The neural basis of love as a subliminal prime: an event-related functional magnetic resonance imaging study

Throughout the ages, love has been defined as a motivated and goal-directed mechanism with explicit and implicit mechanisms. Recent evidence demonstrated that the explicit representation of love recruits subcorticocortical pathways mediating reward, emotion, and motivation systems. However, the neural basis of the implicit (unconscious) representation of love remains unknown. To assess this question, we combined event-related functional magnetic resonance imaging (fMRI) with a behavioral subliminal priming paradigm embedded in a lexical decision task. In this task, the name of either a beloved partner, a neutral friend, or a passionate hobby was subliminally presented before a target stimulus (word, nonword, or blank), and participants were required to decide if the target was a word or not. Behavioral results showed that subliminal presentation of either a beloved's name (love prime) or a passion descriptor (passion prime) enhanced reaction times in a similar fashion. Subliminal presentation of a friend's name (friend prime) did not show any beneficial effects. Functional results showed that subliminal priming with a beloved's name (as opposed to either a friend's name or a passion descriptor) specifically recruited brain areas involved in abstract representations of others and the self, in addition to motivation circuits shared with other sources of passion. More precisely, love primes recruited the fusiform and angular gyri. Our findings suggest that love, as a subliminal prime, involves a specific neural network that surpasses a dopaminergic-motivation system.

Neurobiology of DHEA and effects on sexuality, mood and cognition

Dehydroepiandrosterone (DHEA) and its sulfate ester, DHEAS, are the most abundant steroid hormones in the humans. However, their physiological significance, their mechanisms of action and their possible roles as treatment are not fully clarified. Biological actions of DHEA(S) in the brain involve neuroprotection, neurite growth, neurogenesis and neuronal survival, apoptosis, catecholamine synthesis and secretion, as well as anti-oxidant, anti-inflammatory and antiglucocorticoid effects. In addition, DHEA affects neurosteroidogenis and endorphin synthesis/release. We also demonstrated in a model of ovariectomized rats that DHEA therapy increases proceptive behaviors, already after 1 week of treatment, affecting central function of sexual drive. In women, the analyses of clinical outcomes are far from being conclusive and many issues should still be addressed. Although DHEA preparations have been available in the market since the 1990s, there are very few definitive reports on the biological functions of this steroid. We demonstrate that 1 year DHEA administration at the dose of 10mg provided a significant improvement in comparison with vitamin D in sexual function and in frequency of sexual intercourse in early postmenopausal women. Among symptomatic women, the spectrum of symptoms responding to DHEA requires further investigation, to define the type of sexual symptoms (e.g. decreased sexual function or hypoactive sexual desire disorder) and the degree of mood/cognitive symptoms that could be responsive to hormonal treatment. In this regard, our findings are promising, although they need further exploration with a larger and more representative sample size. This article is part of a Special Issue entitled: Essential role of DHEA.

Erectile dysfunction: to prescribe or not to prescribe?

Even with the help of modern pharmacology, treatment of erectile dysfunction often remains complex, and requires taking into account the social, psychological, and behavioral dimensions of the disorder. This brief report presents a case study highlighting this complexity.

Induced abortion and psychosexuality

Little information exists on the impact of induced abortion on psychosexuality. Negative psychological effects and psychiatric complications due to termination of pregnancy seem to be rare. The objective of this study was to review the impact of induced abortion on sexuality and couple relationships. A systematic search of the literature was performed. Studies had to report a quantitative or qualitative evaluation of sexuality after pregnancy termination. Four studies were included. In the one prospective study using a control group, no difference in sexual functioning between groups after 1 year was reported. In the remaining observational studies, sexual dysfunction was reported in up to 30% of women after termination. Women undergoing abortion had significantly more conflicts in their partnerships. This was similar in all studies. Separation occurred in about one-quarter of all couples. Some studies report sexual dysfunction after termination of pregnancy. In about half of the couples separated after termination, abortion seemed not to have led to the separation. Psychological factors, together with relationship problems, might have played a role in failed contraception. The impact of induced abortion on sexuality needs to be studied in greater detail with rigorous methodology to draw firm conclusions.

Sexuality, partner relations and contraceptive practice after termination of pregnancy

The aim of this study was to determine the impact of termination of pregnancy (TOP) on women's sexual well-being, the couple and contraceptive practice. In a prospective qualitative and quantitative study, 103 women undergoing induced abortion by vacuum aspiration were interviewed before the abortion and 6 months later. The interview was performed by means of a questionnaire including open and closed questions, and two psychological tests (Locke-Wallace and Horowitz). After TOP, the majority of women did not report changes in their sexual behavior and satisfaction. Eighteen per cent of women reported a decrease in sexual desire and 17% reported orgasmic disorders. About one-third of women described psychosomatic symptoms, but a minority were traumatized by the event. Ninety-eight per cent of the women were informed about, and had practiced, contraception in the past; 69% had actually used some kind of contraception during the menstrual cycle that had resulted in pregnancy (31% had had unprotected intercourse). Six months later, 83% practiced contraception, and only 17% did not. Fourteen out of 84 couples separated after TOP (one in six). Six months after TOP, the large majority of women interviewed seemed able to cope with TOP. A minority presented some persisting sexual dysfunction and/or some psychosomatic symptoms.

Prospective evaluation of early postoperative male and female sexual function after radical prostatectomy with erectile nerves preservation

Prostate cancer screening has led to the diagnosis of localized prostate cancer in increasingly young and sexually active men. Accordingly, the impact of cancer treatment on sexual function is gaining more attention. To prospectively evaluate the impact of radical prostatectomy (RP) on male, female and conjugal sexual function. Patients were prospectively assessed by an urologist and a sexologist before and 6 months after robot-assisted laparoscopic RP (RALP). RALP was performed with uni- or bilateral neurovascular bundle preservation by a single surgeon. Postoperatively, all patients were prescribed tadalafil 20 mg, 3 times a week during 6 months. Male and female sexual functions were evaluated by using the International Index of Erectile Function (IIEF-5), the Female Sexual Function Index (FSFI) and the Lock-Wallace Marital Adjustment Test (MAT). Continuous variables were analyzed with rank-sum and t-tests, as needed, and categorical variables with chi-squared tests. All tests were two-sided, with a P-value ⩽ 0.05 considered significant. Twenty-one couples were included. Mean patient male and female age was 62.4 and 60.7 years, respectively. Bilateral nerve sparing was performed in 12/21 (57%) patients. Median preoperative IIEF-5 was 20/25, corresponding to mild erectile dysfunction (ED). Median preoperative FSFI and MAT were both within normal range (28/36 and 114/158, respectively). Six months following surgery, both IIEF-5 (11/25) and FSFI (25/36) had significantly dropped (P=0.007 and 0.003, respectively). Postoperative decreases in IIEF-5 and FSFI scores were associated within couples. MAT scores (115/158), however, remained unaffected by RALP, showing an unmodified relationship satisfaction postoperatively. Finally, bilateral nerve sparing surgery preserved not only male but also female sexual function. This study shows that the expected short-term post-RALP ED is associated with a worsening of female sexual function, whereas nerve sparing surgery has a protective effect on both the patient's and his partner's sexual function with a significant effect of bilateral over unilateral neurovascular bundle preservation. Furthermore, we found that conjugal complicity remains stable throughout the first semestrial postoperative period despite the decrease in sexual function.

Association between weather conditions and the incidence of emergency gynecological consultations

OBJECTIVE

This study examined the influence of weather conditions on the incidence of outpatient emergency consultations at the Department of Obstetrics and Gynecology at the Regional Hospital in Lugano, Switzerland.

STUDY DESIGN

The medical records of all women who attended the outpatient emergency unit at the Department for Obstetrics and Gynecology over the 1-year study period were reviewed. The final diagnosis was pelvic pain of unidentified origin in 180 cases, menorrhagia and/or metrorrhagia in 95 cases, threatened abortion in 56 cases and spontaneous abortion in 54 cases. The meteorological factors considered were atmospheric pressure, temperature, humidity and global radiation. A logistic regression model was used to correlate the occurrence of symptoms with the chosen weather factors.

RESULTS

High mean daily temperature was found to be a significant predictor of pelvic pain (p < 0.001). A rise in barometric pressure compared to the previous day increased the probability of menorrhagia and/or metrorrhagia (p = 0.001). Higher minimal temperature (p = 0.011) and an increase in atmospheric pressure (p = 0.006) were identified as positive predictors of threatened abortion. None of the meteorological factors considered seemed to influence the frequency of spontaneous abortions.

CONCLUSION

Meteorological factors such as temperature and barometric change appear to affect the probability of emergency admissions for gynecological symptoms including uterine bleeding, threatened abortion and pelvic pain.

[Premenstrual dysphoric disorder: approach and treatment]

The premenstrual dysphoric disorder corresponds to a severe form of the premenstrual syndrome that mainly shows psychiatric symptoms. The incidence is about 3 to 8% of women in the reproductive age. The essential characteristics are depressive mood, a marked anxiety, emotional instability, and decrease of activity, appearing during the luteal phase and ceasing in the follicular phase of the menstrual cycle. Several factors are implied in the pathogenesis of this disorder. Neurobiological and psychobiologic effects concerning the metabolism of serotonin and the melatonin play a role. Several therapies were proposed. The most effective treatment seem to be the selective inhibitors of the of serotonin reuptake.

[Alpha-thalassemias and bipolar disorders: a genetic link?]

After a previous paper discussing the possible association between beta-thalassemias and bipolar disorder, this article considers a possible association between alpha-thalassemia and the bipolar disorder. We report the case of a 36 year old woman with bipolar disorder and alpha-thalassemia. The patient, native of Reunion Island, has a family history of bipolar disorder (both parents, one brother, and a paternal uncle). The severity of the bipolar disorder type I in her family, is illustrated by the suicides of both parents, one brother and the paternal uncle, in intervals of only a few years. After a Medline review (1980-2004) we found only two studies suggesting a possible relationship between bipolar disorders and alpha-thalassemias, but without clinical case report information. Some genetic studies described the existence of possible genetic susceptibility for bipolar disorder on the short arm of chromosome 16, close to the gene involved in certain alpha-thalassemias, on the region 16p13.3. An interesting finding is that the sequencing of 258 kb of the chromosome region 16p13.3 not only allowed the identification of genes involved in the alpha-thalassemia and in the vulnerability to bipolar disorders, but also the identification of genes implicated in tuberous sclerosis, in polycystic kidney disease, in cataract with microophtalmia, and in vulnerability genetic factors for ATR-16 syndrome, asthma, epilepsy, certain forms of autism and mental retardation. Numerous clinical descriptions and some familial studies on linkage suggested a possible relationship between tuberous sclerosis, polycystic kidney disease, cataract with microophtalmia, ATR-16 syndrome, asthma, epilepsy, certain forms of autism, mental retardation and bipolar disorder, given the closeness of these vulnerability genes on the short arm of the chromosome 16. A vulnerability gene of alcohol dependence was also identified on this same chromosome region (16p13.3), by a study concerning 105 families. Taking into account the methodological difficulties due to the clinical and genetic heterogeneity of bipolar disorder, we suggest that linkage techniques should be used to confirm the presence of susceptibility genetic factor for bipolar disorders on chromosome 16. Thus a known genetic disease (alpha-thalassemia) could contribute to confirming the presence on the short arm of chromosome 16 of a susceptibility genetic factor for bipolar disorders. Linkage studies should be performed in families with a strong association for both diseases. Thanks to linkage techniques, one could hope for an improvement in understanding the physiopathology of bipolar disorder, with possible implications at a therapeutic level.

Contraception and sexuality after termination of pregnancy: a comparison between Lugano and Geneva

OBJECTIVE

To evaluate the impact of a voluntary termination of pregnancy (TOP) on contraceptive practice and sexual well-being in women.

STUDY DESIGN AND METHODS

Comparative evaluation of a retrospective study conducted in Lugano in 1995 with 85 women interviewed 3-6 months post-TOP, and a prospective study carried out in Geneva in 1998 with 103 women interviewed pre-TOP and 6 months post-TOP. In both studies TOP was performed during the first 12 weeks of pregnancy by vacuum aspiration and curettage.

RESULTS

Oral contraceptive use in the Lugano group increased from 21% pre-TOP to 47% post-TOP, and in the Geneva group from 19% pre-TOP to 69% post-TOP. Condom use decreased in both groups. Those practising unprotected intercourse also decreased by half (around one in five). No effect on sexual well-being was reported by almost two-thirds of both groups.

CONCLUSIONS

Despite large differences between these two populations, the two studies show a similar evolution. The majority of women appeared to be able to cope well with a TOP. About one third presented sexual dysfunction.

[Use of aromatase inhibitors in infertile women]

Aromatase inhibitors (AI) block the last enzymatic step of estrogen production, the aromatization of the A-cycle of aromatizable androgens and particularly, androstenedione (D4) and testosterone (T). Molecules designed for interfering with aromatase activity have existed for many years. Yet the activity of products of the aminogluthetimide era was too unspecific and these substances carried too many side effects for being used clinically. Today, however, 3rd generation AIs have become available that are highly specific and essentially devoid of side effects. These molecules have recently been approved for treating breast cancer in post-menopausal women, either in advanced forms, or as part of adjuvant therapy. In women whose ovaries are active, a temporary inhibition of E2 production will activate gonadotropins and in turn, stimulate follicular growth. In cancer patients, this property precludes the use of AIs in women whose ovaries are still active, unless gonadotropins are blocked. In infertile patients, this property of AIs has been put to play for inducing ovulation. AIs have been used both in women who do not ovulate but whose hypothalamo-pituitary-gonadal (HPG) axis is active (oligo-anovulators of PCOD type) and in those who ovulate regularly but in whom multiple ovulation is sought for treating infertility or as part of IVF. Like CC, AIs are not usable in women whose gonadotropins are suppressed, as in the case of hypothalamic amenorrhea. The sum of data available on the use of AI for inducing ovulation remains however meager to this date and is mainly constituted of pilot and non-randomized trials. Yet mounting evidence tends to support AIs' advantages over CC for induction of ovulation. Hence, we think that these drugs will play a key role for the induction of ovulation in the future.

Contraceptive counselling and social representations: a qualitative study

BACKGROUND

Contraceptive use is a complex issue and several studies have been conducted in an effort to understand user behaviour. It is of interest to explore the representations of professionals who give advice on contraception, since their views could have an impact on contraceptive use.

METHODS

Individual in-depth interviews of 65 healthcare professionals likely to provide contraceptive advice to patients at a Swiss maternity unit.

RESULTS

83% of healthcare professionals interviewed were favourable to contraception in general while being highly critical of its practical efficacy. The methods most often spontaneously cited were oral contraceptive pills, male condom, intrauterine devices and hormonal implants. Theoretically, all methods should be proposed during contraceptive counselling but in practice interviewees have different social representations of user groups and associate them with specific contraceptive methods. Personal experience appears to play a bigger role than scientific knowledge.

CONCLUSIONS

The counsellor's social representations probably play an important role in determining user behaviour. These representations should be taken into consideration in the training of healthcare professionals in this field.

[Sexuality, heart and chocolate]

All along the history, many kinds of magic and aphrodisiac properties were attributed to the chocolate. Because of the presence of certain active substances, cacao and chocolate are supposed to have some potentially beneficial effects on human health, particularly on cardiovascular system. Containing flavoniods, cacao and its products have antioxidant, anti-inflammatory, anti-atherogenic, anti-thrombotic, antihypertensive and neuroprotective effects, as well as influence on insulin sensitivity, vascular endothelial function, and activation of nitric oxide. Other molecules, like methyxantin, biogenic amines and cannabinoid-like fatty acids, may have a psychoactive action. Synergic effect of all these substances could have a positive direct and indirect influence on sexual health and function. Nevertheless, randomized studies are needed to confirm these hypotheses and to elaborate recommendations about cacao consumption.

[An exploration of sexual desire and sexual activities of women with psychosis]

Most clinicians avoid discussing sexuality with patients with severe mental disorders. Sexual disturbances can be related to medication, to psychological issues such as self-stigma and anhedonia, and to the social context. We studied desire and sexual practices in women suffering from schizophrenia, in comparison with healthy women. Contrary to previous research, women with schizophrenia featured dyadic and individual desire similar to women of comparable age. Yet, only half of women with psychosis had sexual practice, either alone or with a partner. They were less satisfied with their activity, both in terms of function and psychological issues such as sexual self-esteem. This finding underscores the stigmatization these women suffer from, which prevents the opportunity of a possible improvement in this important interpersonal domain.

[A socio-cognitive approach of human sexual desire]

The ability to direct motivational feelings towards another person, and develop an intimate partner-relationship is important for social interaction, notably for sexual desire (SD). The recent discovery of a brain network for SD recruiting higher-order cognitive brain areas (angular gyrus), in addition to emotional limbic brain regions, suggests that SD is sustained by cognitive mechanisms, rather than by instinct only. Critically recent studies in social cognitive neuroscience support the interaction between SD and a self expansion model. The findings we report here are important theoretically and practically.

[The neurophysiology of the female orgasm]

The way women experience orgasm during passionate sexual activity has been of interest throughout the ages. The astonishing advances of functional imaging techniques recently allowed unravelling the neuroanatomy of female orgasm within a distributed corticosubcortical neural network. In the present article, we review the clinical and experimental evidence that attributes orgasm not only a peripheral but also a central origin. We thus outline the importance of integrating orgasm as a complex process involving the entire woman, mind and body. In light of this, future studies in female sexuality would need to take account of the consequences of both standard approaches in sexology and functional imaging results in the understanding of the human sexual function and in the treatment of sexual dysfunctions.

[Hypoactive sexual desire disorder in men: clinical approach in sexual medicine]

Hypoactive sexual desire disorder in men: clinical approach in sexual medicine Hypoactive sexual desire disorder (HSDD) has a high prevalence in the population, representing an important cause of consultations in sexual medicine. Although HSDD affects women mostly, it also affects men. HSDD in men can be due to different factors. A precise medical evaluation of these factors is needed to start an efficient therapy. Along these lines, HSDD evaluation must follow a precise schema that integrates psychological factors and also endocrinological, toxic and psychiatric factors. A specific formation in sexual medicine is recommended for an optimal evaluation of HSDD. The present article describes the milestones of the adequate evaluation of HSDD to help the physicians in their daily clinical practice.

[Sexual function after radical prostatectomy: update of 2009]

Prostate cancer is more frequently diagnosed in young males. It is then of utmost importance to improve preservation and recovery of sexual function. The surgical technique of radical prostatectomy has evolved and erectile nerve sparing allows now to achieve recovery in an important proportion of selected patients. However, rehabilitation and sexual counselling protocols are rare and may not include the partner. This has led us to propose a specific urologic and sexologic associated management.

[Model of short-term psychological intervention in psychosomatic gynaecology]

This article proposes a rapid psychological intervention model in psychosomatic gynaecology. The work draws from the method developed by Dr H. Davanloo (Intensive Short Term Dynamic Psychotherapy). First it consists in identifying and clarifying the defence mechanisms, second in exercising pressure on them. This pressure causes an increase in anxiety, an intensification of the defence mechanisms and the development of an intrapsychic crisis that induces emotions and painful feelings linked to past traumata. This activation of the unconscious can activate somatic symptoms (pain, unconscious movements, tics, muscular tensions) that highlight the link between the physical and psychic aspects. This work allows a rapid access to the painful emotions that turn to symptom. It indicates the therapeutic intervention zones and levels. It allows translating psychic reality in a simple, fast and efficient way. It brings heightened consciousness and comprehension for the therapist and the patient.