Brain Imaging of Human Sexual Response: Recent Developments and Future Directions

The purpose of this study is to provide a comprehensive summary of the latest developments in the
experimental brain study of human sexuality, focusing on brain connectivity during the sexual response.

The study of “sexual” brain connectivity is still very young. Yet, by approaching the brain as a connected
organ, the essence of brain function is captured much more accurately, increasing the likelihood of
finding useful biomarkers and targets for intervention in sexual dysfunction.

Human sexuality involves various brain functions, including arousal, reward, memory, cognition, self-
referential thinking, and social behavior. The brain's connectivity is more intuitive than studying
separate activities, and studying the nature of these connections has been a common practice in animal
models of human sexual behavior for decades. Understanding how these networks operate can help
understand the neural mechanisms that regulate human sexual function and account for non-organic
sexual dysfunction. Recent studies have shown that morphologically altered areas in pedophilia are
functionally connected primarily with areas important for sexual responsiveness, such as the sexual
wanting and liking networks. By approaching the brain as a connected organ, studies can capture the
essence of brain function more accurately, increasing the likelihood of finding useful biomarkers and
targets for intervention.

Stable patterns of brain activation have been established for different phases of the sexual response,
especially with regard to the wanting phase, and changes in these patterns can be linked to sexual
response variations, including sexual dysfunctions. From this solid basis, connectivity studies of the
human sexual response have begun to add a deeper understanding of the brain network function and
structure involved.

Ruesink, G.B., Georgiadis, J.R. Brain Imaging of Human Sexual Response: Recent Developments and
Future Directions. Curr Sex Health Rep 9, 183–191 (2017). https://doi.org/10.1007/s11930-017-0123-4

Functional neuroimaging studies of sexual arousal and orgasm in healthy men and women: A review and
meta-analysis
Functional neuroimaging techniques have become a key approach to understanding the brain basis of
sexual behavior (SA) in healthy subjects and patients with sexual disorders. These techniques are
minimally invasive, allowing for the study of the whole brain and investigating cognitive aspects of
sexual behavior. Technological advances have improved spatial and temporal resolutions, making them
suitable for both healthy volunteers and patients with sexual disorders. Currently, 73 published original
studies have used these techniques to specify areas that respond to sexual stimuli in healthy human
subjects. This review aims to review functional neuroimaging studies of brain regions mediating SA in
healthy men and women, with a separate focus on functional neuroimaging studies of patients
presenting sexual disorders.

Functional neuroimaging techniques have been used to study sexual arousal in healthy human subjects.
In heterosexual men, cortical activation is consistent across various regions, including the amygdalas and
thalami. Ejaculation is associated with decreased activation throughout the prefrontal cortex. A
neurophenomenological model explains these responses, with further research focusing on functional
connectivity and subliminal stimuli presentation.

https://doi.org/10.1016/j.neubiorev.2012.03.006

Specificity of the neuroendocrine response to orgasm during sexual arousal in men

We have demonstrated that sexual activity produces transient sympathoadrenal activation and a
pronounced, long-lasting increase in prolactin in men and women. However, by analyzing endocrine
alterations at 10-min intervals, a precise assignment of these changes to the pre-, peri- and
postorgasmic periods was not possible. Thus, the current study aimed to accurately differentiate the
endocrine response to sexual arousal and orgasm in men using an automatic blood collection technique
with 2-min sampling intervals. Blood was drawn continuously before, during and after orgasm over a
total period of 40 min in 10 healthy subjects and were compared with samples obtained under a control
condition. Sexual activity induced transient increases of plasma epinephrine and norepinephrine levels
during orgasm with a rapid decline thereafter. In contrast, prolactin levels increased immediately after
orgasm and remained elevated throughout the experiment. Although oxytocin was acutely increased
after orgasm, these changes were not consistent and did not reach statistical significance. Vasopressin,
LH, FSH and testosterone plasma concentrations remained unaltered during sexual arousal and orgasm.
These data confirm that prolactin is secreted after orgasm and, compared with oxytocin, seems to
represent a more reliable and sustained marker for orgasm in man. The results further reinforce a role
for prolactin either as a neuroendocrine reproductive reflex or as a feedback mechanism modulating
dopaminergic systems in the central nervous system that are responsible for appetitive behavior.

Krüger TH, Haake P, Chereath D, Knapp W, Janssen OE, Exton MS, Schedlowski M, Hartmann U.
Specificity of the neuroendocrine response to orgasm during sexual arousal in men. J Endocrinol. 2003
Apr;177(1):57-64. doi: 10.1677/joe.0.1770057. PMID: 12697037.