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Population data indicate a prevalence of low desire in 32% of women between 18 and 59 years of age [2] A recent European survey of 2467 women, in
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Pathophysiology
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Sexual desire/interest, alternatively referred to as sexual appetite, drive, and sexual impulse, re ects the sexual appetitive feeling that motivates a person
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21 Prolactin, when supraphysiologic, may inhibit the cascade of events involved in the sexual response, in women as in men Hypo- or hyperfunction of other endocrine organs (thyroid, adrenal) may also affect sexual desire Oxytocin is considered to be the most important neurochemical factor that links the affective and the erotic quality of bonding involved in libido itself, but its clinical usefulness in the diagnosis and treatment of FSD has not yet been adequately assessed Alcohol and substance abuse may contribute to sexual disorders, and their potential role should be investigated Psychotropic drugs may further inhibit or excite sexual desire [13] Quality of health and well-being, or severity of diseases, are powerful modulators of the vital energy that nourishes the intensity of sexual drive [14] Other sexual disorders may cause a secondary loss of libido and increasing frustration and dissatisfaction Co-morbidity between different FSD, as mentioned before, is frequent
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to obtain sex and focus her attention on that goal It has three major dimensions: biologic, motivational, and cognitive
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Biologic
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Basic instinctual (or physical) drive is rooted in the rhinencephalic and limbic brain, which is strongly hormone-dependent and is modulated by different mental states, especially mood, and is neurochemically driven Dopamine is the key neurotransmitter of the seeking-appetitive-lust system, in the appetitive side; endorphins mediate the nal consummatory/satisfactory feelings This system interacts with, and is modulated by three other basic emotions command systems [5]: anger-rage, fear-anxiety, and panic-separation-distress The nal sexual behavior expresses the net result of this complex neurobiologic interplay between driving and inhibiting forces Hormones, in their complex interplay, seem to control the intensity of libido and sexual behavior, rather than its direction, which is more dependent on motivational-affective and cognitive factors Estrogens contribute to the appearance and the maintenance of secondary sex characters and to central and peripheral aspects of female sexual function, including level of sexual interest [6 8] Estrogens affect central sexual desire and central arousal (which are dif cult to be differentiated from the research point of view [9], as perception of desire immediately translates into neuronal activation, registered as central sexual arousal) Appropriate levels of androgens also affect sexual interest in women as in men Whether androgens or estrogens are the primary modulators of female sexuality remains controversial [10] Androgens also act as conditioners in the cavernosal bodies in both genders Estrogens and androgens modulate the trophism of sensory organs, which are sexual targets and sexual determinants of libido When all values of sexual hormones are converted to picograms/ml, androgens appear to be much more quantitatively present in the female body than estrogens [11] Postmenopausal hormone-dependent involution of sensory organs may be an important and often ignored biologic contributor of loss of libido in aging women [12]
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Motivational
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Emotional and affective meanings and intimacy needs, which seem to be particularly relevant to women, may contribute to and modulate basic sex drive In our species, motivation for sex may shift from the primary biologic goal reproduction to recreational sex, where the pursuit of pleasure is key, and/or to instrumental sex, where sex is performed as a means to obtain advantages and express motivations different from procreation and/or pleasure
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Cognitive
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Wishes and risks to behave sexually are set against the former two contributing factors in ultimately determining sexual behavior In recent years, research on sexual desire has grown to include a deeper understanding of its biologic roots both endocrine and neurochemical, of the motivational and relational components and of its vulnerability to personal factors and context-dependent agents A populationbased longitudinal study found that relational factors, such as gaining or losing a partner and feelings toward the partner, had greater effects on sexual interest than did hormonal levels [8]
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