The effects of state and trait self-focused attention on sexual arousal in sexually functional and dysfunctional women

A Brief Online Mindfulness Intervention for Women's Sexual Desire: The BROWSE Study

With growing interest in developing digital health tools for treating sexual dysfunction, this pilot study aimed to determine feasibility and gather preliminary efficacy data of a self-led online mindfulness intervention in comparison to an online psychoeducational intervention for women's low sexual desire in a community sample (N = 57). After a four-week intervention, participants showed overall improvements on sexual functioning, orgasm, sexual self-pleasure, sexual self-image, and sexual distress, in both treatment arms. Majority completed assigned homework and felt the intervention enhanced their sexual well-being. This study supports the feasibility of a self-led online mindfulness intervention that could help inform future programs.

A Network Comparison of Sexual Dysfunction, Psychological Factors, and Body Dissociation between Individuals with and without Sexual Trauma Histories

Sexual dysfunction is associated with psychological symptoms, including depression and anxiety. Sexual dysfunctions are often attributed to dissociation symptoms in individuals who reported sexual trauma histories. This study utilized a network approach to analyze relationships between sexual and psychological symptoms and examine whether the identified network structures differed between individuals who reported a history of sexual trauma and those who did not. Sexual dysfunction, history of sexual trauma, internalizing symptoms, dissociation symptoms, sex-related shame, and negative body image were assessed in 1,937 United States college students (women = 69.5%). Nearly half (46.8%) of the participants reported a sexual trauma history in their lifetime. Using regularized partial correlation networks, the relationships between sexual and psychological symptoms were analyzed and compared between groups with and without trauma histories. Internalizing symptoms were positively correlated with sexual dysfunction regardless of the presence of sexual trauma history. Anxiety had a stronger influence in the trauma network than in the no-trauma network. Feeling separated from the body during sexual activity was a central symptom and was related to difficulties relaxing and enjoying sex only in the trauma network. Sex-related shame appeared to play a more important role in men compared to women. To improve clinical practice of assessing and treating sexual dysfunction, researchers and clinicians should consider core symptoms that connect different aspects of sexual and psychological functioning while being aware of the unique role of dissociation in the context of traumatic stress.

Psychometric Validation of the Portuguese Version of the Sexual Self-Consciousness Scale (SSCS)

The Sexual Self-Consciousness Scale (SSCS) is an instrument for assessing dispositional propensities for self-consciousness experienced in a sexual context, with wide application in both clinical and research settings. The objective of the current study was to test some psychometric characteristics of the Portuguese version of the SSCS using a convenience sample of 210 men and 210 women. Participants completed a sociodemographic questionnaire and the Portuguese version of the SSCS. A subsample of 87 participants was assessed at a second time point after a 2-week period for measuring test-retest reliability of the instrument. Confirmatory factor analysis identified two factors and replicated the structure of the original instrument. Measurement invariance was confirmed for men and women with overall index scores indicating a good fit in all models. Reliability analyses indicated that the factors possessed both satisfactory internal consistency and stability over time. The Portuguese version of the SSCS was shown to be a useful and adequate instrument to assess dispositional propensities for self-consciousness in sexual situations within the Portuguese-speaking population.

Determination of Sexual Attitude, Sexual Self-Consciousness, and Sociocultural Status in Women With and Without Lifelong Vaginismus: A Case-Control Study

Vaginismus is a sexual dysfunction occurring in females presented as a contraction of the muscles around the vagina as a reflex, causing the failure of vaginal penetration. Although many psychological, social, and cultural factors that may cause vaginismus have been suggested, its underlying mechanisms are not clear. The aim of this study was to determine the sexual attitude, sexual self-awareness, and sociocultural status of women with and without lifelong vaginismus. This is a case-control study. A total of 148 women were included in the study: 74 women with a lifelong vaginismus diagnosis and 74 women without a history of vaginismus/painful sexual activity controls. Data were collected using a structured questionnaire, the Sexual Self-Consciousness Scale, and the Hendrick Brief Sexual Attitudes Scale. Sexual shyness (OR = 0.854), sexual self-focus (OR = 0.888) and birth control (OR = 1.279), communion (OR = 1.198), and instrumentality (OR = 1.330; the sub-dimensions of the Sexual Attitude Scale) were associated with (χ² = 96.130, p < .001) vaginismus at the rate of 63%. Those who did not receive sexual information; those who obtained information about sexuality from the social media; those who had negative thoughts about sexuality due to religious reasons; those who found the genitals and sexuality as disgusting; and those having more feelings of fear and pain are more likely to have vaginismus. Some socio-cultural factors may negatively affect women and cause vaginismus. Women with vaginismus had low sexual self-consciousness and negative attitudes toward sexuality. It may be incomplete to consider vaginismus only as a vaginal entry problem. Therefore, in the treatment of vaginismus, women's sexual attitude, sexual self-awareness, and sociocultural factors should be evaluated in a holistic manner.

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.

"Pretty hurts": Acceptance of hegemonic feminine beauty ideals and reduced sexual well-being among Black women

Although women are expected to idealize and achieve hegemonic feminine beauty standards such as being slender and lighter skinned, few studies have examined how women's investment in achieving these restrictive feminine appearance ideals may influence their sexual attitudes and behaviors. Even less is known about Black women. We surveyed 640 Black college women to test hypotheses that endorsement of hegemonic beauty ideals would be positively associated with four dimensions of negative sexual affect (sexual guilt, shame, emotional distancing, and self-consciousness) and negatively associated with two dimensions of sexual agency (sexual assertiveness and satisfaction). Correlation and regression analyses showed that hegemonic beauty ideal acceptance was linked with greater sexual guilt, shame, emotional distancing, and sexual self-consciousness in addition to lower levels of sexual assertiveness and satisfaction. Findings highlight how endorsing restrictive, hegemonic standards of beauty is associated with Black women's reduced sexual affect and sexual agency.

Attachment and Sexual Functioning: Understanding the Mediating Role of Body Image Among LGB and Non-LGB Women

INTRODUCTION

Despite studies showing that individuals with insecure attachment suffer from poor body image, and that poor body image is a main risk factor for sexual dysfunction, the mediating role of body image between attachment insecurities and sexual functioning has not been assessed. Moreover, differences in body self-consciousness among sexual minority women have not been examined, even though LGB individuals have been found to be more conscious of stigma and the disapproval of others.

AIM

To fill this gap, the current study examines the mediating role of body image self-consciousness between insecure attachment and sexual functioning among LGB and non-LGB women.

METHODS

The study sample consisted of 1,001 women; of them, 808 defined themselves as heterosexual (80.7%), and 193 (19.3%) identified as LGB. The sample was a convenience sample of women who responded to ads on social media. Participants completed an online questionnaire (via Qualtrics) about their attachment orientation, body-image self-consciousness, and sexual functioning.

MAIN OUTCOME

Body image self-consciousness mediated the relationship between insecure attachment and sexual dysfunction among women in general and LGB women in particular.

RESULTS

Results indicated that among LGB women, the relationship between attachment and sexual functioning was fully mediated by body image self-consciousness. For non-LGB women, a full model with statistically significant direct and indirect effects was revealed. Both avoidant attachment and anxious attachment were related to body image self-consciousness which was, in turn, related to sexual functioning. A statistically significant direct path from avoidant attachment to sexual functioning was also revealed.

CONCLUSION

The study findings contribute to the literature by revealing the mediating role that body image self-consciousness plays between insecure attachment and sexual dysfunction among women in general and LGB women in particular.

CLINICAL IMPLICATIONS

This study provides support for the negative relationship between body image self-consciousness and sexual functioning of women regardless of sexual orientation, and suggests that women affected by body image concerns might be prone to more sexual dysfunction. Therefore, body image self-consciousness should be brought up in sex therapy sessions and future interventions. Clinicians should also be cognizant of differences between LGB and non-LGB women in terms of this effect, taking into account the history of stigma that LGB women may have endured and how this history affects their body image. Gewirtz-Meydan A, Mitchell KJ, Spivak-Lavi Z. Attachment and Sexual Functioning: Understanding the Mediating Role of Body Image Among LGB and Non-LGB Women. J Sex Med 2021;18:1245-1257.

Visual attention and sexual arousal in women with and without sexual dysfunction

Attention to sexual stimuli is a prerequisite to process such stimuli as sexually-meaningful and is an important means to facilitate sexual arousal. Attending to sexual cues is crucial for healthy sexual functioning. Studies suggest that sexual dysfunction is associated with less attention towards sexual stimuli. The goal of this study was to use an eye-tracking-based free-viewing paradigm to investigate whether women with sexual dysfunction visually attend to the genital area in dynamic sexual stimuli (i.e., erotic videos) differently than women with subclinical sexual function or those with typical sexual functioning. A total of 69 women (M_age = 27.77, SD = 8.00) with clinical (n = 30), subclinical (n = 23), and typical (n = 16) levels of sexual functioning watched four 1-min video clips depicting heterosexual couples engaging in vaginal intercourse or cunnilingus while the total fixation duration on the genital area as well as their subjective and genital sexual arousal were recorded. As hypothesized, the clinical group fixated on the genital area less than women with typical sexual functioning. A longer total fixation duration on the genital area was followed by increases in subjective arousal and genital arousal. The relationship between attention and arousal was not moderated by sexual functioning group. This study provides first evidence of the role of sustained visual attention for facilitating sexual arousal in women with and without sexual dysfunction.

Anxiousness and Distractibility Strengthen Mediated Associations Between Men's Penis Appearance Concerns, Spectatoring, and Sexual Difficulties: A Preregistered Study

Men with penis appearance concerns are more likely to experience sexual difficulties because they engage in spectatoring (i.e., negative self-critical attentional focus during sex). This preregistered study investigated whether anxious and distractible personality traits make men with penis appearance concerns more likely to engage in spectatoring and, in turn, experience sexual difficulties. In a sample of 858 sexually active men in predominantly mixed-gender relationships, we replicated previous findings that penis appearance concerns were associated with greater spectatoring, and in turn greater problems with erection and orgasm. Additionally, our novel hypotheses that anxiousness and distractibility would strengthen these associations were partially supported. Anxiousness strengthened associations between penis appearance concerns and sexual embarrassment, and in turn was associated with greater reports of erectile and orgasmic difficulties. However, anxiousness did not strengthen the mediated associations between penis appearance concerns, self-focus, and erectile and orgasmic difficulties. Distractibility strengthened associations between sexual embarrassment and erectile difficulties, and in turn strengthened the mediated associations between penis appearance concerns, sexual embarrassment, and erectile difficulties. However, distractibility did not strengthen associations between sexual embarrassment and orgasmic difficulties, between sexual self-focus and erectile difficulties, nor between sexual self-focus and orgasmic difficulties. Implications for therapeutic treatments are discussed.

Cognitive-Affective Factors and Female Orgasm: A Comparative Study on Women With and Without Orgasm Difficulties

BACKGROUND

Orgasmic difficulties are one of the most common sexual complaints among women. Although models of sexual dysfunction propose that cognitive-affective factors are involved in the development and maintenance of sexual difficulties, there is a need to further examine how these factors are associated with orgasmic difficulties specifically.

AIM

To analyze differences between women who reported orgasm difficulties and controls in regard to sexual inhibition, sexual excitation, sexual beliefs, as well as negative automatic thoughts and affect during sexual activity.

METHODS

A total of 500 women, aged 18 to 72 years, completed a Web survey focused on cognitive-affective factors and sexual health. Two hundred fifty women reported orgasm difficulties and were compared with 250 age-matched women who reported no sexual difficulties.

OUTCOMES

Differences between groups regarding sexual inhibition and sexual excitation (Sexual Inhibition/Sexual Excitation Scales-Short Form), sexual beliefs (Sexual Dysfunctional Beliefs Questionnaire), negative automatic thoughts (Automatic Thoughts Subscale of the Sexual Modes Questionnaire), and affect (Positive and Negative Affect Schedule) during sexual activity.

RESULTS

Women with orgasm difficulties scored higher on sexual inhibition than controls. They also reported more negative automatic thoughts during sexual activity (concerning failure and disengagement, sexual abuse, lack of affection from partner, passivity, body image) and less erotic thoughts. Women with orgasm difficulties reported experiencing higher negative affect and lower positive affect during sexual activity than women who reported no sexual difficulties. No significant differences were found regarding sexual excitation and endorsement of sexual beliefs.

CLINICAL IMPLICATIONS

Helping women shift their focus from non-erotic, negative thoughts to erotic stimuli, as well as addressing sexual inhibition, can be relevant targets of interventions aimed at women's orgasm difficulties.

STRENGTHS & LIMITATIONS

Strengths of the study include the use of a large sample of women who reported orgasm difficulties, offering new insights into the clinical importance of these psychological processes. Limitations include the reliance on self-report measures and a relatively homogeneous sample regarding sexual orientation, education, and age.

CONCLUSION

Results highlight the role of cognitive-affective factors on women's orgasm difficulties and emphasize the potential benefit of cognitive-behavioral and/or mindfulness interventions for orgasm difficulties. Moura CV, Tavares IM, Nobre PJ. Cognitive-Affective Factors and Female Orgasm: A Comparative Study on Women With and Without Orgasm Difficulties. J Sex Med 2020;17:2220-2228.

Comparison of Vaginal Penetration Cognitions and Metacognitions Between Women With Genito-Pelvic Pain and Penetration Disorder and Healthy Controls

BACKGROUND

Investigation of vaginal penetration cognitions and metacognitive beliefs in genito-pelvic pain and penetration disorder (GPPPD) could be important for understanding the underlying mechanisms of sexual disorders.

AIM

The aim of this study was to compare healthy controls and GPPPD women for vaginal penetration cognitions and metacognitions.

METHODS

Outpatients with GPPPD (n = 135) and healthy controls (n = 136) were evaluated with Sociodemographic Data Form, Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders IV (SCID-I), SCID nonpatient version, Golombok-Rust Inventory of Sexual Satisfaction Female Form (GRISS), Vaginal Penetration Cognition Questionnaire, Metacognitions Questionnaire (MQ), Hamilton Anxiety Rating Scale (HAM-A), SCID and Hamilton Depression Rating Scale (HAM-D).

OUTCOMES

The relationship between metacognitions and vaginal penetration cognitions was detected, and patients with GPPPD and healthy controls were compared for metacognitions.

RESULTS

The MQ total score and all MQ subdimension scores other than positive beliefs about worry of GPPPD were found to be significantly higher in the GPPPD group than in controls. All Vaginal Penetration Cognition Questionnaire subdimension scores except positive cognitions for penetration score were significantly higher in patients with GPPPD than in controls. The total and frequency of sexuality, sexual communication between partners, avoidance of sexuality, nonsensuality, vaginismus, satisfaction, and anorgasmia subscores of the GRISS were significantly higher in the GPPPD group. Cognitive self-consciousness, need for controlling thoughts, and HAM-D values had a significant and independent effect on distinguishing the patients with GPPPD from the controls.

CLINICAL IMPLICATIONS

Our results may be important to address the metacognitions in the treatment of women with GPPPD.

STRENGTHS & LIMITATIONS

The strengths are large-sample case and control groups, comparison with the control group using both clinical interviews and scale evaluations, diagnosis of GPPPD using clinical interviews and with 2 validated scales, exclusion of patients with depression and anxiety disorders, and evaluation of metacognitions not affected by concomitant disorders. The cross-sectional nature of our study and the fact that it was performed only in treatment-seeking groups and recruitment of hospital workers' relatives as a control group were limitations of the study.

CONCLUSION

In addition to the behavioral components of GPPPD treatment, the emphasis on metacognitions especially in the treatment process may have a positive effect on treatment. Teksin Ünal G, Şahmelikoğlu Onur Ö, Erten E. Comparison of Vaginal Penetration Cognitions and Metacognitions Between Women With Genito-Pelvic Pain and Penetration Disorder and Healthy Controls. J Sex Med 2020;17:964-974.

Anxiety and Performance in Sex, Sport, and Stage: Identifying Common Ground

Anxiety has long been associated with diminished performance within a number of domains involving evaluative interpersonal interactions, including Sex, Sport, and Stage. Here, we pose three questions: (1) how do these disparate fields approach and understand anxiety and performance; (2) how does the understanding of the issue within one field offer insight to another field; and (3) how could each field benefit from the ideas and strategies used by the others. We begin with a short review of models of anxiety/arousal and performance and then explore definitions, models, presumed underlying physiological processes, and characterizing and influencing factors within each domain separately in a narrative review. This discussion is followed by a synthesis that identifies elements specific to and common across the various domains, with the latter captured in a model of essential characteristics. Concluding remarks note the potential value of promoting increased cross-disciplinary conversation and research, with each domain likely benefiting from the conceptualizations and expert knowledge of the others.

Virtual Reality and Sex Therapy: Future Directions for Clinical Research

Rapidly growing new technologies are revolutionizing the field of mental health, in terms of both understanding and treating mental disorders. Among these, virtual reality (VR) is a powerful tool providing clients with new learning experiences benefiting their psychological well-being. This article offers an overview of the current literature on VR in psychotherapy, highlighting its relevance to sexual dysfunction (SD) treatment.A literature review of PubMed and Google Scholar databases was used to provide a description of the theoretical frameworks and clinical indications associated with VR use in psychotherapy and SD treatment. The effectiveness of VR exposure-based therapy has been empirically validated for several mental disorders, notably anxiety disorders. The emerging combined use of VR and mindfulness tends to focus on chronic pain treatment. Experimental research examining the use of immersive technologies in the treatment of SDs is lacking.Given the shortcomings of conventional SD treatments, exploring and developing specialized VR interventions may prove beneficial. VR offers promising avenues in sex therapy, particularly for the treatment of genital pain disorders or SDs in which anxiety plays a significant etiological role.

Spectatoring Mediates the Association Between Penis Appearance Concerns and Sexual Dysfunction

Men with penis appearance concerns are more likely to experience sexual dysfunction, but the processes underlying this association are unknown. This study investigated whether spectatoring (i.e., negative self-directed attentional focus during sex) mediates the association between penis appearance concerns and sexual dysfunction. Men in romantic relationships (N = 512, in predominantly mixed-gender relationships) reported on sex they had with their partner in the previous month. Indirect effects indicated that penis appearance concerns predicted greater spectatoring, and in turn predicted greater erectile and orgasmic dysfunction. Results suggest that spectatoring is a conduit through which penis appearance concerns impede sexual function.

Sexual vs. Nonsexual Currently Most Upsetting Trauma: A Fresh Look at Attenuation of Sexual Response, Alcohol Intoxication, and Post-Traumatic Stress

This study examined the dependence of sexual response (vaginal pulse amplitude [VPA] and subjective sexual arousal) on alcohol intoxication (.10% breath alcohol concentration [BrAC] versus no alcohol) and the nature of a woman's currently most upsetting traumatic event (C-MUTE), whether it was sexual (e.g., rape) or nonsexual (e.g., combat). Self-reported sexual outcomes were also compared by C-MUTE type. A total of 117 women completed background measures and either drank alcoholic or nonalcoholic beverages. They were shown erotic films and their VPA was assessed. A two (sexual versus nonsexual C-MUTE) by two (.10% BrAC versus no alcohol) analysis of variance (ANOVA) showed that, controlling for post-traumatic stress (PTS) symptoms, women with a sexual C-MUTE showed lower percent VPA change than women with a nonsexual C-MUTE. No significant effects were found for subjective sexual arousal. A multivariate analysis of variance (MANOVA) showed that women with a sexual C-MUTE reported more frequent anxiety and inhibition during partnered sex and more frequent lack of vaginal lubrication versus women with a nonsexual C-MUTE. There was no significant interaction between C-MUTE and alcohol intoxication. Whether a woman is currently upset by past sexual victimization may influence current sexual difficulties. Attenuated VPA may be attributable to the sexual nature of a C-MUTE as opposed to general trauma exposure.

Effects of a Mindfulness Task on Women's Sexual Response

Mindfulness-based interventions are effective at improving symptoms of sexual dysfunction in women. The mechanisms by which mindfulness improves sexual function are less clear. The main objective of our study was to investigate the impact of a mindfulness task on sexual response in women. Forty-one women (mean age = 27.2, SD = 5.6) participated in two laboratory sessions that each included two erotic films and one attention task that were presented in counterbalanced order. Both attention tasks consisted of a six-minute audio recording of either a modified body scan, focusing on genital arousal sensations (mindfulness condition), or a visualization exercise. Subjective and genital sexual arousal were measured continuously during stimulus presentation. The mindfulness task led to greater subjective and lower genital arousal. The agreement of subjective and genital sexual arousal (i.e., concordance) was greater in the mindfulness condition. Trait mindfulness was related to lower sexual arousal but also greater sexual concordance in women. Mindfulness-based interventions that encourage women to focus on physical arousal sensations in the here and now may be associated with women's improved sexual function by enhancing feelings of sexual arousal during sexual activity and by increasing concordance between subjective and genital sexual arousal.

Women's Attributions Regarding Why They Have Difficulty Reaching Orgasm

Difficulty reaching orgasm during partnered sex is relatively common among women. Yet the reasons, likely multivariate, are not fully understood. This study identified perceived causes for orgasmic difficulty in 452 women during partnered sex. The most commonly endorsed reasons were stress/anxiety, insufficient arousal, and lack of time during sex; body image, pain, inadequate lubrication, and medical/medication issues were endorsed less frequently. Distressed and nondistressed women differed on several attributions, including sexual interest, partner perceptions, stress, and adequate time during sex. These findings implicate greater internalization of attributions among distressed women compared with nondistressed women and suggest possible avenues for remediation.

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.

Mindfulness-Based Sex Therapy Improves Genital-Subjective Arousal Concordance in Women With Sexual Desire/Arousal Difficulties

There is emerging evidence for the efficacy of mindfulness-based interventions for improving women's sexual functioning. To date, this literature has been limited to self-reports of sexual response and distress. Sexual arousal concordance-the degree of agreement between self-reported sexual arousal and psychophysiological sexual response-has been of interest due to the speculation that it may be a key component to healthy sexual functioning in women. We examined the effects of mindfulness-based sex therapy on sexual arousal concordance in a sample of women with sexual desire/arousal difficulties (n = 79, M age 40.8 years) who participated in an in-laboratory assessment of sexual arousal using a vaginal photoplethysmograph before and after four sessions of group mindfulness-based sex therapy. Genital-subjective sexual arousal concordance significantly increased from pre-treatment levels, with changes in subjective sexual arousal predicting contemporaneous genital sexual arousal (but not the reverse). These findings have implications for our understanding of the mechanisms by which mindfulness-based sex therapy improves sexual functioning in women, and suggest that such treatment may lead to an integration of physical and subjective arousal processes. Moreover, our findings suggest that future research might consider the adoption of sexual arousal concordance as a relevant endpoint in treatment outcome research of women with sexual desire/arousal concerns.

Role of Body Esteem in the Sexual Excitation and Inhibition Responses of Women With and Without a History of Childhood Sexual Abuse

INTRODUCTION

Women's sexuality is influenced by their perceptions of their bodies. Negative body appraisals have been implicated in the development and maintenance of sexual concerns in women with a history of childhood sexual abuse (CSA). The sexuality of these women is often expressed in extremes of approach and avoidant sexual tendencies, which have been related to the sexual inhibition and sexual excitation pathways of the dual control model.

AIM

To test the influence of body esteem on the sexual excitation and inhibition responses of women with and without a history of CSA.

METHODS

One hundred thirty-nine women with CSA and 83 non-abused women reported on their abuse history, depressive symptomology, sexual response, and affective appraisals of their body.

MAIN OUTCOME MEASURES

Validated self-report measurements of sexual excitation and inhibition responses (Sexual Excitation/Sexual Inhibition Inventory for Women) and body esteem (Body Esteem Scale) were administered.

RESULTS

Body esteem was significantly associated with sexual inhibition responses of women regardless of CSA history status but was significantly related only to the sexual excitation responses of women with a CSA history. Perceived sexual attractiveness was a unique predictor of sexual excitation in women with a history of CSA.

CONCLUSION

Women with a history of CSA have lower body esteem than non-abused women, particularly in self-perceived sexual attractiveness, and these perceptions appear to influence their sexual responses by acting on the sexual excitation and inhibition response pathways.

A Streetcar Named "Derousal"? A Psychophysiological Examination of the Desire-Arousal Distinction in Sexually Functional and Dysfunctional Women

Research indicates that desire and arousal problems are highly interrelated in women. Therefore, hypoactive sexual desire disorder (HSDD) and female sexual arousal disorder (FSAD) were removed from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), and a new diagnostic category, female sexual interest/arousal disorder (FSIAD), was created to include both arousal and desire difficulties. However, no research has tried to distinguish these problems based on psychosocial-physiological patterns to identify whether unique profiles exist. This study compared psychosocial-physiological patterns in a community sample of 84 women meeting DSM-IV (American Psychiatric Association, 2000 ) criteria for HSDD (n = 22), FSAD (n = 18), both disorders (FSAD/HSDD; n = 25), and healthy controls (n = 19). Women completed self-report measures and watched neutral and erotic films while genital arousal (GA) and subjective arousal (SA) were measured. Results indicated that GA increased equally for all groups during the erotic condition, whereas women with HSDD and FSAD/HSDD reported less SA than controls or FSAD women. Women in the clinical groups also showed lower concordance and greater impairment on psychosocial variables as compared to controls, with women with FSAD/HSDD showing lowest functioning. Results have important implications for the classification and treatment of these difficulties.

Gender Differences in Implicit Processing of Sexual Stimuli

The present studies investigated whether men and women differ in cognitive–motivational processing of sexual stimuli in order to better understand the commonly observed gender differences in sexual outcome variables. Because these processes often operate without conscious control, we focused specifically on automatic stimulus processing. Using a series of implicit tasks, we measured inhibition, attentional orientation, appraisal and approach–avoidance motivation regarding sexually explicit stimuli in male and female students. Results showed that men were more strongly motivated to approach sexual stimuli than women and were better able to inhibit sexual information as to prevent activation of the sexual response. With regard to attentional orientation, men were more easily drawn by sexual cues than women, yet only when the cues were presented long enough to allow more elaborative processing. No gender differences were found in the implicit evaluation of sexual information, although men and women did differ at the level of self–reported sexual evaluations. Our results indicate the importance of incorporating information–processing mechanisms and emotion regulation strategies into the conceptualization of the sexual response and promote further research on the specificity, robustness, predictive validity and malleability of the cognitive–motivational processes underlying sexual arousal. Copyright © 2015 European Association of Personality Psychology

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.

Sexual healing: daily diary investigation of the benefits of intimate and pleasurable sexual activity in socially anxious adults

A growing literature attests to deficits in social and romantic life quality in people with elevated social anxiety, but no research to date has explored how intense intimate encounters influence social anxiety symptoms. This study investigated whether the presence and quality of sexual activity on a given day predicted less social anxiety and negative cognitions on a subsequent day. We also explored whether the benefits of sexual activity would be stronger for more socially anxious individuals. Over 21 days, 172 undergraduate students described the presence and quality of sexual activity, social anxiety symptoms, and use of social comparisons on the day in question. Time-lagged analyses determined that being sexually active on one day was related to less social anxiety symptoms and the generation of fewer negative social comparisons the next day. Furthermore, more intense experiences of pleasure and connectedness during sex predicted greater reductions in social anxiety the next day for people high in trait social anxiety, compared to those low in trait social anxiety. These results were similar regardless of whether sex occurred in the context of romantic relationships or on weekdays versus weekends. The results suggest that sexual activity, particularly when pleasurable and intimate, may mitigate some of the social anxiety and negative comparisons frequently experienced by people with high trait social anxiety.

Dissociation during sex and sexual arousal in women with and without a history of childhood sexual abuse

Women with a history of childhood sexual abuse (CSA) experience dissociative symptoms and sexual difficulties with greater frequency than women without a history of CSA. Current models of sexual dysfunction for sexual abuse survivors suggest that dissociation may mediate the relationship between CSA and sexual arousal difficulties. Dissociation, however, is often conceptualized as a single construct in studies of CSA and not as separate domains as in the dissociation literature. In the present study, women with (CSA, N = 37) and without (NSA, N = 22) a history of CSA recruited from the community were asked to indicate the frequency and intensity of their experience in two dissociation subgroups, derealization and depersonalization, during sex with a partner and in their daily life. Findings showed that, in the NSA group, more depersonalization during sex with a partner was associated with lower sexual arousal functioning. However, for both the NSA and CSA groups, more derealization during sex was associated with higher sexual arousal functioning. No measure of dissociation was significantly associated with sexual responses in the laboratory. These findings highlight the importance of distinguishing between different forms of dissociation (i.e., derealization and depersonalization) in the study of sexual arousal functioning. In addition, the findings challenge the notion that dissociation is a main predictor of sexual arousal problems in survivors of CSA and suggest that a more nuanced relationship may exist.

Disentangling desire and arousal: a classificatory conundrum

A controversial proposal to collapse sexual disorders of desire and arousal is forthcoming in the diagnostic and statistical manual of mental disorders (5th ed.) (DSM-5). Yet, no study has attempted to empirically distinguish these disorders by using explicit criteria to recruit and compare distinct groups of low desire and arousal sufferers. The goal of the current study was to test the feasibility of finding medically healthy men and women meeting clearly operationalized DSM-IV-TR criteria for disorders of desire and/or arousal and compare them to matched controls. To assess operational criteria, participants completed a comprehensive telephone screening interview assessing DSM-IV-TR and DSM-5 criteria, as well as standardized self-report measures of sexual functioning. The use of operationalized DSM-IV-TR criteria to recruit participants led to the exclusion of over 75% of those reporting sexual difficulties, with the primary reason for exclusion being failure to meet at least one central diagnostic criterion. The application of the DSM-5 criteria was even more restrictive and led to the exclusion of all but four men and one woman using the original four-symptom criteria, and four men and five women using the revised three-symptom criteria. Cluster analyses supported the distinction between desire and genital arousal difficulties, and suggest that different groups with distinct clusters of symptoms may exist, two of which are consistent with the DSM-5 criteria. Overall, results highlight the need for revisions to the diagnostic criteria, which, as they stand, do not capture the full range of many people's sexual difficulties.

The effects of autobiographic sexual memory recall on the sexual response of sexually functional men

In this experimental study, we investigated how recalling positive, negative, and affectively neutral autobiographic sexual experiences in their personal history affected the current sexual response of sexually functional male volunteers. Based on an attentional-capacity account of sexual arousal, we predicted that affectively charged autobiographic sexual memory recall, both with negative and positive valence, would negatively impact genital arousal, compared to recalling affectively neutral sexual experiences. We expected that subjective sexual arousal would not be differentially affected by emotional memory valence. We measured subjective and genital response to erotic video fragments in sexually functional volunteers (N = 24) in a within-subjects, repeated-measures design. For the memory manipulation, participants received instructions to visualize and mentally re-experience positive, negative, and neutral sexual episodes from autobiographic memory. Memory instructions were found to result in the expected affective states. As predicted, compared to recalling neutral memory, mean genital response was significantly lower during recalling positive and negative memory. However, contrary to prediction, subjective sexual arousal was affected, when multilevel analysis was performed, including a time effect. The implications of the findings were discussed with respect to the advancement of theory and therapeutic intervention.

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.

Body image and female sexual functioning and behavior: a review

Knowledge in the research fields of body image and sexuality has significantly increased in the last decade. In this review, data from 57 studies were compiled for a review of empirical evidence regarding the association between sexuality and body image among healthy women. The overall conclusion is that body image issues can affect all domains of sexual functioning. Cognitions and self-consciousness seem to be key factors in understanding the complex relationships between women's body image and sexuality. Body evaluations and cognitions not only interfere with sexual responses and experiences during sexual activity, but also with sexual behavior, sexual avoidance, and risky sexual behavior.

Cognitive behavioral therapy for sexual dysfunctions in women

Sexual dysfunctions in women are classified into disorders of desire, arousal, orgasm, and pain (including dyspareunia and vaginismus). As the cognitive behavioral treatment (CBT) procedures differ among these sexual disorders, the treatments for each disorder are reviewed separately. The efficacy of CBT differs depending on the specific sexual dysfunction to be treated. It is concluded that only a few CBT treatments for women's sexual dysfunction have yet been empirically investigated in a methodologically sound way and little is known about which of the treatment components are most effective.

An evaluation of the validity of thermography as a physiological measure of sexual arousal in a non-university adult sample

Thermography is a promising technology for the physiological measurement of sexual arousal in both men and women. This study was designed to extend our previous college student thermography study findings to an older sample (M age = 37.05 years), add an anxiety control group to further examine the specificity of temperature change, and examine the relationship between genital temperature and a continuous measure of subjective sexual arousal. Healthy men (n = 40) and women (n = 39) viewed a neutral film clip after which they were randomly assigned to view one of four other videos: neutral (n = 20), humor (n = 19), anxiety provoking (n = 20) or sexually explicit (n = 20). Genital and thigh temperature were continuously recorded using a TSA ImagIR thermographic camera. Continuous and discrete reports of subjective sexual arousal were also obtained. Results supported the validity of thermography as a measure of sexual arousal: temperature change was specific to the genitals during the sexual arousal condition and was significantly correlated with subjective continuous and discrete reports of sexual arousal. Further development should assess the potential of thermography as a tool for the diagnosis and treatment evaluation of sexual arousal difficulties and for studying sex differences.

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.

The association between body esteem and sexual desire among college women

Relationships between body image variables and sexuality have been found among several groups of women. However, research has largely focused on generalized experiences of sexuality. With the exception of two studies which focused on specific medical populations, to our knowledge there has been no investigation of the relationship between body image and acute measures of sexual response. In the current study, we investigated the relationships between body esteem, sexual response to erotica in a laboratory-setting, and self-reported sexual functioning in a non-clinical sample of 85 college women. Women participated in one study session, during which mental sexual arousal, perceptions of physical arousal, and sexual desire were assessed. Results showed that higher body esteem was significantly positively related to sexual desire in response to erotica in the laboratory setting. Similarly, higher body esteem was positively related to self-reported measures of sexual desire, as assessed by a validated measure of sexual function. The sexual attractiveness and weight concern subscales of the Body Esteem Scale, which relate to body characteristics that are most likely to be under public scrutiny, were particularly linked to sexual desire. This is the first study to show that body esteem is related to sexual responses to a standardized erotic stimulus in a laboratory setting.