Neuroendocrinological Aspects of a Tailored Hormonal Contraception

Menstrual Cycle-Driven and Day-to-Day Changes in Sexual Desire

Sexual Desire in Women: Paradoxical and Non-Linear Associations with Depression and Anxiety

Validity and Clinically Meaningful Changes in the Psychosexual Daily Questionnaire and Derogatis Interview for Sexual Function Assessment: Results From the Testosterone Trials

Reports an error in "Using 26,000 diary entries to show ovulatory changes in sexual desire and behavior" by Ruben C. Arslan, Katharina M. Schilling, Tanja M. Gerlach and Lars Penke (Journal of Personality and Social Psychology, Advanced Online Publication, Aug 27, 2018, np). In the original article the number of participants available for robustness checks should have been 1,054, not 1,043; this applies to the third sentence in the abstract, the first sentence of the second paragraph in the Participants section, the first sentence of the second paragraph in the Robustness Checks section, and the subsample size of women in Table 3. The correct number of naturally cycling usable data should have been 429, not 421. The correct number of diary days should have been 26,680, not 25,948. The correct percentage of diary days in the fourth sentence in the Exclusion Criteria section should have been 5%. Figure 1 should have included guessing hypotheses (n 40) and long diary interruptions (n 41) as further reasons for exclusion, and an error in the effsize R package led to the reporting of inflated effect sizes for the differences between hormonal contraceptive users and non-users in Table 1. Figure 1, Table 1, and Table 3 have been corrected. All versions of this article have been corrected. (The following abstract of the original article appeared in record 2018-41799-001.) Previous research reported ovulatory changes in women's appearance, mate preferences, extra- and in-pair sexual desire, and behavior, but has been criticized for small sample sizes, inappropriate designs, and undisclosed flexibility in analyses. In the present study, we sought to address these criticisms by preregistering our hypotheses and analysis plan and by collecting a large diary sample. We gathered more than 26,000 usable online self-reports in a diary format from 1,054 women, of which 429 were naturally cycling. We inferred the fertile period from menstrual onset reports. We used hormonal contraceptive users as a quasi-control group, as they experience menstruation, but not ovulation. We probed our results for robustness to different approaches (including different fertility estimates, different exclusion criteria, adjusting for potential confounds, moderation by methodological factors). We found robust evidence supporting previously reported ovulatory increases in extra-pair desire and behavior, in-pair desire, and self-perceived desirability, as well as no unexpected associations. Yet, we did not find predicted effects on partner mate retention behavior, clothing choices, or narcissism. Contrary to some of the earlier literature, partners' sexual attractiveness did not moderate the cycle shifts. Taken together, the replicability of the existing literature on ovulatory changes was mixed. We conclude with simulation-based recommendations for reading the past literature and for designing future large-scale preregistered within-subject studies to understand ovulatory cycle changes and the effects of hormonal contraception. Interindividual differences in the size of ovulatory changes emerge as an important area for further study. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Many women experience sexual side effects, such as decreased libido, when taking hormonal contraceptives (HCs). However, little is known about the extent to which libido recovers after discontinuing HCs, nor about the timeframe in which recovery is expected to occur. Given that HCs suppress the activities of multiple endogenous hormones that regulate both the ovulatory cycle and women's sexual function, resumption of cycles should predict libido recovery. Here, using a combination of repeated and retrospective measures, we examined changes in sexual desire and partner attraction (among partnered women) across a three-month period in a sample of Natural Cycles users (Survey 1: n = 1596; Survey 2: n = 550) who recently discontinued HCs. We also tested whether changes in these outcomes coincided with resumption of the ovulatory cycle and whether they were associated with additional factors related to HC use (e.g., duration of HC use) or relationship characteristics (e.g., relationship length). Results revealed that both sexual desire and partner attraction, on average, increased across three months after beginning to use Natural Cycles. While the prediction that changes in sexual desire would co-occur with cycle resumption was supported, there was also evidence that libido continued to increase even after cycles resumed. Together, these results offer new insights into relationships between HC discontinuation and women's sexual psychology and lay the groundwork for future research exploring the mechanisms underlying these effects.

In 1960, the first contraceptive pill was introduced. Nowadays, over 100 million women worldwide use some form of hormonal contraception (HC). General side effects of HC are well known, but research on the effects of HC on female sexual functioning and desire remains underfunded and scarce. Starting with the combined contraceptive pill, most methodologically sound studies found no negative impact on sexual desire in the majority of pill starters, while a negative effect was seen in 15%. When using the vaginal ring, most women didn’t report adverse sexual desire changes, although some studies observed an increase in sexual desire. Too few recent studies investigating the link between the progestogenonly pill, the subdermal implants or the injectable progestin and female sexual functioning were available to make a conclusion on their effect. Next, intrauterine devices (IUD) did not influence sexual functioning in the majority of women. Also, the role of other biopsychosocial factors in the process of female sexual functioning was investigated. HC use led to reduced androgen levels, but most studies didn’t observe an effect on sexual desire. Although most women using HC probably don’t experience change in their sexual functioning, a significant minority will. It is important to pay attention to those at risk for developing an impaired sexual function or even a sexual dysfunction. Female sexual functioning is a complex process, not merely driven by androgens. Our review of the recent literature states the urgent need for prospective, randomized trials, in starters of HC, paying attention to a range of relevant biopsychosocial factors.

Introduction We do not know what effect the menstrual cycle has on female sexual desire or behavior. Although some researchers have claimed to demonstrate that female sexuality shows robust changes across the cycle, with a peak close to ovulation, when fertility is high (Bullivant et al., 2004; Caruso et al., 2013; Roney & Simmons, 2013), not all research comes to this conclusion (Bancroft et al., 1983; Clayton et al., 1999). Moreover, a major limitation of this research is the lack of attention to individual differences: the idea that not all women experience cyclical changes and that there may be important differences across women in how they change across the cycle (Kiesner et al. 2023). Objective The objectives are: (1) test for main effects of the menstrual cycle (or hormonal-contraception cycle) on changes in sexual desire (general and for masturbation) and sexual activity (partnered and masturbation); (2) test for individual differences in mean levels of these variables, and (3) test for individual differences in cyclical changes (menstrual cycle and contraceptive cycle) in these variables. Methods A sample of n = 243 university-aged females (M = 22.4 years; SD = 2.3) completed daily questionnaires for two menstrual cycles (M = 51 daily reports per participant; n = 84 using hormonal contraception (HCs) and n = 159 not using HCs). Daily measures were obtained for: sexual desire, desire to masturbate, partnered sexual activity, and masturbation. Mixed models with random slopes and intercepts were used for analyses. Results When data were aggregated across participants, there was a significant but small mid-cycle increase in sexual desire and activity only for non-HC participants (Table 1 and Fig. 1). Variance explained by these average effects of the menstrual cycle ranged from .35% (partnered sex) to 1.29% (sexual desire) for non-HC users. HC users and non-users showed substantial individual differences in their mean levels across all four variables, with variance explained ranging from 11% to 32% (random intercepts; Table 1). Finally, non-HC participants showed significant individual differences in how all measures of sexual desire and activity change across the menstrual cycle (random slopes), whereas HC users showed individual differences in slopes only for the two measures of desire (Table 1). Fig. 2 presents individual slopes for 23 non-HC participants on all four measures, demonstrating that while some women show a mid-cycle increase, others show a perimenstrual increase, and others no cyclical changes (note that these participants were selected to demonstrate variability on the sexual desire measure). Conclusions The present study provides strong evidence that menstrual cycle influences on female sexuality are very weak when considering aggregated data across the full sample (average effects). Moreover, there is significant variability across individuals in how sexuality changes across the menstrual cycle, and thus it is important that we adapt our theories and language to avoid the assumption and inference that mid-cycle increases in sexuality are universal or even common. This has clinical application in contextualizing what is “normal” for women to expect, and these data clearly show that variability and individuality should be considered the norm. Disclosure No.

Gender-affirming medical therapy (GAMT), including puberty blockers (PB) and gender-affirming hormone therapy (GAHT), is part of the transition for many transgender and nonbinary (TGNB) individuals; however, there have been few studies investigating sexual function and desire during GAMT, and no reports on individuals who received PB. We aimed to qualitatively evaluate the sexual experience of TGNB individuals during GAMT and identify significant and consistent themes that arose from our analysis. We performed an Institutional Review Board-approved two-institutional study. Our study group (n = 63) included individuals who had received or were receiving puberty blockers (GnRHa) and/or GAHT (estrogen or testosterone) at the time of enrollment. The enrolled subjects were interviewed using an open-ended topic-based guide, and qualitative analysis was performed by hand coding the interview transcripts using Constructivist Grounded Theory qualitative methods until thematic saturation was reached. A total of 63 TGNB subjects (33 transgender women, 20 transgender men, 10 non-binary, or another gender identity), aged 18-25years, were interviewed about the effect of GAMT on their sexual function and desire. Our analysis uncovered several themes that were consistent among subjects from different subgroups. Half the participants reported feeling no regrets regarding GAMT therapy, and the other half reported that they wished they had started GAMT sooner. Two notable themes were identified: many subjects reported "less dysphoria" as a positive change in sexual desire, and others reported more enjoyable sexual experiences since being on GAMT. The subgroup of subjects with a history of GnRHa use did not differ in their experiences and responses from the subgroup on GAHT alone, which indicated no negative effect of GnRHa on sexual function. Our results illuminate the need for providers to discuss the potential impacts of GAMT on sexual function and desire with transgender and nonbinary patients. An important strength of this study is the open-ended interview design. This design allowed subjects to speak freely and openly about their experience. One limitation is a relatively small sample size, particularly of the puberty blocker (GnRHa) subgroup. A more robust sample is needed to further investigate the effect of GAMT on sexual function and desire in TGNB individuals, specifically those receiving GnRHa. Themes were similar for all subjects; however, the most prominent theme among our subjects was that the positive changes in sexual function and desire outweighed any negative changes.

Introduction Gender affirming hormone therapy (GAHT) is part of the transition for many transgender and nonbinary (TGNB) individuals. Additionally, it has become increasingly more common for TGNB youth to receive puberty blockers (GnRH agonist) to halt the pubertal progression. There have been few studies investigating sexual function and desire either during or after puberty blockers (PB) and/or GAHT. Objective Our aim was to qualitatively evaluate the sexual experience of TGNB individuals during or following PB and/or GAHT, and outline any potential differences between the two groups. Methods We performed an IRB approved two institutional study on the effect of PB and/or GAHT on sexual function and desire. The GAHT group (n=16): individuals who started GAHT (estrogen or testosterone) >18 years. The PB+GAHT group (n=10): subjects with current or past GnRH agonist use +GAHT. All 26 enrolled subjects were interviewed using an open-ended topical guide. Qualitative analysis was performed by hand coding the interview transcripts using Constructivist Grounded Theory qualitative methods. Results A total of 26 TGNB (20 assigned male at birth, 6 assigned female at birth: 18 transgender women, 5 transgender men, 3 non-binary) subjects ages 18-25y were interviewed about the effect of PB and/or GAHT on their sexual function and desire. Our analysis uncovered several themes that were consistent between groups (Table 1). Conclusions Themes were similar for both groups. Half the participants in each group reported feeling no regrets regarding hormone therapy, and the other half reported that they wished they had started hormones sooner. Two notable differences were identified between groups: those on PB+GAHT reported “less dysphoria” as a positive change in sexual desire, and the GAHT group reported more enjoyable sexual experiences since being on hormones. Interestingly, results did not reveal any significant differences between groups. The most prominent theme that arose in both groups was that the positive changes in sexual function and desire outweighed any negative changes that arose. Disclosure No.

Although testosterone replacement treatment (TRT) can improve sexual function in many hypogonadal (HG) men with type 2 diabetes (T2DM), some show either no improvement or only in a limited number of domains. Indeed, it is often difficult for the clinician to offer an indication of the likely efficacy of TRT as little data exist on the proportion of TRT-treated men who will demonstrate improvement in domains such as sexual desire (SxD) and erectile function (EF). We describe in men with T2DM: firstly, the likelihood of improved sexual desire (SxD) and erectile function (EF) following TRT at various time points, and secondly, if probability of SxD change predicted likelihood of subsequent EF change. During a 30-week randomized controlled study of testosterone undecanoate (TU), 199 T2DM men with HG (189 men completing) identified from primary care registers (placebo (P): 107, TU: 92) were stratified using baseline total testosterone (TT)/free testosterone (FT) into Mild (TT 8.1-12nmol/L or FT 0.18-0.25nmol/L) and Severe HG groups (TT ≤8nmol/L and FT ≤0.18nmol/L) and placebo (P)- and TU-treated groups. Associations between TU, SxD and EF were investigated using chi-square and logistic regression analysis. The proportion of men with improved SxD after 6weeks and EF improvement after 30weeks was significantly higher following TU treatment compared to P, this particularly evident in Severe HG men. Changes in SxD and EF were significantly associated in all groups. Logistic regression showed that SxD change at 6weeks predicted of EF change after 30weeks. Our study confirms TRT leads to changes in SxD and EF at different time points and suggests SxD and EF changes are related. SxD change after 6weeks predicting EF change at 30weeks is possibly a useful clinical finding.

[Correction Notice: An Erratum for this article was reported online in Journal of Personality and Social Psychology on Jun 3 2019 (see record 2019-34417-001). In the original article the number of participants available for robustness checks should have been 1,054, not 1,043; this applies to the third sentence in the abstract, the first sentence of the second paragraph in the Participants section, the first sentence of the second paragraph in the Robustness Checks section, and the subsample size of women in Table 3. The correct number of naturally cycling usable data should have been 429, not 421. The correct number of diary days should have been 26,680, not 25,948. The correct percentage of diary days in the fourth sentence in the Exclusion Criteria section should have been 5%. Figure 1 should have included guessing hypotheses (n 40) and long diary interruptions (n 41) as further reasons for exclusion, and an error in the effsize R package led to the reporting of inflated effect sizes for the differences between hormonal contraceptive users and non-users in Table 1. Figure 1, Table 1, and Table 3 have been corrected. All versions of this article have been corrected.] Previous research reported ovulatory changes in women's appearance, mate preferences, extra- and in-pair sexual desire, and behavior, but has been criticized for small sample sizes, inappropriate designs, and undisclosed flexibility in analyses. In the present study, we sought to address these criticisms by preregistering our hypotheses and analysis plan and by collecting a large diary sample. We gathered more than 26,000 usable online self-reports in a diary format from 1,054 women, of which 429 were naturally cycling. We inferred the fertile period from menstrual onset reports. We used hormonal contraceptive users as a quasi-control group, as they experience menstruation, but not ovulation. We probed our results for robustness to different approaches (including different fertility estimates, different exclusion criteria, adjusting for potential confounds, moderation by methodological factors). We found robust evidence supporting previously reported ovulatory increases in extra-pair desire and behavior, in-pair desire, and self-perceived desirability, as well as no unexpected associations. Yet, we did not find predicted effects on partner mate retention behavior, clothing choices, or narcissism. Contrary to some of the earlier literature, partners' sexual attractiveness did not moderate the cycle shifts. Taken together, the replicability of the existing literature on ovulatory changes was mixed. We conclude with simulation-based recommendations for reading the past literature and for designing future large-scale preregistered within-subject studies to understand ovulatory cycle changes and the effects of hormonal contraception. Interindividual differences in the size of ovulatory changes emerge as an important area for further study. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The relationship between mood disorders and personality disorders has been of longstanding interest to clinicians. Despite theoretical reasons to do so, virtually no studies have examined factors that discriminate personality-disordered subjects with a history of mood disorder (PD/HMD) from personality-disordered subjects without a history of mood disorder (PD). This study examined demographic variables, patterns of comorbidity, measures of life functioning, personality traits, and early life experiences differentiating PD/HMD (n = 83) from PD (n = 214). Diagnoses were assigned using structured clinical interviews and a best-estimate procedure. The results suggest that subjects with borderline personality disorder are more likely to have a life history of mood disorder than are subjects with other personality disorders. In addition, PD/HMDs are more likely to receive a diagnosis of anxiety disorder or alcoholism, to have lower Global Assessment of Functioning (GAF) scores, and to have sought treatment than PDs. On self-report measures of personality, PD/HMDs endorse higher levels of trait anxiety and affective lability (e.g., Harm Avoidance, Neuroticism) than do PDs. PD/HMDs are also more likely to report childhood physical and emotional abuse than are PDs, and to describe their parents as using affectionless control. No differences were found between Axis II clusters as a function of mood disorder history. The discussion suggests a potential model in which early environmental stress interacts with constitutional vulnerabilities to put individuals at an increased risk for both mood and anxiety disorders as well as personality disorders.

In a general population survey, 677 urban middle-aged women were interviewed about their sexual desire at two occasions 6 years apart. Data from 497 subjects, who were married at both occasions or were cohabiting with a male partner, were analyzed. Twenty-seven percent reported a decrease in sexual desire between interviews, and 10% experienced an increased desire. There were no clear cohort differences. A decrease in sexual desire was predicted by age, high sexual desire at first interview, lack of a confiding relationship, insufficient support from spouse, alcoholism in spouse, and major depression. Predictors of an increase of sexual desire were weak desire at first interview, negative marital relations before first interview, and mental disorder at first interview. Although sexual desire showed considerable stability over time, a substantial proportion of married middle-aged women experienced major changes, mostly as a decrease. Age, psychosocial factors associated with quality of marital relationship, and mental health were major contributors towards change in sexual desire.

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Changes in prenatal testosterone and sexual desire in expectant couples