A Psychophysiological Investigation of Sexual Arousal in Women with Lifelong Vaginismus

IntroductionRelatively little is known about the subjective reactions of women with lifelong vaginismus to erotic stimuli and genital arousal has never been investigated. Reports of maladaptive cognitions and fears regarding sexuality and intercourse suggest that anxiety may interfere with sexual arousal in women with vaginismus.AimsTo examine the genital and subjective responses to sexually explicit film stimuli of women with lifelong vaginismus compared with women with lifelong dyspareunia and women with no pain.MethodsForty‐five women (15 vaginismus, 15 dyspareunia, and 15 no pain) viewed two neutral and two erotic film sets, one depicting sexual activity without vaginal penetration and the other depicting intercourse, over two testing sessions.Main Outcome MeasuresVulvar temperature was recorded using an infrared camera. Participants completed a measure of subjective responses after viewing each film.ResultsAll groups experienced increased vulvar temperature during the erotic films regardless of activity depicted. In response to the erotic films, the vaginismus group reported less mental arousal than the no‐pain group and a range of negative subjective responses, including threat and disgust. Overall, participants showed concordance between peak subjective sexual arousal and temperature change from baseline to peak arousal.ConclusionDespite negative subjective responses, women with vaginismus responded with increased genital sexual arousal to erotic films. The resilience of genital arousal may have resulted from moderate levels of anxiety experienced in the laboratory setting facilitating sexual response regardless of subjective appraisal; however, anxiety experienced in a dyadic context may interfere more substantially.     

Sexual Arousal in Women with Provoked Vestibulodynia: The Application of Laser Doppler Imaging to Sexual Pain

IntroductionWomen with provoked vestibulodynia (PVD) report lower sexual arousal than nonaffected women, however, laboratory studies of arousal have reported contradictory results about whether group differences exist in genital and subjective arousal.AimTo examine genital and subjective sexual arousal in women with and without PVD.MethodsEligible women with and without PVD (N = 42) attended a laboratory session that included an interview, questionnaire completion, and genital imaging. A direct measure of superficial blood flow—laser Doppler imaging—was used to assess vulvar blood flow levels while participants watched three films, including an erotic film. Participants answered questions about their level of sexual arousal before, during, and after the erotic film.Main Outcome MeasuresAverage vulvar blood flow levels during the baseline and erotic films, numerical ratings of subjective sexual arousal and anxiety, as well as questionnaire measures of arousal.ResultsThere was a significant group difference in genital arousal, whereby the PVD group showed a lower genital response to the erotic film, as well as a significant interaction between baseline blood flow and group membership. Separate group regression analyses demonstrated that baseline blood flow explained a substantial amount of the variance in erotic film blood flow in the control group (70%), while only 27% was explained by this variable in the PVD group. There were no differences in subjective sexual arousal or anxiety between the groups. Across questionnaire measures, women with PVD reported lower sexual arousal than the control group.ConclusionsThe results suggest that women with PVD show lower genital responsiveness than nonaffected women to sexual stimuli in a laboratory setting and that their genital arousal is likely impacted by a number of biopsychosocial factors. Boyer SC, Pukall CF, and Chamberlain SM. Sexual arousal in women with provoked vestibulodynia: The application of laser Doppler imaging to sexual pain. J Sex Med 2013;10:1052-1064.     

Sexual Arousal in East Asian and Euro-Canadian Women: A Psychophysiological Study

IntroductionStudies of ethnic differences in self-report measures of sexuality have shown East Asian women to be more sexually conservative and less sexually experienced than Caucasian women. There is also strong evidence supporting the notion of ethnic group differences in general measures of nonsexual psychophysiological arousal; however, there have been no previous studies exploring ethnicity and physiological sexual arousal.AimThe objective of this study was to explore group differences in self-reported and physiological sexual arousal in Euro-Canadian and East Asian women living in Canada; we also aimed to explore the association between level of acculturation (both mainstream and heritage) and sexual arousal in East Asian women only.MethodsSeventy-five women (N = 38 Euro-Canadian, N = 37 East Asian) completed a battery of questionnaires and underwent psychophysiological sexual arousal testing using the vaginal photoplethysmograph. They also completed a self-report measure of subjective arousal before and after erotic stimulus exposure.Main Outcome MeasuresAll women completed the Female Sexual Function Index, Vancouver Index of Acculturation, and Sexual Beliefs and Information Questionnaire. Change in genital sexual arousal (vaginal pulse amplitude; VPA), and change in subjective sexual arousal were measured during exposure to erotic stimuli.ResultsThe groups did not differ in the percent increase in VPA induced by erotic stimuli, nor was there a correlation between VPA and subjective sexual arousal. Among East Asian women alone, neither heritage nor mainstream acculturation was correlated with change in VPA.ConclusionsEast Asian and Euro-Canadian women who show similar ratings of sexual behaviors and self-reported sexual arousal do not differ in physiological or subjective arousal induced by erotic stimuli in the laboratory. Yule M, Woo JST, and Brotto LA. Sexual arousal in East Asian and Euro-Canadian women: A psychophysiological study.     

The Sensitivity of Continuous Laboratory Measures of Physiological and Subjective Sexual Arousal for Diagnosing Women with Sexual Arousal Disorder

IntroductionPast 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.AimsThe 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.MethodsSexual 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 MeasuresPhysiological sexual arousal was assessed using vaginal photoplethysmography, and subjective sexual arousal was measured continuously and using a Likert-scale in response to sexual videos.ResultsWomen 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.ConclusionPreliminary 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. Meston CM, Rellini AH, and McCall K. The sensitivity of continuous laboratory measures of physiological and subjective sexual arousal for diagnosing women with sexual arousal disorder.     

Habituation of Sexual Responses in Men and Women: A Test of the Preparation Hypothesis of Women's Genital Responses

IntroductionLaboratory studies have revealed two well‐replicated sex differences in sexual arousal patterns: category specificity and sexual concordance. Men's genital responses are dependent on specific sexual cues and are concordant with subjective reports of arousal. Women's genital responses are much less dependent on specific sexual cues and are much less concordant with their subjective reports. The preparation hypothesis provides a functional explanation for these sex differences and posits that women's genital responses are not tied to sexual preferences but rather occur automatically in the presence of any sexual cue to protect the genital tissues from injuries incurred through sexual activity. This hypothesis leads to the expectation that women's genital responses may not habituate as quickly or as completely as men's.AimTo determine whether there is a sex difference in the habituation of genital responses and to further test the preparation hypothesis of women's genital responses.MethodsTwenty men and 20 women had their genital responses measured while they were exposed to nine consecutive presentations of the same erotic film clip (habituation), followed by two presentations of different erotic film clips (novelty), and followed by two presentations of the original erotic film clip (dishabituation).Main Outcome MeasuresGenital responses were measured continuously using penile strain gauges (assessing penile circumference) and vaginal probes (assessing vaginal pulse amplitude). Participants reported subjective sexual arousal, perceived genital arousal, and attention after each film clip presentation.ResultsMen and women displayed very similar patterns of genital responses, consistent with habituation and novelty effects. Effects of habituation and novelty were eliminated once subjective reports of attention were covaried.ConclusionContrary to the prediction from the preparation hypothesis of women's genital responses, men's and women's responses showed similar patterns of habituation upon repeated exposure. Future research should attempt to maintain participants' attention in order to further test the preparation hypothesis. Dawson SJ, Suschinsky KD, and Lalumière ML. Habituation of sexual responses in men and women: A test of the preparation hypothesis of women's genital responses. J Sex Med 2013;10:990-1000.     

Laser Doppler Imaging of Genital Blood Flow: A Direct Measure of Female Sexual Arousal

IntroductionFemale sexual arousal is a challenging construct to measure, partly because of the subtle nature of its indicators, vaginal lubrication and genital swelling. As a result, many instruments have been used in an attempt to accurately measure it; however, problems are associated with each. Furthermore, the relationship between subjective and physiological indicators of arousal appears to be influenced by the instrument used to measure physiological arousal. Specifically, instruments measuring physiological arousal internally yield lower correlations between measures of physiological and subjective arousal than instruments examining the external genitals. Laser Doppler imaging (LDI) is a direct measure of external genital blood flow.AimThe purpose of this study was to investigate the usefulness of LDI for measuring genital blood flow in women in response to erotic visual stimuli, and to explore the relationship between physiological and subjective sexual arousal.MethodSixty-five participants watched three 15-minute films during LDI scanning.Main Outcome MeasuresTwo nature films (measuring acclimatization and baseline blood flow levels) and one randomly assigned experimental film (erotic, anxiety, humor, or neutral) were used. Participants rated their level of subjective arousal following the third film.ResultsResults indicated a significant effect of film condition on genital blood flow, P < 0.001, with the erotic condition differing significantly from the other three conditions. In terms of the relationship between physiological and subjective sexual arousal, physiological arousal was significantly predicted by subjective ratings of sexual arousal (P < 0.001).ConclusionsLDI appears to be able to differentiate blood flow during erotic and nonerotic conditions. In addition, physiological sexual arousal was significantly predicted by women's reported subjective sexual arousal. These findings suggest that LDI is a useful instrument for measuring female sexual arousal, and that women may be more aware of their level of physiological arousal than previously assumed. Waxman SE, and Pukall CF. Laser Doppler imaging of genital blood flow: A direct measure of female sexual arousal. J Sex Med 2009;6:2278–2285.     

Associations Among Physiological and Subjective Sexual Response,Sexual Desire,and Salivary Steroid Hormones in Healthy Premenopausal Women

IntroductionFew studies have examined how sexual arousal influences healthy premenopausal women's hormones, limiting our understanding of basic physiology and our ability to transfer knowledge from clinical and nonhuman populations.AimTo examine how sexual arousal and steroid hormones (testosterone [T], cortisol [C], estradiol [E]) were linked, to see whether hormone levels influenced and/or changed in response to sexual arousal elicited via visual erotic stimuli in healthy women.MethodsParticipants included 40 healthy premenopausal women not using exogenous hormones.Main Outcome MeasuresChange in genital sexual arousal (vaginal pulse amplitude), change in subjective sexual arousal, sexual desire (via the Sexual Desire Inventory and Female Sexual Function Index scales), as well as T, C, and E via saliva samples taken before and following viewing of erotic stimuli as genital arousal was recorded via a vaginal photoplethysmograph.ResultsE increased in response to sexual stimuli but this was not statistically associated with genital sexual arousal, whereas C decreased in association with genital sexual arousal, and T showed no statistically significant change. Relationship status was linked to genital but not subjective sexual arousal such that dating women exhibited higher genital sexual arousal than single or partnered women. Results indicated that all three hormones were associated with self-reported genital arousal (via the Detailed Assessment of Sexual Arousal scales) and sexual desire in different domains, and both T and E were associated with self-reported orgasms.ConclusionFindings point to the need to examine multiple hormones in multiple ways (e.g., baseline, changes, stimulated) and question using erotic stimuli-induced arousal as a model for women's endocrine responses to sexuality. van Anders SM, Brotto L, Farrell J, and Yule M. Associations among physiological and subjective sexual response, sexual desire, and salivary steroid hormones in healthy premenopausal women. J Sex Med 2009;6:739–751.     

Extinction of Aversive Classically Conditioned Human Sexual Response

IntroductionResearch has shown that acquired subjective likes and dislikes are quite resistant to extinction. Moreover, studies on female sexual response demonstrated that diminished genital arousal and positive affect toward erotic stimuli due to aversive classical conditioning did not extinguish during an extinction phase. Possible resistance to extinction of aversive conditioned sexual responses may have important clinical implications. However, resistance to extinction of aversive conditioned human sexual response has not been studied using extensive extinction trials.AimThis article aims to study resistance to extinction of aversive conditioned sexual responses in sexually functional men and women.MethodsA differential conditioning experiment was conducted, with two erotic pictures as conditioned stimulus (CSs) and a painful stimulus as unconditioned stimuli (USs). Only one CS (the CS+) was followed by the US during the acquisition phase. Conditioned responses were assessed during the extinction phase.Main Outcome MeasurePenile circumference and vaginal pulse amplitude were assessed, and ratings of affective value and subjective sexual arousal were obtained. Also, a stimulus response compatibility task was included to assess automatic approach and avoidance tendencies.ResultsMen and women rated the CS+ more negative as compared with the CS−. During the first trials of the extinction phase, vaginal pulse amplitude was lower in response to the CS+ than in response to the CS−, and on the first extinction trial women rated the CS+ as less sexually arousing. Intriguingly, men did not demonstrate attenuated genital and subjective sexual response.ConclusionsAversive conditioning, by means of painful stimuli, only affects sexual responses in women, whereas it does not in men. Although conditioned sexual likes and dislikes are relatively persistent, conditioned affect eventually does extinguish. Brom M, Laan E, Everaerd W, Spinhoven P, and Both S. Extinction of aversive classically conditioned human sexual response. J Sex Med 2015;12:916–935.     

ORIGINAL RESEARCH—ANATOMY/PHYSIOLOGY: Induction of Sexual Arousal in Women Under Conditions of Institutional and Ambulatory Laboratory Circumstances: A Comparative Study

IntroductionMeasuring under naturally occurring circumstances increases ecological validity. We developed an ambulatory psychophysiological laboratory that allows experiments to be performed at home.AimsTo compare institutional laboratory task measures with ambulatory laboratory task measures.Main Outcome MeasuresVaginal pulse amplitude (VPA), clitoral blood volume (CBV), subjective report of sexual arousal, preconscious attentional bias for erotic stimuli, subjective reports about feeling at ease, tense, anxious or inhibited.MethodsVPA and CBV were measured in eight women with hypoactive sexual desire disorder (HSDD) and eight healthy controls while exposed to neutral and erotic film clips both in the institute's laboratory and at home. Before and after film clip presentations, subjects performed an emotional Stroop task and completed two questionnaires.ResultsIn healthy controls, genital measures of sexual arousal were significantly increased at home compared with the institutional laboratory, whereas no differences were observed between the institutional laboratory and the at home measurements in women with HSDD. The responses at home were significantly higher in healthy controls compared with women with HSDD. Subjective experience of genital responding increased at home for both groups of women. Concordance between subjective experience and genital sexual arousal was more pronounced in the institutional laboratory setting. Preconscious attentional bias was stronger in the institutional laboratory for both groups of women. Healthy controls felt more at ease and less inhibited at home while subjects with HSDD did not.ConclusionsThe use of an ambulatory laboratory is a valuable tool allowing psychophysiological (sex) research under more natural circumstances (e.g., a participant's home). In this study, the increase in ecological validity resulted in a qualitative differentiation between the healthy controls and the women with HSDD in the home setting, which is not apparent in the artificial setting of the institutional laboratory. Bloemers J, Gerritsen J, Bults R, Koppeschaar H, Everaerd W, Olivier B, and Tuiten A. Induction of sexual arousal in women under conditions of institutional and ambulatory laboratory circumstances: A comparative study.     

Opinion Paper: On the Diagnosis/Classification of Sexual Arousal Concerns in Women

BackgroundIn the professional literature and among our professional societies, female sexual dysfunction nomenclature and diagnostic criterion sets have been the source of considerable controversy. Recently, a consensus group, supported by the International Society for Women’s Sexual Health, published its recommendations for nosology and nomenclature, which included only one type of arousal dysfunction, female genital arousal disorder, in its classification system. Subjective arousal was considered an aspect of sexual desire and not part of the arousal phase.AimTo advocate for the importance of including subjective arousal disorder in the diagnostic nomenclature in addition to the genital arousal subtype.MethodsWe reviewed how the construct of subjective arousal was included in or eliminated from the iterations of various diagnostic and statistical manuals. The Female Sexual Function Index (FSFI) was used to examine the relations among subjective arousal, genital arousal, and desire in women with and without sexual arousal concerns.Main Outcome MeasuresSexual arousal through a self-report Film Scale, physiologic sexual arousal through vaginal photoplethysmography in response to an erotic film, and the FSFI.ResultsThe clinical literature and experience support differentiating subjective arousal from desire and genital arousal. Correlations between the FSFI domains representing desire and subjective arousal, although sufficient to suggest relatedness, share approximately 58% of the variance between constructs—a lower shared variance than FSFI domains representing subjective arousal and orgasm. Similarly, when looking at FSFI individual items best representative of sexual desire and subjective arousal, the large majority of the variance in subjective arousal was unexplained by desire. A third line of evidence showed no significant difference in levels of subjective arousal to erotic films between sexually functional women and women with desire problems. If desire and subjective arousal were the same construct, then one would expect to see evidence of low subjective arousal in women with low sexual desire.Clinical ImplicationsOptimized treatment efficacy requires differentiating mental and physical factors that contribute to female sexual dysfunction.Strengths and LimitationsSupport for our conclusion is based on clinical qualitative evidence and quantitative evidence. However, the quantitative support is from only one laboratory at this time.ConclusionThese findings strongly support the view that female sexual arousal disorder includes a subjective arousal subtype and that subjective arousal and desire are related but not similar constructs. We advocate for the relevance of maintaining subjective arousal disorder in the diagnostic nomenclature and present several lines of evidence to support this contention.Althof SE, Meston CM, Perelman M, et al. Opinion Paper: On the Diagnosis/Classification of Sexual Arousal Concerns in Women. J Sex Med 2017;14:1365–1371.     

Neural activation toward erotic stimuli in homosexual and heterosexual males

IntroductionStudies investigating sexual arousal exist, yet there are diverging findings on the underlying neural mechanisms with regard to sexual orientation. Moreover, sexual arousal effects have often been confounded with general arousal effects. Hence, it is still unclear which structures underlie the sexual arousal response in homosexual and heterosexual men.AimNeural activity and subjective responses were investigated in order to disentangle sexual from general arousal. Considering sexual orientation, differential and conjoint neural activations were of interest.MethodsThe functional magnetic resonance imaging (fMRI) study focused on the neural networks involved in the processing of sexual stimuli in 21 male participants (11 homosexual, 10 heterosexual). Both groups viewed pictures with erotic content as well as aversive and neutral stimuli. The erotic pictures were subdivided into three categories (most sexually arousing, least sexually arousing, and rest) based on the individual subjective ratings of each participant.Main Outcome MeasuresBlood oxygen level‐dependent responses measured by fMRI and subjective ratings.ResultsA conjunction analysis revealed conjoint neural activation related to sexual arousal in thalamus, hypothalamus, occipital cortex, and nucleus accumbens. Increased insula, amygdala, and anterior cingulate gyrus activation could be linked to general arousal. Group differences emerged neither when viewing the most sexually arousing pictures compared with highly arousing aversive pictures nor compared with neutral pictures.ConclusionResults suggest that a widespread neural network is activated by highly sexually arousing visual stimuli. A partly distinct network of structures underlies sexual and general arousal effects. The processing of preferred, highly sexually arousing stimuli recruited similar structures in homosexual and heterosexual males. Kagerer S, Klucken T, Wehrum S, Zimmermann M, Schienle A, Walter B, Vaitl B, and Stark R. Neural activation toward erotic stimuli in homosexual and heterosexual males. J Sex Med 2011;8:3132–3143.     

Predictors of Men's Sexual Response to Erotic Film Stimuli: The Role of Affect and Self‐Reported Thoughts

IntroductionBoth emotions and cognitions seem to play a role in determining sexual arousal. However, no studies to date have tested the effects of self‐reported thoughts on subjective sexual arousal and genital response using psychophysiological methods.AimThe aim of the present study was to evaluate the role of self‐reported thoughts and affect during exposure to erotic material in predicting subjective and genital responses in sexually healthy men.MethodsTwenty‐seven men were presented with two explicit films, and genital responses, subjective sexual arousal, self‐reported thoughts, and positive and negative affect were assessed.Main Outcome MeasuresMen's genital responses, subjective sexual arousal, affective responses, and self‐reported thoughts during exposure to sexual stimulus were measured.ResultsRegression analyses revealed that genital responses were predicted by self‐reported thoughts (explaining 20% of the variance) but not by affect during exposure to erotic films. On the other hand, subjective sexual arousal was significantly predicted by both positive and negative affect (explaining 18% of the variance) and self‐reported thoughts (explaining 37% of the variance). Follow‐up analyses using the single predictors showed that “sexual arousal thoughts” were the only significant predictor of subjective response (β = 0.64; P < 0.01) and that “distracting/disengaging thoughts” were the best predictor of genital response (β = −0.51; P < 0.05).ConclusionsThe findings of this study suggest that both affect and sexual arousal thoughts play an important role in men's subjective sexual response, whereas genital response seems to be better predicted by distracting thoughts. Oliveira C, Laja P, Carvalho J, Quinta Gomes A, Vilarinho S, Janssen S, and Nobre PJ. Predictors of men's sexual response to erotic film stimuli: The role of affect and self‐reported thoughts. J Sex Med 2014;11:2701–2708.     

Sensation and sexual arousal in circumcised and uncircumcised men

IntroductionResearch, theory, and popular belief all suggest that penile sensation is greater in the uncircumcised as compared with the circumcised man. However, research involving direct measurement of penile sensation has been undertaken only in sexually functional and dysfunctional groups, and as a correlate of sexual behavior. There are no reports of penile sensation in sexually aroused subjects, and it is not known how arousal affects sensation. In principle, this should be more closely related to actual sexual function.AimThis study therefore compared genital and nongenital sensation as a function of sexual arousal in circumcised and uncircumcised men.MethodsTwenty uncircumcised men and an equal number of age-matched circumcised participants underwent genital and nongenital sensory testing at baseline and in response to erotic and control stimulus films. Touch and pain thresholds were assessed on the penile shaft, the glans penis, and the volar surface of the forearm. Sexual arousal was assessed via thermal imaging of the penis.ResultsIn response to the erotic stimulus, both groups evidenced a significant increase in penile temperature, which correlated highly with subjective reports of sexual arousal. Uncircumcised men had significantly lower penile temperature than circumcised men, and evidenced a larger increase in penile temperature with sexual arousal. No differences in genital sensitivity were found between the uncircumcised and circumcised groups. Uncircumcised men were less sensitive to touch on the forearm than circumcised men. A decrease in overall touch sensitivity was observed in both groups with exposure to the erotic film as compared with either baseline or control stimulus film conditions. No significant effect was found for pain sensitivity.ConclusionThese results do not support the hypothesized penile sensory differences associated with circumcision. However, group differences in penile temperature and sexual response were found. Payne K, Thaler L, Kukkonen T, Carrier S, and Binik Y. Sensation and sexual arousal in circumcised and uncircumcised men.     

The Clitoral Photoplethysmograph: A New Way of Assessing Genital Arousal in Women

IntroductionIn the present study, we introduce clitoral photoplethysmography as an instrument to assess clitoral blood volume (CBV). In research on female sexual functioning, vaginal pulse amplitude (VPA), as measured using vaginal photoplethysmography, has been used extensively as a measure of vaginal vasocongestion. Measurement of clitoral blood flow has thus far been problematic, mainly because of methodological constraints.AimTo demonstrate that CBV is a valuable, easy to use complementary measure for the female sexual response, offering additional information to the VPA.MethodsThirty women with and without female sexual dysfunction (FSD) watched neutral and erotic film clips. At the end of the erotic clip, the session was interrupted to induce inhibition of the sexual response. Another neutral clip followed the interruption. VPA and CBV were measured simultaneously, as well as skin conductance levels (SCLs), to assess the amount of sympathetic activity.Main Outcome MeasuresVPA, CBV, SCL.ResultsFor both FSD and non-FSD women, VPA and CBV increased when sexually explicit material was presented. Changes in skin conductance significantly predicted changes in CBV (b = ?0.61, t[27] = ?3.88, P < 0.001), but not in VPA. A large increase in sympathetic activity was accompanied by a large decrease in CBV. Furthermore, a large increase in CBV at the end of the erotic film clip presentation, as compared with the neutral clip, was accompanied by a relatively small increase in VPA (b = ?0.39, t[29] = ?2.25, P < 0.033).ConclusionCBV is a valid and sensitive tool to measure the female genital response. In the present study, it was particularly useful in investigating sexual inhibition, when used in combination with SCL. Furthermore, high CBV appeared to inhibit VPA, suggesting that VPA reflects an automatic preparatory response rather than genital arousal per se. Gerritsen J, van der Made F, Bloemers J, van Ham D, Kleiverda G, Everaerd W, Olivier B, Levin R, and Tuiten A. The clitoral photoplethysmograph: A new way of assessing genital arousal in women. J Sex Med 2009;6:1678–1687.     

How Hot Is He? A Psychophysiological and Psychosocial Examination of the Arousal Patterns of Sexually Functional and Dysfunctional Men

IntroductionDespite much theorizing about the interchangeability of desire and arousal, research has yet to identify whether men with desire vs. arousal disorders can be differentiated based on their psychophysiological patterns of arousal. Additionally, little research has examined the relationship between subjective (SA) and genital arousal (GA) in sexually dysfunctional men.AimsTo compare patterns of SA and GA in a community sample of men meeting DSM‐IV‐TR criteria for hypoactive sexual desire disorder (HSDD), erectile dysfunction (ED), both HSDD and ED (ED/HSDD), and healthy controls.MethodsSeventy‐one men (19 controls, 13 HSDD, 19 ED, 20 ED/HSDD) completed self‐report measures and watched two 15‐minute film clips (neutral and erotic), while GA and SA were measured both continuously and discretely.Main Outcome MeasuresGroups were compared on genital temperature (as an indicator of GA), SA, and psychosocial variables (i.e., body image, emotion regulation, sexual attitudes, sexual inhibition/excitation, mood, and trauma).ResultsGenital temperature increased for all groups during the erotic condition, yet men with ED and ED/HSDD showed less GA than men without erectile difficulties. All groups increased in SA during the erotic condition, yet ED/HSDD men reported less SA than controls or ED men. SA and GA were highly correlated for controls, and less strongly correlated for clinical groups; men with ED showed low agreement between SA and GA. Groups also differed on body image, sexual inhibition/excitation, sexual attitudes and alexithymia.ConclusionLow desire vs. arousal sufferers have unique patterns of response, with those with both difficulties showing greatest impairment. Results have important implications for the diagnosis and treatment of these disorders. Sarin S, Amsel R, and Binik YM. How hot is he? A psychophysiological and psychosocial examination of the arousal patterns of sexually functional and dysfunctional men. J Sex Med 2014;11:1725–1740.     

The Successful Measurement of Clitoral Pulse Amplitude Using a New Clitoral Photoplethysmograph: A Pilot Study

BackgroundAlthough the clitoris is more sensitive to stimulation and its innervation more conducive to sensory feedback than the vagina, the field of sexual psychophysiology, which uses psychophysiological methods including genital response measures to study sexual arousal, relies heavily on the measurement of vaginal, rather than clitoral, pulse amplitude.AimTo develop and test a new clitoral photoplethysmograph for the measurement of clitoral pulse amplitude (CPA).Methods2 versions of the new device, which differed in the orientation of the sensor and light source (parallel vs angled), were tested in 15 premenopausal, sexually functional women. Vaginal pulse amplitude (VPA) was assessed simultaneously. The women viewed a 3-minute erotic and an anxiety-inducing film segment with each clitoral sensor, interspersed with neutral video excerpts. In addition, they were asked to indicate their subjective level of sexual arousal during and after erotic video presentations.OutcomesThe main outcome measures are CPA, VPA, and subjective sexual arousal.ResultsThe clitoral photoplethysmograph successfully detected CPA. The quality of the signals was best for the angled sensor. Main effects of the film and the interaction between the film and epoch were stronger for the clitoral than for the vaginal device. In addition, CPA followed more closely changes in intensity of sexual films than VPA. Within- and between-subject correlations between genital response and subjective sexual arousal were higher for the clitoral than for the vaginal device.Clinical TranslationComparison of CPA with other genital blood flow measures in clinical samples is indicated and may contribute to improved physiological assessments of sexual response in women.Strengths and LimitationsOur sample was small and consisted of healthy volunteers. Future research could examine test-retest reliability, by including multiple recording sessions, and further explore the specificity of CPA by comparing sexual and non-sexual stimuli with positive valence.ConclusionThis study presents the first instrument to successfully measure CPA.Mechelmans DJ, Sachtler WL, von Wiegand TE, et al. The Successful Measurement of Clitoral Pulse Amplitude Using a New Clitoral Photoplethysmograph: A Pilot Study. J Sex Med 2020;17:1118–1125.     

Assessing Women's Sexual Arousal in the Context of Sexual Assault History and Acute Alcohol Intoxication

IntroductionFew studies have examined differences in women's sexual arousal based on sexual assault history (SAH) or in-the-moment alcohol intoxication. Only one has examined combined effects. Findings regarding the relationship between SAH and arousal are contradictory.AimWe aimed to determine the relationship between SAH, alcohol intoxication, and sexual arousal.MethodsWomen were randomly assigned to an alcohol (target blood alcohol level = 0.10%) or control condition and categorized as having an SAH or not. After beverage administration, all women watched erotic films while genital arousal (vaginal pulse amplitude; VPA) was measured. Afterward, self-reported sexual arousal was measured.Main Outcome MeasuresGenital response was measured by VPA using vaginal photoplethysmography while watching erotic films. Self-reported sexual arousal was assessed after watching erotic films.ResultsWomen with an SAH had smaller increases in genital arousal in response to the films than women without an SAH. Intoxicated women had smaller increases in genital arousal than sober women. However, no differences for SAH or intoxication were found in self-reported arousal.ConclusionSAH and alcohol intoxication are associated with smaller increases in genital arousal compared to women without an SAH and sober women, suggesting that these co-occurring factors impact sexual arousal. Gilmore AK, Schacht RL, George WH, Otto JM, Davis KC, Heiman JR, Norris J, and Kajumulo KF. Assessing women's sexual arousal in the context of sexual assault history and acute alcohol intoxication.     

One Session of Autogenic Training Increases Acute Subjective Sexual Arousal in Premenopausal Women Reporting Sexual Arousal Problems

Background

Below average heart rate variability (HRV) has been associated with sexual arousal dysfunction and overall sexual dysfunction in women. Autogenic training, a psychophysiologic relaxation technique, has been shown to increase HRV. In a recent study, sexually healthy women experienced acute increases in physiologic (ie, genital) and subjective sexual arousal after 1 brief session of autogenic training.

Genital and subjective measurement of the time course effects of an acute dose of testosterone vs. placebo in postmenopausal women

IntroductionRecent research on the impact of testosterone (T) on female sexual function has yielded inconsistent results, and few studies have used physiological measures of genital arousal.AimThis study examined the effects of an acute dose of methyltestosterone (MT) on physiological (genital) and subjective sexual response in postmenopausal women.Main Outcome MeasuresVaginal pulse amplitude (VPA) and self-reported sexual response.MethodsRandomized, double-blind, crossover, placebo-controlled trial of 5 mg MT, consisting of two separate 8-hour visits. Participants were 10 postmenopausal women without sexual dysfunction. Participants viewed both neutral and erotic video segments during five post-dose trials while their genital and subjective responses were monitored.ResultsThe Wilcoxon signed rank test indicated a significant difference in VPA between the T (M = 0.018, SD = 0.018) and placebo (M = 0.016, SD = 0.017) conditions at 4.5 hours post-dose (P = 0.03). Higher difference scores were noted for 80% of subjects during the T condition at 4.5 hours, in contrast with only 50% of subjects responding to T at the other four time points. No differences were found on VPA relative change scores or subjective sexual arousal scores. When summed across all five time points, genital and subjective measures were correlated regardless of medication condition (0.62 and 0.60 for self-reported physical and mental sexual arousal scores, respectively).ConclusionsThese findings in postmenopausal women combined with those of two previous investigations in premenopausal women demonstrate a probable acute-dose time delay for genital sexual effects of exogenous T with no change in self-reported sexual arousal. Further investigation is needed to determine whether acute dosing of T has a consistent and predictable impact on genital arousal that has promise for the treatment of any subgroup of women with sexual disorders. Heard-Davison A, Heiman JR, and Kuffel S. Genital and subjective measurement of the time course effects of an acute dose of testosterone vs. placebo in postmenopausal women. J Sex Med 2007;4:209–217.     

Classical conditioning of sexual response in women: a replication study

IntroductionAccording to incentive motivation models, sexual stimuli play a crucial role in eliciting sexual arousal, desire, and behavior. Therefore, it seems highly valuable to investigate the process through which stimuli acquire motivational value. Although many theories of human sexual behavior assume that sexual stimuli obtain arousing properties through classical conditioning, systematic research on classical conditioning of sexual responses in humans is scarce. Recently, however, our research group observed conditioned genital responses in women using a differential conditioning procedure and genital vibrostimulation as unconditional stimulus (US).AimThe aim of the present experiment was to perform an extended replication of this previous study to test the efficacy of our conditioning paradigm.MethodsA differential conditioning experiment was conducted in 32 sexually functional women. Neutral pictures served as conditional stimuli (CSs) and genital vibrostimulation as US. Only one CS (the CS+) was followed by the US during the acquisition phase. Conditioned responses were assessed during the extinction phase.Main Outcome MeasuresVaginal pulse amplitude (VPA) and skin conductance level were assessed, and ratings of affective value and sexual arousal were obtained.ResultsAs expected, during the extinction phase, VPA was higher in response to the CS+ than to the CS?. Also, the CS+ tended to be evaluated as more positive and as more sexually arousing than the CS?. In addition, the magnitude of conditioned subjective affect was related to scores on the Sexual Inhibition\Sexual Excitation Scales. Skin conductance levels showed no conditioning effect.ConclusionGenital and subjective sexual responses were successfully modulated by the differential conditioning paradigm. This replication of our previous study confirms the effectiveness of our conditioning procedure and indicates that it may provide a fruitful paradigm for further research on associative sexual reward learning in humans. Both S, Brauer M, and Laan, E. Classical conditioning of sexual response in women: A replication study. J Sex Med 2011;8:3116–3131.