Journal of Sex & Marital Therapy, 29:1523, 2003

Copyright 2003 Brunner-Routledge

0092-623X/03 $12.00 + .00
DOI: 10.1080/00926230390154808

Concordance Between Womens Physiological

and Subjective Sexual Arousal Is Associated
with Consistency of Orgasm During Intercourse
But Not Other Sexual Behavior
STUART BRODY
Institute for Medical Psychology and Behavioral Neurobiology,
University of Tbingen, Germany

ELLEN LAAN
Department of Clinical Psychology, University of Amsterdam, Netherlands

RIK H.W. VAN LUNSEN

Department of Sexology and Psychosomatic Obstetrics and Gynecology,
Academic Medical Center, University of Amsterdam, Netherlands

Many studies have found a discordance between womens genital

(vaginal pulse amplitude) and subjective sexual arousal responses
to erotica. We hypothesized that the association between the physiological and subjective domains would be greater for women with
greater orgasmic consistency during penile-vaginal intercourse but
not for orgasm consistency during other sexual behaviors. We confirmed this specific hypothesis in a sample (N = 38) of postmenopausal women. In addition, we discovered that the correlation between the domains was unrelated to social desirability responding,
that orgasm consistency was not less for intercourse than for other
sexual activity, and that orgasm consistency during intercourse
was uncorrelated with orgasm consistency during masturbation.
We discuss the results in terms of the unique nature of penile-vaginal
intercourse, our studys implications for sex therapy, and orgasm
consistency during intercourse being an operational measure of
functional vaginal sensitivity and sexual pleasure integration and
organization.

In previous research, the correlation between womens genital and subjective response to visual or fantasized erotic stimuli has generally been fairly
Address correspondence to Stuart Brody, Saarbruecker Strasse 46, 54290 Trier, Germany.
E-mail: stuartbrody@hotmail.com
15

16

S. Brody et al.

low (Laan & Everaerd, 1995). However, Adams, Haynes, and Brayer (1985)
found that the correlation between vaginal pulse amplitude (VPA) and subjective sexual arousal was far greater for women with higher lifetime intercourse frequency and orgasmic consistency than for women with lower orgasmic consistency and intercourse frequency. However, they did not provide
the absolute values of intercourse frequency, except to note that a minimum
of 100 coital experiences were required in the age 1824 sample), or the
details of conditions in which orgasm occurred.
There are many differences between penile-vaginal intercourse and other
sexual behavior (Brody, 1997, In press; Brody, Veit, & Rau, 2000). In addition to the evolutionary (sociobiological) preeminence of the only potentially reproductive sexual behavior, penile-vaginal intercourse (unlike oral
sex, anal sex, and, arguably, most masturbation and partner manual stimulation) provides stimulation of the vaginal wall. An operant model of frequency of penile-vaginal intercourse (FSI) has been developed (Brody, 1997),
in which (for nonprostitute samples) FSI is a function of the pleasure that
intercourse provides. This association of intercourse pleasure with greater
FSI suggests a mediating role of vaginal sensitivity. Orgasm consistency (percentage leading to orgasm) during intercourse provides an index of sexual
reinforcement and is also an indicator of the degree to which women organize and integrate vaginal intercourse stimulation (nominally vaginal, although
clitoral logistics likely have a role for many women) to the point of orgasm.
We hypothesized that this organization and integration allows a greater association between genital and subjective arousal in women exposed to erotica
(visual or fantasized), because of an analogous process of attending to and
integrating vaginal interoceptive or proprioceptive signals. Initiation of orgasm in men and women is characterized by a series of involuntary pelvic
floor contractions with an interval of 8 ms, described by Masters and Johnson
(1966) as the orgastic platform (the congested perineal body in women
and the second phase of ejaculationthe expulsion phasein men). These
involuntary contractions are associated with the physical sensations of orgasm. Pelvic floor contractions probably are the key eliciting event in the
occurrence of orgasm. According to Sherfey (1974), orgasm is a spinal reflex
triggered by firing of the stretch receptors in the pelvic musculature. Stretching of the pubococcygeus muscle is caused by the progressive vasocongestion
during sexual arousal in men and women. Mould (1980) proposes that the
principal effect of vasocongestion is to cause biasing of the fusimotor muscle
spindles. Once the muscle spindles become highly biased and a dynamic
stretch reflex is initiated in the alpha fusimotor system via genital stimulation, the necessary conditions become established for orgasmic contractions
to occur. The clonic nature of the contractions is attributed primarily to the
effects of motor spindle biasing, which is, in turn, progressively diminished
by the dynamic contractions of orgasm because these contractions reduce
the degree of vasocongestion, which gradually disappears (Rosen & Beck,
1988). On the basis of these assumptions regarding integration of proprio-

Vaginal-Subjective Correlation and Coital Orgasm

17

ceptive signals, we offer a specific differential hypothesis: that consistency of

orgasm during intercourse, but not during other sexual behavior, will be
associated with a greater correlation between VPA and subjective arousal.
As a separate issue, we examined the possible role of social desirability
responding in the association between genital and subjective arousal in women
exposed to erotica. Social desirability responding (also known as defensiveness or lie scores) consists of an unsophisticated form of dissimulation
(denial of near-ubiquitous human shortcomings), which distorts the results
of psychological tests and epidemiological studies (Brody, 1997). It is also a
stable personality trait associated with social naivet, which is associated
with less optimal psychophysiological function (Brody, Veit, & Rau 1997;
Brody, Wagner, et al., 2000). In either its simple response bias function (i.e.,
reporting less subjective arousal despite vaginal arousal) or in its psychophysiological correlates (a disturbance of self-regulation), social desirability
responding may influence the association between genital and subjective
arousal.

METHOD
We conducted our analysis with pretest data from a study of postmenopausal
women (Laan & van Lunsen, 1997; see also Laan, van Lunsen, & Everaerd,
2001), because the dataset contained not only physiological and subjective
indices of arousal but also details of habitual sexual behavior and measures
of social desirability responding. In addition, there was ample variability in
the presence of partners and in the degree of felt deterioration of sexual
function with menopause. No significant differences in degree of genital or
subjective response to erotic films between pre- and postmenopausal women
has been found (Brotto & Gorzalka, 2002). This study was conducted in
accordance with Declaration of Helsinki guidelines, and the protocol was
approved by the Medical Ethics Committee of the University of Amsterdam
Academic Medical Center. Subjects provided written informed consent.

Subjects
Postmenopausal women (N = 38) with intact uteri and ovaries, a normal
physical examination, and no current illnesses, whose last menstrual period
occurred 12 months prior to the study, who were less than 65 years old,
and who had body mass indices between 18 and 29 kg/m2 were recruited
through advertisements in newspapers, health and womens magazines and
through a television program. We did not select subjects on the basis of
sexual function; however, we enrolled only those not consuming medication
known to influence sexual desire or response and who had not used hormone replacement therapy in the 3 months prior to enrollment.
Before we conducted the VPA measurements, we administered a Dutch

18

S. Brody et al.

translation (Hermans, 1967) of the Marlowe-Crowne Social Desirability Scale

(MC-SDS; Crowne & Marlowe, 1964). This questionnaire contains 33 items,
with a total score range from 0 (no social desirability responding) to 33
(extreme social desirability responding). Reliability (Cronbachs alpha) of
this scale in a Dutch sample was 0.68 (Brosschot, de Ruiter, & Kindt, 1999).
The total score, as well as the subscales of denial and attribution was
used in the analyses.

Measures of Response to Erotic Stimuli

VPA

MEASUREMENTS

VPA is arguably the best and most specific measure of female genital arousal
up to orgasm (Laan & Everaerd, 1998). We used a photoplethysmograph to
assess vaginal vasocongestion. The plethysmograph consists of a light-emitting diode and a light-detecting photo transistor, which detects light reflected
by the vaginal wall and the blood circulating within it. Connecting the signal
to an alternating current amplifier provides VPA, which reflects phasic changes
in vaginal engorgement accompanying each heart beat (larger amplitudes
reflect higher levels of vaginal blood flow). The plethysmograph was similar
in size to a tampon and was sterilized between uses. It was fitted through a
hole in a 29 cm acrylic plate, which was attached to the cable of the
plethysmograph 5 cm from the center of the phototransistor. Subjects inserted the plethysmograph intravaginally in private so that the acrylic plate
touched their labia. The acrylic plate controlled the depth and orientation of
the plethysmograph in the vagina. The subject then listened to music for 5
min, the last 2 min of which was the baseline period for VPA measurements.
All subjects were then exposed to four erotic stimuli in fixed sequence: a
self-induced erotic fantasy (3 min), an erotic videotape depicting foreplay (5
min), a second self-induced erotic fantasy period (3 min), and a second
erotic videotape depicting cunnilingus and intercourse (5 min). For the erotic
fantasy periods, we asked subjects to fantasize about a pleasant sexual situation and told them that they would not be questioned about the content of
their fantasies. The videotapes had female-initiated, female-centered erotic
content with soundtracks, as previously described (Laan, Everaerd, van Bellen,
& Hanewald, 1994). The erotic stimulation periods were separated by 3 min
intervals during which subjects were distracted by cartoons or concentration
tasks (allowing VPA responses to return to baseline levels), followed by a
new 2 min baseline recording.
SUBJECTIVE

SEXUAL AROUSAL

We asked subjects to assess their overall feeling of sexual arousal and their
strongest feeling of sexual arousal on a 7-point Likert scale at baseline, prior
to erotic stimulation, and immediately after exposure to each of the four

Vaginal-Subjective Correlation and Coital Orgasm

19

erotic stimuli. They did so by answering questions presented on a television

monitor. The scale ranged from 1 (not sexually aroused) to 7 (very strongly
sexually aroused).

Sexual History Questionnaire

Prior to the psychophysiological assessment, subjects filled out a sexual history questionnaire inquiring about masturbation, penile-vaginal intercourse,
and noncoital partner sexual activities (sex with a partner that did not include penile-vaginal intercourse), in one representative month during the
past 3 months (Laan & van Lunsen, 1997) and noted for each occasion whether
orgasm occurred. Orgasm consistency was the percentage of each sexual
event type resulting in orgasm (categorized into no events, 0%, 25%, 50%,
75%, and 100% orgasm consistency).
DATA

AND STATISTICAL ANALYSES

VPA was sampled at 20 Hz and delivered to a computer program specifically

designed to analyze VPA data. We visually detected movement artifacts in
the data and deleted them. We calculated peak-to-trough amplitude for each
remaining pulse and obtained a mean score per stimulus. For each 2 min
baseline recording, we calculated a mean baseline score per subject. We also
calculated VPA during exposure to erotic stimuli, relative to the baseline.
The correlation between VPA and subjective sexual arousal (eight data points:
mean and maximum arousal for each condition) was then calculated on a
within-subjects basis, and then each subjects correlation underwent a Fishers
z transformation (normalizing the distribution and allowing analyses on the
association). We then correlated this z-score with penile-vaginal intercourse
orgasm consistency, noncoital partner sex orgasm consistency, and masturbation orgasm consistency (for each correlation, only subjects engaging in
the activity during the recording period were analyzed). We used SPSS programs for the statistical analyses.

RESULTS
The age data was M = 54 years, SD = 4.4, range = 4664. Twelve women had
no steady partner, and all but two were heterosexual (the two were bisexual). Further details of the sample are available in Laan, van Lunsen, &
Everaerd (2001).
When we restricted analyses to women reporting having engaged in the
given sexual behavior during the reporting period, the z-scoretransformed
correlation between subjective arousal and VPA was associated with greater
consistency of orgasm during intercourse, r (26) = .47, p = .02, but not with
orgasm consistency during masturbation, r (26) = .03, p = .9, or noncoital

20

S. Brody et al.

activities with a partner r (14) = .12; p = .7. We obtained similar results when
women with zero frequencies for the given sexual behavior during the reporting period were included: r (37) = .36, p = .03 for intercourse orgasm
consistency, r (37) = .12, p = .5 for masturbation orgasm consistency, and
r (37) = .02, p = .9 for noncoital partner sex orgasm consistency. The three
activities had similar frequency means and standard deviations (intercourse
M = 4.1, SD = 3.7, noncoital partner sex M = 3.9, SD = 3.8, and masturbation
M = 3.6, SD = 3.3), so the difference in association with subjective and VPA
correlations is not due to differences in variance.
The mean z-score was 0.05 in the group reporting no orgasms during
intercourse, 0.53 for those having no intercourse during the recording period (perhaps a mixture of women who might have been coitally orgasmic if
they had a partner and those who would not be), 0.75 for those coitally
orgasmic 25% of occasions, 0.81 for those coitally orgasmic 50% of occasions, 0.84 for those coitally orgasmic 75% of occasions, and 0.93 for those
coitally orgasmic on 100% of occasions.
When we limited subjects to those who engaged at least once each in
two of the sexual activities during the recording period, we found that orgasm consistency during intercourse was unrelated to orgasm consistency
during masturbation, r (18) = .08, and inversely related to orgasm consistency during noncoital partner sex, r (12) = .57, p = .053. Masturbation
orgasm consistency was not related to noncoital partnered orgasm consistency, r (10) = .40, p = .25: however, given the magnitude of the correlation
coefficient, the latter nonsignificance appears to be at least partially a result
of the small sample size.
Of the women engaging in the activity during the recording period,
38.5% reported having an orgasm during 100% of intercourses (7.7% during
75%, 23.1% during 50%, and 15.4% during 25%), 48.1% during 100% of masturbations (3.7% during 75%, 33.3% during 50%, and 3.7% during 25%), and
40% during 100% of noncoital partner sex occasions (0% at 75% and 25%,
and 6.7% at 50%). These proportions were not significantly different by activity (using the 100%, combined 100% and 75%, 100% and 75% and 50%, or
100%, 75%, 50%, and 25% values; all p values from the chi-square crosstabulations > .1).
The z-scoretransformed correlation between subjective arousal and VPA
was not associated with overall social desirability responding (MC-SDS) or
with the subscales of denial or attribution (all |r| < .03).

DISCUSSION
Women with greater orgasm consistency during intercourse had greater concordance between VPA and subjective arousal. The concordance was unrelated to orgasm consistency during either masturbation or noncoital partner

Vaginal-Subjective Correlation and Coital Orgasm

21

sex. Thus, it is specifically penile-vaginal intercourse orgasm consistency

that is related to integrating of vaginal response into the appraisal of arousal.
Whether the results are the result of general vaginal stimulation or specific to
penile stimulation of the vagina remains to be detailed in other work. Until it
is demonstrated that nonpenile vaginal stimulation produces similar results,
our impression is that it is the latter.
There are important differences between intercourse and other sexual
behaviors (for example, only intercourse frequency is associated with indices of better health status; Brody, 1997; Brody, Veit, & Rau 2000). Not surprisingly, there are differences between the orgasms derived from intercourse
and those from other behaviors (see Davidson & Darling, 1989). It may be
that women with greater intercourse orgasm consistency are more sensitive
to vaginal sensation, more able to organize and integrate vaginal sensations
(as they do in having an orgasm during intercourse), or more attentive to
internal rather than external cues. In this case, external refers at least to a
focus on distracting, less purely sexually stimulating aspects of the erotic
situation. Whether external also pertains to direct clitoral stimulation is
unclear, because we do not know whether or not the women had direct
clitoral stimulation during the intercourse occasions that resulted in orgasm.
There may be an analogy between the finding that only intercourse (but not
other sexual behavior) orgasm consistency is related to VPA-subjective arousal
concordance and the finding that only womens intercourse (but not other
sexual behavior) frequency is related to more emotional integration (lower
alexithymia scores; Brody, In press).
The lack of association between intercourse and masturbation orgasm
consistency has potential implications for sex therapy, because it may provide support for women bypassing directed masturbation in favor of more
coitally focused interventions (Hurlbert & Apt, 1995; Pierce, 2000). The inverse association between orgasm consistency during intercourse and during noncoital partner sex might be the result of a compensatory strategy in
which women who are not consistently orgasmic during intercourse engage
in more noncoital activities. Of course, a womans not being orgasmically
consistent during intercourse may be at least in part the result of her partners
characteristics. It is interesting to note that reported orgasm consistency in
our sample was neither statistically or meaningfully less for intercourse than
for other sexual activity.
The association between VPA and subjective arousal was not mediated
by social desirability responding. A conservative inference is that in this
group of women from the Netherlands (a country that is far more sex-friendly
than most others, including the United States; Posner & Silbaugh, 1996), that
form of nave response bias did not affect the correlation. Although it is
tempting to make further conjectures regarding the lack of psychophysiological correlation with the personality dimension of social desirability responding, it should be noted that in prior studies, such correlations were

22

S. Brody et al.

only found in persons younger than those in the current sample (under age
45; Brody, Wagner, et al., 2000).
Future research should use larger samples, examine premenopausal
women (although in the present study, VPA levels during erotic stimulation
by film in each treatment group were similar to those previously recorded in
younger women; Laan & van Lunsen 1997; Laan, van Lunsen, & Everaerd
2001), and perhaps examine if any subjects had stimulation in addition to
that afforded directly by intercourse to achieve intercourse orgasm (such as
concurrent manual stimulation). In any study of sexual behavior, it is incumbent upon researchers to differentiate between penile-vaginal intercourse
and other sexual behaviors and to not use summary measures.

REFERENCES
Adams, A. E., Haynes, S. N., & Brayer, M. A. (1985). Cognitive distraction in female
sexual arousal. Psychophysiology, 22, 689696.
Brody, S. (1997). Sex at risk: Lifetime number of sexual partners, frequency of intercourse, and the low AIDS risk of vaginal intercourse. New Brunswick, N.J.: Transaction.
Brody, S. (In press). Alexithymia is inversely associated with womens frequency of
vaginal intercourse. Archives of Sexual Behavior.
Brody, S., Veit, R., & Rau, H. (1997). Lie scores are associated with less cardiovascular reactivity to baroreceptor stimulation and to mental arithmetic stress. Personality and Individual Differences, 22, 677681.
Brody, S., Veit, R., & Rau, H. (2000). A preliminary report relating frequency of
vaginal intercourse to heart rate variability, Valsalva ratio, blood pressure, and
cohabitation status. Biological Psychology, 52, 251257.
Brody, S., Wagner, D., Heinrichs, M., James, A., Hellhammer, D., & Ehlert, U. (2000).
Social desirability scores are associated with higher morning cortisol levels in
firefighters. Journal of Psychosomatic Research, 49, 227228.
Brosschot, J. F., de Ruiter, C., & Kindt, M. (1999). Recall and recognition of threatening, pleasant, and neutral words in repressors. European Journal of Personality
13, 114.
Brotto, L. A., & Gorzalka, B. B. (2002). Genital and subjective sexual arousal in
postmenopausal women: Influence of laboratory-induced hyperventilation. Journal of Sex & Marital Therapy, 28, 3953.
Crowne, D. P., & Marlowe, D. (1964). The approval motive: Studies in evaluative
dependence. New York: Wiley.
Davidson, K. J., & Darling, C. (1989). Self-perceived differences in the female orgasmic response. Family Practice Research Journal, 8, 7584.
Hermans, H. (1967). Motivatie en prestatie [Motivation and achievement]. Amsterdam:
Swets & Zeitlinger.
Hurlbert, D. F., & Apt, C. (1995). The coital alignment technique and directed masturbation: A comparative study on female orgasm. Journal of Sex & Marital
Therapy, 21, 2129.
Laan, E., & Everaerd, W. (1995). Determinants of female sexual arousal: Psycho-

Vaginal-Subjective Correlation and Coital Orgasm

23

physiological theory and data. Annual Review of Sex Research, 6, 3276.

Laan, E., & Everaerd, W. (1998). Physiological measures of vaginal vasocongestion.
International Journal of Impotence Research, 10 (Suppl. 2), 107110.
Laan, E., Everaerd, W., van Bellen, G., & Hanewald, G. (1994). Womens sexual and
emotional responses to male- and female-produced erotica. Archives of Sexual
Behavior, 23, 153170.
Laan, E., & van Lunsen, R. H. W. (1997). Hormones and sexuality in postmenopausal
women: A psychophysiological study. Journal of Psychosomatic Obstetrics and
Gynecology, 18, 126133.
Laan, E., van Lunsen, R. H. W., & Everaerd, W. (2001). The effects of tibolone on
vaginal blood flow, sexual desire and arousability in postmenopausal women.
Climacteric, 4, 2841.
Masters, W. H., & Johnson, V. V. (1966). Human sexual response. Boston: Little,
Brown.
Mould, D. E. (1980). Neuromuscular aspects of womens orgasms. Journal of Sex
Research, 16, 193201.
Pierce, A. P. (2000). The coital alignment technique (CAT): An overview of studies.
Journal of Sex & Marital Therapy, 26, 257268.
Posner, R. A., & Silbaugh, K. B. (1996). A guide to Americas sex laws. Chicago:
University of Chicago Press.
Rosen, R. C., & Beck, J. G. (1988). Patterns of sexual arousal: Psychophysiological
processes and clinical applications. New York: The Guilford Press.
Sherfey, M. J. (1974). Some biology of sexuality. Journal of Sex & Marital Therapy, 1,
97102.