What are the problems if disgust is NOT suppressed during sex?

A postscript to Peter de Jong

As you might recall from a previous blog by Professor Peter de Jong, core sexual stimuli are generally high on disgust sensitivity and potency. This is strange because people come in contact with these stimuli on a daily basis and they generally express high sexual appetite for them. As discussed by Professor de Jong, sexual arousal affects our subjective responses in that it suppresses the disgust properties of specific sex stimuli and facilitates approach behavior. Since people can quickly relate to these findings, perhaps it is perceived as pop psychology. However, in that case we fail to appreciate its clinical implications.

Therefore in this blog I wish to give some insights into the existence of important problems of female sexual arousal and sexual pain disorders, such as vaginismus and dyspareunia. In dyspareunia, penetration of the vagina by the penis (or by dildos, fingers, or tampons) is only possible with pain. In vaginismus, it is completely impossible. In the recently published Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), these sexual pain disorders are now merged under the heading of “genito-pelvic pain/penetration disorders”, though discussion about this merging continues.

“If sexual arousal is low, then the disgusting properties of specific stimuli, which are relevant for the engagement in pleasurable sex, are not attenuated, nor is the hesitation to approach these stimuli. This could lead to problems with sexual engagement.”

Let’s go back to the issue of sexual arousal and disgust. There are multiple causes for low sexual arousal in women, including insufficient stimulation, past sexual traumatic experiences, and persistent negative emotions. If sexual arousal is low, then the disgusting properties of specific stimuli, which are relevant for the engagement in pleasurable sex, are not attenuated, nor is the hesitation to approach these stimuli. This could lead to problems with sexual engagement. Consequently, women might experience a lack of physiological readiness to have sex (for instance, a lack of vaginal lubrication), which in turn could increase friction and anxiety. These negative experiences may contribute to feeling pain during intercourse and might lead women to become hyper-vigilant and start interpreting ambiguous sexual cues as negative (for instance, normal smells might be labelled nasty and disgusting). It is thus possible that women acquire negative associations with sex (for instance, sex is painful, vaginal fluid smells bad, the penis is too large) and start to avoid sexual intercourse altogether. Over time, they might even develop a complete inability to have intercourse.

Relevant to this, studies from our lab have shown that, compared to sexually asymptomatic women, women diagnosed with vaginismus experience disgust responses towards erotic stimulation both at the subjective (explicit) level as well as at a more automatic (implicit) level. Moreover, in this group of women sex-related stimuli appear to elicit disgust rather than arousal (Borg et al., 2010). It is conceivable that this worsens the problem, since a typical response to disgust is avoidance behaviour (to create distance from the perceived contaminant).

“Women diagnosed with vaginismus experience disgust responses towards erotic stimulation both at the subjective (explicit) level as well as at a more automatic (implicit) level.”

Another potentially related issue involves the moral standard of a person. A few years ago we found more conservative and fewer liberal values in women with sexual penetration disorders compared to women without any sexual problems (Borg et al., 2011). The first group was also less willing than the second group to come into contact with sex-related stimuli in hypothetical scenarios such as going to a sex shop and touching a vibrator. Women with sexual pain disorders might thus avoid experiences that could confront their beliefs and instead this may reinforce their dysfunctional cognitions.

There are many psychological conditions, in both women and men, that could be attributed to a less functional interplay between disgust and sex. We have a number of ideas for expanding our research. For women with vaginismus or dyspareunia or other penetration-related problems, to counteract the disgusting properties of sex cues, it might be helpful to strengthen the sex-positive-arousal link. It might also be helpful to reduce the disgusting properties and contamination sensitivity and potency of sex stimuli, or of disgusting stimuli in general. This could be done by helping a woman to come into contact with her own vagina, for instance by asking her to touch and smell the vaginal fluids till she becomes more at ease with them (see de Jong et al., 2010). It would be relevant to test whether sexual stimuli in general, and the idea of penetration in particular, elicit less disgust and contamination fear after these types of interventions.

“To counteract the disgusting properties of sex cues, it might be helpful to strengthen the sex-positive-arousal link.”

Usually people do not think about the fact that sexual arousal drives a reduction in disgust properties, and this allows us to come into contact with and touch previously-considered disgusting stimuli like sweat, semen, vaginal fluid, and saliva. I hope this blog post leads us to take it for granted a little less, and that we become more aware of the problems some women face.

References

Borg., C., de Jong, P.J.,Weijmar Schultz, W. (2011) Vaginismus and dyspareunia: Relationship with general and sex-related moral standards. Journal of Sexual Medicine, 8: 223–231.

Borg, C., de Jong, P.J.,Weijmar Schultz, W. (2010) Vaginismus and dyspareunia: Automatic vs. deliberate: Disgust responsivity. Journal of Sexual Medicine, 7: 2149–2157.

de Jong, P.J., van Lankveld, J., Elgersma, H.J., & Borg, C. (2010). Disgust and sexual problems: Theoretical conceptualization and case illustrations. International Journal of Cognitive Therapy, 3: 24-40.

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NOTE: Image by Charmaine Borg

Charmaine Borg

Charmaine Borg completed her B.Sc (Honors) at the University of Malta. In 2006, she was a successful candidate for a Leonardo da Vinci scholarship and had the opportunity to do an internship in Oxfordshire and Buckinghamshire Mental Health Community Services. Charmaine then received a scholarship from the Health Department in Malta to pursue graduate studies. She earned an M.Sc. in Mental Health Sciences from the Institute of Psychiatry, King’s College London, in January 2009. Her majors were in Women’s Health Studies and Cognitive Behavior Therapy. In October 2008, she joined the Department of Psychology at the University of Groningen to conduct her Ph.D. studies under the supervision of Prof. Peter de Jong. She defended her dissertation in 2013. She is a member of the International Academy of Sex Research, the European Society for Sexual Medicine, and the International Society for Sexual Medicine, and has been invited by multiple national and international associations to disseminate her research. Charmaine is continuing her line of research at the University of Groningen as a postdoc since January 2013. Her main research interests are sexual arousal, sexual pain, and sexual preferences, and how disgust interacts with these three factors.

Select Publications

Borg, C., Georgiadis, R. J., Renken, R. J., Spoelstra, K., Weijmar Schultz, W., & de Jong, P. J. (2014) Brain processing of sexual penetration versus core and animal-reminder disgust pictures in women with genito-pelvic pain/penetration disorders, PLoS ONE 9(1): e84882.

Borg, C., de Jong, P. J., Renken, R. J., Georgiadis, R. J., (2013) Disgust trait modulates frontal-posterior coupling as a function of disgust domain. Socio Cognitive and Affective Neuroscience, 8; 351-358.

Borg, C., & de Jong, P. J. (2012) Feelings of disgust and disgust-induced avoidance weaken following induced sexual arousal in women. PLoS ONE 7(9): e44111

Borg, C., Peters, L. M., Weijmar Schultz, W., de Jong, P. J. (2012) Vaginismus: Heightened Harm Avoidance and Pain Catastrophic Cognitions. The Journal of sexual Medicine, 9:558–567.