Agreement of self-reported and genital measures of sexual arousal in men and women: a meta-analysis

Psychometric Properties of Common Measures of Hypersexuality in an Online Canadian Sample

BACKGROUND

Hypersexuality has been posited as the central defining feature of Compulsive Sexual Behavior Disorder, and although the acceptance and inclusion of this construct in psychiatric nosologies provides some legitimacy, concerns surrounding terminology, assessment, and diagnosis remain.

AIM

The present study was an independent psychometric examination of 2 of the most commonly used measures of Compulsive Sexual Behavior Disorder; specifically, the gender invariance of the latent structure, reliability (test retest, internal consistency), and external correlates (concurrent validity) of these measures.

METHODS

The Sexual Compulsivity Scale and the Hypersexual Behavior Inventory were completed by 2 nonclinical online community samples of cisgender women (ns = 525 and 359), cisgender men (ns = 419 and 364), and transgender or non-binary individuals (ns = 38 and 11).

OUTCOMES

Criterion based measures of sexual history and total sexual outlet (number of orgasms per week) were gathered to validate Sexual Compulsivity Scale and Hypersexual Behavior Inventory total and factor scores.

RESULTS

Results supported the factorial validity of both assessment measures: correlated 3 factor solutions were established through exploratory factor analysis of 1 sample, and confirmatory factor analysis in the second sample. Multiple group confirmatory factor analysis, conducted on the 2 combined samples, also supported the gender invariance of the 3-factor solutions. Additional basic psychometric indices of test-retest and internal consistency reliability and criterion-related (concurrent) validity conducted across the 2 online samples were supported.

CLINICAL IMPLICATIONS

Common measures of hypersexuality have potential for use in its assessment, treatment, and management.

STRENGTHS & LIMITATIONS

Study strengths include: the inclusion of 2 fairly large and diverse online samples, thorough checks for insufficient effort/validity of responding, validity and reliability methodology (ie, measurement at multiple time points, obtaining behavioral indicators of sexual health), and a comprehensive set of psychometric analyses to inform conclusions regarding the external validity, reliability, and latent structure of hypersexuality measures across gender groups. Study limitations include: potential concerns related to validity and accuracy of responding owing to a reliance on self-report, the potential for selection bias, and limiting the examination of the latent structure of hypersexuality to cisgender men and women such that the results may not generalize to gender diverse populations.

CONCLUSION

Hypersexuality is a multidimensional construct, with a common latent structure among cisgender men and women, consistency in measurement over time, and meaningful concurrent associations with behavioral criteria that have relevance for sexual health. Olver ME, Kingston DA, Laverty EK, et al. Psychometric Properties of Common Measures of Hypersexuality in an Online Canadian Sample. J Sex Med 2022;19:331-346.

Can the Vaginal Photoplethysmograph and Its Associated Methodology Be Used to Assess Anal Vasocongestion in Women and Men?

Forty years ago, researchers documented changes in vascular and muscular activity within the anal canal of women and men who engaged in sexual self-stimulation. Vascular changes were assessed using a photoplethysmograph that aimed to detect changes in pelvic vasocongestion. An important advantage of detecting sexual response within the anal canal is that the device, its anatomical placement, and the data output are identical for women and men, therefore facilitating gender comparisons of response patterns. In this study, the vaginal photoplethysmograph (VPP), the most common measure of genital response in women, was administered intra-anally as an anal photoplethysmograph (APG) to examine its validity and sensitivity as an indicator of sexual response. The final sample comprised 20 women and 20 men who were exposed to 12, 90-s sexual and nonsexual film clips while their APG responses were recorded. Participants also rated their sexual arousal and affective responses to the stimuli. There was evidence that APG responses were specific to sexual stimuli and were sensitive to erotic intensity in women. The degree of discrimination between sexual and nonsexual stimuli was lower in men. Unlike most sexual psychophysiological studies, the positive correlation between physiological and self-reported sexual arousal was stronger in women than in men. There was a relatively high number of data artifacts and the waveform morphology was uncharacteristic of that typically observed with VPP. The potential role of anal musculature interference on the APG signal is discussed, as well as avenues for future research.

Measurement of Sexual Interests with Pupillary Responses: A Meta-Analysis

Objective measures of sexual interest are important for research on human sexuality. There has been a resurgence in research examining pupil dilation as a potential index of sexual orientation. We carried out a meta-analytic review of studies published between 1965 and 2020 (Mdn year = 2016) measuring pupil responses to visual stimuli of adult men and women to assess sexual interest. Separate meta-analyses were performed for six sexual orientation categories. In the final analysis, 15 studies were included for heterosexual men (N = 550), 5 studies for gay men (N = 65), 4 studies for bisexual men (N = 124), 13 studies for heterosexual women (N = 403), and 3 studies for lesbian women (N = 132). Only heterosexual and gay men demonstrated discrimination in pupillary responses that was clearly in line with their sexual orientation, with greater pupil dilation to female and male stimuli, respectively. Bisexual men showed greater pupil dilation to male stimuli. Although heterosexual women exhibited larger pupils to male stimuli compared to female stimuli, the magnitude of the effect was small and non-significant. Finally, lesbian women displayed greater pupil dilation to male stimuli. Three methodological moderators were identified-the sexual explicitness of stimulus materials, the measurement technique of pupillary response, and inclusion of self-report measures of sexual interest. These meta-analyses are based on a limited number of studies and are therefore preliminary. However, the results suggest that pupillary measurement of sexual interest is promising for men and that standardization is essential to gain a better understanding of the validity of this measurement technique for sexual interest.

Photographs of Actions: What Makes Them Special Cues to Social Perception

I have reviewed studies on neural responses to pictured actions in the action observation network (AON) and the cognitive functions of these responses. Based on this review, I have analyzed the specific representational characteristics of action photographs. There has been consensus that AON responses provide viewers with knowledge of observed or pictured actions, but there has been controversy about the properties of this knowledge. Is this knowledge causally provided by AON activities or is it dependent on conceptual processing? What elements of actions does it refer to, and how generalized or specific is it? The answers to these questions have come from studies that used transcranial magnetic stimulation (TMS) to stimulate motor or somatosensory cortices. In conjunction with electromyography (EMG), TMS allows researchers to examine changes of the excitability in the corticospinal tract and muscles of people viewing pictured actions. The timing of these changes and muscle specificity enable inferences to be drawn about the cognitive products of processing pictured actions in the AON. Based on a review of studies using TMS and other neuroscience methods, I have proposed a novel hypothetical account that describes the characteristics of action photographs that make them effective cues to social perception. This account includes predictions that can be tested experimentally.

Pharmaceutical and Energy-Based Management of Sexual Problems in Women

This article summarizes and critiques the evidence for use of available pharmacotherapies (vasoactive, psychoactive, and hormonal medications) and energy-based therapies (laser, radiofrequency, shockwave, and neurostimulation) for treatment of female sexual dysfunction. The enthusiasm with which energy-based treatments for sexual dysfunction have been adopted is disproportionate to the amount of data currently available to support their clinical use. Pharmacotherapy for female sexual dysfunction has considerably more research evidence to justify its use. Patients must be empowered to make an informed, autonomous determination as to whether the risk/reward ratio favors the use of pharmacotherapy, energy-based therapy, or some other treatment intervention.

An Approach to Reducing Problematic Data in an ACASI Sexual Behavior Assessment

Minimizing error in self-reported sexual behavior could reduce investigators' likelihood of rejecting truly successful interventions to decrease HIV and STI transmission risk. Sexual behavior assessments can elicit problematic data. This may manifest in the form of elevated levels of non-response, inaccurate point estimates, or misclassification errors resulting in inappropriately answering or, perhaps more importantly, skipping questions. We programed conversational interviewing elements into 20 sexual behavior questions in an exit survey of gay bathhouse patrons (N = 459) administered using ACASI. Those elements, called alternate pathways, included follow-up questions to responses to confirm that operational definitions were applied in the answer (with return to the initial question if confirmation failed), and assurances of confidentiality and requests for best guesses in reaction to non-response (including "don't know"). These elements were invoked in nearly 10% of participants, and approximately 74% of all invocations resulted in a usable numeric response, or 87% if the data need only estimate prevalence. Almost two-thirds of the problematic data issues occurred in answers to sexual contact questions, with others related to follow-up questions about specific sexual behavior. It is at this level of important filtering questions where the benefits of the approach are likely to be maximized.

Specific factors and methodological decisions influencing brain responses to sexual stimuli in women

Most of the neuroimaging studies on sexual behavior have been conducted with male participants, leading to men-based models of sexual arousal. Here, possible factors and methodological decisions that might influence brain responses to sexual stimuli, specifically for the inclusion of women, will be reviewed. Based on this review, we suggest that future studies consider the following factors: menstrual phase, hormonal contraception use, history of sexual or psychiatric disorders or diseases, and medication use. Moreover, when researching sexual arousal, we suggest future studies assess sexual orientation and preferences, that women should select visual sexual stimuli, and a longer duration than commonly used. This review is thought to represent a useful guideline for future research in sexual arousal, which hopefully will lead to a higher inclusion of women and therefore more accurate neurobiological models of sexual arousal.

Racial preferences in sexual attraction among White heterosexual and gay men: Evidence from sexual arousal patterns and negative racial attitudes

Racial preferences in sexual attraction are highly visible and controversial. They may also negatively impact those who are excluded. It is unclear whether these preferences are merely self-attributed or extend to patterns of experienced sexual arousal. Furthermore, some argue that racial preferences in sexual attraction reflect idiosyncratic personal preferences, while others argue that they are more systematically motivated and reflect broader negative attitudes toward particular races. In two studies, we examined these issues by measuring the sexual arousal patterns and negative racial attitudes of 78 White men in relation to their racial preferences in sexual attraction to White versus Black people. For both White heterosexual men (n = 40; Study 1) and White gay men (n = 38; Study 2), greater racial preferences in sexual attraction to White versus Black people of their preferred gender were associated with more subjective and genital arousal by erotic stimuli featuring White versus Black people of their preferred gender, and with more explicit and implicit negative attitudes toward Black people. Findings suggest that racial preferences in sexual attraction are reflected in patterns of sexual arousal, and they might also be systematically motivated by negative attitudes toward particular races.

Penile Hemodynamic Response to Phosphodiesterase Type V Inhibitors after Cavernosal Sparing Inflatable Penile Prosthesis Implantation: A Prospective Randomized Open-Blinded End-Point (PROBE) Study

Forceful corporal dilatation amidst penile prosthesis implantation may injure cavernosal arteries compromising penile vasculature. In this study, we aimed to compare the conventional and cavernosal sparing techniques regarding cavernosal artery preservation. Overall, 33 patients underwent inflatable penile prosthesis implantation with Coloplast Titan Touch® three-piece inflatable penile implants. 16 patients had conventional implantations with serial vigorous dilatations, while 17 patients were implanted with the cavernosal sparing technique, consisting of a single minimal corporal dilatation after an intraoperative intracavernosal injection (ICI) of Alprostadil. Postoperatively, a penile duplex Doppler ultrasound study was performed. Whenever a cavernosal artery was spared and thus successfully probed, its hemodynamics were studied before and after an oral administration of a phosphodiesterase type 5 inhibitor (PDE5i). A cavernosal artery was successfully probed in 16/17 (94%) of patients in the cavernosal sparing group compared to 5/16 (31%) of patients in the conventional group with a significant statistical difference (P=0.001). This demonstrated that the cavernosal sparing technique was superior to the conventional approach in preserving the cavernosal artery (odds ratio 35.2, 95% IC 3.5–344.2; P=0.0022). Whenever a cavernosal artery could be probed, its hemodynamic responsiveness was also preserved. This trial is registered with NCT03733860.

Visual attention and sexual arousal in women with and without sexual dysfunction

Attention to sexual stimuli is a prerequisite to process such stimuli as sexually-meaningful and is an important means to facilitate sexual arousal. Attending to sexual cues is crucial for healthy sexual functioning. Studies suggest that sexual dysfunction is associated with less attention towards sexual stimuli. The goal of this study was to use an eye-tracking-based free-viewing paradigm to investigate whether women with sexual dysfunction visually attend to the genital area in dynamic sexual stimuli (i.e., erotic videos) differently than women with subclinical sexual function or those with typical sexual functioning. A total of 69 women (M_age = 27.77, SD = 8.00) with clinical (n = 30), subclinical (n = 23), and typical (n = 16) levels of sexual functioning watched four 1-min video clips depicting heterosexual couples engaging in vaginal intercourse or cunnilingus while the total fixation duration on the genital area as well as their subjective and genital sexual arousal were recorded. As hypothesized, the clinical group fixated on the genital area less than women with typical sexual functioning. A longer total fixation duration on the genital area was followed by increases in subjective arousal and genital arousal. The relationship between attention and arousal was not moderated by sexual functioning group. This study provides first evidence of the role of sustained visual attention for facilitating sexual arousal in women with and without sexual dysfunction.

LGBTQ+ Aging Research in Canada: A 30-Year Scoping Review of the Literature

Canada has a unique socio-political history concerning the inclusion of lesbian, gay, bisexual, transgender, and queer (LGBTQ+) people. With aging populations, understanding diverse groups of older adults is paramount. We completed a systematic search and scoping review of research in Canada to quantify and articulate the scale and scope of research on LGBTQ+ aging. Our search identified over 4000 results and, after screening for relevance, our review focused on 70 articles. Five major themes in the literature on LGBTQ+ aging in Canada were identified: (1) risk, (2) HIV, (3) stigma, and discrimination as barriers to care, (4) navigating care and identity, (5) documenting the history and changing policy landscapes. Most of the articles were not focused on the aging, yet the findings are relevant when considering the lived experiences of current older adults within LGBTQ+ communities. Advancing the evidence on LGBTQ+ aging involves improving the quality of life and aging experiences for LGBTQ+ older adults through research.

Concordance of Paraphilic Interests and Behaviors

We examined the concordance of paraphilic interests and behaviors across 13 themes in an online sample of 1,036 men and women. Paraphilic interests were significantly and positively correlated with behaviors across all 13 themes. Associations were strongest for masochism and sadism, and weakest for pedohebephilia and frotteurism. Paraphilic interest and behavior were significantly and positively correlated after accounting for gender and sexual orientation. Moderated moderation analysis was significant for five themes. Gender was a moderator for eroticized gender, but only among heterosexual participants, where concordance was higher for heterosexual men than for heterosexual women. For both exhibitionism and frotteurism, gender was a significant moderator, but only for nonheterosexual participants, where concordance was stronger for nonheterosexual men than for nonheterosexual women. For pedohebephilia, interest was significantly associated with behavior for heterosexual men, heterosexual women, and nonheterosexual men, but not for nonheterosexual women. For zoophilia, there was a significant association between interest and behavior for heterosexual men, nonheterosexual men, and nonheterosexual women, but not heterosexual women. Additional analyses found sex drive moderated the positive associations of 7 of 13 paraphilic themes, with 5 of these 7 showing the expected effect of higher concordance of interests and behaviors at higher levels of sex drive.

Treatment of Traumatised Sexuality

Based on therapeutic meetings with individuals who have experienced sexual violence and abuse, the challenge is how do we help these couples to establish sexual relationships on their own terms, without interference of defence or coping strategies they have used to protect themselves against the overwhelming experiences of violence or abuse in the past? This article will focus on therapeutic work with such couples and how to interact with them and support their efforts to establish satisfying sexual relationships, based on sexological experience as well as experience from work with traumatisation. The basis for our treatment is a modified version of William Masters and Virginia Johnson's approach. The technique of sensate focus is central, modified by trauma theory, including the understanding of dissociation, and the need to integrate memories from different levels: somatic, emotional, and cognitive. The traumatised client needs special attention to the experiences of predictability and safety and respect due to their history of being transgressed against. The therapists must be aware of the issue of dissociation; different dissociated inner parts can play different roles in the interaction between client and therapist. While couples therapy is a necessary frame for this therapy, the therapist often needs to work with issues unique to each individual. Each partner must be able to identify their own responses and their own sexual needs and preferences. It may therefore be valuable to have a co-therapist. The central goal is for the clients to identify responses to stimulation as a here and now experience in a setting that feels safe and welcome.

Partner intimate touch is associated with increased interpersonal closeness, especially in non-romantic partners

Relationship closeness promotes desirable health outcomes. Most interventions to increase relationship closeness are verbal, which may not suit all couples. We consider whether Orgasmic Meditation (OM), a structured, partnered, largely non-verbal practice that includes genital touch, also increases relationship closeness. We hypothesized that OM would increase feelings of closeness for both romantic and non-romantic partners. This is important, because intimate touch with non-romantic partners is commonly considered deleterious by clinicians, which may inadvertently increase feelings of shame. Dyads (n = 125) reported their feelings of closeness before and after OM. Approximately half of the participants were romantic partners, while the other half only engaged in OM together (non-romantic). Closeness after OM increased on average across participants. Non-romantic dyads increased self-other overlap more than romantic dyads. These data support that a partnered, largely non-verbal practice is associated with increased feelings of closeness in the moment, including for individuals who are not in a romantic relationship.

Sex Differences in the Motivation for Viewing Sexually Arousing Images

Sexual motivation strongly influences mate choice and dating behavior and can be triggered by merely viewing sexually arousing visual images, such as erotic pictures and movies. Previous studies suggested that men, more than women, tend to search for sexual cues that signal promiscuity in short-term mates. However, it remains to be tested whether sex differences in the motivation to view sexual cues can be observed by using robust and well-controlled behavioral measures. To this end, we employed a pay-per-view key-pressing task. Japanese self-identified heterosexual male and female participants viewed images of men, women, or couples with two levels of sexual arousal (sexual vs. less sexual). Participants could alter the viewing time of a presented image according to their willingness to keep viewing it. Male participants were the most eager to view sexually arousing images of the opposite sex, whereas female participants were more strongly motivated to view less sexual images of couples. Such sex differences may reflect differentiated reproductive strategies between men and women in terms of men’s motivation toward promiscuity and women’s motivation toward long-term relationships.

How to improve eyewitness testimony research: theoretical and methodological concerns about experiments on the impact of emotions on memory performance

The purpose of this paper is to present crucial shortcomings of research into eyewitness testimony. It presents the state-of-the-art of research on the relationship between emotions and memory performance. In addition, it addresses contradictions and concerns about previous studies. Despite the declarations of consensus on the role of emotions in memory coding and retrieving, there are as many studies suggesting that emotional events are better remembered than neutral ones, as there are reports that show the opposite. Therefore, by indicating the theoretical and methodological limitations of previous studies, this paper advocates a more rigorous approach to the investigation of emotions and their impact on the quality and quantity of testimony. It also provides a framework for inquiry that allows better comparisons between studies and results, and may help to build a more comprehensive theory of the effects of emotion on memory.

Posttraumatic cognitions predict distorted body perceptions in women with dissociative identity disorder

BACKGROUND

Dissociative identity disorder (DID) is a psychobiological syndrome associated with a history of exposure to childhood abuse and neglect. The consequences of these traumatic events often include a profound impact on the way individuals inhabit and experience their bodies. Despite this, there is a paucity of empirical research on the subject. The aim of this study was to systematically document the occurrence of distorted body perceptions in DID and examine childhood maltreatment, posttraumatic stress disorder (PTSD) symptom severity, and posttraumatic cognitions as predictors of distorted body perceptions in DID.

METHODS

Participants were adult women with histories of childhood abuse and neglect and a current DID diagnosis receiving treatment at a psychiatric care facility. Data were obtained through a battery of self-report measures, including the Body Uneasiness Test, Childhood Trauma Questionnaire, PTSD Checklist for DMS-5, and Posttraumatic Cognitions Inventory.

RESULTS

A series of unpaired t-tests documented elevated levels of weight phobia, body image concerns, body avoidance, compulsive self-monitoring, and depersonalization in DID compared to published non-clinical data on the Body Uneasiness Test. A series of multiple regression models including measures of childhood trauma, PTSD symptoms, and posttraumatic cognitions demonstrated that over and above childhood trauma and PTSD symptom severity, posttraumatic cognitions significantly predicted distorted body perceptions.

CONCLUSIONS

In a treatment-seeking sample of women with DID, distorted body perceptions were elevated. Furthermore, posttraumatic cognitive distortions significantly predicted distorted body perceptions when controlling for childhood maltreatment and PTSD symptom severity. This suggests that distorted cognitions are a key target for therapeutic intervention.

The effect of differential disgust conditioning and subsequent extinction versus counterconditioning procedures on women's sexual responses to erotic stimuli

Recent theoretical accounts point to disgust as an important factor in the development and persistence of sexual dysfunctions. This study tested if (i) contingent disgust experiences can render initially sexually arousing stimuli disgusting, and (ii) such acquired disgust responses could be best neutralized via a CS-only extinction or a counterconditioning procedure. Participants (N = 74) were exposed to a differential conditioning procedure that was followed by either a CS-only extinction or a counterconditioning procedure. Erotic films served as the CS+/CS-. A disgusting film served as the US. During the extinction procedure, the CS+ was no longer followed by the disgusting US. During counterconditioning the CS+ was paired with positive stimuli. After conditioning, the CS + elicited lower genital arousal and was rated as significantly more disgusting, less pleasant, and less sexually arousing than the CS-. These diminished genital and subjective sexual arousal responses to the CS+ were successfully restored after both the extinction and the counterconditioning procedure, whereas conditioned feelings of disgust and behavioral avoidance persisted. There was no evidence for differential effectiveness of either procedure. Thus, sexual responses can be attenuated by learned sex-disgust associations and restored by extinction and counterconditioning procedures, but conditioned feelings of disgust seem more resistant.

Challenging the Standard Model of Sexual Response: Evidence of a Variable Male Sexual Response Cycle

Historically the male sexual response cycle was seen as uniform and used as the standard for women. Recent research has suggested that men's sexual response cycle may vary more than previously thought. We asked 520 sexually active men between the ages of 18-73 to report on their sexual desire and arousal patterns during their last sexual experience. Using a latent class mixture model from retrospective sexual response data, we found five classes of desire and arousal patterns. These patterns were examined for associations with demographics, outcomes during the sexual experience, and outcomes for the global relationship. The experiences of arousal and desire appear to be indistinguishable for men in this sample. The Fluctuation sexual response class (19% of men) and the High sexual response class (40%) were significantly different from most of the other classes in duration of their sexual experiences and overall satisfaction with their sexual experiences. Still, most sexual response patterns were associated with healthy relational and sexual outcomes. Variability in the male sexual response cycle is important to acknowledge and normalize.

Patterns of sexual behavior and psychological processes in asexual persons: a systematic review

Asexuality is commonly regarded as lack of sexual attraction. Research in asexuality grew progressively in the past two decades. However, asexuals' patterns of sexual behavior and psychological processes were not yet systematized. This review searched for articles that could potentially help establishing these patterns. Articles published in English until December 31st 2019 were retrieved from Medline, Embase, Cochrane, EBSCO, PubMed, Scopus, and PsycARTICLES. A systematic search was conducted using an exhaustive list of key terms regarding asexuality and sexual behavior following PRISMA guidelines. Of the 195 initially retrieved, only 23 were considered for this review. Of the 23 articles, 16 were quantitative studies, 5 were qualitative studies, and 2 comprised quantitative and qualitative studies. Overall, current findings suggest that asexuals present great heterogeneity of sexual behaviors and psychological processes regarding sexuality, including different aspects and types of interpersonal and romantic relationships, sexual attitudes or fantasies. Conversely, data did not find support for the claim that asexuals present impaired sexual functioning. The little geographic and cultural diversity of the samples is a major limitation in these studies, preventing the properly representation of asexuals. Furthermore, asexuals may benefit from evidence on the biopsychosocial factors shaping sexual, emotional, and relationship well-being, as far as such evidence is built upon asexuals' lenses, rather than on heteronormativity criteria.

Gender Differences in the Emotional Response and Subjective Sexual Arousal Toward Non-Consensual Sexual Intercourse: A Pupillometric Study

BACKGROUND

Gender differences in sexual response have targeted individuals' emotional appraisal of mainstream erotica. Yet, evidence reveals that men and women commonly endorse non-normative sexual interests, and no evidence has been collected on their emotional responses toward deviant sexual stimuli.

AIM

This study was aimed at evaluating gender differences in the emotional responses toward non-consensual sexual intercourse, thus revealing individuals' appraisal of non-normative sexual contents. In order to provide an initial background to interpret findings, this study further tested the association between individuals' emotional responses and sexual self-schemas (SSSs).

METHODS

29 men and 45 women (all heterosexual) were voluntarily exposed to audiovisual presentations of non-consensual/physically forced sexual intercourse in a laboratory context. Markers of emotional response were collected by psychophysiological and self-report means.

OUTCOMES

Pupil activation, namely pupil diameter ratio, during exposure to the video clips was captured with an eye tracker. Positive and negative emotions and subjective sexual arousal toward the clips were also collected. In addition, participants responded to the SSS scale assessing individuals' sexual self-perceptions.

RESULTS

Findings revealed a small degree of gender differences. While men reported significantly more positive emotions toward the clip displaying a woman as recipient to non-consensual sex, no further differences were found. Also, participants revealed an increased pupil diameter ratio only in the first moments of the video clips. SSSs, including themes of aggression and power, were associated with men's emotional responses toward the clips, while no associations were found in women.

CLINICAL TRANSLATION

Despite its preliminary nature, the current study provides evidence on the emotional mechanisms underpinning human sexual response, and may eventually translate to conceptualizing models with a focus on non-normative sexual behavior.

STRENGTHS & LIMITATIONS

To our best knowledge, this is the first study researching gender specificities in the emotional appraisal of non-consented sex. Current findings may help to understand individuals' deviant sexual interests and establish a framework for future research in this area. However, it is worth noting that lack of previous research prevents the generalization of findings and limits our interpretation of data.

CONCLUSION

Findings revealed a small degree of gender differences in the emotional appraisal of non-consensual sexual intercourse, and suggested partial evidence in the relationship between sexual self-perceptions and emotional responses to forced sex. Carvalho J, Rosa PJ. Gender Differences in the Emotional Response and Subjective Sexual Arousal Toward Non-Consensual Sexual Intercourse: A Pupillometric Study. J Sex Med 2020;17:1865-1874.

Using Arousal Suppression Exercises to Decrease Inappropriate Sexual Arousal in Detained Adolescent Males: Three Clinical Demonstrations

Reyes, Vollmer, and Hall (2011) found that 2 arousal suppression strategies, 1 of which involved counting backward from 100 to 0, decreased sexual arousal for 2 male sex offenders with intellectual disabilities. In the current clinical study, we taught 3 adolescent males who had been adjudicated for illegal sexual behavior to self-report arousal when they were presented with sexually arousing visual stimuli. Based on the procedures in the Reyes et al. (2011) study, we taught participants to count backward from 100 to 0 when they verbally reported a criterion level of sexual arousal in the presence of visual media. Subsequently, we gradually faded therapists' instructions for 2 participants until they independently used the arousal suppression exercise. Results showed that each participant's self-reported sexual arousal decreased upon implementation of treatment relative to baseline. Decreased sexual arousal continued even under conditions of faded therapist instructions for 2 participants. The relative merits of using self-report measures are discussed.

Statistical Mediators of the Association Between Mindfulness and Sexual Experiences in Men with Impaired Sexual Function

Mindfulness-based therapy has shown promise as a treatment for female sexual dysfunction and has the potential to be an efficacious treatment for male sexual dysfunction. However, there has been little empirical evidence regarding the mechanisms through which mindfulness may improve sexual experiences, especially for men. Recent theoretical reviews have suggested potential mediators that may explain the beneficial effects of mindfulness on symptoms of male sexual dysfunction, including reduced avoidance of sex, reduced distraction during sex, and/or reduced activation of negative sexual schemas. We attempted an initial statistical test of these factors as potential mediators of the association between trait mindfulness and multiple sexual outcomes (sexual function, sexual satisfaction, and sexual distress) using a cross-sectional correlational design. A total of 163 men with self-reported current impairments in one or more aspects of sexual function completed self-report scales using a secure online survey. Bivariate correlations indicated that mindfulness was significantly associated with sexual satisfaction, sexual distress, and premature ejaculation, but not other aspects of sexual function. Sexual avoidance statistically mediated the link between mindfulness and sexual satisfaction, both distraction and activation of negative schemas statistically mediated the link between mindfulness and premature ejaculation, and all three factors statistically mediated the link between mindfulness and sexual distress. These results generally supported previous theoretical work and have implications for future treatment outcome research.

Use of the Bogus Pipeline Increases Sexual Concordance in Women But Not Men

Sexual concordance-the agreement between physiological (genital) and psychological (emotional) sexual arousal-is, on average, substantially lower in women than men. Following social role theory, the gender difference in sexual concordance may manifest because women and men are responding in a way that accommodates gender norms. We examined genital and self-reported sexual arousal in 47 women and 50 men using a condition known to discourage conformity to gender norms (i.e., a bogus pipeline paradigm). Participants reported their feelings of sexual arousal during a sexually explicit film, while their genital arousal (penile circumference, vaginal vasocongestion), heart rate (HR), and galvanic skin (GS) responses were recorded. Half of the participants were instructed that their self-reported sexual arousal was being monitored for veracity using their HR and GS responses (bogus pipeline condition; BPC); the remaining participants were told that these responses were recorded for a comprehensive record of sexual response (typical testing condition; TTC). Using multi-level modeling, we found that only women's sexual concordance was affected by testing condition; women in the BPC exhibited significantly higher sexual concordance than those in the TTC. Thus, we provide the first evidence that the gender difference in sexual concordance may at least partially result from social factors.

Behavioral intention to have risky sex in young men and women: The role of sexual excitation and assertiveness

Due to the complex role of sexual excitation in risky sexual behaviors, this study aimed to disentangle this phenomenon by jointly analyzing the combined role of three forms of sexual excitation: genital and subjective, and individual´s propensity. Therefore, we examined the relationship between the components of the Dual Control Model, that is, propensity for sexual excitation/inhibition, in addition to genital and subjective arousal, and sexual assertiveness and intention to engage in casual sexual encounters in which sexual risk was implicitly or explicitly present. The sample consisted of 99 heterosexual young adults (55 men and 45 women) with ages ranging from 18 to 32 years. Participants performed an experiment in the laboratory, which involved them watching a sexual clip and then being presented with two erotic excerpts (stories) depicting casual sexual encounters in which there was an existence of implicit and explicit sexual risks. In men, the propensity for sexual inhibition was the most determining variable in preventing them from sexual risk-taking. In women, intention to engage in risky sexual behaviors was better determined by their propensity for sexual excitation and sexual assertiveness in negotiating the use of contraceptive methods. This research highlights the relevance of excitation and inhibition as a trait, in addition to subjective arousal and sexual assertiveness in intention to engage in risky sexual behaviors.

The Relationship between Subjective and Physiological Sexual Arousal in Women with and without Arousal Concerns

Whereas laboratory studies frequently report low correlations between women's physiological and subjective sexual arousal (i.e., concordance), research employing advanced statistical techniques reveals striking between-person variability in this relationship. Moreover, previous research has shown that interoception (i.e., the awareness of changes within the body) influences concordance in women, though how this effect varies by sexual function is yet unknown. The present study used multilevel modeling to examine concordance in women with (n = 27) and without (n = 28) sexual arousal concerns and explored how concordance varies as a function of interoception. Women viewed a sexual film while their arousal responses were measured and then completed a self-report measure of interoception. A significant relationship emerged between physiological and subjective sexual arousal, in addition to tremendous between-person variability across both groups. Several aspects of interoception moderated concordance (p's between 0.0008 and 0.03), and this pattern varied across groups. Given this variability even in absence of sexual arousal concerns, these findings question the utility of using concordance as a clinical outcome in treatment research. Individual differences in interoception may have implications for treatment matching.

Preliminary Evidence on How the Dual Control Model Predicts Female Sexual Response to a Bogus Negative Feedback

The Dual Control Model of sexual response has been mostly tested with men. As such, there is a lack of evidence on how such model applies to women's experience of sexual arousal, particularly when they face a threatening situation such as the threat of sexual performance failure. The aim of the current study was to test whether the Dual Control Model dimensions predict women's sexual responses to a bogus negative feedback about their sexual performance. In addition, 22 women were exposed to a sexually explicit film clip, while their genital arousal was being measured. During this presentation, a bogus negative feedback, aimed at increasing women's anxiety about their sexual performance, was provided. Vaginal photopletismography and self-report questions were used as means to evaluate women's genital and subjective sexual arousal, respectively. The Sexual Excitation/Sexual Inhibition Inventory for Women was further used to capture women's sexual dynamics. Regression analysis on the high-order factors revealed that sexual excitation proneness was the only predictor of the subjective sexual responses, while none of the factors has predicted genital arousal. "Arousability" and "Concerns about sexual function" dimensions predicted subjective sexual arousal. Sexual arousability may prevent women of lowering their subjective sexual responses in a sexually demanding situation, while "Concerns about sexual function" may have the opposite role, thus being a target of clinical interest. This work provides new data on the Dual Control Model of sexual response, and particularly on its role in women's sexual functioning.

Changes in Sexual Desire in Women and Their Partners during Pregnancy

When studying sexual desire during pregnancy, most research focuses on the pregnant woman’s sexual desire and almost never takes into account her sexual partner. The novelty of this study is that sexual desire during pregnancy is studied from the point of view of the pregnant woman and from that of her male partner. The goal of this study is to see how sexual desire behaves during pregnancy in both partners. For this, a descriptive, longitudinal, and multistage study was designed. Methodologically, in the first stage, the different study variables were described through a single-variate analysis. In the second stage, one variable was related to others by means of a bivariate analysis. Finally, in the third stage, a multivariate analysis was done, composed of binary logistic regression models and latent growth curves. The results confirm that pregnancy influences the sexual desire of both partners, and that sexual desire behaves differently in women than in men during pregnancy. Men have higher levels of sexual desire throughout pregnancy as compared to women. The first trimester of pregnancy is the period when women have less sexual desire.

Designing mate choice experiments

The important role that mate choice plays in the lives of animals is matched by the large and active research field dedicated to studying it. Researchers work on a wide range of species and behaviours, and so the experimental approaches used to measure animal mate choice are highly variable. Importantly, these differences are often not purely cosmetic; they can strongly influence the measurement of choice, for example by varying the behaviour of animals during tests, the aspects of choice actually measured, and statistical power. Consideration of these effects are important when comparing results among studies using different types of test, or when using laboratory results to predict animal behaviour in  natural populations. However, these effects have been underappreciated by the mate choice literature to date. I focus on five key experimental considerations that may influence choice: (i) should mating be allowed to occur, or should a proxy behavioural measure of preference be used instead? (ii) Should subjects be given a choice of options? (iii) Should each subject be tested more than once, either with the same or different stimuli? (iv) When given a choice, how many options should the subject choose between? (v) What form should the experimental stimuli take? I discuss the practical advantages and disadvantages of common experimental approaches, and how they may influence the measurement of mate choice in systematic ways. Different approaches often influence the ability of animals to perceive and compare stimuli presented during tests, or the perceived costs and benefits of being choosy. Given that variation in the design of mate choice experiments is likely unavoidable, I emphasise that there is no single 'correct' approach to measuring choice across species, although ecological relevance is crucial if the aim is to understand how choice acts in natural populations. I also highlight the need for quantitative estimates of the sizes of potentially important effects, without which we cannot make informed design decisions.

Neural Responses to Sexual Stimuli in Heterosexual and Homosexual Men and Women: Men's Responses Are More Specific

Patterns of genital arousal in response to gendered sexual stimuli (i.e., sexual stimuli presenting members of only one sex at a time) are more predictive of men's than of women's sexual orientations. Additional lines of evidence may shed light on the nature of these differences. We measured neural activation in homosexual and heterosexual men and women using fMRI while they viewed three kinds of gendered sexual stimuli: pictures of nude individuals, pictures of same-sex couples interacting, and videos of individuals self-stimulating. The primary neural region of interest was the ventral striatum (VS), an area of central importance for reward processing. For all three kinds of stimuli and for both VS activation and self-report, men's responses were more closely related to their sexual orientations compared with women's. Furthermore, men showed a much greater tendency to respond more positively to stimuli featuring one sex than to stimuli featuring the other sex, leading to higher correlations among men's responses as well as higher correlations between men's responses and their sexual orientations. Whole-brain analyses identified several other regions showing a similar pattern to the VS, and none showed an opposite pattern. Because fMRI is measured identically in men and women, our results provide the most direct evidence to date that men's sexual arousal patterns are more gender specific than women's.

Facilitating Erotic Connection: The Relationship Shared Values Primer (RSVP) to Sex and Relationship Therapy in the Context of Sexual Trauma History

There are few models of sex therapy designed specifically for working with relationships in which one or more partners have a history of sexual trauma. The Relationship Shared Values Primer (RSVP) to sex and relationship therapies is a pre-sex therapy psychoeducation with the goal of promoting buy-in and reducing attrition by fostering safety and connection prior to beginning the therapeutic work through a dialogue of four key values: (1) Intimate Justice, (2) Non-linear Healing, (3) Mindful Acceptance, and (4) Erotic Empathy. We discuss research support for the rationale of the RSVP, how the RSVP can mitigate current obstacles to working with this population, and present a case study of the RSVP application.

The Spanish Version of the Sexual Opinion Survey (SOS-6): Evidence of Validity of a Short Version

The aim of this work was to provide validity evidences of the short Spanish version of the Sexual Opinion Survey (SOS-6). First, a psychometric study was performed to examine the factorial invariance of the scale across different groups. A sample of 1,500 heterosexual adults (50% men, 50% women) from the general Spanish population, aged 18 to 80, was examined. Results showed that the unidimensional model of the SOS-6 is invariant across sex, age range, relationship status, and educational level. Secondly, a laboratory study was performed to determine the relationship between erotophilia and objective and subjective sexual arousal in response to sexual stimuli. The sample consisted of 130 young Spanish university students (46.92% men, 53.08% women) with heterosexual orientation. In men, erotophilia was related to subjective sexual arousal; in women, erotophilia was related to subjective sexual arousal and estimation of genital sensations. In conclusion, this work provides validity evidences of the short version of the SOS-6 and describes the factorial equivalence of the scale across groups and its concurrent validity.

Is Mode of Delivery Associated With Sexual Response? A Pilot Study of Genital and Subjective Sexual Arousal in Primiparous Women With Vaginal or Cesarean Section Births

INTRODUCTION

Although postpartum sexual concerns are common, limited data exist on postpartum sexual response. Furthermore, the physiological process of vaginal birth may negatively impact genital response compared with unlabored cesarean section (C-section), but this hypothesis has yet to be tested.

AIM

To (i) compare genital and subjective sexual response and sexual concordance by mode of delivery with inclusion of a control group, (ii) compare groups on self-reported sexual function over the past month, (iii) examine the relationship between laboratory measurement of sexual response and self-reported sexual function, and (iv) investigate association between obstetrical factors and breastfeeding and between sexual response and self-reported sexual function.

METHODS

3 groups of cisgender women were recruited from the community: primiparous women who delivered via vaginal birth within the past 2 years (VB group; n = 16), primiparous women who delivered via unlabored C-section within the past 2 years (CS group, n = 15), and age-matched nulliparous women (NP group, n = 18). Laser Doppler imaging was used to assess genital response while participants watched a neutral and erotic film.

MAIN OUTCOME MEASURES

The main outcome measures were change in flux units from neural to erotic video as a measure of genital response, subjective sexual arousal rated continuously throughout films, perceived genital response rated after films, and Female Sexual Function Index (FSFI).

RESULTS

Women in the VB group had significantly lower change in flux units than women in the CS (P = .005, d = 1.39) and NP (P < .001, d = 1.80) groups. Groups did not differ on their subjective indices of sexual response or in sexual concordance. Women in both postpartum groups reported lower FSFI scores than women in the NP group. No relationship was determined between FSFI scores and sexual response in the laboratory. Results suggested that genital trauma and breastfeeding may negatively impact FSFI scores, but they were not related to genital response or subjective sexual arousal as measured in the laboratory.

CLINICAL IMPLICATIONS

Results underscore the importance of balancing objective and subjective indices of sexual response and function, especially considering the biopsychosocial nature of postpartum sexuality.

STRENGTHS & LIMITATIONS

The present study is the first to apply modern sexual psychophysiological methodology to the study of postpartum sexuality. Cross-sectional methodology limits the ability to make causal inferences, and the strict inclusion criteria limits generalizability.

CONCLUSION

Physiological changes as a result of labor and delivery may have a detrimental impact on genital response; however, these physiological differences may not impact women's subjective experience of postpartum sexuality. Cappell J, Bouchard KN, Chamberlain SM, et al. Is Mode of Delivery Associated With Sexual Response? A Pilot Study of Genital and Subjective Sexual Arousal in Primiparous Women With Vaginal or Cesarean Section Births. J Sex Med 2020; 17:257-272.

Assessing Paraphilic Interests Among Women Who Sexually Offend

PURPOSE OF REVIEW

We examine the state of scientific research on the assessment of paraphilic interests among women who have committed sexual offences.

RECENT FINDINGS

Research on the assessment of sexual interests in women using genital measures shows little evidence, overall, that women's genital responses are indicative of sexual interests. Some non-genital measures of sexual interest may be a valid indicator of age interests. Very few studies have focused on women who sexually offend. At this time, there is no validated measure that can be used to assess paraphilic interests among women who sexually offend. Much research is needed to determine if some measures (other than self-report) could validly assess a variety of sexual interests in women in general, and women who sexually offend in particular (e.g. interest in children, interest in sexual violence). This research is needed to determine if paraphilic interests are involved in women's motivation for sexual offending, and to determine if such interests are predictive of sexual recidivism.

Understanding sexual arousal and subjective-genital arousal desynchrony in women

Sexual arousal in women comprises two components: genital arousal and subjective arousal. Genital arousal is characterized by genital vasocongestion and other physiological changes that occur in response to sexual stimuli, whereas subjective arousal refers to mental engagement during sexual activity. For some women, genital arousal enhances subjective arousal; for others, the two types of arousal are desynchronous. However, the relationship between genital and subjective arousal might not be relevant to the diagnosis and treatment of sexual arousal dysfunction. Studies have shown that not all women who report sexual arousal problems have decreased genital arousal, and only some women with decreased genital arousal have low subjective arousal. To develop efficacious treatments for female sexual arousal dysfunction, researchers need to differentiate the women for whom genital sensations have a critical role in their subjective arousal from those who are not mentally aroused by genital cues. The mechanisms by which women become aroused and the inputs into arousal have considerable implications for treatment outcomes.

Laser Doppler Imaging as a Measure of Female Sexual Arousal: Further Validation and Methodological Considerations

Laser Doppler imaging has recently been applied to the study of female sexual response, with promising results. The current study sought to provide further validation for its use in this capacity, as well as to examine the sexual psychophysiological concepts of genital non-response and return to baseline with this instrument. A sample of healthy heterosexual women without any sexual concerns (N = 24) participated in a single testing session design, which included self-report measures and genital imaging with the laser Doppler imager (LDI). During the imaging portion of the study, genital and subjective arousal data were collected while participants watched neutral and erotic film stimuli. The results support the validity of the LDI as a measure of female sexual arousal, and highlight its potential utility in research and clinical applications for sexual function and related difficulties.