Turning On and Turning Off: A Focus Group Study of the Factors That Affect Women's Sexual Arousal

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DOI: 10.1023/B:ASEB.0000044737.62561.fd · Source: PubMed
The aim of this study was to inform the development of a questionnaire to assess a woman's tendency to respond with sexual excitation/inhibition in different situations. Nine focus groups, involving 80 women (M age = 34.3 years; range, 18-84), were conducted. Women described a wide range of physical (genital and nongenital), cognitive/emotional, and behavioral cues to arousal. The relationship between sexual interest (desire) and sexual arousal was complex; sexual interest was reported as sometimes preceding arousal, but at other times following it. Many women did not clearly differentiate between arousal and interest. Qualitative data on the factors that women perceived as "enhancers" and "inhibitors" of sexual arousal are presented, with a focus on the following themes: feelings about one's body; concern about reputation; unwanted pregnancy/contraception; feeling desired versus feeling used by a partner; feeling accepted by a partner; style of approach/initiation; and negative mood. The findings can help inform conceptualizations of sexual arousal in women.
Archives of Sexual Behavior, Vol. 33, No. 6, December 2004, pp. 527–538 (
Turning On and Turning Off: A Focus Group Study
of the Factors That Affect Women’s Sexual Arousal
Cynthia A. Graham, Ph.D.,
Stephanie A. Sanders, Ph.D.,
Robin R. Milhausen, M.Sc.,
and Kimberly R. McBride, M.A.
Received August 15, 2003; revision received December 5, 2003; accepted December 5, 2003
The aim of this study was to inform the development of a questionnaire to assess a woman’s
tendency to respond with sexual excitation/inhibition in different situations. Nine focus groups,
involving 80 women (M age = 34.3 years; range, 18–84), were conducted. Women described a wide
range of physical (genital and nongenital), cognitive/emotional, and behavioral cues to arousal. The
relationship between sexual interest (desire) and sexual arousal was complex; sexual interest was
reported as sometimes preceding arousal, but at other times following it. Many women did not clearly
differentiate between arousal and interest. Qualitative data on the factors that women perceived as
“enhancers” and “inhibitors” of sexual arousal are presented, with a focus on the following themes:
feelings about one’s body; concern about reputation; unwanted pregnancy/contraception; feeling
desired versus feeling used by a partner; feeling accepted by a partner; style of approach/initiation;
and negative mood. The findings can help inform conceptualizations of sexual arousal in women.
KEY WORDS: sexual arousal; sexual interest; sexual desire; women.
In most research on sexual arousal, there has been an
assumption that lack of sexual arousal is due to a lack of
excitation. Inhibition of arousal has often been implicitly
acknowledged, but not studied, as a process separate from
excitation. The concept of “inhibited sexual desire” has
been widely used in the clinical literature (American
Psychiatric Association, 1980; Beck, 1994; Lief, 1977),
but there has been little systematic study of this and no
attempt to distinguish between inhibited sexual desire
and lack of desire. The newly developed “dual control”
model of sexual response postulates that, within the
central nervous system, there are separate and relatively
Department of Gender Studies, Indiana University, Bloomington,
The Kinsey Institute for Research in Sex, Gender, and Reproduction,
Indiana University, Bloomington, Indiana.
Department of Applied Health Science, Indiana University,
Bloomington, Indiana.
To whom correspondence should be addressed at The Kinsey Institute
for Research in Sex, Gender, and Reproduction, Indiana University,
Morrison Hall 313, 1165 East Third Street, Bloomington, Indiana
47404-2501; e-mail: cygraham@indiana.edu.
independent excitatory and inhibitory systems (Bancroft,
1999; Bancroft & Janssen, 2000). It is the balance
between these two systems that determineswhethersexual
arousal occurs in any particular situation. The model also
postulates that individuals vary in their propensity for both
sexual excitation (SE) and sexual inhibition (SI).
The capacity to inhibit sexual response is seen as
adaptive, as a means by which the individual can avoid
danger or other risks to well-being that might result
from a sexual response in a given situation. For some,
however, the propensity for SI may be unduly high,
resulting in an impairment of the capacity for sexual
function and, for others, the propensity for SI may be low,
increasing the likelihood of engaging in high-risk sexual
behavior (Bancroft, 1999). Research has been exploring
this model and its possible relationship to both sexual risk-
taking (Bancroft et al., 2004; Bancroft, Janssen, Strong,
Carnes, & Long, 2003) and sexual dysfunction in men
(Bancroft & Janssen, 2000, 2001). A questionnaire (Sex-
ual Inhibition Scale/Sexual Excitation Scale, SIS/SES)
has been developed to assess SI and SE in men and has
been demonstrated to have good psychometric properties
(Janssen, Vorst, Finn, & Bancroft, 2002a, 2002b). Factor
analyses yielded three factors: one excitation factor (SES)
2004 Springer Science+Business Media, Inc.
528 Graham, Sanders, Milhausen, and McBride
and two inhibition factors, which have been labeled “in-
hibition due to threat of performance failure” (SIS1) and
“inhibition due to threat of performance consequences”
The SIS/SES has been adapted for women and used
in a study of 1,067 female college students (Carpenter,
Janssen, & Graham, 2004). The findings suggested that
women had lower SE scores and higher SI scores in
comparison with men, with a fairly normal distribution,
showing variability in SE and SI scores. This study
also found evidence for the convergent and discriminant
validity of women’s SIS/SES scores and for test–retest
Our view, however, was that simply modifying this
measure, originally developed for use with men, might
miss important aspects of SI and SE in women’s experi-
ence or emphasize genital response in a way women find
less relevant or meaningful. There are a number of reasons
for believing that central inhibition in women may be
fundamentally different in its underlying mechanisms and
scope of effects. It has been suggested that inhibition may
be more important for women than for men, particularly
as it pertains to sexuality and reproduction (Bjorklund
& Kipp, 1996). Studying inhibition in women requires
a reexamination of what is likely to be threatening, a
possibly different time relationship between SI and sexual
activity (e.g., SI may occur much earlier in women), and
consideration of exclusively female factors, such as the
menstrual cycle and pregnancy. For example, concerns
about one’s reputation may be a more important SI factor
for women’s sexuality than for men’s (Tiefer, 2001).
This qualitative study was the first stage of a project
to develop a questionnaire, using a woman-centered
approach, to assess a woman’s tendency to respond with
SI and/or SE to a variety of stimuli. Rather than relying on
researchers’ assumptions about what factors are important
to women’s sexual arousal, we wanted to hear from
women themselves about what they regarded as important.
We used focus groups of women to explore the
factors most relevant to SI and SE in women. Morgan
(1996) defined a focus group as “a research technique
that collects data through group interaction on a topic
determined by the researcher” (p. 130). As surveys
are inherently limited by the questions they ask, focus
groups can provide data on how respondents themselves
talk about the topics (Morgan, 1996) and thus have
been recommended as a means to inform questionnaire
development for more than a decade (Morgan, 1997).
Although focus groups have been increasingly used in
sexuality research (Byers, Zeller, & Byers, 2001), few
published accounts exist of using focus groups as a
means to construct questionnaires. Our goal was to use
the information obtained from the focus groups to help
us devise specific items for a questionnaire. This paper
reports on the qualitative data from the nine focus groups
we conducted.
All participants were English-speaking women vol-
unteers at least 18 years of age. An effort was made to ob-
tain age, race, ethnic group, educational, and relationship
status diversity in the sample. Thus, a range of recruitment
strategies was used, including flyers and advertisements
in community newsletters and newspapers, churches,
community organizations, and campus centers. Women
interested in participating were screened by telephone
and if eligible, were mailed a demographic questionnaire.
They were informed that the purpose of the study was
“to collect information on women’s experience of sexual
arousal and assess factors or types of situations that
promote or interfere with women’s sexual interest or
We made the decision to have groups that were
fairly homogenous with respect to age (18–24 years, 25–
45 years, and 46 years and older), but mixed with regard
to other demographic factors, such as student status,
and ethnic and racial background. As recommended by
previous researchers (Seal, Bogart, & Ehrhardt, 1998),
we overrecruited to control for cancellations and no-
shows and scheduled 12 women for each group. To ensure
diversity in these “mixed” groups, no more than six
women who were students or who described their race
as “White” were scheduled for any one group. In total, six
“mixed” groups (two 18- to 24-year groups, N = 6 and
10; two 25- to 45-year groups, N = 9 and 9; two 46+ year
groups, N = 10 and 9) were conducted.
To enhance the overall diversity of our sample, we
also conducted two groups of lesbian/bisexual women
(one aged 18–24 years, N = 9, and one aged 25 years
and older, N = 10) and one group of African American
women (aged 18–35 years, N = 10). Our view was that
these “segmented” groups might facilitate discussion be-
cause minority participants might feel more comfortable
discussing sexuality-related topics with others similar to
Participants were 80 women (mean age = 34.3 years;
SD = 16.1; range, 18–84 years). Table I contains
In this paper, we use the terms “sexual desire” and “sexual interest”
Women’s Sexual Arousal 529
Table I . Participant Characteristics (N = 80)
n %
Race/ethnic group
Asian 2 2.5
Black 14 17.5
Hispanic 2 2.5
White 57 71.3
Other 5 6.3
Marital status
Single/never married 44 55.0
Married 18 22.5
Separated/divorced 15 18.8
Widowed 3 3.8
Sexual orientation
Heterosexual 50 62.5
Bisexual 8 10.0
Lesbian 19 23.8
Uncertain 3 3.8
Protestant 21 26.3
Catholic 12 15.0
Jewish 3 3.8
Other 29 36.3
None 15 18.8
Full-time 24 30.0
Part-time 38 47.5
Not employed 18 22.5
Attended college, technical
school, or university
Yes 77 96.3
No 3 3.8
Relationship status
Exclusive/monogamous 51 63.7
Nonmonogamous relationship 8 10.0
Not in a current sexual 21 26.3
Duration of relationship (N = 59)
M (in years) 5.18
SD 8.6
Range 0.67–54
demographic information on the sample. As can be seen,
participants were highly educated, but were quite diverse
in terms of other demographics, such as employment,
marital status, and race.
Two female moderators facilitated each of the focus
group sessions. In each group, one of the moderators was
a PhD-level psychologist and the other was either an MA-
level researcher or a senior undergraduate student. An
African American researcher was the primary moderator
for the African American group.
All of the sessions were audiotaped and transcribed
for analysis. In addition, moderators made written notes
during the sessions. No individual identifiers were col-
lected to ensure the anonymity of the participants. After
transcription, the audiotapes were destroyed.
The groups were held in a private room in a
local public library, with the exception of the two
lesbian/bisexual groups that met in a conference room
at The Kinsey Institute. The rationale for this was that
womenattendinga lesbian/bisexual group might feel more
comfortable meeting at The Kinsey Institute, rather than
in a public venue, particularly if they had not “come out”
as lesbian or bisexual. Consent forms and background
questionnaires were collected when each woman arrived.
Each session began with introductions by the moderators
and the participants. Name cards were provided for
each participant; however, women were told that they
could choose not to use their real names and could
use a pseudonym. Refreshments were provided. At the
end of the 2-hr session, women were thanked for their
participation and received a $25 payment.
Study approval was obtained from the Indiana
University Bloomington Campus Committee for the
Protection of Human Subjects.
Focus Group Discussion Guide
Moderators utilized a discussion guide that included
the following components:
(1) Description of the purpose of the study and the
procedural rules of the focus group. Women were
told that the purpose of the focus group was:
to share ideas to help us develop a better understanding
of women’s sexual arousal and its components as well
as the factors or types of situations that promote or
interfere with women’s sexual interest and arousal.
We will use the information to help us develop a
Women were told that they could share informa-
tion from their own experience, things they have
observed, or experiences described to them by
others, (i.e., act as participant-observers of their
peers). Participants were also asked to honor the
privacy of the other participants and not to share
any of the focus group discussion with others
outside of the group.
(2) The three topics and the questions introducing
a) Sexual arousal and its components. “How do
women know when they are sexually aroused?
What cues are there? Is vaginal lubrication
530 Graham, Sanders, Milhausen, and McBride
(“wetness”) a counterpart or parallel to erec-
b) Sexual interest and sexual arousal. “How
would you describe sexual interest? How is
it related to sexual arousal? Is there a clear
demarcation between sexual interest and sex-
ual arousal? Does sexual interest always occur
before arousal?”
c) Factors that enhance or inhibit sexual arousal.
(i) “What sorts of things enhance or increase
sexual arousal?(ii)Whatsorts of things prevent
or stop women from being sexually aroused or
end/interrupt arousal?”
The sequence of discussion topics was not rigidly
fixed. In keeping with the primary goal of the study,
to gather information on factors that enhance/inhibit
arousal, the majority of the focus group session was spent
on discussion of Topic 2c. For these latter questions,
the discussion guide also contained a list of possi-
ble situations/factors that could be used as “prompts”;
however, as much as possible, moderators allowed the
group members to generate ideas. The aim was to
have participants react to the ideas and statements of
other group members. The moderators tried to keep
the conversation “on target” but guided the discussion
only when necessary and there was no attempt to try
to control the way that the participants interacted (e.g.,
trying to get everyone to participate equally in the
Data Analysis
All of the four authors were involved in analyzing the
focus group transcripts. Our method of analysis was drawn
from Morgan (1997). In the first stage, transcriptions
from each of the nine focus groups were analyzed
independently by two investigators, who listed recurrent
themes and specific quotes within each theme. Following
this, all four investigators met to compare the themes
across investigators and groups. This was an interactive
process that involved repeated rereading of the transcripts.
Discrepant themes were discussed until agreement was
reached and new themes were added to reflect as much
of the data as possible. Next, themes were organized into
broad categories. Refinements were made to the coding
scheme and the labeling of themes, after discussion and
consensus among the four researchers. The end result was
a coding scheme consisting of eight broad categories and
within most of these, a number of subcategories (see
Appendix). In the final stage of analyses, we applied
the coding framework to all of the data by annotating
the transcripts with the numerical codes that indexed the
Although group comparison was not a focus of our
study, we used a “grid” approach (Knodel, 1993; Morgan,
1997) to provide a descriptive summary of the content of
discussions. On one axis of the grid were the coding cate-
gories/subcategories identified and, on the other, the focus
group session identifiers (e.g., 18–24 lesbian/bisexual
group). The cells contained page numbers of transcripts,
where quotes that illustrated the particular theme were
located. The grid was a useful way to compare responses
to each of the discussion questions across focus groups,
in order to gain an indication of differences that might be
relevant to questionnaire development. We did not rely on
code counting per se, but rather on a more interpretative
summary of the data.
The results are presented in three sections, cor-
responding to the three discussion topics explored in
the focus groups: (1) cues for sexual arousal; (2) the
relationship between sexual arousal and sexual inter-
est; and (3) factors that enhance or inhibit sexual
Cues for Sexual Arousal
In all of the groups, women described a wide range
of cues for sexual arousal, including physical (genital
and nongenital), cognitive/emotional (e.g., distraction,
anticipation, nervousness, heightened sense of aware-
ness), and behavioral (e.g., sighing, moaning) indicators.
Genital changes described were sensations of tingling,
warmth, fullness, swelling, and lubrication, and nongeni-
tal physical changes included “butterflies” in the stomach,
increased heart rate, nipple hardening, increased skin
sensitivity, changes in temperature, shortness of breath,
muscle tightness in stomach and legs, and flushing in the
face and chest.
Although lubrication was reported as one of the cues
of sexual arousal, women’s responses to the question “Is
vaginal lubrication (“wetness”) a counterpart or parallel
to erection?” was a resounding “no. Women observed
that if a man experienced an erection in a sexual situation,
this would be a signal that he was sexually aroused. A
number of participants reported that feeling aroused and
being lubricated did not always co-occur, as illustrated by
this interaction:
Women’s Sexual Arousal 531
Participant (P-1)
: Lubrication and arousal don’t necessa-
rily coincide.
P-2: There’s times of the month too where
there’s just more lubrication because of
whatever’s going on in terms of hormones
where I won’t necessarily feel turned on.
Moderator (M): So you can be aroused and not necessarily
feel wet or vice versa?
P-3: Yeah, I find that wetness comes at a later
stage of arousal for me. There’s more of a
sequence thing. It comes later. It’s not the
first sign. [25–45 group]
The fact that lubrication might be a later sign of arousal,
and one that might not always be perceived, was raised in
other groups:
P-1: It depends on how physical you get.
P-2: And if there’s a chance, I guess, to notice it too
depending on what you’re doing.
P-3: I don’t think that’s one of the first signals to me . . . I
think there are a lot of things that you notice before.
[18–24 group]
Sexual Arousal and Sexual Interest
In the discussions on the relationship between sexual
interest and sexual arousal, a number of women said that
they did not clearly differentiate between sexual arousal
and sexual interest, as illustrated by the following two
P: The arousal, the interest, they tend to, they blur . . . I’m
not even sure how to separate out one from the other.
[25–45 group]
P: Maybe I don’t get interested very often but when I do,
there’s at least a little bit . . . a degree of arousal. . . . For
me if I’m sexually interested in somebody, even a little
bit, then I’m a little bit aroused. [18–24 Lesbian/bisexual
In terms of temporal sequence, interest was perceived
as sometimes preceding arousal, and sometimes following
it, as described by these two women:
P-1: I tend to think of arousal as more physical and interest
more thoughtful and I don’t think one like absolutely
comes before the other.
P-2: For me, it can be either way actually. Some thought
may come to my mind which arouses me or I may feel
aroused and then . . . it’s hard to explain it. I may feel
aroused and have an interest in pursuing it. I think
In all of the quotes involving more than one participant, P-1, P-2 . . . P-N
indicates a statement from a different woman.
At the end of each quote is the focus group identifier (e.g., 25- to
45-year group, etc.).
that’s what I’m trying to say. It’s either way to me.
[25–45 group]
Other women talked about sexual arousal occurring
without any experience of sexual interest:
P-1: I think there can be arousal without interest at all.
You can be like, I don’t know, riding on a tractor or
P-2: You could be ovulating. [18–24 Lesbian/bisexual
Factors That Enhance or Inhibit Arousal
Factors that affected SE and SI (see Questions 2c)
were classified into eight broad categories. Each of these
categories contained a number of subcategories (for a list
of the coding categories, see Appendix). It is important to
note that many of the factors in our coding scheme were
cited as “inhibitors” by some women and as “enhancers”
by others or as both by the same woman, depending
on the specific situation being described. For example,
negative mood states, such as anxiety, were reported by
some women as reducing their ability to become aroused
and by others as increasing it. Similarly, the possibility
of being seen or heard while having sex was described
as arousing by some women, but as inhibiting by others.
In addition to individual variability, women also noted
that context and timing were important in this regard; for
example, a particular style of approach by a partner might
increase their arousal only if the partner was someone they
trusted, rather than a stranger, or a partner in whom they
lacked trust. Factors or situations were also seen as having
variable effects on sexual arousal depending on whether
they occurred in the context of a committed or long-term
relationship versus a casual relationship or a one-night
Although the themes that emerged varied across
groups, particularly different age groups, certain themes
were raised in all of the groups. These consistent themes
included feelings about one’s body; negative conse-
quences of sexual activity (e.g., concern about reputation,
pregnancy); feeling desired and accepted by a sexual
partner; feeling “used” by a sexual partner; and negative
Feelings About One’s Body
Feeling comfortable and positive about one’s body
was frequently mentioned as a factor that would facil-
itate sexual arousal. Statements such as this one were
532 Graham, Sanders, Milhausen, and McBride
P: If I am feeling good about myself, I mean some days
I feel like I’m really okay. My hair is just right and
everything is working and it’s much easier for me to
feel aroused when I’m feeling really comfortable with
myself . . . it’s not as easy to feel aroused when I’m not
feeling good about myself and my body. [25–45 group]
Women also discussed feeling confident and having a
positive self-image as enhancers of arousal:
P-1: If I’m feeling unattractive, like if I’ve gained
weight or something you know . . . but if I’ve lost 5
pounds . . . I’m just like wanting to take my clothes
off a lot . . .
P-2: Yeah, positive self-image is definitely an enhancer.
[25–45 group]
The importance of a partner accepting one’s body was
also raised:
P-1: Yeah, people accepting me and my body is crucial.
P-2: If somebody told me that I had too big a butt or big
thighs, I’d be like “sorry.” [18–24 group]
P: It’s important to me to be comfortable with my body
and for the other person to be comfortable with their
body and for them to be comfortable with my body.
[25–45 group]
P-1: Or your partner telling you you’re heavy.
P-2: Right, big turn-off.
P-3: Or just feeling not accepted in any way by your
partner . . . [46+ group]
Concern About Reputation
Manywomen, particularly in the younger age groups,
said that concern about reputation had a negative impact
on their sexual arousal:
P-1: He’s really cocky and thinks he can get anyone and
like I don’t want to fall for it. There’s so many
consequences that we have to deal with like getting
pregnant and things you just don’t want to go through.
P-2: Not to mention the whole school would know, well,
not in college, but like in high school, the whole
school would know about it in a day and it’d just
be like . . . and then you regret doing it. [18–24 group]
Women talked about a “double standard,” with fear about
damaging one’s reputation as something that only women
had to worry about. One participant voiced concerns about
performance and the double standard:
P: Being single and you know, wanting to be sexual with
another person and thinking “okay, am I going to be too
much?” or “am I going to be not enough?” or “what
are they going to think of me because I’m doing these
things?” and you know, my thinking doesn’t go there
with him. It’s not like, “Oh, is he a whore because he
knows how to do this or that?” I’m pretty much more
grateful that he knows but when it comes to me, there is
this concern about, you know, being good or whatever
that means. [25–45 group]
The following statement describes feelings of ambiva-
lence: wanting to be openly sexual but at the same time,
being concerned about being labeled a “slut”:
P: I think that like if you go out. . . and you’re really
conservative and you don’t do all that kind of stuff and
then you see a girl who is not like that and who is out,
you know, having sex with all these men and having fun.
It’s almost like you hate her but you want to be her at the
same time. You sit there and you’re thinking, “she’s a
slut, I can’t believe she’s doing that.” At the same time,
it’s like “whoa, she’s getting lots of attention. [18–24
There were also some women who described feeling more
sexually aroused in situations where they felt that they
were being “bad” by giving in to their sexual desire:
P: One thing that turns me on is sometimes just being bad,
doing things I know I shouldn’t do. . . Sometimes just
being able to just do what you want and give in and not
care what society or anybody’s thinking, that’s exciting
to me because you . . . can’t be thinking about what your
friends would say if they knew or what your mom would
think of you. [African American group]
Putting on the Brakes
One of the recurrent themes in the younger age
groups was that many women felt the need to “put
on the brakes” to stop themselves from being aroused.
Women talked about knowing that they would be aroused
in a given situation but not allowing themselves to “go
there, for a wide range of reasons, including being in
a current relationship, concerns about reputation, lack of
trust/safety issues, the person being an “inappropriate”
partner, and concerns about pregnancy. Women discussed
this as being something that was their responsibility, rather
than that of their male partners:
P: There’s the typical whether or not to put on the brakes. It
depends on who you’re with, you know, but you always
have to make the decision because you know that the
guy’s not going to make that decision. It’smy job. [18-24
Women in the younger groups also talked about the ease
with which they could switch on and off their arousal:
P: There’s so much control . . . it’s like you can almost
[say] “yeah, I’m interested but no, maybe not, and
then you completely forget about it if it’s not really
Women’s Sexual Arousal 533
that interesting to you. It’s almost like you can turn it
off and on if you want to. [18–24 group]
P-1: . . . with girls I think it’s like you might have some
inclinations and then you’re like, “wait a minute, you
can’t do that, you’re in a relationship or that guy’s
a loser . . . and all of a sudden you just [think] “okay,
fine, forget it, I can’t. That’s a bad idea, and just walk
away from it. It’s a lot easier for a girl to walk away
from a situation.
P-2: You can just shut it off like you said. [18–24 group]
Unwanted Pregnancy/Contraception
Fears about unwanted pregnancy were described
as having a very negative impact on sexual arousal,
particularly if one’s partner did not share these concerns:
P: Unwanted pregnancy is a big turn off and if you’re with a
partner who seems unconcerned about that, then it really
feels like a danger. It feels like a hazard, you know, I
mean more than just if you’re with a steady partner and
you’re both concerned about it. [46+ group]
Women also discussed how a partner’s shared concern
about contraception could serve to buffer potential nega-
tive effects on their ability to feel aroused:
P: Contraceptives are definitely at least a . . . barrier to
arousal at times. The more that my partner is comfort-
able with the use of whatever we’re using, that really
helps . . . and it’s less of a barrier. [25–45 group]
Feeling Desired Versus Feeling Used by Partner
Women identified feeling “desired” or appreciated
by a partner as something that was very arousing:
P: It is very arousing to me to have someone verbally and
physically appreciate my body. [25–45 group]
P: I like it when they caress not only like your body
parts that get sexually aroused but just like your
arms and because it feels like he’s encompassing you
and appreciating your whole body. [African American
Many women talked about how their arousal was in-
creased with partners who seemed particularly interested
in them as individual women, rather than someone that
they just wanted to have sex with; as this woman
P: When they’re attracted to you and it’s like they just have
to touch you and can’t do enough for you. [25–45 group]
This situation was contrasted with that of feeling used by
a partner, which was described as a powerful turn-off:
P: I experienced too many times waking up facing away
from him and ah, I’m not trying to be graphic, but just
rubbing himself on me as though I could have just been
any tree in the forest . . . that would not only kill any
ability that I could have ever found in the morning to be
between caressing and using someone like that. [25–45
Feeling “Accepted” by Partner
As well as feeling desired, a recurrent theme was
the importance of feeling “accepted” by a partner; for
example, a partner who was accepting of one’s responses
during sexual activity could facilitate arousal:
P: If I have permission to make sound, that is much
more arousing. Listening to my partner’s sound and
my sound and having the permission is much more
arousing than feeling like you got to contain that sound.
[46+ group]
The converse of this was feeling inhibited sexually when
a partner did not approve of a woman’s sexual response,
as this woman expressed:
P: Even with my second husband, and we were together 16
years, he was not accepting of my sexual responses. . . . I
make a lot of noise or [with] my favorite way to orgasm,
he felt left out. . . . That was just the beginning of just
really shutting down. [46+ group]
Women also discussed the importance of a partner feeling
comfortable with their sexual past, as this interaction
P-1: I can’t imagine being turned on by someone who
would be morally condemning my past. That would
be a big turn-off.
P-2: It would preclude a relationship. [25–45 group]
More general criticism by a partner was also said to have
a negative effect on sexual arousal:
P-1: . . . guys being cruel and saying, ah, any criticism or
something negative, that’s just a huge turn-off.
P-2: So, criticism of you . . .
P-3: Yeah.
P-4: It doesn’t even haveto be . . . like even if it’s something
that happened earlier that day. [25–45 group]
Style of Approach/Initiation and Timing
Women described various styles of approach/ initia-
tion as potential turn-ons or turn-offs but the importance
to their own arousal of how a partner approached them
was a key theme:
534 Graham, Sanders, Milhausen, and McBride
P: I want to say his “game” . . . you know, how the man
approached you, how did he get me to talk to him
longer than like, five minutes? How did he get me to
be interested in him and the ways he went about it.
[African American group]
Being “surprised” or “overpowered” by a partner was
described as arousing by a number of women:
P-1: It could be because I was raised Catholic and
everybody jokes to me, comes up behind me, you
know “I’m not responsible” then, and he comes up
behind me and puts his arms around my waist and it’s
like, well “it’s not my fault. If they’re going to take
me from behind, it’s not my fault.
P-2: I’m not Catholic and that is very sexually arousing.
P-3: I totally agree. [46+ group]
A potential turn-off was a partner who was too “polite” or
who asked for sex:
P: If somebody asked me to do something. I hate that. Like,
“will you go down on me?” and stuff and like blatantly
ask me . . . It will eventually get there, they don’t have
to ask me, but like the asking is . . . the biggest turn-off
ever. [18–24 group]
Although being able to communicate about sex with a
partner was often seen as positive, particularly in the older
age groups, a partner verbally “asking” for sex was widely
regarded as a turn-off:
P-1: My husband, as long as we’ve met. . . he’s just a very
polite young man and he just would, you know, while
we are in the throes of sexual passion, he would just
say “May I have sex?” or something like that, and I
wish [he] wouldn’t ask. That’s a turn-off.
P-2: It’s like, just do it.
P-3: Even now . . . he’ll say something like . . . “Well,
tonight can we have sex?” or something like that, and
I’m like “Why don’t you just come and you know,
kiss me and like that.
P-4: Make love to me.
P-5: Exactly.
P-6: Seduce me.
P-7: Don’t make me say okay.
P-8: It’s not something that’s a turn-on. [25–45 group]
Many women mentioned that they were less aroused
when partners did not spend long enough on foreplay,
were not enthusiastic during sexual interaction, or were
not attentive to their sexual needs. In particular, making
genital contact too fast, or what some of the younger
participants described as the “head push,” was frequently
mentioned as a turn-off:
P-1: When they grab, that turns me off. Yeah, I mean if
they sort of grab for bits of you . . .
P-2: Well, they gotta know what they’re doing.
P-3: Yeah.
P-4: I get really turned off if people make genital contact
too fast.
P-5: Yeah.
P-6: It’s like they don’t climb the mountain first?
P-7: Right . . . it’s very disappointing, you know . . . it’s
like, let’s build this up, let’s really enhance it. [25–
45 group]
In addition to making genital contact too quickly, sexual
activity that ended quickly because a partner ejaculated
was also brought up:
P-1: Sometimes they get this like stare and their tongue
is kind of half out and, you know, and you’re like
“Whoa, are you there?” The next thing you know,
they’re done.
P-2: Yeah, and they don’t want to do anything, they just
kind of roll over. [18–24 group]
In contrast, the opposite situation was described where
women became more aroused by partners who took time
and were attentive to their needs:
P: I’m a lot slower than my husband in terms of reaching
arousal and if he takes the time and gives. . . and you
know, goes that slow, that’s very arousing to me where
if I feel I have to go fast to keep up . . . it’s the exact
opposite response. [25–45 group]
A related theme was the issue of reciprocity during sexual
P-1: Something that really puts the brakes on for me is if I
can detect that the person that I’m having intercourse
with is in it more for himself and it’s not a fair balance.
Like if I feel like he’s the one receiving more and
I’m not getting an equal amount of pleasure then
that just halts everything. Like if I perform oral and
I want it too and he says “No, I don’t want to do
P-2: That’s interesting because . . . I definitely feel happy
just performing oral sex and feeling like I’m giving
that and that makes me feel really good and he can
give it another way.
P-3: But he is giving it to you in a different way so you’re
still kind of balancing.
P-4: Yeah, you’re right. [25–45 group]
As another participant commented:
P-1: I felt . . . we started out sort of mutually initiating our
sexual encounter and then I felt like I was doing all of
the giving and it wasn’t being reciprocated.
P-2: The physical giving?
P-3: Yes. And I was really put off and just got very angry
and it was over. Get out of here, buddy. Hit the road.
[25–45 group]
Women’s Sexual Arousal 535
Negative Mood
Discussions about the effects of negative mood on
sexual arousal suggested that the relationship between
mood and sexuality is complex. Effects varied as a
function of the particular mood (e.g., anxiety, depression,
or anger), as well as the reasons for the negative mood, and
other contextual factors. A number of participants talked
about experiencing heightened arousal when anxious or
P-1: Frustration can lead to, you know, enhanced arousal.
P-2: Actually, sex is the greatest stress relief so I’d much
rather attack somebody when I’m stressed out. [25–45
Some women made a distinction between being less
interested in sex with a partner, but being more likely
to masturbate, when they were feeling anxious:
P-1: When feeling really anxious, I would probably not be
at all interested in sex, but . . . conceivably interested
in masturbation just as a distraction, as a relaxant, but
not wanting to have to think about someone else and
take care of their needs too.
P-2: Yeah, I agree with that. [25–45 group]
Depression and anger were more often described as having
a negative effect on sexuality.
P: If you’re very upset with your intended sexual partner,
if you’re very upset with him about something, there’s
no way that you are going to be aroused. [46+ group]
Women talked about wanting physical affection but not
sex when they were feeling depressed; however, there
were also women who talked about negative mood having
little effect on their sexual arousal:
P: I’m about to go to sleep and I realize you’re laying next
to me, then the arousal comes no matter if I was angry
or I was happy before I got in the bed.. . . If I’m already
initially attracted to you and we already have that type
of relationship and we lay down next to each other, it’s
just something about that person lying next to me, that
arousal will come instantly no matter what mood I’m
in. [African American group]
Three general topics related to women’s sexual
arousal were explored using focus groups: (1) cues
to sexual arousal; (2) the distinction/overlap of sexual
interest and sexual arousal; and (3) factors related to
excitation and inhibition of sexual arousal. These findings
add support for the use of focus group methodology
to obtain information on sensitive topics (Seal et al.,
1998; Wilkinson, 1999). Our experience was that women
expressed a wide range of thoughts and opinions during
the group discussions and also reported that the experience
was both positive and educational. Clearly, our sample
was self-selected and thus likely comprised women who
felt comfortable discussing sexuality. These limitations
apply to most research on sexuality and other sensitive
topics. A strength of the study is that such qualitative data
give voice to women’s views on the process of sexual
arousal that can help inform future research and clinical
Arousal has traditionally been considered synony-
mous with lubrication (Bartlik & Goldberg, 2000), and
the current DSM-IV definition of Female Sexual Arousal
Disorder is the lack of “an adequate lubrication-swelling
response of sexual excitement” (American Psychiatric
Association, 2000). Our data on how women “recognize”
that they are sexually aroused support the view that a
wide range of physical (both genital and nongenital), psy-
chological, and behavioral changes characterize women’s
sexual arousal (Basson, 2002). Lubrication is only one of
the physiological changes that women experience when
they are sexually aroused, and not a necessary condition
for women to report that they are sexually aroused. Other
researchers have acknowledged the importance of “sub-
jective excitement” in addition to genital or other somatic
responses (Basson, 2002; Everaerd, Laan, Both, & van
der Velde, 2000). Interestingly, however, the importance
of nongenital somatic changes to women’s experience of
sexual arousal has been little studied. In contrast, there is
a large body of research on the relation between genital
response and subjective arousal (Everaerd et al., 2000),
showing lower concordance between genital response and
subjective reports of arousal in women, compared with
men. It is possible that women’s ratings of arousal are
more influenced by their state of general arousal, rather
than genital response. An early study by Levi (1969),
which compared urinary adrenaline and noradrenaline
excretion in men and women after exposure to erotic films,
is consistent with this possibility. Catecholamine changes
in women, but not in men, were positively and signif-
icantly correlated with changes in self-reported sexual
Consistent with previous studies (Ellison, 2000;
Frank, Anderson, & Rubenstein, 1978; The Working
Group for a New View of Women’s Sexual Problems,
2001), our qualitative data support the observation that
women do not usually separate sexual “interest” from
“arousal. Beck, Bozman, and Qualtrough (1991), in
536 Graham, Sanders, Milhausen, and McBride
a study of college-aged males and females, suggested
that nonprofessionals do not draw the same distinction
between sexual desire and arousal as researchers do.
Beck et al. also reported significant correlations between
desire and arousal, which led them to suggest that
sexual desire and arousal may be “two facets of the
same process within the sexual response” (p. 454). In
contrast with males, studies of clinical samples of women
have also reported a considerable overlap between the
dimensions of sexual desire and arousal in women (Rosen
et al., 2000). Some researchers have theorized that sexual
“desire” may reflect early arousal processes (Everaerd
et al., 2000). Yet, desire and arousal continue to be
defined, and studied, as independent constructs, perhaps
primarily to maintain current diagnostic classification
of separate arousal and desire disorders (Rosen et al.,
We designed the study to explore the concepts of
SE and SI, with the goal of the qualitative data guiding
the development of a questionnaire to assess a woman’s
tendency to respond with SE/SI. We were concerned
that the existing questionnaire (SIS/SES; Janssen et al.,
2002a), developed for use with men, might not adequately
assess factors relevant to women. A broad range of themes
emerged in the focus groups, only a subset of which are
presented in detail in this paper. Our data support the
ideas put forward by The Working Group for a New
View of Women’s Sexual Problems (2001). Inhibition
often arises from relational and sociocultural factors as
well as physical and psychological problems. Many of
the themes reflected factors that may be of particular
relevance to women, and ones that are not well represented
in the current SIS/SES scales. For example, the second
SIS/SES factor, SIS2 (labeled “threat of performance
consequences”), has 11 items that mainly relate to
external threats, such as the possibility of pregnancy or
sexually transmitted disease. There are no items that cover
threats that arise from the sexual relationship or partner
behavior (Janssen et al., 2002a). Yet, many women in
our study cited concerns such as being used, criticized,
or rejected by partners as important inhibitors of their
We were not surprised that some of our factors
(e.g., anxiety) were cited as “inhibitors” by some women
and as “enhancers” by others. Regarding questionnaire
development, it is important that the response categories
and item wording allow for the fact that a given situation
(e.g., the possibility of being seen or heard while having
sex) can be a strong “turn-on” for some women, and
a definite “turn-off for others. Whether SE and SI are
best conceptualized as orthogonal versus bipolar factors
remains to be established. Our findings do suggest that
the concepts of sexual inhibition and excitation were
meaningful and “made sense” to women. Also, research
using the male-based SIS/SES questionnaire, with both
male and female samples, has found factors relating to
SE and SI to be relatively independent (Janssen et al.,
Research with adolescents (Fine, 1988; Tolman,
2002) has provided evidence of teenage girls’ need to
avoid becoming sexually aroused in situations where the
“costs” are too high. Our qualitative data suggest that this
is something that may be important beyond adolescence.
Many women in the younger 18–24 groups talked about
the need to stop themselves from becoming aroused,
or to “put on the brakes, because of concerns about
reputation, lack of trust in partner, safety issues, etc.
Younger women also seemed more likely to cite partner-
related themes as important influences on their sexual
arousal. For example, grooming, dress, and personality
were frequent topics of discussion in the younger age
groups, whereas themes in our “self category (e.g.,
mood, physical state) were more often raised in the
older groups. Research on developmental changes and
gender differences in factors affecting SE and SI is
Although the primary purpose of our study was to
gather data that would inform questionnaire develop-
ment, qualitative data such as these can also be useful
in generating hypotheses for further study as well as
informing our concepts of sexual arousal processes. Our
data support a growing concern that current models of
sexual arousal and dysfunction may be too genitally
focused, make distinctions between interest and arousal
that do not reflect the experiences of many women, and
minimize the numerous factors that can affect arousal. In
conclusion, we would agree with Heiman (2001), who
argued for “systematically gathered phenomenological
data” on women’s experiences of sexual desire and sexual
Women’s Sexual Excitation and Inhibition Coding Scheme
Psychological state
Self-confidence; comfort with one’s body;
sexual self-knowledge; stress/worry;
procrastinating/bored; anticipation
Mood/emotional state
Negative mood state (depressed/anxious);
angry; positive mood
Physical state
Energy level; general health
Women’s Sexual Arousal 537
Sexual and relationship history
No available partner; previous sexual
or relationship experience
Emotional “openness”/vulnerability
Personal safety concerns/physical
Reputation/family and peer influence
Familial/peer judgments; religious or societal messages
Feeling desired/feeling used
Psychological characteristics
Comfort with body; personality; comfort with
own or partner’s sexual past; partner desired by others
Physical appearance and manner
Attractiveness; smell
Societal standards; relationship potential
Style of approach/initiation
Relationship dynamics/interaction
Relationship quality
Relationship stage/phase
Chemistry and lust
Physical closeness/contact or touch
Elements of the sexual interaction/activities
Partner attractiveness
Partner skill
Partner inexperience
Partner enthusiasm
Partner acceptance
Partner attentiveness
Power dynamics
Specific sexual acts
Romantic or sexual
Specific environment or time
Setting; time (of day, week, or season)
Sexual or erotic stimuli
External stimuli
Visual images; phone sex; internet
Internal stimuli
Hormones, fertility, contraception, and STDs
Alcohol or drug use
This research was funded, in part, by a grant from the
Lilly Centre for Women’s Health. We thank Leah Davis,
Carol McCord, Sara Upchurch, and Kari Burns for help
with moderating the focus groups and Danielle Wiser for
assistance with data analysis.
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    • "Relationship issues in general (such as lack of trust or worries about the strength of the relationship) can very negatively effect sexual arousal (e.g. Graham, Sanders, Milhausen & McBride, 2004). Problems with sexual arousal can also be caused by prior sexual problems. "
    [Show abstract] [Hide abstract] ABSTRACT: Human sexual arousal is dependent on numerous excitatory and inhibitory psychological processes. In discussing these mechanisms, the present chapter argues that among other negative emotions, disgust should be a factor in understanding the problems of (low) sexual arousal and related disorders. Disgust and sexual arousal are thought to represent opposing evolutionary forces that balance and restrain each other to protect their respective domains that are disease avoidance versus procreation and pleasure. Increasing evidence suggests that sexual arousal is a mechanism that allows for the intermittent reduction of the subjective levels of disgust towards stimuli that are at the core of sexual activity (e.g., saliva, tip of penis); and disgust-mediated avoidance tendencies in order to facilitate pleasurable and functional sexual experiences. The current available treatment interventions of problems with sexual arousal and possible barriers of such treatment options are discussed based on the excitatory-inhibitory model presented in this chapter. Keeping in mind the variability of issues surrounding sexual arousal problems, and bringing in insights from research in other psychopathologies, this chapter ends with a delineation of treatment protocol/s for consideration.
    Chapter · Jan 2017
    • "For F, RA has a sexual nature, but its physical correlate is not limited to the genital area [108]. A wide range of cues, including subliminal ones [109], can generate a significant activation of RA [110]. RA has a passive function; thus, the fact that F's sexuality resides in F-RA tends to (erroneously) characterize F as 'sexually passive' when compared to M's AA-driven sexual initiative. "
    [Show abstract] [Hide abstract] ABSTRACT: In this paper, we propose a new approach to couple formation and dynamics that abridges findings from sexual strategies theory and attachment theory to develop a framework where the sexual and emotional aspects of mating are considered in their strategic interaction. Our approach presents several testable implications, some of which find interesting correspondences in the existing literature. Our main result is that, according to our approach, there are six typical dynamic interaction patterns that are more or less conducive to the formation of a stable couple, and that set out an interesting typology for the analysis of real (as well as fictional, as we will see in the second part of the paper) mating behaviors and dynamics.
    Full-text · Article · May 2016
    • "The SESII-W (Graham et al., 2006) might be the best choice when it comes to research that focuses on specific aspects of female sexual behaviors or experiences without gender comparisons. It includes themes and topics that are particularly relevant for women (Graham et al., 2004), has been translated into four languages, and has been increasingly used in questionnaire surveys and laboratory studies. "
    [Show abstract] [Hide abstract] ABSTRACT: Women’s sexual health can be compromised by sex-related risks and sexual dysfunctions. Theoretical models of human sexuality are useful to systematically investigate predictors of healthy sexuality. According to the dual control model of sexual response, sexual arousal stems from the balance of two mechanisms. These are called sexual excitation and sexual inhibition. Both propensities are supposed to be related to individual variability in sexual responsivity and thereby influence which sexual behaviors are conducted. The aims of this thesis were to investigate the predictive value of sexual excitation and sexual inhibition for sexual risk behaviors, sexual function, and sexual arousal in women. To meet these objectives, a self-report scale was translated and validated in order to assess sexual excitation and sexual inhibition in women in Germany. Two studies—a questionnaire-based study (N = 2,206) with one-year and two-year follow-ups and a laboratory study (N = 58)—were conducted to evaluate if sexual excitation and sexual inhibition were predictive of these sexuality-related outcomes. Data were analyzed using confirmatory factor analysis, hierarchical multiple regression analysis, and hierarchical linear modeling. Lower sexual inhibition and greater sexual excitation were associated with more frequent sexual risk taking and better sexual function. Several aspects of sexual excitation and sexual inhibition were predictive of future sexual risk taking and future sexual function. Sexual excitation and sexual inhibition were not predictive of subjective and genital sexual arousal. Some lower order domains were moderators of the relationship between subjective and genital arousal. The studies presented in this thesis illustrate considerable diversity in women’s sexual behaviors and experiences. Our data provides supportive evidence for the usefulness of the dual control model of sexual response in explaining the variability in women’s sexual expressions.
    Full-text · Thesis · Mar 2016
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