Women with complete spinal cord injury: a phenomenological study of sexual experiences.

This study examines psychosocial, emotional, and relationship aspects of sexuality in the lives of 15 women who sustained complete spinal cord injury (SCI) between the levels of T6 and L2. Phenomenological interviews were organized to chronologically sequence events with the intention of describing the trajectory of sexuality in women with complete SCI. A set of themes emerged from postinjury data that were labeled cognitive-genital dissociation, sexual disenfranchisement, and sexual rediscovery. Broadening the scope of the research beyond the physiological offers insight as to the interplay between the mind and sexual response and guidance for educational and therapeutic interventions.

The consensus-based classification of female sexual dysfunction: barriers to universal acceptance.

Although the CCFSD attempts to clarify and modify the existing definitions of female sexual dysfunctions, the current authors (a sex therapist and a sex researcher) believe that the classification system has significant flaws that will prevent its widespread acceptance and application. The major concern is that the CCFSD is based on the triphasic model of sexual response. The triphasic model is based on male sexual response and does not take into account the documented variety of ways that women respond sexually. Instead, the parameters of male sexual response are extrapolated to women. The current authors suggest an alternative approach that considers a woman's subjective as well as physiological responses, and includes pleasure and satisfaction as characteristics of normal sexual function. A reconsideration of the CCFSD model is suggested and an alternative approach is offered.

Report of the international consensus development conference on female sexual dysfunction: definitions and classifications.

PURPOSE: Female sexual dysfunction is highly prevalent but not well defined or understood. We evaluated and revised existing definitions and classifications of female sexual dysfunction. MATERIALS AND METHODS: An interdisciplinary consensus conference panel consisting of 19 experts in female sexual dysfunction selected from 5 countries was convened by the Sexual Function Health Council of the American Foundation for Urologic Disease. A modified Delphi method was used to develop consensus definitions and classifications, and build on the existing framework of the International Classification of Diseases-10 and DSM-IV: Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association, which were limited to consideration of psychiatric disorders. RESULTS: Classifications were expanded to include psychogenic and organic causes of desire, arousal, orgasm and sexual pain disorders. An essential element of the new diagnostic system is the "personal distress" criterion. In particular, new definitions of sexual arousal and hypoactive sexual desire disorders were developed, and a new category of noncoital sexual pain disorder was added. In addition, a new subtyping system for clinical diagnosis was devised. Guidelines for clinical end points and outcomes were proposed, and important research goals and priorities were identified. CONCLUSIONS: We recommend use of the new female sexual dysfunction diagnostic and classification system based on physiological as well as psychological pathophysiologies, and a personal distress criterion for most diagnostic categories.

Reproductive decision making in mothers with HIV-1.

Eighty percent of women with human immunodeficiency virus (HIV) are of childbearing age and the incidence of HIV in women is rapidly increasing. Despite the risk of perinatal transmission and The Centers for Disease Control's (CDC) recommendation that HIV-positive women delay pregnancy, HIV-infected women continue to become pregnant and have children. To gain insight into reproductive decision-making of women with HIV, 25 mothers who participated in a natural history study of perinatal HIV transmission were interviewed using open-ended questions based on Fishbein's Theory of Reasoned Action. Three major themes emerged from the content analysis of transcripts from interviews with HIV infected women: (1) motherhood viewed as a joy and a means of meeting their own needs, (2) concerns about their children's well-being, and (3) the minor role of HIV infection in their lives. Women reported negative reactions to providers who focused exclusively on their HIV status, and not on the need to view the women's lives as a whole.

Love as sensory stimulation: physiological consequences of its deprivation and expression.

For the present purpose, love is defined as one's having stimulation that one desires. The nature of the stimulation can range on a continuum from the most abstract cognitive, to the most direct sensory, forms. Thus, this definition of love encompasses having an emotional bond with a person for whom one yearns, as well as having sensory stimulation that one desires. We address some of the physiological and perceptual consequences both of having, and of not having, love. We propose a neural mechanism by which deprivation of love may generate endogenous, compensatory sensory stimulation that manifests itself as psychosomatic illness. In addition, we propose a neuroendocrine mechanism underlying sexual response and orgasm. The latter includes vaginocervical sensory pathways to the brain that can produce analgesia, release oxytocin, and/or bypass the spinal cord via the vagus nerve. We present evidence of the existence of non-genital orgasms, which suggests that genital orgasm is a special case of a more pervasive orgasmic process. Through recent studies, the mechanisms and manifestations of love and its deprivation are becoming better understood. The better is our understanding of love, the greater is our respect for the significance and potency of its role in mental and physical health.

'Complete' spinal cord injury does not block perceptual responses to genital self-stimulation in women.

BACKGROUND: A priori hypothesis: vaginal and/or cervical self-stimulation will not produce perceptual responses in women with "complete" spinal cord injury (SCI) at or above the highest level of entry of the hypogastric nerves (T10-12) but will produce perceptual responses if SCI is below T-10. DESIGN: Women with complete SCI were assigned to a group with "upper" (T-10 and/or above) (n = 6) or "lower" (below T-10) (n = 10) SCI; uninjured women (n = 5) constituted a control group. Perceptual response to vaginal and/or cervical self-stimulation was quantified as magnitude of analgesia to calibrated finger compressive force. SETTING: Rutgers, The State University of New Jersey, Human Physiology Laboratory, College of Nursing, Newark. PARTICIPANTS: Consecutive samples of first 16 of 34 women with SCI who responded to nationwide advertisements, met inclusion criteria, and volunteered; control group was the first 5 respondents. INTERVENTION: Vaginal or cervical (cervix uteri) self-stimulation applied for 12 minutes, interspersed with non-stimulation periods, while measuring analgesia. MAIN OUTCOME MEASURE: Quantify analgesia magnitude to vaginal or cervical self-stimulation. RESULTS: Significant analgesia was produced in the uninjured group and the group with lower SCI, supporting the hypothesis. Unexpectedly, significant analgesia was also produced in the group with upper SCI. Women in the group with upper SCI also experienced menstrual discomfort, awareness of vaginal and/or cervical stimulation per se, and orgasms. CONCLUSIONS: (1) Genitospinal visceral afferent pathways function in the women in the group with upper SCI, although unrecognized by the American Spinal Injury Association criteria, and/or (2) there exists a functional genital afferent pathway that bypasses the spinal cord and projects directly to the brain, which we propose to be via the vagus nerves.

Vagotomy blocks responses to vaginocervical stimulation after genitospinal neurectomy in rats.

To ascertain whether any effects of vaginocervical stimulation (VS) are mediated by the vagus nerve, all known afferent nerves from the reproductive tract to the spinal cord were transected and the rats were tested for residual responses to VS. After combined bilateral transection of the pelvic, hypogastric, and pudendal nerves (NX), the following responses to VS were greatly reduced or abolished: lordosis to flank-perineum palpation, leg extension, immobilization, and blockage of both tail withdrawal to radiant heat and leg withdrawal to foot pinch. However, after these nerve cuts, the following persisted as significant residual responses to VS: 1) analgesia [measured as increase in vocalization threshold (VOCT) to tailshock], 2) pupil dilatation (PD), and 3) increase in heart rate (HR). Subsequent bilateral subdiaphragmatic vagotomy (VX) significantly reduced the magnitude of PD and abolished the analgesia. By contrast, VX produced no significant effect on the HR increase to VS. The above findings provide evidence that brain-mediated responses to vaginocervical stimulation can be elicited via the vagus nerves.

Brain-mediated responses to vaginocervical stimulation in spinal cord-transected rats: role of the vagus nerves.

The present study was designed to ascertain whether the vagus nerves convey functional sensory activity from the reproductive tract in rats. Previously, vaginocervical mechanostimulation (VS) was shown to increase pupil diameter (PD) and the threshold of vocalization to tail shock (Voc-T). These responses were attenuated but not abolished by combined bilateral transection of the 'genito-spinal' nerves (i.e. pelvic, hypogastric and pudendal). Subsequent bilateral vagotomy further reduced or abolished the residual responses. In the present study, spinal cord transection above the known level of entry of the genito-spinal nerves was combined with bilateral vagotomy. In ovariectomized rats, after spinal cord transection at thoracic 7 (T7X), lumbar 5 (L5X) levels, or sham surgery (Sh), responses to VS were measured, the vagus nerves were then transected bilaterally, and responses to VS were again measured. VS significantly increased Voc-T and PD after sham procedure or spinal cord transection at either level. Subsequent bilateral vagotomy abolished the VS-induced increase in PD in the T7X group. Due to low survival rate, the effect of vagotomy on Voc-T could not be determined. Consequently, we performed a second experiment. In non-ovariectomized rats, VS significantly increased PD but reduced Voc-T in the T7X group compared to the Sh group, and subsequent bilateral vagotomy abolished both responses. These findings provide evidence that, in the rat, the vagus nerves provide a functional sensory pathway from the reproductive tract directly to the medulla oblongata of the brain, bypassing the spinal cord.

Issues concerning women and AIDS: sexuality.

PIP: In the US and globally women are contracting the human immunodeficiency virus (HIV) and developing the acquired immunodeficiency syndrome (AIDS) the fastest. Worldwide, HIV is transmitted primarily through heterosexual intercourse. In the US, the proportion of women who have contracted AIDS by heterosexual transmission has increased from 11% in 1984 to 34% in 1990. Women are at a greater risk than men for transmission by heterosexual intercourse as the ratio of women to men who acquire AIDS by heterosexual transmission is 3 to 1. Furthermore, 25% of AIDS cases caused by heterosexual transmission or iv drug use occurs in women. Although women often develop HIV-related serious gynecologic problems, including cervical cancer and refractory vaginal candidiasis, these conditions do not fall within the Centers for Disease Control definition of AIDS. Women who have gynecologic symptoms are not diagnosed as having AIDS, are not eligible for AIDS benefits, and live half as long as men do once they are diagnosed as being HIV infected. Little is known about the characteristics of HIV infection or AIDS in women. Sexually transmitted diseases (STDs) seem to act as cofactors for HIV infection. The human papilloma virus or genital warts, the herpes simplex virus, syphilis, chancroid, recurrent vaginal candidiasis, abnormal Pap smears, cervical neoplasias, and pelvic inflammatory disease have been associated with HIV infection in women. HIV infection should be considered in all women with symptoms of any of these disorders. Nurses must first become aware of the clinical manifestations of HIV infection specific to women. Nursing interventions should educate about safer-sex including condom use with nonoxynol 9, and the risks of sharing needles. Strategies must be developed that provide empowerment skills and are sensitive to the women's cultural, religious, and ethnic background, beliefs, and values.^ieng

Physiological correlates of imagery-induced orgasm in women.

Orgasm has been reported to occur in response to imagery in the absence of any physical stimulation. This study was undertaken to ascertain whether the subjective report of imagery-induced orgasm is accompanied by physiological and perceptual events that are characteristic of genitally stimulated orgasm. Subjects were women who claimed that they could experience orgasm from imagery alone. Orgasm from self-induced imagery or genital self-stimulation generated significant increases in systolic blood pressure, heart rate, pupil diameter, pain detection threshold, and pain tolerance threshold over resting control conditions. These findings provide evidence that orgasm from self-induced imagery and genital self-stimulation can each produce significant and substantial net sympathetic activation and concomitant significant increases in pain thresholds. The increases in the self-induced imagery orgasm condition were comparable in magnitude to those in the genital self-stimulation-produced orgasm condition. On this basis we state that physical genital stimulation is evidently not necessary to produce a state that is reported to be an orgasm and that a reassessment of the nature of orgasm is warranted.

Quantification of the effects of listening to music as a noninvasive method of pain control.

This study quantified the effects of listening to music as a noninvasive nursing method of pain control. The effects of soothing and stimulating music on pain and tactile thresholds, heart rate, and blood pressure were determined on healthy female volunteers (N = 10) in a laboratory setting. Data were analyzed by ANOVA for repeated measures and post hoc comparison tests. Soothing music significantly elevated pain thresholds but not tactile thresholds. Stimulating music significantly elevated pain thresholds as well as tactile thresholds. Neither stimulating nor soothing music had a significant effect on autonomic activity. Based on the results of this laboratory study and other studies, the effects of listening to music on people in pain warrants further examination.

Differential roles of hypogastric and pelvic nerves in the analgesic and motoric effects of vaginocervical stimulation in rats.

Bilateral transection of the pelvic and/or hypogastric nerves, which convey afferent activity from the reproductive tract, was performed to ascertain the role of these nerves in the analgesic and motoric effects of vaginocervical mechanostimulation (VS) in rats. Two indices of analgesia were used: tail flick latency to radiant heat (TFL) and vocalization threshold to electrical shock of the tail (Voc-T). Nerve cuts were performed at least one week prior to behavioral testing. Bilateral transection of both the pelvic and hypogastric nerves eliminated the analgesic effects of VS on the TFL and Voc-T tests. Bilateral transection of only the pelvic nerves reduced the number of rats showing maximal VS-induced elevation in TFL, without altering the effect of VS on Voc-T. By contrast, bilateral transection of only the hypogastric nerves attenuated the Voc-T-elevating effect of VS, without reducing the effect of VS on elevating TFL. The effects of VS on producing immobility, hindlimb extension and blockage of hindlimb withdrawal to foot pinch were eliminated by combined bilateral pelvic and hypogastric neurectomy. However, bilateral transection of either nerve alone did not significantly alter the efficacy of VS in producing these effects. These findings indicate that the pelvic and hypogastric nerves contribute to the immobility- and extensor-inducing, and flexor-inhibiting effects of VS, and differentially mediate the analgesia-producing effects of VS.