Brain activation patterns in women with acquired hypoactive sexual desire disorder and women with normal sexual function: a cross-sectional pilot study

Abstract

Objective To examine and compare brain activation patterns of premenopausal women with normal sexual function and those with hypoactive sexual desire disorder (HSDD) during viewing of validated sexually explicit film clips. Design Cross-sectional pilot study. Setting University-based clinical research center. Patient(s) Premenopausal women. Intervention(s) None. Main Outcome Measure(s) Areas of brain activation during viewing of sexually explicit film clips. Result(s) Women with normal sexual function showed significantly greater activation of the right thalamus, left insula, left precentral gyrus, and left parahippocampal gyrus in comparison with women with HSDD, who exhibited greater activation of the right medial frontal gyrus and left precuneus regions. Conclusion(s) Women with HSDD may have alterations in activation of limbic and cortical structures responsible for acquiring, encoding, and retrieving memory, the processing and memory of emotional reactions, and areas responsible for heightened attention to one’s own physical state.

Mechanism of action of flibanserin, a multifunctional serotonin agonist and antagonist (MSAA), in hypoactive sexual desire disorder

“…15 Regardless of the disorder's label, 15,16 if a woman suffers from prolonged loss of sexual desire that causes her distress and cannot be explained by problematic relationships, stressors, or medical conditions, then it is considered to be a disorder of reward processing for sex, and as such is hypothetically mediated by inefficient information processing in reward circuits. [1][2][3][4][5][6] Disorder of Sexual Interest and Desire, or of Arousal?…”

“…3,4,8,18 However, until recently, primary disorders of interest in and desire for sex have not been well recognized. [1][2][3][4][5][6] Recent changes in diagnostic criteria for sexual disorders have arguably made it even more difficult to reach a primary diagnosis of loss of interest in and desire for sex. 15 Confusion exists because some diagnostic systems now merge disorders of interest and desire in women with disorders of arousal, while other diagnostic systems keep them separate.…”

“…1 Recent research suggests that these same brain circuits are also involved when patients experience a lack of interest in and desire for sex. 5,6 Studies also indicate that a new therapeutic agent, flibanserin, improves interest in and desire for sex by hypothetically targeting these circuits and causing the release of dopamine and norepinephrine while also reducing the release of serotonin. [7][8][9][10][11]…”

Advocating For a Transdisciplinary Perspective in Sexual Medicine

“…Yet, evidence from laboratories (including fMRI studies) around the world supporting a mind/body integration becomes more abundant with each year that passes [8][9][10]. For example, a very recent fMRI study demonstrated how neurons in the prefrontal cortex contribute to cognitive and emotional processes and in doing so may both enhance and disrupt sexual desire and function [7].…”

Improving prospects for treating hypoactive sexual desire disorder (HSDD): development status of flibanserin

“…Although the underlying pathophysiology is not completely understood, functional Magnetic resonance imaging (MRI) studies reveal persistent changes in brain activation and deactivation patterns in women with HSDD, compared with women with no history of HSDD. [11][12][13] Thus, treatment options that include pharmacotherapy to correct or counteract these alterations in brain function are likely to be effective in treating HSDD or able to serve in a combined pharmacological and psychological approach. Currently, there are no approved pharmacotherapies for HSDD in the USA.…”