Development and initial validation of the menstrual sensitivity index.

OBJECTIVE: The present study sought to develop and perform the initial validation of a scale assessing sensitivity to menstrual pain and symptoms. METHODS: Data were taken from a larger parent study in which participants were recruited from a nationwide sample of individuals via the UniVox platform (www.univoxcommunity.com). In that study, participants were stratified by age and self-reported menstrual pain. Participants in the parent study completed 2 online surveys, one at baseline and one at a 3-month follow up. Participants who provided complete responses to the potential scale items, as well as a variety of validated questionnaires, were included in the present analyses. Final item selection was determined by factor analyses, and measures of validity and reliability were examined. RESULTS: Factor analyses support an 8-item scale assessing menstrual sensitivity. This scale, the Menstrual Sensitivity Index, demonstrates excellent internal consistency, good item-total correlations, and good total score test-retest reliability. Convergent validity emerged for menstrual- and pain-specific measures, and divergent validity emerged for anxiety sensitivity, anxiety, depression, nonmenstrual bodily pain, and premenstrual symptoms. CONCLUSIONS: Menstrual sensitivity is a unique construct that reflects women's attunement to and fear of menstrual symptoms, and the Menstrual Sensitivity Index is a valid and reliable measure of this construct. This scale could be useful in advancing research and clinical work targeting menstrual pain.

The impact of COVID-19 and long COVID on sexual function in cisgender women.

BACKGROUND: Research suggests that COVID-19 impairs sexual function in men, but little is known about the impact of COVID-19 (or long COVID) on sexual function in women. AIM: We sought to compare the sexual function of cisgender women who had never had COVID-19, who had COVID-19 but not long COVID, and who had long COVID, and assessed whether long COVID symptoms and/or emotional distress mediate the relationship between COVID-19 history and sexual function. METHODS: In total, 2329 adult cisgender women were recruited online as study participants. Half of these women reported having had COVID-19, and the other half reported never having had COVID-19. Of those who had COVID-19, 25% (n = 170) reported having long COVID. We compared the mean Female Sexual Function Index (FSFI) scores by using t-tests for each of the primary comparison categories (never COVID vs COVID and only COVID vs long COVID). Four path models were used to test the hypotheses that (1) long COVID symptoms or (2) depression, anxiety, and/or stress assessed with the subscales of the 21-item Depression, Anxiety, and Stress Scale (DASS-21) mediated the relationship between COVID-19 and sexual function. OUTCOMES: Sexual function was measured with the FSFI, long COVID symptoms were assessed using the Centers for Disease Control working symptom set, and emotional distress was measured with the DASS-21. RESULTS: In total, 1313 participants provided data suitable for analysis. The never-COVID group (n = 645, 49.1%) had higher scores on the Desire, Arousal, Lubrication, and Satisfaction subscales of the FSFI (mean [M] [SD] FSFI total Mnever COVID = 27.98 [4.84] vs MCOVID = 27.05 [5.21]) than the combined only-COVID (n = 498, 37.9%) and long-COVID (n = 170, 12.9%) groups. The FSFI subscale scores were significantly higher in the only-COVID group than in the long-COVID group for the Arousal, Lubrication, and Orgasm and lower for the Pain subscales and higher for overall sexual function (FSFI total Monly COVID = 27.49 [5.00] vs Mlong COVID = 25.77 [5.61]. None of the proposed mediation models had adequate model fit. CLINICAL IMPLICATIONS: Clinicians treating cisgender women who have COVID-19 should consider proactively discussing sexual function with their patients and offering available resources. STRENGTHS AND LIMITATIONS: In this study we used a large and diverse sample, but this sample did not include transgender or gender-diverse persons. This study was also correlational; as such, causal conclusions cannot be drawn. Further, the mechanism of action remains unexplained. CONCLUSIONS: The study findings suggest the following: (1) COVID-19 infection is associated with impaired sexual function in cisgender women, and (2) that women with long COVID experienced incrementally more impaired sexual function than women with COVID-19 who did not develop long COVID.

Reflections on the group dynamic in a group cognitive behavioral therapy intervention for young adult women with moderate to severe dysmenorrhea: a qualitative analysis.

A recent group cognitive behavioral therapy (gCBT) intervention for dysmenorrhea conducted by our team demonstrated feasibility, acceptability, and preliminary efficacy at reducing menstrual pain. This study aimed to use qualitative analyses to explore participants' reflections about the intervention's group dynamic. Participants included 20 young women ages 18-24 years with average menstrual pain of 8.0 (SD = 1.1) on a 0-10 (0 = none, 10 = worst pain possible) numeric rating scale. Semi-structured individual and group interviews were conducted after the intervention. Researchers then conducted deductive, iterative thematic analysis using a template analysis approach. Two themes were generated: benefit and logistics. The benefit theme included two sub-themes: (1) camaraderie (an emotional, psychological, or social connection between participants); and (2) sharing (information, advice, or experiences). The logistics theme highlighted how the structure of the group influenced the dynamic and was divided into two sub-themes according to the time frame being described: (1) reactions (participants' experiences with how the group dynamic was facilitated); and (2) future (how the group structure could be improved). Results of this study contribute to the growing body of literature related to gCBT for pain conditions. Future research is needed to optimize the group dynamic and evaluate its specific therapeutic role in the treatment.

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

BACKGROUND: 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. AIM: 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. METHODS: 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. OUTCOMES: Vaginal blood flow, vaginal lubrication, self-reported vulvovaginal atrophy, and female sexual arousal disorder were assessed. RESULTS: 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. CLINICAL IMPLICATIONS: It is recommended that prescribing clinicians consult patients on such physiological effects of OCPs. STRENGTHS AND LIMITATIONS: 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. CONCLUSION: 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.

Treatment outcomes and patient satisfaction of a virtual partial hospital program: A mixed-method study.

OBJECTIVE: Despite a proliferation of virtual partial hospital programs (PHP) during the COVID-19 pandemic, there is a dearth of research on such programs. In the current study, we compared treatment outcomes and patient satisfaction between an in-person and a virtual PHP. Further, we examined patients' qualitative feedback about the virtual PHP. METHOD: Participants included 282 patients attending a virtual PHP during the COVID-19 pandemic and 470 patients attending an in-person PHP one year prior. Patients completed daily measures of symptom severity, and post-treatment measures of patient satisfaction and treatment outcomes. Patients in the virtual PHP provided feedback about virtual care. Quantitative data were analyzed using multilevel modeling, and qualitative data were analyzed using the principles of inductive analysis. RESULTS: Patients experienced a reduction in depression (b = -.28, p < .001) and anxiety symptoms (b = -.25, p < .001) over time and reported high satisfaction in both the in-person and virtual PHPs. There were no significant differences across programs. Virtual PHP patients identified unique advantages and disadvantages of virtual care. CONCLUSION: Our results suggest that virtual PHPs should be explored as an ongoing model of care that may help to systematically reduce barriers to accessing mental health services.

The Effects of Hormonal and Non-Hormonal Intrauterine Devices on Female Sexual Function: A Systematic Review.

Objectives: The goal of this paper was to review and synthesize the extant literature exploring the impact, if any, of copper (Cu) and levonorgestrel (LNG) intrauterine devices on female sexual function. Methods: To review the literature, Medline, PubMed, and PsychINFO, were searched for primary research articles that were available in English and measured female sexual function in Cu- and LNG-IUD users. 35 quantitative and 2 qualitative research papers met criteria for inclusion in this systematic review. The 35 quantitative articles were then rated based on the STROBE statement. Results: The included articles indicated a positive impact of LNG-IUDs on sexual pain, and a positive-to-neutral effect of IUDs on sexual desire, however more research is warranted. This review also found IUDs to be generally non-impactful on other domains of sexual function, including arousal, lubrication, orgasm, satisfaction, and overall sexual function. Conclusions: As this review highlights that LNG-IUDs may improve sexual pain, future research should explore this connection further. Additional RCTs should also be conducted to confirm effects on sexual function with little bias. A better understanding of the impact of both Cu- and LNG-IUDs is necessary to expand upon this field of research and uncover any other benefits or detriments from IUDs.

Psychiatric Symptoms Across the Menstrual Cycle in Adult Women: A Comprehensive Review.

LEARNING OBJECTIVE: After participating in this activity, learners should be better able to:• Discuss and outline the general and overlapping effects of the menstrual cycle on women's mental health. ABSTRACT: A growing body of research demonstrates menstrual cycle-dependent fluctuations in psychiatric symptoms; these fluctuations can therefore be considered as prevalent phenomena. Possible mechanisms underlying these fluctuations posit behavioral, psychological, and neuroendocrine influences. Recent reviews document cyclic exacerbation of symptoms and explore these mechanisms in the context of specific and often single disorders. The question remains, however, as to whether there are general and overlapping effects of the menstrual cycle on women's mental health. To address this gap, we synthesized the literature examining the exacerbation of a variety of psychiatric symptoms across the menstrual cycle in adult women. Results show that the premenstrual and menstrual phases are most consistently implicated in transdiagnostic symptom exacerbation. Specifically, strong evidence indicates increases in psychosis, mania, depression, suicide/suicide attempts, and alcohol use during these phases. Anxiety, stress, and binge eating appear to be elevated more generally throughout the luteal phase. The subjective effects of smoking and cocaine use are reduced during the luteal phase, but fewer data are available for other substances. Less consistent patterns are demonstrated for panic disorder, symptoms of posttraumatic stress disorder, and borderline personality disorder, and it is difficult to draw conclusions for symptoms of generalized anxiety disorder, social anxiety disorder, obsessive-compulsive disorder, and trichotillomania because of the limited data. Future research should focus on developing standardized approaches to identifying menstrual cycle phases and adapting pharmacological and behavioral interventions for managing fluctuations in psychiatric symptoms across the menstrual cycle.

Change in the Popularity of Transgressive Content in Written Erotica between 2000 and 2016.

There is a widely held belief that the amount and intensity of transgressive content in pornography have been rising. Reliably assessing for such an increase, however, is complicated by methodological factors including hand-coding content using conflicting a priori definitions of what constitutes transgressive content. In response to those limitations, the present study used the results of a published empirical content analysis of ~250,000 erotic stories written over 16 years to determine if the amount or popularity of transgressive content (stories high in the themes of violence, family (incest), or BDSM) has changed in that timeframe. Results from the present study indicated no meaningful increase in either the amount of content with those themes or popularity (as measured by story views per day) of any of the three transgressive themes within the erotic narratives over the 16-year period of analysis. These results, in addition to recent research presenting similar findings within pornographic video, do not support popular perceptions that erotic material is becoming increasingly transgressive. Rather, such content within internet-based erotic material, and particularly erotic narratives, appears to be relatively consistent.

An Objective Measure of Vaginal Lubrication in Women With and Without Sexual Arousal Concerns.

Changes in vaginal blood flow and lubrication are primary components of physiological sexual arousal in women. Despite the existence of well-established tools for measuring vaginal blood flow, there is not yet a consistently implemented measure of physiological lubrication. To address this methodological gap, researchers have begun examining the utility of litmus test strips, primarily in sexually healthy women. The present study builds on this work by examining the utility of an alternative tool, the Schirmer Tear Test strips, in women with (n = 32) and without (n = 32) sexual arousal concerns. Significant increases in physiological lubrication were found in response to a sexual film, and these changes were moderately correlated with self-reported genital arousal (r = .41) and lubrication (r = .30). No between-group differences in lubrication were observed. These results indicate the Schirmer Tear Test strips are sensitive enough to detect increases in lubrication and may be valuable in clinical and research assessments of female sexual arousal.

Impact of COVID-19 predicts perceived risk more strongly than known demographic risk factors.

OBJECTIVE: To identify the factors associated with perceived COVID-19 risk among people living in the US. METHODS: A cross-sectional representative sample of 485 US residents was collected in mid-April 2020. Participants were asked about (a) perceptions of COVID-19 risk, (b) demographic factors known to be associated with increased COVID-19 risk, and (c) the impact of COVID-19 on different life domains. We used a three-step hierarchical linear regression model to assess the differential contribution of the factors listed above on perceived COVID-19 risk. RESULTS: The final model accounted for 16% of variability in perceived risk, F(18,458) = 4.8, p < .001. Participants who were White reported twice as much perceived risk as participants of color (B = -2.1, 95% CI[-3.4,-0.8]. Higher perceived risk was observed among those who reported a negative impact of the pandemic on their sleep (B = 1.5, 95% CI[0.8,2.1]) or work (B = 0.7, 95%CI[0.1,1.3]). The number of cases per capita in their state of residence, age, or proximity to someone with a COVID-19 diagnosis were not found to meaningfully predict perceived risk. CONCLUSIONS: Perceived risk was not found to be associated with known demographic risk factors, except that the effect of race/ethnicity was in the opposite direction of existing evidence. Perception of COVID-19 risk was associated with the perceived personal impact of the pandemic.

The Relationship between Subjective and Physiological Sexual Arousal in Women with and without Arousal Concerns.

Whereas laboratory studies frequently report low correlations between women's physiological and subjective sexual arousal (i.e., concordance), research employing advanced statistical techniques reveals striking between-person variability in this relationship. Moreover, previous research has shown that interoception (i.e., the awareness of changes within the body) influences concordance in women, though how this effect varies by sexual function is yet unknown. The present study used multilevel modeling to examine concordance in women with (n = 27) and without (n = 28) sexual arousal concerns and explored how concordance varies as a function of interoception. Women viewed a sexual film while their arousal responses were measured and then completed a self-report measure of interoception. A significant relationship emerged between physiological and subjective sexual arousal, in addition to tremendous between-person variability across both groups. Several aspects of interoception moderated concordance (p's between 0.0008 and 0.03), and this pattern varied across groups. Given this variability even in absence of sexual arousal concerns, these findings question the utility of using concordance as a clinical outcome in treatment research. Individual differences in interoception may have implications for treatment matching.

Scoring and Interpretation of the FSFI: What can be Learned From 20 Years of use?

INTRODUCTION: Over the past 20 years, the Female Sexual Function Index (FSFI) has been considered the gold standard for the measurement of sexual function in women, with over 1,000 published manuscripts citing the article. Despite the measure's widespread usage and excellent psychometric properties, there has been some confusion over how to best implement and score the measure and interpret corresponding findings. AIM: The aim of the current article is to provide guidance, drawing from 20 years of use, on how to best implement the FSFI in research settings and interpret results based on the validation studies that have been conducted to date. METHODS: The overview of scoring and interpretation procedures found in this article is drawn from a review of the published literature on the psychometric properties of the FSFI. MAIN OUTCOME MEASURE: The measure of interest for the present review is the FSFI. RESULTS: This review article provides information about implementing, scoring, and interpreting the full-scale FSFI. Domain-level scoring and interpretation procedures are also discussed across the 5 domains of the FSFI: arousal, satisfaction, desire, pain, and lubrication. Additionally, guidance is provided for evaluating translated versions of the FSFI and using the measure to examine sexual function in culturally diverse populations. CLINICAL IMPLICATIONS: Guidance on appropriately scoring and interpretating the FSFI has the potential to strengthen our empirical understanding of sexual function, and consequently, to guide theory-driven treatment development and clinical practice. STRENGTH & LIMITATIONS: The present review provides applied guidance for the appropriate use of the FSFI specifically, but does not cover other common measures of sexual function or adaptations of the original measure. CONCLUSION: It is our hope that the guidance found in this review will ultimately lead to more rigorous and appropriate usage of the FSFI in research settings. Meston CM, Freihart BK, Handy AB, et al. Scoring and Interpretation of the FSFI: What can be Learned From 20 Years of use? J Sex Med 2020;17:17-25.

On the Content of "Real-World" Sexual Fantasy: Results From an Analysis of 250,000+ Anonymous Text-Based Erotic Fantasies.

A recurring problem with the study of sexual fantasy is that of social desirability bias. Study participants may report fantasies that are consistent with general societal expectations of fantasy content, as opposed to themes characterized by their actual fantasies. The wide availability of erotic material on the Internet, however, facilitates the study of sexual fantasy narratives as they are anonymously expressed and viewed online. By extracting approximately 250,000 text-based erotic fantasies from a user-generated website, we sought to examine "real-world" sexual fantasies, determine the themes that were typical of these narratives, and explore the relationship between themes and story popularity (as assessed by story views per day). A principal components analysis identified 20 themes that commonly occurred across the massive corpus, and a path analysis revealed that these themes played a significant role in predicting the popularity of the sexual fantasy narratives. In particular, the empirically identified themes reflecting familial words (e.g., mother, father) and colloquial sexual words (e.g., cock, fuck) were predictive of story popularity. Other themes identified included those not obviously erotic, such as those consisting of words reflecting domesticity (e.g., towel, shower) and colors (e.g., brown, blue). By analyzing a sexual fantasy corpus of unprecedented size, this study offers unique insight into both the content of sexual fantasies and the popularity of that content.

Couples' Sexual Communication and Dimensions of Sexual Function: A Meta-Analysis.

Research and clinical data have shown that couples with sexual problems report a lack of sexual communication. However, no published meta-analyses have evaluated the relationship between sexual communication and sexual function. This meta-analysis examines the correlation between couples' sexual communication and dimension of sexual function across 48 studies. Sexual communication was positively associated with sexual desire (r = .16), sexual arousal (r = .21), lubrication (r = .17), orgasm (r = .23), erectile function (r = .19), less pain (r = .12), and overall sexual function (r = .35). The effect sizes for sexual desire (r = .21; r = .12) and orgasm (r = .26; r = .16) were higher for women than for men. For overall sexual function, studies with married participants (r = .47) had a larger effect size than studies with participants with multiple relationship types (r = .31) or than studies with dating participants (r = .11). Effect sizes were larger for studies conducted outside of the United States (r = .39) compared to studies conducted in the United States (r = .12). We discuss the importance of addressing the relationship between sexual communication and sexual function, as well as future directions for research in this area.

What Does Sexual Arousal Mean to You? Women With and Without Sexual Arousal Concerns Describe Their Experiences.

Sexual arousal is frequently characterized by both subjective (i.e., mental) and physiological (e.g., genital) components. The nuances of these components, however, are difficult to capture via self-report instruments. Asking women to describe sexual arousal in their own words may therefore enhance our understanding of this construct. In the present study, women with (n = 190) and without (n = 610) arousal concerns were recruited online and wrote about their experience of sexual arousal. Seven clusters of words were extracted using automated text analysis, and the prominence of these clusters was compared between groups of women. The autonomic arousal cluster differed between groups such that women with arousal concerns invoked this cluster significantly less than did women with no such concerns. Furthermore, the context cluster significantly predicted group membership (odds ratio [OR] = 1.063); greater scores on this cluster were associated with arousal concerns. Results suggest that autonomic arousal and relationship factors may play important roles in arousal concerns. It is suggested that clinicians assess for aspects of the sexual relationship that may facilitate or hinder sexual arousal. Clinicians may also consider inquiring about the presence or appraisal of autonomic arousal (e.g., one's interpretation of an increase in heart rate or respiration) during sexual activity.

The Effects of Exercise on Sexual Function in Women.

BACKGROUND: Acute exercise is associated with transient changes in metabolic rate, muscle activation, and blood flow, whereas chronic exercise facilitates long-lasting adaptations that ultimately improve physical performance. Exercise in general is known to improve both physical and psychological health, but the differential effects of brief bouts of exercise vs long-term exercise regimens on sexual function are less clear. AIM: The purpose of this review was to assess the direct and indirect effects of both acute and chronic exercise on multiple domains of sexual function in women. METHODS: A literature review of published studies on exercise and sexual function was conducted. Terms including "acute exercise," "chronic exercise," "sexual function," "sexual arousal," "sexual desire," "lubrication," "sexual pain," and "sexual satisfaction" were used. OUTCOMES: This review identifies key relationships between form of exercise (ie, chronic or acute) and domain of sexual function. RESULTS: Improvements in physiological sexual arousal following acute exercise appear to be driven by increases in sympathetic nervous system activity and endocrine factors. Chronic exercise likely enhances sexual satisfaction indirectly by preserving autonomic flexibility, which benefits cardiovascular health and mood. Positive body image due to chronic exercise also increases sexual well-being. Though few studies have examined the efficacy of month-long exercise programs for the treatment of sexual dysfunction, exercise interventions have alleviated sexual concerns in 2 specific clinical populations: women with anti-depressant-induced sexual dysfunction and women who have undergone hysterectomies. CONCLUSIONS: This review highlights the positive effects of acute and chronic exercise on sexual function in women. Directions for future research are discussed, and clinicians are encouraged to tailor specific exercise prescriptions to meet their patients' individual needs. Stanton AM, Handy AB, Meston CM. The Effects of Exercise on Sexual Function in Women. Sex Med Rev 2018;6:548-557.

Differences in Perceived and Physiologic Genital Arousal Between Women With and Without Sexual Dysfunction.

BACKGROUND: Many sexual psychophysiologic studies have failed to find differences in physiologic genital arousal between women with and those without sexual dysfunction. However, differences in self-reported (ie, perceived) measures of genital responses between these 2 groups of women have been noted. AIMS: To determine whether women with and without sexual dysfunction differ on measures of physiologic and perceived genital arousal based on type of analytic technique used, to explore differences in perceived genital arousal, and to assess the relation between physiologic and perceived genital arousal. METHODS: Data from 5 studies (N = 214) were used in this analysis. Women were categorized into 3 groups: women with arousal-specific sexual dysfunction (n = 40), women with decreased sexual function (n = 72), and women who were sexually functional (n = 102). Women viewed an erotic film while their physiologic genital arousal was measured using a vaginal photoplethysmograph. After watching the film, women completed a self-report measure of perceived genital arousal. OUTCOMES: There were differences in vaginal pulse amplitude (VPA) levels and association of VPA with perceived genital sensations based on level of sexual function. RESULTS: Commonly used methods of analysis failed to identify significant differences in VPA among these groups of women. When VPA data were analyzed with hierarchical linear modeling, significant differences emerged. Notably, women with arousal-specific dysfunction exhibited lower VPA than sexually functional women at the beginning of the assessment. As the erotic film progressed, women with arousal-specific dysfunction became aroused at a faster rate than sexually functional women, and these 2 groups ultimately reached a similar level of VPA. Sexually functional women reported the highest levels of perceived genital responses among the 3 groups of women. No significant relation between VPA and perceived genital arousal emerged. CLINICAL TRANSLATION: Women's perception of their genital responses could play a role in women's experience of sexual dysfunction and might be more clinically relevant for women with sexual dysfunction than genital blood flow. STRENGTHS AND LIMITATIONS: This study's large sample is unique in sexual psychophysiology, and it strengthens the credibility of the findings. However, this study is limited in that arousal-specific dysfunction was determined with self-report measures, not by a clinician-administered assessment. CONCLUSION: These findings suggest distinct response trajectories in women with and without sexual dysfunction, and although perceived genital responses are important for women who are experiencing problems with arousal, they do not seem to be related to objective measures of physiologic arousal. Handy AB, Stanton AM, Pulverman CS, Meston CM. Differences in Perceived and Physiologic Genital Arousal Between Women With and Without Sexual Dysfunction. J Sex Med 2018;15:52-63.

Understanding Women's Subjective Sexual Arousal Within the Laboratory: Definition, Measurement, and Manipulation.

INTRODUCTION: Subjective sexual arousal (SSA) is positive, cognitive engagement in sexual activity. SSA is considered an important aspect of the sexual experience, as it has been found to facilitate sexual activity and, in situations of chronically low or absent arousal, potentially cause distress. Despite the clinical implications of SSA, a thorough review of how to manipulate SSA has yet to be conducted. AIM: To review the state of knowledge about SSA in women, including its definition, measurement, and the outcomes of studies attempting to manipulate SSA within a laboratory setting. METHOD: A comprehensive search of the electronic databases of PubMed and PsycINFO was conducted. The generated list of articles was reviewed and duplicates were removed. Individual articles were assessed for inclusion and, when appropriate, relevant content was extracted. MAIN OUTCOME MEASURE: The potential effects of various manipulations of SSA in a laboratory setting was the main outcome. RESULTS: 44 studies were included in this review. Manipulations were grouped into 3 primary categories: pharmacological (n = 16), cognitive (n = 22), and those based on changes to the autonomic nervous system (n = 6). Results suggest that cognitive manipulation is the most effective method of increasing SSA. Altering the relative balance of the 2 branches of the autonomic nervous system (the sympathetic nervous system and the parasympathetic nervous system) also appears to be a promising avenue for increasing SSA. CONCLUSION: This review supports the use of cognitive manipulation for increasing women's SSA in a laboratory setting. Avenues for future research and recommendations for clinicians are discussed. Handy AB, Stanton AM, Meston CM. Understanding Women's Subjective Sexual Arousal Within the Laboratory: Definition, Measurement, and Manipulation. Sex Med Rev 2018;6:201-216.

Sexual function in adolescents and young adults diagnosed with cancer: A systematic review.

PURPOSE: The purpose of this systematic review was to identify, with supporting evidence, the impact of cancer and its treatment on the sexual function of adolescents and young adults. METHODS: PubMed, CINAHL, and PsycINFO articles were searched for relevant studies published in English. Fifteen studies, 13 quantitative and two qualitative, were included in this review. RESULTS: Results indicated that cancer during the adolescent and young adult period has a significant negative impact on certain domains of sexual function in both men and women. CONCLUSIONS: Among adolescent and young adult males, there is evidence that cancer has detrimental effects on erection, ejaculation, and orgasm. Among adolescent and young adult females, cancer is associated with decreased desire, but there appear to be mixed findings with respect to arousal, orgasm, and satisfaction. Directions for future research are discussed. IMPLICATIONS FOR CANCER SURVIVORS: A better understanding of the effects of cancer and its treatment during adolescence and young adulthood on sexual function could increase attention paid to sexual health in oncology settings and lead to improved psychosexual services for this population.

Interoception and Awareness of Physiological Sexual Arousal in Women With Sexual Arousal Concerns.

Laboratory studies assessing physiological genital arousal have largely failed to find differences between women with and without female sexual arousal disorder (FSAD). Therefore, it is possible that women with FSAD may be unaware of their genital arousal response. The present study examined the extent to which women with FSAD can report their genital arousal response, as well as the role of interoception (body awareness) in this relationship. Additionally, this study examined the influence of interoception on the relationship between subjective and genital arousal. Twenty-six women who met criteria for FSAD (M age = 29.5, SD = 8.1 years) watched an erotic film and completed a series of questionnaires. Physiological (i.e., genital) and perceived genital arousal were measured continuously throughout the film. Results indicated women were able to perceive their level of physiological arousal. Greater levels of interoception were linked with stronger relationships between perceived and physiological arousal, but not between subjective and genital arousal. Methodological and clinical implications are discussed.