1. EXPLORING PATTERNS OF SEXUAL DESIRE/AROUSAL RESPONSE IN AN ONLINE SAMPLE OF PORTUGUESE WOMEN Ana Carvalheira, PhD 1, Lori Brotto, Ph.D 2 & Isabel Leal, PhD 1 1 Institute of Applied Psychology, Lisbon, Portugal 2 Department of Obstetrics & Gynaecology, University of British Columbia, Canada The main feature of the monosymptomatic criteria for hypoactive sexual desire disorder (HSDD) focuses on the lack of desire for sexual activity. This has been criticized due to the finding that often sexual activity takes place in the absence of sexual desire [1-3], women often experience sexual arousal before sexual desire [4,5], and because despite a low sexual frequency reported in a large multiethnic sample of perimenopausal women, the majority remained sexually satisfied [6]. OBJECTIVES: (1) To explore the proportion of women who engage in sexual activity with no sexual desire at onset but become easily sexually aroused after engaging. We compared women who did and did not report difficulty becoming sexually aroused; (2) to describe women’s experience and recognition of sexual arousal. (3) To explore the frequency of sexual fantasy PARTICIPANTS: A subsample of n = 2186 Portuguese women over the age of 18 (mean age=29.4), heterosexual, in a committed relationship, not taking antidepressants, not pregnant or breastfeeding, more than 6 months postpartum were studied from a larger sample of 3687 total recruited women. INSTRUMENT: Self-report questionnaire developed and piloted by the authors measuring (1) sexual desire and arousal at the onset of sexual activity, (2) difficulty with arousal, (3) experience and recognition of sexual arousal, and (4) frequency of sexual fantasy. PROCEDURE: Web-survey; passive advertisement & snowball by e-mail; Pilot testing was carried out; The IP address was used to control multiple submissions. Corresponding Author: ana.carvalheira@ispa.pt This study was funded by a grant from the Portuguese Foundation for the Science and Technology for the first author (Grant SFRH/BPD/31215/2006) INTRODUCTION How often do you engage in sexual activity, with no sexual desire, but after you begin engaging you can easily get aroused? Women WITH NO arousal difficulties (%) n=1865 Women WITH arousal difficulties (%) n=321 Never15.5 7.8 Occasionally53.8 40.8 Often20.8 34.6 Very often7.7 15.3 Always2.2 1.6 How do you know when you are sexually aroused? Women WITH NO arousal difficulties (%) n=1865 Women WITH arousal difficulties (%) n=321 I feel like having sex80.265.1 My vagina feels wet46.329.9 I have physical sensations in vagina40.636.8 I have subjective feeling of pleasure29.424.9 I feel a kind of heat in my vagina24.518.7 1Hill CA, Preston LK. Individual differences in the experience of sexual motivation: Theory and measurement of dispositional sexual motives. J Sex Res 1996;33:27-45. 2Klusmann D. Sexual motivation and the duration of partnership. Arch Sex Behav 2002; 31:275-87. 3Regan P, Berscheid E. Belief about the states, goals and objects of sexual desire. ] Sex Marital Ther 1996;22:110-20. 4Brotto LA, Heiman J, Tolman. Narratives of desire in mid-age women with and without arousal difficulties. J Sex Res 2009;46:1-12. 5Graham C, Sanders S, Milhausen R, McBride K. Turning on and turning off: A focus group study of the factors that affect women’s sexual arousal. Arch Sex Behav 2004;33:527-538. 6Cain VS, Johannes CB, Avis NE, Mohr B, Schocken M, Skurnick J, Ory M. Sexual functioning and practices in a multi-ethnic study of midlife women: Baseline results from SWAN. J Sex Res 2003;40:266-276. 7Beck JG, Bozman AW, Qualtrough T. The experience of sexual desire: Psychological correlates in a college sample. J Sex Res 1991;28:443-456. 8Ellison C. Women’s sexualities. Oakland, Ca: New Harbinger 2000. 9The Working Group for a New View of Women’s Sexual Problems. A new view of women’s sexual problems. In: Kaschak E & Tiefer L, eds. A new view of women’s sexual problems. Haworth Press: New York, 2001, pp1-8. These data showed a diversity of women’s responses regarding motivation to engage sexually. There was a large group of women who engaged with no sexual desire but experience arousal after engaging, and desire subsequently. A sizable minority typically or always access desire only once they are aroused in both groups (with and without arousal difficulties). Implications for the diagnostic criteria of hypoactive sexual desire and female sexual arousal dysfunction are that: (a) “the lack of desire for sexual activity” is a problematic criteria for HSDD; a lack of initial desire should not denote dysfunction; (b) the definition of dysfunction should address diversity across women; (c) fantasy may be important for some women but not for others, highlighting individual variability. Thus, fantasy should not be considered central to women’s definitions of desire; (d) in the majority of women, arousal is not equated with physical sensations in the vagina [7-9]; (e) most women do not differentiate between desire and arousal: the majority of women reported recognizing arousal when they felt motivated to have sex. To become sexually aroused and to be motivated to have sex have equivalent meanings for the great majority of women. These data refute the concept that desire and arousal are discrete entities and support the future conceptualization of a desire-arousal entity. METHODS RESULTS DISCUSSION REFERENCES sexual desire / arousal Partner stimulation Women WITH NO arousal difficulties n=1865 Women WITH arousal difficulties n=321 “would like to receive more and/or better physical stimulation from partner to become aroused” 56%73.8% partner stimulation How frequently do you have sexual fantasies? Women WITH NO arousal difficulties (%) n=1865 Women WITH arousal difficulties (%) n=321 Never6.5 17.4 Occasionally29.1 38.6 Sometimes53.8 41.1 Often10.6 2.8 Significantly more women with arousal difficulties (M=1305.7) would engage in sexual activity with no desire at the outset compared to women with no arousal difficulties (M=1056.9), U=231201.5, p < 0.001. recognizing sexual arousal sexual fantasy Table 1. Frequency of engaging in sexual activity with no initial sexual desire Table 2. Correlates of sexual arousal among women with and without arousal difficulties Table 3. Effectiveness of partner stimulation Table 4. Frequency of sexual fantasies Less than half of women among the 2 groups reported physical genital sensations which were presented on three response categories: vaginal wetness, sensations of warmth in the vagina and physical sensations in vagina.