Childhood sexual abuse, selective attention for sexual cues and the effects of testosterone with or without vardenafil on physiological sexual arousal in women with sexual dysfunction: a pilot study

J Sex Med. 2009 Feb;6(2):429-39. doi: 10.1111/j.1743-6109.2008.01103.x. Epub 2008 Dec 2.


Introduction: Female sexual dysfunction (FSD) may be associated with reduced central sensitivity for sexual cues. A single dose of testosterone might induce an increase in sensitivity for sexual stimuli, which in turn allows a PDE5 inhibitor to be effective in boosting the physiological sexual response. Negative sexual experience-like childhood sexual abuse (CSA)-might be an important intervening factor in these drugs-induced alterations.

Aim: To investigate if the combination of testosterone and vardenafil causes an increase in sensitivity for sexual cues and an increase in physiological sexual responding in women suffering from hypoactive sexual desire disorder (HSDD).

Methods: Thirteen women with HSDD underwent four different drug treatments: (i) placebo; (ii) vardenafil; (iii) testosterone; and (iv) combination of testosterone and vardenafil. During each treatment, they performed an emotional Stroop task and watched neutral and erotic film clips.

Main outcome measures: A masked version of the emotional Stroop task, and the vaginal pulse amplitude (VPA).

Results: We found different effects in women who had reported CSA (N = 5) compared with those who had not (N = 8). In women without CSA, testosterone induced an increase in their originally low levels of preconscious attention for sexual cues, while women with CSA showed a decrease in their originally high levels of attention. In these groups, we also found different effects of the combination of testosterone and vardenafil on the VPA: women without CSA revealed a statistically significant increase in their VPA during treatment with the combination of testosterone and vardenafil as compared with placebo. Women with CSA, however, showed no alterations in their physiological sexual responding during this combined drug treatment.

Conclusion: In women without CSA, testosterone appears to activate central sexual mechanisms resulting in higher VPA under the combination of testosterone and vardenafil. This effect did not occur in women with CSA.

MeSH terms

  • Adult
  • Attention*
  • Child
  • Child Abuse, Sexual / psychology*
  • Child Abuse, Sexual / statistics & numerical data*
  • Cues
  • Erotica*
  • Female
  • Humans
  • Imidazoles / administration & dosage
  • Imidazoles / pharmacology*
  • Phosphodiesterase Inhibitors / administration & dosage
  • Phosphodiesterase Inhibitors / pharmacology*
  • Photic Stimulation
  • Pilot Projects
  • Piperazines / administration & dosage
  • Piperazines / pharmacology*
  • Plethysmography
  • Sexual Behavior* / psychology
  • Sexual Dysfunctions, Psychological / drug therapy*
  • Sexual Dysfunctions, Psychological / epidemiology*
  • Sulfones / administration & dosage
  • Sulfones / pharmacology
  • Testosterone / pharmacology*
  • Triazines / administration & dosage
  • Triazines / pharmacology
  • Vagina / blood supply
  • Vardenafil Dihydrochloride


  • Imidazoles
  • Phosphodiesterase Inhibitors
  • Piperazines
  • Sulfones
  • Triazines
  • Testosterone
  • Vardenafil Dihydrochloride