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Sexual Desire Discrepancy and Sexual and Relationship Satisfaction among New Parents

Posted on Dec 6, 2017

Image credit: Flickr user michael-mark.com

By Emily Cote

This post is a summary of our paper: Rosen, N. O., Bailey, K., & Muise, A. (2017). Degree and Direction of Sexual Desire Discrepancy are Linked to Sexual and Relationship Satisfaction in Couples Transitioning to Parenthood. The Journal of Sex Research, 1-12.

The transition to parenthood is a unique and often challenging time as couples attempt to balance their roles as parents and partners. Making time for a thriving sex life suddenly seems less important than catching up on sleep or feeding the baby. Even still, sexual partners find themselves concerned with when intimacy will resume and whether their partner feels the same level of desire they do. One particular research study found that both partners in the majority of heterosexual couples welcoming their first child were worried that the father was going to have higher sexual desire than the mother [1-3].

These are not unwarranted concerns – research tells us that new parents do experience declines in sexual desire in the postpartum period. This effect is especially prominent in mothers, although some research shows that fathers experience a decline in desire as well [4-8]. This data makes sense when you consider the physical toll birth can have on a mother’s body! However, both parents still have sexual needs and it can put pressure on an intimate relationship to have differences in sexual desire. The partner who experiences higher sexual desire may feel frustrated by always initiating sex or being rejected, while the partner who experiences lower sexual desire may feel pressure to perform sexually or guilty about rejecting sex [9]. These differences can lead to a decrease in sexual satisfaction, but also a decrease in relationship satisfaction.

We already know a lot about differences in desire and what that might mean for a relationship, but the current available research doesn’t help us predict sexual or relationship satisfaction based on which partner is experiencing higher desire. As previously mentioned, couples typically expect the father to have higher sexual desire. What if the mother is the partner who is attempting to initiate sex? Will couples experience difficulties in their relationship because this difference in desire is not seen as “normal”?

What our research lab wanted to find out was (1) if a larger difference is sexual desire was associated with lower sexual and relationship satisfaction and (2) whether the question of which partner was experiencing higher sexual desire had an effect on sexual and relationship satisfaction.

What did we do?

Using an online survey with validated measures, we asked 255 couples questions about their sexual desire, sexual satisfaction, and relationship satisfaction.

What did we find?

  • 70% of couples reported that the father experienced higher desire than the mother, but 25% of couples reported the mother experiencing higher desire than the father.
  • Both mothers and fathers experienced lower sexual satisfaction when the difference in desire was larger, but their relationship satisfaction remained about the same.
  • Fathers experienced greater sexual and relationship satisfaction when they had higher sexual desire.
  • Mothers experienced greater relationship satisfaction when the father had higher sexual desire, but this desire difference was not associated with the mothers’ sexual satisfaction.
  • Both partners were more satisfied with their sexual and romantic relationship when they had similar and high levels of desire, as opposed to similar but low levels of desire.

What does this mean?

To put it simply, finding out which partner has higher desire does have implications for the sexual and relationship satisfaction of the couple, as does the degree of difference in sexual desire.

Couples should be aware that this is a possibility for them when they are becoming first time parents. Many partners anticipate a return to pre-pregnancy levels of desire, but this is rarely the case. This study helps to contribute to the normalization of desire differences and helps couples to understand they are not alone in their sexual struggles postpartum. Instead, they can look to consult health care professionals and start a conversation about what they can do to overcome these issues. It may be better for their sexual and romantic relationship in the long run!

Sources:

[1] Olsson, A., Lundqvist, M., Faxelid, E., & Nissen, E. (2005). Women’s thoughts about sexual life after childbirth: Focus group discussions with women after childbirth. Scandinavian Journal of Caring Science, 19, 381–387. doi:10.1111/j.1471-6712.2005.00357.x

[2] Pastore, L., Owens, A., & Raymond, C. (2007). Postpartum sexuality concerns among first-time parents from one U.S. academic hospital. Journal of Sexual Medicine, 4, 115–123. doi:10.1111/j.1743-6109.2006.00379.x

[3] Schlagintweit, H., Bailey, K., & Rosen, N. O. (2016). A new baby in the bedroom: Frequency and severity of postpartum sexual concerns and their associations with relationship  satisfaction in new parent couples. Journal of Sexual Medicine, 13, 1455–1465.             doi:10.1016/j. jsxm.2016.08.006

[4] De Judicibus, M., & McCabe, M. (2002). Psychological factors and the sexuality of pregnant and postpartum women. Journal of Sex Research, 39, 94–103.   doi:10.1080/00224490209552128

[5] Gordon, I. B., & Carty, E. (1978). Sexual adjustment of postpartum couples. Canadian Family Physician, 24, 1191–1198

[6] Serati, M., Salvatore, S., Siesto, G., Cattoni, E., Zanirato, M., Khullar, V., … Bolis, P. (2010). Female sexual function during pregnancy and after childbirth. Journal of Sexual Medicine, 7, 2782–2790. doi:10.1111/ j.1743-6109.2010.01893.x

[7] von Sydow, K. (1999). Sexuality during pregnancy and after childbirth: A metacontent analysis of 59 studies. Journal of Psychosomatic Research, 47, 27–49. doi:10.1016/S0022-3999(98)00106-8

[8] Condon, J. T., Boyce, P., & Corkindale, C. J. (2004). The First-Time Fathers Study: A prospective study of the mental health and wellbeing of men during the transition to parenthood. Australian and New Zealand Journal of Psychiatry, 38, 56–64.             doi:10.1111/anp.2004.38. issue-1-2

[9] Sutherland, S. E., Rehman, U. S., Fallis, E., & Goodnight, J. A. (2015). Understanding the phenomenon of sexual desire discrepancy in couples. Canadian Journal of Human Sexuality, 24, 141–150. doi:10.3138/cjhs.242.A3

Couples Coping with Genito-Pelvic Pain: Do relationship goals impact experience of pain?

Posted on Nov 20, 2017

By Kat Merwin

This blog summarizes our recently published paper: Rosen, N.O., Dewitte, M., Merwin, K. E., & Bergeron, S. (2017). Interpersonal Goals and Well-Being in Couples Coping with Genito-Pelvic Pain. Archives of Sexual Behavior, 46, 2007-2019. doi: 10.1007/s10508-016-0877-1

Provoked Vestibulodynia (PVD) is the most frequent cause of unexplained genito-pelvic pain in premenopausal women [1]. It is characterized by an acute pain at the vulvar vestibule (i.e., the entrance to the vagina) –for more information on this please see some of our other blog posts [here, here, here, and here].

As you can imagine, experiencing this type of pain can impact the sexual relationship, overall relationship, and psychological well-being of both the women with PVD and their partners. Women and their male partners* report:

  • lower sexual satisfaction compared to pain-free couples [2]
  • feelings of shame and inadequacy [3]
  • fears of relationship dissolution because of the pain [3]
  • increased rates of psychological distress, such as depression [4]

Research with other chronic pain conditions has found that goals (i.e., the reasons we have for engaging in any number of behaviours) can impact the experience of pain. What do I mean by ‘goals’? We tend to have two general types of goals:

Approach Goals: seeking positive outcomes 

Avoidance Goals: avoiding negative/aversive outcomes

Approach goals in relationships focus on the pursuit of positive experiences (e.g., fun, growth, development, intimacy), whereas Avoidance goals focus on avoiding negative experiences (e.g., disagreements and conflict). It is important to note that approach and avoidance goals are not mutually exclusive –you can be pursuing both types of goals in your relationship at any time!

In general, engaging in a behavior (e.g., having sex with your partner) while strongly motivated by approach goals tends to be associated with greater relationship satisfaction and sexual desire, whereas holding stronger avoidance goals has been associated with lower relationship satisfaction [5,6]. Past research by Rosen and colleagues (2015) found that when women with PVD had sex with their partners for approach reasons (e.g., to pursue intimacy) they reported greater sexual and relationship satisfaction, whereas those with stronger avoidance reasons (e.g., to avoid conflict) reported lower sexual and relationship well-being [7].

However, approach and avoidance relationship goals have not been examined in women with PVD (and their partners).

 Do relationship goals impact the experience of pain and/or psychological distress in women with PVD? What about the well-being of their partners?

 That is what we wanted to know. Specifically, we wanted to:

  • see how both women’s and partner’s approach and avoidance relationship goals were related to women’s experience of pain during intercourse
  • see how women’s and partner’s approach and avoidance relationship goals were related to the sexual, relationship, and psychological well-being of both members of the couple
  • examine the moderating role of sexual approach and avoidance goals in these associations (i.e., does the effect of approach/avoidance relationship goals on sexual, relationship, and psychological well-being of both member of the couple, and women’s pain depend on the amount of approach/avoidance sexual goals?)

What did we do?

We had 134 women diagnosed with PVD and their partners complete online measures assessing relationship and sexual goals, sexual satisfaction, relationship well-being, and depressive symptoms. We also had the women complete a measure to assess the intensity of pain experienced during intercourse. Note: one couple was in a same-sex relationship, but all remaining couples were in mixed-sex relationships.

What did we find?

  • Women with stronger relationship approach goals reported more sexual satisfaction
  • When partners held stronger relationship approach goals both women and partners reported more sexual and relationship satisfaction, and partners reported less depression
  • When partners held stronger relationship avoidance goals, women with PVD reported less sexual satisfaction
  • A combination of stronger relationship & sexual approach goals was associated with greater relationship and sexual satisfaction, and fewer depressive symptoms
  • A combination of stronger relationship & sexual avoidance goals was associated with lower relationship and sexual satisfaction, and greater pain during intercourse for women

What do these findings mean?

Broadly, this research tells us that the sexual and relationship goals that women with PVD and their partners hold have an impact on the sexual and relationship wellbeing of both members of a couple –and on women’s experience of pain during intercourse.

Conclusion

Our findings suggest that the relationship goals of women with PVD –and those of their partners –may contribute to their adaptation to genito-pelvic pain. Approach goals may facilitate positive adjustment whereas avoidance goals appear to be detrimental. When couples focus on approach goals, this may help them build greater intimacy, serve as a buffer to negative psychological consequences reported by women with PVD and their partners, and allow the couple to adapt sexual activities to accommodate the women’s pain —which then results in greater sexual satisfaction, fewer depressive symptoms, and less pain for women during intercourse. These associations also seem to be stronger when pursuing approach (or avoidance) goals in the sexual relationship as well.

Interventions for women and couples coping with PVD should consider encouraging couples to focus more on sexual and relationship approach goals (and help decrease their avoidance goals) to help increase the benefits to sexual and relationship well-being, as well as the pain experienced by women during intercourse.

While these findings are novel and promising, there are some limitations that need to be considered. This study included mainly mixed-sex couples and did not formally assess women’s menopausal status, which means these findings may not be generalizable to all couples with PVD.

Most importantly, this study was cross-sectional, so the associations between goals and sexual and relationship satisfaction, and pain, may go in the other direction: It is possible that couples struggling with greater pain, or poorer sexual and relationship well-being may be more likely to strongly endorse avoidance goals, and those with less pain and greater sexual and relationship well-being may endorse higher approach goals.

*Note: most of the current research on PVD in couples has studied women in mixed-sex relationships. For information on PVD in same-sex couples, please see the following articles:

Blair, K. L., Pukall, C. F., Smith, K. B., & Cappell, J. (2014). Differential associations of communication and love in heterosexual, lesbian, and bisexual women’s perceptions and experiences of chronic vulvar and pelvic pain. Journal of Sex & Marital Therapy, 41. doi: 10.1080/0092623X.2014.931315

Armstrong, H.L., & Reissing, E.D. (2012). Chronic vulvo-vaginal pain in lesbian, bisexual and other sexual minority women. Journal of Sexual Medicine, 9, 166–167. doi: 10.1111/j.1743-6109.2012.02758.x

Robinson, K,  Galloway, K.Y., Bewley, S., Meads, C. (2017) Lesbian and bisexual women’s gynaecological conditions: A systematic review and exploratory meta-analysis. BJOG: An International Journal of Obstetrics & Gynaecology 124:3, pages 381-392. doi: 10.1111/1471-0528.14414

Sources:

[1] Harlow, B. L., Kunitz, C. G., Nguyen, R. H., Rydell, S. A., Turner, R. M., & Maclehose, R. F. (2014). Prevalence of symptoms consistent with a diagnosis of vulvodynia: Population based estimates from 2 geographical regions. American Journal of Obstetrics and Gynecology, 210, 40.e1–40.e8. doi:10.1016/j.ajog.2013.09.033.

[2] Smith, K. B., & Pukall, C. F. (2014). Sexual function, relationship adjustment, and the relational impact of pain in male partners of women with provoked vulvar pain. Journal of Sexual Medicine, 11, 1283–1293. doi:10.1111/jsm.12484.

[3] Ayling, K., & Ussher, J.M. (2008).‘‘If sex hurts, am I still a woman?’’ The subjective experience of vulvodynia in hetero-sexual women. Archives of Sexual Behavior, 37, 294–304. doi:10.1007/s10508- 007-9204-1.

[4] Nylanderlundqvist, E., & Bergdahl, J. (2003). Vulvar vestibulitis: Evidence of depression and state anxiety in patients and partners. Acta dermato-venereologica, 83, 369–373. doi:10.1080/000155503100 03764.

[5] Impett, E. A., Gordon, A. M., Kogan, A., Oveis, C., Gable, S. L., & Keltner, D. (2010). Moving toward more perfect unions: Daily and long-term consequences of approach and avoidance goals in romantic relation- ships. Journal of Personality and Social Psychology, 99, 948–963. doi:10.1037/a0020271.

[6] Muise, A., Impett, E. A., & Desmarais, S. (2013). Getting it on vs giving it up: Sexual motivation, desire and satisfaction in intimate bonds. Personality and Social Psychology Bulletin, 39, 1320–1332. doi:10. 1177/0146167213490963.

[7] Rosen, N. O., Muise, A., Bergeron, S., Impett, E. A., & Boudreau, G. K. (2015). Approach and avoidance sexual goals in couples with provoked vestibulodynia: Associations with sexual, relational, and psychological well-being. Journal of Sexual Medicine, 12(8), 1781-1790. doi: 10.1111/jsm.12948

Pain during vaginal sex: A current issue among young women

Posted on Nov 6, 2017

By Reina Stewart

For many people, sex is an important part of life. But what if sex hurts? What if it keeps hurting, but you continue to do it? Is this common for young women?

These questions were explored in a recent study by Elmerstig, Wijma, and Swahnberg (2013). Their research on this topic works to broaden our understanding of the various ways sex may be experienced and the prevalence of painful vaginal intercourse.

What did the authors address?

Previous research regarding the prevalence of pain during and/or after vaginal sex is not extensive [1]. The main goals of the study were to identify the prevalence of pain during and/or after vaginal intercourse among young women, to determine the proportion of women who continue to have vaginal intercourse regardless of pain, and to consider facilitating factors. It has been suggested that the initial pain may be an involuntary muscle contraction of the outer vagina, which may serve as a defense against a perceived threat (vaginal intercourse in this case), and that may lead to chronic pain [3]. It has also been suggested that striving to be the ‘perfect woman’ may drive young women to continue engaging in painful vaginal intercourse [2].

What did they do?

Questionnaires developed by the researchers were distributed to women (18-22 years old) attending private and public schools in Southern Sweden. The central questions addressed included:

  • Do these women experience pain or discomfort during and/or after vaginal intercourse?
  • Do they continue to engage in this form of sex regardless of pain?
  • Do they pretend to feel pleasure despite discomfort?

What did they find?

  • Roughly half (47%) of the women who had performed vaginal intercourse reported feeling pain during intercourse

Why did women continue to engage in intercourse despite pain?

  1. Prioritizing the pleasure of their sexual partner
  2. Feeling less important than their partner during sex and sexually unsatisfied
  3. Struggling to decline sex

The above items (1,2, and 3) were even more frequently experienced by women who experienced pain during vaginal intercourse and did not stop regardless of pain, compared to those who felt pain during vaginal sex and chose to discontinue.

The most commonly identified reason for enduring uncomfortable vaginal intercourse was “I don’t want to spoil things for my partner”, and one of the most frequently selected reasons for pretending to enjoy this form of sex regardless of pain was “the partner may be disappointed if I don’t enjoy vaginal intercourse.”

What do their findings indicate?

The principal message of this study is that pain during vaginal intercourse is frequently felt by young women. Many of these women continue to have vaginal sex while feeling pain, and a common reason for this is important to consider: they are prioritizing the sexual pleasure of their partner. This notion is alarming and may contribute to a cycle of sexual anguish that these women experience.

Moreover, it has been suggested that pain felt during sexual encounters may be (or may lead to) a vaginismus-like response [3]. More specifically, repeated intercourse may reinforce the production of pain, which may act as a defense mechanism, and perpetuate the perception of sex as threatening [3]. Eventually, this experience may lead to chronic sexual discomfort [1].

The common experience of painful vaginal sex among young women demands the consideration of contributing factors. In one study, a common version of the ideal female construct includes a desire to please and satisfy others [2]. This belief, along with other societal norms, may contribute to sexual dissatisfaction and feelings of inferiority by females [2]. Essentially, it is crucial that medical professionals stress the importance of female’s sexual satisfaction to gain more traction as a relevant issue and worthwhile cause outside of a clinical environment.

What could be done differently next time?

The limitations of this study provide some direction for future research. The primary limitations are as follows:

  • The study is a cross-sectional design, which means that change across time could not be examined.
  • The findings may not represent the entire Swedish population (or the global female population for that matter) as no large cities were included in the sample, nor was northern Sweden

Note:

  • The word “pain” is used interchangeably with the word “discomfort” throughout the study.
  • Vaginismus is the involuntary muscle contraction of the outer vagina.

Sources:

[1] Elmerstig E, Wijma B, Swahnberg K. Prioritizing the partner’s enjoyment: a population-based study on young Swedish women with experience of pain during vaginal intercourse. J Psychosomatic Obstetrics & Gynecology 2013;34:82–89.

[2] Elmerstig E, Wijma B, Sandell K, Bertero¨ C. ‘‘Sexual pleasure on equal terms’’: young women’s ideal sexual situations. J Psychosom Obstetr Gynecol 2012;33:129–34.

[3] van der Velde J, Laan E, Everaerd W. Vaginismus, a component of a general defensive reaction. an investigation of pelvic floor muscle activity during exposure to emotion-inducing film excerpts in women with and without vaginismus. Int Urogynecol J Pelvic Floor Dysfunct 2001;12:328–31.

 

Emotion is My Middle Name

Posted on Oct 18, 2017

By Justin Dube

When I was a little punk-rock-kid I loved this song about emotion. Then, during the third year of my undergrad, I took a course on emotion, and… I hated it. At the time, emotion seemed so nebulous, while other things (like vintage road bikes and Rock ‘n Roll and Simpsons re-runs) seemed so tangible! Now, years later, I find myself immersed in emotion regulation research. This is a recurrent theme in my life – the things that I avoid or dislike tend to be the things I spend the most time with. So, for the record, I’m not really into having lots of chocolate, or money (fingers crossed emoji).

If my early experiences with the study of emotion left me less than enthused, then how did I become interested in understanding the link between emotion regulation and sexual wellbeing? Well, as is often the case, personal experiences spurred my curiosity for my chosen field of study. After sustaining a concussion (which often provokes emotional changes [1]), I noticed that my ability to regulate my emotions was kind of wonky, and that this was affecting the quality of my relationships. I wondered: Is this unique to me? Must I forgo Simpsons re-run bliss for a career in research? What is emotion regulation, anyway?

Emotion regulation refers to the set of processes that people use to manage an emotional response, which includes physiology, behaviour, and experience[2, 3]. Differences in emotion regulation ability predict how quickly an emotional state is resolved [2]. So, the way you regulate your emotions is linked to how and when your heart rate, crying, and sadness return to typical levels after discovering that someone ate your last piece of chocolate. Given that conversations about sex tend to be more fraught than conversations about chocolate (maybe? maybe not…), emotion regulation could be especially relevant to the maintenance of couples’ sexual wellbeing. Indeed, research on emotion regulation in the context of intimate relationships suggests this is the case:

  • In a 13-year longitudinal study of married couples, more successful regulation of negative emotions predicted greater marital satisfaction over time [4].
  • Greater use of emotional reappraisal, the strategy of positively reframing an emotionally-provoking event, was found to protect against typical declines in marital quality [5].
  • Greater use of emotional suppression, the strategy of inhibiting an emotional response, predicted lower relationship quality among newlyweds [6].
  • Difficulty regulating negative emotions has been linked to lower sexual satisfaction in clinical populations, such as those with a history of sexual abuse [7, 8].

Marital quality and sexual satisfaction are associated with sexual wellbeing [9]. Thus, better regulation of negative emotion and more positive reframing of emotional events may help preserve the sexual wellbeing of couples, although this has yet to be systematically studied. Unknowns in the field include whether emotion regulation is linked to sexual desire, whether emotion regulation predicts sexual satisfaction over time, whether changing typical strategies of emotion regulation will improve sexual wellbeing in couples, and whether conversations about sex really are more fraught than conversations about who ate the last piece of your chocolate.

Sources:

[1] Lovell, M.R., et al., Recovery from mild concussion in high school athletes. Journal of neurosurgery, 2003. 98(2): p. 296-301.

[2] Gross, J.J., Emotion and emotion regulation. Handbook of personality: Theory and research, 1999. 2: p. 525-552.

[3] Koole, S., The psychology of emotion regulation: An integrative review. Cognition & Emotion, 2009. 23(1): p. 4-41.

[4] Bloch, L., C.M. Haase, and R.W. Levenson, Emotion Regulation Predicts Marital Satisfaction: More Than a Wives’ Tale. Emotion, 2014. 14(1): p. 130-144.

[5] Finkel, E.J., et al., A Brief Intervention to Promote Conflict Reappraisal Preserves Marital Quality Over Time. Psychological Science, 2013. 24(8): p. 1595-1601.

[6] Velotti, P., et al., X Emotional suppression in early marriage: Actor, partner, and similarity effects on marital quality. Journal of Social and Personal Relationships, 2016. 33(3): p. 277-302.

[7] Rellini, A.H., et al., Childhood Maltreatment and Difficulties in Emotion Regulation: Associations with Sexual and Relationship Satisfaction among Young Adult Women. Journal of Sex Research, 2012. 49(5): p. 434-442.

[8] Rellini, A.H., A.A. Vujanovic, and M.J. Zvolensky, Emotional Dysregulation: Concurrent Relation to Sexual Problems Among Trauma-Exposed Adult Cigarette Smokers. Journal of Sex & Marital Therapy, 2010. 36(2): p. 137-153.

[9] Sanchez-Fuentes, M.D., P. Santos-Iglesias, and J.C. Sierra, A systematic review of sexual satisfaction. International Journal of Clinical and Health Psychology, 2014. 14(1): p. 67-75.

The Prevalence of Dyspareunia and Genito-Pelvic Pain in Pregnancy

Posted on Oct 16, 2017

By Meghan Rossi

Women experience a number of changes throughout pregnancy. One of these changes can include pain, specifically:

Genito-Pelvic Pain

Spontaneous or provoked pain in areas including the pelvis, vulva, perineum, vaginal opening, and inside the vagina

and/or

Dyspareunia

Pain during intercourse

There is limited research on the prevalence of these different pain types during pregnancy. A recent study found that 49% of women experienced genito-pelvic pain in pregnancy [1]. For dyspareunia specifically, some research suggests that 22-30% of women experience this pain in their second trimester [2-3]. Since they can often occur at the same time or one after the other and might have different physical, psychological, and sexual consequences and/or predictors, it’s important to examine both of these types of pain separately in one sample.

This is where our lab comes in! One of our research programs examines the biological, psychological, and social factors that contribute to the development and maintenance of these pains types in pregnancy and postpartum. In our preliminary data with a sample of 320 first time mothers who were 18-24 weeks pregnant:

  • 1.9% reported only genito-pelvic pain
  • 57.2% reported dyspareunia only
  • 8.4% reported both pain type
  • 32.5% reported neither pain

Hmm, what could explain why so many more women are experiencing dyspareunia than GPP? Well, you’ll have to stay tuned for that!

For now, what we do know is that a significant number of women are experiencing pain during intercourse while pregnant, so it is important for research to take the next steps into further understanding these types of pain in pregnancy to develop interventions that will benefit the lives of women and their families during this exciting journey into parenthood!

You can find out more information about our research on the psychological and relational changes that women may experience during pregnancy here and here.

Sources:

[1] Glowacka, M., Rosen, N., Chorney, J., Snelgrove−Clarke, E., George, R. B. (2014). Prevalence and predictors of genito‐pelvic pain in pregnancy and postpartum: The prospective impact of fear avoidance. Journal of Sexual Medicine, 11, 3021-34.

[2] Tennfjord, M. K., Hilde, G., Stær-Jensen, J., Engh, M. E., & Bø, K. (2014). Dyspareunia and pelvic floor muscle function before and during pregnancy and after childbirth. International Urogynecology Journal, 25, 1227-1235.

[3] Kennedy, C. M., Turcea, A. M., & Bradley, C. S. (2009). Prevalence of vulvar and vaginal symptoms during pregnancy and the puerperium. International Journal of Gynecology & Obstetrics105, 236-239.

 

Long-Distance Relationships: Just as beneficial as Proximal Relationships?

Posted on Sep 18, 2017

By Cindy Mackie

My mother always told me to never sacrifice my schooling, a career, or an important goal of mine for a guy. But what are you supposed to do if you are in a loving relationship and an opportunity arises in a location geographically far from your partner? While many people fear long-distance relationships, they may be more rewarding than you think.

Although it is well established that living near, or with, your partner has its benefits such as physical contact, researchers have shown that being in a long-distance relationship might actually be beneficial to your health. Researchers at Adler University in Chicago gathered relationship and health ratings from 296 married couples through an online survey; 201 of these couples were in proximal relationships, and 95 of these couples were in long-distance relationships [1].

Du Bois et al.’s study is based on a concept called the “Marriage-Health-Association”. This concept basically says that married couples are healthier, both mentally and physically, than their single counterparts. Up until recently, evidence for this association has primarily been gathered from couples living together or near each other. Du Bois et al. wished to expand the research on the Marriage-Health-Association to include data from couples in long-distance marriages.

The study compared two groups: married couples in a proximal relationship (PR) and married couples in a long-distance relationship (LDR). Couples in a proximal relationship had to have reported seeing each other daily in a typical month and to have spent no more than 2 days per week separated by over 50 miles. Couples in a long-distance relationship had to have reported seeing their partner less than daily in a typical month and to have spent over three days a week over 50 miles apart. There was no difference in the mean length of marriage or participant age between the two groups. Some of their key findings are highlighted here:

Compared to couples in proximal relationships, couples in long-distance relationships reported:

  • Better overall health
  • Greater satisfaction with their social role
  • Less anxiety
  • Less depression
  • Better eating habits
  • More frequent exercise

The authors speculated that couples in long-distance relationships may have more free time they can spend on themselves, which is why they may exercise more. They also suggested it could have something to do with hormone differences between LDR and PR couples. The authors referenced a study [2] that found LDR couples to have higher testosterone levels than those in a PR. Du Bois et al. suggested that these elevated testosterone levels in LDR couples can increase evolutionary “competitive behaviours”, such as working out to appear more attractive, because their hormone physiology is more similar to being “single” than “in a relationship”.

Although couples in long-distance relationships reported many positive behavior urs, they also reported higher stress levels both inside and outside the relationship. The authors hypothesized that this could be because couples living together, or near each other, have the benefit of physical contact which has been shown to decrease stress levels prior to a stressful event. Fortunately, the authors explained that developing good coping mechanisms, conflict management skills, developing more ways to support each other from afar, and incorporating each other more frequently into your daily lives (via Skype, phone calls, etc.) can alleviate some, or much, of the stress involved with being apart.

Therefore, if opportunity comes knocking a plane-ride away, you don’t necessarily have to choose between your career and your partner. As we have seen, couples in long-distance relationships can have relationships just as happy and healthy as couples in proximal relationships.

Sources:

[1] Du Bois, S. N. Du, T. G. Sher, K. Grotkowski, T. Aizenman, N. Slesinger, and M. Cohen. “Going the Distance: Health in Long-Distance Versus Proximal Relationships.” The Family Journal 24, no. 1 (2015): 5-14. doi:10.1177/1066480715616580.

[2] Anders, Sari M. Van, and Neil V. Watson. “Testosterone levels in women and men who are single, in long-distance relationships, or same-city relationships.” Hormones and Behavior 51, no. 2 (2007): 286-91. doi:10.1016/j.yhbeh.2006.11.005.

The Pros and Cons of the Sex Robot Revolution

Posted on Sep 4, 2017

By Justin Dubé

If you’ve been paying attention to the news, your grandparents, or society in general, you’ve likely been privy to the technology debate. On the one hand, early tech adopters expound on the benefits of progress, of efficiency, of swiping right (or, left?). On the other hand, luddites bemoan the loss of our planet, free-time, and conversation with strangers. Advances in artificial intelligence, robotics, and the ability to build anatomically correct dolls have added some (sexy) fuel to the tech debate. Specifically, should humans be harnessing our technological prowess to build sex-bots (a.k.a., pleasure-bots, service droids, R2-D2, etc.)? Some argue that it’s only a matter of time before human-robot sex becomes as ubiquitous as other human-computer interactions, such as using an iPhone to order pizza [1, 2, 3]. Indeed, four companies are currently shipping sex-bots, and sex-bot brothels are now operating throughout Europe and Asia [4]. While the dawn of pleasure droids may seem inevitable (even for the decidedly low tech and low funded), it’s never too late to consider the opportunities and challenges that accompany advances in the $30 billion (!!!) sex-tech industry [5]. This post will provide a brief (and somewhat lighthearted) summary of the pros and cons of sex-bots.

The following arguments have been made in favour of using robots for sex:

  • Sex robots could provide an alternative for people with socially unacceptable or harmful sexual preferences (i.e., paraphilias), such as pedophila or bestiality [4]
  • Sex robots could take the place of prostitution [3] and mitigate human trafficking.
  • According to the Foundation of Responsible Robotics, pleasure-bots could provide a sexual outlet and companionship for elderly individuals in long-term care homes [4], an argument reminiscent of using robo-pets in nursing homes
  • You could fulfill a lifelong dream of having sex with a robot that kind of looks like a creepy version of a celebrity, like this guy did.
  • Having routine robot sex could make instances of non-robot sex (in which you have sex with a real, live, sweaty human) seem more satisfying [1] – a satisfaction akin to eating Vera Pizza Napoletana after months of eating frozen grocery store pizza.

So, if sex-bots have the potential to mitigate human suffering, fill a niche, and make sex between humans more satisfying, then what’s the big deal? Before getting to the crux of this big deal (spoiler alert: the current state of sex-bot affaires perpetuates harmful gendered ideals of sexuality), I’ll outline some cons of using robots for sex, which include the following:

  • Robots haven’t bought into the tinder hookup culture, so it’s pretty hard to meet robots for sex using dating apps.
  • Sex-bots could increase social isolation.
  • Some argue that sex robots used to treat paraphilias, such as a child sex-bot, could reinforce paraphilic orientations, such a pedophilia. This is similar to the argument made against child sex dolls, which are currently illegal in the UK and are being debated in Canadian courts.
  • Sex-bots are being created by (mostly) men with gendered ideas. This leads to robots being created with biased gender norms, which perpetuate preexisting stereotypes [5]. For example, sex-bots currently on the market have settings to reflect submissive (and even frigid) notions of female sexual companions [4].

Although the lack of robots on tinder and the risk of increased social isolation are scary, the last point gives the most cause for concern. Indeed, the risk of perpetuating harmful gender stereotypes is at the heart of a position paper by Dr. Kathleen Richardson, a researcher in the Ethics of Robotics at the Centre for Computing and Social Responsibility [6]. In her paper, Richardson warns that the development of sex-bots may entrench gender relations that fail to respect the dignity of all parties involved in sexual exchanges. Although I agree with many of the ideas advanced by Richardson, I recognize the march of technology as inevitable. Thus, rather than joining Richardson’s campaign against sex robots, I feel it is more pragmatic to raise awareness of the pitfalls of human-robot sex and to provide people with the skills to foster meaningful and reciprocal human connections. And finally, costing an average of $15,000.00 CAD, who the heck can afford a sex-bot anyway?!

Sources:

[1] Bodkin, H (2016, December 20th). Sex will be just for special occasions in the future as robots will satisfy everyday needs. The Telegraph. Retrieved from http://www.telegraph.co.uk/science/2016/12/19/rise-sex-robots-will-make-people-appreciate-real-thing/

[2] Gurley, G (2015, April 20th). Is This the Dawn of the Sexbots? Vanity Fair Retrieved from http://www.vanityfair.com/culture/2015/04/sexbots-realdoll-sex-toys

[3] Levy, D. (2009). Love and sex with robots: The evolution of human-robot relationships. New York.

[4] Knapton, S (2017, July 5th). Sex robots on way for elderly and lonely…but pleasure-bots have a dark side, warn experts. The Telegraph. Retrieved from http://www.telegraph.co.uk/science/2017/07/04/sex-robots-way-elderly-lonelybut-pleasure-bots-have-dark-side/

[5] Jackson Gee, T (2017, July 5th). Why female sex robots are more dangerous than you think. The Telegraph. Retrieved from http://www.telegraph.co.uk/women/life/female-robots-why-this-scarlett-johansson-bot-is-more-dangerous/

[6] Richardson, K. (2016). The asymmetrical ‘relationship’: parallels between prostitution and the development of sex robots. ACM SIGCAS Computers and Society, 45(3), 290-293.

Trans health education in medical school: The current state of things

Posted on Aug 21, 2017

Image credit: Flickr user Hamza Butt

By Carmen Boudreau

A recent study published in LGBT Health explored the benefit of trans health-specific education sessions for health professions students [1]. In the study, 46 students were asked to complete ten lunchtime sessions where they were educated on transgender health and issues in care. Before and after the study, they were asked to complete measures of transphobia and their knowledge on best practice for trans patients. It was found that after completing the course, students were more competent in specific trans-related knowledge domains including use of appropriate terminology, how to collect gender identity, the DSM-5 diagnosis of gender dysphoria, medications used for gender affirmation, and relevant federal policy. Students also had reduced levels of transphobia. These outcomes speak to the importance increasing education and awareness of trans health among young professionals.

After reading this article, I found myself reflecting on my own experiences in learning about trans health. I am a Canadian medical student entering my third year of training. I have just completed the first two years, which consisted mainly of classroom time. It is during these years that we are able to explore not only the science, but the ethics, philosophy, and practice of modern medicine, with the ultimate goal of being prepared to enter the clinical phase of our training. When you only have two years to learn everything, it is safe to say that no topic is done justice, and trans health is no exception. Unfortunately, we did not have ten lunchtime sessions to explore the complex issues and barriers faced by trans patients. In true medical school form, we grazed the surface of this topic like we would any other: with one three-hour session.

It was a fantastic session.

Our class was divided into small groups of eight students and placed in tutorial rooms with a physician tutor and a volunteer trans patient. Although there were concrete objectives outlining what content to cover in this time, there was relaxed and conversational feel that made the interaction surprisingly organic. Over the course of three hours, we were educated on anatomy and physiology, language, inclusive practice strategies, barriers in care, interview techniques, and stigma against trans patients. We were also provided with an open and safe space to ask questions to our volunteer patient who was understanding and keen to help. It was an informative and engaging session threaded together with a first person narrative of experiencing the healthcare system as a trans patient. I left the tutorial room feeling more confident in my medical knowledge and in my ability to better serve my community as a more thoughtful and inclusive future physician.

The subject was never re-visited.

Sources:

[1] Braun, H. M., Garcia-Grossman, I. R., Quinones-Rivera, A., & Deutsch, M. B. (2017). Outcome and Impact Evaluation of a Transgender Health Course for Health Profession Students. LGBT health, 4(1), 55-61.

We Need to Talk: Disclosure of Sexual Problems

Posted on Aug 8, 2017

By Kat Merwin

This blog summarizes our recently published paper: Merwin, K. E., O’Sullivan, L. F., & Rosen, N. O. (2017). We need to talk: Disclosure of sexual problems is associated with depression, sexual functioning, and relationship satisfaction in women. Journal of Sex & Marital Therapy. doi: 10.1080/0092623X.2017.1283378.

While there is no shortage of sex on our screens these days (be it TV shows, movies, or porn) we tend to only get shown the ‘good stuff.’ We see instant sexual arousal and orgasms (or implied orgasms) a-plenty! What we don’t see is an accurate depiction of what happens for many women: sexual problems.

Sexual problems (e.g., difficulties with desire, arousal, lubrication, orgasm, and pain during sexual activity) are common in women. Shifren and colleagues found that 43% of women reported experiencing at least one sexual problem and that 12% of these women were significantly distressed by their sexual problem(s) [1].

Not only are sexual problems common, but they can also adversely affect women’s psychological, sexual, and relationship well-being. Sexual problems are associated with more depressive symptoms [2-3], poorer sexual functioning [4-5], and lower relationship satisfaction [6-7]. Research tells us that sexual communication, and sexual self-disclosure in particular, is important for the well-being of individuals in romantic relationships [8-9].

But do women with sexual problems tell their partners about these difficulties?

Is telling a partner about sexual problems beneficial to a woman’s psychological, sexual, and relationship well-being?

This is what we wanted to know. Specifically, we wanted to (1) examine the proportion of women with sexual problems that disclose these problems to their partners, and (2) examine the associations between telling a partner about sexual problems and women’s depressive symptoms, sexual functioning, and relationship satisfaction.

What did we do?

We had 277 women (whom reported experiencing at least one distressing sexual problem) complete an online survey that included validated measures assessing sexual problems, relationship satisfaction, sexual functioning, and depressive symptoms. We also asked women to report whether or not they had told their current romantic partner about their sexual problems.

What did we find?

  • The majority of women (69%) reported that they had told their current romantic partner about the sexual problems they were experiencing.
  • Women who disclosed their sexual problems also reported fewer depressive symptoms, greater sexual functioning, and greater relationship satisfaction (compared to women who had not disclosed).

What do these findings mean?

Broadly, this research tells us that if you have a sexual problem, telling your partner about it may be beneficial to your psychological, sexual, and relationship well-being.

Conclusion

Our findings suggest that the majority of women with sexual problems share this information with their romantic partners, and that this disclosure is associated with fewer depressive symptoms, and greater sexual functioning and relationship satisfaction, compared to women who do not disclose their sexual problems.

Telling a partner about sexual problems may be beneficial to women’s well-being by enhancing intimacy or allowing couples to adapt sexual activities to accommodate sexual problems.

However, this study was cross-sectional, so the relationship between disclosure and well-being may go the other direction: It is possible that targeting the improvement of sexual functioning, depressive symptoms, or the global relationship might facilitate disclosure of any sexual problems and allow the couple to work together on improving their sexual well-being.

Sources:

[1] Shifren, J. L., Monz, B. U., Russo, P. A., Segreti, A., & Johannes, C. B. (2008). Sexual problems and distress in United States women: Prevalence and correlates. Obstetrics & Gynecology, 112, 970–978.

[2] Dunn, K. M., Croft, P. R., & Hackett, G. I. (1999). Association of sexual problems with social, psychological, and physical problems in men and women: A cross sectional population survey. Journal of Epidemiology and Community Health, 53, 144–148.

[3] Echeverry, M. C., Arango, A., Castro, B., & Raigosa, G. (2010). Study of the prevalence of female sexual dysfunction in sexually active women 18 to 40 years of age in Medellín, Columbia. Journal of Sexual Medicine, 7, 2663–2669. doi:10.1111/j.1743-6109.2009.01695.x

[4] Meana, M., Binik, Y. M., Khalifé, S., & Cohen, D. R. (1997). Biopsychosocial pro le of women with dyspareunia. Obstetrics & Gynecology, 90, 583–589.

[5] Rosen, C., Brown, J., Heiman, S., Leiblum, C., Meston, R., Shabsigh, D., … D’Agostino, R. (2000). The Female Sex- ual Function Index (FSFI): A multidimensional self-report instrument for the assessment of female sexual function. Journal of Sex & Marital Therapy, 26, 191–208. doi:10.1080/009262300278597

[6] Burri, A., Radwan, S., & Bodenmann, G. (2015). The role of partner-related fascination in the association be- tween sexual functioning and relationship satisfaction. Journal of Sex & Marital Therapy, 41, 672–679. doi:10.1080/0092623X.2014.966398

[7] Burri, A., & Spector, T. (2011). Recent and lifelong sexual dysfunction in a female U.K. population sample: Prevalence and risk factors. Journal of Sexual Medicine, 8, 2420–2430. doi:10.1111/j.1743-6109.2011.02341.x

[8] Pazmany, E., Bergeron, S., Veraeghe, J., Van Oudenhove, L., & Enzlin, P. (2015). Dyadic sexual communication in pre-menopausal women with self-reported dyspareunia and their partners: Associations with sexual function, sexual distress and dyadic adjustment. Journal of Sexual Medicine, 12, 516–528. doi:10.1111/jsm.12787

[9] Rancourt, K. M., Rosen, N. O., Bergeron, S., & Nealis, L. J. (2016). Talking about sex when sex is painful: Dyadic sexual communication is associated with women’s pain, and couples’ sexual and psychological outcomes in provoked vestibulodynia. Archives of Sexual Behavior, 45, 1933–1944. doi:10.1007/s10508-015-0670-6

Understanding gender

Posted on Apr 24, 2017



By Maria Glowacka

A few years ago I went to a workshop entitled, Towards a Collaborative Approach to Trans Health Care. I thought that I knew all of the appropriate terms and how to respect everyone’s gender identities, but realized during this workshop that there was still more for me to learn. I recently came across my notes and thought that others may also want this information. Please note that I am a cisgender female sharing what I learned at a workshop and I welcome other interpretations and explanations. I am always open to learning about people’s experiences and receptive to feedback.

Everyone has the right to identify however they want to regardless of how they look. The following definitions are not meant to help you label others but, rather, to better understand when an individual identifies in a certain way.

Biological sex is measurable gonads, genes, hormones, and chromosomes. Intersex conditions involve variability in these characteristics. Biological sex is not always straightforward, even in those without intersex conditions.

Gender identity is how you think about yourself. It’s your internally felt sense of your gender – male, female, transgender, gender non-conforming, etc. Many cultures view gender identity on a continuum rather than binary.

Gender expression is how you demonstrate your felt sense of gender through your clothes, behavior, interactions, etc. This expression is largely socialized. Gender conformity refers to the societal expectation to adhere to social norms of gender expression.

Cisgender individuals are those people whose biological sex does not conflict with their gender identity. The term transgender encompasses many realities, including people who identify outside of the gender binary (male/female), those who identify on a continuum between male and female, those who identify as a 3rd or 4th gender, those who identify as encompassing both genders, and those who go beyond the boundaries of expressing gender based on social norms. The terms genderqueer, genderfluid, and non-binary encompass identities that are outside of the binary male/female system.

A transition is the process of transforming physically, psychologically, emotionally, and/or spiritually with the goal of self-actualization. Every transition is unique and this process of change can take years. It may or may not include hormones and surgeries. A social transition is expressing one’s true gender in public. A physical transition is when an individual transforms their appearance with or without medical means. Transition is often a very difficult time for individuals; it may come with grief, loss, marginalization, and an increased risk of being the target of violence. However, this process is also associated with increased authenticity, emotional availability, energy, creativity, and self-esteem.

Transphobia is fear and discrimination targetting individuals who identify as transgender, transsexual, queer, or anyone who does not fit into society’s gender categories. This can present in many ways, such as harassment, physical and sexual assault, preventing access to appropriate bathrooms, inappropriate questions, and intentional use of wrong pronouns or names. It can have a significantly negative impact on the lives of targeted individuals. For example, the rates of suicide attempts are substantially higher in transgender individuals.

The take home message is respect everyone, ask questions, and be open to being corrected.

Resources:

  • Bauer, G., Nussbaum, N., Travers, R., Munro, L., Pyne, J., Redman, N. We’ve Got Work to Do: Workplace Discrimination and Employment Challenges for Trans People in Ontario. Trans PULSE e-Bulletin, 30 May, 2011. 2(1). Downloadable in English or French athttp://www.transpulseproject.ca.
  • Françoise, S. (2014). Towards a Collaborative Approach to Trans Health Care, Halifax, NS.
  • Grant, J. M., Mottet, L. A., Tanis, J. Injustice at Every Turn: A report of the National Transgender Discrimination Survey National Center for Transgender Equality (NCTE) and National Gay and Lesbian Task Force (NGLTF), 2011.
  • Tervalon, M. & Murray-Garcia, J. Cultural Humility vs Cultural Competence:A Critical Distinction in Defining Physician Training Outcomes in Multicultural Education, Journal of Health care for the Poor and the Underserved. May 1998, 9(2)
  • http://sypp.org/resources/sypps- definitions/
  • http://transpulseproject.ca/wp-content/uploads/2012/04/E2English.pdf
  • www.youthproject.ca
  • Itspronouncedmetrosexual.com