John Bancroft

Changes in erectile responsiveness during androgen replacement therapy

Erections in response to erotic films and fantasies were measured in eight hypogonadal men, with and without androgen replacement, and eight age-matched controls. Erections to films in the hypogonadal men did not differ from those of the controls and were not affected by androgen replacement. Erections to fantasy were significantly smaller and slower to develop in the hypogonadal men and did show significant improvement during androgen replacement. These preliminary results suggest that erections to certain types of stimuli are relatively independent of androgens, whereas the response to fantasy may be androgen dependent. The implications of these findings are discussed.

Mood, sexuality, hormones, and the menstrual cycle. II: Hormone levels and their relationship to the premenstrual syndrome

&NA; In women with premenstrual syndrome, negative changes start soon after ovulation gradually increasing as the corpus luteum develops, and reach a maximum during the last 5 days of the luteal phase. They decline rapidly once menstruation starts, disappearing within one or two days of ovarian steroids reaching baseline levels. Positive moods are at maximum when preovulatory estradiol reaches its peak. A comparison of hormone levels in women with high and low degrees of cyclical mood change showed no difference in progesterone, estradiol, testosterone, or androstenedione.

Psychiatric Morbidity and Referral on Two General Medical Wards

Psychiatric morbidity among 230 medical inpatients was determined by a two-stage screening procedure, using the General Health Questionnaire and Standardized Psychiatric Interview. Of these patients, 23% were considered psychiatrically ill, affective disorders being the commonest illnesses encountered; and 27 (12%) were psychiatrically referred. While referral was related to severity of psychiatric illness and previous psychiatric illness, the degree to which the psychiatric illness obtruded or created problems in management appeared more crucial in determining referral. In half of those with psychiatric illness the problems did not appear to have been detected or dealt with. It is suggested that medical clerking should routinely include questions about mood and psychological responses to illness.

Steroid hormones, the menopause, sexuality and well-being of women

One hundred and forty-one women, aged 40-60 years, recruited from the community were assessed with an initial interview, plus four interviews at intervals of 1 week and blood samples. The objective was to investigate the determinants of sexuality and well-being in this sample. Measures included interview ratings of sexual function, Frenken Sexual Experience Scales and the Multiple Affect Adjective Check List. Determinants evaluated, using multiple regression analysis, included age, menopausal status, BMI, smoking, ovarian steroids and adrenal androgens. None of the hormonal parameters significantly predicted measures of sexuality; the most important predictors were other aspects of the sexual relationship, sexual attitudes and measures of well-being. The best predictor of both well-being and depression was tiredness. The only hormone positively related to well-being was dehydroepiandrosterone (DHEA).

Mood, Sexuality, Hormones and the Menstrual Cycle. I. Changes in Mood and Physical State: Description of Subjects and Method

&NA; Mood and physical symptoms through the menstrual cycle were investigated in 55 women with normal ovulatory cycles. One‐third had attended a clinic with severe premenstrual syndrome (clinic PMS group); the remainder were volunteers either with a history of PMS (non‐clinic PMS group) or without (no PMS group). Each cycle was divided into six hormonally distinct phases on the basis of repeated hormone measurement. Self‐ratings of “well‐being” reached their maximum in the late follicular phase, declining throughout the luteal half of the cycle. This pattern was pronounced and statistically significant in the “clinic” and “nonclinic PMS” groups. In all three groups, “physical distress” increased during the second half of the cycle to reach a maximum in the late luteal phase. A clear temporal relationship was therefore demonstrated between mood, physical state, and hormonal phases of the cycle. It remains uncertain whether changes in the “clinic” group were extreme forms of a normal pattern or were qualitatively different.

Mood, Sexuality, Hormones, and the Menstrual Cycle. III. Sexuality and the Role of Androgens

&NA; Sexual interest and activity at different stages of the menstrual cycle was recorded by 55 women with normal ovulatory cycles. In women with marked cyclical mood change, there was an associated cyclical pattern of sexual feelings. Subjective sexuality independent of mood change, was maximal in the mid‐follicular (i.e., postmenstrual) and late luteal (i.e., premenstrual) phases. Sexual activity was maximal in the mid‐follicular phase. There was no evidence of a periovulatory increase in sexual interest or activity. Mean testosterone levels were correlated with masturbation frequency but not with sexuality involving the partner. A weak association between testosterone and life style (i.e., in full‐time work or a housewife) was also evident.

The effects of steroidal contraceptives on the well-being and sexuality of women: a double-blind, placebo-controlled, two-centre study of combined and progestogen-only methods

A placebo-controlled, double-blind study was carried out to assess the direct hormonal effects of combined and progestogen-only oral contraceptives on well-being and sexuality of women in two contrasting cultures. One-hundred-fifty women, who had been sterilised or whose partners had been vasectomised, were recruited from two centres-Manila, Philippines, and Edinburgh, Scotland. After one month pretreatment assessment, women were randomly assigned to one of three treatments (combined oral contraceptive (COC), progestogen-only pill (POP), or placebo; 50 within each treatment group, 25 per centre) and continued on treatment for four months. Assessment was by daily ratings, questionnaires and interviews. The COC adversely affected sexuality in the Edinburgh women, with 12 of the 25 women in this group also reporting the side effect of reduced sexual interest. There were modest negative effects of the combined pill on mood, more noticeable in the Edinburgh women. The POP was associated with no adverse effects on sexuality and some improvement in well-being in both centres. Possible explanations for the apparent lack of adverse effects in the Manila women are discussed. The negative effects reported may be less evident in women using the COC for contraceptive purposes but may lead to discontinuation in some women and warrant further investigation.

Sexual responsiveness in diabetic women.

SummarySexual responsiveness in 82 Type 1 (insulin-dependent) diabetic women was compared with that of 47 normal control subjects, using an interview method for rating various aspects of sexual response, and attitude questionnaires. The diabetic women were questioned about symptoms of autonomic neuropathy, and cardiovascular autonomic nerve function tests were performed. There were differences between the two groups in the reports of vaginal lubrication, but in most other respects the groups were similar. The diabetic women were not less orgasmic, and reported significantly fewer unpleasant feelings during sexual intercourse. They saw themselves and their husbands as less ‘potent’ than did the normal subjects. The possible enhancing effect of diabetes on the marriage of some diabetic women possibly counteracted the relatively mild physiological deficits involved. There was very little difference in sexual response between women with and without symptomatic autonomic neuropathy.

Blunting of neuroendocrine responses to infusion of L-tryptophan in women with perimenstrual mood change.

The neuroendocrine response to L-tryptophan infusion was measured at two stages of the menstrual cycle, premenstrually and postmenstrually, in 13 women with and 13 women without premenstrual depression (the MC and NMC groups respectively). Previous studies have shown that in non-depressed women, this challenge test results in an increase in circulating prolactin and growth hormone. In depressed women both responses are blunted. In this study the growth hormone and cortisol responses were smaller in the MC group than the NMC group on both occasions. The prolactin response was blunted premenstrually compared with postmenstrually in both groups. These findings suggest that women who experience premenstrual depression may have neuroendocrine abnormalities throughout the cycle. The neurotransmitter abnormalities reflected in these altered endocrine responses appear to interact with neuroendocrine changes that normally occur premenstrually resulting in a vulnerability to depression at that phase of the cycle.

Mood, sexuality, oral contraceptives and the menstrual cycle

4112 women completed a retrospective questionnaire indicating when during their last menstrual cycle they felt their well-being and sexual interest to be at their best and worst. The commonest pattern was for well-being to be lowest during the premenstrual and highest during the postmenstrual week. Sexual interest was strongly associated with well-being, suggesting that variations of well-being have a powerful effect on sexuality in the majority of women. Oral contraceptive users, though broadly similar in their reported pattern, were less likely to show peaks and troughs of well-being and highs and lows of sexual interest. This was most evident in the subgroup of monophasic pill users who showed the least tendency to variations in both well-being and sexual interest, and a greater tendency to show either peaks or troughs of well-being during menstruation. Triphasic pill users were intermediate between monophasic and non-pill users.