Sonia Milani’s research while affiliated with University of British Columbia and other places

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Publications (15)


CONSORT diagram for participants in sexual orientation groups
Asexuality: Its Relationship to Sibling Sex Composition and Birth Order
  • Article
  • Publisher preview available

December 2024

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69 Reads

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Sonia Milani

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Brett Makarenko

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While recent research has advanced our understanding of asexuality, very little effort has been devoted to examining biomarkers and possible prenatal correlates of asexuality. In response, we recruited a large international sample (N = 1634 women and men) to explore associations between sibling composition and asexual sexual orientation (n = 366) and to replicate previously reported sibship effects in individuals with a same-sex attracted orientation (n = 276) and bisexual sexual orientation (n = 267) compared to heterosexual individuals (n = 725). Our analyses used two of the most recent statistical approaches that attempt to disentangle older sibling effects from family size effects (Ablaza et al., 2022; Khovanova, 2020). We found that higher overall number of siblings (female fecundity effect) predicted higher probability of asexuality in men and having fewer older sisters and being an only-child predicted higher probability of asexuality in women. Regarding the same-sex attracted orientations, higher number of older sisters increased likelihood of being a gay man (sororal birth order effect). Having fewer older sisters was associated with bisexual sexual orientation in women and higher overall number of siblings predicted increased likelihood of bisexuality in men. We did not find a fraternal birth order effect for gay, lesbian, bisexual or asexual groups using the Ablaza et al. (2022) method but the effect was significant for gay men using the Khovanova (2020) analytic approach. These findings point to potential sibship-related contribution to development of asexuality in women and men but future studies will need to replicate these results and articulate potential underlying mechanisms.

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Examining Attentional Biases Elicited by Sexual Stimuli Using MouseView.js: An Online Paradigm to Mimic Eye Movements

May 2023

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71 Reads

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2 Citations

Attention is a key mechanism underlying many aspects of sexuality, with eye-tracking studies revealing that attention is both sustained by sexual stimuli and corresponds with sexual interest. Despite its utility, eye-tracking experiments typically require specialized equipment and are conducted in a laboratory setting. The overarching objective of this research was to assess the utility of a novel online method, MouseView.js, for assessing attentional processing of sexual stimuli outside of a laboratory context. MouseView.js is an open-source, web-based application where the display is blurred to mimic peripheral vision and an aperture is directed using a mouse cursor to fixate on regions of interest within the display. Using a discovery (Study 1, n = 239) and replication (Study 2, n = 483) design, we examined attentional biases to sexual stimuli among two diverse samples with respect to gender/sex and sexual orientation. Results revealed strong attentional biases toward processing sexual stimuli relative to nonsexual stimuli, as well as dwell times that correlated with self-report sexuality measures. Results mirror those observed for laboratory-based eye-tracking research, but using a freely available instrument that mirrors gaze tracking. MouseView.js offers important advantages to traditional eye-tracking methods, including the ability to recruit larger and more diverse samples, and minimizes volunteer biases.


The Impact of Loosening COVID-19 Restrictions and Live-in Partner Status on Sexual and Mental Health in a Canadian Sample

January 2023

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13 Reads

International Journal of Sexual Health

Objectives: We examined changes in frequency of sexual behaviors, dyadic sexual desire, relationship satisfaction, and COVID-19 stress in Canadians across the pandemic, considering partner status. Methods: Participants completed online questionnaires. Results: Participants with live-in partners and single participants decreased in dyadic sexual behaviors. In August–September 2020, participants with live-in partners engaged in more dyadic sexual behaviors than single participants. In November 2021, all partnered participants engaged in more dyadic sexual behaviors than single participants. Decreases in COVID-19 stress were observed. Conclusions: Findings suggest that despite decreases in COVID-19 stress, there may be long-lasting pandemic impacts on sexual behaviors.


The Impact of Loosening COVID-19 Restrictions and Live-in Partner Status on Sexual and Mental Health in a Canadian Sample

January 2023

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20 Reads

International Journal of Sexual Health

Objectives We examined changes in frequency of sexual behaviors, dyadic sexual desire, relationship satisfaction, and COVID-19 stress in Canadians across the pandemic, considering partner status. Methods Participants completed online questionnaires. Results Participants with live-in partners and single participants decreased in dyadic sexual behaviors. In August–September 2020, participants with live-in partners engaged in more dyadic sexual behaviors than single participants. In November 2021, all partnered participants engaged in more dyadic sexual behaviors than single participants. Decreases in COVID-19 stress were observed. Conclusions Findings suggest that despite decreases in COVID-19 stress, there may be long-lasting pandemic impacts on sexual behaviors.


Asexuality: When Sexual Attraction Is Lacking

August 2022

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201 Reads

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10 Citations

In the past decade, human asexuality has garnered much attention and emerged as an empirically documented sexual orientation. Asexuality is generally defined as an absence of sexual attraction and approximately 1% of the general population report not feeling sexually attracted anyone. In this chapter, we examine the evolving definition of asexuality and diversification of individuals who identify as asexual. We provide an overview of gender differences and review the extant literature on human asexuality, which has mainly focused on exploring how to best conceptualize asexuality. Various theories have been proposed to classify asexuality as a mental disorder, a sexual dysfunction, or a paraphilia. However, we challenge these speculations and pose that asexuality may best be thought of as a sexual orientation as it is likely a normal variation in the experience of human sexuality. We discuss factors that make the study of asexuality challenging and propose possible solutions for researchers to consider. Future research into asexuality is necessary and might inform our understanding of sexuality in general. Researchers need to examine and understand the biological correlates of asexuality and directly test asexuality as a sexual orientation.KeywordsAsexualitySexual attractionSexual desireSexual orientationRomantic attraction


Examining Visual Attention Patterns among Asexual and Heterosexual Individuals

June 2022

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221 Reads

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3 Citations

Asexuality has garnered much attention, and empirical data support its classification as a sexual orientation. Asexuality is defined as a lack of sexual attraction to others, with approximately 1% of the population falling in this category. As theoretical models situate attention as a central component of sexual response, the current study examined attentional processing of erotic stimuli in asexuals and heterosexuals. We hypothesized that heterosexual participants would have initial and controlled visual attention patterns favoring erotic images over non-erotic images. We predicted that asexual participants would have significantly smaller or non-existent differences in attention to erotic versus non-erotic images. Ninety-five adults completed an eye-tracking task viewing erotic and non-erotic images. Eye-tracking data showed no group differences in initial attention to erotic images. For controlled attention, there was a large effect size in the hypothesized direction. Heterosexual participants exhibited more and longer fixations on erotic images, whereas asexuals exhibited a more even distribution of attention across image types. Exploratory analysis of group differences in the association between visual attention and ratings of sexual attractiveness revealed a complex pattern of differences, with some indication of a stronger association between total fixation and sexual attraction for heterosexual participants. These findings suggest that differences in attention to sexual stimuli may represent key underlying differences between asexual and allosexual orientation. Findings also contribute to the larger literature on visual attention and attraction.


Gynephilic Men’s and Androphilic Women’s Visual Attention Patterns: The Effects of Gender and Sexual Activity Cues

February 2022

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235 Reads

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4 Citations

Men and women differ in the degree of specificity of sexual response and differences in attention to sexual cues may be a mechanism underlying these gendered patterns. The majority of previous research has examined attention using static images, which differ considerably from the dynamic videos used in studies of sexual response. To test attention as a potential mechanism involved in gendered sexual response, we used eye-tracking to examine visual attention patterns of 33 gynephilic men and 36 androphilic women to videos depicting preferred and nonpreferred gender targets engaging in varying sexual activities. Specificity of controlled attention was gendered, and this effect differed depending on the intensity of sexual activity cues depicted. Regardless of sexual activity cues, men's controlled attention was gender-specific toward preferred targets. Sexual activity cues did, however, impact the degree to which women's controlled attention was gender-specific. Specifically, women's attention was gender-specific to low-intensity stimuli but nonspecific for masturbation and same-sex dyadic stimuli. Women's attention was gender-specific for mixed-sex dyadic stimuli, but with greater attention directed toward nonpreferred gender targets. Overall, contextual cues impact women's attention to a greater degree than men's. Potential explanations for these findings and implications of stimulus selection for sexuality research are discussed.


Mean sexual presence total scores were significantly higher for first-person compared to third-person point of view (POV) only when the 2D videos were viewed in Block 1. When VR videos were viewed in Block 1, no significant differences were observed across POV. Scale range 10–70. Error bars represent 95% CI
Mean dyadic sexual desire scores were significantly lower for videos viewed in Block 1. When 3D virtual reality (VR) videos were viewed in Block 1, dyadic sexual desire scores were higher for 2D videos appearing in Block 2. When 2D videos were viewed in Block 1, dyadic sexual desire scores were higher for VR videos appearing in Block 2. Scale range − 9–9. Error bars represent 95% CI
Virtual Reality Erotica: Exploring General Presence, Sexual Presence, Sexual Arousal, and Sexual Desire in Women

January 2022

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646 Reads

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24 Citations

Virtual reality (VR) media using a three-dimensional (3D) camera facilitates an immersive experience compared to traditional two-dimensional (2D) formats. In this novel study, we used high quality, women-centered erotica and examined whether stimulus modality (VR vs. 2D) and point of view (POV: first-person vs. third-person) impacted women’s feelings of sexual presence (activation of sexual response induced by the perception of being present), sexual arousal, and sexual desire (dyadic and solitary). We also investigated the effects of stimulus modality on feelings of general presence (a sense of “being there”). Results from 38 women indicated that with medium to large effects, general presence, sexual presence, and sexual arousal were significantly higher for VR videos relative to 2D videos. Sexual presence was higher for first-person POV depending on the order of film exposure. A general trend toward increasing dyadic sexual desire over the course of the study was observed. No significant differences were observed for solitary sexual desire. These findings support the adaptability of VR media to sex research and show that it can induce feelings of sexual presence and presence more generally. That sexual arousal was positively impacted by VR erotica may have implications for addressing the limitations that accompany other stimulus modalities used to elicit sexual responses in women.


Visual Attention and Sexual Function in Women

September 2021

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176 Reads

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9 Citations

Current Sexual Health Reports

Purpose of Review Theoretical models situate attention as integral to the onset and regulation of sexual response and propose that problems with sexual response and subsequent sexual dysfunction result from insufficient attentional processing of sexual stimuli. The goal of this paper is to review literature examining the link between attentional processing of sexual stimuli and sexual function in women. Specifically, we sought to understand whether women with and without sexual dysfunction differ in their visual attention to sexual stimuli and examined the link with sexual response, which would support attention as a mechanism underlying sexual dysfunction. Recent Findings Across women with and without sexual concerns, sexual stimuli are preferentially attended to relative to nonsexual stimuli, suggesting that sexual stimuli are more salient than nonsexual stimuli. Differences between women with and without sexual dysfunction emerge when examining visual attention toward the most salient features of sexual stimuli (e.g., genital regions depicting sexual activity). Consistent with theoretical models, visual attention and sexual response are related, such that increasing attention to sexual cues facilitates sexual arousal, whereas reduced attention to sexual stimuli appears to suppress sexual arousal, which may contribute to sexual difficulties in women. Summary Taken together, the research supports the role of visual attention in sexual response and sexual function. These findings provide empirical support for interventions that target attentional processing of sexual stimuli. Future research is required to further delineate the specific attentional mechanisms involved in sexual response and investigate whether these are modifiable. This knowledge may be beneficial for developing novel psychological interventions targeting attentional processes in the treatment of sexual dysfunctions.


Citations (10)


... Because we were keen to accommodate healthcare assistants with testing-at-home, we instead opted for a web-based version in which participants move a high-fidelity aperture through an otherwise blurred display to mimic natural vision. This approach has been validated to identify attentional biases for threatening [30] and sexual stimuli [31]; and has been shown to be reliable and valid in preferential looking tasks with disgusting or pleasant stimuli [22]. ...

Reference:

Long-term disgust habituation with limited generalisation in care home workers
Examining Attentional Biases Elicited by Sexual Stimuli Using MouseView.js: An Online Paradigm to Mimic Eye Movements
  • Citing Article
  • May 2023

... Asexuality is often construed as a sexual identity and a distinct sexual orientation (Brotto & Milani, 2022;Guz et al., 2022). Researchers use the term "asexual" when referring to sexual identity, whereas the term "ace" or "a-spec" (asexuality spectrum) has been used by some members of the community as a more inclusive alternative to encompass the multiple experiences held by individuals. ...

Asexuality: When Sexual Attraction Is Lacking
  • Citing Chapter
  • August 2022

... Recently, there is increasing scientific interest in quantifying some aspects of the asexual experience, such as psychological well-being (Barreto & Boislard, 2023;Greaves et al., 2017), distress and discrimination (Barreto & Boislard, 2023;Boot-Haury, 2023;Brandley & Dehnert, 2024;Chan & Leung, 2023), mate preference (Edge & Vonk, 2024;Scheller et al., 2023), and sexual arousal patterns or basic psychological processes (e.g., attention, perception) captured through laboratory techniques (Bradshaw et al., 2021;Brotto & Yule, 2011;N. B. Brown et al., 2021;Bulmer & Izuma, 2018;Milani et al., 2023;Skorska et al., 2023). ...

Examining Visual Attention Patterns among Asexual and Heterosexual Individuals
  • Citing Article
  • June 2022

... Men continued to direct their attention selectively toward the female stimulus even in the high-intensity conditions, whereas women equally attended the male and female stimulus of high intensity. Thus, men systematically show response selectivity in agreement with their sexual preferences, whereas women show such selectivity only for stimuli of low intensity [147]. ...

Gynephilic Men’s and Androphilic Women’s Visual Attention Patterns: The Effects of Gender and Sexual Activity Cues
  • Citing Article
  • February 2022

... 18 This group of studies focused on diverse sexual responses and their outcomes, which may be impacted by the level of immersion. The synthesis shows sexual responses such as erectile function, 5,11-13 psychogenic symptoms, 5 sexual arousal, [11][12][13][15][16][17][18]20 gaze behavior, 11,12,14,19 and sexual interest and attraction. [11][12][13][14][15]18,20 Some measurements were previously validated or applied standard inventories for erectile function, 24 depressive symptoms, 25 sexual dominance, 39 sexual arousal, 34,35 sexual presence, 46 experiences, 36 and anxiety. ...

Virtual Reality Erotica: Exploring General Presence, Sexual Presence, Sexual Arousal, and Sexual Desire in Women

... To this extent, we can hypothesize that the differences in terms of psycho-sexological well-being could be explained by the context of COVID-19: a large body of evidence has unsurprisingly proven that rates of multiple psychopathological outcomes increased during the pandemic [48][49][50], and that such effects progressively waned over time [51]. Additionally, sexual and psychological health are closely intertwined, and their mutual relationship during the pandemic has already been explored in detail [15,[52][53][54][55][56][57][58]. ...

Impact of COVID-19 Related Stress on Sexual Desire and Behavior in a Canadian Sample
  • Citing Article
  • July 2021

International Journal of Sexual Health

... Visual stimuli were found to improve dyspareunia, which supports the importance of good vision in sustaining sexual function among women. 34,35 There are findings on erectile dysfunction in patients with cataract and glaucoma. 36,37 However, there is no study implicating visual impairment in FSD. ...

Visual attention and sexual arousal in women with and without sexual dysfunction
  • Citing Article
  • June 2021

Behaviour Research and Therapy

... With regard to psychotherapeutic techniques, mindfulness interventions have been proven effective in improving SF (Silverstein et al., 2011;Milani et al., 2021). They could aid in decreasing mind-wandering and worrying during sexual intercourse and thus ultimately reduce inhibition. ...

Visual Attention and Sexual Function in Women

Current Sexual Health Reports

... Such strategies could include affect management, relaxation training, exposure techniques [57,58], as well as other approaches that contribute to the desensitisation of overwhelming (sexual) stimuli. The more integrative approaches, such as mindfulness, have proven to offer highly valuable resources, as they can bring sensory information into awareness during sexual activities, by encouraging attentional focus on bodily sensations [59]. There is also evidence that mindfulness can have an important impact on the autonomic nervous system, by decreasing sympathetic activation, which is closely related to the "fight or flight" response and, therefore, to stress [60,61]. ...

Visual Attention to Sexual Stimuli in Women With Clinical, Subclinical, and Normal Sexual Functioning: An Eye-Tracking Study

Journal of Sexual Medicine

... The difference between conditions was particularly large for behaviors considered less acceptable for women, for example, masturbation or pornography consumption. Similar data were obtained in a study of gaze patterns in men and women exposed to pornographic stimuli [7]. When participants believed that their gaze was monitored, there was a clear sex difference. ...

“I can see you”: The impact of implied social presence on visual attention to erotic and neutral stimuli in men and women
  • Citing Article
  • June 2019

The Canadian journal of human sexuality