Effects of experimentally adopted sexual schemas on vaginal response and subjective sexual arousal: a comparison between women with sexual arousal disorder and sexually healthy women

The association between female sexual function and metabolic features of the polycystic ovary syndrome in Turkish women of reproductive age

OBJECTIVE

To investigate the association between female sexual function and metabolic features among women with polycystic ovary syndrome (PCOS) during reproductive age.

METHOD

This was a cross-sectional study in which 288 women with PCOS and 180 women without PCOS between the ages of 20 and 40 years were evaluated. All women had serum total testosterone, androstenedione, DHEA-S, fasting glucose, total cholesterol, HDL-C, LDL-C, and triglyceride levels analyzed. The McCoy Female Sexual Questionnaire (MFSQ) was applied to all studied women. Exploratory factor analysis and reliability analysis were done after data collection. The factor loadings of MFSQ domains were compared between women with PCOS and controls.

RESULTS

Average factor loadings of the MFSQ sexuality domain and MFSQ sexual partner domain were significantly lower in the PCOS group when compared to controls. There was no correlation between the two sexual function domains of the MFSQ and the PCOS features either in the PCOS group or the controls.

CONCLUSION

PCOS is a heterogeneous disease with different metabolic components, such as insulin resistance, obesity, and hyperandrogenism. Although sexual function among women with PCOS was lower than controls, no differences were found in metabolic features of the PCOS and non-PCOS groups with relation to sexual function determined by the MFSQ.

Sexual anxiety mediate relationship between sexual schemas and body image with sexual function in Iranian women

BACKGROUND

Sexual function is one of the most critical challenges in human society, especially among women. The problems associated with sexual function are significantly ambiguous in a society like Iran. This study investigated the mediating role of sexual anxiety in relationship between sexual schemas and body image with female sexual function.

METHOD

The research method was correlational and specifically path analysis. The statistical population included women aged 25-45 in Rasht, Iran, 2021. 365 women were selected using Cochran's formula and the convenience sampling method. The Female Sexual Function Index (FSFI), Sexual Self-Schema Scale for Women (SSSS), Body Image Scale (BIS), and Multidimensional Sexual Self-Concept Questionnaire (MSQ) were used for data collection. For data analysis, SPSS-26 and LISREL 10.2 software were used.

RESULTS

Descriptive data analysis showed that mean and standard deviation were for further passionate-romantic schema 22.96 and 4.83, open-direct schema 27.64 and 5.09, embarrassed-conservative 20.93 and 4.61, body image 128.96 and 27.35, sexual anxiety 13.13 and 3.91 and sexual function 49.83 and 8.67. According to the results of path analysis, passionate-romantic (β = 0.51), explicit-comfortable (β = 0.27), shy-conservative (β = -0.59), and body image (β = -0.62) schemas showed a significant relationship with sexual function. Sexual function anxiety as a mediating variable also had a significant role (β = -0.41) in female sexual function.

CONCLUSION

Sexual function anxiety, negative body image, and negative sexual schema negatively affect women's sexual function, and positive sexual schemas and body image positively affect sexual function anxiety.

Psychological symptoms and brain activity alterations in women with PCOS and their relation to the reduced quality of life: a narrative review

BACKGROUND

Polycystic ovary syndrome (PCOS) is the most common feminine endocrine disorder, characterized by androgen excess, ovulatory dysfunction, and polycystic ovarian morphology. The negative impact of symptoms on the quality of life (QoL) of patients is still not clear.

PURPOSE

The present review aimed at studying the impact of the symptoms, the psychological symptoms, and brain alterations in women with PCOS.

METHODS

A systematic search was undertaken for studies that assessed the impact of PCOS symptoms on QoL, psychological symptoms, and brain alterations in PCOS patients.

RESULTS

Most of the information about QoL came from psychometric studies, which used culture-based questionnaires. Alterations of sleep quality, body image, and mood disorders can negatively affect the QoL of the patients. Sexual satisfaction and desire were affected by PCOS. Brain imaging studies showed functional alterations that are associated with impairments of visuospatial working memory, episodic and verbal memory, attention, and executive function.

CONCLUSIONS

Several factors can negatively influence the quality of life of the patients, and they are directly related to hyperandrogenism and the risk of infertility. In particular, obesity, hirsutism, acne, and the fear of infertility can have a direct impact on self-esteem and sexual function. Metabolic and psychiatric comorbidities, such as mood, anxiety, and eating disorders, can affect the well-being of the patients. Moreover, specific cognitive alterations, such as impairments in attention and memory, can limit PCOS patients in a series of aspects of daily life.

Female Affective Perception of Mainstream and Paraphilic Pornography: Associations with Sexual and Psychological Intrapersonal Variables

Understanding affective perceptual processes can further contribute to the explanation of motivation and actions, as well as sexual risk behaviors. Pornography can be considered salient emotional content and is popular, also among females. Yet, the female perspective on pornography has often been overlooked and it remains unclear how individual variables may be associated with the affective perception of pornography and could provide a risk profile. Possible associations between several sexual and psychological intrapersonal variables and the affective perception of various forms of pornography were analyzed from the female perspective. A sample of 231 females (M = 21.87 years; SD = 3.9 years) provided ratings of affective valence, arousal, disgust, and moral and ethical acceptance for mainstream pornographic and paraphilic images of dominance, submission, or sexual violence. Paraphilic pornography was perceived as less pleasant, arousing, and moral and ethically acceptable, but more disgusting compared to mainstream pornography. This was more pronounced among females who had never consumed pornography. Results further suggest that the female affective perception of pornography was associated with the following sexual intrapersonal variables: sexual sensation seeking for physical sensations, erotophilia, lack of sexual control, problematic pornography consumption, and sexual disgust sensitivity. Of the assessed psychological intrapersonal variables, only anxiety was negatively associated with disgust for paraphilic pornography. It is important to further analyze the female affective perception of pornography and associated variables to include them in strategies for prevention and for addressing problematic consequences of the acceptance of specific sexual content and behaviors, especially related to sexualized violence.

Effects of Sexual Myths and Intimate Partner Violence on Women's Sexual Self-Schemas

Sexual self-schemas (SSSs) are cognitive generalizations about one's sexual aspects. The aim of this study was to explore the possible effects of intimate partner violence (IPV) and the sexual myths about sexual behavior or roles on women's sexual self-schemas. The research had a cross-sectional and observational design. Fifty women from a psychiatry outpatient clinic between the ages of 18-50 were given the Sexual Self-Schema Scale, sexual myths questionnaire, Beck Depression Inventory, Beck Anxiety Inventory, Golombok-Rust Inventory of Sexual Satisfaction, and Domestic Violence Against Women Scale. A significant relationship was found between the duration of marriage (years) and "Direct/Outspoken" schema (p = .020, r = 0.29). This schema was also correlated with emotional (p = .037, r = - 0.29), total violence score (p = .028, r = - 0.27), and sexual myth score (p = .033, r = 0.26). After the regression analysis, it was observed that the effect of emotional violence and sexual myth score on the "Direct/Outspoken" schema remained significant. Correcting sexual myths through sexual education can make women's SSSs into positive way. In addition, interventions can be made to increase SSSs positively in women exposed to IPV. It is recommended that clinicians take a holistic approach by questioning the sexual functions and schemas of women in addition to IPV in women who experience it and have depression or anxiety disorders. As a policy implication, education about women's rights and sexuality should also be given. Adequate psychological support should be provided to reduce the impact of IPV on SSS.

Probiotic effects on sexual function in women with polycystic ovary syndrome: a double blinded randomized controlled trial

Background

Considering the presence of sexual dysfunction in patients with polycystic ovary syndrome, our aim was to provide scientific evidence studying effect of oral probiotic on sexual function in patients with PCOS treated with letrozole in an Iranian population.

Methods

This study was a double blind randomized clinical trial. Eligible women were allocated to Lactofem plus letrozole (n = 20) or letrozole (n = 20). Folic acid was prescribed to all participants in two groups during the study. In group A, Lactofem capsule was administered daily for the first month. In the second month, letrozole (2.5 mg daily from the third day of the menstrual cycle for 5 days) plus Lactofem capsule same as previous month were prescribed. In group B, letrozole administered 2.5 days from the third day of the menstrual cycle for 5 days in the second month. All questionnaires were completed by patients after the intervention (two months after the start of treatment). The Female Sexual Function Index (FSFI) and Body Image Concern Inventory (BICI) were used to assess sexual function and body satisfaction, respectively.

Results

There is statistically significant increase in chemical pregnancy rate (10% vs. 0%; p = 0.05) and clinical pregnancy (10% vs. 0%; p = 0.05) in Probiotic plus letrozole group compared to letrozole group after intervention. Based on our results, there was a statistically significant difference in each domain and sum score of sexual function of before and after the intervention between group (P < 0.05). Our findings have been shown, after eight weeks, the probiotic plus letrozole group had a significant improvement in the FSFI domains and sum score compared to letrozole alone group. Moreover, there are a significant improvement in mean (IQR) of body image score in probiotic group [30 (4.99) vs. 40 (4.36); P < 0.01].

Conclusion

The results of the current study suggests that eight weeks of administration of probiotic may improve chemical and clinical pregnancy rate, sexual function and body satisfaction in women with PCOS.

Sexual Self-Concept in Women with Disorders/Differences of Sex Development

Many women born with disorders or differences of sex development (DSD) report sexual problems, in particular women who have undergone extensive genital reconstruction. Examining cognitions and emotions that hinder or promote sexuality may facilitate understanding these sexual problems and may contribute to the development of specific interventions. In this study, sexual self-concept, body image, and sexual functioning were investigated in relation to genital surgery. To conduct the study, the women's Sexual Self-Concept Scale was translated to Dutch. Evaluation of psychometric properties was conducted in a sample of healthy Belgian and Dutch women participating in an anonymous web-based survey (N = 589, Mdn age, 23 years). The resulting three-factor structure corresponded largely to that of the original version. Compared to control women, women born with a DSD who were included in the Dutch DSD study (N = 99, Mdn age, 26 years) described themselves as being less interested in sex and less sexually active. These women also harbored more negative emotions and cognitions regarding their sexuality and were less satisfied with their external genitalia. In women with a DSD, sexual self-concept was associated with compromised outcomes on sexual functioning and distress. Women who were in a steady relationship, and/or had been sexually active in the past 4 weeks had a more positive sexual self-concept, took a more active role in their sexual relationship, experienced more sexual desire and arousal and less sexual distress than women who were not involved in a partner relationship. Findings in this study indicate that cognitions and emotions related to sexual self-concept play a role in sexual functioning of women with a DSD. A cognitive behavioral counseling approach with focus on coping and exploration of their own sexual needs could prove useful in this group.

Effect of the Lockdown Due to COVID-19 on Sexuality: The Mediating Role of Sexual Practices and Arousal in the Relationship Between Gender and Sexual Self-Esteem

The scientific evidence suggests that COVID-19 is affecting much more than the physical health of individuals, particularly in places where a lockdown has been established to slow down the spread of the virus. An area that may be particularly affected is human sexuality. This study explored the impact of the situation generated by COVID-19 on the sexuality of 201 adults living in Spain. We collected data cross-sectionally through an online survey during the month of April 2020. Results showed a reduction of sexual self-esteem and a decrease in the number of interpersonal sexual relations, although the frequency of masturbation and the consumption of pornography did not vary compared to previous levels. A regression analysis showed that masturbation, the ability to maintain sexual arousal and interpersonal sex were mediating variables in the relationship between gender - specifically being male - and having higher sexual self-esteem during the lockdown. This study provides new insight on the relevance of certain sexual behaviors in a pandemic situation with considerable social restrictions and on the effect of this situation on sexual self-esteem and arousal. It brings some clarity on the relationship between sexual self-esteem and gender, about which there is currently no consensus in the scientific literature.

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

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

Understanding sexual arousal and subjective-genital arousal desynchrony in women

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

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

We present the first systematic review and meta-analysis of sexual function in women with polycystic ovary syndrome (PCOS) compared with women without PCOS. Data on this topic are limited and often contradicting. Sexual function is influenced by endocrine, mental and social factors, which are often compromised in women with PCOS. The main outcome measures were validated sexual function questionnaires and visual analogue scales (VAS). We identified and assessed 1925 original articles; 18 articles were included. Significant small effect sizes were found on sexual function subscales (total score: P = 0.006; arousal: P = 0.019; lubrication: P = 0.023; satisfaction: P = 0.015; orgasm: P = 0.028), indicating impaired sexual function in women with PCOS. Large effect sizes for the effect of body hair on sex were shown on VAS (P = 0.006); social effect of appearance (P = 0.007); sexual attractiveness (P < 0.001). Satisfaction with sex life was impaired (P < 0.001), but sexual satisfaction was rated equally important in women with PCOS and controls. We conclude that a satisfying sex life is important for women with PCOS; however, sexual function and feelings of sexual attractiveness are impaired. The findings imply that sexual function, sexual satisfaction and psychosocial functioning need to be part of every clinical assessment of women with PCOS.

The Specificity of Women's Sexual Response and Its Relationship with Sexual Orientations: A Review and Ten Hypotheses

Category-specific sexual response describes a pattern wherein the individual shows significantly greater responses to preferred versus nonpreferred categories of sexual stimuli; this pattern is described as gender specific for sexual orientation to gender, or gender nonspecific if lacking response differentiation by gender cues. Research on the gender specificity of women's sexual response has consistently produced sexual orientation effects, such that androphilic women (sexually attracted to adult males) typically show gender-nonspecific patterns of genital response and gynephilic women (sexually attracted to adult females) show more gender-specific responses. As research on the category specificity of sexual response has grown, this pattern has also been observed for other measures of sexual response. In this review, I use the Incentive Motivation and Information Processing Models as complementary frameworks to organize the empirical literature examining the gender specificity of women's sexual response at each stage of sexual stimulus processing and response. Collectively, these data disconfirm models of sexual orientation that equate androphilic women's sexual attractions with their sexual responses to sexual stimuli. I then discuss 10 hypotheses that might explain variability in the specificity of sexual response among androphilic and gynephilic women, and conclude with recommendations for future research on the (non)specificity of sexual response.

The Physiology of Female Sexual Function and the Pathophysiology of Female Sexual Dysfunction (Committee 13A)

INTRODUCTION

The article consists of six sections written by separate authors that review female genital anatomy, the physiology of female sexual function, and the pathophysiology of female sexual dysfunction but excluding hormonal aspects.

AIM

To review the physiology of female sexual function and the pathophysiology of female sexual dysfunction especially since 2010 and to make specific recommendations according to the Oxford Centre for evidence based medicine (2009) "levels of evidence" wherever relevant.

CONCLUSION

Recommendations were made for particular studies to be undertaken especially in controversial aspects in all six sections of the reviewed topics. Despite numerous laboratory assessments of female sexual function, genital assessments alone appear insufficient to characterise fully the complete sexual response.

The Impact of Gain- and Loss-Framed Messages on Young Adults' Sexual Decision Making: An Experimental Study

Messages that frame a target behavior in terms of its benefits (gain frame) or costs (loss frame) have been widely and successfully used for health promotion and risk reduction. However, the impact of framed messages on decisions to have sex and sexual risk, as well as moderators of these effects, has remained largely unexplored. We used a computerized laboratory task to test the effects of framed messages about condom use on young adults' sexual decision making. Participants (N = 127) listened to both gain- and loss-framed messages and rated their intentions to have sex with partners who posed a high and low risk for sexually transmitted infections (STIs). The effects of message frame, partner risk, participant gender, ability to adopt the messages, and message presentation order on intentions to have sex were examined. Intentions to have sex with high-risk partners significantly decreased after the loss-framed message, but not after the gain-framed message, and intentions to have sex increased for participants who received the gain-framed message first. Yet, participants found it easier to adopt the gain-framed message. Results suggest that loss-framed messages may be particularly effective in reducing intentions to have sex with partners who might pose a higher risk for STIs, and that message presentation order may alter the relative effectiveness of gain- and loss-framed messages on sexual decision making. Future studies should examine the precise conditions under which gain- and loss-framed messages can promote healthy sexual behaviors and reduce sexual risk behaviors.

Devices and Methods to Measure Female Sexual Arousal

INTRODUCTION

Multiple methods and devices are available for the assessment of female sexual response, each with strengths and limitations that can impact interpretation of research results. As such, it is important to have an understanding of available methodologies and instruments.

AIM

To review recent literature on the measurement of female sexual response, and to describe the methods and devices, and their strengths and limitations.

METHODS

A literature review was performed regarding methodology and instruments used to quantify female sexual response.

MAIN OUTCOME MEASURES

The description of currently available instruments and methods to quantify sexual response in women.

RESULTS

Methodologies used to examine female sexual arousal employ a variety of stimuli and instruments to elicit and record sexual response. The variation in research designs across studies highlights the importance of understanding (i) how sexual response is elicited in studies; (ii) what kinds of experimental designs are available for assessing sexual psychophysiology; and (iii) the various types of instrumentation used to collect data.

CONCLUSIONS

The physiological and self-reported measurement of female sexual response is crucial to our understanding of the mechanisms and factors involved with healthy sexual functioning. As such, it is important to understand the strengths and limitations associated with different stimuli, research designs, and instruments. Kukkonen TM. Devices and methods to measure female sexual arousal.

Object of desire self-consciousness theory

In this article, the authors discuss the construct of object of desire self-consciousness, the perception that one is romantically and sexually desirable in another's eyes. The authors discuss the nature of the construct, variations in its expression, and how it may function as part of a self-schemata or script related to romance and sexuality. The authors suggest that object of desire self-consciousness may be an adaptive, evolved psychological mechanism allowing sexual and romantic tactics suitable to one's mate value. The authors also suggest that it can act as a signal that one has high mate value in the sexual marketplace. The authors then review literature (e.g., on fantasies, on sexual activity preferences, on sexual dysfunctions, on language) suggesting that object of desire self-consciousness plays a particularly important role in heterosexual women's sexual/romantic functioning and desires.

Gone but not forgotten: virginity loss and current sexual satisfaction

Although loss of virginity remains a salient experience throughout a person's lifetime, little is known about whether this experience has implications for later sexual functioning (e.g., sexual satisfaction). Previous research tends to ask participants about their first time and their current sexual functioning concurrently, which may lead to spillover effects. The authors investigated the relation between first-time sexual intercourse and current sexual satisfaction using an event-sampling methodology. Participants were 331 undergraduate students who answered questions about their first-time sexual encounter and their current sexual functioning (e.g., sexual satisfaction, sexual depression). Participants then described and rated each of their sexual interactions for 2 weeks. Results show that participants who had more positive first-time sexual experiences (e.g., intimacy, respect) report greater feelings of sexual satisfaction and esteem and less sexual depression. A series of multilevel random coefficient modeling analyses revealed that positive first-time experiences were predictive of physical and emotional satisfaction in their current sexual interactions, even when controlling for global sexual satisfaction. These results suggest that one's first-time sexual experience is more than just a milestone in development. Rather, it appears to have implications for their sexual well-being years later.

Structure and innervation of the labia minora: more than minor skin folds

OBJECTIVE

: The objective of this study was to examine the histologic features of the labia minora, within the context of the female sexual response.

METHODS

: Eight cadaver vulvectomy specimens were used for this study. All specimens were embedded in paraffin and were serially sectioned. Selected sections were stained with hematoxylin and eosin, elastic Masson trichrome, and S-100 antibody stains.

RESULTS

: The labia minora are thinly keratinized structures. The primary supporting tissue is collagen, with many vascular and neural elements structures throughout its core and elastin interspersed throughout.

CONCLUSIONS

: The labia minora are specialized, highly vascular folds of tissue with an abundance of neural elements. These features corroborate previous functional and observational data that the labia minora engorge with arousal and have a role in the female sexual response.

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.

Androgenic hormones and aging--the link with female sexual function

In women, sexual function, hormones and aging are inextricably related. Sexual activity in women involves interest and motivation, the ability to become aroused and achieve orgasm, the pleasure of the experience and subsequent personal satisfaction. Androgens, as endogenous hormones or given as a therapy, potentially influence female sexual function, with research into the effects of exogenous androgens in women mostly devoted to effects on sexual desire. Some studies have been conducted to delineate the effects of testosterone on arousal, however arousal determined by laboratory measures does not always correlate with subjective reporting of a sensation of arousal. Overall large randomised controlled trials of exogenous testosterone show benefits over placebo on sexual desire, arousal, orgasm, pleasure and satisfaction. The aspects of consideration of androgen therapy for women that continue to stimulate debate in this therapeutic area include whether female sexual dysfunction is a condition that merits pharmacotherapy, how effective is such treatment and whether testosterone therapy is safe.

Non-erotic thoughts, attentional focus, and sexual problems in a community sample

According to Barlow's model of sexual dysfunction, anxiety in sexual situations leads to attentional focus on sexual performance at the expense of erotic cues, which compromises sexual arousal. This negative experience will enhance anxiety in future sexual situations, and non-erotic thoughts (NETs) relevant to performance will receive attentional priority. Previous research with student samples (Purdon & Holdaway, 2006; Purdon & Watson, 2010) has found that people experience many types of NETs in addition to performance-relevant thoughts, and that, consistent with Barlow's model, the frequency of and anxiety evoked by these thoughts is positively associated with sexual problems. Extending this previous work, the current study found that, in a community sample of women (N = 81) and men (N = 72) in long-term relationships, women were more likely to report body image concerns and external consequences of the sexual activity, while men were more likely to report performance-related concerns. Equally likely among men and women were thoughts about emotional consequences of the sexual activity. Regardless of thought content, experiencing more frequent NETs was associated with more sexual problems in both women and men. Moreover, as per Barlow's model, greater negative affect in anticipation of and during sexual activity predicted greater frequency of NETs and greater anxiety in response to NETs was associated with greater difficulty dismissing the thoughts. However, greater difficulty in refocusing on erotic thoughts during sexual activity uniquely predicted more sexual problems above the frequency and dismissability of NETs. Together, these data support the cognitive interference mechanism implicated by Barlow's causal model of sexual dysfunction and have implications for the treatment of sexual problems.

Female sexual self-schema after interpersonal trauma: relationship to psychiatric and cognitive functioning in a clinical treatment-seeking sample

This study assessed the relationship between sexual self-schema and posttraumatic functioning in a clinical sample of 112 female sexual assault survivors. Contrary to hypotheses, posttraumatic stress disorder and depressive symptom severity were unrelated to the valence of sexual self-schema. Yet, negative posttraumatic cognitions were related to sexual self-schemas. Specifically, less positive self-views were associated with more negative schema (r = -.35). In a multivariate analysis, the measure of negative views of the world and others was associated with more positive schema. Results indicate that intervening to improve survivors' postassault appraisals of the self may help to reduce the impact of interpersonal trauma on women's sexual functioning.

Disorders in sexual desire and sexual arousal in women, a 2010 state of the art

In this contribution, female sexual desire and arousal disorders are viewed from the perspective of incentive motivation and information processing models of sexual response. The effects of hormones, somatic disease, and medication on sexual arousability are discussed, as well as the influence of psychological factors, such as stimulus meaning, mood and cognition, and relational context on female sexual desire and arousal. Specific topics to attend to during the anamnesis of sexual desire and arousal problems, and empirically evaluated psychological and pharmacological treatments for these problems are discussed.

The sensitivity of continuous laboratory measures of physiological and subjective sexual arousal for diagnosing women with sexual arousal disorder

INTRODUCTION

Past findings on the diagnostic sensitivity of vaginal photoplethysmography are limited by testing among women with heterogeneous sexual dysfunctions and by the use of statistical techniques that are unable to assess how changes in subjective arousal are associated with changes in physiological arousal.

AIMS

The aims of this study were to: (i) test the sensitivity of vaginal photoplethysmography and continuous measures of subjective sexual arousal in differentiating between women with and without sexual arousal or orgasm dysfunction; and (ii) examine the diagnostic utility of measuring the synchrony between genital and subjective sexual responses.

METHODS

Sexual arousal was assessed in sexually healthy women (n = 12), women with orgasm disorder (OD; n = 12), and 38 women who met the criteria for the three subcategories of sexual arousal dysfunction described by Basson et al. (i.e., genital sexual arousal disorder [GAD; n = 9], subjective sexual arousal disorder [SAD; n = 13], and combined genital and subjective arousal disorder [CAD; n = 16]).

MAIN OUTCOME MEASURES

Physiological sexual arousal was assessed using vaginal photoplethysmography, and subjective sexual arousal was measured continuously and using a Likert-scale in response to sexual videos.

RESULTS

Women with GAD showed the lowest and women with CAD showed the highest levels of vaginal pulse amplitude response to erotic stimuli. Women with sexual arousal disorder showed significantly lower levels of subjective sexual arousal to erotic stimuli than did sexually healthy women. Relations between subjective and physiological measures of sexual arousal were significantly weaker among women with sexual arousal disorder than sexually healthy women or women with OD.

CONCLUSION

Preliminary support was provided for the diagnostic utility of measuring the synchrony between subjective and genital arousal in women with sexual arousal disorder. Findings do not support the sensitivity of using vaginal photoplethysmography, or continuous or Likert-scale measures of subjective arousal for differentiating between subtypes of women with sexual arousal disorder.

The DSM diagnostic criteria for female sexual arousal disorder

This article reviews and critiques the DSM-IV-TR diagnostic criteria for Female Sexual Arousal Disorder (FSAD). An overview of how the diagnostic criteria for FSAD have evolved over previous editions of the DSM is presented and research on prevalence and etiology of FSAD is briefly reviewed. Problems with the essential feature of the DSM-IV-TR diagnosis-"an inability to attain, or to maintain...an adequate lubrication-swelling response of sexual excitement"-are identified. The significant overlap between "arousal" and "desire" disorders is highlighted. Finally, specific recommendations for revision of the criteria for DSM-V are made, including use of a polythetic approach to the diagnosis and the addition of duration and severity criteria.

Effects of appraisal of sexual stimuli on sexual arousal in women with and without superficial dyspareunia

This study examined the effects of appraisal of sexual stimuli on sexual arousal in women with superficial dyspareunia (n = 50) and sexually functional women (n = 25). To elicit different appraisals of an erotic film fragment, participants received an instruction prior to viewing it, with a focus on genital pain or on sexual enjoyment. A neutral instruction served as a control condition. Assignment to instruction condition was randomized. Genital arousal (vaginal pulse amplitude) and self-report ratings of affect and genital sensations were obtained in response to the erotic stimulus. As predicted, appraisal of the erotic stimulus affected genital responding, albeit marginally significant. Follow-up tests indicated that women who received the genital pain instruction responded with marginally significant lower genital arousal levels than women who received the sexual enjoyment instruction (d = 0.67). A significant instruction effect for negative affect was found, signifying that negative affect ratings were highest after the genital pain instruction and lowest after the sexual enjoyment instruction (d = 0.80). A marginally significant group by instruction interaction effect was observed for positive affect, indicating that women with dyspareunia reported significantly less positive affect than controls after the sexual enjoyment instruction (d = 1.48). Whereas women with dyspareunia reported overall marginally significant more negative affect than controls (d = 0.48), there were no differences in genital responsiveness between groups. These results provided preliminary evidence for the modulatory effects of appraisal of sexual stimuli on subsequent genital responding and affect in women with and without sexual complaints.

The role of attention in sexual arousal: implications for treatment of sexual dysfunction

The literature on the role of attention in sexual arousal is reviewed, especially that which has implications for noninvasive treatment of sexual dysfunction. Findings suggest that voluntary control of sexual arousal can be achieved through attentional focus on nonsexual cognitions or sexual fantasy. Cognitive biases may direct attention and thus facilitate or impede sexual arousal. Sexual arousal may be influenced by directed attentional focus, and preliminary evidence suggests that mindfulness techniques may result in longer-term changes in attentional focus; these changes, in turn, may improve sexual response. Information-processing models of sexual arousal developed in light of such findings are discussed. This research establishes the central role of attentional processes in facilitating physiological and, especially, subjective sexual arousal. Implementing approaches that capitalize on attentional processes could advance noninvasive treatment of sexual dysfunction. Future avenues of research might investigate how play, mammalian play circuits, and flow states are relevant to sexual response and satisfaction.