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The effects of anxiety on arousal in sexually dysfunctional women Palace, Eileen Marie 1988

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THE EFFECTS OF ANXIETY ON AROUSAL IN SEXUALLY DYSFUNCTIONAL WOMEN By EILEEN MARIE PALACE B.A., Whitman C o l l e g e , 1981 THESIS SUBMITTED IN PARTIAL FULFILLMENT THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS in THE FACULTY OF GRADUATE STUDIES Department of Psychology We accept t h i s t h e s i s as conforming to the r e q u i r e d standard THE UNIVERSITY OF BRITISH October 1988 © E i l e e n Marie Palace, COLUMBIA 1988 In present ing this thesis in partial fulf i lment of the requ i rements for an advanced d e g r e e at the University of British C o l u m b i a , I agree that the Library shall make it freely available for re ference and study. 1 further agree that permiss ion for extensive c o p y i n g of this thesis for scholarly pu rposes may b e granted by the head of my depar tment or by his o r her representat ives. It is u n d e r s t o o d that c o p y i n g or pub l i ca t ion of this thesis for financial gain shall not b e a l lowed wi thout my written pe rmiss ion . Depa r tmen t of P s y c h o l o g y T h e University of British C o l u m b i a Vancouve r , C a n a d a Date O c t o b e r 1 2 , 1 9 8 8  DE-6 (2/88) 11 A b s t r a c t The e f f e c t s of a n x i e t y a r o u s a l on subsequent sexual a r o u s a l were i n v e s t i g a t e d to determine i f s e x u a l l y f u n c t i o n a l and d y s f u n c t i o n a l women respond d i f f e r e n t i a l l y to p a i r i n g s of anxi e t y - e v o k i n g and e r o t i c cues. E i g h t s e x u a l l y d y s f u n c t i o n a l and e i g h t s e x u a l l y f u n c t i o n a l women viewed a n e u t r a l c o n t r o l (travelogue videotape) or anx i e t y - e v o k i n g (threatened amputation videotape) preexposure stimulus f o l l o w e d by a s e x u a l l y arousing ( e r o t i c videotape) experimental s t i m u l u s . A repeated measures design was used i n which each s u b j e c t observed both p a i r s of preexposure and experimental s t i m u l i . Changes i n sexual a r o u s a l were measured p h y s i o l o g i c a l l y with a v a g i n a l photoplethysmograph, and s u b j e c t i v e l y with a s e l f - r e p o r t r a t i n g s c a l e . As p r e d i c t e d , f u n c t i o n a l women showed s i g n i f i c a n t l y g r e a t e r p h y s i o l o g i c a l sexual a r o u s a l than d y s f u n c t i o n a l women i n both the n e u t r a l - e r o t i c and anxie.ty-erotic c o n d i t i o n s . C o n s i s t e n t with p r e v i o u s r e s e a r c h , a n x i e t y preexposure s i g n i f i c a n t l y enhanced g e n i t a l a r o u s a l r e l a t i v e to the n e u t r a l - c o n t r o l stimulus f o r f u n c t i o n a l women. Moreover, d y s f u n c t i o n a l women a l s o achieved a s i g n i f i c a n t l y enhanced r a t e and magnitude of g e n i t a l a r o u s a l f o l l o w i n g exposure to the a n x i e t y s t i m u l u s . C o n t r a r y to the s t r e n g t h of t h e i r p h y s i o l o g i c a l responses however, both groups rated the a n x i e t y -e r o t i c c o n d i t i o n as s i g n i f i c a n t l y l e s s s e x u a l l y a r o u s i n g . N o n - s i g n i f i c a n t c o r r e l a t i o n s between v a g i n a l blood volume and s u b j e c t i v e r a t i n g s r e v e a l e d a trend f o r f u n c t i o n a l and d y s f u n c t i o n a l women to e x p e r i e n c e enhanced g e n i t a l a r o u s a l accompanied by an i n h i b i t e d l i k e l i h o o d of acknowledging f e e l i n g a r o u s e d . These f i n d i n g s c o n t r a d i c t the l i t e r a t u r e on s e x u a l l y f u n c t i o n a l and d y s f u n c t i o n a l men, and c h a l l e n g e c u r r e n t c o n c e p t u a l i z a t i o n s of s e x u a l d y s f u n c t i o n . The f i n d i n g s suggest t h a t (1) a n x i e t y a r o u s a l enhances g e n i t a l a r o u s a l i n f u n c t i o n a l and d y s f u n c t i o n a l women, (2) h e i g h t e n e d a r o u s a l o c c u r s d e s p i t e c o n t r a d i c t o r y c o g n i t i v e p e r c e p t i o n s , ( 3 ) the female s e x u a l response system i s desynchronous, ( 4 ) f u n c t i o n a l women do not n e c e s s a r i l y p r o c e s s g e n i t a l cues more e f f e c t i v e l y than d y s f u n c t i o n a l women, (5) the p h y s i o l o g i c a l response system i s i m p e r a t i v e t o d e f i n i n g a response as s e x u a l and must be t a r g e t e d i n t h e r a p y , and ( 6 ) common modes of t r e a t m e n t d i r e c t e d toward i n c r e a s i n g p a r a s y m p a t h e t i c response may be c o u n t e r p r o d u c t i v e t o the e l i c i t a t i o n of s e x u a l a r o u s a l . A l t e r n a t i v e t r e a t m e n t s t r a t e g i e s d i r e c t e d toward response s y n c h r o n y , s y m p a t h e t i c a c t i v a t i o n , and c o g n i t i v e a t t r i b u t i o n a r e d i s c u s s e d . A p r e l i m i n a r y model of s e x u a l d y s f u n c t i o n i n women i s pr o p o s e d , .and d i s c u s s e d i n terms of d i r e c t i o n s f o r f u t u r e r e s e a r c h . i v TABLE OF CONTENTS Page A b s t r a c t i i L i s t of Tables v L i s t of F i g u r e s v i Acknowledgments v i i In t r o d u c t i o n 1 Se x u a l l y F u n c t i o n a l Men and Women 2 M i s a t t r i b u t i o n 6 Se x u a l l y D y s f u n c t i o n a l Men 7 Se x u a l l y D y s f u n c t i o n a l Women 9 A t t e n t i o n to B o d i l y Cues 11 Proposed Model of Sexual D y s f u n c t i o n 12 Purpose of the Present Study 15 Method 20 Subjects 20 Apparatus and M a t e r i a l s 22 P h y s i o l o g i c a l Measurement 22 S u b j e c t i v e Measurement 22 S t i m u l i 23 Derog a t i s Sexual F u n c t i o n i n g Inventory 24 Design and Procedure 25 Data Reduction 27 Res u l t s 28 Group D i f f e r e n c e s i n Sexual F u n c t i o n i n g 28 I n t e r n a l V a l i d i t y of P h y s i o l o g i c a l Measures 30 Vag i n a l Blood Volume L e v e l s 30 Preexposure S t i m u l i 32 P h y s i o l o g i c a l Sexual A r o u s a l 36 S u b j e c t i v e Sexual A r o u s a l 39 R e l a t i o n s h i p between P h y s i o l o g i c a l and S u b j e c t i v e Sexual A r o u s a l 42 D i s c u s s i o n 45 References 63 Appendix F i l m Scale 68 69 V LIST OF TABLES Table 1. D i f f e r e n c e s between S e x u a l l y D y s f u n c t i o n a l and F u n c t i o n a l Women i n P r o f i l e Scores from the Derogatis Sexual F u n c t i o n i n g Inventory. Table 2. A n a l y s i s of Variance f o r V a g i n a l Blood Volume Le v e l s d u r i n g the Onset of Preexposure S t i m u l i to Changeover from Preexposure-Experimental S t i m u l i . Table 3. A n a l y s i s of Variance f o r P h y s i o l o g i c a l Sexual A r o u s a l (VBV) during Preexposure S t i m u l i . Table 4. A n a l y s i s of Variance f o r P h y s i o l o g i c a l Sexual A r o u s a l (VBV) duri n g Experimental S t i m u l i . Table 5. A n a l y s i s of Variance f o r S u b j e c t i v e Ratings of Sexual A r o u s a l d u r i n g Experimental S t i m u l i . Table 6. Pearson Product-Moment C o r r e l a t i o n s between P h y s i o l o g i c a l (VBV) and S u b j e c t i v e Ratings of Sexual Arousal d u r i n g Experimental S t i m u l i . Page 29 31 33 37 40 43 v i LIST OF FIGURES Page F i g u r e 1. Mean v a g i n a l blood volume (absolute d e v i a t i o n 34 i n m i l l i v o l t s from b a s e l i n e ) f o r s e x u a l l y d y s f u n c t i o n a l and f u n c t i o n a l women across 4-second time blocks d u r i n g the n e u t r a l - e r o t i c (N-E) and a n x i e t y - e r o t i c (A-E) condi t i o n s . F i g u r e 2. Continuous measurement of v a g i n a l blood volume 35 (absolute d e v i a t i o n i n m i l l i v o l t s from b a s e l i n e ) f o r s e x u a l l y d y s f u n c t i o n a l and f u n c t i o n a l women at 0.20 second time i n t e r v a l s d u r i n g the n e u t r a l - e r o t i c (N-E) and a n x i e t y - e r o t i c (A-E) c o n d i t i o n s . F i g u r e 3. Mean s u b j e c t i v e r a t i n g s of sexual a r o u s a l f o r 41 s e x u a l l y d y s f u n c t i o n a l and f u n c t i o n a l women durin g the n e u t r a l - e r o t i c (N-E) and a n x i e t y - e r o t i c (A-E) c o n d i t i o n s . v i i ACKNOWLEDGMENTS The author wishes to express her a p p r e c i a t i o n to Dr. B o r i s B. Gorzalka, a d v i s o r and committee c h a i r , whose guidance and advice i n a l l stages of the re s e a r c h , and courage to c o l l a b o r a t e i n i n i t i a t i n g a new program of resea r c h i n human sexual behavior has made t h i s i n v e s t i g a t i o n p o s s i b l e . G r a t i t u d e i s a l s o expressed to the members of the committee, Dr. Lynn Alden f o r her advice, d i r e c t i o n , support, and encouragement; and Dr. Wolfgang Linden, f o r h i s time c o n s u l t i n g on p s y c h o p h y s i o l o g i c a l methodology and generous p r o v i s i o n of the C a r d i o v a s c u l a r Laboratory. S p e c i a l a p p r e c i a t i o n i s expressed to Mr. Loren M. Greenen, computer systems engineer, whose t e c h n i c a l e x p e r t i s e c o n t r i b u t e d to an i n n o v a t i v e computerized system f o r p h y s i o l o g i c a l data c o l l e c t i o n , r e d u c t i o n , and a n a l y s i s . His t e c h n i c a l support from the conception to completion of t h i s i n v e s t i g a t i o n was i n v a l u a b l e . The author a l s o wishes to acknowledge Dr. John P. Wincze f o r p r o v i d i n g the f i l m s used i n h i s o r i g i n a l a n x i e t y paradigm (Hoon, Wincze, & Hoon, 1977), and access to h i s f i l m l i b r a r y f o r the s t i m u l i s e l e c t e d i n the present study; and to Dr. J u l i a R. Heiman for p r o v i d i n g the F i l m Scale she has designed f o r s u b j e c t i v e measurement of sexual a r o u s a l . A p p r e c i a t i o n i s a l s o expressed to the r e f e r r i n g p h y s i c i a n s and t h e r a p i s t s : Dr. R. W. D. Stevenson, Dr. W i l l i a m Maurice, and Dr. George Szasz (Shaughnessy H o s p i t a l Sexual Medicine U n i t ) ; Anne E. Davies, Bianca Rucker, L o r i Van Humbeck, Dr. W i l l i a m C a i r d (St. Paul's H o s p i t a l ) , and Dr. Georgia Nemetz (Royal Columbian H o s p i t a l ) . 1 T h e E f f e c t s o f A n x i e t y on A r o u s a l i n S e x u a l l y D y s f u n c t i o n a l Women A n x i e t y c o n t i n u e s t o be v i e w e d a s a m a j o r d e t e r m i n a n t o f l o w s e x u a l a r o u s a l a n d a l e a d i n g c a u s e o f s e x u a l d y s f u n c t i o n f o r b o t h men a n d women ( e . g . M a s t e r s & J o h n s o n , 1 9 7 0 ; K a p l a n , 1 9 7 4 , 1 9 7 9 ; W o l p e , 1 9 5 8 , 1 9 8 2 ) . M a s t e r s a n d J o h n s o n (1970) h a v e d e f i n e d a n x i e t y i n t e r m s o f f e a r s o f i n a d e q u a c y o r p e r f o r m a n c e d e m a n d s w h i c h p r e v e n t t h e i n d i v i d u a l f r o m e x p e r i e n c i n g s e x u a l a r o u s a l . T h e y a s s e r t t h a t p e r f o r m a n c e a n x i e t y " i s t h e g r e a t e s t known d e t e r r e n t t o e f f e c t i v e s e x u a l f u n c t i o n i n g , s i m p l y b e c a u s e i t s o c o m p l e t e l y d i s t r a c t s t h e f e a r f u l i n d i v i d u a l f r o m h i s o r h e r n a t u r a l r e s p o n s i v i t y b y b l o c k i n g r e c e p t i o n o f s e x u a l s t i m u l i " ( p . 1 3 ) . S i m i l a r l y , K a p l a n (1974) s u g g e s t s t h a t s e x u a l a n x i e t y i s a p r i m a r y c a u s e o f s e x u a l d y s f u n c t i o n d u e t o i t s p s y c h o l o g i c a l a n d p h y s i o l o g i c a l d i s r u p t i o n o f t h e s e x u a l r e s p o n s e c y c l e . W o l p e (1982) s t a t e s t h a t " a n x i e t y i s e m i n e n t l y a d v e r s e t o s e x u a l r e s p o n d i n g b e c a u s e i t i n h i b i t s t h e v e r y a u t o n o m i c r e s p o n s e e l e m e n t s t h a t make up t h e s e x u a l r e s p o n s e . . t h e m o r e i n t e n s e l y a n x i e t y i s a r o u s e d , t h e m o r e i n h i b i t i o n o f t h e e a r l y s e x u a l r e s p o n s e t h e r e w i l l b e " ( p . 2 0 4 ) . B a s e d on t h e a s s u m p t i o n t h a t a n x i e t y i m p a i r s s e x u a l a r o u s a l a n d t h a t a n x i e t y a n d s e x u a l a r o u s a l a r e m u t u a l l y i n h i b i t o r y , many r e s e a r c h e r s a n d c l i n i c i a n s h a v e e m p l o y e d a n x i e t y - r e d u c t i o n p r o c e d u r e s a s t h e t r e a t m e n t o f c h o i c e w i t h s e x u a l l y d y s f u n c t i o n a l men a n d women. T r e a t m e n t o f s e x u a l d y s f u n c t i o n h a s t r a d i t i o n a l l y i n v o l v e d l o w p e r f o r m a n c e demand t e c h n i q u e s s u c h a s " s e n s a t e f o c u s " ( M a s t e r s & J o h n s o n , 1970) o r " n o n - d e m a n d c o i t u s " ( K a p l a n , 1 9 7 4 ) , a n d m o r e 2 r e c e n t l y , r e l a x a t i o n i n d u c i n g p r o c e d u r e s s u c h a s p r o g r e s s i v e m u s c l e r e l a x a t i o n a n d s y s t e m a t i c d e s e n s i t i z a t i o n , a i m e d a t e x t i n g u i s h i n g f e a r a n d a n x i e t y r e s p o n s e s p a i r e d w i t h s e x u a l l y a r o u s i n g s t i m u l i ( C a i r d & W i n c z e , 1 9 7 7 ; E v e r a e r d & D e k k e r , 1 9 8 2 ; K o c k o t t , D i t t m a n , & N u s s e l t , 1 9 7 5 ; O b l e r , 1 9 7 3 ; S o t i l e & K i l m a n n , 1 9 7 8 ; W i n c z e & C a i r d , 1 9 7 6 ) . A g r o w i n g b o d y o f r e s e a r c h l i t e r a t u r e i n d i c a t e s h o w e v e r , t h a t h e i g h t e n e d a n x i e t y may e n h a n c e r a t h e r t h a n i n h i b i t s e x u a l a r o u s a l . S e x u a l l y F u n c t i o n a l Men a n d Women D u t t o n a n d A r o n (1974) e x a m i n e d t h e e f f e c t s o f a n x i e t y e l i c i t e d when s u b j e c t s c r o s s e d a f e a r - a r o u s i n g s u s p e n s i o n b r i d g e o r a n t i c i p a t e d an e l e c t r i c a l s h o c k , on s e x u a l a t t r a c t i o n . T h e y d e m o n s t r a t e d t h a t c o m p a r e d t o c o n t r o l s u b j e c t s i n n o n - a n x i e t y -e l i c i t i n g s i t u a t i o n s , a n x i e t y i n c r e a s e d e x p e r i m e n t a l s u b j e c t s ' s e x u a l c o n t e n t i n T h e m a t i c A p p e r c e p t i o n T e s t c a r d r e s p o n s e s a n d s e l f - r e p o r t e d s e x u a l a t t r a c t i o n t o a f e m a l e r e s e a r c h c o n f e d e r a t e . I n o r d e r t o c l a r i f y t h e r e l a t i o n s h i p b e t w e e n a n x i e t y a n d s e x u a l a r o u s a l , H o o n , W i n c z e , & Hoon (1977) p r e e x p o s e d s e x u a l l y f u n c t i o n a l f e m a l e s u b j e c t s t o n e u t r a l o r a n x i e t y - e l i c i t i n g f i l m s e g m e n t s c o u n t e r b a l a n c e d w i t h s e x u a l l y a r o u s i n g f i l m s . S e x u a l a r o u s a l was m e a s u r e d p h y s i o l o g i c a l l y w i t h a v a g i n a l p h o t o p l e t h y s m o g r a p h . C o n s i s t e n t w i t h W o l p e ' s (1958) r e c i p r o c a l i n h i b i t i o n t h e o r y o f a n x i e t y a n d a r o u s a l i n s e x u a l r e s p o n s e , t h e y f o u n d t h a t when women w e r e s e x u a l l y a r o u s e d by a n e r o t i c p r e e x p o s u r e s t i m u l u s , t h e a n x i e t y - e l i c i t i n g s t i m u l u s i n h i b i t e d s e x u a l - a r o u s a l m o r e r a p i d l y t h a n d i d t h e a t t e n t i o n - c o n t r o l 3 ( n e u t r a l ) s t i m u l u s . H o w e v e r i n t h e c o u n t e r b a l a n c e d c o n d i t i o n , c o n t r a r y t o W o l p e ' s t h e o r y , women b e c a m e m o r e r a p i d l y s e x u a l l y a r o u s e d b y t h e e r o t i c s t i m u l u s f o l l o w i n g t h e a n x i e t y - e l i c i t i n g , r a t h e r t h a n t h e n e u t r a l p r e e x p o s u r e s t i m u l u s . T h e s e r e s u l t s s u g g e s t t h a t t h e p h y s i o l o g i c a l e f f e c t s o f a n x i e t y on s e x u a l a r o u s a l a r e d e p e n d e n t on t h e t e m p o r a l r e l a t i o n s h i p o f t h e a n x i e t y a n d a r o u s a l - e l i c i t i n g s t i m u l i . I f t h e s e x u a l a r o u s a l was e v o k e d p r i o r t o a n x i e t y , a r o u s a l was d i s r u p t e d b y t h e a n x i e t y s t i m u l u s . H o w e v e r i f a n x i e t y was e v o k e d f i r s t , i t was f o l l o w e d b y an e n h a n c e d l e v e l o f s e x u a l a r o u s a l a b o v e t h a t e l i c i t e d b y t h e s e x u a l l y - a r o u s i n g s t i m u l u s a l o n e ( N o r t o n & J e h u , 1 9 8 4 ) . W o l c h i k e t a l . (1980) s y s t e m a t i c a l l y r e p l i c a t e d t h e H o o n e t a l . (1977) d e s i g n w i t h s e x u a l l y f u n c t i o n a l m a l e s b y i n c l u d i n g d e p r e s s i o n , a n x i e t y , a n d n e u t r a l r e s p o n s e - e v o k i n g p r e e x p o s u r e s t i m u l i f o l l o w e d b y t h e e x p e r i m e n t a l a r o u s a l - e v o k i n g s t i m u l i . S e x u a l a r o u s a l was m e a s u r e d p h y s i o l o g i c a l l y w i t h a p e n i l e s t r a i n g a u g e . C o n s i s t e n t w i t h t h e H o o n e t a l . f i n d i n g s , t h e r e s u l t s o f t h i s s t u d y d e m o n s t r a t e d t h a t s e x u a l a r o u s a l f o l l o w i n g t h e a n x i e t y -e v o k i n g f i l m s e g m e n t was g r e a t e r t h a n t h a t f o l l o w i n g e x p o s u r e t o e i t h e r t h e d e p r e s s i o n - e v o k i n g o r n e u t r a l s t i m u l u s f i l m s e g m e n t s . I n an e f f o r t t o p r o v i d e a l a b o r a t o r y a n a l o g u e o f " p e r f o r m a n c e a n x i e t y " t h a t a c c o r d i n g t o M a s t e r s a n d J o h n s o n ' s (1970) h y p o t h e s i s w o u l d i n h i b i t s e x u a l a r o u s a l , B a r l o w , S a k h e i m , a n d B e c k (1983) e x a m i n e d t h e e f f e c t s o f a n x i e t y on a r o u s a l i n f u n c t i o n a l m a l e s u b j e c t s d u r i n g t h r e e c o u n t e r b a l a n c e d c o n d i t i o n s i n w h i c h t h e s u b j e c t s v i e w e d a n e r o t i c f i l m : (a) C o n t i n g e n t t h r e a t (60% c h a n c e o f e l e c t r i c a l s h o c k i f t h e y d i d n o t a c h i e v e a d e q u a t e a r o u s a l ) , 4 (b) n o n c o n t i n g e n t t h r e a t ( c h a n c e o f s h o c k was u n r e l a t e d t o t h e a r o u s a l r e s p o n s e ) , a n d (c) no s h o c k c o n d i t i o n . S e x u a l a r o u s a l was m e a s u r e d p h y s i o l o g i c a l l y w i t h a p e n i l e s t r a i n - g a u g e . T h e r e s u l t s i n d i c a t e d t h a t t h e n o n c o n t i n g e n t t h r e a t ( g e n e r a l i z e d a n x i e t y ) a n d t h e c o n t i n g e n t t h r e a t ( p e r f o r m a n c e a n x i e t y ) i n c r e a s e d p e n i l e r e s p o n s e when c o m p a r e d w i t h t h e n o - s h o c k c o n d i t i o n . F u r t h e r , t h e s h o c k c o n t i n g e n t on s i z e o f e r e c t i o n ( p e r f o r m a n c e a n x i e t y ) p r o d u c e d t h e g r e a t e s t o v e r a l l s e x u a l a r o u s a l . T h i s s t u d y (a) r e f u t e s W o l p e ' s (1978) i n t e r p r e t a t i o n t h a t i n c r e a s e s i n s e x u a l a r o u s a l f o l l o w i n g a n a n x i e t y - p r o v o k i n g e v e n t m i g h t be d u e t o an " a n x i e t y r e l i e f " p h e n o m e n o n , (b) p r o v i d e s c o n t r a d i c t o r y e v i d e n c e f o r M a s t e r s a n d J o h n s o n ' s h y p o t h e s i s o f " p e r f o r m a n c e d e m a n d " a s an i n h i b i t i o n o f s e x u a l a r o u s a l , a n d (c) a d d s f u r t h e r e v i d e n c e t o t h e f a c i l i t a t o r y e f f e c t o f a n x i e t y on s e x u a l a r o u s a l . L a n g e , W i n c z e , Z w i c k , F e l d m a n , a n d H u g h e s (1981) i n v e s t i g a t e d M a s t e r s a n d J o h n s o n ' s (1970) a n d K a p l a n ' s (1974) h y p o t h e s i s r e g a r d i n g t h e e f f e c t s o f a n x i e t y on a r o u s a l , b y o p e r a t i o n a l l y d e f i n i n g a n x i e t y i n t h r e e d i f f e r e n t modes t r a d i t i o n a l l y b e l i e v e d t o i n h i b i t m a l e s e x u a l a r o u s a l : (a) Demand f o r p e r f o r m a n c e , (b) s e l f - m o n i t o r i n g o f e r e c t i o n ( " s p e c t a t o r i n g " ) a n d (c) i n c r e a s e d s y m p a t h e t i c n e r v o u s s y s t e m (SNS) a c t i v i t y . R e s u l t s w i t h f u n c t i o n a l m a l e s u b j e c t s i n d i c a t e d t h a t demand f o r s e x u a l p e r f o r m a n c e ( " p e r f o r m a n c e a n x i e t y " ) o p e r a t i o n a l i z e d a s i n s t r u c t i o n s t o o b t a i n a n d m a i n t a i n an e r e c t i o n v o l u n t a r i l y , d i d n o t i n h i b i t p e n i l e t u m e s c e n c e r e l a t i v e t o t h e n o - d e m a n d c o n t r o l c o n d i t i o n . S i m i l a r l y , s e l f - m o n i t o r i n g ( s p e c t a t o r i n g ) a n d no s e l f -m o n i t o r i n g o f e r e c t i l e r e s p o n s e c a u s e d no d i f f e r e n t i a l 5 p h y s i o l o g i c a l e f f e c t s on sexual a r o u s a l . Masters and Johnson (1970) s t a t e that the e r e c t i l e response i s mediated by the parasympathetic nervous system (PNS), and Zuckerman (1971) suggests that a n x i e t y , a s s o c i a t e d with an i n c r e a s e i n sympathetic nervous system a c t i v i t y , may t h e r e f o r e i n h i b i t p e n i l e tumescence. Induction of a p h y s i o l o g i c a l s t a t e analogous to c l i n i c a l a n x i e t y was achieved by a r t i f i c i a l l y i n c r e a s i n g SNS a c t i v i t y through i n j e c t i o n s of epinephrine p r i o r to exposure to a sexual a r o u s a l -evoking f i l m . The r e s u l t s with f u n c t i o n a l men r e v e a l e d no d i f f e r e n t i a l e f f e c t s on p e n i l e tumescence duri n g the e r o t i c s t i m u l i as compared with the placebo i n j e c t i o n c o n t r o l group. Anxiety, d e f i n e d as epinephrine-induced SNS a c t i v i t y , caused d i f f e r e n t i a l e f f e c t s only i n terms of f a c i l i t a t i n g l o s s of e r e c t i o n f o l l o w i n g the t e r m i n a t i o n of the sexual a r o u s a l - e l i c i t i n g s t i m u l u s . The r e s u l t s of these s e r i e s of experiments with s e x u a l l y f u n c t i o n a l men and women pr o v i d e evidence d i s c o n f i r m i n g the r o l e of a n x i e t y as d e f i n e d by performance demands (Kaplan, 1974, 1979; Masters & Johnson, 1970), s e l f - m o n i t o r i n g or s p e c t a t o r i n g (Masters & Johnson, 1970), and sympathetic nervous system a c t i v i t y (Zuckerman, 1971), as a mechanism of r e c i p r o c a l i n h i b i t i o n of sexual a r o u s a l (Wolpe, 1958, 1982). Rather, these s t u d i e s demonstrate that i n c e r t a i n c o n d i t i o n s , a n x i e t y e i t h e r causes no d i f f e r e n t i a l e f f e c t i n sexual a r o u s a l compared with c o n t r o l c o n d i t i o n s (Lange et a l . , 1981), or as i n the Dutton and Aron (1974), Hoon et a l . (1977), Wolchik et a l . (1980), and Barlow et a l . (1983) s t u d i e s , e l i c i t s enhanced sexual a r o u s a l . 6 M i s a t t r i b u t i o n D u t t o n a n d A r o n (1974) s u g g e s t t h a t t h e f a c i 1 i t a t o r y r o l e o f a n x i e t y on a r o u s a l may be t h e r e s u l t o f s u b j e c t s " m i s a t t r i b u t i n g " t h e i r a n x i e t y a s s e x u a l a r o u s a l . T h i s i n t e r p r e t a t i o n i s b a s e d on S c h a c h t e r ' s t h e o r y o f e m o t i o n ( S c h a c h t e r , 1 9 6 4 ; S c h a c h t e r & S i n g e r , 1962) w h i c h a s s e r t s t h a t e n v i r o n m e n t a l c u e s may be u s e d t o p r o v i d e e m o t i o n a l l a b e l s f o r a m b i g u o u s p h y s i o l o g i c a l s t a t e s o f a r o u s a l . A r o n ( c i t e d i n D u t t o n & A r o n , 1 9 7 4 ) , c o m b i n i n g S c h a c h t e r ' s t h e o r y w i t h r e s u l t s f r o m s e x u a l a t t r a c t i o n r e s e a r c h , s t a t e s t h a t i n t e n s e e m o t i o n s a r e r e l a b e l e d a s s e x u a l a t t r a c t i o n i f an a p p r o p r i a t e o b j e c t i s p r e s e n t a n d t h e c i r c u m s t a n c e s do n o t r e q u i r e t h e i n d i v i d u a l ' s f u l l a t t e n t i o n . H o o n e t a l . (1977) a l s o s u g g e s t t h a t a n x i e t y a r o u s a l a n d s e x u a l a r o u s a l i n t e r a c t w i t h e a c h o t h e r d e p e n d e n t u p o n t h e c o n t e x t i n w h i c h s u b j e c t s p e r c e i v e t h e s t i m u l i t h a t e l i c i t t h e r e s p e c t i v e a r o u s a l s t a t e s . I n o t h e r w o r d s , s u b j e c t s e x p o s e d t o a n x i e t y a r o u s a l - e v o k i n g a n d s e x u a l a r o u s a l - e v o k i n g s t i m u l i may m i s a t t r i b u t e t h e p h y s i o l o g i c a l a r o u s a l e l i c i t e d b y t h e a n x i e t y - e v o k i n g s t i m u l u s , a s f u r t h e r s e x u a l a r o u s a l . I f a n x i e t y - e v o k i n g s t i m u l i p r o d u c e e n h a n c e d s e x u a l a r o u s a l d u e t o a m i s a t t r i b u t i o n o f a n x i e t y a s s e x u a l a r o u s a l i n s e x u a l l y f u n c t i o n a l i n d i v i d u a l s , i t i s p o s s i b l e t h a t s e x u a l l y d y s f u n c t i o n a l i n d i v i d u a l s may be m a k i n g d i f f e r e n t a t t r i b u t i o n s . Due t o t h e i r d i f f e r e n t l e a r n i n g h i s t o r i e s , s e x u a l l y d y s f u n c t i o n a l s u b j e c t s may i n s t e a d p e r c e i v e s e x u a l a r o u s a l a s a n x i e t y , t h e r e b y e x h i b i t i n g d i f f e r e n t p a t t e r n s o f s e x u a l r e s p o n s e ( N o r t o n & J e h u , 1 9 8 4 ) . I n o r d e r t o i n v e s t i g a t e t h e r o l e o f a n x i e t y on a r o u s a l i n s e x u a l l y 7 d y s f u n c t i o n a l men a n d women, i t i s n e c e s s a r y t o d e t e r m i n e i f f u n c t i o n a l a n d d y s f u n c t i o n a l s u b j e c t s r e s p o n d d i f f e r e n t i a l l y t o p a i r i n g s o f a n x i e t y - e v o k i n g a n d e r o t i c c u e s ( N o r t o n & J e h u , 1 9 8 4 ) . F u r t h e r , i n o r d e r t o e x p l o r e t h e c o n c e p t o f d i f f e r e n t i a l a t t r i b u t i o n , i t i s n e c e s s a r y t o i n v e s t i g a t e t h e e m o t i o n a l r e a c t i o n s a c c o m p a n y i n g p h y s i o l o g i c a l r e s p o n s e s . S e x u a l l y D y s f u n c t i o n a l Men H e i m a n a n d R o w l a n d (1983) i n v e s t i g a t e d t h e c o g n i t i v e -a f f e c t i v e a n d p h y s i o l o g i c a l r e s p o n s e p a t t e r n s o f s e x u a l l y f u n c t i o n a l a n d d y s f u n c t i o n a l men b y c o m p a r i n g s e l f - r e p o r t e d s e x u a l a r o u s a l a n d p e n i l e t u m e s c e n c e i n two p r e e x p o s u r e c o n d i t i o n s p a i r e d w i t h e r o t i c t a p e s . T h e f i r s t c o n d i t i o n , a p e r f o r m a n c e demand s e t , i n s t r u c t e d t h e s u b j e c t s i n t h e i m p o r t a n c e o f s e l f - m o n i t o r i n g a n d m a i n t a i n i n g an e r e c t i o n . T h i s c o n d i t i o n p a r a l l e l s t h e L a n g e e t a l . (1981) l a b o r a t o r y a n a l o g u e o f p e r f o r m a n c e a n x i e t y a n d s p e c t a t o r i n g d e s c r i b e d p r e v i o u s l y , w h i c h a c c o r d i n g t o M a s t e r s a n d J o h n s o n ' s (1970) a n d K a p l a n ' s (1979) h y p o t h e s i s , w o u l d be e x p e c t e d t o i n h i b i t s e x u a l a r o u s a l . T h e s e c o n d c o n d i t i o n , a n o n - d e m a n d s e n s a t e f o c u s s e t , i n s t r u c t e d t h e s u b j e c t s t o r e l a x a n d e n j o y a n y p l e a s u r a b l e s e n s a t i o n s t h a t may o c c u r . T h e r e s u l t s i n d i c a t e d t h a t t h e s e x u a l l y d y s f u n c t i o n a l men s h o w e d l e s s p h y s i o l o g i c a l s e x u a l a r o u s a l ( p e n i l e t u m e s c e n c e ) a n d r e p o r t e d l e s s s u b j e c t i v e l y e x p e r i e n c e d s e x u a l a r o u s a l t o t h e e r o t i c s t i m u l i a s c o m p a r e d t o t h e s e x u a l l y f u n c t i o n a l m a l e s u b j e c t s . F u r t h e r , i t was f o u n d t h a t a n x i e t y , o p e r a t i o n a l i z e d a s p e r f o r m a n c e d e m a n d , i n c r e a s e d p h y s i o l o g i c a l s e x u a l a r o u s a l i n t h e s e x u a l l y f u n c t i o n a l s u b j e c t s 8 a n d d e c r e a s e d p h y s i o l o g i c a l a n d s u b j e c t i v e s e x u a l a r o u s a l i n t h e s e x u a l l y d y s f u n c t i o n a l s u b j e c t s . T h e f i n d i n g t h a t a p e r f o r m a n c e a n x i e t y c o n d i t i o n i n c r e a s e d p h y s i o l o g i c a l s e x u a l a r o u s a l i n f u n c t i o n a l s u b j e c t s was c o n t r a r y t o b o t h M a s t e r s a n d J o h n s o n ' s , a n d t h e e x p e r i m e n t e r s ' h y p o t h e s i s , b u t c o n s i s t e n t w i t h t h e p r e v i o u s f i n d i n g s ( B a r l o w e t a l . , 1 9 8 3 ; D u t t o n & A r o n , 1 9 7 4 ; H o o n e t a l . , 1 9 7 7 ; W o l c h i k e t a l . , 1 9 8 0 ) . C o m b i n e d w i t h t h e f i n d i n g s t h a t t h e p e r f o r m a n c e a n x i e t y c o n d i t i o n d e c r e a s e d p h y s i o l o g i c a l a n d s u b j e c t i v e s e x u a l a r o u s a l i n d y s f u n c t i o n a l s u b j e c t s , t h e s e d a t a a r e a l s o c o n s i s t e n t w i t h t h e i d e a o f d i f f e r e n t i a l m i s a t t r i b u t i o n o f a n x i e t y a n d a r o u s a l i n s e x u a l l y f u n c t i o n a l a n d d y s f u n c t i o n a l s u b j e c t s . B e c k , B a r l o w , S a k h e i m , a n d A b r a h a m s o n ( c i t e d i n B a r l o w , 1986) a l s o i n v e s t i g a t e d t h e r o l e o f a n x i e t y on a r o u s a l i n s e x u a l l y f u n c t i o n a l a n d d y s f u n c t i o n a l men b y d e f i n i n g a n x i e t y a s p e r f o r m a n c e d e m a n d . T h i s s t u d y s y s t e m a t i c a l l y r e p l i c a t e d t h e i r p r e v i o u s l y d i s c u s s e d s t u d y w i t h s e x u a l l y f u n c t i o n a l m a l e s ( B a r l o w e t a l . , 1 9 8 3 ) , b y o p e r a t i o n a l l y d e f i n i n g " p e r f o r m a n c e d e m a n d " a s e l e c t r i c a l s h o c k c o n t i n g e n t u p o n s i z e o f e r e c t i o n . T h e r e s u l t s i n d i c a t e d a s i g n i f i c a n t d i f f e r e n c e b e t w e e n t h e s e x u a l l y f u n c t i o n a l a n d d y s f u n c t i o n a l s u b j e c t s ' r e s p o n s e t o a n x i e t y - e v o k i n g s t i m u l i i n a s e x u a l c o n t e x t . I t was f o u n d t h a t a n x i e t y , o p e r a t i o n a l i z e d a s s h o c k t h r e a t i n t h e c o n t i n g e n t ( p e r f o r m a n c e a n x i e t y ) a n d n o n c o n t i n g e n t ( g e n e r a l i z e d a n x i e t y ) c o n d i t i o n , i n c r e a s e d s e x u a l a r o u s a l i n t h e s e x u a l l y f u n c t i o n a l s u b j e c t s a n d d e c r e a s e d s e x u a l a r o u s a l i n t h e s e x u a l l y d y s f u n c t i o n a l s u b j e c t s , a s c o m p a r e d t o t h e n o - s h o c k ( n e u t r a l ) c o n d i t i o n s . T h e r e s u l t s o f t h i s s t u d y , 9 c o n s i s t e n t with both the Heiman and Rowland (1983) i n v e s t i g a t i o n , and the concept of d i f f e r e n t i a l m i s a t t r i b u t i o n , suggest that a n x i e t y d e f i n e d as performance demands to maintain an e r e c t i o n e i t h e r by v e r b a l i n s t r u c t i o n or contingent upon shock, i n c r e a s e d p h y s i o l o g i c a l sexual a r o u s a l i n s e x u a l l y f u n c t i o n a l males and decreased p h y s i o l o g i c a l sexual a r o u s a l i n s e x u a l l y d y s f u n c t i o n a l males. Since the Beck, Barlow, Sakheim, and Abrahamson ( c i t e d i n Barlow, 1986) study d i d not i n c l u d e a s u b j e c t i v e measure of sexual a r o u s a l however, the f u n c t i o n a l and d y s f u n c t i o n a l s u b j e c t s ' c o g n i t i v e a t t r i b u t i o n s of t h e i r a n x i e t y or a r o u s a l may not be compared with the Heiman and Rowland (1983) data. S e x u a l l y D y s f u n c t i o n a l Women The resea r c h l i t e r a t u r e on s e x u a l l y d y s f u n c t i o n a l women has taken a somewhat d i f f e r e n t course. I n i t i a l s t u d i e s with female s u b j e c t s have sought to compare p h y s i o l o g i c a l and s u b j e c t i v e sexual response p a t t e r n s of s e x u a l l y f u n c t i o n a l and d y s f u n c t i o n a l women exposed to e r o t i c s t i m u l i . To date, no s t u d i e s have i n v e s t i g a t e d d y s f u n c t i o n a l women's response to a n x i e t y - e l i c i t i n g s t i m u l i . Wincze et a l . (1976) found that a sample of s i x s e x u a l l y d y s f u n c t i o n a l females e x h i b i t e d l e s s p h y s i o l o g i c a l sexual a r o u s a l , measured by a l i g h t - e m i t t i n g diode (LED) v a g i n a l photoplethysmograph, to e r o t i c f i l m s t i m u l i than a sample of s i x s e x u a l l y f u n c t i o n a l females. Contrary to the authors' hypothesis however, d e s p i t e the d i s c r e p a n t v a g i n a l blood volume r e c o r d i n g s , no d i f f e r e n c e was found between the s e x u a l l y d y s f u n c t i o n a l and f u n c t i o n a l s u b j e c t s ' s u b j e c t i v e r a t i n g s of sexual a r o u s a l to the e r o t i c s t i m u l i . 10 Wincze et a l . conclude that t h i s i n v e s t i g a t i o n p r o v i d e s evidence f o r the s e n s i t i v i t y of the v a g i n a l photoplethysmograph as a d i a g n o s t i c t o o l f o r i d e n t i f i c a t i o n of female sexual d y s f u n c t i o n . They suggest that the e q u i v a l e n t s u b j e c t i v e group r a t i n g s of sexual a r o u s a l may r e f l e c t demand c h a r a c t e r i s t i c s of the experimental s e t t i n g , causing the d y s f u n c t i o n a l group to r e p o r t higher l e v e l s of s u b j e c t i v e a r o u s a l than were a c t u a l l y e x perienced. Morokoff and Heiman (1980) r e p o r t other p o s s i b l e confounding f a c t o r s i n t h i s i n v e s t i g a t i o n such as the use of unmarried s e x u a l l y f u n c t i o n a l s u b j e c t s as a comparison group f o r the married s e x u a l l y d y s f u n c t i o n a l women, and a design whereby h a l f the f u n c t i o n a l s u b j e c t s but none of the d y s f u n c t i o n a l s u b j e c t s viewed a d y s p h o r i c f i l m of Nazi war a t r o c i t i e s p r i o r to the e r o t i c s t i m u l u s . The r e s e a r c h f i n d i n g s p r e v i o u s l y d e s c r i b e d (Barlow et a l . 1983; Dutton & Aron, 1974; Heiman & Rowland, 1983; Hoon et a l . , 1977; Wolchik et a l . , 1980) would suggest that t h i s design may have biased the p h y s i o l o g i c a l , and p o s s i b l y s u b j e c t i v e , a r o u s a l data of the f u n c t i o n a l s u b j e c t s i n a p o s i t i v e d i r e c t i o n i f i t were p e r c e i v e d as a n x i e t y - e v o k i n g . I f however, the f i l m was p e r c e i v e d as d e p r e s s i n g , the p h y s i o l o g i c a l (Wolchik et a l . ) and s u b j e c t i v e a r o u s a l data of the f u n c t i o n a l s u b j e c t s may have been n e g a t i v e l y b i a s e d . These confounds obscure the i n t e r p r e t a b i l i t y of the f i n d i n g that s e x u a l l y f u n c t i o n a l and d y s f u n c t i o n a l s u b j e c t s e x h i b i t d i f f e r e n t p h y s i o l o g i c a l , but equal s u b j e c t i v e sexual a r o u s a l to e r o t i c cues. In order to c l a r i f y the r e l a t i o n s h i p between s u b j e c t i v e and p h y s i o l o g i c a l measures of a r o u s a l , Morokoff and Heiman (1980) 11 measured v a g i n a l p u l s e amplitude by an LED v a g i n a l photoplethysmograph, and s e l f - r a t e d l e v e l s of sexual a r o u s a l i n response to e r o t i c s t i m u l i i n a sample of eleven s e x u a l l y d y s f u n c t i o n a l females before and a f t e r treatment. A s e x u a l l y f u n c t i o n a l sample of eleven females matched on age and years married were u t i l i z e d as the comparison group. The authors hypothesized that (a) the d y s f u n c t i o n a l (low arousal) group pre-treatment would e x h i b i t l e s s p h y s i o l o g i c a l and s u b j e c t i v e sexual a r o u s a l than the f u n c t i o n a l (adequate arousal) comparison group, and that (b) post-treatment the d y s f u n c t i o n a l group would demonstrate s u b j e c t i v e and p h y s i o l o g i c a l responses equal to the f u n c t i o n a l group. Contrary to h y p othesis (a), the f u n c t i o n a l and d y s f u n c t i o n a l women showed e g u i v a l e n t i n c r e a s e s i n p h y s i o l o g i c a l sexual response dur i n g the e r o t i c s t i m u l i pre-treatment. S u b j e c t i v e l y however, the f u n c t i o n a l s u b j e c t s r a t e d t h e i r sexual a r o u s a l as s i g n i f i c a n t l y higher than the d y s f u n c t i o n a l s u b j e c t s . As expected, no d i f f e r e n c e s i n p h y s i o l o g i c a l or s u b j e c t i v e sexual a r o u s a l were found between groups at post-treatment. A t t e n t i o n to B o d i l y Cues The Morokoff and Heiman (1980) r e s u l t s are i n c o n s i s t e n t with the Wincze et a l . (1976) f i n d i n g s . Whereas Wincze et a l . reported that s e x u a l l y f u n c t i o n a l and d y s f u n c t i o n a l s u b j e c t s e x h i b i t d i f f e r e n t p h y s i o l o g i c a l , but equal s u b j e c t i v e sexual a r o u s a l responses to e r o t i c cues, Morokoff and Heiman conclude that these groups e x h i b i t equal p h y s i o l o g i c a l but d i f f e r e n t s u b j e c t i v e sexual a r o u s a l responses to these same e r o t i c cues. Morokoff and Heiman 12 suggest that t h e i r f i n d i n g s support a c o g n i t i v e - a f f e c t i v e i n t e r p r e t a t i o n of sexual d y s f u n c t i o n proposing that women with low ar o u s a l may not attend to g e n i t a l cues. Since women do not have a v i s i b l e source of feedback (a penis) to guide t h e i r s u b j e c t i v e r a t i n g s of a r o u s a l , they may depend on c o n t e x t u a l cues to i n t e r p r e t p h y s i o l o g i c a l changes as sexual a r o u s a l (Heiman, 1977). D y s f u n c t i o n a l women then, may m i s l a b e l environmental or p h y s i o l o g i c a l c o n t e x t u a l cues, and thereby have d i f f i c u l t y d i s c r i m i n a t i n g changes i n a r o u s a l l e v e l s . The hypothesis of " a t t e n t i o n to b o d i l y cues" may compliment the m i s a t t r i b u t i o n h y p o t h e s i s . Morokoff and Heiman (1980) suggest that "(low a r o u s a l women) may experience g e n i t a l s e n s a t i o n s , but l a b e l them as an x i e t y or some other a f f e c t i v e s t a t e " (p. 136). In the a n x i e t y - e r o t i c experimental paradigm, s u b j e c t s who do not attend to g e n i t a l changes, and r e l y on the c o n t e x t u a l cues of the environment to i n t e r p r e t p h y s i c a l change, may m i s a t t r i b u t e the p h y s i o l o g i c a l sexual a r o u s a l they experience f o l l o w i n g the an x i e t y s t i m u l i , as f u r t h e r a n x i e t y . No e x p l a n a t i o n has been proposed however, as to why d y s f u n c t i o n a l i n d i v i d u a l s may experience a t t r i b u t i o n s t h at e l i c i t d i f f e r e n t i a l responses to a n x i e t y . Proposed Model of Sexual D y s f u n c t i o n One e x p l a n a t i o n f o r d i f f e r e n t i a l a t t r i b u t i o n s of a n x i e t y and sexual a r o u s a l - e l i c i t i n g s t i m u l i may be that d y s f u n c t i o n a l women l e a r n to c o n d i t i o n a l l y m i s a t t r i b u t e g e n i t a l a r o u s a l as a n x i e t y . I f an i n d i v i d u a l experiences e i t h e r g e n e r a l i z e d a n x i e t y or s p e c i f i c performance a n x i e t y i n the sexual encounter (as i n the 13 B a r l o w e t a l . , 1983 a n a l o g u e s t u d y ) a n d e x p e r i e n c e s s a t i s f a c t o r y s e x u a l f u n c t i o n i n g , t h e a n x i e t y may f u r t h e r e n h a n c e s e x u a l a r o u s a l t h r o u g h t h e p r o c e s s o f m i s a t t r i b u t i o n . T h e p e r s o n ' s l e a r n i n g h i s t o r y o f s a t i s f y i n g a n d r e i n f o r c i n g s e x u a l c o n t a c t s s t r e n g t h e n s a n d m a i n t a i n s t h i s c o n d i t i o n e d r e s p o n s e o v e r t i m e , a l t h o u g h t h e c o n d i t i o n i n g may o c c u r m o r e r a p i d l y d u e t o t h e p h y s i o l o g i c a l l y a r o u s i n g n a t u r e o f t h e s t i m u l i . I f h o w e v e r , an i n d i v i d u a l i n a n i d e n t i c a l s i t u a t i o n e x p e r i e n c e s e i t h e r g e n e r a l i z e d a n x i e t y o r s p e c i f i c p e r f o r m a n c e a n x i e t y i n t h e s e x u a l e n c o u n t e r , h e o r s h e may e x p e r i e n c e i n a d e q u a t e s e x u a l f u n c t i o n i n g d u e t o a n y number o f s i n g l y - o c c u r r i n g i n c i d e n t s i n v o l v i n g p h y s i o l o g i c a l , a f f e c t i v e , o r b e h a v i o r a l f a c t o r s . A c c o r d i n g t o c o n d i t i o n i n g t h e o r y ( M o w r e r , 1 9 3 9 ) , t h e a r o u s a l - e v o k i n g n a t u r e o f t h e s e x u a l s t i m u l i may p r e d i s p o s e an i n c r e a s e d v u l n e r a b i l i t y t o a m o r e r a p i d a c q u i s i t i o n o f f e a r a n d a n x i e t y i n a s e x u a l s i t u a t i o n . I f t h i s f e a r o f a n x i e t y i s o f s u f f i c i e n t m a g n i t u d e , o r f a i l u r e i s a s s o c i a t e d w i t h s e x u a l l y a r o u s i n g s t i m u l i on r e p e a t e d o c c a s i o n s , c o n d i t i o n i n g t h e o r y w o u l d s u g g e s t t h a t t h e i n d i v i d u a l may a c q u i r e a c o n d i t i o n e d r e s p o n s e o f a n x i e t y i n t h e p r e s e n c e o f a r o u s a l - e l i c i t i n g s t i m u l i a n d c o n s e q u e n t l y a v o i d s i t u a t i o n s r e q u i r i n g s e x u a l p e r f o r m a n c e . I n t h i s w a y , m i s a t t r i b u t i o n may be r e v e r s e d w i t h d y s f u n c t i o n a l i n d i v i d u a l s s u c h t h a t t h e y l e a r n t o m i s a t t r i b u t e s e x u a l a r o u s a l -e l i c i t i n g s t i m u l i a s a n x i e t y . T h e s e m i s a t t r i b u t i o n s may t h e n e l i c i t e n h a n c e d a n x i e t y , d e c r e a s e d s e x u a l a r o u s a l , a n d a v o i d a n c e o f s e x u a l s t i m u l i . T h e s i t u a t i o n d e s c r i b e d e a r l i e r b y Hoon e t a l . (1977) w i t h f u n c t i o n a l women, a n d c o n s i s t e n t w i t h W o l p e ' s (1982) r e c i p r o c a l i n h i b i t i o n t h e o r y , s u g g e s t s t h a t e r o t i c p r e e x p o s u r e 14 f o l l o w e d b y a n x i e t y i n h i b i t s s e x u a l a r o u s a l . T h e H o o n e t a l . e r o t i c - a n x i e t y p a i r i n g may h a v e i n d u c e d i n f u n c t i o n a l women a l a b o r a t o r y a n a l o g u e o f t h e h y p o t h e s i z e d r e v e r s e d a t t r i b u t i o n p a t t e r n c o n d i t i o n e d i n s e x u a l l y d y s f u n c t i o n a l women. U n f a m i l i a r i t y o r i n a t t e n t i o n t o b o d i l y c u e s may f u r t h e r f a c i l i t a t e a m o r e r a p i d c o n d i t i o n e d m i s a t t r i b u t i o n o f s e x u a l a r o u s a l a s a n x i e t y . A c c o r d i n g t o t h i s m o d e l , t h e f o l l o w i n g p h y s i o l o g i c a l a n d s u b j e c t i v e s e x u a l r e s p o n s e p a t t e r n s w o u l d be e x p e c t e d f r o m s e x u a l l y f u n c t i o n a l a n d d y s f u n c t i o n a l s u b j e c t s i n t h e a n x i e t y -e r o t i c s t i m u l i p a r a d i g m : (a) S e x u a l l y f u n c t i o n a l s u b j e c t s m i s a t t r i b u t i n g a n x i e t y a s s e x u a l a r o u s a l w o u l d d e m o n s t r a t e i n c r e a s e d s u b j e c t i v e a n d p h y s i o l o g i c a l s e x u a l a r o u s a l i n t h e a n x i e t y - e r o t i c a n d n e u t r a l - e r o t i c c o n d i t i o n s a s c o m p a r e d t o d y s f u n c t i o n a l s u b j e c t s , w i t h t h e m o s t s e x u a l a r o u s a l d e m o n s t r a t e d i n t h e a n x i e t y - e r o t i c c o n d i t i o n . (b) S e x u a l l y d y s f u n c t i o n a l s u b j e c t s m i s a t t r i b u t i n g g e n i t a l a r o u s a l a s a n x i e t y w o u l d d e m o n s t r a t e l e s s s u b j e c t i v e a n d p h y s i o l o g i c a l s e x u a l a r o u s a l t h a n f u n c t i o n a l s u b j e c t s i n b o t h c o n d i t i o n s , w i t h t h e l e a s t s e x u a l a r o u s a l i n t h e a n x i e t y - e r o t i c c o n d i t i o n . T h e r e s u l t s a n d d a t a t r e n d s f r o m t h e p r e v i o u s l y d i s c u s s e d H e i m a n a n d R o w l a n d (1983) s t u d y w i t h f u n c t i o n a l a n d d y s f u n c t i o n a l m a l e s u b j e c t s i n t h e p e r f o r m a n c e demand p a r a d i g m , a r e c o n s i s t e n t w i t h t h i s h y p o t h e s i s . The H e i m a n a n d R o w l a n d r e s u l t s a n d t h e p r e s e n t h y p o t h e s i s o f d i f f e r e n t p h y s i o l o g i c a l a n d s u b j e c t i v e a r o u s a l t o e r o t i c s t i m u l i b e t w e e n g r o u p s a r e i n c o n s i s t e n t h o w e v e r , w i t h t h e W i n c z e e t a l . (1976) a n d M o r o k o f f a n d H e i m a n (1980) c o n t r a d i c t o r y f i n d i n g s . T h e 15 r e s u l t s w i t h f e m a l e f u n c t i o n a l a n d d y s f u n c t i o n a l s u b j e c t s r e v e a l e d e q u a l s u b j e c t i v e b u t d i f f e r e n t p h y s i o l o g i c a l ( W i n c z e e t a l . ) , a n d d i f f e r e n t s u b j e c t i v e b u t e q u a l p h y s i o l o g i c a l ( M o r o k o f f & H e i m a n ) r e s p o n s e s o f s e x u a l a r o u s a l t o e r o t i c s t i m u l i . T h e P u r p o s e o f t h e P r e s e n t S t u d y T h e p u r p o s e o f t h e p r e s e n t s t u d y was t o e x a m i n e t h e e f f e c t s o f a n x i e t y a r o u s a l on s u b s e q u e n t s e x u a l a r o u s a l t o d e t e r m i n e i f s e x u a l l y f u n c t i o n a l a n d s e x u a l l y d y s f u n c t i o n a l f e m a l e s u b j e c t s r e s p o n d d i f f e r e n t i a l l y t o p a i r i n g s o f a n x i e t y - e v o k i n g a n d e r o t i c c u e s , u t i l i z i n g b o t h p h y s i o l o g i c a l (LED v a g i n a l p h o t o p l e t h y s m o g r a p h ) a n d s u b j e c t i v e ( s e l f - r a t i n g ) m e a s u r e s o f s e x u a l a r o u s a l . T h i s i n v e s t i g a t i o n e x t e n d s t h e work o f b o t h H o o n e t a l . (1977) a n d W o l c h i k e t a l . (1980) on t h e e f f e c t s o f a n x i e t y a n d a r o u s a l i n s e x u a l l y f u n c t i o n a l m a l e s a n d f e m a l e s , a n d W i n c z e e t a l . (1976) a n d M o r o k o f f a n d H e i m a n (1980) on t h e e f f e c t s o f e r o t i c s t i m u l i on s e x u a l l y f u n c t i o n a l a n d d y s f u n c t i o n a l f e m a l e s . A n i n v e s t i g a t i o n o f s e x u a l l y d y s f u n c t i o n a l f e m a l e s ' s e x u a l r e s p o n s e t o a n x i e t y a n d a r o u s a l - e l i c i t i n g s t i m u l i h a s n o t b e e n p r e v i o u s l y p u b l i s h e d , n o r h a s a c o m p a r a t i v e e x a m i n a t i o n o f s e x u a l l y f u n c t i o n a l a n d d y s f u n c t i o n a l f e m a l e s p h y s i o l o g i c a l a n d s u b j e c t i v e r e s p o n s e s t o a n x i e t y a n d a r o u s a l e l i c i t i n g s t i m u l i . U t i l i z i n g t h e c o m b i n e d m e t h o d o l o g i c a l p r o c e d u r e s o f Hoon e t a l . (1977) w i t h f u n c t i o n a l f e m a l e s a n d W o l c h i k e t a l . (1980) w i t h f u n c t i o n a l m a l e s , t h e d i f f e r e n t i a l e f f e c t s o f a n x i e t y on s e x u a l a r o u s a l w e r e m e a s u r e d p h y s i o l o g i c a l l y b y c h a n g e s i n v a g i n a l b l o o d v o l u m e ( V B V ) , w i t h b o t h s e x u a l l y f u n c t i o n a l a n d d y s f u n c t i o n a l women. S e c o n d l y , b y 16 i n c l u d i n g a s u b j e c t i v e ( s e l f - r a t i n g ) m e a s u r e o f s e x u a l a r o u s a l , W i n c z e e t a l . (1976) a n d M o r o k o f f a n d H e i m a n ' s (1980) d a t a on t h e e f f e c t s o f e r o t i c s t i m u l i a l o n e , on s e x u a l l y f u n c t i o n a l a n d d y s f u n c t i o n a l f e m a l e s w e r e i n v e s t i g a t e d . T h e s e f i n d i n g s may e l u c i d a t e t h e c o n t r a d i c t o r y f i n d i n g s b e t w e e n s u b j e c t i v e a n d p h y s i o l o g i c a l a r o u s a l i n f u n c t i o n a l a n d d y s f u n c t i o n a l women e x p o s e d t o e r o t i c s t i m u l i . T h e s e p h y s i o l o g i c a l a n d s u b j e c t i v e m e a s u r e s o f s e x u a l a r o u s a l w e r e a s s e s s e d f o r b o t h s e x u a l l y f u n c t i o n a l a n d d y s f u n c t i o n a l s u b j e c t s d u r i n g t h e s u b s e q u e n t p r e s e n t a t i o n o f a n e u t r a l ( t r a v e l o g u e v i d e o t a p e ) a n d s e x u a l l y a r o u s i n g ( e r o t i c v i d e o t a p e ) s t i m u l u s ; a n d an a n x i e t y - e v o k i n g ( t h r e a t e n e d a m p u t a t i o n v i d e o t a p e ) a n d s e x u a l l y a r o u s i n g s t i m u l u s . T h e p r e s e n t s t u d y e x t e n d s p r e v i o u s r e s e a r c h i n s e v e r a l o t h e r r e s p e c t s . F i r s t , f u n c t i o n a l a n d d y s f u n c t i o n a l women w e r e m a t c h e d on E x p e r i e n c e s u b s c a l e s c o r e s f r o m t h e D e r o g a t i s S e x u a l F u n c t i o n i n g I n v e n t o r y ( D S F I ) ( D e r o g a t i s , 1 9 7 8 ) . P r e v i o u s s t u d i e s ( M o r o k o f f & H e i m a n , 1 9 8 0 ; ) h a v e m a t c h e d f u n c t i o n a l a n d d y s f u n c t i o n a l g r o u p s on t h e number o f y e a r s m a r r i e d , w i t h t h e a s s u m p t i o n t h a t t h e s e women h a v e e x p e r i e n c e d a s i m i l a r f r e q u e n c y a n d r e p e r t o i r e o f s e x u a l b e h a v i o r s . T h e D S F I E x p e r i e n c e s c a l e d i r e c t l y a s s e s s e s a s p e c t r u m o f s e x u a l b e h a v i o r s e x p e r i e n c e d b y t h e i n d i v i d u a l , r a n g i n g f r o m f u n d a m e n t a l t o r e l a t i v e l y a d v a n c e d ( D e r o g a t i s ) . T h i s d e f i n i t i o n o f s e x u a l e x p e r i e n c e may p r o v i d e a m o r e v a l i d a n d r e l i a b l e m e t h o d o f m a t c h i n g p r e e x i s t i n g l e v e l s o f s e x u a l e x p e r i e n c e b e t w e e n s e x u a l l y f u n c t i o n a l a n d d y s f u n c t i o n a l women. I n a d d i t i o n , s i n c e E x p e r i e n c e s c a l e s c o r e s f o r women a n d men show h i g h l e v e l s o f a g r e e m e n t ( D e r o g a t i s ) e x p e r i m e n t a l 17 f i n d i n g s with matched samples of f u n c t i o n a l and d y s f u n c t i o n a l women may be matched with the f i n d i n g s from res e a r c h with men. Second, s u b j e c t i v e sexual a r o u s a l was d e f i n e d by 5 s e l f -r e p o r t items: " S e x u a l l y aroused," "warmth i n g e n i t a l s , " " g e n i t a l wetness or l u b r i c a t i o n , " " g e n i t a l p u l s i n g or t h r o b b i n g , " and "any g e n i t a l f e e l i n g s . " Previous s t u d i e s with women (Heiman, 1980; Morokoff & Heiman, 1980) and men (Heiman & Hatch, 1980) have used one item, " s e x u a l l y aroused," to measure s u b j e c t i v e sexual response. The d e f i n i t i o n used i n the present study i s more encompassing, i n c l u d i n g p h y s i o l o g i c a l sexual change, i n order to measure a wider range of s u b j e c t i v e p e r c e p t i o n s of sexual a r o u s a l . T h i r d , p h y s i o l o g i c a l sexual a r o u s a l was measured using the DC s i g n a l . T h i s component measures the abs o l u t e q u a n t i t y of v a g i n a l blood engorgement ( v a g i n a l blood volume), as opposed to the AC s i g n a l which measures r e l a t i v e changes i n v a g i n a l o p a c i t y due to blood pressure p u l s e ( v a g i n a l p u l s e amplitude, VPA) (Beck, Sakheim, & Barlow, 1983). Since the AC s i g n a l r e f l e c t s r e l a t i v e changes i n blood p u l s e , i t cannot d i s t i n g u i s h parameters of the ar o u s a l response such as d i r e c t i o n a l i t y . For example, the AC s i g n a l i s unable to d i f f e r e n t i a t e i n c r e a s i n g versus d e c r e a s i n g sexual a r o u s a l , or heightened versus lack of sexual a r o u s a l . Previous s t u d i e s using the AC (Morokoff & Heiman, 1980) and DC (Wince et a l . , 1976) s i g n a l to i n v e s t i g a t e p h y s i o l o g i c a l a r o u s a l i n f u n c t i o n a l and d y s f u n c t i o n a l women may have y i e l d e d d i f f e r e n t r e s u l t s due to the use of p h y s i o l o g i c a l measures that are not n e c e s s a r i l y comparable. Beck, Sakheim, and Barlow (1983) conclude t h a t i t i s impossible to a s c e r t a i n any s p e c i f i e d parameters of the 18 s e x u a l a r o u s a l r e s p o n s e u s i n g t h e AC s i g n a l . T h e DC s i g n a l h o w e v e r , a l l o w s f o r t h e d e t e c t i o n o f c h a n g e s i n d i r e c t i o n a n d m a g n i t u d e o f t h e v a s o c o n g e s t i v e r e s p o n s e . T h e c o n s i s t e n t u s e o f t h e m o r e a p p r o p r i a t e c o m p o n e n t , t h e DC s i g n a l , may p r o v i d e m o r e v a l i d a n d r e l i a b l e d a t a a n d c l a r i f y p r e v i o u s c o n t r a d i c t o r y f i n d i n g s . F i n a l l y , t h e s y s t e m o f d a t a c o l l e c t i o n a n d r e d u c t i o n d e s i g n e d f o r t h e p r e s e n t s t u d y i s a m a j o r t e c h n i c a l a d v a n c e i n t h e m e a s u r e m e n t o f p h y s i o l o g i c a l s e x u a l a r o u s a l . P r e v i o u s s t u d i e s i n t h i s a r e a ( i . e . B e c k & B a r l o w , 1 9 8 6 ; B e g g s , C a l h o u n , & W o l c h i k , 1 9 8 7 ; H e i m a n & R o w l a n d , 1 9 8 3 ; H o o n e t a l . , 1 9 7 7 ; M o r o k o f f & H e i m a n , 1 9 8 0 ; W o l c h i k e t a l . , 1980) h a v e h a n d c a l c u l a t e d d e v i a t i o n s f r o m b a s e l i n e p o l y g r a p h r e c o r d i n g s a t 1-10 s e c o n d i n t e r v a l s . T h e m e t h o d d e s i g n e d f o r t h e p r e s e n t s t u d y p r o v i d e s d i r e c t a n a l o g u e t o d i g i t a l t r a n s f e r o f . 0 0 0 1 m i l l i v o l t c h a n g e s i n VBV a t 0 . 2 0 s e c o n d t i m e s a m p l e s . F o r e a c h s u b j e c t , 1 , 3 0 0 d a t a s a m p l e s w e r e c o l l e c t e d a c r o s s t h e 8 0 - s e c o n d p r e e x p o s u r e a n d 1 8 0 - s e c o n d e x p e r i m e n t a l f i l m s t i m u l i . T h i s s y s t e m p r o v i d e s m o r e v a l i d a n d r e l i a b l e d a t a , a n d t h e f i r s t c o n t i n u o u s d i g i t a l m e a s u r e m e n t a n d g r a p h i c r e p r e s e n t a t i o n o f VBV i n women. By m e t h o d o l o g i c a l l y c o m b i n i n g t h e s t u d y o f f e m a l e f u n c t i o n a l a n d d y s f u n c t i o n a l s u b j e c t s e x p o s e d t o a n x i e t y a n d e r o t i c c u e s a n d a s s e s s e d b o t h p h y s i o l o g i c a l l y a n d s u b j e c t i v e l y , i t c a n b e d e t e r m i n e d i f t h e p h y s i o l o g i c a l e f f e c t s o f a n x i e t y a r e d i f f e r e n t i a l l y a t t r i b u t e d u n d e r i d e n t i c a l c o n d i t i o n s a c r o s s g r o u p s . W i t h t h e e x p e c t a t i o n t h a t m i s a t t r i b u t i n g a n x i e t y a r o u s a l a s s e x u a l a r o u s a l i n c r e a s e s t h e s e x u a l a r o u s a l r e s p o n s e i n 19 f u n c t i o n a l women, and m i s a t t r i b u t i n g sexual a r o u s a l as anx i e t y decreases the sexual response i n d y s f u n c t i o n a l women, i t was hypothesized t h a t : 1. The s e x u a l l y f u n c t i o n a l group would demonstrate in c r e a s e d p h y s i o l o g i c a l and s u b j e c t i v e sexual a r o u s a l i n the n e u t r a l - e r o t i c c o n d i t i o n as compared to the s e x u a l l y d y s f u n c t i o n a l group. [This i n v e s t i g a t e s the Wincze et a l . (1976) and Morokoff & Heiman (1980) c o n t r a d i c t o r y f i n d i n g s . ] 2. The s e x u a l l y f u n c t i o n a l group would demonstrate i n c r e a s e d p h y s i o l o g i c a l and s u b j e c t i v e sexual a r o u s a l i n the a n x i e t y - e r o t i c c o n d i t i o n as compared to the s e x u a l l y d y s f u n c t i o n a l group. 3. The s e x u a l l y f u n c t i o n a l group would demonstrate increased s u b j e c t i v e and p h y s i o l o g i c a l sexual a r o u s a l i n the a n x i e t y - e r o t i c as compared to the n e u t r a l - e r o t i c c o n d i t i o n . [This s y s t e m a t i c a l l y r e p l i c a t e s the Hoon et a l . (1977) and Wolchik et a l . (1980) p h y s i o l o g i c a l data.] 4. The s e x u a l l y d y s f u n c t i o n a l group would demonstrate inc r e a s e d s u b j e c t i v e and p h y s i o l o g i c a l sexual a r o u s a l i n the n e u t r a l - e r o t i c as compared to the a n x i e t y - e r o t i c c o n d i t i o n . Both the i d e n t i f i c a t i o n of d i f f e r e n t i a l responses to anx i e t y and a r o u s a l - e l i c i t i n g s t i m u l i , and i n t e r a c t i v e p a t t e r n s of c o g n i t i v e a t t r i b u t i o n s and p h y s i o l o g i c a l response, are viewed as important to (a) the c o n c e p t u a l i z a t i o n of sexual a r o u s a l , (b) the for m u l a t i o n of a model of sexual d y s f u n c t i o n , and (c) the development of e f f e c t i v e treatment procedures f o r s e x u a l l y d y s f u n c t i o n a l women. 20 Method Subjects S i x t e e n women p a r t i c i p a t e d i n the i n v e s t i g a t i o n . E i g h t of these s u b j e c t s , comprising the s e x u a l l y f u n c t i o n a l group were r e c r u i t e d through advertisements i n the l o c a l u n i v e r s i t y newspaper and n o t i c e s on campus. Women i n the f u n c t i o n a l group (M age = 28, range = 22-50) repor t e d an e x c l u s i v e h e t e r o s e x u a l o r i e n t a t i o n , c u r r e n t involvement i n a sexual r e l a t i o n s h i p , no h i s t o r y of treatment f o r sexual d y s f u n c t i o n s or d i s o r d e r s , and s a t i s f a c t i o n with t h e i r c u r r e n t sexual f u n c t i o n i n g . These women r e c e i v e d DSFI sexual experience s c a l e scores (M = 56.31%, range = 45%-63%) s i m i l a r to nonpatient normative samples (40%-60%). The Sexual F u n c t i o n i n g Index (SFI) and Gl o b a l Sexual S a t i s f a c t i o n Index (GSSI) subscales of the DSFI, were used to v a l i d a t e d i f f e r e n c e s between f u n c t i o n a l and d y s f u n c t i o n a l s u b j e c t s i n terms of s a t i s f a c t i o n with t h e i r sexual f u n c t i o n i n g . Subjects i n the f u n c t i o n a l group scored g r e a t e r than or equal to the 50th p e r c e n t i l e on both the SFI and GSSI subscales ( i . e . the g l o b a l l e v e l of sexual f u n c t i o n i n g was g r e a t e r than or equal to the mean f o r the normative sample, and t h e i r present sexual r e l a t i o n s h i p rated "above average" to "could not be b e t t e r " ) . The s e x u a l l y f u n c t i o n a l group was matched to the d y s f u n c t i o n a l group on the v a r i a b l e s of age and expe r i e n c e . The s e x u a l l y d y s f u n c t i o n a l group was comprised of e i g h t women contacted from a l o c a l h o s p i t a l sexual medicine c l i n i c and p r i v a t e t h e r a p i s t s s p e c i a l i z i n g i n the treatment of sexual d i f f i c u l t i e s . A l e t t e r of i n i t i a l c o ntact was sent to i n d i v i d u a l s accepted f o r 21 a s s e s s m e n t o f t h e i r c o n d i t i o n a n d d e s c r i b e d b y t h e i r r e f e r r i n g p h y s i c i a n a s e x p e r i e n c i n g a p s y c h o g e n i c s e x u a l d y s f u n c t i o n . P a r t i c i p a t i o n i n t h e s t u d y was v o l u n t a r y , o c c u r r e d p r i o r t o t r e a t m e n t , a n d d i d n o t a f f e c t t h e c o u r s e o f f u r t h e r t r e a t m e n t o r m e d i c a l c a r e . T h e s u b j e c t s c o m p r i s i n g t h e d y s f u n c t i o n a l g r o u p (M = 2 9 . 5 , r a n g e 2 2 - 3 9 ) r e p o r t e d an e x c l u s i v e h e t e r o s e x u a l o r i e n t a t i o n , c u r r e n t i n v o l v e m e n t i n a s e x u a l r e l a t i o n s h i p , a n d d i s s a t i s f a c t i o n w i t h t h e i r c u r r e n t s e x u a l f u n c t i o n i n g . T h e s e women r e c e i v e d D S F I s e x u a l e x p e r i e n c e s c a l e s c o r e s (M = 5 0 . 2 5 % , r a n g e = 40%-63%) s i m i l a r t o t h e n o r m a t i v e s a m p l e . E a c h s u b j e c t i n t h e d y s f u n c t i o n a l g r o u p h a d r e q u e s t e d t r e a t m e n t f o r o n e o r m o r e s e x u a l d y s f u n c t i o n s : S e v e n w e r e d i a g n o s e d w i t h l o w s e x u a l d e s i r e , two w i t h i n o r g a s m i a , a n d two w i t h d y s p a r e u n i a . I n a d d i t i o n , two r e p o r t e d a h i s t o r y o f s e x u a l a b u s e . S u b j e c t s i n t h e d y s f u n c t i o n a l g r o u p s c o r e d b e l o w t h e 5 0 t h p e r c e n t i l e on b o t h t h e S F I a n d GSSI s u b s c a l e s ( i . e . t h e g l o b a l l e v e l o f s e x u a l f u n c t i o n i n g was l e s s t h a n t h e mean f o r t h e n o r m a t i v e s a m p l e , a n d t h e i r p r e s e n t s e x u a l r e l a t i o n s h i p r a t e d " a d e q u a t e " t o " c o u l d n o t be w o r s e " ) . A l l v o l u n t e e r s w e r e i n i t i a l l y i n t e r v i e w e d b y t e l e p h o n e , a t w h i c h t i m e t h e e x p e r i m e n t a l e q u i p m e n t a n d p r o c e d u r e s , i n c l u d i n g t h e v a g i n a l p h o t o p l e t h y s m o g r a p h a n d s e x u a l l y e x p l i c i t f i l m s w e r e d e s c r i b e d . I n t e r e s t e d a p p l i c a n t s w e r e s c h e d u l e d f o r a n a p p o i n t m e n t w i t h o n e o f two f e m a l e e x p e r i m e n t e r s . D u r i n g t h e a p p o i n t m e n t , t h e v o l u n t e e r s w e r e p r o v i d e d w i t h m o r e d e t a i l e d i n f o r m a t i o n r e g a r d i n g t h e i r p a r t i c i p a t i o n i n t h e i n v e s t i g a t i o n a n d c o m p l e t e d t h e D S F I . T h e B r i e f Symptom I n v e n t o r y ( B S I ) s u b s c a l e o f t h e D S F I was u s e d t o s c r e e n f o r a b s e n c e o f g e n e r a l p s y c h o p a t h o l o g y 22 f o r a l l s u b j e c t s u s i n g t h e 8 5 t h p e r c e n t i l e a s t h e c u t o f f c r i t e r i o n ( i . e . e l e v a t i o n s 1 . 2 5 sp_ a b o v e t h e mean f o r t h e n o r m a t i v e s a m p l e ) . O f t h e s u b j e c t s c h o o s i n g t o p a r t i c i p a t e , s e x u a l l y e x p e r i e n c e d h e t e r o s e x u a l f e m a l e v o l u n t e e r s 2 2 - y e a r s o f a g e a n d a b o v e , who f u l f i l l e d t h e S F I , G S S I , a n d B S I c r i t e r i a w e r e s c h e d u l e d f o r t h e s e c o n d s e s s i o n a n d r e q u e s t e d t o a b s t a i n f r o m p s y c h o a c t i v e d r u g s f o r 24 h o u r s p r i o r t o t h e s e s s i o n . A l l s u b j e c t s w e r e p a i d $20 a t t h e c o m p l e t i o n o f t h e s e c o n d s e s s i o n . A p p a r a t u s a n d M a t e r i a l s P h y s i o l o g i c a l m e a s u r e m e n t . A v a g i n a l p h o t o p l e t h y s m o g r a p h ( S i n t c h a k & G e e r , 1975) c o n t a i n i n g a l i g h t - e m i t t i n g d i o d e a s t h e l i g h t s o u r c e a n d a c a d m i u m s e l e n i d e ( C l a i r e x 9 0 4 L ) p h o t o d e t e c t o r e n c a s e d i n a c l e a r a c r y l i c p r o b e 1 . 2 7 cm i n d i a m e t e r a n d 4 . 4 5 cm i n l e n g t h , was u s e d t o m e a s u r e p h y s i o l o g i c a l s e x u a l a r o u s a l b y c h a n g e s i n v a g i n a l b l o o d v o l u m e (VBV) d u r i n g a l l c o n d i t i o n s . T h i s d e v i c e m e a s u r e s t h e o p a c i t y o f t h e v a g i n a l w a l l , a f f e c t e d b y c h a n g e s i n v a s o c o n g e s t i o n , b y t r a n s d u c i n g t h e r e f l e c t e d l i g h t f r o m t h e v a g i n a l w a l l i n d i r e c t c u r r e n t ( D C ) . R e c o r d i n g s f r o m t h e G e e r g a u g e a n d m o d u l e w e r e c h a n n e l e d t h r o u g h an o p t i c a l i s o l a t o r / p o w e r s u p p l y a n d m o n i t o r e d on a B e c k m a n T y p e R611 4 - c h a n n e l r e c t i l i n e a r p o l y g r a p h . The v a g i n a l p h o t o p l e t h y s m o g r a p h i s c o n s i d e r e d s a f e , c o m f o r t a b l e , a n d e a s y t o p u t i n p l a c e b y t h e s u b j e c t w i t h o u t t h e e x p e r i m e n t e r ' s a s s i s t a n c e ( H e i m a n , 1 9 7 7 ) . S u b j e c t i v e m e a s u r e m e n t . A s e l f - r e p o r t r a t i n g s c a l e was u s e d t o m e a s u r e s u b j e c t i v e l e v e l s o f s e x u a l a r o u s a l a n d a n x i e t y i m m e d i a t e l y f o l l o w i n g t h e n e u t r a l - e r o t i c a n d a n x i e t y - e r o t i c 23 c o n d i t i o n s . T h e r a t i n g s c a l e i s c o m p r i s e d o f 34 i t e m s d e s i g n e d t o a s s e s s p e r c e p t i o n s o f g e n e r a l p h y s i c a l c h a n g e (5 i t e m s ) , p e r c e p t i o n s o f p h y s i c a l s e x u a l c h a n g e (5 i t e m s ) , f e e l i n g s o f s e x u a l a r o u s a l (1 i t e m ) , f e e l i n g s o f a n x i e t y (1 i t e m ) , p o s i t i v e a f f e c t s (11 i t e m s ) , a n d n e g a t i v e a f f e c t s (11 i t e m s ) . S u b j e c t s r a t e d t h e d e g r e e t o w h i c h t h e y e x p e r i e n c e d t h e s e i t e m s on 7 - p o i n t L i k e r t s c a l e s f r o m 0 ( n o t a t a l l ) t o 7 ( i n t e n s e l y ) . T h e s u b j e c t i v e r e a c t i o n s c a l e was a d a p t e d f r o m H e i m a n a n d R o w l a n d (1983) a n d h a s b e e n d e t e r m i n e d t o be a s e n s i t i v e i n d i c a t o r o f e m o t i o n a l r e a c t i o n s t o e r o t i c s t i m u l i ( H e i m a n , 1 9 8 0 ; H e i m a n & H a t c h , 1 9 8 0 ; M o r o k o f f & H e i m a n , 1 9 8 0 ) . S u b j e c t i v e s e x u a l a r o u s a l was d e f i n e d b y 5 i t e m s : S e x u a l l y a r o u s e d , w a r m t h i n g e n i t a l s , g e n i t a l w e t n e s s o r l u b r i c a t i o n , g e n i t a l p u l s i n g o r t h r o b b i n g , a n d a n y g e n i t a l f e e l i n g s . S e l f -r e p o r t e d r a t i n g s f o r t h e s e i t e m s w e r e i n v e s t i g a t e d a s a r e p e a t e d m e a s u r e s f a c t o r w i t h f i v e l e v e l s i n t h e a n a l y s i s o f s u b j e c t i v e s e x u a l a r o u s a l , a n d i n d i v i d u a l l y c o r r e l a t e d w i t h t h e p o i n t o f g r e a t e s t p h y s i o l o g i c a l s e x u a l a r o u s a l f o r t h e c o r r e l a t i o n a l a n a l y s i s . S t i m u l i . P r e e x p o s u r e s t i m u l i c o n s i s t e d o f two 3 - m i n u t e v i d e o t a p e s : A n e u t r a l t r a v e l o g u e s e q u e n c e o f A n t a r c t i c a , a n d an a n x i e t y s e q u e n c e d e p i c t i n g t h r e a t e n e d a m p u t a t i o n . T h e e x p e r i m e n t a l s t i m u l u s , o r e r o t i c s e q u e n c e , c o n s i s t e d o f two 3 - m i n u t e v i d e o t a p e s o f a n u d e h e t e r o s e x u a l c o u p l e e n g a g i n g i n f o r e p l a y a n d i n t e r c o u r s e . T h e c o n t e n t o f t h e e r o t i c s c e n e s was s i m i l a r a c r o s s c o n d i t i o n s b u t d i f f e r e d s l i g h t l y i n o r d e r t o a v o i d r e p e t i t i o n . T h e n e u t r a l a n d e r o t i c f i l m s e g m e n t s w e r e o b t a i n e d 24 from the s t a n d a r d i z e d f i l m l i b r a r y f o r c l i n i c a l r e s e a r c h i n sexual behavior from Dr. J . P. Wincze. These e r o t i c f i l m s have been found to r e l i a b l y evoke sexual a r o u s a l i n s e x u a l l y f u n c t i o n a l s u b j e c t s (personal communication, May 27, 1987). In a d d i t i o n , r e s u l t s from a p i l o t study designed to assess p h y s i o l o g i c a l and s u b j e c t i v e sexual a r o u s a l i n s e x u a l l y f u n c t i o n a l s u b j e c t s confirmed the a n x i e t y - e v o k i n g c a p a c i t y of the a n x i e t y seguence, and the e q u i v a l e n t s e x u a l l y arousing value of the e r o t i c sequences. Der o g a t i s Sexual F u n c t i o n i n g Inventory (DSFI). The DSFI i s a s t a n d a r d i z e d s e l f - r e p o r t m u l t i d i m e n s i o n a l i n v e n t o r y that i s comprised of 10 d i s t i n c t s u b t e s t s designed to measure the c u r r e n t l e v e l of sexual f u n c t i o n i n g : I. Information, I I . Experience, I I I . D r i v e , IV. A t t r i b u t e s , V. Symptoms, VI. A f f e c t s , V I I . Gender Role D e f i n i t i o n , V I I I . Fantasy, IX. Body Image, and X. Sexual S a t i s f a c t i o n (Derogatis, 1978). The s u b t e s t measuring p s y c h o l o g i c a l symptomology i s a d i s t i n c t psychometric d i a g n o s t i c instrument c a l l e d the B r i e f Symptom Inventory (BSI) e m p i r i c a l l y v a l i d a t e d p r i o r to the development of the DSFI, and can be i n t e r p r e t e d independently as a measure of psychopathology v i a 9 symptom dimensions and 3 g l o b a l measures (Derogatis, 1975). The DSFI a l s o p r o v i d e s a s i n g l e summary score of the s u b j e c t s ' g l o b a l l e v e l of sexual f u n c t i o n i n g , the Sexual F u n c t i o n i n g Index (SFI), and a q u a l i t a t i v e p r o f i l e measuring the s u b j e c t s ' s e l f - p e r c e p t i o n of her s t r e n g t h s and weaknesses i n c u r r e n t l e v e l s of sexual f u n c t i o n i n g , the G l o b a l Sexual S a t i s f a c t i o n Index (GSSI). Normative response p a t t e r n s have been compiled f o r both s e x u a l l y 2 5 f u n c t i o n a l and d y s f u n c t i o n a l f e m a l e s on t h e s e i n d i c e s . P r e v i o u s s t u d i e s have d e t e r m i n e d t h a t raw s c o r e s can be c o n v e r t e d t o e s t a b l i s h e d p e r c e n t i l e r a n k i n g s ( t - s c o r e s ) as a v a l i d and r e l i a b l e measure f o r t h e d i f f e r e n t i a t i o n o f s e x u a l l y f u n c t i o n a l and d y s f u n c t i o n a l women ( D e r o g a t i s , 1980; D e r o g a t i s & M e l i s a r a t o s , 1979; D e r o g a t i s & Meyer, 1979). S u b j e c t s c o m p l e t e d t h e DSFI d u r i n g t h e f i r s t l a b o r a t o r y s e s s i o n . D e s i g n and P r o c e d u r e The e x p e r i m e n t a l d e s i g n and p r o c e d u r e u s e d i n t h e p r e s e n t s t u d y was s i m i l a r t o t h a t employed by Hoon e t a l . (1977) f o r s e x u a l l y f u n c t i o n a l f e m a l e s u b j e c t s and W o l c h i k e t a l . (1980) f o r s e x u a l l y f u n c t i o n a l male s u b j e c t s . A r e p e a t e d measures d e s i g n was used i n w h i c h e a c h s u b j e c t was p r e s e n t e d two v i d e o t a p e s t i m u l u s s e q u e n c e s on a v i d e o c a s s e t t e p l a y e r and c o l o r t e l e v i s i o n m o n i t o r . The o r d e r o f t h e v i d e o t a p e s was c o u n t e r b a l a n c e d a c r o s s s u b j e c t s . E ach s e q u e n c e p a i r began w i t h a 1-minute segment d i s p l a y i n g t h e word " r e l a x , " f o l l o w e d by a 1-minute n e u t r a l o r i e n t a t i o n s t i m u l u s , t h e 3-minute n e u t r a l or a n x i e t y p r e e x p o s u r e s t i m u l u s , and f i n a l l y t h e 3-minute e r o t i c e x p e r i m e n t a l s t i m u l u s . C h a n g e o v e r f r o m t h e n e u t r a l o r a n x i e t y p r e e x p o s u r e t o e r o t i c e x p e r i m e n t a l s t i m u l u s was i m m e d i a t e . The i n v e s t i g a t i o n f o c u s e d on p h y s i o l o g i c a l c h a n g e s i n s e x u a l a r o u s a l (VBV) d u r i n g t h e l a s t 80 s e c o n d s o f p r e e x p o s u r e and t h e e n t i r e 180 s e c o n d s o f e x p e r i m e n t a l s t i m u l i , i n two p a i r s o f p r e e x p o s u r e and e x p e r i m e n t a l s t i m u l i : (a) N e u t r a l t o e r o t i c , and (b) a n x i e t y t o e r o t i c . S e x u a l a r o u s a l c h a n g es i n VBV were compared d u r i n g t h e e r o t i c s e q u e n c e s a f t e r e x p o s u r e t o t h e n e u t r a l 26 a n d a n x i e t y s t i m u l i . S u b j e c t i v e c h a n g e s i n s e x u a l a r o u s a l i m m e d i a t e l y f o l l o w i n g e x p o s u r e t o t h e n e u t r a l a n d a n x i e t y s t i m u l i w e r e a l s o c o m p a r e d . T h e e x p e r i m e n t a l p r o c e d u r e was i d e n t i c a l f o r a l l s u b j e c t s . F o l l o w i n g t h e i n i t i a l t e l e p h o n e i n t e r v i e w , s u b j e c t s met w i t h one o f two f e m a l e e x p e r i m e n t e r s t o v i e w t h e l a b o r a t o r y f a c i l i t i e s a n d e q u i p m e n t , r e c e i v e v e r b a l i n s t r u c t i o n s i n t h e u s e o f t h e p h o t o p l e t h y s m o g r a p h , a n d d i s c u s s a n y q u e s t i o n s r e l a t e d t o t h e e x p e r i m e n t . T h e y w e r e t o l d t h a t t h e p u r p o s e o f t h e i n v e s t i g a t i o n was t o l e a r n a b o u t e m o t i o n a l a n d p h y s i o l o g i c a l r e a c t i o n s t o a v a r i e t y o f v i d e o t a p e s i n c l u d i n g s e x u a l l y e x p l i c i t t a p e s ( W o l c h i k e t a l . , 1 9 8 0 ) . S u b j e c t s c h o o s i n g t o p a r t i c i p a t e i n two 1 - h o u r l a b o r a t o r y s e s s i o n s s i g n e d t h e s t a n d a r d c o n s e n t f o r m a n d c o m p l e t e d t h e D S F I i n a s e p a r a t e s u b j e c t r o o m . A s e c o n d s e s s i o n was s c h e d u l e d f o r t h e e x p e r i m e n t a l p r o c e d u r e . D u r i n g t h e s e c o n d s e s s i o n , s u b j e c t s i n s e r t e d t h e v a g i n a l p r o b e i n t h e p r i v a c y o f an i n t e r n a l l y l o c k e d room w i t h t h e a i d o f d i a g r a m m e d i n s t r u c t i o n s . T h e i n s t r u m e n t was s t e r i l i z e d i n C i d e x l o n g - l i f e ( a c t i v a t e d d i a l d e h y d e ) s o l u t i o n b e t w e e n u s e s . A t e l e v i s i o n m o n i t o r was p l a c e d o n a h i g h t a b l e s o t h a t s u b j e c t s c o u l d s i t c o m f o r t a b l y on a r e c l i n e r w i t h f u l l v i e w o f t h e s c r e e n . S u b j e c t s r e m a i n e d f u l l y c l o t h e d a n d w e r e c o v e r e d w i t h a l i g h t b l a n k e t . Room t e m p e r a t u r e was m a i n t a i n e d a t a c o n s t a n t 2 1 . 7 ° C . S u b j e c t s w e r e i n s t r u c t e d t o s i t q u i e t l y f o r a b o u t 10 m i n u t e s p r i o r t o t h e o n s e t o f t h e e x p e r i m e n t f o r p u r p o s e s o f a d a p t a t i o n , a n d t o r e m a i n a s s t i l l a s p o s s i b l e t h r o u g h o u t t h e s e s s i o n . I m m e d i a t e l y f o l l o w i n g t h e c o n c l u s i o n o f t h e e r o t i c s t i m u l i , s u b j e c t s c o m p l e t e d 27 the s u b j e c t i v e r a t i n g s c a l e f o r the preceding sequence. Ten minutes a f t e r the e r o t i c f i l m , and f i v e minutes a f t e r completion of the form, i f the VBV readings had not returned to b a s e l i n e l e v e l , s u b j e c t s were asked to count backwards by 3's from 100 to f a c i l i t a t e decreased a r o u s a l . When the VBV readings returned to b a s e l i n e , the second preexposure stimulus was presented. At the c o n c l u s i o n of the experimental s e s s i o n , each s u b j e c t was d e b r i e f e d i n order to (a) assure t h e i r comfort with the procedure and answer any f u r t h e r q u e s t i o n s , (b) assess t h e i r understanding of the i n s t r u c t i o n s and equipment, and (c) d i s c u s s t h e i r s u b j e c t i v e response forms and a c q u i r e f u r t h e r i n f o r m a t i o n r e g a r d i n g t h e i r r e a c t i o n s and experiences to the s t i m u l i . Data Reduction The l e v e l of sexual a r o u s a l was measured f o r each s u b j e c t as an a b s o l u t e d e v i a t i o n of the VBV from a r e f e r e n c e l e v e l recorded at the p o i n t of changeover from the preexposure ( n e u t r a l or a n x i e t y stimulus) to the experimental ( e r o t i c ) s t i m u l u s . VBV data were c o l l e c t e d 5 times/second d u r i n g the l a s t 80 seconds of preexposure and the e n t i r e 180 seconds of experimental s t i m u l i . Each s u b j e c t ' s VBV data were c o l l e c t e d using the Data T r a n s l a t i o n A/D c o n v e r t e r and Labtech Notebook software (1986), then averaged across 4-second time blocks using the Lotus 1-2-3 spreadsheet a n a l y s i s program (1983). The p o i n t of g r e a t e s t p h y s i o l o g i c a l sexual a r o u s a l (VBV) f o r the c o r r e l a t i o n a l a n a l y s i s , was d e f i n e d f o r each s u b j e c t as the l a r g e s t d i g i t a l VBV absolute d e v i a t i o n from b a s e l i n e averaged 28 a c r o s s 2 0 - s e c o n d t i m e b l o c k s , d u r i n g e a c h o f t h e e x p e r i m e n t a l c o n d i t i o n s . R e s u l t s G r o u p D i f f e r e n c e s I n S e x u a l F u n c t i o n i n g I n o r d e r t o v a l i d a t e d i f f e r e n c e s b e t w e e n s e x u a l l y f u n c t i o n a l a n d d y s f u n c t i o n a l g r o u p s , p r o f i l e s c o r e s f r o m t h e D S F I w e r e a n a l y z e d on m e a s u r e s o f s e x u a l f u n c t i o n i n g w i t h i n c u r r e n t s e x u a l r e l a t i o n s h i p s . T a b l e 1 p r e s e n t s t h e r e s u l t s o f t - t e s t a n a l y s e s f o r i n d e p e n d e n t o b s e r v a t i o n s b e t w e e n s e x u a l l y d y s f u n c t i o n a l a n d f u n c t i o n a l women i n p r o f i l e s c o r e s o f t h e D S F I . S i n c e m u l t i p l e t - t e s t s w e r e e m p l o y e d , B o n f e r r o n i c o r r e c t e d t v a l u e s w e r e u s e d t o d e t e r m i n e t h e l e v e l o f s i g n i f i c a n c e . D y s f u n c t i o n a l s u b j e c t s r e v e a l e d s i g n i f i c a n t l y l o w e r S F I s c o r e s t h a n f u n c t i o n a l s u b j e c t s , j t ( 1 4 ) = 6 . 3 2 , p_ < 0 . 0 0 1 , r e f l e c t i n g d i f f e r e n c e s i n t h e o v e r a l l q u a l i t y o f c u r r e n t s e x u a l f u n c t i o n i n g ; a n d s i g n i f i c a n t l y l o w e r GSSI s c o r e s , j t (14) = 6 . 3 8 , £ < 0 . 0 0 1 , r e f l e c t i n g a d i f f e r e n c e i n s e l f - p e r c e p t i o n s o f s t r e n g t h s a n d w e a k n e s s e s i n s e x u a l f u n c t i o n i n g , a n d t h e o v e r a l l q u a l i t y o f s e x u a l a c t i v i t i e s . D y s f u n c t i o n a l s u b j e c t s w e r e s i g n i f i c a n t l y l e s s s a t i s f i e d w i t h t h e i r s e x u a l b e h a v i o r t h a n f u n c t i o n a l s u b j e c t s , t{14) = 4 . 3 9 , £ < 0 . 0 1 , i n t e r m s o f t h e f r e q u e n c y a n d d e g r e e o f v a r i a t i o n i n s e x u a l a c t i v i t i e s , c o m m u n i c a t i o n b e t w e e n s e x u a l p a r t n e r s , a r o u s a l d u r i n g f o r e p l a y , l e n g t h o f f o r e p l a y , l e n g t h o f i n t e r c o u r s e , a b i l i t y t o a c h i e v e o r g a s m , a n d f e e l i n g f u l f i l l e d f o l l o w i n g s e x u a l a c t i v i t y . S p e c i f i c a l l y , d y s f u n c t i o n a l women w e r e s i g n i f i c a n t l y l e s s i n t e r e s t e d i n s e x u a l a c t i v i t y (75% r e p o r t e d l o w s e x u a l Table 1 Differences between Sexually Dysfunctional and Functional Women in Profile Scores  from the Derogatis Sexual Functioning Inventory. Dysfunctional Functional Profile dj (n = 8) (n = 8) i Mean SD Mean SD SFI 14 43.06 4.11 61.25 7.04 6.32** GSSI 14 38.88 4.91 57.63 6.70 6.38** Satisfaction 14 39.38 8.55 56.50 6.95 4.39* Arousal 14 1.25 0.46 2.00 0.00 4.52* Orgasm 14 1.25 0.46 2.00 0.00 4.52* Experience 14 50.25 8.46 57.88 7.59 1.90 *p<.01 **p<.001 fO ID 30 d e s i r e ) , t_(14) = 4 . 5 2 , £ < 0 . 0 1 , a n d l e s s o r g a s m i c (75% r e p o r t e d l a c k o f o r g a s m d u r i n g s e x u a l a c t i v i t y ) , t;(14) = 4 . 5 2 , £ < 0 . 0 1 , t h a n f u n c t i o n a l women. F u n c t i o n a l women a c h i e v e d s c a l e d s c o r e s w i t h i n t h e r a n g e f o r t h e n o r m a t i v e s a m p l e on t h e s e d i m e n s i o n s . F o r t h e p u r p o s e s o f t h e p r e s e n t s t u d y , t h e s e d i f f e r e n c e s v a l i d a t e t h e d e s i g n a t i o n o f t h e women r e f e r r e d f r o m t h e s e x u a l m e d i c i n e c l i n i c a n d p r i v a t e t h e r a p i s t s a s s e x u a l l y d y s f u n c t i o n a l , a n d t h e n o n - c l i n i c a l c o m p a r i s o n g r o u p a s s e x u a l l y f u n c t i o n a l . I n t e r n a l V a l i d i t y o f P h y s i o l o g i c a l M e a s u r e s V a g i n a l b l o o d v o l u m e l e v e l s . T h e s t a n d a r d i z a t i o n o f V B V l e v e l s a c r o s s r e p e a t e d m e a s u r e s o f p r e e x p o s u r e a n d e x p e r i m e n t a l c o n d i t i o n s f o r a l l s u b j e c t s , i s r e q u i r e d i n o r d e r t o d r a w c o n c l u s i o n s r e g a r d i n g t h e e f f e c t o f a n x i e t y p r e e x p o s u r e s t i m u l i on s e x u a l a r o u s a l . I n o r d e r t o c h e c k t h e a s s u m p t i o n t h a t no n o n r a n d o m c h a n g e s i n V B V o c c u r r e d b e t w e e n c o n d i t i o n s , t h e d i f f e r e n c e i n m i l l i v o l t s o f V B V b a s e l i n e l e v e l s a t c h a n g e o v e r f r o m t h e o r i e n t i n g t o p r e e x p o s u r e s t i m u l i , s u b t r a c t e d f r o m V B V l e v e l s a t c h a n g e o v e r f r o m t h e p r e e x p o s u r e t o e x p e r i m e n t a l s t i m u l i , was c a l c u l a t e d a n d c o m p a r e d b e t w e e n g r o u p s a n d c o n d i t i o n s . A s p r e s e n t e d i n T a b l e 2, a 2 X 2 a n a l y s i s o f v a r i a n c e ( A N O V A ) , G r o u p X S t i m u l i w i t h r e p e a t e d m e a s u r e s on t h e s e c o n d f a c t o r , r e v e a l e d no s i g n i f i c a n t d i f f e r e n c e s i n VBV l e v e l s b e t w e e n G r o u p s , F ( l , 1 4 ) = 0 . 8 4 , £ = 0 . 3 8 ; S t i m u l i c o n d i t i o n s , F ( l , 1 4 ) = 3 . 8 3 , £ = 0 . 0 7 ; o r i n t h e G r o u p X S t i m u l i i n t e r a c t i o n , F ( l , 1 4 ) = 0 . 9 2 , £ = 0 . 3 6 . T h e s e a n a l y s e s v a l i d a t e t h e a s s u m p t i o n t h a t no d i f f e r e n c e s i n l e v e l s o f V B V o c c u r r e d f r o m t h e o n s e t o f t h e T a b l e 2 A n a l y s i s o f V a r i a n c e f o r V a g i n a l B l o o d V o l u m e L e v e l s d u r i n g t h e O n s e t o f P r e e x p o s u r e S t i m u l i t o C h a n g e o v e r f r o m P r e e x p o s u r e - E x p e r i m e n t a l S t i m u l i S o u r c e o f v a r i a t i o n d f S S M S F e B e t w e e n s u b j e c t s G r o u p 1 6 6 . 1 2 5 0 6 6 . 1 2 5 0 0 . 8 4 0 . 3 7 7 2 E r r o r 1 4 1 0 9 7 . 8 8 0 0 7 8 . 4 1 9 6 W i t h i n s u b j e c t s S t i m u l u s 1 3 0 0 . 1 2 5 0 3 0 0 . 1 2 5 0 3 . 8 3 0 . 0 6 7 7 E r r o r 1 4 1 0 9 5 . 8 8 0 0 7 8 . 2 7 6 8 G r o u p x S t i m u l u s 1 7 2 . 0 0 0 0 7 2 . 0 0 0 0 0 . 9 2 0 . 3 5 6 2 E r r o r 1 4 1 0 9 5 . 8 8 0 0 7 8 . 2 7 6 8 32 e x p e r i m e n t t o c h a n g e o v e r f r o m p r e e x p o s u r e t o e x p e r i m e n t a l s t i m u l i b e t w e e n f u n c t i o n a l a n d d y s f u n c t i o n a l , o r n e u t r a l o r a n x i e t y c o n d i t i o n s . P r e e x p o s u r e s t i m u l i . E x p e r i m e n t a l a n a l y s e s o f t h e e f f e c t s o f a n x i e t y on p h y s i o l o g i c a l s e x u a l a r o u s a l r e q u i r e s m u l t i p l e r e p e a t e d m e a s u r e s a c r o s s t i m e , w h i c h a r e l i k e l y t o v i o l a t e t h e s t a t i s t i c a l a s s u m p t i o n s o f l i n e a r i n d e p e n d e n c e a n d h o m o g e n i e t y o f v a r i a n c e -c o v a r i a n c e m a t r i c e s . I n o r d e r t o a v o i d F - t e s t b i a s e s a n d t h e i n c r e a s e d r i s k o f t y p e I e r r o r , t h e G r e e n h o u s e - G e i s s e r c o n s e r v a t i v e c r i t e r i o n o f s i g n i f i c a n c e was u s e d f o r a l l p h y s i o l o g i c a l p r e e x p o s u r e a n d e x p e r i m e n t a l a n a l y s e s o f T i m e , G r o u p X T i m e , S t i m u l u s X T i m e , a n d G r o u p X S t i m u l u s X T i m e e f f e c t s . A 2 X 2 X 20 ANOVA, G r o u p X S t i m u l i X 4 - S e c o n d T i m e B l o c k M e a n s w i t h r e p e a t e d m e a s u r e s on t h e l a s t two f a c t o r s ( W i n e r , 1 9 7 1 ) , was u s e d t o a n a l y z e t h e p h y s i o l o g i c a l p r e e x p o s u r e d a t a . T h e p u r p o s e o f t h i s a n a l y s i s was t o i n v e s t i g a t e t h e a s s u m p t i o n t h a t no s i g n i f i c a n t d i f f e r e n c e s i n p h y s i o l o g i c a l s e x u a l a r o u s a l (VBV) o c c u r r e d a c r o s s t h e l a s t 80 s e c o n d s o f n e u t r a l o r a n x i e t y s t i m u l u s p r e e x p o s u r e r e l a t i v e t o b a s e l i n e l e v e l s a t c h a n g e o v e r , e i t h e r w i t h i n o r b e t w e e n f u n c t i o n a l a n d d y s f u n c t i o n a l g r o u p s . T h e r e s u l t s i n T a b l e 3 r e v e a l no s i g n i f i c a n t m a i n o r i n t e r a c t i o n e f f e c t s o f G r o u p , S t i m u l u s , o r T i m e . F i g u r e 1 p r e s e n t s t h e mean VBV ( a b s o l u t e d e v i a t i o n i n m i l l i v o l t s f r o m b a s e l i n e l e v e l s ) f o r t h e d y s f u n c t i o n a l a n d f u n c t i o n a l s u b j e c t s a c r o s s 4 - s e c o n d t i m e b l o c k s d u r i n g n e u t r a l a n d a n x i e t y p r e e x p o s u r e c o n d i t i o n s . F i g u r e 2 p r e s e n t s t h i s i n f o r m a t i o n i n t h e f o r m o f c o n t i n u o u s T a b l e 3 A n a l y s i s o f V a r i a n c e f o r P h y s i o l o g i c a l S e x u a l A r o u s a l ( V B V ) d u r i n g P r e e x p o s u r e S t i m u l i S o u r c e o f v a r i a t i o n S S M S F a G r e e n h o u s e G e i s s e r p . B e t w e e n s u b j e c t s G r o u p 1 1 . 3 2 7 4 1 . 3 2 7 4 0 . 2 7 0 . 6 0 9 0 E r r o r 1 4 6 7 . 8 8 3 0 4 . 8 4 8 8 W i t h i n s u b j e c t s S t i m u l u s 1 8 . 1 3 5 4 8 . 1 3 5 3 2 . 7 4 0 . 1 1 9 8 G r o u p x S t i m u l u s 1 0 . 9 2 3 5 0 . 9 2 3 5 0 . 3 1 0 . 5 8 5 6 E r r o r 1 4 4 1 . 5 0 1 8 2 . 9 6 4 4 T i m e 3 . 2 7 9 . 2 9 1 8 0 . 4 8 9 0 1 . 8 3 0 . 1 5 0 8 G r o u p x T i m e 3 . 2 7 3 . 3 0 3 5 0 . 1 7 3 8 0 . 6 5 0 . 5 9 9 6 E r r o r 4 5 . 7 6 7 1 . 1 2 7 5 0 . 2 6 7 4 S t i m u l u s x T i m e 4 . 6 9 5 . 7 3 5 6 0 . 3 0 1 8 7 1 . 7 7 0 . 1 3 6 4 G r o u p x S t i m u l u s x T i m e 4 . 6 9 5 . 5 7 4 4 0 . 2 9 3 3 7 1 . 7 2 0 . 1 4 7 4 E r r o r 6 5 . 7 0 4 5 . 4 8 5 2 0 . 1 7 0 8 0 F i g u r e 1 .  M e a n v a g i n a l b l o o d v o l u m e ( a b s o l u t e d e v i a t i o n i n m i l l i v o l t s f r o m b a s e l i n e ) f o r s e x u a l l y d y s f u n c t i o n a l a n d f u n c t i o n a l w o m e n a c r o s s 4 - s e c o n d t i m e b l o c k s d u r i n g t h e n e u t r a l - e r o t i c ( N - E ) a n d a n x i e t y - e r o t i c ( A - E ) c o n d i t i o n s . to 0 . 2 0 - S E C O N D T I M E I N T E R V A L S F i g u r e 2 . C o n t i n u o u s m e a s u r e m e n t o f v a g i n a l b l o o d v o l u m e ( a b s o l u t e d e v i a t i o n i n m i l l i v o l t s f r o m b a s e l i n e ) f o r s e x u a l l y d y s f u n c t i o n a l a n d f u n c t i o n a l w o m e n a t 0 . 2 0 s e c o n d t i m e i n t e r v a l s d u r i n g t h e n e u t r a l - e r o t i c ( N - E ) a n d a n x i e t y - e r o t i c ( A - E ) c o n d i t i o n s . CO 36 m e a s u r e m e n t o f V B V ( 0 . 2 0 s e c o n d t i m e i n t e r v a l s a v e r a g e d a c r o s s a l l s u b j e c t s ) a c r o s s n e u t r a l a n d a n x i e t y p r e e x p o s u r e s t i m u l i . V i s u a l i n s p e c t i o n o f t h e VBV means d u r i n g p r e e x p o s u r e c o n d i t i o n s s u p p o r t t h e s t a t i s t i c a l a n a l y s e s . T h e s e f i n d i n g s v a l i d a t e t h e a s s u m p t i o n t h a t s u b j e c t s d e m o n s t r a t e d s i m i l a r l e v e l s o f s e x u a l a r o u s a l p r i o r t o t h e o n s e t o f t h e e x p e r i m e n t a l s t i m u l i , a n d r e f u t e a l t e r n a t e h y p o t h e s e s a c c o u n t i n g f o r e x p e r i m e n t a l e f f e c t s b y p r e e x i s t i n g d i f f e r e n c e s i n n e u t r a l a n d a n x i e t y c o n d i t i o n s . P h y s i o l o g i c a l S e x u a l A r o u s a l A 2 X 2 X 45 ANOVA, G r o u p X S t i m u l i X 4 - S e c o n d T i m e B l o c k M e a n s w i t h r e p e a t e d m e a s u r e s on t h e l a s t two f a c t o r s , was c o m p u t e d t o i n v e s t i g a t e t h e e f f e c t s o f n e u t r a l a n d a n x i e t y - e l i c i t i n g s t i m u l i on p h y s i o l o g i c a l m e a s u r e s o f a r o u s a l w i t h i n a n d b e t w e e n s e x u a l l y f u n c t i o n a l a n d d y s f u n c t i o n a l g r o u p s . A summary o f t h e r e s u l t s f o r t h e p h y s i o l o g i c a l d a t a i s p r e s e n t e d i n T a b l e 4 . S t a t i s t i c a l a n a l y s i s r e v e a l e d t h a t G r o u p , S t i m u l u s , a n d T i m e e f f e c t s w e r e h i g h l y s i g n i f i c a n t . T h e s e f i n d i n g s show t h a t c o n s i s t e n t w i t h t h e h y p o t h e s e s , t h e f u n c t i o n a l g r o u p was s i g n i f i c a n t l y m o r e a r o u s e d i n b o t h t h e n e u t r a l - e r o t i c a n d a n x i e t y -e r o t i c c o n d i t i o n s t h a n t h e d y s f u n c t i o n a l g r o u p , F ( l , 1 4 ) = 4 . 9 1 , p_ = 0 . 0 4 3 8 . W i t h i n g r o u p f i n d i n g s r e v e a l e d t h a t , c o n s i s t e n t w i t h t h e h y p o t h e s i s , t h e f u n c t i o n a l g r o u p a c h i e v e d s i g n i f i c a n t l y g r e a t e r l e v e l s o f s e x u a l a r o u s a l f o l l o w i n g t h e a n x i e t y - e l i c i t i n g a s c o m p a r e d t o n e u t r a l - c o n t r o l s t i m u l i , F ( l , 1 4 ) = 1 3 . 4 1 , £ = 0 . 0 0 2 6 . C o n t r a r y t o e x p e c t a t i o n , t h e d y s f u n c t i o n a l g r o u p was a l s o s i g n i f i c a n t l y m o r e a r o u s e d f o l l o w i n g t h e a n x i e t y - e l i c i t i n g T a b l e 4 A n a l y s i s o f V a r i a n c e f o r P h y s i o l o g i c a l S e x u a l A r o u s a l ( V B V ) d u r i n g E x p e r i m e n t a l S t i m u l i S o u r c e o f v a r i a t i o n d f S S M S F G r e e n h o u s e p _ G e i s s e r a B e t w e e n s u b j e c t s G r o u p 1 2 1 3 8 . 0 6 0 0 2 1 3 8 . 0 6 0 0 4 . 9 1 0 . 0 4 3 8 * E r r o r 1 4 6 0 9 5 . 4 0 4 8 4 3 5 . 3 8 6 0 W i t h i n s u b j e c t s S t i m u l u s 1 5 1 0 . 8 9 7 0 5 1 0 . 9 8 7 0 1 3 . 4 1 0 . 0 0 2 6 * * G r o u p x S t i m u l u s 1 1 7 2 . 4 4 7 0 1 7 2 . 4 4 7 0 4 . 5 3 0 . 0 5 1 6 E r r o r 1 4 5 3 3 . 4 5 9 9 3 8 . 1 0 4 3 T i m e 1 . 2 9 6 5 9 . 5 5 7 0 1 4 . 9 8 9 9 6 . 1 2 0 . 0 1 7 6 * G r o u p x T i m e 1 . 2 9 3 1 9 . 5 3 6 0 7 . 2 6 2 2 2 . 9 7 0 . 0 9 4 4 E r r o r 1 7 . 9 9 1 5 0 8 . 4 9 5 0 2 . 4 4 8 9 S t i m u l u s x T i m e 2 . 3 1 1 3 1 . 7 8 5 0 2 . 9 9 5 1 4 . 6 8 0 . 0 1 3 0 * G r o u p x S t i m u l u s x T i m e 2 . 3 1 2 9 . 8 9 2 5 0 . 6 7 9 4 1 . 0 6 0 . 3 6 5 9 E r r o r 3 2 . 3 2 3 9 4 . 4 0 5 2 0 . 6 4 0 3 * _ B < . 0 5 * * _ B < . 0 1 38 p r e e x p o s u r e , F ( l , 1 4 ) = 1 3 . 4 1 , £ = 0 . 0 0 2 6 . A G r o u p X S t i m u l u s t r e n d , F ( l , 1 4 ) = 4 . 5 3 , £ = . 0 5 1 6 s u g g e s t s t h a t t h e a n x i e t y s t i m u l u s e l i c i t e d g r e a t e r s e x u a l a r o u s a l i n t h e f u n c t i o n a l a s c o m p a r e d t o t h e d y s f u n c t i o n a l s u b j e c t s . F i g u r e 1 p r e s e n t s t h e mean VBV ( a b s o l u t e d e v i a t i o n i n m i l l i v o l t s f r o m b a s e l i n e l e v e l s ) f o r t h e d y s f u n c t i o n a l a n d f u n c t i o n a l women a c r o s s 4 - s e c o n d t i m e b l o c k s d u r i n g t h e n e u t r a l -e r o t i c ( N - E ) a n d a n x i e t y - e r o t i c ( A - E ) c o n d i t i o n s . F i g u r e 2 p r e s e n t s t h i s same i n f o r m a t i o n i n t h e f o r m o f c o n t i n u o u s m e a s u r e m e n t o f V B V ( 0 . 2 0 s e c o n d t i m e s a m p l e s a v e r a g e d a c r o s s a l l s u b j e c t s ) a c r o s s n e u t r a l - e r o t i c a n d a n x i e t y - e r o t i c c o n d i t i o n s . C o n s i s t e n t w i t h t h e s t a t i s t i c a l a n a l y s e s , F i g u r e s 1 a n d 2 c l e a r l y r e v e a l t h a t t h e f u n c t i o n a l women e x h i b i t e d g r e a t e r a r o u s a l t h a n d y s f u n c t i o n a l women i n b o t h c o n d i t i o n s , a n d t h a t a n x i e t y - e l i c i t i n g s t i m u l i s i g n i f i c a n t l y e n h a n c e d t h e g e n i t a l a r o u s a l o f f u n c t i o n a l a n d d y s f u n c t i o n a l women. S i g n i f i c a n t d i f f e r e n c e s i n s e x u a l a r o u s a l a l s o o c c u r r e d a c r o s s T i m e , F ( 1 . 2 9 , 1 7 . 9 9 ) = 6 . 1 2 , £ = 0 . 0 1 7 6 , a n d i n t h e S t i m u l u s X T i m e i n t e r a c t i o n , F ( 2 . 3 1 , 3 2 . 3 2 ) = 4 . 6 8 , £ = 0 . 0 1 3 0 . S i m p l e m a i n e f f e c t s a n a l y s i s r e v e a l e d t h a t t h e f u n c t i o n a l g r o u p d e m o n s t r a t e d a s i g n i f i c a n t i n c r e a s e i n a r o u s a l o v e r t i m e , F ( 1 . 2 9 , 1 7 . 9 9 ) = 8 . 7 3 , £ = 0 . 0 0 5 5 , a n d t h a t s i g n i f i c a n t l y g r e a t e r l e v e l s o f s e x u a l a r o u s a l o v e r t i m e w e r e f o u n d i n t h e a n x i e t y a s c o m p a r e d t o t h e n e u t r a l c o n d i t i o n f o r t h e s e women, F ( 2 . 3 1 , 3 2 . 3 2 ) = 4 . 9 2 , £ = 0 . 0 1 0 6 . 39 S u b j e c t i v e S e x u a l A r o u s a l A 2 X 2 X 5 ANOVA, G r o u p X S t i m u l i X I t e m w i t h r e p e a t e d m e a s u r e s on t h e l a s t two f a c t o r s , was c o m p u t e d t o i n v e s t i g a t e t h e d i f f e r e n t i a l e f f e c t s o f n e u t r a l a n d a n x i e t y - e l i c i t i n g s t i m u l i on s u b j e c t i v e p e r c e p t i o n s o f a r o u s a l w i t h i n a n d b e t w e e n s e x u a l l y f u n c t i o n a l a n d d y s f u n c t i o n a l g r o u p s . A summary o f t h e r e s u l t s f o r t h e s u b j e c t i v e d a t a i s p r e s e n t e d i n T a b l e 5 . F i g u r e 3 p r e s e n t s t h e mean s u b j e c t i v e r a t i n g s o f s e x u a l a r o u s a l f o r d y s f u n c t i o n a l a n d f u n c t i o n a l women d u r i n g t h e n e u t r a l - e r o t i c ( N - E ) a n d a n x i e t y -e r o t i c ( A - E ) c o n d i t i o n s . S t a t i s t i c a l a n a l y s i s a n d v i s u a l i n s p e c t i o n o f F i g u r e 3 r e v e a l t h a t c o n t r a r y t o e x p e c t a t i o n , b o t h t h e f u n c t i o n a l a n d d y s f u n c t i o n a l g r o u p s r e p o r t e d s i g n i f i c a n t l y g r e a t e r l e v e l s o f s e x u a l a r o u s a l d u r i n g t h e n e u t r a l - e r o t i c a s c o m p a r e d t o t h e a n x i e t y - e r o t i c c o n d i t i o n s , F ( l , 1 4 ) = 4 . 9 3 , £ = 0 . 0 4 3 4 . A l s o c o n t r a r y t o t h e h y p o t h e s e s , no s i g n i f i c a n t d i f f e r e n c e s w e r e f o u n d b e t w e e n t h e f u n c t i o n a l a n d d y s f u n c t i o n a l g r o u p s ' s u b j e c t i v e r a t i n g s o f s e x u a l a r o u s a l i n t h e a n x i e t y - e r o t i c o r n e u t r a l - e r o t i c c o n d i t i o n s , F ( l , 1 4 ) = 1 . 5 6 , £ = 0 . 2 3 1 5 . E x a m i n a t i o n o f F i g u r e 3 h o w e v e r , r e v e a l s t h a t t h e d y s f u n c t i o n a l g r o u p r a t e d t h e m s e l v e s a s m o r e s e x u a l l y a r o u s e d t h a n t h e f u n c t i o n a l g r o u p d u r i n g b o t h t h e n e u t r a l - e r o t i c a n d a n x i e t y - e r o t i c c o n d i t i o n s . None o f t h e s e l f - r e p o r t i t e m s d e s i g n e d t o a s s e s s p e r c e p t i o n s o f s e x u a l a r o u s a l (1 i t e m ) a n d p h y s i c a l s e x u a l c h a n g e (4 i t e m s ) w e r e d i f f e r e n t i a l l y e f f e c t i v e i n r e v e a l i n g s u b j e c t i v e l y e x p e r i e n c e d s e x u a l a r o u s a l , F ( 4 , 5 6 ) = 0 . 7 9 , £ = 0 . 5 3 4 0 . R e s u l t s f r o m t h e s u b j e c t i v e d a t a do n o t p a r a l l e l t h e p h y s i o l o g i c a l f i n d i n g s . A n a l y s i s o f t h e VBV d a t a r e v e a l e d t h a t T a b l e 5 A n a l y s i s o f V a r i a n c e f o r S u b j e c t i v e R a t i n g s o f S e x u a l A r o u s a l d u r i n g E x p e r i m e n t a l S t i m u l i S o u r c e o f v a r i a t i o n d f S S M S F a B e t w e e n s u b j e c t s G r o u p 1 5 0 . 6 2 5 0 5 0 . 6 2 5 0 1 . 5 6 0 . 2 3 1 5 E r r o r 1 4 4 5 2 . 9 5 0 0 3 2 . 3 5 3 6 W i t h i n s u b j e c t s S t i m u l u s 1 1 5 . 6 2 5 0 1 5 . 6 2 5 0 4 . 9 3 0 . 0 4 3 4 * G r o u p x S t i m u l u s 1 0 . 0 2 5 0 0 . 0 2 5 0 0 . 0 1 0 . 9 3 0 5 E r r o r 1 4 4 4 . 3 5 0 0 3 . 1 6 7 9 I t e m 4 2 . 5 6 2 5 0 . 6 4 0 6 0 . 7 9 0 . 5 3 4 0 G r o u p x I t e m 4 4 . 0 6 2 5 1 . 0 1 5 6 1 . 2 6 0 . 2 9 7 0 E r r o r 5 6 4 5 . 1 7 5 0 . 8 0 6 7 S t i m u l u s x I t e m 4 1 . 5 6 2 5 0 . 3 9 0 6 1 . 0 9 0 . 3 6 9 3 G r o u p x S t i m u l u s x I t e m 4 1 . 4 1 2 5 0 . 3 5 3 1 0 . 9 9 0 . 4 2 1 9 E r r o r 5 6 2 0 . 0 2 5 0 0 . 3 5 7 6 * _ p _ < . 0 5 Dysfunctional Functional Figure 3. Mean subjective ratings of sexual arousal for sexually dysfunctional and functional women during the neutral-erotic (N-E) and anxiety-erotic (A-E) conditions. 42 a n x i e t y s t i m u l i e l i c i t e d s i g n i f i c a n t l y g r e a t e r g e n i t a l a r o u s a l than n e u t r a l s t i m u l i f o r both groups, with the f u n c t i o n a l group e x h i b i t i n g s i g n i f i c a n t l y g r e a t e r l e v e l s of sexual a r o u s a l than the d y s f u n c t i o n a l group i n each c o n d i t i o n . Conversely, f i n d i n g s from the s u b j e c t i v e data re v e a l e d that both groups rated the n e u t r a l -e r o t i c c o n d i t i o n as s i g n i f i c a n t l y more s e x u a l l y a r o u s i n g , with the d y s f u n c t i o n a l group r e p o r t i n g n o n - s i g n i f i c a n t l y g r e a t e r l e v e l s of sexual a r o u s a l than the f u n c t i o n a l group i n each c o n d i t i o n . No s i g n i f i c a n t d i f f e r e n c e s were found between groups on the s u b j e c t i v e measure. R e l a t i o n s h i p Between P h y s i o l o g i c a l and S u b j e c t i v e Sexual A r o u s a l In order to i n v e s t i g a t e the degree of a s s o c i a t i o n between VBV and s u b j e c t i v e r a t i n g s of sexual a r o u s a l , Pearson product-moment c o r r e l a t i o n c o e f f i c i e n t s were c a l c u l a t e d s e p a r a t e l y f o r s e x u a l l y f u n c t i o n a l and d y s f u n c t i o n a l women i n the n e u t r a l - e r o t i c and a n x i e t y - e r o t i c c o n d i t i o n s . For each c o n d i t i o n , the l a r g e s t VBV abso l u t e d e v i a t i o n from b a s e l i n e averaged across 20 seconds, was c o r r e l a t e d with s u b j e c t i v e r a t i n g s of sexual a r o u s a l (1 item), p h y s i c a l sexual change (5 ite m s ) , general p h y s i c a l change (5 items), and f e e l i n g s of a n x i e t y (1 item). R e s u l t s presented i n Table 6 r e v e a l that no s i g n i f i c a n t c o r r e l a t i o n s between VBV and s e l f - r a t i n g s of sexual a r o u s a l were found f o r f u n c t i o n a l or d y s f u n c t i o n a l women f o l l o w i n g e i t h e r n e u t r a l or a n x i e t y preexposure. Since both f u n c t i o n a l and d y s f u n c t i o n a l women achieved enhanced g e n i t a l responses f o l l o w i n g the a n x i e t y - e r o t i c c o n d i t i o n , but repor t e d g r e a t e r p e r c e p t i o n s of a r o u s a l f o l l o w i n g 43 T a b l e 6 P e a r s o n P r o d u c t - M o m e n t C o r r e l a t i o n s B e t w e e n P h y s i o l o g i c a l ( V B V )  a n d S u b j e c t i v e R a t i n g s o f S e x u a l A r o u s a l D u r i n g E x p e r i m e n t a l S t i m u l i Dysfunctional Functional r r Item N - E A - E N - E A - E S e x u a l l y A r o u s e d 0 . 4 4 0 - 0 . 0 1 7 0 . 0 7 0 0 . 0 8 8 B r e a s t S e n s a t i o n s 0 . 3 6 0 0 . 5 7 0 0 . 1 9 8 0 . 0 1 5 W a r m t h i n G e n i t a l s 0 . 3 1 0 - 0 . 0 7 1 - 0 . 0 4 1 - 0 . 3 7 0 G e n i t a l W e t n e s s o r L u b r i c a t i o n 0 . 3 1 9 - 0 . 0 6 2 0 . 2 1 3 0 . 0 7 G e n i t a l P u l s i n g o r T h r o b b i n g 0 . 2 7 3 - 0 . 0 1 5 0 . 2 4 8 0 . 0 8 1 A n y G e n i t a l F e e l i n g s 0 . 3 7 0 - 0 . 0 8 2 0 . 2 4 9 - . 0 1 0 7 F a s t e r B r e a t h i n g - 0 . 1 7 4 - 0 . 1 9 4 0 . 2 2 8 - 0 . 2 2 0 F a s t e r H e a r t R a t e 0 . 3 4 8 - 0 . 2 6 2 - 0 . 1 5 7 - 0 . 4 0 9 P e r s p i r a t i o n - 0 . 3 9 0 - 0 . 5 0 6 0 . 2 0 9 - 0 . 3 3 6 F e e l i n g s o f W a r m t h 0 . 0 9 5 - 0 . 3 4 0 - 0 . 1 2 3 - 0 . 4 1 9 A n y P h y s i c a l R e a c t i o n a t A l l 0 . 5 4 6 - 0 . 0 5 6 0 . 0 4 1 - 0 . 0 5 2 A n x i o u s - 0 . 0 5 4 0 . 2 3 2 0 . 5 0 9 - 0 . 0 3 1 44 t h e n e u t r a l c o n d i t i o n , VBV a n d s u b j e c t i v e r e p o r t s w e r e n o n -s i g n i f i c a n t l y i n v e r s e l y r e l a t e d . Mean c o r r e l a t i o n s c a l c u l a t e d b e t w e e n g r o u p s a n d s t i m u l i r e v e a l t h i s d i s c o r d a n c e t o be m o r e e x t r e m e i n t h e a n x i e t y - e r o t i c (r_ = - 0 . 0 7 1 ) v e r s u s n e u t r a l - e r o t i c (r_ = 0 . 1 7 0 ) c o n d i t i o n f o r b o t h g r o u p s , a n d f o r f u n c t i o n a l women (£ = - 0 . 0 0 2 ) a s c o m p a r e d t o d y s f u n c t i o n a l women (£ = 0 . 0 6 8 ) . Mean c o r r e l a t i o n s b e t w e e n s u b j e c t i v e a n d p h y s i o l o g i c a l m e a s u r e s o f s e x u a l a r o u s a l w e r e t h e r e f o r e m o r e i n v e r s e l y r e l a t e d f o r f u n c t i o n a l (r_ = - 0 . 1 4 0 ) a s c o m p a r e d t o d y s f u n c t i o n a l (r_ = - 0 . 0 6 7 ) women i n t h e a n x i e t y - e r o t i c c o n d i t i o n . S i m i l a r l y , s u b j e c t i v e r a t i n g s o f a n x i e t y ( " a n x i o u s " ) i n t h e a n x i e t y - e r o t i c c o n d i t i o n w e r e n o n - s i g n i f i c a n t l y n e g a t i v e l y c o r r e l a t e d w i t h a r o u s a l f o r t h e f u n c t i o n a l (£ = - 0 . 0 3 1 ) b u t n o n - s i g n i f i c a n t l y p o s i t i v e l y c o r r e l a t e d w i t h a r o u s a l f o r d y s f u n c t i o n a l (r_ = 0 . 2 3 2 ) women. T h e d y s f u n c t i o n a l women w e r e t h e r e f o r e m o r e l i k e l y t h a n f u n c t i o n a l women t o r e p o r t s e x u a l a r o u s a l e v e n t h o u g h t h e y f e l t a n x i o u s . I n s u m m a r y , s t a t i s t i c a l a n a l y s e s a n d v i s u a l i n s p e c t i o n o f t h e d a t a show t h a t a n x i e t y e l i c i t i n g s t i m u l i c a u s e d a h i g h l y s i g n i f i c a n t e n h a n c e m e n t i n t h e r a t e a n d m a g n i t u d e o f g e n i t a l a r o u s a l a c r o s s a l l s u b j e c t s . D e s p i t e t h e s t r e n g t h o f t h e p h y s i o l o g i c a l f i n d i n g s h o w e v e r , f u n c t i o n a l a n d d y s f u n c t i o n a l women r e p o r t e d t h e n e u t r a l c o n d i t i o n a s s i g n i f i c a n t l y m o r e s e x u a l l y a r o u s i n g . N o n - s i g n i f i c a n t c o r r e l a t i o n s b e t w e e n VBV a n d r e p o r t e d s e x u a l a r o u s a l , p h y s i c a l s e x u a l c h a n g e , a n d g e n e r a l p h y s i c a l c h a n g e , r e v e a l e d a t r e n d f o r b o t h f u n c t i o n a l a n d d y s f u n c t i o n a l women t o e x p e r i e n c e e n h a n c e d g e n i t a l a r o u s a l a c c o m p a n i e d b y an i n h i b i t e d a c k n o w l e d g m e n t o r l i k e l i h o o d o f r e p o r t i n g t h e i r s e x u a l f e e l i n g s . 45 D i s c u s s i o n The r e s u l t s of the present study p r o v i d e a t h e o r e t i c a l framework f o r c o n c e p t u a l i z i n g female sexual a r o u s a l , and strong c l i n i c a l i m p l i c a t i o n s f o r the treatment of sexual d y s f u n c t i o n i n women. C o n s i s t e n t with the hypotheses, a comparison of the e f f e c t s of an x i e t y on subsequent sexual a r o u s a l between s e x u a l l y f u n c t i o n a l and d y s f u n c t i o n a l women re v e a l e d that the f u n c t i o n a l group demonstrated g r e a t e r p h y s i o l o g i c a l a r o u s a l than the d y s f u n c t i o n a l group i n the n e u t r a l - e r o t i c c o n d i t i o n (hypothesis 1) , and the a n x i e t y - e r o t i c c o n d i t i o n (hypothesis 2). Also c o n s i s t e n t with the hypotheses, the f u n c t i o n a l group demonstrated gr e a t e r p h y s i o l o g i c a l sexual a r o u s a l i n the a n x i e t y - e r o t i c as compared to the n e u t r a l - e r o t i c c o n d i t i o n (hypothesis 3 ) . T h i s f i n d i n g r e p l i c a t e s the r e s u l t s of Hoon et a l . (1977) with s e x u a l l y f u n c t i o n a l women and i s c o n s i s t e n t with the l i t e r a t u r e (Barlow et a l . , 1983; Dutton & Aron, 1974; Heiman & Rowland, 1983; Lange et a l . , 1981; Wolchik et a l . , 1980) r e p o r t i n g that a n x i e t y e l i c i t s enhanced sexual a r o u s a l i n f u n c t i o n a l men and women. Contrary to ex p e c t a t i o n however, the d y s f u n c t i o n a l group a l s o demonstrated gr e a t e r p h y s i o l o g i c a l sexual a r o u s a l i n the a n x i e t y - e r o t i c as compared to the n e u t r a l - e r o t i c c o n d i t i o n (hypothesis 4 ) . To summarize, whereas the f u n c t i o n a l s u b j e c t s a t t a i n e d higher g e n i t a l responses than the d y s f u n c t i o n a l s u b j e c t s during both the n e u t r a l -and a n x i e t y - e r o t i c c o n d i t i o n s , the a n x i e t y c o n d i t i o n e l i c i t e d a s i g n i f i c a n t enhancement of g e n i t a l sexual a r o u s a l f o r the d y s f u n c t i o n a l as well as the f u n c t i o n a l groups. T h i s f i n d i n g i s c o n t r a r y to the Barlow et a l . and Heiman & Rowland f i n d i n g s with 46 men that a n x i e t y e l i c i t e d an i n c r e a s e i n g e n i t a l sexual a r o u s a l i n f u n c t i o n a l men, and a decrease (below the n e u t r a l or non-demand co n d i t i o n ) i n d y s f u n c t i o n a l men. To date, no other i n v e s t i g a t i o n has examined the i n f l u e n c e of a n x i e t y on sexual response i n d y s f u n c t i o n a l women. The present f i n d i n g s suggest that women's p h y s i o l o g i c a l sexual a r o u s a l may be f a c i l i t a t e d by exposure to an a n x i e t y - e l i c i t i n g s t i m u l u s . These e f f e c t s i n c l u d e a more r a p i d a c q u i s i t i o n as we l l as g r e a t e r magnitude of g e n i t a l a r o u s a l (VBV) in the a n x i e t y as compared to the n e u t r a l c o n d i t i o n f o r both f u n c t i o n a l and d y s f u n c t i o n a l women. More i m p o r t a n t l y , these e f f e c t s occurred i n both groups i r r e s p e c t i v e of c o n t r a d i c t o r y s u b j e c t i v e p e r c e p t i o n s . Examination of the s u b j e c t i v e measures r e v e a l e d that c o n t r a r y to the hypotheses, no s i g n i f i c a n t d i f f e r e n c e s were found between the f u n c t i o n a l and d y s f u n c t i o n a l groups. A trend i n the data may be observed however, where c o n t r a r y to e x p e c t a t i o n , the d y s f u n c t i o n a l group reported g r e a t e r s u b j e c t i v e a r o u s a l than the f u n c t i o n a l group i n the n e u t r a l - e r o t i c (hypothesis 1 ) , and the a n x i e t y - e r o t i c (hypothesis 2) c o n d i t i o n s . R e c a l l that the comparison between f u n c t i o n a l and d y s f u n c t i o n a l women's s u b j e c t i v e and p h y s i o l o g i c a l measures of a r o u s a l i n the n e u t r a l - e r o t i c c o n d i t i o n (hypothesis 1) was designed to i n v e s t i g a t e the Wincze et a l . (1976) and Morokoff and Heiman (1980) c o n t r a d i c t o r y f i n d i n g s . A d i f f e r e n c e i n p h y s i o l o g i c a l a r o u s a l between groups was r e v e a l e d . The present r e s u l t s t h e r e f o r e support the Wincze et a l . f i n d i n g that f u n c t i o n a l and d y s f u n c t i o n a l women e x h i b i t d i f f e r e n t p h y s i o l o g i c a l but equal s u b j e c t i v e sexual a r o u s a l 47 r e s p o n s e s t o e r o t i c c u e s . T h e s e r e s u l t s c o n t r a d i c t t h e M o r o k o f f a n d H e i m a n f i n d i n g s o f e q u a l p h y s i o l o g i c a l b u t d i f f e r e n t s u b j e c t i v e s e x u a l a r o u s a l r e s p o n s e s . I t was h y p o t h e s i z e d h o w e v e r , t h a t s i m i l a r t o t h e H e i m a n a n d R o w l a n d (1983) f i n d i n g s w i t h m a l e s , f u n c t i o n a l a n d d y s f u n c t i o n a l f e m a l e s w o u l d d e m o n s t r a t e d i f f e r e n t i a l s u b j e c t i v e a s w e l l a s p h y s i o l o g i c a l s e x u a l a r o u s a l t o e r o t i c s t i m u l i . No o t h e r i n v e s t i g a t i o n h a s c o m p a r e d g r o u p d i f f e r e n c e s i n f u n c t i o n a l a n d d y s f u n c t i o n a l w o m e n ' s s u b j e c t i v e a r o u s a l t o a n x i e t y - e l i c i t i n g s t i m u l i ( h y p o t h e s i s 2 ) . T h e p r e s e n t f i n d i n g s r e v e a l no s i g n i f i c a n t d i f f e r e n c e s b e t w e e n f u n c t i o n a l a n d d y s f u n c t i o n a l w o m e n ' s p e r c e p t i o n s o f s e x u a l r e s p o n s e f o l l o w i n g a n x i e t y a r o u s a l . T h e l a c k o f s i g n i f i c a n t b e t w e e n - g r o u p d i f f e r e n c e s i n s u b j e c t i v e d a t a p a r a l l e l i n g t h e p h y s i o l o g i c a l d a t a may b e e x p l a i n e d b y t h e w i t h i n - g r o u p ( s t i m u l u s c o n d i t i o n ) f i n d i n g s ( h y p o t h e s e s 3 a n d 4 ) . S i g n i f i c a n t d i f f e r e n c e s i n s u b j e c t i v e s e x u a l a r o u s a l w e r e f o u n d b e t w e e n t h e n e u t r a l - e r o t i c a n d a n x i e t y -e r o t i c c o n d i t i o n s . C o n s i s t e n t w i t h t h e h y p o t h e s i s , t h e d y s f u n c t i o n a l women r e p o r t e d g r e a t e r a r o u s a l d u r i n g t h e n e u t r a l -e r o t i c a s c o m p a r e d t o t h e a n x i e t y - e r o t i c c o n d i t i o n ( h y p o t h e s i s 4 ) . C o n t r a r y t o e x p e c t a t i o n h o w e v e r , t h e f u n c t i o n a l women a l s o r e p o r t e d g r e a t e r a r o u s a l d u r i n g t h e n e u t r a l - e r o t i c f i l m p a i r ( h y p o t h e s i s 3 ) . O b s e r v a t i o n o f t h e g r a p h e d mean d i f f e r e n c e s b e t w e e n f u n c t i o n a l a n d d y s f u n c t i o n a l men i n t h e H e i m a n a n d R o w l a n d (1983) s t u d y r e v e a l s i m i l a r r e s u l t s . S e l f - r e p o r t e d s e x u a l a r o u s a l t o e r o t i c s t i m u l i f o l l o w i n g n o n - d e m a n d ( n e u t r a l ) o r p e r f o r m a n c e demand ( a n x i e t y ) c o n d i t i o n s r e v e a l t h a t t h e n o n - d e m a n d c o n d i t i o n 48 e l i c i t e d g r e a t e r s e l f - r e p o r t s o f a r o u s a l i n t h e f u n c t i o n a l a s w e l l a s t h e d y s f u n c t i o n a l g r o u p . F i n d i n g s f r o m b o t h t h e H e i m a n a n d R o w l a n d s t u d y w i t h men a n d t h e p r e s e n t s t u d y w i t h women s u g g e s t t h a t f u n c t i o n a l a n d d y s f u n c t i o n a l s u b j e c t s r e p o r t h i g h e r l e v e l s o f s e x u a l a r o u s a l i n t h e n e u t r a l a s o p p o s e d t o t h e a n x i e t y c o n d i t i o n . I n t h e p r e s e n t s t u d y , t h i s e f f e c t o c c u r r e d a c r o s s a l l s u b j e c t s d e s p i t e c o n t r a d i c t o r y p h y s i o l o g i c a l d a t a i n d i c a t i n g e n h a n c e d g e n i t a l a r o u s a l f o l l o w i n g a n x i e t y - e l i c i t i n g s t i m u l i . C o m p a r i s o n o f F i g u r e s 1 a n d 3 r e v e a l s t h a t g e n i t a l a n d s u b j e c t i v e d a t a a r e i n v e r s e l y r e l a t e d : T h e m o r e g e n i t a l a r o u s a l was e n h a n c e d b y a n x i e t y , t h e m o r e s u b j e c t i v e a c k n o w l e d g m e n t o f s e x u a l a r o u s a l was i n h i b i t e d . S e v e r a l e x p l a n a t i o n s may a c c o u n t f o r t h e f i n d i n g t h a t a n x i e t y s i g n i f i c a n t l y i n c r e a s e d p h y s i o l o g i c a l , a n d d e c r e a s e d s u b j e c t i v e s e x u a l a r o u s a l i n women. F i r s t , s o c i a l c o n d i t i o n i n g o f a c c e p t a b l e s e x u a l a r o u s a l - e l i c i t i n g s t i m u l i may c o m p o u n d s u b j e c t demand i n l a b o r a t o r y a n a l o g u e i n v e s t i g a t i o n s o f s e x u a l a r o u s a l . F o r e x a m p l e , a l t h o u g h women may b e l i e v e i t a c c e p t a b l e t o r e p o r t g e n i t a l s e n s a t i o n s f o l l o w i n g f i l m p a i r i n g s o f p e n g u i n s i n A n t a r c t i c a ( n e u t r a l ) a n d e r o t i c s t i m u l i , i t may be v i e w e d a s i n a p p r o p r i a t e o r a b n o r m a l t o p e r c e i v e e n h a n c e d g e n i t a l a r o u s a l f o l l o w i n g a t h r e a t e n e d a m p u t a t i o n a n d e r o t i c f i l m p a i r i n g . I n a d d i t i o n , t h e p r e v a l e n t a s s u m p t i o n t h a t a n x i e t y i n h i b i t s s e x u a l a r o u s a l may p r e d i s p o s e women n o t t o a t t e n d t o g e n i t a l s e n s a t i o n s i n a n x i e t y - e l i c i t i n g c o n t e x t s . T h i s may b e p a r t i c u l a r l y t r u e o f s e x u a l l y d y s f u n c t i o n a l s u b j e c t s who h a v e a l o n g h i s t o r y o f n o n r e w a r d i n g s e x u a l i n t e r a c t i o n s . A s p r e v i o u s l y d i s c u s s e d , t h e 49 H e i m a n a n d R o w l a n d (1983) s t u d y w i t h men e m p l o y i n g a p e r f o r m a n c e demand i n s t r u c t i o n a l s e t , r e v e a l e d t h e same p a t t e r n o f r e p o r t e d h e i g h t e n e d s u b j e c t i v e a r o u s a l f o l l o w i n g n e u t r a l ( n o n - d e m a n d ) s t i m u l i . A p a r t i a l e x p l a n a t i o n f o r t h e l a c k o f d i f f e r e n t i a l s u b j e c t i v e r a t i n g s o f a r o u s a l b e t w e e n g r o u p s i n t h e W i n c z e e t a l . (1976) a n d t h e p r e s e n t s t u d y v e r s u s t h e M o r o k o f f a n d H e i m a n (1980) s t u d y , may t h e r e f o r e r e f l e c t d i f f e r e n c e s i n t h e l e v e l o f s u b j e c t d e m a n d , i . e . , t h e a n x i e t y a n d a r o u s a l - e l i c i t i n g n a t u r e o f t h e e x p e r i m e n t a l s t i m u l i . W i n c z e e t a l . (1976) c o n c l u d e d t h a t h i s f i n d i n g o f d i f f e r e n t p h y s i o l o g i c a l b u t e q u a l s u b j e c t i v e r e s p o n s e s b e t w e e n f u n c t i o n a l a n d d y s f u n c t i o n a l women was a r e f l e c t i o n o f s u b j e c t d e m a n d ; f u n c t i o n a l women r e p o r t e d m o r e c o n s e r v a t i v e e s t i m a t e s o f a r o u s a l w h i l e d y s f u n c t i o n a l women, a t t e m p t i n g t o a p p e a r f u n c t i o n a l , r e p o r t e d a r t i f i c i a l l y h i g h e s t i m a t e s . T h e r e s u l t was t o e q u a t e t h e g r o u p s on t h e s u b j e c t i v e m e a s u r e . D y s f u n c t i o n a l women i n t h e p r e s e n t s t u d y r e p o r t e d s l i g h t l y m o r e c o n c o r d a n t d a t a t h a n f u n c t i o n a l women h o w e v e r , s u g g e s t i n g t h a t t h e s e f i n d i n g s may n o t o n l y r e f l e c t e x p e r i m e n t a l demand c h a r a c t e r i s t i c s . Many women, i n c l u d i n g s e x u a l l y f u n c t i o n a l women, may n o t a t t e n d t o , a c k n o w l e d g e , o r v e r b a l i z e h e i g h t e n e d s e x u a l a r o u s a l . T h i s d i f f i c u l t y may t h e r e f o r e r e f l e c t m o r e o f a s o c i a l t h a n s u b j e c t d e m a n d . S e c o n d , t h e f i n d i n g t h a t d y s f u n c t i o n a l women e x h i b i t e n h a n c e d p h y s i o l o g i c a l a r o u s a l f o l l o w i n g a n x i e t y - e l i c i t i n g s t i m u l i may be r e f l e c t e d i n t h e i r s u b j e c t i v e r a t i n g s . Women w i t h l o w s e x u a l d e s i r e f o r e x a m p l e , r e p o r t e d g r e a t e r s u b j e c t i v e r a t i n g s o f a r o u s a l 50 t h a n f u n c t i o n a l s u b j e c t s f o l l o w i n g t h e a n x i e t y - e r o t i c c o n d i t i o n . R e l a t i v e t o t h e f u n c t i o n a l g r o u p , l o w d e s i r e women, p e r h a p s l e s s a c c u s t o m e d t o g e n i t a l s e n s a t i o n s , may a m p l i f y r a t i n g s o f a r o u s a l f o l l o w i n g t h e e n h a n c e d p h y s i o l o g i c a l e f f e c t s o f t h e a n x i e t y s t i m u l i . S i n c e t h e y a r e s e e k i n g t r e a t m e n t f o r s e x u a l d i f f i c u l t i e s , s o c i a l d e m a n d s may be t e m p o r a r i l y r e v e r s e d f o r t h e s e women; t h e y may be m o r e m o t i v a t e d t o a t t e n d t o a n d i n v e s t i g a t e g e n i t a l c u e s . To s u m m a r i z e , f o r t h e f u n c t i o n a l women, g r e a t e r a n x i e t y -e l i c i t i n g s t i m u l i may c r e a t e g r e a t e r s u b j e c t demand a n d l o w e r s u b j e c t i v e r a t i n g s o f s e x u a l a r o u s a l . F o r t h e d y s f u n c t i o n a l women, e n h a n c e d p h y s i o l o g i c a l a r o u s a l may e l i c i t h e i g h t e n e d a w a r e n e s s o f g e n i t a l s e n s a t i o n s a n d g r e a t e r s u b j e c t i v e r a t i n g s o f a r o u s a l r e l a t i v e t o f u n c t i o n a l s u b j e c t s . T h e e f f e c t w o u l d be t o e q u a t e b e t w e e n - g r o u p d i f f e r e n c e s i n t h e a n x i e t y c o n d i t i o n ( h y p o t h e s i s 2 ) . C o n s i s t e n t w i t h t h e h y p o t h e s i s , d y s f u n c t i o n a l s u b j e c t s a l s o r e p o r t e d g r e a t e r a r o u s a l i n t h e n e u t r a l a s c o m p a r e d w i t h t h e a n x i e t y c o n d i t i o n . I t was s u g g e s t e d t h a t t h i s e f f e c t may b e d u e t o c o n d i t i o n e d m i s a t t r i b u t i o n o f a r o u s a l a s a n x i e t y . I n a d d i t i o n , t h e d y s f u n c t i o n a l s u b j e c t s may a l s o p e r c e i v e g e n i t a l c h a n g e s a s m o r e e x t r e m e r e l a t i v e t o f u n c t i o n a l women i n t h e n e u t r a l c o n d i t i o n . T h e r e s u l t w o u l d be i n c r e a s e d r a t i n g o f a r o u s a l i n t h e n e u t r a l c o n d i t i o n f o r t h e d y s f u n c t i o n a l g r o u p r e l a t i v e t o t h e f u n c t i o n a l g r o u p . T h e e f f e c t w o u l d be t o e q u a t e b e t w e e n - g r o u p d i f f e r e n c e s i n t h e n e u t r a l c o n d i t i o n ( h y p o t h e s i s 1 ) . A c c o r d i n g l y , l o w d e s i r e d y s f u n c t i o n a l women r e s p o n d e d t o g e n i t a l s e n s a t i o n s i n t h e n e u t r a l a n d a n x i e t y c o n d i t i o n s w i t h h i g h e r 51 s u b j e c t i v e r a t i n g s t h a n f u n c t i o n a l women. T h e e f f e c t o f t h e d y s f u n c t i o n a l w o m e n ' s i n c r e a s e d n e u t r a l r a t i n g s , a n d t h e f u n c t i o n a l w o m e n ' s d e c r e a s e d a n x i e t y r a t i n g s , w o u l d be s i g n i f i c a n t l y g r e a t e r r a t i n g s o f a r o u s a l i n t h e n e u t r a l c o n d i t i o n a c r o s s a l l s u b j e c t s ( h y p o t h e s e s 3 a n d 4 ) . T h i s i n t e r p r e t a t i o n o f t h e p r e s e n t f i n d i n g s w o u l d a c c o u n t f o r t h e s i m i l a r i t y o f s u b j e c t i v e r e s p o n s e s b e t w e e n g r o u p s ( h y p o t h e s e s 1 a n d 2) a n d t h e s i g n i f i c a n t l y g r e a t e r r a t i n g s o f s u b j e c t i v e a r o u s a l w i t h i n g r o u p s t o t h e n e u t r a l s t i m u l i ( h y p o t h e s e s 3 a n d 4 ) . T h e p r e s e n t s t u d y r e v e a l e d no s i g n i f i c a n t c o r r e l a t i o n s b e t w e e n s u b j e c t i v e a n d p h y s i o l o g i c a l m e a s u r e s o f s e x u a l a r o u s a l f o r f u n c t i o n a l o r d y s f u n c t i o n a l women. S i n c e s u b j e c t s d e m o n s t r a t e d s i g n i f i c a n t l y i n c r e a s e d g e n i t a l a r o u s a l b u t r e p o r t e d d e c r e a s e d s u b j e c t i v e a r o u s a l i n t h e a n x i e t y c o n d i t i o n a s c o m p a r e d t o t h e n e u t r a l c o n d i t i o n , VBV a n d s u b j e c t i v e r a t i n g s w e r e n e g a t i v e l y c o r r e l a t e d ( a l b e i t n o n - s i g n i f i c a n t l y ) f o r f u n c t i o n a l women i n t h e n e u t r a l - a n d a n x i e t y - e r o t i c , a n d d y s f u n c t i o n a l women i n t h e a n x i e t y - e r o t i c c o n d i t i o n s . I n o t h e r w o r d s , some f u n c t i o n a l s u b j e c t s i n t h e a n x i e t y - e r o t i c c o n d i t i o n w i t h h i g h e r g e n i t a l r e s p o n s e s r e p o r t e d l o w e r s u b j e c t i v e a r o u s a l , w h i l e some d y s f u n c t i o n a l s u b j e c t s i n t h e n e u t r a l - e r o t i c c o n d i t i o n w i t h l o w e r g e n i t a l r e s p o n s e s r e p o r t e d h i g h e r s u b j e c t i v e a r o u ' s a l . T h i s f i n d i n g i s c o n s i s t e n t w i t h t h e a b o v e i n t e r p r e t a t i o n a c c o u n t i n g f o r s u b j e c t i v e a n d p h y s i o l o g i c a l d i s c o r d a n c e . I t a l s o s u p p o r t s t h e i n t e r p r e t a t i o n t h a t s o c i a l d i s c o r d a n c e b e t w e e n p e r c e p t i o n s o f f e m i n i n i t y a n d s e x u a l a r o u s a l may be r e f l e c t e d i n d i s c o r d a n t s u b j e c t i v e a n d p h y s i o l o g i c a l r e p o r t s . 52 These r e s u l t s are c o n s i s t e n t with the H a l l , B i n i k , and Di Tomasso (1985) r e p o r t that c o r r e l a t i o n s computed between the p h y s i o l o g i c a l and s u b j e c t i v e a r o u s a l of f u n c t i o n a l men exposed to audiotaped e r o t i c s t i m u l i demonstrated c o n s i d e r a b l e v a r i a b i l i t y . S i m i l a r l y , Morokoff and Heiman (1980) reported no s i g n i f i c a n t c o r r e l a t i o n between VPA and s u b j e c t i v e a r o u s a l i n response to e r o t i c s t i m u l i f o r f u n c t i o n a l women pretreatment, and s i g n i f i c a n t negative c o r r e l a t i o n s f o r d y s f u n c t i o n a l women pre- and posttreatment. The r e s u l t s from the H a l l et a l . study with men, and the Morokoff and Heiman and present study with women suggest that p h y s i o l o g i c a l and s u b j e c t i v e dimensions of sexual a r o u s a l may be d i s c r e p a n t due to desynchrony of the sexual response system. Hodgson and Rachman (1974) reported that emotional responses such as f e a r are comprised of s u b j e c t i v e , b e h a v i o r a l , and p h y s i o l o g i c a l response systems that become d i s c o r d a n t at d i f f e r e n t r a t e s . S i m i l a r l y , s u b j e c t i v e and p h y s i o l o g i c a l measures of sexual a r o u s a l may r e f l e c t the i n t e r r e l a t e d but d i f f e r e n t i a l r a t e of systemic responses to e r o t i c cues. The importance of the present f i n d i n g s i s the evidence i t provid e s f o r an a l t e r n a t i v e c o n c e p t u a l i z a t i o n of sexual a r o u s a l and i m p l i c a t i o n s f o r treatment f o r s e x u a l l y d y s f u n c t i o n a l women. Current models of sexual d y s f u n c t i o n (Barlow 1986; Heiman & Rowland, 1983; Rosen & Beck, 1988) s t a t e that the p e r c e p t i o n of p h y s i o l o g i c a l a r o u s a l may serve as a cue f o r s u b j e c t i v e a r o u s a l i n sexual s i t u a t i o n s , and s u b j e c t i v e p e r c e p t i o n s may r e c i p r o c a l l y e f f e c t p h y s i o l o g i c a l response. The degree of concordance between p h y s i o l o g i c a l and s u b j e c t i v e response systems i s t h e r e f o r e 53 e x p e c t e d t o be r e l a t i v e l y h i g h . B a r l o w ' s (1986) m o d e l p r o p o s e s t h a t a n x i e t y i n t e r f e r e s w i t h s e x u a l a r o u s a l i n d y s f u n c t i o n a l s u b j e c t s d u e t o c o g n i t i v e d i s t r a c t i o n o r a t t e n t i o n a l f o c u s away f r o m s e x u a l s t i m u l i . T h i s f o c u s a l l o w s t h e a u t o n o m i c a s p e c t s o f a r o u s a l ( a n x i e t y ) t o r e s u l t i n f u r t h e r d e c r e a s e s i n p h y s i o l o g i c a l a r o u s a l a n d s e x u a l p e r f o r m a n c e . S e x u a l l y f u n c t i o n a l s u b j e c t s h o w e v e r , a r e p r o p o s e d t o a t t e n d t o a n d p r o c e s s e r o t i c c u e s e f f e c t i v e l y s u c h t h a t a n x i e t y e n h a n c e s c o g n i t i v e p r o c e s s i n g a n d f a c i l i t a t e s f u r t h e r p h y s i o l o g i c a l s e x u a l a r o u s a l . T h e s e t h e o r i e s s u g g e s t t h a t d i s t r a c t i n g c o g n i t i o n s , m i s d i r e c t e d a t t e n t i o n a l f o c u s , a n d s u b j e c t i v e a t t r i b u t i o n s may e n h a n c e a n x i e t y w h i c h s e r v e s t o i n h i b i t p h y s i o l o g i c a l a r o u s a l i n d y s f u n c t i o n a l s u b j e c t s . A n x i e t y i s p r o p o s e d t o f a c i l i t a t e s e x u a l a r o u s a l i n f u n c t i o n a l s u b j e c t s , b u t i n h i b i t s e x u a l a r o u s a l i n s e x u a l l y d y s f u n c t i o n a l s u b j e c t s . H e i m a n & R o w l a n d (1983) s t a t e t h a t t h e u l t i m a t e e r o t i c v a l u e o f a g i v e n s i t u a t i o n i s d e t e r m i n e d b y t h e p r o c e s s i n g o f t h e m e s s a g e s w i t h i n t h e s e x u a l c o n t e x t . T h e y c o n c l u d e t h a t a n x i e t y i s d e t r i m e n t a l s i n c e " t h e s i t u a t i o n w i l l f e e l l i k e o n e i n w h i c h s e x u a l a r o u s a l w i l l be i n h i b i t e d " ( p . 1 1 4 ) . S i n c e s u b j e c t i v e p e r c e p t i o n s o f a r o u s a l may a f f e c t p h y s i o l o g i c a l r e s p o n s e , a n i n d i v i d u a l ' s s e l f - r e p o r t o f s u b j e c t i v e l y e x p e r i e n c e d s e x u a l a r o u s a l i s v i e w e d a s p r i m a r y i n d e f i n i n g a r e s p o n s e a s s e x u a l , a n d i s a c e n t r a l f o c u s o f t h e r a p y . T h e s e m o d e l s w e r e d e r i v e d p r i m a r i l y f r o m d a t a c o l l e c t e d on m e n . S i n c e men p o s s e s s g e n i t a l s w h i c h p r o v i d e a m o r e i m m e d i a t e f e e d b a c k l o o p , i t c o u l d be a r g u e d t h a t c o g n i t i v e a n d p h y s i o l o g i c a l r e s p o n s e s y s t e m s may be m o r e c o n c o r d a n t o r s y n c h r o n o u s . R e c e n t r e v i e w s o f t h e l i t e r a t u r e 54 ( R o s e n & B e c k , 1988) s u p p o r t t h i s c o n c e p t o f a s y n c h r o n o u s s e x u a l r e s p o n s e s y s t e m d e s p i t e some e v i d e n c e w i t h men ( H e i m a n & R o w l a n d 1 9 8 3 ; H a l l e t a l . , 1985) c o n t r a d i c t i n g t h i s r e l a t i o n s h i p . T h e p r e s e n t f i n d i n g s w i t h f u n c t i o n a l a n d d y s f u n c t i o n a l women d o n o t p a r a l l e l t h e d a t a d e r i v e d f r o m m e n . T h i s s t u d y r e v e a l e d t h a t a n x i e t y - e l i c i t i n g s t i m u l i f a c i l i t a t e d e n h a n c e d g e n i t a l a r o u s a l a c r o s s a l l s u b j e c t s . A l t h o u g h t h e d y s f u n c t i o n a l women r e p o r t e d h i g h e r s e x u a l a r o u s a l d u r i n g t h e n e u t r a l c o n d i t i o n , t h e i r s u b j e c t i v e a t t r i b u t i o n s d i d n o t i n h i b i t t h e e n h a n c e d g e n i t a l r e s p o n s e e l i c i t e d b y t h e a n x i e t y s t i m u l i . R a t h e r , e n h a n c e d p h y s i o l o g i c a l s e x u a l a r o u s a l o c c u r r e d i r r e s p e c t i v e o f c o n t r a d i c t o r y c o g n i t i v e a t t r i b u t i o n s . T h i s e f f e c t was a l s o f o u n d i n f u n c t i o n a l women. T h e s e f i n d i n g s s u g g e s t t h a t t h e f e m a l e s e x u a l r e s p o n s e s y s t e m i s d e s y n c h r o n o u s , a n d t h a t w h i l e p r i o r c o n d i t i o n i n g o r l e a r n i n g h i s t o r y , a t t e n t i o n a l f o c u s , a n d c o g n i t i v e d i s t r a c t i o n may d e c r e a s e s u b j e c t i v e i n t e r p r e t a t i o n s o f a r o u s a l , i t d o e s n o t i m m e d i a t e l y i n t e r f e r e w i t h p h y s i o l o g i c a l p r o c e s s e s . S e c o n d l y , s i n c e e q u a l s u b j e c t i v e b u t d i f f e r e n t p h y s i o l o g i c a l r e s p o n s e s w e r e f o u n d b e t w e e n g r o u p s , t h e s e d a t a s u g g e s t t h a t f u n c t i o n a l women do n o t n e c e s s a r i l y p r o c e s s c u e s m o r e e f f e c t i v e l y t h a n d y s f u n c t i o n a l women. T h e f a c t t h a t no d i f f e r e n c e i n s u b j e c t i v e r a t i n g s o f a r o u s a l was f o u n d b e t w e e n g r o u p s d e s p i t e e n h a n c e d g e n i t a l a r o u s a l s u g g e s t s t h a t e i t h e r f u n c t i o n a l women a l s o p o s s e s s some d y s f u n c t i o n a l p r o c e s s e s , o r t h a t s o c i a l d i c t a t e s p r e v e n t t h e m f r o m e x p r e s s i n g t h e s e f e e l i n g s . T h e f i n d i n g s t h a t d y s f u n c t i o n a l s u b j e c t s r e p o r t e d g r e a t e r r a t i n g s o f s e x u a l a r o u s a l t h a n , f u n c t i o n a l s u b j e c t s i n t h e a n x i e t y c o n d i t i o n may s u g g e s t t h a t 55 d y s f u n c t i o n a l women do attend to g e n i t a l cues but s t i l l e x h i b i t decreased p h y s i o l o g i c a l a r o u s a l due to c o n d i t i o n e d m i s a t t r i b u t i o n or i n h i b i t i o n of a r o u s a l . These r e s u l t s s t r o n g l y i n d i c a t e that an i n d i v i d u a l ' s p h y s i o l o g i c a l l y experienced sexual a r o u s a l i s at l e a s t as important as s u b j e c t i v e a r o u s a l i n d e f i n i n g a response as se x u a l , and must be s p e c i f i c a l l y t a r g e t e d i n therapy. F i n d i n g s from the present study may be i n c o r p o r a t e d i n t o the p r e v i o u s l y proposed c o n d i t i o n e d m i s a t t r i b u t i o n model of sexual d y s f u n c t i o n . In s h o r t , i f an i n d i v i d u a l experiences e i t h e r g e n e r a l i z e d or s p e c i f i c performance a n x i e t y i n a sexual encounter, she or he may a l s o experience inadequate sexual f u n c t i o n i n g due to any number of s i n g l y - o c c u r r i n g i n c i d e n t s i n v o l v i n g p h y s i o l o g i c a l , a f f e c t i v e , or b e h a v i o r a l f a c t o r s . In accordance with the p r i n c i p l e s of c o n d i t i o n i n g theory, the a r o u s a l - e l i c i t i n g nature of the sexual s t i m u l i w i l l p r e d i s p o s e an inc r e a s e d v u l n e r a b i l i t y to a r a p i d a c q u i s i t i o n of fe a r and a n x i e t y i n sexual s i t u a t i o n s . When t h i s f ear or an x i e t y i s of s u f f i c i e n t magnitude, or f a i l u r e i s a s s o c i a t e d with s e x u a l l y arousing s t i m u l i on repeated o c c a s i o n s , the i n d i v i d u a l a c q u i r e s a c o n d i t i o n e d response of an x i e t y i n the presence of a r o u s a l - e l i c i t i n g s t i m u l i and consequently avoids s i t u a t i o n s r e q u i r i n g sexual performance. In t h i s way, m i s a t t r i b u t i o n i s reversed with d y s f u n c t i o n a l i n d i v i d u a l s such that they l e a r n to m i s a t t r i b u t e sexual a r o u s a l - e l i c i t i n g s t i m u l i as a n x i e t y . These m i s a t t r i b u t i o n s e l i c i t enhanced a n x i e t y and avoidance of sexual s t i m u l i . According to t h i s model, d y s f u n c t i o n a l women c o g n i t i v e l y m i s a t t r i b u t i n g sexual a r o u s a l as an x i e t y would r e p o r t lower s u b j e c t i v e r a t i n g s of a r o u s a l when 56 s y m p a t h e t i c a c t i v a t i o n o c c u r s i n a s e x u a l c o n t e x t . T h e i r s u b j e c t i v e p e r c e p t i o n o f a r o u s a l may be d e s y n c h r o n o u s h o w e v e r w i t h t h e p h y s i o l o g i c a l r e s p o n s e s y s t e m . C o n t r a r y t o t h e i r s u b j e c t i v e a t t r i b u t i o n s , a l t h o u g h t h e e f f e c t s o f s y m p a t h e t i c a c t i v a t i o n may be d e c r e a s e d d u e t o t h e e f f e c t s o f c o n d i t i o n i n g , a n x i e t y s i g n i f i c a n t l y f a c i l i t a t e s e n h a n c e d g e n i t a l a r o u s a l . To s u m m a r i z e , f i n d i n g s f r o m t h e p r e s e n t s t u d y c h a l l e n g e c u r r e n t c o n c e p t u a l i z a t i o n s o f s e x u a l d y s f u n c t i o n i n t h e f o l l o w i n g a r e a s : (1) A n x i e t y - e l i c i t i n g s t i m u l i e n h a n c e g e n i t a l a r o u s a l i n b o t h f u n c t i o n a l a n d d y s f u n c t i o n a l women, (2) t h e d e s y n c h r o n y o f t h e s e x u a l r e s p o n s e s y s t e m a l l o w s d y s f u n c t i o n a l women t o r e p o r t i n h i b i t e d s u b j e c t i v e a r o u s a l w h i l e s i m u l t a n e o u s l y e x p e r i e n c i n g e n h a n c e d g e n i t a l a r o u s a l (3) s u b j e c t i v e a t t r i b u t i o n s , c o g n i t i v e d i s t r a c t i o n , a n d m i s d i r e c t e d a t t e n t i o n a l f o c u s do n o t i n h i b i t t h e e n h a n c e d g e n i t a l r e s p o n s e e l i c i t e d b y a n x i e t y , a n d (4) s u b j e c t i v e a n d p h y s i o l o g i c a l r e s p o n s e s a r e n o t r e c i p r o c a l l y i n t e r a c t i v e a n d a r e t h e r e f o r e e q u a l l y i m p o r t a n t i n u n d e r s t a n d i n g a n d t r e a t i n g i m p a i r e d s e x u a l f u n c t i o n i n g . T h e p r e s e n t f i n d i n g s s u g g e s t t h a t common modes o f t r e a t m e n t f o r s e x u a l l y d y s f u n c t i o n a l women may be c o u n t e r p r o d u c t i v e t o t h e p h y s i o l o g i c a l e l i c i t a t i o n o f s e x u a l a r o u s a l . T h e r a p e u t i c t e c h n i q u e s s u c h a s s e n s a t e f o c u s ( M a s t e r s & J o h n s o n , 1 9 7 0 ) , n o n - d e m a n d c o i t u s ( K a p l a n , 1 9 7 4 ) , p r o g r e s s i v e m u s c l e r e l a x a t i o n , a n d v i d e o a n d i m a g i n a l s y s t e m a t i c d e s e n s i t i z a t i o n a r e d i r e c t e d t o w a r d e x t i n g u i s h i n g a n x i e t y r e s p o n s e s p a i r e d w i t h s e x u a l l y a r o u s i n g s t i m u l i a n d i n c r e a s i n g p a r a s y m p a t h e t i c r e s p o n s e . T h e s e e f f e c t s may i n h i b i t t h e s y m p a t h e t i c a c t i v a t i o n r e q u i r e d f o r t h e 57 i n s t i g a t i o n a n d e n h a n c e m e n t o f p h y s i o l o g i c a l a r o u s a l . T h e p r e s e n t f i n d i n g s s u g g e s t t h a t t r e a t m e n t may i n s t e a d be d i r e c t e d t o w a r d a l t e r i n g c o n d i t i o n e d c o g n i t i v e m i s a t t r i b u t i o n o f s e x u a l a r o u s a l a s a n x i e t y a n d a t t e n d i n g t o t h e e n h a n c e d p h y s i o l o g i c a l e f f e c t e l i c i t e d when s y m p a t h e t i c a c t i v a t i o n o c c u r s i n a s e x u a l c o n t e x t . B a r l o w (1986) h a s s u g g e s t e d t h a t t h e r e l a t i o n s h i p b e t w e e n a n x i e t y a n d i m p r o v e d s e x u a l p e r f o r m a n c e a s s u m e s an i n v e r t e d U - s h a p e d c u r v e . I n a m a n n e r a n a l o g o u s t o t e s t a n x i e t y , p h y s i o l o g i c a l a n x i e t y may t h e r e f o r e e n h a n c e o r i n h i b i t s e x u a l a r o u s a l d e p e n d e n t on t h e a m o u n t , i n t e n s i t y , a n d d u r a t i o n o f t h e s t i m u l u s , a n d t h e c o p i n g s k i l l s o f t h e i n d i v i d u a l . A l t h o u g h c l i n i c a l a p p l i c a t i o n s m u s t be made c a u t i o u s l y , e f f e c t i v e t r e a t m e n t may f o c u s on s t r a t e g i e s f o r t h e b e n e f i c i a l a t t r i b u t i o n a n d u t i l i z a t i o n o f s y m p a t h e t i c a c t i v a t i o n , v e r s u s t h e a l l e v i a t i o n o f an i m p o r t a n t a r o u s a l c o m p o n e n t t h r o u g h r e l a x a t i o n . T e a c h i n g b o t h f u n c t i o n a l a n d d y s f u n c t i o n a l women t o a t t e n d t o a n d i n t e g r a t e p h y s i o l o g i c a l s e n s a t i o n s a n d s u b j e c t i v e p e r c e p t i o n s r a t h e r t h a n i n h i b i t i n g o r i g n o r i n g t h e m , may i n c r e a s e a s e n s e o f c o n t r o l o v e r s e x u a l r e s p o n s e . F o r e x a m p l e t e c h n i q u e s c o m b i n i n g p h o t o p l e t h y s m o g r a p h y b i o f e e d b a c k , f a n t a s y t r a i n i n g , c o g n i t i v e r e s t r u c t u r i n g a n d s e l f - m a s t e r y e x e r c i s e s may d i r e c t a t t r i b u t i o n s o f s y m p a t h e t i c e x c i t a t i o n t o w a r d s e x u a l a r o u s a l r a t h e r t h a n a n x i e t y . C a n t o r , Z i l l m a n n , a n d B r y a n t (1975) e x a m i n e d t h e e f f e c t s o f w h a t Z i l l m a n n ( c i t e d i n C a n t o r e t a l . ) t e r m e d t h e " e x c i t a t i o n t r a n s f e r t h e o r y " b y e x p o s i n g men t o e r o t i c f i l m s f o l l o w i n g p h y s i c a l e x e r c i s e . T h e t h e o r y s u g g e s t s t h a t m i s a t t r i b u t i o n o f 58 r e s i d u a l e x c i t a t i o n f r o m an e x c i t a t o r y p h y s i o l o g i c a l r e s p o n s e w i l l e n h a n c e e m o t i o n a l r e s p o n s e s t o n o v e l s t i m u l i . T h e y f o u n d t h a t r e s i d u a l a u t o n o m i c a r o u s a l e l i c i t e d f r o m e x e r c i s e e n h a n c e d s e l f - r e p o r t e d r a t i n g s o f s e x u a l a r o u s a l o n l y i f t h e t h e c a u s e o f t h e p h y s i o l o g i c a l a r o u s a l was n o t a t t r i b u t e d t o t h e e f f e c t s o f e x e r c i s e . T h e y c o n c l u d e t h a t a c r u c i a l c o m p o n e n t o f e x c i t a t i o n t r a n f e r i s t h e i n a b i l i t y o f t h e i n d i v i d u a l t o a t t r i b u t e t h e c a u s e o f t h e a r o u s a l t o i t s o r i g i n a l s o u r c e . T h e p r e s e n t f i n d i n g s s u g g e s t h o w e v e r , t h a t s y m p a t h e t i c a c t i v a t i o n e l i c i t s e n h a n c e d s e x u a l a r o u s a l i r r e s p e c t i v e o f c o g n i t i v e a t t r i b u t i o n s . A common m e d i c a l p r a c t i c e f o r a s s e s s m e n t o f i m p o t e n c e i n v o l v e s r e q u e s t i n g t h e p a t i e n t t o e x e r c i s e i n o r d e r t o i n c r e a s e b l o o d f l o w n e c e s s a r y f o r p e n i l e t u m e s c e n c e a n d t h e m e a s u r e m e n t o f e r e c t i l e c a p a c i t y ( B e r g e r & B e r g e r , 1 9 8 7 ) . I t i s u n l i k e l y t h a t e x e r c i s e i n c r e a s e s p e n i l e t u m e s c e n c e d u e t o m i s a t t r i b u t i o n o f r e s i d u a l e x c i t a t i o n . S i m i l a r l y , Z i l b e r g e l d a n d E l l i s o n (1980) r e p o r t e d t h e s u c c e s s f u l a p p l i c a t i o n o f t h e e x c i t a t i o n t r a n s f e r c o n c e p t i n t h e c a s e s t u d y o f a woman t r e a t e d f o r l o w s e x u a l d e s i r e . T h e r e s u l t s r e v e a l e d t h a t p r i o r p h y s i c a l e x e r c i s e h e i g h t e n e d t h e w o m a n ' s d e s i r e a n d a r o u s a l d u r i n g s u b s e g u e n t s e x u a l e n c o u n t e r s . D u r i n g a c a s e t r e a t m e n t f o r f e m a l e s e x u a l d y s f u n c t i o n , C a r n e y , B a n c r o f t , a n d M a t h e w s (1978) r e p o r t e d t h a t a d m i n i s t r a t i o n o f t h e a n x i o l y t i c d i a z e p a m i n h i b i t e d t h e r a p e u t i c p r o g r e s s . T h e s e c a s e s t u d i e s (a) s u p p o r t t h e p r e s e n t f i n d i n g t h a t s y m p a t h e t i c a r o u s a l e n h a n c e s r a t h e r t h a n i n h i b i t s s e x u a l a r o u s a l i n d y s f u n c t i o n a l women, a n d c o n t r a r y t o t h e C a n t o r e t a l . e x p l a n a t i o n , (b) s u g g e s t t h a t SNS a c t i v i t y may e n h a n c e s e x u a l a r o u s a l t h r o u g h t h e d i r e c t 59 i n s t i g a t i o n a n d e n h a n c e m e n t o f g e n e r a l p h y s i o l o g i c a l a r o u s a l , ( i . e . i n c r e a s e d b l o o d p r e s s u r e , h e a r t r a t e , r e s p i r a t i o n , m u s c l e t e n s i o n ) p r e p a r i n g t h e i n d i v i d u a l f o r s e x u a l a r o u s a l ( v a s o c o n g e s t i o n , p e n i l e t u m e s c e n c e ) . C o g n i t i v e m i s a t t r i b u t i o n may p r o v i d e a s e c o n d a r y e f f e c t t h a t f u r t h e r i n c r e a s e s o r d e c r e a s e s t h e p h y s i o l o g i c a l e f f e c t e l i c i t e d b y t h e SNS a c t i v a t i o n . To d a t e no o t h e r c l i n i c a l a p p l i c a t i o n s o f t h i s s y m p a t h e t i c a c t i v a t i o n h y p o t h e s i s h a v e b e e n i n v e s t i g a t e d . I f SNS a c t i v a t i o n e n h a n c e s s e x u a l a r o u s a l t h r o u g h p h y s i o l o g i c a l p r e p a r e d n e s s , t h e n o t h e r e m o t i o n s a s s o c i a t e d w i t h SNS a c t i v i t y s u c h a s f e a r , a n g e r , o r a g g r e s s i o n may a l s o p o t e n t i a l l y e n h a n c e s e x u a l a r o u s a l . T h e l i t e r a t u r e on t h e e f f e c t s o f a n g e r a n d a g g r e s s i o n on s e x u a l a r o u s a l h a v e p r o d u c e d o p p o s i n g r e s u l t s . H e i m a n & R o w l a n d (1983) c o n c l u d e d t h a t a n g e r seems d e t r i m e n t a l , w h e r e a s a g g r e s s i o n may a f f e c t i v e l y i n c r e a s e o r d e c r e a s e s e x u a l r e s p o n s e . O t h e r t h e o r i e s ( e . g . S t o l l e r , 1976) s u g g e s t t h a t a n g e r e n h a n c e s s e x u a l a r o u s a l . S i n c e a n g e r , a g g r e s s i o n , a n d f e a r a r e l e s s l i k e l y t o b e e x p e r i e n c e d i n t h e s e x u a l e n c o u n t e r , t h e y may be l e s s l i k e l y t h a n a n x i e t y t o become c o n d i t i o n a l l y m i s a t t r i b u t e d a s s e x u a l a r o u s a l d e s p i t e t h e e n h a n c i n g p h y s i o l o g i c a l e f f e c t s o f t h e a c c o m p a n y i n g SNS a c t i v a t i o n . S i m i l a r l y , i n t h e c a s e o f s e x u a l l y d y s f u n c t i o n a l i n d i v i d u a l s , a n g e r , a g g r e s s i o n , a n d f e a r may be l e s s l i k e l y t h a n a n x i e t y t o be p a i r e d w i t h p e r f o r m a n c e f a i l u r e . T h e s e x u a l a r o u s a l e n h a n c i n g e f f e c t s o f t h e a c c o m p a n y i n g SNS a c t i v a t i o n a r e t h e r e f o r e l e s s l i k e l y t o become r e v e r s e l y a t t r i b u t e d a s f u r t h e r a n g e r o r a g g r e s s i o n . C o n d i t i o n e d m i s a t t r i b u t i o n o f a n x i e t y , 60 a n g e r , a g g r e s s i o n , o r f e a r a s e n h a n c e d s e x u a l a r o u s a l h o w e v e r , p r o v i d e s an i n t r i g u i n g e x p l a n a t i o n f o r t h e d e v e l o p m e n t a n d m a i n t e n a n c e o f s e x u a l d e v i a t i o n s o r p a r a p h i l i a s ( e . g . m a s o c h i s m , s a d i s m , e x h i b i t i o n i s m , f e t i s h i s m ) . F u t u r e r e s e a r c h i s r e q u i r e d i n o r d e r t o e l u c i d a t e c o n t r a d i c t o r y f i n d i n g s r e g a r d i n g t h e e f f e c t s o f t h e s e e m o t i o n s on s e x u a l a r o u s a l , i s o l a t e t h e a c t i v e c o m p o n e n t o f s y m p a t h e t i c e x c i t a t i o n t h a t e n h a n c e s a r o u s a l , a n d e x p l o r e t h e e f f e c t s o f a u t o n o m i c a r o u s a l i n o t h e r p o p u l a t i o n s w i t h s e x u a l d i f f i c u l t i e s . T h e p r i m a r y c r i t i c i s m w i t h l a b o r a t o r y a n a l o g u e i n v e s t i g a t i o n s o f a n x i e t y a n d s e x u a l a r o u s a l i n v o l v e t h e q u e s t i o n a b l e o p e r a t i o n a l i z a t i o n a n d g e n e r a l i z a t i o n o f t h e s e c o n s t r u c t s . R e s e a r c h on t h e e f f e c t s o f a n x i e t y on s e x u a l a r o u s a l h a v e d e f i n e d a n x i e t y a s (1) c r o s s i n g a s u s p e n s i o n b r i d g e , (2) f i l m s t i m u l i , (3) s h o c k t h r e a t , (4) p e r f o r m a n c e demand i n s t r u c t i o n s , (5) s e l f - m o n i t o r i n g o f s e x u a l p e r f o r m a n c e , a n d (6) i n j e c t i o n s o f e p i n e p h r i n e . T h e s e s i t u a t i o n s may n o t p a r a l l e l t h e a n x i e t y e x p e r i e n c e d b y a s e x u a l l y d y s f u n c t i o n a l man o r woman c o n f r o n t e d w i t h p e r f o r m a n c e e x p e c t a t i o n s , work s t r e s s , a n d i n t e r p e r s o n a l c o n f l i c t . I n t e r m s o f t h e a r o u s a l c o n s t r u c t , a s p r e v i o u s l y d i s c u s s e d , W i n c z e e t a l . (1976) c o n c l u d e d t h a t s u b j e c t i v e d i f f e r e n c e b e t w e e n f u n c t i o n a l a n d d y s f u n c t i o n a l women w e r e n o t f o u n d d u e t o demand c h a r a c t e r i s t i c s o f t h e e x p e r i m e n t a l s i t u a t i o n . A l t e r n a t i v e l y , t h e i n a b i l i t y t o r e p o r t o r r e s p o n d t o s e x u a l c u e s may be a v a l i d a n d g e n e r a l i z a b l e p h e n o m e n o n o c c u r r i n g b o t h i n t h e home a n d l a b o r a t o r y e n v i r o n m e n t s . T h e p r e s e n t f i n d i n g t h a t f u n c t i o n a l a n d d y s f u n c t i o n a l women r e s p o n d e d w i t h 61 d e c r e a s e d r a t i n g s o f a r o u s a l d e s p i t e e n h a n c e d g e n i t a l a r o u s a l may s u g g e s t t h a t women l e a r n t o r e s p o n d t o a r o u s a l b y i g n o r i n g i t . F u t u r e r e s e a r c h i s r e q u i r e d t o d e v e l o p a c c u r a t e , u n o b t r u s i v e m e t h o d s o f a s s e s s i n g s e x u a l r e s p o n s e s o t h a t t h e e f f e c t o f a n x i e t y on s e x u a l a r o u s a l may be m o n i t o r e d u n d e r n o r m a t i v e c o n d i t i o n s . T h e g e n e r a l i z a b i l i t y o f c u r r e n t r e s e a r c h may t h e n be a s s e s s e d a n d d i r e c t e d t o w a r d t h e d e v e l o p m e n t o f a p p r o p r i a t e t r e a t m e n t s t r a t e g i e s . A d d i t i o n a l l y , f u t u r e r e s e a r c h r e g a r d i n g t h e i n v e r t e d U - s h a p e d r e l a t i o n s h i p b e t w e e n a n x i e t y a n d s e x u a l a r o u s a l m u s t b e e x p l o r e d i n o r d e r t o d e t e r m i n e m a x i m a l l y c o n s t r u c t i v e l e v e l s o f s y m p a t h e t i c a r o u s a l a n d t h e c o g n i t i v e p r o c e s s b y w h i c h a n x i e t y e n h a n c e s s e x u a l a r o u s a l i n t h e s e i n d i v i d u a l s . S i m i l a r l y , i n v e s t i g a t i o n o f t h e m i s a t t r i b u t i o n a n d a t t e n t i o n t o b o d i l y c u e s h y p o t h e s e s a r e w a r r a n t e d . I t may be t h a t (1) c o n d i t i o n e d m i s a t t r i b u t i o n o f h e i g h t e n e d s y m p a t h e t i c a r o u s a l a s a n x i e t y g r a d u a l l y e l i c i t s a p h y s i o l o g i c a l d e c r e m e n t , o r (2) l a c k o f a t t e n t i o n a l f o c u s t o h e i g h t e n e d p h y s i o l o g i c a l a r o u s a l p e r p e t u a t e s s u b j e c t i v e p e r c e p t i o n s o f l o w a r o u s a l . T h e e f f e c t i v e n e s s o f t h e r a p e u t i c t e c h n i q u e s d i r e c t e d t o w a r d i n c r e a s i n g c o g n i t i v e a n d p h y s i o l o g i c a l s y n c h r o n y may be i n v e s t i g a t e d t h r o u g h b i o f e e d b a c k r e s e a r c h m i m i c k i n g t h e s y n c h r o n y o f m a l e g e n i t a l a r o u s a l . F o r e x a m p l e c o n t i n u o u s p h y s i o l o g i c a l f e e d b a c k o r f a l s e f e e d b a c k o f VBV f o l l o w i n g s u b j e c t i v e r a t i n g s o f a r o u s a l d u r i n g e x p o s u r e t o e r o t i c s t i m u l i , may p r o v i d e v a l u a b l e i n f o r m a t i o n r e g a r d i n g t h e s e x u a l r e s p o n s e s y s t e m a n d p o t e n t i a l t h e r a p e u t i c i n t e r v e n t i o n s . U l t i m a t e l y , u n d e r s t a n d i n g the i n t e r p l a y between c o g n i t i v e and p h y s i o l o g i c a l response systems w i l l d e t e r m i n e the p r o c e s s by which s y m p a t h e t i c a c t i v a t i o n f a c i l i t a t e s enhanced a r o u s a l , and may c o n t r i b u t e to the a l l e v i a t i o n of s e x u a l d y s f u n c t i o n . 63 References Barlow, D. H. (1986). Causes of sexual d y s f u n c t i o n : The r o l e of an x i e t y and c o g n i t i v e i n t e r f e r e n c e . 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E f f e c t s of e r o t i c s t i m u l i on s e x u a l l y f u n c t i o n a l and d y s f u n c t i o n a l women: M u l t i p l e measures before and a f t e r sex therapy. Behaviour Research and  Therapy, 18, 127-137. Mowrer, 0. H. (1939). Stimulus response theory of a n x i e t y . P s y c h o l o g i c a l Review, 4 6, 553-565. 66 N o r t o n , G . R . , & J e h u , D . ( 1 9 8 4 ) . T h e r o l e o f a n x i e t y i n s e x u a l d y s f u n c t i o n s : A r e v i e w . A r c h i v e s o f S e x u a l B e h a v i o r , 1 3 , 1 6 5 - 1 8 3 . O b l e r , M . ( 1 9 7 3 ) . S y s t e m a t i c d e s e n s i t i z a t i o n i n s e x u a l d i s o r d e r s . J o u r n a l o f B e h a v i o r T h e r a p y a n d E x p e r i m e n t a l P s y c h i a t r y , 9 3 - 1 0 1 . R o s e n , R. C . , & B e c k , J . G . ( 1 9 8 8 ) . P a t t e r n s o f s e x u a l a r o u s a l :  P h y s i o l o g i c a l p r o c e s s e s & c l i n i c a l a p p l i c a t i o n s . New Y o r k : G u i l f o r d P r e s s . S c h a c h t e r , S . ( 1 9 6 4 ) . T h e i n t e r a c t i o n o f c o g n i t i v e a n d p h y s i o l o g i c a l d e t e r m i n a n t s o f e m o t i o n a l s t a t e . I n L . B e r k o w i t z ( E d . ) , A d v a n c e s i n e x p e r i m e n t a l s o c i a l p s y c h o l o g y , V o l . 1. New Y o r k : A c a d e m i c P r e s s . S c h a c h t e r , S . , & S i n g e r , J . E . ( 1 9 6 2 ) . C o g n i t i v e , s o c i a l a n d p h y s i o l o g i c a l c o m p o n e n t s o f t h e e m o t i o n a l s t a t e . P s y c h o l o g i c a l  R e v i e w , 6 9 , 3 7 9 - 3 9 9 . S i n t c h a k , G . , & G e e r , J . H . ( 1 9 7 5 ) . A v a g i n a l p l e t h y s m o g r a p h s y s t e m . P s y c h o p h y s i o l o g y , 1 2 , 1 1 3 - 1 1 5 . S o t i l e , W. M . , & K i l m a n n , P . R. ( 1 9 7 8 ) . E f f e c t s o f g r o u p s y s t e m a t i c d e s e n s i t i z a t i o n on f e m a l e o r g a s m i c d y s f u n c t i o n . A r c h i v e s o f S e x u a l B e h a v i o r , 7_, 4 7 7 - 4 9 1 . S t o l l e r , R. J . ( 1 9 7 6 ) . S e x u a l e x c i t e m e n t . A r c h i v e s o f G e n e r a l  P s y c h i a t r y , 3 3 , 8 9 9 - 9 0 9 . W i n c z e , J . P . , & C a i r d , W. K . ( 1 9 7 6 ) . T h e e f f e c t s o f s y s t e m a t i c d e s e n s i t i z a t i o n a n d v i d e o d e s e n s i t i z a t i o n i n t h e t r e a t m e n t o f e s s e n t i a l s e x u a l d y s f u n c t i o n i n women. B e h a v i o r T h e r a p y , 1_, 3 3 5 - 3 4 2 . W i n c z e , J . P . , H o o n , E . F . , & H o o n , P . W. ( 1 9 7 6 ) . P h y s i o l o g i c a l r e s p o n s i v i t y o f n o r m a l a n d s e x u a l l y d y s f u n c t i o n a l women d u r i n g e r o t i c s t i m u l u s e x p o s u r e . J o u r n a l o f P s y c h o s o m a t i c R e s e a r c h , 2 0 , 4 4 5 - 4 5 1 . W i n e r , B . J . ( 1 9 7 1 ) . S t a t i s t i c a l p r i n c i p l e s i n e x p e r i m e n t a l d e s i g n (2nd e d . ) . New Y o r k : M c G r a w - H i l l . 67 W o l c h i k , S . A . , B e g g s , V . E . , W i n c z e , J . P . , S a k h e i m , D . K . , B a r l o w D . H . , & M a v i s s a k a l i a n , M . ( 1 9 8 0 ) . T h e e f f e c t s o f e m o t i o n a l a r o u s a l on s u b s e q u e n t s e x u a l a r o u s a l i n m e n . J o u r n a l o f A b n o r m a l P s y c h o l o g y , 8 9 , 5 9 5 - 5 9 8 . W o l p e , J . ( 1 9 5 8 ) . P s y c h o t h e r a p y b y r e c i p r o c a l i n h i b i t i o n . S t a n f o r d : S t a n f o r d U n i v e r s i t y P r e s s . W o l p e , J . ( 1 9 7 8 ) . Comments on "A t e s t o f r e c i p r o c a l i n h i b i t i o n " b y H o o n , W i n c z e , a n d H o o n . J o u r n a l o f A b n o r m a l P s y c h o l o g y , 8 7 , 4 5 2 - 4 5 4 . W o l p e , J . ( 1 9 8 2 ) . T h e p r a c t i c e o f b e h a v i o r t h e r a p y ( 3 r d e d . ) . New Y o r k : P e r g a m o n P r e s s . Z i l b e r g e l d , B . , & E l l i s o n , C . R. ( 1 9 8 0 ) . D e s i r e d i s c r e p a n c i e s a n d a r o u s a l p r o b l e m s i n s e x t h e r a p y . I n S . R. L e i b l u m & L . A . P e r v i n ( E d s . ) , P r i n c i p l e s a n d p r a c t i c e o f s e x t h e r a p y ( p p . 6 5 -1 0 1 ) . New Y o r k : G u i l f o r d P r e s s . Z u c k e r m a n , M . ( 1 9 7 1 ) . P h y s i o l o g i c a l m e a s u r e s o f s e x u a l a r o u s a l i n t h e h u m a n . P s y c h o l o g i c a l B u l l e t i n , 7 5 , 3 4 7 - 3 5 6 . 68 Appendi x F i l m S c a l e 69 C o d e N o . F I L M S C A L E I n s t r u c t i o n s : P l e a s e u s e t h e f o l l o w i n g s c a l e t o e v a l u a t e how y o u  f e l t d u r i n g t h e l a s t f i l m . P l e a s e a n s w e r h o n e s t l y a n d c a r e f u l l y .  On t h e s c a l e , c i r c l e a n y o f t h e n u m b e r s f r o m 1 ( n o t a t a l l ) t o  7 ( i n t e n s e l y ) . D u r i n g t h e f i l m , I f e l t : 1. F a s t e r b r e a t h i n g 1 2 3 4 5 6 7 2 . F a s t e r h e a r t b e a t 1 2 3 4 5 6 7 3 . P e r s p i r a t i o n 1 2 3 4 5 6 7 4 . F e e l i n g s o f w a r m t h 1 2 3 4 5 6 7 5 . A n y p h y s i c a l r e a c t i o n a t a l l 1 2 3 4 5 6 7 C o n t i n u e on t o t h e n e x t p a g e . 70 C o d e N o . F I L M S C A L E ( C o n t i n u e d ) I n s t r u c t i o n s : P l e a s e u s e t h e f o l l o w i n g s c a l e t o e v a l u a t e how y o u  f e l t d u r i n g t h e l a s t f i l m . P l e a s e a n s w e r h o n e s t l y a n d c a r e f u l l y .  On t h e s c a l e , c i r c l e a n y o f t h e n u m b e r s f r o m 1 ( n o t a t a l l ) t o  7 ( i n t e n s e l y ) . D u r i n g t h e f i l m , I f e l t : 6 . B r e a s t s e n s a t i o n s 1 2 3 4 5 6 7 7. Warmth i n g e n i t a l s 1 2 3 4 5 6 7 8 . G e n i t a l w e t n e s s o r l u b r i c a t i o n 1 2 3 4 5 6 7 9 . G e n i t a l p u l s i n g o r t h r o b b i n g 1 2 3 4 5 6 7 1 0 . A n y q e n i t a l f e e l i n g s 1 2 3 4 5 6 7 11 . S e x u a l l y a r o u s e d 1 2 3 4 5 6 7 1 2 . W o r r i e d 1 2 3 4 5 6 7 1 3 . A n x i o u s 1 2 3 4 5 6 7 1 4 . A n g r y 1 2 3 4 5 6 7 1 5 . D i s g u s t e d 1 2 3 4 5 6 7 1 6 . E m b a r r a s s e d 1 2 3 4 5 6 7 1 7 . G u i l t y 1 2 3 4 5 6 7 1 8 . S e n s u o u s 1 2 3 4 5 6 7 1 9 . A d e s i r e t o b e c l o s e t o s o m e o n e _ 1 2 3 4 5 6 7 2 0 . P l e a s u r e 1 2 3 4 5 6 7 2 1 . I n t e r e s t e d 1 2 3 4 5 6 7 2 2 . A t t r a c t e d 1 2 3 4 5 6 7 2 3 . E x c i t e d 1 2 3 4 5 6 7 2 4 . S e x y 1 2 3 4 5 6 7 2 5 . D i r t y 1 2 3 4 5 6 7 2 6 . L o v i n g 1 2 3 4 5 6 7 2 7 . S e x u a l l y A t t r a c t i v e 1 2 3 4 5 6 7 2 8 . I n h i b i t e d 1 2 3 4 5 6 7 2 9 . E a s y t o a r o u s e 1 2 3 4 5 6 7 3 0 . I n c o m p e t e n t 1 2 3 4 5 6 7 3 1 . S e x u a l l y t u r n e d o f f 1 2 3 4 5 6 7 3 2 . O f f e n d e d 1 2 3 4 5 6 7 3 3 . B o r e d 1 2 3 4 5 6 7 3 4 . F e m i n i n e 1 2 3 4 5 6 7 P l e a s e s t o p a n d w a i t f o r f u r t h e r i n s t r u c t i o n s . 

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