Central inhibition of sexual response in the male: a theoretical perspective

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.

Affective neuroscience: applications for sexual medicine research and clinical practice

INTRODUCTION

Affective neuroscience is the study of the brain substrates of emotional, embodied experiences. Affective neuroscience theory (ANT) is based on experimental evidence that all mammals are hardwired with 7 primary subcortical emotional operating systems, or "core emotions," that have overlapping but distinct circuits buried in the deep, ancient parts of the brain. Imbalances in the 7 core emotions can affect multiple aspects of the individual's psychosocial well-being (eg, depression, anxiety, substance abuse). Here, we propose that core emotions can also influence sexual function and, specifically, that imbalances in core emotions are the bridge connecting psychiatric symptoms (eg, anhedonia) to sexual dysfunction (eg, anorgasmia).

OBJECTIVES

In this targeted review and commentary, we outline potential connections between ANT and sexual medicine research and clinical practice. We summarize ANT by defining the 3-level BrainMind and core emotions; examining how they relate to personality, behavior, and mental health; and determining the implications for sexual health research and clinical practice.

METHODS

A targeted literature review was conducted. Case studies were adapted from client files and clinician interviews and then anonymized.

RESULTS

We propose a novel organizational schema for implementing affective balance therapies for sexual dysfunction, which integrate psychoeducational, somatic, and cognitive therapeutic approaches under the ANT framework. We provide 3 patient case studies (anorgasmia, hypersexuality, spinal cord injury) outlining the implementation of this approach and patient outcomes.

CONCLUSION

ANT has practical translational applications in sexual health research and clinical practice. By integrating our understanding of the role of core emotions in human sexuality, clinicians can better tailor treatments to address sexual dysfunction.

Neurophysiology of male sexual arousal-Behavioral perspective

In the presented review, we analyzed the physiology of male sexual arousal and its relation to the motivational aspects of this behavior. We highlighted the distinction between these processes based on observable physiological and behavioral parameters. Thus, we proposed the experimentally applicable differentiation between sexual arousal (SA) and sexual motivation (SM). We propose to define sexual arousal as an overall autonomic nervous system response leading to penile erection, triggered selectively by specific sexual cues. These autonomic processes include both spinal and supraspinal neuronal networks, activated by sensory pathways including information from sexual partner and sexual context, as well as external and internal genital organs. To avoid misinterpretation of experimental data, we also propose to precise the term "sexual motivation" as all actions performed by the individual that increase the probability of sexual interactions or increase the probability of exposition to sexual context cues. Neuronal structures such as the amygdala, bed nucleus of stria terminalis, hypothalamus, nucleus raphe, periaqueductal gray, and nucleus paragigantocellularis play crucial roles in controlling the level of arousal and regulating peripheral responses via specific autonomic effectors. On the highest level of CNS, the activity of cortical structures involved in the regulation of the autonomic nervous system, such as the insula and anterior cingulate cortex, can visualize an elevated level of SA in both animal and human brains. From a preclinical perspective, we underlie the usefulness of the non-contact erection test (NCE) procedure in understanding factors influencing sexual arousal, including studies of sexual preference in animal models. Taken together results obtained by different methods, we wanted to focus attention on neurophysiological aspects that are distinctly related to sexual arousal and can be used as an objective parameter, leading to higher translational transparency between basic, preclinical, and clinical studies.

When the brain turns on with sexual desire: fMRI findings, issues, and future directions

INTRODUCTION

More than 2 decades of neuroimaging research has sought to uncover the neurologic basis of sexual desire. However, the lack of a clear conceptual distinction between sexual desire and sexual arousal or even a broadly accepted definition of sexual desire has led to confusion in the literature regarding brain areas uniquely associated with sexual desire.

OBJECTIVES

(1) To critically review the neuroimaging literature that seeks to identify brain areas and networks involved in sexual desire; (2) to identify and discuss those brain areas and potential networks that are most promising for providing insights to sexual desire; and (3) to offer recommendations for future studies.

METHODS

Existing meta-analyses were used as a starting point to identify relevant neuroimaging studies on sexual desire, arousal, and love. This base was then expanded via Google Scholar and forward citation tracking of already identified studies.

RESULTS

Brain areas that are commonly associated with sexual desire and arousal include the amygdala, hypothalamus, dorsal and ventral striatum, anterior cingulate, insula, and prefrontal and orbitofrontal cortex. However, because the same basic paradigm has been used to study sexual desire and arousal, unambiguous conclusions regarding areas uniquely involved in sexual desire cannot be drawn. Moreover, the lack of connectivity analyses and a failure to acknowledge negative BOLD (blood-oxygen level dependent) significantly limit conclusions on the neural basis of sexual desire.

CONCLUSION

Five recommendations are made. First, stimulus types (ie, erotic vs sexually explicit) should be selected by the meaningful theoretical conceptualization of the constructs of interest. Second, participants should be provided with definitions of sexual desire, mental sexual arousal, and perceived genital sexual arousal, so they can choose which terms best describe their experience. Third, event-related designs should be used with caution when investigating sexual desire. Fourth, time series analyses should be used to identify both positive and negative BOLD. Fifth, connectivity analyses should be performed to identify brain networks.

The Sexual Incentive Motivation Model and Its Clinical Applications

Sexual motivation (desire) requires the simultaneous presence of an active central motive state and a stimulus with sexual significance. Once activated, sexual motivation leads to visceral responses and approach behaviors directed toward the emitter of the sexual stimulus. In humans, such behaviors follow cognitive evaluation of the context, including predictions of the approached individual's response. After successful approach and establishment of physical contact, manifest sexual activities may be initiated. Sexual interaction is associated with and followed by a state of positive affect in most animals, whereas aversive consequences may be experienced by humans. The affective reactions may become associated with stimuli present during sexual interaction, and these stimuli may thereby alter their incentive properties. Here we show how the incentive motivation model can be used to explain the origins and possible treatments of sexual dysfunctions, notably disorders of desire. We propose that associations formed between negative outcomes of sexual interaction and the salient stimuli, for example, the partner, underlies hypoactive desire disorder. Highly positive outcomes of sexual interaction enhance the incentive value of the stimuli present, and eventually lead to hyperactive sexual desire. Treatments aim to alter the impact of sexual incentives, mainly by modifying cognitive processes.

The Dual Control Model of Sexual Response: A Scoping Review, 2009-2022

The Dual Control Model proposes that sexual arousal and related processes are dependent on the balance between sexual excitation and sexual inhibition, and that individuals vary in their propensity for these processes. This scoping review provides an overview and discussion of the questionnaires used to measure the propensities for sexual excitation and inhibition, their translation and validation in other languages, and their application in empirical research on topics ranging from sexual desire and arousal, sexual (dys)function, sexual risk taking, asexuality, hypersexuality, and sexual aggression. A total of 152 papers, published between 2009 and 2022 and identified using online databases, were included in this review. The findings, consistent with those reviewed by Bancroft et al. (2009), suggest that sexual excitation is particularly relevant to sexual desire and responsivity and predictive of asexuality and hypersexuality. Sexual inhibition plays a role in sexual dysfunction. sexual risk taking, and sexual aggression, although often in interaction with sexual excitation. Suggestions for the further development of the model and for future studies are discussed.

Sexual Pleasure Matters - and How to Define and Assess It Too. A Conceptual Framework of Sexual Pleasure and the Sexual Response

Objective

Sexual pleasure is central to current understandings of sexual function, health, and wellbeing. In this article, we suggest that we lack a sufficiently specific, yet encompassing, definition of sexual pleasure and that we therefore lack comprehensive assessments of sexual pleasure. We introduce a definition of sexual pleasure and position it centrally in an adapted framework of the sexual response. In the framework, we include a taxonomy of rewards which can be retrieved from sex and thereby aim to capture the multifaceted nature of sexual pleasure.

Methods/Results

Through narrative review, we arrive at the definition, framework, and taxonomy by integrating theories of sexual motivation and response with the literature on sexual pleasure and basic rewards. We position this literature within theories of affect and personality which allows us to differentiate between the experience of and the tendency to experience sexual pleasure (i.e., state versus trait sexual pleasure). We discuss how this conceptualization of sexual pleasure could be reflected in self-report assessments to quantitatively assess sexual pleasure.

Conclusions

The framework may aid to understand the role of the diverse facets of sexual pleasure in sexual function, health, and wellbeing and contribute to giving sexual pleasure the center position it deserves in sex research and therapy.

The endogenous cannabinoid system modulates male sexual behavior expression

The endocannabinoid system (ECS) plays a key neuromodulatory role in the brain. Main features of endocannabinoids (eCBs) are that they are produced on demand, in response to enhanced neuronal activity, act as retrograde messengers, and participate in the induction of brain plasticity processes. Sexual activity is a motivated behavior and therefore, the mesolimbic dopaminergic system (MSL) plays a central role in the control of its appetitive component (drive to engage in copulation). In turn, copulation activates mesolimbic dopamine neurons and repeated copulation produces the continuous activation of the MSL system. Sustained sexual activity leads to the achievement of sexual satiety, which main outcome is the transient transformation of sexually active male rats into sexually inhibited animals. Thus, 24 h after copulation to satiety, the sexually satiated males exhibit a decreased sexual motivation and do not respond to the presence of a sexually receptive female with sexual activity. Interestingly, blockade of cannabinoid receptor 1 (CB1R) during the copulation to satiety process, interferes with both the appearance of the long-lasting sexual inhibition and the decrease in sexual motivation in the sexually satiated males. This effect is reproduced when blocking CB1R at the ventral tegmental area evidencing the involvement of MSL eCBs in the induction of this sexual inhibitory state. Here we review the available evidence regarding the effects of cannabinoids, including exogenously administered eCBs, on male rodent sexual behavior of both sexually competent animals and rat sub populations spontaneously showing copulatory deficits, considered useful to model some human male sexual dysfunctions. We also include the effects of cannabis preparations on human male sexual activity. Finally, we review the role played by the ECS in the control of male sexual behavior expression with the aid of the sexual satiety phenomenon. Sexual satiety appears as a suitable model for the study of the relationship between eCB signaling, MSL synaptic plasticity and the modulation of male sexual motivation under physiological conditions that might be useful for the understanding of MSL functioning, eCB-mediated plasticity and their relationship with motivational processes.

Erectile Problems in Polish Straight, Bisexual, and Gay Men: Does Sexual Identity Really Matter?

Erectile dysfunction (ED) is one of the most common sexual health diagnoses in men. Previous studies demonstrated that ED can be even more prevalent among sexual minority men. This study investigated whether sexual identity is related to erectile function (EF) and explored variables possibly contributing to the differences between Polish straight and sexual minority men. The study sample included 1,246 gay, 838 straight, and 535 bisexual men who participated in an online survey. First, the psychometric qualities of the IIEF-2-EF scale used in the study were examined through confirmatory and exploratory factor analysis; a correction to account for potential bias in the questionnaire was also applied. Next, a series of univariate and multivariable models accounting for predictors possibly contributing to the observed differences between the groups of men were conducted. It was demonstrated that gay and bisexual men were more likely to show poorer EF. However, as demonstrated in the subgroup of men who were in relationships, sexual identity lost its significance when the unique characteristics of minority men's sexuality (i.e., less focus on insertive penetrative sex in gay men and more frequent relational non-exclusivity in bisexual men) were controlled for. Erectile problems in minority men may benefit from clinical consideration in the unique context of their sexuality.

Hypo- or hyperfunction? Differential relationships between compulsive sexual behavior disorder facets and sexual health

BACKGROUND

Previous studies linking compulsive sexual behavior disorder (CSBD) and sexual health have shown mixed results, which could be due to the fact that different CSBD facets may have differential relationships with sexual functioning.

AIM

As CSBD is a multidimensional disorder, we wanted to investigate whether distinct CSBD domains are differentially related to sexual health.

METHODS

Two online studies were conducted-the first on a convenience sample (812 Polish participants; mean [SD] age, 22.07 [5.91] years) and a replication study on a representative sample of Polish adults (n = 1526; 43.02 [14.37]). Hierarchical regression was employed with sexual functioning as a predicted variable and CSBD symptoms as predictors.

OUTCOMES

The Compulsive Sexual Behavior Disorder Scale was used to assess CSBD symptoms, and the Arizona Sexual Experience Scale was used to measure sexual dysfunction.

RESULTS

In study 1, CSBD salience (β = -.20, P < .001) predicted hyperfunction (ie, stronger sex drive, easier sexual arousal, easier vaginal lubrication/penile erection, easier ability to reach an orgasm, and more satisfying orgasms). Yet, CSBD negative consequences (β = .15, P = .001) and dissatisfaction (β = .22, P < .001) predicted hypofunction (ie, weaker sex drive, more difficulties in sexual arousal, greater difficulties in vaginal lubrication/penile erection, less ability to reach an orgasm, and less satisfying orgasms). Similar results were found in study 2: salience (β = -.26, P < .001) and relapse (β = -.11, P = .004) predicted hyperfunction, while negative consequences (β = .12, P < .001) and dissatisfaction (β = .12, P < .001) predicted hypofunction.

CLINICAL IMPLICATIONS

Our results stress the importance of assessing the severity of each group of symptoms in patients with CSBD to better understand possible difficulties in their sexual functioning.

STRENGTHS AND LIMITATIONS

Our studies are the first to evaluate the effects of each CSBD domain on sexual health. We also replicated results obtained from a convenience sample on a representative sample. The cross-sectional design of the current studies does not allow causal relations to be tested, so future longitudinal research should be carried out. We also gathered data from a general population-thus, it is important to replicate these results on patients diagnosed with CSBD.

CONCLUSION

Our research points out the differential impact of CSBD domains on sexual health: salience and relapse are related to sexual hyperfunction, while negative consequences and dissatisfaction to hypofunction.

Effects of Kisspeptin on Sexual Brain Processing and Penile Tumescence in Men With Hypoactive Sexual Desire Disorder: A Randomized Clinical Trial

IMPORTANCE

The human physiological sexual response is crucial for reward, satisfaction, and reproduction. Disruption of the associated neurophysiological pathways predisposes to low sexual desire; the most prevalent psychological form is hypoactive sexual desire disorder (HSDD), which affects 8% of men but currently has no effective pharmacological treatment options. The reproductive neuropeptide kisspeptin offers a putative therapeutic target, owing to emerging understanding of its role in reproductive behavior.

OBJECTIVE

To determine the physiological, behavioral, neural, and hormonal effects of kisspeptin administration in men with HSDD.

DESIGN, SETTING, AND PARTICIPANTS

This double-blind, 2-way crossover, placebo-controlled randomized clinical trial was performed at a single academic research center in the UK. Eligible participants were right-handed heterosexual men with HSDD. Physiological, behavioral, functional magnetic resonance imaging (fMRI), and hormonal analyses were used to investigate the clinical and mechanistic effects of kisspeptin administration in response to visual sexual stimuli (short and long video tasks). The trial was conducted between January 11 and September 15, 2021, and data analysis was performed between October and November 2021.

INTERVENTIONS

Participants attended 2 study visits at least 7 days apart, in balanced random order, for intravenous infusion of kisspeptin-54 (1 nmol/kg/h) for 75 minutes or for administration of a rate-matched placebo.

MAIN OUTCOMES AND MEASURES

Changes in (1) brain activity on whole-brain analysis, as determined by fMRI blood oxygen level-dependent activity in response to visual sexual stimuli during kisspeptin administration compared with placebo, (2) physiological sexual arousal (penile tumescence), and (3) behavioral measures of sexual desire and arousal.

RESULTS

Of the 37 men randomized, 32 completed the trial. Participants had a mean (SD) age of 37.9 (8.6) years and a mean (SD) body mass index of 24.9 (5.4). On viewing sexual videos, kisspeptin significantly modulated brain activity in key structures of the sexual-processing network on whole-brain analysis compared with placebo (mean absolute change [Cohen d] = 0.81 [95% CI, 0.41-1.21]; P =  .003). Furthermore, improvements in several secondary analyses were observed, including significant increases in penile tumescence in response to sexual stimuli (by up to 56% more than placebo; mean difference = 0.28 units [95% CI, 0.04-0.52 units]; P = .02) and behavioral measures of sexual desire-most notably, increased happiness about sex (mean difference = 0.63 points [95% CI, 0.10-1.15 points]; P = .02).

CONCLUSIONS AND RELEVANCE

Collectively, this randomized clinical trial provides the first evidence to date showing that kisspeptin administration substantially modulates sexual brain processing in men with HSDD, with associated increases in penile tumescence and behavioral measures of sexual desire and arousal. These data suggest that kisspeptin has potential as the first pharmacological treatment for men with low sexual desire.

TRIAL REGISTRATION

isrctn.org Identifier: ISRCTN17271094.

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.

The Relation of Mood and Sexual Desire: An Experience Sampling Perspective on the Dual Control Model

We investigated the effect of fluctuations in negative and positive affect on momentary sexual motivation in a sample of women and men in a steady relationship (n = 133). Sexual motivation was regarded as the aggregate of sexual desire, subjective sexual arousal and openness to sexual contact. Experience sampling methodology was used to collect up to 70 measurements per participant over a period of seven consecutive days of sexual motivation, and negative and positive affect. Using multilevel analysis, we investigated cross-level interactions between affect and trait measures as specified in the dual control model (DCM). This model postulates sexually excitatory and inhibitory mechanisms as relatively independent systems that together can explain individual differences in sexual motivation and behavior. Results implicated that any intensification of feelings, positive or negative, was associated with a momentary increase in sexual motivation for participants more prone to sexual excitation. In the lagged analysis, higher preceding negative affect, measured 1-2 h earlier, forecasted an increase in current sexual motivation for participants more prone to sexual excitation. The lagged analysis included the autoregressive effect or inertia of sexual motivation. Inertia reflects the extent to which sexual motivation lingers and persists at similar levels. Our findings showed that sexual motivation levels persisted less in individuals with higher sexual inhibition proneness due to threat of performance failure. This study demonstrated how experience sampling methodology can be used to extend research on associations between mood and sexual motivation and implicates that DCM factors moderate these associations.

Sexual Inhibition and Sexual Excitation Profiles in Men With and Without Erectile Disorder

OBJECTIVES

To investigate sexual excitation (SE) and sexual inhibition (SI) profiles in men with erectile dysfunction (ED) and to examine how these dimensions discriminate between men with and without ED.

METHODS

A clinical sample of 37 men with situational (psychogenic) ED and a control group of 40 sexually healthy men (matching the clinical group in age, marital status, and educational level) were constituted. Participants completed self-reported questionnaires assessing sexual function and the propensity for SI and SE.

RESULTS

Higher propensities for SI due to the threat of performance failure (SIS1, p < .001) and SI due to the threat of performance consequences (SIS2, p < .01) were found in the group of men with ED. No significant differences were found between the two groups in the propensity for SE.

CONCLUSIONS

Findings offer additional support for the Dual Control Model of Sexual Response and underscore the relevance of inhibitory mechanisms as potential psychobiological risk factors for the development and maintenance of ED. Findings also highlight the importance of a multidisciplinary approach in the clinical management of ED.

A Psychosocial Approach to Erectile Dysfunction: Position Statements from the European Society of Sexual Medicine (ESSM)

INTRODUCTION

Although erectile dysfunction (ED) involves an interaction between physiological and psychological pathways, the psychosocial aspects of ED have received considerably less attention so far.

AIM

To review the available evidence on the psychosocial aspects of ED in order to develop a position statement and clinical practice recommendations on behalf of the European Society of Sexual Medicine (ESSM).

METHOD

A comprehensive, narrative review of the literature was performed.

MAIN OUTCOME MEASURES

Specific statements and recommendations according to the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence criteria were provided.

RESULTS

A multidisciplinary treatment, in which medical treatment is combined with a psychological approach, is preferred over unimodal treatment. There is increasing evidence that psychological treatments of ED can improve medical treatments, the patient's adherence to treatment, and the quality of the sexual relationship. The main components of psychological treatment of ED involve cognitive and behavioral techniques aimed at reducing anxiety, challenging dysfunctional beliefs, increasing sexual stimulation, disrupting sexual avoidance, and increasing intimacy and communication skills in a relational context. When applicable and possible, it is strongly recommended to include the partner in the assessment and treatment of ED and to actively work on interpartner agreement and shared decision-making regarding possible treatment options. To ensure a better integration of the biopsychosocial model into clinical practice, developing concrete treatment protocols and training programs are desirable.

CONCLUSION

Because the psychosocial approach to ED has been underexposed so far, this position statement provides valuable information for clinicians treating ED. Psychological interventions on ED are based on existing theoretical models that are grounded in empirical evidence. However, the quality of available studies is low, which calls for further research. The sexual medicine field would benefit from pursuing more diversity, inclusivity, and integration when setting up treatments and evaluating their effect. Dewitte M, Bettocchi C, Carvalho J, et al. A Psychosocial Approach to Erectile Dysfunction: Position Statements from the European Society of Sexual Medicine (ESSM). Sex Med 2021;9:100434.

Validation of the Sexual Inhibition/Sexual Excitation Scales (SIS/SES) in Italy: Assessing Gender and Age Differences of Sexual Functioning

The Sexual Inhibition Scales and Sexual Excitation Scales (Janssen et al., 2002a), based on the dual control model by Bancroft and Janssen (2000), are part of a 45-item self-report questionnaire evaluating individual tendencies to sexual inhibition or excitation according to three factors: two inhibition factors, SIS1, threat of performance failure, and SIS2, threat of performance consequences, and one excitation factor, SES. In this paper, we aimed to validate and explore psychometric properties of the SIS/SES in a sample of 2260 Italian men and women aged 18 to 75 years. Confirmatory factor analyses showed that the three-factor structure proposed in the original version of the scales fit with our sample. Moreover, our data confirmed the results of the original validation sample: Women scored higher on the SIS and lower on the SES than men did, but no significant differences appeared in the factor scores by age group, except for a gender × age interaction, where younger women had higher SIS2 scores. The SIS/SES appeared to be an effective, appropriate cross-cultural measurement of human sexuality in Italian samples, also shedding light on sexual arousal differences in women and men in our country. We also discuss clinical and therapeutic aspects.

Sexual Attentional Bias in Young Adult Heterosexual Men: Attention Allocation Following Self-Regulation

Being sexually aroused can lead to a stronger propensity to engage in sexual risk-taking and sexually coercive behaviors possibly by narrowing attentional focus toward immediate gratification rather than long-term consequences. The goal of this paper was to investigate the attentional processes implicated in sexual self-regulation failure and its moderating factors, namely having a stronger sensitivity to sexual cues (dual control model) or being less able to implement behavioral intentions (action control theory) following a first effortful task. A total of 82 young adult heterosexual men completed a Dot Probe task to assess their attentional bias toward sexual stimuli. Effortful control was manipulated using a Stroop task. Regardless of conditions, higher sexual excitability was predictive of a stronger attentional bias toward sexual cues, while higher inhibition due to threat of performance failure was predictive of a lower bias for such cues. In the experimental condition, action-oriented individuals were able to negate this attentional bias by staying more focused on the task, while state-oriented participants showed higher orientation toward the sexual cues and thus a higher bias. These results suggest that both higher-order processes, like intention implementation, and lower-order processes, like sexual inhibition and excitation systems, are the key to regulation failure.

Sexual Excitation and Sexual Inhibition in the Context of Sexual Risk-Taking

The current study examined the roles of sexual excitation and sexual inhibition in the context of sexual risk-taking among heterosexual women and men to better understand the link between sexual arousal and sexual risk-taking. We set out to determine which factors in the Sexual Excitation and Sexual Inhibition Inventory for women and men (SESII-W/M) were most predictive of sexual response and sexual risk-taking behavior. Participants (N = 266, women = 166) completed the SESII-W/M instrument and responded to items assessing their sexual risk-taking intentions and their risk-taking indicators. A sub-sample (n = 133, women = 83) also completed a sexual arousal manipulation. Sexual excitation was linked with higher levels of self-reported sexual arousal (among women and men) and greater risk-taking intentions (among women only). However, controlling for gender, sexual inhibition was a better predictor of sexual risk-taking intentions, compared to sexual excitation. The Dual Control Model offers unique insights into conceptualizations of sexual response to erotic stimuli and behavioral risk-taking. These findings can inform more effective interventions to promote risk reduction through sex positive approaches that capitalize on the pleasure enhancing capabilities of safer sex strategies.

Sexual inhibition and sexual excitation in a sample of Polish women

The contemporary concept of sexual counseling for women with sexual problems, distress, and female sexual dysfunction (FSD) includes tailored medical and/or psychological intervention. The dual control model and the Sexual Excitation/Sexual Inhibition Inventory for Women (SESII-W) are helpful for identifying risk factors and tailoring therapy for FSD. The current study aimed to (1) validate the Polish translation of the SESII-W in a sample of Polish women, and (2) verify the usefulness of the SESII-W in clinical practice. Five hundred nine white women age 18 to 55 years old (M ± SD age = 39.7 ± 11.3 years) were included in this cross-sectional study. Linguistic validation of the Polish translation of the SESII-W was first performed. A battery of tests was then used to evaluate reliability, convergent and discriminant validity, measurement invariances, and correlations between the SESII-W and other measures. Given that the original version of the SESII-W had unsatisfactory model fit, exploratory and confirmatory factor analyses were subsequently performed. Results showed a new final model that included 26 items with seven lower- and two higher-order factors and explained 58.9% of the variance in the data, with CFI = 0.93, RMSEA = 0.05 and χ² = 693.39, p < 0.001. Cronbach’s α was 0.77 for Sexual Excitation (SE) and 0.88 for Sexual Inhibition (SI) scales. A moderate negative association between SI and the presence of FSD according to Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) criteria was noted. SE was positively associated with engaging in risky sexual behaviors, Extraversion and Openness to Experiences traits, and was negatively correlated with relationship quality. Finally, age was negatively correlated with all domains of the SESII-W except Arousal Contingency. SE and SI were both lower in older women as compared to younger once. These results demonstrate that the Polish version of SESII-W shows good psychometric properties. A higher propensity for SI was associated with the presence of sexual problems, distress, and FSD, whereas a higher propensity for SE was associated with greater engagement in risky sexual behaviors and personality type. However, future studies on larger and more diverse populations are required to confirm the replicability of the factor structure of the scale.

Sex and "the City": Financial stress and online pornography consumption

We examine the effects of financial stress on online pornography consumption. We use novel data on daily accesses to one of the most popular porn website (xHamster) for 43 different cities belonging to 10 countries for the year 2016. In financial cities, in which people are more likely to be affected by financial stress, we observe that on average online porn viewing decreases as financial stress increases. We present some evidence suggesting the causing channel to be altered mood.

Behavioral intention to have risky sex in young men and women: The role of sexual excitation and assertiveness

Due to the complex role of sexual excitation in risky sexual behaviors, this study aimed to disentangle this phenomenon by jointly analyzing the combined role of three forms of sexual excitation: genital and subjective, and individual´s propensity. Therefore, we examined the relationship between the components of the Dual Control Model, that is, propensity for sexual excitation/inhibition, in addition to genital and subjective arousal, and sexual assertiveness and intention to engage in casual sexual encounters in which sexual risk was implicitly or explicitly present. The sample consisted of 99 heterosexual young adults (55 men and 45 women) with ages ranging from 18 to 32 years. Participants performed an experiment in the laboratory, which involved them watching a sexual clip and then being presented with two erotic excerpts (stories) depicting casual sexual encounters in which there was an existence of implicit and explicit sexual risks. In men, the propensity for sexual inhibition was the most determining variable in preventing them from sexual risk-taking. In women, intention to engage in risky sexual behaviors was better determined by their propensity for sexual excitation and sexual assertiveness in negotiating the use of contraceptive methods. This research highlights the relevance of excitation and inhibition as a trait, in addition to subjective arousal and sexual assertiveness in intention to engage in risky sexual behaviors.

Preliminary Evidence on How the Dual Control Model Predicts Female Sexual Response to a Bogus Negative Feedback

The Dual Control Model of sexual response has been mostly tested with men. As such, there is a lack of evidence on how such model applies to women's experience of sexual arousal, particularly when they face a threatening situation such as the threat of sexual performance failure. The aim of the current study was to test whether the Dual Control Model dimensions predict women's sexual responses to a bogus negative feedback about their sexual performance. In addition, 22 women were exposed to a sexually explicit film clip, while their genital arousal was being measured. During this presentation, a bogus negative feedback, aimed at increasing women's anxiety about their sexual performance, was provided. Vaginal photopletismography and self-report questions were used as means to evaluate women's genital and subjective sexual arousal, respectively. The Sexual Excitation/Sexual Inhibition Inventory for Women was further used to capture women's sexual dynamics. Regression analysis on the high-order factors revealed that sexual excitation proneness was the only predictor of the subjective sexual responses, while none of the factors has predicted genital arousal. "Arousability" and "Concerns about sexual function" dimensions predicted subjective sexual arousal. Sexual arousability may prevent women of lowering their subjective sexual responses in a sexually demanding situation, while "Concerns about sexual function" may have the opposite role, thus being a target of clinical interest. This work provides new data on the Dual Control Model of sexual response, and particularly on its role in women's sexual functioning.

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

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

Endocannabinoids Interact With the Dopaminergic System to Increase Sexual Motivation: Lessons From the Sexual Satiety Phenomenon

In male rats, copulation to satiety induces a long-lasting sexual inhibitory state, considered to rely on a decreased sexual motivation. Dopaminergic transmission at the mesolimbic system plays a central role in the regulation of male sexual motivation. Endocannabinoids (eCBs) modulate the activity of the mesolimbic system and both dopamine (DA) and cannabinoid receptor activation reverses the sexual inhibition that characterizes sexually satiated rats. The eCB anandamide reverses sexual satiety when systemically administered or infused into the ventral tegmental area (VTA), the region where the activity of mesolimbic dopaminergic neurons is regulated. Thus, it could be thought that sexual motivation is diminished during the long-lasting sexual inhibition of sexually satiated rats and that eCBs reverse that inhibition through the modulation of the dopaminergic system. To test this hypothesis, we assessed the motivational state of sexually satiated male rats and determined if 2-arachidonoylglycerol (2-AG), the most abundant eCB and a full cannabinoid receptor agonist, also reversed the sexual inhibitory state. To establish the possible interaction between 2-AG and anandamide with the dopaminergic system for the reversal of sexual satiety, we analyzed the effects of the co-administration of each eCB and DA receptor agonists or antagonists. Results showed that 24-h after copulation to satiety, when the sexual inhibition is well established, the males’ sexual motivation is diminished as measured in the sexual incentive motivation test. 2-AG, similarly to anandamide, reverses sexual satiety through the activation of CB1 receptors and both eCBs interact with the dopaminergic system to reverse the sexual inhibitory state. 2-AG effects are mediated by the modulation of the D2-like DA receptor family, whereas anandamide’s effects are clearly mediated by the modulation of the D1-like DA receptor family and the activation of D2-like DA receptors. Present results evidence that a reduced sexual motivation underlies the sexual inhibitory state of sexually satiated rats and support the notion that eCBs reverse sexual satiety by modulating dopaminergic transmission, presumably at the mesolimbic system. Anandamide and 2-AG have a different interaction with D1-like and D2-like DA receptor families. Altogether present data endorse the association of the eCB system with the regulation of the motivational tone at the mesolimbic system.

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

Aims

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

Method

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

Results

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

Conclusions

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

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

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

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

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

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

Background

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

Methodology

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

Principal findings

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

Significance

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

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

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

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

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

The Fragile Spell of Desire: A Functional Perspective on Changes in Sexual Desire Across Relationship Development

The sexual behavioral system evolved to motivate reproductive acts by arousing sexual desire. Building on the idea that this system has also been "exploited" by evolutionary processes to promote enduring bonds between romantic partners, the present article introduces an integrative model that delineates the functional significance of sexual desire in relationship formation and maintenance. This model explains why individuals' sexual reaction to their partner is context-dependent, clarifying how changes in the nature of interdependence over the course of relationships alter the ways in which specific predictors of sexual desire tend to promote (or inhibit) desire and thereby affect relationship depth and stability. The model postulates that although desire influences the development of attachment bonds, the contribution that it makes varies over the course of relationships. The model also provides new insight regarding fundamental but unresolved issues in human sexuality, such as the vulnerability of sexual desire and the desire-intimacy paradox.

An Online Assessment of Personality, Psychological, and Sexuality Trait Variables Associated with Self-Reported Hypersexual Behavior

"Hypersexual" behavior represents a perceived inability to control one's sexual behavior. To investigate hypersexual behavior, an international sample of 510 self-identified heterosexual, bisexual, and homosexual men and women completed an anonymous online self-report questionnaire battery. In addition to age and sex (male), hypersexual behavior was related to higher scores on measures of sexual excitation, sexual inhibition due to the threat of performance failure, trait impulsivity, and both depressed mood and anxiety. In contrast, hypersexual behavior was related to lower scores on sexual inhibition due to the threat of performance consequences. Higher neuroticism and extraversion, as well as lower agreeableness and conscientiousness, also predicted hypersexual behavior. Interestingly, interactions among the variables assessed did not significantly predict hypersexual behavior, suggesting the possible existence of multiple and predominantly independent taxa for various persons reporting hypersexual behavior. Core personality features may also be present in persons with hypersexual behavior. Clinical implications and future research directions are discussed.

Sexual Dysfunction Problems in Female College Students: Sexual Victimization, Substance Use, and Personality Factors

Little empirical information is available on sexual dysfunction (SD) among college women even though college years represent a critical period in the development of sexuality. The current study aimed to identify factors associated with the presence, number, and type of SD problems among 547 female college students in the United States. Racial minority status, problematic drinking behaviors, and past sexual victimization were positively related to the presence of SD problems, whereas hormonal contraceptive use and past sexual victimization were associated with a greater number of SD problems. These findings highlight the importance of assessment, treatment, and prevention of sexual health issues on college campuses.

Sexual Desire Inventory: Two or Three Dimensions?

The Sexual Desire Inventory (SDI), developed by Spector, Carey, and Steinberg in 1996, has been widely used to assess sexual desire in men and women throughout the world. This questionnaire categorizes sexual desire in two dimensions: dyadic sexual desire and solitary sexual desire. Our study addressed the factorial structure of the SDI, an aspect that until now has been largely neglected. We recruited two samples of Spanish men and women involved in stable heterosexual relationships. The first sample consisted of 3,417 subjects (1,600 males and 1,817 females), ages 18 to 84; the second sample consisted of 677 subjects (285 males and 392 females), ages 18 to 50. The results of an exploratory factor analysis (EFA) showed that instead of two dimensions the SDI should have three: (1) partner-focused dyadic sexual desire, (2) general dyadic sexual desire for an attractive person, and (3) solitary sexual desire. A confirmatory factor analysis (CFA) supported the robustness of this new three-factor structure. No gender differences were revealed, except for dyadic sexual desire for an attractive person, for which men reported higher scores. Good validity and reliability values were obtained. Moreover, standard scores for men and women by different age groups were developed.

Spanish version of the Sexual Excitation/Sexual Inhibition Inventory for Women: Factorial structure, reliability and validity evidences

Background/Objective: The Dual Control Model suggests that sexual excitation and associated behaviors are the result of the balance between relatively independent excitatory and inhibitory mechanisms. Based on this theoretical model, the Sexual Excitation/Sexual Inhibition Inventory for Women (SESII-W) was developed to evaluate excitation and inhibition dimensions in women. The aim was to adapt and validate the SESII-W in the Spanish population. Method: A sample of 1,380 heterosexual women (aged 18 to 52) completed the Spanish SESII-W, together with other related instruments. After the translation and adaptation of the SESII-W, a Confirmatory Factor Analysis (CFA) was performed. Results: CFA resulted in a version consisting of 33 items divided into eight sub-factors, which were grouped into two higher-order factors (Sexual Excitation and Sexual Inhibition). The sub-factors demonstrated adequate internal consistency values except for Sexual Power Dynamics and Concerns about Sexual Function. Test-retest reliabilities were good. Their scores correlated with erotophilia, sexual sensation seeking, age at first intercourse, and number of sexual partners in the expected direction. Conclusions: The Spanish version of SESII-W has adequate psychometric guarantees for use in clinical practice and research, although it would be necessary to further revise factors that showed a lower level of reliability.

A new role for GABAergic transmission in the control of male rat sexual behavior expression

GABAergic transmission in the ventral tegmental area (VTA) exerts a tonic inhibitory influence on mesolimbic dopaminergic neurons' activity. Blockade of VTA GABA_A receptors increases dopamine release in the nucleus accumbens (NAcc). Increases in NAcc dopamine levels typically accompany sexual behavior display. Copulation to satiety is characterized by the instatement of a long lasting (72h) sexual behavior inhibition and the mesolimbic system appears to be involved in this phenomenon. GABAergic transmission in the VTA might play a role in the maintenance of this long lasting sexual inhibitory state. To test this hypothesis, in the present work we investigated the effect of GABA_A receptor blockade in sexually exhausted males 24h after copulation to satiety, once the sexual inhibitory state is established, and compared it with its effect in sexually experienced rats. Results showed that low doses of systemically administered bicuculline induced sexual behavior expression in sexually exhausted rats, but lacked an effect on copulation of sexually experienced animals. Intra-VTA bilateral infusion of bicuculline did not modify sexual behavior of sexually experienced rats, but induced sexual behavior expression in all the sexually exhausted males. Hence, GABA plays a role in the control of sexual behavior expression at the VTA. The role played by GABAergic transmission in male sexual behavior expression of animals with distinct sexual behavior conditions is discussed.

Role of Body Esteem in the Sexual Excitation and Inhibition Responses of Women With and Without a History of Childhood Sexual Abuse

INTRODUCTION

Women's sexuality is influenced by their perceptions of their bodies. Negative body appraisals have been implicated in the development and maintenance of sexual concerns in women with a history of childhood sexual abuse (CSA). The sexuality of these women is often expressed in extremes of approach and avoidant sexual tendencies, which have been related to the sexual inhibition and sexual excitation pathways of the dual control model.

AIM

To test the influence of body esteem on the sexual excitation and inhibition responses of women with and without a history of CSA.

METHODS

One hundred thirty-nine women with CSA and 83 non-abused women reported on their abuse history, depressive symptomology, sexual response, and affective appraisals of their body.

MAIN OUTCOME MEASURES

Validated self-report measurements of sexual excitation and inhibition responses (Sexual Excitation/Sexual Inhibition Inventory for Women) and body esteem (Body Esteem Scale) were administered.

RESULTS

Body esteem was significantly associated with sexual inhibition responses of women regardless of CSA history status but was significantly related only to the sexual excitation responses of women with a CSA history. Perceived sexual attractiveness was a unique predictor of sexual excitation in women with a history of CSA.

CONCLUSION

Women with a history of CSA have lower body esteem than non-abused women, particularly in self-perceived sexual attractiveness, and these perceptions appear to influence their sexual responses by acting on the sexual excitation and inhibition response pathways.

Examining the Psychometric Properties of the Sexual Excitation/Sexual Inhibition Inventory for Women (SESII-W) in a Sample of Lesbian and Bisexual Women

The Sexual Excitation/Sexual Inhibition Inventory for Women (SESII-W) assesses propensities for sexual excitation (SE) and inhibition (SI). Previous research utilizing the SESII-W included samples comprised exclusively or almost entirely of heterosexual women. The purpose of this study was to examine the psychometric properties of the SESII-W and assess its relation to aspects of sexual function within a sample of lesbian and bisexual women. The sample included 974 self-identified bisexual (n = 733) or lesbian/homosexual (n = 241) women who completed an online survey including items assessing women's sexual behaviors, feelings, and functioning, sociodemographics, and the SESII-W. The sample was split; exploratory factor analyses were conducted on the first half, yielding eight lower-order factors with two higher-order factors. Confirmatory factor analysis was conducted on the second half and suggested reasonable model fit. SI was positively correlated with sexual problems and negatively correlated with sexual pleasure; the correlations were significant but small. Hierarchical regression analyses were conducted to examine the relationships between SESII-W scores and sexual problems/sexual pleasure, controlling for age, relationship duration, and relationship status. Four lower-order factors predicted reports of sexual problems. Findings indicated the SESII-W has similar psychometric properties among sexual minority women as it does among heterosexual women.

Gender Differences in the Development of Sexual Excitation and Inhibition Through the Life Course: Preliminary Findings from a Representative Study in Flanders

The dual control model proposes that there are individual differences in the propensity for sexual excitation and sexual inhibition. Research to date has considered the effect of age on these traits as a simple linear effect, and studies examining gender differences in age effects are lacking. There are, however, indications that the associations of age with excitation and inhibition are nonlinear and that there might be gender differences in these associations. The aim of this study was to examine how these traits develop through an individual's life and whether there are gender differences in this development. In this study we applied polynomial regression analyses to examine the interaction effects of age and gender on sexual excitation and inhibition. We used data from a representative cross-sectional survey on sexual health in Flanders (N = 1,825; mean age = 43.77; SD = 17.98). Most of the associations of excitation and inhibition with age were nonlinear, and there were substantial gender differences in these associations. This indicates that the interplay between age, gender, and excitation and inhibition should be taken into account in research on (dys)functional sexuality.

Single dose sublingual testosterone and oral sildenafil vs. a dual route/dual release fixed dose combination tablet: a pharmacokinetic comparison

AIM

The aim was to compare the pharmacokinetic profiles of two formulations of a combination drug product containing 0.5 mg testosterone and 50 mg sildenafil for female sexual interest/arousal disorder. The prototype (formulation 1) consists of a testosterone solution for sublingual administration and a sildenafil tablet that is administered 2.5 h later. The dual route/dual release fixed dose combination tablet (formulation 2) employs a sublingual and an oral route for systemic uptake. This tablet has an inner core of sildenafil with a polymeric time delay coating and an outer polymeric coating containing testosterone. It was designed to increase dosing practicality and decrease potential temporal non-adherence through circumventing the relatively complex temporal dosing scheme.

METHODS

Twelve healthy premenopausal subjects received both formulations randomly on separate days. Blood was sampled frequently to determine the pharmacokinetics of free testosterone, total testosterone, dihydrotestosterone, sildenafil and N-desmethyl-sildenafil.

RESULTS

Formulation 2 had a higher maximum concentration (Cmax ) for testosterone, 8.06 ng ml(-1) (95% confidence interval [CI] 6.84, 9.28) and higher area under the plasma concentration-time curve (AUC), 7.69 ng ml(-1)  h (95% CI 6.22, 9.16) than formulation 1, 5.66 ng ml(-1) (95% CI 4.63, 6.69) and 5.12 ng ml(-1)  h (95% CI 4.51, 5.73), respectively. Formulation 2 had a lower Cmax for sildenafil, 173 ng ml(-1) (95% CI 126, 220) and a lower AUC, 476 ng ml(-1)  h (95% CI 401, 551) than formulation 1, 268 ng ml(-1) (95% CI 188, 348) and 577 ng ml(-1)  h (95% CI 462, 692), respectively. Formulation 2 released sildenafil after 2.75 h (95% CI 2.40, 3.10).

CONCLUSIONS

The dual route/dual release fixed dose combination tablet fulfilled its design criteria and is considered suitable for further clinical testing.

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT

Female sexual interest/arousal disorder (FSIAD) is a significant problem impacting psychological well-being, but the pharmacotherapeutic options for this problem are lacking. The combined, on-demand, sublingual administration of low dose sublingual testosterone and oral administration of sildenafil is a novel pharmacotherapeutic option under development for FSIAD. In proof-of-concept trials, these compounds were successfully administered via different dosage forms (sublingual and oral) at different time points (separated by 2.5 h) because of their markedly different pharmacokinetic-pharmacodynamic profiles. For future larger scale studies and the clinical practice, this raises obvious adherence issues.

WHAT THIS STUDY ADDS

A newly developed dual route/dual release fixed dose combination tablet containing testosterone and sildenafil mimics the pharmacokinetic profile of these components when they are administered as different dosage forms, 2.5 h apart. This combination tablet is a suitable final pharmaceutical drug product that will be used in future studies.

Psychometric Properties of the Sexual Excitation/Sexual Inhibition Inventory for Women in a German Sample

The Sexual Excitation Sexual/Inhibition Inventory for Women (SESII-W) is a self-report questionnaire for assessing propensities of sexual excitation (SE) and sexual inhibition (SI) in women. According to the dual control model of sexual response, these two factors 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 problems or risky sexual behaviors. Psychometric evaluation of the original scale yielded two higher order and eight lower order factors as well as satisfactory to good construct validity and reliability. The present study was designed to assess the psychometric properties of a German version of the SESII-W utilizing a large convenience sample of 2206 women. Confirmatory factor analysis showed a satisfactory overall model fit, with support for the five lower order factors of SE (Arousability, Sexual Power Dynamics, Smell, Partner Characteristics, Setting) and the three lower order factors of SI (Relationship Importance, Arousal Contingency, and Concerns about Sexual Function). Additionally, the scale demonstrated good convergent and discriminant validity, internal consistency, and test-retest-reliability. The German SESII-W is a sufficiently reliable and valid measure for assessing SE and SI in women. Hence, its use can be recommended for future research in Germany that investigates women's sexual behaviors and experiences.

Unprotected Intercourse and One-Night Stands: Impact of Sexual Excitation, Sexual Inhibition, and Atypical Sexual Arousal Patterns on Risky Sexual Behaviors in Women

INTRODUCTION

Associations among sexual excitation, sexual inhibition, atypical sexual arousal patterns, and risky sexual behaviors have been reported in studies involving men and women. To date, longitudinal studies have not evaluated the predictive value of these propensities for future sexual behaviors in women.

AIM

To investigate associations among sexual excitation, sexual inhibition, atypical sexual arousal patterns, and potentially risky sexual behaviors in women.

METHODS

Overall, 2,214 women (mean age = 30.65 years, standard deviation = 9.91 years) participated in a baseline Web-based survey. The 1- and 2-year follow-up surveys included 396 and 382 participants, respectively. Correlational analyses and multiple linear regression analyses were conducted to analyze the relations between predictor and outcome variables.

MAIN OUTCOME MEASURES

Number of partners, number of one-time sexual encounters, and number of partners with whom no condoms were used during the 12-month periods before each of the three data assessment points.

RESULTS

All five lower-order factors of sexual excitation showed positive correlations and all three lower-order factors of sexual inhibition showed negative correlations with outcomes at baseline and follow-up. Atypical sexual arousal patterns, the tendency to become aroused in unusual sexual situations, and the importance of relationship factors, such as trust, for sexual arousal were the strongest predictors for sexual behaviors at baseline. These variables also predicted the number of sexual partners and the number of one-night stands at follow-up.

CONCLUSION

The findings suggest that increased sexual arousal when experiencing negative mood might be a risk factor for potentially health-threatening sexual decisions and support the assumptions of the dual control model that sexual excitation is positively and sexual inhibition is negatively predictive of risky sexual behavior in women.

The Relationship Between Hypersexual Behavior, Sexual Excitation, Sexual Inhibition, and Personality Traits

The term hypersexuality was introduced to describe excessive sexual behavior associated with a person's inability to control his or her sexual behavior. The main aim of the present study was to investigate the impact of different personality traits on the degree of hypersexual behavior as measured by the Hypersexual Behavior Inventory (HBI). A further aim was to evaluate the association between sexual inhibition and excitation [as described in the Dual Control Model (DCM)] and hypersexual behavior. A sample of 1,749 participants completed an internet-based survey comprised the HBI, the short form of the Sexual Inhibition/Sexual Excitation Scales (SIS/SES-SF) as well as more general personality measures: the Behavioral Inhibition System/Behavioral Activation System-scales (BIS/BAS-scales) and a short version of the Big Five Inventory (BFI-10). Using the recommended HBI cut-off, 6.0 % (n = 105) of the present sample could be categorized as hypersexual, which is comparable to the results of previous studies about the prevalence of hypersexual behavior in the general population. The results provided strong support for the components of the DCM-sexual excitation and inhibition-to explain hypersexual behavior, irrespective of gender and sexual orientation. Some of the general personality traits also showed significant relationships with hypersexual behavior. Taken together, the results of the present study provide further support for the relevance of research about the relationships between sexual problems and disorders, the DCM, and personality variables.