Understanding sexual arousal and subjective–genital arousal desynchrony in women


Sexual arousal in women comprises two components: genital arousal and subjective arousal. Genital arousal is characterized by genital vasocongestion and other physiological changes that occur in response to sexual stimuli, whereas subjective arousal refers to mental engagement during sexual activity. For some women, genital arousal enhances subjective arousal; for others, the two types of arousal are desynchronous. However, the relationship between genital and subjective arousal might not be relevant to the diagnosis and treatment of sexual arousal dysfunction. Studies have shown that not all women who report sexual arousal problems have decreased genital arousal, and only some women with decreased genital arousal have low subjective arousal. To develop efficacious treatments for female sexual arousal dysfunction, researchers need to differentiate the women for whom genital sensations have a critical role in their subjective arousal from those who are not mentally aroused by genital cues. The mechanisms by which women become aroused and the inputs into arousal have considerable implications for treatment outcomes.

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Fig. 1: Inputs to female arousal.
Fig. 2: Neural inputs to the female genitals.
Fig. 3: Typical experimental paradigm in sexual psychophysiology research.
Fig. 4: Hormonal determinants of female arousal.
Fig. 5: Tools for measuring arousal.
Fig. 6: Theoretical models of arousal.


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Nature Reviews Urology thanks W. Everaerd, S. Parish, M. Farmer, and other anonymous reviewer(s) for their help with peer review of this manuscript.

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Correspondence to Cindy M. Meston.

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Sexual self-schemas

Cognitive generalizations about the sexual self that influence beliefs about sexuality and sexual behaviour.

Social desirability bias

The tendency of survey respondents to answer questions in a manner that will be viewed favourably by others.

Interoceptive awareness

The perception of internal bodily sensations.

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Meston, C.M., Stanton, A.M. Understanding sexual arousal and subjective–genital arousal desynchrony in women. Nat Rev Urol 16, 107–120 (2019). https://doi.org/10.1038/s41585-018-0142-6

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