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Focusing “Hot” or Focusing “Cool”: Attentional Mechanisms in Sexual Arousal in Men and Women


Stephanie Both, PhD, Department of Psychosomatic Gynecology and Sexology, Leiden University Medical Center (LUMC), Albinusdreef 2, 2300 RC Leiden, the Netherlands. Tel: +31 715268032; Fax: +31 715266950; E-mail:


Introduction.  Knowledge about the regulation of sexual emotion may add to the understanding of sexual problems such as diminished sexual desire and hypersexuality.

Aim.  To investigate the regulation of sexual arousal by means of attentional focus in healthy sexually functional men and women.

Method.  Using a habituation design with attentional strategies, it was investigated whether a focus on hot, emotional information of sexual stimuli would sustain or amplify sexual responses, whereas a focus on cool, cognitive information would weaken sexual responses.

Main Outcome Measures.  Genital response (in women measured by vaginal photoplethysmography assessing vaginal pulse amplitude, and in men measured by mechanical penile strain gauge assessing penile circumference) and subjective report of sexual arousal and absorption.

Results.  Attenuation of sexual feelings by attentional focus was observed, with stronger sexual feelings under the hot focus condition than under the cool focus condition. Also, sexual feelings diminished during repeated erotic stimulation, and increased with the introduction of novel stimulation, indicating habituation and novelty effects. Contrary to the expectations, the hot attentional focus did not preclude habituation of sexual arousal.

Conclusions.  Attentional focus has substantial regulatory effects on subjective sexual arousal. Taking a participant and emotion-oriented focus rather than a spectator and stimulus-oriented focus while viewing erotic stimuli, enhances feelings of sexual arousal. Implications for the treatment of hypoactive sexual desire, sexual arousal disorder, and hypersexuality are discussed, as well as future directions for studying regulation of sexual emotion. Both S, Laan E, and Everaerd W. Focusing “hot” or focusing “cool”: Attentional mechanisms in sexual arousal in men and women. J Sex Med 2011;8:167–179.