Cynthia A. Graham

A prospective study of the effects of oral contraceptives on sexuality and well-being and their relationship to discontinuation.

The purpose of the study was to explore predictors of discontinuation of oral contraceptives (OC) including pre-OC use characteristics and adverse physical, emotional, and sexual effects of OCs. Women aged 18+ years in committed, sexually active relationships were assessed before starting OC and reassessed at 3, 6, and 12 months or shortly after discontinuation. Assessment included pre-OC use attitudes and expectations about the pill; self-reported side effects and perimenstrual symptoms including premenstrual syndrome (PMS); physical and emotional well-being; and sexual interest, enjoyment, and frequency of sexual activity. Seventy-nine women completed the study, 38% continued OCs, 47% discontinued, and 14% switched to another OC. Emotional side effects, worsening of PMS, decreased frequency of sexual thoughts, and decreased psychosexual arousability correctly categorized 87% of cases by using logistic regression. Emotional and sexual side effects were the best predictors of discontinuation/switching, yet such OC effects have been largely ignored in the research literature.

The Dual Control Model: Current Status and Future Directions

The Dual Control Model proposes that sexual responses involve an interaction between sexual excitatory and sexual inhibitory processes. The model further postulates that individuals vary in their propensity for both sexual excitation and sexual inhibition, and that such variations help us to understand much of the variability in human sexuality. The development of psychometrically validated instruments for measuring such propensities for men (Sexual Inhibition/Sexual Excitation Scales) and for women (Sexual Excitation/Sexual Inhibition Inventory for Women) is described. These measures show close to normal variability in both men and women, supporting the concept that “normal” levels of inhibition proneness are adaptive. The relevance of the model to sexual development, sexual desire, the effects of aging, sexual identity, and the relation between mood and sexuality are discussed, and the available evidence is reviewed. Particular attention is paid to gender differences and similarities in propensities for sexual excitation and inhibition. Research findings related to sexual problems, high-risk sexual behavior, and the relevance of this model to clinical management of such problems are also summarized. Last, ideas for future use and further development of the Dual Control Model are considered.

Selecting Films for Sex Research: Gender Differences in Erotic Film Preference

The aim of this study was to explore gender differences in sexual responsiveness to erotic films that had been selected for their differential appeal for men and women. A secondary objective was to identify variables that influence sexual arousal and explore whether these variables differ for men and women. Fifteen men (M age = 26 yrs) and 17 women (M age = 24 yrs) were presented with 20 film clips depicting heterosexual interactions, half of which were female- and the other half male-selected, and were asked to rate the clips on a number of dimensions. Overall, men found the film clips more sexually arousing than did the women. Gender differences in arousal were negligible for female-selected clips but substantial for male-selected clips. Furthermore, men and women experienced higher levels of sexual arousal to clips selected for individuals of their own gender. Cluster regression analyses, explaining 77% of the variance for male and 65% for female participants, revealed that mens sexual arousal was dependent upon the attractiveness of the female actor, feeling interested, and both “imagining oneself as a participant” and “watching as an observer.” For women, with all variables entered, only “imagining oneself as a participant” contributed to sexual arousal ratings. The findings suggest that how films are selected in sex research is an important variable in predicting levels of sexual arousal reported by men and women.

The effects of steroidal contraceptives on the well-being and sexuality of women: a double-blind, placebo-controlled, two-centre study of combined and progestogen-only methods

A placebo-controlled, double-blind study was carried out to assess the direct hormonal effects of combined and progestogen-only oral contraceptives on well-being and sexuality of women in two contrasting cultures. One-hundred-fifty women, who had been sterilised or whose partners had been vasectomised, were recruited from two centres-Manila, Philippines, and Edinburgh, Scotland. After one month pretreatment assessment, women were randomly assigned to one of three treatments (combined oral contraceptive (COC), progestogen-only pill (POP), or placebo; 50 within each treatment group, 25 per centre) and continued on treatment for four months. Assessment was by daily ratings, questionnaires and interviews. The COC adversely affected sexuality in the Edinburgh women, with 12 of the 25 women in this group also reporting the side effect of reduced sexual interest. There were modest negative effects of the combined pill on mood, more noticeable in the Edinburgh women. The POP was associated with no adverse effects on sexuality and some improvement in well-being in both centres. Possible explanations for the apparent lack of adverse effects in the Manila women are discussed. The negative effects reported may be less evident in women using the COC for contraceptive purposes but may lead to discontinuation in some women and warrant further investigation.

A prospective treatment study of premenstrual symptoms using a triphasic oral contraceptive.

Eighty-two women with complaints of moderate to severe premenstrual symptoms were recruited for a double-blind, controlled trial of a triphasic oral contraceptive (o.c.). Subjects made daily ratings of symptoms for at least one baseline cycle and were then randomly assigned to receive either placebo or o.c. for three months. Twenty-three women dropped out of the study (18 o.c., 5 placebo), 13 failed to show prospective confirmation of moderate to severe premenstrual symptoms, and one placebo subject had an anovulatory cycle. Forty-five women with prospectively-confirmed premenstrual changes (20 o.c., 25 placebo) completed the study. Premenstrual breast pain and bloating were significantly reduced with active treatment compared to placebo (p less than 0.03) but there were no beneficial effects of the o.c. over placebo for any of the mood symptoms. Women who received o.c.s reported decreased sexual interest after starting treatment and this effect was independent of any adverse influence on mood.

The relationship between negative mood and sexuality in heterosexual college women and men

Negative mood states, such as depression and anxiety, are typically associated with decreased sexual interest and arousal. However, there is also some evidence that depressed or anxious mood may increase sexual interest or arousal in some individuals. In this study, 663 female college students (mean age = 18.9 years, SD = 1.21) answered questions regarding the effects of anxious and depressed mood on sexual interest and arousal and completed trait measures of sexual excitation and inhibition, anxiety, and depression. The majority of women reported decreased sexual interest and response when feeling depressed or anxious; a minority (about 10%) of women, however, reported increased sexual interest/response during anxious and depressed mood. This sample of women was compared to a sample of 399 college‐aged men. In general, men were more likely than women to report increased sexual interest during negative mood states. Of the variables explored, propensity for sexual excitation was the strongest predictor of the relationship between negative mood and sexuality in women. Individual differences in the effects of negative mood may prove relevant to our understanding of a variety of topics, including “risky” and “compulsive” sexual behavior and sexual dysfunction.

The DSM diagnostic criteria for female sexual arousal disorder

This article reviews and critiques the DSM-IV-TR diagnostic criteria for Female Sexual Arousal Disorder (FSAD). An overview of how the diagnostic criteria for FSAD have evolved over previous editions of the DSM is presented and research on prevalence and etiology of FSAD is briefly reviewed. Problems with the essential feature of the DSM-IV-TR diagnosis—“an inability to attain, or to maintain…an adequate lubrication-swelling response of sexual excitement”—are identified. The significant overlap between “arousal” and “desire” disorders is highlighted. Finally, specific recommendations for revision of the criteria for DSM-V are made, including use of a polythetic approach to the diagnosis and the addition of duration and severity criteria.

Condom use errors and problems among college men

Background An essential yet understudied aspect of condom use is whether they are used correctly. Goal The goal of the study was to comprehensively evaluate condom use errors and problems reported by heterosexual college men (N = 158). Study Design A cross-sectional survey, involving a 3-month recall period, was conducted. Results Of the 158 participants, 60% did not discuss condom use with their partner before sex; 42% reported they wanted to use condoms but did not have any available; 43% put condoms on after starting sex; 15% removed condoms before ending sex; 40% did not leave space at the tip; 30% placed the condom upside down on the penis and had to flip it over; and 32% reported losing erections in association with condom use. Nearly one-third reported breakage or slippage during sex. Few participants reported errors related to lubrication, storage, and reusing condoms. Higher error scores were associated with breakage/slippage rather than with consistency of condom use. Conclusion Condom use errors were common, and error scores were associated with breakage and slippage. Increasing the focus on correcting potential user failures may be an important public health strategy.

Recalling sexual behavior: a methodological analysis of memory recall bias via interview using the diary as the gold standard

This study examined the effect of time lag on the validity of retrospective self‐reports of sexual behavior. Seventy‐five heterosexual students (44 women, 31 men) made daily recordings of sexual behavior, condom use, and alcohol or substance use for 1 month. Ability of respondents to recall sexual behavior recorded during this period was assessed at 1, 2, and 3 months after diary completion using recall interviews (25 interviewed at each interval). For vaginal intercourse, total recall error was significantly greater at 3 months than at 1 month post‐diary. For all other variables assessed, the 2‐ and 3‐month time intervals did not produce significant increases in total recall error. Higher frequency of vaginal intercourse, orgasm, and alcohol use prior to sexual activity were associated with total recall error for some but not all behaviors and outcomes. The results provide a partial validation of the diary‐interview recall model as a method for studying recall error.

Condom use errors and problems: a global view

BACKGROUND Significantly more research attention has been devoted to the consistency of condom use, with far fewer studies investigating condom use errors and problems. The purpose of this review was to present the frequency of various condom use errors and problems reported worldwide. METHODS A systematic literature search was conducted for peer-reviewed articles, published in English-language journals between 1995 and 2011. RESULTS Fifty articles representing 14 countries met criteria for inclusion. The most common errors included not using condoms throughout sex, not leaving space at the tip, not squeezing air from the tip, putting the condom on upside down, not using water-based lubricants and incorrect withdrawal. Frequent problems included breakage, slippage, leakage, condom-associated erection problems, and difficulties with fit and feel. Prevalence estimates showed great variation across studies. Prevalence varied as a function of the population studied and the period assessed. CONCLUSION Condom use errors and problems are common worldwide, occurring across a wide spectrum of populations. Although breakage and slippage were most commonly investigated, the prevalence of other condom use errors and problems found in this review were substantially higher. As a framework for understanding the role of condom errors and problems in inadequate protection, we put forward a new model: the Condom Use Experience model. This model can be used to generate testable hypotheses for future research. Addressing condom use errors and problems in research and interventions is crucial to closing the gap between the perfect use and typical use of condoms.