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They took the first dance. Edited : I should have said earlier - I don't like weddings. I tend to do anything to get out of a wedding invitation and I'm unhappy when I fail.

Attending a wedding is like going to a dentist's. At my CP which we held like a wedding , we walked in together with the registrars leading us in.

We both had a matron of honour but we didn't have bridesmaids. I am to be 'best woman' for my ex-husband who is marrying his partner in October. They plan to walk in from opposite sides of the venue as it has two aisles.

I think I have to follow walking their dog on a beribboned lead unless I can talk them out of it.

Goldengayer Posts: Forum Member. Duffman Posts: 1, Forum Member. Maxatoria Posts: 17, Forum Member. Work out whats legally required and just do what you want for the rest so long as its legal, tradition is tradition because its been done for a long time so you may be able to start off some traditions of your own since gay weddings are so new.

One of you has to have bridesmaids, because it's tradition for the best man or ushers to try and bang them in the hotel rooms where you have the reception.

Hugh Jboobs Posts: 15, Forum Member. Been to a lesbian wedding. In their relationship there is an obvious "man" and "woman".

As such, their wedding was almost exactly like a straight one. The woman wore a big white dress, the man wore a suit. The woman was walked down the aisle by her dad, the man stood and waited for her with her best man.

The father of the bride made a speech, as did the "groom" and best man. And so on. It was a good day! They had The Conga as their first dance.

When my sister married her partner, they had their daughter as a flower girl. Here, the processing of cues of varying sexual content was assessed in individuals with and without CSB, focusing on neural regions identified in prior studies of drug-cue reactivity.

Ratings of sexual desire and liking were obtained. Relative to healthy volunteers, CSB subjects had greater desire but similar liking scores in response to the sexually explicit videos.

Exposure to sexually explicit cues in CSB compared to non-CSB subjects was associated with activation of the dorsal anterior cingulate, ventral striatum and amygdala.

Functional connectivity of the dorsal anterior cingulate-ventral striatum-amygdala network was associated with subjective sexual desire but not liking to a greater degree in CSB relative to non-CSB subjects.

The dissociation between desire or wanting and liking is consistent with theories of incentive motivation underlying CSB as in drug addictions.

Neural differences in the processing of sexual-cue reactivity were identified in CSB subjects in regions previously implicated in drug-cue reactivity studies.

The greater engagement of corticostriatal limbic circuitry in CSB following exposure to sexual cues suggests neural mechanisms underlying CSB and potential biological targets for interventions.

Citation: Voon V, Mole TB, Banca P, Porter L, Morris L, Mitchell S, et al. PLoS ONE 9 7 : e Received: March 6, ; Accepted: June 19, ; Published: July 11, This is an open-access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: The authors confirm that all data underlying the findings are fully available without restriction.

All data are included within the paper. Potenza was supported in part by grants P20 DA and R01 DA from the National Institutes of Health; the Connecticut State Department of Mental Health and Addiction Services; the Connecticut Mental Health Center; and a Center of Excellence in Gambling Research Award from the National Center for Responsible Gaming.

The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing interests: The authors have declared that no competing interests exist.

Excessive or problematic engagement in sex, which has been termed compulsive sexual behaviour CSB , hypersexuality disorder or sexual addiction, is a relatively common clinical entity that may carry significant mental and physical health consequences [1].

A complicating factor in determining the precise prevalence and impact of CSB involves the lack of a formal definition for the disorder.

Although criteria for hypersexual disorder were proposed for DSM-5 [6] , the disorder was not included in DSM However, as CSB may be associated with significant distress, feelings of shame and psychosocial dysfunction, it warrants direct examination.

Based on existing data, pathological gambling or gambling disorder was recently reclassified in DSM-5 together with substance-use disorders as a behavioural addiction [8].

However, other disorders e. Thus, an improved understanding of CSB and how it might show similarities to or differences from substance-use disorders may help with classification efforts and the development of more effective prevention and treatment efforts.

Given similarities between substance-use, gambling and hypersexual disorders e. Cue reactivity relates importantly to clinically relevant aspects of substance-use disorders.

For example, heightened cue reactivity is associated with relapse [10] , [11]. A recent quantitative meta-analysis of studies in cue reactivity across substances of misuse including alcohol, nicotine and cocaine demonstrated overlapping activity to drug cues in the ventral striatum, dorsal anterior cingulate dACC and amygdala, with overlapping activity to self-reported cue-induced craving in dACC, pallidum and ventral striatum [11].

However, the extent to which these regions may show differential sexual-cue reactivity in individuals with and without CSB has not been studied.

However, the extent to which liking and wanting relate to sexual-cue reactivity and its neural correlates in CSB has not been systematically examined, and findings from such studies may provide data to help guide the most appropriate classification of CSB and identify neural targets for treatment development.

Multiple studies have previously focused on sexual cues in healthy volunteers identifying regions including the hypothalamus, thalamus, amygdala, anterior cingulate cortex, anterior insula, inferior frontal cortex, fusiform gyrus, precentral gyrus, parietal cortex and middle occipital cortex [13] — [19].

These regions are implicated in physiological and emotional arousal, attention and particularly visuospatial attention, and motivation.

Using measures of penile tumescence, the striatum, anterior cingulate, insula, amygdala, occipital cortex, sensorimotor cortex and hypothalamus have been shown to play a role in penile erection [15] , [20].

Gender-related differences have been reported with males having greater amygdala and hypothalamic activity to sexual stimuli relative to females, and these differences may reflect appetitive states [21].

A meta-analysis identified a common brain network to monetary, erotic and food outcomes including the ventromedial prefrontal cortex, ventral striatum, amygdala, anterior insula and mediodorsal thalamus [22].

Food and erotic rewards were associated particularly with anterior insular activity and erotic rewards more specifically with amygdala activity.

A recent study has also shown that longer duration of use of online explicit materials in healthy males correlates with lower left putaminal activity and lower right caudate volumes to brief still sexual images [23].

Neurophysiological studies focusing on CSB in the general population rather than healthy volunteers are comparatively more limited. Subjects were recruited from a treatment program with 7 of 8 subjects having a history of alcohol use disorders, 4 of 8 with a history of other substance abuse or dependence and 1 of 8 with a history of obsessive compulsive disorder.

In a study focusing on 52 male and female CSB subjects with problems regulating online viewing of sexual images recruited from online advertisements, exposure to static sexual images compared to neutral images was associated with elevated amplitudes of the P response, implicated in attentional control [25].

As this measure correlated with dyadic sexual desire but not sexual compulsivity measures, the authors suggested the P amplitude mediated sexual desire rather than compulsive behaviours.

Hypersexuality has been reported in the context of neurological disorders and their associated medications. A case report using technetium m-ethyl cysteinate dimer SPECT showed relatively increased blood flow in mesial temporal regions in the CSB patient [28].

A larger study focusing on Parkinson's disease patients with hypersexuality showed greater functional MRI Blood Oxygen Level Dependent activity to sexual picture cues that correlated with enhanced sexual desire [29] , which the authors suggested might reflect incentive-motivation theories of addiction.

A voxel-based-morphometry study of hypersexuality commonly reported in behavioural variant frontotemporal dementia, a disease which affects ventromedial frontal and anterior temporal regions, showed greater atrophy in the right ventral putamen and pallidum in association with reward-seeking scores [30].

In this current study, we focus on CSB subjects in the general population. Here we assessed cue reactivity comparing sexually explicit video cues with non-sexual exciting stimuli such as videos of sporting activities and assessed scores of sexual desire or wanting and liking in subjects with and without CSB.

We hypothesized that individuals with CSB as compared to those without would show greater desire wanting but not liking similar across groups in response to sexually explicit but not to non-sexually exciting cues.

Although a range of regions have been implicated in response to sexual cues in healthy volunteers, as we were studying patients with CSB, we hypothesized that there would be greater activation to sexually explicit as compared to non-sexual exciting cues in regions implicated in drug cue reactivity studies including the ventral striatum, dACC and amygdala.

We further hypothesized that these regional activations would be functionally linked across groups but more strongly in individuals with CSB as compared to those without, and that sexual desire wanting would be more strongly linked to activity within these regions in individuals with CSB as compared to those without.

Given developmental changes in motivational systems underlying risky behaviours [31] , we also explored relationships with age.

CSB subjects were recruited via Internet-based advertisements and from referrals from therapists. Healthy volunteers were recruited from community-based advertisements in the East Anglia area.

For the CSB group, screening was conducted using the Internet Sex Screening Test ISST [32] and an extensive investigator-designed questionnaire on details including age of onset, frequency, duration, attempts to control use, abstinence, patterns of use, treatment and negative consequences.

CSB subjects underwent a face-to-face interview with a psychiatrist to confirm they fulfilled diagnostic criteria for CSB [6] , [33] , [34] Table S1 in File S1 focusing on compulsive use of online sexually explicit material.

All participants met proposed diagnostic criteria for Hypersexual Disorder [6] , [33] and criteria for sexual addiction [34] Table S1 in File S1.

By design and given the nature of the cues, all CSB subjects and healthy volunteers were male and heterosexual. An additional 25 age-matched male heterosexual healthy volunteers underwent the video ratings outside of the scanner to ensure adequacy of the subjective responses to the videos as assessed by subjective responses.

Other compulsive or behavioural addictions were also exclusions. Subjects were assessed by a psychiatrist regarding problematic use of online gaming or social media, pathological gambling or compulsive shopping, childhood or adult attention deficit hyperactivity disorder, and binge-eating disorder diagnosis.

Subjects were also screened for compatibility with the MRI environment. Subjects completed the UPPS-P Impulsive Behaviour Scale [36] to assess impulsivity, Beck Depression Inventory [37] and State Trait Anxiety Inventory [38] to assess depression and anxiety, respectively, Obsessive-Compulsive Inventory-R to assess obsessive-compulsive features and the Alcohol-Use Disorders Identification Test AUDIT [39].

General Internet use was assessed using the Young's Internet Addiction Test YIAT [40] and the Compulsive Internet Use Scale CIUS [41].

The National Adult Reading Test [42] was used to obtain an index of IQ. A modified version of the Arizona Sexual Experiences Scale ASES [43] was used with one version relevant to intimate relationships and another version relevant to online sexually explicit material.

Subject characteristics are reported in Table S1 in File S1. CSB subjects had higher depression and anxiety scores Table S2 in File S1 but no current diagnoses of major depression.

One CSB subject and 1 healthy volunteer used cannabis intermittently. Written informed consent was obtained, and the study was approved by the University of Cambridge Research Ethics Committee.

Subjects were paid for their participation. Subject characteristics and questionnaire scores were compared using independent t-tests or Chi-square tests.

Multivariate analyses were used for the ASES scores. For the ratings of sexual desire or liking, mixed-measures ANOVA were used to compare the explicit versus erotic ratings with group CSB, non-CSB as a between-subjects measure, video type explicit or erotic cues , and subjective rating desire or liking as within-subjects measures.

In the imaging task, subjects viewed video clips presented in a counter-balanced fashion from one of 5 conditions: explicit sexual, erotic, non-sexual exciting, money and neutral.

The videos were shown for 9 seconds, followed by a question if the video was indoors or outdoors. Subjects responded using a 2-button key-pad with their second and third digits of their right hand to ensure they were paying attention.

The question occurred during a jittered inter-trial interval of to milliseconds. Explicit videos showed consensual sexual interactions between a man and a woman obtained from videos downloaded from the Internet with licenses obtained where necessary.

Examples of erotic videos included a dressed woman dancing erotically or a scene of a woman brushing her thigh. Non-sexual exciting videos displayed sporting videos similar in nature to highly arousing images from the International Affective Picture System such as skiing, sky-diving, rock-climbing, or motorcycle-riding.

Money videos showed images of coins or paper money being paid, falling or scattered. Neutral videos showed scenes of landscapes. The conditions were randomized with eight trials per condition shown for a total of 40 video clips.

Five different videos per condition were shown for a total of 25 different video clips. In the video-rating task outside of the scanner, subjects watched the same videos and completed a continuous rating scale for sexual desire and liking.

An additional 25 male healthy volunteers were tested on the video-rating task. Subjects were asked if they have previously viewed the videos prior to the study.

All tasks were coded using E-Prime 2. The acquisition parameters of the fMRI study are described in File S1.

The 9-second video clips and inter-trial intervals were modelled as box-car functions convolved with hemodynamic response functions.

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