Cognitive processing of sexual cues in asexual individuals and heterosexual women with desire/arousal difficulties

PLOS ONE RESEARCH ARTICLE Cognitive processing of sexual cues in asexual individuals and heterosexual women with desire/arousal difficulties Natalie B. Brown ID1*, Diana Peragine2, Doug P. VanderLaan2,3, Alan Kingstone1, Lori A. Brotto ID4 a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 OPEN ACCESS Citation: Brown NB, Peragine D, VanderLaan DP, Kingstone A, Brotto LA (2021) Cognitive processing of sexual cues in asexual individuals and heterosexual women with desire/arousal difficulties. PLoS ONE 16(5): e0251074. https://doi. org/10.1371/journal.pone.0251074 Editor: Julia Velten, Ruhr-Universität Bochum, GERMANY Received: October 18, 2020 Accepted: April 20, 2021 Published: May 12, 2021 Copyright: © 2021 Brown et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: The data have been uploaded to the project’s pre-registration at the Open Science Framework and can be found using the DOI: 10.17605/OSF.IO/ZYS86. 1 Department of Psychology, University of British Columbia, Vancouver, Canada, 2 Department of Psychology, University of Toronto Mississauga, Mississauga, Canada, 3 Child and Youth Psychiatry, Centre for Addiction and Mental Health, Toronto, Canada, 4 Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada * Abstract Asexuality is defined as a unique sexual orientation characterized by a lack of sexual attraction to others. This has been challenged, with some experts positing that it is better explained as a sexual dysfunction. Sexual Interest/Arousal Disorder (SIAD) is characterized by absent/reduced sexual interest/arousal paired with personal distress, with two subtypes: acquired and lifelong. Research suggests that while asexuality and acquired SIAD are distinct entities, there may be overlap between asexuality and lifelong SIAD. Findings from studies using eye-tracking and implicit association tasks suggest that these methodologies might differentiate these groups on the basis of their neural mechanisms. However, no study has compared their cognitive processing of sexual cues, and the literature on lifelong SIAD is minimal. The current study tested differences in the cognitive processing of sexual cues between asexual individuals and women with SIAD (lifelong and acquired). Forty-two asexual individuals and 25 heterosexual women with SIAD (16: acquired; 9: lifelong) completed three study components: a visual attention task, a Single Category-Implicit Association Task, and the sex semantic differential. ANOVAs examined group differences in: 1) visual attention to erotic cues, 2) implicit appraisals of sexual words, and 3) explicit appraisals of sex. Women with SIAD displayed a controlled attention preference for erotic images and areas of sexual contact, with longer dwell times to these areas relative to asexual individuals, who did not gaze preferentially at erotic cues. For implicit appraisals, all groups demonstrated negative—neutral implicit associations with sexual words. For explicit appraisals, women with acquired SIAD reported more positive evaluations of sex relative to asexual individuals and women with lifelong SIAD. This project sheds light on key differences between asexuality and low desire, and has implications for best clinical practice guidelines for the assessment of lifelong SIAD. Funding: - Author who received award: L. Brotto Grant number: F16-05471 - Full name of funder: Natural Sciences and Engineering Research Council of Canada (NSERC) - URL: https://www. nserc-crsng.gc.ca/index_eng.asp - Sponsor role: the sponsor did not play any role in the study PLOS ONE | https://doi.org/10.1371/journal.pone.0251074 May 12, 2021 1 / 22 PLOS ONE design, data collection or analysis, decision to publish, or preparation of the manuscript. Competing interests: The authors have declared that no competing interests exist. Cognitive processing of sexual cues for different presentations of low desire Introduction Asexuality Human asexuality is generally defined as a lack of sexual attraction to others [1]. There has been a surge of academic interest in asexuality in response to national probability studies suggesting approximately 0.4–1% of the population identifies as asexual [2–4]. Despite this wave of research, there has not been a corresponding shift in societal acceptance of those who do not experience sexual attraction, with empirical evidence suggesting that asexual individuals experience stigmatization [5, 6]. For instance, college students rated asexual people as less likely to possess traits (e.g., friendliness) or to experience emotions (e.g., affection) than their allosexual (non-asexual) counterparts [6]. Further, asexual people describe pathologization when they disclose their sexual identity to others, often being told they are “unnatural” [5, 7]. The Asexuality Visibility and Education Network (AVEN) aims to reduce the marginalization experienced by this group by facilitating open communication about asexuality, which they conceptualize as a unique sexual orientation [8]. However, scholars have argued that the line between asexuality and sexual dysfunction is not clearly defined [5]. Specifically, the psychological community struggles with the distinction between asexuality and Sexual Interest/ Arousal Disorder (SIAD), given both groups’ disinterest in sexual activity [9, 10]. Asexuality spectrum The umbrella term “ace” is used to encompass the diversity of experiences of attraction, relationships, and arousal within the asexual community [11–13]. On one end of the ace continuum are individuals who do not report ever experiencing attraction to others, referred to simply as asexual. Gray-As, who experience sexual attraction infrequently or only with certain people or in specific situations, can also be found on this spectrum [11]. There is evidence of substantial gender diversity, as research suggests that a large number of asexual people do not fit the gender binary [14, 15]. For example, a study of 1,268 asexual participants revealed that 16.2% listed a gender identity other than man/woman [15]. Moreover, the 2016 Asexual Community Census indicated that only 74% of 9,331 ace participants identified as “woman/female” or “man/male” [16]. Notably, there is a sex bias within the ace community, as the majority of 2016 Asexual Community Census respondents (i.e., 89%) disclosed being female at birth [16]. However, 33% of ace census respondents reported a gender identity that was not congruent with their sex at birth [16], suggesting higher rates of trans experience relative to the general population. Sexual Interest/Arousal Disorder (SIAD) SIAD is a sexual dysfunction characterized by absent or reduced sexual interest and/or arousal paired with significant personal distre (...truncated)