The dual control model of male sexual response: a theoretical approach to centrally mediated erectile dysfunction

Sexual Desire and Fantasies in the LGBT+ Community: Focus on Lesbian Women and Gay Men

Purpose of Review

The purpose of this review is to summarize the current knowledge around sexual desire, fantasies, and related biopsychosocial factors that may facilitate or obstruct sexual expressions in lesbian women and gay men.

Recent Findings

Sexual desire levels and related problems do not seem significantly different in people who identify as gay or lesbian compared to their heterosexual counterparts. Evidence has shown lesbian women and gay men may have specific desire expressions and biopsychosocial factors influencing their sexual health. This may suggest the importance of deepening the understanding of the unique factors of LGBT+ sexuality and relationships while paying attention to the sociocultural background in which lesbian and gay people grow and develop their identities.

Summary

A lack of specific and unbiased literature on sexual desire and fantasies in gay and lesbian people is reported. Available evidence is controversial and often biased. LG people showed a variety of sexual expressions that are hard to categorize referring to the heteronormative sexual standards that permeate literature and clinical practice. Implications for future research and clinical practice are discussed.

Validación de las Escalas de Inhibición y Excitación Sexual (SIS/SES-SF) en colombianos

Las escalas SIS/SES-SF han sido desarrolladas para medir la inhibición y la excitación sexual. El objetivo del presente estudio fue adaptar y validar estas escalas en población colombiana. Para esto, se realizó la adaptación cultural y validación de contenido de las escalas por medio del juicio de siete expertos, y se validaron psicométricamente sobre una muestra de 2125 participantes (1000 hombres y 1125 mujeres). Los hombres contestaron al International Index of Erectile Function y la Premature Ejaculation Diagnostic Tool; mientras que el total de la muestra contestó al Sexual Desire Inventory, al Massachusetts General Hospital-Sexual Functioning Questionnaire y a la Sexual Inhibition/Sexual Excitation Scales-Short Form, todo ello junto a una batería sociodemográfica. El muestreo se realizó de forma virtual a través de Facebook. Los índices de las escalas mostraron una apropiada validez y fiabilidad. Además, para ambos sexos, las escalas mostraron un nivel de invarianza estricto. Las relaciones significativas con las otras medidas dan cuenta de su validez de criterio. Se sugiere el uso del instrumento para continuar con la investigación del Modelo de Control Dual dentro de la sexualidad en Latinoamérica.

Sexual Responsivity and the Effects of Negative Mood on Sexual Arousal in Hypersexual Men Who Have Sex With Men (MSM)

BACKGROUND

A number of studies have found that hypersexuality is associated with a high propensity for sexual excitation. In comparison, less is known about the relationship between hypersexuality and sexual arousal at the state level. Also, previous research has revealed a relationship between hypersexuality and negative mood. However, the possibility that sexual response might not be as negatively impacted by negative mood in hypersexual individuals has, as yet, not been tested.

AIM

The purpose of this study was to investigate sexual responsivity and the effects of negative mood on sexual arousal in hypersexual men who have sex with men (MSM).

METHODS

A total of 211 MSM were assigned to a hypersexuality (N = 81) or a control (N = 130) group using an interview patterned with a semi-structured Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders format. Participants filled out questionnaires and were shown neutral, sexual, and anxiety- and sadness-inducing films.

OUTCOMES

Changes in penile circumference and self-reported sexual arousal were the primary outcomes analyzed in this study.

RESULTS

Controlling for age and HIV status, no differences were found in genital response between hypersexual and non-hypersexual men. Also, the 2 groups did not differ in subjective sexual arousal. Moreover, no effects of negative mood were found. Time series clustering analyses revealed 3 groups-low responders and slow and fast high responders. Sexual excitation, but not sexual compulsivity or pornography use, predicted cluster membership.

CLINICAL TRANSLATION

Hypersexual MSM may benefit more from an exploration of motivational and behavioral, as compared to psychophysiological, mechanisms underlying possible links between (negative) mood and sexual behavior.

STRENGTHS & LIMITATIONS

Strengths of the study include its sample size, making it one of the larger psychophysiological sex studies; the use of clinical interviews for group assignment; the inclusion of genital response measures; and the application of time series clustering to examine differences among participants. Limitations include possible sample heterogeneity and the reliance on researcher-selected stimuli.

CONCLUSION

Given the lack of any effects of negative mood on sexual response in hypersexual MSM, future studies could explore in more depth possible motivational and behavioral effects, including, for example, the impact of negative mood on the tendency to seek out sex as a form of distraction or for validation or emotional support. Janssen E, Prause N, Romine RS, et al. Sexual Responsivity and the Effects of Negative Mood on Sexual Arousal in Hypersexual Men Who Have Sex With Men (MSM). J Sex Med 2020;17:1751-1760.

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.

Sexual attraction modulates interpersonal distance and approach-avoidance movements towards virtual agents in males

How does sexual attraction alter social interaction behavior? We examined the influence of sexual orientation on locomotor approach-avoidance behavior and interpersonal distance. We immersed androphilic and gynophilic male subjects into a virtual environment and presented various male and female virtual persons. In the first experiment, subjects took a step forward (approach) or backward (avoidance) in response to the sex of the virtual person. We measured reaction time, peak velocity, and step size, and obtained ratings of sexual attractiveness in every trial. In the second experiment, subjects had to approach the virtual person as if they were to engage in a social interaction. Here, we analyzed interpersonal distance and peak velocity of the approaches. Our results suggest that sexual attraction facilitates the approach response and reduces the preferred interpersonal distance. We discuss our findings in terms of proxemics, current findings in sex research, and the applicability of our novel task in other fields of psychological research.

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.

An Exploratory Study on the Central Nervous Correlates of Sexual Excitation and Sexual Inhibition

The Sexual Inhibition/Sexual Excitation Scales (SIS/SES) measure sexual excitation and sexual inhibition proneness. We used SIS and SES scores of 62 heterosexual teleiophilic men (M_age 34.3, SD = 9.9) to predict brain activation levels during the presentation of male and female visual sexual stimuli in a magnetic resonance imaging (MRI) scanner. Statistical analyses revealed significant correlations. SES and SIS1 scores were positively associated with brain activation in various brain regions during the presentation of both male and female stimuli. SIS2 turned out to be a weaker predictor of brain activation, still revealing one significant correlation in the right lateral orbitofrontal cortex. Significant regions for SES and SIS1 were, among others, primary and supplementary motor areas, the caudate nucleus, the dorsal anterior cingulate cortex, anterior insula, and prefrontal areas. Our study can be seen as an exploratory investigation of SIS and SES with means of functional brain imaging. The results provide a promising contribution to the assertion of neurophysiological systems of sexual inhibition and excitation proneness.

Is "Dilator Use" More Effective Than "Finger Use" in Exposure Therapy in Vaginismus Treatment?

Vaginismus is the persistence of difficulties in allowing the vaginal entry of a penis, a finger or a gynecologic examination. This study aimed to compare the success rates of vaginismus therapy with exposure therapy treatment using a finger or a dilator. The finger training group (FTG) (n = 30) and the dilator training group (DTG) (n = 30) were established. Groups were trained about dilatation and desensitization. The Female Sexual Function Index (FSFI) was applied. From the baseline measurement to the post-treatment measurement, the average change in FSFI scores for both groups was statistically significant (p < 0.001). There was a significant difference between two groups in terms of patient drop-out numbers (p = 0.016); the DTG was more successful in continuing treatment than the FTG. This research revealed that DTG is more successful in treatment continuity and show more improvement in sexual functions.

To What Extent Do Erotic Images Elicit Visuospatial versus Cognitive Attentional Processes? Consistent Support for a (Non-Spatial) Sexual Content-Induced Delay

It is almost a cultural truism that erotic images attract our attention, presumably because paying attention to erotic stimuli provided our ancestors with mating benefits. Attention, however, can be narrowly defined as visuospatial attention (keeping such stimuli in view) or more broadly as cognitive attention (such stimuli taking up one's thoughts). We present four independent studies aiming to test the extent to which erotic images have priority in capturing visuospatial versus cognitive attention. Whereas the former would show in quicker reactions to stimuli presented in locations where erotic images appeared previously, the latter causes delayed responding after erotic images, independent of their location). To this end, we specifically modified spatial cueing tasks to disentangle visuospatial attention capture from general sexual content-induced delay (SCID) effects-a major drawback in the previous literature. Consistently across all studies (total N = 399), we found no evidence in support of visuospatial attention capture but reliably observed an unspecific delay of responding for trials in which erotic images appeared (irrespective of cue location). This SCID is equally large for heterosexual men and women and reliably associated with their self-reported sexual excitability.

Validation of the Sexual Desire Inventory in Colombia

Sexual desire is a cognitive and affective state that motivates an individual to engage in sexual activity. There are no validated measures to assess this construct in Colombia. The present study aimed to validate the Sexual Desire Inventory (SDI) and explore gender-and age-based differences in sexual desire in Colombian population. The sample was composed of 2,125 men and women who answered the Colombian version of the SDI. Results indicated strict invariance between genders, a three-dimension model, and acceptable validity and reliability indicators. Gender-based and age-based differences were observed in the three types of sexual desire. Implications and conclusions of these findings are presented.

Dual Control Model in a Cross-Cultural Context: Role of Sexual Excitation in Sexual Response and Behavior Differences Between Chinese and Euro-Caucasian Women in Canada

Chinese women in Western nations frequently report less engagement with sexuality, such as lower sexual response and behaviors, and more restrictive sexual attitudes, than their Euro-Caucasian peers. This difference is likely related to sexual conservatism within traditional Chinese culture, though the mechanisms underlying how culture influences sexual responding are not well understood. The current study investigated if these differences were consistent with the dual control model, a well-established model for understanding regulation of sexual response. Chinese and Euro-Caucasian women (N = 471; age M = 20.7 years, SD = 3.3) residing in Canada from a university sample completed self-report questionnaires on sexual excitation and inhibition, sexual attitudes, and various sexual response and behavior measures. Sexual excitation was significantly lower in Chinese than Euro-Caucasian women and was significantly associated with sexual response in both groups. Structural equation modeling showed that sexual response variables were associated with a latent sexual excitation factor and that sexual attitudes partially mediated the relationship between this latent factor and ethnicity. The findings showed that sexual excitation and sexual attitudes contribute to cross-cultural differences in women's sexual responding. Theoretical and clinical considerations are discussed.

Mindfulness-Based Group Therapy for Men With Situational Erectile Dysfunction: A Mixed-Methods Feasibility Analysis and Pilot Study

INTRODUCTION

Recent advances in sexual health research support the benefits of mindfulness-based therapy (non-judgmental present-moment awareness) for the treatment of women's sexual dysfunction.

AIM

To determine whether it is feasible to implement an adapted, empirically supported treatment protocol for female sexual dysfunction to the specific needs of men with situational erectile dysfunction (ED).

METHODS

A mixed-methods approach was taken for this feasibility pilot study. A total of 10 men (M_age = 40.3, SD = 14.01, Range = 20-67) with a diagnosis of situational ED were recruited to participate in a 4-week mindfulness-based treatment group. The group was adapted from protocols shown to be effective for women with sexual dysfunction and edited to include content specific to situational ED. Sessions were 2.25 hours in length, included daily home-practice activities, and integrated elements of psychoeducation, sex therapy, and mindfulness skills. Men completed questionnaires (International Index of Erectile Functioning, Relationship Assessment Scale, Five Facets of Mindfulness Questionnaire, a treatment expectation questionnaire) at 3 time points (prior to treatment, immediately after treatment, and 6 months after treatment). 5 men (M_age = 44.4, SD = 15.76, Range = 30-67) participated in qualitative exit interviews.

MAIN OUTCOME MEASURE

Findings support the feasibility of adapting a mindfulness-based group treatment for situational ED.

RESULTS

With respect to feasibility, the dropout rate was 10%, with 1 participant who did not complete the treatment. Comparisons between Time 1 and Time 3 self-reports suggested that this treatment protocol holds promise as a novel means of impacting erectile functioning (Cohen's d = 0.63), overall sexual satisfaction (Cohen's d = 1.02), and non-judgmental observation of one's experience (Cohen's d = 0.52). Participants' expectations for the treatment were generally positive and correlated to self-reported outcomes (r = .68-.73). Qualitative analyses revealed 6 themes: normalization, group magic, identification of effective treatment targets, increased self-efficacy, relationship factors, and treatment barriers.

CLINICAL IMPLICATIONS

In a shift toward a biopsychosocial framework for the treatment of men's sexual dysfunction, clinicians may consider incorporating mindfulness to address psychosocial and psychosexual components of dysfunction.

STRENGTH & LIMITATIONS

This is the first study-to our knowledge-to adapt mindfulness protocols for use with men's sexual dysfunction. Because this is a pilot study aimed at feasibility, the sample size is small and no control group was included, thus conclusions about efficacy and generalizability cannot be made.

CONCLUSION

The current study suggests that a mindfulness group therapy framework offers a feasible and potentially promising treatment avenue for men with situational ED. Bossio JA, Basson R, Driscoll M, et al. Mindfulness-based group therapy for men with situational erectile dysfunction: A mixed-methods feasibility analysis and pilot study. J Sex Med 2018;15:1478-1490.

A Validation Study of the German Version of the Sexual Inhibition/Sexual Excitation Scales-Short Form

The dual control model of human sexual behavior proposes that sexual responses involve an interaction between sexual excitatory and sexual inhibitory systems. The Sexual Inhibition/Sexual Excitation Scales (SIS/SES; Janssen, Vorst, Finn, & Bancroft, 2002) as well as its short form (SIS/SES-SF; Carpenter, Janssen, Graham, Vorst, & Wicherts, 2011) assess individual propensities to become sexually excited and sexually inhibited. The present study utilized a dataset of 2221 German-speaking adults (n = 1214 women and n = 987 men) to examine the psychometric properties of the German version of the SIS/SES-SF. The results of the confirmatory factor analysis indicated that the three factors suggested in the original version can be generally replicated within the current study. Analyses of measurement invariance for gender revealed that the general three-factor structure as well as factor loadings can be regarded as equal for men and women. However, scalar invariance could not be fully obtained, indicating that the intercepts of some items were different for men and women. Taken together, the results of the presents study provide further evidence for the psychometric properties of the German version of the SIS/SES-SF.

Sexual health counselling targeting girls and young women with female genital cutting in Sweden: mind-body dualism affecting social and health care professionals' perspectives

Female genital mutilation (FGM), also referred to as female genital cutting (FGC), has become the subject of an intense debate exposing tensions between varying cultural values about bodies and sexuality. These issues are brought to the fore in settings where professionals provide sexual counselling to young circumcised women and girls in Western, multicultural societies. This article is based on interviews and focus group discussions with professionals in social and healthcare services. The aim of this study was to examine how professionals reflect upon and talk about sexuality and the promotion of sexual wellbeing in young circumcised women and girls. Policy documents guide their obligations, yet they are also influenced by culture-specific notions about bodies and sexuality and what can be called “the FGM standard tale”. The study found that professionals showed great commitment to helping the girls and young women in the best possible way. Their basic starting point, however, was characterised by a reductionist focus on the genitalia’s role in sexuality, thus neglecting other important dimensions in lived sexuality. In some cases, such an attitude may negatively affect an individual’s body image and sexual self-esteem. Future policy making in the field of sexual health among girls and young women with FGC would benefit from taking a broader holistic approach to sexuality. Professionals need to find ways of working that promote sexual wellbeing in girls, and must avoid messages that evoke body shame or feelings of loss of sexual capacity among those affected by FGC.

Development and Validation of a Measure of Responsive Sexual Desire

According to the incentive motivation model, sexual desire does not occur spontaneously but can be triggered by sexual stimuli and stems from one's experience of sexual arousal. Until now, research into responsive sexual desire has been challenged by the lack of measures capturing desire that emerges following sexual arousal. The aim of this study was to validate the 18-item Report of Behavior and Feelings-Desire (RBF-D) scale in a sample of 291 women (M_age = 22.41, SD = 5.82) with varying degrees of sexual desire. Items on the RBF-D were selected to reflect 5 aspects of responsive sexual desire: sexual activity with a primary partner, sexual desire for a primary partner, sexual activity with other persons, sexual desire for other persons, and autoerotic activities. A 5-factor solution was confirmed via exploratory structural equation modeling. Internal consistency of 4 out of 5 factors was good. Convergent validity was established via small to medium associations of the RBF-D factors with other measures of sexual desire. Low and nonsignificant correlations with depression and sexual inhibition supported the discriminant validity. The RBF-D is a valid and reliable measure that can be useful in clinical and research settings where assessment of responsive sexual desire and behavior is needed.

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.

Anxiety and Performance in Sex, Sport, and Stage: Identifying Common Ground

Anxiety has long been associated with diminished performance within a number of domains involving evaluative interpersonal interactions, including Sex, Sport, and Stage. Here, we pose three questions: (1) how do these disparate fields approach and understand anxiety and performance; (2) how does the understanding of the issue within one field offer insight to another field; and (3) how could each field benefit from the ideas and strategies used by the others. We begin with a short review of models of anxiety/arousal and performance and then explore definitions, models, presumed underlying physiological processes, and characterizing and influencing factors within each domain separately in a narrative review. This discussion is followed by a synthesis that identifies elements specific to and common across the various domains, with the latter captured in a model of essential characteristics. Concluding remarks note the potential value of promoting increased cross-disciplinary conversation and research, with each domain likely benefiting from the conceptualizations and expert knowledge of the others.

The relevance of the SESII-W/M in establishing a relationship between sexual difficulties and sexual excitation/inhibition

Aims

The main purpose of this study is to analyse the relationship between sexual difficulties and factors of sexual arousal, excitement, and sexual inhibition among men and women.

Method

A total of 1,878 participants, of whom 983 were men (52%) and 895 were women (48%), with a mean age of 35.9 years (SD = 11.9; range = 18-79), were recruited online. The study’s instruments included a socio-demographic questionnaire, a questionnaire about sexual difficulties, and the Sexual Excitation/Sexual Inhibition Inventory for Women and Men (SESII-W/M).

Results

Women with and without sexual difficulties differed significantly on all subscales of the SESII-W/M. Men with sexual difficulties scored significantly higher in the dimensions of Inhibitory Cognitions and the Dyadic Elements of the Sexual Interaction than men without difficulties. Inhibitory Cognitions was the strongest predictor of sexual difficulties for both men and women. Relationship Importance was also a strong predictor of sexual difficulties in women.

Conclusions

Sexual inhibition serves as a predictor of sexual difficulties. The SESII-W/M seems to work better in determining the factors of sexual inhibition as predictors of sexual difficulties among women, than in identifying causes of sexual difficulties among men.

Genito-Pelvic Pain Through a Dyadic Lens: Moving Toward an Interpersonal Emotion Regulation Model of Women's Sexual Dysfunction

Researchers and clinicians alike widely acknowledge the inherently interpersonal nature of women's sexual dysfunctions given that both partners impact and are impacted by these difficulties. Yet theoretical models for understanding the role of interpersonal factors in women's sexual dysfunctions are severely lacking and have the potential to guide future research and inform more effective interventions. The most widely studied sexual dysfunction in women that has espoused a dyadic approach by including both members of affected couples is genito-pelvic pain/penetration disorder (GPPPD). In this article we use the example of GPPPD to introduce a novel interpersonal emotion regulation model of women's sexual dysfunction. We first review current knowledge regarding distal and proximal interpersonal factors in GPPPD. Then, we describe our theoretical model and consider relevant pain and sex-related research on emotion regulation processes-emotional awareness, expression, and experience-in the context of GPPPD, including sexual function, satisfaction, and distress. Next, we review how existing theories from the fields of chronic pain and sex and relationships research have informed our model and how our model further builds on them. Finally, we discuss the implications of our model and its applications, including to other sexual dysfunctions in women.

Temporal Stability of Sexual Excitation and Sexual Inhibition in Women

The dual control model of sexual response proposes two factors, sexual excitation (SE) and sexual inhibition (SI), that aim to predict sexual behavior and response. While SE and SI are described as stable traits that influence sexuality-related outcomes such as sexual function or sexual risk taking, only a few studies have presented data on the stability of these factors. The aim of this study was to evaluate the temporal stability of SE and SI, and to investigate whether changes in sexual function or partnership status influence SE and SI in a longitudinal sample of women. To address these research questions, the Sexual Excitation/Sexual Inhibition Inventory for Women (SESII-W) was administered five times over the course of 4 years. The SESII-W includes two main scales of SE and SI which consist of five (Arousability, Partner characteristics, Sexual power dynamics, Smell, and Setting) and three subscales (Concerns about sexual function, Arousal contingency, Relationship importance), respectively. Data from 553 women (M_age = 31.38 years, SD = 10.25, range = 18-67) who participated in at least two assessment points were included in this study. Bivariate correlations between baseline and the fifth follow-up assessment indicated a high temporal stability of SE and SI in women (.47 < r < .71). A series of generalized linear models were conducted to investigate the impact of time, changes in sexual function, partnership status, and changes in partnership status on SE and SI. Partner characteristics (SE) that showed small increases over time. Across different subscales, improvements in sexual function were associated with higher SE and lower SI. Changes in partnership status and partnership status itself were predictors of one SE- and three SI-related scales. This study suggests a relatively high temporal stability of SE and SI in women and supports the dual control model's assertion that both factors are stable individual traits. Certain life events such as a new partnership or sexual difficulties may, however, impact time stability of both factors.

Approach and Avoidance Biases Toward Sexual Stimuli and Their Association with the Dual Control Model of Sexual Response in Heterosexual Men

Many models of human behavior work in an interaction of a dual system. While one system usually represents controlled and reflective behavioral responses, the other system reflects automatic and impulsive actions. In the impulsive system, positive stimuli initiate approach reactions and negative cues avoidance reactions. Besides stimulus valence, the behavioral response triggered by the impulsive system is influenced by personality (e.g., the propensity to react with approach or avoidance biases in a specific situation). The present study applied a computerized Approach-Avoidance Task (AAT; Rinck & Becker, 2007) to assess automatic behavioral approach and avoidance biases toward sexual and neutral stimuli in heterosexual men (N = 40). Individual AAT-performance was furthermore related to sexual excitation (SES) and the two sexual inhibition factors (SIS1 and SIS2) as proposed by the Dual Control Model of sexual response (Bancroft & Janssen, 2000). Against our hypotheses, participants did not show a stronger approach bias toward sexually preferred (i.e., images of women) than sexually not preferred stimuli (i.e., images of men or children). However, stronger approach biases toward images of women were positively associated with sexual excitation and negatively correlated with sexual inhibition due to a threat of performance failure (SIS1) even after controlling for potential confounds (i.e., general behavioral activation and inhibition). The results support the importance of the influence of dispositional traits measured with the Dual Control Model of sexual response on approach and avoidance biases toward sexually preferred stimuli in heterosexual men.

Sexual Dysfunctions and Their Association with the Dual Control Model of Sexual Response in Men and Women with High-Functioning Autism

Adults with an Autism Spectrum Disorder (ASD) are characterized by impairments in social interaction and communication, repetitive and stereotyped interests and behaviours as well as hyper- and/or hyposensitivities. These disorder specific symptoms could be associated with the development of sexual disorders. The Dual Control Model of Sexual Response presents one approach that is frequently used to explain the emergence of sexual dysfunctions. The aim of the present study was to assess the extent of symptoms of sexual dysfunctions in men and women with ASD and to evaluate their association with the individual propensity of sexual excitation and inhibition as defined by the Dual Control Model. Both men and women with ASD were more likely to report about sexual dysfunctions than individuals from the control group. In men with ASD, sexual inhibition was significantly correlated with the emergence of sexual dysfunctions, while there was no association between sexual functioning and sexual excitation. In women, the opposite pattern was found. Especially the peculiarities in sensitive perception could be responsible for the observed problems with sexual functioning in individuals with ASD. The present findings highlight the great need for specialized treatment programs addressing the frequently observed sexuality-related problems in individuals with ASD. However, up to now such treatment programs are lacking.

Exploring the Impact of Personal and Partner Traits on Sexuality: Sexual Excitation, Sexual Inhibition, and Big Five Predict Sexual Function in Couples

Sexual difficulties are common among women and men and are associated with various mental and physical health problems. Although psychological traits are known to impact sexual attitudes and behavior, sexuality- and personality-related traits have not been jointly investigated to assess their relevance for sexual functioning in couples. The aim of this study was to investigate how psychological traits of two partners influence women's and men's sexual function. Data from 964 couples, representative of the adult population in Germany, were analyzed. Sexual function was assessed with the Female Sexual Function Index (FSFI) and the International Index of Erectile Function (IIEF). Sexuality-related traits were measured with the Sexual Excitation/Sexual Inhibition Inventory for Women and Men (SESII-W/M). Personality was measured with self-report and partner-rating versions of the Big Five Inventory (BFI). Sexual excitation was a positive and sexual inhibition was a negative predictor of sexual function in both genders. Women whose partners were sexually inhibited reported lower sexual function. Conscientious individuals reported better sexual function. Women whose partners were more conscientious also had better sexual function. Assessing partner-related factors may be helpful to identify predisposing and maintaining factors of sexual dysfunctions, especially in women.

What Does Sexual Arousal Mean to You? Women With and Without Sexual Arousal Concerns Describe Their Experiences

Sexual arousal is frequently characterized by both subjective (i.e., mental) and physiological (e.g., genital) components. The nuances of these components, however, are difficult to capture via self-report instruments. Asking women to describe sexual arousal in their own words may therefore enhance our understanding of this construct. In the present study, women with (n = 190) and without (n = 610) arousal concerns were recruited online and wrote about their experience of sexual arousal. Seven clusters of words were extracted using automated text analysis, and the prominence of these clusters was compared between groups of women. The autonomic arousal cluster differed between groups such that women with arousal concerns invoked this cluster significantly less than did women with no such concerns. Furthermore, the context cluster significantly predicted group membership (odds ratio [OR] = 1.063); greater scores on this cluster were associated with arousal concerns. Results suggest that autonomic arousal and relationship factors may play important roles in arousal concerns. It is suggested that clinicians assess for aspects of the sexual relationship that may facilitate or hinder sexual arousal. Clinicians may also consider inquiring about the presence or appraisal of autonomic arousal (e.g., one's interpretation of an increase in heart rate or respiration) during sexual activity.

The influence of olfactory disgust on (Genital) sexual arousal in men

Background

The generation or persistence of sexual arousal may be compromised when inhibitory processes such as negative emotions, outweigh sexual excitation. Disgust particularly, has been proposed as one of the emotions that may counteract sexual arousal. In support of this view, previous research has shown that disgust priming can reduce subsequent sexual arousal. As a crucial next step, this experimental study tested whether disgust (by means of odor) can also diminish sexual arousal in individuals who are already in a state of heightened sexual excitation.

Methodology

In this study, participants were all men (N = 78). To elicit sexual arousal, participants watched a pornographic video. Following 4.30 minutes from the start of the video clip, they were exposed to either a highly aversive/disgusting odor (n = 42), or an odorless diluent/solvent (n = 36), that was delivered via an olfactometer, while the pornographic video continued. In both conditions the presentation of the odor lasted 1 second and was repeated 11 times with intervals of 26 seconds. Sexual arousal was indexed by both self-reports and penile circumference.

Principal findings

The disgusting odor (released when the participants were already sexually aroused) resulted in a significant decrease of both subjective and genital sexual arousal compared to the control (odorless) condition.

Significance

The finding that the inhibitory effect of disgust was not only expressed in self-report but also expressed on the penile response further strengthens the idea that disgust might hamper behavioral actions motivated by sexual arousal (e.g., poor judgment, coercive sexual behavior). Thus, the current findings indicate that exposure to an aversive odor is sufficiently potent to reduce already present (subjective and) genital sexual arousal. This finding may also have practical relevance for disgust to be used as a tool for self-defence (e.g., Invi Bracelet).

Male Sexual Desire: An Overview of Biological, Psychological, Sexual, Relational, and Cultural Factors Influencing Desire

INTRODUCTION

The literature showed the need for a better understanding of the male sexual response, which has historically been considered as simpler and more mechanistic compared with that in women.

AIM

To examine the literature on biopsychosocial factors associated with the level of sexual desire in men and discuss some interesting directions for future research.

METHODS

A systematic literature review was conducted.

MAIN OUTCOME MEASURES

169 articles published in Google Scholar, Web of Science, Scopus, EBSCO, and Cochrane Library about male sexual desire and related biopsychosocial factors.

RESULTS

We found a lack of multidimensional studies on male sexual desire. Most existing research has focused on hypoactive sexual desire disorder in coupled heterosexual men. Biological factors play important roles in the level of sexual desire, but they are insufficient to explain the male sexual response. Psychological, relational, and sexual factors (eg depression, anxiety, emotions, attraction, conflicts, communication, sexual functioning, distress, satisfaction) are involved in the development/maintenance of lack of sexual interest in men. Cultural influence is also relevant, with cognitive factors linked to gender roles and sexual scripts of masculinity identified as important predictors of low sexual desire.

CONCLUSION

Male sexual desire is characterized by an interplay among biological, psychological, sexual, relational, and cultural elements. This interplay merits further study to better understand how sexual desire works and how treatments for low sexual interest could be improved. Nimbi FM,Tripodi F, Rossi R, et al. Male Sexual Desire: An Overview of Biological, Psychological, Sexual, Relational, and Cultural Factors Influencing Desire. Sex Med Rev 2020;8:59-91.

The Role of Inhibitory Control Mechanisms in the Regulation of Sexual Behavior

Sexual behavior is the open manifestation of a complex interplay between psychophysiological mechanisms that either facilitate or inhibit sexual thoughts, desires, and associated behaviors. Whereas sexual excitation has been widely studied, less is known about the impact of inhibitory control mechanisms that enable individuals to refrain from sexual cognition and behavior. The present study examined: (1) the relationship between general and sexual inhibitory mechanisms (as measured through self-reports and computer-based tasks), (2) the relation between sexual inhibitory processes at cognitive and motor-motivational levels and with sexual inhibition as an individual trait, and (3) the predictive value of these parameters on sexual thoughts (cognition) and behavior. We demonstrate that general inhibitory control (i.e., the ability to suppress any preponderant response) and the specific inhibition of sexual responses represent distinct processes that require at least partly different control mechanisms. Similarly, the ability to inhibit sexual visual input and the ability to suppress sexually driven responses seem to be two independent processes. The different inhibitory processes distinctively predicted the frequency of sexual thoughts and sexual behavior. We propose that these different inhibitory mechanisms are at play during different phases of sexual regulation (before and after the generation and unfolding of sexual arousal) and that a specific deficit in one of these processes may underlie the distinctive symptomatology and comorbidity of sexual disorders.

Putting out the blaze: The neural mechanisms underlying sexual inhibition

The successful inhibition of sexual thoughts, desires, and behaviors represents an essential ability for adequate functioning in our daily life. Evidence derived from lesion studies indicates a link between sexual inhibition and the general ability for behavioral and cognitive control. This is further supported by the high comorbidity of sexual compulsivity with other inhibition-related disorders. Here, we aimed at investigating whether sexual and general inhibition recruit overlapping or distinct neural correlates in the brain. Furthermore, we investigated the specificity of two different kinds of sexual inhibition: inhibition of sexually driven motor responses and inhibition of sexual incoming information. To this end, 22 healthy participants underwent functional Magnetic Resonance Imaging (fMRI) while performing a task requiring general response inhibition (Go/No-go), as well as cognitive and motivational sexual inhibition (Negative Affective Priming and Approach-Avoidance task). Our within-subject within-session design enabled the direct statistical comparison between general and sexual inhibitory mechanisms. The general inhibition task recruited mainly prefrontal and insular regions, replicating previous findings. In contrast, the two types of sexual inhibition activated both common and distinct neural networks. Whereas cognitive sexual inhibition engaged the inferior frontal gyrus, the orbitofrontal cortex and the fusiform gyrus, motivational sexual inhibition was characterized by a hypoactivation in the anterolateral prefrontal cortex. Both types of sexual inhibition recruited the inferior frontal gyrus and the inferotemporal cortex. However, the activity of the inferior frontal gyrus did not correlate with behavioral inhibitory scores. These results support the hypothesis of inhibitory processing being an emergent property of a functional network.

Delay Discounting and Probability Discounting, But Not Response Inhibition, Are Associated With Sexual Risk Taking in Adults

Sexual risk behavior (SRB) is associated with impulsivity, but it is not clear whether different aspects of impulsivity are uniquely related to SRBs in adults. Unmarried adults ages 18 to 30 (N = 296; 41.0% male) recruited from the community reported their frequency of SRBs over the past six months using the Sexual Risk Survey (SRS; Turchik & Garske, 2009) and completed three behavioral measures of impulsivity: insensitivity to delayed consequences (delay discounting [DD]), insensitivity to probabilistic consequences (probability discounting [PD]) and response inhibition (stop signal task [SST]). SRS total scores were significantly related to both DD and PD but not SST. These findings suggest that insensitivity to delayed and probabilistic consequences, but not response inhibition, are meaningfully associated with SRBs in young adults. This may be important for the development of strategies to prevent or reduce sexual risk behaviors.

Gender Differences in the Automatic Attention to Romantic Vs Sexually Explicit Stimuli

INTRODUCTION

Gender differences in sexual responses and cognitive and emotional processing to romantic and sexually explicit stimuli have been reported. However, these differences seem to depend on the automaticity of the task that is being used, thus suggesting that gender differences may be the result of specific mechanisms rather than a generalized effect.

AIM

To expand previous basic processes research on gender differences to romantic vs sexually explicit stimuli, focusing on potential differentiating mechanisms influencing male and female sexual responses, we aim to investigate gender differences on automatic attention to sexual stimuli, and to test its relationship with sexual excitation proneness.

METHODS

26 women and 30 men (heterosexual) performed an automatic attention task, in which romantic and sexually explicit stimuli were presented as distractors, that is, stimuli to be ignored, while a concurrent letter discrimination task was performed, followed by a self-report task assessing subjective sexual and emotional responses to the stimuli.

MAIN OUTCOME MEASURES

Percentage of accuracy and response times (RTs) to discriminate the target letters were used as markers of automatic attention, with lower accuracy and longer RTs reflecting a higher degree of attentional capture by the distractor stimuli (romantic and sexually explicit). Participants completed self-report ratings on emotional valence, general arousal, and sexual arousal toward romantic and sexually explicit stimuli. They further reported on their sexual excitation proneness.

RESULTS

Findings revealed that sexually explicit pictures yielded more automatic attention capture. However, this effect was superseded by pornography consumption, which likely reflects a habituation mechanism. Also, data revealed gender-x type of picture interaction effects only at the self-report task, with men rating sexually explicit stimuli as more sexually exciting, and women rating these stimuli as less pleasant. No relationship was found between automatic attention proxies and sexual excitation proneness.

CLINICAL TRANSLATION

While therapeutic strategies are used as tools to improve attention to sexual stimuli (and, hence, increase sexual arousal), the current findings suggest that the specific pathways by which attention influences sexual response are still to be established. Also, gender differences on the subjective appraisal of sex stimuli suggest that therapeutic approaches, consisting on exposure techniques, must recognize gender specificities.

STRENGTHS & LIMITATIONS

To our knowledge, this is the first study applying an automatic attention task to the field of sex research, thus adding new inputs to the topic of attention, gender differences, and sexual response. However, there is very limited research in the field of automatic attention, which may limit the interpretation of our findings, at the moment.

CONCLUSION

Whereas both genders do not seem to differ in automatic attention toward romantic and sexually explicit stimuli, their responses do differ in their subjective appraisal of the stimuli. Furthermore, despite theoretical assumptions on the relationship between attention and sexual response, automatic attention seemed not to be related to sexual excitation proneness. Carvalho J, Czop O, Rocha M, et al. Gender differences in the automatic attention to romantic vs sexually explicit stimuli. J Sex Med 2018;15:1083-1092.

Domain-Specific Relationships in Sexual Measures of Impulsive Behavior

Impulsivity is an important construct for understanding sexual behaviors, but behavioral and self-report measures of impulsivity often are not correlated. One possible explanation for this is that there is little shared variance in the measures because behavioral measures index impulsivity by asking questions about monetary preferences, while self-report measures index impulsivity by asking about a broad range of real-world outcomes (including those of a sexual nature) largely unrelated to money-related preferences. Undergraduate students (total N = 105; female n = 77, male n = 28) completed laboratory measures-delay discounting (DD) and probability discounting (PD)-for two different outcomes-money and sexual activity. Participants also completed the Delaying Gratification Inventory (DGI), which measures difficulty with delaying gratification (i.e., impulsivity) across different domains, including money and physical pleasures. Findings indicated that DD and PD for money were not related to any of the DGI subscales. However, DD for sexual activity was significantly related to the DGI Physical Pleasures subscale, but not other subscales. These findings suggest that the relationship between behavioral and self-report measures of impulsive choice may be stronger when both are measuring domain-specific rather than domain-general behavioral patterns, but further research is warranted.

Inhibit My Disinhibition: The Role of the Inferior Frontal Cortex in Sexual Inhibition and the Modulatory Influence of Sexual Excitation Proneness

Sexual behaviour is the result of an interplay between distinct neural inhibitory and excitatory mechanisms. Individual differences in sexual excitation and sexual inhibition are proposed to play an important role in the processes sustaining the regulation of sexual behaviour. While much research has focused on the neural correlates of response inhibition, highlighting a prominent role of the inferior frontal gyrus (IFG), very little is known regarding the neural mechanisms underlying different aspects of sexual inhibition. Here, we experimentally combined functional magnetic resonance imaging (fMRI) and transcranial magnetic stimulation (TMS) to: (i) test the functional role of IFG during motivational and cognitive sexual inhibition; and (ii) reveal whether this IFG involvement in sexual inhibitory processes depends on sexual excitation and sexual inhibition as traits. Twenty-two participants performed an Approach-Avoidance (AA) and a Negative Affective Priming (NAP) paradigm to assess motivational and cognitive sexual inhibition respectively. Our fMRI study showed IFG being selectively activated during cognitive but not motivational sexual inhibition. Importantly, the level of this neural activity was modulated by individual sexual excitation scores. Interestingly, a transient disruption of IFG activity using TMS led to an improvement in cognitive, not motivational, sexual inhibition, but only when accounting for individual sexual excitation scores. These findings clearly document that sexual excitation modulates IFG activity levels during cognitive sexual inhibition, and at the same time determines the effects of TMS on IFG by improving cognitive control exclusively for individuals with high sexual excitation scores. These findings provide new insights regarding the functional role of IFG, and underscore the relevance of individual psychological differences in understanding the brain mechanisms underlying socioaffective processes.

Genotype scores predict drug efficacy in subtypes of female sexual interest/arousal disorder: A double-blind, randomized, placebo-controlled cross-over trial

Attempts to develop a drug treatment for female sexual interest/arousal disorder have so far been guided by the principle of ‘one size fits all’, and have failed to acknowledge the complexity of female sexuality. Guided by personalized medicine, we designed two on-demand drugs targeting two distinct hypothesized causal mechanisms for this sexual disorder. The objective of this study was to design and test a novel procedure, based on genotyping, that predicts which of the two on-demand drugs will yield a positive treatment response. In a double-blind, randomized, placebo-controlled cross-over experiment, 139 women with female sexual interest/arousal disorder received three different on-demand drug-combination treatments during three 2-week periods: testosterone 0.5 mg + sildenafil 50 mg, testosterone 0.5 mg + buspirone 10 mg, and matching placebo. The primary endpoint was change in satisfactory sexual events. Subjects’ genetic profile was assessed using a microarray chip that measures 300,000 single-nucleotide polymorphisms. A preselection of single-nucleotide polymorphisms associated with genes that are shown to be involved in sexual behaviour were combined into a Phenotype Prediction Score. The Phenotype Prediction Score demarcation formula was developed and subsequently validated on separate data sets. Prediction of drug-responders with the Phenotype Prediction Score demarcation formula gave large effect sizes (d = 0.66 through 1.06) in the true drug-responders, and medium effect sizes (d = 0.51 and d = 0.47) in all patients (including identified double, and non-responders). Accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of the Phenotype Prediction Score demarcation formula were all between 0.78 and 0.79, and thus sufficient. The resulting Phenotype Prediction Score was validated and shown to effectively and reliably predict which women would benefit from which on-demand drug, and could therefore also be useful in clinical practice, as a companion diagnostic establishing the way to a true personalized medicine approach.

Effects of exposure to erotica on disgust: A preliminary test among contamination-fearful individuals

Disgust has been implicated in the fear of contamination that is commonly observed in obsessive-compulsive disorder (OCD). However, basic and treatment-oriented research has shown that disgust is resistant to extinction among those with a fear of contamination. Consequently, there is growing interest in discovering novel approaches to targeting heightened disgust responding among those with OCD. Recent experimental research suggests that sexual arousal may inhibit disgust responding. Accordingly, the present study examines the effects of exposure to erotica on verbal reports of disgust and behavioral avoidance in a contamination-fearful sample of adults. Participants viewed sexually arousing, positively arousing, or neutral films and participated in a series of sexually relevant and non-sexually relevant behavioral approach tasks. Participants also gave ratings of disgust before and after completing each behavioral task. Although no group differences were observed for the number of steps completed on the behavioral approach tasks, those who viewed sexually arousing films reported significantly less change in disgust throughout the behavioral approach task compared to those who viewed positively arousing and neutral films. The potential clinical implications of the effects of sexual arousal on disgust responding in contamination-based OCD are discussed.

Sexual anxiety and sexual beliefs as mediators of the association between attachment orientation with sexual functioning and distress in university men and women

Previous research has demonstrated the association between sexual functioning and attachment orientation in women. However, the mechanisms of this relation are not yet well understood, and this effect has not been substantially investigated in men. The current study examines the role of sexual anxiety and dysfunctional beliefs about sexuality as mediators of the correlation of attachment orientation with sexual functioning and distress in both women and men. A university sample of men (n=307) and women (n=716) completed questionnaires assessing attachment orientation, sexual functioning, sexual distress, sexual anxiety, and dysfunctional sexual beliefs. Multiple regression analyses indicated that insecure attachment orientation significantly predicted poorer sexual functioning and higher sexual distress in both men and women. Path analyses showed partial mediation of these effects by sexual anxiety and dysfunctional sexual beliefs. Gender differences existed in the specific pattern of associations between the variables. These results suggest that attachment difficulties may facilitate the development of sexual difficulties through an increased vulnerability to maladaptive cognitions and negative affect (specifically anxiety) regarding sexuality.

Psychometric Properties of the Spanish Version of the Sexual Inhibition/Sexual Excitation Scales for Men

The dual control model (DCM) postulates the involvement of relatively independent inhibitory and excitatory systems, which together provide a "double control" over sexual response and associated behavior (Janssen & Bancroft, 2007). Based on this model, the Sexual Inhibition and Sexual Excitation Scales assess the propensity for sexual excitation and sexual inhibition. This research focused on analyzing some psychometric properties of this questionnaire and developing a Spanish version in men. The sample consisted of 823 heterosexual men of ages ranging from 18 to 74 years. Confirmatory factor analysis generated a version of the scale that consisted of 34 items (11 items with the worst factor loadings were eliminated) distributed in four factors (one sexual excitation factor and three sexual inhibition factors). This is consistent with the DCM of sexual response. The four factors demonstrated good reliability coefficients except for sexual inhibition due to the threat of performance consequences, which was found to have a low internal consistency. Consequently, this is something that will be addressed in future studies. The four factors were found to have good test-retest reliability. The measures of the Sexual Inhibition and Sexual Excitation Scales had good validity properties and a coherent relationship with sexual sensation seeking and erotophilia.

Psychometric properties of the Sexual Excitation/Sexual Inhibition Inventory for Women and Men (SESII-W/M) and the Sexual Excitation Scales/Sexual Inhibition Scales short form (SIS/SES-SF) in a population-based sample in Germany

The Sexual Excitation Sexual/Inhibition Inventory for Women and Men (SESII-W/M) and the Sexual Excitation Scales/Sexual Inhibition Scales short form (SIS/SES-SF) are two self-report questionnaires for assessing sexual excitation (SE) and sexual inhibition (SI). According to the dual control model of sexual response, SE and SI differ between individuals and influence the occurrence of sexual arousal in given situations. Extreme levels of SE and SI are postulated to be associated with sexual difficulties or risky sexual behaviors. The present study was designed to assess the psychometric properties of the German versions of both questionnaires utilizing a large population-based sample of 2,708 participants (Mage = 51.19, SD = 14.03). Overall, psychometric evaluation of the two instruments yielded good convergent and discriminant validity and mediocre to good internal consistency. The original 30-item version of the SESII-W/M did not show a sufficient model fit. For a 24-item version of the SESII-W/M partial strong measurement invariance across gender, and strong measurement invariance across relationship status, age, and educational levels were established. The original structure (14 items, 3 factors) of the SIS/SES-SF was not replicated. However, a 4-factor model including 13 items showed a good model fit and strong measurement invariance across the before-mentioned participant groups. For both questionnaires, partial strong measurement invariance with the original American versions of the scales was found. As some factors showed unsatisfactory internal consistency and the factor structure of the original scales could not be replicated, scores on several SE- and SI-factors should be interpreted with caution. However, most analyses indicated sufficient psychometric quality of the German SESII-W/M and SIS/SES-SF and their use can be recommended in German-speaking samples. More research with diverse samples (i.e., different sexual orientations, individuals with sexual difficulties) is needed to ensure the replicability of the factor solutions presented in this study.

Hypersexuality: A Critical Review and Introduction to the "Sexhavior Cycle"

An empirical review of hypersexuality is timely as "compulsive sexual behavior" is being considered as an impulse control disorder for inclusion in the forthcoming International Classification of Diseases, 11th ed. Specifically, hypersexuality has been conceptualized in the literature as the inability to regulate one's sexual behavior that is a source of significant personal distress. Various theoretical models have been posited in an attempt to understand the occurrence of hypersexuality, although disagreement about these divergent conceptualizations of the condition has made assessment and treatment of hypersexual clients more challenging. Theories of sexual compulsivity, sexual impulsivity, dual control (sexual inhibition/excitation), and sex addiction are critically examined, as are the diagnostic criteria for clinically assessing hypersexuality as a sexual disorder. Our discussion of hypersexuality covers a diversity of research and clinical perspectives. We also address various challenges associated with reliably defining, psychometrically measuring, and diagnosing hypersexuality. Furthermore, literature is reviewed that expresses concerns regarding whether hypersexuality (conceptualized as a disorder) exists, whether it is simply normophilic behavior at the extreme end of sexual functioning, or alternatively is a presenting problem that requires treatment rather than a clinical diagnosis. Following our literature review, we developed the "sexhavior cycle of hypersexuality" to potentially explain the neuropsychology and maintenance cycle of hypersexuality. The sexhavior cycle suggests that, for some hypersexual persons, high sexual arousal may temporarily and adversely impact cognitive processing (cognitive abeyance) and explain a repeated pattern of psychological distress when interpreting one's sexual behavior (sexual incongruence). We also suggest that further research is required to validate whether hypersexuality is a behavioral disorder (such as gambling), although some presentations of the condition appear to be symptomatic of a heterogeneous psychological problem that requires treatment.

Sexual Well-Being in Older Women: The Relevance of Sexual Excitation and Sexual Inhibition

The aim of this study was to use the dual control model of sexual response (DCM) to investigate variation in sexual well-being among women 50 years of age and older. Data from 185 women 50 years of age and older (M = 59.46, SD = 6.96) were used to examine the relationships between sexual excitation (SE) and sexual inhibition (SI) and their lower-order factors to indicators of sexual well-being (i.e., sexual functioning, satisfaction, distress, frequency of sexual activity, and breadth of sexual behavior). Possible moderating factors were also explored. Independently, SE and SI were associated with the majority of the indicators of sexual well-being, and the directions of associations were consistent with the tenets of the DCM. SE and SI lower-order factors were significant predictors of sexual function, satisfaction, and frequency of sexual activity. Sexual distress was predicted more strongly by SI factors and breadth of sexual behavior by one SE lower-order factor (arousability). Partner physical and mental health and participant's own mental health were identified as moderating variables of these associations. Findings of this study are discussed considering the contribution of the DCM to understanding the role of diversity in older women's sexual well-being.