(076) History of Sexual Coercion, PGAD Symptoms, and Sexual Function: Evidence for a Mediational Model
Authors: Kiesner J , Bittoni C 
Published: May 2023

Abstract

Introduction
Past research on Persistent Genital Arousal Disorder (PGAD) has shown that a history of sexual abuse is common among women with PGAD (Leiblum et al., 2007; Pink et al., 2014), with higher rates of abuse among those who are most symptomatic (Leiblum et al., 2007). However, there is a need for replication and for developing a theoretical understanding of the mechanisms and developmental course of this association. Moreover, although little is known about the relation between PGAD symptoms and sexual functioning (Jackowich et al., 2016) research has suggested that women with PGAD show FSFI scores that are low but within the normal range (Leiblum & Seehuus, 2009), and that those with subthreshold PGAD symptoms associate those symptoms with positive feelings.

Objective
The goal of the present study was to test a mediational model in which history of sexual coercion is directly associated with PGAD symptoms, and indirectly associated with sexual functioning (desire, masturbation, lubrication), with mediational effects passing through PGAD symptoms.

Methods
A sample of n = 138 female university students completed questionnaires measuring past experience of sexual coercion, PGAD symptoms, sexual desire, masturbation, and lubrication. Structural equation modeling was used to test a theoretical model in which a history of sexual coercion was allowed to directly predict PGAD symptoms and all three sexual function constructs, and PGAD symptoms were allowed to predict all sexual function constructs (see Figure 1).

Results
The SEM model fit the data well (CFI = .96; NFI = .92; RMSEA = .07). As presented in Figure 1, past experience of sexual coercion was positively associated with PGAD symptoms and negatively associated with sexual desire, but had no direct association with masturbation or lubrication. PGAD symptoms were associated with increased desire and masturbation, but decreased lubrication, and sexual desire was positively associated with lubrication. In addition to the directs effects on PGAD symptoms and sexual desire, past experience of sexual coercion also demonstrated indirect effects on all sexual function constructs (positive effects on desire and masturbation, and negative on lubrication).

Conclusions
Based on these results we propose a developmental model in which the effects of PGAD symptoms on desire, arousal, and pleasure, change across time and symptom severity. Specifically, increased attention to genital and sexual sensations is expected to result from past sexual coercion. Then, in the context of this heightened genital awareness, when persistent non-painful genital stimulation is perceived, in the early stages of PGAD symptom development, the combination of those sensations and the heightened attention to them is expected to result in perceived pleasurable sensation and arousal, thus increasing desire and masturbation. This is expected to be limited to the early stages of PGAD development, whereas, during later stages, when PGAD symptoms are severe and unrelenting, this is expected to change (see Figure 2). The overall level of PGAD symptoms in this sample was low (consistent with other non-clinical samples; Jackowich & Pukall, 2020), and thus these results cannot be generalized to women who live with a diagnosis of PGAD.

Disclosure
No