Female rats like clitoral stimulation (CLS) delivered with a soft bristle paint brush (S-CLS). This induces conditioned place and partner preference (CPaP) and 50-kHz ultrasonic vocalizations (USVs), both indicative of reward (pleasure). However, when CLS is delivered with a prickly hard-bristle paint brush (H-CLS), females emit 22-kHz USVs, indicating aversion. The present study tested whether H-CLS could be utilized to induce a conditioned partner aversion (CPaA) and examined brain activation by both S- and H-CLS and a conditioned odor associated with either state. Ovariectomized Long-Evans female rats received full hormone priming with EB and P prior to 12 training trials of either S-CLS (N = 24) or H-CLS (N = 24) conducted at 4-day intervals. Sham CLS consisted of raising the tail without clitoral stimulation. A gauze pad doused with almond extract or water was placed into the holding chamber prior to paired or sham CLS. Partner preference was tested in an open field with two males, one scented and one unscented. After two reconditioning trials, females from each group received either S-CLS, H-CLS, or sham-CLS, or were exposed to a gauze pad soaked in either almond extract or water for 1 hr prior to perfusion with saline and 4% paraformaldehyde, brain extraction and preparation for immunohistochemistry to visualize Fos protein. A conditioned preference to receive ejaculations selectively from the Sc male was found for females assigned to S-CLS (+). Females assigned to H-CLS (+) showed partner aversion to the Sc male. Brain regions for reward were activated by S-CLS. Brain regions for aversion and pain were activated by H-CLS, and this was mimicked by the odor. These data show that S-CLS induces a reward state that supports reward expectancy and thus conditions a sexual partner preference for males bearing an odor previously paired with S-CLS. In contrast, H-CLS induces an aversive state that supports an expectancy of pain leading to an avoidance of sexual interaction with partners bearing an odor previously associated with H-CLS. The behavioral and neural processing of H-CLS represents a new animal model of expectancy-based clitorodynia. None.

INTRODUCTION:Sexual function is a critical issue for human health and impacts the quality of life of patients and their partners. In this ICSM report, basic science and translational perspectives have been examined from the past decade of literature since the last ICSM report, and have been integrated to produce a state of the art summary of the physiology and molecular biology of sexual function/dysfunction and development of novel nanotechnology-based vehicles and treatments to aid regeneration and clinical translation in men and women. OBJECTIVES:Examine, critically assess, and curate the most important and impactful basic and translational research findings on male and female sexual dysfunction since 2015. METHODS:Literature reviews were performed by a multidisciplinary committee of sexual medicine experts between June 2023 through May 2024. Findings were presented at the ICSM meeting in Madrid (June 2024), and comments from the consultation were incorporated to develop this consensus report. RESULTS:Erectile dysfunction (ED), which accompanies prostatectomy, diabetes, aging, and vascular disease in men, develops through both common and distinct mechanisms that involve neural injury, penile remodeling (smooth muscle (SM) apoptosis and increased collagen/fibrosis), dysregulated SM contractility, increased oxidative stress, immune response, and genomic instability. In women, disorders of genital pain, arousal, sexual desire, and orgasm involve multiple, overlapping neurological and endocrine mechanisms. Research on ED has been more extensive and the underlying molecular mechanisms have been better characterized than female sexual dysfunction. Future research directions should focus on pathways that underlie penile tissue remodeling and fibrosis associated with cavernous nerve injury in prostatectomy and diabetes, since this leads to irreversible ED. Particular emphasis should be placed on therapeutic targets to improve/enhance nerve regeneration, neuroprotection, "on demand" sexual function, SM contractility/relaxation, oxidative stress, immune response, and hormone function. In women, despite the existence of approved and off-label treatments for disorders of sexual desire and orgasm, the greater influence of psychosocial factors for these aspects of sexual function demands a multidisciplinary approach, along with predictive animal models. Genome-wide association studies have great potential in advancing the field but require replication and functional validation of findings from bioinformatic analyses. Progress in nanotechnology and regenerative therapies offers an exciting frontier in the targeted delivery of ameliorative/restorative treatments. CONCLUSIONS:Research in sexual medicine has expanded through accelerated rates of discovery and increased breadth and diversity. However, much work remains in translating preclinical findings into biomarkers and clinical therapies that can improve patient outcomes.

INTRODUCTION:The purported predominance of the biopsychosocial model is reviewed, including its underlying factors that determine the etiology and treatment of sexual disorders. We recommend that sexual health professionals embrace a broader recognition of all facets of the model. Periodic re-examination is necessary to optimize its strengths and minimize misapplication. OBJECTIVES:Improving the application of the full scope of the biopsychosocial model will help ensure that it remains robust and inclusive. Awareness of its limitations should prompt clinicians to expand their knowledge through continuing education. METHODS:Co-authors reviewed database searches, including PubMed, Google Scholar, and ClinicalTrials.gov. Publications, sexual society presentations, and guidelines were also considered, along with expert opinions. Authored by an intentionally recruited, diverse group of experts representing different disciplines, geographic regions, genders, and perspectives, our manuscript deserves substantial consideration. However, this work does not employ the rigorous methodology used by professional societies in producing guidelines. RESULTS:The biopsychosocial model is widely used; however, too many sex therapists and sexual medicine experts claim to adopt the model while merely paying it lip service. Clinicians support multidisciplinary approaches, yet siloed thinking persists. Collegial respect is increasing, but perspectives remain divided. While sex therapists recognize psychosocial nuances, many are unaware of biomedical advances in diagnosis and treatment that impact sexuality. Conversely, many physicians lack sufficient awareness of the cognitive, emotional, behavioral, and cultural factors contributing to sexual disorders. Physicians who prefer broader assessments often find that time constraints in clinical practice hinder multilayered engagement. CONCLUSION:The biopsychosocial model must encompass all predisposing, precipitating, and maintaining biological, medical/surgical, cognitive, behavioral, emotional, social, and cultural factors involved in the etiology and management of sexual disorders. Etiology is best understood at a granular level that acknowledges multiple proportional contributing factors. We recommend that clinicians across disciplines increase their awareness of all relevant etiologic and treatment factors while continuing to use the accessible term "biopsychosocial."

Female rats like clitoral stimulation (CLS) delivered with a soft bristle paint brush (S-CLS). This induces conditioned place and partner preference (CPaP) and 50-kHz ultrasonic vocalizations (USVs), both indicative of reward (pleasure). However, when CLS is delivered with a prickly hard-bristle paint brush (H-CLS), females emit 22-kHz USVs, and rejection responses indicative of aversion. Notably, if an odor is associated with H-CLS, females will reject males bearing the odor. To examine whether H-CLS could be utilized to induce a conditioned partner aversion (CPaA) and examine brain activation by both S-CLS and H-CLS and a conditioned odor associated with either state. Ovariectomized Long-Evans female rats received full hormone priming with EB and P prior to 12 training trials of either S-CLS (N = 24) or H-CLS (N = 24) conducted at 4-day intervals. Sham CLS consisted of raising the tail without clitoral stimulation. A gauze pad doused with almond extract or water was placed into the holding chamber prior to paired or sham CLS. Partner preference was tested in an open field with two males, one scented and one unscented. After two reconditioning trials, females from each group received either S-CLS, H-CLS, or sham-CLS, or were exposed to a gauze pad soaked in either almond extract or water for 1 hr prior to perfusion with saline and 4% paraformaldehyde, brain extraction and preparation for immunohistochemistry to visualize Fos protein. A conditioned preference to receive ejaculations selectively from the Sc male was found for females assigned to S-CLS. Females assigned to H-CLS showed partner aversion to the Sc male. Brain regions for reward were activated by S-CLS, and this activational pattern was mimicked by the odor alone. Brain regions for aversion and pain were activated by H-CLS, and this pattern was mimicked by the odor alone. These data show that S-CLS induces a reward state that supports reward expectancy and thus conditions asexual partner preference for males bearing an odor previously paired with S-CLS. In contrast, H-CLS induces an aversive state that supports an expectancy of pain leading to an avoidance of sexual interaction with partners bearing an odor previously associated with H-CLS. The behavioral and neural processing of H-CLS represents a new animal model of expectancy-based clitorodynia. Any of the authors act as a consultant, employee or shareholder of an industry for: FirmTech Inc. (USA); Kadence Bio (UK); Ovoca Bio/IVIX Corp. (Ireland); Reunion Neuroscience (Canada); SmartBod/Lioness, Inc. (USA); Vella Bioscience (USA).

Introduction:Persistent genital arousal disorder/genitopelvic dysesthesia (PGAD/GPD) is associated with poor quality of life. Due to social stigma and its heterogeneous nature, many patients suffer without treatment. Aims:This case presents the first example of the successful use of a glucagon-like peptide 1 and glucose-dependent insulinotropic polypeptide receptor agonist (GLP1/GIP RA) medication for the treatment of PGAD/GPD. Methods:The patient was identified by the Sexual Medicine Research Team, retained as a patient at a sexual medicine clinic, and interviewed for the purposes of this case report. Results:This case presents a 44-year-old woman with a lifelong history of PGAD/GPD symptoms that caused extreme distress and depression who experienced 95% resolution of her symptoms within 2 days of starting tirzepatide, a GLP1/GIPRA medication, for weight loss. Conclusion:Increasing benefits of GLP1/GIPRAs are being uncovered, and further studies must investigate the potential for these medications to be used in patients with PGAD/GPD. This study also provides a potential mechanism for decreased arousal resulting from GLP1/GIP receptor activation in attention/reward pathways in the brain.

The present study investigated the role of the oxytocin (OT)/prostaglandin E2 (PGE2)/gonadotropin-releasing hormone (GnRH) and the progesterone receptor (PR) pathways in facilitating lordosis behavior induced by intrahypothalamic administration of 0.75 μg of apelin-13 in ovariectomized (OVX) rats primed with estradiol benzoate (EB). To explore this pathway, various inhibitors were administered bilaterally into the ventromedial hypothalamus (VMH) of EB-primed rats 30 min before the infusion of apelin-13. The inhibitors used included atosiban (ATO), an OT receptor antagonist; acetylsalicylic acid (aspirin), a cyclooxygenase-2 (COX-2) inhibitor; ONOAE3-208 (ONO), a PGE2 receptor antagonist; RU486, an antiprogestin for the PR; and antide, a GnRH-1 receptor antagonist. Apelin-13 at this dosage used, consistently induced lordosis at 30, 120, and 240 min post-infusion. The administration of atosiban, ONO, antide, and RU486, significantly reduced both the lordosis quotient (LQ) and lordosis reflex score (LS) at all assessed time points. In contrast, aspirin only decreased the LQ at 30 and 120 min, while the LS was reduced at all times tested. Because the OT/PGE2/GnRH pathway has been widely demonstrated in hypothalamic astrocytes as a regulator of GnRH release, it may also play a role in regulating female sexual behavior in estradiol-pretreated rats.

Sexual orgasm is a complex, multimodal reflex induced typically by genital stimulation. Such stimulation activates excitatory neurochemical pathways in the brain and spinal cord that ultimately stimulate sympathetic outflow. In women, this can be achieved by stimulation of the external and internal clitoris, anterior cervix, nipples, and other erogenous zones in sensitized individuals. Although the reflex is a product of “bottom-up” genitosensory stimulation, it is also controlled by “top-down” processing of excitation and inhibition that controls both the timing of parasympathetic and sympathetic blood flow, and the subjective ability to “let go” into the orgasm when it is imminent. Indeed, orgasms activate cortical, limbic, hypothalamic, and brainstem structures, have characteristic pelvic floor muscle signatures and spinal cord activation that characterizes sexual “climax”, and can be rated subjectively in terms of the quality and type of sensory stimulation, affective experience, and the evaluation of pleasure. Orgasms are also accompanied by neurochemical and endocrine changes that characterize ecstatic pleasure, satiety, and refractoriness. Among these correlates is a consistent, orgasm-induced surge of prolactin released from the anterior pituitary into the peripheral bloodstream due to an immediate inhibition of dopamine. Orgasms can also be induced without genital stimulation. People experience orgasms during sleep or after exercise. Some women can have orgasms simply by engaging in imagery and fantasy. Paraplegic men and women also report “phantom” orgasms. This suggests that top-down control of orgasm can be activated on its own. Women with Tantric experience can give themselves orgasms of different durations. In one report, these resulted in lawful increases in plasma prolactin. Here we examined prolactin and pelvic floor contractions in a surgically menopausal woman who has developed a systematic methodology to induce NGSOs by sensitized pelvic floor movements. Blood was obtained before, immediately after, and 15 min after either a 2.5-min or 10-min NGSO, or a control condition (10 min Pilates workout). Plasma was assayed for prolactin, luteinizing hormone, follicle-stimulating hormone, and total testosterone. The woman also recorded her pelvic floor movements during a separate 10-min NGSO. Importantly, the woman was fully clothed during the NGSOs, and used only her pelvic floor movements without any tactile stimulation of the clitoral glans. Plasma prolactin increased to 109 and 141% of baseline immediately after the 2.5 min and 10 min NGSO. In contrast, the 10-min Pilates workout decreased plasma prolactin levels to 88% of baseline. Changes in LH, FSH, and total T were not significant. Characteristic pelvic floor contractions of orgasm came at approximately 20-sec intervals and were preceded by a sensitizing set of small contractions that built in intensity. NGSOs induced by systematic and reproducible training of the pelvic floor represent a new vista in the study of women’s orgasms and a potential therapeutic intervention for women with orgasm difficulties. Any of the authors act as a consultant, employee or shareholder of an industry for: Consultant: FirmTech Inc. (USA); Kanna Health Ltd. (UK); Ovoca Bio/IVIX Corp. (Ireland); Reunion Neuroscience (Canada); SmartBod/Lioness, Inc. (USA); Vella Bioscience (USA).

Although sexual orgasm is typically a product of “bottom-up” genitosensory stimulation, it is also controlled by “top-down” processing of excitation and inhibition that controls both the timing of parasympathetic and sympathetic blood flow, and the subjective ability to “let go” into the orgasm when it is imminent. Consistent with this, orgasms activate cortical, limbic, hypothalamic, and brainstem structures, have characteristic pelvic floor muscle signatures and spinal cord activation that characterizes sexual “climax”, and can be rated subjectively in terms of the quality and type of sensory stimulation, affective experience, and the evaluation of pleasure. Orgasms are also accompanied by neurochemical and endocrine changes that characterize ecstatic pleasure, satiety, and refractoriness. Among these correlates is a consistent, orgasm-induced surge of prolactin released from the anterior pituitary into the peripheral bloodstream due to an immediate inhibition of dopamine. Orgasms can also be induced without genital stimulation. People experience orgasms during sleep, with exercise, with particular pelvic floor movements, and during hypnotic suggestion. Some women can have orgasms simply by engaging in imagery and fantasy. Paraplegic men and women also report “phantom” orgasms. This suggests that top-down control of orgasm can be activated on its own, suggesting a kind of “orgasm motor memory”. To examine whether orgasms induced by hypnotic suggestion are “real,” in that they are accompanied by a prolactin surge, and how they are rated afterwards on Subjective, Affective, and Evaluative domains of the Orgasm Rating Scale (ORS; Mah and Binik, 2002). Hypnotic induction of laughter was used as a control condition. Blood was taken before and immediately after each condition in 5 healthy premenopausal women who were susceptible to hypnotic induction and were fully clothed during the inductions. In addition to prolactin, blood plasma was assayed for LH, FSH, and total testosterone. Subjective ratings of the orgasms were made using the ORS, and compared to a separate group of age-matched women who used the ORS to rate orgasms induced by solo masturbation and partnered sex. Plasma prolactin increased to an average of 147% of baseline after hypnotic orgasm induction, but decreased to an average of 89% of baseline after hypnotic laughter induction. Changes in LH, FSH, and total T were not significant. Characteristic pelvic floor and abdominal contractions of orgasm were observed. Abdominal contractions were also observed with laughter. Relative to orgasms induced by solo masturbation and partnered sex, hypnotic orgasm induction showed the highest scores on the Subjective and Affective domains of the ORS, but did not differ in the Evaluative domain. Hypnotic orgasm induction appears to be real, despite no direct genital stimulation. It is likely induced by top-down motor memory and pelvic floor stimulation of pudendal, hypogastric, and/or pelvic nerves. Hypnotic orgasm induction offers therapeutic intervention for women with orgasm difficulties. Any of the authors act as a consultant, employee or shareholder of an industry for: FirmTech Inc. (USA); Kadence Bio (UK); Ovoca Bio/IVIX Corp. (Ireland); Reunion Neuroscience (Canada); SmartBod/Lioness, Inc. (USA); Vella Bioscience (USA).

Jaroslav Madlafousek, Ph.D., C.Sc. (1922–2008) was a Czech comparative psychologist, physiologist, ethologist, and sexologist. He made extremely important empirical contributions to the study of sexual behavior in both humans and rats, among others, helping to pioneer the use of plethysmography to measure genital sexual arousal in men. Here, we present a biography of his life, his struggles against the dictatorships that ruled his country, and his scientific and clinical achievements, many of which were decades ahead of their time but still remain unknown to researchers outside Czechia. We include a complete bibliography of his scientific contributions in both Czech and English journals in the supplementary material.

Engel’s (1977) introduction of the biopsychosocial model emphasized multiple etiological determinants and upended traditional medical views of disease and its treatments. Evidence gradually accumulated that a combined biomedical and psychotherapeutic approaches were the most effective treatment for most sexual conditions. Urologists were late to this realization, in part because of sildenafil’s successful launch (1998), which catalyzed urology’s ascendancy over other specialties (psychiatry, psychology, and gynecology) which previously had managed sexual issues. The educational efforts of sexual medicine societies (ISSM, ISSWSH, SMSNA, SSTAR, etc.) in the early 21st century helped rebalance appreciation for multidisciplinary expertise and multidimensional understanding. Subsequently, most sex therapy and sexual medicine experts have adopted a biopsychosocial model. The biopsychosocial model’s path to its current predominance is reviewed, including the specifics of how its underlying factors’ can determine sexual disorder etiology and treatment. Given the biopsychosocial model’s importance to sexual medicine and sex therapy, the need for periodic re-examination is encouraged in order to optimize the models’ strengths and minimize misapplication. The authors encourage sexual health professionals to embrace a broadened recognition of all facets of the model, not merely those emphasized by their profession of origin disciplines. The author searched relevant terms using databases, including PubMed, Google Scholar, https://clinicaltrials.gov, etc. Co-authors reviewed the articles, offering additional references and expert opinions. Authored by an intentionally recruited diverse expert group from different disciplines, geography, gender, and opinion, their view has substantial merit. However, it lacks the rigorous process used by professional societies’ methodologies when producing guidelines. The biopsychosocial model is used productively, but many secondary to their discipline’s training have limited focus with insufficient awareness of alternative etiologic factors. Clinicians support a multidisciplinary approach, but siloed thinking remains. Collegial respect is increasing, but perspectives remain separated. Sex therapists are aware of psychosocial nuances, but many are ignorant regarding the impact of biomedical advances in diagnosis and treatment that impact sexuality. Reciprocally, too many physicians are insufficiently aware of the cognitive, emotional, behavioral, social and cultural factors contributing to sexual disorders. Physicians preferring broader assessment often find office time limitations negating multilayered engagement. The necessity of fully embracing the comprehensive scope of the biopsychosocial model for sexual health professionals cannot be overstated. Biopsychosocial must stand for all the predisposing, precipitating, and maintaining biological, medical/surgical, cognitive, behavioral, emotional, social, and cultural factors involved in the etiology and management of sexual disorders. These components are best understood at a granular detail level that recognizes multiple proportional factor contributions. Having disciplines spending more time training together would enhance understanding of each other’s strengths and contributions. We must train the next generation of sexual medicine and sex therapy/sexology experts to have an appreciation of all the contributory and mutually influential factors that underlie sexual disorder etiology and treatment to best serve their patients. Furthermore, it is incumbent upon all of us to mindfully seek continuing education opportunities (offered by our professional societies, etc.) to fill in our own gaps in both knowledge and expertise. Any of the authors act as a consultant, employee or shareholder of an industry for: None of the relationships to industry are relevant to this presentation’s content. If the presentation is selected and if detailed information regarding the above question is required, all 8 authors would be happy to detail all industry relationships they have, despite their clear lack of relavance to the presentation.

Depictions of visual sexual stimuli are changing with the advent of computer-generated imagery (CGI), hyper-realistic and idealized images created by artificial Intelligence (AI), and artistic styles such as hentai that depict a more diverse range of sexual situations and characteristics. Here we assessed the subjective realism, aesthetic value, subjective sexual attractiveness, and valence (pleasantness) of images depicting natural or surgically enhanced naked women taken from real photographs, or in formats created by CGI, AI, or as dolls or hentai. Self-identified gynephilic males and females (N = 649) participated in a nationwide online Czech survey about the perception of visual sexual stimuli. Although the real and AI-generated nudes were rated as significantly more realistic than the other categories, the AI-generated nudes were found significantly more aesthetically appealing, sexually attractive, and pleasant, than the other categories, with men generally rating all categories higher than women (although men and women found AI and CGI images equally aesthetically pleasing). There was also a significant correlation of age, such that older participants found the real and AI-generated nudes more aesthetically appealing, sexually attractive, and pleasant than younger participants, whereas younger participants rated hentai significantly higher in these measures than older participants. Together, these data suggest that AI-generated erotic material is superior to even real photographs in generating aesthetic appeal and positive valence, and ratings of sexual attractiveness, although both real and AI-generated nudes produced higher ratings in all measures compared to enhanced nudes, or those created by CGI, or as dolls or hentai. Dr. Pfaus is a consultant to FirmTech Inc., Kanna Health Ltd., Ovoca Bio/IVIX Corp., Reunion Neuroscience Inc., SmartBod/Lioness, Inc., and Vella Bioscience. However, there are no conflicts of interest regarding the present study.

INTRODUCTION:Sexual activity produces pleasure related to sexual arousal, desire, and genitosensory and erogenous stimulation. Orgasms produce a whole brain and body rush of ecstatic pleasure followed by relaxation and refractoriness. This pleasure results from the activation of neurochemical reward pathways in the brain. This is differentiated by spinal pathways that control climax, the particular motor movements of the pelvic floor and the experience of tension release. OBJECTIVES:To relate the activation of key neurochemical reward and bonding systems, notably dopamine, oxytocin, and opioids, to the pleasure of sexual activity in general and orgasms in particular. METHODS:A narrative review of the neurochemical and neuroanatomical mechanisms activated during sexual stimulation and orgasm in rats and humans, and how they are related overall to the generation of sexual pleasure and reward. RESULTS:Appetitive sexual pleasure involves the activation of dopamine and oxytocin release in hypothalamic and mesolimbic regions that regulate sexual arousal and desire, and are reinforced by localized opioid activity. Orgasms are thought to result in part from a massive release of opioids into these regions that inhibits dopamine and oxytocin transmission, but that initiates molecular changes to sensitize both systems and induce sexually conditioned place and partner preferences. Serotonin is also activated at orgasm and contributes to feelings of satiety and refractoriness. Orgasm disorders are distressing, cause resentment and conflict in a relationship, and diminish overall sexual health and well-being. CONCLUSIONS:Orgasms are an important component of sexual pleasure for humans and perhaps all vertebrates. Endogenous opioids like β-endorphin that bind to mu opioid receptors are likely responsible for sexual pleasure and reward.

The largely binary nature of biological sex and its conflation with the socially constructed concept of gender has created much strife in the last few years. The notion of gender identity and its differences and similarities with sex have fostered much scientific and legal confusion and disagreement. Settling the debate can have significant repercussions for science, medicine, legislation, and people's lives. The present review addresses this debate though different levels of analysis (i.e., genetic, anatomical, physiological, behavioral, and sociocultural), and their implications and interactions. We propose a rationale where both perspectives coexist, where diversity is the default, establishing a delimitation to the conflation between sex and gender, while acknowledging their interaction. Whereas sex in humans and other mammals is a biological reality that is largely binary and based on genes, chromosomes, anatomy, and physiology, gender is a sociocultural construct that is often, but not always, concordant with a person' sex, and can span a multitude of expressions.

Male rats trained to associate a neutral odor (almond) with nonreceptive females during their initial sexual experiences develop a conditioned sexual inhibition (CSI) toward the female bearing the olfactory cue when given a choice in a final copulatory preference test between two receptive females (one unscented and one scented) in an open field. We have previously shown that this CSI can be abolished by acute alcohol before the final copulatory preference test. To examine whether acute treatment with d-amphetamine could also disrupt CSI. Male rats received 20 alternating conditioning sessions with an unscented receptive female or an almond-scented non-receptive female. Forty minutes prior to the copulatory preference test with two receptive females, one unscented and the other scented (almond extract), males were injected with saline or one of three doses of d-amphetamine (d- 0.5, 1.0, or 2.0 mg/kg). After two reconditioning trials, males were injected with d-amp or saline and exposed to the olfactory cue alone for 1 h. Brains were fixed and processed for immunohistochemical analysis of Fos protein as a marker of neuronal activation. Fos expression was assessed in several brain regions involved in male sexual behavior. Saline-treated males displayed inhibition of copulatory behavior directed toward the scented female. In contrast, and regardless of the dose, males treated with d-amp prior to the final test copulated with both scented and unscented females, indicating that d-amp disrupted the CSI. Exposure to d-amphetamine and the odor alone induced a differential pattern of Fos expression in several brain areas involved in the expression and/or the regulation of male sexual behavior. As observed previously with alcohol, a low dose of d-amphetamine disrupted the display of a CSI by acting on brain regions mediating sexual behavior.

Sexual desires can be defined as sexual fantasies that want to be acted out and that one craves or wishes to try. However, the content of those desires is rarely publicly shared and also academically remains unknown. This leads to people struggling with insecurity, shame and the taboo around (some of) their sexual wishes. Especially sexual desires of the elderly remain obscured. Hence, this project aimed to normalize sexual desires and break the taboo around them with graphic design and visualisation. In the first part of the project, a psychological questionnaire investigating what people desire to have in their sex life was created with over 440 responses. As a next step, 69 sexual desires across all age groups were selected to be visually represented in a picture book. Through an exploration phase of different artistic styles and methods, two illustrative styles were decided on – one style was marked by black and red ink representing sexual desires with minimalistic line drawings in their humanity and purity of the desires. The other style described the playfulness of sexuality by illustrating its diversity through colours and lots of detail in flower paintings in Gouache. The older the age group, the more colourful the illustrations are, as a symbol that sexuality may have different colours over our lifetime. The result is a 90-page picture book taking the audience on a visual journey through the sexual desires of different generations, eventually reaching the reader’s confrontation with their own desires. The book has one chapter per age group and it goes up to the age group of 78+. So far it is only a Pilot version. The picture book may be used in sex therapy as a creative psychoeducational method. With its simple and straight-forward visual style, a low entry barrier to the client’s world of sexual desires was created. There is no conflict of interest.

Salient sexual cues (erect penis, attractive individuals) are thought to capture initial attention and automatically trigger genital arousal in women. Conscious appraisal activates subjective sexual arousal and further visual attention. The present study tested whether the attractiveness category (attractive/unattractive) and/or sexual arousal condition (in underwear, naked with flaccid penis, naked with erect penis) of male stimuli predicted female sexual responding and attentional patterns. Genital arousal, visual attention, and subjective ratings (subjective sexual arousal, pleasantness) of 26 predominantly heterosexual women (Mage = 31.2, SDage = 6.8) were measured while exposed to male stimuli across the experimental conditions. Neither attractiveness nor sexual arousal condition of male models significantly predicted genital arousal, subjective sexual arousal ratings or visual attention patterns of women. Results however showed high concordance between genital and subjective sexual arousal measures, and the pleasantness rating of the stimuli positively predicted subjective sexual arousal, suggesting a positive feedback loop of female sexual response.

There is growing evidence that endocrine disruptive chemicals have deleterious effects on sexual and reproductive function. To examine subjective sexual functions in human females and their relationship to postnatal phthalate exposure and perinatal androgenization, a Sexuality Score (SS) was established from a first-stage survey questionnaire of subjective sexual function filled out by female university students (n = 68; average age 25.23 ± 5.17 years; rural 25.51 ± 6.74 vs. urban 25.85 ± 1.43 years). Seventeen phthalate metabolites in urine samples were analyzed by high‐performance liquid chromatography (HPLC) and tandem mass spectrometry (MS/MS). Females were also assessed for the 2D:4D digit ratio as an index of perinatal androgenization. The mean age of menarche was 12.82 ± 1.35 years (rural 12.59 ± 1.39 vs. urban 13.18 ± 1.27; p = 0.01). The mean age at first sexual intercourse was 14.88 ± 6.89 years (rural 14.62 ± 7.20 vs. urban 15.24 ± 6.55), and as the age of first sexual intercourse increases, the SS score tends to increase as well, albeit moderately (r = 0.25, p = 0.037). Mono‐iso‐butyl phthalate, mono(2‐ethyl‐5‐carboxypentyl) phthalate, mono(hydroxy‐n‐butyl) phthalate, mono(2‐ethyl‐5‐oxohexyl) phthalate (p ≤ 0.05) and mono(2-carboxymethylhexyl) phthalate (p ≤ 0.01) were negatively associated with SS. A compounding butterfly effect of prenatal exposure to androgens was observed with disruptive effects of mono(2‐ethyl‐5‐oxohexyl) phthalate and mono(2‐ethyl‐5‐carboxypentyl) phthalate on sexual function. Exposure to phthalates in adult females may lead to disruption of subjective sexual function, especially concerning sexual desire and sexual satisfaction, and perinatal androgenization could augment these effects.

Female sexual behaviors in rodents (lordosis and appetitive or “proceptive” behaviors) are induced through a genomic mechanism by the sequential actions of estradiol (E2) and progesterone (P), or E2 and testosterone (T) at their respective receptors. However, non-steroidal agents, such as gonadotropin-releasing hormone (GnRH), Prostaglandin E2 (PGE2), noradrenaline, dopamine, oxytocin, α-melanocyte stimulating hormone, nitric oxide, leptin, apelin, and others, facilitate different aspects of female sexual behavior through their cellular and intracellular effects at the membrane and genomic levels in ovariectomized rats primed with E2. These neurotransmitters often act as intermediaries of E2 and P (or T). The classical model of steroid hormone action through intracellular receptor binding has been complemented by an alternative scenario wherein the steroid functions as a transcription factor after binding the receptor protein to DNA. Another possible mechanism occurs through the activation of second messenger systems (cyclic AMP, cyclic GMP, calcium), which subsequently initiate phosphorylation events via diverse kinase systems (protein kinases A, G, or C). These kinases target the progesterone receptor (PR) or associated effector proteins that connect the PR to the trans-activation machinery. This may also happen to the androgen receptor (AR). In addition, other cellular mechanisms could be involved since the chemical structure of these non-steroidal agents causes a change in their lipophobicity that prevents them from penetrating the cell and exerting direct transcriptional effects; however, they can exert effects on different components of the cell membrane activating a cross-talk between the cell membrane and the regulation of the transcriptional mechanisms.

INTRODUCTION:The addition of compulsive sexual behavior disorder (CSBD) into the ICD-11 chapter on mental, behavioral, or neurodevelopmental disorders has greatly stimulated research and controversy around compulsive sexual behavior, or what has been termed "hypersexual disorder," "sexual addiction," "porn addiction," "sexual compulsivity," and "out-of-control sexual behavior." OBJECTIVES:To identify where concerns exist from the perspective of sexual medicine and what can be done to resolve them. METHODS:A scientific review committee convened by the International Society for Sexual Medicine reviewed pertinent literature and discussed clinical research and experience related to CSBD diagnoses and misdiagnoses, pathologizing nonheteronormative sexual behavior, basic research on potential underlying causes of CSBD, its relationship to paraphilic disorder, and its potential sexual health consequences. The panel used a modified Delphi method to reach consensus on these issues. RESULTS:CSBD was differentiated from other sexual activity on the basis of the ICD-11 diagnostic criteria, and issues regarding sexual medicine and sexual health were identified. Concerns were raised about self-labeling processes, attitudes hostile to sexual pleasure, pathologizing of nonheteronormative sexual behavior and high sexual desire, mixing of normative attitudes with clinical distress, and the belief that masturbation and pornography use represent "unhealthy" sexual behavior. A guide to CSBD case formulation and care/treatment recommendations was proposed. CONCLUSIONS:Clinical sexologic and sexual medicine expertise for the diagnosis and treatment of CSBD in the psychiatric-psychotherapeutic context is imperative to differentiate and understand the determinants and impact of CSBD and related "out-of-control sexual behaviors" on mental and sexual well-being, to detect forensically relevant and nonrelevant forms, and to refine best practices in care and treatment. Evidence-based, sexual medicine-informed therapies should be offered to achieve a positive and respectful approach to sexuality and the possibility of having pleasurable and safe sexual experiences.

Although women and men rate their subjective arousal similarly in response to “female-centric” erotic videos, women rate their subjective arousal lower than men in response to “male-centric” videos, which often end with the male’s ejaculation. This study asked whether ratings of subjective sexual arousal and desire using the Sexual Arousal and Desire Inventory (SADI) would be altered if this ending was present or absent, and whether including or excluding the accompanying soundtrack would influence the magnitude and direction of the responses. A total of 119 cis-gendered heterosexual undergraduates (59 women and 60 men) viewed an 11-min sexually explicit heterosexual video that ended with a 15-s ejaculation scene. Two versions of the video were created, one with the ejaculatory ending (E+) and one without (E−). Participants were assigned randomly to view one of the two versions with (S+) or without (S−) the accompanying soundtrack, after which they completed the state version of the SADI. Women and men found both sequences without sound less arousing on the Evaluative, Motivational, and Physiological subscales of the SADI relative to the S+ sequences. However, on the Negative/Aversive subscale, women found the E + S- sequence more negative than did men, whereas this difference was not found with sound. Thus, women and men were sensitive to the auditory content of sexually explicit videos, and scenes of sexual intercourse ending with explicit ejaculation increased the Evaluative and Motivational properties of subjective sexual arousal and desire. However, this occurred in women only when the auditory cues signaled a clear and gratifying sexual interaction.