A study to evaluate the different levels of attention and VALence direction for erotic stimuli, in relation to genital and subjective sexual arousal in healthy female subjects and healthy female subjects with female sexual dysfunction

1. Evaluation of the women's judgment of valence (negative or positive) for erotic stimuli under placebo condition and the condition of 0.5 mg sublingual testosterone combined with sildenafil (50 mg) and the influence of positive and/or negative valence on attention for erotic cues, in healthy female subjects with and without Female Sexual Dysfunction.

Data for analysis:
1. Attention for erotic stimuli (strooptask: speedrate). A masked version of the Emotional Stroop Task comparing colour-naming latencies on neutral and erotic words will be used. The word is presented before and after the erotic film excerpts in the attention condition for about 24 ms and then masked by randomly cut, reassembled signs in the same colour (red, green, yellow or blue). The colour of the mask has to be assigned, and subjects are asked to verbally name the colours as quickly as possible. The stimuli are presented in the centre of the screen. An extra set of stimuli will be prepared for practice-trials. A trial consists of a fixation point, which will be shown for 750 ms, followed by the target stimulus (the coloured neutral or erotic word and mask). Vocal responses will be recorded and will terminate the trials. The order of these 2 blocks will be randomly assigned. Attention will be measured on both the experimental days in the morning (pre-dose) and in the afternoon (post-dose).
2. Vaginal Pulse Amplitude (VPA. A vaginal photoplethysmograph will be used to measure Vaginal Pulse Amplitude (VPA) (the AC component of the signal), which is a reliable index for genital vasocongestion. Changes in the amplitude of the signal reflect changes in vaginal vasocongestion. The Vaginal Photoplethysmograph (VP) is a clean tampon shaped device, which contains an infrared Light-Emitting Diode (LED) as a light source and a photosensitive light detector (photodiode). It measures the blood volume in the tissue surrounding the plethysmograph. The light emitted by the LED is reflected by the blood vessels in the tissue. This light is measured by the photodiode. The output signal of the photodiode varies with changes in the amount of blood in the vessels. VPA will be measured on both the experimental days in the morning (pre-dose) and in the afternoon (post-dose)
3. Valence for erotic stimuli. Perceived emotional valence of erotic stimuli will be measured and compared to neutral, pleasant and unpleasant stimuli. Facial expressions reveal emotions with corresponding appetitive and defensive motivational circuits. The amygdala projects to the facial motor nucleus, which reflects the chosen motivational circuit; appetitive or defensive. Therefore, Electromyographic (EMG) activity will be measured over the corrugator, zygomatic major and orbicularis oculi muscles. Activation of the zygomatic muscle reveals a smile, but co-activation of the zygomatic and orbicularis mirrors a major smile. Activation of the corrugator muscle alone is correlated with viewing unpleasant events. More specifically, co-activation of the corrugator and orbicularis oculi reflects the emotion of repulsion and aversion. While viewing International Affective Picture System (IAPS) pictures (eight pictures for each domain; pleasant, neutral, unpleasant and erotic) and an additional category of sexually explicit pictures (depicting vaginal coitus), activation of the three muscles will be measured two seconds before picture onset and for six seconds during picture presentation. The activation of the orbicularis oculi muscle is also a component of the startle reflex. When viewing the pictures, half of all pictures will be accompanied by a startle stimulus. The acoustic startle stimulus consists of a 50-ms burst of white noise, presented at 95 dB. The startle stimuli will be presented through earplugs, between 3 and 5 seconds following picture onset. Prior to the first block, six startle sounds will be presented to allow habituation of the startle reflex. After the presentation of the pictures subjects are instructed to give a subjective rating of the emotional pictures by finger pointing at a touch screen. Each emotional picture will be followed by a picture of five figures with expressions ranging from happy (smiling) to unhappy (frowning). Subjects are instructed to rate on a 9-point scale how their feeling towards the preceding picture was reflected by one of the figures. The same was done for arousal, with excited, wide-eyed figures to sleepy, relaxed figures. Valence be measured on both the experimental days in the morning (pre-dose) and in the afternoon (post-dose).

1. To evaluate the correlation between subjective ratings of sexual functioning and physiological sexual responses
2. To evaluate the changes in differences in direction of valence when viewing visual erotic stimuli under the placebo condition and the condition with testosterone combined with sildenafil
3. To evaluate the individual differences in attention in relation to positive and/or negative valence induced by visual erotic stimuli
4. To evaluate the influence of personality traits on the differences in vaginal & subjective sexual arousal, EMG, valence direction and startle reflex
5. Subjective ratings of sexual functioning
6. Startle reflex
7. EMG activation
8. Personality traits
9. Negative sexual experiences will be assessed with a questionnaire and in the clinical interview, both during screening