Impact of mindfulness versus supportive sex education on stress in women with sexual interest/arousal disorder.

Low desire in women is the most common sexual difficulty, and stress has been identified as a significant predictor of symptoms. We evaluated a mindfulness-based cognitive therapy (MBCT) group treatment versus a sex education comparison group treatment (STEP) on self-reported stress and on the physiological stress response measured via morning-to-evening cortisol slope in 148 women with a diagnosis of sexual interest/arousal disorder (SIAD). Perceived stress decreased following treatment in both groups, and significantly more after MBCT. The cortisol slope was steeper (indicative of better stress system regulation) from pre-treatment to 6-month follow-up, with no differences between the groups. As an exploratory analysis, we found that the reduction in perceived stress predicted increases in sexual desire and decreases in sex-related distress for participants after MBCT only. These findings suggest that group mindfulness targeting women with low sexual desire leads to improvements in self-reported and physiological stress, with improvements in self-reported stress partially accounting for improvements in sexual desire and distress.

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

BACKGROUND: 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). AIM: To assess the role of SIAD status and relationship satisfaction in the associations between genital arousal and 4 types of responsive desire. METHODS: 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 3 days later (delayed desire). OUTCOMES: Outcomes consisted of genital response (z scored by method) and associations between genital response and responsive sexual desire. RESULTS: 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. CLINICAL IMPLICATIONS: 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. STRENGTHS AND LIMITATIONS: 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. CONCLUSION: 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.

Effects of Group Mindfulness-Based Cognitive Therapy versus Supportive Sex Education on Sexual Concordance and Sexual Response Among Women with Sexual Interest/Arousal Disorder.

Low interest in sexual activity and impaired sexual response are among women's most frequent sexual concerns. Mindfulness-based treatments improve low sexual desire and arousal and associated distress. One theorized mechanism of change is the cultivation of increased mind-body awareness via greater concordance between psychological and physiological components of sexual response. We examined sexual psychophysiology data from 148 cisgender women randomized to receive mindfulness-based cognitive therapy (MCBT: n = 70) or supportive sex education (STEP: n = 78) over eight weekly group sessions. Women completed in-lab assessments of subjective, affective, and genital sexual responses to an erotic film pre- and post-treatment, and at 6- and 12-month follow-ups. Both groups showed positive changes in sexual and affective responses, but these were generally more pronounced for MBCT. MCBT increased sexual concordance to a greater degree, and gains in sexual concordance predicted improvements in sexual distress throughout treatment.

Sexual Desire Emerges from Subjective Sexual Arousal, but the Connection Depends on Desire Type and Relationship Satisfaction.

According to models of responsive sexual desire, desire emerges from sexual arousal. This study examined how sexual desire type (dyadic-partner, dyadic-other, solitary) and relationship satisfaction affect the connection between subjective sexual arousal (SSA) and desire. Women (N = 100; 27% with sexual interest/arousal disorder symptoms) reported SSA while viewing a sexual film. Solitary and dyadic responsive sexual desire were assessed immediately before and following the film (immediate desire) and three days later (delayed desire). SSA predicted higher immediate solitary desire. SSA also predicted higher immediate dyadic desire, and this link was stronger for those with higher relationship satisfaction; for those with low relationship satisfaction, SSA was unrelated. For delayed desire, SSA predicted higher dyadic-partner desire, regardless of relationship satisfaction. SSA also predicted higher dyadic-other desire, yet this association was stronger for those with low relationship satisfaction; for those with high relationship satisfaction, SSA was unrelated to dyadic-other desire. Findings support the theoretical premise that desire emerges from arousal, but that this connection is dependent upon additional factors, specifically the target and timing of desire and participants' current relationship quality. Relationship satisfaction may affect the motivational value of sex with (and without) a current partner.

The Role of Attractiveness in Gendered Sexual Response Patterns.

Previously documented sexual response patterns of gender-specificity among gynephilic men and gender-nonspecificity among gynephilic women could be explained by women responding more strongly to non-gendered aspects of sexual stimuli. Cues of attractiveness are known determinants of sexual decision-making, yet have not been directly tested as determinants of sexual response. The current study investigated the role of attractiveness cues in explaining gender-based patterns of sexual response. Thirty-one gynephilic men and 60 androphilic women were presented slideshows of images depicting individual nude men and women that were pre-rated in a pilot study as either attractive or unattractive. The men and women were posed with legs spread and aroused genitals displayed prominently. Images were isolated against a white background and included minimal contextual information. Three sexual responses - genital arousal (via photoplethysmographs), self-reported arousal, and visual attention (via eye-tracking) - were recorded continuously. Across all three response modalities, men's and women's responses were stronger for the attractive versus unattractive images and for their preferred versus non-preferred gender. For men's arousal and women's self-reported arousal, the effect of attractiveness was stronger for their preferred versus non-preferred gender. Thus, both men and women demonstrated preference-specific patterns of sexual response. Gender cues had the strongest effect on men's visual attention, whereas attractiveness cues had the strongest effect on women's visual attention. Findings establish the importance of target attractiveness in arousal to sexual stimuli and add to mounting evidence that androphilic women's sexual responses are sensitive to gender, but may be more sensitive to non-gendered features of sexual stimuli.

Use of sexual stimuli in research and clinical settings: expert opinion and recommendations.

Background: Sexual stimuli, such as sexual videos, images, and narratives describing sexual interactions, are one of many tools used by clinicians and researchers to elicit or augment sexual response. Given the wide variability within sexual stimuli and their effects on sexual response, we provide guidance on when and how to use sexual stimuli, selecting sexual stimuli, and standardizing the use and reporting of sexual stimuli in research and clinical practice. Aim: This expert opinion review article discusses standard operating procedures when using sexual stimuli in clinical and research applications, addressing 3 broad areas: settings in which sexual stimuli are used, characteristics and contexts of the stimuli, and practical and ethical considerations when using the stimuli. Methods: This article is based on an expert opinion review of the sexual psychophysiology literature. Results: First, we discuss the settings in which sexual stimuli are typically used and evaluate the ecological validity of each setting. Second, we review the types of sexual stimuli used in sexual response research, including physical characteristics, depicted sexual activity, and context, and the impacts of these characteristics on sexual response. Last, we discuss the practical and ethical considerations that come with the choice and use of sexual stimuli in clinical and research settings. We address potential limitations of certain sexual stimuli, including practical and ethical considerations such as participant vs experimenter choice, diversity and representation, and proper sourcing of sexual stimuli for use in clinical and research applications. Discussions on the future applications of sexual stimuli, such as the use of virtual reality, and ethical considerations in terms of user-generated Internet sexual stimuli are also explored. Conclusion: We provide an expert opinion review of the literature regarding use of sexual stimuli for clinical and research applications and offer best use practices and recommendations.

ERP responses to sexual cues among young women attracted to men.

Previous event-related potential (ERP) studies reported larger N170, P3, and late positive potential (LPP) amplitudes to sexual than nonsexual stimuli. These ERPs may not be specifically sensitive to processing sexual cues, however, because the sexual stimuli included information beyond sexual cues (e.g., faces, bodies, social interaction) to a greater extent than comparison stimuli. We investigated ERPs to stimuli that focused on sexual and nonsexual body regions, in different states of readiness for activity, to elucidate neural responses involved in processing sexual cues. Forty cisgender, primarily white, undergraduate women who were attracted to men (Mage  = 18.6, SD = 0.9) viewed images that varied by male body part (penis, arm) and activity state (rest, poised for activity). Participants viewed 40 images per category (flaccid penises, erect penises, outstretched arms, bent arms). Electroencephalography (EEG) was recorded using a 128-channel net, time-locked to the onset of each image. Using a whole-head cluster-mass approach, we found that the P3 was sensitive to sexual readiness-P3 amplitudes were larger to erect than flaccid penises, but not to bent than outstretched arms. The N170 and LPP components did not show evidence of similarly specific responses to sexual readiness, revealing potential dissociation of different neural processes commonly elicited in response to more complex sexual stimuli. An additional novel finding was that an anterior N270-400 was sensitive to sexual readiness. Findings clarify the brain's rapid responses to sexual stimuli, setting the stage for future research aimed at better understanding the neurocognitive processes that contribute to the coordination of sexual arousal.

Gynephilic Men's and Androphilic Women's Visual Attention Patterns: The Effects of Gender and Sexual Activity Cues.

Men and women differ in the degree of specificity of sexual response and differences in attention to sexual cues may be a mechanism underlying these gendered patterns. The majority of previous research has examined attention using static images, which differ considerably from the dynamic videos used in studies of sexual response. To test attention as a potential mechanism involved in gendered sexual response, we used eye-tracking to examine visual attention patterns of 33 gynephilic men and 36 androphilic women to videos depicting preferred and nonpreferred gender targets engaging in varying sexual activities. Specificity of controlled attention was gendered, and this effect differed depending on the intensity of sexual activity cues depicted. Regardless of sexual activity cues, men's controlled attention was gender-specific toward preferred targets. Sexual activity cues did, however, impact the degree to which women's controlled attention was gender-specific. Specifically, women's attention was gender-specific to low-intensity stimuli but nonspecific for masturbation and same-sex dyadic stimuli. Women's attention was gender-specific for mixed-sex dyadic stimuli, but with greater attention directed toward nonpreferred gender targets. Overall, contextual cues impact women's attention to a greater degree than men's. Potential explanations for these findings and implications of stimulus selection for sexuality research are discussed.

Mindfulness and Sex Education for Sexual Interest/Arousal Disorder: Mediators and Moderators of Treatment Outcome.

Sexual Interest/Arousal Disorder (SIAD) is a common sexual dysfunction in women. Both mindfulness-based cognitive therapy (MBCT) plus psychoeducation and sex therapy, education, and support (STEP; which contains the same educational information as in the MBCT arm but also integrates supportive-expressive therapy), are effective. We tested mediators and moderators of improvements. Each treatment arm consisted of eight sessions delivered weekly, and participants completed measures online pre-treatment, immediately post-treatment, and at 6- and 12-month post-treatment. Depression, self-reported interoceptive awareness, self-compassion, self-criticism, and mindfulness were examined as mediators, and expectations for improvement as a moderator. Of 148 cisgender women who consented, 70 were randomized to the MBCT plus psychoeducation group (mean age 39.3 ± 13.2 yrs) and 78 to the STEP group (mean age 37.9 ± 12.2 yrs). Decreases in depression mediated decreases in sexual distress in the MBCT plus psychoeducation group only. Improvements in interoceptive awareness mediated changes in both sexual desire and arousal, and sexual distress, and to a greater degree after MBCT plus psychoeducation. Changes in self-compassion mediated changes in sexual desire and arousal only for the MBCT plus psychoeducation group and mediated changes in sexual distress in both groups. Reductions in self-criticism mediated improvements in sexual distress to a greater extent after MBCT plus psychoeducation. Changes in mindfulness predicted changes in desire and arousal, and distress only in the MBCT plus psychoeducation group. Expectations for improvement did not moderate any outcomes. The findings have implications for understanding common and potentially distinct pathways by which MBCT plus psychoeducation and supportive sex education improve symptoms of SIAD.

A Penny for Your (Sexual) Thoughts: Qualitative Analysis of Women's Self-Described Reactions to Sexual and Nonsexual Stimuli.

Women display a wide range of subjective (self-reported), physiological (genital response), and emotional responses to sexual stimuli. Sexual responses are often assessed using quantitative methodologies; qualitative data can corroborate quantitative data and reveal novel information and avenues for discovery for understanding variations in patterns of sexual response. The current study examined women's (n = 148) responses to various sexual and non-sexual stimuli through open-ended, free response thought journals immediately after watching various neutral (nature themed) and sexually explicit video clips (e.g., solitary masturbation, intercourse). A qualitative content analysis of 842 responses was conducted by five independent coders to determine participants' thoughts immediately after viewing stimuli. Prominent themes included: (1) stimulus appraisals; (2) emotional expressions; and (3) self-reflections and disclosures, which further included participants' sexual-self-disclosures; (4) various degrees of sexual arousal (or lack thereof); and (5) sexual and non-sexual desires. Additional analyses include frequencies and comparisons of specific themes between stimulus types. Findings contribute to understanding cognitive and emotional components of sexual response.

A randomized trial comparing group mindfulness-based cognitive therapy with group supportive sex education and therapy for the treatment of female sexual interest/arousal disorder.

Objective: Sexual interest/arousal disorder (SIAD) is the most prevalent sexual dysfunction in women. Our goal was to compare (a) group mindfulness-based cognitive therapy (MBCT) plus sex education with (b) group supportive sex education and therapy (STEP) for women with SIAD. Method: Eight-session treatments were delivered weekly and participants completed the measures of sexual desire and arousal, sexual distress, relationship satisfaction, rumination, and global impressions of change, at baseline, immediately posttreatment, and at 6- and 12-month posttreatment. Of 148 women who consented, 70 were randomized to MBCT (mean age 39.3 ± 13.2 years) and 78 were randomized to STEP (mean age 37.9 ± 12.2 years). Results: Sexual desire and arousal significantly improved at each time point relative to baseline, with large effect sizes (d = -1.29 to -1.60), and similarly for MBCT and STEP. Sexual distress also improved at each time point with large effect sizes (d = 0.83-1.17), and more so for MBCT relative to STEP. Relationship satisfaction significantly improved (d = -0.17 to -0.20), and rumination about sex improved significantly in both arms, with medium effect sizes (d = 0.42-0.69), with both outcomes responding more to MBCT. About half the participants across both treatments reported moderate or great improvements in global indicators of desire and overall sexuality. Conclusions: Results support the efficacy of both group MBCT and group supportive sex education for improving symptoms of SIAD with 12-month retention of improvements. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

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.

Concordance of Paraphilic Interests and Behaviors.

We examined the concordance of paraphilic interests and behaviors across 13 themes in an online sample of 1,036 men and women. Paraphilic interests were significantly and positively correlated with behaviors across all 13 themes. Associations were strongest for masochism and sadism, and weakest for pedohebephilia and frotteurism. Paraphilic interest and behavior were significantly and positively correlated after accounting for gender and sexual orientation. Moderated moderation analysis was significant for five themes. Gender was a moderator for eroticized gender, but only among heterosexual participants, where concordance was higher for heterosexual men than for heterosexual women. For both exhibitionism and frotteurism, gender was a significant moderator, but only for nonheterosexual participants, where concordance was stronger for nonheterosexual men than for nonheterosexual women. For pedohebephilia, interest was significantly associated with behavior for heterosexual men, heterosexual women, and nonheterosexual men, but not for nonheterosexual women. For zoophilia, there was a significant association between interest and behavior for heterosexual men, nonheterosexual men, and nonheterosexual women, but not heterosexual women. Additional analyses found sex drive moderated the positive associations of 7 of 13 paraphilic themes, with 5 of these 7 showing the expected effect of higher concordance of interests and behaviors at higher levels of sex drive.

Use of the Bogus Pipeline Increases Sexual Concordance in Women But Not Men.

Sexual concordance-the agreement between physiological (genital) and psychological (emotional) sexual arousal-is, on average, substantially lower in women than men. Following social role theory, the gender difference in sexual concordance may manifest because women and men are responding in a way that accommodates gender norms. We examined genital and self-reported sexual arousal in 47 women and 50 men using a condition known to discourage conformity to gender norms (i.e., a bogus pipeline paradigm). Participants reported their feelings of sexual arousal during a sexually explicit film, while their genital arousal (penile circumference, vaginal vasocongestion), heart rate (HR), and galvanic skin (GS) responses were recorded. Half of the participants were instructed that their self-reported sexual arousal was being monitored for veracity using their HR and GS responses (bogus pipeline condition; BPC); the remaining participants were told that these responses were recorded for a comprehensive record of sexual response (typical testing condition; TTC). Using multi-level modeling, we found that only women's sexual concordance was affected by testing condition; women in the BPC exhibited significantly higher sexual concordance than those in the TTC. Thus, we provide the first evidence that the gender difference in sexual concordance may at least partially result from social factors.

Development and Validation of a Measure of Responsive Sexual Desire.

According to the incentive motivation model, sexual desire does not occur spontaneously but can be triggered by sexual stimuli and stems from one's experience of sexual arousal. Until now, research into responsive sexual desire has been challenged by the lack of measures capturing desire that emerges following sexual arousal. The aim of this study was to validate the 18-item Report of Behavior and Feelings-Desire (RBF-D) scale in a sample of 291 women (Mage = 22.41, SD = 5.82) with varying degrees of sexual desire. Items on the RBF-D were selected to reflect 5 aspects of responsive sexual desire: sexual activity with a primary partner, sexual desire for a primary partner, sexual activity with other persons, sexual desire for other persons, and autoerotic activities. A 5-factor solution was confirmed via exploratory structural equation modeling. Internal consistency of 4 out of 5 factors was good. Convergent validity was established via small to medium associations of the RBF-D factors with other measures of sexual desire. Low and nonsignificant correlations with depression and sexual inhibition supported the discriminant validity. The RBF-D is a valid and reliable measure that can be useful in clinical and research settings where assessment of responsive sexual desire and behavior is needed.

Is Mode of Delivery Associated With Sexual Response? A Pilot Study of Genital and Subjective Sexual Arousal in Primiparous Women With Vaginal or Cesarean Section Births.

INTRODUCTION: Although postpartum sexual concerns are common, limited data exist on postpartum sexual response. Furthermore, the physiological process of vaginal birth may negatively impact genital response compared with unlabored cesarean section (C-section), but this hypothesis has yet to be tested. AIM: To (i) compare genital and subjective sexual response and sexual concordance by mode of delivery with inclusion of a control group, (ii) compare groups on self-reported sexual function over the past month, (iii) examine the relationship between laboratory measurement of sexual response and self-reported sexual function, and (iv) investigate association between obstetrical factors and breastfeeding and between sexual response and self-reported sexual function. METHODS: 3 groups of cisgender women were recruited from the community: primiparous women who delivered via vaginal birth within the past 2 years (VB group; n = 16), primiparous women who delivered via unlabored C-section within the past 2 years (CS group, n = 15), and age-matched nulliparous women (NP group, n = 18). Laser Doppler imaging was used to assess genital response while participants watched a neutral and erotic film. MAIN OUTCOME MEASURES: The main outcome measures were change in flux units from neural to erotic video as a measure of genital response, subjective sexual arousal rated continuously throughout films, perceived genital response rated after films, and Female Sexual Function Index (FSFI). RESULTS: Women in the VB group had significantly lower change in flux units than women in the CS (P = .005, d = 1.39) and NP (P < .001, d = 1.80) groups. Groups did not differ on their subjective indices of sexual response or in sexual concordance. Women in both postpartum groups reported lower FSFI scores than women in the NP group. No relationship was determined between FSFI scores and sexual response in the laboratory. Results suggested that genital trauma and breastfeeding may negatively impact FSFI scores, but they were not related to genital response or subjective sexual arousal as measured in the laboratory. CLINICAL IMPLICATIONS: Results underscore the importance of balancing objective and subjective indices of sexual response and function, especially considering the biopsychosocial nature of postpartum sexuality. STRENGTHS & LIMITATIONS: The present study is the first to apply modern sexual psychophysiological methodology to the study of postpartum sexuality. Cross-sectional methodology limits the ability to make causal inferences, and the strict inclusion criteria limits generalizability. CONCLUSION: Physiological changes as a result of labor and delivery may have a detrimental impact on genital response; however, these physiological differences may not impact women's subjective experience of postpartum sexuality. Cappell J, Bouchard KN, Chamberlain SM, et al. Is Mode of Delivery Associated With Sexual Response? A Pilot Study of Genital and Subjective Sexual Arousal in Primiparous Women With Vaginal or Cesarean Section Births. J Sex Med 2020; 17:257-272.

Exploring Comfort Levels and the Role of Compensation in Sexual Psychophysiology Study Participation.

A number of devices have been developed to assess physiological sexual response. Some come into direct contact with the genitals (e.g., vaginal/clitoral/penile plethysmography [VPP/CPP/PPG], labial thermistors [LT]), whereas others capture images of the genitals remotely (e.g., thermal imaging [TI], laser Doppler imaging [LDI]). Researchers have speculated about the relative invasiveness of these measurement tools, with limited empirical work examining participants' perceptions of different devices and how these may impact volunteer bias. We investigated individuals' levels of comfort with participating in hypothetical sexual psychophysiology studies and their reasons for discomfort. We also examined the relationship between comfort level and compensation for participation. Men (n = 291) and women (n = 716) completed an online survey where they were presented with vignettes describing studies using VPP, CPP, PPG, LT, TI, and LDI. Participants reported their comfort level with the idea of participating in each study, the amount of compensation that would be reasonable, and factors influencing their decision not to participate if they were unwilling. Participants were similarly comfortable with some studies involving genital contact (VPP) or remote imaging (TI), and somewhat less comfortable with others (LDI, LT, PPG; small or small-medium effect sizes). Along with our qualitative analysis, these findings reveal that direct genital contact is one aspect of study intrusiveness, but that it is not necessarily the most important study feature influencing comfort with participation. Our results suggest that providing additional information regarding protocols at screening and offering $50 compensation might attract wider samples of participants.