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Lakhsassi L, Borg C, de Jong PJ. The Influence of Subjective Sexual Arousal and Disgust on Pain. JOURNAL OF SEX RESEARCH 2024; 61:671-681. [PMID: 37651743 DOI: 10.1080/00224499.2023.2252422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Current models propose that inhibited sexual arousal is a key component in maintaining sexual pain in women with Genito-Pelvic Pain/Penetration Disorder. It thus follows that enhancing sexual arousal may be an effective strategy to modulate pain, but this effect has not been successfully demonstrated with women, although it has been successful with men. This study built on previous works and examined if the pain-killing effect of sexual arousal might have been undermined by concurrently-elicited disgust. We tested whether women experience disgust as well as sexual arousal when viewing sex stimuli, and whether disgust has an exacerbating effect on pain. Female participants (N = 164) were randomly distributed to watch a porn, disgust, or neutral train-ride film. A cold pressor test (CPT) was utilized to induce pain at the same time that participants viewed their respective film. Pain was indexed by the duration that participants kept their hand in the cold water, and by self-reported pain intensity at the time they quit the CPT. The results showed no differences in pain across conditions. The sex stimulus elicited substantial disgust as well as sexual arousal, and there was a negative correlation between the two emotions. Disgust was not found to increase pain compared to both the neutral and sex conditions. Thus, the findings provide no support for a pain-modulatory effect of subjective sexual arousal on pain in women. This might, however, be due to the sex stimulus having elicited an ambivalent state between an appetitive and aversive emotion concurrently.
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Affiliation(s)
- Lara Lakhsassi
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen
| | - Charmaine Borg
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen
| | - Peter J de Jong
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen
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Alarcon-Rodriguez R, Fernández-Sola C, García-Alvarez R, Fadul-Calderón R, Ruiz-Ortiz A, Requena-Mullor M, Garcia-Gonzalez J. Experiences of Dyspareunia in Dominican Women with a History of Sexual Abuse: A Phenomenological Study. J Midwifery Womens Health 2023; 68:637-644. [PMID: 37288822 DOI: 10.1111/jmwh.13520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/29/2023] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Dyspareunia refers to painful sexual intercourse that negatively affects a person's psychological well-being and quality of life and can also have an impact on their partner, family, and social circle. The objective of this study was to understand the experiences of women with dyspareunia and a history of sexual abuse in the Dominican Republic. METHODS This was a qualitative study based on Merleau-Ponty's hermeneutic phenomenology. Fifteen women with a diagnosis of dyspareunia and a history of sexual abuse participated. The study was carried out in Santo Domingo, Dominican Republic. RESULTS In-depth interviews were conducted for data collection. Through inductive analysis using ATLAS.ti, 3 main themes were developed that represent women's experiences of dyspareunia and sexual abuse: (1) a history of sexual abuse as a background to dyspareunia, (2) living in fear in a society that revictimizes the survivor, and (3) the sexual consequences of dyspareunia. DISCUSSION In some Dominican women, dyspareunia stems from their history of sexual abuse, which was unknown to their families and partners. The participants experienced dyspareunia in silence and found it difficult to seek help from health care professionals. In addition, their sexual health was marked by fear and physical pain. There are individual, cultural, and social factors that influence the occurrence of dyspareunia; a better understanding of these factors is vital for planning innovative preventive strategies that reduce the progression of sexual dysfunction and its impact on the quality of life of people with dyspareunia.
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Affiliation(s)
- Raquel Alarcon-Rodriguez
- Department of Nursing, Physiotherapy and Medicine, Faculty of Health Sciences, University of Almería, Almería, Spain
| | - Cayetano Fernández-Sola
- Department of Nursing, Physiotherapy and Medicine, Faculty of Health Sciences, University of Almería, Almería, Spain
| | - Rafael García-Alvarez
- Faculty of Health Sciences, Human Sexuality Institute, Autonomous University of Santo Domingo, Santo Domingo, Dominican Republic
| | - Rosario Fadul-Calderón
- Faculty of Health Sciences, Human Sexuality Institute, Autonomous University of Santo Domingo, Santo Domingo, Dominican Republic
| | - Antonio Ruiz-Ortiz
- Faculty of Health Sciences, Human Sexuality Institute, Autonomous University of Santo Domingo, Santo Domingo, Dominican Republic
| | - Mar Requena-Mullor
- Department of Nursing, Physiotherapy and Medicine, Faculty of Health Sciences, University of Almería, Almería, Spain
| | - Jessica Garcia-Gonzalez
- Department of Nursing, Physiotherapy and Medicine, Faculty of Health Sciences, University of Almería, Almería, Spain
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Schippers EE, Smid WJ, Both S, Smit JH. Excitation Transfer Between Sexual Arousal and Other Emotions in a Community Sample. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:3905-3918. [PMID: 35471677 DOI: 10.1007/s10508-021-02235-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 11/12/2021] [Accepted: 11/12/2021] [Indexed: 06/14/2023]
Abstract
Excitation transfer, the transfer of arousal from one emotion to another, might be a mechanism in the development of unusual sexual interests. In this pilot study, we investigated whether we could induce excitation transfer between various emotions and sexual arousal in a laboratory setting with 30 male volunteers. We induced low-level sexual arousal in four different emotional states (aggression/dominance, endearment, fear, disgust) and a neutral state. Sexual arousal was measured using penile plethysmography and self-report. Although there was no mean group effect, possibly due to large interindividual variations, 60% of the subjects showed more sexual arousal in response to sexual stimulation in at least one of the emotional states than in the neutral state. Excitation transfer was most prominent with aggression/dominance and least prominent with disgust. Genital excitation transfer was strongly related to lower penile reactivity and to higher self-reported erotophilia. This pilot study paves the way for further research into excitation transfer as a mechanism to increase the salience of stimuli that otherwise would not have been sexual in nature.
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Affiliation(s)
- Eveline E Schippers
- Forensic Care Specialists, Oudlaan 9, 3515 GA, Utrecht, The Netherlands.
- Faculty of Psychology and Neuroscience, Section Forensic Psychology, Maastricht University, Maastricht, The Netherlands.
| | - Wineke J Smid
- Forensic Care Specialists, Oudlaan 9, 3515 GA, Utrecht, The Netherlands
| | - Stephanie Both
- Department of Psychosomatic Gynaecology and Sexology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Johannes H Smit
- Department of Research and Innovation, GGZ INGEEST Specialized Mental Health Care, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam University Medical Centers, Amsterdam Public Health, Free University Amsterdam, Amsterdam, The Netherlands
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Kelly KJ, Fisher BL, Rosen NO, Hamilton LD. Anxiety and Anticipated Pain Levels of Women With Self-Reported Penetration-Related Genito-Pelvic Pain are Elevated in Response to Pain-related Images. J Sex Med 2022; 19:1281-1289. [DOI: 10.1016/j.jsxm.2022.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 04/20/2022] [Accepted: 04/28/2022] [Indexed: 12/01/2022]
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de Pierrepont C, Brassard A, Bécotte K, Lessard I, Polomeno V, Péloquin K. Sexual activity based fears during pregnancy, sexual function and dyadic adjustment in couples who are expecting their first child. J Psychosom Obstet Gynaecol 2022; 43:107-113. [PMID: 35341456 DOI: 10.1080/0167482x.2022.2052844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Purpose: Sexual activity based fears during pregnancy are common, but very few studies have examined their association with relationship variables. Secondary analysis of associations between these fears during pregnancy and both partners' sexual function and dyadic adjustment were conducted.Materials and Methods: A sample of 67 French-Canadian first-time parenting couples living in Ontario completed online questionnaires on sexual activity based fears, sexual function, and dyadic adjustment as experienced during pregnancy.Results: While one-third of participants reported no fears, other couples experienced one to six fears, the two most common fears among partners being inducing labor and causing a miscarriage. Dyadic path analyses supported indirect associations between sexual activity based fears and lower dyadic adjustment via poorer sexual function. During pregnancy, these fears in women and men are associated with poorer dyadic adjustment in both partners through the women's poorer sexual function.Conclusion: These findings suggest including prenatal sexual activity based fears in perinatal sexuality counseling, education, and interventions.
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Affiliation(s)
- Catherine de Pierrepont
- Department of Population Health, University of Ottawa, Ontario, Canada.,Departement of Psychology, Université de Sherbrooke, Québec, Canada
| | - Audrey Brassard
- Departement of Psychology, Université de Sherbrooke, Québec, Canada
| | | | - Isabelle Lessard
- Departement of Psychology, Université de Sherbrooke, Québec, Canada
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Mooney KM, Poirier É, Pukall CF. Persistent Genital Arousal in Relationships: A Comparison of Relationship, Sexual, and Psychological Well-Being. J Sex Med 2022; 19:234-248. [PMID: 34903472 DOI: 10.1016/j.jsxm.2021.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/04/2021] [Accepted: 10/15/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Persistent Genital Arousal Disorder/Genitopelvic Dysesthesia (PGAD/GPD) is characterized by sensations of physiological genital sexual arousal (and/or other types of genitopelvic dysesthesia) that occur in the absence of subjective feelings of sexual desire. AIMS The aim of this study was to compare relationship, sexual, and psychological well-being in partnered individuals with and without distressing symptoms of PGAD/GPD. METHODS The sample (N = 65 individuals with vulvas and vaginas, N = 11 individuals with penises) of 152 partnered individuals (N = 76 with and 76 without PGAD/GPD symptoms) participated in a one-time anonymous online survey. OUTCOMES The questionnaires assessed relationship satisfaction (Couple Satisfaction Index-Short Form, CSI); sexual satisfaction (Global Measure of Sexual Satisfaction, GMSEX); sexual functioning (Female Sexual Functioning Index, FSFI, or International Index of Erectile Functioning, IIEF); sexual distress (Sexual Distress Scale, SDS); and psychological well-being, as determined by the presence of depression and/or anxiety symptoms (Hospital Anxiety and Depression Scale, HADS). RESULTS Among individuals with vulvas and vaginas, those with PGAD/GPD symptoms reported significantly lower relationship and sexual satisfaction, greater sexual distress, and more symptoms of depression and anxiety than their counterparts in the control group. In addition, these individuals with PGAD/GPD symptoms also reported significantly worse sexual functioning (arousal, orgasm, satisfaction, and pain), and they were significantly more distressed about each aspect of their sexual functioning difficulties compared to those in the control group. Among the small sample of individuals with penises (N = 11), descriptive analyses revealed that total sexual functioning scores did not differ across the PGAD/GPD symptom and control groups. In addition, 64.5% of the total sample with PGAD/GPD symptoms managed unwanted genital arousal by avoiding sex with their partner, while 55.3% managed their symptoms by having sex with their partner, and some individuals with PGAD/GPD used both strategies. CLINICAL IMPLICATIONS The finding that PGAD/GPD symptoms impact relationships indicates that treatment for PGAD/GPD should include consideration of the well-being of one's intimate relationship(s). STRENGTHS & LIMITATIONS This study added to the small literature on experiences of PGAD/GPD in relationships, and it was the first to assess sexual satisfaction. Limitations include the small sample of individuals with penises, and the cross-sectional, correlational design, which does not allow for causal conclusions to be drawn. CONCLUSION Results emphasize the importance of continued research of this population (and their partners) in order to improve diagnosis, intervention, and recognition within the medical community. Mooney KM, Poirier É, Pukall CF., Persistent Genital Arousal in Relationships: A Comparison of Relationship, Sexual, and Psychological Well-Being. J Sex Med 2022;19:234-248.
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Affiliation(s)
- Kayla M Mooney
- Department of Psychology, Queen's University, Kingston, ON, Canada
| | - Évéline Poirier
- Department of Psychology, Queen's University, Kingston, ON, Canada
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Koops TU, Briken P. "A Woman Should Still Be a Woman" - A Grounded Theory of the Origins of Sexual Pain and Difficulties with Intercourse. JOURNAL OF SEX & MARITAL THERAPY 2021; 47:707-720. [PMID: 34176446 DOI: 10.1080/0092623x.2021.1942348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The origin of women's sexual pain and difficulties with intercourse is still under-researched. The aim of this study was to examine women's constructions of origins. Twenty-eight participants previously diagnosed with vaginismus or dyspareunia were recruited via patient lists and private practices. Interviews had a semi-structured biographic-narrative format; transcripts were analyzed using Grounded Theory. Participants' narratives were constructed based on two major processes: Negotiating Womanhood and Othering the Body. They were integrated in an explanatory model. Identified processes permeated women's subjective experience and construction of the origin of their sexual difficulties, and were related to societal discourses and women's embodied experience.
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Affiliation(s)
- Thula U Koops
- Institute for Sex Research, Sexual Medicine, and Forensic Psychiatry, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Peer Briken
- Institute for Sex Research, Sexual Medicine, and Forensic Psychiatry, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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Mauser‐Bunschoten EP, Kadir RA, Laan ETM, Elfvinge P, Haverman L, Teela L, Degenaar MEL, Fransen van de Putte DE, D'Oiron R, van Galen KPM. Managing women-specific bleeding in inherited bleeding disorders: A multidisciplinary approach. Haemophilia 2021; 27:463-469. [PMID: 33314402 PMCID: PMC8246991 DOI: 10.1111/hae.14221] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/27/2020] [Accepted: 11/13/2020] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Multidisciplinary management of women-specific bleeding is important to preserve quality of life, healthy reproduction and social participation of women and girls with bleeding disorders (WBD). AIM To support appropriate multidisciplinary care for WBD in haemophilia treatment centres. METHODS Two case examples are presented and management issues discussed from different health care perspectives, including the nurse, patient, psychologist, gynaecologist, geneticist, psychosexual therapist and haematologist. RESULTS Woman with bleeding disorders may experience heavy menstruation from menarche onwards. This has a physical and psychosocial impact requiring a multidisciplinary approach. If a woman with an inherited bleeding disorder desires to become pregnant, preconception counselling is essential, to discuss genetic diagnosis, state of the art treatment options for the bleeding disorder in question and possible choices to prevent having an affected child, as well as maternal bleeding risks during conception, delivery and the post-partum period. CONCLUSION Adequate management and good education of WBD requires a patient-centred multidisciplinary approach with experienced specialists in a haemophilia treatment centre.
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Affiliation(s)
| | - Rezan A. Kadir
- Katharine Dormandy Haemophilia and Thrombosis UnitDepartment of Obstetrics and GynaecologyRoyal Free Foundation Hospital and Insitiute for Women's HealthUniversity College LondonLondonUK
| | - Ellen T. M. Laan
- Department of Sexology and Psychosomatic GynaecologyAmsterdam University Medical CenterAmsterdamThe Netherlands
| | - Petra Elfvinge
- Department of HaematologyKarolinska UniversityStockholmSweden
| | - Lotte Haverman
- Department of PsychologyEmma Children's HospitalAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Lorynn Teela
- Department of PsychologyEmma Children's HospitalAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | | | | | - Roseline D'Oiron
- APHP Paris SaclayHôpital BicêtreINSERM U 1176Le Kremlin BicêtreFrance
| | - Karin P. M. van Galen
- Van CreveldkliniekUniversity Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
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Zhang B, Wang C, Shen C, Wang W. Responses to External Emotions or their Transitions at Central to Peripheral Nervous System Levels: A Methodological Contribution to Mental Health. CURRENT PSYCHIATRY RESEARCH AND REVIEWS 2020. [DOI: 10.2174/2666082216666200317143114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Responses to external emotional-stimuli or their transitions might help to
elucidate the scientific background and assist the clinical management of psychiatric problems, but
pure emotional-materials and their utilization at different levels of neurophysiological processing
are few.
Objective:
We aimed to describe the responses at central and peripheral levels in healthy volunteers
and psychiatric patients when facing external emotions and their transitions.
Methods:
Using pictures and sounds with pure emotions of Disgust, Erotica, Fear, Happiness, Neutral,
and Sadness or their transitions as stimuli, we have developed a series of non-invasive techniques,
i.e., the event-related potentials, functional magnetic resonance imaging, excitatory and
inhibitory brainstem reflexes, and polygraph, to assess different levels of neurophysiological responses
in different populations.
Results:
Sample outcomes on various conditions were specific and distinguishable at cortical to
peripheral levels in bipolar I and II disorder patients compared to healthy volunteers.
Conclusions:
Methodologically, designs with these pure emotions and their transitions are applicable,
and results per se are specifically interpretable in patients with emotion-related problems.
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Affiliation(s)
- Bingren Zhang
- Department of Clinical Psychology and Psychiatry/School of Public Health, Zhejiang University College of Medicine, Hangzhou, China
| | - Chu Wang
- Department of Clinical Psychology and Psychiatry/School of Public Health, Zhejiang University College of Medicine, Hangzhou, China
| | - Chanchan Shen
- Department of Clinical Psychology and Psychiatry/School of Public Health, Zhejiang University College of Medicine, Hangzhou, China
| | - Wei Wang
- Department of Clinical Psychology and Psychiatry/School of Public Health, Zhejiang University College of Medicine, Hangzhou, China
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Pastoor H, Both S, Timman R, Laan ETM, Laven JSE. Sexual Function in Women With Polycystic Ovary Syndrome: Design of an Observational Prospective Multicenter Case Control Study. Sex Med 2020; 8:718-729. [PMID: 32798148 PMCID: PMC7691880 DOI: 10.1016/j.esxm.2020.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/26/2020] [Accepted: 07/03/2020] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION The prevalence of polycystic ovary syndrome (PCOS) is 10-15% in women of reproductive age. Its characteristics are (i) clinical or biochemical hyperandrogenism, (ii) oligomenorrhea or amenorrhea, and (iii) polycystic ovaries on ultrasound. PCOS is associated with lower quality of life, depression, anxiety, diabetes, and cardiovascular disease. Treatment commonly entails oral contraceptive use to lower endogenous androgen levels. Androgen levels and comorbidities may affect sexual function. Previous studies have addressed a limited range of possible contributing factors. We will assess sexual function as well as genital and self-reported sexual arousal in a laboratory setting in women with PCOS compared to an age-matched healthy control group. Modulation by biopsychosocial factors mentioned will be studied. METHODS This is a multicenter prospective case control study. The study population includes healthy women with and without PCOS, aged 18-40 years, in a stable heterosexual relationship for at least 6 months. Power is calculated at 67 participants in each group. Anticipating a drop out of 10%, 150 participants will be recruited. MAIN OUTCOME MEASURES The main outcomes measured are sexual function using the Female Sexual Function Index, Sexual Desire Inventory, and Female Sexual Distress Scale-Revised; genital sexual arousal measured as vaginal pulse amplitude; and self-reported sexual arousal in response to erotic stimuli in a laboratory setting. The mediators that will be investigated include testosterone, free androgen levels, oral contraceptive use, sensitivity to androgens (using CAG repeat length), body mass index, body image, mental health, and self-esteem. CONCLUSION Strengths of this study are the inclusion of a broad range of biopsychosocial outcome measures including DNA analysis, a healthy control group, and standardized assessment of genital and self-reported sexual arousal in a laboratory setting. With the design of this study we aim to provide an insight into which biopsychosocial factors associated with PCOS are related to sexual function, and how sexual function may be affected by treatment. These new insights may help to improve clinical management of PCOS while improving the quality of life. Pastoor H, Both S, Timman R, et al. Sexual Function in Women With Polycystic Ovary Syndrome: Design of an Observational Prospective Multicenter Case Control Study. Sex Med 2020;8:718-729.
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Affiliation(s)
- Hester Pastoor
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - Stephanie Both
- Department of Psychosomatic Gynecology and Sexology, Leiden University Medical Center, Leiden, the Netherlands
| | - Reinier Timman
- Department of Psychiatry, Section of Medical Psychology and Psychotherapy, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Ellen T M Laan
- Department of Sexology and Psychosomatic OBGYN, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Joop S E Laven
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam, the Netherlands
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Comparison of primipara women's pre-pregnancy, pregnancy, and postpartum sexual lives. JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.765082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Weijenborg PTM, Kluivers KB, Dessens AB, Kate-Booij MJ, Both S. Sexual functioning, sexual esteem, genital self-image and psychological and relational functioning in women with Mayer-Rokitansky-Küster-Hauser syndrome: a case-control study. Hum Reprod 2020; 34:1661-1673. [PMID: 31418785 DOI: 10.1093/humrep/dez130] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 06/19/2019] [Indexed: 01/08/2023] Open
Abstract
STUDY QUESTION Do sexual functioning, sexual esteem, genital self-image and psychological and relational functioning in women with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome differ from a comparison group of women without the condition? SUMMARY ANSWER In comparison to controls, women with MRKH with a non-surgically or surgically created neovagina did not differ in psychological and relational functioning but reported lower sexual esteem and more negative genital self-image, intercourse-related pain, clinically relevant sexual distress and sexual dysfunction, with sexual esteem levels strongly associated with sexual distress and sexual dysfunction. WHAT IS KNOWN ALREADY Studies on sexual functioning measured with standardized questionnaires in women with MRKH syndrome compared with women without the condition have yielded contradictory results. Factors associated with sexual functioning in this patient population have rarely been investigated. STUDY DESIGN, SIZE, DURATION Between November 2015 and May 2017, 54 women with MRKH syndrome with a neovagina and 79 age-matched healthy women without the condition were enrolled in this case-control study. PARTICIPANTS/MATERIALS, SETTING, METHODS All participants had to be at least 18-years old and had to live in a steady heterosexual relationship. Women with MRKH syndrome were asked to participate by their (former) gynecologists at three university hospitals and by MRKH peer support group. Controls were recruited via advertisement in local newspapers and social media. Standardized questionnaires were administered to assess sexual functioning, sexual esteem, genital self-image and psychological and relational functioning. MAIN RESULTS AND THE ROLE OF CHANCE Women with MRKH syndrome with a surgically or non-surgically created neovagina reported significantly more pain during intercourse (P < 0.05, d = 0.5), but did not differ in overall sexual functioning from control women. More women with MRKH syndrome reported clinically relevant sexuality-related distress (P < 0.05, odds ratio (OR): 2.756, 95% CI 1.219-6.232) and suffered a sexual dysfunction (P < 0.05, OR: 2.654, 95% CI: 1.088-6.471) in comparison with controls. MRKH women scored significantly lower on the sexual esteem scale (SES) (P < 0.01, d = 0.5) and the female genital self-image scale (FGSIS) (P < 0.01, d = 0.6) than controls. No significant differences were found between the two groups regarding psychological distress, anxiety and depression, global self-esteem and relational dissatisfaction. Sexual esteem was significantly associated with the presence of clinically relevant sexual distress (ß = 0.455, P = 0.001) and suffering a sexual dysfunction (ß = 0.554, P = 0.001) and explained, respectively, 40% and 28% of the variance. LIMITATIONS, REASONS FOR CAUTION Given the nature of the study focusing on sexual functioning, a potential selection bias cannot be excluded. It is possible that those women with the most severe sexual and/or psychological disturbances did or did not choose to participate in our study. WIDER IMPLICATIONS OF THE FINDINGS The study results add new data to the very limited knowledge about psychosexual functioning of women with MRKH syndrome and are of importance for more adequate counseling and treatment of these women. STUDY FUNDING/COMPETING INTEREST(S) The research was financially supported by the Dutch Scientific Society of Sexology (Nederlandse wetenschappelijke Vereniging Voor Seksuologie). The funding was unrestricted, and there was no involvement in the conduct of the research. There are no conflicts of interest to declare.
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Affiliation(s)
- P T M Weijenborg
- Outpatient Clinic Psychosomatic Gynaecology and Sexology, Department of Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands
| | - K B Kluivers
- Department of Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - A B Dessens
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - M J Kate-Booij
- Department of Gynaecology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - S Both
- Outpatient Clinic Psychosomatic Gynaecology and Sexology, Department of Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands
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Hinzmann J, Borg C, de Jong PJ. Implicit Measures in Clinical Sex Research: A Critical Evaluation. Sex Med Rev 2020; 8:531-541. [PMID: 32768359 DOI: 10.1016/j.sxmr.2020.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 06/11/2020] [Accepted: 06/14/2020] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Current information-processing models of sexual arousal imply that both controlled and automatic affective-motivational processes are critically involved in sexual responding and suggest that dysfunctional automatic processes may be involved in the development and persistence of sexual dysfunctions. Because (dysfunctional) automatic processes and responses cannot be adequately captured by common self-report measures, implicit performance-based measures have been developed to index these processes. OBJECTIVES This review provides an overview of studies that used implicit tasks in clinical sexual research, and critically evaluates the contribution and promise of these measures to improve our understanding of the mechanisms involved in sexual dysfunctions. METHODS 6 electronic main databases (AMED, MEDLINE, PsycArticles, Psychology & Behavioral Sciences Collection, PsycINFO, and SocINDEX) were searched for studies involving implicit measurement techniques to measure automatic processes in clinical sex research. RESULTS A series of studies examined if lowered (or heightened) attention for sex stimuli may be involved in low sexual arousal, low desire, and genital pain. Preliminary evidence showed that lowered attention is involved in low sexual arousal. The pattern with regard to desire and genital pain was mixed which may be due to heterogeneity in assessment instruments. A limited number of studies examined automatic memory associations with sexual cues. Preliminary evidence showed negative (sex-threat/sex-disgust) associations in women with genito-pelvic pain or penetration disorder, less positive associations in women with hypoactive sexual desire disorder, and sex-positive and sex-failure associations in men with sexual distress. Thus far, no studies have examined lowered (or heightened) automatic sexual approach tendencies related to sexual dysfunctions. CONCLUSION Implicit measures showed some promise as tools to index automatic sex-relevant cognitive mechanisms in sexual dysfunctions. Yet, more systematic research and the development of psychometrically sound measures are critical for a more comprehensive evaluation of the relevance of implicit measures in clinical sex research and their usefulness as indices of individual differences in clinical practice. Hinzmann J, Borg C, de Jong PJ. Implicit Measures in Clinical Sex Research: A Critical Evaluation. Sex Med Rev 2020;8:531-541.
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Affiliation(s)
- Jessica Hinzmann
- Department of Psychology, Friedrich-Alexander University, Erlangen-Nuremberg, Germany.
| | - Charmaine Borg
- Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, Netherlands
| | - Peter J de Jong
- Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, Netherlands
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Padoa A, McLean L, Morin M, Vandyken C. "The Overactive Pelvic Floor (OPF) and Sexual Dysfunction" Part 1: Pathophysiology of OPF and Its Impact on the Sexual Response. Sex Med Rev 2020; 9:64-75. [PMID: 32238325 DOI: 10.1016/j.sxmr.2020.02.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 11/30/2019] [Accepted: 02/02/2020] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Overactive pelvic floor (OPF) muscles are defined as muscles that do not relax, or may even contract, when relaxation is needed, for example, during micturition or defecation. Conditions associated with OPF are multifactorial and include multiple possible etiologies and symptom complexes. The complex interplay between biological and psychosocial elements can lead to the persistence of OPF symptoms along with psychological and emotional distress. OBJECTIVES (1) To review and contextualize, from a pathophysiologic perspective, the evidence for OPF, (2) to provide an overview of common clinical presentations and comorbidities of OPF, and (3) to discuss the effect of OPF on sexual function in men and women. METHODS Review of the updated literature on the pathophysiology of OPF was carried out. OPF-associated conditions were overviewed, with special emphasis on the impact on sexual function in men and women. RESULTS Individuals with suspected OPF often present with a combination of gastrointestinal, gynecological, musculoskeletal, sexual, and urological comorbidities, mostly accompanied by psychoemotional distress. In both women and men, sexual function is significantly impaired by OPF and genitopelvic pain penetration disorders are often the primary manifestation of this condition. Women with OPF report less sexual desire, arousal, and satisfaction; more difficulty reaching orgasm; lower frequencies of intercourse; more negative attitudes toward sexuality; and more sexual distress than women without sexual pain. The most frequently reported sexual dysfunctions in men with OPF include erectile dysfunction, premature ejaculation, and ejaculatory pain. CONCLUSION The complex pathophysiology of OPF involving multisystemic comorbidities and psychosocial factors emphasize the importance of a biopsychosocial assessment for guiding effective and personalized management. Padoa A, McLean L, Morin M, et al. "The Overactive Pelvic Floor (OPF) and Sexual Dysfunction" Part 1: Pathophysiology of OPF and Its Impact on the Sexual Response. Sex Med 2021;9:64-75.
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Affiliation(s)
- Anna Padoa
- Department of Obstetrics and Gynecology, Yitzhak Shamir (formerly Assaf Harofe) Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Linda McLean
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Melanie Morin
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke and Research Center of the Centre hospitalier de l'Université de Sherbrooke (CHUS), Sherbrooke, QC, Canada
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You S, Liu S, Dong X, Li H, Zhu Y, Hu L. Intravaginal Administration of Human Type III Collagen-Derived Biomaterial with High Cell-Adhesion Activity to Treat Vaginal Atrophy in Rats. ACS Biomater Sci Eng 2020; 6:1977-1988. [PMID: 33455320 DOI: 10.1021/acsbiomaterials.9b01649] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Shuang You
- Department of Obstetrics and Gynecology, Second Affiliated Hospital, Chongqing Medical University, Linjiang Road No. 76, Chongqing 400010, China
| | - Shuaibin Liu
- Department of Obstetrics and Gynecology, Second Affiliated Hospital, Chongqing Medical University, Linjiang Road No. 76, Chongqing 400010, China
| | - Xiaojing Dong
- Department of Obstetrics and Gynecology, Second Affiliated Hospital, Chongqing Medical University, Linjiang Road No. 76, Chongqing 400010, China
| | - Hu Li
- Department of Obstetrics and Gynecology, Second Affiliated Hospital, Chongqing Medical University, Linjiang Road No. 76, Chongqing 400010, China
| | - Yun Zhu
- National Laboratory of Biomacromolecules, Institute of Biophysics, Chinese Academy of Sciences, Beijing 100101, China
| | - Lina Hu
- Department of Obstetrics and Gynecology, Second Affiliated Hospital, Chongqing Medical University, Linjiang Road No. 76, Chongqing 400010, China
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16
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Fiacco S, Walther A, Ehlert U. Steroid secretion in healthy aging. Psychoneuroendocrinology 2019; 105:64-78. [PMID: 30314729 DOI: 10.1016/j.psyneuen.2018.09.035] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 09/25/2018] [Accepted: 09/26/2018] [Indexed: 01/16/2023]
Abstract
Nowadays, people spend a considerable amount of their lives as older adults, but this longer lifespan is often accompanied by an increase in chronic conditions and disease, resulting in reduced quality of life and unprecedented societal and economic burden. Healthy aging is therefore increasingly recognized as a healthcare priority. Physical and mental adaptations to changes over the life course, and the maintenance of well-being, represent pivotal challenges in healthy aging. To capture the complexity of healthy aging, we propose a specific phenotype based on body composition, cognition, mood, and sexual function as indicators of different dimensions of healthy aging. With increasing age, sex hormones as well as glucocorticoids undergo significant alterations, and different patterns emerge for women and men. This review describes age-related patterns of change for women and men, and sheds light on the underlying mechanisms. Furthermore, an overview is provided of the challenges for healthy aging resulting from these age-related steroid alterations. While clinical practice guidelines recommend hormonal treatment only in the case of consistently low hormone levels and symptoms of hormone deficiency, physical exercise and a healthy lifestyle emerge as preventive strategies which can counter age-related hormonal changes and at best prevent chronic conditions.
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Affiliation(s)
- Serena Fiacco
- Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland; URPP Dynamics of Healthy Aging Research Priority Program, University of Zurich, Zurich, Switzerland
| | - Andreas Walther
- Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland; Biopsychology, TU Dresden, Dresden, Germany
| | - Ulrike Ehlert
- Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland; URPP Dynamics of Healthy Aging Research Priority Program, University of Zurich, Zurich, Switzerland.
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Simon SC, Greitemeyer T. The impact of immersion on the perception of pornography: A virtual reality study. COMPUTERS IN HUMAN BEHAVIOR 2019. [DOI: 10.1016/j.chb.2018.12.018] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Tavares IM, Vardasca R, Cera N, Pereira R, Nimbi FM, Lisy D, Janssen E, Nobre PJ. A review of infrared thermography as applied to human sexual psychophysiology. Int J Psychophysiol 2018; 133:28-40. [PMID: 30208297 DOI: 10.1016/j.ijpsycho.2018.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 09/05/2018] [Accepted: 09/07/2018] [Indexed: 11/17/2022]
Abstract
Infrared thermography (IRT) is a non-contact technique that permits mapping and analysis of the temperature of the body's skin surface. This method has been applied to sexual psychophysiology since the 1980s and its use has been expanding ever since, mainly because it provides several advantages over existing genital response measures. This article presents a review of experimental studies employing IRT to investigate human sexual arousal, with the aim of summarizing the available procedures and evidence so far and to identify important caveats in the literature. The studies reviewed support the feasibility and validity of IRT as a real-time physiological measure of sexual arousal but varied substantially regarding methodology and procedures. The results of this review underscore the value and validity of IRT in sexual psychophysiology and point at the critical need for the standardization of IRT protocols to accommodate the specific needs of applying this methodology to sexual physiology.
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Affiliation(s)
- Inês M Tavares
- SexLab, Center of Psychology of the University of Porto, Porto, Portugal.
| | - Ricardo Vardasca
- SexLab, Center of Psychology of the University of Porto, Porto, Portugal; LABIOMEP, INEGI-LAETA, Faculty of Engineering, University of Porto, Portugal; Medical Imaging Research Unit, Faculty of Computing, Engineering and Science, University of South Wales, United Kingdom
| | - Nicoletta Cera
- SexLab, Center of Psychology of the University of Porto, Porto, Portugal
| | - Raquel Pereira
- SexLab, Center of Psychology of the University of Porto, Porto, Portugal
| | - Filippo M Nimbi
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy
| | - Dominika Lisy
- Faculty of Behavioural and Social Sciences, University of Groningen, the Netherlands
| | - Erick Janssen
- Institute for Family and Sexuality Studies, Department of Neurosciences, University of Leuven, Leuven, Belgium; Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, IN, USA
| | - Pedro J Nobre
- SexLab, Center of Psychology of the University of Porto, Porto, Portugal
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Both S, Kluivers K, Ten Kate-Booij M, Weijenborg P. Sexual response in women with Mayer-Rokitansky-Küster-Hauser syndrome with a nonsurgical neovagina. Am J Obstet Gynecol 2018; 219:283.e1-283.e8. [PMID: 30017684 DOI: 10.1016/j.ajog.2018.07.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 06/21/2018] [Accepted: 07/05/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Sexual dysfunction is prevalent in women with Mayer-Rokitansky-Küster-Hauser syndrome after the creation of a neovagina. Insight into the physiologic response of the neovagina during sexual arousal is lacking, although this would help in the understanding of sexual function of these patients. The physiologic sexual response of the vagina can be measured objectively by vaginal photoplethysmography to assess vaginal blood flow. OBJECTIVE Testing whether the physiologic and subjective sexual response in women with Mayer-Rokitansky-Küster-Hauser syndrome with a neovagina differs from the response in women with a natal vagina. STUDY DESIGN Vaginal blood flow (vaginal pulse amplitude) and subjective sexual responses during neutral and erotic film viewing were assessed in premenopausal women with Mayer-Rokitansky-Küster-Hauser syndrome with a nonsurgically created neovagina (n=15) and were compared with responses of an age-matched control group (n=21). RESULTS All women with Mayer-Rokitansky-Küster-Hauser syndrome had created their neovagina themselves by dilation. Women with Mayer-Rokitansky-Küster-Hauser syndrome showed a significantly smaller vaginal pulse amplitude compared with control subjects during neutral film viewing (P=.002). In both groups, vaginal pulse amplitude increased significantly during erotic film viewing, but this increase was significantly smaller in the Mayer-Rokitansky-Küster-Hauser syndrome group (P<.005). Levels of subjective sexual arousal did not significantly differ between the 2 groups (P>.2). CONCLUSION Women with Mayer-Rokitansky-Küster-Hauser syndrome with a nonsurgically created neovagina showed a weaker vaginal blood flow response during visual sexual stimulation and poorer basal blood flow compared with control subjects. The differences in vaginal blood flow may be related to less vascularization and innervation of the neovagina compared with the natal vagina. The weaker vaginal sexual response can play a role in sexual dysfunction; however, despite the weaker vaginal response, women with Mayer-Rokitansky-Küster-Hauser syndrome did not differ in their level of subjective sexual arousal. Future studies may compare vaginal blood flow and subjective sexual response of women with Mayer-Rokitansky-Küster-Hauser syndrome with nonsurgically and surgically created vaginas.
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Affiliation(s)
- Stephanie Both
- Outpatient Clinic of Psychosomatic Gynecology and Sexology, Leiden University Medical Centre Leiden, The Netherlands.
| | - Kirsten Kluivers
- Department of Gynecology, Radboud University Medical Centre Nijmegen, The Netherlands
| | | | - Philomeen Weijenborg
- Department of Gynecology, Leiden University Medical Centre Leiden, The Netherlands
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Zarski AC, Berking M, Ebert DD. Efficacy of Internet-Based Guided Treatment for Genito-Pelvic Pain/Penetration Disorder: Rationale, Treatment Protocol, and Design of a Randomized Controlled Trial. Front Psychiatry 2018; 8:260. [PMID: 29403395 PMCID: PMC5786827 DOI: 10.3389/fpsyt.2017.00260] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 11/14/2017] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Genito-pelvic pain/penetration disorder (GPPPD) not only adversely affects women's sexuality and sexual satisfaction but is also associated with a wide range of psychosocial consequences such as reduced quality of life and well-being, mental health comorbidities, and relationship distress. Evidence for effective treatment options is scarce. AIM This article describes the rationale, treatment protocol, and study design for a randomized controlled trial examining the efficacy of an Internet-based guided intervention for GPPPD. METHOD Two hundred women who meet the criteria for GPPPD and have not been able to experience sexual intercourse for at least the last 6 months will be recruited and randomly assigned either to the intervention group (IG) or a 6-month waitlist control group. Assessments take place at baseline (T1), peritreatment after completion of Session 5 in IG (T2), after completion of Session 8 or 12 weeks after randomization (T3), and after 6 months (T4). Data will be analyzed on an intention-to-treat and a completer basis. MAIN OUTCOME MEASURES The primary outcome will be sexual intercourse involving the insertion of the partner's penis at posttreatment. Secondary outcomes include, e.g., improved non-intercourse penetration, sexual functioning, dyadic stress coping, reduced fear of sexuality and negative penetration-related cognitions. Fear of sexuality, penetration-related cognitions, and exercise intensity will be assessed as mediators of intercourse in the IG. Sexual dysfunctions of partners will be measured at baseline (T1) and investigated as a potential moderator of the primary treatment outcome. DISCUSSION Given the burden associated with GPPPD and the need for specialized treatment, there is a surprising lack of evidence-based treatment options. This study aims to assess whether Internet-based interventions could contribute to closing this treatment gap. CLINICAL TRIAL REGISTRATION German Register of Clinical Studies (DRKS): DRKS00010228.
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Affiliation(s)
- Anna-Carlotta Zarski
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
- Institute of Psychology, Leuphana University Lüneburg, Lüneburg, Germany
| | - Matthias Berking
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - David Daniel Ebert
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
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21
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Pazmany E, Ly HG, Aerts L, Kano M, Bergeron S, Verhaeghe J, Peeters R, Tack J, Dupont P, Enzlin P, Van Oudenhove L. Brain responses to vestibular pain and its anticipation in women with Genito-Pelvic Pain/Penetration Disorder. NEUROIMAGE-CLINICAL 2017; 16:477-490. [PMID: 28932680 PMCID: PMC5596304 DOI: 10.1016/j.nicl.2017.07.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 07/02/2017] [Accepted: 07/22/2017] [Indexed: 01/27/2023]
Abstract
Objective In DSM-5, pain-related fear during anticipation of vaginal penetration is a diagnostic criterion of Genito-Pelvic Pain/Penetration Disorder (GPPPD). We aimed to investigate subjective and brain responses during anticipatory fear and subsequent induction of vestibular pain in women with GPPPD. Methods Women with GPPPD (n = 18) and age-matched healthy controls (HC) (n = 15) underwent fMRI scanning during vestibular pain induction at individually titrated pain threshold after a cued anticipation period. (Pain-related) fear and anxiety traits were measured with questionnaires prior to scanning, and anticipatory fear and pain intensity were rated during scanning using visual analog scales. Results Women with GPPPD reported significantly higher levels of anticipatory fear and pain intensity. During anticipation and pain induction they had stronger and more extensive brain responses in regions involved in cognitive and affective aspects of pain perception, but the group difference did not reach significance for the anticipation condition. Pain-related fear and anxiety traits as well as anticipatory fear ratings were positively associated with pain ratings in GPPPD, but not in HC. Further, in HC, a negative association was found between anticipatory fear ratings and brain responses in regions involved in cognitive and affective aspects of pain perception, but not in women with GPPPD. Conclusions Women with GPPPD are characterized by increased subjective and brain responses to vestibular pain and, to a lesser extent, its anticipation, with fear and anxiety associated with responses to pain, supporting the introduction of anticipatory fear as a criterion of GPPPD in DSM-5. Both subjective and brain responses during anticipation and induction of vestibular pain are increased in women with GPPPD. Between-group differences were found in brain regions involved in cognitive and affective aspects of the pain experience. These results support the addition of pain-related fear and anxiety in the diagnostic criteria of GPPPD in DSM-5.
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Key Words
- Anticipation of pain
- DSM-5, Diagnostic Statistical Manual of Mental Disorders, fifth edition
- FM, fibromyalgia
- FPQ, Fear of Pain Questionnaire
- GPPPD, Genito-Pelvic Pain/Penetration Disorder
- Genito-pelvic pain/penetration disorder
- HC, healthy controls
- IBS, irritable bowel syndrome
- OFC, orbitofrontal cortex
- PASS, Pain Anxiety Symptoms Scale
- PVD, provoked vestibulodynia
- Pain-related fear and anxiety
- Provoked vestibulodynia
- Q1, Quartile 1
- Q3, Quartile 3
- SAS, statistical analysis software
- SD, standard deviation
- SII, secondary somatosensory cortex
- SMA, supplementary motor area
- SPM8, Statistical Parametric Mapping, SPM8
- SPSS, Statistical Package for Social Sciences
- STAI, State-Trait Anxiety Inventory
- TR/TE, repetition time/echo time
- VAS, Visual Analogue Scale
- Vestibular pain
- aMCC, anterior midcingulate cortex
- dlPFC, dorsolateral prefrontal cortex
- fMRI
- fMRI, functional magnetic resonance imaging
- n, number
- pACC, perigenual anterior cingulate cortex
- vlPFC, ventrolateral prefrontal cortex
- vmPFC, ventromedial prefrontal cortex
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Affiliation(s)
- Els Pazmany
- Institute for Family and Sexuality Studies, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Huynh Giao Ly
- Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium
| | - Leen Aerts
- Department of Psychology, Université de Montréal, Montreal, Canada
| | - Michiko Kano
- The Frontier Research Institute for Interdisciplinary Sciences, Tohoku University, Sendai, Japan
| | - Sophie Bergeron
- Department of Psychology, Université de Montréal, Montreal, Canada
| | - Johan Verhaeghe
- Department of Gynaecology, University Hospitals Leuven, Leuven, Belgium
| | - Ronald Peeters
- Medical Diagnostic Sciences, KU Leuven & Radiology University Hospitals Leuven, Leuven, Belgium
| | - Jan Tack
- Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium
| | - Patrick Dupont
- Laboratory for Cognitive Neurology, Department of Neurosciences, KU Leuven & Medical Imaging Centre, University Hospitals Leuven, Leuven, Belgium
| | - Paul Enzlin
- Institute for Family and Sexuality Studies, Department of Neurosciences, KU Leuven, Leuven, Belgium.,Centre for Clinical Sexology and Sex Therapy, University Psychiatric Centre, KU Leuven, Leuven, Belgium
| | - Lukas Van Oudenhove
- Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium
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Levin RJ, Both S, Georgiadis J, Kukkonen T, Park K, Yang CC. The Physiology of Female Sexual Function and the Pathophysiology of Female Sexual Dysfunction (Committee 13A). J Sex Med 2017; 13:733-59. [PMID: 27114190 DOI: 10.1016/j.jsxm.2016.02.172] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 02/22/2016] [Accepted: 02/24/2016] [Indexed: 01/01/2023]
Abstract
INTRODUCTION The article consists of six sections written by separate authors that review female genital anatomy, the physiology of female sexual function, and the pathophysiology of female sexual dysfunction but excluding hormonal aspects. AIM To review the physiology of female sexual function and the pathophysiology of female sexual dysfunction especially since 2010 and to make specific recommendations according to the Oxford Centre for evidence based medicine (2009) "levels of evidence" wherever relevant. CONCLUSION Recommendations were made for particular studies to be undertaken especially in controversial aspects in all six sections of the reviewed topics. Despite numerous laboratory assessments of female sexual function, genital assessments alone appear insufficient to characterise fully the complete sexual response.
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Affiliation(s)
- Roy J Levin
- Reader in Physiology (Retired), Department of Biomedical Science, University of Sheffield, Sheffield, UK: Section 2.
| | - Stephanie Both
- Department of Psychosomatic Gynecology and Sexology, Leiden University Medical Center, Leiden, The Netherlands: Section 3
| | - Janniko Georgiadis
- Department of Neuroscience, University Medical Center, Groningen, University of Groningen, The Netherlands: Section 4
| | - Tuuli Kukkonen
- College of Social and Applied Human Science, University of Guelph, Guelph, ON, Canada: Section 6
| | - Kwangsung Park
- Department of Urology, Chonnan National University Medical School, Gwangju, Korea: Section 5
| | - Claire C Yang
- Department of Urology, University of Washington, Seattle, WA, USA: Section 1
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Is uncertain vulvovaginal candidiasis a marker of vulvodynia? A study in a Dutch general practice research database. BJGP Open 2017; 1:bjgpopen17X100905. [PMID: 30564664 PMCID: PMC6169963 DOI: 10.3399/bjgpopen17x100905] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background A recent Dutch study in general practice showed a clear relationship between the diagnosis of vulvovaginal candidiasis (VVC) and symptoms suggestive of provoked vulvodynia (PVD). PVD accounts for the largest group of vulvar pains, but is often not recognised by GPs. Aim To investigate whether diagnostic uncertainty about VVC in general practice could also point to the diagnosis of PVD, and whether and how this diagnostic uncertainty affects management. Design & setting An observational study in 2014 in Dutch general practices of the NIVEL Primary Care Database. Method Women with an uncertain diagnosis of VVC were distinguished from those with certain VVC based on the occurrence of recurrent episodes and persisting complaints, despite treatment. Factors known to be associated with PVD were hypothesised to be more prevalent in women with uncertain VVC. Data on symptom management by GPs were collected. Results In total 7066 women with VVC or uncertain VVC were included. Uncertain VVC was found to account for 28% of these patients. Compared to VVC, the group uncertain VVC included significantly more women with female genital symptoms, tiredness, irritable bowel syndrome (all P<0.001), feeling anxious, reduced sexual desire, depressive disorder, relationship problems, and micturition symptoms (all P<0.05). Compared to VVC, the group uncertain VVC included significantly higher mean numbers of telephone consultations (P<0.001), more referrals to gynaecology (P = 0.009), and higher mean numbers of prescriptions per patient (P<0.001). Conclusion This study's findings indicate that uncertain VVC could be a marker of PVD. GPs might reconsider their diagnostics and management when women present recurrent and persistent vulvovaginal complaints, especially if accompanied by dyspareunia, functional syndromes, micturition symptoms, and psychological conditions.
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Effects of Aversive Classical Conditioning on Sexual Response in Women With Dyspareunia and Sexually Functional Controls. J Sex Med 2017; 14:687-701. [DOI: 10.1016/j.jsxm.2017.03.244] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 02/14/2017] [Accepted: 03/03/2017] [Indexed: 01/23/2023]
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Attentional Bias for Pain and Sex, and Automatic Appraisals of Sexual Penetration: Differential Patterns in Dyspareunia vs Vaginismus? J Sex Med 2016; 13:1255-62. [DOI: 10.1016/j.jsxm.2016.05.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 04/15/2016] [Accepted: 05/22/2016] [Indexed: 12/29/2022]
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Brauer M, van Lunsen RH, Laan ET, Burger MP. A Qualitative Study on Experiences After Vulvar Surgery in Women With Lichen Sclerosus and Sexual Pain. J Sex Med 2016; 13:1080-90. [DOI: 10.1016/j.jsxm.2016.04.072] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 04/06/2016] [Accepted: 04/23/2016] [Indexed: 10/21/2022]
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Vulvodynia: Definition, Prevalence, Impact, and Pathophysiological Factors. J Sex Med 2016; 13:291-304. [DOI: 10.1016/j.jsxm.2015.12.021] [Citation(s) in RCA: 166] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 12/18/2015] [Accepted: 12/20/2015] [Indexed: 11/18/2022]
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Anderson AB, Rosen NO, Price L, Bergeron S. Associations Between Penetration Cognitions, Genital Pain, and Sexual Well-being in Women With Provoked Vestibulodynia. J Sex Med 2016; 13:444-52. [DOI: 10.1016/j.jsxm.2015.12.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 11/02/2015] [Accepted: 12/05/2015] [Indexed: 11/27/2022]
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Daily Associations Among Male Partner Responses, Pain During Intercourse, and Anxiety in Women With Vulvodynia and Their Partners. THE JOURNAL OF PAIN 2015; 16:1312-1320. [DOI: 10.1016/j.jpain.2015.09.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 08/24/2015] [Accepted: 09/12/2015] [Indexed: 01/30/2023]
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Fleischman DS, Hamilton LD, Fessler DMT, Meston CM. Disgust versus Lust: Exploring the Interactions of Disgust and Fear with Sexual Arousal in Women. PLoS One 2015; 10:e0118151. [PMID: 26106894 PMCID: PMC4479551 DOI: 10.1371/journal.pone.0118151] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 01/05/2015] [Indexed: 11/18/2022] Open
Abstract
Sexual arousal is a motivational state that moves humans toward situations that inherently pose a risk of disease transmission. Disgust is an emotion that adaptively moves humans away from such situations. Incongruent is the fact that sexual activity is elementary to human fitness yet involves strong disgust elicitors. Using an experimental paradigm, we investigated how these two states interact. Women (final N=76) were assigned to one of four conditions: rate disgust stimuli then watch a pornographic clip; watch a pornographic clip then rate disgust stimuli; rate fear stimuli then watch a pornographic clip; or watch a pornographic clip then rate fear stimuli. Women's genital sexual arousal was measured with vaginal photoplethysmography and their disgust and fear reactions were measured via self-report. We did not find that baseline disgust propensity predicted sexual arousal in women who were exposed to neutral stimuli before erotic content. In the Erotic-before-Disgust condition we did not find that sexual arousal straightforwardly predicted decreased image disgust ratings. However, we did find some evidence that sexual arousal increased self-reported disgust in women with high trait disgust and sexual arousal decreased self-reported disgust in women with low trait disgust. Women who were exposed to disgusting images before erotic content showed significantly less sexual arousal than women in the control condition or women exposed to fear-inducing images before erotic content. In the Disgust-before-Erotic condition the degree of self-reported disgust was negatively correlated with genital sexual arousal. Hence, in the conflict between the ultimate goals of reproduction and disease avoidance, cues of the presence of pathogens significantly reduce the motivation to engage in mating behaviors that, by their nature, entail a risk of pathogen transmission.
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Affiliation(s)
- Diana S. Fleischman
- Department of Psychology, University of Portsmouth, Portsmouth, Hampshire, United Kingdom
| | - Lisa Dawn Hamilton
- Department of Psychology, Mt. Allison University, Sackville, New Brunswick, Canada
| | - Daniel M. T. Fessler
- Department of Anthropology and Center for Behavior, Evolution, and Culture, University of California Los Angeles, Los Angeles, California, United States of America
| | - Cindy M. Meston
- Department of Psychology, The University of Texas at Austin, Austin, Texas, United States of America
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Bel LGJ, Vollebregt AM, Van der Meulen-de Jong AE, Fidder HH, Ten Hove WR, Vliet-Vlieland CW, Ter Kuile MM, de Groot HE, Both S. Sexual Dysfunctions in Men and Women with Inflammatory Bowel Disease: The Influence of IBD-Related Clinical Factors and Depression on Sexual Function. J Sex Med 2015; 12:1557-67. [PMID: 26054013 DOI: 10.1111/jsm.12913] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Inflammatory bowel disease (IBD) is likely to have an impact on sexual function because of its symptoms, like diarrhea, fatigue, and abdominal pain. Depression is commonly reported in IBD and is also related to impaired sexual function. This study aimed to evaluate sexual function and its association with depression among patients with IBD compared with controls. METHODS IBD patients registered at two hospitals participated. The control group consisted of a general practitioner practice population. The web-based questionnaire included the Female Sexual Function Index (FSFI) for women and the International Index of Erectile Function (IIEF) for men. Other variables evaluated were depression, disease activity, IBD-related quality of life, body image, and fatigue. RESULTS In total, 168 female and 119 male patients were available for analysis (response rate 24%). Overall, patients with IBD did not significantly differ in prevalence of sexual dysfunctions from controls: female patients 52%, female controls 44%, male patients and male controls both 25%. However, men and women with an active disease scored significantly lower than patients in remission and controls, indicating impaired sexual functioning during disease activity. Significant associations were found between active disease, fatigue, depressive mood, quality of life, and sexual function for both male and female patients. The association between disease activity and sexual function was totally mediated by depression. CONCLUSION Male and female IBD patients with an active disease show impaired sexual function relative to patients in remission and controls. Depression is the most important determinant for impaired sexual function in IBD.
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Affiliation(s)
- Linda G J Bel
- Outpatient Clinic for Psychosomatic Gynaecology and Sexology, Department of Gastroenterology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Anna M Vollebregt
- Outpatient Clinic for Psychosomatic Gynaecology and Sexology, Department of Gastroenterology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Andrea E Van der Meulen-de Jong
- Outpatient Clinic for Psychosomatic Gynaecology and Sexology, Department of Gastroenterology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Herma H Fidder
- Department of Gastroenterology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Willem R Ten Hove
- Department of Gastroenterology, Diaconessenhuis Leiden, Leiden, The Netherlands
| | | | - Moniek M Ter Kuile
- Outpatient Clinic for Psychosomatic Gynaecology and Sexology, Department of Gastroenterology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Helena E de Groot
- Outpatient Clinic for Psychosomatic Gynaecology and Sexology, Department of Gastroenterology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Stephanie Both
- Outpatient Clinic for Psychosomatic Gynaecology and Sexology, Department of Gastroenterology, Leiden University Medical Centre, Leiden, The Netherlands
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A Prospective 2-Year Examination of Cognitive and Behavioral Correlates of Provoked Vestibulodynia Outcomes. Clin J Pain 2015; 31:333-41. [DOI: 10.1097/ajp.0000000000000128] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Brom M, Laan E, Everaerd W, Spinhoven P, Both S. Extinction of Aversive Classically Conditioned Human Sexual Response. J Sex Med 2015; 12:916-35. [DOI: 10.1111/jsm.12800] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Clifton J, Seehuus M, Rellini AH. Testing cognitive predictors of individual differences in the sexual psychophysiological responses of sexually functional women. Psychophysiology 2015; 52:957-68. [DOI: 10.1111/psyp.12423] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 01/26/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Jessica Clifton
- Department of Psychological Science; University of Vermont; Burlington Vermont USA
| | - Martin Seehuus
- Department of Psychological Science; University of Vermont; Burlington Vermont USA
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Brauer M, Lakeman M, van Lunsen R, Laan E. Predictors of Task‐Persistent and Fear‐Avoiding Behaviors in Women with Sexual Pain Disorders. J Sex Med 2014; 11:3051-63. [DOI: 10.1111/jsm.12697] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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36
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Bergeron S, Likes WM, Steben M. Psychosexual aspects of vulvovaginal pain. Best Pract Res Clin Obstet Gynaecol 2014; 28:991-9. [DOI: 10.1016/j.bpobgyn.2014.07.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 07/10/2014] [Indexed: 12/18/2022]
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Melles RJ, ter Kuile MM, Dewitte M, van Lankveld JJ, Brauer M, de Jong PJ. Automatic and Deliberate Affective Associations with Sexual Stimuli in Women with Lifelong Vaginismus Before and After Therapist‐Aided Exposure Treatment. J Sex Med 2014; 11:786-99. [DOI: 10.1111/jsm.12360] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Borg C, Georgiadis JR, Renken RJ, Spoelstra SK, Weijmar Schultz W, de Jong PJ. Brain processing of visual stimuli representing sexual penetration versus core and animal-reminder disgust in women with lifelong vaginismus. PLoS One 2014; 9:e84882. [PMID: 24465445 PMCID: PMC3898929 DOI: 10.1371/journal.pone.0084882] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 11/19/2013] [Indexed: 11/18/2022] Open
Abstract
It has been proposed that disgust evolved to protect humans from contamination. Through eliciting the overwhelming urge to withdraw from the disgusting stimuli, it would facilitate avoidance of contact with pathogens. The physical proximity implied in sexual intercourse provides ample opportunity for contamination and may thus set the stage for eliciting pathogen disgust. Building on this, it has been argued that the involuntary muscle contraction characteristic of vaginismus (i.e., inability to have vaginal penetration) may be elicited by the prospect of penetration by potential contaminants. To further investigate this disgust-based interpretation of vaginismus (in DSM-5 classified as a Genito-Pelvic Pain/Penetration Disorder, GPPPD) we used functional magnetic resonance imaging (fMRI) to examine if women with vaginismus (n = 21) show relatively strong convergence in their brain responses towards sexual penetration- and disgust-related pictures compared to sexually asymptomatic women (n = 21) and women suffering from vulvar pain (dyspareunia/also classified as GPPPD in the DSM-5, n = 21). At the subjective level, both clinical groups rated penetration stimuli as more disgusting than asymptomatic women. However, the brain responses to penetration stimuli did not differ between groups. In addition, there was considerable conjoint brain activity in response to penetration and disgust pictures, which yield for both animal-reminder (e.g., mutilation) and core (e.g., rotten food) disgust domains. However, this overlap in brain activation was similar for all groups. A possible explanation for the lack of vaginismus-specific brain responses lies in the alleged female ambiguity (procreation/pleasure vs. contamination/disgust) toward penetration: generally in women a (default) disgust response tendency may prevail in the absence of sexual readiness. Accordingly, a critical next step would be to examine the processing of penetration stimuli following the induction of sexual arousal.
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Affiliation(s)
- Charmaine Borg
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
| | - Janniko R. Georgiadis
- Department of Neuroscience, section Anatomy, University Medical Centre Groningen (UMCG), Groningen, The Netherlands
| | - Remco J. Renken
- Department of Neuroscience, Neuroimaging Centre (BCN-NiC), University Medical Centre Groningen (UMCG), Groningen, The Netherlands
| | - Symen K. Spoelstra
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | - Willibrord Weijmar Schultz
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | - Peter J. de Jong
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
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Brom M, Both S, Laan E, Everaerd W, Spinhoven P. The role of conditioning, learning and dopamine in sexual behavior: a narrative review of animal and human studies. Neurosci Biobehav Rev 2013; 38:38-59. [PMID: 24211372 DOI: 10.1016/j.neubiorev.2013.10.014] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 10/22/2013] [Accepted: 10/29/2013] [Indexed: 12/24/2022]
Abstract
Many theories of human sexual behavior assume that sexual stimuli obtain arousing properties through associative learning processes. It is widely accepted that classical conditioning contributes to the etiology of both normal and maladaptive human behaviors. Despite the hypothesized importance of basic learning processes in sexual behavior, research on classical conditioning of the sexual response in humans is scarce. In the present paper, animal studies and studies in humans on the role of pavlovian conditioning on sexual responses are reviewed. Animal research shows robust, direct effects of conditioning processes on partner- and place preference. On the contrast, the empirical research with humans in this area is limited and earlier studies within this field are plagued by methodological confounds. Although recent experimental demonstrations of human sexual conditioning are neither numerous nor robust, sexual arousal showed to be conditionable in both men and women. The present paper serves to highlight the major empirical findings and to renew the insight in how stimuli can acquire sexually arousing value. Hereby also related neurobiological processes in reward learning are discussed. Finally, the connections between animal and human research on the conditionability of sexual responses are discussed, and suggestions for future directions in human research are given.
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Affiliation(s)
- Mirte Brom
- Institute of Psychology, Clinical, Health and Neuropsychology Unit, Leiden University, The Netherlands; Department of Psychosomatic Gynaecology and Sexology, Leiden University Medical Center, Leiden, The Netherlands.
| | - Stephanie Both
- Department of Psychosomatic Gynaecology and Sexology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ellen Laan
- Department of Sexology and Psychosomatic Obstetrics and Gynaecology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Walter Everaerd
- Department Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Philip Spinhoven
- Institute of Psychology, Clinical, Health and Neuropsychology Unit, Leiden University, The Netherlands; Department of Psychiatry, Leiden University Medical Center, The Netherlands
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Pain and Psychological Outcomes After Rehabilitative Treatment for a Woman With Chronic Pelvic Pain With Stage III Cervical Cancer: A Case Report. ACTA ACUST UNITED AC 2013; 37:97-102. [PMID: 27134605 DOI: 10.1097/jwh.0000000000000004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Chronic pelvic pain and sexual dysfunction are adverse effects of treatment of cervical cancer. Surgery and radiation therapies may result in soft tissue pain and dysfunction, including spasms and trigger points of the pelvic floor muscles that result in pain. In addition to physical restrictions, negative mood associated with pain is believed to intensify and prolong the pain experience. STUDY DESIGN The purpose of this case report was to describe outcomes of pelvic physical therapy in a 58-year-old woman with chronic pelvic pain after medical treatments for cervical cancer. CASE DESCRIPTION The patient reported dyspareunia, hip pain, and lower abdominal, pelvic pain, and fatigue with activities lasting greater than 30 minutes. Interventions included pelvic floor massage, dilator use, and patient education. Symptoms were assessed at baseline and completion of physical therapy, using the Female Sexual Function Index, Fear of Pain Questionnaire-III, Pain Catastrophizing Scale, and Numerical Pain Rating Scale. OUTCOMES The Female Sexual Function Index score decreased from 7.8 to 2.8, the Fear of Pain Questionnaire- III score decreased from 85 to 73, the Pain Catastrophizing Scale score decreased from 18 to 8, and lower abdominal and pelvic pain decreased from 4 of 10 to 0 of 10, while bilateral hip pain remained at 4 of 10. In addition, she exhibited increased tolerance to mechanical pressure, evidenced by progression in size of a vaginal dilator. DISCUSSION These results suggest that pelvic physical therapy may be useful in treating chronic pelvic pain after cervical cancer treatments and may also help decrease the magnitude of negative mood aspects such as pain-related fear and catastrophizing.
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41
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42
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Cherner RA, Reissing ED. A Psychophysiological Investigation of Sexual Arousal in Women with Lifelong Vaginismus. J Sex Med 2013; 10:1291-303. [DOI: 10.1111/jsm.12102] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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43
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Boyer SC, Pukall CF, Chamberlain SM. Sexual Arousal in Women with Provoked Vestibulodynia: The Application of Laser Doppler Imaging to Sexual Pain. J Sex Med 2013; 10:1052-64. [DOI: 10.1111/j.1743-6109.2012.02855.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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44
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Both S, van Lunsen R, Weijenborg P, Laan E. A New Device for Simultaneous Measurement of Pelvic Floor Muscle Activity and Vaginal Blood Flow: A Test in a Nonclinical Sample. J Sex Med 2012; 9:2888-902. [DOI: 10.1111/j.1743-6109.2012.02910.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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45
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Brauer M, van Leeuwen M, Janssen E, Newhouse SK, Heiman JR, Laan E. Attentional and affective processing of sexual stimuli in women with hypoactive sexual desire disorder. ARCHIVES OF SEXUAL BEHAVIOR 2012; 41:891-905. [PMID: 21892693 DOI: 10.1007/s10508-011-9820-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2010] [Revised: 06/06/2011] [Accepted: 06/06/2011] [Indexed: 05/31/2023]
Abstract
Hypoactive sexual desire disorder (HSDD) is the most common sexual problem in women. From an incentive motivation perspective, HSDD may be the result of a weak association between sexual stimuli and rewarding experiences. As a consequence, these stimuli may either lose or fail to acquire a positive meaning, resulting in a limited number of incentives that have the capacity to elicit a sexual response. According to current information processing models of sexual arousal, sexual stimuli automatically activate meanings and if these are not predominantly positive, processes relevant to the activation of sexual arousal and desire may be interrupted. Premenopausal U.S. and Dutch women with acquired HSDD (n = 42) and a control group of sexually functional women (n = 42) completed a single target Implicit Association Task and a Picture Association Task assessing automatic affective associations with sexual stimuli and a dot detection task measuring attentional capture by sexual stimuli. Results showed that women with acquired HSDD displayed less positive (but not more negative) automatic associations with sexual stimuli than sexually functional women. The same pattern was found for self-reported affective sex-related associations. Participants were slower to detect targets in the dot detection task that replaced sexual images, irrespective of sexual function status. As such, the findings point to the relevance of affective processing of sexual stimuli in women with HSDD, and imply that the treatment of HSDD might benefit from a stronger emphasis on the strengthening of the association between sexual stimuli and positive meaning and sexual reward.
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Affiliation(s)
- Marieke Brauer
- Department of Sexology and Psychosomatic Obstetrics and Gynecology, University of Amsterdam, Amsterdam, The Netherlands.
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46
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Basson R. The recurrent pain and sexual sequelae of provoked vestibulodynia: a perpetuating cycle. J Sex Med 2012; 9:2077-92. [PMID: 22672388 DOI: 10.1111/j.1743-6109.2012.02803.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Optimal management of provoked vestibulodynia (PVD), thought to be the most common form of chronic dyspareunia, is unclear. AIM To integrate recent brain data on chronic pain circuitry with stress-induced neuroendocrine mechanisms in the skin and the stress burden (allostatic load) of women with PVD; to also clarify the typical chronicity and negative sexual sequelae associated with PVD; and then review modulation of pain circuitry by cognitive therapy and mindfulness practice and apply to PVD management. Methods. Review of scientific publications in the areas of sexual medicine, pain, brain imaging, gynecology, stress response, mindfulness, and cognitive behavioral therapy (CBT). MAIN OUTCOME MEASURES (i) A model of PVD to reflect its etiology, typical chronicity, and the detrimental effects on sexual function; (ii) Interventions of sexual rehabilitation based on principles underlying changes associated with CBT and mindfulness practice. RESULTS A model emerges which reflects how stress-induced changes of pain amplification (central sensitization), characteristic of chronic pain conditions, may impair sexual response in addition to sexual dysfunction that arises from conscious pain avoidance and/or fear-related inattention to sexual cues. Stress from low self-acceptance may be a major component of the allostatic load present in women with PVD, only to be exacerbated by the sexual dysfunction precipitated by the pain of intercourse. Mindfulness-based CBT appears promising to target both the pain and sexual suffering from PVD. CONCLUSION New findings on brain activity associated with recurrent clinical pain, functional brain changes associated with CBT and mindfulness, plus new data on stress systems within the skin along with data on increased stress load in women with PVD, support the use of mindfulness-based CBT for the recurrent pain and sexual suffering from PVD.
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Affiliation(s)
- Rosemary Basson
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
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Borg C, Peters ML, Schultz WW, de Jong PJ. Vaginismus: Heightened Harm Avoidance and Pain Catastrophizing Cognitions. J Sex Med 2012; 9:558-67. [DOI: 10.1111/j.1743-6109.2011.02535.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Acele EÖ, Karaçam Z. Sexual problems in women during the first postpartum year and related conditions. J Clin Nurs 2011; 21:929-37. [PMID: 22008061 DOI: 10.1111/j.1365-2702.2011.03882.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study was to evaluate the sexual problems in women during the first postpartum year and related conditions. BACKGROUND In the postpartum period, women encounter numerous physical, psychological and sociocultural factors. These factors negatively affect both the sexual function and the quality of life of woman. DESIGN A descriptive survey. METHODS In this study, 230 women were included. The study was conducted between September 2007 and December 2008 in Izmir, Turkey. A questionnaire form developed by authors, the Arizona Sexual Experience Scale-female version and the Beck depression inventory were applied for participants. RESULTS The women began to have sexual intercourse within 7·06 weeks after delivery. Of the women, 58·3% reported that they had dyspareunia in the postpartum period. According to Arizona Sexual Experience Scale, the total score was ≥ 11 in 91·3% of women and they had sexual problems in the first postpartum year. The results of the multivariate analysis revealed that the increase in age, the presence of sexual problems during pregnancy and the increase in time after delivery significantly increased the possibility of postpartum sexual problems. CONCLUSION This study revealed that the majority of the women had postpartum sexual problems and the possibility of postpartum sexual problems increased with the increase in age, the presence of sexual problems during pregnancy and the increase in time after delivery. RELEVANCE TO CLINICAL PRACTICE Healthcare professionals should evaluate women in terms of their sexual functions during both pregnancy and postpartum period. Health education, counselling, referral services for early diagnosis and treatment might contribute to the protection and improvement of the sexual health of women during the postpartum period.
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Affiliation(s)
- Elif Özge Acele
- Department of Mental Health and Psychiatric, Medical Faculty Hospital, Ege University, Izmir, Turkey.
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Psychological factors in chronic pelvic pain in women: relevance and application of the fear-avoidance model of pain. Phys Ther 2011; 91:1542-50. [PMID: 21835893 PMCID: PMC3185223 DOI: 10.2522/ptj.20100368] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Chronic pelvic pain in women is a debilitating, costly condition often treated by physical therapists. The etiology of this condition is multifactorial and poorly understood, given the complex interplay of muscles, bones, and soft tissue that comprise the pelvis. There are few guidelines directing treatment interventions for this condition. In the last decade, several investigators have highlighted the role of psychological variables in conditions such as vulvodynia and painful bladder syndrome. Pain-related fear is the focus of the fear-avoidance model (FAM) of pain, which theorizes that some people are more likely to develop and maintain pain after an injury because of their emotional and behavioral responses to pain. The FAM groups people into 2 classes on the basis of how they respond to pain: people who have low fear, confront pain, and recover from injury and people who catastrophize pain-a response that leads to avoidance/escape behaviors, disuse, and disability. Given the presence of pain-related cognitions in women with chronic pelvic pain, including hypervigilance, catastrophizing, and anxiety, research directed toward the application of the FAM to guide therapeutic interventions is warranted. Isolated segments of the FAM have been studied to theorize why traditional approaches (ie, medications and surgery) may not lead to successful outcomes. However, the explicit application of the FAM to guide physical therapy interventions for women with chronic pelvic pain is not routine. Integrating the FAM might direct physical therapists' clinical decision making on the basis of the pain-related cognitions and behaviors of patients. The aims of this article are to provide information about the FAM of musculoskeletal pain and to provide evidence for the relevance of the FAM to chronic pelvic pain in women.
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50
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Hamilton LD, Meston CM. The role of salivary cortisol and DHEA-S in response to sexual, humorous, and anxiety-inducing stimuli. Horm Behav 2011; 59:765-71. [PMID: 21195074 PMCID: PMC3085649 DOI: 10.1016/j.yhbeh.2010.12.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2009] [Revised: 12/22/2010] [Accepted: 12/23/2010] [Indexed: 12/21/2022]
Abstract
Stress and anxiety are commonly thought to be detrimental to sexual function. Several studies in both the human and animal literature, however, have found that inducing anxiety can enhance sexual function in women. The mechanisms that explain a negative relationship between physical and psychological stress and sexual functioning are well documented, but little is known about how stress or anxiety might have a facilitatory effect on sexual arousal. As an initial step in exploring the relationship between anxiety and sexual arousal, the present study examined the role of the autonomic nervous system, and the adrenal hormones cortisol and dehydroepiandrosterone-sulfate (DHEA-S) in response to a sexual film, an anxiety-inducing film, and a humorous film. Nineteen premenopausal women (mean age 24.4 years) who were free from sexual difficulties came into the lab on three separate days. At each session they were shown an anxiety-inducing, sexually arousing, or humorous (control) film while their physiological arousal was measured. They also provided saliva samples before and after each film. Cortisol significantly decreased, while DHEA-S increased in the sexual and humorous conditions. Neither hormone changed significantly in the anxiety-inducing condition. Autonomic nervous system activity measured by heart rate and heart rate variability did not change in response to the sexual or anxiety-inducing films, but heart rate variability increased significantly in response to the humorous film. The cortisol/DHEA-S ratio at the post-sexual film time point was significantly negatively correlated with genital arousal (measured by vaginal pulse amplitude). Anxiety-inducing films did not result in a physiological stress response, which can explain why they do not impair sexual function.
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Affiliation(s)
- Lisa Dawn Hamilton
- Psychology Department, Mount Allison University, 49A York Street, Sackville, NB, Canada E4L 3A9
- Department of Psychology, University of Texas at Austin, 1 University Station A8000, Austin, TX, 78712, USA
| | - Cindy M. Meston
- Department of Psychology, University of Texas at Austin, 1 University Station A8000, Austin, TX, 78712, USA
- Corresponding author. Fax: +1 512 471 6175. (C.M. Meston)
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