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Sharman LS, Fitzgerald R, Douglas H. Prevalence of Sexual Strangulation/Choking Among Australian 18-35 Year-Olds. ARCHIVES OF SEXUAL BEHAVIOR 2024:10.1007/s10508-024-02937-y. [PMID: 38961025 DOI: 10.1007/s10508-024-02937-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 06/07/2024] [Accepted: 06/09/2024] [Indexed: 07/05/2024]
Abstract
In Australia, strangulation has been explicitly criminalized in all states and territories. However, it continues to be a "normalized" sexual practice despite its potentially fatal consequences and associated short and long-term sequelae. This research aimed to establish the prevalence of strangulation during sex and examine predictors of positive perceptions toward sexual strangulation in Australia. Confidential, cross-sectional online surveys were conducted with 4702 Australians aged 18-35 years. Participants were 47% cis-men, 48% cis-women, and 4% trans or gender diverse. A total of 57% reported ever being sexually strangled (61% women, 43% men, 79% trans or gender diverse) and 51% reported ever strangling a partner (40% women, 59% men, 74% trans or gender diverse). Differences were found across genders on all variables of sexual strangulation, including frequency of engagement, level of pressure on the neck, consequences, wanting and enjoyment, and how consent was given/received. However, when split by gender, sexual orientation of men and women revealed further differences in behaviors, consequences, and wanting, particularly among straight and bisexual women. After accounting for exposure to strangulation in pornography and previous experience of sexual strangulation, positive perceptions of being strangled (R2 = .51) and strangling a partner (R2 = .53) were predicted by ratings that it could be done safely and social normative factors. These findings suggest strangulation is common during sex among young Australians. Non-stigmatizing education strategies are needed to engage with young people so they have a better understanding of the risks involved and how to negotiate consent and safety regarding sexual strangulation.
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Affiliation(s)
- Leah S Sharman
- Melbourne Law School, Faculty of Law, University of Melbourne, Melbourne, VIC, 3010, Australia.
| | - Robin Fitzgerald
- Faculty of Humanities and Social Science, University of Queensland, Brisbane, Australia
| | - Heather Douglas
- Melbourne Law School, Faculty of Law, University of Melbourne, Melbourne, VIC, 3010, Australia
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2
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Larva MA, Rantala MJ. An Evolutionary Psychological Approach Toward BDSM Interest and Behavior. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:2253-2267. [PMID: 38769280 PMCID: PMC11176219 DOI: 10.1007/s10508-024-02881-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/23/2024] [Accepted: 04/24/2024] [Indexed: 05/22/2024]
Abstract
Bondage/discipline, Dominance/submission, and Sadism/Masochism (BDSM) have gained increased attention and discussion in recent years. This prevalence is accompanied by a shift in perceptions of BDSM, including the declassification of sadomasochism as a paraphilic disorder. Evolutionary psychology offers a unique perspective of why some individuals are interested in BDSM and why some prefer certain elements of BDSM over others (e.g., dominance versus submission). In this paper, we examine BDSM from an evolutionary standpoint, examining biopsychosocial factors that underlie the BDSM interests and practice. We articulate this perspective via an exploration of: proximate processes, such as the role of childhood experiences, sexual conditioning, and physiological factors; as well as ultimate explanations for power play and pain play dimensions of BDSM, highlighting the potential adaptive advantages of each. While BDSM may not be adaptive in itself, we examine the literature of sex differences in BDSM role preferences and argue that these preferences may stem from the extreme forms of behaviors which enhance reproductive success. In the realm of pain play, we explore the intersection of pain and pleasure from both physiological and psychological perspectives, highlighting the crucial role of psychological and play partner factors in modulating the experience of pain. Finally, we encourage future research in social sciences to utilize evolutionary frameworks to further explore the subject and help alleviate the mystification surrounding BDSM. This multifaceted exploration of BDSM provides valuable insights for clinicians, kink-identified individuals, and scholars seeking to understand the evolutionary perspectives of human sexual behavior and preferences.
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Affiliation(s)
- Michelle A Larva
- INVEST Research Flagship Centre (Psychology), University of Turku, Assistentinkatu 7, N20014, Turku, Finland.
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3
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Vetterlein A, Hogeterp SA, Monzel M, Reuter M. A matter of personality and point of view: How the interplay of reinforcement sensitivity and general attitudes towards pain impacts the responsivity to acute pain. Eur J Pain 2024. [PMID: 38329141 DOI: 10.1002/ejp.2248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 01/16/2024] [Accepted: 01/26/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND The relatively stable individual differences reflected in Grey's revised reinforcement sensitivity theory (rRST), with foundations in neurophysiology and learning theory, appear particularly applicable to the study of pain. However, remarkably little research has been conducted in this area. In acute pain, activation of the behavioural approach system (BAS), the behavioural inhibition system (BIS) and the fight, flight, freezing system might depend on an individual's evaluation of pain. It was thus hypothesised that higher-order interactions of rRST traits and pain attitudes affect pain responsiveness. METHODS To investigate relationships between rRST traits and pain attitudes and to identify patterns between clusters of participants, we conducted a study in which N = 275 healthy participants filled in Reuter and Montag's rRST-Q and the General Attitudes Towards Pain Inventory (GATPI). Experimental (pressure, electrical, thermal) and self-report data of pain responsiveness were collected in a subsample (N = 113). RESULTS We found significant correlations between rRST-Q and GATPI subscales of up to r = 0.34. Two clusters were identified, significantly differing in rRST-Q and GATPI scores. Pain avoiders, characterized by high BIS, flight, freezing and negative pain attitudes, were found to be significantly more pain sensitive than pain approachers, characterized by high BAS, fight and positive pain attitudes. Moderate effects (d = 0.56 to d = 0.70) were demonstrated in subjective and objective measures and across pain modalities. CONCLUSIONS The present study expands the scientific knowledge on factors influencing pain responsiveness. Future research is needed to confirm implications for chronic pain prevention and therapy, particularly concerning pain avoiders. SIGNIFICANCE We have identified two clusters of participants, pain avoiders and pain approachers, that not only present differential patterns of revised reinforcement theory traits and general attitudes towards pain but also differ in their pain responsiveness. Pain avoiders appeared more pain sensitive compared to pain approachers, both in objective and subjective measurements, with implications for the improvement of chronic pain prevention and therapy.
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Affiliation(s)
- A Vetterlein
- Department of Psychology, Personality & Biological Psychology, University of Bonn, Bonn, Germany
| | - S A Hogeterp
- Department of Psychology, Personality & Biological Psychology, University of Bonn, Bonn, Germany
| | - M Monzel
- Department of Psychology, Personality & Biological Psychology, University of Bonn, Bonn, Germany
| | - M Reuter
- Department of Psychology, Personality & Biological Psychology, University of Bonn, Bonn, Germany
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Mautz TT, Mulroy ME, Krapf JM, Goldstein AT, Pukall CF. Pleasure despite pain: Associations between experiences of vulvar pleasure, vulvar pain, and sexual function in patients with chronic vulvar pain conditions. Sex Med 2023; 11:qfad047. [PMID: 37671069 PMCID: PMC10475856 DOI: 10.1093/sexmed/qfad047] [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: 05/25/2023] [Revised: 07/17/2023] [Accepted: 07/25/2023] [Indexed: 09/07/2023] Open
Abstract
Background Chronic pain can occur in the vulva, one of the primary pleasure centers of the body; however, the associations between pleasurable vulvar experiences and chronic vulvar pain have not yet been explored. Aim The aim of this study was to investigate associations between vulvar pleasure and pain experiences in patients with chronic vulvar pain. Methods This was a prospective cross-sectional study of 547 patients (aged ≥17 years) presenting over 10 months to 2 urban outpatient gynecology clinics specializing in vulvar pain. Prior to the initial evaluation, patients completed online validated questionnaires of pain-related anxiety, pain catastrophizing, and sexual functioning, as well as a researcher-developed questionnaire evaluating vulvar pleasure. Patients were divided into groups based on their pleasure and pain experiences. Between-group analyses consisting of t-tests, analyses of variance, and multivariate analyses of variance were conducted. Outcomes Outcomes consisted of total and subscale scores on the Pain Anxiety Symptoms Scale-20, Pain Catastrophizing Scale, Female Sexual Function Index, and a researcher-developed vulvar pleasure questionnaire. Results More than 70% of patients with chronic vulvar pain had experienced vulvar pleasure since the onset of their vulvar pain, with the clitoris as the most common source of pleasure. Average vulvar pleasure intensity was rated 7 (0, no pleasure; 10, extremely pleasurable). Masturbation ranked higher in pleasurable activities than vulvar stimulation by a partner or penetrative intercourse and was the most likely activity to lead to orgasm. When compared with patients who had not experienced vulvar pleasure since the onset of their vulvar pain, patients experiencing both pain and pleasure scored lower on the Pain Anxiety Symptoms Scale-20 total (P = .026) and fear subscale (P = .016), lower on the Pain Catastrophizing Scale total (P = .002) and all subscales (P = .008-.018), and higher on the Female Sexual Function Index total and all subscales (all P ≤ .001). Clinical Implications Incorporating strategies for cultivating vulvar pleasure in patients with chronic vulvar pain may be useful in comprehensive management approaches. Strengths and Limitations Strengths of this study include the novel examination of vulvar pleasure in a population with chronic vulvar pain and a large sample size. Limitations include the lack of a nonclinical comparator group and reliance on patient self-report. Conclusion Results suggest that greater vulvar pleasure is associated with lower pain-related anxiety, lower pain catastrophizing, and higher sexual functioning in patients with chronic vulvar pain conditions.
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Affiliation(s)
- Theodora T Mautz
- The Centers for Vulvovaginal Disorders, New York City, NY 10036, United States
| | - Maeve E Mulroy
- Department of Psychology, Queen’s University, Kingston K7L 3N6, Canada
| | - Jill M Krapf
- The Centers for Vulvovaginal Disorders, Washington, DC 20037, United States
| | - Andrew T Goldstein
- The Centers for Vulvovaginal Disorders, New York City, NY 10036, United States
- The Centers for Vulvovaginal Disorders, Washington, DC 20037, United States
| | - Caroline F Pukall
- Department of Psychology, Queen’s University, Kingston K7L 3N6, Canada
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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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Claeys W, Bronselaer G, Lumen N, Hoebeke P, Spinoit AF. The self-assessment of genital anatomy, sexual function, and genital sensation (SAGASF-M) questionnaire in a Belgian Dutch-speaking male population: A validating study. Andrology 2023; 11:489-500. [PMID: 36426587 DOI: 10.1111/andr.13348] [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: 05/06/2022] [Revised: 10/28/2022] [Accepted: 11/15/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Penile and genital surgery for congenital or acquired conditions is daily practice in reconstructive urology. These procedures, which carry the risk of disrupting nerves and blood vessels, may impair the genital sensation, and affect the capacity for sexual pleasure. Self-reported tools are needed to systematically assess the male genitalia before and after reconstructive surgeries in terms of genital sensation and sexual experience. AIM This study validated the Dutch translation of the "self-assessment of genital anatomy and sexual functioning in male" (SAGASF-M) questionnaire and investigated the perceptions of healthy men regarding their genital anatomy and sensory function. METHODS Eight hundred and eight sexually active men with a median age of 39 years (18-79 years) and no history of genital procedures other than circumcision filled out an online version of the questionnaire. Twenty-four participants were randomly recruited to confirm the responses of the "self-assessment of genital anatomy and sexual functioning in male" questionnaire by a clinical evaluation. MAIN OUTCOME MEASURES The "self-assessment of genital anatomy and sexual functioning in male" questionnaire comprises of multiple-choice questions and clarifying illustrations asking men to rate their genital appearance, overall sexual sensitivity, and pain perception as well as the intensity and the effort to reach orgasm. Prespecified regions of the glans, penile shaft, scrotum, perineum, and anus are evaluated through this questionnaire. RESULTS Only slight variability in anatomical ratings was observed. Overall discrimination between different genital areas in terms of genital sensation was significant. The bottom of the glans or frenular area was rated the highest contributor to "sexual pleasure," followed by the other regions of the glans and shaft. The same distribution was found for "orgasm intensity" and "orgasm effort." The anal region was generally rated the lowest. "Discomfort/pain" was rated lower than any of the other sensory function indicators and the top of the glans and anal region were rated most likely to perceive this unpleasant sensation. Participants reported significantly more sexual pleasure and intense orgasms when stimulated by a sexual partner than self-stimulation. Homosexual and bisexual men reported a higher contribution of the perineal and anal regions in sexual pleasure and orgasm. No significant difference between circumcised and uncircumcised individuals regarding overall genital sensation could be found. CONCLUSION The Dutch translation of the SAGASF-M questionnaire is a valuable and reliable tool for self-assessment of genital anatomy and sensation, providing a site-specific attribution of a patient's perceived sexual function. Further prospective research with this questionnaire could aid in the patient-centered improvement of genital surgery.
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Affiliation(s)
- Wietse Claeys
- Department of Urology, University Hospital Ghent and Ghent University, Ghent, Belgium
| | - Guy Bronselaer
- Department of Urology, University Hospital Ghent and Ghent University, Ghent, Belgium
| | - Nicolaas Lumen
- Department of Urology, University Hospital Ghent and Ghent University, Ghent, Belgium
| | - Piet Hoebeke
- Department of Urology, University Hospital Ghent and Ghent University, Ghent, Belgium
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Baudic S, Poindessous‐Jazat F, Bouhassira D. Pain and masochistic behaviour: The role of descending modulation. Eur J Pain 2022; 26:2227-2237. [PMID: 36094743 PMCID: PMC9826249 DOI: 10.1002/ejp.2037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 08/31/2022] [Accepted: 09/07/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND The mechanisms of pain perception in individuals with masochistic behaviour (MB) remain poorly documented. We hypothesized that MB is associated with context-specific changes in descending pain modulation. METHODS We compared the effects of four standardized sets of images with positive (erotic), negative (mutilations), masochistic or neutral emotional valences on the RIII nociceptive reflex evoked by electrical stimulation of the sural nerve and recorded on the ipsilateral biceps femoris in 15 controls and 15 men routinely engaging in MB. We systematically assessed the RIII reflex threshold and recruitment curves (up to the tolerance threshold), thermal (heat and cold) pain thresholds measured on the upper and lower limbs and responses to the pain sensitivity questionnaire, to compare basal pain perception between our two groups of participants. We also assessed anxiety, depression, empathy, alexithymia, high sensation seeking and catastrophizing, to investigate their potential influence on the emotional modulation of pain. RESULTS Thermal pain thresholds, RIII reflex recruitment curves, and responses to the psychological and pain sensitivity questionnaires were similar in the two groups. Neutral, positive and negative images modulated the RIII reflex similarly in the two groups. By contrast, masochistic images induced a significant (p < 0.01) decrease in RIII reflex responses in subjects with MB, whereas it tended to increase these responses in control subjects. CONCLUSIONS Our data suggest that psychological profile, basal pain sensitivity and the emotional modulation of pain are normal in individuals with MB but that these subjects selectively engage descending pain inhibition in the masochistic context. SIGNIFICANCE Decrease pain perception related to masochistic behaviours is associated with specific activation of descending pain inhibition.
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Affiliation(s)
- Sophie Baudic
- Inserm U987, APHP, UVSQ, Paris‐Saclay University, CHU Ambroise ParéBoulogne‐BillancourtFrance
| | | | - Didier Bouhassira
- Inserm U987, APHP, UVSQ, Paris‐Saclay University, CHU Ambroise ParéBoulogne‐BillancourtFrance
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8
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Vetterlein A, Monzel M, Richter-Hetzer S, Kapala K, Geppert J, Baki S, Reuter M. Pain sensitivity is associated with general attitudes towards pain: Development and validation of a new instrument for pain research and clinical application. Eur J Pain 2022; 26:1079-1093. [PMID: 35263817 DOI: 10.1002/ejp.1932] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND With regard to attitudes towards pain, many questionnaires have been developed. Although undoubtedly useful, they were specifically designed for the use in chronic pain and are less suitable for the assessment in the general population. The purpose of the present paper was to develop a measure for the assessment of general attitudes towards pain applicable in the general population, regardless of clinical condition, and to test its psychometric properties. METHODS We developed the General Attitudes Towards Pain Inventory and conducted two studies in order to provide psychometric data: In a general population sample (N = 362, study one), participants were asked to complete a questionnaire battery. To assess test-retest reliability, participants were contacted again after four weeks (retest sample: N = 101). For the evaluation of criterion validity (study two), a sample with sadomasochistic sexual preference (N = 68) was additionally recruited. RESULTS Statistical analyses revealed, overall, acceptable internal consistencies and test-retest reliabilities. A ten-factor model showed acceptable fit and was superior to alternative models. The inventory demonstrated convergent and divergent validity. In this context, we found pain sensitivity to be associated with pain attitudes. Finally, compared to the general population sample, individuals with sadomasochistic sexual preference showed significantly higher scores on fascination-pleasure and challenge subscales. CONCLUSIONS In the present paper, we introduce a new and comprehensive instrument for pain research and provide evidence for its reliability and validity. In addition, we present new insights into how interindividual differences in pain sensitivity relate to pain attitudes.
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Affiliation(s)
- A Vetterlein
- Department of Psychology, University of Bonn, Germany
| | - M Monzel
- Department of Psychology, University of Bonn, Germany
| | | | - K Kapala
- Department of Neuropsychology and Psychotherapy, Neurological Therapy Center (NTC), Cologne, Germany
| | - J Geppert
- Department of Neurology, Neurological Therapy Center (NTC), Cologne, Germany
| | - S Baki
- Grunwald Private Dental Practice, Cologne, Germany
| | - M Reuter
- Department of Psychology, University of Bonn, Germany.,Center for Economics and Neuroscience (CENs), Laboratory of Neurogenetics, University of Bonn, Germany
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Herbenick D, Guerra-Reyes L, Patterson C, Rosenstock Gonzalez YR, Wagner C, Zounlome N. "It Was Scary, But Then It Was Kind of Exciting": Young Women's Experiences with Choking During Sex. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:1103-1123. [PMID: 34761344 PMCID: PMC8579901 DOI: 10.1007/s10508-021-02049-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 04/21/2021] [Accepted: 05/15/2021] [Indexed: 05/12/2023]
Abstract
Choking/strangulation during sex is prevalent among young adults, with one study finding that 58% of women college students had ever been choked during sex. However, no qualitative study has examined women's experiences with choking/strangulation during sex outside of intimate partner violence. The purpose of our qualitative interview study was to investigate women's experiences with choking and/or being choked during partnered sex. Through in-depth interviews with 24 undergraduate and graduate women students ages 18 to 33, we sought to understand how women communicate about choking, their learning about and initiation into choking, their feelings about being choked and choking others, as well as consent and safety practices used in relation to choking. We found that women had first learned about choking through diverse sources including pornography, erotic stories, magazines, social media, friends, and partners. While all 24 women had been choked during sex, only 13 of 24 had ever choked a partner. They described having engaged in choking with men as well as women and with committed as well as more casual partner types. Participants described consensual and non-consensual choking experiences. While many women enjoyed choking, others did it largely to please their sexual partner. Women described different methods and intensities of having been choked. Although very few had ever sought out information on safety practices or risk reduction, and only some had established safe words or safe gestures with partners, participants consistently expressed a belief that the ways in which they and their partner(s) engaged in choking were safe.
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Affiliation(s)
- Debby Herbenick
- Department of Applied Health Science, Indiana University School of Public Health-Bloomington, Indiana University, Bloomington, IN, 47401, USA.
- Center for Sexual Health Promotion, Indiana University, Bloomington, IN, USA.
- PH 116, Indiana University School of Public Health, Indiana University, Bloomington, IN, 47405, USA.
| | - Lucia Guerra-Reyes
- Department of Applied Health Science, Indiana University School of Public Health-Bloomington, Indiana University, Bloomington, IN, 47401, USA
- Center for Sexual Health Promotion, Indiana University, Bloomington, IN, USA
| | - Callie Patterson
- Department of Applied Health Science, Indiana University School of Public Health-Bloomington, Indiana University, Bloomington, IN, 47401, USA
- Center for Sexual Health Promotion, Indiana University, Bloomington, IN, USA
| | - Yael R Rosenstock Gonzalez
- Department of Applied Health Science, Indiana University School of Public Health-Bloomington, Indiana University, Bloomington, IN, 47401, USA
- Center for Sexual Health Promotion, Indiana University, Bloomington, IN, USA
| | - Caroline Wagner
- Department of Applied Health Science, Indiana University School of Public Health-Bloomington, Indiana University, Bloomington, IN, 47401, USA
- Center for Sexual Health Promotion, Indiana University, Bloomington, IN, USA
| | - Nelson Zounlome
- Department of Counseling and Educational Psychology, School of Education, Indiana University, Bloomington, USA
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Kimmey BA, McCall NM, Wooldridge LM, Satterthwaite T, Corder G. Engaging endogenous opioid circuits in pain affective processes. J Neurosci Res 2022; 100:66-98. [PMID: 33314372 PMCID: PMC8197770 DOI: 10.1002/jnr.24762] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/29/2020] [Accepted: 11/02/2020] [Indexed: 01/03/2023]
Abstract
The pervasive use of opioid compounds for pain relief is rooted in their utility as one of the most effective therapeutic strategies for providing analgesia. While the detrimental side effects of these compounds have significantly contributed to the current opioid epidemic, opioids still provide millions of patients with reprieve from the relentless and agonizing experience of pain. The human experience of pain has long recognized the perceived unpleasantness entangled with a unique sensation that is immediate and identifiable from the first-person subjective vantage point as "painful." From this phenomenological perspective, how is it that opioids interfere with pain perception? Evidence from human lesion, neuroimaging, and preclinical functional neuroanatomy approaches is sculpting the view that opioids predominately alleviate the affective or inferential appraisal of nociceptive neural information. Thus, opioids weaken pain-associated unpleasantness rather than modulate perceived sensory qualities. Here, we discuss the historical theories of pain to demonstrate how modern neuroscience is revisiting these ideas to deconstruct the brain mechanisms driving the emergence of aversive pain perceptions. We further detail how targeting opioidergic signaling within affective or emotional brain circuits remains a strong avenue for developing targeted pharmacological and gene-therapy analgesic treatments that might reduce the dependence on current clinical opioid options.
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Affiliation(s)
- Blake A. Kimmey
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA, Department of Neuroscience, Mahoney Institute for Neurosciences, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA, Equal contributions
| | - Nora M. McCall
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA, Department of Neuroscience, Mahoney Institute for Neurosciences, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA, Equal contributions
| | - Lisa M. Wooldridge
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA, Department of Neuroscience, Mahoney Institute for Neurosciences, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Theodore Satterthwaite
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA, Lifespan Informatics and Neuroimaging Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Gregory Corder
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA, Department of Neuroscience, Mahoney Institute for Neurosciences, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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11
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Wuyts E, Morrens M. The Biology of BDSM: A Systematic Review. J Sex Med 2022; 19:144-157. [PMID: 36963978 DOI: 10.1016/j.jsxm.2021.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 10/31/2021] [Accepted: 11/03/2021] [Indexed: 01/22/2023]
Abstract
INTRODUCTION BDSM is an abbreviation used to reference the concepts of bondage and discipline, dominance and submission, sadism and masochism, enacted by power exchanges between consensual partners. In recent years, attention has shifted from the idea of BDSM as a pathological and tabooed niche practice towards viewing BDSM as a healthy form of intimacy. AIM This systematic review brings together all existing literature on the biology of BDSM and places it in a broader biological context. METHODS A systematic search was conducted on PubMed, Web of Science and PsycARTICLES, of which 10 articles are included and discussed in this systematic review. RESULTS There is evidence for cortisol changes in submissives as a result of a BDSM interaction, suggesting involvement of the physiological stress system. Endocannabinoid changes implicate the pleasure and reward system. In dominants, this biologically measured pleasure seemed to be dependent on power play rather than pain play. Testosterone and oxytocin are also implicated in BDSM, though their role is less evident. Research into brain region activity patterns related to BDSM interest suggests a role for the parietal operculum and ventral striatum in the context of the pleasure and reward system, the primary and secondary somatosensory cortex in the context of pain perception, empathy-related circuits such as the anterior insula, anterior midcingulate cortex and sensorimotor cortex and the left frontal cortex in the context of social and sexual interactions. Pain thresholds are shown to be higher in submissive individuals and a BDSM interaction may cause pain thresholds to rise in submissives as well. CONCLUSION BDSM interactions are complex and influenced by several psychological, social and biological processes. Though research is limited, there is emerging evidence for an interaction between several biological systems involved in these types of interests and activities. This means there is an important role for future research to replicate and supplement current results.
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Affiliation(s)
- Elise Wuyts
- Faculty of Medicine and Health Sciences, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Campus Drie Eiken, University of Antwerp, Antwerp, Belgium
| | - Manuel Morrens
- Faculty of Medicine and Health Sciences, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Campus Drie Eiken, University of Antwerp, Antwerp, Belgium
- University Department of Psychiatry, Campus Duffel, Duffel, Belgium
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12
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Schippers EE, Smid WJ, Huckelba AL, Hoogsteder LM, Beekman ATF, Smit JH. Exploratory Factor Analysis of Unusual Sexual Interests. J Sex Med 2021; 18:1615-1631. [PMID: 37057429 DOI: 10.1016/j.jsxm.2021.07.002] [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: 03/09/2021] [Revised: 06/23/2021] [Accepted: 07/06/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Unusual sexual interests are largely intercorrelated, yet not much is known about underlying patterns of clusters between various sexual interests. AIM To identify underlying clusters of unusual sexual interests using exploratory factor analysis. METHODS We conducted exploratory factor analysis with self-reported interest in a wide variety of unusual sexual acts for an online, international sample (N = 669; 61% female), and for women and men separately. Factor regression weights were correlated to self-reported sex life satisfaction, sexual outlet, and psychiatric symptoms. OUTCOMES Participants rated the attractiveness of 50 unusual sexual activities, and reported on their sex life satisfaction (Arizona Sexual Experiences Scale), sexual outlet, and symptoms regarding ADHD (Adult ADHD Self-Report Screening Scale for DSM-5), depression, anxiety, and stress (Depression, Anxiety, and Stress Scale). RESULTS We identified 5 factors of unusual sexual interests that were largely comparable for women and men: submission/masochism, forbidden sexual activities, dominance/sadism, mysophilia (attraction to dirtiness or soiled things), and fetishism. For women, unusual sexual interests related to more psychiatric symptoms and higher sexual outlet, whereas this relation was less explicit for men. CLINICAL IMPLICATIONS Different factors of unusual sexual interests may serve different underlying functions or motivations, for instance related to sexual, and emotional regulation. A better understanding of the nature of unusual sexual interests is important to be able to influence sexual interests that are unwanted or cause damage to others. STRENGTHS & LIMITATIONS Strength of this study include its anonymity, the avoidance of sexual orientation effects, and the possibility to indicate only a slight endorsement toward sexual items. Limitations include the sample's generalizability and the truthfulness of online responding. CONCLUSION Unusual sexual interests could be clustered into 5 factors that were largely comparable for women and men: submission/masochism, forbidden sexual activities, dominance/sadism, mysophilia, and fetishism. Schippers EE, Smid WJ, Huckelba AL, et al. Exploratory Factor Analysis of Unusual Sexual Interests. J Sex Med 2021;18:1615-1631.
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Affiliation(s)
- Eveline E Schippers
- Forensic Care Specialists, Utrecht, the Netherlands; Department of Psychiatry, and GGZ inGeest, Amsterdam University Medical Centers, Free University Amsterdam, Amsterdam, the Netherlands.
| | | | - Anna Laura Huckelba
- Department of Experimental and Applied Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | | | - Aartjan T F Beekman
- Department of Psychiatry, and GGZ inGeest, Amsterdam University Medical Centers, Free University Amsterdam, Amsterdam, the Netherlands
| | - Jan H Smit
- Department of Psychiatry, and GGZ inGeest, Amsterdam University Medical Centers, Free University Amsterdam, Amsterdam, the Netherlands
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Herbenick D, Fu TC, Valdivia DS, Patterson C, Gonzalez YR, Guerra-Reyes L, Eastman-Mueller H, Beckmeyer J, Rosenberg M. What Is Rough Sex, Who Does It, and Who Likes It? Findings from a Probability Sample of U.S. Undergraduate Students. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:1183-1195. [PMID: 33564979 DOI: 10.1007/s10508-021-01917-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 01/02/2021] [Accepted: 01/13/2021] [Indexed: 05/12/2023]
Abstract
Using data from an undergraduate probability sample, we aimed to: (1) describe the prevalence and demographic characteristics of students who reported having engaged in rough sex with their current partner; (2) assess which sexual behaviors students consider to be rough sex; (3) describe the frequency with which participants report engaging in rough sex as well as their reports of initiating and liking rough sex, in relation to gender and sexual identity; and (4) examine predictors of rough sex frequency. Participants were 4998 students randomly sampled from a large Midwestern university who completed a confidential Internet-based survey (2453 women, 2445 men, 41 gender non-binary, 36 transgender or other gender non-conforming identities). Within these, 1795 individuals who reported a romantic/sexual partner of at least 3 months responded to questions about engaging, liking, and initiating rough sex. The most common behaviors participants considered to be rough sex were choking, hair pulling, and spanking. Transgender and gender non-binary students more often endorsed behaviors as rough sex. Also, rough sex was conceptualized as multidimensional, with one cluster being more consistent with earlier conceptualizations of rough sex (e.g., hair pulling, spanking) and the second cluster including behaviors such as choking, slapping, punching, and making someone have sex. About 80% of those with a current sexual or romantic partner engaged in rough sex with them and most who engaged it liked it. Bisexual women reported greater rough sex frequency and enjoyment (54.1% indicated enjoying it "very much"). Implications for sexuality research and education are discussed.
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Affiliation(s)
- Debby Herbenick
- Department of Applied Health Science, Indiana University School of Public Health, Indiana University, Bloomington, IN, 47401, USA.
- The Center for Sexual Health Promotion, Indiana University School of Public Health, Indiana University, Bloomington, IN, USA.
| | - Tsung-Chieh Fu
- Department of Applied Health Science, Indiana University School of Public Health, Indiana University, Bloomington, IN, 47401, USA
- The Center for Sexual Health Promotion, Indiana University School of Public Health, Indiana University, Bloomington, IN, USA
| | - Dubravka Svetina Valdivia
- Department of Counseling and Educational Psychology, School of Education, Indiana University, Bloomington, IN, USA
| | - Callie Patterson
- Department of Applied Health Science, Indiana University School of Public Health, Indiana University, Bloomington, IN, 47401, USA
- The Center for Sexual Health Promotion, Indiana University School of Public Health, Indiana University, Bloomington, IN, USA
| | - Yael Rosenstock Gonzalez
- Department of Applied Health Science, Indiana University School of Public Health, Indiana University, Bloomington, IN, 47401, USA
- The Center for Sexual Health Promotion, Indiana University School of Public Health, Indiana University, Bloomington, IN, USA
| | - Lucia Guerra-Reyes
- Department of Applied Health Science, Indiana University School of Public Health, Indiana University, Bloomington, IN, 47401, USA
- The Center for Sexual Health Promotion, Indiana University School of Public Health, Indiana University, Bloomington, IN, USA
| | - Heather Eastman-Mueller
- Department of Applied Health Science, Indiana University School of Public Health, Indiana University, Bloomington, IN, 47401, USA
- The Center for Sexual Health Promotion, Indiana University School of Public Health, Indiana University, Bloomington, IN, USA
| | - Jonathon Beckmeyer
- Department of Applied Health Science, Indiana University School of Public Health, Indiana University, Bloomington, IN, 47401, USA
- The Center for Sexual Health Promotion, Indiana University School of Public Health, Indiana University, Bloomington, IN, USA
| | - Molly Rosenberg
- The Center for Sexual Health Promotion, Indiana University School of Public Health, Indiana University, Bloomington, IN, USA
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health, Indiana University, Bloomington, IN, USA
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