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

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Abstract

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

Research Highlights

► 46 women diagnosed with Hypoactive Sexual Desire Disorder (HSDD) were compared to 47 women without sexual problems (SF). ► Relationships between hormones and sexual function differed depending on HSDD or SF status. ► FT was positively associated with physiological and subjective sexual arousal in the SF group. ► FT was negatively associated with subjective sexual responsiveness in HSDD group. ► Self-reported arousal and desire were lower in the HSDD than the SF group only for non OC women.

Introduction

Patterns of sexual arousal in women have been examined in the laboratory using both subjective (self report) and physiological measures. The assessment of genital responses in women has been facilitated by the introduction in the early 1970s of vaginal photoplethysmography (Sintchak and Geer, 1975), which has been tested (Geer et al., 1974) and modified (Laan et al., 1995; see Janssen et al., 2007, for a review) over the years. Various genital measurement issues have been examined with revised interest in women's sexual arousal when sildenafil citrate (Viagra™) was released in 1998, and its success in men raised new questions about women's sexual arousal. In the past decade, the overlap of desire and arousal as subjective experiences became more apparent and human research became less precise on this point, in part because there has not been a clear consensus on definitions of sexual desire and sexual arousal. In addition, there is no physiological measure of sexual desire that has been fully tested and validated.

In spite of these issues, low sexual desire (typically defined as involving some type of loss of interest in sexual activity over a period of months to years) is believed to be the most common sexual problem among women, with prevalence rates varying between 20 and 30% (Laumann et al., 1999, Laumann et al., 2005, Mercer et al., 2003, Simons and Carey, 2001). When low or absent sexual desire is persistent or recurrent and leads to distress or interpersonal problems, it may be diagnosed as Hypoactive Sexual Desire Disorder (HSDD; American Psychiatric Association, 2000). In addition, it can be classified as acquired or lifelong; acquired HSDD referring to women who once did experience sexual desire and lifelong HSDD applied to those who report never having experienced sexual desire. Acquired HSDD is far more prevalent and believed to be related to sociocultural, relationship, intrapersonal mood/motivational and/or physiological factors, possibly with multiple interacting influences (Brotto et al., 2010).

The role of hormones in women's sexual desire has been of significant interest and attention. For example, the expectation that androgens, particularly testosterone, are related to levels of desire has been supported. In that literature, it has been found that exogenous delivery of higher doses of testosterone may impact sexual desire, response, and behavior in both sexually functional and low desire women, particularly those who are naturally or surgically postmenopausal (Sherwin et al., 1985, Shifren et al., 2000, Shifren et al., 2006). However, endogenous levels of hormones do not appear to be related to sexual desire in any predictable way in healthy women, although there are reports that testosterone is correlated with increased coital activity as well as with higher levels of desire and masturbation (Van Goozen et al., 1997). A useful reference point in this area is a study conducted by Davis et al. (2005), who found, in a large community sample of 1021 Australian women, that endogenous of total testosterone (T), free testosterone (FT), and androstenedione (A) were not correlated with sexual functioning, including sexual desire and arousal. Though dehydroepiandrosterone sulfate (DHEAS) levels below the 10th percentile were associated with low arousal, desire, and responsiveness in the 18–44 age group, the majority of women with low DHEAS levels did not have decreased sexual functioning.

What has received only limited attention in women is how endogenous hormonal levels may relate to acute changes in sexual desire or arousal as measured under laboratory conditions. The present protocol was specifically designed to test acute changes in female sexual desire, with a secondary interest in sexual arousal, using a variety of measures to tap sexual responsiveness. We compared two groups of healthy premenopausal women – those who met criteria for acquired HSDD and those who experienced no sexual difficulties – on measures of sexual desire, arousal, mood, and genital response to fantasy, videos, and a photo task. As the study is part of a larger, multi-session project, only the hormone-related findings from the first experimental session will be presented here.

The goal of the project was to add to our scientific understanding of sexual desire, while developing a methodology that is sensitive to acute change in this domain of female sexuality. Sexual desire has been seen as a general and rather enduring quality (one could say trait) rather than a state that fluctuates, such as sexual arousal. Yet in women there is evidence of some sexual desire fluctuation in response to environmental changes (Both et al., 2005, Klusmann, 2002). In addition, desire is correlated with sexual arousal changes as measured in the psychophysiological lab and with questionnaires (Both et al., 2004, Heard-Davison et al., 2007, Laan et al., 2001, Rosen et al., 2000). For that reason, we included indicators of sexual arousal. It was considered important to examine methods for rapid detection of desire changes in order to better understand sexual desire and to see if one or a combination of methods might later be valuable for detecting change caused by pharmacological or psychological treatment interventions.

The specific goal of the current study was to investigate whether there is a relationship between women's hormone levels and their genital and subjective sexual responsiveness. To test this, we 1) compared hormone levels between women with and without HSDD, 2) tested for differences in sexual responsiveness in women with and without HSDD, and 3) examined correlations between endogenous hormone levels and women's sexual interest and arousal. Although this is an exploratory study, we expected, based on prior research, that SF women would have higher levels of FT and show stronger subjective desire and arousal responses to sexual stimuli, and higher correlations between hormones and sexual desire and arousal.

Section snippets

Participants

A total of 93 women were included in the study (mean age = 31, SD 8.0; mean BMI = 25.3, SD 7.4). Forty-nine of these women were tested in the US (N = 24 HSDD, N = 25 sexually functional (SF)) and 44 in the Netherlands (N = 22 HSDD; N = 22 SF). Of the 47 women who reported currently using hormonal contraceptives, 21 were tested in the US (N = 26 NL), and 21 were in the HSDD group, (N = 26 SF). Of the 46 women who reported not using hormonal contraceptives, 28 were tested in the US (N = 18 NL) and 25 were in the

Results

The hormones of interest in the current study were estradiol, total T, free T, and SHBG. The primary interest was in FT, based on prior research. Sexual responsiveness was measured as women's VPA response, subjective desire in response to sexual videos, and responses to the male faces in the photo task. Women's VPA difference scores (calculated as the 3-min average for each video/fantasy condition minus the average of the last minute of the first neutral video) were averaged across the four

Discussion

The present study examined several measures of acute sexual desire and arousal and potential hormonal correlates for healthy premenopausal women across two sites, the US and the Netherlands. Participants were carefully screened for diagnosis, health and medication factors. The results demonstrate that correlations between hormonal levels and women's sexual function differ depending on whether a woman does or does not report HSDD. Specifically, in SF women results were consistent with previous

Acknowledgments

This investigator-initiated study was financially supported by an unrestricted investigator-initiated grant from Pfizer Central Research, Sandwich, UK to Julia R. Heiman and Ellen T. Laan, co-PIs. The authors would like to thank Chris Breton and Steve Pearson of the Pfizer, Inc. New Haven Clinical Research Unit (New Haven, Connecticut, USA) for their work on the hormone assays. The design, conceptualization, analysis, and interpretation of the results were the sole product of discussions among

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