Genital arousal and responsive desire among women with and without sexual interest/arousal disorder symptoms

BACKGROUND

Models depicting sexual desire as responsive to sexual arousal may be particularly apt for women experiencing arousal or desire difficulties, and the degree to which arousal triggers desire may depend on the relationship context and desire target and timing-yet, these associations have not been directly tested among women with and without sexual interest/arousal disorder (SIAD).

AIM

To assess the role of SIAD status and relationship satisfaction in the associations between genital arousal and 4 types of responsive desire.

METHODS

One hundred women (n = 27 meeting diagnostic criteria for SIAD) in romantic relationships with men viewed a sexual film (pleasurable intimate depiction of oral sex and penile-vaginal intercourse) while their genital arousal was recorded via vaginal photoplethysmography (n = 63) or thermal imaging of the labia (n = 37). Partner and solitary desire was assessed immediately before and after the film (immediate desire) and 3 days later (delayed desire).

OUTCOMES

Outcomes consisted of genital response (z scored by method) and associations between genital response and responsive sexual desire.

RESULTS

The key difference between women with and without SIAD was not in their ability to experience genital arousal but in how their genital responses translated to responsive sexual desire. Women with SIAD actually exhibited greater genital arousal than unaffected women. Associations between genital arousal and desire were significant only for women with SIAD and depended on relationship satisfaction and desire type. For women with SIAD with low relationship satisfaction, higher arousal predicted lower immediate desire for a partner; for those with high relationship satisfaction, arousal was either positively related (vaginal photoplethysmography) or unrelated (thermal imaging of the labia) to immediate desire for a partner. Associations with other desire types were not significant.

CLINICAL IMPLICATIONS

Patterns of genital arousal and partner-specific responsive desire among women affected with SIAD were indicative of an avoidance model in response to heightened genital arousal, unless relationship satisfaction was high; attending to genital arousal sensations could be a means of triggering sexual desire for women with SIAD who are satisfied in their relationships.

STRENGTHS AND LIMITATIONS

This is one of the first sexual psychophysiologic studies to connect relationship factors to patterns of sexual response. The differing arousal assessment procedures and lack of official diagnosis may have attenuated results. The homogeneous sample and in-person session requirement limit generalizability.

CONCLUSION

When compared with unaffected women, women affected by SIAD may exhibit stronger arousal responses with sufficiently incentivized sexual stimuli, and the connection between their genital arousal and responsive desire for their partners may be stronger and more dependent on relationship context.

Sexual function in women with polycystic ovary syndrome: a systematic review and meta-analysis

BACKGROUND

Polycystic ovary syndrome (PCOS) is a common and distressing endocrine disorder associated with lower quality of life, subfertility, diabetes, cardiovascular disease, depression, anxiety, and eating disorders. PCOS characteristics, its comorbidities, and its treatment can potentially influence sexual function. However, studies on sexual function in women with PCOS are limited and contradictory.

OBJECTIVE AND RATIONALE

The aim was to perform a systematic review of the published literature on sexual function in women with PCOS and assess the quality of the research and certainty of outcomes, to inform the 2023 International Guidelines for the Assessment and Management of PCOS.

SEARCH METHODS

Eight electronic databases were searched until 1 June 2023. Studies reporting on sexual function using validated sexuality questionnaires or visual analogue scales (VAS) in PCOS populations were included. Random-effects models were used for meta-analysis comparing PCOS and non-PCOS groups with Hedges' g as the standardized mean difference. Study quality and certainty of outcomes were assessed by risk of bias assessments and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) method according to Cochrane. Funnel plots were visually inspected for publication bias.

OUTCOMES

There were 32 articles included, of which 28 used validated questionnaires and four used VAS. Pooled Female Sexual Function Index (FSFI) scores in random-effects models showed worse sexual function across most subdomains in women with PCOS, including arousal (Hedges's g [Hg] [95% CI] = -0.35 [-0.53, -0.17], I2 = 82%, P < 0.001), lubrication (Hg [95% CI] = -0.54 [-0.79, -0.30], I2 = 90%, P < 0.001), orgasm (Hg [95% CI] = -0.37 [-0.56, -0.19], I2 = 83%, P < 0.001), and pain (Hg [95% CI] = -0.36 [-0.59, -0.13] I2 = 90%, P < 0.001), as well as total sexual function (Hg [95% CI] = -0.75 [-1.37, -0.12], I2 = 98%, P  =  0.02) and sexual satisfaction (Hg [95% CI] = -0.31 [-0.45, -0.18], I2 = 68%, P < 0.001). Sensitivity and subgroup analyses based on fertility status and body mass index (BMI) did not alter the direction or significance of the results. Meta-analysis on the VAS studies demonstrated the negative impact of excess body hair on sexuality, lower sexual attractiveness, and lower sexual satisfaction in women with PCOS compared to controls, with no differences in the perceived importance of a satisfying sex life. No studies assessed sexual distress. GRADE assessments showed low certainty across all outcomes.

WIDER IMPLICATIONS

Psychosexual function appears to be impaired in those with PCOS, but there is a lack of evidence on the related distress scores, which are required to meet the criteria for psychosexual dysfunction. Health care professionals should discuss sexual function and distress and be aware of the multifactorial influences on sexual function in PCOS. Future research needs to assess both psychosexual function and distress to aid in understanding the degree of psychosexual dysfunction in PCOS. Finally, more diverse populations (e.g. non-heterosexual and more ethnically diverse groups) should be included in future studies and the efficacy of treatments for sexual dysfunction should also be assessed (e.g. lifestyle and pharmacological interventions).

Real is the new sexy: the influence of perceived realness on self-reported arousal to sexual visual stimuli

As state-of-art technology can create artificial images that are indistinguishable from real ones, it is urgent to understand whether believing that a picture is real or not has some import over affective phenomena such as sexual arousal. Thus, in two pre-registered online studies, we tested whether 60 images depicting models in underwear elicited higher self-reported sexual arousal when believed to be (N = 57) or presented as (N = 108) real photographs as opposed to artificially generated. In both cases, Realness correlated with significantly higher scores on self-reported sexual arousal. Consistently with the literature on downregulation of emotional response to fictional works, our result indicates that sexual images that are perceived to be fake are less arousing than those believed to portray real people.

The characteristics of sexual behavior in blind men in Ganzhou, China: A cross-sectional study

Visual stimuli play key roles in influencing men sexual behavior. However, few studies have explored the sexual behavior of blind men. To provide more information about blind men for the study of andrology by surveying the characteristics of their current sexual behavior. A questionnaire-based cross-sectional study design was performed. The questionnaire contained questions regarding demographic characteristics of participants, access to sexual knowledge, perception of the sexual partners' beauty, and sexual arousal. Blind men were interviewed face-to-face by the trained investigator. Complete questionnaires were collected from 54 participants, with an average age of 40.57 ± 9.80 years old. Eye diseases were the most frequent cause of blindness. In terms of sexual orientation, all participants were heterosexual. Notably, 90.7% of the participants reported to have had a sexual experience. Among those who had engaged in sexual behavior, 93.6% experienced sexual pleasure and 69.4% had a normal erectile function. Overall, 16.7% of the participants received sex education. The participants obtained sexual knowledge mainly through sounds from mobile phones, peer-to-peer communication, sounds of television and radio. Voice was the most frequent perception of the sexual partners' beauty, followed by figure, skin, and body fragrance. In terms of stimuli of sexual arousal, tactile sensation and auditory sensation in that order were the most frequent stimuli of sexual arousal. Stimuli of sexual arousal in blind men are mainly mediated by sound and touch. Blind men understand their sexual partners' beauty through auditory, tactile, and olfactory sensations. Blind men in Ganzhou lack formal and systematic sex education.

'Staying Hot': Investigating the influence of overnight conditions on the penile skin temperature during male sexual arousal-A novel methodology for nocturnal erection detection

Objective

The objective of this study is to assess the impact of overnight environmental conditions on erectile penile temperature within a controlled setting, with the aim of investigating the feasibility of using temperature measurements for nocturnal erection detection in erectile dysfunction diagnostics.

Subjects/patients and methods

We conducted a proof-of-concept study involving 10 healthy male participants aged 20 to 25. The study was carried out at the Department of Urology, St. Antonius Ziekenhuis, the Netherlands. Penile temperature thermistor measurements were taken during visually aroused erections of participants in naked state and in simulated overnight condition (underwear and blankets). Main outcome variables were peak and baseline temperature during erectile periods. To minimize the impact of differences in erectile strength and duration between consecutive measurements, we applied randomization to the order of the environmental conditions.

Results

We observed a significant increase in penile temperature during erection in both the naked (p < 0.01) and simulated overnight condition (p < 0.01). The mean temperature increase was 1.70 and 0.67°C, respectively. While penile temperature returned to baseline immediately after naked erections, the 'Staying Hot effect' was noted in the simulated overnight condition measurements, where the temperature remained elevated at peak temperature for the entire 30-min period following the erection.

Conclusions

The findings from this study indicate that the penile temperature not only significantly increases during naked sexual arousal but is also detectable under simulated overnight conditions. This underscores the potential of using temperature measurements for nocturnal erection detection, representing a crucial initial step in developing a modernized, non-invasive sensor system for ambulatory erectile dysfunction diagnostics. Further research, including an overnight study, is needed to gain insights into the feasibility of utilizing penile temperature measurements for nocturnal erection detection and to assess the impact of the 'Staying Hot effect' on subsequent erection detection.

Combined estrogen-progestin oral contraceptives and female sexuality: an updated review

INTRODUCTION

Sexual side effects of combined oral contraceptives (COCs) have not been fully understood, but increasing evidence prompts broader risk/benefit evaluation and merits inclusion in counseling on contraceptive options.

OBJECTIVES

The study sought to explore the impact of combined estrogens-progestin oral contraceptives on components of female sexuality, including sexual desire, anatomic genitourinary changes, lubrication, orgasm, provoked vestibulodynia, well-being, body image, partner preference, and relationship stability.

METHODS

A literature review was performed between April 2023 and January 2024 exploring the association between combined oral contraceptive pills and sexual health.

RESULTS

Although COCs decrease free testosterone, it is unclear if COCs affect sexual function, including desire. Antiandrogenic COCs do seem to have a negative effect on sexual arousal, lubrication, and orgasm. Provoked vestibulodynia may be related to early onset of COC use, low-estrogen pills, and antiandrogenic progestins. Emotional and sexual side effects are strong predictors of COC discontinuation. Longitudinal data indicate that using COCs when meeting and selecting a partner has implications on sexual satisfaction and relationship length. Analysis of data is complicated by various doses and forms of estrogen and progestin in COCs, which have changed over time.

CONCLUSION

Lack of randomized placebo-controlled studies and heterogenicity in study design hampers generalized statements about the effects of COCs on sexual function. Despite these challenges, consideration of sexual dysfunction when presenting and prescribing hormonal contraception is essential for informed consent, shared decision making, and ensuring reliable contraceptive choices.

Pudendal nerve blockade for persistent genital arousal disorder (PGAD): A clinical review and case report

BACKGROUND

Persistent genital arousal disorder (PGAD) is a condition characterized by unwanted and potentially painful genital sensations or spontaneous orgasms without stimulation. We present a case of a 55-year-old woman with refractory genital arousal disorder that was treated with serial pudendal nerve blocks.

CASE

RW is a 55-year-old woman with chronic pelvic pain, pudendal neuralgia, MDD, SI, GAD, CRPS, and persistent genital arousal disorder for 11 years. Her PGAD was refractory to conservative management, physical therapy, and bilateral clitoral artery embolization. We performed bilateral pudendal nerve blocks with Kenalog and Bupivacaine, which provided almost complete relief for 2-3 months. We performed a bilateral pudendal nerve radiofrequency ablation; however, there was minimal benefit. RW continues to have significant relief with serial pudendal nerve blocks.

SUMMARY AND CONCLUSION

Persistent genital arousal disorder is often refractory to medication and physical therapy requiring significant intervention such as entrapment surgery or artery embolization. Our case demonstrates pudendal nerve blocks as a potential treatment modality with minimal side effects.

Blame and Severity Attributions in Vignette-Based Female-On-Male Rape: The Case of the Victim's Prior Sexual Victimization, Resistance, and Sexual Arousal

This study examines blame attributions of victims and perpetrators in female-on-male rape cases and event severity attributions as affected by three victim-related variables: prior sexual victimization, resistance during the rape, and sexual arousal during the rape. It assesses the relative weight of each of these variables in determining the attribution of blame to the victim and perpetrator and the attribution of severity to the event. The study found that sexual arousal and absence of resistance correlated with higher victim blame attribution, lower perpetrator blame, and lower event severity attributions, while prior sexual victimization had the opposite correlations. We therefore conclude that blame and severity attributions are affected by the victim's behavior prior to the rape and during the rape.

Neurophysiology of male sexual arousal-Behavioral perspective

In the presented review, we analyzed the physiology of male sexual arousal and its relation to the motivational aspects of this behavior. We highlighted the distinction between these processes based on observable physiological and behavioral parameters. Thus, we proposed the experimentally applicable differentiation between sexual arousal (SA) and sexual motivation (SM). We propose to define sexual arousal as an overall autonomic nervous system response leading to penile erection, triggered selectively by specific sexual cues. These autonomic processes include both spinal and supraspinal neuronal networks, activated by sensory pathways including information from sexual partner and sexual context, as well as external and internal genital organs. To avoid misinterpretation of experimental data, we also propose to precise the term "sexual motivation" as all actions performed by the individual that increase the probability of sexual interactions or increase the probability of exposition to sexual context cues. Neuronal structures such as the amygdala, bed nucleus of stria terminalis, hypothalamus, nucleus raphe, periaqueductal gray, and nucleus paragigantocellularis play crucial roles in controlling the level of arousal and regulating peripheral responses via specific autonomic effectors. On the highest level of CNS, the activity of cortical structures involved in the regulation of the autonomic nervous system, such as the insula and anterior cingulate cortex, can visualize an elevated level of SA in both animal and human brains. From a preclinical perspective, we underlie the usefulness of the non-contact erection test (NCE) procedure in understanding factors influencing sexual arousal, including studies of sexual preference in animal models. Taken together results obtained by different methods, we wanted to focus attention on neurophysiological aspects that are distinctly related to sexual arousal and can be used as an objective parameter, leading to higher translational transparency between basic, preclinical, and clinical studies.

Altered Sexual Response-Related Functional Connectivity and Morphometric Changes Influenced by Sex Hormones across Menopausal Status

Our study retrospectively investigated differential patterns of the functional connectivity (FC) of core brain regions synchronous with morphometric changes associated with sexual dysfunction in menopausal women, and their correlations with sexual hormones. Twenty-three premenopausal women (mean age: 41.52 ± 7.38 years) and 21 menopausal women (mean age: 55.52 ± 2.80 years) underwent sex hormone level measurements with high-resolution T1 and functional magnetic resonance imaging (MRI) during rest, neutral, and sexual arousal conditions. Analysis of covariance adjusted for age was used to compare the FC and gray matter (GM) volume between the two groups. Menopausal women showed lower GM volumes in the superior frontal gyrus (SFG), superior temporal pole, parahippocampal gyrus (PHG), hippocampus (Hip), amygdala (Amg), and cerebellum (Cb) compared to premenopausal women (p < 0.05). In addition, compared to premenopausal women, menopausal women showed decreased FC of seed regions involved in the SFG, frontal eye fields, and Amg, as well as target regions involved in the PHG, Hip, inferior frontal gyrus, Cb, and vermis (p < 0.005). Furthermore, the FC between the right Amg and right Cb and between the left Amg and right Cb during sexual arousal in both groups was positively correlated with total estrogen and estradiol levels, respectively (p < 0.01). The GM volume values in the right Amg and right Cb were positively correlated with total estrogen and estradiol levels (p < 0.05). Our study demonstrated an association between menopause-related differential FC and GM volume variations and fluctuating sex hormones. Our findings highlight that overlapping brain regions with functional alterations and morphometric changes are closely linked with menopausal symptom-related decreases in sexual arousal and hormone levels.

When the brain turns on with sexual desire: fMRI findings, issues, and future directions

INTRODUCTION

More than 2 decades of neuroimaging research has sought to uncover the neurologic basis of sexual desire. However, the lack of a clear conceptual distinction between sexual desire and sexual arousal or even a broadly accepted definition of sexual desire has led to confusion in the literature regarding brain areas uniquely associated with sexual desire.

OBJECTIVES

(1) To critically review the neuroimaging literature that seeks to identify brain areas and networks involved in sexual desire; (2) to identify and discuss those brain areas and potential networks that are most promising for providing insights to sexual desire; and (3) to offer recommendations for future studies.

METHODS

Existing meta-analyses were used as a starting point to identify relevant neuroimaging studies on sexual desire, arousal, and love. This base was then expanded via Google Scholar and forward citation tracking of already identified studies.

RESULTS

Brain areas that are commonly associated with sexual desire and arousal include the amygdala, hypothalamus, dorsal and ventral striatum, anterior cingulate, insula, and prefrontal and orbitofrontal cortex. However, because the same basic paradigm has been used to study sexual desire and arousal, unambiguous conclusions regarding areas uniquely involved in sexual desire cannot be drawn. Moreover, the lack of connectivity analyses and a failure to acknowledge negative BOLD (blood-oxygen level dependent) significantly limit conclusions on the neural basis of sexual desire.

CONCLUSION

Five recommendations are made. First, stimulus types (ie, erotic vs sexually explicit) should be selected by the meaningful theoretical conceptualization of the constructs of interest. Second, participants should be provided with definitions of sexual desire, mental sexual arousal, and perceived genital sexual arousal, so they can choose which terms best describe their experience. Third, event-related designs should be used with caution when investigating sexual desire. Fourth, time series analyses should be used to identify both positive and negative BOLD. Fifth, connectivity analyses should be performed to identify brain networks.

Oral sodium oxybate does not alter plasma kisspeptin levels in healthy male volunteers

Gamma-hydroxybutyrate (GHB, clinically administrated as sodium oxybate) is a GABA-B/GHB receptor agonist inducing prosexual effects and progesterone secretion in humans. As the neuropeptide kisspeptin has well-established roles in regulating sexual behavior and as it was also associated with GABA-B receptor and progesterone function, we investigated the effect of two GHB doses (20 and 35 mg/kg p.o.) on plasma kisspeptin levels in 30 healthy male volunteers, using a double-blind, randomized, placebo-controlled cross-over design. We found no significant alterations of kisspeptin levels after GHB administration compared to placebo. In conclusion, plasma kisspeptin levels are not related to the prosexual effects of GHB.

Reduction in genital sexual arousal varies by type of oral contraceptive pill

BACKGROUND

Although oral contraceptive pills (OCPs) have been associated with decrements in self-reported genital arousal and vaginal lubrication, 1,2 little is known about how these outcomes vary across types of OCPs.

AIM

The present study examined differences in physiological lubrication and vaginal blood flow, as well as rates of self-reported vulvovaginal atrophy and female sexual arousal disorder, among women using OCPs with varying androgenic properties.

METHODS

Participants in this study were 130 women: 59 naturally cycling control women, 50 women taking androgenic OCPs, and 21 women taking antiandrogenic OCPs. Participants watched sexual films while their sexual arousal responses were measured, completed questionnaires, and participated in a clinical interview.

OUTCOMES

Vaginal blood flow, vaginal lubrication, self-reported vulvovaginal atrophy, and female sexual arousal disorder were assessed.

RESULTS

Results indicated deficits in vaginal pulse amplitude and lubrication for women taking either form of OCP, with marked inhibitory effects found in women taking antiandrogenic OCPs. Rates of self-reported vulvovaginal atrophy and female sexual arousal disorder were also significantly greater in the antiandrogenic group compared with the control group.

CLINICAL IMPLICATIONS

It is recommended that prescribing clinicians consult patients on such physiological effects of OCPs.

STRENGTHS AND LIMITATIONS

To our knowledge, this was the first study to compare multiple measures of physiological sexual arousal across groups of women taking OCPs with varying hormonal profiles. Because all OCPs included in this study contained low doses of ethinylestradiol, we were able to identify the specific effects of the androgenic properties on women's sexual arousal responses. However, the self-administered lubrication test strip was subject to user error. Additionally, the generalizability of findings is limited by the largely heterosexual and college-aged sample.

CONCLUSION

Compared with naturally cycling women, women taking OCPs that contain antiandrogenic progestins experienced decreased vaginal blood flow and lubrication as well as higher rates of self-reported vaginal bleeding and female sexual arousal disorder.

The way you make me feel: an ecological momentary assessment study on couple similarity in sexual arousal and its sexual, relational, and affective correlates

BACKGROUND

Although sexual arousal is commonly experienced in the daily context of relationships, most of what we know about sexual arousal comes from studies on individuals, often conducted in a laboratory context.

AIM

To explore to what extent similarity in levels of sexual arousal during nongenital physical intimacy (ie, cuddling and kissing) was associated with each partner's affect as well as sexual and relationship satisfaction.

METHODS

Ninety-four cohabitating couples (mean ± SD age, 26.30 ± 7.60; 88 mixed gender, 6 same gender) completed 6 ecological momentary assessments a day for 10 consecutive days. We used response surface analysis to examine the associations among the degree and direction of similarity in partners' sexual arousal and affective, sexual, and relational outcome variables.

OUTCOMES

Sexual satisfaction, relationship satisfaction, and positive and negative affect.

RESULTS

Sexual arousal levels covaried only when partners engaged in physically intimate behaviors, unlike affective responses, which covaried within couples more globally over time. Within-couple similarity at high levels of sexual arousal was positively associated with women's sexual satisfaction but unrelated to men and women's relationship satisfaction and affect. Individual- and couple-level sexual arousal was positively associated with men's sexual satisfaction and women's sexual and relationship satisfaction. Couple-level sexual arousal was relevant to men's affect such that positive affect was higher when sexual arousal levels within the couple were high. Our analyses also revealed a discrepancy effect in that women's positive affect was higher when their own sexual arousal levels were higher than those of their partners.

CLINICAL IMPLICATIONS

These findings suggest that as long as sexual arousal levels within a couple are sufficiently high, sexual arousal similarity and discrepancy can be beneficial to one's well-being, supporting the relevance of therapeutical techniques aimed at increasing arousal levels to promote a better affective and relational climate for couples.

STRENGTHS AND LIMITATIONS

This study is the first to test the daily associations among sexual arousal similarity and its correlates in a sample of cohabitating couples, providing a more comprehensive view of the interpersonal dynamics through which sexual arousal may influence individual, relational, and sexual well-being. Given our sample's relatively young age, as well as high sexual and relationship satisfaction, the results may not generalize to couples experiencing sexual or relational distress.

CONCLUSION

Within the context of daily relationships, individual- and couple-level dynamics of sexual arousal were associated with sexual and relationship satisfaction, as well as with affective responses of relationship partners.

The Concept of "Hypersexuality" in the Boundary between Physiological and Pathological Sexuality

INTRODUCTION

The concept of hypersexuality belongs to modern parlance, according to a predominantly clinical meaning, and is understood as a psychological and behavioural alteration as a result of which sexually motivated stimuli are sought in inappropriate ways and often experienced in a way that is not completely satisfactory.

METHODS

Literature up to February 2023 was reviewed, with 25 searches selected.

RESULTS

Forty-two articles were included in the review.

CONCLUSION

Hypersexuality is a potentially clinically relevant condition consisting of one or more dysfunctional and pathological behaviours of one's sexual sphere and graded according to the severity of impairment of subjective acting out; for this reason, the Perrotta Hypersexuality Global Spectrum of Gradation (PH-GSS) is suggested, which distinguishes high-functioning forms (pro-active and dynamic hypersexuality) from those of attenuated and corrupted functioning (dysfunctional and pathological hypersexuality of grades I and II). Future research is hoped to address the practical needs of this condition, such as the exact etiopathology, the role of oxytocin in dopaminergic hypotheses (and its ability to attenuate the symptomatology suffered by the patient in terms of manic drive), the best structural and functional personality framing of the subject, and the appropriate therapy to pursue.

Men's Self-Reported and Psychophysiological Affective Responses to Sexual Violence and Their Associations with Rape Myths, Personality, and Sexual Traits: A Preliminary Study

Objective: Despite alarming evidence on sexual violence against women, little is known about men's emotional responses to rape and how these may be involved in sexual violence dynamics. Accordingly, our aim was to capture how rape scenarios are emotionally appraised. Methods: The current study evaluated men's (N = 30) self-reported and psychophysiological emotional responses (facial EMG, electrodermal activity) to a rape scene, and contrasted it with their responses to stimuli depicting nonsexual violence and nonviolent male-female interactions. The associations between men's emotional responses and their endorsement of rape myths, personality, and sexual traits were also examined. Results: Findings revealed that the rape scene resulted in higher negative affect, both subjectively and indexed by increased facial EMG (corrugator activity), than the other two stimuli. Additionally, personality traits of neuroticism, lower agreeableness, lower consciousness, psychopathic tendencies, as well as lower sexual inhibition proneness, were all associated with higher subjective sexual arousal toward rape. Conclusions: Findings add to the literature on the putative emotional processes underpinning the appraisal of sexual violence against women.

Pattern recognition reveals sex-dependent neural substrates of sexual perception

Sex differences in brain activity evoked by sexual stimuli remain elusive despite robust evidence for stronger enjoyment of and interest toward sexual stimuli in men than in women. To test whether visual sexual stimuli evoke different brain activity patterns in men and women, we measured hemodynamic brain activity induced by visual sexual stimuli in two experiments with 91 subjects (46 males). In one experiment, the subjects viewed sexual and nonsexual film clips, and dynamic annotations for nudity in the clips were used to predict hemodynamic activity. In the second experiment, the subjects viewed sexual and nonsexual pictures in an event-related design. Men showed stronger activation than women in the visual and prefrontal cortices and dorsal attention network in both experiments. Furthermore, using multivariate pattern classification we could accurately predict the sex of the subject on the basis of the brain activity elicited by the sexual stimuli. The classification generalized across the experiments indicating that the sex differences were task-independent. Eye tracking data obtained from an independent sample of subjects (N = 110) showed that men looked longer than women at the chest area of the nude female actors in the film clips. These results indicate that visual sexual stimuli evoke discernible brain activity patterns in men and women which may reflect stronger attentional engagement with sexual stimuli in men.

Effect of epidural spinal cord stimulation on female sexual function after spinal cord injury

Sexual dysfunction is a common consequence for women with spinal cord injury (SCI); however, current treatments are ineffective, especially in the under-prioritized population of women with SCI. This case-series, a secondary analysis of the Epidural Stimulation After Neurologic Damage (E-STAND) clinical trial aimed to investigate the effect of epidural spinal cord stimulation (ESCS) on sexual function and distress in women with SCI. Three females, with chronic, thoracic, sensorimotor complete SCI received daily (24 h/day) tonic ESCS for 13 months. Questionnaires, including the Female Sexual Function Index (FSFI) and Female Sexual Distress Scale (FSDS) were collected monthly. There was a 3.2-point (13.2%) mean increase in total FSFI from baseline (24.5 ± 4.1) to post-intervention (27.8 ± 6.6), with a 4.8-50% improvement in the sub-domains of desire, arousal, orgasm and satisfaction. Sexual distress was reduced by 55%, with a mean decrease of 12 points (55.4%) from baseline (21.7 ± 17.2) to post-intervention (9.7 ± 10.8). There was a clinically meaningful change of 14 points in the International Standards for Neurological Classification of Spinal Cord Injury total sensory score from baseline (102 ± 10.5) to post-intervention (116 ± 17.4), without aggravating dyspareunia. ESCS is a promising treatment for sexual dysfunction and distress in women with severe SCI. Developing therapeutic interventions for sexual function is one of the most meaningful recovery targets for people with SCI. Additional large-scale investigations are needed to understand the long-term safety and feasibility of ESCS as a viable therapy for sexual dysfunction. Clinical Trial Registration:https://clinicaltrials.gov/ct2/show/NCT03026816, NCT03026816.

"Blue balls" and sexual coercion: a survey study of genitopelvic pain after sexual arousal without orgasm and its implications for sexual advances

Background

Blue balls/vulva has received increasing interest from the public in recent years, sparking debate about genital physiology, controversy around "sexual release" as a treatment for this type of pain, and sexual consent.

Aim

This cross-sectional, mixed-methods online study aimed to evaluate the general understanding and frequency of blue balls/vulva and whether individuals have ever been pressured to continue sexual activity because of a partner's fears of experiencing pain without orgasm.

Methods

A total of 2621 individuals with a penis (n = 1483) or vagina (n = 1138) were recruited for an online survey on the experience of "blue balls/vulva." Quantitative analyses consisted primarily of descriptive statistics and chi-square analyses. Between-group differences were analyzed (based on whether respondents reported having a penis or vagina), and responses to open-ended questions were examined via thematic analysis.

Outcomes

The primary outcomes of interest were reports of the belief in blue balls/vulva, the frequency and pain characteristics of blue balls/vulva, and the incidence of being pressured to continue sexual activity due to a partner's fears of experiencing pain without orgasm.

Results

Results indicated that significantly more individuals with a penis than a vagina reported believing that blue balls are real, endorsed experiencing pain when they approached orgasm but did not ejaculate, and reported moderate and severe pain. Significantly more individuals with a vagina than a penis reported being pressured into a sexual act due to a partner's fear of experiencing pain without orgasm. Results from the thematic analysis indicated that participants recognized that those with a vagina are expected to act sexually to prevent their partners' experience of blue balls, despite agreement that this phenomenon should not be used to coerce or manipulate partners into engaging sexually.

Clinical Implications

Education on the frequency of this phenomenon and methods to relieve pain alternative to partnered sexual activity should be addressed in patients who present with this condition.

Strengths and Limitations

Although the survey was brief, it provided information from a relatively large sample about whether people believe that this phenomenon exists, how many experience it, how painful it is, and how often it has been used as an excuse for a partner to continue sexual activity.

Conclusion

Results indicated that severe pain exists in a minority of individuals, that solitary sexual and nonsexual activities can help to alleviate the discomfort, and that this pain is not a valid reason to continue unwanted sexual activity.

Use of sexual stimuli in research and clinical settings: expert opinion and recommendations

Background

Sexual stimuli, such as sexual videos, images, and narratives describing sexual interactions, are one of many tools used by clinicians and researchers to elicit or augment sexual response. Given the wide variability within sexual stimuli and their effects on sexual response, we provide guidance on when and how to use sexual stimuli, selecting sexual stimuli, and standardizing the use and reporting of sexual stimuli in research and clinical practice.

Aim

This expert opinion review article discusses standard operating procedures when using sexual stimuli in clinical and research applications, addressing 3 broad areas: settings in which sexual stimuli are used, characteristics and contexts of the stimuli, and practical and ethical considerations when using the stimuli.

Methods

This article is based on an expert opinion review of the sexual psychophysiology literature.

Results

First, we discuss the settings in which sexual stimuli are typically used and evaluate the ecological validity of each setting. Second, we review the types of sexual stimuli used in sexual response research, including physical characteristics, depicted sexual activity, and context, and the impacts of these characteristics on sexual response. Last, we discuss the practical and ethical considerations that come with the choice and use of sexual stimuli in clinical and research settings. We address potential limitations of certain sexual stimuli, including practical and ethical considerations such as participant vs experimenter choice, diversity and representation, and proper sourcing of sexual stimuli for use in clinical and research applications. Discussions on the future applications of sexual stimuli, such as the use of virtual reality, and ethical considerations in terms of user-generated Internet sexual stimuli are also explored.

Conclusion

We provide an expert opinion review of the literature regarding use of sexual stimuli for clinical and research applications and offer best use practices and recommendations.

Solitary Sexual Desire: Its Relation to Subjective Orgasm Experience and Sexual Arousal in the Masturbation Context within a Spanish Population

The tridimensional sexual desire proposal (i.e., dyadic to partner, dyadic to attractive other and solitary) has been empirically supported. However, solitary sexual desire and its relationship to other dimensions of sexual functioning has received less attention. Hence, we examined the capacity of solitary sexual desire to explain the subjective orgasm experience (Study 1) and sexual arousal (Study 2) in the context of solitary masturbation. Study 1, composed of 2406 heterosexual adults (M age = 39.72, SD = 11.81), assessed for solitary sexual desire, dyadic sexual desire, and the intensity of the subjective orgasm experience obtained through solitary masturbation, along with other associated parameters. Study 2, consisting of 41 heterosexual young people (M age = 22.49, SD = 3.17), evaluated the genital response (penile circumference/vaginal pulse amplitude) and subjective arousal to sexually explicit films related to solitary masturbation. In both men and women, solitary sexual desire accounted for a significant percentage of the subjective orgasm experience obtained through solitary masturbation. In addition, in women, the propensity for sexual arousal was explained by solitary sexual desire. It is concluded that solitary sexual desire -as opposed to dyadic- is important to explain sexual arousal and orgasm in the solitary masturbation context. These results highlight the importance of addressing sexual desire in the solitary context, given its implications with other dimensions of sexual functioning.

External validity of analogue sexual risk laboratory data

This article presents data on the external validity of an alcohol administration study of sexual decision-making in men who have sex with men (MSM) ages 21-50. Men (N = 135) randomized to alcohol (blood alcohol concentration [BAC] = .075%) or water control conditions reported intentions to engage in condomless anal intercourse (CAI) in response to video vignettes. Following the experiment participants provided 6 weeks of experience sampling method (ESM) data assessing intoxication, sexual arousal, partner relationship, and sexual behavior. Laboratory CAI intentions were hypothesized to predict future CAI behavior, and associations were hypothesized to be conditional upon sexual arousal and intoxication contextual factors as well as laboratory beverage condition. The hypotheses were partially supported. CAI intentions were correlated with subject proportions of days engaging in CAI (r = .29). A multilevel analysis indicated, on average, CAI intention predicted increased probability of CAI versus anal intercourse with a condom (relative risk ratio [RRR] = 1.43). There was mixed evidence of CAI intentions effects being conditional upon laboratory condition as well as arousal and intoxication contextual factors. Graphs of conditional marginal effects identified regions of significance. Effects of CAI intention for men in the alcohol condition on the CAI versus No Sex contrast were significant when sexual arousal was elevated. CAI intentions for men in the water control condition predicted a higher probability of CAI versus anal intercourse with a condom when intoxication was moderately elevated and/or arousal moderately low. The results support the external validity of alcohol administration experiments of sexual decision-making among MSM and, reciprocally, provide support for the validity of ESM assessment of sexual behavior. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Increased pupil and heart-rate responses to sexual stimuli in men after physical exertion

Physical stress has been found to enhance arousability by visual sexual stimuli on a short-term basis, as reflected in higher phasic pupil dilation responses, probably mediated by sympathetic nervous system (SNS)-related processes. However, previous research has not addressed the specificity of this effect in terms of emotional valence, that is, whether it reflects an instance of general excitation transfer or a more specific mechanism. Thus, to further investigate changes in sexual processing after acute stress exposure, 40 male participants underwent either a predominantly sympathetic stressor (3 min sustained handgrip) or similar control procedure. After stress induction, pictures varying in valence as well as sexual versus non-sexual arousal were presented (for 5000 ms each). Using principal component analysis, pupillary responses during picture viewing were dissociated into fast and slow components (early vs. late response phases). In addition, startle eyeblink responses were elicited by bursts of white noise (50 ms, 105 dB) in half of the trials and recorded at the orbicularis oculi via electromyography. Skin conductance and heart rate were co-registered, as well. While affective startle modulation and skin conductance responses to emotional stimuli were unaffected by previous stress exposure, both evoked heart-rate deceleration (but not acceleration) and pupil responses were specifically enhanced with sexually arousing stimuli in stressed participants, and this effect was mediated by blood pressure reactivity as an index of preceding SNS activation. Taken together, our findings provide strong evidence for enhancement of sexual processing by acute stress exposure in men and suggest differential involvement of parasympathetic versus sympathetic mechanisms.

Measuring Sexual Intelligence for Evaluating Sexual Health

The current paper reports four consecutive studies that were conducted to link sexual health with a new construct of sexual intelligence by developing and validating a new scale to measure sexual intelligence. Sexual intelligence was defined as "the ability to perceive, understand and respond to sexual needs and desires in a personal and social context." Sexual Intelligence Scale (SIS), comprising of 8 items in English and 2 factors (sexual knowledge & sexual behavior), was developed and validated by involving 959 respondents in the process of 4 consecutive studies. The validity of SIS was tested step by step for its face, content, factorial, convergent, discriminant, and predictive validities. The reliability was measured through internal consistency and item-total & item-scale correlations. The study found significantly higher levels of sexual intelligence in men as compared to women. Sexual intelligence, moreover, had significant positive correlations with age, education, emotional intelligence, social intelligence, sexual health, and satisfaction with life. Sexual health was linked with sexual intelligence and the SIS was accepted as a reliable and valid tool to measure sexual intelligence.