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Nimbi FM, Galizia R, Ciocca G, Zimic AB, Jannini EA, Simonelli C, Tambelli R. Sexual desire and erotic fantasies questionnaire: development and validation of the sexual desire scale (SDEF1). Int J Impot Res 2024:10.1038/s41443-024-00942-2. [PMID: 38926631 DOI: 10.1038/s41443-024-00942-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 06/07/2024] [Accepted: 06/20/2024] [Indexed: 06/28/2024]
Abstract
The evolution in conceptualization of sexual desire has stimulated many attempts to measure it. However measures able to assess multiple expressions of desire in all sexual identities are still lacking. The main aim of the present study was to test the psychometric properties of the Sexual Desire and Erotic Fantasies questionnaire - Part 1 Sexual Desire (SDEF1), developed as a sex-positive measure of different sexual desire expressions. The SDEF1 was assessed in 1773 participants from the Italian general population (1105 women, 645 men, and 23 other genders; ranged between 18-78 years old, mean age 29.31 ± 10.35) on an online survey, together with the Sexual Desire Inventory - 2, the International Index of Erectile Function, the Female Sexual Function Index, and the Marlowe-Crowne Social Desirability Scale-Short Form. Results support a factorial structure of six dimensions, including 28 items and accounting for 58.11% of the total variance: sexual desire, negative feelings to sexual desire, autoerotic desire, regular partner desire, attractive person desire, and responsive desire. The confirmatory factorial analysis showed satisfactory indexes (RMSEA = 0.042 [90% CI = 0.039-0.045]; GFI = 0.97; NFI = .96; and CFI = 0.97). Regression coefficients ranged from 0.39 to 0.94 and were all statistically significant (p < 0.001). The SDEF1 showed good psychometric properties such as internal reliability, construct, and discriminant validity, and to differentiate women and men with and without sexual difficulties. Men reported significantly higher levels of desire than women in all areas except for desire for a regular partner, were no gender difference was detected. Desire for autoerotic activity was the factor accounting for more variance explained among genders (11.7%). The SDEF1 could be a useful measure to assess different areas of sexual desire and its use could be recommended for clinical and research purposes.
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Affiliation(s)
- Filippo Maria Nimbi
- Dept. of Dynamic and Clinical Psychology and Health Studies, Sapienza University of Rome, Rome, Italy.
| | - Roberta Galizia
- Dept. of Dynamic and Clinical Psychology and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Giacomo Ciocca
- Dept. of Dynamic and Clinical Psychology and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Aleša Bratina Zimic
- Dept. of Dynamic and Clinical Psychology and Health Studies, Sapienza University of Rome, Rome, Italy
| | | | - Chiara Simonelli
- Dept. of Dynamic and Clinical Psychology and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Renata Tambelli
- Dept. of Dynamic and Clinical Psychology and Health Studies, Sapienza University of Rome, Rome, Italy
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Tetik S, Yalçınkaya Alkar Ö. Incidence and Predictors of Low Sexual Desire and Hypoactive Sexual Desire Disorder in Women: A Systematic Review and Meta-Analysis. JOURNAL OF SEX & MARITAL THERAPY 2023; 49:842-865. [PMID: 37158079 DOI: 10.1080/0092623x.2023.2208564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
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.
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Affiliation(s)
- Sinan Tetik
- Psychiatric Outpatient Clinic, Ankara Etlik City Hospital, Ankara, Turkey
| | - Özden Yalçınkaya Alkar
- Clinical Psychology Department, Faculty of Humanities and Social Sciences, Ankara Yildirim Beyazit University, Ankara, Turkey
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Jones SL, Rosenbaum S, Gardner Gregory J, Pfaus JG. Aromatization Is Not Required for the Facilitation of Appetitive Sexual Behaviors in Ovariectomized Rats Treated With Estradiol and Testosterone. Front Neurosci 2019; 13:798. [PMID: 31447629 PMCID: PMC6691068 DOI: 10.3389/fnins.2019.00798] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 07/17/2019] [Indexed: 11/13/2022] Open
Abstract
Testosterone can be safely and effectively administered to estrogen-treated post-menopausal women experiencing hypoactive sexual desire. However, in the United States and Canada, although it is often administered off-label, testosterone co-administered with estradiol is not a federally approved treatment for sexual arousal/desire disorder, partly because its mechanism is poorly understood. One possible mechanism involves the aromatization of testosterone to estradiol. In an animal model, the administration of testosterone propionate (TP) given in combination with estradiol benzoate (EB) significantly increases sexually appetitive behaviors (i.e., solicitations and hops/darts) in ovariectomized (OVX) Long-Evans rats, compared to those treated with EB-alone. The goal of current study was to test whether blocking aromatization of testosterone to estradiol would disrupt the facilitation of sexual behaviors in OVX Long-Evans rats, and to determine group differences in Fos immunoreactivity within brain regions involved in sexual motivation and reward. Groups of sexually experienced OVX Long-Evans rats were treated with EB alone, EB+TP, or EB+TP and the aromatase inhibitor Fadrozole (EB+TP+FAD). Females treated with EB+TP+FAD displayed significantly more hops and darts, solicitations and lordosis magnitudes when compared to EB-alone females. Furthermore, TP, administered with or without FAD, induced the activation of Fos-immunoreactivity in brain areas implicated in sexual motivation and reward including the medial preoptic area, ventrolateral division of the ventromedial nucleus of the hypothalamus, the nucleus accumbens core, and the prefrontal cortex. These results suggest that aromatization may not be necessary for TP to enhance female sexual behavior and that EB+TP may act via androgenic pathways to increase the sensitivity of response to male-related cues, to induce female sexual desire.
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Affiliation(s)
- Sherri Lee Jones
- Department of Psychology, Center for Studies in Behavioral Neurobiology, Concordia University, Montreal, QC, Canada
| | - Stephanie Rosenbaum
- Department of Psychology, Center for Studies in Behavioral Neurobiology, Concordia University, Montreal, QC, Canada
| | - James Gardner Gregory
- Department of Psychology, Center for Studies in Behavioral Neurobiology, Concordia University, Montreal, QC, Canada
| | - James G Pfaus
- Department of Psychology, Center for Studies in Behavioral Neurobiology, Concordia University, Montreal, QC, Canada
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Abstract
Female sexual dysfunction can drastically diminish quality of life for many women. It is estimated that in the United States 40% of women have sexual complaints. These conditions are frequently underdiagnosed and undertreated. Terminology and classification systems of female sexual dysfunction can be confusing and complicated, which hampers the process of clinical diagnosis, making accurate diagnosis difficult. There are few treatment options available for female sexual dysfunctions, however, some interventions may be of benefit and are described. Additional treatments are in development. The development of clear clinical categories and diagnostic guidelines for female sexual dysfunction are of utmost importance and can be of great benefit for clinical and public health uses and disease-related research.
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Affiliation(s)
- Anita H Clayton
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia Health System, P.O. Box 800623, Charlottesville, VA 22908-0623, USA.
| | - Elia Margarita Valladares Juarez
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia Health System, P.O. Box 800623, Charlottesville, VA 22908-0623, USA
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Nimbi FM, Tripodi F, Rossi R, Navarro-Cremades F, Simonelli C. Male Sexual Desire: An Overview of Biological, Psychological, Sexual, Relational, and Cultural Factors Influencing Desire. Sex Med Rev 2019; 8:59-91. [PMID: 30803921 DOI: 10.1016/j.sxmr.2018.12.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 12/15/2018] [Accepted: 12/16/2018] [Indexed: 01/10/2023]
Abstract
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.
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Affiliation(s)
- Filippo Maria Nimbi
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy; Institute of Clinical Sexology, Rome, Italy.
| | | | | | | | - Chiara Simonelli
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy; Institute of Clinical Sexology, Rome, Italy
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Lakshmi M, Khan SD. Female Sexual Dysfunction. Sex Med 2019. [DOI: 10.1007/978-981-13-1226-7_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Jodouin JF, Bergeron S, Janssen E. The Mediating Role of Sexual Behavior in Event-Level Associations Between Sexual Difficulties and Sexual Satisfaction in Newlywed Mixed-Sex Couples. J Sex Med 2018; 15:1384-1392. [PMID: 30245023 DOI: 10.1016/j.jsxm.2018.08.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Revised: 08/17/2018] [Accepted: 08/20/2018] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Many sexual difficulties encountered by couples in their day-to-day lives, although of insufficient intensity and persistence to warrant a clinical diagnosis of sexual disorder, are nevertheless frequent and a source of individual and relational distress. AIM The aim of this study was to assess the event-level associations between couples' everyday, subclinical sexual difficulties (specifically, low subjective sexual arousal, low physiological sexual arousal, and genito-pelvic pain), the range of sexual behaviors that these couples engage in, and their sexual satisfaction. METHODS 70 Newlywed participants (35 couples, average age = 25.6 years, SD = 3.2 years; average duration of relationship = 5.4 years, SD = 3.4 years) individually completed daily diaries about sexual difficulties, range of activities performed during sex, and sexual satisfaction over the course of 5 weeks. Analyses were guided by the actor-partner interdependence model. MAIN OUTCOME MEASURE The main outcome was sexual satisfaction, measured at the event-level on a 5-point Likert scale using a single-item question. RESULTS On days of sexual activity, men and women's difficulties with subjective sexual arousal were associated with lower sexual satisfaction in both partners (actor and partner effects). This association was mediated by the range of couples' sexual behaviors, such that lower subjective arousal was associated with a more restricted range of sexual activities, which in turn was associated with lower sexual satisfaction. Men's and women's difficulties with physiological sexual arousal, and women's genito-pelvic pain, were each associated with their own lower sexual satisfaction. No partner effects were observed for these sexual difficulties, nor were they mediated by the range of couples' sexual activities. CLINICAL IMPLICATIONS The study's results highlight how couples' sexual difficulties can interfere with same-day sexual satisfaction, and how for subjective sexual arousal, this interference is reflected by a more restricted range of sexual behaviors. STRENGTH & LIMITATIONS Strengths of the study include the daily diary methodology, which allowed a focus on event-level sexual activities with minimal retrospective bias. Further, the dyadic analyses allowed both intra-individual and inter-individual effects to be assessed. Limitations include the lack of a more general measure of sexual desire and of a more diverse sample, in terms of age, race, and sexual orientation. CONCLUSION These findings underscore the importance of treatments that include both partners, and that target the types as well as range of sexual activities in which couples engage. Jodouin J-F, Bergeron S, Janssen E. The Mediating Role of Sexual Behavior in Event-Level Associations Between Sexual Difficulties and Sexual Satisfaction in Newlywed Mixed-Sex Couples. J Sex Med 2018;15:1384-1392.
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Affiliation(s)
| | - Sophie Bergeron
- Département de Psychologie, Université de Montréal, Montreal, Quebec, Canada
| | - Erick Janssen
- Institute for Family and Sexuality Studies, University of Leuven, Leuven, Belgium; Kinsey Institute, Indiana University, Bloomington, IN, USA
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O'Loughlin JI, Basson R, Brotto LA. Women With Hypoactive Sexual Desire Disorder Versus Sexual Interest/Arousal Disorder: An Empirical Test of Raising the Bar. JOURNAL OF SEX RESEARCH 2018; 55:734-746. [PMID: 29095039 DOI: 10.1080/00224499.2017.1386764] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
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.
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Affiliation(s)
| | | | - Lori A Brotto
- c Department of Obstetrics and Gynaecology , University of British Columbia
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An international Urogynecological association (IUGA)/international continence society (ICS) joint report on the terminology for the assessment of sexual health of women with pelvic floor dysfunction. Int Urogynecol J 2018; 29:647-666. [DOI: 10.1007/s00192-018-3603-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 12/18/2017] [Indexed: 01/13/2023]
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Rogers RG, Pauls RN, Thakar R, Morin M, Kuhn A, Petri E, Fatton B, Whitmore K, Kinsberg S, Lee J. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for the assessment of sexual health of women with pelvic floor dysfunction. Neurourol Urodyn 2018; 37:1220-1240. [PMID: 29441607 DOI: 10.1002/nau.23508] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 12/18/2017] [Indexed: 12/18/2022]
Abstract
AIMS The terminology in current use for sexual function and dysfunction in women with pelvic floor disorders lacks uniformity, which leads to uncertainty, confusion, and unintended ambiguity. The terminology for the sexual health of women with pelvic floor dysfunction needs to be collated in a clinically-based consensus report. METHODS This report combines the input of members of the Standardization and Terminology Committees of two International Organizations, the International Urogynecological Association (IUGA), and the International Continence Society (ICS), assisted at intervals by many external referees. Internal and external review was developed to exhaustively examine each definition, with decision-making by collective opinion (consensus). Importantly, this report is not meant to replace, but rather complement current terminology used in other fields for female sexual health and to clarify terms specific to women with pelvic floor dysfunction. RESULTS A clinically based terminology report for sexual health in women with pelvic floor dysfunction encompassing over 100 separate definitions, has been developed. Key aims have been to make the terminology interpretable by practitioners, trainees, and researchers in female pelvic floor dysfunction. Interval review (5-10 years) is anticipated to keep the document updated and as widely acceptable as possible. CONCLUSION A consensus-based terminology report for female sexual health in women with pelvic floor dysfunction has been produced aimed at being a significant aid to clinical practice and a stimulus for research.
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Affiliation(s)
| | | | - Ranee Thakar
- Croydon University Hospital Croydon, London, United Kingdom
| | | | - Annette Kuhn
- University Teaching Hospital Berne (Inselspital), Bern, Switzerland
| | | | - Brigitte Fatton
- University Hospital Nîmes, Nimes, Languedoc-Roussillon, France
| | | | | | - Joseph Lee
- University of New South Wales, St Vincents Hospital, Sydney, New South Wales, Australia
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Kingsberg SA, Althof S, Simon JA, Bradford A, Bitzer J, Carvalho J, Flynn KE, Nappi RE, Reese JB, Rezaee RL, Schover L, Shifrin JL. Female Sexual Dysfunction-Medical and Psychological Treatments, Committee 14. J Sex Med 2018; 14:1463-1491. [PMID: 29198504 DOI: 10.1016/j.jsxm.2017.05.018] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 05/15/2017] [Accepted: 05/17/2017] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Since the millennium we have witnessed significant strides in the science and treatment of female sexual dysfunction (FSD). This forward progress has included (i) the development of new theoretical models to describe healthy and dysfunctional sexual responses in women; (ii) alternative classification strategies of female sexual disorders; (iii) major advances in brain, hormonal, psychological, and interpersonal research focusing on etiologic factors and treatment approaches; (iv) strong and effective public advocacy for FSD; and (v) greater educational awareness of the impact of FSD on the woman and her partner. AIMS To review the literature and describe the best practices for assessing and treating women with hypoactive sexual desire disorder, female sexual arousal disorder, and female orgasmic disorders. METHODS The committee undertook a comprehensive review of the literature and discussion among themselves to determine the best assessment and treatment methods. RESULTS Using a biopsychosocial lens, the committee presents recommendations (with levels of evidence) for assessment and treatment of hypoactive sexual desire disorder, female sexual arousal disorder, and female orgasmic disorders. CONCLUSION The numerous significant strides in FSD that have occurred since the previous International Consultation of Sexual Medicine publications are reviewed in this article. Although evidence supports an integrated biopsychosocial approach to assessment and treatment of these disorders, the biological and psychological factors are artificially separated for review purposes. We recognize that best outcomes are achieved when all relevant factors are identified and addressed by the clinician and patient working together in concert (the sum is greater than the whole of its parts). Kingsberg SA, Althof S, Simon JA, et al. Female Sexual Dysfunction-Medical and Psychological Treatments, Committee 14. J Sex Med 2017;14:1463-1491.
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Affiliation(s)
| | - Stanley Althof
- Case Western Reserve University Medical School, Cleveland, OH, USA.
| | - James A Simon
- George Washington University School of Medicine, Washington, DC, USA
| | | | | | | | | | | | | | - Roya L Rezaee
- Case Western Reserve University Medical School, Cleveland, OH, USA
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Abstract
Purpose Although research into the neurobiology of sexual desire in women is active, relatively little is understood about the origins of sexual motivation in women. The purpose of our review is to discuss factors that influence a central sexual motivate state and generalized arousal as potential drivers of sexual motivation in women and female rats. Recent Findings Sexual motivation is the product of interactions of the central motive state and salient sexually-relevant cues. Ovarian hormones and generalized arousal influence the central motive state, and endogenous levels of estradiol and progesterone correlate with sexual motivation and behavior in women. The amygdala is a key integratory site for generalized arousal and sexual sensory stimulation, which could then increase sexual motivation through its downstream projections. Summary Our model of enhanced female sexual motivation suggests that the combined effects of dopamine and progesterone receptor activation in the medial amygdala increases the incentive properties of a sexual stimulus. Further study into the interactions of ovarian hormones and mediators of generalized arousal on the processing of sexually-relevant cues informs our understanding of the neurobiology of female sexual motivation and could lead to the development of therapeutics to treat the dysfunctions of sexual desire in women.
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Cacioppo S. Neuroimaging of Female Sexual Desire and Hypoactive Sexual Desire Disorder. Sex Med Rev 2017; 5:434-444. [DOI: 10.1016/j.sxmr.2017.07.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 07/13/2017] [Accepted: 07/15/2017] [Indexed: 10/18/2022]
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Standards for Clinical Trials in Male and Female Sexual Dysfunction: IV. Unique Aspects of Clinical Trials in Female Sexual Dysfunction. J Sex Med 2017; 14:19-26. [PMID: 28065357 DOI: 10.1016/j.jsxm.2016.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 09/12/2016] [Accepted: 09/15/2016] [Indexed: 11/20/2022]
Abstract
The focus of this article, the fourth in the series, Standards for Clinical Trials in Male and Female Sexual Dysfunction, is on aspects of clinical trial design and measurement that are specific to clinical trials for treatments of female sexual dysfunction. Challenges in this area include the limited extent of treatment development and clinical trial research across the spectrum of female sexual dysfunctions, changing regulatory considerations, changing diagnostic criteria for female sexual dysfunction, and the need to articulate assessment procedures to these changes. Discussion focuses on approaches to addressing these challenges in clinical trials in female sexual dysfunction.
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Abstract
Female sexual dysfunction can drastically diminish quality of life for many women. It is estimated that in the United States 40% of women have sexual complaints. These conditions are frequently underdiagnosed and undertreated. Terminology and classification systems of female sexual dysfunction can be confusing and complicated, which hampers the process of clinical diagnosis, making accurate diagnosis difficult. There are few treatment options available for female sexual dysfunctions, however, some interventions may be of benefit and are described. Additional treatments are in development. The development of clear clinical categories and diagnostic guidelines for female sexual dysfunction are of utmost importance and can be of great benefit for clinical and public health uses and disease-related research.
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Affiliation(s)
- Anita H Clayton
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia Health System, P.O. Box 800623, Charlottesville, VA 22908-0623, USA
| | - Elia Margarita Valladares Juarez
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia Health System, P.O. Box 800623, Charlottesville, VA 22908-0623, USA.
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Moyano N, Vallejo-Medina P, Sierra JC. Sexual Desire Inventory: Two or Three Dimensions? JOURNAL OF SEX RESEARCH 2017; 54:105-116. [PMID: 26756821 DOI: 10.1080/00224499.2015.1109581] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The Sexual Desire Inventory (SDI), developed by Spector, Carey, and Steinberg in 1996, has been widely used to assess sexual desire in men and women throughout the world. This questionnaire categorizes sexual desire in two dimensions: dyadic sexual desire and solitary sexual desire. Our study addressed the factorial structure of the SDI, an aspect that until now has been largely neglected. We recruited two samples of Spanish men and women involved in stable heterosexual relationships. The first sample consisted of 3,417 subjects (1,600 males and 1,817 females), ages 18 to 84; the second sample consisted of 677 subjects (285 males and 392 females), ages 18 to 50. The results of an exploratory factor analysis (EFA) showed that instead of two dimensions the SDI should have three: (1) partner-focused dyadic sexual desire, (2) general dyadic sexual desire for an attractive person, and (3) solitary sexual desire. A confirmatory factor analysis (CFA) supported the robustness of this new three-factor structure. No gender differences were revealed, except for dyadic sexual desire for an attractive person, for which men reported higher scores. Good validity and reliability values were obtained. Moreover, standard scores for men and women by different age groups were developed.
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Affiliation(s)
- Nieves Moyano
- a Mind, Brain, and Behavior Research Center (CIMCYC) , University of Granada; Facultad de Artes Liberales, Escuela de Psicología, Universidad de Especialidades Espíritu Santo (UEES)
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Parish SJ, Goldstein AT, Goldstein SW, Goldstein I, Pfaus J, Clayton AH, Giraldi A, Simon JA, Althof SE, Bachmann G, Komisaruk B, Levin R, Spadt SK, Kingsberg SA, Perelman MA, Waldinger MD, Whipple B. Toward a More Evidence-Based Nosology and Nomenclature for Female Sexual Dysfunctions—Part II. J Sex Med 2016; 13:1888-1906. [DOI: 10.1016/j.jsxm.2016.09.020] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 09/09/2016] [Accepted: 09/25/2016] [Indexed: 01/23/2023]
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Reed GM, Drescher J, Krueger RB, Atalla E, Cochran SD, First MB, Cohen‐Kettenis PT, Arango‐de Montis I, Parish SJ, Cottler S, Briken P, Saxena S. Disorders related to sexuality and gender identity in the ICD-11: revising the ICD-10 classification based on current scientific evidence, best clinical practices, and human rights considerations. World Psychiatry 2016; 15:205-221. [PMID: 27717275 PMCID: PMC5032510 DOI: 10.1002/wps.20354] [Citation(s) in RCA: 188] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
In the World Health Organization's forthcoming eleventh revision of the International Classification of Diseases and Related Health Problems (ICD-11), substantial changes have been proposed to the ICD-10 classification of mental and behavioural disorders related to sexuality and gender identity. These concern the following ICD-10 disorder groupings: F52 Sexual dysfunctions, not caused by organic disorder or disease; F64 Gender identity disorders; F65 Disorders of sexual preference; and F66 Psychological and behavioural disorders associated with sexual development and orientation. Changes have been proposed based on advances in research and clinical practice, and major shifts in social attitudes and in relevant policies, laws, and human rights standards. This paper describes the main recommended changes, the rationale and evidence considered, and important differences from the DSM-5. An integrated classification of sexual dysfunctions has been proposed for a new chapter on Conditions Related to Sexual Health, overcoming the mind/body separation that is inherent in ICD-10. Gender identity disorders in ICD-10 have been reconceptualized as Gender incongruence, and also proposed to be moved to the new chapter on sexual health. The proposed classification of Paraphilic disorders distinguishes between conditions that are relevant to public health and clinical psychopathology and those that merely reflect private behaviour. ICD-10 categories related to sexual orientation have been recommended for deletion from the ICD-11.
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Affiliation(s)
- Geoffrey M. Reed
- Department of Mental Health and Substance AbuseWorld Health OrganizationGenevaSwitzerland,School of PsychologyUniversidad Nacional Autónoma de MéxicoMexico CityMexico
| | - Jack Drescher
- Department of PsychiatryNew York Medical CollegeNew YorkNYUSA
| | - Richard B. Krueger
- Department of PsychiatryColumbia University, College of Physicians and Surgeons, New York State Psychiatric Institute and New York Presbyterian HospitalNew YorkNYUSA
| | - Elham Atalla
- Primary Care and Public Health Directorate, Ministry of HealthManamaBahrain
| | - Susan D. Cochran
- Fielding School of Public HealthUniversity of CaliforniaLos AngelesCAUSA
| | - Michael B. First
- Department of PsychiatryColumbia University, College of Physicians and Surgeons, New York State Psychiatric Institute and New York Presbyterian HospitalNew YorkNYUSA
| | - Peggy T. Cohen‐Kettenis
- Department of Medical PsychologyVU University Medical Centre, and Center of Expertise on Gender DysphoriaAmsterdamThe Netherlands
| | | | - Sharon J. Parish
- Departments of Medicine and PsychiatryWeill Cornell Medical College and New York Presbyterian Hospital/Westchester DivisionWhite PlainsNYUSA
| | - Sara Cottler
- Department of Reproductive Health and ResearchWorld Health OrganizationGenevaSwitzerland
| | - Peer Briken
- Institute for Sex Research and Forensic Psychiatry, University Medical Center Hamburg‐EppendorfHamburgGermany
| | - Shekhar Saxena
- Department of Mental Health and Substance AbuseWorld Health OrganizationGenevaSwitzerland
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19
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Neural Representation of Subjective Sexual Arousal in Men and Women. J Sex Med 2016; 13:1508-22. [PMID: 27614922 DOI: 10.1016/j.jsxm.2016.08.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 08/03/2016] [Accepted: 08/05/2016] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Studies investigating brain indices of sexual arousal have begun to elucidate the brain's role in processing subjective arousal; however, most research has focused on men, used discrete ratings of subjective arousal, and used stimuli too short to induce significant arousal in women. AIM To examine brain regions modulated by changes in subjective sexual arousal (SSA) rating intensity in men and women. METHODS Two groups (20 men, 20 women) viewed movie clips (erotic or humorous) while continuously evaluating changes in their SSA using a Likert-like scale (0 = not aroused, 10 = most aroused) and answering discrete questions about liking the movies and wanting sexual stimulation. Brain activity was measured using functional magnetic resonance imaging. MAIN OUTCOME MEASURES Blood oxygen level-dependent responses and continuous and discrete measurements of sexual arousal. RESULTS Erotic movies induced significant SSA in men and women. No sex difference in mean SSA was found in response to the erotic movies on continuous or discrete measurements. Several brain regions were correlated with changes in SSA. Parametric modulation with rating intensity showed a specific group of regions within the parietal lobe that showed significant differences in activity among low, medium, and high SSA. CONCLUSION Multiple regions were concordant with changes in SSA; however, a subset of regions in men and women was modulated by SSA intensity, a subset previously linked to attentional processes, monitoring of internal body representation, and processing of sensory information from the genitals. This study highlights that similar brain regions are activated during subjective assessment of sexual arousal in men and women. The data further highlight the fact that SSA is a complex phenomenon made up of multiple interoceptive and attentional processes.
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20
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Future Targets for Female Sexual Dysfunction. J Sex Med 2016; 13:1147-65. [DOI: 10.1016/j.jsxm.2016.05.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 05/22/2016] [Accepted: 05/27/2016] [Indexed: 12/18/2022]
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21
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Sarin S, Amsel R, Binik YM. A Streetcar Named "Derousal"? A Psychophysiological Examination of the Desire-Arousal Distinction in Sexually Functional and Dysfunctional Women. JOURNAL OF SEX RESEARCH 2016; 53:711-729. [PMID: 26457746 DOI: 10.1080/00224499.2015.1052360] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Research indicates that desire and arousal problems are highly interrelated in women. Therefore, hypoactive sexual desire disorder (HSDD) and female sexual arousal disorder (FSAD) were removed from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), and a new diagnostic category, female sexual interest/arousal disorder (FSIAD), was created to include both arousal and desire difficulties. However, no research has tried to distinguish these problems based on psychosocial-physiological patterns to identify whether unique profiles exist. This study compared psychosocial-physiological patterns in a community sample of 84 women meeting DSM-IV (American Psychiatric Association, 2000 ) criteria for HSDD (n = 22), FSAD (n = 18), both disorders (FSAD/HSDD; n = 25), and healthy controls (n = 19). Women completed self-report measures and watched neutral and erotic films while genital arousal (GA) and subjective arousal (SA) were measured. Results indicated that GA increased equally for all groups during the erotic condition, whereas women with HSDD and FSAD/HSDD reported less SA than controls or FSAD women. Women in the clinical groups also showed lower concordance and greater impairment on psychosocial variables as compared to controls, with women with FSAD/HSDD showing lowest functioning. Results have important implications for the classification and treatment of these difficulties.
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22
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Abstract
INTRODUCTION Multiple methods and devices are available for the assessment of female sexual response, each with strengths and limitations that can impact interpretation of research results. As such, it is important to have an understanding of available methodologies and instruments. AIM To review recent literature on the measurement of female sexual response, and to describe the methods and devices, and their strengths and limitations. METHODS A literature review was performed regarding methodology and instruments used to quantify female sexual response. MAIN OUTCOME MEASURES The description of currently available instruments and methods to quantify sexual response in women. RESULTS Methodologies used to examine female sexual arousal employ a variety of stimuli and instruments to elicit and record sexual response. The variation in research designs across studies highlights the importance of understanding (i) how sexual response is elicited in studies; (ii) what kinds of experimental designs are available for assessing sexual psychophysiology; and (iii) the various types of instrumentation used to collect data. CONCLUSIONS The physiological and self-reported measurement of female sexual response is crucial to our understanding of the mechanisms and factors involved with healthy sexual functioning. As such, it is important to understand the strengths and limitations associated with different stimuli, research designs, and instruments. Kukkonen TM. Devices and methods to measure female sexual arousal.
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Affiliation(s)
- Tuuli M Kukkonen
- Department of Family Relations and Applied NutritionUniversity of GuelphGuelphONCanada.
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23
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Brain responses to erotic and other emotional stimuli in breast cancer survivors with and without distress about low sexual desire: a preliminary fMRI study. Brain Imaging Behav 2014; 7:533-42. [PMID: 23955492 DOI: 10.1007/s11682-013-9252-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Many breast cancer survivors report a loss of sexual desire and arousability, consonant with the new DSM-V category of female sexual interest/arousal disorder. The cause of decreased sexual desire and pleasure after treatment for cancer is unknown. One possibility is that cancer, or treatment for cancer, damages brain circuits that are involved in reward-seeking. To test the hypothesis that brain reward systems are involved in decreased sexual desire in breast cancer survivors, we used functional magnetic resonance imaging (fMRI) to compare brain responses to erotica and other emotional stimuli in two groups of women previously treated for breast cancer with chemotherapy: those who were distressed about a perceived loss of sexual desire and those who may have had low desire, but were not distressed about it. Women distressed about their desire had reduced brain responses to erotica in the anterior cingulate and dorsolateral prefrontal cortex, which are part of the brain reward system. This study is the first to demonstrate, in cancer survivors, that problems with sexual desire/arousability are associated with blunted brain responses to erotica in reward systems. Future research is necessary to determine whether brain responses differ as a result of chemotherapy, hormone therapy, and menopausal status. This may contribute to the development of new, evidence-based interventions for one of the most prevalent and enduring side effects of cancer treatment.
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24
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Dawson SJ, Chivers ML. Gender Differences and Similarities in Sexual Desire. CURRENT SEXUAL HEALTH REPORTS 2014. [DOI: 10.1007/s11930-014-0027-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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25
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Schover LR. Premature ovarian failure is a major risk factor for cancer-related sexual dysfunction. Cancer 2014; 120:2230-2. [DOI: 10.1002/cncr.28735] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 01/08/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Leslie R. Schover
- Department of Behavioral Science; The University of Texas MD Anderson Cancer; Houston Texas
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26
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Sarin S, Amsel R, Binik YM. How hot is he? A psychophysiological and psychosocial examination of the arousal patterns of sexually functional and dysfunctional men. J Sex Med 2014; 11:1725-40. [PMID: 24820313 DOI: 10.1111/jsm.12562] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Despite much theorizing about the interchangeability of desire and arousal, research has yet to identify whether men with desire vs. arousal disorders can be differentiated based on their psychophysiological patterns of arousal. Additionally, little research has examined the relationship between subjective (SA) and genital arousal (GA) in sexually dysfunctional men. AIMS To compare patterns of SA and GA in a community sample of men meeting DSM-IV-TR criteria for hypoactive sexual desire disorder (HSDD), erectile dysfunction (ED), both HSDD and ED (ED/HSDD), and healthy controls. METHODS Seventy-one men (19 controls, 13 HSDD, 19 ED, 20 ED/HSDD) completed self-report measures and watched two 15-minute film clips (neutral and erotic), while GA and SA were measured both continuously and discretely. MAIN OUTCOME MEASURES Groups were compared on genital temperature (as an indicator of GA), SA, and psychosocial variables (i.e., body image, emotion regulation, sexual attitudes, sexual inhibition/excitation, mood, and trauma). RESULTS Genital temperature increased for all groups during the erotic condition, yet men with ED and ED/HSDD showed less GA than men without erectile difficulties. All groups increased in SA during the erotic condition, yet ED/HSDD men reported less SA than controls or ED men. SA and GA were highly correlated for controls, and less strongly correlated for clinical groups; men with ED showed low agreement between SA and GA. Groups also differed on body image, sexual inhibition/excitation, sexual attitudes and alexithymia. CONCLUSION Low desire vs. arousal sufferers have unique patterns of response, with those with both difficulties showing greatest impairment. Results have important implications for the diagnosis and treatment of these disorders.
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Affiliation(s)
- Sabina Sarin
- Department of Psychology, McGill University, Montreal, Quebec, Canada
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