Sexual desire, sexual arousal and hormonal differences in premenopausal US and Dutch women with and without low sexual desire

The interaction between women's hormonal condition and subjective, physiological, and behavioral indices of desire or arousal remains only partially explored, in spite of frequent reports from women about problems with a lack of sexual desire. The present study recruited premenopausal women at two sites, one in the United States and the other in the Netherlands, and incorporated various measures of acute changes in sexual desire and arousal. A sample of 46 women who met criteria for Hypoactive Sexual Desire Disorder (HSDD) was compared to 47 women who experienced no sexual problems (SF). Half of each group used oral contraceptives (OCs). The specific goal was to investigate whether there is a relationship between women's hormone levels and their genital and subjective sexual responsiveness. Background demographics and health variables, including oral contraceptive (OC) use, were recorded and hormones (total testosterone (T), free testosterone (FT), SHBG, and estradiol) were analyzed along with vaginal pulse amplitude and self-report measures of desire and arousal in response to sexual fantasy, visual sexual stimuli, and photos of men's faces. Self-reported arousal and desire were lower in the HSDD than the SF group, but only for women who were not using oral contraceptives. Relationships between hormones and sexual function differed depending on whether a woman was HSDD or not. In line with prior literature, FT was positively associated with physiological and subjective sexual arousal in the SF group. The HSDD women demonstrated the opposite pattern, in that FT was negatively associated with subjective sexual responsiveness. The findings suggest a possible alternative relationship between hormones and sexual responsiveness in women with HSDD who have characteristics similar to those in the present study.     

Increasing women's sexual desire: The comparative effectiveness of estrogens and androgens

Both estradiol and testosterone have been implicated as the steroid critical for modulating women's sexual desire. By contrast, in all other female mammals only estradiol has been shown to be critical for female sexual motivation and behavior. Pharmaceutical companies have invested heavily in the development of androgen therapies for female sexual desire disorders, but today there are still no FDA approved androgen therapies for women. Nonetheless, testosterone is currently, and frequently, prescribed off-label for the treatment of low sexual desire in women, and the idea of testosterone as a possible cure-all for female sexual dysfunction remains popular. This paper places the ongoing debate concerning the hormonal modulation of women's sexual desire within a historical context, and reviews controlled trials of estrogen and/or androgen therapies for low sexual desire in postmenopausal women. These studies demonstrate that estrogen-only therapies that produce periovulatory levels of circulating estradiol increase sexual desire in postmenopausal women. Testosterone at supraphysiological, but not at physiological, levels enhances the effectiveness of low-dose estrogen therapies at increasing women's sexual desire; however, the mechanism by which supraphysiological testosterone increases women's sexual desire in combination with an estrogen remains unknown. Because effective therapies require supraphysiological amounts of testosterone, it remains unclear whether endogenous testosterone contributes to the modulation of women's sexual desire. The likelihood that an androgen-only clinical treatment will meaningfully increase women's sexual desire is minimal, and the focus of pharmaceutical companies on the development of androgen therapies for the treatment of female sexual desire disorders is likely misplaced.     

Are gonadal steroids linked with orgasm perceptions and sexual assertiveness in women and men?

Past findings suggest links between orgasms and testosterone (T), as well as sexuality and estradiol (E), and we examined hormone–orgasm links in this study via two hypotheses (below). Participants were 86 women and 91 men who provided a saliva sample and completed a demographics questionnaire, the Orgasm Checklist (Mah and Binik, 2002), the Hurlbert (1991) Index of Sexual Assertiveness, and the Sexual Desire Inventory (Spector and Fremeth, 1996). Results supported the first hypothesis of correlations between T and positive orgasm experience in women, specifically with the relaxation, soothing, and peaceful items in both partnered and solitary orgasm contexts. Results also indicated correlations between E and flooding and spreading items in a solitary orgasm context. There were no associations between hormones and men's perceptions of their orgasm experiences. There was no support for the second hypothesis of associations between higher T and more sexual assertiveness. Post hoc analyses showed associations between E and women's sexual desire, and T and men's sexual desire. We discuss implications of these findings including that solitary vs. partnered orgasm experiences may differ, and suggest that T might be associated with perceptions of psychological experiences of orgasms, and E might be associated with perceptions of physical experiences of orgasms.     

Female sexual arousal: genital anatomy and orgasm in intercourse

In men and women sexual arousal culminates in orgasm, with female orgasm solely from sexual intercourse often regarded as a unique feature of human sexuality. However, orgasm from sexual intercourse occurs more reliably in men than in women, likely reflecting the different types of physical stimulation men and women require for orgasm. In men, orgasms are under strong selective pressure as orgasms are coupled with ejaculation and thus contribute to male reproductive success. By contrast, women's orgasms in intercourse are highly variable and are under little selective pressure as they are not a reproductive necessity. The proximal mechanisms producing variability in women's orgasms are little understood. In 1924 Marie Bonaparte proposed that a shorter distance between a woman's clitoris and her urethral meatus (CUMD) increased her likelihood of experiencing orgasm in intercourse. She based this on her published data that were never statistically analyzed. In 1940 Landis and colleagues published similar data suggesting the same relationship, but these data too were never fully analyzed. We analyzed raw data from these two studies and found that both demonstrate a strong inverse relationship between CUMD and orgasm during intercourse. Unresolved is whether this increased likelihood of orgasm with shorter CUMD reflects increased penile–clitoral contact during sexual intercourse or increased penile stimulation of internal aspects of the clitoris. CUMD likely reflects prenatal androgen exposure, with higher androgen levels producing larger distances. Thus these results suggest that women exposed to lower levels of prenatal androgens are more likely to experience orgasm during sexual intercourse.     

Sexy thoughts: effects of sexual cognitions on testosterone, cortisol, and arousal in women

Previous research suggests that sexual stimuli increase testosterone (T) in women and shows inconsistent effects of sexual arousal on cortisol (C), but effects of cognitive aspects of arousal, rather than behaviors or sensory stimuli, are unclear. The present study examined whether sexual thoughts affect T or C and whether hormonal contraceptive (HC) use moderated this effect, given mixed findings of HC use confounding hormone responses. Participants (79 women) provided a baseline saliva sample for radioimmunoassay. We created the Imagined Social Situation Exercise (ISSE) to test effects of imagining social interactions on hormones, and participants were assigned to the experimental (sexual) or one of three control (positive, neutral, stressful) conditions. Participants provided a second saliva sample 15 min post-activity. Results indicated that for women not using HCs, the sexual condition increased T compared to the stressful or positive conditions. In contrast, HC using women in the sexual condition had decreased T relative to the stressful condition and similar T to the positive condition. The effect was specific to T, as sexual thoughts did not change C. For participants in the sexual condition, higher baseline T predicted larger increases in sexual arousal but smaller increases in T, likely due to ceiling effects on T. Our results suggest that sexual thoughts change T but not C, baseline T levels and HC use may contribute to variation in the T response to sexual thoughts, and cognitive aspects of sexual arousal affect physiology.     

The female orgasm and the homology concept in evolutionary biology

The definition of homology and its application to reproductive structures, external genitalia, and the physiology of sexual pleasure has a tortuous history. While nowadays there is a consensus on the developmental homology of genital and reproductive systems, there is no agreement on the physiological translation, or the evolutionary origination and roles, of these structural correspondences and their divergent histories. This paper analyzes the impact of evolutionary perspectives on the homology concept as applied to the female orgasm, and their consequences for the biological and social understanding of female sexuality and reproduction. After a survey of the history of pre-evolutionary biomedical views on sexual difference and sexual pleasure, we examine how the concept of sexual homology was shaped in the new phylogenetic framework of the late 19th century. We then analyse the debates on the anatomical locus of female pleasure at the crossroads of theories of sexual evolution and new scientific discourses in psychoanalysis and sex studies. Moving back to evolutionary biology, we explore the consequences of neglecting homology in adaptive explanations of the female orgasm. The last two sections investigate the role played by different articulations of the homology concept in evolutionary developmental explanations of the origin and evolution of the female orgasm. These include the role of sexual, developmental homology in the byproduct hypothesis, and a more recent hypothesis where a phylogenetic, physiological concept of homology is used to account for the origination of the female orgasm. We conclude with a brief discussion on the social implications for the understanding of female pleasure derived from these different homology frameworks.     

Low sexual desire in women: the role of reproductive hormones

The role of reproductive hormones in mediating sexual desire in healthy women is still unclear. Elucidation was sought in this study by comparing the hormonal milieu of two groups of subjects with markedly different levels of sexual desire. Seventeen women ages 27-39 who met DSM III-R criteria for severe, persistent, and generalized loss of desire (hypoactive sexual desire disorder, HSD), but had no other current psychological or medical problem, were compared to 13 healthy, sexually active women. All subjects and spouses were interviewed extensively to determine the women's sexual desire and responsiveness. Blood samples were drawn every 3 to 4 days for one menstrual cycle and were analyzed by RIA for testosterone, SHBG, estradiol, progesterone, prolactin, and luteinizing hormone. Results indicated that the HSD women's gonadal hormones fluctuated normally over the menstrual cycle, were within normal limits for each cycle phase, and were never significantly different from those of controls. Neither testosterone, non-SHBG bound testosterone, nor prolactin differentiated between the HSD women with the most and least severe HSD parameters (e.g., frequency of fantasy, masturbation, or female-initiated coitus), nor between women with lifelong and acquired HSD. The present findings did not provide evidence that reproductive hormones are important determinants of individual differences in the sexual desire of these eugonadal women.     

Rôle des androgènes dans la motivation sexuelle masculine: approche par la neuroanatomie cérébrale fonctionnelle

The central nervous system plays a crucial role in all of the successive stages of sexual behaviour, particularly for the processing of external stimuli. One important step consists of the evaluation of these stimuli and the assessment of their potential reward value, which will determine the development of the sexual response. These different stages involve complex cognitive processes interacting with emotional and physiological components. Androgens, and particularly testosterone, are closely related to the regulation of sexual behaviour. Many of the various effects of testosterone on sexual behaviour have been thought to result from its effects on the central nervous system. Several studies have demonstrated that a minimum concentration of plasma testosterone is necessary to maintain a normal level of sexual desire in human males. Consequently, in normal men, acute and profound androgen deficiency induced by an experimental pharmacological treatment results in decreased sexual desire and fantasies. This reduced sexual desire is also one of the major symptoms observed in male hypogonadism. Conversely, in hypogonadal men, androgen substitution therapy results in increased sexual interest and activity. Over recent years, the development of brain functional imaging techniques (Positron Emission Tomography, functional Magnetic Resonance Imaging) has demonstrated the brain regions participating in a neural network that controls and regulates sexual arousal. We have proposed a four component neurobehavioural model, comprising cognitive (e.g. orbitofrontal cortex), motivational (e.g. anterior cingulate gyrus), emotional (e.g. somatosensory cortex, insula) and physiological (e.g. hypothalamus) processes, to describe this cerebral control of sexual motivation in human males. This network comprises activating and inhibiting structures that interact with each other. As testosterone can modulate sexual desire via its action on cerebral function, we decided to perform a brain imaging study in hypogonadal patients (both when they were untreated and when they received hormone replacement therapy), to obtain e better understanding of the specificity of these brain regions in sexual arousal processes. This study could also help describe the brain regions via which testosterone acts to modulate sexual behaviour.     

Immune function during early adolescence positively predicts adult facial sexual dimorphism in both men and women

Evolutionary theories suggest that humans prefer sexual dimorphism in faces because masculinity in men and femininity in women may be an indicator of immune function during development. In particular, the immunocompetence handicap hypothesis proposes that sexual dimorphism indicates good immune function during development because the sex hormones, particularly testosterone in men, required for the development of sexually dimorphic facial features also taxes the immune system. Therefore, only healthy males can afford the high level of testosterone for the development of sexually dimorphic traits without compromising their survival. Researchers have suggested that a similar mechanism via the effects of oestrogen might also explain male preferences for female femininity. Despite the prominence of the immunocompetence handicap hypothesis, no studies have tested whether immune function during development predicts adult facial sexual dimorphism. Here, using data from a longitudinal public health dataset, the Western Australian Pregnancy Cohort (Raine) Study (Generation 2), we show that some aspects of immune function during early adolescence (14 years) positively predict sexually dimorphic 3D face shape in both men and women. Our results support a fundamental assumption that facial sexual dimorphism is an indicator of immune function during the development of facial sexual dimorphism.     

Discovery that a melanocortin regulates sexual functions in male and female humans

Melanocortins (MCs) are multifunctional peptide hormones that regulate a diversity of physiological functions. MCs have been implicated in sexual function in animals. We document here that a MC analog, Melanotan II (MTII), can enhance sexual function in human males (erectile activity) and females (increased levels of sexual desire and genital arousal). Unlike other sexual-enhancement drugs, MTII works at the level of the brain, thus eliciting a rather natural sexual response with minimal or no undesirable side effects. The actions of the peptide were discovered accidentally while studying the effects of the peptide and related analogs on human skin pigmentation (tanning).     

Menstruation and marital sex

This paper explores differences in sexual behavior between menstrual and nonmenstrual days, using daily report data from 85 husbands and wives for about 100 days each. Most of the men were in graduate school and the wives had a mean education of 16 years. All couples practiced contraception, but not a hormonal or rhythm method. Husband's desire for intercourse was reduced by 6%, the wife's by 19%. A sexual frustration index is arrived at by taking the % of nonintercourse days on which the respondents nevertheless reported wanting intercourse. Husbands showed a frustration index of 22% on nonmenstrual days and 36% on menstrual days. Wives demonstrated a 15% sexual frustration level when not menstruating, 19% during menstruation. The frustration reduction index (arrived at by counting the number of "want intercourse days" on which orgasm occurred without intercourse), was 17% in husbands on menstrual days, 10% on nonmenstrual days; for wives the index was 7% on menstrual days, 6% on nonmenstrual days. The authors conclude that in the highly educated group studied, intercourse and orgasm are reduced during menstruation, in association with impressively less female desire for intercourse during menstruation. The women respond to a resultant potential increase in male sexual frustration by providing the husbands an increase in noncoital orgasm on menstrual days. However, the wives do not experience an increased intercourse frustration level during menstruation and their heterosexual noncoital orgasm rate is relatively stable throughout the cycle. The different patterns of desire levels for husbands and wives may have a biological base, and the different behavior observed represent a sociological compromise.     

Sexual Dysfunction in Sheehan Syndrome

ObjectiveThe study was done to objectively document the sexual function in Sheehan syndrome (SS). SS is not an uncommon cause of hypopituitarism in developing countries. The lack of sex steroids from both ovaries and adrenal glands could lead to sexual dysfunction in SS. Sexual function is a neglected aspect of health in women in developing countries, although it greatly contributes toward the quality of life and feeling of well-being. Objective documentation of sexual function in SS is limited.MethodsThirty-two subjects with SS on conventional therapy (except growth hormone) were evaluated. SS was diagnosed as per standard criteria. Sexual function was assessed by validated questionnaires using the Female Sexual Function Index (FSFI). Thirty healthy women of a similar age range and socioeconomic background were included as comparators.ResultsThe mean age (±SD) of the study population and healthy controls was 39.9 (±8.6) years and 38.2 (±6.8) years, respectively. The median interval between inciting events and diagnosis of SS was 8.3 years (interquartile range, 5.2-13.5 years). Thirty subjects were sexually active. Of the 30 subjects, 28 (93%) had sexual dysfunction, that is, an FSFI score of ≤26.55. The median total FSFI scores of subjects with SS and controls were 20.8 and 29.05, respectively, (P = .001). There was a statistically significant difference for individual parameters of sexual function, including desire, arousal, lubrication, orgasm, and satisfaction, between those with SS and controls. However, the pain during intercourse was not different. FSFI score in subjects with SS was not correlated with any endocrine parameter or duration of the disease since diagnosis.ConclusionSexual dysfunction is very common, affecting >90% of subjects with SS.     

Genetic influences on variation in female orgasmic function: a twin study

Orgasmic dysfunction in females is commonly reported in the general population with little consensus on its aetiology. We performed a classical twin study to explore whether there were observable genetic influences on female orgasmic dysfunction. Adult females from the TwinsUK register were sent a confidential survey including questions on sexual problems. Complete responses to the questions on orgasmic dysfunction were obtained from 4037 women consisting of 683 monozygotic and 714 dizygotic pairs of female twins aged between 19 and 83 years. One in three women (32%) reported never or infrequently achieving orgasm during intercourse, with a corresponding figure of 21% during masturbation. A significant genetic influence was seen with an estimated heritability for difficulty reaching orgasm during intercourse of 34% (95% confidence interval 27-40%) and 45% (95% confidence interval 38-52%) for orgasm during masturbation. These results show that the wide variation in orgasmic dysfunction in females has a genetic basis and cannot be attributed solely to cultural influences. These results should stimulate further research into the biological and perhaps evolutionary processes governing female sexual function.     

Testosterone and sport: current perspectives

Testosterone and other anabolic-androgenic steroids enhance athletic performance in men and women. As a result, exogenous androgen is banned from most competitive sports. However, due to variability in endogenous secretion, and similarities with exogenous testosterone, it has been challenging to establish allowable limits for testosterone in competition. Endogenous androgen production is dynamically regulated by both exercise and winning in competition. Furthermore, testosterone may promote athletic performance, not only through its long-term anabolic actions, but also through rapid effects on behavior. In women, excess production of endogenous testosterone due to inborn disorders of sexual development (DSD) may convey a competitive advantage. For many years, female competitors have been subject to tests of sexual genotype and phenotype known as gender verification. Although gender verification has not identified any normal man competing as a woman, this process has identified women athletes with DSD. As understanding of DSD has expanded in recent years, women with DSD are increasingly able to continue athletic competition.     

Hormonal predictors of women's extra-pair vs. in-pair sexual attraction in natural cycles: Implications for extended sexuality

In naturally cycling women, Roney and Simmons (2013) examined hormonal correlates of their desire for sexual contact. Estradiol was positively associated, and progesterone negatively associated, with self-reported desire. The current study extended these findings by examining, within a sample of 33 naturally cycling women involved in romantic relationships, hormonal correlates of sexual attraction to or interests in specific targets: women's own primary partner or men other than women's primary partner. Women's sexual interests and hormone (estradiol, progesterone, and testosterone) levels were assessed at two different time points. Whereas estradiol levels were associated with relatively greater extra-pair sexual interests than in-pair sexual interests, progesterone levels were associated with relatively greater in-pair sexual interests. Both hormones specifically predicted in-pair sexual desire, estradiol negatively and progesterone positively. These findings have implications for understanding the function of women's extended sexuality — their sexual proceptivity and receptivity outside the fertile phase, especially during the luteal phase.     

睾酮对鸟类繁殖影响研究进展

类固醇激素睾酮是影响鸟类繁殖最重要的性激素之一,与鸟类的繁殖行为的各个方面息息相关。睾酮通过影响鸟类的羽色、鸣声等来影响鸟类的配偶选择,同时睾酮可以调节配偶选择和繁殖投入之间的平衡。睾酮水平影响出雏数、出飞数、孵化率成功率等繁殖成效。睾酮还对个体的免疫活性和个体的存活率等产生影响。目前关于睾酮对鸟类繁殖影响的研究大多是通过外源性植入睾酮的方式来改变个体睾酮的浓度,其研究结果也常出现相互矛盾之处,对于自然状态下影响睾酮水平变化的因素尚缺乏了解,睾酮对雌雄鸟在繁殖过程中的影响也不尽相同,有必要继续深入研究。     

Androgens and breast cancer risk

Transdermal testosterone supplementation is a treatment option for postmenopausal women with distressful decreased libido. Side effects are minor, but there is a long-term safety concern with respect to breast cancer, as women with high testosterone serum levels appear to be at a significantly increased risk to have or to develop breast cancer within a few years. Epidemiological studies of sufficient duration to study long-term effects of testosterone supplementation are limited, both in number and in methodological quality and are, therefore, inconclusive. Preclinical studies do not provide evidence for an androgen receptor-mediated stimulating effect of androgens on breast epithelium. However, one biologically plausible possibility, which cannot be ruled out, is that exogenous androgens become mitogenic after aromatization into bioactive oestradiol, either in peripheral fat or within the breast or even within small occult tumours. The evidence available so far makes counselling women interested in testosterone supplementation for distressful low sexual desire, more of an art than science.     

Beneficial effects of natural products on female sexual dysfunction: A systematic review and meta-analysis

BackgroundFemale sexual dysfunction (FSD) includes female orgasmic disorder, female sexual interest or arousal disorder, and genito-pelvic pain or penetration disorder. FSD affects 40% of women worldwide, but it is understudied and likely undertreated. Natural products are frequently used by women to treat FSD, but scientific evidence of their efficacy is lacking.ObjectiveThis systematic review and meta-analysis focused on the study of the efficacy of natural products on FSD.Study designSystematic review and meta-analysis of existing studies on natural products in the treatment of FSD.MethodsThe literature search included MEDLINE, EMBASE, PsycINFO, and the Cochrane Central Register of Controlled Trial databases for studies published from January 2000 to February 2020. The quality and the level of evidence of the studies were assessed. The association between natural products and FSD was summarized using standardized mean differences (SMD) with a 95% confidence interval (CI).ResultsA total of 536 studies were identified, with 20 of them meeting the criteria. According to this meta-analysis, Tribulus terrestris showed a significant positive effect in improving overall female sexual function (SMD = 1.12, 95% CI = 0.46 - 1.79, p = 0.001) and individual sexual arousal (SMD = 1.03, 95% CI = 0.22 - 1.84, p = 0.013), sexual desire (SMD = 1.08, 95% CI = 0.52 - 1.63, p ≤ 0.001) and sexual orgasm (SMD = 0.51, 95% CI = 0.02 - 1.00, p = 0.040) domains compared to placebo. Panax ginseng was found to be effective in treating sexual arousal (SMD = 0.54, 95% CI = 0.11 - 0.97, p = 0.014) and sexual desire (SMD = 0.59, 95% CI = 0.27 - 0.90, p < 0.001) compared to placebo. Meanwhile, other natural products reviewed in this study, such as Trifolium pretense, did not differ significantly from placebo in terms of improving FSD.ConclusionPreliminary evidence suggests that Tribulus terrestris and Panax ginseng may be effective as alternative treatments for FSD in a clinical setting.     

Female Sexual Dysfunction in Women with Non-Malignant Cervical Diseases: A Study from an Urban Chinese Sample

Non-malignant cervical diseases are common causes of disease among women worldwide. Although many studies have focused on sexual function in women with cervical cancer, little is known about the prevalence of female sexual dysfunction and its risk factors in women with non-malignant cervical diseases. The present study aims to assess sexual function in Chinese women with non-malignant cervical diseases and to identify potential risk factors for these diseases. A cross-sectional hospital-based survey was conducted in Nanjing, China. The Chinese version of the Female Sexual Function Index (CVFSFI) was used to evaluate sexual function. Three hundred three women who had been diagnosed with at least one non-malignant cervical disease and 293 healthy women were recruited from Nanjing Maternity and Child Health Hospital of Nanjing Medical University. We found that women with non-malignant cervical diseases had a significantly higher prevalence of female sexual dysfunction (FSD) (51.8% vs. 34.8%), low desire (43.2% vs. 26.3%), arousal disorder (41.6% vs. 28.3%), and lubrication disorder (51.2% vs. 36.9%) compared with the control group. Cervicitis and cervical intraepithelial neoplasia (CIN) were found to be independent risk factors for FSD. Our study indicates that women with cervicitis and CIN are at a high risk for FSD and deserve focused initial and follow-up management.     

Sex and context: hormones and primate sexual motivation

Gonadal hormones regulate the ability to copulate in most mammalian species, but not in primates because copulatory ability has been emancipated from hormonal control. Instead, gonadal hormones primarily influence sexual motivation. This separation of mating ability from hormonally modulated mating interest allows social experience and context to powerfully influence the expression of sexual behavior in nonhuman primates, both developmentally and in adulthood. For example, male rhesus monkeys mount males and females equally as juveniles, but mount females almost exclusively as adults. Having ejaculated with a female better predicted this transition to female mounting partners than did increased pubertal testosterone (T). It is proposed that increased pubertal T stimulates male sexual motivation, increasing the male's probability of sexual experience with females, ultimately producing a sexual preference for females. Eliminating T in adulthood reduces male sexual motivation in both humans and rhesus monkeys, but does not eliminate the capacity to engage in sex. In male rhesus monkeys the effects of reduced androgens on sexual behavior vary with social status and sexual experience. Human sexual behavior also varies with hormonal state, social context, and cultural conventions. Ovarian hormones influence female sexual desire, but the specific sexual behaviors engaged in are affected by perceived pregnancy risk, suggesting that cognition plays an important role in human sexual behavior. How the physical capacity to mate became emancipated from hormonal regulation in primates is not understood. This emancipation, however, increases the importance of motivational systems and results in primate sexual behavior being strongly influenced by social context.