How do subjective reports of sexual arousal correlate with physiological measures in clinical studies, and what explains mismatches?
Executive summary
Clinical research finds a positive but variable correlation between self-reported sexual arousal and physiological genital measures, with men typically showing stronger concordance than women and large between-person variability across studies [1] [2] [3]. Mismatches arise from measurement choices, individual differences in interoception and attention, affective and clinical states, and methodological or stimulus-related moderators that can inflate or depress observed agreement [4] [5] [6].
1. What the data show: modest-to-strong correlations, but not perfect agreement
Meta-analytic and lab-series evidence reports positive correlations between subjective sexual arousal (SSA) and genital measures (e.g., vaginal pulse amplitude in women, penile tumescence in men), with pooled effects substantially positive for men and smaller and more heterogeneous for women, producing average correlations that clinicians and researchers interpret as meaningful but far from one-to-one concordance [1] [2] [7]. Continuous-recording studies using hierarchical models often identify significant within-session concordance, but effect sizes vary widely across samples and experimental paradigms, and many studies document only modest correlations (r values around 0.2–0.6 depending on sex, measure, and method) [8] [3].
2. How “subjective” and “physiological” are defined and why that matters
Subjective sexual arousal is commonly measured with discrete Likert-style or continuous self-ratings that capture an emotional appraisal, while physiological genital arousal is quantified with devices such as vaginal photoplethysmography (VPA/VPA-derived VPA change scores) or penile plethysmography and Rigiscan measures; these instruments index different constructs—phasic blood flow/engorgement versus conscious appraisal—which complicates direct comparison and statistical aggregation [5] [9] [4]. Choice of physiological metric (e.g., VPA vs. measures of blood volume) and data transformation strategies influence results because raw units (mV) lack simple psychophysiological meaning and may require particular transformations to align with subjective reports [1] [4].
3. Individual differences that create mismatches: interoception, emotion, and clinical status
People differ in interoceptive awareness (the ability to sense internal bodily changes), and studies show interoception moderates concordance: higher interoceptive accuracy predicts closer alignment between genital change and reported arousal in women, while low interoception and trait negative affect can produce under-reporting relative to physiology [3] [10]. Clinical groups—those with sexual dysfunction such as erectile disorder or female arousal concerns—often show attenuated or altered concordance patterns compared with healthy controls, indicating that dysfunction, worry, or performance anxiety can decouple subjective experience from genital responding [10] [11].
4. Situational and cognitive causes of desynchrony: attention, distraction, and meaning-making
Cognitive factors like distraction, spectatoring, and demand characteristics change how much attention is paid to erotic stimuli or bodily signals; experimental manipulations that increase distraction or anxiety typically reduce genital and/or subjective responding or change their correlation, while instructions that heighten body awareness can increase self-reported arousal without corresponding genital change [6] [5]. Context and stimulus content also matter: sexual stimuli congruent with a participant’s preferences produce stronger subjective–physiological alignment, and social or cultural scripts (e.g., sexual double standards) can bias self-report independent of genital response [12] [2].
5. Methodological confounds and how they bias conclusions
Heterogeneity in study design—between-subjects vs. continuous within-subject measures, how change scores are computed, statistical models used (ANOVA vs. hierarchical models), and whether external stimuli or individualized content are presented—produces varying effect sizes and can explain contradictory findings in the literature [4] [8] [7]. Authors caution that some apparent sex differences may reflect measurement artifacts rather than pure biological divergence, and that better-aligned continuous measures and advanced modeling reduce apparent discordance [4] [13].
6. Bottom line and clinical implications
Subjective reports and physiological measures are related but distinct signals; clinicians and researchers should treat discordance as informative—potentially indicating interoceptive deficits, anxiety, cultural influences, or methodological artifacts—rather than as simple error, and should combine measures, refine stimulus methods, and consider individual moderators when diagnosing or treating sexual concerns [3] [13] [11].