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Viewing Sexual Stimuli Associated with Greater Sexual Responsiveness, Not Erectile Dysfunction
Abstract and Figures
IntroductionTime spent viewing visual sexual stimuli (VSS) has the potential to habituate the sexual response and generalize to the partner context.AimThe aim of this study was to examine whether the time spent viewing VSS is related to sexual responsiveness felt in the laboratory or with a sexual partner.Methods
Nontreatment-seeking men (N = 280) reported their weekly average VSS viewing in hours. VSS hours were examined in relation to the sexual arousal experienced while viewing a standardized sexual film in the laboratory and erectile problems experienced with a sexual partner.Main Outcome MeasuresSelf-reported sexual arousal in response to sexual films and erectile problems on the International Index of Erectile Function were the main outcome measures.ResultsMore hours viewing VSS was related to stronger experienced sexual responses to VSS in the laboratory, was unrelated to erectile functioning with a partner, and was related to stronger desire for sex with a partner.ConclusionsVSS use within the range of hours tested is unlikely to negatively impact sexual functioning, given that responses actually were stronger in those who viewed more VSS. Prause N and Pfaus J. Viewing sexual stimuli associated with greater sexual responsiveness, not erectile dysfunction. Sex Med **;**:**–**.
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... Because of this process, it is possible that sensitized sexual arousal to Internet pornography may cause that sexual experience with a real partner may no longer trigger the sufficient dopamine release to produce and sustain sexual arousal and erection (Melis and Argiolas, 2011;Prause and Pfaus, 2015;Schultz, 1998). Prause and Pfaus suggested that "erectile problems may occur when real-life sexual stimulation does not match the broad content [accessible online]" (Prause and Pfaus, 2015). ...
... Because of this process, it is possible that sensitized sexual arousal to Internet pornography may cause that sexual experience with a real partner may no longer trigger the sufficient dopamine release to produce and sustain sexual arousal and erection (Melis and Argiolas, 2011;Prause and Pfaus, 2015;Schultz, 1998). Prause and Pfaus suggested that "erectile problems may occur when real-life sexual stimulation does not match the broad content [accessible online]" (Prause and Pfaus, 2015). Human and animal studies also indicate that when expectations are not met (due to a negative prediction error), then such a "disappointing event" may cause that as a response certain activities in the mesolimbic dopaminergic system are inhibited (Bayer and Glimcher, 2005;Hart et al., 2014;Mauer-Vakil and Bahji, 2020;McClure et al., 2003;Sunsay and Rebec, 2014). ...
According to recent studies, the growing consumption of Internet pornography mainly in male population becomes an increasing problem, which is closely linked to compulsive sexual behavior. Some findings also suggest that Internet pornography consumption might represent a defense mechanism against excessive stress, which enables to cope with stressful events, helps in mood regulation, and decreases depression and anxiety. Users of online pornography involved in these activities also reported that their self-exposition to pornographic material may create guilty feelings and internal conflict in themselves with respect to their own "involuntary" sexual behavior, which suggest that psychosocial stress and possibly traumatic experiences may play a significant role in Internet pornography addiction. Taken together, these findings show that stressful experiences, anxiety, and depression are strongly related to pornography consumption. In addition, conflicting emotional experiences as well as identity problems significantly increase vulnerability to addictive sexual behavior and pornography consumption.
... However, no clear relationship between FPU and sexual dysfunction was found in either male or female participants. 22 On the other hand, Prause and Pfaus 23 reported that time spent viewing visual sexual stimuli led to a stronger desire for sexual intercourse with a partner and did not predict changes in erectile functioning. Also, conclusions from the literature review indicate no clear evidence of time spent on pornography use altering erectile functioning or ejaculation. ...
... As sexual dysfunctions are associated with age, gender, and sexual orientation, 42,43 we also included these demographic characteristics as additional variables in the analyses. Sexual functioning can also depend on the frequency of sexual activities, 23,25 and thus we additionally controlled analyses for relationship status as well as frequency of pornography use, masturbation, and sexual intercourse. Also, instead of only controlling for gender in the analyses, we performed the same steps of the analyses separately for males and females, to clearly present possible differences between genders. ...
Background
Previous studies linking compulsive sexual behavior disorder (CSBD) and sexual health have shown mixed results, which could be due to the fact that different CSBD facets may have differential relationships with sexual functioning.
Aim
As CSBD is a multidimensional disorder, we wanted to investigate whether distinct CSBD domains are differentially related to sexual health.
Methods
Two online studies were conducted—the first on a convenience sample (812 Polish participants; mean [SD] age, 22.07 [5.91] years) and a replication study on a representative sample of Polish adults (n = 1526; 43.02 [14.37]). Hierarchical regression was employed with sexual functioning as a predicted variable and CSBD symptoms as predictors.
Outcomes
The Compulsive Sexual Behavior Disorder Scale was used to assess CSBD symptoms, and the Arizona Sexual Experience Scale was used to measure sexual dysfunction.
Results
In study 1, CSBD salience (β = −.20, P < .001) predicted hyperfunction (ie, stronger sex drive, easier sexual arousal, easier vaginal lubrication/penile erection, easier ability to reach an orgasm, and more satisfying orgasms). Yet, CSBD negative consequences (β = .15, P = .001) and dissatisfaction (β = .22, P < .001) predicted hypofunction (ie, weaker sex drive, more difficulties in sexual arousal, greater difficulties in vaginal lubrication/penile erection, less ability to reach an orgasm, and less satisfying orgasms). Similar results were found in study 2: salience (β = −.26, P < .001) and relapse (β = −.11, P = .004) predicted hyperfunction, while negative consequences (β = .12, P < .001) and dissatisfaction (β = .12, P < .001) predicted hypofunction.
Clinical Implications
Our results stress the importance of assessing the severity of each group of symptoms in patients with CSBD to better understand possible difficulties in their sexual functioning.
Strengths and Limitations
Our studies are the first to evaluate the effects of each CSBD domain on sexual health. We also replicated results obtained from a convenience sample on a representative sample. The cross-sectional design of the current studies does not allow causal relations to be tested, so future longitudinal research should be carried out. We also gathered data from a general population—thus, it is important to replicate these results on patients diagnosed with CSBD.
Conclusion
Our research points out the differential impact of CSBD domains on sexual health: salience and relapse are related to sexual hyperfunction, while negative consequences and dissatisfaction to hypofunction.
... [40,41,[53][54][55][56]. In fact, a number of other studies have suggested no role-or even an opposite and beneficial role-for pornography use on sexual arousal and erectile response [46,57,58]. In a recent comprehensive review, Dwulit and Rzymski [45] concluded that a causal link between pornography use and erectile problems has yet to be demonstrated, noting methodological issues such as unreliable self-reported ED (i.e., not using standardized instruments) and interpretation issues regarding direction of effect (e.g., it may be that men experiencing erectile problems increase their use of pornography during masturbation as a means of increasing arousability and sexual satisfaction, rather than pornography use being the cause of impaired erectile response). ...
... At the same time, over-dependence on strong pornographic content to achieve adequate sexual arousal could place some men at risk for diminished sexual and overall relationship satisfaction-probable characteristics of men who seek out treatment for problematic pornography use and thus come to the attention of the clinical/ health community. Men distressed by their pornography use are also more likely to be depressed or anxious, or to have low selfesteem, factors also known to affect sexual and relationships satisfaction [3,54,57]. ...
Both masturbation frequency and pornography use during masturbation have been hypothesized to interfere with sexual response during partnered sex as well as overall relationship satisfaction. However, results from prior studies have been inconsistent and frequently based on case studies, clinical reports, and simple binary analyses. The current study investigated the relationships among masturbation frequency, pornography use, and erectile functioning and dysfunction in 3586 men (mean age = 40.8 yrs, SE = 0.22) within a multivariate context that assessed sexual dysfunctions using standardized instruments and that included other covariates known to affect erectile functioning. Results indicated that frequency of pornography use was unrelated to either erectile functioning or erectile dysfunction (ED) severity in samples that included ED men with and without various sexual comorbidities or in a subset of men 30 years or younger (p = 0.28–0.79). Masturbation frequency was also only weakly and inconsistently related to erectile functioning or ED severity in the multivariate analyses (p = 0.11–0.39). In contrast, variables long known to affect erectile response emerged as the most consistent and salient predictors of erectile functioning and/or ED severity, including age (p < 0.001), having anxiety/depression (p < 0.001 except for a subset of men ≤ 30 years), having a chronic medical condition known to affect erectile functioning (p < 0.001 except for a subset of men ≤ 30 years), low sexual interest (p < 0.001), and low relationship satisfaction (p ≤ 0.04). Regarding sexual and relationship satisfaction, poorer erectile functioning (p < 0.001), lower sexual interest (p < 0.001), anxiety/depression (p < 0.001), and higher frequency of masturbation (p < 0.001) were associated with lower sexual and lower overall relationship satisfaction. In contrast, frequency of pornography use did not predict either sexual or relationship satisfaction (p ≥ 0.748). Findings of this study reiterate the relevance of long-known risk factors for understanding diminished erectile functioning while concomitantly indicating that masturbation frequency and pornography use show weak or no association with erectile functioning, ED severity, and relationship satisfaction. At the same time, although verification is needed, we do not dismiss the idea that heavy reliance on pornography use coupled with a high frequency of masturbation may represent a risk factor for diminished sexual performance during partnered sex and/or relationship satisfaction in subsets of particularly vulnerable men (e.g., younger, less experienced).
... One neglected characteristic of the hypersexual patient is the loss of the pleasure principle. Some data account, in fact, for the absence of sexual pleasure and satisfaction after the adoption of compulsive sexual behavior [65,66]. Furthermore, in a significant percentage of hypersexual patients, available data show the presence of associated sexual disorders, such as erectile dysfunction (16%), premature ejaculation (12%), or a paraphilic disorder (60%), [67], among which the most prevalent are the voyeuristic disorder (36%), the fetishistic disorder and the sexual coercive behavior (males: 21%; females: 4%), and of the adoption of sexually risky behaviors (32%) [68,69]. ...
... Partly different is, instead, the relationship between viewing visual sexual stimuli (VSS), an aspect which, in some cases, is put in relation to hypersexuality, and the presence of sexual dysfunctions. Recently, a study has evidenced that the VSS induces a stronger sexual response, but is not related to erectile functioning during partnered sexual intercourse [65]. Rather, VSS may induce a stronger sexual desire for sexual intercourse with the partner. ...
In the last years, hypersexual behavior has been broadly scientifically studied. The interest in this topic, belonging to psycho-sexology and sexual medicine, has been due to its still unclear aetiology, nature, and its manifestation in relationship with several organic and psychopathological conditions. So, the specialist (the psychologist, psychiatrist, endocrinologist, neurologist) may encounter some difficulties in diagnosing and managing this symptom. The first main objective of this position statement, which has been developed in collaboration between the Italian Society of Andrology and Sexual Medicine (SIAMS) and the Italian Society of Psychopathology (SOPSI) is to give to the reader evidence about the necessity to consider hypersexuality as a symptom related to another underlying condition. Following this consideration, the second main objective is to give specific statements, for the biopsychosocial assessment and the diagnosis of hypersexual behavior, developed on the basis of the most recent literature evidence. To develop a psycho-pharmacological treatment tailored on patients' needs, our suggestion is to assess the presence of specific comorbid psychopathological and organic conditions, and the impact of pharmacological treatments on the presence of an excess of sexual behavior. Finally, a suggestion of a standardized psychometric evaluation of hypersexuality will be given.
... Sex is generally assumed to be an inherent primary reward that elicits approach behaviors and positive emotions, such as pleasure, happiness, and trust [113]. Sex is further incentivized by conditioned and unconditioned pleasurable and aversive aspects of sexual responding [114]. While contextual factors contribute to variation in sexual pleasure and reward, E2 and P4 play significant roles in regulating sexual motivation [15,109]. ...
Purpose of Review
Hormones undeniably play a role in women’s sexual function, but there is much controversy regarding when and how—potentially because psychological effects of hormones depend on social and developmental context. Existing literature documents various health outcomes of sexual trauma and hormonal changes, however, specific mechanisms linking trauma experiences and hormones to sexual wellbeing remain unclear. This review aims to bridge two disparate lines of research, illustrating how sexual trauma may moderate the role of hormones in supporting women’s sexual function.
Recent Findings
Testosterone, estradiol, progesterone, and cortisol orchestrate an array of physiological, behavioral, psychological, and social effects, each of which may be impacted by sexual trauma experiences. In particular, the adaptive role of steroid hormones in regulating approach and avoidance of sexual behavior may be disrupted by sexual trauma experiences, especially childhood sexual abuse. Mirroring hormonal effects on anxious, depressed, and anhedonic mood, hormones show wide individual variation in effects on sexual function, and sexual trauma may amplify these effects, leading to more extreme sexual outcomes.
Summary
Research synthesized here supports the notion that effects of sexual trauma on sexual physiology and psychology have been inconsistently considered in basic and applied research—often neglected as a factor altogether or grouped with non-sexual trauma types. Yet, many processes by which hormones regulate women’s sexual motivation and pleasure, such as attention to sexual cues and reward processing, are impacted by sexual trauma. Poor consideration of factors related to sexual trauma has likely contributed to variable reported effects of hormones on women’s sexual wellbeing. As such, we propose that clinical research examining the role of hormonal treatments in sexual wellbeing should account for women’s sexual trauma histories.
... Men that have a greater frequency of pornography consumption per week are actually better able to achieve erection to visual sexual stimuli in laboratory situations relative to men with a lower frequency of pornography consumption [22]. However, men with frequent but problematic pornography consumption who also have high sexual desire show a blunted processing of visual sexual cues [23], suggesting some attempt at active inhibition. ...
Reward based learning is broadly acknowledged to underpin the development and maintenance of addictive behaviour although the mechanism in sexual compulsivity is less understood. Using a Pavlovian-to-Instrumental Transfer (PIT) task we tested whether the motivational aspect of conditioned Pavlovian conditioned stimulus invigorated instrumental responding in relation to specific compatible monetary rewards. Performance on the task was analysed between two groups of males based on Low (N = 38) and High (N = 41) self-report online sexual behaviour (OSB). Psychometric tests including sexual compulsivity scale and behavioural activation/behavioural inhibition (BIS/BAS) were also administered to determine the relationship between OSB and general reward sensitivity. We show clear evidence of acquisition in the Pavlovian and instrumental conditioning phases. Specific transfer effect was greater in the High-OSB group although the difference compared to the Low-OSB group was non-significant. OSB negatively correlated with both BIS and BAS indicative of introversion and low reward sensitivity. OSB positively correlated with sexual compulsivity although it is unclear whether individuals in the High-OSB group considered their behaviour either excessive or problematic. These findings contribute to the ongoing debate regarding the nature of problematic OSB. Fundamental differences in motivational characteristics and mechanism contributing to compulsive behaviour in relation to high-OSB might indicate incompatibility with behavioural addiction models. PIT was not enhanced in high-OSB by appetitive conditioning, although problematic OSB could stem from failure to inhibit actions. Further research should investigate whether aversive conditioning differentially affects responding in high-OSB individuals, potentially explaining perseverant behaviour despite negative consequences.
... The link between pornography viewing and erectile difficulties presents what might appear to be a confusing picture. Prause and Pfaus (2015) found that longer hours of watching pornography were not associated with erectile difficulties. However, their participants were described as "non-treatment seeking men" so it cannot be concluded that even the high end met criteria of addiction. ...
An integrative model of sexual addiction is presented, involving a combination of models based upon (i) incentive motivation theory and (ii) the dual organisation of the control of behavior. The model is related to ongoing arguments about the validity of the notion of addiction when applied to sexual behavior. It is suggested that the evidence strongly favors the viability of an addiction model of sex. Strong similarities to the classical addiction to hard drugs are observed and features can be better understood with the help of the model. These include tolerance, escalation and withdrawal symptoms. It is argued that other candidates for accounting for the phenomena, such as obsessive-compulsive behavior, faulty impulse control, high drive and hypersexuality do not fit the evidence. The role of dopamine is central to the model. The model’s relevance to stress, abuse, development, psychopathy, fantasy, sex differences, evolutionary psychology and the interaction with drug-taking is shown.
Objetivo:
El objetivo de este estudio es identificar la relación entre el consumo de pornografía y los comportamientos de riesgo.
Material y Métodos:
Se evaluaron comportamientos sexuales de riesgo y el consumo de pornografía. Muestreo tipo bola de nieve, tuvo 245 participantes, los cuales accedieron participar voluntariamente. Los datos se recolectaron mediante un cuestionario en Google Forms. Los participantes dieron su consentimiento informado después de leer la descripción del estudio, donde se indicó el anonimato de la encuesta.
Resultados:
Para el análisis de razón de probabilidades se encontró que las mayores probabilidades de ser positivos para VIH se asociaron con ser LGTB, con no tener la percepción de la pornografía fomentan el sexo sin condón. Los individuos que consuman pornografía se asociaron con ser LGBT y con no tener la percepción de que el tipo de pornografía que visualiza influye en sus relaciones. Las mayores probabilidades de haber tenido sexo anal sin condón se asociaron con ser LGTB, con tener una educación superior, con tener un salario mensual mayor al sueldo mínimo y con tener sexo en grupo. Es necesario investigaciones futuras que nos permitan estudiar más a fondo los efectos de la pornografía en la vida sexual de quienes la consumen.
Conclusión:
Se encontró que los participantes LGBT tienen mayor riesgo de tener VIH, no usar condón, ver pornografía y sexo casual. Las ITS se relacionaron con educación superior y tener pareja estable.
Male sexual dysfunction (MSD) is a common and distressful condition which is often amenable to counseling and other non pharmacological therapy. These ALLIANCE guidelines are an exhaustive coverage of the counseling and related non-pharmacological methods used for management of MSD. The guidelines discuss various concepts of medical care, including the bio-psychosocial model, patient centered care, couple centered care, therapeutic patient education, shared decision making, minimizing the discomfort of change, and coping skills training, as related to MSD. They go on to describe the ideal environment and prerequisites in which a proper history should be elicited, and physical examination performed. Counseling related to investigations, physical activity and yoga is described. Specific examples of psychotherapy for various sexual disorders are presented to illustrate the usage of counseling. The guidelines discuss cognitive behavioral therapy, couple centered therapy, family therapy, and use of religion in detail. Counseling regarding pharmacological, device and invasive therapy is also covered. The guidelines conclude with a call to enhance community awareness of MSD
A person's ability to control their own sexual arousal is important both to reduce the risks associated with some sexual behaviours and to respond sexually with intimate partners. A lack of control over sexual urges is a proposed feature of "hypersexual disorder", though some evidence suggests that sexual desire predicts the self-regulation of sexual arousal better than hypersexuality. In the current study, a sample (N = 116) of men and women recruited from community ads viewed a series of 20-second neutral and sexual films. Before each sexual film, participants were instructed to increase their sexual arousal, decrease their sexual arousal or respond as usual. Higher levels of desire for sex with a partner consistently predicted failures to downregulate sexual arousal. Hypersexuality was unrelated. These findings replicate Winters et al.'s study and extend their findings by including upregulation, women, a new measure of hypersexuality and a higher-trial design.
Although compulsive sexual behaviour (CSB) has been conceptualized as a "behavioural" addiction and common or overlapping neural circuits may govern the processing of natural and drug rewards, little is known regarding the responses to sexually explicit materials in individuals with and without CSB. Here, the processing of cues of varying sexual content was assessed in individuals with and without CSB, focusing on neural regions identified in prior studies of drug-cue reactivity. 19 CSB subjects and 19 healthy volunteers were assessed using functional MRI comparing sexually explicit videos with non-sexual exciting videos. Ratings of sexual desire and liking were obtained. Relative to healthy volunteers, CSB subjects had greater desire but similar liking scores in response to the sexually explicit videos. Exposure to sexually explicit cues in CSB compared to non-CSB subjects was associated with activation of the dorsal anterior cingulate, ventral striatum and amygdala. Functional connectivity of the dorsal anterior cingulate-ventral striatum-amygdala network was associated with subjective sexual desire (but not liking) to a greater degree in CSB relative to non-CSB subjects. The dissociation between desire or wanting and liking is consistent with theories of incentive motivation underlying CSB as in drug addictions. Neural differences in the processing of sexual-cue reactivity were identified in CSB subjects in regions previously implicated in drug-cue reactivity studies. The greater engagement of corticostriatal limbic circuitry in CSB following exposure to sexual cues suggests neural mechanisms underlying CSB and potential biological targets for interventions.
The Female Sexual Function Index (FSFI; Rosen et al., 2000 ) and International Index of Erectile Function (IIEF; Rosen et al., 1997 ) are two of the most widely used measures of sexual dysfunction. However, they have potential measurement and psychometric flaws that have not been addressed in the literature. This article examines the measurement capabilities of these measures based on data collected from an online study in 2010. A convenience sample of 518 sexually active adults (65% female) drawn from the general community were included in the analyses. Both measures displayed critical theoretical and measurement problems for the assessment of sexual problems beyond sexual arousal, and for the sexual desire domains in particular. Based on these results, we encourage clinicians and researchers to think critically about whether the FSFI and IIEF are appropriate measures for their practice and research. In particular, these measures are inappropriate for use among individuals who are not currently sexually active, and research with a focus other than sexual arousal should consider supplementary measures of sexual function. The psychometric properties of these measures should be reassessed in clinical samples, but the theoretical issues with the measures raised in this article are relevant across clinical and research contexts.
Introduction:
Condom-associated erection problems (CAEPs) are reported by a substantial number of young men and are associated with inconsistent and/or incomplete condom use. The underlying mechanisms of CAEP are not well understood, and research examining the possibility that men who report CAEP differ from other men in their sexual responsivity is lacking.
Aim:
This study used psychophysiological methods to examine whether men who report CAEP have a higher threshold for sexual arousal, a stronger need for tactile stimulation, and/or more easily lose their sexual arousal due to neutral distractors or performance-related demands.
Methods:
A total of 142 young, heterosexual men (53% reporting CAEP) were presented with four 3-minute erotic film clips. Three film clips were combined with one of the following manipulations: (i) distraction; (ii) performance demand; or (iii) vibrotactile stimulation. One erotic film clip was presented with no further instructions or manipulations.
Main outcome measures:
Average penile circumference changes during the first, second, and third minute (time) of the erotic film stimuli (condition) were submitted to a mixed-model analysis of variance with condition and time as within-subjects factors and group (CAEP/no-CAEP) as between-subjects factor.
Results:
Significant main effects of condition and time and a significant interaction of group × time were found. No significant interactions involving condition were found. Men who reported CAEP had smaller erectile responses during the first minute, regardless of film condition, than men who reported no CAEP (F(1,141) = 8.64, P < 0.005).
Conclusion:
The findings suggest that men with and without CAEP differ in the ease with which they become sexually aroused. Men reporting CAEP needed more time and/or more intense stimulation to become aroused. To our knowledge, this study is the first to use psychophysiological methods to assess sexual responsivity in men who report CAEP.
Masturbation is a common sexual activity among people of all ages throughout life. It has been traditionally prohibited and judged as immoral and sinful by several religions. Although it is no longer perceived as a negative behavior, masturbation is often omitted in the diagnostic inquiry of patients with sexual problems.
The aims of this study are to increase the awareness of clinicians to the importance of including questions regarding masturbatory habits in the process of sexual history taking, to analyze cases of male sexual dysfunction (SD) associated with unusual masturbatory practices, and to propose a practical tool for clinicians to diagnose and manage such problems.
A clinical study of four cases that include a range of unusual masturbatory practices by young males who applied for sex therapy is described. An intervention plan involving specific questions in case history taking was devised. It was based on detailed understanding of each patient's masturbatory practice and its manifestation in his SD.
Effects of identifying and altering masturbatory practices on sexual function.
The four men described unusual and awkward masturbatory practices, each of which was associated with different kinds of SD. The unlearning of the masturbatory practices contributed notably to improvement of their sexual function.
The four cases in this study indicate that the detailed questioning of masturbatory habits is crucial for a thorough assessment and adequate treatment of sexual problems in men. We propose specific questions on masturbatory behavior as well as a diagnostic and therapeutic flowchart for physicians and sex therapists to address those problems. Bronner G and Ben-Zion IZ. Unusual masturbatory practice as an etiological factor in the diagnosis and treatment of sexual dysfunction in young men. J Sex Med **;**:**-**.
The present study was designed to test the hypothesis that exposure to nonviolent pornography would prime a heterosexuality subschema in gender schematic males and thus lead these males to view and treat a woman as a sexual object. In a 2 × 2 design, 60 male subjects, half gender schematic and half gender aschematic, watched either a pornographic or a control video prior to being interviewed by a female research assistant. Although she was blind to condition, the female experimenter found the gender schematic males who had viewed the pornographic video to be significantly more sexually motivated than subjects in the three other conditions. Further, in the first minute of a free recall task given after the interview, 72% of the information recalled by this group of males concerned the physical features of the female experimenter, as compared with 49% for the males in the other conditions. The implications of these findings for real-world settings are discussed.
Abstract Hypersexuality remains an increasingly common but poorly understood patient complaint. Despite diversity in clinical presentations of patients referred for hypersexuality, the literature has maintained treatment approaches that are assumed to apply to the entire phenomenon. This approach has proven ineffective, despite its application over several decades. The present study used quantitative methods to examine demographic, mental health, and sexological correlates of common clinical subtypes of hypersexuality referrals proposed by Cantor and colleagues (2013). Findings support the existence of subtypes, each with distinct clusters of features. Paraphilic Hypersexuals reported greater numbers of sexual partners, more substance abuse, initiation to sexual activity at an earlier age, and novelty as a driving force behind their sexual behavior. Avoidant Masturbators reported greater levels of anxiety, delayed ejaculation, and use of sex as an avoidance strategy. Chronic Adulterers reported premature ejaculation and later onset of puberty. Designated Patients were less likely to report substance abuse, employment, or finance problems. Although quantitative, this paper nonetheless presents a descriptive study in which the underlying typology emerged from features most salient in routine sexological assessment. Future studies might apply purely empirical statistical techniques, such as cluster analyses, to ascertain to what extent similar typologies emerge when examined prospectively.
Importance
Since pornography appeared on the Internet, the accessibility, affordability, and anonymity of consuming visual sexual stimuli have increased and attracted millions of users. Based on the assumption that pornography consumption bears resemblance with reward-seeking behavior, novelty-seeking behavior, and addictive behavior, we hypothesized alterations of the frontostriatal network in frequent users.Objective
To determine whether frequent pornography consumption is associated with the frontostriatal network.Design, Setting, and Participants
In a study conducted at the Max Planck Institute for Human Development in Berlin, Germany, 64 healthy male adults covering a wide range of pornography consumption reported hours of pornography consumption per week. Pornography consumption was associated with neural structure, task-related activation, and functional resting-state connectivity.Main Outcomes and Measures
Gray matter volume of the brain was measured by voxel-based morphometry and resting state functional connectivity was measured on 3-T magnetic resonance imaging scans.Results
We found a significant negative association between reported pornography hours per week and gray matter volume in the right caudate (P < .001, corrected for multiple comparisons) as well as with functional activity during a sexual cue–reactivity paradigm in the left putamen (P < .001). Functional connectivity of the right caudate to the left dorsolateral prefrontal cortex was negatively associated with hours of pornography consumption.Conclusions and Relevance
The negative association of self-reported pornography consumption with the right striatum (caudate) volume, left striatum (putamen) activation during cue reactivity, and lower functional connectivity of the right caudate to the left dorsolateral prefrontal cortex could reflect change in neural plasticity as a consequence of an intense stimulation of the reward system, together with a lower top-down modulation of prefrontal cortical areas. Alternatively, it could be a precondition that makes pornography consumption more rewarding.
Brain dysfunction in erectile dysfunction (ED) has been identified by multiple neuroimaging studies. A recent MRI study indicated grey matter alterations in ED patients. This study aims to investigate the microstructural changes of cerebral white matter (WM) in psychological ED patients and their possible correlations with clinical variables. Twenty-seven psychological ED patients and 27 healthy subjects (HS) were included and underwent a magnetic resonance (MR) diffusion tensor imaging (DTI) scan. The tract-based spatial statistics were employed to identify the WM structure alterations in psychological ED patients. The multiple DTI-derived indices′ [fractional anisotropy (FA), axial diffusivity (AD) and mean diffusivity (MD)] correlations with the symptoms and their durations, respectively, were analysed. The IIEF-5, quality of erection questionnaire (QEQ) and the self-esteem and relationship (SEAR) questionnaire were used to assess the symptoms of psychological ED patients. Compared with HS, the psychological ED patients showed increased FA values, reduced MD values and reduced AD values in multiple WM tracts including the corpus callosum (genu, body and splenium), corticospinal tract, internal capsule, corona radiata, external capsule and superior longitudinal fasciculus (p < 0.05, threshold-free cluster enhancement corrected). Both of the IIEF scores and QEQ scores of ED patients showed a significantly negative correlation with the average FA values, and positive correlation with average AD values and MD values in the splenium of the corpus callosum (p < 0.05). The results provided preliminary evidence of WM microstructural changes in patients with psychological ED. The morphological alterations in the splenium of the corpus callosum were related to the symptom severity.