Wednesday, October 27, 2010

Media HSDD: "Hyperactive Sexual Disorder Detection"



You might have seen the news stories with their facile headlines:
Women with low libidos 'have different brains'

Women with low libidos have a different mental response to intimate situations than those with a 'normal' sex drive, researchers have found.

By Stephen Adams, Medical Correspondent, in Denver
Published: 5:59AM BST 26 Oct 2010

MRI scans show that women diagnosed with what is termed hypoactive sexual desire disorder (HSDD) - defined as a distressing lack of sexual desire - have different patterns of brain activity.

Certain areas of the brain that normally light up when thinking about sex fail to do so in women with HSDD, found medics at Wayne State University in Detroit, US, while other areas that don't normally light up, do.
...and even worse:
Libido problems 'brain not mind'

Scans appear to show differences in brain functioning in women with persistently low sex drives, claim researchers.

The US scientists behind the study suggest it provides solid evidence that the problem can have a physical origin.
[NOTE: The mind is separate from the brain? Really?? Then where is the mind located? In the big toe? The pancreas?]

Hypoactive Sexual Desire Disorder (HSDD) is a controversial diagnosis given to women who have a low (or nonexistent) libido and are distressed about it. Dr. Petra Boynton has written extensively about the problematic aspects of the HSDD diagnosis and the screening tools used to assess it, as well as the medicalization of sexuality for pharmaceutical marketing purposes.


The issue to be discussed here is the widespread press coverage given to an unpublished study presented at a conference. This is fairly standard practice, as professional organizations such as the Society for Neuroscience have a well-staffed press room where properly credentialed reporters have access to:
  • Embargoed annual meeting news releases
  • Lay-friendly summaries of newsworthy findings
  • Press conference slides and video footage

Here's the HSDD abstract in question, from an oral presentation at the American Society for Reproductive Medicine's 66th Annual Meeting:

[O-199] CEREBRAL ACTIVATION PATTERNS IN WOMEN WITH HYPOACTIVE SEXUAL DESIRE DISORDER (HSDD) VERSUS WOMEN WITH NORMAL SEXUAL FUNCTION.

T. L. Woodard, N. T. Nowak, S. D. Moffat, M. P. Diamond, M. E. Tancer, R. Balon. Wayne State University School of Medicine, Detroit, MI

OBJECTIVE: To identify and compare cerebral activation patterns of premenopausal women with acquired HSDD versus those with normal sexual function during viewing of sexually explicit film clips.

DESIGN: Prospective Cohort Study.

MATERIALS AND METHODS: After IRB approval, 19 premenopausal women with HSDD and 7 women with normal sexual function were recruited to participate in the study. The diagnosis of HSDD was confirmed using the Sexual Function Questionnaire (SFQ), Female Sexual Distress Scale (FSDS) and a clinical interview. Functional neuroimaging was performed on a 4 T Siemens Bruker Hybrid Scanner while participants viewed three categories of video stimuli (solid blue screen, neutral videos, and sexually explicit videos), which alternated every 60 seconds for 32 minutes in a block design. Data were analyzed using Statistical Parametric Mapping 2 (SPM2).

RESULTS: When cerebral activation patterns associated with viewing sexually-explicit videos in normal women was compared to that of women with HSDD, women with normal sexual function had greater activation in superior frontal and supramarginal gyri. Women with HSDD exhibited greater activation in the inferior frontal, primary motor, and insular cortices. Additionally, normal women had greater activation in the posterior cingulate cortex while women with HSDD appeared to recruit the midcingulate region.

CONCLUSION: Cerebral activation patterns in women with HSDD differs from those in women with normal sexual function and may reflect differences in how they interpret sexual stimuli.

Supported by: Wayne State University Departments of Psychiatry and Obstetrics and Gynecology.
----------

Access to the meeting website requires registration, although one does not have to be a member of the ASRM to do so. Nonetheless, the barrier to finding this information online is rather high, and I imagine only 3 other people cared enough to do the proper searches.

Do these researchers have any peer reviewed publications related to neuroimaging studies of HSDD? There's a brief mention of fMRI and PET in one review paper (Woodard & Diamond, 2009). They also have a fun paper on how they chose their stimuli (i.e., erotic films). Q: What kind of erotic film clips should we use in female sex research? A: heterosexual vaginal intercourse.1 [See this summary by Scicurious.]

Let's return to the abstract and the major neuroimaging results:
When cerebral activation patterns associated with viewing sexually-explicit videos in normal women was compared to that of women with HSDD, women with normal sexual function had greater activation in superior frontal and supramarginal gyri. Women with HSDD exhibited greater activation in the inferior frontal, primary motor, and insular cortices. Additionally, normal women had greater activation in the posterior cingulate cortex while women with HSDD appeared to recruit the midcingulate region.
The supramarginal gyrus in the parietal lobe? Yeah, that's a real sexy area of the brain. So is the superior frontal gyrus, for that matter. Neither of these brain areas are implicated in sexual arousal, so the fact that these regions showed greater activation in the 7 women with "normal" libidos seems largely irrelevant.

How about the women with HSDD? They showed greater activity in the insula, which has been implicated in feelings of disgust, but it's also been associated with interoceptive awareness of bodily states and many other functions (e.g., subjective emotional feelings, perception, cognition, performance, and attention). Moving right along (so to speak) to the motor cortex... now that's an interesting finding. Greater motor resonance or "mirroring" of action in the film clips for those with HSDD? With top-down control involving the inferior frontal cortex preventing actual movement? Mirror neurons have, in fact, been found in the primary motor cortex of monkeys (Tkach et al., 2007). These cells showed similar activity during both the execution and observation of actions. So if anything, this finding might suggest that the women with HSDD were actually more engaged while watching the erotic films!

The abstract concludes by saying "Cerebral activation patterns in women with HSDD differs from those in women with normal sexual function and may reflect differences in how they interpret sexual stimuli", which doesn't tell us very much. It seems the authors need to take their own advice from another paper (Woodard & Diamond, 2009):
Many physiologic methods [of sexual function in women] exist, but most are not well-validated. In addition there has been an inability to correlate most physiologic measures with subjective measures of sexual arousal. Furthermore, given the complex nature of the sexual response in women, physiologic measures should be considered in context of other data, including the history, physical examination, and validated questionnaires...

Footnote

1 The participants in the study were:
21 women [who] have viewed pornography in the past. Informed consent was obtained. The mean age of the subjects was 31.2 ± 10.46 years (range: 18–57 years). The majority of the participants were Caucasian (66.7%) and 23.8% were black, 4.8% were Asian and 4.8% did not respond. ... With regard to sexual orientation, 76.2% [n=16] described themselves as heterosexual while 19% [n=4] were bisexual and 4.8% [n=1] were unknown.
NOTE: Why include the one participant with unknown sexual orientation? Why not drop her? And don't you imagine the bisexual women might have liked some clips that were not preferred by the heterosexual women?

References

Tkach D, Reimer J, Hatsopoulos NG. (2007). Congruent activity during action and action observation in motor cortex. J Neurosci. 27:13241-50.

Woodard TL, Collins K, Perez M, Balon R, Tancer ME, Kruger M, Moffat S, Diamond MP. (2008). What kind of erotic film clips should we use in female sex research? An exploratory study. J Sex Med. 5:146-54.

Woodard TL, Diamond MP. (2009). Physiologic measures of sexual function in women: a review. Fertil Steril. 92:19-34.

Figure 4 (Woodard & Diamond, 2009). The Genitosensory Analyzer is used to measure temperature and vibratory sensation of the genitalia.

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from
Brain in a Vat.

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11 Comments:

At October 27, 2010 6:55 AM, Blogger Neuroskeptic said...

Excellent post. Bad study. worse media reporting.

For one thing, the BBC get things entirely backwards

"In the seven women who did not have the HSDD diagnosis, increased activity in the insular cortices - parts of the brain believed to be involved in the processing of emotion - could be seen. The same did not happen in the women with HSDD."

When in fact women with HSDD had more activation in the insula. of course not that it matters because either way round it doesn't prove anything, but it's quite funny.

The study design is bizarre - why only 7 controls? A study is only as big as its smallest group. Why not go for an even split with 13 per group - that would be almost twice as good (and actually quite big for an fMRI study). A group with 7 people on the other hand is paltry. Size matters!

Did they have trouble finding women who reported high libidos?

 
At October 27, 2010 7:47 AM, Blogger SustainableFamilies said...

The genitosensory analizer? Holy *(*. It's like they borrowed from my twisted scientest fantasy repertoire.

Who agrees to do these studies? Either you get off on naughty scientists wanting to explore your special places or it seems like you would be totally weirded out. Wouldn't that skew the results?

 
At October 27, 2010 9:58 AM, Blogger gregory said...

reason #98727 why science is held in bad repute

 
At October 27, 2010 10:28 AM, Blogger The Neurocritic said...

Neuroskeptic - Thanks for pointing that out. I noticed the insula gaffe the first time I read the BBC article but then forgot to mention it. The 19 vs. 7 number disparity between the groups is indeed statistically inappropriate. It might have been more forgivable had any of the press materials indicated, "OK, we have added 10 controls to the study since the abstract submission deadline" but perhaps that would have changed the results.


Sustainable Families - As NCBI ROFL pointed out, for some reason women don’t volunteer for vaginal photoplethysmographs:

Volunteer bias in erotica research: effects of intrusiveness of measure and sexual background.

"Men were significantly more likely to volunteer than women, and volunteer rates for both men and women decreased significantly when and only when subjects were required to undress."


Gregory - Unfortunately, studies (and media reporting) like this don't help.

 
At October 27, 2010 12:37 PM, Blogger Neuroskeptic said...

I was also amused by this:

"Women with HSDD exhibited greater activation in the... primary motor cortex"

Given that the only way to activate your primary motor cortex is to decide to move, and given that activation in this area always causes you to move (e.g. if you TMS it, you move), this can only mean that the women in the HSDD group were moving around more in the scanner.

As to what they were doing, we can only guess...

But it shows that there was a behavioural confound.

 
At October 27, 2010 3:33 PM, Blogger The Neurocritic said...

Overt movement is the most trivial explanation. However, fMRI and EEG evidence suggests that motor cortex can also be activated by imagined movement. As I mentioned in the post as well, there are "mirror neurons" in the primary motor cortex of monkeys. So we don't know whether there was movement artifact or not.

 
At October 28, 2010 5:10 PM, Anonymous scicurious said...

Glad you covered this too! I will actually say I've got no problem with the paper YET (it's not published, so their conclusions may change), except for the fact that...this study appears really pointless. As you pointed out, they never say anything about what this all means, and the various brain areas could mean anything, they were never correlated with function of any kind. But sadly, this is exactly the kind of story that's going to get the media excited.

 
At October 28, 2010 5:44 PM, Blogger SustainableFamilies said...

I don't know if we want more women to subject themselves to the genitosensory anylizer. What kind of phsychological after affects would come from being hooked up to that thing and subjected to whatever sort of stimulation they have in mind while your brains all hooked up to gidgets and gazmos.

It seems one would have to either be twisted, be numb to clinical men sticking their widgits all over you, or have some sort of issue (needing money, fetish disorder, self esteem issue, nymphomania)

No normal person would subject themselves to the genitosensory analyzer with a bunch of (horny) scientists standing around.

Even having already had that particular fantasy run through my head(seriously, I want credit, I thought of it first wahah) I would never in a million years want such a thing to actually happen. (In theory, pretty kinky. It would make for good porn.)

And I want to see the follow up research on how people are affected by participating in such research if (when) they do more of it. Oh yeah, they don't do that kind of research, do they?

 
At October 29, 2010 10:06 AM, Anonymous Mike Lisieski said...

@SustainableFamilies - the stimulation is probably mild and mostly sub-threshold (considering that it measures sensitivity. In addition, that's a pretty unfair generalization regarding scientists (it also assumes that scientists are always men, which I'm sure the many female sex and sexuality researchers in the world would feel misrepresented by.)

In addition, even if the participants in some studies aren't quite typical of society-at-large, they do everyone a great service by facilitating science (in general, as well as in this field,) and deserve respect. Notably, they don't deserve being made fun of or marginalized.

Finally, research evaluating how people respond to being research participants is on-going. People do that research. Whether or not enough is done is another issue.

Generally - Correlative brain imaging studies are sooooo easy to over-interpret, especially if you're not familiar with neuroscience. It's unfortunate that the media ran with this one, but it (sadly) doesn't surprise me.

 
At October 30, 2010 8:20 AM, Blogger SustainableFamilies said...

In my world everyone is horny (yes my world is my perception is myself yada yada) but seriously, I find it hard to believe you wouldn't be thinking "this is rather kinky" while creating such a contraption. The actual research done here didn't involve anything invasive, from what I could tell. I have to confess it totally does worry me (invasive studies of human sexuality). But then again, I sincerely worry about people participating in porn as well.

I also worry about studies done on animals. It's not that I can't see the value of such studies, I just often read studies that are done and thing "really, they can do this?"

I have no desire to stiffle scientific research though, so long as it "does no harm" (but there a million ways to define "do no harm" so who knows what that means)

 
At October 30, 2010 9:57 AM, Anonymous Anonymous said...

"Why include the one participant with unknown sexual orientation? Why not drop her?"

Could it be because when you remove her, the results change or go away?

 

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