Gynecological Endocrinology, December 2007; 23(12): 673–681

EDITORIAL

A comparison of 19th century and current attitudes to female sexuality

JOHN STUDD

London PMS and Menopause Centre, London, UK

(Received 21 June 2007; accepted 26 September 2007)

Abstract
The 19th century medical attitude to normal female sexuality was cruel, with gynecologists and psychiatrists leading the way
in designing operations for the cure of the serious contemporary disorders of masturbation and nymphomania. The
gynecologist Isaac Baker Brown (1811–1873) and the distinguished endocrinologist Charles Brown-Séquard (1817–1894)
advocated clitoridectomy to prevent the progression to masturbatory melancholia, paralysis, blindness and even death. Even
after the public disgrace of Baker Brown in 1866–7, the operation remained respectable and widely used in other parts of
Europe. This medical contempt for normal female sexual development was reflected in public and literary attitudes. Or
perhaps it led and encouraged public opinion. There is virtually no novel or opera in the last half of the 19th century where
the heroine with ‘a past’ survives to the end. H. G. Wells’s Ann Veronica and Richard Strauss’s Der Rosenkavalier, both of
which appeared in 1909, broke the mould and are important milestones. In the last 50 years new research into the sociology,
psychology and physiology of sexuality has provided an understanding of decreased libido and inadequate sexual response in
the form of hypoactive sexual desire disorder. This is now regarded as a disorder worthy of treatment, either by various forms
of counseling or by the use of hormones, particularly estrogens and testosterone.

Keywords: Nymphomania, hysteria, clitoris, clitoridectomy, masturbation, orgasm, testosterone, genital mutilation

In medieval times people feared three things: the In the last half of the 19th century, the female
devil, Jews, and women. Female sexuality was a disorders of nymphomania, masturbation, moral
particular source of anxiety for men, an anxiety insanity, hysteria and neurasthenia were universally
which continued until the beginning of the 20th believed to be a serious threat to health and life, and
century. Wilmot in 1775 translated from the French were considered to be the result of reading inap-
the book Nymphomania, or the Furor Uterinus, clearly propriate novels or playing romantic music. This was
and methodically explaining the different causes of that also the case with what was called ‘menstrual
horrible distemper [1], which outlined the dangers to madness’ and insanity, the history of which is
women and society from this serious medical disease. reported elsewhere [2]. They were diseases which
Details of female anatomy and function seem to be required radical cure. Menstrual madness was dealt
surprisingly well informed for the period, but it is the with by laparotomy and bilateral ‘normal ovariotomy’
condemnation of a normal robust sexuality which but Charcot, with his public demonstrations of
seems eccentric to us today. We are told that female hysteria in women in the 1870s, emphasized his
sexuality is a serpent that is secretly guided into belief that most mental disease in women resulted
the heart. Goethe, writing about syphilis around the from abnormalities or excitation of the female
same time, uses similar imagery, demonizing the external genitalia [3]. These clinical tutorials were
disease as a beast and warning of ‘a serpent which very well attended by scores of men, who witnessed
lurks in the loveliest of gardens and strikes us at our in pornographic detail the role of the vulva and
pleasures’. The word ‘garden’, as in the title of Sir clitoris in the causation of hysterical attacks in
Richard Burton’s translation of the Arabic erotic Charcot’s young and attractive patients. Charcot’s
work, The Perfumed Garden (1886), was a contem- pupil, Sigmund Freud, who attended these demon-
porary euphemism for vulva. strations at La Salpêtrière for 5 months, repeated this

Correspondence: J. Studd, London PMS and Menopause Centre, 46, Wimpole St. London, WIG 8SD, UK. Tel: 02074860497. Fax: 02072244190.
www.studd.co.uk. E-mail: harley@studd.co.uk
ISSN 0951-3590 print/ISSN 1473-0766 online ª 2007 Informa UK Ltd.
DOI: 10.1080/09513590701708860
674 J. Studd

fashionable view in his writings and lectures while private practice, he always visited Dublin, his
also stressing the effect of the mind on gynecological favorite city in the British Isles, and Baker Brown,
and mental disease [4]. There is good evidence that the best surgeon in the British Isles [11]. Inciden-
Freud even modified his case histories – excluding tally, this irritated Lawson Tait of Birmingham, who
the realities of deviant sexuality and sexual abuse and considered Baker Brown to be a surgeon of great
replacing them with sexual fantasies [5] which would ability but only the second best surgeon in Britain
be much more acceptable to the Viennese upper [12]. Baker Brown was a gynecologist at the
middle class who were his audience. Samaritan Hospital London and had his own private
There was also the clear belief that masturbation clinic, the London Surgical Home, where he
led to a series of disasters progressing through operated on rich upper-class women. The wealth
insomnia, exhaustion, neurasthenia, epilepsy, moral of his practice and the social credentials of his
insanity, insanity, convulsions, melancholia and patients were legendary.
paralysis, to eventual coma and death. Charles He published in 1866 a short 90-page book on the
Brown-Séquard, the founder of modern endocrinol- Curability of Certain Forms of Insanity, Epilepsy,
ogy, added blindness to this list of penalties [6]. This Catalepsy and Hysteria in Females [12]. This caused
clinical entity was known as ‘masturbatory melanch- one of the biggest medical rows of the century and
olia’ or ‘masturbatory paralysis’. Even the usually was perhaps the most famous publication resulting in
sound Lawson Tait stated in 1889 that the evils of professional suicide in the history of medicine.
masturbation had been greatly exaggerated, although Before publication, Baker Brown had been held in
he had seen epidemics of ‘this vice’ in girls’ schools. high repute, but within a year he was ruined.
If it persisted, the child should be taken into care [7]. Because the clitoris was widely understood to be an
The irrepressible physician Colombat d’Isere, who important source of disease, Baker Brown believed
had already shocked his contemporaries by suggest- that clitoridectomy was a cure not only for nympho-
ing that young women should have a tepid bath at mania and masturbation but also epilepsy, catalepsy,
least once a month, confirmed the danger of the painful periods, heavy periods, depression, insanity,
violent intimacies formed at boarding schools. The hysteria and dementia. In his book, he did not use the
end result of ‘onanism, that execrable and fatal evil, word masturbation, preferring the term ‘peripheral
soon destroys her beauty, impairs her health, and excitement’, the euphemism always used by the ex-
conducts her almost always to an early grave’ [8]. perts of on this subject, including Brown-Séquard
This horror of female sexuality was also shared and [6].
promoted by gynecologists, who seemed to put white An example of this usage occurs in a case from
professional women on a pedestal of virtuous Baker Brown: ‘there was evidence of peripheral
decency. Charles Meigs, Professor of Gynecology excitement. I performed my usual operation and
in Philadelphia, wrote extensively on the purity of the patient made a good recovery. She remained
women and the harmful effects of the speculum on quite well and became in every respect a good wife’.
these ‘dear little ladies fit only for love’ [8]. The Baker Brown’s interpretation of this case is worth
suggestion was that ‘modesty was preferable to noting: ‘the illness’ was her desire to obtain a divorce
diagnosis and treatment’ and the speculum was a under the new divorce act of 1857. On another
‘piece of gratuitous and unprincipled indecency’. occasion, he performed a clitoridectomy on a 20-
Matters became worse when it was claimed that year-old woman because she was ‘disobedient to her
ladies of rank in France would write notes to their mother’s wishes, sent visiting cards to men she liked
surgeon requesting him to call at the house and bring and spent much time in serious reading’.
his speculum [9]. As the clitoris seemed to be the A typical non-sexual indication was in case
cause of this potential moral decline, the treatment XVI [12]:
was clear. It had to be removed or destroyed.
Initially, leaches were applied to the vulva and Has never been strong but 5 years ago had an
anus, the clitoris was cauterized, and the first known attack of gastric fever and since then has suffered
therapeutic function of X-rays was to irradiate and constantly from great pain during the menstrual
destroy the clitoris in these women. All of these period, occasionally loses a great deal and passes
assaults on the female genitalia were superseded by large clots of blood. During this time has suffered
the fashion for clitoridectomy from the 1860s, being almost constantly from leucorrhoea, suffers se-
supported by Isaac Baker Brown in London and verely from pain over the region of the left ovary
Charles Brown-Séquard in Paris. Both were highly and in the spine. Is hardly ever free from head-
distinguished figures who influenced practice greatly. aches, is very restless, never sleeps well, frequent
Isaac Baker Brown was by repute a brilliant faints, has little or no appetite, all her ills are
surgeon who wrote the first book devoted purely to exaggerated at the menstrual époque. August 7th
gynecological surgery in 1854 [10]. When Marion usual operation performed. September 1st is
Sims from New York visited Europe for his extensive menstruating without pain. September 30th is
 Attitudes to female sexuality 675

again menstruating without pain and in normal enjoyed an illustrious career and became a comman-
quantity. Is to be discharged cured. der of the Legion of Honour. The article was cited by
Krafft-Ebing, Professor of Psychiatry in Vienna, who
Readers will note the long period of hospitalization in called it a disgusting story not because of what
Baker Brown’s private clinic and a very short Zambaco did but because of what Zambaco saw [15].
duration of follow-up before claiming success for Although Zambaco’s long paper is so shockingly
his procedure. explicit in its inhumanity and pornographic detail, we
His book produced criticism from the Lancet and should not forget the unheeded silent suffering that is
the British Medical Journal and unrestrained hostility still occurring today in thousands of young girls in
in the London Times. Within a year Baker Brown was parts of Africa and the Middle East. We have a long
expelled from the London Obstetric Society after a way to go before female genital mutilation in all its
fierce debate led by his professional rivals. This forms is consigned to history.
meeting was notable for being fired by commercial It is interesting to note how literature followed the
jealousy as much as disapproval of his surgery. Baker contemporary prudish and censorious views prevalent
Brown’s downfall was complete when he resigned in in medicine – or perhaps it led the way. Mark Twain,
the same year from the London Medical Society in his A Tramp Abroad (1889) [16], wrote about the
where he served as President. exquisite Titian portrait, Venus of Urbino (1538)
He died in 1873, in penury and suffering from (Figure 1). She famously adorns the Uffizi Gallery,
incurable paralysis. The autopsy was allegedly lying naked with her left hand over her pubic hair. At
performed by his professional rival, Lawson Tait first sight it may be unclear whether she is being
(although no primary source can be found to modest or having fun. But to judge from her fingers,
substantiate this claim). Lawson Tait pronounced curled into her pubis, and the look on her beautiful
that Baker Brown had the cerebral softening of face, she is clearly teasing her lover, the Duke of
advanced neurosyphilis. It is tempting believe that Urbino. The erotic nature of this picture has always
this gifted and pioneering surgeon, who is now been clear to art historians. Mark Twain wrote about
remembered only because of his advocacy of
clitoridectomy, had this aberration later in life the foulest, the vilest, the obscenest picture the
because of the behavioral disorder of cerebral world possesses. It isn’t that she is naked and
syphilis. Or perhaps the temptation to unfairly stretched out on the bed – no, it is the position of
stigmatize a rival even in death was irresistible to her hand. I saw a young girl stealing furtive glances
Lawson Tait. This is unlikely, however, as it is clear at her, I saw young men gazing long and
from a publication 20 years later that Lawson Tait absorbedly at her, I saw aged infirm men hanging
had some respect for ‘the second best ovariotomist’ upon her charms with a pathetic interest. How I
who, in his view, did not deserve his disgrace [13]. should like to describe her . . . yet the world is
We are told that although ‘semi-demented epileptics willing to let its sons and its daughters and itself
were habitual masturbators’, the mistake of Baker look at Titian’s beast but won’t stand a description
Brown was ‘jumping over two grave omissions in the of it in words.
syllogism and putting the cart before the horse, he
arrived at the conclusion that the removal of the Of course Mark Twain loved the picture. His protest
clitoris would stop the pernicious habit and therefore was about the limitation imposed on the written word
cure the epilepsy’ [13]. by censorship from publishers and the powerful
But the practice continued in Europe, supported lending libraries.
by influential physicians and psychiatrists. Zambaco In 19th century European literature there is a
of Paris reported, in 1882, ‘masturbation and hardly an example of a female character who has
psychological problems in two little girls’, one aged what is called ‘a past’, or who has had an adulterous
10 and her sister, aged 6 [14]. He reported that relationship, who survives to the end of the novel,
neither corporal punishment such as whipping or regardless of the country of origin. The fate of the
restraint with straps helped, nor did the threat that fallen woman was suicide, murder, or deportation to
excessive masturbation would damage the elder girl’s Australia. It would be reassuring if redemption was
health and her reputation. Only cautery without one of the options, but no examples come to mind.
anesthesia helped. This was performed by electro- David Copperfield’s childhood sweetheart, little
cautery, or more effectively by a red hot iron from the Emily, is deported to Australia as the result of having
coals. This was applied to the clitoris, the vulvar been seduced by David’s best friend. In Oliver Twist,
orifice repeatedly, and on one occasion to the the prostitute Nancy dies horribly at the hands of her
buttocks as ‘punishment’. He concluded that one lover, Bill Sykes, and in another Dickens’ novel,
should not hesitate to have recourse to the red hot Bleak House, Lady Deadlock – who had a lover and
iron at a very early stage as a cure for clitoral or an illegitimate child years before marrying her
vaginal masturbation in little girls. The author husband – dies after a 12 hour walk through the
676 J. Studd

Figure 1. Venus of Urbino by Titian (1538).

night in the snow. Tolstoy’s Anna Karenina expiates York for 27 years after a mere two performances.
her sins by jumping under a train. And Flaubert’s However, the libidinous Salome also meets her end
Emma Bovary dies of arsenic poisoning, as described in the final minutes of the opera. Eighteenth century
in horrific detail over many pages. It is said that composers were more forgiving. Poppea, one of the
Tolstoy and Flaubert loved their heroines but were most promiscuous women in opera, survived to
forced by public expectation to end their characters’ marry the emperor in both the Handel and Mon-
lives by such shocking and ghastly deaths. teverdi account. Agrappina and Calisto thrive, and
Similarly, in 19th century opera, all of the heroines Don Giovanni’s seduced women survive to witness
with a sexual past die. The most famous and perhaps his descent into hell.
the first musical description of sexual intercourse The prudery and hypocrisy of the last half of the
occurs in Act II of Tristan and Isolde, which leaves 19th century was challenged by artists. Manet’s
nothing to the imagination. But in this opera, both Dejeuner sur l’Herbe (Figure 2), refused for exhibition
lovers have to die in the end – like most of Wagner’s in1863, is now recognized as a masterpiece. Cour-
wonderful heroines. Wagner the man allowed himself bet’s graphically gynecological L’Origine du Monde
much sexual license – a freedom he does not allow (Figure 3) in the Musee d’Orsay, and the erotic
his Brunnhilde, Seiglinde, Kundry and even the lesbianism of The Sleepers (Figure 4), were both
Dutchman’s poor Senta, who only makes such a painted in 1866 and probably appear less shocking in
promise. All these heroines succumb to the con- these enlightened days than in the artistic world of
temporary need for punishment of female sexuality. contemporary Paris. Even the half-naked Salome of
The virtuous women like Eva, Elizabeth, Gutrune Lovis Corinth (1900) (Figure 5) is now allowed to be
and the Rhinemaidens live another day. Most of given a sexual interpretation – inspecting the head of
Verdi’s heroines with a sexual history – Aida, Violetta her would-be lover in anything but a biblical pose.
and Gilda – die; although mezzos, who are usually What happened at the end of the 19th century?
more sinister characters, seem to have a better When did literature, society and indeed medicine
survival rate than sopranos. Similarly, all Puccini’s catch up with the artists and accept that sex was fun
heroines with a sexual past – such as Mimi and Tosca and that fallen women did not have to end up dead or
– succumb before the final curtain. In contrast, transported? And in the real world, when did
Turandot’s virginity guarantees her survival in spite enthusiastic female sexuality cease to be a target for
of her appalling murderous behavior. demented doctors? Literary colleagues have in-
Richard Strauss’s Salome (1905) – using Oscar formed me that the novel Ann Veronica (1909), by
Wilde’s play as libretto – could have been a turning H. G. Wells, was such a turning point. Wells was a
point, as the play is unashamedly sexual. It was feminist as well as a futurist, and his headstrong
banned in the UK until 1908 and was banned in New heroine leaves home after her father forbids her to
 Attitudes to female sexuality 677

Figure 2. Manet’s Dejeuner sur l’Herbe (1863).

Masters and Johnson’s four phases of human sexual

response in the music. The quotes are not mine or
invented but belong to Mann from his classic
reference work, The Operas of Richard Strauss [17]:

(1) Excitation – ‘nobody who understands the

language of music can misunderstand the
meaning of the initial rising horn call’.
(2) Plateau – ‘the piercing and rising arpeggios that
rise higher than expected’.
(3) Climax – ‘whooping horns rather too soon’.
(4) Resolution – ‘dawn and birdsong and music of
loving contentment and a theme of aching
passion’.

Then the curtain is raised to reveal a scene with two

Figure 3. L’Origine du Monde, Gustav Courbet (1866).
scantily clad women in bed. There is no ambiguity
here: the young boy Octavian, mezzo soprano, and
the older, but very beautiful, Field Marshall’s wife,
Marie Therese, the soprano. Sadly, the music tells us
that Octavian, in his youthful inexperience, reaches
study science, lives by herself, has boyfriends, has his climax too soon, with the whole sexual episode in
intercourse for the first time after the opera (Tristan the Prelude lasting no more than 53 seconds, in what
and Isolde, as it so happens), and continues a life of is a clear musical account of premature ejaculation.
politics and feminism among the Suffragettes. Strauss wrote similar erotic descriptions in
The turning point in music must be Der Rosenka- Symphony Domestica and the Prelude to Act 3 of
valier, first produced in the same year as the Arabella – but nothing to match the prelude to Der
publication of Wells’s Ann Veronica, 1909. In the Rosenkavalier. It is hoped that the reader will never
words of the opera critic, William Mann, the prelude again listen to this piece without understanding, a
is ‘an unrestrained and highly suggestive musical smile on the face, and satisfaction in the soul.
description of the act of love’. Decades later, with our In the real world, however, acceptance of
new knowledge of physiology, we are able to follow the importance of satisfactory orgasmic sexual
678 J. Studd

Figure 4. The Sleepers by Gustav Coubet (1866).

Figure 5. Lovis Corinth’s Salome (1900).

intercourse was slow. Marie Stopes’s Married Love a female doctor falling back on her own painful
(1918) [18] has been listed by Bragg [19] as one of sexual failures before and after her marriage, it
the twelve books that ‘changed the world’. Written by movingly relates the dangers of ignorance, and the
 Attitudes to female sexuality 679

no longer forbidden pleasures that can be achieved Response was a landmark piece of research which has
with sexual intercourse within marriage. Most pub- helped women, their partners and medical advisers
lishers turned down the manuscript but eventually it understand the events of sexual excitement. They
was accepted by a small publisher and became an brought discussion rather than an embarrassed, silent
immediate best-seller. However it was banned in dismissal of the subject. The researchers initially used
America, where it was first published in 1931. Marie prostitutes for the laboratory studies of coitus but had
Stopes wrote about the ‘virgin sweetness of women to change to other volunteers as the sex workers were
shut in ignorance and these in the pristine purity of habituated to intercourse without orgasm.
an educated girl of the northern race’. She accepts They were able to show the hyperemia of the vulva,
that men are often bewildered by causing pain with the enlargement and erection of the clitoris and the
intercourse ‘. . .as he finds restraint and self-control transudation of fluids from the perivaginal vascula-
urged on him by books he compensates by working ture during the excitation phase. This was followed
hard and arriving home late in the evening’. She in the plateau stage by dilatation of the upper third of
believed that such was the fear of sexuality that the vagina and the formation of the orgasmic
several brides resorted to suicide or insanity rather platform in the outer third of the vagina. Orgasm
than accept the horrors of the first night. She consisted of involuntary contractions of the pelvic
regretted the notion deeply rooted in society that a and uterine musculature, often accompanied by
woman is lowered by sexual intercourse. Married uncontrolled physical and verbal responses. Resolu-
Love achieved a realization in the community that sex tion was essentially the reversal of these hyperemic
was good, but Stopes deliberately only discussed changes back to the normal unstimulated state.
sexual intercourse within marriage and in early Attitudes to the female orgasm have undergone a
editions did not speak about contraception, mis- revolution. The front covers of monthly magazines
carriage or even achieving an orgasm without the for women blatantly advertise ‘40 ways to Orgasm
husband. However, she does seem a little out of date, this Weekend – How to Achieve an Orgasm Every
informing us that even when the woman is ‘strongly Time – Would you dare Hire a Male Escort – How to
sexed with a well marked recurrence of desire it is Effectively Perform Oral Sex, With or Without a
generally satisfied by fortnightly unions’. She states Condom’. We now recognize the problems of loss of
that the supreme law for husbands is to remember libido produced in relationships and even have a
that each active union must be tenderly wooed for syndrome of hypoactive sexual desire disorder
and won, and that no union should ever take place (HSDD) [24]. Sexual satisfaction has now become
unless the woman also desires and it is made virtually compulsory, with treatments ranging from
physically ready for it. psychosexual counseling to hormone therapy with
Kinsey and colleagues in 1953 [20] broke the estrogens or androgens.
scientific silence by publishing the controversial HSDD is a complex issue, probably made more
Sexual Behaviour in the Human Female, which complex by investigators who subdivide it into sexual
reported on taboo subjects such as orgasm, mastur- desire disorder, sexual arousal disorder, sexual
bation, premarital sex and infidelity within marriage. aversion and many other subgroups. The different
The public reaction ranged from disbelief and factors which play a part in female sexual response
disgust to admiration and gratitude. But at last are physiological, psychological, interpersonal rela-
people were armed with the facts of female sexuality tionships and socio-cultural influences. These are
and the work remains the standard text on the perhaps expressed more simply as Heart, Head and
subject. Hormones. Patients understand this.
Twenty years later Seymour Fisher [21] devoted a Finally, there must be a brief comment on the 21st
whole book to the female orgasm, discussing the century to see how attitudes to female sexuality have
psychology, physiology and fantasy of the event. In been modified with acceptance of the concept of
his study of 300 women only 39% claimed to always androgen deficiency [25]. For about 30 years now,
or nearly always orgasm during intercourse, with only there have been a few eccentrics like Greenblatt [26]
20% stating that they did not need ‘a final push’ for and Studd [27] who gave testosterone to women for
orgasm by manual stimulation. If given the choice, various psychosexual and mood problems. This was
64% would chose clitoral stimulation rather than in the form of testosterone implants because that was
vaginal. The Victorians would never have believed it. the only preparation licensed for use in women. The
Not to be outdone, Shere Hite [22], in her extensive clinical response has been impressive, but the
use of questionnaires from women, describes six treatment for loss of libido did lack scientific
basic types of masturbation in women, each sub- confirmation until very recently.
divided into five variations. It is unscientific but a Testosterone is a normal female hormone present
fascinating read. at ten times the level of estradiol in young women,
Masters and Johnson’s [23] work on the physiol- but levels begin to decline at the age of 20 years: by
ogy of Sexual Intercourse in the Normal Female Social the time of the natural menopause there is also a 50%
680 J. Studd

fall, and a 75% fall after bilateral oophorectomy [28]. They are happy with the change, or perhaps they wish
The decline in androgen levels contributes to the to avoid the 19th century attack on the clitoris.
decline in sexual desire, arousal and orgasm, and also We have come a long way from Baker Brown’s
has effects on general well-being, energy, mood, clitoridectomy as a cure for a young woman’s normal
bone physiology and decreased muscle mass, as well sexual behavior, but the revolting practice of female
as hot flushes. This is now regarded as female circumcision remains a commonplace cultural re-
androgen deficiency syndrome (FADS) [25]. It is no quirement in many parts of the world. Even the new
surprise that FADS occurs commonly after bilateral Western vogue of vulvovaginal rejuvenation and
salpingo-oophorectomy, but we do not know its labial trimming – performed in order to look like an
incidence after hysterectomy with ovarian conserva- airbrushed porn star, as advertised on more dis-
tion. It is not rare. Nor is it rare in intact reputable medical websites – looks backwards to
postmenopausal women, perimenopausal women or these customs of female genital mutilation.
even younger women who have an impaired sexual In general, we still have a great deal to learn, with
response. medical history teaching us that many of our beliefs
There are now gels licensed for men which are today will be regarded as eccentric at least, or
often used off-license in a smaller dose for women, perhaps clearly dangerous, in years to come. We
and at last a testosterone patch has recently received must never forget that we used to bleed for anemia.
a license specifically for use in women who have had
a hysterectomy and bilateral salpingo-oophorectomy.
Acknowledgement
The studies have demonstrated positive effects of the
transdermal testosterone patch on sexual desire, This paper was originally given as a lecture to The
sexual activity, orgasm, pleasure, responsiveness London Medical Society in 2006.
and self-image, with a corresponding decrease in
sexual distress [29]. Although there is a tendency to
equate testosterone therapy with a sexual response References
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