Assessing female sexual arousal with the labial thermistor: response specificity and construct validity.

The labial thermistor offers several potential psychometric advantages over existing measures of female sexual response; however, the thermistor lacked data to support these presumed advantages, especially with respect to its discriminant validity. In this study, both the labial thermistor was worn simultaneously with the vaginal photoplethysmograph as women viewed films. They also indicated their level of subjective sexual arousal using a lever. The labial thermistor discriminated sexual from nonsexual arousing stimuli and was sensitive to different levels of sexual arousal. The correspondence of the instrument with subjective sexual arousal, measured using a continuous lever, was lower during the mildly arousing sexual film and higher during the maximally sexual arousing film. One woman reported that the labial thermistor was very uncomfortable, while others indicated no or mild discomfort from each instrument. The vaginal photoplethysmograph largely replicated the effects documented by the labial thermistor, although it did not discriminate sexual stimuli of different intensity nor correspond with women's continuous lever responses as closely during the more arousing stimulus. Difficulties recording simultaneously with these instruments are noted. The labial thermistor adequately discriminates between generally arousing and sexually arousing stimuli, increasing its utility as a measure for between-subject study designs.

Influence of PDE5 inhibitor on MRI measurement of clitoral volume response in women with FSAD: a feasibility study of a potential technique for evaluating drug response.

The purpose of this study was to determine if magnetic resonance imaging (MRI) could quantify a difference in clitoral response following administration of a vasoactive medication, in 12 women with female sexual arousal disorder (FSAD). Subjects were entered into a double-blind, randomized two-way crossover study of sildenafil 50 mg vs placebo administered 1 h prior to genital MRI. Each subject underwent two MR studies, performed while subjects viewed alternating segments of nonerotic and erotic video. MR images were analyzed for change in clitoral volume during each session. The mean change in clitoral volume for the entire group was higher in the sildenafil MRI session (1282 mm(3)) compared with placebo (849 mm(3)) but did not reach statistical significance (P=0.064). Comparison using analysis of variance between the two sessions for each individual subject revealed a significant increase in clitoral volume following sildenafil compared with placebo in 6 of 12 subjects, no significant change in either imaging session in three subjects and in three subjects, there was a robust clitoral response in both MR sessions. In conclusion, MR measurements of clitoral volume can provide an objective measure of engorgement change following a vasoactive medication in women with FSAD.

Sexual function and satisfaction in heterosexual couples when men are administered sildenafil citrate (Viagra) for erectile dysfunction: a multicentre, randomised, double-blind, placebo-controlled trial.

OBJECTIVE: To investigate the effect of improvement in erectile dysfunction (ED) on sexual function and satisfaction measures in heterosexual couples in which the woman reports that sexual intercourse is unsatisfactory at least half of the time. DESIGN: Multicentre, double-blind, placebo-controlled study. SETTING: Outpatient medical clinics. POPULATION: Hundred and eighty men with ED and their female partners in whom sexual intercourse was satisfactory about half the time or less (score of < or =3 on the Female Partner of ED Subject Questionnaire question 3 [FePEDS Q3]). METHODS: Men were randomised to flexible-dose sildenafil (25, 50, and 100 mg) or placebo as needed for 12 weeks. MAIN OUTCOME MEASURES: Primary: FePEDS Q3 ('Over the past four weeks, when you had sexual intercourse, how often was it satisfactory for you?') scored as 0 (no sexual activity) and 1 (almost never or never) to 5 (almost always or always). Secondary, partners: Sexual Function Questionnaire, Female Sexual Function Index (FSFI), and ED Inventory of Treatment Satisfaction (EDITS) partner version (EDITS-Partner). Secondary, men: International Index of Erectile Function (IIEF), General Efficacy Questions, event log data, Self-Esteem And Relationship questionnaire, and EDITS. Secondary, partners and men: Dyadic Adjustment Scale. RESULTS: The intention-to-treat population included 85 sildenafil recipients (mean age 59 +/- 12 years) and 91 placebo recipients (mean age 57 +/- 11 years). Most partners (aged 20-79 years; mean, 54 years) were postmenopausal. Sildenafil compared with placebo couples had greater improvement in the primary outcome (FePEDS Q3 [P < 0.0001]) and in sexual function, intercourse success rates, and secondary sexual satisfaction measures (FSFI satisfaction domain [P < 0.0001] and IIEF satisfaction domains [P < 0.001]) and had higher treatment satisfaction (EDITS and EDITS-Partner; P < 0.0001). Several predictors of improvement were identified, and improvement in one member of the couple correlated positively with improvement in the other member. CONCLUSIONS: The interdependence of sexual function and sexual satisfaction measures between members of couples consisting of men with ED and sexually healthy women reporting infrequent satisfactory sexual intercourse underscores the importance of including partners in ED treatment discussions.

MRI of female genital and pelvic organs during sexual arousal.

We utilized contrast enhanced magnetic resonance imaging (MRI) to delineate the anatomy of the female genital and pelvic organs during sexual arousal. Eleven healthy pre-menopausal women and eight healthy post-menopausal women underwent MRI of the pelvis while watching an erotic video. A 1.5 Tesla MR system was used to produce T1-weighted images following administration of MS-325, a gadolinium-based blood pool contrast agent. Selected structural dimensions and enhancement were measured prior to and during sexual arousal. In both pre- and post-menopausal subjects, vestibular bulb and labia minora width increased with arousal. Enhancement measurements increased in the bulb, labia minora and clitoris in both pre- and post-menopausal subjects, and in the vagina in pre-menopausal subjects. There were no marked changes in size or enhancement of the labia majora, urethra, cervix, or rectum during sexual arousal in pre- or post-menopausal subjects. Using MRI, we observed specific changes in the female genitalia and pelvic organs with sexual arousal, in both pre- and post-menopausal women. MRI can potentially provide detailed anatomical information in the assessment of female sexual function, particularly with regard to changes in blood flow.

Definitions of women's sexual dysfunction reconsidered: advocating expansion and revision.

In light of various shortcomings of the traditional nosology of women's sexual disorders for both clinical practice and research, an international multi-disciplinary group has reviewed the evidence for traditional assumptions about women's sexual response. It is apparent that fullfilment of sexual desire is an uncommon reason/incentive for sexual activity for many women and, in fact, sexual desire is frequently experienced only after sexual stimuli have elicited subjective sexual arousal. The latter is often poorly correlated with genital vasocongestion. Complaints of lack of subjective arousal despite apparently normal genital vasocongestion are common. Based on the review of existing evidence-based research, many modifications to the definitions of women's sexual dysfunctions are recommended. There is a new definition of sexual interest/desire disorder, sexual arousal disorders are separated into genital and subjective subtypes and the recently recognized condition of persistent sexual arousal is included. The definition of dyspareunia reflects the possibility of the pain precluding intercourse. The anticipation and fear of pain characteristic of vaginismus is noted while the assumed muscular spasm is omitted given the lack of evidence. Finally, a recommendation is made that all diagnoses be accompanied by descriptors relating to associated contextual factors and to the degree of distress.

National trends in condom use among at-risk heterosexuals in the united states.

Based on national level surveys, we examined data relevant to the United States' overall effort to prevent the spread of HIV among heterosexual adults. We examined changes in condom use among at-risk heterosexuals over the past decade. The observed increases over time in condom use across all heterosexual at-risk population segments are consistent with the observed (declines) trends in HIV and syphilis in the 1990s. These results and findings from prior studies suggest that U.S. efforts to facilitate condom use and contain HIV and related sexually transmitted disease (STD)-cofactors among adult at risk heterosexuals was succeeding over most of the 1990s. The absence of national level behavioral trend data after 1996, and the ambiguities of HIV spread suggest some caution in projecting trends into this century. National and local efforts need to be directed at sustaining behavioral change and conducting more rigorous studies on population trends in HIV/STD-related behaviors/pathogens.

Sexual abuse and sexual function: an examination of sexually relevant cognitive processes.

Participants were 61 sexually abused and 57 nonsexually abused women. The authors examined whether recent methodologies adopted from social-cognitive psychology might prove helpful in understanding the previously reported negative relation between childhood sexual abuse (CSA) and adult sexual function. In Part I, a card-sort task was used to explore potential differences between sexually abused and nonsexually abused women in the categorization of positive/negative self-information. In Part 2, sexually relevant information networks, believed to represent the way in which information is organized, accessed, and retrieved from memory, were compared. Sexually abused women differed from nonsexually abused women in the meanings they attributed to many sexuality-relevant concepts but not in how they compartmentalized positive/negative self-information. The findings provide insight into the cognitive processes by which CSA experiences might influence adult sexual function and provide a starting point for future research using this type of methodology.

Ethnicity, desirable responding, and self-reports of abuse: a comparison of European- and Asian-ancestry undergraduates.

One thousand fifty-two (582 non-Asian, 470 Asian) university students were assessed regarding levels of physical abuse, emotional abuse, sexual abuse, neglect, and socially desirable responding. Differences between Asian-ancestry and European-ancestry students in self-reported incidence and expression of abuse were evaluated, as was gender and the relation between self-reported abuse and socially desirable responding. Asian-ancestry men and women reported higher levels of physical abuse, emotional abuse, and neglect than did their Euro-ancestry counterparts, and Euro-ancestry women reported a higher incidence of sexual abuse than did Asian-ancestry women. Across ethnicity, men reported higher levels of physical abuse and neglect but lower levels of sexual abuse than did women. Socially desirable responding was not related to measures of abuse. Findings are discussed in terms of cultural influences on child-rearing and disciplinary practices.

Relating body image to psychological and sexual functioning in child sexual abuse survivors.

Cognitive-affective body image variables and their relation to long-term psychological and sexual functioning were investigated in a community sample of 57 female adult child sexual abuse (CSA) survivors and 47 comparison subjects. The Body-Self Relations Questionnaire and the Body Esteem Scale were administered to assess cognitive-affective body image. Group comparisons indicated that, after controlling for actual weight status, survivors evaluated their health more negatively and reported less body esteem regarding their sexual attractiveness than comparison subjects. Body image variables related to health and sexual attractiveness significantly explained variance on symptom measures that reflect the diverse CSA long-term sequelae. Results suggest the need for careful assessment of body image disturbances and the development of effective interventions targeting body image in the treatment of CSA survivors.

Ephedrine-activated physiological sexual arousal in women.

BACKGROUND: The present investigation was designed to provide the first empirical examination of the effects of ephedrine sulfate, an alpha- and beta-adrenergic agonist, on subjective and physiological sexual arousal in women. The purpose was to help elucidate the effects of increased peripheral adrenergic activity on sexual response in women. METHODS: Twenty sexually functional women participated in 2 experimental conditions in which subjective (self-report) and physiological (vaginal photoplethysmography) sexual responses to erotic stimuli were measured following administration of either ephedrine sulfate (50 mg) or placebo in a randomized, double-blind, cross-over protocol. RESULTS: Ephedrine significantly (P<.01) increased vaginal pulse amplitude responses to the erotic films and had no significant (P>. 10) effect on subjective ratings of sexual arousal. CONCLUSIONS: Ephedrine can significantly facilitate the initial stages of physiological sexual arousal in women. These findings have implications for deriving new pharmacological approaches to the management of sexual dysfunction in women.

Psychophysiological models of female sexual response.

Psychophysiology provides a methodology and a model for evaluating physiological and psychological (cognitive-affective) components of sexuality in a relatively controlled laboratory setting. Laboratory responses can then be correlated with key sexual or nonsexual self-reported behaviors, thoughts and feelings occurring in the person's daily environment. Given the fact that human sexual response is the result of a complex interaction of psychosocial and physiological factors, a psychophysiological model provides one valuable inroad to exploring and analyzing sexual response patterns. The following comments briefly evaluate the current status of the use of this model as it applies to female sexual response.

Ethical and cultural concerns in sexual function assessment.

The ethical and cultural issues accompanying sex research methods are rarely discussed. The present remarks briefly examine three previously described ethical principles--respect for people, beneficence and justice--as they might relate to sexual dysfunction assessment in clinical trials. Given the fact that sexuality is a social behavior and the outcome measures are reliant on some form of self report, there are specific pressures on investigators to conduct research assessment that respects ethical principles and cultural values. Examples with respect to screening criteria and participant selection are discussed. Recommendations include: (a) excluding participants with selected sexual and non-sexual diagnoses, psychosocial behaviors and habits; (b) including proportional ethnic groups as well as non-heterosexual participants; and (c) considering the couple, rather than just an individual, as study subjects who each require medical and psychosocial screening, assessment, and informed consent.

Psychological and physical factors involved in chronic idiopathic prostatitis.

Idiopathic prostatitis is a common, often chronic condition in which psychological factors are suspected to play a role. Men with chronic prostatitis (n = 51) and a control group of 34 men without any chronic pain condition, equivalent on demographic characteristics, were compared on psychological and perineal muscle tension measures. Prostate-specific antigen and expressed prostatic secretion cell counts were also measured. Chronic prostatitis patients were consistently more elevated than controls on hypochondriasis, depression, and hysteria (MMPI), and on somaticization and depression (Brief Symptom Inventory), and were less elevated on masculine/instrumentality (Personal Attributes Questionnaire) scales. A cluster analysis of MMPI profiles revealed that 57% of the chronic prostatitis patients produced generally unelevated MMPI profiles, whereas the remaining 43% fell into two groups with distinct patterns of distress. The results indicate depression and psychosocial distress are common among chronic prostatitis patients, calling for careful evaluation and attention to psychological symptoms.

Sickness impact of chronic nonbacterial prostatitis and its correlates.

PURPOSE: There is evidence that many patients experiencing chronic idiopathic prostatitis or prostadynia not only have recurrent physical symptoms but also display a range of psychological symptoms, such as depression or anxiety, suggesting that the symptoms of chronic prostatitis may seriously impact on quality of life functioning. We investigated the degree of sickness impact of chronic prostatitis, and the differential importance of physical and psychological symptoms in predicting sickness impact. MATERIALS AND METHODS: The sickness impact profile as well as several symptom measures were administered to 39 patients with chronic prostatitis. Multiple regression analyses were performed to evaluate what proportion of the variance in quality of life or functional status was explained by physical and psychological symptoms. RESULTS: The sickness impact profile mean total score of chronic prostatitis patients was within the range of scores reported in the literature for patients suffering myocardial infarction, angina or Crohn's disease. Pain was the only physical symptom that significantly contributed towards explaining variance in sickness impact. Psychological symptoms added significantly to the amount of predicted variance. CONCLUSIONS: The results indicate a need for careful evaluation and attention to sickness related dysfunctions in patients with chronic prostatitis.

A preliminary investigation of affective and cognitive response to erotic stimulation in men before and after sex therapy.

Affective and cognitive responses to erotic stimulation were studied in sexually dysfunctional men before and after treatment in a sex therapy program. A comparison group of functional men was studied over the same time interval. A pool of 34 Likert-scaled items assessing various cognitions, affects, and perceptions was administered during baseline and following two erotic audiotapes and a self-generated sexual fantasy. To focus on global response patterns rather than individual item responses, five aggregate indices (sexual arousal, physicality, sensuality, negative affect, positive affect) were derived using a strategy that combined face-validity and reliability analysis. Cluster analysis was employed as an auxiliary technique to confirm the coherence of these groupings. All five indices differentiated dysfunctional men from controls, and further, three indices (physicality, sensuality, sexual arousal) showed significant variation across types of erotic stimulation. Correlations among the five indices, as well as with penile response, revealed two trends that differentiated dysfunctional men from controls during the pretest, but that diminished following sex therapy in the dysfunctional men. Future investigations might further rely on multiple-item indices as described here. Such measures may provide a more integrated view of sexual response in the laboratory and lead to greater understanding of affective and perceptual differences between functional and dysfunctional men.

Metabolic and behavioral effects of high-dose, exogenous testosterone in healthy men.

In addition to their use as replacement therapy for hypogonadal males, androgens, particularly testosterone (T), are being explored as potential hormonal male contraceptive agents, alone or in combination with other compounds. Androgens have regulatory effects on a variety of physiological systems in addition to gonadotropin secretion and spermatogenesis. Therefore, as hormonal contraceptive regiments that alter serum T levels are explored, it is important to evaluate their effects on these aspects of normal male physiology. The effects of exogenous T on suppression of spermatogenesis in 19 healthy men were recently compared, using a T dosage of 200 mg im/week for 20 weeks. Before treatment, the men were evaluated during a 3-month pretreatment period, and after treatment, they were followed for 4-6 months or until their sperm counts normalized. Because of the lack of information regarding the effects of exogenous T on nonreproductive physiology, we examined the effects of high-dose T on plasma lipids, calcium metabolism, and sexual behavior in our subjects. Mean serum T and estradiol levels increased significantly during the treatment period. Plasma high-density lipoprotein (HDL) cholesterol levels decreased significantly within the first month and remained suppressed during the duration of T administration. At the end of the treatment period, mean plasma HDL cholesterol had decreased by 13 +/- 2% (P < 0.05); plasma levels of HDL2, HDL3, and apoprotein AI also decreased significantly; mean levels of low density lipoprotein cholesterol and triglycerides were unchanged. After 1 month of the recovery period, plasma HDL levels had returned to the baseline range. Serum calcium levels decreased slightly during treatment; this decrease was statistically significant. Urinary calcium excretion did not change. Mean levels of serum intact PTH increased by 84 +/- 17% (P < 0.05) during T administration; in contrast, 25-hydroxyvitamin D levels decreased by 16 +/- 4% (P < 0.05), and 1,25-dihydroxyvitamin D levels did not change significantly. All markers of calcium metabolism returned to baseline during the posttreatment period. Little change was found in self-reported sexual and aggressive behaviors during the study. There was a trend toward increased arousal and spontaneous erections during T administration, but this did not reach statistical significance. Frequency of sexual intercourse, masturbation, and kissing and fondling did not change, nor was the subjects' satisfaction in their relationships affected by T administration. Mean body weight increased by 4.0 +/- 0.5 kg. Approximately half the men noted mild acne. Body weight and acne symptoms returned to baseline during the recovery period.(ABSTRACT TRUNCATED AT 400 WORDS)

Effects of endogenous testosterone and estradiol on sexual behavior in normal young men.

The importance of androgens in establishing and maintaining sexual function in males of most species is well recognized. Estrogens also stimulate male sexual function in some species. In men, most studies of androgen effects on behavior have used hypogonadal men as an experimental model; much less is known about the role of endogenous testosterone (T) or estradiol (E2) in the regulation of behavior in healthy, eugonadal men. In a randomized, double-blind study, we used a GnRH antagonist, Nal-Glu, without T replacement, to induce acute, profound, reversible gonadal steroid deficiency in 9 normal men for 6 weeks (Nal-Glu alone). We also studied the effects of partial androgen replacement by administering Nal-Glu together with T enanthate, 50 mg im weekly, to 10 other men. A third group of 10 men received Nal-Glu plus T, 100 mg im weekly. We studied the role of endogenous E2 by administering Nal-Glu plus T, 100 mg im weekly, plus an aromatase inhibitor, testolactone (Teslac), 250 mg po qid, to 10 additional men (Nal - Glu + T + Teslac). Nine men received placebo injections and tablets. All subjects completed a behavioral questionnaire during the pretreatment period, at weeks 2, 4, and 6 of treatment, and at 3 weeks posttreatment. Men who received Nal-Glu alone became profoundly hypogonadal within 1 week after treatment began. Serum T levels did not change significantly in the controls and in the men who received full T replacement but decreased to approximately half the baseline level in men who received partial T replacement. E2 levels decreased profoundly in men who received Nal-Glu alone or Nal - Glu + T + Teslac and to a lesser degree in men who received partial T replacement. In men who received Nal-Glu alone, there were clinically and statistically significant decreases in the frequency of sexual desire, sexual fantasies, and intercourse at 4-6 weeks. These men also showed a strong trend (P = 0.55) towards decreased spontaneous erections after 4 and 6 weeks of treatment. A significant decrease in the frequency of masturbation was evident after 6 weeks. All measures returned to normal by posttreatment week 3. There was a trend toward increased aggression in the hypogonadal men, but this did not reach statistical significance. No changes in satisfaction or happiness with their partners were observed.(ABSTRACT TRUNCATED AT 400 WORDS)