Interoception and sexual response in women with low sexual desire

Study of Sexual Concordance in Men and Women with Different Typologies of Adherence to the Sexual Double Standard

Background/Objective

Sexual concordance (i.e., relationship between genital response and subjective sexual arousal) is higher in men than in women. Among the factors that could explain this difference would be the sexual double standard (SDS). Sexual concordance is examined by SDS typologies of adherence (egalitarian, man-favorable, and woman-favorable).

Method

During exposure to a film with sexual content, genital response (penile circumference/vaginal pulse amplitude) and self-reported sexual arousal were recorded in 104 young adults (42 men and 62 women), distributed into SDS typologies of adherence on the basis of their scores on the Sexual Double Standard Scale.

Results

Sexual concordance was obtained in men and women with egalitarian and man-favorable typology. Subjective sexual arousal explained a significant percentage of the variance in genital response in the egalitarian typology (men: R² = .32, p < .01; women: R² = .19, p < .05) and man-favorable typology (men: R² = .21, p < .05; women: R² = .23, p < .05).

Conclusions

Agreement between genital responsiveness and subjective sexual arousal depends on DES adherence typology.

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

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

Women's Sexual Desire, Trauma Exposure, and Posttraumatic Stress Disorder

Research suggests that posttraumatic stress disorder (PTSD) is associated with sexual dysfunction; however, there is a paucity of research examining the relations among trauma exposure, PTSD, and low sexual desire, specifically. Thus, the goal of the present study was to investigate whether women with hypoactive sexual desire disorder (HSDD; n = 132) were more likely to meet criteria for a diagnosis of current or lifetime PTSD relative to women with no sexual desire concerns (n = 137). We also sought to compare the type, frequency, and intensity of PTSD symptoms between the two groups. Finally, we examined whether women in the two groups were exposed to more, or different types of, potentially traumatic events. Compared to women with no sexual health concerns, women with HSDD were more likely to meet criteria for current PTSD, odds ratio (OR) = 5.50, 95% CI [1.18, 25.61]; and lifetime PTSD, OR = 2.78, 95% CI [1.56, 4.94]. Women in the HSDD group also had higher odds of meeting criteria for avoidance (5.10 times) and hyperarousal symptoms (4.48 times) and scored higher on measures of past-month PTSD symptom frequency, d = 0.62, and intensity, d = 0.57. No group differences were observed regarding reexperiencing symptoms, the associated features of PTSD, or type or frequency of exposure to potentially traumatic events. The findings indicate PTSD symptomatology may be a predisposing or perpetuating contributor to low sexual desire, and low sexual desire and PTSD may be related through an alteration in stress adaptability.

The Relationship between Subjective and Physiological Sexual Arousal in Women with and without Arousal Concerns

Whereas laboratory studies frequently report low correlations between women's physiological and subjective sexual arousal (i.e., concordance), research employing advanced statistical techniques reveals striking between-person variability in this relationship. Moreover, previous research has shown that interoception (i.e., the awareness of changes within the body) influences concordance in women, though how this effect varies by sexual function is yet unknown. The present study used multilevel modeling to examine concordance in women with (n = 27) and without (n = 28) sexual arousal concerns and explored how concordance varies as a function of interoception. Women viewed a sexual film while their arousal responses were measured and then completed a self-report measure of interoception. A significant relationship emerged between physiological and subjective sexual arousal, in addition to tremendous between-person variability across both groups. Several aspects of interoception moderated concordance (p's between 0.0008 and 0.03), and this pattern varied across groups. Given this variability even in absence of sexual arousal concerns, these findings question the utility of using concordance as a clinical outcome in treatment research. Individual differences in interoception may have implications for treatment matching.

An interoceptive illusion of effort induced by false heart-rate feedback

Interoception, or the sense of the internal state of the body, is key to the adaptive regulation of our physiological needs. Recent theories contextualize interception within a predictive coding framework, according to which the brain both estimates and controls homeostatic and physiological variables, such as hunger, thirst, and effort levels, by orchestrating sensory, proprioceptive, and interoceptive signals from inside the body. This framework suggests that providing false interoceptive feedback may induce misperceptions of physiological variables, or "interoceptive illusions." Here we ask whether it is possible to produce an illusory perception of effort by giving participants false acoustic feedback about their heart-rate frequency during an effortful cycling task. We found that participants reported higher levels of perceived effort when their heart-rate feedback was faster compared with when they cycled at the same level of intensity with a veridical feedback. However, participants did not report lower effort when their heart-rate feedback was slower, which is reassuring, given that failing to notice one's own effort is dangerous in ecologically valid conditions. Our results demonstrate that false cardiac feedback can produce interoceptive illusions. Furthermore, our results pave the way for novel experimental manipulations that use illusions to study interoceptive processing.

Interoceptive Awareness, Alexithymia, and Sexual Function

Research in women suggests a relation between sexual difficulties and lower interoceptive awareness, the conscious perception of internal bodily states. Lower interoceptive awareness is theoretically linked to greater alexithymia, which has been related to sexual dysfunctions. Hence, we examined the relations of interoceptive awareness and alexithymia with several dimensions of sexual functioning in a nonclinical sample of both sexes. Methods: Three hundred forty Portuguese (228 women, 112 men) completed the Toronto Alexithymia Scale (TAS-20) and the Multidimensional Assessment of Interoceptive Awareness (MAIA). Women additionally completed the Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale-Revised (FSDS-R). Men additionally completed the International Index of Erectile Function (IIEF) and one question on difficulties delaying ejaculation. Greater alexithymia correlated with lesser interoceptive awareness. For women, greater alexithymia and lesser interoceptive awareness correlated with lesser arousal, lesser lubrication, more orgasm difficulties, more dissatisfaction, more pain, and more sexual distress. Higher female desire correlated with greater interoceptive awareness, but was unrelated to alexithymia. In men, lesser interoceptive awareness correlated with more difficulties delaying ejaculation, and greater alexithymia correlated with more erectile difficulties. The present investigation corroborates that awareness of emotions and internal bodily states is important for sexual functioning.

Trust, Sexual Trust, and Sexual Health: An Interrogative Review

Trust is experienced almost constantly in all forms of social and interpersonal relationships, including sexual relationships, and may contribute both directly and indirectly to sexual health. The purpose of this review is to link three aspects of trust to sexual health: (1) the role of trust in sexual relationships; (2) the role of trust in sexually transmitted infection (STI) prevention, particularly condom use; and (3) the relevance of trust in sexual relationships outside of the traditional model of monogamy. The review ends with consideration of perspectives that could guide new research toward understanding the enigmas of trust in partnered sexual relations in the context of sexual and public health.

The Relationship Between Sexual Functioning and Sexual Concordance in Women

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

Correction: Interoception and sexual response in women with low sexual desire

[This corrects the article DOI: 10.1371/journal.pone.0185979.].