Physiological Synchrony During Partnered Sexual Activity.

Physiological synchrony (PS) refers to the coordination of bodily responses in close relationships. It seems to be linked to relational well-being, satisfaction, closeness, and empathy. Recent research extends these findings to sexual relationships as well, with evidence suggesting that PS may predict attraction and sexual satisfaction. The current study focuses on PS during sexual activity within established couples. Results suggest that PS develops during sexual activity, in certain contexts, and tends to be greater in magnitude during sexual encounters than during non-sexual interactions. Results may shed light on the dyadic psychophysiological factors relevant to sexual experiences.

Psychometric Evaluation and Adaptation of the Five-Factor Sexual Satisfaction Scale (SSS-W) for Use in Men: The Sexual Satisfaction Scale (SSS).

The Sexual Satisfaction Scale for Women (SSS-W) is a psychometrically sound, widely used instrument for assessing sexual satisfaction and distress in women. Because the majority of scale items are gender nonspecific, numerous researchers have adapted this scale for use in male samples. The goal of the current study was to assess the reliability and validity of a slightly modified version of the SSS-W in a male sample (N = 268). A Confirmatory Factor Analysis of five previously established factors provided evidence for consistency of internal structure in men. The adapted scale (SSS) exhibited acceptable test-retest reliability, as well as evidence for validity based on relationships with theoretically predicted variables. Taken together, there is evidence to suggest that the SSS may be a reliable and valid psychometric tool for the measurement of sexual satisfaction and distress in both men and women.

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.

Why Hungarians Have Sex (YSEX?-HSF).

Using the same methodology as Meston and Buss (2007), three studies were conducted on a Hungarian sample (total N = 4913) which corroborate previous findings on the universal diversity of sexual motivation. Study 1 (N = 2728; 1069 women and 1659 men) identified 197 reasons for having sex based on participants' free responses. In Study 2 (N = 1161; 820 women and 341 men), participants indicated the extent to which each of the 197 reasons had led them to have sexual intercourse. Factor analyses yielded three factors and 24 subfactors. This differed from the original YSEX? four-factor questionnaire. In Study 3 (N = 1024; 578 women and 446 men), a reliable and valid 73-item short form version of the YSEX? questionnaire was developed in a Hungarian sample (YSEX?-HSF). In addition to similarities and differences in the factor structure, we found important links between reasons for having sex and age, gender, personality, and mating strategy. For example, number of reasons for having sex tended be higher in younger compared to older participants. Men exceeded women on having sex for novelty-seeking and infidelity opportunities, whereas women exceeded men on having sex for relationship commitment and mate retention. Extraversion and neuroticism were linked with reasons for having sex, and those who pursued a short-term mating strategy reported having sex for a larger variety of reasons.

Why Hungarians Have Sex: Development and Validation of a Brief 15-Item Instrument (YSEX?-15H).

The present study developed a brief version of the Hungarian Why Sex? questionnaire (Meskó et al., 2022). The study was in part based on previously reported data obtained from several samples (N = 6193; 1976 men, 4217 women). Using Mokken Scaling Procedure, Item Response Model and redundancy analysis indicated that retaining three summary scales comprising five items each was the optimal solution for the brief version. The validity of the brief scale was tested with the Sexual System Functioning Scale (SSFS), the Experiences in Close Relationships Scale-Short Form (ECR-S) and, the Hungarian version of the Attachment Style Questionnaire (ASQ-H; n = 297, 127 men, 170 women). In addition, correlations between the long and brief versions of YSEX? with sociosexual orientation (SOI-R) and the five-factor personality construct (BFI-S) were compared (n = 1024, 578 women, 446 men). The results suggest that the three summary scales of the Hungarian 15-item Form of the Why Sex Questionnaire (YSEX?-15H) provide reliable and valid measures of the previously affirmed three broad sexual motives (Personal Goal Attainment, Relational Reasons, Sex as Coping). The Relational Reasons summary scale was associated with secure emotional and sexual attachment. The Personal Goal Attainment and Sex as Coping summary scales showed coherent patterns of associations with the emotional and sexual aspects of secondary attachment strategies (over- and under-functioning). The YSEX?-15H offers both researchers and practitioners a concise and useful instrument for the assessment of sexual motivation.

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.

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.

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.

Why Humans Have Sex: Development and Psychometric Assessment of a Short-Form Version of the YSEX? Instrument.

Research has documented 237 distinct reasons for engaging in sex, which have been clustered into the 141-item, 13 subscale YSEX? instrument. Although the YSEX? has impressive psychometric properties, the required completion time is a barrier to its use in time-constrained contexts. The current studies develop and validate a short-form version of the instrument. The new 28-item, 14 subscale YSEX?-SF demonstrates acceptable model fit and good internal-reliability, with evidence for cross-form and construct validity. The YSEX?-SF maintains the original instrument's sound psychometric properties with a significantly shorter completion time, which may facilitate the study of sexual motivation.

Preliminary Evidence for a Relationship Between Physiological Synchrony and Sexual Satisfaction in Opposite-Sex Couples.

INTRODUCTION: Over the past 3 decades, our understanding of physiological synchrony (PS) has increased substantially. Research has shown that interpersonal PS is stronger in relationships characterized by emotional closeness and intimacy and that the magnitude of PS is moderated by relational satisfaction. Despite growing momentum for this area of study, no research to date has examined the relationship between PS and sexual satisfaction. AIM: The current study seeks to elucidate the relationship between PS and sexual satisfaction using study tasks that have been used in previous research to assess PS. METHODS: Heterosexual couples completed several survey measures in a laboratory setting. They were then connected to an electrocardiogram and instructed to complete baseline, gazing, and mirroring tasks. Subsequently, heart rate (HR) data for each dyad were analyzed for PS using a moderated multilevel modeling approach. MAIN OUTCOME MEASURE: Scores on the Sexual Satisfaction Scale were used to moderate dyadic coherence between male and female partner HRs over time. RESULTS: PS was detected in our sample, with both men reliably predicting the HR of their female partners, and women reliably predicting the HR of their male partners. Akaike information criterion values indicate the better fitting model for each task was for men predicting the women's HRs. A significant interaction effect was found between observed PS during the mirroring task (with male HR predicting female HR) and overall sexual satisfaction scores. There was no relationship between PS during baseline or gazing and overall sexual satisfaction. CLINICAL IMPLICATIONS: Results provide initial evidence for the relevance of PS in sexual dyanmics. STRENGTHS & LIMITATIONS: The current analysis used a dyadic psychophysiological approach to extend the growing body of literature on PS into the theoretically linked field of sexuality. Because of the small sample size and nondirectional nature of the study design, future research is needed to replicate and extend findings. CONCLUSION: The ability of couples to co-regulate while attempting actively to synchronize (as in the mirroring task) may be connected to how they perceive and experience their sexual relationship. Conversely, more sexually satisfied couples may be more likely to synchronize physiologically. Taken together, these findings reflect the first evidence that PS and sexual satisfaction may be associated at the couple-level. Freihart BK, Meston CM. Preliminary Evidence for a Relationship Between Physiological Synchrony and Sexual Satisfaction in Opposite-Sex Couples. J Sex Med 2019;16:2000-2010.

Toward a More Evidence-Based Nosology and Nomenclature for Female Sexual Dysfunctions-Part III.

INTRODUCTION: In 2016 the International Society for the Study of Women's Sexual Health (ISSWSH) published an expert consensus report on new nomenclature that addressed the need for comprehensive, evidence-based criteria for new diagnoses in desire, arousal, and orgasm, with the definition on arousal focusing exclusively on female genital arousal disorder (FGAD). AIM: A new expert panel solely focused on mechanisms of arousal disorders convened to revise the nomenclature to include female cognitive arousal disorder (FCAD) and FGAD. METHODS: The ISSWSH co-chairs identified experts on arousal disorders in women. The 10 participants included clinicians, researchers, and educators, representing a diverse, multidisciplinary group. Pre-meeting preparation included evidence-based literature review as the basis of presentations panelists made at the meeting on the current knowledge in cognitive arousal. Consensus was reached using a modified Delphi method. Writing assignments were made as a basis of manuscript development. MAIN OUTCOME MEASURES: The new definition of FCAD is characterized by distressing difficulty or inability to attain or maintain adequate mental excitement associated with sexual activity, as manifested by problems with feeling engaged and mentally turned on or sexually aroused for a minimum of 6 months. RESULTS: Female sexual arousal disorder encompasses both FGAD (revised definition) and FCAD (new definition). Recommendations regarding diagnosis include a clinical interview to assess for FCAD using targeted questions. Patient-reported outcomes that contain questions to assess FCAD are described, including limitations for differentiating between cognitive arousal, genital arousal, and sexual desire. Laboratory measures of cognitive and genital arousal are discussed, including the relationships between genital and cognitive arousal patterns. Biopsychosocial risk factors for FCAD and FGAD, as well as exclusionary conditions, are presented. CLINICAL IMPLICATIONS: The revision of the ISSWSH nomenclature regarding the criteria for the 2 arousal categories, FCAD and FGAD, and the recommended diagnostic strategies offers a framework for management of women with arousal disorders. STRENGTHS & LIMITATIONS: This nomenclature allows for basic science and clinical research in subtypes of arousal in order to develop better diagnostic and treatment options for use by clinicians, scientists, and regulatory agencies. There are limited validated measures of cognitive arousal, including the Female Sexual Function Index, the most commonly used measure, which does not effectively distinguish between cognitive excitement, genital sensations, and event-related desire. CONCLUSION: Future directions include the refinement of FCAD and FGAD and development and validation of patient-reported outcomes that distinguish between the cognitive processes and genital responses to enhance clinical care and research in this area. Parish SJ, Meston CM, Althof SE, et al. Toward a More Evidence-Based Nosology and Nomenclature for Female Sexual Dysfunctions-Part III. J Sex Med 2019;16:452-462.

The Sexual Satisfaction Scale for Women (SSS-W): Adaptation and Validation of a Traditional Chinese Version in Taiwan.

Sexual satisfaction is a key factor in an individual's sexual health and overall well-being. The aim of this study was to validate the most comprehensive index of sexual satisfaction-the SSS-W-for use among Chinese-speaking individuals. A total of 103 women (20-65 years old) participated in this survey study. An SSS-W traditional Chinese version (SSS-W-TC) was developed following the guidelines for cross-cultural translation and adaptation. The translated version, the SSS-W-TC, demonstrates psychometric properties within the satisfactory range, suggesting the feasibility of the SSS-W-TC for use in Taiwan. In terms of internal consistency, the reliability of the SSS-W-TC and its subscales is excellent. High test-retest reliability coefficients were obtained for all subscales of the translated version, demonstrating acceptable stability of the SSS-W-TC across measurement intervals. The ability of the SSS-W-TC to discriminate sexually functional and dysfunctional women shows evidence of concurrent validity. Low to modest correlations between the total and domain scores of the SSS-W and the Female Sexual Function Index Satisfaction domain echo the need for a multidimensional measure of sexual satisfaction in this population. The development of the SSS-W-TC lays the groundwork for future researchers who wish to conduct cross-cultural work in sexual satisfaction using Chinese-speaking samples.

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

BACKGROUND: Below average heart rate variability (HRV) has been associated with sexual arousal dysfunction and overall sexual dysfunction in women. Autogenic training, a psychophysiologic relaxation technique, has been shown to increase HRV. In a recent study, sexually healthy women experienced acute increases in physiologic (ie, genital) and subjective sexual arousal after 1 brief session of autogenic training. AIM: To build on these findings by testing the effects of a single session of autogenic training on sexual arousal in a sample of women who reported decreased or absent sexual arousal for at least 6 months. METHODS: Genital sexual arousal, subjective sexual arousal, and perceived genital sensations were assessed in 25 women 20 to 44 years old before and after listening to a 22-minute autogenic training recording. HRV was assessed with electrocardiography. OUTCOMES: Change in genital sexual arousal, subjective sexual arousal, and perceived genital sensations from the pre-manipulation erotic film to the post-manipulation erotic film. RESULTS: Marginally significant increases in discrete subjective sexual arousal (P = .051) and significant increases in perceived genital sensations (P = .018) were observed. In addition, degree of change in HRV significantly moderated increases in subjective arousal measured continuously over time (P < .0001). There were no significant increases in genital arousal after the manipulation. CLINICAL IMPLICATIONS: The results of this study suggest that autogenic training, and other interventions that aim to increase HRV, could be a useful addition to treatment protocols for women who are reporting a lack of subjective arousal or decreased genital sensations. STRENGTHS AND LIMITATIONS: There are few treatment options for women with arousal problems. We report on a new psychosocial intervention that could improve arousal. Limitations include a relatively small sample and the lack of a control group. CONCLUSION: Our findings indicate that autogenic training significantly improves acute subjective arousal and increases perceived genital sensations in premenopausal women with self-reported arousal concerns. Stanton AM, Hixon JG, Nichols LM, Meston CM. One Session of Autogenic Training Increases Acute Subjective Sexual Arousal in Premenopausal Women Reporting Sexual Arousal Problems. J Sex Med 2018;15:64-76.

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.

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.

Automated Artifact-Detection Procedure for Vaginal Photoplethysmography.

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

Identification of Nonconsensual Sexual Experiences and the Sexual Self-Schemas of Women: Implications for Sexual Functioning.

Many individuals who experience nonconsensual sexual experiences (NSEs) do not identify their experiences with common sexual violence labels (e.g., sexual assault, rape, or abuse), and cognitive mechanisms of identification have yet to be examined. Identification may involve the integration of the experience into sexual self-schemas, which would have implications for sexual well-being. Women were recruited through Amazon's Mechanical Turk (N = 818) to take part in an anonymous online study of sexual experiences. The current study assessed the relationship between textually derived sexual self-schemas and sexual function (measured by the Female Sexual Function Index) in women (M = 35.37 years, SD = 11.27) with NSEs who both did (identifiers, n = 305) and did not (non-identifiers, n = 176) identify with common sexual violence labels, in comparison with those with no NSEs (n = 337). Text analyses revealed nine sexual self-schema themes in participants' essays: Virginity, Openness, Erotophilia, NSEs, Romantic, Sexual Activity, Warmth, Relationships, and Reflection. Analyses demonstrated that identifiers reported significantly poorer sexual functioning and less use of both the Warmth and Openness themes than those with no NSEs. Identifiers also invoked the NSE theme more frequently than both those with no NSE histories and non-identifiers. While greater prominence of the Warmth theme was predictive of greater sexual functioning for both non-identifiers and those with no NSEs, this was not true for identifiers. Instead, the NSE theme was significantly predictive of lower sexual functioning in identifiers. The results suggest that NSE identification may result in greater internalization of the NSE into one's sexual self-schema and, in turn, predict decrements in sexual functioning. The results are discussed in relation to identification interpretation and clinical intervention.

Opinion Paper: On the Diagnosis/Classification of Sexual Arousal Concerns in Women.

BACKGROUND: In the professional literature and among our professional societies, female sexual dysfunction nomenclature and diagnostic criterion sets have been the source of considerable controversy. Recently, a consensus group, supported by the International Society for Women's Sexual Health, published its recommendations for nosology and nomenclature, which included only one type of arousal dysfunction, female genital arousal disorder, in its classification system. Subjective arousal was considered an aspect of sexual desire and not part of the arousal phase. AIM: To advocate for the importance of including subjective arousal disorder in the diagnostic nomenclature in addition to the genital arousal subtype. METHODS: We reviewed how the construct of subjective arousal was included in or eliminated from the iterations of various diagnostic and statistical manuals. The Female Sexual Function Index (FSFI) was used to examine the relations among subjective arousal, genital arousal, and desire in women with and without sexual arousal concerns. MAIN OUTCOME MEASURES: Sexual arousal through a self-report Film Scale, physiologic sexual arousal through vaginal photoplethysmography in response to an erotic film, and the FSFI. RESULTS: The clinical literature and experience support differentiating subjective arousal from desire and genital arousal. Correlations between the FSFI domains representing desire and subjective arousal, although sufficient to suggest relatedness, share approximately 58% of the variance between constructs-a lower shared variance than FSFI domains representing subjective arousal and orgasm. Similarly, when looking at FSFI individual items best representative of sexual desire and subjective arousal, the large majority of the variance in subjective arousal was unexplained by desire. A third line of evidence showed no significant difference in levels of subjective arousal to erotic films between sexually functional women and women with desire problems. If desire and subjective arousal were the same construct, then one would expect to see evidence of low subjective arousal in women with low sexual desire. CLINICAL IMPLICATIONS: Optimized treatment efficacy requires differentiating mental and physical factors that contribute to female sexual dysfunction. STRENGTHS AND LIMITATIONS: Support for our conclusion is based on clinical qualitative evidence and quantitative evidence. However, the quantitative support is from only one laboratory at this time. CONCLUSION: These findings strongly support the view that female sexual arousal disorder includes a subjective arousal subtype and that subjective arousal and desire are related but not similar constructs. We advocate for the relevance of maintaining subjective arousal disorder in the diagnostic nomenclature and present several lines of evidence to support this contention. Althof SE, Meston CM, Perelman M, et al. Opinion Paper: On the Diagnosis/Classification of Sexual Arousal Concerns in Women. J Sex Med 2017;14:1365-1371.

Vagal Activity During Physiological Sexual Arousal in Women With and Without Sexual Dysfunction.

Recently, heart rate variability (HRV) level has been found to be a risk factor for female sexual dysfunction. Low HRV was a significant predictor of female sexual arousal dysfunction and overall sexual dysfunction. Building upon this finding, the present study examined whether differences in vagal activity between sexually functional and sexually dysfunctional women may be driving the association between low HRV and female sexual dysfunction. Specifically, respiratory sinus arrhythmia (RSA) was assessed before, during, and after physiological sexual arousal in 84 women, aged 18 to 47, to examine potential differences in vagal activity between sexually functional and sexually dysfunctional women. Significant differences in vagal activity between these two groups were observed (p =.02). These findings provide additional specificity to the recently established relationship between HRV and female sexual function while also proposing a mechanism to target during treatments for sexual dysfunction.

Differences in Neural Response to Romantic Stimuli in Monogamous and Non-Monogamous Men.

In non-human animal research, studies comparing socially monogamous and promiscuous species of voles (Microtus) have identified some key neural differences related to monogamy and non-monogamy. Specifically, densities of the vasopressin V1a receptor and dopamine D2 receptors in subcortical reward-related and limbic areas of the brain have been linked to monogamous behavior in prairie voles (Microtus ochrogaster). Similar brain areas have been shown to be correlated with feelings of romantic love in monogamously pair-bonded humans. Humans vary in the degree to which they engage in (non-)monogamous behaviors. The present study examined the differences in neural activation in response to sexual and romantic stimuli in monogamous (n = 10) and non-monogamous (n = 10) men. Results indicated that monogamous men showed more reward-related neural activity when viewing romantic pictures compared to non-monogamous men. Areas with increased activation for monogamous men were all in the right hemisphere and included the thalamus, accumbens, striatum, pallidum, insula, and orbitofrontal cortex. There were no significant differences between groups in activation to sexual stimuli. These results demonstrate that the neural processing of romantic images is different for monogamous and non-monogamous men. There is some overlap in the neural areas showing increased activation in monogamous men in the present study and the neural areas that show differences in the vole models of monogamy and affiliation. Future research will be needed to clarify whether similar factors are contributing to the neural differences seen in monogamous and non-monogamous humans and voles.