The basic relationship between alcohol and women's sexual arousal - especially genital arousal - received little research attention for nearly 30 years (e.g. Wilson and Lawson, 1978) until very recently (e.g. George et al., 2009). To investigate hypotheses based on earlier findings and Alcohol Myopia Theory (AMT), two experiments evaluated the effects of high blood alcohol concentrations (BACs) and arousal instructional demands on indices of vaginal responding and self-reported sexual arousal. In Experiment 1, self-control instructions to maximize (versus suppress) arousal increased peak and average Vaginal Pulse Amplitude (VPA) change. Self-control also interacted with a target BAC of .08%(versus .00%) to influence latency to peak arousal onset: Intoxicated women instructed to maximize showed a shorter latency to peak arousal than did intoxicated women instructed to suppress; however, sober women showed an undifferentiated pattern. Also, in Experiment 1, the target BAC of .08% had no effect on VPA or subjective arousal measures. In Experiment 2, a target BAC of .10%(versus .00%) attenuated peak change and average change in VPA, but this dosage had no effects on latency to peak achieved arousal, or on subjective arousal. Instructions to maximize arousal (versus no instruction) had no effect on any arousal measures. Overall, among young moderate drinking women, alcohol had attenuating effects but only at the higher dosage. Maximize versus suppress instructions about arousal had predicted effects on arousal and interactive effects on latency, but only at the lower dosage. The findings highlight the importance of dosage and contextual factors in alcohol's impact on the variability of women's sexual responding.

Based on research showing that alcohol expectancy and gender both play a role in sexual perceptions, we factorially crossed the apparent drinking status of yoked pairs consisting of a participant and a target person (a confederate posing as co-participant). Alcohol expectancy interacted with gender in complex ways to influence sexual perceptions. We also found behavioral effects: Men showed more erotic material to both male and female targets than women did. Men perceived the target as more sexually aroused by erotic material than women did. Men also showed more erotic material to drinking targets than to non-drinking targets. Sexual perceptions and erotica showing behavior were correlated significantly and positively. These findings are discussed in terms of implications for postdrinking heterosexual encounters.

Alcohol has been implicated as having a causal role in a variety of sexual processes and outcomes. We review nonexperimental research illustrating the nature of alcohol's association with sexuality. Methodological considerations limiting causal assertions permissible with nonexperimental data are discussed. We also review findings from experiments, mostly analogue paradigms, examining the effects of alcohol on genital arousal, sexual risk taking, and sexual assault. In each case, it is observed that alcohol can exert a causal effect on one or more of the constituent responses undergirding these phenomena. We conclude that alcohol does appear to have a causal impact on many sexuality indices studied in laboratory conditions. Both alcohol expectancy and alcohol myopia models have been applied to explain these causal linkages. Expectancy models seem to account well for postdrinking sexual reactions and perceptions. Overall, myopia analyses seem to offer the most persuasive explanations of postdrinking expressions of sexual risk taking and sexual assault.

OBJECTIVE: We evaluated the self-fulfilling prophecy hypothesis that belief in an "alcohol enhances/stimulates sex" expectancy fosters heightened sexual behavior-via effects on intermediate sexual perceptions. To test this notion, we investigated the effects of self-reported alcohol expectancies, alcohol expectancy set and a co-participant's gender and apparent drinking status on dyadic viewing of erotica. METHOD: Sex-related alcohol expectancies were assessed in 100 male moderate social drinkers. In a subsequent session, participants were led to believe they were consuming either alcoholic or nonalcoholic drinks. No alcohol was actually administered. Each participant rated his sexual arousal, rated an alcohol-drinking or nondrinking co-participant on sexual disinhibition and then viewed erotic slides with the co-participant. Slide viewing times were assessed unobtrusively. RESULTS: Path analysis revealed support for the self-fulfilling prophecy hypothesis: Expectancy score (moderated by alcohol expectancy set) heightened viewing indirectly via effects on sexual arousal (beta =.26) and perceived disinhibition (beta =.25). Sexual arousal in turn predicted perceived disinhibition (beta =.37), which in turn predicted viewing (beta =.23). Co-participant drinking had direct (beta =.21) and indirect (beta =.40 via perceived disinhibition) effects on viewing. CONCLUSIONS: Alcohol expectancy variables-apart from alcohol-interactively determined men's responding in a dyadic sexual situation. Consistent with psychosocial formulations, predrinking expectancy steered postdrinking perceptions along an expectancy-congruent course to shape subsequent behavior. Thus, alcohol's role in stimulating men's sexual responding cannot be construed as occurring through a strictly pharmacological mechanism. Speculations about the comparative domains of expectancy versus alcohol explanations are discussed.

OBJECTIVE We examined the role of drinking restraint (temptation and restriction), beverage instructions and content and self- monitoring in alcohol-related outcomes (consumption, subjective intoxication and blood alcohol concentration [BAC]) in a sample of moderate-to heavy-drinking young men. METHOD Male social drinkers (N = 132) participated in an individualized taste-rating task (TRT), an unobtrusive method for determining ad libitum alcohol consumption. Beverages were presented using the format of the balanced placebo design (BPD), in which subjects' expectation of an alcoholic versus a non- alcoholic beer was crossed with their receipt of an alcoholic versus a nonalcoholic beer. During a single 30-minute drinking occasion, each subject sampled two beers and rated their taste characteristics on a computer. RESULTS Consumption during the TRT, ratings of subjective intoxication and postdrinking BAC, served as criterion variables in regressions in which BPD beverage condition, the two aspects of drinking restraint, self-monitoring, and their interactions, served as the predictors. The results indicated that TRT consumption was mainly a function of the temptation to drink (an aspect of restraint). As expected, assignment to the conditions of the BPD predicted subjective intoxication and BAC. Self-monitoring did not have an impact on any of the alcohol- related outcomes. CONCLUSIONS The results for TRT consumption suggest that drinking restraint, particularly the temptation to drink (i.e., view the regulation of intake as difficult and/or drink to repair negative affective states), enhances the consumption of social drinkers during a single drinking occasion. Consistent with previous research, the conditions of the BPD predicted some alcohol-related outcomes.

Summarizes physiological findings and reviews the psychological experimental literature investigating the relationship between alcohol and human sexuality. Specifically, the authors attempt to reconcile the apparent contradictions found in the effects of alcohol on male and female sexual responding. The review concludes (a) that alcohol disinhibits psychological sexual arousal and suppresses physiological responding, the former effect being stronger at lower doses of alcohol and the latter effect at higher doses;(b) that although suppression is strictly pharmacological in nature, disinhibition appears to be both pharmacological (the result of cognitive impairment) and psychological (the result of socially learned expectancies); and (c) that expectancies and cognitive impairment can disinhibit separately or jointly.

A principal components factor analysis of survey data from 393 college student drinkers (178 males) extracted four dimensions from a set of 16 reasons for drinking: avoidance, social, sensation seeking, and enjoyment. Motivational patterns and the relationships with alcohol use were examined with a canonical correlation analysis. Three significant canonical variates were found. The first variate contained students with high scores on all motivational factors. They were heavy drinkers with many alcohol-related problems. The second variate indicated that drinkers who drank primarily for enjoyment tended to be women who drank moderately. Male beer drinkers with strong sensation seeking motivations formed the third variate.

Background This phase IIb study explored the antiviral activity and safety of the investigational CC chemokine receptor 5 (CCR5) antagonist aplaviroc (APL) in antiretroviral-naïve patients harbouring R5- or R5X4-tropic virus. Methods A total of 191 patients were randomized 2:2:2:1 to one of three APL dosing regimens or to lamivudine (3TC)/zidovudine (ZDV) twice daily (bid), each in combination with lopinavir/ritonavir (LPV/r) 400 mg/100 mg bid. Efficacy, safety and pharmacokinetic parameters were assessed. Results This study was terminated prematurely because of APL-associated idiosyncratic hepatotoxicity. A total of 141 patients initiated treatment early enough to have been able to complete 12 weeks on treatment [modified intent-to-treat (M-ITT) population]; of these, 133 completed the 12-week treatment phase. The proportion of subjects in the M-ITT population with HIV-1 RNA <400 copies/mL at week 12 was 50, 48, 54 and 75% in the APL 200 mg bid, APL 400 mg bid, APL 800 mg once a day (qd) and 3TC/ZDV arms, respectively. Similar responses were seen in the few subjects harbouring R5X4-tropic virus (n=17). Common clinical adverse events (AEs) were diarrhoea, nausea, fatigue and headache. APL demonstrated nonlinear pharmacokinetics with high interpatient variability. Conclusions While target plasma concentrations of APL were achieved, the antiviral activity of APL+LPV/r did not appear to be comparable to that of 3TC/ZDV+LPV/r.

BACKGROUND Vulvo-vaginal swabs (VVSs) are not validated for use by the manufacturers of two widely used nucleic acid amplification tests (NAAT) for the detection of Chlamydia trachomatis. However, there is evidence that this type of swab is suitable for diagnosis. OBJECTIVE To validate the Cobas Taqman CT assay for the detection of C trachomatis in VVS. METHOD Women aged 18-24 years attending a genitourinary medicine clinic were invited to take part in the study. Participants provided a self-taken VVS and the results obtained with these samples were compared with those obtained with an endocervical swab collected by a healthcare worker. A total of 267 women took part. RESULTS 255/267 (96%; 95% CI 92 to 98%) sets of samples gave concordant results. 12/267 (4.5%) VVSs were invalid/inhibitory and so no result was available for these samples. This compared with 2/267 (0.7%) for endocervical swabs. CONCLUSION VVS are suitable samples for detecting C trachomatis.

A 63-year-old female developed respiratory failure and was admitted to the Intensive Care Unit for non-invasive ventilation, inotropic support and antibiotic therapy. The patient was initially stable but then suddenly deteriorated with acute pulmonary oedema requiring mechanical ventilation. An electrocardiogram showed an acute ST elevation myocardial infarction and the patient subsequently had an urgent coronary angiogram which revealed normal coronary arteries but apical ballooning characteristic of Takotsubo cardiomyopathy. A short review is provided of this relatively newly described heart syndrome which has the potential to present in numbers of intensive care patients. This case emphasises the importance of being aware of uncommon causes of acute ECG changes in the critically ill.

Both influenza and respiratory syncytial virus (RSV) cause epidemics of respiratory illness of variable severity during the winter season. Influenza in particular has been blamed for hospital winter bed pressures, although it is thought that RSV may also play a role. Human metapneumovirus (hMPV) is a new respiratory virus reported to be important in children; only a limited number of studies are available for adult populations. We aimed to determine initially the burden of virologically confirmed infections, i.e. influenza, RSV and hMPV using polymerase chain reaction (PCR) technology and, in addition, to assess the feasibility of this approach as a surveillance tool for these respiratory viruses. Adult patients admitted to hospital in the previous 24 hours with onset of acute respiratory symptoms in the last 14 days were asked to participate. Informed written consent was obtained and nose and throat swabs taken. Multiplex PCR for influenza A (H1N1 and H3N2), influenza B and RSV A and B were carried out together with a separate PCR for hMPV. A total of 219 patients in 2001-2002 and 216 in 2002-2003 were tested and the combined results for both seasons were: 8 positive for influenza A/H1N1, 14 for influenza A/H3N2, 2 for influenza B, 14 for RSV A and 6 for RSV B. Most patients (261/435) were >65 years and most positives (30/44) were found within this age group. A number of patients aged >65 years who were positive for influenza (12/15) reported having had vaccine. In total, 373 samples were tested for hMPV and 20 were found positive across all age groups except the 45-54 years age group. As influenza activity was low during the study period the impact of infection on admissions could not be assessed. Nevertheless the viruses studied accounted for 15% of hospital admissions for respiratory infection. Most patients were aged >65 years, as expected. In the two years studied RSV and hMPV were each responsible for as many hospitalized cases of respiratory infection as influenza. Influenza infection must be considered even in those who give a history of vaccination. The molecular methods used in this study showed that surveillance of these respiratory viruses can be conducted and may help in the management of patients.

The declining incidence of AIDS-related opportunistic diseases among people with HIV infection has shifted the focus of clinical management to prevention and treatment of comorbidities such as chronic liver disease. The increased risk of hepatitis C virus (HCV)-related advanced liver disease in people with HIV infection makes early HCV diagnosis a priority. To assess HCV prevalence and predictors of HIV/HCV coinfection, we have conducted a retrospective analysis of people enrolled in the CAESAR (Canada, Australia, Europe, South Africa) study, a multinational randomized placebo-controlled study of the addition of lamivudine to background antiretroviral therapy. The impact of HCV on HIV disease progression was also examined. Anti-HCV antibody testing on 1649 CAESAR study participants demonstrated a HIV/HCV coinfection prevalence of 16.1%, which varied from 1.9% in South Africa to 48.6% in Italy. The strongest predictor of HIV/HCV coinfection was HIV exposure category (P<0.0001), with odds ratios (ORs) compared to homosexual as follows: injecting drug use (IDU), 365 [95% confidence interval (CI): 179-742]; transfusion or blood products, 32.2 (95% CI: 15.2-67.6); homosexual and IDU, 22.9 (95% CI: 8.5-62.1). The prevalence of HIV/HCV was low (3.7%) among homosexual men without reported IDU. Other predictors of HIV/HCV coinfection were alanine aminotransferase (ALT), country of residence, ethnicity and stage of HIV disease. A history of IDU or ALT > or =40 U/L at baseline had a positive predictive value (PPV) of 35%, negative predictive value (NPV) of 96%, sensitivity of 82% and specificity of 71% for HIV/HCV coinfection. HIV disease progression was similar in HIV monoinfected and HIV/HCV coinfected patients. People with HIV and a history of IDU or elevated liver function tests should be targeted for HCV testing. The low prevalence of HIV/HCV coinfection among homosexual men without a history of IDU suggests low efficiency of sexual HCV transmission.

ABSTRACT Introduction. Few studies have examined differences in women's sexual arousal based on sexual assault history (SAH) or in-the-moment alcohol intoxication. Only one has examined combined effects. Findings regarding the relationship between SAH and arousal are contradictory. Aim. We aimed to determine the relationship between SAH, alcohol intoxication, and sexual arousal. Methods. Women were randomly assigned to an alcohol (target blood alcohol level = 0.10%) or control condition and categorized as having an SAH or not. After beverage administration, all women watched erotic films while genital arousal (vaginal pulse amplitude; VPA) was measured. Afterward, self-reported sexual arousal was measured. Main Outcome Measures. Genital response was measured by VPA using vaginal photoplethysmography while watching erotic films. Self-reported sexual arousal was assessed after watching erotic films. Results. Women with an SAH had smaller increases in genital arousal in response to the films than women without an SAH. Intoxicated women had smaller increases in genital arousal than sober women. However, no differences for SAH or intoxication were found in self-reported arousal. Conclusion. SAH and alcohol intoxication are associated with smaller increases in genital arousal compared to women without an SAH and sober women, suggesting that these co-occurring factors impact sexual arousal. Gilmore AK, Schacht RL, George WH, Otto JM, Davis KC, Heiman JR, Norris J, and Kajumulo KF. Assessing women's sexual arousal in the context of sexual assault history and acute alcohol intoxication. J Sex Med **;**:**-**.

Basic mechanisms through which men and women self-regulate arousal have received little attention in human experimental addiction research, although stress-response-dampening and craving theories suggest an important role of emotional arousal in motivating alcohol use. This study examined gender differences in the effects of acute alcohol intoxication on psychophysiological and self-reported arousal in response to emotionally negative, positive, and neutral, and alcohol-related, picture cues. Thirty-six social drinkers (16 women) were randomly assigned to an alcohol, placebo, or control beverage group and exposed to picture cues every 10 s (0.1 Hz presentation frequency). Psychophysiological arousal was assessed via a 0.1-Hz heart rate variability (HRV) index. A statistically significant beverage group-by-gender interaction effect on psychophysiological, but not self-reported, arousal was found. The 0.1-Hz HRV responses to picture cues were suppressed by alcohol only in men. This gender-specific suppression pattern did not differ significantly across picture cue types. There were no significant gender differences in the placebo or control group. Greater dampening of arousal by alcohol intoxication in men, compared with women, may contribute to men's greater tendency to use alcohol to cope with stress.

Sex and drinking go hand-in-hand in Western societies. Men also tend to report more sexual disinhibition under the influence of alcohol and drugs than women. At a vacation resort, we conducted a survey of young men and women regarding self-reported alcohol-related sexual disinhibition (ARSD), and we administered the Drinking-Induced Disinhibition Scale (DIDS). We made several comparisons of behavioral patterns using the ARSD scale of the DIDS for each gender: kissing or having sex vs. no sexual contact, or having sex versus kissing or no contact. In general, men reported more ARSD than women. Men who reported either kissing or having sex the night before reported significantly more ARSD than men not reporting either kissing or having sex. Women who had had sex the night before reported more ARSD than women who had either kissed or not reported any sexual contact on the night before, but women who had kissed did not differ from women who had not had any sexual contact. We suggest that while the DIDS scale of alcohol-related sexual disinhibition is a valid instrument, gender bias exists. In conclusion, the DIDS does measure the constructs that it sets out to measure. However, significant gender differences do exist and appear to go beyond differences in actual behavior in terms of sexual disinhibition. Men and women describe themselves differently when they describe sexual behavior in general, even when they report similar recent behavior, and we suggest that these differences at least partly reflect sexual stereotypes.

Three experiments supported the idea that alcohol fosters sexual risk-taking in men and women, in part, through its effects on sexual arousal. In Experiment 1, increasing alcohol dosage (target blood alcohol levels of .00,.04,.08%) heightened men's and women's risk-taking intentions. Alcohol's effect was indirect via increased subjective sexual arousal; also, men exhibited greater risk-taking than women. In Experiment 2, an extended dosage range (target blood alcohol levels of .00,.06,.08,.10%) heightened men's risk-taking intentions. Alcohol's effect again was indirect via subjective arousal. Physiological sexual arousal, which was unaffected by alcohol, increased risk-taking via increased subjective arousal. In Experiment 3, alcohol increased women's risk-taking indirectly via subjective arousal, but alcohol-attenuated physiological arousal had no effect on risk-taking. Implications for alcohol myopia theory and prevention interventions are discussed.

This article reviews what is currently known about how men and women respond to the presentation of visual sexual stimuli. While the assumption that men respond more to visual sexual stimuli is generally empirically supported, previous reports of sex differences are confounded by the variable content of the stimuli presented and measurement techniques. We propose that the cognitive processing stage of responding to sexual stimuli is the first stage in which sex differences occur. The divergence between men and women is proposed to occur at this time, reflected in differences in neural activation, and contribute to previously reported sex differences in downstream peripheral physiological responses and subjective reports of sexual arousal. Additionally, this review discusses factors that may contribute to the variability in sex differences observed in response to visual sexual stimuli. Factors include participant variables, such as hormonal state and socialized sexual attitudes, as well as variables specific to the content presented in the stimuli. Based on the literature reviewed, we conclude that content characteristics may differentially produce higher levels of sexual arousal in men and women. Specifically, men appear more influenced by the sex of the actors depicted in the stimuli while women's response may differ with the context presented. Sexual motivation, perceived gender role expectations, and sexual attitudes are possible influences. These differences are of practical importance to future research on sexual arousal that aims to use experimental stimuli comparably appealing to men and women and also for general understanding of cognitive sex differences.

Previous studies have identified a positive relationship between dietary restraint and alcohol use. However, it is unclear whether heavier drinking is associated with higher dietary restraint per se, or restraint combined with a tendency towards disinhibition. The aim of the present study was to examine alcohol use behaviours in women classified using both restraint and disinhibition scores. Forty-four young female social drinkers gave self-reported measures of their drinking behaviour, including frequency and quantity of alcohol consumed and frequency of drunkenness and binge drinking. Attentional bias for alcohol-related stimuli was also assessed using a dot probe detection task. Finally, the Temptation and Restraint Inventory was used to investigate whether preoccupation with drinking might underlie the relationship between dietary and drinking behaviours. Women classified as both highly restrained and disinhibited tended to report more episodes of drunkenness, showed an attentional bias for alcohol-related words, and had greater cognitive preoccupation with drinking compared to other dietary groups. These data suggest that a tendency towards overeating (disinhibition) combined with attempts at restriction is associated with increased alcohol use behaviours, perhaps due to a greater preoccupation with alcohol.

The role of pain-related fear in the etiology and/or maintenance of superficial dyspareunia is still unclear. The objective of this experiment was to investigate the effects of pain-related fear on sexual arousal in women with superficial dyspareunia (n=48) and women without sexual complaints (n=48). To induce pain-related fear, participants were told that they had a 60% chance of receiving painful stimuli while being exposed to one of two erotic film clips. Genital arousal was assessed using vaginal photoplethysmography. Self-reported ratings of genital sensations and affect were collected after both erotic stimulus presentations. Elevated levels of skin conductance and higher ratings of experienced threat during the pain threat condition indicated that fear was successfully elicited. Pain-related fear impeded genital arousal in all women. Women of both groups reported significantly less positive affect and more negative affect when threatened. Although women with dyspareunia did not differ in their genital responsiveness from women without sexual complaints, they experienced overall significantly more negative affect than the control group. The present results indicate that pain-related fear reduces genital and subjective sexual responding in women with and without sexual problems. We conclude that emotional appraisal of the sexual situation determines genital responsiveness in both sexually dysfunctional and functional women.

Previous research findings indicate that women suffer a variety of detrimental effects from exposure to violent pornography. This study used an experimental paradigm to examine the effects of a moderate alcohol dose and alcohol expectancies on women's acute reactions to a violent pornographic stimulus. A community sample of female social drinkers (N = 134) read an eroticized rape depiction after completing an alcohol administration protocol. As predicted, intoxicated participants were less likely to label the depicted events as rape than their sober counterparts. A path analytic model illustrated that participants' self-reported sexual arousal to the stimulus, as influenced by alcohol consumption and expectancies, resulted in increased rape myth congruent perceptions of the victim and decreased labeling of the incident as rape. Findings suggest that acute alcohol intoxication during violent pornography exposure may ultimately result in women developing more calloused attitudes toward rape and rape victims.

Conflicting data exist regarding the sexual arousal patterns of post-operative male-to-female (MTF) women with Gender Identity Disorder. The purpose of this study was to examine objective and subjective aspects of the sexual arousal response using a vaginal photoplethysmograph. Fifteen MTF women viewed neutral and erotic audiovisual film segments while their blood flow patterns were monitored. Subjective measures of affect and sexual arousal were taken before and immediately after the films. There was a significant increase in self-reported subjective arousal, perceived genital arousal, perceived autonomic arousal, and positive affect; however, movement artefacts interfered with our assessment of the genital arousal response. MTF women reported both low levels of pain and low levels of awareness of the vaginal probe during testing. These data are discussed in the context of differences in pelvic musculature between natal and new women and have implications for future studies that aim to measure sexual arousal objectively in MTF women.

The goals of this study were to determine the effects of past-year stimulant and sedative drug use on alcohol-related aggression and to examine whether the relation between stimulant drug use and intoxicated aggression is better accounted for by behavioral disinhibition. Participants were 330 healthy social drinkers (164 men and 166 women) between 21 and 35 years of age. Past-year stimulant and sedative use and behavioral disinhibition were assessed via self-report questionnaires. Following the consumption of either an alcohol or a placebo beverage, participants were tested on a modified version of the Taylor Aggression Paradigm [Taylor, S.(1967). Aggressive behavior and physiological arousal as a function of provocation and the tendency to inhibit aggression. Journal of Personality, 35, 297-310] in which mild electric shocks were received from, and administered to, a fictitious opponent. Aggressive behavior was operationalized as the shock intensities administered to the fictitious opponent under conditions of low and high provocation. Results indicated that alcohol significantly strengthened the relation between stimulant drug use and aggression, but only among men. Behavioral disinhibition did not account for this effect. Regardless of past-year drug use, alcohol did not facilitate aggression among women. The present findings suggest that stimulant drug use may be a risk factor for intoxicated aggression for men. However, the underlying mechanisms accounting for this effect remain unclear.