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International Journal of Sexual Health logoLink to International Journal of Sexual Health
. 2023 Jan 30;35(1):91–104. doi: 10.1080/19317611.2023.2172511

Difficulties in Emotion Regulation and Sexual Functioning in Sports Practitioners: A Pilot Study

Maria Manuela Peixoto a,✉, Fábio Sousa b
PMCID: PMC10903616  PMID: 38596761

Abstract

Emotion regulation is a transdiagnostic process strongly related with emotional difficulties, which may interfere with sexual functioning. Little is known about this association in athletes. The current study examined differences in difficulties in emotion regulation in sports practitioners with and without sexual difficulties. A total of 174 athletes (64 women and 110 men) completed a web-survey, answering a sociodemographic information questionnaire, the Difficulties in Emotion Regulation Scale – Short Form, and the Female Sexual Functioning Index/the International Index of Erectile Function. Results suggested that 34 women (53.1%) experienced sexual difficulties and 40 men (35.1%) reported erectile difficulties. Women with sexual difficulties revealed greater difficulties in goal-directed behavior. Men with erectile difficulties revealed greater lack of emotional awareness and clarity, more difficulties in goal-directed behavior (focusing on relevant information and ignoring distractors) and impulse control, and higher nonacceptance of emotions. Overall, current findings enhance the role of difficulties in emotional regulation in sexual functioning in male and female sports practitioners.

Keywords: Emotion regulation, men, sexual functioning, sports practitioners, women

Introduction

Sexual health is an important feature of global health and an indicator of overall well-being (WHO, 2010), which includes a good level of sexual functioning and the experience of sexual pleasure and satisfaction (Pascoal et al., 2020). In addition, psychopathology, particularly emotional disorders, has been associated with a decrease in sexual functioning (Baldwin, 2001; Quinta-Gomes & Nobre, 2011) and consequently with poor sexual health. A transdiagnostic feature of a broad spectrum of emotional disorders is emotion dysregulation (Faustino, 2021; Gratz & Roemer, 2004; Sloan et al., 2017), which has been conceptualized as a dimension of vulnerability to the onset and maintenance of psychopathology (Barlow et al., 2017). Overall, the promotion of sexual health and sexual pleasure is paramount given the recognition of sexual pleasure as a sexual right and a human right (Coleman et al., 2021) for all people.

Emotion regulation is described and theorized as a complex and multifaceted construct that involves different approaches to regulating emotional experiences as well as difficulties in this process (Moore et al., 2022; Sörman et al., 2022). Gratz and Roemer (2004) describe the process of emotion regulation as the ability to recognize and identify emotions, align with personal goals, and control impulsive actions when confronted with unpleasant emotional experiences, and use various strategies to regulate these experiences.

Emotion dysregulation occurs when certain skills related to emotion management and regulation are underdeveloped or not developed at all (Gratz & Roemer, 2004; Gross, 2002). According to Gratz and Roemer (2004), emotional dysregulation can be summarized in six dimensions: (1) awareness or lack of awareness of emotional reactions and experiences; (2) clarity or difficulty understanding emotional reactions and experiences; (3) non-acceptance of emotional reactions and experiences; (4) impulses or lack of impulse control; (5) goals or lack of control in engaging in goal-directed behaviors when faced with unpleasant experiences or emotions; and (6) strategies or difficulty accessing effective emotion regulation strategies.

The process of emotion (dys)regulation has been conceptualized as a transdiagnostic process, which is a cognitive process common across a wide range of disorders, acting as risk factor or maintaining factor (Barlow et al., 2017; Faustino, 2021; Sloan et al, 2017), that has been empirically associated with a wide range of emotional difficulties and psychopathology, particularly depression, anxiety, eating disorders, obsessive-compulsive spectrum, and personality disorders (Aldao & Nolen-Hoeksema, 2010; Aldao et al., 2016; Barlow et al., 2017; Cludius et al., 2020; Faustino, 2021; Fernandez et al., 2016; Mallorquí-Bagué et al., 2018; Sloan et al., 2017). Over the past decade, efforts have been made to promote evidence-based psychotherapeutic interventions for mental disorders with lower costs and greater efficacy (Barlow et al., 2017). Consistent with this research, studies targeting the psychological processes underlying depressive, anxiety, and related symptoms have focused on transdiagnostic dimensions that affect emotion regulation (Aldao & Nolen-Hoeksema, 2010; Barlow et al., 2017; Faustino, 2021; Fernandez et al., 2016; Sloan et al., 2017).

The presence of psychiatric symptoms, psychopathology or psychological distress has been empirically associated with a decrease in sexual response and function in both men and women (Baldwin, 2001; Barlow, 1986; Castellini et al., 2018; Ciocca et al., 2015; Derogatis et al., 1981; Kaplan, 1988; Laurent & Simons, 2009; Moghalu et al., 2020; Quinta-Gomes & Nobre, 2011; Rellini et al., 2010), suggesting that cognitive and emotional vulnerability processes of psychopathology can also be conceptualized as vulnerability dimensions related to sexual dysfunction. Moreover, research has shown that individuals with depression have significantly impaired sexual functioning and sexual satisfaction (Baldwin, 2001) and that men with sexual problems have more depressive symptomatology and higher levels of neuroticism (Quinta-Gomes & Nobre, 2012). Anxiety spectrum disorders have also been linked with decreased levels of sexual desire, sexual arousal and sexual excitation (Moghalu et al., 2020), negatively interfering in sexual responsiveness and sexual pleasure. In addition, women with eating disorders have decreased sexual responsiveness (Dunkley et al., 2020). Overall, mood, anxiety spectrum, and eating disorders have significant difficulties with emotion regulation (Brockmeyer et al., 2014; Faustino, 2021). A recent study found evidence linking emotion regulation difficulties to sexual activity, with college students with greater emotion regulation difficulties reporting engaging less in exclusive sexual activity (Stroud et al., 2016). Nevertheless, there is a lack of empirical research on emotion (dys)regulation and sexual functioning, and further studies are needed to fill this gap.

In the context of physical activity and athletic performance, studies on mental health are still scarce (Rice et al., 2016). On the one hand, empirical studies have shown that psychopathological symptoms and distress are prevalent among elite athletes (Åkesdotter et al., 2020; Foskett & Longstaff, 2018; Reardon et al., 2019) and college student-athletes (Egan, 2019), with significant levels of depression, anxiety, and psychological distress reported in samples of elite athletes (Foskett & Longstaff, 2018). On the other hand, exercise appears to act as a buffer for mental health problems (Chekroud et al., 2018; Ten Have et al., 2011), but it remains unclear whether there is a true causal relationship (Ten Have et al., 2011). Also, longer exercise participation is not positively associated with fewer psychological problems in individuals who exercise extremely frequently (i.e., more than 23 times/month or more than 90 minutes/session) (Chekroud et al., 2018). Research on the psychological processes and mechanisms involved in the effects of physical activity and exercise on mood and mental health is mainly related to increasing individuals’ self-efficacy or promoting distraction from current negative emotionality (Mikkelsen et al., 2017). Thus, distraction from current negative emotionality can be understood as an adaptive or maladaptive emotion regulation strategy when it is associated with acceptance or avoidance of the current emotional experience, respectively (Wolgast & Lundh, 2017).

In the context of sport performance, emotion regulation has been extensively researched as a key dimension that affects athletic and sport practitioners’ performance (Cece et al., 2021; Doorley & Kashdan, 2021; Jones, 2012; Lane et al., 2012; Wagstaff, 2014), but also influences team dynamics, injury risk, and well-being (Cece et al., 2021; Lane et al., 2012), with emotional dysregulation in sports practice being linked to depression and burnout (Cece et al., 2021). The process of emotion dysregulation occurs when a discrepancy between available and desired emotions is experienced during and after a sport performance or competition (Lane et al., 2012), when athletes or sport practitioners use conscious or automatic strategies to enhance, modify, or suppress emotional experiences (Gross, 2002; Lane et al., 2012). Performance impairments have been observed in athletes and sport practitioners who use maladaptive emotion regulation strategies, such as emotion suppression (Wagstaff, 2014). Functional emotion regulation in sport focuses on recognizing and being aware of current emotions and acting in a goal-directed manner (Lane et al., 2012).

The role of transdiagnostic processes in sexuality is under-researched, with limited empirical evidence of repetitive negative thinking on sexual distress and sexual pleasure (Pascoal et al., 2020) and on sexual functioning (Peixoto & Ribeiro, 2022). Regarding psychological maladjustment and psychiatric illness, there is empirical evidence that sexual functioning is impaired in psychiatric samples (Castellini et al., 2018; Derogatis et al., 1981; Laurent & Simons, 2009) and that individuals with depressed mood and anxiety complain of impaired sexual desire, sexual arousal, and sexual satisfaction (Baldwin, 2001; Moghalu et al., 2020; Quinta-Gomes & Nobre, 2011). Given the close relationship between emotion dysregulation and psychiatric disorders, and the relationship between emotion dysregulation and impaired sexual functioning, it can be concluded that difficulties in emotion regulation negatively affect sexual response.

Although there is limited research on sexuality in sport practitioners, the main findings emphasize the role of sport on sexual response, for example, the role of cycling on erectile function (Dettori et al., 2004; Gan et al., 2021) or Crossfit and pelvic floor dysfunction in women (Pisani et al., 2020), with one of the most common problems researched in sports and sexuality being pelvic floor dysfunctions due to sports practice (Giagio et al., 2021). To date, fewer studies have been conducted to investigate and explore sexual functioning and sexual difficulties in sports practitioners and athletes. Sexual health is an important indicator of global health, and sexual functioning levels had been linked to sexual pleasure (Pascoal et al., 2020). Also, sexual functioning levels appear to be correlated with transdiagnostic processes, such as repetitive negative thinking, which have been described as a vulnerability dimension for emotional disorders (Peixoto & Ribeiro, 2022). Thus, exploring the role of emotion regulation difficulties in sports practitioners with and without sexual difficulties could help improve the comprehensive knowledge on emotion regulation and transdiagnostic processes related with emotional disorders in sports practitioners with and without sexual difficulties and, consequently, suggest guidelines for assessment and intervention in sexual difficulties in this population.

Considering the current literature review and to our knowledge, this study is the first attempt to investigate and explore differences in difficulties in emotion regulation (as a transdiagnostic process) in sports practitioners with and without sexual difficulties. Differences in emotion regulation difficulties (i.e., awareness, clarity, goals, impulses, non-acceptance, and strategies) are explored in a sample of sports practitioners, including women with and without sexual difficulties, and men with and without erectile difficulties. Consistent with previously established associations between difficulties in emotion regulation and psychopathology, and between psychopathology and impaired sexual functioning, women who practices sports and reported sexual difficulties and men who practices sports and experienced erectile problems are expected to report greater difficulties in emotion regulation, when compared to women and men who practices sports and reported no sexual difficulties.

Methods

Participants

A total of 178 Portuguese adult sport practitioners (69.7% men, n = 114; 30.3% women, n = 64) participated in the current study. The mean age of the participants was 27.82 (SD = 8.37), ranging from 18 to 70 years. Most of the sample identified themselves as heterosexual (93.3%, n = 166), had 13 years of schooling or more (58.4%, n = 104), were single (74.2%, n = 132), had a current sexual partner (60.7%, n = 108), practice a collective sport (67.4%, n = 120), for more than 10 years (50.6%, n = 90), as amateurs (59.6%, n = 106). Detailed sociodemographic characteristics are described in Table 1.

Table 1.

Sociodemographic Characterization (N = 178).

  Total sample
 Male sample
 Female sample
(N = 178)
 (n = 114)
 (n = 64)
  M(SD) Range M(SD) Range M(SD) Range
Age 27.82 (8.37) 18–70 28.92 (8.95) 18–70 25.86 (6.89) 18–45
  n % n % N %
Sex            
 Male 124 69.7 114 100.0 – –
 Female 54 30.3 – – 64 100.0
Gender            
 Men 124 69.7 114 100.0 – –
 Women 54 30.3 – – 64 100.0
Sexual orientation            
 Heterosexual 166 93.3 107 93.9 59 89.1
 Bisexual 7 3.9 3 2.6 4 6.3
 Gay/Lesbian 3 1.7 2 1.8 1 2.6
 Asexual 2 1.1 2 1.8 – –
Current sexual partner            
 Yes 108 60.7 74 64.9 34 53.1
 No 70 39.3 40 35.1 30 46.9
Educational level            
 6 Years 2 1.1 2 1.8 – –
 9 Years 6 3.4 5 4.4 1 1.6
 12 Years 66 37.1 45 39.5 21 32.8
 13 Years or more 104 58.4 62 54.4 42 65.6
Marital status            
 Single 132 74.2 75 65.8 57 89.1
 Married/civil union 42 23.6 36 31.6 6 9.4
 Divorced/separated 3 1.7 2 1.8 1 1.6
 Widower 1 0.6 1 0.9 – –
Type of sport            
 Collective 120 67.4 78 68.4 42 65.6
 Individual 58 32.6 36 31.6 22 34.4
Years of practice            
 Less than 5 years 33 18.5 15 13.2 18 28.1
 Between 5 and 10 years 55 30.9 35 30.7 20 31.3
 More than 10 years 90 50.6 64 56.1 26 40.6
Type of practice            
 Amateur 106 59.6 67 58.8 39 60.9
 Semi professional 57 32.0 35 30.7 22 34.4
 Professional 15 8.4 12 10.5 3 4.7
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Procedures

The proposal for the study was submitted to the Ethics Committee of the University of Lusíada in Porto. After ethical approval was granted, the Portuguese versions of the self-reports were included in a web survey, on the Google Forms platform, along with the sociodemographic questionnaire. Volunteers were invited to participate in the current study and were provided with a detailed explanation of the purpose of the study and of its voluntary nature and anonymity. The web survey was advertised on social media (i.e., Facebook and LinkedIn), sports clubs, athletic associations, university athletic associations, and mailing lists between May and August 2021 as a study of sexual functioning and emotion regulation in athletes. Participants were required to read the online consent form and provide informed consent. They were then asked to complete the self-report forms, which took nearly 10 minutes. No monetary compensation or other incentives were offered to participants, and no IP addresses or other personal information was requested. All ethical standards and procedures established by Portuguese legislation and the Declaration of Helsinki were followed.

Measures

Sociodemographic information

A sociodemographic information questionnaire was developed for the current study purpose, and allowed to assessing age, biologic sex (i.e., male, female, intersex), gender identity (i.e., men, women, other), sexual orientation (i.e., heterosexual, lesbian, bisexual or asexual), years of schooling (i.e., 4 years, 6 years, 9 years, 12 years, or 13 or more years), marital status (i.e., single, married/civil union, divorced/separated, widower), having a current intimate relationship, type of sports practice (i.e., collective vs. individual), years of sports practicing (i.e., less than 5 years, between 5 and 10 years, more than 10 years), and type of practice (i.e., professional, semiprofessional or amateur).

Difficulties in emotion regulation

Difficulties in Emotion Regulation were assessed with the Difficulties in Emotion Regulation Scale – Short Form (DERS-SF; Kaufman et al., 2016). The DERS-SF is a short form of the Difficulties in Emotion Regulation Scale (Gratz & Roemer, 2004), comprising 18-items assessing difficulties in emotion regulation. The scale allows to assess six dimensions of difficulties in emotion regulation: (i) awareness (lack of emotional awareness); (ii) clarity (lack of emotional clarity); (iii) goals (difficulty engaging in goal-directed behavior); (iv) impulse (impulse control difficulties); (v) non-acceptance (non-acceptance of emotional responses and experiences); and (vi) strategies (limited access to emotion regulation strategies). The scale allows to compute a total score of difficulties, as well as a score for each of the six dimensions of difficulties in emotion regulation. Higher scores indicated more difficulties in emotion regulation. The original scale revealed good psychometric properties (Kaufman et al., 2016), and the Portuguese version replicated the original factorial structure (Moreira, Ribeiro, & Canavarro, 2022). Internal consistency level for current study was 0.75 for the total scale, 0.82 for the nonacceptance subscale, 0.79 for the impulse subscale, 0.76 for the awareness subscale, 0.74 for the goals subscale, 0.71 for the clarity subscale, and 0.70 for the strategies subscale.

Sexual functioning

The sexual functioning in the female sample was measured using the Female Sexual Functioning Index (FSFI; Rosen et al., 2000), which is self-report instrument that includes 19 questions that allows to collect information about sexual function in women. The FSFI provides a sexual function index, as well as indexes for several dimensions: (i) sexual desire, (ii) sexual arousal, (iii) lubrication, (iv) orgasm, (v) sexual satisfaction, and (vi) sexual pain). Greater scores in the overall sexual function index and specific dimensions indexes reflect greater levels of sexual functioning. In terms of psychometric characteristics and properties, the original version of the FSFI yielded good internal consistency, and construct validity (Rosen et al., 2000). The Portuguese version of the FSFI also yielded good internal consistency and construct validity (Pechorro et al., 2009). In addition, the instrument has the ability to discriminate women with sexual difficulties and without sexual difficulties, according to a cutoff score (<26.55; Wiegel et al., 2005). Internal consistency level of 0.96 was found for the current female sample.

The male sexual functioning was measured with the International Index of Erectile Function (IIEF; Rosen et al., 1997). The IIEF is a very brief measure that included 15 questions, self-administered, for assessing different features of men’s sexual function. The instrument allows to computed a total score and several indexes of men’s sexual function: (i) erectile function, (ii) sexual desire, (iii) orgasmic function, (iv) intercourse satisfaction, and (v) overall satisfaction. In terms of psychometric characteristics and properties, the original version of the IIEF and the Portuguese translated version yielded good internal consistency and construct validity (Quinta-Gomes & Nobre, 2012; Rosen et al., 1997). Also, the erectile function subscale has the ability to discriminate men with erectile disorder and men without erectile disorder using a cutoff score (<25; Cappelleri et al., 1999). Internal consistency level of 0.98 for the IIEF total score and 0.97 for the erectile function subscale was found the male sample.

Data analysis

In order to detect a medium-size effect, with a power of 85%, using the software G*power for power analysis, an a priori procedure was performed, recommending a n = 64 for a multivariate analysis of variance with two groups.

Means and standard deviations were calculated for difficulties in emotion regulation (awareness, clarity, goals, impulse, non-acceptance, and strategies), for female sexual functioning, for male sexual functioning and for erectile function. The total score of the FSFI (Rosen et al., 2000) was used for creating the group of women with and without sexual difficulties. According to the cutoff score for the FSFI (FSFI <26.55; Wiegel et al., 2005), women were assigned to a group with and without difficulties. For men, cutoff scores empirically reliable and valid were only found for erectile function and not for overall sexual functioning (Cappelleri et al., 1999); therefore, the subscale of erectile function from the IIEF (Rosen et al., 1997) was considered for allocating men in the group with and without erectile difficulties. Thus, men were assigned to a group with and without erectile difficulties, according to the cutoff score for the Erectile Function subscale of the IIEF (ED <25; Cappelleri et al., 1999). A set of multivariate analyses of variance, with Bonferroni corrections, were performed to assess differences in difficulties in emotional regulation between women with and without sexual difficulties (awareness, clarity, goals, impulse, nonacceptance, and strategies), and between men with and without erectile difficulties. According to Cohen (1988), effect size interpretation for partial η2 was: small (η2=0.01), medium (η2=0.06), and large (η2=0.14) effect.

Results

Difficulties in emotion regulation and sexual functioning in sport practitioners

Table 2 presented means, standard deviations and range for difficulties in emotion regulation (i.e., awareness, clarity, goals, impulse, nonacceptance, and strategies) for all sample and form male and female sample, separately. Means, standard deviations and range for female sexual functioning, male sexual functioning and erectile function were also presented in Table 2.

Table 2.

Means, Standard Deviations, and Range for all Variables in Study.

  Male sample
 Female sample
(n = 114)
 (n = 64)
Variables M(SD) Range M(SD) Range
DERS        
Awareness 10.92 (2.60) 4.00–15.00 11.44 (2.58) 5.00–15.00
Clarity 7.56 (1.52) 4.00–14.00 7.72 (2.09) 4.00–14.00
Goals 7.47 (2.15) 4.00–13.00 7.66 (2.58) 4.00–15.00
Impulse 6.58 (2.78) 3.00–14.00 7.08 (2.84) 3.00–14.00
Non-acceptance 6.69 (2.59) 3.00–14.00 7.45 (2.86) 3.00–15.00
Strategies 8.63 (1.59) 6.00–15.00 8.91 (1.43) 7.00–13.00
FSFI – – 24.84 (8.38) 3.20–36.00
IIEF 59.19 (20.16) 5.00–75.00 – –
Erectile function 24.14 (9.28) 1.00–30.00 – –
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Note. DERS: Difficulties in Emotion Regulation Scale; FSFI: Female Sexual Functioning Index; IIEF: International Index of Erectile Function.

According to the cutoff score for the FSFI, 34 women (53.1%) scored below 26.55 which indicated they experienced sexual difficulties, and were assigned to a group of women with sexual difficulties. An identical procedure was conducted for men, according to the cutoff score for the Erectile Function subscale of the IIEF, and 40 men (35.1%) experienced erectile difficulties, and were assigned to a group with erectile difficulties.

Difficulties in emotion regulation in athlete women sport practitioners with and without sexual difficulties

A multivariate analysis of variance, with Bonferroni corrections, was performed to test the differences between women with and without sexual difficulties according to the FSFI cutoff score (Wiegel et al., 2005) in difficulties in emotional regulation. Significant main effects were found for group (with vs. without sexual difficulties), Wilks’ lambda = 0.73, F(6,57) = 3.46, p = 0.006, partial η2 = 0.267. As presented at Table 3, the univariate analysis revealed that significant main effects were found for goals, F(1,63) = 4.53, p = .037, partial η2 = 0.068, with women with sexual difficulties reporting higher levels of difficulties in engaging in goal-directed behavior (M = 8.37; SD = 2.22) compared with women without sexual difficulties (M = 7.03; SD = 2.74). No significant main effects were found for awareness, F(1,63) = 0.32, p = .572, partial η2 = 0.005; for clarity, F(1,63) = 1.62, p = 0.208, partial η2 = 0.025; for impulse, F(1,63) = 0.03, p = 0.954, partial η2 < 0.001; for non-acceptance, F(1,63) = 1.18, p = .281, partial η2 = 0.019; and for strategies, F(1,63) = 2.43, p = .124, partial η2 = 0.038.

Table 3.

Univariate Results for Differences in Difficulties in Emotion Regulation Between Groups With and Without Sexual Difficulties.

  Men with erectile difficulties (n = 40)
 Men without erectile difficulties (n = 74)
 Univariate test
 Univariate test when controlling for age
 Women with sexual difficulties (n = 34)
 Women without sexual difficulties (n = 30)
 Univariate test
 Univariate test when controlling for age
  M SD M SD F(1,113) Partial η2 F(1,112) Partial η2 M SD M SD F(1,64) Partial η2 F(1,63) Partial η2
DERS                                
Awareness 11.32 2.37 10.18 2.87 5.25* 0.045 5.06* 0.044 11.63 2.22 11.26 2.87 0.32 0.005 0.43 0.007
Clarity 8.00 1.84 7.32 1.27 5.31* 0.045 5.56* 0.048 8.03 2.18 7.37 1.96 1.62 0.025 1.22 0.020
Goals 8.20 2.18 7.08 2.03 7.46** 0.062 6.74* 0.057 8.37 2.22 7.03 2.74 4.53* 0.068 5.63* 0.084
Impulse 7.98 3.05 5.82 2.31 17.85*** 0.137 16.84*** 0.132 7.10 2.80 7.06 2.91 0.03 <0.001 0.11 0.002
Nonacceptance 7.98 2.73 6.00 2.25 17.21*** 0.133 16.65*** 0.130 7.87 2.83 7.09 2.89 1.18 0.019 2.18 0.035
Strategies 9.00 1.66 8.43 1.53 3.37 0.029 3.64 0.032 9.20 1.47 8.65 1.27 2.42 0.038 3.09 0.048
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Note. DERS: Difficulties in Emotion Regulation Scale; *p<.05; **p<.01; ***p<.001.

In addition, a multivariate analysis of variance, with Bonferroni corrections, was performed to test the differences between women with and without sexual difficulties according to the FSFI cutoff score (Wiegel et al., 2005) in difficulties in emotional regulation, controlling for age. Significant main effects were found for group (with vs. without sexual difficulties), Wilks’ lambda = 0.73, F(6,56) = 3.49, p = .005, partial η2 = 0.272, whereas no significant main effects were found for age, Wilks’ lambda = 0.90, F(6,56) = 1.05, p = .403, partial η2 = 0.101. Univariate analysis results are presented at Table 3.

Difficulties in emotion regulation in men sport practitioners with and without erectile difficulties

A multivariate analysis of variance, with Bonferroni corrections, was performed to test the differences between men with and without erectile difficulties according to the Erectile Function cutoff score (Cappelleri et al., 1999) in difficulties in emotional regulation. Significant main effects were found for group (with vs. without erectile difficulties), Wilks’ lambda = 0.83, F(6,107) = 3.55, p = .003, partial η2 = 0.166. Table 3 presented the univariate analysis, that revealed significant main effects were found for awareness, F(1,113) = 5.25, p = .024, partial η2 = 0.045, with men with erectile difficulties scoring higher on lack of emotional awareness (M = 11.32; SD = 2.37) compared with men without erectile difficulties (M = 10.18; SD = 2.87); for clarity, F(1,113) = 11.85, p = .023, partial η2 = 0.045, with men with erectile difficulties scoring higher on lack of emotional clarity (M = 8.00; SD = 1.84) compared with men without erectile difficulties (M = 7.32; SD = 1.27); for goals, F(1,113) = 7.46, p = .007, partial η2 = 0.062, with men with erectile difficulties scoring higher on difficulty in engaging in goal-directed behavior (M = 8.20; SD = 2.19) compared with men without erectile difficulties (M = 7.08; SD = 2.03); for impulse, F(1,113) = 17.85, p < .001, partial η2 = 0.137, with men with erectile difficulties scoring higher impulse control difficulty (M = 7.98; SD = 3.05) compared with men without erectile difficulties (M = 5.82; SD = 2.31); and for non-acceptance, F(1,113) = 17.21, p < .001, partial η2 = 0.133, with men with erectile difficulties scoring higher on nonacceptance of emotional responses and experiences (M = 7.98; SD = 2.73) compared with men without erectile difficulties (M = 6.00; SD = 2.25). No significant main effects were found for strategies, F(1,113) = 3.37, p = .069, partial η2 = 0.029.

In addition, a multivariate analysis of variance, with Bonferroni corrections, was performed to test the differences between men with and without erectile difficulties according to the Erectile Function cutoff score (Cappelleri et al., 1999) in difficulties in emotional regulation, controlling for age. Significant main effects were found for group (with vs. without erectile difficulties), Wilks’ lambda = 0.84, F(6,106) = 3.43, p = .004, partial η2 = 0.163, but not significant main effects were found for age, Wilks’ lambda = 0.98, F(6,106) = 0.40, p = .851, partial η2 = 0.024. Univariate analysis results are presented at Table 3.

Discussion

Emotion regulation has been associated with a wide range of emotional difficulties and psychopathology (e.g., Faustino, 2021), which are also related to sexual response and functioning (e.g., Baldwin, 2001; Barlow, 1986; Castellini et al., 2018). The current study aimed to investigate differences in emotion regulation difficulties (i.e., awareness, clarity, goals, impulse, non-acceptance, and strategies) in a sample of Portuguese sports practitioners, comparing groups of women with and without sexual difficulties and men with and without erectile dysfunction. Overall, 53.1% of women reported having sexual difficulties and 35.1% of men had erectile difficulties. Women and men who had some type of sexual difficulty also reported more difficulty regulating emotions. Sexual functioning plays a key role in well-being and global health, just as general health and mental health affect sexual responsiveness and pleasure (Gianotten et al., 2021). In this sense, poor sexual functioning and sexual expressiveness inhibit the process of emotional regulation, and difficulties in emotional regulation impair sexual responsiveness.

Women with sexual difficulties also reported greater difficulty in engaging in goal-directed behaviors when faced with intense emotions that required a regulation process (i.e., difficulty in engaging in relevant behaviors toward their goals, and ignoring distractors – when facing anxiety, for instance, women with sexual difficulties have more tendency to be overwhelmed with distractor stimuli in the environment and not focusing on behaviors and tasks to regulate their anxiety). Difficulty engaging in goal-directed behaviors during emotion regulation is related to difficulties completing tasks and focusing attention and concentration when emotions are dysregulated (Gratz & Roemer, 2004; Kaufman et al., 2016; Moreira et al., 2020). It is possible that difficulties in completing tasks and focusing attention and concentration when emotionally dysregulated increase the cognitive distraction processes that significantly impair sexual response and functioning in women (Adams et al., 1985; Cuntim & Nobre, 2011; Dove & Wiederman, 2000; Pascoal et al., 2018; Tavares et al., 2020). In addition, the effect size for differences in the difficulty engaging in goal-directed behaviors during emotion regulation between women with and without sexual difficulties was a medium effect size (Cohen, 1988). Other difficulties with emotion regulation, such as lack of emotional awareness and clarity, non-acceptance of emotional experiences and reactions, difficulties with impulse control, or limited access to emotion regulation strategies, did not differ between women with and without sexual difficulties. A possible explanation for these non-significance differences could be the small sample size, which could limit the power of the analysis.

Regarding the male sample, men with erectile dysfunction reported greater difficulty being aware of their emotional reactions, having clarity and accepting their emotional experiences, controlling their impulses in response to their emotions, and engaging in goal-directed behaviors when experiencing unpleasant and uncomfortable emotions. When effect sizes were analyzed, a small effect size was found for differences in awareness and clarity, a medium effect size was found for goals, and a large effect size was found for impulse and non-acceptance (Cohen, 1988). Erectile dysfunction has been linked to anxious behaviors and the process of spectatoring (Barlow, 1986), as well as negative emotions and cognitions (Nobre, 2010). The ability to be aware of emotional experiences and to have clarity about emotional responses, as well as to accept one’s own emotional experiences, has been associated with mindfulness states (Coffey et al., 2010; Cooper et al., 2018; Roemer et al., 2015; Tsur et al., 2016), and mindfulness states have been associated with better erectile function and greater satisfaction with sexual life and erectile function (Banbury et al., 2021; Jaderek & Lew-Starowicz, 2019; Stephenson, 2017). Consistent with these empirical findings, it is possible that male sports practitioners with erectile problems reported significantly more difficulty with emotion regulation strategies such as clarity, awareness, and, particularly, acceptance compared to male sports practitioners without erectile problems. Research has previously demonstrated that men appear to be more emotionally restrictive (Cohn et al., 2010), which can interfere with non-acceptance of emotional experiences. According to current results, acceptance of negative emotions appears to have a larger effect, when compared to awareness and clarity of negative emotions, suggesting that men who practice sports may be aware and have clarity about their own emotional experiences, but non-accepting those negative emotional experiences appears to be more significant for their erectile function. Difficulties with impulse control have been linked to an overall decrease in sexual functioning (Bancroft & Vukadinovic, 2004; Bőthe et al., 2019), and it is possible that these particular difficulties with emotion regulation also negatively affect erectile function in male athletes. Previous research has found evidence of the association between the dimension of impulsive decision making and sexual risk behaviors (Charnigo et al., 2013), including sexual behaviors involving alcohol consumption (Charnigo et al., 2013; George, 2019), which appears to be significant in sports practitioners, athletes (Sønderlund et al., 2014), and college student-athletes (Ford, 2007; Hildebrand et al., 2001; Neal & Fromme, 2007). In addition, alcohol consumption has been associated with erectile and arousal problems in men (George, 2019; George & Gilmore, 2013). Furthermore, according to a study by Dvorak et al. (2014), problematic alcohol use has been associated with difficulties with emotion regulation (i.e., difficulties with impulse control, non-acceptance and lack of emotional clarity, and difficulties with goal-directed behavior), highlighting the need for mindfulness-based interventions. Thus, it is possible that the level of alcohol consumption helps explain the larger effect found in differences in impulse control between athletes with and without erectile difficulties. In addition, the ability to engage in goal-directed behaviors when unpleasant and uncomfortable emotions occur in male sports practitioners with erectile dysfunction may be related to the process of spectatorship (Barlow, 1986), which can impair focus on erotic thoughts and sexual experiences (Nobre, 2010).

The current study has several limitations that should be considered and that may limit the generalizability of the results. First, the sample collected is small and has an overrepresentation of male participants, which could be due to gendered participation in sport (Armstrong & Hutchison, 2022). It is possible that non-significance differences in difficulties in emotion regulation strategies in women could be explained by the sample size of women, which is smaller than men’s sample size. Similarly, professional athletes are underrepresented in the current sample, which also limits potential group differences between professional, semiprofessional, and amateur sports practitioners, or even between sports (i.e., collective vs. individual) or years of training. Therefore, future studies should follow larger samples of sports practitioners to replicate the current findings, and to explore further comparisons between groups.

Emotion regulation is a transdiagnostic process that involves various strategies and skills to promote emotional adjustment and well-being and is closely related to sexual function and sports practice and performance. To our knowledge, the current study was the first empirical approach to examine differences between women with and without sexual difficulties and between men with and without erectile difficulties in relation to difficulties with emotion regulation in sports practitioners. Overall, the main findings highlight the presence of emotion regulation difficulties in female sports practitioners with sexual difficulties and male sports practitioners with erectile difficulties compared to female and male sports practitioners without sexual difficulties. Reducing emotion suppression, supporting acceptance of negative emotions, and promoting impulse control skills in men who practice sports, and encouraging goal-directed behavior during emotional experiences in women who practice sports may help improve levels of sexual functioning. Furthermore, emotion regulation involves awareness of emotional experiences (i.e., thoughts, behaviors, and bodily sensations). Given the role of body awareness in sports practice, the current findings emphasize greater exploration of the manifestations of sexual responsiveness in the mind and body, including for this group of individuals. As sexual health is an important global health indicator, it is of utmost importance to promote emotion regulation in sports practitioners to prevent psychological maladjustment and sexual difficulties in this community, as well as to promote sexual pleasure and satisfaction.

Ethical approval

All procedures performed were in accordance with the ethical standards of the institutional ethics committee and with the 1964 Helsinki declaration and its later amendments. The current study is part of a research project approved by University Ethics Committee. Informed consent was obtained from all individual participants included in the study.

Funding Statement

Maria Manuela Peixoto was supported by national funding from the Portuguese Foundation for Science and Technology (UIDB/00050/2020).

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Data availability statement

The datasets generated during and/or analyzed during the current study are not publicly available due to further data analysis in the scope of the ongoing project. Datasets may be made available in the future from the corresponding author on reasonable request.

References

  1. Adams, A., Haynes, S. N., & Brayer, M. A. (1985). Cognitive distraction in female sexual arousal. Psychophysiology, 22(6), 689–696. 10.1111/j.1469-8986.1985.tb01669.x [DOI] [PubMed] [Google Scholar]
  2. Åkesdotter, C., Kenttä, G., Eloranta, S., & Franck, J. (2020). The prevalence of mental health problems in elite athletes. Journal of Science and Medicine in Sport, 23(4), 329–335. 10.1016/j.jsams.2019.10.022 [DOI] [PubMed] [Google Scholar]
  3. Aldao, A., & Nolen-Hoeksema, S. (2010). Specificity of cognitive emotion regulation strategies: A transdiagnostic examination. Behaviour research and Therapy, 48(10), 974–983. 10.1016/j.brat.2010.06.002 [DOI] [PubMed] [Google Scholar]
  4. Aldao, A., Gee, D. G., De Los Reyes, A., & Seager, I. (2016). Emotion regulation as a transdiagnostic factor in the development of internalizing and externalizing psychopathology: Current and future directions. Development and Psychopathology, 28(4pt1), 927–946. 10.1017/S0954579416000638 [DOI] [PubMed] [Google Scholar]
  5. Armstrong, L., & Hutchison, A. (2022). Participation in sport, empowerment, and safety from violence: Critiquing the connections through women’s experiences in Aotearoa/New Zealand. Violence against Women, 28(3–4), 801–822. 10.1177/10778012211008982 [DOI] [PubMed] [Google Scholar]
  6. Baldwin, D. S. (2001). Depression and sexual dysfunction. British medical Bulletin, 57(1), 81–99. 10.1093/bmb/57.1.81 [DOI] [PubMed] [Google Scholar]
  7. Banbury, S., Lusher, J., Snuggs, S., & Chandler, C. (2021). Mindfulness-based therapies for men and women with sexual dysfunction: A systematic review and meta-analysis. Sexual and Relationship Therapy, 1–22. 10.1080/14681994.2021.1883578 [DOI] [Google Scholar]
  8. Bancroft, J., & Vukadinovic, Z. (2004). Sexual addiction, sexual compulsivity, sexual impulsivity, or what? Toward a theoretical model. Journal of Sex Research, 41(3), 225–234. 10.1080/00224490409552230 [DOI] [PubMed] [Google Scholar]
  9. Barlow, D. H. (1986). Causes of sexual dysfunction: The role of anxiety and cognitive interference. Journal of Consulting and Clinical Psychology, 54(2), 140–148. 10.1037/0022-006X.54.2.140 [DOI] [PubMed] [Google Scholar]
  10. Barlow, D. H., Farchione, T. J., Bullis, J. R., Gallagher, M. W., Murray-Latin, H., Sauer-Zavala, S., et al. (2017). The unified protocol for transdiagnostic treatment of emotional disorders compared with diagnosis-specific protocols for anxiety disorders. A randomized clinical trial. JAMA Psychiatry, 4, 875–884. 10.1001/jamapsychiatry.2017.2164 [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Bőthe, B., Tóth-Király, I., Potenza, M. N., Griffiths, M. D., Orosz, G., & Demetrovics, Z. (2019). Revisiting the role of impulsivity and compulsivity in problematic sexual behaviors. Journal of Sex Research, 56(2), 166–179. 10.1080/00224499.2018.1480744 [DOI] [PubMed] [Google Scholar]
  12. Brockmeyer, T., Skunde, M., Wu, M., Bresslein, E., Rudofsky, G., Herzog, W., & Friederich, H. C. (2014). Difficulties in emotion regulation across the spectrum of eating disorders. Comprehensive Psychiatry, 55(3), 565–571. 10.1016/j.comppsych.2013.12.001 [DOI] [PubMed] [Google Scholar]
  13. Cappelleri, J. C., Rosen, R. C., Smith, M. D., Mishra, A., & Osterloh, I. H. (1999). Diagnostic evaluation of the erectile function domain of the international index of erectile function. Urology, 54(2), 346–351. 10.1016/s0090-4295(99)00099-0 [DOI] [PubMed] [Google Scholar]
  14. Castellini, G., Maggi, M., & Ricca, V. (2018). Sexual Dysfunction in Eating Disorders. In Jannini E. & Siracusano A. (Eds), Sexual dysfunctions in mentally ill patients. Trends in andrology and sexual medicine. Springer. [Google Scholar]
  15. Cece, V., Guillet-Descas, E., Brenas, M., & Martinent, G. (2021). The role of dispositional emotion regulation strategies on the longitudinal emotional process and subjective performance during a competitive season. European journal of Sport Science, 21(10), 1448–1458. 10.1080/17461391.2020.1862304. [DOI] [PubMed] [Google Scholar]
  16. Charnigo, R., Noar, S. M., Garnett, C., Crosby, R., Palmgreen, P., & Zimmerman, R. S. (2013). Sensation seeking and impulsivity: Combined associations with risky sexual behavior in a large sample of young adults. The Journal of Sex Research, 50(5), 480–488. 10.1080/00224499.2011.652264 [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Chekroud, S. R., Gueorguieva, R., Zheutlin, A. B., Paulus, M., Krumholz, H. M., Krystal, J. H., & Chekroud, A. M. (2018). Association between physical exercise and mental health in 1·2 million individuals in the USA between 2011 and 2015: A cross-sectional study. The Lancet–Psychiatry, 5(9), 739–746. 10.1016/S2215-0366(18)30227-X [DOI] [PubMed] [Google Scholar]
  18. Ciocca, G., Limoncin, E., Di Tommaso, S., Mollaioli, D., Gravina, G. L., Marcozzi, A., Tullii, A., Carosa, E., Di Sante, S., Gianfrilli, D., Lenzi, A., & Jannini, E. A. (2015). Attachment styles and sexual dysfunctions: A case-control study of female and male sexuality. International journal of Impotence Research, 27(3), 81–85. 10.1038/ijir.2014.33. [DOI] [PubMed] [Google Scholar]
  19. Cludius, B., Mennin, D., & Ehring, T. (2020). Emotion regulation as a transdiagnostic process. Emotion, 20(1), 37–42. 10.1037/emo0000646 [DOI] [PubMed] [Google Scholar]
  20. Coffey, K. A., Hartman, M., & Fredrickson, B. L. (2010). Deconstructing mindfulness and constructing mental health: Understanding mindfulness and its mechanisms of action. Mindfulness, 1(4), 235–253. 10.1007/s12671-010-0033-2. [DOI] [Google Scholar]
  21. Cohen, J. (1988). Statistical power analysis for the behavioral sciences. Routledge Academic. [Google Scholar]
  22. Cohn, A. M., Jakupcak, M., Seibert, L. A., Hildebrandt, T. B., & Zeichner, A. (2010). The role of emotion dysregulation in the association between men’s restrictive emotionality and use of physical aggression. Psychology of Men & Masculinity, 11(1), 53–64. 10.1037/a0018090. [DOI] [Google Scholar]
  23. Coleman, E., Corona-Vargas, E., & Ford, J. V. (2021). Advancing sexual pleasure as a fundamental human right and essential for sexual health, overall health and well-being: An introduction to the special issue on sexual pleasure. International Journal of Sexual Health, 33(4), 473–477. 10.1080/19317611.2021.2015507. [DOI] [Google Scholar]
  24. Cooper, D., Yap, K., & Batalha, L. (2018). Mindfulness-based interventions and their effects on emotional clarity: A systematic review and meta-analysis. Journal of Affective Disorders, 235, 265–276. 10.1016/j.jad.2018.04.018 [DOI] [PubMed] [Google Scholar]
  25. Cuntim, M., & Nobre, P. (2011). The role of cognitive distraction on female orgasm. Sexologies, 20(4), 212–214. 10.1016/j.sexol.2011.08.001 [DOI] [Google Scholar]
  26. Derogatis, L. R., Meyer, J. K., & King, K. M. (1981). Psychopathology in individuals with sexual dysfunction. The American Journal of Psychiatry, 138(6), 757–763. 10.1176/ajp.138.6.757 [DOI] [PubMed] [Google Scholar]
  27. Dettori, J. R., Koepsell, T. D., Cummings, P., & Corman, J. M. (2004). Erectile dysfunction after a long-distance cycling event: Associations with bicycle characteristics. The Journal of Urology, 172(2), 637–641. 10.1097/01.ju.0000130749.37731.9f. [DOI] [PubMed] [Google Scholar]
  28. Doorley, J. D., & Kashdan, T. B. (2021). Positive and negative emotion regulation in college athletes: A preliminary exploration of daily savoring, acceptance, and cognitive reappraisal. Cognitive Therapy and Research, 45(4), 598–613. 10.1007/s10608-020-10202-4 [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Dove, N. L., & Wiederman, M. W. (2000). Cognitive distraction and women’s sexual functioning. Journal of Sex & Marital Therapy, 26(1), 67–78. 10.1080/009262300278650. [DOI] [PubMed] [Google Scholar]
  30. Dunkley, C. R., Svatko, Y., & Brotto, L. A. (2020). Eating disorders and sexual function reviewed: A Trans-diagnostic, dimensional perspective. Current Sexual Health Reports, 12(1), 1–14. 10.1007/s11930-020-00236-w. [DOI] [Google Scholar]
  31. Dvorak, R. D., Sargent, E. M., Kilwein, T. M., Stevenson, B. L., Kuvaas, N. J., & Williams, T. J. (2014). Alcohol use and alcohol-related consequences: Associations with emotion regulation difficulties. The American Journal of Drug and Alcohol Abuse, 40(2), 125–130. 10.3109/00952990.2013.877920 [DOI] [PubMed] [Google Scholar]
  32. Egan, K. P. (2019). Supporting mental health and well-being among student-athletes. Clinics in Sports Medicine, 38(4), 537–544. 10.1016/j.csm.2019.05.003. [DOI] [PubMed] [Google Scholar]
  33. Faustino, B. (2021). Transdiagnostic perspective on psychological inflexibility and emotional dysregulation. Behavioural and Cognitive Psychotherapy, 49(2), 233–246. 10.1017/S1352465820000600 [DOI] [PubMed] [Google Scholar]
  34. Fernandez, K. C., Jazaieri, H., & Gross, J. J. (2016). Emotion regulation: A transdiagnostic perspective on a new RDoC domain. Cognitive therapy and Research, 40(3), 426–440. 10.1007/s10608-016-9772-2. [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Ford, J. A. (2007). Alcohol use among college students: A comparison of athletes and nonathletes. Substance use & Misuse, 42(9), 1367–1377. 10.1080/10826080701212402. [DOI] [PubMed] [Google Scholar]
  36. Foskett, R. L., & Longstaff, F. (2018). The mental health of elite athletes in the United Kingdom. Journal of Science and Medicine in Sport, 21(8), 765–770. 10.1016/j.jsams.2017.11.016 [DOI] [PubMed] [Google Scholar]
  37. Gan, Z. S., Ehlers, M. E., Lin, F., Wright, S. T., Figler, B. D., & Coward, R. M. (2021). Systematic review and meta-analysis of cycling and erectile dysfunction. Sexual medicine Reviews, 9(2), 304–311. 10.1016/j.sxmr.2020.01.002. [DOI] [PubMed] [Google Scholar]
  38. George, W. H., & Gilmore, A. K. (2013). Alcohol’s effects on sexual arousal and sexual functioning. In Miller P. M. (Ed.), Principles of addiction: Comprehensive addictive behaviors and disorders (pp. 339–347). Elsevier Inc. [Google Scholar]
  39. George, W. H. (2019). Alcohol and sexual health behavior: “What we know and how we know it.” The Journal of Sex Research, 56(4–5), 409–424. 10.1080/00224499.2019.1588213. [DOI] [PubMed] [Google Scholar]
  40. Giagio, S., Salvioli, S., Pillastrini, P., & Innocenti, T. (2021). Sport and pelvic floor dysfunction in male and female athletes: A scoping review. Neurourology and Urodynamics, 40(1), 55–64. 10.1002/nau.24564. [DOI] [PubMed] [Google Scholar]
  41. Gianotten, W. L., Alley, J. C., & Diamond, L. M. (2021). The health benefits of sexual expression. International Journal of Sexual Health, 33(4), 478–493. 10.1080/19317611.2021.1966564 [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in Emotion Regulation Scale. Journal of Psychopathology and Behavioral Assessment, 26(1), 41–54. 10.1023/B:JOBA.0000007455.08539.94. [DOI] [Google Scholar]
  43. Gross, J. J. (2002). Emotion regulation: affective, cognitive, and social consequences. Psychophysiology, 39(3), 281–291. 10.1017/S0048577201393198 [DOI] [PubMed] [Google Scholar]
  44. Hildebrand, K. M., Johnson, D. J., & Bogle, K. (2001). Comparison of patterns of alcohol use between high school and college athletes and non-athletes. College Student Journal, 35(3), 358–365. [Google Scholar]
  45. Jaderek, I., & Lew-Starowicz, M. (2019). A systematic review on mindfulness meditation–based interventions for sexual dysfunctions. The Journal of Sexual Medicine, 16(10), 1581–1596. 10.1016/j.jsxm.2019.07.019 [DOI] [PubMed] [Google Scholar]
  46. Jones, M. V. (2012). Emotion regulation and performance. In Murphy S. M. (Ed.), The Oxford handbook of sport and performance psychology (pp. 154–172). Oxford University Press. [Google Scholar]
  47. Kaplan, H. S. (1988). Anxiety and sexual dysfunction. The Journal of Clinical Psychiatry, 49, 21–25. [PubMed] [Google Scholar]
  48. Kaufman, E. A., Xia, M., Fosco, G., Yaptangco, M., Skidmore, C. R., & Crowell, S. E. (2016). The Difficulties in Emotion Regulation Scale Short Form (DERS-SF): Validation and replication in adolescent and adult samples. Journal of Psychopathology and Behavioral Assessment, 38(3), 443–455. 10.1007/s10862-015-9529-3. [DOI] [Google Scholar]
  49. Lane, A. M., Beedie, C. J., Jones, M. V., Uphill, M., & Devonport, T. J. (2012). The BASES expert statement on emotion regulation in sport. Journal of Sports Sciences, 30(11), 1189–1195. 10.1080/02640414.2012.69362.1. [DOI] [PubMed] [Google Scholar]
  50. Laurent, S. M., & Simons, A. D. (2009). Sexual dysfunction in depression and anxiety: Conceptualizing sexual dysfunction as part of an internalizing dimension. Clinical psychology Review, 29(7), 573–585. 10.1016/j.cpr.2009.06.007 [DOI] [PubMed] [Google Scholar]
  51. Mallorquí-Bagué, N., Vintró-Alcaraz, C., Sánchez, I., Riesco, N., Agüera, Z., Granero, R., Jiménez-Múrcia, S., Menchón, J. M., Treasure, J., & Fernández-Aranda, F. (2018). Emotion regulation as a transdiagnostic feature among eating disorders: Cross-sectional and longitudinal approach. European Eating Disorders Review, 26(1), 53–61. 10.1002/erv.2570 [DOI] [PubMed] [Google Scholar]
  52. Mikkelsen, K., Stojanovska, L., Polenakovic, M., Bosevski, M., & Apostolopoulos, V. (2017). Exercise and mental health. Maturitas, 106, 48–56. 10.1016/j.maturitas.2017.09.003/ [DOI] [PubMed] [Google Scholar]
  53. Moghalu, O., Hotaling, J., & Pastuszak, A. (2020). Psychiatric comorbidities and sexual health. Current Sexual Health Reports, 12(3), 91–100. 10.1007/s11930-020-00264-6. [DOI] [Google Scholar]
  54. Moore, R., Gillanders, D., & Stuart, S. (2022). The impact of group emotion regulation interventions on emotion regulation ability: A systematic review. Journal of Clinical Medicine, 11(9), 2519. 10.3390/jcm11092519. [DOI] [PMC free article] [PubMed] [Google Scholar]
  55. Moreira, H., Ribeiro, M. J., & Canavarro, M. C. (2022). A bifactor analysis of the difficulties in Emotion Regulation Scale - Short Form (DERS-SF) in a sample of adolescents and adults. Current Psychology, 41, 757–782 10.1007/s12144-019-00602-5 [DOI] [Google Scholar]
  56. Neal, D. J., & Fromme, K. (2007). Hook ‘em horns and heavy drinking: Alcohol use and collegiate sports. Addictive behaviors, 32(11), 2681–2693. 10.1016/j.addbeh.2007.06.020. [DOI] [PMC free article] [PubMed] [Google Scholar]
  57. Nobre, P. J. (2010). Psychological determinants of erectile dysfunction: Testing a cognitive-emotional model. The journal of Sexual Medicine, 7(4 Pt 1), 1429–1437. 10.1111/j.1743-6109.2009.01656.x [DOI] [PubMed] [Google Scholar]
  58. Pascoal, P. M., Raposo, C. F., & Roberto, M. S. (2020). A transdiagnostic approach to sexual distress and sexual pleasure: A preliminary mediation study with repetitive negative thinking. International Journal of Environmental Research and Public Health, 17(21), 7864. 10.3390/ijerph17217864 [DOI] [PMC free article] [PubMed] [Google Scholar]
  59. Pascoal, P. M., Rosa, P. J., Silva, E. P., & Nobre, P. J. (2018). Sexual beliefs and sexual functioning: The mediating role of cognitive distraction. International Journal of Sexual Health, 30(1), 60–71. 10.1080/19317611.2018.1424064. [DOI] [Google Scholar]
  60. Pechorro, P., Diniz, A., Almeida, S., & Vieira, R. (2009). Validação portuguesa do índice de Funcionamento Sexual Feminino (FSFI) [Portuguese validation of the Female Sexual Functioning Index (FSFI)]. Laboratório de Psicologia, 7, 33–44. [Google Scholar]
  61. Peixoto, M. M., & Ribeiro, V. (2022). Repetitive negative thinking and sexual functioning in Portuguese men and women: A cross-sectional study. International Journal of Sexual Health, 34(4), 567–576. 10.1080/19317611.2022.2084201 [DOI] [PMC free article] [PubMed] [Google Scholar]
  62. Pisani, G. K., de Oliveira Sato, T., & Carvalho, C. (2020). Pelvic floor dysfunctions and associated factors in female CrossFit practitioners: A cross-sectional study. International Urogynecology Journal, 32, 2975–2984. 10.1007/s00192-020-04581-1 [DOI] [PubMed] [Google Scholar]
  63. Quinta-Gomes, A. L., & Nobre, P. (2012). The International Index of Erectile Function (IIEF-15): Psychometric properties of the Portuguese version. The Journal of Sexual Medicine, 9(1), 180–187. 10.1111/j.1743-6109.2011.02467.x. [DOI] [PubMed] [Google Scholar]
  64. Quinta-Gomes, A. L., & Nobre, P. (2011). Personality traits and psychopathology on male sexual dysfunction: An empirical study. The Journal of Sexual Medicine, 8(2), 461–469. 10.1111/j.1743-6109.2010.02092.x. [DOI] [PubMed] [Google Scholar]
  65. Reardon, C. L., Hainline, B., Aron, C. M., Baron, D., Baum, A. L., Bindra, A., Budgett, R., Campriani, N., Castaldelli-Maia, J. M., Currie, A., Derevensky, J. L., Glick, I. D., Gorczynski, P., Gouttebarge, V., Grandner, M. A., Han, D. H., McDuff, D., Mountjoy, M., Polat, A., … Engebretsen, L. (2019). Mental health in elite athletes: International Olympic Committee consensus statement (2019). British journal of Sports Medicine, 53(11), 667–699. 10.1136/bjsports-2019-100715 [DOI] [PubMed] [Google Scholar]
  66. Rellini, A. H., Vujanovic, A. A., & Zvolensky, M. J. (2010). Emotional dysregulation: Concurrent relation to sexual problems among trauma-exposed adult cigarette smokers. Journal of Sex & Marital Therapy, 36(2), 137–153. 10.1080/00926230903554545. [DOI] [PMC free article] [PubMed] [Google Scholar]
  67. Rice, S. M., Purcell, R., De Silva, S., Mawren, D., McGorry, P. D., & Parker, A. G. (2016). The mental health of elite athletes. A narrative systematic review. Sports Medicine, 46(9), 1333–1353. 10.1007/s40279-016-0492-2. [DOI] [PMC free article] [PubMed] [Google Scholar]
  68. Roemer, L., Williston, S. K., & Rollins, L. G. (2015). Mindfulness and emotion regulation. Current Opinion in Psychology, 3, 52–57. 10.1016/j.copsyc.2015.02.006 [DOI] [Google Scholar]
  69. Rosen, R. C., Riley, A., Wagner, G., Osterloh, I. H., Kirkpatrick, J., & Mishra, A. (1997). The international index of erectile function (IIEF): A multidimensional scale for assessment of erectile dysfunction. Urology, 49(6), 822–830. 10.1016/s0090-4295(97)00238-0 [DOI] [PubMed] [Google Scholar]
  70. Rosen, R., Brown, C., Heiman, J., Leiblum, S., Meston, C., Shabsigh, R., Ferguson, D., & D'Agostino, R. (2000). The Female Sexual Function Index (FSFI): A multidimensional self-report instrument for the assessment of female sexual function. Journal of Sex & Marital Therapy, 26(2), 191–208. 10.1080/009262300278597 [DOI] [PubMed] [Google Scholar]
  71. Sloan, E., Hall, K., Moulding, R., Bryce, S., Mildred, H., & Staiger, P. K. (2017). Emotion regulation as a transdiagnostic treatment construct across anxiety, depression, substance, eating and borderline personality disorders: A systematic review. Clinical psychology Review, 57, 141–163. 10.1016/j.cpr.2017.09.002 [DOI] [PubMed] [Google Scholar]
  72. Sønderlund, A. L., O'Brien, K., Kremer, P., Rowland, B., De Groot, F., Staiger, P., Zinkiewicz, L., & Miller, P. G. (2014). The association between sports participation, alcohol use and aggression and violence: A systematic review. Journal of Science and Medicine in Sport, 17(1), 2–7. 10.1016/j.jsams.2013.03.01. [DOI] [PubMed] [Google Scholar]
  73. Sörman, K., Garke, M. Å., Isacsson, N. H., Jangard, S., Bjureberg, J., Hellner, C., Sinha, R., & Jayaram-Lindström, N. (2022). Measures of emotion regulation: Convergence and psychometric properties of the difficulties in emotion regulation scale and emotion regulation questionnaire. Journal of Clinical Psychology, 78(2), 201–217. 10.1002/jclp.23206 [DOI] [PubMed] [Google Scholar]
  74. Stephenson, K. R. (2017). Mindfulness-based therapies for sexual dysfunction: A review of potential theory-based mechanisms of change. Mindfulness, 8(3), 527–543. 10.1007/s12671-016-0652-3 [DOI] [Google Scholar]
  75. Stroud, C. B., Hershenberg, R., Cardenas, S., Greiter, E., & Richmond, M. (2016). US college students’ sexual activity: The unique and interactive effects of emotion regulation difficulties and attachment style. International Journal of Sexual Health, 28(1), 37–49. 10.1080/19317611.2015.1073824 [DOI] [Google Scholar]
  76. Tavares, I. M., Moura, C. V., & Nobre, P. J. (2020). The role of cognitive processing factors in sexual function and dysfunction in women and men: A systematic review. Sexual Medicine Reviews, 8(3), 403–430. 10.1016/j.sxmr.2020.03.002. [DOI] [PubMed] [Google Scholar]
  77. Ten Have, M., de Graaf, R., & Monshouwer, K. (2011). Physical exercise in adults and mental health status findings from the Netherlands mental health survey and incidence study (NEMESIS). Journal of Psychosomatic Research, 71(5), 342–348. 10.1016/j.jpsychores.2011.04.001 [DOI] [PubMed] [Google Scholar]
  78. Tsur, N., Berkovitz, N., & Ginzburg, K. (2016). Body awareness, emotional clarity, and authentic behavior: The moderating role of mindfulness. Journal of Happiness Studies, 17(4), 1451–1472. 10.1007/s10902-015-9652-6 [DOI] [Google Scholar]
  79. Wagstaff, C. R. D. (2014). Emotion regulation and sport performance. Journal of Sport & Exercise Psychology, 36(4), 401–412. 10.1123/jsep.2013-0257 [DOI] [PubMed] [Google Scholar]
  80. Wiegel, M., Meston, C., & Rosen, R. (2005). The female sexual function index (FSFI): cross-validation and development of clinical cut-off scores. Journal of Sex & Marital Therapy, 31(1), 1–20. 10.1080/00926230590475206 [DOI] [PubMed] [Google Scholar]
  81. Wolgast, M., & Lundh, L. G. (2017). Is distraction an adaptive or maladaptive strategy for emotion regulation? A person-oriented approach. Journal of Psychopathology and Behavioral Assessment, 39(1), 117–127. 10.1007/s10862-016-9570-x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  82. World Health Organization. (2010). Measuring sexual health: Conceptual and practical considerations and related indicators. World Health Organization. https://apps.who.int/iris/handle/10665/70434 [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

The datasets generated during and/or analyzed during the current study are not publicly available due to further data analysis in the scope of the ongoing project. Datasets may be made available in the future from the corresponding author on reasonable request.

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