Anxiety and Anticipated Pain Levels of Women With Self-Reported Penetration-Related Genito-Pelvic Pain are Elevated in Response to Pain-related Images.

BACKGROUND: Genito-pelvic pain (GPP) affects a sizable minority of women and results of existing treatments can be variable. A method of general pain treatment that has not yet been extended to penetration-related GPP is Explicit Motor Imagery (EMI), which uses pain-related images to help individuals with pain alter their responses to pain, resulting in reduced pain, less pain-related anxiety, and improved function. AIM: As a first step toward determining if EMI is a feasible method for treating penetration-related GPP, this study examined whether images that potentially signal genital pain are sufficient to induce an anxiety or anticipated pain response in women. METHODS: Participants were 113 women (62 with genital pain, 51 pain-free) recruited to complete an online study. Participants viewed randomized images of women engaging in various activities that potentially cause pain for people with penetration-related GPP (sitting, walking, running, lifting, inserting a tampon, implied penetrative sex, actual penetrative sex, implied gynecological exam, actual gynecological exam). Participants then rated each image on how much anxiety they experienced viewing the picture (viewing anxiety), and how much anxiety (anticipated anxiety) and pain (anticipated pain) they expected to experience doing the activity in the picture. OUTCOMES: Outcomes were the self-reported viewing anxiety, anticipated anxiety, and anticipated pain of women with and without self-reported penetration-related GPP in response to the pain-related images. RESULTS: Women who experienced self-reported penetration-related GPP reported significantly higher levels of viewing anxiety, anticipated anxiety, and anticipated pain in almost all categories of images, compared to women who were free of pain. The key exception was that women with and without self-reported penetration-related GPP reported similar levels of viewing anxiety when looking at images of implied and actual penetrative sex. CLINICAL TRANSLATION: These results support that pelvic and genital imagery serve as a sufficient stimulus to generate anxiety and anticipated pain in our study sample. EMI, which targets desensitization of heightened anxiety warrants further research as a potential novel treatment option. STRENGTHS & LIMITATIONS: This study was the first to assess responses to a wide array of pain-eliciting images in women with and without self-reported penetration-related GPP. A key limitation was that the pain sample was self-reported and not clinically diagnosed. CONCLUSION: Images of pain-related stimuli were sufficient to induce anxiety and anticipated pain in women with self-reported penetration-related GPP. This first step suggests that EMI may be a useful treatment option for women with penetration-related GPP. Kelly KJM, Fisher BL, Rosen NO, et al. Anxiety and Anticipated Pain Levels of Women With Self-Reported Penetration-Related Genito-Pelvic Pain are Elevated in Response to Pain-related Images. J Sex Med 2022;19:1281-1289.

Male-Centric and Female-Centric Pornography Consumption: Relationship With Sex Life and Attitudes in Young Adults.

Pornography availability has increased in recent years, and while there is plenty of speculation about its effects, empirical investigation about how porn influences our lives has yielded mixed results. Additionally, few studies have addressed the effects of specific pornography characteristics. Past research has shown that male-centric pornography can be related to negative outcomes, while female-centric pornography is related to more positive outcomes, particularly in women. The present survey study examined the relationship between pornography characteristics (male- and female-centric) and the self-reported attitudes and sexual experiences of men and women. Participants in the full sample were 195 men and 310 women who completed an online questionnaire. Although effect sizes were small, women who reported viewing pornography with more female-centric features also reported more positive effects of pornography on sex life and perceptions of the other gender. While men were more likely than women to report negative effects relating to pornography use on these same measures, there were very few reported negative effects of pornography overall. These findings demonstrate a small association between the use of female-centric pornography and more positive outcomes, particularly for women.

Differences in Neural Response to Romantic Stimuli in Monogamous and Non-Monogamous Men.

In non-human animal research, studies comparing socially monogamous and promiscuous species of voles (Microtus) have identified some key neural differences related to monogamy and non-monogamy. Specifically, densities of the vasopressin V1a receptor and dopamine D2 receptors in subcortical reward-related and limbic areas of the brain have been linked to monogamous behavior in prairie voles (Microtus ochrogaster). Similar brain areas have been shown to be correlated with feelings of romantic love in monogamously pair-bonded humans. Humans vary in the degree to which they engage in (non-)monogamous behaviors. The present study examined the differences in neural activation in response to sexual and romantic stimuli in monogamous (n = 10) and non-monogamous (n = 10) men. Results indicated that monogamous men showed more reward-related neural activity when viewing romantic pictures compared to non-monogamous men. Areas with increased activation for monogamous men were all in the right hemisphere and included the thalamus, accumbens, striatum, pallidum, insula, and orbitofrontal cortex. There were no significant differences between groups in activation to sexual stimuli. These results demonstrate that the neural processing of romantic images is different for monogamous and non-monogamous men. There is some overlap in the neural areas showing increased activation in monogamous men in the present study and the neural areas that show differences in the vole models of monogamy and affiliation. Future research will be needed to clarify whether similar factors are contributing to the neural differences seen in monogamous and non-monogamous humans and voles.

Androgen deprivation therapy's impact on the mood of prostate cancer patients as perceived by patients and the partners of patients.

OBJECTIVE: To assess the relationship between of androgen deprivation therapy (ADT) and the mood of prostate cancer (PCa) patients and partners of PCa patients. METHODS: PCa patients (n = 295) and partners of patients (n = 84) completed an online survey assessing the patients' current mood and mood prior to treatment, relationship adjustment, and sexual function. We compared men on ADT to men who received non-hormonal treatments for their PCa. RESULTS: Patients currently treated with ADT (n = 82) reported worsened mood as measured by the Profile of Mood States compared to those not on ADT (n = 213). The negative impact of ADT on mood, however, was reduced in older patients. Partners of patients on ADT (n = 42) reported similar declines in the patient's mood that patients reported, but to a greater degree than patient-reported levels. CONCLUSIONS: Our data support ADT's impact on PCa patients' mood and verify that partners concurrently see the effects. The psychological changes related to ADT can impact relationships and affect the quality of life of both PCa patients and partners. Patients and their partners are likely to benefit from being well informed about the psychological effects of androgen deprivation on men beginning ADT. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

The perspective of prostate cancer patients and patients' partners on the psychological burden of androgen deprivation and the dyadic adjustment of prostate cancer couples.

OBJECTIVE: Prostate cancer and its treatments, particularly androgen deprivation therapy (ADT), affect both patients and partners. This study assessed how prostate cancer treatment type, patient mood, and sexual function related to dyadic adjustment from patient and partner perspectives. METHODS: Men with prostate cancer (n = 206) and partners of men with prostate cancer (n = 66) completed an online survey assessing the patients' mood (profile of mood states short form), their dyadic adjustment (dyadic adjustment scale), and sexual function (expanded prostate cancer index composite). RESULTS: Analyses of covariance found that men on ADT reported better dyadic adjustment compared with men not on ADT. Erectile dysfunction was high for all patients, but a multivariate analysis of variance found that those on ADT experienced greater bother at loss of sexual function than patients not on ADT, suggesting that loss of libido when on ADT does not mitigate the psychological distress associated with loss of erections. In a multiple linear regression, patients' mood predicted their dyadic adjustment, such that worse mood was related to worse dyadic adjustment. However, more bother with patients' overall sexual function predicted lower relationship scores for the patients, while the patients' lack of sexual desire predicted lower dyadic adjustment for partners. CONCLUSIONS: Both patients and partners are impacted by the prostate cancer treatment effects on patients' psychological and sexual function. Our data help clarify the way that prostate cancer treatments can affect relationships and that loss of libido on ADT does not attenuate distress about erectile dysfunction. Understanding these changes may help patients and partners maintain a co-supportive relationship. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

Disgust versus Lust: Exploring the Interactions of Disgust and Fear with Sexual Arousal in Women.

Sexual arousal is a motivational state that moves humans toward situations that inherently pose a risk of disease transmission. Disgust is an emotion that adaptively moves humans away from such situations. Incongruent is the fact that sexual activity is elementary to human fitness yet involves strong disgust elicitors. Using an experimental paradigm, we investigated how these two states interact. Women (final N=76) were assigned to one of four conditions: rate disgust stimuli then watch a pornographic clip; watch a pornographic clip then rate disgust stimuli; rate fear stimuli then watch a pornographic clip; or watch a pornographic clip then rate fear stimuli. Women's genital sexual arousal was measured with vaginal photoplethysmography and their disgust and fear reactions were measured via self-report. We did not find that baseline disgust propensity predicted sexual arousal in women who were exposed to neutral stimuli before erotic content. In the Erotic-before-Disgust condition we did not find that sexual arousal straightforwardly predicted decreased image disgust ratings. However, we did find some evidence that sexual arousal increased self-reported disgust in women with high trait disgust and sexual arousal decreased self-reported disgust in women with low trait disgust. Women who were exposed to disgusting images before erotic content showed significantly less sexual arousal than women in the control condition or women exposed to fear-inducing images before erotic content. In the Disgust-before-Erotic condition the degree of self-reported disgust was negatively correlated with genital sexual arousal. Hence, in the conflict between the ultimate goals of reproduction and disease avoidance, cues of the presence of pathogens significantly reduce the motivation to engage in mating behaviors that, by their nature, entail a risk of pathogen transmission.

Assessment of distraction from erotic stimuli by nonerotic interference.

Distraction from erotic cues during sexual encounters is a major contributor to sexual difficulties in men and women. Being able to assess distraction in studies of sexual arousal will help clarify underlying contributions to sexual problems. The current study aimed to identify the most accurate assessment of distraction from erotic cues in healthy men (n = 29) and women (n = 38). Participants were assigned to a no distraction, low distraction, or high distraction condition. Distraction was induced using an auditory distraction task presented during the viewing of an erotic video. Attention to erotic cues was assessed using three methods: a written quiz, a visual quiz, and a self-reported distraction measure. Genital and psychological sexual responses were also measured. Self-reported distraction and written quiz scores most accurately represented the level of distraction present, while self-reported distraction also corresponded with a decrease in genital arousal. Findings support the usefulness of self-report measures in conjunction with a brief quiz on the erotic material as the most accurate and sensitive ways to simply measure experimentally-induced distraction. Insight into distraction assessment techniques will enable evaluation of naturally occurring distraction in patients suffering from sexual problems.

The relationship between daily hassles and sexual function in men and women.

Psychological stressors can interfere with sexual function through psychological and physiological mechanisms. Chronic stress, in particular, seems to have a negative effect on sexual functioning for men and women. The present study was designed to identify categories of stressors that contribute to sexual difficulties as well as assess the role of anxiety and depression in the relationship between stress and sexual function. Participants were recruited for an online survey in which they completed questionnaires on daily stressors, anxiety, depression, and sexual function. Results indicated that daily stressors predicted lower scores on sexual satisfaction for men and women and sexual activity for women. These effects were mediated by scores on the depression scale. Daily stressors, depression, and anxiety were highly correlated. A factor analysis of stressors resulted in 5 distinct categories of stressors. Of these, financial stressors and stressors related to low socioeconomic status were related to lower scores on all aspects of sexual functioning for women but not for men. Women's sexual functioning scores were more strongly related to stress and depression than men's scores. Results suggest that contextual factors (e.g., daily stressors, depression) are important considerations when assessing problems with sexual functioning.

Chronic stress and sexual function in women.

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.

Evidence for a curvilinear relationship between sympathetic nervous system activation and women's physiological sexual arousal.

There is increasing evidence that women's physiological sexual arousal is facilitated by moderate sympathetic nervous system (SNS) activation. Literature also suggests that the level of SNS activation may play a role in the degree to which SNS activity affects sexual arousal. We provide the first empirical examination of a possible curvilinear relationship between SNS activity and women's genital arousal using a direct measure of SNS activation in 52 sexually functional women. The relationship between heart rate variability (HRV), a specific and sensitive marker of SNS activation, and vaginal pulse amplitude (VPA), a measure of genital arousal, was analyzed. Moderate increases in SNS activity were associated with higher genital arousal, while very low or very high SNS activation was associated with lower genital arousal. These findings imply that there is an optimal level of SNS activation for women's physiological sexual arousal.

The role of salivary cortisol and DHEA-S in response to sexual, humorous, and anxiety-inducing stimuli.

Stress and anxiety are commonly thought to be detrimental to sexual function. Several studies in both the human and animal literature, however, have found that inducing anxiety can enhance sexual function in women. The mechanisms that explain a negative relationship between physical and psychological stress and sexual functioning are well documented, but little is known about how stress or anxiety might have a facilitatory effect on sexual arousal. As an initial step in exploring the relationship between anxiety and sexual arousal, the present study examined the role of the autonomic nervous system, and the adrenal hormones cortisol and dehydroepiandrosterone-sulfate (DHEA-S) in response to a sexual film, an anxiety-inducing film, and a humorous film. Nineteen premenopausal women (mean age 24.4 years) who were free from sexual difficulties came into the lab on three separate days. At each session they were shown an anxiety-inducing, sexually arousing, or humorous (control) film while their physiological arousal was measured. They also provided saliva samples before and after each film. Cortisol significantly decreased, while DHEA-S increased in the sexual and humorous conditions. Neither hormone changed significantly in the anxiety-inducing condition. Autonomic nervous system activity measured by heart rate and heart rate variability did not change in response to the sexual or anxiety-inducing films, but heart rate variability increased significantly in response to the humorous film. The cortisol/DHEA-S ratio at the post-sexual film time point was significantly negatively correlated with genital arousal (measured by vaginal pulse amplitude). Anxiety-inducing films did not result in a physiological stress response, which can explain why they do not impair sexual function.

The effects of partner togetherness on salivary testosterone in women in long distance relationships.

The present study examined whether women's testosterone levels are influenced by being with a sexual and romantic partner after a period of sexual abstinence. Women in long distance relationships (n=15) provided five saliva samples: at least 1 week before seeing their partner (and at least 2 weeks since their last visit), the day before seeing their partner, when they were with their partner but prior to engaging in sexual activity, the day after their first sexual activity, and 3 days after they were separated from their partners. Salivary testosterone was lowest when participants had been away from their partners for at least 2 weeks and highest the day before they were to see their partners and the day after sexual activity. Results from this study indicated that women's testosterone increased both the day before they were with their partners and they day after they first engaged in sexual activity. However, something about initially reuniting with their partners returned their testosterone to baseline levels, which may be an effect of being in the same location as a partner, or just a state fluctuation due to nervousness or other psychological state.

The cortisol response during physiological sexual arousal in adult women with a history of childhood sexual abuse.

Many women with a history of childhood sexual abuse (CSA) experience difficulties becoming sexually aroused. This study measured cortisol and physiological sexual arousal during exposure to sexual stimuli in women with and without a history of CSA. Childhood sexual abuse survivors showed a smaller decrease in cortisol during sexual arousal than the nonsexually abused, control group potentially due to an increase in cortisol in some of the participants in the CSA group. Physiological sexual arousal was weaker in CSA survivors compared to women with no history of sexual abuse and posttraumatic stress disorder symptoms showed characteristics consistent with mediation for the relationship between a history of CSA and inhibited sexual arousal responses.

The effect of competition on salivary testosterone in elite female athletes.

The association between androgens and competition in women has been understudied compared with men. The current study examined the link between testosterone (T) and competition in elite female athletes, using a sample of female wrestlers that included athletes competing at both the national and international level. In a repeated-measures design, saliva samples were collected before and after wrestling bouts, with comparable samples of wins and losses, and subsequently analyzed for T. Study results showed a 22% increase in circulating bioavailable T from pre- to postbout, F(1, 12) = 9.71, P = .009. There was no significant difference in T between win or loss outcomes. These findings-showing a link between individual head-to-head competition and T in women-demonstrate that women's androgenic responses to environmental contexts are dynamic and may be an important factor to address in research on competitive performance.

Sexual motivation in women as a function of age.

INTRODUCTION: Women's motivations to engage in sex are likely influenced by their past sexual experiences, the type of relationship in which they are involved in, and numerous lifestyle factors such as career and family demands. The influences of these factors undoubtedly change as women age. AIM: This study aimed to examine potential differences in sexual motivation between three distinct age groups of premenopausal women. METHODS: Women aged 18-22 years (N = 137), 23-30 years (N = 103), and 31-45 years (N = 87) completed an online survey that assessed the proportion with which they had engaged in sexual intercourse for each of 140 distinct reasons. MAIN OUTCOME MEASURES: The YSEX? Questionnaire by Meston and Buss [1] was used to measure sexual motivation. The items of this questionnaire were composed of four primary sexual motivation factors (physical, goal attainment, emotional, insecurity), and 13 subfactors. RESULTS: Women aged 31-45 years reported a higher proportion of engaging in sex compared with one or both of the younger age groups of women for nine of the 13 YSEX? subfactors: stress reduction, physical desirability, experience seeking, resources, social status, revenge, expression, self-esteem boost, and mate guarding. At an item level, the top 25 reasons for having sex were virtually identical across age groups. CONCLUSION: Women aged 31-45 have more motives for engaging in sex than do women aged 18-30, but the primary reasons for engaging in sex do not differ within this age range. Women aged 18-45 have sex primarily for pleasure, and love and commitment. The implications for diagnosis and treatment of women with sexual dysfunctions were discussed.

Physiological stress response of young adults exposed to bullying during adolescence.

Peer victimization in the form of bullying is a chronic social stressor experienced by many humans during development. Exposure to bullying has been associated with a variety of mental disorders, such as anxiety and depression. Participants pre-selected for the presence or absence of a history of being bullied were brought into a laboratory and placed in a stressful situation. Blood pressure, heart rate, and salivary cortisol levels were measured before the introduction of the stressor (Time 1), at the end of the stressor (Time 2), and after its removal (Time 3). Men with a history of exposure to frequent bullying showed blunted blood pressure responses at Time 2 compared to control men. Bullied and Non-bullied women did not show any differences in any of the measures. Men and women in both groups showed an increase in heart rate in response to the stressor. There were no significant differences in salivary cortisol levels between Bullied and Non-bullied participants. However, salivary cortisol levels and systolic blood pressure were lower in Bullied male participants who reported having no feelings of anger about their experience compared to controls and those who did report anger. These data show altered sympathetic responses to stress in men with a history of victimization as well as suggesting long-term effects on the HPA axis in the most affected individuals.

Cortisol, sexual arousal, and affect in response to sexual stimuli.

INTRODUCTION: Theoretically, the physiological response to stress should inhibit the sexual response. This has been demonstrated experimentally in animal models, and correlationally in studies of human reproduction. It is reasonable to expect, then, that the stress response would be blunted during sexual arousal, and several researchers have found a pattern of decreasing cortisol during sexual arousal. AIM: In the present study, we explored individual differences in women's cortisol response to sexual arousal in a laboratory setting. We also examined how cortisol response in the laboratory related to a validated measure of sexual arousal functioning in real life. MAIN OUTCOME MEASURES: Cortisol levels were measured in saliva via enzyme immunoassay. Subjective arousal was measured by a self-report questionnaire, and genital arousal was measured by a vaginal photoplethysmograph. METHODS: Subjective and physiological responses to an erotic film were assessed in 30 women. Saliva samples were taken at baseline and following the film. RESULTS: The majority of women (N = 20) showed a decrease in cortisol; nine women showed an increase in response to an erotic film. The women who showed an increase in cortisol had lower scores on the Arousal, Desire, and Satisfaction domains of the Female Sexual Function Index. Genital arousal in the laboratory was not related to cortisol change. CONCLUSIONS: Women who show an increase in cortisol in response to sexual stimuli in the laboratory have lower levels of functioning in certain areas of their sexual life compared with women who show a decrease in cortisol. Stress related to sexual performance may interfere with sexual arousal.