Sexual difficulties in eating disorders may stem from different causes in men and women

The underlying causes of sexual difficulties may differ between men and women who experience symptoms of eating disorders, according to new research. While depression appears to be the primary driver of sexual challenges among women with these symptoms, eating disorder behaviors themselves play a more direct role for men. These findings were published in the International Journal of Sexual Health.

Sexual functioning is a fundamental aspect of human health and quality of life. It encompasses desire, arousal, and the ability to achieve orgasm. Problems in these areas can lead to lower psychological well-being and relationship dissatisfaction.

Previous research has established a clear link between eating disorders and sexual dysfunction. Individuals struggling with disordered eating often report higher rates of sexual dissatisfaction and physiological difficulties. This connection makes intuitive sense given that eating disorders involve severe disturbances in body image and physical health.

Hormonal imbalances caused by malnutrition can physically impede sexual response. Simultaneously, psychological factors such as body shame and anxiety about appearance can create mental barriers to intimacy. However, the exact nature of this relationship remains a subject of scientific inquiry.

A complicating factor is the presence of other mental health conditions. Anxiety and depression are highly common among people with eating disorders. These conditions are also well-known causes of sexual dysfunction on their own.

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It has been difficult for researchers to determine if sexual problems are caused specifically by the eating disorder or by co-occurring depression and anxiety. Additionally, the vast majority of research on this topic has focused on women. There is a lack of data regarding how these dynamics play out in men.

To address these gaps, a team of researchers led by Maegan B. Nation undertook a comprehensive investigation. Nation is affiliated with the Department of Psychology at the University of Nevada Las Vegas. The team aimed to disentangle the effects of eating pathology from the effects of general distress.

The researchers sought to understand if eating disorder symptoms predict sexual problems when the influence of anxiety and depression is mathematically removed. They also aimed to compare these patterns across genders. This approach allows for a more precise understanding of which symptoms should be targeted in treatment.

The study recruited a large sample of undergraduate students from two public universities in the United States. The final analysis included 1,488 cisgender women and 646 cisgender men. Cisgender refers to individuals whose gender identity matches the sex they were assigned at birth.

Participants completed a series of online questionnaires. To assess eating disorder symptoms, the researchers used the Eating Disorder Examination Questionnaire. This tool measures behaviors such as dietary restraint and concerns regarding body shape and weight.

To evaluate sexual health, the team utilized the Medical Outcomes Study Sexual Functioning Scale. This measure asks participants to rate the severity of various problems. These issues include a lack of sexual interest, difficulty becoming aroused, inability to relax during sex, and difficulty reaching orgasm.

The researchers also administered a standard assessment for anxiety and depression. This allowed them to control for these variables in their statistical models. By doing so, they could isolate the unique contribution of eating disorder symptoms to sexual functioning.

The results revealed distinct patterns for men and women. Among the female participants, sexual functioning problems were quite common. Approximately 73 percent of women reported some level of difficulty.

The most frequent complaints among women were difficulty reaching orgasm and an inability to relax and enjoy sex. When the researchers ran their statistical models, they found an association between eating disorder symptoms and sexual problems.

However, once the researchers adjusted for anxiety and depression, the picture changed. For women, the direct link between eating disorder symptoms and sexual dysfunction became very weak. The effect sizes were small enough that they might not be clinically meaningful.

Instead, depression symptoms emerged as the stronger predictor of sexual difficulties in women. This suggests that the sexual problems often seen in women with disordered eating may actually be a byproduct of depressive symptoms. The eating disorder itself may not be the primary culprit for the sexual dysfunction.

The findings for men told a different story. About half of the male participants reported sexual functioning problems. The most common issues for men were a lack of sexual interest and an inability to relax.

For men, eating disorder symptoms continued to predict sexual dysfunction even after controlling for anxiety and depression. While the effect was small, it remained statistically relevant. This implies that for men, there is a unique pathway between disordered eating and sexual health that is independent of general mood.

The authors propose several explanations for this gender disparity. One possibility involves the drive for muscularity. Men with body image issues often strive for a hyper-muscular physique rather than thinness.

This specific drive might influence sexual self-esteem and functioning in ways that differ from the drive for thinness typically seen in women. It is also possible that men experience unique sociocultural pressures regarding sexual performance and body image. These pressures could interact with eating pathology to disrupt sexual function.

The results for women align with existing theories about the heavy impact of depression on libido and arousal. It reinforces the idea that treating depression could alleviate sexual side effects in women with eating disorders.

For men, the results suggest that clinicians should look specifically at eating behaviors and body image cognitions. Addressing depression alone might not fully resolve sexual issues for male patients.

The study also examined sexual attraction as a variable. The researchers found that sexual orientation was linked to different levels of functioning. Men who reported attraction to the same gender or multiple genders reported higher levels of sexual problems compared to heterosexual men.

Conversely, women who were exclusively attracted to women reported fewer sexual functioning problems than those attracted to men. This adds nuance to the understanding of how sexual orientation interacts with sexual health.

There are limitations to this study that warrant consideration. The sample consisted of undergraduate students rather than a clinical population. People with diagnosed, severe eating disorders might show different patterns.

The study was also cross-sectional. This means the data represents a single snapshot in time. Researchers cannot definitively say that one factor causes another, only that they are related.

It is possible that the relationship is bidirectional. Sexual problems could contribute to body dissatisfaction, or vice versa. Longitudinal research, which follows participants over time, would be needed to establish causality.

The researchers also noted that the study focused on cisgender individuals. The experiences of transgender and gender-diverse individuals were not analyzed due to sample size constraints. Given that gender-diverse people often face higher rates of eating disorders, this is an area for future investigation.

Despite these limitations, the study offers new insights. It challenges the assumption that the relationship between eating disorders and sex is the same for everyone. It highlights the importance of considering gender when assessing and treating these co-occurring issues.

Maegan Nation and her colleagues suggest that screening for sexual functioning problems should be a routine part of mental health care. For women, this might involve a closer look at depressive symptoms. For men, it might require a specific focus on body image and eating behaviors.

Future research should aim to replicate these findings in clinical settings. Studies involving older adults or community samples would also be beneficial. Understanding the mechanisms behind these associations could lead to more effective interventions.

This research underscores the complexity of human sexuality and its relationship to mental health. It serves as a reminder that broad assumptions often fail to capture individual experiences. By breaking down these associations by gender and accounting for mood disorders, scientists can develop more targeted treatments.

The study, “Sexual Functioning and Eating Disorder Symptoms: Examining the Role of Gender and Internalizing Symptoms in an Undergraduate Population,” was authored by Maegan B. Nation, Shane W. Kraus, Melanie Garcia, Nicholas C. Borgogna, and Kara A. Christensen Pacella.