The DSM diagnostic criteria for hypoactive sexual desire disorder in women

Why College Women and Men Refrain from Sex Despite Desire: Development of the No Sex Despite Desire (NSDD) Measure

Humans have sex for myriad reasons, many unrelated to desire. But under what conditions does sexual desire not lead to sex? We investigated reasons college students refrain from sex despite desire and having an attractive, willing partner and relationships between these reasons and other aspects of sexuality and personality. For item generation, 604 participants identified 109 reasons why individuals may refrain from sex despite desire. For construct validation, 712 participants reported the frequency they experienced these reasons on a novel measure. Every reason evidencing discernible gender differences was endorsed more by women. These items largely concentrated in factors of Personal Insecurities and Principled Concerns. No gender differences emerged on the Partner Issues factor. Factors differentially related to sexuality and personality variables. Principled Concerns related negatively to sociosexual behavior and attitudes and positively to sexual traditionalism across genders. Partner Issues positively correlated with sociosexual behavior and desire for women. Personal Insecurities negatively correlated with sociosexual attitudes for men. Principled Concerns related to sexual functioning issues for women. Personal Insecurities and Principled Concerns related to worse sexual functioning for men. Personal Insecurities related to Neuroticism across genders. These results suggest potential directions for therapeutic interventions and further research.

Turkish women's perception of low sexual desire, its causes and consequences: an online qualitative survey

Background The nature of sexual desire is complex, and little phenomenological consensus exists about its meaning. Low sexual desire (LSD) is a commonly reported sexual difficulty among women, but it is less frequently associated with sexual distress. The aim of this qualitative study is to explore women's understanding of sexual desire, and their perceptions of factors that may contribute to LSD, its effects and their methods of seeking help. Methods The research employed a questionnaire with 12 open-ended questions, developed by the researchers based on sexual script theory. Data were collected from 165 heterosexual Turkish women who reported LSD, recruited through social media platforms between August and October 2021. The data were analysed using a contextual form of thematic analysis to identify and explore patterns. Results The ages of the participants ranged from 20 to 63years. The majority of participants held a Bachelor's degree (81.2%) and in a relationship (78.8%). Three main themes emerged from the study: (1) gendered messages concerning sex, (2) multi-level sexual desire, and (3) minimisation. The research revealed that women's sexual desire is often ignored and repressed, and has negative consequences if not expressed in socially acceptable contexts. The causes of LSD in women go beyond personal factors, and include relational and social influences. Women experiencing LSD report distressing effects on their relationships and general wellbeing, yet they tend not to seek help. Conclusions Our findings contribute to a deeper understanding of the factors impacting women's sexual desire and the barriers to seeking help.

Small Effects, Questionable Outcomes: Bremelanotide for Hypoactive Sexual Desire Disorder

Efficacy outcomes are only informative to the extent that they are validated. We examined the measurement properties of efficacy measures from the phase III ("RECONNECT") bremelanotide trials for hypoactive sexual desire disorder (HSDD) in women. Continuous efficacy outcomes, including a) the Female Sexual Function Index (FSFI) and its Desire domain (FSFI-D) and b) the Female Sexual Distress Scale-Desire/Arousal/Orgasm (FSDS-DAO) and its item assessing distress due to low desire (FSDS-DAO #13) have questionable, at best, validity evidence for women with HSDD. We found no validity evidence for previously published categorical treatment response outcomes from the RECONNECT trials. All efficacy results should be reported, but results on 8 of the 11 clinicaltrials.gov-specified efficacy outcomes were heretofore unpublished (including FSDS-DAO total score, FSFI total score, FSFI arousal domain, and items from the Female Sexual Encounter Profile-Revised). We analyzed these outcomes, upon which effect sizes ranged from nil to small. Several other continuous and categorical outcomes generated modest apparent benefits, though nearly all of these outcomes were likely derived post-hoc. Across RECONNECT trial data from two prior publications and the current study, bremelanotide's benefits are statistically modest and limited to outcomes for which scant evidence of validity among women with HSDD exists.

Feasibility of a Cognitive-Behavioral Couple Therapy Intervention for Sexual Interest/Arousal Disorder

Female sexual interest/arousal disorder (SIAD) is strongly influenced by interpersonal factors; however, there are no empirically-supported, couple-based sex therapy interventions for this disorder. This pre-registered study tested the feasibility of a cognitive-behavioral couple therapy (CBCT) intervention for SIAD. A sample of 19 couples in which a female partner was diagnosed with SIAD completed a 16-session CBCT intervention delivered online by therapists with PhD-level training in clinical psychology. Women with SIAD (Mage = 43.47, SD = 12.76) and their partners (Mage = 43.74, SD = 11.68) were in long-term relationships (M = 13.86, SD = 9.15). The CBCT sessions were video recorded and independently coded for treatment manual adherence and therapists reported on the completion of in-session and homework exercises. Participants completed measures of treatment satisfaction following the intervention as well as dyadic sexual desire (women with SIAD only) and sexual distress prior to treatment, post-treatment, and at 6 months follow-up. The therapists exhibited a high level of adherence to the treatment manual and couples had high rates of homework completion. Moreover, couples had low dropout rates, high attendance rates, and reported moderately high global treatment satisfaction and high satisfaction with virtual care. Women with SIAD reported large improvements in dyadic sexual desire and sexual distress from pre-treatment to post-treatment and pre-treatment to 6-month follow-up. Partners reported moderate and small improvements in sexual distress for post-treatment and 6-month follow-up, respectively. Results support the feasibility of an evidence-based CBCT intervention for SIAD and the need for a randomized clinical trial of the intervention.

Effects of Group Mindfulness-Based Cognitive Therapy versus Supportive Sex Education on Sexual Concordance and Sexual Response Among Women with Sexual Interest/Arousal Disorder

Low interest in sexual activity and impaired sexual response are among women's most frequent sexual concerns. Mindfulness-based treatments improve low sexual desire and arousal and associated distress. One theorized mechanism of change is the cultivation of increased mind-body awareness via greater concordance between psychological and physiological components of sexual response. We examined sexual psychophysiology data from 148 cisgender women randomized to receive mindfulness-based cognitive therapy (MCBT: n = 70) or supportive sex education (STEP: n = 78) over eight weekly group sessions. Women completed in-lab assessments of subjective, affective, and genital sexual responses to an erotic film pre- and post-treatment, and at 6- and 12-month follow-ups. Both groups showed positive changes in sexual and affective responses, but these were generally more pronounced for MBCT. MCBT increased sexual concordance to a greater degree, and gains in sexual concordance predicted improvements in sexual distress throughout treatment.

Understanding Hypoactive Sexual Desire Disorder (HSDD) in Women: Etiology, Diagnosis, and Treatment

Hypoactive Sexual Desire Disorder (HSDD) is a complex and multifaceted condition that significantly impacts the sexual well-being and overall quality of life of women. This comprehensive review aims to provide a holistic understanding of HSDD by exploring its etiology, diagnostic criteria, treatment approaches, and broader societal implications. The review delves into the intricate interplay of biological factors, including hormonal changes and neurotransmitter imbalances, that contribute to HSDD. Psychological factors, such as relationship issues, body image, and stress, are examined with sociocultural factors like societal norms, cultural influences, and media portrayals of sexuality. Diagnostic criteria and assessment methods, including The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria, and self-report questionnaires, are explored to facilitate accurate identification of HSDD and differentiation from other sexual disorders. The impact of HSDD on women's quality of life and relationships is examined, highlighting the emotional strain and interpersonal challenges associated with the disorder. Societal and personal consequences of untreated HSDD underscore the need for increased awareness and support. Treatment approaches encompass non-pharmacological interventions such as cognitive-behavioral therapy, sex therapy, and couples therapy and pharmacological interventions like hormone therapy and selective serotonin reuptake inhibitors. Novel treatments like bremelanotide, flibanserin, and integrative strategies combining psychotherapy and lifestyle changes are discussed. Challenges and controversies surrounding HSDD, including the lack of consensus on diagnostic criteria, debates about the medicalization of sexuality, ethical concerns regarding pharmaceutical interventions, and cultural considerations, are addressed. Future directions in research, including advances in neurobiological understanding, personalized medicine, long-term treatment studies, and destigmatization initiatives, offer promising pathways for enhancing the management of HSDD.

Sexual Desire Emerges from Subjective Sexual Arousal, but the Connection Depends on Desire Type and Relationship Satisfaction

According to models of responsive sexual desire, desire emerges from sexual arousal. This study examined how sexual desire type (dyadic-partner, dyadic-other, solitary) and relationship satisfaction affect the connection between subjective sexual arousal (SSA) and desire. Women (N = 100; 27% with sexual interest/arousal disorder symptoms) reported SSA while viewing a sexual film. Solitary and dyadic responsive sexual desire were assessed immediately before and following the film (immediate desire) and three days later (delayed desire). SSA predicted higher immediate solitary desire. SSA also predicted higher immediate dyadic desire, and this link was stronger for those with higher relationship satisfaction; for those with low relationship satisfaction, SSA was unrelated. For delayed desire, SSA predicted higher dyadic-partner desire, regardless of relationship satisfaction. SSA also predicted higher dyadic-other desire, yet this association was stronger for those with low relationship satisfaction; for those with high relationship satisfaction, SSA was unrelated to dyadic-other desire. Findings support the theoretical premise that desire emerges from arousal, but that this connection is dependent upon additional factors, specifically the target and timing of desire and participants' current relationship quality. Relationship satisfaction may affect the motivational value of sex with (and without) a current partner.

A Different Perspective on the Characterization of a New Degradation Product of Flibanserin With HPLC-DAD-ESI-IT-TOF-MSn and Its Pharmaceutical Formulation Analysis With Inter-Laboratory Comparison

BACKGROUND

Flibanserin (FLB) was first synthesized as an antidepressant drug; however, due to its enhancing effects on sexual activity, it was approved for treatment of hypoactive sexual desire disorder in women in 2015.

OBJECTIVE

The aim of this study was to develop a new and fully validated HPLC method for analysis of FLB in pharmaceutical formulations besides its degradation products, and identification of possible formation mechanisms by using HPLC-DAD-ESI-IT-TOF-MSn.

METHOD

The HPLC separation was achieved in a Supelco Ascentis® Express series phenyl hexyl column (100 × 4.6 mm, ID 2.7 µm). The mobile phase was acetonitrile-ammonium acetate solution (50:50, v/v, 10 mM, pH 5.4) mixture, which was pumped at the rate of 0.5 mL/min. Chromatography, detection, and structural identification was performed by using a LCMS-IT-TOF instrument (Shimadzu, Japan).

RESULTS

1-(2-(4-(3-hydroxy-5-(trifluoromethyl)phenyl)piperazine-1-yl)ethyl)-1,3-dihydro-2H-benzo[d]imidazol-2-one is proposed as a novel degradation product, with a mass of 407.1695 and a formula of C20H21F3N4O2 with a margin of error about 0.001 ppm. The developed method is applicable with 98% accuracy within the 2.5-50.0 µg/mL range. The LOD and LOQ were about 500 ng/mL and 1.50 µg/mL, respectively. The transferability and variation between laboratories were tested by inter-laboratory comparison and evaluated with one-way analysis of variance.

CONCLUSIONS

A novel FLB degradation product, which was produced under oxidative forced degradation conditions was observed and identified for the first time; in addition, the formation kinetics of the degradation product besides decomposition of FLB was studied. Furthermore, an inter-laboratory comparison was carried out, and application of the proposed method on a pseudo Addyi® (Sprout Pharmaceuticals, Inc.) sample was tested using both instrument configurations.

HIGHLIGHTS

A novel stability-indicating assay method was developed and fully validated according to the International Council on Harmonization (Q2) R1 for the analysis of FLB in the pharmaceutical preparations. A new degradation product was identified in the oxidative forced degradation condition and characterized using HPLC-DAD-ESI-IT-TOF-MS3. Moreover, the possible mechanism and the formation kinetic of the degradation product were revealed. In addition, the developed method was transferred to another LC-PDA instrument for inter-laboratory comparison. Finally, the current method was applied to a pseudo formulation of Addy in both instruments, and ANOVA was applied for evaluation.

Characteristics of Chinese women in need of enhanced sexual health attention and at risk of hypoactive sexual desire disorder

BACKGROUND

The target population for women's sexual health services in China was unclear. To identify high-risk individuals with psychological barriers to sexual health-seeking behaviors and those at high risk of hypoactive sexual desire disorder (HSDD), we investigated correlates of Chinese women's unwillingness to communicate sexual health, the shame of sexual health-related disorders, sexual distress, and HSDD.

METHODS

An online survey was conducted from April to July 2020.

RESULTS

We received 3443 valid responses online (effective rate 82.6%). Participants were mainly Chinese urban women of childbearing age (median 26 years old, Q1-Q3 23-30). Women who knew little about sexual health knowledge (aOR 0.42, 95%CI 0.28-0.63) and were ashamed (aOR 0.32-0.57) of sexual health-related disorders were less willing to communicate sexual health. Age (aOR 4.29, 95%CI 2.26-8.17), low income (aOR 1.52-2.11), family burden (aOR 1.34-1.43), and living with friends (aOR 1.39, 95%CI 1.02-1.91) were independent correlates of women's shame about sexual health-related disorders while living with a spouse (aOR 0.66, 95%CI 0.51-0.86) or children (aOR 0.77, 95%CI 0.62-0.96) were correlated with less shame. Age (aOR 0.98, 95%CI 0.96-0.99) and a postgraduate degree (aOR 0.45, 95%CI 0.28-0.71) were linked with less sexual distress of low sexual desire while having children (aOR 1.38-2.10), intense work pressure (aOR 1.32, 95%CI 1.10-1.60) and heavy family burden (aOR 1.43, 95%CI 1.07-1.92) increased women's odds of having distress. Women with a postgraduate degree (aOR 0.42, 95%CI 0.19-0.90), more knowledge about sexual health (aOR 0.53-0.67), and decreased sexual desire caused by pregnancy, recent childbirth, or menopausal symptoms (aOR 0.60, 95%CI 0.41-0.85) were less likely to have HSDD, while they were more likely to have HSDD when their decreased sexual desire was due to other sexual issues (aOR 2.56, 95%CI 1.84-3.57) and partners' sexual problems (aOR 1.72, 95%CI 1.23-2.39).

CONCLUSION

Sexual health education and related services need to focus on psychological barriers of women with older age, insufficient knowledge of sexual health, intense work pressure, and poor economic conditions. The medical staff need to pay attention to the sexual health of women with intense work or life pressure and a history of gynecological disease. Low sexual desire is not equal to the sexual desire problem, which should be noticed in the future.

Incidence and Predictors of Low Sexual Desire and Hypoactive Sexual Desire Disorder in Women: A Systematic Review and Meta-Analysis

Determining the true incidence and identifying the risk factors of low sexual desire (LSD) and hypoactive sexual desire disorder (HSDD) are essential to prevent sexual dysfunctions and provide adequate treatment resources. This systematic review and meta-analysis were performed on research articles reporting women with LSD and HSDD in PsycArticles, Scopus, MEDLINE, Web of Science databases, and reference lists till October 2021. All cross-sectional studies published in English that assessed both sexual desire and sexual distress were included. Of 891 full-text articles identified, 24 were eligible, all of which had a low risk of overall bias. We did separate random-effects meta-analyses for LSD and HSDD outcomes. The incidence of LSD and HSDD were 29% and 12%, respectively. Studies that used the convenience sampling method reported a higher incidence of HSDD than studies that used the probability sampling method. No differences were found between the assessment method and across cultures in LSD and HSDD. A majority of studies reviewed addressed demographic (e.g. age, education), physiological (e. g. menopausal status, body mass index), psychological (e.g. depression, daily internal stress), relational (e.g. relationship length, relationship satisfaction), and sexual predictors (e.g. sexual activity, sexual pleasure) between LSD and HSDD. This systematic review may inform researchers, guideline developers, and policy-makers about LSD associated with distress and help health professionals to identify women most at risk.

Regulate and Communicate: Associations between Emotion Regulation and Sexual Communication among Men with Hypoactive Sexual Desire Disorder and their Partners

Hypoactive Sexual Desire Disorder (HSDD) is characterized by a persistent and distressing lack of sexual desire. Affected men report lower sexual well-being and romantic partners may also experience consequences. According to the Interpersonal Emotion Regulation Model of sexual dysfunction, how couples manage their emotions in relation to sexual problems may promote or hinder sexual communication. In the first dyadic study to date of men with HSDD and their partners (n = 64 couples), we investigated associations between two emotion regulation strategies - reappraisal and suppression - and couples' communication about their sexual relationship. Participants completed measures assessing use of reappraisal and suppression about their sexual relationship, sexual communication, and sexual assertiveness. Men with HSDD who reported greater suppression also reported lower sexual assertiveness and both partners reported poorer sexual communication. Partners of men with HSDD who used greater suppression were less sexually assertive. In contrast, while reappraisal was only marginally associated with perceived quality of sexual communication, men with HSDD who employed more reappraisal were also more sexually assertive. While suppression may hinder sexual communication, reappraisal may allow men with HSDD to better assert their sexual needs. Findings may inform interventions to help couples navigate impactful emotional experiences associated with HSDD.

"Feeling It": Links between elements of compassion and sexual well-being

Introduction

Compassion may be a particularly important component of a sexual relationship as it facilitates needed self-awareness, understanding, and connection to frame deeply intimate expressions of sexual emotion and vulnerability. Given the lack of research on how broad concepts of compassionate elements may be linked to sexual well-being, we examine how mindfulness (an ability to maintain awareness in the present moment), compassionate relational attitudes (i.e., accessibility, responsiveness, and engagement), and compassionate relational behaviors (i.e., forgiveness and gratitude), are linked to sexual well-being (sexual harmony, orgasm consistency, and sexual frequency), and sexual mindfulness (a state of being mindful during sex) for oneself and one's partner.

Methods

We constructed an actor partner structural equation model with newly married couples (n = 2,111) and regressed sexual outcomes at time 1 and time 2 on each partner's compassionate attitudes, behaviors and mindfulness reported at time 1.

Results

Results showed that cross-sectionally, nearly all elements of one's compassion related to one's own sexual well-being for both partners. Strongest paths included positive significant relations for women between mindfulness and non-judgment and from compassionate relational attitudes and behaviors to sexual harmony. Men's compassionate behaviors were positively related to their own sexual awareness. Perhaps more importantly, women's and men's compassionate behaviors had significant effects on their partner's sexual well-being longitudinally.

Discussion

Implications include an emphasis on compassion as a key mechanism that can increase sexual satisfaction and strengthen relationships, particularly in the critical time of early marriage where patterns of interconnectedness are being established.

Pharmacologic therapeutic options for sexual dysfunction

PURPOSE OF REVIEW

Sexual problems are reported by up to 45% of individuals assigned female at birth. Although sexual function is a complex biopsychosocial construct, there are a number of pharmacologic treatment options aimed at addressing the changing vaginal hormonal milieu in postmenopausal individuals and moderating the excitatory and inhibitory aspects of the central nervous system in those with hypoactive sexual desire disorder.

RECENT FINDINGS

The last decade has seen an increase in the number and type of pharmacologic treatment options for dysfunction primarily associated with menopause and hypoactive sexual desire disorder. Recent publications and systematic reviews have strengthened the safety data of existing FDA-approved medications as well as off-label therapies.

SUMMARY

Pharmacologic treatment with local estrogen and testosterone replacement in postmenopausal individuals and with centrally-acting therapies such as flibanserin, bremelanotide, and testosterone in premenopausal individuals assigned female at birth are safe and can be used to improve sexual desire and sexual satisfaction.

Effects of Flibanserin on Subdomain Scores of the Female Sexual Function Index in Women With Hypoactive Sexual Desire Disorder

INTRODUCTION

Flibanserin treatment increases sexual desire and satisfying sexual events while decreasing distress in certain women diagnosed with acquired, generalized hypoactive sexual desire disorder (HSDD). Additional aspects of sexual function and the time course of response have not been fully characterized.

AIM

To evaluate changes in sexual function assessed by the subdomains of the Female Sexual Function Index (FSFI) in women with HSDD treated with flibanserin.

METHODS

FSFI data pooled from 3 pivotal flibanserin trials in premenopausal women (flibanserin = 1,165; placebo = 1,203) and FSFI data from one complete flibanserin trial in postmenopausal women (flibanserin = 432; placebo = 463) were subjected to post-hoc analyses. For each FSFI subdomain, least squares mean change from baseline was calculated at each assessment visit (treatment weeks 4, 8, 16, 24) and treatment groups were compared using analysis of covariance. Standardized effect size (Cohen's d) was also determined for each FSFI subdomain.

MAIN OUTCOME MEASURE

Changes from baseline in FSFI subdomains.

RESULTS

Compared to placebo, both premenopausal (P < .02) and postmenopausal (P < .045) patients in the flibanserin group reported significantly greater increases over baseline in the FSFI subdomain scores of desire, arousal, lubrication, orgasm, and satisfaction. In premenopausal patients, significant improvements were observed at the first assessment of response (week 4) and were maintained through week 24. In postmenopausal patients, significant improvements were observed at week 4 for desire and arousal, while significant improvements in lubrication, orgasm, and satisfaction were observed at week 8. At week 24, excluding the pain subdomain, standardized effect sizes ranged from 0.18 to 0.28 in the premenopausal cohort and 0.12 to 0.29 in the postmenopausal cohort. In both pre- and postmenopausal patients, improvements in pain were smaller and largely undifferentiated between treatment groups.

CLINICAL IMPLICATIONS

While variations in time to response should be taken into consideration, on average, the beneficial impact of flibanserin on overall sexual function occurs within the first month of treatment. The data also suggest that the response to flibanserin is sustained for the duration of treatment.

STRENGTHS AND LIMITATIONS

Sexual function assessments were performed in a large cohort of 2,368 premenopausal women and 895 postmenopausal women. However, the FSFI assesses changes over a 1-month period and time points earlier than 4 weeks could not be assessed.

CONCLUSION

These analyses suggest that assessment of benefit of flibanserin in HSDD should include improvements across all domains of sexual function, not only desire. Simon JA, Clayton AH, Goldstein I, et al. Effects of Flibanserin on Subdomain Scores of the Female Sexual Function Index in Women With Hypoactive Sexual Desire Disorder. Sex Med 2022;10:100570.

Relational and Trait Factors Mediate the Associations between Women's Intoxication-Related Unwanted Sexual Experiences, Pleasure, and Desire

Despite documented negative sexual health sequelae of unwanted sexual contact (USC), it is unclear why individuals who have experienced USC within the context of intoxication (intoxication-related USC) are at particular risk for poor sexual functioning. Intoxication-related USC may impact relational factors like relationship satisfaction, as trauma symptoms interfere with emotional closeness during sex. Additionally, although individual traits - such as sexual excitation and sensation seeking - affect the relationship between trauma and sexual functioning, it is unknown whether these factors differentially impact those who have experienced intoxication-related USC. Finally, because presence of a partner may evoke trauma-related symptoms during partnered (dyadic) sexual activity, mediators may differ across solitary versus dyadic sexual pleasure and desire. We tested relational and individual trait mediators of the association between intoxication-related USC and solitary and dyadic sexual pleasure and desire in a sample of heterosexual and sexual minority women. Trait factors consistently mediated the association between intoxication-related USC and both dyadic and solitary desire and pleasure, while relational factors such as emotional closeness were inconsistently related to sexual wellbeing. If replicated, these findings would suggest that trait factors may be useful targets for clinical sexual wellness interventions among sexuality-diverse women who have experienced intoxication-related USC.

Lack of Evidence for a Relationship Between Salivary CRP and Women's Sexual Desire: An Investigation Across Clinical and Healthy Samples

BACKGROUND

Inflammation has been linked to a variety of mental and physical health outcomes that disproportionately impact women, and which can impair sexual function; thus, there is reason to expect a link between inflammation and women's sexual functioning.

AIM

To test the hypothesis that higher concentrations of C-reactive protein (CRP), a general biomarker of inflammation, would predict women's lower sexual desire.

METHOD

As 2 independent research teams, we conducted 3 separate studies (total n = 405) that assessed salivary CRP and various measurements of sexual desire in different women populations.

OUTCOMES

Female Sexual Function Index, Sexual Desire Inventory-2, Decreased Sexual Desire Screener, and Sexual Interest and Desire Inventory.

RESULTS

Regardless of the way sexual desire was measured (e.g., state vs trait; general desire vs. desire functioning) and the population sampled (i.e., healthy vs. clinically diagnosed with sexual dysfunction), all the studies revealed null results.

CLINICAL IMPLICATIONS

While exploratory, the convergence of these null results across studies and researchers suggests that if there is an association between inflammation and women's sexual desire, it is likely very subtle.

STRENGTHS & LIMITATIONS

Across 2 independent research teams, 3 unrelated studies, and various measurements of sexual desire, results were consistent. These points lend to the generalizability of the results. However, study designs were cross-sectional.

CONCLUSIONS

Future research may reveal (i) a non-linear threshold effect, such that inflammation does not begin to impact women's sexual desire until it is at a high level, (ii) inflammatory biomarkers other than CRP might be more sensitive in detecting associations between inflammation and desire, should they exist, or (iii) the mechanisms underlying sexual dysfunction may differ between sexes. Clephane K, et al. Lack of Evidence for a Relationship Between Salivary CRP and Women's Sexual Desire: An Investigation Across Clinical and Healthy Samples. J Sex Med 2022;19:745-760.

Sexual Difficulties, Problems, and Help-Seeking in a National Representative Sample: The Second Australian Study of Health and Relationships

The Australian Study of Health and Relationships is a large national population-representative survey of sexual behavior and attitudes conducted every decade. We describe experiences of sexual difficulties lasting at least a month among Australians surveyed in 2012-2013 and identify changes since the previous survey in 2001-2002. Computer-assisted telephone interviews were completed by 20,091 people aged 16-69 years (participation rate 66%) of whom 16,897 people had had sex with a partner in the previous year. We asked how long each difficulty lasted, whether it was a problem, and whether they sought treatment. Half (48%) the men and 68% of women reported at least one difficulty. Lack of interest in having sex was common (28% men, 52% women); 21% of men reported coming to orgasm "too quickly" and women reported inability to reach orgasm (25%) and trouble with vaginal dryness (22%). Women were more likely than men not to find sex pleasurable and to have physical pain during intercourse. Some differences by age group were also apparent. Many difficulties were not seen as problems, especially lacking interest and reaching orgasm too quickly. People with erection/dryness problems, or with pain in intercourse, were more likely to seek treatment, as were people with multiple difficulties. Between 2001-2002 and 2012-2013, there was little change for men, but among women rates of all sexual difficulties fell by 4-10 percentage points. This change accompanied a drop in frequency of sex among people in ongoing relationships and an increase in masturbation and use of pornography. One explanation might be that, over time, fewer women were agreeing to "service sex" when they were not in the mood. Overall, the drop in prevalence of women's sexual difficulties since a decade earlier suggests a change towards more egalitarian sexual relations.

Problematic product management: the case of flibanserin to address women’s hypoactive sexual desire disorder

Purpose

A Viagra-inspired drug, flibanserin, was marketed to treat women’s hypoactive sexual desire disorder (HSDD). This paper aims to explore the value orientation of flibanserin as a treatment for female’s HSDD among different consumer segments.

Design/methodology/approach

Two surveys were run in the UK (Study 1, n = 223) and Israel (Study 2, n = 233), in which partnered heterosexual adults evaluated the value of the drug before and after being exposed to information on its side effects. Then, using content analysis of 36 online reviews among women who had tried the drug, the reported effectiveness and side effects were explored.

Findings

HSDD prevalence in both studies was about 50% (Study 1) and 66% (Study 2) (no gender differences in evaluations). All segments gave the drug less than neutral or negative value orientation ratings. Women did not relate low sexual desire to low levels of sexual thoughts that would increase flibanserin’s value orientation; however, men did. Information about flibanserin and its side effects decreased its value orientation for women, especially those with HSDD. The content analysis of user’s reviews showed most women reported side effects, said it was not effective and gave it a poor rating.

Research limitations/implications

The results reveal the strategic problems in the marketing of the drug, both in its value orientation before and especially after exposure to information.

Originality/value

This research points to the necessity of evaluating the value orientation of flibanserin before marketing and satisfying the core expectations from the product (effectiveness and limited aversive side effects) among women with HSDD.

Bremelanotide for Treatment of Female Hypoactive Sexual Desire

Hypoactive sexual desire disorder (HSDD) is a persistent deficiency or absence of sexual fantasies and desire resulting in significant distress or interpersonal difficulty. Women with this disorder may display a lack of motivation for sexual activity, reduced responsiveness to erotic cues, a loss of interest during sexual activity, and avoidance of situations that could lead to sexual activity. The pathophysiology of HSDD is thought to be centered around inhibitory and excitatory hormones, neurotransmitters, and specific brain anatomy. Due to the multifactorial nature of HSDD, treatment can be complex and must attempt to target the biological and psychosocial aspects of the disorder. Bremelanotide is a melanocortin receptor agonist and has been recently approved by the FDA to treat HSDD. Bremelanotide is administered intranasally or as a subcutaneous injection. The recommended dosage of bremelanotide is 1.75 mg injected subcutaneously in the abdomen or thigh at least 45 min before sexual activity. Studies showed improvements in desire, arousal, and orgasm scores when 1.75 mg of bremelanotide was administered before sexual activity compared to a placebo. Bremelanotide is a promising way to treat HSDD.

The Heteronormativity Theory of Low Sexual Desire in Women Partnered with Men

Low sexual desire in women partnered with men is typically presumed to be a problem-one that exists in women and encourages a research agenda on causation and treatment targeting women. In this paper, we present a distinct way forward for research on low sexual desire in women partnered with men that attends to a more structural explanation: heteronormativity. A heteronormative worldview assumes that relationships and structures are heterosexual, gender (usually conflated with sex) is binary and complementary, and gender roles fit within narrow bounds including nurturant labor for women. We propose the heteronormativity theory of low sexual desire in women partnered with men, arguing that heteronormative gender inequities are contributing factors. We outline four hypotheses and their predictions related to: inequitable divisions of household labor, blurring of partner and mother roles, objectification of women, and gender norms surrounding sexual initiation. We discuss some mechanisms-social, physiological, and otherwise-for the heteronormativity theory, especially related to stress, objectification, and nurturance. We close by noting some limitations of our paper and the ways that the heteronormativity theory of low sexual desire in women partnered with men provides a rigorous, generative, and empirical way forward.

Prevalence and associated risk factors for sexual dysfunction among postmenopausal women: a study from Iran

BACKGROUND

Female Sexual Dysfunction (FSD) is a distressing condition linked to menopause. This study aimed to determine the prevalence and contributing factors for FSD among postmenopausal women.

METHODS

This was a cross-sectional study. A convenience sample of postmenopausal women attending a gynecology clinic in a teaching hospital affiliated with Tehran University of Medical Sciences was enrolled into the study. The Female Sexual Function Index (FSFI) was used to assess sexual function. In addition, demographic and psychosocial information were recorded. The association between sexual function and anxiety and depression were examined to explore the data.

RESULTS

In all 162 postmenopausal women were studied. We performed general linear regression analysis to assess the relationship between sexual function and anxiety while including demographic variables in the model. The results showed that the model could explain about 46% of the variance observed in sexual function (adjusted R2 = 0.467). The analysis indicated that among independent variables, age (p <  0.001), sexual frequency (p <  0.001), and anxiety (p = 0.003) were significant contributing factors associated with sexual function. A similar analysis evaluating the relationship between sexual function and depression in menopausal women found that age (p <  0.001), sexual frequency (p <  0.001), and depression (p = 0.003), were significant contributing factors associated with sexual function; explaining about 46% of the variance observed (adjusted R2 = 0.466).

CONCLUSION

The findings showed that nearly half of menopausal women had sexual dysfunction in this convenience sample of women seeking gynecologic care. Women reporting sexual dysfunction also reported a higher prevalence of anxiety and depression. Indeed, recognition of such factors requires a holistic therapeutic approach to sexual dysfunction among postmenopausal women.

Re-Analyzing Phase III Bremelanotide Trials for "Hypoactive Sexual Desire Disorder" in Women

Kingsberg et al. described results from two 24-week Phase III trials of bremelanotide for treating hypoactive sexual desire disorder (HSDD) in women. 72.72% of protocol-listed outcomes were not reported by Kingsberg et al., who provided results of 15 secondary measures which were not listed in the study protocols. None of their efficacy outcomes were reported in line with CONSORT data reporting standards and no secondary outcome had a stated rationale or cited evidence of validity. My meta-analysis of the trials' data, based on the FDA New Drug Application, found similar results to Kingsberg et al. However, Kingsberg et al. did not report that a) adverse event-induced study discontinuation was substantially higher on bremelanotide: OR = 11.98, 95% CI = 3.74-38.37, NNH: 6 or b) participants preferred placebo, measured by the combination of both 1) completing a clinical trial and 2) electing to participate in the follow-up open-label study (OR = 0.30, 95% CI = .24-.38, NNH: 4). Bremelanotide's modest benefits on incompletely reported post-hoc measures of questionable validity in combination with participants substantially preferring to take placebo suggest that the drug is generally not useful. Kingsberg et al.'s data reporting and measurement practices were incomplete and lacked transparency.

How Relevant is the Systemic Oxytocin Concentration for Human Sexual Behavior? A Systematic Review

Introduction

Despite its role in social cognition and affiliative behavior, less is known about the role played by oxytocin in human sexual behavior.

Aim

In the present systematic review, we aimed to find the levels of oxytocin related to human sexual arousal and orgasm.

Methods

We conducted the study according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We performed a systematic search in the principal databases for studies that reported collection of salivary or plasmatic samples, with dosage of oxytocin in relation to sexual activity during induction of sexual arousal and orgasm.

Results

414 articles were obtained. After duplicates removal and the application of pre exclusion criteria, 16 articles were considered eligible and 13 articles were included with a Cohen's k of 0.827. Most of the studies used sexual self-stimulation and collected plasmatic or salivary samples to measure oxytocin. The sexual arousal and orgasm were assessed based on subjective reports.

Main Outcome Measure

The primary outcomes were the oxytocin levels collected during the induction of sexual arousal and orgasm.

Conclusions

Several studies collected only subjective reports about the sexual arousal and the orgasm. Most of the studies found higher levels of oxytocin during the orgasm or ejaculation. Given the sexual arousal evoked by self-stimulation in which sexual fantasies play an important role, it should be possible to postulate for a role of the oxytocin in sexual desire. In particular, we hypothesize a complex role of the oxytocin in the modulation of sexual fantasies and thoughts that are relevant in the sexual desire and help to trigger genital and sexual arousal.

Cera N, Vargas-Cáceres S, Oliveira C, et al. How Relevant is the Systemic Oxytocin Concentration for Human Sexual Behavior? A Systematic Review. Sex Med 2021;9:100370.

Sexual Dysfunctions in Women: Are Androgens at Fault?

A critique of the literature that androgen deficit underlies women's sexual dysfunctions is provided. Although there is scant evidence that androgens are responsible, many aspects of androgen activity remain to be investigated. Research does link serum levels of dehydroepiandrosterone (DHEA) to women's sexual desire but apparently not via DHEA's androgenic activity. Current assessment and management of women's sexual dysfunction are summarized.

I Want You to Want Me: A Qualitative Analysis of Heterosexual Men's Desire to Feel Desired in Intimate Relationships

Current sexual scripts for heterosexual relationships in the Western world stipulate that men should be the ones to initiate sexual activity, push to the next level of physical intimacy, and to desire women (and not be desirable themselves). However, there is building evidence that sexual scripts and gender roles are not only limited, they may be evolving and shifting over time. The purpose of the current study was to explore the degree to which feeling desired is considered important to heterosexual men in intimate relationships as well as how heterosexual men feel desired by their partners. Three hundred men between the ages of 18 and 65 were recruited from the online platform Reddit. Using Thematic Analysis, we determined that the vast majority of men in this study felt that feeling desired was very important to their sexual experiences. Men in this study listed several ways they felt desired, many that fell outside of traditional gender roles such as romantic, non-sexual touch and having women initiate sexual activity. The findings add to a growing body of literature which suggests traditional sexual scripts for heterosexual men may be limiting and not accurate for all men's sexual experiences.

Difference or dysfunction?: Deconstructing desire in the DSM-5 diagnosis of Female Sexual Interest/Arousal Disorder

This article answers ongoing calls within critical sexuality scholarship to explore how constructions of women’s bodies influence and are influenced by broader sociocultural contexts. Specifically, this article offers a conceptual analysis of female sexual desire, highlighting the deeply political nature of its pathologization. We briefly explore dominant definitions and models of sexual desire to highlight the erasure of embodied desire as an important part of healthy female sexuality. The DSM-5 diagnosis of Female Sexual Interest/Arousal Disorder is critically analyzed to highlight how desire differences are framed as gendered, individual problems which sidelines relational, contextual, and sociopolitical factors contributing to individual distress. When the language of desire is displaced by the language of interest (particularly when framed as receptivity), the capacity to theorize wanting and entitlement is undermined. We argue that the pathologization of diverse desires obscures possibilities for embodied wanting and neglects the consideration that all types of desire (absent, frequent, physical, emotional) may represent normal sexual variations.

Pubertal timing predicts adult psychosexuality: Evidence from typically developing adults and adults with isolated GnRH deficiency

Evidence suggests that psychosexuality in humans is modulated by both organizational effects of prenatal and peripubertal sex steroid hormones, and by activational effects of circulating hormones in adulthood. Experimental work in male rodents indicates that sensitivity to androgen-driven organization of sexual motivation decreases across the pubertal window, such that earlier puberty leads to greater sex-typicality. We test this hypothesis in typically developing men (n = 231) and women (n = 648), and in men (n = 72) and women (n = 32) with isolated GnRH deficiency (IGD), in whom the precise timing of peripubertal hormone exposure can be ascertained via the age at which hormone replacement therapy (HRT) was initiated. Psychosexuality was measured with the Sexual Desire Inventory-2 (SDI-2) and Sociosexual Orientation Inventory-Revised (SOI-R). In both sexes, earlier recalled absolute pubertal timing predicted higher psychosexuality in adulthood, although the magnitude of these associations varied with psychosexuality type and group (i.e., typically developing and IGD). Results were robust when controlling for circulating steroid hormones in typically developing participants. Age of initiation of HRT in men with IGD negatively predicted SOI-R. We discuss the clinical implications of our findings for conditions in which pubertal timing is medically altered.

The Evolution of the Female Sexual Disorder/Dysfunction Definitions, Nomenclature, and Classifications: A Review of DSM, ICSM, ISSWSH, and ICD

INTRODUCTION

The 2 most well-known classification systems that include sexual medicine diagnoses are the International Classification of Diseases and Statistics (ICD) and the Diagnostic and Statistical Manual of Mental Disorders (DSM). Sexual medicine experts from international societies representing an array of disciplines have revised and redefined female sexual dysfunctions (FSDs) to reflect current scientific evidence and the state of the art.

AIM

To summarize the evidence and interactive and chronological process by which sexual medicine societies' consensus groups developed the current nomenclature, classifications, and definitions for FSDs.

METHODS

We review the contributions and collaborations of the Fourth International Consultation in Sexual Medicine (ICSM), the International Society for the Study of Women's Sexual Health (ISSWSH), and the World Association of Sexual Health in conjunction with the World Health Organization.

MAIN OUTCOME MEASURES

The ICSM and ISSWSH diagnostic systems are contrasted with the DSM classification. We discuss innovations and strengths; relevant evidence regarding epidemiology, etiology, and risk factors; and key differences. We describe how sexual medicine expertise informed FSD codes in the ICD-11 classification.

RESULTS

ICSM and ISSWSH published evidence-based guidelines on the definitions, nomenclature, and diagnostic criteria for FSD that diverge from the DSM psychiatric compendia. These definitions and nomenclature recommend the separation of female sexual desire and arousal disorders, elaborate on subtypes of arousal problems, broaden the scope of sexual pain definitions, and provide a greater understanding of etiologies and risk factors for FSDs.

CONCLUSIONS

These collaborations among sexual medicine experts and their role in the ICD-11 development process provide confidence that the ICD-11 Sexual Dysfunction codes are based on current scientific evidence for diagnosing and coding FSDs in clinical settings worldwide, can serve as endpoints in clinical trials, and will provide specificity for treatment outcomes for FSD therapies. Parish SJ, Cottler-Casanova S, Clayton AH, et al. The Evolution of the Female Sexual Disorder/Dysfunction Definitions, Nomenclature, and Classifications: A Review of DSM, ICSM, ISSWSH, and ICD. Sex Med 2021;9:36-56.

Different Ways to Get There: Evidence of a Variable Female Sexual Response Cycle

Research has suggested women's sexual response cycle may vary more than previously thought. We asked 769 sexually active women between the ages of 18-70 to report on their sexual desire and arousal patterns during their last sexual experience. Using a latent class mixture model from retrospective sexual response data, we found six classes of desire and arousal patterns (Low, Middle Steady, High Fluctuation, Low Fluctuation, Upper Steady, High). We examined how these patterns were related to demographics, outcomes during the sexual experience, and outcomes for the global relationship. The Low sexual response class (8% of women) was significantly different from other classes in duration of the sexual experience, orgasms, and overall satisfaction with the sexual experience. Most sexual response patterns were associated with healthy relational and sexual outcomes. All classes except for the Low arousal and desire class showed associations with a neutral or positive sexual satisfaction evaluation. The non-problematic variation of women's sexual experience is an important concept to consider as it impacts determinations of dysfunction and women's self-evaluations. Not all women need to experience high levels of arousal throughout the sexual experience or to have desire at the outset in order to have positive sexual experiences and sexual outcomes.

The Relational and Bodily Experiences Theory of Sexual Desire in Women

We review the theory and research on women's sexual desire and present a theory that incorporates internalized representations of relational and bodily experiences into our understanding of the full range of desire in women. To this end, we move away from the current tendency to focus on low sexual desire in women and instead consider desire on a spectrum or continuum from absent or diminished to high desire across multiple sexual orientations, including heterosexual, bisexual, and lesbian. We review definitions of sexual desire, as well as the epidemiology and etiology of hypoactive sexual desire, the most prevalent sexual complaint in women, including the biological, psychological, and relationship correlates of inhibited sexual desire. Subsequently, we examine the research on highly sexual women, who tend to experience high levels of sexual desire, sexual agency, and sexual esteem, and distinguish between high sexual desire and hypersexuality. We introduce two important constructs that are integrated into the Relational and Bodily Experiences Theory (RBET) of sexual desire in women: attachment and sexual body self-representations, suggesting that women's internalized representations of self and other that stem from childhood and their capacity to embody their sexual bodies are integral to our understanding of the phenomenology of sexual desire in women. RBET calls for further research into the links between attachment, sexual body self-representations, and desire, and suggests that clinical interventions for sexual desire difficulties in women should emphasize internalized working models of relationships (i.e., attachment) and integrate bodily based approaches.

Sexual Function among Women in Midlife: Findings from the Nurses' Health Study II

BACKGROUND

Women's sexual well-being is an important determinant of overall health and quality of life across the life course. Yet the factors associated with women's levels of sexual activity and sexual function in midlife are little understood. This study sought to assess the prevalence of recent sexual activity and sexual dysfunction symptoms among middle-aged women and evaluate the associations of partner status, menopause, and health status factors with sexual dysfunction.

METHODS

Participants of this cross-sectional study were 68,131 women who responded to the 2013 Nurses' Health Study II observational cohort questionnaire when they were age 48-68 years. Sexual activity and dysfunction symptoms were assessed with the Female Sexual Function Index. Age-adjusted multivariable regression models estimated risk ratios for the association of health-related factors with past month sexual dysfunction symptoms among women who were sexually active over the past month, overall and stratified by partner status.

RESULTS

Of middle-aged women participants, 73% were sexually active (n = 49,701) and 50% of sexually active women reported symptoms of sexual dysfunction. Symptoms of sexual dysfunction were less common among unpartnered than partnered women (42% vs. 51%; p < .0001). A positive association between menopause and sexual dysfunction was greater for unpartnered women (risk ratio, 2.37, 2.99; p < .001) than partnered women (risk ratio, 1.89, 2.00; p < .001).

CONCLUSIONS

Difficulty with sexual function is common among women in midlife, but less so than previously estimated. Regular monitoring of women's sexual function could enable clinicians to offer women timely, supportive interventions tailored by partner status and menopausal status.

The International Society for the Study of Women's Sexual Health Process of Care for the Identification of Sexual Concerns and Problems in Women

Sexual problems are common in women of all ages. Despite their frequency and impact, female sexual dysfunctions (FSDs) are often unrecognized and untreated in clinical settings. In response, the International Society for the Study of Women's Sexual Health convened a multidisciplinary, international expert panel to develop a process of care (POC) that outlines recommendations for identification of sexual problems in women. This POC describes core and advanced competencies in FSD for clinicians who are not sexual medicine specialists and serve as caregivers of women and, therefore, is useful for clinicians with any level of competence in sexual medicine. The POC begins with the expectation of universal screening for sexual concerns, proceeds with a 4-step model (eliciting the story, naming/reframing attention to the problem, empathic witnessing of the patient's distress and the problem's impact, and referral or assessment and treatment) that accommodates all levels of engagement, and delineates a process for referral when patients' needs exceed clinician expertise. Distressing problems related to desire, arousal, and orgasm affect 12% of women across the lifespan. Low desire is the most common sexual problem, but sexual pain and other less common disorders of arousal and orgasm are also seen in clinical practice. Screening is best initiated by a ubiquity statement that assures the patient that sexual concerns are common and can be revealed. Patient-centered communication skills facilitate and optimize the discussion. The goal of the POC is to provide guidance to clinicians regarding screening, education, management, and referral for women with sexual problems.

A Descriptive Analysis of Sexual Problems in Long-Term Heterosexual Relationships

BACKGROUND

Although much research has described individual sexual dysfunctions, few studies to date have examined the types of problems that couples consider most significant in their sexual relationships.

AIM

To clarify the types of relational sexual problems that are most common and most severe in the sexual lives of individuals in long-term romantic relationships.

METHODS

A community sample of 117 mixed-sex couples completed this in-lab study. Members of each couple separately completed a demographics questionnaire and a measure of their relational sexual problems, the Sexual Problems Questionnaire (SPQ). Descriptive analyses (eg, examination of means, frequency counts) were conducted to determine the most common and severe sexual problems reported by participants. t-Tests were performed to examine gender differences in mean severity ratings for each SPQ item. Qualitative data were examined by conducting a frequency count on the SPQ items that participants reported to be most important in their sexual relationships. Results of all frequency counts were divided by the total sample size and are reported as percentages.

MAIN OUTCOME MEASURES

Participants reported on the severity of their sexual problems using the 25-item SPQ.

RESULTS

Quantitative analyses revealed that the most common and problematic sexual problems endorsed by both sexes were frequency of sex, sexual initiation, and showing interest. A frequency count of participants' qualitative reports also revealed that frequency of sex (women = 36%; men = 39%), sexual initiation (women = 33%; men = 32%), and showing interest (women and men = 25%) were the most important sexual issues for most individuals.

CLINICAL IMPLICATION

The most pressing relational sexual problems for couples in long-term romantic relationships are consistent between sexes and pertain to the domain of sexual desire.

STRENGTH & LIMITATIONS

The current study used an expanded measure of sexual problems, which allowed participants to report on a broad range of issues in their sexual relationships. The direction of such relational sexual problems (eg, desiring more or less sexual frequency) was not explored.

CONCLUSION

The key problems in sexual relationships center on the theme of sexual desire, and men and women consider these issues to be problematic to a similar extent. Sutherland SE, Rehman US, Fallis EE. A Descriptive Analysis of Sexual Problems in Long-Term Heterosexual Relationships. J Sex Med 2019;16:701-710.

What Does Sexual Arousal Mean to You? Women With and Without Sexual Arousal Concerns Describe Their Experiences

Sexual arousal is frequently characterized by both subjective (i.e., mental) and physiological (e.g., genital) components. The nuances of these components, however, are difficult to capture via self-report instruments. Asking women to describe sexual arousal in their own words may therefore enhance our understanding of this construct. In the present study, women with (n = 190) and without (n = 610) arousal concerns were recruited online and wrote about their experience of sexual arousal. Seven clusters of words were extracted using automated text analysis, and the prominence of these clusters was compared between groups of women. The autonomic arousal cluster differed between groups such that women with arousal concerns invoked this cluster significantly less than did women with no such concerns. Furthermore, the context cluster significantly predicted group membership (odds ratio [OR] = 1.063); greater scores on this cluster were associated with arousal concerns. Results suggest that autonomic arousal and relationship factors may play important roles in arousal concerns. It is suggested that clinicians assess for aspects of the sexual relationship that may facilitate or hinder sexual arousal. Clinicians may also consider inquiring about the presence or appraisal of autonomic arousal (e.g., one's interpretation of an increase in heart rate or respiration) during sexual activity.

Male Sexual Desire: An Overview of Biological, Psychological, Sexual, Relational, and Cultural Factors Influencing Desire

INTRODUCTION

The literature showed the need for a better understanding of the male sexual response, which has historically been considered as simpler and more mechanistic compared with that in women.

AIM

To examine the literature on biopsychosocial factors associated with the level of sexual desire in men and discuss some interesting directions for future research.

METHODS

A systematic literature review was conducted.

MAIN OUTCOME MEASURES

169 articles published in Google Scholar, Web of Science, Scopus, EBSCO, and Cochrane Library about male sexual desire and related biopsychosocial factors.

RESULTS

We found a lack of multidimensional studies on male sexual desire. Most existing research has focused on hypoactive sexual desire disorder in coupled heterosexual men. Biological factors play important roles in the level of sexual desire, but they are insufficient to explain the male sexual response. Psychological, relational, and sexual factors (eg depression, anxiety, emotions, attraction, conflicts, communication, sexual functioning, distress, satisfaction) are involved in the development/maintenance of lack of sexual interest in men. Cultural influence is also relevant, with cognitive factors linked to gender roles and sexual scripts of masculinity identified as important predictors of low sexual desire.

CONCLUSION

Male sexual desire is characterized by an interplay among biological, psychological, sexual, relational, and cultural elements. This interplay merits further study to better understand how sexual desire works and how treatments for low sexual interest could be improved. Nimbi FM,Tripodi F, Rossi R, et al. Male Sexual Desire: An Overview of Biological, Psychological, Sexual, Relational, and Cultural Factors Influencing Desire. Sex Med Rev 2020;8:59-91.

Female Sexual Function at Midlife and Beyond

Sexual function is an important component of quality of life for women. Midlife poses several challenges to optimal sexual function and intimacy for women. In addition to anatomic factors related to estrogen deficiency, such as genitourinary syndrome of menopause, vulvovaginal atrophy, and pelvic organ prolaps, psychosocial factors, including prior sexual trauma, play an important role in sexual function in women. Several treatments have emerged for female sexual dysfunction; long-term studies and head-to-head comparisons are lacking.

Average Associations Between Sexual Desire, Testosterone, and Stress in Women and Men Over Time

Sexual desire and testosterone are widely assumed to be directly and positively linked to each other despite the lack of supporting empirical evidence. The literature that does exist is mixed, which may result from a conflation of solitary and dyadic desire, and the exclusion of contextual variables, like stress, known to be relevant. Here, we use the Steroid/Peptide Theory of Social Bonds as a framework for examining how testosterone, solitary and partnered desire, and stress are linked over time. To do so, we collected saliva samples (for testosterone and cortisol) and measured desire as well as other variables via questionnaires over nine monthly sessions in 78 women and 79 men. Linear mixed models showed that testosterone negatively predicted partnered desire in women but not men. Stress moderated associations between testosterone and solitary desire in both women and men, but differently: At lower levels of stress, higher average testosterone corresponded to higher average solitary desire for men, but lower solitary desire on average for women. Similarly, for partnered desire, higher perceived stress predicted lower desire for women, but higher desire for men. We conclude by discussing the ways that these results both counter presumptions about testosterone and desire but fit with the existing literature and theory, and highlight the empirical importance of stress and gender norms.

Women With Hypoactive Sexual Desire Disorder Versus Sexual Interest/Arousal Disorder: An Empirical Test of Raising the Bar

In 2013, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was published with a major revision to the sexual dysfunction categories, and the diagnosis of female hypoactive sexual desire disorder (HSDD) was replaced with female sexual interest/arousal disorder (SIAD). Since being introduced, concern has been expressed that SIAD inappropriately "raises the bar" for diagnosis. To address these concerns, we sought to evaluate the number of women with a diagnosis of HSDD who also met criteria for SIAD. In a sample of 151 women, we found that 73.5% of women with a diagnosis of HSDD met criteria for SIAD. The two groups were compared on the Sexual Interest/Desire Inventory, and women who met criteria for both HSDD and SIAD consistently scored lower on sexual desire frequency and satisfaction, satisfaction with sex, receptivity, positive sexual thoughts, reactions to erotica, arousal frequency, ease, continuation, and orgasm ease/achievement, and higher on distress. In addition, women meeting criteria for HSDD only tended to have mild symptoms across the six SIAD criteria compared to those meeting criteria for both HSDD and SIAD. These findings suggest that the SIAD criteria does not unduly raise the bar for diagnosis.