A systematic review of relationship adjustment and sexual satisfaction among women with provoked vestibulodynia

The main objective of this article was to conduct a systematic review of the literature examining relationship adjustment and sexual satisfaction among women with provoked vestibulodynia (PVD). Although only a small number of studies have included partners, the literature regarding partner's relationship adjustment and sexual satisfaction was also examined. Relevant articles were identified by a literature search conducted between August 2008 and May 2010. Studies were included if they contained at least one group or subset of participants with PVD or dyspareunia (i.e., painful sexual intercourse), and if they assessed relationship adjustment or sexual satisfaction as a primary outcome measure. Within this review, the methodological quality of 33 studies was systematically rated, and effect sizes were calculated when possible. Methodological type and quality greatly varied across the studies, as did the pain samples included and the outcomes reported. Nevertheless, the results of controlled studies indicate that PVD is associated with decreased sexual satisfaction. The controlled results also suggest, however, that PVD is not necessarily associated with general relationship maladjustment for women and their partners. Future research, using various methodologies, is needed to further understand intimate relationships among women with PVD and the impact that this condition may have on couples.     

Effects of erotic guided imagery on female sexual arousal and emotional response

The discrepancy between survey findings that women require a romantic context for arousal to erotica and the results of laboratory research which have failed to confirm this effect has led to continued controversy over the role of context in female sexual arousal. Methodological criticisms of laboratory research have focused on the passive nature of cue manipulations utilized to create casual versus committed contexts and failure to validate the effectiveness of context manipulations. The present study investigated the effects of erotic guided imagery on female sexual arousal in committed and casual contexts. Sixty‐five women listened to tapes of erotic guided imagery. Participants imagined either themselves or another woman engaging in a committed or casual sexual relationship. Dependent variables consisted of three measures of subjective sexual arousal and the Differential Emotions Scale. A self‐report measure revealed that subjects clearly differentiated the two contexts. Examination of mean scores on the dependent variables indicated that all subjects were sexually aroused by the guided imagery, experienced moderate interest and enjoyment, and experienced minimal negative emotional responses. Multivariate analysis of variance revealed no significant differences for the main effects of context, person, or the interaction between person and context. The findings reaffirm previous laboratory research indicating that women do not require a committed context as a prerequisite for sexual arousal and positive emotional response to imagined erotic stimuli     

Circular and linear modeling of female sexual desire and arousal

There is debate in the scientific literature regarding which model most accurately represents the female sexual response. Traditionally, sex research has been conducted within the framework of the linear sexual response model proposed by Masters and Johnson, modified by Kaplan, then Robinson. Criticism of linear models prompted the development of a composite model of the female sexual response by Basson et al., which included linear and circular pathways. This review aims to systematically assess published studies to determine the extent to which circular and linear models or pathways reflect the female sexual response. Medline, EMBASE, and PsychINFO databases were searched for original data papers and review articles. Inclusion criteria were that articles were published since 1990, in English, and compared linear and circular sexual response models or addressed aspects of these models. Reviews were required to be systematic and include a meta-analysis. Of the 898 studies identified through the initial literature search, 13 original studies and one review met the inclusion criteria. Two studies directly compared models providing limited evidence that most women identify with linear sexual response pathways. However, there is increasing evidence that circular pathways may accurately reflect some aspects of the female sexual response. Further comparative studies are encouraged.     

The effects of target attractiveness on men's sexual arousal in response to erotic auditory stimuli

Previous research on sexual arousal resulting from auditory stimuli indicates that visual imagery acts as a mediator between stimulus input and resulting arousal. This leads to the question of whether imagery, and subsequent arousal, can be manipulated by providing differing information to hold in semantic memory. This research hypothesizes that attractive images held within semantic memory and pattern-matched with an erotic auditory stimulus facilitate higher self-reported arousal, and at a more rapid rate, than unattractive images. Participants in an "Unattractive" condition experienced slower rates and lower mean levels of arousal in response to an auditory stimulus, compared to participants in an "Attractive" or "No Picture" condition. No differences existed between groups in maximum arousal scores or the tendency to visualize the target during the listening task. Implications for the role of imagery in sexual response, possible measurement issues, and suggestions for future research are addressed in the discussion.     

Effects of sexual arousal on men's and women's behavior in sexual disagreement situations

A role‐play procedure was used to investigate the effects of acceptance of rape supportive beliefs (RMA), sexual intimacy, and sexual arousal on behavior in sexual disagreement situations. In Experiment 1, 67 college women role‐played their responses to their date's initial and continued unwanted sexual advances after viewing either an erotic or a neutral videotape. The women were more definite in their nonverbal responses to the “continued” than to the “initial” sexual advances. Low RMA women were less definite, and high RMA women were more definite, in their nonverbal refusals of unwanted intercourse than of unwanted breast fondling. Low RMA women were more definite in their verbal refusals after viewing the neutral than the erotic videotape. In Experiment 2, 78 college men role‐played their responses to their date's first and second refusal of their sexual advances. Men were less compliant in response to the first than to the second refusal. High RMA men who viewed the neutral film were less compliant than were low RMA men. However, high RMA men who viewed the erotic film were more compliant than high RMA men who viewed the neutral film. The men who viewed the neutral film were less compliant with refusals of breast fondling than with refusals of intercourse. Additionally, men who viewed the erotic film were more compliant with refusals of genital fondling than with refusals of intercourse. Finally, sexual experience and sex‐role ideology predicted when the man would try the same advances again.     

The Relationship between Female Sexual Arousal and Response Bias in Women with and without Provoked Vestibulodynia

Smaller correlations have typically been found between genital and subjective sexual arousal in female versus male samples. This study evaluated the association between response bias and the relationship between genital and subjective arousal (i.e., concordance) in women with (n = 20) and without (n = 21) provoked vestibulodynia. Participants (M = 21.27 years, SD = 2.27) underwent blood flow imaging via a laser Doppler imager to assess genital responsiveness to a visual erotic stimulus; subjective arousal was assessed during and following the film. The relationships between three types of subjective arousal ratings (perceived sexual arousal, perceived genital responsiveness, and reported desire to engage in sexual activity) and two forms of socially desirable responding (impression management and self-deceptive enhancement) were examined. Concordance estimates were statistically non-significant in both groups, with the exception of the desire to engage in sexual activity, which was moderately correlated with genital arousal in the control group. Impression management was not a statistically significant moderator of the relationship between genital and subjective arousal, but was moderately negatively related to the three forms of subjective arousal ratings in the provoked vestibulodynia group. The results highlight the importance of assessing response bias in laboratory studies comparing women with and without sexual dysfunction.     

Resiliency factors in the relation between childhood sexual abuse and adulthood sexual assault in college-age women

Research has suggested that childhood sexual abuse (CSA) may be a risk factor for adulthood sexual assault. This study examined associations between CSA experiences, cognitive resiliency variables, and revictimization. Participants were 73 college-age females who completed self-report questionnaires assessing CSA, adult assault, self-efficacy, locus of control (LOC), and coping styles. Sexual assault was categorized as forced or coerced assault based on the tactics used by the perpetrator. Results indicated that CSA alone was the strongest independent predictor of forced adult assault; however, LOC and positive coping were associated with resiliency to coercive sexual assault. The current findings have clinical implications in that LOC and coping styles are characteristics that can be enhanced through therapy.     

The lives and voices of highly sexual women

American women who experience very strong and frequent sexual desire have often been either ignored or stigmatized. This exploratory study of 44 highly sexual women ages 20 to 82, which used a convenience sample and a semi-structured in-depth interview method, allowed participants to describe their lives and how their sexuality has affected them. Highly sexual women reported that their lives have been strongly affected by their sexuality. First, the participants internally sensed demand for sexual excitement and satisfaction is too intense to be ignored. For some it was a major organizing principle of their time and energy. Second, their lives are lived in a society that often defines highly sexual women in pejorative ways. Women reported experiencing struggles and challenges in almost every area of their lives because of their sexuality, including feelings about themselves and their relationships with partners, female friends, and acquaintances.     

The relationship between sex guilt and sexual desire in a community sample of Chinese and Euro-Canadian women

Many studies have documented significant differences in sexual desire between individuals of European and Chinese descent, but few have examined the mechanisms that underlie these differences. A recent study of university students found that sex guilt is one mechanism by which culture influences sexual desire among Chinese and Euro-Canadian women. The goal of this study was to examine whether sex guilt also mediates the relationship between ethnicity and sexual desire in a sample that is more representative of women in the general population. Euro-Canadian (n = 78; mean age = 42.1 years) and Chinese (n = 87; mean age = 42.8 years) women were recruited from the community. Euro-Canadian women reported greater sexual desire and less sex guilt. In the entire sample, sex guilt mediated the relationship between ethnicity and sexual desire such that the Chinese women reported greater sex guilt, which, in turn, was associated with lower sexual desire. Among the Chinese women, sex guilt mediated the relationship between mainstream acculturation (degree of Westernization) and sexual desire such that more Westernized Chinese women reported less sex guilt, which, in turn, was associated with greater sexual desire. These results support recent findings and further suggest that sex guilt may be one mechanism by which ethnicity affects sexual desire.     

The lives and voices of highly sexual women

Two questionnaire studies on female genital slang (FGTs) are presented. Study One explored semantic categories in 317 different FGTs (and 351 different male genital terms [MGTs]) collected from 156 females and 125 males. Data were coded into 17 categories, and tested for sex differences. More FGTs were coded standard slang, euphemism, space, receptacle, abjection, hair, animal, or money. More MGTs were coded personification, gender identity, edibility, danger, or nonsense. Study Two used 49 FGTs to investigate the extent to which slang provides a consistent specific vocabulary for female genitals. The 251 respondents commented on 5 terms each. Respondents absolutely agreed on meaning for only 4% of terms. The implications of both findings for women's genital experiences and sexuality are discussed.     

Association between child sexual abuse and sexual revictimization in adulthood among women sex partners of injection drug users

Community-recruited women (n = 1490) were interviewed about their early and adult sexual victimization histories to determine whether there was an association between child sexual abuse and adult revictimization by sex partners and strangers/nonsex partners. Adolescent sexual abuse, lifetime sex-trading, drug treatment, and mental health treatment were examined as mediating variables. One-fourth of the women had been revictimized (i.e., experienced child sexual abuse and at least one instance of adult sexual victimization). Child sexual abuse was associated with both rape and other sexual victimization by a sex partner in adulthood, as well as adult rape by a stranger/nonsex partner. Drug and mental health treatments reduced abused women's chances of being raped by a sex partner; drug treatment also decreased the likelihood of other sexual victimization by a sex partner. Sex-trading increased abused women's likelihood of rape by a stranger or nonsex partner. Intervention--including drug treatment--can help women with child sexual abuse histories overcome some of the abuse-related sequelae that make them vulnerable to adult revictimization.     

Determinants of sexual arousal and accuracy of its self-estimation in sexually functional males

Men with and without sexual dysfunction present with varying patterns of agreement between subjective estimates of sexual arousal and more objective psychophysiological measures of the same construct. This relative accuracy seems to be associated with sexual function, with men who have sexual dysfunction presenting less accurate estimations (mostly reporting below measured arousal levels). The purpose of this study is to clarify the processes underlying sexual arousal and the accuracy of its self-estimation. We looked at potential predictors of sexual arousal (subjective and physiological) and accuracy in estimating objective sexual arousal in a sample of 60 sexually functional males. Predictors included pre-existing sexual attitudes (erotophobia), both trait and state positive and negative affect, self-focused attention, and interoceptive awareness. Results indicate that this sexually functional sample generally reported below their own erection level. Interestingly, trait negative affect was associated with somewhat lower levels of subjective arousal and higher levels of physiological arousal. On the other hand, state positive affect facilitated both subjective and objective arousal and increased somewhat the accuracy of estimates of erectile responding. Pre-existing sexual attitudes as well as variations in self-focused attention and interoceptive awareness evidenced little effect on sexual arousal or the accuracy of its estimation.     

Hymenal characteristics in girls with and without a history of sexual abuse

This article reviews the recent literature on physical findings related to the hymen in pubertal and prepubertal girls with and without a history of sexual abuse. Characteristics of normal hymenal anatomy, acute traumatic findings, and characteristics of healed trauma are discussed, particularly with regard to changes in the interpretation of these findings that have occurred over time.     

The relationship between indicators of sexual compulsivity and high risk sexual practices among men and women receiving services from a sexually transmitted infection clinic

Sexual compulsivity, defined by sexual preoccupation and lack of sexual impulse control, is related to high-risk sexual behaviors. However, little is known about the prevalence and predictors of sexual compulsivity in people at high risk for contracting sexually transmitted infections (STIs). In the current study, patients receiving diagnostic and treatment services (85% African American) at an urban STI clinic completed measures of demographic characteristics, sexual compulsivity, substance use, and sexual behaviors. Measures were administered to 492 men and 193 women using confidential procedures and audio computer-assisted interviewing technology. Results showed that men and women receiving STI clinic services frequently endorsed multiple indicators of sexual compulsivity. In this mostly African American sample, individuals with scores above the 80th percentile on the sexual compulsivity scale (translating to over one standard deviation above the mean) had more sex partners, engaged in higher rates of sexual risk behaviors with casual or one-time sex partners, and were nearly four times as likely to have been recently diagnosed with multiple STIs than were individuals who scored below the 80th percentile. Although sexual compulsivity scores were associated with alcohol and other drug use, associations between sexual compulsivity and sexual risks were not accounted for by substance abuse. Findings suggest an urgent need for interventions to help men and women with sexual preoccupations and poor sexual impulse control to reduce their risks for sexually transmitted infections.     

The relationship between indicators of sexual compulsivity and high risk sexual practices among men and women receiving services from a sexually transmitted infection clinic

Sexual compulsivity, defined by sexual preoccupation and lack of sexual impulse control, is related to high‐risk sexual behaviors. However, little is known about the prevalence and predictors of sexual compulsivity in people at high risk for contracting sexually transmitted infections (STIs). In the current study, patients receiving diagnostic and treatment services (85% African American) at an urban STI clinic completed measures of demographic characteristics, sexual compulsivity, substance use, and sexual behaviors. Measures were administered to 492 men and 193 women using confidential procedures and audio computer‐assisted interviewing technology. Results showed that men and women receiving STI clinic services frequently endorsed multiple indicators of sexual compulsivity. In this mostly African American sample, individuals with scores above the 80th percentile on the sexual compulsivity scale (translating to over one standard deviation above the mean) had more sex partners, engaged in higher rates of sexual risk behaviors with casual or one‐time sex partners, and were nearly four times as likely to have been recently diagnosed with multiple STIs than were individuals who scored below the 80th percentile. Although sexual compulsivity scores were associated with alcohol and other drug use, associations between sexual compulsivity and sexual risks were not accounted for by substance abuse. Findings suggest an urgent need for interventions to help men and women with sexual preoccupations and poor sexual impulse control to reduce their risks for sexually transmitted infections.     

Understanding and controlling response bias in needs assessment studies

This study demonstrated that estimates of agency awareness in the typical needs assessment study are probably inflated by a response bias labeled "agency awareness overclaming." Overclaimers (respondents who reported being aware of fictitious agencies) reported being aware of more real agencies than other respondents. Estimates of agency awareness may also be biased, because certain segments of the population were more likely to exhibit agency awareness overclaiming. Age was positively correlated with overclaiming, and African Americans were more likely to exhibit agency awareness overclaiming than Caucasians. General overclaiming was correlated with agency awareness overclaiming, but social desirability and acquiescence were not.