Introduction For women, the correlation between circulating androgens and sexual desire is inconclusive. Substitution with androgens at physiological levels improves sexual function in women who experience decreased sexual desire and androgen deficiency from surgical menopause, pituitary disease, and age-related decline in androgen production in the ovaries. Measuring bioactive testosterone is difficult and new methods have been proposed, including measuring the primary androgen metabolite androsterone glucuronide (ADT-G). Aim The aim of this study was to investigate a possible correlation between serum levels of androgens and sexual desire in women and whether the level of ADT-G is better correlated than the level of circulating androgens with sexual desire. Methods This was a cross-sectional study including 560 healthy women aged 19–65 years divided into three age groups. Correlations were considered to be statistically significant at P < 0.05. Main Outcome Measure Sexual desire was determined as the total score of the sexual desire domain of the Female Sexual Function Index. Total testosterone (TT), calculated free testosterone (FT), androstenedione, dehydroepiandrosterone sulfate (DHEAS), and ADT-G were analyzed using mass spectrometry. Results Sexual desire correlated overall with FT and androstenedione in the total cohort of women. In a subgroup of women aged 25–44 years with no use of systemic hormonal contraception, sexual desire correlated with TT, FT, androstenedione, and DHEAS. In women aged 45–65 years, androstenedione correlated with sexual desire. No correlations between ADT-G and sexual desire were identified. Conclusions In the present study, FT and androstenedione were statistically significantly correlated with sexual desire in the total cohort of women. ADT-G did not correlate more strongly than circulating androgens with sexual desire and is therefore not superior to measuring circulating androgens by mass spectrometry.
Introduction The female sexual response is complex and influenced by several biological, psychological, and social factors. Testosterone is believed to modulate a woman's sexual response and desire, because low levels are considered a risk factor for impaired sexual function, but previous studies have been inconclusive. Aim To investigate how androgen levels and psychosocial factors are associated with female sexual dysfunction (FSD), including hypoactive sexual desire disorder (HSDD). Methods The cross-sectional study included 428 premenopausal women 19 to 58 years old who completed a questionnaire on psychosocial factors and had blood sampled at days 6 to 10 in their menstrual cycle. Logistic regression models were built to test the association among hormone levels, psychosocial factors, and sexual end points. Main Outcome Measures Five different sexual end points were measured using the Female Sexual Function Index and the Female Sexual Distress Scale: impaired sexual function, sexual distress, FSD, low sexual desire, and HSDD. Serum levels of total and free testosterone, androstenedione, dehydroepiandrosterone sulfate, and androsterone glucuronide were analyzed using mass spectrometry. Results After adjusting for psychosocial factors, women with low sexual desire had significantly lower mean levels of free testosterone and androstenedione compared with women without low sexual desire. None of the androgens were associated with FSD in general or with HSDD in particular. Relationship duration longer than 2 years and mild depressive symptoms increased the risk of having all the sexual end points, including FSD in general and HSDD in particular in multivariate analyses. Conclusion In this large cross-sectional study, low sexual desire was significantly associated with levels of free testosterone and androstenedione, but FSD in general and HSDD in particular were not associated with androgen levels. Length of relationship and depression were associated with FSD including HSDD.
Objective: To investigate the relationship between combined hormonal contraception (CHC) and women's sexual function with special emphasis on the type of progestin in the CHC Methods: A community sample of 252 healthy, sexually active women aged 18 to 35 completed a questionnaire including the Female Sexual Function Index (FSFI), the Female Sexual Distress Scale (FSDS), and questions about contraception use. Participants were divided into 151 users of CHC, also subdivided into progestin-type subgroups, and 101 users of non-hormonal or no contraception (non-HC). Results: Significantly fewer women using CHC reported sexual distress (p=0.038) compared to non-HC users, but the number reporting sexual problems did not differ (p=0.081). In subgroup analyses, significantly fewer women in the 'other progestin'-CHC group reported sexual problems (p<0.001) and sexual distress (p=0.008) compared to women in the anti-androgenic progestin-CHC group. Significantly, fewer women in the 'other progestin'-CHC group reported sexual problems (p=0.003) and sexual distress (p=0.006) versus women in the non-HC group. Results remained significant after controlling for age, relationship, children living at home, alcohol consumption, and smoking. Conclusions: Women using CHC containing anti-androgenic progestins more often reported sexual problems and sexual distress than women using CHC with other types of progestins.
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