Stress, serotonergic function, and mood in users of oral contraceptives.

The relationship between stress and changes in insulin levels, plasma ratio of tryptophan to other large neutral amino acids (LNAAs), mood, and food intake was investigated in women taking monophasic oral contraceptives containing progestagens. Subjects experiencing high levels of stress displayed significant decreases of insulin and tryptophan to other LNAAs ratios, before and after the consumption of a standard meal during the pill-free period as compared with the period of pill use. The decline of the tryptophan to other LNAAs ratio was accompanied by worsening of mood. In a control group of subjects experiencing low levels of stress there was no relationship between insulin and tryptophan to other LNAAs ratio, nor between tryptophan to other LNAAs ratio and mood. These results suggest that the combination of stress and alterations in sex hormones may be responsible for mood changes during the pill-free period in women taking oral contraceptives.

PIP: Serotonin, a neurotransmitter, may be involved in premenstrual mood and appetite changes such that the reduced central activity of serotonin is frequently associated with depressed mood and increased food intake. The plasma ratio of tryptophan, the precursor of serotonin, to the sum of the other large neutral amino acids (LNAAs) is important for the uptake of tryptophan in the brain and the subsequent central synthesis of serotonin; an increase in the plasma tryptophan to other LNAAs ratio produces an increase in brain tryptophan and serotonin. Higher insulin levels induced by carbohydrate uptake cause an increase in tryptophan to other LNAAs ratio, while progesterone and progestagens induce insulin resistance as well as a direct increase of insulin-release by the pancreatic islets in response to glucose. Using a sample of 102 female, oral contraceptive-using Utrecht University students, the authors investigated the relationship between stress and changes in insulin levels, plasma ratio of tryptophan to other LNAAs, mood, and food intake. All participants were current users of monophasic oral contraceptives containing progestagens. The study found the subjects who experienced high levels of stress to display significant decreases of insulin and tryptophan to other LNAAs ratios, before and after the consumption of a standard meal during a pill-free period as compared with the period of pill use. The decline of the tryptophan to other LNAAs ratio was accompanied by worsening of mood. In a control group of subjects experiencing low levels of stress, there was no relationship between insulin and tryptophan to other LNAAs ratio, nor between tryptophan to other LNAAs ratio and mood. These results suggest that the combination of stress and alterations in sex hormones may be responsible for mood changes during the pill-free period in women taking oral contraceptives.

Perceptions of asthma by adolescents at home.

OBJECTIVES: To test symptom perception in asthma under natural circumstances and to establish relationships between changes in airway obstruction as indicated by wheeze, dyspnea, general sensations, and emotional state. DESIGN: Continuous in vivo monitoring. METHOD: Symptom perception was tested in 30 adolescents with severe, unstable asthma. They were continuously monitored in their homes for 72 h. Symptom perception was defined as the relation between self-reported dyspnea and airway obstruction as evident from audible wheeze. Tracheal sounds were continuously recorded with wireless telemetry for wheeze assessment. Dyspnea was assessed four times per day on a Likert-type 10-point scale, as well as four times randomly after pager remote command. The subjects kept records of use of medication, daily activities, general symptoms, and mood state in a diary. RESULTS: There were nine subjects with one or two wheeze episodes, another three subjects with three or four episodes, and one subject with almost continuous wheeze. The presence of wheeze in general related significantly to a rise (from individual baseline) in dyspnea of > 2.5 scale points. Acute wheeze was the best predictor of a rise in dyspnea, but prolonged wheeze correlated significantly with negative mood and general symptoms. CONCLUSION: Patients with prolonged airway obstruction perceived symptoms less well and were more vulnerable to negative effects of asthma than patients with acute onset airway obstruction.

Memory for emotional events: differential effects of centrally versus peripherally acting beta-blocking agents.

Substantial evidence from animal research indicates that enhanced memory associated with emotional experiences involves activation of the beta-adrenergic system. This hypothesis is further supported by the finding in human subjects that blockade of beta-adrenergic receptors with propranolol selectively reduced memory for emotional events. In the present study, we compared the effects of propranolol, a lipid soluble drug which crosses the blood-brain barrier easily, with those of nadolol, a water soluble drug which crosses the blood-brain barrier to a considerably lesser extent, to determine whether the effect involved peripheral or central beta-adrenergic receptors. The effects of these drugs, taken before subjects watched a slide show that was either emotionally arousing or relatively neutral in content, were tested 1 week later with a surprise memory test. Consistent with previous results, propranolol impaired memory (recall and recognition) in the subjects who saw the emotional version of the slide show. In contrast, nadolol did not impair memory of the emotional slide show. These results indicate that the blockade of central beta-adrenergic receptors is responsible for the reduction in storage of emotional events. The results support the view that memory of a mild emotional event involves activation of central, but not necessarily peripheral beta-adrenergic receptors.

Validation of a psychophysiological waking erectile assessment (WEA) for the diagnosis of male erectile disorder.

OBJECTIVE: The aim of the present study was to evaluate a psychophysiological waking erectile assessment (WEA). WEA was designed to elicit penile responses using visual and vibrotactile stimuli and cognitive tasks (distraction and monitoring of erections). METHODS: One hundred consecutive patients with erectile dysfunction and a control group of 50 sexually functional males were examined. Clinical decision analysis, including a receiver operating characteristic (ROC) analysis, was used to determine the accuracy of WEA in predicting independent diagnostic classifications. RESULTS: Fifty percent of the patients were independently diagnosed as having pure psychogenic impotence. In 45 percent of the patients an organic factor was found. Discrimination was best in three (out of 7) WEA conditions in which film was combined with vibration. This combination of conditions resulted in a test sensitivity of 81 percent, and predictive values positive (the probability of "no organic involvement" given a penile response greater than 12 mm) ranging from 66 to 95 percent. About one third of the patients with pure psychogenic erectile dysfunction had an average response of more than 30 mm to the three conditions combining vibration and film. None of the patients with organic involvement exceeded this 30 mm criterion. Thus, the predictive value positive reached its maximum of 100 percent. CONCLUSIONS: The results suggest that WEA is an appropriate initial screening procedure, and that it is of particular value in the detection of psychogenic cases.

Physiological measures of vaginal vasocongestion.

This paper reviews reliability, specificity, and practical applicability of the two most promising and widely used methods for measuring blood flow within the vagina: the oxygenation-temperature method and vaginal photoplethysmography. It was concluded that the oxygenation-temperature method and vaginal pulse amplitude as measured by the photoplethysmograph are both specific indicators of physiological sexual arousal. Although vaginal pulse amplitude seems to be the method of choice for measuring vaginal vasocongestion up to orgasm, and the oxygenation-temperature method for measuring orgasm, these measures should not be used in isolation. It is argued that women's sexual function should be evaluated using vaginal vasocongestion measures in conjunction with subjective indices. Finally, the field is in need of studies comparing physiological and subjective sexual responses in clinical and non-clinical groups.

Visual stimulation facilitates penile responses to vibration in men with and without erectile disorder.

This study compared reflexogenic and psychogenic penile responses in men with and without erectile disorder. It was hypothesized that men with psychogenic erectile dysfunction respond minimally to vibrotactile stimulation. An enhancement of penile responses was expected when vibration was combined with erotic film. Patients were 50 men with psychogenic erectile dysfunction, 45 men with organic erectile dysfunction, and 50 sexually functional men. The combination of film and vibration resulted in stronger penile responses than the stimuli presented separately. Men with psychogenic erectile dysfunction and sexually functional men did not differ in responses to film and film-and-vibration conditions. As predicted, responses of the 2 groups were different in the vibration condition. Interpretations are provided in terms of attention and appraisal. The findings are relevant to the development of psychophysiological diagnostic procedures.

Measurement of menopausal hot flushes: validation and cross-validation.

Specificity and sensitivity of two physiological markers for hot flushes were investigated. One marker, proposed by Freedman, is an increase of sternal skin conductance, the second marker, proposed by Swartzman, is a physiological profile which consists of skin conductance changes in combination with circulation changes. In our laboratory 20 menopausal women, 15 with frequent hot flushes and 5 without hot flushes, and 5 women with regular menstrual cycles were continuously monitored for 2.5 h on subjective hot flush experience, sternal and palmar skin conductance, dorsal and palmar finger temperature and pulse blood volume. Increase in sternal skin conductance proved to be very specific in contrast to Swartzman's physiological profile, although it was less sensitive. Receiver operating characteristics revealed that an increase combined with a preceding decrease in sternal skin conductance as most specific for, and most sensitive to, subjectively reported hot flushes. This was confirmed by a cross-validation with 34 "flushing' menopausal women.

Contraceptive use and attitudes in Great Britain.

In order to update current knowledge on contraceptive use and attitudes in Great Britain (i.e. England, Scotland and Wales), a survey was conducted among 1753 randomly selected British women aged 15-45. Replies were received from 967 women (55.2%). Seventy-three percent (73%) of fertile, sexually active women who wished to avoid pregnancy were using reliable methods of contraception, viz. oral contraceptives (OCs), intrauterine devices (IUDs) or sterilization. However, it was found that adolescents and women over 40 who wished to avoid pregnancy were, nevertheless, especially likely not to be using any contraceptive method at all. The women surveyed were concerned about weight gain, cardiovascular and cancer risks associated with OC use, and infection and infertility risks associated with IUD use. Sixty percent (60%) perceived sterilization as a major and risky surgical operation. It was concluded that contraceptive practice in Britain had not improved greatly in recent years. The latest scientific findings regarding the true advantages and disadvantages of OCs, IUDs and sterilization, therefore, need to be brought to the attention of the lay public more effectively. Special efforts need to be directed towards providing adolescents and women over 40 with proper information. Physicians and the mass media could play a considerable role in this respect.

Psychological determinants of sexual arousal: a review.

The literature on the psychological determinants of genital and subjective sexual arousal is reviewed. Various psychological mechanisms are identified and in each instance the available empirical evidence is summarized. Areas requiring further research are indicated and suggestions for methodological improvements are presented.

The relationship between involuntary pelvic floor muscle activity, muscle awareness and experienced threat in women with and without vaginismus.

This study assessed the relationship between involuntary pelvic floor muscle activity, muscle awareness and experienced threat in women with and without vaginismus. Information about this relationship may help understand the mechanism of vaginismus. Twenty-two women with vaginismus and seven control women participated in the study. Women were exposed to four emotion-inducing film excerpts. Vaginal electromyography was recorded. Experienced threat was continuously monitored with the use of a lever. Women responded with increased pelvic floor muscle activity to the threatening and sexually-threatening film excerpt. No changes occurred during the neutral and erotic excerpt. The subjective experienced threat as indicated with the lever showed the same response pattern. However, awareness of changes in muscle activity showed a slightly different pattern. Individual data were inspected. In general, agreement was found between recorded changes in muscle activity and experienced threat. The results of the erotic excerpt showed that awareness of changes in muscle activity is not only determined by information from the pelvic floor muscles, but also by other factors like situational information and the expectations of the women. The data support the idea of a general defense reaction as a mechanism of involuntary pelvic floor muscle activity.

Excessive breathlessness through emotional imagery in asthma.

Breathlessness and negative emotions during asthma attacks interact in complex patterns. This study tested the influence of emotional imagery on breathlessness during voluntary breath holding. Adolescents with and without asthma (n = 36 + 36) were assigned to positive imagery, negative imagery, or no imagery. There were four trials with close to thresholds for breath holding combined with imagery. Breathlessness and quality of imagery were measured by the end of breath holding. Additional measures were lung function and anxiety. The results showed that positive and negative imagery were only influencing breathlessness in participants with asthma. Although threshold duration for the groups were not significantly different, participants with asthma reported more breathlessness. The intensity of imagery enhanced breathlessness but diminished the accuracy of symptom perception. Positive imagery diminished breathlessness in participants with asthma, but also the difference in breathlessness between 75% and 95% of threshold duration. Breathlessness did not correlate with lung function, anxiety or other variables. It was concluded that emotional imagery during asthma attacks distracts from accurate introspection or enhances breathlessness, irrespective of anxiety.

Psychological confounds in medical research: the example of excessive cough in asthma.

This experiment tested the hypothesis that the setting in which research is conducted may dominate symptom magnitude. Cough was induced with inhaled citric acid and its magnitude was influenced by changing the setting in 30 adolescents with asthma. Cough thresholds for citric acid were determined. The participants were assigned to a condition emphasising asthma, or a control condition, described as estimation of lemon flavors. All participants inhaled (in different order) thresholds for citric acid, 50% of these thresholds, or placebo. Results showed that both cough frequency and subjective 'cough tendency' were significantly higher in the asthma condition. State anxiety was higher in the asthma condition, but correlated only moderately with cough. Lung function, severity of asthma, trait anxiety, age or sex did not correlate with cough. It was concluded that patients with asthma cough more often in a situation which they have learned to associate with asthma.

Mood and sexual arousal in women.

The objective of this study was to investigate the effect of a positive 'mood for sex' on genital and subjective sexual arousal in functional women, using a musical mood induction procedure. Fifty-one female Ss were randomly assigned to one of four conditions: erotic film preceded by mood induction; erotic fantasy preceded by mood induction; erotic film without mood induction; and erotic fantasy without mood induction. Photoplethysmographic pulse amplitude was continuously recorded and self-report ratings of sexual arousal and affective reactions were collected before and after erotic conditions. Results showed that a positive sexual mood did not facilitate subsequent genital and subjective sexual arousal. Positive sexual mood did inhibit negative emotional experiences to erotic film.

Performance demand and sexual arousal in women.

Up to now, no experimental studies have inquired into the possible role of performance demand in female sexuality. The objective of this study is to investigate the effects of performance demand on sexual arousal in functional women, using explicit instructions. Forty-eight female subjects were asked to respond with maximum sexual arousal within 2 min, both during sexual fantasy and while watching an erotic film excerpt. Photoplethysmographic pulse amplitude was continuously recorded and self-report ratings of sexual arousal and affective reactions were collected after each erotic condition. Subjects were also instructed to continuously indicate their subjective sexual excitement during the conditions by means of a lever. Performance demand resulted in higher genital responses and was most effective in the fantasy condition. These results corroborate the findings for functional men. Although for both measures of subjective experience of sexual arousal performance demand yielded significantly higher ratings, this was conditioned by the order in which subjects were exposed to conditions. Women who masturbate with a mean frequency of 4 times a month reported higher subjective sexual arousal during performance demand conditions as compared with women who masturbate substantially more or who do not masturbate. Genital vasocogestion did not differ between masturbation-groups. Continuous subjective monitoring yielded lower correlations with vasocongestion than discrete ratings of sexual arousal and appears to be more sensitive to order effects.

Sexual outcomes following treatment for early stage gynecological cancer: a prospective multicenter study.

Data are presented of a prospective, longitudinal study on the impact of early stage gynecological cancer on sexuality. Women with a partner (n = 58) completed self-report questionnaires following diagnosis but prior to treatment and then at 6 and 12 months post-treatment. A single assessment was also obtained from a healthy comparison group (n = 103). Pre-treatment cancer patients reported fewer and less trouble with sexual problems compared to healthy controls. Neither sexual satisfaction nor sexual activity changed from pre- to post-treatment and was comparable to that of healthy controls. Post-treatment, relatively minor sexual difficulties were shown; a notable difficulty for cancer patients concerned lubrication. At 12 months post-treatment, the sexual functioning of cancer patients was comparable to healthy controls.

Symptom perception: psychological correlates of symptom reporting and illness behavior of women with medically unexplained gynecological symptoms.

Medically unexplained (gynecological) symptoms can be viewed as an indication of the somatization of negative emotions. Most studies regarding psychological correlates of medically unexplained gynecological symptoms have paid attention only to certain personality characteristics of women with these symptoms. In this study the reporting of physical symptoms and the resulting illness behavior is explained in terms of information processing or a perception process, i.e. the process by which people detect and interpret physical sensations as symptoms of illness (symptom perception). Symptom perception is in part determined by environmental characteristics and cognitive and emotional processes, such as variation in daily life, (coping with) emotional threat and the use of cognitive illness schemes. Differences in symptom perception and illness behavior of women with medically unexplained and explained gynecological symptoms, compared to women with medically explained gynecological symptoms and a control group, were established with the help of a questionnaire, containing a number of scales. As expected, women with medically unexplained gynecological symptoms had higher reports of common symptoms and sensations and showed also more other illness behavior than the other two groups. They reported less variation and more threat in daily life than the other two groups. These variables together with the use of illness schemes contributed most to symptom reporting of women with medically unexplained symptoms. It is concluded that defence against threat is probably an important determinant. Suggestions for further research and some practical implications are discussed.

Sexual outcomes following treatment for early-stage gynecological cancer: a prospective and cross-sectional multi-center study.

This study evaluates the impact of early-stage gynecological cancer and its treatment on sexuality and assessed needs for care regarding sexual rehabilitation. Data from 58 women from a prospective, longitudinal study were compared to data from 220 women from a cross-sectional study. Patients in the prospective study completed questionnaires prior to treatment and then 6 and 12 months post-treatment. A single assessment was obtained from patients in the cross-sectional study. All women had a partner. Both groups were comparable on important independent variables. Both samples had an equal level of sexual contact, but participants in the cross-sectional study (mean time 46 months post-treatment) reported a higher frequency of sexual problems, were more troubled by those problems and reported a lower sexual satisfaction. However, in both groups the level of the reported dysfunctions was relatively low. Around 80% of the patients were satisfied with the information provided on sexual rehabilitation. Little need for extra care on sexual rehabilitation was reported. In conclusion, women with early-stage gynecological cancer were not especially prone to severe sexual problems and seemed to cope well with the consequences of cancer and its treatment on their sexual lives. It was suggested that this relatively positive outcome is a result of the improved patient care and education on sexual aspects in the last decade.

Contraceptive use and attitudes in reunified Germany.

Contraceptive use and attitudes were assessed in a random sample of 1064 German women. The majority (76%) of the sexually active, fertile women who were not pregnant and did not wish to get pregnant at the time of the survey were using very reliable contraceptive methods, namely oral contraceptives (OCs), intrauterine devices (IUDs) or sterilization. Comparison with a previous survey showed that contraceptive practice in West Germany had improved considerably since 1985. Attitudes towards the most reliable methods available (OCs, IUDs and sterilization) were found to be ambivalent. Perceived side effects and health risks were a particular matter of concern to the respondents. Although most respondents (88%) recognized that condoms prevent the transmission of AIDS, 66% of those who had occasional sexual partners did not use barrier methods. It is concluded that German contraceptive practice is reasonably effective and that if attitudes were to become more realistic the level of effectiveness could even be raised.

PIP: The sample for this 1992 survey of contraceptive use and attitudes was obtained by random-walk sampling, whereby field workers from a survey agency that collaborated in carrying out the study followed designated routes throughout the country, starting from 257 predetermined locations. They identified subjects 15-45 years old by visiting their homes and inviting the woman in each household to participate in the study. Of the 1064 women surveyed, 75.7% were defined as being exposed to the risk of conception; 3.8% stated they were infertile, 4.2% were currently pregnant, 4.0% intended to get pregnant, and 15.6% were not sexually active. The barrier methods used comprised condoms (10.4%), diaphragms (0.9%), spermicides (0.6%), and combinations of condoms and spermicides (0.4%), of diaphragms and spermicides (0.1%), and of diaphragms and condoms (0.2%). Although most respondents (88%) recognized that condoms prevent the transmission of AIDS, 66% of those who had occasional sexual partners did not use barrier methods. 75.7% of exposed German women used reliable methods, namely OCs, IUDs, and sterilization. Women from what had been East Germany cited the common reasons mentioned for using contraceptives as often as did women from what had been West Germany (p 0.05), except for AIDS and sexually transmitted disease prevention (1.1% and 5.8%, respectively, p 0.05) and alleviation of skin disorders (2.3% and 12.5%, respectively, p 0.01). Information on contraception was obtained mainly from gynecologists (67.7%) and friends (30.9%). Comparison with a previous survey showed that contraceptive practice in the former West Germany had improved considerably since 1985. Attitudes towards the most reliable methods available (OCs, IUDs and sterilization) were found to be ambivalent. Perceived side effects and health risks were a particular matter of concern to the respondents. Certain disadvantages of OCs and IUDs were less frequently perceived by women from the former East Germany than by women from the former West Germany, whereas "East German" women were more frequently of the opinion that sterilization was a major and risky operation. German contraceptive practice is reasonably effective, and if attitudes were to become more realistic the level of effectiveness could even be raised.

Place of delivery in The Netherlands: actual location of confinement.

Preferred and actual locations of confinement were compared in a group of 170 nulliparous women. Voluntary changes in preferred location for birth were rare and concerned only changes from hospital to home confinement. Obligatory changes due to referral to consultant obstetricians occurred frequently: 58.8% of the total sample. Fewer referrals were found for women with an initial preference for a home confinement (53%) than for those who preferred a hospital confinement (64%). Most referrals occurred in the group of older women initially in doubt about their preferred location for giving birth: 72%. The differences were not significant, however. To reveal differences between referrals and non-referrals, discriminant analysis was performed at the 18th week of gestation. The explained variance for the total group of referrals was 64.7%. Partially, the variables pertaining to the explained variance were the same as those related to a preferred hospital confinement. The explained variance for the group of referrals in which psychosocial influences were presupposed was not better, with the exception of referrals due to insufficient progress during labour: 76.4% of the variance could be explained at the 34th gestational week. When birth weight and amenorrhoea were included, these percentages increased to 79.0 and 84.8%, respectively.

Place of delivery in The Netherlands: maternal motives and background variables related to preferences for home or hospital confinement.

The decision-making process regarding the preferred site for confinement was investigated in a total of 170 nulliparous women with initially uncomplicated pregnancies. Of these women, 100 had a preference for delivery at home and 45 for hospital confinement. The remaining 25 women were in doubt about the preferred location. Interviews were held at the 18th week of pregnancy. Motives for choosing either a home or a hospital confinement were analysed. Preferences for either home or hospital confinement were predicted by a stepwise discriminant analysis. Educational level, psychological well-being, anxiety concerning complications at birth, and attitudes towards female social roles accounted for 78.6% of the variance. Fear that something might go wrong during labour together with an older age predicted for 62% the group of women doubtful about the place of confinement.