An evolutionary interpretation of the significance of physical pain experienced by human females: defloration and childbirth pains

The Opaque Language of Sexuality: Medical Students' and Providers' Beliefs About Virginity

Although virginity is not a medical term and is instead socially constructed, it remains unknown what medical providers believe about the biological basis of virginity. This study explored providers' and medical students' beliefs about virginity and the potential impact of such beliefs on healthcare. This was a concurrent mixed-method survey study of 124 medical students and 216 healthcare providers (Registered Nurse, Physician Assistant, Nurse Practitioner, and Doctor of Medicine) at Penn State Health and The Pennsylvania State University College of Medicine. Participants rated their level of agreement with common misconceptions about virginity on a six-point Likert scale. Open-ended questions gave respondents the opportunity to define virginity and to describe terms like virgin and virginal in the context of sexual experience and the medical lexicon. We identified common themes in the qualitative data using thematic analysis. Frequencies of misconceptions and statistically significant demographic associations were identified in the quantitative data. Definitions of virginity were varied and vague, most with negative connotations. A majority of respondents said that virginity has no biological basis. Many participants identified downsides to use of terms like virgin, virginity, and virginal in medicine. The most prevalent misconceptions about virginity were related to the hymen. Seventeen percent of students and 26% of providers at least somewhat agreed that it was possible to determine whether a person has engaged in vaginal intercourse through a gynecological exam. Misconceptions about virginity persist in medicine and bias, even if unintended, may impact the quality-of-care people with vaginas receive. Language around sexual health should be specific, inclusive, clinically relevant, and free from judgment. Medical education must continue to work to eliminate the concept of a biological basis to virginity.

Human Labor Pain Is Influenced by the Voltage-Gated Potassium Channel KV6.4 Subunit

By studying healthy women who do not request analgesia during their first delivery, we investigate genetic effects on labor pain. Such women have normal sensory and psychometric test results, except for significantly higher cuff pressure pain. We find an excess of heterozygotes carrying the rare allele of SNP rs140124801 in KCNG4. The rare variant K_V6.4-Met419 has a dominant-negative effect and cannot modulate the voltage dependence of K_V2.1 inactivation because it fails to traffic to the plasma membrane. In vivo, Kcng4 (K_V6.4) expression occurs in 40% of retrograde-labeled mouse uterine sensory neurons, all of which express K_V2.1, and over 90% express the nociceptor genes Trpv1 and Scn10a. In neurons overexpressing K_V6.4-Met419, the voltage dependence of inactivation for K_V2.1 is more depolarized compared with neurons overexpressing K_V6.4. Finally, K_V6.4-Met419-overexpressing neurons have a higher action potential threshold. We conclude that K_V6.4 can influence human labor pain by modulating the excitability of uterine nociceptors.

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KCNG4 variant highly prevalent in women requiring no analgesia in childbirth

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KCNG4 variant encodes K_V6.4Met-419; K_V6.4 is a silent subunit modifying K_V activity

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K_V6.4Met-419 is retained in the cytoplasm and acts in a dominant-negative manner

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K_V6.4Met-419 overexpression results in hypoexcitable sensory neurons