Brain Activity Unique to Orgasm in Women: An fMRI Analysis

BackgroundAlthough the literature on imaging of regional brain activity during sexual arousal in women and men is extensive and largely consistent, that on orgasm is relatively limited and variable, owing in part to the methodologic challenges posed by variability in latency to orgasm in participants and head movement.AimTo compare brain activity at orgasm (self- and partner-induced) with that at the onset of genital stimulation, immediately before the onset of orgasm, and immediately after the cessation of orgasm and to upgrade the methodology for obtaining and analyzing functional magnetic resonance imaging (fMRI) findings.MethodsUsing fMRI, we sampled equivalent time points across female participants’ variable durations of stimulation and orgasm in response to self- and partner-induced clitoral stimulation. The first 20-second epoch of orgasm was contrasted with the 20-second epochs at the beginning of stimulation and immediately before and after orgasm. Separate analyses were conducted for whole-brain and brainstem regions of interest. For a finer-grained analysis of the peri-orgasm phase, we conducted a time-course analysis on regions of interest. Head movement was minimized to a mean less than 1.3 mm using a custom-fitted thermoplastic whole-head and neck brace stabilizer.OutcomesTen women experienced orgasm elicited by self- and partner-induced genital stimulation in a Siemens 3-T Trio fMRI scanner.ResultsBrain activity gradually increased leading up to orgasm, peaked at orgasm, and then decreased. We found no evidence of deactivation of brain regions leading up to or during orgasm. The activated brain regions included sensory, motor, reward, frontal cortical, and brainstem regions (eg, nucleus accumbens, insula, anterior cingulate cortex, orbitofrontal cortex, operculum, right angular gyrus, paracentral lobule, cerebellum, hippocampus, amygdala, hypothalamus, ventral tegmental area, and dorsal raphe).Clinical TranslationInsight gained from the present findings could provide guidance toward a rational basis for treatment of orgasmic disorders, including anorgasmia.Strengths and LimitationsThis is evidently the first fMRI study of orgasm elicited by self- and partner-induced genital stimulation in women. Methodologic solutions to the technical issues posed by excessive head movement and variable latencies to orgasm were successfully applied in the present study, enabling identification of brain regions involved in orgasm. Limitations include the small sample (N = 10), which combined self- and partner-induced stimulation datasets for analysis and which qualify the generalization of our conclusions.ConclusionExtensive cortical, subcortical, and brainstem regions reach peak levels of activity at orgasm.Wise NJ, Frangos E, Komisaruk BR. Brain Activity Unique to Orgasm in Women: An fMRI Analysis. J Sex Med 2017;14:1380–1391.     

Neural bases of hypoactive sexual desire disorder in women: an event-related FMRI study

IntroductionAlthough there is an abundant debate regarding the mechanisms sustaining one of the most common sexual complaints among women, i.e., female hypoactive sexual desire disorder (HSDD), little remains known about the specific neural bases of this disorder.AimThe main goal of this study was to determine whether women with HSDD showed differential patterns of activation within the brain network that is active for sexual desire in subjects without HSDD.MethodsA total of 28 right‐handed women participated in this study (mean age 31.1 ± 7.02 years). Thirteen out of the 28 women had HSDD (HSDD participants), while 15 women reported no hypoactive sexual desire disorder (NHSDD participants). Using event‐related functional magnetic resonance imaging (fMRI), we compared the regional cerebral blood flow responses between these two groups of participants, while they were looking at erotic vs. non‐erotic stimuli.Main Outcome MeasureBlood‐oxygenation level dependent (BOLD) signal changes in response to erotic stimuli (compared with non‐erotic stimuli). Statistical Parametric Mapping was used to identify brain regions that demonstrated significant differential activations between stimuli and between groups.ResultsAs expected, behavioral results showed that NHSDD participants rated erotic stimuli significantly higher than HSDD participants did on a 10‐point desirable scale. No rating difference was observed for the non‐erotic stimuli between NHSDD and HSDD participants. Our functional neuroimaging results extended these data by demonstrating two distinct types of neural changes in participants with and without HSDD. In comparison with HSDD participants, participants without HSDD demonstrated more activation in brain areas involved in the processing of erotic stimuli, including intraparietal sulcus, dorsal anterior cingulate gyrus, and ento/perirhinal region. Interestingly, HSDD participants also showed additional activations in brain areas associated with higher order social and cognitive functions, such as inferior parietal lobule, inferior frontal gyrus, and posterior medial occipital gyrus.ConclusionTogether, these findings indicate that HSDD participants do not only show a hypo activation in brain areas mediating sexual desire, but also a different brain network of hyper activation, which might reflect differences in subjective, social, and cognitive interpretations of erotic stimuli. Collectively, these data are in line with the incentive motivation model of sexual functioning. Bianchi‐Demicheli F, Cojan Y, Waber L, Recordon N, Vuilleumier P, and Ortigue S. Neural bases of hypoactive sexual desire disorder in women: An event‐related fMRI study. J Sex Med 2011;8:2546–2559.     

Pontine Control of Ejaculation and Female Orgasm

IntroductionThe physiological component of ejaculation shows parallels with that of micturition, as both are essentially voiding activities. Both depend on supraspinal influences to orchestrate the characteristic pattern of activity in the pelvic organs. Unlike micturition, little is known about the supraspinal pathways involved in ejaculation and female orgasm.AimTo identify brainstem regions activated during ejaculation and female orgasm and to compare them with those activated during micturition.MethodsEjaculation in men and orgasm in women were induced by manual stimulation of the penis or clitoris by the participants' partners. Positron emission tomography (PET) with correction for head movements was used to capture the pattern of brain activation at the time of sexual climax.Main Outcome MeasuresPET scans showing areas of activation during sexual climax.ResultsEjaculation in men and orgasm in women resulted in activation in a localized region within the dorsolateral pontine tegmentum on the left side and in another region in the ventrolateral pontine tegmentum on the right side. The dorsolateral pontine area was also active in women who attempted but failed to have an orgasm and in women who imitated orgasm. The ventrolateral pontine area was only activated during ejaculation and physical orgasm in women.ConclusionActivation of a localized region on the left side in the dorsolateral pontine tegmentum, which we termed the pelvic organ‐stimulating center, occurs during ejaculation in men and physical orgasm in women. This same region has previously been shown to be activated during micturition, but on the right side. The pelvic organ‐stimulating center, via projections to the sacral parasympathetic motoneurons, controls pelvic organs involved in voiding functions. In contrast, the ventrolateral pontine area, which we term the pelvic floor‐stimulating center, produces the pelvic floor contractions during ejaculation in men and physical orgasm in women via direct projections to pelvic floor motoneurons. Huynh HK, Willemsen ATM, Lovick TA, and Holstege G. Pontine control of ejaculation and female orgasm. J Sex Med 2013;10:3038–3048.     

Variation in Orgasm Occurrence by Sexual Orientation in a Sample of U.S. Singles

IntroductionDespite recent advances in understanding orgasm variation, little is known about ways in which sexual orientation is associated with men's and women's orgasm occurrence.AimTo assess orgasm occurrence during sexual activity across sexual orientation categories.MethodsData were collected by Internet questionnaire from 6,151 men and women (ages 21–65+ years) as part of a nationally representative sample of single individuals in the United States. Analyses were restricted to a subsample of 2,850 singles (1,497 men, 1,353 women) who had experienced sexual activity in the past 12 months.Main Outcome MeasuresParticipants reported their sex/gender, self-identified sexual orientation (heterosexual, gay/lesbian, bisexual), and what percentage of the time they experience orgasm when having sex with a familiar partner.ResultsMean occurrence rate for experiencing orgasm during sexual activity with a familiar partner was 62.9% among single women and 85.1% among single men, which was significantly different (F_1,2848 = 370.6, P < 0.001, η² = 0.12). For men, mean occurrence rate of orgasm did not vary by sexual orientation: heterosexual men 85.5%, gay men 84.7%, bisexual men 77.6% (F_2,1494 = 2.67, P = 0.07, η² = 0.004). For women, however, mean occurrence rate of orgasm varied significantly by sexual orientation: heterosexual women 61.6%, lesbian women 74.7%, bisexual women 58.0% (F_2,1350 = 10.95, P < 0.001, η² = 0.02). Lesbian women had a significantly higher probability of orgasm than did either heterosexual or bisexual women (P < 0.05).ConclusionsFindings from this large dataset of U.S. singles suggest that women, regardless of sexual orientation, have less predictable, more varied orgasm experiences than do men and that for women, but not men, the likelihood of orgasm varies with sexual orientation. These findings demonstrate the need for further investigations into the comparative sexual experiences and sexual health outcomes of sexual minorities. Garcia JR, Lloyd EA, Wallen K, and Fisher HE. Variation in orgasm occurrence by sexual orientation in a sample of U.S. singles. J Sex Med 2014;11:2645–2652.     

The Quality of Sexual Experience in Women Correlates with Post‐Orgasmic Prolactin Surges: Results from an Experimental Prototype Study

IntroductionSexual intercourse, orgasm, and sexual satisfaction are associated with well‐being and improved quality of life. The pituitary hormone prolactin (PRL) may have an important role in regulating (and thus indexing) sexual satiety and satisfaction.AimPhysiological indices to quantify the quality and resulting satisfaction from female orgasm would be valuable. Therefore we aim to validate associations of orgasm‐induced PRL surges with women's orgasm quality and subsequent sexual satisfaction.MethodsIn a prospective study, with a pre‐post, single‐blinded, cross‐over design in a naturalistic field setting, we analyzed the correlation of women's post‐orgasmic serum PRL surges following sexual intercourse with women's perceived quality of orgasm and resulting sexual satisfaction, as measured by a questionnaire.Main Outcome MeasuresPRL levels prior to and following penile‐vaginal intercourse with and without orgasm, and scores from the Acute Sexual Experience Scale (ASES) on quality of orgasm and sexual satisfaction.ResultsAn analysis of variance of the blood samples in nine women indicated large magnitude, significant effects of intercourse orgasm on PRL levels (P = 0.004, eta squared = 0.78), as well as an interaction with the effect of multiple orgasms (P = 0.008, eta squared = 0.80). PRL post/pre ratios and arithmetic difference correlated strongly with orgasm quality (r = 0.85, P = 0.016, and r = 0.69, P = 0.08) and sexual satisfaction (r = 0.75, P = 0.05 and r = 0.77, P = 0.045).ConclusionWomen's intercourse orgasm induced PRL surges are strongly related to the quality of orgasm and subsequent sexual satisfaction. This implies that post‐orgasmic PRL surges are an objective index of orgasm and orgasm quality. PRL might be used in future studies on basic research as well as a treatment target in sexual disorders in women.     

Sexual Satisfaction and Frequency of Orgasm in Women With Chronic Pelvic Pain due to Endometriosis

BackgroundDyspareunia, one of the main symptoms of the chronic gynecological pelvic pain disorder endometriosis, may interfere with the likelihood of reaching an orgasm, yet for women with dyspareunia, no data on orgasm rates in different sexual activities are available.AimThe aim of this study was to evaluate the ability to reach an orgasm and its association with sexual satisfaction during different sexual activities in women with a chronic pelvic pain disorder and in healthy control women.MethodsA set of questionnaires including the brief index of sexual functioning and global sexual functioning was used to evaluate sexuality in women affected with endometriosis (n = 434) and a nonaffected control group (n = 434) recruited in German-speaking countries.OutcomesThe primary outcome measure of this study was the orgasm rate during different types of sexual activities.ResultsOnly the ability to have an orgasm during sexual intercourse (P = .002) but not during masturbation (P = .509) or partnered noncoital sexual activities (P = .229) is affected by endometriosis. Dyspareunia was associated with a reduced ability to experience an orgasm during intercourse for endometriosis patients (P = .020) and control women (P = .006). The ability to orgasm during noncoital sexual activities (P = .006) and sexual intercourse (P = .038) was associated with a higher sexual satisfaction in women with endometriosis. For controls, only the ability to achieve an orgasm with sexual intercourse was associated with sexual satisfaction (P = .038).Clinical implicationsSexual counselling as part of medical support could help couples living with chronic pelvic pain of the female partner integrate noncoital sexual activities in their sex lives, leading to fewer sex-related problems and higher sexual desire and satisfaction.Strengths and limitationsThis study is the first to examine different ways of achieving an orgasm and sexual satisfaction in a large group of women with endometriosis and a matched control group. The breadth of the questionnaire allowed a differentiated analysis of factors influencing the likelihood of achieving an orgasm and overall sexual satisfaction. The one limitation is that the length and the intimate nature of the questionnaire possibly resulted in reluctance to answer this part of the questionnaire.ConclusionPartnered noncoital sexual activities may represent an alternative to reach orgasm for women with endometriosis-related chronic pelvic pain or anorgasmia during sexual intercourse.Hämmerli S, Kohl-Schwartz A, Imesch P, et al. Sexual Satisfaction and Frequency of Orgasm in Women With Chronic Pelvic Pain due to Endometriosis. J Sex Med 2020;17:2417–2426.     

Assessment of Brain Metabolites Change during Visual Sexual Stimulation in Healthy Women Using Functional MR Spectroscopy

IntroductionNumerous 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.AimThis 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.MethodsTwenty‐three healthy, right‐handed women (38.4 ± 10.0 years) participated in ¹H‐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 MeasuresThe changes of brain metabolites were measured using ¹H‐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.ResultsThe CV_mean 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.Conclusions¹H‐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.     

Delayed Ejaculation and Associated Complaints: Relationship to Ejaculation Times and Serum Testosterone Levels

BackgroundAlthough delayed ejaculation (DE) is typically characterized as a persistently longer than anticipated or desired time to ejaculation (or orgasm) during sexual activity, a timing-based definition of DE and its association with serum testosterone has not been established in a large cohort.AimTo examine in an observational study estimated intravaginal ejaculatory latency time (IELT) and masturbatory ejaculation latency time (MELT) in men self-reporting DE, assess the association of IELT and MELT with serum testosterone levels, and determine whether correlation with demographic and sexual parameters exist.MethodsMen who resided in the United States, Canada, and Mexico were enrolled from 2011 to 2013. Self-estimated IELT and MELT were captured using an Ejaculatory Function Screening Questionnaire in a sample of 988 men screened for possible inclusion in a randomized clinical trial assessing testosterone replacement therapy for ejaculatory dysfunction (EjD) and who self-reported the presence or absence of DE and symptoms of hypogonadism. Additional comorbid EjDs (ie, anejaculation, perceived decrease in ejaculate volume, and decreased force of ejaculation) were recorded. Men with premature ejaculation were excluded from this analysis. IELT and MELT were compared between men self-reporting DE and men without DE. The associations of IELT and MELT with serum testosterone were measured.OutcomesIELT, MELT, and total testosterone levels.ResultsSixty-two percent of screened men self-reported DE with or without comorbid EjDs; 38% did not report DE but did report at least one of the other EjDs. Estimated median IELTs were 20.0 minutes for DE vs 15 minutes for no DE (P < .001). Estimated median MELTs were 15.0 minutes for DE vs 8.0 minutes for no DE (P < .001). Ejaculation time was not associated with serum testosterone levels. Younger men and those with less severe erectile dysfunction had longer IELTs and MELTs.Clinical ImplicationsEstimated ejaculation times during vaginal intercourse and/or masturbation were not associated with serum testosterone levels in this study; thus, routine androgen evaluation is not indicated in these men.Strengths and LimitationsThis large systematic analysis attempted to objectively assess the ejaculation latency in men with self-reported DE. Limitations were that ejaculation time estimates were self-reported and were queried only once; the questionnaire did not distinguish between failure to achieve orgasm and ejaculation; and assessment of DE was limited to heterosexual vaginal intercourse and masturbation.ConclusionIELT and MELT were longer in men with DE, and there was no association of ejaculation times with serum testosterone levels in this study population.Morgentaler A, Polzer P, Althof S, et al. Delayed Ejaculation and Associated Complaints: Relationship to Ejaculation Times and Serum Testosterone Levels. J Sex Med 2017;14:1116–1124.     

Female Urinary Incontinence at Orgasm: A Possible Marker of a More Severe Form of Detrusor Overactivity. Can Ultrasound Measurement of Bladder Wall Thickness Explain It?

IntroductionCoital incontinence (CI) during orgasm is a form of urinary incontinence possibly because of detrusor overactivity (DO), as the underlying pathophysiological condition. Women with this symptom usually show a pharmacological lower cure rate than those with DO alone. The ultrasound measurement of the bladder wall thickness (BWT) allows an indirect evaluation of detrusor muscle thickness, giving a potential index of detrusor activity.AimWe wanted to understand if CI at orgasm could be a marker of severity of DO by comparing BWT in women with both DO and CI at orgasm vs. women with DO alone. In addition we aimed to confirm if CI during orgasm is related to antimuscarinics treatment failure.MethodsThis is a prospective cohort study performed in two tertiary urogynecological referral departments, recruiting consecutive patients seeking treatment for symptomatic DO.Main Outcome MeasuresAll patients were thoroughly assessed including physical examination, urodynamic evaluation, and BWT measurement according to the International Continence Society/International Urogynecological Association and ICI recommendations. Solifenacine 5 mg once daily was then prescribed and follow-up was scheduled to evaluate treatment. Multiple logistic regression (MLR) was performed to identify risk factors for treatment failure.ResultsBetween September 2007 and March 2010, 31 (22.6%) and 106 (77.4%) women with DO with and without CI at orgasm were enrolled. Women complaining of CI at orgasm had significantly higher BWT than the control group (5.8 ± 0.6 mm vs. 5.2 ± 1.2 mm [P = 0.007]). In patients with CI at orgasm, the nonresponder rate to antimuscarinics was significantly higher than controls (P = 0.01). After MLR, CI at orgasm was the only independent predictor decreasing antimuscarinics efficacy (odds ratio [OR] 3.16 [95% CI 1.22–8.18], P = 0.02).ConclusionsWomen with DO and CI at orgasm showed a significantly higher BWT values and worse cure rates than women with DO alone. CI at orgasm could be a marker of a more severe form of DO. Serati M, Salvatore S, Cattoni E, Siesto G, Soligo M, Braga A, Sorice P, Cromi A, Ghezzi F, Cardozo L, and Bolis P. Female urinary incontinence at orgasm: A possible marker of a more severe form of detrusor overactivity. Can ultrasound measurement of bladder wall thickness explain it?.     

Depressive Symptoms as a Predictor of Sexual Function during Pregnancy

IntroductionBiopsychological and sociocultural factors have been reported to be associated with sexual function in pregnancy. To date, very few studies have focused on the relationship between sexual function and depression during pregnancy.AimTo determine whether depressive symptoms predict overall sexual function, desire, arousal, lubrication, orgasm, satisfaction, and pain during pregnancy by using the Female Sexual Function Index (FSFI).MethodsPregnant women undergoing prenatal examinations were randomly selected for this cross‐sectional investigation. The study included 555 pregnant women who completed the Taiwanese versions of the Center for Epidemiologic Studies Depression Scale (CES‐D), FSFI, and a demographic questionnaire during pregnancy.Main Outcome MeasuresCES‐D scores for depressive symptoms, scores for overall sexual function on the FSFI, and the FSFI domains: desire, arousal, lubrication, orgasm, satisfaction, and pain.ResultsAfter adjusting for demographic factors, CES‐D scores during the first trimester negatively predicted overall sexual function (P = 0.0004), arousal (P = 0.0104), lubrication (P = 0.0016), orgasm (P = 0.0022), and pain (P < 0.0001). Moreover, CES‐D scores during the third trimester negatively predicted sexual desire (P = 0.0005) and satisfaction (P < 0.0001). Furthermore, gestational age negatively predicted overall sexual function, arousal, lubrication, orgasm, and pain (all P < 0.0001). Parity was a positive predictor of overall sexual function, arousal, lubrication, and orgasm (all P < 0.0005). Medical conditions were positive predictors of sexual desire (P = 0.0023).ConclusionsThe present study revealed that depressive symptom scores during early and late pregnancy were significant negative predictors of sexual function during pregnancy. Chang S‐R, Ho H‐N, Chen K‐H, Shyu M‐K, Huang L‐H, and Lin W‐A. Depressive symptoms as a predictor of sexual function during pregnancy. J Sex Med **;**:**–**.     

Differing Default Mode Network Activities in Men with Homosexual or Heterosexual Preferences

IntroductionNeuroimaging studies have reported differences in brain structure and function between homosexual and heterosexual men. The neural basis for homosexual orientation, however, is still unknown.AimThis study characterized the association of homosexual preference with measures of fractional amplitude of low‐frequency fluctuation (fALFF) and functional connectivity (FC) in the resting state.MethodsWe collected echo planar magnetic resonance imaging data in 26 healthy homosexual men and 26 age‐matched heterosexual men in the resting state.Main Outcome MeasuresSexual orientation was evaluated using the Kinsey scale. We assessed group differences in fALFF and then, taking the identified group differences as seed regions, we compared groups on measures of FC from those seeds. The behavioral significance of the group differences in fALFF and FC was assessed by examining their associations with the Kinsey scores.ResultsCompared with heterosexual participants, homosexual men showed significantly increased fALFF in the right middle frontal gyrus and right anterior cerebellum, and decreased fALFF in the left postcentral gyrus, left lingual gyrus, right pallidum, right postcentral gyrus, left interior parietal gyrus, right superior temporal gyrus, left cuneus, and left inferior frontal gyrus. Additionally, fALFF in the left postcentral gyrus and left cuneus correlated positively with Kinsey scores in the homosexual participants. When the seeds in the left cuneus, left cuneus, and left superior parietal gyrus also had reduced FC in homosexual participants, FC correlated positively with the Kinsey scores.ConclusionsDifferences in fALFF and FC suggest male sexual preference may influence the pattern activity in the default mode network. Hu S, Xu D, Peterson BS, Wang Q, Lai J, Hu J, Wei N, Zhang M, and Xu Y. Differing default mode network activities in men with homosexual or heterosexual preferences. J Sex Med 2014;11:2474–2484.     

Neural activation toward erotic stimuli in homosexual and heterosexual males

IntroductionStudies investigating sexual arousal exist, yet there are diverging findings on the underlying neural mechanisms with regard to sexual orientation. Moreover, sexual arousal effects have often been confounded with general arousal effects. Hence, it is still unclear which structures underlie the sexual arousal response in homosexual and heterosexual men.AimNeural activity and subjective responses were investigated in order to disentangle sexual from general arousal. Considering sexual orientation, differential and conjoint neural activations were of interest.MethodsThe functional magnetic resonance imaging (fMRI) study focused on the neural networks involved in the processing of sexual stimuli in 21 male participants (11 homosexual, 10 heterosexual). Both groups viewed pictures with erotic content as well as aversive and neutral stimuli. The erotic pictures were subdivided into three categories (most sexually arousing, least sexually arousing, and rest) based on the individual subjective ratings of each participant.Main Outcome MeasuresBlood oxygen level‐dependent responses measured by fMRI and subjective ratings.ResultsA conjunction analysis revealed conjoint neural activation related to sexual arousal in thalamus, hypothalamus, occipital cortex, and nucleus accumbens. Increased insula, amygdala, and anterior cingulate gyrus activation could be linked to general arousal. Group differences emerged neither when viewing the most sexually arousing pictures compared with highly arousing aversive pictures nor compared with neutral pictures.ConclusionResults suggest that a widespread neural network is activated by highly sexually arousing visual stimuli. A partly distinct network of structures underlies sexual and general arousal effects. The processing of preferred, highly sexually arousing stimuli recruited similar structures in homosexual and heterosexual males. Kagerer S, Klucken T, Wehrum S, Zimmermann M, Schienle A, Walter B, Vaitl B, and Stark R. Neural activation toward erotic stimuli in homosexual and heterosexual males. J Sex Med 2011;8:3132–3143.     

Sexual function in women with polycystic ovary syndrome

IntroductionPolycystic ovary syndrome (PCOS) is a common endocrinologic disorder. Little is known about the effects of PCOS on overall sexual functioning, phases of the sexual response cycle, and sexual satisfaction.AimTo compare the differences in sexual function between women with PCOS and controls, and to assess the relationship of serum testosterone, body mass index (BMI), hirsutism, and acne with sexual function scores in women with PCOS.MethodsA cross‐sectional analysis in which women who met the National Institute of Child Health and Human Development criteria for PCOS were compared with a group of healthy volunteers.Main Outcome MeasuresResults from the validated Changes in Sexual Functioning Questionnaire (CSFQ) were used to assess sexual function. In women with PCOS, serum testosterone levels, BMI, self‐reported hirsutism, and acne were assessed as independent variables.ResultsNinety‐two women with PCOS and 82 controls were studied. Based on total CSFQ scores, sexual dysfunction was present in 27.2% of cases vs. 24.4% of controls (not signifcant). Women with PCOS had a significantly lower orgasm/completion score compared with women in the control group (P < 0.001). Women with PCOS whose testosterone levels were >1 standard deviation above the mean had significantly better sexual functioning vs. those within 1 SD (P = 0.015) and those >1 SD below the mean (P = 0.033). In women with PCOS, increasing BMI was associated with a significant reduction in the orgasm/completion subdomain, but no significant associations were found in regard to acne or hirsutism.ConclusionsWomen with PCOS have similar sexual functioning scores compared with controls except in regard to orgasm/completion. The subpopulation of women with PCOS whose serum testosterone levels are in the normal reproductive range are at increased risk for sexual dysfunction. Stovall DW, Scriver JL, Clayton AH, Williams CD, and Pastore LM. Sexual function in women with polycystic ovary syndrome. J Sex Med 2012;9:224–230.     

When Is Enough Enough? Orgasm's Curvilinear Association With Relational and Sexual Satisfaction

BackgroundCurvilinearity has been found for sexual frequency, but research has not examined whether curvilinear associations exist for other aspects of sexual relationships like orgasm consistency.AimWe examined whether there is curvilinearity and the nature of that curvilinearity between orgasm consistency and sexual and relational satisfaction for men and women.MethodsWith pooled samples of 1,619 and 1,695 men and women from Amazon's Mechanical Turk, we examined the differences of orgasm consistency values and both sexual satisfaction and relationship satisfaction through analysis of variance. We then tested for curvilinearity between orgasm consistency and sexual and relational satisfaction with regression analyses.OutcomesFor men we found no evidence of a curvilinear relationship, but for women we found a curvilinear relationship between orgasm consistency values and both sexual satisfaction and relationship satisfaction.ResultsAcross tests, the overall picture suggests that there is no curvilinear association for men, but there is for women. For women, with each unit increase in orgasm consistency, the increase in sexual satisfaction and relationship satisfaction became progressively smaller. Past the 61-80% threshold for orgasm consistency, there was little gain in sexual satisfaction and no gain in relational satisfaction.Clinical TranslationPhysicians, therapists, and educators can reorient women's orgasm expectations by explaining that having regular orgasms—not necessarily always—is associated with satisfaction in their relationship and sexual experience.Strengths & LimitationsConverging large samples and data analytic techniques evinced the curvilinear association between orgasm consistency and both relational and sexual satisfaction for women. However, this study is cross-sectional and correlational, which limits the conclusions we can draw from it.ConclusionWhile men's orgasm consistency is linearly associated with relational and sexual satisfaction, more consistent orgasms seem to be associated with women's sexual and relational satisfaction, to a point.Leavitt CE, Leonhardt ND, Busby DM, et al. When Is Enough Enough? Orgasm's Curvilinear Association With Relational and Sexual Satisfaction. J Sex Med 2021;18:167–178.     

A Randomized Study Comparing Video-Based Mindfulness-Based Cognitive Therapy With Video-Based Traditional Cognitive Behavioral Therapy in a Sample of Women Struggling to Achieve Orgasm

IntroductionThis study examines the effectiveness of integrating mindfulness-based techniques within therapy for women suffering to achieve orgasm. Although widely applied in psychotherapy, this approach has only recently been introduced in the treatment of female sexual dysfunction.AimTo compare the effectiveness of a video-based self-administered treatment, rooted within the cognitive behavioral treatment (CBT) framework, with a video-based self-administered mindfulness treatment applying cognitive behavioral sexual therapy (mindfulness-based cognitive therapy), the latter of which was specifically created to increase women's ability to achieve orgasm.MethodsA convenience sample of 65 women suffering from difficulties to achieve orgasm, aged 18 to 58 years (mean = 32.66, standard deviation = 9.48), were randomly allocated using a randomization procedure to either a mindfulness-based cognitive therapy (N = 35) or CBT (N = 30) group. Each participant completed questionnaires before and after the start of treatment and 2 months after its completion.Main Outcome MeasureWe applied repeated-measure general linear models to compare the 2 groups (ie, between participant factor) on each dependent variable across time (ie, the within-participant factor). Compare mean analyses for paired samples were only conducted when the interaction effect between condition and time was significant (ie, P <.05).ResultsStatistical analyses show that women in both groups presented increased sexual functioning (P = .001) and decreased sexual distress (P < .001), as well as improved desire, arousal, orgasm, and sexual satisfaction (P < .05) after their respective treatments. Contrary to our hypothesis, significant reductions in sexual pain were only observed in CBT participants.Clinical ImplicationsTo the best of our knowledge, this is the first study to apply a randomized allocation procedure to evaluate the effectiveness of a video-based mindfulness intervention for women struggling to achieve orgasm. These results should guide clinicians' decisions with respect to evaluating the relevance and the real added value of proposing mindfulness exercises to their patients with such difficulties.ConclusionWhen women suffering from difficulties to achieve orgasm are randomly assigned to a mindfulness group or an active control, improvements in sexual functioning and reductions in sexual distress can be observed after both treatments.Adam F, De Sutter P, Day J, et al. A Randomized Study Comparing Video-Based Mindfulness-Based Cognitive Therapy With Video-Based Traditional Cognitive Behavioral Treatment in a Sample of Women Struggling to Achieve Orgasm. J Sex Med 2020;17:312–324.     

Simultaneous penile-vaginal intercourse orgasm is associated with satisfaction (sexual, life, partnership, and mental health)

IntroductionPrevious multivariate research found that satisfaction was associated positively with frequency of specifically penile–vaginal intercourse (PVI; as opposed to other sexual activities) as well as with vaginal orgasm. The contribution to satisfaction of simultaneous orgasm produced by PVI merited direct examination in a large representative sample.AimsTo examine the associations of aspects of satisfaction (sexual, life, own mental health, partner relationship) with consistency of simultaneous orgasm produced by PVI (as well as with PVI frequency and vaginal orgasm consistency).MethodsA representative sample of Czechs (N = 1,570) aged 35–65 years completed a survey on aspects of satisfaction, PVI frequency, vaginal orgasm consistency, and consistency of simultaneous orgasm produced by PVI (the latter being a specially timed version of vaginal orgasm for women).Main Outcome MeasuresAnalysis of variance of satisfaction components (LiSat scale items) from age and the sexual behaviors.ResultsFor both sexes, all aspects of satisfaction were associated with simultaneous PVI orgasm consistency and with PVI frequency (except female life satisfaction). All aspects of satisfaction were also associated with vaginal orgasm consistency. Multivariate analyses indicated that PVI frequency and simultaneous orgasm consistency make independent contributions to the aspects of satisfaction for both sexes.ConclusionsFor both sexes, PVI frequency and simultaneous orgasm produced by PVI (as well as vaginal orgasm for women) are associated with greater life, sexual, partnership, and mental health satisfaction. Greater support for these specific aspects of sexual activity is warranted. Brody S and Weiss P. Simultaneous penile–vaginal intercourse orgasm is associated with satisfaction (sexual, life, partnership, and mental health). J Sex Med 2011;8:734–741.     

The Role of Left Superior Parietal Lobe in Male Sexual Behavior: Dynamics of Distinct Components Revealed by fMRI

IntroductionDespite the interest for the brain correlates of male sexual arousal, few studies investigated neural mechanisms underlying psychogenic erectile dysfunction (ED). Although these studies showed several brain regions active in ED patients during visual erotic stimulation, the dynamics of inhibition of sexual response is still unclear.AimThis study investigated the dynamics of brain regions involved in the psychogenic ED.MethodsFunctional magnetic resonance imaging (fMRI) and simultaneous penile tumescence (PT) were used to study brain activity evoked in 17 outpatients with psychogenic ED and 19 healthy controls during visual erotic stimulation. Patterns of brain activation related to different phases of sexual response in the two groups were compared.Main Outcome MeasuresSimultaneous recording of blood oxygen level-dependent fMRI responses and PT during visual erotic stimulation.ResultsDuring visual erotic stimuli, a larger activation was observed for the patient group in the left superior parietal lobe, ventromedial prefrontal cortex, and posterior cingulate cortex, whereas the control group showed larger activation in the right middle insula and dorsal anterior cingulate cortex and hippocampus. Moreover, the left superior parietal lobe showed a larger activation in patients than controls especially during the later stage of sexual response.ConclusionsOur results suggest that, among regions more active in patient group, the left superior parietal lobe plays a crucial role in inhibition of sexual response. Previous studies showed that left superior parietal lobe is involved in monitoring of internal body representation. The larger activation of this region in patients during later stages of sexual response suggests a high monitoring of the internal body representation, possibly affecting the behavioral response. These findings provide insight on brain mechanisms involved in psychogenic ED. Cera N, Di Pierro ED, Sepede G, Gambi F, Perrucci MG, Merla A, Tartaro A, Del Gratta C, Galatioto Paradiso G, Vicentini C, Romani GL, and Ferretti A. The role of left superior parietal lobe in male sexual behavior: Dynamics of distinct components revealed by fMRI. J Sex Med 2012;9:1602–1612.     

An Evaluation of Sexual Functioning in Employed Outpatients with Major Depressive Disorder Treated with Desvenlafaxine 50mg or Placebo

IntroductionThe symptoms of major depressive disorder (MDD) include sexual dysfunction, but antidepressant pharmacotherapies are also associated with treatment-emergent sexual dysfunction.AimThese secondary and post hoc analyses evaluated sexual functioning in employed adult outpatients with MDD treated with desvenlafaxine (administered as desvenlafaxine succinate) and placebo.MethodPatients were randomly assigned (2:1 ratio) to 12 weeks of double-blind treatment with desvenlafaxine 50 mg/day or placebo.Main Outcome MeasuresThe Arizona Sexual Experiences Scale (ASEX) was administered every 4 weeks. Analysis of covariance was used to compare differences in mean change from baseline ASEX scores between desvenlafaxine and placebo for women and men.ResultsThere were 422 evaluable patients with baseline ASEX scores (desvenlafaxine, N = 281; placebo, N = 141). Among women (desvenlafaxine, N = 184; placebo, N = 92), baseline scores were 20.0 (5.2) and 20.5 (5.3) for desvenlafaxine and placebo, respectively; mean changes at week 12 were ?1.93 (0.37) and ?1.03 (0.54), respectively (mean difference: 0.90 [–0.38, 2.18]; P = 0.169). Among men (desvenlafaxine, N = 97; placebo, N = 49), baseline scores were 16.4 (4.9) and 15.9 (4.8) for desvenlafaxine and placebo, respectively; mean changes at week 12 were ?1.13 (0.47) and ?1.06 (0.70), respectively (mean difference: 0.07 [–1.59, 1.74]; P = 0.932). Significantly greater orgasmic dysfunction at week 12 was observed in the subgroup of men without baseline sexual dysfunction treated with desvenlafaxine relative to placebo. Conversely, women without baseline sexual dysfunction experienced poorer overall sexual functioning and orgasm satisfaction at week 12 with placebo relative to desvenlafaxine treatment. Subgroup analyses of treatment responders and nonresponders found no difference in the proportion of men or women that developed or had resolution of sexual dysfunction in the desvenlafaxine and placebo groups.ConclusionWith the exception of orgasmic dysfunction in men without preexisting sexual dysfunction, no significant negative effect on sexual functioning was observed over 12 weeks of treatment with desvenlafaxine. Clayton AH, Reddy S, Focht K, Musgnung J, and Fayyad R. An evaluation of sexual functioning in employed outpatients with major depressive disorder treated with desvenlafaxine 50 mg or placebo. J Sex Med 2013;10:768–776.     

Sexual Function and Satisfaction in Couples with Infertility: A Closer Look at the Role of Personal and Relational Characteristics

BackgroundResearch to date suggests that couples undergoing assisted reproductive technology (ART) are at a high risk of experiencing sexual difficulties.AimThis dyadic cross-sectional study aimed to provide a better understanding of the infertility-specific personal (ie, emotional, mind-body) and relational stressors associated with the sexual desire, orgasm, arousal, and sexual satisfaction of infertile couples seeking ART.MethodsThe sample included 185 mixed-sex infertile couples seeking ART. Participants completed online the Fertility Quality of Life tool and either the Female Sexual Function Index or the International Index of Erectile Function. Data were analyzed using path analyses based on the Actor-Partner Interdependence Model.OutcomesIndividuals’ own and their partners’ sexual function (desire, orgasm, arousal domains) and sexual satisfaction.ResultsFor men and women, infertility-related emotional stressors were associated with their own and their partner's lower sexual desire. For women, experiencing greater infertility-related emotional stressors was also associated with their partner's lower sexual satisfaction. While experiencing greater infertility-related mind-body stressors was not associated with men and women's own sexual desire, arousal, orgasm, and satisfaction, for women, it was associated with their partner's lower sexual arousal. Lastly, for men and women, infertility-related relational stressors were associated with their own lower sexual arousal, as well as with their own and their partner's lower sexual satisfaction. For women, experiencing greater relational stressors was also associated with their own lower sexual desire and orgasm.Clinical ImplicationsInterventions addressing the emotional, mind-body, and relational spheres of infertile couples seeking ART may help facilitate improvements in sexual function and satisfaction and better serve their needs.Strengths & LimitationsThis study included a large sample of couples. Our sample was heterogeneous with regards to couples’ cause of infertility and treatment stage. The use of an infertility-related measure allowed us to better capture personal and relational stressors specific to couples seeking ART. Given the cross-sectional design of our study, causality between infertility-related stressors and sexual function and satisfaction cannot be inferred. Our sample included predominantly White, mixed-sex individuals with a high level of education, which may reduce the generalizability of our findings.ConclusionCouples’ subjective experience of infertility and treatment (personal and relational stressors) seems to be strongly associated with their sexual health, allowing us to identify potential targets of intervention with couples seeking ART.S.E. Amiri, A Brassard, N.O. Rosen, et al. Sexual Function and Satisfaction in Couples with Infertility: A Closer Look at the Role of Personal and Relational Characteristics. J Sex Med 2021;18:1984–1997.