The Effects of Anxiety and Distraction on Sexual Arousal in a Nonclinical Sample of Heterosexual Women

The effects of anxiety and distraction on sexual arousal in a nonclinical sample of heterosexual women between the ages of 19 and 35 were studied. Using a dichotic listening paradigm, the study extended Geer and Fuhr's (1976) research by examining the effects of distraction on sexual arousal in women. Results indicated that both vaginal pulse amplitude and subjective measures of sexual arousal vary as a function of distraction level, with increased distraction leading to decreased arousal. However, the data failed to support Masters and Johnson's (1970) assertion that anxiety decreases sexual arousal. Although no significant effect for anxiety emerged using a physiological measure of sexual arousal, a significant Anxiety × Distraction interaction was observed using a subjective measure of sexual arousal. Several competing interpretations of this interaction are discussed.     

Effects of Depressive Symptoms and Experimentally Adopted Schemas on Sexual Arousal and Affect in Sexually Healthy Women

The present study examined the effects of depressive mood symptoms and experimentally adopted sexual schemas on women's sexual arousal and affect. Women's vaginal response, subjective sexual arousal, and affect were measured in response to sexually explicit visual material in a laboratory setting. At baseline on a self-report measure, women with depressive mood symptoms (n = 28) reported significantly lower sexual desire than women with normal mood (n=28), but no significant differences in arousal, orgasm, satisfaction, or pain. Participants were asked to adopt both a positive and negative sexual self-schema prior to viewing erotic stimuli. Women in both mood groups demonstrated significantly greater subjective sexual arousal, vaginal response, and positive affect in the positive schema condition than in the negative schema condition when controlling for anxiety. There were no main effects for mood symptoms. These findings support an information processing conceptualization of sexual arousal and suggest that an acute dose of cognitive sexual schemas can significantly impact subsequent sexual and affective responses. Implications of findings for the assessment and treatment of sexual dysfunction are noted.     

The role of anxiety on sexual arousal

Sex therapists have long argued that anxiety is the primary psychological mechanism that underlies the interference with sexual arousal that is responsible for such conditions as erectile failure. However, laboratory research on anxiety's effects has yielded mixed results. Studies have found that sexual arousal may be unaffected, disrupted, or even facilitated by anxiety. Fiftyfour men, ages 21–46, viewed a series of erotic videotape segments after having received one of three types of information; (i) neutral feedback, (ii) feedback indicating that they would be receiving a painful electric shock, and (iii) feedback indicating that their level of sexual arousal during baseline measurement was subnormal. Subsequent plethysmographic measurement of sexual arousal while viewing the erotic material revealed that leading subjects to worry either about their physical well-being (shock threat) or their psychosexual well-being (negative feedback) were both effective strategies for interfering substantially with sexual arousal. The hypothesis that attention/memory would mediate the effects of anxiety on arousal received only partial support. Theoretical and clinical implications of these findings are explored.This research was supported in part by an NIH Biomedical Research Support Grant RR-07092 to the second author.     

Turning On and Turning Off: A Focus Group Study of the Factors That Affect Women's Sexual Arousal

The aim of this study was to inform the development of a questionnaire to assess a woman's tendency to respond with sexual excitation/inhibition in different situations. Nine focus groups, involving 80 women (M age = 34.3 years; range, 18-84), were conducted. Women described a wide range of physical (genital and nongenital), cognitive/emotional, and behavioral cues to arousal. The relationship between sexual interest (desire) and sexual arousal was complex; sexual interest was reported as sometimes preceding arousal, but at other times following it. Many women did not clearly differentiate between arousal and interest. Qualitative data on the factors that women perceived as "enhancers" and "inhibitors" of sexual arousal are presented, with a focus on the following themes: feelings about one's body; concern about reputation; unwanted pregnancy/contraception; feeling desired versus feeling used by a partner; feeling accepted by a partner; style of approach/initiation; and negative mood. The findings can help inform conceptualizations of sexual arousal in women.     

The physiology of sexual arousal in the human female: a recreational and procreational synthesis

Changes induced by human sexual arousal serve reproductive and recreational functions. The current sexual phase model (desire, excitation, orgasm, and resolution) conveys little about this duarchy. Lack of spontaneous sexual desire in a third of nonclinic females indicates that the D phase needs splitting into D1 (the spontaneous endogenous activation of desire) and D2 (desire activated by sexual excitation at and during the E phase). Attempts to link D1 with reproduction by studies monitoring it over the menstrual cycle revealed a D1 peak just before or at ovulation, but its reliability is criticized because of the poor identification of the time of ovulation. Sexual arousal initiates enhanced genital blood flow, leading to the formation of a neurogenic transudate, lubricating the vagina, partly buffering its acidity, and increasing its oxygen tension all features that enhance spermatozoal function and survival. Orgasm occurs with vaginal and uterine contractions. The latter have been misinterpreted as powering rapid sperm transport to facilitate fertilization, but such fast transport would lead to the tubal deposition of noncapacitated, incompetent spermatozoa. Vagino–cervico elevation, however, delays rapid sperm transport and allows the initiation of decoagulation and sperm capacitation before the elevation resolves. The fastest transport of spermatozoa from cervix to the fallopian tubes occurs in the nonaroused female by uterine/subendometrial smooth muscle peristalsis. There is some evidence that even this may be reduced for a time after coitus, adding to the transport delay. If a number of the changes induced by sexual arousal are inadequately expressed, sexual as well as reproductive dysfunctions could arise.     

Thermographic measurement of sexual arousal: A methodological note

A thermographic measure of sexual arousal in terms of the four stages of sexual stimulation (excitement phase, plateau phase, orgasm phase, and resolution phase) articulated by Masters and Johnson (1966) is described. A male and female masturbated to orgasm; the results are presented in terms of interpretations of both the thermographic image and the quantitative temperature profile. Possible future research applications are suggested, including sexual dysfunctions, sexual arousal, and gender differences.This research was supported by University of California, Los Angeles, Biomedical Research Funds and a University Research Grant.Requests for reprints should be sent to Paul R. Abramson, Department of Psychology, University of California, Los Angeles, 405 Hilgard Avenue, Los Angeles, California 90024.     

The relation between sexual activity among children during preadolescence and/or early adolescence and sexual behavior and sexual adjustment in young adulthood

This study examined whether current sexual behavior and sexual adjustment in a sample of 433 college students differed as a function of having engaged in sexual activity with other children during preadolescence (prior to age 13) and/or early adolescence (ages 13–15). Four groups were compared: subjects who only had an early adolescent sexual experience; subjects who had both preadolescent and early adolescent experiences; subjects who had no sexual experience with another child during either preadolescence or early adolescence. There were no significant differences between these groups on measures of incidence of premarital intercourse, age at first intercourse, number of different intercourse partners, sexual satisfaction, sexual arousal, or sexual dysfunctions. It was concluded that in general the simple occurrence or nonoccurrence of sexual activity among children during these developmental periods has little impact, either positive or negative, on later sexual adjustment during young adulthood. Some expections, depending on the specific types of childhood sexual activity involved, were noted.     

The Effects of False Positive and False Negative Physiological Feedback on Sexual Arousal: A Comparison of Women with or without Sexual Arousal Disorder

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

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.     

Timing of Puberty and Sexuality in Men and Women

We examined the relations among timing of puberty, timing of first experience of sexual arousal, strength of sex drive, and sexual attitudes and behaviors in 277 men (M age, 22.4 years) and women (M age, 21.8 years). Kinsey had suggested that earlier maturers have a stronger sex drive and, therefore, engage in a higher frequency of sexual behaviors (including same-sex contacts) than do later maturers. The purpose of this study was to test Kinseys claim. Participants completed questionnaires on pubertal timing, timing of first experience of sexual arousal, sex drive in adulthood, sexual attitudes (e.g., sociosexuality or degree of comfort with casual sex), and sexual behaviors (e.g., lifetime number of sexual partners). Timing of puberty (i.e., emergence of secondary sex characteristics) was related to these variables for men but not for women. Timing of first sexual arousal was related to several aspects of adult sexuality in both sexes, but particularly in women. Earlier first sexual arousal was associated with having a higher sex drive, a less restricted sociosexual orientation, and with having had more sexual partners than was later first sexual arousal. Earlier first sexual arousal, but not timing of puberty, was related to sexual orientation for women only. We discuss classes of explanations for these results.     

Measurement of Sexual Arousal in Postoperative Male-to-Female Transsexuals Using Vaginal Photoplethysmography

Mens sexual arousal patterns are category-specific: Men typically display significantly greater physiological responses to sexual stimuli depicting members of their preferred gender category. Category-specific patterns of sexual arousal have not been consistently reported in natal women. We used vaginal photoplethysmography to examine patterns of sexual arousal in 11 male-to-female (MtF) transsexuals following sex reassignment surgery (SRS) and in 72 natal women. Subjective arousal was measured with a continuous response lever. Video clips depicting sexual activity between two males, two females, or one male and one female were used as erotic stimuli. All transsexual participants displayed category-specific sexual arousal. Five homosexual transsexual participants (attracted exclusively to males before sex reassignment) showed greater genital and subjective responses to male than to female stimuli, while six nonhomosexual transsexual participants showed the opposite pattern. Vaginal pulse amplitude (VPA) was lower in transsexual participants than in natal women. The mean correlation between VPA and subjective responses was high in nonhomosexual transsexuals, but was significantly lower in homosexual transsexuals and in natal women. One transsexual participant who reported a change in sexual orientation following sex reassignment displayed VPA and subjective responses consistent with her pre-reassignment sexual orientation. We conclude that male-to-female transsexuals display male-typical category-specific sexual arousal following SRS, and that vaginal photoplethysmography is a promising methodology for studying patterns of sexual arousal in postoperative transsexuals.     

Long-term effects of sexual experiences with siblings and nonsiblings during childhood

Long-term differences in young adults' sexual behavior and adjustment following preadolescent sibling and nonsibling peer childhood sexual experiences were investigated. Questionnaire data were collected from 526 undergraduate college students. Of this sample, 25 (5%) reported having had only a sibling sexual encounter, 61 (12%) reported having had both a sibling and a nonsibling childhood sexual experience, 236 (45%) reported having had only a nonsibling sexual experience, and 204 (39%) reported no sexual experience with another child prior to age 13. No differences were found between the sibling, nonsibling, and no-experience groups on a variety of adult sexual behavior and sexual adjustment measures, including incidence of premarital intercourse, age at first intercourse, number of intercourse partners, sexual satisfaction, sexual arousal, and sexual dysfunctions. It was concluded that adult sexual adjustment is not negatively or positively influenced by typical early childhood sexual experiences among similar-aged siblings.     

The Association of Sexual Dysfunction and Substance Use Among a Community Epidemiological Sample

This study examines the prevalence of DSM-III sexual dysfunctions and their association with comorbid drug and alcohol use in a community epidemiologic sample. The data for these analyses are based on the Epidemiological Catchment Area Project, a multistage probability study of the incidence and prevalence of psychiatric disorders in the general population conducted in 1981-83. Only the sample of 3,004 adult community residents in the St. Louis area was queried on DSM-III sexual dysfunctions of inhibited orgasm, functional dyspareunia (painful sex), inhibited sexual excitement (i.e., lack of erection/arousal), and inhibited sexual desire. There was a prevalence rate of 11% for inhibited orgasm, 13% for painful sex, 5% for inhibited sexual excitement, 7% for inhibited sexual desire, and 26% for any of these sexual dysfunctions (14% for men and 33% for women). The prevalence of qualifying lifetime substance use among the population was 37%, with males meeting more drug and alcohol use criteria than females. After controlling for demographics, health status variables, and psychiatric comorbidity (depression disorder, generalized anxiety disorder, antisocial personality disorder, and residual disorders), inhibited orgasm was associated with marijuana and alcohol use. Painful sex was associated with illicit drug use and marijuana use. Inhibited sexual excitement was more likely among illicit drug users. Inhibited sexual desire was not associated with drug or alcohol use.     

Vibrotactile stimulation enhances sexual response in sexually functional men: A study using concomitant measures of erection

The role of vibrotactile stimulation on the penis in producing erection was investigated in 34 sexually functional men. Subjects were presented with three stimulus segments: erotic video (VID); vibrotactile stimulation (VT) applied to the underside of the penis; and combined vibrotactile and erotic video stimulation (VID+VT). Maximum erectile response was recorded to each stimulus using both an erectiometer and a Barlow strain gauge. Self-reported sexual arousal and affective response to each stimulus segment were also obtained. Results indicated significant variation in erectile response and self-reported arousal over the stimulus segments. Erectile response was lowest to VT alone and highest to VID+VT for both erectile measures, although the pattern of change across stimuli was different for each measure. Self-reported sexual arousal was consistent with erectile measures, but the difference between VID and VID+VT was not statistically significant. VT stimulation alone was perceived as somewhat unpleasant; both VID and VID+VT were perceived as more pleasant than VT, but VID and VID+VT did not differ significantly from each other. This study demonstrates that, while not perceived as more pleasurable or arousing, VT stimulation on the penis combined with erotic video stimulation augments erectile response in functional men in a controlled laboratory situation. The possible use of this methodology for the improved study of men with sexual dysfunctions is discussed.     

Sexual dysfunction, Part I: Classification, etiology, and pathogenesis.

BACKGROUND: The sexual dysfunctions are extremely common but are rarely recognized by primary care physicians. They represent inhibitions in the appetitive or psychophysiologic changes that characterize the complete adult sexual response and are classified into four major categories: (1) sexual desire disorders (hypoactive sexual desire, sexual aversion disorder), (2) sexual arousal disorders (female sexual arousal disorder, male erectile dysfunction), (3) orgasmic disorders (inhibited male or female orgasm, premature ejaculation), and (4) sexual pain disorders (dyspareunia, vaginismus). METHODS: Articles about the sexual dysfunctions were obtained from a search of MEDLINE files from 1966 to the present using the categories as key words, along with the general key word "sexual dysfunction." Additional articles came from the reference lists of dysfunction-specific reviews. RESULTS AND CONCLUSIONS: Cause and pathogenesis span a continuum from organic to psychogenic and most often include a mosaic of factors. Organic factors include chronic illness, pregnancy, pharmacologic agents, endocrine alterations, and a host of other medical, surgical, and traumatic factors. Psychogenic factors include an array of individual factors (e.g., depression, anxiety, fear, frustration, guilt hypochondria, intrapsychic conflict), interpersonal and relationship factors (e.g., poor communication, relationship conflict, diminished trust, fear of intimacy, poor relationship models, family system conflict), psychosexual factors (e.g., negative learning and attitudes, performance anxiety, prior sexual trauma, restrictive religiosity, intellectual defenses), and sexual enactment factors (e.g., skill and knowledge deficits, unrealistic performance expectations). Understanding the cause and pathophysiology of sexual disorders will help primary care physicians diagnose these problems accurately and manage them effectively.     

Treating sexual dysfunction in sex offenders: a case example

Sex offender treatment as a specialized procedure is maturing, and more comprehensive approaches that treat co-morbid patient problems (e.g., mood and anxiety disorders, relationship conflicts, social skills deficits) have emerged. However, little attention has been given to the role of sexual dysfunction in the assessment and treatment of sex offenders. We propose that: (a) sexual dysfunction is a prevalent co-occurring sexual disorder in sex offenders; (b) sexual dysfunction is, by definition, a lack of sexual health, which diminishes overall life satisfaction; and (c) sexual dysfunction can be a contributing factor for some in maintaining offense-related arousal patterns and therefore is a potential contributor to sex-offense risk. This article describes the importance of treating sex dysfunction in selected cases when it is present among men in sex offender treatment, in order to improve the men's quality of life and to deter sex offense recidivism. A brief case example illustrates this benefit.     

Sexual Arousal in Women with Superficial Dyspareunia

The role of sexual arousal in the etiology and/or maintenance of superficial dyspareunia is still unclear. Lack of sexual arousal may be both the cause and the result of anticipated pain. This study compared genital and subjective sexual responses to visual sexual stimuli of women with dyspareunia and women without sexual complaints. We investigated whether women with dyspareunia were less genitally and subjectively responsive to noncoital (oral sex) as well as coital visual sexual stimuli than women without sexual problems, or whether they exhibited a conditioned anxiety response such that sexual arousal responses were lower only to stimuli that may induce fear of pain (i.e., coitus). A total of 50 women with dyspareunia and 25 women without sexual problems were shown two sexual stimuli, one depicting oral sex and the other one depicting coitus. Genital arousal was assessed as vaginal pulse amplitude using vaginal photoplethysmography. Self-reported ratings of subjective sexual arousal were collected after each erotic stimulus presentation. Women with dyspareunia had comparable levels of genital arousal to two different visual sexual stimuli as women without sexual complaints. Contrary to expectation, there was an indication that women with dyspareunia reacted with higher levels of genital arousal to the explicitly depicted coitus stimulus than controls, whereas controls had higher genital responses to the oral sex stimulus. With respect to subjective sexual arousal, it was found that women with dyspareunia reported less positive feelings in response to both erotic stimuli than controls. We conclude that, with adequate visual sexual stimulation, women with dyspareunia showed equal levels of genital sexual arousal to visual sexual stimuli as women without sexual complaints. Therefore, there was no evidence for impaired genital responsiveness associated with dyspareunia. Also, we found no evidence for a conditioned anxiety reaction in response to exposure to a coitus scene.