Skip to main content
Springer Nature Link
Log in

Measurement of Sexual Arousal in Postoperative Male-to-Female Transsexuals Using Vaginal Photoplethysmography

  • Published:
Archives of Sexual Behavior Aims and scope Submit manuscript

Abstract

Men’s sexual arousal patterns are category-specific: Men typically display significantly greater physiological responses to sexual stimuli depicting members of their preferred gender category. Category-specific patterns of sexual arousal have not been consistently reported in natal women. We used vaginal photoplethysmography to examine patterns of sexual arousal in 11 male-to-female (MtF) transsexuals following sex reassignment surgery (SRS) and in 72 natal women. Subjective arousal was measured with a continuous response lever. Video clips depicting sexual activity between two males, two females, or one male and one female were used as erotic stimuli. All transsexual participants displayed category-specific sexual arousal. Five homosexual transsexual participants (attracted exclusively to males before sex reassignment) showed greater genital and subjective responses to male than to female stimuli, while six nonhomosexual transsexual participants showed the opposite pattern. Vaginal pulse amplitude (VPA) was lower in transsexual participants than in natal women. The mean correlation between VPA and subjective responses was high in nonhomosexual transsexuals, but was significantly lower in homosexual transsexuals and in natal women. One transsexual participant who reported a change in sexual orientation following sex reassignment displayed VPA and subjective responses consistent with her pre-reassignment sexual orientation. We conclude that male-to-female transsexuals display male-typical category-specific sexual arousal following SRS, and that vaginal photoplethysmography is a promising methodology for studying patterns of sexual arousal in postoperative transsexuals.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Allesandrescu, D., Peltecu, G. C., Buhimschi, C. S., & Buhimschi, I. A. (1996). Neocolpopoiesis with split-thickness skin graft as a surgical treatment of vaginal agenesis: Retrospective review of 201 cases. American Journal of Obstetrics and Gynecology, 175, 131–138.

    Google Scholar 

  • Balsma, A., Wouda, J., Vessies, D., Bakker, J. O., van de Wiel, H. B. M., & Weijmar Schultz, W. C. M. (1995). Onderzoek van de doorbloeding van de wund van de neovagina na erotische prikkeling bij man-vrouwtransseksuelen [Blood flow in the neovagina after erotic stimulation in male-to-female transsexuals]. Nederlands Tijdschrift voor Geneeskunde, 139, 1713–1714.

    Google Scholar 

  • Bancroft, J., & Wu, F. C. W. (1983). Changes in erectile responsiveness during androgen replacement therapy. Archives of Sexual Behavior, 12, 59–66.

    PubMed  Google Scholar 

  • Barlow, D. H., Mills, J. R., Agras, W. S., & Steinman, D. L. (1980). Comparison of sex-typed motor behavior in male-to-female transsexuals and women. Archives of Sexual Behavior, 9, 245–253.

    PubMed  Google Scholar 

  • Barr, R. F. (1973). Responses to erotic stimuli of transsexual and homosexual males. British Journal of Psychiatry, 123, 579–585.

    Article  PubMed  Google Scholar 

  • Barr, R., & Blaszczynski, A. (1976). Autonomic responses of transsexual and homosexual males to erotic film sequences. Archives of Sexual Behavior, 5, 211–222.

    PubMed  Google Scholar 

  • Barr, R. F., Raphael, B., & Hennessey, N. (1974). Apparent heterosexuality in two male patients requesting change-of-sex operation. Archives of Sexual Behavior, 3, 325–330.

    PubMed  Google Scholar 

  • Bentler, P. M. (1976). A typology of transsexualism: Gender identity theory and data. Archives of Sexual Behavior, 5, 567–584.

    PubMed  Google Scholar 

  • Blanchard, R. (1989). The concept of autogynephilia and the typology of male gender dysphoria. Journal of Nervous and Mental Disease, 177, 616–623.

    Article  PubMed  Google Scholar 

  • Blanchard, R., Racansky, I. G., & Steiner, B. W. (1986). Phallometric detection of fetishistic arousal in heterosexual male cross–dressers. Journal of Sex Research, 22, 452–462.

    Google Scholar 

  • Carani, C., Granata, A. R., Bancroft, J., & Marrama, P. (1995). The effects of testosterone replacement on nocturnal penile tumescence and rigidity and erectile response to visual erotic stimuli in hypogonadal men. Psychoneuroendocrinology, 20, 743–753.

    PubMed  Google Scholar 

  • Chivers, M. L., Rieger, G., Latty, E., & Bailey, J. M. (2004). A sex difference in the specificity of sexual arousal. Psychological Science, 15, 736–744.

    PubMed  Google Scholar 

  • Cohen-Kettenis, P. T., van Goozen, S. H., Doorn, C. D., & Gooren, L. J. G. (1998). Cognitive ability and cerebral lateralisation in transsexuals. Psychoneuroendocrinology, 23, 631–641.

    PubMed  Google Scholar 

  • D’Amati, G., di Gioia, C. R., Bologna, M., Giordano, D., Giorgi, M., Dolci, S., et al. (2002). Type 5 phosphodiesterase expression in the human vagina. Urology, 60, 191–195.

    PubMed  Google Scholar 

  • Daskalos, C. T. (1998). Changes in sexual orientation of six heterosexual male-to-female transsexuals. Archives of Sexual Behavior, 27, 605–613.

    PubMed  Google Scholar 

  • Fleming, M. Z., Jenkins, S. R., & Bugarin, C. (1980). Questioning current definitions of gender identity: Implications of the Bem Sex-Role Inventory for transsexuals. Archives of Sexual Behavior, 9, 13–26.

    PubMed  Google Scholar 

  • Freund, K. (1985). Cross-gender identity in a broader context. In B. W. Steiner (Ed.), Gender dysphoria: Development, research, management (pp. 259–324). New York: Plenum.

    Google Scholar 

  • Freund, K., & Watson, R. J. (1991). Assessment of the sensitivity and specificity of a phallometric test: An update of phallometric diagnosis of pedophilia. Psychological Assessment, 3, 254–260.

    Google Scholar 

  • Freund, P. R., Brengelmann, G. L., Rowell, L. B., Engrav, L., & Heimbach, D. M. (1981). Vasomotor control in healed grafted skin in humans. Journal of Applied Physiology, 51, 168–171.

    PubMed  Google Scholar 

  • Geer, J. H., Morokoff, P., & Greenwood, P. (1974). Sexual arousal in women: The development of a measurement device for vaginal blood volume. Archives of Sexual Behavior, 3, 559–564.

    PubMed  Google Scholar 

  • Giraldo, F., Mora, M. J., Solano, A., Gonzáles, C., & Smith-Fernández, V. (2002). Male perineogenital anatomy and clinical applications in genital reconstructions and male-to-female sex reassignment surgery. Plastic and Reconstructive Surgery, 109, 1301–1310.

    PubMed  Google Scholar 

  • Giuliano, F., Rampin, O., & Allard, J. (2002). Neurophysiology and pharmacology of female genital sexual response. Journal of Sex and Marital Therapy, 28(Suppl. 1), 101–121.

    PubMed  Google Scholar 

  • Gorman, C. (1995, November 13). Trapped in the body of a man? Time, 146(20), 94–95.

    Google Scholar 

  • Hage, J. J. (1999). Vaginoplasty in male-to-female transsexuals by inversion of penile and scrotal skin. In R. Ehrlich & G. Alter (Eds.), Reconstructive and plastic surgery of the external genitalia: Adult and pediatric (pp. 294–300). Philadelphia: W. B. Saunders.

    Google Scholar 

  • Harris, G. T., & Rice, M. E. (1996). The science in phallometric measurement of male sexual interest. Current Directions in Psychological Science, 5, 156–160.

    Google Scholar 

  • Harris, G. T., Rice, M. E., Quinsey, V. L., Chaplin, T. C., & Earls, C. (1992). Maximizing the discriminant validity of phallometric assessment data. Psychological Assessment, 4, 502–511.

    Google Scholar 

  • Herman-Jegliñska, A., Grabowska, A., & Dulko, S. (2002). Masculinity, femininity, and transsexualism. Archives of Sexual Behavior, 31, 527–534.

    PubMed  Google Scholar 

  • Hoyle, C. H. V., Stones, R. W., Robson, T., Whitley, K., & Burnstock, G. (1996). Innervation of vasculature and microvasculature of the human vagina by NOS and neuropeptide-containing nerves. Journal of Anatomy, 188, 633–644.

    PubMed  Google Scholar 

  • Hunt, D. D., Carr, J. E., & Hampson, J. L. (1981). Cognitive correlates of biologic sex and gender identity in transsexualism. Archives of Sexual Behavior, 10, 65–77.

    PubMed  Google Scholar 

  • Karim, R. B., Hage, J. J., Bouman, F. G., & Dekker, J. J. M. L. (1991). The importance of near total resection of the corpus spongiosum and total resection of the corpora cavernosa in the surgery of male to female transsexuals. Annals of Plastic Surgery, 26, 554–557.

    PubMed  Google Scholar 

  • Karim, R. B., Hage, J. J., & Mulder, J. W. (1996). Neovaginoplasty in male transsexuals: Review of surgical techniques and recommendations regarding eligibility. Annals of Plastic Surgery, 37, 669–675.

    PubMed  Google Scholar 

  • Kenna, J. C., & Hoenig, J. (1984). Transsexualism and Slater’s Selective Vocabulary Test. International Journal of Social Psychiatry, 30, 207–212.

    PubMed  Google Scholar 

  • Kinsey, A. C., Pomeroy, W. B., & Martin, C. E. (1948). Sexual behavior in the human male. Philadelphia: W. B. Saunders.

    Google Scholar 

  • Korff, J., & Geer, J. H. (1983). The relationship between sexual arousal experience and genital response. Psychophysiology, 20, 121–127.

    PubMed  Google Scholar 

  • Kwan, M., Greenleaf, W. J., Mann, J., Crapo, L. & Davidson, J. M. (1983). The nature of androgen action on male sexuality: A combined laboratory-self-report study on hypogonadal men. Journal of Clinical Endocrinology and Metabolism, 57, 557–562.

    PubMed  Google Scholar 

  • Laan, E., Everaerd, W., & Evers, A. (1995). Assessment of female sexual arousal: Response specificity and construct validity. Psychophysiology, 32, 476–485.

    PubMed  Google Scholar 

  • Laan, E., Everaerd, W., van der Velde, J., & Geer, J. H. (1995). Determinants of subjective experience of sexual arousal in women: Feedback from genital arousal and erotic stimulus content. Psychophysiology, 32, 444–451.

    PubMed  Google Scholar 

  • Laan, E., & van Lunsen, R. H. W. (1997). Hormones and sexuality in postmenopausal women: A psychophysiological study. Journal of Psychosomatic Obstetrics and Gynecology, 18, 126–133.

    PubMed  Google Scholar 

  • 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, 28–41.

    CAS  PubMed  Google Scholar 

  • Lawrence, A. A. (1999). Changes in sexual orientation in six male-to-female (MtF) transsexuals [Letter to the editor]. Archives of Sexual Behavior, 28, 581–583.

    PubMed  Google Scholar 

  • Lawrence, A. A. (2004). Outcomes of male-to-female sex reassignment surgery in 232 patients. Manuscript in preparation.

  • Lawrence, A. A. (2005). Sexuality before and after male-to-female sex reassignment surgery. Archives of Sexual Behavior, 34, 147–166.

    PubMed  Google Scholar 

  • Levin, R. J. (1991). VIP, vagina, clitoral and periurethral glans: An update on human female genital arousal. Experimental and Clinical Endocrinology, 98, 61–69.

    Article  PubMed  Google Scholar 

  • Lippa, R. A. (2001). Gender-related traits in transsexuals and nontranssexuals. Archives of Sexual Behavior, 30, 603–614.

    PubMed  Google Scholar 

  • Masters, W. H., & Johnson, V. E. (1961). The artificial vagina: Anatomic, physiologic, psychosexual function. Western Journal of Surgery, Obstetrics, and Gynecology, 69, 192–212.

    PubMed  Google Scholar 

  • Masters, W. H., & Johnson, V. E. (1966). Human sexual response. Boston: Little, Brown.

    Google Scholar 

  • Muirhead-Allwood, S., Royle, M., & Young, R. (1999a, August). Factor analysis of satisfaction with vaginal reconstructive surgery in male-to-female transsexuals. Poster session presented at the Harry Benjamin International Gender Dysphoria Association XVI Biennial Symposium, London.

  • Muirhead-Allwood, S. K., Royle, M. G., & Young, R. (1999b, August). Sexuality and satisfaction with surgical results in male-to-female transsexuals. Poster session presented at the Harry Benjamin International Gender Dysphoria Association XVI Biennial Symposium, London.

  • Myers, L. S., Dixen, J., Morrissette, D., Carmichael, M., & Davidson, J. M. (1990). Effects of estrogen, androgen, and progestin on sexual psychophysiology and behavior in postmenopausal women. Journal of Clinical Endocrinology and Metabolism, 70, 1124- 1131.

    PubMed  Google Scholar 

  • Myers, L. S., & Morokoff, P. J. (1986). Physiological and subjective sexual arousal in pre- and postmenopausal women and postmenopausal women taking replacement therapy. Psychophysiology, 23, 283–292.

    PubMed  Google Scholar 

  • Oefelein, M. G., Feng, A., Scolieri, M. J., Ricchiutti, D., & Resnick, M. I. (2000). Reassessment of the definition of castrate levels of testosterone: Implications for clinical decision making. Urology, 56, 1021–1024.

    PubMed  Google Scholar 

  • Pillard, R. C., & Bailey, J. M. (1995). A biological perspective on sexual orientation. Psychiatric Clinics of North America, 18, 71–84.

    PubMed  Google Scholar 

  • Røhl, H. F., & Beuke, H.-P. (1992). Effect of orchidectomy on serum concentrations of testosterone and dihydrotestosterone in patients with prostatic cancer. Scandinavian Journal of Urology and Nephrology, 26, 11–14.

    Article  PubMed  Google Scholar 

  • Rosen, R. C., & Beck, J. G. (1988). Patterns of sexual arousal: Psychophysiological processes and clinical applications. New York: Guilford Press.

    Google Scholar 

  • Schroder, M., & Carroll, R. (1999). New women: Sexological outcomes of male-to-female gender reassignment surgery. Journal of Sex Education and Therapy, 24, 137–146.

    Google Scholar 

  • Seto, M. C. (2001). The value of phallometry in the assessment of male sex offenders. Journal of Forensic Psychology Practice, 1, 65–75.

    Google Scholar 

  • Steinman, D. L., Wincze, J. P., Sakheim, D. K., Barlow, D. H., & Mavissakalian, M. (1981). A comparison of male and female patterns of sexual arousal. Archives of Sexual Behavior, 10, 529–547.

    PubMed  Google Scholar 

  • Trienekens, P. H., Schmidt, N. A., & Thijssen, J. H. (1986). The effect of age, weight-related parameters and hormonal contraceptives on andrological assays. Contraception, 33, 503–517.

    PubMed  Google Scholar 

  • Tuiten, A., Laan, E., Panhuysen, G., Everaerd, W., de Hann, E., Koppeschaar, H., et al. (1996). Discrepancies between genital responses and subjective sexual function during testosterone substitution in women with hypothalamic amenorrhea. Psychosomatic Medicine, 58, 234–241.

    PubMed  Google Scholar 

  • Tuiten, A., van Honk, J., Koppeschaar, H., Bernaards, C., Thijssen, J., & Verbaten, R. (2000). Time course of effects of testosterone administration on sexual arousal in women. Archives of General Psychiatry, 57, 149–153.

    PubMed  Google Scholar 

  • Tuiten, A., van Honk, J., Verbaten, R., Laan, E., & Everaerd, W. (2002). Can sublingual testosterone increase subjective and physiological measures of laboratory-induced sexual arousal? [Letter to the editor]. Archives of General Psychiatry, 59, 465–466.

    PubMed  Google Scholar 

  • van Goozen, S. H. M., Slabbekoorn, D., Gooren, L. J. G., Sanders, G., & Cohen-Kettenis, P. T. (2002). Organizing and activating effects of sex hormones in homosexual transsexuals. Behavioral Neuroscience, 116, 982–988.

    PubMed  Google Scholar 

  • Wincze, J. P, Venditti, E., Barlow, D., & Mavissakalian, M. (1980). The effects of a subjective monitoring task in the physiological measure of genital response to erotic stimulation. Archives of Sexual Behavior, 9, 533–545.

    PubMed  Google Scholar 

  • Wolfradt, U., & Neumann, K. (2001). Depersonalization, self-esteem and body image in male-to-female transsexuals compared to male and female controls. Archives of Sexual Behavior, 30, 301–310.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. 1812 E. Madison St., Seattle, Washington

    Anne A. Lawrence M.D., Ph.D. & Elizabeth M. Latty M.A.

  2. Department of Psychology, Northwestern University, Evanston, Illinois

    J. Michael Bailey Ph.D.

  3. Clinical Sexology Services, Centre for Addiction and Mental Health, Toronto, Ontario

    Meredith L. Chivers Ph.D.

  4. Department of Psychology, Northwestern University, 2029 Sheridan Road, Evanston, Illinois, 60208

    J. Michael Bailey Ph.D.

Authors
  1. Anne A. Lawrence M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Elizabeth M. Latty M.A.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Meredith L. Chivers Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. Michael Bailey Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. Michael Bailey Ph.D..

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lawrence, A.A., Latty, E.M., Chivers, M.L. et al. Measurement of Sexual Arousal in Postoperative Male-to-Female Transsexuals Using Vaginal Photoplethysmography. Arch Sex Behav 34, 135–145 (2005). https://doi.org/10.1007/s10508-005-1792-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10508-005-1792-z

Keywords

Search

Navigation