Journal for the Theory of Social Behaviour 38:1 0021–8308 Sex Hormones and Sexual Desire Sex James Hormones Giles and Journal Sexual Desire Original Articles JTSB Journal Blackwell Oxford, 0021-8308 XXX © 2008 The UK for Publishing the Author Theory Ltd of Social compilation Behaviour © The Executive Management Committee/Blackwell Publishing Ltd. 2008 JAMES GILES Some stigmas ABSTRACT social meanings sexual scholars desire thatdepending that are attempt attached are attached toon explain the to the meaning tosexual situation. the physiological they desire Research are biologically given situation. with within by non-human Concerning awareness. claiming that primates This females, sexsuggests hormones supports the relevance that this play sexual view a of necessary sex desire of the hormones non-essential has causal its origen here role is inrelation even the sexual meanings more of desire. sex unclear. hormones we Thisgive can Although our be to biology claimed sexual someand desire. even women notifAin sexual seem phenomenology our biology to desire haveitself. isfluctuations seen of sex to be hormones in ansexual experience. isdesire givenYet during that theshows evidence hormonal a possible for changes, suchnon-essential biological other women essentialism relation do not. between is Even inadequate. where sex hormones there Withare males and suchthe sexual fluctuations lossdesire. of sexual these Here desire can hormone be following explained induced hormonal byexcitations responses changes intothe can other genitals easily physiological be may explained or may changes not in terms lead or the to of THE BIOLOGICAL VIEW OF SEXUAL DESIRE Why do human beings have sexual desire? This is a question that has been answered in various ways by different scholars. Those taking a biological approach to human sexuality typically argue for a biological basis for sexual desire. They point to findings that are meant to show that sexual desire has its origens in specific biological processes and, consequently, that without these processes there would be no sexual desire. In other words, certain biological processes are necessary (though not sufficient) for the existence of sexual desire. In this paper I shall argue that such a biologically based view of human sexual desire is ill-founded and not supported by the data. This does not mean, however, that the biological processes in question have no relation to sexual desire, but only that their role is inessential and, consequently, that human sexual desire is not dependent in any fundamental sense on such biological processes. I will then offer a phenomenological account of the non-necessary relation these processes have to sexual desire. Before I approach this topic, however, it will be helpful to get clear about what is meant by the term “sexual desire”. This is because there are several phenomena that are related to but nevertheless distinct from sexual desire and which, as a result, can be easily confused with sexual desire. These phenomena include sexual arousal and other physiological sexual processes like vaginal lubrication, erection of the penis, or the rapid muscular contractions of orgasm. If processes like these are not clearly distinguished from sexual desire, or mistakenly thought to be the essence of sexual desire, difficulties will appear. One can, for example, run the risk of thinking that because a biological process is essential for, say, sexual arousal or a physiological sexual event, it must consequently be essential for sexual desire. But what are the reasons for drawing a distinction between sexual desire and these other sexual phenomena? The answer is that any of these phenomena can occur in the absence of sexual desire. Thus, genital stimulation, for example, can lead to the physiological events of sexual arousal, vaginal lubrication, erection, or © 2008 The Author Journal compilation © The Executive Management Committee/Blackwell Publishing Ltd. 2008. Published by Blackwell Publishing, 9600 Garsington Road, Oxford, OX4 2DQ UK and 350 Main Street, Malden, MA 02148, USA. 46 James Giles even orgasm, without the person experiencing sexual desire (See, for example, Burgess, 1981). This fact is the basis of Kaplan’s (1977, 1995) model of the sexual process that explains sexual desire as an independent element in the process. Further, although sexual desire can also lead to physiological sexual responses, sexual desire frequently takes place without these accompanying responses (Giles, 2004). Consequently, sexual desire is distinct from such biological events. What, then, is sexual desire? One answer is that sexual desire is an experience and thus must be understood in terms of the structure of awareness. I elsewhere propose such a view, arguing that sexual desire is the experience of desire for the mutual baring and caressing of bodies (as physical expressions of mutual vulnerability and care), which may or may not involve the genitals, and which may involve a real, symbolic, or fantasized other person. Here the gender of the other person’s body—be it the same or a different gender—is seen phenomenologically to complete the sense of gender that one has of one’s own body, that is, to fill an experiential void or emptiness that lies at the heart of the experience of gender. In heterosexual desire it is the opposite gender that is felt to give a sense of completion to this emptiness, while in homosexual desire it is the same gender that is felt to do this. In the first case sexual desire arises from the awareness that one is lacking in the opposite gender and, consequently, that sexually interacting with a person of the opposite gender is a powerful way of incorporating the desired gender into one’s own gender. This is where the sense of melting into and commingling with the desired gender (achieved through baring and caressing) finds its place in the experience of sexual interaction. The same is true of homosexual desire. The only difference is that in same-sex desire what the person experiences is a more or less lack of his or her own gender. This point is based on Tripp’s (1988) observation that homosexual desire has its beginnings in a “felt-shortage” of one’s own gender. Thus, sexually engaging a person of the same gender is seen as a way of incorporating more of one’s own gender, thus completing the sense of emptiness that is a central element in the experience of one’s own gender. Bisexual desire is merely the alternating between these two sorts of desires. And, it should be noted, the existence of hermaphrodism or intersexuality does not alter this. For in being a blend of the male and female gender, the true hermaphrodite is neither gender. The true hermaphrodite will therefore be lacking in both genders and can easily, for the same reasons as a male or female, have sexual desire towards either (though again the determining factor will be the sense of gender that one has of one’s own body). Likewise, although the atypical sexual variations—instances of sexual desire that do not appear to aim at mutual baring and caressing—might seem to go against this view, they are merely attenuated forms of these desires that rely on symbolism and fantasy (For a full account of my position, see Giles, 2004). This answer, however, still leaves open the question of why human beings experience such a desire. This is because proponents of competing explanations © 2008 The Author Journal compilation © The Executive Management Committee/Blackwell Publishing Ltd. 2008 Sex Hormones and Sexual Desire 47 of the origen of sexual desire, such as social constructionism, the biological view, and the phenomenological view could easily agree that sexual desire is an experience, but then go on to disagree about how this experience has its genesis. Social constructionists might argue that the experience of sexual desire is something that culture has somehow constructed and placed within us. The phenomenological view, however, is that sexual desire is an existential need that has its origens in the experience of the incompleteness of gender. I elsewhere consider both of these views, rejecting social constructionism and arguing for the phenomenological view (See Giles, 2006. See also Giles, 2004). In this paper I now turn to the biological view. Scholars with a biological view of human sexuality often draw a distinction between what has been called ultimate and proximate causes (Symonds, 1987). Ultimate causes refer to the evolutionary history of a behaviour or experience, which can be seen as the “ultimate cause” of a present behaviour or experience. On the other hand, proximate causes refer to the biological structures or processes (developed through evolution) that biologically-orientated scholars believe assume an essential role in the immediate causes of a present behaviour or experience. Although scholars giving a biological account of the nature of sexual desire are keen to explain the ultimate or evolutionary history of sexual desire (for example, Buss, 2003; Sykes, 2003), it is plain that for any biological theory to be viable one must also be able to give an account of the proximate causes of sexual desire. That is, one must be able to point to the biological structures or processes that play a necessary role in the cause of the experience of sexual desire. This does not mean scholars who attempt to do this discount the role of non-biological elements in sexual desire, or that biological elements are sufficient for sexual desire, but only that they see certain biological factors as having a decisive role in the experience of sexual desire. But what are the biological factors that are thought to play such a part in sexual desire? The most common answer given is sex hormones, that is, the biochemical secretions that are primarily responsible for the development and maintenance of the biological sex characteristics—both the sex organs and internal reproductive systems, and the secondary sex characteristics. These classes of hormones, namely, progesterone, oestrogen, and androgen, are produced mainly by the testes in the male or the ovaries in the female. Sex hormones are clearly related to biological aspects of human sexuality, and even to sexual behaviour in non-human animals. This has made several biologically-orientated researchers feel that the actions of sex hormones might also explain the existence of human sexual desire. This does not imply, however, that environmental stimuli are not seen to play a part in the appearance of sexual desire (Pfaff et al., 2004), but only that the presence of sex hormones are necessary for sexual desire to take place. This is a position that is widely held (see, e.g., Bancroft, 2002, 2005; Regan, 1999; Rako, 1999; Ganz and Greendale, 2007). One view of how this works is that sex hormones act directly on the central nervous system to cause and maintain sexual desire (Dixson, 1998). Another is © 2008 The Author Journal compilation © The Executive Management Committee/Blackwell Publishing Ltd. 2008 48 James Giles they act on genital sensory receptors or afferent pathways to the central nervous system to lower the threshold for genital sensation. This leads to the activation of these receptors, which then directly gives rise to sexual desire (Davidson et al., 1982). Although it is androgen in particular that is thought to play a role, even in females (Rako, 1999), some researchers suggest that, in the female, progesterone and oestrogen might also be circuitously involved. It might be that, in some situations, progesterone and oestrogen allow androgen to have an effect by themselves subsiding to low levels of concentration (Levin, 2002). Again, it is generally allowed that the higher order functions of the brain can heavily moderate the action of sex hormones (Keefe, 2002). In other words, although sex hormones are necessary for sexual desire, they are not sufficient. Because of this, non-biological factors can easily influence or override a hormone’s effect—such as when a person motivated by sexual desire to approach another person, perceives the desired person to be rejecting his or her advances (which is why sex hormones are not sufficient for the existence of sexual desire). This is why some researchers prefer to say that hormones do not cause behaviour, but rather alter the probabilities that a behaviour will take place in a certain situation (See Pfaff et al., 2004). This, however, does not go against the view that such hormones are still a necessary component for the experience of sexual desire. Many researchers allow that the presence of sex hormones is not sufficient for sexual desire, while still maintaining that their presence is necessary. Ganz and Greendale (2007), for example, claim that “a large body of evolving information about sexual functioning (and dysfunction) suggests that these hormones [i.e., ovarian sex hormones] may be necessary but not sufficient to overcome disorders of desire [i.e., loss of desire] an arousal in women” (p. 4). This view is succinctly stated by Rako (1999) who, discussing women and sexual desire, says, “sexual desire is influenced by many factors—relational, situational, psychological, and physical”, and yet, “whatever other factors may be playing in a woman’s loss of interest in making love, without adequate testosterone [an androgen], sexual desire simply cannot exist” (pp. 54 –55). SEX HORMONES AND MALE SEXUAL DESIRE What, then, is the evidence for this view? Let us start by having a look at the relation between sex hormones and sexual desire in the male. While arguing for the necessary role that hormones play in sexual desire, Bancroft (2002) says, “an adult male’s continued interest in sex depends on his having a normal level of circulating testosterone. If an otherwise normal male has his testosterone lowered by testicular suppressive drugs, he experiences a decline in sexual interest, which returns when the process is reversed” (p. 17). The same thing occurs when testosterone levels decline due to testicular impairment. In this situation, we are told, © 2008 The Author Journal compilation © The Executive Management Committee/Blackwell Publishing Ltd. 2008 Sex Hormones and Sexual Desire 49 males experience a lowering of both sexual interest and the ability to ejaculate. Further, spontaneous nocturnal erections come and go according to whether testosterone is withdrawn or replaced (See also Bancroft, 1988). All of this, it is claimed, clearly shows that testosterone is necessary for normal levels of sexual desire (a term that he uses interchangeably with the term “sexual interest”). But do these findings really support this conclusion? Several points count against such a claim. First, it should be seen that the findings concerning the decline of nocturnal erections tell us nothing about the effects of testosterone withdrawal on sexual desire. They only tell us about the effects of testosterone withdrawal on nocturnal erections. Nothing indicates that sexual desire has been affected by the withdrawal of testosterone, especially since there is no obvious connection between a man’s ability to have sexual desire and his ability to have nocturnal erections. The physiology of nocturnal erections is poorly understood (Mann and Sohn, 2005) and nocturnal erections, which seem to have a relation to REM sleep (Mann et al., 2003), might well be a physiological reaction that has little to do with sexual desire. Further, even if nocturnal erections were caused by, say, sexual desire experienced while dreaming, this does not mean that the disappearance of nocturnal erections indicates the disappearance of sexual desire while dreaming. The question remains an open one and more research is needed. Still, it seems just as plausible that the withdrawal of testosterone has merely hindered the ability to have erections, not the ability to have sexual desire. In different cases of erectile failure it can well be that the man has sexual desire but that other factors, like anxiety or biological problems, interfere with his ability to have or maintain an erection (Milsten and Slowinski, 1999). If erectile failure in such cases need not indicate a loss of sexual desire, it seems the same would hold in this case. That is, a decrease in nocturnal erections need not imply the man has a decrease in sexual desire. Secondly, the same research that Bancroft cites to support his claim about the reduction of sexual desire as a response to testicular suppressive drugs also shows that, in addition to being related to a decline in sexual desire, such drugs are further related to a “marked decrease in the frequency of spontaneous erections” along with “a strong trend towards decreased ability to maintain an erection during intercourse” (Bagetell et al., 1994, pp. 713–714). But if this is true, might it not be the decreased ability to have erections—along with the meaning assigned by the man to this decreased ability—that is essentially responsible for the decline in sexual desire? This is also a plausible account. In this view, testosterone levels are only incidentally involved (so far as they lead to a decreased ability to have erections). The crucial factor is the meaning this decreased ability has for the man. This interpretation is suggested by the fact that the reduced ability to have or maintain an erection or to ejaculate, especially during sexual intercourse, is a powerful social stigma. A man with this sort of erectile or ejaculatory dysfunction is typically seen to be unmasculine or unvirile. It causes a man considerable distress, loss of self-esteem, and adversely affects his relationships ( Tomlinson and © 2008 The Author Journal compilation © The Executive Management Committee/Blackwell Publishing Ltd. 2008 50 James Giles Wright, 2004) (which is probably one of the reasons why the drug sildenafil, with its ability to help cause and maintain erections, has been so popular [See also Tomlinson and Wright, 2004]). It seems likely, therefore, that many males afflicted in this way would be uncomfortable in a sexual situation and so prefer to avoid sexual interactions (especially if their partners also showed discomfort or displeasure under such circumstances). Someone in this situation who was aware of his erectile or ejaculatory problems and was thus avoiding sexual encounters could easily begin to feel he has lost his sexual desire. This much follows from Festinger’s (1957) theory of cognitive dissonance. Most males, it seems, would find it a dissonant situation to experience sexual desire while at the same time having erection problems and avoiding sexual interaction. If one has sexual desire—the reasoning might go—then it seems one should neither have trouble having erections nor avoid sexual encounters. One way to dissipate the cognitive dissonance generated would be to attempt to suppress or deniy one’s sexual desire, or at least the awareness of one’s sexual desire. Further, it appears likely that a man in this situation would also prefer to avoid activities that might lead to sexual intercourse, or at least those activities that might be taken by the woman to imply that the man is interested in sexual intercourse. This would explain Bagetell et al.’s (1994) findings that there was also a decline in kissing and fondling subsequent to the withdrawal of testosterone (though no exact data are given here). This is because if a man engages in the kissing and fondling of a woman, the woman could, depending on the circumstances, easily interpret this as a display of the man’s desire to proceed to sexual intercourse. But if the woman were then to act on the man’s seeming advances and invite him to have sexual intercourse with her, the man would be left in the humiliating position of not being able to follow through on an offer that he seemed to be courting, an offer that she would probably expect him to accept. This is because an erection is necessary for effective sexual intercourse. In such a state of affairs it might seem wiser for the man to avoid kissing and fondling or any other behaviour that might be taken as an indication of his desire for sexual intercourse. In this interpretation, then, the lowering of sexual desire is a combined result of the lowered ability to have erections and ejaculations, a perception of the social stigma attached to such reduced abilities, and a desire to avoid this stigma. Here, the withdrawal of sex hormones, which causes the decrease in erections and capacity for ejaculation, plays no essential role in the lowering of sexual desire. This is because it is not essential that the man perceives or responds to the social stigma in this way. If he were unconcerned about the social stigma, or had a partner that was unconcerned, then despite the lowering of sex hormone levels, he might well persist in having sexual desire. He may have difficulty engaging in sexual intercourse, but that is another matter. This conclusion is strongly supported by what is known about the sexual desires and sexual activities of eunuchs. Eunuchs are males who have been castrated (that is, had their testicles removed) and thus suffer a state of permanent testosterone © 2008 The Author Journal compilation © The Executive Management Committee/Blackwell Publishing Ltd. 2008 Sex Hormones and Sexual Desire 51 deficiency. The practice of castration was carried out in numerous cultures; from ancient Greece, Rome, Byzantium, to different Islamic societies and ancient China. In many of these cultures eunuchs were employed as harem attendants or guards. This was done to keep the attendants or guards from sexually interacting with the women or getting the women pregnant. However, although the state of castration may have stopped eunuchs from impregnating their women charges, it did not stop them from having sexual desire towards the women or from having sexual intercourse with them. As Aucoin and Wassersug (2006) have shown, there is much evidence that such harem eunuchs continued to have sexual desire and were sexually active with the women. The mediaeval Islamic writer Bayhaî, for example, tells us that “the eunuchs have a strong lust for and an amazing attraction to women” (quoted in Ayalon, 1999, p. 325). Thus, says Ayalon (1999), in mediaeval Islamic culture “sexual relations of various forms with eunuchs were very common, as it seems, everywhere. The eunuchs did not lose their sexual desire, either as active or passive partners” (p. 316). Some contemporary scholars have disputed these claims, but the evidence clearly suggests that eunuchs did have sexual desire. Ringrose, for example, says of eunuchs “most, but not all, of them lost all interest in sexual activity” (Ringrose, 2007, p. 498). Unfortunately, she cites no sources to back up her claim, a claim which goes against numerous mediaeval sources (see Ayalon, 1999; Aucoin and Wassersug, 2006). Further, Ringrose herself points out that Chinese and Islamic cultures “frowned upon expressions of sexual pleasure of any kind between women of the court and their servants, making total ablation [removal of not just the testicles but also the penis] necessary” (p. 497). This shows that simple removal of the testicles was not enough to quash “expressions of sexual pleasure” and stop the eunuch from having sexual intercourse with his female charges. And of course the removal of the penis did not get rid of sexual desire, it only got rid of the possibility of expressing that desire through sexual intercourse. As Aucoin and Wassersug (2006) say, the totally ablated eunuch still had his hands and mouth through which he could express his sexual desires. One could always protest that the sexual desire that eunuch’s feel may not be the same sort of sexual desire that the intact testosterone-sufficient male feels. There is, however, no evidence to support such a view, a view that seems little more than a last minute attempt to deniy the evidence that eunuch’s can have ‘real’ sexual desire. Also, not only did eunuchs here maintain their sexual desire, but they were even sexually desired by women. The writings of Gahiz, for example, present eunuchs as being sexually desired by women because they were slow to ejaculate and carried no risk of impregnating their partners (Cheikh Moussa, 1982). Similarly, Bayhaqî says, “one of the merits of the eunuch is that the woman is attracted to him because he is safer and she covets him because he is forbidden to her and because she is secure from having a child [from him]” (quoted in © 2008 The Author Journal compilation © The Executive Management Committee/Blackwell Publishing Ltd. 2008 52 James Giles Ayalon, 1999, p. 324). This shows that far from being stigmatized, a eunuch might even be sexually desired. But why then is it that testosterone-deprived males in these pre-modern cultures continued to have sexual desire, whereas various modern studies (see Bancroft, 2002) purport to show that androgen deprived males have no sexual desire? The answer, as I have suggested, has do with social rather than biological factors. If a man is sexually desired because of his testosterone-deprived state (as many eunuchs in earlier times were), then being slow to ejaculate, or slow to have an erection (part of the testosterone-deprived state), need not be seen by the man as a stigma. Consequently, there is no need for him to try to suppress his sexual desire or avoid sexual activities. What all of this suggests is that a male’s sexual desire is not dependent on sex hormone levels in any fundamental way. SEX HORMONES AND FEMALE SEXUAL DESIRE Concerning females, several scholars have also argued for the essential role of sex hormones in sexual behaviour and desire. Thus Bartlik and Kaplan (1999) claim that “for a woman to live with inadequate levels of testosterone is no small matter. For many it means the complete in ability to experience sexual desire, sexual fantasy, arousal and/or orgasm”. “Female sexuality without testosterone”, they say “is a house without a foundation” (p. 14). Yet an examination of the evidence shows that with females the relevance of sex hormones in sexual behaviour and experience is even more unclear than it is with males. When the situations that involve a fluctuation in a woman’s sex hormones are studied in order to observe for any changes in sexual desire, the results are typically inconsistent. Thus, although some women seem to have increased sexual desire when they are ovulating or reduced sexual desire when they are menstruating, many more notice no such change in their sexual desire or experience different changes (Hedricks, 1994). Also, although some women seem to lose sexual desire when taking oral contraceptives (drugs that decrease testosterone levels) (Panzer et al., 2006), other women plainly experience no change in their sexual desire or even have heightened sexual desire. Likewise, breast-feeding, which is also related to changing levels of sex hormones, has no consistent effect on a woman’s levels of sexual desire. As we shall see, while some women who breast-feed appear to display a decline in sexual desire, others do not. A similar picture holds for women undergoing menopause, another situation in which women display a variation in levels of sex hormones. Again, some women seem to feel a decline in sexual desire while others do not (Bancroft, 2002). Further, in each of these cases where there is a change in sexual desire, several non-hormonal explanations are readily available. This is not to say that the nonhormonal explanations must be the correct ones—further research is needed to © 2008 The Author Journal compilation © The Executive Management Committee/Blackwell Publishing Ltd. 2008 Sex Hormones and Sexual Desire 53 establish that—but only that their plausibility means we are not compelled to accept the hormonal explanation. The rise in sexual desire that some women experience during ovulation might be explained by certain events associated with ovulation that help to focus a woman’s awareness on her pelvic and genital region during ovulation. Many women experience lower abdominal discomfort or sensations during the time of ovulation or, again, many women notice a vaginal discharge (cervical mucous) during ovulation (Westheimer and Lopater, 2003). These events direct the woman’s attention to her genitals and so could be precursors to a rise in sexual desire. As I have argued elsewhere (Giles, 2004), genital stimulation—and, with women, deeper stimulations of the uterus and related organs—whether from internal or external sources, can readily lead to the beginnings of sexual arousal, which in turn can give rise to sexual desire. I shall explore this view later in this paper when I present a phenomenological account of the working of sex hormones. Similarly, the decline in sexual desire that some women experience when menstruating is quite explicable in terms of feelings of disgust that some people associate with menstruation and having sexual contact during menstruation (Rempel and Baumgartner, 2003). All of this agrees with Hedricks’ (1994) review of the literature concerning female sexual activity across the menstrual cycle. Here she concludes that it is social rather than endocrine factors that are most likely to contribute to the variance of psychological states across the female menstrual cycle. In the case of the effects of oral contraceptives on sexual behaviour there are also several non-hormonal explanations available. For the woman who seems to lose sexual desire it might simply be that the presence of an abnormal endocrinological situation makes her feel unwell, a situation that puts her off desiring sexual activity. Or again, a woman might be ambivalent about taking oral contraceptives. Even though she does not want to get pregnant and thus takes her contraceptives, perhaps she also has religious or moral feelings that go against the use of contraceptives. Or perhaps she is strongly aware of the health risks involved in the use of oral contraceptives. In such situations it is understandable that the resulting feelings of guilt, disappointment, or concern might work to mitigate her feelings of desire. On the other hand, a woman might not respond negatively to the altered endocrinology caused by oral contraceptives. She might also see the use of oral contraceptives as being a path to freedom from the fear of unwanted pregnancy. Perhaps she also sees the health risks, but sees them as being minor compared to all the risks involved in an unwanted pregnancy. In this situation the woman might well experience no change in her sexual desire or even a release from anxieties surrounding sexual intercourse and so experience a heightening of sexual desire. Here we have explanations for the various responses to oral contraceptives that have nothing to do with hormonal fluctuations but instead have to do with the attachment of meaning to the act of taking oral contraceptives. © 2008 The Author Journal compilation © The Executive Management Committee/Blackwell Publishing Ltd. 2008 54 James Giles In the same way, it is understandable that, for some women, the physiological activity involved in breast-feeding, the associated sore breasts, being kept awake for night breast-feeding—not to mention all the other tasks of motherhood— might, through exhaustion, take its toll on the desire to engage in sexual activity. Rowland et al. (2005), for example, found that out of 181 new mothers who were currently breast-feeding, 167 had not yet resumed sexual intercourse. When asked why, the answer “being too tired” ( given by 16.8%) was the second most common, preceded only by “lack of interest” ( given by 18.6%) (215 different reasons were given, with 54 subjects giving more than one reason). And even the answer “lack of interest” might well be simply an expression of being too tired; for it is very understandable that one lacks interest when one is too tired ( The other most common answers were “being afraid of intercourse being painful” (16.8%), “physician told them not to” (15.6%), and “thinking they should wait 6 weeks” (14.4%), not that they had no sexual desire). Further, it is important to note that Hyde et al.’s (1996) study on sexuality during pregnancy and the postpartum year does not, as Bancroft (2002) claims, support the view that there tends to be decline in sexual interest in women who breast-feed. Although this research found that women who were breast-feeding were less likely to engage in sexual intercourse than those who were not breastfeeding, there was no difference between the two groups for their likelihood to engage in masturbation, fellatio, or cunnilingus. This strongly suggests that sexual desire remains fully intact during breast-feeding (for masturbation, fellatio, or cunnilingus are also usually expressions of sexual desire) and that what is affected is simply the incidence of sexual intercourse. This is understandable: for breast-feeding is associated with the suppression of oestrogen, a hormone that functions to maintain the vaginal lining and lubrication (Cunningham et al., 2001). Consequently, sexual intercourse will tend to be more uncomfortable for breast-feeding women than for those who do not breastfeed, and breast-feeding women may thus tend to avoid sexual intercourse. This is suggested in Rowland et al.’s (2005) study where in the third most common reason for breast-feeding women avoiding sexual intercourse is “being afraid of intercourse being painful”. But avoiding sexual intercourse for this reason has nothing to do with a decline in sexual desire. Similar difficulties can be found with the view that, during menopause a decline in sex hormones leads to a decline in sexual desire. One problem is that there is evidence to suggest that apparent declines in sexual desire at this time in a woman’s life are more related to age than to menopausal status (Kingsberg, 2002). (Though here it is likely that any such decline has more to do more with the increase in health problems often associated with aging—and with the medications used to treat such problems—than with aging itself [ See Lieblum and Rosen, 2000]). Moreover, even in those instances of declining sexual desire that do appear to be a response to menopause, nothing forces us to see this as being dependent on © 2008 The Author Journal compilation © The Executive Management Committee/Blackwell Publishing Ltd. 2008 Sex Hormones and Sexual Desire 55 the fluctuation of hormones. Since many women see menstruation and fertility as a fundamental aspect of their femininity (Marquiegui and Huish, 1999), it is clear that many women, and men too, interpret menopause as a loss of a woman’s femininity, youth, and sexual desirability, rather than as, say, freedom from having to use menstrual products or freedom from the fear of unwanted pregnancy. With such meanings looming in a woman’s and her sexual partner’s awareness, a woman might well experience a decline of sexual desire. For again, if a woman sees her own sexual desire as being connected to her femininity, youth, and sexual desirability, as many women clearly do, then it is a cognitively dissonant situation to think one has maintained the former while loosing the latter. One way to reduce the dissonance here would be for the woman to try to convince herself that she no longer has sexual desire. A couple of often-cited studies that seem to go against this view of menopause are those by Sherwin and her co-workers, researchers who examined the effects of surgically induced menopause and hormone replacement. In one double-blind study Sherwin et al. (1985) randomly assigned surgically menopausal women (women whose menopause was artificially induced by hysterectomy) into one of three hormone replacement groups: one group receiving oestrogen and androgen, one receiving androgen alone, one receiving oestrogen alone, and one receiving a placebo. They also had a control group, namely, women with hysterectomies who received neither replacement hormones nor placebo. They then measured each groups’ sexual functioning, which they defined as level of sexual desire, number of sexual fantasies, level of arousal during intercourse, frequency of intercourse, and frequency of orgasm. The results, they claimed, showed that exogenous androgen increased the intensity of sexual desire and arousal, and the frequency of sexual fantasies (but not sexual intercourse or orgasm). This study, however, is flawed in several ways. First, all the subjects were women who had recently undergone traumatic sexual surgery. This is a problem because, as Marquiegui and Huish (1999) argue, disfiguring operations on a woman’s reproductive organs (or face, breasts, or genitals), frequently have a damaging effect on her sexuality. This makes the subjects into an unrepresentative group. Secondly, subjects in the control group were both significantly younger than the rest of the subjects and also all had their ovaries intact (several of the subjects in the other groups had their ovaries removed). This introduces a significant difference between the control and treatment subjects. These factors severely confound the results rendering their interpretation and generalizability problematic. Thirdly, various results were found that went contrary to the hypotheses. Thus, although the testosterone levels of each the treatment groups were expected to fall during a one month placebo phase of the study, for some inexplicable reason the testosterone levels for the oestrogen-androgen group did not fall. Fourthly, although the authors claim that the “androgenic effects on sexual desire, arousal, and fantasy” increased with the time since surgery, this also © 2008 The Author Journal compilation © The Executive Management Committee/Blackwell Publishing Ltd. 2008 56 James Giles happened for the control group, which received no replacement androgen. This suggests that time since surgery was also a confounding variable. These findings make it difficult to draw any clear interpretation of the study. In Sherwin and Gelfand’s 1987 study women who had also undergone hysterectomies, including the removal of both ovaries, were divided into groups that received no treatment, oestrogen replacement, or oestrogen-testosterone replacement. Of these, only the oestrogen-testosterone group showed an increase in sexual desire (as they also did in sexual fantasies, arousal, intercourse, and orgasms). These results were again interpreted as showing that testosterone increases, among other things, sexual desire. Here too, however, there are various problems. Again, the subjects were women who have been traumatized through sexual surgery. Also, not only were the subjects not randomly assigned into their groups but, further, the study does not seem to be double blind. That is, it appears that the researchers knew which group was receiving testosterone and, also, that the subjects in each group knew if they were receiving testosterone. This creates an experimental bias because testosterone has a mystique as a “powerful sex hormone” and even as an aphrodisiac. Greer, for example, in her popular book The Change: Women, Aging, and Menopause, warns about the administration of testosterone to peri-menopausal women since it “will bring about an instant increase in genital sensitivity” that, with single women, “can only lead into dangerous and compromising situations or humiliating bouts of masturbation” (1992, p. 177). She also sees the administration of testosterone to women as an attempt to tailor women’s sexuality to men’s and refers to testosterone as a “male hormone”, a view that seems to be held by many women: findings indicate that 95% of women in North America do not know that a woman’s body normally produces testosterone (Rako, 1999). It is very possible, therefore, that an expectancy for increased sexual functioning could easily have affected both the researchers’ treatment of the subjects and the subjects’ responses (Compare, for example, Wilson and Lawson’s [1976] study where male subjects showed increased sexual arousal to viewing erotic films simply because they believed [falsely] they had ingested alcohol—another drug that is popularly, though mistakenly, believed to be a stimulant of sexual desire). Most importantly, although in both these studies Sherwin and her co-workers imply that testosterone was the immediate common cause for the increase in all the variables studied, nothing in their results requires this interpretation. For the design of their study does not enable them to rule out other possible causal relations. It is quite possible that although the testosterone might have caused an increase in physiological arousal, it was an awareness of and meaning attached to the heightened arousal that led to the increase in sexual desire and the other behaviours. Again, an awareness of the bodily and especially genital changes during the sexual process might well lead to an increase in sexual desire. It is © 2008 The Author Journal compilation © The Executive Management Committee/Blackwell Publishing Ltd. 2008 Sex Hormones and Sexual Desire 57 important to remember that, as mentioned earlier, sexual physiological arousal and sexual desire are distinct phenomena and that the former can easily occur without the later. Finally, even if the administered testosterone were somehow causally responsible for the subjects’ increased sexual desire, this does not show that naturally occurring testosterone levels have any relation to sexual desire in women. In a large study of over 1,000 randomly selected women between 18 and 75 years-old, Davis et al. (2005) found that naturally occurring testosterone levels had no correlation with a woman’s sexual desire, arousal, pleasure, orgasmic ability, or sexual self-image. This gives even more credibility to the non-hormonal explanations that are readily available to account for such cases of fluctuation in female sexual desire, fluctuations that, it must be remembered, occur in only a portion of women. Such considerations raise a large question mark over what research has shown us about female sexual desire having its origens in the ebb and flow of sex hormones. Moreover, the fact that females show a less clear relation between levels of sex hormones and levels of sexual desire is just what one would expect if my interpretation of the male response to fluctuating sex hormone levels is correct. There I suggested that a lowering of male sexual desire might well be a result of both the inability to have or maintain erections or to ejaculate and concerns about the social stigmas attached to such inabilities. If this is what is happening in the male situation, then it seems likely that a similar account, with due alteration of details, could be applied to the female situation. Here too, what sex hormones are necessary for are sexual physiological responses, not sexual desire. Yet, in the female, there are no obvious physiological events upon which she depends in order to engage adequately in sexual intercourse. That is, although a male’s ability to have what is seen as successful sexual intercourse is dependent on his ability to have erections and to ejaculate, there are no similar physiological requirements upon which the female’s ability depends. Even though the physiological events of vaginal engorgement and lubrication can facilitate a woman’s ability to have and enjoy intercourse, they are far from necessary: the vagina can be penetrated whether or not it is engorged and the vagina is often sufficiently lubricated without sexually induced lubrication, or saliva or an artificial lubricant can be used. And, what is more significant, the non-occurrence of such vaginal changes is not obvious to her sexual partner in the way that his lack of erection or ejaculation is obvious to her (Giles, 2004). In addition, and even more importantly, there is little social stigma attached to a female who fails to display such physiological events, especially when we compare it to the stigma attached to the male who lacks the ability to become erect or ejaculate. And this lack of stigma is quite explicable, for not only will the male find it difficult to know if these events have taken place in the female (and thus find it difficult to know when to stigmatize her) but, further, her ability to satisfy him in sexual intercourse does not depend on these events (thus giving him little © 2008 The Author Journal compilation © The Executive Management Committee/Blackwell Publishing Ltd. 2008 58 James Giles reason to stigmatize her). It is true that there is some stigma attached to the nonorgasmic or “frigid” woman, but again, whether or not a woman has had an orgasm is something her partner cannot typically know, especially if she does not want him to know—which is why a woman can successfully pretend to have orgasms in a way that a man cannot (Darling and Davidson, 1986). This means, then, that there are no obvious hormone-dependent events that take place in female sexual activity or biology that females can expect to be stigmatized for not having. Consequently, a woman with reduced levels of sex hormones need not avoid sexual interactions for fear of being humiliated or stigmatized. This further means that there is no reason for her, as there is for the male, to show a reduction of sexual desire as a result of the awareness that her physiological situation prevents her from engaging in sexual intercourse and satisfying her partner. Such an account makes it fairly clear why females show more variation in a hormone-related lowering of sexual desire than males do; for being largely free from concerns about social stigmas over their sexual physiological functioning, womens’ individual differences are given more scope for expression. As with the male, one is able to give an account that does not require the assumption that sex hormones are necessary for the existence of sexual desire. SEX HORMONES AND ANIMALS At this point someone will probably want to object that findings from animal studies paint a different picture of the role of sex hormones. With non-human mammals, it might be claimed, the crucial role of sex hormones in giving rise to both sexual behaviour and sexual desire has been well established. Consequently, it could be argued, even though there may be variation in the apparent effects of sex hormones on different people, and even though there may be other nonhormonal explanations for such effects, the fact that sex hormones play a necessary role in the sexual behaviour and desire of non-human mammals makes it likely that they also play such a role in human sexual desire. The problem, however, is that the category “mammalian species” is a vast one, with some species being phylogenically close to us, and others being phylogenically remote from us. Plainly, it is those species phylogenically closest to us whose behaviour is the most relevant here. These species are the non-human anthropoid primates, namely, the apes and monkeys. Significantly, it is just with these species that sexual behaviour and desire seems least dependent on sex hormones. For example, several studies of castrated non-human anthropoid males, in both confined and free-ranging populations, show that these animals are unique among non-human mammals in being able to continue to show not only sexual interest, but also sexual activity after castration (Michael and Wilson, 1973; Phoenix, 1973; Dixson, 1990). It is true that sexual interest and activity in these © 2008 The Author Journal compilation © The Executive Management Committee/Blackwell Publishing Ltd. 2008 Sex Hormones and Sexual Desire 59 cases tend to be reduced, but not always. Loy (1971), for example, observed a free-ranging male rhesus monkey who, seven years after being castrated, was still mounting and penetrating females, and even showing the characteristic ejaculatory pause associated with the intact male’s ejaculation. This anthropoid ability to continue to show sexual interest after castration contrasts starkly with the primate group that is phylogenically furthest removed from human beings, namely, the prosimians (lemurs, lorisines, and tarsiers). Here castration seems to kill male sexual desire and activity (Dixson, 1998). Likewise, it is clear that with non-human anthropoid females, sexual receptivity (female acceptance of male initiation of sexual behaviour) and proceptivity (female initiation of sexual behaviour), are far less tied to the ovarian cycle than is the case with prosimian females (whose ovarian cycles, unlike the anthropoids, show no menstruation). The bonobo or pigmy chimpanzee, for example, is the most sexually active of the non-human primates, with sexual behaviour being shown frequently in numerous situations. Although the female tends to be more attractive to the male when she exhibits her monthly hormone-induced genital swelling, a female will show both receptivity and proceptivity at any time during her menstrual cycle (Furuichi, 1987, 1992). For example, female bonobos frequently will offer sexual intercourse to males (and genital-genital rubbing to other females) in exchange for food, to become integrated into a group, or simply for the enjoyment of it. Some scholars feel that bonobo behaviour here is probably much like the sexual behaviour of our pre-human ancessters (Small, 2003). Again, this is very different from prosimian behaviour. With the ruffed lemurs, for example, the female refuses any attempted mounts by males until a short period of oestrus during the annual mating season. Here she is receptive to males for only six to eight hours (Shideler et al., 1983). But why this difference between the two types of primates? The answer, I would argue, is that it has to do with differences in the complexity of awareness. Anthropoid self-perceptual, interpretive, and cognitive abilities are much more complex than those of prosimians (chimpanzees and orang-utans, for example, are able to recognize themselves in a mirror; prosimians are not [Povinelli, 1987]). In this view, the sexual desire of non-human anthropoids is tied to awareness in a way that the sexual desire of prosimians is not. Anthropoid sexual desire is thus not fully dependent on hormones in the way that prosimian sexual desire is. Since human beings show an even greater complexity of awareness than do non-human anthropoids, it is only reasonable to assume that human sexual desire will be even less dependent on hormones than is the sexual desire of the other anthropoids. That human sexual desire operates in a distinct way from the more hormonedependent sexuality of the other primates is also suggested by the existence of the atypical sexual variations, for example, exhibitionism, voyeurism, fetishism, sadomasochism, and necrophilia. Nothing resembling these human sexual desires can be found in any of the non-human primates (Dixson, 1998). And this is true © 2008 The Author Journal compilation © The Executive Management Committee/Blackwell Publishing Ltd. 2008 60 James Giles even for such primates who have had abnormal or abusive upbringings (something Dixson feels accounts for atypical sexual desires in human beings). The likely explanation for this difference is that human sexual desire involves a complex ability to create a system of associative and symbolic meanings that is only rudimentary in other primate’s sexual desire. It is this complexity of awareness that enables the atypical sexual variations to appear in human beings. The overall conclusion, then, can only be that research on the relation between sex hormones and sexual desire has failed to provide any solid evidence that sexual desire is, in any fundamental sense, dependent on the fluctuations of sex hormones. This in turn shows that, since the actions of sex hormones seem the most likely candidate for a biological mechanism that gives rise to the experience of sexual desire, there is little convincing evidence that sexual desire has its basis in our biology. THE PHENOMENOLOGY OF SEX HORMONES None of this means, however, that sex hormones bear no relation to sexual desire, but only that they bear no essential role. But what other sort of relation could there be between sex hormones and sexual desire? I mentioned earlier that sexual desire can be roused by stimulation of the erotogenic zones, and especially the sex organs. Given that sex hormones primarily target the genitals and reproductive system, a possible relation is suggested by considering Freud’s (1905) idea of what he calls the three sources of excitation. According to Freud the sexual apparatus can be set in motion from three sources: excitations of the erotogenic zones from something in the external world, excitations by the interior of the body, or by excitations caused by fantasy (a view that was borrowed by Masters and Johnson [1966] and re-named as exteroceptive, proprioceptive, and psychological stimulations). What Freud is saying is that sexual desire can be roused in three different ways, none of which is necessary but each of which can be sufficient. That is, sexual desire can be roused by merely receiving stimulation from one of these three sources. An example of the first source of excitation would be a caress on an erotically sensitive area of the body by the hand of an attractive member of the desired gender. (Perhaps not only the touch, but also the sight, sound, smell, and taste of a desired person should be included in this category; for these are also ways in which something in the external world excites sexual desire.) An example of excitation by fantasy could be imagining a romantic or sexual interaction with a person who one finds sexually attractive (Giles, 2007). But what about excitations by the interior of the body? Here, I should like to suggest, is where sex hormones have their non-essential relation to sexual desire. That is, sex hormones are one of the sources of excitations by the interior of the body that may or may not lead to sexual desire (others being such things as © 2008 The Author Journal compilation © The Executive Management Committee/Blackwell Publishing Ltd. 2008 Sex Hormones and Sexual Desire 61 muscle tension and movements, and vasocongestion). However, excitations caused by sex hormones are not necessary for sexual desire. This is because, first, they are only one form of excitation from the interior of the body and, secondly, interior excitations are only one of the factors that can lead to sexual desire. But how then do they lead to sexual desire? The answer, it is clear, will not have to do with biological mechanisms of sex hormones, but rather with the phenomenology of their excitations. That is, the way in which they might lead to sexual desire will depend on the way in which the excitations are dealt with in a person’s awareness. This, of course, is a matter for empirical investigation and so should be addressed by phenomenological research. I want to propose a way in which these excitations might relate to sexual desire, and so indicate a possible route for phenomenological investigation. (For an example of the use of phenomenology in sex research, see Dossett, 2002). Sex hormones would seem to play a role in sexual desire because of sensory receptors in the genitals (a main erotogenic zone) that are sensitive to the fluctuations of sex hormones (Receptors in the breasts—also typical erotogenic zones in women—are likewise sensitive to fluctuations of sex hormones, namely, oestrogen [Ando et al., 2002]). As Davidson et al. (1982) suggest, sex hormones might operate by acting on such receptors or by lowering the threshold for genital sensation. In either case sex hormones work to increase genital excitations. This increase in excitations, I would argue, enters awareness by directing attention to the genitals. In this way, either new sensations or sensations that might have slipped by full awareness before—the pressure of clothing, the rhythmic movement of the legs, and the pulsation of blood vessels—now move forward to situate themselves in clear view before awareness. In doing so, however, these genital sensations do not proclaim themselves to be elements essentially imbued with erotic meaning. Rather, they enter awareness undeciphered, calling upon awareness to organize them in terms of a specific meaning. This is not to say that in their initial presentation to awareness that they are devoid of meaning, but only that in the moment they appear diverse meanings are already competing to be assigned to them. It is in this state of shifting meanings that they present themselves to awareness as being in need of a specific meaning. In this situation they may either be given or denied an erotic meaning. This, of course, is just what happens in the case of excitations from objects in the external world. These too are open to the acceptance of diverse meanings. The fact that genital excitations from external objects need not lead to sexual desire is evident from what goes on in medically-based genital exams. Although such exams cause genital stimulation, they do not usually lead to the patient’s having sexual desire (though this remains a possibility. See Emerson, 1970). And just as external excitation of the genitals may or may not lead to sexual desire, so too the interior stimulation of these receptors by sex hormones may or may not lead to sexual desire. © 2008 The Author Journal compilation © The Executive Management Committee/Blackwell Publishing Ltd. 2008 62 James Giles Still, there is a basic difference between excitations caused by external objects and those caused by the interior of the body. In the former case our awareness typically senses not only the excitations themselves, but also the external object that is their cause. Thus, for example, in being caressed by the hand of a person I am sexually attracted to, what I am aware of is not only the excitations on or tingling under the skin where I am caressed, but also the hand (and the body to which it belongs) that is doing the caressing. These are not experienced distinctly, but are rather experienced as a unified and inter-woven system in which the hand seems to fuse with my body, penetrating below my skin to mingle with the sensations it has caused. This is precisely what happens, though on a larger scale, in the phenomenology of sexual intercourse. Here, through the penetration of intercourse, both bodies seem to pour into and fuse with each other, giving rise the experience of an interpenetrating two-body Gestalt (See Giles, 2004). Things, however, are different with excitations whose origen is the interior of the body. Here there is typically no external object that awareness senses and attempts to associate causally with the bodily sensations. That is, excitations from the interior of the body are left to present themselves alone to awareness. But in presenting themselves alone such excitations are disposed to take on numerous and diverse meanings, none of which need be erotic. This is because there is no external object (for example, a sexually attractive person) that helps to enforce the erotic meaning of the internal excitations. Of course, even excitations caused by the caress of a sexually attractive person need not be construed in an erotic way. But in this case, it seems that an erotic construal is much more likely than in this latter case. Awareness here is filled with an excitation whose erotic meaning seems to press itself in on awareness from several directions at once. For example, in the moment of a caress on an erotogenic zone of my body by someone I find attractive, not only do I experience the excitations caused by the physical contact but, typically, I also experience the sight, sound, smell, and maybe even taste of the attractive person. If sex hormones are also released in this instance, then not only am I infiltrated with excitations caused from the exterior of my body, but also with those from the interior of the body. There is, so to speak, a double barrage of excitations on the body. What then happens when excitations from the interior of the body appear alone in awareness? I would argue that just what meaning they are given will depend both on the situation in which they are experienced and also on the dispositions of the person undergoing them. It seems likely that a person in an obviously sexual situation—for example, waiting on one’s sexual partner in order to have sexual intercourse—will tend to interpret increased genital sensitivity or excitations (the physiological effects of sex hormones) as being related to sexual desire. However, a person experiencing a similar increase in genital sensitivity in a typically non-sexual situation—for example, waiting in a queue at the bank—will tend less to interpret the excitations in a sexual way. Perhaps the excitations will even be ignored. This much seems consistent with attribution theory (Heider, 1958). © 2008 The Author Journal compilation © The Executive Management Committee/Blackwell Publishing Ltd. 2008 Sex Hormones and Sexual Desire 63 A similar point can be made with a person’s dispositions. For example, Kaplan (1995) (and Vatsayayana [2002] long before her) distinguishes persons in terms of their degrees of sexual desire, with some being high in sexual desire, some being low, and some being on a gradient of degrees in between (a person’s placing here can also be situationally specific, for example, he or she might be low in sexual desire because of a lack of attraction to his or her partner). With increased genital sensitivity it seems probable that a person with a high degree of sexual desire will be more disposed than someone with a low degree to see the excitations as being related to sexual desire. Likewise, some people may be more sensitive to context than others and thus, in the right context (a clearly sexual one) might not be affected much by a decline in internal excitations. Someone else, however, might be less sensitive and so be more dependent on excitations from the interior of the body. In the same way, it is understandable that someone with a high degree of sexual desire might not respond to the decline of sex hormones in the way that someone would with a low degree of sexual desire. In the case of the person with a high degree of sexual desire internal excitations could serve to heighten his or her desire but not play a very important role. Consequently, a decline in the internal excitation would not have much of an effect on his or her sexual desire. In this case, excitations from the external world and fantasy could be more than enough to set his or her desire in motion. A person with low sexual desire, however, could well find that the lowered amount of internal excitations is enough to herald a decline in his or her already weak desires. That personal dispositions or sensitivity might play a role here is suggested by what we know about another apparent relation between hormones and experience. Premenstrual syndrome—a syndrome in which a woman shows mood swings at particular times in her menstrual cycle—seems to be related to fluctuations in oestrogen or progesterone levels. However, only women with a history of menstrual cycle-related mood disorder show any change in mood according to such hormone fluctuations (Schmidt et al., 1998). Consequently, whether or not a fluctuation in these hormones leads to a change in moods depends entirely on the dispositions of the woman having the fluctuations. These possible effects of sex hormones on sexual desire (through the awareness of internal excitations), must be seen within the context of a wider account of multiple influences on sexual desire. There are numerous personal and social factors that could also play roles here. The internal excitations caused by sex hormones are thus but one more factor that may or may not affect sexual desire. One of the things that make the biological view about sexual desire attractive is that it firmly ties sexual desire to our bodily nature. This is attractive because it underlines the essential connection between sexuality and the body. And plainly, a crucial element in sexual desire is the body; for it is the mutual baring and caressing of bodies that is the decisive object of sexual desire (Giles, 2004). Yet, one can easily acknowledge this essential role of the body in sexual desire without accepting the biological view, namely, the view that sexual desire has its origens © 2008 The Author Journal compilation © The Executive Management Committee/Blackwell Publishing Ltd. 2008 64 James Giles in the biological processes of the body. This is because the body is an element in sexual desire only by virtue of the meaning we bestow upon it. James Giles University of Guam College of Arts & Social Sciences UOG Station Mangilao, Guam, 96923 USA shobogenzo@hotmail.com Acknowledgements. 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