{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T06:00:21Z","timestamp":1781244021835,"version":"3.54.1"},"reference-count":40,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T00:00:00Z","timestamp":1781222400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Posttraumatic stress disorder (PTSD) is associated with impaired sexual functioning in women, but the effects of complex PTSD (CPTSD) remain unclear. This study tested three hypotheses: (1) women with CPTSD would report lower overall sexual function than women with PTSD and trauma-exposed controls; (2) the pain domain would show the largest group differences; and (3) CPTSD symptom severity would be negatively associated with sexual function, while PTSD symptom severity would not.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A cross-sectional study included 386 Mexican female university students (18\u201355 years) who completed the Female Sexual Function Index (FSFI), International Trauma Questionnaire (ITQ), and Adverse Childhood Experiences Questionnaire (ACE-IQ). Group differences were assessed using ANOVA with\n                      <jats:italic>post-hoc<\/jats:italic>\n                      comparisons. Multivariable linear regressions examined whether CPTSD severity predicted sexual function independently of PTSD severity and age. A sensitivity analysis excluded women aged 45 and older.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      FSFI total scores differed significantly across groups (F\u00a0=\u00a03.52, p = 0.031). Women with CPTSD reported lower overall sexual function (M\u00a0=\u00a026.56, SD\u00a0=\u00a06.41) than trauma-exposed controls (M\u00a0=\u00a028.86, SD\u00a0=\u00a05.03; p = 0.047). In the pain domain, women with CPTSD reported greater sexual pain than controls (F\u00a0=\u00a06.35, p = 0.002). Multivariable regressions showed that CPTSD severity predicted lower FSFI total scores (\u03b2 = -0.22, p &amp;lt; 0.001), independent of age and PTSD severity (adjusted R\n                      <jats:sup>2<\/jats:sup>\n                      = 0.028). For sexual pain, the bivariate association with CPTSD (rho = -0.16, p &amp;lt; 0.01) did not persist after adjusting for age; age was the only significant predictor (\u03b2 = 0.02, p = 0.007). Sensitivity analyses yielded unchanged results.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>CPTSD severity is associated with poorer overall sexual function, independent of age and PTSD severity. However, the association with sexual pain did not persist after accounting for age. Clinical and research implications are discussed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpsyt.2026.1796972","type":"journal-article","created":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T05:48:48Z","timestamp":1781243328000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Sexual function in women with complex PTSD: a comparative study"],"prefix":"10.3389","volume":"17","author":[{"given":"Rodrigo","family":"Ramirez-Rodriguez","sequence":"first","affiliation":[{"name":"Instituto Polit\u00e9cnico Nacional","place":["Ciudad de Mexico, Mexico"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00c1ngel Alberto","family":"Puig-Lagunes","sequence":"additional","affiliation":[{"name":"Facultad de Medicina, Universidad Veracruzana","place":["Minatitl\u00e1n, Veracruz, Mexico"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafael","family":"Fern\u00e1ndez-Demeneghi","sequence":"additional","affiliation":[{"name":"Instituto de Investigaciones en Comportamiento Alimentario y Nutrici\u00f3n, Universidad de Guadalajara","place":["Ciudad Guzm\u00e1n, Mexico"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Karina","family":"Ceja-Venegas","sequence":"additional","affiliation":[{"name":"Instituto Colimense de Ciencias Forenses","place":["Colima, Mexico"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuliana Yessy","family":"Gomez-Rutti","sequence":"additional","affiliation":[{"name":"Universidad Privada del Norte","place":["Lima, Peru"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miriam","family":"Tecamachaltzi-Silvar\u00e1n","sequence":"additional","affiliation":[{"name":"Facultad de Ciencias en Desarrollo Humano, Universidad Aut\u00f3noma de Tlaxcala","place":["Tlaxcala, Mexico"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isidro","family":"Vargas-Moreno","sequence":"additional","affiliation":[{"name":"Instituto de Investigaciones en Comportamiento Alimentario y Nutrici\u00f3n, Universidad de Guadalajara","place":["Ciudad Guzm\u00e1n, Mexico"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alma Gabriela","family":"Mart\u00ednez-Moreno","sequence":"additional","affiliation":[{"name":"Instituto de Investigaciones en Comportamiento Alimentario y Nutrici\u00f3n, Universidad de Guadalajara","place":["Ciudad Guzm\u00e1n, Mexico"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Le\u00f3n","family":"Germ\u00e1n-Ponciano","sequence":"additional","affiliation":[{"name":"Laboratorio de Neurofarmacolog\u00eda, Instituto de Neuroetolog\u00eda, Universidad Veracruzana","place":["Xalapa, Veracruz, Mexico"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gilberto Uriel","family":"Rosas-Sanchez","sequence":"additional","affiliation":[{"name":"Departamento de Ciencias de la Tierra y la Vida, Centro Universitario de Los Lagos","place":["Lagos de Moreno, Jalisco, Mexico"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,12]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1080\/20008198.2017.1353383","article-title":"Trauma and PTSD in the WHO World Mental Health Surveys","volume":"8","author":"Kessler","year":"2017","journal-title":"Eur J Psychotraumatol"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/j.neubiorev.2019.09.013","article-title":"Risk factors for posttraumatic stress disorder: An umbrella review of systematic reviews and meta-analyses","volume":"107","author":"Tortella-Feliu","year":"2019","journal-title":"Neurosci Biobehav Rev"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1192\/j.eurpsy.2021.2239","article-title":"Sex and age differences in ICD-11 PTSD and complex PTSD: An analysis of four general population samples","volume":"64","author":"McGinty","year":"2021","journal-title":"Eur Psychiatry J Assoc Eur Psychiatr"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1080\/0092623X.2021.1958964","article-title":"Female sexual function six months after sexual assault: post-traumatic stress disorder strongest risk factor for impaired function","volume":"48","author":"H\u00f6gbeck","year":"2022","journal-title":"J Sex Marital Ther"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsxm.2021.05.011","article-title":"Relationship between posttraumatic stress disorder and sexual difficulties: A systematic review of veterans and military personnel","volume":"18","author":"Bird","year":"2021","journal-title":"J Sex Med"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1111\/jsm.12247","article-title":"Effects of expressive writing on sexual dysfunction, depression, and PTSD in women with a history of childhood sexual abuse: results from a randomized clinical trial","volume":"10","author":"Meston","year":"2013","journal-title":"J Sex Med"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1002\/jts.22485","article-title":"Women\u2019s sexual desire, trauma exposure, and posttraumatic stress disorder","volume":"33","author":"O\u2019Loughlin","year":"2020","journal-title":"J Trauma Stress"},{"key":"B8","unstructured":"ICD-11 for Mortality and Morbidity Statistics\n          \n          2018"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1080\/20008198.2020.1866423","article-title":"Complex PTSD: assessment and treatment","volume":"12","author":"Cloitre","year":"2021","journal-title":"Eur J Psychotraumatol"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2022.896981","article-title":"Exploring the links between various traumatic experiences and ICD-11 PTSD and Complex PTSD: A cross-sectional study","volume":"13","author":"Kairyte","year":"2022","journal-title":"Front Psychol"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.3390\/psychiatryint7020046","article-title":"Body esteem in women with complex PTSD: A comparative study","volume":"7","author":"Ramirez-Rodriguez","year":"2026","journal-title":"Psychiatry Int"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.33937\/reveco.2025.472","article-title":"The role of social norms in the employment status of Mexican women","volume":"42","author":"Blanquel-Castro","year":"2025","journal-title":"Rev Econ"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.22201\/iij.24484881e.2024.51.18161","article-title":"El derecho a la salud sexual y reproductiva: su accesibilidad desde la interpretaci\u00f3n internacional","volume":"51","author":"Alonso de los Santos","year":"2024","journal-title":"Cuest Const"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1002\/hpm.3512","article-title":"Care friendliness in adolescent sexual and reproductive health services in Mexico and a characterization of their clients","volume":"37","author":"Garc\u00eda-Bello","year":"2022","journal-title":"Int J Health Plann Manage"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pgph.0002396","article-title":"Sexual and reproductive health among adolescents in vulnerable contexts in Mexico: Needs, knowledge, and rights","volume":"3","author":"Villalobos","year":"2023","journal-title":"PLoS Glob Public Health"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1016\/j.heliyon.2020.e03322","article-title":"Gender inequality and gender-based poverty in Mexico","volume":"6","author":"Ramos","year":"2020","journal-title":"Heliyon"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1080\/10926771.2023.2171828","article-title":"International Trauma Questionnaire (ITQ): Psychometric properties of the Spanish-language version in a clinical sample of Mexican women","volume":"32","author":"Valdovinos","year":"2023","journal-title":"J Aggress Maltreatment Trauma"},{"key":"B18","doi-asserted-by":"publisher","first-page":"293","DOI":"10.5209\/psic.77755","article-title":"Factor structure, internal consistency and distribution of Female Sexual Function Index among Mexican women with early diagnostic of breast cancer","volume":"18","author":"Miaja Avila","year":"2021","journal-title":"Psicooncolog\u00eda Investig Cl\u00ednica Biopsicosocial En Oncol"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1080\/10926771.2022.2144788","article-title":"Validating the Spanish Adverse Childhood Experiences International Questionnaire (ACE-IQ): A Mexican analysis","volume":"32","author":"T\u00e9llez","year":"2023","journal-title":"J Aggress Maltreatment Trauma"},{"key":"B20","volume-title":"RStudio: Integrated Development Environment for R","year":"2025"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsxm.2018.02.016","article-title":"Sexual functioning after childhood abuse: The influence of post-traumatic stress disorder and trauma exposure","volume":"15","author":"Bornefeld-Ettmann","year":"2018","journal-title":"J Sex Med"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1002\/ijgo.16112","article-title":"The gynecological sequelae of sexual violence in adolescence in the United States: A scoping review","volume":"169","author":"Hill","year":"2025","journal-title":"Int J Gynecol Obstet Off Organ Int Fed Gynecol Obstet"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1007\/s10508-011-9865-7","article-title":"Latent structures of female sexual functioning","volume":"41","author":"Carvalho","year":"2012","journal-title":"Arch Sex Behav"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsxm.2021.07.004","article-title":"Vaginismus, dyspareunia and abuse history: A systematic review and meta-analysis","volume":"18","author":"Tetik","year":"2021","journal-title":"J Sex Med"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291719003921","article-title":"The distinctive neural circuitry of complex posttraumatic stress disorder during threat processing","volume":"51","author":"Bryant","year":"2021","journal-title":"Psychol Med"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.58511","article-title":"The role of the insula in chronic pain and associated structural changes: An integrative review","volume":"16","author":"McBenedict","year":"2024","journal-title":"Cureus"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1016\/b978-0-12-815134-1.00004-0","article-title":"Amygdala physiology in pain","volume":"26","author":"Neugebauer","year":"2020","journal-title":"Handb Behav Neurosci"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1002\/da.23235","article-title":"Neural processes during response inhibition in complex posttraumatic stress disorder","volume":"39","author":"Bryant","year":"2022","journal-title":"Depress Anxiety"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1523\/JNEUROSCI.0067-17.2017","article-title":"The human thalamus is an integrative hub for functional brain networks","volume":"37","author":"Hwang","year":"2017","journal-title":"J Neurosci Off J Soc Neurosci"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.3389\/fnbeh.2023.1147686","article-title":"Association of age of adverse childhood experiences with thalamic volumes and post-traumatic stress disorder in adulthood","volume":"17","author":"Huffman","year":"2023","journal-title":"Front Behav Neurosci"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1080\/20008198.2020.1764246","article-title":"Sexual function and pelvic floor activity in women: the role of traumatic events and PTSD symptoms","volume":"11","author":"Karsten","year":"2020","journal-title":"Eur J Psychotraumatol"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1097\/NMD.0000000000000581","article-title":"The impact of trauma type or number of traumatic events on PTSD diagnosis and symptom severity in treatment seeking veterans","volume":"205","author":"Jakob","year":"2017","journal-title":"J Nerv Ment Dis"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1017\/S2045796014000092","article-title":"Association between traumatic events and post-traumatic stress disorder: results from the ESEMeD-Spain study","volume":"24","author":"Olaya","year":"2015","journal-title":"Epidemiol Psychiatr Sci"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2016.09.032","article-title":"Evidence of distinct profiles of posttraumatic stress disorder (PTSD) and complex posttraumatic stress disorder (CPTSD) based on the new ICD-11 Trauma Questionnaire (ICD-TQ)","volume":"207","author":"Karatzias","year":"2017","journal-title":"J Affect Disord"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1037\/tra0001100","article-title":"Massed cognitive processing therapy for posttraumatic stress disorder in women survivors of intimate partner violence","volume":"14","author":"Galovski","year":"2022","journal-title":"Psychol Trauma Theory Res Pract Policy"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2025.120389","article-title":"Change in sexual distress during cognitive processing therapy: Characterization and baseline predictors","volume":"393","author":"Meis","year":"2026","journal-title":"J Affect Disord"},{"key":"B37","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1080\/00332747.2019.1672439","article-title":"Sexual desire among veterans receiving prolonged exposure therapy for PTSD: Does successful PTSD treatment also yield improvements in sexual desire","volume":"83","author":"Badour","year":"2020","journal-title":"Psychiatry"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2023.1191916","article-title":"The impact of intensive trauma-focused treatment on sexual functioning in individuals with PTSD","volume":"14","author":"van Woudenberg","year":"2023","journal-title":"Front Psychol"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2025.03.153","article-title":"Efficacy of psychological interventions for complex post-traumatic stress disorder in adults exposed to complex traumas: A meta-analysis of randomized controlled trials","volume":"380","author":"Hu","year":"2025","journal-title":"J Affect Disord"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.1136\/bmjment-2024-301158","article-title":"Psychotherapies for adults with complex presentations of PTSD: a clinical guideline and five systematic reviews with meta-analyses","volume":"28","author":"Schaug","year":"2025","journal-title":"BMJ Ment Health"}],"container-title":["Frontiers in Psychiatry"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2026.1796972\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T05:48:51Z","timestamp":1781243331000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2026.1796972\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,12]]},"references-count":40,"alternative-id":["10.3389\/fpsyt.2026.1796972"],"URL":"https:\/\/doi.org\/10.3389\/fpsyt.2026.1796972","relation":{},"ISSN":["1664-0640"],"issn-type":[{"value":"1664-0640","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,12]]},"article-number":"1796972"}}