{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T09:40:36Z","timestamp":1784022036736,"version":"3.55.0"},"reference-count":61,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2020,10,27]],"date-time":"2020-10-27T00:00:00Z","timestamp":1603756800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Sexual distress is a core characteristic of sexual dysfunction; however, little is known about its correlates. In the current study, we aimed to contribute to the understanding of both sexual distress and its positive counterpart, sexual pleasure, by taking a transdiagnostic approach to sexual distress using two types of repetitive negative thinking: worry and rumination. Because sexual activity mostly occurs in a dyadic context, we also looked at the potential mediating effect of co-worry and co-rumination, and we used them as mediators. Our preliminary exploratory quantitative study used a cross-sectional design, with a sample of 206 partnered heterosexual people. We used path analysis with parallel mediation, with structural equation modelling being performed using lavaan designed for R environment. Overall, our results show that repetitive negative thinking is associated with both sexual distress and sexual pleasure, and that neither co-rumination nor co-worry mediates these associations. The exception is the indirect effect of rumination on sexual pleasure that is mediated by co-rumination. These results demonstrate that a transdiagnostic approach to sexual distress is a new field worth exploring, and they contribute to establishing the relevance of a cognitive approach to sexual dysfunction.<\/jats:p>","DOI":"10.3390\/ijerph17217864","type":"journal-article","created":{"date-parts":[[2020,10,27]],"date-time":"2020-10-27T09:22:45Z","timestamp":1603790565000},"page":"7864","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":28,"title":["A Transdiagnostic Approach to Sexual Distress and Sexual Pleasure: A Preliminary Mediation Study with Repetitive Negative Thinking"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2810-4034","authenticated-orcid":false,"given":"Patr\u00edcia M.","family":"Pascoal","sequence":"first","affiliation":[{"name":"CICPSI, Faculdade de Psicologia, Universidade de Lisboa, 1649-013 Lisboa, Portugal"},{"name":"Escola de Psicologia e Ci\u00eancias da Vida, Universidade Lus\u00f3fona de Humanidades e Tecnologias, 1649-013 Lisboa, Portugal"},{"name":"CPUP, Faculdade de Psicologia e Ci\u00eancias da Educa\u00e7\u00e3o, Universidade do Porto, Rua Alfredo Allen, 4200-135 Porto, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catarina F.","family":"Raposo","sequence":"additional","affiliation":[{"name":"CPUP, Faculdade de Psicologia e Ci\u00eancias da Educa\u00e7\u00e3o, Universidade do Porto, Rua Alfredo Allen, 4200-135 Porto, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magda Sofia","family":"Roberto","sequence":"additional","affiliation":[{"name":"CICPSI, Faculdade de Psicologia, Universidade de Lisboa, 1649-013 Lisboa, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,10,27]]},"reference":[{"key":"ref_1","unstructured":"Griffiths, N. (2017). The Relationship between Co-Rumination and Depression, Anxiety and Social Anxiety in a UK Community Sample. [Ph.D. Thesis, University of Surrey]."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1016\/j.beth.2016.09.004","article-title":"Current definitions of \u201ctransdiagnostic\u201d in treatment development: A search for consensus","volume":"48","author":"Gutner","year":"2017","journal-title":"Behaviour"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.jbtep.2019.02.006","article-title":"Is repetitive negative thinking a transdiagnostic process? A comparison of key processes of RNT in depression, generalized anxiety disorder, obsessive-compulsive disorder, and community controls","volume":"64","author":"Wahl","year":"2019","journal-title":"J. Behav. Exp. Psychiatry"},{"key":"ref_4","first-page":"968","article-title":"Sexual problems and distress in united states women: Prevalence and correlates","volume":"112","author":"Shifren","year":"2008","journal-title":"Obs. Gynecol"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"942","DOI":"10.1080\/00224499.2015.1063576","article-title":"A structural equation modeling analysis of the relationships between depression, anxiety, and sexual problems over time","volume":"53","author":"Forbes","year":"2016","journal-title":"J. Sex. Res."},{"key":"ref_6","unstructured":"Davey, G.C.L., and Tallis, F. (1994). The nature, functions, and origins of worry. Worrying: Perspectives on Theory, Assessment, and Treatment, John Wiley & Sons."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Sweeny, K., and Dooley, M.D. (2017). The surprising upsides of worry. Soc. Personal Psychol. Compass., 11.","DOI":"10.1111\/spc3.12311"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"636","DOI":"10.1007\/s10862-018-9683-5","article-title":"The contribution of worry behaviors to the diagnosis of generalized anxiety disorder","volume":"40","author":"Brown","year":"2018","journal-title":"J. Psychopathol. Behav. Assess."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2646","DOI":"10.1111\/j.1743-6109.2008.00842.x","article-title":"Worry, desire, and sexual satisfaction and their association with severity of ED and age","volume":"5","author":"Gralla","year":"2008","journal-title":"J. Sex. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1080\/00926239908404006","article-title":"The relationship between worry, sexual aversion, and low sexual desire","volume":"25","author":"Katz","year":"1999","journal-title":"J. Sex. Marital."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1111\/j.1745-6924.2008.00088.x","article-title":"Rethinking rumination","volume":"3","author":"Wisco","year":"2008","journal-title":"Perspect. Psychol. Sci."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1016\/j.brat.2010.12.006","article-title":"Rumination as a transdiagnostic factor in depression and anxiety","volume":"49","author":"McLaughlin","year":"2011","journal-title":"Behav. Res."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1177\/0011000014527002","article-title":"Rumination, sexual orientation uncertainty, and psychological distress in sexual minority university students","volume":"42","author":"Borders","year":"2014","journal-title":"Couns. Psychol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1016\/j.chiabu.2003.05.004","article-title":"Childhood and adult sexual abuse, rumination on sadness, and dysphoria","volume":"28","author":"Conway","year":"2004","journal-title":"Child. Abus. Negl."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"McCool-Myers, M., Theurich, M., Zuelke, A., Knuettel, H., and Apfelbacher, C. (2018). Predictors of female sexual dysfunction: A systematic review and qualitative analysis through gender inequality paradigms. BMC Womens Health, 18.","DOI":"10.1186\/s12905-018-0602-4"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1080\/00224499.2017.1332153","article-title":"The burden of sexual problems: Perceived effects on men\u2019s and women\u2019s sexual partners","volume":"55","author":"Rowland","year":"2018","journal-title":"J. Sex. Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1549","DOI":"10.1111\/j.1743-6109.2009.01252.x","article-title":"Correlates of sexually related personal distress in women with low sexual desire","volume":"6","author":"Rosen","year":"2009","journal-title":"J. Sex. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1016\/j.sxmr.2018.12.002","article-title":"Male sexual desire: An overview of biological, psychological, sexual, relational, and cultural factors influencing desire","volume":"8","author":"Nimbi","year":"2020","journal-title":"Sex. Med. Rev."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1080\/0167482X.2019.1599857","article-title":"Self-reported reasons for having difficulty reaching orgasm during partnered sex: Relation to orgasmic pleasure","volume":"41","author":"Hevesi","year":"2020","journal-title":"J. Psychosom. Obs. Gynecol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1080\/00224499.2018.1493570","article-title":"Who\u2019s distressed by sexual difficulties? Exploring associations between personal, perceived partner, and relational distress and sexual difficulties in heterosexual men and women","volume":"56","author":"Hendrickx","year":"2019","journal-title":"J. Sex. Res."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1007\/s10608-008-9200-3","article-title":"Rumination in interpersonal relationships: Does co-rumination explain gender differences in emotional distress and relationship satisfaction among college students?","volume":"32","author":"Calmes","year":"2008","journal-title":"Cogn. Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"512","DOI":"10.1002\/cpp.2023","article-title":"The relationship between co-rumination and internalizing problems: A systematic review and meta-analysis","volume":"24","author":"Spendelow","year":"2017","journal-title":"Clin. Psychol. Psychother."},{"key":"ref_23","unstructured":"Dombrowski, C. (2014). Gender Differences in Co-Rumination, Co-Worry, and Internalizing Symptoms in Late Adolescence. [Master\u2019s Thesis, University of Connecticut]. Available online: https:\/\/opencommons.uconn.edu\/gs_theses\/542."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1830","DOI":"10.1111\/1467-8624.00509","article-title":"Co\u2013rumination in the friendships of girls and boys","volume":"73","author":"Rose","year":"2002","journal-title":"Child. Dev."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1023\/A:1018790003416","article-title":"Worry: A cognitive phenomenon intimately inked to affective, physiological, and interpersonal behavioral processes","volume":"22","author":"Borkovec","year":"1998","journal-title":"Cognit. Ther. Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"462","DOI":"10.1080\/02699931.2011.651101","article-title":"Worry spreads: Interpersonal transfer of problem-related anxiety","volume":"26","author":"Parkinson","year":"2012","journal-title":"Cogn. Emot."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1037\/a0040112","article-title":"Sharing concerns: Interpersonal worry regulation in romantic couples","volume":"16","author":"Parkinson","year":"2016","journal-title":"Emotion"},{"key":"ref_28","unstructured":"Goldstein, M. (2014). Co-Worry in Friendship Dyads. [Honors Scholar Thesis, University of Connecticut]. Available online: https:\/\/opencommons.uconn.edu\/srhonors_theses\/402."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1016\/j.janxdis.2010.09.009","article-title":"A preliminary investigation of worry content in sexual minorities","volume":"25","author":"Weiss","year":"2011","journal-title":"J. Anxiety Disord."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"726","DOI":"10.1080\/10926771.2011.608184","article-title":"Psychiatric symptoms as a predictor of sexual aggression among male college students","volume":"20","author":"Calzada","year":"2011","journal-title":"J. Aggress. Maltreatment Trauma"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2458","DOI":"10.1111\/j.1743-6109.2010.01836.x","article-title":"Differentiating components of sexual well-being in women: Are sexual satisfaction and sexual distress independent constructs?","volume":"7","author":"Stephenson","year":"2010","journal-title":"J. Sex. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1111\/bjc.12052","article-title":"Development and assessment of brief versions of the Penn State Worry Questionnaire and the Ruminative Response Scale","volume":"53","author":"Topper","year":"2014","journal-title":"Br. J. Clin. Psychol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1023\/A:1023910315561","article-title":"Rumination reconsidered: A psychometric analysis","volume":"27","author":"Treynor","year":"2003","journal-title":"Cogn. Res."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1037\/1040-3590.15.2.173","article-title":"Assessing worry in older adults: Confirmatory factor analysis of the Penn State Worry Questionnaire and psychometric properties of an abbreviated model","volume":"15","author":"Hopko","year":"2003","journal-title":"Psychol. Assess."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1016\/0005-7967(90)90135-6","article-title":"Development and validation of the Penn State Worry Questionnaire","volume":"28","author":"Meyer","year":"1990","journal-title":"Behav. Res. Ther."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"E63","DOI":"10.1017\/sjp.2019.61","article-title":"Pathological worry in portugal: The portuguese version of the Penn State Worry Questionnaire (PSWQ)","volume":"22","author":"Pascual","year":"2019","journal-title":"Span. J. Psychol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1111\/j.1743-6109.2007.00672.x","article-title":"Validation of the Female Sexual Distress Scale-Revised for assessing distress in women with hypoactive sexual desire disorder","volume":"5","author":"Derogatis","year":"2008","journal-title":"J. Sex. Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1733","DOI":"10.1007\/s10508-018-1146-2","article-title":"Psychometric validation of the female sexual distress scale in male samples","volume":"47","author":"Mohamed","year":"2018","journal-title":"Arch. Sex. Behav."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1408","DOI":"10.1016\/j.jsxm.2016.06.010","article-title":"Initial validation of the sexual pleasure scale in clinical and non-clinical samples of partnered heterosexual people","volume":"13","author":"Pascoal","year":"2016","journal-title":"J. Sex. Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1002\/job.326","article-title":"Consistency of implications of three role Stressors across four countries","volume":"26","author":"Glazer","year":"2005","journal-title":"J. Organ. Behav."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1080\/08824096.2016.1214121","article-title":"Statistical and practical concerns with published communication research featuring structural equation modeling","volume":"34","author":"Goodboy","year":"2017","journal-title":"Commun. Res. Rep."},{"key":"ref_42","unstructured":"Hayes, A.F. (2013). Introduction to Mediation, Moderation, and Conditional Process Analysis, Guilford Press."},{"key":"ref_43","unstructured":"Hair, J.F., Black, W.C., Babin, B.J., and Anderson, R.E. (2010). Multivariate Data Analysis, Pearson Education International. [7th ed.]."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"108","DOI":"10.2307\/2981746","article-title":"Residuals and influence in regression","volume":"147","author":"Robinson","year":"1984","journal-title":"J. R Stat. Soc. Ser. A"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1","DOI":"10.18637\/jss.v048.i02","article-title":"Lavaan: An R package for structural equation modeling","volume":"48","author":"Rosseel","year":"2012","journal-title":"J. Stat. Softw."},{"key":"ref_46","unstructured":"(2020, June 20). R Core Team R: A Language and Environment for Statistical Computing. Available online: http:\/\/www.R-project.org\/."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1177\/0022167891313007","article-title":"The medicalization of sex","volume":"31","author":"Szasz","year":"1991","journal-title":"J. Humanist. Psychol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1023\/A:1014517718949","article-title":"Distinct and overlapping features of rumination and worry: The relationship of cognitive production to negative affective states","volume":"26","author":"Fresco","year":"2002","journal-title":"Cogn. Res."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1007\/s10608-014-9620-1","article-title":"Interpersonal emotion regulation model of mood and anxiety disorders","volume":"38","author":"Hofmann","year":"2014","journal-title":"Cogn. Res."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1792","DOI":"10.1037\/a0025309","article-title":"The \u201ccost of caring\u201d in youths\u2019 friendships: Considering associations among social perspective taking, co-rumination, and empathetic distress","volume":"47","author":"Smith","year":"2011","journal-title":"Dev. Psychol."},{"key":"ref_51","first-page":"37","article-title":"What is sexual satisfaction? Thematic analysis of lay people\u2019s definitions","volume":"51","author":"Pascoal","year":"2013","journal-title":"J. Sex. Res."},{"key":"ref_52","first-page":"101","article-title":"A thematic analysis of a sample of partnered lesbian, gay, and bisexual people\u2019s concepts of sexual satisfaction","volume":"10","author":"Pascoal","year":"2019","journal-title":"Psychol. Sex."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1080\/00224490609552300","article-title":"Dysfunctional sexual beliefs as vulnerability factors for sexual dysfunction","volume":"43","author":"Nobre","year":"2006","journal-title":"J. Sex. Res."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1007\/s10508-006-9047-1","article-title":"Emotions during sexual activity: Differences between sexually functional and dysfunctional men and women","volume":"35","author":"Nobre","year":"2006","journal-title":"Arch. Sex. Behav."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1080\/19317611.2018.1424064","article-title":"Sexual beliefs and sexual functioning: The mediating role of cognitive distraction","volume":"30","author":"Pascoal","year":"2018","journal-title":"Int. J. Sex. Heal."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1080\/00926230500442334","article-title":"Prevalence and comorbidity of sexual dysfunctions in a portuguese clinical sample","volume":"32","author":"Nobre","year":"2006","journal-title":"J. Sex. Marital"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1019","DOI":"10.1037\/0012-1649.43.4.1019","article-title":"Prospective associations of co-rumination with friendship and emotional adjustment: Considering the socioemotional trade-offs of co-rumination","volume":"43","author":"Rose","year":"2007","journal-title":"Dev. Psychol."},{"key":"ref_58","first-page":"74","article-title":"The mediating role of sexual self-disclosure satisfaction in the association between expression of feelings and sexual satisfaction in heterosexual adults. [O papel mediador da autorrevela\u00e7\u00e3o sexual na rela\u00e7\u00e3o entre a express\u00e3o de sentimentos e a satisfa\u00e7","volume":"51","author":"Pascoal","year":"2019","journal-title":"Rev. Lat. Psicol."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"1643","DOI":"10.1016\/j.jsxm.2020.06.013","article-title":"Sexual and relationship satisfaction in young, heterosexual couples: The role of sexual frequency and sexual communication","volume":"17","author":"Roels","year":"2020","journal-title":"J. Sex. Med."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"796","DOI":"10.1037\/a0024843","article-title":"All data collection and analysis methods have limitations: Reply to Rabbitt (2011) and Raz and Lindenberger","volume":"137","author":"Salthouse","year":"2011","journal-title":"Psychol. Bull."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1662","DOI":"10.1016\/j.jsxm.2016.09.016","article-title":"Predictors of sexual distress in women with desire and arousal difficulties: Distinguishing between personal, partner, and interpersonal distress","volume":"13","author":"Hendrickx","year":"2016","journal-title":"J. Sex. Med."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/21\/7864\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T10:29:07Z","timestamp":1760178547000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/21\/7864"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,10,27]]},"references-count":61,"journal-issue":{"issue":"21","published-online":{"date-parts":[[2020,11]]}},"alternative-id":["ijerph17217864"],"URL":"https:\/\/doi.org\/10.3390\/ijerph17217864","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,10,27]]}}}