Sexual Response In Women Research Articles

Eye-tracking does not reveal early attention processing of sexual copulatory movement in heterosexual men and women

Men and women respond differently when presented with sexual stimuli. Men's reaction is gender-specific, and women's reaction is gender-nonspecific. This might be a result of differential cognitive processing of sexual cues, namely copulatory movement (CM), which is present in almost every dynamic erotic stimulus. A novelty eye-tracking procedure was developed to assess the saliency of short film clips containing CM or non-CM sexual activities. Results from 29 gynephilic men and 31 androphilic women showed only small and insignificant effects in attention bias and no effects in attentional capture. Our results suggest that CM is not processed differently in men and women and, therefore, is not the reason behind gender-nonspecific sexual responses in women.

(099) A Systematic Review Investigating the Involvement of the Pelvic Floor Muscles in Sexual Function and Sexual Response

Abstract Introduction The pelvic floor muscles (PFM) have been suggested to play a key role in sexual function and sexual response in women. However, current syntheses of the evidence have been limited to interventional studies investigating the effect of modalities targeting the PFM on sexual function in women with pelvic pain and pelvic floor disorders. The literature has therefore never been critically appraised while excluding these potential confounders, which prevents to fully capture and understand the involvement of the PFM in sexual function and sexual response. Objective To examine and synthesize the available evidence on: i) the effects of PFM training on sexual function in women without pelvic pain or pelvic disorders, ii) the association between PFM function and sexual function/response and iii) the differences in the PFM function between women with and without sexual dysfunctions. Methods Electronic databases including Medline, Cochrane, CENTRAL, CINAHL, Psycinfo, Sportdiscuss, AMED, Scopus and EMBASE were searched using a peer-reviewed search strategy. We also performed a hand search of the references of all relevant articles and a grey literature search. Main outcomes included sexual function (self-reported questionnaire), sexual response (physiological test) and PFM function (strength and tone assessed with various assessment tools). We included interventional studies (randomized controlled trials and non-randomized studies) investigating the effects of PFM training on sexual outcomes as well as observational studies examining the association between PFM function (strength and tone) and sexual outcomes or the differences in PFM function in women with and without sexual dysfunctions. Quality of selected studies was assessed using the Mixed Methods Appraisal Tool by a team of two reviewers and disagreements were resolved by consensus or involvement of a third-party. Results The literature search resulted in 33 eligible studies including 14 interventional studies and 19 observational studies. Most studies (31/33) were of moderate quality or higher. Overall, 10 of the 14 interventional studies reported that PFM training had a significant effect on sexual function. Of the 11 observational studies investigating the association between PFM function and sexual function, 8 showed significant correlations (ranging from weak to strong) with sexual satisfaction, lubrication, arousal, orgasm or overall sexual function. Of the observational studies, 7 supported the involvement of the PFM as part of the sexual response (i.e. in the arousal and orgasm phases). Regarding the 3 studies evaluating the differences in the PFM function of women with and without sexual dysfunctions, the results were conflicting. Conclusions Findings of this review support the involvement of the PFM in sexual function and in sexual response in women without pain and pelvic dysfunctions. This review supports the need to further investigate modalities targeting the PFM as part of the management for sexual dysfunctions. Disclosure No

(131) Sexual Activity After Pelvic Surgery

Abstract Introduction Around 50%-70% of all women, at any moment of their lives, will undergo pelvic surgery such as abdominal and vaginal hysterectomies, laparoscopic or robotic-assisted hysterectomies, and exploratory laparotomies for multiple reasons. These reasons include; endometriosis, chronic pelvic pain, pelvic adhesions secondary to pelvic inflammatory disease, infected or perforated IUDs, previous surgeries, abscesses or cysts, peritonitis, and genital prolapses such as cystoceles, rectoceles, uterine prolapse or vaginal prolapse in patients with previous hysterectomies, urinary and fecal incontinence, and total procidentia. The general public knowledge, distorted sexual education curriculum, and the influence of this inappropriate sexual education (produced by religions and cultures) affect the medical practice and investigations at scientific levels. These influences have expanded the beliefs that sexual activity is deteriorated for all of these kinds of procedures. Few American publications and many Asian publications report the frank deterioration of the sexual response in women who have had pelvic surgeries. Objective To show how a very high percentage of women, that have had pelvic surgeries, have an improvement in their sexual activity after these kinds of procedures. Methods This investigation analyzed the postoperative sexual function of hundreds of patients at our two centers in which all the procedures previously named were practiced. Results We found an improvement in sexual activity, not only in the women but also in the couples in more than 95% of the cases. The pre and post-procedure evaluations were done. Conclusions Contradictory to what several studies have shown regarding how pelvic surgeries produced deterioration in sexual activity, we have demonstrated the opposite. We found that in more than 95% of the cases, sexual activity was improved. These procedures included repairing total procidentia, cystocele, rectocele, urinary incontinence or rectal incontinence, fibroid uterus, or chronic pelvic pain. Disclosure No

MP45-11 FEMALE SEXUAL DYSFUNCTION AND TYPE 2 DIABETES: RESULTS FROM THE DIABETES PREVENTION PROGRAM OUTCOMES STUDY (DPPOS)

You have accessJournal of UrologyCME1 Apr 2023MP45-11 FEMALE SEXUAL DYSFUNCTION AND TYPE 2 DIABETES: RESULTS FROM THE DIABETES PREVENTION PROGRAM OUTCOMES STUDY (DPPOS) Priyanka Gupta, Lindsay Doherty, Marinella Temprosa, Hunter Wessells, Rodica Pop-Busui, Kishore Gadde, Arthur H. Owora, Aruna V. Sarma, and DPP Research Group Priyanka GuptaPriyanka Gupta More articles by this author , Lindsay DohertyLindsay Doherty More articles by this author , Marinella TemprosaMarinella Temprosa More articles by this author , Hunter WessellsHunter Wessells More articles by this author , Rodica Pop-BusuiRodica Pop-Busui More articles by this author , Kishore GaddeKishore Gadde More articles by this author , Arthur H. OworaArthur H. Owora More articles by this author , Aruna V. SarmaAruna V. Sarma More articles by this author , and DPP Research Group More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003291.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Female sexual dysfunction (FSD) has been reported to be more common in women with T2D. However, detailed risk profiles are lacking. We sought to determine the burden and correlates of FSD in a well characterized cohort of women with Prediabetes (PreD) and T2D enrolled in the DPPOS. METHODS: Between 1996-1999, 3,234 adults with PreD were randomized to intensive lifestyle intervention, masked metformin, or placebo in the DPP. In 2001, open-label metformin was continued for those originally randomized to it and modified lifestyle intervention offered to all. In 2016-2017, 1320 of 1464 participants completed the Female Sexual Function Index (FSFI). 426 women were sexually active and included in the current report. FSD was defined as FSFI≥26.55. A backwards selection multivariable logistic regression model estimated odds of FSD for sociodemographic, clinical, and diabetes-related covariates significant in bivariate analysis. RESULTS: Overall, 185 (43%) women met the criteria for FSD. After adjustment for treatment arm, age and race, depression (defined by the Beck Depression inventory or antidepressant use) and weekly urinary incontinence were both associated with over a two-fold (OR=2.81, 95%CI=1.57, 5.02; and OR=2.14, 95%CI=1.31, 3.51) increase in odds of FSD, respectively. Women who reported hysterectomy were 1.95 times more likely (95%CI=1.07, 3.54) to report FSD. Mean study BMI was slightly protective for FSD (OR=0.93, 95%CI=0.89, 0.96). Neither DPP treatment group nor any diabetes-related factors were associated with FSD. CONCLUSIONS: FSD is highly prevalent in this population of women with PreD and T2D. Our findings suggest that FSD in this cohort is most strongly associated with depression. The lack of association between any measures of diabetes or glycemic control suggests that the sexual response in women is more likely to be affected by psychosocial aspects than by metabolic control or complications of diabetes. Source of Funding: National Institute of Diabetes and Digestive and Kidney Diseases (UDK048489, UDK048339, UDK048377, UDK048349, UDK048381, UDK048468, UDK048434, UDK048485, UDK048375, UDK048514, UDK048437, UDK048413, UDK048411, UDK048406, UDK048380, UDK048397, UDK048412, UDK048404, UDK048387, UDK048407, UDK048443, and UDK048400) © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e625 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Priyanka Gupta More articles by this author Lindsay Doherty More articles by this author Marinella Temprosa More articles by this author Hunter Wessells More articles by this author Rodica Pop-Busui More articles by this author Kishore Gadde More articles by this author Arthur H. Owora More articles by this author Aruna V. Sarma More articles by this author DPP Research Group More articles by this author Expand All Advertisement PDF downloadLoading ...

87-OR: Female Sexual Dysfunction and Type 2 Diabetes: Results from the Diabetes Prevention Program Outcomes Study (DPPOS)

Introduction and Objective: Female sexual dysfunction (FSD) has been reported to be more common in women with T2D. However, detailed risk profiles are lacking. We sought to determine the burden and correlates of FSD in a well characterized cohort of women with Prediabetes (PreD) and T2D enrolled in the DPPOS. Methods: Between 1996-1999, 3,234 adults with PreD were randomized to intensive lifestyle intervention, masked metformin, or placebo in the DPP. In 2001, open-label metformin was continued for those originally randomized to it and modified lifestyle intervention offered to all. In 2016-2017, 1320 of 1464 participants completed the Female Sexual Function Index (FSFI) . 426 women were sexually active and included in the current report. FSD was defined as FSFI≥26.55. A backwards selection multivariable logistic regression model estimated odds of FSD for sociodemographic, clinical, and diabetes-related covariates significant in bivariate analysis. Results: Overall, 185 (43%) women met the criteria for FSD. After adjustment for treatment arm, age and race, depression (defined by the Beck Depression inventory or antidepressant use) and weekly urinary incontinence were both associated with over a two-fold (OR=2.81, 95%CI=1.57, 5.02; and OR=2.14, 95%CI=1.31, 3.51) increase in odds of FSD, respectively. Women who reported hysterectomy were 1.95 times more likely (95%CI=1.07, 3.54) to report FSD. Mean study BMI was slightly protective for FSD (OR=0.93, 95%CI=0.89, 0.96) . Neither DPP treatment group nor any diabetes-related factors were associated with FSD. Conclusions: FSD is highly prevalent in this population of women with PreD and T2D. Our findings suggest that FSD in this cohort is most strongly associated with depression. The lack of association between any measures of diabetes or glycemic control suggests that the sexual response in women is more likely to be affected by psychosocial aspects than by metabolic control or complications of diabetes. Disclosure P.Gupta: Consultant; Inspire . L.Doherty: None. M.Temprosa: None. H.Wessells: None. R.Pop-busui: Advisory Panel; Averitas Pharma, Inc., Boehringer Ingelheim International GmbH, Nevro Corp., Novo Nordisk, Reata Pharmaceuticals, Inc., Regenacy Pharmaceuticals, Inc. K.M.Gadde: Research Support; AstraZeneca, BioKier, Inc. A.H.Owora: None. A.V.Sarma: None. D.Research group: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (UDK048489, UDK048339, UDK048377, UDK048349, UDK048381, UDK048468, UDK048434, UDK048485, UDK048375, UDK048514, UDK048437, UDK048413, UDK048411, UDK048406, UDK048380, UDK048397, UDK048412, UDK048404, UDK048387, UDK048407, UDK048443, and UDK048400)

Melanocortin-4 receptor agonism modulates sexual brain processing in women with low sexual desire

ABSTRACT Introduction Hypoactive sexual desire disorder (HSDD) is characterized by a persistent lack of sexual desire and sexual fantasies, causing marked interpersonal distress1. It is the most common global female sexual health problem, affecting up to 1 in 10 women2,3. Despite its significant social and economic burden4,5, the exact pathophysiology of this condition remains unknown. Furthermore, existing treatment options are limited by their efficacy and side effects6. Melanocortin-4 receptor (MC4R) agonists are a promising therapeutic avenue, although their exact mechanism of action within the CNS remains unknown. Investigating the neural pathways through which MC4Ra's exert their effect will deepen our knowledge of normal and abnormal sexual behaviour, and hence provide information which could contribute to the development of novel treatment strategies. Objective To determine the mechanism by which MC4R agonists mediate their effects on sexual behaviour in women with HSDD. Methods We performed a randomized, double-blind, placebo-controlled crossover study in 31 premenopausal women with HSDD. A combination of psychometric, functional neuroimaging and hormonal analyses was used to investigate the effect of MC4R agonism versus placebo on sexual brain processing. A standard fMRI block design task with short (20 second) erotic videos was used to examine brain activation. Additionally, a ‘naturalistic’ fMRI paradigm was used with long (ten minute) erotic videos to examine functional brain connectivity. Results MC4R agonism increased self-reported sexual desire for up to 24-hours following administration, when compared with placebo (P=0.007). The mechanism of action behind this effect may be explained by the changes in brain activation and connectivity, in response to visual erotic stimuli. In the short video task, MC4R agonism led to increased activation of the supplementary motor area and cerebellum, alongside deactivation of the secondary somatosensory cortex, when compared with placebo (Z=2.3, P<0.05). In the long video task, a reduction of functional connectivity between the amygdala and insula in response to erotic stimuli was prevented by MC4R agonism (F (1,30) = 5.553, P=0.025). Regarding hormonal analyses, MC4R agonism led to a small mean increase in LH of 1.1iU/L (F [1,58] = 13.38, P=0.0005) and FSH of 0.35iU/L (F [1,60] = 10.97, P=0.0016) during the study, with no effect on estradiol or progesterone levels. Conclusions This is the first study investigating the effect of MC4R agonism on sexual brain processing in women with HSDD. These results shed light on the neural substrates through which MC4R agonism increases sexual desire. The observed changes in brain activation may serve to ease self-consciousness, enhance sexual imagery and disinhibit the sexual response in women with HSDD. This is in line with the “top-down” neurofunctional model of HSDD whereby inspecting and monitoring one's sexual response interferes with desire7. This information is important for the ongoing development of therapies for HSDD, as well as MC4R agonist development more widely, such as in obesity medicine where there their use is being rapidly developed. Disclosure Work supported by industry: yes, by AMAG Pharmaceuticals Inc.

Virtual Reality Erotica: Exploring General Presence, Sexual Presence, Sexual Arousal, and Sexual Desire in Women.

Virtual reality (VR) media using a three-dimensional (3D) camera facilitates an immersive experience compared to traditional two-dimensional (2D) formats. In this novel study, we used high quality, women-centered erotica and examined whether stimulus modality (VR vs. 2D) and point of view (POV: first-person vs. third-person) impacted women's feelings of sexual presence (activation of sexual response induced by the perception of being present), sexual arousal, and sexual desire (dyadic and solitary). We also investigated the effects of stimulus modality on feelings of general presence (a sense of "being there"). Results from 38 women indicated that with medium to large effects, general presence, sexual presence, and sexual arousal were significantly higher for VR videos relative to 2D videos. Sexual presence was higher for first-person POV depending on the order of film exposure. A general trend toward increasing dyadic sexual desire over the course of the study was observed. No significant differences were observed for solitary sexual desire. These findings support the adaptability of VR media to sex research and show that it can induce feelings of sexual presence and presence more generally. That sexual arousal was positively impacted by VR erotica may have implications for addressing the limitations that accompany other stimulus modalities used to elicit sexual responses in women.

The Successful Measurement of Clitoral Pulse Amplitude Using a New Clitoral Photoplethysmograph: A Pilot Study

BackgroundAlthough the clitoris is more sensitive to stimulation and its innervation more conducive to sensory feedback than the vagina, the field of sexual psychophysiology, which uses psychophysiological methods including genital response measures to study sexual arousal, relies heavily on the measurement of vaginal, rather than clitoral, pulse amplitude. AimTo develop and test a new clitoral photoplethysmograph for the measurement of clitoral pulse amplitude (CPA). Methods2 versions of the new device, which differed in the orientation of the sensor and light source (parallel vs angled), were tested in 15 premenopausal, sexually functional women. Vaginal pulse amplitude (VPA) was assessed simultaneously. The women viewed a 3-minute erotic and an anxiety-inducing film segment with each clitoral sensor, interspersed with neutral video excerpts. In addition, they were asked to indicate their subjective level of sexual arousal during and after erotic video presentations. OutcomesThe main outcome measures are CPA, VPA, and subjective sexual arousal. ResultsThe clitoral photoplethysmograph successfully detected CPA. The quality of the signals was best for the angled sensor. Main effects of the film and the interaction between the film and epoch were stronger for the clitoral than for the vaginal device. In addition, CPA followed more closely changes in intensity of sexual films than VPA. Within- and between-subject correlations between genital response and subjective sexual arousal were higher for the clitoral than for the vaginal device. Clinical TranslationComparison of CPA with other genital blood flow measures in clinical samples is indicated and may contribute to improved physiological assessments of sexual response in women. Strengths and LimitationsOur sample was small and consisted of healthy volunteers. Future research could examine test-retest reliability, by including multiple recording sessions, and further explore the specificity of CPA by comparing sexual and non-sexual stimuli with positive valence. ConclusionThis study presents the first instrument to successfully measure CPA.Mechelmans DJ, Sachtler WL, von Wiegand TE, et al. The Successful Measurement of Clitoral Pulse Amplitude Using a New Clitoral Photoplethysmograph: A Pilot Study. J Sex Med 2020;17:1118–1125.

Ethnic differences in visual attention to sexual stimuli among Asian and White heterosexual women and men

Previous theory suggests that women's sexual response patterns are more dependent on cultural context than men's. However, there is little empirical data on culture-based sexual responding between women versus men using psychophysiological methods. In this study, we used eye-tracking to compare the visual attention patterns to explicit sexual stimuli among heterosexual women and men of Asian and White ethnicity residing in Australia. Overall, we found greater variability in Asian versus White women's sexual responding to erotic material than in Asian vs. White men. When gazing at explicit images of men, women, and couples engaged in sex acts, Asian women demonstrated greater visual avoidance of genital regions than White women. Lower sexual sensation-seeking fully mediated Asian women's greater visual avoidance of genital regions in solo images, and partly mediated their greater avoidance of genital-contact regions in couple images. Asian men showed broadly similar attentional patterns to White men, except for reduced attention to facial regions of males. Neither sensation-seeking nor disgust explained Asian men's lower fixation on male faces. Our findings suggest that cultural effects on sexual responding are more accentuated in women than men, supporting the view that sexual responses vary by ethnicity and culturally-differentiated mediators, particularly for women.

PO-02-024 The effect of breast cancer in female sexual health: A prospective cohort study

Psychological, anatomical and hormonal changes, as a result of diagnosis and treatment of breast cancer, may affect female sexuality. These changes are most pronounced in women of reproductive age. The purpose of the study is to record the changes in women's sexual response cycle following breast cancer treatment Sixty seven breast cancer patients (group A) and 33 with benign breast lesions (group 0) were studied prospectively. Sexuality was studied by using a self-completed questionnaire (SFQ) and by measuring the hormones: testosterone, estrogen and cortisol. The blood collection and the completion of the questionnaire performed before the surgery and a year later. Of the 67 breast cancer patients, 48% were of reproductive age, with mean age of 39 years. The scales of sexual desire and stimulation were decreased in group A (-0.6 ± 2.2) and (-1.2 ± 2.5) and increased in the control group (1.1 ± 2.1) (P: 0.001) and (0.5 ± 2.5) (P: 0.001) respectively. The scale for the orgasm phase recorded the same change in Group A -1.2 ± 2.6 and in control group of 0.5 ± 2.8 (P: 0.006). Testosterone levels did not change before and after surgery but were significantly lower than the control group (39.1 ± 13.9 and 54.4 ± 16.7 respectively)

Sexual satisfaction in pregnancy: a cross section study in Japan

Sexuality is one of the most important quality of life issues for both men and women. Sexual dysfunction is a highly prevalent women's sexual response is characterized as highly variable and influenced by a wide range of determinants, including physiologic, psychosocial, and contextual factors. The aim of this study was to assess the sexual satisfaction in pregnant women. This was a cross-sectional study involving 685 Japanese pregnant women aging between17-43 years, who were recruited from January 01, 2012 – January 01, 2014 at the antenatal clinic of Jichi Medical University Hospital. The Female Sexual Function Index (FSFI) questionnaire was used to assess sexual function. Overall, 284/685, 41.45% of the 685 pregnant women were at risk for sexual dysfunction symptoms (FSFI scores ≤26); this rate was significantly higher among pregnant women in 3rd trimester (187/254, 73%; P<0.05). Furthermore, our present study showed that the 3rd trimester of pregnancy had lower mean scores in sexual satisfaction, desire, lubrication, orgasm, arousal and dyspareunia than 1st and 2nd trimester. According to these results, pregnant women in the third trimester of pregnancy have lower female sexual function scores than 2nd and 1st trimester of pregnancy.

Clinical hypnosis and female sexual dysfunction

Background: Female sexual function comprises variable and multi-layered conditions that incorporate complex interactions of physiological, psychological, and interpersonal components. Despite the progress in understanding the neurobiology of sexual response, the definition of normal sexual response in women remains unresolved. Normal female sexual function differs from individual to individual and depends on the culture, ideology, beliefs, and other factors. Methods: We used a case report, the purpose of which is to justify further investigation into the effectiveness of hypnosis for the treatment of cervical pain during penetration, as well as orgasm disorder. Results: An orgasm was reached by masturbation performed on her by her partner, but without an orgasm by penile-vaginal penetration. The frequency of sexual intercourse has increased (3-4 times/week) in comparison to prior to therapy (once/ 2 months). Orgasm does not occur by self- and by partner masturbation every time, but sporadically; however, more frequently than before therapy. Success has been achieved with the orgasm by penile-vaginal penetration. Conclusions: Hypnotherapy may be a promising co-intervention or intervention per se for both physical and psychological symptoms. The results of hypnotherapy demonstrate that symptoms were significantly alleviated and, consequently, the quality of life improved. Symptoms of pain during sexual intercourse were not eliminated, but the patient had achieved significant control over those symptoms.

Is Pelvic Floor sEMG a Measure of Women’s Sexual Response?

IntroductionPelvic floor surface electromyography (sEMG) is often used in the assessment and treatment of individuals with pelvic floor abnormalities to measure muscle tone and neural control of the pelvic floor muscles (PFM); however, little is known about the role of the PFM in sexual arousal. AimThe aim of this pilot study was to examine whether changes in deep and superficial PFM activity—assessed with sEMG—can be observed during the presentation of sexual stimuli. MethodsDeep PFM sEMG activity was assessed with a vaginal probe. Superficial PFM activity was assessed with sEMG electrodes placed over the bulbocavernosus and perianal muscles. 15 sexually healthy women (mean age 27 years) watched a series of neutral, anxiety-evoking, and sexually explicit films. Continuous subjective sexual arousal was measured using a handheld arousometer. Main Outcome MeasureChanges in microvolts were measured by sEMG sensors, from neutral to anxiety-evoking and neutral to sexually explicit films. ResultsThere was an increase in intravaginal and perianal sEMG for both the erotic and anxiety films. Bulbocavernosus sEMG responses did not differ among the 3 films. Concordance between self-reported continuous sexual arousal for the erotic film and bulbocavernosus sEMG (r = 0.349) was not significantly different than concordance using intravaginal sEMG (r = 0.293) or perianal sEMG (r = 0.236). Clinical ImplicationsUnderstanding more about which parts of the PFM respond specifically to sexual stimuli may have implications for measuring the effects of treatments aimed at improving sexual response in women. Strength & LimitationsThe results of this pilot study provide a preliminary understanding of which pelvic floor muscles respond to sexual stimuli. A limitation of this study was the small sample size. ConclusionTaken together, these findings suggest that intravaginal and perianal sEMG respond to erotic stimuli, whereas bulbocavernosal sEMG responses do not.Hannan-Leith MN, Dayan M, Hatfield G, et al. Is Pelvic Floor Surface Electromyography a Measure of Women’s Sexual Response? A Pilot Study. J Sex Med 2019;16:70–82.

Sexual response in women with Mayer-Rokitansky-Küster-Hauser syndrome with a nonsurgical neovagina

Sexual dysfunction is prevalent in women with Mayer-Rokitansky-Küster-Hauser syndrome after the creation of a neovagina. Insight into the physiologic response of the neovagina during sexual arousal is lacking, although this would help in the understanding of sexual function of these patients. The physiologic sexual response of the vagina can be measured objectively by vaginal photoplethysmography to assess vaginal blood flow. Testing whether the physiologic and subjective sexual response in women with Mayer-Rokitansky-Küster-Hauser syndrome with a neovagina differs from the response in women with a natal vagina. Vaginal blood flow (vaginal pulse amplitude) and subjective sexual responses during neutral and erotic film viewing were assessed in premenopausal women with Mayer-Rokitansky-Küster-Hauser syndrome with a nonsurgically created neovagina (n=15) and were compared with responses of an age-matched control group (n=21). All women with Mayer-Rokitansky-Küster-Hauser syndrome had created their neovagina themselves by dilation. Women with Mayer-Rokitansky-Küster-Hauser syndrome showed a significantly smaller vaginal pulse amplitude compared with control subjects during neutral film viewing (P=.002). In both groups, vaginal pulse amplitude increased significantly during erotic film viewing, but this increase was significantly smaller in the Mayer-Rokitansky-Küster-Hauser syndrome group (P<.005). Levels of subjective sexual arousal did not significantly differ between the 2 groups (P>.2). Women with Mayer-Rokitansky-Küster-Hauser syndrome with a nonsurgically created neovagina showed a weaker vaginal blood flow response during visual sexual stimulation and poorer basal blood flow compared with control subjects. The differences in vaginal blood flow may be related to less vascularization and innervation of the neovagina compared with the natal vagina. The weaker vaginal sexual response can play a role in sexual dysfunction; however, despite the weaker vaginal response, women with Mayer-Rokitansky-Küster-Hauser syndrome did not differ in their level of subjective sexual arousal. Future studies may compare vaginal blood flow and subjective sexual response of women with Mayer-Rokitansky-Küster-Hauser syndrome with nonsurgically and surgically created vaginas.

006 Genital and subjective sexual response in women with the Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome with a non-surgically created neo-vagina

006 Genital and subjective sexual response in women with the Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome with a non-surgically created neo-vagina

Cardiometabolic Risk and Female Sexuality-Part I. Risk Factors and Potential Pathophysiological Underpinnings for Female Vasculogenic Sexual Dysfunction Syndromes.

Erectile dysfunction is recognized as an opportunity for preventing cardiovascular (CV) events, and assessing the impairment of penile vascular flow by Doppler ultrasound is an important tool to ascertain CV risk. Conversely, the role of genital vascular impairment in the pathophysiology of female sexual dysfunction (FSD) remains contentious. To focus on the current scientific support for an association between CV risk factors and female sexual health in the 1st part of a 2-part review. A thorough literature search of peer-reviewed publications on the associations between CV risk factors and FSD and their underlying mechanisms was performed using the PubMed database. We present a summary of the evidence from clinical studies and discuss the possible mechanisms providing the pathophysiologic bases of vasculogenic FSD syndromes. The peripheral sexual response in women is a vascular-dependent event, and evidence suggests that cardiometabolic-related perturbations in endothelial function can determine vascular insufficiency in female genital tissues. Although epidemiologic and observational studies demonstrate that the prevalence of FSD is higher in women with diabetes mellitus, a cause-effect relation between these clinical conditions cannot be assumed. Evidence on the effect of obesity, metabolic syndrome, and polycystic ovary syndrome on sexual function in women is controversial. Data on the associations of dyslipidemia and hypertension with FSD are limited. Common cardiometabolic alterations could affect vascular function in the female genital tract. Based on limited data, there is an association between CV risk factors and female sexual health in women; however, this association appears milder than in men. Maseroli E, Scavello I, Vignozzi L. Cardiometabolic Risk and Female Sexuality-Part I. Risk Factors and Potential Pathophysiological Underpinnings for Female Vasculogenic Sexual Dysfunction Syndromes. Sex Med Rev 2018;6:508-524.

Validation of the Sexual Inhibition and Sexual Excitation Scales (SIS/SES) in Portugal: Assessing Gender Differences and Predictors of Sexual Functioning.

The Sexual Inhibition and Sexual Excitation Scales (SIS/SES) were developed to assess individual propensities for sexual excitation and sexual inhibition in men and women. The objective of the present study was to validate the Portuguese version of the SIS/SES and to investigate the degree to which SIS/SES scores predict different dimensions of Portuguese men's and women's sexual functioning. Gender differences were also examined. A community sample of 370 Portuguese men and 373 women completed self-report measures of sexual function (IIEF, Rosen et al., 1997; FSFI, Rosen et al., 2000) and of the propensity for sexual inhibition and sexual excitation (SIS/SES, Janssen et al., 2002a). Exploratory factor analysis revealed a three-factor solution further supported by confirmatory factor analysis. The three factors identified resemble the original ones, and reliability analyses indicated they have both satisfactory internal consistency and stability over time. Age and Sexual Inhibition Due to the Threat of Performance Failure (SIS1) were both significant negative predictors of men's sexual desire, erectile function, and orgasm. Sexual Excitation (SES) was a positive predictor of sexual desire in both men and women and of men's erectile function and of women's lubrication and orgasm. Age was also a significant and negative predictor of women's sexual desire. Significant gender differences were found for all three SIS/SES scales with men having significantly higher excitation and lower inhibition scores as compared to women. The Portuguese version of the SIS/SES was shown to be suitable for use within the Portuguese population in both clinical and basic research. Our findings provide further cross-cultural validation of the Dual Control Model of Sexual Response and underscore the importance of the role of excitatory and inhibitory processes in women's and men's sexual functioning and response.

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.

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.

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.