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Background: Pelvic pain worsened by orgasm is a poorly understood symptom in patients with endometriosis., Aim: To assess the prevalence of pelvic pain worsened by orgasm in patients with endometriosis and explore its association with potential etiologic factors, including pelvic floor myalgia, uterine tenderness and adenomyosis, and central nervous system sensitization., Methods: An analysis was done of a prospective data registry based at a tertiary referral center for endometriosis. Eligible participants were patients aged 18 to 50 years who were referred between January 1, 2018, and December 31, 2019, diagnosed with endometriosis, and subsequently underwent surgery at the center. Clinical features were compared between participants reporting worsening pelvic pain with orgasm and those without worsening pain with orgasm, including patient-reported variables, physical examination findings, and anatomic phenotyping at the time of surgery. Pelvic floor myalgia and uterine tenderness were assessed by palpation on pelvic examination, adenomyosis by ultrasound, and central nervous system sensitization via the Central Sensitization Inventory (range, 0-100)., Outcomes: Outcomes included pelvic or lower abdominal pain in the last 3 months that worsened with orgasm (yes/no)., Results: Among 358 participants with endometriosis, 14% (49/358) reported pain worsened by orgasm while 86% (309/358) did not. Pain with orgasm was significantly associated with pelvic floor myalgia (55% [27/49] vs 35% [109/309]; Cohen's h = 0.40, P = .01) and higher scores on the Central Sensitization Inventory (mean ± SD, 53.3 ± 17.0 vs 42.7 ± 18.2; Cohen's d = 0.60, P < .001) but not with uterine tenderness or adenomyosis. Other clinical features associated with pain with orgasm were poorer sexual health (higher scores: deep dyspareunia, Cohen's h = 0.60; superficial dyspareunia, Cohen's h = 0.34; and Female Sexual Distress Scale-Revised, Cohen's d = 0.68; all P < .05) and poorer mental health (higher scores: Patient Health Questionnaire-9, 12.9 ± 6.7 vs 9.1 ± 6.3, Cohen's d = 0.59, P < .001; Generalized Anxiety Disorder-7, 9.4 ± 5.6 vs 6.8 ± 5.5, Cohen's d = 0.48, P = .002). Anatomic findings at the time of surgery did not significantly differ between the groups., Clinical Implications: Interventions targeting pelvic floor myalgia and central nervous system sensitization may help alleviate pain worsened by orgasm in patients with endometriosis., Strengths and Limitations: A strength is that pain worsened by orgasm was differentiated from dyspareunia. However, pain with orgasm was assessed by only a binary question (yes/no). Also, the study is limited to a single center, and there were limited data on sexual function., Conclusion: Pelvic pain exacerbated by orgasm in people with endometriosis may be related to concurrent pelvic floor myalgia and central sensitization., (© The Author(s) 2024. Published by Oxford University Press on behalf of The International Society of Sexual Medicine.)

There is a critical gap in sex education such that many people lack access to evidence-based and accessible information about sexuality, putting them at risk for endorsing myths about sex and in turn having poorer sexual wellbeing. To address this gap, we developed a novel social media knowledge translation initiative-MisconSEXions-to debunk common myths about sexuality. The goal of this study was twofold. First, to examine whether exposure to MisconSEXions is effective for reducing sexuality myth endorsement. Second, to evaluate the acceptability (participants' satisfaction with the content), appropriateness (the perceived fit of the content with participants), adoption (participants' intention to engage with the initiative), and penetration (participants' perception of the content's impact on their lives) of MisconSEXions among study participants. We also examined possible group differences in our observed effects by assigned sex, gender modality, and sexual orientation. A large and diverse sample ( N = 2,356) of adults completed an online survey and reported on their demographics, sexuality myth endorsement before and after exposure to MisconSEXions content, and the acceptability, appropriateness, adoption, and penetration of the MisconSEXions content. We found that participants' sexuality myth endorsement was significantly lower following exposure to MisconSEXions content, and this effect held across assigned sex, gender modality, and sexual orientation groups. Regardless of participants' assigned sex, gender modality, or sexual orientation, MisconSEXions content was reported to be both acceptable and appropriate to people's lives. Participants reported relatively low levels of adoption, such that they reported reluctance to engage with the content on social media. Additionally, participants reported mixed feelings regarding the impact of the content on their lives (i.e., penetration). Overall, the findings have implications for how sexuality social media knowledge translation initiatives can fill important gaps in providing inclusive and accessible sex education., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 O’Kane, Goldberg, Bouchard and Dawson.)

Female sexual interest/arousal disorder (SIAD) is strongly influenced by interpersonal factors; however, there are no empirically-supported, couple-based sex therapy interventions for this disorder. This pre-registered study tested the feasibility of a cognitive-behavioral couple therapy (CBCT) intervention for SIAD. A sample of 19 couples in which a female partner was diagnosed with SIAD completed a 16-session CBCT intervention delivered online by therapists with PhD-level training in clinical psychology. Women with SIAD ( M age  = 43.47, SD  = 12.76) and their partners ( M age  = 43.74, SD  = 11.68) were in long-term relationships ( M  = 13.86, SD  = 9.15). The CBCT sessions were video recorded and independently coded for treatment manual adherence and therapists reported on the completion of in-session and homework exercises. Participants completed measures of treatment satisfaction following the intervention as well as dyadic sexual desire (women with SIAD only) and sexual distress prior to treatment, post-treatment, and at 6 months follow-up. The therapists exhibited a high level of adherence to the treatment manual and couples had high rates of homework completion. Moreover, couples had low dropout rates, high attendance rates, and reported moderately high global treatment satisfaction and high satisfaction with virtual care. Women with SIAD reported large improvements in dyadic sexual desire and sexual distress from pre-treatment to post-treatment and pre-treatment to 6-month follow-up. Partners reported moderate and small improvements in sexual distress for post-treatment and 6-month follow-up, respectively. Results support the feasibility of an evidence-based CBCT intervention for SIAD and the need for a randomized clinical trial of the intervention.

Negative genital self-image is linked with lower sexual satisfaction, but no research has examined its association with perceptions of partners' sexual satisfaction. In two studies ( N  = 475, N  = 234), we examined links between genital self-image and own and individuals' perceived partner sexual satisfaction. In the second study, we tested whether a mindfulness intervention moderated these associations. In both studies, more negative genital self-image was significantly associated with individuals' lower own and perceived partner sexual satisfaction concurrently and over a two-week period. Mindfulness intervention exposure did not moderate associations. Findings support negative genital self-image as a risk factor for sexual dissatisfaction.

Background: Couples in long-term relationships often face sexual challenges (eg, sexual response difficulties) that may disrupt their typical sexual routine or sexual script. Individuals with more rigid sexual scripts (eg, sex must include penile-vaginal intercourse) may struggle to navigate their sexual difficulties, potentially resulting in lower sexual well-being for themselves and their partners., Aim: In a dyadic longitudinal study, we examined whether individuals' greater sexual script flexibility when coping with recent sexual challenges was associated with their own and their partner's greater sexual well-being (ie, dyadic sexual desire, sexual satisfaction, low sexual distress)., Methods: Seventy-four mixed- and same-gender/sex couples in long-term relationships completed online surveys about sexual script flexibility and facets of sexual well-being at baseline and 4 months later. Dyadic data were treated as indistinguishable and analyzed using multilevel modeling guided by the actor-partner interdependence model., Outcomes: Self-report measures of dyadic sexual desire (Sexual Desire Inventory-2), sexual satisfaction (Global Measure of Sexual Satisfaction), and sexual distress (Sexual Distress Scale-Short Form) were assessed at baseline and follow-up., Results: Cross-sectional results showed that when individuals reported greater sexual script flexibility in response to recent sexual challenges, they and their partners reported greater sexual satisfaction. Individuals' greater sexual script flexibility was also linked to their own greater dyadic sexual desire and lower sexual distress. Unexpectedly, individuals' greater sexual script flexibility was associated with their partner's lower dyadic sexual desire at baseline and their own lower dyadic sexual desire 4 months later. No other associations were found between sexual script flexibility and sexual outcomes 4 months later and there were no interactions between individuals' gender and sexual script flexibility for the cross-sectional models., Clinical Implications: The cross-sectional associations between sexual script flexibility and sexual well-being provides some support for the idea that modifying rigid sexual scripts in sex and couple therapy may promote contemporaneous sexual well-being., Strengths and Limitations: This is the first dyadic study, to our knowledge, to assess the assumed benefits of greater sexual script flexibility for couples' sexual well-being. The relatively small and homogeneous sample of community couples who had largely intact sexual well-being limits generalizability., Conclusion: Findings provide preliminary evidence of cross-sectional links between sexual script flexibility and sexual well-being for individuals and couples, lending empirical support to the convention of promoting sexual script flexibility to help couples cope with sexual challenges. The mixed findings for the association between sexual script flexibility and dyadic sexual desire warrant additional study and replication., (© The Author(s) 2023. Published by Oxford University Press on behalf of The International Society of Sexual Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Laser Doppler imaging is a valid method of assessing genital response, detecting increases in genital blood flow to sexual, but not nonsexual stimuli. Although laser Doppler imaging provides a direct measure of genital blood flow, its discrete perfusion images provide a discontinuous assessment of genital response, limiting some study designs. The aims of this study were to investigate the measurement properties of laser Doppler flowmetry, a direct and continuous measure of blood flow, as well as examine the time course of genital response using flowmetry. A sample of 45 cisgender women attended two experimental sessions wherein they viewed sexual and nonsexual stimuli (e.g., neutral, anxiety, humor) while their genital responses were assessed using laser Doppler flowmetry. As expected, laser Doppler flowmetry was a valid measure of genital response-detecting increases in genital blood flow elicited by the sexual stimuli only-and was sensitive to varying degrees of genital response elicited by low, moderate, and high-intensity sexual stimuli. The measure also exhibited convergent validity with genital response assessed via laser Doppler imaging, test-retest reliability across testing sessions, and internal consistency as well as high sexual concordance with self-reported sexual arousal. Descriptive analyses showed that genital blood flow assessed using laser Doppler flowmetry was highly responsive, with initial, peak, and return to baseline responses occurring within timeframes appropriate for repeated measurement within a single session. Laser Doppler flowmetry is a valid, reliable, and sensitive measure of women's genital response that can be usefully applied in sexual psychophysiology research., (© 2022 Society for Psychophysiological Research.)

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., (Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.)

Purpose of Review: We examine the state of scientific research on the assessment of paraphilic interests among women who have committed sexual offences., Recent Findings: Research on the assessment of sexual interests in women using genital measures shows little evidence, overall, that women's genital responses are indicative of sexual interests. Some non-genital measures of sexual interest may be a valid indicator of age interests. Very few studies have focused on women who sexually offend. At this time, there is no validated measure that can be used to assess paraphilic interests among women who sexually offend. Much research is needed to determine if some measures (other than self-report) could validly assess a variety of sexual interests in women in general, and women who sexually offend in particular (e.g. interest in children, interest in sexual violence). This research is needed to determine if paraphilic interests are involved in women's motivation for sexual offending, and to determine if such interests are predictive of sexual recidivism.

Sexuality research is often regarded as more intrusive than other types of research, contributing to sample self-selection biases. Researchers have consistently found that volunteers and non-volunteers for sexuality studies differ on a number of sexuality-related variables. Despite a large number of studies examining volunteer biases, relatively few have examined the effects of gender and exclusivity of sexual attraction on willingness to volunteer. Given that comparisons on the basis of gender and/or sexual attraction are frequently made in sexuality studies, understanding how these factors may contribute to volunteer bias is particularly important. In the current study, we investigated the impact of gender and sexual attraction, as well as individual difference variables, on hypothetical willingness to volunteer for a variety of sexuality studies, including new measurement technologies not previously investigated. Greater proportions of men and individuals with any degree of same-gender attraction reported that they were willing to volunteer for eye tracking and psychophysiology studies, whereas there were no significant effects of gender or sexual attraction on willingness to volunteer for sexuality surveys. The proportions of volunteers willing to participate were inversely related to study invasiveness. Greater sexual experience and more positive sexual attitudes were significant predictors of willingness to volunteer, whereas gender, sexual attraction, and other sexuality characteristics were not significant predictors. Implications of volunteer bias for research findings are discussed. Strategies to minimize volunteer bias and to examine whether or not recruited samples differ from the population are provided.

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.

Laser Doppler imaging has recently been applied to the study of female sexual response, with promising results. The current study sought to provide further validation for its use in this capacity, as well as to examine the sexual psychophysiological concepts of genital non-response and return to baseline with this instrument. A sample of healthy heterosexual women without any sexual concerns (N = 24) participated in a single testing session design, which included self-report measures and genital imaging with the laser Doppler imager (LDI). During the imaging portion of the study, genital and subjective arousal data were collected while participants watched neutral and erotic film stimuli. The results support the validity of the LDI as a measure of female sexual arousal, and highlight its potential utility in research and clinical applications for sexual function and related difficulties., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Genital lubrication and blood flow are theoretically related outcomes of women's sexual response that prepare the genitals for sexual activity. Despite its importance for sexual function, few experimental studies have directly assessed genital lubrication or empirically demonstrated how genital lubrication and blood flow relate during sexual arousal. In this study, 36 women viewed stimuli that varied by sexual activity intensity (nonsexual, low-intensity sexual, and high-intensity sexual) while their genital responses were assessed using concurrent measures of genital lubrication (using litmus test strips) and genital blood flow (using laser Doppler imaging). Both measures detected a genital response to high-intensity sexual stimuli relative to nonsexual; however, only the laser Doppler imager was sensitive to varying degrees of genital response elicited by stimuli of different sexual activity intensities. The two measures of genital response were suitable for repeated measurement within a single session. Genital lubrication and blood flow were positively correlated for the high-intensity sexual stimuli. Implications for the assessment of women's genital response and understanding women's sexual arousal are discussed., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Investigations of sexual concordance suggest that, on average, women exhibit a low, positive correlation between their subjective sexual arousal and genital response. However, this relationship appears to be stronger, on average, when genital response is measured via the external tissues of the vulva than within the vagina walls. Given the methodological variations, such as stimulus content and duration, in studies of vulvar and vaginal concordance, direct comparisons between individual studies are limited. In the current study, sexual concordance was examined using concurrent measures of vulvar blood flow (using laser Doppler imaging) and vaginal vasocongestion (using vaginal photoplethysmography) to investigate potential differences in vulvar and vaginal concordance. Twenty-five women viewed two erotic films that differed in sexual activity content (foreplay and intercourse) while their subjective sexual arousal and genital response was measured. In support of previous meta-analytic findings, results suggest that subjective sexual arousal is more strongly correlated with vulvar blood flow than with vaginal vasocongestion. Likewise, perceived genital response and actual vulvar blood flow are more strongly related than are vaginal vasocongestion and self-reported genital sensations. Practical implications for the study of women's sexual concordance as well as broader implications for the understanding of female sexuality are considered.

Gender differences in the specificity of sexual response have been a primary focus in sexual psychophysiology research, however, within-gender variability suggests sexual orientation moderates category-specific responding among women; only heterosexual women show gender-nonspecific genital responses to sexual stimuli depicting men and women. But heterosexually-identified or "straight" women are heterogeneous in their sexual attractions and include women who are exclusively androphilic (sexually attracted to men) and women who are predominantly androphilic with concurrent gynephilia (sexually attracted to women). It is therefore unclear if gender-nonspecific responding is found in both exclusively and predominantly androphilic women. The current studies investigated within-gender variability in the gender-specificity of women's sexual response. Two samples of women reporting concurrent andro/gynephilia viewed (Study 1, n = 29) or listened (Study 2, n = 30) to erotic stimuli varying by gender of sexual partner depicted while their genital and subjective sexual responses were assessed. Data were combined with larger datasets of predominantly gyne- and androphilic women (total N = 78 for both studies). In both studies, women reporting any degree of gynephilia, including those who self-identified as heterosexual, showed significantly greater genital response to female stimuli, similar to predominantly gynephilic women; gender-nonspecific genital response was observed for exclusively androphilic women only. Subjective sexual arousal patterns were more variable with respect to sexual attractions, likely reflecting stimulus intensity effects. Heterosexually-identified women are therefore not a homogenous group with respect to sexual responses to gender cues. Implications for within-gender variation in women's sexual orientation and sexual responses are discussed.