Sexual Dysfunction in Chronically Medicated Male Inpatients With Schizophrenia: Prevalence, Risk Factors, Clinical Manifestations, and Response to Sexual Arousal

BackgroundSexual dysfunction is a common symptom in patients with schizophrenia, especially in chronically medicated patients. However, the relationship between sexual dysfunction and emotional response to sexual arousal in male patients with schizophrenia remains unclear. This study aimed to assess the incidence, risk factors of sexual dysfunction in males, and their clinical correlations to sexual arousal in male patients with schizophrenia in China.MethodsA total of 162 male patients, aged 18–50 years, with schizophrenia were recruited from a psychiatric hospital in Ganzhou. The clinical symptoms were assessed by the Positive and Negative Syndrome Scale (PANSS). The Arizona Sexual Experience Scale was utilized to evaluate sexual dysfunction. Erotic images were selected from International Affective Picture System (IAPS). Sixty-eight out of the 162 subjects completed the erotic pictures reactivity task.ResultsOverall, 48 (29.6%) patients were measured as having global sexual dysfunction, 72 (44.4%) patients as having strength of sex drive dysfunction, 51 (31.5%) patients as having sexual arousal dysfunction, 55 (34.0%) patients as having penile erection dysfunction, 60 (37.0%) patients as having reached orgasm dysfunction, and 60 (37.0%) patients as having satisfaction with orgasm dysfunction. The sexual dysfunction patients had significantly higher scores on the negative symptoms of the PANSS. The only important predictor of sexual dysfunction was the severity of PANSS negative factor. The sense of pleasure and arousal post viewing erotic images in the sexual dysfunction group were lower compared to the non-sexual dysfunction group. The sense of pleasure and approach motivation were significantly negatively correlated with the severity of sexual dysfunction.ConclusionsThis study shows that nearly one-third of young and middle-aged chronically medicated male inpatients with schizophrenia suffer from sexual dysfunction. The negative factor of the PANSS can be regarded as the risk factor of sexual dysfunction. Schizophrenia patients with sexual dysfunction experienced lower pleasure and higher avoidance motivation than non-sexual dysfunction patients when exposed to erotic stimuli.

Event-Related Potentials in Women on the Pill: Neural Correlates of Positive and Erotic Stimulus Processing in Oral Contraceptive Users

Background/Aims: Exposure toward positive emotional cues with – and without – reproductive significance plays a crucial role in daily life and regarding well-being as well as mental health. While possible adverse effects of oral contraceptive (OC) use on female mental and sexual health are widely discussed, neural processing of positive emotional stimuli has not been systematically investigated in association with OC use. Considering reported effects on mood, well-being and sexual function, and proposed associations with depression, it was hypothesized that OC users showed reduced neural reactivity toward positive and erotic emotional stimuli during early as well as later stages of emotional processing and also rated these stimuli as less pleasant and less arousing compared to naturally cycling (NC) women.Method: Sixty-two female subjects (29 NC and 33 OC) were assessed at three time points across the natural menstrual cycle and corresponding time points of the OC regimen. Early (early posterior negativity, EPN) and late (late positive potential, LPP) event-related potentials in reaction to positive, erotic and neutral stimuli were collected during an Emotional Picture Stroop Paradigm (EPSP). At each appointment, subjects provided saliva samples for analysis of gonadal steroid concentration. Valence and arousal ratings were collected at the last appointment.Results: Oral contraceptive users had significantly lower endogenous estradiol and progesterone concentrations compared to NC women. No significant group differences in either subjective stimulus evaluations or neural reactivity toward positive and erotic emotional stimuli were observed. For the OC group, LPP amplitudes in reaction to erotic vs. neutral pictures differed significantly between measurement times across the OC regimen.Discussion: In this study, no evidence regarding alterations of neural reactivity toward positive and erotic stimuli in OC users compared to NC was found. Possible confounding factors and lines for future research are elaborated and discussed.

Asexuality vs. sexual interest/arousal disorder: Examining group differences in initial attention to sexual stimuli

Attention is considered to be a critical part of the sexual response cycle, and researchers have differentiated between the roles of initial (involuntary) and subsequent (voluntary) attention paid to sexual stimuli as part of the facilitation of sexual arousal. Prior studies using eye-tracking methodologies have shown differing initial attention patterns to erotic stimuli between men and women, as well as between individuals of different sexual orientations. No study has directly compared initial attention to sexual stimuli in asexual individuals, defined by their lack of sexual attraction, to women with Sexual Interest/Arousal Disorder (SIAD), a disorder characterized by a reduced or absent interest in sex coupled with significant personal distress. The current study tested differences in the initial attention patterns of 29 asexual individuals (Mage = 26.56, SD = 4.80) and 25 heterosexual women with SIAD (Mage = 27.52, SD = 4.87), using eye-tracking. Participants were presented with sexual and neutral stimuli, and their initial eye movements and initial fixations to both image types and areas of erotic contact within sexual images were recorded. Mixed-model ANOVAs and t-tests were used to compare the two groups on the speed with which their initial fixations occurred, the duration of their initial fixations, and the proportion of initial fixations made to sexual stimuli. On two indices of initial attention, women with SIAD displayed an initial attention preference for sexual stimuli over neutral stimuli compared to asexual participants. This study adds to a growing literature on the distinction between asexuality and SIAD, indicating that differences in early attention may be a feature that differentiates the groups.

Gender dysphoria and sexual euphoria - A Bayesian perspective on the influence of gender-affirming hormone therapy on sexual arousal

While the concept of sexual orientation is more clearly defined in cisgender, this is less so in transgender individuals. Both experienced gender and sex hormones have a relation to sexual preferences, arousal in response to erotic stimuli, and thus sexual orientation. In transgender individuals sexual orientation occasionally changes before or during transition, which may involve gender-affirming hormone therapy. Using functional magnetic resonance imaging, we investigated whether the neuronal and behavioral patterns of sexual arousal in transgender individuals moved from the given (before) to their chosen gender after 4.5 months of hormone therapy. To this aim, trans women and men as well as age-matched cisgender controls rated visual stimuli showing heterosexual, lesbian or gay intercourse for subjective sexual arousal. Utilizing a Bayesian framework allowed us to incorporate behavioral findings in cisgender individuals of different sexual orientations. The hypothesized changes in response patterns could indeed be observed in the behavioral responses to the single but not the differentiation between stimulus categories with the strongest results for trans men and lesbian scenes. Activation of the ventral striatum supported our hypothesis only for lesbian scenes in trans women. This prominent role of lesbian stimuli might be explained by their differential responses in cis women and men. We show that correlates of sexual arousal in transgender individuals might change in direction of the chosen gender. Future investigations longer into transition might resolve the discrepancy on behavioral and neuronal levels.

To what extent do erotic images elicit visuospatial versus cognitive attentional processes? Consistent support for a (non-spatial) Sexual Content-Induced Delay

It is almost a cultural truism that erotic images attract our attention, presumably because paying attention to erotic stimuli provided our ancestors with mating benefits. Attention, however, can be narrowly defined as visuospatial attention (keeping such stimuli in view) or more broadly as cognitive attention (such stimuli taking up one’s thoughts). We present four independent studies aiming to test the extent to which erotic images have priority in capturing visuospatial versus cognitive attention. Whereas the former would show in quicker reactions to stimuli presented in locations where erotic images appeared previously, the latter causes delayed responding after erotic images, independent of their location). To this end, we specifically modified spatial cueing tasks to disentangle visuospatial attention capture from general sexual content-induced delay (SCID) effects—a major drawback in the previous literature. Consistently across all studies (total N = 399), we found no evidence in support of visuospatial attention capture but reliably observed an unspecific delay of responding for trials in which erotic images appeared (irrespective of cue location). This SCID is equally large for heterosexual men and women and reliably associated with their self-reported sexual excitability.

The East Asian Erotic Picture Dataset and Gender Differences in Response to Opposite-Sex Erotic Stimuli in Chinese College Students

Understanding the processing of sexual stimuli has become a significant part of research on human sexuality. In addition to individual characteristics (gender and sexual orientation), empirical studies have shown that cultural factors play an important role in sexual stimuli processing. The attitudes toward sex have been reported to be more conservative in East Asian societies as compared to western countries, and significantly more sexual difficulties are observed among East Asian people. However, stimulus materials, which potentially facilitate human sexuality research on native East Asian people, are relatively not satisfactory. Erotic stimuli depicting East Asian figures are limited in the existing picture datasets. To address this issue, we present a collection of 237 erotic and 108 control pictures, accompanied by self-reported ratings of sexual arousal, pleasantness, and sexual attractiveness for opposite-sex erotic stimuli by heterosexual males and females (n = 40, divided into two equal-sized subsamples). This collection is divided into six categories, depending on their contents: dressed males (44), semi-nude males (65), nude males (64), dressed females (64), semi-nude females (52), and nude females (56). We showed gender differences in sexual arousal, pleasantness, and sexual attractiveness ratings in response to opposite-sex erotic pictures. Males reported the highest levels of sexual arousal, pleasantness, and sexual attractiveness for nude female pictures, whereas females reported the highest levels of sexual arousal, pleasantness, and sexual attractiveness for semi-nude male pictures. The erotic picture dataset may provide a useful resource of erotic stimuli that can be used as stimulus materials in experimental research on sexual function in East Asians.

The East Asian erotic picture dataset and gender differences in response to opposite-sex erotic stimuli in Chinese college students

Understanding the processing of sexual stimuli has become a significant part of research on human sexuality. In addition to individual characteristics (gender and sexual orientation), empirical studies have shown that cultural factors play an important role in sexual stimuli processing. The attitudes toward sex have been reported to be more conservative in East Asian societies as compared to western countries, and significantly more sexual difficulties are observed among East Asian people. However, stimulus materials which potentially facilitate human sexuality research on native East Asian people are relatively not satisfactory. Erotic stimuli depicting East Asian figures are limited in the existing picture datasets. To address this issue, we present a collection of 237 erotic and 108 control pictures, accompanied by self-reported ratings of sexual arousal, pleasantness and sexual attractiveness for opposite-sex erotic stimuli by heterosexual males and females (n = 40, divided into two equal-sized subsamples). This collection is divided into six categories, depending on their content: non-erotic male (44), low-erotic male (65), high-erotic male (64), non-erotic female (64), low-erotic female (52) and high-erotic female (56). We showed gender differences in sexual arousal, pleasantness and sexual attractiveness ratings in response to opposite-sex erotic pictures. Males reported the highest levels of sexual arousal, pleasantness and sexual attractiveness for high-erotic female pictures, whereas females reported the highest levels of sexual arousal, pleasantness and sexual attractiveness for low-erotic male pictures. The erotic picture dataset may provide a useful resource of erotic stimuli that can be used as stimulus materials in experimental research on sexual function in East Asians.

Robust evidence for bisexual orientation among men

The question whether some men have a bisexual orientation—that is, whether they are substantially sexually aroused and attracted to both sexes—has remained controversial among both scientists and laypersons. Skeptics believe that male sexual orientation can only be homosexual or heterosexual, and that bisexual identification reflects nonsexual concerns, such as a desire to deemphasize homosexuality. Although most bisexual-identified men report that they are attracted to both men and women, self-report data cannot refute these claims. Patterns of physiological (genital) arousal to male and female erotic stimuli can provide compelling evidence for male sexual orientation. (In contrast, most women provide similar physiological responses to male and female stimuli.) We investigated whether men who self-report bisexual feelings tend to produce bisexual arousal patterns. Prior studies of this issue have been small, used potentially invalid statistical tests, and produced inconsistent findings. We combined nearly all previously published data (from eight previous studies in the United States, United Kingdom, and Canada), yielding a sample of 474 to 588 men (depending on analysis). All participants were cisgender males. Highly robust results showed that bisexual-identified men’s genital and subjective arousal patterns were more bisexual than were those who identified as exclusively heterosexual or homosexual. These findings support the view that male sexual orientation contains a range, from heterosexuality, to bisexuality, to homosexuality.