Persistent genital arousal/genito-pelvic dysesthesia (PGAD/GPD; henceforth “PGA”) has often been studied as a dichotomous variable, comparing symptomatic vs asymptomatic individuals (e.g., Jackowich, Poirier, & Pukall, 2020). Consequently, little is known about the associations between PGA symptoms and sexual function across a continuum of PGA symptom intensity. The objectives are: (1) test for linear and non-linear associations between PGA symptoms and sexual desire; (2) test for linear and non-linear associations between PGA symptoms and other sexual function variables; and (3) distinguish between PGA symptoms and distress caused by those symptoms when predicting sexual function. Testing for non-linear associations is possible only by treating PGA symptoms as a continuum. A sample of n = 1904 females (M = 30 years, SD = 9.7) completed an online survey on sexual function (Female Sexual Function Index, FSFI), genital pain (1 question), PGA symptoms (Jackowich & Pukall, 2020), and distress associated with PGA symptoms (Jackowich & Pukall, 2020). Analyses tested for linear and quadratic (curvilinear) associations between PGA symptoms and sexual function, and between distress caused by PGA symptoms and sexual function. The correlation between PGA symptoms and distress caused by those symptoms was r = .31 (p < .0001, no evidence of a curvilinear association), suggesting that these symptoms are only moderately associated with distress. Groups reporting (a) no genital pain, (b) vulvar pain, (c) vaginal pain, or (d) vulvar and vaginal pain differed in their levels of PGA symptoms (Fig. 1), with vaginal pain appearing to contribute little to the pain-related elevation in PGA symptoms. Analyses testing for linear and non-linear associations between PGA symptoms and FSFI sexual desire found a significant positive association and a negative quadratic (curvilinear) effect (Fig. 2), showing that as PGA symptoms increase so does desire, but that this association reverses at the high end of PGA symptoms. Finally, analyses testing for linear and non-linear associations between PGA symptoms and sexual function (total FSFI), and between distress caused by PGA symptoms and sexual function (total FSFI), showed no significant effects of PGA symptoms, but significant negative linear and curvilinear effects for distress caused by those symptoms (Fig. 3). Negative associations (either linear, curvilinear, or both) between distress and sexual function were observed for all FSFI subscales except the satisfaction subscale. This is the first study to document an inverted-u shaped association between PGA symptoms and sexual desire. Moreover, whereas PGA symptoms themselves had a negligible effect on sexual function, distress caused by those symptoms had a consistent negative effect. Clinically, these results suggest that PGA symptoms are not universally a negative experience, and that emphasis should be placed on the consequent distress. However, the distinction between sexual function as defined by the FSFI, and distress about sexual function, may be especially relevant to those experiencing PGA symptoms. Finally, the finding that vulvar pain is associated with PGA symptoms, with vaginal pain contributing little to the increased levels of PGA symptoms, may provide insights to the neural underpinning for some people’s PGA symptoms (refer to Pukall, Jackowich, Mooney, Chamberlain, 2018, for related discussion). Any of the authors act as a consultant, employee or shareholder of an industry for: Initiator Pharma; Pelva Health.

The objective of the present study was to investigate changes in sexual desire, lubrication, and sexual activity across the menstrual cycle. It was expected that, in addition to a small mid-cycle increase, women would show a high degree of variability in whether and in what phase of the menstrual cycle they report changes in these variables. A total of n = 585 women aged 18-40 provided complete data on an online survey in which they were asked whether they notice changes across the menstrual cycle in sexual desire, desire to masturbate, lubrication, and frequency of having sex, and if they do, during which phase of the cycle they experience an increase. Results suggest that an increase in sexual desire, and especially lubrication, were somewhat more common during the ovulatory phase. However, as hypothesized, across all four variables, there was a high degree of variability in the specific cycle phase in which participants reported experiencing increases. In some cases, age, having a partner, and hormonal contraception moderated menstrual cycle phase increases in these variables. These results confirm that women differ significantly in whether and when, during the menstrual cycle, they experience increases in sexual desire, lubrication, and sexual activity.

Past research has investigated several factors that can influence the frequency and intensity of female orgasm, such as sexual desire and self-esteem (Kontula & Miettinen, 2016), mindfulness (Adam et al., 2014), and kegel exercise (Khosravi et al., 2022). However, the role of specific cognitive and behavioural strategies activated during sex to get to orgasm, has never been tested. Note that, while this topic has been overlooked, decades of research have discussed the importance of cognitive distraction during sex in interfering with orgasm (Barlow, 1986). The goals of the analyses are: 1) to investigate the cognitive and behavioural strategies used by women to experience orgasm; 2) to investigate which of these strategies are correlated with orgasm’s intensity; and 3) whether using multiple strategies affect intensity of orgasm. Previous research, and techniques from sex therapy, guided the definition of the strategies included in the questionnaire. Participants (n = 367) were asked to fill out a questionnaire every day for 2 menstrual cycles. Among others, daily questions included: whether they had sex; whether they had one/multiple orgasms; how intense the orgasm was; which strategies they used to get to orgasm. Mixed model analyses were conducted to account for the nested structure of the data. Results show that focusing on the positive bodily sensations was the most used strategy for reaching orgasm. Moreover, five out of eight strategies were significantly positively associated with intensity of orgasm, with “enjoying the moment” showing the strongest association. Finally, using more strategies was associated with more intense orgasms. Our results represent the first empirical evidence of the role that some cognitive and behavioural strategies play in the intensity of orgasm. This data suggests an important role of both top-down (attention) and bottom-up (bodily sensations) mechanisms in orgasm, paving the way to future studies and tools for sex therapy. None.

Despite decades of research, there is no scientific consensus method for representing the menstrual cycle as a continuous timeline. Common phase-and count-based methods oversimplify hormonal dynamics and overlook individual variability in ovulation timing, reducing statistical power and misaligning trajectories. To address this, we introduce Phase-Aligned Cycle Time Scaling (PACTS) and its companion R package, `menstrualcycleR`, which generates continuous time variables anchored to both menses and ovulation, improving alignment of hormonal dynamics across individuals and cycles in an accessible, reproducible way. This approach accommodates variable cycle lengths and supports various ovulation detection methods or norm-based ovulation estimation when biomarkers are unavailable. Using daily urinary hormone data from 44 cycles, we show that PACTS improves alignment and estimation of estradiol (E2) and progesterone (P4) trajectories compared to traditional methods. This has implications for improved cycle effect estimation both within samples and across studies. The variables produced by PACTS also support hierarchical nonlinear models, such as generalized additive mixed models, for high-resolution analysis of cyclical outcomes and quantification of related effect sizes. Since a variety of clinical disorders are currently diagnosed using cycle count methods, future directions should consider how this approach may improve diagnostic accuracy (e.g., in premenstrual dysphoric disorder (PMDD), catamenial epilepsy, or menstrual migraine). Together, PACTS and `menstrualcycleR` offer a reproducible framework that improves precision and interpretability in menstrual cycle research.

BACKGROUND:Past research suggests that oral contraceptive (OC) use increases the risk for vulvodynia/vestibulodynia, although results are often mixed or inconsistent. AIM:To test whether OC use is associated with having a diagnosis of vulvodynia/vestibulodynia, whether the observed association varies across the type of OC, and whether side effects associated with OC use (ie, genital specific, negative affect, non-genital physical symptoms) are associated with having a diagnosis of vulvodynia/vestibulodynia. METHODS:A sample of n = 2171 adult females completed a questionnaire regarding OC use and associated side effects, and provided information on having a diagnosis of vulvodynia or vestibulodynia. Recruitment oversampled for women with genitopelvic pain, which provided n = 582 women (26.8% of overall sample) who had a diagnosis of vulvodynia or vestibulodynia. Binary logistic regressions were conducted to test for associations. OUTCOME:Self-report of having received a diagnosis of vulvodynia or vestibulodynia. RESULTS:Results showed that all types of OCs were significantly associated with having a diagnosis, and that genital-specific side effects (vulvar/genital pain and vaginal dryness), but not affective or non-genital physical side effects, were associated with having a diagnosis of vulvodynia/vestibulodynia, with the strongest and most consistent effect being for vulvar/genital pain. Specifically, participants who reported vulvar/genital pain as a side effect of OC use were 3-5 times more likely than those without this side effect to have a diagnosis of vulvodynia/vestibulodynia. Analyses also controlled for 23 potential comorbid diagnoses with no or very little change to the associations between vulvodynia/vestibulodynia and the OC-use variables. CLINICAL IMPLICATIONS:Early recognition and identification of genital-specific side effects of OC use may provide an opportunity for preventing genital pain from becoming chronic and difficult to manage. STRENGTHS AND LIMITATIONS:This study uses a large sample, assesses unique associations with combined and progestin-only OCs, and for the first time addresses diverse OC-related side effects as potential risk indicators of vulvodynia. Limitations are the lack of prospective data, reliance on self-report measures, recruitment through social media outlets that may result in overestimating the effect sizes, and a lack of information on specific OCs used. CONCLUSIONS:The present study provides evidence that OC use and genital-specific side effects of OC use are associated with having a diagnosis of vulvodynia/vestibulodynia and provides important information for managing potential OC-related risk for vulvodynia/vestibulodynia.

Abstract Introduction There is a lack of research using prospective daily reports to study the associations between genital pain, psychological state, and sexual function. Although many studies have examined the relations among these variables, the most common strategy used is one-time retrospective accounts, which are limited by recall bias and the inability to study day-to-day variations in these symptoms. Objective To examine how day-to-day changes in genital pain influence daily changes in negative mood, and how day-to-day changes in genital pain and psychological symptoms are associated with daily changes in sexual desire and having sex with a partner. Methods A sample of 258 women with genital pain completed daily surveys measuring pain symptoms, psychological state, and sexual desire and activity (n=5831 surveys total; M=20.6 surveys per participant). Daily reports of genital pain addressed pain intensity, duration, and type (continuous vs intermittent); daily reports of psychological state addressed feeling depressed, tense/on edge, happy, and attractive/beautiful; and daily reports of non-genital pain addressed headaches and cramps. Presence of menstruation was also queried. Multilevel analyses tested for effects of genital pain on negative mood; and for effects of all pain and psychological symptoms on sexual desire and sex with partner. Results Analyses presented in tables 1 and 2 consider only days when genital pain was present (3316 surveys; 57% of surveys). Analyses including days with no genital pain were also conducted, recoding pain intensity and duration as zero, and excluding pain type, with only minor changes in results which did not change the overall conclusions. Table 1 presents results from models testing for effects of genital pain on feeling depressed and feeling tense/on edge, and show that, controlling for random intercepts of individual participants, feeling depressed was significantly predicted by all three pain scores, whereas feeling tense/on edge was predicted only by pain intensity and duration. Table 2 presents results from models predicting sexual desire/libido and having sex with partner from all predictor variables while controlling for random intercepts of individual participants. Overall, the results from these models show that the strongest and most consistent predictors across the two outcomes were the psychological variables of feeling tense/on edge, feeling happy and feeling attractive. Feeling depressed had no effect on either outcome. Of the genital pain symptoms, only pain duration had an effect on desire, whereas both pain duration and intensity predicted sex with partner. Pain intensity showed a positive association with sex with partner, which likely reflects an increase in pain intensity after having sex. Conclusions The current findings illustrate the potential impact of genital pain on negative emotions, as well as the importance of positive mood (feeling happy and attractive) on sexual desire and activity. Whereas past research has often focused on negative affect as an outcome of genital pain1, and as a predictor of sexual function2, the present study suggests that we give more attention to positive mood and a positive psychology approach3 in addressing the link between genital pain and sexual function. Such an approach may also have broader implications for general wellness. Disclosure Yes, this is sponsored by industry/sponsor: Data was partially collected using the app “Vulvae”, which is a free-to-use app, and presents no conflict of interest for either of the authors. Clarification: No industry support in study design or execution.

Abstract Introduction Vulvar pain is a transdiagnostic symptom that is associated with diverse end organs, neurological, and musculoskeletal mechanisms. A better understanding of the neural mechanisms behind the spreading/worsening of vulvar pain across different sites on the vulva, could guide future research, classification, and treatment of vulvar pain-related conditions. Objective Examine the topographic correlations of vulvar pain and provide insights regarding the involvement of neural pathways underlying the topographic distribution of such pain. Methods Self-reports of sexual and genital health were collected from 2199 women through online questionnaires, as part of a larger study. Efforts were made to recruit a heterogenous sample, oversampling for women with genito-pelvic pain. Participants were asked about the presence and location of vulvar and/or vaginal pain. In addition, participants were asked about history and types of non-genital injuries. If a participant reported chronic vulvar pain, they were then presented with a drawing of a vulva divided into 24 areas, asking them to indicate the location(s) of their pain (localization of vaginal pain not included). Correlations were conducted on the presence of pain across vulvar areas that were contralaterally distributed (horizontal) vs spatially close but ipsilaterally distributed (vertical and radial), and distinguishing between women with vs without a history of back and/or pelvic injury. Results 911 women reported experiencing chronic vulvar or vulvar-vaginal pain. Results from correlations across vulvar areas are reported in Figure 1, 2 and 3, distinguishing between women with and without a history of back/pelvic injury. In both groups, horizontal correlations across left and right sides of the same tissue/structure were the strongest (Figure 1), whereas areas that were spatially close on the ipsilateral side (vertical and radial) showed weaker correlations (Figures 2 & 3). Statistical tests confirmed differences in correlations both between-groups and within-groups, across different spatial relations (horizontal, vertical, radial). Conclusions The observed pattern of topographic correlations suggests specific constraints on the mechanisms involved in the spreading of vulvar pain, showing a horizontally symmetrical distribution of correlations (within tissue/structure), as opposed to a proximity-based distribution of correlations. This appears to reflect symmetrically contralateral sensitization within the same structure, even if the areas were relatively distant (e.g., right and left labia minora). According to our results, this applies more to women without a history of back/pelvic injury, compared to women with a history back/pelvic injury. Consistent with past research showing that a temporary nociceptive stimulus induces hyperalgesia and allodynia in the ipsilateral and symmetrically contralateral site of noxious stimulation (Shenker et al.,2008), our results suggest that similar neural mechanism(s) might be involved in chronic vulvar pain. The pattern of correlations found could be mediated by chronic pain-induced activation of the commissural fibers that connect, and perhaps sprout into, the symmetrically contralateral sides at the level of the dorsal horn. This would constitute a form of central sensitization (Latremoliere & Woolf, 2007). Whether a comparable central sensitization process also occurs at the level of the sensory cortex (or other brain regions), or whether different forms of synaptic potentiation at the neural level are involved, must also be considered. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Adamo Bioscience.

Abstract Introduction Research has shown that hormonal contraceptive (HC) use is associated with risk for vulvar pain [1] and vulvodynia [2,3]. Although some literature has focused on combined hormonal contraceptives (CHCs), Bouchard et al [2] found that risk was higher for those using high progestin potency HCs. In addition to increased risk associated with HC use, research also suggests that characteristics of the menstrual cycle (eg., premenstrual symptoms) are associated with risk for vulvodynia [4]. Objective Test for associations between having a diagnosis of vulvodynia (including vestibulodynia) and experiencing vulvar/vaginal, psychological, and physical side effects from OC use. Test for differences in these associations across estroprogestinic OCs, progesterone only OCs, and OCs of an unknown composition (based on self-reports). Methods A sample of 2199 females participated in a larger study on genito-pelvic pain and sexuality and provided data on both HC use and genito-pelvic pain. Efforts were made to recruit a heterogenous sample, with an oversampling of females with genito-pelvic pain. The dependent variable was a dichotomous variable of whether they had ever received a diagnosis of vulvodynia or vestibulodynia. Predictor variables were: ever used each type of OC (analyses conducted separately for estroprogestinic, progesterone only, and unknown type); and experiencing the following side effects associated with each OC type: vulvar pain (dichotomous), vaginal dryness (dichotomous), decreased sexual desire (dichotomous), affective symptoms (sum of dichotomous responses to: anxiety, nervousness, depression, anger, mood swings) and physical symptoms (sum of dichotomous responses to: cramps, back and joint pain, bloating, cellulite, breast discomfort). Three nominal logistic regression analyses were conducted (one for each OC), and a final nominal logistic regression was conducted combining the relevant predictors for each OC into one analysis. Results Of the 2199 participants, n=673 had never used OCs, n=827 had used them in the past, and n=699 were currently using them. Regarding vulvar/vaginal pain, n=1083 had no vulvar or vaginal pain, n=341 had only vulvar pain, n=194 had only vaginal pain, and n=581 both vulvar and vaginal pain. Finally, regarding diagnoses, n=582 (26%) had a diagnosis of vulvodynia/vestibulodynia (all types combined). Results from the nominal logistic regressions are presented in Tables 1 and 2. Findings of central importance are: having ever used any of the three categories of OCs was associated with increased risk for a diagnosis; vulvar pain and vaginal dryness were the only side effects of OCs that demonstrated a consistent association with increased risk of having a diagnosis; side effects of estroprogestinic OCs were the most strongly associated with increased risk of having a diagnosis; and the effects observed in the first three models remained significant even when all were included in the same final analysis (with the exception of vulvar pain with progesterone only OC). Conclusions Use of both estroprogestinic and progesterone only OCs are associated with diagnosis of vulvodynia, but side effects of estroprogestinic OCs demonstrated the strongest association. Genital-specific side effects of OCs may represent indicators of a tissue-specific sensitivity to hormonal changes that are associated with risk for vulvodynia. Disclosure No.

Abstract Introduction Persistent genital pain represents a significant health issue among females, with prevalence ranging from 18.5% for lower genital tract discomfort [2], 20% for chronic dyspareunia [3], and 8.3%-27.9% for vulvodynia [6, 7]. Latent class analyses (LCA) allow the identification of groups of individuals who share common symptom profiles and have been used to subgroup vulvodynia patients based on psychological distress and pain sensitivity [1], spontaneous vs provoked pain and pain comorbidities [8] and based only on comorbid pain conditions [5]. Nonetheless, to our knowledge no study has been conducted investigating clusters of symptom-types commonly reported for persistent genital pain. Objective Test for latent classes (clusters) of individuals based on symptom-types profiles among women with vulvar and/or vaginal pain. Methods Self-reports on sexual and genital health were collected from 2199 women through online questionnaires, as part of a larger study. Efforts were made to recruit a heterogenous sample, with an oversampling of females with genito-pelvic pain. Participants were asked about the presence of specific vulvo-vaginal symptoms. Specifically, eight types of vulvar pain (itching, burning, irritation, needles, cut, electric-shock, bladder weight and urinary urgency) and nine types of vaginal pain (dryness, itching, burning, pulsating, needles, cut, electric shocks, spontaneous spasms and spasms at penetration) were measured. LCA were conducted to identify clusters of individuals sharing similar symptom profiles. Analyses were first done including all women with genital pain, then separately for women experiencing only vaginal and only vulvar pain. Results Of the 2199 participants, 1116 (51%) reported experiencing some type of genital pain, with 52% experiencing vulvar and vaginal pain, 17% only vaginal pain and 31% only vulvar pain. Results from LCA analyses suggest that women experiencing vulvo-vaginal pain could best be grouped into 5 clusters, based on the presence of vulvar and vaginal symptoms (Figure 1). Women with only vaginal pain were grouped into 3 clusters based on vaginal symptoms (Figure 2) and women with only vulvar pain were grouped into 3 clusters based on vulvar symptoms (Figure 3). Across all sets of analyses, clusters were clearly differentiated by specific symptoms. Conclusions Although rates of genital pain are high among females, classification of genito-pelvic pain conditions have been, and still are, a matter of debate. While in the DSM-5 vaginismus and dyspareunia were combined into one diagnostic entity, many clinicians continue referring to them as two distinct conditions, creating incoherence in terminology. In addition, chronic vulvar pain (or Vulvodynia) remains often undiagnosed [7], with women waiting an average of a 6-years before receiving a diagnosis [4]. Our data, obtained from a large sample, allowed us to identify profiles based on an empirical/data driven strategy, and provides an innovative approach to defining genital pain conditions. These results offer a starting point to re-think and discuss how diagnoses currently used to categorize female vulvo-vaginal pain can be improved. Longitudinal studies should be conducted to test whether the current strategy of grouping women with vulvo-vaginal pain provides improved diagnoses, more accurate prognoses, or improves our ability to identify patients who will or will not respond to specific treatments. Disclosure No.

Introduction More than 2 decades of neuroimaging research has sought to uncover the neurologic basis of sexual desire. However, the lack of a clear conceptual distinction between sexual desire and sexual arousal or even a broadly accepted definition of sexual desire has led to confusion in the literature regarding brain areas uniquely associated with sexual desire. Objectives (1) To critically review the neuroimaging literature that seeks to identify brain areas and networks involved in sexual desire; (2) to identify and discuss those brain areas and potential networks that are most promising for providing insights to sexual desire; and (3) to offer recommendations for future studies. Methods Existing meta-analyses were used as a starting point to identify relevant neuroimaging studies on sexual desire, arousal, and love. This base was then expanded via Google Scholar and forward citation tracking of already identified studies. Results Brain areas that are commonly associated with sexual desire and arousal include the amygdala, hypothalamus, dorsal and ventral striatum, anterior cingulate, insula, and prefrontal and orbitofrontal cortex. However, because the same basic paradigm has been used to study sexual desire and arousal, unambiguous conclusions regarding areas uniquely involved in sexual desire cannot be drawn. Moreover, the lack of connectivity analyses and a failure to acknowledge negative BOLD (blood-oxygen level dependent) significantly limit conclusions on the neural basis of sexual desire. Conclusion Five recommendations are made. First, stimulus types (ie, erotic vs sexually explicit) should be selected by the meaningful theoretical conceptualization of the constructs of interest. Second, participants should be provided with definitions of sexual desire, mental sexual arousal, and perceived genital sexual arousal, so they can choose which terms best describe their experience. Third, event-related designs should be used with caution when investigating sexual desire. Fourth, time series analyses should be used to identify both positive and negative BOLD. Fifth, connectivity analyses should be performed to identify brain networks.

BACKGROUND:Past research on the association between sexual desire and the menstrual cycle has provided inconclusive results and has not considered the potential influence of psychological and physical changes that are frequently associated with the menstrual cycle. AIM:To test the strength of association between the menstrual cycle (and associated symptoms) and changes in sexual desire. METHODS:Prospective daily reports across 2 full menstrual cycles (2 months) from a sample of female university students (n = 213), were analysed. Analyses tested for average effects of the menstrual cycle on sexual desire, individual differences in these effects, and cyclical and noncyclical associations between sexual desire and the 9 menstrual cycle-related changes. Note that data presented in the current article come from a larger study from which other reports have been published. OUTCOMES:Target variables were (1) daily change in sexual desire and (2) daily reports of 5 psychological changes and 4 physical changes that are commonly associated with the menstrual cycle. RESULTS:Results showed that when considering average effects across participants, the menstrual cycle was associated with a small midcycle increase in sexual desire. However, multilevel analyses showed large individual differences in how the menstrual cycle influences sexual desire. Specifically, some participants showed a midcycle increase, others a perimenstrual increase, and others no change across the menstrual cycle. Moreover, results demonstrated that psychological changes were more important for predicting sexual desire as compared with physical changes. CLINICAL IMPLICATIONS:These results suggest that daily measurement of sexual desire across multiple menstrual cycles may be an important tool in the assessment of sexual desire among some females. STRENGTHS AND LIMITATIONS:Strengths of this study are the daily assessment of sexual desire and all symptoms for 2 menstrual cycles and multilevel analyses that allow the study of individual differences. Limitations include limited measurement of sexual desire based on only 2 questions and the lack of measures of relationship status and sexual orientation. CONCLUSION:Emphasis is placed on the need to apply more rigorous research methods and to abandon simplistic average-effects models that are based on outdated theories and stereotypes.

Abstract Introduction Past research on Persistent Genital Arousal Disorder (PGAD) has shown that a history of sexual abuse is common among women with PGAD (Leiblum et al., 2007; Pink et al., 2014), with higher rates of abuse among those who are most symptomatic (Leiblum et al., 2007). However, there is a need for replication and for developing a theoretical understanding of the mechanisms and developmental course of this association. Moreover, although little is known about the relation between PGAD symptoms and sexual functioning (Jackowich et al., 2016) research has suggested that women with PGAD show FSFI scores that are low but within the normal range (Leiblum & Seehuus, 2009), and that those with subthreshold PGAD symptoms associate those symptoms with positive feelings. Objective The goal of the present study was to test a mediational model in which history of sexual coercion is directly associated with PGAD symptoms, and indirectly associated with sexual functioning (desire, masturbation, lubrication), with mediational effects passing through PGAD symptoms. Methods A sample of n = 138 female university students completed questionnaires measuring past experience of sexual coercion, PGAD symptoms, sexual desire, masturbation, and lubrication. Structural equation modeling was used to test a theoretical model in which a history of sexual coercion was allowed to directly predict PGAD symptoms and all three sexual function constructs, and PGAD symptoms were allowed to predict all sexual function constructs (see Figure 1). Results The SEM model fit the data well (CFI = .96; NFI = .92; RMSEA = .07). As presented in Figure 1, past experience of sexual coercion was positively associated with PGAD symptoms and negatively associated with sexual desire, but had no direct association with masturbation or lubrication. PGAD symptoms were associated with increased desire and masturbation, but decreased lubrication, and sexual desire was positively associated with lubrication. In addition to the directs effects on PGAD symptoms and sexual desire, past experience of sexual coercion also demonstrated indirect effects on all sexual function constructs (positive effects on desire and masturbation, and negative on lubrication). Conclusions Based on these results we propose a developmental model in which the effects of PGAD symptoms on desire, arousal, and pleasure, change across time and symptom severity. Specifically, increased attention to genital and sexual sensations is expected to result from past sexual coercion. Then, in the context of this heightened genital awareness, when persistent non-painful genital stimulation is perceived, in the early stages of PGAD symptom development, the combination of those sensations and the heightened attention to them is expected to result in perceived pleasurable sensation and arousal, thus increasing desire and masturbation. This is expected to be limited to the early stages of PGAD development, whereas, during later stages, when PGAD symptoms are severe and unrelenting, this is expected to change (see Figure 2). The overall level of PGAD symptoms in this sample was low (consistent with other non-clinical samples; Jackowich & Pukall, 2020), and thus these results cannot be generalized to women who live with a diagnosis of PGAD. Disclosure No

Abstract Introduction To evaluate the presence of negative thoughts and how these interfere with sexual functioning (as hypothesized by Barlow, 1986), Nobre and Pinto-Gouveia (2003) developed the Automatic Negative Thoughts scale (ANT). Research using this scale has shown that negative thoughts during sex interferes with subjective sexual arousal (SSA), lubrication, and orgasm (Cuntim and Nobre, 2011; Nobre & Pinto-Gouveia, 2003). While this early work has made a crucial contribution toward understanding how negative thoughts are associated with female sexual response, the ANT has important limitations. One limitation is that some items are not relevant to the constructs they are supposed to measure (e.g., “I have more important matters to deal with” is part of the “Sexual Abuse Thoughts” factor; and “This way of having sex is immoral” is part of the “Partner’s Lack of Affection” factor), and thus in some cases it is not clear what the scales themselves are measuring. Moreover, effect sizes on sexual functioning are modest, and the full measure is long. Objective The aim of this study was to test a new measure of negative thoughts during sex (NTs) and to investigate the associations between specific types of NTs and specific domains of sexual functioning. Using fewer and more focused questions we also aimed at having a shorter and more precise measure. Methods A sample of 138 female university students completed questionnaires investigating frequency of specific NTs and female sexual functioning (measured through the FSFI). Structural equation modelling was used to test the effect of NTs, as a latent construct, on three dimensions of sexual functioning, namely SSA, lubrication, and orgasm. Next, the effect of the four individual domains of NTs (i.e., orgasm, body image, fear of being hurt, and external thoughts) on SSA, lubrication and orgasm, was tested. Results The first SEM model fits the data well (CFI = .97; NFI = .93; RMSEA = .08). This model is presented in Figure 1 and shows that NTs have strong direct negative effects on SSA (78% variance explained), lubrication (76% variance explained), and orgasm (63% variance explained). Moreover, NTs also have an indirect effect on lubrication, mediated by SSA. The effects of single domains of NTs are presented in Figure 2 (saturated model). Overall, NTs about orgasm and fear of being hurt showed negative associations with orgasm and SSA, external thoughts showed an effect on SSA and lubrication, and NTs about body image showed no significant association. Conclusions The new measure of NTs has advantages of brevity, specificity, and stronger effect sizes as compared to the ANT. These data provide increasingly strong evidence that NTs significantly interfere with women’s sexual response, and that some domains of NTs have a stronger impact than others on different domains of sexual functioning. More work is needed to understand the sources and types of NTs, and their role in different aspects of sexual response. Furthermore, neuroimaging technology should be exploited to shed light on the neural pathways involved in cognitive interference and sexual inhibition, which are expected to be linked with the presence of NTs. Disclosure No

Abstract Introduction While researchers and clinicians have long discussed sexual desire and sexual arousal as two distinct entities, the DSM has moved from treating them separately (DSM-IV) to amalgamating desire and arousal disorders into one single diagnosis (“Female Sexual Interest/Arousal Disorder”; DSM-5). Consistent with the idea of combining them, the original publication of the FSFI found a single factor for desire and arousal (Rosen et al, 2000). Experts in sexual medicine, however, have opposed the use of this single diagnostic entity (Goldstein et al., 2017). Furthermore, Meston and colleagues have provided extensive data showing that among women, a distinction should also be made between mental and genital arousal, given the low concordance between the two. Objective The aim of these analyses was to clarify the distinction between three constructs of female sexual function: sexual desire (SD); mental sexual arousal (MSA); and genital sexual arousal/lubrication. Methods A sample of 138 female university students completed the FSFI. Structural equation modelling was used to test the goodness of fit of four different models examining the structure of the SD, MSA and lubrication subscales. The first model includes only a single factor (Fig. 1), the second and third models include two factors (Fig. 2 and 3), and the fourth model includes three factors (Fig. 4), thus maintaining the distinction between the three constructs. Results Factor loadings and correlations for the four models are presented in Figures 1-4, and although all questions loaded well on the latent factors in all four models (with the exception of fantasy in model 3), the fit indices differed significantly across models. Specifically, models 1 and 2 did not fit the data well (CFI = .64; TLI = .55; RMSEA = .21, Figure 1; CFI = .67; TLI = .58; RMSEA = .21 Figure 2). The third model showed improvement, but still did not fit the data well (CFI = .90; TLI = .87; RMSEA = .11; Figure 3), whereas the fourth model did fit the data well (CFI = .93; TLI = .91; RMSEA = .09; Figure 4). Moreover, the fourth model was found to be the best fitting model: AICc weight = .999, showing 99.9% certainty that the fourth model is the best model (1,427 times more likely to be the best model as compared to the third model). Correlations among constructs in the final model were low (r = .25) to moderate (r = 62). Conclusions Although the DSM-5 and a plethora of research have combined and confounded sexual desire and arousal as if they are the same, the current study shows that the subjective experience of these constructs are clearly differentiated. Moreover, although it has been claimed that the distinction between MSA and lubrication might be theoretically, but not clinically, relevant (Meston & Stanton, 2018), consensus in terminology is essential to move toward a more accurate understanding of sexual desire, and mental and genital sexual arousal. Doing so will also enable the use of appropriate measures and labels in the context of new research and in reference to past literature. Disclosure No

ABSTRACT Introduction Although research has attempted to quantify the effects of the menstrual cycle on sexual desire, we lack a clear understanding of how the menstrual cycle, and the many physical and psychological changes of the menstrual cycle, are related to changes in sexual desire. For example, whereas evolutionary theories predict that women should converge on increased sexual interest around ovulation, methodologically strong tests of this idea are lacking, and there is reason to hypothesize that there are significant individual differences in these associations. Objective This study has three main objectives. First, to quantify the contributions of (a) mean-level differences across individuals, (b) average effects of the menstrual cycle, and (c) individual differences in the effects of the menstrual cycle, to sexual desire. Second, to test for the influence of day-to-day changes in physical and psychological symptoms on day-to-day changes in sexual desire, independent of the menstrual cycle. Third, to test for associations between cyclical changes in physical and psychological symptoms attributable to the menstrual cycle and cyclical changes in sexual desire attributable to the menstrual cycle. Methods A sample of n = 213 university-aged women with regular menstrual cycles, who were not using hormonal birth control, completed daily questionnaires for two full menstrual cycles (M = 58 daily reports per participant). Measurement included changes in sexual desire (increase and decrease), as well as physical (headaches, back and joint pain, cramps, breast changes) and psychological changes (anxiety, depression, happiness, mood swings, low energy) that are commonly associated with the menstrual cycle. Multilevel modeling with random intercepts and slopes, as well as linear regression of cosine coefficients of all physical and psychological symptom scores, were used to test these hypotheses. Results Relative to the three objectives described above, results showed that: mean-level differences across participants accounted for 21.5% of the overall variance in changes in sexual desire; the average/fixed effects of the menstrual cycle accounted for 1.6% of the variance; and random effects of the menstrual cycle (e.g., individual differences in menstrual cycle effects) accounted for 7.8% of the variance. Only day-to-day changes in psychological symptoms, but not day-to-day changes in physical symptoms, were associated with day-to-day changes in sexual desire (independent of the menstrual cycle). Finally, only menstrual cycle-related cyclical changes in depression were associated with menstrual cycle-related changes in sexual desire. Conclusions Results from the present study demonstrate that average effects of the menstrual cycle play a very small role in influencing changes in sexual desire (see left panel of Figure 1). Most variance in changes in sexual desire, instead, is explained by individual differences in mean levels, and in individual differences in the effects of the menstrual cycle (see right panel in Figure 1). Thus, women differ significantly in their average levels of desire and how the menstrual cycle influences changes in their desire. Moreover, only psychological symptoms, and not physical symptoms, are associated with changes in sexual desire. Of the psychological symptoms, happiness is the most strongly associated with changes in sexual desire. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: ApexNeuro

The aim of the present study was to expand previous findings regarding paradoxical effects of negative mood on sexual desire. This was done by considering the full range of depressed mood and anxiety symptoms and using methods that are unaffected by recall bias and that don't require participants to infer causal associations between their mood and sexual desire. A convenience sample of 213 university students completed daily questionnaires for approximately two months. Multilevel random-effects models were used to estimate average effects for the entire sample and to test for variability across participants in the associations between negative mood and sexual desire, controlling also for potential influences of the menstrual cycle. Previous findings showing that some women report decreased sexual desire and others increased sexual desire when depressed or anxious were confirmed. More importantly, for both depressed mood and anxiety, results demonstrated the presence of within-person paradoxical associations, whereby there were some women for whom both low and high levels of negative mood were associated with the same change (an increase or a decrease) in sexual desire. Related to these diverse response patterns, paradoxical associations between negative mood and sexual desire were also present at low levels of negative mood. The discussion underlines the importance of considering individual variability and multifactorial nonlinear models when studying sexual desire.

ABSTRACT Introduction Previous studies aimed at defining the relationship between high levels of negative mood and sexual desire have shown that, in addition to people describing an expected decrease in sexual desire, some people report an unexpected increase in sexual desire when depressed or anxious (referred to as a “paradoxical effect”, Bancroft et al., 2003). However, these past findings are based on self-inferred causal attributions and retrospective, one-time measurements. Moreover, tests of these associations at the low extreme of negative mood have not been previously conducted. Objective The aim of the present study was to replicate and expand previous findings regarding paradoxical effects of negative mood on sexual desire (Bancroft et al., 2003; Lykins, Janssen & Graham, 2006), by analyzing the associations between negative mood and sexual desire across the entire range of depression and anxiety symptoms. Moreover, to address previous limitations, we sought to test for replication using methods that are unaffected by recall bias, and that don't require participants to infer causal associations between their mood and sexual desire. Methods A sample of n=213 university-aged women completed daily questionnaires for two full menstrual cycles (M = 58 daily reports per participant). Measurement included changes in sexual desire, as well as psychological changes (anxiety and depression) and other symptoms associated with the menstrual cycle. Multilevel modeling with random intercepts and slopes, were used to test for individual differences in linear and non-linear associations between mood symptoms and changes in sexual desire. Cluster analyses were used to identify different patterns of change in sexual desire associated with different levels of mood. Results Previous findings were successfully replicated. Specifically, high levels of depression were associated with increased sexual desire in 12% of the sample (paradoxical association), and high levels of anxiety were associated with increased sexual desire in 20% of the sample (paradoxical association). Thus, in addition to women who showed either no significant changes or a decrease in sexual desire when depressed or anxious, results confirmed the presence of paradoxical associations between high levels of negative mood and sexual desire (see shaded area on Fig.1). Interestingly, these between-group paradoxical effects were also present at low levels of negative mood. That is, at low levels of negative mood some women reported increased sexual desire while others reported decreased sexual desire. Moreover, for both depression and anxiety, analyses revealed three clusters of women presenting different patterns of change in sexual desire across different levels of mood symptoms. Specifically, results demonstrated the presence of within-person paradoxical associations, whereby, there are some women for whom both low and high levels of negative mood are associated with the same change (an increase or a decrease) in sexual desire. These groups are labeled "Positive Paradoxical" and "Negative Paradoxical" in Fig.1. Conclusions Results from the present study underline the importance of considering individual variability when studying sexual desire. Multiple mechanisms, based on personality traits, learning, autonomic activity, or situational factors, might moderate the relationship between mood and sexual desire. A new integrative theoretical framework is proposed to interpret these results (see Figure 2). Disclosure No

In the present study we test whether cyclical changes in affective symptoms of the menstrual cycle are associated with higher mean levels of those same symptoms. Using prospective daily reports across two full menstrual cycles, from two samples of female University students (n = 213; n = 163), we applied both quartic polynomial regressions and cosine regressions to model cyclical change in symptoms, and to test for mean-level differences in symptoms across the resulting trajectory patterns. Counter to prior findings, but consistent with theoretical expectations, these results show that females who experience menstrual cycle-related changes in affect (whether a perimenstrual or mid-cycle increase) are at risk for higher average levels of affective symptoms. These results suggest that the mid-cycle group should be recognized as a target for future research that is associated with increased risk for chronic negative affective symptoms.

A considerable amount of recent psychological research has attributed a variety of menstrual-cycle-related changes in social behavior to evolutionarily adaptive functions. Although these studies often draw interesting and unusual conclusions about female emotion and behavior within evolutionary theory, their significant limitations have not yet been addressed. In this article, we outline several methodological and conceptual issues related to the menstrual cycle that constitute threats to the internal validity and theoretical integrity of these studies. We recommend specific guidelines to address these issues and emphasize the need to apply more comprehensive and sophisticated theoretical structures when considering menstrual-cycle-related changes in emotion and behavior.

BACKGROUND:Premenstrual dysphoric disorder (PMDD) is a new Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 diagnosis characterized by the cyclical emergence of emotional and physical symptoms in the luteal phase of the menstrual cycle, with symptom remission in the follicular phase. Converging evidence highlights the possibility of distinct subtypes of PMDD with unique pathophysiologies, but temporal subgroups have yet to be explored in a systematic way.METHODS:In the current work, we use group-based trajectory modeling to identify unique trajectory subgroups of core emotional and total PMDD symptoms across the perimenstrual frame (days -14 to +9, where day 0 is menstrual onset) in a sample of 74 individuals prospectively diagnosed with DSM-5 PMDD.RESULTS:For the total daily symptom score, the best-fitting model was comprised of three groups: a group demonstrating moderate symptoms only in the premenstrual week (65%), a group demonstrating severe symptoms across the full 2 weeks of the luteal phase (17.5%), and a group demonstrating severe symptoms in the premenstrual week that were slow to resolve in the follicular phase (17.5%).CONCLUSIONS:These trajectory groups are discussed in the context of the latest work on the pathophysiology of PMDD. Experimental work is needed to test for the presence of possible pathophysiologic differences in trajectory groups, and whether unique treatment approaches are needed.