Vaginal Pulse Amplitude Research Articles

Sexual response in women with Polycystic Ovary Syndrome: a case control study.

To study genital response and sexual arousal in women with and without PCOS and to assess associations with sex steroid levels. This observational prospective case control study was conducted from March 2017 until March 2020. Heterosexual women with (n=68) and without PCOS (n=67), aged 18-40 years, in a steady relationship and without any comorbidities. All participants underwent an extensive medical and endocrine screening as well as assessment of genital blood flow (vaginal pulse amplitude (VPA)), assessed with photoplethysmography), and sexual arousal and affect (Likert scale questionnaire) in response to erotic and vibrotactile stimulation. Vaginal pulse amplitude, lubrication, subjective sexual arousal and affect. There were no significant differences in genital blood flow response and self-reported lubrication between women with and without PCOS. After adjusting for confounders, women with PCOS did report significantly lower positive affect in the fantasy and vibrotactile condition compared to women without PCOS. Regression analyses adjusted for confounders showed only few and weak associations of sexual responses with androgen levels explaining only a maximum of 6% of variance in all models in women with and those without PCOS. The PCOS group showed only weak associations between subjective sexual arousal and DHEA (fantasy: β=1.719, P=0.049, Adj R2=0.020), and SHBG (fantasy: β=-1.728, P=0.020, Adj R2=0.044). Women with PCOS show similar genital sexual response and lubrication, but lower positive affect compared to women without PCOS, however, only few, and weak associations with androgen levels were found. Androgen levels are not indicative of genital response and subjective arousal. Sexual function should be discussed in clinical care and psychosexual counseling should be offered.

Sexual Excitation in Young Women with Different Levels of Sexual Satisfaction in Relationships: A Laboratory Study.

Sexual satisfaction is an important dimension of sexual health. Despite there being evidence about its relations with sexual arousal, this association has not been addressed considering arousal as a trait and as a state. Therefore, the goal of this laboratory study was to examine, in young women with different levels of sexual satisfaction in their relationships, sexual arousal as a trait (i.e., propensity for sexual excitation/inhibition) and as a state (i.e., genital response and self-reported sexual arousal to a video with explicit sexual content). The sample was composed of 45 Spanish heterosexual women with a partner, from 18 to 25 years old. In the first phase, we evaluated the propensity for sexual inhibition/excitation and sexual satisfaction of the participants. In the second phase-in the context of a sexuality laboratory-the vaginal pulse amplitude, the rating of sexual arousal, and the rating of genital sensations were evaluated. The participants, distributed in three groups with different levels of sexual satisfaction (p < 0.001), were compared based on the different measures of sexual arousal. The results indicated that the group with lower sexual satisfaction, compared to the group with higher sexual satisfaction, reported more sexual inhibition due to the threat of performance failure (p = 0.011) and due to the threat of performance consequences (p = 0.038). However, no significant differences in sexual arousal status were found between the three groups. In conclusion, the negative association between sexual satisfaction and propensity for sexual inhibition in young women with a partner is supported, but not the positive association between trait/state sexual arousal and sexual satisfaction.

(118) ORGASM AND HEART RATE VARIABILITY IN FEMALE BREAST CANCER SURVIVORS: RESULTS FROM A PSYCHOPHYSIOLOGY STUDY

Abstract Introduction Over 70 % of female breast cancer survivors suffer from sexual dysfunction. Sexual dysfunction can cause great amounts of stress and negatively impact overall health and well-being. Most studies focus on sexual arousal disorders and hypoactive sexual desire disorders. The research on orgasm in this specific group is limited. A better understanding of sexual function in breast cancer patients may yield potential targets for new treatment strategies for sexual dysfunction in this population. Low heart rate variability (HRV) has been shown to be predictive of erectile dysfunction and female sexual arousal as well as orgasm frequency. Reduced HRV and low cardiac vagal tone have previously been reported in breast cancer survivors during the first year post-treatment. If HRV is a reliable indicator of female sexual dysfunction, it could be used to assess and monitor it in a clinical setting. Objectives This study aimed to explore whether there is a link between HRV and both, sexual arousal and the ability to orgasm. We were expecting to find a difference in HRV between breast cancer survivors and healthy controls as well as orgasmic and anorgasmic women. Methods Participants were prescreened during a telephone interview. We included 40 premenopausal breast cancer survivors currently on hormonal treatment with an age range of 29 to 57 years (M = 43.5, SD = 6.4) and 20 healthy controls with an age range of 22 to 35 (M = 27.6, SD = 3.2). The vaginal pulse amplitude, heart rate variability (SDNN), subjective sexual arousal and self-reported number of orgasms were assessed in response to audiovisual sexual stimuli and vibrotactile clitoral stimulation in breast cancer survivors and healthy controls. Validated patient-reported outcome measures were used to assess sexual dysfunctions (Female Sexual Function Index, Female Sexual Distress Scale − Desire/Arousal/Orgasm), sexual self-esteem (Sexual Self-Esteem Inventory-Short Form), health-related quality of life (Patient-Reported Outcomes Measurement Information System 29 (PROMIS-29) profile questionnaire). Results Breast cancer survivors showed lower sexual function, health-related quality of life, sexual self-esteem and higher sexual distress than healthy controls. Preliminary results show a difference in baseline HRV scores between healthy controls and breast cancer survivors. However, this finding is likely due to age differences between our two groups and not cancer treatment effects. We could find no apparent differences in baseline HRV between anorgasmic and orgasmic women. Further analyses on the predictive value of HRV during sexual arousal for orgasm occurrence will be conducted. Conclusions Our data did not corroborate either of our hypotheses related to baseline HRV. For the evaluation of HRV as a predictor for orgasm occurrence, further exploratory analyses will follow. More research on the physiological parameters of sexual dysfunction is needed to reveal underlying mechanisms and find targets for future therapies.

Genital arousal and responsive desire among women with and without sexual interest/arousal disorder symptoms.

Models depicting sexual desire as responsive to sexual arousal may be particularly apt for women experiencing arousal or desire difficulties, and the degree to which arousal triggers desire may depend on the relationship context and desire target and timing-yet, these associations have not been directly tested among women with and without sexual interest/arousal disorder (SIAD). To assess the role of SIAD status and relationship satisfaction in the associations between genital arousal and 4 types of responsive desire. One hundred women (n = 27 meeting diagnostic criteria for SIAD) in romantic relationships with men viewed a sexual film (pleasurable intimate depiction of oral sex and penile-vaginal intercourse) while their genital arousal was recorded via vaginal photoplethysmography (n = 63) or thermal imaging of the labia (n = 37). Partner and solitary desire was assessed immediately before and after the film (immediate desire) and 3days later (delayed desire). Outcomes consisted of genital response (z scored by method) and associations between genital response and responsive sexual desire. The key difference between women with and without SIAD was not in their ability to experience genital arousal but in how their genital responses translated to responsive sexual desire. Women with SIAD actually exhibited greater genital arousal than unaffected women. Associations between genital arousal and desire were significant only for women with SIAD and depended on relationship satisfaction and desire type. For women with SIAD with low relationship satisfaction, higher arousal predicted lower immediate desire for a partner; for those with high relationship satisfaction, arousal was either positively related (vaginal photoplethysmography) or unrelated (thermal imaging of the labia) to immediate desire for a partner. Associations with other desire types were not significant. Patterns of genital arousal and partner-specific responsive desire among women affected with SIAD were indicative of an avoidance model in response to heightened genital arousal, unless relationship satisfaction was high; attending to genital arousal sensations could be a means of triggering sexual desire for women with SIAD who are satisfied in their relationships. This is one of the first sexual psychophysiologic studies to connect relationship factors to patterns of sexual response. The differing arousal assessment procedures and lack of official diagnosis may have attenuated results. The homogeneous sample and in-person session requirement limit generalizability. When compared with unaffected women, women affected by SIAD may exhibit stronger arousal responses with sufficiently incentivized sexual stimuli, and the connection between their genital arousal and responsive desire for their partners may be stronger and more dependent on relationship context.

Short-Term Dorsal Genital Nerve Stimulation Increases Subjective Arousal in Women With and Without Spinal Cord Injury: A Preliminary Investigation

ObjectivesFemale sexual dysfunction (FSD) affects an estimated 40% of women. Unfortunately, FSD is understudied, leading to limited treatment options for FSD. Neuromodulation has shown some success in alleviating FSD symptoms. We developed a pilot study to investigate the short-term effect of electrical stimulation of the dorsal genital nerve and tibial nerve on sexual arousal in healthy women, women with FSD, and women with spinal cord injury (SCI) and FSD. Materials and MethodsThis study comprises a randomized crossover design in three groups: women with SCI, women with non-neurogenic FSD, and women without FSD or SCI. The primary outcome measure was change in vaginal pulse amplitude (VPA) from baseline. Secondary outcome measures were changes in subjective arousal, heart rate, and mean arterial pressure from baseline. Participants attended one or two study sessions where they received either transcutaneous dorsal genital nerve stimulation (DGNS) or tibial nerve stimulation (TNS). At each session, a vaginal photoplethysmography sensor was used to measure VPA. Participants also rated their level of subjective arousal and were asked to report any pelvic sensations. ResultsWe found that subjective arousal increased significantly from before to after stimulation in DGNS study sessions across all women. TNS had no effect on subjective arousal. There were significant differences in VPA between baseline and stimulation, baseline and recovery, and stimulation and recovery periods among participants, but there were no trends across groups or stimulation type. Two participants with complete SCIs experienced genital sensations. ConclusionsTo our knowledge, this is the first study to measure sexual arousal in response to short-term neuromodulation in women. This study indicates that short-term DGNS but not TNS can increase subjective arousal, but the effect of stimulation on genital arousal is inconclusive. This study provides further support for DGNS as a treatment for FSD.

Reduction in genital sexual arousal varies by type of oral contraceptive pill.

Although oral contraceptive pills (OCPs) have been associated with decrements in self-reported genital arousal and vaginal lubrication, 1,2 little is known about how these outcomes vary across types of OCPs. The present study examined differences in physiological lubrication and vaginal blood flow, as well as rates of self-reported vulvovaginal atrophy and female sexual arousal disorder, among women using OCPs with varying androgenic properties. Participants in this study were 130 women: 59 naturally cycling control women, 50 women taking androgenic OCPs, and 21 women taking antiandrogenic OCPs. Participants watched sexual films while their sexual arousal responses were measured, completed questionnaires, and participated in a clinical interview. Vaginal blood flow, vaginal lubrication, self-reported vulvovaginal atrophy, and female sexual arousal disorder were assessed. Results indicated deficits in vaginal pulse amplitude and lubrication for women taking either form of OCP, with marked inhibitory effects found in women taking antiandrogenic OCPs. Rates of self-reported vulvovaginal atrophy and female sexual arousal disorder were also significantly greater in the antiandrogenic group compared with the control group. It is recommended that prescribing clinicians consult patients on such physiological effects of OCPs. To our knowledge, this was the first study to compare multiple measures of physiological sexual arousal across groups of women taking OCPs with varying hormonal profiles. Because all OCPs included in this study contained low doses of ethinylestradiol, we were able to identify the specific effects of the androgenic properties on women's sexual arousal responses. However, the self-administered lubrication test strip was subject to user error. Additionally, the generalizability of findings is limited by the largely heterosexual and college-aged sample. Compared with naturally cycling women, women taking OCPs that contain antiandrogenic progestins experienced decreased vaginal blood flow and lubrication as well as higher rates of self-reported vaginal bleeding and female sexual arousal disorder.

(058) Acute Dorsal Genital Neuromodulation can Improve Subjective Arousal: A Pilot Study in Women With and Without Spinal Cord Injury

Abstract Introduction Female sexual dysfunction (FSD) is a potentially life altering condition that impacts an estimated 40% of women. Unfortunately, the few treatment options available have limited success due to adverse events and an inability to improve subjective arousal. One potential treatment option, neuromodulation, has improved female sexual function index (FSFI) scores in small studies. The underlying mechanisms of how neuromodulation may improve FSD are not understood. We hypothesize that neuromodulation provides benefits by increasing genital blood flow. Objective Our primary objective is to determine if a single period of dorsal genital nerve stimulation (DGNS) or tibial nerve stimulation (TNS) directly causes a change in vaginal blood flow (VBF). Our secondary objective is to assess if subjective arousal increases during a single period of DGNS or TNS. These interventions will be compared among three cohorts of women: women with C6–T10 spinal cord injury (SCI), women with FSD (FSFI lubrication sub-score &amp;lt; 4), and able-bodied women without FSD. Methods Participants attended two separate visits, one for each nerve target, randomly ordered and separated by 1–5 months. We are testing two experimental paradigms: without and with erotic audio-visual materials. The first experiments measured vaginal pulse amplitude (VPA) using a vaginal photoplethysmography transducer (VPP) before, during, and after 20 minutes of nerve stimulation. After data processing, we calculated average peak to peak (p2p) amplitudes for each time period and performed an ANOVA and post-hoc pairwise comparisons within each participant. For the second experiment we measured VPA during neutral and erotic videos both without stimulation and with stimulation. In both experiments we measured subjective arousal via a Likert-type scale at 4 timepoints and made comparisons across participants with a paired t-test. The first experiments are complete and data collection for the second experiments is ongoing. Results We recruited three participants in each cohort in the first experiments, with five participants completing both sessions. All participants saw significant changes in their p2p amplitude from before stimulation to after stimulation in DGNS trials (n = 3 increased, n = 4 decreased). Three of five participants had significant p2p increases in TNS trials and one participant had significant decreases. DGNS subject arousal scores increased significantly after stimulation, but TNS scores did not (Figure 1). Most participants reported genital sensations during DGNS (7 of 8) and TNS (3 of 6) sessions. Three participants have completed both visits in the second set of experiments, with similar trends. Conclusions Acute DGNS, but not TNS, increased subjective arousal across all participants. VPA responses to stimulation were heterogeneous and although most changes were significant, there may not be physiological or clinical relevance. It is possible that repeated stimulation sessions over time may enhance changes in VPA. Disclosure No

(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, &amp; 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 &amp; 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

(512) Towards Scalable Future Interventions for Breast Cancer Survivors: Effects of a Brief Mindfulness Exercise on Genital and Subjective Sexual Arousal

Abstract Introduction Breast Cancer (BC) with a lifetime prevalence of 12.0%, is the most common cancer in women. Out of all BC cases, 70% are hormone receptor positive, requiring anti-hormonal therapy and, in some patients, supplementary chemotherapy. The condition itself, as well as respective BC treatment, often comes with physical impairments (i.e., diminished lubrication, vaginal atrophy), as well as psychological stressors (i.e., sexual self- and body-esteem, performance anxiety) that result in sexual problems in 73.4% of BC survivors (BCS). Sexual problems are frequently accompanied by sexual distress and impaired quality of life. Overall, limited attention is given to sexual health in oncology and treatment options are scarce. Currently, hardly any therapies target the interplay of physical and psychological symptoms to improve sexual distress and overall quality of life of BCS. Recently, meta-analyses have shown the efficacy of mindfulness-based cognitive behavioral therapy for women with sexual dysfunctions (i.e., experiencing sexual problems and simultaneous sexual distress) including BCS. However, the access to health care providers offering such treatments is limited. Psychophysiology studies have identified specific mindfulness exercises, which can lead to an increase of subjective and genital sexual arousal in non-clinical samples after a single brief session. These findings serve as an underpinning for the promising effects of including mindfulness tasks in future therapeutic interventions and scalable digital health applications in order to improve the access to evidence-based treatments for BCS with sexual dysfunctions. Objectives The aim of the present study is to test the effect of a brief audio-based mindfulness exercise on genital and subjective sexual arousal, and their concordance in BCS currently undergoing endocrine therapy. Methods For this study, 60 women (20 healthy controls, 40 premenopausal BCS currently undergoing anti-hormonal therapy) are recruited to participate in a psychophysiology lab study. Participants are randomly assigned to three experimental conditions: 1) neutral audio, 2) body scan mindfulness exercise, 3) mindfulness exercise with focus on genitals, followed by self-stimulation with a vacuum stimulation device (Womanizer Premium, WOW Tech™ GmbH) in all three groups. Genital arousal and subjective sexual arousal (SSA) serve as outcome variables. As a measure of genital arousal, the vaginal pulse amplitude (VPA) is continuously recorded using vaginal photoplethysmography (BIOPAC®). SSA is repeatedly measured on a scale from 0 (not aroused) to 10 (extremely aroused). Demographic data, hormone levels, heart rate variability, sexual self-esteem, sexual function, and sexual distress are assessed as control variables. Results In order to analyze the repeated measures data nested within individuals, intra- (SSA, VPA) and inter-individual (BCS, healthy controls) differences are appraised using hierarchical linear modelling (HLM). Separate 2-level mixed effect models are constructed for each outcome variable (subjective arousal, genital arousal). In order to measure the agreement of genital and subjective arousal (i.e., concordance) within-subject correlations between subjective and genital arousal are calculated. Conclusion If effective, a single brief evidence-based mindfulness exercise could serve as a directive for future clinical trials and potentially constitute an accessible treatment approach for sexual dysfunction in BCS. Disclosure Yes - WOW Tech™ GmbH

MP27-13 PERIPHERAL NEUROMODULATION OF VAGINAL BLOOD FLOW: A POTENTIAL TREATMENT FOR FEMALE SEXUAL DYSFUNCTION

You have accessJournal of UrologyCME1 Apr 2023MP27-13 PERIPHERAL NEUROMODULATION OF VAGINAL BLOOD FLOW: A POTENTIAL TREATMENT FOR FEMALE SEXUAL DYSFUNCTION Priyanka Gupta, Elizabeth Bottorff, Patricia Maymi-Castrodad, Mackenzie Moore, Giulia Lane, Gianna Rodriguez, and Tim Bruns Priyanka GuptaPriyanka Gupta More articles by this author , Elizabeth BottorffElizabeth Bottorff More articles by this author , Patricia Maymi-CastrodadPatricia Maymi-Castrodad More articles by this author , Mackenzie MooreMackenzie Moore More articles by this author , Giulia LaneGiulia Lane More articles by this author , Gianna RodriguezGianna Rodriguez More articles by this author , and Tim BrunsTim Bruns More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003255.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Female sexual dysfunction (FSD) is a potentially life altering condition that impacts an estimated 40% of women. Unfortunately, the few treatment options available have limited success due to their high incidence of adverse events and inability to improve subjective arousal. One potential treatment option, peripheral neuromodulation, has been successful in improving female sexual function index scores. However, the underlying mechanisms of how neuromodulation improves FSD are still largely unknown. We hypothesize that improvements in FSD symptoms are due to improvements in genital hemodynamics. METHODS: We developed a clinical study to investigate changes in vaginal blood flow (VBF) in response to dorsal genital nerve (DGN) and tibial nerve stimulation in three cohorts of women: healthy controls, women with FSD, and women with spinal cord injury (SCI). Incorporating women with SCI allows us to investigate which neural pathways contribute to genital sexual arousal. Each participant attends two study visits: one for each nerve target, randomly ordered. At each visit, a vaginal photoplethysmography (VPP) sensor is used to measure blood flow during a 5-minute baseline, 20 minutes of nerve stimulation, and a 5-minute washout period. The VPP signals are filtered in the neurogenic energy frequency spectrum (0.76 – 0.20 Hz) for analysis. RESULTS: Seven out of eight participants reported genital sensations due to nerve stimulation, three of whom have SCI. One participant with a complete SCI had increases in their VPP neurogenic energy during dorsal genital nerve stimulation (Figure 1). An animal study is being planned to investigate the VBF response observed in complete SCI. CONCLUSIONS: This work provides further support for neuromodulation as a treatment for neurogenic and non-neurogenic FSD. Source of Funding: Craig H. Neilsen Foundation and International Society for the Study of Women’s Sexual Health © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e367 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Priyanka Gupta More articles by this author Elizabeth Bottorff More articles by this author Patricia Maymi-Castrodad More articles by this author Mackenzie Moore More articles by this author Giulia Lane More articles by this author Gianna Rodriguez More articles by this author Tim Bruns More articles by this author Expand All Advertisement PDF downloadLoading ...

Sexual violence history predicts changes in vaginal immune parameters during sexual arousal

ObjectiveTo examine the influence of sexual arousal on vaginal mucosal inflammatory cytokine and antibody production in healthy women with and without histories of childhood and/or adult sexual violence. MethodsNinety-one premenopausal healthy women (ages 18–42) attended a single laboratory session in which they provided vaginal fluid samples before and after viewing one neutral and one erotic film. While viewing the films, participants’ vaginal sexual arousal was recorded using vaginal photoplethysmography. ResultsOf the 91 participants, 41 (45%) reported no history of sexual violence, 17 (19%) reported a history of childhood sexual abuse (CSA) only, 19 (21%) reported a history of adult sexual assault (ASA) only, and 10 (11%) reported a history of both CSA and ASA, with 4 participants choosing not to provide information on their sexual violence history. For women with a history of ASA but not CSA, there was a significant increase in vaginal IL-1β following arousal, while for women with a history of CSA (with or without ASA), there was a significant decrease. Women without CSA histories had a significant increase in vaginal IgA following sexual arousal, while women with CSA histories had a decrease. ConclusionSexual arousal possibly plays a role in modifying vaginal immune responses in young, healthy women. Moreover, these effects may vary depending upon sexual assault histories, such that relative to women without assault histories, women with a history of early life sexual trauma showed significantly altered vaginal immune responses following sexual arousal. If replicated, these findings may help explain the increased risk for sexually transmitted infections observed among women with sexual assault histories.

Orgasm consistency and its relationship to women’s self-reported and genital sexual response

According to the Incentive Motivation Model (IMM) of sexual response, the rewarding and pleasurable aspects of a sexual act strengthen its incentive value and capacity to trigger sexual motivation. One such sexual reward is orgasm consistency, the percentage of time that orgasm is experienced during a sex act. Orgasm consistency may serve to influence the incentive value of a sexual behaviour. We tested this tenet of the IMM by examining whether orgasm consistency predicted women’s sexual responses to films depicting various sex acts. Data were collected from four separate studies examining women’s genital and subjective sexual response. Participants ( N = 144, age range = 18–65) were presented with neutral and erotic film stimuli while their genital arousal was assessed using vaginal photoplethysmography or thermography. Participants reported their sexual arousal level before, during, and after each stimulus presentation, and completed questionnaires assessing sexual history and experiences, sexual interests, and sexual functioning. Orgasm consistency during penile–vaginal intercourse (PVI) significantly predicted genital arousal to films depicting PVI, but similar relationships were not observed between genital or self-reported arousal and orgasm consistency during receptive oral sex and masturbation. Findings suggest that increasing orgasm consistency to a sex act may increase its incentive value, thereby triggering greater genital response to depictions of that act. Lack of consistent orgasm or generally pleasurable and rewarding sex may limit the capacity of sex acts to trigger sexual motivation in future sexual encounters, thus contributing to low sexual arousal and desire in women.

Inflammation predicts sexual arousability in healthy women

BackgroundThough many women report sexual arousal difficulties, the mechanisms driving these difficulties are unclear. Sexual response relies on a host of psychophysiological processes that have bidirectional relationships with inflammation. Additionally, chronic inflammation may impair genital blood flow, which in turn may impact sexual arousal. C-reactive protein (CRP) is an acute-phase marker of inflammation produced in response to cytokine signaling throughout the body, which makes it a useful marker of systemic inflammation. AimThe present study examined interactions between inflammation and women's sexual arousal. MethodsCRP, self-reported frequency of partnered sexual activity, and subjective and vaginal arousal were assessed in 91 healthy, pre-menopausal women. Data were collected during a single laboratory session. Main outcome measuresSubjective sexual arousal and vaginal pulse amplitude (a measure of vaginal arousal) were the main outcome measures. ResultsChange in subjective sexual arousal in response to a sexual film was unaffected by baseline CRP and sexual frequency. However, there were significant interactions between inflammation and sexual frequency in predicting vaginal arousal during the sexual film. Among women reporting more frequent sexual activity, higher CRP predicted lower magnitude arousal response and longer time to maximum vaginal arousal. Among women reporting less frequent sex, higher CRP predicted shorter time to maximum arousal and greater magnitude of arousal response. Controlling for cortisol strengthened the effects seen for time to maximum vaginal arousal but weakened those observed for percent change. ConclusionsAmong healthy young women, higher CRP may be associated with vaginal arousal, but not subjective sexual arousal. Specifically, our results suggest that higher baseline CRP is associated with lower genital sexual arousal for women who have sex frequently, which is consistent with clinical evidence that elevated inflammation can be detrimental to sexual function.

Can the Vaginal Photoplethysmograph and Its Associated Methodology Be Used to Assess Anal Vasocongestion in Women and Men?

Forty years ago, researchers documented changes in vascular and muscular activity within the anal canal of women and men who engaged in sexual self-stimulation. Vascular changes were assessed using a photoplethysmograph that aimed to detect changes in pelvic vasocongestion. An important advantage of detecting sexual response within the anal canal is that the device, its anatomical placement, and the data output are identical for women and men, therefore facilitating gender comparisons of response patterns. In this study, the vaginal photoplethysmograph (VPP), the most common measure of genital response in women, was administered intra-anally as an anal photoplethysmograph (APG) to examine its validity and sensitivity as an indicator of sexual response. The final sample comprised 20 women and 20 men who were exposed to 12, 90-s sexual and nonsexual film clips while their APG responses were recorded. Participants also rated their sexual arousal and affective responses to the stimuli. There was evidence that APG responses were specific to sexual stimuli and were sensitive to erotic intensity in women. The degree of discrimination between sexual and nonsexual stimuli was lower in men. Unlike most sexual psychophysiological studies, the positive correlation between physiological and self-reported sexual arousal was stronger in women than in men. There was a relatively high number of data artifacts and the waveform morphology was uncharacteristic of that typically observed with VPP. The potential role of anal musculature interference on the APG signal is discussed, as well as avenues for future research.

Systematic Review of l-Arginine for the Treatment of Hypoactive Sexual Desire Disorder and Related Conditions in Women.

This systematic review evaluates the efficacy and safety of l-arginine alone or in combination for the treatment of women with hypoactive sexual desire disorder (HSDD) or related conditions, such as female sexual interest/arousal disorder and female sexual arousal disorder. Medline, Embase, International Pharmaceutical s, Science Direct, and the Cumulative Index to Nursing and Allied Health Literature were searched using keywords “arginine”, “Lady Prelox”, “ArginMax”, “Stronvivo”, “Ristela”, “hypoactive sexual desire disorder”, “female sexual interest arousal disorder”, “female sexual arousal disorder”, “sexual dysfunction”, “sexual behavior”, “dyspareunia”, “libido”, and permutations thereof. Relevant records were retained if they were primary literature, conducted in women with HSDD or related conditions, and published as full text in English. Five randomized controlled trials and two nonrandomized studies met eligibility criteria. Six of the seven studies reported either an increase in the total mean Female Sexual Function Index score or significant increases in multiple domains therein. One study assessed vaginal pulse amplitude and found a statistically significant increase in a combination treatment group compared to placebo. No significant side effects were reported. Four of seven studies had potential risk-of-bias concerns per Cochrane assessments. This systematic review found that combination products containing l-arginine in the form of ArginMax or Lady Prelox may be considered for the treatment of HSDD and related conditions in women regardless of age.

Mindfulness-based therapies for men and women with sexual dysfunction: a systematic review and meta-analysis

Mindfulness based interventions (MBI) may be an effective treatment for sexual dysfunction among men and women. A literature review identified seven trials for sexual dysfunction and MBI. Of these, four trials were Randomised Control Trials (RCTs) including a control-group wait list and three studies used within-subjects design. A meta-analysis synthesized the results across these trials which demonstrated an overall low to moderate effect size (Cohen’s d = 0.55). Moderate heterogeneity between studies was evident with possible publication bias. Sub-group analysis revealed differences between study weights, where overall higher effect sizes were found among RCTs (d = 0.65) than within subject design studies (d = 0.27). However, within subject design studies tended to include pre and post-physiological measurements (e.g. vaginal photoplethysmography), which may provide a more precise evaluation of the benefits of MBI, rather than studies based on self-report measures only. This review identified a gender inequality in which clinical trials predominated among women compared to men with a 6:1 ratio. Whilst MBI looks promising, significantly more research is needed, particularly among men, so that science, practice and policy can develop an understanding of the potential benefits of non-prescription intervention alternatives, or as a biopsychosocial adjunct, such as MBI, in support of those experiencing sexual dysfunction.

Sexual Function in Women With Polycystic Ovary Syndrome: Design of an Observational Prospective Multicenter Case Control Study.

IntroductionThe prevalence of polycystic ovary syndrome (PCOS) is 10–15% in women of reproductive age. Its characteristics are (i) clinical or biochemical hyperandrogenism, (ii) oligomenorrhea or amenorrhea, and (iii) polycystic ovaries on ultrasound. PCOS is associated with lower quality of life, depression, anxiety, diabetes, and cardiovascular disease. Treatment commonly entails oral contraceptive use to lower endogenous androgen levels. Androgen levels and comorbidities may affect sexual function. Previous studies have addressed a limited range of possible contributing factors. We will assess sexual function as well as genital and self-reported sexual arousal in a laboratory setting in women with PCOS compared to an age-matched healthy control group. Modulation by biopsychosocial factors mentioned will be studied.MethodsThis is a multicenter prospective case control study. The study population includes healthy women with and without PCOS, aged 18–40 years, in a stable heterosexual relationship for at least 6 months. Power is calculated at 67 participants in each group. Anticipating a drop out of 10%, 150 participants will be recruited.Main outcome measuresThe main outcomes measured are sexual function using the Female Sexual Function Index, Sexual Desire Inventory, and Female Sexual Distress Scale-Revised; genital sexual arousal measured as vaginal pulse amplitude; and self-reported sexual arousal in response to erotic stimuli in a laboratory setting. The mediators that will be investigated include testosterone, free androgen levels, oral contraceptive use, sensitivity to androgens (using CAG repeat length), body mass index, body image, mental health, and self-esteem.ConclusionStrengths of this study are the inclusion of a broad range of biopsychosocial outcome measures including DNA analysis, a healthy control group, and standardized assessment of genital and self-reported sexual arousal in a laboratory setting. With the design of this study we aim to provide an insight into which biopsychosocial factors associated with PCOS are related to sexual function, and how sexual function may be affected by treatment. These new insights may help to improve clinical management of PCOS while improving the quality of life.Pastoor H, Both S, Timman R, et al. Sexual Function in Women With Polycystic Ovary Syndrome: Design of an Observational Prospective Multicenter Case Control Study. Sex Med 2020;8:718–729.

The time course of genital response cue-specificity among androphilic women

Women’s genital responses measured with a vaginal photoplethysmograph (VPP) demonstrate relatively low cue-specificity for gender/sex cues—the difference in genital responses between sexual stimuli with male or female content is relatively small compared to that of men. Cue-specificity for gender/sex cues is particularly low for androphilic women. It is common practice to compare responses to sexual stimuli (typically 60–120 s film clips) using a mean or peak (highest) value. This approach overlooks the continuous and dynamic nature of sexual responding during a stimulus. Recent results suggest that cue-specificity of genital response may increase throughout the duration of a sexual stimulus. We tested this possibility in a sample of 18 androphilic women. Sexual stimuli consisted of 240 s audiovisual film clips depicting male and/or female partnered sex or solitary masturbation. Gender/sex cue-specificity, assessed using VPP, did not vary across time: The degree of cue-specificity and the magnitude of genital response were established by approximately 60–90 s and were consistent throughout the stimulus duration. Low cue-specificity for genital response was observed despite variation in self-reported sexual arousal across stimulus categories. The findings are discussed within the context of initial- and later-occurring aspects of the sexual response, according to the information processing model of sexual arousal. The results also suggest that 90–120 s stimuli are of sufficient duration to capture vaginal photoplethysmographic responses to audiovisual stimuli in sexual psychophysiological research.

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.

Effect of a Condom Cover on Vaginal Photoplethysmographic Responses

IntroductionThe vaginal photoplethysmograph (VPP) is a reusable intravaginal device often employed in sexual psychophysiology studies to assess changes in vaginal blood flow, an indicator of sexual arousal. AimTo test whether placing a disposable cover on the VPP probe impacts the acquired data. A condom cover would reduce risk of disease transmission and likely increase participant comfort but may negatively impact the VPP signal. MethodThe genital responses of 25 cisgender women (mean age = 21.3 years, standard deviation = 2.6) were assessed with VPP in a within-subjects design with 2 conditions—with and without a polyisoprene condom cover. Sexual responses were elicited by audiovisual film clips that varied in erotic intensity: nonsexual (nonsexual male-female interaction), low-intensity sexual (nude exercise), and high-intensity sexual (male-female intercourse). Women continuously rated their sexual arousal during stimulus presentations. Main Outcome MeasureChange in vaginal pulse amplitude and also self-reported sexual arousal. ResultsThe magnitude of sexual response to each stimulus category and the overall pattern of results were found to be highly similar in the cover-off and cover-on conditions. The high-intensity sexual stimulus category elicited a greater sexual response than all other categories. The low-intensity sexual category elicited a (small) genital response in only the cover-on condition, although we suspect this is a spurious finding. There was no difference in the average number of edited movement artifacts across conditions. Clinical ImplicationsPotential benefits of encasing the VPP probe with a protective cover include enhanced participant safety and comfort, especially if assessing genital responses of high-risk or immunocompromised samples. The use of a cover complies with current guidelines for reprocessing semi-critical medical devices (eg, vaginal ultrasound probes) in many regions. Strengths & LimitationsAlthough the idea of a VPP probe cover had been discussed among sexual psychophysiology researchers, this is the first study to empirically test whether a cover could jeopardize VPP data. Potential limitations include the use of a 10-Hz VPP sampling rate and a cover that was not tailored to the size of the VPP probe. ConclusionPlacing a protective cover on the VPP probe did not appear to meaningfully impact sexual arousal or the VPP data. Based on these results and the potential advantages of a protective cover, researchers may wish to integrate the use a condom cover in their experiment protocols and clinical applications.Sawatsky ML, Lalumière ML. Effect of a Condom Cover on Vaginal Photoplethysmographic Responses. J Sex Med 2020; 17:702–715.