SEX HORMONES IN HUMAN EROTICISM 



1391 



biologic discontinuity if erotic imagery, sen- 

 sations, and actions in the female of the 

 human species should be, by contrast with 

 estrous behavior of lower animals, inde- 

 pendent of hormonal functioning. A tenable 

 hypothesis is that erotic imagery, sensa- 

 tions, and actions are maintained well func- 

 tioning in both men and women by andro- 

 gens. In women, the androgens of eroticism 

 might conceivably be of adrenal origin, or 

 they may be derived from gestagens, or 

 they may be of an origin as yet unknown. 

 The most likely explanation is that these 

 androgens are of adrenal origin. Waxen- 

 berg, Drellich and Sutherland (1959) re- 

 ported an excellent study of eroticism in 29 

 women who had both ovaries and both ad- 

 renals removed in the treatment of breast 

 cancer. Loss of only the ovaries and ovarian 

 hormones had no definite adverse effect on 

 sexual drive, activity, and response, but all 

 three were diminished or abolished in most 

 of the women after their adrenals also had 

 been removed. The adrenals secrete some 

 estrogen, but larger amounts of androgen. 

 The authors concluded that the loss of ad- 

 renal androgens was the responsible factor 

 in the women's lessened or abolished eroti- 

 cism. 



Other evidence can be marshaled to sup- 

 port the hypothesis that androgen is the 

 hormone of eroticism in men and women. 

 Many women for whom androgen therapy 

 is prescribed report an increase of sexual 

 desire as a side-effect (Shorr, Papanicolaou 

 and Stimmel, 1938; Salmon, 1941; Green- 

 blatt, Mortara and Torpin, 1942; Green- 

 blatt, 1943; Salmon and Geist, 1943; Foss, 

 1951; Kupperman and Studdiford, 1953; 

 Dorfman and Shipley, 1956). In the clinical 

 lore of urology, conversely, many men for 

 whom estrogen is prescribed report great 

 diminution or total abolition of sexual de- 

 sire and activity (Footc, 1944; Paschkis and 

 Rakoff, 1950). 



The role of gonadal hormones in stimu- 

 lating eroticism in males and females is 

 discussed by Carter, Cohen and Shorr 

 (1947) in a review of the use of androgens 

 in women and by Perloff (1949) . It is noted 

 in both articles (1) that the return of nor- 

 mal libido in certain menopausal women 

 under treatment with estrogens may per- 

 haps be related to increased vascularity and 



epithelial proliferation of the genital tract, 

 and (2) that the increased libido in women 

 who receive testosterone occurs coinciden- 

 tally with hypertrophy of the clitoris. From 

 these observations, the hypothesis follows 

 that the hormones, especially androgens, al- 

 though not the exclusive basis of libidinous 

 urge which is multidetermined, may in- 

 fluence the libido by affecting end-organ 

 sensitivity. 



Whatever its nature, the androgen-eroti- 

 cism relationship is far from being a simple 

 linear correlation. There are irregularities 

 that cannot at present be explained. Such 

 irregularities show up in the different reac- 

 tions in hyperadrenocortical female her- 

 maphrodites before and after their gross 

 excess of adrenal androgens is low^ered by 

 cortisone therapy. 



G. HYPERADRENOCORTICAL DIVERSITIES 



There were 21 hyperadrenocortical, her- 

 maphroditic females in the larger series in 

 Table 22.1 who satisfied the triple condi- 

 tions: (a) they had been brought up and 

 lived as girls and women; (b) they were 

 over the age of 8 and, therefore, precociously 

 virilized before cortisone treatment was in- 

 stituted; (c) they were interviewed after 

 (in some instances before, also) their viri- 

 lism had been suppressed and their femini- 

 zation established by cortisone treatment. 

 Among the 21, 9 were hormonally treated 

 and psychologically studied before the age 

 of 14; 12 were between the ages of 15 and 

 53. 



Erotically, 4 of these 21 patients were 

 noteworthy as follows. One of the younger 

 patients suffered from painful priapism of 

 her enlarged clitoris and, postsurgically, 

 from persistent erections of its stump; the 

 clitoral stump became flaccid and unbother- 

 some after cortisone therapy. Two of the 

 older patients manifested extreme hyper- 

 eroticism, including compulsive copulatory 

 episodes, before cortisone treatment. Al- 

 though they reported mild lowering of erotic 

 drive after treatment, they continued to rate 

 higher than all but 1 other of the 21 in post- 

 treatment erotic participation. There was 

 one older patient who showed no evidence 

 of erotic activity, and claimed no erotic 

 sensations or inclinations either before or 

 after the cortisone treatment. Her absence 



