Sexual Excitation/Sexual Inhibition Inventory for Women

1. Abstract

The Sexual Excitation/Sexual Inhibition Inventory for Women (SESII-W) is a psychometric instrument designed to evaluate individual propensities for sexual excitation (SE) and sexual inhibition (SI) in women. Grounded conceptually in the Dual Control Model of Sexual Response developed by John Bancroft and Erick Janssen, the SESII-W posits that human sexual response is regulated through a balance between neurobiological activation (“accelerator”) and central suppression (“brakes”). Developed by Cynthia A. Graham, Stephanie A. Sanders, and Robin R. Milhausen in 2006, the instrument addresses specific limitations observed when applying male-derived psychometric models of sexual arousal to female populations. The SESII-W contains 36 items organized hierarchically into eight lower-order factors and two higher-order factors: Sexual Excitation (encompassing Arousability, Partner Characteristics, Sexual Power Dynamics, Smell, and Setting) and Sexual Inhibition (encompassing Concerns About Sexual Function, Arousal Contingency, and Relationship Importance).

Items are evaluated on an authentic 4-point Likert-type rating scale ranging from 1 (“Strongly Disagree”) to 4 (“Strongly Agree”). Extensive psychometric evaluation among non-clinical and clinical cohorts confirms that the SESII-W possesses robust construct validity, high test-retest reliability ($r = .81$ for SE; $r = .82$ for SI), and acceptable to good internal consistency across its subscales (Cronbach’s $\alpha = .63$ to $.80$, overall mean $\alpha = .72$). The scale provides clinical and empirical insight into female sexual difficulties, such as hypoactive sexual desire disorder and female sexual interest/arousal disorder (FSIAD), while also explaining individual differences in sexual risk-taking, relational dynamics, and psychophysiological arousal patterns.

2. Keywords

Sexual Excitation/Sexual Inhibition Inventory for Women, SESII-W, Dual Control Model, sexual excitation, sexual inhibition, female sexual arousal, psychometrics, sexual desire, sexual dysfunction, Kinsey Institute, Arousability, Arousal Contingency, sexology

3. Authors

The Sexual Excitation/Sexual Inhibition Inventory for Women was developed by a team of researchers associated with The Kinsey Institute for Research in Sex, Gender, and Reproduction and Indiana University:

• Cynthia A. Graham, Ph.D.: Department of Psychology and Oxford Doctoral Course in Clinical Psychology, Isis Education Centre, Warneford Hospital, Oxford, England; Senior Research Fellow at The Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, Indiana, United States.
• Stephanie A. Sanders, Ph.D.: The Kinsey Institute for Research in Sex, Gender, and Reproduction; Department of Gender Studies, Indiana University, Bloomington, Indiana, United States; Rural Center for AIDS/STD Prevention.
• Robin R. Milhausen, Ph.D.: Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, Canada; formerly of The Kinsey Institute for Research in Sex, Gender, and Reproduction and the Rural Center for AIDS/STD Prevention, Indiana University.

Correspondence regarding the original scale development was directed to Dr. Cynthia A. Graham at the Oxford Doctoral Course in Clinical Psychology, Warneford Hospital, Headington, Oxford OX3 7JX, England (Email: [email protected]).

4. Purpose

The primary purpose of the SESII-W is to provide a reliable, theoretically grounded self-report measure to assess individual differences in the propensity for sexual excitation and sexual inhibition in women. Historically, sexological research relied heavily on normative physiological models derived predominantly from male anatomy and subjective male experiences, exemplified by the original Sexual Inhibition/Sexual Excitation Scales (SIS/SES) developed by Janssen, Vorst, Finn, and Bancroft (2002). Although the SIS/SES provided breakthroughs in understanding male erectile dysfunction and hypersexuality, subsequent empirical evaluations demonstrated that women’s sexual arousal patterns diverge markedly from men’s in contextual dependence, relational relevance, and affective appraisal.

To overcome these conceptual limitations, Graham and colleagues conducted qualitative investigations using focus groups involving diverse groups of women across varied ages, relationship statuses, racial/ethnic backgrounds, and sexual orientations. These qualitative analyses revealed that female sexual arousal is uniquely shaped by cognitive distraction, emotional safety, partner attributes, sensory stimuli, and relational intimacy. The resulting 36-item SESII-W was purpose-built to quantify these nuanced dimensions, allowing researchers and clinicians to:

• Examine the neurobiological and psychological mechanisms that facilitate or impede sexual arousal in women.
• Differentiate normative variability in female sexual response from clinically significant pathology, such as female sexual interest/arousal disorder (FSIAD) and genito-pelvic pain/penetration disorder.
• Identify cognitive vulnerability factors (such as performance anxiety, body image self-consciousness, and relationship ambivalence) that trigger central inhibition.
• Predict sexual risk behaviors, such as non-condom use or engagement in high-risk sexual encounters, which are frequently linked to elevated sexual excitation combined with diminished sexual inhibition.
• Provide tailored clinical intervention targets within cognitive-behavioral sex therapy, couple therapy, and mindfulness-based interventions by identifying whether a client’s distress stems from an underactive excitatory mechanism, an overactive inhibitory mechanism, or a combination of both.

5. Psychological Construct

The SESII-W evaluates two distinct, orthogonal higher-order constructs—Sexual Excitation (SE) and Sexual Inhibition (SI)—which are further subdivided into eight lower-order psychological dimensions reflecting distinct cognitive, emotional, sensory, and situational triggers:

Higher-Order Factor: Sexual Excitation (SE)

Sexual Excitation represents an individual’s proneness to become sexually aroused in response to a wide array of internal and external sexual cues. It reflects the neurochemical sensitivity of the central nervous system’s appetitive drive. Within the SESII-W, SE comprises five lower-order factors:

• Arousability (Items 10, 14, 18, 20, 23, 30): Quantifies general baseline conditionability and physical ease of becoming sexually aroused across internal fantasies, external visual stimuli, and physiological shifts. An illustrative item includes: “I get sexually aroused just thinking about having sex.”
• Partner Characteristics (Items 6, 8, 17, 27): Assesses the degree to which specific partner behaviors, verbal cues, sexual competence, or physical presentation trigger arousal. An illustrative item includes: “When a partner talks dirty to me, it really turns me on.”
• Setting (Unusual or Unconcealed) (Items 1, 9, 24, 32): Captures the propensity to experience elevated sexual arousal in response to novel, taboo, unconventional, or semi-public environments where an element of risk or being observed exists. An illustrative item includes: “Having sex when there is a risk of getting caught turns me on.”
• Sexual Power Dynamics (Items 15, 21, 28, 34): Measures sexual arousal elicited by consensual power imbalances, dominant/submissive role play, or being sexually overpowered within a trusted environment. An illustrative item includes: “Feeling that a partner is totally in control sexually can be a turn-on for me.”
• Smell (Item 36): Evaluates the capacity of olfactory cues, such as bodily scents, pheromonal stimuli, or perfumes, to initiate or enhance sexual excitation. The representative item is: “Specific scents or perfumes can get me sexually aroused.”

Higher-Order Factor: Sexual Inhibition (SI)

Sexual Inhibition represents the propensity of the central nervous system to suppress or shut down sexual arousal in the presence of real or perceived physical, emotional, social, or performance-related threats. Within the SESII-W, SI comprises three lower-order factors:

• Relationship Importance (Items 3, 5, 7, 12, 13, 22, 29, 35): Gauges the necessity of emotional security, mutual trust, interpersonal respect, and emotional commitment as prerequisites for sexual arousal. High scores indicate that emotional vulnerability, relational ambiguity, or perceived lack of respect acts as a potent sexual inhibitor. An illustrative item includes: “I have to trust a partner completely before I can let myself get sexually aroused.”
• Arousal Contingency (Items 2, 4, 16, 19, 25, 31, 33): Captures the fragility of sexual arousal and the degree to which arousal is readily disrupted by situational distractors, fatigue, physical discomfort, negative environmental factors, or sudden cognitive shifts. An illustrative item includes: “If I am distracted by outside noises during sex, I lose my arousal.”
• Concerns About Sexual Function (Items 11, 26): Measures performance-related anxieties, such as worry over achieving orgasm, taking too long to become aroused, or failing to satisfy a partner, which paradoxically impair the physiological arousal response. An illustrative item includes: “When I am sexually aroused, I worry about whether or not I will have an orgasm.”

6. Theoretical Framework

The foundational framework underlying the SESII-W is the Dual Control Model of Sexual Response, formulated by John Bancroft and Erick Janssen at the Kinsey Institute. The model posits that sexual response is governed by two independent, centrally mediated neurobiological systems:

• A central excitatory system (the “accelerator”), which processes reinforcing sexual stimuli through ascending dopaminergic, noradrenergic, and melanocortinergic pathways.
• A central inhibitory system (the “brakes”), which suppresses sexual arousal through descending serotonergic, endocannabinoid, and opioid pathways, often mediated by prefrontal cortical executive control.

From an evolutionary psychology perspective, the dual control mechanism evolved as an adaptive survival strategy. While sexual excitation promotes reproductive success and genetic transmission, unregulated sexual arousal could lead to catastrophic consequences if enacted during situations of acute physical danger, high social costs, or in the presence of uninvested or exploitative mates. Sexual inhibition acts as a vital protective mechanism, preventing reproductive engagement in threatening, unsafe, or reproductively disadvantageous contexts.

The Dual Control Model proposes that individuals possess stable, trait-like differences in their thresholds for both excitation and inhibition. These systems operate relatively independently: an individual may have high excitation and low inhibition, low excitation and high inhibition, both high, or both low. The SESII-W specifically accounts for sexual response in women, in whom evolutionary pressures selected for heightened sensitivity to relational context, partner safety, emotional investment, and environmental privacy. Consequently, female sexual inhibition is heavily distributed across interpersonal dimensions (such as Relationship Importance) rather than solely threat of physical performance failure.

7. Validity

The psychometric validity of the SESII-W was systematically evaluated by Graham, Sanders, and Milhausen (2006) across an initial development sample of 655 women (226 recruited via random postal sampling of university staff and students; 429 recruited through electronic mailing lists). Subsequent research across North America, Europe, and Asia has corroborated these findings:

Construct and Structural Validity

Confirmatory factor analyses demonstrated that the two-level hierarchical model—consisting of eight lower-order factors loading onto two higher-order factors—yielded superior fit compared to single-factor or non-hierarchical multi-factor configurations. The distributions of the higher-order SE and SI scores approximate a normal Gaussian distribution in community samples, confirming that individual variability in sexual excitation and sexual inhibition represents a continuous, normative trait distribution rather than discrete pathology.

Convergent and Divergent Validity

Empirical correlations with established personality and sexuality measures confirmed theoretical expectations:

• Behavioral Activation/Inhibition: Modest correlations were found between SESII-W factors and Carver and White’s (1994) Behavioral Inhibition System/Behavioral Activation System (BIS/BAS) Scales. This confirmed divergent construct validity, demonstrating that the SESII-W assesses domain-specific sexual excitation and inhibition rather than broad, non-specific behavioral activation or generalized neurosis.
• Erotophilia and Sensation Seeking: Higher-order Sexual Excitation exhibited moderate positive correlations with the Sexual Opinion Survey (SOS; Fisher, 1998) measuring erotophilia, and the Sexual Sensation Seeking Scale (SSSS; Kalichman & Rompa, 1995). Conversely, higher-order Sexual Inhibition correlated negatively with erotophilia and sexual sensation seeking.
• Social Desirability: Correlations with the Social Desirability Scale (SDSR-5; Hays, Hayashi, & Stewart, 1989) were near zero and non-significant across all eight subscales, confirming that SESII-W responses are robust against socially desirable response bias.

Criterion and Psychophysiological Validity

Laboratory-based psychophysiological investigations using vaginal photoplethysmography have demonstrated that women scoring higher on SESII-W Sexual Excitation subscales exhibit greater vaginal pulse amplitude (VPA) changes when presented with erotic films. Conversely, women scoring high on Arousal Contingency and Concerns About Sexual Function demonstrate marked decreases in subjective and physiological arousal when minor cognitive distractors are introduced during laboratory testing.

8. Reliability

The SESII-W exhibits strong psychometric reliability across internal consistency, inter-item stability, and temporal reproducibility:

Internal Consistency

In the primary validation study by Graham et al. (2006), Cronbach’s alpha coefficients across the eight lower-order factors ranged from satisfactory to strong ($lpha = .63$ to $.80$), with a mean alpha of $.72$ across subscales:

• Arousability: $\alpha = .78 – .80$
• Partner Characteristics: $\alpha = .70 – .74$
• Setting: $\alpha = .68 – .72$
• Sexual Power Dynamics: $\alpha = .68 – .71$
• Smell: Evaluated as a single-item specific sensory indicator (inter-item correlations evaluated in longer preliminary drafts)
• Relationship Importance: $\alpha = .73 – .77$
• Arousal Contingency: $\alpha = .71 – .75$
• Concerns About Sexual Function: $\alpha = .63 – .69$

Composite reliability coefficients for the higher-order domains of Sexual Excitation and Sexual Inhibition routinely exceed $.82$ in both community and clinical validation cohorts.

Test-Retest Reliability

Temporal stability was established by administering the SESII-W to a subsample of participants over a 4-to-6-week retest interval. Intraclass correlations for all subscales were statistically significant at $p < .005$. Test-retest reliability coefficients for the higher-order factors were excellent:

• Higher-Order Sexual Excitation (SE): $r = .81$
• Higher-Order Sexual Inhibition (SI): $r = .82$

These findings demonstrate that the propensities measured by the SESII-W operate as stable psychological traits over time rather than fluctuating situational states.

9. Factor Analysis

The structural dimensionality of the SESII-W was developed using a multi-phase factor analytic strategy:

Exploratory Factor Analysis (EFA)

Item generation initially produced a comprehensive pool of 115 items derived from qualitative focus group data (Graham et al., 2004). An initial sample of 655 women completed the 115-item inventory. An exploratory factor analysis utilizing principal axis factoring with oblique (Promax) rotation was conducted, allowing underlying dimensions to correlate naturally. Items were systematically evaluated based on the following empirical criteria:

• Primary factor loadings $ge .40$.
• Cross-loadings on secondary factors $le .25$.
• Theoretical relevance to the Dual Control Model.
• Maintenance of adequate item-total correlations within prospective subscales.

Through this iterative refinement, 36 items were retained across eight distinct, interpretable first-order factors accounting for the majority of the common variance.

Second-Order Hierarchical Factor Structure

Subsequent factor analysis of the correlations among the eight lower-order factor scores revealed two prominent second-order factors, demonstrating clear biological and behavioral alignment with the Dual Control Model:

• Factor 1 (Higher-Order SE): Subsumed the lower-order dimensions of Arousability, Partner Characteristics, Sexual Power Dynamics, Smell, and Setting.
• Factor 2 (Higher-Order SI): Subsumed the lower-order dimensions of Relationship Importance, Arousal Contingency, and Concerns About Sexual Function.

Confirmatory factor analyses in independent replication samples have substantiated this hierarchical structure, yielding acceptable goodness-of-fit indices (Comparative Fit Index [CFI] $ge .90$; Tucker-Lewis Index [TLI] $ge .90$; Root Mean Square Error of Approximation [RMSEA] $le .055$; Standardized Root Mean Square Residual [SRMR] $le .060$).

10. Instrument / Measurement Tool

Below are the structural specifications, administration guidelines, and scoring criteria for the instrument:

• Instrument Name: Sexual Excitation/Sexual Inhibition Inventory for Women (SESII-W)
• Constructs Assessed: Trait propensities for sexual excitation and sexual inhibition
• Number of Items: 36 items
• Target Population: Women aged 18 years and older, regardless of sexual orientation, marital status, or current relationship status
• Administration Format: Paper-and-pencil questionnaire or computerized self-report assessment
• Completion Time: Approximately 10 to 15 minutes
• Reading Level: Estimated 7th to 8th-grade reading level
• Response Scale: 4-point Likert scale (1 = Strongly Disagree, 2 = Disagree, 3 = Agree, 4 = Strongly Agree)
• Scoring Procedure:
  • Direct Scoring: Items with positive loadings are scored directly: 1 = Strongly Disagree, 2 = Disagree, 3 = Agree, 4 = Strongly Agree.
  • Reverse Scoring: Items with negative loadings (e.g., Item 18) are reverse-coded: 4 = Strongly Disagree, 3 = Disagree, 2 = Agree, 1 = Strongly Agree.
  • Lower-Order Factor Scores: Calculated as the unweighted mathematical mean of the items comprising each subscale:
  • Arousability: Mean of Items 10, 14, 18 (reversed), 20, 23, 30
  • Partner Characteristics: Mean of Items 6, 8, 17, 27
  • Setting: Mean of Items 1, 9, 24, 32
  • Sexual Power Dynamics: Mean of Items 15, 21, 28, 34
  • Smell: Score of Item 36
  • Relationship Importance: Mean of Items 3, 5, 7, 12, 13, 22, 29, 35
  • Arousal Contingency: Mean of Items 2, 4, 16, 19, 25, 31, 33
  • Concerns About Sexual Function: Mean of Items 11, 26
  • Higher-Order Factor Scores: Calculated as the mean of the corresponding lower-order factor means:
    • Sexual Excitation (SE) = $(\text{Arousability} + \text{Partner Characteristics} + \text{Sexual Power Dynamics} + \text{Smell} + \text{Setting}) / 5$
    • Sexual Inhibition (SI) = $(\text{Concerns About Sexual Function} + \text{Arousal Contingency} + \text{Relationship Importance}) / 3$

11. Permissions & Fee and Test Year

The Sexual Excitation/Sexual Inhibition Inventory for Women was published in 2006 in the peer-reviewed journal Archives of Sexual Behavior. The instrument is copyrighted by its authors (Cynthia A. Graham, Stephanie A. Sanders, and Robin R. Milhausen) and Springer Science+Business Media.

The authors actively encourage the use of the SESII-W for non-profit academic research, scientific studies, and clinical assessment. No licensing fee is required for academic or independent scientific investigations. Researchers wishing to utilize the instrument are requested to notify the corresponding author (Dr. Cynthia A. Graham) and share empirical findings derived from its administration. Commercial applications, integration into for-profit digital applications, or pharmaceutical clinical trials require explicit written authorization and formal licensing agreements from the copyright holders.

12. References

• Bancroft, J. (1999). Central inhibition of sexual response in the male: A theoretical perspective. Neuroscience and Biobehavioral Reviews, 23(6), 763–784. https://doi.org/10.1016/S0149-7634(99)00019-6
• Bancroft, J., Graham, C. A., Janssen, E., & Sanders, S. A. (2009). The dual control model: Current status and future directions. The Journal of Sex Research, 46(2–3), 121–142. https://doi.org/10.1080/00224490902747222
• Bancroft, J., & Janssen, E. (2000). The dual control model of male sexual response: A theoretical approach to centrally mediated erectile dysfunction. Neuroscience and Biobehavioral Reviews, 24(5), 571–579. https://doi.org/10.1016/S0149-7634(00)00024-5
• Carver, C. S., & White, T. L. (1994). Behavioral inhibition, behavioral activation, and affective responses to impending reward and punishment: The BIS/BAS Scales. Journal of Personality and Social Psychology, 67(2), 319–333. https://doi.org/10.1037/0022-3514.67.2.319
• Fisher, W. A. (1998). The Sexual Opinion Survey. In C. M. Davis, W. L. Yarber, R. Bauserman, G. Schreer, & S. L. Davis (Eds.), Handbook of sexuality-related measures (pp. 218–223). Sage Publications.
• Graham, C. A., Sanders, S. A., & Milhausen, R. R. (2006). The Sexual Excitation and Sexual Inhibition Inventory for Women: Psychometric properties. Archives of Sexual Behavior, 35(4), 397–410. https://doi.org/10.1007/s10508-006-9041-7
• Graham, C. A., Sanders, S. A., Milhausen, R. R., & McBride, K. R. (2004). Turning on and turning off: A focus group study of the factors that affect women’s sexual arousal. Archives of Sexual Behavior, 33(6), 527–538. https://doi.org/10.1023/B:ASEB.0000044737.60623.56
• Hays, R. D., Hayashi, T., & Stewart, A. L. (1989). A five-item measure of socially desirable response set. Educational and Psychological Measurement, 49(3), 629–636. https://doi.org/10.1177/001316448904900315
• Janssen, E., Vorst, H., Finn, P., & Bancroft, J. (2002). The Sexual Inhibition (SIS) and Sexual Excitation (SES) Scales: II. Predicting psychophysiological response patterns. The Journal of Sex Research, 39(2), 127–132. https://doi.org/10.1080/00224490209552130
• Kalichman, S. C., & Rompa, D. (1995). Sexual Sensation Seeking and Sexual Compulsivity Scales: Reliability, validity, and predicting HIV risk behavior. Journal of Personality Assessment, 65(3), 586–601. https://doi.org/10.1207/s15327752jpa6503_16

13. Items of the Scale (Questionnaire)