Both Stephanie, Brauer Marieke, Weijenborg Philomeen, Laan Ellen
Centre for Psychosomatic Gynaecology and Sexology, Leiden University Medical Centre, Leiden, The Netherlands.
Centre for Psychosomatic Obstetrics and Sexology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
J Sex Med. 2017 May;14(5):687-701. doi: 10.1016/j.jsxm.2017.03.244. Epub 2017 Mar 31.
In dyspareunia-a somatically unexplained vulvovaginal pain associated with sexual intercourse-learned pain-related fear and inhibited sexual arousal are supposed to play a pivotal role. Based on research findings indicating that enhanced pain conditioning is involved in the etiology and maintenance of chronic pain, in the present study it was hypothesized that enhanced pain conditioning also might be involved in dyspareunia.
To test whether learned associations between pain and sex negatively affect sexual response; whether women with dyspareunia show stronger aversive learning; and whether psychological distress, pain-related anxiety, vigilance, catastrophizing, and sexual excitation and inhibition were associated with conditioning effects.
Women with dyspareunia (n = 36) and healthy controls (n = 35) completed a differential conditioning experiment, with one erotic picture (the CS) paired with a painful unconditional stimulus and one erotic picture never paired with pain (the CS).
Genital sexual response was measured by vaginal photoplethysmography, and ratings of affective value and sexual arousal in response to the CS and CS were obtained. Psychological distress, pain cognitions, and sexual excitation and inhibition were assessed by validated questionnaires.
The two groups showed stronger negative affect and weaker subjective sexual arousal to the CS during the extinction phase, but, contrary to expectations, women with dyspareunia showed weaker differential responding. Controls showed more prominent lower genital response to the CS during acquisition than women with dyspareunia. In addition, women with dyspareunia showed stronger expectancy for the unconditional stimulus in response to the safe CS. Higher levels of pain-related fear, pain catastrophizing, and sexual inhibition were associated with weaker differential conditioning effects.
Pairing of sex with pain negatively affects sexual response. The results indicate that a learned association of sex with pain and possibly deficient safety learning play a role in dyspareunia. Both S, Brauer M, Weijenborg P, Laan E. Effects of Aversive Classical Conditioning on Sexual Response in Women With Dyspareunia and Sexually Functional Controls. J Sex Med 2017;14:687-701.
性交困难是一种与性交相关的、躯体检查无异常的外阴阴道疼痛，习得的疼痛相关恐惧和性唤起抑制被认为起关键作用。基于表明增强的疼痛条件作用参与慢性疼痛的病因及维持的研究结果，本研究假设增强的疼痛条件作用也可能参与性交困难。
测试疼痛与性之间的习得性关联是否对性反应产生负面影响；性交困难女性是否表现出更强的厌恶学习；以及心理困扰、疼痛相关焦虑、警觉、灾难化思维、性兴奋和抑制是否与条件作用效应相关。
性交困难女性（n = 36）和健康对照者（n = 35）完成一项差异条件作用实验，其中一张色情图片（条件刺激）与一个疼痛的无条件刺激配对，另一张色情图片从不与疼痛配对（对照条件刺激）。
通过阴道光电容积描记法测量生殖器性反应，并获得对条件刺激和对照条件刺激的情感价值和性唤起评分。通过经过验证的问卷评估心理困扰、疼痛认知、性兴奋和抑制。
在消退阶段，两组对条件刺激均表现出更强的负面情绪和较弱的主观性唤起，但与预期相反，性交困难女性表现出较弱的差异反应。与性交困难女性相比，对照组在习得阶段对条件刺激表现出更明显的下生殖道反应。此外，性交困难女性对安全的对照条件刺激对无条件刺激表现出更强的预期。更高水平的疼痛相关恐惧、疼痛灾难化思维和性抑制与较弱的差异条件作用效应相关。
性与疼痛的配对对性反应产生负面影响。结果表明，性与疼痛的习得性关联以及可能存在的安全学习缺陷在性交困难中起作用。
Both S, Brauer M, Weijenborg P, Laan E. 厌恶经典条件作用对性交困难女性和性功能正常对照者性反应的影响。《性医学杂志》2017；14：687 - 701。
