Changes in the Agriculture Improvement Act of 2018 increased popularity of Cannabidiol (CBD) as a supplement. Exogenous CBD, derived from Cannabis Sativa L., binds to cannabinoid receptors in the ...endocannabinoid system. These receptors are located throughout the body, CB1 being prominent in the central nervous system and CB2 in the immune system. Physiological effects of CBD have been well researched but the effects on libido have not. Lack of libido or sexual drive can be detrimental to stallion breeding productivity. The use of CBD as a calming supplement in animals is increasing due to marketing strategies. The study objective was to evaluate libido and heart rate (HR) in stallions given a daily oral CBD supplement for 90d. Two-year old stallions (n = 7) were assigned to either Control (CON; n = 3) or Cannabidiol (CBD; n = 4) treatment groups. CBD was administered at 0.6mg/kg of BW/d, while CON was administered an equal volume of olive oil, as a placebo of similar nature. Treatments were top-dressed over morning feed. Horses were weighed every Monday with dosages recalculated accordingly. Data collections occurred 2x/wk during semen collections with an artificial vagina. Behaviors were previously defined, calmly called out and logged as they occurred. Observations included time spent licking a tease mare, time to erection, time to first mount, and time to ejaculation. A Polar® heart rate monitoring system linked to the KER® ClockItapp was usedto measure HR. Variations of HR included resting HR, teasing HR, mounting HR, step-off HR, and walk-off HR. Data was analyzed using a repeated measures ANOVA within R Statistical Program®(R Core Team, 2022). Results were considered significant at P ≤ 0.05. Throughout the duration all stallions exhibited normal sexual behavior, regardless of treatment. A treatment affect was not seen for licking time between CBD and CON (11.92s ± 3.76 and 0.32s ± 0.20 respectively). There was no difference between CBD and CON for time to erection (27.64s ± 6.84 and 22.9s ± 4.76 respectively). Time to first mount CBD stallions averaged 330.6s ± 23.04, CON stallions averaged 359.5s ± 25.51, with no effect of treatment. Time to ejaculation in CBD stallions was 356s ± 23.78 and 374s ± 24.84 in CON stallions. There were no differences in behaviors over time. There was a time x day effect for walk-off HR(P = 0.04), though this was significant in both groups. No other differences in HR occurred. Long-term use of CBD for young stallions was seen to not affect libido. However, supplementation may lower HR over time. The immediate and lasting response to CBD use in mature stallions and older aggressive stallions is needed to understand the effects of using these products.
The benefits and risks of testosterone treatment for women with diminished sexual wellbeing remain controversial. We did a systematic review and meta-analysis to assess potential benefits and risks ...of testosterone for women.
We searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, and Web of Science for blinded, randomised controlled trials of testosterone treatment of at least 12 weeks' duration completed between Jan 1, 1990, and Dec 10, 2018. We also searched drug registration applications to the European Medicine Agency and the US Food and Drug Administration to identify any unpublished data. Primary outcomes were the effects of testosterone on sexual function, cardiometabolic variables, cognitive measures, and musculoskeletal health. This study is registered with the International Prospective Register of Systematic Reviews (PROSPERO), number CRD42018104073.
Our search strategy retrieved 46 reports of 36 randomised controlled trials comprising 8480 participants. Our meta-analysis showed that, compared with placebo or a comparator (eg, oestrogen, with or without progestogen), testosterone significantly increased sexual function, including satisfactory sexual event frequency (mean difference 0·85, 95% CI 0·52 to 1·18), sexual desire (standardised mean difference 0·36, 95% CI 0·22 to 0·50), pleasure (mean difference 6·86, 95% CI 5·19 to 8·52), arousal (standardised mean difference 0·28, 95% CI 0·21 to 0·35), orgasm (standardised mean difference 0·25, 95% CI 0·18 to 0·32), responsiveness (standardised mean difference 0·28, 95% CI 0·21 to 0·35), and self-image (mean difference 5·64, 95% CI 4·03 to 7·26), and reduced sexual concerns (mean difference 8·99, 95% CI 6·90 to 11·08) and distress (standardised mean difference -0·27, 95% CI -0·36 to -0·17) in postmenopausal women. A significant rise in the amount of LDL-cholesterol, and reductions in the amounts of total cholesterol, HDL-cholesterol, and triglycerides, were seen with testosterone administered orally, but not when administered non-orally (eg, by transdermal patch or cream). An overall increase in weight was recorded with testosterone treatment. No effects of testosterone were reported for body composition, musculoskeletal variables, or cognitive measures, although the number of women who contributed data for these outcomes was small. Testosterone was associated with a significantly greater likelihood of reporting acne and hair growth, but no serious adverse events were recorded.
Testosterone is effective for postmenopausal women with low sexual desire causing distress, with administration via non-oral routes (eg, transdermal application) preferred because of a neutral lipid profile. The effects of testosterone on individual wellbeing and musculoskeletal and cognitive health, as well as long-term safety, warrant further investigation.
Australian National Health and Medical Research Council.
Many women experience sexual side effects, such as decreased libido, when taking hormonal contraceptives (HCs). However, little is known about the extent to which libido recovers after discontinuing ...HCs, nor about the timeframe in which recovery is expected to occur. Given that HCs suppress the activities of multiple endogenous hormones that regulate both the ovulatory cycle and women's sexual function, resumption of cycles should predict libido recovery. Here, using a combination of repeated and retrospective measures, we examined changes in sexual desire and partner attraction (among partnered women) across a three-month period in a sample of Natural Cycles users (Survey 1: n = 1596; Survey 2: n = 550) who recently discontinued HCs. We also tested whether changes in these outcomes coincided with resumption of the ovulatory cycle and whether they were associated with additional factors related to HC use (e.g., duration of HC use) or relationship characteristics (e.g., relationship length). Results revealed that both sexual desire and partner attraction, on average, increased across three months after beginning to use Natural Cycles. While the prediction that changes in sexual desire would co-occur with cycle resumption was supported, there was also evidence that libido continued to increase even after cycles resumed. Together, these results offer new insights into relationships between HC discontinuation and women's sexual psychology and lay the groundwork for future research exploring the mechanisms underlying these effects.
•Women's sexual desire increased after discontinuing hormonal contraception.•These changes in sexual desire occurred alongside resumption of menstrual cycles.•Most women resumed cycling within three months of discontinuing contraception.•Attraction to romantic partners also increased after discontinuing contraceptives.•Partner attraction was not related to the return of menstrual cycles.
Abstract Context The interpretation of available clinical evidence related to the effect of testosterone (T) treatment (TTh) on sexual function has been inconsistent, in part due to the use of ...different and self-reported measures to assess outcomes. The International Index of Erectile Function (IIEF) is the most frequently used validated tool to assess male sexual function. Objective To perform a meta-analysis of available data evaluating the effect of TTh on male sexual function using IIEF as the primary outcome. Evidence acquisition An extensive Medline, Embase, and Cochrane search was performed including all placebo-controlled randomized clinical trials enrolling men comparing the effect of TTh on sexual function. Evidence synthesis Out of 137 retrieved articles, 14 were included in the study enrolling 2298 participants, with a mean follow-up of 40.1 wk and mean age of 60.2 ± 6.5 yr. Using IIEF-erectile function domain (IIEF-EFD) as the outcome, we found that TTh significantly improved erectile function compared with placebo (mean difference = 2.31 1.41;3.22 IIEF-EFD score, p < 0.0001). Patients with more severe hypogonadism (total T < 8 nmol/l) reported greater changes in final IIEF-EFD score when compared with those with a milder T deficiency (total T < 12 nmol/l; 1.47 0.90;2.03 and 2.95 1.86;4.03 for total T < 12 nmol/l and <8 nmol/l, respectively, Q = 5.61, p = 0.02). The magnitude of the effect was lower in the presence of metabolic derangements, such as diabetes and obesity. Other aspects of sexual function, as evaluated by IIEF subdomains, were also improved with TTh including libido, intercourse satisfaction, orgasm, and overall sexual satisfaction. Conclusions TTh significantly improves erectile function and other sexual parameters as measured by IIEF in hypogonadal men. These results argue that sexual dysfunction should be considered a hallmark manifestation of T deficiency, since those symptoms can be significantly improved with normalization of serum T. In addition, these results suggest that TTh alone may be considered a reasonable treatment for hypogonadal men with milder degrees of erectile dysfunction, whereas the addition of other treatments, such as phosphodiesterase type 5 inhibitors, may be more appropriate for men with more severe erectile dysfunction. Patient summary We investigated the effect of testosterone treatment on sexual function by performing a meta-analysis of all available studies that used the most frequently used assessment tool, the International Index of Erectile Function. We found that testosterone treatment significantly improves erectile dysfunction, as well as other aspects of sexual function, in men with testosterone deficiency. This treatment may be all that is required for hypogonadal men with milder erectile dysfunction; however, additional treatments may be necessary in more severe cases.
Female sexual desire is a complex interplay of neurotransmitters and hormones. Diagnosis is based on clinical features and sexual distress. Treatments that affect neurotransmitters and hormones that ...may be out of balance can help improve sexual desire in women with hypoactive sexual desire disorder.
The role of testosterone supplementation (TS) as a treatment for male sexual dysfunction remains questionable.
The aim of this study was to attempt a meta-analysis on the effect of TS on male sexual ...function and its synergism with the use of phosphodiesterase type 5 inhibitor (PDE5i).
An extensive Medline, Embase, and Cochrane search was performed.
All randomized controlled trials (RCTs) comparing the effect of TS vs. placebo or the effect of TS as add on to PDE5is on sexual function were included. Data extraction was performed independently by two of the authors (A. M. Isidori and G. Corona), and conflicts resolved by the third investigator (M. Maggi).
Out of 1,702 retrieved articles, 41 were included in the study. In particular, 29 compared TS vs. placebo, whereas 12 trials evaluated the effect of TS as add on to PDE5is. TS is able to significantly ameliorate erectile function and to improve other aspects of male sexual response in hypogonadal patients. However, the presence of possible publication bias was detected. After applying “trim and fill” method, the positive effect of TS on erectile function and libido components retained significance only in RCTs partially or completely supported by pharmaceutical companies (confidence interval 0.04–0.53 and 0.12; 0.52, respectively). In addition, we also report that TS could be associated with an improvement in PDE5i outcome. These results were not confirmed in placebo-controlled studies. The majority of studies, however, included mixed eugonadal/hypogonadal subjects, thus imparting uncertainty to the statistical analyses.
TS plays positive effects on male sexual function in hypogonadal subjects. The role of TS is uncertain in men who are not clearly hypogonadal. The apparent difference between industry-supported and independent studies could depend on trial design more than on publication bias. New RCTs exploring the effect of TS in selected cases of PDE5i failure that persistently retain low testosterone levels are advisable. Corona G, Isidori AM, Buvat J, Aversa A, Rastrelli G, Hackett G, Rochira V, Sforza A, Lenzi A, Mannucci E., and Maggi M. Testosterone supplementation and sexual function: A meta-analysis study. J Sex Med 2014;11:1577–1592.
Both estradiol and testosterone have been implicated as the steroid critical for modulating women's sexual desire. By contrast, in all other female mammals only estradiol has been shown to be ...critical for female sexual motivation and behavior. Pharmaceutical companies have invested heavily in the development of androgen therapies for female sexual desire disorders, but today there are still no FDA approved androgen therapies for women. Nonetheless, testosterone is currently, and frequently, prescribed off-label for the treatment of low sexual desire in women, and the idea of testosterone as a possible cure-all for female sexual dysfunction remains popular. This paper places the ongoing debate concerning the hormonal modulation of women's sexual desire within a historical context, and reviews controlled trials of estrogen and/or androgen therapies for low sexual desire in postmenopausal women. These studies demonstrate that estrogen-only therapies that produce periovulatory levels of circulating estradiol increase sexual desire in postmenopausal women. Testosterone at supraphysiological, but not at physiological, levels enhances the effectiveness of low-dose estrogen therapies at increasing women's sexual desire; however, the mechanism by which supraphysiological testosterone increases women's sexual desire in combination with an estrogen remains unknown. Because effective therapies require supraphysiological amounts of testosterone, it remains unclear whether endogenous testosterone contributes to the modulation of women's sexual desire. The likelihood that an androgen-only clinical treatment will meaningfully increase women's sexual desire is minimal, and the focus of pharmaceutical companies on the development of androgen therapies for the treatment of female sexual desire disorders is likely misplaced.
•We reviewed hormone therapies for low sexual desire in postmenopausal women.•Estradiol, at periovulatory levels, increases sexual desire in postmenopausal women.•Supraphysiological testosterone increases sexual desire in postmenopausal women.•Physiological testosterone does not increase sexual desire in postmenopausal women.
Evidence regarding functional hypogonadism, previously referred to as 'late-onset' hypogonadism, has increased substantially during the last 10 year.
To update the European Academy of Andrology (EAA) ...guidelines on functional hypogonadism.
Expert group of academicians appointed by the EAA generated a series of consensus recommendations according to the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) system.
The diagnosis of functional hypogonadism should be based on both the presence of clinical symptoms supported by repeatedly low morning fasting serum total testosterone (T) measured with a well-validated assay, after exclusion of organic causes of hypogonadism. Lifestyle changes and weight reduction should be the first approach in all overweight and obese men. Whenever possible, withdrawal/modification of drugs potentially interfering with T production should be advised. Testosterone replacement therapy (TRT) is contraindicated in men with untreated prostate or breast cancer, as well as severe heart failure. Severe low urinary tract symptoms and haematocrit >48%-50% represent relative contraindications for TRT. Prostate-specific antigen and digital rectal examination of the prostate should be undertaken in men >40 years of age before initiating TRT to exclude occult prostate cancer. Transdermal T should be preferred for initiation of TRT, whereas gonadotrophin therapy is only recommended when fertility is desired in men with secondary hypogonadism. TRT is able to improve sexual function in hypogonadal men. Other potential positive outcomes of TRT remain uncertain and controversial.
TRT can reliably improve global sexual function in men with hypogonadism in the short term. Long-term clinical benefits, and safety of TRT in functional hypogonadism, remain to be fully documented. Clinicians should therefore explicitly discuss the uncertainties and benefits of TRT and engage them in shared management decision-making.
Céline publie Voyage au bout de la nuit en 1932 et Mort à crédit en 1936, deux œuvres qui marquent un tournant dans la littérature moderne au lendemain de la Grande Guerre. Il s’agit d’y analyser les ...formes à travers lesquelles les pulsions se manifestent surtout que Céline considérait Freud comme : « notre grand maître à tous ». De fait, l’écrivain a trouvé dans les sujets et les concepts freudiens une nouvelle vision qui adhérait à son expérience de la vie : la guerre, la sexualité, la mort en font partie. D’abord, il s’agit de dégager les dimensions de la guerre, qui est un thème initiateur dans la narration célinienne, à travers d’abord la violence de la pulsion de mort, constamment présente dans l’œuvre, puis en se concentrant sur la pulsion sexuelle, que ni les mœurs ni la maladie en pleine guerre, n’entravent. Enfin, cette analyse du monde pulsionnel est complétée par la mise en évidence des formes du délire.
Celine published Voyage au bout de la nuit in 1932 and Mort à credit in 1936, two works that marked a turning point in modern literature after the Second World War. This study analyses the forms through which the drives manifest themselves, especially that Celine considered Freud as: “our great master of all.” In fact, the writer found in Freudian subjects and concepts a new vision that adhered to his experience of life including war, sexuality, death that are part of it. On the one hand, this study brings out the dimensions of the war, which is an initiating theme in the Celinian narration through the violence of the death drive, constantly present in the work, and on the second hand, it centers on the sexual drive which neither morals nor disease, in the midst of war, hindered. Finally, this analysis of the instinctual world is completed by highlighting the forms of delirium.
In the last fifteen years, functional neuroimaging techniques have been used to investigate the neuroanatomical correlates of sexual arousal in healthy human subjects. In most studies, subjects have ...been requested to watch visual sexual stimuli and control stimuli. Our review and meta-analysis found that in heterosexual men, sites of cortical activation consistently reported across studies are the lateral occipitotemporal, inferotemporal, parietal, orbitofrontal, medial prefrontal, insular, anterior cingulate, and frontal premotor cortices as well as, for subcortical regions, the amygdalas, claustrum, hypothalamus, caudate nucleus, thalami, cerebellum, and substantia nigra. Heterosexual and gay men show a similar pattern of activation. Visual sexual stimuli activate the amygdalas and thalami more in men than in women. Ejaculation is associated with decreased activation throughout the prefrontal cortex. We present a neurophenomenological model to understand how these multiple regional brain responses could account for the varied facets of the subjective experience of sexual arousal. Further research should shift from passive to active paradigms, focus on functional connectivity and use subliminal presentation of stimuli.
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