ORIGINAL PAPER
Laboratory-Induced Hyperventilation Differentiates Female
Sexual Arousal Disorder Subtypes
Lori A. Brotto Æ Carolin Klein Æ Boris B. Gorzalka
Received: 21 November 2006 / Revised: 26 May 2007 / Accepted: 20 October 2007 / Published online: 15 March 2008
Ó Springer Science+Business Media, LLC 2008
Abstract The effects of heightened sympathetic nervous
system (SNS) activity via laboratory-induced hyperventila-
tion (LIH) on subjective and physiological sexual arousal
were examined in a heterogeneous group of women with
Sexual Arousal Disorder (SAD; n = 60), as well as across
subtypes of SAD, in comparison to a control group of women
without sexual difficulties (n = 42). Participants took part in
2 min of rapid breathing, a technique previously found to
increase SNS activity, immediately prior to viewing erotic
stimuli. Physiological arousal (i.e., vaginal pulse amplitude;
VPA) was measured via the vaginal photoplethysmograph
and subjective arousal was measured via self-report ques-
tionnaires. LIH differentiated women with SAD from those
in the control group, with LIH increasing VPA in the latter,
but having no significant effect in the heterogeneous SAD
group. However, among subtypes of SAD, LIH differenti-
ated women with genital (n = 16) and subjective (n = 16)
subtypes of SAD from women with combined SAD (n = 28)
and women without sexual difficulties. Specifically, women
in the control group and those with combined SAD had a
significant increase in VPA whereas women with genital or
subjective SAD had a significant decrease in VPA following
LIH. There was no significant effect of LIH on any self-
report measure of sexual arousal following erotic stimuli.
Implications of the results for the conceptualization, diag-
nosis, and treatment of SAD are discussed.
Keywords Female Sexual Arousal Disorder Á
Sexual dysfunction Á Sympathetic nervous system Á
Photoplethysmograph
Introduction
Diagnostic Issues in Female Sexual Arousal Disorder
Masters and Johnson’s (1966) proposed human sexual res-
ponse cycle conceptualized the stages of the cycle—excite-
ment (now termed arousal), plateau, orgasm, and resolution—
in terms of physiological changes. This conceptualization has
carried on to the current classification system of sexual dys-
functions. Both the current versions of the Diagnostic and
Statistical Manual of Mental Disorders (DSM-IV-TR; Ameri-
can Psychiatric Association, 2000)andtheInternational Clas-
sification of Diseases (ICD-10; World Health Organization,
1999) define the majority of the sexual dysfunctions solely in
terms of physiological difficulties as described by Masters and
Johnson.
Female Sexual Arousal Disorder (SAD) is defined
according to both the DSM-IV-TR and the ICD-10 as ‘‘per-
sistent or recurrent inability to attain, or to maintain until
completion of the sexual activity, an adequate lubrication or
swelling response of sexual excitement.’’ Sexual arousal com-
plaints are seen in approximately 12–21% of women in
American and Swedish samples (Fugl-Meyer & Fugl-Meyer,
1999; Laumann, Paik, & Rosen, 1999), with even higher
prevalence rates found in Asian and Southeast Asian women
(Laumann et al., 2005). Among women seeking routine care
in gynecologic settings, as many as 75% have been suggested
L. A. Brotto (&)
Department of Obstetrics and Gynaecology, University of British
Columbia, 2775 Laurel Street, 6th floor, Vancouver, BC, Canada
V5Z 1M9
e-mail: lori.brotto@vch.ca
C. Klein Á B. B. Gorzalka
Department of Psychology, University of British Columbia,
Vancouver, BC, Canada
123
Arch Sex Behav (2009) 38:463–475
DOI 10.1007/s10508-007-9288-7