The Impact of Heterosexual Scripts on Women's Sexual Desire in Relationships

Numerous studies have described that women's sexual desire is lower than men's desire. Within a heterosexual couple, a sexual desire discrepancy can be associated with sexual and relationship dissatisfaction. The factors that negatively influence women's sexual desire are biological, psychological, relational, cognitive and sociocultural. The present study aimed to determine the extent to which adherence to sexual norms predicted sexual desire in women engaged in a romantic relationship (min. 6 months). These norms were addressed by Simon and Gagnon's (1984) notion of sexual scripts, which designate the sociocultural norms governing the sexual behaviors of men and women. A sample of women (N = 829, M age = 32 years, SD = 12.20, range = 18-72) completed a questionnaire about sexual desire and heterosexual scripts. The results showed that the more women in relationships say they felt desire, the less they subscribed to heterosexual scripts and particularly the conception that a man's sex drive is higher than a woman's. This conception seems to be the most determinant of women's sexual desire in relationships. The results attest also to the persistence and strength of heterosexual scripts which, despite greater equality between men and women, continue to negatively influence women's sexual desire. By becoming aware of these conditionings, women suffering from low sexual desire and sexual desire discrepancy within their couple can break free from them and experience a more fulfilling sexuality. Lastly, some interesting contradictory results are addressed in discussion.

The Complex Role Played by the Default Mode Network during Sexual Stimulation: A Cluster-Based fMRI Meta-Analysis

The default mode network (DMN) is a complex network that plays a significant and active role during naturalistic stimulation. Previous studies that have used naturalistic stimuli, such as real-life stories or silent or sonorous films, have found that the information processing involved a complex hierarchical set of brain regions, including the DMN nodes. The DMN is not involved in low-level features and is only associated with high-level content-related incoming information. The human sexual experience involves a complex set of processes related to both external context and inner processes. Since the DMN plays an active role in the integration of naturalistic stimuli and aesthetic perception with beliefs, thoughts, and episodic autobiographical memories, we aimed at quantifying the involvement of the nodes of the DMN during visual sexual stimulation. After a systematic search in the principal electronic databases, we selected 83 fMRI studies, and an ALE meta-analysis was calculated. We performed conjunction analyses to assess differences in the DMN related to stimulus modalities, sex differences, and sexual orientation. The results show that sexual stimulation alters the topography of the DMN and highlights the DMN's active role in the integration of sexual stimuli with sexual schemas and beliefs.

Interplay between sexual excitation and inhibition: impact on sexual function and neural correlates of erotic stimulus processing in women

Background

As outlined by the dual control model (DCM), individual differences in the regulation of sexual arousal following sexual stimulation depend on two distinct neurophysiological processes: sexual excitation (SE) and sexual inhibition (SI). Although associations with sexual function, behavior, and cue processing have been demonstrated in previous research, underlying neural correlates remain insufficiently explored. Moreover, interactive effects of SE/SI as proposed by the DCM, as well as factors impacting SE/SI properties, such as the use of oral contraceptives (OCs), have not received adequate attention in existing research.

Methods

90 healthy, sexually active women (n = 51 using OCs, n = 39 naturally cycling) completed an Emotional-Picture-Stroop-Paradigm (EPSP) while a 64-channel EEG was recorded. LPP amplitudes toward erotic and neutral stimuli were consecutively computed as a marker of motivational salience and approach motivation. Additionally, women provided self-reports of SE/SI and sexual function. Moderation analyses were performed to assess interactive effects of SE/SI in predicting LPP amplitudes and sexual function.

Results

Sexual function was negatively associated with SI levels but unrelated to SE. Higher SI was associated with reduced LPP amplitudes in response to erotic stimuli. This negative association was, however, attenuated for women high in SE, suggesting interactive effects of SE/SI. Furthermore, women using OCs reported lower SE compared to naturally cycling women.

Conclusion

The observed findings provide additional psychophysiological evidence supporting the DCM and underscore the relevance of interactive SE/SI effects in stimulus processing and approach motivation. They also highlight the possible impact of OCs on psychosexual variables that warrants further research.

When the brain turns on with sexual desire: fMRI findings, issues, and future directions

INTRODUCTION

More than 2 decades of neuroimaging research has sought to uncover the neurologic basis of sexual desire. However, the lack of a clear conceptual distinction between sexual desire and sexual arousal or even a broadly accepted definition of sexual desire has led to confusion in the literature regarding brain areas uniquely associated with sexual desire.

OBJECTIVES

(1) To critically review the neuroimaging literature that seeks to identify brain areas and networks involved in sexual desire; (2) to identify and discuss those brain areas and potential networks that are most promising for providing insights to sexual desire; and (3) to offer recommendations for future studies.

METHODS

Existing meta-analyses were used as a starting point to identify relevant neuroimaging studies on sexual desire, arousal, and love. This base was then expanded via Google Scholar and forward citation tracking of already identified studies.

RESULTS

Brain areas that are commonly associated with sexual desire and arousal include the amygdala, hypothalamus, dorsal and ventral striatum, anterior cingulate, insula, and prefrontal and orbitofrontal cortex. However, because the same basic paradigm has been used to study sexual desire and arousal, unambiguous conclusions regarding areas uniquely involved in sexual desire cannot be drawn. Moreover, the lack of connectivity analyses and a failure to acknowledge negative BOLD (blood-oxygen level dependent) significantly limit conclusions on the neural basis of sexual desire.

CONCLUSION

Five recommendations are made. First, stimulus types (ie, erotic vs sexually explicit) should be selected by the meaningful theoretical conceptualization of the constructs of interest. Second, participants should be provided with definitions of sexual desire, mental sexual arousal, and perceived genital sexual arousal, so they can choose which terms best describe their experience. Third, event-related designs should be used with caution when investigating sexual desire. Fourth, time series analyses should be used to identify both positive and negative BOLD. Fifth, connectivity analyses should be performed to identify brain networks.

Melanocortin 4 receptor agonism enhances sexual brain processing in women with hypoactive sexual desire disorder

BACKGROUND

Hypoactive sexual desire disorder (HSDD) is characterized by a persistent deficiency of sexual fantasies and desire for sexual activity, causing marked distress and interpersonal difficulty. It is the most prevalent female sexual health problem globally, affecting approximately 10% of women, but has limited treatment options. Melanocortin 4 receptor (MC4R) agonists have emerged as a promising therapy for women with HSDD, through unknown mechanisms. Studying the pathways involved is crucial for our understanding of normal and abnormal sexual behavior.

METHODS

Using psychometric, functional neuroimaging, and hormonal analyses, we conducted a randomized, double-blinded, placebo-controlled, crossover clinical study to assess the effects of MC4R agonism compared with placebo on sexual brain processing in 31 premenopausal heterosexual women with HSDD.

RESULTS

MC4R agonism significantly increased sexual desire for up to 24 hours after administration compared with placebo. During functional neuroimaging, MC4R agonism enhanced cerebellar and supplementary motor area activity and deactivated the secondary somatosensory cortex, specifically in response to visual erotic stimuli, compared with placebo. In addition, MC4R agonism enhanced functional connectivity between the amygdala and the insula during visual erotic stimuli compared with placebo.

CONCLUSION

These data suggest that MC4R agonism enhanced sexual brain processing by reducing self-consciousness, increasing sexual imagery, and sensitizing women with HSDD to erotic stimuli. These findings provide mechanistic insight into the action of MC4R agonism in sexual behavior and are relevant to the ongoing development of HSDD therapies and MC4R agonist development more widely.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04179734.

FUNDING

This is an investigator-sponsored study funded by AMAG Pharmaceuticals Inc., the Medical Research Council (MRC) (MR/T006242/1), and the National Institute for Health Research (NIHR) (CS-2018-18-ST2-002 and RP-2014-05-001).

Effects of Kisspeptin Administration in Women With Hypoactive Sexual Desire Disorder: A Randomized Clinical Trial

IMPORTANCE

Despite being the most common female sexual health complaint worldwide, current treatment options for hypoactive sexual desire disorder (HSDD) are limited in their safety and effectiveness. The hormone kisspeptin is a key endogenous activator of the reproductive hormonal axis with additional emerging roles in sexual and emotional behavior; however, its effects in women with HSDD are unknown.

OBJECTIVE

To test the hypothesis that kisspeptin enhances sexual and attraction brain processing in women with HSDD.

DESIGN, SETTING, AND PARTICIPANTS

This randomized clinical trial was double-masked and placebo controlled with a 2-way crossover. The trial was conducted in a university research setting in the UK from October 2020 to April 2021. Eligible participants were premenopausal women with HSDD. Functional neuroimaging, psychometric, and hormonal analyses were employed to investigate the effects of kisspeptin administration on brain processing, in response to erotic stimuli (erotic videos) and facial attraction (face images of varying attractiveness). Data were analyzed from May to December 2021.

INTERVENTIONS

A 75-minute intravenous infusion of kisspeptin-54 (1 nmol/kg/h) vs equivalent-rate placebo infusion.

MAIN OUTCOMES AND MEASURES

Blood oxygen level-dependent responses across the whole brain and regions of interest during kisspeptin vs placebo administration in response to erotic and facial attraction stimuli.

RESULTS

Of the 40 participants who were randomized, 32 women completed both kisspeptin and placebo visits, with a mean (SE) age of 29.2 (1.2) years. Kisspeptin administration resulted in modulations in sexual and facial attraction brain processing (deactivation of the left inferior frontal gyrus: Z max, 3.76; P = .01; activation of the right postcentral and supramarginal gyrus: Z max, 3.73; P < .001; deactivation of the right temporoparietal junction: Z max 4.08; P = .02). Furthermore, positive correlations were observed between kisspeptin-enhanced hippocampal activity in response to erotic videos, and baseline distress relating to sexual function (r = 0.469; P = .007). Kisspeptin's enhancement of posterior cingulate cortex activity in response to attractive male faces also correlated with reduced sexual aversion, providing additional functional significance (r = 0.476, P = .005). Kisspeptin was well-tolerated with no reported adverse effects.

CONCLUSIONS AND RELEVANCE

These findings lay the foundations for clinical applications for kisspeptin in women with HSDD.

TRIAL REGISTRATION

ISRCTN trial registry identifier: ISRCTN17271094.

The neurobiology of bremelanotide for the treatment of hypoactive sexual desire disorder in premenopausal women

Hypoactive sexual desire disorder (HSDD) is a common female sexual dysfunction and is estimated to affect approximately 10% of women in the United States. It has been suggested that HSDD is associated with an imbalance of hormone and neurotransmitter levels in the brain, resulting in decreased excitation, increased inhibition, or a combination of both. Evidence suggests neurotransmitters, including dopamine (DA), norepinephrine, and serotonin, as well as hormones such as estradiol and testosterone, contribute to female sexual desire and response. Current treatments for HSDD include psychotherapy, and two US Food and Drug Administration-approved medications for premenopausal women: flibanserin, a serotonin mixed agonist and antagonist, and bremelanotide, a melanocortin receptor (MCR) agonist. Melanocortins are endogenous neuropeptides associated with the excitatory pathway of the female sexual response system. MCRs are found throughout the body, including the brain. Bremelanotide is an MCR agonist that nonselectively activates several of the receptor subtypes, of which subtype 4 (MC4R) is the most relevant at therapeutic doses. MC4R is predominantly expressed in the medial preoptic area (mPOA) of the hypothalamus in the brain, and is important for female sexual function. Animal studies suggest that bremelanotide may affect female sexual desire by activating presynaptic MC4Rs on neurons in the mPOA of the hypothalamus, leading to increased release of DA, an excitatory neurotransmitter that increases sexual desire. This review presents what is known about the mechanism of action of bremelanotide in the context of treating HSDD.

Randomized Controlled Phase II Evaluation of Two Dose Levels of Bupropion Versus Placebo for Sexual Desire in Female Cancer Survivors: NRG-CC004

PURPOSE

Because of the negative impact of cancer treatment on female sexual function, effective treatments are warranted. The purpose of this multisite study was to evaluate the ability of two dose levels of extended-release bupropion, a dopaminergic agent, to improve sexual desire more than placebo at 9 weeks, measured by the desire subscale of the Female Sexual Function Index (FSFI), and to evaluate associated toxicities.

METHODS

Postmenopausal women diagnosed with breast or gynecologic cancer and low baseline FSFI desire scores (< 3.3), who had completed definitive cancer therapy, were eligible. Women were randomly assigned to receive 150 mg or 300 mg once daily of extended-release bupropion or a matching placebo. t-tests were performed on the FSFI desire subscale to evaluate whether there was a significantly greater change from baseline to 9 weeks between placebo and each bupropion arm as the primary end point. Sixty-two patients per arm provided 80% power using a one-sided t-test.

RESULTS

Two hundred thirty women were randomly assigned from 72 institutions through the NRG Oncology NCORP network. At 9 weeks, there were no statistically significant differences in change of the desire subscale scores between groups; participants in all three arms reported improvement. The mean changes for each arm were placebo 0.62 (standard deviation [SD] = 1.18), 150-mg once daily bupropion 0.64 (SD = 0.95), and 300-mg once daily bupropion 0.60 (SD = 0.89). Total and subscale scores on the FSFI were low throughout the study, indicating dysfunction in all groups.

CONCLUSION

Bupropion was not more effective than placebo in improving the desire subscale of the FSFI. Subscale and total scores of the FSFI demonstrated dysfunction throughout the 9 weeks of the study. More research is needed to support sexual function in female cancer survivors.

Event-Related Potentials in Women on the Pill: Neural Correlates of Positive and Erotic Stimulus Processing in Oral Contraceptive Users

Background/Aims: Exposure toward positive emotional cues with - and without - reproductive significance plays a crucial role in daily life and regarding well-being as well as mental health. While possible adverse effects of oral contraceptive (OC) use on female mental and sexual health are widely discussed, neural processing of positive emotional stimuli has not been systematically investigated in association with OC use. Considering reported effects on mood, well-being and sexual function, and proposed associations with depression, it was hypothesized that OC users showed reduced neural reactivity toward positive and erotic emotional stimuli during early as well as later stages of emotional processing and also rated these stimuli as less pleasant and less arousing compared to naturally cycling (NC) women. Method: Sixty-two female subjects (29 NC and 33 OC) were assessed at three time points across the natural menstrual cycle and corresponding time points of the OC regimen. Early (early posterior negativity, EPN) and late (late positive potential, LPP) event-related potentials in reaction to positive, erotic and neutral stimuli were collected during an Emotional Picture Stroop Paradigm (EPSP). At each appointment, subjects provided saliva samples for analysis of gonadal steroid concentration. Valence and arousal ratings were collected at the last appointment. Results: Oral contraceptive users had significantly lower endogenous estradiol and progesterone concentrations compared to NC women. No significant group differences in either subjective stimulus evaluations or neural reactivity toward positive and erotic emotional stimuli were observed. For the OC group, LPP amplitudes in reaction to erotic vs. neutral pictures differed significantly between measurement times across the OC regimen. Discussion: In this study, no evidence regarding alterations of neural reactivity toward positive and erotic stimuli in OC users compared to NC was found. Possible confounding factors and lines for future research are elaborated and discussed.

Specific factors and methodological decisions influencing brain responses to sexual stimuli in women

Most of the neuroimaging studies on sexual behavior have been conducted with male participants, leading to men-based models of sexual arousal. Here, possible factors and methodological decisions that might influence brain responses to sexual stimuli, specifically for the inclusion of women, will be reviewed. Based on this review, we suggest that future studies consider the following factors: menstrual phase, hormonal contraception use, history of sexual or psychiatric disorders or diseases, and medication use. Moreover, when researching sexual arousal, we suggest future studies assess sexual orientation and preferences, that women should select visual sexual stimuli, and a longer duration than commonly used. This review is thought to represent a useful guideline for future research in sexual arousal, which hopefully will lead to a higher inclusion of women and therefore more accurate neurobiological models of sexual arousal.

Food addiction symptoms are related to neuroaffective responses to preferred binge food and erotic cues

It has been proposed that some individuals succumb to maladaptive eating behaviors because, like those with addiction, they attribute high incentive salience to food-associated cues. Here, we tested whether women that attribute high incentive salience to food-associated cues report high food addiction symptomatology. In 76 college women, we assessed self-reported food addiction symptoms using the Yale Food Addiction Scale and we recorded event-related potentials (ERPs, a direct measure of brain activity) to preferred food, erotic, unpleasant, and neutral images. We used the amplitude of the late positive potential (LPP, a component of the ERPs) as an index of the incentive salience attributed to the images. Using a multivariate classification algorithm (k-means cluster analysis), we identified two neuroaffective reactivity profiles that have been previously associated with individual differences in the tendency to attribute incentive salience to cues and with differences in vulnerability to addictive behaviors. Results showed that women with elevated LPP responses to preferred food cues relative to erotic images report higher food addiction symptoms than women with low LPP responses to preferred food cues relative to other motivationally relevant stimuli. These results support the hypothesis that individual differences in the tendency to attribute incentive salience to food cues play an important role in modulating food addiction symptomatology.

Understanding heterosexual women's erotic flexibility: the role of attention in sexual evaluations and neural responses to sexual stimuli

Many women experience desires, arousal and behavior that run counter to their sexual orientation (orientation inconsistent, 'OI'). Are such OI sexual experiences cognitively and neurobiologically distinct from those that are consistent with one's sexual orientation (orientation consistent, 'OC')? To address this question, we employed a mindful attention intervention-aimed at reducing judgment and enhancing somatosensory attention-to examine the underlying attentional and neurobiological processes of OC and OI sexual stimuli among predominantly heterosexual women. Women exhibited greater neural activity in response to OC, compared to OI, sexual stimuli in regions associated with implicit visual processing, volitional appraisal and attention. In contrast, women exhibited greater neural activity to OI, relative to OC, sexual stimuli in regions associated with complex visual processing and attentional shifting. Mindfully attending to OC sexual stimuli reduced distraction, amplified women's evaluations of OC stimuli as sexually arousing and deactivated the superior cerebellum. In contrast, mindfully attending to OI sexual stimuli amplified distraction, decreased women's evaluations of OI stimuli as sexually arousing and augmented parietal and temporo-occipital activity. Results of the current study constrain hypotheses of female erotic flexibility, suggesting that sexual orientation may be maintained by differences in attentional processing that cannot be voluntarily altered.

Basal ganglia lateralization in different types of reward

Reward processing is a fundamental human activity. The basal ganglia are recognized for their role in reward processes; however, specific roles of the different nuclei (e.g., nucleus accumbens, caudate, putamen and globus pallidus) remain unclear. Using quantitative meta-analyses we assessed whole-brain and basal ganglia specific contributions to money, erotic, and food reward processing. We analyzed data from 190 fMRI studies which reported stereotaxic coordinates of whole-brain, within-group results from healthy adult participants. Results showed concordance in overlapping and distinct cortical and sub-cortical brain regions as a function of reward type. Common to all reward types was concordance in basal ganglia nuclei, with distinct differences in hemispheric dominance and spatial extent in response to the different reward types. Food reward processing favored the right hemisphere; erotic rewards favored the right lateral globus pallidus and left caudate body. Money rewards engaged the basal ganglia bilaterally including its most anterior part, nucleus accumbens. We conclude by proposing a model of common reward processing in the basal ganglia and separate models for money, erotic, and food rewards.

Association of ADHD and hypersexuality and paraphilias

Subjects with ADHD suffer from inattention, hyperactivity, and impulsivity. Clinicians often assume that specific symptoms of ADHD are bound to affect sexual desire by increasing the frequency of hypersexuality. There is a lack of knowledge about the comorbidity between ADHD, hypersexuality, and paraphilias. The aim of this article was to provide a review of the literature on the association of ADHD and hypersexuality and paraphilias and to discuss the screening and the management of these syndromes when associated with ADHD. A systematic review of the literature was performed in PubMed, PsychInfo, and Embase databases. The studies reviewed show that some individuals who suffer from ADHD report hypersexuality and paraphilias, but no clear data emerged supporting the idea that hypersexuality and paraphilias are more frequent in an ADHD population. On the other hand, some studies showed a high prevalence of ADHD in hypersexual and paraphilic subjects. This is the first systematic review of hypersexuality and paraphilias in individuals with ADHD. However, the results are limited by differences in the methodology and measurement instruments for hypersexuality and paraphilias as well as by the small number of studies and the small sample sizes of many studies.

Hypoactive sexual desire disorder (HSDD) is not "female erectile dysfunction (ED)": challenges with the characterization of HSDD in women based on a systematic literature review

Objective: Hypoactive sexual desire disorder (HSDD) in women has been viewed inaccurately by some in the medical and payer community as analogous to erectile dysfunction (ED) in men. This literature review aims to highlight the distinctions between HSDD and ED.Methods: Two systematic literature searches were conducted on the epidemiology, symptomatology and biopsychosocial outcomes of HSDD and ED. Studies published since 2007 were considered for HSDD; studies published since 2012 were considered for ED.Results: HSDD in women is primarily a central nervous system condition related to neuroendocrine factors, whereby neural pathways that regulate sexual excitation and/or inhibition appear to be involved. A combination of organic and psychogenic factors often contributes to ED. HSDD and ED are associated with similar psychological and interpersonal consequences, but affect different phases of the sexual response model (desire versus arousal) and have different pathophysiologies, therefore requiring different treatment and outcome paradigms. ED is measured by objective, physiological responses (erection and sexual function), but quantitative assessments for HSDD are more difficult because loss of desire with associated distress has to be assessed. Outcome measures used to assess ED, such as the number of satisfying sexual events, are far less informative as an endpoint for randomized clinical trials of treatments for HSDD.Conclusions: HSDD and ED are distinct conditions affecting different phases of the sexual response model, and thus require clear and unique clinical characterization and adequate communication between the health care professional and patient for appropriate diagnosis, management and treatment.

Long-Term Safety and Efficacy of Bremelanotide for Hypoactive Sexual Desire Disorder

The 52-week open-label extension of the RECONNECT studies demonstrates bremelanotide's favorable safety profile, with sustained efficacy in treating hypoactive sexual desire disorder in premenopausal women.

To evaluate the long-term safety and efficacy of bremelanotide as treatment for hypoactive sexual desire disorder in premenopausal women.

Evaluation of safety for flibanserin

Introduction: Hypoactive sexual desire disorder (HSDD) is the most prevalent sexual dysfunction in women, previously managed with off-label therapies. Indicated for premenopausal women, flibanserin is the first FDA-approved medication to treat HSDD.Areas covered: This review summarizes flibanserin's pharmacokinetics, proposed mechanism of action, and safety data in clinical trials with a focus on sedation- and hypotension-related adverse events, and drug interactions with alcohol and antidepressants. Sources included peer-reviewed publications and internal data from the manufacturer.Expert opinion: Flibanserin is a well-tolerated and effective treatment that decreases distress and restores sexual desire to a level that is normative for the individual patient with HSDD. Simplification of a risk mitigation program for flibanserin in the US is likely to increase the number of prescribing clinicians if accompanied with educational efforts to clarify flibanserin's risk-benefit profile. As flibanserin is dosed daily and may be used for a decade or more in the typical premenopausal patient, long-term pharmacovigilance data will be essential. Over time, HSDD will be treated by more nonspecialist health care professionals and flibanserin will likely become established as a significant treatment option along with other medications approved for this indication in the context of a holistic biopsychosocial treatment paradigm.

Flibanserin - the female Viagra?

This article provides a clinically relevant review of the first medication approved by the US Food and Drug Administration for hypoactive sexual desire disorder (HSDD) in premenopausal women. In this short piece, the human sexual response cycle and its relevance to HSDD will be described as well as the pharmacological mechanism of action of flibanserin. Finally, efficacy and safety data of this new medication will be summarised.

Brain Imaging of Human Sexual Response: Recent Developments and Future Directions

PURPOSE OF REVIEW

The purpose of this study is to provide a comprehensive summary of the latest developments in the experimental brain study of human sexuality, focusing on brain connectivity during the sexual response.

RECENT FINDINGS

Stable patterns of brain activation have been established for different phases of the sexual response, especially with regard to the wanting phase, and changes in these patterns can be linked to sexual response variations, including sexual dysfunctions. From this solid basis, connectivity studies of the human sexual response have begun to add a deeper understanding of the brain network function and structure involved.

SUMMARY

The study of "sexual" brain connectivity is still very young. Yet, by approaching the brain as a connected organ, the essence of brain function is captured much more accurately, increasing the likelihood of finding useful biomarkers and targets for intervention in sexual dysfunction.

Individual prolactin reactivity modulates response of nucleus accumbens to erotic stimuli during acute cannabis intoxication: an fMRI pilot study

RATIONALE

Self-report studies indicate that cannabis could increase sexual desire in some users. We hypothesized that intoxication increases activation of brain areas responsive to visual erotica, which could be useful in the treatment of hypoactive sexual desire disorder, a condition marked by a lack of sexual desire.

OBJECTIVES

The aim of this study is to assess the aphrodisiacal properties of cannabis.

METHODS

We conducted an open-randomized study with 21 heterosexual casual cannabis users. A 3T MRI was used to measure brain activation in response to erotic pictures. Blood samples were collected to determine the serum levels of cannabinoids, cortisol and prolactin. Participants were grouped according to whether they had ever experienced any aphrodisiacal effects during intoxication (Group A) or not (Group non-A).

RESULTS

Intoxication was found to significantly increase activation in the right nucleus accumbens in the Group A while significantly decreasing activation in the Group non-A. There was also a significant interaction between the group and intoxication, with elevated prolactin in the Group non-A during intoxication. No intoxication-related differences in subjective picture evaluations were found.

CONCLUSION

Cannabis intoxication increases activation of the right nucleus accumbens to erotic stimuli. This effect is limited to users whose prolactin is not elevated in response to intoxication. This effect may be useful in the treatment of low sexual desire.

The neural basis of sex differences in sexual behavior: A quantitative meta-analysis

Sexuality as to its etymology presupposes the duality of sexes. Using quantitative neuroimaging meta-analyses, we demonstrate robust sex differences in the neural processing of sexual stimuli in thalamus, hypothalamus, and basal ganglia. In a narrative review, we show how these relate to the well-established sex differences on the behavioral level. More specifically, we describe the neural bases of known poor agreement between self-reported and genital measures of female sexual arousal, of previously proposed male proneness to affective sexual conditioning, as well as hints of unconscious activation of bonding mechanisms during sexual stimulation in women. In summary, our meta-analytic review demonstrates that neurofunctional sex differences during sexual stimulation can account for well-established sex differences in sexual behavior.

Perception of men's beauty and attractiveness by women with low sexual desire

INTRODUCTION

Despite the high prevalence of hypoactive sexual desire disorder (HSDD), especially among women, this sexual disorder remains poorly understood. Among the multiple factors possibly involved in HSDD, particularities in the cognitive evaluations of social stimuli need to be better characterized. Especially, beauty and attractiveness judgments, two dimensions of interpersonal perception that are related but differ on their underlying motivational aspects, may vary according to the level of sexual desire.

AIM

The main goal of this study was to investigate whether women with and without HSDD differ in their evaluations of beauty and attractiveness of men's faces and voices.

METHODS

Young women from the general population (controls, n = 16) and with HSDD (patients, n = 16) took part in the study. They were presented with a series of neutral/nonerotic voices and faces of young men from the GEneva Faces And Voices database.

MAIN OUTCOME MEASURES

Ratings of beauty (i.e., assessments of aesthetic pleasure) and of attractiveness (i.e., assessments of the personal propensity to feel attracted to someone) and the frequency to which the participants pressed a key to see or listen to each stimulus again were the main outcome measures.

RESULTS

Ratings of attractiveness were lower than ratings of beauty in both groups of women. The dissociation between beauty and attractiveness was larger in women with HSDD than in control participants. Patients gave lower attractiveness ratings than the controls and replayed the stimuli significantly less often.

CONCLUSION

These results suggest that women with HSDD are characterized by specific alterations of the motivational component of men's perception, very early in the process of interpersonal relationships. Our findings have significant implications, both in better understanding the specific cognitive processes underlying hypoactive sexual desire and more largely the evaluative processes involved in human mate choice.

Brain responses to erotic and other emotional stimuli in breast cancer survivors with and without distress about low sexual desire: a preliminary fMRI study

Many breast cancer survivors report a loss of sexual desire and arousability, consonant with the new DSM-V category of female sexual interest/arousal disorder. The cause of decreased sexual desire and pleasure after treatment for cancer is unknown. One possibility is that cancer, or treatment for cancer, damages brain circuits that are involved in reward-seeking. To test the hypothesis that brain reward systems are involved in decreased sexual desire in breast cancer survivors, we used functional magnetic resonance imaging (fMRI) to compare brain responses to erotica and other emotional stimuli in two groups of women previously treated for breast cancer with chemotherapy: those who were distressed about a perceived loss of sexual desire and those who may have had low desire, but were not distressed about it. Women distressed about their desire had reduced brain responses to erotica in the anterior cingulate and dorsolateral prefrontal cortex, which are part of the brain reward system. This study is the first to demonstrate, in cancer survivors, that problems with sexual desire/arousability are associated with blunted brain responses to erotica in reward systems. Future research is necessary to determine whether brain responses differ as a result of chemotherapy, hormone therapy, and menopausal status. This may contribute to the development of new, evidence-based interventions for one of the most prevalent and enduring side effects of cancer treatment.

Social neuroscience and its potential contribution to psychiatry

Most mental disorders involve disruptions of normal social behavior. Social neuroscience is an interdisciplinary field devoted to understanding the biological systems underlying social processes and behavior, and the influence of the social environment on biological processes, health and well-being. Research in this field has grown dramatically in recent years. Active areas of research include brain imaging studies in normal children and adults, animal models of social behavior, studies of stroke patients, imaging studies of psychiatric patients, and research on social determinants of peripheral neural, neuroendocrine and immunological processes. Although research in these areas is proceeding along largely independent trajectories, there is increasing evidence for connections across these trajectories. We focus here on the progress and potential of social neuroscience in psychiatry, including illustrative evidence for a rapid growth of neuroimaging and genetic studies of mental disorders. We also argue that neuroimaging and genetic research focused on specific component processes underlying social living is needed.

Assessment of brain metabolites change during visual sexual stimulation in healthy women using functional MR spectroscopy

INTRODUCTION

Numerous functional magnetic resonance imaging (fMRI) studies demonstrated the key brain areas associated with visual sexual arousal. However, the changes in brain metabolites involved in sexual stimuli have not been reported.

AIM

This study utilized functional MR spectroscopy (fMRS) to evaluate the changes in brain metabolites associated with sexual arousal induced by stimulation with erotic video clips in healthy women.

METHODS

Twenty-three healthy, right-handed women (38.4 ± 10.0 years) participated in (1) H-fMRS and fMRI studies. T1 and T2 MR images were used for voxel localization of the anterior cingulate gyrus, which is one of the most important key centers associated with sexual arousal.

MAIN OUTCOME MEASURES

The changes of brain metabolites were measured using (1) H-fMRS during time-course activation: "before," "during," and "after" visual sexual stimulation. The time-course variation of the brain metabolites was analyzed by the repeated-measures analysis of variance.

RESULTS

The CVmean of all the metabolites had <30% (range, 9-29%). The ICCs of α-glutamine-glutamate (Glx), choline (Cho), β·γ-Glx, N-acetylaspartate (NAA) and lactate (Lac) all exceeded 0.6. However, myo-inositol (mI) and lipid (Lip) were <0.6. The concentration of brain metabolites including α-Glx, β·γ-Glx, Cho, and Lac comparatively increased significantly during visual sexual stimulation.

CONCLUSIONS

(1) H-fMRS, for the first time, was applied to assess the brain metabolic changes during visually-evoked sexual arousal. The fMRS outcomes in relation to functional MRI data will be useful to understand the neural mechanism associated with sexual arousal.

Hypoactive sexual desire disorder

PURPOSE OF REVIEW

Hypoactive sexual desire disorder (HSDD) is the most prevalent female sexual dysfunction, with estimates of prevalence approximating 10%. By definition it is a deficiency of sexual desire that causes distress. HSDD has no single cause, but physiological, psychological and socio-cultural factors underpinning female sexual desire may all be important in its development.

RECENT FINDINGS

Medical therapeutic strategies to date have concentrated on modulation of hormone levels, particularly androgen administration, yet few products have been approved for the treatment of HSDD in developed countries. More recent medical targets have included agents with 5-hydroxytryptamine agonist activity. Psychological therapeutic approaches have been infrequently studied but concentrate on cognitive behavioural therapy.

SUMMARY

HSDD is an evolving diagnosis, the existence of which has been questioned by some critics. Whilst HSDD remains the subject of ongoing research, its title and definition are under debate as a new edition of the Diagnostic and Statistical Manual of the American Psychiatric Association approaches publication in 2012.

Sex for fun: a synthesis of human and animal neurobiology

Sex is a fundamental pleasure, and crucial to the survival of our species. Though not many people would disagree with the proposition that sexual behaviour depends on the brain, the neuroscientific study of human sex is still relatively taboo and much remains to be discovered. On the contrary, excellent experimental animal models (mostly rat) are available that have uncovered major behavioural, neurochemical, and neuroanatomical characteristics of sexual behaviour. Restructuring sexual behaviour into broader terms reflecting behavioural states (wanting, liking, and inhibition) facilitates species comparison, revealing many similarities between animal and human sexual pleasure cycles, some of which can serve as potential avenues of new human sex research. In particular, behavioural and brain evidence clearly shows that motivational and consummatory phases are fundamentally distinct, and that genitally-induced sexual reward is a major factor in sexual learning mechanisms.

The human sexual response cycle: brain imaging evidence linking sex to other pleasures

Sexual behavior is critical to species survival, yet comparatively little is known about the neural mechanisms in the human brain. Here we systematically review the existing human brain imaging literature on sexual behavior and show that the functional neuroanatomy of sexual behavior is comparable to that involved in processing other rewarding stimuli. Sexual behavior clearly follows the established principles and phases for wanting, liking and satiety involved in the pleasure cycle of other rewards. The studies have uncovered the brain networks involved in sexual wanting or motivation/anticipation, as well as sexual liking or arousal/consummation, while there is very little data on sexual satiety or post-orgasmic refractory period. Human sexual behavior also interacts with other pleasures, most notably social interaction and high arousal states. We discuss the changes in the underlying brain networks supporting sexual behavior in the context of the pleasure cycle, the changes to this cycle over the individual's life-time and the interactions between them. Overall, it is clear from the data that the functional neuroanatomy of sex is very similar to that of other pleasures and that it is unlikely that there is anything special about the brain mechanisms and networks underlying sex.

The common neural bases between sexual desire and love: a multilevel kernel density fMRI analysis

INTRODUCTION

One of the most difficult dilemmas in relationship science and couple therapy concerns the interaction between sexual desire and love. As two mental states of intense longing for union with others, sexual desire and love are, in fact, often difficult to disentangle from one another.

AIM

The present review aims to help understand the differences and similarities between these two mental states using a comprehensive statistical meta-analyses of all functional magnetic resonance imaging (fMRI) studies on sexual desire and love.

METHODS

Systematic retrospective review of pertinent neuroimaging literature.

MAIN OUTCOME MEASURES

Review of published literature on fMRI studies illustrating brain regions associated with love and sexual desire to date.

RESULTS

Sexual desire and love not only show differences but also recruit a striking common set of brain areas that mediate somatosensory integration, reward expectation, and social cognition. More precisely, a significant posterior-to-anterior insular pattern appears to track sexual desire and love progressively.

CONCLUSIONS

This specific pattern of activation suggests that love builds upon a neural circuit for emotions and pleasure, adding regions associated with reward expectancy, habit formation, and feature detection. In particular, the shared activation within the insula, with a posterior-to-anterior pattern, from desire to love, suggests that love grows out of and is a more abstract representation of the pleasant sensorimotor experiences that characterize desire. From these results, one may consider desire and love on a spectrum that evolves from integrative representations of affective visceral sensations to an ultimate representation of feelings incorporating mechanisms of reward expectancy and habit learning.