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Pavlovian and instrumental conditioning are fundamental processes helping organisms learn about stimuli that predict rewards in the environment and actions that lead to their obtainment. These two forms of learning and their interplay notably exert a strong impact on reward-seeking behaviors. Here, we examined in humans whether Pavlovian and instrumental learning along with their effects on cue-driven behaviors involving sexual rewards are modulated by the reward relevance to the individual’s sexual orientation. In two experiments, we manipulated the concern-relevance of sexual outcomes in a Pavlovian-instrumental transfer paradigm by recruiting heterosexual and homosexual men and selecting sexual stimuli for each sexual orientation. Results showed enhanced instrumental and Pavlovian learning in response to the most relevant sexual outcome to participants’ sexual orientation as well as increased reward-seeking behaviors in response to its associated cue compared to the less relevant sexual outcome and its associated cue, respectively, thereby reflecting that inter-individual differences in sexual concerns modulated these effects. These findings suggest that motivational influence on reward-related learning and behaviors involving sexual stimuli relies on inter-individual differences in concerns and contribute to fostering further insight into the mechanisms underlying human reward-seeking behaviors.

Les cancers affectent la fonction sexuelle, la santé sexuelle, la relation de couple, ainsi que la santé mentale et la qualité de vie. Pour assurer une prise en charge et une qualité de soins optimales, en raison de l'importance de la santé sexuelle pour chaque individu, nous avons évalué la demande concernant la sexualité et la santé sexuelle chez les patients atteints d'un cancer et les besoins de connaissances professionnelles dans ce domaine du personnel soignant. Les résultats ont montré que la sexualité avait une place importante chez les patients et les soignants. De plus, les soignants souhaitent créer un meilleur réseau professionnel, dans le but de rediriger les patients vers des spécialistes, en fonction de leurs besoins spécifiques. Enfin les soignants ont exprimé une volonté de mieux se former en sexologie et en santé sexuelle.

Sexual dysfunctions, particularly sexual pain, are common in adult women of all ages. In patients with endometriosis, a chronic gynecological pain condition affecting women of reproductive age, sexual pain is the third most common symptom. Multiple biological factors are involved in endometriosis-related sexual pain including tissue damage, inflammation, hormonal changes, alterations within the peripheral and central nervous system and pelvic floor muscle dysfunctions. Conceptual models of sexual pain espouse a multifactorial view, with empirical evidence suggesting the implication of psychosexual and relationship difficulties in the development and persistence of sexual pain and associated distress. We review literature on the biological, psychological, sexual and interpersonal factors associated with development and persistence of sexual pain in women with endometriosis. In addition, we discuss chronic pain conditions frequently associated with endometriosis (vulvodynia, bladder pain syndrome and inflammatory bowel syndrome) and how they are linked with sexual pain. Finally we discuss the clinical implications and provided suggestions for future research and medical care, focusing on a multidisciplinary and biopsychosocial approach.

International audience

Le cancer et ses traitements peuvent induire de nombreux effets secondaires. Parmi eux, les problèmes liés à la santé sexuelle sont souvent laissés de côté, tant par les cliniciens que par les patients eux-mêmes. Du côté des cliniciens, les principaux obstacles évoqués sont le sentiment d'une formation inadéquate, ou le manque de temps ou d'intimité. Du côté des patients, la gêne ou l'impression que les problèmes sexuels liés au cancer sont incurables, sont souvent retrouvées. Devant cette problématique, un groupe multidisciplinaire a été créé pour traiter de la santé sexuelle des patients oncologiques et mettre en place une formation spécialisée pour les cliniciens, avec comme objectif global d'intégrer la problématique sexuelle dans la prise en charge globale de ces patients.

Sexual health is a critical aspect of quality of life and is also influenced by medical conditions and health care interventions, particularly when gynaecological disorders are involved. Dyspareunia is a common symptom of endometriosis, a cause of personal distress and a main raison for seeking treatment. Endometriosis negatively affects different domains of sexual function and specific biopsychological variables (chronic pain, recurrence, infertility) may further worsen quality of sexual function and relationship. Consequences of endometriosis treatment on global sexual functioning have not been featured prominently in the available literature, assuming wrongly that sexual pain improvement was always translated into a recovered sexual health.