Sexual desire and the brain

Disfunción sexual femenina: una mirada a los últimos 44 años. Análisis bibliométrico

Objetivo La disfunción sexual femenina (DSF) es un trastorno prevalente que afecta la calidad de vida de las mujeres y combina factores biológicos, psicológicos e interpersonales. Su estudio ha sido de poco interés, en campos como la investigación y el tratamiento, debido a la dificultad en la medición de las respuestas sexuales en las mujeres y otros factores, como el tabú acerca de la sexualidad femenina. Este estudio caracteriza las tendencias de publicaciones científicas acerca del tema, para que los urólogos puedan comprender la necesidad de realizar la búsqueda de este trastorno en la práctica diaria.

Métodos Se realizó una búsqueda de la literatura en las bases de datos PubMed, FABUMED y Scopus, utilizando la estrategia «((«female sexual dysfunction» [Title/Abstract])». Se realizó un análisis bibliométrico descriptivo, de corte retrospectivo, de la literatura médica obtenida en MEDLINE. A través de las herramientas estadísticas FABUMED, PubReminer y Scopus, se recopilaron los datos y se obtuvo los resultados de las variables que posteriormente fueron analizadas de forma estadística y descriptiva. Con base en esta información, elaboramos tablas y gráficas en Microsoft Office Excel 2017. Adicionalmente, realizamos un análisis de mapeo bibliométrico utilizando el programa VOSviewer. Para la obtención del factor de impacto (FI), utilizamos el Journal Citation Reports 2017/2018.

Resultados Desde 1975 hasta 2019, se publicaron 1.292 estudios, y la tasa anual de publicación permaneció estable entre 1975 y 2000. Pero, a partir del año 2000, se evidenció un aumento en el número de publicaciones, con un crecimiento del 92,1%. De las veinte revistas con más publicaciones, sólo cuatro son de urología. Los países con más publicaciones fueron: Estados Unidos (31,4%), Reino Unido (12,9%), Italia (8,9%), Turquía (5,9%), y Australia (4%). Estos datos son muy diferentes a los de los países de América Latina, en los que se encontraron muy pocas publicaciones, como Colombia, con tan sólo tres estudios.

Conclusiones Este análisis bibliométrico mostró las diferentes tendencias y tasas de publicación de estudios sobre DSF, y evidenció una baja tasa de producción con relación a otras temáticas, sobre todo en las revistas urológicas, con predominio de mujeres como autores, aunque en los últimos años se ha identificado un crecimiento importante y sostenido. Se hace evidente la necesidad de desarrollar estrategias para mejorar la formación tanto en los niveles de posgrado como de pregrado y, así, generar más adhesión a este tema en una especialidad quirúrgica como la nuestra.

Tandem Androgenic and Psychological Shifts in Male Reproductive Effort Following a Manipulated "Win" or "Loss" in a Sporting Competition

Male-male competition is involved in inter- and intrasexual selection, with both endocrine and psychological factors presumably contributing to reproductive success in human males. We examined relationships among men's naturally occurring testosterone, their self-perceived mate value (SPMV), self-esteem, sociosexuality, and expected likelihood of approaching attractive women versus situations leading to child involvement. We then monitored changes in these measures in male rowers (N = 38) from Cambridge, UK, following a manipulated "win" or "loss" as a result of an indoor rowing contest. Baseline results revealed that men with heightened testosterone and SPMV values typically had greater inclinations toward engaging in casual sexual relationships and a higher likelihood of approaching attractive women in a hypothetical social situation. As anticipated, both testosterone and SPMV increased following a manipulated "victory" and were associated with heightened sociosexuality, and increased expectations toward approaching attractive women versus individuals who would involve them in interacting with children after the race. SPMV and self-esteem appeared to mediate some of the effects of testosterone on post-race values. These findings are considered in the broader context of individual trade-offs between mating and parental effort and a model of the concurrent and dynamic androgenic and psychological influences contributing to male reproductive effort and success.

Short-term resource allocation during extensive athletic competition

OBJECTIVES

Following predictions from life history theory, we sought to identify acute trade-offs between reproductive effort (as measured by psychological arousal) and somatic maintenance (via functional measures of innate immunity) during conditions of severe energetic imbalance.

METHODS

Sixty-six male ultramarathon runners (ages 20 to 37 years) were sampled before and after a lengthy race. Saliva and sera were collected for testosterone and immunological analyses (hemolytic complement activity and bacterial killing ability). Lean body mass was assessed by bioelectrical impedance, and libido was measured using a slideshow of arousing and neutral images.

RESULTS

Following predictions, there was a significant decrease in salivary testosterone levels (109.59 pg/mL versus 97.61 pg/mL, P < .001) and arousal scores in response to provocative images (5.40 versus 4.89, P = .001) between prerace and postrace time points. Additionally, participant bacterial killing ability (P = .035) and hemolytic complement activity (P = .021) increased between prerace and postrace.

CONCLUSIONS

Decreased libido and testosterone with concomitant heightened innate immune responses suggest a shift in energetic priorities away from reproduction and toward maintenance/defense during a period of energetic stress.

Review: Female sexual dysfunctions — the new models

A new model of women's sexual response reflects their various motivations to be sexual and the fact that psychological and biological factors strongly influence their arousability. Examples of factors stemming from diabetes are included. To increase emotional intimacy with their partner, women will deliberately find or be receptive to sexual stimuli that can potentially be sexually arousing. Only later do they sense specifically sexual need to continue for the sake of sexual sensations, sexual tension and possible orgasmic release. A model of women's subjective sexual arousal reflects the ongoing modulation from her emotions and cognitions as well as highly variable genital feedback.

Gender Differences in Liking and Wanting Sex: Examining the Role of Motivational Context and Implicit Versus Explicit Processing

The present study investigated the specificity of sexual appraisal processes by making a distinction between implicit and explicit appraisals and between the affective (liking) and motivational (wanting) valence of sexual stimuli. These appraisals are assumed to diverge between men and women, depending on the context in which the sexual stimulus is encountered. Using an Implicit Association Test, explicit ratings, and film clips to prime a sexual, romantic or neutral motivational context, we investigated whether liking and wanting of sexual stimuli differed at the implicit and explicit level, differed between men and women, and were differentially sensitive to context manipulations. Results showed that, at the implicit level, women wanted more sex after being primed with romantic mood whereas men showed the least wanting of sex in the romantic condition. At the explicit level, men reported greater liking and wanting of sex than women, independently of context. We also found that women's (self-reported) sexual behavior was best predicted by the incentive salience of sexual stimuli whereas men's sexual behavior was more closely related to the hedonic qualities of sexual stimuli. Results were discussed in relation to an emotion-motivational account of sexual functioning.

Sexual life impact evaluation of different hormonal contraceptives on the basis of their methods of administration

PURPOSE

The aim of this study is to evaluate and compare sexual satisfaction with the use of three types of hormonal contraceptives.

METHODS

We have evaluated the sexological profile of 23 patients, treated with a subdermal hormonal contraceptive containing 68 mg etonogestrel. We have compared this profile to that of other two groups of previously studied patients: one consisting of 26 women treated with a vaginal ring releasing 120 µg/day of etonogestrel and 15 µg/day of ethinylestradiol (EE) and one consisting of 25 women treated with an oral contraceptive containing 20 µg of EE and 150 µg of desogestrel. A further group of 25 women, not in treatment with any type of hormonal contraceptive, has been studied as control group. The Interviewer Rating of Sexual Function (IRSF) has been completed by the patients at the beginning of the study and after cycles of 3 and 6 months of contraceptive usage.

RESULTS

All three types of hormonal contraceptives have increased positive indicators of patients' sexual life (sexual interest and fantasies, of orgasm number and intensity and satisfaction) and decreased negative ones (anxiousness, discomfort).

CONCLUSIONS

Subdermal contraception is slower than both intravaginal and oral hormonal contraceptives in giving these effects, but is more effective after a cycle of 6 months of usage.

On the interpersonal dynamics of sexuality

To date, theory and research on the interpersonal dynamics of sexuality is scarce. This is remarkable because people most often have sex in a relationship. To create more valid models of sexual functioning, it is important to go beyond the study of individual factors and take into account relational and contextual variables, which may act as risk and protective factors for developing, maintaining, and exacerbating sexual problems. This article describes theoretical ideas on how sexuality and relationships can be linked through motivation and emotion regulation. First, the sexual system is conceptualized as an emotion regulation device that involves a dynamic interplay between cognitive, affective, and motivational responses. Then, it is illustrated how partner variables, relationship processes, and sociorelational context may interact with these different responses and eventually shape how sexual emotions are generated and regulated. The author continues with explaining the implications of such emotion-motivational perspective for studying determinants of sexual responding, the role of coregulation in tuning sexual responses in the couple, and the interrelation between the sexual and relational goals of both partners. Linking sexual and nonsexual aspects of relationships and including data of both couple members is necessary for a clearer insight into the nature of sexual dysfunctions.

Different perspectives on the sex-attachment link: towards an emotion-motivational account

Although the link between sex and attachment was made decades ago (Hazan & Shaver, 1987), theories on sexual and attachment functioning have been developed in relative isolation. Recent efforts to integrate both literatures have been complicated by the fact that the sex-attachment link has been approached from very different perspectives, including biological, evolutionary, developmental, cognitive, and social psychology approaches. Also, at the empirical level, research on sex and attachment lacks overarching synthesis. This article gives an overview of the most important theoretical ideas and empirical insights on sex and attachment. It starts with describing general models that approach the sex-attachment link from an evolutionary and neurobiological perspective. Then, it summarizes theoretical and empirical ideas of attachment theory and describes how attachment style differences are manifested in intimate and sexual relationships. Research so far has been limited to studying the predicted link between sex and attachment in terms of broad descriptives, and it would benefit the literature to specify the processes and pathways that mediate the sex-attachment link. After a short discussion of the functional similarities between the sexual and the attachment systems, the article describes some specific--dynamical--models that focus on the emotional and cognitive-motivational processes through which attachment schemas influence sexual experiences. Such an emotion-motivational perspective on sex and attachment can help to organize theoretical ideas and empirical findings and eventually promote an integrative view on how attachment dynamics can interact with sexual experiences.

Normal Sexual Response in Women

In summary, women's sexual response is characterized as highly variable and influenced by a wide range of determinants, including physiologic, psychosocial, and contextual factors. This complexity is reflected also in the multiple etiologic factors and determinants of sexual problems in women. It is evident in current conceptualizations of normal female sexual response, as presented in this article, in which the circularity and overlap of different components and aspects of sexual response in women are viewed differently from the more linear and invariable trajectory of sexual response in men. It is not surprising, therefore, that treatments that target limited physiologic aspects of women's sexual response, such as PDE-5 inhibitors and other vasoactive agents, have demonstrated little overall effectiveness in treating women's sexual dysfunctions [21, 22]. Rather there is consensus at present regarding the need for a more holistic or biopsychosocial approach to management of sexual dysfunction in women. Clearly the roles of psychologic and interpersonal determinants need to be taken into account in this approach. Perhaps most important and especially relevant for treating female sexual dysfunction is the emphasis on interpersonal factors as contributors to the ultimate sexual satisfaction of women. Clinicians should be especially mindful of this influence when addressing women's sexual problems. Another implication of this research is the need for broader definitions and conceptualization of sexual dysfunction in women. Current diagnostic definitions of female sexual dysfunction are based largely on the traditional sexual response cycle models of Masters and Johnson [7] and Kaplan [9]. With the development of new models and concepts of normal sexual response in women, it is increasingly necessary for new definitions and concepts of sexual dysfunction to be developed. Promising efforts have been made in this regard, although much work remains to be done.

Women's sexual desire: a feminist critique

This paper offers a critical feminist analysis of the biomedical conceptualization of women's sexual desire. The five major features of the biomedical model of female sexual desire examined and critiqued are: 1) use of the male model as the standard, 2) use of a linear model of sexual response, 3) biological reductionism, 4) depoliticalization, and 5) medicalization of variation. A "New View", an alternative to the biomedical model, is offered for reconceptualizing women's sexual problems. This analysis concludes with recommendations for feminist-based biopsychosocial research.

The impotent couple: low desire

Hypoactive sexual desire (HSD) is the deficiency of sexual fantasies and desire that should be considered as a disorder if it causes distress to the couple. In the general population, it is the most widespread sexuality-related problem. It is generally accepted that testosterone and prolactin regulate sexual desire. We recently reported that other psychobiological factors associate with HSD in a sample of almost 500 male patients attending our Outpatient Clinic for sexual dysfunction, by using SIEDY structured interview. We now originally extend investigation to a threefold broader patient sample. Considering marital parameters, perceived partner's libido and climax, patient's partner diseases, conflictual or even prolonged couple relationship were all significantly associated with an impairment of patients' sexual desire. Moreover, other lifestyle factors as satisfaction at work and/or domestic inhabitant relationship were significantly correlated to hypoactive sexual desire disorder (HSDD). Among hormonal parameters, severe hyperprolactinaemia (>700 mU/L), although rarely diagnosed (<2.0%), seems to play a greater role than the more common (23%) endocrine disease hypogonadism (testosterone < 12 nm) to the pathogenesis of HSD (RR = 7.5 [2.5-22.4] vs. 1.5 [1.1-1.9], respectively). Both mental disorders and use of medication interfering with sexual function were also significantly associated with HSDD, as well as depressive and anxiety symptoms. Finally, HSD was inversely correlated to sexual and masturbation frequency attempts. In conclusion, HSD is associated with several biological, psychological, and relational factors that can be simultaneously identified and quantified using the SIEDY structured interview.

Effects of two types of hormonal contraception—oral versus intravaginal—on the sexual life of women and their partners

BACKGROUND

Data relating to the influence of hormonal contraception on sexual life are conflicting and mostly they refer to oral contraceptives. In this randomized, controlled, prospective study we compared the effect of an intravaginal hormonal contraceptive with the effect of a combined oral contraceptive on sexual function.

METHODS

Fifty-one healthy women with a permanent partner and an active sexual life were randomly divided in two groups according to a computer-generated randomization list: 26 women (group A) used an intravaginal contraceptive releasing 120 microg/day of etonogestrel and 15 microg/day of ethinylestradiol (EE) and 25 women (group B) used an oral contraceptive containing 20 microg di EE and 150 microg of desogestrel. Twenty-five women participated in the study as control group (group C). A specific questionnaire was completed by the patients and their partners at the start of the study and after cycles 3 and 6 of contraceptive use.

RESULTS

Within 3 months of contraceptive use, women from both groups A and B reported a global improvement in sexual function. A statistically significant increase in sexual fantasy was reported only by patients of group A. Whereas partners of the women in both groups A and B reported an improvement in sexual function after 3 months of contraceptive intake, only patients' partners of group A reported a significant increase in sexual interest, complicity and sexual fantasy.

CONCLUSIONS

Both hormonal contraceptives tested were seen to have a positive effect on some aspects of sexual function. The intravaginal contraceptive ring seems to exert a further positive effect on the psychological aspect of both women and their partners, which is evident from an improved complicity and sexual satisfaction.

What does sexual orientation orient? A biobehavioral model distinguishing romantic love and sexual desire

Although it is typically presumed that heterosexual individuals only fall in love with other-gender partners and gay-lesbian individuals only fall in love with same-gender partners, this is not always so. The author develops a biobehavioral model of love and desire to explain why. The model specifies that (a) the evolved processes underlying sexual desire and affectional bonding are functionally independent; (b) the processes underlying affectional bonding are not intrinsically oriented toward other-gender or same-gender partners: (c) the biobehavioral links between love and desire are bidirectional, particularly among women. These claims are supported by social-psychological, historical, and cross-cultural research on human love and sexuality as well as by evidence regarding the evolved biobehavioral mechanisms underlying mammalian mating and social bonding.

Libido: the biologic scenario

Libido is a comprehensive and yet elusive word that indicates basic human mental states--and their biological counterparts--involved in the beginning of sexual behavior. It has three main roots: biological, motivational-affective and cognitive. All these dimensions may be variably affected in the post menopause, contributing to a progressive decrease of sexual drive that parallels the process of aging. Loss of estrogens and, specifically, of androgens deprives female libido of major biological fuel. The effect of this loss is pervading, affecting the central nervous system, the sensory organs that are the major windows to environmental sexual stimuli and the quality of sexual response, central, peripheral non-genital and genital. Prolactin increase may further inhibit libido. Arousal disorders, dyspareunia, orgasmic difficulties, dissatisfaction, both physical and emotional, may contribute to a secondary loss of libido. Depression, anxiety and chronic stress, may interfere with central and peripheral pathways of the sexual response, reducing the quality of sexual function mostly in its motivational root. Relational conflicts and/or marital delusions and partner-specific problems, erectile deficit first, may contribute to the fading of sexual drive in the post-menopausal years. Well tailored HRT, including androgens in selected cases, may reduce the biological causes of loss of libido. A comprehensive treatment requires a balanced evaluation between biological and psychodynamic factors.

Understanding and affirming the sexual/relationship realities of end-stage renal disease patients and their significant others

End-stage renal disease (ESRD) frequently occurs within the social context of relationships and has many predictable consequences in the experience of patients and their significant others. Relationship and sexual issues and concerns must be assessed early in the treatment process and be continually attended to as patients seek new levels of coping. Sex-role conflicts, changes in sexual functioning and sexual self-esteem, challenges to both physical and emotional intimacy, and the life-altering consequences of chronic illness are all very real for ESRD patients. If a holistic perspective on the health care needs of ESRD patients is to be a reality, it will contain a concern for, active attention to, and involvement in the relationship/sexual dimension of life.

Androgen-behavior correlations in hypogonadal men and eugonadal men. I. Mood and response to auditory sexual stimuli

Mood and response to auditory sexual stimuli were assessed in 33 hypogonadal men receiving testosterone (T) replacement therapy, 10 eugonadal men receiving T in a male contraceptive clinical trial, and 19 eugonadal men not administered T. Prior to and after 6 weeks of hormone administration, men completed a mood questionnaire, rated sexual arousal to and sexual enjoyment of auditory sexual stimuli, and performed a dichotic listening task measuring selective attention for sexual stimuli. Mood questionnaire results suggest that T has positive effects on mood in hypogonadal men when hormone levels are well below the normal male range of values, but does not have any effects on mood when hormone levels are within or above the normal range. However, increased sexual arousal and sexual enjoyment were associated with T administration regardless of gonadal status. Eugonadal men administered T also increased in the bias to attend to sexual stimuli. In contrast, the comparison group of eugonadal men not administered T showed no mood or sexual behavior changes across the two test sessions. These data support a positive relationship between T and sexual interest, sexual arousal, and sexual enjoyment in men.

Discrepancies between genital responses and subjective sexual function during testosterone substitution in women with hypothalamic amenorrhea

Psychosexual dysfunction is often suggested the cause of the disturbed eating habits associated with hypothalamic secondary amenorrhea. In contrast, we explored the possibility that impaired sexual function may result from reduced levels of testosterone in amenorrheic subjects as a consequence of particular lifestyles. We studied the effects of erotic stimuli in two experiments, one comparing amenorrheic women to normal controls, the other comparing testosterone substitution to a placebo treatment. The amenorrheic women had a higher incidence of lifestyle and bodily conditions identified as risk factors for amenorrhea (i.e., weight loss before the onset of amenorrhea, low body weight, strenuous exercise, and vegetarianism), lower levels of testosterone, and impaired sexual function compared with normally menstruating women. In an experimental session in which amenorrheic women were asked to produce erotic fantasies, they demonstrated a reduced capacity for sexual fantasizing, less subjective sexual excitement, and less vaginal vasocongestion (vaginal pulse amplitude). However, when exposed to the stronger of two erotic film excerpts, the degree of vaginal response of the amenorrheic women was comparable to that of normally menstruating women. Subsequently, we showed that treatment with testosterone increased vaginal vasocongestion in the same amenorrheic women during exposure to the most potent visual stimulus but had no effect on subjective sexual experience. Testosterone substitution influenced physiological aspects of sexual function, but the psychological level remained unaffected.

Beliefs about the state, goals, and objects of sexual desire

Little is known about how men women conceptualize sexual desire. This descriptive study explored beliefs about the nature of sexual desire. Participants defined sexual desire in a free response format. The results suggest that there is no single common understanding of sexual desire. In particular, although men and women conceptualize the state of sexual desire in a manner similar to researchers and theorists (i.e., as a subjective, psychological experience rather than as a physiological or behavioral sexual event), sexual desire represents a more romantic, interpersonal experience for women than for men. Significantly more women than men believed that love and emotional intimacy are important goals of sexual desire, and fewer women than men viewed sexual activity as a goal of sexual desire.

Paedophilia and hyperprolactinaemia

The case of a man presenting with paedophilia who has found to be hyperprolactinaemic is described. There is possibly a link between paedophilia and endocrine disorders.

Neuropeptides and male sexual behavior

Evidence is rapidly accumulating that a number of neuropeptides are involved in the central control of male sexual behavior. This is consistent with their neuroanatomical distribution, i.e., in CNS loci previously implicated in the control of this behavior such as the medial preoptic area, and with recent findings that the peptide content of some of these regions is regulated by testosterone or its metabolites. Most of the work has been done using rats, but relevant human studies have been included whenever such material has been available. At this point there are relatively few studies which directly demonstrate the involvement of peptides in this behavior. Inhibitory and facilitatory actions, however, have been demonstrated following injections of peptides, peptide antisera, or antagonists into the CNS of male rats. Significant new developments include demonstrations that injections of substance P and A-MSH directly into the medial preoptic area can facilitate this behavior, while ventricular injection of an oxytocin antagonist can produce a powerful inhibition. The emerging picture is that GnRH, oxytocin, A-MSH and substance P stimulate, while CRF, beta-endorphin, prolactin, and neuropeptide Y are inhibitory. The inhibitory peptides CRF, beta-endorphin and prolactin are related, as they are released in response to stress. This may be relevant to the low level of sexual motivation in some depressed men. Questions concerning sites of action and mechanisms of action which mediate the behavioral effects which have been demonstrated remain largely unanswered.