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Blumenstock SM, Suschinsky K, Brotto LA, Chivers ML. Genital arousal and responsive desire among women with and without sexual interest/arousal disorder symptoms. J Sex Med 2024; 21:539-547. [PMID: 38582607 PMCID: PMC11144479 DOI: 10.1093/jsxmed/qdae036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 01/30/2024] [Accepted: 02/19/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Models depicting sexual desire as responsive to sexual arousal may be particularly apt for women experiencing arousal or desire difficulties, and the degree to which arousal triggers desire may depend on the relationship context and desire target and timing-yet, these associations have not been directly tested among women with and without sexual interest/arousal disorder (SIAD). AIM To assess the role of SIAD status and relationship satisfaction in the associations between genital arousal and 4 types of responsive desire. METHODS One hundred women (n = 27 meeting diagnostic criteria for SIAD) in romantic relationships with men viewed a sexual film (pleasurable intimate depiction of oral sex and penile-vaginal intercourse) while their genital arousal was recorded via vaginal photoplethysmography (n = 63) or thermal imaging of the labia (n = 37). Partner and solitary desire was assessed immediately before and after the film (immediate desire) and 3 days later (delayed desire). OUTCOMES Outcomes consisted of genital response (z scored by method) and associations between genital response and responsive sexual desire. RESULTS The key difference between women with and without SIAD was not in their ability to experience genital arousal but in how their genital responses translated to responsive sexual desire. Women with SIAD actually exhibited greater genital arousal than unaffected women. Associations between genital arousal and desire were significant only for women with SIAD and depended on relationship satisfaction and desire type. For women with SIAD with low relationship satisfaction, higher arousal predicted lower immediate desire for a partner; for those with high relationship satisfaction, arousal was either positively related (vaginal photoplethysmography) or unrelated (thermal imaging of the labia) to immediate desire for a partner. Associations with other desire types were not significant. CLINICAL IMPLICATIONS Patterns of genital arousal and partner-specific responsive desire among women affected with SIAD were indicative of an avoidance model in response to heightened genital arousal, unless relationship satisfaction was high; attending to genital arousal sensations could be a means of triggering sexual desire for women with SIAD who are satisfied in their relationships. STRENGTHS AND LIMITATIONS This is one of the first sexual psychophysiologic studies to connect relationship factors to patterns of sexual response. The differing arousal assessment procedures and lack of official diagnosis may have attenuated results. The homogeneous sample and in-person session requirement limit generalizability. CONCLUSION When compared with unaffected women, women affected by SIAD may exhibit stronger arousal responses with sufficiently incentivized sexual stimuli, and the connection between their genital arousal and responsive desire for their partners may be stronger and more dependent on relationship context.
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Affiliation(s)
- Shari M Blumenstock
- Department of Psychology, Queen’s University, Kingston K7L 3L3, Canada
- Kinsey Institute, Indiana University–Bloomington, Bloomington IN 47405, United States
| | - Kelly Suschinsky
- Royal Ottawa Mental Health Centre, University of Ottawa, Ottawa K1Z 7K4, Canada
| | - Lori A Brotto
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver V6T 2A1, Canada
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Hamilton LD, Kaufmann JG. More Research on Context and Moderators Is Needed to Understand Reflexive Vaginal Arousal Responses. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:757-761. [PMID: 33398707 DOI: 10.1007/s10508-020-01893-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/22/2020] [Accepted: 11/24/2020] [Indexed: 06/12/2023]
Affiliation(s)
- Lisa Dawn Hamilton
- Psychology Department, Mount Allison University, 49A York Street, Sackville, NB, E4L 1C7, Canada.
| | - Julia G Kaufmann
- Psychology Department, Mount Allison University, 49A York Street, Sackville, NB, E4L 1C7, Canada
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Laser Doppler Imaging as a Measure of Female Sexual Arousal: Further Validation and Methodological Considerations. Biol Psychol 2019; 148:107741. [PMID: 31425725 DOI: 10.1016/j.biopsycho.2019.107741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 07/07/2019] [Accepted: 08/12/2019] [Indexed: 11/21/2022]
Abstract
Laser Doppler imaging has recently been applied to the study of female sexual response, with promising results. The current study sought to provide further validation for its use in this capacity, as well as to examine the sexual psychophysiological concepts of genital non-response and return to baseline with this instrument. A sample of healthy heterosexual women without any sexual concerns (N = 24) participated in a single testing session design, which included self-report measures and genital imaging with the laser Doppler imager (LDI). During the imaging portion of the study, genital and subjective arousal data were collected while participants watched neutral and erotic film stimuli. The results support the validity of the LDI as a measure of female sexual arousal, and highlight its potential utility in research and clinical applications for sexual function and related difficulties.
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Suschinsky KD, Huberman JS, Maunder L, Brotto LA, Hollenstein T, Chivers ML. The Relationship Between Sexual Functioning and Sexual Concordance in Women. JOURNAL OF SEX & MARITAL THERAPY 2019; 45:230-246. [PMID: 30898058 DOI: 10.1080/0092623x.2018.1518881] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Previous research using clinical samples has shown a positive relationship between women's sexual functioning and sexual concordance (i.e., agreement between genital and subjective sexual arousal). We further examined this relationship using concurrent measures of vaginal, clitoral, and subjective sexual responses in a community sample of women (N = 64, with 59.4% and 34.1% reporting sexual desire and/or arousal difficulties, respectively). Contrary to studies using clinical samples, sexual desire and arousal difficulties were associated with stronger sexual concordance, specifically when changes in subjective arousal predicted changes in genital responses. The subjective experience of arousal may be particularly important in influencing genital responses in women with sexual desire and arousal difficulties compared to unaffected women.
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Affiliation(s)
- Kelly D Suschinsky
- a Department of Psychology , Queen's University , Kingston , Ontario , Canada
| | - Jackie S Huberman
- a Department of Psychology , Queen's University , Kingston , Ontario , Canada
| | - Larah Maunder
- a Department of Psychology , Queen's University , Kingston , Ontario , Canada
| | - Lori A Brotto
- b Department of Obstetrics & Gynaecology , University of British Columbia , Vancouver , British Columbia , Canada
| | - Tom Hollenstein
- a Department of Psychology , Queen's University , Kingston , Ontario , Canada
| | - Meredith L Chivers
- a Department of Psychology , Queen's University , Kingston , Ontario , Canada
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Handy AB, Meston CM. Interoception and Awareness of Physiological Sexual Arousal in Women With Sexual Arousal Concerns. JOURNAL OF SEX & MARITAL THERAPY 2018; 44:398-409. [PMID: 29166215 DOI: 10.1080/0092623x.2017.1405305] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Laboratory studies assessing physiological genital arousal have largely failed to find differences between women with and without female sexual arousal disorder (FSAD). Therefore, it is possible that women with FSAD may be unaware of their genital arousal response. The present study examined the extent to which women with FSAD can report their genital arousal response, as well as the role of interoception (body awareness) in this relationship. Additionally, this study examined the influence of interoception on the relationship between subjective and genital arousal. Twenty-six women who met criteria for FSAD (M age = 29.5, SD = 8.1 years) watched an erotic film and completed a series of questionnaires. Physiological (i.e., genital) and perceived genital arousal were measured continuously throughout the film. Results indicated women were able to perceive their level of physiological arousal. Greater levels of interoception were linked with stronger relationships between perceived and physiological arousal, but not between subjective and genital arousal. Methodological and clinical implications are discussed.
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Affiliation(s)
- Ariel B Handy
- a Department of Psychology , University of Texas at Austin , Austin , TX, USA
| | - Cindy M Meston
- a Department of Psychology , University of Texas at Austin , Austin , TX, USA
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Sarin S, Amsel R, Binik YM. A Streetcar Named "Derousal"? A Psychophysiological Examination of the Desire-Arousal Distinction in Sexually Functional and Dysfunctional Women. JOURNAL OF SEX RESEARCH 2016; 53:711-729. [PMID: 26457746 DOI: 10.1080/00224499.2015.1052360] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Research indicates that desire and arousal problems are highly interrelated in women. Therefore, hypoactive sexual desire disorder (HSDD) and female sexual arousal disorder (FSAD) were removed from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), and a new diagnostic category, female sexual interest/arousal disorder (FSIAD), was created to include both arousal and desire difficulties. However, no research has tried to distinguish these problems based on psychosocial-physiological patterns to identify whether unique profiles exist. This study compared psychosocial-physiological patterns in a community sample of 84 women meeting DSM-IV (American Psychiatric Association, 2000 ) criteria for HSDD (n = 22), FSAD (n = 18), both disorders (FSAD/HSDD; n = 25), and healthy controls (n = 19). Women completed self-report measures and watched neutral and erotic films while genital arousal (GA) and subjective arousal (SA) were measured. Results indicated that GA increased equally for all groups during the erotic condition, whereas women with HSDD and FSAD/HSDD reported less SA than controls or FSAD women. Women in the clinical groups also showed lower concordance and greater impairment on psychosocial variables as compared to controls, with women with FSAD/HSDD showing lowest functioning. Results have important implications for the classification and treatment of these difficulties.
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Clifton J, Seehuus M, Rellini AH. Testing cognitive predictors of individual differences in the sexual psychophysiological responses of sexually functional women. Psychophysiology 2015; 52:957-68. [DOI: 10.1111/psyp.12423] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 01/26/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Jessica Clifton
- Department of Psychological Science; University of Vermont; Burlington Vermont USA
| | - Martin Seehuus
- Department of Psychological Science; University of Vermont; Burlington Vermont USA
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Orri M, Abraham L, Giraldi A. A Phase 2a Multicenter, Double‐Blind, Placebo‐Controlled, Crossover Trial to Investigate the Efficacy, Safety, and Toleration of CP‐866,087 (a High‐Affinity Mu‐Opioid Receptor Antagonist) in Premenopausal Women Diagnosed with Female Sexual Arousal Disorder (FSAD). J Sex Med 2013; 10:2484-96. [DOI: 10.1111/jsm.12071] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Chen CH, Lin YC, Chiu LH, Chu YH, Ruan FF, Liu WM, Wang PH. Female sexual dysfunction: definition, classification, and debates. Taiwan J Obstet Gynecol 2013; 52:3-7. [PMID: 23548211 DOI: 10.1016/j.tjog.2013.01.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2012] [Indexed: 01/23/2023] Open
Abstract
Sexual dysfunction refers to difficulties that occur during the sexual response cycle that prevent the individual from experiencing satisfaction from sexual activity. It is relatively difficult to estimate the prevalence of female sexual dysfunction (FSD), because the definition and diagnostic criteria are still controversial and under development. These difficulties reveal our insufficient understanding of the basis of FSD. This review was conducted in an effort to deal with this complicated clinical issue, by examining the most updated clinical criteria of FSD under the context of a redefined female sexual response model.
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Affiliation(s)
- Ching-Hui Chen
- Department of Obstetrics and Gynecology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Sarin S, Amsel RM, Binik YM. Disentangling desire and arousal: a classificatory conundrum. ARCHIVES OF SEXUAL BEHAVIOR 2013; 42:1079-1100. [PMID: 23546888 DOI: 10.1007/s10508-013-0100-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Revised: 09/03/2012] [Accepted: 11/08/2012] [Indexed: 06/02/2023]
Abstract
A controversial proposal to collapse sexual disorders of desire and arousal is forthcoming in the diagnostic and statistical manual of mental disorders (5th ed.) (DSM-5). Yet, no study has attempted to empirically distinguish these disorders by using explicit criteria to recruit and compare distinct groups of low desire and arousal sufferers. The goal of the current study was to test the feasibility of finding medically healthy men and women meeting clearly operationalized DSM-IV-TR criteria for disorders of desire and/or arousal and compare them to matched controls. To assess operational criteria, participants completed a comprehensive telephone screening interview assessing DSM-IV-TR and DSM-5 criteria, as well as standardized self-report measures of sexual functioning. The use of operationalized DSM-IV-TR criteria to recruit participants led to the exclusion of over 75% of those reporting sexual difficulties, with the primary reason for exclusion being failure to meet at least one central diagnostic criterion. The application of the DSM-5 criteria was even more restrictive and led to the exclusion of all but four men and one woman using the original four-symptom criteria, and four men and five women using the revised three-symptom criteria. Cluster analyses supported the distinction between desire and genital arousal difficulties, and suggest that different groups with distinct clusters of symptoms may exist, two of which are consistent with the DSM-5 criteria. Overall, results highlight the need for revisions to the diagnostic criteria, which, as they stand, do not capture the full range of many people's sexual difficulties.
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Affiliation(s)
- Sabina Sarin
- Department of Psychology, McGill University, 1205 Dr. Penfield Ave., Montreal, QC, H3A 1B1, Canada.
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Caruso S, Cicero C, Romano M, Lo Presti L, Ventura B, Malandrino C. Tadalafil 5 mg Daily Treatment for Type 1 Diabetic Premenopausal Women Affected by Sexual Genital Arousal Disorder. J Sex Med 2012; 9:2057-65. [DOI: 10.1111/j.1743-6109.2012.02777.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Klein C, Hill MN, Chang SCH, Hillard CJ, Gorzalka BB. Circulating endocannabinoid concentrations and sexual arousal in women. J Sex Med 2012; 9:1588-601. [PMID: 22462722 DOI: 10.1111/j.1743-6109.2012.02708.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Several lines of evidence point to the potential role of the endocannabinoid system in female sexual functioning. These include results from studies describing the subjective effects of exogenous cannabinoids on sexual functioning in humans and the observable effects of exogenous cannabinoids on sexual functioning in other species, as well as results from studies investigating the location of cannabinoid receptors in the brain and periphery, and the effects of cannabinoid receptor activation on neurotransmitters implicated in sexual functioning. While these lines of research suggest a role for the endocannabinoid system in female sexual functioning, no studies investigating the relationship between concentrations of endogenous cannabinoids (i.e., arachidonoylethanolamide [AEA] and 2-arachidonoylglycerol [2-AG]) and sexual functioning have been conducted in any species. AIM To measure circulating endocannabinoid concentrations in relation to subjective and physiological indices of sexual arousal in women (N = 21). METHODS Serum endocannabinoid (AEA and 2-AG) concentrations were measured immediately prior to, and immediately following, viewing of neutral (control) and erotic (experimental) film stimuli in a repeated measures design. Physiological sexual arousal was measured via vaginal photoplethysmography. Subjective sexual arousal was measured both continuously and noncontinuously. Pearson's correlations were used to investigate the relationships between endocannabinoid concentrations and sexual arousal. MAIN OUTCOME MEASURES Changes in AEA and 2-AG concentrations from pre- to post-film and in relation to physiological and subjective indices of sexual arousal. RESULTS Results revealed a significant relationship between endocannabinoid concentrations and female sexual arousal, whereby increases in both physiological and subjective indices of sexual arousal were significantly associated with decreases in AEA, and increases in subjective indices of sexual arousal were significantly associated with decreases in 2-AG. CONCLUSIONS These findings support the hypothesis that the endocannabinoid system is involved in female sexual functioning, with implications for furthering understanding of the biological mechanisms underlying female sexual functioning.
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Affiliation(s)
- Carolin Klein
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada.
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Brotto LA, Seal BN, Rellini A. Pilot study of a brief cognitive behavioral versus mindfulness-based intervention for women with sexual distress and a history of childhood sexual abuse. JOURNAL OF SEX & MARITAL THERAPY 2012; 38:1-27. [PMID: 22268979 DOI: 10.1080/0092623x.2011.569636] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Although sexual difficulties related to a history of childhood sexual abuse (CSA) are common, there are no efficacious treatments to address sexual distress. Recent evidence for the benefits of mindfulness, which emphasizes present-moment non-judgmental awareness, in the treatment of women's sexual concerns provided the impetus for this pilot study. Twenty partnered women with sexual difficulties and significant sexual distress, and a history of CSA were randomized to two sessions of either a cognitive behavioral (CBT, n = 8) or mindfulness-based (MBT, n = 12) group treatment (age: M = 35.8 years, range: 22-54 years). Hierarchical Linear Modeling to assess changes in concordance between laboratory-based subjective and genital sexual arousal revealed a significant effect of MBT on concordance such that women in the MBT group experienced a significantly greater subjective sexual arousal response to the same level of genital arousal compared to the CBT group and to pre-treatment. Both groups also experienced a significant decrease in sexual distress. These data support the further study of mindfulness-based approaches in the treatment of sexual difficulties characterized by a disconnection between genital and subjective sexual response.
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Affiliation(s)
- Lori A Brotto
- University of British Columbia, Vancouver, British Columbia, Canada.
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Brotto LA, Yule MA. Physiological and subjective sexual arousal in self-identified asexual women. ARCHIVES OF SEXUAL BEHAVIOR 2011; 40:699-712. [PMID: 20857185 DOI: 10.1007/s10508-010-9671-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Revised: 07/27/2010] [Accepted: 07/27/2010] [Indexed: 05/25/2023]
Abstract
Asexuality can be defined as a lifelong lack of sexual attraction. Empirical research on asexuality reveals significantly lower self-reported sexual desire and arousal and lower rates of sexual activity; however, the speculation that there may also be an impaired psychophysiological sexual arousal response has never been tested. The aim of this study was to compare genital (vaginal pulse amplitude; VPA) and subjective sexual arousal in asexual and non-asexual women. Thirty-eight women between the ages of 19 and 55 years (10 heterosexual, 10 bisexual, 11 homosexual, and 7 asexual) viewed neutral and erotic audiovisual stimuli while VPA and self-reported sexual arousal and affect were measured. There were no significant group differences in the increased VPA and self-reported sexual arousal response to the erotic film between the groups. Asexuals showed significantly less positive affect, sensuality-sexual attraction, and self-reported autonomic arousal to the erotic film compared to the other groups; however, there were no group differences in negative affect or anxiety. Genital-subjective sexual arousal concordance was significantly positive for the asexual women and non-significant for the other three groups, suggesting higher levels of interoceptive awareness among asexuals. Taken together, the findings suggest normal subjective and physiological sexual arousal capacity in asexual women and challenge the view that asexuality should be characterized as a sexual dysfunction.
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Affiliation(s)
- Lori A Brotto
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada.
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Meston CM, Rellini AH, McCall K. The sensitivity of continuous laboratory measures of physiological and subjective sexual arousal for diagnosing women with sexual arousal disorder. J Sex Med 2010; 7:938-50. [PMID: 20487501 DOI: 10.1111/j.1743-6109.2009.01548.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Past findings on the diagnostic sensitivity of vaginal photoplethysmography are limited by testing among women with heterogeneous sexual dysfunctions and by the use of statistical techniques that are unable to assess how changes in subjective arousal are associated with changes in physiological arousal. AIMS The aims of this study were to: (i) test the sensitivity of vaginal photoplethysmography and continuous measures of subjective sexual arousal in differentiating between women with and without sexual arousal or orgasm dysfunction; and (ii) examine the diagnostic utility of measuring the synchrony between genital and subjective sexual responses. METHODS Sexual arousal was assessed in sexually healthy women (n = 12), women with orgasm disorder (OD; n = 12), and 38 women who met the criteria for the three subcategories of sexual arousal dysfunction described by Basson et al. (i.e., genital sexual arousal disorder [GAD; n = 9], subjective sexual arousal disorder [SAD; n = 13], and combined genital and subjective arousal disorder [CAD; n = 16]). MAIN OUTCOME MEASURES Physiological sexual arousal was assessed using vaginal photoplethysmography, and subjective sexual arousal was measured continuously and using a Likert-scale in response to sexual videos. RESULTS Women with GAD showed the lowest and women with CAD showed the highest levels of vaginal pulse amplitude response to erotic stimuli. Women with sexual arousal disorder showed significantly lower levels of subjective sexual arousal to erotic stimuli than did sexually healthy women. Relations between subjective and physiological measures of sexual arousal were significantly weaker among women with sexual arousal disorder than sexually healthy women or women with OD. CONCLUSION Preliminary support was provided for the diagnostic utility of measuring the synchrony between subjective and genital arousal in women with sexual arousal disorder. Findings do not support the sensitivity of using vaginal photoplethysmography, or continuous or Likert-scale measures of subjective arousal for differentiating between subtypes of women with sexual arousal disorder.
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Affiliation(s)
- Cindy M Meston
- Department of Psychology, The University of Texas at Austin, Austin, TX, USA.
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Salonia A, Giraldi A, Chivers ML, Georgiadis JR, Levin R, Maravilla KR, McCarthy MM. Physiology of Women's Sexual Function: Basic Knowledge and New Findings. J Sex Med 2010; 7:2637-60. [DOI: 10.1111/j.1743-6109.2010.01810.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gelez H, Poirier S, Facchinetti P, Allers KA, Wayman C, Alexandre L, Giuliano F. Neuroanatomical Evidence for a Role of Central Melanocortin-4 Receptors and Oxytocin in the Efferent Control of the Rodent Clitoris and Vagina. J Sex Med 2010; 7:2056-2067. [DOI: 10.1111/j.1743-6109.2010.01760.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Graham CA. The DSM diagnostic criteria for female sexual arousal disorder. ARCHIVES OF SEXUAL BEHAVIOR 2010; 39:240-255. [PMID: 19777335 DOI: 10.1007/s10508-009-9535-1] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
This article reviews and critiques the DSM-IV-TR diagnostic criteria for Female Sexual Arousal Disorder (FSAD). An overview of how the diagnostic criteria for FSAD have evolved over previous editions of the DSM is presented and research on prevalence and etiology of FSAD is briefly reviewed. Problems with the essential feature of the DSM-IV-TR diagnosis-"an inability to attain, or to maintain...an adequate lubrication-swelling response of sexual excitement"-are identified. The significant overlap between "arousal" and "desire" disorders is highlighted. Finally, specific recommendations for revision of the criteria for DSM-V are made, including use of a polythetic approach to the diagnosis and the addition of duration and severity criteria.
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Affiliation(s)
- Cynthia A Graham
- Oxford Doctoral Course in Clinical Psychology, Isis Education Centre, Warneford Hospital, Headington, Oxford, OX3 7JX, UK.
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Bloemers J, Gerritsen J, Bults R, Koppeschaar H, Everaerd W, Olivier B, Tuiten A. ORIGINAL RESEARCH—ANATOMY/PHYSIOLOGY: Induction of Sexual Arousal in Women Under Conditions of Institutional and Ambulatory Laboratory Circumstances: A Comparative Study. J Sex Med 2010; 7:1160-76. [DOI: 10.1111/j.1743-6109.2009.01660.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Prause N, Heiman J. Reduced Labial Temperature in Response to Sexual Films with Distractors among Women with Lower Sexual Desire. J Sex Med 2010; 7:951-63. [DOI: 10.1111/j.1743-6109.2009.01525.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Chivers ML, Seto MC, Lalumière ML, Laan E, Grimbos T. Agreement of self-reported and genital measures of sexual arousal in men and women: a meta-analysis. ARCHIVES OF SEXUAL BEHAVIOR 2010; 39:5-56. [PMID: 20049519 PMCID: PMC2811244 DOI: 10.1007/s10508-009-9556-9] [Citation(s) in RCA: 336] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2007] [Revised: 04/29/2009] [Accepted: 09/05/2009] [Indexed: 05/12/2023]
Abstract
The assessment of sexual arousal in men and women informs theoretical studies of human sexuality and provides a method to assess and evaluate the treatment of sexual dysfunctions and paraphilias. Understanding measures of arousal is, therefore, paramount to further theoretical and practical advances in the study of human sexuality. In this meta-analysis, we review research to quantify the extent of agreement between self-reported and genital measures of sexual arousal, to determine if there is a gender difference in this agreement, and to identify theoretical and methodological moderators of subjective-genital agreement. We identified 132 peer- or academically-reviewed laboratory studies published between 1969 and 2007 reporting a correlation between self-reported and genital measures of sexual arousal, with total sample sizes of 2,505 women and 1,918 men. There was a statistically significant gender difference in the agreement between self-reported and genital measures, with men (r = .66) showing a greater degree of agreement than women (r = .26). Two methodological moderators of the gender difference in subjective-genital agreement were identified: stimulus variability and timing of the assessment of self-reported sexual arousal. The results have implications for assessment of sexual arousal, the nature of gender differences in sexual arousal, and models of sexual response.
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Affiliation(s)
- Meredith L Chivers
- Department of Psychology, Queen's University, Kingston, ON, K7L 3N6, Canada.
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Brotto LA, Bitzer J, Laan E, Leiblum S, Luria M. Women's Sexual Desire and Arousal Disorders. J Sex Med 2010; 7:586-614. [DOI: 10.1111/j.1743-6109.2009.01630.x] [Citation(s) in RCA: 134] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Chivers ML, Rosen RC. Phosphodiesterase type 5 inhibitors and female sexual response: faulty protocols or paradigms? J Sex Med 2009; 7:858-72. [PMID: 19929916 DOI: 10.1111/j.1743-6109.2009.01599.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Phosphodiesterase type 5 inhibitors (PDE5), such as sildenafil, tadalafil, and vardenafil, have revolutionized the treatment of erectile dysfunction. Few successes, in contrast, have been reported for the use of these agents in treatment of sexual arousal problems in women. AIM To review research examining efficacy of PDE5 in women, critique the methods and models employed, and integrate the findings within a broader, gender-specific understanding of female sexual response. METHODS A conceptual and methodological review of all published studies examining PDE5 efficacy in female samples. MAIN OUTCOME MEASURES Study methods, populations, outcome measures, study results. RESULTS A total of 16 studies were reviewed. Studies using self-reported measures of sexual functioning showed mixed results whereas studies examining physiological effects of PDE5 on genital vasocongestion consistently report significant effects on genital sexual response. CONCLUSIONS The lack of efficacy of PDE5 treatment in women is likely attributable to gender differences in the concordance between physiological and psychological components of sexual response. Discordance between genital and subjective measures of sexual response in women may be augmented by PDE5 effects on genital vasocongestion in some populations, rendering successful treatment unlikely via pharmacological treatment alone.
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Brauer M, ter Kuile MM, Laan E. Effects of appraisal of sexual stimuli on sexual arousal in women with and without superficial dyspareunia. ARCHIVES OF SEXUAL BEHAVIOR 2009; 38:476-485. [PMID: 18561015 PMCID: PMC2695553 DOI: 10.1007/s10508-008-9371-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2006] [Revised: 11/14/2007] [Accepted: 01/19/2008] [Indexed: 05/26/2023]
Abstract
This study examined the effects of appraisal of sexual stimuli on sexual arousal in women with superficial dyspareunia (n = 50) and sexually functional women (n = 25). To elicit different appraisals of an erotic film fragment, participants received an instruction prior to viewing it, with a focus on genital pain or on sexual enjoyment. A neutral instruction served as a control condition. Assignment to instruction condition was randomized. Genital arousal (vaginal pulse amplitude) and self-report ratings of affect and genital sensations were obtained in response to the erotic stimulus. As predicted, appraisal of the erotic stimulus affected genital responding, albeit marginally significant. Follow-up tests indicated that women who received the genital pain instruction responded with marginally significant lower genital arousal levels than women who received the sexual enjoyment instruction (d = 0.67). A significant instruction effect for negative affect was found, signifying that negative affect ratings were highest after the genital pain instruction and lowest after the sexual enjoyment instruction (d = 0.80). A marginally significant group by instruction interaction effect was observed for positive affect, indicating that women with dyspareunia reported significantly less positive affect than controls after the sexual enjoyment instruction (d = 1.48). Whereas women with dyspareunia reported overall marginally significant more negative affect than controls (d = 0.48), there were no differences in genital responsiveness between groups. These results provided preliminary evidence for the modulatory effects of appraisal of sexual stimuli on subsequent genital responding and affect in women with and without sexual complaints.
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Affiliation(s)
- Marieke Brauer
- Department of Psychosomatic Gynecology and Sexology, Leiden University Medical Center, RC, The Netherlands.
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Brotto LA, Klein C, Gorzalka BB. Laboratory-induced hyperventilation differentiates female sexual arousal disorder subtypes. ARCHIVES OF SEXUAL BEHAVIOR 2009; 38:463-475. [PMID: 18343989 DOI: 10.1007/s10508-007-9288-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2006] [Revised: 05/26/2007] [Accepted: 10/20/2007] [Indexed: 05/26/2023]
Abstract
The effects of heightened sympathetic nervous system (SNS) activity via laboratory-induced hyperventilation (LIH) on subjective and physiological sexual arousal were examined in a heterogeneous group of women with Sexual Arousal Disorder (SAD; n = 60), as well as across subtypes of SAD, in comparison to a control group of women without sexual difficulties (n = 42). Participants took part in 2 min of rapid breathing, a technique previously found to increase SNS activity, immediately prior to viewing erotic stimuli. Physiological arousal (i.e., vaginal pulse amplitude; VPA) was measured via the vaginal photoplethysmograph and subjective arousal was measured via self-report questionnaires. LIH differentiated women with SAD from those in the control group, with LIH increasing VPA in the latter, but having no significant effect in the heterogeneous SAD group. However, among subtypes of SAD, LIH differentiated women with genital (n = 16) and subjective (n = 16) subtypes of SAD from women with combined SAD (n = 28) and women without sexual difficulties. Specifically, women in the control group and those with combined SAD had a significant increase in VPA whereas women with genital or subjective SAD had a significant decrease in VPA following LIH. There was no significant effect of LIH on any self-report measure of sexual arousal following erotic stimuli. Implications of the results for the conceptualization, diagnosis, and treatment of SAD are discussed.
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Affiliation(s)
- Lori A Brotto
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada.
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de Jong DC. The role of attention in sexual arousal: implications for treatment of sexual dysfunction. JOURNAL OF SEX RESEARCH 2009; 46:237-248. [PMID: 19308846 DOI: 10.1080/00224490902747230] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The literature on the role of attention in sexual arousal is reviewed, especially that which has implications for noninvasive treatment of sexual dysfunction. Findings suggest that voluntary control of sexual arousal can be achieved through attentional focus on nonsexual cognitions or sexual fantasy. Cognitive biases may direct attention and thus facilitate or impede sexual arousal. Sexual arousal may be influenced by directed attentional focus, and preliminary evidence suggests that mindfulness techniques may result in longer-term changes in attentional focus; these changes, in turn, may improve sexual response. Information-processing models of sexual arousal developed in light of such findings are discussed. This research establishes the central role of attentional processes in facilitating physiological and, especially, subjective sexual arousal. Implementing approaches that capitalize on attentional processes could advance noninvasive treatment of sexual dysfunction. Future avenues of research might investigate how play, mammalian play circuits, and flow states are relevant to sexual response and satisfaction.
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Affiliation(s)
- David C de Jong
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada.
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Middleton LS, Kuffel SW, Heiman JR. Effects of experimentally adopted sexual schemas on vaginal response and subjective sexual arousal: a comparison between women with sexual arousal disorder and sexually healthy women. ARCHIVES OF SEXUAL BEHAVIOR 2008; 37:950-961. [PMID: 18256919 DOI: 10.1007/s10508-007-9310-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2006] [Revised: 06/13/2007] [Accepted: 08/18/2007] [Indexed: 05/25/2023]
Abstract
The present study evaluated and compared the effects of experimentally adopted sexual schemas on vaginal response, subjective sexual arousal, and affect in 17 women with Female Sexual Arousal Disorder (FSAD) and 17 sexually healthy women. Positive and negative cognitive schemas were presented to participants before viewing sexually explicit video segments. They were asked to temporarily adopt both schemas, and vaginal response, subjective sexual arousal, and affect were measured in each schema condition. Participants in both groups had significantly greater vaginal response and reported more subjective sexual arousal in the positive schema condition than in the negative schema condition. Sexually healthy women demonstrated significantly higher subjective sexual arousal than women with FSAD, but there were no significant group differences in vaginal response. Moreover, participants in both groups reported higher levels of Positive Affect and Vigor in the positive schema condition than in the negative schema condition but higher levels of Negative Affect, Tension-Anxiety, and Anger-Hostility in the negative schema condition than in the positive schema condition. These findings demonstrate the impact of cognitions on sexual arousal, which has important implications for addressing cognitions in the treatment of FSAD. Moreover, these findings have implications for the conceptualization of FSAD, which may be best characterized as a complex, heterogeneous cluster of symptoms.
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Affiliation(s)
- Laura S Middleton
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
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Laan E, Van Driel EM, Van Lunsen RH. Genital Responsiveness in Healthy Women With and Without Sexual Arousal Disorder. J Sex Med 2008; 5:1424-35. [DOI: 10.1111/j.1743-6109.2008.00827.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sidi H, Abdullah N, Puteh SEW, Midin M. The Female Sexual Function Index (FSFI): Validation of the Malay Version. J Sex Med 2007; 4:1642-54. [PMID: 17608666 DOI: 10.1111/j.1743-6109.2007.00476.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Female sexual dysfunction (FSD) is a prevalent sexual health problem that has been inadequately investigated in Malaysia, a nation with a conservative multiethnic society. AIM To validate the Malay version of the Female Sexual Function Index (MVFSFI) for the study of FSD. MAIN OUTCOME MEASURE To measure the validity and reliability of the MVFSFI and its domains. METHODS Validation was carried out on aspects of face, content, discriminant, and criterion (concurrent) validity. Reliability studies on test-retest and on internal consistency were conducted with Cronbach's alpha and Pearson correlation, respectively. The values with the highest sensitivity and specificity generated from the receiver operating characteristic curves were taken as the cutoff scores to differentiate cases and noncases. RESULTS A total of 230 married women aged 18-70 years participated in this study. There was a high test-retest correlation by respondents (r at least >0.7). The MVFSFI was found to have good discriminant validity as a whole and for each domain. A total score of 55 was taken as the cutoff point for the MVFSFI to distinguish between women with sexual dysfunction and those without (sensitivity = 99%, specificity = 97%). Scores lower than 55 indicate sexual dysfunction. The cutoff score for each domain was also established for the MVFSFI: </=5 for sexual desire disorder (sensitivity = 95%, specificity = 89%); </=9 for sexual arousal disorder (sensitivity = 77%, specificity = 95%); </=10 for disorder of lubrication (sensitivity = 79%, specificity = 87%); </=4 for orgasmic disorder (sensitivity = 83%, specificity = 85%); </=11 for sexual dissatisfaction (sensitivity = 83%, specificity = 85%); and </=7 for sexual pain disorder (sensitivity = 86%, specificity = 95%). CONCLUSION The MVFSFI is a validated and locally accepted questionnaire for use in the assessment of FSD in the Malaysian population.
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Affiliation(s)
- Hatta Sidi
- National University Malaysia--Psychiatry, Kuala Lumpur, Malaysia.
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Giuseppe PG, Pace G, Vicentini C. Sexual Function in Women with Urinary Incontinence Treated by Pelvic Floor Transvaginal Electrical Stimulation. J Sex Med 2007; 4:702-707. [PMID: 17034409 DOI: 10.1111/j.1743-6109.2006.00318.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Women's sexual dysfunctions (WSD) have been commonly associated with urinary incontinence (UI). Women with UI and who scored low on the Female Sexual Function Index (FSFI) showed an improvement in urinary leakage and also in their sexual life following treatment by transvaginal electrical stimulation (TES). AIMS To determine the effects of TES in 37 women complaining of UI, of whom 23 also had WSD, and to compare the FSFI scores of women with UI and 43 women not affected by UI who underwent routine urologic evaluation. METHODS Thirty-seven women complaining of UI were evaluated by voiding diary and with FSFI before and after 3 months of TES. All had a urogynecologic evaluation and urodynamic study. MAIN OUTCOME MEASURES In the voiding diary the women reported the types of liquid they ingested, urinary frequency, and episodes of urgency and urine leakage. The domain scores of the FSFI, including desire, arousal, lubrication, orgasm, satisfaction, and pain, were calculated. TES was conducted for 15-30 minutes, twice a week for 3 months, using biphasic intermittent current with a frequency of 50 Hz for stress UI (SUI) and 20 Hz for urge UI (UUI), and the most tolerable intensity of stimulation. RESULTS After TES, only two of the 10 women with UUI experienced a few leakage incidents; patients with SUI were completely dry during TES; and only three reported a few episodes of UI during intense activities. The five patients with mixed UI improved mainly as regards urgency. The FSFI scores of patients complaining of UI showed significantly lower desire and sexual satisfaction, and higher sexual pain than controls. After 3 months, the 23 women affected by WSD, of the 37 participants with UI, reported a remarkable improvement in their sexual life. CONCLUSIONS TES was found to be a safe and effective therapy for selected patients affected by mild to moderate UI. Because women with UI also complain of WSD compared with the general female population, an investigation of female sexuality is suggested for these patients.
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Affiliation(s)
| | - Gianna Pace
- University of L'Aquila-Surgery, Laquila, Italy.
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Abstract
INTRODUCTION The complex condition of the menopause is experienced by all women going through the physical and emotional changes associated with ovarian sexual hormones loss. It may impact directly on their physical and mental health. AIM The complexity of this condition makes it necessary to accumulate large bodies of data to define the patterns and trends in its evaluable manifestations. To this end, large amounts of data were collected on women from France, Germany, Italy, and the United Kingdom, via the Women's International Survey on Health and Sexuality. MAIN OUTCOME MEASURES The key measures within the survey were the Profile of Female of Sexual Function (PFSF and the Personal Distress Scale (PDS. RESULTS The survey yielded 2,467 responders aged between 20 and 70, capturing women with surgical and natural menopausal status and those with premenopausal status. In the four EU countries studied, sexual activity decreases by age. An increase in female sexual dysfunction (FSD), particularly loss of sexual desire, is directly correlated with increasing age. However, the distress associated with loss of sexual desire is inversely correlated with age. Cultural and context-dependent factors modulate the percentage of any FSD in the different European countries. This is exemplified in the significant intercountry variation observed in the percentage of low desire in women aged 20-49, with normal ovarian function. However, when women undergo surgical menopause, with concomitant loss of their sexual hormones, the culture-related differences are blunted. CONCLUSIONS The findings of this survey have implications for the understanding of hypoactive sexual desire disorder (HSDD), not only the way it should be assessed in clinical practice, but also the most appropriate means for its treatment. Testosterone deficiency is a significant cause of HSDD, and new therapies have been investigated which offer considerable potential to address this hormonal etiology.
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Kukkonen TM, Binik YM, Amsel R, Carrier S. ORIGINAL RESEARCH—PHYSIOLOGY: Thermography as a Physiological Measure of Sexual Arousal in Both Men and Women. J Sex Med 2007; 4:93-105. [PMID: 17233778 DOI: 10.1111/j.1743-6109.2006.00399.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Current physiological measures of sexual arousal are intrusive, hard to compare between genders, and quantitatively problematic. AIM To investigate thermal imaging technology as a means of solving these problems. METHODS Twenty-eight healthy men and 30 healthy women viewed a neutral film clip, after which they were randomly assigned to view one of three other video conditions: (i) neutral (N = 19); (ii) humor (N = 19); and (iii) sexually explicit (N = 20). MAIN OUTCOME MEASURES Genital and thigh temperatures were continuously recorded using a TSA ImagIR camera. Subjective measures of sexual arousal, humor, and relaxation were assessed using Likert-style questions prior to showing the baseline video and following each film. RESULTS Statistical (Tukey HSD) post-hoc comparisons (P < 0.05) demonstrated that both men and women viewing the sexually arousing video had significantly greater genital temperature (mean = 33.89 degrees C, SD = 1.00) than those in the humor (mean = 32.09 degrees C, SD = 0.93) or neutral (mean = 32.13 degrees C, SD = 1.24) conditions. Men and women in the erotic condition did not differ from each other in time to peak genital temperature (men mean = 664.6 seconds, SD = 164.99; women mean = 743 seconds, SD = 137.87). Furthermore, genital temperature was significantly and highly correlated with subjective ratings of sexual arousal (range r = 0.51-0.68, P < 0.001). There were no significant differences in thigh temperature between groups. CONCLUSION Thermal imaging is a promising technology for the assessment of physiological sexual arousal in both men and women.
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Affiliation(s)
| | - Yitzchak M Binik
- Department of Psychology, McGill University, Montreal, Canada;; Sex and Couple Therapy Service, Department of Psychology, McGill University Health Center, Montreal, Quebec, Canada
| | - Rhonda Amsel
- Department of Psychology, McGill University, Montreal, Canada
| | - Serge Carrier
- Department of Urology, McGill University, Montreal, Canada
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Pauls R, Mutema G, Segal J, Silva WA, Kleeman S, Dryfhout V, Karram M. ORIGINAL RESEARCH—BASIC SCIENCE: A Prospective Study Examining the Anatomic Distribution of Nerve Density in the Human Vagina. J Sex Med 2006; 3:979-987. [PMID: 17100930 DOI: 10.1111/j.1743-6109.2006.00325.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Women possess sufficient vaginal innervation such that tactile stimulation of the vagina can lead to orgasm. However, there are few anatomic studies that have characterized the distribution of nerves throughout the human vagina. AIM The aim of this prospective study was to better characterize the anatomic distribution of nerves in the adult human vagina. A secondary aim was to assess whether vaginal innervation correlates with the subject's demographic information and sexual function. METHODS Full-thickness biopsies of anterior and posterior vagina (proximal and distal), cuff, and cervix were taken during surgery in a standardized manner. Specimens were prepared with hematoxylin and eosin, and S100 protein immunoperoxidase. The total number of nerves in each specimen was quantified. Enrolled patients completed a validated sexual function questionnaire (Female Sexual Function Index, FSFI) preoperatively. MAIN OUTCOME MEASURES A description of vaginal innervation by location and an assessment of vaginal innervation in association with the subject's demographic information and sexual function. RESULTS Twenty-one patients completed this study, yielding 110 biopsy specimens. Vaginal innervation was somewhat regular, with no site consistently demonstrating the highest nerve density. Nerves were located throughout the vagina, including apex and cervix. No significant differences were noted in vaginal innervation based on various demographic factors, including age, vaginal maturation index, stage of prolapse, number of vaginal deliveries, or previous hysterectomy. There were no correlations between vaginal nerve quantity and FSFI domain and overall scores. Fifty-seven percent of the subjects had female sexual dysfunction; when compared to those without dysfunction, there were no significant differences in total or site-specific nerves. CONCLUSIONS In a prospective study, vaginal nerves were located regularly throughout the anterior and posterior vagina, proximally and distally, including apex and cervix. There was no vaginal location with increased nerve density. Vaginal innervation was not associated with demographic information or sexual function.
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Affiliation(s)
- Rachel Pauls
- Division of Urogynecology and Reconstructive Pelvic Surgery, Good Samaritan Hospital, Cincinnati, OH.
| | - George Mutema
- Department of Pathology, Good Samaritan Hospital, Cincinnati, OH
| | - Jeffrey Segal
- Saint Barnabas Medical Center-Center for Urogynecology, Livingston, NJ
| | - W Andre Silva
- Pacific Northwest Urogynecology-Urogynecology, Federal Way, WA
| | - Steven Kleeman
- Division of Urogynecology and Reconstructive Pelvic Surgery, Good Samaritan Hospital, Cincinnati, OH
| | - Vicki Dryfhout
- Hatton Institute for Research and Education, Good Samaritan Hospital, Cincinnati, OH, USA
| | - Mickey Karram
- Division of Urogynecology and Reconstructive Pelvic Surgery, Good Samaritan Hospital, Cincinnati, OH
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Diamond LE, Earle DC, Heiman JR, Rosen RC, Perelman MA, Harning R. An effect on the subjective sexual response in premenopausal women with sexual arousal disorder by bremelanotide (PT-141), a melanocortin receptor agonist. J Sex Med 2006; 3:628-638. [PMID: 16839319 DOI: 10.1111/j.1743-6109.2006.00268.x] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Melanocortins affect multiple physiological responses, including sexual behaviors. Bremelanotide is a synthetic peptide melanocortin analog of alpha-melanocyte-stimulating hormone that is an agonist at melanocortin receptors MC3R and MC4R. AIM To evaluate a single intranasal dose of bremelanotide for potential effects on physiological and subjective measurements of sexual arousal and desire in premenopausal women with sexual arousal disorder. MAIN OUTCOME MEASURES Change in vaginal pulse amplitude during neutral and erotic videos after treatment with bremelanotide or placebo and subjects' perceptions of physiological and sexual response within 24 hours of treatment with bremelanotide or placebo. METHODS Eighteen premenopausal women with a primary diagnosis of female sexual arousal disorder were randomly assigned to receive a single intranasal dose of 20 mg bremelanotide or matching placebo in a double-blind manner during the first in-clinic treatment session, and the alternate medication during the second in-clinic treatment session. During each session, subjects viewed a 20-minute neutral video followed by a 20-minute sexually explicit video. Vaginal photoplethysmography was used to monitor vaginal vasocongestion and questionnaires were used to evaluate perceptions of sexual response within the following 24-hour period. RESULTS More women reported moderate or high sexual desire following bremelanotide treatment vs. placebo (P = 0.0114), and a trend toward more positive responses regarding feelings of genital arousal occurred after bremelanotide compared with placebo (P = 0.0833). Among women who attempted sexual intercourse within 24 hours after treatment, significantly more were satisfied with their level of sexual arousal following bremelanotide, compared with placebo (P = 0.0256). Vaginal vasocongestion did not change significantly while viewing erotic videos following bremelanotide administration compared with placebo. CONCLUSION This preliminary evaluation suggests the potential for bremelanotide to positively affect desire and arousal in women with female sexual arousal disorder and indicates that bremelanotide is a promising candidate for further evaluation in an at-home study.
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Affiliation(s)
| | | | - Julia R Heiman
- Kinsey Institute, Indiana University, Bloomington, IN, USA
| | - Raymond C Rosen
- Department of Psychiatry, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, Piscataway, NJ, USA
| | - Michael A Perelman
- Weill Medical College of Cornell University, Psychiatry, Reproductive Medicine, and Urology, NY, USA
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Rellini A, Meston C. The sensitivity of event logs, self-administered questionnaires and photoplethysmography to detect treatment-induced changes in female sexual arousal disorder (FSAD) diagnosis. J Sex Med 2006; 3:283-91. [PMID: 16490021 PMCID: PMC2861501 DOI: 10.1111/j.1743-6109.2005.00153.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The literature provides little evidence on what type of endpoints should be used to assess treatment-induced improvement in female sexual function. AIM The main goal of this study was to provide empiric evidence on the sensitivity of different types of measures for detecting treatment-induced changes in female sexual dysfunction diagnosis. METHODS The measures investigated in this study included event logs, self-administered questionnaires (Female Sexual Functioning Index; FSFI), vaginal photoplethysmography, and continuous subjective sexual arousal measured during exposure to erotic videos. Participants were 24 women with female sexual arousal disorder (FSAD) who received sex therapy, placebo, or gingko biloba in a four-arm double-blind placebo-controlled clinical trial. FSAD was diagnosed utilizing a semistructured interview administered at pre- and post-treatment. Those women who did not meet FSAD criteria at post-treatment (N = 10) were labeled as "improved," while women who still met FSAD criteria (N = 14) were categorized as "not improved" even if they showed signs of improvements. MAIN OUTCOME MEASURE Change scores from pre- to post-treatment on the FSFI, event logs, vaginal photoplethysmography, and continuous subjective levels of sexual arousal were used to predict whether women improved at post-treatment. Results were checked with exact logistic regression to control for the small sample size. RESULTS The FSFI was the only measure to significantly predict whether women improved at post-treatment. The findings from this study lend support for the use of validated questionnaires as endpoint criteria in detecting treatment-induced changes in women's sexual dysfunction.
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Basson R, Brotto LA, Laan E, Redmond G, Utian WH. Assessment and management of women's sexual dysfunctions: problematic desire and arousal. J Sex Med 2006; 2:291-300. [PMID: 16422860 DOI: 10.1111/j.1743-6109.2005.20346.x] [Citation(s) in RCA: 119] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Women frequently report low sexual desire or interest. An associated lack of subjective arousal during sexual activity is clinically highly apparent but has not been the focus of traditional sexual inquiry, definitions of dysfunction, or management. The frequent poor correlation of women's subjective sexual arousal and observable increases in genital congestion in response to sexual stimulation has not been reflected in assessment, diagnosis, or management. AIM To provide recommendations/guidelines for the assessment and management of women's sexual dysfunctions focusing on low desire, low interest, and lack of arousal. METHODS An international consultation, in collaboration with major sexual medicine associations, assembled over 200 multidisciplinary experts from 60 countries into 17 committees. One subcommittee of five members focused on women's sexual desire and arousal, developing over a 2-year period various recommendations. MAIN OUTCOME MEASURE Expert opinion was based on grading of evidence-based scientific literature, widespread internal committee discussion, public presentation, and debate. RESULTS Women's sexual response in health can be reconceptualized as a circular model of overlapping phases of variable order influenced by psychological, societal, and biological factors. Subsequent revisions to definitions of arousal and desire disorder are given. Recommendations regarding assessment and management focus on factors reducing arousability and satisfaction. These include women's mental health and feelings for their partner, generally and at the time of sexual activity. Recommendations reflect the poor correlation of subjective arousal and increases in genital vasocongestion. CONCLUSION Further outcome research of management based on new conceptualization of sexual response and revised definitions of dysfunction is needed. The basis of the variable correlation between genital vasocongestion and subjective arousal needs clarification as do the biological underpinnings of sexual response and their changes with age and life cycle.
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Affiliation(s)
- Rosemary Basson
- UBC Department of Psychiatry, B.C. Centre for Sexual Medicine, Vancouver, BC, Canada.
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Abstract
Acceptance of an evidence-based conceptualization of women's sexual response combining interpersonal, contextual, personal psychological and biological factors has led to recently published recommendations for revision of definitions of women's sexual disorders found in the American Psychiatric Association's Diagnostic and Statistical Manual (DSM-IV-TR). DSM-IV definitions have focused on absence of sexual fantasies and sexual desire prior to sexual activity and arousal, even though the frequency of this type of desire is known to vary greatly among women without sexual complaints. DSM-IV definitions also focus on genital swelling and lubrication, entities known to correlate poorly with subjective sexual arousal and pleasure. The revised definitions consider the many reasons women agree to or instigate sexual activity, and reflect the importance of subjective sexual arousal. The underlying conceptualization of a circular sex-response cycle of overlapping phases in a variable order may facilitate not only the assessment but also the management of dysfunction, the principles of which are briefly recounted.
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Affiliation(s)
- Rosemary Basson
- Department of Psychiatry, University of British Columbia and B.C. Centre for Sexual Medicine, Vancouver General Hospital, Vancouver, BC.
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