Female Genital Arousal Research Articles

(023) The Acute Effect of Caffeine on Genital Arousal in Women: A Pilot Study

Abstract Introduction Genital sexual arousal, a process characterized by increased vaginal lubrication and vasocongestion in females, is facilitated by moderate activation of the sympathetic nervous system (SNS) (for review, see Stanton, Handy, & Meston, 2018). Among the range of factors that impede the female genital arousal response (e.g., disrupted endocrine functioning and vascular and neurological problems), antidepressants have strikingly deleterious effects on genital arousal function that hinder quality of life (Nappi et al., 2016) and jeopardize medication adherence. When patients present with antidepressant-induced sexual side effects, physicians may switch their antidepressant or tack on an additional medication (e.g., bupropion) to counter them. While sometimes effective, this increases patients’ financial burden and often introduces a host of new side effects. Moderate activation of the SNS through exercise has shown promising results for ameliorating antidepressant-induced genital arousal dysfunction (Lorenz & Meston, 2012; 2014). Given that SNS activation prior to sex counteracts the inhibitory effect of antidepressants on genital blood flow, it is feasible that caffeine – an SNS stimulant (Biaggioni et al., 1991; Zahn et al., 1987) – could improve antidepressant-induced genital arousal difficulties if ingested prior to sex. Caffeine could serve as a low-cost, widely accessible intervention with minimal side effects if efficacy is shown. Objective The goal of the present pilot study is to examine whether the acute administration of 300mg of caffeine increases genital arousal (i.e., vaginal pulse amplitude) in women experiencing antidepressant-induced genital arousal difficulties. Methods Women attended two counterbalanced in-laboratory sessions in which they ingested either 300mg caffeine or placebo. Fifteen minutes post-ingestion, they viewed an erotic film while their heart rate and genital sexual arousal were measured. Caffeine consumption was controlled for. Results Preliminary data analyses suggest that compared to placebo, 300mg of caffeine increases vaginal pulse amplitude fifteen minutes post-ingestion among women experiencing antidepressant-induced genital arousal difficulties. Additional pilot subjects are currently being tested; results will be updated with an addendum upon completion. Conclusions If efficacy is demonstrated in our sample, caffeine may serve as a low-cost, widely accessible treatment for women experiencing antidepressant-induced genital arousal dysfunction. While we aim to target genital arousal concerns with caffeine, improvements in genital arousal are likely to positively impact other stages of women’s sexual response given the high degree of overlap between these stages. Disclosure No

Eating Disorder Symptoms as a Risk Factor for Hypoactive Sexual Desire Disorder in Women: A Pilot-study

ABSTRACT Introduction Eating and sexual behavior are driven by neurological mechanisms that are extremely intertwined; emerging evidence indicates that their deep relationship can be mediated by the presence of specific psychopathologies. Objective To investigate the relationship between female sexual dysfunction (FSD) and eating disorders (EDs). Methods 123 retrospectively recruited women consulting for FSD underwent physical examination and completed the following validated questionnaires: Female Sexual Function Index (FSFI), Female Sexual Distress Scale-Revised (FSDS-R), Eating Disorder Examination Questionnaire (EDE-Q), Binge Eating Scale (BES), Emotional Eating Scale (EES), Barrat Impulsiveness Scale-11 (BIS-11), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory Y (STAI Y), Symptom Checklist 90-Revised (SCL-90-R), Body Uneasiness Test (BUT), Dyadic Adjustment Scale (DAS) and Sexual Inhibition/Sexual Excitation Scales (SIS/SES). Moreover, demographic, medical and psycho-sexuological data were obtained through a structured interview. Results In relation to menopausal status, we did not observe any significant difference in all the investigated questionnaires in pre- vs. postmenopausal women. When stratifying patients for BMI (<25, 25-30, >30 kg/m2) we found that all the scores related to EDE-Q subscales were significantly different among the three subgroups (all p<0.001). Furthermore, patients with a history of Unwanted Sexual Experience (USE) had significantly higher BES (p=0.034) and EES (p=0.027) total scores compared with those without. Moreover, when we stratified our patients according to the clinical diagnosis of Hypoactive Sexual Desire Disorder (HSDD), we found that those with HSDD showed a worst psychological profile than those without, in particular a higher score at EDE-Q and BDI (all p<0.05). In contrast, when stratifying patients for the other two main FSD diagnosis, Female Genital Arousal Disorder (FGAD) and Female Orgasm Disorder (FOD), no significant differences among all the investigated questionnaires were observed. To further verify the impact of the different psychopathological aspects on the risk of having HSDD, we found that the only questionnaires scores that contributed to this dysfunction were EDE-Q (OR 1.678, IC [1.164-2.421]; p=0.006), total BDI (OR 1.055, IC [1.006-1.107]; p=0.027) and SIS1 (OR 1.101, IC [1.109-1.190]; p=0.015), after adjustment for age. After simultaneous analysis in a multivariate model of the three questionnaires, we found that both a higher EDE-Q score and a higher SIS1 score were significant risk factors for HSDD (p=0.007 and p=0.034, respectively). Finally, we subdivided our patients into three groups: no Binge Eating (BE), sporadic BE and frequent BE, observing a significant positive association between frequency of BE and sexual distress, as assessed by FSDS-R total score. Conclusions In a population of women affected by FSD, ED traits could negatively affect sexual desire, representing a relevant risk factor for the clinical diagnosis of HSDD. Among all the investigated psychopathological aspects, the psychological alterations related to EDs seem to play a more pronounced effect on HSDD than other commonly accepted risk factors for sexual desire disorders, such as depression and increased inhibitory trait. In a clinical perspective, it would worth to investigate the relative change in FSD and ED after treatment for ED and vice versa. Disclosure No

Eating disorder symptoms as a risk factor for hypoactive sexual desire disorder in women: A pilot-study

ABSTRACT Introduction Eating and sexual behavior are driven by neurological mechanisms that are extremely intertwined; emerging evidence indicates that their deep relationship can be mediated by the presence of specific psychopathologies. Objective to investigate the relationship between female sexual dysfunction (FSD) and eating disorders (EDs). Methods 123 retrospectively recruited women consulting for FSD underwent physical examination and completed the following validated questionnaires: Female Sexual Function Index (FSFI), Female Sexual Distress Scale-Revised (FSDS-R), Eating Disorder Examination Questionnaire (EDE-Q), Binge Eating Scale (BES), Emotional Eating Scale (EES), Barrat Impulsiveness Scale-11 (BIS-11), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory Y (STAI Y), Symptom Checklist 90-Revised (SCL-90-R), Body Uneasiness Test (BUT), Dyadic Adjustment Scale (DAS) and Sexual Inhibition/Sexual Excitation Scales (SIS/SES). Moreover, demographic, medical and psycho-sexuological data were obtained through a structured interview. Results in relation to menopausal status, we did not observe any significant difference in all the investigated questionnaires in pre- vs. post-menopausal women. When stratifying patients for BMI (<25, 25-30, >30 kg/m2) we found that all the scores related to EDE-Q subscales were significantly different among the three subgroups (all p<0.001). Furthermore, patients with a history of Unwanted Sexual Experience (USE) had significantly higher BES (p=0.034) and EES (p=0.027) total scores compared with those without. Moreover, when we stratified our patients according to the clinical diagnosis of Hypoactive Sexual Desire Disorder (HSDD), we found that those with HSDD showed a worst psychological profile than those without, in particular a higher score at EDE-Q and BDI (all p<0.05). In contrast, when stratifying patients for the other two main FSD diagnosis, Female Genital Arousal Disorder (FGAD) and Female Orgasm Disorder (FOD), no significant differences among all the investigated questionnaires were observed. To further verify the impact of the different psychopathological aspects on the risk of having HSDD, we found that the only questionnaires scores that contributed to this dysfunction were EDE-Q (OR 1.678, IC [1.164-2.421]; p=0.006), total BDI (OR 1.055, IC [1.006-1.107]; p=0.027) and SIS1 (OR 1.101, IC [1.109-1.190]; p=0.015), after adjustment for age (Fig. 1). After simultaneous analysis in a multivariate model of the three questionnaires, we found that both a higher EDE-Q score and a higher SIS1 score were significant risk factors for HSDD (p=0.007 and p=0.034, respectively). Finally, we subdivided our patients into three groups: no Binge Eating (BE), sporadic BE and frequent BE, observing a significant positive association between frequency of BE and sexual distress, as assessed by FSDS-R total score (Fig. 2). Conclusions in a population of women affected by FSD, ED traits could negatively affect sexual desire, representing a relevant risk factor for the clinical diagnosis of HSDD. Among all the investigated psychopathological aspects, the psychological alterations related to EDs seem to play a more pronounced effect on HSDD than other commonly accepted risk factors for sexual desire disorders, such as depression and increased inhibitory trait. In a clinical perspective, it would worth to investigate the relative change in FSD and ED after treatment for ED and vice versa. Disclosure Work supported by industry: no.

Female Genital Arousal: A Focus on How Rather than Why

Female Genital Arousal: A Focus on How Rather than Why

022 Preliminary Efficacy of Sildenafil Cream, 3.6% During Female Sexual Arousal

To date, there are no FDA-approved treatments for Female Sexual Arousal Disorder (FSAD), a sexual dysfunction characterized by diminished vaginal lubrication, decreased clitoral and labial sensation and reduced genital engorgement. As research supports the role of the NO-cGMP smooth muscle-mediated vasodilatory pathway in the female genital arousal response, Sildenafil Cream, 3.6%, a novel topical formulation in Phase 2 clinical development, could become a first-in-class therapy for FSAD.

105 Spironolactone May be a Cause of Hormonally Associated Vestibulodynia and Female Genital Arousal Disorder

The use of hormone modulating treatments for the treatment of androgen-mediated cutaneous disorders (AMCDs) in women including acne, hirsutism, and female pattern hair loss has been increasing. While these disorders can have a significant impact on women, the importance of androgens in the maintenance of women’s health is often overlooked. Specifically, androgens affect bone density, muscle mass and strength, adipose tissue distribution, mood, energy, and psychological well-being. In addition, androgen play a critical role in women’s sexual desire, arousal, genital sensitivity, and orgasm. The impact of combined hormonal contraceptives (CHC), which are the most prescribed medication for AMCDs, on female sexual dysfunction has been significantly examined in the peer-reviewed medical literature. However, spironolactone, another medication commonly prescribed for AMCDs, has not received the same attention. Spironolactone is an androgen antagonist that decreases the effect of endogenous androgens by competitive inhibition of testosterone and dihydrotestosterone (DHT) binding to androgen receptors. This abstract reports on two cases of women with hormonally associated vestibulodynia and female arousal disorder most likely caused by spironolactone.

Examining the Validity and Utility of Two New Measurement Devices in Sexual Psychophysiology Research

Background: Female genital arousal is an important, yet difficult phenomenon to measure.
 The Laser Doppler Imager (LDI) and the Litmus Test Strip (LTS) are new measurement devices for assessing vulvar blood flow and vaginal lubrication, respectively. Given their recent development, few studies have used these measures, and further testing of their validity is needed. Using both devices concurrently provides an opportunity to demonstrate convergent validity (i.e., a significant, positive correlation) between these measures. Investigation of the utility of these devices—such as their sensitivity to varying intensity of sexual arousal—is also needed. Measures that can detect intensity of genital arousal allow researchers to study more complex questions than measures that only indicate the presence or absence of it.
 Method: Sexual arousal will be induced using erotic videos depicting foreplay and penile-vaginal intercourse. Vulvar blood flow and vaginal lubrication will be assessed using the LDI and the LTS. Participants will self-report their experience of sexual arousal.
 Hypotheses: I predict that: 
 1. Changes in vulvar blood flow (as measured by LDI) and vaginal lubrication (as measured by LTS) will be positively correlated with self-reported sexual arousal;
 2. Changes in vulvar blood flow and vaginal lubrication will be positively correlated with each other;
 3. Vulvar blood flow and vaginal lubrication will vary according to intensity of sexual response.
 Results: Data collection in progress. Results will be available at the time of the presentation.
 Implications: Further development of two new measurement devices for sexual psychophysiology research.

Peripheral Female Genital Arousal as Assessed by Thermography Following Topical Genital Application of Alprostadil vs Placebo Arousal Gel: A Proof-of-Principle Study Without Visual Sexual Stimulation.

IntroductionFemale sexual arousal disorder is a pathophysiologic state characterized clinically by persistent or recurrent inability to attain or maintain an adequate lubrication-swelling response of sexual excitement until completion of sexual activity. Prior clinical experience with alprostadil products for men with erectile dysfunction supports its use in women with female sexual arousal disorder.AimTo compare the effect of topical alprostadil with over-the-counter (OTC) lubricant on female genital arousal in the absence of visual sexual stimuli.MethodsHealthy premenopausal women without sexual dysfunction were recruited from the community to participate in the study. Of 17 women who consented, 10 were enrolled and completed the trial. The mean age of subjects was 32 years (range = 27–43). Study drug or placebo was applied topically to the genitals. Continuous temperature monitoring was performed. Participants completed questionnaires assessing genital sensation, effect, intensity, and duration.Main Outcome MeasuresChange in temperature from baseline in vestibule, clitoris and vulva.ResultsIn all 10 subjects, topical alprostadil induced a statistically significant increase in temperature of the vestibule, clitoris, and vulva compared with the OTC lubricant. The most rapid difference in genital temperature between placebo and alprostadil was seen on the vulva, which demonstrated a significant difference at approximately 9 minutes. There was a significant difference in temperature seen for the vestibule and clitoris at 11 and 19 minutes, respectively. Sixty percent of women reported being aware or conscious of genital sensations with topical alprostadil, but not with OTC lubricant. Discordance was noted in 30% of subjects who reported being aware or conscious of genital sensations with the two treatments and 10% who reported not being aware or conscious of genital sensations with either treatment.ConclusionTopical alprostadil administered to healthy premenopausal women induced statistically significant, sustained increases in genital temperatures of the vestibule, clitoris, and vulva within 20 minutes compared with OTC lubricant.

Assessment of female sexual arousal in forensic populations.

Sexual offenses cause significant harm to victims, their families, and society as a whole and thus are an important social concern. While it is commonly assumed that sexual offenses are committed solely by males, research has shown that approximately 5% of sex crimes in the USA and Canada are committed by females. Penile plethysmography (PPG) is a method to measure male genital arousal, which is commonly used in the assessment and treatment of male sex offenders and men with paraphilic sexual interests. Similarly, vaginal photoplethysmography (VPP) is a test to measure female genital arousal and is commonly used to assess female sexual dysfunctions. Although VPP is currently the most validated method to measure genital arousal in women, its use with female sex offenders or females with paraphilic sexual interests has been almost nonexistent. One explanation for this is that some research has suggested that female genital arousal may not be category-specific, meaning that women will respond to any sexual cues, not just those involving their preferred sexual interests. However, not all research supports this finding. Due to the potential benefits of using VPP in the assessment and treatment of female sex offenders or females with paraphilic sexual interests, it is important that further research be done before dismissing the use of VPP in forensic populations. The purpose of this article is to review the current research on VPP and its applicability to female sex offenders and females with paraphilic sexual interests.

The Pars Intermedia: An Anatomic Basis for a Coordinated Vascular Response to Female Genital Arousal

The pars intermedia is an area of the vulva that has been inconsistently described in the literature. We conducted anatomic studies to better describe the tissues and vascular structures of the pars intermedia and proposed a functional rationale of the pars intermedia in the female sexual response. Nine cadaveric vulvectomy specimens were used. Each was serially sectioned and stained with hematoxylin and eosin and Masson's trichrome. Histologic ultrastructural description of the pars intermedia. The pars intermedia contains veins traveling longitudinally in the angle of the clitoris, supported by collagen-rich stromal tissues. These veins drain the different vascular compartments of the vulva, including the clitoris, the bulbs, and labia minora; also, the interconnecting veins link the different vascular compartments. The pars intermedia is not composed of erectile tissue, distinguishing it from the erectile tissues of the corpora cavernosa of the clitoris as well as the corpus spongiosum of the clitoral (vestibular) bulbs. The venous communications of the pars intermedia, linking the erectile tissues with the other vascular compartments of the vulva, appear to provide the anatomic basis for a coordinated vascular response during female sexual arousal.

ORIGINAL RESEARCH–PHYSIOLOGY: Unconscious Classical Conditioning of Sexual Arousal: Evidence for the Conditioning of Female Genital Arousal to Subliminally Presented Sexual Stimuli

Although the assumption that sexual behavior is at least partly learned is common across theories of sexual behavior, classical conditioning of sexual response in women has been seldom studied. The study of unconscious classical conditioning of appetitive sexual responses in women. Vaginal pulse amplitude assessed by vaginal photoplethysmography, and ratings of sexual affective value. Pavlovian conditioning was examined in 18 sexually functional women by using two erotic pictures as conditional stimuli (CSs) and genital vibrotactile stimulation as unconditional stimulus (US). During the acquisition phase, the CSs were presented briefly (30 ms) and were masked by an immediately following masking stimulus. Only one CS (the CS+) was followed by the US during the acquisition phase. Conditioned responses were assessed during the extinction phase with supraliminal presentations of the CS+ and the CS-. Vaginal pulse amplitude was higher in response to the CS+ than during the CS- during the first extinction trial. There was no conditioning effect on ratings of affective value. The experiment demonstrates evidence for unconscious conditioning of genital responses in women, but no evidence for evaluative conditioning. The results add to the limited evidence for classical conditioning of sexual arousal in women, and to increasing evidence for associative emotional learning without awareness.

Oral contraceptive use and female genital arousal: Methodological considerations

This study explored effects of oral contraceptive pill (OCP) use on physiological sexual arousal as measured by a vaginal photoplethysmograph. Sixteen women aged 18–29 viewed audiovisual neutral and erotic stimuli before and an average of 6 weeks following the onset of OCP use. Although subjective measures of sexual arousal, including perceptions of genital arousal, significantly increased in response to erotic stimuli both before and after OCP onset, physiological sexual arousal only increased before OCP use. A comparison of individual responses before and after OCP onset reveals a much higher degree of intrasubject variability after OCP onset. We discuss these findings as they relate to OCP use as a confounding methodological variable to consider in future investigations employing vaginal photoplethysmography.

A Review of the Physiology and Pharmacology of Peripheral (Vaginal and Clitoral) Female Genital Arousal in the Animal Model

We review contemporary scientific data concerning the physiology and pharmacology of peripheral female genital arousal responses in the animal (rabbit and rat) model. We reviewed the contemporary literature and our research studies concerning physiology and pharmacology of peripheral genital arousal from 3 experimental animal models, including genital smooth muscle cell culture, genital strip organ bath and in vivo animal model studies. Nitric oxide (NO) appears to be a key pathway mediating clitoral smooth muscle relaxation. In the vagina NO appeared to have a more controversial role in mediating vaginal muscularis smooth muscle relaxation. Vasoactive intestinal polypeptide induced vaginal smooth muscle relaxation. Functional alpha-adrenergic receptors were expressed in the clitoris and vagina, and mediated norepinephrine induced genital smooth muscle contraction. Androgens and estrogens modulated distinct physiological responses in vagina, and androgens facilitated vaginal smooth muscle relaxation. Papaverine hydrochloride, a smooth muscle relaxant, and phentolamine mesylate, an alpha-blocker, administered into the vaginal spongy muscularis layer increased vaginal wall pressure and vaginal blood flow. Sildenafil caused significant increases in genital (clitoral and vaginal) blood flow and vaginal lubrication in intact and ovariectomized animals. This response was more pronounced in animals treated with estradiol, suggesting that the NO cyclic guanosine monophosphate pathway is involved in the physiological mechanism of female genital arousal and that sildenafil facilitates this response in an in vivo animal model. To achieve improved understanding of the biological aspects of female sexual function, further research is needed in the physiology and pharmacology of peripheral (clitoral and vaginal) genital arousal in the animal model.

Spinal Control of Sexual Reflexes: An Overview from Studies in Animal Models

Central nervous system control of female genital arousal and climax has been reviewed from data obtained in animal studies. Sensory inputs from the pelvic organs are mediated via the pudendal nerve (motor) and pelvic and hypogastric nerves (autonomic). The afferents of these nerves that relay sensory information terminate in L6-S1 and T13-L3. Interneurons located in the spinal gray (T13-S1), especially in the dorsal gray, commissure and surrounding the intermediolateral cell column are important in relaying afferent information to spinal efferent neurons. These interneurons also send messages to the brain. Vagal innervation of the pelvic organs may supplement the spinal systems and may be important in relaying sensory information after spinal cord injury.

Sildenafil augments pelvic nerve-mediated female genital sexual arousal in the anesthetized rabbit.

The NO-cGMP pathway has been implicated in clitoral and vaginal smooth muscle relaxation based on previous immunochemical, biochemical and physiologic studies. There are limited data from in vivo studies demonstrating enhancement of the genital sexual arousal response by pharmacologic agents influencing the NO-cGMP pathway. The goal of this study was to investigate if sildenafil, a phosphodiesterase type-5 inhibitor, facilitated female genital sexual arousal in an animal model in response to pelvic nerve stimulation (PNS). Using female New Zealand White rabbits, we measured the following parameters before, during and after PNS at 4, 16, and 32 Hz: a) hemoglobin concentration and oxygen saturation in female genital (vaginal, labial, clitoral) tissues by laser oximetry; b) clitoral blood flow by laser Doppler flowmetry; c) vaginal luminal pressure by a balloon catheter pressure transducer; d) vaginal lubrication by tampon. Sildenafil was administered intravenously (0.21 microg/kg, 0.42 microg/kg, 2.1 microg/kg) to achieve a systemic concentration of 5, 10 and 50 nM, respectively. After 20 minutes, physiologic measurements were repeated. Sildenafil (50 nM) caused a significant increase in genital oxyhemoglobin concentration and a significant decrease in genital deoxyhemoglobin concentration. Sildenafil also increased the duration of response following PNS, relative to genital hemoglobin concentration and mean clitoral blood flow. Sildenafil caused a decrease in vaginal luminal pressure and resulted in an increase in vaginal lubrication. These data indicate that the NO-cGMP pathway is involved in the physiologic mechanism of female genital arousal and that sildenafil facilitates this response in an in vivo animal model.