Studies on the Relationship Between Physiological and Psychological Sexual Arousal in Women

Sexual arousal in women involves both psychological (i.e., subjective) and physiological components. Subjective sexual arousal has been conceptualized as the “emotional” or “cognitive” state of sexual arousal, and has been defined as positive mental engagement in response to a sexual stimulus (Althof et al., 2017). Physiological sexual arousal in women involves both genital (i.e., vasocongestion, vaginal lubrication), and nongenital responses (e.g., increased heart rate, sweating, pupil dilation, hardening and erection of the nipples, and flushing of the skin). In a laboratory setting, genital arousal is most commonly measured using a vaginal photoplethysmograph to obtain a measure of vaginal pulse amplitude (VPA), which is thought to reflect phasic changes in vaginal engorgement with each heartbeat. Subjective sexual arousal (SSA) is most often assessed in a laboratory setting immediately after the presentation of an erotic film with several Likert-style, self-report questions. In my lab, we developed a device referred to as the “Arousometer” that allows for the continuous measurement of subjective sexual arousal throughout the film presentation (Rellini, McCall, Randall, & Meston, 2005).

A considerable amount of research has examined the concordance, or agreement, between VPA and SSA. Concordance is frequently measured as a “change score,” which condenses genital arousal data collected continuously throughout the assessment into a single data point. This data point is then correlated with a discrete measure of SSA. Results from a meta-analysis indicate that correlations between physiological and subjective arousal are generally low in women (r 1⁄4 .26; Chivers et al., 2010). Much has been made of this low correlation, likely due to its contrast with results from laboratory studies of men for whom correlations are much higher (r 1⁄4 .66; Chivers et al., 2010). Several explanations have been offered for these findings, namely that women’s attitudes toward sex and sexual stimuli, pressure to inhibit sexuality in response to cultural messages, and inability to perceive genital responses may play a role in concordance.

We conducted a series of studies examining the possibility that methodological issues play a role in the low correlation between physiological and subjective sexual arousal. As noted above, past studies of this nature have sampled numerous VPA data points and correlated an average of these points with a single Likert-scale SSA data point or a mean composite of several Likert-scale questions. In doing so, the richness of the data is reduced, and how changes in one measure may be associated with changes in the other measure cannot be assessed. Also, the majority of previous studies of this nature have computed correlations based on within-participants repeated measures which provide meaningful information on individual participants but does not allow for the assessment of the overall group or between group differences. With regard to analyses based on ANOVA techniques, the large between-subjects variance that characterizes VPA data violates the repeated measures ANOVA assumption of equal variance and covariance of the data at different points in time. We proposed that a more appropriate way to analyze these relationships is to continuously and simultaneously measure the two variables throughout exposure to the films and to use hierarchical linear modeling (HLM) for the statistical analysis. To this end, using the Arousometer and HLM to assess the relation between VPA and continuous measures of sexual arousal, we reported significant relations between genital and subjective sexual arousal in sexually healthy women (Rellini, McCall, Randall, & Meston, 2005).

In a second study, we (Meston, Rellini, & McCall, 2010) used this methodology to test the sensitivity of VPA  and continuous measures of SSA in differentiating between women with and without sexual arousal or orgasm dysfunction; and to examine the diagnostic utility of measuring the synchrony between VPA and SSA. Sexual arousal was assessed in sexually healthy women, women with orgasm disorder, and in women who met the criteria for the three subcategories of sexual arousal dysfunction described by Basson et al. (i.e., genital sexual arousal disorder [GAD], subjective sexual arousal disorder [SAD], and combined genital and subjective arousal disorder [CAD]). Women with GAD showed the lowest and women with CAD showed the highest levels of VPA response to erotic stimuli. Women with sexual arousal disorder showed significantly lower levels of subjective sexual arousal to erotic stimuli than did sexually healthy women. Relations between subjective and physiological measures of sexual arousal were significantly weaker among women with sexual arousal disorder than sexually healthy women or women with OD. Our findings provide preliminary support for the diagnostic utility of measuring the synchrony between SSA and VPA in women with sexual arousal disorder.

In a third study using this same methodology, we examined whether interoception (the awareness of internal states) may play a role in the concordance between VPA and SSA. Women who are more aware of changes in their body may find it easier to notice genital changes and incorporate this into their subjective experience of arousal. For women who are less aware of bodily changes, their subjective arousal may be less dependent on genital changes, thus weakening concordance. This pattern may not be true for all women, but rather for women who specifically look to their body for cues when determining their arousal state. If this is the case, interventions designed to increase interoception may be beneficial for women who report awareness of genital changes as an important aspect of their sexual arousal response. Women viewed a sexual film while their arousal responses were measured and then completed a self-report measure of interoception. A significant relationship emerged between VPA and SSA, in addition to tremendous between-person variability across both groups. Several aspects of interoception moderated concordance and this pattern varied across groups.

Based on the findings of this series of studies, we have concluded that the relationship between genital and subjective arousal might not be relevant to the diagnosis and treatment of sexual arousal dysfunction. Studies have shown that not all women who report sexual arousal problems have decreased genital arousal, and only some women with decreased genital arousal have low subjective arousal. To develop efficacious treatments for female sexual arousal dysfunction, researchers need to differentiate the women for whom genital sensations have a critical role in their subjective arousal from those who are not mentally aroused by genital cues. Read the two review/opinion papers here. [Courtney insert the two papers with Amelia here]

Recommended papers:

Handy, A. B., Freihart, B. K., & Meston, C. M. (2020). The relationship between subjective and physiological sexual arousal in women with and without sexual arousal concerns. Journal of Sex and Marital TherapyPDF (193 KB).

Meston, C.M. & Stanton, A.M. (2019). Understanding sexual arousal and subjective-genital arousal desynchrony in women. Nature Reviews Urology. PDF (2 MB)

Meston, C.M. & Stanton, A.M. (2018). The gender difference in concordance is theoretically interesting but clinically irrelevant. Current Sexual Health Reports, 10, 73-75.  PDF (306 KB)

Meston, CM, Rellini, AH, McCall, K (2010). The sensitivity of continuous laboratory measure of physiological and subjective sexual arousal for diagnosing women with sexual arousal disorder. Journal of Sexual Medicine, 7, 938-950. PDF (216 KB)

Rellini, AH, McCall, KM, Randall, PK & Meston, CM (2005). The relationship between self-reported and physiological measures of female sexual arousal. Psychophysiology, 42, 116-124. PDF (193 KB)