Abstract
It has been proposed that disgust evolved to protect humans from contamination. Through eliciting the overwhelming urge to withdraw from the disgusting stimuli, it would facilitate avoidance of contact with pathogens. The physical proximity implied in sexual intercourse provides ample opportunity for contamination and may thus set the stage for eliciting pathogen disgust. Building on this, it has been argued that the involuntary muscle contraction characteristic of vaginismus (i.e., inability to have vaginal penetration) may be elicited by the prospect of penetration by potential contaminants. To further investigate this disgust-based interpretation of vaginismus (in DSM-5 classified as a Genito-Pelvic Pain/Penetration Disorder, GPPPD) we used functional magnetic resonance imaging (fMRI) to examine if women with vaginismus (n = 21) show relatively strong convergence in their brain responses towards sexual penetration- and disgust-related pictures compared to sexually asymptomatic women (n = 21) and women suffering from vulvar pain (dyspareunia/also classified as GPPPD in the DSM-5, n = 21). At the subjective level, both clinical groups rated penetration stimuli as more disgusting than asymptomatic women. However, the brain responses to penetration stimuli did not differ between groups. In addition, there was considerable conjoint brain activity in response to penetration and disgust pictures, which yield for both animal-reminder (e.g., mutilation) and core (e.g., rotten food) disgust domains. However, this overlap in brain activation was similar for all groups. A possible explanation for the lack of vaginismus-specific brain responses lies in the alleged female ambiguity (procreation/pleasure vs. contamination/disgust) toward penetration: generally in women a (default) disgust response tendency may prevail in the absence of sexual readiness. Accordingly, a critical next step would be to examine the processing of penetration stimuli following the induction of sexual arousal.
Highlights
After being labelled as the ‘forgotten emotion of psychiatry’ [1], disgust has increasingly been given the spot light in the context of psychopathology
Our sample consisted of three groups: i) women diagnosed with primary vaginismus (n = 20, Meanage = 25.3 years, SD = 4.4), ii) women without sexual complaints (n = 21 Meanage = 23.0, SD = 1.9) and, iii) women diagnosed with dyspareunia (n = 21, Meanage = 23.1, SD = 3.9)
For the validation of the stimulus material and relevant group differences, we ran two manipulation tests: for manipulation test (i) we investigated whether A-R and Core disgust (CORE) disgust differ in how they were rated, when contrasted with FEAR and if there were differences between groups
Summary
After being labelled as the ‘forgotten emotion of psychiatry’ [1], disgust has increasingly been given the spot light in the context of psychopathology. The majority of clinical disgust research focused on its role in various types of anxiety disorders, such as specific phobia [2], obsessive compulsive disorder [3], and posttraumatic stress disorder [4] It has been suggested, that disgust might be a factor in certain forms of sexual dysfunctions [5,6]. It has been proposed that the involuntary contraction (i.e., flinching) of the pelvic floor muscles that typifies vaginismus may be elicited by the (implicit) prospect of penetration by a potential contaminant [11]. This response is possibly part of a general defence mechanism elicited in the context of a physical threat [12,13]. The vaginistic response may essentially reflect a fear of physical contact with disgusting stimuli [16], precluding sexual penetration
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