Physiological stress responses predict sexual functioning and satisfaction differently in women who have and have not been sexually abused in childhood

Sex in the Shadow of Child Sexual Abuse: The Development and Psychometric Evaluation of the Post-Traumatic Sexuality (PT-SEX) Scale

Sexual-related post-traumatic stress symptoms (sexual-related PTSS) refers to the traumatic reactions that are replicated during sexual activity among survivors of child sexual abuse (CSA). However, the construct of sexual-related PTSS have been adapted from clinical work with survivors, and research with limited examination of the scales themselves. Given this gap, the current study offers the development of a new measure (PT-SEX) that examines sexual-related PTSS. The study was conducted online, among two convenience samples of women survivors of CSA (study 1 included 451 women and study 2 included 330 women). Six reliable PT-SEX factors emerged from Study 1: Dissociation during sex, intrusiveness during sex, shame and guilt in regard to sexual aspects, pleasing the other during sex, interpersonal distress, and hypervigilance during sex. Study 2 revealed survivors of CSA had significantly higher sexual-related PTSS levels as compared to participants without such a history. Also, post-traumatic stress disorder and sexual-related PTSS made unique and unshared contributions to the observed data, including sexual self-esteem, sexual motives, relationship satisfaction, compulsive sexual behavior, and mental health. CSA significantly moderated the associations between sexual-related PTSS and sexual self-esteem, sexual motivations of self-affirmation and coping, and depression and anxiety. Findings from the current study show that over time, the trauma of CSA seems to be implicated in survivors' sexual experience. As sexual difficulties are accompanied by sexual-related PTSS, these symptoms are unlikely to resolve by trauma-focused therapy and must be actively targeted in therapy.

Subjective and Oxytocinergic Responses to Mindfulness Are Associated With Subjective and Oxytocinergic Responses to Sexual Arousal

Mindfulness – the ability to pay attention, on purpose, without judgment, and in the present moment – has consistently been shown to enhance women’s sexual arousal. As a first step toward understanding potential neuroendocrine underpinnings of mindfulness and sexual arousal, we examined whether individual differences in subjective and neuroendocrine (i.e., oxytocin) responses to mindful breathing were associated with individual differences in subjective and neuroendocrine responses to sexual arousal. To achieve this aim, 61 lesbian, bisexual, and heterosexual women completed a questionnaire assessing dispositional mindfulness, underwent an arousal task while continuously rating their sexual arousal and a mindful breathing task, after which participants reported on their ability to detect attentional shifts, and provided salivary samples after each assessment. Results indicated that women who were quicker to detect attentional shifts and women who reported greater sexual arousability reported larger changes (decreases) in oxytocin in response to mindful breathing and were the only women to report increases in oxytocin in response to the sexual arousal induction. Results further indicated that individuals who report greater subjective responsiveness to mindfulness and sexual arousal appear to have an oxytocinergic system that is also more responsive to both arousal and to mindfulness. These results make a significant contribution to our understanding of the role of attentional processes in sexual arousal, and warrant future examination of oxytocin as a potential neuroendocrine mechanism underlying the link between mindfulness and sexual arousal.

Gender-based violence and trauma in marginalized populations of women: Role of biological embedding and toxic stress

Gender-based violence (GBV) and trauma can dysregulate and recalibrate environmentally sensitive physiological (i.e. central nervous, endocrine, and immune) systems placing survivors at risk for multiple health problems. The researchers build the case that the effects of GBV are likely to be particularly high impact and contribute to health disparities for marginalized survivors of GBV. Further, the researchers underscore a need for a multi-level bio-socio-ecological model that deciphers, characterizes, and explains individual differences in these effects and the need to establish an evidence base from which to derive interventions that address biological effects of toxic stress among marginalized survivors of GBV.

Average Associations Between Sexual Desire, Testosterone, and Stress in Women and Men Over Time

Sexual desire and testosterone are widely assumed to be directly and positively linked to each other despite the lack of supporting empirical evidence. The literature that does exist is mixed, which may result from a conflation of solitary and dyadic desire, and the exclusion of contextual variables, like stress, known to be relevant. Here, we use the Steroid/Peptide Theory of Social Bonds as a framework for examining how testosterone, solitary and partnered desire, and stress are linked over time. To do so, we collected saliva samples (for testosterone and cortisol) and measured desire as well as other variables via questionnaires over nine monthly sessions in 78 women and 79 men. Linear mixed models showed that testosterone negatively predicted partnered desire in women but not men. Stress moderated associations between testosterone and solitary desire in both women and men, but differently: At lower levels of stress, higher average testosterone corresponded to higher average solitary desire for men, but lower solitary desire on average for women. Similarly, for partnered desire, higher perceived stress predicted lower desire for women, but higher desire for men. We conclude by discussing the ways that these results both counter presumptions about testosterone and desire but fit with the existing literature and theory, and highlight the empirical importance of stress and gender norms.

Masturbation to Orgasm Stimulates the Release of the Endocannabinoid 2-Arachidonoylglycerol in Humans

BACKGROUND

Endocannabinoids are critical for rewarding behaviors such as eating, physical exercise, and social interaction. The role of endocannabinoids in mammalian sexual behavior has been suggested because of the influence of cannabinoid receptor agonists and antagonists on rodent sexual activity. However, the involvement of endocannabinoids in human sexual behavior has not been studied.

AIM

To investigate plasma endocannabinoid levels before and after masturbation in healthy male and female volunteers.

OUTCOMES

Plasma levels of the endocannabinoids 2-arachidonoylglycerol (2-AG), anandamide, the endocannabinoid-like lipids oleoyl ethanolamide and palmitoyl ethanolamide, arachidonic acid, and cortisol before and after masturbation to orgasm.

METHODS

In study 1, endocannabinoid and cortisol levels were measured before and after masturbation to orgasm. In study 2, masturbation to orgasm was compared with a control condition using a single-blinded, randomized, 2-session crossover design.

RESULTS

In study 1, masturbation to orgasm significantly increased plasma levels of the endocannabinoid 2-AG, whereas anandamide, oleoyl ethanolamide, palmitoyl ethanolamide, arachidonic acid, and cortisol levels were not altered. In study 2, only masturbation to orgasm, not the control condition, led to a significant increase in 2-AG levels. Interestingly, we also found a significant increase of oleoyl ethanolamide after masturbation to orgasm in study 2.

CLINICAL TRANSLATION

Endocannabinoids might play an important role in the sexual response cycle, leading to possible implications for the understanding and treatment of sexual dysfunctions.

STRENGTHS AND LIMITATIONS

We found an increase of 2-AG through masturbation to orgasm in 2 studies including a single-blinded randomized design. The exact role of endocannabinoid release as part of the sexual response cycle and the biological significance of the finding should be studied further. Cannabis and other drug use and the attainment of orgasm were self-reported in the present study.

CONCLUSION

Our data indicate that the endocannabinoid 2-AG is involved in the human sexual response cycle and we hypothesize that 2-AG release plays a role in the rewarding consequences of sexual arousal and orgasm. Fuss J, Bindila L, Wiedemann K, et al. Masturbation to Orgasm Stimulates the Release of the Endocannabinoid 2-Arachidonoylglycerol in Humans. J Sex Med 2017;14:1372-1379.

Betrayal of the Body: Group Approaches to Hypo-Sexuality for Adult Female Sufferers of Childhood Sexual Abuse

Hypo-sexuality, self-reported hypoactive sexual desire and/or sexual aversion, is a common symptom experienced by women who were victims of childhood sexual abuse. This symptom may be distressing to the patient herself, and may place strain on her romantic relationships in adulthood. Unfortunately, this problem often remains undiscussed between patient and provider, in part due to the provider's lack of comfort or knowledge regarding how best to address this issue. In this article, we explore several strategies that providers may employ in a group setting in order to help women realize their sexuality while minimizing untoward side effects such as feelings of guilt or shame, or flashbacks. We highlight the merits of each technique, and provide insights from clinical experience to guide practitioners to help their patients facing this difficult issue.

The Physiology of Female Sexual Function and the Pathophysiology of Female Sexual Dysfunction (Committee 13A)

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.

Interaction of menstrual cycle phase and sexual activity predicts mucosal and systemic humoral immunity in healthy women

Several studies have documented shifts in humoral immune parameters (e.g., immunoglobulins) across the menstrual cycle in healthy women. It is thought that these shifts may reflect dynamic balancing between reproduction and pathogen defense, as certain aspects of humoral immunity may disrupt conception and may be temporarily downregulated at ovulation. If so, one could expect maximal cycle-related shifts of humoral immunity in individuals invested in reproduction - that is, women who are currently sexually active - and less pronounced shifts in women who are not reproductively active (i.e., abstinent). We investigated the interaction of sexual activity, menstrual cycle phase, and humoral immunity in a sample of 32 healthy premenopausal women (15 sexually active, 17 abstinent). Participants provided saliva samples during their menses, follicular phase, ovulation (as indicated by urine test for LH surge), and luteal phase, from which IgA was assayed. Participants also provided blood samples at menses and ovulation, from which IgG was assayed. Sexually active participants provided records of their frequency of sexual activity as well as condom use. At ovulation, sexually active women had higher IgG than abstinent women (d=0.77), with women reporting regular condom use showing larger effects (d=0.63) than women reporting no condom use (d=0.11). Frequency of sexual activity predicted changes in IgA (Cohen's f(2)=0.25), with women reporting high frequency of sexual activity showing a decrease in IgA at ovulation, while women reporting low frequency or no sexual activity showing an increase in IgA at ovulation. Taken together, these findings support the hypothesis that shifts in humoral immunity across the menstrual cycle are associated with reproductive effort, and could contribute to the mechanisms by which women's physiology navigates tradeoffs between reproduction and immunity.

Determining women's sexual self-schemas through advanced computerized text analysis

The meaning extraction method (MEM), an advanced computerized text analysis technique, was used to analyze women's sexual self-schemas. Participants (n=239) completed open-ended essays about their personal feelings associated with sex and sexuality. These essays were analyzed using the MEM, a procedure designed to extract common themes from natural language. Using the MEM procedure, we extracted seven unique themes germane to sexual self-schemas: family and development, virginity, abuse, relationship, sexual activity, attraction, and existentialism. Each of these themes is comprised of frequently used words across the participants' descriptions of their sexual selves. Significant differences in sexual self-schemas were observed to covary with age, relationship status, and sexual abuse history.

Changes in Autonomic Nervous System Activity are Associated with Changes in Sexual Function in Women with a History of Childhood Sexual Abuse

INTRODUCTION

Women with histories of childhood sexual abuse (CSA) have higher rates of sexual difficulties, as well as high sympathetic nervous system response to sexual stimuli.

AIM

The study aims to examine whether treatment-related changes in autonomic balance, as indexed by heart rate variability (HRV), were associated with changes in sexual arousal and orgasm function.

METHODS

In study 1, we measured HRV while writing a sexual essay in 42 healthy, sexually functional women without any history of sexual trauma. These data, along with demographics, were used to develop HRV norms equations. In study 2, 136 women with a history of CSA were randomized to one of three active expressive writing treatments that focused on their trauma, sexuality, or daily life (control condition). We recorded HRV while writing a sexual essay at pretreatment, posttreatment, and 2-week, and 1- and 6-month follow-ups; we also calculated the expected HRV for each participant based on the norms equations from study 1.

MAIN OUTCOME MEASURES

The main outcome measures used were HRV, Female Sexual Function Index, Sexual Satisfaction Scale--Women.

RESULTS

The difference between expected and observed HRV decreased over time, indicating that, posttreatment, CSA survivors displayed HRV closer to the expected HRV of a demographics-matched woman with no history of sexual trauma. Also, over time, participants whose HRV became less dysregulated showed the biggest gains in sexual arousal and orgasm function. These effects were consistent across condition.

CONCLUSIONS

Treatments that reduce autonomic imbalance may improve sexual well-being among CSA populations.

Dissociation during sex and sexual arousal in women with and without a history of childhood sexual abuse

Women with a history of childhood sexual abuse (CSA) experience dissociative symptoms and sexual difficulties with greater frequency than women without a history of CSA. Current models of sexual dysfunction for sexual abuse survivors suggest that dissociation may mediate the relationship between CSA and sexual arousal difficulties. Dissociation, however, is often conceptualized as a single construct in studies of CSA and not as separate domains as in the dissociation literature. In the present study, women with (CSA, N = 37) and without (NSA, N = 22) a history of CSA recruited from the community were asked to indicate the frequency and intensity of their experience in two dissociation subgroups, derealization and depersonalization, during sex with a partner and in their daily life. Findings showed that, in the NSA group, more depersonalization during sex with a partner was associated with lower sexual arousal functioning. However, for both the NSA and CSA groups, more derealization during sex was associated with higher sexual arousal functioning. No measure of dissociation was significantly associated with sexual responses in the laboratory. These findings highlight the importance of distinguishing between different forms of dissociation (i.e., derealization and depersonalization) in the study of sexual arousal functioning. In addition, the findings challenge the notion that dissociation is a main predictor of sexual arousal problems in survivors of CSA and suggest that a more nuanced relationship may exist.