A new study shows that there is an association between hormones such as testosterone and sexual function among women in their 40s and early 50s.
However, the role of these hormones in driving women’s interest in sex and sexual function is limited, and other factors such as relationships and mood play a much bigger role, say the researchers, led by Dr John D Randolph (University of Michigan School of Public Health, Ann Arbor).
“This is the first really, really solid evidence that there is an association with hormones, particularly testosterone, and sexual function, but it’s pretty modest. It’s a really big study with a lot of women, and the effects of [hormones] were pretty small and were not nearly as big as the psychosocial issues,” Dr Randolph toldMedscape Medical News.
The work is published online November 20 in Journal of Clinical Endocrinology and Metabolism.
Dr Randolph advises that if a woman is coming to the doctor’s office and complaining about problems with sexual function, “look at relationship issues, and make sure her mood is okay first.”
Then, he says, examine any medications: “Make sure she’s not on antidepressants, which can affect sexual function. I’d think about those factors first before I’d have a conversation about testosterone.”
Ask About Masturbation Too
The study was also somewhat unique in that it addressed the issue of masturbation as one of the main outcomes. This is an important topic because “a woman doesn’t have to have a partner [for this], so it’s probably a better window on what her own issues are,” Dr Randolph noted.
Asking about masturbation “should be on the list of questions because it might help in figuring out what the underlying problem is,” he stressed.
And while he acknowledges that some clinicians may feel uncomfortable bringing up this topic, he added, “If a woman is coming in and talking about her sexual function, she is going to be somewhat comfortable talking about masturbation — that’s part of sexual behavior, so that should be an okay thing to discuss.”
Researchers studied SWAN Multiethnic Cohort of Women
To determine what was affecting sexual function, Dr Randolph and colleagues studied 3,302 participants in the decade-long multi-ethnic cohort Study of Women’s Health Around the Nation (SWAN), which is following women through menopausal transition at seven sites in the US.
At baseline, all women had an intact uterus and at least one ovary and were not using exogenous hormones.
Sexual function was assessed at baseline by self-administered questionnaires and at 10 follow-up visits. Blood was drawn to assay serum testosterone, estradiol, follicle-stimulating hormone (FSH), sex hormone-binding globulin (SHBG), and dehydroepiandrosterone sulfate (DHEAS).
The main outcomes were self-reported frequency of masturbation, sexual desire, sexual arousal, orgasm, and pain during intercourse.
Masturbation and sexual desire and arousal were positively associated with testosterone (ie, those with naturally higher levels reported higher scores on all those counts). Masturbation, arousal, and orgasm were negatively associated with FSH.
Estradiol was not associated with any measure of sexual function, however, an observation the researchers say is surprising.
Not Worth Measuring Testosterone in Women
Because the observed associations between hormones and sexual function were modest, Dr Randolph said he doesn’t believe that measuring testosterone levels in women experiencing difficulties in this area of their lives is helpful.
“Our take is that there is a relationship there, but it’s pretty much dwarfed by relationship status, mood, etc,” he reiterated.
And he said, “The assays for testosterone aren’t very accurate when it’s gets low, and so it’s always been a problem in women because they have so much less testosterone [than men]. When you get down to low levels, we don’t trust the values very much, so it’s hard to tell what’s normal and what’s not.”
There is also much variability in hormone levels from woman to woman, which adds to the complexity, he notes.
And although some studies have suggested that testosterone therapy may be able to improve sexual function in women who have had their ovaries removed, there are many unknowns regarding its long-term health effects.
In its recent updated Clinical Practice Guideline on Androgens in Women, the US Endocrine Society advised against prescribing testosterone to healthy women and called for more research into the long-term safety of testosterone therapy.
Dr Randolph says he agrees with this stance.
“Any woman who has issues with her sexual function should really have other issues addressed first: relationship status is probably the number-one issue when it comes to female sexual function,” he concludes.
The authors have reported they have no relevant financial relationships.
J Clin Endocrinol Metab. Published online November 20, 2014. Abstract
Relationship issues, as mentioned in the above article, may include insecurity, self esteem, poor communication, gelousy, etc. Hypnotherapy may provide appropriate techniques to help us deal with those issues.
The importance of masturbation is stated above, and it is of relevance to those interested in, amongst other things, learning alternative ways to move away from an anxiety response. Sexual arousal, together with the act of eating, drinking, or relaxing, is not compatible with anxiety. by learning to master our sexual potential we may find one more way to release energy and achieve a comfortable state of well being. This knowledge may also bring us close to a better understanding of our needs and wants and how to communicate or express them. With the contribution of hypnotherapy we may be able to increase and improve the use of our imagination, helping us explore our inner selves, including our sexual desire.