The Biopsychosocial Puzzle of Painful Sex.

Genital pain associated with sex is a prevalent and distressing problem with a complex research and clinical profile. This article reviews the historical context of the "sexual pain disorders" and the circuitous trajectory that has led from the first mention of painful sex in ancient documents to the latest diagnostic category of genito-pelvic pain penetration disorder in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders as well as in other existing and proposed nomenclatures. Prominent etiologic research and emergent theoretical models are critically assessed, as is the latest treatment outcome research of note. Finally, the review points to a number of extant needs in the research and clinical effort, including an integrated biopsychosocial and multidisciplinary approach, randomized clinical trials, targeting of treatment barriers, and expansion of the entire enterprise to include populations that have not been considered.

Sex differences in concordance rates between auditory event-related potentials and subjective sexual arousal.

Much research indicates men show a greater concordance between subjective and genital sexual arousal than do women. We investigated the relationship between subjective sexual arousal and brain activation in men and women. Subjective sexual arousal and auditory N1 and P3b ERP amplitudes were measured while 38 participants viewed erotic and non-erotic films. Most notably, there was a significant correlation between N1 amplitude and sexual arousal in men; for women, there was a significant correlation between the P3b amplitude and sexual arousal. ERP amplitudes were inversely associated with reported arousal, suggesting that sexual arousal interferes with early tone processing for men, and with later tone processing for women. Lastly, for women, pornography/erotica consumption was negatively correlated with P3b amplitudes, suggesting that women who consume more pornography/erotica may also show greater attention to erotic films.

Developments and trends in sex therapy.

Recent developments and trends in sex therapy are reviewed and assessed. Major trends identified are: (1) multidisciplinarity in the treatment of sexual problems, whereby psychological interventions are combined with medical and other types of treatment (e.g. physical therapy); (2) systemic and theoretical integration, as evidenced by an emphasis on contextual influences on sexual responses and an openness to different theoretical perspectives; (3) a shift in focus from sexual function to sexual satisfaction and eroticism; (4) an emphasis on age and the aligning of expectations to reality; (5) the impact and applications of new technologies, and (6) progress toward the recognition of diversity in the human sexual experience. The overall challenge to sex therapy is to address the complexity of sexual problems in ways that are considered feasible to a public with limited time and resources.

Early dyspareunia experience in young women: confusion, consequences, and help-seeking barriers.

INTRODUCTION: Recurrent painful intercourse or dyspareunia is a highly prevalent health problem associated with impairments in sexual function and psychosocial well-being. Despite its particularly high prevalence in young women, little is known about how young women experience the onset of dyspareunia and how they attempt to manage or address the problem. AIMS: To explore the subjective experience of early dyspareunia symptoms in young women so as to model its cognitive, emotional, behavioral, and help-seeking trajectory. METHODS: Using a qualitative methodology broadly based on grounded theory, 14 young women reporting recurrent entry and/or deep pain with intercourse underwent in-depth semistructured interviews asking them to describe their personal experience with dyspareunia symptoms. MAIN OUTCOME MEASURES: The Female Sexual Function Index was used to screen women with symptoms of dyspareunia. The main outcome measure was a semistructured interview inquiring about the cognitions and emotions associated with the experience of pain with intercourse, causal attributions for the pain, interference with personal, relational, and sexual well-being, and help-seeking decisions. RESULTS: The model/theory that emerged suggested a sequence of experiences that began with confusion about the onset of pain and a relatively fruitless search for causal attributions. Attempts to self-manage the pain via a number of cognitive and behavioral strategies provided little relief. Deleterious consequences on sexual function, well-being, and relationships ensued, and women reported a number of barriers to help-seeking. CONCLUSION: The findings from this study suggest that a lack of public health information about dyspareunia and the reluctance of health care providers to inquire about sexual problems may contribute to many young women delaying treatment for a serious sexual health problem with potentially negative biopsychosocial outcomes.

Priorities for endometriosis research: a proposed focus on deep dyspareunia.

Women with endometriosis have a substantial increase in risk of deep dyspareunia with respect to the general female population of corresponding age. This symptom has personal and intimate implications, including unfavorable emotional impact in partners. Deep dyspareunia caused by endometriosis can be viewed as an originally visceral type of pain secondary to chronic inflammation (nociception) but with several superimposed components, including hyperalgesia, abnormal cortical perception, and psychological factors. Therefore, a simplistic biometric approach does not allow a comprehensive and elaborated assessment of the global impact of the symptom on women's sexual function, psychological well-being, body-image, self-esteem, and relational adjustment. We suggest 10 specific issues to be addressed in future research on a clinically as well as scientifically neglected aspect of female health. Time has come to address this physically and psychologically distressing affliction without embarrassment and with a decidedly multidisciplinary perspective.

Visual attention to erotic images in women reporting pain with intercourse.

The coupling of sex and pain creates an interesting theoretical conundrum of clinical significance: Are women with dyspareunia distracted from sexual stimuli, or are they hypervigilant to sexual stimuli because these stimuli elicit thoughts and expectations of pain? This study measured attention to sexual stimuli in women reporting persistent pain with intercourse, women reporting low sexual desire, and women reporting no sexual problems. Participants viewed a series of erotic images, each containing an object intended to distract from the erotic scene regions, while an eye tracker recorded their eye movements. Women with pain looked for shorter periods of time and fewer times at the sexual scene region than did both women with low sexual desire (p = .024 and p = .018, respectively) and the no-dysfunction control group (p < .001 and p = .003, respectively). Women with pain also looked at the context (nonsexual) scene region significantly more times and for longer periods than did the no-dysfunction control women (p = .013 and p = .042, respectively). Results are interpreted to be potentially supportive of the cognitive distraction hypothesis associated with sexual dysfunction, with an additional component of cognitive avoidance of sexual stimuli for the women reporting sexual pain.

Why did passion wane? A qualitative study of married women's attributions for declines in sexual desire.

The high prevalence of sexual desire complaints in women have led a number of researchers and theorists to argue for a reconceptualization of female sexual desire that deemphasizes the drive model and places more focus on relational factors. Lacking in this effort has been a critical mass of qualitative research that asks women to report on their causal attributions for low desire. In this study, the authors conducted open-ended interviews with 19 married women who had lost desire in their marriage and asked what causal attributions they made for their loss of sexual desire and what barriers they perceived to be blocking its reinstatement. Three core themes emerged from the data, all of which represented forces dragging down on sexual desire in the present sample: (a) institutionalization of the relationship, (b) over-familiarity, and (c) the de-sexualization of roles in these relationships. Interpersonal and intrapersonal sexual dynamics featured more prominently than did relationship problems in women's attributions. The authors discuss the results in terms of clinical implications in the psychosocial component of treatment for hypoactive sexual desire disorder.

Elucidating women's (hetero)sexual desire: definitional challenges and content expansion.

The literature on women's sexual desire is reviewed with an emphasis on definitional challenges, an assessment of the empirical basis for the distinction between spontaneous and responsive desire, a reconsideration of the extent to which women's sexual desire is relational in nature, and an exploration of the incentive value of sex for women as a factor partially independent from the experience of sexual desire. Nine recommendations are made regarding research and diagnostic directions. The article concludes with an appeal for the inclusion of eroticism in research and clinical work on sexual desire.

The future of sex therapy: specialization or marginalization?

Sex therapy's claims to specialization may be exaggerated and ultimately damaging to the integrated treatment of sexual dysfunction. In fact, sex therapy does not have a unified underlying theory, a unique set of practices, or an empirically demonstrated efficacious treatment outcome. Paradoxically, the practice of sex therapy has gained widespread professional and popular acceptance since the publication in 1970 of Human Sexual Inadequacy by Masters and Johnson. Consequences of the widespread acceptance of this supposed specialization include the marginalization of sex therapy from other forms of treatment and the perpetuation of the notion that sex therapy is a special form of therapy requiring highly specialized training. This specialization focus also helps to perpetuate societal discomfort with sexuality. The very modest empirical success of most so-called sex therapy interventions and the lack of theoretical development suggest that sex therapy needs a recalibration in order to survive. It is suggested that the treatment of sexual dysfunction be integrated into the general psychotherapy enterprise and into a multidisciplinary biopsychosocial framework.

Misremembering pain: memory bias for pain words in women reporting sexual pain.

INTRODUCTION: The debate over the classification of dyspareunia as a sexual dysfunction or as a pain disorder raises the question of the comparative cognitive salience of sex and/or pain in the experience of women who report pain with intercourse. Refinements in our understanding of cognitive factors in the experience of pain with intercourse may be important in the development of effective treatments. AIM: This study aimed to compare the cognitive salience of sex and pain word stimuli in women reporting pain with intercourse and in a control group of women without sexual dysfunction. METHODS: Twenty women reporting pain during sexual intercourse and 20 women reporting no sexual dysfunction (controls) participated in a memory protocol designed to detect differences as a function of group membership and type of stimulus (sex, pain, and two other control stimuli). MAIN OUTCOME MEASURES: Dependent measures were recall, recognition, intrusions, and false positives for sex words, pain words, and two other control word types. RESULTS: Regardless of group membership, women had best recall for sex-related words; however, women reporting sexual pain evidenced more false memories for pain words than did control women, and pain words elicited more false memories than any other type of word for women with sexual pain. CONCLUSION: Results are interpreted to suggest that repeated activation through experience with persistent sexual pain may have contributed to the: (i) development of stronger semantic networks related to pain in comparison to no sexual dysfunction controls and; (ii) activation of pain networks more easily triggered by pain-related stimuli in women with sexual pain than in no sexual dysfunction controls. Sex, however, had not attained the cognitive salience of pain.

Negative affect and somatically focused anxiety in young women reporting pain with intercourse.

After a long history of privileging psychosexual etiological factors over pain and physiological processes, dyspareunia has enjoyed 1 decade of pointed research focused on the presenting problem of pain. Although it is generally acknowledged that certain affective and cognitive styles may play a role in an individual's experience of pain in general, investigations into these questions specifically as they pertain to pain that occurs during sex are relatively scarce. To add to this growing body of knowledge, 759 women aged 18 to 29 completed questionnaires about current sexual functioning, gynecologic history, expectations about intercourse, and various personality and health-related anxiety measures. One-hundred-one women (14% of the sample) reported pain during intercourse on at least 50% of attempts. This group of women significantly differed from 536 women reporting pain on less than 10% of intercourse attempts on personality constructs related to emotional and relational well-being (e.g., neuroticism, extraversion, agreeableness), as well as anxiety sensitivity, anxiety related to physical health concerns, and the amplification of somatosensory experiences. This affective and cognitive profile is consistent with previous studies that have found an attentional hypervigilance to health and pain-related information in women with dyspareunia, all of which could prove germane to cognitive-behavioral treatments targeting this disorder.

Acculturation and sexuality: investigating gender differences in erotic plasticity.

The contention that women are more erotically plastic than men is supported by a significant body of data, from which it has been inferred (Baumeister, 2000) that female sexuality may be more flexible and more heavily influenced by contextual factors than that of men. As a direct test of erotic plasticity, the present study investigated the extent to which acculturation was associated differentially (as would be predicted by the theory of greater female erotic plasticity) with the sexual attitudes and experiences of 111 college men and 167 college women. For sexual attitudes, main effects were found for gender, acculturation level, and ethnicity. Women endorsed more conservative attitudes than men, less acculturated individuals endorsed more conservative sexual attitudes than the more acculturated group, and Asian Americans had the most conservative sexual attitudes. For sexual experience, a main effect was found for acculturation, with the more highly acculturated group reporting a greater variety of sexual experiences than the less acculturated group. There were no gender-by-acculturation interactions. This study thus did not find support for the theory of female erotic plasticity, insofar as the impact of acculturation on a sample of ethno-culturally diverse college students.

Psychosexual characteristics of vestibulodynia couples: partner solicitousness and hostility are associated with pain.

INTRODUCTION: Provoked vestibulodynia is a prevalent yet misunderstood women's sexual health issue. In particular, data concerning relationship characteristics and psychosexual functioning of partners of these women are scarce. Moreover, no research to date has examined the role of the partner in vestibulodynia. AIMS: This study aimed to characterize and compare the psychosexual profiles of women with vestibulodynia and their partners, in addition to exploring whether partner-related variables correlated with women's pain and associated psychosexual functioning. METHODS: Forty-three couples in which the woman suffered from vestibulodynia completed self-report questionnaires focusing on their sexual functioning, dyadic adjustment, and psychological adjustment. Women were diagnosed using the cotton-swab test during a standardized gynecological examination. They also took part in a structured interview during which they were asked about their pain during intercourse and frequency of intercourse. They also completed a questionnaire about their perceptions of their partners' responses to the pain. MAIN OUTCOME MEASURES: Dependent measures for both members of the couple included the Sexual History Form, the Locke-Wallace Marital Adjustment Scale and the Brief Symptom Inventory. Women completed a horizontal analog scale assessing the intensity of their pain during intercourse and reported their frequency of intercourse per month. RESULTS: Findings show that women with vestibulodynia and their partners did not differ from population norms with regard to global sexual functioning, dyadic adjustment and psychological adjustment. However, mean frequency of intercourse was lower than the standard for this age group. Also, women had significantly poorer sexual functioning than men. In addition, a regression analysis revealed that partner solicitousness and hostility were significantly associated with higher levels of pain during intercourse. CONCLUSIONS: Results suggest that although the psychosexual and relationship characteristics of partners of women with vestibulodynia are within norms, their responses may play a role in the experience of pain.

Sex differences in visual attention to erotic and non-erotic stimuli.

It has been suggested that sex differences in the processing of erotic material (e.g., memory, genital arousal, brain activation patterns) may also be reflected by differential attention to visual cues in erotic material. To test this hypothesis, we presented 20 heterosexual men and 20 heterosexual women with erotic and non-erotic images of heterosexual couples and tracked their eye movements during scene presentation. Results supported previous findings that erotic and non-erotic information was visually processed in a different manner by both men and women. Men looked at opposite sex figures significantly longer than did women, and women looked at same sex figures significantly longer than did men. Within-sex analyses suggested that men had a strong visual attention preference for opposite sex figures as compared to same sex figures, whereas women appeared to disperse their attention evenly between opposite and same sex figures. These differences, however, were not limited to erotic images but evidenced in non-erotic images as well. No significant sex differences were found for attention to the contextual region of the scenes. Results were interpreted as potentially supportive of recent studies showing a greater non-specificity of sexual arousal in women. This interpretation assumes there is an erotic valence to images of the sex to which one orients, even when the image is not explicitly erotic. It also assumes a relationship between visual attention and erotic valence.

Ankle taping does not impair performance in jump or balance tests.

This study aimed to investigate the influence of prophylactic ankle taping on two balance tests (static and dynamic balance) and one jump test, in the push off and the landing phase. Fifteen active young subjects (age: 21.0 ± 4.4 years) without previous ankle injuries volunteered for the study. Each participant performed three tests in two different situations: with taping and without taping. The tests were a counter movement jump, static balance, and a dynamic posturography test. The tests and conditions were randomly performed. The path of the center of pressures was measured in the balance tests, and the vertical ground reaction forces were recorded during the push-off and landing phases of the counter movement jump. Ankle taping had no influence on balance performance or in the push off phase of the jump. However, the second peak vertical force value during the landing phase of the jump was 12% greater with ankle taping (0.66 BW, 95% CI -0.64 to 1.96). The use of prophylactic ankle taping had no influence on the balance or jump performance of healthy young subjects. In contrast, the taped ankle increased the second peak vertical force value, which could be related to a greater risk of injury produced by the accumulation of repeated impacts in sports where jumps are frequently performed. Key pointsAnkle taping has no influence on balance performance.Ankle taping does not impair performance during the push-off phase of the jump.Ankle taping could increase the risk of injury during landings by increasing peak forces.

Remembering the pain: accuracy of pain recall in endometriosis.

Endometriosis diagnosis and treatment planning are guided primarily by retrospective pain recall, despite the facts that (1) there is only a tenuous relationship between pain reports and physical pathology, and (2) the accuracy of pain recall has never been assessed in this population. The current study investigated the accuracy of endometriotic pain recall for pain experienced over a 30-day period, as well as potential psychological mediators of pain recall accuracy, including psychological wellbeing, distress specific to infertility, passive and active coping, and pain present at time of recall in 100 women with endometriosis. Findings indicated that women were relatively accurate in their recall of pain. Only passive coping and pain present at recall were predictive of accuracy, with greater passive coping and lower pain at recall predictive of overestimation of past pain. Study implications are discussed, including: (1) report of pain over a 30-day duration appears credible for the majority of patients with endometriosis and (2) women exhibiting greater passive coping may benefit from psychological treatment in addition to medical intervention.

Detection of differential viewing patterns to erotic and non-erotic stimuli using eye-tracking methodology.

As a first step in the investigation of the role of visual attention in the processing of erotic stimuli, eye-tracking methodology was employed to measure eye movements during erotic scene presentation. Because eye-tracking is a novel methodology in sexuality research, we attempted to determine whether the eye-tracker could detect differences (should they exist) in visual attention to erotic and non-erotic scenes. A total of 20 men and 20 women were presented with a series of erotic and non-erotic images and tracked their eye movements during image presentation. Comparisons between erotic and non-erotic image groups showed significant differences on two of three dependent measures of visual attention (number of fixations and total time) in both men and women. As hypothesized, there was a significant Stimulus x Scene Region interaction, indicating that participants visually attended to the body more in the erotic stimuli than in the non-erotic stimuli, as evidenced by a greater number of fixations and longer total time devoted to that region. These findings provide support for the application of eye-tracking methodology as a measure of visual attentional capture in sexuality research. Future applications of this methodology to expand our knowledge of the role of cognition in sexuality are suggested.

Gender differences in the content of cognitive distraction during sex.

This study compared 220 college men and 237 college women on two types of self-reported cognitive distraction during sex, performance- and appearance-based. Affect, psychological distress, sexual knowledge, attitudes, fantasies, experiences, body image, satisfaction, and sexual function were assessed with the Derogatis Sexual Functioning Inventory and the Sexual History Form to determine associations with distraction. Between-gender analyses revealed that women reported higher levels of overall and appearance-based distraction than did men, but similar levels of performance-based distraction. Within-gender analyses revealed that women reported as much of one type of distraction as the other, while men reported more performance- than appearance-based distraction. In women, appearance-based distraction was predicted by negative body image, psychological distress, and not being in a relationship, while performance-based distraction was predicted by negative body image, psychological distress, and sexual dissatisfaction. In men, appearance-based distraction was predicted by negative body image, sexual dissatisfaction and not being in a relationship, while performance-based distraction was predicted by negative body image and sexual dissatisfaction. Investigating the content of cognitive distraction may be useful in understanding gender differences in sexual experience and in refining cognitive components of sex therapy.

Avances del vendaje funcional de tobillo en el deporte / Advances on ankle taping in sport

El objetivo de este artículo ha sido realizar una revisión de los estudios con vendajes funcionales preventivos de tobillo en el deporte y formular unas hipótesis de futuros trabajos en base a unos ensayos biomecánicos con plataforma de fuerzas. En relación a la biomecánica de los vendajes funcionales preventivos de tobillo en la bibliografía encontramos cuatro temas principales: el estudio del posible descenso del rendimiento, la medición de la restricción de movimiento, la fatiga del vendaje y finalmente las revisiones bibliográficas y trabajos que aportan hipótesis para posibles investigaciones. Podemos concluir que predominan estudios estáticos de las restricciones del vendaje en la amplitud articular y sin embargo hay muy pocos estudios que analicen el comportameitno del vendaje realizando movimientos de situaciones deportivas. Pese a que los beneficios de la utilización de los vendajes están demostrados, cuando su uso no es el adecuado pueden darse una serie de efectos no deseados. A menudo, la dependencia que pueden provocar en el sujeto, le llevará a que esté expuesto a una lesión en el momento en que no esté protegido. El artículo acaba analizando movimientos básicos, presentes en muchos deportes: marcha, carrera, salto, cambio de dirección y amortiguación de caída. En estos movimientos se presentan resultados de la bibliografía y de estudios piloto propios, en los que se analiza la cinética del contacto en el suelo con y sin vendaje funcional preventivo del tobillo, de cara a proponer nuevas vías de investigación, que aborden no solo la eficacia del vendaje sino también la posible disminución en la eficacia de gestos deportivos y el riesgo añadido de nuevas lesiones

The purposes of this paper were to review the research on prophylactic ankle taping in sport, and to formulate hypotheses for future researches, on the basis of biomechanical trials on a force platform. There are four main topics on prophylactic ankle taping in the literature: the study of a possible performance decrease, the measurement of the limitation in the range of motion (ROM), the fatigue of the ankle taping and finally, the reviews and researches that contribute with hypotheses for further works. Most studies have been carried out in static conditions to test the limitations in the ROM; however, there are few studies where the ankle taping response during sports tasks or specfic movements had been analysed. Although the benefit of the use ankle taping are well established, when it is misused, undesirable effects could appear. The subjects´ dependence to these orthoses could lead to an injury, when they do not wear ankle taping during the sports activity. Dinally, the review analyses basic sports movements: gait, running, changes of direction ad landings. Data of these actions are presentes, from the literature and pilot studies performed in our laboratory, where ground reaction forces with and without prophylactic ankle taping have been analysed. Further investigations should focus more in deep not only on the ankle taping effectiveness but on the decreases in the effectiveness of sports movements, and the increase in the risk of injuries