The Dual Control Model of Sexual Response: A Scoping Review, 2009-2022.

The Dual Control Model proposes that sexual arousal and related processes are dependent on the balance between sexual excitation and sexual inhibition, and that individuals vary in their propensity for these processes. This scoping review provides an overview and discussion of the questionnaires used to measure the propensities for sexual excitation and inhibition, their translation and validation in other languages, and their application in empirical research on topics ranging from sexual desire and arousal, sexual (dys)function, sexual risk taking, asexuality, hypersexuality, and sexual aggression. A total of 152 papers, published between 2009 and 2022 and identified using online databases, were included in this review. The findings, consistent with those reviewed by Bancroft et al. (2009), suggest that sexual excitation is particularly relevant to sexual desire and responsivity and predictive of asexuality and hypersexuality. Sexual inhibition plays a role in sexual dysfunction. sexual risk taking, and sexual aggression, although often in interaction with sexual excitation. Suggestions for the further development of the model and for future studies are discussed.

Distribution of Salivary Testosterone in Men and Women in a British General Population-Based Sample: The Third National Survey of Sexual Attitudes and Lifestyles (Natsal-3).

INTRODUCTION: Measurement of salivary testosterone (Sal-T) to assess androgen status offers important potential advantages in epidemiological research. The utility of the method depends on the interpretation of the results against robustly determined population distributions, which are currently lacking. AIM: To determine age-specific Sal-T population distributions for men and women. METHODS: Morning saliva samples were obtained from participants in the third National Survey of Sexual Attitudes and Lifestyles, a probability sample survey of the British general population. Sal-T was measured using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Linear and quantile regression analyses were used to determine the age-specific 2.5th and 97.5th percentiles for the general population (1675 men and 2453 women) and the population with health exclusions (1145 men and 1276 women). RESULTS: In the general population, the mean Sal-T level in men decreased from 322.6 pmol/L at 18 years of age to 153.9 pmol/L at 69 years of age. In women, the decrease in the geometric mean Sal-T level was from 39.8 pmol/L at 18 years of age to 19.5 pmol/L at 74 years of age. The annual decrease varied with age, with an average of 1.0% to 1.4% in men and 1.3% to 1.5% in women. For women, the 2.5th percentile fell below the detection limit (<6.5 pmol/L) from age 52 years onward. The mean Sal-T level was approximately 6 times greater in men than in women, and this remained constant over the age range. The Sal-T level was lowest for men and highest for women in the summer. The results were similar for the general population with exclusions. CONCLUSIONS: To our knowledge, this is the first study to describe the sex- and age-specific distributions for Sal-T in a large representative population using a specific and sensitive LC-MS/MS technique. The present data can inform future population research by facilitating the interpretation of Sal-T results as a marker of androgen status.

Estimating the Prevalence of Sexual Function Problems: The Impact of Morbidity Criteria.

Establishing the clinical significance of symptoms of sexual dysfunction is challenging. To address this, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) introduced two new morbidity criteria (duration and symptom severity) to the existing criteria of distress. This study sought to establish the impact of these three criteria on the population prevalence of sexual function problems. The data come from a national probability survey (Natsal-3) and are based on 11,509 male and female participants aged 16-74, reporting at least one sexual partner in the past year. The key outcomes were: proportion of individuals reporting proxy measures of DSM-5 problems, and the proportion of those meeting morbidity criteria. We found that among sexually active men, the prevalence of reporting one or more of four specific sexual problems was 38.2%, but 4.2% after applying the three morbidity criteria; corresponding figures for women reporting one or more of three specific sexual problems, were 22.8% and 3.6%. Just over a third of men and women reporting a problem meeting all three morbidity criteria had sought help in the last year. We conclude that the DSM-5 morbidity criteria impose a focus on clinically significant symptoms.

Linguistic validation of the Sexual Inhibition and Sexual Excitation Scales (SIS/SES) translated into five South Asian languages: Oxford Sexual Dysfunction Study (OSDS).

BACKGROUND: The purpose of the linguistic validation of the Sexual Inhibition and Sexual Excitation Scales (SIS/SES) was to produce translated versions in five South Asian languages (Hindi, Urdu, Panjabi, Tamil and Sinhalese) that was "conceptually equivalent" to the original U.S. English version, for use in the Oxford Sexual Dysfunction Study (OSDS). METHODS: Initially an expert committee was appointed to carry out the task of linguistic validation. This committee included the principal investigator, project coordinator and the associate project manager of the OSDS and a language consultant for each of the South Asian languages. The process of translation and validation was conducted in the following order; a) production of two independent forward translations, b) comparison and reconciliation of the translations, c) backward translation of the first reconciled version, d) comparison of the original version of SIS/SES and the backward version leading to the production of the second reconciled version and e) pilot testing and finalization. RESULTS: Several linguistic and conceptual issues arose during the process of translating the instrument. Problems were also encountered with cultural differences in acceptability of certain concepts, and with semantic difficulties in finding an appropriate translation. In addition, the researchers had to find culturally acceptable equivalents for some terms and idiomatic phrases. The problems encountered in pilot testing, during cognitive debriefing and clinicians' review, were categorized as cultural or conceptual/semantic. Cultural issues describe the acceptability of using certain terms and phrases in a particular socio-cultural milieu. The conceptual and semantic difficulties reflect the inability to deliver the idea/meaning of a source statement in the target language. The current paper describes a selection of these issues. CONCLUSIONS: We applied a rigorous translation method to ensure conceptual equivalence and acceptability of SIS/SES in the five different South Asian languages prior to its utilization in the OSDS. However, to complete the cultural adaptation process, future psychometric validation of the translated versions is required among the different language speakers.

Sexual well-being: a comparison of U.S. black and white women in heterosexual relationships.

In the United States, considerable attention has been directed to sexual behaviors of black and white adolescents, particularly age at first sexual experience and the prevalence of teenage pregnancies. More limited attention has been paid to comparing established sexual relationships in these two racial groups. In this study, we used a national probability sample to compare black (n = 251) and white (n = 544) American women, aged 20-65 years, who were in an established heterosexual relationship of at least 6 months duration. We focused on two aspects of their sexual well-being; how a woman evaluated (1) her sexual relationship and (2) her own sexuality. A range of possible determinants of sexual well-being, including demographic factors, physical and mental health, and aspects of the women's recent sexual experiences, were also assessed using Telephone-Audio-Computer-Assisted Self-Interviewing (T-ACASI). We found no significant difference between black and white women in their evaluation of their sexual relationships nor in the independent variables that were correlated with this evaluation. Black women, however, evaluated their own sexuality more positively than white women. In examining the correlates of this evaluation, a woman's rating of her own sexual attractiveness proved to be the strongest predictor, with black women rating themselves significantly more sexually attractive than did the white women. Overall, these findings were consistent with previous findings that, compared to white women, black women in the United States have higher self-esteem and tend towards more independence and individualism.

Male homosexuality: nature or culture?

INTRODUCTION: Debate continues on whether or not male homosexuality (MH) is a result of biological or cultural factors. The debate persists despite the fact that these two sides have different abilities to create a scientific environment to support their cause. Biological theorists produced evidence, however, that these are not always robust. On the other hand, social theorists, without direct evidence confirming their positions, criticize, with good argument, methods and results of the other side. The aim of this Controversy is to understand the reasons of both perspectives. METHODS: Two scientists (R.B. and A.C.C.) with expertise in the area of biology of MH were asked to contribute their opinions. The nurture position is discussed by a third expert in sexology (J.B.). MAIN OUTCOME MEASURE: Expert opinion supported by the critical review of the currently available literature. RESULT: The role of the Controversy's editor (E.A.J.) is to highlight the strengths and weaknesses of both sides. The two experts of the biological issue answer with their data to the questions: "Is male homosexuality partly explainable by immunology?" and "How is male homosexuality a Darwinian paradox?", respectively. Genetic and immunological factors, birth order, and fertility of relatives are largely discussed. Finally, the expert sustaining the idea that culture and experiences are important determining factors in sexual orientation used a psychosocial and holistic perspective to explain his position. CONCLUSIONS: The JSM's readers should recognize that there are several biological factors in MH. However, these findings do not seem to be able to explain all cases of homosexuality. Some others may be due to particular environmental factors. The issue is complicated and multifactorial, suggesting that further research should be undertaken to produce the final answer to the question raised in this Controversy section.

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.

Psychophysiological response patterns and risky sexual behavior in heterosexual and homosexual men.

The past few years have seen an increased awareness of the relevance of studying the role of sexual response, emotion, and traits such as sensation seeking and the propensity for sexual inhibition in risky sexual behavior. The current study examined the association between self-reported sexual risk taking and psychophysiological response patterns in 76 heterosexual and homosexual men. Measures included genital, electrodermal, startle eyeblink, and cardiovascular responses, and stimuli included threatening (depicting coercive sexual interactions) and nonthreatening (depicting consensual sexual interactions) sexual film excerpts. Sexual risk taking was hypothesized to be associated with decreased inhibition of sexual arousal and hyporeactive affective and autonomic responses to threatening sexual stimuli. Controlling for age and number of sexual partners in the past year, sexual risk taking (number of partners during the past 3 years with whom no condoms were used) was found to be associated with stronger genital responses and smaller eyeblink responses to both threatening and nonthreatening sexual stimuli. Correlations between genital and subjective sexual arousal were relatively low. Sexual risk taking was related to sensation seeking but not to the propensity for sexual inhibition. The findings suggest that risky sexual behavior may involve a role for psychophysiological mechanisms that are specific to sex as well as for ones that are associated with more general approach/avoidance response tendencies.

Sexual behavior that is "out of control": a theoretical conceptual approach.

At this stage of our knowledge, it seems reasonable to assume that out-of-control sexual behavior results from a variety of etiological mechanisms associated with different behavioral patterns that share Goodman's two key features of addictive behavior: (1) a recurrent failure to control the sexual behavior; and (2) continuation of the behavior despite harmful consequences. Any overriding definition relevant to clinical management seems premature until we better understand the various patterns and their likely determinants. The concepts of "compulsivity" and "addiction" may have explanatory value in some cases, but are not helpful when used as general terms for this class of behavior problem. Stein and colleagues suggested that, in these circumstances, we use the term "hypersexuality." In my opinion, out-of-control sexual behavior or "impulse control disorders" as proposed by Barth and Kinder are more appropriate nonspecific terms because they focus on the issue of control rather than on high levels of sexuality. A number of clinically relevant and researchable hypotheses need to be addressed in further research, which hopefully will lead to more etiologically or therapeutically relevant subcategories of out-of-control sexual behavior.

The effects of oral contraceptives on androgen levels and their relevance to premenstrual mood and sexual interest: a comparison of two triphasic formulations containing norgestimate and either 35 or 25 microg of ethinyl estradiol.

PURPOSE: This study compared two oral contraceptives (OCs) with the same triphasic regimen of progestin (norgestimate 0.18, 0.215 and 0.25 mg) but differing doses of ethinyl estradiol (EE) - 25 and 35 microg EE - in their effects on androgens, mood and sexual interest in women starting on OCs. METHODS: Total testosterone (T), free testosterone (FT), sex-hormone-binding globulin (SHBG) and dehydroepiandrosterone sulphate (DHEA-S), together with measures of mood [Beck Depression Inventory (BDI)], sexual interest [Dyadic and Solitary subscales of the Sexual Desire Inventory (SDI)] and self-reported side effects were assessed before starting on the OC and again after 3 months of use. RESULTS: Sixty women, all university students, were randomized to receive either the 25 microg EE (N/EE25) or the 35 microg EE (N/EE35) pill; 12 women discontinued, leaving 48 who completed the 3-month study. Their mean age was 19.7 years (18-30) and they were predominantly white and single. Both OCs produced reductions in mean T [N/EE35: from 1.33 to 0.60 nmol/L, p<.001; N/EE25: from 1.12 to 1.02 nmol/L; nonsignificant (NS)] and FT (N/EE35: from 41.3 to 4.4 pmol/L, p<.001; N/EE25: from 25.4 to 7.9 pmol/L, p<.01), but the reduction in both T and FT was significantly greater with the higher EE dose (N/EE35) (p=.05 and p=.03, respectively). DHEA-S was also reduced with both formulations (N/EE35: from 7.26 to 5.22 micromol/L); N/EE25: from 7.50 to 5.39 micromol/L), although the reduction was only significant in the N/EE35 group (p<.02). Considerable variability in changes in mood was evident with both OCs, with some women showing predominantly negative effects (10 in N/EE35, 5 in N/EE25); others, positive effects (9 in N/EE35, 17 in N/EE25) and some, no change (four in each group). Women using N/EE25 were significantly more likely to show improvement in premenstrual mood than those in the N/EE35 group (p<.02), although there was no correlation between changes in BDI and FT or DHEA-S. Sexual interest scores did not change significantly from baseline to posttreatment with either OC (N/EE35: dyadic, from 40.5 to 39.6, NS; solitary, from 5.9 to 6.4, NS; N/EE25: dyadic, from 36.7 to 37.0, NS; solitary, from 5.0 to 4.2, NS). CONCLUSION: The lower EE pill reduced FT less and was associated with greater improvement in premenstrual mood. A causal relation between these two effects is uncertain.

Does oral contraceptive-induced reduction in free testosterone adversely affect the sexuality or mood of women?

The aim of this study was to examine whether changes in plasma androgen levels (total testosterone (T), free testosterone (FT), and dehydro-epiandrosterone-sulfate (DHEA-S)) induced by oral contraceptive (OC) use were related to changes in sexual interest or response or in mood. Sixty-one women provided blood samples and were assessed, using interviews and standardized questionnaires, prior to starting, and after 3 months on OCs (Ortho-Tricyclen, Ortho-Tricyclen-Lo, or Ortho-Cyclen, all containing the same progestagen, norgestimate). Significant decreases in T, FT, and DHEA-S were found after 3 months, although the extent of reduction was variable across women. There was some support for a relationship between the degree of reduction in total T and FT and the frequency of sexual thoughts after 3 months on OCs. However, some women had no loss of sexual interest in spite of substantial reduction in FT, and there was overall no evidence that reduction in FT affected enjoyment of sexual activity with a partner. The findings are consistent with the idea that some women may be more sensitive to changes in T than others. No relationship was found between negative mood, as assessed by the Beck Depression Inventory, and changes in T, FT, or DHEA-S.

The prevalence of suspected Barrett's esophagus in children and adolescents: a multicenter endoscopic study.

BACKGROUND: The prevalence of Barrett's esophagus (BE) in young individuals is unclear. OBJECTIVE: To estimate the prevalence of suspected BE in children and adolescent patients undergoing endoscopy. DESIGN: A retrospective cross-sectional study. SETTING: Prospectively collected data in the Pediatric Clinical Outcomes Research Initiative (PEDS-CORI). PATIENTS: We identified patients younger than 20 years of age with suspected BE in the PEDS-CORI between 1999 and 2002; the corresponding histopathologic records were examined. MAIN OUTCOME MEASUREMENTS: We analyzed the distribution of demographic and endoscopic risk factors for BE between cases and non-cases with and without suspected BE in bivariate and multivariable analyses. RESULTS: We identified a total of 6731 patients who underwent upper endoscopy in 12 pediatric facilities. Only 17 patients had suspected BE (prevalence, 2.5 per 1000). Intestinal metaplasia was reported in only 9 of these patients (53%). Patients with suspected BE were older than patients without BE (median 14.7 vs 10.1 years; P = .011). Hiatus hernia was more commonly recorded in patients with suspected BE (11.8% vs 2.2%; P = .008). In a logistic regression model, both older age (odds ratio [OR] 1.13, 95% confidence interval [CI] 1.02-1.35) and hiatus hernia (OR 4.62, 95% CI 1.03-20.66) were independently associated with suspected BE. CONCLUSIONS: Endoscopically suspected BE is rare (<0.25%) in children and adolescents. Older age and the presence of hiatus hernia are possible risk factors for BE in this group. LIMITATIONS: Lack of standardization for identifying and recording endoscopic landmarks.

Psychological and interpersonal correlates in men with erectile dysfunction and their partners: a pilot study of treatment outcome with sildenafil.

The role of psychological and interpersonal factors in the treatment of erectile dysfunction (ED) with sildenafil or other oral therapies has not been sufficiently investigated. We conducted a pilot study of psychosocial predictors of pharmacotherapy treatment outcome and satisfaction in men with ED and their partners. Sixty-nine men with mild to moderate ED and their partners were enrolled in a multicenter, open-label, treatment trial with sildenafil. Treatment measures included a battery of validated self-report measures and questionnaires. Subjects also were interviewed according to a semistructured interview protocol. Partner assessments included self-report measures of sexual function, mood, and relationship satisfaction. Results indicated that, prior to treatment, patients had erectile function scores in the range of mild to moderate ED, with relatively low levels of concomitant depression, anxiety, and psychological stress and high overall levels of relationship adjustment. Partner sexual function was in the normal range of total Brief Index of Sexual Functioning for Women (BISF-W; Taylor, Rosen, Leiblum, 1994) scores, although more than one third of female partners had specific sexual complaints or problems. Among couples who completed one or both follow-up visits (N = 34), sildenafil treatment resulted in significant improvements in all aspects of sexual function in men, including sexual desire, orgasmic function, erectile function and overall sexual satisfaction. Significant improvements also were noted in partners' ratings of sexual function in most domains, including arousal, pleasure, and orgasm. Higher baseline levels of sex-specific anxiety were negatively associated with improvement in erections following treatment. Relationship adjustment at baseline, contrary to expectations, did not predict erectile or sexual satisfaction following treatment in the men or their partners but was significantly correlated with changes in sexual desire. Baseline levels of depression, anxiety, and stress generally were unrelated to efficacy or treatment satisfaction. However, we observed a curvilinear relationship in the men between baseline levels of stress and treatment discontinuation (i.e., subjects with moderate levels of stress were less likely to discontinue treatment). Because of a high number of dropouts, results of this pilot study await confirmation in a larger and more adequately powered clinical trial.