Physiologic assessment of sexual response in women: the unfulfilled promise

With the exception of work by Semmens (1979), the clinical value of physiologic measures of female sexual response has not been demonstrated; it almost seems that controlled attempts to apply measures of vaginal muscular tone or blood flow to clinical settings has been jinxed. Hence, this author takes issue with Hatch (1980), who gives the impression that physiologic measures can now be used in clinical applications. The reasons for failure in sex therapy or biofeedback are uncertain, but it may be useful to speculate briefly. Sexual arousal in women is too personal a phenomenon to be objectively assessed during waking states in an "artificial" laboratory context. Orgasmic response is not related to genital muscle tone, but to other unknown anatomic, learning-history, and psychological components. The circumstances under which there is agreement between physiologic and either psychometric or self-reports of arousal or pleasure are complex and interactive. Therefore, physiologic measures of female sexual response may not reflect the subjective experience of women and, taken alone, may be misleading. This conclusion should not surprise anyone, for human beings are truly a "cognitive" species with representational imagery and language. Sexuality is very much "in the frontal lobes," and what we perceive eroticism to mean in a given context is probably much more important than the physiologic and behavioral aspects of actual sexual expression. Despite these problems of employing physiologic measures of female response in clinical settings, research into more basic issues has been quite profitable and heuristic. For example, several common assumptions about female sexuality are now open to question: women are more arousable just prior to menses; Kegel exercises improve orgasm consistency; sex therapy for inhibited arousal and desire is efficacious; there is usually agreement between the physiologic intensity of sexual response and a patient's subjective estimate of that intensity. On the other hand, there is evidence that vaginal engorgement in women remains at a high level after an initial orgasm, thus setting the physiologic stage for consecutive orgasmic responses; sexual arousal can be measured physiologically with acceptable degrees of reliability and specificity; muscle contractions in women during orgasm can be measured with high levels of precision; women respond to direct representations of erotic activity much the way men do; there are cortical "physiologic" signatures of orgasmic response in men and women. Obviously, a number of clinical research issues in female sexuality can now be investigated with physiologic measures.(ABSTRACT TRUNCATED AT 400 WORDS)