Examining gender specificity of sexual response with concurrent thermography and plethysmography

Genital arousal and responsive desire among women with and without sexual interest/arousal disorder symptoms

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.

Sexual Desire Emerges from Subjective Sexual Arousal, but the Connection Depends on Desire Type and Relationship Satisfaction

According to models of responsive sexual desire, desire emerges from sexual arousal. This study examined how sexual desire type (dyadic-partner, dyadic-other, solitary) and relationship satisfaction affect the connection between subjective sexual arousal (SSA) and desire. Women (N = 100; 27% with sexual interest/arousal disorder symptoms) reported SSA while viewing a sexual film. Solitary and dyadic responsive sexual desire were assessed immediately before and following the film (immediate desire) and three days later (delayed desire). SSA predicted higher immediate solitary desire. SSA also predicted higher immediate dyadic desire, and this link was stronger for those with higher relationship satisfaction; for those with low relationship satisfaction, SSA was unrelated. For delayed desire, SSA predicted higher dyadic-partner desire, regardless of relationship satisfaction. SSA also predicted higher dyadic-other desire, yet this association was stronger for those with low relationship satisfaction; for those with high relationship satisfaction, SSA was unrelated to dyadic-other desire. Findings support the theoretical premise that desire emerges from arousal, but that this connection is dependent upon additional factors, specifically the target and timing of desire and participants' current relationship quality. Relationship satisfaction may affect the motivational value of sex with (and without) a current partner.

What can the eyes tell us about atypical sexual preferences as a function of sex and age? Linking eye movements with child-related chronophilias

Visual attention plays a central role in current theories of sexual information processing and is key to informing the use of eye-tracking techniques in the study of typical sexual preferences and more recently, in the study of atypical preferences such as pedophilia (prepubescent children) and hebephilia (pubescent children). The aim of this theoretical-empirical review is to connect the concepts of a visual attention-based model of sexual arousal processing with eye movements as indicators of atypical sexual interests, to substantiate the use of eye-tracking as a useful indirect measure of sexual preferences according to sex and age of the stimuli. Implications for research are discussed in terms of recognizing the value, scope and limitations of eye-tracking in the study of pedophilia and other chronophilias in males and females, and the generation of new hypotheses using this type of indirect measure of human sexual response.

Sex at every size: A content analysis of weight inclusivity in sexual functioning research

Sexual functioning research has been slow to address sizeism within its volumes. Much of the sexual health science has adopted a weight normative model rather than a weight inclusive model. The purpose of this study was to, through systematic literature review, describe the sexual functioning research landscape with respect to weight inclusivity. The review included three databases (Google Scholar, Medline and Ebsco) between 2010 and 2020. Each article was double coded for weight inclusivity and sexual functioning. Sixty-seven articles met the criteria and were included in analysis. The articles, overall, only endorsed weight inclusive tenets 16 % of the time. Articles were most weight inclusive when discussing sexual satisfaction (22.5 %). Meanwhile, when discussing sexual arousal, the articles were the least weight inclusive (16.7 %). These findings suggest there is needs to be greater education and intention for sex educators, therapists, and clinicians, to explore and enhance body positivity and sexual health.

Excitation Transfer Between Sexual Arousal and Other Emotions in a Community Sample

Excitation transfer, the transfer of arousal from one emotion to another, might be a mechanism in the development of unusual sexual interests. In this pilot study, we investigated whether we could induce excitation transfer between various emotions and sexual arousal in a laboratory setting with 30 male volunteers. We induced low-level sexual arousal in four different emotional states (aggression/dominance, endearment, fear, disgust) and a neutral state. Sexual arousal was measured using penile plethysmography and self-report. Although there was no mean group effect, possibly due to large interindividual variations, 60% of the subjects showed more sexual arousal in response to sexual stimulation in at least one of the emotional states than in the neutral state. Excitation transfer was most prominent with aggression/dominance and least prominent with disgust. Genital excitation transfer was strongly related to lower penile reactivity and to higher self-reported erotophilia. This pilot study paves the way for further research into excitation transfer as a mechanism to increase the salience of stimuli that otherwise would not have been sexual in nature.

Gynephilic Men's and Androphilic Women's Visual Attention Patterns: The Effects of Gender and Sexual Activity Cues

Men and women differ in the degree of specificity of sexual response and differences in attention to sexual cues may be a mechanism underlying these gendered patterns. The majority of previous research has examined attention using static images, which differ considerably from the dynamic videos used in studies of sexual response. To test attention as a potential mechanism involved in gendered sexual response, we used eye-tracking to examine visual attention patterns of 33 gynephilic men and 36 androphilic women to videos depicting preferred and nonpreferred gender targets engaging in varying sexual activities. Specificity of controlled attention was gendered, and this effect differed depending on the intensity of sexual activity cues depicted. Regardless of sexual activity cues, men's controlled attention was gender-specific toward preferred targets. Sexual activity cues did, however, impact the degree to which women's controlled attention was gender-specific. Specifically, women's attention was gender-specific to low-intensity stimuli but nonspecific for masturbation and same-sex dyadic stimuli. Women's attention was gender-specific for mixed-sex dyadic stimuli, but with greater attention directed toward nonpreferred gender targets. Overall, contextual cues impact women's attention to a greater degree than men's. Potential explanations for these findings and implications of stimulus selection for sexuality research are discussed.

The Empirical Status of the Preparation Hypothesis: Explicating Women's Genital Responses to Sexual Stimuli in the Laboratory

Research conducted in our laboratory and in other laboratories has revealed that (1) women's genital responses to visual and auditory stimuli are strongly affected by the presence of sexual cues, but that (2) specific sexual cues (e.g., gender of actors, the presence of sexual violence) often have little impact on the magnitude of the responses-that is, similar genital responses are observed to very different sexual stimuli. In addition, (3) women's genital responses do not strongly correspond with self-reported sexual partner and activity preferences, or (4) with self-reported sexual arousal during the presentation of sexual stimuli. Taken together, these facts represent a puzzle, especially considering that men's genital responses are highly affected by specific sexual cues and strongly correspond to stated preferences and self-reported sexual arousal. One hypothesis to explain female low cue-specificity and low concordance (relative to men) is the preparation hypothesis: Women's indiscriminate genital responses serve a protective function. That is, they do not indicate or necessarily promote sexual interest and motivation, but rather prepare the vaginal lumen for possible sexual activity and therefore prevent injuries that may occur as a result of penetration. We review evidence for and against this hypothesis. We conclude that the evidence is favorable but not entirely convincing, and more work is required to reach a firm conclusion. We offer directions for future research.

Can the Vaginal Photoplethysmograph and Its Associated Methodology Be Used to Assess Anal Vasocongestion in Women and Men?

Forty years ago, researchers documented changes in vascular and muscular activity within the anal canal of women and men who engaged in sexual self-stimulation. Vascular changes were assessed using a photoplethysmograph that aimed to detect changes in pelvic vasocongestion. An important advantage of detecting sexual response within the anal canal is that the device, its anatomical placement, and the data output are identical for women and men, therefore facilitating gender comparisons of response patterns. In this study, the vaginal photoplethysmograph (VPP), the most common measure of genital response in women, was administered intra-anally as an anal photoplethysmograph (APG) to examine its validity and sensitivity as an indicator of sexual response. The final sample comprised 20 women and 20 men who were exposed to 12, 90-s sexual and nonsexual film clips while their APG responses were recorded. Participants also rated their sexual arousal and affective responses to the stimuli. There was evidence that APG responses were specific to sexual stimuli and were sensitive to erotic intensity in women. The degree of discrimination between sexual and nonsexual stimuli was lower in men. Unlike most sexual psychophysiological studies, the positive correlation between physiological and self-reported sexual arousal was stronger in women than in men. There was a relatively high number of data artifacts and the waveform morphology was uncharacteristic of that typically observed with VPP. The potential role of anal musculature interference on the APG signal is discussed, as well as avenues for future research.

The New Genetic Evidence on Same-Gender Sexuality: Implications for Sexual Fluidity and Multiple Forms of Sexual Diversity

In September of 2019, the largest-ever (N = 477,522) genome-wide-association study of same-gender sexuality was published in Science. The primary finding was that multiple genes are significantly associated with ever engaging in same-gender sexual behavior, accounting for between 8-25% of variance in this outcome. Yet an additional finding of this study, which received less attention, has more potential to transform our current understanding of same-gender sexuality: Specifically, the genes associated with ever engaging in same-gender sexual behavior differed from the genes associated with one's relative proportion of same-gender to other-gender behavior. I review recent research on sexual orientation and sexual fluidity to illustrate how these findings speak to longstanding questions regarding distinctions among subtypes of same-gender sexuality (such as mostly-heterosexuality, bisexuality, and exclusive same-gender experience). I conclude by outlining directions for future research on the multiple causes and correlates of same-gender expression.

Who Counts as Sexually Fluid? Comparing Four Different Types of Sexual Fluidity in Women

Previous research has examined the phenomenon of "sexual fluidity," but there is no current consensus on the specific meaning and operationalization of this construct. The present study used a sample of 76 women with diverse sexual orientations to compare four different types of sexual fluidity: (1) fluidity as overall erotic responsiveness to one's less-preferred gender, (2) fluidity as situational variability in erotic responsiveness to one's less-preferred gender, (3) fluidity as discrepancy between the gender patterning of sexual attractions and the gender patterning of sexual partnering, and (4) fluidity as instability in day-to-day attractions over time. We examined how these four types of fluidity relate to one another and to other features of women's sexual profiles (bisexual vs. exclusive patterns of attraction, sex drive, interest in uncommitted sex, age of sexual debut, and lifetime number of sexual partners). The four types of fluidity were not correlated with one another (with the exception of the first and fourth), and each showed a unique pattern of association with other features of women's sexual profiles. The only type of fluidity associated with bisexuality was overall erotic responsiveness to the less-preferred gender. The findings demonstrate that future research on sexual fluidity should distinguish between its different forms.

The Influence of Sexual Arousal on Self-Reported Sexual Willingness and Automatic Approach to Models of Low, Medium, and High Prior Attractiveness

Anecdotal evidence suggests that sexual attraction is flexible, and that high levels of sexual arousal can promote sexual willingness and approach tendencies toward a priori low attractive mates. This experimental study tested whether heightened sexual arousal can lower the threshold for sexual willingness and automatic approach tendencies toward potential sex partners of low and medium attractiveness. Heterosexual male (n =54) and female (n =61) participants were randomly assigned to a sexual arousal or control condition. Approach tendencies were indexed using a reaction time task. Sexual willingness was indexed using participant ratings of willingness to kiss and to consider having sex with same- and other-sex models of low, medium, and high attractiveness. Overall, participants showed stronger approach to models of high and medium than of low attractiveness. Sexual arousal weakened this differential responding but did not result in a robust increase of approach toward less attractive other-sex or same-sex models. Sexual willingness toward less attractive models was not affected by sexual arousal. Independent of condition, women reported greater sexual willingness toward same-sex models. The current pattern of findings does not support the notion that sexual arousal promotes automatic approach and sexual willingness to a broader array of sex partners.

Women's Cortisol Stress Responsivity, Sexual Arousability, and Sexual History

Life history theory and the adaptive calibration model state that characteristics of one's early environment influence individual differences in both neuroendocrine reactivity to stress and sexual risk-taking behavior. However, few studies have directly examined the relationship between neuroendocrine reactivity to stress and risky sexual behavior. This study used multilevel modeling to test whether cortisol reactivity and recovery in response to laboratory stress were associated with women's history of sexual behavior and their sexual arousability in response to laboratory sexual stimuli. Participants were 65 women (35% heterosexual, 44% bisexual, and 21% lesbian) who completed two laboratory sessions, two weeks apart. Women's self-reported sexual arousability to sexual stimuli interacted with their sexual abuse history to predict their trajectories of cortisol stress reactivity and recovery. Cortisol reactivity and recovery were not associated with women's sexual risk taking, such as the age of sexual debut, sociosexuality, or lifetime number of sexual partners.

Effect of a Condom Cover on Vaginal Photoplethysmographic Responses

INTRODUCTION

The vaginal photoplethysmograph (VPP) is a reusable intravaginal device often employed in sexual psychophysiology studies to assess changes in vaginal blood flow, an indicator of sexual arousal.

AIM

To test whether placing a disposable cover on the VPP probe impacts the acquired data. A condom cover would reduce risk of disease transmission and likely increase participant comfort but may negatively impact the VPP signal.

METHOD

The genital responses of 25 cisgender women (mean age = 21.3 years, standard deviation = 2.6) were assessed with VPP in a within-subjects design with 2 conditions-with and without a polyisoprene condom cover. Sexual responses were elicited by audiovisual film clips that varied in erotic intensity: nonsexual (nonsexual male-female interaction), low-intensity sexual (nude exercise), and high-intensity sexual (male-female intercourse). Women continuously rated their sexual arousal during stimulus presentations.

MAIN OUTCOME MEASURE

Change in vaginal pulse amplitude and also self-reported sexual arousal.

RESULTS

The magnitude of sexual response to each stimulus category and the overall pattern of results were found to be highly similar in the cover-off and cover-on conditions. The high-intensity sexual stimulus category elicited a greater sexual response than all other categories. The low-intensity sexual category elicited a (small) genital response in only the cover-on condition, although we suspect this is a spurious finding. There was no difference in the average number of edited movement artifacts across conditions.

CLINICAL IMPLICATIONS

Potential benefits of encasing the VPP probe with a protective cover include enhanced participant safety and comfort, especially if assessing genital responses of high-risk or immunocompromised samples. The use of a cover complies with current guidelines for reprocessing semi-critical medical devices (eg, vaginal ultrasound probes) in many regions.

STRENGTHS & LIMITATIONS

Although the idea of a VPP probe cover had been discussed among sexual psychophysiology researchers, this is the first study to empirically test whether a cover could jeopardize VPP data. Potential limitations include the use of a 10-Hz VPP sampling rate and a cover that was not tailored to the size of the VPP probe.

CONCLUSION

Placing a protective cover on the VPP probe did not appear to meaningfully impact sexual arousal or the VPP data. Based on these results and the potential advantages of a protective cover, researchers may wish to integrate the use a condom cover in their experiment protocols and clinical applications. Sawatsky ML, Lalumière ML. Effect of a Condom Cover on Vaginal Photoplethysmographic Responses. J Sex Med 2020; 17:702-715.

Assessing Paraphilic Interests Among Women Who Sexually Offend

PURPOSE OF REVIEW

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

RECENT FINDINGS

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

Exploring Comfort Levels and the Role of Compensation in Sexual Psychophysiology Study Participation

A number of devices have been developed to assess physiological sexual response. Some come into direct contact with the genitals (e.g., vaginal/clitoral/penile plethysmography [VPP/CPP/PPG], labial thermistors [LT]), whereas others capture images of the genitals remotely (e.g., thermal imaging [TI], laser Doppler imaging [LDI]). Researchers have speculated about the relative invasiveness of these measurement tools, with limited empirical work examining participants' perceptions of different devices and how these may impact volunteer bias. We investigated individuals' levels of comfort with participating in hypothetical sexual psychophysiology studies and their reasons for discomfort. We also examined the relationship between comfort level and compensation for participation. Men (n = 291) and women (n = 716) completed an online survey where they were presented with vignettes describing studies using VPP, CPP, PPG, LT, TI, and LDI. Participants reported their comfort level with the idea of participating in each study, the amount of compensation that would be reasonable, and factors influencing their decision not to participate if they were unwilling. Participants were similarly comfortable with some studies involving genital contact (VPP) or remote imaging (TI), and somewhat less comfortable with others (LDI, LT, PPG; small or small-medium effect sizes). Along with our qualitative analysis, these findings reveal that direct genital contact is one aspect of study intrusiveness, but that it is not necessarily the most important study feature influencing comfort with participation. Our results suggest that providing additional information regarding protocols at screening and offering $50 compensation might attract wider samples of participants.

The biological basis of sexual orientation: How hormonal, genetic, and environmental factors influence to whom we are sexually attracted

Humans develop relatively stable attractions to sexual partners during maturation and present a spectrum of sexual orientation from homosexuality to heterosexuality encompassing varying degrees of bisexuality, with some individuals also displaying asexuality. Sexual orientation represents a basic life phenomenon for humans. However, the molecular mechanisms underlying these diverse traits of sexual orientation remain highly controversial. In this review, we systematically discuss recent advancements in sexual orientation research, including those related to measurements and associated brain regions. Current findings regarding sexual orientation modulation by hormonal, genetic, maternal immune system, and environmental factors are summarized in both human and model systems. We also emphasize that future studies should recognize the differences between males and females and pay more attention to minor traits and the epigenetic regulation of sexual orientation. A comprehensive view of sexual orientation may promote our understanding of the biological basis of sex, and that of human reproduction, and evolution.

Sexual Orientation: Categories or Continuum? Commentary on Bailey et al. (2016)

Bailey et al. (2016) have provided an excellent, state-of-the-art overview that is a major contribution to our understanding of sexual orientation. However, whereas Bailey and his coauthors have examined the physiological, behavioral, and self-report data of sexual orientation and see categories, I see a sexual and romantic continuum. After noting several objections concerning the limitations of the review and methodological shortcomings characteristic of sexual-orientation research in general, I present evidence from research investigating in-between sexualities to support an alternative, continuum-based perspective regarding the nature of sexual orientation for both women and men. A continuum conceptualization has potential implications for investigating the prevalence of nonheterosexuals, sexual-orientation differences in gender nonconformity, causes of sexual orientation, and political issues.

The Effects of Gender and Relationship Context Cues on Responsive Sexual Desire in Exclusively and Predominantly Androphilic Women and Gynephilic Men

Sexual desire may be "responsive," emerging from sexual arousal to sexually competent cues. Cues that elicit sexual arousal and desire differ, however, by gender and direction of sexual attractions. Further, relationship context cues are thought to be important for responsive desire, but this has not been tested directly. The current study examined gynephilic men's (n = 27) and exclusively (n = 23) and predominantly (n = 17) androphilic women's dyadic and solitary responsive sexual desire, as well as genital and self-reported arousal, to audio narratives varying by gender (male, female) of the sexual partner and relationship context (stranger, friend, long-term relationship). Consistent with previous literature, gynephilic men's solitary and dyadic desire were gender-specific (greater to female than to male sexual partners). Exclusively androphilic women's dyadic desire differentiated less to cues of gender than gynephilic men's, and their solitary desire did not differentiate by gender cues at all, replicating previous research. Androphilic women with some gynephilia reported a gender-nonspecific pattern of dyadic and solitary desire (i.e., responsive desire to both male and female narratives). No effect of relationship context was found for any groups. Results suggest that responsive sexual desire may be more closely associated with self-reported than genital arousal patterns.

A review of infrared thermography as applied to human sexual psychophysiology

Infrared thermography (IRT) is a non-contact technique that permits mapping and analysis of the temperature of the body's skin surface. This method has been applied to sexual psychophysiology since the 1980s and its use has been expanding ever since, mainly because it provides several advantages over existing genital response measures. This article presents a review of experimental studies employing IRT to investigate human sexual arousal, with the aim of summarizing the available procedures and evidence so far and to identify important caveats in the literature. The studies reviewed support the feasibility and validity of IRT as a real-time physiological measure of sexual arousal but varied substantially regarding methodology and procedures. The results of this review underscore the value and validity of IRT in sexual psychophysiology and point at the critical need for the standardization of IRT protocols to accommodate the specific needs of applying this methodology to sexual physiology.

The Relationship Between Sexual Concordance and Orgasm Consistency in Women

Sexual concordance (the relationship between genital and self-reported sexual responses) may be associated with orgasm consistency (OC; the proportion of sexual acts leading to orgasm) during penile-vaginal intercourse (PVI) in women. We investigated the relationship between women's sexual concordance (assessed using different stimulus modalities and self-reported sexual arousal methods) and OC during various sexual activities (assessed using different types of questions). For Study 1 (n = 51), when sexual concordance was assessed using audiovisual sexual stimuli, we did not find a statistically significant relationship between OC and poststimulus self-reports of sexual arousal or genital sensations, raw values of OC, or ranges of OC. For Study 2 (n = 44), where sexual concordance was assessed using audionarrative sexual stimuli, we did find a statistically significant relationship between PVI OC and sexual concordance using change in self-reported sexual arousal, and ranges of orgasm consistency. Two findings were inconsistent with previous research. First, OC varied significantly by activity type in both studies; masturbation yielded the highest OC. Second, PVI OC was significantly related to oral sex and masturbation OC (Study 2). We discuss the need for further research and various factors that may affect women's orgasm consistency and sexual concordance.

The effect of static versus dynamic stimuli on visual processing of sexual cues in androphilic women and gynephilic men

Models of sexual response posit that attentional processing of sexual cues is requisite for sexual responding. Despite hypothesized similarities in the underlying processes resulting in sexual response, gender differences in sexual arousal patterns are abundant. One such gender difference relates to the stimulus features (e.g. gender cues, sexual activity cues) that elicit a response in men and women. In this study, we examined how stimulus modality (static visual images versus dynamic audiovisual films) and stimulus features (gender, sexual activity and nonsexual contextual cues) influences attentional (i.e. gaze) and elaborative (i.e. self-reported attraction (SRA), self-reported arousal) processing of sexual stimuli. Men's initial and controlled attention was consistently gender-specific (i.e. greater attention towards female targets), and this was not influenced by stimulus modality or the presence of sexual activity cues. By contrast, gender-specificity of women's attention patterns differed as a function of attentional stage, stimulus modality and the features within the stimulus. Degree of specificity was positively predictive of SRA in both genders; however, it was not significantly predictive of self-reported arousal. These findings are discussed in the context of gendered processing of visual sexual information, including a discussion of implications for research designs.

Does Repeated Testing Impact Concordance Between Genital and Self-Reported Sexual Arousal in Women?

Women show a substantial variability in their genital and subjective responses to sexual stimuli. The level of agreement between these two aspects of response is termed sexual concordance and has been increasingly investigated because of its implications for understanding models of sexual response and as a potential endpoint in clinical trials of treatments to improve women's sexual dysfunction. However, interpreting changes in sexual concordance may be problematic because, to date, it still is unclear how repeated testing itself influences sexual concordance in women. We are aware of only one study that evaluated temporal stability of concordance in women, and it found no evidence of stability. However, time stability would be necessary for arguing that concordance is a stable individual difference. The main goal of this study was to investigate the test-retest reliability of sexual concordance in a sample of 30 women with sexual difficulties. Using hierarchical linear modeling, we found that sexual concordance was not influenced by repeated testing 12 weeks later, but showed test-retest reliability suggesting temporal stability. Our findings support the hypothesis that sexual concordance is a relatively stable individual difference and that changes in sexual concordance after treatment or experimental conditions could, therefore, be attributed to effects of those conditions.

Gynephilic Men's Self-Reported and Genital Sexual Responses to Relationship Context Cues

The current study examined men's sexual responses to relationship context. Chivers and Timmers (2012) previously reported that heterosexual men's genital and self-reported sexual arousal varied by gender but not relationship context, suggesting that gender cues are more salient determinants of sexual response than relationship context cues for men. Those analyses were, however, significantly underpowered to detect relationship context effects (n = 9). The current study utilized the same paradigm as Chivers and Timmers' study, exposing a larger sample of heterosexual men (n = 26) to audio narratives describing sexual interactions that varied by partner gender (man, woman) and relationship context (stranger, friend, long-term relationship), and observing effects on genital and self-reported sexual response. Results indicated that men's genital response to relationship context cues mirrored those previously reported for heterosexual women (Chivers & Timmers, 2012); heterosexual men demonstrated less genital response to the friend than to the stranger or long-term relationship conditions. No significant effect of relationship context was found for men's self-reported sexual arousal. These data suggest that, in addition to gender cues, relationship cues may also be an important determinant of men's genital sexual responses.

Sexual Arousal and Sexually Explicit Media (SEM): Comparing Patterns of Sexual Arousal to SEM and Sexual Self-Evaluations and Satisfaction Across Gender and Sexual Orientation

Introduction

Investigations of patterns of sexual arousal to certain groups of sexually explicit media (SEM) in the general population in non-laboratory settings are rare. Such knowledge could be important to understand more about the relative specificity of sexual arousal in different SEM users.

Aims

(i) To investigate whether sexual arousal to non-mainstream vs mainstream SEM contents could be categorized across gender and sexual orientation, (ii) to compare levels of SEM-induced sexual arousal, sexual satisfaction, and self-evaluated sexual interests and fantasies between non-mainstream and mainstream SEM groups, and (iii) to explore the validity and predictive accuracy of the Non-Mainstream Pornography Arousal Scale (NPAS).

Methods

Online cross-sectional survey of 2,035 regular SEM users in Croatia.

Main Outcomes Measures

Patterns of sexual arousal to 27 different SEM themes, sexual satisfaction, and self-evaluations of sexual interests and sexual fantasies.

Results

Groups characterized by sexual arousal to non-mainstream SEM could be identified across gender and sexual orientation. These non-mainstream SEM groups reported more SEM use and higher average levels of sexual arousal across the 27 SEM themes assessed compared with mainstream SEM groups. Only few differences were found between non-mainstream and mainstream SEM groups in self-evaluative judgements of sexual interests, sexual fantasies, and sexual satisfaction. The internal validity and predictive accuracy of the NPAS was good across most user groups investigated.

Conclusions

The findings suggest that in classified non-mainstream SEM groups, patterns of sexual arousal might be less fixated and category specific than previously assumed. Further, these groups are not more judgmental of their SEM-related sexual arousal patterns than groups characterized by patterns of sexual arousal to more mainstream SEM content. Moreover, accurate identification of non-mainstream SEM group membership is generally possible across gender and sexual orientation using the NPAS.

Hald GM, Stulhofer A, Lange T, et al. Sexual Arousal and Sexually Explicit Media (SEM): Comparing Patterns of Sexual Arousal to SEM and Sexual Self-Evaluations and Satisfaction Across Gender and Sexual Orientation. Sex Med 2018;6:30–38.

Treatment seeking for problematic pornography use among women

Background and aims Previous studies examined psychological factors related to treatment seeking for problematic pornography use (PU) among males. In this study, we focused on females who seek treatment for problematic PU and compared them with non-problematic pornography users with regard to variables related to problematic PU. Second, we investigated the relationships between critical constructs related to problematic PU with the path analysis method, emphasizing the predictors for treatment seeking among women. We also compared our results with previous studies on males. Methods A survey study was conducted on 719 Polish-speaking Caucasian females, 14-63 years old, including 39 treatment seekers for problematic PU. Results The positive relationship between the mere amount of PU and treatment seeking loses its significance after introducing two other predictors of treatment-seeking: religiosity and negative symptoms associated with PU. This pattern is different from the results obtained in previous studies on males. Discussion Different from previous studies on male samples, our analysis showed that in the case of women, mere amount of PU may be related to treatment-seeking behavior even after accounting for negative symptoms associated with PU. Moreover, religiousness is a significant predictor of treatment seeking among women, which may indicate that in the case of women, treatment seeking for problematic PU is motivated not only by experienced negative symptoms of PU but also by personal beliefs about PU and social norms. Conclusion For females, negative symptoms associated with PU, the amount of PU and religiosity is associated with treatment seeking. Those factors should be considered in treatment.

Effects of Genital Response Measurement Device and Stimulus Characteristics on Sexual Concordance in Women

Investigations of sexual concordance suggest that, on average, women exhibit a low, positive correlation between their subjective sexual arousal and genital response. However, this relationship appears to be stronger, on average, when genital response is measured via the external tissues of the vulva than within the vagina walls. Given the methodological variations, such as stimulus content and duration, in studies of vulvar and vaginal concordance, direct comparisons between individual studies are limited. In the current study, sexual concordance was examined using concurrent measures of vulvar blood flow (using laser Doppler imaging) and vaginal vasocongestion (using vaginal photoplethysmography) to investigate potential differences in vulvar and vaginal concordance. Twenty-five women viewed two erotic films that differed in sexual activity content (foreplay and intercourse) while their subjective sexual arousal and genital response was measured. In support of previous meta-analytic findings, results suggest that subjective sexual arousal is more strongly correlated with vulvar blood flow than with vaginal vasocongestion. Likewise, perceived genital response and actual vulvar blood flow are more strongly related than are vaginal vasocongestion and self-reported genital sensations. Practical implications for the study of women's sexual concordance as well as broader implications for the understanding of female sexuality are considered.

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

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

Gender-Specificity in Viewing Time Among Heterosexual Women

Measures of sexual interest tend to be more gender-specific in heterosexual men than in heterosexual women. Cognitive measures, such as viewing time to attractive stimuli, may also show similar patterns of gender-specificity or nonspecificity among men and women and thus serve as useful adjuncts to more direct measures of sexual interest. The objectives of the present research were to determine the extent of gender-specificity in women's viewing times for female pictures (varying in their perceived physical attractiveness) and explore the influence of social comparison of physical appearance on these patterns of responses. In Study 1, we recorded only women's viewing times for pictures of both genders, measured self-reported menstrual cycle phase, and manipulated the waist-to-hip ratio of the women in the female pictures. In Study 2, we recorded women's and men's viewing times, self-reported sexual attraction to pictures of males and females, and physical appearance social comparison. Study 1 found that heterosexual women's viewing time toward female pictures was not associated with manipulation of the perceived attractiveness of those pictures. Study 2 found that heterosexual men were more gender-specific than heterosexual women in their viewing time patterns. We also found that reported sexual attraction and physical appearance social comparison were associated with heterosexual women's viewing times for female pictures, while heterosexual men's viewing times were associated with sexual attraction only. Our results are discussed in relation to the utility of viewing time as an indicator of visual attention toward attractive or sexually appealing visual stimuli.

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

INTRODUCTION

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

AIM

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

CONCLUSION

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

Controversies of Women’s Sexual Arousal and Desire

Abstract. The past three decades have seen an unprecedented increase in empirical research on women’s sexual response. In this review, we critically examine current controversies and assumptions associated with the nature of women’s sexual arousal and desire. We focus specifically on four assumptions: (1) the assumption that women should be aroused by stimuli that align with their stated preferences, (2) the assumption that women’s physiological and self-reported arousal should perfectly align, (3) the assumption that sexual desire precedes sexual arousal, and (4) the assumption that a single pharmaceutical compound will adequately restore women’s sexual response to her level of satisfaction. Engaging a gendered psychological framework for conceptualizing women’s sexuality, we emphasize the need for models of women’s sexual response to be sensitive to the sexed biological processes and gendered psychosocial factors that contribute to a woman’s unique sexual experience.

Assessing the Relationship Between Sexual Concordance, Sexual Attractions, and Sexual Identity in Women

On average, there is a gender difference in sexual concordance, with men exhibiting greater agreement between genital and self-reported sexual arousal, relative to women. Much less is known about the substantial variation in women's sexual concordance; women's genital and self-reported sexual responses may correlate strongly and positively, not at all, or even strongly negatively. The within-gender variation in sexual concordance suggests that individual differences may be related to sexual concordance. We examined whether sexual concordance varies as a function of sexual orientation (based on self-reported sexual attractions and sexual identity labels) in a sample (N = 76) that included exclusively androphilic, predominantly androphilic, ambiphilic, and predominantly/exclusively gynephilic women. Participants viewed sexual and nonsexual stimuli that varied by actor gender while their vaginal vasocongestion and subjective sexual responses were measured. Women's sexual concordance varied as a function of their sexual attractions; women with any degree of gynephilia exhibited higher sexual concordance than exclusively androphilic women across a variety of sexual concordance measures, and these effects were demonstrated using correlation and multi-level modeling analyses. Only sexual concordance based on overall feelings of arousal varied by sexual identity, with heterosexual women exhibiting the lowest sexual concordance. Stimulus gender significantly influenced sexual concordance for most groups of women: Ambiphilic and predominantly/exclusively gynephilic women exhibited greater sexual concordance to female stimuli and exclusively androphilic women exhibited greater sexual concordance to male stimuli. These findings suggest that sexual orientation (particularly one's degree of gynephilia) may explain some of the within-gender variation seen in women's sexual concordance.

Pupil Dilation to Explicit and Non-Explicit Sexual Stimuli

Pupil dilation to explicit sexual stimuli (footage of naked and aroused men or women) can elicit sex and sexual orientation differences in sexual response. If similar patterns were replicated with non-explicit sexual stimuli (footage of dressed men and women), then pupil dilation could be indicative of automatic sexual response in fully noninvasive designs. We examined this in 325 men and women with varied sexual orientations to determine whether dilation patterns to non-explicit sexual stimuli resembled those to explicit sexual stimuli depicting the same sex or other sex. Sexual orientation differences in pupil dilation to non-explicit sexual stimuli mirrored those to explicit sexual stimuli. However, the relationship of dilation to non-explicit sexual stimuli with dilation to corresponding explicit sexual stimuli was modest, and effect magnitudes were smaller with non-explicit sexual stimuli than explicit sexual stimuli. The prediction that sexual orientation differences in pupil dilation are larger in men than in women was confirmed with explicit sexual stimuli but not with non-explicit sexual stimuli.

Category Specificity of Self-Reported Sexual Attraction and Viewing Times to Male and Female Models in a Large U.S. Sample: Sex, Sexual Orientation, and Demographic Effects

Recent research has documented large and robust sex differences in the category specificity of self-reported sexual attraction and viewing times to men and women, with men showing more polarized responses to the two sexes than women. However, this research has been limited by the use of small and restricted samples. To address this, the current study assessed a representative sample of more than 2800 U.S. adults on demographic and attitudinal variables and on two measures of category specificity: one based on self-reported sexual attraction and the other based on viewing times to male and female swimsuit models. Key findings were replicated. On average, men were considerably more category specific in self-reported sexual attraction and viewing times than women, and this was true for both heterosexual and homosexual participants. Self-identified bisexual and asexual participants tended to be lower on category specificity than other groups. Although demographic and attitudinal factors such as age, ethnicity, state and region of residence, social class, political liberalism-conservatism, and religiousness were sometimes weakly related to category specificity, sex differences in category specificity remained robust despite demographic and attitudinal variation.

Visual Attention Patterns of Women with Androphilic and Gynephilic Sexual Attractions

Women who report exclusive sexual attractions to men (i.e., androphilia) exhibit gender-nonspecific patterns of sexual response-similar magnitude of genital response to both male and female targets. Interestingly, women reporting any degree of attraction to women (i.e., gynephilia) show significantly greater sexual responses to stimuli depicting female targets compared to male targets. At present, the mechanism(s) underlying these patterns are unknown. According to the information processing model (IPM), attentional processing of sexual cues initiates sexual responding; thus, attention to sexual cues may be one mechanism to explain the observed within-gender differences in specificity findings among women. The purpose of the present study was to examine patterns of initial and controlled visual attention among women with varying sexual attractions. We used eye tracking to assess visual attention to sexually preferred and nonpreferred cues in a sample of 164 women who differed in their degree of androphilia and gynephilia. We found that both exclusively and predominantly androphilic women showed gender-nonspecific patterns of initial attention. In contrast, ambiphilic (i.e., concurrent androphilia and gynephilia) and predominantly/exclusively gynephilic women oriented more quickly toward female targets. Controlled attention patterns mirrored patterns of self-reported sexual attractions for three of these four groups of women, such that gender-specific patterns of visual attention were found for androphilic and gynephilic women. Ambiphilic women looked significantly longer at female targets compared to male targets. These findings support predictions from the IPM and suggest that both initial and controlled attention to sexual cues may be mechanisms contributing to within-gender variation in sexual responding.

Assessing differences in physiologic subjective response toward male and female orientated sexually explicit videos in heterosexual individuals

The goal of the present study was to examine sexual response to male- and female- oriented sexually explicit films in heterosexual men and women. Forty participants (20 men and 20 women; mean age=29.42 years) attended three separate lab sessions. One 15 minute sexually explicit video was shown per session. For session one, all participants viewed a female-oriented film selected by the experimenters. The films used for subsequent sessions were counterbalanced male-oriented or female-oriented clips that had been previously studied. A thermographic camera measured temperature on the penile shaft for men and labia for women. Continuous and discrete self-reported sexual arousal was also obtained. Genital temperature was averaged into 15 one-minute bins and a repeated-measures ANOVA was conducted. Men demonstrated significantly greater increases in temperature over time than women, F (14, 980)=19.27, p=.000, however there were no significant differences between films or sex × film interaction. Women reported significantly higher subjective sexual arousal to the films than men, F (1, 69) range=3.89 to 9.67, p range=.01 to .05, but there were no significant differences between films or a sex × film interaction. Results suggest that film orientation has minimal impact on physiologic sexual responsiveness in men or women. Although both sexes demonstrated significant increases in sexual arousal for these pre-selected films, future laboratory research would benefit from examining whether participant-selected stimuli produces a greater response than experimenter-selected films.

Gender-Specificity of Initial and Controlled Visual Attention to Sexual Stimuli in Androphilic Women and Gynephilic Men

Research across groups and methods consistently finds a gender difference in patterns of specificity of genital response; however, empirically supported mechanisms to explain this difference are lacking. The information-processing model of sexual arousal posits that automatic and controlled cognitive processes are requisite for the generation of sexual responses. Androphilic women's gender-nonspecific response patterns may be the result of sexually-relevant cues that are common to both preferred and nonpreferred genders capturing attention and initiating an automatic sexual response, whereas men's attentional system may be biased towards the detection and response to sexually-preferred cues only. In the present study, we used eye tracking to assess visual attention to sexually-preferred and nonpreferred cues in a sample of androphilic women and gynephilic men. Results support predictions from the information-processing model regarding gendered processing of sexual stimuli in men and women. Men's initial attention patterns were gender-specific, whereas women's were nonspecific. In contrast, both men and women exhibited gender-specific patterns of controlled attention, although this effect was stronger among men. Finally, measures of attention and self-reported attraction were positively related in both men and women. These findings are discussed in the context of the information-processing model and evolutionary mechanisms that may have evolved to promote gendered attentional systems.

Peripheral Female Genital Arousal as Assessed by Thermography Following Topical Genital Application of Alprostadil vs Placebo Arousal Gel: A Proof-of-Principle Study Without Visual Sexual Stimulation

Introduction

Female sexual arousal disorder is a pathophysiologic state characterized clinically by persistent or recurrent inability to attain or maintain an adequate lubrication-swelling response of sexual excitement until completion of sexual activity. Prior clinical experience with alprostadil products for men with erectile dysfunction supports its use in women with female sexual arousal disorder.

Aim

To compare the effect of topical alprostadil with over-the-counter (OTC) lubricant on female genital arousal in the absence of visual sexual stimuli.

Methods

Healthy premenopausal women without sexual dysfunction were recruited from the community to participate in the study. Of 17 women who consented, 10 were enrolled and completed the trial. The mean age of subjects was 32 years (range = 27–43). Study drug or placebo was applied topically to the genitals. Continuous temperature monitoring was performed. Participants completed questionnaires assessing genital sensation, effect, intensity, and duration.

Main Outcome Measures

Change in temperature from baseline in vestibule, clitoris and vulva.

Results

In all 10 subjects, topical alprostadil induced a statistically significant increase in temperature of the vestibule, clitoris, and vulva compared with the OTC lubricant. The most rapid difference in genital temperature between placebo and alprostadil was seen on the vulva, which demonstrated a significant difference at approximately 9 minutes. There was a significant difference in temperature seen for the vestibule and clitoris at 11 and 19 minutes, respectively. Sixty percent of women reported being aware or conscious of genital sensations with topical alprostadil, but not with OTC lubricant. Discordance was noted in 30% of subjects who reported being aware or conscious of genital sensations with the two treatments and 10% who reported not being aware or conscious of genital sensations with either treatment.

Conclusion

Topical alprostadil administered to healthy premenopausal women induced statistically significant, sustained increases in genital temperatures of the vestibule, clitoris, and vulva within 20 minutes compared with OTC lubricant.

Recidivism Risk Assessment for Adult Sexual Offenders

Sexual offending is a significant public health problem in the USA due to its prevalence and the substantial impact it has on victims, victims' families, and the legal and mental health systems. The assessment of sexual offender recidivism risk is an important aspect of developing effective management strategies for sexual offenders in terms of placement, treatment, and other interventions. Researchers have developed numerous tools to aid in the assessment of sexual violence recidivism risk, including actuarial measures, structured professional judgment methods, and psychophysiologic assessment of sexual interests. The Static-99R and Sexual Violence Risk-20 are two instruments that have received substantial research attention for their ability to accurately compare offenders' risk of recidivism to normative group data. Penile plethysmography and visual reaction time are used to evaluate subjects' responses to sexual stimuli in an effort to characterize offenders' sexual arousal and interest, respectively. Though current research has focused on risk assessment tools' predictive utility, future research will need to examine the impact that actuarial and structured professional judgment tools have on reducing recidivism if they are to have relevance in the management of sexual offenders.

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

INTRODUCTION

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

AIM

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

METHODS

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

MAIN OUTCOME MEASURES

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

RESULTS

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

CONCLUSION

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