Heart rate variability (HRV) has emerged as a valuable non-invasive test to assess autonomic nervous system (ANS) activity. Several studies have linked low resting HRV to mental health conditions including depression, anxiety, and alcohol dependence, indicating these disorders may be related to an imbalance in autonomic activity.  In my lab we showed HRV level is a risk factor for female sexual dysfunction (Stanton, Lorenz, Pulverman, & Meston, 2015). We examined whether differences in vagal activity between sexually functional and sexually dysfunctional women may be driving the association between low HRV and female sexual dysfunction. Specifically, respiratory sinus arrhythmia was assessed before, during, and after physiological sexual arousal in 84 women, aged 18 to 47, to examine potential differences in vagal activity between sexually functional and sexually dysfunctional women. We found differences in vagal activity between sexually functional and dysfunctional women which provides further support to the recently established relationship between HRV and female sexual function and offers a mechanism to target during treatments for sexual dysfunction (Stanton, Pulverman, & Meston, 2016).

Based on our findings of a relationship between HRV and female sexual function, we examined the effect of autogenic training to increase HRV on acute physiological and subjective sexual arousal in women. We assessed vaginal pulse amplitude (VPA), an index of genital sexual arousal, and subjective sexual arousal in women before and after a short session of autogenic training. Autogenic training, a relaxation technique that restores the balance between the activity of the sympathetic and the parasympathetic branches of the autonomic nervous system, has previously been shown to significantly increase HRV. We found significant increases in both VPA and subjective sexual arousal after autogenic training (Stanton & Meston, 2017). In a follow-up study (Stanton, Hixon, Nichols, & Meston, 2018) we examined whether this effect held true for women who reported decreased or absent sexual arousal. Genital sexual arousal, subjective sexual arousal, and perceived genital sensations were assessed in 25 women 20 to 44 years old before and after listening to a 22-minute autogenic training recording. HRV was assessed with electrocardiography. We found marginally significant increases in subjective sexual arousal and significant increases in perceived genital sensations. Our findings suggest that autogenic training, and other interventions that aim to increase HRV, could be a useful addition to treatment protocols for women who are reporting a lack of subjective arousal or decreased genital sensations.

To expand upon these laboratory findings, we tested the efficacy of HRV biofeedback, with and without autogenic training, as a treatment for sexual arousal dysfunction in an at-home setting. Women were randomized into one of three conditions: HRV biofeedback, HRV biofeedback + autogenic training, or waitlist control. Each condition included three laboratory sessions; participants in the two active conditions completed 4–6 biofeedback sessions at home, and participants in the HRVB + A condition listened to a 14-min autogenic training recording before completing the biofeedback. Across the three laboratory visits, participants in the three conditions significantly differed in their genital arousal, subjective sexual arousal, and their perceived genital sensations. Compared to women in the control group, women who engaged in HRV biofeedback at home, with and without additional autogenic training, experienced increases in genital arousal, subjective sexual arousal, and perceived genital sensations. These results provide preliminary support for the contribution of heart rate variability level to female sexual arousal function and for the use of either of these interventions in the treatment of sexual arousal concerns (Stanton, Boyd, Fogarty, & Meston, 2019).

Recommended papers: 

Stanton, A.M., Boyd, R.L., Fogarty, J.J., & Meston, C.M. (2019). Heart rate variability biofeedback increases sexual arousal among women with female sexual arousal disorder: Results from a randomized-controlled trial. Behaviour Research and Therapy, 115: 90-102. PDF (1 MB)

Stanton, A. M., Hixon, J. G., Nichols, L. M., & Meston, C. M. (2018). One session of autogenic training increases acute subjective sexual arousal in pre-menopausal women with sexual arousal problems. Journal of Sexual Medicine, 15(1), 64-76. PDF (462 KB)

Stanton, AM, & Meston, CM. (2017). A Single Session of Autogenic Training Increases Acute Subjective and Physiological Sexual Arousal in Sexually Functional Women. Journal of Sex & Marital Therapy, 43(7), 601-617. PDF (217 KB)

Stanton, AM, Pulverman, CS, & Meston, CM (2016). Vagal activity during physiological sexual arousal in women with and without sexual dysfunction. Journal of Sex & Marital Therapy, 43(1), 78-89. PDF (317 KB)