摘要
性欲包括复杂的动机和动力。在生物和认知-情感科学艺术的背景下，它往往是医学中一个被忽视的领域。在治疗方面，与男性行为相比，关于妇女性功能的研究受到的关注较少。在过去，这一努力相对地没有在科学界得到很好的传播。最近，用于治疗性欲低的妇女的药物靶点出现了革命性的激增。现在是及时回顾相关的生物学方法，特别是在药物治疗的背景下，了解这一有趣的临床实体，它是由许多互动的心理社会相互作用和因素调节。许多维度因素之间复杂的相互作用为理解神经机制，即奖励中心通路及其与外部心理刺激的相互作用，如关系或其他有意义的生活事件提供了深刻的见解。描述了激素的作用，如催产素或睾酮调节。神经递质的作用，反映在引入了一个分子的翻转，一个完全的激动剂的5-HT1A和部分激动剂的D4治疗绝经前妇女低性欲。基于这一基本的科学核心知识，我们提出了一个关于性疗法(即“内我”和“外我”)的介绍技巧的大纲，其中叙述了伴侣的角色。然后，我们还强调了使用药物作为辅助范围的治疗，即磷酸舒张-5(PDE-5)抑制剂和激素治疗，以帮助低性欲患者。
关键词: 女性性欲，神经基础，心理社会维度，氟班色林，pd -5抑制剂，低性欲。
图形摘要
[1]
Spencer RA, Jeffrey NS, Lois F-R, Edward HS. McKenzie. Human Sexuality.In: A World Of Diversity. 2nd ed. Canada: Pearson Education 2005.
[2]
Veney SL, Rissman EF. Immunolocalization of androgen receptors and aromatase enzyme in the adult musk shrew brain. NeuroendoCrinol 2000; 72: 29-36.
[3]
Jankowska M. Sexual functioning of testicular cancer survivors and their partners-A review of literature. Rep Pract Oncol Radiother 2012; 17: 54-62.
[4]
Regan PC, Atkins L. Sex differences and similarities in frequency and intensity of sexual desire. Soc Behav Personal 2006; 34: 95-101.
[5]
Schnarch D. Passionate marriage: Sex, love, and intimacy in emotionally committed relationships. New York: W. W. Norton & Co. 1997.
[6]
Swanson LW. Anatomy of the soul as reflected in the cerebral hemispheres: neural circuits underlying voluntary control of basic motivated behaviors. J Comp Neurol 2005; 493: 122-31.
[8]
Basson R, Driscoll M, Correia S. Flibanserin for low sexual desire in women: A molecule from bench to bed? EBioMedicine 2015; 2: 772-3.
[9]
Sidi H, Shaharom MH, Hassan R. Keharmonian Jalinan Antara Jantina 2nd ed Kuala Lumpur: Dewan Bahasa dan Pustaka;. 2006.
[11]
Lorenz TK, Demas GE, Heiman JR. Interaction of menstrual cycle phase and sexual activity predicts mucosal and systemic humoral immunity in healthy women. Physiol Behav 2015; 152: 92-8.
[15]
Spector IP, Carey MP, Steinberg L. The sexual desire inventory: Development, factor structure, and evidence of reliability. J Sex Marital Ther 1996; 22: 175-90.
[16]
Wynn LL. ‘Like a Virgin’: Hymenoplasty and Secret Marriage in Egypt. Med Anthropol 2016; 35: 547-59.
[17]
Grubbs JB, Exline JJ, Pargament KI, Volk F, Lindberg MJ. internet Pornography Use, Perceived addiction, and Religious/Spiritual Struggles. Arch Sex Behav 2017; 46(6): 1733-45.
[18]
Angel K. Contested psychiatric ontology and feminist critique: ‘Female sexual dysfunction’ and the diagnostic and statistical manual. Hist Human Sci 2012; 25: 3-24.
[19]
Masters WH, Johnson VE. Human Sexual Response. 1st ed. Reno, NV: Little, Brown and Company 1966.
[21]
Brotto LA, Petkau AJ, Labrie F, Basson R. Predictors of sexual desire disorders in women. J Sex Med 2011; 8: 742-53.
[22]
Sugrue DP, Whipple B. The consensus based classification of female sexual dysfunction: Barriers to universal acceptance. J Sex Marital Ther 2001; 27: 221-6.
[23]
Basson R. Clinical practice. Sexual desire and arousal disorders in women. N Engl J Med 2006; 354: 1497-506.
[24]
Ferenidou F, Kirana PS, Fokas K, Hatzichristou D, Athanasiadis L. Sexual response models: Toward a more flexible pattern of women’s sexuality. J Sex Med 2016; 13: 1369-76.
[25]
Giraldi A, Kristensen E, Sand M. Endorsement of models describing sexual response of men and women with a sexual partner: An online survey in a population sample of Danish adults ages 20-65 years. J Sex Med 2015; 12: 116-28.
[26]
Lewis RW, Fugl-Meyer KS, Corona G, et al. Definitions/epidemiology/risk factors for sexual dysfunction. J Sex Med 2010; 7: 1598-607.
[27]
Sand M, Fisher WA. Women’s endorsement of models of female sexual response: The nurses’ sexuality study. J Sex Med 2007; 4: 708-19.
[28]
Basson R, Wierman ME, van Lankveld J, Brotto L. Summary of the recommendations on sexual dysfunctions in women. J Sex Med 2010; 7: 314-26.
[29]
Sidi H, Naing L, Midin M, Nik Jaafar NR. The female sexual response cycle: do Malaysian women conform to the circular model? J Sex Med 2008; 5: 2359-66.
[30]
Nik Jaafar NR, Midin M, Sharifah Ezat WP, Sidi H. Sexual desire and sexual arousal in malaysian women: Are they of the same entity? ASEAN J Psych 2009; 10: 43-53.
[31]
Nowosielski K, Wrobel B, Kowalczyk R. Women’s endorsement of models of sexual response: Correlates and predictors. Arch Sex Behav 2016; 45: 291-302.
[32]
Giles KR, McCabe MP. Conceptualizing women’s sexual function: linear vs. circular models of sexual response. J Sex Med 2009; 6: 2761-71.
[33]
Frederick DA, Lever J, Gillespie BJ, Garcia JR. What keeps passion alive? Sexual satisfaction is associated with sexual communication, mood setting, sexual variety, oral sex, orgasm, and sex frequency in a national U.S. study. J Sex Res 2016; 22: 1-16.
[34]
Balon R, Segraves RT, Clayton A. Issues for DSM-V: sexual dysfunction, disorder, or variation along normal distribution: Toward rethinking DSM criteria of sexual dysfunctions. Am J Psychiatry 2007; 164: 198-200.
[35]
Kaplan HS. The classification of the female sexual dysfunctions. J Sex Marital Ther 1974; 1: 124-38.
[36]
American Psychiatric Association Diagnostic and statistical manual of mental disorders. 5th ed. Washington, DC: Author 2013.
[37]
Cyranowski JM, Bromberger J, Youk A, Matthews K, Kravitz HM, Powell LH. Lifetime depression history and sexual function in women at midlife. Arch Sex Behav 2004; 33: 539-48.
[38]
de Jong DC. The role of attention in sexual arousal: Implications for treatment of sexual dysfunction. J Sex Res 2009; 46: 237-48.
[39]
Nelson AL, Purdon C. Non-erotic thoughts, attentional focus, and sexual problems in a community sample. Arch Sex Behav 2011; 40: 395-406.
[40]
Nobre PJ, Pinto-Gouveia J. Cognitions, emotions, and sexual response: analysis of the relationship among automatic thoughts, emotional responses, and sexual arousal. Arch Sex Behav 2008; 37: 652-61.
[41]
Simon JA. Low sexual desire - Is it all in her head? Pathophysiology, diagnosis, and treatment of hypoactive sexual desire disorder. Postgrad Med 2015; 122: 128-36.
[42]
Mouras HJ. [Identifying distinct components in the cerebral treatment of visual sexual information through functional neuroimaging]. Article in French. Soc Biol 2004; 198: 247-53.
[43]
Miyagawa Y, Tsujimura A, Fujita K, et al. Differential brain processing of audiovisual sexual stimuli in men: comparative positron emission tomography study of the initiation and maintenance of penile erection during sexual arousal. Neuroimage 2007; 36: 830-42.
[44]
Burbridge S, Stewart I, Placzek M. Development of the Neuroendocrine Hypothalamus. Compr Physiol 2016; 15: 623-43.
[45]
Llewellyn-Smith IJ, Verberne AJM. Central regulation of autonomic functions. 2nd ed. New York: Oxford University Press, Inc. 2011.
[46]
Arnow BA, Millheiser L, Garrett A, et al. Women with hypoactive sexual desire disorder compared to normal females: A functional magnetic resonance imaging study. Neuroscience 2009; 158: 484-502.
[47]
McFarland K, Davidge SB, Lapish CC, Kalivas PW. Limbic and motor circuitry underlying footshock-induced reinstatement of cocaine-seeking behavior. J Neurosci 2004; 24: 1551-60.
[48]
McFarland K, Kalivas PW. The circuitry mediating cocaineinducedreinstatement of drug-seeking behavior. J Neurosci 2001; 21: 8655-63.
[49]
McFarland K, Lapish CC, Kalivas PW. Prefrontal glutamate release into the core of the nucleus accumbens mediates cocaine-induced reinstatement of drug-seeking behavior. J Neurosci 2003; 23: 3531-7.
[50]
Pierce RC, Kumaresan V. The mesolimbic dopamine system: The final common pathway for the reinforcing effect of drugs of abuse? Neurosci Biobehav Rev 2006; 30: 215-38.
[51]
Alexander GE, DeLong MR, Strick PL. Parallel organization of functionally segregated circuits linking basal ganglia and cortex. Annu Rev Neurosci 1986; 9: 357-81.
[52]
Williams DJ, Crossman AR, Slater P. The efferent projections of the nucleus accumbens in the rat. Brain Res 1977; 130: 217-27.
[53]
Goldstein I, Kim NN, Clayton AH, et al. Hypoactive sexual desire
disorder: International society for the study of women's sexual
health (ISSWSH) expert consensus panel review. Mayo Clin Proc
2016; S0025-6196: 30596. 2016.
[54]
Leiblum S, Bachman G, Kemmann E, Colburn D, Schwartzman L. Vaginal atrophy in the post-menopausal women: the importance of sexual activity and hormones. JAMA 1983; 249: 2195-8.
[55]
McCoy N, Davidson JM. A longitudinal study of the effects of menopause on sexuality. Mauritas 1985; 7: 203-10.
[56]
Schreiner-Engel P, Schiavi RC, White D, Ghizani A. Low sexual desire in women: the role of reproductive hormones. Horm Behav 1989; 23: 21-34.
[57]
Sherwin BB. Changes in sexual behavioural as a function of plasma sex steroid level in post-menopausal women. Mauritas 1985; 7: 225.
[58]
Sherwin BB, Gelfand MM, Brender W. Androgen enhances sexual motivation in females: a prospective, crossover study of sex steroid administration in the surgical menopause. Psychosom Med 1985; 47: 339-51.
[59]
Drellich MG, Waxenberg SE. Erotic and affective components of female sexuality. In: Masserman J ed.Science and psychoanalysis. New York: Grune & Statton Inc 1966.
[60]
Gorzynski G, Katz JL. The polycystic ovary syndrome: Psychosexual correlates. Arch Sex Behav 1977; 6: 215-22.
[61]
Simerly RB. Organization and regulation of sexually dimorphic neuroendocrine pathways. Behav Brain Res 1998; 92: 195-203.
[62]
Simerly RB, Swanson LW. Projections of medial preoptic nucleus: aPhaseolus vulgaris leucoagglutinin anterograde tract-tracing study in the rat. J Comp Neurol 1988; 270: 209-42.
[63]
Chou TC, Bjorkum AA, Gaus SC, Lu J, Scammell TE, Saper CB. Afferents to the ventrolateral preoptic nucleus. J Neurosci 2002; 22: 997-0.
[64]
Clancy AN, Whitman C, Michael RP, Albers HE. Distribution of androgen-like receptor immunoreactivity in the brains of intact an castrated male hamsters. Brain Res Bull 1994; 33: 325-32.
[65]
Simerly RB, Chang C, Muramatsu M, Swanson LW. Distribution of androgen and estrogen receptor mRNA containing cells in the rat brain: an in situ hybridization study. J Comp Neurol 1990; 204: 76-95.
[66]
Traish AM, Botchevar E, Kim NN. Biochemical factors modulating female genital sexual arousal physiology. J Sex Med 2010; 7: 2925-46.
[67]
Dennerstein L, Randolph J, Taffe J, Dudley E, Burger H. Hormones, mood, sexuality, and the menopausal transition. Fertil Steril 2002; 77: s42-8.
[69]
Davis S, Davison S, Donath S, Bell R. Circulating androgen levels and self-reported sexual function in women. JAMA 2005; 294: 91-6.
[70]
Kupfermann I.
Hypothalamus and limbic system: Peptidergic neurons,
homeostasis, and emotional behavior. Principles of Neural
Science. 3 ed. ER Kandel JSTJ, editor. Norwalk: Appleton &
Lange;
1991.
[72]
Cushing BS, Carter CS. Prior exposure to oxytocin mimics the effects of social contact and facilitates sexual behavior in females. J Neuroendocrinol 1999; 11: 765-9.
[73]
Melis MR, Argiolas A. Central oxytocinergic neurotransmission: A drug target for the therapy of psychogenic erectile dysfunction. Curr Drug Targets 2003; 4: 55-66.
[74]
Stahl SM. Essential Psychopharmacology: Neuroscientific Basis and Practical Applications. 2nd ed. New York: Cambridge University Press 2000.
[75]
Laan E, van Lunsen RHW. Hormones and sexuality in postmenopausal women: A psychophysiological study. J Psychosom Obstet Gynaecol 1997; 18: 126-33.
[76]
Voisey J, Carroll L, Van Daal A. Melanocortins and their receptors and antagonists. Curr Drug Targets 2003; 4: 586-97.
[77]
Van der Ploeg LH, Martin WJ, Howard AD, et al. A role for the melanocortin 4 receptor in sexual function. Proc Natl Acad Sci USA 2002; 99: 11381-6.
[78]
Becker JB. Estrogen rapidly potentiates amphetamine-induced striatal dopamine release and rotational behavior during microdialysis. Neurosci Lett 1990; 118: 169-71.
[79]
Wallen K. Sex and context: hormones and primate sexual motivation. Horm Behav 2001; 40: 339-57.
[80]
Stahl SM. Stahl’s Essential Psychopharmacology. 3rd ed. New York: Cambridge University Press 2008.
[81]
Putnam SK, Sato S, Riolo JV, Hull EM. Effects of testosterone metabolites on copulation, medial preoptic dopamine, and NOS-immunoreactivity in castrated male rats. Horm Behav 2005; 47: 513-22.
[82]
Kleitz-Nelson HK, Dominguez JM, Cornil CA, Ball GF. Is sexual motivational state linked to dopamine release in the medial preoptic area? Behav Neurosci 2010; 124: 300-4.
[84]
Meyerson BJ. Central nervous monoamines and hormone-induced estrous behaviour in the spayed rat. Acta Physiol Scand 1964; 1-32.
[85]
Shen WW, Hsu JH. Female sexual side effects associated with selective serotonin reuptake inhibitors: a descriptive clinical study of 33 patients. Int J Psychiatry Med 1995; 25: 239-48.
[86]
Corona G, Ricca V, Bandini E, et al. Selective serotonin reuptake inhibitor-induced sexual dysfunction. J Sex Med 2009; 6: 1259-69.
[87]
Stahl SM. The psychopharmacology of sex, Part 1: Neurotransmitters and the 3 phases of the human sexual response. J Clin Psychiatry 2001; 62: 80-1.
[88]
Keltner NL, McAfee KM, Taylor CL. Mechanisms and treatments of SSRI-induced sexual dysfunction. Perspect Psychiatr Care 2002; 38: 111-6.
[89]
Carroll JL, Volk KD, Hyde JS. Differences between males and females in motives for engaging in sexual intercourse. Arch Sex Behav 1985; 14: 131-9.
[91]
Althof SE, Rosen RC, DeRogatis L, Corty E, Quirk F, Symonds T. Outcome measurement in female sexual dysfunction clinical trials: review and recommendations. J Sex Marital Ther 2005; 31: 153-66.
[92]
Clayton AH. The pathophysiology of hypoactive sexual desire disorder in women. Int J Gynaecol Obstet 2010; 110: 7-11.
[94]
Simon JA. Low sexual desire-is it all in her head? Pathophysiology, diagnosis, and treatment of hypoactive sexual desire disorder. Postgrad Med 2010; 122: 128-36.
[96]
Semens JF, Wagner G. Estrogen deprivation and hormonal function in postmenopausal women. JAMA 1982; 445: 248-53.
[97]
Bachmann G, Leiblum S, Grill J. Brief sexual inquiry in gynecologic practice. Obstet Gynecol 1989; 73: 425-7.
[98]
Berman JR. Physiology of female sexual function and dysfunction. Int J Impot Res 2005; 17: S44-51.
[99]
Labrie F, Cusan L, Gomez JL, et al. Effect of one-week treatment with vaginal estrogen preparations on serum estrogen levels in postmenopausal women. Menopause 2009; 16: 30-6.
[100]
Laan E, van Lunsen RH, Everaerd W. The effects of tibolone on vaginal blood flow, sexual desire and arousability in postmenopausal women. Climacteric 2001; 4: 28-41.
[101]
Nijland EA, Weijmar Schultz WC, Nathorst-Boös J, et al. Tibolone and transdermal E2/NETA for the treatment of female sexual dysfunction in naturally menopausal women: results of a randomized active-controlled trial. J Sex Med 2008; 5: 646-56.
[102]
Brown AD, Blagg J, Reynolds DS. Designing drugs for the treatment of female sexual dysfunction. Drug Discov Today 2007; 12: 757-66.
[103]
Davis SR, van der Mooren MJ, van Lunsen RH, et al. Efficacy and safety of a testosterone patch for the treatment of hypoactive sexual desire disorder in surgically menopausal women: A randomized, placebo-controlled trial. Menopause 2006; 13: 387-96.
[105]
Berman JR, Berman LA, Lin H, et al. Effect of sildenafil on subjective and physiologic parameters of the female sexual response in women with sexual arousal disorder. J Sex Marital Ther 2001; 27: 411-20.
[106]
Caruso S, Intelisano G, Lupo L, Agnello C. Premenopausal women affected by sexual arousal disorder treated with sildenafil: A double-blind, cross-over, placebo-controlled study. BJOG 2001; 108: 623-8.
[107]
Cavalcanti AL, Bagnoli VR, Fonseca AM, et al. Effect of sildenafil on clitoral blood flow and sexual response in postmenopausal women with orgasmic dysfunction. Int J Gynaecol Obstet 2008; 102: 115-9.
[108]
Rosen RC, Phillips NA, Gendrano NC 3rd, Ferguson DM. Oral phentolamine and female sexual arousal disorder: A pilot study. J Sex Marital Ther 1999; 25: 137-44.
[109]
Rubio-Aurioles E, Lopez M, Lipezker M, et al. Phentolamine mesylate in postmenopausal women with female sexual arousal disorder: A psychophysiological study. J Sex Marital Ther 2002; 28: 205-15.
[110]
Goldstein I, Bassam D, Frank D, Hachicha M, Fernando Y, Schupp J. Results of a phase 3 clinical trial for female sexual arousal disorder (FSAD) with Femprox, A topical alprostadil 0.4% cream with a novel transdermal delivery technology. J Sex Med 2012; 9: 22.
[111]
Islam A, Mitchel J, Rosen R, et al. Topical alprostadil in the treatment of Female Sexual Arousal Disorder: A pilot study. J Sex Marital Ther 2001; 27: 531-40.
[112]
Krychman ML. Female sexual disorders: Treatment options in the pipeline Formulary Watch. United States: Modern Medicine Network 2013.
[113]
Caruso S, Agnello C, Intelisano G, Farina M, Di Mari L, Cianci A. Placebo-controlled study on efficacy and safety of daily apomorphine SL intake in premenopausal women affected by hypoactive sexual desire disorder and sexual arousal disorder. Urology 2004; 63: 355-9.
[114]
Oh KJ, Chae MJ, Lee HS, Hong HD, Park K. Effects of Korean red ginseng on sexual arousal in menopausal women: Placebo-controlled, double-blind crossover clinical study. J Sex Med 2010; 7: 1469-77.
[115]
Ferguson DM, Hosmane B, Heiman JR. Randomized, placebo-controlled, double-blind, parallel design trial of the efficacy and safety of Zestra in women with mixed desire/interest/arousal/ orgasm disorders. J Sex Marital Ther 2010; 36: 66-86.
[116]
Bygdeman M, Swahn ML. Replens versus dienoestrol cream in the symptomatic treatment of vaginal atrophy in postmenopausal women. Maturitas 1996; 23: 259-63.
[117]
Ückert S, Bannowsky A, Albrecht K, Kuczyk MA. Melanocortin receptor agonists in the treatment of male and female sexual dysfunctions: Results from basic research and clinical studies. Expert Opin Investig Drugs 2006; 23: 1477-83.
[118]
Bloemers J, van Rooij K, Poels S, et al. Toward personalized sexual medicine (Part 1): Integrating the “Dual Control Model” into differential drug treatments for hypoactive sexual desire disorder and female sexual arousal disorder. J Sex Med 2013; 10: 791-809.
[119]
Lodise NM. Hypoactive sexual desire disorder in women: treatment options beyond testosterone and approaches to communicating with patients on sexual health. Pharmacotherapy 2013; 33: 411-21.
[120]
Stahl SM. Circuits of sexual desire in HSDD (hypoactive sexual desire disorder). J Clin Psychiatry 2010; 71: 518-9.
[122]
Dhanuka I, Simon JA. Flibanserin for the treatment of hypoactive sexual desire disorder in premenopausal women. Expert Opin Pharmacother 2015; 16: 2523-9.
[123]
Kennedy S. Flibanserin: Initial evidence on sexual dysfunction, in patients with major depressive disorder. J Sex Med 2010; 7: 3449-59.
[124]
Thorp J, Simon J, Dattani D, et al. Treatment of hypoactive sexual desire disorder in premenopausal women: efficacy of flibanserin in the DAISY study. J Sex Med 2012; 9: 793-804.
[125]
Jaspers L, Feys F, Bramer WM, Franco OH, Leusink P, Laan ET. Efficacy and safety of flibanserin for the treatment of hypoactive sexual desire disorder in women: A systematic review and meta-analysis. JAMA Intern Med 2016; 176: 453-62.
[126]
Yeoh SH, Razali R, Sidi H, et al. The relationship between sexual functioning among couples undergoing infertility treatment: a pair of perfect gloves. Compr Psychiatry 2014; 55: S1-6.
[127]
Creed KE, Carati CJ, Keogh EJ. The physiology of penile erection. Rev Reprod Biol 1991; 13: 73-95.
[128]
O’Carrol R, Shapiro C, Androgens BJ. Behavior and nocturnal erection in hypogonadial men: the effects of varying the replacement dose. Clin Endocrinol 1985; 23: 527-38.
Article Metrics
39
4