Andrea Burri

The acute effects of intranasal oxytocin administration on endocrine and sexual function in males

The role of the neuropeptide oxytocin (OT) ranges from the modulation of neuroendocrine physiological effects to the establishment of complex social and bonding behaviours. Experimental studies in animals, as well as case reports in humans, suggest that OT affects different aspects of sexual behaviour and has predominantly facilitating properties for sexual appetence and performance. Using a previously established experimental paradigm of sexual arousal and masturbation-induced orgasm, this study investigated the acute effects of intranasal OT application (24I.U.) on endocrine parameters and measures of sexual appetence and function in healthy men (n=10). In a double-blind, placebo-controlled, balanced cross-over design, sexual arousal, and orgasm were induced by an erotic film and masturbation. In addition to the continuous recording of endocrine (OT, cortisol, prolactin, epinephrine, norepinephrine) and cardiovascular data (heart rate), parameters of appetitive, consummatory, and refractory sexual behaviour were assessed using the acute sexual experience scale (ASES). OT plasma levels were significantly elevated after intranasal OT throughout the whole experiment (>60 min). In addition, OT treatment induced significantly higher increases in epinephrine plasma levels during sexual activity without affecting cortisol levels, prolactin levels or heart rate. OT treatment did not alter appetitive, consummatory, and refractory sexual behaviour according to the ASES. However, when subjects were asked about their subjective perception of whether OT or placebo had been applied, eight out of 10 subjects in the OT group answered correctly, thus pointing to an altered perception of arousal. In conclusion, intranasally administered OT leads to a marked increase in OT plasma levels together with increased secretion of catecholamines when subjects are engaged in sexual activity in a laboratory setting. As the effects of OT on sexual behaviour were equivocal, future studies should examine possible facilitating effects further by including males, females, and couples in a field setting, taking into account that OT exerts the most prominent behavioural effects in pair bond formations.

Recent and Lifelong Sexual Dysfunction in a Female UK Population Sample: Prevalence and Risk Factors

INTRODUCTION To date, no studies have tried to explore the prevalence and risk factors of recent and lifelong female sexual dysfunction (FSD) in the United Kingdom using validated questionnaires for the assessment of symptom severity and levels of associated sexual distress. AIM To estimate the prevalence and comorbidity of recent and lifelong FSD and to further identify potential psychosocial and behavioral risk factors in a nationally representative sample of UK women. METHODS One thousand four hundred eighty-nine unselected female twin individuals aged 18-85 years. Validated questionnaires, such as the Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale, were used for the assessment of symptom severity and degree of sexual distress. MAIN OUTCOME MEASURES Prevalence and comorbidity of recent and lifelong FSD according to the FSFI cutoff points and the existence of sexual distress. Lifelong FSD refers to an individuals average sexual function ever since they have been sexually active. We further calculated odds ratios (ORs) with 95% confidence interval for FSD. RESULTS We found that 5.8% of women reported any recent sexual dysfunction and 15.5% reported any lifelong sexual dysfunction. Hyposexual desire was the most prevalent recent and lifelong sexual complaint (21.4% and 17.3%, respectively). High intercorrelations were found for both recent and lifelong FSD (r=0.3-0.7). The most common independent, clinical predictor of recent and lifelong FSD diagnosis was relationship dissatisfaction (OR 1.2-4.5). Experience of abuse (OR 1.6-2.1), increased anxiety, and obsessive compulsive behavior were the most common predictors for lifelong FSD. CONCLUSIONS The study provides the first UK population-based assessment of recent and lifelong FSD using validated outcome measures and accounting for sexual distress. Our results indicate that FSD is common in the general population and is influenced by psychosocial factors with different pathoetiologies underlying recent and lifelong FSD.

The Female Sexual Function Index: Translation and Validation of an Iranian Version

INTRODUCTION Female sexual dysfunction (FSD) is a prevalent problem in the female population in Iran. A subjective assessment instrument that allows cross-cultural comparison of FSD is urgently needed. AIM The aims of the study were to translate, validate, and enhance cross-cultural comparability of an Iranian version (IV) of the Female Sexual Function Index (FSFI)-the IV-FSFI. METHODS A total of 448 women (19-54 years, mean 29.7, standard deviation 7.3) from five different Iranian outpatient obstetrics and gynecology clinics were eligible for this study. The IV-FSFI was developed through forward and backward translation, revision by a research team, and a subsequent pilot study. After an interview for clinical diagnosis of FSD based on the Diagnostic and Statistical Manual of Mental Disorders, all participants completed the IV-FSFI for the validation study. Three hundred sixty-two women completed the IV-FSFI again, 4 weeks after the first visit. MAIN OUTCOME MEASURES Test-retest reliability was determined by Pearsons product-moment correlations. Reliability was tested using Cronbachs alpha coefficient. Construct validity was evaluated by principal component analysis using varimax rotation and by subsequent confirmatory factor analysis (CFA). Discriminant validity was assessed with between-groups analysis of variance. RESULTS The overall test-retest reliability coefficients were high for each domain of the IV-FSFI (r ranging from 0.73 to 0.86) and the internal consistencies within the acceptable range (α from 0.72 to 0.90). Principal component analysis with varimax rotation revealed a best fitting five-factor structure similar to the original FSFI (χ(2) = 2.1, degree of freedom = 17, P < 0.001). CFA confirmed the underlying domain structure, supporting the factorial validity of the IV-FSFI. CONCLUSIONS In conclusion, the newly developed IV-FSFI has demonstrated to be a reliable and valid instrument with good psychometric properties that allows a quick and accurate preliminary screening of women with unknown sexual health status in clinics and other medical settings.

A genome-wide association study of early menopause and the combined impact of identified variants

Early menopause (EM) affects up to 10% of the female population, reducing reproductive lifespan considerably. Currently, it constitutes the leading cause of infertility in the western world, affecting mainly those women who postpone their first pregnancy beyond the age of 30 years. The genetic aetiology of EM is largely unknown in the majority of cases. We have undertaken a meta-analysis of genome-wide association studies (GWASs) in 3493 EM cases and 13 598 controls from 10 independent studies. No novel genetic variants were discovered, but the 17 variants previously associated with normal age at natural menopause as a quantitative trait (QT) were also associated with EM and primary ovarian insufficiency (POI). Thus, EM has a genetic aetiology which overlaps variation in normal age at menopause and is at least partly explained by the additive effects of the same polygenic variants. The combined effect of the common variants captured by the single nucleotide polymorphism arrays was estimated to account for ∼30% of the variance in EM. The association between the combined 17 variants and the risk of EM was greater than the best validated non-genetic risk factor, smoking.

Emotional Intelligence and Its Association with Orgasmic Frequency in Women

INTRODUCTION Up to 30% of women suffer from female orgasmic disorder (FOD)-the second most common type of female sexual dysfunction. FOD has been acknowledged to be multifactorial and recent research has implicated the importance of psychosocial risk factors. AIM The aim of this study is to investigate whether normal variations in emotional intelligence--the ability to identify and manage emotions of ones self and others--are associated with orgasmic frequency during intercourse and masturbation. To our knowledge, this is the first such study in a large unselected population. METHODS A total of 2035 women from the TwinsUK registry completed questionnaires relating to emotional intelligence and sexual behavior. Global emotional intelligence was measured using the Trait Emotional Intelligence Questionnaire-Short Form (TEIQue-SF). Orgasmic frequency was assessed using two self-constructed questions. MAIN OUTCOME MEASURES Using Spearmans rank correlation and quartile logistic regression, we investigated whether variations in emotional intelligence are associated with female orgasmic frequency during intercourse and masturbation. RESULTS Emotional intelligence was not associated with the potential confounders of age and years of education, nor did we find a significant association between emotional intelligence and potential risk factors for FOD such as age, body mass index, physical or sexual abuse, or menopause. We found emotional intelligence to be positively correlated with both frequency of orgasm during intercourse (r = 0.13, P < 0.001) and masturbation (r = 0.23, P < 0.001). Women in the lowest quartile of emotional intelligence had an approximate twofold increased risk of infrequent orgasm (Intercourse = odds ratio [OR] 2.3, 95% confidence interval [CI] 1.4-3.9; Masturbation = [OR] 1.8, [CI] 1.3-2.5). CONCLUSION Low emotional intelligence seems to be a significant risk factor for low orgasmic frequency. Consideration of this behavioral risk factor may need to be incorporated into research into FOD and possible treatment approaches.

Childhood Trauma and PTSD Symptoms Increase the Risk of Cognitive Impairment in a Sample of Former Indentured Child Laborers in Old Age

A growing body of evidence suggests a link between early childhood trauma, post-traumatic stress disorder (PTSD) and higher risk for dementia in old age. The aim of the present study was to investigate the association between childhood trauma exposure, PTSD and neurocognitive function in a unique cohort of former indentured Swiss child laborers in their late adulthood. To the best of our knowledge this is the first study ever conducted on former indentured child laborers and the first to investigate the relationship between childhood versus adulthood trauma and cognitive function. According to PTSD symptoms and whether they experienced childhood trauma (CT) or adulthood trauma (AT), participants (n = 96) were categorized as belonging to one of four groups: CT/PTSD+, CT/PTSD-, AT/PTSD+, AT/PTSD-. Information on cognitive function was assessed using the Structured Interview for Diagnosis of Dementia of Alzheimer Type, Multi-infarct Dementia and Dementia of other Etiology according to ICD-10 and DSM-III-R, the Mini-Mental State Examination, and a vocabulary test. Depressive symptoms were investigated as a potential mediator for neurocognitive functioning. Individuals screening positively for PTSD symptoms performed worse on all cognitive tasks compared to healthy individuals, independent of whether they reported childhood or adulthood adversity. When controlling for depressive symptoms, the relationship between PTSD symptoms and poor cognitive function became stronger. Overall, results tentatively indicate that PTSD is accompanied by cognitive deficits which appear to be independent of earlier childhood adversity. Our findings suggest that cognitive deficits in old age may be partly a consequence of PTSD or at least be aggravated by it. However, several study limitations need to considered. Consideration of cognitive deficits when treating PTSD patients and victims of lifespan trauma (even without a diagnosis of a psychiatric condition) is crucial. Furthermore, early intervention may prevent long-term deficits in memory function and development of dementia in adulthood.

The Genetics and Epidemiology of Female Sexual Dysfunction: A Review

INTRODUCTION Female sexual dysfunction (FSD) is an often underestimated and common problem with serious effects on womens quality of life. Despite a high overall prevalence in the female population--exceeding that of male sexual dysfunction--until recently, little research has focused on this area. In contrast to the successful advances of genetic research in a wide variety of human diseases, genetic exploration in FSD lags far behind. AIM The aim of this review is to acquaint the reader with the current behavioral and molecular genetic research in the field of FSD. Methods. Because of the heterogeneity of the included studies, we are providing a nonsystematic review. RESULTS Recent epidemiological and candidate gene studies have suggested a strong genetic influence on female sexual functioning. While these findings provide a clear rationale for more genetic research in the field, they need to be replicated on a much larger scale to be definitive. CONCLUSIONS Successful identification of biomarkers and novel genes underlying FSD should improve the diagnosis, identification, and treatment of different subgroups. Future pharmacotherapeutic approaches to FSD will benefit from novel targets and the concept that individual variations have a genetic component may help destigmatize our views of sexual problems. Burri AV, Cherkas LM, and Spector TD.

Replication of Psychometric Properties of the FSFI and Validation of a Modified Version (FSFI-LL) Assessing Lifelong Sexual Function in an Unselected Sample of Females

INTRODUCTION The 19-item Female Sexual Function Index (FSFI) is an easy-to-administer self-report questionnaire, allowing multidimensional assessment of female sexual function and female sexual dysfunction (FSD) over the past 4 weeks. However, studies aiming to dissect the underlying pathoetiology-especially biophysiological factors-often require assessment of sexual function over a broader time frame. AIM The purpose of this study was to develop a modified version of the widely used FSFI which allows assessment of womens lifelong sexual function-the FSFI-LL-and to evaluate the psychometric properties and aptness of this new version. METHODS A total of 1,589 unselected female twins from the TwinsUK registry completed both original and new versions of the FSFI. After applying exclusion criteria, 1,489 women were eligible for this study. MAIN OUTCOME MEASURE Reliability was tested using Cronbachs alpha coefficient. Construct validity was evaluated by exploratory factor analysis and confirmatory factor analysis (CFA). Domain response differences between the original FSFI and the FSFI-LL were assessed using unpaired t-tests. RESULTS The modified FSFI-LL showed adequate internal consistency reliabilities for all six dimensions and the total score (Cronbachs α = 0.79 - 0.92). Principal component analysis resulted in a best fitting five-factor solution. CFA confirmed the underlying domain structure to be same as for the FSFI, supporting the factorial validity of the modified questionnaire. In addition, successful replication of the psychometric properties of the original FSFI was demonstrated. CONCLUSIONS The results provide evidence of good reliability and validity of the FSFI-LL. This modified version therefore represents a suitable tool for screening lifelong sexual function in women and can be applied in trials investigating etiological factors contributing to more enduring patterns of FSD.

ORIGINAL RESEARCH—ANATOMY/PHYSIOLOGY: Genetic and Environmental Influences on self-reported G-Spots in Women: A Twin Study

INTRODUCTION There is an ongoing debate around the existence of the G-spot--an allegedly highly sensitive area on the anterior wall of the human vagina. The existence of the G-spot seems to be widely accepted among women, despite the failure of numerous behavioral, anatomical, and biochemical studies to prove its existence. Heritability has been demonstrated in all other genuine anatomical traits studied so far. AIM To investigate whether the self-reported G-spot has an underlying genetic basis. METHODS 1804 unselected female twins aged 22-83 completed a questionnaire that included questions about female sexuality and asked about the presence or absence of a G-spot. The relative contribution of genetic and environmental factors to variation in the reported existence of a G-spot was assessed using a variance components model fitting approach. MAIN OUTCOME MEASURES Genetic variance component analysis of self-reported G-spot. RESULTS We found 56% of women reported having a G-spot. The prevalence decreased with age. Variance component analyses revealed that variation in G-spot reported frequency is almost entirely a result of individual experiences and random measurement error (>89%) with no detectable genetic influence. Correlations with associated general sexual behavior, relationship satisfaction, and attitudes toward sexuality suggest that the self-reported G-spot is to be a secondary pseudo-phenomenon. CONCLUSIONS To our knowledge, this is the largest study investigating the prevalence of the G-spot and the first one to explore an underlying genetic basis. A possible explanation for the lack of heritability may be that women differ in their ability to detect their own (true) G-spots. However, we postulate that the reason for the lack of genetic variation-in contrast to other anatomical and physiological traits studied-is that there is no physiological or physical basis for the G-spot.

A multivariate twin study of female sexual dysfunction

INTRODUCTION There is little work on the etiology of female sexual dysfunction (FSD), a highly contentious and heterogeneous disorder from classification and clinical perspectives. Clarifying causative mechanisms may enhance current psychiatric nosology. AIM To elucidate the structure of genetic and environmental risk factors underlying the major subtypes of FSD. METHODS Self-report questionnaires and multivariate twin model fitting on a population-based adult twin register (TwinsUK, London) including 1,489 female twins aged 18 to 85, comprising 244 MZ pairs, 189 DZ pairs, and 623 women whose co-twins did not participate. MAIN OUTCOME MEASURES Scores on the Female Sexual Function Index-Lifelong and its six dimensions (desire, arousal, lubrication, orgasm, satisfaction, and pain) were subject to univariate and multivariate variance component analysis. RESULTS The best-fitting multivariate model was an ACE Cholesky model, in which both additive genetic effects and non-shared environmental effects loaded on four FSD dimensions. There was significant genetic sharing between desire, arousal, lubrication and orgasm, but there was also significant genetic sharing between arousal, lubrication and orgasm independent of desire. These genetic loadings were small to modest effects (7% to 33%). Bivariate heritabilities suggested that a third of the covariance between these dimensions was genetic. Desire shared the least amount of genetic association with lubrication and orgasm. Non-shared environmental effects (which were stronger than genetic effects) were somewhat more dimension-specific. CONCLUSIONS FSD is not etiologically homogeneous. There are at least two genetic factors to FSD symptomatology, and a tendency for more dimension-specific non-shared environmental factors as a more important indicative of unique factors involved in specific types of sexual problems reported by women. These results emphasize genetic factors as possible organizing principles for an etiologically based classification approach of FSD.