Aspects Of Sexual Response Research Articles

(005) When Paying Attention is Inconvenient: The Effect of Negative Thoughts During Sex on Female Sexual Response

Abstract Introduction To evaluate the presence of negative thoughts and how these interfere with sexual functioning (as hypothesized by Barlow, 1986), Nobre and Pinto-Gouveia (2003) developed the Automatic Negative Thoughts scale (ANT). Research using this scale has shown that negative thoughts during sex interferes with subjective sexual arousal (SSA), lubrication, and orgasm (Cuntim and Nobre, 2011; Nobre & Pinto-Gouveia, 2003). While this early work has made a crucial contribution toward understanding how negative thoughts are associated with female sexual response, the ANT has important limitations. One limitation is that some items are not relevant to the constructs they are supposed to measure (e.g., “I have more important matters to deal with” is part of the “Sexual Abuse Thoughts” factor; and “This way of having sex is immoral” is part of the “Partner’s Lack of Affection” factor), and thus in some cases it is not clear what the scales themselves are measuring. Moreover, effect sizes on sexual functioning are modest, and the full measure is long. Objective The aim of this study was to test a new measure of negative thoughts during sex (NTs) and to investigate the associations between specific types of NTs and specific domains of sexual functioning. Using fewer and more focused questions we also aimed at having a shorter and more precise measure. Methods A sample of 138 female university students completed questionnaires investigating frequency of specific NTs and female sexual functioning (measured through the FSFI). Structural equation modelling was used to test the effect of NTs, as a latent construct, on three dimensions of sexual functioning, namely SSA, lubrication, and orgasm. Next, the effect of the four individual domains of NTs (i.e., orgasm, body image, fear of being hurt, and external thoughts) on SSA, lubrication and orgasm, was tested. Results The first SEM model fits the data well (CFI = .97; NFI = .93; RMSEA = .08). This model is presented in Figure 1 and shows that NTs have strong direct negative effects on SSA (78% variance explained), lubrication (76% variance explained), and orgasm (63% variance explained). Moreover, NTs also have an indirect effect on lubrication, mediated by SSA. The effects of single domains of NTs are presented in Figure 2 (saturated model). Overall, NTs about orgasm and fear of being hurt showed negative associations with orgasm and SSA, external thoughts showed an effect on SSA and lubrication, and NTs about body image showed no significant association. Conclusions The new measure of NTs has advantages of brevity, specificity, and stronger effect sizes as compared to the ANT. These data provide increasingly strong evidence that NTs significantly interfere with women’s sexual response, and that some domains of NTs have a stronger impact than others on different domains of sexual functioning. More work is needed to understand the sources and types of NTs, and their role in different aspects of sexual response. Furthermore, neuroimaging technology should be exploited to shed light on the neural pathways involved in cognitive interference and sexual inhibition, which are expected to be linked with the presence of NTs. Disclosure No

Eating Disorders and Sexual Function Reviewed: A Trans-diagnostic, Dimensional Perspective

Clinical observation and a growing body of empirical research point to an association between disordered eating and sexual function difficulties. The present review identifies and connects the current knowledge on sexual dysfunction in the eating disorders, and provides a theoretical framework for conceptualizing the association between these important health conditions. Research on sexuality and eating pathology has focused on clinical samples of women with anorexia nervosa (AN) and bulimia nervosa (BN). All aspects of sexual response can be impacted in women with an eating disorder, with sexual function in women with AN appearing to be more compromised than in women with BN. Research of this nature is extremely limited with respect to BED, non-clinical samples, men, and individuals with non-binary gender identities. Sexuality should be examined and addressed within the context of eating disorder treatment. Sexual dysfunction and eating disorders, along with commonly comorbid disorders of anxiety and mood, can be seen as separate but frequently overlapping manifestations of internalizing psychopathology. Psychological, developmental, sociocultural, etiological, and biophysical factors likely represent risk and maintenance factors for internalizing disorders. A dimensional, trans-diagnostic approach to disordered eating and sexuality has promising implications for future research and clinical interventions.

The Power of the Present: Effects of Three Mindfulness Tasks on Women’s Sexual Response

Mindfulness-based interventions are effective at improving sexual dysfunctions in women, yet the mechanisms of action are less clear. Our objective was to investigate the impact of three mindfulness exercises on women’s sexual response. Forty-nine women participated in a laboratory session involving a series of 5-min exercises and erotic films. They completed three mindfulness-based exercises and a mental-imagery task. Genital and subjective arousal were measured continuously during erotic films, and genital arousal was measured during the exercises. A focus on the genitals led to greater genital arousal during the exercise. A focus on sensations in the body and on the genitals was associated with greater subjective sexual arousal during erotic films. Effects were small in size. Taken together, the focus of attention during a mindfulness practice may differentially affect genital and subjective sexual arousal and has implications for women experiencing difficulties in different aspects of sexual response.

Endocrine and psychological aspects of sexual dysfunction in Klinefelter patients.

Klinefelter syndrome is a frequent cause of hypogonadism, but despite hundreds of publications on different aspects of Klinefelter syndrome, only a few studies dealt with sexual dysfunction. In particular, testosterone is critical for various aspects of sexual response, but its role on sexuality in Klinefelter syndrome patients is debatable and no studies have evaluated the efficacy of testosterone treatment on sexual dysfunction in these subjects. Furthermore, the impact of psychological and relational aspects on sexual function of Klinefelter syndrome subjects is poorly defined. In this study, we aimed to determine the presence and type of sexual dysfunctions in Klinefelter syndrome subjects; to correlate them with testosterone levels and psychosexological and relational domains; and to evaluate the effects of testosterone therapy. We studied 62 non-mosaic naïve Klinefelter syndrome patients and 60 age-matched controls by means of medical history, psychosexological history, 15-item International Index of Erectile Function questionnaire, endocrine assessment, and dynamic penile color Doppler ultrasound. Twenty-five hypogonadal Klinefelter syndrome patients were studied after 6months of testosterone replacement therapy. Klinefelter syndrome subjects have reduced 15-item International Index of Erectile Function scores regarding sexual desire, intercourse satisfaction, and overall satisfaction with respect to controls, and these aspects were significantly associated with testosterone levels. Klinefelter syndrome subjects had also higher prevalence of erectile dysfunction, but no relation with testosterone levels was evident. A high prevalence of a range of psychological disturbances was present in Klinefelter syndrome subjects with erectile dysfunction with respect to those without erectile dysfunction. No statistical difference in the prevalence of premature and delayed ejaculation was observed between Klinefelter syndrome and control subjects. Testosterone replacement therapy improved sexual desire, intercourse satisfaction, and overall satisfaction scores, but had no effect on erectile function. Penile color Doppler ultrasound was normal in all subjects. This study shows that sexual dysfunction in Klinefelter syndrome is multifactorial and related only in part to hypogonadism and largely to psychological disturbances. Evaluation and therapy of sexual dysfunction should include a combined andrological and psychosexological approach.

Examining the time course of genital and subjective sexual responses in women and men with concurrent plethysmography and thermography

Sexual response is a dynamic process, though there is limited knowledge of the time course and relationships among its psychological and physiological components. To address this gap, we concurrently assessed self-reported sexual arousal, genital temperature (with thermography), and genital vasocongestion (with vaginal photoplethysmography [VPP] or penile plethysmography [PPG]) during sexual and nonsexual films in 28 androphilic women (attracted to men) and 27 gynephilic men (attracted to women). Men and women had similarly strong agreement between subjective and genital responses (sexual concordance) with thermography, but this agreement was stronger in men than women with PPG/VPP. The time course of changes in self-reported arousal was most similar to changes in genital temperature (i.e., time to onset and peak response). Time-lagged correlations and multilevel modeling revealed changes in the strength of relationships between aspects of sexual response over time. Results highlight the dynamic nature of sexual response and drawbacks of relying on zero-order correlations to characterize sexual concordance.

Current Research on Sexual Response and Sexual Functioning Among Lesbian Women

The majority of research on women’s sexual response has been conducted with heterosexual women, with limited investigation into the experiences of women in same-sex relationships. This review examines the literature published over the past 5 years (2010–2015) that has focused on aspects of sexual response and functioning among lesbian women. Lesbian women’s experiences reflect a fluid pattern of sexual response that expands beyond emotional closeness as the primary motivation for sexual contact. Recent research demonstrates the following: (a) women in same-sex relationships report a variety of motivations for sexual activity, (b) desire is often conflated with sexual frequency, (c) lesbian women report higher rates of orgasm, (d) sexual orientation influences variations in sexual arousal, and (e) sexual orientation does not appear to significantly impact sexual problems. Future research should address the current gaps in sexuality research among lesbian women, most notably related to sexual desire/arousal and orgasm.

Eastern Approaches for Enhancing Women's Sexuality: Mindfulness, Acupuncture, and Yoga (CME)

A significant proportion of women report unsatisfying sexual experiences despite no obvious difficulties in the traditional components of sexual response (desire, arousal, and orgasm). Some suggest that nongoal-oriented spiritual elements to sexuality might fill the gap that more contemporary forms of treatment are not addressing. Eastern techniques including mindfulness, acupuncture, and yoga, are Eastern techniques, which have been applied to women's sexuality. Here, we review the literature on their efficacy. Our search revealed two empirical studies of mindfulness, two of acupuncture, and one of yoga in the treatment of sexual dysfunction. Literature review of empirical sources. Mindfulness significantly improves several aspects of sexual response and reduces sexual distress in women with sexual desire and arousal disorders. In women with provoked vestibulodynia, acupuncture significantly reduces pain and improves quality of life. There is also a case series of acupuncture significantly improving desire among women with hypoactive sexual desire disorder. Although yoga has only been empirically examined and found to be effective for treating sexual dysfunction (premature ejaculation) in men, numerous historical books cite benefits of yoga for women's sexuality. The empirical literature supporting Eastern techniques, such as mindfulness, acupuncture, and yoga, for women's sexual complaints and loss of satisfaction is sparse but promising. Future research should aim to empirically support Eastern techniques in women's sexuality.

Hypoactive Sexual Desire Disorder in Menopausal Women: A Survey of Western European Women

The prevalence of hypoactive sexual desire disorder (HSDD) in menopausal women and the frequency of sexual activity, sexual behavior, and relationship or sexual satisfaction associated with HSDD have not been studied using validated instruments to identify women with HSDD. To determine: (i) the prevalence of HSDD among women who have undergone hysterectomy and bilateral oophorectomy (surgical menopause) with that of premenopausal or naturally menopausal women; (ii) the relationship between low sexual desire and sexual activity and behavior; and (iii) the relationship between low sexual desire and sexual or partner relationship satisfaction. Cross-sectional survey of 2,467 European women aged 20-70 years, resident in France, Germany, Italy, and the United Kingdom. Measures were the Profile of Female Sexual Function (PFSF), Personal Distress Scale (PDS), and a sexual activities measure. Clinically derived cutoff scores for the desire domain of the PFSF and the PDS were used, sequentially, to classify women as having low sexual desire and to further classify these women with low desire as distressed or nondistressed. Thus, women with HSDD had low sexual desire and were distressed by their low desire. The analysis population included 1,356 women who had current sexual partners and were surgically menopausal, regularly menstruating, or naturally postmenopausal. A greater proportion of surgically menopausal women had low sexual desire compared with premenopausal or naturally menopausal women (odds ratio [OR] = 1.4; confidence interval [CI] = 1.1, 1.9; P = 0.02). Surgically menopausal women were more likely to have HSDD than premenopausal or naturally menopausal women (OR = 2.1; CI = 1.4, 3.4; P = 0.001). Sexual desire scores and sexual arousal, orgasm, and sexual pleasure were highly correlated (P < 0.001), demonstrating that low sexual desire is frequently associated with decreased functioning in other aspects of sexual response. Women with low sexual desire were less likely to engage in sexual activity and more likely to be dissatisfied with their sex life and partner relationship than women with normal desire (P < 0.001). Surgically menopausal women are at increased risk for HSDD. HSDD is associated with diminished sexual and partner relationship satisfaction and negative emotional states.

Sexual Response In Women With Spinal Cord Injury: Neurologic Pathways And Recommendations For The Use Of Electrical Stimulation

Background: Determination of the exact level and degree of a woman’s spinal cord injury (SCI) has allowed researchers to document the aspects of sexual response that are altered with specific patterns of SCI. Based on these findings, recommendations can be made regarding the development and testing of electrical stimulation systems designed to facilitate sexual responses in women with SCI.Design: Literature reviewFindings: Studies of the arousal stages of response indicate that psychogenic vaginal lubrication is maintained with pinprick sensation in T11 -T12 dermatomes, and that reflex lubrication occurs in women with upper motor neuron injuries affecting the sacral segments. Studies of the orgasmic stage support the hypothesis that orgasm is a reflex response of the autonomic nervous system that appears to depend on an intact sacral arc.Conclusions: Laboratory studies of arousal and orgasm among women with different types of SCI, and comparisons with ablebodied controls, provide valuable information regarding female sexual neurophysiology. Electrical stimulation can be used to improve sexual response, as well as bladder and bowel function. Interventions that interfere with the sacral reflex arc, such as sacral rhizotomy, can impair the ability to achieve orgasm. To develop alternative treatment protocols, further investigation of sexual response and orgasm is recommended.f Spinal Cord Med. 2001 ;24:155–158

Yohimbine, erectile capacity, and sexual response in men.

In a double-blind, placebo-controlled crossover study on a group of men with erectile problems and a sexually functional comparison group, the effect of yohimbine (up to 30 mg/day) was assessed on a number of objective and subjective measures of erectile response through the use of daily logs and psychophysiological laboratory procedures involving response to visual sexual stimulation (VSS). Sexual desire, arousal, and ejaculatory response were also assessed. Results indicated no effect of yohimbine on most aspects of sexual response in sexually functional men. Mixed effects were found on measures of sexual function in men erectile dysfunction, with 3 of 11 men reporting strong positive effects. Under yohimbine, frequency of sexual activities increased, as did self-assessed genital response to VSS. Daily diaries indicated increased sexual arousal and erectile response during masturbation but not intercourse. A number of other measures, including NPT and retrospective summaries of erectile functioning at the end of drug phases, showed no effect. Results are discussed in terms of possible yohimbic effects on psychological factors that modulate overall sexual response, and consequently, erectile response.

The differential impact of diabetes type on female sexuality

Although diabetes is associated with a high prevalence of erectile impairment in men, its effect on the sexuality of women remains unclear. Since diabetes consists of different disorders, diabetes type may have confounded previous studies by differentially impacting on sexual functioning and marital satisfaction. To evaluate this possibility, 35 Type I diabetic married women were compared with 42 healthy married controls and 23 Type II diabetic women with 23 controls. Assessments were made on all aspects of sexual response, activity, dysfunction and satisfaction; on cognitive and psychological dimensions of sexuality; and on marital adjustment. Results indicated that diabetes type is highly associated with sexual responsiveness and marital satisfaction. Type I diabetes was found to have little or no effect on women, while Type II diabetes had a pervasively negative impact on sexual desire, orgasmic capacity, lubrication, sexual satisfaction, sexual activity, and on the relationship with the sexual partner.

Sexual responsiveness in diabetic women.

Sexual responsiveness in 82 Type 1 (insulin-dependent) diabetic women was compared with that of 47 normal control subjects, using an interview method for rating various aspects of sexual response, and attitude questionnaires. The diabetic women were questioned about symptoms of autonomic neuropathy, and cardiovascular autonomic nerve function tests were performed. There were differences between the two groups in the reports of vaginal lubrication, but in most other respects the groups were similar. The diabetic women were not less orgasmic, and reported significantly fewer unpleasant feelings during sexual intercourse. They saw themselves and their husbands as less 'potent' than did the normal subjects. The possible enhancing effect of diabetes on the marriage of some diabetic women possibly counteracted the relatively mild physiological deficits involved. There was very little difference in sexual response between women with and without symptomatic autonomic neuropathy.

The Problem of Sex Today

Sexual problems, especially problems of sexual inadequacy, persist in spite of the current presumed sexual freedom. The author relates this to certain unfortunate aspects of our culture and particularly to increasing alienation and mechanization. She offers a critique of the Masters-Johnson sexual studies, feeling that these researchers have overextended the physiologic aspects of sexual response to cover the entire realm of sexuality. She concludes: We must reaffirm the fundamental connection between human relatedness and physiological sex.