Amelia M. Stanton

Changes in the Sexual Self-Schema of Women With a History of Childhood Sexual Abuse Following Expressive Writing Treatment.

Objective: Sexual self-schemas are cognitive generalizations about the sexual self that influence the processing of sexually pertinent information and guide sexual behavior. Until recently sexual self-schemas were exclusively assessed with self-report instruments. Recent research using the meaning extraction method, an inductive method of topic modeling, identified 7 unique themes of sexual self-schemas: family and development, virginity, abuse, relationship, sexual activity, attraction, and existentialism from essays of 239 women (Stanton, Boyd, Pulverman, & Meston, 2015). In the current study, these themes were used to examine changes in theme prominence after an expressive writing treatment. Method: Women (n = 138) with a history of childhood sexual abuse completed a 5-session expressive writing treatment, and essays on sexual self-schemas written at pretreatment and posttreatment were examined for changes in themes. Results: Women showed a reduction in the prominence of the abuse, family and development, virginity, and attraction themes, and an increase in the existentialism theme. Conclusions: This study supports the validity of the 7 themes identified by Stanton and colleagues (2015) and suggests that expressive writing may aid women with a history of sexual abuse to process their abuse history such that it becomes a less salient aspect of their sexual self-schemas.

A Single Session of Autogenic Training Increases Acute Subjective and Physiological Sexual Arousal in Sexually Functional Women

Heart rate variability (HRV) has recently been associated with female sexual function (Stanton, Lorenz, Pulverman, & Meston, 2015). Below-average HRV was identified as a possible risk factor for sexual arousal dysfunction and overall sexual dysfunction in women. Based on this newly established relationship between HRV and female sexual function, the present study examined the effect of autogenic training to increase HRV on acute physiological and subjective sexual arousal in women. Specifically, vaginal pulse amplitude (VPA), an index of genital sexual arousal, and subjective sexual arousal were assessed in 33 sexually functional women, aged 18 to 27, before and after a short session of autogenic training. Autogenic training, a relaxation technique that restores the balance between the activity of the sympathetic and the parasympathetic branches of the autonomic nervous system, has been shown to significantly increase HRV (Miu, Heilman, & Miclea, 2009). After autogenic training, significant increases in both VPA (p <.05) and subjective sexual arousal (p <.005) were observed. Moreover, change in HRV from pre- to postmanipulation significantly moderated changes in subjective sexual arousal (p <.05) when it was measured continuously during the presentation of the erotic stimulus. This cost-effective, easy-to-administer behavioral intervention may have important implications for increasing sexual arousal in women.

Vagal Activity During Physiological Sexual Arousal in Women With and Without Sexual Dysfunction

Recently, heart rate variability (HRV) level has been found to be a risk factor for female sexual dysfunction. Low HRV was a significant predictor of female sexual arousal dysfunction and overall sexual dysfunction. Building upon this finding, the present study examined whether differences in vagal activity between sexually functional and sexually dysfunctional women may be driving the association between low HRV and female sexual dysfunction. Specifically, respiratory sinus arrhythmia (RSA) was assessed before, during, and after physiological sexual arousal in 84 women, aged 18 to 47, to examine potential differences in vagal activity between sexually functional and sexually dysfunctional women. Significant differences in vagal activity between these two groups were observed (p =.02). These findings provide additional specificity to the recently established relationship between HRV and female sexual function while also proposing a mechanism to target during treatments for sexual dysfunction.

Sexual function in adolescents and young adults diagnosed with cancer: A systematic review

PurposeThe purpose of this systematic review was to identify, with supporting evidence, the impact of cancer and its treatment on the sexual function of adolescents and young adults.MethodsPubMed, CINAHL, and PsycINFO articles were searched for relevant studies published in English. Fifteen studies, 13 quantitative and two qualitative, were included in this review.ResultsResults indicated that cancer during the adolescent and young adult period has a significant negative impact on certain domains of sexual function in both men and women.ConclusionsAmong adolescent and young adult males, there is evidence that cancer has detrimental effects on erection, ejaculation, and orgasm. Among adolescent and young adult females, cancer is associated with decreased desire, but there appear to be mixed findings with respect to arousal, orgasm, and satisfaction. Directions for future research are discussed.Implications for Cancer SurvivorsA better understanding of the effects of cancer and its treatment during adolescence and young adulthood on sexual function could increase attention paid to sexual health in oncology settings and lead to improved psychosexual services for this population.

Sexual Self-Schemas in the Real World: Investigating the Ecological Validity of Language-Based Markers of Childhood Sexual Abuse

This is the first study to examine language use and sexual self-schemas in natural language data extracted from posts to a large online forum. Recently, two studies applied advanced text analysis techniques to examine differences in language use and sexual self-schemas between women with and without a history of childhood sexual abuse. The aim of the current study was to test the ecological validity of the differences in language use and sexual self-schema themes that emerged between these two groups of women in the laboratory. Archival natural language data were extracted from a social media website and analyzed using LIWC2015, a computerized text analysis program, and other word counting approaches. The differences in both language use and sexual self-schema themes that manifested in recent laboratory research were replicated and validated in the large online sample. To our knowledge, these results provide the first empirical examination of sexual cognitions as they occur in the real world. These results also suggest that natural language analysis of text extracted from social media sites may be a potentially viable precursor or alternative to laboratory measurement of sexual trauma phenomena, as well as clinical phenomena, more generally.

What Does Sexual Arousal Mean to You? Women With and Without Sexual Arousal Concerns Describe Their Experiences

Sexual arousal is frequently characterized by both subjective (i.e., mental) and physiological (e.g., genital) components. The nuances of these components, however, are difficult to capture via self-report instruments. Asking women to describe sexual arousal in their own words may therefore enhance our understanding of this construct. In the present study, women with (n = 190) and without (n = 610) arousal concerns were recruited online and wrote about their experience of sexual arousal. Seven clusters of words were extracted using automated text analysis, and the prominence of these clusters was compared between groups of women. The autonomic arousal cluster differed between groups such that women with arousal concerns invoked this cluster significantly less than did women with no such concerns. Furthermore, the context cluster significantly predicted group membership (odds ratio [OR] = 1.063); greater scores on this cluster were associated with arousal concerns. Results suggest that autonomic arousal and relationship factors may play important roles in arousal concerns. It is suggested that clinicians assess for aspects of the sexual relationship that may facilitate or hinder sexual arousal. Clinicians may also consider inquiring about the presence or appraisal of autonomic arousal (e.g., one’s interpretation of an increase in heart rate or respiration) during sexual activity.

Comprehensive Assessment of Women's Sexual Arousal Requires Both Objective and Subjective Measurement

The principles of incentive motivation suggest that (i) sexual arousal emerges in response to a set of cues and (ii) each individual has a predisposition to sexual responsiveness that is influenced by biology and psychology. Often, arousal concerns in women are driven by biopsychosocial etiologies (ie, by a combination of factors), but sometimes they stem primarily from either physiologic decrements or decreased mental engagement with a sexual stimulus. Treatment for arousal problems should focus on the most likely causal factor. To that end, a comprehensive assessment of sexual arousal concerns needs to address biological etiologies and psychological etiologies and therefore must include objective and subjective measurements of arousal.

Desynchrony Between Subjective and Genital Sexual Arousal in Women: Theoretically Interesting but Clinically Irrelevant

Due in part to Chivers and colleagues’ [1] comprehensive meta-analysis on the topic, a great deal of attention has been paid to the relationship between genital and subjective sexual arousal. The Chivers et al. paper analyzed the results of laboratory studies that quantified levels of concordance, or the relative agreement between genital and subjective arousal, in both men and women. One of the major findings was a striking gender difference; the agreement between these two types of arousal is much higher in men (r = .66) than in women (r = .26). To understand the nuances of this gender difference, it is important to address the ways in which arousal and concordance are measured. Genital sexual arousal in the laboratory is most often assessed with a vaginal photoplethysmograph [2], which is an acrylic, tampon-shaped device that contains a light source and a photosensitive light detector. When the device is inserted in the vagina, the amount of back-scattered light directly relates to the transparency of engorged and unengorged vaginal tissue and therefore serves as an indirect index of vasocongestion [3]. Subjective sexual arousal is typically measured using a Likert-style, self-report questionnaire that asks a woman to report her level of mental arousal and/or the degree to which she feels “turned on.” Researchers typically present a series of short videos—a non-sexual film (e.g., a travel film, nature documentary) followed by an erotic film—and ask participants to retrospectively report on their subjective arousal after the end of the erotic film. Traditionally, concordance between genital and subjective arousal has been assessed through correlations. Continuous genital arousal data is collapsed or averaged and compared to discrete, self-reported subjective arousal. Researchers have attempted to explain the gender difference in concordance in various ways. Low correlations between subjective and genital measures of arousal in women may be the result of negative affect that is induced when maleproduced erotica is used as sexual stimuli. If “man-made” films are not associated with negative mood states among men, then these films could be responsible for the gender difference. However, the meta-analysis revealed that femalecentered stimuli did not increase the agreement between subjective and genital arousal in women. The gender difference could also be driven by anatomy. A penile erection is apparent, and it provides much more direct feedback than does vaginal vasocongestion. Throughout childhood and adolescence, the strength of an erection as an arousal cue may reinforce the importance of the genitals in men’s assessments of their subjective arousal. For this reason, it may be easier for men than for women to attend to their genital cues. Although male attention to genital cues can be explained anatomically, their attendance to bodily changes may not be sexuality-specific. Men are also more accurate than women at detecting other physiological changes, such as differences in blood pressure, heart rate, and temperature [4]. However, this does not mean that women are incapable of attending to their genital cues. Women do exhibit a significant degree of agreement between VPA and their subjective arousal when they are directed to focus on their genitals. When women were told to monitor either their genital changes or their overall physiological changes, they had higher levels of concordance than women who were given no attentional cues [5]. A separate study in which sexually functional women were asked to continuously rate their genital sensations during an erotic film revealed that correlations between subjective and genital arousal were particularly high for women with greater interoceptive awareness (i.e., women who were more likely to focus on internal cues) [6]. Women with arousal concerns also show a significant relationship between their perceived and actual genital arousal when instructed to attend to genital cues [7]. Concordance levels for women who are * Cindy M. Meston mestoncm@gmail.com

The Effects of Acute Exercise on Physiological Sexual Arousal in Women

This chapter examines the relationship between acute exercise and physiological sexual arousal in women. The first section of the chapter provides foundational knowledge on the physiological sexual arousal response, which is characterized by increased blood flow to the genitals and subsequent vasocongestion, and then highlights the faciliatory effect of acute exercise on this response. Based on a series of studies that investigated autonomic nervous system influences on sexual arousal in women, the second section suggests that activation of the sympathetic nervous system is most likely the mechanism that facilitates the relationship between acute exercise and increased physiological sexual arousal. Finally, the chapter discusses key clinical implications of the relationship between acute exercise and physiological arousal, particularly for women who have a history of childhood sexual abuse, women who have undergone hysterectomies, and women who report sexual arousal problems due to antidepressant medication use.

Treatment of Female Sexual Interest/Arousal Disorder

In this chapter, we review current treatments of female sexual interest/arousal disorder. We distinguish between biological treatments, which include hormonal replacement options, nonhormonal centrally acting agents, and other forms of pharmacotherapy, and psychosocial treatments, such as sensate focus, cognitive-behavioral techniques, and mindfulness-based approaches. Attention is paid to the dearth of FDA-approved pharmacological treatments for sexual desire and arousal problems in women. Given the variability in symptom profiles associated with this disorder, the importance of individualized treatment approaches is briefly discussed.