Measuring Pedophilic Sexual Interest

IntroductionPedophilic sexual interest is an important risk factor in sexual offender recidivism and remains a key component in the clinical assessment of child sexual offenders and people diagnosed with pedophilia. Despite concerns about the absence of universally accepted standardized clinical assessment methods, there are a number of established techniques aimed at assessing people with sexual interest in children.AimTo provide a foundation from which to understand existing methods available for the assessment of people with pedophilic sexual interests, including strengths and limitations of each approach.MethodsA group of clinical experts provide a clinically oriented, narrative review on assessment methods for pedophilic sexual interest, including the rationale behind each method and its implementation. Evidence on validity supporting the techniques, limitations, and ethical issues is also discussed.ResultsThe assessment methods were grouped according to the following categories: self-report, genital psychophysiological assessment, indirect measurement, and behavioral measurement of pedophilic interest. Although most techniques performed well in discriminating child sexual offenders with pedophilic interest from distinct comparison groups, there are several limitations, including the current lack of standardization and the ethical challenges posed by this sensitive area.Clinical implicationsAn understanding of the different measures available for the assessment of problematic sexual interests plays a vital role in forensic clinical determinations of risk of recidivism and in the identification of treatment targets for men who have committed sexual offenses. Several independent but complimentary methods exist to assess sexual interest. Ongoing work on the international standardization of assessment based on methodologically sound research aimed at determining best practices will address some of the shortcomings of these assessments while improving their reliability.Strengths & limitationsThis article provides a general review on a number of methods aimed at assessing pedophilic interest. However, these methods mirror clinical practice largely used within North America and parts of continental Europe. As a result of cultural differences, opposing paradigms on assessment and treatment of pedophilia, and diverse legal regulation between jurisdictions and countries, these practices may not be applicable on an international scale where other special procedures may be required.ConclusionA number of techniques have been used within clinical and research settings that vary from self-report to objective measures. Most methods have demonstrated efficacy. Continued work to combine evidence and experience from diverse populations and multiple countries will improve the quality of the methods available.Carvalho J, Bradford J, Murphy L, et al. Measuring Pedophilic Sexual Interest. J Sex Med 2020;17:378–392.     

Standardization of Penile Plethysmography Testing in Assessment of Problematic Sexual Interests

Murphy L, Ranger R, Fedoroff JP, Stewart H, Dwyer RG, and Burke W. Standardization of penile plethysmography testing in assessment of problematic sexual interests. J Sex Med 2015;12:1853–1861Penile plethysmography (PPG) is an objective measure of sexual arousal for men, commonly used to assess sexual arousal to both abnormal (i.e., paraphilic) and normal stimuli. While PPG has become a standard measure in the assessment and treatment of male sex offenders and men with paraphilic interests in both Canada and the United States, there is a lack of standardization of stimulus sets and interpretation of results between sites. The current article critically reviews the current state of the art while highlighting clinical and research efforts that may be undertaken in an attempt to reduce issues arising from lack of standardization across sites. Types and themes of stimulus sets, assessment apparatuses, laboratory preparation, and testing procedures are discussed. The continued development of standardized testing protocol and procedures across multiple international sites continues to be encouraged to promote unified PPG administration and interpretation, thus further enhancing the practical utility of the measurements and decreasing inter‐rater discrepancies and error.     

Concurrent Assessment of Penile Blood Flow and Circumference as Indicators of Male Sexual Arousal

Introduction

The current study aims to validate a new imaging tool to assess men’s sexual psychophysiological responding: laser Doppler imaging (LDI), which directly measures subcutaneous genital blood flow. In this study, we concurrently assessed genital sexual arousal in a sample of men using the LDI and the current gold standard of male sexual psychophysiology, the penile strain gauge (PSG).

Successful Aging and Changes in Sexual Interest and Enjoyment Among Older European Men and Women

Introduction

Despite the popularity and analytical relevance of the concept of successful aging, little efforts have been made to address its relationship to sexuality in older individuals.

Sexual Responsivity and the Effects of Negative Mood on Sexual Arousal in Hypersexual Men Who Have Sex With Men (MSM)

BackgroundA number of studies have found that hypersexuality is associated with a high propensity for sexual excitation. In comparison, less is known about the relationship between hypersexuality and sexual arousal at the state level. Also, previous research has revealed a relationship between hypersexuality and negative mood. However, the possibility that sexual response might not be as negatively impacted by negative mood in hypersexual individuals has, as yet, not been tested.AimThe purpose of this study was to investigate sexual responsivity and the effects of negative mood on sexual arousal in hypersexual men who have sex with men (MSM).MethodsA total of 211 MSM were assigned to a hypersexuality (N = 81) or a control (N = 130) group using an interview patterned with a semi-structured Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders format. Participants filled out questionnaires and were shown neutral, sexual, and anxiety- and sadness-inducing films.OutcomesChanges in penile circumference and self-reported sexual arousal were the primary outcomes analyzed in this study.ResultsControlling for age and HIV status, no differences were found in genital response between hypersexual and non-hypersexual men. Also, the 2 groups did not differ in subjective sexual arousal. Moreover, no effects of negative mood were found. Time series clustering analyses revealed 3 groups—low responders and slow and fast high responders. Sexual excitation, but not sexual compulsivity or pornography use, predicted cluster membership.Clinical TranslationHypersexual MSM may benefit more from an exploration of motivational and behavioral, as compared to psychophysiological, mechanisms underlying possible links between (negative) mood and sexual behavior.Strengths & LimitationsStrengths of the study include its sample size, making it one of the larger psychophysiological sex studies; the use of clinical interviews for group assignment; the inclusion of genital response measures; and the application of time series clustering to examine differences among participants. Limitations include possible sample heterogeneity and the reliance on researcher-selected stimuli.ConclusionGiven the lack of any effects of negative mood on sexual response in hypersexual MSM, future studies could explore in more depth possible motivational and behavioral effects, including, for example, the impact of negative mood on the tendency to seek out sex as a form of distraction or for validation or emotional support.Janssen E, Prause N, Romine RS, et al. Sexual Responsivity and the Effects of Negative Mood on Sexual Arousal in Hypersexual Men Who Have Sex With Men (MSM). J Sex Med 2020;17:1751–1760.     

Patients' Conceptions of Terms Related to Sexual Interest,Desire, and Arousal

BackgroundMeasurement of sexual function typically uses self-report, which, to work as intended, must use language that is understood consistently by diverse respondents. Commonly used measures employ multiple terms, primarily (sexual) interest, desire, and arousal, that might not be understood in the same way by laypeople and professionals.AimTo inform self-reported measurement efforts for research and clinical settings by examining how US men and women recruited from a health care setting understand and interpret different terms.MethodsWe conducted 10 focus groups in Durham, NC (N = 57). Discussions were audio-recorded and transcribed, and the content of the discussions was systematically analyzed in 2 phases of coding by the research team, facilitated by Nvivo qualitative analysis software (QSR International, Doncaster, VIC, Australia).OutcomesPatient focus group discussions about the meanings and connotations of multiple terms related to sexual function, especially interest, desire, and arousal.Results5 groups included male participants and 5 included female participants. Participants characterized (sexual) interest as a cognitive phenomenon and a situational response to a specific person. Similarly, they characterized (sexual) desire as a situational person-specific experience with some support for it as a cognitive phenomenon but more support for it as a physical phenomenon. In contrast, participants characterized sexual arousal as a physical phenomenon occurring in response to physical or visual stimulation and not related to a specific person.Clinical ImplicationsThese results can help us understand how laypeople are using and responding to these terms when they are used in clinical and research settings.Strengths and LimitationsPatient participants in these groups were diverse in age, gender, sexual orientation, and health, with the potential to voice diverse perspectives on sexual functioning; however, the sample was limited to a single city in the southeastern United States.ConclusionThe meanings of interest, desire, and arousal were defined, compared, and contrasted in the context of patient focus groups. Qualitative coding showed that interest was considered the most “cognitive,” arousal the most “physical,” and desire somewhere in between.DeLamater JD, Weinfurt KP, Flynn KE. Patients' Conceptions of Terms Related to Sexual Interest, Desire, and Arousal. J Sex Med 2017;14:1327–1335.     

Psychometric Properties of the Sexual Event Diary in a Sample of Dutch Women With Female Sexual Interest/Arousal Disorder

Background

Efficacy of on-demand drugs for women with hypoactive sexual desire disorder or female sexual interest/arousal disorder (FSIAD) should be assessed using a validated instrument that assesses the discrete sexual events during which the on-demand drug is taken, because this type of assessment is more proximate to an on-demand drug's efficacy compared to instruments that assess sexual function over longer periods of time.

Psychobiological Correlates of Women's Sexual Interest as Perceived by Patients with Erectile Dysfunction

IntroductionWe have recently reported that the perceived loss of a partner's sexual desire is independently associated with an increased incidence of major cardiovascular events in patients with erectile dysfunction (ED). No study has ever evaluated the specific impact of men's perception of women's sexual desire on male sexual function and lifestyle attitudes in ED subjects.AimTo evaluate the clinical correlates of the perception of a partner's sexual desire [hypoactive sexual desire (HSD)] in a consecutive series of subjects seeking medical care for ED.MethodsA consecutive series of 2,303 heterosexual male patients (mean age 58.1 ± 10.5) was studied.Main Outcome MeasuresPatients were interviewed with the Structured Interview on Erectile Dysfunction (SIEDY) structured interview. They also completed the Middlesex Hospital Questionnaire, a brief questionnaire for the screening of the symptoms of mental disorders.ResultsAmong the patients studied, 458 (19.9%) reported a mild loss of their partner's desire, 302 (13.1%) a moderate reduction of libido, while 118 (5.1%) complained of a complete absence of sexual interest on the part of their partner. After adjustment for confounding factors, the perceived women's HSD was associated with different sexual, lifestyle, and relational factors. In particular, more extra-marital affairs, a longer and more hostile couple relationship, as well as a stressful job and both alcohol and smoking abuse were all significantly associated with perceived women's HSD. In addition, the perceived women's moderate to severe HSD was significantly associated with severe ED and less frequent sexual intercourse. Finally, partner HSD was significantly associated with a stepwise increase of free-floating anxiety and depressive symptoms (adj. r = 0.081, P < 0.05 and 0.158, P < 0.0001, respectively).ConclusionsPerceived sexual interest (éros) on the part of the woman can be seen for men not only as a fun and enjoyable behavior, but also a safe strategy for improving a man's overall health and life expectancy. Corona G, Bandini E, Fisher A, Elisa M, Boddi V, Balercia G, Sforza A, Forti G, Mannucci E, and Maggi M. Psychobiological correlates of women's sexual interest as perceived by patients with erectile dysfunction.     

Feasibility of a Brief Online Psychoeducational Intervention for Women With Sexual Interest/Arousal Disorder

BackgroundLow sexual desire and arousal are the most common sexual concerns in women, but most women lack access to effective treatment such as cognitive behavioral therapy. Web-based psychological interventions, which are economical, private, easily accessible, and potentially effective, may increase the reach of evidence-based treatment.AimTo determine the feasibility of translating cognitive behavioral therapy for the most common female sexual dysfunction, Female Sexual Interest/Arousal Disorder, into an online format. The present study examined the feasibility of an introductory psychoeducational module of eSense, an online program currently being developed that is based on existing empirically supported in-person treatments, which delivers content to the user in a visually appealing and interactive manner.MethodsSixteen cisgender women (M age = 31.9) with female sexual arousal/interest disorder worked through a pilot module of eSense inperson at a sexual health laboratory.OutcomesQualitative semistructured interviews and online questionnaires were used to assess participants’ experiences of usability of the platform, clarity/relevance of the content, satisfaction with the experience, and any changes in clinical outcomes of sexual function and distress.ResultsParticipants reported a high level of satisfaction with the website’s functionality and presentation. They reported greater knowledge, felt validated and more hopeful, and were eager to continue the remaining modules. Participants also reported notable prepost improvements in sexual desire, arousal, and satisfaction.Clinical ImplicationsInitial user-experience assessment may represent a method of simultaneously improving online interventions and providing therapeutic education to participants.Strengths & LimitationsThis is one of the first studies, to our knowledge, to test a graphics-rich, interactive online intervention for sexual difficulties that does not require direct contact with expert providers or support groups. Limitations include the high level of education, motivation, and technical fluency of the sample and the potentially confounding effect of the researcher’s presence during interviews. Because this was a feasibility study, the sample size was small, and no control group was included, limiting conclusions about efficacy and generalizability.ConclusionThe format of eSense appears to be feasible and usable, lending support to the growing evidence that it is possible to take in-person therapeutic interventions online.Zippan N, Stephenson KR, Brotto LA, Feasibility of a Brief Online Psychoeducational Intervention for Women With Sexual Interest/Arousal Disorder. J Sex Med 2020;17:2208–2219.     

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.     

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.

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.     

Circulating Endocannabinoid Concentrations and Sexual Arousal in Women

IntroductionSeveral lines of evidence point to the potential role of the endocannabinoid system in female sexual functioning. These include results from studies describing the subjective effects of exogenous cannabinoids on sexual functioning in humans and the observable effects of exogenous cannabinoids on sexual functioning in other species, as well as results from studies investigating the location of cannabinoid receptors in the brain and periphery, and the effects of cannabinoid receptor activation on neurotransmitters implicated in sexual functioning. While these lines of research suggest a role for the endocannabinoid system in female sexual functioning, no studies investigating the relationship between concentrations of endogenous cannabinoids (i.e., arachidonoylethanolamide [AEA] and 2-arachidonoylglycerol [2-AG]) and sexual functioning have been conducted in any species.AimTo measure circulating endocannabinoid concentrations in relation to subjective and physiological indices of sexual arousal in women (N = 21).MethodsSerum endocannabinoid (AEA and 2-AG) concentrations were measured immediately prior to, and immediately following, viewing of neutral (control) and erotic (experimental) film stimuli in a repeated measures design. Physiological sexual arousal was measured via vaginal photoplethysmography. Subjective sexual arousal was measured both continuously and noncontinuously. Pearson's correlations were used to investigate the relationships between endocannabinoid concentrations and sexual arousal.Main Outcome MeasuresChanges in AEA and 2-AG concentrations from pre- to post-film and in relation to physiological and subjective indices of sexual arousal.ResultsResults revealed a significant relationship between endocannabinoid concentrations and female sexual arousal, whereby increases in both physiological and subjective indices of sexual arousal were significantly associated with decreases in AEA, and increases in subjective indices of sexual arousal were significantly associated with decreases in 2-AG.ConclusionsThese findings support the hypothesis that the endocannabinoid system is involved in female sexual functioning, with implications for furthering understanding of the biological mechanisms underlying female sexual functioning. Klein C, Hill MN, Chang SCH, Hillard CJ, and Gorzalka BB. Circulating endocannabinoid concentrations and sexual arousal in women. J Sex Med 2012;9:1588–1601.     

Sexual Dysfunctions and Sexual Quality of Life in Men with Multiple Sclerosis

IntroductionMultiple sclerosis (MS) is one of the most frequent diseases of the central nervous system and usually occurs at the age when people would be expected to be in the prime of their sexual lives. Clinicians working in this field commonly concentrate on the classical neurological deficits and often overlook symptoms that seriously affect the quality of life, such as sexual dysfunction (SD). Sexual functioning of MS patients remains poorly understood.AimThe aim of this study was to assess the prevalence of SDs, their relationship with demographic factors, and sexual quality of life in men with multiple sclerosis (MS).MethodsSixty‐seven patients from the National Multiple Sclerosis Center were interviewed, completed the questionnaires, and underwent neurological assessment.Main Outcome MeasuresPrimary outcome measures included the International Index of Erectile Function (IIEF), the Sexual Quality of Life Questionnaire (SQoL), and the Expanded Disability Status Scale (EDSS).ResultsThe most common complaints were erectile dysfunction (52.9%), decreased sexual desire (26.8%), and difficulties in reaching orgasm (23.1%) or ejaculation (17.9%). The severity of SD had a clear impact on sexual quality of life, especially in the domains of erectile function and intercourse satisfaction. However, neither IIEF nor SQoL scores were correlated with age, time since onset of MS symptoms, or EDSS scores. Only 6% of the patients had ever discussed their concerns with a medical professional or undergone sexual therapy.ConclusionsSD is highly prevalent but commonly overlooked in MS patients and has a significant impact on their sexual quality of life. The data support a multifactorial etiology of SD in MS. More focus on SD and use of appropriate screening tools in clinical practice with MS patients are recommended. Lew‐Starowicz M and Rola R. Sexual dysfunctions and sexual quality of life in men with multiple sclerosis. J Sex Med 2014;11:1294–1301.     

Sexual Experiences of Men with Incontinent Partners

IntroductionSeveral studies show that urinary incontinence (UI) impairs women's sexual functioning and sexual satisfaction. However, there is no scientific knowledge about the effects of UI on sexual functioning of the male partners.AimTo analyze sexual functioning of the male partners of females with UI.MethodsDuring a period of 2.5 years all new female patients and their partners (both groups aged 18 years and older), who presented at our outpatient clinic for urological evaluation, were asked for demographic characteristics, medical history, and referral indication including the main urological complaint. In addition they were asked to fill in the Golombok Rust Inventory of Sexual Satisfaction questionnaires about sexual functioning.Main Outcome MeasuresSexual function measured by the Golombok Rust Inventory of Sexual Satisfaction questionnaire.ResultsA total of 189 sexually active couples completed the questionnaires. Eighty-one (42.9%) of the women had UI as main urological complaint. Differences were found between women with UI and those without. Women with UI have a lower overall sexual function (P = 0.02), lower frequency of intercourse (P = 0.02), more problems with communication (P = 0.036), and more often show avoidable behavior with regard to sexual activity. (P = 0.002) Men with partners with UI showed a diminished overall sexual function (6.66 ± 1.53) compared with men with women without UI (5.95 ± 1.22, P = 0.001). Furthermore, comparisons of subscales also demonstrate a lower frequency of intercourse (5.62 ± 2.00, 6.49 ± 1.96), less satisfaction (8.08 ± 2.79, 9.69 ± 3.63), and more erectile problems (6.01 ± 2.28, 6.87 ± 3.23) in men with partners with UI. (P = 0.03, P = 0.001, P = 0.037)ConclusionsThis study shows that female urinary incontinence correlates with their partners’ overall sexual functioning and sexual satisfaction. In addition, significant differences were found with regard to the satisfaction with one's sex life between a woman with UI and her partner. Bekker MD, Beck JJH, Putter H, van Driel MF, Pelger RCM, Weijmar Schultz WC, Lycklama à Nijeholt GAB, and Elzevier HW. Sexual experiences of men with incontinent partners.     

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.     

Flaccid Penile Acceleration as a Marker of Cardiovascular Risk in Men without Classical Risk Factors

IntroductionConventional cardiovascular (CV) risk factors identify only half of subjects with incident major adverse CV events (MACE). Hence new markers are needed in high CV risk subjects, as those with erectile dysfunction (ED). A role for dynamic peak systolic velocity (D-PSV) at penile color Doppler ultrasound (PCDU) has been suggested, but it is operator dependent and time consuming. Flaccid penile acceleration (FPA) is a PCDU parameter that reflects PSV, the systolic rise time (SRT), and end diastolic velocity (EDV), arithmetically defined as (PSV−EDV)/SRT.AimThe study aims to verify, in a large series of ED patients, whether FPA has a role in predicting MACE.MethodsA selected series of 1,903 patients (aged 54.6 ± 11.7) with a suspected organic component for ED was retrospectively studied from January 2000 until July 2012. A subset of this sample (n = 622) was enrolled in a longitudinal study that ended in December 2007.Main Outcome MeasuresSeveral clinical, biochemical, and instrumental (PCDU) parameters were studied.ResultsDecreased FPA levels were associated with worse metabolic profile and sexual symptoms. In addition, FPA was positively associated with both total and calculated free testosterone. In the longitudinal study, unadjusted incidence of MACE was significantly associated with lower baseline FPA. When FPA was introduced in a multivariate model, along with D-PSV, after adjusting for age and Chronic Disease Score, lower FPA, but not D-PSV, was associated with incident MACE in lower-risk—i.e., younger (HR = 0.48 [0.23–0.99]), nonhypertensive (HR = 0.59 [0.38–0.92]), nonobese (HR = 0.68 [0.49–0.96]), or nondiabetic (HR = 0.67 [0.49–0.96] subjects; all P < 0.05—but not in higher-risk ones. FPA demonstrated a threshold effect in predicting MACE at a value <1.17 m/s² which showed a threefold increase in incidence of MACE in apparently lower-risk individuals.ConclusionsFPA is an easily obtained PCDU parameter and capable of identifying adverse metabolic and CV profiles, particularly in apparently lower-risk individuals with ED. Rastrelli G, Corona G, Lotti F, Aversa A, Bartolini M, Mancini M, Mannucci E, and Maggi M. Flaccid penile acceleration as a marker of cardiovascular risk in men without classical risk factors. J Sex Med 2014;11:173–186.     

Influence of Sildenafil on Genital Engorgement in Women with Female Sexual Arousal Disorder

IntroductionWe previously described dynamic, noncontrast magnetic resonance imaging (MRI) of the female genitalia as a reproducible, nonintrusive, objective means of quantifying sexual arousal response in women without sexual difficulties. These studies showed an increase in clitoral engorgement ranging from 50 to 300% in healthy women during sexual arousal.AimThis study sought to evaluate the genital arousal response in women with female sexual arousal disorder (FSAD) after administration of sildenafil and placebo. We performed a multicenter, double‐blind, placebo‐controlled, cross‐over study to assess the clitoral engorgement response using dynamic MRI in women with FSAD after administering sildenafil and placebo followed by audiovisual sexual stimulation (AVSS).MethodsNineteen premenopausal women with FSAD underwent two MRI sessions. Subjects were randomized to receive either (i) sildenafil 100 mg during the first session followed by placebo during the second session, or (ii) placebo followed by sildenafil. During each session, baseline MR images were obtained while subjects viewed a neutral video. Subjects then ingested sildenafil or placebo. After 30 minutes, a series of MRIs were obtained at 3‐minute intervals for 10 time points while subjects viewed AVSS.Main Outcome MeasuresA positive sexual arousal response was achieved if clitoral volume increased ≥50% from baseline.ResultsThirteen of 19 (68%) subjects achieved a ≥50% increase in clitoral engorgement from baseline when administered sildenafil or placebo 30 minutes after dose administration. At 60 minutes after administration, 17/19 (89%) subjects receiving sildenafil and 16/19 (84%) subjects receiving placebo had responded (P value 0.3173).ConclusionsSildenafil did not augment the genital response in women with FSAD. Secondarily, a majority of women in this study did not have impaired clitoral engorgement as measured by MRI, suggesting that FSAD is not predominantly a disorder of genital engorgement. Leddy LS, Yang CC, Stuckey BG, Sudworth M, Haughie S, Sultana S, and Maravilla KR. Influence of sildenafil on genital engorgement in women with female sexual arousal disorder. J Sex Med **;**:**–**.