Female Sexual Function and Dysfunction in the Reproductive Years: The Influence of Endogenous and Exogenous Sex Hormones

Abstract

Sexual function in women in the reproductive age years is under psychological, sociocultural, and relationship influences, as well as the influence of sex hormones. To examine the data relating to sexual function in women in the reproductive age group, particularly the influence of sex hormones. To examine, in particular, the influence of the menstrual cycle, pregnancy, the oral contraceptive pill and endogenous and exogenous testosterone. Review of the literature on female sexual function, confining the search to the reproductive age range. Population studies of sexual function identify sexual disinterest as being the most common sexual complaint in premenopausal women. Most studies of menstrual cyclicity identify a periovulatory increase in sexual desire or activity. All prospective studies of sexuality in pregnancy document a decline in sexual function with progression of pregnancy. Studies of the influence of the oral contraceptive pill on sexual function are contradictory with most prospective controlled studies showing no deleterious effect. Studies of the influence of endogenous androgens on sexuality are also contradictory with one large cross-sectional study showing no correlation, but some case-controlled studies show low androgens in women with sexual dysfunction. Studies of testosterone therapy in premenopausal women are ambiguous, with no clear dose-response effect. Sexual disinterest is prevalent in premenopausal woman despite being hormone replete. The assessment of androgen contribution is hampered by the unreliability of the testosterone assay in the female range. Large cross-sectional and longitudinal studies have not identified a correlation between testosterone and sexual function in women. Sexual dysfunction in the premenopausal age range is common. Sex hormones have a modifying effect on sexual function but social influences and learned responses are as important. The role of testosterone requires further study.