Dyadic Sexual Desire Research Articles

Relational and Trait Factors Mediate the Associations between Women’s Intoxication-Related Unwanted Sexual Experiences, Pleasure, and Desire

ABSTRACT Despite documented negative sexual health sequelae of unwanted sexual contact (USC), it is unclear why individuals who have experienced USC within the context of intoxication (intoxication-related USC) are at particular risk for poor sexual functioning. Intoxication-related USC may impact relational factors like relationship satisfaction, as trauma symptoms interfere with emotional closeness during sex. Additionally, although individual traits – such as sexual excitation and sensation seeking – affect the relationship between trauma and sexual functioning, it is unknown whether these factors differentially impact those who have experienced intoxication-related USC. Finally, because presence of a partner may evoke trauma-related symptoms during partnered (dyadic) sexual activity, mediators may differ across solitary versus dyadic sexual pleasure and desire. We tested relational and individual trait mediators of the association between intoxication-related USC and solitary and dyadic sexual pleasure and desire in a sample of heterosexual and sexual minority women. Trait factors consistently mediated the association between intoxication-related USC and both dyadic and solitary desire and pleasure, while relational factors such as emotional closeness were inconsistently related to sexual wellbeing. If replicated, these findings would suggest that trait factors may be useful targets for clinical sexual wellness interventions among sexuality-diverse women who have experienced intoxication-related USC.

Coercive Sexual Experiences that Include Orgasm Predict Negative Psychological, Relationship, and Sexual Outcomes.

Psychological sexual coercion is known to negatively impact those who experience it, yet sexual encounters where orgasm is present are often presumed to be positive and absent of coercion. In the present study, we conducted an online survey with women (n = 179) and men (n = 251) to test associations between sexually coercive experiences that include orgasm and negative psychological, sexual, and relationship outcomes. To do so, we focused on three experiences: having an orgasm during coerced sex (CS), having a coerced orgasm during desired sex (CO), and having a coerced orgasm during coerced sex (COS). Using structural equation modeling, we found that ever having any of these coercion-plus-orgasm experiences with a current partner predicted significantly higher avoidance motivations (i.e., engaging in sex to avoid conflict with one's partner), which in turn predicted significantly worse psychological distress, sexual satisfaction, relationship satisfaction, and sexual functioning (but not dyadic sexual desire). We also found that CS, CO, and COS predicted negative outcomes to a similar degree. However, testing gender/sex as a moderator clarified that CS predicted significantly lower sexual satisfaction, sexual functioning, and sexual desire for women but not men. Furthermore, CO predicted faking orgasms in women, but COS predicted faking orgasms in men. Together, results demonstrate that experiencing psychological sexual coercion and/or orgasm coercion is significantly associated with negative outcomes even if the coerced person's orgasm occurs.

Dyadic Sexual Desire in Romantic Relationships: The Dyadic Interactions Affecting Dyadic Sexual Desire Model.

In most theoretical models, sexual desire for one's partner is predominantly conceptualized from an individual perspective. There is, however, a growing body of empirical evidence on the dyadic aspects of sexual desire. That evidence is as yet not well-integrated into theoretical conceptualizations of sexual desire. Aiming to fill this gap, we present the Dyadic Interactions Affecting DyadIC Sexual desire model (DIADICS), a new conceptual model inspired by systems theory that describes how dyadic interactions between partners influence dyadic sexual desire in romantic relationships. After defining dyadic sexual desire, we discuss (1) the structure of dyadic interactions, (2) their content, and (3) the process through which they affect dyadic sexual desire in a romantic relationship. Thereafter, we review theoretical, clinical, and empirical insights underscoring the relation between dyadic interactions and (dyadic) sexual desire, use DIADICS as a framework for understanding fluctuations in dyadic sexual desire in long-term relationships, and conclude by discussing implications of DIADICS for research and clinical practice.

Single and Partnered Individuals' Sexual Satisfaction as a Function of Sexual Desire and Activities: Results Using a Sexual Satisfaction Scale Demonstrating Measurement Invariance Across Partnership Status.

Although some evidence exists to suggest that single (i.e., unpartnered) individuals are less sexually satisfied on average than are partnered individuals, it is unclear whether the variables correlating with each group’s sexual satisfaction are similar or different. This research sought to examine how desire for and actual engagement in solitary and partnered sexual activities are associated with both groups’ sexual satisfaction. We first conducted a preliminary study (n = 572) to test and refine existing measures of sexual satisfaction for applicability across relationship status. In two follow-up studies (N = 1,238), measurement invariance (across relationship status and gender) of the resulting 4-item sexual satisfaction scale was established. Further, results across the studies showed that for singles dyadic sexual desire was negatively related to sexual satisfaction, whereas no significant link was found with solitary desire. For individuals in romantic relationships, having higher sexual desire involving a partner and lower solitary desire were both associated with greater sexual satisfaction. When analyzing participants’ responses on the desired and actual frequency of engaging in specific sexual acts, we found that for both single and partnered individuals, frequent engagement in partnered acts was associated with greater sexual satisfaction. Wanting frequent engagement in partnered acts was associated with lower sexual satisfaction for both groups, but only if the current frequency of engaging in these acts was low. These findings suggest that at least during the COVID-19 pandemic, meeting desires for partnered sex plays an important role in maintaining a sexually satisfying life, regardless of one’s relationship status.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10508-021-02153-y.

Sexual Desire, Depressive Symptoms and Medication Use Among Women With Fibromyalgia in Flanders.

BackgroundFibromyalgia (FM) is associated with sexual dysfunction, though much less is known about the sexual desire, and especially dyadic and solitary sexual desire, among women with fibromyalgia.AimTo investigate on the one hand the global sexual desire, the dyadic sexual and solitary sexual desire, and on the other hand the association with depressive symptoms, fibromyalgia symptoms and medication use among women with fibromyalgia in Flanders, Belgium.MethodsAn online survey was spread through the Flemish league for Fibromyalgia Patients to be completed by women with fibromyalgia. The sexual desire inventory-2 (SDI-2) was used to measure sexual desire (global, dyadic, solitary), the VASFIQ for fibromyalgia symptoms, and the PHQ-2 for depressive symptoms, while also including questions on demographic factors (time since FM, age) and medication usage (antidepressants, pain medication, sleeping medication).Main Outcome MeasureGlobal sexual desire, dyadic sexual desire and solitary sexual desire were studied in relation to depressive symptoms, medication use and fibromyalgia symptoms.ResultsOne hundred and three women with FM answered the survey. Depressive symptoms were significantly associated with a lower global, dyadic and solitary sexual desire, as was the use of antidepressant medication. The association between solitary sexual desire and depressive symptoms disappeared when controlled for antidepressant medication. Age, fibromyalgia symptoms nor time since diagnosis were significantly associated with any form of sexual desire.ConclusionDepressive symptoms and antidepressant medication, and not fibromyalgia symptoms, were associated with decreased sexual desire of women with FM. As antidepressant medication and depressive symptoms are associated with a decreased sexual desire, more attention should be paid towards the mental health issues associated with fibromyalgia, as well as the prescription of antidepressant medication. This study is the first to investigate sexual desire among women with fibromyalgia in Flanders, and one of the few internationally to have done so. It is limited by its cross-sectional design, and for not providing information on men with FM.Van Overmeire R, Vesentini L, Vanclooster S, et al. Sexual Desire, Depressive Symptoms and Medication Use Among Women With Fibromyalgia in Flanders. Sex Med 2022;10:100457.

Women and Men’s Perspectives on the Factors Related to Women’s Dyadic Sexual Desire, and on the Treatment of Hypoactive Sexual Desire Disorder

Sexuality is a basic human need, which is expressed in the context of intimate personal relations. However, in studies of women’s sexuality, men’s attitudes are often overlooked. Health care providers can benefit from the examination of how both women and men perceive women’s sexual desire and what are the most acceptable avenues for treatment for women’s hypoactive sexual desire disorder (HSDD). This research aimed to explore differences between women and men on the factors affecting women’s sexual desire and the appropriate avenues for treatment. Data were collected using an online questionnaire from 233 heterosexual adults who had a dyadic, steady intimate relationship over most of the previous year. A theory-based questionnaire of 28 items was developed to explore the factors associated with women’s sexual desire. One quarter (7/28) of the items affecting women’s sexual desire were ranked significantly differently between women and men. Among women, interpersonal issues and physical attraction, and among men, physical attraction and daily hassles were the significant predictors of women’s sexual desire. Women more than men endorsed psychological help such as a sex therapist or psychologist as a more appropriate treatment for HSDD, while both men and women viewed the internet as a reasonable way to gain treatment information. Both women and men viewed gynecologists as a more acceptable source of treatment than a family doctor. Religious authorities were the least likely source of treatment advice for both women and men. The results support a multi-dimensional model of women’s sexual desire and suggest that psychological interventions to treat HSDD may be preferred by women more than men.

Virtual Reality Erotica: Exploring General Presence, Sexual Presence, Sexual Arousal, and Sexual Desire in Women.

Virtual reality (VR) media using a three-dimensional (3D) camera facilitates an immersive experience compared to traditional two-dimensional (2D) formats. In this novel study, we used high quality, women-centered erotica and examined whether stimulus modality (VR vs. 2D) and point of view (POV: first-person vs. third-person) impacted women's feelings of sexual presence (activation of sexual response induced by the perception of being present), sexual arousal, and sexual desire (dyadic and solitary). We also investigated the effects of stimulus modality on feelings of general presence (a sense of "being there"). Results from 38 women indicated that with medium to large effects, general presence, sexual presence, and sexual arousal were significantly higher for VR videos relative to 2D videos. Sexual presence was higher for first-person POV depending on the order of film exposure. A general trend toward increasing dyadic sexual desire over the course of the study was observed. No significant differences were observed for solitary sexual desire. These findings support the adaptability of VR media to sex research and show that it can induce feelings of sexual presence and presence more generally. That sexual arousal was positively impacted by VR erotica may have implications for addressing the limitations that accompany other stimulus modalities used to elicit sexual responses in women.

Discrepancy in Dyadic Sexual Desire Predicts Sexual Distress over Time in a Community Sample of Committed Couples: A Daily Diary and Longitudinal Study.

In long-term relationships, sexual desire discrepancy (SDD) occurs frequently between partners. For many, this discrepancy is persistent and significant, and a source of distress. However, the dynamics of SDD in couples and, specifically, its implications for sexual distress have received scant empirical attention. This study examined the associations between SDD and sexual distress from one day to the next and over a 12-month span, in a community sample of 229 same-sex/gender and mixed-sex/gender couples. Two datasets were collected: A 35-day daily diary and a 12-month longitudinal survey. In both, dyadic sexual desire and sexual distress were measured, and SDD was calculated as the absolute value of the difference in sexual desire between partners. Directional associations between SDD at one time point and sexual distress at the next time point were assessed using multilevel, 2-pane autoregressive cross-lagged models, controlling for within-variable changes, dependencies between partners, and partner age. Results were consistent with the study's hypotheses: Couples' SDD on one day predicted sexual distress on the next day. Similarly, SDD at baseline predicted sexual distress 12months later. Participant gender, partner gender, and couple type did not significantly moderate these associations, nor did differentiating partners based on higher and lower average sexual desire. The reverse associations (i.e., sexual distress predicting SDD) were non-significant. The associations' directionality and the fact that they remained significant over days and months were consistent with the proposal that SDD is a precursor of sexual distress. The present study provides support for dyadic conceptualizations of sexual desire. Clinically, findings suggest that therapeutic approaches should address issues with sexual desire and sexual distress by focusing not on the individual, but on the couple.

Impact of COVID-19 Related Stress on Sexual Desire and Behavior in a Canadian Sample

Objectives We evaluated various facets of sexual health in Canadians across phases of the COVID-19 pandemic. Methods: Online questionnaires every four weeks from April–August 2020. Results: Higher COVID-19 stress predicted higher baseline dyadic sexual desire, lower relationship satisfaction, higher desire for solitary sexual behavior, and higher likelihood of experiencing sexual coercion among people with a live-in romantic partner. Dyadic sexual desire and pandemic-related stress both decreased with time, whereas solitary sexual behavior decreased and dyadic sexual behavior increased among participants without a live-in romantic partner. Conclusions: Our findings reveal differential impacts of COVID-19 related stress on sexual outcomes.

Uncovering the Most Important Factors for Predicting Sexual Desire Using Explainable Machine Learning

Low sexual desire is the most common sexual problem reported with 34% of women and 15% of men reporting lack of desire for at least 3 months in a 12-month period. Sexual desire has previously been associated with both relationship and individual well-being highlighting the importance of understanding factors that contribute to sexual desire as improving sexual desire difficulties can help improve an individual's overall quality of life. The purpose of the present study was to identify the most salient individual (eg, attachment style, attitudes toward sexuality, gender) and relational (eg, relationship satisfaction, sexual satisfaction, romantic love) predictors of dyadic and solitary sexual desire from a large number of predictor variables. Previous research has relied primarily on traditional statistical models which are limited in their ability to estimate a large number of predictors, non-linear associations, and complex interactions. We used a machine learning algorithm, random forest (a type of highly non-linear decision tree), to circumvent these issues to predict dyadic and solitary sexual desire from a large number of predictors across 2 online samples (N = 1,846; includes 754 individuals forming 377 couples). We also used a Shapley value technique to estimate the size and direction of the effect of each predictor variable on the model outcome. The outcomes included total, dyadic, and solitary sexual desire measured using the Sexual Desire Inventory. The models predicted around 40% of variance in dyadic and solitary desire with women's desire being more predictable than men's overall. Several variables consistently predicted dyadic sexual desire such as sexual satisfaction and romantic love, and solitary desire such as masturbation and attitudes toward sexuality. These predictors were similar for both men and women and gender was not an important predictor of sexual desire. The results highlight the importance of addressing overall relationship satisfaction when sexual desire difficulties are presented in couples therapy. It is also important to understand clients' attitudes toward sexuality. The study improves on existing methodologies in the field and compares a large number of predictors of sexual desire. However, the data were cross-sectional and there may have been variables that are important for desire but were not present in the datasets. Higher sexual satisfaction and feelings of romantic love toward one's partner are important predictors of dyadic sexual desire whereas regular masturbation and more permissive attitudes toward sexuality predicted solitary sexual desire.

The Role of Sexual Desire, Sexual Satisfaction, and Relationship Satisfaction in the Sexual Function of Arab Couples Living in Saudi Arabia

IntroductionThis study is one of the first to examine the association between relationship and sexual variables as approached from a dyadic perspective in Saudi Arabian couples. Theoretical models assign an important role to relationship factors in women's sexuality.AimWe examined the role of sexual and relationship satisfaction relative to sexual desire in explaining sexual function in a sample of clinical versus nonclinical couples.MethodsThis is a cross-sectional, observational study in a sample of 50 heterosexual couples with sexual problems and 50 control couples without problems (N = 100 couples; 200 men and women).Main Outcome MeasureAll participants completed an Arabic version of measures of relationship satisfaction, sexual satisfaction, sexual desire, sexual distress, and sexual function.ResultsResults showed that in the clinical group, sexual function of women was predicted by their own and their partner's level of sexual satisfaction, and their own level of solitary and dyadic sexual desire. Men's sexual function was predicted by their own sexual satisfaction and their partner's relationship satisfaction. In the control group, the sexual function of women was predicted only by their level of sexual satisfaction. In men, sexual function was predicted by their own sexual satisfaction and their level of dyadic sexual desire.ConclusionThese results suggest that sexual desire rather than relationship satisfaction plays an important role in women's sexual dysfunction. Being the most consistent determinant of male and female sexual functioning, sexual satisfaction is an important target of intervention in Arabian couples.A Attaky, J Schepers, G Kok, et al. The Role of Sexual Desire, Sexual Satisfaction, and Relationship Satisfaction in the Sexual Function of Arab Couples Living in Saudi Arabia. Sex Med 2021;9:100303.

Repetitive Transcranial Magnetic Stimulation as a Potential Tool to Reduce Sexual Arousal: A Proof of Concept Study

BackgroundHypersexuality and hyposexuality occur frequently, often in a variety of psychiatric disorders, and are difficult to treat. While there is meta-analytic evidence for the significant effect of non-invasive brain stimulation on drug and food craving, no study has investigated the potential of this technique to modulate sexual behavior. AimHere, we tested the hypothesis that a single session of high-frequency repetitive transcranial magnetic stimulation (rTMS) over the dorsolateral prefrontal cortex (DLPFC) would reduce sexual arousal. MethodsWe employed a randomized, double-blind, sham-controlled crossover study design. 19 healthy male participants received high-frequency rTMS over the left DLPFC, high-frequency rTMS over the right DLPFC, and sham rTMS (each 10 Hz; 110% resting motor threshold; 60 trains with 50 pulses) in randomized and counterbalanced order with a 1-week interval between stimulation sessions to avoid carryover effects. Participants were exposed to neutral and sexual cues before and after each intervention and rated their sexual arousal after each block of cue presentation. Main Outcome MeasureEfficacy of the respective intervention was operationalized by the change of subjective sexual arousal according to a rating scale. ResultsrTMS of the right DLPFC significantly reduced subjective sexual arousal (t18 = 2.282, P = .035). In contrast, neither sham rTMS nor rTMS of the left DLPFC affected sexual arousal (P > .389). Greater rTMS-induced reduction of subjective sexual arousal was observed in participants with higher trait-based dyadic sexual desire within the last 12 months (r = −0.417, P = .038). Clinical ImplicationNon-invasive brain stimulation might hold potential for influencing hypersexual behavior. Strength & LimitationThis was a randomized, double-blind, sham-controlled crossover study with subjective but no physiological measures of sexual arousal. ConclusionThe results indicate that 1 session of high-frequency rTMS (10 Hz) of the right DLPFC could significantly reduce subjective sexual arousal induced by visual stimuli in healthy subjects. On this basis, future studies with larger sample sizes and more stimulation sessions are needed to explore the therapeutic potential of rTMS in hypersexual behavior.Schecklmann M, Sakreida K, Oblinger B, et al. Repetitive Transcranial Magnetic Stimulation as a Potential Tool to Reduce Sexual Arousal: A Roof of Concept Study. J Sex Med 2020;17:1553–1559.

OR27-05 Sexual Desire Changes in Transgender Individuals upon Initiation of Hormone Treatment; Results from the Longitudinal ENIGI Study

Introduction: Several steps in the transitioning process may affect sexual desire in transgender people. This is often underexposed by those providing gender affirming care. Testosterone therapy in transgender men (TM) generally leads to increasing frequency of desire, masturbation, sexual fantasies and arousal. Studies in transgender women (TW) are inconclusive: some report an increase in the prevalence of hypoactive sexual desire after initiation of hormone therapy, whereas others have shown a positive impact of hormonal therapy on sexual quality of life. The current study prospectively assesses sexual desire during the first three years of hormonal therapy (HT) in transgender people. Methods: This prospective cohort study was part of the European Network for the Investigation of Gender Incongruence (ENIGI). Sexual desire was prospectively assessed in 766 participants (401 TW, 364 TM) by Sexual Desire Inventory (SDI) during a three-year follow-up period, starting at the initiation of hormone treatment (HT). SDI scores were analyzed as total, dyadic and solitary SDI scores. At baseline, psychological questionnaires were administered. Sex steroids were measured at each follow-up visit. Data were analyzed cross-sectionally and prospectively. Results: In TW, total, dyadic and solitary SDI scores decreased during the first three months of HT. However, after 36 months, total and dyadic SDI scores were higher than baseline scores. Solitary scores after 36 months were comparable to baseline scores. In TM, total, dyadic and solitary SDI scores increased over the first three months, remaining stable thereafter. However, total and dyadic SDI scores after thirty-six months were comparable to baseline scores, whereas solitary scores remained higher than baseline. Factors associated with a prospective increase in SDI scores included having undergone gonadectomy, no longer experiencing vaginal bleedings (in TM) or higher gender dysphoria levels at baseline (in TM only). Factors associated with higher cross-sectional SDI scores included being in a relationship, undergoing gonadectomy, no longer experiencing vaginal bleedings (TM), lower gender dysphoria scores (TW only) and lower body dysphoria scores (TW only). Conclusion: Gender affirming hormonal therapy induces short-term changes in sexual desire in transgender people. Over a longer period of time, a net increase in dyadic sexual desire in TW receiving feminizing HT was observed. Sexual desire scores comparable to baseline in TM receiving virilizing HT were found. We observed no correlation between sexual desire and absolute serum testosterone levels. However, other factors, including undergoing gonadectomy, persistence of vaginal bleedings (in TM) and psychological factors may influence sexual desire in transgender people.

The Role of Sexual Self-Control as Moderator between Sexual Desire and Premarital Sexual Behaviors

Sexual desire can be one of the antecedents for individual premarital sexual behavior. Otherwise, sexual self-control can prevent individuals from engaging premarital sexual behavior. This study aimed to examine the role of self-control in moderating the relationship between sexual desire and premarital sexual behavior. This study involved 209 emerging adults (18-25 years old) who were dating and not undergoing a long-distance relationship. The current study used Premarital Sexual Permissiveness measurement, dyadic sexual desire subscale from Sexual Desire Inventory-II, general sex-drive and stimulus-elicited sex-drive subscales from Perceived Sexual Control to measure premarital sexual behavior, sexual desire, and sexual self-control respectively. Results of regression analysis showed that sexual self-control did not moderate the relationship between sexual desire and kissing (∆R2 = 0.006, p > 0.05), as well as sexual desire and petting (∆R2 = 0.001, p > 0.05). However, self-control could be a moderator in the relationship between sexual desire and intercourse (∆R2 = 0.027, p < 0.01).

Sexual Behavior, Desire, and Psychosexual Experience in Gynephilic and Androphilic Trans Women: A Cross-Sectional Multicenter Study

BackgroundOne of the most prominent etiological theories of gender incongruence in trans women proposes a paraphilic erotic target location error (ie, autogynephilia) as a causal factor in gynephilic (ie, exclusively gynephilic and bisexual) trans women. We hypothesized that a paraphilic erotic target location should manifest itself in various aspects of sexual behavior, solitary and dyadic sexual desire, and psychosexual experience. AimTo compare sexual behavior, sexual desire, and psychosexual experience of exclusively gynephilic and bisexual trans women with that of androphilic trans women to explore whether their sexuality differs substantially. MethodsTrans women diagnosed with gender dysphoria (Diagnostic and Statistical Manual of Mental Disorders–5) were recruited at 4 transgender healthcare centers in Germany. The present study analyzed items on sexual behavior, desire, and experience of a self-report questionnaire, collected as part of a cross-sectional multicenter study. Main OutcomesMultiple aspects of sexuality were examined using self-constructed items. Sexual desire was measured using the Sexual Desire Inventory and psychosexual experience using the Multidimensional Sexuality Questionnaire. ResultsSignificantly more exclusively gynephilic than androphilic trans women reported a history of sexual arousal in relation to cross-dressing. However, little evidence was found that gynephilic and androphilic sexual desire, behavior, and psychosexual experience differ profoundly. Interestingly, a statistically non-significant trend indicated that gynephilic trans women who had not yet undergone gender affirming surgery showed the highest levels of sexual desire (solitary and dyadic), whereas the opposite was the case for androphilic trans women. Clinical TranslationData of this study indicate that sexual orientation does not appear to be a good predicator for sexual behavior, desire, and psychosexual experience in trans women. Strengths and LimitationsWe investigated sexual desire and experience using standardized and evaluated measures such as the Sexual Desire Inventory and Multidimensional Sexuality Questionnaire. Future studies with a larger sample size should investigate how different gender affirming medical intervention might have diverging influences on sexual behavior, desire, and experience. ConclusionUltimately, this study found little evidence for the hypothesis that sexual behavior, sexual desire, and psychosexual experience differ substantially in gynephilic (exclusively gynephilic and bisexual) and androphilic trans women.Laube JS, Auer M, Biedermann SV, et al. Sexual Behavior, Desire, and Psychosexual Experience in Gynephilic and Androphilic Trans Women: A Cross-Sectional Multicenter Study. J Sex Med 2020;17:1182–1194.

Predictors of Sexual Desire and Sexual Function in Sedentary Middle-Aged Adults: The Role of Lean Mass Index and S-Klotho Plasma Levels. The FIT-AGEING Study

BackgroundUnhealthy lifestyle and aging negatively impact sexuality; consequently, the prevalence of sexual problems increases sharply in middle-aged adults, but the determinants of low sexual desire and sexual dysfunction are not fully elucidated. AimsTo investigate the association of cardiometabolic profile, free testosterone plasma levels, body composition, physical fitness, and S-Klotho plasma levels with sexual desire and sexual function in middle-aged sedentary adults. MethodsSeventy-four (39 women) sedentary middle-aged adults (45–65 years old) were recruited for the present cross-sectional study. OutcomesThe blood samples were collected in the morning (12 h of fasting) to determine cardiometabolic biomarkers and free testosterone and S-Klotho plasma levels. The cardiometabolic risk score was calculated based on the International Diabetes Federation's clinical criteria, quantitative insulin sensitivity check index, and homeostatic model assessment of insulin resistance index. A dual-energy X-ray absorptiometry scanner was used to determine the lean mass index (LMI) and the fat mass index. Maximal oxygen uptake was determined by a maximum treadmill test using indirect calorimetry. Muscular strength was measured with knee extensor isokinetic dynamometry (60° s−1). Sexual desire was assessed with the Sexual Desire Inventory 2. Sexual function was assessed with the Massachusetts General Hospital-Sexual Functioning Questionnaire. ResultsAfter age adjustment, free testosterone plasma levels were associated with solitary sexual desire in women (R2 = 0.193, β = 0.342, P = .044). The LMI was associated with solitary sexual desire in men (R2 = 0.258, β = 0.445, P = .024) and sexual function in women (R2 = 0.470, β = −0.607, P < .001). S-Klotho plasma levels were associated with solitary sexual desire and sexual function in men (R2 = 0.412, β = 0.817, P = .001; R2 = 0.193, β = −0.659, P = .021, respectively) and with dyadic sexual desire and sexual function in women (R2 = 0.270, β = 0.508, P = .020; R2 = 0.467, β = −0.676, P < .001, respectively). Clinical ImplicationsS-Klotho plasma levels may represent a potential new biomarker for sexual desire and sexual function. Lean body mass development may benefit sexual desire and sexual function. Strengths and LimitationsStrengths include the analysis of novel and diverse biomarkers of health for sexual desire and sexual function. Limitations include the cross-sectional design and a relatively small sample size; thus, results should be interpreted cautiously and in the study population context. ConclusionS-Klotho plasma levels were strongly associated with dyadic sexual desire, solitary sexual desire, and sexual function in sedentary middle-aged adults. The LMI was also positively associated with solitary sexual desire and sexual function in men and women, respectively.Dote-Montero M, De-la-O A, Castillo MJ, et al. Predictors of Sexual Desire and Sexual Function in Sedentary Middle-Aged Adults: The Role of Lean Mass Index and S-Klotho Plasma Levels. The FIT-AGEING Study. J Sex Med 2020;17:665–677.

Sexual Desire Changes in Transgender Individuals Upon Initiation of Hormone Treatment: Results From the Longitudinal European Network for the Investigation of Gender Incongruence

IntroductionSeveral steps in the transitioning process may affect sexual desire in transgender people. This is often underexposed by those providing gender-affirming care. AimTo prospectively assess sexual desire during the first 3 years of hormonal therapy (HT) in transgender people. MethodsThis prospective cohort study was part of the European Network for the Investigation of Gender Incongruence. At baseline, different psychological questionnaires were administered. Sex steroids were measured at each follow-up visit. Data were analyzed cross-sectionally and prospectively. Main Outcome MeasureProspective analysis of total, dyadic (with another person), and solitary (with oneself) sexual desire in 766 participants (401 transgender women [TW], 364 transgender men [TM]) was carried out using the Sexual Desire Inventory (SDI) questionnaire during a 3-year follow-up period, starting at the initiation of HT. Other factors associated with prospective changes were assessed. ResultsIn TW, total, dyadic, and solitary SDI scores decreased during the first 3 months of HT. However, after 36 months, total and dyadic SDI scores were higher than baseline scores. Solitary scores after 36 months were comparable with baseline scores. In TM, total, dyadic, and solitary SDI scores increased over the first 3 months, remaining stable thereafter. However, total and dyadic SDI scores after 36 months were comparable with baseline scores, whereas solitary scores remained higher than baseline. Factors associated with a prospective increase in SDI scores included having undergone gonadectomy, no longer experiencing menstrual bleeding or higher gender dysphoria levels at baseline (in TM only). Clinical ImplicationsThis study offers clear data on the time course of sexual desire after starting HT and thereby helps to inform people who want to start HT. Transgender people can be informed that changes in sexual desire after initiating HT are temporary. Over a longer period of time, the current research does not suggest induction of hypoactive sexual disorder in TW or long-term increased sexual desire in TM. Strength & LimitationsStrengths include the prospective design of this large multicentric study, the well-defined cohort, controlling for HT, sex steroids, and other factors. Limitations include performing a data lock, the absence of an objective measure of sexual desire, and the timing of laboratory measurements. ConclusionGender-affirming HT only induces short-term changes in sexual desire in transgender people. Over a longer period of time, a net increase in dyadic sexual desire in TW receiving feminizing HT and sexual desire scores comparable with baseline in TM receiving virilizing HT, were observed.Defreyne J, Elaut E, Kreukels B, et al. Sexual Desire Changes in Transgender Individuals Upon Initiation of Hormone Treatment: Results From the Longitudinal European Network for the Investigation of Gender Incongruence Study. J Sex Med 2020;17:812–825.

A comparison of sexual desire in opiate-dependent men receiving methadone and buprenorphine maintenance treatment

BackgroundMethadone is an effective therapy for opiate dependence. However, one of the commonest side effects is sexual dysfunction among male patients. Buprenorphine is an alternative to methadone. This study aimed to compare sexual desire among opiate-dependent male patients on buprenorphine (BMT) and methadone maintenance therapy (MMT).MethodsThis cross-sectional study involved 126 male opiate-dependent patient who were tested for total testosterone (TT) and prolactin levels, and were interviewed and completed the Sexual Desire Inventory-2 (SDI-2), Malay language of International Index of Erectile Function (Mal-IIEF-15) and the Malay version of the self-rated Montgomery-Asberg Depression Rating Scale (MADRS-BM) questionnaires.ResultsThere were 95 (75.4%) patients on MMT and 31 (24.6%) on BMT. Patients on MMT scored significantly lower in the sexual desire domain (Mal-IIEF-15 scores) (p < 0.01), dyadic sexual desire (p = 0.04) and TT plasma level (p < 0.01) when compared to BMT group after controlling all the confounders.ConclusionsPatients on MMT are associated with lower sexual desire when compared with patients on BMT. Smoking may further lower testosterone and, hence, sexual desire in those already on methadone.

Using Sexual Selection Theories to Examine Contextual Variation in Heterosexual Women\u2019s Orientation Toward High Heels

High heels are symbols of female sexuality and are “costly signals” if the risks of wearing them are offset by improving women’s attractiveness to men. From a functionalist perspective, the costs versus benefits of wearing heels may vary according to personal and contextual factors, such as her effectiveness at competing for mates, or at times when such motives are stronger. Here, we examined potential differences between women (self-rated attractiveness, dyadic versus solitary sexual desire, women’s age, competitive attitudes toward other women) and contextual variation (priming mating and competitive motives) in their responses to high heels. Study 1 (N = 79) and Study 2 (N = 273) revealed that self-rated attractiveness was positively related to orientation toward heeled shoes. When examining responses to two very attractive shoes (one higher heel, one lower heel) in Study 2, dyadic sexual desire, but not solitary sexual desire or intrasexual competitiveness, predicted their inclination to buy the higher-heeled shoe. In Study 3 (N = 142), young women chose high heels when primed with free choice of a designer shoe (95% CI [53.02 mm, 67.37 mm]) and preferred a heel 22 mm (0.87”) higher than older women (Study 4, N = 247). Contrary to predictions, priming mating or competitive motives did not alter women’s preference toward a higher heel (Studies 3 and 4). Our studies suggest that attractive women augment their physical appeal via heels. High heels may be a subtle indicator of dyadic sexual desire, and preferences for heels are stronger at times in the lifespan when mating competition is relatively intense.

PS-01-013 The role of sexual desire, sexual satisfaction and relationship satisfaction in the sexual function of Arab couples living in Saudi Arabia

Abstract Introduction This study is one of the first to examine the association between relationship and sexual variables as approached from a dyadic perspective in Saudi Arabian couples. Theoretical models assign an important role to relationship factors in women's sexuality. Aim We examined the role of sexual and relationship satisfaction relative to sexual desire in explaining sexual function in a sample of clinical versus nonclinical couples. Methods This is a cross-sectional, observational study in a sample of 50 heterosexual couples with sexual problems and 50 control couples without problems (N = 100 couples; 200 men and women). Main Outcome Measure All participants completed an Arabic version of measures of relationship satisfaction, sexual satisfaction, sexual desire, sexual distress, and sexual function. Results Results showed that in the clinical group, sexual function of women was predicted by their own and their partner's level of sexual satisfaction, and their own level of solitary and dyadic sexual desire. Men's sexual function was predicted by their own sexual satisfaction and their partner's relationship satisfaction. In the control group, the sexual function of women was predicted only by their level of sexual satisfaction. In men, sexual function was predicted by their own sexual satisfaction and their level of dyadic sexual desire. Conclusion These results suggest that sexual desire rather than relationship satisfaction plays an important role in women's sexual dysfunction. Being the most consistent determinant of male and female sexual functioning, sexual satisfaction is an important target of intervention in Arabian couples. A Attaky, J Schepers, G Kok, et al. The Role of Sexual Desire, Sexual Satisfaction, and Relationship Satisfaction in the Sexual Function of Arab Couples Living in Saudi Arabia. Sex Med 2021;9:100303.