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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.

Women’s genital responses measured with a vaginal photoplethysmograph (VPP) demonstrate relatively low cue-specificity for gender/sex cues—the difference in genital responses between sexual stimuli with male or female content is relatively small compared to that of men. Cue-specificity for gender/sex cues is particularly low for androphilic women. It is common practice to compare responses to sexual stimuli (typically 60–120 s film clips) using a mean or peak (highest) value. This approach overlooks the continuous and dynamic nature of sexual responding during a stimulus. Recent results suggest that cue-specificity of genital response may increase throughout the duration of a sexual stimulus. We tested this possibility in a sample of 18 androphilic women. Sexual stimuli consisted of 240 s audiovisual film clips depicting male and/or female partnered sex or solitary masturbation. Gender/sex cue-specificity, assessed using VPP, did not vary across time: The degree of cue-specificity and the magnitude of genital response were established by approximately 60–90 s and were consistent throughout the stimulus duration. Low cue-specificity for genital response was observed despite variation in self-reported sexual arousal across stimulus categories. The findings are discussed within the context of initial- and later-occurring aspects of the sexual response, according to the information processing model of sexual arousal. The results also suggest that 90–120 s stimuli are of sufficient duration to capture vaginal photoplethysmographic responses to audiovisual stimuli in sexual psychophysiological research.

Introduction The vaginal photoplethysmograph (VPP) is a reusable intravaginal device often employed in sexual psychophysiology studies to assess changes in vaginal blood flow, an indicator of sexual arousal. Aim To test whether placing a disposable cover on the VPP probe impacts the acquired data. A condom cover would reduce risk of disease transmission and likely increase participant comfort but may negatively impact the VPP signal. Method The genital responses of 25 cisgender women (mean age = 21.3 years, standard deviation = 2.6) were assessed with VPP in a within-subjects design with 2 conditions—with and without a polyisoprene condom cover. Sexual responses were elicited by audiovisual film clips that varied in erotic intensity: nonsexual (nonsexual male-female interaction), low-intensity sexual (nude exercise), and high-intensity sexual (male-female intercourse). Women continuously rated their sexual arousal during stimulus presentations. Main Outcome Measure Change in vaginal pulse amplitude and also self-reported sexual arousal. Results The magnitude of sexual response to each stimulus category and the overall pattern of results were found to be highly similar in the cover-off and cover-on conditions. The high-intensity sexual stimulus category elicited a greater sexual response than all other categories. The low-intensity sexual category elicited a (small) genital response in only the cover-on condition, although we suspect this is a spurious finding. There was no difference in the average number of edited movement artifacts across conditions. Clinical Implications Potential benefits of encasing the VPP probe with a protective cover include enhanced participant safety and comfort, especially if assessing genital responses of high-risk or immunocompromised samples. The use of a cover complies with current guidelines for reprocessing semi-critical medical devices (eg, vaginal ultrasound probes) in many regions. Strengths & Limitations Although the idea of a VPP probe cover had been discussed among sexual psychophysiology researchers, this is the first study to empirically test whether a cover could jeopardize VPP data. Potential limitations include the use of a 10-Hz VPP sampling rate and a cover that was not tailored to the size of the VPP probe. Conclusion Placing a protective cover on the VPP probe did not appear to meaningfully impact sexual arousal or the VPP data. Based on these results and the potential advantages of a protective cover, researchers may wish to integrate the use a condom cover in their experiment protocols and clinical applications.

Vaginal photoplethysmography is a method for physiological evaluation of sexual arousal in women. This paper undertook to obtain the validity and reliability of a set of sexual stimuli in young heterosexual women. Six six-minute video clips were selected. A total of 34 women aged 18–30 years (M = 22.38, SD = 2.52) participated in this study. Objective Sexual Arousal, Subjective Sexual Arousal, emotional activation, emotional valence and socio-psycho-sexual information were evaluated. Three of the six sexual stimuli were selected from the scores obtained after the experimental phase. It was observed that the aforementioned video clips produced the most arousal-activation-pleasure, with internally consistent measures. As expected, good indicators of external validity were observed, with statistically significant differences. According to the data obtained, the pooled use of the three stimuli increases the likelihood of obtaining an objective arousal response in healthy young women, thereby minimizing the possibilities of displeasure.

Introduction Validated instruments for assessing specific thought content during exposure to sexually explicit material are lacking. Aim To investigate the psychometric properties of a measure that assesses self-reported thoughts during exposure to sexual stimuli in laboratory settings, namely the Sexual Thoughts Questionnaire. The factorial structure of the questionnaire and its reliability and validity were examined. Methods One hundred sixty-seven sexually functional individuals (97 women and 70 men) were exposed to sexually explicit material while their genital arousal was being assessed. Subjective sexual arousal and thoughts during exposure to sexually explicit material also were assessed. Main Outcome Measures Women's genital arousal was measured with a vaginal photoplethysmograph and men's genital arousal was measured with an indium-gallium strain gauge. Subjective sexual arousal and thoughts during exposure to erotica were assessed with self-report scales. Results Principal component analysis with varimax rotation identified five factors: sexual arousal thoughts, distractive and disengaging thoughts, body image and performance thoughts, actress's physical attractiveness thoughts, and sinful and lack of affection thoughts. Moreover, the scale showed satisfactory levels of internal consistency. Studies on convergent validity showed an association between self-reported thoughts and subjective sexual arousal levels in the women and men. Conclusion The Sexual Thoughts Questionnaire showed adequate psychometric properties in a sexually functional sample. It could be useful in further experimental research on the role of cognitions in sexual response and allow further comparison between sexually functional and dysfunctional individuals, with possible significant implications for the assessment and treatment of sexual problems.

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.

Introduction Sexual concordance refers to the association between physiological and self‐reported sexual arousal. Women typically exhibit lower sexual concordance scores than men. There is also a sex difference in interoception —awareness of (nonsexual) physiological states or responses—such that women, compared with men, tend to be less aware of and less accurate at detecting changes in their physiological responses. Women with anxiety problems tend to have better interoceptive abilities than nonanxious women. Aim To investigate whether women's lower sexual concordance is associated with interoception using a sample likely to show high variation in interoceptive abilities. Method Sixteen anxious and 15 nonanxious women were presented with twelve 90 seconds sexual and nonsexual film clips while their genital response, heart rate, and respiration rate were measured. A heartbeat mental tracking task was also employed. Main Outcome Measures Genital response was measured with a vaginal photoplethysmograph. Heart rate was measured with an electrocardiogram and respiration rate with a thermistor. Participants estimated their physiological responses after each film. A mental tracking task was also used to assess participants' awareness of heart rate. Within‐subject correlations were computed for each physiological/self‐reported response combination. Results Overall, sexual concordance (i.e., the correlation between genital responses and perceptions of genital response) was not significantly associated with heart rate awareness or respiration rate awareness. Anxious women did not exhibit significantly higher sexual concordance or heart rate awareness than nonanxious women; the nonanxious women actually exhibited higher respiration rate awareness. Conclusion The results suggest that sexual concordance may be a distinct phenomenon from interoception and in need of its own explanation. Suschinsky KD and Lalumiere ML. The relationship between Sexual concordance and interoception in anxious and nonanxious women. J Sex Med 2014;11:942–955.

Introduction In general, laboratory studies have shown low correlations between subjective (ie, self-report) and physiologic (ie, vaginal pulse amplitude) measurements of sexual arousal in women. One explanation for this presumed low concordance is that women might not be attending to their genital responses and/or might be unable to accurately perceive their genital responses. Aim To examine the extent to which women can perceive their genital arousal sensations, the role that interoceptive awareness plays in this ability, and whether interoceptive awareness influences sexual concordance in women. Methods Twenty-six sexually functional women viewed an erotic film while their physiologic and perceived genital sexual arousal levels were measured continuously. Self-report measurements of sexual function and bodily awareness also were administered. Main Outcome Measures Physiologic sexual arousal was measured with a vaginal photoplethysmograph, and perception of genital arousal was measured with an arousometer. Degree of bodily awareness was measured with the Multidimensional Assessment of Interoceptive Awareness questionnaire. Results Women exhibited a significant degree of agreement between physiologic and perceived genital arousal (P < .05). Interoceptive awareness was found to significantly moderate this relation (P < 0.05), such that a greater degree of interoceptive awareness facilitated greater agreement between physiologic and perceived genital arousal. Interoceptive awareness also was found to facilitate greater concordance between subjective and physiologic sexual arousal (P < .05). Conclusion Women can perceive their genital response, and interoceptive awareness influences this ability and the relation between subjective and physiologic sexual arousal. Increasing bodily awareness could be a plausible route for treatment development.

Vaginal pulse amplitude (VPA) has been the most commonly analyzed signal of the vaginal photoplethysmograph. Frequent, large, and variable-morphology artifacts typically have crowded this signal. These artifacts usually were corrected by hand, which may have introduced large differences in outcomes across laboratories. VPA signals were collected from 22 women who viewed a neutral film and a sexual film. An automated, wavelet-based, denoising algorithm was compared against the uncorrected signal and the signal corrected in the typical manner (by hand). The automated wavelet denoising resulted in the same pattern of results as the hand-corrected signal. The wavelet procedure automated artifact reduction in the VPA, and this mathematical instantiation permits the comparison of competing methods to improve signal:noise in the future.

The assessment of sexual arousal in men and women informs theoretical studies of human sexuality and provides a method to assess and evaluate the treatment of sexual dysfunctions and paraphilias. Understanding measures of arousal is, therefore, paramount to further theoretical and practical advances in the study of human sexuality. In this meta-analysis, we review research to quantify the extent of agreement between self-reported and genital measures of sexual arousal, to determine if there is a gender difference in this agreement, and to identify theoretical and methodological moderators of subjective-genital agreement. We identified 132 peer- or academically-reviewed laboratory studies published between 1969 and 2007 reporting a correlation between self-reported and genital measures of sexual arousal, with total sample sizes of 2,505 women and 1,918 men. There was a statistically significant gender difference in the agreement between self-reported and genital measures, with men (r = .66) showing a greater degree of agreement than women (r = .26). Two methodological moderators of the gender difference in subjective-genital agreement were identified: stimulus variability and timing of the assessment of self-reported sexual arousal. The results have implications for assessment of sexual arousal, the nature of gender differences in sexual arousal, and models of sexual response.

Introduction An automatic algorithm for processing vaginal photoplethysmograph signals could benefit researchers investigating sexual behaviors by standardizing interlaboratory methods. Female sexual response does not co‐vary consistently in the self‐report and physiological domains, making the advancement of measurements difficult. Automatic processing algorithms would increase analysis efficiency. Vaginal pulse amplitude (VPA) is a method used to measure female sexual responses. However, VPA are problematic because of the movement artifacts that impinge on the signal. This article suggests a real‐time approach for automatic artifact detection of VPA signals. The stochastic changes (artifacts) of VPA are characterized mathematically in this research, and a method is presented to automatically extract the frequency of interest from VPA based on the autocorrelation function and wavelet analysis. Additionally, a calculation is presented for the vaginal blood flow change rate (VBFCR) during female sexual arousal using VPA signals. Aim The primary aim is to investigate the experimental VPA measures based on theoretical techniques. Particularly, the goal is to introduce an automatic monitoring system for female sexual behaviors, which may be helpful for experts of female sexuality. Methods The methods in the research are divided into experimental and theoretical parts. The VPA in twenty women was measured by a common vaginal photoplethysmography system in two conditions. Each subject was tested watching a neutral video followed by an erotic video. For theoretical analysis, an approach was applied based on wavelet transform to process the VPA. Main Outcome Measures Introduction of an automatic and real‐time monitoring system for female sexual behaviors, automatic movement artifact detection, VBFCR, first application of wavelet transform, and correlogram in VPA analysis. Results The natural and significant frequency information of VPA signals was extracted to automatically detect movement artifacts and to investigate the effects of erotic videos on female sexual responses. Conclusions The computerized automatic systems based on advanced math and statistics have several advantages for human sexuality research such as: savings in time and budget; increase in the accuracy of results; and reduction in human errors for data analysis. Rafiee J, Rafiee MA, and Michaelsen D. Female sexual responses using signal processing techniques.

Introduction. Theoretically, the physiological response to stress should inhibit the sexual response. This has been demonstrated experimentally in animal models, and correlationally in studies of human reproduction. It is reasonable to expect, then, that the stress response would be blunted during sexual arousal, and several researchers have found a pattern of decreasing cortisol during sexual arousal. Aim. In the present study, we explored individual differences in women's cortisol response to sexual arousal in a laboratory setting. We also examined how cortisol response in the laboratory related to a validated measure of sexual arousal functioning in real life. Main Outcome Measures. Cortisol levels were measured in saliva via enzyme immunoassay. Subjective arousal was measured by a self-report questionnaire, and genital arousal was measured by a vaginal photoplethysmograph. Methods. Subjective and physiological responses to an erotic film were assessed in 30 women. Saliva samples were taken at baseline and following the film. Results. The majority of women (N = 20) showed a decrease in cortisol; nine women showed an increase in response to an erotic film. The women who showed an increase in cortisol had lower scores on the Arousal, Desire, and Satisfaction domains of the Female Sexual Function Index. Genital arousal in the laboratory was not related to cortisol change. Conclusions. Women who show an increase in cortisol in response to sexual stimuli in the laboratory have lower levels of functioning in certain areas of their sexual life compared with women who show a decrease in cortisol. Stress related to sexual performance may interfere with sexual arousal. Hamilton LD, Rellini AH, and Meston CM. Cortisol, sexual arousal, and affect in response to sexual stimuli. J Sex Med 2008;5:2111-2118.

The effects of heightened sympathetic nervous system (SNS) activity via laboratory-induced hyperventilation (LIH) on subjective and physiological sexual arousal were examined in a heterogeneous group of women with Sexual Arousal Disorder (SAD; n = 60), as well as across subtypes of SAD, in comparison to a control group of women without sexual difficulties (n = 42). Participants took part in 2 min of rapid breathing, a technique previously found to increase SNS activity, immediately prior to viewing erotic stimuli. Physiological arousal (i.e., vaginal pulse amplitude; VPA) was measured via the vaginal photoplethysmograph and subjective arousal was measured via self-report questionnaires. LIH differentiated women with SAD from those in the control group, with LIH increasing VPA in the latter, but having no significant effect in the heterogeneous SAD group. However, among subtypes of SAD, LIH differentiated women with genital (n = 16) and subjective (n = 16) subtypes of SAD from women with combined SAD (n = 28) and women without sexual difficulties. Specifically, women in the control group and those with combined SAD had a significant increase in VPA whereas women with genital or subjective SAD had a significant decrease in VPA following LIH. There was no significant effect of LIH on any self-report measure of sexual arousal following erotic stimuli. Implications of the results for the conceptualization, diagnosis, and treatment of SAD are discussed.

In this study we investigated the effects of state and trait aspects of self-focused attention on genital and subjective sexual arousal of sexually functional, healthy women during presentation of audiovisual erotic stimuli. Psychophysiological sexual response was measured as vaginal pulse amplitude using a vaginal photoplethysmograph. Experiential aspects of sexual arousal were measured both during stimulus presentation and retrospectively after stimulus offset. Trait level of sexual self-focus was measured with the Sexual Self-Consciousness Scale. State self-focus was induced by switching on a TV camera that pointed at the participant's face and upper torso. A manipulation check revealed that both groups experienced equally elevated levels of self-focused attention of their physical appearance. Induction of state self-focus per se did not affect genital responses, but an interaction effect of self-focus and participants' level of trait sexual self-focus was revealed. Compared with women with low scores on this trait, women with high scores exhibited smaller genital responses when state self-focus was induced. Both groups did not differ when no self-focus was induced. Increase of state self-focus did not affect subjective sexual arousal, but participants with a high level of trait sexual self-focus reported stronger subjective arousal, compared with those with low trait level. The results were discussed with reference to previous work in this field. Some implications for treatment of sexual arousal disorder were discussed.

This study examined the influence of distraction on genital and subjective sexual responses of women with (N=20) and without (N=21) sexual problems. Female-produced erotic film fragments were presented to induce sexual response and a vaginal photoplethysmograph was used to measure genital sexual responding. Subjective sexual arousal was assessed in real time using a rotating button and, retrospectively, with visual analogue scales. Distraction load was manipulated through different verbal instructions on how to deal with pairs of digits. The results revealed an equally strong impeding effect of distraction on genital sexual responses and on subjective sexual responses when these were measured retrospectively in women with and without sexual problems. However, distraction did not affect subjective sexual responses when these were measured in real time. The implications of the finding that distraction equally affects women with and without sexual problems are discussed.

Conflicting data exist regarding the sexual arousal patterns of post-operative male-to-female (MTF) women with Gender Identity Disorder. The purpose of this study was to examine objective and subjective aspects of the sexual arousal response using a vaginal photoplethysmograph. Fifteen MTF women viewed neutral and erotic audiovisual film segments while their blood flow patterns were monitored. Subjective measures of affect and sexual arousal were taken before and immediately after the films. There was a significant increase in self-reported subjective arousal, perceived genital arousal, perceived autonomic arousal, and positive affect; however, movement artefacts interfered with our assessment of the genital arousal response. MTF women reported both low levels of pain and low levels of awareness of the vaginal probe during testing. These data are discussed in the context of differences in pelvic musculature between natal and new women and have implications for future studies that aim to measure sexual arousal objectively in MTF women.

This study explored effects of oral contraceptive pill (OCP) use on physiological sexual arousal as measured by a vaginal photoplethysmograph. Sixteen women aged 18-29 viewed audiovisual neutral and erotic stimuli before and an average of 6 weeks following the onset of OCP use. Although subjective measures of sexual arousal, including perceptions of genital arousal, significantly increased in response to erotic stimuli both before and after OCP onset, physiological sexual arousal only increased before OCP use. A comparison of individual responses before and after OCP onset reveals a much higher degree of intrasubject variability after OCP onset. We discuss these findings as they relate to OCP use as a confounding methodological variable to consider in future investigations employing vaginal photoplethysmography.

Aim The labial photoplethysmograph (LP), a new measure for assessing genital responses in women, was compared to the vaginal photoplethysmograph (VP). Methods Fifteen women wore both devices simultaneously while viewing neutral, sexual, sexually‐threatening, and threatening film clips. Results The LP and VP exhibited comparable specificity to sexual stimuli. Additionally, the LP demonstrated greater resistance to movement artifacts and a slightly higher correspondence with subjective measures of sexual arousal. Conclusion The LP, while somewhat more difficult to place and less comfortable than the VP, is a promising new measure of genital response in women that warrants further development.

Sexual arousal is category-specific in men; heterosexual men are more aroused by female than by male sexual stimuli, whereas homosexual men show the opposite pattern. There is reason to believe that female sexual arousal is organized differently. We assessed genital and subjective sexual arousal to male and female sexual stimuli in women, men, and postoperative male-to-female transsexuals. In contrast to men, women showed little category specificity on either the genital or the subjective measure. Both heterosexual and homosexual women experienced strong genital arousal to both male and female sexual stimuli. Transsexuals showed a category-specific pattern, demonstrating that category specificity can be detected in the neovagina using a photoplethysmographic measure of female genital sexual arousal. In a second study, we showed that our results for females are unlikely to be explained by ascertainment biases. These findings suggest that sexual arousal patterns play fundamentally different roles in male and female sexuality.

There is emerging evidence for the efficacy of mindfulness-based interventions for improving women’s sexual functioning. To date, this literature has been limited to self-reports of sexual response and distress. Sexual arousal concordance—the degree of agreement between self-reported sexual arousal and psychophysiological sexual response—has been of interest due to the speculation that it may be a key component to healthy sexual functioning in women. We examined the effects of mindfulness-based sex therapy on sexual arousal concordance in a sample of women with sexual desire/arousal difficulties (n = 79, M age 40.8 years) who participated in an in-laboratory assessment of sexual arousal using a vaginal photoplethysmograph before and after four sessions of group mindfulness-based sex therapy. Genital-subjective sexual arousal concordance significantly increased from pre-treatment levels, with changes in subjective sexual arousal predicting contemporaneous genital sexual arousal (but not the reverse). These findings have implications for our understanding of the mechanisms by which mindfulness-based sex therapy improves sexual functioning in women, and suggest that such treatment may lead to an integration of physical and subjective arousal processes. Moreover, our findings suggest that future research might consider the adoption of sexual arousal concordance as a relevant endpoint in treatment outcome research of women with sexual desire/arousal concerns.

The neuropeptide oxytocin (OXT) has an impressive variety of physiological functions in maternal and paternal behavior as well as in human sexual behaviors. Based on our previous studies, we hypothesized that OXT should be able to positively influence parameters of sexual function in females. We employed a double-blind, placebo-controlled, crossover design in a laboratory setting involving 27 healthy females (mean±SD: 27.52 ± 8.04). The acute effects of intranasal administered OXT (24 I.U.) on sexual drive, arousal, orgasm and refractory aspects of sexual behavior were analyzed using a psychometric instrument (Acute Sexual Experiences Scale). Additionally we assessed the physiological parameters (e.g. vaginal pulse amplitude, VPA; vaginal blood volume, VBV) using vaginal photoplethysmograph. A confirmatory data analysis, a particularly suitable approach for crossover-design data was chosen for the psychometric parameters. Confirmatory analysis of treatment differences yielded an effect of oxytocin on the ability of having an orgasm in the laboratory ( p > 0.05) as well as on post orgasm contentment ( p > 0.05). Moreover, data indicated a trend concerning the effect of oxytocin on lubrication ( p = 0.085). The physiological parameters (VPA and VBV) showed moderate psychophysiological activation but were not affected by OXT. Our results indicated that intranasal OXT administration in healthy females significantly increased the ability of having orgasm and contentment after orgasm. Women with OXT administration felt easier to have orgasm and more satisfied after sexual intercourse. These findings warrant further investigations, including subjects with sexual and relationship problems.

This study examined the effects of the nitric oxide-precursor L-arginine combined with the α2-blocker yohimbine on subjective and physiological sexual arousal in postmenopausal women with Female Sexual Arousal Disorder. Twenty-four women participated in three treatment sessions in which self-report and physiological (vaginal photoplethysmograph) sexual responses to erotic stimuli were measured following treatment with either L-arginine glutamate (6 g) plus yohimbine HCl (6 mg), yohimbine alone (6 mg), or placebo, using a randomized, double-blind, three-way cross-over design. Sexual responses were measured at approximately 30, 60, and 90 min postdrug administration. The combined oral administration of L-arginine glutamate and yohimbine substantially increased vaginal pulse amplitude responses to the erotic film at 60 min postdrug administration compared with placebo. Subjective reports of sexual arousal were significantly increased with exposure to the erotic stimuli but did not differ significantly between treatment groups.

Despite the high prevalence of sexual problems in women, relatively few clinical trials have been conducted to date of either vasoactive drugs (e.g., sildenafil, apomorphine) or hormone replacement therapy or a combination of the two on sexual function problems in women. This article addresses the key conceptual and methodological issues to be addressed in clinical trials, particularly in the area of response outcomes or efficacy assessment. In particular, the use of self-report questionnaires and event-log or diary-based responses as primary outcome variables or endpoints in clinical trials is considered. Physiological measures, such as the vaginal photoplethysmograph probe, are being used in early proof of concept studies. There may be some value in the use of these measures for proof-of-concept and early dose-finding studies. Physiological measures are not used in large-scale, multicenter clinical trials, where patient-based or diary measures are clearly preferable. Clinical trials in this area should also make use of the new consensus classification system for female sexual dysfunction in determining inclusion and exclusion criteria for the trial.

The success of sildenafil in treating male erectile dysfunction has brought increasing attention from researchers, drug companies, and funding sponsors to develop an effective pharmacological treatment for female sexual dysfunction. Demonstrating treatment efficacy necessitates a valid and reliable index of female sexual response. The first observable sign of sexual arousal in women is vaginal lubrication and a simultaneous increase in vaginal vasocongestion. The three primary psychophysiological assessment devices that rely on indirect measures of vasocongestion are the vaginal photoplethysmograph, devices that indirectly measure heat dissipation, and pulsed-wave Doppler ultrasonography. The most widely used and studied of these is the vaginal photoplethysmograph, which detects differences in transparency of engorged and unengorged vaginal tissue using a light reflectance method. Research has demonstrated the construct validity of this device and its response specificity to sexual stimuli. However, a rec...

Introduction The specific cognitive–affective mechanisms involved in the activation and regulation of the subjective and genital components of sexual arousal are not fully understood yet. Aim The aim of the present study was to investigate the contribution of self-reported thoughts and affect to the prediction of women's subjective and genital responses to erotica. Methods Twenty-eight sexually functional women (mean age = 32, SD = 6.29) were presented with sexually explicit and nonexplicit romantic films. Genital responses, subjective sexual arousal, state affect, and self-reported thoughts were assessed. Main Outcome Measures Vaginal pulse amplitude was measured using a vaginal photoplethysmograph. Subjective sexual arousal, thoughts, and affective responses were assessed through self-report scales. Results Correlations between subjective and physiological sexual arousal were low ( r = −0.05, P > 0.05). Self-reported thoughts and affect were significant predictors of subjective sexual arousal. The strongest single predictor of subjective arousal was sexual arousal thoughts (e.g., “I'm getting excited”) (β = 0.63, P Conclusions Overall, results support the role of cognitive (self-reported thoughts) and affective dimensions in women's subjective sexual arousal to erotica and, consistent with previous findings, suggest that subjective and physiological sexual arousal may be impacted by different processes. Vilarinho S, Laja P, Carvalho J, Quinta-Gomes AL, Oliveira C, Janssen E, and Nobre PJ. Affective and cognitive determinants of women's sexual response to erotica. J Sex Med 2014;11:2671–2678.

Specificity of vaginal pulse amplitude and vaginal blood volume in reaction to visual sexual stimuli was investigated by comparing responses to sexual, anxiety-inducing, sexually threatening, and neutral film excerpts. Subjective sexual arousal, body sensations, emotional experience, skin conductance, and heart rate were monitored along with the genital measures. Self-report data confirmed the generation of affective states as intended. Results demonstrated response specificity of vaginal vasocongestion to sexual stimuli. In terms of both convergent and divergent validity, vaginal pulse amplitude was the superior genital measure. Skin conductance discriminated among stimuli only to a small degree, whereas heart rate failed to discriminate among stimuli altogether.

Introduction Dyspareunia in women, defined as persistent or recurrent genital pain associated with sexual intercourse, is hypothesized to be related to (fear associated) pelvic floor hyperactivity and to diminished sexual arousal. Psychophysiological research to support these hypotheses is scarce and concentrates mostly on the role of either pelvic floor activity or sexual arousal. To investigate both factors, a measurement device that enables simultaneous assessment of pelvic floor muscle activity and genital sexual arousal would be most optimal. Aim The aim of this study was to test a new vaginal device—a vaginal photoplethysmograph with build‐in surface electromyography (EMG)—that allows simultaneous assessment of pelvic floor muscle activity and vaginal blood flow. Main Outcome Measures Genital arousal measured as vaginal pulse amplitude (VPA) and vaginal surface EMG. Methods Thirty‐six sexually functional women participated. To investigate the sensitivity of the device for changes in genital blood flow and involuntary changes in pelvic floor activity, VPA and vaginal surface EMG were monitored during exposure to sexual and anxiety‐evoking film clips. In addition, vaginal surface EMG was monitored during voluntary flick and hold contractions. Results VPA increased in response to the sexual film, and EMG values were significantly higher in response to the anxiety‐evoking film. Higher EMG values in response to the anxiety film were associated with lower VPA. EMG during the instructed 3‐second hold pelvic floor contractions showed, as expected, higher values during pelvic floor contractions with support of surrounding muscle groups, compared with pelvic floor muscles alone. Conclusion The device is sensitive to changes in vaginal blood flow in response to sexual stimuli, and it is able to pick up small, involuntary changes in pelvic floor activity associated with anxiety. Also, the device is able to record changes in pelvic floor activity during voluntary pelvic floor contractions. This new device will be a valuable tool in further research on superficial dyspareunia. Both S, van Lunsen R, Weijenborg P, and Laan E. A new device for simultaneous measurement of pelvic floor muscle activity and vaginal blood flow: A test in a nonclinical sample. J Sex Med 2012;9:2888–2902.

Whether erotic films made by women are more arousing for women than erotic films made by men was studied. Forty-seven subjects were exposed to both a woman-made, female-initiated, and female-centered, erotic film excerpt and a man-made, male-initiated, and male-centered erotic film excerpt. Photoplethysmographic vaginal pulse amplitude was recorded continuously. Self-report ratings of sexual arousal and affective reactions were collected after each stimulus presentation. Contrary to expectation, genital arousal did not differ between films, although genital response to both films was substantial. Subjective experience of sexual arousal was significantly higher during the woman-made film. The man-made film evoked more feelings of shame, guilt, and aversion. Correlations between subjective experience of sexual arousal and photoplethysmographic measures of sexual arousal were nonsignificant. The largest contribution to female sexual excitement might result from the processing of stimulus-content and stimulus-meaning and not from peripheral vasocongestive feedback.

Five groups of women ages 35 to 55 years were studied, including a nonsurgical control group (CTL), a hysterectomy-only (HYS), and three oophorectomy groups: an untreated group (UNT), women on estrogen replacement therapy (EST), and women on androgen-estrogen replacement therapy (COM). The interview/questionnaire session assessed mood, body image, and sexual functioning. In a second session completed by 58 of 129 subjects (45%), a photoplethysmograph measured vaginal blood flow in response to an erotic stimulus while subjects concurrently monitored subjective arousal. Overall, the UNT and EST groups had significantly lower self-reported desire and arousal than the remaining three groups. Body image was significantly poorer in the UNT group. All surgical groups reported more sexual problems than the control group. Furthermore, about a third of the CTL group reported positive changes in body image and sexuality in the previous 5 years. This effect was attenuated in the HYS, COM, and EST groups and almost absent in the UNT group. No significant group differences were obtained, however, on mood or vaginal blood flow and subjective arousal to an erotic stimulus. The role of differential levels of testosterone on sexuality is discussed as well as its clinical implications.

Introduction. Studies of ethnic differences in self-report measures of sexuality have shown East Asian women to be more sexually conservative and less sexually experienced than Caucasian women. There is also strong evidence supporting the notion of ethnic group differences in general measures of nonsexual psychophysiological arousal; however, there have been no previous studies exploring ethnicity and physiological sexual arousal. Aim. The objective of this study was to explore group differences in self-reported and physiological sexual arousal in Euro-Canadian and East Asian women living in Canada; we also aimed to explore the association between level of acculturation (both mainstream and heritage) and sexual arousal in East Asian women only. Methods. Seventy-five women (N = 38 Euro-Canadian, N = 37 East Asian) completed a battery of questionnaires and underwent psychophysiological sexual arousal testing using the vaginal photoplethysmograph. They also com- pleted a self-report measure of subjective arousal before and after erotic stimulus exposure. Main Outcome Measures. All women completed the Female Sexual Function Index, Vancouver Index of Accul- turation, and Sexual Beliefs and Information Questionnaire. Change in genital sexual arousal (vaginal pulse ampli- tude; VPA), and change in subjective sexual arousal were measured during exposure to erotic stimuli. Results. The groups did not differ in the percent increase in VPA induced by erotic stimuli, nor was there a correlation between VPA and subjective sexual arousal. Among East Asian women alone, neither heritage nor mainstream acculturation was correlated with change in VPA. Conclusions. East Asian and Euro-Canadian women who show similar ratings of sexual behaviors and self-reported sexual arousal do not differ in physiological or subjective arousal induced by erotic stimuli in the laboratory. Yule M, Woo JST, and Brotto LA. Sexual arousal in East Asian and Euro-Canadian women: A psychophysiological study. J Sex Med 2010;7:3066-3079.

Introduction. Few studies have examined how sexual arousal influences healthy premenopausal women's hormones, limiting our understanding of basic physiology and our ability to transfer knowledge from clinical and nonhuman populations. Aim. To examine how sexual arousal and steroid hormones (testosterone (T), cortisol (C), estradiol (E)) were linked, to see whether hormone levels influenced and/or changed in response to sexual arousal elicited via visual erotic stimuli in healthy women. Methods. Participants included 40 healthy premenopausal women not using exogenous hormones. Main Outcome Measures. Change in genital sexual arousal (vaginal pulse amplitude), change in subjective sexual arousal, sexual desire (via the Sexual Desire Inventory and Female Sexual Function Index scales), as well as T, C, and E via saliva samples taken before and following viewing of erotic stimuli as genital arousal was recorded via a vaginal photoplethysmograph. Results. E increased in response to sexual stimuli but this was not statistically associated with genital sexual arousal, whereas C decreased in association with genital sexual arousal, and T showed no statistically significant change. Relationship status was linked to genital but not subjective sexual arousal such that dating women exhibited higher genital sexual arousal than single or partnered women. Results indicated that all three hormones were associated with self-reported genital arousal (via the Detailed Assessment of Sexual Arousal scales) and sexual desire in different domains, and both T and E were associated with self-reported orgasms. Conclusion. Findings point to the need to examine multiple hormones in multiple ways (e.g., baseline, changes, stimulated) and question using erotic stimuli-induced arousal as a model for women's endocrine responses to sexuality. van Anders SM, Brotto L, Farrell J, and Yule M. Associations among physiological and subjective sexual response, sexual desire, and salivary steroid hormones in healthy premenopausal women. J Sex Med 2009;6:739-751.

Lack of sexual interest is the most common sexual complaint among women. However, factors affecting sexual desire in women have rarely been studied. While the role of the brain in integrating the sensory, attentional, motivational, and motor aspects of sexual response is commonly acknowledged as important, little is known about specific patterns of brain activation and sexual interest or response, particularly among women. We compared 20 females with no history of sexual dysfunction (NHSD) to 16 women with hypoactive sexual desire disorder (HSDD) in a functional magnetic resonance imaging (fMRI) study that included assessment of subjective sexual arousal, peripheral sexual response using a vaginal photoplethysmograph (VPP), as well as brain activation across three time points. Video stimuli included erotic, sports, and relaxing segments. Subjective arousal to erotic stimuli was significantly greater in NHSD participants compared with HSDD. In the erotic-sports contrast, NHSD women showed significantly greater activation in the bilateral entorhinal cortex than HSDD women. In the same contrast, HSDD females demonstrated higher activation than NHSD females in the medial frontal gyrus (Brodmann area (BA) 10), right inferior frontal gyrus (BA 47) and bilateral putamen. There were no between group differences in VPP-correlated brain activation and peripheral sexual response was not significantly associated with either subjective sexual response or brain activation patterns. Findings were consistent across the three experimental sessions. The results suggest differences between women with NHSD and HSDD in encoding arousing stimuli, retrieval of past erotic experiences, or both. The findings of greater activation in BA 10 and BA 47 among women with HSDD suggest that this group allocated significantly more attention to monitoring and/or evaluating their responses than NHSD participants, which may interfere with normal sexual response.

A 20 year old female pedophile exhibiting multiple paraphilias and who had been both a victim of incest and an active participant, undertook extensive clinical, psychometric, endocrine and laboratory sexual arousal studies. Her psychiatric, psychometric and physiologic arousal profiles showed similarities to those of a sizable proportion of male child molesters, especially incestors. It is suggested that laboratory arousal tests (using the vaginal photoplethysmograph) may have a role in the assessment of some female sex offenders.

Introduction Female sexual arousal disorder (FSAD) is a complex diagnostic category whose definition continues to evolve. Aim The purpose of this study was to explore the physiological patterns of genital arousal in 31 women with and 30 women without sexual arousal difficulties using a vaginal photoplethysmograph. In addition, subtypes of FSAD, based on a recently proposed redefinition, were explored on measures of sexual arousal. Results Whereas there were no psychophysiological or subjective sexual arousal differences when the entire group of women with arousal complaints was compared to a control group, significant differences emerged when subtypes of arousal disorder were compared. Only women fitting the description of “Genital Arousal Disorder” showed evidence of impaired psychophysiological arousal, whereas those characterized with “Subjective Sexual Arousal Disorder” and “Combined Genital and Subjective Sexual Arousal Disorder” did not differ from the control group. These subgroups also differed in the correlation between psychophysiological and subjective arousal. Conclusion Overall, there is evidence for diagnostic heterogeneity in FSAD which supports the recent redefinition of this disorder into subtypes.

This study was designed to assess potential differences between sexually functional and dysfunctional women in dopamine (DA) and norepinephrine (NE) responses to erotic stimuli. Blood levels of homovanillic acid (HVA; the major metabolite of DA) and NE were taken during the showing of a nonsexual and a sexual film from 9 women with female sexual arousal disorder and hypoactive sexual desire disorder and from 13 sexually functional women. We assessed sexual arousal subjectively using a self-report scale and physiologically using a vaginal photoplethysmograph. HVA levels significantly decreased in sexually functional and dysfunctional women during the erotic versus during the neutral film. NE levels were not significantly different for either group of women during the neutral and erotic films. Sexually dysfunctional women had significantly higher levels of NE during both the neutral and erotic films compared with functional women. Subjective or physiological arousal differences between neutral and erotic films were not significantly different between functional and dysfunctional women.

This brief report describes the circumstances under which the photoplethysmograph vaginal probe was developed. The role that many individuals played in its development is emphasized.

Previous research suggests that women's genital arousal is an automatic response to sexual stimuli, whereas men's genital arousal is dependent upon stimulus features specific to their sexual interests. In this study, we tested the hypothesis that a nonhuman sexual stimulus would elicit a genital response in women but not in men. Eighteen heterosexual women and 18 heterosexual men viewed seven sexual film stimuli, six human films and one nonhuman primate film, while measurements of genital and subjective sexual arousal were recorded. Women showed small increases in genital arousal to the nonhuman stimulus and large increases in genital arousal to both human male and female stimuli. Men did not show any genital arousal to the nonhuman stimulus and demonstrated a category-specific pattern of arousal to the human stimuli that corresponded to their stated sexual orientation. These results suggest that stimulus features necessary to evoke genital arousal are much less specific in women than in men.

The present investigation was designed to provide the first empirical examination of the effects of acute dehydroepiandrosterone (DHEA) administration on subjective and physiological sexual arousal in women. The primary purpose was to assess whether DHEA influences vaginal blood flow response in sexually functional women. Subjective (self-report) and physiological (vaginal photoplethysmograph) sexual responses to erotic stimuli were measured following DHEA (300 mg) and placebo administration in 12 sexually functional, premenopausal women, using a single-blind protocol. Acute DHEA significantly increased blood levels of dehydroepiandrosterone sulfate (DHEA-S) 30 min following drug administration but had no significant effect on either vaginal pulse amplitude responses or subjective responses to the erotic films. Acute DHEA does not appear to substantially influence sexual responding among sexually functional, premenopausal women.

AIMS: To compare the effects of 3 months' tibolone treatment with the effects of placebo on sexual function (in particular, vaginal blood flow, and sexual desire and arousability) and climacteric symptoms in postmenopausal women. METHODS: A randomized, double-blind, cross-over study was conducted in 38 postmenopausal women who received tibolone 2.5 mg/day and placebo. Vaginal blood flow during erotic stimulation by fantasy and film was measured using a vaginal photoplethysmograph and subjects completed sexual function questionnaires and daily diaries. RESULTS: Tibolone significantly increased baseline vaginal pulse amplitude (VPA) levels compared with placebo. There were significant treatment differences in VPA in favor of tibolone during fantasy periods but not during erotic film stimulation. Tibolone was associated with significant increases in sexual desire, and the frequency of arousability and of sexual fantasies compared with those with placebo. Vaginal lubrication was significantly improved on tibolone. Twenty-five of 38 (66%) subjects correctly guessed when they were on active treatment. Tibolone was well tolerated. CONCLUSIONS: Tibolone was associated with significant improvements in sexual function in postmenopausal women, reflecting both its estrogenic and androgenic properties. There were significantly greater increases in vaginal blood flow with tibolone in response to erotic fantasy but not film, suggesting two possible pathways of female sexual response

Objective The present investigation was designed to provide the first empirical examination of the effects of clonidine, a selective alpha2-adrenergic agonist, on sexual arousal in women with and without prior sympathetic nervous system (SNS) stimulation by exercise. The purpose was to help elucidate the influence of adrenergic mechanisms on sexual function in women. Methods Thirty sexually functional women participated in two experimental sessions in which subjective (self-report) and physiological (vaginal photoplethysmograph) sexual responses to erotic stimuli were measured after either clonidine (0.2 mg) or placebo administration in a randomized, double-blind, crossover protocol. Before viewing the experimental films, 15 subjects engaged in 20 minutes of intense exercise designed to elicit significant SNS activation. Results Clonidine significantly decreased vaginal pulse amplitude, vaginal blood volume, and subjective sexual responses to the erotic films in subjects who were in a state of heightened (via exercise), but not baseline (no exercise) SNS arousal. Conclusions Clonidine can significantly inhibit subjective and physiological sexual arousal in women. These findings have implications for deriving an etiological theory of sexual function in women and for understanding the effects of psychotherapeutic drugs on female sexual function.

Sixty-two women participated in a study designed to explore the association between genital and subjective sexual arousal. Four stimulus conditions were created, designed to evoke differential patterns of genital arousal over time. Subjects were instructed to report sensations in their genitalia while being exposed to the same erotic stimulus on repeated trials or to a series of varying erotic stimuli. Detection of genital arousal was facilitated by the occurrence of changes in genital arousal over trials. That is, genital and subjective sexual arousal were linearly related in conditions that resulted in large differences in genital arousal over trials, whereas such a relation was absent in conditions in which genital arousal levels remained relatively constant. In women, peripheral feedback from consciously detected genital arousal seems to be a relatively unimportant determinant of subjective sexual arousal.

Physiological and subjective patterns of sexual arousal were compared for sexually functional and dysfunctional women. Previous studies revealed seemingly contradictory findings: Some found significant group differences on physiological but not on subjective responses to erotic stimuli, whereas others found the opposite. To reconcile this discrepancy, subjects were presented with edited versions of the three erotic videotapes used in previous studies. Sexual arousal was measured physiologically with a vaginal photoplethysmograph, and subjectively with a self-report rating scale. Previous methodology was systematically replicated and extended by developing alternate physiological data collection and reduction techniques, employing alternate methods of subjective assessment, evaluating the arousal-eliciting capacity of the erotic stimuli, and designing scripts to reduce social demand. Results indicated that dysfunctional women exhibited significantly less physiological and subjectively experienced sexual arousal than functional women in all three stimulus conditions. Dysfunctional women also reported significantly less autonomic arousal. Results (i) replicate several seemingly contradictory findings in the literature, (ii) reconcile and provide evidence supporting an explanation for the apparent discrepancy, and (iii) reveal that subjective experience and genital vasocongestion are two primary components of sexual arousal that reliably discriminate dysfunctional from functional patterns of sexual response in women.