Female orgasmic disorder/difficulty (FOD) remains prevalent, yet treatments are limited and outcomes variable. Traditional approaches have focused primarily on stimulation, behavioral techniques, sex therapy, and psychological processes, without fully accounting for state-dependent and non-genital pathways through which orgasm may become accessible. These pathways may involve altered states, defined as shifts from ordinary waking consciousness, or absorbed states characterized by non-striving attention and reduced self-monitoring. This review introduces orgasmic learning as a state-dependent treatment framework for FOD using Perelman’s Sexual Tipping Point® Model, which conceptualizes sexual response as a balance between excitatory and inhibitory processes. Evidence spanning more than five decades suggests that orgasmic accessibility may be shaped by genital, non-genital, somatic, pelvic floor, imagery-based, hypnotic, cannabis-associated, breath-based, and altered-state pathways. These pathways have been reported to increase or have been associated with increased orgasmic accessibility, and in some cases, have been applied in FOD treatment. Across the evidence, state transition emerges as a unifying feature, with diverse pathways reducing inhibition, increasing sensory salience, facilitating absorption, and shifting the excitation-inhibition balance toward orgasmic access. Orgasmic learning conceptualizes FOD as difficulty accessing the regulatory, attentional, sensory, and state-dependent conditions under which orgasmic response becomes available. This review proposes that the shared therapeutic target across orgasmic learning pathways is the induction or facilitation of a transition into an altered, absorbed, or otherwise orgasm-supportive state in which orgasmic response becomes accessible. This framework expands FOD treatment conceptualization beyond stimulation-centered and psychosexual approaches by organizing interventions around shifts in state, excitation, inhibition, sensory access, and orgasm-supportive learning conditions.
The objectives of this narrative review are to describe existing research and to examine the effectiveness of online interventions used to address sexual dysfunction and improve couples’ sex lives. Following the PRISMA guidelines, we conducted a narrative review to synthesize the evidence for the efficacy of online sexual intervention from experimental studies in the past five years. After removing duplicates, 554 articles were screened for eligibility, and 17 fulfilled the inclusion criteria for the review. Ten studies were conducted in North America or Europe, with the rest focusing on Asia. Participants were mostly young and middle-aged adults, with the average age ranging from 25 to 46 years, except for one study in which the median participant age was 60. Some study samples were drawn from clinical populations with a diagnosed condition (e.g., sexual dysfunction, infertility, or related concerns), while others were recruited from the general population. Eleven studies utilized online videos, including psychoeducation about sex, sexual communication, and problem-solving skills. Six studies had therapists or coaches provide feedback or answer questions in between online sessions. The effectiveness of the online intervention varied significantly across studies, with the unified effect sizes ranging from 0.02 to 1.76. For the outcome measures specifically assessing sexual function, 2 out of the 23 outcomes had large effects, 9 had moderate effects, and 12 had small effects. On the other hand, measures of relationship satisfaction and communication showed greater improvements, with 21 out of the 32 outcomes (66
Sleep disturbances and sexual dysfunction are among the most prevalent and burdensome symptoms experienced during the menopausal transition. Although emerging evidence suggests these domains may be interconnected, their relationship has not previously been systematically synthesized. This systematic review examines associations between sleep disturbances and sexual dysfunction among peri- and postmenopausal women. Across the 10 included studies, insomnia symptoms, reduced sleep duration, poor sleep quality, and obstructive sleep apnea were consistently associated with worse overall sexual functioning. Findings for other sexual function domains (desire, arousal, interest, libido, and orgasm) and vaginal symptoms were more variable. Evidence supports a meaningful association between poor sleep and sexual dysfunction during and after the menopausal transition. Future longitudinal and intervention studies are needed to clarify mechanisms, establish directionality, and determine whether interventions targeting one domain may improve outcomes in the other in menopausal populations.
Heart failure (HF) is a chronic condition with a steadily increasing prevalence that significantly reduces patients’ quality of life, with women experiencing a greater psychosocial burden and poorer quality-of-life indicators than men. One of the insufficiently recognised areas of functioning in this population includes sexuality, body image perception, and partner relationships, despite the fact that these are integral components of health and overall well-being. The aim of this review was to present the current state of knowledge regarding sexual functioning, body image, and satisfaction with partner relationship in women with heart failure, as well as to identify significant research gaps and clinical implications. Sexual dysfunctions are highly prevalent among women with HF and involve reduced sexual desire, difficulties with arousal, lubrication, and orgasm, as well as pain during sexual activity. The key aspects limiting sexual activity include fatigue, dyspnoea, fear of disease exacerbation or death during intercourse, adverse effects of pharmacotherapy, and a negative body image, which may be amplified by somatic symptoms, menopause, and the presence of implantable cardiac devices. The topic of partner relationships and intimacy remains poorly explored. However, available data indicate changes in relationship roles and the importance of adaptive strategies to maintain intimacy. A significant issue is the lack of systematic sexual counselling in cardiovascular care. Sexuality and partner relationships in women with heart failure require greater clinical attention and an interdisciplinary approach that addresses both the somatic and psychosocial aspects of the disease. Sexual dysfunction is highly prevalent in women with heart failure, affecting desire, arousal, lubrication, orgasm, and satisfaction. Fear of cardiac events during intercourse and absent medical counselling are primary barriers to sexual activity in women with heart failure. Disease symptoms, pharmacotherapy side effects, and negative body image significantly impair sexual well-being. Heart failure may shift partner relationships toward caregiving dynamics, reducing intimacy and relational satisfaction. Sexual health assessment should be integrated into routine cardiovascular care for women with heart failure.
This review examines recent advances in animal models of same-sex preference, focusing on: (1) the biological factors underlying its development, (2) the experimental paradigms used to measure it, and (3) its neurobiology. Recent research has identified several developmental factors contributing to the establishment of same-sex preference, including prenatal stress, aromatase inhibition, maternal immune responses, and order of birth effects. Specific brain circuits controlling sex preference are beginning to be established. Despite these significant advances, methodological limitations remain a major challenge, particularly in how sexual preference is assessed. Sexual preference is defined as the choice of a sexual partner of a specific sex. Animal models are useful for investigating the biological bases of sexual preference. These animal models may reproduce key developmental processes that organize brain circuits controlling partner selection. However, accurately and quantitatively assessing sexual preference remains a challenge. Future progress requires paradigms that capture the multidimensional, context-dependent, and qualitative dimensions of partner preference, thus providing a more comprehensive and biologically grounded understanding of sexual diversity.
