Skip to main content
SpringerLink
Log in

Site and size of multiple sclerosis lesions predict enhanced or decreased female orgasmic function

  • Original Communication
  • Published:
Journal of Neurology Aims and scope Submit manuscript

Abstract

Neuroimaging identified brain areas involved in female orgasm. In women with multiple sclerosis (MS), associations between orgasmic function and the site and size of MS-related magnetic resonance imaging (MRI) changes are undetermined. This study intended to correlate MS-associated cerebral lesion load and location with clinical scores of female orgasmic function. In 50 women with MS (mean age 37.0 ± 9.9 years), we assessed Female Sexual Function Index (FSFI) scores for orgasmic frequency, difficulty and satisfaction. We determined disease duration, Expanded Disability Status Scale (EDSS) scores, and cerebral MS-lesion load and location using T2-weighed 1.5 T MRIs. We correlated FSFI scores for orgasm with patient age, disease duration, EDSS scores, and cerebral MS-lesion load (Spearman rank correlation; significance: p < 0.05). FSFI scores for orgasm correlated inversely with MS-lesion load in the left temporal periventricular white matter and right middle-inferior occipital area, but directly with MS-lesion load in the right frontal primary motor cortex, left prefrontal/inferior frontal cortex, right amygdala, left temporal middle-inferior and fusiform areas, and midbrain. FSFI scores for orgasm did not correlate with patient age, disease duration and EDSS scores (p > 0.05). In conclusion, our results indicate that MS-lesions in left temporal periventricular and right visual association areas deteriorate orgasmic function. In contrast, direct correlations between frontotemporal or midbrain lesions and higher FSFI scores, indicating enhanced or disinhibited orgasmic function, suggest that these brain regions normally buffer orgasmic responses. Moreover, our results indicate that orgasmic dysfunction in women with MS evolves independently of disease duration and physical disability.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Augustine JR (1996) Circuitry and functional aspects of the insular lobe in primates including humans. Brain Res Brain Res Rev 22:229–244

    Article  CAS  PubMed  Google Scholar 

  2. Barak Y, Achiron A, Elizur A, Gabbay U, Noy S, Sarova-Pinhas I (1996) Sexual dysfunction in relapsing-remitting multiple sclerosis: magnetic resonance imaging, clinical, and psychological correlates. J Psychiatry Neurosci 21:255–258

    PubMed Central  CAS  PubMed  Google Scholar 

  3. Bocher M, Chisin R, Parag Y, Freedman N, Meir Weil Y, Lester H, Mishani E, Bonne O (2001) Cerebral activation associated with sexual arousal in response to a pornographic clip: a 15O-H2O PET study in heterosexual men. Neuroimage 14:105–117

    Article  CAS  PubMed  Google Scholar 

  4. Damasio H, Grabowski T, Frank R, Galaburda AM, Damasio AR (1994) The return of Phineas Gage: clues about the brain from the skull of a famous patient. Science 264:1102–1105

    Article  CAS  PubMed  Google Scholar 

  5. Davis JF, Loos M, Di Sebastiano AR, Brown JL, Lehman MN, Coolen LM (2010) Lesions of the medial prefrontal cortex cause maladaptive sexual behavior in male rats. Biol Psychiatry 67:1199–1204

    Article  PubMed Central  PubMed  Google Scholar 

  6. De Coene B, Hajnal JV, Gatehouse P, Longmore DB, White SJ, Oatridge A, Pennock JM, Young IR, Bydder GM (1992) MR of the brain using fluid-attenuated inversion recovery (FLAIR) pulse sequences. AJNR Am J Neuroradiol 13:1555–1564

    PubMed  Google Scholar 

  7. De Stefano N, Matthews PM, Fu L, Narayanan S, Stanley J, Francis GS, Antel JP, Arnold DL (1998) Axonal damage correlates with disability in patients with relapsing-remitting multiple sclerosis. Results of a longitudinal magnetic resonance spectroscopy study. Brain 121(Pt 8):1469–1477

    Article  PubMed  Google Scholar 

  8. Demirkiran M, Sarica Y, Uguz S, Yerdelen D, Aslan K (2006) Multiple sclerosis patients with and without sexual dysfunction: are there any differences? Mult Scler 12:209–214

    Article  CAS  PubMed  Google Scholar 

  9. Ge Y (2006) Multiple sclerosis: the role of MR imaging. AJNR Am J Neuroradiol 27:1165–1176

    CAS  PubMed  Google Scholar 

  10. Georgiadis JR, Kortekaas R, Kuipers R, Nieuwenburg A, Pruim J, Reinders AA, Holstege G (2006) Regional cerebral blood flow changes associated with clitorally induced orgasm in healthy women. Eur J Neurosci 24:3305–3316

    Article  PubMed  Google Scholar 

  11. Hamann S, Herman RA, Nolan CL, Wallen K (2004) Men and women differ in amygdala response to visual sexual stimuli. Nat Neurosci 7:411–416

    Article  CAS  PubMed  Google Scholar 

  12. Hilz MJ, Dütsch M, Perrine K, Nelson PK, Rauhut U, Devinsky O (2001) Hemispheric influence on autonomic modulation and baroreflex sensitivity. Ann Neurol 49:575–584

    Article  CAS  PubMed  Google Scholar 

  13. Hulter BM, Lundberg PO (1995) Sexual function in women with advanced multiple sclerosis. J Neurol Neurosurg Psychiatry 59:83–86

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  14. Karama S, Lecours AR, Leroux JM, Bourgouin P, Beaudoin G, Joubert S, Beauregard M (2002) Areas of brain activation in males and females during viewing of erotic film excerpts. Hum Brain Mapp 16:1–13

    Article  PubMed  Google Scholar 

  15. Klucken T, Schweckendiek J, Merz CJ, Tabbert K, Walter B, Kagerer S, Vaitl D, Stark R (2009) Neural activations of the acquisition of conditioned sexual arousal: effects of contingency awareness and sex. J Sex Med 6:3071–3085

    Article  PubMed  Google Scholar 

  16. Klüver H, Bucy PC (1997) Preliminary analysis of functions of the temporal lobes in monkeys. 1939. J Neuropsychiatry Clin Neurosci 9:606–620

    Article  CAS  PubMed  Google Scholar 

  17. Komisaruk BR, Whipple B, Crawford A, Liu WC, Kalnin A, Mosier K (2004) Brain activation during vaginocervical self-stimulation and orgasm in women with complete spinal cord injury: fMRI evidence of mediation by the vagus nerves. Brain Res 1024:77–88

    Article  CAS  PubMed  Google Scholar 

  18. Kurtzke JF (1983) Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology 33:1444–1452

    Article  CAS  PubMed  Google Scholar 

  19. Lilly R, Cummings JL, Benson DF, Frankel M (1983) The human Kluver–Bucy syndrome. Neurology 33:1141–1145

    Article  CAS  PubMed  Google Scholar 

  20. Marson L, McKenna KE (1990) The identification of a brainstem site controlling spinal sexual reflexes in male rats. Brain Res 515:303–308

    Article  CAS  PubMed  Google Scholar 

  21. Marson L, Murphy AZ (2006) Identification of neural circuits involved in female genital responses in the rat: a dual virus and anterograde tracing study. Am J Physiol Regul Integr Comp Physiol 291:R419–R428

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  22. McKenna KE, Chung SK, McVary KT (1991) A model for the study of sexual function in anesthetized male and female rats. Am J Physiol 261:R1276–R1285

    CAS  PubMed  Google Scholar 

  23. Normandin JJ, Murphy AZ (2011) Serotonergic lesions of the periaqueductal gray, a primary source of serotonin to the nucleus paragigantocellularis, facilitate sexual behavior in male rats. Pharmacol Biochem Behav 98:369–375

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  24. Oppenheimer S (2006) Cerebrogenic cardiac arrhythmias: cortical lateralization and clinical significance. Clin Auton Res 16:6–11

    Article  PubMed Central  PubMed  Google Scholar 

  25. Oppenheimer SM, Gelb A, Girvin JP, Hachinski VC (1992) Cardiovascular effects of human insular cortex stimulation. Neurology 42:1727–1732

    Article  CAS  PubMed  Google Scholar 

  26. Palmer S, Bradley WG, Chen DY, Patel S (1999) Subcallosal striations: early findings of multiple sclerosis on sagittal, thin-section, fast FLAIR MR images. Radiology 210:149–153

    Article  CAS  PubMed  Google Scholar 

  27. Park K, Kang HK, Seo JJ, Kim HJ, Ryu SB, Jeong GW (2001) Blood-oxygenation-level-dependent functional magnetic resonance imaging for evaluating cerebral regions of female sexual arousal response. Urology 57:1189–1194

    Article  CAS  PubMed  Google Scholar 

  28. Pfaff DW, Sakuma Y (1979) Deficit in the lordosis reflex of female rats caused by lesions in the ventromedial nucleus of the hypothalamus. J Physiol 288:203–210

    PubMed Central  CAS  PubMed  Google Scholar 

  29. Pfaff DW, Sakuma Y (1979) Facilitation of the lordosis reflex of female rats from the ventromedial nucleus of the hypothalamus. J Physiol 288:189–202

    PubMed Central  CAS  PubMed  Google Scholar 

  30. Rees PM, Fowler CJ, Maas CP (2007) Sexual function in men and women with neurological disorders. Lancet 369:512–525

    Article  PubMed  Google Scholar 

  31. Rorden C, Karnath HO, Bonilha L (2007) Improving lesion-symptom mapping. J Cogn Neurosci 19:1081–1088

    Article  PubMed  Google Scholar 

  32. Rosen R, Brown C, Heiman J, Leiblum S, Meston C, Shabsigh R, Ferguson D, D’Agostino R Jr (2000) The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther 26:191–208

    Article  CAS  PubMed  Google Scholar 

  33. Tzourio-Mazoyer N, Landeau B, Papathanassiou D, Crivello F, Etard O, Delcroix N, Mazoyer B, Joliot M (2002) Automated anatomical labeling of activations in SPM using a macroscopic anatomical parcellation of the MNI MRI single-subject brain. Neuroimage 15:273–289

    Article  CAS  PubMed  Google Scholar 

  34. van Walderveen MA, Kamphorst W, Scheltens P, van Waesberghe JH, Ravid R, Valk J, Polman CH, Barkhof F (1998) Histopathologic correlate of hypointense lesions on T1-weighted spin-echo MRI in multiple sclerosis. Neurology 50:1282–1288

    Article  PubMed  Google Scholar 

  35. Vigeveno RM, Wiebenga OT, Wattjes MP, Geurts JJ, Barkhof F (2012) Shifting imaging targets in multiple sclerosis: from inflammation to neurodegeneration. J Magn Reson Imaging 36:1–19

    Article  PubMed  Google Scholar 

  36. Yang JC, Park K, Eun SJ, Lee MS, Yoon JS, Shin IS, Kim YK, Chung TW, Kang HK, Jeong GW (2008) Assessment of cerebrocortical areas associated with sexual arousal in depressive women using functional MR imaging. J Sex Med 5:602–609

    Article  PubMed  Google Scholar 

  37. Zamrini EY, Meador KJ, Loring DW, Nichols FT, Lee GP, Figueroa RE, Thompson WO (1990) Unilateral cerebral inactivation produces differential left/right heart rate responses. Neurology 40:1408–1411

    Article  CAS  PubMed  Google Scholar 

  38. Zivadinov R, Zorzon M, Locatelli L, Stival B, Monti F, Nasuelli D, Tommasi MA, Bratina A, Cazzato G (2003) Sexual dysfunction in multiple sclerosis: a MRI, neurophysiological and urodynamic study. J Neurol Sci 210:73–76

    Article  PubMed  Google Scholar 

  39. Zorzon M, Zivadinov R, Bosco A, Bragadin LM, Moretti R, Bonfigli L, Morassi P, Iona LG, Cazzato G (1999) Sexual dysfunction in multiple sclerosis: a case-control study. I. Frequency and comparison of groups. Mult Scler 5:418–427

    CAS  PubMed  Google Scholar 

  40. Zorzon M, Zivadinov R, Locatelli L, Stival B, Nasuelli D, Bratina A, Bosco A, Tommasi MA, Pozzi Mucelli RS, Ukmar M, Cazzato G (2003) Correlation of sexual dysfunction and brain magnetic resonance imaging in multiple sclerosis. Mult Scler 9:108–110

    Article  CAS  PubMed  Google Scholar 

  41. Zorzon M, Zivadinov R, Monti Bragadin L, Moretti R, De Masi R, Nasuelli D, Cazzato G (2001) Sexual dysfunction in multiple sclerosis: a 2-year follow-up study. J Neurol Sci 187:1–5

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The study was partially funded by Bayer-Vital GmbH, Germany.

Author information

Author notes

    Authors and Affiliations

    1. Department of Neurology, University Hospital Erlangen, Schwabachanlage 6, 91054, Erlangen, Germany

      Klemens Winder, Frank Seifert, Julia Koehn, Martina Deutsch, De-Hyung Lee, Ralf A. Linker & Max J. Hilz

    2. Department of Neuroradiology, University Hospital Erlangen, Schwabachanlage 6, 91054, Erlangen, Germany

      Tobias Engelhorn & Arnd Dörfler

    Authors
    1. Klemens Winder
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. Frank Seifert
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. Julia Koehn
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. Martina Deutsch
      View author publications

      You can also search for this author in PubMed Google Scholar

    5. Tobias Engelhorn
      View author publications

      You can also search for this author in PubMed Google Scholar

    6. Arnd Dörfler
      View author publications

      You can also search for this author in PubMed Google Scholar

    7. De-Hyung Lee
      View author publications

      You can also search for this author in PubMed Google Scholar

    8. Ralf A. Linker
      View author publications

      You can also search for this author in PubMed Google Scholar

    9. Max J. Hilz
      View author publications

      You can also search for this author in PubMed Google Scholar

    Corresponding author

    Correspondence to Max J. Hilz.

    Ethics declarations

    Conflicts of interest

    Max. J. Hilz received speaker honoraria and research support from Genzyme, a Sanofi company, Novartis Pharma GmbH, and Bayer HealthCare pharmaceuticals. De-Hyung Lee received travel grants or speaker honoraria from Bayer HealthCare Pharmaceuticals, Biogen Idec, Merck Serono, Novartis Pharma GmbH, and TEVA Pharmaceutical Industries LTD as well as research support from Novartis Pharma GmbH. Julia Koehn received travel grants from Genzyme, a Sanofi company and Bayer HealthCare Pharmaceuticals. Ralf A. Linker received travel grants or speaker honoraria from Bayer HealthCare Pharmaceuticals, Biogen Idec, Merck Serono, Novartis Pharma GmbH, Roche, and TEVA Pharmaceutical Industries LTD as well as research support from Novartis Pharma GmbH, Biogen Idec, and Merck Serono.

    Ethical standards

    The study has been approved by the local ethics committee and has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

    Additional information

    K. Winder and F. Seifert contributed equally.

    Rights and permissions

    Reprints and permissions

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    Winder, K., Seifert, F., Koehn, J. et al. Site and size of multiple sclerosis lesions predict enhanced or decreased female orgasmic function. J Neurol 262, 2731–2738 (2015). https://doi.org/10.1007/s00415-015-7907-0

    Download citation

    • Received:

    • Revised:

    • Accepted:

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s00415-015-7907-0

    Keywords

    Search

    Navigation