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Learn More. This study examined the impact of state anxiety, trait anxiety, and anxiety sensitivity on physiological and self-report measures of sexual arousal and sexual function in a non-clinical sample of women. Physiological sexual responses to an erotic stimulus were assessed using vaginal photoplethysmography, and subjective reactions were measured using questionnaires.
suggested a curvilinear relationship between state anxiety and physiological sexual arousal vaginal pulse amplitude; VPA. Trait anxiety and anxiety sensitivity were correlated with self-reported sexual arousal outside the laboratory. The findings may be interpreted in light of sympathetic nervous system SNS influences on sexual arousal and potential cognitive interference mechanisms associated with anxiety.
Research on the role of anxiety in sexual arousal has focused primarily on anxiety arising from specific concerns about sexual performance e. A high prevalence of sexual dysfunction has been reported in women with anxiety disorders e. High—normal levels of anxiety in normal populations may also be a risk factor for sexual problems.
In a large community epidemiological survey, Dunn, Croft, and Hackett reported that women with moderate to high scores on a self-report measure of anxiety were at ificantly higher risk for a of sexual problems, but particularly for arousal difficulties. Heaven et al.
The mechanisms by which anxiety impacts sexual arousal in women are not firmly established. Clearly, anxiety proneness may predispose women to developing worries and fears about their sexual lives and sexual behavior.
Sex-related anxiety can make it difficult to psychologically engage in sexual activity, as the woman may be too preoccupied with her sex-related fears to fully attend to sexually arousing stimuli Barlow, It is also possible that, in the absence of specific sexual concerns, high levels of anxiety may be associated with non-sexual cognitive distractions such as worry, obsessions, and hypervigilance to bodily sensations that can interfere with sexual responding. Even among women without sexual disorders, laboratory studies have demonstrated that non-sexual cognitive distractions reduce both physiological and subjective arousal to erotic stimuli e.
Finally, because both acute anxiety and sexual arousal are mediated by changes in autonomic arousal, there may be a physiological basis to impaired sexual responding secondary to anxiety. Although clinical reports generally link anxiety to impaired sexual arousal, laboratory studies suggest that, under certain conditions, anxiety may facilitate genital sexual arousal responses.
For example, Hoon, Wincze, and Hoon and Palace and Gorzalka concluded that anxiety induced by an anxiety-evoking film enhanced vaginal vasocongestive responses to erotic stimuli in the laboratory. Discrepancies between experimental and clinical data may be attributable to distinctions between physiological i.
Experimental studies that have assessed both physiological and self-reported sexual arousal often report low correlations between these measures in women e. The discrepancy between clinical reports and experimental data concerning the effects of anxiety on sexual arousal may also be explained by the fact that anxiety has been treated as a vague, unitary construct in many studies to date. Because state anxiety may entail this additional influence on sexual arousal by means of SNS arousal, differentiating between acute and chronic anxiety states in sexual arousal studies may have meaningful implications.
Because state anxiety is transitory and can easily be manipulated e.
The of two such studies Hoon et al. With regard to subjective anxiety, however, state anxiety could theoretically distract the individual from cognitively processing sexually arousing stimuli Barlow,leading to lower self-reported sexual arousal. Indeed, Palace and Gorzalka noted that, in contrast to physiological measures, subjective arousal responses to an erotic film were lower when preceded by an anxiety-provoking film than by a neutral film. It is not surprising, therefore, that Palace and Gorzalka also noted a lack of correlation between physiological and subjective measures of sexual arousal.
Research to date has relied on the use of anxiety-evoking stimuli to induce state anxiety reactions, but the impact of spontaneous anxiety reactions on sexual arousal has, to our knowledge, not been examined in the laboratory. According to Spielbergerindividuals higher in trait anxiety experience more frequent and more intense acute anxiety states. From a cognitive perspective, high trait anxiety may interfere with psychological sexual arousal because the individual is biased to perceive threatening information, which may distract her from sexually arousing stimuli or cause negative interpretations of those stimuli.
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Although trait anxiety is necessarily related to state anxiety, research has indicated that it is not as reliably predictive of autonomic responses to stressors Lamb, Given that trait anxiety represents only a tendency toward autonomic excitation state anxietyit is reasonable to assume that it would be less predictive of acute physiological sexual responses mediated by autonomic arousal.
However, with regard to measuring the generalized effects of anxiety on sexual function over the long term, trait anxiety would be the more stable, and therefore preferred, construct. Anxiety sensitivity can be described as a fear of the anxiety response itself, and is related to, but distinct from, trait anxiety for a review, see Reiss, ; Taylor, Indeed, anxiety sensitivity may encompass the fear of perceived changes in autonomic arousal in general. Because sexual arousal also entails a series of bodily responses mediated by autonomic arousal, it follows that individuals with high anxiety sensitivity could react anxiously to the physical experience of sexual arousal.
Based on laboratory studies indicating that physiological sexual arousal increased in the presence of an anxiety-provoking stimulus Hoon et al. In light of findings that suggest a negative effect of dispositional anxiety on sexual function e. Participants were recruited from advertisements posted in a local newspaper and on a local website. All participants were sexually active at the time of the study and reported no sexual concerns or difficulties.
Prior to participation, women who were interested in the study were screened to rule out any medical conditions e. Women who reported current distress related to a history of sexual abuse or assault were also excluded from participation due to the potentially upsetting nature of the procedures. Four participants Participants were predominantly unmarried Although most participants were predominantly heterosexual, 13 Both clips were excerpted from commercially available films and digitally edited.
The erotic film clip was selected based on data indicating that women found the clip sexually arousing Rellini et al.
The impact of anxiety on sexual arousal in women
An infrared vaginal photoplethysmograph was used to record VPA responses. VPA data were analyzed by first measuring the peak-to-trough amplitude expressed in mV of each individual pulse recorded during the film presentation, omitting movement artifacts identified by visual inspection of the data.
The average VPA was then calculated separately across neutral and erotic film segments for each participant. This value was used as the dependent variable; larger values indicated greater relative increases in VPA during the erotic stimulus. Psychophysiological data from two participants were not interpretable due to extreme and sustained increases in VPA that could not clearly be attributed to movement artifacts. Therefore, only 36 participants are represented in analyses that include VPA data. Participants were asked to rate the intensity of perceived physiological reactions to the film using a post-film questionnaire adapted from Heiman and Rowland The post-film questionnaire also contained items assessing psychological sexual arousal in response to the film.
Participants also rated the intensity of positive and negative affective reactions to the film e. The FSFI is a item self-report measure assessing sexual desire, sexual arousal, orgasm, sexual satisfaction, and sexual pain over the past 4-week period. Subscores pertaining to six domains of sexual function may be derived from FSFI responses. Of particular interest to this study were the Arousal domain, consisting of four items assessing consistency and satisfaction with psychological arousal during sexual activity, and the Lubrication domain, consisting of four items assessing consistency and satisfaction with physiological sexual arousal vaginal lubrication during sexual activity.
Both domains have been shown to discriminate between women diagnosed with female sexual arousal disorder and controls Wiegel et al. Using a 4-point scale, participants answered 20 items assessing state momentary, reactive anxiety and 20 items assessing trait stable, dispositional anxiety. Raw scores were computed separately for state and trait anxiety by adding the individual item scores.
The raw scores were then converted to T -scores based on the appropriate age and gender group norms. Participants attended a single laboratory session during which they completed questionnaires and a psychophysiological assessment of their sexual responses to the film stimulus. The procedures in this study were approved by an institutional review board prior to commencement of the study.
Participants were asked to refrain from caffeine, alcohol, and sexual activity for 24 h prior to the study session to minimize potential physiological sources of variation between responses. Upon arrival, participants were oriented to the laboratory and asked to read and an informed consent document. Participants then completed questionnaires and the psychophysiology session in counterbalanced order.
The psychophysiology session took place in an internally locked room in which participants were able to insert the vaginal photoplethysmograph in privacy. Participants sat in a reclining chair that was placed a comfortable viewing distance from a cm television screen that displayed the film. In order to limit the occurrence of movement artifacts in the al from the photoplethysmograph, participants were instructed to remain as motionless as possible after placing the device and being seated. The plate was adjusted to rest approximately 2. Between each use, the photoplethysmograph and the placement device were sanitized in a solution of 3.
After each participant placed the probe and was seated comfortably, an adaptation recording of 5 min was taken to ensure that a stable baseline VPA was established prior to beginning the film stimulus. More time was allowed to establish a stable baseline in the event that a participant moved frequently during the adaptation period.
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VPA was recorded continuously throughout the film. Immediately after viewing the film, participants rated their subjective reactions using the post-film questionnaire. There was no ificant linear correlation between state anxiety and VPA. However, on examination of the raw data, a non-linear pattern seemed to better characterize the relationship between state anxiety and VPA responses.
Participant age was not associated with anxiety group membership nor ificantly correlated with VPA response, and was therefore excluded from further analyses. Thus, state anxiety appeared to be largely related to affective reactions reflecting anxiety and shame.
There was no evidence of a curvilinear relationship among subjective arousal or affective variables as a function of anxiety measures. Table 1 displays intercorrelations of scores on anxiety, subjective arousal, and affective measures. State and trait anxiety scores were also negatively correlated with FSFI domains assessing orgasm and sexual satisfaction see Table 2 for correlations among each of the FSFI domain scores and anxiety measures. The present study aimed to elucidate the relationships of three distinct anxiety-related constructs with sexual arousal in a sample of sexually healthy women.
State anxiety was expected to have positive associations with physiological sexual arousal in response to an erotic film and negative associations with subjective self-report sexual arousal to the film. It was predicted that trait anxiety and anxiety sensitivity would show negative relationships with self-reported sexual arousal to the erotic film and with scores on a validated questionnaire assessing sexual arousal function. Consistent with predictions, participants with state anxiety scores in the moderate range showed greater increases in VPA in response to an erotic film than participants who endorsed relatively low levels of state anxiety, suggesting a positive association between state anxiety and physiological sexual arousal.
Unexpectedly, however, state anxiety scores in the high range were not associated with greater increases in VPA. Low and high state anxiety scores were associated with similar mean VPA responses that were ificantly lower than VPA responses associated with moderate state anxiety scores. In contrast to state anxiety, trait anxiety was not associated with VPA responses. This is not surprising given that trait anxiety reflects only general anxiety-proneness and not an acute reaction to a stimulus Zuckerman,