Archives of Sexual Behavior, VoL 6, No. 2, 1977
Sexual Arousal in Women: A Comparison of Cognitive and Physiological Responses by Continuous Measurement John P. Wineze, Ph.D., 1 Peter Hoon, Ph.D., 2 and Emily Franck Hoon, B.A. 3
Six sexually normal women were exposed to a wide variety o f erotic video tapes while vaginal, groin, and breast vasoeongestion measures were taken. The women indicated their subjective level o f sexual arousal while viewing the tapes by positioning a lever device along a calibrated scale. The results indicated highly significant positive correlations among the cognitive and physiological measures for five out o f six individual subjects, although the pooled group data failed to show significance. The methodology described in this research shows promise as a diagnostic and research tool. KEY WORDS: cognitive; physiological; sexual arousal; women.
INTRODUCTION The importance of cognitive factors in the experience of sexual arousal in men and women is widely accepted by sex therapists and sex researchers. It is well documented that cognition can either facilitate or hinder sexual response (Heiman, 1975a). Geer and Fuhr (1976) demonstrated that physiological sexual arousal in men, as measured by the penile strain gauge, decreased as the complex-
This research was funded in part by grants from the National Research Council of Canada and from Carl Abbott, M.D., Dalhousie Medical School. 1Associate Professor, Brown University Medical School/Providence VA Hospital, Providence, Rhode Island 02908. 2Assistant Professor, Dalhousie University, Halifax, Nova Scotia. 3Staff Psychologist, Nova Scotia Hospital, Dartmouth, Nova Scotia. 121 © 1977 Plenum Publishing Corp., 227 West 17th Street, N e w Y o r k , N . Y . 10011. T o prom o t e freer access to published material in the spirit of the 2976 C o p y r i g h t Law, Plenum sells reprint articles f r o m all its journals. This availability underlines the fact that no part o f this p u b l i c a t i o n may be reproduced, stored in a retrieval system, or t r a n s m i t t e d , in any f o r m o r by any means, electronic, mechanical, P h o t o c o p y i n g , m i c r o f i l m i n g , r e c o r d i n g , o r otherwise, w i t h o u t w r i t t e n permission of the publisher. S h i p m e n t is p r o m p t ; rate per article is $7.50.
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ity of a distracting cognitive operation increased. Researchers have also shown that cognitive operations (namely, sexual fantasies) may have a facilitative effect on physiological sexual arousal in men (Bancroft and Mathews, 1971) and women (P. Hoon et al., 1976). This is not to say, however, that the relationship between cognitive and physiological correlates or sexual arousal is well understood in either males or females. Our understanding is less clear when one considers dysfunctional sexual problems. For example, a number of women whom we have treated have reported experiencing orgasms but little sexual arousal; others have been content ~ith subjective sexual arousal accompanied by a lack of orgasmic responsiveness. The exact meaning of these experiences is difficult to understand, especially if one assumes that in the process of sexual excitation cognitive and physiological arousal both increase and decrease simultaneously and proportionately. This relationship may not be true and is certainly worthy of experimental investigation. The identification of characteristic patterns of physiological responses associated with certain emotions or thoughts has been difficult. Lacey (1967) was one of the first to point out that different types of arousal (e.g., behavioral, cortical, and autonomic) can occur simultaneously but, in fact, are independent. Furthermore, there may be individual differences to consider when attempting to identify physiological response patterns associated with specific thoughts, pictures, or other stimuli. In the search for physiological correlates of sexual arousal, there has been the additional problem of selecting a physiological response system which is a valid and reliable measure of sexual arousal (Zuckerman, 1971). Direct measurement of genital changes seems to be the best choice at this point, and new developments have allowed researchers to move forward. Freund (1963, 1967), Baflow e t al. (1970), and Bancroft (1971) have all devised penile mechanisms which allow accurate measurement of the male erectile response, while Sintchak and Geer (1975) and P. Hoon et al. (1976) have developed photoplethysmographic devices for measuring vaginal vasocongestion in the female. The validation of physiological measures of sexual arousal has relied for the most part on the assumption that verbal reports of sexual arousal correlate with changes in physiological arousal measures. Heiman (1974, 1975a), however, found that subjective reports of sexual arousal and, indeed, reports of physiological sensations of sexual arousal do not always correlate highly with actual physiological indices of arousal. While this finding was more pronounced in women than in men, it was nonetheless present in both. Heiman (1974) hypothesized that women were less accurate in identifying physical sexual arousal "in part because of a long developmental history of 'non-labeling' or negative labeling of genital sensations, and in part because women have not had experience with a visible arousal feedback device like a penis" (p. 12). In her more recent
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study, Heiman (1975b) compared physiological and cognitive arousal in sexually dysfunctional and nondysfunctional women. Women were asked to fantasize scenes, listen to tapes, and view fdms having sexual content. Continuous measurement of vaginal pressure pulse and blood volume was taken, and all women filled out subjective response forms immediately following each fantasy and film. Heiman's (1975b) results showed an overall lack of subjective-physiological agreement for both groups during fantasy alone sessions. However, for nonclinical subjects, there was significant correlation between subjective and physiological measures of arousal during films and tapes. Heiman (1975b) concludes: "apparently, then, higher levels of arousal combined with the presence of an external erotic stimulus are more likely to result in agreement between physiological and subjective ratings of arousal" (p. 10). One problem with the Heiman (1975b) study is that while continuous physiological measures of arousal were taken, the measurement of cognitive arousal occurred only intermittently, at the end of each stimulus presentation. Continuous monitoring of physiological and cognitive variables during a stimulus presentation would allow a better understanding of (1) the precise relationship between cognitive and physiological measures based on data taken throughout the entire stimulus exposure, (2) determination of whether cognitive arousal precedes or follows physiological arousal, and (3) determination of individual differences in arousal patterns. The information might be especially important for understanding and treating sexual dysfunction. The purpose of this study was to examine the relationship between cognitive and physiological measures of sexual arousal in normal women during continuous monitoring of both measures. A wide range of video tapes of varying erotic content were presented to produce sufficient variability in cognitive and physiological measures of sexual arousal. Data were sampled and analyzed in ways that allowed determination of idiosyncratic response patterns within subjects, as well as possible response patterns characteristic of the entire group.
METHOD
Subjects Six women between the ages of 20 and 29 (x- = 24.3) volunteered for the study. All reported having no current sexual problems. All of the women were sexually experienced and all had some experience with pornography. Three were married and three were single. Educational background ranged from grade 11 completed to college educated.
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Measures and Apparatus Three measures of physiological functioning and one measure ot~cognitive sexual arousal were recorded continuously during the experiment. The physiological measures included the following: 1. Groin temperature and breast temperature. Temperature was measured with Yellow Springs Instrument Co. model YSI 729 thermistor probes. These thermistors provided input to two Scott Behavioral Electronics TI-B electronic thermometers. The output of these thermometers was in turn coupled to two Grass 7-DAE driver amplifiers. The driver amplifiers were calibrated so that 1 mm of pen deflection corresponded to 0.065°C change in temperature. The ten-turn potentiometer dial in the electronic thermometer was used to set the polygraph pen at the midpoint after a 5-min rest period, but before the experiment began for each subject separately. The two electronic thermometers were calibrated with a Hewlett Packard 2801 A quartz thermometer accurate to within 0.0001°C. One thermistor was placed approximately 2 cm from the symphysis pubis on a line from the anterior superior iliac spine. The other thermistor was placed just below the areola of the left breast. 2. Vaginal capillary engorgement. The instrumentation used to measure vaginal capillary engorgement is identical to that described by P. Hoon et al. (1976). Briefly, vaginal capillary engorgement was measured by a clear acrylic probe inserted in the vagina. The probe consists of a LED embedded in the anterior end and a photodetector transistor mounted on one side. 3. Measurement of cognitive sexual arousal. The cogntive measuring apparatus consisted of a potentiometer driven by a mechanical lever so that it changed resistance according to where the lever was placed. The lever could swing through approximately a 90 ° arc and was mounted on a table so that each subject could operate the 'lever comfortably and effortlessly with one hand, while reclining. Each subject was given prior instructions on how to use the lever and had a chance to practice and experience what it felt like to move the lever completely forward and backward. The lever swang through a metal scale calibrated from 0 to 10 which each subject inspected before the experiment began. A 6 V lantern battery was connected across the potentiometer so that voltage drop was produced which was proportional to the location of the lever in its range. This voltage differential drove a Grass 7-DAE driver amplifier so that millimeters of pen deflection corresponded in a linear manner to the position of the lever in its range. Subjects could view the position of the lever at all times during the experiment.
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PROCEDURE Prescreening All subjects for the study were paid volunteers who responded to a local advertisement. Upon arriving at a university laboratory, each subject was greeted by a female research associate and told that the purpose of the research was to study the process of sexual arousal in women. Each subject was shown the experimental setup and was interviewed and encouraged to talk about her sexual experiences. All subjects filled out a battery of questionnaires as follows: 1. Sexual Arousal I n v e n t o r y - - P . Hoon et al. (1976): High score indicates more sexual arousal. Mean score in normal women = 80.9, SD = 22.7. 2. Willoughby Scale: High score indicates more anxiety. Score above 30 generally taken to indicate some neuroticism. 3. Bentler Scale: High score indicates more sexual experience. Mean scores in normal women = 11.0, SD = 6.9. 4. Pornography Experience Scale 4 : High score indicates more pornography experience. Norms for this scale unavailable. Subjects chosen for the study were scheduled to return for the experimental session. The first six subjects who volunteered appropriate; i.e., none had any history of psychiatric problems and none reported any sexual problems. Table I shows background data and pretest scores for the six women. Experimental Sessions Subjects participated individually and were informed of the nature of the physiological measures to be taken. Each was also given the following instructions before the experiment began: You will be shown a variety of scenes on video tape which may or may not be related to each other. As you watch them, use the lever to indicate your level of sexual arousal. Let's practice with the lever. Moving it all the way forward to the 10 is maximum sexual arousal. Zero represents no sexual arousal. Try to be certain to use the lever at all times during the experiment. That is, even if there are only small changes in how sexually aroused you think you are and during breaks ff fantasizing. Try to get as involved as possible in the scenes, perhaps imagining yourself as participant. One final note: there are no right or wrong ways to react to these scenes. Each person is unique. Your charts will be coded and kept confidential. Any questions? 4 This may be obtained from the authors by writing to John P. Wincze, Ph.D., VA Hospital, Davis Park, Providence, Rhode Island 02908.
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Wineze, Hoon, a nd H o o n Table I. Background Data and Pretest Scores of Subjects Subject No.
Age
1
2
3
29
28
4
21
21
5 20
Occupation
Housewife, Student mother
Student
Student
Stenographer
Marital status
Married
Living with
Single
Single
Separated
6 27 Research assistant, secretary Married
Education
11
13
14
16
12
14
Sexual Arousal Inventory
89
77
106
99
104
90
Present frequency of intercourse Pornography Experience Scale
2-4 times 1-10 times 5 or more Never exper week per week pot week perienced intercourse
2-4 times per week
1-4 times per month
5
7
10
19
17
7
Willoughby
22
29
62
23
46
30
Bentler Subjective rating of own physiological arousal
20
19
19
9
21
15
49
47
50
55
41
54
Following the instructions, subjects inserted the probe in privacy and then attached the thermistor sensors with the assistance of a female research associate. Subjects reclined on a comfortable couch and viewed a TV monitor at the foot of the couch. After a stabilization period of 5 - 1 0 min, subjects were presented a video tape sequence as follows: 1. The word "Relax" -- 2 rain. 2. Travelogue -- 1 min. 3. Seventeen different scenes of varying sexual content including very mild heterosexual involvement to heterosexual intercourse, group sex, and a single homosexual scene. Each different scene was 1 min in duration. Thirty seconds of blank tape separated each scene. The purpose of the relax scene was to signal the beginning of the experimental session and to ensure further stabilization of the measures. The travelogue served as a control for any possible stimulus orientation response due to the viewing of a video sequence involving people.
Debriefing All subjects were debriefed by a female research associate immediately following the experiment in order to gain additional information about their reactions. The following questions were a part of every debriefing: 1. Which scenes do you recall as most arousing? 2. Which scenes do you recall as least arousing? 3. Did any scenes upset you or turn you off?.
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4. Do you have any general comments about the experiment? 5. Were you aware of any physical changes in your body during the session?
Data Sampling The three physiological measures and one cognitive measure were sampled every 15 sec from the polygraph record during the entire experiment. Specifically, there were nine data points during the relax scene, four during the travelogue, 35 during breaks between each scene, and 67 during the erotic scenes. Each data point was expressed as the deviation in millimeters from the midpoint of the polygraph scale.
Data Analysis Three separate statistical analyses were performed: (1) First, Person product-moment correlations were computed separately for each subject between the four measures (three physiological and one cognitive). Following computation of the correlations, their significance was determined. The n for each subject was 115 pairs of data points. (2) Next, certain research questions were posed, and the number of correlations for the group as a whole which were significant was compared to the number of correlations which were not significant using the binomial test (Siegel, 1956). For example, one research question was "considering all six subjects as a group, and taking their three physiological measures together, were there a greater number of significant correlations between them than nonsignificant correlations?" (3) Finally, to determine whether certain scenes produced differential changes in the four measures for the group as a whole, one-way repeated-measures ANOVAs were computed separately for each measure. The scenes were kissing, homosexuality, intercourse, and group sex. Since so many scenes were presented, and responsivity during any particular scene depended in part on the level of responsivity during the preceding scene, the data in this analysis consisted of difference scores. Means in millimeters of deviation were first computed for all scenes for each subject. Next, means from the scenes directly preceding the four chosen scenes were subtracted from the means of the four chosen scenes. This computation produced difference scores for each subject on each scene, which were submitted to a one-way repeated measures ANOVA (six subjects by four scenes). This analysis was performed to get only a general estimation of whether scenes produced differential changes in the measures.
RESULTS The results of the Pearson product-moment correlations are presented in Table II. The correlations in Table II permit an analysis of individual response
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Table II. Pearson Product-Moment Correlations Between Each of the Four Measures Separately for Each Subject Subject Groin Breast No. temperature temperature
Groin temperature
Vaginal
Cognitive
1 2 3 4 5 6
0.85 a 0.63 a 0.94a 0.87 a 0.91 a 0.87 a
1
0.16 b
0.06 c
2 3 4 5 6
0.83 a 0.8t a -0.70 a 0.40 a 0.73 a
0.88 a 0.86 a -0.52 a 0.51 a 0.94 a
1
0.20 b 0.27 b 0.63 a -0.11 c 0.54 a -0.05 c
0.15 c 0.16 b 0.70 a -0.05 c 0.53 a 0.03 c
2 3 4 5 6
Vaginal
0.28 a 0.27 b 0.78a 0.21b 0.60 a 0.12 c
ap < 0.001. bp < 0.05. CNot significant, p > 0.05. patterns, while the binomial tests based on these correlations delineate relationsships which hold for the entire group. All o f the subjects showed highly significant correlations between breast and groin temperature measures. Similarly, highly significant positive correlations between vaginal vasocongestion changes and breast and groin temperature changes were observed in most cases. Subject 1 did not show significant correlations between breast temperature and vaginal vasocongestion changes, and subject 4 showed significantly negative correlations between vaginal vasocongestion changes and breast and groin temperature changes. All but one subject showed significant positive correlations between the cognitive measure and vaginal measure. Three subjects showed significant positive correlations between breast temperature and the cognitive measure, while four subjects showed significant positive correlations between groin temperature and the cognitive measure. Binomial tests were c o m p u t e d for a number of specific research questions. The results o f the binomial tests and the questions posed are presented in Table III. The one-way repeated analysis o f variance was c o m p u t e d in order to estimate whether certain scenes produced differential changes in the four measures o f the group o f subjects as a whole. On the cognitive measure, the subjects significantly responded in a differential way to the four selected scenes F (3, 15) =
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Table II1. Binomial Tests for Specific Research Questions Pertaining to the Subjects as a Group Binomial test, significance level
Question 1. Are there a greater number of significant positive correlations r between all three physiological measures than either nonsignificant or negative correlations?
Yes a
2. Are there more significant positive correlations between the cognitive measure and the three physiological measures than nonsignificant or negative correlations?
No b
3. Is the correlation between the vaginal vasocongestion measure and the cognitive measure greater than correlations between the cognitive measure and the two temperature measures?
Yes a
4. Is the correlation between the cognitive measure and both temperature measures more often positive and significant than either negative or nonsignificant?
No b
5. Is the correlation between the cognitive measure and vaginal vasocongestion measure more often significant and positive than either negative or nonsignificant?
No b
6. Whenever the lever showed an increase or a decrease, and vaginal vasocongestion changes were noted within 9 sec (either before or after), did vaginal changes precede the cognitive changes?
Yes c
ap < 0.05. bNot significant, p > 0.05. Cp < 0.001. 8.62, p < 0.001. N o n e o f the three physiological measures p r o d u c e d significant F values. Six r a n d o m l y selected pairs o f m e a s u r e m e n t s taken by two observers for each o f f o u r measures were c o m p a r e d . The percentage at w h i c h the two measures differed relative to the original r e c o r d e d value was calculated for the six pairs separately. This percentage was averaged for the six comparisons, divided by 2, and expressed as plus or m i n u s percentage deviation. M e a s u r e m e n t errors were w i t h i n acceptable ranges and were no greater than + 3.5%.
Debriefing All subjects were asked during the debriefing to report the scenes w h i c h t h e y f o u n d least arousing and m o s t arousing. In addition, all were asked if any o f the scenes were upsetting. Table IV presents the subjects' response to the debriefing questions along w i t h the least and m o s t arousing scenes as d e t e r m i n e d by the cognitive and vaginal measures.
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Table IV. Most and Least Arousing Scenes as Stated in Debriefing and as Measured by Cognitive Lever and Vaginal Vasocongestion Subject No.
1 Most arousing scene, debriefing Most arousing scene, cognitive
Most arousing scene, vaginal
2
3
4
Intercourse Oral sex, Genital Intercourse intercourse, stimulation male masturbation Intercourse Intercourse Intercourse, Nude breast group sex, stimulation male masturbation, genital stimulation Oral sex Group sex Group sex Group sex, nude breast stimulation
Least arousing scene, debriefing
Nonsexual, kissing
Least arousing scene, cognitive
Nonsexual, Nonsexual, all scenes kissing, except oral breast and interstimulacourse tion Nonsexual Nonsexual
Least arousing scene, vaginal Upsetting scenes, None debriefing
6
Oral sex, male masturbation, group sex
Intercourse
Group sex, male masturbation
Group sex, intercourse
Nonsexual scenes
Nonsexual, kissing
Nonsexual Nonsexual, male nude, homosexual, eunnilingus
Nonsexual
Nonsexual, nude breast, genital stimulation Nonsexual, nude breast, genital stimulation
Nonsexual
Nonsexual
Nonsexual
None
Group sex
Nonsexual, Nonsexual, homosexual male nude
Homosexual
5
Oral sex, male Intercourse masturbation
Nonsexual
Genital expo- None sure
Across measures (cognitive, debriefing, and vaginal) and across subjects in Table IV, nonsexual scenes produced the least amount of sexual arousal. All subjects showed most arousal on the vaginal measure during oral sex and group sex scenes. Subjects indicated the most arousal by cognitive measure and during debriefing in intercourse and oral sex scenes.
DISCUSSION The advantage of the methodology described in the present study is that it is unobtrusive and requires almost no effort on the part of the subject. It does not appear to produce any artifacts in physiological response systems and does not interfere with attention to visual stimuli. During debriefing, non of the subjects reported any difficulty in attending to the TV monitor or manipulating the lever. Since this study utilizes new instrumentation, there may be questions raised concerning validity and reliability. Studies have now been completed which support the vaginal photoplethysmographic probe as a valid measure of female sexual arousal (P. Hoon et al., 1976; Wincze et al., 1976). Repeated use of the probe in our own laboratory and in other laboratories (Heiman, 1974,
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1975a, b; Geer et al., 1974) has supported the observational reliability of this measure, although there are no direct studies as yet which quantitatively demonstrate its reliability. The continuous cognitive measure did not correlate significantly with the physiological vaginal measure for the group data, although it did for five out of the six subjects. Thus the group data do not support the validity of the cognitive measure. However, in terms of exposure to explicit erotic scenes, the cognitive measure has validity. It was activated by erotic scenes relative to less erotic and homosexual scenes as indicated by the repeated-measures ANOVA. The cognitive lever is reliable across different points in time in single subjects. Erotic scenes activate the lever repeatedly in single subjects while less erotic scenes such as couples talking, travelogues, and homosexuality deactivate the lever. The most common means of correlating cognitive and physiological indices of sexual arousal has been by asking subjects to report their subjective level of arousal (usually on some scale) immediately after they have been exposed to erotic stimuli (Adamson et al., 1972; Bancroft, 1971; Hamrick, 1974; Heiman, 1975b; Mavissakalian et al., 1975; Wenger et al., 1968). Most researchers have accepted this as a valid means of measuring cognitive levels of sexual arousal, even though Heiman (1975b) appears to have been the first to question the agreement of "subjective-objective" sexual measures. The disadvantage of questioning subjects after the fact is that they simply may not recall their exact feelings during the erotic stimulus exposure. More importantly, perhaps, subjects may be indicating their highest level, lowest level, or average level of subjective arousal when asked after the fact. The results of the present study indicate that in almost all cases there were highly significant positive correlations between vaginal vasocongestion changes and breast and groin vasocongestion changes. This extends the findings of P. Hoon et al. (1976), who have shown that vaginal vasocongestion along with forehead vasocongestion can discriminate among erotic, dysphoric, and neutral stimuli presentation. The results comparing individual cognitive changes and physiological changes are less clear. In three of the subjects (subjects 2, 3, and 5), the correlations between cognitive and physiological measures were highly significant; in subject 1, the correlation between cognitive and breast temperature was not significant; in subject 5, correlations between cognitive and both temperature measures were nonsignificant; in subject 6, correlations between all of the cognitive and physiological measures were nonsignificant. For the subjects as a group, the binomial test showed no significant relationship between cognitive and physiological indices of arousal. Subjects 4 and 6 showed the least amount of correlation between cognitive and physiological measures. It is interesting to note that these two subjects reported the least amount of sexual experience as measured by the Bentler Heterosexual Experience Scale (Bentler, 1968). Also subject 4 was single, and reported that she had never experienced intercourse (see Table I). It may be that the re-
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lationship between cognitive and physiological indices of sexual arousal is greater in sexually experienced women. All subjects recorded at least 50% subjective arousal, and three subjects recorded 100% subjective arousal on two or more scenes. This indicates that the data in this investigation are based on moderate to extreme levels of subjectively reported sexual arousal. None of the subjects rated the heterosexual kissing scene as even slightly arousing (lever at zero for all subjects), while all the subjects rated intercourse, oral sex, and group sex as moderately to extremely arousing (lever at 50-100%). This finding extends the work of Heiman (1975b), who found women to be most highly aroused by explicit sexual scenes. None of the women rated the male homosexual scenes as arousing, nor did any of the women show physiological increases in arousal to these scenes. This is a very different response compared to that of males, who find lesbian films highly erotic (Mavissakalian et al., 1975). It is interesting to note that five out of six subjects showed the greatest vaginal vasocongestion to the group sex scene but none of these subjects reported her arousal related to group sex during the debriefing. This inconsistency may be a result of the cultural taboo placed on group sex. In this study, physiological arousal preceded cognitive arousal. Perhaps cognitive sexual arousal has a higher threshold than physiological sexual arousal, or physiological arousal may have to reach a certain threshold above the absence of arousal before a woman will become cognitively aware that sexual arousal is present. This relationship would also be interesting to explore in males, who may use penile erection as the major indicator of their arousal. There are shortcomings of this research design which raise some questions concerning the results: 1. All subjects viewed the same video sequence in the same order. Thus it is possible that the results reflect a temporal variable. Perhaps women showed most arousal in group and oral sex scenes because of the temporal placement of these scenes. Examination of the individual response patterns would tend to argue against this, however. Women showed very individual response patterns and did not seem to be showing a cumulative response buildup. The oral sex scenes appeared very early in the sequence while the group sex scene appeared almost at the end. Nevertheless, future research could emphasize a design in which scenes were presented to subjects in random order. 2. Since only 30-sec breaks between scenes were provided, physiological return to baseline levels was not always consistently achieved, although in all cases the cognitive measure was returned to baseline during this intertrial interval. Future research may utilize longer breaks between scenes. This was not possible in the present study because of limited time. A larger number of scenes was used in order to reveal relationships between measures, and to delineate the effects of different erotic stimuli.
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Adamson, J., Romano, K., Burdick, J., Corman, C., and Chebib, F. (1972). Physiological responses to sexual and unpleasant film stimuli. J. Psyehosom. Res. 16: 153-162. Bancroft, J. (1971). The application of psychophysiological measures to the assessment and modification of sexual behaviour. Behav. Res. Ther. 9: 119-130. Bancroft, J., and Mathews, A. (1971). Autonomic correlates of penile erection. Z Psycho. sorn. Res. 15: 159-167. Barlow, D., Becker, R., Leitenberg, H., and Agras, W. (1970). Mechanical strain gauge recording penile circumference change. J. Appl. Behav. Anal. 3: 73-76. Bentler, P. (1968). Heterosexualbehavior assessment: II. Females.Behav. Res. Tiler. 6: 27-30. Brown, P. (1964). On the differentiation of homo- or hetero-erotic interest in the male: An operant technique illustrated in a case of a motorcycle fetishist. Behav. Res. Ther. 2: 31-35. Freund, K. (1963). A laboratory method for diagnosing predominance of homo- and heteroerotic interest in the male. Behav. Res. Ther. 1 : 85-93. Freund, K. (1967). Erotic preference in paedophilia. Behav. Res. Ther. 5: 339-348. Geer, J., and Fuhr, R. (1976). Cognitive factors in sexual arousal: The role of distraction. Z Consult. Clin. Psychol. 44: 238-243. Geer, J., Morokoff, P., and Greenwood, P. (1974). Sexual arousal in women: The development of a measurement device for vaginal bloodvolume.Arch. Sex. Behav. 3: 559-564. Hamrick, N. (1974). Physiological and verbal responses to erotic visual stimuli in a female population. Behav. Eng. 11: 9-11. Heiman, J. (1974). Facilitating erotic arousal: Toward sex-positive sex research. Paper delivered at 1974 meeting of the American Psychological Association, New Orleans. Heiman, J. (1975a). Use of the vaginal photoplethysmograph as a diagnostic and treatment aid in female sexual dysfunction. Paper delivered at 1975 meeting of the American Psychological Association, Chicago. Heiman, J. (1975b). Women's sexual arousal. PsychoL Today 8: 91-94. Hoon, E., Hoon, P., and Wincze, J. (1976). An inventory for the measurement of female sexual arousal: The SAI. Arch. Sex. Behav. 5: 291-300. Hoon, P,, Wincze, J., and Hoon, E. (1976). Physiological assessment of sexual arousal in women. Psychophysiology 13: 196-204. Lacey, J. (1967). Somatic response patterning and stress: Some revisions of activation theory. In Appley, M. H., and Trumbull, R. (eds.), Psychological Stress, Appleton'Century-Crofts, New York. Mavissakalian, M., Blanchard, R., Abel, G., and Barlow, D. (1975). Responses to complex erotic stimuli in homosexual and heterosexual males. Br. J. Psychiat. 1215: 252-257. Siegel, S. (1956). Non-parametric Statistics for the Behavioral Sciences, McGraw-Hill, New York. Sintchak, G., and Geer, J. (1975). A vaginal photoplethysmograph system. Psychophysiology 12: 113-115. Wenger, M., Averill, J., and Smith, D. (1968). Autonomic activity during sexual arousal. Psychophysiology 4: 468-478. Wincze, J., Hoon, P., and Hoon, E. (1976). Physiologicalresponsivity of normal and sexually dysfunctional women during erotic stimulus exposure. J. Psychosom. Res. (in press). Zuckerman, M. (1971). Physiological measures of sexual arousal in the human. Psychol. Bull. 75: 297-329.
Sexual Arousal in Women: A Comparison of Cognitive and Physiological Responses by Continuous Measurement John P. Wineze, Ph.D., 1 Peter Hoon, Ph.D., 2 and Emily Franck Hoon, B.A. 3
Six sexually normal women were exposed to a wide variety o f erotic video tapes while vaginal, groin, and breast vasoeongestion measures were taken. The women indicated their subjective level o f sexual arousal while viewing the tapes by positioning a lever device along a calibrated scale. The results indicated highly significant positive correlations among the cognitive and physiological measures for five out o f six individual subjects, although the pooled group data failed to show significance. The methodology described in this research shows promise as a diagnostic and research tool. KEY WORDS: cognitive; physiological; sexual arousal; women.
INTRODUCTION The importance of cognitive factors in the experience of sexual arousal in men and women is widely accepted by sex therapists and sex researchers. It is well documented that cognition can either facilitate or hinder sexual response (Heiman, 1975a). Geer and Fuhr (1976) demonstrated that physiological sexual arousal in men, as measured by the penile strain gauge, decreased as the complex-
This research was funded in part by grants from the National Research Council of Canada and from Carl Abbott, M.D., Dalhousie Medical School. 1Associate Professor, Brown University Medical School/Providence VA Hospital, Providence, Rhode Island 02908. 2Assistant Professor, Dalhousie University, Halifax, Nova Scotia. 3Staff Psychologist, Nova Scotia Hospital, Dartmouth, Nova Scotia. 121 © 1977 Plenum Publishing Corp., 227 West 17th Street, N e w Y o r k , N . Y . 10011. T o prom o t e freer access to published material in the spirit of the 2976 C o p y r i g h t Law, Plenum sells reprint articles f r o m all its journals. This availability underlines the fact that no part o f this p u b l i c a t i o n may be reproduced, stored in a retrieval system, or t r a n s m i t t e d , in any f o r m o r by any means, electronic, mechanical, P h o t o c o p y i n g , m i c r o f i l m i n g , r e c o r d i n g , o r otherwise, w i t h o u t w r i t t e n permission of the publisher. S h i p m e n t is p r o m p t ; rate per article is $7.50.
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ity of a distracting cognitive operation increased. Researchers have also shown that cognitive operations (namely, sexual fantasies) may have a facilitative effect on physiological sexual arousal in men (Bancroft and Mathews, 1971) and women (P. Hoon et al., 1976). This is not to say, however, that the relationship between cognitive and physiological correlates or sexual arousal is well understood in either males or females. Our understanding is less clear when one considers dysfunctional sexual problems. For example, a number of women whom we have treated have reported experiencing orgasms but little sexual arousal; others have been content ~ith subjective sexual arousal accompanied by a lack of orgasmic responsiveness. The exact meaning of these experiences is difficult to understand, especially if one assumes that in the process of sexual excitation cognitive and physiological arousal both increase and decrease simultaneously and proportionately. This relationship may not be true and is certainly worthy of experimental investigation. The identification of characteristic patterns of physiological responses associated with certain emotions or thoughts has been difficult. Lacey (1967) was one of the first to point out that different types of arousal (e.g., behavioral, cortical, and autonomic) can occur simultaneously but, in fact, are independent. Furthermore, there may be individual differences to consider when attempting to identify physiological response patterns associated with specific thoughts, pictures, or other stimuli. In the search for physiological correlates of sexual arousal, there has been the additional problem of selecting a physiological response system which is a valid and reliable measure of sexual arousal (Zuckerman, 1971). Direct measurement of genital changes seems to be the best choice at this point, and new developments have allowed researchers to move forward. Freund (1963, 1967), Baflow e t al. (1970), and Bancroft (1971) have all devised penile mechanisms which allow accurate measurement of the male erectile response, while Sintchak and Geer (1975) and P. Hoon et al. (1976) have developed photoplethysmographic devices for measuring vaginal vasocongestion in the female. The validation of physiological measures of sexual arousal has relied for the most part on the assumption that verbal reports of sexual arousal correlate with changes in physiological arousal measures. Heiman (1974, 1975a), however, found that subjective reports of sexual arousal and, indeed, reports of physiological sensations of sexual arousal do not always correlate highly with actual physiological indices of arousal. While this finding was more pronounced in women than in men, it was nonetheless present in both. Heiman (1974) hypothesized that women were less accurate in identifying physical sexual arousal "in part because of a long developmental history of 'non-labeling' or negative labeling of genital sensations, and in part because women have not had experience with a visible arousal feedback device like a penis" (p. 12). In her more recent
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study, Heiman (1975b) compared physiological and cognitive arousal in sexually dysfunctional and nondysfunctional women. Women were asked to fantasize scenes, listen to tapes, and view fdms having sexual content. Continuous measurement of vaginal pressure pulse and blood volume was taken, and all women filled out subjective response forms immediately following each fantasy and film. Heiman's (1975b) results showed an overall lack of subjective-physiological agreement for both groups during fantasy alone sessions. However, for nonclinical subjects, there was significant correlation between subjective and physiological measures of arousal during films and tapes. Heiman (1975b) concludes: "apparently, then, higher levels of arousal combined with the presence of an external erotic stimulus are more likely to result in agreement between physiological and subjective ratings of arousal" (p. 10). One problem with the Heiman (1975b) study is that while continuous physiological measures of arousal were taken, the measurement of cognitive arousal occurred only intermittently, at the end of each stimulus presentation. Continuous monitoring of physiological and cognitive variables during a stimulus presentation would allow a better understanding of (1) the precise relationship between cognitive and physiological measures based on data taken throughout the entire stimulus exposure, (2) determination of whether cognitive arousal precedes or follows physiological arousal, and (3) determination of individual differences in arousal patterns. The information might be especially important for understanding and treating sexual dysfunction. The purpose of this study was to examine the relationship between cognitive and physiological measures of sexual arousal in normal women during continuous monitoring of both measures. A wide range of video tapes of varying erotic content were presented to produce sufficient variability in cognitive and physiological measures of sexual arousal. Data were sampled and analyzed in ways that allowed determination of idiosyncratic response patterns within subjects, as well as possible response patterns characteristic of the entire group.
METHOD
Subjects Six women between the ages of 20 and 29 (x- = 24.3) volunteered for the study. All reported having no current sexual problems. All of the women were sexually experienced and all had some experience with pornography. Three were married and three were single. Educational background ranged from grade 11 completed to college educated.
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Measures and Apparatus Three measures of physiological functioning and one measure ot~cognitive sexual arousal were recorded continuously during the experiment. The physiological measures included the following: 1. Groin temperature and breast temperature. Temperature was measured with Yellow Springs Instrument Co. model YSI 729 thermistor probes. These thermistors provided input to two Scott Behavioral Electronics TI-B electronic thermometers. The output of these thermometers was in turn coupled to two Grass 7-DAE driver amplifiers. The driver amplifiers were calibrated so that 1 mm of pen deflection corresponded to 0.065°C change in temperature. The ten-turn potentiometer dial in the electronic thermometer was used to set the polygraph pen at the midpoint after a 5-min rest period, but before the experiment began for each subject separately. The two electronic thermometers were calibrated with a Hewlett Packard 2801 A quartz thermometer accurate to within 0.0001°C. One thermistor was placed approximately 2 cm from the symphysis pubis on a line from the anterior superior iliac spine. The other thermistor was placed just below the areola of the left breast. 2. Vaginal capillary engorgement. The instrumentation used to measure vaginal capillary engorgement is identical to that described by P. Hoon et al. (1976). Briefly, vaginal capillary engorgement was measured by a clear acrylic probe inserted in the vagina. The probe consists of a LED embedded in the anterior end and a photodetector transistor mounted on one side. 3. Measurement of cognitive sexual arousal. The cogntive measuring apparatus consisted of a potentiometer driven by a mechanical lever so that it changed resistance according to where the lever was placed. The lever could swing through approximately a 90 ° arc and was mounted on a table so that each subject could operate the 'lever comfortably and effortlessly with one hand, while reclining. Each subject was given prior instructions on how to use the lever and had a chance to practice and experience what it felt like to move the lever completely forward and backward. The lever swang through a metal scale calibrated from 0 to 10 which each subject inspected before the experiment began. A 6 V lantern battery was connected across the potentiometer so that voltage drop was produced which was proportional to the location of the lever in its range. This voltage differential drove a Grass 7-DAE driver amplifier so that millimeters of pen deflection corresponded in a linear manner to the position of the lever in its range. Subjects could view the position of the lever at all times during the experiment.
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PROCEDURE Prescreening All subjects for the study were paid volunteers who responded to a local advertisement. Upon arriving at a university laboratory, each subject was greeted by a female research associate and told that the purpose of the research was to study the process of sexual arousal in women. Each subject was shown the experimental setup and was interviewed and encouraged to talk about her sexual experiences. All subjects filled out a battery of questionnaires as follows: 1. Sexual Arousal I n v e n t o r y - - P . Hoon et al. (1976): High score indicates more sexual arousal. Mean score in normal women = 80.9, SD = 22.7. 2. Willoughby Scale: High score indicates more anxiety. Score above 30 generally taken to indicate some neuroticism. 3. Bentler Scale: High score indicates more sexual experience. Mean scores in normal women = 11.0, SD = 6.9. 4. Pornography Experience Scale 4 : High score indicates more pornography experience. Norms for this scale unavailable. Subjects chosen for the study were scheduled to return for the experimental session. The first six subjects who volunteered appropriate; i.e., none had any history of psychiatric problems and none reported any sexual problems. Table I shows background data and pretest scores for the six women. Experimental Sessions Subjects participated individually and were informed of the nature of the physiological measures to be taken. Each was also given the following instructions before the experiment began: You will be shown a variety of scenes on video tape which may or may not be related to each other. As you watch them, use the lever to indicate your level of sexual arousal. Let's practice with the lever. Moving it all the way forward to the 10 is maximum sexual arousal. Zero represents no sexual arousal. Try to be certain to use the lever at all times during the experiment. That is, even if there are only small changes in how sexually aroused you think you are and during breaks ff fantasizing. Try to get as involved as possible in the scenes, perhaps imagining yourself as participant. One final note: there are no right or wrong ways to react to these scenes. Each person is unique. Your charts will be coded and kept confidential. Any questions? 4 This may be obtained from the authors by writing to John P. Wincze, Ph.D., VA Hospital, Davis Park, Providence, Rhode Island 02908.
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Wineze, Hoon, a nd H o o n Table I. Background Data and Pretest Scores of Subjects Subject No.
Age
1
2
3
29
28
4
21
21
5 20
Occupation
Housewife, Student mother
Student
Student
Stenographer
Marital status
Married
Living with
Single
Single
Separated
6 27 Research assistant, secretary Married
Education
11
13
14
16
12
14
Sexual Arousal Inventory
89
77
106
99
104
90
Present frequency of intercourse Pornography Experience Scale
2-4 times 1-10 times 5 or more Never exper week per week pot week perienced intercourse
2-4 times per week
1-4 times per month
5
7
10
19
17
7
Willoughby
22
29
62
23
46
30
Bentler Subjective rating of own physiological arousal
20
19
19
9
21
15
49
47
50
55
41
54
Following the instructions, subjects inserted the probe in privacy and then attached the thermistor sensors with the assistance of a female research associate. Subjects reclined on a comfortable couch and viewed a TV monitor at the foot of the couch. After a stabilization period of 5 - 1 0 min, subjects were presented a video tape sequence as follows: 1. The word "Relax" -- 2 rain. 2. Travelogue -- 1 min. 3. Seventeen different scenes of varying sexual content including very mild heterosexual involvement to heterosexual intercourse, group sex, and a single homosexual scene. Each different scene was 1 min in duration. Thirty seconds of blank tape separated each scene. The purpose of the relax scene was to signal the beginning of the experimental session and to ensure further stabilization of the measures. The travelogue served as a control for any possible stimulus orientation response due to the viewing of a video sequence involving people.
Debriefing All subjects were debriefed by a female research associate immediately following the experiment in order to gain additional information about their reactions. The following questions were a part of every debriefing: 1. Which scenes do you recall as most arousing? 2. Which scenes do you recall as least arousing? 3. Did any scenes upset you or turn you off?.
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4. Do you have any general comments about the experiment? 5. Were you aware of any physical changes in your body during the session?
Data Sampling The three physiological measures and one cognitive measure were sampled every 15 sec from the polygraph record during the entire experiment. Specifically, there were nine data points during the relax scene, four during the travelogue, 35 during breaks between each scene, and 67 during the erotic scenes. Each data point was expressed as the deviation in millimeters from the midpoint of the polygraph scale.
Data Analysis Three separate statistical analyses were performed: (1) First, Person product-moment correlations were computed separately for each subject between the four measures (three physiological and one cognitive). Following computation of the correlations, their significance was determined. The n for each subject was 115 pairs of data points. (2) Next, certain research questions were posed, and the number of correlations for the group as a whole which were significant was compared to the number of correlations which were not significant using the binomial test (Siegel, 1956). For example, one research question was "considering all six subjects as a group, and taking their three physiological measures together, were there a greater number of significant correlations between them than nonsignificant correlations?" (3) Finally, to determine whether certain scenes produced differential changes in the four measures for the group as a whole, one-way repeated-measures ANOVAs were computed separately for each measure. The scenes were kissing, homosexuality, intercourse, and group sex. Since so many scenes were presented, and responsivity during any particular scene depended in part on the level of responsivity during the preceding scene, the data in this analysis consisted of difference scores. Means in millimeters of deviation were first computed for all scenes for each subject. Next, means from the scenes directly preceding the four chosen scenes were subtracted from the means of the four chosen scenes. This computation produced difference scores for each subject on each scene, which were submitted to a one-way repeated measures ANOVA (six subjects by four scenes). This analysis was performed to get only a general estimation of whether scenes produced differential changes in the measures.
RESULTS The results of the Pearson product-moment correlations are presented in Table II. The correlations in Table II permit an analysis of individual response
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Table II. Pearson Product-Moment Correlations Between Each of the Four Measures Separately for Each Subject Subject Groin Breast No. temperature temperature
Groin temperature
Vaginal
Cognitive
1 2 3 4 5 6
0.85 a 0.63 a 0.94a 0.87 a 0.91 a 0.87 a
1
0.16 b
0.06 c
2 3 4 5 6
0.83 a 0.8t a -0.70 a 0.40 a 0.73 a
0.88 a 0.86 a -0.52 a 0.51 a 0.94 a
1
0.20 b 0.27 b 0.63 a -0.11 c 0.54 a -0.05 c
0.15 c 0.16 b 0.70 a -0.05 c 0.53 a 0.03 c
2 3 4 5 6
Vaginal
0.28 a 0.27 b 0.78a 0.21b 0.60 a 0.12 c
ap < 0.001. bp < 0.05. CNot significant, p > 0.05. patterns, while the binomial tests based on these correlations delineate relationsships which hold for the entire group. All o f the subjects showed highly significant correlations between breast and groin temperature measures. Similarly, highly significant positive correlations between vaginal vasocongestion changes and breast and groin temperature changes were observed in most cases. Subject 1 did not show significant correlations between breast temperature and vaginal vasocongestion changes, and subject 4 showed significantly negative correlations between vaginal vasocongestion changes and breast and groin temperature changes. All but one subject showed significant positive correlations between the cognitive measure and vaginal measure. Three subjects showed significant positive correlations between breast temperature and the cognitive measure, while four subjects showed significant positive correlations between groin temperature and the cognitive measure. Binomial tests were c o m p u t e d for a number of specific research questions. The results o f the binomial tests and the questions posed are presented in Table III. The one-way repeated analysis o f variance was c o m p u t e d in order to estimate whether certain scenes produced differential changes in the four measures o f the group o f subjects as a whole. On the cognitive measure, the subjects significantly responded in a differential way to the four selected scenes F (3, 15) =
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Table II1. Binomial Tests for Specific Research Questions Pertaining to the Subjects as a Group Binomial test, significance level
Question 1. Are there a greater number of significant positive correlations r between all three physiological measures than either nonsignificant or negative correlations?
Yes a
2. Are there more significant positive correlations between the cognitive measure and the three physiological measures than nonsignificant or negative correlations?
No b
3. Is the correlation between the vaginal vasocongestion measure and the cognitive measure greater than correlations between the cognitive measure and the two temperature measures?
Yes a
4. Is the correlation between the cognitive measure and both temperature measures more often positive and significant than either negative or nonsignificant?
No b
5. Is the correlation between the cognitive measure and vaginal vasocongestion measure more often significant and positive than either negative or nonsignificant?
No b
6. Whenever the lever showed an increase or a decrease, and vaginal vasocongestion changes were noted within 9 sec (either before or after), did vaginal changes precede the cognitive changes?
Yes c
ap < 0.05. bNot significant, p > 0.05. Cp < 0.001. 8.62, p < 0.001. N o n e o f the three physiological measures p r o d u c e d significant F values. Six r a n d o m l y selected pairs o f m e a s u r e m e n t s taken by two observers for each o f f o u r measures were c o m p a r e d . The percentage at w h i c h the two measures differed relative to the original r e c o r d e d value was calculated for the six pairs separately. This percentage was averaged for the six comparisons, divided by 2, and expressed as plus or m i n u s percentage deviation. M e a s u r e m e n t errors were w i t h i n acceptable ranges and were no greater than + 3.5%.
Debriefing All subjects were asked during the debriefing to report the scenes w h i c h t h e y f o u n d least arousing and m o s t arousing. In addition, all were asked if any o f the scenes were upsetting. Table IV presents the subjects' response to the debriefing questions along w i t h the least and m o s t arousing scenes as d e t e r m i n e d by the cognitive and vaginal measures.
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Table IV. Most and Least Arousing Scenes as Stated in Debriefing and as Measured by Cognitive Lever and Vaginal Vasocongestion Subject No.
1 Most arousing scene, debriefing Most arousing scene, cognitive
Most arousing scene, vaginal
2
3
4
Intercourse Oral sex, Genital Intercourse intercourse, stimulation male masturbation Intercourse Intercourse Intercourse, Nude breast group sex, stimulation male masturbation, genital stimulation Oral sex Group sex Group sex Group sex, nude breast stimulation
Least arousing scene, debriefing
Nonsexual, kissing
Least arousing scene, cognitive
Nonsexual, Nonsexual, all scenes kissing, except oral breast and interstimulacourse tion Nonsexual Nonsexual
Least arousing scene, vaginal Upsetting scenes, None debriefing
6
Oral sex, male masturbation, group sex
Intercourse
Group sex, male masturbation
Group sex, intercourse
Nonsexual scenes
Nonsexual, kissing
Nonsexual Nonsexual, male nude, homosexual, eunnilingus
Nonsexual
Nonsexual, nude breast, genital stimulation Nonsexual, nude breast, genital stimulation
Nonsexual
Nonsexual
Nonsexual
None
Group sex
Nonsexual, Nonsexual, homosexual male nude
Homosexual
5
Oral sex, male Intercourse masturbation
Nonsexual
Genital expo- None sure
Across measures (cognitive, debriefing, and vaginal) and across subjects in Table IV, nonsexual scenes produced the least amount of sexual arousal. All subjects showed most arousal on the vaginal measure during oral sex and group sex scenes. Subjects indicated the most arousal by cognitive measure and during debriefing in intercourse and oral sex scenes.
DISCUSSION The advantage of the methodology described in the present study is that it is unobtrusive and requires almost no effort on the part of the subject. It does not appear to produce any artifacts in physiological response systems and does not interfere with attention to visual stimuli. During debriefing, non of the subjects reported any difficulty in attending to the TV monitor or manipulating the lever. Since this study utilizes new instrumentation, there may be questions raised concerning validity and reliability. Studies have now been completed which support the vaginal photoplethysmographic probe as a valid measure of female sexual arousal (P. Hoon et al., 1976; Wincze et al., 1976). Repeated use of the probe in our own laboratory and in other laboratories (Heiman, 1974,
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1975a, b; Geer et al., 1974) has supported the observational reliability of this measure, although there are no direct studies as yet which quantitatively demonstrate its reliability. The continuous cognitive measure did not correlate significantly with the physiological vaginal measure for the group data, although it did for five out of the six subjects. Thus the group data do not support the validity of the cognitive measure. However, in terms of exposure to explicit erotic scenes, the cognitive measure has validity. It was activated by erotic scenes relative to less erotic and homosexual scenes as indicated by the repeated-measures ANOVA. The cognitive lever is reliable across different points in time in single subjects. Erotic scenes activate the lever repeatedly in single subjects while less erotic scenes such as couples talking, travelogues, and homosexuality deactivate the lever. The most common means of correlating cognitive and physiological indices of sexual arousal has been by asking subjects to report their subjective level of arousal (usually on some scale) immediately after they have been exposed to erotic stimuli (Adamson et al., 1972; Bancroft, 1971; Hamrick, 1974; Heiman, 1975b; Mavissakalian et al., 1975; Wenger et al., 1968). Most researchers have accepted this as a valid means of measuring cognitive levels of sexual arousal, even though Heiman (1975b) appears to have been the first to question the agreement of "subjective-objective" sexual measures. The disadvantage of questioning subjects after the fact is that they simply may not recall their exact feelings during the erotic stimulus exposure. More importantly, perhaps, subjects may be indicating their highest level, lowest level, or average level of subjective arousal when asked after the fact. The results of the present study indicate that in almost all cases there were highly significant positive correlations between vaginal vasocongestion changes and breast and groin vasocongestion changes. This extends the findings of P. Hoon et al. (1976), who have shown that vaginal vasocongestion along with forehead vasocongestion can discriminate among erotic, dysphoric, and neutral stimuli presentation. The results comparing individual cognitive changes and physiological changes are less clear. In three of the subjects (subjects 2, 3, and 5), the correlations between cognitive and physiological measures were highly significant; in subject 1, the correlation between cognitive and breast temperature was not significant; in subject 5, correlations between cognitive and both temperature measures were nonsignificant; in subject 6, correlations between all of the cognitive and physiological measures were nonsignificant. For the subjects as a group, the binomial test showed no significant relationship between cognitive and physiological indices of arousal. Subjects 4 and 6 showed the least amount of correlation between cognitive and physiological measures. It is interesting to note that these two subjects reported the least amount of sexual experience as measured by the Bentler Heterosexual Experience Scale (Bentler, 1968). Also subject 4 was single, and reported that she had never experienced intercourse (see Table I). It may be that the re-
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lationship between cognitive and physiological indices of sexual arousal is greater in sexually experienced women. All subjects recorded at least 50% subjective arousal, and three subjects recorded 100% subjective arousal on two or more scenes. This indicates that the data in this investigation are based on moderate to extreme levels of subjectively reported sexual arousal. None of the subjects rated the heterosexual kissing scene as even slightly arousing (lever at zero for all subjects), while all the subjects rated intercourse, oral sex, and group sex as moderately to extremely arousing (lever at 50-100%). This finding extends the work of Heiman (1975b), who found women to be most highly aroused by explicit sexual scenes. None of the women rated the male homosexual scenes as arousing, nor did any of the women show physiological increases in arousal to these scenes. This is a very different response compared to that of males, who find lesbian films highly erotic (Mavissakalian et al., 1975). It is interesting to note that five out of six subjects showed the greatest vaginal vasocongestion to the group sex scene but none of these subjects reported her arousal related to group sex during the debriefing. This inconsistency may be a result of the cultural taboo placed on group sex. In this study, physiological arousal preceded cognitive arousal. Perhaps cognitive sexual arousal has a higher threshold than physiological sexual arousal, or physiological arousal may have to reach a certain threshold above the absence of arousal before a woman will become cognitively aware that sexual arousal is present. This relationship would also be interesting to explore in males, who may use penile erection as the major indicator of their arousal. There are shortcomings of this research design which raise some questions concerning the results: 1. All subjects viewed the same video sequence in the same order. Thus it is possible that the results reflect a temporal variable. Perhaps women showed most arousal in group and oral sex scenes because of the temporal placement of these scenes. Examination of the individual response patterns would tend to argue against this, however. Women showed very individual response patterns and did not seem to be showing a cumulative response buildup. The oral sex scenes appeared very early in the sequence while the group sex scene appeared almost at the end. Nevertheless, future research could emphasize a design in which scenes were presented to subjects in random order. 2. Since only 30-sec breaks between scenes were provided, physiological return to baseline levels was not always consistently achieved, although in all cases the cognitive measure was returned to baseline during this intertrial interval. Future research may utilize longer breaks between scenes. This was not possible in the present study because of limited time. A larger number of scenes was used in order to reveal relationships between measures, and to delineate the effects of different erotic stimuli.
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