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Ventura-Aquino E, Ågmo A. The elusive concept of sexual motivation: can it be anchored in the nervous system? Front Neurosci 2023; 17:1285810. [PMID: 38046659 PMCID: PMC10691110 DOI: 10.3389/fnins.2023.1285810] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 10/16/2023] [Indexed: 12/05/2023] Open
Abstract
Sexual motivation is an abstract concept referring to the mechanisms determining the responsivity to sexually relevant stimuli. This responsivity determines the likelihood of producing a sexual response and the intensity of that response. Both responsivity to stimuli and the likelihood of making a response as well as the intensity of response are characteristics of an individual. Therefore, we need to assume that the concept of sexual motivation materializes in physiological mechanisms within the individual. The aim of the present communication is to analyze the requisites for the endeavor to materialize sexual motivation. The first requisite is to provide an operational definition, making the concept quantifiable. We show that parameters of copulatory behavior are inappropriate. We argue that the intensity of sexual approach behaviors provides the best estimate of sexual motivation in non-human animals, whereas the magnitude of genital responses is an exquisite indicator of human sexual motivation. Having assured how to quantify sexual motivation, we can then proceed to the search for physiological or neurobiological underpinnings. In fact, sexual motivation only manifests itself in animals exposed to appropriate amounts of gonadal hormones. In female rats, the estrogen receptor α in the ventrolateral part of the ventromedial nucleus of the hypothalamus is necessary for the expression of sexual approach behaviors. In male rats, androgen receptors within the medial preoptic area are crucial. Thus, in rats sexual motivation can be localized to specific brain structures, and even to specific cells within these structures. In humans, it is not even known if sexual motivation is materialized in the brain or in peripheral structures. Substantial efforts have been made to determine the relationship between the activity of neurotransmitters and the intensity of sexual motivation, particularly in rodents. The results of this effort have been meager. Likewise, efforts of finding drugs to stimulate sexual motivation, particularly in women complaining of low sexual desire, have produced dismal results. In sum, it appears that the abstract concept of sexual motivation can be reliably quantified, and the neurobiological bases can be described in non-human animals. In humans, objective quantification is feasible, but the neurobiological substrate remains enigmatic.
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Affiliation(s)
- Elisa Ventura-Aquino
- Escuela Nacional de Estudios Superiores, Unidad Juriquilla, UNAM, Juriquilla, Mexico
| | - Anders Ågmo
- Department of Psychology, University of Tromsø, Tromsø, Norway
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Boothby CA, Santana MJ, Norris CM, Campbell TS, Rabi DM. Sexual Activity After Acute Coronary Syndrome: A Qualitative Approach to Patient and Partner Experiences. J Cardiovasc Nurs 2021; 36:E71-E79. [PMID: 33852497 PMCID: PMC8366597 DOI: 10.1097/jcn.0000000000000815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Little is known about how best to support both patients and their partners in the reengagement of sexual activity (SA) after acute coronary syndrome (ACS), with sparse direct data from the partner on their needs and concerns in the area of SA support. OBJECTIVES We undertook a qualitative study to address this gap in the literature through 3 objectives from a patient and partner perspective: (1) to characterize the experience of reengaging in SA post ACS, (2) to identify needs and priorities in the area of SA support post ACS, and (3) to determine whether cardiac rehabilitation (CR) could be an acceptable point of intervention for SA support. METHODS Semistructured qualitative interviews were conducted with 6 male patients who were post ACS and their partners (age range, 47-81 years). Patients were criterion sampled from the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease database. Inductive thematic data analysis was conducted. RESULTS Four themes were identified: "importance," "support received," "on their own," and "wanting support." Couples reaffirmed the importance of SA pre and post ACS, reported SA support as currently insufficient but articulated ways it could be improved, and reported CR as a current source of SA support but thought there could be room for improvement on the content and delivery of such information. CONCLUSIONS This study illustrates the potential value of promoting SA support for both patients who are post ACS and their partners and reports that SA support provided at CR would be viewed as important, needed, and acceptable.
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Abstract
Sexual arousal in women comprises two components: genital arousal and subjective arousal. Genital arousal is characterized by genital vasocongestion and other physiological changes that occur in response to sexual stimuli, whereas subjective arousal refers to mental engagement during sexual activity. For some women, genital arousal enhances subjective arousal; for others, the two types of arousal are desynchronous. However, the relationship between genital and subjective arousal might not be relevant to the diagnosis and treatment of sexual arousal dysfunction. Studies have shown that not all women who report sexual arousal problems have decreased genital arousal, and only some women with decreased genital arousal have low subjective arousal. To develop efficacious treatments for female sexual arousal dysfunction, researchers need to differentiate the women for whom genital sensations have a critical role in their subjective arousal from those who are not mentally aroused by genital cues. The mechanisms by which women become aroused and the inputs into arousal have considerable implications for treatment outcomes.
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Le Moëne O, Ågmo A. Modeling Human Sexual Motivation in Rodents: Some Caveats. Front Behav Neurosci 2019; 13:187. [PMID: 31507386 PMCID: PMC6719563 DOI: 10.3389/fnbeh.2019.00187] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 08/05/2019] [Indexed: 01/03/2023] Open
Abstract
Sexual behavior is activated by motivation. An overwhelming majority of experimental studies of the intricacies of sexual motivation has been performed in rodents, most of them in rats. Sometimes it is desirable to generalize results obtained in this species to other species, particularly the human. It is hoped that studies of the neurobiology of rodent sexual behavior may shed light on the central nervous mechanisms operating in the human, and the search for efficient pharmacological treatments of human sexual dysfunctions relies partly on studies performed in rodents. Then the issue of generalizability of the rodent data to the human becomes crucial. We emphasize the importance of distinguishing between copulatory acts, behavior involving the genitals, and the preceding event, the establishment of physical contact with a potential mate. Comparisons between the structure of copulatory behavior in rats and humans show abysmal differences, but there may be some similarity in the underlying mechanisms. The endocrine control of sex behavior is shortly mentioned, and we also compare the effects of the few drugs known to affect both rodent and human copulatory behavior. The stimuli activating sexual motivation, often called desire in the human literature, are examined, and the sexual approach behaviors in rats and humans are compared. There is a striking similarity between these species in how these behaviors respond to drugs. It is then shown that the intensity of sexual approach is unrelated to the intensity of copulatory behavior. Even though the approach is a requisite for copulation, an activity that requires at least two individuals in close physical contact, these two aspects of sexuality do not covary. This is similar to the role of the testosterone in men and male rats: although the hormone is needed for sex behavior, there is no correlation between serum testosterone concentration and the intensity of copulation. It is also pointed out that human sexual behavior is mostly determined by social conventions, whereas this is not the case in rats and other rodents. It is concluded that some observations in rats can be generalized to the human, but extreme caution must be exercised.
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Affiliation(s)
- Olivia Le Moëne
- Department of Psychology, University of Tromsø, Tromsø, Norway
| | - Anders Ågmo
- Department of Psychology, University of Tromsø, Tromsø, Norway
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The Effect of Cardiac Rehabilitation Attendance on Sexual Activity Outcomes in Cardiovascular Disease Patients: A Systematic Review. Can J Cardiol 2018; 34:1590-1599. [DOI: 10.1016/j.cjca.2018.08.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 07/25/2018] [Accepted: 08/12/2018] [Indexed: 01/18/2023] Open
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The Effects of Exercise on Sexual Function in Women. Sex Med Rev 2018; 6:548-557. [DOI: 10.1016/j.sxmr.2018.02.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 02/04/2018] [Accepted: 02/12/2018] [Indexed: 12/17/2022]
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Rullo JE, Lorenz T, Ziegelmann MJ, Meihofer L, Herbenick D, Faubion SS. Genital vibration for sexual function and enhancement: a review of evidence. SEXUAL AND RELATIONSHIP THERAPY 2018; 33:263-274. [PMID: 33223960 DOI: 10.1080/14681994.2017.1419557] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Vibration, as provided by a genital vibrator, is commonly regarded as a tool to enhance sexual pleasure and in modern day society falls under the category of a sex toy. However, the vibrator was not originally intended to be a toy, and its benefits reach far beyond that of a plaything. This article is a narrative review of the current evidence regarding the use of vibratory stimulation for the treatment of sexual dysfunction and/or sexual and relationship enhancement. The literature indicates that vibratory stimulation has evidence-based support for the treatment of erectile dysfunction, ejaculatory dysfunction and anorgasmia. Vibratory stimulation is positively correlated with increased sexual desire and overall sexual function. It has also shown benefit for sexual arousal difficulties and pelvic floor dysfunction. Though definitive evidence is lacking, genital vibration is a potential treatment for sexual dysfunction related to a wide variety of sexual health concerns in men and women.
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Affiliation(s)
- Jordan E Rullo
- Department of Psychology and Psychiatry, Mayo Clinic, Rochester, MN, USA.,Division of General Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Tierney Lorenz
- Department of Psychological Science, University of North Carolina at Charlotte, Charlotte, NC, USA
| | | | - Laura Meihofer
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | - Debra Herbenick
- Center for Sexual Health Promotion, Indiana University, Bloomington, IN, USA
| | - Stephanie S Faubion
- Division of General Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
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Hackney AC, Lane AR, Register-Mihalik J, Oʼleary CB. Endurance Exercise Training and Male Sexual Libido. Med Sci Sports Exerc 2017; 49:1383-1388. [PMID: 28195945 DOI: 10.1249/mss.0000000000001235] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE This article aimed to study the associations between aspects of endurance exercise training and sexual libido in healthy men using a cross-sectional online survey study design. METHODS A developed online survey questionnaire was used. The questionnaire was based on preexisting validated questionnaires and was used to assess elements of physical characteristics, exercise training habits, and libido of participants (n = 1077). Three evidence-based categories were created for the primary outcome of total libido score and low, normal, and high-response category sets. The high and normal categories were combined to form a high/normal score group, and the low category formed a low score group. Odds ratio (OR) values were calculated to examine group categorization. RESULTS Age, training intensity, and training duration of participants had significant (P < 0.02) univariate relationships, with libido scores, and were thus included in the multivariate model. In the multivariate model, training intensity (P < 0.0001) and duration (P < 0.002) components were the most significantly associated with libido group designation (high/normal vs low). Participants with the lowest (OR = 6.9, 95% confidence interval [CI] = 2.6-17.9) and mid-range training intensities (OR = 2.8, 95% CI = 1.4-5.3) had greater odds of high/normal libido state than those with the highest training intensity. Participants with the shorter (OR = 4.1, 95% CI = 1.6-10.0) and mid-range training durations (OR = 2.5, 95% CI = 1.3-4.8) at their current intensity also had greater odds of high/normal libido score than those with a greatest duration. CONCLUSION Exposure to higher levels of chronic intense and greater durations of endurance training on a regular basis is significantly associated with a decreased libido scores in men. Clinicians who treat male patients for sexual disorders and/or council couples on infertility issues should consider the degree of endurance exercise training a man is performing as a potential complicating factor.
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Affiliation(s)
- Anthony C Hackney
- 1Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, NC; and 2Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
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Abstract
Heart rate variability (HRV) is a measure of autonomic nervous system activity, which reflects an individual's ability to adapt to physiological and environmental changes. Low resting HRV has been linked to several mental health conditions, including depression, anxiety, and alcohol dependence (Kemp et al. in Biological Psychiatry 67(11):1067-1074, 2010. doi:10.1016/j.biopsych.2009.12.012; Kemp et al. in PloS One, 7(2):e30777, 2012; Quintana et al. in Drug and Alcohol Dependence, 132(1-2):395-398, 2013. doi:10.1016/j.drugalcdep.2013.02.025). HRV has also been used as a method for indexing the relative balance of sympathetic nervous system (SNS) activity to parasympathetic nervous system activity. This balance--in particular, moderately dominant SNS activity--has been shown to play a significant role in women's genital sexual arousal in the laboratory; however, the role of SNS activity in clinically relevant sexual arousal function is unknown. The present study assessed the feasibility of using HRV as an index of women's self-reported sexual arousal function outside the laboratory. Sexual arousal function, overall sexual function, and resting HRV were assessed in 72 women, aged 18-39. Women with below average HRV were significantly more likely to report sexual arousal dysfunction (p < .001) and overall sexual dysfunction (p < .001) than both women with average HRV and women with above average HRV. In conclusion, low HRV may be a risk factor for female sexual arousal dysfunction and overall sexual dysfunction.
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The Female Sexual Response: Current Models, Neurobiological Underpinnings and Agents Currently Approved or Under Investigation for the Treatment of Hypoactive Sexual Desire Disorder. CNS Drugs 2015; 29:915-33. [PMID: 26519340 DOI: 10.1007/s40263-015-0288-1] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
How a woman responds to sexual cues is highly dependent on a number of distinct, yet related, factors. Researchers have attempted to explain the female sexual response for decades, but no single model reigns supreme. Proper female sexual function relies on the interplay of somatic, psychosocial and neurobiological factors; misregulation of any of these components could result in sexual dysfunction. The most common sexual dysfunction disorder is hypoactive sexual desire disorder (HSDD). HSDD is a disorder affecting women across the world; a recent in-person diagnostic interview study conducted in the USA found that an estimated 7.4% of US women suffer from HSDD. Despite the disorder's prevalence, it is often overlooked as a formal diagnosis. In a survey of primary care physicians and obstetrics/gynaecology specialists, the number one reason for not assigning an HSDD diagnosis was the lack of a safe and effective therapy approved by the US Food and Drug Administration (FDA). This changed with the recent FDA approval of flibanserin (Addyi™) for the treatment of premenopausal women with acquired, generalized HSDD; there are still, however, no treatments approved outside the USA. HSDD is characterized by a marked decrease in sexual desire, an absence of motivation (also known as avolition) to engage in sexual activity, and the condition's hallmark symptom, marked patient distress. Research suggests that HSDD may arise from an imbalance of the excitatory and inhibitory neurobiological pathways that regulate the mammalian sexual response; top-down inhibition from the prefrontal cortex may be hyperactive, and/or bottom-up excitation to the limbic system may be hypoactive. Key neuromodulators for the excitatory pathways include norepinephrine, oxytocin, dopamine and melanocortins. Serotonin, opioids and endocannabinoids serve as key neuromodulators for the inhibitory pathways. Evolving treatment strategies have relied heavily on these crucial research findings, as many of the agents currently being investigated as treatment options for HSDD target and influence key players within these excitatory and inhibitory pathways, including various hormone therapies and centrally acting drugs, such as buspirone, bupropion and bremelanotide.
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Lorenz TK, Harte CB, Meston CM. Changes in Autonomic Nervous System Activity are Associated with Changes in Sexual Function in Women with a History of Childhood Sexual Abuse. J Sex Med 2015; 12:1545-54. [PMID: 25963394 DOI: 10.1111/jsm.12908] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Women with histories of childhood sexual abuse (CSA) have higher rates of sexual difficulties, as well as high sympathetic nervous system response to sexual stimuli. AIM The study aims to examine whether treatment-related changes in autonomic balance, as indexed by heart rate variability (HRV), were associated with changes in sexual arousal and orgasm function. METHODS In study 1, we measured HRV while writing a sexual essay in 42 healthy, sexually functional women without any history of sexual trauma. These data, along with demographics, were used to develop HRV norms equations. In study 2, 136 women with a history of CSA were randomized to one of three active expressive writing treatments that focused on their trauma, sexuality, or daily life (control condition). We recorded HRV while writing a sexual essay at pretreatment, posttreatment, and 2-week, and 1- and 6-month follow-ups; we also calculated the expected HRV for each participant based on the norms equations from study 1. MAIN OUTCOME MEASURES The main outcome measures used were HRV, Female Sexual Function Index, Sexual Satisfaction Scale--Women. RESULTS The difference between expected and observed HRV decreased over time, indicating that, posttreatment, CSA survivors displayed HRV closer to the expected HRV of a demographics-matched woman with no history of sexual trauma. Also, over time, participants whose HRV became less dysregulated showed the biggest gains in sexual arousal and orgasm function. These effects were consistent across condition. CONCLUSIONS Treatments that reduce autonomic imbalance may improve sexual well-being among CSA populations.
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Affiliation(s)
- Tierney K Lorenz
- The Kinsey Institute for Research on Sex, Gender, and Reproduction, Indiana University, Bloomington, IN, USA
| | - Christopher B Harte
- Research Service, VA Boston Healthcare System, Boston, MA, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Cindy M Meston
- Department of Psychology, University of Texas at Austin, Austin, TX, USA
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Zhang N, Xu MJ. Effects of epidural neostigmine and clonidine in labor analgesia: A systematic review and meta-analysis. J Obstet Gynaecol Res 2014; 41:214-21. [PMID: 25369869 DOI: 10.1111/jog.12517] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 06/11/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Ning Zhang
- Department of Anesthesiology; Beijing Obstetrics and Gynecology Hospital; Capital Medical University; Beijing China
| | - Ming-jun Xu
- Department of Anesthesiology; Beijing Obstetrics and Gynecology Hospital; Capital Medical University; Beijing China
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Ågmo A. Animal models of female sexual dysfunction: Basic considerations on drugs, arousal, motivation and behavior. Pharmacol Biochem Behav 2014; 121:3-15. [DOI: 10.1016/j.pbb.2013.10.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 10/04/2013] [Indexed: 12/19/2022]
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Sun Q, Huang J, Yang DL, Cao XN, Zhou WL. Activation of β-adrenergic receptors during sexual arousal facilitates vaginal lubrication by regulating vaginal epithelial Cl(-) secretion. J Sex Med 2014; 11:1936-48. [PMID: 24840080 DOI: 10.1111/jsm.12583] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Vaginal lubrication, an indicator of sexual arousal and tissue health, increases significantly during genital sexual arousal. Adrenergic alpha-receptors (AR) are an important regulator of genital physiological responses involved in mediating vascular and nonvascular smooth muscle contractility; the role of β-AR in sexual arousal, however, has not yet been investigated. AIM The goal of this study was to reveal the functional role of β-AR in modulating vaginal lubrication during sexual arousal and the mechanisms underlying the process. METHODS The effects of adrenaline on vaginal epithelial ion transport, intracellular cyclic adenosine monophosphate (cAMP) content ([cAMP]i ), and vaginal lubrication were investigated using short-circuit current (ISC ) of rat vaginas incubated in vitro, enzyme-linked immunosorbent assay (ELISA), and measurement of vaginal lubrication in vivo, respectively. The expressions of β-AR in vaginal epithelium were analyzed by reverse transcription-polymerase chain reaction, western blot, and immunofluorescence. MAIN OUTCOME MEASURES Changes of ISC responses; mRNA, protein expressions and localization of β-AR; [cAMP]i ; vaginal lubrication. RESULTS Serosal application of adrenaline induced an increase of ISC across rat vaginal epithelium that blocked by propranolol, a β-AR antagonist, rather than phentolamine, an α-AR antagonist. β1/2-AR were both present in rat and human vaginal epithelial cells. Removing Cl(-) or application of CFTR(inh) -172, an inhibitor of cystic fibrosis transmembrane conductance regulator (CFTR), abolished adrenaline-induced ISC responses. The elevated levels of [cAMP]i induced by adrenaline were prevented by the pretreatment with propranolol. Vaginal lubrication measured in vivo showed that adrenaline or pelvic nerve stimulation caused a marked increase in vaginal lubrication, whereas pretreatment with propranolol or CFTR(inh) -172 reduced the effect. CONCLUSIONS Activation of epithelial β-AR facilitates vaginal lubrication during sexual arousal by stimulating vaginal epithelial Cl(-) secretion in a cAMP-dependent pathway. Thus, vaginal epithelial β-AR might be another regulator of vaginal sexual arousal responses.
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Affiliation(s)
- Qing Sun
- School of Life Sciences, Sun Yat-sen University, Guangzhou, Guangdong, China
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Dundon CM, Rellini AH. Emotional states of love moderate the association between catecholamines and female sexual responses in the laboratory. J Sex Med 2012; 9:2617-30. [PMID: 22621174 DOI: 10.1111/j.1743-6109.2012.02799.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Research suggests that there are three interrelated, yet distinct, emotion-motivation brain systems for human love (lust, romantic love, and attachment), each associated with a unique catecholaminergic and hormonal profile. Of interest for the current study are norepinephrine (NE) and dopamine (DA), which have a hypothesized connection with romantic love. As NE and DA are also known to facilitate sexual arousal, it is plausible that NE and DA may have a greater positive association with the sexual arousal responses of women in romantic love compared with women in lust. AIM This study investigated if the effects of NE and DA activity on sexual arousal responses would differ depending on emotion-motivation state (Lust or Romantic). MAIN OUTCOME MEASURES Physiological sexual arousal was assessed by photoplethysmography and subjective sexual arousal was assessed with a participant-controlled lever. METHODS Seventeen women were included in the Lust group and 29 in the Romantic group. All participants provided a urine sample (to assess NE and DA) and completed a psychophysiological assessment. RESULTS Elevated NE was positively and significantly associated with greater subjective and physiological sexual arousal for the Lust group, but not for the Romantic group. Similarly, elevated DA was positively and significantly associated with greater subjective sexual arousal for the Lust group, but not for the Romantic group. CONCLUSIONS The sexual arousal responses of women in the Lust group, but not in the Romantic group, were positively and significantly associated with elevated NE and DA. It is feasible that, when women are seeking a partner (Lust), NE and DA may facilitate attention toward sexually relevant stimuli.
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Klein C, Hill MN, Chang SCH, Hillard CJ, Gorzalka BB. Circulating endocannabinoid concentrations and sexual arousal in women. J Sex Med 2012; 9:1588-601. [PMID: 22462722 DOI: 10.1111/j.1743-6109.2012.02708.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Several lines of evidence point to the potential role of the endocannabinoid system in female sexual functioning. These include results from studies describing the subjective effects of exogenous cannabinoids on sexual functioning in humans and the observable effects of exogenous cannabinoids on sexual functioning in other species, as well as results from studies investigating the location of cannabinoid receptors in the brain and periphery, and the effects of cannabinoid receptor activation on neurotransmitters implicated in sexual functioning. While these lines of research suggest a role for the endocannabinoid system in female sexual functioning, no studies investigating the relationship between concentrations of endogenous cannabinoids (i.e., arachidonoylethanolamide [AEA] and 2-arachidonoylglycerol [2-AG]) and sexual functioning have been conducted in any species. AIM To measure circulating endocannabinoid concentrations in relation to subjective and physiological indices of sexual arousal in women (N = 21). METHODS Serum endocannabinoid (AEA and 2-AG) concentrations were measured immediately prior to, and immediately following, viewing of neutral (control) and erotic (experimental) film stimuli in a repeated measures design. Physiological sexual arousal was measured via vaginal photoplethysmography. Subjective sexual arousal was measured both continuously and noncontinuously. Pearson's correlations were used to investigate the relationships between endocannabinoid concentrations and sexual arousal. MAIN OUTCOME MEASURES Changes in AEA and 2-AG concentrations from pre- to post-film and in relation to physiological and subjective indices of sexual arousal. RESULTS Results revealed a significant relationship between endocannabinoid concentrations and female sexual arousal, whereby increases in both physiological and subjective indices of sexual arousal were significantly associated with decreases in AEA, and increases in subjective indices of sexual arousal were significantly associated with decreases in 2-AG. CONCLUSIONS These findings support the hypothesis that the endocannabinoid system is involved in female sexual functioning, with implications for furthering understanding of the biological mechanisms underlying female sexual functioning.
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Affiliation(s)
- Carolin Klein
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada.
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Lorenz TA, Harte CB, Hamilton LD, Meston CM. Evidence for a curvilinear relationship between sympathetic nervous system activation and women's physiological sexual arousal. Psychophysiology 2011; 49:111-7. [PMID: 22092348 DOI: 10.1111/j.1469-8986.2011.01285.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Accepted: 07/13/2011] [Indexed: 11/27/2022]
Abstract
There is increasing evidence that women's physiological sexual arousal is facilitated by moderate sympathetic nervous system (SNS) activation. Literature also suggests that the level of SNS activation may play a role in the degree to which SNS activity affects sexual arousal. We provide the first empirical examination of a possible curvilinear relationship between SNS activity and women's genital arousal using a direct measure of SNS activation in 52 sexually functional women. The relationship between heart rate variability (HRV), a specific and sensitive marker of SNS activation, and vaginal pulse amplitude (VPA), a measure of genital arousal, was analyzed. Moderate increases in SNS activity were associated with higher genital arousal, while very low or very high SNS activation was associated with lower genital arousal. These findings imply that there is an optimal level of SNS activation for women's physiological sexual arousal.
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Kirkpatrick M, Merrill L. Effect of systemic blockade of α1-noradrenergic receptors on sex behavior and vaginal–cervical stimulation-induced Fos in female rats. Pharmacol Biochem Behav 2011; 97:486-93. [DOI: 10.1016/j.pbb.2010.09.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Revised: 09/21/2010] [Accepted: 09/25/2010] [Indexed: 11/25/2022]
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Traish AM, Botchevar E, Kim NN. Biochemical Factors Modulating Female Genital Sexual Arousal Physiology. J Sex Med 2010; 7:2925-46. [DOI: 10.1111/j.1743-6109.2010.01903.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Pfaus JG, Wilkins MF, Dipietro N, Benibgui M, Toledano R, Rowe A, Couch MC. Inhibitory and disinhibitory effects of psychomotor stimulants and depressants on the sexual behavior of male and female rats. Horm Behav 2010; 58:163-76. [PMID: 19837072 DOI: 10.1016/j.yhbeh.2009.10.004] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2009] [Revised: 09/24/2009] [Accepted: 10/01/2009] [Indexed: 11/20/2022]
Abstract
Drugs of abuse comprise several pharmacological classes, including psychomotor stimulants, such as amphetamine and cocaine, and CNS depressants, such as morphine and alcohol. Few studies have examined the effects of those drugs systematically on human sexual behavior, although substantial clinical and epidemiological literatures suggest that drugs in both classes either inhibit sexual responding or can be "prosexual" in certain situations, thereby increasing the potential of risky sexual activity and the spread of sexually transmitted diseases. This paper reviews original data in rats showing that both classes of drug inhibit or disinhibit sexual behavior depending on the animal's baseline level of sexual responding, hormonal status, whether the drug is given acutely or chronically, and whether the animal has learned to inhibit sexual responding toward nonreceptive partners or in the presence of conditioned olfactory cues that predict sexual nonreward.
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Affiliation(s)
- James G Pfaus
- Center for Studies in Behavioral Neurobiology, Department of Psychology, Concordia University, 7141 Sherbrooke W., Montréal, QC, Canada H4B 1R6.
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Allers KA, Richards N, Scott L, Sweatman C, Cheung J, Reynolds D, Casey JH, Wayman C. II. Slow Oscillations in Vaginal Blood Flow: Regulation of Vaginal Blood Flow Patterns in Rat by Central and Autonomic Mechanisms. J Sex Med 2010; 7:1088-103. [DOI: 10.1111/j.1743-6109.2009.01466.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Chivers ML, Seto MC, Lalumière ML, Laan E, Grimbos T. Agreement of self-reported and genital measures of sexual arousal in men and women: a meta-analysis. ARCHIVES OF SEXUAL BEHAVIOR 2010; 39:5-56. [PMID: 20049519 PMCID: PMC2811244 DOI: 10.1007/s10508-009-9556-9] [Citation(s) in RCA: 341] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2007] [Revised: 04/29/2009] [Accepted: 09/05/2009] [Indexed: 05/12/2023]
Abstract
The assessment of sexual arousal in men and women informs theoretical studies of human sexuality and provides a method to assess and evaluate the treatment of sexual dysfunctions and paraphilias. Understanding measures of arousal is, therefore, paramount to further theoretical and practical advances in the study of human sexuality. In this meta-analysis, we review research to quantify the extent of agreement between self-reported and genital measures of sexual arousal, to determine if there is a gender difference in this agreement, and to identify theoretical and methodological moderators of subjective-genital agreement. We identified 132 peer- or academically-reviewed laboratory studies published between 1969 and 2007 reporting a correlation between self-reported and genital measures of sexual arousal, with total sample sizes of 2,505 women and 1,918 men. There was a statistically significant gender difference in the agreement between self-reported and genital measures, with men (r = .66) showing a greater degree of agreement than women (r = .26). Two methodological moderators of the gender difference in subjective-genital agreement were identified: stimulus variability and timing of the assessment of self-reported sexual arousal. The results have implications for assessment of sexual arousal, the nature of gender differences in sexual arousal, and models of sexual response.
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Affiliation(s)
- Meredith L Chivers
- Department of Psychology, Queen's University, Kingston, ON, K7L 3N6, Canada.
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Brotto LA, Klein C, Gorzalka BB. Laboratory-induced hyperventilation differentiates female sexual arousal disorder subtypes. ARCHIVES OF SEXUAL BEHAVIOR 2009; 38:463-475. [PMID: 18343989 DOI: 10.1007/s10508-007-9288-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2006] [Revised: 05/26/2007] [Accepted: 10/20/2007] [Indexed: 05/26/2023]
Abstract
The effects of heightened sympathetic nervous system (SNS) activity via laboratory-induced hyperventilation (LIH) on subjective and physiological sexual arousal were examined in a heterogeneous group of women with Sexual Arousal Disorder (SAD; n = 60), as well as across subtypes of SAD, in comparison to a control group of women without sexual difficulties (n = 42). Participants took part in 2 min of rapid breathing, a technique previously found to increase SNS activity, immediately prior to viewing erotic stimuli. Physiological arousal (i.e., vaginal pulse amplitude; VPA) was measured via the vaginal photoplethysmograph and subjective arousal was measured via self-report questionnaires. LIH differentiated women with SAD from those in the control group, with LIH increasing VPA in the latter, but having no significant effect in the heterogeneous SAD group. However, among subtypes of SAD, LIH differentiated women with genital (n = 16) and subjective (n = 16) subtypes of SAD from women with combined SAD (n = 28) and women without sexual difficulties. Specifically, women in the control group and those with combined SAD had a significant increase in VPA whereas women with genital or subjective SAD had a significant decrease in VPA following LIH. There was no significant effect of LIH on any self-report measure of sexual arousal following erotic stimuli. Implications of the results for the conceptualization, diagnosis, and treatment of SAD are discussed.
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Affiliation(s)
- Lori A Brotto
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada.
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Hamilton LD, Fogle EA, Meston CM. The roles of testosterone and alpha-amylase in exercise-induced sexual arousal in women. J Sex Med 2008; 5:845-853. [PMID: 18221285 DOI: 10.1111/j.1743-6109.2007.00751.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Several studies have demonstrated that moderate exercise increases genital response to erotic stimuli in women. The increase in genital arousal could be the result of various changes that can occur in response to exercise including changes in hormone levels, neurotransmitter levels, mood, and autonomic nervous system activity. AIM The present study was an attempt to shed light on two such mechanisms through which exercise enhances sexual arousal. METHOD Sixteen participants came into the lab on two separate occasions: during one visit, they filled out questionnaires for 20 minutes, and during the other visit, they exercised on a treadmill for 20 minutes. The questionnaires and exercise were both followed by the presentation of a neutral then erotic film during which the women's physiological sexual arousal was measured. Saliva samples were taken at baseline, prefilm, and postfilm. Main Outcome Measures. Subjective arousal was measured using a self-report questionnaire, and genital arousal was measured by a vaginal photoplethysmograph. Testosterone and alpha-amylase (a marker of sympathetic nervous system [SNS] activity) were measured via saliva assays. RESULTS Findings replicated previous studies showing a significant increase in physiological sexual arousal with exercise. There was a significant increase in alpha-amylase across the study in the exercise condition, but not in the no-exercise condition. There were no differences in testosterone levels between the exercise and no-exercise conditions. CONCLUSIONS SNS activity is one mechanism through which exercise increases genital sexual arousal. Testosterone does not mediate the relationship between exercise and genital sexual arousal.
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Affiliation(s)
| | - Emily A Fogle
- University of Texas at Austin-Psychology, Austin, TX, USA
| | - Cindy M Meston
- University of Texas at Austin-Psychology, Austin, TX, USA.
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Abstract
Many drugs may have effects on sexual function. Sexual function is complex and psychological and relationship issues are likely to have greater impacts on sexual function in women than drugs. Although it is important to understand the effects of drugs on sexual function, physicians should use caution in "medicalization" of sexual function in women [106].
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Affiliation(s)
- J Chris Carey
- Department of Obstetrics and Gynecology, Denver Health, 777 Bannock Street, Mail Code 0660, Denver, CO 80204, USA.
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Diamond LE, Earle DC, Heiman JR, Rosen RC, Perelman MA, Harning R. An effect on the subjective sexual response in premenopausal women with sexual arousal disorder by bremelanotide (PT-141), a melanocortin receptor agonist. J Sex Med 2006; 3:628-638. [PMID: 16839319 DOI: 10.1111/j.1743-6109.2006.00268.x] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Melanocortins affect multiple physiological responses, including sexual behaviors. Bremelanotide is a synthetic peptide melanocortin analog of alpha-melanocyte-stimulating hormone that is an agonist at melanocortin receptors MC3R and MC4R. AIM To evaluate a single intranasal dose of bremelanotide for potential effects on physiological and subjective measurements of sexual arousal and desire in premenopausal women with sexual arousal disorder. MAIN OUTCOME MEASURES Change in vaginal pulse amplitude during neutral and erotic videos after treatment with bremelanotide or placebo and subjects' perceptions of physiological and sexual response within 24 hours of treatment with bremelanotide or placebo. METHODS Eighteen premenopausal women with a primary diagnosis of female sexual arousal disorder were randomly assigned to receive a single intranasal dose of 20 mg bremelanotide or matching placebo in a double-blind manner during the first in-clinic treatment session, and the alternate medication during the second in-clinic treatment session. During each session, subjects viewed a 20-minute neutral video followed by a 20-minute sexually explicit video. Vaginal photoplethysmography was used to monitor vaginal vasocongestion and questionnaires were used to evaluate perceptions of sexual response within the following 24-hour period. RESULTS More women reported moderate or high sexual desire following bremelanotide treatment vs. placebo (P = 0.0114), and a trend toward more positive responses regarding feelings of genital arousal occurred after bremelanotide compared with placebo (P = 0.0833). Among women who attempted sexual intercourse within 24 hours after treatment, significantly more were satisfied with their level of sexual arousal following bremelanotide, compared with placebo (P = 0.0256). Vaginal vasocongestion did not change significantly while viewing erotic videos following bremelanotide administration compared with placebo. CONCLUSION This preliminary evaluation suggests the potential for bremelanotide to positively affect desire and arousal in women with female sexual arousal disorder and indicates that bremelanotide is a promising candidate for further evaluation in an at-home study.
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Affiliation(s)
| | | | - Julia R Heiman
- Kinsey Institute, Indiana University, Bloomington, IN, USA
| | - Raymond C Rosen
- Department of Psychiatry, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, Piscataway, NJ, USA
| | - Michael A Perelman
- Weill Medical College of Cornell University, Psychiatry, Reproductive Medicine, and Urology, NY, USA
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Millan MJ. Multi-target strategies for the improved treatment of depressive states: Conceptual foundations and neuronal substrates, drug discovery and therapeutic application. Pharmacol Ther 2006; 110:135-370. [PMID: 16522330 DOI: 10.1016/j.pharmthera.2005.11.006] [Citation(s) in RCA: 389] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2005] [Accepted: 11/28/2005] [Indexed: 12/20/2022]
Abstract
Major depression is a debilitating and recurrent disorder with a substantial lifetime risk and a high social cost. Depressed patients generally display co-morbid symptoms, and depression frequently accompanies other serious disorders. Currently available drugs display limited efficacy and a pronounced delay to onset of action, and all provoke distressing side effects. Cloning of the human genome has fuelled expectations that symptomatic treatment may soon become more rapid and effective, and that depressive states may ultimately be "prevented" or "cured". In pursuing these objectives, in particular for genome-derived, non-monoaminergic targets, "specificity" of drug actions is often emphasized. That is, priority is afforded to agents that interact exclusively with a single site hypothesized as critically involved in the pathogenesis and/or control of depression. Certain highly selective drugs may prove effective, and they remain indispensable in the experimental (and clinical) evaluation of the significance of novel mechanisms. However, by analogy to other multifactorial disorders, "multi-target" agents may be better adapted to the improved treatment of depressive states. Support for this contention is garnered from a broad palette of observations, ranging from mechanisms of action of adjunctive drug combinations and electroconvulsive therapy to "network theory" analysis of the etiology and management of depressive states. The review also outlines opportunities to be exploited, and challenges to be addressed, in the discovery and characterization of drugs recognizing multiple targets. Finally, a diversity of multi-target strategies is proposed for the more efficacious and rapid control of core and co-morbid symptoms of depression, together with improved tolerance relative to currently available agents.
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Affiliation(s)
- Mark J Millan
- Institut de Recherches Servier, Centre de Recherches de Croissy, Psychopharmacology Department, 125, Chemin de Ronde, 78290-Croissy/Seine, France.
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Meston CM, McCall KM. Dopamine and norepinephrine responses to film-induced sexual arousal in sexually functional and sexually dysfunctional women. JOURNAL OF SEX & MARITAL THERAPY 2005; 31:303-17. [PMID: 16020148 DOI: 10.1080/00926230590950217] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
This study was designed to assess potential differences between sexually functional and dysfunctional women in dopamine (DA) and norepinephrine (NE) responses to erotic stimuli. Blood levels of homovanillic acid (HVA; the major metabolite of DA) and NE were taken during the showing of a nonsexual and a sexual film from 9 women with female sexual arousal disorder and hypoactive sexual desire disorder and from 13 sexually functional women. We assessed sexual arousal subjectively using a self-report scale and physiologically using a vaginal photoplethysmograph. HVA levels significantly decreased in sexually functional and dysfunctional women during the erotic versus during the neutral film. NE levels were not significantly different for either group of women during the neutral and erotic films. Sexually dysfunctional women had significantly higher levels of NE during both the neutral and erotic films compared with functional women. Subjective or physiological arousal differences between neutral and erotic films were not significantly different between functional and dysfunctional women.
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Affiliation(s)
- C M Meston
- Department of Psychology, University of Texas, Austin, Texas 78712, USA.
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Frohlich PF, Meston CM. Tactile sensitivity in women with sexual arousal disorder. ARCHIVES OF SEXUAL BEHAVIOR 2005; 34:207-217. [PMID: 15803254 DOI: 10.1007/s10508-005-1798-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2003] [Revised: 04/01/2004] [Accepted: 06/09/2004] [Indexed: 05/24/2023]
Abstract
Evidence suggests that tactile sensitivity may differ between women with sexual arousal difficulties and women with normal sexual functioning. Tactile sensitivity was examined on the distal portion of the dominant hand index finger and on the lower lip in women with female sexual arousal disorder (FSAD) (n = 17) and in normally functioning women (n = 17). The two groups did not differ significantly in age, length of current relationship or on measures of sexual experience and sexual desire. Hierarchical binary logistic regression indicated that finger threshold was significantly associated with FSAD women versus control women, and hierarchical linear regression indicated that finger threshold was associated with severity of arousal dysfunction. Logistic regression showed that 76.5% of participants were correctly classified and 23.5% were incorrectly classified using tactile sensation as a predictor variable. Possible underlying mechanisms and clinical implications are discussed.
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Affiliation(s)
- Penny F Frohlich
- Department of Psychology, University of Texas at Austin, Austin, Texas 78712, USA
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Alevizos B, Vaidakis N, Alevizos E. Increased libido with the combined use of venlafaxine and mirtazapine. J Clin Psychopharmacol 2005; 25:194-6. [PMID: 15738758 DOI: 10.1097/01.jcp.0000161448.73840.5f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Motofei IG, Rowland DL. The physiological basis of human sexual arousal: neuroendocrine sexual asymmetry. ACTA ACUST UNITED AC 2005; 28:78-87. [PMID: 15811068 DOI: 10.1111/j.1365-2605.2004.00514.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Normal sexual arousal and response suppose an integrated process involving both physiological and psychological processes. However, the current understanding of sexual arousal does not provide a coherent model that accounts for the integration of multiple physiological systems that subsequently generate a coordinated sexual response at both the spinal peripheral and cerebral central levels. Herein we suggest a model that involves both sympathetic and parasympathetic activation during sexual arousal via the two classes of gonadal hormones, androgens and oestrogens. We discuss the manner in which gonadal hormones may activate such a system, transforming pre-pubertal (non-erotic) genital stimulation to post-pubertal erogenization of stimulation and subsequent sexual arousal. Finally, we indicate that the different balance of androgens and oestrogens in men and women may generate asymmetric effects on each of the components of the autonomic nervous system, thereby explaining some of the differences in patterns of sexual arousal and the responses cycle across the sexes.
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Affiliation(s)
- Ion G Motofei
- St Pantelimon Hospital, Carol Davila University of Medicine and Pharmacy, Dionisie Lupu Street, No. 37, Sect. 1, Bucharest, Romania.
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Meston CM. A randomized, placebo-controlled, crossover study of ephedrine for SSRI-induced female sexual dysfunction. JOURNAL OF SEX & MARITAL THERAPY 2004; 30:57-68. [PMID: 14742097 DOI: 10.1080/00926230490247093] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The objective of this study was to determine whether ephedrine, an alpha- and beta-adrenergic agonist previously shown to enhance genital blood flow in women, has beneficial effects in reversing antidepressant-induced sexual dysfunction. Nineteen sexually dysfunctional women receiving either fluoxetine, sertraline, or paroxetine participated in an eight-week, double-blind, placebo-controlled, cross-over study of the effects of ephedrine (50 mg) on self-report measures of sexual desire, arousal, orgasm, and sexual satisfaction. Although there were significant improvements relative to baseline in sexual desire and orgasm intensity/pleasure on 50 mg ephedrine 1-hr prior to sexual activity, significant improvements in these measures, as well as in sexual arousal and orgasmic ability also were noted with placebo. These findings highlight the importance of conducting placebo-controlled trials for this condition.
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Affiliation(s)
- Cindy M Meston
- Department of Psychology, University of Texas at Austin, Austin, Texas, USA.
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Polan ML, Desmond JE, Banner LL, Pryor MR, McCallum SW, Atlas SW, Glover GH, Arnow BA. Female sexual arousal: a behavioral analysis. Fertil Steril 2004; 80:1480-7. [PMID: 14667887 DOI: 10.1016/s0015-0282(03)02210-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE This study was designed to assess female sexual arousal by using a combination of physiologic measures and self-reported level of arousal. DESIGN Twenty subjects viewed a 23-minute sequence of randomly ordered relaxation and erotic tapes, both with and without auditory stimulus. The physiologic parameters of vaginal blood flow, galvanic skin resistance, respiration, pulse, and blood pressure, as well as self-reported level of arousal, were simultaneously recorded and correlated with video segments. SETTING An academic teaching hospital. PATIENT(S) The 20 subjects (mean age +/- SD: 24.9 +/- 3.0 years) included Caucasian (10), Hispanic (2), Asian-American (4), and African-American (4) women. All women were screened for normal sexual function with the Female Sexual Function Index (FSFI) and with the Beck Anxiety Inventory and Beck Depression Inventory. INTERVENTION(S) Randomly ordered sequences of erotic and relaxation tapes with and without sound. MAIN OUTCOME MEASURE(S) Physiologic and behavioral data, as well as subjective arousal rating, were acquired. The resulting set of multichannel data was correlated with erotic segments and analyzed for sound vs. no sound and time to maximal physiologic arousal. RESULT(S) Four independent variables were found to have beta values that were significantly different from 0: respiration (mean = -0.239, SD = 0.177, range = -0.55-0.09, t = -6.04), VPP (mean = 0.158, SD = 0.37, range = -0.48-0.80, t = 1.91), rVPP (mean = 0.161, SD = 0.35, range = -0.537-0.686, t = 2.075), and erotic marker (mean = 0.582, SD = 0.191, range = 0.16-0.85, t = 13.6). Neither heart rate nor galvanic skin resistance beta values approached significance. Respiration period was correlated negatively with arousal rating, indicating that subjects breathed faster when aroused. Auditory stimuli during erotic segments did not increase subjective arousal, and for both subjective arousal rating as well as VPP measurement, maximal response occurred within 2 minutes. CONCLUSION(S) Simultaneous measurement of vaginal blood flow, respiration, pulse, and a variable accounting for the onset and offset of erotic video segments accounts for approximately 50% of the variance in predicting subjective female arousal. Regardless of the presence or absence of audio input, 2 minutes was the average minimum time required to reach maximal arousal in young, sexually functional women.
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Affiliation(s)
- Mary Lake Polan
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California 94305-5317, USA.
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Munarriz R, Kim SW, Kim NN, Traish A, Goldstein I. A review of the physiology and pharmacology of peripheral (vaginal and clitoral) female genital arousal in the animal model. J Urol 2003; 170:S40-4; discussion S44-5. [PMID: 12853772 DOI: 10.1097/01.ju.0000075352.03144.15] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
PURPOSE We review contemporary scientific data concerning the physiology and pharmacology of peripheral female genital arousal responses in the animal (rabbit and rat) model. MATERIALS AND METHODS We reviewed the contemporary literature and our research studies concerning physiology and pharmacology of peripheral genital arousal from 3 experimental animal models, including genital smooth muscle cell culture, genital strip organ bath and in vivo animal model studies. RESULTS Nitric oxide (NO) appears to be a key pathway mediating clitoral smooth muscle relaxation. In the vagina NO appeared to have a more controversial role in mediating vaginal muscularis smooth muscle relaxation. Vasoactive intestinal polypeptide induced vaginal smooth muscle relaxation. Functional alpha-adrenergic receptors were expressed in the clitoris and vagina, and mediated norepinephrine induced genital smooth muscle contraction. Androgens and estrogens modulated distinct physiological responses in vagina, and androgens facilitated vaginal smooth muscle relaxation. Papaverine hydrochloride, a smooth muscle relaxant, and phentolamine mesylate, an alpha-blocker, administered into the vaginal spongy muscularis layer increased vaginal wall pressure and vaginal blood flow. Sildenafil caused significant increases in genital (clitoral and vaginal) blood flow and vaginal lubrication in intact and ovariectomized animals. This response was more pronounced in animals treated with estradiol, suggesting that the NO cyclic guanosine monophosphate pathway is involved in the physiological mechanism of female genital arousal and that sildenafil facilitates this response in an in vivo animal model. CONCLUSIONS To achieve improved understanding of the biological aspects of female sexual function, further research is needed in the physiology and pharmacology of peripheral (clitoral and vaginal) genital arousal in the animal model.
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Affiliation(s)
- Ricardo Munarriz
- Institute for Sexual Medicine, Department of Urology, Boston University School of Medicine, 720 Harrison Ave., Suite 600, Boston, Massachusetts 02118, USA
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Modelska K, Cummings S. Female sexual dysfunction in postmenopausal women: systematic review of placebo-controlled trials. Am J Obstet Gynecol 2003; 188:286-93. [PMID: 12548231 DOI: 10.1067/mob.2003.117] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE This systematic review includes all randomized and placebo-controlled trials (RCTs) of treatment for female sexual dysfunction (FSD) in postmenopausal women published since 1990. STUDY DESIGN Electronic database and manual bibliography searches were conducted to identify all relevant publications. RESULTS Only six RCTs have been done to assess the effects of different therapies on sexual function in postmenopausal women: one with sildenafil citrate (Viagra), three with hormone replacement therapy, and two with tibolone. CONCLUSIONS In women with FSD, many treatments that are used in practice are not supported by adequate evidence. Although an improvement of sexual function was reported with tibolone and the combination of estrogen-androgen therapy, it still remains unclear which groups of postmenopausal women with FSD would benefit most from these therapies. The adverse effects of testosterone replacement therapy should be assessed against the effects of placebo in RCTs with larger sample sizes and longer duration.
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Affiliation(s)
- Katharina Modelska
- Prevention Sciences Group, Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.
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Abstract
Although the psychosocial and relationship aspects of female sexuality have been extensively investigated, studies concerning the anatomy, physiology and pathophysiology of female sexual function and dysfunction are limited. The paucity of biologic data may be attributed to a lack of reliable experimental models and tools for investigating female sexual function and to limited funding, which is critical for developing experimental approaches. Research efforts by several investigators in different laboratories have been establishing experimental models needed for investigating the physiologic mechanisms involved in the genital arousal response of sexual function. These experimental models have permitted assessment of genital hemodynamics, vaginal lubrication, regulation of genital smooth muscle contractility and signaling pathways, providing preliminary information about the role of neurotransmitters and sex steroid hormones in sexual function. Further research is needed to define the neurotransmitters responsible for vaginal smooth muscle relaxation and the role of sex steroid hormones and their receptors in modulating genital hemodynamics, smooth muscle contractility, and neurotransmitter receptor expression. Finally, a global and integral understanding of the biologic aspects of female sexual function requires investigation of the vascular, neurologic (central and peripheral), and structural components of this extremely complex physiologic process.
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Affiliation(s)
- Ricardo Munarriz
- Department of Urology, Boston University School of Medicine, 720 Harrison Avenue, Suite 606, Boston, MA 02118, USA.
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39
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Abstract
Female sexual dysfunction (FSD) was recently recognized as arising from multiple organic etiologies; it is not primarily a psychological symptom as believed previously. A symptom-related complex resulting in physiologic changes, FSD can respond to either treatment of the underlying condition or supportive measures. A new diagnostic classification allows physicians to perform a clinical evaluation of women with FSD, and recently validated FSD question naires allow monitoring of treatment efficacy. This article details the clinical evaluation and physical examination of women with FSD and outlines the fledgling research and treatment options.
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40
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Abstract
This article explores how sexual desire operates in ordinary life in both sexes. Fifteen considerations divided into six categories are provided: basic aspects; easily overlooked aspects; energy concepts; politically sensitive aspects; maintaining desire; and toward a definition. Sexual desire is the sum of the forces that incline us toward and away from sexual behavior. Clinicians need to conceptualize desire richly to understand its disorders. Scientists need to simplify the concept in order to conduct pharmacological research. Ideally, the limitations of both approaches must be accepted; in anyone's hands, sexual desire can be a slippery concept.
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Affiliation(s)
- Stephen B Levine
- Case Western Reserve University School of Medicine, Beachwood, Ohio, USA
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41
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Min K, O'Connell L, Munarriz R, Huang YH, Choi S, Kim N, Goldstein I, Traish A. Experimental models for the investigation of female sexual function and dysfunction. Int J Impot Res 2001; 13:151-6. [PMID: 11525313 DOI: 10.1038/sj.ijir.3900683] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
There have been limited anatomic and physiological investigations of the female sexual arousal response. A broader understanding of the physiologic mechanisms of female sexual arousal function is required to improve the management of women with sexual dysfunction. Three experimental test systems have been developed to understand better the biochemical and physiological mechanisms of female sexual arousal response. An in vivo animal model was developed to record physiological and hemodynamic changes in the clitoris and vagina following pelvic nerve stimulation and administration of vasoactive agents and physiological modulators. In vitro organ baths of clitoral and vaginal tissue were utilized to investigate mechanisms involved in the regulation of smooth muscle contractility. In addition, primary cell cultures of human and animal clitoral and vaginal smooth muscle cells were developed to investigate signal transduction pathways modulating smooth muscle tone. In vivo studies revealed hemodynamic changes in vagina and clitoris in response to pelvic nerve stimulation, vasodilators and physiological modulators. Organ bath studies have demonstrated that clitoral and vaginal smooth muscle tone is affected by non-adrenergic and non-cholinergic neurotransmitters, and the presence of functional alpha 1 and alpha 2 adrenergic receptors in these tissues has been established through biochemical studies. These changes are regulated by the tone of vascular and non-vascular smooth muscle in the vagina and clitoris. Primary cell culture studies have suggested that several physiological modulators such as vasoactive intestinal polypeptide (VIP), nitric oxide (NO), and prostaglandin E (PGE) regulate vaginal smooth muscle contractility. Data from experimental models have provided a preliminary understanding of the mechanisms of the female sexual arousal response.
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Affiliation(s)
- K Min
- Department of Urology, Boston University School of Medicine, MA 02118, USA
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42
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Frohlich PF, Meston CM. Evidence that serotonin affects female sexual functioning via peripheral mechanisms. Physiol Behav 2000; 71:383-93. [PMID: 11150571 DOI: 10.1016/s0031-9384(00)00344-9] [Citation(s) in RCA: 97] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A review of the literature indicates that serotonin is active in several peripheral mechanisms that are likely to affect female sexual functioning. Serotonin has been found in several regions of the female genital tract in both animals and humans. In the central nervous system (CNS), serotonin acts primarily as a neurotransmitter, but in the periphery, serotonin acts primarily as a vasoconstrictor and vasodilator. Since, in the periphery, the principal component of sexual arousal is vasocongestion of the genital tissue, it is likely that serotonin participates in producing normal sexual arousal. In addition, serotonin administration produces contraction of the smooth muscles of the genito-urinary system and is found in nerves innervating the sexual organs. Taken together, this evidence suggests that peripheral serotonergic activity may be involved in the normal sexual response cycle. In addition, exogenous substances that alter serotonin activity, such as selective serotonin uptake inhibitors (SSRIs) and the atypical antipsychotics, can produce sexual dysfunction. It is possible that sexual side effects seen with these drugs may result, at least in part, from their action on peripheral mechanisms.
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Affiliation(s)
- P F Frohlich
- Department of Psychology, University of Texas at Austin, 78712, Austin, TX, USA
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43
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Abstract
The results of a series of human and animal studies that were conducted in an effort to better understand autonomic nervous system influences on female sexual arousal are presented. The effects of sympathetic nervous system (SNS) activation on self-report and vaginal photoplethysmographic measures of sexual arousal were examined in 4 studies using intense acute exercise, and in 1 study using ephedrine, to activate the SNS. The effects of SNS inhibition on sexual responses in the female rat were examined in 3 studies using clonidine, an alpha(2)-adrenergic agonist; guanethidine, a postganglionic noradrenergic blocker; and naphazoline, an alpha(2)-adrenoreceptor agonist, to inhibit sympathetic outflow. In humans, the effects of SNS inhibition on subjective and physiologic sexual arousal were also examined using clonidine to suppress SNS activity. Together, the findings from these studies suggest that SNS activation may facilitate, and SNS inhibition inhibit, the early stages of sexual arousal in sexually functional women and in women with low sexual desire.
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Affiliation(s)
- C M Meston
- Department of Psychology, University of Texas at Austin, Austin, Texas 78712, USA
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DeBusk R, Drory Y, Goldstein I, Jackson G, Kaul S, Kimmel SE, Kostis JB, Kloner RA, Lakin M, Meston CM, Mittleman M, Muller JE, Padma-Nathan H, Rosen RC, Stein RA, Zusman R. Management of sexual dysfunction in patients with cardiovascular disease: recommendations of the Princeton Consensus Panel. Am J Cardiol 2000; 86:62F-68F. [PMID: 10899282 DOI: 10.1016/s0002-9149(00)01117-6] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Sexual dysfunction is highly prevalent in both sexes and adversely affects patients' quality of life and well being. Given the frequent association between sexual dysfunction and cardiovascular disease, in addition to the potential cardiac risk of sexual activity itself, a consensus panel was convened to develop recommendations for clinical management of sexual dysfunction in patients with cardiovascular disease. Based upon a review of the research and presentations by invited experts, a classification system was developed for stratification of patients into high, low, and intermediate categories of cardiac risk. The large majority of patients are in the low-risk category, which includes patients with (1) controlled hypertension; (2) mild, stable angina; (3) successful coronary revascularization; (4) a history of uncomplicated myocardial infarction (MI); (5) mild valvular disease; and (6) no symptoms and <3 cardiovascular risk factors. These patients can be safely encouraged to initiate or resume sexual activity or to receive treatment for sexual dysfunction. An important exception is the use of sildenafil in patients taking nitrates in any form. Patients in the intermediate-risk category include those with (1) moderate angina; (2) a recent MI (<6 weeks); (3) left ventricular dysfunction and/or class II congestive heart failure; (4) nonsustained low-risk arrhythmias; and (5) >/=3 risk factors for coronary artery disease. These patients should receive further cardiologic evaluation before restratification into the low- or high-risk category. Finally, patients in the high-risk category include those with (1) unstable or refractory angina; (2) uncontrolled hypertension; (3) congestive heart failure (class III or IV); (4) very recent MI (<2 weeks); (5) high-risk arrhythmias; (6) obstructive cardiomyopathies; and (7) moderate-to-severe valvular disease. These patients should be stabilized by specific treatment for their cardiac condition before resuming sexual activity or being treated for sexual dysfunction. A simple algorithm is provided for guiding physicians in the management of sexual dysfunction in patients with varying degrees of cardiac risk.
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Affiliation(s)
- R DeBusk
- Stanford University School of Medicine, Palo Alto, California, USA
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45
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DeBusk R, Drory Y, Goldstein I, Jackson G, Kaul S, Kimmel SE, Kostis JB, Kloner RA, Lakin M, Meston CM, Mittleman M, Muller JE, Padma-Nathan H, Rosen RC, Stein RA, Zusman R. Management of sexual dysfunction in patients with cardiovascular disease: recommendations of The Princeton Consensus Panel. Am J Cardiol 2000; 86:175-81. [PMID: 10913479 DOI: 10.1016/s0002-9149(00)00896-1] [Citation(s) in RCA: 166] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Sexual dysfunction is highly prevalent in both sexes and adversely affects patients' quality of life and well being. Given the frequent association between sexual dysfunction and cardiovascular disease, in addition to the potential cardiac risk of sexual activity itself, a consensus panel was convened to develop recommendations for clinical management of sexual dysfunction in patients with cardiovascular disease. Based upon a review of the research and presentations by invited experts, a classification system was developed for stratification of patients into high, low, and intermediate categories of cardiac risk. The large majority of patients are in the low-risk category, which includes patients with (1) controlled hypertension; (2) mild, stable angina; (3) successful coronary revascularization; (4) a history of uncomplicated myocardial infarction (MI); (5) mild valvular disease; and (6) no symptoms and <3 cardiovascular risk factors. These patients can be safely encouraged to initiate or resume sexual activity or to receive treatment for sexual dysfunction. An important exception is the use of sildenafil in patients taking nitrates in any form. Patients in the intermediate-risk category include those with (1) moderate angina; (2) a recent MI (<6 weeks); (3) left ventricular dysfunction and/or class II congestive heart failure; (4) nonsustained low-risk arrhythmias; and (5) >/=3 risk factors for coronary artery disease. These patients should receive further cardiologic evaluation before restratification into the low- or high-risk category. Finally, patients in the high-risk category include those with (1) unstable or refractory angina; (2) uncontrolled hypertension; (3) congestive heart failure (class III or IV); (4) very recent MI (<2 weeks); (5) high-risk arrhythmias; (6) obstructive cardiomyopathies; and (7) moderate-to-severe valvular disease. These patients should be stabilized by specific treatment for their cardiac condition before resuming sexual activity or being treated for sexual dysfunction. A simple algorithm is provided for guiding physicians in the management of sexual dysfunction in patients with varying degrees of cardiac risk.
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