The effects of sympathetic activation on physiological and subjective sexual arousal in women

The elusive concept of sexual motivation: can it be anchored in the nervous system?

Sexual motivation is an abstract concept referring to the mechanisms determining the responsivity to sexually relevant stimuli. This responsivity determines the likelihood of producing a sexual response and the intensity of that response. Both responsivity to stimuli and the likelihood of making a response as well as the intensity of response are characteristics of an individual. Therefore, we need to assume that the concept of sexual motivation materializes in physiological mechanisms within the individual. The aim of the present communication is to analyze the requisites for the endeavor to materialize sexual motivation. The first requisite is to provide an operational definition, making the concept quantifiable. We show that parameters of copulatory behavior are inappropriate. We argue that the intensity of sexual approach behaviors provides the best estimate of sexual motivation in non-human animals, whereas the magnitude of genital responses is an exquisite indicator of human sexual motivation. Having assured how to quantify sexual motivation, we can then proceed to the search for physiological or neurobiological underpinnings. In fact, sexual motivation only manifests itself in animals exposed to appropriate amounts of gonadal hormones. In female rats, the estrogen receptor α in the ventrolateral part of the ventromedial nucleus of the hypothalamus is necessary for the expression of sexual approach behaviors. In male rats, androgen receptors within the medial preoptic area are crucial. Thus, in rats sexual motivation can be localized to specific brain structures, and even to specific cells within these structures. In humans, it is not even known if sexual motivation is materialized in the brain or in peripheral structures. Substantial efforts have been made to determine the relationship between the activity of neurotransmitters and the intensity of sexual motivation, particularly in rodents. The results of this effort have been meager. Likewise, efforts of finding drugs to stimulate sexual motivation, particularly in women complaining of low sexual desire, have produced dismal results. In sum, it appears that the abstract concept of sexual motivation can be reliably quantified, and the neurobiological bases can be described in non-human animals. In humans, objective quantification is feasible, but the neurobiological substrate remains enigmatic.

Consequences of spinal cord injury on the sympathetic nervous system

Spinal cord injury (SCI) damages multiple structures at the lesion site, including ascending, descending, and propriospinal axons; interrupting the conduction of information up and down the spinal cord. Additionally, axons associated with the autonomic nervous system that control involuntary physiological functions course through the spinal cord. Moreover, sympathetic, and parasympathetic preganglionic neurons reside in the spinal cord. Thus, depending on the level of an SCI, autonomic function can be greatly impacted by the trauma resulting in dysfunction of various organs. For example, SCI can lead to dysregulation of a variety of organs, such as the pineal gland, the heart and vasculature, lungs, spleen, kidneys, and bladder. Indeed, it is becoming more apparent that many disorders that negatively affect quality-of-life for SCI individuals have a basis in dysregulation of the sympathetic nervous system. Here, we will review how SCI impacts the sympathetic nervous system and how that negatively impacts target organs that receive sympathetic innervation. A deeper understanding of this may offer potential therapeutic insight into how to improve health and quality-of-life for those living with SCI.

The effect of pre-match sexual intercourse on football players' performance: a prospective cross over study

BACKGROUND

Current research suggests that pre-competition sexual intercourse does not influence athletes' performance. Yet, high quality studies in this field are scarce.

METHODS

We aimed to investigate whether sexual activity negatively influences physiological performance. We conducted a prospective cross over study, which enrolled active players from the first team of a football club in the Israeli Football Premier League during the 2018-19 season. We gathered participants' physiological performance using GPS driven data per match. In addition, we assessed sexual activity the night before using telephone interviews at the end of every match. We used a linear mixed models methodology, accounting for each player as a cluster.

RESULTS

We enrolled 14 participants who participated in 88 football matches. The mean age was 29.7 (±3.8) years and the majority were in permanent relationships for longer than 6 months (78.6%). We identified sexual intercourses the night before the match in 9 (10.2%) cases. The average speed during the match was slower when participants had pre-match intercourse (6.5 vs. 6.0 Km/h, P=0.02). The results remained consistent when using linear mixed models analysis adjusted for age, for previous belief that a pre-match sexual intercourse may affect match performance and for player as a cluster (P=0.02, 95% C.I -0.85- -0.07). Other parameters were not associated with pre-match intercourse.

CONCLUSIONS

To the best of our knowledge, this study is the first to show that sexual intercourse the night before a football match may have a negative influence on players' performance.

Sexual Desire in Women: Paradoxical and Nonlinear Associations with Anxiety and Depressed Mood

The aim of the present study was to expand previous findings regarding paradoxical effects of negative mood on sexual desire. This was done by considering the full range of depressed mood and anxiety symptoms and using methods that are unaffected by recall bias and that don't require participants to infer causal associations between their mood and sexual desire. A convenience sample of 213 university students completed daily questionnaires for approximately two months. Multilevel random-effects models were used to estimate average effects for the entire sample and to test for variability across participants in the associations between negative mood and sexual desire, controlling also for potential influences of the menstrual cycle. Previous findings showing that some women report decreased sexual desire and others increased sexual desire when depressed or anxious were confirmed. More importantly, for both depressed mood and anxiety, results demonstrated the presence of within-person paradoxical associations, whereby there were some women for whom both low and high levels of negative mood were associated with the same change (an increase or a decrease) in sexual desire. Related to these diverse response patterns, paradoxical associations between negative mood and sexual desire were also present at low levels of negative mood. The discussion underlines the importance of considering individual variability and multifactorial nonlinear models when studying sexual desire.

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

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

The Successful Measurement of Clitoral Pulse Amplitude Using a New Clitoral Photoplethysmograph: A Pilot Study

BACKGROUND

Although the clitoris is more sensitive to stimulation and its innervation more conducive to sensory feedback than the vagina, the field of sexual psychophysiology, which uses psychophysiological methods including genital response measures to study sexual arousal, relies heavily on the measurement of vaginal, rather than clitoral, pulse amplitude.

AIM

To develop and test a new clitoral photoplethysmograph for the measurement of clitoral pulse amplitude (CPA).

METHODS

2 versions of the new device, which differed in the orientation of the sensor and light source (parallel vs angled), were tested in 15 premenopausal, sexually functional women. Vaginal pulse amplitude (VPA) was assessed simultaneously. The women viewed a 3-minute erotic and an anxiety-inducing film segment with each clitoral sensor, interspersed with neutral video excerpts. In addition, they were asked to indicate their subjective level of sexual arousal during and after erotic video presentations.

OUTCOMES

The main outcome measures are CPA, VPA, and subjective sexual arousal.

RESULTS

The clitoral photoplethysmograph successfully detected CPA. The quality of the signals was best for the angled sensor. Main effects of the film and the interaction between the film and epoch were stronger for the clitoral than for the vaginal device. In addition, CPA followed more closely changes in intensity of sexual films than VPA. Within- and between-subject correlations between genital response and subjective sexual arousal were higher for the clitoral than for the vaginal device.

CLINICAL TRANSLATION

Comparison of CPA with other genital blood flow measures in clinical samples is indicated and may contribute to improved physiological assessments of sexual response in women.

STRENGTHS AND LIMITATIONS

Our sample was small and consisted of healthy volunteers. Future research could examine test-retest reliability, by including multiple recording sessions, and further explore the specificity of CPA by comparing sexual and non-sexual stimuli with positive valence.

CONCLUSION

This study presents the first instrument to successfully measure CPA. Mechelmans DJ, Sachtler WL, von Wiegand TE, et al. The Successful Measurement of Clitoral Pulse Amplitude Using a New Clitoral Photoplethysmograph: A Pilot Study. J Sex Med 2020;17:1118-1125.

Testosterone therapy and other treatment modalities for female sexual dysfunction

PURPOSE OF REVIEW

Recently in October 2019 a Global Consensus Position on the use of Testosterone Therapy for Women was published. The use of testosterone and other agents for female sexual dysfunction (FSD) is an important topic for the urologist focusing on sexual health. This review describes the known causes for FSD, and discusses the role of androgens in this disorder, the evidence for using testosterone treatment, and other current and emerging therapies.

RECENT FINDINGS

A recent meta-analysis, published in The Lancet Diabetes & Endocrinology evaluated a total of 36 randomized control trials spanning 1990-2018 and includes a total of 8480 patients. The primary findings were that testosterone therapy (TTh) increased sexual function including satisfactory sexual event frequency, sexual desire, pleasure, arousal, orgasm, responsiveness, and self-image when compared with either a placebo or drug-control (e.g., estrogen ± progestogen). In addition, TTh reduced sexual concerns and distress in postmenopausal women. Side effects included an increase in weight, acne, and hair growth, but there was no increase in serious adverse events. Importantly, TTh duration was greater than 12 weeks in all randomized control trials included in this meta-analysis.

SUMMARY

TTh is effective to treat FSD in postmenopausal women. More data is required to evaluate the long-term safety data on the effects of TTh on cardiovascular health, breast health, cognitive function, and the musculoskeletal system in women.

Sexual Dysfunction and Mood Stabilizers in Long-Term Stable Patients With Bipolar Disorder

BACKGROUND

In addition to factors intrinsic to bipolar disorder (BD), sexual functioning (SF) can be affected by extrinsic causes, such as psychotropic drugs. However, the effect of mood stabilizers on SF and quality of life (QoL) is an underexplored research area.

AIM

To analyze SF in BD outpatients in euthymia for at least 6 months treated only with mood stabilizers and the association between SF and QoL.

METHODS

A multicenter cross-sectional study was conducted in 114 BD outpatients treated with (i) lithium alone (L group); (ii) anticonvulsants alone (valproate or lamotrigine; A group); (iii) lithium plus anticonvulsants (L+A group); or (iv) lithium plus benzodiazepines (L+B group). The Changes in Sexual Functioning Questionnaire Short Form (CSFQ-14) was used. Statistical analyses were performed to compare CSFQ-14 scores among the pharmacological groups. An adaptive lasso was used to identify potential confounding variables, and linear regression models were used to study the association of the CSFQ-14 with QoL.

MAIN OUTCOME MEASURES

Self-reports on phases of the sexual response cycle (ie, desire, arousal, and orgasm) and QoL were assessed.

RESULTS

The A group had better total SF scores than the L group and the L+B group. Relative to the A group, the L and L+B groups had worse sexual desire; the L group had worse sexual arousal; and the L+A group and the L+B group had worse sexual orgasm. Regarding sociodemographic factors, being female and older age were associated with worse total SF and all subscale scores. Among all subscales scores, higher sexual arousal scores were associated with better QoL.

CLINICAL IMPLICATIONS

Potential modified extrinsic factors such as psychotropic medication that can affect SF can be addressed and adjusted to lessen side effects on SF.

STRENGTHS & LIMITATIONS

Sample of patients with euthymic BD in treatment with mood stabilizers and no antipsychotics or antidepressants, substance use as an exclusion criterion, and use of a validated, gender-specific scale to evaluate SF. Major limitations were cross-sectional design, sample size, and lack of information about stability of relationship with partner.

CONCLUSIONS

Lithium in monotherapy or in combination with benzodiazepines is related to worse total SF and worse sexual desire than anticonvulsants in monotherapy. While the addition of benzodiazepines or anticonvulsants to lithium negatively affects sexual orgasm, sexual arousal (which plays a significant role in QoL) improves when benzodiazepines are added to lithium. Anticonvulsants in monotherapy have the least negative effects on SF in patients with BD. García-Blanco A, García-Portilla MP, Fuente-Tomás L de la, et al. Sexual Dysfunction and Mood Stabilizers in Long-Term Stable Patients With Bipolar Disorder. J Sex Med 2020;17:930-940.

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.

The Relationship Between Sexual Functioning and Sexual Concordance in Women

Previous research using clinical samples has shown a positive relationship between women's sexual functioning and sexual concordance (i.e., agreement between genital and subjective sexual arousal). We further examined this relationship using concurrent measures of vaginal, clitoral, and subjective sexual responses in a community sample of women (N = 64, with 59.4% and 34.1% reporting sexual desire and/or arousal difficulties, respectively). Contrary to studies using clinical samples, sexual desire and arousal difficulties were associated with stronger sexual concordance, specifically when changes in subjective arousal predicted changes in genital responses. The subjective experience of arousal may be particularly important in influencing genital responses in women with sexual desire and arousal difficulties compared to unaffected women.

Acute stress enhances pupillary responses to erotic nudes: Evidence for differential effects of sympathetic activation and cortisol

Chronic stress attenuates reproductive behavior in many species, but evidence regarding the impact of acute stress on human sexual arousability is insufficient. Stressor-specific effects might result from divergent roles of both stress response systems. Social self-threat, linked to affiliation-oriented coping, might also influence sexual responsivity. To investigate stress-induced modulation of the processing of sexual cues and its relationship with cortisol, 58 participants underwent either a predominantly sympathetic stressor (3 min sustained handgrip) or similar control procedure. In both conditions, half of the sample was monitored by an opposite-sex person (social evaluation). Pupillary responses to erotic nudes were recorded and dissociated into fast and slow PCA components. Physically stressed participants showed enhanced (slow) dilation to explicit pictures. Cortisol levels after stress negatively predicted rapid responses to opposite-sex and (marginally) explicit stimuli. Our results suggest that acute sympathetic stress exposure facilitates cognitive sexual processing, whereas subsequent HPA-axis activation may induce counteracting effects.

Genital vibration for sexual function and enhancement: a review of evidence

Vibration, as provided by a genital vibrator, is commonly regarded as a tool to enhance sexual pleasure and in modern day society falls under the category of a sex toy. However, the vibrator was not originally intended to be a toy, and its benefits reach far beyond that of a plaything. This article is a narrative review of the current evidence regarding the use of vibratory stimulation for the treatment of sexual dysfunction and/or sexual and relationship enhancement. The literature indicates that vibratory stimulation has evidence-based support for the treatment of erectile dysfunction, ejaculatory dysfunction and anorgasmia. Vibratory stimulation is positively correlated with increased sexual desire and overall sexual function. It has also shown benefit for sexual arousal difficulties and pelvic floor dysfunction. Though definitive evidence is lacking, genital vibration is a potential treatment for sexual dysfunction related to a wide variety of sexual health concerns in men and women.

Health and wellness among incoming resident physicians: A multi-domain survey

Introduction

Burnout and depression are well-described in medical students and physicians and can lead to adverse personal and patient outcomes; however, their time course and risk factors remain understudied. Here, we measured multiple domains of mental and physical health and wellness and assessed gender differences among incoming physician trainees beginning residency at an academic medical center.

Methods

Using a cross-sectional study design, all incoming trainees (i.e. housestaff) at Johns Hopkins Hospital received a questionnaire assessing depression, burnout, sleep, exercise, and alcohol consumption, among other domains. Standardized instruments were utilized for questionnaire development. Tests of significance were two-tailed.

Results

196 of 229 incoming housestaff (86%) completed the survey, and 49% were female. A history of depression was reported in 8%, and 5.4% met criteria for at least moderate depression by Patient Health Questionnaire (PHQ-9). Females were more likely to report a history of depression than males (13% vs. 3%, p=0.02) but had similar PHQ-9 scores. Four percent of participants reported feeling they were in the wrong profession. Goal and mean sleep were 7 and 6.7 hours/night, respectively. Forty-seven percent reported exercising once/week or not at all. While mean reported weekly alcohol consumption was three drinks, participants reported consuming ≥5 drinks in one sitting on average 1.6 times in the prior 6 months, and 4% used alcohol to sleep.

Conclusions

Incoming housestaff reported generally favorable mental and physical health at the beginning of residency training. However, exercise rates were low, and ill-suited alcohol consumption was noted, though infrequent. The few areas of possible improvement were largely similar between males and females. Wellness interventions might capitalize on the relatively high morale and health at the completion of medical school by helping to promote healthy habits, including regular exercise and avoidance of excess alcohol consumption, throughout future training and practice.

A Single Session of Autogenic Training Increases Acute Subjective and Physiological Sexual Arousal in Sexually Functional Women

Heart rate variability (HRV) has recently been associated with female sexual function (Stanton, Lorenz, Pulverman, & Meston, 2015). Below-average HRV was identified as a possible risk factor for sexual arousal dysfunction and overall sexual dysfunction in women. Based on this newly established relationship between HRV and female sexual function, the present study examined the effect of autogenic training to increase HRV on acute physiological and subjective sexual arousal in women. Specifically, vaginal pulse amplitude (VPA), an index of genital sexual arousal, and subjective sexual arousal were assessed in 33 sexually functional women, aged 18 to 27, before and after a short session of autogenic training. Autogenic training, a relaxation technique that restores the balance between the activity of the sympathetic and the parasympathetic branches of the autonomic nervous system, has been shown to significantly increase HRV (Miu, Heilman, & Miclea, 2009). After autogenic training, significant increases in both VPA (p <.05) and subjective sexual arousal (p <.005) were observed. Moreover, change in HRV from pre- to postmanipulation significantly moderated changes in subjective sexual arousal (p <.05) when it was measured continuously during the presentation of the erotic stimulus. This cost-effective, easy-to-administer behavioral intervention may have important implications for increasing sexual arousal in women.

Vagal Activity During Physiological Sexual Arousal in Women With and Without Sexual Dysfunction

Recently, heart rate variability (HRV) level has been found to be a risk factor for female sexual dysfunction. Low HRV was a significant predictor of female sexual arousal dysfunction and overall sexual dysfunction. Building upon this finding, the present study examined whether differences in vagal activity between sexually functional and sexually dysfunctional women may be driving the association between low HRV and female sexual dysfunction. Specifically, respiratory sinus arrhythmia (RSA) was assessed before, during, and after physiological sexual arousal in 84 women, aged 18 to 47, to examine potential differences in vagal activity between sexually functional and sexually dysfunctional women. Significant differences in vagal activity between these two groups were observed (p =.02). These findings provide additional specificity to the recently established relationship between HRV and female sexual function while also proposing a mechanism to target during treatments for sexual dysfunction.

Review: Female sexual dysfunctions — the new models

A new model of women's sexual response reflects their various motivations to be sexual and the fact that psychological and biological factors strongly influence their arousability. Examples of factors stemming from diabetes are included. To increase emotional intimacy with their partner, women will deliberately find or be receptive to sexual stimuli that can potentially be sexually arousing. Only later do they sense specifically sexual need to continue for the sake of sexual sensations, sexual tension and possible orgasmic release. A model of women's subjective sexual arousal reflects the ongoing modulation from her emotions and cognitions as well as highly variable genital feedback.

Sexual Activity before Sports Competition: A Systematic Review

Sexual activity before competition has been considered as a possible cause for reduced performance since ancient Greece and Rome. Recently, the hypothesis that optimal sport performance could be influenced by a variety of factors including sexual activity before competition has been investigated. However, few scientific data are available, with the exception of anecdotal reports of individual experiences. The present systematic review focused on the current scientific evidence on the effects of sexual activity on sport performance regardless of sport type. Data were obtained following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, using PubMed/MEDLINE, ISI/Web of Science, the Cochrane Collaboration Database, Cochrane Library, Evidence Database (PEDro), Evidence Based Medicine (EBM) Search review, National Guidelines, ProQuest, and Scopus, all searched from inception further, to broaden the search, no time filter nor language restriction have been applied. Also, the gray literature was mined using Google Scholar. Only relevant scientific articles reporting outcomes of athletic performance after sexual activity were considered. The impact of sexual activity before a sport competition is still unclear, but most studies generally seem to exclude a direct impact of sexual activity on athletic aerobic and strength performance. The most important aspect seems to be the interval from the time of the sports competition that affects negatively the performance if it is shorter than 2 h. There are possible negative effects from some possible concurrent wrong behaviors such as smoking or alcohol abuse. There are no investigations about the effect of masturbation in this context. There is a need to clarify the effects of sexual activity on competition performance. The present evidence suggests that sexual activity the day before competition does not exert any negative impact on performance, even though high-quality, randomized controlled studies are urgently needed.

Heart Rate Variability: A Risk Factor for Female Sexual Dysfunction

Heart rate variability (HRV) is a measure of autonomic nervous system activity, which reflects an individual's ability to adapt to physiological and environmental changes. Low resting HRV has been linked to several mental health conditions, including depression, anxiety, and alcohol dependence (Kemp et al. in Biological Psychiatry 67(11):1067-1074, 2010. doi:10.1016/j.biopsych.2009.12.012; Kemp et al. in PloS One, 7(2):e30777, 2012; Quintana et al. in Drug and Alcohol Dependence, 132(1-2):395-398, 2013. doi:10.1016/j.drugalcdep.2013.02.025). HRV has also been used as a method for indexing the relative balance of sympathetic nervous system (SNS) activity to parasympathetic nervous system activity. This balance--in particular, moderately dominant SNS activity--has been shown to play a significant role in women's genital sexual arousal in the laboratory; however, the role of SNS activity in clinically relevant sexual arousal function is unknown. The present study assessed the feasibility of using HRV as an index of women's self-reported sexual arousal function outside the laboratory. Sexual arousal function, overall sexual function, and resting HRV were assessed in 72 women, aged 18-39. Women with below average HRV were significantly more likely to report sexual arousal dysfunction (p < .001) and overall sexual dysfunction (p < .001) than both women with average HRV and women with above average HRV. In conclusion, low HRV may be a risk factor for female sexual arousal dysfunction and overall sexual dysfunction.

The Clitoral Photoplethysmograph: A Pilot Study Examining Discriminant and Convergent Validity

INTRODUCTION

The clitoral photoplethysmograph (CPP) is a relatively new device used to measure changes in clitoral blood volume (CBV); however, its construct validity has not yet been evaluated.

AIM

To evaluate the discriminant and convergent validity of the CPP. For discriminant validity, CBV responses should differ between sexual and nonsexual emotional films if the CPP accurately assesses clitoral vasocongestion associated with sexual arousal; for convergent validity, CBV responses should significantly correlate with subjective reports of sexual arousal.

METHODS

Twenty women (M age = 21.2 years, SD = 3.4) watched neutral, anxiety-inducing, exhilarating, and sexual (female-male sex) audiovisual stimuli while their genital responses were measured simultaneously using vaginal and clitoral photoplethysmographs and CPPs. Most of these participants continuously reported sexual arousal throughout each stimulus (n = 16), and all reported their sexual and nonsexual affect before and after each stimulus; subjective responses were recorded via button presses using a keypad.

MAIN OUTCOME MEASURES

Vaginal pulse amplitude (VPA), CBV, and self-reported sexual arousal and nonsexual affect were used as main outcome measures.

RESULTS

CBV demonstrated both discriminant and convergent validity. CBV responses were similar to VPA responses and self-reported sexual arousal; all responses differed significantly as a function of stimulus content, with the sexual stimulus eliciting greater relative changes than nonsexual stimuli. CBV, but not VPA, was significantly (negatively) correlated with continuous self-reported sexual arousal during the shorter sexual stimulus. CBV was significantly negatively correlated with VPA for the shorter sexual stimulus.

CONCLUSION

CBV may be a valid measure of women's genital sexual arousal that provides complementary information to VPA and correlates with self-reported sexual arousal. Given our relatively small sample size, and that this is among the first research to use the CPP, the current findings must be replicated. More research using the CPP and other devices is required for a more comprehensive description of women's physiological sexual arousal.

Disgust versus Lust: Exploring the Interactions of Disgust and Fear with Sexual Arousal in Women

Sexual arousal is a motivational state that moves humans toward situations that inherently pose a risk of disease transmission. Disgust is an emotion that adaptively moves humans away from such situations. Incongruent is the fact that sexual activity is elementary to human fitness yet involves strong disgust elicitors. Using an experimental paradigm, we investigated how these two states interact. Women (final N=76) were assigned to one of four conditions: rate disgust stimuli then watch a pornographic clip; watch a pornographic clip then rate disgust stimuli; rate fear stimuli then watch a pornographic clip; or watch a pornographic clip then rate fear stimuli. Women's genital sexual arousal was measured with vaginal photoplethysmography and their disgust and fear reactions were measured via self-report. We did not find that baseline disgust propensity predicted sexual arousal in women who were exposed to neutral stimuli before erotic content. In the Erotic-before-Disgust condition we did not find that sexual arousal straightforwardly predicted decreased image disgust ratings. However, we did find some evidence that sexual arousal increased self-reported disgust in women with high trait disgust and sexual arousal decreased self-reported disgust in women with low trait disgust. Women who were exposed to disgusting images before erotic content showed significantly less sexual arousal than women in the control condition or women exposed to fear-inducing images before erotic content. In the Disgust-before-Erotic condition the degree of self-reported disgust was negatively correlated with genital sexual arousal. Hence, in the conflict between the ultimate goals of reproduction and disease avoidance, cues of the presence of pathogens significantly reduce the motivation to engage in mating behaviors that, by their nature, entail a risk of pathogen transmission.

Does menstrual cycle phase influence the gender specificity of heterosexual women's genital and subjective sexual arousal?

Unlike men, heterosexual women's genital arousal is gender nonspecific, such that heterosexual women show relatively similar genital arousal to sexual stimuli depicting men and women but typically report greater subjective arousal to male stimuli. Based on the ovulatory-shift hypothesis-that women show a mid-cycle shift in preferences towards more masculine features during peak fertility-we predicted that heterosexual women's genital and subjective arousal would be gender specific (more arousal towards male stimuli) during peak fertility. Twenty-two naturally-cycling heterosexual women were assessed during the follicular and luteal phases of their menstrual cycle to examine the role of menstrual cycle phase in gender specificity of genital and subjective sexual arousal. Menstrual cycle phase was confirmed with salivary hormone assays; phase at the time of first testing was counterbalanced. Women's genital and subjective sexual arousal patterns were gender nonspecific, irrespective of cycle phase. Cycle phase at first testing session did not influence genital or subjective arousal in the second testing session. Similar to previous research, women's genital and subjective sexual arousal varied with cues of sexual activity, but neither genital nor subjective sexual arousal varied by gender cues, with the exception of masturbation stimuli, where women showed higher genital arousal to the stimuli depicting male compared to female actors. These data suggest that menstrual cycle phase does not influence the gender specificity of heterosexual women's genital and subjective sexual arousal.

Women's genital sexual arousal to oral versus penetrative heterosexual sex varies with menstrual cycle phase at first exposure

Reproductive-aged women show increased interest in sexual activity during the fertile phase of the menstrual cycle that can motivate sexual behavior and thereby increase the likelihood of conception. We examined whether women demonstrated greater sexual responses (subjective and genital sexual arousal) to penetrative versus oral sexual activities during the fertile versus non-fertile phases of their cycles, and whether women's arousal responses were influenced by the phase during which they were first exposed to these sexual stimuli (e.g., Slob et al., 1991; Wallen and Rupp, 2010). Twenty-two androphilic women completed two identical sexual arousal assessments in which genital responses were measured with a vaginal photoplethysmograph and their feelings of sexual arousal were recorded. Women viewed an array of 90s films varying by couple type (female-female, male-male, female-male) and sexual activity type (oral or penetrative), during the fertile (follicular) and non-fertile (luteal) phases of their menstrual cycle, with the order of cycle phase at the first testing session counter-balanced. Women tested first in the fertile phase showed significantly greater genital arousal to female-male penetrative versus oral sex in both testing sessions, whereas self-reports of sexual arousal were not affected by cycle phase or testing order. These results contribute to a growing body of research suggesting that fertility status at first exposure to sexual stimuli has a significant effect on subsequent sexual responses to sexual stimuli, and that this effect may differ for subjective versus genital sexual arousal.

Erotica viewing effects on intimate relationships and self/partner evaluations

Viewing visual sexual stimuli (VSS) has been documented to have both positive (e.g., increased sexual arousal and sexual behaviors) and negative (e.g., higher anxiety, devaluing of partner attractiveness) effects. Excitation transfer and social comparison theories were used to generate hypotheses that could explain these mixed findings. Forty-four monogamous, heterosexual couples viewed erotic, exciting (non-erotic films), and nature films both alone and together. They rated their feelings of general arousal and relationship satisfaction as well as perceptions of self and partner sexual behaviors and attractiveness. Participants viewing both the erotic and exciting films reported equivalent increases in excitement; however, the erotic film was rated as slightly more generally arousing and increased participant's desire to be close to their partner. Viewing the erotic films also induced greater reports of negative affect, guilt, and anxiety. These findings moderately support a transfer of excitation interpretation. No effects of partner presence or absence while viewing the films was found. Viewing erotic films led to more positive evaluations of one's own sexual behaviors. These findings provide mixed support in regard to self and partner social comparisons. Co-occurring positive and negative emotional reactions were explored as possible explanation to the complex reactions to VSS.

The role of trait-affect, depression, and anxiety in women with sexual dysfunction: a pilot study

Despite the increasing number of studies, it is not yet clear how emotions affect sexual response in women with and without sexual problems. The aim of this study was to explore the relation among trait-affect, depression, anxiety, and sexual functioning. Participants were 237 women: 167 without sexual problems, 37 with low levels of sexual functioning, and 17 with sexual dysfunction. Participants completed the Positive and Negative Affect Schedule, the Brief Symptom Inventory, the Beck Depression Inventory, and the Female Sexual Function Index. Results showed that women with sexual problems presented lower levels of positive trait-affect in comparison with women without sexual problems. Mediation analysis indicated that depression mediated 44% of the total effect of positive trait-affect and 83% of the total effect of negative trait-affect on sexual functioning. Moreover, anxiety (Brief Symptom Inventory subscale) mediated 18% of the total effect of positive trait-affect on sexual functioning and 61% of the total effect of negative trait-affect on sexual functioning. These results may help explain the high comorbidity among sexual dysfunction, depression, and anxiety, and raise the hypothesis that trait-affect may act as a common vulnerability factor for these clinical conditions.

Anxiety and female sexual functioning: an empirical study

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

Women's rape fantasies: an empirical evaluation of the major explanations

This study evaluated explanations of rape fantasy in a sample of female undergraduates (N = 355) using a sexual fantasy checklist which included eight types of rape fantasy, participants' detailed descriptions of a rape fantasy they have had, a rape fantasy scenario audio presentation, and measures of personality. Three explanations of rape fantasy were tested: openness to sexual experience, sexual desirability, and sexual blame avoidance. Women who were higher in erotophilia and self-esteem and who had more frequent consensual sexual fantasies and more frequent desirability fantasies, particularly of performing as a stripper, had more frequent rape fantasies. Women who were higher in erotophilia, openness to fantasy, desirability fantasies, and self-esteem reported greater sexual arousal to rape fantasies. Sexual blame avoidance theory was not supported; sexual desirability theory was moderately supported; openness to sexual experience theory received the strongest support.

On the intricate relationship between sexual motivation and arousal

Sexual motivation and sexual arousal are widely used concepts. While there seem to be considerable agreement as to the meaning of sexual motivation, there is certain confusion about the exact meaning of sexual arousal. Some use it as a synonym to sexual motivation and others make it equivalent to erection or vaginal lubrication. An unresolved question is the relationship between sexual arousal and general arousal as well as that between arousal and motivation. I present arguments for the view that arousal refers to the general state of alertness of the organism. Consequently, there is no such thing as a specific sexual arousal. I suggest that this term should be abandoned, or if that is not feasible, to make it a synonym to enhanced genital blood flow. The notion of a subjective sexual arousal, some kind of vaguely described mental state, seems to lack all explanatory value. I then show that general arousal is an important determinant of sexual motivation, and that the execution of copulatory acts leads to increased general arousal. This increase leads to enhanced sexual motivation, making the activation of sexual reflexes requiring high levels of motivation possible. Examples of such reflexes may be ejaculation in males of many species, and perhaps the psychic state of orgasm in women.

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

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

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.

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

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

Laboratory-induced hyperventilation differentiates female sexual arousal disorder subtypes

The effects of heightened sympathetic nervous system (SNS) activity via laboratory-induced hyperventilation (LIH) on subjective and physiological sexual arousal were examined in a heterogeneous group of women with Sexual Arousal Disorder (SAD; n = 60), as well as across subtypes of SAD, in comparison to a control group of women without sexual difficulties (n = 42). Participants took part in 2 min of rapid breathing, a technique previously found to increase SNS activity, immediately prior to viewing erotic stimuli. Physiological arousal (i.e., vaginal pulse amplitude; VPA) was measured via the vaginal photoplethysmograph and subjective arousal was measured via self-report questionnaires. LIH differentiated women with SAD from those in the control group, with LIH increasing VPA in the latter, but having no significant effect in the heterogeneous SAD group. However, among subtypes of SAD, LIH differentiated women with genital (n = 16) and subjective (n = 16) subtypes of SAD from women with combined SAD (n = 28) and women without sexual difficulties. Specifically, women in the control group and those with combined SAD had a significant increase in VPA whereas women with genital or subjective SAD had a significant decrease in VPA following LIH. There was no significant effect of LIH on any self-report measure of sexual arousal following erotic stimuli. Implications of the results for the conceptualization, diagnosis, and treatment of SAD are discussed.

Conscious regulation of sexual arousal in men

The goals of this study were to examine the effectiveness of emotional reappraisal in regulating male sexual arousal and to investigate a set of variables theoretically linked to sexual arousal regulation success. Participants first completed a series of online sexuality questionnaires. Subsequently, they were assessed for their success in regulating sexual arousal in the laboratory. Results showed that the ability to regulate emotion may cross emotional domains; those men best able to regulate sexual arousal were also the most skilled at regulating their level of amusement to humorous stimuli. Participants, on average, were somewhat able to regulate their physiological and cognitive sexual arousal, although there was a wide range of regulation success. Whereas some men were very adept at regulating their sexual arousal, others became more sexually aroused while trying to regulate. Age, sexual experience, and sexual compulsivity were unrelated to sexual arousal regulation. Conversely, sexual excitation, inhibition, and desire correlated with sexual arousal regulation success. Increased sexual excitation and desire were associated with poorer regulatory performance, whereas a propensity for sexual inhibition due to fear of performance consequences was related to regulatory success.

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

Summary

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

The inhibitory effects of nicotine on physiological sexual arousal in nonsmoking women: results from a randomized, double-blind, placebo-controlled, cross-over trial

INTRODUCTION

Extensive research suggests that long-term cigarette smoking is an independent risk factor for the introduction of sexual dysfunction in men. However, results of limited data investigating this relationship in women are mixed. No studies have examined the acute effects of tobacco or nicotine on physiological sexual response in women. Controlled experimental studies examining acute effects of isolated nicotine intake on female physiological sexual responses are necessary in order to help elucidate tobacco's potential role in the development and/or maintenance of sexual impairment in women.

AIM

To examine whether isolated nicotine intake acutely affects sexual arousal responses in nonsmoking women.

METHODS

Twenty-five sexually functional women (mean age = 20 years) each with less than 100 direct exposures to nicotine completed two counterbalanced conditions in which they were randomized to received either nicotine gum (6 mg) or placebo gum, both administered double-blind and matched for appearance, taste, and consistency, approximately 40 minutes prior to viewing an erotic film.

MAIN OUTCOME MEASURES

Physiological (changes in vaginal pulse amplitude via vaginal photoplethysmography) and subjective (continuous self-report) sexual responses to erotic stimuli were examined, as well as changes in mood.

RESULTS

Nicotine significantly reduced genital responses to the erotic films (P = 0.05), corresponding to a 30% attenuation in physiological sexual arousal. This occurred in 11 of 18 women with valid physiological assessments. Nicotine had no significant effect on continuous self-report ratings of sexual arousal (P = 0.45), or on mood (all Ps > 0.05).

CONCLUSIONS

Acute nicotine intake significantly attenuates physiological sexual arousal in healthy nonsmoking women. Our findings provide support to the hypothesis that nicotine may be the primary pharmacological agent responsible for genital hemodynamic disruption, thereby facilitating a cascade of biochemical and vascular events which may impair normal sexual arousal responses.

Watching emotional movies: affective reactions and gender differences

Previous studies have found that unpleasant film clips depicting mutilated bodies or injuries evoke a sustained heart rate deceleration which has been interpreted as reflecting a stimulus-specific aversive response or as increased orienting and attentional processing that varies with stimulus significance. Few studies, however, have examined cardiac changes during the viewing of high arousal pleasant films. To clarify this issue, the present study assessed evaluative, facial and autonomic reactions in both men and women during the viewing of highly arousing pleasant, as well as unpleasant, films. Results indicated a similar skin conductance increase and heart rate deceleration which were greater than those observed during the viewing of a neutral film. Compared to men, women rated both films as less pleasant and rated the unpleasant film as more arousing. The present findings suggest that sustained exposure to pleasant and unpleasant stimuli elicit similar cardiac orienting when stimuli are equated for subjective report of emotional arousal.

The roles of testosterone and alpha-amylase in exercise-induced sexual arousal in women

INTRODUCTION

Several studies have demonstrated that moderate exercise increases genital response to erotic stimuli in women. The increase in genital arousal could be the result of various changes that can occur in response to exercise including changes in hormone levels, neurotransmitter levels, mood, and autonomic nervous system activity.

AIM

The present study was an attempt to shed light on two such mechanisms through which exercise enhances sexual arousal.

METHOD

Sixteen participants came into the lab on two separate occasions: during one visit, they filled out questionnaires for 20 minutes, and during the other visit, they exercised on a treadmill for 20 minutes. The questionnaires and exercise were both followed by the presentation of a neutral then erotic film during which the women's physiological sexual arousal was measured. Saliva samples were taken at baseline, prefilm, and postfilm. Main Outcome Measures. Subjective arousal was measured using a self-report questionnaire, and genital arousal was measured by a vaginal photoplethysmograph. Testosterone and alpha-amylase (a marker of sympathetic nervous system [SNS] activity) were measured via saliva assays.

RESULTS

Findings replicated previous studies showing a significant increase in physiological sexual arousal with exercise. There was a significant increase in alpha-amylase across the study in the exercise condition, but not in the no-exercise condition. There were no differences in testosterone levels between the exercise and no-exercise conditions.

CONCLUSIONS

SNS activity is one mechanism through which exercise increases genital sexual arousal. Testosterone does not mediate the relationship between exercise and genital sexual arousal.

Body concerns in and out of the bedroom: implications for sexual pleasure and problems

Objectification theory (Fredrickson B. L., & Roberts, T. A. (1997). Psychology of Women Quarterly, 21, 173-206) proposes that body image concerns impair sexual function and satisfaction. The present study was designed to test whether body shame was related to sexual problems and pleasure among heterosexual men and women (N = 320). Using structural equation modeling, we tested whether adult men and women's body shame was linked to greater sexual problems (lower sexual arousability and ability to reach orgasm) and less pleasure from physical intimacy. Although women were significantly more likely to report appearance concerns than men across sexual and non-sexual contexts, appearance concerns were positively related to both men and women's sexual problems. The relationship between body shame and sexual pleasure and problems was mediated by sexual self-consciousness during physical intimacy. Men and women's body shame was related to greater sexual self-consciousness, which in turn predicted lower sexual pleasure and sexual arousability. Results persisted controlling for relationship status and age. Being in a relationship was associated with less sexual self-consciousness and less orgasm difficulty for men and women. Although some paths were significantly stronger for women than for men, results largely supported the proposition that body concerns negatively affect sexual pleasure and promote sexual problems for both men and women. Findings were discussed in terms of objectification theory and the increased cultural emphasis on physical appearance.