Sexual dysfunction is a multifaceted health issue impacting a significant portion of the adult population worldwide. The condition arises from a complex interaction of biological, psychological, and social factors. Adverse life events, especially those in childhood, have been noted for their enduring effects on adult health, including sexual function (1).
Previous research has predominantly concentrated on the impact of childhood sexual abuse, often neglecting other forms such as physical, emotional, and psychological abuse (2). This study broadens the scope by including these additional adverse events and by considering life adversities occurring in both childhood and adulthood. Analyzing the connections between adversities at different life stages and adult sexual dysfunction, the research seeks to offer a more inclusive understanding of these problems. Additionally, most prior studies have limited their focus to single-gender samples, whereas this study includes both men and women, recognizing that all are potentially affected by such experiences. The objectives are twofold: first, to ascertain the prevalence of childhood and adulthood adverse events within a population-based sample, and second, to evaluate the association between these adversities and sexual dysfunction in male and female adults.

This research involved a supplementary analysis of baseline data collected from the Coevorden observational cohort study. The main aim of the study was to monitor the occurrence and progression of pelvic floor symptoms (PFS) across two years using questionnaires. Men and women aged 16 and above, residing within a Dutch community, were enrolled via invitations sent by their family doctors. Those excluded from the study were persons with cognitive impairments, those with a life-threatening condition, or those considered too ill to participate.
Sexual dysfunction was measured in participants who were sexually active through various tools: the pelvic organ prolapse/Incontinence Sexual Questionnaire (PISQ), the revised version by the International Urogynecological Association, and a single query regarding sexual issues from the Sexual Health in the Netherlands survey. Male participants additionally answered three questions from the ICIQ-MLUTS sex questionnaire concerning erectile and ejaculation issues. Sexual dysfunction in men was identified by the presence of difficulties related to erection, ejaculation, pain during sexual activity or ejaculation; for women, it was characterized by challenges such as orgasmic dysfunction, vaginismus, vaginal dryness, or pain during sexual interaction.
Adverse childhood experiences (ACEs) were assessed via selected questions from the NEMESIS questionnaire that target experiences of emotional, psychological, physical, and sexual abuse before turning 16. These questions were graded on a four-point scale, ranging from 0 for 'never' to 3 for 'often.' The sum of these responses yielded an ACEs index ranging from 0 to 12, with higher scores indicates more frequent adverse events. The presence of ACEs was determined by a score of 1 or more on any of the ACE items, signifying at least one occurrence of abuse. Adverse experiences occurring after the age of 16 were recorded using the same questions as for childhood adversities. We conducted a multivariable logistic regression analysis using SPSS software, version 28, with adjusting for potentially confounding variables.

In assessing the prevalence of ACEs in our study, distinct patterns emerged when comparing genders. Our findings indicate that men reported lower rates of ACEs compared to women across all categories. Specifically, sexual abuse was reported by 4.2% of men and 16.4% of women, physical abuse by 12.5% of men and 15.4% of women, emotional abuse by 14.3% of men and 21.6% of women, and psychological abuse by 11.9% of men and 15.4% of women.
Furthermore, when considering the prevalence of adverse events in adulthood, women continued to report higher prevalence rates than men. 
The multivariable logistic regression analysis, incorporating depression, age, body mass index (BMI), and smoking as covariates, yielded non-significant associations between both ACEs and adulthood adverse events with sexual dysfunction across genders. In men, ACEs (p = 0.058) and adulthood adverse events (p = 0.283) did not emerge as significant factors. This pattern was represented in women, with no significant findings for ACEs (p = 0.513) and adulthood adverse events (p = 0.765). However, in men, depression, along with age and BMI, showed a statistically significant relationship with sexual dysfunction (p < 0.001). In contrast, these factors did not demonstrate significance in women.

The analysis of ACEs within our study revealed notable gender-related disparities. The prevalence rates of ACEs were consistently higher in women compared to men. The pattern persisted into adulthood. However, it is important to consider the possibility of underreporting, particularly among men, which may be influenced by cultural norms that discourage men from disclosing experiences of abuse (2). Further research may be needed to understand the full extent of these disparities and to explore the underlying reasons for any potential underreporting.
Regarding the relationship between ACEs and sexual dysfunction, our findings indicate that while ACEs and adulthood adverse events are prevalent within the sample, their direct association with sexual dysfunction is not evident when controlling for other factors. The impact of depression, age, and BMI on sexual dysfunction was observed in men but not in women, indicating potential gender differences. These differences underscore the need for gender-sensitive approaches in research and intervention strategies addressing sexual health.

In conclusion, our study showed gender differences in the reported prevalence of both ACEs and adulthood adverse events, with higher rates noted among women. While associations were found between depression, age, and BMI with sexual dysfunction in men, we acknowledge the presence of additional potential variables not examined in this study. It is also critical to recognize that the assessment tools for sexual dysfunction differed between genders, which may influence the comparability of our findings.

The absence of significant associations in women suggests the involvement of other, unidentified factors that warrant further investigation. As such, these gender-specific nuances call for a more tailored approach in subsequent research. Despite the study's limitations, the findings add valuable insight into the complex interplay of sexual health, setting a foundation for more extensive future research that could inform gender-sensitive interventions.

Gewirtz-Meydan A. Sexual Dysfunction Among Childhood Sexual Abuse Survivors: The “Functional” Dysfunction? J Sex Marital Ther. 2022;48(7):694–705.
Wang SJ, Chang JJ, Cao LL, Li YH, Yuan MY, Wang GF, et al. The Relationship Between Child Sexual Abuse and Sexual Dysfunction in Adults: A Meta-Analysis. Trauma Violence Abuse. 2023 Oct 1;24(4):2772–88.