Sexuality

"There is good reason to believe that orgasms while sleeping are not, in fact, the result of genital stimulation, but instead are created in the brain."

"The five-minute movie shows how activity changes across 80 separate regions of the brain in snapshots taken every two seconds. The animation uses a "hot metal" colour scale that begins at dark red and progresses through orange and yellow to white at the highest levels of activity. "The general aim of this research is to understand how the orgasm builds up from genital stimulation and what parts of the brain become recruited and finally build up into an orgasm," said Prof Komisaruk, who presented the work at the Society for Neuroscience annual meeting in Washington DC on Monday. The work has yet to be published in a peer-reviewed journal. As the animation plays, activity first builds up in the genital area of the sensory cortex, a response to being touched in that region. Activity then spreads to the limbic system, a collection of brain structures involved in emotions and long-term memory. As the orgasm arrives, activity shoots up in two parts of the brain called the cerebellum and the frontal cortex, perhaps because of greater muscle tension. During orgasm, activity reaches a peak in the hypothalamus, which releases a chemical called oxytocin that causes pleasurable sensations and stimulates the uterus to contract. Activity also peaks in the nucleus accumbens, an area linked to reward and pleasure. After orgasm, the activity in all these regions gradually calms down."

"Results: The results confirmed transient increases in adrenaline and prolactin plasma concentrations. Sexual arousal and orgasm increased the absolute number of leukocytes, in particular natural killer cells (CD3-CD16+CD56+), in the peripheral blood. In contrast, T cell (CD3+) and B cell (CD3-CD20+) subpopulations as well as the production of interleukin 6 and tumor necrosins factor alpha remained unaffected by sexual activity. Conclusion: These findings demonstrate that components of the innate immune system are activated by sexual arousal and orgasm."

"Recent work with real-time fMRI, in conjunction with compatible EEG/MEG, shows promise in allowing us to observe the brain at work (or play). Perhaps this method, in conjunction with effective connectivity data analysis techniques, will permit us to unravel the continuing mysteries of the orgasm sequence. How the various brain regions influence each other, activating and inhibiting one another, to produce the pleasures leading up to and including orgasm may well have applications beyond the bedroom. This method has already been therapeutically applied as a tool for neuro biofeedback, with the goal to increase activity in the left amygdala (Zotev et al., 2014) and insula (Veit et al., 2012), which has been associated with enhanced mood regulation and reduced symptoms of anxiety and depression. It is possible that by studying people who are virtuosos in regulation of their pleasure systems, such as the easily orgasmic women in our study who activated their genital sensory cortex simply by “imagining” genital stimulation, or the population of women who can literally “think” themselves into orgasm, previously studied by our group(Whipple et al, 1992), we will learn more effective strategies for helping mood-challenged individuals exercise the brain’s capacity for self-regulation."

"As predicted, the results showed clear evidence that many brain regions were differentially activated during the course of genital stimulation leading up to and culminating in orgasm in these women. These activations include sensory, motor, reward, frontal cortical and brainstem regions, i.e., the genital sensory cortex (paracentral lobule), secondary somatosensory cortex (operculum SII, regions OP1 and OP4), precuneus, inferior parietal lobule, insula, hippocampus, amygdala, cerebellum, supplementary motor area, dorsal and ventral striatum (caudate, putamen, and nucleus accumbens), substantia nigra, the mesolimbic dopamine system (ventral tegmentum), hypothalamus, pons, anterior and posterior cingulate cortex, temporal pole, and the prefrontal cortex."

"What happens in the brain that initiates and orchestrates the “going over” from stimulation to orgasm? This is of interest for clinical applications for individuals suffering from the inability to experience an orgasm. We attempted to elucidate this by comparing the stimulation period that immediately precedes the onset of orgasm with that at the onset of orgasm."

"Based upon the results of the various analyses of the transition from the later stimulation through orgasm, we conclude that “going over” into orgasm involves a complex interaction between sensory integration, motor, reward, and cognitive region, involving the autonomic nervous system. The evidence of activation of brain regions that control both sympathetic and parasympathetic activity at orgasm in this study of women suggests that, similar to the dual activation involved in orgasm in men (penile erection: parasympathetic function; ejaculation: sympathetic), both divisions of the autonomic nervous system contribute to the process of orgasm in women."

"Overall, our findings lead us to conclude that women’s orgasm is a major neurological event, involving widespread activity in many regions of the brain. Future effective connectivity studies should help elucidate how the activity of these regions develops and is integrated over the course of stimulation, orgasm, and recovery in the totality of the orgasm sequence."

"Our laboratory, the Komisaruk group, has consistently found widespread, regional brain activation leading up to and peaking at orgasm, including frontal and temporal brain regions, while conversely, the Georgiadis group report diametrically opposite results in which the frontal cortex—specifically the right medial orbitofrontal, left lateral orbifrontal, and left dorsolateral cortices—and right amygdala were deactivated during orgasm. And also in contrast with our findings of widespread activation during orgasm, the Dutch group has reported finding reliable orgasm-related activation only in the cerebellum (Georgiadis et al., 2006), and more recently, the pons (Huynhet al., 2013)"

"The findings presented in this dissertation suggest that the brain is capable of responding robustly to both physical “touch” and mental “imagined” stimulation. As physical genital stimulation builds up and culminates in the major neurological event of orgasm, many brain regions implicated in sensory, motor, cognitive, and reward processes are recruited along the way. How these regions interact to create the complex phenomenological experiences of sexual arousal and orgasm are yet to be fully understood. Fortunately, we are at the brink of advances in methodology that will facilitate our ability to address this, and other questions, raised by this dissertation."

"The orgasm is a strong analgesic. With brain-activation studies of orgasm showing unique patterns of activation in regions implicated in attention, self-awareness and consciousness, researchers believe its study may also help with the control of pain. “Orgasm is a special case of consciousness,” says Barry Komisaruk at Rutgers University in Newark, New Jersey. “If we can look at different ways of inducing orgasm, we may better understand how we can use top-down processing to control what we physically feel.”"

"“This kind of research is incredibly useful,” says Heiman. “Orgasm is tied into the brain’s reward system and likely other important systems as well. There is much we can learn about the brain, about sensation, about how pleasure works and probably much more from this one physical response.”"

"This experiment occurred during the context of an orgasm study. All participants described themselves as being “consistently highly orgasmic” during study enrollment. As there has been support in the literature for a correlation between orgasm reliability and higher hypnotic suggestibility(Bridges, et al., 1985), and imagery ability (Harris et al., 1980), the degree of suggestibility of these participants may potentially have biased the results toward more robust imagery activations than expected. This may have contributed to the lack of robustness of the brain response to the physical stimulation conditions by having the explicit modeling be too suggestive of the actual physical stimulation."

"The female orgasm is a variable, transient peak sensation of intense pleasure, creating an altered state of consciousness, usually with an initiation accompanied by involuntary, rhythmic contractions of the pelvic striated circumvaginal musculature, often with concomitant uterine and anal contractions, that resolves the sexually induced vasocongestion and myotonia, generally with an induction of well-being and contentment. Findings from surveys and clinical reports suggest that orgasm problems are the first or second most frequently reported sexual problems in women. Between 11 and 60% of adult women suffer from lack of orgasm, depending on factors such as culture and religion. On an individual level, self-insight and a positive attitude towards one’s own genitals and sexuality are important. Female anorgasmia is a significant sexual problem. The woman who lacks orgasm often also lacks desire and joy of sexuality, has low self-esteem, often feels like a sexual failure, and feels sexually wrong and ashamed of herself for not being the “woman she was meant to be”. Perceptions of not being fully able to satisfy her partner sexually are normal and quality of life is often low. The problem of female anorgasmia, from a psychodynamic perspective, often goes back to the parental lack of acceptance of the patient’s genitals, body, and sexuality, often leading to intense feelings of shame and guilt, which seem to be repressed by a denial of physical and sexual needs, and accumulate in the pelvic and genital area. Sexual abuse and sexual traumas from rape and incest often cause lack of orgasm. If self-esteem is low, it is our clinical observation that there can be lack of orgasm from the simple psychological reason that the patient feels she does not deserve such pleasure, or does not know how to get it. It is very likely that anorgasmia is a socially inherited sexual dysfunction, but this has never been investigated scientifically. It is generally believed that anorgasmia, as most other sexual dysfunctions, is caused by a disturbed psychosexual development."

"The female patients in holistic existential therapy and holistic sexology with life-long anorgasmia often find their situation pretty hopeless; many of them have been dysfunctional and incurable for many years or they suffer from conditions for which there has been no efficient biomedical or psychotherapeutical cure. They suffer from a condition that is a serious burden to their marital life, if they have a husband; often the problem makes them unable to find or keep a partner. Often the problem of anorgasmia is caused by traumas from earlier sexual abuse, which needs more effective and direct tools for the induction of healing (salutogenesis)."

"Masters and Johnson’s major conclusion was that there was only one female orgasm and that it originated in the clitoris regardless of where it was felt. This was in spite of their description of the vaginal response to erotic stimulation, explained here by the Breechers: ‘’The vagina too, responds. It can be thought of as a cylinder or ‘barrel’, which remains in a collapsed state in the absence of erotic stimulation. The Masters-Johnson studies have established that the outer third of this barrel reacts in one way and the inner two-thirds in a very different way during the successive phases of sexual response. As sexual tension mounts during the excitement phase… [t]he cervix and the uterus are pulled back and up…producing a ‘tenting’ of the vaginal walls surrounding the cervix. The net result of these and other changes is a dramatic ‘ballooning’ of the inner two thirds of the vagina. The diameter at the widest point of the ballooning may be three times the diameter of the erotically unstimulated vagina; and the total length of the vaginal barrel may be increased as much as a full inch.’’ Given this physical response the vagina cannot be described as inactive or even passive. However, Masters, and Johnson assumed this to be the case, and their findings focused on what they called clitorical orgasms. The female research subjects were chosen on the basis of their capacity to produce orgasms in the laboratory while under observation. Regarding these women, Masters and Johnson found that as ‘contrasted with the male’s usual inability to have more than one orgasm in a short period, many females, especially when clitorally stimulated can regularly have five or six full orgasms within a matter of minutes’. In this context, with these female subjects, it was found that the most intense orgasms on a physiological level occurred as a result of masturbation, not while engaging in penile-vaginal intercourse. In response to these findings, Dr Mary Jane Sherfey, an American psychoanalyst, concluded in 1966 that ‘biology gives to women an inordinate sexual drive and capacity which had to be suppressed in the interests of maternal responsibility and male property rights with the rise of modern civilisation’."

"The objective of this study was to test the Betty Dodson method of breaking the female orgasm barrier in chronic anorgasmic women. The aim was sexual and existential healing (salutogenesis) through direct confrontation and integration of both the repressed shame, guilt, and other negative feelings associated with body, genitals, and sexuality, and the repressed sexual pleasure and desire. We conducted a retrospective analysis of clinic data from holistic sexological manual therapeutic intervention, an intensive subtype of clinical holistic medicine (CHM). The patients received 3 × 5 h of group therapy, integrating short-term psychodynamic psychotherapy (STPP) and complementary medicine (CAM bodywork, manual sexology similar to the “sexological examination”). The therapy used the advanced tools of reparenting, genital acceptance, acceptance through touch, and direct sexual clitoral stimulation. A clitoral vibrator was used. Participants were 500 female patients between 18 and 88 years of age (mean of 35 years) with chronic anorgasmia (for 12 years on average) who were participating in the “orgasm course for anorgasmic women”; 25% of the patients had never experienced an orgasm. Our results show that 465 patients (93%) had an orgasm during therapy, witnessed by the therapist, and 35 patients (7%) did not. Postmenopausal women were as able to achieve orgasm as fertile women, as were women who never had an orgasm. No patients had detectable negative side effects or adverse effects. NNT: 1.04 < NNT < 1.12, NNH > 500. Therapeutic value: TV = NNH/NNT > 446. Our conclusions are that holistic sexological manual therapy may be rational, safe, ethical, and efficient."

"In this study, 500 female patients with often lifelong anorgasmia received direct sexual stimulation of the clitoris during the therapy and 93% of the patients experienced that the procedure solved their problem. The success of this study gives us one more very important tool for holistic medicine. Together with the other tools of holistic manual therapy, such as acceptance through touch and acupressure through the vagina, we now have tools for solving problems related to female sexual dysfunction. We therefore conclude that direct sexual stimulation can be a safe and efficient procedure, and an important new tool in the holistic medical toolbox."

"This study investigated the relative effectiveness of specific genital regional self-stimulation in elevating pain thresholds. Anecdotal reports in humans suggest that sexual activity and orgasm decrease a wide variety of human responses to pain and touch, but the phenomenon has not been evaluated objectively. Two types of self-stimulation, pressure and pleasurable, were applied by 10 women to the anterior vaginal wall, the posterior vaginal wall, and the clitoris. Significant increases in pain thresholds but not tactile thresholds occurred when pressure stimulation was applied to the anterior wall of the vagina or when "pleasurable" self-stimulation was applied to any of the three areas. Tactile thresholds were not significantly affected by any genital stimulation condition. However, there was a significant increase in tactile threshold but not pain thresholds in the distraction control condition. On the basis of these findings, we conclude that (a) a sensation of pleasure evoked by genital stimulation can elevate pain thresholds, (b) these pleasurable stimuli were not general "distractants" because they elevated pain thresholds but not tactile thresholds differentially, and (c) genital pleasurable stimuli activate an analgesic process that is distinct from a distraction process."

"In 2 studies with 10 women each, vaginal self-stimulation significantly increased the threshold to detect and tolerate painful finger compression, but did not significantly affect the threshold to detect innocuous tactile stimulation. The vaginal self-stimulation was applied with a specially designed pressure transducer assembly to produce a report of pressure or pleasure. In the first study, 6 of the women perceived the vaginal stimulation as producing pleasure. During that condition, the pain tolerance threshold increased significantly by 36.8% and the pain detection threshold increased significantly by 53%. A second study utilized other types of stimuli. Vaginal self-stimulation perceived as pressure significantly increased the pain tolerance threshold by 40.3% and the pain detection threshold by 47.4%. In the second study, when the vaginal stimulation was self-applied in a manner that produced orgasm, the pain tolerance threshold and pain detection threshold increased significantly by 74.6% and 106.7% respectively, while the tactile threshold remained unaffected. A variety of control conditions, including various types of distraction, did not significantly elevate pain or tactile thresholds. We conclude that in women, vaginal self-stimulation decreases pain sensitivity, but does not affect tactile sensitivity. This effect is apparently not due to painful or non-painful distraction."

"[T]here were reasons for the acceptance of vaginal orgasm by female manual authors. The strong resistance to masturbatory activities reveals that such women were not internalizing a new prohibition in rejecting clitoral stimulation but extending an existing one. Manuals by women (and the evidence on behavior) also suggest that English women were generally less comfortable with varied sexual practices that were men. For many married women of this generation their sexual aspirations lay in a different direction. Although the theme had been present in the manuals throughout the inter-war period, the 1950s saw the peak of the insistence on vaginal orgasm for women and the peak of the glorification of sexual intercourse as a transcendent, shared emotional experience for the couple. Authors used phrases such as “their spirits as well as their bodies seem to rise together to a flame of ecstasy which is quite indescribable’ or ‘total emotional surrender’. Definitions of marital sexual pleasure incorporated emotion. In ‘’The Golden Notebook’’ (1962) the Rhodesian-born novelist Doris Lessing (b. 1919) made a frequently quoted, classic statement of support for the vaginal orgasm. She wrote that a ‘vaginal orgasm is emotion and nothing else, felt as emotion and expressed in sensation that are indistinguishable from emotion’. In her 1995 autobiography she also commented that ‘when I masturbated in my adolescence it was the vagina and its amazing possibilities I learned about. The clitoris was only part of the whole ensemble.’ In the 1950s, there were many articulate middle-class women who agreed with Doris Lessing and her perception of female sexual experience. They experienced coitus and vaginal orgasm as an emotional experience and they wanted men to participate emotionally also. Men had to alter their attitude to marital sexuality if they were to accommodate this demand, as a shared emotional experience was incompatible with the exercise of conjugal rights. Thus, in a context where male initiation and management of physical sexual activity was still the norm, the vaginal orgasm involved a further step toward the destruction of the double standard."

"“Possibly about a third of civilized women get their climax externally [clitorally]; perhaps another third achieve it mainly in the vaginal passage, and another third achieve it seldom or never. Of women who can reach it from either area it is found that the inner climax is generally-but not quite always-the one most valued. It is held by psychiatrists that the emotional content of the two types of orgasm is different. Most women will confirm this, though there can be no question of the significance being identical for everybody.’’ This revealed considerable problems. According to Malleson, two-thirds of women were not achieving the vaginal orgasms held to be most desirable by Freud, by most sex manual authors, and frequently by women themselves. Less specifically, Helena Wright, who saw London women through her private medical practice and Family Planning clinics, wrote in 1947 that she had kept careful records of her patients’ experiences since 1928, and that ‘sexual satisfaction is not obtained by more than 50 per cent of married women’. Unsurprisingly Macaulay, who advised women to lower their expectations, was more sanguine about female sexual pleasure: ‘The answers I have received on questioning my patients about their sexual life are in complete contrast to the somewhat gloomy figures published by other writers.’ In her second sex manual, published in 1947, Wright commented that ‘Fifteen years ago most workers along this line thought that the main problem [for women] was ignorance.’ This, Wright felt, had changed, revealing another problem, which was that both men and women expected female sexual response to conform to a male pattern: [Men] discover very early in their sexual experience that…a comparatively short time of rhythmic movements of the penis in the vagina produces an orgasm and ejaculation easily and completely…men, therefore, expect that…"

"Preliminary work has revealed that only about 7% of women always have orgasms with sex alone, he says, while 27% say they never do. The current research hold-up: developing a reliable, at-home technique for measuring C-V distance, especially one that can deal with stretchy skin. Women with a large C-V distance should not be discouraged, Wallen says. "Personally, I don't think the inability to experience no-hands, penis-only intercourse with orgasm says anything about a happy sex life," he says. "Maybe it could allow couples to be a bit more inventive in how they have sex.""

"Despite orgasm being a near-universal human phenomenon, we still don’t know all that much about it. “The amount of speculation versus actual data on both the function and value of orgasm is remarkable,” says Julia Heiman, director of the Kinsey Institute for Research in Sex, Gender and Reproduction in Bloomington, Indiana. It is estimated that one in four women in the US has had difficulty achieving orgasm in the past year, while between 5 and 10 per cent of women are anorgasmic – unable to achieve orgasm at all. But without precise data to explain what happens during this experience, there are few treatment options available for women who might want help."

"Orgasms are a truly altered, if fleeting, state of consciousness. And most people (though not all) experience them somewhat regularly. So it's a bit surprising how seldom we talk about orgasms publicly — and scientifically, how little we know about them."

"Generally, no functional role, except pleasure, is assigned to a women's coital orgasm. Recently, however, researchers have suggested that women can regulate the number of sperm accepted or rejected by manipulation coital orgasm timing. Baker and Bellis (1995) demonstrated that women retain more sperm if coital orgasm occurs after, rather than before male ejaculation. The present study investigated (i) factors associated with coital orgasm frequency and (ii) whether women desirous of becoming pregnant report more coital orgasms after than before their partners. Sixty-nine women rated their desire for pregnancy and answered questions about their sexual behaviors, coital orgasm frequency, and coital orgasm timing in relation to their partners. In regression analysis, coital orgasm frequency was predicted by foreplay duration, masturbation frequency, and active sexual participation; desire for pregnancy did not predict coital orgasm frequency. Desire for pregnancy was predicted by age (negatively), active sexual participation (positively), and positively by orgasm after partner ejaculation. Consistent with the Baker and Bellis hypothesis, frequency of orgasm after partner's orgasm remained a significant predictor for desire for pregnancy after controlling for degree of marital happiness, sexual foreplay duration, and coital orgasm frequency."

""Their brain activity is very similar to women who have orgasms from physical self-stimulation," Komisaruk says. This even includes heightened activity in the sensory cortex, the area that primarily responds to touch. "Just thinking about stimulation, it turns out, is a very potent way of stimulating this region," he says."

"By the time you actually experience an orgasm, "more than 30 major brain systems are activated," Komisaruk says. "It's not a local, discrete event. There's no 'orgasm center.' It's everywhere.""

"Georgiadis argues that the OFC may be the basis of sexual control – and perhaps only by letting go, so to speak, can orgasm be achieved. He suggests this deactivation may be the most telling example of an “altered state of consciousness” and one not seen, as yet, during any other type of activity. “I don’t think orgasm turns off consciousness but it changes it,” he says. “When you ask people how they perceive their orgasm, they describe a feeling of a loss of control.” Georgiadis suggests that perhaps orgasm offsets systems that usually dominate attention and behaviour. “I’m not sure if this altered state is necessary to achieve more pleasure or is just some side effect,” he says. It is possible that the inability to let go and reach this altered state may be what prohibits individuals with anorgasmia from reaching climax."

"It has generally been assumed that a male's experience of orgasm is different from a female's experience of orgasm. In this study, a questionnaire consisting of 48 description of orgasm (24 male and 24 female) was submitted to 70 judges. These professionals (obstetrician-gynecologists, psychologists and medical students) were to sex-identify the description to discover whether sex differences could be detected. The judges could not correctly identify the sex of the person describing an orgasm. Furthermore, none of the three professional groups represented in the sample of judges did better than any of the other groups. Male judges did no better than female judges and vice versa. These findings suggest that the experience of orgasm for males and females is essentially the same."

"Ali Wong: I think that’s part of it, for sure. But it really helped me when I had a miscarriage to talk to other women and hear that they’d been through it, too. It’s one thing to hear the statistics, but it’s another to put faces to the numbers so you stop feeling like it’s your fault. I think that’s one of the reasons women don’t tell people when they’ve had a miscarriage – they think it’s their fault. I remember I worried what my in-laws would think, which is so crazy. I thought they’d think their son had married a terrible person. Also, because I made the mistake of telling people as soon as I got pregnant, I then had to tell them the bad news, and then I felt like I was burdening them. So being able to joke about it was such a relief. Comedy only works when it comes from an honest place, and the relief that I’d miscarried twins was real!"

"Q: The moment in your special that really made me gasp out loud is when you joke about how you suffered a miscarriage before, and how you were secretly relieved because they were twins. Do you think that joke only works because the audience could see that you got pregnant again, so there is redemption to the loss?"

"Of those who took part 15% said they or their partner had suffered a miscarriage, but the majority of respondents (55%) believed that miscarriages are uncommon (defined as less than 6% of all pregnancies). The truth is that miscarriages end one in four pregnancies and are by far the most common pregnancy complication, the paper says. A fifth of people incorrectly believed that lifestyle choices during pregnancy, such as smoking or using drugs or alcohol, were the single most common cause of miscarriage, more common than genetic or medical causes. In reality, 60% of miscarriages are caused by a genetic problem."

"The authors concluded: “Patients who have experienced miscarriage may benefit from further counselling by healthcare providers, identification of the cause, and revelations from friends and celebrities. Healthcare providers have an important role in assessing and educating all pregnant patients about known prenatal risk factors, diminishing concerns about unsubstantiated but prevalent myths and, among those who experience a miscarriage, acknowledging and dissuading feelings of guilt and shame.”"

"Our study findings support the concept of ‘biological superfertility’ in women with RMC and present a unique finding that superfertility may be more prevalent in obese women with a history of RMC. Further prospective studies in women with idiopathic RMC are required to confirm the association of BMI, RMC and superfertility. If confirmed, further investigation is required to understand why obesity predisposes to superfertility. Superfertility may likely be linked to impaired endometrial development in the peri‐implantation period; further research to describe the peri‐implantation endometrium in obese women and to study the exact mechanism by which obesity affects the endometrium is required. Clinical trials with therapeutic targets to improve decidualisation and thus reproductive outcome in obese women could hold significant clinical potential."

"A significant number of the respondents were under misapprehensions as to what caused the loss of the pregnancy. Three-quarters believed that a stressful event could bring about a miscarriage, 64% thought that lifting a heavy object could be a cause, and a fifth that previous use of oral contraceptives could induce pregnancy loss."

"It is difficult to investigate very early miscarriages using prospectively collected exposure information, since the time period, in which collection of exposure information must take place, that is, the time from detection of pregnancy to the occurrence of an early miscarriage, is short."

"Only a few previous studies have investigated the association between exercise and miscarriage. The only study that clearly supports our findings is a cohort study, which concluded that self-reported physical strain around the time of implantation (days 6–9 after ovulation) was associated with an increased risk of miscarriage (HR 2.5, 95% CI = 1.3–4.6). In contrast, Latka et al found a reduced risk of miscarriage with no chromosome defect in women who exercised compared with those who did not (OR = 0.5, 95% CI = 0.3–1.0). The case–control design was, however, based on a hypothesis that exercise cannot lead to chromosome aberrations in the fetus, as the control group consisted of women with miscarriages with chromosome aberrations. This assumption may be questioned since mode of action is unknown. In a small prospective study, Clapp found no statistically significant difference in risk of miscarriage between recreational runners (n = 49), aerobic dancers (n = 39) and a control group of active women, who had stopped exercising before the time of conception (n = 29). The study population was in excellent condition and had been exercising for years prior to the pregnancy, and the results may not be representative of the population at large. Two other studies have only investigated late miscarriages."

"In this study, based on data from nearly 93,000 women, a dose-response relation was seen for the association between the amount of weekly exercise and the risk of miscarriage early in pregnancy. Certain types of exercise, and particularly high-impact types of exercise, were found to be associated with a higher risk of miscarriage. In the analyses based only on prospectively collected exposure data, the association did, however, attenuate, indicating a certain degree of recall bias. An alternative explanation to recall bias may be that exercise only in the early stages of pregnancy hurts the pregnancy outcome. In this case, the difference in the HRs between the analyses based on the total data material and the subcohort of only prospectively collected data is not as much a result of the mode of data collection as a reflection of the fact that the total data material encompasses the very early miscarriages. Even within the subperiods of gestational age, the miscarriages occur earlier for the pregnancies with retrospectively collected exposure information than for pregnancies with a first pregnancy interview (Figure 2). In addition, we did see a positive trend in the association between exercise and the risk of miscarriages in the earliest period of pregnancy (gestational weeks 11–14) in the subcohort using prospectively collected data only."

"Miscarriage remains the most common complication of pregnancy despite many advances in the understanding of early pregnancy. Loss of three or more consecutive pregnancies before 24 weeks of gestation is the most accepted definition for recurrent miscarriage (RMC) in Europe, but has recently been defined by the American Society for Reproductive Medicine as a disease with two or more failed pregnancies. Despite best efforts to identify the underlying causes for RMC, it remains ‘unexplained’ in the majority of cases. Chromosomal errors appear to be common in the pre-implantation developing embryos6, 7, which predispose to increased risk of pregnancy losses. High rates of chromosomally abnormal cells within human embryos mean that the reproductive success is dependent on the endometrial ability to distinguish between normal and abnormal embryos. In vitro studies have provided convincing evidence that perturbation in the bio‐sensor function of the decidualised endometrium is an important mechanism underpinning RMC."

"Fetus death risk reduction is included in the United Nations Sustainable Development Goals. However, little is known about how missed abortion in the first trimester (MAFT) is related to maternal air pollution exposure. We quantify the link between air pollution exposure and MAFT in Beijing, China, a region with severe MAFT and air quality problems. We analyse the records of 255,668 pregnant women from 2009 to 2017 and contrast them with maternal exposure to air pollutants (particulate matter PM2.5, SO2, O3 and CO). We adjust for confounding factors such as sociodemographic characteristics, spatial autocorrelation and ambient temperature. We find that, for all four pollutants, an increased risk of MAFT is associated with rises in pollutant concentrations, and the adjusted odds ratios (ORs) of these associations increase with higher concentrations. For example, the adjusted OR of MAFT risk for a 10.0 μg m−3 increase in SO2 exposure is between 1.29 and 1.41 at concentrations of 7.1–19.5 μg m−3; it drops to 1.17 below this range and rises to 1.52 above it at higher SO2 concentrations. This means that the risk increase is not linear but becomes more severe the higher the pollutant concentration. The findings provide evidence linking fetus disease burden and maternal air pollution exposure."

"In the existing body of literature, exercise during pregnancy has generally not been associated with miscarriage,17–19 and one case–control study has even reported a protective effect of exercise during pregnancy.20 In contrast, Hjollund et al.21 found an increased risk of early miscarriage among women who reported a high physical strain around the time of implantation of the embryo. Furthermore, lay people have tried to use excessive physical exercise as an abortifacient, and older literature mentions physical activity (e.g. jumping, running, and horseback riding) as a cause of miscarriage. Considering the relatively sparse literature and the somewhat inconsistent results, we wanted to examine the association between exercise during pregnancy and miscarriage in a large population-based cohort."

"Our study findings are supportive of the concept that increased female BMI may have a negative influence on the early pregnancy outcome. We found a significant positive correlation between the BMI and first-trimester pregnancy losses and anembryonic miscarriages. There were also significantly more first-trimester miscarriages in obese women than in normal-weight or overweight women with recurrent miscarriage."

"The main results based on the total data material showed that an increasing amount of time spent on exercise was associated with a greater risk of miscarriage compared with non-exercisers. Exercising 1–44 minutes/week was not associated with an increased risk of miscarriage."

"The effect of long-term exposure to dirty air on the risk of miscarriage has been analysed previously. Studies from Brazil to Italy to Mongolia found a link, but others failed to do so. However, the latest study is the first to assess the impact of short-term exposure to air pollution. It found that raised levels of nitrogen dioxide (NO2) pollution that are commonplace around the world increased the risk of losing a pregnancy by 16%. “It’s pretty profound,” said Dr Matthew Fuller, at the University of Utah’s department of emergency medicine and one of the research team. “If you compare that increase in risk to other studies on environmental effects on the foetus, it’s akin to tobacco smoke in first trimester pregnancy loss.” NO2 is produced by fuel burning, particularly in diesel vehicles."

"Dr Sarah Stock, at the University of Edinburgh and not part of the research team, said: “Air pollution is clearly detrimental to the health of millions of mothers, babies and children worldwide. Measures to reduce the impact of air pollution are crucial to ensure the health of future generations.”"

"Occupational studies included in this review found that several occupational and non-occupational factors influenced reproductive outcomes. Occupational factors involved included standing, lifting, and exposure to chemicals—typically, individuals exposed to noise were also exposed to other occupational hazards. Important non-occupational factors were mother’s age, mother's weight and height, mother’s weight gain during pregnancy, smoking, education, race and socioeconomic status. Gravidity and parity, and chronic diseases of the mother were also important factors for the examination of spontaneous abortion or preterm labour."

"New multi-disciplinary research on brain–body interactions triggered by stress in early pregnancy has shown that maternal biological responses, including localised inflammation in uterine tissue and sustained depression of progesterone production, challenge the endocrine-immune steady state during pregnancy, leading to serious consequences for the fetal environment. Recent basic science findings and new theoretical development around a ‘pregnancy stress syndrome’ associated with over-activation of the HPA axis warrant a new look at the epidemiological evidence around the age-old question of whether or not stress can actually cause human reproductive failure."

"Obesity has become a major health problem across the world. In the UK, obesity affects one‐fifth of the female population ( Anonymous, 2001 ). Maternal obesity has been reported as a risk factor for adulthood obesity in offspring ( Parsons et al ., 2001 ). Obesity may also lead to a poor pregnancy out-come, such as sudden and unexplained intrauterine death ( Froen et al ., 2001 ), and in women with polycystic ovary syndrome (PCOS) receiving infertility treatment is associated with an increased risk of miscarriage ( Hamilton‐Fairley et al ., 1992 ; Wang et al ., 2000 ). However, in the general population there is less evidence for a link between obesity and spontaneous miscarriage ( Risch et al ., 1990 )."

"We always write stories of tragedies because that's how we reach our human depth. How we get to the other side of it? We look at the cruelty, the darkness and horrific events that happened in our life, whether it be a miscarriage or a husband who is not faithful. Then you find this ability to transcend. And that is called the passion, like the passion of Christ. You could call this the passion of Frida Kahlo, in a way. When I talk about passion, and I'm not a religious person, but I absolutely am drawn and attracted to the power of religious art because it gets at that most extreme emotion of the human experience."