What to Expect When You're Expecting: Perinatal Sexual Education Is Linked with Couples' Sexual Well-Being in Pregnancy and the Postpartum

Up to 88% of expectant and new parents report problems with their sexual well-being, yet less than 30% of individuals receive information about potential sexual problems from health-care professionals. Lack of information may contribute to difficulty adjusting to sexual challenges, and in turn, to poorer sexual well-being. The current study examined the following: 1) the amount of perinatal sexual health information individuals receive/access; 2) gaps between desired and received information; 3) barriers to accessing information; and 4) links between the quantity of information received/accessed and sexual well-being outcomes in one sample of pregnant couples (N = 102) and another sample of couples in the postpartum (N = 102). Results revealed that most participants reported receiving/accessing little-to-no sexual health information, despite most participants wanting to receive a variety of information related to their perinatal sexuality. On average, expectant and new parents were indifferent regarding how easy/comfortable they felt discussing their sexuality with health-care professionals. Overall, when gestational parents received/accessed more pregnancy-related sexual health information and when either parent received/accessed more postpartum-related sexual health information, both members of the couples reported greater sexual well-being. Access to information might not only address couples' needs and concerns but may also bolster sexual well-being during a vulnerable period.

Associations between Genital Self-Image and Individuals' Own and Perceived Partner Sexual Satisfaction

Negative genital self-image is linked with lower sexual satisfaction, but no research has examined its association with perceptions of partners' sexual satisfaction. In two studies (N = 475, N = 234), we examined links between genital self-image and own and individuals' perceived partner sexual satisfaction. In the second study, we tested whether a mindfulness intervention moderated these associations. In both studies, more negative genital self-image was significantly associated with individuals' lower own and perceived partner sexual satisfaction concurrently and over a two-week period. Mindfulness intervention exposure did not moderate associations. Findings support negative genital self-image as a risk factor for sexual dissatisfaction.

Self-Compassion and Compassionate Love Are Positively Associated with Sexual and Relational Well-Being Among Expectant and New Parent Couples

Pregnancy and the postpartum period can be a challenging time for many couples' relationships. Outside of pregnancy and the postpartum period, being more attentive and sensitive to one's own suffering (i.e., high in self-compassion) and showing love that centers on another person's well-being (i.e., compassionate love) has been linked with greater sexual and relationship satisfaction and lower sexual distress. Both self-compassion and compassionate love may benefit couples during the perinatal period by facilitating more adaptive coping and greater responsiveness to one's own and one's partner's needs. The goal of this study was to examine associations between self-compassion and compassionate love and sexual and relationship satisfaction and sexual distress in two samples of (1) expectant (n = 102) and (2) new parent (n = 102) couples. During pregnancy, self-compassion and compassionate love were linked with higher relationship and sexual satisfaction and lower sexual distress. In the postpartum, higher self-compassion and compassionate love were associated with greater relationship satisfaction, but were less consistently linked with sexual satisfaction and sexual distress. Consistent with theory, self-compassion and compassionate love may allow expectant and new parent couples to adjust to the demands of new parenthood more easily, with benefits for their sexual and relationship wellbeing. Given our data and the established benefits of self-compassion and compassionate love for facilitating adjustment during stressful life events, educating couples about the importance of fostering self-compassion and compassionate love during pregnancy, and after the baby is born, may cultivate resilience which, in turn, may promote stronger relationships.

SABRSeq: A Randomized Phase Ib Trial of SABR Sequencing with Pembrolizumab in Metastatic Non-Small Cell Lung Cancer (NSCLC)

PURPOSE/OBJECTIVE(S)

The optimal sequencing of stereotactic ablative body radiotherapy (SABR) with anti-PD1 checkpoint blockade is unknown. The purpose of SABRseq was to assess the toxicity of the combination of SABR delivered either before or after the commencement of pembrolizumab. The central hypothesis is that the treatment combination will have a safety profile that is clinically acceptable and demonstrate anti-tumor efficacy. Furthermore, we hypothesize that differences in systemic immune activation will be observed between treatment arms.

MATERIALS/METHODS

This was a single institutional phase Ib randomized clinical trial (Trial ID NCT03307759). Eligible patients had metastatic NSCLC, ECOG performance 0-1, and had not received prior checkpoint immunotherapy, high-dose radiation (>36 Gy) within 6 months, or either systemic or radiation therapy within 4 weeks of randomization. Eligible patients had either TPS≥50% PD-L1 expression in the first-line or TPS≥1% PD-L1 expression with prior chemotherapy exposure. Patients were randomized to SABR before the commencement of pembrolizumab [ARM1] or SABR commencing after pembrolizumab [ARM2]. SABR was delivered in a single fraction of 18-20 Gy to 1-3 lesions. The primary endpoint was treatment-related adverse events (AE's) related to SABR and/or pembrolizumab. Secondary endpoints included best overall response (BOR), overall survival (OS), and progression-free survival (PFS). Translational objectives included the evaluation of longitudinal changes in immunological cellular subsets within peripheral blood to explore changes in systemic immunity and circulating tumor DNA (ctDNA) dynamics.

RESULTS

Between December 2017 and December 2019, 13 patients were randomized. The median follow-up was 37 months. The study was closed early due to poor accrual. Median age was 66 years, with 11 patients (84%) having adenocarcinoma. Nine (69%) were enrolled in the first-line setting. The median [range] number of lesions was 6 [3-11]. The median [range] cycles of pembrolizumab delivered in ARM 1 was 13 [12-32] and ARM 2 was 9 [3-34]. Grade 3 treatment-related AEs were experienced in 0 of 5 patients in ARM1 and in 1 of 8 patients in ARM 2 (hyperglycemia). There were no grade 4 or 5 adverse events reported. The BOR by both RECIST and iRECIST criteria was CR in one patient, PR in seven patients, SD in five patients. Median (95% Cis) PFS was 12.4 months (6.3-21.0), and median (95% Cis) OS was 47.1 months (12.6-not reached; 2-year point estimate 62% [31-82]). Mass cytometry was used on serial peripheral blood samples to examine changes in the frequency of immune cells, changes in T cell activation, differentiation and functional polarization state. Targeted sequencing was performed to assess ctDNA. Translational outcomes will be presented.

CONCLUSION

There was no evidence of a concerning safety signal from either SABR before or after start of pembrolizumab. The combination demonstrated activity with promising PFS and OS and is worthy of evaluation in larger randomized trials.

Examining Attentional Biases Elicited by Sexual Stimuli Using MouseView.js: An Online Paradigm to Mimic Eye Movements

Attention is a key mechanism underlying many aspects of sexuality, with eye-tracking studies revealing that attention is both sustained by sexual stimuli and corresponds with sexual interest. Despite its utility, eye-tracking experiments typically require specialized equipment and are conducted in a laboratory setting. The overarching objective of this research was to assess the utility of a novel online method, MouseView.js, for assessing attentional processing of sexual stimuli outside of a laboratory context. MouseView.js is an open-source, web-based application where the display is blurred to mimic peripheral vision and an aperture is directed using a mouse cursor to fixate on regions of interest within the display. Using a discovery (Study 1, n = 239) and replication (Study 2, n = 483) design, we examined attentional biases to sexual stimuli among two diverse samples with respect to gender/sex and sexual orientation. Results revealed strong attentional biases toward processing sexual stimuli relative to nonsexual stimuli, as well as dwell times that correlated with self-report sexuality measures. Results mirror those observed for laboratory-based eye-tracking research, but using a freely available instrument that mirrors gaze tracking. MouseView.js offers important advantages to traditional eye-tracking methods, including the ability to recruit larger and more diverse samples, and minimizes volunteer biases.

A Longitudinal Investigation of Couples' Sexual Growth and Destiny Beliefs in the Transition to Parenthood

Beliefs about sexuality tend to become more salient during sexual challenges and are associated with how individuals respond to these difficulties and, in turn, their sexual well-being. The transition to parenthood is marked by significant changes to couples' sexuality. As such, this period of vulnerability may be an important context in which these beliefs impact how couples manage sexual stressors and may have implications for their sexual well-being. In a longitudinal dyadic study, we examined whether couples' sexual growth beliefs (e.g., beliefs that sexual problems can be resolved through effort) and sexual destiny beliefs (e.g., beliefs that sexual problems reflect incompatibility with their partner) correspond with changes to various facets of couples' sexual well-being over time. First-time parent couples (N = 203) completed online surveys assessing these beliefs in pregnancy (32 weeks) and measures of sexual well-being (satisfaction, desire, and distress) in pregnancy (20 and 32 weeks) and across the postpartum period (3, 6, 9, 12 months). Dyadic latent growth curve models showed that expectant mothers who reported stronger sexual destiny beliefs in pregnancy reported higher sexual distress and lower sexual satisfaction at 3 months postpartum. When partners reported stronger sexual destiny beliefs in pregnancy, both they and new mothers reported greater sexual desire at 3 months postpartum. Unexpectedly, partners' higher sexual growth beliefs in pregnancy predicted mothers' lower sexual desire at 3 months postpartum. Sexual growth and destiny beliefs were not associated with change in couples' sexual well-being beyond 3 months postpartum. Findings shed light on the potential benefits and costs of sexual growth and destiny beliefs for couples' sexual well-being early in the postpartum period, but not over time.

A Longitudinal Examination of Common Dyadic Coping and Sexual Distress in New Parent Couples during the Transition to Parenthood

New parents experience significant disruption to their sexual relationships such as lower desire and sexual frequency relative to prepregnancy. Little is known about the sexual distress new parents feel related to these changes, how sexual distress evolves over time, or how coping with stress relates to this distress. New parent couples who engage in more adaptive, joint coping with mutual stressors-common dyadic coping (CDC)-may be better able to manage distress related to their sexuality and thus, experience less sexual distress at 3-months postpartum and experience more marked improvement over time. In 99 first-time parent couples, we examined the link between CDC measured at 3-months postpartum and trajectories of sexual distress across 3-, 6-, and 12-months postpartum. Analyses used dyadic latent growth curve modeling informed by the actor-partner interdependence model. Mothers' sexual distress at 3-months postpartum was clinically elevated and higher than their partner's. Mothers' sexual distress declined significantly over time, whereas partners' sexual distress remained low and stable. An individual's higher perceptions of CDC was significantly associated with their own (but not their partner's) lower sexual distress at 3-months postpartum. No significant associations were found between CDC and change in sexual distress over time. How new parents jointly cope with stressors early in the postpartum period may lessen the distress they have about their sexuality at a time when most couples have just resumed sexual activity. Results identify CDC as a possible novel target for interventions aimed at helping couples manage sexual distress during the transition to parenthood.

Gynephilic Men's and Androphilic Women's Visual Attention Patterns: The Effects of Gender and Sexual Activity Cues

Men and women differ in the degree of specificity of sexual response and differences in attention to sexual cues may be a mechanism underlying these gendered patterns. The majority of previous research has examined attention using static images, which differ considerably from the dynamic videos used in studies of sexual response. To test attention as a potential mechanism involved in gendered sexual response, we used eye-tracking to examine visual attention patterns of 33 gynephilic men and 36 androphilic women to videos depicting preferred and nonpreferred gender targets engaging in varying sexual activities. Specificity of controlled attention was gendered, and this effect differed depending on the intensity of sexual activity cues depicted. Regardless of sexual activity cues, men's controlled attention was gender-specific toward preferred targets. Sexual activity cues did, however, impact the degree to which women's controlled attention was gender-specific. Specifically, women's attention was gender-specific to low-intensity stimuli but nonspecific for masturbation and same-sex dyadic stimuli. Women's attention was gender-specific for mixed-sex dyadic stimuli, but with greater attention directed toward nonpreferred gender targets. Overall, contextual cues impact women's attention to a greater degree than men's. Potential explanations for these findings and implications of stimulus selection for sexuality research are discussed.

The Empirical Status of the Preparation Hypothesis: Explicating Women's Genital Responses to Sexual Stimuli in the Laboratory

Research conducted in our laboratory and in other laboratories has revealed that (1) women's genital responses to visual and auditory stimuli are strongly affected by the presence of sexual cues, but that (2) specific sexual cues (e.g., gender of actors, the presence of sexual violence) often have little impact on the magnitude of the responses-that is, similar genital responses are observed to very different sexual stimuli. In addition, (3) women's genital responses do not strongly correspond with self-reported sexual partner and activity preferences, or (4) with self-reported sexual arousal during the presentation of sexual stimuli. Taken together, these facts represent a puzzle, especially considering that men's genital responses are highly affected by specific sexual cues and strongly correspond to stated preferences and self-reported sexual arousal. One hypothesis to explain female low cue-specificity and low concordance (relative to men) is the preparation hypothesis: Women's indiscriminate genital responses serve a protective function. That is, they do not indicate or necessarily promote sexual interest and motivation, but rather prepare the vaginal lumen for possible sexual activity and therefore prevent injuries that may occur as a result of penetration. We review evidence for and against this hypothesis. We conclude that the evidence is favorable but not entirely convincing, and more work is required to reach a firm conclusion. We offer directions for future research.

Longitudinal Associations between Depressive Symptoms and Postpartum Sexual Concerns Among First-time Parent Couples

Most first-time parents experience novel concerns about their sexuality such as worries about the effects of labor and delivery on their sex lives. The link between postpartum depressive symptoms and problems with sexual function is bidirectional; however, associations with postpartum sexual concerns (i.e., worries about one's sexuality that are not necessarily related to sexual function) have not been examined. First-time parent couples (N = 99) completed measures assessing their postpartum sexual concerns and depressive symptoms at 3, 6, and 12 months postpartum. Dyadic latent growth curve modeling revealed that mothers' and partners' initial frequencies of postpartum sexual concerns were positively associated, with significant declines in the frequency of these concerns over time for both partners. Mothers' and partners' initial depressive symptoms were also positively associated; however, mothers' depressive symptoms did not change over time whereas partner's depressive symptoms worsened. Mothers' and partners' higher initial depressive symptoms were associated with partners' higher frequency of postpartum sexual concerns. Mothers' depressive symptoms at 3 months postpartum and the degree to which these symptoms changed over time were associated with a steeper decline in partners' postpartum sexual concerns over time. Results provide preliminary support for depressive symptoms as a risk factor for partners' postpartum sexual concerns.

Sex Drive as a Possible Mediator of the Gender Difference in the Prevalence of Paraphilic Interests in a Nonclinical Sample

There is a general gender difference in paraphilic interests, such that men report more interest (and greater engagement) in a variety of paraphilic behaviors. Using a nonclinical sample, Dawson et al. (Sexual Abuse, 28(1):20-45, 2016, https://doi.org/10.1177/1079063214525645 ) found that the gender difference in paraphilic interests was eliminated when scores on measures of sex drive were used as mediators. However, their measures of sex drive were about more than just sex drive and included a measure of hypersexuality (i.e., distress, perceived lack of control, and problematic consequences of one's sexuality). This study had two aims: to replicate Dawson et al.'s mediation results (using the same measures and scoring methods), and to discern the effect of sex drive itself (by replacing their measure of hypersexuality with a measure of sex drive). A nonclinical sample of 517 men and 615 women completed an online questionnaire. As expected, men reported less repulsion than women for most paraphilic themes. The gender difference in paraphilic interests was reduced (but not eliminated) both when reproducing Dawson et al.'s analysis and when examining a mediation model focused on sex drive specifically. The same results were obtained when examining the paraphilic interest with the largest gender difference (i.e., voyeurism). A full mediation effect was obtained in an unplanned supplementary analysis using a factor score (derived from eight measures) putatively assessing sex drive. While the main findings are consistent with Dawson et al.'s conclusions that sex drive is a possible mediator, they also suggest that other factors need to be considered to help explain the gender difference in the prevalence of paraphilic interests.

Individual and Relationship Predictors of Trajectories of Sexual Function across Adolescent and Young Adult Relationships

Many young adults report poor sexual function, but research typically fails to consider relationship context and how problems might evolve over time. Research is needed to provide insights into how sexual problems are experienced across relationships, as well as the types of sexual function problems associated with various trajectories. We investigated retrospective trajectories of sexual problems across the multiple relationships of 688 young adults (18-24 years) as well as the individual and relationship factors associated with these trajectories. Both persistent suboptimal and optimal trajectories emerged for men and women. However, persistent and variable problematic function trajectories also emerged for women (and not men). Across all individual and relationship factors analyzed, multivariate multinomial regression analysis indicated that higher sexual esteem and more traditional gender beliefs best predicted membership in trajectories capturing better sexual function. Implications are discussed in terms of the need to provide substantive information regarding sexual function to young people as they transition to adulthood.

Associations Between Postpartum Depressive Symptoms and Couples' Sexual Function and Sexual Distress Trajectories Across the Transition to Parenthood

BACKGROUND

The transition to parenthood is associated with changes to new parents' mood and sexual health. Sexual dysfunction-problems with sexual function accompanied by sexual distress (i.e., worries and concerns about one's sex life)-is linked to poorer overall health, yet few studies have examined how sexual dysfunction unfolds for couples during this transition. Postpartum depression is a risk factor for sexual dysfunction; however, the association between depressive symptoms and how postpartum sexual dysfunction evolves has not been examined.

PURPOSE

To establish trajectories of sexual function and sexual distress for mothers and partners and to examine if postpartum depressive symptoms were associated with these trajectories.

METHODS

Data were collected from 203 first-time parent couples from midpregnancy until 12-months postpartum. Sexual function and sexual distress were assessed at six time points (two prenatal) and depressive symptoms were assessed at 3-months postpartum.

RESULTS

Dyadic latent piece-wise growth curve models revealed significant declines in mothers' and partners' sexual function between pregnancy and 3-months postpartum and significant improvements from 3- to 12-months postpartum. Mothers' sexual distress increased between pregnancy and 3-months postpartum and decreased thereafter, whereas partner's sexual distress remained stable. Depressive symptoms were associated with poorer sexual function and higher sexual distress at 3-months postpartum for both partners but did not predict change over time.

CONCLUSIONS

Mothers and their partners experience changes to their sexual function during the transition to parenthood; however, mothers are at greater risk of sexual dysfunction. Depressive symptoms are a risk factor for poorer sexual health at 3-months postpartum for both parents.

Visual Attention and Sexual Function in Women

Purpose of Review

Theoretical models situate attention as integral to the onset and regulation of sexual response and propose that problems with sexual response and subsequent sexual dysfunction result from insufficient attentional processing of sexual stimuli. The goal of this paper is to review literature examining the link between attentional processing of sexual stimuli and sexual function in women. Specifically, we sought to understand whether women with and without sexual dysfunction differ in their visual attention to sexual stimuli and examined the link with sexual response, which would support attention as a mechanism underlying sexual dysfunction.

Recent Findings

Across women with and without sexual concerns, sexual stimuli are preferentially attended to relative to nonsexual stimuli, suggesting that sexual stimuli are more salient than nonsexual stimuli. Differences between women with and without sexual dysfunction emerge when examining visual attention toward the most salient features of sexual stimuli (e.g., genital regions depicting sexual activity). Consistent with theoretical models, visual attention and sexual response are related, such that increasing attention to sexual cues facilitates sexual arousal, whereas reduced attention to sexual stimuli appears to suppress sexual arousal, which may contribute to sexual difficulties in women.

Summary

Taken together, the research supports the role of visual attention in sexual response and sexual function. These findings provide empirical support for interventions that target attentional processing of sexual stimuli. Future research is required to further delineate the specific attentional mechanisms involved in sexual response and investigate whether these are modifiable. This knowledge may be beneficial for developing novel psychological interventions targeting attentional processes in the treatment of sexual dysfunctions.

Trajectories of sexual well-being among couples in the transition to parenthood

Sexual well-being is an important contributor to romantic relationship quality, health, and quality of life, yet couples face significant disruptions to their sexuality during the transition to parenthood. While there is evidence of variability in the sexual well-being of new parents, distinct classes of dyadic trajectories have not been established. Sexual frequency, desire, satisfaction, and distress are each unique components of sexual well-being and may follow different patterns of change within couples. We sought to establish classes of trajectories of four aspects of sexual well-being for couples in the transition to parenthood as well as the associations among identified classes. Couples (N = 203) expecting their first child completed online standardized measures of sexual well-being at 20 and 32 weeks in pregnancy and at 3, 6, 9, and 12 months postpartum. Dyadic latent class growth analyses were conducted to identify classes of trajectories for each facet of sexual well-being, and dual trajectory analyses examined the probability of group membership across classes. Couples' sexual well-being over time was heterogeneous. Sexual frequency had two classes: high (33%) and low (67%); sexual desire had three classes: moderate (36%), high (25%), and discrepant (39%); sexual satisfaction had two classes: high (64%) and low (36%); and sexual distress had two classes: low (76%) and discrepant (24%). Overlap in classes of sexual well-being was variable such that high and low or discrepant (between partners) classes did not always co-occur. Findings provide more nuanced information about new parents' postpartum sexual health, which may facilitate early assessment and intervention. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Concordance of Paraphilic Interests and Behaviors

We examined the concordance of paraphilic interests and behaviors across 13 themes in an online sample of 1,036 men and women. Paraphilic interests were significantly and positively correlated with behaviors across all 13 themes. Associations were strongest for masochism and sadism, and weakest for pedohebephilia and frotteurism. Paraphilic interest and behavior were significantly and positively correlated after accounting for gender and sexual orientation. Moderated moderation analysis was significant for five themes. Gender was a moderator for eroticized gender, but only among heterosexual participants, where concordance was higher for heterosexual men than for heterosexual women. For both exhibitionism and frotteurism, gender was a significant moderator, but only for nonheterosexual participants, where concordance was stronger for nonheterosexual men than for nonheterosexual women. For pedohebephilia, interest was significantly associated with behavior for heterosexual men, heterosexual women, and nonheterosexual men, but not for nonheterosexual women. For zoophilia, there was a significant association between interest and behavior for heterosexual men, nonheterosexual men, and nonheterosexual women, but not heterosexual women. Additional analyses found sex drive moderated the positive associations of 7 of 13 paraphilic themes, with 5 of these 7 showing the expected effect of higher concordance of interests and behaviors at higher levels of sex drive.

Exploring Comfort Levels and the Role of Compensation in Sexual Psychophysiology Study Participation

A number of devices have been developed to assess physiological sexual response. Some come into direct contact with the genitals (e.g., vaginal/clitoral/penile plethysmography [VPP/CPP/PPG], labial thermistors [LT]), whereas others capture images of the genitals remotely (e.g., thermal imaging [TI], laser Doppler imaging [LDI]). Researchers have speculated about the relative invasiveness of these measurement tools, with limited empirical work examining participants' perceptions of different devices and how these may impact volunteer bias. We investigated individuals' levels of comfort with participating in hypothetical sexual psychophysiology studies and their reasons for discomfort. We also examined the relationship between comfort level and compensation for participation. Men (n = 291) and women (n = 716) completed an online survey where they were presented with vignettes describing studies using VPP, CPP, PPG, LT, TI, and LDI. Participants reported their comfort level with the idea of participating in each study, the amount of compensation that would be reasonable, and factors influencing their decision not to participate if they were unwilling. Participants were similarly comfortable with some studies involving genital contact (VPP) or remote imaging (TI), and somewhat less comfortable with others (LDI, LT, PPG; small or small-medium effect sizes). Along with our qualitative analysis, these findings reveal that direct genital contact is one aspect of study intrusiveness, but that it is not necessarily the most important study feature influencing comfort with participation. Our results suggest that providing additional information regarding protocols at screening and offering $50 compensation might attract wider samples of participants.

Effects of Individual Difference Variables, Gender, and Exclusivity of Sexual Attraction on Volunteer Bias in Sexuality Research

Sexuality research is often regarded as more intrusive than other types of research, contributing to sample self-selection biases. Researchers have consistently found that volunteers and non-volunteers for sexuality studies differ on a number of sexuality-related variables. Despite a large number of studies examining volunteer biases, relatively few have examined the effects of gender and exclusivity of sexual attraction on willingness to volunteer. Given that comparisons on the basis of gender and/or sexual attraction are frequently made in sexuality studies, understanding how these factors may contribute to volunteer bias is particularly important. In the current study, we investigated the impact of gender and sexual attraction, as well as individual difference variables, on hypothetical willingness to volunteer for a variety of sexuality studies, including new measurement technologies not previously investigated. Greater proportions of men and individuals with any degree of same-gender attraction reported that they were willing to volunteer for eye tracking and psychophysiology studies, whereas there were no significant effects of gender or sexual attraction on willingness to volunteer for sexuality surveys. The proportions of volunteers willing to participate were inversely related to study invasiveness. Greater sexual experience and more positive sexual attitudes were significant predictors of willingness to volunteer, whereas gender, sexual attraction, and other sexuality characteristics were not significant predictors. Implications of volunteer bias for research findings are discussed. Strategies to minimize volunteer bias and to examine whether or not recruited samples differ from the population are provided.

Development and Validation of a Measure of Responsive Sexual Desire

According to the incentive motivation model, sexual desire does not occur spontaneously but can be triggered by sexual stimuli and stems from one's experience of sexual arousal. Until now, research into responsive sexual desire has been challenged by the lack of measures capturing desire that emerges following sexual arousal. The aim of this study was to validate the 18-item Report of Behavior and Feelings-Desire (RBF-D) scale in a sample of 291 women (M_age = 22.41, SD = 5.82) with varying degrees of sexual desire. Items on the RBF-D were selected to reflect 5 aspects of responsive sexual desire: sexual activity with a primary partner, sexual desire for a primary partner, sexual activity with other persons, sexual desire for other persons, and autoerotic activities. A 5-factor solution was confirmed via exploratory structural equation modeling. Internal consistency of 4 out of 5 factors was good. Convergent validity was established via small to medium associations of the RBF-D factors with other measures of sexual desire. Low and nonsignificant correlations with depression and sexual inhibition supported the discriminant validity. The RBF-D is a valid and reliable measure that can be useful in clinical and research settings where assessment of responsive sexual desire and behavior is needed.

The Effects of Gender and Relationship Context Cues on Responsive Sexual Desire in Exclusively and Predominantly Androphilic Women and Gynephilic Men

Sexual desire may be "responsive," emerging from sexual arousal to sexually competent cues. Cues that elicit sexual arousal and desire differ, however, by gender and direction of sexual attractions. Further, relationship context cues are thought to be important for responsive desire, but this has not been tested directly. The current study examined gynephilic men's (n = 27) and exclusively (n = 23) and predominantly (n = 17) androphilic women's dyadic and solitary responsive sexual desire, as well as genital and self-reported arousal, to audio narratives varying by gender (male, female) of the sexual partner and relationship context (stranger, friend, long-term relationship). Consistent with previous literature, gynephilic men's solitary and dyadic desire were gender-specific (greater to female than to male sexual partners). Exclusively androphilic women's dyadic desire differentiated less to cues of gender than gynephilic men's, and their solitary desire did not differentiate by gender cues at all, replicating previous research. Androphilic women with some gynephilia reported a gender-nonspecific pattern of dyadic and solitary desire (i.e., responsive desire to both male and female narratives). No effect of relationship context was found for any groups. Results suggest that responsive sexual desire may be more closely associated with self-reported than genital arousal patterns.

The 4G/5G Genetic Polymorphism in the Promoter of the Plasminogen Activator Inhibitor-1 (PAI-1) Gene Is Associated with Differences in Plasma PAI-1 Activity but not with Risk of Myocardial Infarction in the ECTIM Study

We have investigated the interrelationships of plasma PAI-1 activity, the PAI-1 4G/5G polymorphism and risk of myocardial infarction (MI) in the ECTIM study, a case-control study of MI based in Belfast, Lille, Strasbourg and Toulouse. Mean PAI-1 levels in cases were similar across all centres but in controls, levels in the French centres were significantly higher. Only in Belfast were PAI-1 levels higher in cases (11.7AU/ml) than controls (10.5AU/ml). The PAI-1 4G allele frequency was similar in cases and controls (0.55 and 0.54). In all groups, 4G homozygotes had the highest mean plasma PAI-1 level (4G4G vs 5G5G; cases overall: 14.2 vs 12.1 AU/ml; controls overall: 15.0 vs 12.6AU/ml), with the heterozygotes generally intermediate. The data from Belfast are consistent with the literature implicating PAI-1 level as an MI risk factor. In ECTIM, the PAI-1 4G/5G polymorphism is not a genetic risk factor for MI but is associated with PAI-1 activity. Thus homozygosity for the 4G allele may predispose to elevated PAI-1 and impaired fibrinolysis, perhaps requiring interaction with other genetic or environmental factors to influence MI risk.

The effect of static versus dynamic stimuli on visual processing of sexual cues in androphilic women and gynephilic men

Models of sexual response posit that attentional processing of sexual cues is requisite for sexual responding. Despite hypothesized similarities in the underlying processes resulting in sexual response, gender differences in sexual arousal patterns are abundant. One such gender difference relates to the stimulus features (e.g. gender cues, sexual activity cues) that elicit a response in men and women. In this study, we examined how stimulus modality (static visual images versus dynamic audiovisual films) and stimulus features (gender, sexual activity and nonsexual contextual cues) influences attentional (i.e. gaze) and elaborative (i.e. self-reported attraction (SRA), self-reported arousal) processing of sexual stimuli. Men's initial and controlled attention was consistently gender-specific (i.e. greater attention towards female targets), and this was not influenced by stimulus modality or the presence of sexual activity cues. By contrast, gender-specificity of women's attention patterns differed as a function of attentional stage, stimulus modality and the features within the stimulus. Degree of specificity was positively predictive of SRA in both genders; however, it was not significantly predictive of self-reported arousal. These findings are discussed in the context of gendered processing of visual sexual information, including a discussion of implications for research designs.

Assessing the Relationship Between Sexual Concordance, Sexual Attractions, and Sexual Identity in Women

On average, there is a gender difference in sexual concordance, with men exhibiting greater agreement between genital and self-reported sexual arousal, relative to women. Much less is known about the substantial variation in women's sexual concordance; women's genital and self-reported sexual responses may correlate strongly and positively, not at all, or even strongly negatively. The within-gender variation in sexual concordance suggests that individual differences may be related to sexual concordance. We examined whether sexual concordance varies as a function of sexual orientation (based on self-reported sexual attractions and sexual identity labels) in a sample (N = 76) that included exclusively androphilic, predominantly androphilic, ambiphilic, and predominantly/exclusively gynephilic women. Participants viewed sexual and nonsexual stimuli that varied by actor gender while their vaginal vasocongestion and subjective sexual responses were measured. Women's sexual concordance varied as a function of their sexual attractions; women with any degree of gynephilia exhibited higher sexual concordance than exclusively androphilic women across a variety of sexual concordance measures, and these effects were demonstrated using correlation and multi-level modeling analyses. Only sexual concordance based on overall feelings of arousal varied by sexual identity, with heterosexual women exhibiting the lowest sexual concordance. Stimulus gender significantly influenced sexual concordance for most groups of women: Ambiphilic and predominantly/exclusively gynephilic women exhibited greater sexual concordance to female stimuli and exclusively androphilic women exhibited greater sexual concordance to male stimuli. These findings suggest that sexual orientation (particularly one's degree of gynephilia) may explain some of the within-gender variation seen in women's sexual concordance.

Visual Attention Patterns of Women with Androphilic and Gynephilic Sexual Attractions

Women who report exclusive sexual attractions to men (i.e., androphilia) exhibit gender-nonspecific patterns of sexual response-similar magnitude of genital response to both male and female targets. Interestingly, women reporting any degree of attraction to women (i.e., gynephilia) show significantly greater sexual responses to stimuli depicting female targets compared to male targets. At present, the mechanism(s) underlying these patterns are unknown. According to the information processing model (IPM), attentional processing of sexual cues initiates sexual responding; thus, attention to sexual cues may be one mechanism to explain the observed within-gender differences in specificity findings among women. The purpose of the present study was to examine patterns of initial and controlled visual attention among women with varying sexual attractions. We used eye tracking to assess visual attention to sexually preferred and nonpreferred cues in a sample of 164 women who differed in their degree of androphilia and gynephilia. We found that both exclusively and predominantly androphilic women showed gender-nonspecific patterns of initial attention. In contrast, ambiphilic (i.e., concurrent androphilia and gynephilia) and predominantly/exclusively gynephilic women oriented more quickly toward female targets. Controlled attention patterns mirrored patterns of self-reported sexual attractions for three of these four groups of women, such that gender-specific patterns of visual attention were found for androphilic and gynephilic women. Ambiphilic women looked significantly longer at female targets compared to male targets. These findings support predictions from the IPM and suggest that both initial and controlled attention to sexual cues may be mechanisms contributing to within-gender variation in sexual responding.

Gender-Specificity of Initial and Controlled Visual Attention to Sexual Stimuli in Androphilic Women and Gynephilic Men

Research across groups and methods consistently finds a gender difference in patterns of specificity of genital response; however, empirically supported mechanisms to explain this difference are lacking. The information-processing model of sexual arousal posits that automatic and controlled cognitive processes are requisite for the generation of sexual responses. Androphilic women's gender-nonspecific response patterns may be the result of sexually-relevant cues that are common to both preferred and nonpreferred genders capturing attention and initiating an automatic sexual response, whereas men's attentional system may be biased towards the detection and response to sexually-preferred cues only. In the present study, we used eye tracking to assess visual attention to sexually-preferred and nonpreferred cues in a sample of androphilic women and gynephilic men. Results support predictions from the information-processing model regarding gendered processing of sexual stimuli in men and women. Men's initial attention patterns were gender-specific, whereas women's were nonspecific. In contrast, both men and women exhibited gender-specific patterns of controlled attention, although this effect was stronger among men. Finally, measures of attention and self-reported attraction were positively related in both men and women. These findings are discussed in the context of the information-processing model and evolutionary mechanisms that may have evolved to promote gendered attentional systems.

Paraphilic Interests: An Examination of Sex Differences in a Nonclinical Sample

Little research has been conducted to examine paraphilic sexual interests in nonclinical samples. The little that exists suggests that atypical sexual interests are more common in men than in women, but the reasons for this difference are unknown. In this study, we explored the prevalence of paraphilic interests in a nonclinical sample of men and women. We expected that men would report greater arousal (or less repulsion) toward various paraphilic acts than women. We also examined putative correlates of paraphilias in an attempt to explain the sex difference. In all, 305 men and 710 women completed an online survey assessing sexual experiences, sexual interests, as well as indicators of neurodevelopmental stress, sex drive, mating effort, impulsivity, masculinity/femininity, and socially desirable responding. As expected, significant sex differences were found, with men reporting significantly less repulsion (or more arousal) to the majority of paraphilic acts than women. Using mediation analysis, sex drive was the only correlate to significantly and fully mediate the sex difference in paraphilic interests. In other words, sex drive fully accounted for the sex difference in paraphilic interests. The implications of these findings for understanding the etiology of atypical sexual interests are discussed.

Assessment of Introital Lubrication

Vaginal vasocongestion and lubrication serve to prepare the vaginal lumen for sexual activity. Lubrication is important for sexual functioning and difficulties with lubrication are one of the most commonly reported symptoms of sexual dysfunction. Few studies have empirically examined how vasocongestion and lubrication relate to one another and there are currently no well-established measures of lubrication. In this study, we designed and tested a simple method to assess lubrication at the vaginal introitus in 19 healthy women, using litmus test strips. We examined the relationship between lubrication and vaginal vasocongestion (measured with a photoplethysmograph) when elicited by audiovisual sexual stimuli (male-female sexual interactions). Lubrication was elicited by the sexual stimuli and was strongly correlated with reports of sexual arousal. Unexpectedly, lubrication was not correlated with vasocongestion, even though the latter was also elicited by the sexual stimuli. We discuss the implications of these findings for informing our understanding of the female sexual response and the potential clinical and scientific utility of this new measure.

Consensual Victim-Perpetrator Intercourse after Nonconsensual Sex: The Impact of Prior Relationship

Some female victims of nonconsensual sex subsequently have consensual sexual intercourse with the perpetrator and are more likely to do so if intercourse occurred during the nonconsensual sex than if it did not. Some evolutionary psychologists have postulated that there is something significant about nonconsensual intercourse that causes women to subsequently have a sexual relationship with the perpetrator (e.g., risk of pregnancy). In this study, we investigated a parsimonious explanation that has previously been overlooked: Intercourse is more likely during nonconsensual sex when the victim and perpetrator have previously had a sexual relationship; thus, subsequent consensual intercourse may simply be a continuation of that prior relationship. A sample of 945 women completed an Internet-based survey, of whom 41% had experienced nonconsensual sex since age 14. As expected, victims who had intercourse with perpetrators prior to the nonconsensual sex event were significantly more likely than other victims to experience nonconsensual intercourse and to engage in subsequent consensual intercourse with the perpetrator. When considering only the small subsample of victims who never had a prior romantic or sexual relationship with the perpetrator, the odds of subsequent consensual intercourse were still significantly greater following nonconsensual sex with intercourse versus without intercourse.

Sexual fantasies and viewing times across the menstrual cycle: a diary study

Recent research has revealed that many aspects of female sexuality change across the menstrual cycle. In this study, we examined changes in sexual fantasies and visual sexual interests across the menstrual cycle. A total of 27 single, heterosexual women (M age=21.5 years) not using hormonal contraceptives answered questions on a web-based diary every day for 30 days about their sexual fantasies and behaviors. Twenty-two of them also completed a viewing time task during three different menstrual cycle phases (follicular, ovulation, and luteal) to assess changes in visual sexual interest. Ovulation status was determined by a self-administered urine test. Results showed that the frequency and arousability of sexual fantasies increased significantly at ovulation. The number of males in the fantasies increased during the most fertile period, with no such change for the number of females. Fantasy content became more female-like during ovulation, focusing more on emotions rather than explicit sexual content. Women displayed a category non-specific pattern of viewing time with regard to target age and gender, regardless of fertility status. Results were discussed in the context of the ovulatory shift hypothesis of female sexuality.

Triple negative breast cancers: clinical and prognostic implications

Triple negative breast cancers are defined by the absence of oestrogen, progesterone and HER2 expression. Most triple negative cancers display distinct clinical and pathological characteristics with a high proportion of these tumours occurring at a younger age of onset and in African-American women. Triple negative tumours typically demonstrate high histological grade and are the most common breast cancer subtype in BRCA1 carriers. In addition, many of the features of triple negative cancers are similar to those identified in the basal-like molecular subtype which has recently been characterised by gene expression profiling. Although the two groups overlap, they are not synonymous. Triple negative breast cancers are of pivotal clinical importance given the lack of therapeutic options. The prognostic significance of triple negative tumours remains unclear since the group is heterogeneous and worst prognosis seems to be mostly confined to those that express basal cytokeratins or epidermal growth factor receptor (EGFR). This review focuses on outlining the pathological, molecular, and clinical features of triple negative breast cancers, discusses its prognostic value and summarises current therapeutic approaches and future directions of research.

Severe hypoglycaemia after long-acting octreotide in a patient with an unrecognized malignant insulinoma

Insulinomas are the most common hormone-producing pancreatic neuroendocrine tumours (NETs), and patients usually present with symptoms secondary to hypoglycaemia. Octreotide has been widely used in the symptomatic treatment of patients with pancreatic NETs, including insulinomas. We describe a case of a patient with a metastatic NET, subsequently identified as a malignant insulinoma, who developed severe hypoglycaemia after treatment with long-acting octreotide.

A phase I/II trial of celecoxib with chemotherapy and radiotherapy in the treatment of patients with locally advanced oesophageal cancer

BACKGROUND

The study's aim was to determine the maximum tolerated dose (MTD) of celecoxib combined with chemoradiotherapy (CRT) for locally advanced oesophageal cancer (OC).

METHODS

CRT comprised of 5FU (1000 mg/m(2)/day, days 1-4, weeks 1 & 5), cisplatin (75 mg/m(2), days 1 & 29) and radiotherapy (50 Gy in 25 fractions or 50.4 Gy in 28 fractions). Celecoxib was given daily during CRT at one of five doses (200 mg bd to 600 mg bd). Three to six patients were assigned per dose.

RESULTS

Thirteen patients were recruited before trial closure due to external safety concerns regarding celecoxib. Median follow up was 17 months (95% CI 9 - >39). The highest administered dose was 400 mg bd (n=4) with one dose-limiting toxicity at this level: grade 3 rash. Five (38%) and 8(62%) patients had grade 3 non-haematological and haematological toxicities respectively. No grade 4 toxicities occurred. Radiological response rate was 54% (n=7: all CR). Six patients had resection with one pathological CR. Median progression-free and overall survival were 8.8 (95% CI 5.1 - >24.8) and 19.6 months (95% CI 7.3 - >39) respectively.

CONCLUSIONS

A MTD was not reached. The regimen was tolerable, indicating that celecoxib can be safely administered with CRT for locally advanced OC.

Listeria outbreak associated with sandwich consumption from a hospital retail shop, United Kingdom

An outbreak of listeriosis occurred in the Swindon area of the UK in autumn 2003. Five cases were detected in pregnant women. Four of these women were thought to have eaten prepacked sandwiches from a retail outlet in one particular hospital. Sampling at the supplier detected Listeria monocytogenes, which was indistinguishable on molecular testing from the patients’ isolates. Recent changes in UK food legislation should help diminish the risk of further outbreaks/cases such as ours occurring.

Listeria outbreak associated with sandwich consumption from a hospital retail shop, United Kingdom

An outbreak of listeriosis occurred in the Swindon area of the UK in autumn 2003. Five cases were detected in pregnant women. Four of these women were thought to have eaten prepacked sandwiches from a retail outlet in one particular hospital. Sampling at the supplier detected Listeria monocytogenes, which was indistinguishable on molecular testing from the patients isolates. Recent changes in UK food legislation should help diminish the risk of further outbreaks/cases such as ours occurring.

Survey, characterization and susceptibility to fusidic acid of Staphylococcus aureus in the Carmarthen area

OBJECTIVE

This retrospective study was designed to investigate the possible reasons for an apparent increase in fusidic acid resistance among Staphylococcus aureus.

MATERIALS AND METHODS

The Datastore records of the Communicable Disease Surveillance Centre, Wales, UK were reviewed in conjunction with information concerning the prescribing of fusidic acid.

RESULTS

During the 5 year study period (1997-2001), a rise in the incidence of fusidic acid resistance was noted, particularly among paediatric patients presenting with infected eczema and impetigo, which may be related to the observed increase in prescriptions of topical fusidic acid. Extended phenotypic and genotypic characterization of a limited number (n=31) of isolates from 2002 showed that fusidic acid-resistant strains of S. aureus were typically from patients with impetigo and isolates fell into a single clonal group. Conversely, isolates from other skin disease (eczema, dermatitis and abscesses) were usually susceptible to fusidic acid and proved a diverse group.

CONCLUSION

This study provides valuable data on the prevalence of fusidic acid-resistant S. aureus, the genetic background of the strains, and their association with clinical disease in both the healthcare environment and community setting in the catchment area served by the Laboratory.

The role of the infection control link nurse

Link nurses act as a link between their own clinical area and the infection control team. Their role is to increase awareness of infection control issues in their ward and motivate staff to improve practice. It is essential that they receive training from the infection control team to ensure their competence. They have been shown to be of value to Trusts by improving clinical ward audit scores, helping infection control nurses implement policies and collecting data on hospital-acquired infections. In some hospitals, however, there are operational difficulties for link nurse schemes including high turnover of staff and insufficient time for training and monitoring their effectiveness.