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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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2
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Merli CEM, Cetera GE, Caia C, Facchin F, Vercellini P. "The sound of silence" Giving voice to endometriosis-related positional dyspareunia. Arch Gynecol Obstet 2024; 309:887-893. [PMID: 37689593 DOI: 10.1007/s00404-023-07205-3] [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] [Received: 05/10/2023] [Accepted: 08/23/2023] [Indexed: 09/11/2023]
Abstract
Deep dyspareunia is one of the main symptoms of endometriosis. It appears to be submerged by a two-way disconnection between patients and their physicians. The aim of our review is to provide clear, ready-to-use advice on how to manage deep dyspareunia overcoming the gap in communication. Sexual history should always be taken as part of routine health care in these regards, using a patient-centered approach. An educational pelvic examination, which actively includes patients in the identification of painful areas, may prove useful to improve patients' understanding of their condition. Correlating painful pelvic areas with sexual positions and inviting patients to adopt alternative positions may represent a simple but extremely effective coping strategy to mitigate pain. Revealing and explaining to partners the nature of the pain is essential to allow them to take part in shared research of coping mechanisms, empowering the couple to make choices and changes. Couples who do not feel comfortable talking about intimacy by themselves may find that including a psychotherapist or a sexual therapist, may be a good way to start communication. Investigating and managing dyspareunia during medical encounters is a medical and ethical duty all healthcare practitioners should pursue.
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Affiliation(s)
- Camilla Erminia Maria Merli
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda, 12, 20122, Milan, Italy.
| | - Giulia Emily Cetera
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda, 12, 20122, Milan, Italy
| | - Carlotta Caia
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda, 12, 20122, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Federica Facchin
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
| | - Paolo Vercellini
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda, 12, 20122, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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3
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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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Ågmo A, Laan E. The Sexual Incentive Motivation Model and Its Clinical Applications. JOURNAL OF SEX RESEARCH 2023; 60:969-988. [PMID: 36378887 DOI: 10.1080/00224499.2022.2134978] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Sexual motivation (desire) requires the simultaneous presence of an active central motive state and a stimulus with sexual significance. Once activated, sexual motivation leads to visceral responses and approach behaviors directed toward the emitter of the sexual stimulus. In humans, such behaviors follow cognitive evaluation of the context, including predictions of the approached individual's response. After successful approach and establishment of physical contact, manifest sexual activities may be initiated. Sexual interaction is associated with and followed by a state of positive affect in most animals, whereas aversive consequences may be experienced by humans. The affective reactions may become associated with stimuli present during sexual interaction, and these stimuli may thereby alter their incentive properties. Here we show how the incentive motivation model can be used to explain the origins and possible treatments of sexual dysfunctions, notably disorders of desire. We propose that associations formed between negative outcomes of sexual interaction and the salient stimuli, for example, the partner, underlies hypoactive desire disorder. Highly positive outcomes of sexual interaction enhance the incentive value of the stimuli present, and eventually lead to hyperactive sexual desire. Treatments aim to alter the impact of sexual incentives, mainly by modifying cognitive processes.
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Affiliation(s)
- Anders Ågmo
- Department of Psychology, University of Tromsø
| | - Ellen Laan
- Department of Sexology and Psychosomatic Gynaecology, Amsterdam UMC, University of Amsterdam
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Janssen E, Bancroft J. The Dual Control Model of Sexual Response: A Scoping Review, 2009-2022. JOURNAL OF SEX RESEARCH 2023; 60:948-968. [PMID: 37267113 DOI: 10.1080/00224499.2023.2219247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The Dual Control Model proposes that sexual arousal and related processes are dependent on the balance between sexual excitation and sexual inhibition, and that individuals vary in their propensity for these processes. This scoping review provides an overview and discussion of the questionnaires used to measure the propensities for sexual excitation and inhibition, their translation and validation in other languages, and their application in empirical research on topics ranging from sexual desire and arousal, sexual (dys)function, sexual risk taking, asexuality, hypersexuality, and sexual aggression. A total of 152 papers, published between 2009 and 2022 and identified using online databases, were included in this review. The findings, consistent with those reviewed by Bancroft et al. (2009), suggest that sexual excitation is particularly relevant to sexual desire and responsivity and predictive of asexuality and hypersexuality. Sexual inhibition plays a role in sexual dysfunction. sexual risk taking, and sexual aggression, although often in interaction with sexual excitation. Suggestions for the further development of the model and for future studies are discussed.
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Affiliation(s)
- Erick Janssen
- Institute for Family and Sexuality Studies, Department of Neurosciences, KU Leuven, Belgium
- The Kinsey Institute, Indiana University, Bloomington, IN, USA
| | - John Bancroft
- Horspath, Oxfordshire, UK
- The Kinsey Institute, Indiana University, Bloomington, IN, USA
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Dewitte M, Meulders A. Fear Learning in Genital Pain: Toward a Biopsychosocial, Ecologically Valid Research and Treatment Model. JOURNAL OF SEX RESEARCH 2023; 60:768-785. [PMID: 36648251 DOI: 10.1080/00224499.2022.2164242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Although fear learning mechanisms are implicated in the development, maintenance, exacerbation, and reduction of genital pain, systematic research on how fear of genital pain emerges, spreads, persists, and reemerges after treatment is lacking. This paper provides an overview of the literature on pain-related fear, integrates the ideas on learning and sexual arousal responding, and specifies the pathways through which compromised learning may contribute to the development and persistence of genital pain. In order to refine theories of genital pain and optimize treatments, we need to adopt a biopsychosocial framework to pain-related fear learning and uncover potential moderators that shape individual trajectories. This involves examining the role of physiological processes, subjective experiences, as well as partner and relational cues in fear acquisition, excessive generalization and impaired safety learning, extinction of fear, counterconditioning, and return of fear. Recent methodological advances in fear conditioning and sex research are promising to enable more symptom-specific and ecologically valid experimental paradigms.
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Affiliation(s)
- Marieke Dewitte
- Department of Clinical Psychological Science, Maastricht University
| | - Ann Meulders
- Department of Clinical Psychological Science, Maastricht University
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Schlitt F, Schmidt K, Merz CJ, Wolf OT, Kleine-Borgmann J, Elsenbruch S, Wiech K, Forkmann K, Bingel U. Impaired pain-related threat and safety learning in patients with chronic back pain. Pain 2022; 163:1560-1570. [PMID: 35135995 PMCID: PMC9341232 DOI: 10.1097/j.pain.0000000000002544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 10/28/2021] [Accepted: 11/16/2021] [Indexed: 11/29/2022]
Abstract
ABSTRACT Pain-related learning mechanisms likely play a key role in the development and maintenance of chronic pain. Previous smaller-scale studies have suggested impaired pain-related learning in patients with chronic pain, but results are mixed, and chronic back pain (CBP) particularly has been poorly studied. In a differential conditioning paradigm with painful heat as unconditioned stimuli, we examined pain-related acquisition and extinction learning in 62 patients with CBP and 61 pain-free healthy male and female volunteers using valence and contingency ratings and skin conductance responses. Valence ratings indicate significantly reduced threat and safety learning in patients with CBP, whereas no significant differences were observed in contingency awareness and physiological responding. Moreover, threat learning in this group was more impaired the longer patients had been in pain. State anxiety was linked to increased safety learning in healthy volunteers but enhanced threat learning in the patient group. Our findings corroborate previous evidence of altered pain-related threat and safety learning in patients with chronic pain. Longitudinal studies exploring pain-related learning in (sub)acute and chronic pain are needed to further unravel the role of aberrant pain-related learning in the development and maintenance of chronic pain.
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Affiliation(s)
- Frederik Schlitt
- Department of Neurology, Center for Translational Neuro- and Behavioral Sciences, University Medicine Essen, Essen, Germany
| | - Katharina Schmidt
- Department of Neurology, Center for Translational Neuro- and Behavioral Sciences, University Medicine Essen, Essen, Germany
| | - Christian J. Merz
- Department of Cognitive Psychology, Institute of Cognitive Neuroscience, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
| | - Oliver T. Wolf
- Department of Cognitive Psychology, Institute of Cognitive Neuroscience, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
| | - Julian Kleine-Borgmann
- Department of Neurology, Center for Translational Neuro- and Behavioral Sciences, University Medicine Essen, Essen, Germany
| | - Sigrid Elsenbruch
- Department of Neurology, Center for Translational Neuro- and Behavioral Sciences, University Medicine Essen, Essen, Germany
- Department of Medical Psychology and Medical Sociology, Ruhr University Bochum, Bochum, Germany
| | - Katja Wiech
- Nuffield Department of Clinical Neurosciences, Wellcome Centre for Integrative Neuroimaging (WIN), University of Oxford, John Radcliffe Hospital, Headley Way, Oxford, United Kingdom
| | - Katarina Forkmann
- Department of Neurology, Center for Translational Neuro- and Behavioral Sciences, University Medicine Essen, Essen, Germany
| | - Ulrike Bingel
- Department of Neurology, Center for Translational Neuro- and Behavioral Sciences, University Medicine Essen, Essen, Germany
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Hu B, Ruan Y, Liu K, Wei X, Wu Y, Feng H, Deng Z, Liu J, Wang T. A Mid-to-Long Term Comprehensive Evaluation of Psychological Distress and Erectile Function in COVID-19 Recovered Patients. J Sex Med 2021; 18:1863-1871. [PMID: 34600862 PMCID: PMC8387224 DOI: 10.1016/j.jsxm.2021.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/12/2021] [Accepted: 08/20/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND The psychological and sexual health of different populations are negatively affected during the coronavirus disease 2019 (COVID-19) pandemic. However, little is known about psychological distress and erectile function of male recovered patients with COVID-19 in the long term. AIM We aimed to evaluate psychological distress and erectile function of male recovered patients with COVID-19 in the mid-to-long terms. METHODS We recruited 67 eligible male recovered patients with COVID-19 and followed them up twice within approximately 6 months of recovery time. The psychological distress and erectile function were assessed by validated Chinese version of paper questionnaires. OUTCOMES The primary outcomes were Symptom Checklist 90 questionnaire for psychological distress and International Index of Erectile Function-5 for erectile function. RESULTS In the first visit, COVID-19 patients with a median recovery time of 80 days mainly presented the following positive symptoms: Obsessive-Compulsive, additional items (ADD), Hostility, Interpersonal Sensitivity, Depression, and Somatization; while the dimension scores in Somatization, Anxiety, ADD, and Phobia were higher than Chinese male norms. Besides, the prevalence of erectile dysfunction (ED) in the first-visit patients was significantly higher than Chinese controls. In the second visit, the primary psychological symptoms of COVID-19 patients with a median recovery time of 174 days were Obsessive-Compulsive, ADD, Interpersonal Sensitivity, and Hostility, while all dimensions scores of Symptom Checklist 90 were lower than Chinese male norms. Moreover, second-visit patients had no significant difference with Chinese controls in ED prevalence. In addition, it suggested that GSI was the independent risk factor for ED in the regression analysis for the first-visit patients. CLINICAL IMPLICATIONS The study showed the changes of psychological symptoms and erectile function in COVID-19 recovered patients, and provided reference on whether psychological and sexual supports are needed after a period of recovery. STRENGTHS AND LIMITATIONS To our knowledge, it is the first study to comprehensively evaluate the psychological distress and erectile function of COVID-19 recovered patients in the mid-to-long terms. The main limitations were the low number of analyzed participants, and the psychological distress and erectile function of healthy Chinese men over the same period were not evaluated, and the psychological and sexual related data of participants prior to COVID-19 were not available. Additionally, there was a selection bias in comparing COVID-19 patients with healthy controls. CONCLUSION With less impact of COVID-19 event, the impaired erectile function and psychological distress improved in COVID-19 recovered patients with a recovery time of nearly half a year. Hu B, Ruan Y, Liu K, et al. A Mid-to-Long Term Comprehensive Evaluation of Psychological Distress and Erectile Function in COVID-19 Recovered Patients. J Sex Med 2021;18:1863-1871.
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Affiliation(s)
- Bintao Hu
- Department of Urology, Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yajun Ruan
- Department of Urology, Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Kang Liu
- Department of Urology, Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xian Wei
- Department of Urology, Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yue Wu
- Department of Urology, Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Huan Feng
- Department of Urology, Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zhiyao Deng
- Department of Urology, Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jihong Liu
- Department of Urology, Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Tao Wang
- Department of Urology, Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
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Tetik S, Yalçınkaya Alkar Ö. Vaginismus, Dyspareunia and Abuse History: A Systematic Review and Meta-analysis. J Sex Med 2021; 18:1555-1570. [PMID: 37057445 DOI: 10.1016/j.jsxm.2021.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 06/29/2021] [Accepted: 07/09/2021] [Indexed: 01/23/2023]
Abstract
BACKGROUND Genito-pelvic pain/penetration disorder, which consists of a combination of vaginismus and dyspareunia, is considered a new diagnosis in the latest version of the Diagnostic and Statistical Manual of Mental Disorders. Although the etiology of this diagnosis is not well known, a history of abuse has been suggested to be a primary factor in the emergence of this disorder. AIM This systematic review and meta-analysis aimed to determine the association of abuse history with vaginismus and dyspareunia diagnosis. METHODS Related keywords were used to search articles in PubMed, PsycArticles, PsycINFO, Scopus, Web of Science, and the Turkish scientific information database (TRDizin). All articles published in English and Turkish until August 2020 were systematically reviewed. A total of 14 case-control studies, including 1428 participants, were included in the final analysis. The fixed-effects model was used to pool odd ratios (ORs) and 95% confidence intervals (CIs) of the studies. Heterogeneity was evaluated using the I2 statistic. OUTCOMES Case-control studies that reported vaginismus or dyspareunia outcomes in individuals with or without a history of abuse. RESULTS A significant relationship was found between a history of sexual (1.55 OR; 95% CI, 1.14-2.10; 12 studies) and emotional abuse (1.89 OR; 95% CI, 1.24-2.88; 3 studies) and the diagnosis of vaginismus. A significant relationship was found between sexual abuse and dyspareunia (1.53 OR; 95% CI, 1.03-2.27; 6 studies). No statistically significant relationship was observed between physical abuse, vaginismus, and dyspareunia. No significant difference was found between sexual or physical abuse in terms of assessment methods for the diagnosis of vaginismus and dyspareunia. CLINICAL IMPLICATIONS This systematic review and meta-analysis points out that in the assessment of vaginismus patients, the risk of sexual and emotional abuse and in the assessment for dyspareunia patients, the risk of sexual abuse should be questioned and addressed in its treatment. STRENGHT AND LIMITATIONS The strength of the current meta-analysis is the inclusion of all forms of abuse, and studies published in Turkish and English with a broad and reproducible search strategy. The limitations of this meta-analysis are the exclusion of sources and design other than journal articles and case-control studies, including studies both childhood and adult abuse, which in some studies were not differentiated, having potential language and recall bias. CONCLUSION The study analysis suggests an association of vaginismus with sexual and emotional abuse and dyspareunia with sexual abuse. However, both disorders showed no association with physical abuse. S. Tetik, ÖY. Alkar, Vaginismus, Dyspareunia, and Abuse History: A Systematic Review and Meta-analysis. J Sex Med 2021;18:1555-1570.
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Affiliation(s)
- Sinan Tetik
- Etlik Zubeyde Hanim Gynecology Training and Research Hospital, Ankara, Turkey.
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Icenhour A, Petrakova L, Hazzan N, Theysohn N, Merz CJ, Elsenbruch S. When gut feelings teach the brain to fear pain: Context-dependent activation of the central fear network in a novel interoceptive conditioning paradigm. Neuroimage 2021; 238:118229. [PMID: 34082119 DOI: 10.1016/j.neuroimage.2021.118229] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 04/16/2021] [Accepted: 05/31/2021] [Indexed: 11/18/2022] Open
Abstract
The relevance of contextual factors in shaping neural mechanisms underlying visceral pain-related fear learning remains elusive. However, benign interoceptive sensations, which shape patients' clinical reality, may context-dependently become conditioned predictors of impending visceral pain. In a novel context-dependent interoceptive conditioning paradigm, we elucidated the putative role of the central fear network in the acquisition and extinction of pain-related fear induced by interoceptive cues and pain-predictive contexts. In this fMRI study involving rectal distensions as a clinically-relevant model of visceroception, N = 27 healthy men and women underwent differential conditioning. During acquisition training, visceral sensations of low intensity as conditioned stimuli (CS) predicted visceral pain as unconditioned stimulus (US) in one context (Con+), or safety from pain in another context (Con-). During extinction training, interoceptive CS remained unpaired in both contexts, which were operationalized as images of different rooms presented in the MRI scanner. Successful contextual conditioning was supported by increased negative valence of Con+ compared to Con- after acquisition training, which resolved after extinction training. Although interoceptive CS were perceived as comparatively pleasant, they induced significantly greater neural activation of the amygdala, ventromedial PFC, and hippocampus when presented in Con+, while contexts alone did not elicit differential responses. During extinction training, a shift from CS to context differentiation was observed, with enhanced responses in the amygdala, ventromedial, and ventrolateral PFC to Con+ relative to Con-, whereas no CS-induced differential activation emerged. Context-dependent interoceptive conditioning can turn benign interoceptive cues into predictors of visceral pain that recruit key regions of the fear network. This first evidence expands knowledge about learning and memory mechanisms underlying interoceptive hypervigilance and maladaptive avoidance behavior, with implications for disorders of the gut-brain axis.
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Affiliation(s)
- Adriane Icenhour
- Department of Neurology, University Hospital Essen, Hufelandstr. 55, Essen 45147, Germany.
| | - Liubov Petrakova
- Department of Medical Psychology and Medical Sociology, Ruhr University Bochum, Universitaetsstr. 150, Bochum 44801 Germany
| | - Nelly Hazzan
- Department of Neurology, University Hospital Essen, Hufelandstr. 55, Essen 45147, Germany
| | - Nina Theysohn
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, Essen 45147, Germany
| | - Christian J Merz
- Institute of Cognitive Neuroscience, Department of Cognitive Psychology, Ruhr University Bochum, Universitaetsstr. 150, Bochum 44801, Germany
| | - Sigrid Elsenbruch
- Department of Neurology, University Hospital Essen, Hufelandstr. 55, Essen 45147, Germany; Department of Medical Psychology and Medical Sociology, Ruhr University Bochum, Universitaetsstr. 150, Bochum 44801 Germany
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11
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Feng YJ, Fan YJ, Su ZZ, Li BB, Li B, Liu N, Wang PX. Correlation of Sexual Behavior Change, Family Function, and Male-Female Intimacy Among Adults Aged 18-44 Years During COVID-19 Epidemic. Sex Med 2021; 9:100301. [PMID: 33429243 PMCID: PMC7930884 DOI: 10.1016/j.esxm.2020.100301] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 11/24/2020] [Accepted: 11/27/2020] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Coronavirus disease (COVID-19) has been declared a global pandemic. In this unprecedented situation, the intimate relationship, sexual behavior, and family functions of partners have also undergone unique changes. There are few reports on whether sexual behavior and family function affect intimate relationships between partners, especially among people aged 18 to 44 years. AIM To analyze the influence of sociodemographic characteristics, family function, and changes in sexual behavior on male-female intimacy, the independent contributions of the aforementioned factors in this population group are required to be further investigated. METHODS In the present study, 284 Chinese citizens aged 18-44 years completed the online questionnaire. The univariate analysis and cluster multiple linear regression were used to analyze the associations between sociodemographic factors, sexual-behavior changes, family function, and male-female intimacy. MAIN OUTCOME MEASURE Family adaptation, partnership, growth, affection, resolve (APGAR) Scale and Relationship Assessment Scale were used to evaluate participants' family function and their intimacy. Details of the participants (sociodemographic and sexual factors) were obtained. RESULTS The summary scores, with Relationship Assessment Scale and APGAR scales, were 27.19 ± 4.49 and 6.76 ± 2.28, respectively. About 43.3% of participants reported a decrease in sexual frequency. There were considerable differences among age, education level, sexual desire, sexual satisfaction, quality of sexual life, family function with male-female intimacy (P < .05). The sexual satisfaction and intimacy demonstrated a significant positive correlation (P < .05) by cluster multiple linear regression analysis. Compared with those who had a sexual life of mediocre quality, respondents who experienced a good quality sexual life had relatively higher scores in intimacy. The independent contributions of sociodemographic factors, sexual behavior factors, and family function in male-female intimacy were 13.0%, 38.2%, and 48.8%, respectively. CONCLUSIONS Sexual behavior factors and family function were important independent determinants of partner intimacy among people aged 18-44 years. It can provide supportive information for health care to develop intervention plans and services to promote the harmonious development of intimate relationship. Feng Y-J, Fan Y-J, Su Z-Z, et al. Correlation of Sexual Behavior Change, Family Function, and Male-Female Intimacy Among Adults Aged 18-44 Years During COVID-19 Epidemic. Sex Med 2021;9:100301.
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Affiliation(s)
- Yi-Jin Feng
- Institute of Chronic Disease Risks Assessment, School of Nursing and Health, Henan University, Kaifeng, China
| | - Yu-Jun Fan
- Institute of Chronic Disease Risks Assessment, School of Nursing and Health, Henan University, Kaifeng, China
| | - Zhen-Zhen Su
- Institute of Chronic Disease Risks Assessment, School of Nursing and Health, Henan University, Kaifeng, China
| | - Bing-Bing Li
- Institute of Chronic Disease Risks Assessment, School of Nursing and Health, Henan University, Kaifeng, China
| | - Bo Li
- Institute of Chronic Disease Risks Assessment, School of Nursing and Health, Henan University, Kaifeng, China
| | - Nan Liu
- Institute of Chronic Disease Risks Assessment, School of Nursing and Health, Henan University, Kaifeng, China
| | - Pei-Xi Wang
- Institute of Chronic Disease Risks Assessment, School of Nursing and Health, Henan University, Kaifeng, China; General Practice Center, Nanhai Hospital, Southern Medical University, Foshan, China.
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12
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Schiavi MC, Spina V, Zullo MA, Colagiovanni V, Luffarelli P, Rago R, Palazzetti P. Love in the Time of COVID-19: Sexual Function and Quality of Life Analysis During the Social Distancing Measures in a Group of Italian Reproductive-Age Women. J Sex Med 2020; 17:1407-1413. [PMID: 32653391 PMCID: PMC7342024 DOI: 10.1016/j.jsxm.2020.06.006] [Citation(s) in RCA: 108] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 06/08/2020] [Accepted: 06/10/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND The beginning of 2020 was characterized by the COVID-19 pandemic. The world governments have adopted restrictive measures to reduce the spread of infection. These measures could affect the sexual function and quality of life of women living with their partner. AIM The aim is to assess the impact of the social distancing measures caused by the COVID-19 pandemic on sexual function and quality of life of noninfected reproductive-age women, living with their sexual partner. METHODS Observational analysis on sexually active women, living with their partner, and without COVID-19 infection was performed. The population previously answered FSFI, FSDS, and SF-36 questionnaires. 4 weeks after the introduction of the restrictive measures, these women were invited to complete the same questionnaires by e-mail for an evaluation during the COVID-19 outbreak. MAIN OUTCOME MEASURES The primary endpoint was the assessment of the women's sex function change during the social restriction period, by analyzing the FSFI and FSDS questionnaires. The secondary endpoint was the evaluation of the impact on the quality of life calculated by the SF-36 questionnaire. RESULTS 89 patients were considered. The median age was 39 (28-50) years. Mean sexual intercourses/month decreased from 6.3 ± 1.9 to 2.3 ± 1.8, mean difference: -3.9 ± 1.2. FSFI decreased significantly (29.2 ± 4.2 vs 19.2 ± 3.3, mean difference: -9.7 ± 2.6) and FSDS increased significantly (9.3 ± 5.5 vs 20.1 ± 5.2, mean difference: 10.8 ± 3.4). The SF-36 showed a significant change from 82.2 ± 10.2 to 64.2 ± 11.8 4 weeks after the introduction of the restrictive measures; mean difference: -17.8 ± 6.7. The univariable analysis identified working outside the home, university educational level, and parity ≥1 as predictive factors of lower FSFI. In multivariable analysis, working outside the home and combination of working outside the home + university educational level + parity ≥1 were the independent factors of a lower FSFI. CLINICAL IMPLICATION The negative impact of the COVID-19 epidemic period on sexual function and quality of life in women shows how acute stress might affect the psychological state. Thus, psychological or sexual support could be useful. STRENGTHS AND LIMITATIONS To our knowledge, this study is the first that analyzes the change in sexual activity in women during the COVID-19 outbreak period. The limitations were the low number of the analyzed participants, psychological tests were not included, and no data were collected on masturbation, self-heroism, solitary, and nonpenetrative sex. CONCLUSION The COVID-19 epidemic and the restrictive social distancing measures have negatively influenced the sexual function and quality of life in not-infected reproductive-age women who live with their sexual partners. Schiavi MC, Spina V, Zullo MA, et al. Love in the Time of COVID-19: Sexual Function and Quality of Life Analysis During the Social Distancing Measures in a Group of Italian Reproductive-Age Women. J Sex Med 2020;17:1407-1413.
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Affiliation(s)
- Michele Carlo Schiavi
- Department of Gynecological and Obstetrics, Sandro Pertini Hospital, Rome, Italy; Department of Gynecological and Obstetrics, University "Sapienza" of Rome, Rome, Italy.
| | - Vincenzo Spina
- Department of Gynecological and Obstetrics, Sandro Pertini Hospital, Rome, Italy
| | - Marzio Angelo Zullo
- Department of Surgery-Week Surgery, Campus Biomedico University, Rome, Italy
| | - Vanessa Colagiovanni
- Department of Gynecological and Obstetrics, University "Sapienza" of Rome, Rome, Italy
| | - Paolo Luffarelli
- Department of Surgery-Week Surgery, Campus Biomedico University, Rome, Italy
| | - Rocco Rago
- Physiopathology of Reproduction and Andrology Unit, Sandro Pertini Hospital, Rome, Italy
| | - Pierluigi Palazzetti
- Department of Gynecological and Obstetrics, Sandro Pertini Hospital, Rome, Italy
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13
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Meulders A. Fear in the context of pain: Lessons learned from 100 years of fear conditioning research. Behav Res Ther 2020; 131:103635. [DOI: 10.1016/j.brat.2020.103635] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 04/20/2020] [Accepted: 04/24/2020] [Indexed: 02/06/2023]
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14
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Harvie DS, Weermeijer JD, Olthof NA, Meulders A. Learning to predict pain: differences in people with persistent neck pain and pain-free controls. PeerJ 2020; 8:e9345. [PMID: 32612886 PMCID: PMC7319024 DOI: 10.7717/peerj.9345] [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: 12/05/2019] [Accepted: 05/21/2020] [Indexed: 11/20/2022] Open
Abstract
Background Learning to predict threatening events enables an organism to engage in protective behavior and prevent harm. Failure to differentiate between cues that truly predict danger and those that do not, however, may lead to indiscriminate fear and avoidance behaviors, which in turn may contribute to disability in people with persistent pain. We aimed to test whether people with persistent neck pain exhibit contingency learning deficits in predicting pain relative to pain-free, gender-and age-matched controls. Method We developed a differential predictive learning task with a neck pain-relevant scenario. During the acquisition phase, images displaying two distinct neck positions were presented and participants were asked to predict whether these neck positions would lead to pain in a fictive patient with persistent neck pain (see fictive patient scenario details in Appendix A). After participants gave their pain-expectancy judgment in the hypothetical scenario, the verbal outcome (PAIN or NO PAIN) was shown on the screen. One image (CS+) was followed by the outcome “PAIN”, while another image (CS−) was followed by the outcome “NO PAIN”. During the generalization phase, novel but related images depicting neck positions along a continuum between the CS+ and CS− images (generalization stimuli; GSs) were introduced to assess the generalization of acquired predictive learning to the novel images; the GSs were always followed by the verbal outcome “NOTES UNREADABLE” to prevent extinction learning. Finally, an extinction phase was included in which all images were followed by “NO PAIN” assessing the persistence of pain-expectancy judgments following disconfirming information. Results Differential pain-expectancy learning was reduced in people with neck pain relative to controls, resulting from patients giving significantly lower pain-expectancy judgments for the CS+, and significantly higher pain-expectancy judgments for the CS−. People with neck pain also demonstrated flatter generalization gradients relative to controls. No differences in extinction were noted. Discussion The results support the hypothesis that people with persistent neck pain exhibit reduced differential pain-expectancy learning and flatter generalization gradients, reflecting deficits in predictive learning. Contrary to our hypothesis, no differences in extinction were found. These findings may be relevant to understanding behavioral aspects of chronic pain.
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Affiliation(s)
- Daniel S Harvie
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia.,School of Allied Health Sciences, Griffith University, Gold Coast, QLD, Australia
| | | | - Nick A Olthof
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia.,School of Allied Health Sciences, Griffith University, Gold Coast, QLD, Australia
| | - Ann Meulders
- Research Group Health Psychology, KU Leuven, Leuven, Belgium.,Experimental Health Psychology, Maastricht University, Maastricht, The Netherlands
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Pfaus JG, Quintana GR, Mac Cionnaith CE, Gerson CA, Dubé S, Coria-Avila GA. Conditioning of Sexual Interests and Paraphilias in Humans Is Difficult to See, Virtually Impossible to Test, and Probably Exactly How It Happens: A Comment on Hsu and Bailey (2020). ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:1403-1407. [PMID: 32462414 DOI: 10.1007/s10508-020-01739-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 04/30/2020] [Accepted: 05/05/2020] [Indexed: 06/11/2023]
Affiliation(s)
- James G Pfaus
- Centro de Investigaciones Cerebrales, Universidad Veracruzana, Xalapa, VER, CP 91193, Mexico.
| | - Gonzalo R Quintana
- Department of Psychology, Centre for Studies in Behavioral Neurobiology, Concordia University, Montréal, QC, Canada
| | - Conall E Mac Cionnaith
- Department of Psychology, Centre for Studies in Behavioral Neurobiology, Concordia University, Montréal, QC, Canada
| | - Christine A Gerson
- Department of Psychology, Centre for Studies in Behavioral Neurobiology, Concordia University, Montréal, QC, Canada
| | - Simon Dubé
- Department of Psychology, Centre for Studies in Behavioral Neurobiology, Concordia University, Montréal, QC, Canada
| | - Genaro A Coria-Avila
- Centro de Investigaciones Cerebrales, Universidad Veracruzana, Xalapa, VER, CP 91193, Mexico
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Both S, Van Veen RJB, Brom M, Weijenborg PTM. A randomized, placebo-controlled laboratory study of the effects of D-cycloserine on sexual memory consolidation in women. Psychopharmacology (Berl) 2020; 237:1291-1303. [PMID: 31984445 PMCID: PMC7196949 DOI: 10.1007/s00213-020-05457-4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 01/10/2020] [Indexed: 11/29/2022]
Abstract
RATIONALE AND OBJECTIVE The aim of this study was to investigate the possible facilitating effect of the partial NMDA receptor agonist D-cycloserine (DCS) on memory consolidation of conditioned sexual responses and to examine the capability of DCS to reduce context-specificity of learning. METHODS In a randomized placebo-controlled double-blind trial, 50 healthy females were exposed to a differential conditioning procedure. Two pictures of a male abdomen were used as conditional stimuli (CSs), of which one (the CS+) was followed by the unconditional stimulus (US), a genital vibrotactile stimulus. After the conditioning session on day 1, participants received either 125 mg of DCS or a placebo. The effects of DCS on affect, sexual arousal and US expectancy in response to the CS+ and CS- were examined 24 h after the conditioning procedure. RESULTS A main effect of DCS was found on affect at the first test trials (p = 0.04, ηp2 = 0.09), and a similar non-significant but trend level effect was found for sexual arousal (p = 0.06, ηp2 = 0.07), which appeared to persist over a longer time (p = 0.07, ηp2 = 0.08). Unexpectedly, ratings of positive affect and sexual arousal in response to both the CS+ and the CS- were higher in the DCS condition compared to the control condition, possibly indicating that DCS administration reduced stimulus specificity. Since the results did not show clear evidence for context learning, we were not able to test effects on context-specificity of learning. CONCLUSION Although largely inconclusive, the results provide tentative support for a facilitating effect of DCS on affect and sexual arousal in response to stimuli that were presented in a sexual conditioning procedure, however, no conclusions can be drawn about effects of DCS on sexual reward learning, since the design and results do not lend themselves to unambiguous interpretation.
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Affiliation(s)
- S. Both
- Department of Psychosomatic Gynecology and Sexology, Leiden University Medical Center, Poortgebouw-Zuid, 4e etage, Rijnsburgerweg 10, 2333 AA Leiden, The Netherlands
| | - R. J. B. Van Veen
- Department of Psychosomatic Gynecology and Sexology, Leiden University Medical Center, Poortgebouw-Zuid, 4e etage, Rijnsburgerweg 10, 2333 AA Leiden, The Netherlands
| | - M. Brom
- Department of Psychosomatic Gynecology and Sexology, Leiden University Medical Center, Poortgebouw-Zuid, 4e etage, Rijnsburgerweg 10, 2333 AA Leiden, The Netherlands
| | - P. T. M. Weijenborg
- Department of Psychosomatic Gynecology and Sexology, Leiden University Medical Center, Poortgebouw-Zuid, 4e etage, Rijnsburgerweg 10, 2333 AA Leiden, The Netherlands
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17
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Sexual Disgust: Evolutionary Perspectives and Relationship to Female Sexual Function. CURRENT SEXUAL HEALTH REPORTS 2019. [DOI: 10.1007/s11930-019-00219-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Hoffmann H. Situating Human Sexual Conditioning. ARCHIVES OF SEXUAL BEHAVIOR 2017; 46:2213-2229. [PMID: 28698969 DOI: 10.1007/s10508-017-1030-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 04/09/2017] [Accepted: 06/28/2017] [Indexed: 06/07/2023]
Abstract
Conditioning is often thought of as a basic, automatic learning process that has limited applicability to higher-level human behavior. In addition, conditioning is seen as separable from, and even secondary to, "innate" processes. These ideas involve some misconceptions. The aim of this article is to provide a clearer, more refined sense of human sexual conditioning. After providing some background information and reviewing what is known from laboratory conditioning studies, human sexual conditioning is compared to sexual conditioning in nonhumans, to "innate" sexual responding, and to other types of human learning processes. Recommendations for moving forward in human sexual conditioning research are included.
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Affiliation(s)
- Heather Hoffmann
- Department of Psychology, Knox College, Galesburg, IL, 61401, USA.
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