The varied nature of women's sexuality: unresolved issues and a theoretical approach

Sex and Sexual Orientation Differences in Dark Triad Traits, Sexual Excitation/Inhibition, and Sociosexuality

The present study sought to investigate sex and sexual orientation differences in several traits related to sexuality and sexual behavior. Examining sexual orientation differences alongside basic sex differences to help identify correlates of sexual orientation diversity, and whether individuals with varying degrees of same-sex attraction show concurrent sex-atypical shifts in other domains. Males tend to score higher than females in the Dark Triad (DT) traits of sub-clinical narcissism, psychopathy, and Machiavellianism. Similarly, females tend to be more cautious than males in their attitudes and desires toward casual sex activity (i.e., sociosexuality). These sex differences may be related to the propensity for individuals to become easily sexually excited, which is higher in males, or to instead inhibit sexual arousal, which is higher in females. In a large undergraduate sample (N = 2047), we replicated expected sex differences in DT traits, sociosexuality, and sexual excitation/inhibition. We found that non-heterosexual females were "male-shifted" in some of these traits, but these shifts tended to be strongest among mostly heterosexual and bisexual individuals. Furthermore, we found that within-sex variation in sociosexuality, sexual excitation, and sexual inhibition was not related to sexual orientation in a linear fashion. Instead, sociosexuality and sexual excitation were related to sexual orientation in a curvilinear (inverted-U) fashion, especially among females. The fact that traits correlated with bisexuality and homosexuality were somewhat distinct is consistent with the idea that different developmental pathways may lead to these discrete sexual attraction patterns.

Correlation of sexual desire with sexual hormone binding globulin and free androgen index in women using combined contraceptives

PURPOSE

To correlate the sexual desire levels with sexual hormone binding globulin and free androgen index in women taking different types of hormonal contraceptives (HCs) containing ethinylestradiol (EE), oestradiol valerate (E2V), 17β-oestradiol (E2), or estetrol (E4), combined or in phasic formulation with different progestogens having antiandrogenic properties.

METHODS

Three hundred and sixty-seven women (age range 18-46) participated in the study. SHBG and total testosterone (TT) were measured, and the Free Androgen Index (FAI) was calculated. The Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale (FSDS) questionnaires were used to assess sexual function and distress, respectively.

RESULTS

The highest SHBG values and the lowest FAIs were obtained of women on HCs containing EE than those of women on HCs containing E2V/17β E2 or E4 (p < 0.001). Desire scores and FSFI total scores were lower in women on HCs with EE than in those using HCs containing E2V, 17β E2, or E4 (p ≤ 0.001). The women who were on HCs containing EE reported FSDS levels higher than those containing all the other types of oestrogen. Finally, sexual desire and FSFI total scores had a negative correlation with the SHBG values and a positive correlation with FAI percentage (p ≤ 0.0001).

CONCLUSIONS

A minority of women using HCs with EE might experience a decreased sexual desire. This was not observed in women on HCs containing E2V, 17 E2, or E4. To avoid HC discontinuation, due to sexual desire reduction, HCs having minor antiandrogenic effects could be taken into consideration.

Sexual Function and Satisfaction in the Context of Obesity

PURPOSE OF REVIEW

Sexual dysfunction is commonly associated with overweight/obesity, but the underlying physiological and psychosocial mechanisms are not fully understood. This review contextualizes the obesity-sexual (dys)function relationship, describes recent insights from the medical and social science literature, and suggests opportunities for continued research.

RECENT FINDINGS

Although sexual dysfunction has been historically evaluated as a consequence/outcome of obesity, it is increasingly considered as a harbinger of future metabolic comorbidities, including type 2 diabetes and cardiovascular disease. Body image dissatisfaction is a consistent predictor for lower sexual satisfaction across BMI categories, likely mediated by cognitive distraction during partnered sex. To fully capture the relationship between obesity and sexual dysfunction, multidisciplinary research approaches are warranted. While clinically significant weight loss tends to improve sexual functioning for women and men, higher body image satisfaction may independently promote sexual function and satisfaction without concomitant weight loss.

Sexual Functioning, Satisfaction, and Well-Being Among Contraceptive Users: A Three-Month Assessment From the HER Salt Lake Contraceptive Initiative

Few large, longitudinal studies document multiple contraceptive methods' effects on sexual functioning, satisfaction, and well-being. We leveraged data from the HER Salt Lake Contraceptive Initiative, a prospective cohort study with patient surveys at baseline, one month, and three months. Surveys assessed bleeding changes, contraceptive-related side effects, sexual functioning and satisfaction, and perceptions of methods' impact on sexual well-being. Individuals in the final sample (N = 2,157) initiated either combined oral contraceptives, levonorgestrel intrauterine devices (IUDs), copper IUDs, implants, injectables, or vaginal rings. Across methods, participants exhibited minimal changes in sexual function (Female Sexual Function Index-6 scores) or satisfaction (New Scale of Sexual Satisfaction scores) over three months. However, many perceived contraception-related changes to sexual well-being. Half (51%) reported their new method had made their sex life better; 15% reported it had made their sex life worse. Sexual improvements were associated with decreased vaginal bleeding, fewer side effects, and IUD use. Negative sexual impacts were associated with physical side effects (e.g., bloating and breast tenderness), increased bleeding, and vaginal ring use. In conclusion, contraceptive users did not experience major changes in sexual functioning or satisfaction over three months, but they did report subjective sexual changes, mostly positive, due to their method.

Sexual Dysfunction and Quality of Life in Patients with Rheumatoid Arthritis

Background: Sexual health is a major component of human well-being. As repeatedly shown in research, satisfaction with sex life and sexual fulfillment correlate positively with quality of life (QoL) in most of its aspects. It is thus true that a reduced quality of one’s sex life and lack of sexual fulfillment can contribute to poorer QoL overall. The aim of this study is to describe an assessment of sexual dysfunction and factors affecting sexual dysfunctions of patients with rheumatoid arthritis (RA). Material and methods: 171 consecutive RA patients (mean age 48.3 ± 14.6) attending the rheumatology outpatient clinic. Standardized questionnaires used in the study were the sexological questionnaire, WHOQOL-BREF to assess QoL level, Disease Acceptance Scale, and VAS scale to assess pain intensity. Results: The mean duration of the disease in the study group was 13 ± 9 years, mean score of subjective assessment of mobility was 6.2 ± 1.6, and the mean score of the DAS-28 was 4.0 ± 1.9. The study group presented a mean level of disease acceptance (AIS 29.6 ± 11.6). The comparative analysis showed significant differences in reaching orgasm and declared sexual dysfunctions. These problems occurred more often in women than in men (34.2% vs. 18% and 43% vs. 40%, respectively). In univariate analysis, factors correlating positively with the frequency of declaring sexual dysfunction were subjective motor score less < 6 points, AIS < 36 points, WHOQOL-BREF < 59 points, disease activity ≥3.5 points, and VAS > 3. In multivariate logistic regression analysis, independent factors positively correlating with frequency of sexual dysfunction declaration were general QoL (β = 1.255; p = 0.035) and pain limiting social life (β = 1.564; p = 0.030). The absence of comorbidities correlated negatively and reduced the prevalence of sexual dysfunction (β = −1.030; p = 0.043). Patients with reduced QoL and patients with pain limiting social life had 3.5 and 4.8 times higher risk of sexual dysfunction than other patients, respectively. In contrast, those without comorbidities were 2.8 times more likely to be free of sexual dysfunction than those diagnosed with other chronic diseases besides RA. Conclusions: Sexual dysfunction is an emerging problem in both men and women with RA. The absence of comorbidities is an independent determinant of sexual dysfunction, whereas poor QoL and pain limiting social life are independent determinants that exacerbate sexual dysfunction in both genders.

Salivary Testosterone and Sexual Function and Behavior in Men and Women: Findings from the Third British National Survey of Sexual Attitudes and Lifestyles (Natsal-3)

Using data from the third British National Survey of Sexual Attitudes and Lifestyles (Natsal-3) we examined associations between salivary testosterone (Sal-T) and sexual function and behavior. Single morning saliva samples were self-collected from a subsample of participants aged 18-74 years and analyzed using mass spectrometry. 1,599 men and 2,123 women were included in the analysis (40.6% of those invited to provide a sample). We adjusted for confounders in a stepwise manner: in model 1 we adjusted for age only; model 2 for age, season and relationship status, and model 3 we added BMI and self-reported health. In the fully adjusted models, among men, Sal-T was positively associated with both partnered sex (vaginal sex and concurrent partners) and masturbation. Among women, Sal-T was positively associated with masturbation, the only association with partnered sex was with ever experience of same-sex sex. We found no clear association between Sal-T and sexual function. Our study contributes toward addressing the sparsity of data outside the laboratory on the differences between men and women in the relationship between T and sexual function and behavior. To our knowledge, this is the first population study, among men and women, using a mass spectrometry Sal-T assay to do so.

A Cluster Analysis on Sexual Boredom Profiles in A Community Sample of Men and Women

Research evidence of the attributes of sexual boredom is extremely limited. Understanding variability in the experience of sexual boredom may offer relevant insights for the field of human sexuality. This study aimed to explore the co-occurrence of sexual boredom and other sexuality-related dimensions. The sample consisted of 1021 participants aged between 18 and 75 years old (M = 32.68, SD = 8.79). A gender-stratified cluster analysis was performed to classify individuals regarding their scores on sexual boredom, general boredom, sexual sensation seeking, sexual desire, sexual excitation, sexual pleasure, and sexual satisfaction. A three-cluster solution was revealed for both men and women. Based on our findings, we put forward a profile for the sexually bored individual, who is more likely to be married or cohabiting with a partner, to have a boredom prone personality, to lack sexual sensation seeking, experience low sexual pleasure and satisfaction, and to present with sexual arousal and/or desire problems. Women dealing with sexual boredom might present low sexual desire for their partner but experience high sex desire for attractive others. Results are critically discussed and implications for sexual therapy explored.

Obesity, Body Image Dissatisfaction, and Sexual Dysfunction: A Narrative Review

With approximately two-thirds of the United States adult population classified as overweight or obese, obesity remains a critical public health concern. Obesity not only contributes to several health complications including type 2 diabetes mellitus and cardiovascular disease, but the condition is also associated with sexual dysfunction in both women and men. Despite evidence linking obesity and its concomitant pathophysiology to sexual problems, the potential roles of psychosocial factors such as body image are understudied. This narrative review evaluates the research linkages between obesity and sexual dysfunction, with particular attention to the potential effects of body image dissatisfaction. A literature search of biomedical and psychological databases was used to identify research pertaining to obesity, sexual function, and/or body image constructs. The pathophysiological effects of obesity on sexual function are well-documented in mechanistic studies and animal trials, often with corroboration in human clinical samples. However, very few studies examine obesity, body image, and sexual function in tandem. Body image dissatisfaction appears to independently impinge upon the sexual response cycle and mental health outcomes, irrespective of body weight. While obesity is often associated with negative body image appraisal, it is unclear whether these constructs exert additive, synergistic, or antagonistic effects on sexual responsivity. Additionally, overweight/obese individuals who exhibit higher levels of body image satisfaction or self-confidence appear to be protected from the deleterious effects of obesity on sexual satisfaction, at least to some extent. Greater reliance upon conceptual/theoretical models from the body image literature may better clarify the relationships between these constructs.

Using Three Indirect Measures to Assess the Role of Sexuality-Related Associations and Interpretations for Women's Sexual Desire: An Internet-Based Experimental Study

Theoretical models emphasize the role of both automatic appraisals (i.e., associations) and conscious appraisals (i.e., interpretations) for sexual desire. Studies on sexuality-related appraisals have not combined self-report measures and experimental paradigms in order to compare the relevance of associations or interpretations. The aim of this study was to assess the relative contribution of both associations and interpretations to the explanation of low sexual desire in women. Toward this goal, indirect measures assessing associations (via a Single Target Implicit Association Test [STIAT]) and interpretations (via a Scrambled Sentences Test [SST] and a scenario task) were administered in a sample of 263 women (M_age = 27.90, SD 8.27) with varying levels of sexual desire and different sexual orientations (exclusively heterosexual women: 54.6%). Negative sexuality-related interpretations as assessed with two variants of the SST as well as the scenario task added to the explanation of lower sexual desire in women. Negative associations as measured with the STIAT were predictive of lower sexual desire only in women who did not indicate an exclusively heterosexual orientation. In this study, sexuality-related interpretations were more relevant to women's sexual desire than automatic associations. Future studies should assess the causal mechanism underlying sexuality-related interpretations (e.g., by evaluating whether these can be changed via cognitive bias modification techniques or psychological treatments).

Prolactin as a neuroendocrine clue in sexual function of women across the reproductive life cycle: an expert point of view

Prolactin is a proteic hormone best known for its role in enabling the production of milk by female mammals. Secreted by the pituitary gland in response to the stimuli of eating, estrogen treatment, mating, ovulation and nursing, prolactin is involved in over 300 separate processes in a range of vertebrates, including humans. The hormone is released in a pulsatile manner and plays an essential role in metabolism, as well as in the regulation of the immune system and pancreatic development. Nevertheless, prolactin exerts other relevant roles, as it acts at the central nervous system level to modulate behavior, arousal and sexuality. In this experts' opinion, we aim to give insights into the main activities of prolactin to advance the ability of medical doctors and specialists in obstetrics and gynecology to provide more emphasis in their clinical practices to the link between prolactin and sexuality.

When Desire Fades: Women Talk About Their Subjective Experience of Declining Sexual Desire in Loving Long-term Relationships

Women's sexual desire has been shown to decline over the course of loving long-term relationships. Yet, accounts of partnered women's subjective experience of this occurrence are rather limited. In order to broaden the examination of this topic, the present exploratory qualitative study extended it cross-culturally to explore how women in Israel are impacted by, perceive, and experience this decline in their sexual desire, with the objective of sketching an account of the experiences of women who share this reality. Semi-structured interviews were conducted with 15 women, aged 25 and over, in fulfilling long-term heterosexual relationships. The participants reported a sharp decline in sexual desire in comparison to the early stages of the relationship, experiencing it as quite perplexing given their love and affection for their partner. All also described their intimate connection as based on much more than sex. Additionally, while the reduction in desire did not result from difficulties in the relationship it did create some. These included frustration, conflict, and pressure from partner, which often led to sexual compliance on the women's part. Suggested solutions included open and honest dialogue, thoughtfulness, and mutual respect. A critical discussion of the findings outlines implications for partnered women's and couples' wellbeing.

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

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

Assessing Paraphilic Interests Among Women Who Sexually Offend

PURPOSE OF REVIEW

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

RECENT FINDINGS

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

Different Ways to Get There: Evidence of a Variable Female Sexual Response Cycle

Research has suggested women's sexual response cycle may vary more than previously thought. We asked 769 sexually active women between the ages of 18-70 to report on their sexual desire and arousal patterns during their last sexual experience. Using a latent class mixture model from retrospective sexual response data, we found six classes of desire and arousal patterns (Low, Middle Steady, High Fluctuation, Low Fluctuation, Upper Steady, High). We examined how these patterns were related to demographics, outcomes during the sexual experience, and outcomes for the global relationship. The Low sexual response class (8% of women) was significantly different from other classes in duration of the sexual experience, orgasms, and overall satisfaction with the sexual experience. Most sexual response patterns were associated with healthy relational and sexual outcomes. All classes except for the Low arousal and desire class showed associations with a neutral or positive sexual satisfaction evaluation. The non-problematic variation of women's sexual experience is an important concept to consider as it impacts determinations of dysfunction and women's self-evaluations. Not all women need to experience high levels of arousal throughout the sexual experience or to have desire at the outset in order to have positive sexual experiences and sexual outcomes.

Determinants of Female Sexual Function in Breastfeeding Women

Knowledge about the determinants of female sexual function in breastfeeding women is limited. A total of 355 breastfeeding women completed the Female Sexual Function Index (FSFI) and the Qol-8 quality of life questionnaire. FSFI scores decreased in the first six months of breast feeding. There was a positive relationship between FSFI scores and the importance of sex, level of communication, income, quality of life, and receiving brief sexual counseling.

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

INTRODUCTION

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

AIM

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

METHODS

A systematic literature review was conducted.

MAIN OUTCOME MEASURES

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

RESULTS

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

CONCLUSION

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

Young women's perceptions of the impact of their body image on their sexual experiences

The goal of this study was to explore women's perceptions of their body within the context of their sexual relationship with a male partner. Semi-structured interviews were conducted with 16 young women (ages 19 to 29). Thematic analysis revealed that women described a fluctuating body image that influences their behaviour and experience of sexual activity including initiating or avoiding, openness or inhibition, and feeling engaged or distracted. They described contextual factors that affect their body image in sexual situations (e.g., lighting, sexual position) as well as strategies they used to ameliorate the impact of body image concerns (e.g., self-talk, shifting focus), to varying degrees of success. Most indicated that they were able to enjoy partnered sexual activity despite their insecurities. Thus, women viewed their sexual experiences as influenced by body image in dynamic, fluctuating ways, with numerous influencing factors. Strategies for mitigating these perceived negative effects are discussed.

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

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

Multifaceted Sexual Desire and Hormonal Associations: Accounting for Social Location, Relationship Status, and Desire Target

Sexual desire is typically measured as a unitary erotic phenomenon and is often assumed by biological and biomedical researchers, as well as the lay public, to be directly connected to physiological parameters like testosterone (T). In the present study, we empirically examined how conceptualizing sexual desire as multifaceted might clarify associations with T and contextual variables. To do so, we used the Sexual Desire Questionnaire (DESQ), which assesses multifaceted dyadic sexual desire, to explore how contextual variables such as social location, relationship status, and desire target (e.g., partner vs. stranger) might be meaningful for reports of sexual desire and associated hormonal correlations. We focused on women (N = 198), because sexual desire and testosterone are generally unlinked in healthy men. Participants imagined a partner or stranger while answering the 65 DESQ items and provided a saliva sample for hormone assay. Analyses showed that the DESQ factored differently for the current sample than in previous research, highlighting how sexual desire can be constructed differently across different populations. We also found that, for the Intimacy, Eroticism, and Partner Focus factors, mean scores were higher when the desire target was a partner relative to a stranger for participants in a relationship, but equally high between partner versus stranger target for single participants. DESQ items resolved into meaningful hormonal desire components, such that high endorsement of Fantasy Experience was linked to higher T, and higher cortisol was linked with lower endorsement of the Intimacy factor. We argue that conceptualizing desire as multifaceted and contextualized when assessing hormonal links-or questions in general about desire-can clarify some of its complexities and lead to new research avenues.

Sexual Desire in Sexual Minority and Majority Women and Men: The Multifaceted Sexual Desire Questionnaire

Sexual desire is increasingly understood to be multifaceted and not solely erotically oriented, but measures are still generally unitary and eroticism-focused. Our goals in this article were to explore the multifaceted nature of sexual desire and develop a measure to do so, and to determine how multifaceted sexual desire might be related to gender/sex and sexual orientation/identity. In the development phase, we generated items to form the 65-item Sexual Desire Questionnaire (DESQ). Next, the DESQ was administered to 609 women, 705 men, and 39 non-binary identified participants. Results showed that the DESQ demonstrated high reliability and validity, and that sexual desire was neither unitary nor entirely erotic, but instead was remarkably multifaceted. We also found that multifaceted sexual desire was in part related to social location variables such as gender/sex and sexual orientation/identity. We propose the DESQ as a measure of multifaceted sexual desire that can be used to compare factor themes, total scores, and scores across individual items in diverse groups that take social context into account. Results are discussed in light of how social location variables should be considered when making generalizations about sexual desire, and how conceptualizations of desire as multifaceted may provide important insights.

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.

Combined Oral Contraceptives and Sexual Function in Women-a Double-Blind, Randomized, Placebo-Controlled Trial

CONTEXT

There is a lack of knowledge about how oral contraceptives may affect sexual function.

OBJECTIVE

To determine whether there is a causal effect of oral contraceptives on sexuality. We hypothesized that a widely used pill impairs sexuality.

DESIGN

A double-blind, randomized, placebo-controlled trial. Enrollment began in February 2012 and was completed in August 2015.

SETTING

Karolinska University Hospital, Stockholm, Sweden.

PARTICIPANTS

A total of 340 healthy women, aged 18-35 years, were randomized to treatment, and 332 completed the study.

INTERVENTIONS

A combined oral contraceptive (150 μg levonorgestrel and 30 μg ethinylestradiol) or placebo for 3 months of treatment.

MAIN OUTCOME MEASURES

The primary outcome was the aggregate score on the Profile of Female Sexual Function (PFSF). Secondary outcomes were the seven domains of the PFSF, the Sexual Activity Log, and the Personal Distress Scale.

RESULTS

Overall sexual function was similar in women in the oral contraceptive and placebo groups. The PFSF domains desire (-4.4; 95% confidence interval [CI], -8.49 to -0.38; P = .032), arousal (-5.1; 95% CI, -9.63 to -0.48; P = .030), and pleasure (-5.1; 95% CI, -9.97 to -0.32; P = .036) were significantly reduced in comparison to placebo, whereas orgasm, concern, responsiveness, and self-image were similar between groups. The mean frequency of satisfying sexual episodes and personal distress were also similar between groups.

CONCLUSIONS

This study shows no negative impact of a levonorgestrel-containing oral contraceptive on overall sexual function, although three of seven sexual function domains were adversely affected.

Defining Pleasure: A Focus Group Study of Solitary and Partnered Sexual Pleasure in Queer and Heterosexual Women

Solitary and partnered sexuality are typically depicted as fundamentally similar, but empirical evidence suggests they differ in important ways. We investigated how women's definitions of sexual pleasure overlapped and diverged when considering solitary versus partnered sexuality. Based on an interdisciplinary literature, we explored whether solitary pleasure would be characterized by eroticism (e.g., genital pleasure, orgasm) and partnered pleasure by nurturance (e.g., closeness). Via focus groups with a sexually diverse sample of women aged 18-64 (N = 73), we found that women defined solitary and partnered pleasure in both convergent and divergent ways that supported expectations. Autonomy was central to definitions of solitary pleasure, whereas trust, giving pleasure, and closeness were important elements of partnered pleasure. Both solitary and partnered pleasure involved exploration for self-discovery or for growing a partnered relationship. Definitions of pleasure were largely similar across age and sexual identity; however, relative to queer women, heterosexual women (especially younger heterosexual women) expressed greater ambivalence toward solitary masturbation and partnered orgasm. Results have implications for women's sexual well-being across multiple sexual identities and ages, and for understanding solitary and partnered sexuality as overlapping but distinct constructs.

Female sexual dysfunction (FSD): Prevalence and impact on quality of life (QoL)

Female sexual dysfunction (FSD) and quality of life (QOL) are both multidimensional and have a bidirectional relationship across the reproductive life span and beyond. Methodological difficulties exist in estimating the real prevalence of FSD because it is hard to determine the level of distress associated with sexual symptoms in a large-scale survey. Approximately 40-50% of all women report at least one sexual symptom, and some conditions associated with hormonal changes at menopause, such as vulvovaginal atrophy (VVA) and hypoactive sexual desire disorder (HSDD), have a significant impact on sexual function and QOL. Sexual distress peaks at midlife, declines with age and is strongly partner-related. Many postmenopausal women are still sexually active, especially if they are in a stable partnership. Even though sexual functioning is impaired, a variety of psychosocial factors may maintain sexual satisfaction. That being so, health care providers (HCPs) should proactively address sexual symptoms at midlife and in older women, from a balanced perspective. Adequate counselling should be offered. Women with distressing symptoms may benefit from tailored hormonal and non-hormonal therapies, whereas women without distress related to their sexual experiences should not receive any specific treatment.

To be or not to be in sexual desire: the androgen dilemma

The androgen milieu and sexual desire in women seem to be tightly linked because they both decline with age. However, we are still missing a cut-off plasma level for androgens (total testosterone, free testosterone) or androgen precursors (androstenedione, dehydroepiandrosterone (DHEA) and DHEA sulfate (DHEAS)) to diagnose androgen deficiency in clinical practice. Apart from the complex multidimensional nature of sexual desire across the reproductive lifespan, the correlation between measurements of testosterone and specific signs and symptoms has been difficult because, according to guidelines, most available assays are unreliable at baseline and under hormonal treatments. Recent data obtained with accurate methods based on mass spectrometry to measure total testosterone levels found a significant positive association with sexual desire, arousal and masturbation in midlife US women across the menopausal transition. Even in a European cohort of healthy women aged 19-65 years, sexual desire, measured with a validated questionnaire, correlated overall with free testosterone and androstenedione measured with mass spectrometry. Collectively, these data support the therapeutic use of testosterone for low desire and sexual dysfunction in those clinical conditions in which androgen deficiency may be accurately diagnosed.

The Sexual Acceptability of Contraception: Reviewing the Literature and Building a New Concept

How contraceptives affect women's sexual well-being is critically understudied. Fortunately, a growing literature focuses on sexual aspects of contraception, especially hormonal contraception's associations with libido. However, a more holistic approach to contraceptive sexual acceptability is needed to capture the full range of women's sexual experiences. We conducted a narrative literature review of this topic, working with an original sample of 3,001 citations published from 2005 to 2015. In Part 1, we draw from a subset of this literature (264 citations) to build a new conceptual model of sexual acceptability. Aspects include macro factors (gender, social inequality, culture, and structure), relationship factors (dyadic influences and partner preferences), and individual factors (sexual functioning, sexual preferences, such as dis/inhibition, spontaneity, pleasure, the sexual aspects of side effects, such as bleeding, mood changes, sexual identity and sexual minority status, and pregnancy intentions). In Part 2, we review the empirical literature on the sexual acceptability of individual methods (103 citations), applying the model as much as possible. Results suggest contraceptives can affect women's sexuality in a wide variety of positive and negative ways that extend beyond sexual functioning alone. More attention to sexual acceptability could promote both women's sexual well-being and more widespread, user-friendly contraceptive practices.

Flibanserin-Stimulated Partner Grooming Reflects Brain Metabolism Changes in Female Marmosets

INTRODUCTION

Female sexual interest and arousal disorder is personally distressing for women. To better understand the mechanism of the candidate therapeutic, flibanserin, we determined its effects on an index of brain glucose metabolism.

AIM

We hypothesized that chronic treatment with flibanserin would alter metabolism in brain regions associated with serotonergic function and female sexual behavior.

METHODS

In a crossover design, eight adult female common marmosets (Calithrix jacchus) received daily flibanserin or vehicle. After 7-12 weeks of treatment, the glucose metabolism radiotracer [(18) F]fluorodeoxyglucose (FDG) was administered to each female immediately prior to 30 minutes of interaction with her male pairmate, after which females were anesthetized and imaged by positron emission tomography. Whole-brain normalized images were analyzed with anatomically defined regions of interest. Whole-brain voxelwise mapping was used to explore treatment effects. Correlations were examined between alterations in metabolism and pairmate social grooming.

MAIN OUTCOME MEASURES

Changes in metabolism associated with flibanserin were determined for dorsal raphe, medial prefrontal cortex (mPFC), medial preoptic area of hypothalamus (mPOA), ventromedial nucleus of hypothalamus, and field cornu ammonis 1 (CA1) of the hippocampus.

RESULTS

In response to chronic flibanserin, metabolism in mPOA declined, and this reduction correlated with increases in pairmate grooming. A cluster of voxels in frontal cortico-limbic regions exhibited reduced metabolism in response to flibanserin and overlapped with a voxel cluster in which reductions in metabolism correlated with increases in pairmate grooming. Finally, reductions in mPOA metabolism correlated with increases in metabolism in a cluster of voxels in somatosensory cortex.

CONCLUSIONS

Taken together, these results suggest that flibanserin-induced reductions in female mPOA neural activity increase intimate affiliative behavior with male pairmates.

Hormonal contraception and sexual desire: A questionnaire-based study of young Swedish women

OBJECTIVES

The aim of the study was to determine whether a decrease in sexual desire is more prevalent among women using hormonal contraception than among women using hormone-free contraception, and whether a decrease increases the risk of changing to another contraceptive method.

METHODS

A validated questionnaire was posted to 3740 women (aged 22, 25 or 28 years) living in Sweden. Descriptive statistics were used to present the results; differences between groups were tested using χ(2) analyses. A multiple logistic regression model was used for analysis of possible confounders.

RESULTS

The response rate was 50%. The majority (81%) of respondents used some kind of contraception, and 88% were generally satisfied with the method used. Regardless of the type of method, 27% of hormonal contraceptive users reported a decrease in sexual desire that they attributed to their use of hormonal contraception, whereas only 12% of women using hormone-free contraception reported a decrease in sexual desire (p<0.01). This twofold risk of a decrease in sexual desire was shown in the multiple regression analysis to be independent of age group, depression, BMI, educational level and parity. However, having a partner was found to be a factor of equal importance: women with partners experienced reduced desire twice as often as women without partners. The observed odds ratio for planning to stop hormonal contraception or to change to a different type due to reduced desire was 8.16 (95% confidence interval 6.65-10.1) among women who had had the same experience during a previous period of hormonal contraceptive use.

CONCLUSIONS

Women using hormonal contraception were more likely to experience reduced sexual desire compared with women using hormone-free contraception. Experiencing reduced desire was a strong predictive factor for women to change contraceptive method.

Sex and the menopausal woman: A critical review and analysis

Medical discourse has positioned the menopausal transition as a time of sexual atrophy and loss of femininity, with hormonal replacement as the solution. In contrast, feminist critics have argued that women’s experience of sexual embodiment during menopause is culturally and relationally mediated, tied to discursive constructions of aging and sexuality, which are negotiated by women. The aim of this article is to present a critical examination of women’s experiences of sexuality during and after the menopausal transition, drawing on previous research in this field, as well as qualitative research we have conducted with women at midlife, and women who have experienced premature menopause as a consequence of cancer treatment. We aim to challenge myths and misconceptions about the inevitability of sexual decline at menopause, as well as normalise the embodied changes that some women experience – whether menopause is premature, or occurs at midlife. We argue that sexual difficulties or disinterest reported by women during and after menopause are more strongly associated with psycho-social factors than hormonal status, in particular psychological well-being, relationship context and a woman’s negotiation of cultural constructions of sex, aging and femininity. However, sexuality can continue to be a positive experience for women throughout adult life and into old age, with many menopausal women reporting increased sexual desire and response. This undermines the biomedical construction of menopause as a time of inevitable sexual atrophy and decay.

Sociosexual attitudes and dyadic sexual desire independently predict women's preferences for male vocal masculinity

Research suggests that the desire to behave sexually with a partner (dyadic sexual desire) may reflect desire for intimacy whereas solitary sexual desire may reflect pleasure seeking motivations more generally. Because direct reproductive success can only be increased with a sexual partner, we tested whether dyadic sexual desire was a better predictor of women's preferences for lower pitched men's voices (a marker of relatively high reproductive success) than was solitary sexual desire. In Study 1, women (N = 95) with higher dyadic sexual desire scores on the Sexual Desire Inventory-2 preferred masculinized male voices more than did women with lower dyadic sexual desire scores. We did not find a significant relationship between women's vocal masculinity preferences and their solitary sexual desire scores. In Study 2, we tested whether the relationship between voice preferences and dyadic sexual desire scores was related to differences in sociosexual orientation. Women (N = 80) with more positive attitudes towards uncommitted sex had stronger vocal masculinity preferences regardless of whether men's attractiveness was judged for short-term or long-term relationships. Independent of the effect of sociosexual attitudes, dyadic sexual desire positively predicted women's masculinity preferences when assessing men's attractiveness for short-term but not long-term relationships. These effects were independent of women's own relationship status and hormonal contraceptive use. Our results provide further evidence that women's mate preferences may independently reflect individual differences in both sexual desire and openness to short-term relationships, potentially with the ultimate function of maximizing the fitness benefits of women's mate choices.

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.

Do hormones influence women's sex? Sexual activity over the menstrual cycle

INTRODUCTION

In mammals, the effects of ovarian steroids influence sexual behavior. In humans, there are a few studies that take into account if ovulation occurs.

AIM

The study aims to investigate if a woman's sexuality changes during the week and over the menstrual cycle, and if so, in what way.

METHODS

This is a prospective cohort study; 1,957 heterosexual women were involved over the period January 2004-December 2011. Two subgroups were taken into consideration, women having a partner and singles.

MAIN OUTCOME MEASURE

Sexual interview and the Female Sexual Function Index and Female Sexual Distress Scale questionnaires were used to exclude women with sexual dysfunction. Women with ovulation confirmed by sonography were enrolled. Women were given diary cards on which to report their daily sexual activity. Serum concentrations of estradiol, progesterone, total testosterone, sex hormone binding globulin, and free androgen index were measured during the follicular, periovular, and luteal phase of the menstrual cycle.

RESULTS

One thousand one hundred eighty women (age range 18-40 years) were included in the analyses. Of them, 925 had a heterosexual relationship and 255 were single. Women with a partner had more sexual activity during the weekend, while the singles had a constant sexual activity over the week. The sexual activity of singles was higher during the ovulatory phase and lower during menses than that of the women with a partner. A linear correlation between sexual activity and androgenic hormonal profile during the menstrual cycle in women with and without a partner was observed.

CONCLUSIONS

Ovarian steroids modulate a woman's sexual activity. This aspect was more evident in singles than in women having a partner, in which a variety of nonhormonal factors can have a role.

The evolving sexual health paradigm: transforming definitions into sexual health practices

Sexual health is an evolving paradigm that integrates a positive approach to sexuality with existing public health policy and practice for reducing the burdens of sexually transmitted infections, including those due to HIV. The sexual health paradigm rests in commitment to sexual rights, sexual knowledge, sexual choice, and sexual pleasure, as well as key elements of sexuality addressed by sexual desire, sexual arousal, and sexual function, and sexual behaviors. The sexual health paradigm offers new approaches to supporting general health and well being while reducing the burdens of sexual diseases and their consequences.

Beyond masculinity: testosterone, gender/sex, and human social behavior in a comparative context

Largely based on pre-theory that ties high testosterone (T) to masculinity, and low T to femininity, high T is mainly studied in relation to aggression, mating, sexuality, and challenge, and low T with parenting. Evidence, however, fails to support this, and the social variability in T is better accounted for by a competition-nurturance trade-off as per the Steroid/Peptide Theory of Social Bonds (van Anders et al., 2011). Four key domains are discussed: adult-infant interactions, sexual desire, sexual behavior, and partnering. Empirical engagements with gender/sex are shown to lead to important insights over assumptions about masculinity-femininity. Humans are discussed within a comparative framework that attends to cross-species principles informed by human insights alongside human-specific particularities like social constructions, which are critical to evolutionary understandings of the social role of T. This paper thus integrates seemingly orthogonal perspectives to allow for transformative approaches to an empirically-supported social phenomenology of T.