#1303 Charmaine Borg: Sexual Arousal, Sexual Disgust, and Sexual Dysfunction

00:00 Ricardo Lopes: Hello everyone. Welcome to a new episode of The Dissenter. I'm your host, as always, Ricardo Lops, and today I'm joined by Dr. Charmaine Borg. She is an assistant professor at the Faculty of Behavioral and Social Sciences at the University of Groningen. She's a certified psycho sexologist and an expert in clinical and experimental psychology, and today we're going to talk about sexual arousal, sexual disgust, psychopathology, and other related topics. So Doctor Borg, welcome to the show. It's a huge pleasure to everyone.

00:36 Charmaine Borg: Thank you for the invite and it's a pleasure for me to be here as well.

00:40 Ricardo Lopes: So uh I would like to start by asking you about sexual arousal before we get into the part of your work where you explore sexual disgust and how it can have an interplay with sexual arousal. So how do people get sexually aroused? What triggers it?

01:03 Charmaine Borg: So sexual arousal is triggered when the brain interprets a stimulus as a sexually relevant or rewarding stimulus. This can happen through different pathways, as you know yourself, um, it can be visual cue said that seeing someone attractive, uh, walking next to you, that you are, um, triggered by that attraction, by the sexual stimulus now. Um, WHICH is a common trigger, I believe, but arousal can be also triggered or um induced by touch, right, so you can be not in the mood, but someone starts touching you or stroking you and you start feeling sexual arousal. So this is different than seeing someone walking by and you feel sexually aroused spontaneously, but this is more like a triggered by the touch. It can also be by fantasies, smells. Memories sometimes um someone passes by, not necessarily attractive, but the smell is for you associated with something positive, with something sexual, perhaps an experience that you had with someone that now this particular smell triggers an um sexual arousal in you. Emotional intimacy can also increase sexual arousal. Sometimes you're intimate with your partner, um, in bed or having a shower together, and you start feeling sexual arousal because the intimacy is creating space for sexual arousal or related contexts. Now, from a biological perspective, sexual arousal involves the activation of circuits in the brain, so particularly the dopaminergic pathways. Um, WHAT is important is that sexual arousal kind of is very sensitive to the duration of the relationship. So in the beginning of a relationship, there is generally more arousal, more wanting, more, um, needing, um, while later on in the relationship, there might be more a. IN sexual arousal that you might need more um novel stimuli, exciting new things to try to trigger create erotic space we refer to this as erotic space to again start um. Um, CREATING the space for sexual arousal to occur, so sexual arousal, I find it is very variable in how it is triggered in how it shows, um. Depending which phase of your relationship you are in, and there are many psychological factors as biological ones, of course, but I'm more, um, my expertise are surrounded more the surrounding more the psychological factors and for example, mood has a big impact on how quickly or on our ability to uh trigger sexual arousal, but also the relationship quality. If you're, as I said already, if there is intimacy, then there is more likely to have sexual arousal, but if there are, um, issues that you feel rejected or you don't feel appreciated or your partner is on texting on the phone, then there is less likely that you feel the urge um to kind of let go because sexual arousal, what it is biologically, you need to, um, as I said in the beginning. Opening of this question to interpret the stimulus as a relevant sexual stimulus, but then you elaborate cognitively on it and focus the attention on it. So if you're distracted, either because of what you are doing, what you are thinking, or because of what your partner is doing, then of course you're not going to promote and facilitate. The um sexual arousal to to roll so uh previous experiences, mood, relationship quality will all shape how you interpret that particular stimulus, um, as sexual arousal or not. And when I want to say also when I, when you ask me what, um, how people get sexually aroused, I feel that previously in sex research we always talked about. Um, MEN have spontaneous type of sexual arousal, and women have responsive type of sexual arousal, literally meaning that women need more context, need more, uh, focus, um, need more in order to have sexual arousal, while men can spontaneously feel sexual arousal. I think the the script about how men and women experience sexual arousal is shifting, and I, I strongly believe. That we all men and women and everything in between, um, I have a strong idea and I think this is in line with congruent with other what other sex researcher feel is that we all have a responsive type of sexual arousal. You first need to interpret the sexual. To a stimulus as sexually relevant otherwise um you cannot have a spontaneous I mean that would be very dysfunctional if a person can spontaneously experience sexual arousal you need to interpret to have the ability to interpret that stimulus as sexually relevant and we also see this how in children. Um, BEFORE puberty, they are actually disgusted with sexual stimuli, both boys and girls, because they don't have the ability as yet to interpret these stimuli as sexually relevant for them. So they might say, oh yuck, they are kissing mouth to mouth, or, oh, what are, what are you doing? Why are you touching mama like this? Um, IT'S because they are not yet. Ah, um, able to interpret such stimuli as sexual stimuli.

07:10 Ricardo Lopes: Yes, that that that's that's really interesting and it really includes a multitude of factors then, so, uh and what is sexual disgust then and what uh types of factors, cues, stimuli can induce uh sexual disgust?

07:34 Charmaine Borg: So sexual disgust, of course, it's an aversive emotional response to sexual stimuli or sexual situations and. Disgust developed as a protective mechanism against contamination in the outside world, so it surrounds our body, the exterior part of our body, and it concentrates on body apertures like the mouth, the nostrils, the vagina, or, or the tip of the penis. So as you can imagine, these are the core body products and parts that are very central to our sexual activities and. Across cultures, people tend to find these body parts and stimuli, body products like saliva, sweat, and the ejaculate, extremely disgusting if you are not sexually aroused. So that's disgust, more generic type of disgust. There are different uh triggers of disgust. It can be more sexual type of elicitors, um, pathogen type of elicitors and moral type of elicitors. So these are different triggers that can elicit disgust in a sexual context, for example, if, um. You are irritated by specific smells. These are more what we refer to as pathogen disgust. Um, SEXUAL disgust is quite ambiguous as how to describe it. What, what I can say is that it's generally induced if you are, um. Um, HOW can I say that? Like you are invited to participate in a sexual activity with someone that you do not perceive as an appropriate sexual mate. So sexual disgust is very much, um, there to protect us against having sex or engaging in sexual encounters with people that are not optimal for us, um, from a sexual per like a, like um. Like a sexual perspective. So as an example, there were experiments done and not from our lab where they ask participants, would you have sex with this person, with this person, and then they show different pictures and then they would say with your brother, um, or your sister, and there is like this disgust response or or with the parents, so it's a protection of incest insectious types of uh sexual behavior. So, uh, sexual behavior, sexual disgust story is very much experienced with a concrete example. I might be very comfortable, um, touching or rubbing arms with a colleague of mine if we're having a drink and we happen to be seated next to each other. So there is contact that I'm not interpreting as a sexual contact, but if that partner like that colleague of mine is giving me the idea that he's interested to have sexual encounters with me while I'm not interested in this person, I don't see this person as an attractive or. Appealing person to be involved with, then I might respond with disgust to the touching that previously had no meaning for me, no sexual meaning. So this is the type of um what triggers sexual disgust and what sexual disgust is really.

10:55 Ricardo Lopes: I mean, and what is the interplay, if there's an interplay, of course, between sexual disgust and sexual arousal? I mean how do they interact with one another?

11:10 Charmaine Borg: So, I've done a number of research on this and what we can say at a global level, that sexual arousal and um disgust, or sexual disgust, let's say disgust more generally. They work in opposing oppo opposing motivational system. So if sexual arousal is high, there is less capacity for disgust or other negative emotions. So if you are sexually aroused, there is less chance that you experience pain. There is less chance that you interpret ambiguous cues as painful cues or as disgusting cues. When sexual arousal is low, generally negative emotions such as disgust is high, and we also have done a number of experimental studies where we induced sexual arousal, provided people with disgusting tasks, and we could see that the people in the sexual arousal group, they were more willing to come in contact with these. Disgusting stimuli and independently they were also rating these disgusting stimuli as less disgusting. Now we also see the other way round that when we induce disgust, sexual arousal is decreased. Even the genital sexual arousal, so even the erection is gone, and it makes lots of sense that Um, if you're sexually aroused, you, um, are more captured by pleasure, by the appeal, and you have less capacity for the negative interpretation of, uh, ambiguous cues, as I said, and also true that when women are not sexually aroused, sufficiently stimulated, for example, there is more chance that they experience pain with penile vaginal intercourse, for example, um. And if there is um higher sexual arousal, higher stimulation, higher sexual pleasure, there is less chance to experience negative aspects of sex.

13:23 Ricardo Lopes: Uh, SO you've told us there how sexual disgust can be induced, but do we know if there are, uh, interindividual differences, differences between people in terms. Of their disgust sensitivity, I mean, is it that some people are simply more sensitive to sexual disgust than others, generally speaking?

13:54 Charmaine Borg: Yes, so what I explained before that certain stimuli and behaviors are disgusting across cultures. So most people, if they are not sexually aroused and they had to touch something that feels like the ejaculate, they will, they, most people say, oh, yuck, or if they step on duck poop, they in general, people will say, oh yuck, this happened. But indeed, as you're, um, indicating uh or or questioning upon. People vary in their frequency in experiencing disgust and and um and in the intensity with which they experience disgust. So we see a difference in what we refer to as disgust. Sensitivity and disgust propensity, so the frequency with how often you experience disgust and the negativity or difficulty that you experience when you are disgusted, yes, indeed there are differences.

15:01 Ricardo Lopes: Can sexual disgust occur or can people experience sexual disgust even with long-term partners with whom I mean they've already established a relationship and had sex several times? Can, I mean, even at certain points in their relationship, can they experience sexual disgust?

15:27 Charmaine Borg: Yes, absolutely. So when, um, you're in a long term relationship, perhaps. Um, THERE is some level of safety and familiarity, so that you would expect that disgust will reduce because we know that disgust increases with the more unfamiliar, more foreign, um, source of disgust. So if you, uh, have someone familiar that reduces the likelihood of experiencing disgust, but. Sexual disgust and disgust more generally is experienced as I said when Sexual arousal is low, and in long-term relationship we refer to the low frequency of having sex as bedroom boredom, so sex becomes another task, you do it quickly to get rid of it, no play, no pleasure, or very minimal pleasure. And sex becomes kind of another task. Now in long term relationship things happen. There might be resentment. There might be just the day to day um relationship um family demands and relationship difficulties that will lower um this complicit this engagement with each other. Perhaps there's no more time for each other and there's no erotic space anymore. And because of this, I believe that there is a higher chance that later on in the relationship when sexual arousal is lower, or when bedroom, bedroom boredom settles in, that there is more likely to experience disgust. And disgust is very much, as I said, associated with negative emotions. So if you have resentment, contempt, there is more likely to be disgust at the cue of engaging with that person in a sexual manner. Besides, there might be pressure to perform, pain, repeated rejection. And all these negative emotions, all these negative experiences that now this partner that it's either being rejected every time he or she tries to have sex, or that they experience pain during sex, or that they have problems with performing either not coming at a specific time or coming to. Or not having an erection when these negative kind of features are attached with the idea of sex and the engagement of intimacy, then there is more space for disgust towards the self to be experienced. If you're rejected often or you have issues with performance. But it can also be that you experience disgust uh in your partner perhaps because of sexual preferences or because they ditch they took uh some decisions or made choices that do not match your um standards of living and I, I also think that the disgust experience can be um. Can be also due to, for example, um, cancer diagnosis or a cancer treatment or other issues that change, for example, how the partner that you used to be aroused towards or for now has a specific. Feature due to a surgery or cancer treatment or any other oncological related thing or due to an accident that now triggers in you aversion rather than sexual arousal and I think in these cases it's very difficult for um. The partner of this person to even verbalize these emotions because they feel very guilty, they feel very bad that they um when their partner is going through all these difficulties that you are now thinking oh but I'm I cannot find attraction but we need to validate these emotions because these are also very relevant emotions that we need to take into account of course um generally phys physiological pain. And and um like oncological problems take priority. Totally understand that and support it, but it also needs to be, uh, the feelings of the partner needs to be validated and hopefully find ways how we can recreate the erotic space and then there are always creative ways how we can bring the couple together if that is their wish and in that way also minimizing the capacity for negative emotions such as disgust.

20:16 Ricardo Lopes: So sexual disgust, if it develops in a long-term relationship, it can be dealt with clinically. Or

20:28 Charmaine Borg: definitely definitely

20:30 Ricardo Lopes: and in what ways specifically?

20:34 Charmaine Borg: It depends very much what is the trigger of disgust um and if the clients can actually verbalize the emotion of disgust, so you really need to understand what are the emotions at play, uh, triggering such behavior or avoidance, um, and then it depends whether. Direct contact, prolonged physical contact with that particular stimulus that is bothering them can help. Or if, for example, increasing intimacy and sexual pleasure would be a better strategy to reduce the capacity for negative emotions. So it's very much dependent on. What is the cause, and generally there is not one cause, but a number of um different triggers that will lead to negative emotions and as well disgust. I don't think disgust generally happens in isolation. I think there are many factors at play to make space for disgust.

21:37 Ricardo Lopes: So in your work I read about um issues like vaginus and I I hope I will pronounce this word correctly, desperunia. uh uh I mean what are them? Can you explain each of them and uh can they also be induced by this gust?

21:56 Charmaine Borg: No, so far vaginismus and speronia are um sexual pain disorders. Vaginismus is the inability to have anything in, in the vagina, so no tampon, no finger, no penis, and the speronia is when there is pain experiences experienced with penetration in approximately 50% of the um attempts. Now, um, in the last version, a decade ago now of the DSM, these two vaginisus and dysperonia were merged under the genital pelvic pain penetration disorder or genital pelvic or genital penetration, uh, disorders. Um, um, NOW your question was, can this be induced by this gust? No, I think there's many, many factors that can, um, put a person at a vulnerability, increased vulnerability, increased risk factor for experiencing, um, pain during penetration. I think one of the basis of this is lack of stimulation. So we did a study recently, one of our PhD students, now she has done, Carlotta Sterling, where she found that in 200, um, if I'm not mistaken, 33 students that had no sexual problems. From a liberal part of the world, um, a large percentage of these women, I, I, I believe 75%, but I don't have the numbers correctly in my head, but very large percentage, despite not having any sexual problems with penile vaginal intercourse, 75% experienced pain. So they are not vaginismus or dysperonia, but they experience pain, and half of that do not communicate it to their partner and continue engaging in penile vaginal sex. So that tells me very clearly that it's not that we need to focus on vaginismus or speronia and what is it cause, but we can understand from such data that lack of sufficient stimulation. Will put the woman at risk of pain. And this is also true because we for many long neglected the clitoris, which is the main organ of sexual pleasure for women, while in man we stimulate the penis. We reduce sex to just penetrative sex, but in that way we're stimulating the penis, but we're not stimulating the. Sexual organ for pleasure in women, so some women do experience orgasm with penetration if they are stimulating the clitoris with the penetration or because independently they are also stimulating the clitoris, but in general women do not come reach orgasm. Due to penetration alone. Um, AND we also see that when they are masturbating or when they are, um, in a homosexual relationship, they reach more orgasms, they don't put anything in their vaginas. So for me, it's more relevant to look at what is causing pain in women than what is the trigger of vaginas mus and dysperonia. Um, THAT'S kind of on a continuum. We have the general population experiencing pain, and then we have the most extreme that are diagnosed with vaginous mus and dysporonia in these people when they do, uh, exposure treatments, specific exposure treatment, um, they do improve with a very efficient, um, high level and very quickly, but sometimes sexual rehabilitation does not occur. So they, when they compare to. Women with without vaginism and dysperonia, they are still less in terms of liking um sex instead of sexual pleasure, um, so. I think we have very efficient treatment from Leiden University in the Netherlands, but we still need to work more in exposing emotions like disgust, which is very persevering when you. Learn disgust, it's very difficult to unlearn this emotion so because disgust was not part of this treatment, I think the treatment was mostly focused on fear, the emotion of fear, because they say I fear penetration, um, then the symptoms were more persevering.

26:43 Ricardo Lopes: Right, uh, can it, can there be cases where people, if they experience low sexual arousal, it is a sexual dysfunction, and I mean, what are, what are the I, I mean, at what point can we say that low sexual arousal is a sexual dysfunction?

27:09 Charmaine Borg: Yes, I feel, um, we should not run to conclusions very quickly because of course persistently low or absent sexual arousal can be classified as a sexual dysfunctional as a female sexual interest and arousal disorder or men who have the delayed ejaculation where men cannot reach um orgasm or they take very long to reach orgasm. There's a lot of biological reasons, there's a lot of psychological reasons, porn addiction or or the problematic use of porn, I should not use the word addiction, um, but, uh, a lot of use of porn perhaps can. Offer you a lot of excitement, you can fast forward, you can find what you want and then perhaps that's a mismatch with your reality of having one partner, and perhaps they are not really into you as you want them to be, and then that's a very mismatch in sexual arousal, and that like I want more to feel stimulated, this is not sufficient, so, There are all these different features that can lower sexual arousal. Sexual arousal can be lowered if a woman is experiencing sex, not in a very stimulating way, not in a rewarding way, but it's more about penetration. Penetration is done. The men came. OK then, done. There is less likelihood that the woman will look forward to engaging another next time in sexual behavior if that experience was very negative for her or not. Sufficiently positive, so I feel we need to be very careful in diagnosing anyone with low sexual disorder as a disorder because I feel there's so many contextual issues that first needs to be assessed in order to. Really see that as a diagnosis, and there is also a difference in sometimes in the like there's a discrepancy in the partners, like within the couple in sexual arousal, for example, at some point, maybe the woman is going through hormonal changes or she has some issues that she doesn't feel like engaging in sexual activity, while, Maybe the men at some stages they are going through other issues and they don't feel like engaging in sexual activity or one of the two really needs more, the other one needs less. I don't know, there can be a lot of discrepancy within the couple, um, so. It's not very easy to label, um. Sexual arousal disorder because there's, I think a lot of factor that first needs to be considered, of course, if a person comes for treatment, um, for herself and saying like I used to enjoy orgasm, I used to fantasize a lot, I used to masturbate quite often, and now I don't feel like it. When I do it, I don't reach orgasm, the orgasm is different, um, the quality of it, um, I. Almost never fantasize anymore, then that's a different angle because the person is distressed by the change in her experience sexual arousal. So I think in that case you can more easily arrive to a conclusion that this person has low sexual arousal and interest disorder, but if it's a relationship in a relationship context, I think there's many, many more drawers that needs to be opened, checked in order to arrive at a good conclusion.

30:56 Ricardo Lopes: OK, but if, uh, whether by, uh, I mean, uh, people consulting with a sexologist, psychologist or some other expert, uh, they arrive or by themselves they arrive at the conclusion that they. ARE suffering from low sexual arousal and it is actually diagnosed in their specific case as a dysfunction. How can problems with sexual arousal be treated clinically?

31:34 Charmaine Borg: Um, SO low sexual arousal, uh, issues can be treated very much dependent on what is the cause or causes. In many cases, it's a combination of treatment, psychological and um relationship treatment, but also medical intervention can be necessary. So psychological interventions often focus on reducing anxiety, negative emotions, and communication between the partners. I very much, um, consider increasing sexual pleasure and recreating the erotic space as essential for making space for sexual arousal and novelty. So I would work mostly in, um. You know, like I always give the example of food that when you eat the same food over and over again, at some point, you will start salivating less, and at some point it becomes aversive. And if you add the spice here and there or change the presentation, you know, you open the dialogue of, huh, I like this, or I am interested in it. What did you do here and there? Um. So I think it's good to work on the foundations first, and novelty, creating space and time for each other is the fundamental, um, of starting having sexual arousal again. So, for example, we also did a randomized control study that it's not yet published. That when we um had couples, some couples had creative sex and some couples continued with having time together, but not with any sexual creativity. We found that even the couples that did not have creative sex but just had time together, they were, they were, um, improved in their relationship cohesion, but also in their sexual um satisfaction. And it makes sense sometimes when you're living with someone and their life is happening. You don't even look in the eyes of your partner, you don't even see their face because life is so fast, it's so rushed, and when you create these moments of contact of looking at each other, appreciating each other, you kind of reignite the sexual space, this erotic space, but also like this complicity again. So those are the fundamentals of um recreating space for sexual pleasure. Then of course medical interventions might be important if, for example, the woman is going through perimenopause or even reached the menopause, menopause is one day, of course, so, um, postmenopause, you might need some hormonal, um, um, help to um increase your willingness to interpret cues. Sexual cues um and if there are medication side effects that might impact the ability to experience sexual arousal, they need to be considered and vascular issues can contribute to sexual problems and also how to experience sexual arousal. So in that case, um, so for example if it's a particular erectile disorder. THERE'S again a lot of psychological issues, but there can be hormonal and medical problems as well as a foundation of it. So I believe that treatment is usually effective when you combine both psychological and and and relationship aspects, but also not forgetting the medical profile of that particular person that is at um at help so it's. I always think that if a client comes with a referral, it's nice to have a profile of their testosterone level, their hormones levels, and then you can start working on the relationship and psychological aspect.

35:30 Ricardo Lopes: Great, so I have just one last question then, Dr. Borgo. Would you like to tell people what kinds of questions you are interested in exploring in your future work, and I mean when it comes to the kinds of topics you explore or tend to be interested in sexual arousal, sexual disgust, and so on. Uh, WHAT are perhaps the kinds of still unanswered questions about those topics that that you would like to see more explored in the scientific and psychological literature and possibly answered in the future?

36:13 Charmaine Borg: And then we would need another 2 hours I would think because I have so many unanswered questions and that's I feel the pleasure and the privilege to have the work that I do, um, because. One answer just triggers more questions, and that's not in any way negative, it's just you are unpacking and unpacking and delving deeper into um different mechanisms and aspects, so I feel. At the moment I'm very much interested in sexual arousal and how can we utilize sexual arousal to minimize the experience of pain. Um, WE'RE interested in learning how when people are expecting pain. Uh, BECAUSE we condition stimulus with a painful stimulus when they are expecting pain, how can we, uh, how, what is the impact on genital and subjective sexual arousal? But then the step after that would be, how can we then, um, create interventions to unlearn this, uh, pain that we are expecting. Um, I'm very much interested in the line of how sex can improve our quality of sleep. We are now we published one paper and we're about to publish the second one, and we have a, um, kind of a line of interesting work we can continue developing in that. I'm very much interested in knowing when opening the meaning of sex. Not just penetrative sex, but just psycho education, psycho education, how can this improve the quality of sex and sexual pleasure in women, especially if they are not informed, what is sex, what is the stimulation that one needs, etc. um. There are so many things that I'm interested in, and yeah, all I find very relevant and important, um, but I think these are the ones that come at the top of my mind at the moment.

38:19 Ricardo Lopes: Great. So would you like, just before we go to tell people where they can find you and your work on the internet?

38:29 Charmaine Borg: Yes, so I have Intima now, um, which is a small company that where I see clients, very few clients a month, um, but which is giving me a lot of energy and excitement again. It's an online intervention sessions that I offer. And then of course the work at my university, which is my main um work and there I do share most of our findings outcomes on LinkedIn. So there I share when we need participants. I share the main publications and the main findings, um. And we also offer opportunities for internships or or people that are interested in this field to come to to join our lab. So I think, yes, that's where people can keep up to date with our work.

39:26 Ricardo Lopes: Great, I will be leaving links to that in the description of the interview and Doctor Borg, thank you so much for taking the time to come on the show. It's been a fascinating conversation.

39:37 Charmaine Borg: Thank you so much, Ricardo.

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