Relationship between loss of libido and signs and symptoms of depression in a sample of Puerto Rican middle-aged women

Female sexual dysfunction is a multi-causal and multidimensional problem combining sexual, physiological, physical, psychological, and interpersonal determinants. Loss of libido or loss of sexual desire, as a symptom of one of the primary sexual dysfunctions described in females, is highly prevalent in the general female population. Research on the psychological aspect associated with loss of libido among Hispanic female populations is limited. The objective of this study was to determine how the loss of libido is affected by signs and symptoms of depression, once potential confounders are controlled. Nine-hundred and nineteen Puerto Rican women ages 40 to 59 years living in Puerto Rico participated in health-fairs conducted in twenty-two municipalities between May 2000 and November 2001. Contingency tables and chi-square statistics were used to evaluate the bivariate associations of loss of libido with demographic and lifestyle characteristics, symptom experience and obstetric and gynecologic histories. A logistic regression model was used to estimate the magnitude of the association between loss of libido and signs and symptoms of depression, after controlling for confounders. The overall prevalence of loss of libido in this population was 40.8%. Loss of libido was significantly associated with depressive symptoms (p < 0.05) after adjusting for age, educational attainment, employment status, physical activity, menopausal status/ hormone therapy use and genitourinary symptoms. Women reporting 1-2 depressive symptoms were 67% (95% CI = 1.08-2.60) more likely than women reporting no symptomatology to report loss of libido. The odds of loss of libido increased as the number of depressive symptoms increased [(3-4 symptoms: POR = 3.67, 95% CI = 2.16-5.56); (5-6 symptoms: POR = 5.52, 95% CI = 3.16-9.66)]. Consistent with previous studies, signs and symptoms of depression were significantly associated with loss of libido. Future longitudinal studies should further elucidate the temporal sequence between depression and sexual dysfunctions in this population.     

Sexual activity and background variables among Finnish middle-aged women

OBJECTIVE: To characterize the associations of sexual experience, orgasm experience, and lack of sexual desire with background variables. METHODS: Questionnaire was mailed to population-based samples (n=5510, 70% response) of soon-to-be-menopausal (aged 42-46 years) and menopausal (aged 52-56 years) women. RESULTS: Being married/having a spouse meant more sexual activity for both groups but also the likelihood to experience lack of sexual desire. Hormones emerged as the most important perceived reason for lack of sexual desire. CONCLUSION: The findings indicated a discrepancy between the reported frequencies of sexual experiences/orgasms with spouse and lack of desire.     

Use of the female sexual function index in women with vulvar intraepithelial neoplasia

The present investigation extends the validation of the Female Sexual Function Index (FSFI; Rosen et al., 2000) to include women with vulvar excisions for vulvar intraepithelial neoplasia (VIN). No instrument previously has been validated in this population. We administered the instrument to 43 women (n = 43) with VIN treated with vulvar excision and age-matched healthy controls (n = 43). We found the FSFI to have high reliability and validity in the VIN excision population. Discriminant validity and internal consistency were within acceptable ranges. Using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ C-30; Agronson et al., 1993) and the FSFI in this population, we found a correlation between a related construct of quality of life and sexual function.     

The enhancement of female sexual function with ArginMax, a nutritional supplement, among women differing in menopausal status

We conducted a double-blind, placebo-controlled study to determine the role of dietary supplementation on sexual function in women of differing menopausal status. One hundred eight (108) women, age 22-73 years, who reported a lack of sexual desire, enrolled as participants. Of these, 55 received ArginMax for women and 53 received placebo. ArginMax for women contains L-arginine, ginseng, ginkgo, damiana, multivitamins, and minerals. The 108 women, given definitions, self-reported as 59 premenopausal (PRE); 20 perimenopausal (PERI), and 29 postmenopausal (POST). After 4 weeks, PRE women on ArginMax primarily reported significant improvement in level of sexual desire (72%; p = 0.03) and satisfaction with overall sex life (68%; p = 0.007), compared with placebo group, according to the Female Sexual Function Index (FSFI; Kaplan et al., 1999) scales. Frequency of sexual desire (60%; p = 0.05) and frequency of intercourse (56% p = 0.01) also increased among the PRE women. In contrast, among PERI women, primary improvements were reported for frequency of intercourse (86%; p = 0.002), satisfaction with sexual relationship (79%; p = 0.03), and vaginal dryness (64%; p = 0.03) compared with placebo group. POST women primarily showed an increased in level of sexual desire, with 51% showing improvement, compared with only 8% in the placebo group (p = 0.008). Nutritional intervention plays an important role in women's sexual health, but issues and areas of greatest improvement differ among women of different menopausal states. The largest number of attribute improvements were seen in PRE and PERI women, although attribute types vary among these groups. Level of desire was shown to increase significantly in POST women. Since ArginMax for women has been shown to exhibit no estrogen activity, it may be desirable alternative to hormone therapy for sexual concerns.     

Managing low sexual desire in women

Low sexual desire is a prevalent symptom, but not one frequently volunteered by women. When accompanied by distress, loss of libido is known as hypoactive sexual desire disorder, which can have a significant impact on a woman's wellbeing. The etiology of hypoactive sexual desire disorder is multifactorial and its management requires a combination of psychosocial and pharmacological interventions. This article outlines the assessment of patients presenting with the symptom of low sexual desire and discusses the evidence for pharmacological management.     

Validation of the Female Sexual Function Index (FSFI) in women with female orgasmic disorder and in women with hypoactive sexual desire disorder

The Female Sexual Functioning Index (FSFI; Rosen et al., 2000) is a self-report measure of sexual functioning that has been validated on a clinically diagnosed sample of women with female sexual arousal disorder. The present investigation extended the validation of the FSFI to include women with a primary clinical diagnosis of female orgasmic disorder (FOD; n = 71) or hypoactive sexual desire disorder (HSDD; n = 44). Internal consistency and divergent validity of the FSFI were within the acceptable range for these populations of women. Significant differences between women with FOD and controls and between women with HSDD and controls were noted for each of the FSFI domain and total scores.     

In the mood for sex: the value of androgens

Androgen substitution is increasingly being employed to enhance sexual desire in women based on the assumption that low androgen levels cause low sexual desire. Sexual functioning in women is complex; therefore, decreased sexual interest can have various causes. An adequate female sexual biopsychosocial model that includes the role of androgens has not yet been developed. Moreover, a higher or lower degree of sexual desire does not form a measure for sexual satisfaction. One group of women at risk for androgen deficiency are women with pathophysiological problems that affect androgen production in the ovaries and/or adrenal glands. The available literature indicates that androgen substitution, despite leading to supraphysiological androgen levels, improves some aspects of sexual functioning, especially in women who have undergone oophorectomy. What this means in terms of satisfaction with sexual functioning in these women is not clear. We believe that, from an evidence-based point of view, testosterone substitution should only be administered as adjuvant treatment to sexological counseling in women with low libido in combination with low bioavailable androgen levels because of insufficiency of ovarian and/or adrenal function and normal estrogen levels. The routine administration of androgens to endocrinologically healthy women who have complaints of decreased sexual interest is not based on available evidence.     

Decreased testosterone in regularly menstruating women with decreased libido: a clinical observation

Much more information is available concerning decreased libido in postmenopausal than in premenopausal women. Even less is known about androgen deficiency in younger women. We measured total and free testosterone levels in 12 consecutive premenopausal women complaining of decreased libido. Of the 12 women, 8 had low or immeasurable levels of testosterone despite having regular menstrual periods. Androgen precursor hormones, DHEA-S and Androstenedione, were low-normal to high-normal. Treatment with oral DHEA, 50 to 100 mg per day, restored sexual desire in 6 of the 8 women, gave partial improvement in one, and failed in another. Possible significance and etiological mechanism are discussed.     

A prospective cohort study on the effect of sexual activity, libido and widowhood on mortality among the elderly people: 14-year follow-up of 2,453 elderly Taiwanese

BACKGROUND: Sexual activity in elderly people is a topic of growing interest but the relationships of sexual activity, libido and widowhood to mortality have been barely investigated. METHODS: A total of 2,453 subjects enrolled from a nationwide survey on health status of residents aged 65 years or older in Taiwan between 1989 and 1991 were followed up until 31 December 2003 for ascertaining cause of death. Information on the frequency of sexual activity, libido (sexual desire), widowhood, disease status and relevant risk factors for risk of death at baseline were collected. RESULTS: After controlling for age and relevant confounding factors, sexual activity was found to be inversely related to mortality {adjusted hazard ratio (aHR) = 0.67 [95% confidence interval (CI):0.56-0.80] for males, aHR = 0.84 (95% CI:0.65-1.09) for females and aHR = 0.72 (95% CI: 0.62-0.84) for both sexes combined}. Men having libido had lower mortality [aHR = 0.81 (95% CI:0.68-0.97)]. Widowhood status was positively correlated with mortality [aHR = 1.66 (95% CI: 1.25-2.19) for males, aHR = 1.33 (95% CI: 1.09 to -1.62) for females and aHR = 1.43 (95% CI: 1.21-1.68) for both sexes combined]. Sexual activity was also inversely related to mortality from stroke [aHR = 0.64 (95% CI: 0.41-1.00)]. CONCLUSIONS: Sexual activity was associated with all-cause and cause-specific mortality independently of other risk factors. This finding was consistent with the elevated risk of death associated with widowhood for both men and women, and by the decreased mortality risk in men having libido.     

Preliminary clinical experience with androgen administration for pre- and postmenopausal women with hypoactive sexual desire

The present study examined effects of testosterone on hypoactive sexual desire in pre- and postmenopausal women (treated) compared with an age-matched reference group (reference). Treated participants received 100 mg of testosterone cypionate in oil injected intramuscularly (i.m.) monthly for 3 months. We measured salivary testosterone and scores on the Sexual Desire Inventory pretreatment and posttreatment. Treated and reference participants' baseline testosterone was equivalent, however, treated participants exhibited higher testosterone levels than did reference participants posttreatment. As expected, treated participants exhibited lower baseline sexual desire than did reference participants and showed a significant increase in sexual desire posttreatment. This research suggests that testosterone may effectively alleviate hypoactive sexual desire, even in women with normal testosterone levels.     

Sexual desire, distress, and associated factors in premenopausal women: preliminary findings from the hypoactive sexual desire disorder registry for women

This article presents data from a validation sample of 390 premenopausal women clinically diagnosed with hypoactive sexual desire disorder (HSDD) enrolled in the HSDD Registry for Women. Participants completed validated measures of sexual distress (e.g., Female Sexual Distress Scale Revised, Question 13) and sexual function including desire (e.g., Female Sexual Function Index). Results showed that lower levels of desire in these women were associated with diminished sexual satisfaction, increased sexually related distress, and fatigue or stress in the women's lives. In addition, the level of distress related to sexual desire decreased with age. The authors conclude that even among women with clinically diagnosed HSDD, the level of sexually related distress varies with situational factors, such as stress and fatigue.     

Sexualität und Pharmakotherapie

This contribution addresses two different areas of the complex relationship between pharmacotherapy and sexual function and dysfunction in men and women. As many impairments of sexual function are caused by side effects of medications, particularly psychotropic drugs, the first part of the paper describes substances and mechanisms often related to sexual dysfunction with a special focus on antidepressants and neuroleptics. While serotonin reuptake inhibitors entail a high risk of sexual dysfunction, it is often difficult to differentiate the negative impact of the drug from the impairment caused by the mental disorder itself. Ways to deal with these dysfunctions and remedial measures are discussed. In the second section, current pharmacological treatments for female and male sexual dysfunctions are reviewed. While there is no approved pharmacotherapy with established efficacy for female sexual dysfunction with the possible exception of the transdermal testosterone patch for surgically menopausal women, effective pharmacological therapies are available for male erectile disorders. In addition, testosterone substitution is the treatment of choice for hypoactive sexual desire disorders caused by hypogonadism. As sexual dysfunctions are often caused by a mixture of psychological and organic factors, treatment strategies combining pharmacological options and sex therapy are advocated.     

Sildenafil for psychotropic-induced sexual dysfunction in 31 women and 61 men

Ninety-two outpatients (31 women, 61 men) who were treated with oral sildenafil for psychotropic-induced sexual dysfunction (PISD) completed ratings of their sexual functioning pre- and posttreatment. Both women and men reported significant improvements (p = .001) in all domains of sexual functioning, with 88% reporting improvement in overall sexual satisfaction. Significant improvements were reported regardless of psychotropic medication type. However, patients taking selective serotonin re-uptake inhibitors reported less improvement in arousal, libido, and overall sexual satisfaction than did other patients, whereas patients taking benzodiazepines reported significantly more improvement in libido and overall sexual satisfaction. Oral sildenafil may be an effective treatment for PISD.     

Evaluating changes in sexual functioning in depressed patients: sensitivity to change of the CSFQ

Accurately evaluating alterations in sexual functioning requires a validated instrument that measures clinically relevant change over time. One-hundred one depressed patients from 15 Spanish out-patient clinics completed the Changes in Sexual Functioning Questionnaire (CFSQ; Clayton, McGarvey, & Clavet, 1997) at baseline and after 6 months of treatment with fluoxetine, nefazodone, paroxetine, or venlafaxine. Sexual desire/interest showed a nearly substantial floor effect (30% of patients indicated the maximum score) for women in the nefazodone group at baseline and in the paroxetine group at final visit. The percentage of dimensions recording change was greater for women (80%) than for men (20%) in the nefazodone group (improving changes) and greater for men (40%) than for women (20%) in the paroxetine group (worsening changes). Highest effect sizes were found on sexual desire/frequency with improvement in women in the nefazodone group (SES = 0.49), and on orgasm/ejaculation with worsening in men in the paroxetine group (SES = -1.45). In conclusion, the CSFQ is sensitive to bidirectional changes and is appropriate for measuring sexual dysfunction.     

Climacteric complaints, female identity, and sexual dysfunctions

Forty early menopausal women seeking relief from sexual symptoms within a long-term marital relationship and 40 matched women seeking relief of climacteric complaints completed questionnaires concerning three subject: vasomotor and psychosocial symptoms, sexual dysfunctions, and female identity. Results showed that women with sexual dysfunctions were more likely to suffer from vasomotor and psychosocial complaints and their feminine identity was based mainly on ideals of motherhood and beauty. In addition, sexual desire disorders were present significantly in those women with higher psychosocial symptoms, while sexual arousal disorders were particularly evident in women suffering more vasomotor symptoms.     

Negotiating sexual agency in marriage: The experience of migrant and refugee women

In this study, adult migrant and refugee women’s negotiation of sexual agency in the context of marriage is explored. In Sydney, Australia and Vancouver, Canada, 78 semistructured individual interviews, and 15 focus groups, comprised of 82 participants, were conducted with women who had recently migrated from Afghanistan, Iraq, Somalia, South Sudan, Sudan, Sri Lanka, and South America. Women’s negotiation of sexual agency was evident with respect to husband choice, disclosure of sexual desire, pleasure, pain, and sexual consent. While some participants took up subjugated sexual subject positions reflecting dominant cultural or religious discourses, many women also resisted these discourses to enact sexual agency.     

Role of socio-economic factor on menopausalhypertension

Arterial blood pressures were measured in 716 Nigerian women (age 35–54 years). Menopausal or postmenopausal women had higher mean blood pressure levels and were more apt to be hypertensive than the age-matched premenopausal counterparts. Irrespective of menopausal status, women in the high socio-economic class had higher pressure levels than those in the low social class but within the low socio-economic class menopausal or postmenopausal women had a higher prevalence of hypertension than the age-matched premenopausal women. Our data suggest that the prevalence of menopausal hypertension in the Nigerian female (age 40–49 years) is higher in the low than in the high socio-economic class.     

Confirmatory factor analysis of a Spanish version of the sex fantasy questionnaire: assessing gender differences

The objective of this study was to validate the factor structure of Wilson's Sex Fantasy Questionnaire (SFQ; Wilson, 1978; Wilson & Lang, 1981) using a Spanish version. In order to do this, we conducted confirmatory factor analysis on two nonclinical samples containing 195 men and 315 women. Both groups were tested for the structure proposed by Wilson and also for some alternative models. Confirmatory factor analysis showed that four factors were reasonably distinct, especially for the men. We proposed shortened version of the instrument that would have sufficient psychometric guarantees for assessing sexual fantasies in both genders. This abridged version improved the fit of the four-factor oblique factor equally for both the samples of men and women. In the light of the results of the validation hypothesis established with some criterion variables (dyadic sexual desire, unconventional sex, homophobia), we discuss discrepancies between both versions.     

The female sexual function index (FSFI): cross-validation and development of clinical cutoff scores

The Female Sexual Function Index (FSFI) is a brief multidimensional scale for assessing sexual function in women. The scale has received initial psychometric evaluation, including studies of reliability, convergent validity, and discriminant validity (Meston, 2003; Rosen et al., 2000). The present study was designed to crossvalidate the FSFI in several samples of women with mixed sexual dysfunctions (N = 568) and to develop diagnostic cut-off scores for potential classification of women's sexual dysfunction. Some of these samples were drawn from our previous validation studies (N = 414), and some were added for purposes of the present study (N = 154). The combined data set consisted of multiple samples of women with sexual dysfunction diagnoses (N = 307), including female sexual arousal disorder (FSAD), hypoactive sexual desire disorder (HSDD), female sexual orgasm disorder (FSOD), dyspareunia/vaginismus (pain), and multiple sexual dysfunctions, in addition to a large sample of nondysfunctional controls (n = 261). We conducted analyses on the individual and combined samples, including replicating the original factor structure using principal components analysis with varimax rotation. We assessed Cronbach's alpha (internal reliability) and interdomain correlations and tested discriminant validity by means of a MANOVA (multivariate analysis of variance; dysfunction diagnosis x FSFI domain), with Bonferroni-corrected post hoc comparisons. We developed diagnostic cut off scores by means of standard receiver operating characteristics-curves and the CART (Classification and Regression Trees) procedure. Principal components analysis replicated the original five-factor structure, including desire/arousal, lubrication, orgasm, pain, and satisfaction. We found the internal reliability for the total FSFI and six domain scores to be good to excellent, with Cronbach alpha's >0.9 for the combined sample and above 0.8 for the sexually dysfunctional and nondysfunctional samples, independently. Discriminant validity testing confirmed the ability of both total and domain scores to differentiate between functional and nondysfunctional women. On the basis of sensitivity and specificity analyses and the CART procedure, we found an FSFI total score of 26.55 to be the optimal cut score for differentiating women with and without sexual dysfunction. On the basis of this cut-off we found 70.7% of women with sexual dysfunction and 88.1% of the sexually functional women in the cross-validation sample to be correctly classified. Addition of the lubrication score in the model resulted in slightly improved specificity (from .707 to .772) at a slight cost of sensitivity (from .881 to .854) for identifying women without sexual dysfunction. We discuss the results in terms of potential strengths and weaknesses of the FSFI, as well in terms of further clinical and research implications.