Genital Sexual Arousal Research Articles

018 Development of a Multi-functional Sensor based on Optical Fibers for Measurement of Female Genital Sexual Arousal Response

Not many diagnostic tools have been developed for female sexual dysfunction. The goals were to develop a multi-functional sensor based on optical fibers to measure female genital sexual arousal responses. We developed a multi-functional optical probe to measure the change of oxy-, deoxy-, and total hemoglobin concentration along with blood flow in the vaginal wall of female rats. A cylindrical stainless steel probe with a diameter of 3 mm was designed for the vaginal wall of rats, which consisted of broadband tungsten-halogen light source, a 785nm laser and two spectrometers with a separation of 2 mm. A thermistor was placed on the top of the probe to measure the temperature change in the vaginal wall. For in vivo animal model study, female Sprague Dawley (∼400 g) rats (n=8) were anesthetized using isoflurane or ketamine. Vaginal oxygenation, blood flow, and temperature were continuously monitored before and after sexual arousal induced by apomorphine (80g/kg, s.c.). The level of oxyhemoglobin increased after apomorphine treatment and then gradually decreased. Interestingly, different hemodynamic responses were observed after apomorphine administration depending on anesthetic agents. Temperature did not change much even after apomorphine administration compared to the baseline level. Blood flow dramatically increased initially and then decreased afterwards. Compared with a saline administration, apomorphine administration caused a significant increase of oxy-, deoxy-, and total hemoglobin concentration.

Automated Artifact-Detection Procedure for Vaginal Photoplethysmography

ABSTRACTVaginal photoplethysmography is the most commonly used method of assessing women's genital sexual arousal. Raw photoplethysmograph data consist of a series of peaks and troughs, and movement by the participant results in artifacts indicated by unusually high or low peak-to-trough amplitudes. The gold-standard approach to artifact detection involves visual inspection by a trained experimenter and manual removal of artifacts from the data set, however, this process is time-consuming and subject to human error. We present an automated data-processing procedure that uses a series of smoothing regression splines to model the data and identify outliers. The automated procedure was applied to a set of neutral data and sexual-arousal response data, and artifacts identified were compared to artifacts identified by the standard approach of visual inspection. The automated method showed acceptable accuracy in terms of sensitivity and specificity comparable to the manual-processing method. The automated procedure could reduce human error and data-processing time for studies using vaginal photoplethysmography.

Tibial Nerve Stimulation to Drive Genital Sexual Arousal in an Anesthetized Female Rat

BackgroundThere is clinical evidence that percutaneous tibial nerve stimulation can positively benefit women with female sexual interest/arousal disorder, yet no studies have explored the potential mechanisms further. AimTo investigate the effect of tibial nerve stimulation on vaginal blood perfusion (VBP) in an anesthetized rat model. Methods16 ketamine-anesthetized rats were surgically implanted with a nerve cuff electrode on 1 tibial nerve. The tibial nerve was stimulated for 30 minutes continuously or non-continuously at a frequency of 10 to 25 Hz. OutcomesVBP was measured with laser Doppler flowmetry and analyzed using a wavelet transform of time-frequency representations with a focus on the neurogenic energy range (0.076–0.200 Hz). Results25 of 33 (75.8%) stimulation periods had at least a 500% increase in laser Doppler flowmetry neurogenic energy compared with baseline. This increase was most common within 20 to 35 minutes after the start of stimulation. There was no statistically significant difference for frequency used or estrous cycle stage. Clinical TranslationThe results of this study provide further support for percutaneous tibial nerve stimulation as an alternative treatment option for women with genital arousal aspects of female sexual interest/arousal disorder. Strengths and LimitationsThis study successfully demonstrates the ability of tibial nerve stimulation to increase VBP. However, further studies to determine parameter optimization and to illuminate neural mechanisms are needed. Further studies also are necessary to determine effects of repeated stimulation sessions. ConclusionLong-duration tibial stimulation was successful at driving increases in the neurogenic component of VBP, providing evidence that tibial nerve stimulation could be used to treat genital arousal aspects of female sexual interest/arousal disorder by improving pelvic blood flow.Zimmerman LL, Rice IC, Berger MB, Bruns TM. Tibial Nerve Stimulation to Drive Genital Sexual Arousal in an Anesthetized Female Rat. J Sex Med 2018;15:296–303.

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

BackgroundBelow 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. AimTo build on these findings by testing the effects of a single session of autogenic training on sexual arousal in a sample of women who reported decreased or absent sexual arousal for at least 6 months. MethodsGenital sexual arousal, subjective sexual arousal, and perceived genital sensations were assessed in 25 women 20 to 44 years old before and after listening to a 22-minute autogenic training recording. HRV was assessed with electrocardiography. OutcomesChange in genital sexual arousal, subjective sexual arousal, and perceived genital sensations from the pre-manipulation erotic film to the post-manipulation erotic film. ResultsMarginally significant increases in discrete subjective sexual arousal (P = .051) and significant increases in perceived genital sensations (P = .018) were observed. In addition, degree of change in HRV significantly moderated increases in subjective arousal measured continuously over time (P < .0001). There were no significant increases in genital arousal after the manipulation. Clinical ImplicationsThe results of this study suggest that autogenic training, and other interventions that aim to increase HRV, could be a useful addition to treatment protocols for women who are reporting a lack of subjective arousal or decreased genital sensations. Strengths and LimitationsThere are few treatment options for women with arousal problems. We report on a new psychosocial intervention that could improve arousal. Limitations include a relatively small sample and the lack of a control group. ConclusionOur findings indicate that autogenic training significantly improves acute subjective arousal and increases perceived genital sensations in premenopausal women with self-reported arousal concerns.Stanton AM, Hixon JG, Nichols LM, Meston CM. One Session of Autogenic Training Increases Acute Subjective Sexual Arousal in Premenopausal Women Reporting Sexual Arousal Problems. J Sex Med 2018;15:64–76.

Effects of a Mindfulness Task on Women’s Sexual Response

Mindfulness-based interventions are effective at improving symptoms of sexual dysfunction in women. The mechanisms by which mindfulness improves sexual function are less clear. The main objective of our study was to investigate the impact of a mindfulness task on sexual response in women. Forty-one women (mean age = 27.2, SD = 5.6) participated in two laboratory sessions that each included two erotic films and one attention task that were presented in counterbalanced order. Both attention tasks consisted of a six-minute audio recording of either a modified body scan, focusing on genital arousal sensations (mindfulness condition), or a visualization exercise. Subjective and genital sexual arousal were measured continuously during stimulus presentation. The mindfulness task led to greater subjective and lower genital arousal. The agreement of subjective and genital sexual arousal (i.e., concordance) was greater in the mindfulness condition. Trait mindfulness was related to lower sexual arousal but also greater sexual concordance in women. Mindfulness-based interventions that encourage women to focus on physical arousal sensations in the here and now may be associated with women’s improved sexual function by enhancing feelings of sexual arousal during sexual activity and by increasing concordance between subjective and genital sexual arousal.

Time-Frequency Analysis of Increases in Vaginal Blood Perfusion Elicited by Long-Duration Pudendal Neuromodulation in Anesthetized Rats

Female sexual dysfunction (FSD) affects a significant portion of the population. Although treatment options for FSD are limited, neuromodulation for bladder dysfunction has improved sexual function in some women. A few studies have investigated peripheral neuromodulation for eliciting changes in vaginal blood flow, as a proxy for modulating genital sexual arousal, however results are generally transient. Our central hypothesis is that repeated or extended-duration pudendal nerve stimulation can elicit maintained vaginal blood flow increases. Under ketamine anesthesia, the pudendal nerve of 14 female rats was stimulated at varying frequencies (1-100 Hz) and durations (0.15-60 min). Vaginal blood perfusion was measured with a laser Doppler flowmetry probe. Changes in blood perfusion were determined through raw signal analysis and increases in the energy of neurogenic (0.076-0.200 Hz) and myogenic (0.200-0.740 Hz) frequency bands through wavelet analysis. Additionally, a convolution model was developed for a carry-over stimulation effect. Each experiment had significant increases in vaginal blood perfusion due to pudendal nerve stimulation. In addition, there were large concurrent increases in neurogenic and myogenic frequency-band energy in 11/14 experiments, with an average maximal response at 31.3 min after stimulation initiation. An effective stimulation model with a 30-min carry-over effect had a stronger correlation to blood perfusion than the stimulation period itself. Repeated or extended-duration pudendal nerve stimulation can elicit maintained increases in vaginal blood perfusion. This work indicates the potential for pudendal neuromodulation as a method for increasing genital arousal as a potential treatment for FSD.

The impact of Fiera, a women's personal care device, on genital engorgement as measured by thermography: a proof-of-principle study.

To determine the degree of vasoengorgement of the external genitalia caused by Fiera, a personal care device developed specifically to increase sexual arousal and interest. Time to onset of self-reported genital sexual arousal and development of responsive sexual desire were also measured. This nonblinded, prospective cohort, single-site study was conducted in women without sexual dysfunction between the ages of 18 and 70. Each participant underwent a single-visit procedure that established a baseline temperature of the external genitalia, followed by 15 minutes of Fiera use. A post-Fiera temperature assessment lasting 10 minutes was performed. Subjective measures assessed the development of genital arousal and responsive desire as a result of Fiera use. Fourteen premenopausal and 12 postmenopausal participants completed the study. Mean time to reach genital arousal was 5.2 + 4.2 minutes in the premenopausal group, and 4.5 + 4.3 minutes in the postmenopausal group. Statistically significant increases in the temperature of the clitoris and vestibule were demonstrated in both groups up to 10 minutes after removal of Fiera. At the labia, temperature increase was significant up to 8 minutes in the premenopausal group and up to 2 minutes in the postmenopausal group. All of the participants experienced responsive sexual desire as a result of Fiera. Use of Fiera produced statistically significant increases in the temperature of the external genitalia, markers of vasoengorgement, in both the premenopausal and postmenopausal participants. The onset of genital sexual arousal was rapid in both groups, and responsive sexual desire was experienced by all of the participants.

Gynephilic Men's Self-Reported and Genital Sexual Responses to Relationship Context Cues.

The current study examined men's sexual responses to relationship context. Chivers and Timmers (2012) previously reported that heterosexual men's genital and self-reported sexual arousal varied by gender but not relationship context, suggesting that gender cues are more salient determinants of sexual response than relationship context cues for men. Those analyses were, however, significantly underpowered to detect relationship context effects (n=9). The current study utilized the same paradigm as Chivers and Timmers' study, exposing a larger sample of heterosexual men (n=26) to audio narratives describing sexual interactions that varied by partner gender (man, woman) and relationship context (stranger, friend, long-term relationship), and observing effects on genital and self-reported sexual response. Results indicated that men's genital response to relationship context cues mirrored those previously reported for heterosexual women (Chivers & Timmers, 2012); heterosexual men demonstrated less genital response to the friend than to the stranger or long-term relationship conditions. No significant effect of relationship context was found for men's self-reported sexual arousal. These data suggest that, in addition to gender cues, relationship cues may also be an important determinant of men's genital sexual responses.

Interoception and sexual response in women with low sexual desire.

Sexual concordance is defined as the association between genital response and self-reported sexual arousal. Though one might predict a strong association between sexual concordance and awareness of other internal physiological sensations (termed interoception), past research on sexually healthy women has not found these different domains to be related. The aim of the present study was to test the association between interoception and sexual concordance in a clinical sample of women with Sexual Interest/Arousal Disorder (SIAD). Fifty-two women with SIAD completed the Multidimensional Assessment of Interoceptive Awareness (MAIA), a validated self-report measure of interoception, and completed a heart-beat accuracy test, an objective measure of interoception. They also participated in a laboratory-based assessment of physiological sexual arousal and self-reported sexual arousal while viewing an erotic film. Mental and physiological arousal were correlated at r = 0.27 (range -0.80 to 0.95). There was no significant association between sexual concordance and women’s heartrate awareness. However, five aspects of interoceptive awareness (noticing, emotional awareness, self-regulation, body-listening, and trusting), were predictive of lower, and one aspect (not-distracting) was predictive of higher sexual concordance. We discuss the findings in relation to the role of emotions and arousal states in the interoception-sexual concordance relationship.

041 The Relationship between Physiological Genital Arousal and Genital Sensations in Women

Past research has shown that genital arousal as measured via vaginal photoplethysmography (VPA) cannot reliably differentiate women with and without sexual dysfunction. However, little research has assessed the relationship between VPA and women's genital sensations. One study that examined this relationship found that mean VPA was associated with genital sensations in sexually functional, but not dysfunctional, women (Laan et al., 2008). The aim of the current study was to replicate and extend these findings to a large sample of both sexually functional and dysfunctional women, both with and without a history of childhood sexual abuse. Data from three studies totaling 170 women (sexually functional = 78, sexually dysfunctional = 92, history of childhood sexual abuse = 49, no history of abuse = 121) were compiled. The Female Sexual Function Index cutoff score of 26.55 was used in determining sexual function status. In each study, women were presented with a neutral and erotic film while their genital sexual arousal was measured. After the films, participants completed a self-report measure of subjective arousal and perceived genital sensations.

One Session of Autogenic Training Increases Acute Subjective Sexual Arousal in Pre-Menopausal Women With Sexual Arousal Problems

Below average heart rate variability (HRV) has been associated with sexual arousal dysfunction and overall sexual dysfunction in women. Autogenic training, a psychophysiological relaxation technique, has been shown to increase HRV. In a recent study, sexually healthy women experienced acute increases in both physiological and subjective sexual arousal after one brief session of autogenic training (Stanton & Meston, in press). The present study builds on these findings by testing the effects of a single session of autogenic training on sexual arousal in a sample of women with Female Sexual Arousal Disorder (FSAD). The final sample included 25 women, aged 20 to 44, with an average age of 31.16 (SD = 6.71). Vaginal pulse amplitude (VPA), an index of genital sexual arousal, and subjective sexual arousal were assessed before and after listening to a 22-minute autogenic training recording. Heart rate variability was assessed with electrocardiography. Data were analyzed with hierarchical linear modeling and paired samples t-tests.

Neural Correlates of Sexual Orientation in Heterosexual, Bisexual, and Homosexual Men

Studies of subjective and genital sexual arousal in monosexual (i.e. heterosexual and homosexual) men have repeatedly found that erotic stimuli depicting men’s preferred sex produce strong responses, whereas erotic stimuli depicting the other sex produce much weaker responses. Inconsistent results have previously been obtained in bisexual men, who have sometimes demonstrated distinctly bisexual responses, but other times demonstrated patterns more similar to those observed in monosexual men. We used fMRI to investigate neural correlates of responses to erotic pictures and videos in heterosexual, bisexual, and homosexual men, ages 25–50. Sixty participants were included in video analyses, and 62 were included in picture analyses. We focused on the ventral striatum (VS), due to its association with incentive motivation. Patterns were consistent with sexual orientation, with heterosexual and homosexual men showing female-favoring and male-favoring responses, respectively. Bisexual men tended to show less differentiation between male and female stimuli. Consistent patterns were observed in the whole brain, including the VS, and also in additional regions such as occipitotemporal, anterior cingulate, and orbitofrontal cortices. This study extends previous findings of gender-specific neural responses in monosexual men, and provides initial evidence for distinct brain activity patterns in bisexual men.

Interoceptive Awareness Moderates the Relationship Between Perceived and Physiological Genital Arousal in Women

IntroductionIn general, laboratory studies have shown low correlations between subjective (ie, self-report) and physiologic (ie, vaginal pulse amplitude) measurements of sexual arousal in women. One explanation for this presumed low concordance is that women might not be attending to their genital responses and/or might be unable to accurately perceive their genital responses. AimTo examine the extent to which women can perceive their genital arousal sensations, the role that interoceptive awareness plays in this ability, and whether interoceptive awareness influences sexual concordance in women. MethodsTwenty-six sexually functional women viewed an erotic film while their physiologic and perceived genital sexual arousal levels were measured continuously. Self-report measurements of sexual function and bodily awareness also were administered. Main Outcome MeasuresPhysiologic sexual arousal was measured with a vaginal photoplethysmograph, and perception of genital arousal was measured with an arousometer. Degree of bodily awareness was measured with the Multidimensional Assessment of Interoceptive Awareness questionnaire. ResultsWomen exhibited a significant degree of agreement between physiologic and perceived genital arousal (P < .05). Interoceptive awareness was found to significantly moderate this relation (P < 0.05), such that a greater degree of interoceptive awareness facilitated greater agreement between physiologic and perceived genital arousal. Interoceptive awareness also was found to facilitate greater concordance between subjective and physiologic sexual arousal (P < .05). ConclusionWomen can perceive their genital response, and interoceptive awareness influences this ability and the relation between subjective and physiologic sexual arousal. Increasing bodily awareness could be a plausible route for treatment development.

Bisexual Phenomena Among Gay-Identified Men.

A high proportion of self-identified gay men exhibit aspects of bisexuality during their lives. Some identify as bisexual before later identifying as gay; this has been called transitional bisexuality. Although many gay men report no attraction to women-or even sexual disgust toward them-others report some slight attraction to women. The latter have been studied as mostly homosexual men. We studied men with and without a history of transitional bisexuality, as well as mostly homosexual (i.e., those with Kinsey scores of 5) and completely homosexual (i.e., those with Kinsey scores of 6) men with respect to their sexual history with women, their current self-reported sexual arousal and disgust toward women and men, and their patterns of genital sexual arousal to female and male stimuli. Gay men with a history of transitional bisexuality generally lacked current sexual attraction and sexual arousal to women, compared with other gay men. Thus, transitional bisexuality among future gay men is mostly a matter of transitional bisexual identification. In contrast, mostly homosexual men showed statistically significant increases in genital arousal to female stimuli, compared with completely homosexual men.

A Single Session of Autogenic Training Increases Acute Subjective and Physiological Sexual Arousal in Sexually Functional Women

Heart rate variability (HRV) has recently been associated with female sexual function (Stanton, Lorenz, Pulverman, & Meston, 2015). Below-average HRV was identified as a possible risk factor for sexual arousal dysfunction and overall sexual dysfunction in women. Based on this newly established relationship between HRV and female sexual function, the present study examined the effect of autogenic training to increase HRV on acute physiological and subjective sexual arousal in women. Specifically, vaginal pulse amplitude (VPA), an index of genital sexual arousal, and subjective sexual arousal were assessed in 33 sexually functional women, aged 18 to 27, before and after a short session of autogenic training. Autogenic training, a relaxation technique that restores the balance between the activity of the sympathetic and the parasympathetic branches of the autonomic nervous system, has been shown to significantly increase HRV (Miu, Heilman, & Miclea, 2009). After autogenic training, significant increases in both VPA (p <.05) and subjective sexual arousal (p <.005) were observed. Moreover, change in HRV from pre- to postmanipulation significantly moderated changes in subjective sexual arousal (p <.05) when it was measured continuously during the presentation of the erotic stimulus. This cost-effective, easy-to-administer behavioral intervention may have important implications for increasing sexual arousal in women.

Investigating Female Sexual Concordance: Do Sexual Excitation and Sexual Inhibition Moderate the Agreement of Genital and Subjective Sexual Arousal in Women?

The agreement of subjective and genital sexual response, also referred to as sexual concordance, shows substantial variability between women. Identifying predictors of sexual arousal and sexual concordance is important to improve our understanding of female sexual response and its relationship to sexual function or dysfunction. The aim of this study was to assess the relevance of sexual excitation and sexual inhibition as predictors of subjective sexual arousal, genital arousal, and sexual concordance. In a laboratory setting, sexual arousal was induced by erotic video stimuli. Subjective sexual arousal was assessed continuously during stimulus presentation and genital arousal was measured with vaginal photoplethysmography. Data of 58 women (Mage=24.95, SD=4.65) were analyzed using multilevel analyses (HLM). This data analytic technique estimates the within-subject associations of subjective and genital arousal, by controlling for between-subject differences. An interaction term of sexual excitation and sexual inhibition significantly predicted genital sexual arousal. In exploratory analyses, two lower order factors of sexual inhibition (Concerns about Sexual Function and Arousal Contingency) were predictive of sexual concordance. Further examination of these associations might increase our knowledge of female sexual function and deepen our understanding of how sexual excitation and sexual inhibition affect sexual arousal and consequently, impact sexual behaviors, in women.

005 Sexual Dysfunction among Women with a History of Childhood Sexual Abuse: The Role of Negative Appraisal of Genital Sexual Arousal and Sexual Shame

005 Sexual Dysfunction among Women with a History of Childhood Sexual Abuse: The Role of Negative Appraisal of Genital Sexual Arousal and Sexual Shame

Sex differences in concordance rates between auditory event-related potentials and subjective sexual arousal.

Much research indicates men show a greater concordance between subjective and genital sexual arousal than do women. We investigated the relationship between subjective sexual arousal and brain activation in men and women. Subjective sexual arousal and auditory N1 and P3b ERP amplitudes were measured while 38 participants viewed erotic and non-erotic films. Most notably, there was a significant correlation between N1 amplitude and sexual arousal in men; for women, there was a significant correlation between the P3b amplitude and sexual arousal. ERP amplitudes were inversely associated with reported arousal, suggesting that sexual arousal interferes with early tone processing for men, and with later tone processing for women. Lastly, for women, pornography/erotica consumption was negatively correlated with P3b amplitudes, suggesting that women who consume more pornography/erotica may also show greater attention to erotic films.

P-03-076 Female sexual desire and genital sexual arousal dysfunction after ovarian cancer therapy

A 30 year old woman came in for a consultation because of the absence of sexual desire and problematic arousal, lubrication, orgasm and pain after the ovarian cancer diagnosis and treatment. Her sexuality declined and has not significantly improved after the therapy in time. She wanted to improve her sexual life before undergoing in vitro fertilisation. The bio-psycho-social approach was used to elicit the patient’s history. In 2006, at the age of 23, she underwent bilateral adnexectomy due to ovarian cancer. The surgery was followed by a chemotherapy treatment. She did not have birth prior to adnexectomy therefore her eggs were removed and frozen. Due to surgical menopause symptoms after the operation she is being treated by the hormonal menopause treatment Cycolo-Progynova (norgestrel and estrogen). She is scheduled for the IVF and ET. She comes from a typical patriarchal family where sex was considered taboo. She felt embarrassed about sex and when there was kissing on TV, she looked away in shame. She has a negative self-image and low self-esteem. She had her first sexual intercourse at the age of 21 and it does not incite bad memories. She did not have any sexual problems before the treatment of ovarian cancer. She masturbated before the adnexectomy, but she has not felt any need for it since. In the past she gained weight. She focuses all her energy on her hobbies: gardening, jewellery making and running. She has a good relationship with her current partner. Their main sexual script is coitus.

Mindfulness-Based Sex Therapy Improves Genital-Subjective Arousal Concordance in Women With Sexual Desire/Arousal Difficulties.

There is emerging evidence for the efficacy of mindfulness-based interventions for improving women's sexual functioning. To date, this literature has been limited to self-reports of sexual response and distress. Sexual arousal concordance-the degree of agreement between self-reported sexual arousal and psychophysiological sexual response-has been of interest due to the speculation that it may be a key component to healthy sexual functioning in women. We examined the effects of mindfulness-based sex therapy on sexual arousal concordance in a sample of women with sexual desire/arousal difficulties (n=79, M age 40.8 years) who participated in an in-laboratory assessment of sexual arousal using a vaginal photoplethysmograph before and after four sessions of group mindfulness-based sex therapy. Genital-subjective sexual arousal concordance significantly increased from pre-treatment levels, with changes in subjective sexual arousal predicting contemporaneous genital sexual arousal (but not the reverse). These findings have implications for our understanding of the mechanisms by which mindfulness-based sex therapy improves sexual functioning in women, and suggest that such treatment may lead to an integration of physical and subjective arousal processes. Moreover, our findings suggest that future research might consider the adoption of sexual arousal concordance as a relevant endpoint in treatment outcome research of women with sexual desire/arousal concerns.