Interplay between sexual excitation and inhibition: impact on sexual function and neural correlates of erotic stimulus processing in women.

Background: As outlined by the dual control model (DCM), individual differences in the regulation of sexual arousal following sexual stimulation depend on two distinct neurophysiological processes: sexual excitation (SE) and sexual inhibition (SI). Although associations with sexual function, behavior, and cue processing have been demonstrated in previous research, underlying neural correlates remain insufficiently explored. Moreover, interactive effects of SE/SI as proposed by the DCM, as well as factors impacting SE/SI properties, such as the use of oral contraceptives (OCs), have not received adequate attention in existing research. Methods: 90 healthy, sexually active women (n = 51 using OCs, n = 39 naturally cycling) completed an Emotional-Picture-Stroop-Paradigm (EPSP) while a 64-channel EEG was recorded. LPP amplitudes toward erotic and neutral stimuli were consecutively computed as a marker of motivational salience and approach motivation. Additionally, women provided self-reports of SE/SI and sexual function. Moderation analyses were performed to assess interactive effects of SE/SI in predicting LPP amplitudes and sexual function. Results: Sexual function was negatively associated with SI levels but unrelated to SE. Higher SI was associated with reduced LPP amplitudes in response to erotic stimuli. This negative association was, however, attenuated for women high in SE, suggesting interactive effects of SE/SI. Furthermore, women using OCs reported lower SE compared to naturally cycling women. Conclusion: The observed findings provide additional psychophysiological evidence supporting the DCM and underscore the relevance of interactive SE/SI effects in stimulus processing and approach motivation. They also highlight the possible impact of OCs on psychosexual variables that warrants further research.

Acute ethanol disrupts conditioned inhibition in the male rat.

RATIONALE: Alcohol can disrupt conditioned sexual inhibition (CSI) established by first-order conditioning in male rats. CSI can also be induced using second-order conditioning, during which male rats are trained to associate a neutral odor with a nonreceptive female. As a result, when given access to two receptive females (one scented and one unscented) during a copulatory preference test, they display CSI toward the scented female. OBJECTIVE: The present study examined the effect of low-to-moderate doses of alcohol on CSI and brain activation following exposure to alcohol and the olfactory cue alone. METHODS: Sexually-naïve Long-Evans rats received alternate conditioning sessions with unscented receptive or scented (almond extract) non-receptive females. Following the conditioning phase, males were injected with saline, alcohol 0.5 g/kg or 1 g/kg, 45 min before a copulatory test with two receptive females, with one bearing the olfactory cue. Fos activation was later assessed, following exposure to alcohol and the olfactory cue alone, in several brain regions involved in the expression and regulation of male sexual behavior. RESULTS: While males in the saline group displayed sexual avoidance towards the scented female, those injected with alcohol before the copulatory test, regardless of the dose, copulated indiscriminately with both females. Subsequent exposure to alcohol and the olfactory cue alone induced different Fos expression between groups in several brain regions. CONCLUSIONS: Low to moderate doses of alcohol disrupt conditioned sexual inhibition in male rats and induce a differential pattern of neural activation, particularly in regions involved in the expression and regulation of sexual behavior.

The behavioral component of sexual inhibition and its relation with testosterone levels: An fMRI study in transgender and cisgender individuals.

Many transgender individuals report having difficulties with initiating and seeking sexual contacts. Relatively to cisgender individuals, transgender individuals are more likely to avoid sexual activity, indicating that the groups might differ in the neural underpinnings of the behavioral component of sexual inhibition. In this fMRI study, transgender (n = 33) and cisgender (n = 34) participants performed an Approach Avoidance Task (AAT) assessing sexual inhibition. We found that over the entire sample, the task elicited brain activation commonly associated with general and sexual inhibition, for instance in the bilateral insula, right inferior parietal lobule, and right inferior and middle frontal gyri. Upon investigating group differences between transgender and cisgender participants, we mainly found similarities in neural activation during the task. However, there were group differences in regions involved in decision making processes (left middle temporal gyrus) and sexual response inhibition (right anterior cingulate cortex and left inferior parietal lobule). In order to investigate whether these group differences were modulated by testosterone levels, we performed ROI-analyses assessing the relationship between testosterone and neural activation during the AAT (controlling for sex assigned at birth), but no correlations were found. On the whole brain level, however, we found that testosterone correlated positively with cerebral activation in the right claustrum (a region associated with sexual arousal) during the approach of sexual stimuli in the transgender group. Overall, these findings indicate that transgender and cisgender individuals mostly show similarities in their neural response to a sexual Approach-Avoidance task, and that testosterone levels are unlikely to play an important role.

Validity and Reliability Evidence and Norms for the Spanish Version of the Sexual Inhibition/Sexual Excitation Scales-Short Form / Evidencias de Validez y Fiabilidad y Baremos de la Versión Española de las Sexual Inhibition/Sexual Excitation Scales-Short Form

Background: The Sexual Inhibition/Sexual Excitation Scales-Short Form (SIS/SES-SF) is a brief instrument for assessing the propensity for sexual excitement and inhibition in men and women. The aim of the present study was to provide evidence for the validity and reliability of the Spanish version of the SIS/SES-SF scores by examining invariance, reliability (information function and internal consistency), the relationship between the scores and sexual functioning, and presenting its standard scores. Method: A total of 2,223 Spanish heterosexuals (43.41% men and 56.59% women) aged 18 to 83 years (M = 39.94, SD = 11.95), distributed across age groups (18-34, 35-49, ≥ 50 years old) participated. Results: The three-factor structure of the Spanish version of SIS/SES-SF showed weak measurement invariance by sex and strict measurement invariance by age. The scores explained the dimensions of sexual functioning, especially sexual arousal and erection/lubrication. In addition, men and women without difficulties in sexual functioning demonstrated more propensity for sexual excitation and less sexual inhibition. The standard scores are presented by sex and age group. Conclusions: The study provides evidence of the validity and reliability of the SIS/SES-SF measures, confirming its usefulness for assessing propensity to sexual excitation and inhibition.(AU)

Antecedentes: Las Sexual Inhibition/Sexual Excitation Scales-Short Form (SIS/SES-SF) son un instrumento breve que evalúa, en hombres y mujeres, la propensión hacia la excitación e inhibición sexual. El objetivo fue aportar evidencias de validez y fiabilidad a las puntuaciones de la versión española de SIS/SES-SF, examinando la invarianza, la fiabilidad (función de información y consistencia interna), la relación de sus puntuaciones con el funcionamiento sexual, y presentar sus puntuaciones estandarizadas. Método: Participaron 2.223 españoles heterosexuales (43,41% hombres y 56,59% mujeres) de 18 a 83 años (M = 39,94; DT = 11,95), distribuidos en tres grupos de edad (18-34, 35-49, ≥ 50 años). Resultados: La estructura trifactorial de la versión española de SIS/SES-SF mostró nivel de invarianza débil por sexo y estricto por edad. Sus puntuaciones explicaron las dimensiones del funcionamiento sexual, especialmente excitación sexual y erección/lubricación. Además, hombres y mujeres sin dificultades en el funcionamiento sexual mostraron más propensión a la excitación sexual y menor inhibición sexual. Se presentan baremos de sus puntuaciones por sexo y grupos de edad. Conclusiones: Se aportan adecuadas evidencias de validez y fiabilidad a las medidas de SIS/SES-SF, lo que confirma la utilidad de este instrumento para evaluar la propensión a la excitación e inhibición sexual.(AU)

Couples' sexual health after gynaecological cancer diagnosis - an unexplored area for further research.

Introduction: The aim of the study was to assess the sexual inhibitory tone, body image, self-concept, and sexual performance in couples after gynaecological cancer treatment, and to identify areas for further prospective studies. Material and methods: Thirty gynaecological cancer survivors with a heterosexual partner were assessed during a semi-structural sexual interview. Sexual excitation/sexual inhibition scales were used to evaluate proneness to sexual stimuli, whereas a body exposure during sexual activity questionnaire was used to assess body avoidance during sex. Self-concept in cancer survivors was evaluated by a sexual self-scheme scale. The differences in sexual needs, satisfaction, and sexual activity were comped between women and their partners. Results: In survivors and their partners the sexual inhibitory tone was higher than the excitatory tone - 3.91 and 2.45 vs. 2.97 and 2.31, respectively. Most women were schematic-positive and co-schematic - 46.7% and 40.0%, respectively. The decrease in importance of sex was higher in women compared to their partners (D change -0.88 and -0.22, respectively). The frequency of satisfying sex decreased after treatment in women but increased in their partners - D change: -1.04 and +2.94, respectively. Satisfaction with sexual life and quality of relationship improved or did not change after cancer diagnosis in women. None of the sexual response elements were changed by the cancer diagnosis in partners. Conclusions: In cancer survivors with a sexual partner, both people should be carefully counselled because there are some important differences in perception of sexual needs within the couple. Avoiding body exposure during sex and differences in proneness to sexual stimuli should be explored in further studies.

Hypo- or hyperfunction? Differential relationships between compulsive sexual behavior disorder facets and sexual health.

BACKGROUND: Previous studies linking compulsive sexual behavior disorder (CSBD) and sexual health have shown mixed results, which could be due to the fact that different CSBD facets may have differential relationships with sexual functioning. AIM: As CSBD is a multidimensional disorder, we wanted to investigate whether distinct CSBD domains are differentially related to sexual health. METHODS: Two online studies were conducted-the first on a convenience sample (812 Polish participants; mean [SD] age, 22.07 [5.91] years) and a replication study on a representative sample of Polish adults (n = 1526; 43.02 [14.37]). Hierarchical regression was employed with sexual functioning as a predicted variable and CSBD symptoms as predictors. OUTCOMES: The Compulsive Sexual Behavior Disorder Scale was used to assess CSBD symptoms, and the Arizona Sexual Experience Scale was used to measure sexual dysfunction. RESULTS: In study 1, CSBD salience (ß = -.20, P < .001) predicted hyperfunction (ie, stronger sex drive, easier sexual arousal, easier vaginal lubrication/penile erection, easier ability to reach an orgasm, and more satisfying orgasms). Yet, CSBD negative consequences (ß = .15, P = .001) and dissatisfaction (ß = .22, P < .001) predicted hypofunction (ie, weaker sex drive, more difficulties in sexual arousal, greater difficulties in vaginal lubrication/penile erection, less ability to reach an orgasm, and less satisfying orgasms). Similar results were found in study 2: salience (ß = -.26, P < .001) and relapse (ß = -.11, P = .004) predicted hyperfunction, while negative consequences (ß = .12, P < .001) and dissatisfaction (ß = .12, P < .001) predicted hypofunction. CLINICAL IMPLICATIONS: Our results stress the importance of assessing the severity of each group of symptoms in patients with CSBD to better understand possible difficulties in their sexual functioning. STRENGTHS AND LIMITATIONS: Our studies are the first to evaluate the effects of each CSBD domain on sexual health. We also replicated results obtained from a convenience sample on a representative sample. The cross-sectional design of the current studies does not allow causal relations to be tested, so future longitudinal research should be carried out. We also gathered data from a general population-thus, it is important to replicate these results on patients diagnosed with CSBD. CONCLUSION: Our research points out the differential impact of CSBD domains on sexual health: salience and relapse are related to sexual hyperfunction, while negative consequences and dissatisfaction to hypofunction.

The nucleus accumbens dopamine increase, typically triggered by sexual stimuli in male rats, is no longer produced when animals are sexually inhibited due to sexual satiety.

RATIONALE: Exposure of male rats to an inaccessible receptive female and copulation increases dopamine (DA) levels in the nucleus accumbens (NAcc). Males copulating to satiety become sexually inhibited and most of them do not display sexual activity when presented with a sexually receptive female 24 h later. This inhibitory state can be pharmacologically reversed. There are no studies exploring NAcc DA levels during this sexual inhibitory state. OBJECTIVES: To characterize changes in NAcc DA and its metabolites' levels during sexual satiety development, during the well-established sexual inhibitory state 24 h later, and during its pharmacological reversal. METHODS: Changes in NAcc DA and its metabolites were measured in sexually experienced male rats, using in vivo microdialysis, during copulation to satiety, when presented to a new sexually receptive female 24 h later, and during the pharmacological reversal of the sexual inhibition by anandamide. RESULTS: NAcc DA levels remained increased during copulation to satiety. DA basal levels were significantly reduced 24 h after copulation to satiety, as compared to the initial basal levels. Presenting a receptive female behind a barrier 24 h after satiety did not induce the typical NAcc DA elevation in the sexually satiated males but there was a decrease that persisted when they got access to the female, with which they did not copulate. Anandamide injection slightly increased NAcc DA levels coinciding with sexual satiety reversal. CONCLUSIONS: Reduced NAcc DA concentrations coincide with the inhibition of an instinctive, natural rewarding behavior suggesting that there might be a DA concentration threshold needed to be responsive to a rewarding stimulus.

The Risks and Benefits of Being "Early to Bed": Toward a Broader Understanding of Age at Sexual Debut and Sexual Health in Adulthood.

BACKGROUND: A younger age at sexual intercourse has frequently been linked to adverse sexual health outcomes. Yet, little is known about its associations with healthy sexual function, and less still about the timing of pre-coital sexual debuts and adult sexual health. AIM: We examined associations between an earlier sexual debut and subsequent sexual health, using broad operationalizations of each that capture pre-coital experiences and positive outcomes. Connections to sexual health risk and healthy sexual function were assessed through the lens of the dual-control model of sexual response. METHODS: Data on age at first sexual intercourse, first sexual contact, first sexual stimulation, and first orgasm, as well as sexual health risk and healthy sexual function were gathered from 3,139 adults. OUTCOMES: Adverse sexual events (reproductive illness, infection, or injury affecting sexual activity; pregnancy termination and/or loss; non-volitional sex) and current sexual difficulties (Female [FSFI] and/or Male Sexual Function Index [MSFI] scores; Sexual Excitation and/or Sexual Inhibition Inventory for Women and Men [SESII-W/M] scores). RESULTS: When defined narrowly as first sexual intercourse, earlier sexual debut was associated with adverse sexual events, including non-volitional sex, pregnancy termination and/or loss, and reproductive illness, infection, or injury affecting sexual activity. However, it was also related to healthier sexual function, including less pain during vaginal penetration, better orgasmic functioning, and lower sexual inhibition. When sexual debut was broadened to include pre-coital experiences, earlier sexual contact, like earlier sexual intercourse, was associated with non-volitional sex. However, earlier sexual stimulation and orgasm were unrelated to adverse outcomes. Rather, these related to fewer sexual desire difficulties, and greater sexual excitation. Exploratory mediation analyses revealed later sexual intercourse and orgasm were connected to sexual difficulties through higher sexual inhibition and lower sexual excitation, respectively. CLINICAL IMPLICATIONS: When sexual functioning is impaired, delay of both coital and noncoital debuts may warrant assessment, and sexual excitation and inhibition may be targets for intervention. To facilitate healthy sexual development of young people, non-coital debuts with and without a partner may warrant inclusion in risk management and health promotion strategies, respectively. STRENGTHS & LIMITATIONS: Although this research operationalized sexual debut and sexual health broadly, and examined associations between them, it is limited by its cross-sectional retrospective design and non-clinical convenience sample. CONCLUSION: From a risk-based perspective, earlier sexual intercourse is adversely related to sexual health. Yet, it is also associated with healthy sexual function. Indeed, earlier sexual initiation may confer more benefits than risks when sexual debuts beyond intercourse are considered. Peragine DE, Skorska MN, Maxwell JA, et al. The Risks and Benefits of Being "Early to Bed": Toward a Broader Understanding of Age at Sexual Debut and Sexual Health in Adulthood. J Sex Med 2022;19:1343-1358.

Individual Differences in Testosterone and Self-Control Predict Compulsive Sexual Behavior Proneness in Young Males.

The ability to control sexual urges and impulses is essential to achieve individual and social harmony. Failing to regulate sexual behavior can lead to the interference with daily life goals, sexual diseases transmission and moral violations, among others. The dual control model of sexual response proposes that an imbalance between sexual excitation and sexual inhibition mechanisms may lead to sexual dysregulation, thereby explaining problematic sexual behavior. Interindividual differences in self-control and testosterone levels are likely to modulate sexual regulation mechanisms, but these individual features have scarcely been studied in the context of compulsive sexual behavior. This study investigated the role of sexual excitation and inhibition, self-control and testosterone levels in predicting individuals' proneness to display compulsive sexual behavior. Seventy healthy young males provided a saliva sample for testosterone measurements and filled in questionnaires on self-control, sexual excitation, sexual inhibition, sexual compulsivity and sexual behavior. High testosterone levels and low self-control were associated with higher sexual compulsivity scores. Additionally, testosterone levels and sexual inhibition negatively predicted the frequency of sexual behavior with a partner. The results of our study highlight the joint role of psychological traits and testosterone levels in compulsive sexual behavior proneness, providing implications regarding the prevention and treatment of this condition in young males.

Analysis of Sexual Inhibition and Satisfaction from a Gender Perspective among University Students.

University is characterized by a critical stage where students experience their sexuality, across a range of relationships. From these experiences, university students consolidate their personality and their sexual role. Factors such as age, sex, or traumatic experiences of violence or sexual abuse can affect their sexual role. The present study aims to analyze how the variables age, sex and having suffered abuse or violence may predict sexual satisfaction and inhibition. In addition, we analyze the mediating effect that sexual role plays on these relationships. For this purpose, Bem Sex Role Inventory (BSRI-12), Sociosexual Orientation Inventory (SOI-R), Inhibited Sexual Desire Test (ISD) and New Sexual Satisfaction Scale (NESS) were administered to 403 university students. The findings report that sex (ß = -0.313), age (ß = -0.116) and being a survivor of sexual assault (ß = 0.413) are predictive of male role, but not from the female role. Also, people with more male features tend to have lower levels of commitment and inhibition than those who have more female ones.

Validation of the Sexual Inhibition/Sexual Excitation Scales (SIS/SES) in Italy: Assessing Gender and Age Differences of Sexual Functioning.

The Sexual Inhibition Scales and Sexual Excitation Scales (Janssen et al., 2002a), based on the dual control model by Bancroft and Janssen (2000), are part of a 45-item self-report questionnaire evaluating individual tendencies to sexual inhibition or excitation according to three factors: two inhibition factors, SIS1, threat of performance failure, and SIS2, threat of performance consequences, and one excitation factor, SES. In this paper, we aimed to validate and explore psychometric properties of the SIS/SES in a sample of 2260 Italian men and women aged 18 to 75 years. Confirmatory factor analyses showed that the three-factor structure proposed in the original version of the scales fit with our sample. Moreover, our data confirmed the results of the original validation sample: Women scored higher on the SIS and lower on the SES than men did, but no significant differences appeared in the factor scores by age group, except for a gender × age interaction, where younger women had higher SIS2 scores. The SIS/SES appeared to be an effective, appropriate cross-cultural measurement of human sexuality in Italian samples, also shedding light on sexual arousal differences in women and men in our country. We also discuss clinical and therapeutic aspects.

Sexual Inhibition and Sexual Excitation Scales in Men: Psychometric Properties of a Polish Adaptation.

The present study aimed to develop a Polish version of the Sexual Inhibition/Sexual Excitation Scale (SIS/SES-PL) and explore its psychometric validity in a sample of 498 men aged between 18 and 55 years. We used exploratory and confirmatory factor analyses to obtain the best model fit. Out of the 45 items in the original scale, 32 items with eight subscales and three higher-order factors: (sexual excitation [SES], sexual inhibition due to performance failure [SIS1], and sexual inhibition due to performance consequences [SIS2]) were included in the SIS/SES-PL. The SIS/SES-PL was found to have a good and satisfactory fit (comparative fit index = .87; Tucker-Lewis Index = .85; root mean square error of approximation = .054; χ2 = 1108.7; p < .001; test-retest reliability Cronbach's alpha = .93). A small correlation between age and the SIS1 and SIS2 scores was detected. However, forward multiple regression analysis revealed a significant correlation only between age and SIS1 [ß = .23, p < .001, R2 for model = .05; F(1, 494) = 27.52, p < .001]. Furthermore, a moderate correlation between SIS1 and SES2, as well as SIS1 and general inhibition properties (measured using the Behavioral Inhibition Scale), was noted. In the case of SIS2, only small effects were observed, with the highest values for engaging in risky sexual behavior. Out of the total number of 42 variables, a moderate correlation between SES and the following was described: importance of sex, hypersexual behaviors, frequency of masturbation, frequency of sexual activities per month, sexual risk-taking, high promiscuity (measured using the Sociosexual Orientation Inventory Revised-Drive), general activation properties (measured using the Behavioral Activation Scale), neuroticism, and erotophilic tendencies (measured using the Sexual Opinion Survey-Short Form). The results of the study allowed us to conclude that the SIS/SES-PL might be a useful tool for tailoring therapy for men with sexual problems, as well as in the field of clinical research on sexual inhibition and excitation. Furthermore, it is a reliable and useful tool for measuring propensities for sexual excitement and inhibition.

Preliminary Evidence on How the Dual Control Model Predicts Female Sexual Response to a Bogus Negative Feedback.

The Dual Control Model of sexual response has been mostly tested with men. As such, there is a lack of evidence on how such model applies to women's experience of sexual arousal, particularly when they face a threatening situation such as the threat of sexual performance failure. The aim of the current study was to test whether the Dual Control Model dimensions predict women's sexual responses to a bogus negative feedback about their sexual performance. In addition, 22 women were exposed to a sexually explicit film clip, while their genital arousal was being measured. During this presentation, a bogus negative feedback, aimed at increasing women's anxiety about their sexual performance, was provided. Vaginal photopletismography and self-report questions were used as means to evaluate women's genital and subjective sexual arousal, respectively. The Sexual Excitation/Sexual Inhibition Inventory for Women was further used to capture women's sexual dynamics. Regression analysis on the high-order factors revealed that sexual excitation proneness was the only predictor of the subjective sexual responses, while none of the factors has predicted genital arousal. "Arousability" and "Concerns about sexual function" dimensions predicted subjective sexual arousal. Sexual arousability may prevent women of lowering their subjective sexual responses in a sexually demanding situation, while "Concerns about sexual function" may have the opposite role, thus being a target of clinical interest. This work provides new data on the Dual Control Model of sexual response, and particularly on its role in women's sexual functioning.

The Modulatory Role of Cortisol in the Regulation of Sexual Behavior in Young Males.

The proneness to be sexually aroused, to perform sexual acts, or to be sexually disinhibited during a particular mood varies across individuals. However, the physiological mechanisms underlying this specific and variable relationship between mood and sex-related processes are poorly understood. We propose that cortisol may act as an important moderator in this as it has shown to influence sexual arousal and to play a neuromodulatory role during emotion regulation. Here, we conducted a functional magnetic resonance imaging study in a sample of young males to investigate whether cortisol modulates the neural response during the approach of sexual stimuli in an approach-avoidance task and whether this potential relationship explains the individual differences in sexual inhibition and in mood-related sexual interest and activity. We revealed that cortisol associates with the anteromedial prefrontal cortex activation during the approach towards sexual stimuli. Moreover, this anteromedial prefrontal cortex response was dependent on individual differences in sexual inhibition and the improvements of negative mood as a result of sexual activity. The anteromedial prefrontal cortex is already known to process bottom-up information, reward, and risk estimation. The neuromodulatory role of cortisol within this region during sexual approach may represent a previously unknown yet key element in the regulation of sexual behavior in young males.

Cognitive-Affective Factors and Female Orgasm: A Comparative Study on Women With and Without Orgasm Difficulties.

BACKGROUND: Orgasmic difficulties are one of the most common sexual complaints among women. Although models of sexual dysfunction propose that cognitive-affective factors are involved in the development and maintenance of sexual difficulties, there is a need to further examine how these factors are associated with orgasmic difficulties specifically. AIM: To analyze differences between women who reported orgasm difficulties and controls in regard to sexual inhibition, sexual excitation, sexual beliefs, as well as negative automatic thoughts and affect during sexual activity. METHODS: A total of 500 women, aged 18 to 72 years, completed a Web survey focused on cognitive-affective factors and sexual health. Two hundred fifty women reported orgasm difficulties and were compared with 250 age-matched women who reported no sexual difficulties. OUTCOMES: Differences between groups regarding sexual inhibition and sexual excitation (Sexual Inhibition/Sexual Excitation Scales-Short Form), sexual beliefs (Sexual Dysfunctional Beliefs Questionnaire), negative automatic thoughts (Automatic Thoughts Subscale of the Sexual Modes Questionnaire), and affect (Positive and Negative Affect Schedule) during sexual activity. RESULTS: Women with orgasm difficulties scored higher on sexual inhibition than controls. They also reported more negative automatic thoughts during sexual activity (concerning failure and disengagement, sexual abuse, lack of affection from partner, passivity, body image) and less erotic thoughts. Women with orgasm difficulties reported experiencing higher negative affect and lower positive affect during sexual activity than women who reported no sexual difficulties. No significant differences were found regarding sexual excitation and endorsement of sexual beliefs. CLINICAL IMPLICATIONS: Helping women shift their focus from non-erotic, negative thoughts to erotic stimuli, as well as addressing sexual inhibition, can be relevant targets of interventions aimed at women's orgasm difficulties. STRENGTHS & LIMITATIONS: Strengths of the study include the use of a large sample of women who reported orgasm difficulties, offering new insights into the clinical importance of these psychological processes. Limitations include the reliance on self-report measures and a relatively homogeneous sample regarding sexual orientation, education, and age. CONCLUSION: Results highlight the role of cognitive-affective factors on women's orgasm difficulties and emphasize the potential benefit of cognitive-behavioral and/or mindfulness interventions for orgasm difficulties. Moura CV, Tavares IM, Nobre PJ. Cognitive-Affective Factors and Female Orgasm: A Comparative Study on Women With and Without Orgasm Difficulties. J Sex Med 2020;17:2220-2228.

Endocannabinoids mediate long-lasting behavioural and physiological changes in male rats induced by the repeated activation of the mesolimbic system by copulation to satiety.

Sexually satiated male rats exhibit long-lasting physiological changes, suggestive of brain plasticity, the most conspicuous of which are a sexual behaviour inhibition and a generalised drug hypersensitivity. Copulation activates the mesolimbic circuit increasing dopamine (DA) release in the nucleus accumbens (NAcc) and, enhanced midbrain DA neuron activity promotes endocannabinoid (eCB) release in the ventral tegmental area (VTA). The objective of this work was to explore the possible participation of DA and/or eCB transmission in the induction of these two long-lasting phenomena. To this aim we analysed the effect of blocking DA or CB1 receptors during the process of copulation to exhaustion, on the expression 24 h later, of the sexual inhibitory state and the hypersensitivity to two different drugs: 8-OH-DPAT, a 5-HT1A receptor agonist, and yohimbine, an α2-adrenoceptor antagonist. Blockade of DA receptors failed to prevent these phenomena, while blockade of CB1 receptors interfered with the appearance of the sexual inhibition and the hypersensitivity to both drugs in the sexually satiated animals. Specific blockade of CB1 receptors in the VTA during copulation to satiety mimicked these results, suggesting that both eCB-mediated effects were exerted in this brain region. It is concluded that eCBs play a role in the induction of behavioural and physiological changes, triggered by copulation to satiety, by acting at the VTA, while increased NAcc DA levels appear not to contribute to the changes induced by intense copulation. Results pose sexual satiety as a useful model for the study of brain plasticity phenomena induced by natural rewards.

Dual Control Model in a Cross-Cultural Context: Role of Sexual Excitation in Sexual Response and Behavior Differences Between Chinese and Euro-Caucasian Women in Canada.

Chinese women in Western nations frequently report less engagement with sexuality, such as lower sexual response and behaviors, and more restrictive sexual attitudes, than their Euro-Caucasian peers. This difference is likely related to sexual conservatism within traditional Chinese culture, though the mechanisms underlying how culture influences sexual responding are not well understood. The current study investigated if these differences were consistent with the dual control model, a well-established model for understanding regulation of sexual response. Chinese and Euro-Caucasian women (N = 471; age M = 20.7 years, SD = 3.3) residing in Canada from a university sample completed self-report questionnaires on sexual excitation and inhibition, sexual attitudes, and various sexual response and behavior measures. Sexual excitation was significantly lower in Chinese than Euro-Caucasian women and was significantly associated with sexual response in both groups. Structural equation modeling showed that sexual response variables were associated with a latent sexual excitation factor and that sexual attitudes partially mediated the relationship between this latent factor and ethnicity. The findings showed that sexual excitation and sexual attitudes contribute to cross-cultural differences in women's sexual responding. Theoretical and clinical considerations are discussed.

A Validation Study of the German Version of the Sexual Inhibition/Sexual Excitation Scales-Short Form.

The dual control model of human sexual behavior proposes that sexual responses involve an interaction between sexual excitatory and sexual inhibitory systems. The Sexual Inhibition/Sexual Excitation Scales (SIS/SES; Janssen, Vorst, Finn, & Bancroft, 2002) as well as its short form (SIS/SES-SF; Carpenter, Janssen, Graham, Vorst, & Wicherts, 2011) assess individual propensities to become sexually excited and sexually inhibited. The present study utilized a dataset of 2221 German-speaking adults (n = 1214 women and n = 987 men) to examine the psychometric properties of the German version of the SIS/SES-SF. The results of the confirmatory factor analysis indicated that the three factors suggested in the original version can be generally replicated within the current study. Analyses of measurement invariance for gender revealed that the general three-factor structure as well as factor loadings can be regarded as equal for men and women. However, scalar invariance could not be fully obtained, indicating that the intercepts of some items were different for men and women. Taken together, the results of the presents study provide further evidence for the psychometric properties of the German version of the SIS/SES-SF.

Sexual Dysfunctions and Their Association with the Dual Control Model of Sexual Response in Men and Women with High-Functioning Autism.

Adults with an Autism Spectrum Disorder (ASD) are characterized by impairments in social interaction and communication, repetitive and stereotyped interests and behaviours as well as hyper- and/or hyposensitivities. These disorder specific symptoms could be associated with the development of sexual disorders. The Dual Control Model of Sexual Response presents one approach that is frequently used to explain the emergence of sexual dysfunctions. The aim of the present study was to assess the extent of symptoms of sexual dysfunctions in men and women with ASD and to evaluate their association with the individual propensity of sexual excitation and inhibition as defined by the Dual Control Model. Both men and women with ASD were more likely to report about sexual dysfunctions than individuals from the control group. In men with ASD, sexual inhibition was significantly correlated with the emergence of sexual dysfunctions, while there was no association between sexual functioning and sexual excitation. In women, the opposite pattern was found. Especially the peculiarities in sensitive perception could be responsible for the observed problems with sexual functioning in individuals with ASD. The present findings highlight the great need for specialized treatment programs addressing the frequently observed sexuality-related problems in individuals with ASD. However, up to now such treatment programs are lacking.

Temporal Stability of Sexual Excitation and Sexual Inhibition in Women.

The dual control model of sexual response proposes two factors, sexual excitation (SE) and sexual inhibition (SI), that aim to predict sexual behavior and response. While SE and SI are described as stable traits that influence sexuality-related outcomes such as sexual function or sexual risk taking, only a few studies have presented data on the stability of these factors. The aim of this study was to evaluate the temporal stability of SE and SI, and to investigate whether changes in sexual function or partnership status influence SE and SI in a longitudinal sample of women. To address these research questions, the Sexual Excitation/Sexual Inhibition Inventory for Women (SESII-W) was administered five times over the course of 4 years. The SESII-W includes two main scales of SE and SI which consist of five (Arousability, Partner characteristics, Sexual power dynamics, Smell, and Setting) and three subscales (Concerns about sexual function, Arousal contingency, Relationship importance), respectively. Data from 553 women (Mage = 31.38 years, SD = 10.25, range = 18-67) who participated in at least two assessment points were included in this study. Bivariate correlations between baseline and the fifth follow-up assessment indicated a high temporal stability of SE and SI in women (.47 < r < .71). A series of generalized linear models were conducted to investigate the impact of time, changes in sexual function, partnership status, and changes in partnership status on SE and SI. Partner characteristics (SE) that showed small increases over time. Across different subscales, improvements in sexual function were associated with higher SE and lower SI. Changes in partnership status and partnership status itself were predictors of one SE- and three SI-related scales. This study suggests a relatively high temporal stability of SE and SI in women and supports the dual control model's assertion that both factors are stable individual traits. Certain life events such as a new partnership or sexual difficulties may, however, impact time stability of both factors.