using the SDI-R 4.0 should undertake a critical evaluation of its role and usefulness in their therapeutic approach. There are numerous free tests available to them, with greater levels of research and support, which are less onerous for their patients, and which stand less likelihood of stigmatizing healthy aspects of sexual diversity.

The Clitoris: The Great Unknown….