Recently, a crescent number of works have tried to highlight how sexual desire works according to the biopsychosocial perspective. However, this area remains strongly lacking, especially regarding the reliability of studies on psychological and social aspects connected to different desire expressions (involving specific activities or partners, highlighting the difference between specific sexual interests and the related acting out, responsive desire to the partner stimulation or as a reaction to a dysphoric status) and their effects on sexual and mental health. The erotic fantasies are considered among the diagnostic criteria of some disorders in the DSM-5 and in the proposal for the ICD-11, and they are frequently used in clinical interventions for sexual problems, paraphilic disorders, and sex offenders. Despite this, research on the relationship between erotic fantasies and sexual and mental health is extremely lacking and influenced by prejudice and stigma.
The current cross-sectional study aims to investigate different aspects of desire and fantasies, trying to deepen the relationship between sexual interest characteristics and sexual and mental health factors. An anonymous web-survey with a snowball recruitment will be administered to 1000 volunteers from the general population and 200 patients from the Department of Gynaecological-Obstetric Sciences and Urological Sciences (Policlinic Umberto I, Rome) with desire problems (clinical group). Based on literature, we expect to highlight significant differences in the experience of sexual desire in the general population, not only gender based, but also on other considered variables (age, sexual orientation, education, relationship). Furthermore, we expect to find a different pattern of desire/fantasies characteristics in the clinical groups, which may lay the foundations for future improvements of the clinical care in this area.
The project aims to help to fill the scientific gap in research on desire and fantasies, considering that studies on these topics at the national and the international level are still in an embryonic stage and scientific data are rare, very dated and characterized by differences and methodological deficiencies which considerably limit their reliability. Some innovative elements of this research are:
1. Seehuus et al. (2019) highlighted the number of participants as one of the main limitations in studies on this topic. The goal we set ourselves is to reach around 1000 participants from the general population and 200 people with HSDD and FSI/AD (screened in the hospital departments). Considering our experience with the snowball recruitment method and the use of social media, these numbers are likely to be reached. Even if the selected method does not allow us to have a representative sample, the project will lay important foundations for future studies with a more clinical and less exploratory imprinting.
2. Erotic fantasies is difficult area to explore. One of the reasons is related to the lack of validity and reliability of the available measures. Joyal et al. (2015) highlighted the tendency to use preselected items as a factor limiting the free attribution and narration of one¿s fantasy. To partially avoid this bias, items used in closed-question tools should be varied and selected based on objective criteria. Furthermore, open questions should be included (Seehuus et al., 2019). Following these suggestions, the Sexual Desire and Erotic Fantasy Questionnaire (SDEF; Nimbi et al., in publication), a new tool that demonstrated a good validity and reliability, will be assessed in the project. In fact, the SDEF is able to collect information on sexual desire, erotic fantasies and how they are experienced during sexual behaviour on the basis of the latest studies on desire, fantasies and pornography use. Specifically, it collects over 120 categories of erotic fantasies and gives the possibility to participants to write their own fantasies, if those are not reported in the above-mentioned categories.
3. In literature, cross-sectional studies on desire and fantasies are usually addressed in cisgender heterosexual people (Joyal et al., 2015; Nimbi et al., 2018; 2019). The studies referring to sexual minorities, exploring possible similarities and peculiarities, are very rare. In the present study we will consider several groups, stratified by gender, age, sexual orientation, type of relationship, level of study, and data will also be collected on populations with different gender identities (e.g., transsexual, non-binary, agender). In fact, the SDEF was built to be easily completed also by sexual minorities, without stigmatizing or relating to genital sex (such as the IIEF, the FSFI and the most used questionnaire available in sexology).
4. To limit potential bias due to social desirability, very consistent in studies on sexuality and erotic fantasies (Seifert, et al., 2017), the Short Form Marlowe-Crowne social desirability scale (Fischer & Fick, 1993) was included in our protocol and will be used as a control variable (covariates) in the analyses.
5. A deeper knowledge of sexual drive components would be very helpful for physicians and therapists. A public diffusion of the results could also increase the awareness of people dealing with sexual desire problems (HSDD and FSI/AD) and help to foster the access to proper health care services.
6. Clinical work on sexual fantasies is very useful in various areas of couple and individual therapy, especially for desire claims. The project will explore the differences between the general population and the HSDD and FSI/AD groups. In sexual therapy, these data may be useful to help patients to reflect on their erotic imagery and to stimulate critical thinking and discussion about sexuality in the couple. Surprisingly, such information is seldom available (Joyal et al., 2015).
7. Sexual fantasies, their recurrence, intensity, necessity, and the lack of overall diversity are useful in risk assessment of sexual offenders to evaluate risk of acting out (Grundmann et al., 2016; Seehuus et al., 2019). This study, in addition to these variables, will analyse their association with some peculiar sexual and mental health factors, possibly helping to take a step forward also in the forensic psychology field.
8. Besides following the DSM-5 diagnostic criteria, this study falls within the discussion for the ICD-11 proposal in matter of paraphilias. This study will help to confirm (or to discredit) the new proposal stating the cancellation of different types of paraphilia such as the fetishism, the fetishistic transvestism and the sadomasochism due to their large presence of these fantasies and behaviours in the general population (Giami, 2015).