The influence of sexual activity on sleep: A diary study.

Aiming to promote overall health and well-being through sleep, the present studies examine to what extent sexual activity serves as a behavioural mechanism to improve sleep. The relation between sexual activity, i.e., partnered sex and masturbation with or without orgasm, and subjective sleep latency and sleep quality is examined by means of a cross-sectional and a longitudinal (diary) study. Two hundred fifty-six male and female participants, mainly students, completed a pre-test set of questionnaires and, thereafter, a diary during 14 consecutive days. The cross-sectional study was analysed using analysis of covariance and demonstrated that both men and women perceive partnered sex and masturbation with orgasm to improve sleep latency and sleep quality, while sexual activity without orgasm is perceived to exert negative effects on these sleep parameters, most strongly by men. Accounting for the repeated measurements being nested within participants, the diary data were analysed using multilevel linear modelling (MLM). Separate models for subjective sleep latency and sleep quality were constructed, which included 2076 cases at level 1, nested within 159 participants at level 2. The analyses revealed that only partnered sex with orgasm was associated with a significantly reduced sleep latency (b = -0.08, p < 0.002) and increased sleep quality (b = 0.19, p < 0.046). Sexual activity without orgasm and masturbation with and without orgasm were not associated with changes in sleep. Further, no gender differences emerged. The present studies confirm and significantly substantiate findings indicating that sexual activity and intimacy may improve sleep and overall well-being in both men and women and serve as a directive for future research.

Is disgust sensitive to classical conditioning as indexed by facial electromyography and behavioural responses?

Earlier studies provided preliminary support for the role of classical conditioning as a pathway of disgust learning, yet this evidence has been limited to self-report. This study included facial electromyographical (EMG) measurements (corrugator and levator muscles) and a behavioural approach task to assess participants' motivation-to-eat the actual food items (conditioned stimuli, CS). Food items served as CS and film excerpts of a woman vomiting served as unconditioned stimuli (US). Following acquisition the CS+ (neutral CS paired with US disgust) was rated as more disgusting and less positive. Notably, the conditioned response was transferred to the actual food items as evidenced by participants' reported lowered willingness-to-eat. Participants also showed heightened EMG activity in response to the CS+ which seemed driven by the corrugator indexing a global negative affect. These findings suggest that classical conditioning as a pathway of disgust learning can be reliably observed in subjective but not in disgust-specific physiological responding.

The Influence of Subjective Sexual Arousal and Disgust on Pain.

Current models propose that inhibited sexual arousal is a key component in maintaining sexual pain in women with Genito-Pelvic Pain/Penetration Disorder. It thus follows that enhancing sexual arousal may be an effective strategy to modulate pain, but this effect has not been successfully demonstrated with women, although it has been successful with men. This study built on previous works and examined if the pain-killing effect of sexual arousal might have been undermined by concurrently-elicited disgust. We tested whether women experience disgust as well as sexual arousal when viewing sex stimuli, and whether disgust has an exacerbating effect on pain. Female participants (N = 164) were randomly distributed to watch a porn, disgust, or neutral train-ride film. A cold pressor test (CPT) was utilized to induce pain at the same time that participants viewed their respective film. Pain was indexed by the duration that participants kept their hand in the cold water, and by self-reported pain intensity at the time they quit the CPT. The results showed no differences in pain across conditions. The sex stimulus elicited substantial disgust as well as sexual arousal, and there was a negative correlation between the two emotions. Disgust was not found to increase pain compared to both the neutral and sex conditions. Thus, the findings provide no support for a pain-modulatory effect of subjective sexual arousal on pain in women. This might, however, be due to the sex stimulus having elicited an ambivalent state between an appetitive and aversive emotion concurrently.

Self-Disgust and Sexual Functioning: A Scenario-Based Study Testing the Ability of Sex-Related Experiences to Elicit Self-Directed Disgust.

Increasing evidence indicates that disgust might compromise sexual functioning and can contribute to sexual problems. Although the stimuli and conditions that elicit disgust vary greatly across individuals, they cluster in three categories of disgust elicitors: Stimuli that are associated with an increased risk of the transmission of infectious diseases (pathogen disgust), stimuli that signal poor mating quality and may jeopardize reproductive success (sexual disgust), and behaviors that violate social norms (moral disgust). It has been argued that each of these categories of disgust may interfere with sexual responses. Thus far, research on the role of disgust in sexual contexts focused on external stimuli (e.g., sperm). Yet, recently it has been proposed that disgust can also become directed to features of the self. Such self-directed disgust may also apply to sexual contexts and contribute to sexual problems. As a first step to explore the relevance of self-disgust in sexual functioning, we tested if indeed particular sexual experiences have the ability to elicit self-disgust. Using a within subject design, participants (N = 124; all women) imagined themselves as well as others experiencing a series of sex-related scenarios, each relevant for one of the three categories of disgust, and subsequently rated their self-disgust. For all types of disgust, the scenarios evoked self-disgust, and the "self-perspective" elicited significantly more self-disgust than the "other-perspective." These findings support theoretical models pointing to the relevance of taking self-disgust into consideration as a factor that may compromise sexual functioning. Future research should test whether this also holds for men.

Vaginismus: heightened harm avoidance and pain catastrophizing cognitions.

INTRODUCTION: Catastrophic appraisal of experienced pain may promote hypervigilance and intense pain, while the personality trait of harm avoidance (HA) might prevent the occurrence of correcting such experiences. Women inflicted with vaginismus may enter a self-perpetuating downward spiral of increasing avoidance of (anticipated) pain. In vaginismus the anticipation of pain may give rise to catastrophic pain ideation. This may establish hypervigilance toward painful sexual stimuli, which consequently results in negative appraisal of sexual cues. This process could impair genital and sexual responding, intensify pain and trigger avoidance, which in turn may contribute to the onset and persistence of symptoms in vaginismus and to certain extent also in dyspareunia. AIMS: To investigate whether women suffering from vaginismus are characterized by heightened levels of habitual pain catastrophic cognitions, together with higher levels of HA. METHODS: This study consisted of three groups: a lifelong vaginismus group (N = 35, mean age = 28.4; standard deviation [SD] = 5.8), a dyspareunia group (N = 33, mean age = 26.7; SD = 6.8), and women without sexual complaints (N = 54, mean age = 26.5; SD = 6.7). MAIN OUTCOME MEASURES: HA scale of Cloninger's tridimensional personality questionnaire, and the pain catastrophizing scale. RESULTS: Specifically women inflicted with vaginismus showed significantly heightened levels of catastrophic pain cognitions compared with the other two groups, as well as significant enhanced HA vs. the control group, and a trend vs. the dyspareunia group. Both traits were shown to have cumulative predictive validity for the presence of vaginismus. CONCLUSION: This study focused on the personality traits of catastrophizing pain cognitions and HA in women with lifelong vaginismus. Our findings showed that indeed, women suffering from vaginismus are characterized by trait of HA interwoven with habitual pain catastrophizing cognitions. This study could help in the refinement of the current conceptualization and might shed light on the already available treatment options for women with vaginismus.

The influence of sexual arousal on subjective pain intensity during a cold pressor test in women.

BACKGROUND & OBJECTIVES: Pain can be significantly lessened by sex/orgasm, likely due to the release of endorphins during sex, considered potent analgesics. The evidence suggests that endorphins are also present during sexual arousal (that is, prior to sex/orgasm). It follows then that pain can be modulated during sexual arousal, independent of sex/orgasm, too. Accordingly, sexual arousal induced by erotic slides has been demonstrated to lessen pain in men, but not in women. One explanation could be that for women, the erotic slides were not potent enough to elicit a lasting primed state of sexual arousal by the time pain was induced. Thus, the current study aims to optimize the means of inducing a potent state of sexual arousal and subsequently examine the potentially analgesic influence of sexual arousal on pain in women. As a subsidiary aim, the study also assesses whether the anticipated analgesic effect of sexual arousal would be stronger than that of distraction or generalized (non-sexual) arousal. METHODS: Female participants (N = 151) were randomly distributed across four conditions: sexual arousal, generalized arousal, distraction, neutral. Mild pain was induced using a cold pressor while participants were concurrently exposed to film stimuli (pornographic, exciting, distracting, neutral) to induce the targeted emotional states. A visual analogue scale was utilized to measure the subjective level of pain perceived by the participants. RESULTS: Sexual arousal did not reduce subjective pain. Generalized arousal and distraction did not result in stronger analgesic effects than the neutral condition. CONCLUSION: The present findings do not support the hypothesis that sexual arousal alone modulates subjective pain in women. This might be due to the possibility that genital stimulation and/or orgasm are key in pain reduction, or, that feelings of disgust may inadvertently have been induced by the pornographic stimulus and interfered with sexual arousal in influencing pain.

Vaginismus and dyspareunia: relationship with general and sex-related moral standards.

INTRODUCTION: Relatively strong adherence to conservative values and/or relatively strict sex-related moral standards logically restricts the sexual repertoire and will lower the threshold for experiencing negative emotions in a sexual context. In turn, this may generate withdrawal and avoidance behavior, which is at the nucleus of vaginismus. AIM: To examine whether indeed strong adherence to conservative morals and/or strict sexual standards may be involved in vaginismus. MAIN OUTCOME MEASURES: The Schwartz Value Survey (SVS) to investigate the individual's value pattern and the Sexual Disgust Questionnaire (SDQ) to index the willingness to perform certain sexual activities as an indirect measure of sex-related moral standards. METHODS: The SVS and SDQ were completed by three groups: women diagnosed with vaginismus (N=24), a group of women diagnosed with dyspareunia (N=24), and a healthy control group of women without sexual complaints (N=32). RESULTS: Specifically, the vaginismus group showed relatively low scores on liberal values together with comparatively high scores on conservative values. Additionally, the vaginismus group was more restricted in their readiness to perform particular sex-related behaviors than the control group. The dyspareunia group, on both the SVS and the SDQ, placed between the vaginismus and the control group, but not significantly different than either of the groups. CONCLUSIONS: The findings are consistent with the view that low liberal and high conservative values, along with restricted sexual standards, are involved in the development/maintenance of vaginismus.

Automatic affective appraisal of sexual penetration stimuli in women with vaginismus or dyspareunia.

INTRODUCTION: Current psychological views are that negative appraisals of sexual stimuli lie at the core of sexual dysfunctions. It is important to differentiate between deliberate appraisals and more automatic appraisals, as research has shown that the former are most relevant to controllable behaviors, and the latter are most relevant to reflexive behaviors. Accordingly, it can be hypothesized that in women with vaginismus, the persistent difficulty to allow vaginal entry is due to global negative automatic affective appraisals that trigger reflexive pelvic floor muscle contraction at the prospect of penetration. AIM: To test whether sexual penetration pictures elicited global negative automatic affective appraisals in women with vaginismus or dyspareunia and to examine whether deliberate appraisals and automatic appraisals differed between the two patient groups. METHODS: Women with persistent vaginismus (N = 24), dyspareunia (N = 23), or no sexual complaints (N = 30) completed a pictorial Extrinsic Affective Simon Task (EAST), and then made a global affective assessment of the EAST stimuli using visual analogue scales (VAS). MAIN OUTCOME MEASURES: The EAST assessed global automatic affective appraisals of sexual penetration stimuli, while the VAS assessed global deliberate affective appraisals of these stimuli. RESULTS: Automatic affective appraisals of sexual penetration stimuli tended to be positive, independent of the presence of sexual complaints. Deliberate appraisals of the same stimuli were significantly more negative in the women with vaginismus than in the dyspareunia group and control group, while the latter two groups did not differ in their appraisals. CONCLUSION: Unexpectedly, deliberate appraisals seemed to be most important in vaginismus, whereas dyspareunia did not seem to implicate negative deliberate or automatic affective appraisals. These findings dispute the view that global automatic affect lies at the core of vaginismus and indicate that a useful element in therapeutic interventions may be the modification of deliberate global affective appraisals of sexual penetration (e.g., via counter-conditioning).

Up-regulating Sexual Arousal and Down-regulating Disgust while Watching Pornography: Effects on Sexual Arousal and Disgust.

Sexual response occurs when sexual excitatory factors outweigh inhibitory factors. Problems with sexual arousal may occur when sexual excitation is too low and/or inhibitory influences such as feelings of disgust are too strong. To explore interventions that may help overcome decreased sexual responding, we examined if sexual responding could be amplified by instructions to up-regulate sexual arousal and/or down-regulate disgust. Women with no sexual difficulties (N = 255; µage = 20.55; SD = 2.23) were randomly assigned to a sexual arousal up-regulation, disgust down-regulation, or passive control condition. Participants were instructed to use the assigned regulation strategy while viewing pornography. To prevent floor effects due to low disgust responsivity in a non-clinical sample, half of the participants were presented with a prime that was designed to make the contaminating properties of sex more salient. Instruction to up-regulate sexual arousal successfully enhanced feelings of sexual arousal in the unprimed group, yet the increase in sexual arousal was not paralleled by reductions in feelings of disgust. Instruction to down-regulate disgust successfully decreased disgust; however, this decrease was not paralleled by increases in sexual arousal. Overall, findings indicate that emotion regulation techniques could facilitate affective control in sexual contexts.

Vaginismus and dyspareunia: automatic vs. deliberate disgust responsivity.

INTRODUCTION: The difficulty of penetration experienced in vaginismus and dyspareunia may at least partly be due to a disgust-induced defensive response. AIMS: To examine if sex stimuli specifically elicit: (i) automatic disgust-related memory associations; (ii) physiological disgust responsivity; and/or (iii) deliberate expression of disgust/threat. METHODS: Two single target Implicit Association Task (st-IAT) and electromyography (EMG) were conducted on three groups: vaginismus (N = 24), dyspareunia (N = 24), and control (N = 31) group. MAIN OUTCOME MEASURES: st-IAT, to index their initial disgust-related associations and facial EMG for the m. levator labii and m. corrugator supercilii regions. RESULTS: Both clinical groups showed enhanced automatic sex-disgust associations. As a unique physiological expression of disgust, the levator activity was specifically enhanced for the vaginismus group, when exposed to a women-friendly SEX video clip. Also at the deliberate level, specifically the vaginismus group showed enhanced subjective disgust toward SEX pictures and the SEX clip, along with higher threat responses. CONCLUSIONS: Supporting the view that disgust is involved in vaginismus and dyspareunia, for both, clinical groups' sex stimuli automatically elicited associations with disgust. Particularly for the vaginismus group, these initial disgust associations persisted during subsequent validation processes and were also evident at the level of facial expression and self-report data. Findings are consistent with the notion that uncontrollable activated associations are involved in eliciting defensive reactions at the prospect of penetration seen in both conditions. Whereas deliberate attitudes, usually linked with the desire for having intercourse, possibly generate the distinction (e.g., severity) between these two conditions.

Implicit Measures in Clinical Sex Research: A Critical Evaluation.

INTRODUCTION: Current information-processing models of sexual arousal imply that both controlled and automatic affective-motivational processes are critically involved in sexual responding and suggest that dysfunctional automatic processes may be involved in the development and persistence of sexual dysfunctions. Because (dysfunctional) automatic processes and responses cannot be adequately captured by common self-report measures, implicit performance-based measures have been developed to index these processes. OBJECTIVES: This review provides an overview of studies that used implicit tasks in clinical sexual research, and critically evaluates the contribution and promise of these measures to improve our understanding of the mechanisms involved in sexual dysfunctions. METHODS: 6 electronic main databases (AMED, MEDLINE, PsycArticles, Psychology & Behavioral Sciences Collection, PsycINFO, and SocINDEX) were searched for studies involving implicit measurement techniques to measure automatic processes in clinical sex research. RESULTS: A series of studies examined if lowered (or heightened) attention for sex stimuli may be involved in low sexual arousal, low desire, and genital pain. Preliminary evidence showed that lowered attention is involved in low sexual arousal. The pattern with regard to desire and genital pain was mixed which may be due to heterogeneity in assessment instruments. A limited number of studies examined automatic memory associations with sexual cues. Preliminary evidence showed negative (sex-threat/sex-disgust) associations in women with genito-pelvic pain or penetration disorder, less positive associations in women with hypoactive sexual desire disorder, and sex-positive and sex-failure associations in men with sexual distress. Thus far, no studies have examined lowered (or heightened) automatic sexual approach tendencies related to sexual dysfunctions. CONCLUSION: Implicit measures showed some promise as tools to index automatic sex-relevant cognitive mechanisms in sexual dysfunctions. Yet, more systematic research and the development of psychometrically sound measures are critical for a more comprehensive evaluation of the relevance of implicit measures in clinical sex research and their usefulness as indices of individual differences in clinical practice. Hinzmann J, Borg C, de Jong PJ. Implicit Measures in Clinical Sex Research: A Critical Evaluation. Sex Med Rev 2020;8:531-541.

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

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

The Reciprocal Relationship Between Sexual Arousal and Disgust as Evidenced in Automatic Approach-Avoidance Behavior.

Sexual encounters imply exposure to stimuli that in other contexts typically elicit disgust-induced avoidance. To explain why people nevertheless tend to show sexual approach, it has been proposed that heightened sexual arousal may temporarily inhibit disgust. In line with this, studies have found that sexually aroused individuals showed heightened willingness to approach disgusting stimuli. Because automatic processes are critically involved in sexual behaviors, we examined whether the impact of sexual arousal extends to automatic responses to disgust-elicitors. To test the proposed reciprocal relationship between sex and disgust, we also investigated whether disgust reduces automatic sexual approach. In Study 1, 116 female participants (M = age 19.53) were assigned to a sexual arousal or control condition and performed a speeded approach-avoidance task to assess automatic responses to disgusting stimuli. In Study 2, 174 female participants (M = age 22.14) were assigned to a disgust, sexual arousal, or control condition and performed an approach-avoidance task involving both sex and disgust-relevant stimuli. Sexual arousal did not affect automatic responses to disgusting stimuli, and disgust did not influence automatic responses towards sexual stimuli. The reciprocal relationship between sexual arousal and disgust that was previously found for controllable responses did not extend to automatic responses.

The Influence of Sexual Arousal on Self-Reported Sexual Willingness and Automatic Approach to Models of Low, Medium, and High Prior Attractiveness.

Anecdotal evidence suggests that sexual attraction is flexible, and that high levels of sexual arousal can promote sexual willingness and approach tendencies toward a priori low attractive mates. This experimental study tested whether heightened sexual arousal can lower the threshold for sexual willingness and automatic approach tendencies toward potential sex partners of low and medium attractiveness. Heterosexual male (n =54) and female (n =61) participants were randomly assigned to a sexual arousal or control condition. Approach tendencies were indexed using a reaction time task. Sexual willingness was indexed using participant ratings of willingness to kiss and to consider having sex with same- and other-sex models of low, medium, and high attractiveness. Overall, participants showed stronger approach to models of high and medium than of low attractiveness. Sexual arousal weakened this differential responding but did not result in a robust increase of approach toward less attractive other-sex or same-sex models. Sexual willingness toward less attractive models was not affected by sexual arousal. Independent of condition, women reported greater sexual willingness toward same-sex models. The current pattern of findings does not support the notion that sexual arousal promotes automatic approach and sexual willingness to a broader array of sex partners.

Influence of COVID-19 pandemic on sexuality: a cross-sectional study among couples in Turkey.

Coronavirus disease 2019 (COVID-19) pandemic has been continuing to affect the lives of all people globally. It has been shown that restrictions due to changes in lifestyles lead to mental health problems. This study aims to investigate the effect of COVID-19 pandemic on couples' sexuality. A total of 245 volunteers (148 men and 97 women) were enrolled in the study. Generalized Anxiety Disorder-7, Patient Health Questionnaire, Perceived Stress Scale were administered to screen anxiety and depression symptoms. International Index of Erectile Function (IIEF-15) and Female Sexual Function Index (FSFI) along with self-constructed sexual behavior questionnaire were administered to participants, in order to evaluate sexual functions and behavioral changes during the pandemic. Sexual function scores (IIEF erectile function domain and total FSFI) during pandemic (24.55 ± 5.79 and 24.87 ± 7.88, respectively) were lower compared to the prepandemic period (26.59 ± 4.51 and 26.02 ± 6.22, respectively) (p = 0.001 and p = 0.027, respectively). During pandemic compared to prepandemic period, the frequency of sexual intercourse decreased in men (p = 0.001) and women (p = 0.001) while sexual avoidance and solitary sexual approach behaviors (masturbation or watching sexual content videos, etc.) increased in men (p = 0.001) and women (p = 0.022). However, the couples that spent more time together during the pandemic reported better sexual function scores (men; p = 0.001, women; p = 0.006). Although this is the first study evaluating couples from Turkey with a convenience sample, further studies with a greater number may better elucidate the effects of this pandemic on sexuality.

Disgust Toward Sex-Relevant and Sex-Irrelevant Stimuli in Pre-, Early, and Middle Adolescence.

For prepubertal youth, sexual stimuli elicit disgust and avoidance, yet in adolescence this avoidance shifts to sexual approach. One explanation could be that disgust declines in adolescence. This project examined whether disgust is indeed lower in adolescence compared to preadolescence, and whether this difference across age groups would be restricted to sex-relevant disgust elicitors. We also examined whether the strength of disgust would depend on familiarity between participant and source. To examine disgust responses in youths, two cross-sectional studies (N = 248, ages six to 17 years) were conducted using scenario-based measurements. Disgust was overall higher in early adolescence than in preadolescence and relatively weak when the source of disgust was a familiar person. Specifically, when parents were the source, sex-relevant disgust was higher in the groups of early and middle adolescents than in the group of preadolescents. Sex-relevant disgust elicited by a stranger or best friend, however, was lower in middle than in early adolescence. The latter is consistent with the view that repeated confrontation with disgusting stimuli might attenuate disgust, which could contribute to healthy sexual functioning. The heightened sex-relevant disgust in middle adolescents when parents were the source might reflect a functional avoidance mechanism of inappropriate sex mates.

The influence of olfactory disgust on (Genital) sexual arousal in men.

BACKGROUND: The generation or persistence of sexual arousal may be compromised when inhibitory processes such as negative emotions, outweigh sexual excitation. Disgust particularly, has been proposed as one of the emotions that may counteract sexual arousal. In support of this view, previous research has shown that disgust priming can reduce subsequent sexual arousal. As a crucial next step, this experimental study tested whether disgust (by means of odor) can also diminish sexual arousal in individuals who are already in a state of heightened sexual excitation. METHODOLOGY: In this study, participants were all men (N = 78). To elicit sexual arousal, participants watched a pornographic video. Following 4.30 minutes from the start of the video clip, they were exposed to either a highly aversive/disgusting odor (n = 42), or an odorless diluent/solvent (n = 36), that was delivered via an olfactometer, while the pornographic video continued. In both conditions the presentation of the odor lasted 1 second and was repeated 11 times with intervals of 26 seconds. Sexual arousal was indexed by both self-reports and penile circumference. PRINCIPAL FINDINGS: The disgusting odor (released when the participants were already sexually aroused) resulted in a significant decrease of both subjective and genital sexual arousal compared to the control (odorless) condition. SIGNIFICANCE: The finding that the inhibitory effect of disgust was not only expressed in self-report but also expressed on the penile response further strengthens the idea that disgust might hamper behavioral actions motivated by sexual arousal (e.g., poor judgment, coercive sexual behavior). Thus, the current findings indicate that exposure to an aversive odor is sufficiently potent to reduce already present (subjective and) genital sexual arousal. This finding may also have practical relevance for disgust to be used as a tool for self-defence (e.g., Invi Bracelet).