Use of sexual stimuli in research and clinical settings: expert opinion and recommendations

Background

Sexual stimuli, such as sexual videos, images, and narratives describing sexual interactions, are one of many tools used by clinicians and researchers to elicit or augment sexual response. Given the wide variability within sexual stimuli and their effects on sexual response, we provide guidance on when and how to use sexual stimuli, selecting sexual stimuli, and standardizing the use and reporting of sexual stimuli in research and clinical practice.

Aim

This expert opinion review article discusses standard operating procedures when using sexual stimuli in clinical and research applications, addressing 3 broad areas: settings in which sexual stimuli are used, characteristics and contexts of the stimuli, and practical and ethical considerations when using the stimuli.

Methods

This article is based on an expert opinion review of the sexual psychophysiology literature.

Results

First, we discuss the settings in which sexual stimuli are typically used and evaluate the ecological validity of each setting. Second, we review the types of sexual stimuli used in sexual response research, including physical characteristics, depicted sexual activity, and context, and the impacts of these characteristics on sexual response. Last, we discuss the practical and ethical considerations that come with the choice and use of sexual stimuli in clinical and research settings. We address potential limitations of certain sexual stimuli, including practical and ethical considerations such as participant vs experimenter choice, diversity and representation, and proper sourcing of sexual stimuli for use in clinical and research applications. Discussions on the future applications of sexual stimuli, such as the use of virtual reality, and ethical considerations in terms of user-generated Internet sexual stimuli are also explored.

Conclusion

We provide an expert opinion review of the literature regarding use of sexual stimuli for clinical and research applications and offer best use practices and recommendations.

Is Pornography Really about "Making Hate to Women"? Pornography Users Hold More Gender Egalitarian Attitudes Than Nonusers in a Representative American Sample

According to radical feminist theory, pornography serves to further the subordination of women by training its users, males and females alike, to view women as little more than sex objects over whom men should have complete control. Composite variables from the General Social Survey were used to test the hypothesis that pornography users would hold attitudes that were more supportive of gender nonegalitarianism than nonusers of pornography. Results did not support hypotheses derived from radical feminist theory. Pornography users held more egalitarian attitudes--toward women in positions of power, toward women working outside the home, and toward abortion--than nonusers of pornography. Further, pornography users and pornography nonusers did not differ significantly in their attitudes toward the traditional family and in their self-identification as feminist. The results of this study suggest that pornography use may not be associated with gender nonegalitarian attitudes in a manner that is consistent with radical feminist theory.

Erotica viewing effects on intimate relationships and self/partner evaluations

Viewing visual sexual stimuli (VSS) has been documented to have both positive (e.g., increased sexual arousal and sexual behaviors) and negative (e.g., higher anxiety, devaluing of partner attractiveness) effects. Excitation transfer and social comparison theories were used to generate hypotheses that could explain these mixed findings. Forty-four monogamous, heterosexual couples viewed erotic, exciting (non-erotic films), and nature films both alone and together. They rated their feelings of general arousal and relationship satisfaction as well as perceptions of self and partner sexual behaviors and attractiveness. Participants viewing both the erotic and exciting films reported equivalent increases in excitement; however, the erotic film was rated as slightly more generally arousing and increased participant's desire to be close to their partner. Viewing the erotic films also induced greater reports of negative affect, guilt, and anxiety. These findings moderately support a transfer of excitation interpretation. No effects of partner presence or absence while viewing the films was found. Viewing erotic films led to more positive evaluations of one's own sexual behaviors. These findings provide mixed support in regard to self and partner social comparisons. Co-occurring positive and negative emotional reactions were explored as possible explanation to the complex reactions to VSS.

The impact of brief exposure to sexually explicit video clips on partnered female clitoral self-stimulation, orgasm and sexual satisfaction

Inconsistent coital orgasm is a common complaint among women presenting with sexual function concerns. While sex therapy interventions incorporating explicit instructions and specific models of direct clitoral stimulation have been used to improve coital orgasm consistency among women, it is unclear whether simple exposure to sexually explicit models without specific instructional focus can stimulate such change. The purpose of this study was to determine if exposure to models of clitoral stimulation can induce imitative behaviour and enhance sexual functioning in a nonclinical sample of women. Female undergraduate students (N=64) were randomly assigned to view humourous media, or erotic media, or erotic media featuring explicit models of clitoral self-stimulation during partnered sexual behaviour. One week later, participants reported on their sexual behaviours, including frequency of clitoral self-stimulation (over the previous seven days), consistency of orgasm, and sexual satisfaction. The results indicated partial support for the hypothesized effect of exposure to clitoral stimulation models. Women who viewed explicit models of clitoral self-stimulation subsequently engaged in clitoral self-stimulation 3.51 times more often during subsequent partnered sexual behaviour than women exposed to humorous media, and engaged in clitoral self-stimulation in a greater proportion of their partnered sexual behaviours (Mdn=29%) than did women who viewed erotic media (Mdn=0%), or humorous media (Mdn=0%). However, no differences were found in reported consistency of orgasm or sexual satisfaction among the groups. These preliminary results provide evidence for a specific imitative effect following exposure to sexual media.

Viewing sexually-explicit materials alone or together: associations with relationship quality

This study investigated associations between viewing sexually-explicit material (SEM) and relationship functioning in a random sample of 1291 unmarried individuals in romantic relationships. More men (76.8%) than women (31.6%) reported that they viewed SEM on their own, but nearly half of both men and women reported sometimes viewing SEM with their partner (44.8%). Measures of communication, relationship adjustment, commitment, sexual satisfaction, and infidelity were examined. Individuals who never viewed SEM reported higher relationship quality on all indices than those who viewed SEM alone. Those who viewed SEM only with their partners reported more dedication and higher sexual satisfaction than those who viewed SEM alone. The only difference between those who never viewed SEM and those who viewed it only with their partners was that those who never viewed it had lower rates of infidelity. Implications for future research in this area as well as for sex therapy and couple therapy are discussed.

The impact of diabetes mellitus on female sexual well-being

For women, the risk for developing diabetes mellitus is reaching epidemic levels. As a result of the impact of diabetes on multiple body systems, women may suffer from medical and psychologic problems, including sexual dysfunction. It is difficult to separate sexual response from the many emotional and other contributing factors that may influence a relationship. Therefore, it is vital that clinicians address the issue of sexuality with their female diabetic patients. This article provides a brief review of the literature, followed by a discussion addressing the proper approach for sexual dysfunction screening. Finally, this article considers some of the current and future treatment modalities that can be used to enhance sexual functioning in female diabetics with impaired sexual function.

Treatment of female sexual dysfunction

OBJECTIVE

To review the pathophysiology and psychology of female sexual dysfunction (FSD) and describe potential prevention and treatment strategies for the disorder.

DATA SOURCES

Articles identified from a MEDLINE search (1966-June 2002) using the term female sexual dysfunction. Additional references were obtained from cross referencing retrieved articles.

STUDY SELECTION AND DATA EXTRACTION

After evaluating various review articles, clinical trials, and investigational studies, all information that was deemed relevant by the reviewers was included.

DATA SYNTHESIS

FSD is a multicausal and multidimensional problem combining biological, psychological, and interpersonal factors. The American Foundation for Urological Disease classifies FSD into 4 broad categories: sexual desire disorders, arousal disorder, orgasmic disorder, and sexual pain disorders. Depending on specific individual characteristics and category of disorder, a variety of potential treatments are available. Pharmacists can play a role in identifying and managing medication-related adverse effects that may be exacerbating FSD and educating women on treatment modalities.

CONCLUSIONS

FSD is a complicated disorder that is often difficult to identify, classify, and treat appropriately. Pharmacists should have an understanding of the potential causes of FSD and the treatment options available so that they may make appropriate recommendations and counsel women effectively.