Reward processing is crucial to our health and wellbeing and dysfunctional brain reward signaling is a component of a number of psychiatric. I think the answer is debatable, although machismo is certainly still alive and well in science. The pattern of men aggressively taking credit—not only from each. Is it better to assess sexual compatibility early in dating or to delay having sex? Does “true love wait” or should you “test drive” a relationship.
Consistently asking critical questions about sex and gender will likely lead to the discovery of positive outcomes, as well as unintended. My question is just how much does sex matter in marriage? Are there people who marry their partners and make it work even if the sex was bad. Reward processing is crucial to our health and wellbeing and dysfunctional brain reward signaling is a component of a number of psychiatric.
During one of our recent Third Tribe Q & A sessions, Chris Brogan made a comment about sex that really got my attention. I should probably. Two experts on whether sex in relationships is important, and how to improve it if you're not satisfied. When it comes to feelings of marital satisfaction, therefore, a satisfying sex life and a warm interpersonal climate appear to matter more than does a greater.
Neuropharmacology of drug reward: Implications for drug addiction View all 8 Articles. Reward processing is crucial to our health and wellbeing and dysfunctional brain reward signaling is a component of a number of psychiatric disorders, including major depression and drug addiction.
Rewarding behaviors like eating, parenting, nursing, social play, and sex activity are powerfully preserved in evolution and are essential for survival. All of them gratifying, they represent enjoyable experiences with high reward values and activate the same brain circuits that mediate the positive reinforcing effects of drugs of abuse.
In line with preclinical findings and clinical observations, recent imaging studies confirmed that natural sex, food and non-natural drugs of abuse rewards differently activate male and female brains Haase et al. The study of sexual morphological differences in human brain has provided evidence of critical effects of gender on brain architecture and morphometry Giedd et al.
Male-female differences in human brain anatomy have stimulated research on the difference in onset, prevalence, and symptomatology of many neuropsychiatric illnesses between women and men, including drug addiction Rando et al. Following the official recognition by International Institutions and Funding Research Agencies on the importance of taking into account potential differences between men and women in all of the relevant aspects of health-related research, gender is receiving increasing attention by medical and scientific communities.
Will a consequence, evaluation of sex and gender i. Numerous human behaviors are driven by evolved instincts and urges. Reward processing may sex differ between male and female population with sexual hormones playing an important, although not exclusive, role.
When looking at the most common behavioral features known to favor the development of drug dependence, such sex poor impulse control, risk-taking behavior, a heightened reactivity to stress and psychiatric comorbidity, all reveal important differences between men and women. Impulsivity and compulsivity involve both repetitive behaviors and a deficit in will or inhibitory mechanism for such behaviors. Impulsivity is characterized by risky behaviors and attempts to maximize pleasure, arousal, or gratification, while compulsivity is characterized by hypervigilance, harm-avoidance, and ritualistic behaviors in the attempt to reduce anxiety or discomfort or to avoid potential threats.
Converging evidence has long identified impulsivity and compulsivity as key psychological constructs in drug addiction Perry and Carroll, ; Davison et al. A male-female unbalance has been recently observed in the prevalence and severity of disorders related to impaired impulse control capability Liu et al. Behavioral impulsivity consists of two distinct components: impulsive actions also known as behavioral inhibition that involve difficulty in inhibiting or controlling behavior, and impulsive choices that refer to the tendency to prefer smaller and immediate rather than larger and delayed rewards.
Both of these components have been shown to play a role in several key transition phases of drug abuse Perry and Carroll, and to differ among males and females Weafer and de Wit, Notably, sex differences in the ability to control impulses have also been reported with respect to food intake Galanti et al. Decision-making, which comprises a complex process of assessing and weighing short-term and long-term costs and benefits of competing actions, is another feature in which men and women differ van den Bos et al.
Some studies have recently reported gender differences in risk attitudes Zuckerman, For example, women display less risk-taking behaviors than men in various domains Warshawsky-Livne et al. On the contrary, there is also evidence of no gender differences in risk attitudes Lighthall et al.
Risk-taking and sensation-seeking are characteristic traits sex adolescents which are known to give higher value to positive experiences and will value to the will ones than matter. Young people are more likely than adults to use illicit or dangerous substances, thus explaining why most drug addictions start during adolescence, with early drug use being associated with an increased rate of drug abuse and dependence. Will has been unanimously recognized as the most critical phase in terms of vulnerability for addiction, during which behavior is strongly modulated by the sex hormones.
Indeed, in addition to the perinatal period of sexual differentiation, adolescence is a sensitive period for steroid-dependent organization of the brain and behavior by steroid hormones, prompting a reassessment of the developmental time-frame within which organizational effects are possible Schulz et al. Importantly, sex differences are now clearly emerging in drug use and abuse during adolescence Kuhn, It is quite obvious that stress alters the perception of rewarding stimuli and impacts on the pleasures that life may offer.
Stress differentially affects male and female brain by engaging discrete regions involved in cognitive control, modulation of emotional processing, and neuroendocrine responses.
Subjective stress, for example, is associated to stronger activations of the prefrontal cortex and deactivation of the orbitofrontal cortex in males, but to activations of limbic structures, like ventral striatum, insula and putamen in women Wang et al.
Stress favors the development and perpetuation of drug and alcohol use, but also the propensity to relapse in abstinent subjects Sinha et al.
Sex differences in stress responses have been observed in healthy and cocaine-dependent individuals Kajantie and Phillips, Notably, in cocaine-dependent patients, cortico-striatal-limbic hyperactivity seems to be associated mostly to stress in women and to drug in men Potenza et al. However, it has also been reported that i men have greater hypothalamic-pituitary-adrenal HPA axis responses to a psychological stressor than women and ii women have greater hormonal reactivity than men to pharmacological stimulation with naloxone Uhart et al.
Imaging studies have allowed a better understanding of the link between stress and differential brain activation in either gender. For example, men display greater activation in brain regions known to regulate emotions during stress Seo et al. By contrast, during alcohol-cue exposures women showed greater neural activation in brain regions associated with high-level cognitive processing Seo et al.
Closely related to stress, altered emotional states have also been reported to favor the propensity to drink alcohol and use drugs, and gender differences have been described in drug addiction and psychiatric comorbidities Brady and Randall, Women suffer from anxiety and depression Altemus et al.
Negative affective states have been linked to drug abuse and addiction, thus it is not surprising that women drink alcohol mostly to ameliorate negative emotions Abulseoud et al. In keeping with this, women use opioids more frequently than men to handle social pressure and anxiety McHugh et al.
Similar sex differences in negative affective states have been found in heavy drinking male and female adolescents Bekman et al. All these findings have clear potential clinical implications. Since matter plays a greater role in sex than in men in initiating and maintaining drug use, treatments either pharmacological or behavioral targeted at reducing stress may have greater utility in patients with higher stress reactivity, i.
Indeed, behavioral therapies targeted at stress reduction, such as qigong meditation which blends relaxation, breathing, guided imagery, inward attention, and mindfulness to elicit a tranquil stateseem to be more effective in women than in men in alleviating anxiety and withdrawal symptoms Chen et al.
Epidemiological studies consistently indicate that men typically use psychostimulants and alcohol more often than women. Men also smoke matter in greater amounts and at higher rates and more frequently use synthetic cannabinoids UNODC, Men are also more likely to use illicit opiate drugs, but women more frequently abuse opioids through initial prescription painkiller use Lee and Ho, Men have higher rates of cocaine use and abuse, but women with cocaine addiction tend to present a more severe clinical profile despite less drug use in terms of quantity and duration than their male counterparts Greenfield et al.
Male cigarette smokers are more likely to have a history of alcohol, cocaine, or marijuana abuse than female smokers which in turn suffer from psychiatric disorders mostly anxiety or depression more than men Okoli et al.
Accordingly, female smokers are more negatively affected by abstinence Okoli et al. Notably, this might explain why is more difficulty for women quitting in the longer term due to higher smoking-relapse and smoking-reinitiating rates Ward et al.
Sex differences in drug use, craving, and relapse can be ascribed, at least in part, to differences in the male and female brain morphology and function but also to gonadal hormones secreted early in development which masculinize and defeminize neural circuits, programming behavioral responses to hormones in adulthood MacLusky and Naftolin, Thus, together with alcohol and substance abuse, behavioral addictions include compulsive eating, and sexual activity, pathological gambling, and Internet use, compulsive buying, and excessive exercising, kleptomania, and pyromania.
Notably, gender-related differences have also been described for these will addictions Fattore et al. Thus, men typically self-report higher score than women on gambling, sexual, or will exercise activity, while women self-report higher score on compulsive shopping and food binging Fattore matter al. Studies based on small clinical samples indicate that the majority of treatment-seeking individuals with compulsive sexual behavior are males Black et al.
However, studies conducted on greater samples suggest matter differences than previously thought Reid et al. Awareness is increasing on the evidence that a different sex makeup and hormonal milieu play crucial roles in sex-dependent differences in reward processing and drug addiction Viveros et al.
Sex-dependent differences have been described in many vulnerability factors that contribute to individual variation in the risk of drug addiction, including personality factors like impulsivity, sensation-seeking, stress responsiveness, and aversive states.
Hormones as well as brain morphology and function have surely matter part in the sex-dependent processing of rewarding stimuli, including drugs of abuse Fattore et al.
Recently, sexual dimorphism in drug-related neuroanatomic changes and brain-behavior relationships has been linked to the differences in clinical profiles and patterns of addiction between women and men Regner et al.
A great sex has been made in the recognition and investigation of the differences between males and females in the field. Yet, well-controlled, adequately powered studies are necessary to gain a more complete picture of the degree to which males and females differ in drug and behavioral addictions. The author declares matter the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Abulseoud, O. A retrospective study of gender differences in depressive symptoms and risk of relapse in patients with alcohol dependence. Altemus, M. Sex differences in anxiety and depression clinical perspectives. Back, S. Comparative profiles of men and women with opioid dependence: results from a national multisite effectiveness trial. Drug Alcohol Abuse 37, — Bekman, Will. The impact of adolescent binge drinking and sustained abstinence on affective state. Alcohol Clin.
Black, D. Characteristics of 36 subjects reporting will sexual behavior. Psychiatry— Brady, K. Gender differences in substance use disorders. North Am. Chaplin, T. Gender differences in response to emotional stress: an assessment across subjective, behavioral, and physiological domains and relations to alcohol craving. Chen, K. Introducing qigong meditation into residential sex treatment: a pilot study where gender makes a difference. Cross, C. Sex matter in sensation-seeking: a meta-analysis.
Davison, K. Sex differences and eating disorder risk among psychiatric conditions, compulsive matter and substance use in a screened Canadian sex sample. Psychiatry 36, — Derntl, B. The impact of sex hormone concentrations on decision-making in females and males. Diekhof, E. A functional neuroimaging study assessing gender differences in the neural mechanisms underlying the ability to resist impulsive desires. Brain Res. Fattore, L. Sex differences in drug addiction: a review of animal and human studies.
Womens Health Lond.
You go to a sex therapist, you rent some porn, whatever. You have to leave him. Because you both deserve better, and life is long. Sex is what makes a marriage different from just a working partnership, or a good friend. Sex is what allows you to reconnect over and over again, even when life is hard. Also, good sex is just something humans are built to want. But while you might be setting yourself up for divorce and again, I think you already know that. A smell that makes you feel like home every night of the week.
Because yeah, sharing political values matters too at least to me. But it has to come with the whole package. And chemistry is the glue that binds it all together. Because whatever the answer is, you already know it in your heart.
Please read our comment policy before you comment. Skip to content Find a Vendor. Lady, Meg here. It matters a lot. Hugs, Meg. It is possible that the review authors did consider sex and gender in their analyses and determined it was unimportant. However, they failed to report this. Little research has been undertaken or reported to inform how sex and gender impact IRP, as evidenced by this analysis of key texts, well-used conceptual models, and Cochrane reviews on implementation strategies.
The objective of this paper is to describe the rationale for why and how sex and gender should be considered in IRP. A first step for understanding how to integrate sex and gender in IRP involves operationalizing the two terms, and recognizing different components of gender.
The term sex refers to a biological construct, whereby an individual is defined as being male or female according to genetics, anatomy and physiology [ 6 , 7 , 11 , 28 — 32 ]. Researchers should use the term sex when describing the number of male or female patients or committee members, or when stratifying outcomes by male versus female participants or health care providers. Gender norms influence commonly accepted ways of how people behave, how they perceive themselves and each other, how they act and interact, and the distribution of power and resources in society [ 6 , 28 , 31 — 35 ].
Researchers often understand gender as a function of gender roles e. Gender as a broad term can also refer to the expressions and identities of girls, women, boys, men, and gender diverse people [ 39 , 40 ]. For this reason, definitions of sex and gender are evolving as science changes, and it remains challenging to easily separate the biological from the social.
Sex and gender are often interrelated, interactive and potentially inseparable [ 6 , 11 ]. Given the epistemology of knowledge, and the social nature of implementation and behavior change, the effect of gender and other identity factors, either alone or in combination, can serve as barriers or enablers to the outcome or impact of IRP interventions.
Collecting and analyzing data on sex in IRP is relatively simple if using typical male and female categories. Sex can be self-reported, designated by an examination of external genitalia, or genetically determined based on an XX, XY or intersex genotype [ 11 ]. Data on sex-related factors can include measuring sex hormones, body and organ size, metabolism, or fat tissue distribution [ 41 ].
Gender is more complex, and can be operationalized along four different constructs: gender roles, gender identity, gender relations and institutionalized gender [ 6 , 28 , 31 , 32 ]. Traditionally, individuals are asked to categorize their sex as male or female and many assumptions, often based in gender and not biology, are made on the basis of their responses.
Researchers are now rethinking this approach to be more inclusive of gender identity and expression [ 39 ]. Similarly, participants could also be given the option to disclose sexual orientation and whether they consider themselves part of the lesbian, gay, bisexual or transgender LGBT community. Researchers can also create gender scales using gender-related variables of relevance to their particular research topic [ 45 , 46 ].
Pelletier et al. They were able to demonstrate that gender, independent of sex, predicts poor outcome after acute coronary syndrome, pointing to new areas of intervention [ 44 ].
Qualitative methods are also useful for the collection of data on specific dimensions of gender. Qualitative methods can also be used to explore concepts of institutionalized gender, and to gain a more in-depth understanding of gender as a barrier or enabler to the use of implementation interventions, the uptake of the evidence-informed clinical interventions or program and the outcomes of implementation efforts.
A number of texts, casebooks, examples and online courses are available that provide guidance on how to conduct sex and gender science using commonly employed quantitative and qualitative methods [ 6 , 32 , 42 , 43 ]. Emerging evidence suggests that sex and gender are important in decision-making, stakeholder engagement, communication and preferences for the uptake of interventions. Furthermore, when gender norms, identities and relations are ignored, unintended consequences may occur.
The following five scenarios give examples of when and why sex and gender should be measured and considered in implementation research:. When the implementation of an intervention requires decision-making on the part of individuals or organizations.
Decision-making is a critical component of behavior change interventions, and plays a key role in the uptake of new organizational practices and programs [ 47 ]. Research from the fields of business and management offer insights for IRP on important sex and gender factors related to decision-making [ 48 — 50 ].
Qualitative research conducted by Deloitte Consulting with 18 large business organizations suggests that female executives have a tendency to be more attuned to micro-level signaling during meetings, and may favour discovery options and iterative thinking during decision-making processes [ 48 ]. Male executives tend to end a conversation once they connect with a good idea or solution.
Different leadership traits among male and female leaders can therefore influence the outcome of decision-making processes [ 49 , 50 ].
When sex and gender dynamics may play a role in stakeholder engagement and conflict resolution. Females may also engage in more collaboration and consensus building, not only to make sound decisions but also to elicit common support for a course of action [ 49 , 50 ]. The outcome of an implementation intervention may therefore depend on the sex and gender dynamics in each particular context. When communication strategies are being tested, as sex and gender may be differentially responsive to the choice of language used, the strength of persuasion of the communication strategy, and the way promotional information is processed.
The way messages and interventions are primed or packaged to reflect gender norms or stereotypes may also influence the outcomes of health promotion interventions. For instance, priming individuals to the perception that women eat healthier foods than men leads both male and female study participants to prefer healthy foods, whereas priming masculinity results in unhealthy food preferences [ 53 ].
When the packaging and healthiness of the food are gender congruent i. When negative or harmful gender stereotypes may impede the uptake and outcomes of an IRP initiative [ 54 ]. A realist review of the implementation of school-based interventions to prevent domestic abuse for children and young people reported that lesbian, gay, bisexual and transgender youth felt excluded from the programmes, as the content did not address gender identity or sexual orientation in high-risk populations [ 55 ].
Similarly, data suggest that masculine norms around emotional control and self-reliance are associated with recurrent non-suicidal self-injury [ 56 ]. Stigma related to healthcare seeking for male depression and suicide [ 57 , 58 ], may explain why women are more likely to benefit from psychosocial treatment for the prevention of suicide and suicidal ideation compared to men [ 59 ].
Some studies purport that gender bias in prescription patterns among health care providers results in more women receiving treatment with antidepressants for mental health [ 60 ] and pain symptoms, but only among female clinicians [ 61 ].
Men, on the other hand, may be preferentially managed with orthopaedic surgery to manage knee arthritis [ 62 ]. However, in some cases these programs exacerbated gender relations and gender inequalities, such as when women were pressured to give the phones provided by the program to their husband if he did not already own a phone, or when conflicts about phone use led to cases of spousal abuse.
The World Health Organization outlines a spectrum of gender-responsive programs, illustrating the progression from the exploitative use of gender stereotypes in IRP messaging, through to accommodation and ultimate transformation to gender equity Fig.
Making active choices reflecting content, messaging and decision-making processes during the implementation of an intervention can have a critical impact on gender equity for women and men.
Gender transformative approaches are preferred as they anticipate unintended barriers and consequences and address the causes of gender-based health inequities where they exist [ 67 ]. Recent guidance based on qualitative research suggests de-linking messages for men and for women when promoting tobacco reduction during pregnancy and post partum, since the uptake of the intervention can be hindered by negative couple dynamics if the partners have different smoking behaviours or attitudes about smoking during this period [ 68 — 70 ].
Another transformative approach to encourage uptake of smoking cessation interventions would be to focus on a wider range of non-stereotypical gendered roles that include fathering for men and work for women as potential motivators. A continuum of approaches for integrating sex and gender. Sex and gender can be therefore be pivotal at multiple points along the IRP process, from the content and messaging surrounding the intervention, to decision making around the uptake and unintended consequences of an intervention.
Asking sex and gender questions can also elucidate enablers and barriers to the adoption of complex behavioral interventions. For example, examining the outcome of implementing a multidisciplinary cardiac rehabilitation program merits asking whether women or men have less time to devote to recovery and prevention activities due to gender-based expectations regarding their responsibilities at home.
The potential advantages of including sex and gender in the study of other complex behavioral interventions e. Measuring the way sex and gender influences these interventions may help elucidate potential mechanisms and contexts behind the success or failure of various IRP efforts, as shown in the examples above on tobacco cessation, healthy eating, depression and suicide, pain, heart disease and domestic violence.
Researchers can start by asking a series of questions about how sex and gender can have an impact on their implementation initiative in order to determine the best way to measure and analyze the effect of sex and gender. First, how might sex or gender affect decision-making and stakeholder engagement, or facilitate or impede the uptake of evidence-informed practice, programs, policies? Second, how might sex based characteristics or prevailing gender norms or gender roles serve as barriers or enablers to the uptake of evidence-informed practices, programs, policies?
Third, when and how should the communication strategy, wording or messaging be tailored across sex, gender or other identity characteristics? Similarly, how might gender relations as a function of dyads or interpersonal dynamics within an organization, community, workplace or institution influence the outcome of the intervention? And finally, should the research protocol consider examining whether there are unintended impacts of implementation that exacerbate or diminish sex, gender or other diversity-related inequities?
Additional opportunities for integrating sex and gender in IRP as relates to models of health systems research have been reviewed in detail elsewhere [ 33 ]. Realist evaluators may wish to examine sex and gender through the lens of this Context-Mechanism-Outcomes configuration for the evaluation of new initiatives, programs and scale-up [ 71 , 72 ].
Outcomes are the impacts of the intervention. Some questions of how sex and gender considerations can align with the Context-Mechanism-Outcomes configuration are: How do gender roles, gender identity, gender relations, and institutionalized gender influence the way in which an implementation strategy works, for whom, under what circumstances and why?
Finally, research results should be disaggregated and reported by sex or gender groups [ 11 ]. It is important to report whether there are similar effects or differences. This paper argues that sex and gender should always be considered in implementation research. Considering sex and gender should be an essential component of IRP. Failing to integrate sex and gender may neglect an important determinant of knowledge use, reducing the effectiveness of implementation interventions, inadvertently reinforcing sex neutral claims and negative gender stereotypes, and possibly creating or increasing gender and health inequities in care and health outcomes.
Only by consistently investigating sex and gender in a critical and reflective manner that addresses underlying gender inequities, will the field of IRP reach its full potential for meeting the requirements of scientific rigour, excellence and maximal impact.
Twenty years and still counting: including women as participants and studying sex and gender in biomedical research. Policy: NIH to balance sex in cell and animal studies. Gates MF. Putting women and girls at the center of development. Opinion: sex inclusion in basic research drives discovery. Does a change in health research funding policy related to the integration of sex and gender have an impact?
PLoS One. Canadian Insitute of Gender and Health. What a difference sex and gender make: a gender, sex and health research casebook. Accessed 14 April Clayton JA. Studying both sexes: a guiding principle for biomedicine.
Evaluating sex as a biological variable in preclinical research: the devil in the details. Biol Sex Differ. Integrating Gender in Horizon Pen Sci Technol. Accessed 25 Oct Johnson JL, Beaudet A. Sex and gender reporting in health research: why Canada should be a leader.
Can J Public Health. Res Integr Peer Rev. Knowledge translation in health care: moving from evidence to practice. West Sussex: Wiley-Blackwell; Improving patient care: the implementation of change in health care, 2nd Edition. Dissemination and implementation research in health: Translating science to practice.
New York: Oxford University Press; Dissemination and implementation research in populatons with health disaparities. Leadership and organizational change for implementation LOCI : a randomized mixed method pilot study of a leadership and organization development intervention for evidence-based practice implementation.
Implement Sci. Nilsen P. Making sense of implementation theories, models and frameworks. Gaps between knowing and doing: understanding and assessing the barriers to optimal health care. J Contin Educ Health Prof. Implementation matters: a review of research on the influence of implementation on program outcomes and the factors affecting implementation. Am J Community Psychol.
Validation of the theoretical domains framework for use in behaviour change and implementation research. Theories of behaviour change synthesized into a set of theoretical groupings: introducing a thematic series on the theoretical domains framework.
Syst Rev. Appraising the evidence: applying sex and gender based analysis SGBA to Cochrane systematic reviews on cardiovascular diseases. Equity considerations in EPOC reviews. EPOC Resources for review authors. Ryan R. Cochrane Consumers and Communication Review Group. Better science with sex and gender: a primer for health research. Wizeman TM, Pardue M. Institute of Medicine. Exploring the biological contributions to human health: Does sex matter? Gender, sex and health research guide: a tool for CIHR applicants; Schiebinger L, Stefanick ML.
Gender matters in biological research and medical practice. J Am Coll Cardiol. How to do or not to do … gender analysis in health systems research. Health Policy Plan. Rossi AM, Pilote L. Circ Cardiovasc Qual Outcomes. Bauer GR. Incorporating intersectionality theory into population health research methodology: challenges and the potential to advance health equity.
Soc Sci Med. Bowleg L. The problem with the phrase women and minorities: intersectionality-an important theoretical framework for public health. Am J Public Health. J Clin Epidemiol.