Abstract

This study aimed to develop and validate the Female Expanded Sexual Response Scale (FESRS) while exploring the interplay between sexual response and mindfulness. The research consisted of three phases: (1) item generation and scale development, (2) psychometric evaluation (reliability testing, factor analysis, and construct validity comparisons with the Sexual Mindfulness Measure), and (3) exploratory analysis of age-based response patterns. The FESRS demonstrated strong internal consistency and a confirmed three-factor structure, with significant positive associations between mindfulness and expanded sexual response. The exploratory analysis also hinted to older women having a higher expanded sexual response, though further research is needed to clarify contributing factors. These findings highlight the FESRS as a psychometrically tool for assessing multidimensional sexual response, emphasizing the interplay between mindfulness and sexual well-being, with implications for both clinical and research settings.

Keywords: expanded sexual response, sexual response, mindfulness, scale design, scale validation, women's sexual wellbeing

Literature Review

Sexual response in women has historically been viewed primarily through the lens of physical and anatomical capacity, often overlooking the psychological and emotional dimensions of the sexual experience. However, emerging research highlights the importance of understanding sexual response as a complex interplay between the mind and body.

Sexual response is a multifaceted phenomenon that encompasses psychological, physiological and relational dimensions. It is a dynamic interconnection influenced by several factors including thoughts, fantasies, individual capacities, life experiences, developmental stage, relationship dynamics, medications, and overall physical and emotional wellness (Understanding Sexual Response, n.d.). Another key factor that plays a major role in the cycle of sexual response is the pleasurable release of tension known as an orgasm (Werner et al., 2023).

Orgasm Response

The female orgasm is a neuro-psychological response that typically occurs as a result of sexual arousal and stimulation, leading to the buildup of tension and ultimately culminating in a release or peak experience (Georgiadis & Kringelbach, 2012; Leavitt et al., 2021; Sayin, 2012). This peak point of pleasure is followed by a relaxation period. However, the intensity and response of an orgasm can reach a level that is expanded and different from the ordinary. Expanded Sexual Response (ESR) is a relatively recent term, defined as the capacity to achieve long-lasting, prolonged, or multiple orgasms that tend to last longer and create a more intense feeling than the classical orgasm frequently described in research (Sayin, 2011; Taylor, 2002). Pleasure in ESR orgasms is more intense than that of a single orgasm, as it involves a non-stop, continuous orgasming pattern that can last for minutes or even tens of minutes. During this time, the woman experiences a chain of orgasms as long as she is stimulated (Sayin, 2019). Many others have touched base into the idea of ESR as is Status orgasmus, a prolonged pattern of orgasms that may last for 43 seconds on the human females as defined by Masters and Johnson earlier (1966).

Extraordinary sexual experiences, such as those associated with Expanded Sexual Response (ESR), have been described in the literature using a variety of terms, including ecstatic, optimal, peak, mystical, and transcendent (Elfers & Offringa, 2019; Kleinplatz & Menard, 2007). These experiences are often characterized by a profound sense of connection, intensity, and transcendence, which can lead to altered states of consciousness (ASC). According to Farthing (1992), ASC involves a temporary shift in subjective experience that diverges from typical waking consciousness. In the context of ESR, such states may include rare phenomena like hallucinations, defined by the American Psychological Association as false sensory perceptions experienced as real despite the absence of external stimuli (VandenBos, 2007). These perceptual and experiential alterations, often induced by intense sexual stimulation, highlight the potential for sexual experiences to transcend ordinary physiological and psychological boundaries.

Mindfulness in a Sexual Context

This connection between extraordinary sexual experiences and psychological states is further supported by the role of mindfulness, defined as the non-judgmental awareness of the present moment (APA Dictionary of Psychology, n.d.). Mindfulness has been shown to enhance sexual satisfaction and intimacy by fostering a deeper connection to one's body and sensations (Brotto et al., 2008). Research indicates that mindfulness, when applied in the context of sexuality, demonstrates strong effects, positively influencing both relational and sexual outcomes (Brotto & Basson, 2014; Leavitt, 2024). Furthermore, mindfulness has proven to be therapeutically beneficial for women seeking treatment for acquired sexual desire and/or arousal concerns, as it helps increase erotic stimulus responsiveness and overall sexual well-being (Brotto et al., 2008). Sexual response is deeply connected to sexual well-being because of it's a dynamic, multifaceted experience influenced by physical, emotional, and relational factors. A positive and fulfilling sexual response directly contributes to a woman's overall sexual health and well-being, as these experiences are inherently linked to her physical and psychological satisfaction and sense of agency during the experience (Mitchell et al., 2021 and WAS Declaration on Sexual Pleasure, 2019).

Gaps in The Literature

Currently, there is no standardized or validated measure to assess ESR as a distinct construct, leaving researchers and clinicians without a reliable tool to study or address it, even though there are documented characteristics outlined to identify women with ESR (Sayin, 2019). Additionally, existing research on ESR has primarily focused on physiological and experiential aspects, with little attention to the psychological mechanisms that facilitate such responses. Scales like the Sexual Ecstasy Scale (SES) document hallucinatory experiences during peak sexual response, but they do not provide insight into the psychological or behavioral factors that may lead to such states (Elfers & Offringa, 2019). On the other hand, the Arizona Sexual Experiences Scale (ASEX) measures desire and satisfaction but does not delve deeply into the expanded side of sexual response or attribute meaning to the psychology behind sexual desire and satisfaction (McGahuey et al., 2000). Given the lack of a comprehensive tool to measure ESR and the limited understanding of the psychological mechanisms that facilitate such responses, there is a pressing need for a validated scale that measures ESR and explores its interplay with mindfulness. It's important to note that there is a need for more research on women’s positive sexual experiences and sexual pleasure as these mostly focus on experiences with partners or morality surrounding sex (Armstrong et al., 2012).

Current Study

The purpose of the current study is to develop and validate a comprehensive sexual response scale that captures peak behaviors of sexual response while exploring the interplay between sexual response and mindfulness. This study consisted of three phases: The purpose of Phase 1 was to develop the initial item pool based on conceptual knowledge and assess three major aspects of Expanded Sexual Response (ESR): sexual desire, orgasmic capacity, and altered states of consciousness (ASC).

Phase 2 was used to measure internal scale consistency through reliability testing, conduct factor analyses to determine the appropriate factor structure for this scale, and establish construct validity in comparison to the Sexual Mindfulness Measure (Leavitt, 2024). It was predicted that the scale would demonstrate good psychometrics, including Cronbach’s alphas > 0.70. Furthermore, it was hypothesized that the factor analysis would support the three-factor structure proposed (sexual desire, orgasmic capacity, and altered states of consciousness) based on Sayin’s research on ESR. Also it was expected that the construct validity would show a positive relationship between mindfulness and ESR.

In Phase 3, an exploratory analysis was conducted with the results of the scale to find whether age groups score differently across the subscales of the FESRS (Sexual Desire, Orgasmic Capacity, and Altered States of Consciousness). This analysis was conducted to test the FESRS as a psychometric tool for examining potential variations in ESR patterns across the lifespan. It was expected that the older age group would score higher in all subscales of the FESRS specifically in the Orgasmic Capacity subscale.

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