How to arouse a woman sexually pdf

of erotic arousal. – Erection is the obvious arousal response in the male. – Lubrication of the vagina is an important response of females. – Both result from. In men and women sexual arousal culminates in orgasm, with Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has. Your Sexual Health: Terms to Know. Arousal: For women, arousal starts in the mind, not the body. Even if a woman's heart rate and body temperature increases​.

Sexual arousal is frequently interpreted to result from of the awareness of feeling sexual desire. It is not this simple, however, particularly among women. Your Sexual Health: Terms to Know. Arousal: For women, arousal starts in the mind, not the body. Even if a woman's heart rate and body temperature increases​. topics for hypoactive sexual desire disorder (HSDD), female sexual arousal disorder Leiblum S, and Luria M. Women's sexual desire and arousal disorders​.

sex, male and female homosexual sex, a man masturbating, a woman masturbating understand the workings of women's arousal and desire. in women remain unanswered, the two components to sexual arousal in women, genital arousal and subjec tive arousal, are generally well. PDF | In men and women sexual arousal culminates in orgasm, with female orgasm solely from sexual intercourse often regarded as a unique feature of | Find.

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Help us improve our products. Sign up to take part. A Nature Research Journal. Sexual arousal in women comprises two components: genital arousal and subjective arousal. Genital arousal is characterized by genital vasocongestion and other physiological changes how occur in response to sexual stimuli, whereas subjective arousal refers to mental how during sexual activity.

For some women, genital arousal enhances subjective arousal; for others, the two types of arousal are desynchronous. However, the relationship between genital woman subjective arousal might not be relevant to the diagnosis and treatment of sexual arousal dysfunction. Studies how shown that not all women who report arouse arousal problems have decreased genital arousal, and only some women with decreased genital arousal have low subjective arousal.

To sexually efficacious treatments for female sexual arousal dysfunction, researchers need to differentiate the women for whom genital sensations have a critical role in their subjective arousal from those who are not mentally aroused by genital cues. The mechanisms by which women become aroused and the inputs into arousal have considerable implications for treatment outcomes.

McCabe, M. Definitions of sexual dysfunctions in women and men: a consensus statement from the Pdf International Consultation on Sexual Medicine Basson, R.

Marital Arouse. Althof, S. Chivers, M. Agreement of self-reported and genital measures of sexual pdf in men and women: a meta-analysis. How, E. Determinants of female sexual arousal: psychophysiological theory and data.

Masters, W. Levin, How. The ins and outs of vaginal lubrication. Santoro, N. Role of estrogens and estrogen-like compounds in female woman function and dysfunction. Mac Bride, M. Vulvovaginal atrophy. Mayo Clin. Nappi, R. Wagner, G. Pdf tension of the vaginal surface during sexual stimulation in arouse human. Sexually vaginal fluid-ionic composition and modification by sexual arousal [proceedings].

Berman, J. Effect of sildenafil on woman and physiologic parameters of the female sexually response in women with sexual arousal disorder. Human vaginal pH how sexual arousal. Bancroft, J.

Sexual effects of androgens in women: some theoretical considerations. Sourla, A. Effect of dehydroepiandrosterone on vaginal and uterine histomorphology in the rat. Steroid Pdf. Labrie, F. Physiological changes in dehydroepiandrosterone are not reflected by serum levels of active androgens and estrogens but of their metabolites: Intracrinology. DHEA and peripheral androgen and estrogen formaton: intracrinology. NY Acad. Physiology of female sexual function and dysfunction. Azadzoi, K. Neurologic factors in female sexual function and dysfunction.

Vaginal blood sexually during sexual stimulation. The physiology of sexual function in women. Rosen, R. The physiology of sexual arousal pdf the human female: a recreational and procreational synthesis.

The enhancement of vaginal vasocongestion by sildenafil in healthy premenopausal women. Health Gend. Efficacy and safety of woman citrate in women with sexual dysfunction associated with female sexual arousal disorder. Womens Health Gend. Based Med. Sexual psychophysiology and effects of sildenafil citrate in oestrogenised women with acquired genital arousal disorder and impaired orgasm: a randomised controlled sexually.

BJOG— Giuliano, F. Neurophysiology and pharmacology of female genital sexual response. Sexually, D. Pudendal SEP and bulbocavernous reflex in women. Holstege, G. How the emotional how system controls the pelvic organs. Jovanovic, U. The recording of physiological evidence of genital arousal in human woman and arouse.

Fox, C. Blood pressure and respiratory patterns woman human coitus. Arouse, C. Sipski, M. Sexual arouse in women with spinal cord injuries: differential effects of anxiety-eliciting stimulation. Krantz, K. Innervation of the human vulva and vagina: a microscopic study.

Komisaruk, B. Meston, C. The effects of sympathetic activation on physiological and subjective sexual arousal in women. Ephedrine-activated physiological sexual arousal in women. Psychiatry 55— Inhibition of subjective and physiological sexual arousal in women by clonidine. Lorenz, T. Psychophysiology 49— Xhyheri, B. Heart rate variability today.

Woman, A. Heart rate variability: a risk factor for female sexual dysfunction. Biofeedback 40— A single pdf of autogenic training increases acute subjective and physiological sexual arousal in pdf functional women. One session of autogenic training increases acute subjective sexual arousal in sexually women reporting sexual arousal problems. Yoon, H. Effects of estrogen on nitric oxide synthase and histological composition in the rabbit clitoris and vagina.

Batra, S. Characterization of nitric oxide synthase activity in rabbit uterus and vagina: downregulation by estrogen. Life Sci. Al-Hijji, J. Effect of ovarian steroids on nitric oxide synthase in the rat uterus, cervix, and vagina. Palle, C.

Psychophysiology 22 , — Dove, N. Salemink, E. The effects of increasing neutral distraction on sexual responding of women with and without sexual problems. Cranston-Cuebas, M. Cognitive and affective contributions to sexual functioning. Barlow, D. Causes of sexual dysfunction: the role of anxiety and cognitive interference. Cacioppo, J. Jiann, B. Risk factors for individual domains of female sexual function.

Pascoal, P. Emotional intimacy is the best predictor of sexual satisfaction of men and women with sexual arousal problems. MacNeil, S.

The relationships between sexual problems, communication, and sexual satisfaction. Role of sexual self-disclosure in the sexual satisfaction of long-term heterosexual couples.

Goldstein, I. Heiman, J. Sexual function and satisfaction in heterosexual couples when men are administered sildenafil citrate Viagra for erectile dysfunction: a multicentre, randomised, double-blind, placebo-controlled trial. Chevret-Measson, M. Improvement in quality of sexual life in female partners of men with erectile dysfunction treated with sildenafil citrate: findings of the Index of Sexual Life ISL in a couple study.

Human sex-response cycles. Nobre, P. Cognitions, emotions, and sexual response: analysis of the relationship among automatic thoughts, emotional responses, and sexual arousal. Woo, J. The relationship between sex guilt and sexual desire in a community sample of Chinese and Euro-Canadian women.

Middleton, L. Effects of experimentally adopted sexual schemas on vaginal response and subjective sexual arousal: a comparison of women with sexual arousal disorder and sexually healthy women. McCarthy, B. Balon, R. Rellini, A.

Review of the empirical evidence for a theoretical model to understand the sexual problems of women with a history of CSA. Kilimnik, C. Andersen, B. Child Abuse Negl. Kennedy, S. Sexual dysfunction before antidepressant therapy in major depression. Baldwin, D. Sexual side-effects of antidepressant and antipsychotic drugs. Clayton, A. Sexual dysfunction associated with major depressive disorder and antidepressant treatment. Expert Opin. Drug Saf. Keks, N. Management of antidepressant-induced sexual dysfunction.

Psychiatry 22 , — Keltner, N. Mechanisms and treatments of SSRI-induced sexual dysfunction. Care 38 , — Beck, A. Brotto, L. Kalmbach, D. Specificity of anhedonic depression and anxious arosual with sexual problems among sexually healthy young adults. Attention, arousal and expectancies in anxiety and sexual disorders.

Preliminary evidence that acute and chronic daily psychological stress affect sexual arosual in sexually functional women. Wiegel, M. Wiederman, M. Satinsky, S. An assessment of body appreciation and its relationship to sexual function in women. Body Image 9 , — Birnbaum, G. The meaning of heterosexual intercourse among women with female orgasmic disorder. Graham, C. Shapiro, A. Vaginal blood flow changes during sleep and sexual arousal.

Psychophysiology 4 , Ohlmeyer, P. Periodic processes in sleep. Pflugers Arch. Gesamte Physiol. Menschen Teirre , — The psychophysiological assessment of female sexual function. Sintchak, G. Vaginal plethysmograph system. Psychophysiology 12 , — Hoon, P. Physiological assessment of sexual arousal in women. Psychophysiology 13 , — Geer, J. Sexual arousal in women: the development of a measurement device for vaginal blood volume. A psychophysiological exploration of sexual arousal patterns in females and males.

Psychophysiology 14 , — The effects of immediate, delayed, and residual sympathetic activation on sexual arousal in women. Differential effects of sympathetic activation on sexual arousal in sexually dysfunctional and functional women. Bacon, M. Thermography — explanation and description.

Kukkonen, T. Thermography as a physiological meausre of sexual arousal in both men and women. Abramson, P. Negative attitudes toward masturbation and pelvic vasocongestion: a thermographic analysis. Thermographic measurement of sexual arousal: a discriminant validity analysis. Seeley, T. Thermographic measurement of sexual arousal: a methodological note.

Huberman, J. Examining the time course of genital and subjective sexual responses in women and men with concurrent plethysmography and thermography. Woodard, T. Physiologic measures of sexual function in women: a review. Vasculogenic female sexual dysfunction: vaginal engorgement and clitoral insufficiency syndromes. Handy, A. Paulhus, D. Wincze, J. Sexual arousal in women: a comparison of cognitive and physiological responses by continuous measurement.

Psychophysiology 42 , — Martial Ther. Sills, T. Quirk, F. Development of a sexual function questionnaire for clinical trials of female sexual dysfunction. American Psychiatric Association. Oxford University Press. Subjective definition of subjective in English by Oxford Dictionaries. Parish, S. Any of these sources of stimulation could possibly produce the higher incidence of orgasm in intercourse found in women with shorter CUMD measurements. One possibility, originally suggested by Bonaparte Narjani, , is that a shorter distance between the clitoris and the vagina facilitates direct clitoral-penile contact during sexual intercourse.

This explanation is plausible given the configuration between penile shape and clitoral location as revealed in MRI or ultrasound images of men and women during coitus Schultz, et al. However, without evidence of increased direct penile-clitoral contact during intercourse in women with shorter CUMD measurements it is not possible to conclude whether this is the mechanism through which CUMD affects orgasm in intercourse.

Although the notion of pelvic or penile stimulation of the clitoral glans or shaft is intuitively appealing and is consistent with the data presented here, short CUMD, instead of being the actual mechanism increasing orgasm in intercourse, could be an external marker of other processes producing increased vaginal sensitivity that increases the likelihood of orgasm solely from sexual intercourse.

The clitoris consists of more than the shaft and clitoral glans. The majority of clitoral anatomy is internal, consisting primarily of two clitoral bodies and two clitoral bulbs that partially surround the vagina and form a vaulted structure above the anterior vaginal wall O'Connell, et al. Similarly, the internal clitoral structures are capable of participating in women's sexual arousal and orgasm as the anterior vaginal wall transmits penile force to these clitoral structures Ingelman-Sundberg, In this regard, smaller CUMD may both represent a shorter distance between the clitoral glans and the vagina, but may also reflect that the bulbs and bodies of the clitoris are packed into a smaller volume pressing closer to the vagina.

This compact spatial arrangement could result, for example, in more direct contact between the anterior vaginal wall and the erotically sensitive bulbs or bodies of the clitoris. This more direct contact between the vagina and portions of the clitoris distal to the shaft and glans produces increased vaginal sensitivity that is unlikely or impossible if these clitoral structures are distributed through out a larger volume.

Thus shorter CUMD would not directly affect external clitoral stimulation, but would be a proxy for increased vaginal sensitivity and an increased likelihood that vaginal stimulation can produce orgasm even if there is no increased penile stimulation of the clitoral glans or shaft during sexual intercourse.

However, this view would not support Master's and Johnson's contention that all women's orgasms during intercourse result from penile traction on the woman's labia minora pulling them across the clitoral glans to produce clitoral stimulation during intercourse.

Instead it would support a vaginal-clitoral stimulation route to orgasm during intercourse. Freud's theory of women's sexual development focused on the type of genital stimulation producing female orgasm. Freud contrasted orgasms from vaginal responsiveness with clitorally-induced orgasms, by which he meant orgasms resulting from stimulation of the external aspects of the clitoris.

Ironically, Freud's distinction between vaginally- and clitorally-triggered orgasms may actually reflect a natural typology of women's orgasm induction. This typology has nothing to do with psychological maturity as Freud argued, but instead contrasts women who reach orgasm through vaginal stimulation of deep clitoral structures with women who reach orgasm through stimulation of external clitoral structures of the shaft or glans.

However, Freud, by valuing vaginal induction of orgasm over external clitoral induction has likely negatively affected many women and impeded investigation of the sources of this natural variation in women's sexual arousal and orgasm. The results of the studies analyzed here suggest that these two different forms of orgasm induction might reflect which anatomical aspects of the clitoris have primary erotic sensitivity.

Both types of orgasm induction occur naturally in women, with orgasms induced by direct stimulation of the clitoral glans or shaft being more common then those induced by vaginal stimulation.

Possibly, women with a short CUMD are more likely to have orgasms induced through vaginal stimulation of the deep clitoral structures, whereas women with long CUMD are likely to be primarily responsive to stimulation of the external aspects of the clitoris. What seems apparent is that whether a woman experiences one type of orgasm or the other likely reflects her anatomical nature, not her psychoanalytic maturity or her psychological health.

The source of anatomical variation in clitoral placement was speculated on by Bonaparte and the notion that the differences in CUMD result from embryological processes particularly intrigued her Narjani, She noted that the range of variation in the distance of the clitoris from the vagina in women exceeded that seen in other species, such as the cow and the dog, and even in nonhuman primates, where the clitoris was located quite near the vagina.

Only in humans, she argued, was there great variation in the separation between the two genital structures Narjani, Interestingly, Bonaparte suggested that this variation resulted from embryological events, and she was aware that the genital tubercle migrates rostrally in men during prenatal development.

She noted that the genitals of girls are similar to those of boyd around the 9 th or 10 th week of gestation before the genital tubercle has migrated very far rostrally leaving it in a more caudal location Narjani, It is unclear how Bonaparte developed this very modern theory of prenatal genital development, but today we would find her conclusions consistent with the notion that women with longer CUMD measures have been exposed to higher levels of prenatal androgens than have women with smaller distances.

Bonaparte suggested that variation in CUMD likely reflects the timing of the cessation of rostral migration of the woman's genital tubercle during prenatal life. This migration is necessary in males to produce the much more rostral location of the penis necessary for successful sexual intercourse. Genital tubercle migration occurs in mammalian males and studies in animals show that prenatal androgens control this migration.

Females, in a variety of species, treated with male-like levels of androgen develop male-like external genitalia with a rostrally-located penis summarized in Wallen, and Baum, In rhesus monkeys low levels of testosterone administered to pregnant females when the genitals are differentiating gestational days resulted in their daughters having clearly female genitalia, but with an increased clitoris to vagina distance compared to females from untreated mothers Herman, Jones, Mann, and Wallen, It seems likely that small endogenous variations in prenatal androgens produce variation in CUMD and that longer CUMD reflects greater exposure to prenatal androgen and thus greater rostral migration of the genital tubercle.

While there is no direct evidence for the relationship between CUMD and natural variation in prenatal androgens in women there is such evidence in rats. Anogenital distance AGD , the distance from the genital tubercle to the anus, a measure analogous to CUMD, is longer in female rats located in utero between or downstream from sibling males and thus exposed to the male's endogenously secreted testosterone Clemens, Gladue, and Coniglio, ; Meisel and Ward, Such females have a longer AGD i.

In addition, prenatal treatment of pregnant female rats with flutamide, a nonsteroidal anti-androgen, eliminated the effects on AGD of a female gestating near a male sibling Clemens, Gladue, and Coniglio, , supporting the notion that small differences in endogenous prenatal androgen exposure affect AGD.

Interestingly, natural variation in female rat AGD predicts better adult reproductive function and earlier e. Thus data from rats support the notion that AGD serves as a proxy for the degree of prenatal exposure to androgens. If CUMD is similarly affected by endogenous prenatal androgen variation, it may be an external indicator of a woman's exposure to prenatal androgens.

If true, this suggests that women exposed to lower levels of prenatal androgens are more likely to achieve orgasm solely through intercourse than are women exposed to higher levels of prenatal androgens. Variation in exposure to prenatal androgens may explain why clitoral size is much more variable in women than is penis size in men Wallen, and Lloyd, , suggesting that women are exposed to a wider range of androgen levels than are men.

Particularly intriguing is the notion that orgasm solely from sexual intercourse seems most likely to occur in women who may have been exposed to the lowest levels of prenatal androgens. Exposure to higher levels of androgens does not preclude orgasm, but may result in easier orgasm from direct stimulation of the clitoral shaft or glans, than from stimulation of the vagina or internal clitoral structures in close proximity to the vaginal walls. Thus the clitoral and vaginal eroticism that Freud invested with substantial psychoanalytic importance, may exist, but simply reflect the extent to which a woman was prenatally exposed to androgens.

Possibly variation in prenatal androgens produces other genital changes, in addition to rostral migration of the genital tubercle, that influence the type of stimulation a women requires for reaching orgasm. In males the genital tubercle differentiates into the penis under the influence of prenatal androgens.

In this process the primary erogenous areas of the penis become the underside of the glans penis, where the frenulum connects the foreskin to the glans penis and, to a much lesser extent, the penile shaft. Thus, although the penis enlarges substantially under the influence of androgens the parts which contribute to sexual sensations remain, or become, quite small.

In females the genital tubercle, without the strong influence of androgens, migrates much less than in males and differentiates into the clitoris possibly with a more diffuse distribution of erotic sensitivity such that the clitoral bulbs and bodies as well as the shaft and glans are erotically responsive. Women who are exposed to higher levels of prenatal androgens may not only have a more male-like rostral clitoral location, but also their clitoral eroticism may become more similar to that of the penis.

Thus, increased prenatal androgen exposure may focus erotic sensitivity to the clitoral shaft and glans reducing or eliminating erotic sensitivity in the bulbs and bodies of the clitoris.

In this view, all women possess erotic sensitivity in the clitoral shaft and glans, but only women exposed to lower levels of prenatal androgens retain significant erotic sensitivity in the internal clitoral structures.

CUMD size, which likely reflects the extent of prenatal androgen exposure, might also be a proxy for the erotic sensitivity of internal clitoral structures, and thus the likelihood that women will experience orgasm solely from intercourse.

These findings support CUMD as a potential proxy for prenatal androgen exposure in women and suggest a number of studies. The first is that CUMD should be positively correlated with clitoral size, since in males the rostral migration of the genital tubercle is combined with an increase in genital tubercle size.

A second study would combine CUMD measures with imaging studies allowing reconstruction of internal pelvic volumes to identify the relationship between internal clitoral anatomy and the vagonal walls Gravina et al, Such a study could support the notion that short CUMD measurements are associated with the packing of internal clitoral anatomy into a smaller space leading to more intimate contact between internal clitoral structures and the vaginal walls.

Hypotheses offered here could be directly tested by investigating women with atypical prenatal androgen exposure. For example, women with complete androgen insensitivity CAIS resulting from not having functional androgen receptors, would be expected to have very short CUMD, with their internal clitoral structures packed into a much smaller volume than would women with typical androgen exposure.

Women with CAIS would also be expected to more reliably experience orgasm in intercourse than women exposed to androgens. We do not know how this might affect the relationship between the vaginal walls and the internal aspects of the clitoris. Women with congenital adrenal hyperplasia CAH could contribute significantly to our understanding of genital anatomical development and orgasm.

Studies of same and mixed sex twins could directly test the hypothesis that small differences in prenatal androgen exposure affect CUMD, with women with female co-twins having smaller CUMD measurements than would women with male co-twins. Lastly, the findings of Bonaparte and Landis need to be replicated using an assessment of orgasm that clearly distinguishes orgasms during intercourse without concurrent clitoral stimulation from those with concurrent clitoral stimulation. A standardized method of measuring CUMD needs to be developed, possibly one which measures actual clitoral-vaginal distances, though the size and flexibility of the vaginal opening make this challenging.

Such studies might explain the great variation among women in the sexually arousing stimulation necessary for orgasm and why some women more easily experience orgasm in intercourse than do others. Ultimately such studies could establish the factors that cause the natural variation in women's orgasms and possibly why men and women differ so markedly in the likelihood that they will experience orgasm solely from sexual intercourse.

Rachel Maines is thanked for starting this project by tracking down Marie Bonaparte's article, published under the pseudonym A.

Liana Zhou and Shawn C. Wilson of the Kinsey Institute for Research in Sex, Gender and Reproduction library are thanked for discovering the original Landis data sheets. Cecile J. Click is thanked for transcribing the Landis raw data from the original records. Daniella Sanchez is thanked for blind coding of the Landis data. Nancy Bliwise is thanked for introducing Receiver Operating Characteristic curves as an analytical tool. Harold Gouzoules is thanked for advice on the use of discriminant analysis.

It is unclear why Bonaparte used the pseudonym, which she revealed, without explanation, in her paper Bonaparte, Her assumption that the urinary meatus was a constant distance from the vagina was likely incorrect as the urethra in women can be completely separate from the vagina or within the vaginal opening itself Dickinson, However, CUMD has been used in all subsequent studies and there appears to be no study in which actual clitoral-vaginal distance has been measured.

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Elisabeth A. National Center for Biotechnology Information , U. Horm Behav. Author manuscript; available in PMC Jan Kim Wallen , Ph. Lloyd , Ph. Author information Copyright and License information Disclaimer. Corresponding Author: Kim Wallen, ude. Copyright notice. The publisher's final edited version of this article is available at Horm Behav.

See other articles in PMC that cite the published article. Abstract In men and women sexual arousal culminates in orgasm, with female orgasm solely from sexual intercourse often regarded as a unique feature of human sexuality.

Keywords: orgasm in intercourse, genital anatomy, sex differences, clitoral position, prenatal androgens. Open in a separate window. Figure 1. Table 2 Classification of subjects from the Bonaparte and Landis samples when using discriminant functions generated from either the Bonaparte or the Landis samples. Classification using discriminant function A.

Bonaparte sample genital measurement A detailed description of how the genital measurements were obtained was included in the article. Figure 2. Landis sample genital measurement All subjects in the Landis sample received a gynecological examination which included measuring the clitoris to urinary meatus distance.

Landis sample measurement of orgasm Orgasm occurrence during intercourse was assessed during a lengthy face to face interview, done by one of the study's authors with Bowles doing the majority of the interviews according to the published text. Figure 3. Relationship between orgasm and CUMD The relationship between the reported occurrence of orgasm during intercourse and CUMD was investigated by determining whether women in each sample who reported orgasm in intercourse had shorter CUMD measurements than did women who never reported orgasm in intercourse.

Figure 4. Receiver Operator Characteristic curves To determine whether CUMD reliably predicts orgasm in intercourse we calculated Receiver Operator Characteristic ROC curves, a technique developed for signal detection, but often used to assess the validity of medical diagnoses Hanley and McNeil, , ; Zweig and Campbell, Figure 5.

Table 1 Percentage of women experiencing orgasm in relation to whether their CUMD measurement is greater than or equal to 2. Discriminant analysis Lastly we asked whether CUMD could be used to accurately classify individuals into those who have orgasm in intercourse and those who do not.

Discussion Data from two independent samples, collected over 70 years ago and more than 15 years apart, support the notion that the distance between a woman's clitoris and her vagina influences the likelihood that she will regularly experience orgasm solely from intercourse. Acknowledgments Dr. Footnotes 1 Narjani is a pseudonym for the psychoanalyst Marie Bonaparte whose idea it was that the distance between the clitoris and vagina affects the likelihood of woman experiencing orgasm in intercourse.

References Alzate H. Vaginal eroticism: a replication study. Arch Sex Behav. Vaginal orgasm is associated with less use of immature psychological defense mechanisms. J Sex Med. Sonography of the clitoris. Biostatistics Discriminant analysis. Singapore Med J. Prenatal endogenous androgenic influences on masculine sexual behavior and genital morphology in male and female rats. A power primer.

Psychological Bulletin. Atlas of Human Sexual Anatomy. Williams and Wilkins; Baltimore, MD: Basic Books; New York: The clitoral complex: a dynamic sonographic study.

Behavioral and physiological evidence of sexual climax in the female stump-tailed macaque Macaca arctoides Science. Measurement of the thickness of the urethrovaginal space in women with or without vaginal orgasm. Selection and interpretation of diagnostic tests and procedures. Principles and applications.

Ann Intern Med. The meaning and use of the area under a receiver operating characteristic ROC curve. A method of comparing the areas under receiver operating characteristic curves derived from the same cases.

Timing of prenatal androgen exposure: anatomical and endocrine effects on juvenile male and female rhesus monkeys. The Hite Report. Macmillan; New York: The anterior vaginal wall as an organ for the transmission of active forces to the urethra and the clitoris. Sexual Behavior in the Human Male. The present contribution discusses issues in the assessment of female sexuality from the organizational framework of concepts rather than measures.

Here, we provide information on classic and contemporary approaches, and the discussion is framed within the conceptual domains of sexual behaviors, sexual responses i. However, research on the assessment of female sexual behavior, exclusive of behaviors that lead to increased HIV risk, remains limited but see sex survey of Laumann et al. The coverage is most complete for heterosexual behaviors.

This is not an intentional bias, and we acknowledge the dearth of data on sexuality topics for lesbians.

We regard a sexual response cycle conceptualization, specifically desire, excitement, orgasm, and resolution, as an important second component in a working model of female sexuality.

Although there are significant and important interrelationships among the phases, there are sufficient data to suggest that each has unique aspects, too.

The separate elaboration of the phases may also clarify the female sexual dysfunctions, as the majority of Diagnostic and Statistical Manual of Mental Disorders 4th ed. Here we discuss the contemporary organization of personality structure, the Big Five model, as well as sexually relevant personality factors, such as sexual self-schema. In the Kinsey interviews, conducted with thousands of women and men, the focus was similar, yet with a life-span orientation. They included the following: preadolescent heterosexual and homosexual play; masturbation; nocturnal sex emissions and dreams; heterosexual petting; premarital, marital, and extramarital coitus; intercourse with prostitutes for men only ; homosexual contacts; animal contacts; and, finally, the total sexual outlet, defined as the sum of the various activities which culminated in orgasm.

Other topics that are now recognized as important to sexual development and perhaps the subsequent occurrence of sexual dysfunctions , such as incest and other traumatic sexual experiences, received less coverage. In addition to the significant public attention that the Kinsey volumes received, it is clear that their behavior chronicle interview is one of the few examples of a method affecting the nature of sex research for decades.

It was mirrored, for example, in the late s to the early s with investigators including Podell and Perkins , Brady and Levitt , and Zuckerman publishing listings of heterosexual behaviors for men and women.

The scales consisted of 12 to 20 items and included experiences that ranged from kissing to intercourse or mutual oral stimulation. Undergraduates were typically the research participants—an unusually relevant group because one aspect of these studies was to provide an ordinal Guttman scaling of the items.

These data suggest, in part, a hierarchical or chronological ordering of sexual experiences. Years later, this method continues to appear in assessment and therapy arenas. For example, omnibus sexual functioning inventories, such as the Sexual Interaction Inventory by LoPiccolo and Steger , include the same hierarchical listing of sexual behaviors for each of its 11 scales.

Such orderings also provide an empirical basis for generic hierarchy construction in systematic desensitization therapy studies see Andersen, , for a review.

Rather than use the Derogatis yes—no format for scoring, we asked undergraduate women mean age, On the first assessment previous scoring , they indicated whether they had ever experienced the activity. As indicated in the far left column of Table 1 , a hierarchical ordering of the items can be determined. In large part, comparison of the ordering with the much earlier Bentler data is similar, with the addition of the items masturbation, anal intercourse, and anal stimulation on the low-frequency end of the listing.

Also of note is male-initiated or male-dominated versions of many of the items preceding the female counterpart items e. These trends are consistent with gender differences found in the frequency of oral sex, as reported in the most recent comprehensive sex survey e.

On the second assessment, women indicated their frequency of behaviors in the past 30 days on a scale ranging from 0 activity did not occur to 9 activity occurred two or more times per day for each item. As might be expected, data for the present scoring reflect the previous scoring hierarchical ordering. For the previous scoring, items were scored 0 never experienced in my lifetime and 1 experienced at least once in my lifetime. Values are percentages of women in the sample who endorsed each item as having been experienced at least once.

Despite the usefulness of such scales, questions have been raised about the reliability and validity of any method that uses self-reports of sexual behavior. Rather than discuss them here, we refer the reader to reviews of these issues e. The behavior listings noted earlier may provide a useful starting point. Women rated each item in a yes—no format, indicating whether the activity had occurred in the previous 3 months.

We have since replicated this factor solution with the sample of undergraduate women who provided the data in Table 1. Data from the previous scoring was submitted to a principal-axis factor analysis with an oblique Harris-Kaiser rotation. The solutions are identical with one exception: items from groupings b and c combine to form a single factor, with the oral-genital stimulation items forming a second, separate factor.

As any factor solution is dependent on the items represented, these are unique to the items included by Derogatis and the participants in the samples described. The notable additions by Derogatis to the earlier behavioral scales were items assessing masturbation and anal stimulation. In summary, these analyses suggest that behavioral listing measures may provide a reasonable sampling of the sexual behavior domain for adult heterosexual women.

However, there has been disagreement about the number and importance of each phase. Although popularized by Masters and Johnson , the concept of stages of sexual engagement has early origins.

As summarized in Table 2 , the number of stages has ranged from two to four. The phases of desire, plateau, and resolution are inconsistently represented, whereas a two-dimensional model of arousal—excitement process and an orgasm or orgasm—immediate postorgasm phase has been consistent.

Historically, researchers have focused on understanding excitement or sexual arousal , but more recently there has been similar emphases on defining the psychological and behavioral boundaries of sexual desire. We combed the literature to find assessment strategies for these four dimensions, yet there are few that follow this comprehensive conceptualization.

Even their own assessment strategy—a lengthy oral interview described in the book—has little continuity with the model. In articles and chapters by researchers, a functional analysis of the antecedents, problem behaviors, and consequences of the particular sexual difficulty is most common. Although the latter is very useful, one may not necessarily obtain information about all phases of the sexual response cycle.

Whereas our efforts have concentrated on such a measure e. What is sexual desire? Current theories range from purely dynamic models to ones that emphasize biologic factors. Kaplan , in her influential volume, Disorders of Sexual Desire, reiterated the psychoanalytic position of libido as an innate emotional force that would be expressed in either sexual or nonsexual outlets.

It would follow, then, that any inhibition of desire would be due to the unconscious repression or conscious suppression of urges for sexual contact. In either case, such defenses would arise from intrapsychic conflicts surrounding sexuality. There are interactional models of desire and ones that emphasize other, nondynamic, psychological processes see also a discussion by Beck, In contrast, Singer and Toates offer a central-nervous-system-mediated motivational model.

They propose that sexual motivation, like hunger or thirst, emerges from an interaction of external incentives i. Leiblum and Rosen note both intrapsychic and interpersonal aspects, but they define sexual desire functionally i.

Finally, Hatfield relies on her rich conceptualization of passionate love for the context of sexual desire; she sees sexual desire as a psychological longing for sexual union that is tied to sexual satisfaction and interpersonal relationship satisfaction i.

Biologic models of sexual desire are controversial and currently emphasize hormonal mechanisms. Data are most consistent for the necessary but not sufficient role of androgens, probably testosterone.

For this model, the majority of supporting data comes from men e. Bancroft proposes that the occurrence of spontaneous erections during sleep are the behavioral manifestations of the androgen-based neurophysiological substrate of sexual desire; in contrast, erections with fantasy or erotic visual cues are seen as evidence for androgen-independent responses.

Hormone—sexual behavior relationships for women are less clear, although estrogen, progesterone, and androgen testosterone have been studied.

Regarding estrogen effects, it is clear that some amount of estrogen is necessary for normal vaginal lubrication, and receipt of estrogen replacement therapy after menopause may reduce the problematic symptoms e. In contrast, progesterone may actually have an inhibitory effect Bancroft, Finally, testosterone may have direct effects on sexual functioning; both Bancroft and Wu and Schreiner-Engel, Schiavi, Smith, and White have found positive relationships between testosterone levels and frequency of masturbation and vaginal responses to erotic stimuli.

In studies of women for whom estrogen therapy was not effective for postmenopausal symptoms, testosterone administration improved sexual desire and related outcomes Burger et al. Perhaps the most direct data on this topic are by Alexander and Sherwin In studying 19 oral contraceptive users, they reported that plasma levels of free testosterone was correlated with self-report measures of sexual desire, sexual thoughts, and anticipation of sexual activity.

However, an interesting and more direct test of the hypothesis that testosterone is related to sexual cognitions was disconfirmed; using a selective attention dichotic listening task, Alexander and Sherwin found no relationship between levels of free testosterone and an attentional bias for sexual stimuli.

Blood samples were drawn every 3—4 days for one menstrual cycle and were analyzed for testosterone, estradiol, progesterone, prolactin, and luteinizing hormone.

No differences between the groups were found, and subgroup analyses e. At present, it is unclear whether physiologic measures, and hormonal assays in particular, are useful physiologic indicators of sexual desire. Considering the other channels for assessment, cognitions have been emphasized. Instead, a circular statement i. Not surprisingly, fantasy does play an important role in sex therapies e. Although these lines of data suggest some importance to the role of fantasy, there are not data at present suggesting that the absence of fantasy is pathognomic for low sexual desire.

Data comparing the frequency of internally generated thoughts fantasies and externally prompted thoughts sexual urges among young heterosexual men and women indicate that men report a greater frequency of urges than do women 4.

Related data from Laumann, Gagnon, Michael, and Michaels indicate a normal distribution in the frequency of autoerotic activities e.

This indicates that, on average, men have higher rates of autoerotic activities and that there is less variance among men; for women, this indicates that, on average, women have generally lower rates but there are more individual differences among women in the frequency of autoerotic activity.

There are self-report measures of sexual fantasy. Correlation analyses reveal that higher self-reported levels of sex drive are correlated with more frequent sexual fantasies, particularly intimate fantasies for women e. There is also a item fantasy scale on the DSFI; however, there are few psychometric data on this scale. Internal consistency of the measure is high. There are few convergent and discriminant data, but they are supportive.

Measures such as these may be useful to assess sexual cognitions. When such measures are not used, researchers often use proxy variables. One strategy has been to have participants rate their sexual desire and then correlate these data with other indicators, such as sexual arousal or behavior e. Provided below are symptom descriptions of individuals complaining of low desire. These may provide useful phenomenologic information for future assessment research. Specifically, we note the following.

Individuals with low desire report that they are generally uninterested in sexual activity. These behaviors are presumably not due to strong negative responses to interpersonal or genital contact, an important point to consider when ruling out alternatives, specifically a sexual aversion disorder see Discussion; for an early example of the absence of distinction, see McCarthy, Instead, individuals with low desire disorder are thought to be indifferent or neutral toward sexual activity.

Sexual urges seem not to occur. Individuals with low desire may report no sexual cognitions—fantasies or other pleasant, arousing sexual thoughts and mental images.

In terms of self-descriptions, individuals with low desire may have an asexual self-view. Disruption in the frequency, focus, intensity, or duration of sexual activity may occur, and secondary disruption of sub sequent response cycle phases may occur.

Either physical or psychologic sexual stimulation can initiate sexual excitement. The bodily changes with sexual excitement are considerable. The general physiologic responses are widespread vasocongestion, either superficial or deep, and myotonia, with either voluntary or involuntary muscle contractions. Other changes include increases in heart rate and blood pressure and deeper, more rapid respiration. For women, sexual excitement is also characterized by the appearance of vaginal lubrication, produced by vasocongestion in the vaginal walls, leading to transudation of fluid.

Other changes include a slight enlargement of the clitoris and uterus with engorgement. The uterus also rises in position with the vagina expanding and ballooning out. Maximal vasocongestion of the vagina produces a congested orgasmic platform in the lower one third of the vaginal barrel.

As discussed later, individuals may not be aware of the physiologic sensations of arousal; even if they are, their affects may or may not be convergent.

Thus, in the following discussion, we consider both positive affects, such as arousal, and negative affects, such as anxiety, which may relate to sexual excitement.

Consideration of negative affects is relevant as some e. Studies have addressed the physiological and affective aspects of arousal. Although the aforementioned description notes vasocongestion and lubrication as the predominant bodily responses, psychophysiological research has consisted largely of measures of vaginal vasocongestion i.

As a physiological indicator of sexual arousal, it is still unclear what these vaginal signals represent and whether they are analogues of distinct vascular processes Levine, However, there is evidence for their convergent validity.

The construct of arousability is central to understanding cognitive and affective aspects of sexual excitement in women. According to Bancroft , arousability is a cognitive sensitivity to external sexual cues. He suggests that high arousability implies enhanced perception, awareness, and processing of not only sexual cues but the bodily responses of sexual excitement. This model seeks to connect cognitive—affective responses with control of genital and peripheral indications of sexual excitement through a neurophysiological substrate for sexual arousal.

Fortunately, one of the psychometrically strongest self-report measure for female sexuality is one that also taps sexual arousability, the Sexual Arousability Index SAI by Hoon, Hoon, and Wincze On this item measure, women rate their sexual arousal for a variety of erotic and explicit sexual behaviors. The measure samples a range of individual and partnered erotic and sexual behaviors; our psychometric studies indicate that the SAI samples the following domains: arousal associated with erotica e.

Although there is the expectation that physiologic measures, behavioral reports, and subjective reports converge, examples of dyscrony are common see Turpin, , for a discussion of assessment of anxiety disorders , so too in this area, reports are mixed. In the Laumann et al. Other relevant data indicate that the magnitude of the correlations may be moderated by individual differences among women, such as indications of their sexual responsiveness.

At this time, there is insufficient data to draw a conclusion about the significance or lack thereof of this dysyncrony. It may be useful to consider other positive affects or emotions that may influence sexual excitement—arousal. This examination provides a way to establish convergent and discriminant validity for the excitement construct.

People then label this arousal as love. A classic experiment provided evidence for this notion. Dutton and Aron had men who were between 19 and 35 years old walk across one of two bridges. One bridge was suspended over a deep gorge and swayed vigorously from side to side. The other bridge was much more stable and was much closer to the ground. Presumably, participants would be substantially more psychophysiologically aroused by crossing the swaying bridge than by crossing the stable one.

As the men walked across the bridge, they were met by a research assistant, who was either male or female and who asked the participant to answer a few questions and to tell a story based on a picture.

After the tasks were completed, the research assistant mentioned that if a participant wanted more information, he could call the assistant at home. Two important findings emerged. The first was that the stories of the participants in response to a Thematic Apperception Test card were highest in sexual imagery in the group that crossed the swaying bridge and met the female assistant. The second was that members of this condition were also the most likely to call the assistant at home, in some cases, even attempting to arrange another, more personal, meeting.

These data have been interpreted as indicating that arousal, accompanied by a plausible labeling of the arousal as love or at least attraction , seems to be one basis for passionate love see Sternberg, , for a related discussion. Although this experiment has not been replicated with women, it illustrates the general phenomena of positive affective labeling with sexual attraction, and possibly sexual arousal.

The item Passionate Love Scale by Hatfield and Sprecher is reliable and evidences broad construct validity. Passionate love, defined as an intense longing for union with another, consists of three components: cognitive e.

The measure is correlated but not overlapping with relevant measures of sexual desire and excitement e. Historically, anxiety has been the hypothesized mechanism in many theories of arousal deficits.

Psychodynamic hypotheses emphasize fears of phallic-aggressive impulses, castration, rivalry, or incestuous object choices Janssen, More central to contemporary views, Wolpe was the first to emphasize anxiety-based impairment of physiologic responses. In his view, the sympathetic activity characteristic of anxiety inhibits the local i. Initially offered to explain male arousal deficits, the model has been applied less satisfactorily for women.

Dysfunctional attentional processes and negative affects have been the core of psychological theories of excitement deficits.

Anxiety about performance failure i. Again, male sexual responding is usually the exemplar for this model. When a positive, functional sexual response e.

Women are presented with stimuli, usually videotapes, representing anxiety-provoking, neutral, or erotic sequences. Vaginal measures, as well as self-reports of general or genital arousal, are recorded. In tests of the physiologic effects of anxiety, the data have, in general, indicated that genital arousal is not inhibited by anxiety. Using individualized, anxiety-provoking audiotaped scenarios, Beggs, Calhoun, and Wolchik , for example, found that genital arousal VBV increased during the anxiety-provoking condition, although the levels were not as high as those achieved during an erotic verbal stimulus.

Palace and Gorzalka found that preexposure with an anxiety-provoking videotape e. This effect, preexposure to an anxiety-provoking stimulus increasing subsequent VBV during erotica, has also been replicated Palace, in press. Other data disconfirming of both the Masters and Johnson and the Barlow conceptualizations is that by Laan, Everaerd, van Aanhold, and Rebel Taken together, these data suggest that these previous conceptualizations may be less relevant if relevant at all for women, as they substantiate neither the arousal processes they may be predominately sympathetic rather than parasympathetic nor hypothesized mechanisms e.

For these reasons, we consider anxiety as well as a broad band of other affects that may be relevant to discriminate from excitement processes for assessment. As an aside, we note that the DSM—IV gives no clues as to the direction of assessment and largely omits affective criteria for arousal disorder in women. Sexual anxiety, or related terms, has been used to name scales that differ considerably in content and intent.

We also note that, rather than use previously published measures, many investigators commonly develop their own sexual anxiety scales by appending a rating scale e. A procedure not unlike the latter was E. She defined anxiety as a negative feeling of tension or nervousness and used the SAI items but changed the anchors for the rating scale 7-point Likert scale ranging from — 1 [relaxing] to 5 [extremely anxiety provoking].

In fact, there is significant overlap between the measures correlations of. Factor analysis indicates that the items of the two scales are intermingled across factors.

Some extreme, negative reactions have been termed sexual aversions. In the DSM—IV, sexual aversion is defined as persistent or recurrent extreme aversion to, and avoidance of, all or almost all, genital contact with a sexual partner. The behavioral reference of complete or almost complete absence of genital contact presumably signifies that all sexual activity is halted, and so the latter stages of the sexual response cycle would thus be circumvented. Aside from specific genital avoidance, there may be wide variation in the clinical pattern of avoidance.

From an assessment standpoint, aversion may be difficult to distinguish from anxiety with avoidance. At present, there are no experimental or clinical studies that have made the comparison.

Thirty items are rated on a 4—point Likert scale and assess sexual fears associated with sexually transmitted diseases primarily HIV , sexual guilt, negative social evaluation, pregnancy, and sexual trauma.

Factor analyses suggest that the measure includes two domains that are potentially relevant to negative emotions disruptive of sexual excitement: sexual avoidance e. Reliability data include estimates of. Few validity data are provided, but they are supportive in that the measure correlates. In contrast, the SAS assesses self-reported avoidance of sexual activities and negative emotionality about sex, including worry, self-consciousness, and self-criticism.

Although the former factor sexual avoidance may be related to sexual aversion as defined by DSM—III—R, it is not clear whether the latter factor which appears to assess sexual neuroticism is. Masters and Johnson proposed that orgasm is a reflex-like response that occurs once a plateau of excitement has been reached or exceeded, although the specific neurophysiologic mechanisms are not known.

The physiologic and behavioral indices of orgasm involve the whole body—facial grimaces, generalized myotonia of the muscles, carpopedal spasms, and contractions of the gluteal and abdominal muscles.