Effects of erotic stimuli on sexually functional and dysfunctional women: multiple measures before and after sex therapy

In Pursuit of Pleasure: A Biopsychosocial Perspective on Sexual Pleasure and Gender

Objective: Various sources of evidence suggest that men and women differ in their experience of sexual pleasure. Such gender differences have been attributed to men's higher innate sex drive, supported by evolutionary psychology perspectives and gender differences in reproductive strategies. Method: This paper presents biopsychosocial evidence for gender similarities in the capacity to experience pleasure, and for substantial gender differences in opportunities for sexual pleasure. Results: We conclude that sexual activity, in most cultures, is less pleasurable and associated with greater cost for heterosexual women than for heterosexual men, even though they do not differ in the capacity for sexual pleasure. Conclusion: Since gender differences in experienced sexual pleasure are not a biological given, a more critical discourse of sexual pleasure might create awareness of current inequalities, help lift restrictions for women's opportunities for pleasure, and could reduce gender differences in the cost of sex. That would truly serve sexual justice around the globe.

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.

Cardiometabolic Risk and Female Sexuality-Part II. Understanding (and Overcoming) Gender Differences: The Key Role of an Adequate Methodological Approach

INTRODUCTION

Although basic science and clinical research indicate that the vascular physiopathology of male and female sexual dysfunction (FSD) is similar, to date the association between FSD and cardiovascular (CV) diseases has been only marginally explored.

AIM

To discuss the potential reasons for differences in the role of CV diseases and risk factors in sexual function in women vs men in the 2nd part of a 2-part review.

METHODS

A thorough literature search of peer-reviewed publications on the topic was performed using the PubMed database.

MAIN OUTCOME MEASURES

We present a review of the main factors that could account for this gap: (i) actual physiologic discrepancies and (ii) factors related to the inadequacy of the methodologic approach used to investigate CV risk in patients with FSD. A summary of the available methods to assess female sexual response, focusing on genital vascularization, is reported.

RESULTS

The microanatomy and biochemistry of the male and female peripheral arousal response are similar; in contrast, there are differences in the interplay between the metabolic profile and sex steroid milieu, in the relative weighting of cardiometabolic risk factors in the pathogenesis of CV disease, and their clinical presentation and management. CV diseases in women are under-recognized, leading to less aggressive treatment strategies and poorer outcomes. Moreover, evaluation of hemodynamic events that regulate the female sexual response has thus far been plagued by methodologic problems.

CONCLUSION

To clarify whether sexuality can be a mirror for CV health in women, the female genital vascular district should be objectively assessed with standardized and validated methods. Studies designed to establish normative values and longitudinal intervention trials on the effect of the treatment of CV risk factors on FSD are urgently needed. Maseroli E, Scavello I, Vignozzi L. Cardiometabolic Risk and Female Sexuality-Part II. Understanding (and Overcoming) Gender Differences: The Key Role of an Adequate Methodological Approach. Sex Med Rev 2018;6:525-534.

Ignorance Is Not Bliss: If We Don't Understand Hypoactive Sexual Desire Disorder, How Can Flibanserin Treat It? Commentary

BACKGROUND

Female sexual dysfunction (FSD) affects as many as 1 in every 3 women, with a significant portion of these with hypoactive sexual desire disorder (HSDD). These figures alone present significant psychological and pharmacologic challenges. Partly in response to this situation, in 2015 the US Food and Drug Administration approved flibanserin for the treatment of HSDD. This approval has drawn criticism on the grounds of efficacy and necessity.

AIM

To better inform potential consumers about FSD, flibanserin and other interventions for the treatment of HSDD, the importance of understanding the mechanism of FSD, and the efficacy of flibanserin and to review existing relevant knowledge.

METHODS

A literature review of extant clinic studies and theoretical discussion articles was performed.

OUTCOMES

Efficacy of flibanserin for addressing symptoms associated with HSDD in premenopausal women.

RESULTS

Extant literature and empirical evidence suggest that the efficacy of flibanserin for the treatment of HSDD in premenopausal women is at least questionable.

CLINICAL TRANSLATION

Clinicians considering the prescription of flibanserin would be well advised to appreciate some of the controversies concerning the efficacy of the drug.

STRENGTHS AND LIMITATIONS

The prohibitive usage guidelines, tenuous risk-benefit profile, and considerable cost of use of flibanserin are each worthy of consideration. Flibanserin thus far has been trialed in only a narrow patient range: premenopausal women in long-term relationships with acquired or generalized HSDD.

CONCLUSIONS

Although we acknowledge that the discovery and use of flibanserin constitute a compelling narrative, we conclude by questioning the specific efficacy and necessity of flibanserin in providing a treatment for HSDD in women. Anderson R, Moffatt CE. Ignorance Is Not Bliss: If We Don't Understand Hypoactive Sexual Desire Disorder, How Can Flibanserin Treat It?

COMMENTARY

J Sex Med 2018;15:273-283.

A Single Session of Autogenic Training Increases Acute Subjective and Physiological Sexual Arousal in Sexually Functional Women

Heart rate variability (HRV) has recently been associated with female sexual function (Stanton, Lorenz, Pulverman, & Meston, 2015). Below-average HRV was identified as a possible risk factor for sexual arousal dysfunction and overall sexual dysfunction in women. Based on this newly established relationship between HRV and female sexual function, the present study examined the effect of autogenic training to increase HRV on acute physiological and subjective sexual arousal in women. Specifically, vaginal pulse amplitude (VPA), an index of genital sexual arousal, and subjective sexual arousal were assessed in 33 sexually functional women, aged 18 to 27, before and after a short session of autogenic training. Autogenic training, a relaxation technique that restores the balance between the activity of the sympathetic and the parasympathetic branches of the autonomic nervous system, has been shown to significantly increase HRV (Miu, Heilman, & Miclea, 2009). After autogenic training, significant increases in both VPA (p <.05) and subjective sexual arousal (p <.005) were observed. Moreover, change in HRV from pre- to postmanipulation significantly moderated changes in subjective sexual arousal (p <.05) when it was measured continuously during the presentation of the erotic stimulus. This cost-effective, easy-to-administer behavioral intervention may have important implications for increasing sexual arousal in women.

The impact of ejaculatory dysfunction upon the sufferer and his partner

Ejaculatory function cannot be evaluated outside the dyadic process and without taking into account the men’s and women’s cognition of the condition and how their subjective perception impacts on the evaluation of the relationship and sexual quality. Although the distress of the sufferer and his partner has been a motivating factor in leading men with ejaculatory dysfunction to seek medical help, few objective or prospective evaluations of the effects on the couple have been reported. Specialized literature has been dealing with ejaculatory disorders in a heterogeneous manner. Comparatively, there are far more studies on premature ejaculation (PE) than on delayed ejaculation (DE) and even fewer studies on other male orgasm disorders. Therefore, the review focuses on the literature of the two most studied ejaculatory disorders. The matter presented in this article can also be considered for other ejaculatory disorders, since all of them relate to a failure of control, changing the intravaginal ejaculatory latency time (IELT), with consequences for men and their partners. There are multiple psychological explanations as to why a man develops PE or DE. Unfortunately, none of the theories evolve from evidence-based studies. The common final pathway of these factors is the irrational fear of ejaculating intravaginally. These sexual disorders may also cause personal distress for the sexual partner and decreased sexual satisfaction for the couple. An association between pre-existing anxiety disorders and sexual performance anxiety has been found in men and couples with ejaculatory dysfunction. This could reflect a process in which pre-existing anxiety triggers sexual dysfunction, causing performance anxiety and leading to a vicious cycle: anxiety, sexual dysfunction, more anxiety. Men with DE are similar to men with other sexual dysfunctions. They show the same elevated level of sexual dissatisfaction and they also show lower levels of coital frequency. To a lower extent, they use more masturbatory activity relative to controls. The burden of PE for the patient is revealed in three different levels: the emotional burden, the health burden, and the burden on the relationship. In terms of the emotional burden, there is often a sense of embarrassment and shame at not being able to satisfy their partner, and patients often have low self-esteem, feelings of inferiority, anxiety, anger, and disappointment. Men feel frustrated about their PE and how it affects their intimacy with their partners and the sexual relationship. In conclusion, ejaculatory dysfunction has a negative impact on both the man and his female partner and, consequently, it has implications for the couple as a whole. Additionally, ejaculatory dysfunction extending beyond a year elevates the risk of depression in these patients. Although partner perceptions of PE generally indicated less dysfunction than those of subjects, partner outcomes measures play a part in the assessment of PE. Ejaculatory dysfunction involves the integration of physiological, psychobehavioral, cultural, and relationship dimensions. All these elements need to be considered in the treatment.

Topical Alprostadil for the Treatment of Female Sexual Arousal Disorder

Female sexual dysfunction is a common disorder that is present in over 40% of women in the USA. An evaluation of female sexual dysfunction differs greatly from male erectile dysfunction in that female sexual dysfunction is a very general term that encompasses a variety of sexual complaints in women, rather than a specific physiological disorder. No pharmacological treatment is presently approved for the treatment of the myriad of disorders that are involved in female sexual dysfunction. One of the more common disorders of female sexual dysfunction involves disturbances in objective or subjective sexual arousal. Sexual arousal in women has a central component and a peripheral, or vulvar, component. Disorders in vulvar blood flow and stimulation may lead to decreased genital and central arousal. A logical corollary of this statement is that an improvement in local blood flow by the use of a local or systemic vasodilator may lead to an increase in overall sexual arousal and an increase in sexual satisfaction. This article will explore the use of topical alprostadil as a local vasodilator to improve sexual arousal and sexual satisfaction in women with female sexual arousal disorder.

Review: Female sexual dysfunctions — the new models

A new model of women's sexual response reflects their various motivations to be sexual and the fact that psychological and biological factors strongly influence their arousability. Examples of factors stemming from diabetes are included. To increase emotional intimacy with their partner, women will deliberately find or be receptive to sexual stimuli that can potentially be sexually arousing. Only later do they sense specifically sexual need to continue for the sake of sexual sensations, sexual tension and possible orgasmic release. A model of women's subjective sexual arousal reflects the ongoing modulation from her emotions and cognitions as well as highly variable genital feedback.

Devices and Methods to Measure Female Sexual Arousal

INTRODUCTION

Multiple methods and devices are available for the assessment of female sexual response, each with strengths and limitations that can impact interpretation of research results. As such, it is important to have an understanding of available methodologies and instruments.

AIM

To review recent literature on the measurement of female sexual response, and to describe the methods and devices, and their strengths and limitations.

METHODS

A literature review was performed regarding methodology and instruments used to quantify female sexual response.

MAIN OUTCOME MEASURES

The description of currently available instruments and methods to quantify sexual response in women.

RESULTS

Methodologies used to examine female sexual arousal employ a variety of stimuli and instruments to elicit and record sexual response. The variation in research designs across studies highlights the importance of understanding (i) how sexual response is elicited in studies; (ii) what kinds of experimental designs are available for assessing sexual psychophysiology; and (iii) the various types of instrumentation used to collect data.

CONCLUSIONS

The physiological and self-reported measurement of female sexual response is crucial to our understanding of the mechanisms and factors involved with healthy sexual functioning. As such, it is important to understand the strengths and limitations associated with different stimuli, research designs, and instruments. Kukkonen TM. Devices and methods to measure female sexual arousal.

Female sexual dysfunction: definition, classification, and debates

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.

Attentional and affective processing of sexual stimuli in women with hypoactive sexual desire disorder

Hypoactive sexual desire disorder (HSDD) is the most common sexual problem in women. From an incentive motivation perspective, HSDD may be the result of a weak association between sexual stimuli and rewarding experiences. As a consequence, these stimuli may either lose or fail to acquire a positive meaning, resulting in a limited number of incentives that have the capacity to elicit a sexual response. According to current information processing models of sexual arousal, sexual stimuli automatically activate meanings and if these are not predominantly positive, processes relevant to the activation of sexual arousal and desire may be interrupted. Premenopausal U.S. and Dutch women with acquired HSDD (n = 42) and a control group of sexually functional women (n = 42) completed a single target Implicit Association Task and a Picture Association Task assessing automatic affective associations with sexual stimuli and a dot detection task measuring attentional capture by sexual stimuli. Results showed that women with acquired HSDD displayed less positive (but not more negative) automatic associations with sexual stimuli than sexually functional women. The same pattern was found for self-reported affective sex-related associations. Participants were slower to detect targets in the dot detection task that replaced sexual images, irrespective of sexual function status. As such, the findings point to the relevance of affective processing of sexual stimuli in women with HSDD, and imply that the treatment of HSDD might benefit from a stronger emphasis on the strengthening of the association between sexual stimuli and positive meaning and sexual reward.

The effect of pain-related fear on sexual arousal in women with superficial dyspareunia

The role of pain-related fear in the etiology and/or maintenance of superficial dyspareunia is still unclear. The objective of this experiment was to investigate the effects of pain-related fear on sexual arousal in women with superficial dyspareunia (n=48) and women without sexual complaints (n=48). To induce pain-related fear, participants were told that they had a 60% chance of receiving painful stimuli while being exposed to one of two erotic film clips. Genital arousal was assessed using vaginal photoplethysmography. Self-reported ratings of genital sensations and affect were collected after both erotic stimulus presentations. Elevated levels of skin conductance and higher ratings of experienced threat during the pain threat condition indicated that fear was successfully elicited. Pain-related fear impeded genital arousal in all women. Women of both groups reported significantly less positive affect and more negative affect when threatened. Although women with dyspareunia did not differ in their genital responsiveness from women without sexual complaints, they experienced overall significantly more negative affect than the control group. The present results indicate that pain-related fear reduces genital and subjective sexual responding in women with and without sexual problems. We conclude that emotional appraisal of the sexual situation determines genital responsiveness in both sexually dysfunctional and functional women.

The Relationship between female sexual arousal and response bias in women with and without provoked vestibulodynia

Smaller correlations have typically been found between genital and subjective sexual arousal in female versus male samples. This study evaluated the association between response bias and the relationship between genital and subjective arousal (i.e., concordance) in women with (n = 20) and without (n = 21) provoked vestibulodynia. Participants (M = 21.27 years, SD = 2.27) underwent blood flow imaging via a laser Doppler imager to assess genital responsiveness to a visual erotic stimulus; subjective arousal was assessed during and following the film. The relationships between three types of subjective arousal ratings (perceived sexual arousal, perceived genital responsiveness, and reported desire to engage in sexual activity) and two forms of socially desirable responding (impression management and self-deceptive enhancement) were examined. Concordance estimates were statistically non-significant in both groups, with the exception of the desire to engage in sexual activity, which was moderately correlated with genital arousal in the control group. Impression management was not a statistically significant moderator of the relationship between genital and subjective arousal, but was moderately negatively related to the three forms of subjective arousal ratings in the provoked vestibulodynia group. The results highlight the importance of assessing response bias in laboratory studies comparing women with and without sexual dysfunction.

The sensitivity of continuous laboratory measures of physiological and subjective sexual arousal for diagnosing women with sexual arousal disorder

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.

The DSM diagnostic criteria for female sexual arousal disorder

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.

Agreement of self-reported and genital measures of sexual arousal in men and women: a meta-analysis

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.

Phosphodiesterase type 5 inhibitors and female sexual response: faulty protocols or paradigms?

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.

Measurement of sexual functioning after spinal cord injury: preferred instruments

BACKGROUND/OBJECTIVE

To determine the utility of certain instruments to assess sexuality and fertility after SCI, an expert panel identified key areas to study and evaluated available instruments. These were rated according to certain predefined criteria.

METHODS

The authors divided sexual issues into male and female sexual function, male reproductive function, and female reproductive function. The instruments that have been used most frequently to measure these aspects of sexual function over the past 5 years were identified by expert consensus. Finally, these instruments were subjected to a critical review.

RESULTS

The Female Sexual Function Index (FSFI), measurement of vaginal pulse amplitude (VPA), the International Index of Erectile Function (IIEF), and the measurement of ejaculatory function and semen quality were considered appropriate measures to assess sexual responses and reproductive function after SCI. There were no measures identified to assess female reproductive function.

CONCLUSIONS

For clinical trials aiming to improve sexual function after SCI, the FSFI or the IIEF is currently preferred. Although VPA is an appropriate means to assess female sexual responses, it is only useful for laboratory studies and is too invasive for use in clinical trials. For assessment of male fertility potential, assessment of ejaculatory capacity and semen analysis are recommended.

Effects of appraisal of sexual stimuli on sexual arousal in women with and without superficial dyspareunia

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.

The p300 event-related potential technique for libido assessment in women with hypoactive sexual desire disorder

INTRODUCTION

There is a need for an objective technique to assess the degree of hypoactive sexual desire disorder (HSDD). Recently, we described such a methodology (event-related potential technique [ERP]) based on recording of p300 electroencephalography (EEG) waves elicited by auditory stimuli during synchronous exposure to erotic films.

AIMS

To compare sexual interest of sexually healthy women to females with sexual dysfunction (FSD) using ERP, and to explore whether FSD women with and without HSDD would respond differently to two different types of erotic stimuli-films containing (I) or not containing (NI) sexual intercourse scenes.

METHODS

Twenty-two women with FSD, of which nine had HSDD only, and 30 sexually healthy women were assessed by the Female Sexual Functioning Index. ERP methodology was performed applying erotic NI or I films.

MAIN OUTCOME MEASURES

Significant differences in percent of auditory p300 amplitude reduction (PR) in response to erotic stimuli within and between all three groups for each film type.

RESULTS

PRs to each film type were similar in sexually healthy women (60.6% +/- 40.3 (NI) and 51.7% +/- 32.3 [I]), while in women with FSD, reduction was greater when viewing the NI vs. I erotic films (71.4% +/- 41.0 vs. 37.7% +/- 45.7; P = 0.0099). This difference was mainly due to the greater PR of the subgroup with HSDD in response to NI vs. I films (77.7% +/- 46.7 vs. 17.0% +/- 50.3) than in the FSD women without HSDD group or the sexually healthy women (67.5% +/- 38.7 vs. 50.4% +/- 39.4 respectively), P = 0.0084. For comparisons, we used the mixed-model one-way analysis of variance.

CONCLUSIONS

Differences in neurophysiological response patterns between sexually healthy vs. sexually dysfunctional females may point to a specific inverse discrimination ability for sexually relevant information in the subgroup of women with HSDD. These findings suggest that the p300 ERP technique could be used as an objective quantitative tool for libido assessment in sexually dysfunctional women.

Sexuality and the menopause

Sexuality is innate within all women to a greater or lesser extent, and is affected by a number of extrinsic factors that occur in the menopausal transition. Assessing hormone status is difficult as evidence exists that sex hormones may differ between ethnic groups, and that bio-assays may be insensitive at lower testosterone levels. Data are available on the prevalence of female sexual dysfunction, but results from cross-sectional studies differ from those of longitudinal studies. The original traditional models of human sexual response have been challenged, and new models have been defined which show more complex interaction between intrinsic and extrinsic factors. Definitions of sexual dysfunction have been redefined. There are a limited number of randomized, placebo-controlled trials of drugs to improve sexual function. These include sildenafil citrate, tibolone and hormone replacement therapy. Randomized controlled trials on testosterone replacement in naturally and/or surgically menopausal patients with female sexual dysfunction have been criticized for a high placebo response rate and short duration. This chapter seeks to put sexuality into perspective and to define both function and dysfunction.

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

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.

Physiologic measures of sexual function in women: a review

OBJECTIVE

To review and describe physiologic measures of assessing sexual function in women.

DESIGN

Literature review.

SETTING

Studies that use instruments designed to measure female sexual function.

PATIENT(S)

Women participating in studies of female sexual function.

INTERVENTION(S)

Various instruments that measure physiologic features of female sexual function.

MAIN OUTCOME MEASURE(S)

Appraisal of the various instruments, including their advantages and disadvantages.

RESULT(S)

Many unique physiologic methods of evaluating female sexual function have been developed during the past four decades. Each method has its benefits and limitations.

CONCLUSION(S)

Many physiologic methods exist, but most are not well-validated. In addition there has been an inability to correlate most physiologic measures with subjective measures of sexual arousal. Furthermore, given the complex nature of the sexual response in women, physiologic measures should be considered in context of other data, including the history, physical examination, and validated questionnaires. Nonetheless, the existence of appropriate physiologic measures is vital to our understanding of female sexual function and dysfunction.

What Makes Women Experience Desire?

What makes women experience sexual desire? According to Kaplan, normal sexual response starts with desire, progresses through excitement or arousal, and ends with orgasm (Kaplan, 1974). This model implies that sexual desire is something you either have or don't have, and, if you don't have it, there may be no sex in your future. This drive model of sexual desire, a biomedical model, assumes that lack of desire represents a deviation from a physiological norm. In contrast, the biopsychosocial model promoted by the New View emphasizes that a woman's sexuality is largely produced by her social context and rejects the idea of desire norms rooted in physiology. The incentive motivation model of sexual desire that we will present here is based on new findings suggesting that the experience of desire may follow rather than precede sexual excitement, and suggests that desire emerges following sexual arousal initiated by a sexually meaningful stimulus.

The effects of false positive and false negative physiological feedback on sexual arousal: a comparison of women with or without sexual arousal disorder

The effects of false positive and false negative physiological feedback (vaginal photoplethymograph response print-out) on women's sexual arousal were examined. Participants included women without sexual dysfunction (n=16) and women with Sexual Arousal Disorder (SAD; n=15). Measures of subjective sexual arousal, physiological sexual arousal (vaginal pulse amplitude), expectancies, affect, and anxiety were obtained in response to viewing an erotic film. Results indicated that false positive feedback significantly increased subjective levels of sexual arousal, whereas false negative feedback significantly decreased subjective levels of sexual arousal in both groups. Sexually functional women had overall higher expectancies for sexual arousal than women with SAD. Unexpectedly, false positive feedback did not significantly impact physiological sexual arousal in sexually functional women; however, it resulted in significantly decreased responses in physiological sexual arousal in women with SAD. False negative feedback had no significant effect on physiological sexual response in sexually functional women or women with SAD.

Women's Endorsement of Models of Female Sexual Response: The Nurses' Sexuality Study

INTRODUCTION

The current Summary of Recommendations on Sexual Dysfunction in Women is conceptually grounded on a model of women's sexual function that has not been empirically tested in samples of women with and without sexual dysfunction.

AIM

The current research represents an initial effort to assess the extent to which women in a community sample endorse current theoretical models of female sexual function based upon work by Masters and Johnson, Kaplan, and Basson as accurately reflecting their own sexual experience.

MAIN OUTCOME MEASURES

Women's endorsement of brief descriptions of current models of female sexual function (Masters and Johnson, Kaplan, and Basson) as accurately reflecting their own sexual experience and their own levels of sexual function or dysfunction as assessed by the Female Sexual Function Index (FSFI).

METHODS

A random sample of 580 Registered Nurses was mailed a 58-item questionnaire which assessed women's perception of the fit of their sexual experience with current models of female sexual response and included the FSFI.

RESULTS

In total, 133 women, of whom 111 had a current man partner, returned responses. Approximately equal proportions of women endorsed the Masters and Johnson, Kaplan, and Basson models of female sexual response as representing their own sexual experience. Women endorsing the Basson model had significantly lower FSFI domain scores than women who endorsed either the Masters and Johnson or Kaplan models.

CONCLUSION

These are the first data to assess the proportion of a community sample of women who endorse widely accepted models of female sexual response as representing their own sexual experience. Women in this sample were equally likely to endorse each of these different models, emphasizing the heterogeneity of women's sexual response, and highlighting the need for additional research to guide the field's acceptance and application of particular models of female sexuality in particular situations. Women's endorsement of models of female sexual response was correlated with their FSFI scores, and findings suggest that the Basson model, currently advanced by the Second International Consultation on Sexual Medicine, may best reflect women with sexual concerns (e.g., FSFI < 26.55), rather than a single normative sexual response pattern.