Samantha J. Dawson

Paraphilic Interests: An Examination of Sex Differences in a Nonclinical Sample

Little research has been conducted to examine paraphilic sexual interests in nonclinical samples. The little that exists suggests that atypical sexual interests are more common in men than in women, but the reasons for this difference are unknown. In this study, we explored the prevalence of paraphilic interests in a nonclinical sample of men and women. We expected that men would report greater arousal (or less repulsion) toward various paraphilic acts than women. We also examined putative correlates of paraphilias in an attempt to explain the sex difference. In all, 305 men and 710 women completed an online survey assessing sexual experiences, sexual interests, as well as indicators of neurodevelopmental stress, sex drive, mating effort, impulsivity, masculinity/femininity, and socially desirable responding. As expected, significant sex differences were found, with men reporting significantly less repulsion (or more arousal) to the majority of paraphilic acts than women. Using mediation analysis, sex drive was the only correlate to significantly and fully mediate the sex difference in paraphilic interests. In other words, sex drive fully accounted for the sex difference in paraphilic interests. The implications of these findings for understanding the etiology of atypical sexual interests are discussed.

Gender‐Specificity of Solitary and Dyadic Sexual Desire among Gynephilic and Androphilic Women and Men

INTRODUCTION Incentive motivation theory proposes that sexual desire emerges from sexual arousal, and is triggered by sexually competent stimuli. Research demonstrates gender and sexual orientation differences in the features that contribute to the competency of sexual stimuli. Mens and gynephilic womens genital arousal tends to be gender-specific with preferred gender eliciting significantly greater genital arousal than nonpreferred gender. In contrast, stimuli depicting preferred and nonpreferred gender elicit similar degrees of genital arousal among androphilic women, termed a gender-nonspecific pattern. Given these differences in the features that elicit a sexual response, and that sexual desire is proposed to emerge from sexual arousal, the question remains as to whether sexual desire would emerge only through exposure to preferred stimuli or whether patterns of responsive desire would parallel those observed for genital arousal. AIM The study aims to examine patterns of dyadic and solitary sexual desire in response to stimuli differing in incentive value. METHODS Thirty androphilic women, 21 gynephilic women, 21 gynephilic men, and 16 androphilic men participated in a sexual psychophysiological session. Participants viewed sexual stimuli that varied the gender of the actors and the intensity of sexual activities depicted. MAIN OUTCOME MEASURES Participants reported their degree of desire for sex with a partner (dyadic desire) and desire to masturbate (solitary desire), before and after each film. RESULTS Men and gynephilic women exhibited gender-specific patterns of sexual desire. Androphilic womens dyadic desire showed significantly less differentiation between genders, and their solitary desire did not differentiate at all. No gender difference was observed for either type of desire. All groups reported greater desire as stimulus intensity increased. CONCLUSIONS Gender-nonspecific sexual response is not limited to the sexual arousal patterns of androphilic women, but extends to include responsive sexual desire. Men and gynephilic women, however, show gender-specific responsive sexual desire that parallels their sexual arousal patterns.

Assessment of Introital Lubrication.

Vaginal vasocongestion and lubrication serve to prepare the vaginal lumen for sexual activity. Lubrication is important for sexual functioning and difficulties with lubrication are one of the most commonly reported symptoms of sexual dysfunction. Few studies have empirically examined how vasocongestion and lubrication relate to one another and there are currently no well-established measures of lubrication. In this study, we designed and tested a simple method to assess lubrication at the vaginal introitus in 19 healthy women, using litmus test strips. We examined the relationship between lubrication and vaginal vasocongestion (measured with a photoplethysmograph) when elicited by audiovisual sexual stimuli (male–female sexual interactions). Lubrication was elicited by the sexual stimuli and was strongly correlated with reports of sexual arousal. Unexpectedly, lubrication was not correlated with vasocongestion, even though the latter was also elicited by the sexual stimuli. We discuss the implications of these findings for informing our understanding of the female sexual response and the potential clinical and scientific utility of this new measure.

Gender-Specificity of Initial and Controlled Visual Attention to Sexual Stimuli in Androphilic Women and Gynephilic Men

Research across groups and methods consistently finds a gender difference in patterns of specificity of genital response; however, empirically supported mechanisms to explain this difference are lacking. The information-processing model of sexual arousal posits that automatic and controlled cognitive processes are requisite for the generation of sexual responses. Androphilic women’s gender-nonspecific response patterns may be the result of sexually-relevant cues that are common to both preferred and nonpreferred genders capturing attention and initiating an automatic sexual response, whereas men’s attentional system may be biased towards the detection and response to sexually-preferred cues only. In the present study, we used eye tracking to assess visual attention to sexually-preferred and nonpreferred cues in a sample of androphilic women and gynephilic men. Results support predictions from the information-processing model regarding gendered processing of sexual stimuli in men and women. Men’s initial attention patterns were gender-specific, whereas women’s were nonspecific. In contrast, both men and women exhibited gender-specific patterns of controlled attention, although this effect was stronger among men. Finally, measures of attention and self-reported attraction were positively related in both men and women. These findings are discussed in the context of the information-processing model and evolutionary mechanisms that may have evolved to promote gendered attentional systems.

Visual Attention Patterns of Women with Androphilic and Gynephilic Sexual Attractions.

Women who report exclusive sexual attractions to men (i.e., androphilia) exhibit gender-nonspecific patterns of sexual response—similar magnitude of genital response to both male and female targets. Interestingly, women reporting any degree of attraction to women (i.e., gynephilia) show significantly greater sexual responses to stimuli depicting female targets compared to male targets. At present, the mechanism(s) underlying these patterns are unknown. According to the information processing model (IPM), attentional processing of sexual cues initiates sexual responding; thus, attention to sexual cues may be one mechanism to explain the observed within-gender differences in specificity findings among women. The purpose of the present study was to examine patterns of initial and controlled visual attention among women with varying sexual attractions. We used eye tracking to assess visual attention to sexually preferred and nonpreferred cues in a sample of 164 women who differed in their degree of androphilia and gynephilia. We found that both exclusively and predominantly androphilic women showed gender-nonspecific patterns of initial attention. In contrast, ambiphilic (i.e., concurrent androphilia and gynephilia) and predominantly/exclusively gynephilic women oriented more quickly toward female targets. Controlled attention patterns mirrored patterns of self-reported sexual attractions for three of these four groups of women, such that gender-specific patterns of visual attention were found for androphilic and gynephilic women. Ambiphilic women looked significantly longer at female targets compared to male targets. These findings support predictions from the IPM and suggest that both initial and controlled attention to sexual cues may be mechanisms contributing to within-gender variation in sexual responding.

Gender Differences and Similarities in Sexual Desire

Sexual desire can be operationalized as the motivation to seek out solitary or partnered sexual experiences. A large body of evidence suggests that men experience sexual desire more strongly and more frequently than do women; however, it is not clear whether sexual desire is truly gendered or if gender differences are influenced by how sexual desire is operationalized and assessed. Moreover, little research has examined similarities and differences in trait versus state sexual desire in women and men. Recent changes to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) reflect the movement away from situating desire as the onset of the traditional linear model to framing desire as a state emerging from sexual excitement. We examine evidence for gender differences and similarities in trait and state sexual desire in both clinical and nonclinical populations. We conclude that sexual desire emerges similarly in women and men and that other factors may influence the observed gender difference in sexual desire. We then discuss the implications of conceptualizing desire as responsive for sexual medicine practitioners.

Examining the time course of genital and subjective sexual responses in women and men with concurrent plethysmography and thermography

Sexual response is a dynamic process, though there is limited knowledge of the time course and relationships among its psychological and physiological components. To address this gap, we concurrently assessed self-reported sexual arousal, genital temperature (with thermography), and genital vasocongestion (with vaginal photoplethysmography [VPP] or penile plethysmography [PPG]) during sexual and nonsexual films in 28 androphilic women (attracted to men) and 27 gynephilic men (attracted to women). Men and women had similarly strong agreement between subjective and genital responses (sexual concordance) with thermography, but this agreement was stronger in men than women with PPG/VPP. The time course of changes in self-reported arousal was most similar to changes in genital temperature (i.e., time to onset and peak response). Time-lagged correlations and multilevel modeling revealed changes in the strength of relationships between aspects of sexual response over time. Results highlight the dynamic nature of sexual response and drawbacks of relying on zero-order correlations to characterize sexual concordance.

Effectiveness of Group Cognitive Behavioral Therapy for Insomnia (CBT-I) in a Primary Care Setting

ABSTRACT Objective/Background: Primary care is where many patients with insomnia first ask for professional help. Cognitive-behavioral therapy for insomnia (CBT-I) is the recommended treatment for chronic insomnia. Although CBT-I’s efficacy is well established, its effectiveness in real-life primary care has seldom been investigated. We examined the effectiveness of CBT-I as routinely delivered in a Canadian primary care setting. Participants: The patients were 70 women and 11 men (mean age = 57.0 years, SD = 12.3); 83% had medical comorbidity. Methods: For the first 81 patients who took the six-session group program we compared initial and postprogram sleep diaries, sleep medication use, Insomnia Severity Index (ISI), the Hospital Anxiety and Depression Scale (HADS), and visits to the family physician. Results: Sleep onset latency, wake after sleep onset, total sleep time, sleep efficiency, and ISI scores improved significantly (p < .001). Mood ratings also improved (p < .001). Use of sleep medication decreased (p < .001). Effect sizes were medium to large. Eighty-eight percent of patients no longer had clinically significant insomnia (ISI score ≤ 14) by the last session; 61% showed at least “moderate” improvement (ISI score reduction > 7). Wait-list data from 42 patients showed minimal sleep and mood improvements with the passage of time. Number of visits to the family physician six months postprogram decreased, although not significantly (p = .108). Conclusions: The CBT-I program was associated with improvement on all sleep and mood measures. Effect sizes were similar to, or larger than, those found in randomized controlled trials, demonstrating the real-world effectiveness of CBT-I in an interdisciplinary primary care setting.

The effect of static versus dynamic stimuli on visual processing of sexual cues in androphilic women and gynephilic men

Models of sexual response posit that attentional processing of sexual cues is requisite for sexual responding. Despite hypothesized similarities in the underlying processes resulting in sexual response, gender differences in sexual arousal patterns are abundant. One such gender difference relates to the stimulus features (e.g. gender cues, sexual activity cues) that elicit a response in men and women. In this study, we examined how stimulus modality (static visual images versus dynamic audiovisual films) and stimulus features (gender, sexual activity and nonsexual contextual cues) influences attentional (i.e. gaze) and elaborative (i.e. self-reported attraction (SRA), self-reported arousal) processing of sexual stimuli. Mens initial and controlled attention was consistently gender-specific (i.e. greater attention towards female targets), and this was not influenced by stimulus modality or the presence of sexual activity cues. By contrast, gender-specificity of womens attention patterns differed as a function of attentional stage, stimulus modality and the features within the stimulus. Degree of specificity was positively predictive of SRA in both genders; however, it was not significantly predictive of self-reported arousal. These findings are discussed in the context of gendered processing of visual sexual information, including a discussion of implications for research designs.

The Effects of Gender and Relationship Context Cues on Responsive Sexual Desire in Exclusively and Predominantly Androphilic Women and Gynephilic Men

Sexual desire may be “responsive,” emerging from sexual arousal to sexually competent cues. Cues that elicit sexual arousal and desire differ, however, by gender and direction of sexual attractions. Further, relationship context cues are thought to be important for responsive desire, but this has not been tested directly. The current study examined gynephilic men’s (n = 27) and exclusively (n = 23) and predominantly (n = 17) androphilic women’s dyadic and solitary responsive sexual desire, as well as genital and self-reported arousal, to audio narratives varying by gender (male, female) of the sexual partner and relationship context (stranger, friend, long-term relationship). Consistent with previous literature, gynephilic men’s solitary and dyadic desire were gender-specific (greater to female than to male sexual partners). Exclusively androphilic women’s dyadic desire differentiated less to cues of gender than gynephilic men’s, and their solitary desire did not differentiate by gender cues at all, replicating previous research. Androphilic women with some gynephilia reported a gender-nonspecific pattern of dyadic and solitary desire (i.e., responsive desire to both male and female narratives). No effect of relationship context was found for any groups. Results suggest that responsive sexual desire may be more closely associated with self-reported than genital arousal patterns.