Cynthia Graham | Indiana University (original) (raw)

Papers by Cynthia Graham

Journal of Sex Research, 2006

Archives of Sexual Behavior, 2003

The aim of this study was to explore gender differences in sexual responsiveness to erotic films ... more The aim of this study was to explore gender differences in sexual responsiveness to erotic films that had been selected for their differential appeal for men and women. A secondary objective was to identify variables that influence sexual arousal and explore whether these variables differ for men and women. Fifteen men (M age = 26 yrs) and 17 women (M age = 24 yrs) were presented with 20 film clips depicting heterosexual interactions, half of which were female- and the other half male-selected, and were asked to rate the clips on a number of dimensions. Overall, men found the film clips more sexually arousing than did the women. Gender differences in arousal were negligible for female-selected clips but substantial for male-selected clips. Furthermore, men and women experienced higher levels of sexual arousal to clips selected for individuals of their own gender. Cluster regression analyses, explaining 77% of the variance for male and 65% for female participants, revealed that men's sexual arousal was dependent upon the attractiveness of the female actor, feeling interested, and both “imagining oneself as a participant” and “watching as an observer.” For women, with all variables entered, only “imagining oneself as a participant” contributed to sexual arousal ratings. The findings suggest that how films are selected in sex research is an important variable in predicting levels of sexual arousal reported by men and women.

Journal of Sex Research, 2008

The Sexual Inhibition/Sexual Excitation Scales (SIS/SES) assess individual propensities to become... more The Sexual Inhibition/Sexual Excitation Scales (SIS/SES) assess individual propensities to become sexually aroused and to inhibit arousal. Prior analyses of men's SIS/SES data (Janssen, Vorst, Finn, & Bancroft, 2002a) yielded one excitation factor (SES) and two inhibitory factors (SIS1/Threat of Performance Failure and SIS2/Threat of Performance Consequences). The current study utilized a dataset of 2,045 undergraduates (1,067 women and 978 men) to examine the psychometric properties of women's SIS/SES scores. Women scored higher on sexual inhibition and lower on sexual excitation compared with men. The convergent/discriminant validity of women's SIS/SES scores globally resembled men's, but showed stronger associations with other sexuality − related measures and less pronounced relationships with measures of general behavioral approach/avoidance. The test–retest reliability of men's and women's SIS/SES scores were similar, but individual items exhibited differential relevance to men's and women's arousal. An exploratory factor analysis of women's scores was utilized to further examine shared and unshared themes.

Contraception, 1995

A placebo-controlled, double-blind study was carried out to assess the direct hormonal effects of... more A placebo-controlled, double-blind study was carried out to assess the direct hormonal effects of combined and progestogen-only oral contraceptives on well-being and sexuality of women in two contrasting cultures. Onehundred-fifty women, who had been sterilised or whose partners had been vasectomised, were recruited from two centres-Manila, Philippines, and Edinburgh, Scotland. After one month pretreatment assessment, women were randomly assigned to one of three treatments (combined oral contraceptive (COC), progestogen-only pill (POP), or placebo; 50 within each treatment group, 25 per centre) and continued on treatment for four months. Assessment was by daily ratings, questionnaires and interviews.

Contraception, 2007

Purpose: This study compared two oral contraceptives (OCs) with the same triphasic regimen of pro... more Purpose: This study compared two oral contraceptives (OCs) with the same triphasic regimen of progestin (norgestimate 0.18, 0.215 and 0.25 mg) but differing doses of ethinyl estradiol (EE) -25 and 35 μg EEin their effects on androgens, mood and sexual interest in women starting on OCs. Methods: Total testosterone (T), free testosterone (FT), sex-hormone-binding globulin (SHBG) and dehydroepiandrosterone sulphate (DHEA-S), together with measures of mood [Beck Depression Inventory (BDI)], sexual interest [Dyadic and Solitary subscales of the Sexual Desire Inventory (SDI)] and self-reported side effects were assessed before starting on the OC and again after 3 months of use. Results: Sixty women, all university students, were randomized to receive either the 25 μg EE (N/EE25) or the 35 μg EE (N/EE35) pill; 12 women discontinued, leaving 48 who completed the 3-month study. Their mean age was 19.7 years (18-30) and they were predominantly white and single. Both OCs produced reductions in mean T [N/EE35: from 1.33 to 0.60 nmol/L, pb.001; N/EE25: from 1.12 to 1.02 nmol/L; nonsignificant (NS)] and FT (N/EE35: from 41.3 to 4.4 pmol/L, pb.001; N/EE25: from 25.4 to 7.9 pmol/L, pb.01), but the reduction in both T and FT was significantly greater with the higher EE dose (N/EE35) (p=.05 and p=.03, respectively). DHEA-S was also reduced with both formulations (N/EE35: from 7.26 to 5.22 μmol/L); N/EE25: from 7.50 to 5.39 μmol/L), although the reduction was only significant in the N/EE35 group (pb.02). Considerable variability in changes in mood was evident with both OCs, with some women showing predominantly negative effects (10 in N/EE35, 5 in N/EE25); others, positive effects (9 in N/EE35, 17 in N/EE25) and some, no change (four in each group). Women using N/EE25 were significantly more likely to show improvement in premenstrual mood than those in the N/EE35 group (pb.02), although there was no correlation between changes in BDI and FT or DHEA-S. Sexual interest scores did not change significantly from baseline to posttreatment with either OC (N/EE35: dyadic, from 40.5 to 39.6, NS; solitary, from 5.9 to 6.4, NS; N/EE25: dyadic, from 36.7 to 37.0, NS; solitary, from 5.0 to 4.2, NS). Conclusion: The lower EE pill reduced FT less and was associated with greater improvement in premenstrual mood. A causal relation between these two effects is uncertain.

Contraception, 2001

The purpose of the study was to explore predictors of discontinuation of oral contraceptives (OC)... more The purpose of the study was to explore predictors of discontinuation of oral contraceptives (OC) including pre-OC characteristics and adverse physical, emotional and sexual effects of OCs. Women aged 18+ in committed, sexually active relationships were assessed before starting OC and reassessed at 3, 6 and 12 months or shortly after discontinuation. Assessment included: pre-OC attitudes and expectations about the pill; self-reported side effects; and perimenstrual symptoms including PMS, physical and emotional well-being, and sexual interest, enjoyment and frequency of sexual activity. Seventy-nine women completed the study, 38%

American Journal of Preventive Medicine, 2003

To assess and compare condom-use errors and problems among condom-using university males and fema... more To assess and compare condom-use errors and problems among condom-using university males and females.

Archives of Sexual Behavior, 2006

This article reports on the development of a new questionnaire designed to assess the propensity ... more This article reports on the development of a new questionnaire designed to assess the propensity for sexual excitation and sexual inhibition in women: The Sexual Excitation/Sexual Inhibition Inventory for Women (SESII-W). The theoretical model underlying this research, the Dual Control Model, postulates that sexual response depends on a balance between excitatory and inhibitory mechanisms and that individuals vary in their propensity for excitation and inhibition. This study describes the development and initial validation of the SESII-W in a sample of 655 women (M age, 33.9 years). Factor analysis identified eight factors and two higher-order factors: one related to sexual excitation and one to sexual inhibition. The measure demonstrated good test-retest reliability and discriminant and convergent validity. Our data underscore that a number of factors affect women's sexual arousal and these appear to be related to opposing processes of sexual excitation and sexual inhibition. Theoretical issues, possible gender differences, and the value of using qualitative data to inform questionnaire development are discussed.

Psychophysiology, 2000

The effects of fragrance on sexual response in women were investigated using subjective and physi... more The effects of fragrance on sexual response in women were investigated using subjective and physiological measures of sexual arousal and of mood. Responses were obtained from female participants in three different fragrance conditions female fragrance, male fragrance, and a "blank" or neutral substance!, as they viewed erotic and sexually neutral films, and fantasized about sexual situations. Each woman was tested twice: during the midfollicular and periovulatory phases of her menstrual cycle. Menstrual cycle phase effects were apparent; self-report data indicated greater sexual arousal and more positive mood during the periovulatory than during the follicular phase. Results demonstrated a positive effect of the male fragrance on genital arousal during erotic fantasy, but this finding was apparent only during the follicular phase testing session. This effect did not appear to be mediated by any effects of fragrance on mood.

Journal of American College Health, 2005

In addition to consistent use, condoms must be used correctly. The purpose of this study was to i... more In addition to consistent use, condoms must be used correctly. The purpose of this study was to identify prevalence and types of condom-associated discomfort among university students, the outcomes of this discomfort, and the role of discomfort in condom breakage. We conducted a cross-sectional study of 206 students attending a private university in the southern United States. We assessed 3 potential outcomes: breakage, not using condoms throughout sex, and low condom-use motivation. Nearly one third reported discomfort, including tightly fitting condoms, vaginal irritation, and loss of sensation. Discomfort was associated with breakage (p = .0001), incomplete use (p = .0001), and less motivation to use condoms (p = .018). Gender moderated the latter 2 findings. Adjusted findings indicate that students reporting discomfort were 3.6 times more likely to also report breakage (p = .0009). Continued investigation of this topic is warranted. Prevention education may benefit university students by promoting several key practices, such as adding lubricant to condoms before they dry out and acquiring condoms that fit properly.

Archives of Sexual Behavior, 2004

The aim of this study was to inform the development of a questionnaire to assess a woman's tenden... more 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 nongenital), cognitive/emotional, and behavioral cues to arousal. The relationship between sexual interest (desire) 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.

Aids and Behavior, 2004

Transformation of nonnormally distributed measures of condom use frequency can be problematic for... more Transformation of nonnormally distributed measures of condom use frequency can be problematic for researchers. Distributions are typically dichotomized. We used data collected from 483 university undergraduates in an anonymous, cross-sectional survey to illustrate the value of a screening analysis before dichotomization. Inconsistent condom users were compared to consistent users with respect to 14 measures. Subsequently, inconsistent users were compared to those who never used condoms with regard to the same 14 measures. Findings suggest that a screening analysis is a potentially important aspect of analyzing distributions that assess frequency of condom use.

Psychoneuroendocrinology, 2007

The aim of this study was to examine whether changes in plasma androgen levels (total testosteron... more The aim of this study was to examine whether changes in plasma androgen levels (total testosterone (T), free testosterone (FT), and dehydro-epiandrosterone-sulfate (DHEA-S)) induced by oral contraceptive (OC) use were related to changes in sexual interest or response or in mood. Sixty-one women provided blood samples and were assessed, using interviews and standardized questionnaires, prior to starting, and after 3 months on OCs (Ortho-Tricyclen s , Ortho-Tricyclen-Lo s , or Ortho-Cyclen s , all containing the same progestagen, norgestimate). Significant decreases in T, FT, and DHEA-S were found after 3 months, although the extent of reduction was variable across women. There was some support for a relationship between the degree of reduction in total T and FT and the frequency of sexual thoughts after 3 months on OCs. However, some women had no loss of sexual interest in spite of substantial reduction in FT, and there was overall no evidence that reduction in FT affected enjoyment of sexual activity with a partner. The findings are consistent with the idea that some women may be more sensitive to changes in T than others. No relationship was found between negative mood, as assessed by the Beck Depression Inventory, and changes in T, FT, or DHEA-S. (C.A. Graham).

International Journal of Std & Aids, 2004

An anonymous questionnaire was used to explore relationships between condom breakage, slippage an... more An anonymous questionnaire was used to explore relationships between condom breakage, slippage and possible correlates in a sample of 428 single, never married college men and women. Specific condom use errors and problems that could lead to breakage and slippage were also examined. A three-month recall period was used. Breakage/slippage was found to be associated with never receiving instruction on correct condom use (P = 0.001), more than one sex partner (P = 0.001), more frequent use of condoms (P = 0.001), and partner(s) being less than highly motivated to use condoms (P = 0.02). Those reporting that condoms had contacted a sharp object were three times as likely to report breakage (P = 0.001). Those using condoms without proper lubrication (P = 0.006) and those experiencing loss of erection during sex (P = 0.001) were more likely to report slippage. Further research should investigate the efficacy of instruction addressing specific factors that may reduce the incidence of breakage/slippage, thereby enhancing condom effectiveness.

Sexually Transmitted Diseases, 2002

An essential yet understudied aspect of condom use is whether they are used correctly.

Sexual Health, 2010

Background: Understanding the signification of the word 'sex' has implications for both medical r... more Background: Understanding the signification of the word 'sex' has implications for both medical research and clinical practice. Little is known about how people of varying ages define sex and how situational qualifiers influence definitions across age groups. To our knowledge, this is the first study of a representative sample to assess attitudes about which sexual behaviours constitute having 'had sex' and to examine possible mediating factors (gender, age, giving/receiving stimulation, male ejaculation, female orgasm, condom use or brevity). Methods: A telephone survey of English-speaking residents of Indiana (USA) using random-digit-dialling produced a final sample of 204 men and 282 women (n = 486) ranging in age from 18 to 96 years. Questions assessed the respondents' attitudes on manual-genital (MG), oral-genital (OG), penile-vaginal intercourse (PVI) and penile-anal intercourse (PAI) behaviours. Results: There was no universal consensus on which behaviours constituted having 'had sex'. More than 90% responded 'yes' to PVI but one in five responded 'no' to PAI, three in 10 responded 'no' to OG and about half endorsed MG. Fewer endorsed PVI with no male ejaculation (89.1%) compared with PVI without a qualifier (94.8%, P < 0.001). MG was endorsed more often when received (48.1%) than given (44.9%, P < 0.001). Among men, the oldest and youngest age groups were significantly less likely to believe certain behaviours constituted having 'had sex'. Conclusions: These findings highlight the need to use behaviour-specific terminology in sexual history taking, sex research, sexual health promotion and sex education. Researchers, educators and medical practitioners should exercise caution and not assume that their own definitions of having 'had sex' are shared by their research participants or patients. Additional keywords: condom, meanings of sex, orgasm, sex definitions. PVI-no ejaculation 89.1 (86.3-91.9) Penile-vaginal intercourse with no female orgasm; that is, the woman did not 'come'? PVI-no female orgasm 92.7 (90.4-95.0) Penile-vaginal intercourse, but very brief? PVI-very brief 94.4 (92.3-96.5) Penile-vaginal intercourse with a condom? PVI-condom 93.3 (91.0-95.6) Penile-anal intercourse? PAI 80.8 (77.3-84.3) Penile-anal intercourse with no male ejaculation; that is, the man did not 'come'? PAI-no ejaculation 79.5 (75.9-83.1) Penile-anal intercourse with no female orgasm; that is, the woman did not 'come'? PAI-no female orgasm 81.1 (77.6-84.6) Penile-anal intercourse, but very brief PAI-very brief 81.8 (78.4-85.2) Penile-anal intercourse with a condom? PAI-condom 82.0 (78.6-85.4) 32 Sexual Health S. A. Sanders et al.