Functional neuroimaging studies of sexual arousal and orgasm in healthy men and women: a review and meta-analysis

In the last fifteen years, functional neuroimaging techniques have been used to investigate the neuroanatomical correlates of sexual arousal in healthy human subjects. In most studies, subjects have been requested to watch visual sexual stimuli and control stimuli. Our review and meta-analysis found that in heterosexual men, sites of cortical activation consistently reported across studies are the lateral occipitotemporal, inferotemporal, parietal, orbitofrontal, medial prefrontal, insular, anterior cingulate, and frontal premotor cortices as well as, for subcortical regions, the amygdalas, claustrum, hypothalamus, caudate nucleus, thalami, cerebellum, and substantia nigra. Heterosexual and gay men show a similar pattern of activation. Visual sexual stimuli activate the amygdalas and thalami more in men than in women. Ejaculation is associated with decreased activation throughout the prefrontal cortex. We present a neurophenomenological model to understand how these multiple regional brain responses could account for the varied facets of the subjective experience of sexual arousal. Further research should shift from passive to active paradigms, focus on functional connectivity and use subliminal presentation of stimuli.