K-E Andersson, Department of Clinical Pharmacology, Lund University Hospital, Lund, Sweden

In the central nervous system and peripherally, noradrenergic nerves are involved in the regulation of different sexual functions. Released noradrenaline (NA) acts on a-adrenoceptors (ARs), which are of various subtypes, and which are distributed differently in the brain, spinal cord and genital organs. In monkeys and rats, central activation of a1-ARs facilitates, whereas activation of a2-ARs inhibits, copulation. In male rats, a2-AR antagonists like yohimbine facilitate sexual behavior, reducing ejaculation latency and increasing sexual motivation. Experimentally, inhibition of the a2A-AR subtype in the region of locus ceruleus increases sexual activity. The effect of a2-AR antagonists (e.g., yohimbine) for treatment of male erectile dysfunction has not been convincing. In women, the effects of a2-AR antagonists have not been established, but it is known that a2-AR agonists like clonidine, inhibit the early stages of arousal.

Peripherally, a-AR antagonists may have both positive and negative effects on sexual functions. The erectile state of the penis is dependent on the balance between contractant and relaxant factors. During detumscence and flaccidity, contractile factors (mainly noradrenaline) predominate. All a1-AR subtypes (a1A, a1B, a1D, a1L) can be demonstrated in human penile erectile tissues, but It has not been established if one subtype is more important than the others. Non-subtype selective a1-AR antagonists (phentolamine, moxisylyte) are moderately effective in the treatment of erectile dysfunction. Ejaculation has two distinct successive phases: emission and expulsion. Both phases are largely mediated by spinal reflexes activated by pudendal nerve afferents with supraspinal modulation, and may be negatively affected when a1-AR antagonists are used for the treatment of e.g., hypertension or benign prostatic hyperplasia. The cause may be found within the pelvic organs, at the spinal cord level, or within the brain. a1-AR antagonists can decrease seminal emission, which may lead to retarded ejaculation or decreased orgasmic pleasure. a1-AR antagonist relaxes the bladder neck and may give rise to retrograde ejaculation

The effects of different a-AR antagonists may vary, due to the fact that a-AR subtypes are distributed differently in structures involved in sexual functions, but also depending on pharmacokinetic differences. The actions of subtype selective a-AR antagonists (a1 as well as a2) on different sexual functions should be further explored.

Erotic plasticity and female sexuality

Baumeister, R., Department of Psychology, Case Western Reserve University, Cleveland, OH, USA

Erotic plasticity refers to the degree to which the sex drive is shaped by social, cultural, and situational forces. The core idea is that women have more erotic plasticity than men; in other words, female sexuality is relatively more cultural, whereas male sexuality is more natural. As evidence, individual women exhibit more change across time in their sexual responses; most specific sociocultural variable have larger effects on women than men; and general attitudes are less closely linked to specific behaviors for women than men (indicating greater context-specific responding).

Is written patient information a motivational help in erectile dysfunction?

Berner, M.M., Stodden, V., Porst, H., and Wetterauer, U. Dpt. of Psychiatry and Psychotherapy, University Hospital of the Albert-Ludwigs-University Freiburg, Germany

BACKGROUND: Erectile Dysfunction has a high prevalence in the community.The Information Center for Sexuality and Health (ISG e.V.)is a charitable organization that aims to improve the knowledge about sexual dysfunction in the community.The ISG conducts and supports epidemiologic research in the field of sexual dysfunction. METHODS:In a public campaign concerning erectile dysfunction a representative sample of the German reading community was approached by adverts.Interested persons could use an affixed coupon to order information material free of charge. In a sequential 8000 packages we asked to fill in an epidemiologic questionnaire.The response was 1484 questionnaires (18,5 %).RESULTS: 96,22% of the responders were male. The mean age was 59,01 years. 85% suffered from erectile dysfunction with a duration of more than one year in 75,6% of cases.There was marked comorbidity both sexual and medical. 39,4% already had been treated, 15,8% did not have any contacts so far. The quality-rating for the information provided was high. 21,6% of respondents planned a first communication with their partners, 30% intended to ask for treatment.CONCLUSION: Our data reflects the high information needs in the community.The considerable sexual and medical comorbidity requires an integrated view of sexual dysfunction that incorporates biological, psychological as well as sociological facts. It underlines the importance of high quality standards in the education of sexual therapists.

The role of religion and culture in shaping sexuality and gender

Buchanan, C.H., Education, Knowledge, and Religion, The Ford Foundation, New York, NY, USA

Religious traditions at once reflect basic cultural values regarding gender and sexuality and help shape and legitimize them. The dominant interpretation of what a religion has to say about sex and gender affects all social institutions and all individuals, whether they are believers or not, through religious values that pass into a society’s secular value system. Most of the major and minor religions of the world have been interpreted and led by elite, often celibate men. The religious experience and perspectives of women, in past and present, are only now beginning to be a significant focus of study. Our understanding in the West, therefore, of what biblical religious traditions have to say about sex and gender comes from men and is based on sacred texts written and selected by men. More influential even than what these texts say explicitly about sexuality and gender are the conceptions they have been understood to set forth of the proper God-given social order: of “the way things are and the way they are meant to be.” These have defined “natural” hierarchies of Divine/human, male/female, mind/body, free/enslaved, etc. that reflect and justify a fundamental social dynamic of domination and subordination. Until it is recognized and addressed, this dynamic will remain a potent barrier to women’s control of their own sexuality and to broader social change.

Sexual interest, sexual activity, and sexual satisfaction in the second half of life: Influences of the relationship

Bucher, T., Department of Social Psychology II, University of Zurich, Switzerland

Many studies about sexuality emphasize the importance of the partnerstatus for maintaining sexual activity in middle and old age. But having a spouse or a steady partner per se is no guarantee for a satisfying sex life. The quality of the relationship is a further important factor to be considered. This study aimed to identify 'relationship variables' which explain sexual interest, activity and satisfaction in the second half of life. The influence of age (own and of the partner), duration of the relationship, emotional intimacy (Dyadic Adjustment Scale, Spanier, 1976), physical attractiveness and various aspects of intimate communication (e.g. ability to express own sexual needs) was investigated.

Methods: A sample of 400 men (age: 45-87; M=58.5 years old) and 443 women (age: 45-78; M=54.8 years old) who were either married or had a steady relationship was drawn from the study 'Sexual Interest, Sexual Activity and Satisfaction in the Second Half of Life' (see Bucher, Hornung & Buddeberg, 2002). The effects of the relationship variables on sexual interest, sexual activity and satisfaction were tested simultaneously using structural equation models.

Results: The main determinants of sexual interest for both sexes were age, duration of relationship and perceived physical attractiveness of partner. For women the partner's ability to respond to their sexual needs was an additional significant predictor. No further relationship variables had an effect on sexual interest. Sexual activity was mainly determined by sexual interest; emotional intimacy and intimate communication showed weaker effects and were more important for women than for men. Emotional intimacy and intimate communication explained as much variance of sexual satisfaction as the frequency of sexual interaction.

Conclusions: The quality of the relationship has little effect on sexual interest for women only. It seems that women play a more active part in maintaining sexual activity in long lasting relationships. Emotional factors and the expression of sexual needs explain more variance of sexual activity in women than in men. Sexual satisfaction in the second half of life results from sexual activity as well as from intimate communication and emotional aspects of the relationship. The relationship should be considered more closely in future research about sexuality.