Fear Learning in Genital Pain: Toward a Biopsychosocial, Ecologically Valid Research and Treatment Model

Although fear learning mechanisms are implicated in the development, maintenance, exacerbation, and reduction of genital pain, systematic research on how fear of genital pain emerges, spreads, persists, and reemerges after treatment is lacking. This paper provides an overview of the literature on pain-related fear, integrates the ideas on learning and sexual arousal responding, and specifies the pathways through which compromised learning may contribute to the development and persistence of genital pain. In order to refine theories of genital pain and optimize treatments, we need to adopt a biopsychosocial framework to pain-related fear learning and uncover potential moderators that shape individual trajectories. This involves examining the role of physiological processes, subjective experiences, as well as partner and relational cues in fear acquisition, excessive generalization and impaired safety learning, extinction of fear, counterconditioning, and return of fear. Recent methodological advances in fear conditioning and sex research are promising to enable more symptom-specific and ecologically valid experimental paradigms.

Excitation Transfer Between Sexual Arousal and Other Emotions in a Community Sample

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.

A Learning Experience? Enjoyment at Sexual Debut and the Gender Gap in Sexual Desire among Emerging Adults

Gender differences in experience of first intercourse are among the largest in sexuality research, with women recalling less pleasure and satisfaction than men. This "enjoyment gap" has not been considered in explanations of gender differences in sexual desire. Yet, reinforcement and incentive learning feature prominently in recent models of women's sexual desire, and nonhuman animal models demonstrate their impact at sexual debut. We examined whether women's lower sexual desire is explained by their gender or by gendered experience of enjoyment at sexual debut. Emerging adults (N = 838) provided retrospective accounts of physical (orgasm) and affective (satisfaction) enjoyment at (hetero)sexual debut. We replicated gender differences across behavioral, general, and multidimensional measures of trait sexual desire; however, they were contingent on experience and measurement method. When its cognitive multidimensional properties were appreciated, women's sexual desire varied with experience of orgasm at sexual debut and diverged from men's only when orgasm did not occur. Such effects were not observed for satisfaction, nor for men. Nor did effects of a control event - masturbatory debut - extend beyond solitary sexual desire. Findings underscore the importance of orgasm equality, and suggest its absence at sexual debut may play an unacknowledged role in differentiating sexual desire.

The effect of differential disgust conditioning and subsequent extinction versus counterconditioning procedures on women's sexual responses to erotic stimuli

Recent theoretical accounts point to disgust as an important factor in the development and persistence of sexual dysfunctions. This study tested if (i) contingent disgust experiences can render initially sexually arousing stimuli disgusting, and (ii) such acquired disgust responses could be best neutralized via a CS-only extinction or a counterconditioning procedure. Participants (N = 74) were exposed to a differential conditioning procedure that was followed by either a CS-only extinction or a counterconditioning procedure. Erotic films served as the CS+/CS-. A disgusting film served as the US. During the extinction procedure, the CS+ was no longer followed by the disgusting US. During counterconditioning the CS+ was paired with positive stimuli. After conditioning, the CS + elicited lower genital arousal and was rated as significantly more disgusting, less pleasant, and less sexually arousing than the CS-. These diminished genital and subjective sexual arousal responses to the CS+ were successfully restored after both the extinction and the counterconditioning procedure, whereas conditioned feelings of disgust and behavioral avoidance persisted. There was no evidence for differential effectiveness of either procedure. Thus, sexual responses can be attenuated by learned sex-disgust associations and restored by extinction and counterconditioning procedures, but conditioned feelings of disgust seem more resistant.

Approach and Avoidance Biases Toward Sexual Stimuli and Their Association with the Dual Control Model of Sexual Response in Heterosexual Men

Many models of human behavior work in an interaction of a dual system. While one system usually represents controlled and reflective behavioral responses, the other system reflects automatic and impulsive actions. In the impulsive system, positive stimuli initiate approach reactions and negative cues avoidance reactions. Besides stimulus valence, the behavioral response triggered by the impulsive system is influenced by personality (e.g., the propensity to react with approach or avoidance biases in a specific situation). The present study applied a computerized Approach-Avoidance Task (AAT; Rinck & Becker, 2007) to assess automatic behavioral approach and avoidance biases toward sexual and neutral stimuli in heterosexual men (N = 40). Individual AAT-performance was furthermore related to sexual excitation (SES) and the two sexual inhibition factors (SIS1 and SIS2) as proposed by the Dual Control Model of sexual response (Bancroft & Janssen, 2000). Against our hypotheses, participants did not show a stronger approach bias toward sexually preferred (i.e., images of women) than sexually not preferred stimuli (i.e., images of men or children). However, stronger approach biases toward images of women were positively associated with sexual excitation and negatively correlated with sexual inhibition due to a threat of performance failure (SIS1) even after controlling for potential confounds (i.e., general behavioral activation and inhibition). The results support the importance of the influence of dispositional traits measured with the Dual Control Model of sexual response on approach and avoidance biases toward sexually preferred stimuli in heterosexual men.

Can music cue sexual arousal?

The preparation hypothesis posits that women's genital responses (vasocongestion and lubrication) occur automatically in the presence of any sexual stimulus to prevent injuries from sexual activities. It follows that women's genital responses should be easily conditioned to non-sexual cues that reliably predict impending sexual activities. It has been difficult, however, to demonstrate classical conditioning of genital responses in women in the laboratory. In the current study, we used music as an auditory conditioned stimulus (CS) and vignette narrations of consensual sex, non-consensual sex, and neutral (nonsexual) interactions as unconditioned stimuli (US). Eighteen women (range=18–27 years, M=21.9 years, SD=2.2 years,) and 18 men (range=19–29 years, M=22.8 years, SD=2.8 years) were exposed to three neutrally-rated classical music pieces, each paired with a different type of vignette. Participants were exposed to 3 pre-acquisition trials, 12 acquisition trials, and a minimum of 9 extinction trials. After each trial, participants were asked to rate the CS (or the US in CS-US pairings) on pleasantness, anxiousness, and perceived sexual arousal. Vaginal photoplethysmography and penile plethysmography were used to assess changes in genital responses. The sexual vignettes produced genital responses and the nonsexual vignettes did not. We did not observe conditioning of genital responses to music in either sex, but did so for men's and women's feelings of sexual arousal toward songs paired with a consensual sex story. The results were not consistent with the preparation hypothesis.

Situating Human Sexual Conditioning

Conditioning is often thought of as a basic, automatic learning process that has limited applicability to higher-level human behavior. In addition, conditioning is seen as separable from, and even secondary to, "innate" processes. These ideas involve some misconceptions. The aim of this article is to provide a clearer, more refined sense of human sexual conditioning. After providing some background information and reviewing what is known from laboratory conditioning studies, human sexual conditioning is compared to sexual conditioning in nonhumans, to "innate" sexual responding, and to other types of human learning processes. Recommendations for moving forward in human sexual conditioning research are included.

The effect of a dopamine antagonist on conditioning of sexual arousal in women

RATIONALE

Dopamine (DA) plays a key role in reward-seeking behaviours. Accumulating evidence from animal and human studies suggests that human sexual reward learning may also depend on DA transmission. However, research on the role of DA in human sexual reward learning is completely lacking.

OBJECTIVES

To investigate whether DA antagonism attenuates classical conditioning of sexual response in humans.

METHODS

Healthy women were randomly allocated to one of two treatment conditions: haloperidol (n = 29) or placebo (n = 29). A differential conditioning paradigm was applied with genital vibrostimulation as unconditional stimulus (US) and neutral pictures as conditional stimuli (CSs). Genital arousal was assessed, and ratings of affective value and subjective sexual arousal were obtained.

RESULTS

Haloperidol administration affected unconditional genital responding. However, no significant effects of medication were found for conditioned responding.

CONCLUSIONS

No firm conclusions can be drawn about whether female sexual reward learning implicates DA transmission since the results do not lend themselves to unambiguous interpretation.