Repetitive Transcranial Magnetic Stimulation as a Potential Tool to Reduce Sexual Arousal in cases of hypersexuality

Schecklmann M, Sakreida K, Oblinger B, et al. Repetitive Transcranial Magnetic Stimulation as a Potential Tool to Reduce Sexual Arousal: A Proof of Concept Study. J Sex Med 2020;XX:XXX–XXX. https://www.sciencedirect.com/science/article/abs/pii/S1743609520306093

Abstract
Background: Hypersexuality and hyposexuality occur frequently, often in a variety of psychiatric disorders, and are difficult to treat. While there is meta-analytic evidence for the significant effect of non-invasive brain stimulation on drug and food craving, no study has investigated the potential of this technique to modulate sexual behavior.

Aim: Here, we tested the hypothesis that a single session of high-frequency repetitive transcranial magnetic stimulation (rTMS) over the dorsolateral prefrontal cortex (DLPFC) would reduce sexual arousal.

Methods: We employed a randomized, double-blind, sham-controlled crossover study design. 19 healthy male participants received high-frequency rTMS over the left DLPFC, high-frequency rTMS over the right DLPFC, and sham rTMS (each 10 Hz; 110% resting motor threshold; 60 trains with 50 pulses) in randomized and counterbalanced order with a 1-week interval between stimulation sessions to avoid carryover effects. Participants were exposed to neutral and sexual cues before and after each intervention and rated their sexual arousal after each block of cue presentation.

Main Outcome Measure: Efficacy of the respective intervention was operationalized by the change of subjective sexual arousal according to a rating scale.

Results: rTMS of the right DLPFC significantly reduced subjective sexual arousal (t18 = 2.282, P = .035). In contrast, neither sham rTMS nor rTMS of the left DLPFC affected sexual arousal (P > .389). Greater rTMS-induced reduction of subjective sexual arousal was observed in participants with higher trait-based dyadic sexual desire within the last 12 months (r = −0.417, P = .038).

Clinical Implication: Non-invasive brain stimulation might hold potential for influencing hypersexual behavior.

Strength & Limitation: This was a randomized, double-blind, sham-controlled crossover study with subjective but no physiological measures of sexual arousal.

Conclusion: The results indicate that 1 session of high-frequency rTMS (10 Hz) of the right DLPFC could significantly reduce subjective sexual arousal induced by visual stimuli in healthy subjects. On this basis, future studies with larger sample sizes and more stimulation sessions are needed to explore the therapeutic potential of rTMS in hypersexual behavior.

Key Words: Dorsolateral Prefrontal CortexHypersexualNeuromodulationSexual ArousalRepetitive Transcranial Magnetic Stimulation