The impact of anxiety on sexual arousal in women

Sexual Sensation Seeking, Sexual Compulsivity, and Gender Identity and Its Relationship With Sexual Functioning in a Population Sample of Men and Women

INTRODUCTION

Despite awareness of the importance of psycho-affective factors in the development of sexual problems, there is a lack of studies exploring the relation of sexual sensation seeking (SSS) and sexual compulsivity (SC) to sexual functioning. Because sex differences in SSS and SC have been reported, gender identity (GI; an individual's own experience of his or her gender that is unrelated to the actual biological sex) might act as a moderator in this relation.

AIM

To understand the role of SSS and SC for men and women's sexual functioning and to explore whether these potential associations are moderated by GI.

METHODS

A population-based cross-sectional online survey targeted 279 individuals (69.2% women, 30.8% men; mean age = 32 years). Validated questionnaires, including the Sexual Sensation Seeking Scale, the Sexual Compulsivity Scale, the Female Sexual Function Index, the Premature Ejaculation Diagnostic Tool, and the International Index of Erectile Function, were applied.

MAIN OUTCOME MEASURES

Variations in SSS and SC and their association with sexual functioning were investigated using Spearman rank correlation. Moderation analyses were conducted using regression models in which the interaction terms between SSS and GI and between SCS and GI as predictors of sexual functioning were included.

RESULTS

A statistically significant correlation between SSS and SC could be detected in men and women (r = 0.41 and 0.33, respectively; P < .001 for the two comparisons). In women, higher levels of SSS were associated with higher levels of desire, arousal, lubrication, and orgasm and less sexual pain (P < .05 for all comparisons). No moderating effect of GI could be detected. In men, GI was a significant moderator in the relation between SC and erectile function (β = 0.47; P < .001) and between SSS and erectile and ejaculatory function (β = -0.41 and 0.30; P < .001 for the two comparisons).

CONCLUSION

The present study is the first to show a link between SSS and SC and sexual functioning. The results might have important clinical implications and can provide useful information for programs aimed at sexual health enhancement.

Poorer Subjective Sleep Quality Is Related to Higher Fantasy-Induced Sexual Arousal in Women of Reproductive Age

Lack of sleep enhances erections and lubrication the next day. This raises the possibility that poorer subjective sleep quality is related to sexual arousal. To test this hypothesis, sexual arousal was elicited in 70 Portuguese women of reproductive age by means of fantasy. The level of salivary testosterone before and shortly after fantasy was determined by luminescence immunoassays. Participants completed the Pittsburgh Sleep Quality Index (PSQI), reported their sexual arousal before and during fantasy, and how anxious they were after the fantasy. The hypothesis was confirmed. Anxiety did not explain the association, but testosterone response (poststimulus minus baseline) had a slight explanatory effect.

Cardiometabolic Risk and Female Sexuality: Focus on Clitoral Vascular Resistance

INTRODUCTION

The relation between sexual and cardiovascular health in women is not well defined. Clitoral color Doppler ultrasound (CDU) with assessment of the pulsatility index (PI), reflecting resistance to blood flow, has been proposed as an objective measurement of sexual functioning.

AIM

To investigate associations between clitoral PI and cardiometabolic risk factors, sexual and intrapsychic parameters, and self-perception of body image.

METHODS

Seventy-one adult heterosexual women in a stable relationship attending our clinic for sexual dysfunction were consecutively recruited.

MAIN OUTCOME MEASURES

Patients underwent physical, laboratory, and clitoral color Doppler ultrasound examinations and completed the Female Sexual Function Index, the Middlesex Hospital Questionnaire, and the Body Uneasiness Test (BUT).

RESULTS

Clitoral PI was positively correlated with body mass index (r = 0.441, P < .0001), waist circumference (r = 0.474, P < .0001), glycemia (r = 0.300, P = .029), insulin (r = 0.628, P = .002), homeostatic model assessment index (r = 0.605, P = .005), triglycerides (r = 0.340, P = .011), total cholesterol (r = 0.346, P = .010), and low-density lipoprotein cholesterol (r = 0.334, P = .016). All relations, with the exception of glycemia, retained statistical significance after adjusting for age, smoking habit, and years since menopause (P < .0001 for body mass index, waist circumference, and triglycerides; P < .05 for all other associations). Analysis of covariance, after adjusting for confounders, showed that women with obesity or metabolic syndrome (MetS) showed significantly higher PI values (obesity: F = 17.79, P = .001; MetS: F = 7.37, P = .019). In particular, a stepwise increase of PI was found as a function of increasing MetS components (β = 0.434, P = .007). Clitoral PI was negatively associated with Female Sexual Function Index arousal (β = -0.321, P = .014) and satisfaction (β = -0.289, P = .026) scores and positively associated with Middlesex Hospital Questionnaire somatized anxiety symptoms, even after adjusting for age, smoking habit, years since menopause, and current use of psychiatric medication (β = 0.354, P = .011). A positive association also was observed between PI and the BUT positive symptom distress index (β = 0.322, P = .039) and BUT for dislike of the womb, genitals, and breast (β = 0.538, P < .0001; β = 0.642, P < .0001; β = 0.549, P < .0001, respectively). After introducing waist circumference as another covariate, the associations between clitoral PI and the BUT positive symptom distress index and BUT dislike of the womb, genitals, and breast retained statistical significance (P = .038 for positive symptom distress index; P < .0001 for dislike of womb, genitals, and breast).

CONCLUSION

Clitoral vascular resistance is positively associated with MetS (in particular insulin resistance), decreased sexual arousal, body image concerns, and increased somatized anxiety symptoms. Further studies are needed to establish whether treatment of metabolic abnormalities might improve clitoral color Doppler ultrasound indices and sexual outcomes.

Should Sexual Problems Be Included in the Internalizing Spectrum? A Comparison of Dimensional and Categorical Models

Preliminary research has suggested that sexual problems should be included in the internalizing spectrum alongside depressive and anxiety disorders. This study aimed to empirically examine and compare an extended internalizing spectrum model with a categorical framework model implied by the current nosological structure. Responses to an online survey from a community sample (n = 518) were analyzed to compare the fit of six alternative models of the relationship between sexual problems and depressive and anxiety disorders, separately for men and women. The best model for women (n = 336) was a dimensional spectrum model that included sexual arousal, orgasm, and pain difficulties in the internalizing spectrum. The results for men (n = 182) were less clear-cut: there were apparent categorical relationships for a small group (n = 8), and the spectrum model showed a good fit for 96% of the sample. These findings are consistent with a nosology that maintains discrete disorders and diagnostic chapters while recognizing the relationships between them, as in the new structure of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. As such, this study offers further evidence that there are dimensional relationships between sexual problems and depressive and anxiety disorders, which should be explicitly recognized in diagnostic systems.

Acceptance of vulvovaginal pain in women with provoked vestibulodynia and their partners: associations with pain, psychological, and sexual adjustment

INTRODUCTION

Provoked vestibulodynia (PVD) is a common vulvovaginal pain condition associated with negative psychological and sexual consequences for affected women and their sexual partners. Greater pain acceptance has been found to be associated with better functional and psychological outcomes in individuals with chronic pain, and acceptance-based strategies are being increasingly incorporated into treatment protocols. The present study is a novel investigation of pain acceptance in PVD couples.

AIM

The aim was to examine the associations between acceptance of vulvovaginal pain and women's pain during intercourse, as well as the psychological and sexual adjustment of both women with PVD and their partners.

METHODS

Sixty-one couples (M(age) for women = 27.95 years, SD = 5.87; M(age) for men = 30.48 years, SD = 6.70) in which the woman was diagnosed with PVD completed the Chronic Pain Acceptance Questionnaire, in reference to women's vulvovaginal pain. Women also rated their pain during intercourse, and couples completed measures of anxiety, depression, sexual function, and sexual satisfaction.

MAIN OUTCOME MEASURES

Dependent measures were (i) women's self-reported pain during intercourse on a numerical rating scale; (ii) State-Trait Anxiety Inventory trait subscale; (iii) Beck Depression Inventory-II; (iv) Derogatis Interview for Sexual Functioning; and (v) Global Measure of Sexual Satisfaction Scale.

RESULTS

Women's greater pain acceptance was associated with their lower self-reported pain during intercourse, controlling for partner's pain acceptance. Greater pain acceptance among women was associated with their own lower anxiety and depression, greater sexual functioning, as well as their own and their partner's greater sexual satisfaction, controlling for the partner's pain acceptance. Additionally, greater pain acceptance among male partners was associated with their own lower depression.

CONCLUSIONS

Findings suggest that psychological interventions for PVD should target increasing couples' vulvovaginal pain acceptance in order to improve women's pain and the sexual and psychological functioning of both members of the couple.

Persistent genital arousal disorder: confluent patient history of agitated depression, paroxetine cessation, and a tarlov cyst

We report a case of a woman suffering from persistent genital arousal disorder (PGAD) after paroxetine cessation. She was admitted to a psychiatric department and diagnosed with agitated depression. Physical investigation showed no gynaecological or neurological explanation; however, a pelvic MRI scan revealed a Tarlov cyst. Size and placement of the cyst could not explain the patient's symptoms; thus neurosurgical approach would not be helpful. Her depression was treated with antidepressant with little effect. Electroconvulsive therapy improved the patient's symptoms though they did not fully resolve. More awareness of PGAD and thorough interdisciplinary conferences are necessary to insure an unequivocal treatment strategy.

The relationship between daily hassles and sexual function in men and women

Psychological stressors can interfere with sexual function through psychological and physiological mechanisms. Chronic stress, in particular, seems to have a negative effect on sexual functioning for men and women. The present study was designed to identify categories of stressors that contribute to sexual difficulties as well as assess the role of anxiety and depression in the relationship between stress and sexual function. Participants were recruited for an online survey in which they completed questionnaires on daily stressors, anxiety, depression, and sexual function. Results indicated that daily stressors predicted lower scores on sexual satisfaction for men and women and sexual activity for women. These effects were mediated by scores on the depression scale. Daily stressors, depression, and anxiety were highly correlated. A factor analysis of stressors resulted in 5 distinct categories of stressors. Of these, financial stressors and stressors related to low socioeconomic status were related to lower scores on all aspects of sexual functioning for women but not for men. Women's sexual functioning scores were more strongly related to stress and depression than men's scores. Results suggest that contextual factors (e.g., daily stressors, depression) are important considerations when assessing problems with sexual functioning.

A discordant monozygotic twin approach to testing environmental influences on sexual dysfunction in women

The present study explored the causal role played by putative environmental factors on variation in female sexual dysfunction (FSD) by investigating FSD discordant monozygotic (MZ) twins, which permits a control over genetic confounders. In a population-based sample of female twins aged 25-69 years (M = 55 years), MZ twins discordant for recent and lifelong FSD were selected. Sample sizes varied depending on the specific sexual problem (N = 33-90 pairs). The Female Sexual Function Index (FSFI) score was used to discriminate cases from controls. Once genetic factors were controlled for, relationship satisfaction emerged as the strongest independent predictor for recent and lifelong FSD, being associated with FSFI dimensions measuring desire, arousal, and lubrication problems. The association with orgasm problems was especially strong (OR 7.1, 95% CI: 1.9-25.3) as was the association with sexual dissatisfaction (OR 5.1, 95% CI: 2.1-12.1). Furthermore, obsessive-compulsive symptomatology was weakly associated with desire problems (OR 1.5, 95% CI: 1.4-1.8) and anxiety-sensitivity with orgasm problems (OR 1.1, 95% CI: 0.9-1.3). Negligible effects were found for personality factors and small effects for self-reported abusive experiences. These data indicate, for the first time, that in women at identical genetic risk, relationship factors play a key role in the development of sexual problems. These findings require replication in prospective designs which can provide additional powerful tests of the direction of causality between interpersonal factors and later sexual dysfunction.

Chronic stress and sexual function in women

INTRODUCTION

Chronic stress is known to have negative effects on reproduction, but little is known about how it affects the sexual response cycle. The present study examined the relationship between chronic stress and sexual arousal and the mechanisms that mediate this relationship.

AIM

The aim of this study is to test the relationship between chronic stress and sexual arousal and identify mechanisms that may explain this relationship. We predicted that women experiencing high levels of chronic stress would show lower levels of genital arousal and dehydroepiandrosterone (DHEAS) and higher levels of cortisol and cognitive distraction compared with women with average levels of stress.

METHODS

Women who were categorized as high in chronic stress (high stress group; n=15) or average in chronic stress (average stress group; n=15) provided saliva samples and watched an erotic film while having their genital and psychological arousal measured.

MAIN OUTCOME MEASURES

Main outcome measures were vaginal pulse amplitude, psychological arousal, salivary cortisol, salivary DHEAS, and heart rate and compared them between women with high and average levels of chronic stress.

RESULTS

Women in the high stress group had lower levels of genital, but not psychological arousal, had higher levels of cortisol, and reported more distraction during the erotic film than women in the average stress group. The main predictor of decreased genital sexual arousal was participants' distraction scores.

CONCLUSIONS

High levels of chronic stress were related to lower levels of genital sexual arousal. Both psychological (distraction) and hormonal (increased cortisol) factors were related to the lower levels of sexual arousal seen in women high in chronic stress, but distraction was the only significant predictor when controlling for other variables.

Anxiety and female sexual functioning: an empirical study

Previous research regarding anxiety and female sexual functioning has yielded conflicting conclusions. This study examined the effect of state/trait anxiety and anxiety sensitivity on sexual responding and the propensity toward sexual inhibition/excitation in women without an anxiety disorder (n = 100, M age = 28.8 years) compared with women with an anxiety disorder (panic disorder or generalized anxiety disorder, n = 30, M age = 30.2 years). Participants completed self-report measures of state and trait anxiety, anxiety sensitivity, sexual functioning, and sexual inhibition/excitation. Women with an anxiety disorder reported worse sexual functioning compared with those without an anxiety disorder (except for desire, lubrication, and pain) and a greater propensity toward sexual inhibition, because of the threat of performance failure and its consequences. Dispositional anxiety and related worries significantly predicted various types of sexual dysfunctions. Findings suggested the importance of considering the relation between anxiety and sexual functioning to design optimal prevention and therapeutic interventions for women with anxiety disorders.

The mediating effect of daily stress on the sexual arousal function of women with a history of childhood sexual abuse

Psychopathologies such as posttraumatic stress disorder are often proposed as mediators of the sexual arousal dysfunction experienced by women with a history of childhood maltreatment. However, posttraumatic stress disorder symptoms are only part of the difficulties experienced by these women. Other factors to consider include negative affectivity and perceived daily stress. To assess the mediating role of posttraumatic stress disorder symptoms, negative affectivity, and perceived daily stress, we collected data from 62 women with and without a history of childhood maltreatment (sexual, physical and emotional abuse). A comprehensive assessment of sexual arousal functioning and sexual responses was obtained using self-reported measures and psychophysiological measures of vaginal engorgement and subjective sexual arousal during exposure to sexual visual stimuli. The model assessed the simultaneous mediating effect of posttraumatic stress disorder symptoms, negative affectivity and perceived daily stress on the relation between childhood maltreatment and sexual variables. Daily stress, showed a significant and stronger mediation effect on sexual arousal functioning as compared to posttraumatic stress disorder and negative affectivity. These findings suggest that daily stress may be an important mechanism to consider when treating sexual arousal functioning in women who have a history of childhood maltreatment.

Sexual thoughts: links to testosterone and cortisol in men

Sexual stimuli increase testosterone (T) or cortisol (C) in males of a variety of species, including humans, and just thinking about sex increases T in women. We investigated whether sexual thoughts change T or C in men and whether hormone measures (baseline, post-activity, and changes) correlate with psychological sexual arousal. We used the Imagined Social Situation Exercise to assess how hormones respond to and correlate with sexual thoughts and arousal relative to three control conditions: neutral, stressful, and positive. A total of 99 men provided a baseline saliva sample, imagined and wrote about a sexual or control situation, and provided a second saliva sample 15 min later. Results indicated that, for participants in the sexual condition, higher baseline and post-activity C corresponded to larger increases in self- reported sexual and autonomic arousal. Although sexual thoughts increased sexual arousal, they did not change T or C compared to control conditions. Our results suggest that sexual thoughts are not sufficient to change T or C in men, but C may facilitate sexual arousal by directing energy towards a sexual situation.

Individual differences in the effects of mood on sexuality: the revised Mood and Sexuality Questionnaire (MSQ-R)

Previous research using the Mood and Sexuality Questionnaire (MSQ) has revealed substantial variability in how negative mood impacts sexual response and behavior. However, the MSQ does not address differences between desire for solo or partnered sexual activity, examine the effects of sexual activity on mood, or assess the effects of positive mood. This article presents the development and factor structure of the Revised Mood and Sexuality Questionnaire (MSQ-R). An exploratory factor analysis in a sample of heterosexual men, homosexual men, and heterosexual women (N = 1,983) produced eight factors. Considerable variability was found in how moods influence sexual desire and arousal, in the effects of mood on sexual behavior, and in the reciprocal effects of sexual activity on mood. Among other findings, heterosexual women were less likely than heterosexual men and homosexual men to experience increased sexual desire and arousal when anxious or stressed, whereas homosexual men and heterosexual women were less likely than heterosexual men to experience increased desire when sad or depressed. Heterosexual men and heterosexual women were more likely than homosexual men to report increased desire when in a positive mood. Intercorrelations and correlations with various sexual behaviors varied by group. Limitations and implications of the findings are discussed.

Sexual touching and difficulties with sexual arousal and orgasm among U.S. older adults

Little is known about the non-genitally-focused sexual behavior of those experiencing sexual difficulties. The objective of this study was to review the theory supporting a link between sexual touching and difficulties with sexual arousal and orgasm, and to examine associations between these constructs among older adults in the United States. The data were from the 2005-2006 National Social Life Health and Aging Project, which surveyed 3,005 community-dwelling men and women ages 57-85 years. The 1,352 participants who had had sex in the past year reported on their frequency of sexual touching and whether there had been a period of several months or more in the past year when they were unable to climax, had trouble getting or maintaining an erection (men) or had trouble lubricating (women). Women also reported how often they felt sexually aroused during partner sex in the last 12 months. The odds of being unable to climax were greater by 2.4 times (95% CI 1.2-4.8) among men and 2.8 times (95% CI 1.4-5.5) among women who sometimes, rarely or never engaged in sexual touching, compared to those who always engaged in sexual touching, controlling for demographic factors and physical health. These results were attenuated but persisted after controlling for emotional relationship satisfaction and psychological factors. Similar results were obtained for erectile difficulties among men and subjective arousal difficulties among women, but not lubrication difficulties among women. Infrequent sexual touching is associated with arousal and orgasm difficulties among older adults in the United States.

Emotional states of love moderate the association between catecholamines and female sexual responses in the laboratory

INTRODUCTION

Research suggests that there are three interrelated, yet distinct, emotion-motivation brain systems for human love (lust, romantic love, and attachment), each associated with a unique catecholaminergic and hormonal profile. Of interest for the current study are norepinephrine (NE) and dopamine (DA), which have a hypothesized connection with romantic love. As NE and DA are also known to facilitate sexual arousal, it is plausible that NE and DA may have a greater positive association with the sexual arousal responses of women in romantic love compared with women in lust.

AIM

This study investigated if the effects of NE and DA activity on sexual arousal responses would differ depending on emotion-motivation state (Lust or Romantic).

MAIN OUTCOME MEASURES

Physiological sexual arousal was assessed by photoplethysmography and subjective sexual arousal was assessed with a participant-controlled lever.

METHODS

Seventeen women were included in the Lust group and 29 in the Romantic group. All participants provided a urine sample (to assess NE and DA) and completed a psychophysiological assessment.

RESULTS

Elevated NE was positively and significantly associated with greater subjective and physiological sexual arousal for the Lust group, but not for the Romantic group. Similarly, elevated DA was positively and significantly associated with greater subjective sexual arousal for the Lust group, but not for the Romantic group.

CONCLUSIONS

The sexual arousal responses of women in the Lust group, but not in the Romantic group, were positively and significantly associated with elevated NE and DA. It is feasible that, when women are seeking a partner (Lust), NE and DA may facilitate attention toward sexually relevant stimuli.

The effect of pre-existing affect on the sexual responses of women with and without a history of childhood sexual abuse

Women with a history of childhood sexual abuse (CSA) are at greater risk for experiencing sexual problems in their adult lives. Yet, little is known about the possible role of cognitive and affective mechanisms in the development of sexual arousal difficulties in this population. This study investigated the role of pre-existing affect (affect prior to exposure to sexual stimuli) on genital responses, subjective sexual arousal, and affect elicited during the presentation of erotic film excerpts in a community sample of 25 women with and 25 women without a history of CSA. The CSA group showed greater pre-existing negative affect and smaller genital responses to the erotic film stimuli compared to the NSA group. Findings support a moderating effect of CSA, in that pre-existing negative affect was associated with strength of genital responses in the NSA but not in the CSA group. The results did not support a mediation model of pre-existing negative affect as an explanation for smaller physiological sexual responses in the CSA group. Taken together, the findings suggest that pre-existing affect may be more relevant for women with no history of CSA and call for more research on factors implicated in impaired sexual responses in women with a history of CSA.

The etiological relationship between anxiety sensitivity, sexual distress, and female sexual dysfunction is partly genetically moderated

INTRODUCTION

Presence of sexual distress is diagnostic requirement for female sexual dysfunction (FSD). However, previous correlational research indicates that sexual distress in women may be related to general anxiety per se rather than being an outcome of FSD.

AIM

In this exploratory study, we test, for the first time, whether the correlation between anxiety sensitivity, sexual distress, and FSD can be explained by shared genetic and nongenetic factors using multivariate twin modeling.

METHODS

Questionnaire data were available on a representative final sample of 930 Caucasian British female twin individuals (119 monozygotic twin pairs, 67 dizygotic twin pairs, and 558 single twins; aged 18-85 years). Validated scales assessed anxiety sensitivity, sexual distress, and FSD and included the Female Sexual Function Index, the Female Sexual Distress Scale, and the Anxiety Sensitivity Index.

MAIN OUTCOME MEASURES

Questionnaire responses were subject to trivariate heritability analyses to assess common genetic and environmental influences underlying specific trait variance and the covariance between the phenotypes.

RESULTS

Heritability for FSD was 28%, 48% for anxiety sensitivity, and 44% for sexual distress. The phenotypic associations among anxiety sensitivity, sexual distress, and FSD were all significant. Trivariate analysis indicated that additive genetic factors accounted for approximately 75% of the covariance between anxiety sensitivity and FSD 35% of the covariance between anxiety sensitivity and sexual distress, and 11% between sexual distress and FSD.

CONCLUSIONS

The association between anxiety sensitivity and FSD has a common genetic component. There is a weaker genetic link between anxiety sensitivity and sexual distress and between sexual distress and FSD. These data, while silent on direction of causality, suggest a role for pleiotropic genetic factors influencing anxiety sensitivity and FSD. They also highlight a need to refine the inclusion of distress in classifications of disorders of female sexual functioning.

An Epidemiological Survey of Post-Coital Psychological Symptoms in a UK Population Sample of Female Twins

Postcoital psychological symptoms (PPS) is a virtually unexplored phenomenon in the female population even though women frequently complain about irritability and motiveless crying after intercourse and/or orgasm. The aim of this study was to explore the epidemiology and genetic influences of PPS in a UK population sample of women. 1,489 unselected female twins aged 18–85 completed questions on recent and persistent PPS and potential risk factors. Standard methods of quantitative genetic analysis were used to model latent genetic and environmental factors influencing variation in PPS. For identification of potential risk factors, regression analyses were conducted. Phenotypic variation in PPS was explored using a genetic variance component analysis (VCA) approach. We found 3.7% of women reported suffering from recent PPS and 7.7% from persistent PPS. Relationship satisfaction and experience of abuse were found to be independently associated with recent (OR 4.5, 95% CI 4.13–4.87 and OR 1.3, 95% CI 1.02–1.34, respectively) and persistent PPS (OR 2.53, 95% CI 2.17–2.81 and OR 1.16, 95% CI 1.09–1.26, respectively). VCA revealed that phenotypic variance was best explained by an additive genetic (AE) model, ascribing 28% (for recent PPS) and 26% (for persistent PPS) of phenotypic variance to additive genetic effects, with the rest being a result of individual experiences and random measurement error. To our knowledge, this is the first and largest study investigating the epidemiology of PPS. It seems that the most important targets for intervention and prevention occur outside of the family, such as relationship quality and satisfaction, and history of abuse.

Effects of gender and relationship context in audio narratives on genital and subjective sexual response in heterosexual women and men

Previous research suggests that heterosexual women's sexual arousal patterns are nonspecific; heterosexual women demonstrate genital arousal to both preferred and nonpreferred sexual stimuli. These patterns may, however, be related to the intense and impersonal nature of the audiovisual stimuli used. The current study investigated the gender specificity of heterosexual women's sexual arousal in response to less intense sexual stimuli, and also examined the role of relationship context on both women's and men's genital and subjective sexual responses. Assessments were made of 43 heterosexual women's and 9 heterosexual men's genital and subjective sexual arousal to audio narratives describing sexual or neutral encounters with female and male strangers, friends, or long-term relationship partners. Consistent with research employing audiovisual sexual stimuli, men demonstrated a category-specific pattern of genital and subjective arousal with respect to gender, while women showed a nonspecific pattern of genital arousal, yet reported a category-specific pattern of subjective arousal. Heterosexual women's nonspecific genital response to gender cues is not a function of stimulus intensity or relationship context. Relationship context did significantly affect women's genital sexual arousal--arousal to both female and male friends was significantly lower than to the stranger and long-term relationship contexts--but not men's. These results suggest that relationship context may be a more important factor in heterosexual women's physiological sexual response than gender cues.

Evidence for a curvilinear relationship between sympathetic nervous system activation and women's physiological sexual arousal

There is increasing evidence that women's physiological sexual arousal is facilitated by moderate sympathetic nervous system (SNS) activation. Literature also suggests that the level of SNS activation may play a role in the degree to which SNS activity affects sexual arousal. We provide the first empirical examination of a possible curvilinear relationship between SNS activity and women's genital arousal using a direct measure of SNS activation in 52 sexually functional women. The relationship between heart rate variability (HRV), a specific and sensitive marker of SNS activation, and vaginal pulse amplitude (VPA), a measure of genital arousal, was analyzed. Moderate increases in SNS activity were associated with higher genital arousal, while very low or very high SNS activation was associated with lower genital arousal. These findings imply that there is an optimal level of SNS activation for women's physiological sexual arousal.

The Relationship between female sexual arousal and response bias in women with and without provoked vestibulodynia

Smaller correlations have typically been found between genital and subjective sexual arousal in female versus male samples. This study evaluated the association between response bias and the relationship between genital and subjective arousal (i.e., concordance) in women with (n = 20) and without (n = 21) provoked vestibulodynia. Participants (M = 21.27 years, SD = 2.27) underwent blood flow imaging via a laser Doppler imager to assess genital responsiveness to a visual erotic stimulus; subjective arousal was assessed during and following the film. The relationships between three types of subjective arousal ratings (perceived sexual arousal, perceived genital responsiveness, and reported desire to engage in sexual activity) and two forms of socially desirable responding (impression management and self-deceptive enhancement) were examined. Concordance estimates were statistically non-significant in both groups, with the exception of the desire to engage in sexual activity, which was moderately correlated with genital arousal in the control group. Impression management was not a statistically significant moderator of the relationship between genital and subjective arousal, but was moderately negatively related to the three forms of subjective arousal ratings in the provoked vestibulodynia group. The results highlight the importance of assessing response bias in laboratory studies comparing women with and without sexual dysfunction.

Recent and lifelong sexual dysfunction in a female UK population sample: prevalence and risk factors

INTRODUCTION

To date, no studies have tried to explore the prevalence and risk factors of recent and lifelong female sexual dysfunction (FSD) in the United Kingdom using validated questionnaires for the assessment of symptom severity and levels of associated sexual distress.

AIM

To estimate the prevalence and comorbidity of recent and lifelong FSD and to further identify potential psychosocial and behavioral risk factors in a nationally representative sample of UK women.

METHODS

One thousand four hundred eighty-nine unselected female twin individuals aged 18-85 years. Validated questionnaires, such as the Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale, were used for the assessment of symptom severity and degree of sexual distress.

MAIN OUTCOME MEASURES

Prevalence and comorbidity of recent and lifelong FSD according to the FSFI cutoff points and the existence of sexual distress. Lifelong FSD refers to an individual's average sexual function ever since they have been sexually active. We further calculated odds ratios (ORs) with 95% confidence interval for FSD.

RESULTS

We found that 5.8% of women reported any recent sexual dysfunction and 15.5% reported any lifelong sexual dysfunction. Hyposexual desire was the most prevalent recent and lifelong sexual complaint (21.4% and 17.3%, respectively). High intercorrelations were found for both recent and lifelong FSD (r=0.3-0.7). The most common independent, clinical predictor of recent and lifelong FSD diagnosis was relationship dissatisfaction (OR 1.2-4.5). Experience of abuse (OR 1.6-2.1), increased anxiety, and obsessive compulsive behavior were the most common predictors for lifelong FSD.

CONCLUSIONS

The study provides the first UK population-based assessment of recent and lifelong FSD using validated outcome measures and accounting for sexual distress. Our results indicate that FSD is common in the general population and is influenced by psychosocial factors with different pathoetiologies underlying recent and lifelong FSD.

The role of salivary cortisol and DHEA-S in response to sexual, humorous, and anxiety-inducing stimuli

Stress and anxiety are commonly thought to be detrimental to sexual function. Several studies in both the human and animal literature, however, have found that inducing anxiety can enhance sexual function in women. The mechanisms that explain a negative relationship between physical and psychological stress and sexual functioning are well documented, but little is known about how stress or anxiety might have a facilitatory effect on sexual arousal. As an initial step in exploring the relationship between anxiety and sexual arousal, the present study examined the role of the autonomic nervous system, and the adrenal hormones cortisol and dehydroepiandrosterone-sulfate (DHEA-S) in response to a sexual film, an anxiety-inducing film, and a humorous film. Nineteen premenopausal women (mean age 24.4 years) who were free from sexual difficulties came into the lab on three separate days. At each session they were shown an anxiety-inducing, sexually arousing, or humorous (control) film while their physiological arousal was measured. They also provided saliva samples before and after each film. Cortisol significantly decreased, while DHEA-S increased in the sexual and humorous conditions. Neither hormone changed significantly in the anxiety-inducing condition. Autonomic nervous system activity measured by heart rate and heart rate variability did not change in response to the sexual or anxiety-inducing films, but heart rate variability increased significantly in response to the humorous film. The cortisol/DHEA-S ratio at the post-sexual film time point was significantly negatively correlated with genital arousal (measured by vaginal pulse amplitude). Anxiety-inducing films did not result in a physiological stress response, which can explain why they do not impair sexual function.

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

The assessment of sexual arousal in men and women informs theoretical studies of human sexuality and provides a method to assess and evaluate the treatment of sexual dysfunctions and paraphilias. Understanding measures of arousal is, therefore, paramount to further theoretical and practical advances in the study of human sexuality. In this meta-analysis, we review research to quantify the extent of agreement between self-reported and genital measures of sexual arousal, to determine if there is a gender difference in this agreement, and to identify theoretical and methodological moderators of subjective-genital agreement. We identified 132 peer- or academically-reviewed laboratory studies published between 1969 and 2007 reporting a correlation between self-reported and genital measures of sexual arousal, with total sample sizes of 2,505 women and 1,918 men. There was a statistically significant gender difference in the agreement between self-reported and genital measures, with men (r = .66) showing a greater degree of agreement than women (r = .26). Two methodological moderators of the gender difference in subjective-genital agreement were identified: stimulus variability and timing of the assessment of self-reported sexual arousal. The results have implications for assessment of sexual arousal, the nature of gender differences in sexual arousal, and models of sexual response.

Physical therapy treatment of persistent genital arousal disorder during pregnancy: a case report

INTRODUCTION

Persistent genital arousal disorder (PGAD) is described as the spontaneous, intrusive, and unwanted genital arousal in the absence of sexual interest and desire. Whether the etiology of this disorder is essentially central or peripheral is unclear; however, a presenting symptom may be persistent engorgement of genital erectile and vascular tissue.

AIM

To describe a case of a distressed 27 year old pregnant woman with symptoms consistent with PGAD, and the intervention leading to the resolution of symptoms.

METHODS

A patient with symptoms of PGAD was assessed. Information regarding this condition was offered. A manual therapy treatment was provided to decrease muscle hypertonus near the pudendal nerve, and a home intervention was suggested.

RESULTS

Complete resolution of symptoms per patient's report 1 week later.

CONCLUSION

Treatment with pelvic floor manual therapy directed at the pudendal nerve may provide safe and significant relief from PGAD symptoms in a pregnant woman patient.

Persistent genital arousal disorder: a review of the literature and recommendations for management

Persistent genital arousal disorder is a newly recognized condition that is poorly understood. There is a paucity of research in this area and there are concerns as to the validity of the results of what little research there has been. This article aims to draw together current literature on this topic and provide readers with guidance on the management of this condition. This includes a working definition, an exploration of possible aetiologies within the confines of current knowledge, practical advice regarding assessment, management and auditable outcomes of practice.

Sexual dysfunction in depression and anxiety: conceptualizing sexual dysfunction as part of an internalizing dimension

Sexual dysfunction is often implicated in depression and anxiety disorders, but the current nosology of sexual dysfunction, depression, and anxiety (i.e., DSM-IV) does not adequately address these relationships. Because recent papers (Krueger, R. F., & Markon, K. E. (2006). Reinterpreting comorbidity: A model-based approach to understanding and classifying psychopathology. Annual Review of Clinical Psychology, 2, 111-133) have suggested and provided evidence for latent internalizing and externalizing dimensions that help explain high comorbidity between mental disorders, the current paper suggests that sexual dysfunction might conceptually belong to a latent internalizing factor. To address this, evidence is presented for the relationship among disorders of sexual desire, arousal, and orgasm comorbid with depression and anxiety. A review of sexual disorders is also presented along with a critical examination of the way the current DSM is organized with respect to sexual dysfunction, depression, and anxiety.

Interaction of organic and psychological factors in persistent genital arousal disorder in women: a report of six cases

Summary

There have been a number of case reports published recently describing women who complain of persistent genital arousal. Most of these papers do not report medical data or observations from genital examination. We report in such detail on six cases of persistent genital arousal disorder (PGAD) in women. We further advance the hypothesis that in many cases the objective genital component may be induced by a variety of psychophysiological and pathological factors such as anxiety, genital prolapses and dermatoses. Genital engorgement so produced may not be continuous but when present may be enhanced and perpetuated by both anxiety focussed on the genitals and masturbation used in an attempt to relieve the sensations. Premorbid affective psychological illness negatively colours the subjective perception of this genital engorgement, leading to either elicitation or maintenance of PGAD. We discuss this hypothesis in relation to our six cases.

ORIGINAL RESEARCH—OUTCOMES ASSESSMENT: The Sexual Arousal and Desire Inventory (SADI): A Multidimensional Scale to Assess Subjective Sexual Arousal and Desire

INTRODUCTION

Sexual arousal and desire are integral parts of the human sexual response that reflect physiological, emotional, and cognitive processes. Although subjective and physiological aspects of arousal and desire tend to be experienced concurrently, their differences become apparent in certain experimental and clinical populations in which one or more of these aspects are impaired. There are few subjective scales that assess sexual arousal and desire specifically in both men and women.

AIMS

(i) To develop a multidimensional, descriptor-based Sexual Arousal and Desire Inventory (SADI) to assess subjective sexual arousal and desire in men and women; (ii) to evaluate convergent and divergent validity of the SADI; and (iii) to assess whether scores on the SADI would be altered when erotic fantasy or exposure to an erotic film was used to increase subjective arousal.

METHODS

Adult men (N = 195) and women (N = 195) rated 54 descriptors as they applied to their normative experience of arousal and desire on a 5-point Likert scale. Another sample of men (N = 40) and women (N = 40) completed the SADI and other measures after viewing a 3-minute female-centered erotic film or engaging in a 3-minute period of erotic fantasy.

MAIN OUTCOME MEASURES

Principal components analyses derived factors that the scale descriptors loaded onto. These factors were categorized as subscales of the SADI, and gender differences in ratings and internal validity were analyzed statistically. Factors were considered subscales of the SADI, and mean ratings for each subscale were generated and related to the other scales used to assess convergent and divergent validity. These scales included the Feeling Scale, the Multiple Indicators of Subjective Sexual Arousal, the Sexual Desire Inventory, and the Attitudes Toward Erotica Questionnaire, the Beck Depression Inventory (BDI)-II, and the Beck Anxiety Inventory.

RESULTS

Descriptors loaded onto four factors that accounted for 41.3% of the variance. Analysis of descriptor loadings > or = 0.30 revealed an Evaluative factor, a Physiological factor, a Motivational factor, and a Negative/Aversive factor based on the meaning of the descriptors. Men's and women's subjective experiences of sexual desire and arousal on the Physiological and Motivational factors were not significantly different, although on the Evaluative and Negative factors, statistically significant differences were found between the genders. Mean scores on the Evaluative factor were higher for men than for women, whereas mean scores on the Negative factor were higher for women than for men. Internal consistency estimates of the SADI and its subscales confirmed strong reliability. Mean scores on the Evaluative, Motivational, and Physiological subscales of the SADI were significantly higher in the fantasy condition than in the erotic clip condition. Women had significantly higher mean scores than men on the Physiological subscale in the fantasy condition. Cronbach's alpha coefficients demonstrated excellent reliability of the SADI subscales. Evidence of convergent validity between the SADI subscales and other scales that measured the same constructs was strong. Divergent validity was also confirmed between the SADI subscales and the other scales that did not measure levels of sexual arousal, desire, or affect, such as the BDI-II.

CONCLUSION

The SADI is a valid and reliable research tool to evaluate both state and trait aspects of subjective sexual arousal and desire in men and women.