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Turning On and Turning Off: A Focus Group Study of the Factors

That Affect Women‟s Sexual Arousal

Cynthia A. Graham, Ph.D.,1,2,4 Stephanie A. Sanders, Ph.D.,1,2

Robin R. Milhausen, M.Sc.,3 & Kimberly R. McBride, M.A.3

1
Department of Gender Studies, Indiana University, Bloomington, Indiana.
2
The Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University,

Bloomington, Indiana.
3
Department of Applied Health Science, Indiana University, Bloomington, Indiana.
4
To whom correspondence should be addressed at The Kinsey Institute for Research in Sex,

Gender, and Reproduction, Indiana University, Morrison Hall 313, 1165 East Third Street,

Bloomington, Indiana 47404-2501; e-mail: [email protected].

RUNNING HEAD: Women‟s Sexual Arousal

Correspondence and galley proofs:

Cynthia A. Graham, Ph.D.

The Kinsey Institute for Research in Sex, Gender, and Reproduction
Indiana University, Morrison Hall 313
1165 East Third Street, Bloomington, IN 47405-2501
(812) 856-5393
Fax: (812) 855-8277
E-mail: [email protected]
 Women‟s sexual arousal 2

ABSTRACT

The aim of this study was to inform the development of a questionnaire to assess a woman‟s

tendency to respond with sexual excitation/inhibition in different situations. Nine focus groups,

involving 80 women (M age = 34.3 years; range, 18-84), were conducted. Women described a

wide range of physical (genital and non-genital), cognitive/emotional, and behavioral cues to

arousal. The relationship between sexual interest and sexual arousal was complex; sexual interest

was reported as sometimes preceding arousal, but at other times following it. Many women did

not clearly differentiate between arousal and interest. Qualitative data on the factors that women

perceived as “enhancers” and “inhibitors” of sexual arousal are presented, with a focus on the

following themes: feelings about one‟s body; concern about reputation; unwanted

pregnancy/contraception; feeling desired versus feeling used by a partner; feeling accepted by a

partner; style of approach/initiation; and negative mood. The findings can help inform

conceptualizations of sexual arousal in women.

KEY WORDS: sexual arousal; sexual interest; sexual desire; women.

 Women‟s sexual arousal 3

INTRODUCTION

In most research on sexual arousal, there has been an assumption that lack of sexual

arousal is due to a lack of excitation. Inhibition of arousal has often been implicitly

acknowledged, but not studied, as a process separate from excitation. The concept of “inhibited

sexual desire” has been widely used in the clinical literature (American Psychiatric Association,

1980; Beck, 1994; Lief, 1977) but there has been little systematic study of this and no attempt to

distinguish between inhibited sexual desire and lack of desire. The newly developed “dual

control” model of sexual response postulates that, within the central nervous system, there are

separate and relatively independent excitatory and inhibitory systems (Bancroft, 1999; Bancroft

& Janssen, 2000). It is the balance between these two systems that determines whether sexual

arousal occurs in any particular situation. The model also postulates that individuals vary in their

propensity for both sexual excitation (SE) and sexual inhibition (SI).

The capacity to inhibit sexual response is seen as adaptive, as a means by which the

individual can avoid danger or other risks to well-being that might result from a sexual response

in a given situation. For some, however, the propensity for SI may be unduly high, resulting in

an impairment of the capacity for sexual function and, for others, the propensity for SI may be

low, increasing the likelihood of engaging in high-risk sexual behavior (Bancroft, 1999).

Research has been exploring this model and its possible relationship to both sexual risk-taking

(Bancroft, Janssen, Strong, Carnes, & Long, 2003; Bancroft et al., in press) and sexual

dysfunction in men (Bancroft & Janssen, 2000; 2001). A questionnaire (Sexual Inhibition

Scale/Sexual Excitation Scale, SIS/SES) has been developed to assess SI and SE in men and has

been demonstrated to have good psychometric properties (Janssen, Vorst, Finn, & Bancroft,

2002a; 2002b). Factor analyses yielded three factors–one excitation factor (SES) and two
 Women‟s sexual arousal 4

inhibition factors, which have been labeled “inhibition due to threat of performance failure”

(SIS1) and “inhibition due to threat of performance consequences” (SIS2).

The SIS/SES has been adapted for women and used in a study of 1067 female college

students (Carpenter, Janssen, & Graham, 2003). The findings suggested that women had lower

SE scores and higher SI scores in comparison with men, with a fairly normal distribution,

showing variability in SE and SI scores. This study also found evidence for the convergent and

discriminant validity of women‟s SIS/SES scores and for test-retest reliability.

Our view, however, was that simply modifying this measure, originally developed for use

with men, might miss important aspects of SI and SE in women‟s experience or emphasize

genital response in a way women find less relevant or meaningful. There are a number of reasons

for believing that central inhibition in women may be fundamentally different in its underlying

mechanisms and scope of effects. It has been suggested that inhibition may be more important

for women than for men, particularly as it pertains to sexuality and reproduction (Bjorklund &

Kipp, 1996). Studying inhibition in women requires a reexamination of what is likely to be

threatening, a possibly different time relationship between SI and sexual activity (e.g., SI may

occur much earlier in women), and consideration of exclusively female factors, such as the

menstrual cycle and pregnancy. For example, concerns about one‟s reputation may be a more

important SI factor for women‟s sexuality than for men‟s (Tiefer, 2001).

This qualitative study was the first stage of a project to develop a questionnaire, using a

woman-centered approach, to assess a woman‟s tendency to respond with SI and/or SE to a

variety of stimuli. Rather than relying on researchers‟ assumptions about what factors are

important to women‟s sexual arousal, we wanted to hear from women themselves about what

they regarded as important.

 Women‟s sexual arousal 5

We used focus groups of women to explore the factors most relevant to SI and SE in

women. Morgan (1996) defined a focus group as “a research technique that collects data through

group interaction on a topic determined by the researcher” (p. 130). As surveys are inherently

limited by the questions they ask, focus groups can provide data on how respondents themselves

talk about the topics (Morgan, 1996) and thus have been recommended as a means to inform

questionnaire development for more than a decade (Morgan, 1997). Although focus groups have

been increasingly used in sexuality research (Byers, Zeller, & Byers, 2002), few published

accounts exist of using focus groups as a means to construct questionnaires. Our goal was to use

the information obtained from the focus groups to help us devise specific items for a

questionnaire. This article reports on the qualitative data from the nine focus groups we

conducted.

METHOD

Participants

All participants were English-speaking women volunteers at least 18 years of age. An

effort was made to obtain age, race, ethnic group, educational, and relationship status diversity in

the sample. Thus, a range of recruitment strategies was used, including flyers and

advertisements in community newsletters and newspapers, churches, community organizations,

and campus centers. Women interested in participating were screened by telephone and if

eligible, were mailed a demographic questionnaire. They were informed that the purpose of the

study was “to collect information on women‟s experience of sexual arousal and assess factors or

types of situations that promote or interfere with women‟s sexual interest or arousal.”1

__________________________________________________________________________
1
In this article, we are using the terms “sexual desire” and “sexual interest” interchangeably.
 Women‟s sexual arousal 6

We made the decision to have groups that were fairly homogenous with respect to age

(18-24 years, 25-45 years, and 46 years and older), but mixed with regard to other demographic

factors, such as student status, and ethnic and racial background. As recommended by previous

researchers (Seal, Bogart, & Ehrhardt, 1998), we over-recruited to control for cancellations and

no-shows and scheduled 12 women for each group. To ensure diversity in these “mixed” groups,

no more than six women who were students or who described their race as “white” were

scheduled for any one group. In total, six “mixed” groups (two 18-24 year groups, Ns = 6 and

10; two 25-45 year groups, Ns = 9 and 9; two 46+ year groups, Ns = 10 and 9) were conducted.

In order to enhance the overall diversity of our sample, we also conducted two groups of

lesbian/bisexual women (one aged 18-24 years, N = 9, and one aged 25 years and older, N = 10)

and one group of African-American women (aged 18-35 years, N = 10). Our view was that these

“segmented” groups might facilitate discussion because minority participants might feel more

comfortable discussing sexuality-related topics with others similar to themselves.

Participants were 80 women (mean age = 34.3 years; SD = 16.1; range = 18–84 years).

Table I contains demographic information on the sample. As can be seen, participants were

highly educated, but were quite diverse in terms of other demographics, such as employment,

marital status, and race.

-----------------------------

Insert Table I about here

-----------------------------

Measures
 Women‟s sexual arousal 7

Procedure

Two female moderators facilitated each of the focus group sessions. In each group, one of

the moderators was a Ph.D. level psychologist and the other was either an M.A. level researcher

or a senior undergraduate student. An African-American researcher was the primary moderator

for the African-American group.

All of the sessions were audiotaped and transcribed for analysis. In addition, moderators

made written notes during the sessions. No individual identifiers were collected to ensure the

anonymity of the participants. After transcription, the audiotapes were destroyed.

The groups were held in a private room in a local public library, with the exception of the

two lesbian/bisexual groups that met in a conference room at The Kinsey Institute. The rationale

for this was that women attending a lesbian/bisexual group might feel more comfortable meeting

at The Kinsey Institute, rather than in a public venue, particularly if they had not “come out” as

lesbian or bisexual. Consent forms and background questionnaires were collected when each

woman arrived. Each session began with introductions by the moderators and the participants.

Name cards were provided for each participant; however, women were told that they could

choose not to use their real names and could use a pseudonym. Refreshments were provided. At

the end of the 2-hour session, women were thanked for their participation and received a $25

payment.

Study approval was obtained from the Indiana University Bloomington Campus

Committee for the Protection of Human Subjects.

Focus Group Discussion Guide

Moderators utilized a discussion guide that included the following components:

 Women‟s sexual arousal 8

1) Description of the purpose of the study and the procedural rules of the focus group. Women

were told that the purpose of the focus group was:

to share ideas to help us develop a better understanding of women‟s sexual arousal and its

components as well as the factors or types of situations that promote or interfere with

women‟s sexual interest and arousal. We will use the information to help us develop a

questionnaire.

Women were told that they could share information from their own experience, things they have

observed, or experiences described to them by others, (i.e., act as participant-observers of their

peers). Participants were also asked to honor the privacy of the other participants and not to share

any of the focus group discussion with others outside of the group.

2) The three topics and the questions introducing them:

a) Sexual arousal and its components. “How do women know when they are sexually

aroused? What cues are there? Is vaginal lubrication (“wetness”) a counterpart or parallel

to erection?”

b) Sexual interest and sexual arousal. “How would you describe sexual interest? How is it

related to sexual arousal? Is there a clear demarcation between sexual interest and sexual

arousal? Does sexual interest always occur before arousal?”

c) Factors that enhance or inhibit sexual arousal. (i) “What sorts of things enhance or

increase sexual arousal? (ii) What sorts of things prevent or stop women from being

sexually aroused or end/interrupt arousal?”

The sequence of discussion topics was not rigidly fixed. In keeping with the primary goal

of the study, to gather information on factors that enhance/inhibit arousal, the majority of the

focus group session was spent on discussion of topic 2c. For these latter questions, the discussion
 Women‟s sexual arousal 9

guide also contained a list of possible situations/factors that could be used as “prompts”;

however, as much as possible, moderators allowed the group members to generate ideas. The

aim was to have participants react to the ideas and statements of other group members. The

moderators tried to keep the conversation “on target” but guided the discussion only when

necessary and there was no attempt to try to control the way that the participants interacted (e.g.,

trying to get everyone to participate equally in the discussion).

Data Analysis

All of the four authors were involved in analyzing the focus group transcripts. Our

method of analysis was drawn from Morgan (1997). In the first stage, transcriptions from each of

the nine focus groups were analyzed independently by two investigators, who listed recurrent

themes and specific quotes within each theme. Following this, all four investigators met to

compare the themes across investigators and groups. This was an interactive process that

involved repeated rereading of the transcripts. Discrepant themes were discussed until agreement

was reached and new themes were added to reflect as much of the data as possible. Next, themes

were organized into broad categories. Refinements were made to the coding scheme and the

labeling of themes, after discussion and consensus among the four researchers. The end result

was a coding scheme consisting of eight broad categories and within most of these, a number of

sub-categories (see Appendix). In the final stage of analyses, we applied the coding framework

to all of the data by annotating the transcripts with the numerical codes that indexed the

categories.

Although group comparison was not a focus of our study, we used a “grid” approach

(Knodel, 1993; Morgan, 1997) to provide a descriptive summary of the content of discussions.

On one axis of the grid were the coding categories/subcategories identified and, on the other, the
 Women‟s sexual arousal 10

focus group session identifiers (e.g., 18-24 lesbian/bisexual group). The cells contained page

numbers of transcripts, where quotes that illustrated the particular theme were located. The grid

was a useful way to compare responses to each of the discussion questions across focus groups,

in order to gain an indication of differences that might be relevant to questionnaire development.

We did not rely on code counting per se, but rather on a more interpretative summary of the data.

RESULTS

The results are presented in three sections, corresponding to the three discussion topics

explored in the focus groups: (1) cues for sexual arousal; (2) the relationship between sexual

arousal and sexual interest; and, (3) factors that enhance or inhibit sexual arousal.

Cues for Sexual Arousal

In all of the groups, women described a wide range of cues for sexual arousal, including

physical (genital and non-genital), cognitive/emotional (e.g., distraction, anticipation,

nervousness, heightened sense of awareness), and behavioral (e.g., sighing, moaning) indicators.

Genital changes described were sensations of tingling, warmth, fullness, swelling, and

lubrication, and non-genital physical changes included “butterflies” in the stomach, increased

heart rate, nipple hardening, increased skin sensitivity, changes in temperature, shortness of

breath, muscle tightness in stomach and legs, and flushing in the face and chest.

Although lubrication was reported as one of the cues of sexual arousal, women‟s

responses to the question “Is vaginal lubrication (“wetness”) a counterpart or parallel to

erection?” was a resounding “no”. Women observed that if a man experienced an erection in

sexual situation, this would be a signal that he was sexually aroused. A number of participants

reported that feeling aroused and being lubricated did not always co-occur, as illustrated by this

interaction:
 Women‟s sexual arousal 11

Participant (P–1)2: Lubrication and arousal don‟t necessarily coincide.

P–2: There‟s times of the month too where there‟s just more lubrication because of whatever‟s

going on in terms of hormones where I won‟t necessarily feel turned on.

Moderator (M): So you can be aroused and not necessarily feel wet or vice versa?

P–3: Yeah, I find that wetness comes at a later stage of arousal for me. There‟s more of a

sequence thing. It comes later. It‟s not the first sign. [25-45 group]3

The fact that lubrication might be a later sign of arousal, and one that might not always be

perceived, was raised in other groups:

P–1: It depends on how physical you get.

P–2: And if there‟s a chance, I guess, to notice it too depending on what you‟re doing.

P–3: I don‟t think that‟s one of the first signals to me . . . I think there are a lot of things that you

notice before. [18-24 group]

Sexual Arousal and Sexual Interest

In the discussions on the relationship between sexual interest and sexual arousal, a

number of women said that they did not clearly differentiate between sexual arousal and sexual

interest, as illustrated by the following two quotes:

P: The arousal, the interest, they tend to, they blur . . . I‟m not even sure how to separate out one

from the other. [25-45 group]

P: Maybe I don‟t get interested very often but when I do, there‟s at least a little bit . . . a degree

of arousal. . . . For me if I‟m sexually interested in somebody, even a little bit, then I‟m a

little bit aroused. [18-24 Lesbian/bisexual group]

__________________________________________________________________________
2
In all of the quotes involving more than one participant, P–1, P–2…P–N indicates a

statement from a different woman.

3
At the end of each quote is the focus group identifier (e.g. 25-45 year group, etc.)
 Women‟s sexual arousal 12

In terms of temporal sequence, interest was perceived as sometimes preceding arousal,

and sometimes following it, as described by these two women:

P–1: I tend to think of arousal as more physical and interest more thoughtful and I don‟t think

one like absolutely comes before the other.

P–2: For me, it can be either way actually. Some thought may come to my mind which arouses

me or I may feel aroused and then . . . it‟s hard to explain it. I may feel aroused and have an

interest in pursuing it. I think that‟s what I‟m trying to say. It‟s either way to me. [25-45

group]

Other women talked about sexual arousal occurring without any experience of sexual

interest:

P–1: I think there can be arousal without interest at all. You can be like, I don‟t know, riding on a

tractor or something.

P–2: You could be ovulating. [18-24 Lesbian/bisexual group]

Factors that Enhance or Inhibit Arousal

Factors that affected SE and SI (see questions 2c) were classified into eight broad

categories. Each of these categories contained a number of sub-categories (for a list of the coding

categories, see Appendix). It is important to note that many of the factors in our coding scheme

were cited as “inhibitors” by some women and as “enhancers” by others or as both by the same

woman, depending on the specific situation being described. For example, negative mood states,

such as anxiety, were reported by some women as reducing their ability to become aroused and

by others as increasing it. Similarly, the possibility of being seen or heard while having sex was

described as arousing by some women, but as inhibiting by others. In addition to individual

variability, women also noted that context and timing were important in this regard; for example,

a particular style of approach by a partner might increase their arousal only if the partner was
 Women‟s sexual arousal 13

someone they trusted, rather than a stranger, or a partner in whom they lacked trust. Factors or

situations were also seen as having variable effects on sexual arousal depending on whether they

occurred in the context of a committed or long-term relationship vs. a casual relationship or a

one-night stand.

Although the themes that emerged varied across groups, particularly different age groups,

certain themes were raised in all of the groups. These consistent themes included: feelings about

one‟s body; negative consequences of sexual activity (e.g., concern about reputation, pregnancy);

feeling desired and accepted by a sexual partner; feeling “used” by a sexual partner; and negative

mood.

Feelings about One’s Body

Feeling comfortable and positive about one‟s body was frequently mentioned as a factor

that would facilitate sexual arousal. Statements such as this one were typical:

P: If I am feeling good about myself, I mean some days I feel like I‟m really okay. My hair is

just right and everything is working and it‟s much easier for me to feel aroused when I‟m

feeling really comfortable with myself . . . it‟s not as easy to feel aroused when I‟m not

feeling good about myself and my body. [25-45 group]

Women also discussed feeling confident and having a positive self-image as enhancers of

arousal:

P–1: If I‟m feeling unattractive, like if I‟ve gained weight or something you know . . . but if I‟ve

lost 5 pounds . . . I‟m just like wanting to take my clothes off a lot . . .

P–2: Yeah, positive self-image is definitely an enhancer. [25-45 group]

The importance of a partner accepting one‟s body was also raised:

P–1: Yeah, people accepting me and my body is crucial.

P–2: If somebody told me that I had too big a butt or big thighs, I‟d be like “sorry”. [18-24 group]
 Women‟s sexual arousal 14

P: It‟s important to me to be comfortable with my body and for the other person to be

comfortable with their body and for them to be comfortable with my body. [25-45 group]

P–1: Or your partner telling you you‟re heavy.

P–2: Right, big turn-off.

P–3: Or just feeling not accepted in any way by your partner . . .[46+ group]

Concern about Reputation

Many women, particularly in the younger age groups, said that concern about reputation

had a negative impact on their sexual arousal:

P–1: He‟s really cocky and thinks he can get anyone and like I don‟t want to fall for it. There‟s

so many consequences that we have to deal with like getting pregnant and things you just

don‟t want to go through.

P–2: Not to mention the whole school would know, well, not in college, but like in high school,

the whole school would know about it in a day and it‟d just be like . . . and then you regret

doing it. [18-24 group]

Women talked about a “double standard,” with fear about damaging one‟s reputation as

something that only women had to worry about. One participant voiced concerns about

performance and the double standard:

P: Being single and you know, wanting to be sexual with another person and thinking “okay, am

I going to be too much?” or “am I going to be not enough?” or “what are they going to think

of me because I‟m doing these things?” and you know, my thinking doesn‟t go there with

him. It‟s not like, “Oh, is he a whore because he knows how to do this or that?” I‟m pretty

much more grateful that he knows but when it comes to me, there is this concern about, you

know, being good or whatever that means. [25-45 group]

The following statement describes feelings of ambivalence: wanting to be openly sexual but at

the same time, being concerned about being labeled a “slut”:

 Women‟s sexual arousal 15

P: I think that like if you go out . . . and you‟re really conservative and you don‟t do all that kind

of stuff and then you see a girl who is not like that and who is out, you know, having sex with

all these men and having fun. It‟s almost like you hate her but you want to be her at the same

time. You sit there and you‟re thinking, “she‟s a slut, I can‟t believe she‟s doing that.” At the

same time, it‟s like “whoa, she‟s getting lots of attention.” [18-24 group]

There were also some women who described feeling more sexually aroused in situations where

they felt that they were being “bad” by giving in to their sexual desire:

P: One thing that turns me on is sometimes just being bad, doing things I know I shouldn‟t do.. . .

Sometimes just being able to just do what you want and give in and not care what society or

anybody‟s thinking, that‟s exciting to me because you . . . can‟t be thinking about what your

friends would say if they knew or what your mom would think of you. [African-American

group]

“Putting on the Brakes”

One of the recurrent themes in the younger age groups was that many women felt the

need to “put on the brakes” to stop themselves from being aroused. Women talked about

knowing that they would be aroused in a given situation but not allowing themselves to “go

there,” for a wide range of reasons, including being in a current relationship, concerns about

reputation, lack of trust/safety issues, the person being an “inappropriate” partner, and concerns

about pregnancy. Women discussed this as being something that was their responsibility, rather

than that of their male partners:

P: There‟s the typical whether or not to put on the brakes. It depends on who you‟re with, you

know, but you always have to make the decision because you know that the guy‟s not going

to make that decision. It‟s my job. [18-24 group]

 Women‟s sexual arousal 16

Women in the younger groups also talked about the ease with which they could switch on and

off their arousal:

P: There‟s so much control . . . it‟s like you can almost [say] “yeah, I‟m interested but no, maybe

not, and then you completely forget about it if it‟s not really that interesting to you. It‟s

almost like you can turn it off and on if you want to. [18-24 group]

P–1: . . . with girls I think it‟s like you might have some inclinations and then you‟re like, “wait

a minute, you can‟t do that,” you‟re in a relationship or that guy‟s a loser . . . and all of a

sudden you just [think] “okay, fine, forget it, I can‟t. That‟s a bad idea,” and just walk away

from it. It‟s a lot easier for a girl to walk away from a situation.

P–2: You can just shut it off like you said. [18-24 group]

Unwanted Pregnancy/Contraception

Fears about unwanted pregnancy were described as having a very negative impact on

sexual arousal, particularly if one‟s partner did not share these concerns:

P: Unwanted pregnancy is a big turn off and if you‟re with a partner who seems unconcerned

about that, then it really feels like a danger. It feels like a hazard, you know, I mean more

than just if you‟re with a steady partner and you‟re both concerned about it. [46+ group]

Women also discussed how a partner‟s shared concern about contraception could serve to buffer

potential negative effects on their ability to feel aroused:

P: Contraceptives are definitely at least a . . . barrier to arousal at times. The more that my

partner is comfortable with the use of whatever we‟re using, that really helps . . . and it‟s less

of a barrier. [25-45 group]

Feeling Desired vs. Feeling Used by Partner

Women identified feeling “desired” or appreciated by a partner as something that was

very arousing:
 Women‟s sexual arousal 17

P: It is very arousing to me to have someone verbally and physically appreciate my body. [25-45

group]

P: I like it when they caress not only like your body parts that get sexually aroused but just like

your arms and because it feels like he‟s encompassing you and appreciating your whole body.

[African-American group]

Many women talked about how their arousal was increased with partners who seemed particularly

interested in them as individual women, rather than someone that they just wanted to have sex

with; as this woman described:

P: When they‟re attracted to you and it‟s like they just have to touch you and can‟t do enough

for you. [25-45 group]

This situation was contrasted with that of feeling used by a partner, which was described as a

powerful turn-off:

P: I experienced too many times waking up facing away from him and ah, I‟m not trying to be

graphic, but just rubbing himself on me as though I could have just been any tree in the forest

. . . that would not only kill any ability that I could have ever found in the morning to be

aroused but ah . . . probably for days. There‟s a difference between caressing and using

someone like that. [25-45 group]

Feeling “Accepted” by Partner

As well as feeling desired, a recurrent theme was the importance of feeling “accepted” by

a partner; for example, a partner who was accepting of one‟s responses during sexual activity

could facilitate arousal:

P: If I have permission to make sound, that is much more arousing. Listening to my partner‟s

sound and my sound and having the permission is much more arousing than feeling like you

got to contain that sound. [46+ group]

 Women‟s sexual arousal 18

The converse of this was feeling inhibited sexually when a partner did not approve of a woman‟s

sexual response, as this woman expressed:

P: Even with my second husband, and we were together 16 years, he was not accepting of my

sexual responses. . . . I make a lot of noise or [with] my favorite way to orgasm, he felt left

out. . . . That was just the beginning of just really shutting down. [46+ group]

Women also discussed the importance of a partner feeling comfortable with their sexual past, as

this interaction demonstrates:

P–1: I can‟t imagine being turned on by someone who would be morally condemning my past.

That would be a big turn-off.

P–2: It would preclude a relationship. [25-45 group]

More general criticism by a partner was also said to have a negative effect on sexual arousal:

P–1: . . . guys being cruel and saying, ah, any criticism or something negative, that‟s just a huge

turn-off.

P–2: So, criticism of you . . .

P–3: Yeah.

P–4: It doesn‟t even have to be . . . like even if it‟s something that happened earlier that day. [25-

45 group]

Style of Approach/Initiation and Timing

Women described various styles of approach/initiation as potential turn-ons or turn-offs

but the importance to their own arousal of how a partner approached them was a key theme:

P: I want to say his “game” . . . you know, how the man approached you, how did he get me to

talk to him longer than like, five minutes? How did he get me to be interested in him and the

ways he went about it. [African-American group]

Being “surprised” or “overpowered” by a partner was described as arousing by a number of

women:
 Women‟s sexual arousal 19

P-1: It could be because I was raised Catholic and everybody jokes to me, comes up behind me,

you know “I‟m not responsible” then, and he comes up behind me and puts his arms around

my waist and it‟s like, well “it‟s not my fault.” If they‟re going to take me from behind, it‟s

not my fault.

P–2: I‟m not Catholic and that is very sexually arousing.

P–3: I totally agree. [46+ group]

A potential turn-off was a partner who was too “polite” or who asked for sex:

P: If somebody asked me to do something. I hate that. Like, “will you go down on me?” and stuff

and like blatantly ask me . . . It will eventually get there, they don‟t have to ask me, but like

the asking is . . . the biggest turn-off ever. [18-24 group]

Although being able to communicate about sex with a partner was often seen as positive,

particularly in the older age groups, a partner verbally “asking” for sex was widely regarded as a

turn-off:

P–1: My husband, as long as we‟ve met . . . he‟s just a very polite young man and he just would,

you know, while we are in the throes of sexual passion, he would just say “May I have sex?”

or something like that, and I wish [he] wouldn‟t ask. That‟s a turn-off.

P–2: It‟s like, just do it.

P–3: Even now . . . he‟ll say something like . . . “Well, tonight can we have sex?” or something

like that, and I‟m like “Why don‟t you just come and you know, kiss me and like that.”

P–4: Make love to me.

P–5: Exactly.

P–6: Seduce me.

P–7: Don‟t make me say okay.

P–8: It‟s not something that‟s a turn-on. [25-45 group]

 Women‟s sexual arousal 20

Many women mentioned that they were less aroused when partners did not spend long

enough on foreplay, were not enthusiastic during sexual interaction, or were not attentive to their

sexual needs. In particular, making genital contact too fast, or what some of the younger

participants described as the “head push,” was frequently mentioned as a turn-off:

P–1: When they grab, that turns me off. Yeah, I mean if they sort of grab for bits of you . . .

P–2: Well, they gotta know what they‟re doing.

P–3: Yeah.

P–4: I get really turned off if people make genital contact too fast.

P–5: Yeah.

P–6: It‟s like they don‟t climb the mountain first?

P–7: Right . . . it‟s very disappointing, you know . . . it‟s like, let‟s build this up, let‟s really

enhance it. [25-45 group]

In addition to making genital contact too quickly, sexual activity that ended quickly because a

partner ejaculated was also brought up:

P–1: Sometimes they get this like stare and their tongue is kind of half out and, you know, and

you‟re like “Whoa, are you there?” The next thing you know, they‟re done.

P–2: Yeah, and they don‟t want to do anything, they just kind of roll over. [18-24 group]

In contrast, the opposite situation was described where women became more aroused by partners

who took time and were attentive to their needs:

P: I‟m a lot slower than my husband in terms of reaching arousal and if he takes the time and

gives . . . and you know, goes that slow, that‟s very arousing to me where if I feel I have to go fast

to keep up . . . it‟s the exact opposite response. [25-45 group]

A related theme was the issue of reciprocity during sexual interaction:

P–1: Something that really puts the brakes on for me is if I can detect that the person that I‟m

having intercourse with is in it more for himself and it‟s not a fair balance. Like if I feel like
 Women‟s sexual arousal 21

he‟s the one receiving more and I‟m not getting an equal amount of pleasure then that just

halts everything. Like if I perform oral and I want it too and he says “No, I don‟t want to do

that.”

P–2: That‟s interesting because . . . I definitely feel happy just performing oral sex and feeling

like I‟m giving that and that makes me feel really good and he can give it another way.

P–3: But he is giving it to you in a different way so you‟re still kind of balancing.

P–4: Yeah, you‟re right. [25-45 group]

As another participant commented:

P–1: I felt . . . we started out sort of mutually initiating our sexual encounter and then I felt like I

was doing all of the giving and it wasn‟t being reciprocated.

P–2: The physical giving?

P–3: Yes. And I was really put off and just got very angry and it was over. Get out of here,

buddy. Hit the road. [25-45 group]

Negative Mood

Discussions about the effects of negative mood on sexual arousal suggested that the

relationship between mood and sexuality is complex. Effects varied as a function of the

particular mood (e.g., anxiety, depression, or anger), as well as the reasons for the negative

mood, and other contextual factors. A number of participants talked about experiencing

heightened arousal when anxious or stressed:

P–1: Frustration can lead to, you know, enhanced arousal.

P–2: Actually, sex is the greatest stress relief so I‟d much rather attack somebody when I‟m

stressed out. [25-45 group]

Some women made a distinction between being less interested in sex with a partner, but being

more likely to masturbate, when they were feeling anxious:

 Women‟s sexual arousal 22

P–1: When feeling really anxious, I would probably not be at all interested in sex, but . . .

conceivably interested in masturbation just as a distraction, as a relaxant, but not wanting to have

to think about someone else and take care of their needs too.

P–2: Yeah, I agree with that. [25-45 group]

Depression and anger were more often described as having a negative effect on sexuality.

P: If you‟re very upset with your intended sexual partner, if you‟re very upset with him about

something, there‟s no way that you are going to be aroused. [46+ group]

Women talked about wanting physical affection but not sex when they were feeling depressed;

however, there were also women who talked about negative mood having little effect on their

sexual arousal:

P: I‟m about to go to sleep and I realize you‟re laying next to me, then the arousal comes no

matter if I was angry or I was happy before I got in the bed. … If I‟m already initially attracted to

you and we already have that type of relationship and we lay down next to each other, it‟s just

something about that person lying next to me, that arousal will come instantly no matter what

mood I‟m in. [African-American group]

DISCUSSION

Three general topics related to women‟s sexual arousal were explored using focus

groups: (1) cues to sexual arousal; (2) the distinction/overlap of sexual interest and sexual

arousal; and (3) factors related to excitation and inhibition of sexual arousal. These findings add

support for the use of focus group methodology to obtain information on sensitive topics (Seal et

al., 1998; Wilkinson, 1999). Our experience was that women expressed a wide range of thoughts

and opinions during the group discussions and also reported that the experience was both

positive and educational. Clearly, our sample was self-selected and thus likely comprised of

women who felt comfortable discussing sexuality. These limitations apply to most research on
 Women‟s sexual arousal 23

sexuality and other sensitive topics. A strength of the study is that such qualitative data give

voice to women‟s views on the process of sexual arousal that can help inform future research and

clinical work.

Arousal has traditionally been considered synonymous with lubrication (Bartlik &

Goldberg, 2000), and the current DSM-IV definition of Female Sexual Arousal Disorder is the

lack of “an adequate lubrication-swelling response of sexual excitement” (American Psychiatric

Association, 2000). Our data on how women “recognize” that they are sexually aroused support

the view that a wide range of physical (both genital and non-genital), psychological, and

behavioral changes characterize women‟s sexual arousal (Basson, 2002). Lubrication is only one

of the physiological changes that women experience when they are sexually aroused, and not a

necessary condition for women to report that they are sexually aroused. Other researchers have

acknowledged the importance of “subjective excitement” in addition to genital or other somatic

responses (Basson, 2002; Everaerd, Laan, Both, & Van der Velde, 2000). Interestingly, however,

the importance of non-genital somatic changes to women‟s experience of sexual arousal has been

little studied. In contrast, there is a large body of research on the relation between genital

response and subjective arousal (Everaerd et al., 2000), showing lower concordance between

genital response and subjective reports of arousal in women, compared with men. It is possible

that women‟s ratings of arousal are more influenced by their state of general arousal, rather than

genital response. An early study by Levi (1969), which compared urinary adrenaline and

noradrenaline excretion in men and women after exposure to erotic films, is consistent with this

possibility. Catecholamine changes in women, but not in men, were positively and significantly

correlated with changes in self-reported sexual arousal.

 Women‟s sexual arousal 24

Consistent with previous studies (Ellison, 2000; Frank, Anderson, & Rubenstein, 1978;

The Working Group for a New View of Women‟s Sexual Problems, 2001), our qualitative data

support the observation that women do not usually separate sexual “interest” from “arousal.”

Beck and Bozman (1991), in a study of college-aged males and females, suggested that

nonprofessionals do not draw the same distinction between sexual desire and arousal as

researchers do. Beck and Bozman also reported significant correlations between desire and

arousal, which led them to suggest that sexual desire and arousal may be “two facets of the same

process within the sexual response” (p. 454). In contrast with males, studies of clinical samples

of women have also reported a considerable overlap between the dimensions of sexual desire and

arousal in women (Rosen et al., 2000). Some researchers have theorized that sexual “desire”

may reflect early arousal processes (Everaerd et al., 2000). Yet, desire and arousal continue to be

defined, and studied, as independent constructs, perhaps primarily to maintain current diagnostic

classification of separate arousal and desire disorders (Rosen et al., 2000).

We designed the study to explore the concepts of SE and SI, with the goal of the

qualitative data guiding the development of a questionnaire to assess a woman‟s tendency to

respond with SE/SI. We were concerned that the existing questionnaire (SIS/SES) (Janssen et al.,

2002a), developed for use with men, might not adequately assess factors relevant to women. A

broad range of themes emerged in the focus groups, only a subset of which are presented in

detail in this paper. Our data support the ideas put forward by The Working Group for a New

View of Women‟s Sexual Problems (2001). Inhibition often arises from relational and socio-

cultural factors as well as physical and psychological problems. Many of the themes reflected

factors that may be of particular relevance to women, and ones that are not well represented in

the current SIS/SES scales. For example, the second SIS/SES factor, SIS2 (labeled “threat of
 Women‟s sexual arousal 25

performance consequences”), has 11 items that mainly relate to external threats, such as the

possibility of pregnancy or sexually transmitted disease. There are no items that cover threats

that arise from the sexual relationship or partner behavior (Janssen et al., 2002a). Yet, many

women in our study cited concerns such as being used, criticized, or rejected by partners as

important inhibitors of their arousal.

We were not surprised that some of our factors (e.g., anxiety) were cited as “inhibitors”

by some women and as “enhancers” by others. Regarding questionnaire development, it is

important that the response categories and item wording allow for the fact that a given situation

e.g., the possibility of being seen or heard while having sex can be a strong “turn-on” for some

women, and a definite “turn-off” for others. Whether SE and SI are best conceptualized as

orthogonal vs. bipolar factors remains to be established. Our findings do suggest that the

concepts of sexual inhibition and excitation were meaningful and “made sense” to women. Also,

research using the male-based SIS/SES questionnaire, with both male and female samples, has

found factors relating to SE and SI to be relatively independent (Janssen et al., 2002a).

Research with adolescents (Fine, 1988; Tolman, 2002) has provided evidence of teenage

girls‟ need to avoid becoming sexually aroused in situations where the “costs” are too high. Our

qualitative data suggest that this is something that may be important beyond adolescence. Many

women in the younger 18-24 groups talked about the need to stop themselves from becoming

aroused, or to “put on the brakes,” because of concerns about reputation, lack of trust in partner,

safety issues, etc. Younger women also seemed more likely to cite partner-related themes as

important influences on their sexual arousal. For example, grooming, dress, and personality were

frequent topics of discussion in the younger age groups, whereas themes in our “self” category
 Women‟s sexual arousal 26

(e.g. mood, physical state) were more often raised in the older groups. Research on

developmental changes and gender differences in factors affecting SE and SI is warranted.

Although the primary purpose of our study was to gather data that would inform

questionnaire development, qualitative data such as these can also be useful in generating

hypotheses for further study as well as informing our concepts of sexual arousal processes. Our

data support a growing concern that current models of sexual arousal and dysfunction may be too

genitally focused, make distinctions between interest and arousal that do not reflect the

experiences of many women, and minimize the numerous factors that can affect arousal. In

conclusion, we would agree with Heiman (2001), who argued for “systematically gathered

phenomenological data” on women‟s experiences of sexual desire and sexual arousal.

 Women‟s sexual arousal 27

ACKNOWLEDGMENTS

This research was funded (in part) by a grant from the Lilly Centre for Women‟s Health.

We thank Leah Davis, Carol McCord, Sarah Upchurch, and Kari Burns for help with moderating

the focus groups, and Danielle Wiser for assistance with data analysis.
 Women‟s sexual arousal 28

REFERENCES

American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders

(3rd ed.). Washington, DC: Author.

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders

(4th ed., text rev.). Washington, DC: Author.

Bancroft, J. (1999). Central inhibition of sexual response in the male: A theoretical perspective.

Neuroscience & Biobehavioral Reviews, 23, 763-784.

Bancroft, J., & Janssen, E. (2000). The dual control model of male sexual response: A theoretical

approach to centrally mediated erectile dysfunction. Neuroscience and Biobehavioral

Reviews, 24, 571-579.

Bancroft, J., & Janssen, E. (2001). Psychogenic erectile dysfunction in the era of

pharmacotherapy: A theoretical approach. In J. Mulcahy (Ed.), Male sexual function: A

guide to clinical management (pp. 79-89). Totowa, NJ: Humana.

Bancroft, J., Janssen, E., Strong, D., Carnes, L., & Long J. S. (2003). Sexual risk taking in gay

men: The relevance of sexual arousability, mood, and sensation seeking. Archives of

Sexual Behavior, 32. 555-572.

Bancroft, J., Janssen, E, Carnes, L, Strong, D. A., Goodrich, D., & Long, J. S. (in press). Sexual

risk taking in young heterosexual men: The relevance of personality factors. Journal of

Sex Research.

Bartlik, B., & Goldberg, J. (2000). Female sexual arousal disorder. In S. R. Leiblum & R. C.

Rosen, (Eds). Principles and practice of sex therapy, (3rd ed., pp. 85-117). New York:

Guilford Press.

Basson, R. (2002). Are our definitions of women‟s desire, arousal and sexual pain disorder too
 Women‟s sexual arousal 29

broad and our definition of orgasmic disorder too narrow? Journal of Sex and Marital

Therapy, 28, 289-300.

Beck, J. G. (1994). Hypoactive sexual desire disorder: An overview. Journal of Consulting and

Clinical Psychology, 63, 919-927.

Beck, J. G., Bozman, A. W., & Qualtrough, T. (1991). The experience of sexual desire:

Psychological correlates in a college sample. Journal of Sex Research, 28, 443-456.

Bjorklund, D. F., & Kipp, K. (1996). Parental investment theory and gender differences in the

evolution of inhibition mechanisms. Psychological Bulletin, 120,163-188.

Byers, P.Y., Zeller, R. A., & Byers, B. D. (2001). Focus group methods. In M. W. Wiederman &

B. E. Whitley (Eds.), Handbook for conducting research on human sexuality (pp. 173-

194). Belmont, CA: Wadsworth.

Carpenter, D. L., Janssen, E., & Graham, C. A. (2003). Gender differences in the factor structure

of the Sexual Excitation/Sexual Inhibition Scales (SIS/SES). (Manuscript in preparation).

Ellison, C. (2000). Women’s sexualities. Oakland, CA: New Harbinger.

Fine, M. (1988). Sexuality, schooling, and adolescent females: The missing discourse of desire.

Harvard Educational Review, 29, 501-536.

Frank, E., Anderson, C., & Rubenstein, D. (1978). Frequency of sexual dysfunction in “normal”

couples. New England Journal of Medicine, 299, 111-115.

Everaerd, W., Laan, E., Both, S., & van der Velde, J. (2000). Female sexuality. In L. Szuchman

& F. Muscarella (Eds.), Psychological perspectives on human sexuality (pp. 108-122).

New York: Wiley.

Heiman, J. R. (2001). Sexual desire in human relationships. In W. Everaerd, E. Laan, & S. Both.

(Eds.), Sexual appetite, desire and motivation: Energetics of the sexual system (pp. 117-
 Women‟s sexual arousal 30

134). Amsterdam: Royal Netherlands Academy of Arts and Sciences.

Janssen, E., Vorst, H., Finn, P., & Bancroft, J. (2002a). The Sexual Inhibition (SIS) and Sexual

Excitation (SES) Scales: I. Measuring sexual inhibition and excitation proneness in men.

Journal of Sex Research, 39, 114-126.

Janssen, E., Vorst, H., Finn, P., & Bancroft, J. (2002b). The Sexual Inhibition (SIS) and Sexual

Excitation (SES) Scales: II. Predicting psychophysiological response patterns. Journal of

Sex Research, 39, 127-132.

Knodel, J. (1993). The design and analysis of focus group studies: A practical approach. In D. L.

Morgan (Ed.), Successful focus groups: Advancing the state of the art (pp. 35-50).

Newbury Park, CA: Sage.

Levi, L. (1969). Sympatho-adreno-medullary activity, diuresis and emotional reactions during

visual sexual stimulation in human females and males. Psychosomatic Medicine, 31, 251-

268.

Lief, H. I. (1977). What‟s new in sex research? Inhibited sexual desire. Medical Aspects of

Human Sexuality, 11(7), 94-95.

Morgan, D. L. (1996). Focus groups. Annual Review of Sociology, 22, 129-152.

Morgan, D. L. (1997). Focus groups as qualitative research (2nd ed.). Thousand Oaks, CA:

Sage.

Rosen, R., Brown, C., Heiman, J., Leiblum, S., Meston, C., Shabsigh, D., et al. (2000). The

Female Sexual Function Index (FSFI): A multidimensional self–report instrument for the

assessment of female sexual function. Journal of Sex and Marital Therapy, 26, 191–208.

Seal, D. W., Bogart, L. M., & Ehrhardt, A. A. (1998). Small group dynamics: The utility of focus

group discussions as a research method. Group Dynamics: Theory, Research, and

 Women‟s sexual arousal 31

Practice, 2, 253-266.

The Working Group for a New View of Women‟s Sexual Problems. (2001). A new view of

women‟s sexual problems. In E. Kaschak & L. Tiefer (Eds.), A new view of women’s

sexual problems (pp. 1-8). New York: The Haworth Press.

Tiefer, L. (2001). General discussion. In J. Bancroft (Ed.), The role of theory in sex research (pp.

235-236). Bloomington: Indiana University Press.

Tolman, D. (2002). Dilemma of desire: Teenage girls and sexuality. Cambridge MA: Harvard

University Press.

Wilkinson, S. (1999). Focus groups. A feminist method. Psychology of Women Quarterly, 23,

221-244.
 Women‟s sexual arousal 32

Table I.

Participant Characteristics (N = 80)

n %

Race/ethnic group

Asian 2 (2.5)

Black 14 (17.5)

Hispanic 2 (2.5)

White 57 (71.3)

Other 5 (6.3)

Marital status

Single/never married 44 (55.0)

Married 18 (22.5)

Separated/divorced 15 (18.8)

Widowed 3 (3.8)

Sexual orientation

Heterosexual 50 (62.5)

Bisexual 8 (10.0)

Lesbian 19 (23.8)

Uncertain 3 (3.8)

Religion

Protestant 21 (26.3)

Catholic 12 (15.0)
 Women‟s sexual arousal 33

Jewish 3 (3.8)

Other 29 (36.3)

None 15 (18.8)

Employed

Full-time 24 (30.0)

Part-time 38 (47.5)

Not employed 18 (22.5)

Attended college, technical school

or university

Yes 77 (96.3)

No 3 (3.8)

Relationship status

Exclusive/monogamous relationship 51 (63.7)

Non-monogamous relationship 8 (10.0)

Not in a current sexual relationship 21 (26.3)

Duration of relationship (N=59)

M (in yrs) 5.18

SD 8.6

Range .67-54
 Women‟s sexual arousal 34

APPENDIX

Women‟s Sexual Excitation and Inhibition Coding Scheme

Self

Psychological state

Self-confidence; comfort with one‟s body; sexual self-knowledge;

stress/worry; procrastinating/bored; anticipation

Mood/emotional state

Negative mood state (depressed/anxious); angry; positive mood

Physical state

Energy level; general health

Sexual and relationship history

No available partner; previous sexual or relationship experience

Emotional „openness‟/vulnerability

Personal safety concerns/physical

Reputation/family and peer influence

Familial/peer judgments; religious or societal messages

Feeling desired/feeling used

Partner

Psychological characteristics

Comfort with body; personality; comfort with own or partner‟s sexual past;

partner desired by others

Physical appearance and manner

 Women‟s sexual arousal 35

Attractiveness; smell

Appropriateness

Societal standards; relationship potential

Style of approach/initiation

Relationship dynamics/interaction

Relationship quality

Relationship stage/phase

Chemistry and lust

Physical closeness/contact or touch

Elements of the sexual interaction/activities

Partner attractiveness

Partner skill

Partner inexperience

Partner enthusiasm

Partner acceptance

Partner attentiveness

Variation

Equality

Communication

Risk

Power dynamics

Specific sexual acts

Timing
 Women‟s sexual arousal 36

Imagery/fantasy/thoughts

Interruptions/physical

Comfort/discomfort

Masturbation

Setting

Romantic or sexual

Specific environment or time

Setting; time (of day, week or season)

Liberating

Sexual or erotic stimuli

External stimuli

Visual images; phone sex; internet

Internal stimuli

Fantasy/imagery

Hormones, fertility, contraception and STDs

Hormones

Fertility

Contraception

STDs/HIV

Alcohol or drug use