Article

Women's Motivations for Sex: Exploring the Diagnostic and Statistical Manual, Fourth Edition, Text Revision Criteria for Hypoactive Sexual Desire and Female Sexual Arousal Disorders

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Women's Motivations for Sex: Exploring the Diagnostic and Statistical Manual, Fourth Edition, Text Revision Criteria for Hypoactive Sexual Desire and Female Sexual Arousal Disorders

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Abstract

Introduction. There are problems with the existing definition of hypoactive sexual desire disorder (HSDD) in that desire for sex and sexual fantasy are not a universal experience. Aims. To explore: (i) women's motivations to engage in sexual activity; (ii) frequency and predictors of sexual fantasies; (iii) sexual arousal; (iv) recognition of sexual arousal; and (v) association between relationship duration and these variables. Methods. Three thousand six hundred eighty-seven women completed a web-based survey of previously pilot-tested items. Main Outcome Measures. Investigator-derived self-report questions of sexual desire and arousal, and sexual fantasies. Results. Among women who easily became aroused, 15.5% reported only engaging in sex if they felt sexual desire at the outset whereas 30.7% typically or always accessed desire only once they were aroused. Women in longer-term relationships engaged in sex with no sexual desire more often (42%) than women in short-term relationships (22.4%) (P < 0.001). The percentage of women that reported fantasies only sometimes was 52.5%. A logistic regression revealed that religion (odds ratio [OR] = 1.45; P < 0.001), difficulty getting aroused (OR = 0.511; P < 0.001), responsive desire (OR = 0.919; P < 0.05), and frequency of orgasm (OR = 1.11; P < 0.05) were significantly associated with sexual fantasy. After controlling for age, relationship duration was negatively associated with frequency of initiating sex (r = −0.116, P < 0.001), women's satisfaction with their own sexuality (r = −0.173, P < 0.001) and sexual satisfaction with the partner (r = −0.162, P < 0.001). Conclusions. Results reflect diversity in women's motivations for sex, and there is evidence that responsive desire occurs in women with and without arousal difficulties. We strongly recommend relationship duration as well as adequacy of partner sexual stimulation to be recognized in any future diagnostic framework of dysfunction. Clinical implications as well as those for future diagnostic nomenclature are considered. Carvalheira AA, Brotto LA, and Leal I. Women's motivations for sex: Exploring the Diagnostic and Statistical Manual, Fourth Edition, Text Revision criteria for hypoactive sexual desire and female sexual arousal disorders. J Sex Med 2010;7:1454–1463.

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... [37][38][39] Many young and adult men report enjoying close emotional ties to sexual partners, 40,41 and many women pursue specific sexual activities 42 or have sex in non-relational scenarios 43 simply in response to sexual desire. 44,45 Among young and emerging adults, both men and women endorse satisfying sexual desires as a primary reason, and feeling in love with a boy/girlfriend as a secondary reason, to have sex. 14 Other work has shown that, regardless of sexual orientation, women frequently cite pleasure, as well as emotional elements, such as love and commitment, as the most frequent drivers of sexual behaviour. ...
... 1,6,11,12,15,18,19 Other work has posited that physical and emotional motivators are both important for men and women. 1,2,5,14,40,41,[43][44][45][46][49][50][51][52] Our data provide greatest support for the latter body of work, demonstrating that being sexually interested, wanting to have sex, or perceiving one's partners wanting to have sex, each significantly increased men's and women's odds of men's and women's partnered sex over choosing not to have sex during any given sexual event. These findings add context to a growing body of literature documenting the importance of men's emotional connection to their sexual partners 40,41 and women's experiences of sexual desire and sexual pleasure. ...
Article
Methods: Adult men (n=156) and women (n=192) completed thrice-daily electronic diaries assessing individual- and partner-specific attributes and non-coital or coital sexual behaviours. Sexual motivations were: interest in sex, feeling in love with partner, wanted to have sex and partner wanted to have sex. The outcome variable was: sexual behaviour type (no sex, one vaginal sex event, one vaginal sex event+any other sex types, multiple vaginal sex events, any other sex types). Mixed-effect multinomial logistic regression modelled the influence of each sexual motivation on sexual behaviour type (Stata; all p<0.05). 'No sex' was the referent in all models; all models controlled for gender. Results: Participants contributed 14856 total partner-associated diary entries. Most (54%; women: 56.5%, men: 51.2%) were associated with no sex; when sex occurred, the most common behaviour type was one vaginal sex event (13.1%) for women and other sex types (16.4%) for men. Wanting to have sex or perceiving a partner wanted to have sex were the strongest predictors of sexual behaviour type, and were associated with a greater number of reported sexual behaviours. Conclusions: Event-specific sexual motivations are associated with the choice to have sex, and with variation in the chosen sexual behaviours.
... Considering this, we assessed religion and religiosity À particularly Christian religion À as they have been found to impact on several aspects of sexuality. Previous research on sexual thoughts has revealed that Christian individuals usually report a lower frequency of thoughts experienced as pleasant than non-Christian ones (Ahrold, Farmer, Trapnell, & Meston, 2011; Carvalheira, Brotto, & Leal, 2010; Di eguez, L opez, & Sueiro, 2002; Sierra, Ortega, & Guti errez-Quintanilla, 2008). In addition, Christian individuals often report feeling guilty for their sexual thoughts, which may lead them to assess such thoughts negatively (Gil, 1990). ...
... Regarding religion, Christian men and women reported a lower frequency of all subtypes of PSC except for cognitions involving submission, compared to non-Christian participants. This finding is consistent with a broad range of studies on sexual thoughts and religiosity that have shown that religious individuals tend to express a lower overall frequency of erotic and sexual thoughts (Ahrold et al., 2011; Carvalheira et al., 2010; Gil, 1990; Lefkowitz, Gillen, Shearer, & Boone, 2004). However, the reported frequency of religious service attendance was not associated with the frequency of PSC, probably due to the low number of individuals that frequently attend religious services. ...
Article
The aim of this study was to explore the frequency of sexual cognitions in Spanish men and women, distinguishing between positive sexual cognitions (PSC) and negative sexual cognitions (NSC), and various subtypes of such cognitions based on their content (intimate, exploratory, dominance, submission, and impersonal). We also examined the relationship between both age and education level and Christian religion/religiosity and the frequency of all subtypes of sexual cognitions. The sample was composed of 1332 participants aged between 18 and 45 years. Results showed that the most and least frequent sexual cognitions were intimate and sadomasochistic cognitions, respectively. Overall, men reported a higher frequency of PSC than did women, except for cognitions involving submission. In addition, undergraduate students reported a higher frequency of dominant PSC than older individuals. Regarding NSC, men reported a higher frequency of dominance themes, while women reported more frequent cognitions involving submission. In addition, intimate, exploratory, and impersonal NSC were more frequently reported in the younger sample. Religion was associated with the frequency of most PSC but not with NSC. We discuss the implications of assessing both the affect and content of sexual cognitions for their training in sex therapy.
... Frequency of sexual activity is often not a meaningful metric for assessing sexual satisfaction in a woman's life [19]. Fantasy appears often to have an instrumental purpose of heightening arousal for women [20], but not for all women, and fantasy overall is not a useful marker of stand-alone desire [21]. In general, the focus on behavior and fantasy within the criteria for HSDD reinforced a fairly truncated perspective of how women experience desire. ...
... Women at times agree to sex that they do not want for both "approach" reasons, such as to increase intimacy or to please a partner, or "avoidance" reasons, such as felt obligation, pressure, or to circumvent conflict or a partner's disappointment [22][23][24]. In one study of 3687 women's experiences of desire, only 16 % of women reported engaging in sex if they felt desire beforehand, whereas 31 % noted desire only after becoming aroused in sexual activity [21]. These studies support new models of functioning wherein desire does not necessarily precede, can co-occur with, and in fact might reflect a response to sexual stimuli [9]. ...
Article
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Research on girls’ and women’s sexual desire has focused primarily on experiences of low desire, rather than positive experiences or high levels of desire. Recent conceptualizations of low desire have incorporated distress as a central feature because not all forms of low sexual desire are problematic for women. Despite a need to rely primarily on cross-sectional data, research indicates that sexual desire does not necessarily dwindle across the life course and that rates of low desire might be fairly consistent over time. A small body of work suggests that girls’ rates of problematic low desire resemble rates found among samples of women, making clear that there is a substantial minority who consistently experience distressing low levels of sexual desire. What emerges from this review is that women’s sexual desire is difficult to capture meaningfully using standardized measures and that understanding this issue depends on more nuanced approaches to assessment and analysis.
... According to Basson (2000Basson ( , 2001, female desire usually follows rather than precedes sexual arousal, which is triggered by external erotic stimuli. Within this model of female sexual response, the importance of partners' positive behaviors can hardly be overstated-as such behaviors often trigger (either directly or indirectly) a transition from sexual ''neutrality'' to sexual arousal (Basson, 2000(Basson, , 2001Carvalheira, Brotto, & Leal, 2010). ...
Article
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We examined the interplay between husbands' and wives' positive and negative nonsexual interpersonal behaviors, frequency of sexual intercourse, sexual satisfaction, and feelings of marital satisfaction. To do this, we conducted an in-depth face-to-face interview and completed a series of telephone diaries with 105 couples during their second, third, and fourteenth years of marriage. Consistent with the argument that women's sexual response is tied to intimacy (Basson, 2000), multilevel analyses revealed that husbands' positive interpersonal behaviors directed toward their wives-but not wives' positivity nor spouses' negative behaviors (regardless of gender)-predicted the frequency with which couples engaged in intercourse. The frequency of sexual intercourse and interpersonal negativity predicted both husbands' and wives' sexual satisfaction; wives' positive behaviors were also tied to husbands' sexual satisfaction. When spouses' interpersonal behaviors, frequency of sexual intercourse, and sexual satisfaction were considered in tandem, all but the frequency of sexual intercourse were associated with marital satisfaction. When it comes to feelings of marital satisfaction, therefore, a satisfying sex life and a warm interpersonal climate appear to matter more than does a greater frequency of sexual intercourse. Collectively, these findings shed much-needed light on the interplay between the nonsexual interpersonal climate of marriage and spouses' sexual relationships.
... Furthermore, all of these non-heterosexual women reported an increased ratio of othersex to same-sex behavior over time, suggesting a potential continuity between female homosexuality and bisexuality. Although one could question the representativeness of this sample for heterosexually identified women (Mock & Eibach, 2012), these findings provide additional support for the hypothesis that sexual motivation may be more complexly determined (on average) in women than in men (Carvalheira et al., 2010;Carvalho & Nobre, 2010Rupp & Wallen, 2008). ...
Chapter
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Is sexual orientation an evolutionary adaptation or social construct? With respect to sexual preferences, to what extent are we “born that way” and to what extent does learning matter? This chapter discusses how nature and nurture may interact to shape sexual motivation by reviewing existing literature on sexual preferences and orientations, as well as by considering sex/gender differences in erotic plasticity, sexual fluidity, and the specificity of sexual arousal. We describe how these phenomena might be accounted for by processes in which mind-body feedback loops amplify some sexual responses over others on multiple levels, which we refer to as the Reward Competition Feedback (RCF) model. With respect to sex/gender differences, we describe how these positive feedback processes might be amplified in men compared with women, potentially substantially driven by differences in the constraints and affordances of female and male anatomy. More specifically, we argue that the well-known female-male difference in the concordance of genital and subjective arousal may contribute to well-known differences in sexual specificity and plasticity/fluidity. We further provide convergent support for RCF by reviewing preexisting theories of sexual learning. Finally, we consider some of the ethical implications of models in which sexual orientation might be shaped by experiences over the course of development.KeywordsSexual preferenceSexual orientationSexGenderDevelopmentLearning
... Given that several relationship dimensions, including sexual and relationship satisfaction, have been shown to be influenced by age and relationship duration (e.g. Basson, 2000;Carvalheira et al., 2010;Milhausen and Murray, 2012), these variables, which were measured in years, were included as control variables in this study's analyses. Moreover, given that relationship agreement tends to vary by sexual orientation McLean, 2004;Taormino, 2008) and that men and women tend to respond differently to items assessing relationship dimensions (e.g. ...
Article
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While past studies have measured several indicators of relationship quality in relation to types of relationship agreement, most have not included polyamorous relationships, and have almost exclusively included samples of gay men. The purpose of this study was to address this gap by examining five dimensions of relationship quality and eight dimensions of relationship equity in a sexually diverse Canadian sample (n=3463) across three types of relationship agreements (monogamous, open, and polyamorous). The data were collected online as part of a larger study. In order to compare relationship types on relationship dimensions, MANCOVAs were computed using age, relationship duration, cohabitation status, sex, sexual orientation, and an interaction term of sex and sexual orientation as control variables. High scores of relationship quality and equity were reported by the overall sample, and scores on all scales did not significantly differ by types of relationship agreements. Overall, these results strongly suggest that these types of relationship agreements are equally healthy viable options.
... Because sexual desire is a component of sexual functioning, 14 including sexual functioning might have extended our findings on links to contraceptive use in long-term partnerships. In addition, women's experiences with arousal and desire diverse and unique to the individual, 35 including sexual arousal, might have added to the present findings. ...
Article
Introduction: Research investigating the impact of contraceptive use on sexual desire has produced mixed results. This scholarship also has had inconsistent methodology, with some studies not separating contraceptive types and others lacking non-hormonal comparison groups. Relationship context of contraceptive use and sexual behavior also have not been well represented. Aims: To investigate the impact of contraceptive type on sexual desire in women and in men who are partnered to contraceptive-using women. Methods: In two separate studies we examined the impact of contraceptives on the sexual desire of women currently using contraceptives and men partnered to women using contraceptives. The first study examined the impact of contraceptive type on sexual desire in women and in men partnered to contraceptive users in relationships of different lengths. The second study examined this impact in heterosexual couples in long-term relationships. Main outcome measures: Solitary and dyadic sexual desire as measured by the Sexual Desire Inventory and contraceptive type as categorized into three types: oral hormonal contraceptive, other hormonal contraceptive, and non-hormonal contraceptive. Results: Contraceptive type significantly affected solitary and dyadic desire. Women on non-hormonal contraceptives reported higher solitary sexual desire than women on other hormonal contraceptives. Women on oral hormonal contraceptives reported significantly higher dyadic sexual desire than women on non-hormonal contraceptives. In male partners of female contraceptive users, solitary and dyadic sexual desires were not affected by partner contraceptive type. In the multivariate model, relationship length and age were stronger predictors of contraceptive type than was solitary or dyadic sexual desire. At the couple level, contraceptive type also was not related to solitary or dyadic sexual desire in men and women. Conclusion: Contraceptive type can affect solitary and dyadic sexual desire in women; however, contextual factors seem to be stronger predictors of sexual desire for long-term coupled women and men than contraception type.
... Heterosexual women need to experience intimacy, love, sensuality and erotic feelings, within a satisfactory and fulfilling relationship, in order to experience pleasure and sexual satisfaction, which in turn become motivators for responding further during the sexual activity (Basson, 2000;Tiefer, 2001). This also conforms to a "circular" model of sexual functioning (Basson, 2000), which holds that women need some psychological motivation, apart from spontaneous biological stimulation like genital and non-genital stimulation, for the initiation of sexual activities (Basson, 2002;Carvalheira, Brotto, & Lael, 2010). ...
Article
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This metasynthesis presents the empirical evidence for heterosexual women's interpretation of sexuality using the Sandelowski-Barroso framework. Most women framed sexuality as the integration of patriarchal culture, gendered identity and religious understanding and placed intercourse at the centre of the sexual act. Some women acknowledged it from the negative point of view which may increase the risk for sexual difficulties. However, women who accepted male dominant partners and focused on self-gratification, found that this would lead to positive well-being; while those who internalised female centricity emphasised equality in achieving a quality sex life. Clinical implications of these findings are also discussed.
... Problems of sexual function of short duration may create frustration and anguish, and when chronic, may lead to anxiety and depression and may damage relationships or create problems in other areas of the patient's life [4,5]. Sexual problems may occur in any one of the domains of the sexual cycle (desire, arousal, or orgasm) or in more than one, and these domains may be interconnected [6][7][8]. ...
... Thus, in terms of incentive motivation models, there is no such thing as ''spontaneous'' desire-although one may not be consciously aware of the cues that resulted in sexual desire, and, therefore, experience it as coming about spontaneously (e.g., Both et al., 2007). Indeed, growing evidence suggest that sexual desire is primarily responsive (e.g., Both, Everaerd, & Laan, 2003;Bancroft, Loftus, & Long, 2003;Cain, Johannes, & Avis, 2003;Carvalheira, Brotto, & Leal, 2010;Laan, Everaerd, van der Velde & Geer, 1995;McCall & Meston, 2006). ...
... The report by Ahrold et al. confirmed that fantasizing was more frequent among atheists or agnostics, compared to religious followers. However; in the case of believers, no statistical differences were noted, also according to the division into the groups of conservative followers within each religion [19,20]. ...
Article
Introduction: Sexual fantasies are among the exponents of sexual desire, and constitute a positive aspect of sexual health. Objective: The objective of the study was to examine whether, and in what way, the presence of pregnancy affects the frequency of sexual fantasies experienced by women. Material and method: A prospective survey was conducted in two stages, and covered: at Stage 1 - 1730 women, and at Stage 2 - 260. The questionnaire form used was designed for the purpose of the presented study. The results obtained were subjected to descriptive and statistical analyses. Results: Before pregnancy 232 (89.2%) women experienced sexual fantasies, whereas during pregnancy - 252 (96.9%). The frequency of these fantasies greatly varied, both at the first and the second stage of the survey, i.e. from their total lack to several times a day. The largest number of respondents admitted that they had sexual fantasies with erotic content 2-3 times a week, while the smallest number - several times a day. No statistically significant differences were found in the material analyzed. Conclusions: The presence of pregnancy does not exert an effect on the frequency of sexual fantasies experienced by women. No statistically significant differences in the frequency of sexual fantasies experienced by women prior to and in pregnancy were observed according to the variables adopted in the study.
... This finding may emphasize the link between sexual satisfaction and dyadic aspects of sexuality . It may be that some past studies have failed to find a link between sexual thoughts and satisfaction because they examined the overall frequency of sexual fantasies, and did not take their specific content into account (e.g., Carvalheira, Brotto, & Leal, 2010). In contrast to most of these studies, Renaud and Byers (2001) found that the overall frequency of PSC was positively related to sexual satisfaction. ...
Article
Full-text available
This study examined the relationship between various subtypes of positive and negative sexual cognitions (NSC) based on their content (intimate, exploratory, sadomasochistic, impersonal) and sexual functioning, including aspects of sexual response (desire), sexual motivation (sexual excitation and sexual inhibition), and cognitive-affective domains (satisfaction). Participants were 789 Spanish adults (322 men and 467 women) who were in a heterosexual relationship of at least 6 months duration. Overall, the men reported more frequent exploratory and impersonal positive sexual cognitions than did the women. The men and women did not differ in the frequency of their positive intimate and sadomasochistic cognitions or in any of their NSC. Using canonical correlation, the results revealed that, after controlling for the overall frequency of NSC, the men and women who reported a higher frequency of all subtypes of positive sexual cognitions reported more dyadic and solitary sexual desire, more propensity to get sexually excited, and less sexual inhibition. A second canonical variate was identified for both the men and the women that revealed different patterns of association between the subtypes of cognitions and specific areas of sexual functioning, highlighting the role of positive, intimate cognitions for dyadic aspects of sexual functioning. The subtypes of NSC were not associated with poorer sexual functioning for either men or women, perhaps because they, on average, occurred infrequently. The findings were discussed in terms of the relationship between the specific content of sexual cognitions and the sexual functioning of men and women.
... A woman feels sexual desire in three situations: spontaneously (reflecting the natural sexual instinct), when she receives sexual stimulation from her partner, and when engaging in sexual fantasies. 27 There are many reasons women agree to or instigate sexual activity, and desire may be experienced once the sexual stimuli have triggered arousal; thus, arousal and desire co-occur and reinforce each other. 28 It is necessary to think about sex to generate sexual fantasies that can lead to desire. ...
Article
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Introduction?Sexual pleasure is fundamental for the maintenance of health and well-being, but it may be adversely affected by medical and psychosocial conditions. Many patients only feel that their health is fully restored after they resume normal sexual activities. Any discussion of sexuality in a doctor's office is typically limited, mainly because of a lack of models or protocols available to guide the discussion of the topic. Objectives?To present a model designed to guide gynecologists in the management of female sexual complaints. Methods?This study presents a protocol used to assess women's sexual problems. A semi-structured interview is used to assess sexual function, and the teaching, orienting and permitting (TOP) intervention model that was designed to guide gynecologists in the management of sexual complaints. Results?The use of protocols may facilitate the discussion of sexual issues in gynecological settings, and has the potential to provide an effective approach to the complex aspects of sexual dysfunction in women. The TOP model has three phases: teaching the sexual response, in which the gynecologist explains the physiology of the female sexual response, and focuses on the three main phases thereof (desire, excitement and orgasm); orienting a woman toward sexual health, in which sexual education is used to provide information on the concept and healthy experience of sexuality; and permitting and stimulating sexual pleasure, which is based on the assumption that sexual pleasure is an individual right and is important for the physical and emotional well-being. Conclusion?The use of protocols may provide an effective approach to deal with female sexual dysfunction in gynecological offices. Thieme-Revinter Publica??es Ltda Rio de Janeiro, Brazil.
... The changes were specifically designed to improve precision, "reduce likelihood of overdiagnosis" and "distinguish transient sexual difficulties from more persistent sexual dysfunction" (APA, 2013, p. 809-816). The diagnostic categories were also extensively revised (see Box 1), reflecting a move away from the conceptualization of sexual response as a linear progression, essentially similar for women and men, towards recognition of substantial inter-personal variation without a single underlying model (Carvalheira, Brotto, & Leal, 2010;Graham, 2015;Sand & Fisher, 2007). Where the previous version (DSM-IV-TR) referred to "psychophysiological changes" and the "sexual response cycle" (APA, 2000;p. ...
Article
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Establishing the clinical significance of symptoms of sexual dysfunction is challenging. To address this, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) introduced two new morbidity criteria (duration and symptom severity) to the existing criteria of distress. This study sought to establish the impact of these three criteria on the population prevalence of sexual function problems. The data come from a national probability survey (Natsal-3) and are based on 11,509 male and female participants aged 16-74, reporting at least one sexual partner in the past year. The key outcomes were: proportion of individuals reporting proxy measures of DSM-5 problems, and the proportion of those meeting morbidity criteria. We found that among sexually active men, the prevalence of reporting one or more of four specific sexual problems was 38.2%, but 4.2% after applying the three morbidity criteria; corresponding figures for women reporting one or more of three specific sexual problems, were 22.8% and 3.6%. Just over a third of men and women reporting a problem meeting all three morbidity criteria had sought help in the last year. We conclude that the DSM-5 morbidity criteria impose a focus on clinically significant symptoms.
... Women commonly report experiencing these as part of the same process. 10 The DSM-5 criteria for female sexual interest/arousal disorder are presented in Table 4. 9 It is important to determine whether the patient's problem with desire or arousal is a dysfunction or a normal variation of sexual response. The following examples are not considered sexual dysfunction: a patient reports little or no spontaneous desire but continues to experience responsive desire; a patient maintains spontaneous or responsive desire but reports a desire discrepancy between herself and her partner; a patient has reduced physiologic sexual arousal (e.g., decreased vaginal lubrication or genital blood flow) related to menopausal transition. ...
Article
Full-text available
Sexual dysfunction in women is a common and often distressing problem that has a negative impact on quality of life and medication compliance. The problem is often multifactorial, necessitating a multidisciplinary evaluation and treatment approach that addresses biological, psychological, sociocultural, and relational factors. Criteria for sexual interest/arousal disorder require the presence of at least three specific symptoms lasting for at least six months. Lifelong anorgasmia may suggest the patient is unfamiliar or uncomfortable with self-stimulation or sexual communication with her partner. Delayed or less intense orgasms may be a natural process of aging due to decreased genital blood flow and dulled genital sensations. Genito-pelvic pain/penetration disorder includes fear or anxiety, marked tightening or tensing of the abdominal and pelvic muscles, or actual pain associated with attempts toward vaginal penetration that is persistent or recurrent for at least six months. Treatment depends on the etiology. Estrogen is effective for the treatment of dyspareunia associated with genitourinary syndrome of menopause. Testosterone, with and without concomitant use of estrogen, is associated with improvements in sexual functioning in naturally and surgically menopausal women, although data on long-term risks and benefits are lacking. Bupropion has been shown to improve the adverse sexual effects associated with antidepressant use; however, data are limited. Psychotherapy or sex therapy is useful for management of the psychological, relational, and sociocultural factors impacting a woman's sexual function. Clinicians can address many of these issues in addition to providing education and validating women's sexual health concerns.
... For example, emotional problems increase with the duration of infertility and with advancing age in women as their childless years increase [25]. Additionally, a long marital relationship may reduce sexual desire [26], alter the excitatory response, and reduce coital frequency, leading to sexual dissatisfaction [27]. Moreover, data of the 4 reviewed studies that used specific instruments for assessment of sexual function were not comparable because they measured different outcomes. ...
... Despite reference to the lack of evidence supporting DSM-IV's hypoactive sexual desire disorder (HSDD) and the evidence presented in support of an incentivesbased model of response (e.g., Basson, 2001;Brotto, 2010;Brotto, Heiman, & Tolman, 2009;Carvalheira, Brotto, & Leal, 2010;Goldhammer & McCabe, 2011;Janssen, Everaerd, & Spiering, 2000;Laan & Both, 2008;Stoléru, Fonteille, Cornélis, Joyal, & Moulier, 2012), the focus of many-both members of the panel and the audience-was to assume and strongly recommend the continuance of the DSM-IV diagnosis of HSDD. They insisted that distinguishing arousal from desire was not difficult and that they ''knew'' the loss of desire was ''the'' problem. ...
Article
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There were numerous missed opportunities at the October 2014 U.S. Food and Drug Administration (FDA) meeting on female sexual dysfunction (FSD). They included opportunities to hear from a diverse range of patients and to engage in evidence-based discussions of unmet medical needs, diagnostic instruments, trial end points, and inclusion criteria for clinical trials. Contributions of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) nomenclature, based on extensive research, were dismissed in favor of language favoring a seemingly clear but scientifically unsupportable distinction between women's sexual desire and arousal. Numerous participants, including patients recruited by their physicians, acknowledged travel expenses paid for by interested pharmaceutical companies. Conflicts of interest were manifold. The meeting did not advance the FDA's understanding of women's sexual distress and represents a setback for our field.
... This study had several limitations, including the lack of control of some variables, which may contribute to the improvement of sexual function, particularly relationship status and other psychosocial factors such as subjective distress regarding sexual activity [48], and long-term relationship status [49], which may compromise relationship satisfaction for women [50]. The socializing of women who exercise in groups, the supervised nature of the exercise, the awareness of the objectives of the investigation in which they participate, the assignment of time to self-care and the expectation of improved physical conditions are some variables that may motivate women and may improve their emotional and physical aspects and their willingness to experience their sexuality and may also have interfered with our results. ...
Article
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There is a need for specific measures to address overall care in women with polycystic ovary syndrome (PCOS). Physical resistance training (PRT) has been shown to improve certain body parameters. However, the effect of PRT on the sexual function of PCOS women has not been evaluated. The study aimed to assess sexual function and emotional status of PCOS women after 16 weeks of PRT. This case-control study involved 43 women with PCOS and 51 control ovulatory women, aged 18-37 years. All women were subjected to a supervised PRT protocol for 16 weeks and evaluated at the end of the program. Sexual function was assessed at baseline and after PRT protocol. The main outcome measure used was the Female Sexual Function Index (FSFI). Of the 43 women with PCOS, 30 (69.70%) had a basal total FSFI score ≤ 26.55 and 24 of them (58.54%) had a score ≤ 26.55 after PRT (P = 0.08). Of the 51 control women, 32 (62.7%) and 27 (52.9%) had FSFI scores < 26.55 at baseline and after PRT, respectively (P = 0.06). Control women experienced a significant improvement in pain domain score after PRT (P < 0.03). PCOS women experienced significant increases in total score and in the desire, excitement and lubrication domains after PRT (P < 0.01 each). After PRT, there was a significant difference between the PCOS and control groups in the sexual desire domain (4.09 ± 1.29 vs. 3.75 ± 1.42, P = 0.04). Significantly fewer women in the PCOS group were at risk of depression (P < 0.01) and anxiety (P < 0.02) after than before PRT, whereas the differences in the control group were not significant. Mean depression and anxiety scores were reduced significantly in both the PCOS (P < 0.01 each) and control (P < 0.01) groups. PRT significantly enhanced total score and the desire, excitement, and lubrication domains of the FSFI in PCOS women. PRT reduced pain, and total depression and anxiety scores in both groups. Lara LAS, Ramos FKP, Kogure GS, Silva Costa, Silva de Sá MF, Ferriani RA, and dos Reis, RM. Impact of physical resistance training on the sexual function of women with polycystic ovary syndrome. J Sex Med **;**:**-**. © 2015 International Society for Sexual Medicine.
... For example, emotional problems increase with the duration of infertility and with advancing age in women as their childless years increase [25]. Additionally, a long marital relationship may reduce sexual desire [26], alter the excitatory response, and reduce coital frequency, leading to sexual dissatisfaction [27]. Moreover, data of the 4 reviewed studies that used specific instruments for assessment of sexual function were not comparable because they measured different outcomes. ...
Article
OBJECTIVE: Assess the state of the art on the relationship between infertility and the sexual function of couples. DATA SOURCES: The PubMed, Lilacs, and Google Scholar databases were searched for articles that assessed the sexual function of infertile couples (IC). Recent patents on this subject were assessed. STUDY SELECTION: Quantitative studies published in the English language (case-control, cross-sectional, cohort, multicenter, observational studies, randomized controlled trials, meta-analyses, systematic reviews) that used structured and semi-structured questionnaires for quantitative assessment of the sexual function of infertile couples were identified using the search terms: "infertile couple" and "sexuality", "sexual dysfunction", "sexual function", "sexual disorder", "hypoactive sexual desire". DATA EXTRACTION: One researcher identified 12 studies, and extracted data on 1871 IC. Five studies used different instruments to assess different aspects of sexual function and 7 studies assessed sexual function based on sub-domains of instruments used to evaluate marital relationships. DATA SYNTHESIS: Incongruent results due to different objectives and methodologies, the lack of specific questionnaires to assess sexual function, and uncontrolled social and relationship variables that could have interfered with sexual function were evident in most studies. CONCLUSION: The lack of standardized methodology or validated tools in most studies prevents to establish the impact of infertility on the sexual function of IC.
... However, heterosexual men were less satisfied with their partner's sexual creativity and ability to orgasm, the variety of sexual activities, and the frequency of sexual activity. This may be explained by possible sexual difficulties of female partners, namely the lack of sexual interest, the most frequent women's sexual complaint (Carvalheira, Brotto, & Leal, 2010;Laumann et al., 1999;Laumann et al., 2005;Mercer et al., 2003). On the other hand, homosexual men were less satisfied with their mood after sexual activity. ...
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Objective: This study analyzed the correlates of sexual satisfaction among exclusively heterosexual and homosexual men. Method: Analyses were carried out using data from a 2011 web survey about male sexual interest in two European countries. A total of 2,968 men with exclusive heterosexual behavior and 285 men with exclusive homosexual behavior in the previous five years from Portugal and Croatia, participated in the current study. Hierarchical multiple regressions were performed in order to explore which variables predicted sexual satisfaction. Results: Among heterosexuals, in step one, both age and sexual difficulties emerged as highly significant predictors, and in step two, the frequency of intercourse and the number of sexual partners also emerged as significant predictors. Finally, in the third step, intimacy and length of relationship emerged as highly significant predictors of sexual satisfaction. Among homosexuals, in step one, sexual difficulties and country were significant predictors, in step two, only the frequency of sexual intercourse was a significant predictor, and in step three, both relational variables (relationship length and relationship intimacy) were significant predictors Conclusions: The findings suggest that relational factors, particularly couple intimacy were the strongest predictors of sexual satisfaction for both heterosexual and homosexual men.
... Further support for the dissolution of a "spontaneous desire" concept stems from findings of the "Study of Women's Health Across the Nation" which found that among the 2,400 women sampled, 41.4% reported that they never or infrequently felt sexual desire prior to sex (Avis et al., 2005); however, nearly all of the sample reported moderate to extreme levels of sexual satisfaction. Moreover, even among women who report high levels of sexual arousal, the majority (85%) reported that they at least occasionally began a sexual encounter with no awareness of sexual desire but then experience responsive desire as the encounter unfolds (Carvalheira, Brotto, & Leal, 2010). ...
Article
The past three decades have seen an unprecedented increase in empirical research on women?s sexual response. In this review, we critically examine current controversies and assumptions associated with the nature of women?s sexual arousal and desire. We focus specifically on four assumptions: (1) the assumption that women should be aroused by stimuli that align with their stated preferences, (2) the assumption that women?s physiological and self-reported arousal should perfectly align, (3) the assumption that sexual desire precedes sexual arousal, and (4) the assumption that a single pharmaceutical compound will adequately restore women?s sexual response to her level of satisfaction. Engaging a gendered psychological framework for conceptualizing women?s sexuality, we emphasize the need for models of women?s sexual response to be sensitive to the sexed biological processes and gendered psychosocial factors that contribute to a woman?s unique sexual experience.
... Sexual desire and general sexual functioning have been found to be associated with many variables. For example, a developmental history of sexual abuse (Rellini & Meston, 2007; for reviews, see Brotto et al., 2010;Leonard et al., 2002) and the length of one's current sexual relationship (Carvalheira et al., 2010;Klusmann, 2002) have been consistently associated with women's sexual desire. Considering women's sexual functioning more generally (i.e., not specific to sexual desire), evidence suggests that general emotional well-being (Bancroft et al., 2003a(Bancroft et al., , 2003b(Bancroft et al., , 2003c(Bancroft et al., , 2003d, feeling desired and accepted by one's partner (Graham et al., 2004), body-image satisfaction (Graham et al., 2004), sexual conservativism and cognitive interference (Nobre, 2009), psychiatric history , and menopausal status (Cawood & Bancroft, 1996) are all important contributors. ...
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The aim of the present study was to expand previous findings regarding paradoxical effects of negative mood on sexual desire. This was done by considering the full range of depressed mood and anxiety symptoms and using methods that are unaffected by recall bias and that don’t require participants to infer causal associations between their mood and sexual desire. A convenience sample of 213 university students completed daily questionnaires for approximately two months. Multilevel random-effects models were used to estimate average effects for the entire sample and to test for variability across participants in the associations between negative mood and sexual desire, controlling also for potential influences of the menstrual cycle. Previous findings showing that some women report decreased sexual desire and others increased sexual desire when depressed or anxious were confirmed. More importantly, for both depressed mood and anxiety, results demonstrated the presence of within-person paradoxical associations, whereby there were some women for whom both low and high levels of negative mood were associated with the same change (an increase or a decrease) in sexual desire. Related to these diverse response patterns, paradoxical associations between negative mood and sexual desire were also present at low levels of negative mood. The discussion underlines the importance of considering individual variability and multifactorial nonlinear models when studying sexual desire.
... Hypoactive sexual desire disorder is characterized by "persistently or recurrently deficient (or absent) sexual fantasies and desire for sexual activity" (APA, 2000: 541). Dissatisfaction has been reported with this definition as it is considered that desire for sex and sexual fantasy are not universal experiences (Carvalheira, Brotto and Leal, 2010). It is considered that sexual desire in a woman may often be "neutral" or absent at the initiation of a sexual encounter, but can be triggered by a variety of (non-sexual) factors, such as emotional intimacy (current status of relationship with partner, desire to express love and give and receive pleasure) and general wellbeing. ...
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Recent research has increased our understanding of the underlying mechanisms and processes involved in positive sexual functioning. Sexual difficulties are common within the general population and these problems tend to increase with age and poor health. Although psychological issues are common reasons for the presence of sexual dysfunction, a number of biological risk factors are causative and the presence of erectile dysfunction in men may hide an underlying, serious medical problem such as diabetes or heart disease. A comprehensive assessment of an individual’s medical, sexual and psychosocial history is recommended for treatment of sexual dysfunction. A clinical interview and various physical investigations are usually necessary. Assessment of the general relationship between the couple is vital to rule out what may be primarily a relationship, rather than a sexual problem. Education of couples and ensuring the environment is right for positive sexual experiences are both an essential part of the process of treatment. The couple in each case need to be aware of the time commitment required from them for a successful outcome. Although there are general treatment principles that must be followed (e.g. sensate focus exercises; exploration of dysfunctional beliefs, etc.), each case will usually require a tailored intervention depending on the nature of the problem. Oral medications are playing an increasing role in the treatment of male sexual dysfunction. The relevance of treating pain-related sexual dysfunction in women has gained increased attention. Further research into understanding persistent genital arousal disorder among women is necessary and such a presentation needs to be dealt with sympathetically. Among males, sexual addiction is gaining increased attention and can have enormous negative effects on an individual across many areas of their life. The focus of treatment is on helping the individual develop a healthy sexuality and addressing underlying psychopathology. I Internet pornography addiction is proving problematic for many individuals affecting relationships among families and couples. A variety of treatments have been proposed but no full clinical trials have been carried out. The use of the Internet has fostered much growth in sexually deviant behaviours and the course of paraphilia is usually chronic and unremitting. Such cases require specialist treatment. Gender identity disorder has a better outcome if diagnosed early and it is not uncommon for initial presentation to occur in childhood. Referral of both the individual and the family to an appropriate psychiatric service is necessary. The diagnosis and treatment of sexual dysfunction in non-heterosexuals should not differ to that among the heterosexual population, although possible ambivalence about sexuality needs consideration. There is still very little available research into the prevalence of sexual dysfunction among non-heterosexuals.
... Initially, a woman may not feel sexually aroused, relying on sexual stimulation from both herself and her partner in order to enable her to enjoy the sexual experience (Basson, 2005). In a study with 3,687 Portuguese women, Carvalheira, Brotto, and Leal (2010) determined that a woman might engage in sexual activity in order to please her partner, whether or not she initially feels sexual desire. However, in general, once a woman becomes sexually involved, she is easily aroused. ...
Article
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Aims The main purpose of this study is to analyse the relationship between sexual difficulties and factors of sexual arousal, excitement, and sexual inhibition among men and women. Method A total of 1,878 participants, of whom 983 were men (52%) and 895 were women (48%), with a mean age of 35.9 years (SD = 11.9; range = 18-79), were recruited online. The study’s instruments included a socio-demographic questionnaire, a questionnaire about sexual difficulties, and the Sexual Excitation/Sexual Inhibition Inventory for Women and Men (SESII-W/M). Results Women with and without sexual difficulties differed significantly on all subscales of the SESII-W/M. Men with sexual difficulties scored significantly higher in the dimensions of Inhibitory Cognitions and the Dyadic Elements of the Sexual Interaction than men without difficulties. Inhibitory Cognitions was the strongest predictor of sexual difficulties for both men and women. Relationship Importance was also a strong predictor of sexual difficulties in women. Conclusions Sexual inhibition serves as a predictor of sexual difficulties. The SESII-W/M seems to work better in determining the factors of sexual inhibition as predictors of sexual difficulties among women, than in identifying causes of sexual difficulties among men.
... In addition, prior studies have found that women do not masturbate very often (Burri & Carvalheira, 2019;Carvalheira & Leal, 2013), which affects their sexual fantasy repertoire (Carvalheira, Brotto, & Leal, 2010). Although our methodology did not allow to assess masturbatory behavior, the overall sample showed lower levels of solitary and attractive person-related sexual desire. ...
Article
Women's sexual difficulties have been associated with sexual-related dimensions. The present study aims to analyze the differences between women with and without sexual concerns, according to the Female Sexual Functioning Index cutoff score, on dyadic and solitary sexual desire and sexual satisfaction dimensions. A total of 314 women participated in the study and answered to a sociodemographic screening, to the Sexual Desire Inventory − 2, to the Female Sexual Functioning Index, and to the Sexual Satisfaction Scale for Women. Main findings showed that women with sexual concerns revealed lower levels of global sexual desire and partner-related sexual desire, experienced lower levels of communication and compatibility with sexual partner, and have more personal and relational sexual concerns. Overall, results enhance the role of dyadic and relational dimensions that allow to differentiate between women with and without sexual concerns. Clinical implications are discussed.
... Thus, women may become aware of interest in sexual desire after having chosen to engage in sexual activity for relationship-focussed and/or non-sexual reasons (Basson, 2000;Goldey & van Anders, 2012;Sheldon et al., 2006). Indeed, responsive desire (i.e., sex to satisfy a partner) is commonly reported to occur by older women in long-term relationships (Basson, 2000) and those with arousal difficulties (Carvalheira et al., 2010). In women with low interest in sex, non-hormonal variables (e.g., negative early childhood experiences, psychiatric symptoms, history of sexual trauma) are more predictive of interest in sex than are hormonal variables (Brotto et al., 2011). ...
Article
Women’s interest in sex is asserted to increase at the mid-cycle pre-ovulatory estradiol peak. We explored this belief in healthy, spontaneously normally menstruating/ovulating women. Women recorded “interest in sex” in a daily diary; validated Quantitative Basal Temperature analysis documented ovulation. Interest in sex showed no mid-cycle peak in 61 normal-weight, nonsmoking women, ages 33.7 ± 5.6 years, over a mean of 311 consecutive days. The cycle-plotted diary “self-worth” factor (including feelings of energy, interest in sex) also showed no mid-cycle peak. Thus, interest in sex is related more strongly to women’s feelings/experiences than to hormones, challenging deterministic or sex-hormone-dependent cultural and sociobiological understandings.
... Furthermore, all of these non-heterosexual women reported an increased ratio of other-sex to same-sex behavior over time, suggesting a potential continuity between female homosexuality and bisexuality. Although one could question the representativeness of this sample for heterosexually identified women (Mock & Eibach, 2011), these findings provide additional support for the hypothesis that sexual motivation may be more complexly determined (on average) in women than in men (Carvalheira et al., 2010;Carvalho & Nobre, 2010Rupp & Wallen, 2008). ...
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Is sexual orientation an evolutionary adaptation or social construct? With respect to sexual preferences, to what extent are we "born that way" and to what extent does learning matter? This chapter discusses how nature and nurture may interact to shape sexual motivation by reviewing existing literature on sexual preferences and orientations, as well as by considering sex/gender differences in erotic plasticity, sexual fluidity, and the specificity of sexual arousal. We describe how these phenomena might be accounted for by processes in which mind body feedback loops amplify some sexual responses over others on multiple levels, which we refer to as the Reward Competition Feedback (RCF) model. With respect to sex/gender differences, we describe how these positive feedback processes might be amplified in men compared with women, potentially substantially driven by differences in the constraints and affordances of female and male anatomy. More specifically, we argue that the well-known female-male difference in the concordance of genital and subjective arousal may contribute to well-known differences in sexual specificity and plasticity/fluidity. We further provide convergent support 2 for RCF by reviewing preexisting theories of sexual learning. Finally, we consider some of the ethical implications of models in which sexual orientation might be shaped by experiences over the course of development.
... Further, sexual response cycles are far from universal. Some researchers suggest women's sexual desire is responsive and extremely context-sensitive, with interest in sex sometimes preceding and other times following some form of sexual arousal or excitement (Brotto et al. 2009;Carvalheira et al. 2010;Goldhammer and McCabe 2011;Graham et al. 2004). Others point out that sexual arousal consists of both physiological (e.g., lubrication) and cognitive (e.g., feeling Bturned on^) elements, with nonconcordance between the body and the mind being common among women (Graham et al. 2004). ...
Article
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In the context of HIV, women’s sexual rights and sexual autonomy are important but frequently overlooked and violated. Guided by community voices, feminist theories, and qualitative empirical research, we reviewed two decades of global quantitative research on sexuality among women living with HIV. In the 32 studies we found, conducted in 25 countries and composed mostly of cis-gender heterosexual women, sexuality was narrowly constructed as sexual behaviours involving risk (namely, penetration) and physiological dysfunctions relating to HIV illness, with far less attention given to the fullness of sexual lives in context, including more positive and rewarding experiences such as satisfaction and pleasure. Findings suggest that women experience declines in sexual activity, function, satisfaction, and pleasure following HIV diagnosis, at least for some period. The extent of such declines, however, is varied, with numerous contextual forces shaping women’s sexual well-being. Clinical markers of HIV (e.g., viral load, CD4 cell count) poorly predicted sexual outcomes, interrupting widely held assumptions about sexuality for women with HIV. Instead, the effects of HIV-related stigma intersecting with inequities related to trauma, violence, intimate relations, substance use, poverty, aging, and other social and cultural conditions primarily influenced the ways in which women experienced and enacted their sexuality. However, studies framed through a medical lens tended to pathologize outcomes as individual “problems,” whereas others driven by a public health agenda remained primarily preoccupied with protecting the public from HIV. In light of these findings, we present a new feminist approach for research, policy, and practice toward understanding and enhancing women’s sexual lives—one that affirms sexual diversity; engages deeply with society, politics, and history; and is grounded in women’s sexual rights.
... Interestingly, androgen predictors of low desire and HSDD generally became nonsignificant after controlling for relationship duration, especially for naturally cycling women. Although not specifically measuring HSDD, other research has reported that relationship duration positively predicts the frequency of having sex without first experiencing sexual desire [58], perhaps reflecting a transition from spontaneous desire associated with pair bond establishment to responsive desire associated with pair bond maintenance. ...
Article
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Purpose of Review This review attempts to explain female hypoactive sexual desire disorder (HSDD) from a functional evolutionary perspective. Can theory and data regarding the evolved functions of female sexual motivation help explain cases of low sexual desire in women? If so, might some such cases be the product of brain mechanisms operating in ways that promoted reproductive success during human evolution, rather than low desire resulting from pathology? Recent Findings A functional theory of women’s sexual motivation is first summarized, which posits that sexual desire is modulated by both conception probability and social variables related to the initiation and maintenance of pair bonds. Recent evidence consistent with this theory is reviewed, followed by review of evidence showing that variables predicting sexual desire in most women may also explain cases of HSDD. Summary Women’s sexual desire varies in functionally patterned ways. Discovering the evolved design of brain mechanisms that generate those patterns is crucial for understanding HSDD.
... The reverse SDS may also be a result of differences in the assumed sexual motives of men and women. As discussed earlier, men report motives for sexual behaviors that are often based on their own pleasure and desires, whereas women report motives based on intimacy and relationships (Meston and Buss 2007;Carvalheira et al. 2010;Vannier and O'Sullivan 2011). Because individuals in relationships with partners who report intimacy-focused motives benefit from increased relationship satisfaction (Young and Burke 2017), those with intimacy-focused motives may be judged as higher quality partners than those with pleasure-focused motives. ...
Article
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Research reveals that masturbation is a highly stigmatized behavior for which people are harshly judged. Stigmatized sexual behaviors often result in discrepancies in social judgment such as the Sexual Double Standard (SDS; the tendency to judge women’s sexual behavior more harshly than men’s). However, no research has experimentally examined the SDS with respect to masturbation or the assumed motives influencing the potential SDS. Thus, in study one, a total of 496 U.S. adults (246 women, 250 men) were required to read one of four vignettes depicting a hypothetical man or woman engaged in masturbation. After reading the vignette, the endorsement of the SDS was assessed by asking participants to rate the perceived partner quality of the hypothetical masturbator. In study two, a total of 264 U.S. adults (115 women, 149 men) were again required to read vignettes, rate the target’s perceived partner quality, and report on the assumed pleasure and intimacy-focused motives of the target. The results of both studies revealed a reverse SDS, in which women were viewed as higher quality partners than men. Study two further demonstrated that women were assumed to have masturbated for both pleasure and intimacy-focused motives to a greater extent than men and that these motives helped to explain the reverse SDS. Overall, these findings highlight the need to equalize double standards in Western cultures to reduce potentially harmful effects on sexual health.
... In contrast, men in long-term relationships had less sexual drive than they did at the beginning of their relationships. 24 Another research indicated that a long-term marital relationship (> 10 years) was associated with reduced sexual desire, 24 less intimacy, reduced arousal, and more sexual dissatisfaction. 25 The present study indicated that the IG and the CG had similar proportions of women with FSFI score 26.55 (the threshold for sexual dysfunction). ...
Article
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Objective To assess the sexual function, anxiety, and depression of infertile women relative to a control group. Methods Infertile women (infertile group, IG) of reproductive age were invited to participate in this controlled study. A control group (CG) of women was recruited from the general population of the same city. Sexual function was assessed by the Female Sexual Function Index (FSFI), and anxiety and depression were measured by the Hospital Anxiety and Depression Scale (HADS). Results A total of 280 women participated in the present study, 140 in the IG and 140 in the CG. The analysis of the FSFI scores showed that 47 women (33.57%) in the IG and 49 women (35%) in the CG had sexual dysfunction (FSFI ≤ 26.55; p = 0.90). Women with anxiety or depression had a greater risk of sexual dysfunction, and sexual dysfunction increased the risk of anxiety and depression. Married women had a lower risk of depression than single women who were living with their partners. Conclusion Infertile women had no increased risk of sexual dysfunction relative to controls. Anxiety and depression increased the risk of sexual dysfunction in the studied population.
... This information may include a description of spontaneous and responsive sexual desire, the role of motivation in sexual desire, the importance of adequate sexual stimulation, the impact of pleasurable sexual experiences on desire, and the influence of age and relationship duration. [109][110][111] Second, educate the patient about factors that are derived from the sexual and medical history that may disrupt sexual desire (eg, mood disorders, relationship satisfaction, body image). 5 Third, HCPs may assess motivation for treatment and discuss treatment options. ...
Article
The International Society for the Study of Women's Sexual Health process of care (POC) for management of hypoactive sexual desire disorder (HSDD) algorithm was developed to provide evidence-based guidelines for diagnosis and treatment of HSDD in women by health care professionals. Affecting 10% of adult females, HSDD is associated with negative emotional and psychological states and medical conditions including depression. The algorithm was developed using a modified Delphi method to reach consensus among the 17 international panelists representing multiple disciplines. The POC starts with the health care professional asking about sexual concerns, focusing on issues related to low sexual desire/interest. Diagnosis includes distinguishing between generalized acquired HSDD and other forms of low sexual interest. Biopsychosocial assessment of potentially modifiable factors facilitates initiation of treatment with education, modification of potentially modifiable factors, and, if needed, additional therapeutic intervention: sex therapy, central nervous system agents, and hormonal therapy, guided in part by menopausal status. Sex therapy includes behavior therapy, cognitive behavior therapy, and mindfulness. The only central nervous system agent currently approved by the US Food and Drug Administration (FDA) for HSDD is flibanserin in premenopausal women; use of flibanserin in postmenopausal women with HSDD is supported by data but is not FDA approved. Hormonal therapy includes off-label use of testosterone in postmenopausal women with HSDD, which is supported by data but not FDA approved. The POC incorporates monitoring the progress of therapy. In conclusion, the International Society for the Study of Women's Sexual Health POC for the management of women with HSDD provides a rational, evidence-based guideline for health care professionals to manage patients with appropriate assessments and individualized treatments.
... In the DSM-5, the previous diagnoses of hypoactive sexual desire (which applied to both women and men) and female sexual arousal disorder have been merged, while sexual aversion disorder was removed. The diagnostic merger is based on multiple studies that have demonstrated a high level of comorbidity between arousal and desire disorders (Brotto, 2010;Brotto, Bitzer, Laan, Leiblum, & Luria, 2010;Brotto, Graham, Binik, Segraves, & Zucker, 2011a;Carvalheira, Brotto, & Leal, 2010). The current criteria for the newly introduced diagnosis of female sexual interest/arousal disorder (FSIAD) in the DSM-5 include absent or decreased (1) sexual interest, (2) erotic thoughts or fantasies, (3) initiation of sexual activity or responsiveness to a partner's attempts to initiate it, (4) excitement and pleasure during sexual activity, (5) response to any internal or external sexual or erotic cues (e.g., verbal, visual, written), and (6) genital and/or nongenital sensations during sexual activity. ...
Article
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We review the theory and research on women’s sexual desire and present a theory that incorporates internalized representations of relational and bodily experiences into our understanding of the full range of desire in women. To this end, we move away from the current tendency to focus on low sexual desire in women and instead consider desire on a spectrum or continuum from absent or diminished to high desire across multiple sexual orientations, including heterosexual, bisexual, and lesbian. We review definitions of sexual desire, as well as the epidemiology and etiology of hypoactive sexual desire, the most prevalent sexual complaint in women, including the biological, psychological, and relationship correlates of inhibited sexual desire. Subsequently, we examine the research on highly sexual women, who tend to experience high levels of sexual desire, sexual agency, and sexual esteem, and distinguish between high sexual desire and hypersexuality. We introduce two important constructs that are integrated into the Relational and Bodily Experiences Theory (RBET) of sexual desire in women: attachment and sexual body self-representations, suggesting that women’s internalized representations of self and other that stem from childhood and their capacity to embody their sexual bodies are integral to our understanding of the phenomenology of sexual desire in women. RBET calls for further research into the links between attachment, sexual body self-representations, and desire, and suggests that clinical interventions for sexual desire difficulties in women should emphasize internalized working models of relationships (i.e., attachment) and integrate bodily based approaches.
... A growing body of research, over the past decades, has focused on female sexual desire (e.g., DeRogatis, Clayton, D'Agostino, Wunderlich, & Fu, 2008;Basson, 2001;Carvalheira, Brotto, & Leal, 2010), neglecting a deeper comprehension of male sexual desire. Nevertheless, the physiological role on male 45 sexuality has been highlighted in the literature (e.g., Isidori et al., 2005), and studies assessing gender differences in sexual desire levels have consistently described higher levels of sexual desire in male samples (Beutel, Stobel-Richter, & Brahler, 2008;Carvalheira, Traeen, & Stulhofer, 2015;Holmberg & Blair, 2009;Levine, 2002;Regan & Atkins, 2006;Santtila et al., 2008;50 Schmitt et al., 2003;Van Anders, 2012). ...
Article
Research on male sexual desire and satisfaction, according to sexual orientation remains insufficient. An online-survey was fulfilled by 415 men (142 gay; 273 heterosexual), and participants completed the SDI-2 and the GMSEX. Main findings suggested that gay men scored significantly higher on both solitary sexual desire and attractive person-related dyadic sexual desire subscales, but not on partner-related dyadic sexual desire subscale, compared to heterosexual men. Despite sexual orientation, partner-related dyadic sexual desire positively predicts sexual satisfaction, whereas solitary and attractive person-related dyadic sexual desire negatively predicts sexual satisfaction in men. Overall, gay men appear to experience higher levels of both attractive person-related dyadic and solitary sexual desire. Also, experiencing sexual desire towards a partner predicts positively, whereas experiencing desire to engage in sexual behavior with oneself and towards an attractive person predict negatively sexual satisfaction in men.
... Also emphasized was the critical role of incentives (both nonsexual and sexual ones) that move a person out of sexually "neutral" toward being sexually receptive to his or her sexual stimuli. Informed by empirical research findings (e.g., Carvalheira, Brotto, & Leal, 2010;Meston & Buss, 2007), the circular sexual response cycle also included intimacy-based incentives, indicating that one may initiate sex purely to obtain intimacy-related goals. The circular cycle also included the fact that the individual may still experience what feels to be spontaneous desire, depicted as a potential but not essential reinforcing component in the center of the cycle (Basson, 2001). ...
Article
In 2013, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was published with a major revision to the sexual dysfunction categories, and the diagnosis of female hypoactive sexual desire disorder (HSDD) was replaced with female sexual interest/arousal disorder (SIAD). Since being introduced, concern has been expressed that SIAD inappropriately “raises the bar” for diagnosis. To address these concerns, we sought to evaluate the number of women with a diagnosis of HSDD who also met criteria for SIAD. In a sample of 151 women, we found that 73.5% of women with a diagnosis of HSDD met criteria for SIAD. The two groups were compared on the Sexual Interest/Desire Inventory, and women who met criteria for both HSDD and SIAD consistently scored lower on sexual desire frequency and satisfaction, satisfaction with sex, receptivity, positive sexual thoughts, reactions to erotica, arousal frequency, ease, continuation, and orgasm ease/achievement, and higher on distress. In addition, women meeting criteria for HSDD only tended to have mild symptoms across the six SIAD criteria compared to those meeting criteria for both HSDD and SIAD. These findings suggest that the SIAD criteria does not unduly raise the bar for diagnosis.
Thesis
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Over the last decades, women’s sexual life has recorded some noticeable changes, along with new light-shedding perspectives on the understanding of women’s sexuality. A relevant set of studies highlight the importance of different biological, psychological and social dimensions as determinants of sexual functioning and satisfaction, although only a few of them consider those dimensions in an integrated and interdependent way, in order to ascertain each dimension’s significance. Furthermore, and despite the close relation between sexual functioning and sexual satisfaction, the existing literature tends to show some confusion and overlapping between both concepts. Considering this, the present study is intended to analyse the main relational, psychological, contextual and biomedical predictors of women’s sexual functioning and satisfaction, as well as to explore the relation between these two dimensions of women’s sexuality. In this light, using a sample of 497 women, ten empirical studies were conducted, based on queries aimed at assessing the participants’ social and demographic characteristics, medical history and lifestyle, psychopathology, well-being, cognitive and affective variables, relational aspects, sexual context, sexual activity, sexual functioning and sexual satisfaction. Results suggested significant differences between women with high and low levels of sexual functioning, and between high and low levels of sexual satisfaction regarding the various dimensions analysed. On the other hand, the combined analysis of all the biopsychosocial dimensions confirmed the unequivocal contribution of the psychological variables to explain women’s sexual functioning, particularly the role of self-awareness of one’s pleasure during sexual activity, the satisfaction and contentment that derive from meaningful sexual experiences, as well as sexual self-esteem, that is, the image that the woman has of herself as a sexual being. As to the other dimensions considered, only the use of cardiotonic drugs significantly predicted reduced sexual functioning, whereas age, or other social and demographic variables, diseases and the perception of one’s health, menopausal state, lifestyle, psychopathology, general concerns during sexual activity or other contextual variables have shown no predictive value. Regarding sexual satisfaction, the best predictors were the emotional variables, especially the specific responses of joy and absence of guilt during sexual activity, as well as relational aspects, particularly the relationship’s quality, but also the presence of a sensitive partner to the woman’s needs and sexual preferences. Furthermore, cognitive variables have also shown a significant role, such as women resorting to sexual fantasies and minding their behaviour during sexual activity, contributing to an increased sexual satisfaction. Besides that, sexual self-esteem and the ability to achieve orgasm during sexual encounters were also significant predictors of satisfactory sexual experiences. Conversely, no medical, sociodemographical, lifestyle or psychopathological variables have shown any predictive value for sexual satisfaction. In a simultaneous analysis of the different biopsychosocial predictors of women’s sexual functioning, cognitive and emotional determinants stand out. Concerning satisfactory sexual experiences, besides those, relational aspects also played a central role, all the more important given the close relation and circularity between sexual functioning and sexual satisfaction. However, these two dimensions of women’s sexual experience seem to have different predictors, thus supporting the need for a differentiated and specific approach, whether in empirical studies or in interventions. In general, this study was intended to fill a void in the research field regarding women’s sexual experiences, in a positive perspective (both sexual functioning and satisfaction), enabling a deeper knowledge on its determinants, with repercussions for clinical intervention and for the promotion of a more gratifying women’s sexual life.
Article
Introduction: 'Female sexual dysfunction' (FSD) is an umbrella term comprising a range of common disorders, including hypoactive sexual desire, reduced subjective and/or physical genital arousal (poor sensation, vasocongestion, lubrication), sexual pain and inability to achieve orgasm/satisfaction, which are multidimensional by nature and often coexisting. Psychological and contextual factors have a significant influence on organic components of sexual response and behavior and a tailored medical approach to sexual symptoms is inevitably limited. Areas covered: The paper reports the most recent advances in pharmacotherapy for women taking into account the biopsychosocial model. Hormone therapy, including estrogens, testosterone, tibolone and dehydroepiandrosterone, are discussed in term of efficacy and safety in postmenopausal women both for female sexual interest/arousal disorder (FSIAD) and genito-pelvic pain/penetration disorder. Ospemifene, a selective estrogen receptor modulator, approved to treat dyspareunia at menopause, is also discussed. Data on psychoactive agents for treatment of FSIAD in premenopausal women are discussed, including the potential use of on-demand combined hormonal (testosterone) and non-hormonal (buspirone or sildenafil) treatments to address possible neurophysiological profiles of women. Expert opinion: We are still waiting for an approved pharmacotherapy for FSD. This is not the result of gender inequality in sexual medicine, but it reflects the need of balancing benefits and risks in order to provide effective and safe treatments to women of any age.
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Doğum genellikle bir kadının hayatındaki en unutulmaz ve acı verici deneyimlerden biri olarak kabul edilmektedir (Kolan ve ark., 2020). Doğum ağrısı karmaşık ve çok boyutlu bir olaydır ve fizyolojik bir süreç olarak en şiddetli ağrılardan biri olarak bilinmektedir (Shaterian ve ark., 2021). Normal, müdahale edilmeyen vajinal doğum, sezaryene göre daha güvenli ve annenin hastanede kalış süresini kısaltan fizyolojik bir süreçtir. Ancak doğum sırasındaki ağrı ve kaygı bu fizyolojik süreci olumsuz etkileyebilmektedir. Doğum ağrısı kadınlarda sezaryen oranını artıran önemli bir faktördür. Ayrıca doğum deneyiminin olmaması kadınların doğum sırasında kaygı ve korku yaşamalarını arttıran bir faktördür (Yüksel ve ark. 2017). Doğum ağrısı bireysel bir deneyim olmasına rağmen, doğum ağrısının doğum ilerledikçe daha yoğun hale geldiği bilinmektedir (Hu ve ark., 2021). Doğumun ikinci evresinde ağrı daha yoğundur ve karnın alt kısmında yerleşmiştir (Yüksel ve ark. 2017). Uluslararası Ağrı Araştırmaları Derneği (IASP), ağrının genellikle uyum sağlayıcı bir role sahip olduğunu ancak işlevsel durum, sosyal ve psikolojik iyilik hali üzerinde olumsuz etkileri olabileceğini belirtektedir. Williams ve Craig ağrıyı “duyusal, duygusal, bilişsel ve sosyal bileşenlerle gerçek veya potansiyel doku hasarı ile ilişkili rahatsız edici bir deneyim” olarak tanımlamaktadır (Raja ve ark. 2020). Doğum ağrısının yoğun hissedilmesi anne adayında uterus kan akımını azaltma, kalp debisini artırma, oksijen tüketimini arttırma ve ciddi solunum alkalozuna yol açma gibi olumsuz etkilere yol açabilmektedir (Hu ve ark., 2021). Bu fizyolojik değişiklikler, fetüse giden oksijen miktarını etkilemekte ve fetal hipoksemi ve metabolik asidoza neden olmaktadır. Ayrıca doğumda ağrısının yoğun hissedilmesi, travma sonrası stres bozukluğu için hazırlayıcı bir faktördür ve olumsuz bir doğum sonrası deneyimine neden olmaktadır (Taheri ve ark. 2018). Doğum sırasında aşırı ağrı, korkuyu artırarak kadını ağrıya karşı daha duyarlı hale getirmekte ve korku-gerginlik-acı döngüsü kavramı ortaya çıkmaktadır. Bu döngüyü kırmak, olumlu bir doğum deneyimine sahip olmak için gereklidir Ayrıca korku, stres hormonlarının salınmasına neden olan kortizolün dolaşımda salınmasına neden olur. Yüksek bir kortizol seviyesi, uterin arter kan akışında azalmaya neden olur, bu da kasılmaların yavaşlamasına veya durmasına sebep olur. Rahim kasılmalarının etkinliğindeki düşüş, doğumun süresini uzatmaktadır. Uzun bir doğum, bebek ve anne için komplikasyonları artırabilir (Çiçek ve Başar. 2017). 96Bununlabirlikte doğum ağrısına uyumlanma, annelerin doğum sürecinden daha fazla memnun olmalarını sağlamaktadır(Geltore ve Angelo, 2020). Bu nedenle, doğum ağrısının yoğunluğunu ve süresini güvenli bir aralığa indirmek için uygun ağrıya uyumlanma yöntemlerini benimsemek esastır. Dünya Sağlık Örgütü’de doğumun ilk aşamasında doğum ağrısını azaltacak ve böylece kadınların doğum deneyimini iyileştirecek önlemler alınmasını tavsiye etmektedir (WHO, 2018). Yaşanan ağrılı süreç, gebe ve ebenin birlikte yol alması gereken bir süreçtir. Ebeler, doğum sürecinde gebe ile pozitif iletişim sağlayarak bireyselleştirilmiş bakım sağlamalı ve gebenin doğum ağrısıyla uyumlanabilmesine destek olmalıdır (Kaçar, 2020). Doğum ağrısını gidermek için farmakolojik ve farmakolojik olmayan yöntemler kullanılmaktadır. Bu yöntemlerin amacı anneye ve bebeğe herhangi bir zarar vermeden ağrının giderilmesi ve anneye konforlu bir doğum deneyimi yaşatılmasıdır. Farmakolojik olmayan ağrı giderme yöntemleri herhangi bir ilaç kullanılmadan kadının gevşemesine odaklanan, ağrısını en az algılamasını sağlayan yöntemlerdir. Farmakolojik olmayan yöntemler genellikle maliyet etkin ve girişimsel olmadığı için genellikle farmakolojik tedavilere tercih edilir (Young ve ark., 2021). Farmakolojik olmayan yöntemlerin uygulanması doğum sürecinde anne ve bebeğe önemli yararlar sağlamaktadır. Bunun yanı sıra bu yöntemlerin kullanılması bireyselleştirilmiş, kadın merkezli bakımın alınmasını gerektirmektedir. Çünkü tüm farmakolojik olmayan yöntemlerin kullanılması ebe liderliğinde kadın merkezli bir bakım felsefesi ile sunulabilmektedir. Farmakolojik olmayan yöntemlerin uygulandığı ebelik bakım modeli kadının fiziksel, zihinsel ve ruhsal boyutlara sahip bir bütün olarak görüldüğü “bütünsellik” kavramını benimsemektedir (Bertone ve Dekker, 2021). Son on yılda giderek daha popüler hale gelen farmakolojik olmayan yöntemlerin kullanımının yaygınlık oranlarını gösteren çalışmalar %1 ile %87 arasında değiştiğini bildirmektedir. Son yıllarda doğum ağrısına uyumlanmada kullanılan farmakolojik olmayan başlıca yöntemler; nefes teknikleri, refakatçi eşliğinde doğum, suda doğum, yoga, hareket özgürlüğü, aromaterapidir (Bertone ve Dekker, 2021). Doğum korkusu, stres hormonlarının salınmasına neden olan kortizolün dolaşımda salınmasına neden olur. Yükselen kortizol seviyesi, uterin arter kan akışında azalmaya neden olur, bu da kasılmaların yavaşlamasına veya durmasına sebep olur. Rahim kasılmalarının etkinliğindeki düşüş, doğumun süresini uzatmaktadır.
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Schimpansen leben in einem polygynandrienen Paarungssystem, in dem sich Weibchen mit mehreren Männchen und Männchen mit mehreren Weibchen paaren. Vermutlich haben sich Menschen nach dem pan-homo Split vor ca. 7 Millionen Jahren von einem polygynandrienen zu einem polygynen (Harem) und dann zu einem überwiegend monogamen Paarungssystem entwickelt. Die Sexualität des Jetzt-Menschen zeigt zugleich Merkmale des älteren polygynen und des neueren monogamen Paarungssystems. In diesem Kapitel werden zahlreiche Beispiele von Anpassungen an das ältere und an das jüngere Paarungssystem des Menschen erläutert. Im Ergebnis bedeutet es, dass wir Menschen ein sexuelles Mischwesen sind. Daraus können sich Probleme in unserer Sexualität und Partnerschaft ergeben. Die Kenntnis dieser sehr verschiedenen sexuellen Strategien des Jetzt-Menschen hilft, die eigene Sexualität und insbesondere die des Gegengeschlechts besser zu verstehen und eine gute Sexualtherapie zu machen.
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Introduction: The Female Sexual Function Index (FSFI) is a patient-reported outcome measure measuring female sexual dysfunction. The FSFI-19 was developed with 6 theoretical subscales in 2000. In 2010, a shortened version became available (FSFI-6). Aim: To investigate the measurement properties of the FSFI-19 and FSFI-6. Methods: A systematic search was performed of Embase, Medline, and Web of Science for studies that investigated measurement properties of the FSFI-19 or FSFI-6 up to April 2018. Data were extracted and analyzed according to COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines. Evidence was categorized into sufficient, insufficient, inconsistent, or indeterminate, and quality of evidence as very high, high, moderate, or low. Main outcome measures: The Main Outcome Measure is the evidence of a measurement property, and the quality of evidence based on the COSMIN guidelines. Results: 83 studies were included. Concerning the FSFI-19, the evidence for internal consistency was sufficient and of moderate quality. The evidence for reliability was sufficient but of low quality. The evidence for criterion validity was sufficient and of high quality. The evidence for structural validity was inconsistent of low quality. The evidence for construct validity was inconsistent of moderate quality. Concerning the FSFI-6, the evidence for criterion validity was sufficient of moderate quality. The evidence for internal consistency was rated as indeterminate. The evidence for reliability was inconsistent of low quality. The evidence for construct validity was inconsistent of very low quality. No information was available on structural validity of the FSFI-6, and measurement error, responsiveness, and cross-cultural validity of both FSFI-6 and FSFI-19. Clinical implications: Conflicting and lack of evidence for some of the measurement properties of the FSFI-19 and FSFI-6 indicates the importance of further research on the validity of these patient-reported outcome measures. We advise researchers who use the FSFI-19 to perform confirmatory factor analyses and report the factor structure found in their sample. Regardless of these concerns, the FSFI-19 and FSFI-6 have strong criterion validity. Pragmatically, they are good screening tools for the current definition of female sexual dysfunction. Strength & limitation: A strong point of the review is the use of predefined guidelines. A limitation is the use of a precise rather than a sensitive search filter. Conclusions: The FSFI requires more research on structural validity (FSFI-19 and FSFI-6), reliability (FSFI-6), construct validity (FSFI-19), measurement error (FSFI-19 and FSFI-6), and responsiveness (FSFI-19 and FSFI-6). Further corroboration of measurement invariance (both across cultures and across subpopulations) in the factor structure of the FSFI-19 is necessary, as well as tests for the unidimensionality of the FSFI-6. Neijenhuijs KI, Hooghiemstra N, Holtmaat K, et al. The Female Sexual Function Index (FSFI)-A Systematic Review of Measurement Properties. J Sex Med 2019;16:640-660.
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Female sexual dysfunction (FSD) and quality of life (QOL) are both multidimensional and have a bidirectional relationship across the reproductive life span and beyond. Methodological difficulties exist in estimating the real prevalence of FSD because it is hard to determine the level of distress associated with sexual symptoms in a large-scale survey. Approximately 40–50% of all women report at least one sexual symptom, and some conditions associated with hormonal changes at menopause, such as vulvovaginal atrophy (VVA) and hypoactive sexual desire disorder (HSDD), have a significant impact on sexual function and QOL. Sexual distress peaks at midlife, declines with age and is strongly partner-related. Many postmenopausal women are still sexually active, especially if they are in a stable partnership. Even though sexual functioning is impaired, a variety of psychosocial factors may maintain sexual satisfaction. That being so, health care providers (HCPs) should proactively address sexual symptoms at midlife and in older women, from a balanced perspective. Adequate counselling should be offered. Women with distressing symptoms may benefit from tailored hormonal and non-hormonal therapies, whereas women without distress related to their sexual experiences should not receive any specific treatment.
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The chapter deals with female sexual dysfunctions and gender dysphoria/incongruence in women. Concept, classification, clinical presentation, diagnosis and differential diagnosis, and treatment are the aspects addressed for each of these two categories. Preceding this content, the chapter considers the female sexual response cycle and its relation to the classification of female sexual dysfunction. This model also emphasizes the importance of emotional satisfaction during sexual activity and recognizes that female sexual functioning is more complex and is less linear than male sexual functioning. Another aspect that has received special mention in this chapter was the Brazilian program of assistance to transgender people, currently being updated by the experts. Nevertheless, the fundamental challenge remains as to how the standards of care will be negotiated, approved, and implemented by the public and private health authorities of various countries, in the context of broader sociopolitical issues. The whole text of the chapter is supplemented by diagnostic and therapeutic schemes that summarize these topics, to facilitate apprehension.
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Research on sex in later life has been concerned with documenting that older people continue to have sex and establishing the links between good health and sexual activity. Although sexual avoidance is common in clinical and nonclinical populations of older adults, little attention has been given to the motives for sexual avoidance. To address gaps in the literature on sexual avoidance, the present study explored the self-reported reasons for, and correlates of, sexual avoidance in older partnered individuals with probability samples of 60–75-year-olds in four European countries (Norway, Denmark, Belgium, and Portugal). Results revealed significant differences between men and women in sexual avoidance, with women reporting more avoidance than men. The main reasons reported for avoiding sex were sexual difficulties, health problems, partner’s sexual difficulties, and lack of sexual interest. Among men, significant predictors of sexual avoidance were age, relationship intimacy (the only relational predictor), physical health, and own and partner’s sexual problems. In women, significant predictors of sexual avoidance were age, relationship duration, relationship satisfaction, relationship intimacy, physical and mental health, and own and partner’s sexual problems. Thus, in men, health-related factors were more important predictors of sexual avoidance than relationship factors. In women, relationship factors were as important as health-related factors. These findings provide insight into an under-researched area. They also have important implications for healthcare and could inform the development of tailored sexual health interventions in older adults. Keywords: Older adults; sexual avoidance; relationship intimacy; relationship satisfaction; sexual problems; <br/
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Sexual function is an essential component of physical and psychological well-being and should be addressed as such in the clinical setting. This is an unconventional chapter regarding sexual function, in which issues for both men and women are combined to illustrate similar complexities in both genders and to minimize the traditional emphasis on gender differences. To this end, the chapter is divided into primary sections, addressing dysfunctions in the realms of desire/libido, arousal (erection/lubrication) and climax/ejaculation as well as metabolic syndrome. The final section briefly addresses nonpharmacological interventions as well as prescribed therapies for respective dysfunction. But the most important take home message is “just ask!”
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People might not be able or willing to accurately report how much they sexually desire their romantic partners due to concerns over the well-being of one’s relationship or impression management. This research assessed the predictive validity of a sexual desire implicit association task. First, a pilot study determined the psychometrically optimal length for the task. Study 1, using a dyadic weekly diary method, found that people with higher implicit desire experienced more intimacy during sex, were more responsive to their partner during sex, and perceived that their partners felt more desire, arousal, and intimacy during sex. In Study 2, higher implicit desire predicted quicker attentional disengagement from attractive alternatives for women; however, among men, higher implicit desire predicted slower attentional disengagement from attractive alternatives. Implications for understanding sexual desire in romantic relationships are discussed.
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Low desire is the most common sexual dysfunction in women. Pharmaceuticals are being developed to treat it, most notably Flibanserin, owned by Sprout Pharmaceuticals. Sometimes inaccurately referred to as "female Viagra," Flibanserin actually treats an entirely different problem. Viagra allows men to get an erection, meaning that it treats physical arousal problems. Flibanserin, and other drugs for low sexual desire in women, act on the brain. Women with low desire don't have a problem with physical arousal or with orgasm, but with desiring sex before it starts. Most women with low sexual desire disorder have partners with higher desire than they do. So is low desire a medical, physiological problem in the brain? Or is it a sociocultural, interpersonal issue? Some experts think that the majority of women with what has been called a "disorder" of low sexual desire have no abnormal physiological problem, but instead are living in a sociocultural and medical system that encourages them to think of themselves as broken, and may be best treated with non-pharmaceutical methods. Other experts think that low desire is a physiological problem and drugs are important to treat it. Cultural shame around communicating about sex, undervaluing of women's sexuality compared to men's, and unrealistic sexual expectations all feed into and complicate the issue.
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A construct consisting of eight dispositional sexual motives was proposed to expand upon and integrate earlier theory and research. The eight motives are desire for (a) feeling valued by one's partner, (b) showing value for one's partner, (c) obtaining relief from stress, (d) providing nurturance to one's partner, (e) enhancing feelings of personal power, (f) experiencing the power of one's partner, (g) experiencing pleasure, and (h) procreating. Based on this formulation, a self‐report questionnaire was developed to measure stable interest in the eight incentives hypothesized to influence sexual motivation and behavior. Initial factor analyses supported the proposed model in that items clustered predominantly into the theoretically proposed dimensions. The questionnaire was revised, and two subsequent factor analyses supported the earlier factor structure. AMORE scales were moderately correlated with erotophobic versus erotophilic attitudes, attitudes about uncommitted sex, sensation‐seeking tendencies, and need for attention. The Value For Partner and Nurturance scales were correlated with a personality measure of interpersonal warmth, and the Power and Partner Power scales were correlated with aggression tendencies. All AMORE scales were correlated with a measure of general sexual desire. Many AMORE scales were also correlated with self‐reports of sexual behavior and contraception/protection use. The distinction among sexual motives provides a more complete understanding of sexual motivation and is likely to improve prediction of sexual behavior.
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In order to elaborate on available models of sexual desire, we administered a sexual desire questionnaire to 144 college students, ages 18 to 54. Included in this measure were questions concerning the frequency of sexual desire, whether the respondent had participated in sexual activity without desire, or vice versa, experienced desire without sexual behavior, and a question assessing which cues are used by the subject to gauge sexual desire (e.g., frequency of intercourse, sexual dreams). Subjects also completed the Passionate Love Scale, Sexual Arousal Inventory, and Crowne‐Marlowe Social Desirability Scale. The results indicate that as a group, males report experiencing sexual desire more frequently than females. Males appeared to rely on similar indicators of desire as females, specifically genital arousal and sexual daydreams. For both males and females, sexual desire was significantly correlated with sexual arousal (r = 0.50, females; r = 0.44, males) while the correlation of desire and love was nonsignificant for both sexes. However, desire and sexual behavior did not necessarily co‐occur, as both males and females reported engaging in sexual behavior without desire. These data suggest that greater attention be paid to the definitional features of sexual desire in nonclinical samples, in an effort to clarify current diagnostic categories and to provide population base rates.
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This document was written by a group of 12 clinicians and social scientists and released at a press conference on October 25, 2000. The 1st part criticizes current American Psychiatric Association nomenclature for women's sexual problems because of false equivalency between men and women, erasing the relational contact of sexuality, and ignoring differences among women. The 2nd part offers guidance for new nomenclature from international sexual rights documents. The 3rd part offers a new classification system. It begins with a woman-centered definition of sexual problems, "discontent or dissatisfaction with any emotional, physical, or relational aspect of sexual experience," and provides 4 categories of causes: socio-cultural, political, or economic factors, partner and relationship factors, psychological factors, and medical factors. The document is designed for researchers, educators, clinicians, and the public. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Hypoactive Sexual Desire Disorder (HSDD) is one of two sexual desire disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and is defined by the monosymptomatic criterion "persistently or recurrently deficient (or absent) sexual fantasies and desire for sexual activity" that causes "marked distress or interpersonal difficulty." This article reviews the diagnosis of HSDD in prior and current (DSM-IV-TR) editions of the DSM, critiques the existing criteria, and proposes criteria for consideration in DSM-V. Problems in coming to a clear operational definition of desire, the fact that sexual activity often occurs in the absence of desire for women, conceptual issues in understanding untriggered versus responsive desire, the relative infrequency of unprovoked sexual fantasies in women, and the significant overlap between desire and arousal are reviewed and highlight the need for revised DSM criteria for HSDD that accurately reflect women's experiences. The article concludes with the recommendation that desire and arousal be combined into one disorder with polythetic criteria.
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There is controversy about the nature of women's sexual desire. The aim was to explore narrative descriptions of sexual desire among mid-aged women in hopes of clarifying how women define and experience sexual desire, and how these might differ among women with and without female sexual arousal disorder (FSAD). Mid-aged women without (age: M = 45, n = 12) and with (age: M = 55, n = 10) FSAD took part in in-depth interviews that invited them to share personal stories of sexual desire. Women also completed the Brief Index of Sexual Functioning and the Female Sexual Function Index (FSFI). Women in both groups described sexual desire in genital, non-genital physical, and in cognitive-emotional terms. Although women with FSAD had low ratings of sexual desire on the FSFI, they could recall recent experiences of desire that did not differ from the control group. Women identified a number of triggers of desire including touch, memories, and partner's responses--the latter of which acted as both a trigger and an inhibitor. Women in the control group were more likely to express conflation about the distinction between desire and arousal. Among the different "objects" of women's desire, most women acknowledged emotional connection as most important.
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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.
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In a recent experiment, Meston and Gorzalka (1995) [Behaviour, Research and Therapy, 33, 651-664] demonstrated a facilitatory effect of sympathetic activation, via acute exercise, on female sexual arousal. The present investigation was designed to examine the time course of this effect. Thirty-six sexually functional women participated in two experimental sessions in which they viewed a neutral film followed by an erotic film. In one of these sessions, Ss were exposed to 20 min of intense exercise (stationary cycling) prior to viewing the films. Subjective (self-report) and physiological (photoplethysmograph) sexual arousal were measured at either 5 min, 15 min, or 30 min post-exercise. Acute exercise marginally decreased vaginal pulse amplitude (VPA) and had no effect on vaginal blood volume (VBV) responses to an erotic film when measured 5 min post-exercise. At 15 min post-exercise, exercise significantly increased VPA and marginally increased VBV responses. At 30 min post-exercise, both VPA and VBV responses to an erotic film were marginally increased. Acute exercise had no significant effect on subjective perceptions of sexual arousal in any of the experimental conditions.
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Little is known about how men women conceptualize sexual desire. This descriptive study explored beliefs about the nature of sexual desire. Participants defined sexual desire in a free response format. The results suggest that there is no single common understanding of sexual desire. In particular, although men and women conceptualize the state of sexual desire in a manner similar to researchers and theorists (i.e., as a subjective, psychological experience rather than as a physiological or behavioral sexual event), sexual desire represents a more romantic, interpersonal experience for women than for men. Significantly more women than men believed that love and emotional intimacy are important goals of sexual desire, and fewer women than men viewed sexual activity as a goal of sexual desire.
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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. 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. 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. 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.
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This article presents the development of a brief, self-report measure of female sexual function. Initial face validity testing of questionnaire items, identified by an expert panel, was followed by a study aimed at further refining the questionnaire. It was administered to 131 normal controls and 128 age-matched subjects with female sexual arousal disorder (FSAD) at five research centers. Based on clinical interpretations of a principal components analysis, a 6-domain structure was identified, which included desire, subjective arousal, lubrication, orgasm, satisfaction, and pain. Overall test-retest reliability coefficients were high for each of the individual domains (r = 0.79 to 0.86) and a high degree of internal consistency was observed (Cronbach's alpha values of 0.82 and higher) Good construct validity was demonstrated by highly significant mean difference scores between the FSAD and control groups for each of the domains (p < or = 0.001). Additionally, divergent validity with a scale of marital satisfaction was observed. These results support the reliability and psychometric (as well as clinical) validity of the Female Sexual Function Index (FSFI) in the assessment of key dimensions of female sexual function in clinical and nonclinical samples. Our findings also suggest important gender differences in the patterning of female sexual function in comparison with similar questionnaire studies in males.
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The variation of sexual motivation with duration of partnership is analyzed in data from a survey of German students. The sample of 1865 includes only students aged 19-32 who reported to be heterosexual and to live in a steady partnership. Main results are (1) sexual activity and sexual satisfaction decline in women and men as the duration of partnership increases; (2) sexual desire only declines in women; and (3) desire for tenderness declines in men and rises in women. Because these results are based on cross-sectional data, a longitudinal explanation is precarious. Individual differences in mating strategy associated with the probability of having a partnership of shorter or longer duration at the time of the survey may account for some part of the findings. This possibility set aside, post hoc explanations for the results as reflecting a modal time course of partnership are evaluated with regard to habituation, routine, gender role prescriptions, and polarization of roles. In addition, an explanation from evolutionary psychology is offered, entailing the following ideas: the psychological mechanisms of attachment in an adult pair bond have evolved from the parent-child bond. Due to this nonsexual origin, a stable pair-bond does not require high levels of sexual desire, after an initial phase of infatuation has passed. Nevertheless, male sexual desire should stay at a high level because it was selected for in evolutionary history as a precaution against the risk of sperm competition. The course of female sexual desire is assumed to reflect an adaptive function: to boost attachment in order to establish the bond.
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As a consequence of the impact of Viagra on male sexual dysfunction, considerable attention is now being paid to sexual dysfunctions in women, which might respond to pharmacological treatment. Should women's sexual problems be conceptualized in the same way as men's? The objective of this study was to assess the prevalence of distress about sexuality among women, and examine the predictors of such distress, including aspects of the woman's sexual experience, as well as other aspects of hercurrent situation. A telephone survey of women used Computer Assisted Telephone Interviewing and Telephone-Audio-Computer-Assisted Self-Interviewing methodology to investigate respondents' sexual experiences in the previous month. A national probability sample was used of 987 White or Black/African American women aged 20-65 years, with English as first language, living for at least 6 months in a heterosexual relationship. The participation rate was 53.1%. Weighting was applied to increase the representativeness of the sample. A total of 24.4% of women reported marked distress about their sexual relationship and/or their own sexuality. The best predictors of sexual distress were markers of general emotional well-being and emotional relationship with the partner during sexual activity. Physical aspects of sexual response in women, including arousal, vaginal lubrication, and orgasm, were poor predictors. In general, the predictors of distress about sex did not fit well with the DSM-IV criteria for the diagnosis of sexual dysfunction in women. These findings are compared with those from other studies involving representative samples of women, and the conceptual issues involved in the use of terms such as "sexual problem" and "sexual dysfunction" are discussed.
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This study examined the sexual practices and function of midlife women by ethnicity (African American, Caucasian, Chinese, Hispanic, Japanese) and menopausal status. Sexual behavior was compared in 3,262 women in the baseline cohort of SWAN. Participants were 42 to 52 years old, premenopausal or early perimenopausal, and not hysterectomized or using hormones. Analysis used multivariate proportional odds regression. In our sample, 79% had engaged in sex with a partner in the last 6 months, and a third considered sex to be very important. Common reasons for no sex (n = 676) were lack of partner (67%), lack of interest (33%), and fatigue (16%). Compared with Caucasians, Japanese and Chinese women were less likely, and African Americans more likely, to report sex as very important (p < 0.005). Significant ethnic differences were found for frequency of all practices. Perimenopause status was associated only with higher frequencies of masturbation and pain during intercourse.
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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.
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This article reviews and critiques the DSM-IV-TR diagnostic criteria for Female Sexual Arousal Disorder (FSAD). An overview of how the diagnostic criteria for FSAD have evolved over previous editions of the DSM is presented and research on prevalence and etiology of FSAD is briefly reviewed. Problems with the essential feature of the DSM-IV-TR diagnosis-"an inability to attain, or to maintain...an adequate lubrication-swelling response of sexual excitement"-are identified. The significant overlap between "arousal" and "desire" disorders is highlighted. Finally, specific recommendations for revision of the criteria for DSM-V are made, including use of a polythetic approach to the diagnosis and the addition of duration and severity criteria.
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Insufficient documentation exists regarding the prevalence of hypoactive sexual desire disorder (HSDD) in surgically menopausal (SM) women in European countries. Women who have undergone hysterectomy and bilateral oophorectomy experience a loss of ovarian hormones. Inclusion of these women in an epidemiological study provided the opportunity to study biological and cultural impacts on sexual function. The aim of this study was to compare the prevalence of HSDD among SM women in France, Germany, Italy, and the United Kingdom, as well as the relationship between low sexual desire and sexual activity or behavior, and sexual or partner relationship satisfaction. Cross-sectional survey of a convenience sample of 427 SM women aged 20-70 years. Main Outcome Measures. The desire domain of the Profile of Female Sexual Function (PFSF) to identify women with low sexual desire, Personal Distress Scale (PDS) to measure distress caused by low sexual desire, and a sexual activities measure. Women with low sexual desire who were distressed were classified as having HSDD. SM women having low sexual desire ranged from 35% (United Kingdom) to 44% (Italy); of these women, 16% (Germany) to 56% (France) were distressed because of their low sexual desire. Overall, SM women classified with HSDD ranged from 7% (Germany) to 22% (France). A strong positive correlation was observed between sexual desire and arousal, orgasm, and sexual pleasure in all countries (P < 0.001). Low sexual desire leads to less sexual activity, more dissatisfaction with sex life and partner relationship, and more negative emotional or psychological states, than normal desire in each country. A similar percentage of SM women with low sexual desire were found across countries suggesting the role of biological factors (i.e., losing ovarian hormones) in determining sexual desire. Differences in the percentage of SM women with HSDD suggest a role for cultural factors in determining how low sexual desire is perceived.
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Synopsis One hundred and forty-one women, aged 40–60 years, recruited from the community were assessed with an initial interview, plus four interviews at intervals of 1 week and blood samples. The objective was to investigate the determinants of sexuality and well-being in this sample. Measures included interview ratings of sexual function, Frenken Sexual Experience Scales and the Multiple Affect Adjective Check List. Determinants evaluated, using multiple regression analysis, included age, menopausal status, BMI, smoking, ovarian steroids and adrenal androgens. None of the hormonal parameters significantly predicted measures of sexuality; the most important predictors were other aspects of the sexual relationship, sexual attitudes and measures of well-being. The best predictor of both well-being and depression was tiredness. The only hormone positively related to well-being was dehydroepiandrosterone (DHEA).
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Clarification of women's sexual response during long-term relationships is needed. I have presented a model that more accurately depicts the responsive component of women's desire and the underlying motivational forces that trigger it. The variety of arousal/orgasm responses is also acknowledged. The purpose is both to prevent diagnosing dysfunction when the response is simply different from the traditional human sex-response cycle and to more clearly define subgroups of dysfunction. The latter would appear to be necessary before progress in newer treatment modalities, including pharmacological, can be made.
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An intimacy-based sex response cycle was used in the assessment of 47 women referred with low sexual desire. All could relate to the model and multiple breaks in the cycles were identified. Emotional intimacy to motivate the women to find sexual stimuli to elicit arousal was insufficient in 50%. Sexual stimuli and context were minimal in 53%. Psychological factors diminishing arousability were identified in 85%, depression contributing in 43%. Androgen deficiency (the cause suggested by referring doctors) contributed in 25%. Identifying missing components of their "normal" but currently problematic sex response cycles was itself therapeutic.
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The current study was aimed at comparing genital and subjective sexual arousal in pre- and postmenopausal women and exploring the effects of heightened sympathetic nervous system (SNS) activity on these parameters. Seventy-one women (25 young and premenopausal, 25 postmenopausal, and 21 age-matched premenopausal women) participated in two counterbalanced sessions consisting of genital arousal assessment with vaginal photoplethysmography and subjective arousal assessment with self-report questionnaires. SNS activity was enhanced using laboratory-induced hyperventilation. Results demonstrated no significant differences between pre- and postmenopausal women on genital and subjective measures of arousal in response to neutral and erotic films. SNS manipulation increased genital excitement only in young, premenopausal women. These data suggest that prior SNS enhancement can differentiate pre- from postmenopausal genital arousal. Data also revealed significant correlations between genital and subjective sexual arousal in older pre- and postmenopausal women, but not in young premenopausal women. These data are