Sexual pleasure is a legitimate right of the human being.
- Samael Aun Weor
It is my pleasure and privilege to invite you to participate in the 2017 Annual Meeting of ISSWSH in Atlanta, Georgia. The theme of the scientific program is The Embodied Mind, and we have an intriguing line-up of speakers and topics that will explore the core components of the mind-body relationship as they relate to female sexual expression, physiological milieu, resilience, and change.
ISSWSH is the only society devoted to a multidisciplinary understanding of female sexuality across the lifespan and is led by a passionate group of international academics, clinicians, health professionals, and scientists who have largely shaped the field of female sexual health research. Our attendees include gynecologists, sex therapists, clinical psychologists, patient advocates, physical therapists, family physicians, nurse practitioners, basic scientists, clinical researchers, sex educators, and trainees who share this passion for understanding and actively promoting female sexual health. Collectively, we believe that women are entitled to health, pleasure, and freedom from pain.
The field of female sexuality is approaching a critical turning point in its evolution. We are positioned to explore, question, and potentially redefine the traditional sexual constructs we have inherited, as these ideas do not capture the broad spectrum of sexuality we encounter in the streets, in the clinic, in the lab, or in our homes. This freedom is both exhilarating and terrifying. We are entering one of the most exciting periods of change in modern sexology. Every step forward is a small revolution.
Looking back, we have come a long way from Masters and Johnson’s groundbreaking work that both buoyed and to some degree restricted the field’s evolution. As Helen Singer Kaplan aptly summarized in 1974, “The human sexual response is a highly rational and orderly sequence of physiological events, the object of which is to prepare the bodies of two mates for reproductive union.” Masters and Johnson certainly constructed a rational and orderly sexual gestalt. Their biomechanical model of sexual response (excitement, arousal, plateau, orgasm, and satiety) was based on a narrow definition of the ultimate form of sexual expression: genital arousal with vaginal penetration leading to orgasm. This focus is precisely why the classic reductionist model has failed to account for the broad range of sexual variability we observe in women. In the words of the late philosopher Robert Solomon, “Orgasm is the ‘end’ of sexual activity, perhaps, but only in the sense that swallowing is the ‘end’ of tasting a Viennese torte.”
Ironically, the pivotal events that would challenge the Masters and Johnson monolith began with the vaginal insertion of phallic diodes designed to measure vasocongestion.
In a series of female sexual psychophysiology (mind-body) experiments conducted in the 1990s, pioneering researchers in the Netherlands and North America performed a series of laboratory experiments in which women viewed erotic film clips after self-inserting a vaginal photoplethysmograph, a term for a device that measures light-derived (photo) increases (plethysmos) of fluid with a recording (graph) used to measure genital vasocongestion. These researchers reported that women exhibited varying levels of awareness of their genital sexual arousal, yet this awareness appeared to be unrelated to their subjective experience of arousal and sexual functioning (Rosen and Beck noted this discordance as early as 1988). These controversial findings have since been replicated across numerous international laboratories, using multiple methods to measure sexual desire, subjective sexual arousal and genital sexual arousal. After more than two decades of experimentation, intensive debate, proposals of new models, and many discarded erotic films, deciphering the mind-body interaction remains at the crux of understanding female sexual health and dysfunction. Critically, Masters and Johnson’s terminology and early data have been used to parse these constructs and to validate their accuracy.
An Embodied Mind
At present, there is universal agreement that a woman’s perception of desire, subjective and genital arousal, orgasm, and distress are the gold standards for validating new measures of function/dysfunction. A woman’s subjective perception depends on her relationship with her body, and every woman has a different relationship with her body. The theme of the scientific program is The Embodied Mind because this will be the new standard against which the field’s success is judged. However, we acknowledge the need to refine the definitions of these constructs with empirically-based information that can, in turn, inform expert consensus-based terminology in the future.
Also inherent in the embodied mind is an understanding of how the body impacts consciousness and how information is iteratively shared between the peripheral and central nervous systems. This requires the identification and validation of more accurate and precise physiological indicators of sexual desire, arousal, orgasm, and the many states in between. Ultimately, a woman’s embodied mind is the product of her biology, psychology, and social relationships and must be approached from a biopsychosocial perspective.
The Adapting Brain
Any man could, if he were so inclined, be the sculptor of his own brain.
- Santiago Ramón y Cajal
With each sexual experience, a woman learns about her capacity for sexual pleasure. This process has been conceptualized as a delicate balance of excitatory and inhibitory factors stemming from her cognitive-emotional state, her history of sexual interactions, appreciation of erogenous sensory input, and a gamut of contextual, interpersonal, and existential considerations. The culmination of this learning results in a personalized sexual script, represented in the brain as a network of memories that can be adapted over time, between partners, and according to new sexual experiences. We will learn how modern neuroscience reveals that the act of recalling these memories can allow these scripts to be re-written. The changes in brain activity and anatomy that accompany and facilitate these adaptations are collectively called neuroplasticity. The main principle underlying neuroplasticity is surprisingly simple: brain activity and anatomy are shaped by the memories you use most often.
Memories can reflect movement, habits, reward, beliefs, sensory experiences, even conditioned immune responses. Therefore, it is fair to say that every individual who attends this meeting—regardless of discipline—interacts with and treats memories. Although strong, maladaptive memories are difficult to change, the mere fact that we understand how they can be changed is nothing short of amazing. The symposium on The Adapting Brain explores the mechanisms of emotional memory creation and revision, the networks of communicating brain regions that mediate these memories, and the how these principles are clinically applied for the phenomenon of sexual addiction. The power of these ideas is their immense potential to transform our research, science, and clinical practice, as we will understand why therapeutic change happens and what can be done to facilitate that change.
Update from the Experts
We feature eminent clinician-researchers in female sexual health highlighting recent major advances in the field. Topics range from the health impact of different forms of estrogen delivery (intradermal versus oral), new insights into vulvodynia etiology and treatment, and critical issues underlying symptom and disease classifications that will impact coding and future research on sexual desire and arousal disorders.
The Logic of Chronic Pelvic Pain
Pain is a common human experience. Chronic pelvic pain, however, is not. When chronic pelvic pain interferes with daily life—directly by avoiding activities that hurt or indirectly through mood disturbances, stress, poor sleep, social isolation—sex loses its luster and exacerbates the impact of pain. A pioneer pain scientist will speak on the real reasons why chronic pain is so tough to experience, assess, and treat in the clinic: chronic pain breaks normal physiological rules in surprisingly consistent ways. Moreover, these counter-intuitive “rules” clarify the causes and psychological consequences of chronic pain. Without mincing words, attendees will understand chronic pain more deeply than the majority of the medical and clinical professions.
Persistent Genital Arousal Disorder
An equally debilitating condition that desperately needs clinical and scientific attention is persistent genital arousal disorder (PGAD). Our current understanding of this perplexing symptom complex reflects the efforts of a few deeply committed researchers, yet more momentum is needed to push the science forward. We will hold a research symposium dedicated to PGAD, led by prominent clinical and basic science researchers who will collaborate in generating essential research on the topic. Novel findings will be presented, and collaborators will propose an action plan for priority research on the mechanisms, manifestations, clinical assessment and treatment of the condition. This experimental symposium is a unique opportunity for ISSWSH to directly facilitate scientific discovery and disseminate new knowledge about PGAD.
Trauma and Resilience
We present a symposium that highlights why the principles of learning and memory are also essential to protection of women’s sexual health. Many women experience the devastating fallout of sexual assault and trauma, and their healthcare needs are complex and unique to each individual. In some traumatic situations, a very powerful form of emotional learning can trigger post-traumatic stress disorder (PTSD). The sexual consequences of sexual trauma and PTSD will be discussed in the larger context of a woman’s recovery and resilience as well as interventional strategies.
“Our bodies are instruments, not ornaments.” (Gloria Steinem)
A woman’s body is her instrument in the world: it supports her actions, helps her pursue her goals, unites her with loved ones, brings her pleasure, propels her away from danger, and helps her bear and nourish new life. A unique symposium will focus distinct approaches to pelvic floor physical therapy and will be particularly relevant to those who care for women with genito-pelvic pain/penetration disorder, incontinence, comorbid pain disorders, injuries, or disabilities that have impacted the tension, stability, and control of the pelvic floor muscles. This complex network of muscles work synergistically to provide stability, support posture and core strength, facilitate arousal, and mount defensive responses to potential threat. We will learn about different ideologies that have shaped theory and practice of contemporary physical therapy and how these divergent approaches can benefit personalized treatment approaches and psychoeducation.
The orgasm is often discussed as a destination. We will delve into the modern science of orgasm that is led by researchers using state-of-the-art technology to identify objective indicators of orgasm. Interestingly, this research has highlighted the inherent interactions between pleasure and pain. And speaking of pleasure… Betty Friedan famously quipped, “No woman gets an orgasm from shining the kitchen floor.” Whereas the personal massagers of previous generations resembled utilitarian kitchen appliances, modern sex toys look like rainbow-colored Dali sculptures. Sex toys have become a staple ingredient of the modern sexual diet, particularly for women. We present a special historical lecture that explores the sociocultural environments that initially popularized sex toys, the justifications of their use, and the recent acceptance of sex toys as essential sexual accessories.
On behalf of the Scientific Program Committee, I invite you to join us in exploring how these ideas can enrich the sexual lives of women, as well as your practice. I will see you in Atlanta!
Chair, Scientific Program Committee