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Learn More. Classic and contemporary approaches to the assessment of female sexuality are discussed. General approaches, assessment strategies, and models of female sexuality are organized within the conceptual domains of sexual behaviors, sexual responses desire, excitement, orgasm, and resolutionand individual differences, including general and sex-specific personality models.
Where applicable, important trends and relationships are highlighted in the literature with both existing reports and ly unpublished data. The present conceptual overview highlights areas in sexual assessment and model building that are in need of further research and theoretical clarification. Research in female sexuality is fractionated. ificant contributions in specific areas, such as assessment, treatment, or understanding sexual phenomena have not necessarily led to offshoot contributions in related areas. The present contribution discusses issues in the assessment of female sexuality from the organizational framework of concepts rather than measures.
Here, we provide information on classic and contemporary approaches, and the discussion is framed within the conceptual domains of sexual behaviors, sexual responses i. However, research on the assessment of female sexual behavior, exclusive of behaviors that lead to increased HIV risk, remains limited but see sex survey of Laumann et al.
The coverage is most complete for heterosexual behaviors. This is not an intentional bias, and we acknowledge the dearth of data on sexuality topics for lesbians. We regard a sexual response cycle conceptualization, specifically desire, excitement, orgasm, and resolution, as an important second component in a working model of female sexuality. Although there are ificant and important interrelationships among the phases, there are sufficient data to suggest that each has unique aspects, too.
The separate elaboration of the phases may also clarify the female sexual dysfunctions, as the majority of Diagnostic and Statistical Manual of Mental Disorders 4th ed. Here we discuss the contemporary organization of personality structure, the Big Five model, as well as sexually relevant personality factors, such as sexual self-schema. In the Kinsey interviews, conducted with thousands of women and men, the focus was similar, yet with a life-span orientation.
They included the following: preadolescent heterosexual and homosexual play; masturbation; nocturnal sex emissions and dreams; heterosexual petting; premarital, marital, and extramarital coitus; intercourse with prostitutes for men only ; homosexual contacts; animal contacts; and, Housewives seeking real sex Powers, the total sexual outlet, defined as the sum of the various activities which culminated in orgasm. Other topics that are now recognized as important to sexual development and perhaps the subsequent occurrence of sexual dysfunctionssuch as incest and other traumatic sexual experiences, received less coverage.
In addition to the ificant public attention that the Kinsey volumes received, it is clear that their behavior chronicle interview is one of the few examples of a method affecting the nature of sex research for decades. It was mirrored, for example, in the Housewives seeking real sex Powers s to the early s with investigators including Podell and PerkinsBrady and Levittand Zuckerman publishing listings of heterosexual behaviors for men and women. The scales consisted of 12 to 20 items and included experiences that ranged from kissing to intercourse or mutual oral stimulation.
Undergraduates were typically the research participants—an unusually relevant group because one aspect of these studies was to provide an ordinal Guttman scaling of the items. These data suggest, in part, a hierarchical or chronological ordering of sexual experiences.
Years later, this method continues to appear in assessment and therapy arenas. For example, omnibus sexual functioning inventories, such as the Sexual Interaction Inventory by LoPiccolo and Stegerinclude the same hierarchical listing of sexual behaviors for each of its 11 scales. Such orderings also provide an empirical basis for generic hierarchy construction in systematic desensitization therapy studies see Andersen,for a review. Rather than use the Derogatis yes—no format for scoring, we asked undergraduate women mean age, On the first assessment scoringthey indicated whether they had ever experienced the activity.
As indicated in the far left column of Table 1a hierarchical ordering of the items can be determined. In large part, comparison of the ordering with the much earlier Bentler data is similar, with the addition of the items masturbation, anal intercourse, and anal stimulation on the low-frequency end of the listing.
Also of note is male-initiated or male-dominated versions of many of the items preceding the female counterpart items e. These trends are consistent with gender differences found in the frequency of oral sex, as reported in the most recent comprehensive sex survey e. On the second assessment, women indicated their frequency of behaviors in the past 30 days on a scale ranging from 0 activity did not occur to 9 activity occurred two or more times per day for each item.
As might be expected, data for the present scoring reflect the scoring hierarchical ordering. For the scoring, items were scored 0 never experienced in my lifetime and 1 experienced at least once in my lifetime. Values are percentages of women in the sample who endorsed each item as having been experienced at least once. Despite the usefulness of such scales, questions have been raised about the reliability and validity of any method that uses self-reports of sexual behavior.
Rather than discuss them here, we refer the reader to reviews of these issues e. The behavior listings noted earlier may provide a useful starting point. Women rated each item in a yes—no format, indicating whether the activity had occurred in the 3 months. We have since replicated this factor solution with the sample of undergraduate women who provided the data in Table 1.
Data from the scoring was submitted to a principal-axis factor analysis with an oblique Harris-Kaiser rotation. The solutions are identical with one exception: items from groupings b and c combine to form a single factor, with the oral-genital stimulation items forming a second, separate factor. As any factor solution is dependent on the items represented, these are unique to the items included by Derogatis and the participants in the samples described.
The notable additions by Derogatis to the earlier behavioral scales were items assessing masturbation and anal stimulation. In summary, these analyses suggest that behavioral listing measures may provide a reasonable sampling of the sexual behavior domain for adult heterosexual women. However, there has been disagreement about the and importance of each phase. Although popularized by Masters and Johnsonthe concept of stages of sexual engagement has early origins. As summarized in Table 2the of stages has ranged from two to four.
The phases of desire, plateau, and resolution are inconsistently represented, whereas a two-dimensional model of arousal—excitement process and an orgasm or orgasm—immediate postorgasm phase has been consistent. Historically, researchers have focused on understanding excitement or sexual arousalbut more recently there has been similar emphases on defining the psychological and behavioral boundaries of sexual desire.
Housewives seeking real sex Powers combed the literature to find assessment strategies for these four dimensions, yet there are few that follow this comprehensive conceptualization. Even their own assessment strategy—a lengthy oral interview described in the book—has little continuity with the model.
In articles and chapters by researchers, a functional analysis of the antecedents, problem behaviors, and consequences of the particular sexual difficulty is most common. Although the latter is very useful, one may not necessarily obtain information about all phases of the sexual response cycle. Whereas our efforts have concentrated on such a measure e. What is sexual desire? Current theories range from purely dynamic models to ones that emphasize biologic factors. Kaplanin her influential volume, Disorders of Sexual Desire, reiterated the psychoanalytic position of libido as an innate emotional force that would be expressed in either sexual or nonsexual outlets.
It would follow, then, that any inhibition of desire would be due to the unconscious repression or conscious suppression of urges for sexual contact. In either case, such defenses would arise from intrapsychic conflicts surrounding sexuality. There are interactional models of desire and ones that emphasize other, nondynamic, psychological processes see also a discussion by Beck, In contrast, Singer and Toates offer a central-nervous-system-mediated motivational model.
They propose that sexual motivation, like hunger or thirst, emerges from an interaction of external incentives i. Leiblum and Rosen note both intrapsychic and interpersonal aspects, but they define sexual desire functionally i.
Finally, Hatfield relies on her rich conceptualization of passionate love for the context of sexual desire; she sees sexual desire as a psychological longing for sexual union that is tied to sexual satisfaction and interpersonal relationship satisfaction i. Biologic models of sexual desire are controversial and currently emphasize hormonal mechanisms.
Data are most consistent for the necessary but not sufficient role of androgens, probably testosterone. For this model, the majority of supporting data comes from men e. Bancroft proposes that the occurrence of spontaneous erections during sleep are the behavioral manifestations of the androgen-based neurophysiological substrate of sexual desire; in contrast, erections with fantasy or erotic visual cues are seen as evidence for androgen-independent responses. Hormone—sexual behavior relationships for women are less clear, although estrogen, progesterone, and androgen testosterone have been studied.
Regarding estrogen effects, it is clear that some amount of estrogen is necessary for normal vaginal lubrication, and receipt of estrogen replacement therapy after menopause may reduce the problematic symptoms e. In contrast, progesterone may actually have an inhibitory effect Bancroft, Finally, testosterone may have direct effects on sexual functioning; both Bancroft and Wu and Schreiner-Engel, Schiavi, Smith, and White have found positive relationships between testosterone levels and frequency of masturbation and vaginal responses to erotic stimuli.
In studies of women for whom estrogen therapy was not effective for postmenopausal symptoms, testosterone administration improved sexual desire and related outcomes Burger et al. Perhaps the most direct data on this topic are by Alexander and Sherwin In studying 19 oral contraceptive users, they reported that plasma levels of free testosterone was correlated with self-report measures of sexual desire, sexual thoughts, and anticipation of sexual activity. However, an interesting and more direct test of the hypothesis that testosterone is related to sexual cognitions was disconfirmed; using a selective attention dichotic listening task, Alexander and Sherwin found no relationship between levels of free testosterone and an attentional bias for sexual stimuli.
Blood samples were drawn every 3—4 days for one menstrual cycle and were analyzed for testosterone, estradiol, progesterone, prolactin, and luteinizing hormone. No differences between the groups were found, and subgroup analyses e. At present, it is unclear whether physiologic measures, and hormonal assays in particular, are useful physiologic indicators of sexual desire. Considering the other channels for assessment, cognitions have been emphasized. Instead, a circular statement Housewives seeking real sex Powers. Not surprisingly, fantasy does play an important role in sex therapies e.
Although these lines of data suggest some importance to the Housewives seeking real sex Powers of fantasy, there are not data at present suggesting that the absence of fantasy is pathognomic for low sexual desire. Data comparing the frequency of internally generated thoughts fantasies and externally prompted thoughts sexual urges among young heterosexual men and women indicate that men report a greater frequency of urges than do women 4.
Related data from Laumann, Gagnon, Michael, and Michaels indicate a normal distribution in the frequency of autoerotic activities e. This indicates that, on average, men have higher rates of autoerotic activities and that there is less variance among men; for women, this indicates that, on average, women have generally lower rates but there are more individual differences among women in the frequency of autoerotic activity. There are self-report measures of sexual fantasy. Correlation analyses reveal that higher self-reported levels of sex drive are correlated with more frequent sexual fantasies, particularly intimate fantasies for women e.
There is also a item fantasy scale on the DSFI; however, there are few psychometric data on this scale.
Internal consistency of the measure is high. There are few convergent and discriminant data, but they are supportive. Measures such as these may be useful to assess sexual cognitions. When such measures are not used, researchers often use proxy variables. One strategy has been to have participants rate their sexual desire and then correlate these data with other indicators, such as sexual arousal or behavior e.
Provided below are symptom descriptions of individuals complaining of low desire. These may provide useful phenomenologic information for future assessment research. Specifically, we note the following. Individuals with low desire report that they are generally uninterested in sexual activity. These behaviors are presumably not due to strong negative responses to interpersonal or genital contact, an important point to consider when ruling out alternatives, specifically a sexual aversion disorder see Discussion; for an early example of the absence of distinction, see McCarthy, Instead, individuals with low desire disorder are thought to be indifferent or neutral toward sexual activity.
Sexual urges seem not to occur. Individuals with low desire may report no sexual cognitions—fantasies or other pleasant, arousing sexual thoughts and mental images. In terms of self-descriptions, individuals with low desire may have an asexual self-view.
Disruption in the frequency, focus, intensity, or duration of sexual activity may occur, and secondary disruption of sub sequent response cycle phases may occur. Either physical or psychologic sexual stimulation can initiate sexual excitement. The bodily changes with sexual excitement are considerable. The general physiologic responses are widespread vasocongestion, either superficial or deep, and myotonia, with either voluntary or involuntary muscle contractions.
Other changes include increases in heart rate and blood pressure and deeper, more rapid respiration. For women, sexual excitement is also characterized by the appearance of vaginal lubrication, produced by vasocongestion in the vaginal Housewives seeking real sex Powers, leading to transudation of fluid. Other changes include a slight enlargement of the clitoris and uterus with engorgement. The uterus also rises in position with the vagina expanding and ballooning out.
Maximal vasocongestion of the vagina produces a congested orgasmic platform in the lower one third of the vaginal barrel. As discussed later, individuals may not be aware of the physiologic sensations of arousal; even if they are, their affects may or may not be convergent. Thus, in the following discussion, we consider both positive affects, such as arousal, and negative affects, such as anxiety, which may relate to sexual excitement.
Consideration of negative affects is relevant as some e. Studies have addressed the physiological and affective aspects of arousal. Although the aforementioned description notes vasocongestion and lubrication as the predominant bodily responses, psychophysiological research has consisted largely of measures of vaginal vasocongestion i. As a physiological indicator of sexual arousal, it is still unclear what these vaginal als represent and whether they are analogues of distinct vascular processes Levine, However, there is evidence for their convergent validity.
The construct of arousability is central to understanding cognitive and affective aspects of sexual excitement in women.
According to Bancroftarousability is a cognitive sensitivity to external sexual cues. He suggests that high arousability implies enhanced perception, awareness, and processing of not only sexual cues but the bodily responses of sexual excitement. This model seeks to connect cognitive—affective responses with control of genital and peripheral indications of sexual excitement through a neurophysiological substrate for sexual arousal. Fortunately, one of the psychometrically strongest self-report measure for female sexuality is one that also taps sexual arousability, the Sexual Arousability Index SAI by Hoon, Hoon, and Wincze On this item measure, women rate their sexual arousal for a variety of erotic and explicit sexual behaviors.
The measure samples a range of individual and partnered erotic and sexual behaviors; our psychometric studies indicate that the SAI samples the following domains: arousal associated with erotica e.Housewives seeking real sex Powers
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