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Mills-Finnerty C, Staggs H, Bittoni C, Wise N. Affective neuroscience: applications for sexual medicine research and clinical practice. Sex Med Rev 2024; 12:127-141. [PMID: 38281754 DOI: 10.1093/sxmrev/qead048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 10/03/2023] [Accepted: 10/26/2023] [Indexed: 01/30/2024]
Abstract
INTRODUCTION Affective neuroscience is the study of the brain substrates of emotional, embodied experiences. Affective neuroscience theory (ANT) is based on experimental evidence that all mammals are hardwired with 7 primary subcortical emotional operating systems, or "core emotions," that have overlapping but distinct circuits buried in the deep, ancient parts of the brain. Imbalances in the 7 core emotions can affect multiple aspects of the individual's psychosocial well-being (eg, depression, anxiety, substance abuse). Here, we propose that core emotions can also influence sexual function and, specifically, that imbalances in core emotions are the bridge connecting psychiatric symptoms (eg, anhedonia) to sexual dysfunction (eg, anorgasmia). OBJECTIVES In this targeted review and commentary, we outline potential connections between ANT and sexual medicine research and clinical practice. We summarize ANT by defining the 3-level BrainMind and core emotions; examining how they relate to personality, behavior, and mental health; and determining the implications for sexual health research and clinical practice. METHODS A targeted literature review was conducted. Case studies were adapted from client files and clinician interviews and then anonymized. RESULTS We propose a novel organizational schema for implementing affective balance therapies for sexual dysfunction, which integrate psychoeducational, somatic, and cognitive therapeutic approaches under the ANT framework. We provide 3 patient case studies (anorgasmia, hypersexuality, spinal cord injury) outlining the implementation of this approach and patient outcomes. CONCLUSION ANT has practical translational applications in sexual health research and clinical practice. By integrating our understanding of the role of core emotions in human sexuality, clinicians can better tailor treatments to address sexual dysfunction.
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Affiliation(s)
- Colleen Mills-Finnerty
- Mental Illness Research, Education, and Clinical Care, Palo Alto Veterans Health Care System, Palo Alto, CA 94304, United States
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA 94304, United States
| | - Halee Staggs
- Mental Illness Research, Education, and Clinical Care, Palo Alto Veterans Health Care System, Palo Alto, CA 94304, United States
| | - Celeste Bittoni
- Department of Psychology, University of Padova, Padova 2 35122, Italy
| | - Nan Wise
- Department of Psychology, Rutgers University, Newark, NJ 07102, United States
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Gaither TW, Vincent NW, Piqueiras E, Barzallo D, Siapno A, Williams KC, Russell M, Litwin MS. Atlas of the receptive anal sex experience among people with prostates. J Sex Med 2023; 20:126-138. [PMID: 36763914 DOI: 10.1093/jsxmed/qdac024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 09/15/2022] [Accepted: 11/21/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Receptive anal intercourse (RAI) is commonly practiced among individuals of all sexual orientations. However, negative stigmatization by society and health care professionals leads to the underreporting or this practice. AIM We sought to assess and describe the subjective role of the prostate as a pleasure center in participants with diverse RAI experiences. The secondary aim was to describe nonprostatic areas within the anorectal region that produce erotic sensation and/or pain. METHODS The exploratory sequential multimethod study design included focus groups and semistructured interviews with 30 individuals with prostates who had engaged in RAI. We used graphic elicitation of natal male anatomy to enhance visualization and assess participant perspectives. OUTCOMES The main outcome of interest was the identification of anatomic locations of erogenous sensation and pain during RAI. RESULTS Among the participants (median age 38, range 24-77 years), most participants (90%) identified as cisgender male. Three major themes emerged within the motivations for RAI, including (1) deriving intrinsic pleasure, (2) providing both pleasure for a partner and a way to improve intimacy/connection, and (3) an inability to be the insertive partner due to physical or mental challenges. The data suggest that the anorectal region produces a variety of erogenous sensations which participants find pleasurable. Overall, 2 major areas of erogenous sensation occur along the anterior rectal wall and within the anus. Within the context of RAI, 2 distinct categories of pain emerged, including pain with insertion and pain at other times. CLINICAL IMPLICATIONS Understanding where erogenous sensation originates for each individual may predict sexual functioning after various surgical interventions. Timing and location of pain may aid in further characterizing anodyspareunia. STRENGTHS AND LIMITATIONS Our study utilized a sequential design (from focus groups to interviews) with diverse RAI experiences, especially regarding age, geographic location, and prostate pathology. We included individuals of diverse gender identities, but too few to evaluate these groups independently from cisgender men. CONCLUSION People with prostates experience pleasure in multiple areas during RAI. Contrary to some lay literature, the prostate region is not the subjective pleasure center for all individuals. Timing and location of pain during RAI may inform areas for intervention. Providing a language for pleasure and pain during RAI may improve communication between not only sexual partners but also clinicians and patients.
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Affiliation(s)
- Thomas W Gaither
- Department of Urology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | | | - Eduardo Piqueiras
- Department of Urology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - Devin Barzallo
- Case Western Reserve School of Medicine, Cleveland, OH, United States
| | - Allen Siapno
- Department of Urology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - Kristen C Williams
- Department of Urology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - Marcia Russell
- Department of Surgery, Section of Colorectal Surgery, David Geffen School of Medicine, Los Angeles, United States, CA.,Surgical and Perioperative Careline, VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States
| | - Mark S Litwin
- Department of Urology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States.,Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States.,School of Nursing, University of California Los Angeles, Los Angeles, CA, United States
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Mills-Finnerty C, Frangos E, Allen K, Komisaruk B, Wise N. Functional Magnetic Resonance Imaging Studies in Sexual Medicine: A Primer. J Sex Med 2022; 19:1073-1089. [DOI: 10.1016/j.jsxm.2022.03.217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 01/27/2022] [Accepted: 03/04/2022] [Indexed: 11/17/2022]
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Okafor IA, Okpara UD, Ibeabuchi KC. The Reproductive Functions of the Human Brain Regions: A Systematic Review. J Hum Reprod Sci 2022; 15:102-111. [PMID: 35928473 PMCID: PMC9345277 DOI: 10.4103/jhrs.jhrs_18_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 04/26/2022] [Accepted: 05/27/2022] [Indexed: 11/04/2022] Open
Abstract
Reproduction remains a vital characteristic of living things necessary for survival and continuity. Specific brain regions and structures are responsible for regulating the different aspects of human reproduction. This study systematically reviewed the brain regions that play structural, hormonal and physiological roles in controlling the various aspects of human reproduction from puberty, sexual function, gametogenesis, childbirth and fertility to infertility to inform advancement in research and therapeutic interventions in human reproductive disorders. A systematic literature search of online databases (MEDLINE, Europe PMC and Google Scholar) was made using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for observational and cross-sectional studies providing evidence for the role(s) of the brain region in human reproduction from the year 2011-2021. Out of 141 articles found, 15 studies met the inclusion criteria, including six cross-sectional and nine randomised controlled trials. The study acknowledged the roles of the pituitary gland, hypothalamus and pineal gland, widely known for regulating the human reproductive system in a gender-based approach while highlighting essential gaps and opportunities for future research. This review provides a 10-year update and overview of the role of different brain regions in human reproduction and will stimulate future research in human reproduction.
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Affiliation(s)
- Izuchukwu Azuka Okafor
- Department of Anatomy, Faculty of Basic Medical Sciences, College of Health Sciences, Nnamdi Azikiwe University, Nnewi Campus, Nnewi, Nigeria.,Department of Obstetrics and Gynaecology, College of Medicine, University of Ibadan, Ibadan, Nigeria.,Reproductive Health Sciences Program, Pan African University of Life and Earth Sciences Institute (Including Health and Agriculture), PAULESI, University of Ibadan, Ibadan, Nigeria
| | - Ugochukwu Damian Okpara
- Department of Anatomy, Faculty of Basic Medical Sciences, College of Medicine, Chukwuemeka Odumegwu OjukwuUniversity, Uli Campus, Uli, Anambra State, Nigeria
| | - Kingsley Chinemerem Ibeabuchi
- Department of Anatomy and Physiology, College of Nursing Sciences, Our Lady of Lourdes Hospital Complex, Ihiala, Anambra State, Nigeria
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Hentzen C, Musco S, Amarenco G, Del Popolo G, Panicker JN. Approach and management to patients with neurological disorders reporting sexual dysfunction. Lancet Neurol 2022; 21:551-562. [DOI: 10.1016/s1474-4422(22)00036-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/28/2021] [Accepted: 01/18/2022] [Indexed: 12/13/2022]
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Colonnello E, Limoncin E, Ciocca G, Sansone A, Mollaioli D, Balercia G, Porst H, Zhang H, Yu X, Zhang Y, Jannini EA. The Lost Penis Syndrome: A New Clinical Entity in Sexual Medicine. Sex Med Rev 2021; 10:113-129. [PMID: 34620562 DOI: 10.1016/j.sxmr.2021.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 08/22/2021] [Accepted: 08/28/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The "lost penis syndrome" (LPS) is a term often used in non-clinical settings to describe the subjective perception of the loss of cutaneous and proprioceptive feelings of the male organ during vaginal penetration. Although deserving clinical attention, this syndrome did not receive any consideration in the medical literature. Notwithstanding, it represents a relatively unexceptional condition among patients in sexual medicine clinics, and it is often reported together with other sexual dysfunctions, especially delayed ejaculation, anejaculation, male anorgasmia and inability to maintain a full erection. OBJECTIVES To draft a new conceptual characterization of the LPS, defined as a lack of penile somesthetic sensations during sexual penetration due to various causes and leading to several sexual consequences in both partners. METHODS Based on an extensive literature review and physiological assumptions, the mechanisms contributing to friction during penovaginal intercourse, and their correlation to LPS, have been explored, as well as other nonanatomical factors possibly contributing to the loss of penile sensations. RESULTS Efficient penile erection and sensitivity, optimal vaginal lubrication and trophism contribute to penovaginal friction. Whenever one of these processes does not occur, loss of penile sensation defined as LPS can occur. Sociocultural, psychopathological and age-related (ie, couplepause) factors are also implicated in the etiology. Four types of LPS emerged from the literature review: anatomical and/or functional, behavioral, psychopathological and iatrogenic. According to the subtype, a wide variety of treatments can be employed, including PDE5i, testosterone replacement therapy and vaginal cosmetic surgery, as well as targeted therapy for concomitant sexual comorbidity. CONCLUSION We held up the mirror on LPS as a clinically existing multifactorial entity and provided medical features and hypotheses contributing to or causing the occurrence of LPS. In the light of a sociocultural and scientific perspective, we proposed a description and categorization of this syndrome hypothesizing its usefulness in daily clinical practice. Colonnello E, Limoncin E, Ciocca G, et al. The Lost Penis Syndrome: A New Clinical Entity in Sexual Medicine. Sex Med Rev 2021;XX:XXX-XXX.
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Affiliation(s)
- Elena Colonnello
- Chair of Endocrinology & Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Erika Limoncin
- Chair of Endocrinology & Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy; Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy; Division of Endocrinology, Department of Clinical and Molecular Sciences, Umberto I Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Giacomo Ciocca
- Chair of Endocrinology & Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy; Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Andrea Sansone
- Chair of Endocrinology & Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Daniele Mollaioli
- Chair of Endocrinology & Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Giancarlo Balercia
- Division of Endocrinology, Department of Clinical and Molecular Sciences, Umberto I Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Hartmut Porst
- European Institute for Sexual Health (EISH), Hamburg, Germany
| | - Hui Zhang
- Department of Infertility and Sexual Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, PRC
| | - Xi Yu
- Department of Infertility and Sexual Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, PRC
| | - Yan Zhang
- Department of Infertility and Sexual Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, PRC
| | - Emmanuele A Jannini
- Chair of Endocrinology & Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
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Willoughby WR, Thoenes K, Bolding M. Somatotopic Arrangement of the Human Primary Somatosensory Cortex Derived From Functional Magnetic Resonance Imaging. Front Neurosci 2021; 14:598482. [PMID: 33488347 PMCID: PMC7817621 DOI: 10.3389/fnins.2020.598482] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 12/08/2020] [Indexed: 11/13/2022] Open
Abstract
Functional magnetic resonance imaging (fMRI) was used to estimate neuronal activity in the primary somatosensory cortex of six participants undergoing cutaneous tactile stimulation on skin areas spread across the entire body. Differences between the accepted somatotopic maps derived from Penfield's work and those generated by this fMRI study were sought, including representational transpositions or replications across the cortex. MR-safe pneumatic devices mimicking the action of a Wartenberg wheel supplied touch stimuli in eight areas. Seven were on the left side of the body: foot, lower, and upper leg, trunk beneath ribcage, anterior forearm, middle fingertip, and neck above the collarbone. The eighth area was the glabella. Activation magnitude was estimated as the maximum cross-correlation coefficient at a certain phase shift between ideal time series and measured blood oxygen level dependent (BOLD) time courses on the cortical surface. Maximally correlated clusters associated with each cutaneous area were calculated, and cortical magnification factors were estimated. Activity correlated to lower limb stimulation was observed in the paracentral lobule and superomedial postcentral region. Correlations to upper extremity stimulation were observed in the postcentral area adjacent to the motor hand knob. Activity correlated to trunk, face and neck stimulation was localized in the superomedial one-third of the postcentral region, which differed from Penfield's cortical homunculus.
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Affiliation(s)
- W. R. Willoughby
- Department of Radiology, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - Kristina Thoenes
- Department of Neurobiology, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - Mark Bolding
- Department of Radiology, The University of Alabama at Birmingham, Birmingham, AL, United States
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Case LK, Liljencrantz J, McCall MV, Bradson M, Necaise A, Tubbs J, Olausson H, Wang B, Bushnell MC. Pleasant Deep Pressure: Expanding the Social Touch Hypothesis. Neuroscience 2020; 464:3-11. [PMID: 32768616 DOI: 10.1016/j.neuroscience.2020.07.050] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 07/20/2020] [Accepted: 07/21/2020] [Indexed: 11/25/2022]
Abstract
Neuroscientific research on pleasant touch has focused on the C-tactile pathway for gentle stroking and has successfully explained how these sensory fibers transmit information about affective social touch to the brain and induce sensations of pleasantness. The C-tactile social/affective touch hypothesis even proposes that C-tactile fibers form a privileged pathway underlying social touch. However, deep pressure is a type of touch commonly considered pleasant and calming, occurring in hugs, cuddling, and massage. In this paper we introduce a paradigm for studying pleasant deep pressure and propose that it constitutes another important form of social touch. We describe development of the oscillating compression sleeve (OCS) as one approach to administering deep pressure and demonstrate that this touch is perceived as pleasant and calming. Further, we show that deep pressure can be imaged with functional magnetic resonance imaging (MRI) using the air-pressure-driven OCS and that deep pressure activates brain regions highly similar to those that respond to C-tactile stroking, as well as regions not activated by stroking. We propose that deep pressure constitutes another social touch pathway of evolutionary importance signaling the close proximity of conspecifics.
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Affiliation(s)
- Laura K Case
- National Center for Complementary and Integrative Health, NIH, Bethesda, MD, United States; Department of Anesthesiology, UC San Diego School of Medicine, La Jolla, CA, United States.
| | - Jaquette Liljencrantz
- National Center for Complementary and Integrative Health, NIH, Bethesda, MD, United States
| | - Micaela V McCall
- National Center for Complementary and Integrative Health, NIH, Bethesda, MD, United States
| | - Megan Bradson
- National Center for Complementary and Integrative Health, NIH, Bethesda, MD, United States
| | - Aaron Necaise
- National Center for Complementary and Integrative Health, NIH, Bethesda, MD, United States
| | - Justin Tubbs
- National Center for Complementary and Integrative Health, NIH, Bethesda, MD, United States
| | - Håkan Olausson
- Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Binquan Wang
- National Center for Complementary and Integrative Health, NIH, Bethesda, MD, United States
| | - M Catherine Bushnell
- National Center for Complementary and Integrative Health, NIH, Bethesda, MD, United States
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Mapping the male urogenital system. Nat Rev Urol 2020; 17:132. [DOI: 10.1038/s41585-020-0295-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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