Browsing by Subject "Sexual function"
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Item An assessment of vaginal lubrication and blood flow in women taking oral contraceptive pills(2021-08-05) Handy, Ariel Baker; Meston, Cindy M.; Carlson, Caryn; Delville, Yvon; Goldstein, IrwinGenital sexual arousal, which consists of genital vasocongestion and lubrication, is critical to healthy sexual function in women and closely linked with hormone function. Oral hormonal contraceptive pills, which are used by over a quarter of reproductive-age women in the United States (Daniels, Daugherty, Jones, & Mosher, 2015; Jones, Mosher, & Daniels, 2013), contain either both ethinylestradiol and a synthetic progestin, or solely a synthetic progestin. Oral hormonal contraceptive pills (OCPs) tend to reduce the number of bioavailable androgens through upregulation of sex hormone binding globulin (SHBG; Zimmerman, Eijkemans, Coelingh Bennink, Blankenstein, & Fauser, 2014), and they have been associated with decrements in self-reported arousal and vaginal lubrication (Hassanin, El-Halwagy, Ismail, & Shehab, 2018; Smith, Jozkowski, & Sanders, 2014). The primary aim of this dissertation was to examine differences in physiological lubrication and vaginal blood flow among women using OCPs with varying androgenic properties, as well as the possible mediating role of SHBG in these relationships. Participants in this study were 130 women: 59 naturally-cycling control women, 50 women taking androgenic OCPs, and 21 women taking antiandrogenic OCPs. Participants watched sexual films while their sexual arousal responses were measured, completed questionnaires, and took part in a blood draw. Results indicated physiological deficits in women taking either form of OCP, with marked inhibitory effects found in women taking antiandrogenic OCPs. Whereas SHBG did not meaningfully mediate the relationships between study group and physiological sexual arousal response, paths within the models indicated significant relationships among these variables. Rates of sexual dysfunction were significantly greater in the antiandrogenic group compared to control. These results further elucidate the effect of sex steroid hormones on women’s sexual arousal response and suggest the presence of physiological sexual side effects of various OCPs. It is recommended that prescribing clinicians consult patients on such physiological effects, and future research should examine the maintenance of these effects after OCP discontinuation.Item The effects of acute and chronic stress on sexual arousal in women(2010-05) Hamilton, Lisa Dawn, 1979-; Meston, Cindy M.; Delville, Yvon; Jones, Theresa A.; Gore, Andrea C.; Dormire, Sharon L.In most adult animals, stress is generally thought to be detrimental to reproductive (sexual) function. However, in humans, there is a limited body of literature that indicates some stress can potentially be beneficial for sexual function. One theory is that there is an inverted U relationship between stress and sexual function with low and high levels of stress (or anxiety) causing an impairment of sexual response, while a moderate level of stress facilitates sexual arousal. This aim of this dissertation is to identify the mechanisms through which both acute and chronic stress may facilitate or impair sexual arousal in women. In particular, I examined the role of adrenal hormones, the autonomic nervous system (ANS), and psychological factors. To test these mechanisms, I measured cortisol, dehydroepiandrosterone sulfate (DHEAS), heart rate, distraction, and misattribution of arousal during stressful and sexual laboratory situations. Two of the studies examined the effects of acute stress, and the final study focused on chronic stress. Results indicated that acute stress is beneficial for genital arousal in women, and that the sympathetic branch of the ANS is the key mechanism involved in that relationship. High levels of chronic stress were found to significantly impair genital arousal compared to average levels of chronic stress. Increased levels of cortisol and distractions contributed to this effect. DHEAS did not appear to play a role in the relationship between stress and sexual arousal, and there was no evidence for misattribution of arousal. Neither acute nor chronic stress affected women’s subjective (psychological) arousal. Acute and chronic stressors affect sexual arousal in different ways and through separate mechanisms. The findings from these studies can inform treatment approaches for women with sexual arousal difficulties.Item Efficacy of an exercise intervention for sexual side effects of antidepressant medications in women(2013-08) Lorenz, Tierney Kyle Ahrold; Meston, Cindy M.Antidepressants are associated with sexual side effects (Clayton, Keller, & McGarvey, 2006). Sexual side effects are associated with non-compliance or discontinuance of antidepressants (Werneke, Northey, & Bhugra, 2006). Despite this, there are few empirically supported treatments for antidepressant side effects. However, in laboratory studies, exercise immediately before sexual stimuli improved sexual arousal of women taking antidepressants (Lorenz & Meston, 2012). I evaluated if exercise improves sexual functioning in women experiencing antidepressant-induced sexual side effects. Fifty-two women reporting antidepressant sexual side effects were followed for 3 weeks of sexual activity only. They were randomized to complete either three weeks of exercise immediately before sexual activity (3x/week) or 3 weeks of exercise separate from sexual activity (3x/week). At the end of the first exercise arm, participants crossed to the other. I measured sexual functioning, sexual satisfaction, depression and physical health. Completers showed modest improvements in sexual functioning and satisfaction. For women taking selective serotonin and norepinephrine reuptake inhibitors, exercising immediately before sexual activity was superior to exercise in general. As well as known effects in improved physical and psychological health, exercise may help improve sexual health and pleasure in women taking antidepressants. These findings have important implications for public health, as exercise is accessible, cheap, and does not add to burden of care.Item The relationship between affective appraisal of physiological sexual arousal and sexual dysfunction among women with a history of childhood sexual abuse(2017-07-25) Pulverman, Carey Shayne; Meston, Cindy M.; Dominguez, Juan M; Carlson, Caryn L; Frohlich, Penelope; Hixon, J. Gregory; Holahan, Charles JWomen with a history of childhood sexual abuse (CSA) are at a higher risk of sexual dysfunction than non-abused women and standard treatments for sexual dysfunction have been less effective in abused women. Although low desire is the sexual difficulty most commonly reported by women in general, for abused women arousal problems are most prevalent. The variation in presentation of sexual dysfunction and treatment response for abused women suggests that the sexual dysfunction of abused women may develop via unique pathways from that of their non-abused peers. The aim of this study was to identify mechanisms underlying the relationship between a history of CSA and sexual dysfunction. Prior work suggests that sexual arousal may be associated with negative affect and trauma memories for abused women, therefore I hypothesized that greater negative and shameful and less positive appraisal of genital sexual arousal would explain the relationship between a history of CSA and sexual dysfunction. I also tested a number of other candidate mechanisms to explain this relationship. Participants were 107 women from the local community: 61 abused women and 46 non-abused women. Participants completed a single laboratory session in which they viewed an erotic film and completed questionnaires on appraisal of genital sexual arousal and other candidate mechanisms. Results supported the notion that the sexual difficulties of abused women develop through distinct pathways by indicating that appraisal of genital sexual arousal and body image focused on sexual attractiveness explain the relationship between a history of CSA and sexual dysfunction. Greater negative appraisal of genital arousal and one’s own sexual attractiveness during sexual arousal could be highly distracting to abused women trying to engage in consensual sexual activity and suggest an extension of Barlow’s cognitive affective model of sexual function to abused women. Although Barlow’s model helps to explain the sexual function of women in general, the current results suggest that the content that distracts women during sexual activity may differ by abuse history. Clinically these findings call for greater attention to negative appraisals of genital arousal and the overall body when treating sexual dysfunction in women with a history of CSA.Item When are sexual difficulties distressing to women? The selective protective value of intimate relationships(2011-08) Stephenson, Kyle Richard; Meston, Cindy M.; Carlson, CarynRecent studies have shown that sexual functioning and sexually related personal distress are weakly related in women, with only a minority of sexual difficulties resulting in significant levels of distress. However, there has been little systematic research to date on which factors moderate the relationship between sexual functioning and sexual distress. Our aim was to assess the degree to which relational intimacy and attachment anxiety moderate the association between sexual functioning and sexual distress in college-age women. Two hundred women (mean age = 20.25) completed surveys assessing sexual functioning, relational intimacy, attachment anxiety, and sexual distress. Relational intimacy and attachment anxiety moderated the association between multiple aspects of sexual functioning and sexual distress. For lubrication and sexual pain, functioning was more strongly associated with distress in low-intimacy vs. high-intimacy relationships, but only for women with high levels of attachment anxiety. Results regarding desire were mixed and neither intimacy nor attachment anxiety interacted with subjective arousal or orgasm in predicting distress. We conclude that both relational intimacy and attachment anxiety are important moderators of the association between sexual functioning and subjective sexual distress in women. Theoretical and practical implications are discussed.