title: Toward personalized sexual medicine (part 3): testosterone combined with a Serotonin1A receptor agonist increases sexual satisfaction in women with HSDD and FSAD, and dysfunctional activation of sexual inhibitory mechanisms.
abstract: BACKGROUND
  Among other causes, low sexual desire in women may result from dysfunctional activation of sexual inhibition mechanisms during exposure to sex. Administration of sublingual 0.5 mg testosterone (T) increases the sensitivity of the brain to sexual cues, which might amplify sexual inhibitory mechanisms further in women already prone to sexual inhibition. Sexual stimulation might elicit a prefrontal cortex (PFC)-mediated phasic increase in sexual inhibition, in which activity of 5-hydroxytryptamine (5-HT, serotonin) is involved. A single dose of 5-HT receptor agonist (5-HT(1A)ra) might reduce the sexual stimulation induced PFC-mediated sexual inhibition during a short period after administration. Consequently, treatment with a single dose of T+5-HT(1A)ra might enhance sexual responsiveness, particularly in women exhibiting sexual inhibition.
  
  
  OBJECTIVE
  To investigate if treatment with a single dosage of T+5-HT(1A)ra will produce improvement in sexual functioning in women with Hypoactive Sexual Desire Disorder (HSDD) as the result of dysfunctional high sexual inhibition.
  
  
  METHODS
  Fifty-four women were divided on the basis of their excitatory or inhibitory responses during T+phosphodiesterase type 5 inhibitor (PDE5i) in low (N = 26) and high inhibitors (N = 28). Physiological and subjective indices of sexual functioning were measured in a participant-controlled ambulatory psychophysiological experiment at home (the first week of each drug treatment). In a bedroom experiment (the subsequent 3 weeks), sexual functioning was evaluated by event, week, and monthly diaries.
  
  
  METHODS
  Subjective: sexual satisfaction, experienced genital arousal, sexual desire. Physiological: vaginal pulse amplitude.
  
  
  RESULTS
  Women with high inhibition show a marked improvement in sexual function in response to treatment with T+5-HT ra relative to placebo and relative to T+PDE5i.
  
  
  CONCLUSIONS
  The present study demonstrated that on-demand T+5-HT ra is a potentially promising treatment for women with HSDD, particularly for those women who are prone to sexual inhibition.
authors.affiliation: Emotional Brain BV, Almere, The Netherlands.
authors.forename: Kim
authors.initials: K
authors.lastname: van Rooij
authors.forename: Saskia
authors.initials: S
authors.lastname: Poels
authors.forename: Jos
authors.initials: J
authors.lastname: Bloemers
authors.forename: Irwin
authors.initials: I
authors.lastname: Goldstein
authors.forename: Jeroen
authors.initials: J
authors.lastname: Gerritsen
authors.forename: Diana
authors.initials: D
authors.lastname: van Ham
authors.forename: Frederiek
authors.initials: F
authors.lastname: van Mameren
authors.forename: Meredith
authors.initials: M
authors.lastname: Chivers
authors.forename: Walter
authors.initials: W
authors.lastname: Everaerd
authors.forename: Hans
authors.initials: H
authors.lastname: Koppeschaar
authors.forename: Berend
authors.initials: B
authors.lastname: Olivier
authors.forename: Adriaan
authors.initials: A
authors.lastname: Tuiten
mesh_terms: D000328:Adult; D000728:Androgens / Q000627:therapeutic use*; D002065:Buspirone / Q000627:therapeutic use*; D003071:Cognition; D018592:Cross-Over Studies; D003463:Cues; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D004882:Erotica; D005260:Female; D006801:Humans; D058986:Phosphodiesterase 5 Inhibitors / Q000627:therapeutic use; D017156:Photoplethysmography; D010879:Piperazines / Q000627:therapeutic use; D011687:Purines / Q000627:therapeutic use; D058825:Serotonin 5-HT1 Receptor Agonists / Q000627:therapeutic use*; D012725:Sexual Behavior / Q000187:drug effects; D020018:Sexual Dysfunctions, Psychological / Q000188:drug therapy*; D000068677:Sildenafil Citrate; D013450:Sulfones / Q000627:therapeutic use; D011795:Surveys and Questionnaires; D013739:Testosterone / Q000627:therapeutic use*; D014621:Vagina / Q000098:blood supply
chemical_list: D000728:Androgens; D058986:Phosphodiesterase 5 Inhibitors; D010879:Piperazines; D011687:Purines; D058825:Serotonin 5-HT1 Receptor Agonists; D013450:Sulfones; D013739:Testosterone; D000068677:Sildenafil Citrate; D002065:Buspirone