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Dive into the research topics where Marieke Brauer is active.

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Featured researches published by Marieke Brauer.


Journal of Sex & Marital Therapy | 2006

The Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale (FSDS): Psychometric Properties within a Dutch Population

Moniek M. ter Kuile; Marieke Brauer; Ellen Laan

The aim of the present study was to investigate the psychometric properties of the Female Sexual Function Index (FSFI; Rosen et al., 2000) and the Female Sexual Distress Scale (FSDS; Derogatis, Rosen, Leiblum, Burnett, & Heiman, 2002) within a Dutch population of approximately 350 women with and without sexual complaints. The main conclusions of this study are that the multidimensional structure of the FSFI and the unidimensional structure of the FSDS are fairly well replicated in a Dutch sample. The amount of variance explained by confirmatory and exploratory factor analyses was good. Internal consistency and stability of the FSFI and its subscales and the FSDS are satisfactory to good, and the subscales are reasonably stable across demographic variables. The discriminant validity and the ability of the scales to predict the presence or absence of sexual complaints was excellent. The convergent and divergent construct validity of the FSFI and the FSDS was good. These results support the reliability and psychometric validity of the FSFI and the FSDS in the assessment of dimensions of female sexual functioning and sexual distress in clinical and nonclinical samples.


European Journal of Pain | 2007

The effect of pain-related fear on sexual arousal in women with superficial dyspareunia.

Marieke Brauer; Moniek M. ter Kuile; Sabine A. Janssen; Ellen Laan

The role of pain‐related fear in the etiology and/or maintenance of superficial dyspareunia is still unclear. The objective of this experiment was to investigate the effects of pain‐related fear on sexual arousal in women with superficial dyspareunia (n=48) and women without sexual complaints (n=48). To induce pain‐related fear, participants were told that they had a 60% chance of receiving painful stimuli while being exposed to one of two erotic film clips. Genital arousal was assessed using vaginal photoplethysmography. Self‐reported ratings of genital sensations and affect were collected after both erotic stimulus presentations. Elevated levels of skin conductance and higher ratings of experienced threat during the pain threat condition indicated that fear was successfully elicited. Pain‐related fear impeded genital arousal in all women. Women of both groups reported significantly less positive affect and more negative affect when threatened. Although women with dyspareunia did not differ in their genital responsiveness from women without sexual complaints, they experienced overall significantly more negative affect than the control group. The present results indicate that pain‐related fear reduces genital and subjective sexual responding in women with and without sexual problems. We conclude that emotional appraisal of the sexual situation determines genital responsiveness in both sexually dysfunctional and functional women.


Journal of Sex & Marital Therapy | 2008

Cognitive-affective correlates and predictors of superficial dyspareunia

Marieke Brauer; Moniek M. ter Kuile; Ellen Laan; Baptist Trimbos

This study investigated the role of cognitive-affective variables related to sexuality, chronic pain, individual and relational well-being in superficial dyspareunia. Although symptomatic women (n = 80) differed from complaint-free controls (n = 62) on all variables, sexuality related measures had the most important contribution into the prediction of group membership. Dyspareunia subgroups based on the presence/absence of a concomitant diagnosis of provoked vestibulodynia were only distinguishable on pain intensity but not on variables related to sexuality and psychological well-being. The present findings underscore the relevance of psychosexual factors in women with superficial dyspareunia.


Archives of Sexual Behavior | 2009

Effects of Appraisal of Sexual Stimuli on Sexual Arousal in Women with and Without Superficial Dyspareunia

Marieke Brauer; Moniek M. ter Kuile; Ellen Laan

This study examined the effects of appraisal of sexual stimuli on sexual arousal in women with superficial dyspareunia (nxa0=xa050) and sexually functional women (nxa0=xa025). To elicit different appraisals of an erotic film fragment, participants received an instruction prior to viewing it, with a focus on genital pain or on sexual enjoyment. A neutral instruction served as a control condition. Assignment to instruction condition was randomized. Genital arousal (vaginal pulse amplitude) and self-report ratings of affect and genital sensations were obtained in response to the erotic stimulus. As predicted, appraisal of the erotic stimulus affected genital responding, albeit marginally significant. Follow-up tests indicated that women who received the genital pain instruction responded with marginally significant lower genital arousal levels than women who received the sexual enjoyment instruction (dxa0=xa00.67). A significant instruction effect for negative affect was found, signifying that negative affect ratings were highest after the genital pain instruction and lowest after the sexual enjoyment instruction (dxa0=xa00.80). A marginally significant group by instruction interaction effect was observed for positive affect, indicating that women with dyspareunia reported significantly less positive affect than controls after the sexual enjoyment instruction (dxa0=xa01.48). Whereas women with dyspareunia reported overall marginally significant more negative affect than controls (dxa0=xa00.48), there were no differences in genital responsiveness between groups. These results provided preliminary evidence for the modulatory effects of appraisal of sexual stimuli on subsequent genital responding and affect in women with and without sexual complaints.


The Journal of Sexual Medicine | 2014

Predictors of Task-Persistent and Fear-Avoiding Behaviors in Women with Sexual Pain Disorders

Marieke Brauer; Marielle M. E. Lakeman; Rik H. W. van Lunsen; Ellen Laan

INTRODUCTIONnDyspareunia and vaginismus are the most common sexual pain disorders (SPDs). Literature suggests that many women with dyspareunia continue with intercourse despite pain (task persistence), whereas many women with vaginismus avoid penetrative activities that may cause pain (fear avoidance). Both forms of sexual pain behavior may maintain or aggravate complaints.nnnAIMnThis study examined (i) whether women with SPD differ from pain-free controls in motives for sexual intercourse, sexual autonomy, maladaptive beliefs regarding vaginal penetration, and partner responses to pain; and (ii) which of these factors best predict whether women with SPD stop or continue painful intercourse (attempts).nnnMETHODSnWomen with superficial dyspareunia (nu2009=u200950), women with lifelong vaginismus (nu2009=u200920), and pain-free controls (nu2009=u200945) completed questionnaires.nnnMAIN OUTCOME MEASURESnFor Aim 1, the main outcome measures were (i) motives for intercourse; (ii) sexual autonomy; (iii) maladaptive beliefs regarding vaginal penetration; and (iv) partner responses to pain. For Aim 2, sexual pain behavior (to continue or discontinue with painful intercourse) was the outcome measure.nnnRESULTSn(i) Women with dyspareunia exhibited more mate guarding and duty/pressure motives for intercourse and were less sexually autonomous than controls. (ii) Symptomatic women had more maladaptive penetration-related beliefs than controls, with women with vaginismus reporting the strongest maladaptive beliefs. (iii) Partners of women with dyspareunia self-reported more negative responses to pain than those of women with vaginismus. (iv) The factors that best predicted sexual pain behavior were the partner responses to pain and the womans maladaptive beliefs regarding vaginal penetration.nnnCONCLUSIONSnOur findings reveal support for task persistence in women with dyspareunia and fear avoidance in women with lifelong vaginismus. As such, it is important to consider these distinct types of responding to sexual pain when treating SPD.


Archives of Sexual Behavior | 2009

Automatic and Deliberate Affective Associations with Sexual Stimuli in Women with Superficial Dyspareunia

Marieke Brauer; Peter J. de Jong; Jorg Huijding; Ellen Laan; Moniek M. ter Kuile

Current views suggest that in women with superficial dyspareunia the prospect of penile–vaginal intercourse automatically activates fear-related associations. The automatic activation of negative associations is assumed to interfere with the development of sexual arousal. In turn, this may further aggravate the dyspareunia-related complaints. To assess whether automatic negative associations are involved in this sexual pain disorder, women with superficial dyspareunia (nxa0=xa035) and a control group (nxa0=xa035) completed a modified pictorial Affective Simon Task (AST). Questioning the role of dysfunctional automatic associations in superficial dyspareunia, the AST indicated that symptomatic women displayed relatively positive rather than negative automatic associations with sexual stimuli. At the self-report level, however, affective associations with sex cues were significantly more negative for women with dyspareunia than for controls. This discrepancy between “reflective” and “reflexive” affective associations with sexual stimuli in women with dyspareunia points to the relevance of conscious appraisal and deliberate rather than automatic processes in the onset and maintenance of dyspareunia.


Hormones and Behavior | 2011

Sexual desire, sexual arousal and hormonal differences in premenopausal US and Dutch women with and without low sexual desire

Julia R. Heiman; Heather A. Rupp; Erick Janssen; Sarah Newhouse; Marieke Brauer; Ellen Laan

The interaction between womens hormonal condition and subjective, physiological, and behavioral indices of desire or arousal remains only partially explored, in spite of frequent reports from women about problems with a lack of sexual desire. The present study recruited premenopausal women at two sites, one in the United States and the other in the Netherlands, and incorporated various measures of acute changes in sexual desire and arousal. A sample of 46 women who met criteria for Hypoactive Sexual Desire Disorder (HSDD) was compared to 47 women who experienced no sexual problems (SF). Half of each group used oral contraceptives (OCs). The specific goal was to investigate whether there is a relationship between womens hormone levels and their genital and subjective sexual responsiveness. Background demographics and health variables, including oral contraceptive (OC) use, were recorded and hormones (total testosterone (T), free testosterone (FT), SHBG, and estradiol) were analyzed along with vaginal pulse amplitude and self-report measures of desire and arousal in response to sexual fantasy, visual sexual stimuli, and photos of mens faces. Self-reported arousal and desire were lower in the HSDD than the SF group, but only for women who were not using oral contraceptives. Relationships between hormones and sexual function differed depending on whether a woman was HSDD or not. In line with prior literature, FT was positively associated with physiological and subjective sexual arousal in the SF group. The HSDD women demonstrated the opposite pattern, in that FT was negatively associated with subjective sexual responsiveness. The findings suggest a possible alternative relationship between hormones and sexual responsiveness in women with HSDD who have characteristics similar to those in the present study.


Archives of Sexual Behavior | 2012

Attentional and affective processing of sexual stimuli in women with hypoactive sexual desire disorder.

Marieke Brauer; Matthijs L. van Leeuwen; Erick Janssen; Sarah Newhouse; Julia R. Heiman; Ellen Laan

Hypoactive sexual desire disorder (HSDD) is the most common sexual problem in women. From an incentive motivation perspective, HSDD may be the result of a weak association between sexual stimuli and rewarding experiences. As a consequence, these stimuli may either lose or fail to acquire a positive meaning, resulting in a limited number of incentives that have the capacity to elicit a sexual response. According to current information processing models of sexual arousal, sexual stimuli automatically activate meanings and if these are not predominantly positive, processes relevant to the activation of sexual arousal and desire may be interrupted. Premenopausal U.S. and Dutch women with acquired HSDD (nxa0=xa042) and a control group of sexually functional women (nxa0=xa042) completed a single target Implicit Association Task and a Picture Association Task assessing automatic affective associations with sexual stimuli and a dot detection task measuring attentional capture by sexual stimuli. Results showed that women with acquired HSDD displayed less positive (but not more negative) automatic associations with sexual stimuli than sexually functional women. The same pattern was found for self-reported affective sex-related associations. Participants were slower to detect targets in the dot detection task that replaced sexual images, irrespective of sexual function status. As such, the findings point to the relevance of affective processing of sexual stimuli in women with HSDD, and imply that the treatment of HSDD might benefit from a stronger emphasis on the strengthening of the association between sexual stimuli and positive meaning and sexual reward.


The Journal of Sexual Medicine | 2014

Automatic and deliberate affective associations with sexual stimuli in women with lifelong vaginismus before and after therapist-aided exposure treatment

Reinhilde Melles; Moniek M. ter Kuile; Marieke Dewitte; Jacques van Lankveld; Marieke Brauer; Peter J. de Jong

INTRODUCTIONnThe intense fear response to vaginal penetration in women with lifelong vaginismus, who have never been able to experience coitus, may reflect negative automatic and deliberate appraisals of vaginal penetration stimuli which might be modified by exposure treatment.nnnAIMSnThe aim of this study is to examine whether (i) sexual stimuli elicit relatively strong automatic and deliberate threat associations in women with vaginismus, as well as relatively negative automatic and deliberate global affective associations, compared with symptom-free women; and (ii) these automatic and more deliberate attitudes can be modified by therapist-aided exposure treatment.nnnMETHODSnA single target Implicit Association Test (st-IAT) was used to index automatic threat associations, and an Affective Simon Task (AST) to index global automatic affective associations. Participants were women with lifelong vaginismus (N = 68) and women without sexual problems (N = 70). The vaginismus group was randomly allocated to treatment (n = 34) and a waiting list control condition (n = 34).nnnMAIN OUTCOME MEASURESnIndices of automatic threat were obtained by the st-IAT and automatic global affective associations by the AST, visual analogue scales (VAS) were used to assess deliberate appraisals of the sexual pictures (fear and global positive affect).nnnRESULTSnMore deliberate fear and less global positive affective associations with sexual stimuli were found in women with vaginismus. Following therapist-aided exposure treatment, the strength of fear was strongly reduced, whereas global positive affective associations were strengthened. Automatic associations did not differ between women with and without vaginismus and did not change following treatment.nnnCONCLUSIONSnRelatively stronger negative (threat or global affect) associations with sexual stimuli in vaginismus appeared restricted to the deliberate level. Therapist-aided exposure treatment was effective in reducing subjective fear of sexual penetration stimuli and led to more global positive affective associations with sexual stimuli. The impact of exposure might be further improved by strengthening the association between vaginal penetration and positive affect (e.g., by using counter-conditioning techniques).


The Journal of Sexual Medicine | 2015

Motives for Vulvar Surgery of Women with Lichen Sclerosus

Marieke Brauer; Rik H. W. van Lunsen; Matthé P.M. Burger; Ellen Laan

INTRODUCTIONnWomen with lichen sclerosus (LS) may experience (superficial) dyspareunia or the inability to have vaginal intercourse due to painful fissures and narrowing of the vaginal introitus. A surgical procedure may contribute to the relief of these sexual pain problems. It is unknown what motives women have to undergo surgery in order to regain the ability to have sexual intercourse. Such knowledge can offer important insights that are indispensable when discussing the option of vulvar surgery with patients with LS and might prevent potential patient dissatisfaction. This studys purpose is to examine why women with LS decide to undergo vulvar surgery in order to restore intercourse.nnnMETHODSnNineteen women with anogenital LS participated in audiotaped qualitative individual interviews, in which their motives for undergoing vulvar surgery to restore intercourse were explored retrospectively. Interview data were analyzed using the constant comparative method.nnnRESULTSnThree main motives for wanting to undergo surgery in order to restore intercourse were found. These were the desire to be a normal woman, the desire to sexually satisfy the male partner, and the desire to regain the experience of intimacy and sexual enjoyment. Another reason for surgery was to reduce daily life LS symptoms. The sexual pain complaints prevented the women from living up to their norms about heterosexuality and gender roles. Being unable to have intercourse led women to feel inadequate as a woman and as a sexual partner.nnnCONCLUSIONSnWomen with LS may opt for surgery to restore their identity as a normal woman and sexual partner, to regain the experience of coital intimacy, and to be less bothered by LS symptoms in daily life. The present findings point to the importance of a thorough couple-based sexual history in which womens motives for and expectations of vulvar surgery will be explored in order to facilitate a good decision and to increase treatment satisfaction.

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Ellen Laan

University of Amsterdam

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Moniek M. ter Kuile

Leiden University Medical Center

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E. Laan

Academic Medical Center

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Erick Janssen

Katholieke Universiteit Leuven

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