Abstract
BACKGROUND: The hormonal composition of amniotic fluid during prenatal development, particularly the androgen-to-estrogen ratio, may influence neuronal differentiation related to sexual response patterns and the capacity to control impulsive sexual behaviors in later life. AIM: This study aims to assess sexual behaviors and characterize sexual responses in women with borderline personality disorder (BPD) compared to a control group. METHODS: The study included 33 women diagnosed with BPD and 56 women in a control group. BPD diagnoses were based on clinical psychiatric evaluation and the Structured Clinical Interview for DSM-IV. Elements of sexual response were measured using the Arizona Sexual Experience Scale (ASEX). The digit ratio (2D:4D) served as a biomarker for testosterone and estrogen exposure during early prenatal development. MAIN OUTCOMES: ASEX results were analyzed in the categories of "desire," "arousal," and "vaginal lubrication" subscales, along with the 2D:4D digit ratio for both hands. RESULTS: Lower values for the right-hand digit ratio were observed in the BPD group compared to the control group (0.989, SD = 0.034 vs. 1.016, SD = 0.039; P = 0.0014), potentially indicating higher prenatal testosterone levels. Significant correlations were found in the BPD group between the right-hand digit ratio and scores on the ASEX subscales, specifically "sexual arousal" (r = 0.406, P = 0.019) and "vaginal lubrication" (r = 0.362, P = 0.038). CLINICAL IMPLICATIONS: These results may support biological hypotheses regarding the origins of sexual dysfunction in women with BPD. STRENGTHS AND LIMITATIONS: This study is a pioneering attempt to explore the indirect impact of early amniotic hormone composition on the neurobiological conditioning of sexual response and behavior in women with BPD. Limitations include the preliminary nature of the findings, a small sample size, and results that may not be generalizable across all genders. CONCLUSIONS: Physiological aspects of sexual response, such as arousal and vaginal lubrication, in women with BPD appear to be significantly correlated with prenatal testosterone levels, as indicated by the 2D:4D digit ratio.