1
|
Vandervoort M, Liosatos A, Aladhami H, Suschinsky KD, Lalumière ML. Victim Sexual Arousal During Nonconsensual Sex: A Scoping Review. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:2305-2318. [PMID: 38724699 DOI: 10.1007/s10508-024-02852-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 03/05/2024] [Accepted: 03/06/2024] [Indexed: 06/14/2024]
Abstract
Sexual arousal in male and female victims during nonconsensual sex is an understudied phenomenon with many potential psychological, clinical, and legal implications for survivors. The aim of this scoping review was to assess the literature to determine whether we could estimate the frequency and circumstances of physiological sexual arousal (e.g., erection, lubrication, ejaculation, orgasm) among victims during nonconsensual sex. Six reference database and hand searches led to the screening of 13,894 articles and other reports. Eight articles and one book published between 1977 and 2019 included relevant data from 136 male survivors and 250 female survivors. Results confirmed that physiological sexual arousal (only genital responses were mentioned) can occur in both male and female victims during nonconsensual sex. The frequency of these responses could not be determined because of the widely different methodologies used. In addition, it was not possible to determine the circumstances in which victim sexual arousal was more likely to occur although some were inferred. The results of the scoping review highlight that physiological sexual arousal during nonconsensual sex does occur for victims but has not been studied systematically. There is a clear need to properly assess the type, circumstances, consequences, and frequency of sexual arousal during nonconsensual sex in large and diverse populations of male and female survivors.
Collapse
Affiliation(s)
- Mariève Vandervoort
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier, Ottawa, ON, K1Y 0X7, Canada
| | - Andrea Liosatos
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier, Ottawa, ON, K1Y 0X7, Canada
| | - Haybet Aladhami
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier, Ottawa, ON, K1Y 0X7, Canada
| | | | - Martin L Lalumière
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier, Ottawa, ON, K1Y 0X7, Canada.
| |
Collapse
|
2
|
Steil R, Weiss J, Bornefeld-Ettmann P, Priebe K, Kleindienst N, Müller-Engelmann M. A preliminary study on the effect of trauma-focused therapies on sexual dysfunctions in women with PTSD after childhood abuse. J Psychiatr Res 2024; 170:340-347. [PMID: 38211457 DOI: 10.1016/j.jpsychires.2024.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 01/02/2024] [Accepted: 01/06/2024] [Indexed: 01/13/2024]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is often associated with female sexual dysfunctions (FSD). However, little is known about the impact of therapies for PTSD on FSD according to DSM-5 criteria. AIM/OBJECTIVE To examine if sexual functioning diagnosed according to DSM-5 criteria improves after treatment for PTSD in women with a PTSD diagnosis after interpersonal child abuse. METHOD FSD according to DSM-5 criteria were assessed with the structured clinical interview SISEX in N = 152 female participants (mean age = 36.5 years) of a large randomized controlled trial three months into treatment and after 15 months of receiving either dialectical behavior therapy for PTSD or cognitive processing therapy. Number of fulfilled FSD criteria and diagnostic status were compared from pre-to post-treatment using Poisson and negative binomial regression analyses and the McNemar test. The effect of treatment type on reduction of FSD symptoms and the association between reduction in PTSD symptoms and reduction in FSD symptoms were assessed. RESULTS From pre-to post-treatment, the number of fulfilled criteria for each FSD decreased (Incident rate ratios between 0.60 and 0.71, p between <. 001 and <0 .05). Less women met criteria for genito-pelvic pain/penetration disorder at post-treatment compared to pre-treatment (11.8 % vs. 6.6 %, p < .05). No difference was found between treatments in reduction of FSD symptoms. Reduction of PTSD symptoms was associated with greater decrease in FSD symptoms. CONCLUSIONS Our results suggest a positive association between effective PTSD treatments and improvements in sexual functioning of women with PTSD after child abuse.
Collapse
Affiliation(s)
- Regina Steil
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt am Main, Germany.
| | - Judith Weiss
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt am Main, Germany
| | - Pia Bornefeld-Ettmann
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt am Main, Germany
| | - Kathlen Priebe
- Faculty of Life Sciences, Department of Psychology, Humboldt-University of Berlin, Berlin, Germany; Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Nikolaus Kleindienst
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Meike Müller-Engelmann
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt am Main, Germany; Faculty of Human Sciences, Department of Psychology, Medical School Hamburg, Germany
| |
Collapse
|
3
|
Abu-Raya NE, Gewirtz-Meydan A. Childhood Sexual Abuse and Relationship Satisfaction: The Moderating Role of PTSD and Sexual-Related Posttraumatic Stress Symptoms. JOURNAL OF SEX & MARITAL THERAPY 2023; 49:996-1012. [PMID: 37497823 DOI: 10.1080/0092623x.2023.2237510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Research on childhood sexual abuse (CSA) has consistently demonstrated the long-term effects of such abuse, not only on survivors' development, but also on the nature and quality of their adult relationships, particularly romantic ones. In this study we examined the moderating role of posttraumatic stress disorder (PTSD) and sexual-related posttraumatic stress symptoms (sexual-related PTSS) between CSA and relationship satisfaction. Survey data from 529 individuals who reported being currently in a romantic relationship were analyzed. In the first set of analyses, results demonstrated that participants with CSA reported significantly lower relationship satisfaction and significantly greater severity of PTSD and sexual-related PTSS than participants without CSA. Sexual-related PTSS but not PTSD moderated the association between CSA and participants' relationship satisfaction, with the model of sexual-related PTSS explaining 20.8% of the variance in relationship satisfaction and the model of PTSD explaining 11.3% of this variance. In the second set of analyses conducted among survivors of CSA only, higher sexual-related PTSS severity was linked with ongoing abuse and with abuse by a non-family member. This study points to the potential contribution made by sexual-related PTSS to relationship satisfaction among survivors of CSA.
Collapse
Affiliation(s)
- Narges Evon Abu-Raya
- School of Social Work, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Ateret Gewirtz-Meydan
- School of Social Work, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| |
Collapse
|
4
|
Gewirtz-Meydan A, Godbout N. Between pleasure, guilt, and dissociation: How trauma unfolds in the sexuality of childhood sexual abuse survivors. CHILD ABUSE & NEGLECT 2023; 141:106195. [PMID: 37116448 DOI: 10.1016/j.chiabu.2023.106195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 03/02/2023] [Accepted: 04/07/2023] [Indexed: 06/05/2023]
Abstract
BACKGROUND Childhood sexual abuse (CSA) is a significant risk factor for sexual difficulties in adulthood. OBJECTIVE In the current study we aimed to expand the understanding of the association between CSA and sexual difficulties by examining the moderating role of traumatic sexuality in the association between CSA and sexual difficulties among a sample of CSA survivors. PARTICIPANTS AND SETTING The hypothesized moderation model was examined among a sample of 393 CSA survivors. METHODS Significant interactions were probed using simple slopes tests using the interactions R package. RESULTS The results indicated main effects of traumatic sexuality on survivors' sexual difficulties: Greater severity of dissociation during sex was linked with greater sexual dysfunction and higher compulsive sexual behavior disorder (CSBD), and greater intrusiveness during sex and pleasing the other during sex were linked with higher CSBD. Experiencing higher sex-related guilt and/or shame and hypervigilance with regard to sex were associated with greater sexual dysfunction. As for the moderations, intrusiveness during sex and pleasing the other during sex moderated the association between CSA and sexual dysfunction. Intrusiveness during sex and sex-related guilt and/or shame moderated the association between CSA and CSBD. Intrusiveness during sex, pleasing the other during sex, and/or hypervigilance with regard to sex moderated the association between CSA and problematic pornography use. CONCLUSION This study points to the potential contribution of traumatic sexuality symptoms to sexual difficulties among survivors of CSA and lends support to the idea of offering trauma-focused therapy when treating the sexual difficulties of CSA survivors.
Collapse
Affiliation(s)
- Ateret Gewirtz-Meydan
- School of Social Work, Faculty of Social Welfare & Health Sciences, University of Haifa, Israel. agewirtz-@univ.haifa.ac.il
| | - Natacha Godbout
- Sexology department, Université du Québec à Montréal (UQAM), Canada.
| |
Collapse
|
5
|
Gewirtz-Meydan A, Lassri D. Sex in the Shadow of Child Sexual Abuse: The Development and Psychometric Evaluation of the Post-Traumatic Sexuality (PT-SEX) Scale. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:4714-4741. [PMID: 36000712 DOI: 10.1177/08862605221118969] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
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.
Collapse
Affiliation(s)
- Ateret Gewirtz-Meydan
- School of Social Work, Faculty of Social Welfare & Health Sciences, University of Haifa, Israel
| | - Dana Lassri
- The Paul Baerwald School of Social Work and Social Welfare, The Hebrew University of Jerusalem, Israel
| |
Collapse
|
6
|
Wulf MJ, Tom VJ. Consequences of spinal cord injury on the sympathetic nervous system. Front Cell Neurosci 2023; 17:999253. [PMID: 36925966 PMCID: PMC10011113 DOI: 10.3389/fncel.2023.999253] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 02/09/2023] [Indexed: 03/06/2023] Open
Abstract
Spinal cord injury (SCI) damages multiple structures at the lesion site, including ascending, descending, and propriospinal axons; interrupting the conduction of information up and down the spinal cord. Additionally, axons associated with the autonomic nervous system that control involuntary physiological functions course through the spinal cord. Moreover, sympathetic, and parasympathetic preganglionic neurons reside in the spinal cord. Thus, depending on the level of an SCI, autonomic function can be greatly impacted by the trauma resulting in dysfunction of various organs. For example, SCI can lead to dysregulation of a variety of organs, such as the pineal gland, the heart and vasculature, lungs, spleen, kidneys, and bladder. Indeed, it is becoming more apparent that many disorders that negatively affect quality-of-life for SCI individuals have a basis in dysregulation of the sympathetic nervous system. Here, we will review how SCI impacts the sympathetic nervous system and how that negatively impacts target organs that receive sympathetic innervation. A deeper understanding of this may offer potential therapeutic insight into how to improve health and quality-of-life for those living with SCI.
Collapse
Affiliation(s)
| | - Veronica J. Tom
- Marion Murray Spinal Cord Research Center, Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA, United States
| |
Collapse
|
7
|
Schippers EE, Smid WJ, Both S, Smit JH. Excitation Transfer Between Sexual Arousal and Other Emotions in a Community Sample. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:3905-3918. [PMID: 35471677 DOI: 10.1007/s10508-021-02235-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 11/12/2021] [Accepted: 11/12/2021] [Indexed: 06/14/2023]
Abstract
Excitation transfer, the transfer of arousal from one emotion to another, might be a mechanism in the development of unusual sexual interests. In this pilot study, we investigated whether we could induce excitation transfer between various emotions and sexual arousal in a laboratory setting with 30 male volunteers. We induced low-level sexual arousal in four different emotional states (aggression/dominance, endearment, fear, disgust) and a neutral state. Sexual arousal was measured using penile plethysmography and self-report. Although there was no mean group effect, possibly due to large interindividual variations, 60% of the subjects showed more sexual arousal in response to sexual stimulation in at least one of the emotional states than in the neutral state. Excitation transfer was most prominent with aggression/dominance and least prominent with disgust. Genital excitation transfer was strongly related to lower penile reactivity and to higher self-reported erotophilia. This pilot study paves the way for further research into excitation transfer as a mechanism to increase the salience of stimuli that otherwise would not have been sexual in nature.
Collapse
Affiliation(s)
- Eveline E Schippers
- Forensic Care Specialists, Oudlaan 9, 3515 GA, Utrecht, The Netherlands.
- Faculty of Psychology and Neuroscience, Section Forensic Psychology, Maastricht University, Maastricht, The Netherlands.
| | - Wineke J Smid
- Forensic Care Specialists, Oudlaan 9, 3515 GA, Utrecht, The Netherlands
| | - Stephanie Both
- Department of Psychosomatic Gynaecology and Sexology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Johannes H Smit
- Department of Research and Innovation, GGZ INGEEST Specialized Mental Health Care, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam University Medical Centers, Amsterdam Public Health, Free University Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
8
|
Bekhbat M, Turpin RE. Sexual arousal after abuse: (Mal)adaptations of the local immune response. Brain Behav Immun 2022; 106:127-128. [PMID: 36041684 PMCID: PMC10659124 DOI: 10.1016/j.bbi.2022.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 08/25/2022] [Indexed: 10/31/2022] Open
Affiliation(s)
- Mandakh Bekhbat
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30322, USA.
| | - Rodman E Turpin
- Department of Global and Community Health, College of Health and Human Services, George Mason University, Fairfax, VA 22030, USA
| |
Collapse
|
9
|
Sartin-Tarm A, Lorenz T. Sexual Trauma Moderates Hormonal Mediators of Women’s Sexual Function. CURRENT SEXUAL HEALTH REPORTS 2022. [DOI: 10.1007/s11930-022-00337-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
10
|
Paced Mating Behaviour Is Influenced by Duration of Female Post-Ejaculatory Interval. J Sex Med 2022; 19:1506-1516. [PMID: 35995714 DOI: 10.1016/j.jsxm.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 06/10/2022] [Accepted: 07/17/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Laboratory paradigms that enable the female rat to control the frequency and temporal distribution of sexual stimulation are well-suited to gaining knowledge about female sexual function; however, the variety of procedures used influence the specific behaviors exhibited by female rats and bring uncertainty into the conclusions that can be drawn. AIM In this study, we evaluated the effects of test parameters on the display of paced mating behavior in female rats to develop better preclinical models for exploring female sexual health. METHODS Sexually experienced, estradiol- and progesterone-primed female rats were tested under paced mating conditions to determine whether sexual behavior differed as a function of number of male partners (1 or 3; Experiment 1), the time span between receipt of an ejaculation and the next intromission (ie, the post-ejaculatory interval or PEI; Experiment 2), or the duration of ejaculations (Experiment 3). OUTCOMES Contact-return latency, exit latency, and withdrawal duration after mounts, intromissions, and ejaculations. RESULTS The shorter withdrawal latency after intromission and longer return latency after ejaculation observed in 30-minute paced mating tests is best attributed to the female's PEI. The duration of the PEI is a specific factor that affects the display of paced mating behavior. CLINICAL TRANSLATION Understanding of neurobiological mechanisms and sensory factors influencing sexual behavior learned from these models can be applied to studies of human female sexual health. STRENGTHS & LIMITATIONS Sexual motivation is indicated by analogous behaviors and supported by evolutionarily conserved systems in women and rats, meaning that animal models can be used to identify neurobiological mechanisms subserving these behaviors. Nonetheless, data related specifically to physiological effects of different mating paradigms are needed in future research. CONCLUSION Procedures that mimic naturalistic settings, and thus enable female sexual motivation to drive behavior, are apt for studies aimed at understanding mechanisms supporting female sexual function whereas artificially lengthening the interval between an ejaculation and subsequent intromission may provide a model to study female sexual dysfunction.
Collapse
|
11
|
Clephane K, Wilson MC, Heiman JR, Craig AN, Lorenz T. Sexual violence history predicts changes in vaginal immune parameters during sexual arousal. Brain Behav Immun 2022; 104:171-180. [PMID: 35697156 PMCID: PMC9734281 DOI: 10.1016/j.bbi.2022.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/24/2022] [Accepted: 06/05/2022] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To examine the influence of sexual arousal on vaginal mucosal inflammatory cytokine and antibody production in healthy women with and without histories of childhood and/or adult sexual violence. METHODS Ninety-one premenopausal healthy women (ages 18-42) attended a single laboratory session in which they provided vaginal fluid samples before and after viewing one neutral and one erotic film. While viewing the films, participants' vaginal sexual arousal was recorded using vaginal photoplethysmography. RESULTS Of the 91 participants, 41 (45%) reported no history of sexual violence, 17 (19%) reported a history of childhood sexual abuse (CSA) only, 19 (21%) reported a history of adult sexual assault (ASA) only, and 10 (11%) reported a history of both CSA and ASA, with 4 participants choosing not to provide information on their sexual violence history. For women with a history of ASA but not CSA, there was a significant increase in vaginal IL-1β following arousal, while for women with a history of CSA (with or without ASA), there was a significant decrease. Women without CSA histories had a significant increase in vaginal IgA following sexual arousal, while women with CSA histories had a decrease. CONCLUSION Sexual arousal possibly plays a role in modifying vaginal immune responses in young, healthy women. Moreover, these effects may vary depending upon sexual assault histories, such that relative to women without assault histories, women with a history of early life sexual trauma showed significantly altered vaginal immune responses following sexual arousal. If replicated, these findings may help explain the increased risk for sexually transmitted infections observed among women with sexual assault histories.
Collapse
Affiliation(s)
- Kirstin Clephane
- Department of Psychology, University of Nebraska-Lincoln, United States; Center for Brain, Biology & Behavior, University of Nebraska-Lincoln, United States
| | - M Claire Wilson
- Department of Psychological and Brain Sciences, Indiana University, United States
| | - Julia R Heiman
- Department of Psychological and Brain Sciences, Indiana University, United States
| | - Amber N Craig
- Medical College of Wisconsin, Department of Psychiatry and Behavioral Medicine, United States
| | - Tierney Lorenz
- Department of Psychology, University of Nebraska-Lincoln, United States; Center for Brain, Biology & Behavior, University of Nebraska-Lincoln, United States.
| |
Collapse
|
12
|
Oliva-Lozano JM, Alacid F, López-Miñarro PA, Muyor JM. What Are the Physical Demands of Sexual Intercourse? A Systematic Review of the Literature. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:1397-1417. [PMID: 35147835 PMCID: PMC8917001 DOI: 10.1007/s10508-021-02246-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 11/22/2021] [Accepted: 11/22/2021] [Indexed: 06/14/2023]
Abstract
The aim of this study was to systematically review the literature investigating the physical demands of sexual intercourse and to synthesize the evidence related to this research topic. Original studies published on PubMed, Scopus, and Web of Science up until April 2020 were examined. The Effective Public Health Practice Project scale was used to assess the methodological quality of each study. Eighteen studies analyzed physical demands during sexual intercourse through the physiological demands (n = 14) and kinematics (n = 4) of sexual intercourse. Sexual intercourse can elicit an energy expenditure of ~ 100 kcal (or ~ 6 metabolic equivalent units, METs) during the activity, mean heart rates between ~ 90 and ~ 130 beats per minute (bpm), and peak heart rates up to ~ 170 bpm. However, these physical demands may vary depending on health status, intercourse position, activity duration, intercourse phase, and sex differences. The movement pattern was cyclic in all positions and the greatest demands in lumbar spine flexion were found in the missionary positions for women. Missionary and side-lying positions elicited the greatest lumbar flexion movement in men. Regarding the movement of the hip joint during sexual intercourse, flexion, abduction, and external rotation mainly characterized the woman's movement while external rotation did so in the man. In conclusion, sexual intercourse may elicit moderate intensity physical demands, but these demands vary depending on contextual variables. In addition, not only studies combining physiological and kinematic analyses are necessary but also more high-quality studies need to be published in order to have a better understanding of the physical demands of sexual intercourse.
Collapse
Affiliation(s)
- José M Oliva-Lozano
- Health Research Centre, Faculty of Educational Sciences, University of Almería, Edificio de Humanidades A, Ctra. Sacramento s/n. 04120, La Cañada de San Urbano, Almería, Spain
| | - Fernando Alacid
- Health Research Centre, Faculty of Educational Sciences, University of Almería, Edificio de Humanidades A, Ctra. Sacramento s/n. 04120, La Cañada de San Urbano, Almería, Spain
| | | | - José M Muyor
- Health Research Centre, Faculty of Educational Sciences, University of Almería, Edificio de Humanidades A, Ctra. Sacramento s/n. 04120, La Cañada de San Urbano, Almería, Spain.
- Laboratory of Kinesiology, Biomechanics and Ergonomics, Research Central Services, University of Almería, Almería, Spain.
| |
Collapse
|
13
|
Clephane K, Wilson MC, Craig AN, Heiman JR, Lorenz TK. Inflammation predicts sexual arousability in healthy women. COMPREHENSIVE PSYCHONEUROENDOCRINOLOGY 2021; 8. [PMID: 35669911 PMCID: PMC9165647 DOI: 10.1016/j.cpnec.2021.100086] [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] [Indexed: 01/08/2023] Open
Abstract
Background Though many women report sexual arousal difficulties, the mechanisms driving these difficulties are unclear. Sexual response relies on a host of psychophysiological processes that have bidirectional relationships with inflammation. Additionally, chronic inflammation may impair genital blood flow, which in turn may impact sexual arousal. C-reactive protein (CRP) is an acute-phase marker of inflammation produced in response to cytokine signaling throughout the body, which makes it a useful marker of systemic inflammation. Aim The present study examined interactions between inflammation and women's sexual arousal. Methods CRP, self-reported frequency of partnered sexual activity, and subjective and vaginal arousal were assessed in 91 healthy, pre-menopausal women. Data were collected during a single laboratory session. Main outcome measures Subjective sexual arousal and vaginal pulse amplitude (a measure of vaginal arousal) were the main outcome measures. Results Change in subjective sexual arousal in response to a sexual film was unaffected by baseline CRP and sexual frequency. However, there were significant interactions between inflammation and sexual frequency in predicting vaginal arousal during the sexual film. Among women reporting more frequent sexual activity, higher CRP predicted lower magnitude arousal response and longer time to maximum vaginal arousal. Among women reporting less frequent sex, higher CRP predicted shorter time to maximum arousal and greater magnitude of arousal response. Controlling for cortisol strengthened the effects seen for time to maximum vaginal arousal but weakened those observed for percent change. Conclusions Among healthy young women, higher CRP may be associated with vaginal arousal, but not subjective sexual arousal. Specifically, our results suggest that higher baseline CRP is associated with lower genital sexual arousal for women who have sex frequently, which is consistent with clinical evidence that elevated inflammation can be detrimental to sexual function. Among healthy young women, higher CRP may be associated with vaginal sexual arousal, but not subjective sexual arousal. Frequency of sexual activity interacts with CRP levels to contribute to vaginal arousal in healthy women. Higher CRP predicted lower genital sexual arousal in women who engage in sexual activity more than once a week. However, higher CRP predicted greater genital sexual arousal in women who engage in sexual activity less than once a week.
Collapse
|
14
|
Bird ER, Piccirillo M, Garcia N, Blais R, Campbell S. Relationship Between Posttraumatic Stress Disorder and Sexual Difficulties: A Systematic Review of Veterans and Military Personnel. J Sex Med 2021; 18:1398-1426. [PMID: 37057456 DOI: 10.1016/j.jsxm.2021.05.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 04/26/2021] [Accepted: 05/15/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is associated with sexual difficulties but the nuances of this relationship remain elusive. Research has increased in recent years, most notably following publication of several reviews in 2015. AIM This systematic review examines the relationship between PTSD and sexual difficulties in veterans/military personnel. METHODS A systematic review was conducted using PRISMA guidelines in PsycINFO and PubMed databases for studies examining a diagnosis of PTSD or PTSD severity in relation to a range of sexual difficulties. Forty-three studies were identified that met inclusion and exclusion criteria for this review. RESULTS PTSD was associated with increased risk of experiencing at least one sexual difficulty. PTSD was most clearly associated with overall sexual function, sexual desire, sexual satisfaction, and sexual distress. Results were mixed for sexual arousal, orgasm function, erectile dysfunction, premature ejaculation, sexual pain, and frequency of sexual activity. PTSD symptom clusters of avoidance and negative alterations in cognition/mood were most commonly associated sexual difficulties. Few studies compared results by gender and trauma type. CLINICAL IMPLICATIONS Clinicians should inquire about sexual health in relation to PTSD symptoms and target avoidance and negative mood symptoms by incorporating sexual exposure assignments and sexual activation exercises when appropriate. STRENGTHS & LIMITATIONS This systematic review synthesizes an extensive literature that has grown substantially in the past 5 years and includes studies with low to moderate risk of bias. Limitations of the existing literature include challenges differentiating between PTSD and depression, inconsistent measurement of PTSD and trauma histories, inconsistent operationalization and measurement of sexual outcomes, and largely cross-sectional study designs. CONCLUSION PTSD is linked to a range of sexual outcomes. The current literature suggests that PTSD is associated with sexual difficulties related to both the sexual response cycle (ie, sexual desire) and one's emotional relationship to sexual activity (eg, sexual distress). More research is needed to increase confidence in findings. Bird ER, Piccirillo M, Garcia N, et al. Relationship Between Posttraumatic Stress Disorder and Sexual Difficulties: A Systematic Review of Veterans and Military Personnel. J Sex Med 2021;18:1398-1426.
Collapse
Affiliation(s)
- Elizabeth R Bird
- VA Puget Sound Healthcare System, Seattle Division, Seattle, WA.
| | - Marilyn Piccirillo
- VA Puget Sound Healthcare System, Seattle Division, Seattle, WA; University of Washington, Department of Psychology, Seattle, WA
| | - Natalia Garcia
- VA Puget Sound Healthcare System, Seattle Division, Seattle, WA
| | - Rebecca Blais
- Utah State University, Department of Psychology, Logan, UT
| | - Sarah Campbell
- Seattle-Denver Center of Innovation in Veteran-Centered and Value-Driven Care, Health Services Research and Development, VA Puget Sound Health Care System, Seattle, WA; Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
| |
Collapse
|
15
|
Lorenz T, Finley N. Mind-body-spirit model for the medical management of female sexual well-being. CURRENT SEXUAL HEALTH REPORTS 2020; 12:389-397. [PMID: 33815006 PMCID: PMC8011421 DOI: 10.1007/s11930-020-00291-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW Although healthcare providers are increasingly interested in addressing their female patient's sexual wellbeing in a holistic fashion, most do not receive training in how to conceptualize the complex interactions between mind, body and spirit that drive health and wellness, let alone how to apply empirical data in any of these dimensions to their individual patients. Here, we present a simple mind-body-spirit model, grounded in an integrative medicine approach, to help translate research on sexual functioning and satisfaction into a shared decision-making plan for the management and enhancement of women's sexual wellness. RECENT FINDINGS In considering the dimensions of physical and behavioral health, spirituality and sensuality, physicians can help women orient to the ways in which their sexual healthcare can address their core values and connection to others, which in turn can improve sexual satisfaction. The application of the model is outlined in a case study. SUMMARY Too often female sexual wellbeing is not discussed in the medical setting and this mind-body-spirit model is a tool that health care providers could use address this important aspect of well-being.
Collapse
Affiliation(s)
- Tierney Lorenz
- Department of Psychology, University of Nebraska – Lincoln
- Center for Brain, Biology & Behavior, University of Nebraska – Lincoln
| | | |
Collapse
|
16
|
Muallem MZ, Diab Y, Jöns T, Sehouli J, Muallem J. Nerve-Sparing Systematic Lymph Node Dissection in Gynaecological Oncology: An Innovative Neuro-Anatomical and Surgical Protocol for Enhanced Functional Outcomes. Cancers (Basel) 2020; 12:E3473. [PMID: 33266391 PMCID: PMC7700575 DOI: 10.3390/cancers12113473] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/19/2020] [Accepted: 11/20/2020] [Indexed: 11/29/2022] Open
Abstract
Whilst systematic lymph node dissection has been less prevalent in gynaecological cancer cases in the last few years, there is still a good number of cases that mandate a systematic lymph node dissection for diagnostic and therapeutic purposes. In all of these cases, it is crucial to perform the procedure as a nerve-sparing technique with utmost exactitude, which can be achieved optimally only by isolating and sparing all components of the aortic plexus and superior hypogastric plexus. To meet this purpose, it is essential to provide a comprehensive characterization of the specific anatomy of the human female aortic plexus and its variations. The anatomic dissections of two fresh and 17 formalin-fixed female cadavers were utilized to study, understand, and decipher the hitherto ambiguously annotated anatomy of the autonomic nervous system in the retroperitoneal para-aortic region. This study describes the precise anatomy of aortic and superior hypogastric plexus and provides the surgical maneuvers to dissect, highlight, and spare them during systematic lymph node dissection for gynaecological malignancies. The study also confirms the utility and feasibility of this surgery in gynaecological oncology.
Collapse
Affiliation(s)
- Mustafa Zelal Muallem
- Department of Gynecology with Center for Oncological Surgery, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Virchow Campus Clinic, Charité Medical University, 13353 Berlin, Germany; (J.S.); (J.M.)
| | - Yasser Diab
- Department of Gynecology, Portland Hospital, Portland, 3305 VIC, Australia;
| | - Thomas Jöns
- Department of Anatomy, Mitte Campus Clinic, Charité Medical University, 10117 Berlin, Germany;
| | - Jalid Sehouli
- Department of Gynecology with Center for Oncological Surgery, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Virchow Campus Clinic, Charité Medical University, 13353 Berlin, Germany; (J.S.); (J.M.)
| | - Jumana Muallem
- Department of Gynecology with Center for Oncological Surgery, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Virchow Campus Clinic, Charité Medical University, 13353 Berlin, Germany; (J.S.); (J.M.)
| |
Collapse
|
17
|
Sexual Dysfunction and Distress Among Childhood Sexual Abuse Survivors: The Role of Post-Traumatic Stress Disorder. J Sex Med 2020; 17:2267-2278. [DOI: 10.1016/j.jsxm.2020.07.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/14/2020] [Accepted: 07/20/2020] [Indexed: 12/21/2022]
|
18
|
Bachem R, Levin Y, Solomon Z. Posttraumatic Stress and Sexual Satisfaction in Husbands and Wives: A Dyadic Analysis. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:1533-1543. [PMID: 32246223 DOI: 10.1007/s10508-020-01680-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 03/04/2020] [Accepted: 03/04/2020] [Indexed: 06/11/2023]
Abstract
Trauma survivors who suffer from posttraumatic stress symptoms (PTSS) are known to experience impairments in sexual satisfaction. However, the negative effects of PTSS are not limited to the primary survivors, as they can lead to secondary PTSS in their spouses as well. The implications of secondary PTSS in the sexuality of couples remain unknown. This study aimed to investigate whether specific symptom clusters of PTSS (i.e., intrusions, hyperarousal, and avoidance) are implicated in the sexual satisfaction of couples. We assessed a sample of primarily exposed Israeli veterans from the Yom Kippur War and their wives who had been secondarily exposed (N = 191). The dyadic data were analyzed in an Actor-Partner Independence Model. When scrutinizing specific PTSS clusters, the husbands' avoidance related to their own sexual satisfaction. The wives' hyperarousal related to their own and their spouses' sexual satisfaction, whereas their intrusions were associated only with their husbands' sexual satisfaction. In conclusion, PTSS in one spouse is related to both spouses' sexual satisfaction; it is therefore recommended that clinicians adopt a dyadic approach when delivering interventions.
Collapse
Affiliation(s)
- Rahel Bachem
- I-Core Research Center for Mass Trauma, Tel Aviv University, Chaim Levanon 30, 6997801, Tel Aviv, Israel.
- Bob Shapell School of Social Work, Tel-Aviv University, Tel Aviv, Israel.
| | - Yafit Levin
- I-Core Research Center for Mass Trauma, Tel Aviv University, Chaim Levanon 30, 6997801, Tel Aviv, Israel
- Bob Shapell School of Social Work, Tel-Aviv University, Tel Aviv, Israel
| | - Zahava Solomon
- I-Core Research Center for Mass Trauma, Tel Aviv University, Chaim Levanon 30, 6997801, Tel Aviv, Israel
- Bob Shapell School of Social Work, Tel-Aviv University, Tel Aviv, Israel
| |
Collapse
|
19
|
Alley J, Diamond LM, Lipschitz DL, Grewen K. Women's Cortisol Stress Responsivity, Sexual Arousability, and Sexual History. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:1489-1503. [PMID: 32006207 DOI: 10.1007/s10508-019-01585-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 10/30/2019] [Accepted: 11/05/2019] [Indexed: 06/10/2023]
Abstract
Life history theory and the adaptive calibration model state that characteristics of one's early environment influence individual differences in both neuroendocrine reactivity to stress and sexual risk-taking behavior. However, few studies have directly examined the relationship between neuroendocrine reactivity to stress and risky sexual behavior. This study used multilevel modeling to test whether cortisol reactivity and recovery in response to laboratory stress were associated with women's history of sexual behavior and their sexual arousability in response to laboratory sexual stimuli. Participants were 65 women (35% heterosexual, 44% bisexual, and 21% lesbian) who completed two laboratory sessions, two weeks apart. Women's self-reported sexual arousability to sexual stimuli interacted with their sexual abuse history to predict their trajectories of cortisol stress reactivity and recovery. Cortisol reactivity and recovery were not associated with women's sexual risk taking, such as the age of sexual debut, sociosexuality, or lifetime number of sexual partners.
Collapse
Affiliation(s)
- Jenna Alley
- Department of Psychology, University of Utah, 380 South 1530 East, Room 502, Salt Lake City, UT, 84112-0251, USA.
| | - Lisa M Diamond
- Department of Psychology, University of Utah, 380 South 1530 East, Room 502, Salt Lake City, UT, 84112-0251, USA
| | - David L Lipschitz
- Department of Psychology, University of Utah, 380 South 1530 East, Room 502, Salt Lake City, UT, 84112-0251, USA
| | - Karen Grewen
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| |
Collapse
|
20
|
Badour CL, Cox KS, Goodnight JR, Flores J, Tuerk PW, Rauch SA. Sexual Desire among Veterans Receiving Prolonged Exposure Therapy for PTSD: Does Successful PTSD Treatment Also Yield Improvements in Sexual Desire? Psychiatry 2020; 83:70-83. [PMID: 31577915 PMCID: PMC7083685 DOI: 10.1080/00332747.2019.1672439] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: People with posttraumatic stress disorder (PTSD) commonly report difficulties with sexual desire and other aspects of sexual functioning, but it is currently unknown if people who respond to psychotherapy for PTSD also report improvements in sexual desire. Method: One hundred and eighty-seven veterans with PTSD received prolonged exposure (PE) therapy at two outpatient PTSD specialty clinics and completed measures of PTSD symptoms (the PTSD Checklist - Military Version) and sexual desire (item 21 of the Beck Depression Inventory - Second Edition) repeatedly throughout the course of treatment. Results: The results of a conditional generalized mixed ordinal regression model showed a significant interaction between weeks in treatment and PTSD treatment response in predicting change in sexual desire across the course of treatment. Specifically, PTSD treatment responders reported improvement in sexual desire over the course of treatment, whereas nonresponders did not show changes in sexual desire over time. However, the effect of PTSD treatment response was no longer significant when accounting for severity of depression at the start of treatment. Participants reporting more severe depression at the start of treatment reported less improvement in sexual desire, regardless of PTSD symptom response. Conclusions: People with PTSD who respond to PE also report improvements in sexual desire over time, indicating that response to PE is associated with improved sexual desire, but the effect is complicated by the presence of co-occurring depression symptomatology.
Collapse
Affiliation(s)
| | - Keith S. Cox
- University of North Carolina, Asheville, Department of Psychology
| | | | | | | | - Sheila A.M. Rauch
- Emory University, Department of Psychiatry and Behavioral Sciences,VA Atlanta Healthcare System, Mental Health Service Line
| |
Collapse
|
21
|
Abstract
Sexual arousal in women comprises two components: genital arousal and subjective arousal. Genital arousal is characterized by genital vasocongestion and other physiological changes that occur in response to sexual stimuli, whereas subjective arousal refers to mental engagement during sexual activity. For some women, genital arousal enhances subjective arousal; for others, the two types of arousal are desynchronous. However, the relationship between genital and subjective arousal might not be relevant to the diagnosis and treatment of sexual arousal dysfunction. Studies have shown that not all women who report sexual arousal problems have decreased genital arousal, and only some women with decreased genital arousal have low subjective arousal. To develop efficacious treatments for female sexual arousal dysfunction, researchers need to differentiate the women for whom genital sensations have a critical role in their subjective arousal from those who are not mentally aroused by genital cues. The mechanisms by which women become aroused and the inputs into arousal have considerable implications for treatment outcomes.
Collapse
|
22
|
Lahav Y, Price N, Crompton L, Laufer A, Solomon Z. Sexual Satisfaction in Spouses of Ex-POWs: The Role of PTSD Symptoms and Self-Differentiation. JOURNAL OF SEX & MARITAL THERAPY 2019; 45:755-766. [PMID: 30924723 DOI: 10.1080/0092623x.2019.1594478] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Spouses of former prisoners-of-war (ex-POWs) are at risk for posttraumatic stress symptoms (PTSS) and marital distress. This study assessed the implications of PTSS and self-differentiation for sexual satisfaction among 90 ex-POWs' spouses and 75 matched combatants' spouses from the 1973 Yom Kippur War. Standardized questionnaires were used. Ex-POWs' spouses had elevated PTSS and imbalanced self-differentiation. PTSS were associated with poorer self-differentiation and lower sexual satisfaction. Imbalanced self-differentiation mediated the association between PTSS and sexual satisfaction. The findings imply that PTSS and imbalanced self-differentiation contribute to low sexual satisfaction among spouses of primary trauma survivors.
Collapse
Affiliation(s)
- Yael Lahav
- Bob Shapell School of Social Work, Tel Aviv University , Tel Aviv, Israel
- I-CORE Research Center for Mass Trauma, Tel Aviv University , Tel Aviv, Israel
| | - Naomi Price
- Bob Shapell School of Social Work, Tel Aviv University , Tel Aviv, Israel
| | - Laura Crompton
- Bob Shapell School of Social Work, Tel Aviv University , Tel Aviv, Israel
- I-CORE Research Center for Mass Trauma, Tel Aviv University , Tel Aviv, Israel
| | - Avital Laufer
- School of Behavioral Sciences, Netanya Academic College , Netanya, Israel
| | - Zahava Solomon
- Bob Shapell School of Social Work, Tel Aviv University , Tel Aviv, Israel
- I-CORE Research Center for Mass Trauma, Tel Aviv University , Tel Aviv, Israel
| |
Collapse
|
23
|
Rowland DL, van Lankveld JJDM. Anxiety and Performance in Sex, Sport, and Stage: Identifying Common Ground. Front Psychol 2019; 10:1615. [PMID: 31379665 PMCID: PMC6646850 DOI: 10.3389/fpsyg.2019.01615] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 06/26/2019] [Indexed: 12/11/2022] Open
Abstract
Anxiety has long been associated with diminished performance within a number of domains involving evaluative interpersonal interactions, including Sex, Sport, and Stage. Here, we pose three questions: (1) how do these disparate fields approach and understand anxiety and performance; (2) how does the understanding of the issue within one field offer insight to another field; and (3) how could each field benefit from the ideas and strategies used by the others. We begin with a short review of models of anxiety/arousal and performance and then explore definitions, models, presumed underlying physiological processes, and characterizing and influencing factors within each domain separately in a narrative review. This discussion is followed by a synthesis that identifies elements specific to and common across the various domains, with the latter captured in a model of essential characteristics. Concluding remarks note the potential value of promoting increased cross-disciplinary conversation and research, with each domain likely benefiting from the conceptualizations and expert knowledge of the others.
Collapse
Affiliation(s)
- David L Rowland
- Department of Psychology, Valparaiso University, Valparaiso, IN, United States
| | | |
Collapse
|
24
|
Stanton AM, Boyd RL, Fogarty JJ, Meston CM. Heart rate variability biofeedback increases sexual arousal among women with female sexual arousal disorder: Results from a randomized-controlled trial. Behav Res Ther 2019; 115:90-102. [DOI: 10.1016/j.brat.2018.10.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 10/27/2018] [Accepted: 10/31/2018] [Indexed: 11/28/2022]
|
25
|
Bischof-Campbell A, Hilpert P, Burri A, Bischof K. Body Movement Is Associated With Orgasm During Vaginal Intercourse in Women. JOURNAL OF SEX RESEARCH 2019; 56:356-366. [PMID: 30358427 DOI: 10.1080/00224499.2018.1531367] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Very few studies have investigated the relationship between women's ability to experience an orgasm during vaginal intercourse and specific stimulation techniques. We examined two common techniques during vaginal intercourse both with and without simultaneous external clitoral stimulation: (1) body movement, in particular back-and-forth swinging movements of the pelvis and trunk; and (2) precise rubbing of the clitoris with an immobilized body. Structural equation modeling was used to compare the effects of the two stimulation techniques on women's orgasm frequency (N = 1,239). As hypothesized, the frequency of orgasm during vaginal intercourse with simultaneous clitoral stimulation was positively associated with a preference for body movement during arousal. Body movement, as opposed to body immobilization, was also associated with a higher frequency of orgasm during vaginal intercourse without simultaneous clitoral stimulation. We conclude that body movement is associated with more orgasms during vaginal intercourse, whereas precise rubbing of the clitoris with an immobilized body is not associated with more orgasms. Teaching women to move their pelvis and trunk in a swinging back-and-forth movement during vaginal intercourse might therefore facilitate reaching an orgasm, whereas encouraging them to self-stimulate the clitoris might be less helpful if done with an immobilized body.
Collapse
Affiliation(s)
| | - Peter Hilpert
- b School of Psychology, University of Surrey; and Department of Psychology, University of Zurich
| | - Andrea Burri
- c Health and Rehabilitation Research Institute, Auckland University of Technology; and European Institute for Sexual Health
| | | |
Collapse
|
26
|
Handy AB, Stanton AM, Meston CM. What Does Sexual Arousal Mean to You? Women With and Without Sexual Arousal Concerns Describe Their Experiences. JOURNAL OF SEX RESEARCH 2019; 56:345-355. [PMID: 29746186 DOI: 10.1080/00224499.2018.1468867] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Sexual arousal is frequently characterized by both subjective (i.e., mental) and physiological (e.g., genital) components. The nuances of these components, however, are difficult to capture via self-report instruments. Asking women to describe sexual arousal in their own words may therefore enhance our understanding of this construct. In the present study, women with (n = 190) and without (n = 610) arousal concerns were recruited online and wrote about their experience of sexual arousal. Seven clusters of words were extracted using automated text analysis, and the prominence of these clusters was compared between groups of women. The autonomic arousal cluster differed between groups such that women with arousal concerns invoked this cluster significantly less than did women with no such concerns. Furthermore, the context cluster significantly predicted group membership (odds ratio [OR] = 1.063); greater scores on this cluster were associated with arousal concerns. Results suggest that autonomic arousal and relationship factors may play important roles in arousal concerns. It is suggested that clinicians assess for aspects of the sexual relationship that may facilitate or hinder sexual arousal. Clinicians may also consider inquiring about the presence or appraisal of autonomic arousal (e.g., one's interpretation of an increase in heart rate or respiration) during sexual activity.
Collapse
Affiliation(s)
- Ariel B Handy
- a Department of Psychology , University of Texas at Austin
| | | | - Cindy M Meston
- a Department of Psychology , University of Texas at Austin
| |
Collapse
|
27
|
|
28
|
Lopes IP, Ribeiro VB, Reis RM, Silva RC, Dutra de Souza HC, Kogure GS, Ferriani RA, Silva Lara LAD. Comparison of the Effect of Intermittent and Continuous Aerobic Physical Training on Sexual Function of Women With Polycystic Ovary Syndrome: Randomized Controlled Trial. J Sex Med 2018; 15:1609-1619. [DOI: 10.1016/j.jsxm.2018.09.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 08/19/2018] [Accepted: 09/01/2018] [Indexed: 12/16/2022]
|
29
|
The Effects of Exercise on Sexual Function in Women. Sex Med Rev 2018; 6:548-557. [DOI: 10.1016/j.sxmr.2018.02.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 02/04/2018] [Accepted: 02/12/2018] [Indexed: 12/17/2022]
|
30
|
Bird ER, Seehuus M, Heiman JR, Davis KC, Norris J, George WH. Sexual vs. Nonsexual Currently Most Upsetting Trauma: A Fresh Look at Attenuation of Sexual Response, Alcohol Intoxication, and Post-Traumatic Stress. JOURNAL OF SEX RESEARCH 2018; 55:915-926. [PMID: 29023137 PMCID: PMC6195219 DOI: 10.1080/00224499.2017.1380159] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This study examined the dependence of sexual response (vaginal pulse amplitude [VPA] and subjective sexual arousal) on alcohol intoxication (.10% breath alcohol concentration [BrAC] versus no alcohol) and the nature of a woman's currently most upsetting traumatic event (C-MUTE), whether it was sexual (e.g., rape) or nonsexual (e.g., combat). Self-reported sexual outcomes were also compared by C-MUTE type. A total of 117 women completed background measures and either drank alcoholic or nonalcoholic beverages. They were shown erotic films and their VPA was assessed. A two (sexual versus nonsexual C-MUTE) by two (.10% BrAC versus no alcohol) analysis of variance (ANOVA) showed that, controlling for post-traumatic stress (PTS) symptoms, women with a sexual C-MUTE showed lower percent VPA change than women with a nonsexual C-MUTE. No significant effects were found for subjective sexual arousal. A multivariate analysis of variance (MANOVA) showed that women with a sexual C-MUTE reported more frequent anxiety and inhibition during partnered sex and more frequent lack of vaginal lubrication versus women with a nonsexual C-MUTE. There was no significant interaction between C-MUTE and alcohol intoxication. Whether a woman is currently upset by past sexual victimization may influence current sexual difficulties. Attenuated VPA may be attributable to the sexual nature of a C-MUTE as opposed to general trauma exposure.
Collapse
Affiliation(s)
| | | | - Julia R Heiman
- c Psychological and Brain Sciences , Indiana University
- d The Kinsey Institute , Indiana University
| | | | - Jeanette Norris
- f Alcohol and Drug Abuse Institute , University of Washington
| | | |
Collapse
|
31
|
Pulverman CS, Meston CM, Hixon JG. Automated Artifact-Detection Procedure for Vaginal Photoplethysmography. JOURNAL OF SEX & MARITAL THERAPY 2018; 44:566-590. [PMID: 29400613 DOI: 10.1080/0092623x.2018.1436627] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Vaginal photoplethysmography is the most commonly used method of assessing women's genital sexual arousal. Raw photoplethysmograph data consist of a series of peaks and troughs, and movement by the participant results in artifacts indicated by unusually high or low peak-to-trough amplitudes. The gold-standard approach to artifact detection involves visual inspection by a trained experimenter and manual removal of artifacts from the data set, however, this process is time-consuming and subject to human error. We present an automated data-processing procedure that uses a series of smoothing regression splines to model the data and identify outliers. The automated procedure was applied to a set of neutral data and sexual-arousal response data, and artifacts identified were compared to artifacts identified by the standard approach of visual inspection. The automated method showed acceptable accuracy in terms of sensitivity and specificity comparable to the manual-processing method. The automated procedure could reduce human error and data-processing time for studies using vaginal photoplethysmography.
Collapse
Affiliation(s)
- Carey S Pulverman
- a Department of Psychology , The University of Texas at Austin , Austin , TX , USA
| | - Cindy M Meston
- a Department of Psychology , The University of Texas at Austin , Austin , TX , USA
| | - J Gregory Hixon
- a Department of Psychology , The University of Texas at Austin , Austin , TX , USA
| |
Collapse
|
32
|
Rullo JE, Lorenz T, Ziegelmann MJ, Meihofer L, Herbenick D, Faubion SS. Genital vibration for sexual function and enhancement: a review of evidence. SEXUAL AND RELATIONSHIP THERAPY 2018; 33:263-274. [PMID: 33223960 DOI: 10.1080/14681994.2017.1419557] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Vibration, as provided by a genital vibrator, is commonly regarded as a tool to enhance sexual pleasure and in modern day society falls under the category of a sex toy. However, the vibrator was not originally intended to be a toy, and its benefits reach far beyond that of a plaything. This article is a narrative review of the current evidence regarding the use of vibratory stimulation for the treatment of sexual dysfunction and/or sexual and relationship enhancement. The literature indicates that vibratory stimulation has evidence-based support for the treatment of erectile dysfunction, ejaculatory dysfunction and anorgasmia. Vibratory stimulation is positively correlated with increased sexual desire and overall sexual function. It has also shown benefit for sexual arousal difficulties and pelvic floor dysfunction. Though definitive evidence is lacking, genital vibration is a potential treatment for sexual dysfunction related to a wide variety of sexual health concerns in men and women.
Collapse
Affiliation(s)
- Jordan E Rullo
- Department of Psychology and Psychiatry, Mayo Clinic, Rochester, MN, USA.,Division of General Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Tierney Lorenz
- Department of Psychological Science, University of North Carolina at Charlotte, Charlotte, NC, USA
| | | | - Laura Meihofer
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | - Debra Herbenick
- Center for Sexual Health Promotion, Indiana University, Bloomington, IN, USA
| | - Stephanie S Faubion
- Division of General Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
33
|
Levin RJ, Both S, Georgiadis J, Kukkonen T, Park K, Yang CC. The Physiology of Female Sexual Function and the Pathophysiology of Female Sexual Dysfunction (Committee 13A). J Sex Med 2017; 13:733-59. [PMID: 27114190 DOI: 10.1016/j.jsxm.2016.02.172] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 02/22/2016] [Accepted: 02/24/2016] [Indexed: 01/01/2023]
Abstract
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.
Collapse
Affiliation(s)
- Roy J Levin
- Reader in Physiology (Retired), Department of Biomedical Science, University of Sheffield, Sheffield, UK: Section 2.
| | - Stephanie Both
- Department of Psychosomatic Gynecology and Sexology, Leiden University Medical Center, Leiden, The Netherlands: Section 3
| | - Janniko Georgiadis
- Department of Neuroscience, University Medical Center, Groningen, University of Groningen, The Netherlands: Section 4
| | - Tuuli Kukkonen
- College of Social and Applied Human Science, University of Guelph, Guelph, ON, Canada: Section 6
| | - Kwangsung Park
- Department of Urology, Chonnan National University Medical School, Gwangju, Korea: Section 5
| | - Claire C Yang
- Department of Urology, University of Washington, Seattle, WA, USA: Section 1
| |
Collapse
|
34
|
Lorenz TK, Demas GE, Heiman JR. Partnered sexual activity moderates menstrual cycle-related changes in inflammation markers in healthy women: an exploratory observational study. Fertil Steril 2016; 107:763-773.e3. [PMID: 27919440 DOI: 10.1016/j.fertnstert.2016.11.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 11/09/2016] [Accepted: 11/10/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine differences in inflammation markers in sexually active versus abstinent women and observe changes in inflammation markers across the menstrual cycle. Cycle-related immune fluctuations may have evolved to reduce interference with conception. If so, reproductively active (i.e., sexually active) women should show the most variability in cytokine expression. DESIGN Participants provided serum samples at menses and ovulation (from which cytokines were assayed) and saliva samples at menses and during follicular, ovulation, and luteal phases (from which C-reactive protein [CRP] was assayed). Participants self-reported intercourse frequency during the study. SETTING Academic research laboratory. PATIENT(S) Thirty-two healthy, naturally cycling premenopausal women (sexually active, n = 15; abstinent, n = 17). INTERVENTION(S) Observational study. MAIN OUTCOME MEASURE(S) Levels of proinflammatory cytokines (interleukin-6 [IL-6], interferon γ [IFN-γ], tumor necrosis factor-α [TNF-α]), an anti-inflammatory cytokine (interleukin-4 [IL-4]), and a marker of total inflammation (CRP). RESULT(S) Sexually active women had higher levels of all of the immune markers measured, including both pro- and anti-inflammatory cytokines, than abstinent women. Relative to sexually active women, abstinent women had less change across the menstrual cycle in levels of CRP. Among sexually active women, higher intercourse frequency predicted greater midcycle decreases in CRP, IL-6, and IFN-γ and midcycle increases in IL-4. CONCLUSION(S) Sexual activity may stimulate a complex interaction between pro- and anti-inflammatory cytokines that subsequently drives midcycle declines in inflammation.
Collapse
Affiliation(s)
- Tierney K Lorenz
- Kinsey Institute, Indiana University, Bloomington, Indiana; Center for Integrative Study for Animal Behavior, Indiana University, Bloomington, Indiana; Department of Psychology, University of North Carolina at Charlotte, Charlotte, North Carolina.
| | - Gregory E Demas
- Center for Integrative Study for Animal Behavior, Indiana University, Bloomington, Indiana; Department of Biology, Indiana University, Bloomington, Indiana
| | - Julia R Heiman
- Kinsey Institute, Indiana University, Bloomington, Indiana; Center for Integrative Study for Animal Behavior, Indiana University, Bloomington, Indiana; Department of Psychological and Brain Sciences, Indiana University, Bloomington, Indiana
| |
Collapse
|
35
|
Costa RM, Oliveira TF. Poorer Subjective Sleep Quality Is Related to Higher Fantasy-Induced Sexual Arousal in Women of Reproductive Age. JOURNAL OF SEX & MARITAL THERAPY 2016; 42:740-748. [PMID: 26549821 DOI: 10.1080/0092623x.2015.1113591] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Lack of sleep enhances erections and lubrication the next day. This raises the possibility that poorer subjective sleep quality is related to sexual arousal. To test this hypothesis, sexual arousal was elicited in 70 Portuguese women of reproductive age by means of fantasy. The level of salivary testosterone before and shortly after fantasy was determined by luminescence immunoassays. Participants completed the Pittsburgh Sleep Quality Index (PSQI), reported their sexual arousal before and during fantasy, and how anxious they were after the fantasy. The hypothesis was confirmed. Anxiety did not explain the association, but testosterone response (poststimulus minus baseline) had a slight explanatory effect.
Collapse
Affiliation(s)
- Rui M Costa
- a Unidade de Investigação em Eco-Etologia , ISPA-Instituto Universitário , Lisbon , Portugal
| | - Tânia F Oliveira
- a Unidade de Investigação em Eco-Etologia , ISPA-Instituto Universitário , Lisbon , Portugal
| |
Collapse
|
36
|
Lorenz T, Rullo J, Faubion S. Antidepressant-Induced Female Sexual Dysfunction. Mayo Clin Proc 2016; 91:1280-6. [PMID: 27594188 PMCID: PMC6711470 DOI: 10.1016/j.mayocp.2016.04.033] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 04/20/2016] [Accepted: 04/25/2016] [Indexed: 01/23/2023]
Abstract
Because 1 in 6 women in the United States takes antidepressants and a substantial proportion of patients report some disturbance of sexual function while taking these medications, it is a near certainty that the practicing clinician will need to know how to assess and manage antidepressant-related female sexual dysfunction. Adverse sexual effects can be complex because there are several potentially overlapping etiologies, including sexual dysfunction associated with the underlying mood disorder. As such, careful assessment of sexual function at the premedication visit followed by monitoring at subsequent visits is critical. Treatment of adverse sexual effects can be pharmacological (dose reduction, drug discontinuation or switching, augmentation, or using medications with lower adverse effect profiles), behavioral (exercising before sexual activity, scheduling sexual activity, vibratory stimulation, psychotherapy), complementary and integrative (acupuncture, nutraceuticals), or some combination of these modalities.
Collapse
Affiliation(s)
- Tierney Lorenz
- Kinsey Institute and Center for the Integrative Study of Animal Behavior, Indiana University, Bloomington; Dr Lorenz is now with the Department of Psychology, University of North Carolina at Charlotte.
| | - Jordan Rullo
- Women's Health Clinic, Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN; Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Stephanie Faubion
- Women's Health Clinic, Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
| |
Collapse
|
37
|
Abstract
Heart rate variability (HRV) is a measure of autonomic nervous system activity, which reflects an individual's ability to adapt to physiological and environmental changes. Low resting HRV has been linked to several mental health conditions, including depression, anxiety, and alcohol dependence (Kemp et al. in Biological Psychiatry 67(11):1067-1074, 2010. doi:10.1016/j.biopsych.2009.12.012; Kemp et al. in PloS One, 7(2):e30777, 2012; Quintana et al. in Drug and Alcohol Dependence, 132(1-2):395-398, 2013. doi:10.1016/j.drugalcdep.2013.02.025). HRV has also been used as a method for indexing the relative balance of sympathetic nervous system (SNS) activity to parasympathetic nervous system activity. This balance--in particular, moderately dominant SNS activity--has been shown to play a significant role in women's genital sexual arousal in the laboratory; however, the role of SNS activity in clinically relevant sexual arousal function is unknown. The present study assessed the feasibility of using HRV as an index of women's self-reported sexual arousal function outside the laboratory. Sexual arousal function, overall sexual function, and resting HRV were assessed in 72 women, aged 18-39. Women with below average HRV were significantly more likely to report sexual arousal dysfunction (p < .001) and overall sexual dysfunction (p < .001) than both women with average HRV and women with above average HRV. In conclusion, low HRV may be a risk factor for female sexual arousal dysfunction and overall sexual dysfunction.
Collapse
|
38
|
Steadman CJ, Hubscher CH. Sexual Function after Spinal Cord Injury: Innervation, Assessment, and Treatment. CURRENT SEXUAL HEALTH REPORTS 2016. [DOI: 10.1007/s11930-016-0067-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
|
39
|
Alexander MS, Kozyrev N, Bosma RL, Figley CR, Richards JS, Stroman PW. fMRI Localization of Spinal Cord Processing Underlying Female Sexual Arousal. JOURNAL OF SEX & MARITAL THERAPY 2016; 42:36-47. [PMID: 25635474 DOI: 10.1080/0092623x.2015.1010674] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Using functional magnetic resonance imaging, the authors aimed to determine the roles of the human spinal cord in mediating sexual responses in women. Functional magnetic resonance imaging of the entire lower thoracic, lumbar, and sacral spinal cord was performed using a sexual stimulation paradigm designed to elicit psychological and physical components of sexual arousal. Responses were measured in 9 healthy adult women during 3 consecutive conditions: (a) erotic audiovisual, (b) manual clitoral, and (c) audiovisual plus manual stimulation. Functional magnetic resonance imaging results in healthy subjects demonstrate that this method is sensitive for mapping sexual function in the spinal cord, and identify several key regions involved in human sexual response, including the intermediolateral cell column, the dorsal commissural nucleus, and the sacral parasympathetic nucleus. Using spinal functional magnetic resonance imaging, this study identified many of the spinal cord regions involved in female sexual responses. Results from audiovisual and manual clitoral stimulation correspond with previous data regarding lumbar and sacral neurologic changes during sexual arousal. This study provides the first characterization of neural activity in the human spinal cord underlying healthy female sexual responses and sets a foundation for future studies aimed at mapping changes that result from sexual dysfunction, spinal cord trauma or disease.
Collapse
Affiliation(s)
- Marcalee S Alexander
- a Department of Physical Medicine and Rehabilitation , University of Alabama at Birmingham , Birmingham , Alabama , USA
| | - Natalie Kozyrev
- b Centre for Neuroscience Studies , Queen's University , Kingston , Ontario , Canada
| | - Rachael L Bosma
- b Centre for Neuroscience Studies , Queen's University , Kingston , Ontario , Canada
| | - Chase R Figley
- b Centre for Neuroscience Studies , Queen's University , Kingston , Ontario , Canada
| | - J Scott Richards
- a Department of Physical Medicine and Rehabilitation , University of Alabama at Birmingham , Birmingham , Alabama , USA
| | - Patrick W Stroman
- b Centre for Neuroscience Studies , Queen's University , Kingston , Ontario , Canada
| |
Collapse
|
40
|
Suschinsky KD, Shelley AJ, Gerritsen J, Tuiten A, Chivers ML. The Clitoral Photoplethysmograph: A Pilot Study Examining Discriminant and Convergent Validity. J Sex Med 2015; 12:2324-38. [PMID: 26632084 DOI: 10.1111/jsm.13047] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The clitoral photoplethysmograph (CPP) is a relatively new device used to measure changes in clitoral blood volume (CBV); however, its construct validity has not yet been evaluated. AIM To evaluate the discriminant and convergent validity of the CPP. For discriminant validity, CBV responses should differ between sexual and nonsexual emotional films if the CPP accurately assesses clitoral vasocongestion associated with sexual arousal; for convergent validity, CBV responses should significantly correlate with subjective reports of sexual arousal. METHODS Twenty women (M age = 21.2 years, SD = 3.4) watched neutral, anxiety-inducing, exhilarating, and sexual (female-male sex) audiovisual stimuli while their genital responses were measured simultaneously using vaginal and clitoral photoplethysmographs and CPPs. Most of these participants continuously reported sexual arousal throughout each stimulus (n = 16), and all reported their sexual and nonsexual affect before and after each stimulus; subjective responses were recorded via button presses using a keypad. MAIN OUTCOME MEASURES Vaginal pulse amplitude (VPA), CBV, and self-reported sexual arousal and nonsexual affect were used as main outcome measures. RESULTS CBV demonstrated both discriminant and convergent validity. CBV responses were similar to VPA responses and self-reported sexual arousal; all responses differed significantly as a function of stimulus content, with the sexual stimulus eliciting greater relative changes than nonsexual stimuli. CBV, but not VPA, was significantly (negatively) correlated with continuous self-reported sexual arousal during the shorter sexual stimulus. CBV was significantly negatively correlated with VPA for the shorter sexual stimulus. CONCLUSION CBV may be a valid measure of women's genital sexual arousal that provides complementary information to VPA and correlates with self-reported sexual arousal. Given our relatively small sample size, and that this is among the first research to use the CPP, the current findings must be replicated. More research using the CPP and other devices is required for a more comprehensive description of women's physiological sexual arousal.
Collapse
Affiliation(s)
| | - Amanda J Shelley
- Department of Psychology, Queen's University, Kingston, ON, Canada
| | | | | | | |
Collapse
|
41
|
Lorenz TK, Demas GE, Heiman JR. Interaction of menstrual cycle phase and sexual activity predicts mucosal and systemic humoral immunity in healthy women. Physiol Behav 2015; 152:92-8. [PMID: 26394125 DOI: 10.1016/j.physbeh.2015.09.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 08/14/2015] [Accepted: 09/18/2015] [Indexed: 12/23/2022]
Abstract
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.
Collapse
Affiliation(s)
- Tierney K Lorenz
- Center for Integrative Study for Animal Behavior, Indiana University, Bloomington, 409 N Park Ave, Bloomington, IN, United States; The Kinsey Institute, Indiana University, Bloomington, 1165 E 3rd St., Bloomington, IN 47405, United States.
| | - Gregory E Demas
- Center for Integrative Study for Animal Behavior, Indiana University, Bloomington, 409 N Park Ave, Bloomington, IN, United States; Department of Biology, Indiana University, Bloomington, 1001 E 3rd St, Bloomington, IN, United States; Department of Psychological and Brain Sciences, Indiana University, Bloomington, 1101 E 10th St., Bloomington, IN, United States.
| | - Julia R Heiman
- Center for Integrative Study for Animal Behavior, Indiana University, Bloomington, 409 N Park Ave, Bloomington, IN, United States; The Kinsey Institute, Indiana University, Bloomington, 1165 E 3rd St., Bloomington, IN 47405, United States; Department of Psychological and Brain Sciences, Indiana University, Bloomington, 1101 E 10th St., Bloomington, IN, United States.
| |
Collapse
|
42
|
Lorenz TK, Heiman JR, Demas GE. Sexual activity modulates shifts in TH1/TH2 cytokine profile across the menstrual cycle: an observational study. Fertil Steril 2015; 104:1513-21.e1-4. [PMID: 26385401 DOI: 10.1016/j.fertnstert.2015.09.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 09/01/2015] [Accepted: 09/01/2015] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To investigate if sexual activity moderated menstrual cycle-related shifts in cytokines associated with T-helper type 1 (TH1) cells (e.g., interferon [IFN] γ) and T-helper type 2 (TH2) cells (e.g., interleukin [IL] 4). Immune activity shifts across the menstrual cycle, with higher follicular-phase TH1-cell activity but higher luteal-phase TH2-cell activity. Little is known about how social behaviors alter TH1-TH2 ratios, despite evidence that psychosocial factors can influence immunity. Of particular interest is how sexual activity influences immune responses that may support conception, such as the TH1-TH2 balance. DESIGN Participants provided saliva samples at four time points (menstrual, follicular, ovulatory, and luteal phases), which were assayed by means of ELISA. SETTING Academic laboratory. PARTICIPANT(S) Thirty healthy premenopausal women (16 sexually abstinent, 14 sexually active) not taking hormonal or immunoactive medications. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Salivary E2, P, IFN-γ, and IL-4. RESULT(S) Sexually active, but not abstinent, women were significantly more likely to express TH2-like cytokine ratios (IFN-γ < IL-4) in the luteal phase than in other phases. Similarly, sexually active women had significantly higher P, and higher P-E2 ratios, in the luteal phase than did abstinent women. The P-E2 ratio mediated menstrual variations in cytokine ratios in sexually active women. CONCLUSION(S) These results support the hypothesis that shifts in immune response across the menstrual cycle may reflect tradeoffs between reproduction and immunity. These findings point to the need for further research on the interaction between sexual behavior, the menstrual cycle, and immune response.
Collapse
Affiliation(s)
- Tierney K Lorenz
- Center for Integrative Study for Animal Behavior, Indiana University, Bloomington, Indiana; Kinsey Institute for Research on Sex, Gender, and Reproduction, Indiana University, Bloomington, Indiana.
| | - Julia R Heiman
- Center for Integrative Study for Animal Behavior, Indiana University, Bloomington, Indiana; Kinsey Institute for Research on Sex, Gender, and Reproduction, Indiana University, Bloomington, Indiana; Department of Psychological and Brain Sciences, Indiana University, Bloomington, Indiana
| | - Gregory E Demas
- Center for Integrative Study for Animal Behavior, Indiana University, Bloomington, Indiana; Department of Biology, Indiana University, Bloomington, Indiana
| |
Collapse
|
43
|
Lorenz TK, Harte CB, Meston CM. Changes in Autonomic Nervous System Activity are Associated with Changes in Sexual Function in Women with a History of Childhood Sexual Abuse. J Sex Med 2015; 12:1545-54. [PMID: 25963394 DOI: 10.1111/jsm.12908] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
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.
Collapse
Affiliation(s)
- Tierney K Lorenz
- The Kinsey Institute for Research on Sex, Gender, and Reproduction, Indiana University, Bloomington, IN, USA
| | - Christopher B Harte
- Research Service, VA Boston Healthcare System, Boston, MA, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Cindy M Meston
- Department of Psychology, University of Texas at Austin, Austin, TX, USA
| |
Collapse
|
44
|
Yehuda R, Lehrner A, Rosenbaum TY. PTSD and Sexual Dysfunction in Men and Women. J Sex Med 2015; 12:1107-19. [DOI: 10.1111/jsm.12856] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
|
45
|
Oliveira C, Laja P, Carvalho J, Quinta Gomes A, Vilarinho S, Janssen E, Nobre PJ. Predictors of Men's Sexual Response to Erotic Film Stimuli: The Role of Affect and Self‐Reported Thoughts. J Sex Med 2014; 11:2701-8. [DOI: 10.1111/jsm.12650] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
46
|
Stephenson KR, Pulverman CS, Meston CM. Assessing the association between childhood sexual abuse and adult sexual experiences in women with sexual difficulties. J Trauma Stress 2014; 27:274-82. [PMID: 24948536 DOI: 10.1002/jts.21923] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Self-report instruments for assessing sexual well-being in women with sexual difficulties have not to date been explicitly validated among women with a history of childhood sexual abuse (CSA). Given an extensive literature suggesting psychological differences between women with and without a history of CSA, it is possible that sexual well-being has a different meaning for these groups. Without validated scales, it is difficult to evaluate the impact of early sexual trauma on adult sexuality. The present study assessed whether the factor structure of widely used measures of sexual well-being were consistent across women experiencing sexual difficulties, with and without an abuse history, and to estimate effect sizes for the statistical effect of CSA on sexual well-being in this population. A sample of women with and without a history of CSA (N = 238) completed the Female Sexual Function Index and the Sexual Satisfaction Scale for Women. Structural equation models indicated generally consistent factor structures across groups, suggesting good construct validity. Effect size estimates indicated medium to large (0.53-0.72) effects of CSA on sexual well-being for women with sexual difficulties. These findings support and extend research regarding the potential effects of CSA that may inform treatment for this population.
Collapse
Affiliation(s)
- Kyle R Stephenson
- Division of Social, Behavioral and Global Studies, California State University Monterey Bay, Monterey, California, USA
| | | | | |
Collapse
|
47
|
Harte CB. Nicotine acutely inhibits erectile tumescence by altering heart rate variability. Urology 2014; 83:1093-8. [PMID: 24642073 DOI: 10.1016/j.urology.2014.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 12/15/2013] [Accepted: 01/02/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To examine potential mechanisms underlying nicotine's effects on male sexual arousal by exploring the mediating role of heart rate variability (HRV). METHODS The sample comprised 22 healthy, nicotine-naïve men (mean age = 20.91 years; standard deviation = 2.43). Data were taken from a double-blind, randomized, placebo-controlled, crossover trial previously completed and published elsewhere. During each laboratory visit, time-domain parameters of HRV (standard deviation of normal-to-normal [NN] intervals, square root of the mean squared difference of successive NN intervals, and percent of NN intervals for which successive heartbeat intervals differed by at least 50 ms [pNN50]) along with the objective (via penile plethysmography) and subjective indices of sexual arousal were assessed. RESULTS Acute nicotine ingestion (compared with placebo) was associated with dysregulated sympathovagal balance, which in turn was related to relatively reduced erectile tumescence. HRV did not mediate relations between nicotine intake and self-reported indices of sexual arousal. CONCLUSION HRV mediated the association between nicotine ingestion and erectile capacity. Findings suggest that dysfunctional cardiac autonomic tone may be an underlying mechanism by which nicotine exerts its deleterious effects on erectile health.
Collapse
Affiliation(s)
- Christopher B Harte
- Research Service, VA Boston Healthcare System, Boston, MA; Department of Psychiatry, Boston University School of Medicine, Boston, MA.
| |
Collapse
|
48
|
Lorenz TA, Meston CM. Exercise improves sexual function in women taking antidepressants: results from a randomized crossover trial. Depress Anxiety 2014; 31:188-95. [PMID: 24754044 PMCID: PMC4039497 DOI: 10.1002/da.22208] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND In laboratory studies, exercise immediately before sexual stimuli improved sexual arousal of women taking antidepressants [1]. We evaluated if exercise improves sexual desire, orgasm, and global sexual functioning in women experiencing antidepressant-induced sexual side effects. METHODS Fifty-two women who were reporting antidepressant sexual side effects were followed for 3 weeks of sexual activity only. They were randomized to complete either three weeks of exercise immediately before sexual activity (3×/week) or 3 weeks of exercise separate from sexual activity (3×/week). At the end of the first exercise arm, participants crossed to the other. We measured sexual functioning, sexual satisfaction, depression, and physical health. RESULTS Exercise immediately prior to sexual activity significantly improved sexual desire and, for women with sexual dysfunction at baseline, global sexual function. Scheduling regular sexual activity significantly improved orgasm function; exercise did not increase this benefit. Neither regular sexual activity nor exercise significantly changed sexual satisfaction. CONCLUSIONS Scheduling regular sexual activity and exercise may be an effective tool for the behavioral management of sexual side effects of antidepressants
Collapse
Affiliation(s)
- Tierney Ahrold Lorenz
- Kinsey Institute, Indiana University, Bloomington, Indiana,Department of Psychology, University of Texas at Austin, Austin, Texas,Correspondence to: Tierney Lorenz, Ph.D., Kinsey Institute, Indiana University, Morrison Hall 326, Bloomington, IN 47405.
| | - Cindy May Meston
- Department of Psychology, University of Texas at Austin, Austin, Texas
| |
Collapse
|
49
|
Abstract
INTRODUCTION Chronic stress is known to have negative effects on reproduction, but little is known about how it affects the sexual response cycle. The present study examined the relationship between chronic stress and sexual arousal and the mechanisms that mediate this relationship. AIM The aim of this study is to test the relationship between chronic stress and sexual arousal and identify mechanisms that may explain this relationship. We predicted that women experiencing high levels of chronic stress would show lower levels of genital arousal and dehydroepiandrosterone (DHEAS) and higher levels of cortisol and cognitive distraction compared with women with average levels of stress. METHODS Women who were categorized as high in chronic stress (high stress group; n=15) or average in chronic stress (average stress group; n=15) provided saliva samples and watched an erotic film while having their genital and psychological arousal measured. MAIN OUTCOME MEASURES Main outcome measures were vaginal pulse amplitude, psychological arousal, salivary cortisol, salivary DHEAS, and heart rate and compared them between women with high and average levels of chronic stress. RESULTS Women in the high stress group had lower levels of genital, but not psychological arousal, had higher levels of cortisol, and reported more distraction during the erotic film than women in the average stress group. The main predictor of decreased genital sexual arousal was participants' distraction scores. CONCLUSIONS High levels of chronic stress were related to lower levels of genital sexual arousal. Both psychological (distraction) and hormonal (increased cortisol) factors were related to the lower levels of sexual arousal seen in women high in chronic stress, but distraction was the only significant predictor when controlling for other variables.
Collapse
Affiliation(s)
- Lisa Dawn Hamilton
- Department of Psychology, University of Texas at Austin, Austin, TX, USA
| | | |
Collapse
|
50
|
Meston CM, Lorenz TA. Physiological stress responses predict sexual functioning and satisfaction differently in women who have and have not been sexually abused in childhood. PSYCHOLOGICAL TRAUMA : THEORY, RESEARCH, PRACTICE AND POLICY 2013; 5:350-358. [PMID: 24748915 PMCID: PMC3988280 DOI: 10.1037/a0027706] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Physiological responses to sexual stimuli may contribute to the increased rate of sexual problems seen in women with childhood sexual abuse (CSA) histories. We compared two physiological stress responses as predictors of sexual function and satisfaction, sympathetic nervous system (SNS) activation and cortisol in women with (CSA, N = 136) and without CSA histories (NSA, N = 102). In CSA survivors, cortisol response to sexual stimuli did not significantly predict sexual functioning; however, in NSA women, cortisol increases were associated with poorer sexual functioning, and decreases with higher functioning. For women with CSA histories, lower SNS activity was associated with poorer sexual functioning. For CSA survivors with low lifetime trauma, lower SNS activity was associated with higher sexual satisfaction; for women with high lifetime trauma, the reverse was true. Decreased SNS activity during sexual stimuli predicted higher sexual functioning in NSA women with low lifetime exposure to traumatic events, but lower sexual functioning in those with high exposure. Differences between women with and without CSA histories in the association between cortisol and SNS response and sexual functioning and satisfaction suggests that CSA causes disruptions in both short and long-term stress responses to sexual stimuli that perpetuate into adulthood.
Collapse
|