Evidence for Persistence of Sexual Evaluative Learning Effects (2020)

The Journal of Sexual Medicine

Volume 17, Issue 3, March 2020, Pages 505-517



Several studies demonstrated that genital arousal and enhanced positive affect toward neutral stimuli due to sexual conditioning did not extinguish during a brief extinction phase, but other studies showed contrasting results. Possible resistance to extinction of conditioned human sexual response has, however, not been studied using extensive extinction trials.


To study resistance to extinction of conditioned sexual response in men and women.


Healthy sexually functional men (N = 34) and women (N = 32) participated in a differential conditioning experiment, with neutral pictures as conditioned stimuli (CSs) and genital vibrostimulation as unconditioned stimulus. Only one CS (the CS+) was followed by the unconditioned stimulus during the acquisition phase.

Main Outcome Measure

Penile circumference and vaginal pulse amplitude were assessed, and ratings of affective value and subjective sexual arousal were obtained. In addition, a stimulus response compatibility task was included to assess automatic approach and avoidance tendencies.


Men and women rated the CS+ as more positive than the CS− during all 24 extinction trials and demonstrated a slight tendency to approach the CS+ directly after the extinction procedure. Participants rated the CS+ as more sexually arousing than the CS− during 20 extinction trials. No evidence was found for conditioned genital sexual response.

Clinical Implications

Learned sexual evaluations may be difficult to modify through an extinction procedure; therefore, unwanted but persistent subjective sexual evaluations may be better targeted by interventions such as the deployment of emotion regulation strategies.

Strength & Limitations

Extensive extinction trials were used; however, only relatively short-term effects within one experimental session were studied and there was no (unpaired) control condition.


The results provide evidence that conditioned sexual likes are relatively persistent, also at the behavioral level.

Both S, Brom M, Laan E, et al. Evidence for Persistence of Sexual Evaluative Learning Effects. J Sex Med 2020;17:505–517.

The present study provides evidence that sexual evaluative learning effects are difficult to modify through the procedure of extinction, at least in an appetitive sexual paradigm, in healthy sexually functional men and women. The results revealed that although conditioned subjective sexual arousal did not last over the entire extinction phase, it remained during the first 20 extinction trials. Importantly, appetitively conditioned subjective affect and approach tendencies toward the CSs seemed to be even more persistent. Stronger positive affect toward the CSþ than toward the CS_ remained during the entire extinction phase, although at the final extinction trial, there was only a trend effect

The absence of a conditioning effect for the genital measure does not hamper any conclusions about the persistence of sexual evaluative learning effects. In agreement with a previous study from our laboratory, we observed that in men, penile circumference to the CS_ was larger than that to CSþ during the acquisition phase when the vibration stimulus was provided..

Finally, and clinically relevant, the present study investigated only newly acquired sexual evaluative learning and relatively short-term effects within one experimental session.

Findings from the present study and from earlier research19 suggest that although an extinction procedure may reduce the CS-US contingency, learned sexual evaluations may

be difficult to modify through this procedure. Therefore, in the treatment of sexual disorders with a learned component, such as hypersexuality or paraphilia, unwanted but persistent subjective sexual evaluations may be better targeted by interventions such as counterconditioning or the deployment of emotion regulation strategies. In counter conditioning, the CS is paired with a stimulus evoking a response that is incompatible with the original unconditioned response, thereby altering the valence of a stimulus.18 Although the effects of counterconditioning on evaluative learning has received little attention in the literature, research on appetitive conditioning in the domain of food and alcohol stimuli has shown that counterconditioning is more

effective than extinction alone in changing evaluations of the CS.45,46 In addition, research on the deployment of an emotion regulation strategy (ie, attentional deployment) during sexual conditioning demonstrated that emotion down-regulation affected extinction of conditioned evaluative sexual learning effects in men, and in women, down-regulation resulted in attenuated conditioned approach tendencies toward the CSs.20