Heart Rate Variability: A Risk Factor for Female Sexual Dysfunction

Abstract

Heart rate variability (HRV) is a measure of autonomic nervous system activity, which reflects an individual’s ability to adapt to physiological and environmental changes. Low resting HRV has been linked to several mental health conditions, including depression, anxiety, and alcohol dependence (Kemp et al. in Biological Psychiatry 67(11):1067–1074, 2010. doi:10.1016/j.biopsych.2009.12.012; Kemp et al. in PloS One, 7(2):e30777, 2012; Quintana et al. in Drug and Alcohol Dependence, 132(1–2):395–398, 2013. doi:10.1016/j.drugalcdep.2013.02.025). HRV has also been used as a method for indexing the relative balance of sympathetic nervous system (SNS) activity to parasympathetic nervous system activity. This balance—in particular, moderately dominant SNS activity—has been shown to play a significant role in women’s genital sexual arousal in the laboratory; however, the role of SNS activity in clinically relevant sexual arousal function is unknown. The present study assessed the feasibility of using HRV as an index of women’s self-reported sexual arousal function outside the laboratory. Sexual arousal function, overall sexual function, and resting HRV were assessed in 72 women, aged 18–39. Women with below average HRV were significantly more likely to report sexual arousal dysfunction (p < .001) and overall sexual dysfunction (p < .001) than both women with average HRV and women with above average HRV. In conclusion, low HRV may be a risk factor for female sexual arousal dysfunction and overall sexual dysfunction.

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References

  1. Appelhans, B. M., & Luecken, L. J. (2006). Heart rate variability as an index of regulated emotional responding. Review of General Psychology, 10(3), 229–240. doi:10.1037/1089-2680.10.3.229.

    Article  Google Scholar 

  2. Billups, K. L., Bank, A. J., Padma-Nathan, H., Katz, S., & Williams, R. (2005). Erectile dysfunction is a marker for cardiovascular disease: results of the minority health institute expert advisory panel. The Journal of Sexual Medicine, 2(1), 40–50; discussion 50–52. doi: 10.1111/j.1743-6109.2005.20104_1.x.

  3. Bloemers, J., Gerritsen, J., Bults, R., Koppeschaar, H., Everaerd, W., Olivier, B., & Tuiten, A. (2010). Induction of sexual arousal in women under conditions of institutional and ambulatory laboratory circumstances: a comparative study. The Journal of Sexual Medicine, 7(3), 1160–1176. doi:10.1111/j.1743-6109.2009.01660.x.

    PubMed  Article  Google Scholar 

  4. Coulter, S. A. (2011). Epidemiology of cardiovascular disease in women. Texas Heart Institute Journal, 38(2), 145–147.

    PubMed Central  PubMed  Google Scholar 

  5. Fernandez, E. A., Neto, E. P. S., Abry, P., Macchiavelli, R., Balzarini, M., Cuzin, B., et al. (2010). Assessing erectile neurogenic dysfunction from heart rate variability through a generalized linear mixed model framework. Computer Methods and Programs in Biomedicine, 99(1), 49–56. doi:10.1016/j.cmpb.2009.11.001.

    PubMed  Article  Google Scholar 

  6. Giuliano, F., & Rampin, O. (2004). Neural control of erection. Physiology and Behavior, 83(2), 189–201. doi:10.1016/j.physbeh.2004.08.014.

    PubMed  Article  Google Scholar 

  7. Greenstein, A., Chen, J., Miller, H., Matzkin, H., Villa, Y., & Braf, Z. (1997). Does severity of ischemic coronary disease correlate with erectile function? International Journal of Impotence Research, 9(3), 123–126.

    PubMed  Article  Google Scholar 

  8. Heiman, J. R. (1980). Female sexual response patterns: Interactions of physiological, affective, and contextual cues. Archives of General Psychiatry, 37, 1311–1316.

    PubMed  Article  Google Scholar 

  9. Hejjel, L., & Roth, E. (2004). What is the adequate sampling interval of the ECG signal for heart rate variability analysis in the time domain? Physiological Measurement, 25(6), 1405–1411. doi:10.1088/0967-3334/25/6/006.

    PubMed  Article  Google Scholar 

  10. Janssen, E., Prause, N., & Geer, J. H. (2007). The sexual response. In J. T. Cacioppo (Ed.), Handbook of psychophysiology (3rd ed., pp. 245–266). Cambridge, England: Cambridge University Press.

    Google Scholar 

  11. Kemp, A. H., & Quintana, D. S. (2013). The relationship between mental and physical health: Insights from the study of heart rate variability. International Journal of Psychophysiology: Official Journal of the International Organization of Psychophysiology, 89(3), 288–296. doi:10.1016/j.ijpsycho.2013.06.018.

    Article  Google Scholar 

  12. Kemp, A. H., Quintana, D. S., Felmingham, K. L., Matthews, S., & Jelinek, H. F. (2012). Depression, comorbid anxiety disorders, and heart rate variability in physically healthy, unmedicated patients: Implications for cardiovascular risk. PLoS One, 7(2), e30777. doi:10.1371/journal.pone.0030777.

    PubMed Central  PubMed  Article  Google Scholar 

  13. Kemp, A. H., Quintana, D. S., Gray, M. A., Felmingham, K. L., Brown, K., & Gatt, J. M. (2010). Impact of depression and antidepressant treatment on heart rate variability: A review and meta-analysis. Biological Psychiatry, 67(11), 1067–1074. doi:10.1016/j.biopsych.2009.12.012.

    PubMed  Article  Google Scholar 

  14. Laurent, S. M., & Simons, A. D. (2009). Sexual dysfunction in depression and anxiety: Conceptualizing sexual dysfunction as part of an internalizing dimension. Clinical Psychology Review, 29(7), 573–585. doi:10.1016/j.cpr.2009.06.007.

    PubMed  Article  Google Scholar 

  15. Lee, J. Y., Joo, K.-J., Kim, J. T., Cho, S. T., Cho, D. S., Won, Y.-Y., & Choi, J. B. (2011). Heart rate variability in men with erectile dysfunction. International Neurourology Journal, 15(2), 87–91. doi:10.5213/inj.2011.15.2.87.

    PubMed Central  PubMed  Article  Google Scholar 

  16. Levin, R. J. (2002). The physiology of sexual arousal in the human female: a recreational and procreational synthesis. Archives of Sexual Behavior, 31(5), 405–411.

    PubMed  Article  Google Scholar 

  17. Lorenz, T. A., Harte, C. B., Hamilton, L. D., & Meston, C. M. (2012). Evidence for a curvilinear relationship between sympathetic nervous system activation and women’s physiological sexual arousal. Psychophysiology, 49(1), 111–117. doi:10.1111/j.1469-8986.2011.01285.x.

    PubMed Central  PubMed  Article  Google Scholar 

  18. McVary, K. (2006). Lower urinary tract symptoms and sexual dysfunction: Epidemiology and pathophysiology. BJU International, 97 (Suppl 2), 23–28; discussion 44–45. doi:10.1111/j.1464-410X.2006.06102.x.

  19. Meston, C. M., & Gorzalka, B. B. (1995a). The effects of sympathetic activation on physiological and subjective sexual arousal in women. Behaviour Research and Therapy, 33(6), 651–664.

    PubMed  Article  Google Scholar 

  20. Meston, C. M., & Gorzalka, B. B. (1995b). The effects of sympathetic activation on physiological and subjective sexual arousal in women. Behavior Research and Therapy, 33(6), 651–664.

    Article  Google Scholar 

  21. Meston, C. M., & Gorzalka, B. B. (1996a). Differential effects of sympathetic activation on sexual arousal in sexually dysfunctional and functional women. Journal of Abnormal Psychology, 105(4), 582–591.

    PubMed  Article  Google Scholar 

  22. Meston, C. M., & Gorzalka, B. B. (1996b). The effects of immediate, delayed, and residual sympathetic activation on sexual arousal in women. Behavior Research and Therapy, 34(2), 143–148.

    Article  Google Scholar 

  23. Meston, C. M., Gorzalka, B. B., & Wright, J. M. (1997). Inhibition of subjective and physiological sexual arousal in women by clonidine. Psychosomatic Medicine, 59, 339–407.

    Article  Google Scholar 

  24. Meston, C. M., & Heiman, J. R. (1998). Ephedrine-activated physiological sexual arousal in women. Archives of General Psychiatry, 55(7), 652–656.

    PubMed  Article  Google Scholar 

  25. Montorsi, P., Ravagnani, P. M., Galli, S., Rotatori, F., Briganti, A., Salonia, A., et al. (2005). The artery size hypothesis: A macrovascular link between erectile dysfunction and coronary artery disease. The American Journal of Cardiology, 96(12B), 19M–23M. doi:10.1016/j.amjcard.2005.07.006.

    PubMed  Article  Google Scholar 

  26. Pagani, M., & Malliani, A. (2000). Interpreting oscillations of muscle sympathetic nerve activity and heart rate variability. Journal of Hypertension, 18(12), 1709–1719.

    PubMed  Article  Google Scholar 

  27. Quintana, D. S., Guastella, A. J., McGregor, I. S., Hickie, I. B., & Kemp, A. H. (2013). Heart rate variability predicts alcohol craving in alcohol dependent outpatients: Further evidence for HRV as a psychophysiological marker of self-regulation. Drug and Alcohol Dependence, 132(1–2), 395–398. doi:10.1016/j.drugalcdep.2013.02.025.

    PubMed  Article  Google Scholar 

  28. Rajendra Acharya, U., Paul Joseph, K., Kannathal, N., Lim, C. M., & Suri, J. S. (2006). Heart rate variability: A review. Medical and Biological Engineering and Computing, 44(12), 1031–1051. doi:10.1007/s11517-006-0119-0.

    PubMed  Article  Google Scholar 

  29. Rellini, A., & Meston, C. M. (2007). Sexual function and satisfaction in adults based on the definition of child sexual abuse. The Journal of Sexual Medicine, 4(5), 1312–1321. doi:10.1111/j.1743-6109.2007.00573.x.

    PubMed Central  PubMed  Article  Google Scholar 

  30. Roose, S. P. (2003). Depression: Links with ischemic heart disease and erectile dysfunction. The Journal of Clinical Psychiatry, 64(suppl 10), 26–30.

    PubMed  Google Scholar 

  31. Rosen, R., Brown, C., Heiman, J., Leiblum, S., Meston, C., Shabsigh, R., et al. (2000). The Female Sexual Function Index (FSFI): A multidimensional self-report instrument for the assessment of female sexual function. Journal of Sex and Marital Therapy, 26(2), 191–208. doi:10.1080/009262300278597.

    PubMed  Article  Google Scholar 

  32. Simpson, J. D., Doux, J. D., Lee, P. Y., & Yun, A. J. (2006). Peripheral arterial disease: A manifestation of evolutionary dislocation and feed-forward dysfunction. Medical Hypotheses, 67(4), 947–950. doi:10.1016/j.mehy.2006.03.027.

    PubMed  Article  Google Scholar 

  33. Solomon, H., Man, J. W., & Jackson, G. (2003). Erectile dysfunction and the cardiovascular patient: endothelial dysfunction is the common denominator. Heart (British Cardiac Society), 89(3), 251–253.

    Article  Google Scholar 

  34. Thompson, I. M., Tangen, C. M., Goodman, P. J., Probstfield, J. L., Moinpour, C. M., & Coltman, C. A. (2005). Erectile dysfunction and subsequent cardiovascular disease. JAMA, the Journal of the American Medical Association, 294(23), 2996–3002. doi:10.1001/jama.294.23.2996.

    PubMed  Article  Google Scholar 

  35. Umetani, K., Singer, D. H., McCraty, R., & Atkinson, M. (1998). Twenty-four hour time domain heart rate variability and heart rate: Relations to age and gender over nine decades. Journal of the American College of Cardiology, 31(3), 593–601.

    PubMed  Article  Google Scholar 

  36. Xhyheri, B., Manfrini, O., Mazzolini, M., Pizzi, C., & Bugiardini, R. (2012). Heart rate variability today. Progress in Cardiovascular Diseases, 55(3), 321–331. doi:10.1016/j.pcad.2012.09.001.

    PubMed  Article  Google Scholar 

  37. Ziemssen, T., Gasch, J., & Ruediger, H. (2008). Influence of ECG sampling frequency on spectral analysis of RR intervals and baroreflex sensitivity using the EUROBAVAR data set. Journal of Clinical Monitoring and Computing, 22(2), 159–168. doi:10.1007/s10877-008-9117-0.

    PubMed  Article  Google Scholar 

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Acknowledgments

This research was supported by a grant from the National Institute of Child Health and Human Development (NICHD, RO1 HD051676) to Cindy M. Meston. Tierney A. Lorenz was supported by a grant from the NICHD (T32HD049336). The views presented here are solely those of the authors and do necessarily not represent the official views of the National Institutes of Health.

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Correspondence to Amelia M. Stanton.

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Stanton, A.M., Lorenz, T.A., Pulverman, C.S. et al. Heart Rate Variability: A Risk Factor for Female Sexual Dysfunction. Appl Psychophysiol Biofeedback 40, 229–237 (2015). https://doi.org/10.1007/s10484-015-9286-9

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Keywords

  • Heart rate variability
  • Sympathetic nervous system
  • Female sexual dysfunction
  • Female sexual arousal