Testing a Conceptual Model for Men's Sexual Desire Referring to Automatic Thoughts, Emotions, Sexual Function, and Sexism

Introduction: Literature lacks biopsychosocial models of men's sexuality. Regarding sexual desire, Carvalho and Nobre (J Sex Med 2011;8:754-763.) presented a cognitive-affective model including age, medical factors, dyadic adjustment, psychopathology, restrictive attitudes toward sexual activity, erection concerns, lack of erotic thoughts (LET), sadness, and shame as predictors. In particular, automatic thoughts were highlighted as the main predictors of sexual desire in men. Aim: To test a conceptual model (confronting full and partial mediation) considering the interrelated role of automatic thoughts, emotional factors, sexual function, and sexism in influencing the levels of men's sexual desire. Methods: Selected variables were the best predictors of men's sexual desire in a previous study on 450 heterosexual Italian men (age 31.36 +/- 10.73 years). Path diagrams were built including orgasmic function, LET, erection concerns thoughts (ECT), hostile sexism, and positive affect as predictors of sexual desire. The 2 versions of the model were designed as a partial and a full mediation from automatic thoughts toward desire. ECT and LET were selected as main predictors, with direct paths going from ECT to positive affect and sexual desire, and from LET to positive affect, orgasmic function, and sexual desire. Direct paths were also drawn from emotions and orgasm to sexual desire. Moreover, in the partial mediation model, part of ECT and LET effect was mediated by emotions and orgasm, and part directly influenced sexual desire. Hostile sexism and sociodemographic variables were considered as exogenous variables influencing sexual desire. Path analyses were performed through structural equation modeling approach. Main Outcome Measure: Results from 4 standardized questionnaires and sociodemographic information were considered for this study: International Index of Erectile Function, Positive and Negative Affect Schedule, Ambivalent Sexism Inventory, and Sexual Modes Questionnaire. Results: Results showed a satisfactory data fit for both versions, but the partial mediation model was retained (chi(2) = 35.312, degree of freedom = 34, P = .406; goodness of fit = .987; normed fit index = .945; comparative fit index = .998; root mean square error of approximation = .009 [95% CI.000-.036]). All the endogenous paths and hostile sexism were found to be significant. Clinical Implications: The model selected could suggest the need to operate under an biopsychosocial approach, considering cognitive, emotional, and sexual aspects all together to elicit an effective arise of sexual desire level. Strength & Limitations: The study can claim a good methodology and the proposal of an interesting model, even if the results should be carefully interpreted due to the use of no representative sample, self-report measures, and the limited number of variables involved. Conclusion: Our findings suggest that cognitive, emotional, sexual functioning, and cultural variables interplay affecting men's sexual interest. Copyright (C) 2018, International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.