Markus Wiegel

This chapter discusses the theoretical foundations for, development of, empirical evidence for, and continued development of visual reaction time (VRT) as a measure of sexual interest. The evaluation of paraphilic sexual interests must adapt to scientific and technical advances, as well as to the cultural and societal attitudes, sociopolitical context, and legal environment in which these advances occur. The thorough evaluation of individuals with possible paraphilias must include assessment of their sexual interest patterns, especially evaluation of any sexual interest in children. The chapter then details the formation of the Behavioral Medicine Institute of Atlanta to research VRT as a potential psychological test to assist clinicians in determining the sexual interests of individuals with potential paraphilias. The most critical objective of the research was to determine whether a brief, valid screening instrument could be developed to identify those with sexual interests in chi...

Introduction. A validated cutpoint for the total Female Sexual Function Index scale score exists to classify women with and without sexual dysfunction. However, there is no sexual desire (SD) domain-specific cutpoint for assessing the presence of diminished desire in women with or without a sexual desire problem. Aims. This article defines and validates a specific cutpoint on the SD domain for differentiating women with and without hypoactive sexual desire disorder (HSDD).

The Female Sexual Function Index (FSFI) is a brief multidimensional scale for assessing sexual function in women. The scale has received initial psychometric evaluation, including studies of reliability, convergent validity, and discriminant validity (Meston, 2003; Rosen et al., 2000). The present study was designed to crossvalidate the FSFI in several samples of women with mixed sexual dysfunctions (N = 568) and to develop diagnostic cut-off scores for potential classification of women's sexual dysfunction. Some of these samples were drawn from our previous validation studies (N = 414), and some were added for purposes of the present study (N = 154). The combined data set consisted of multiple samples of women with sexual dysfunction diagnoses (N = 307), including female sexual arousal disorder (FSAD), hypoactive sexual desire disorder (HSDD), female sexual orgasm disorder (FSOD), dyspareunia/vaginismus (pain), and multiple sexual dysfunctions, in addition to a large sample of nondysfunctional controls (n = 261). We conducted analyses on the individual and combined samples, including replicating the original factor structure using principal components analysis with varimax rotation. We assessed Cronbach's alpha (internal reliability) and interdomain correlations and tested discriminant validity by means of a MANOVA (multivariate analysis of variance; dysfunction diagnosis x FSFI domain), with Bonferroni-corrected post hoc comparisons. We developed diagnostic cut off scores by means of standard receiver operating characteristics-curves and the CART (Classification and Regression Trees) procedure. Principal components analysis replicated the original five-factor structure, including desire/arousal, lubrication, orgasm, pain, and satisfaction. We found the internal reliability for the total FSFI and six domain scores to be good to excellent, with Cronbach alpha's >0.9 for the combined sample and above 0.8 for the sexually dysfunctional and nondysfunctional samples, independently. Discriminant validity testing confirmed the ability of both total and domain scores to differentiate between functional and nondysfunctional women. On the basis of sensitivity and specificity analyses and the CART procedure, we found an FSFI total score of 26.55 to be the optimal cut score for differentiating women with and without sexual dysfunction. On the basis of this cut-off we found 70.7% of women with sexual dysfunction and 88.1% of the sexually functional women in the cross-validation sample to be correctly classified. Addition of the lubrication score in the model resulted in slightly improved specificity (from .707 to .772) at a slight cost of sensitivity (from .881 to .854) for identifying women without sexual dysfunction. We discuss the results in terms of potential strengths and weaknesses of the FSFI, as well in terms of further clinical and research implications.

... View all references; Finlay & Lyons, 200218. Finlay, WML and Lyons, E. 2002. Acquiescence in interviews with people who have mental retardation. Mental Retardation , 40(1): 14–29. ... View all references). Finlay and Lyons (200117. Finlay, WML and Lyons, E. 2001. ...

ABSTRACT Key variables contributing to sexual liberality or conservatism of sexual attitudes appear to be ethnicity, religion and religiosity, gender and degree of acculturation to mainstream Western culture. This study investigated the relative contribution of these variables to the sexual beliefs of US and Canadian medical students of diverse ethnic backgrounds. Significant differences were found in total scores on a Cross Cultural Attitude Scale (CCAS) with Caucasians coming from the USA, Canada, Western Europe and South Africa being the most liberal, and students self-identifying as Middle Eastern or Asian being the most sexually conservative. However, acculturation played a major role in attenuating the impact of ethnic background. Despite significant main effects of religion, ethnicity, gender and acculturation on sexual attitudes, the overall sample tended to be fairly liberal, suggesting the impact of globalization and acculturation on students of diverse ethnic backgrounds.

Men with and without sexual dysfunction present with varying patterns of agreement between subjective estimates of sexual arousal and more objective psychophysiological measures of the same construct. This relative accuracy seems to be associated with sexual function, with men who have sexual dysfunction presenting less accurate estimations (mostly reporting below measured arousal levels). The purpose of this study is to clarify the processes underlying sexual arousal and the accuracy of its self-estimation. We looked at potential predictors of sexual arousal (subjective and physiological) and accuracy in estimating objective sexual arousal in a sample of 60 sexually functional males. Predictors included pre-existing sexual attitudes (erotophobia), both trait and state positive and negative affect, self-focused attention, and interoceptive awareness. Results indicate that this sexually functional sample generally reported below their own erection level. Interestingly, trait negative affect was associated with somewhat lower levels of subjective arousal and higher levels of physiological arousal. On the other hand, state positive affect facilitated both subjective and objective arousal and increased somewhat the accuracy of estimates of erectile responding. Pre-existing sexual attitudes as well as variations in self-focused attention and interoceptive awareness evidenced little effect on sexual arousal or the accuracy of its estimation.

ABSTRACT Key variables contributing to sexual liberality or conservatism of sexual attitudes appear to be ethnicity, religion and religiosity, gender and degree of acculturation to mainstream Western culture. This study investigated the relative contribution of these variables to the sexual beliefs of US and Canadian medical students of diverse ethnic backgrounds. Significant differences were found in total scores on a Cross Cultural Attitude Scale (CCAS) with Caucasians coming from the USA, Canada, Western Europe and South Africa being the most liberal, and students self-identifying as Middle Eastern or Asian being the most sexually conservative. However, acculturation played a major role in attenuating the impact of ethnic background. Despite significant main effects of religion, ethnicity, gender and acculturation on sexual attitudes, the overall sample tended to be fairly liberal, suggesting the impact of globalization and acculturation on students of diverse ethnic backgrounds.

In this study, we investigated the use of Visual Reaction Time™ (VRT™) for sexual interest in children to predict recidivism of sexual offenses among men who sexually abused children and men with other sexually deviant behaviors. The authors hypothesized that study participants with a higher VRT™ to stimuli of children would be more likely to sexually reoffend compared with those with a lower VRT™ to stimuli of children. Participants included 621 adult males on parole or probation for acting on a range of sexual paraphilias who sought outpatient treatment or evaluation at two separate therapists' practices. Sample 1 consisted of 284 adult males followed up (by the lead author) during a 15-year period, while Sample 2 consisted of 337 adult males followed up (by the second author) during a 7-year period. A discrete-time hazard model found VRT™ to children to be significantly related to sexual recidivism. The researchers found that VRT™ to children measured at intake held up in its predictive ability over a 15-year period. When the participants were divided into three groups based on their VRT™, of the 97 participants who measured at least one standard deviation lower than the mean VRT™, 0% reoffended. The 432 participants in the medium-VRT™ group had an estimated recidivism rate of 7% after 15 years and the 92 participants who measured at least one standard deviation higher than the mean had an estimated recidivism rate of 27%.

Few medical schools or residency programs offer adequate training in sexual medicine. Using the experience gained in our long-standing program in human sexuality for medical students, we have pilot tested a half-day intensive workshop curriculum for residents that focuses on sexual communication skills and management of sexual problems. Unlike our medical school program, this residency course was offered on an elective, one-day basis. The current report describes the successful implementation of our pilot program with 46 medical residents from subspecialty and primary care residency programs. Before the workshop, 22 (48%) residents indicated that they were uncomfortable with open discussion of sexual issues and would not feel comfortable in addressing the topic with their patients. A number of factors were identified as barriers to communication, including lack of time, inadequate training, and personal discomfort. After the workshop, the participants rated themselves as more comfortable with the topic and as more likely to address sexual issues with their patients. The participants evaluated the workshop positively overall and responded well to the interactive format and audience-response components. Most of the participants showed interest and willingness to participate in further training in sexual medicine skills. Our program offers a model for training of residents in communication skills and management of sexual problems. The difficulties in implementation and overcoming institutional barriers to curriculum reform are addressed.

The Female Sexual Function Index (FSFI) is a brief multidimensional scale for assessing sexual function in women. The scale has received initial psychometric evaluation, including studies of reliability, convergent validity, and discriminant validity (Meston, 2003; Rosen et al., 2000). The present study was designed to crossvalidate the FSFI in several samples of women with mixed sexual dysfunctions (N = 568) and to develop diagnostic cut-off scores for potential classification of women's sexual dysfunction. Some of these samples were drawn from our previous validation studies (N = 414), and some were added for purposes of the present study (N = 154). The combined data set consisted of multiple samples of women with sexual dysfunction diagnoses (N = 307), including female sexual arousal disorder (FSAD), hypoactive sexual desire disorder (HSDD), female sexual orgasm disorder (FSOD), dyspareunia/vaginismus (pain), and multiple sexual dysfunctions, in addition to a large sample of nondysfunctional controls (n = 261). We conducted analyses on the individual and combined samples, including replicating the original factor structure using principal components analysis with varimax rotation. We assessed Cronbach's alpha (internal reliability) and interdomain correlations and tested discriminant validity by means of a MANOVA (multivariate analysis of variance; dysfunction diagnosis x FSFI domain), with Bonferroni-corrected post hoc comparisons. We developed diagnostic cut off scores by means of standard receiver operating characteristics-curves and the CART (Classification and Regression Trees) procedure. Principal components analysis replicated the original five-factor structure, including desire/arousal, lubrication, orgasm, pain, and satisfaction. We found the internal reliability for the total FSFI and six domain scores to be good to excellent, with Cronbach alpha's >0.9 for the combined sample and above 0.8 for the sexually dysfunctional and nondysfunctional samples, independently. Discriminant validity testing confirmed the ability of both total and domain scores to differentiate between functional and nondysfunctional women. On the basis of sensitivity and specificity analyses and the CART procedure, we found an FSFI total score of 26.55 to be the optimal cut score for differentiating women with and without sexual dysfunction. On the basis of this cut-off we found 70.7% of women with sexual dysfunction and 88.1% of the sexually functional women in the cross-validation sample to be correctly classified. Addition of the lubrication score in the model resulted in slightly improved specificity (from .707 to .772) at a slight cost of sensitivity (from .881 to .854) for identifying women without sexual dysfunction. We discuss the results in terms of potential strengths and weaknesses of the FSFI, as well in terms of further clinical and research implications.

... View all references; Finlay & Lyons, 200218. Finlay, WML and Lyons, E. 2002. Acquiescence in interviews with people who have mental retardation. Mental Retardation , 40(1): 14–29. ... View all references). Finlay and Lyons (200117. Finlay, WML and Lyons, E. 2001. ...

Relatively few studies have measured sexual functioning in women using a large, diverse, community-based sample with measures that allow for direct comparisons with previous findings. In this article, we: (1) describe prevalence of sexual activity in women by key sociodemographic characteristics, including age, race/ethnicity, marital status, and socioeconomic status; and (2) estimate the influence of key correlates on sexual problems. Data were analyzed from the Boston Area Community Health (BACH) Survey, a 2002-2005 community-based epidemiologic study of urologic and gynecologic symptoms, sociodemographics, health status, and psychosocial characteristics in a diverse sample of Boston area residents (N = 3,205 women aged 30-79 years). Analyses of sexual activity prevalence and reasons for inactivity were conducted on the full sample, while analyses of sexual problems and their correlates were conducted for the subset of women who engaged in sexual activity with a partner in the previous 4 weeks. A total of 49% of participants were not sexually active, citing lack of interest (51.5%) and lack of a partner (60.8%) as the most common reasons. Data pertaining to five dimensions of sexual functioning were gathered through a self-administered questionnaire adapted from the Female Sexual Function Index, measuring desire among all women and arousal, lubrication, orgasm, and pain among those who were sexually active. Among the sexually active, we obtained a 38.4% prevalence rate of sexual problems and 34.9% of those participants reported that they were also dissatisfied with their sex lives. Therefore, only 13.7% of the sexually active sample exhibited both sexual problems and dissatisfaction with their overall sex lives. Age was strongly and positively associated with sexual problems. In terms of psychosocial factors, depression, sexual and physical abuse in adulthood, global mental health functioning, and alcohol were associated with sexual problems, with variation across racial/ethnic groups.