European Journal of Neuroscience

European Journal of Neuroscience, Vol. 27, pp. 29222927, 2008

doi:10.1111/j.1460-9568.2008.06241.x

Hypothalamus, sexual arousal and psychosexual identity in human males: a functional magnetic resonance imaging study
M. Brunetti,1,2 C. Babiloni,3,4,5 A. Ferretti,1,2 C. Del Gratta,1,2 A. Merla,1,2 M. Olivetti Belardinelli6 and G. L. Romani1,2
Institute for Advanced Biomedical Technologies, University G. DAnnunzio of Chieti, Chieti (CH), Italy Department of Clinical Sciences and Biomedical Imaging, University G. DAnnunzio of Chieti, Via dei Vestini 33, 66013 Chieti (CH), Italy 3 Dipartimento di Scienze Biomediche, University of Foggia, Foggia, Italy 4 Casa di Cura San Raffaele Cassino and IRCCS San Raffaele Pisana, Rome, Italy 5 AFaR, S. Giovanni Calibita, Fatebenefratelli Isola Tiberina, Rome, Italy 6 ECONA (Interuniversity Centre for Research on Cognitive Processing in Natural and Articial Sistems) and Department of Psychology, La Sapienza University of Rome, Rome, Italy
2 1

Keywords: deep sexual identity, functional magnetic resonance imaging, hypothalamus, male sexual arousal

Abstract
In a recent functional magnetic resonance imaging study, a complex neural circuit was shown to be involved in human males during sexual arousal [A. Ferretti et al. (2005) Neuroimage, 26, 1086]. At group level, there was a specic correlation between penile erection and activations in anterior cingulate, insula, amygdala, hypothalamus and secondary somatosensory regions. However, it is well known that there are remarkable inter-individual differences in the psychological view and attitude to sex of human males. Therefore, a crucial issue is the relationship among cerebral responses, sexual arousal and psychosexual identity at individual level. To address this issue, 18 healthy male subjects were recruited. Their deep sexual identity (DSI) was assessed following the construct revalidation by M. Olivetti Belardinelli [(1994) Sci. Contrib. Gen. Psychol., 11, 131] of the Franck drawing completion test, a projective test providing, according to this revalidation, quantitative scores on accordance non-accordance between self-reported and psychological sexual identity. Cerebral activity was evaluated by means of functional magnetic resonance imaging during hard-core erotic movies and sport movies. Results showed a statistically signicant positive correlation between the blood oxygen leveldependent signal in bilateral hypothalamus and the Franck drawing completion test score during erotic movies. The higher the blood oxygen level-dependent activation in bilateral hypothalamus, the higher the male DSI prole. These results suggest that, in male subjects, inter-individual differences in the DSI are strongly correlated with blood ow to the bilateral hypothalamus, a dimorphic brain region deeply implicated in instinctual drives including reproduction.

Introduction
Several neuroimaging studies have investigated the cerebral activation during erotic visual stimulation, highlighting a complex neural circuit involved in the human sexual response (Stoleru et al., 1999; Redoute et al., 2000; Bocher et al., 2001; Arnow et al., 2002; Karama et al., 2002, Holstege & Georgiadis, 2003; Mouras et al., 2003; Hamann et al., 2004, Redoute et al., 2005 and Beauregard et al., 2001). These studies showed that, at group level, there was an increase in neural activity within a distributed cortical network including inferior right frontal, inferior temporal, left anterior cingulate and right insula areas. In a recent functional magnetic resonance imaging (fMRI) study, the pattern of cerebral responses to erotic movies was revealed by correlating blood oxygen level-dependent (BOLD) signal with the time course of penile erection (Ferretti et al., 2005). The activation maps indicated that only anterior cingulate, insula, amygdala, hypothalamus and secondary somatosensory cortices were specically correlated with penile erection. Those results conrmed the importance of sub-cortical other than cortical regions as neural correlates of sexual arousal in human males. Indeed, two previous fMRI studies had shown that amygdala (i.e. a brain region involved in emotional arousal) and hypothalamus (i.e. a brain region central to reproductive functions) were more strongly activated in men than in women when viewing identical visual sexually-arousing stimuli (Hamann et al., 2004) and that males but not females presented signicant activation in the hypothalamus. This was true even if there was a similar degree of self-reported arousal (Canli et al., 2002). In contrast, men and women showed similar activation patterns across multiple brain regions, including ventral striatal regions involved in reward (Hamann et al., 2004). The above-mentioned study focused on the neural correlates of sexual arousal at group level. However, it is well known that there are remarkable inter-individual differences in psychological view and attitude to sex. These differences, determining among others the human response to erotic visual stimuli, are linked not only to the individuals sex identity (Money & Ehrhardt, 1972) but also take their root in the deep sexual identity (DSI) as a multi-determined constancy

Correspondence: Marcella Brunetti, 1Institute of Advanced Biomedical Technologies, as above. E-mail: mbrunetti@itab.unich.it Received 3 February 2008, revised 29 March 2008, accepted 3 April 2008

The Authors (2008). Journal Compilation Federation of European Neuroscience Societies and Blackwell Publishing Ltd

Hypothalamus, sexual arousal and sexual identity 2923 system combining together biological, psychological and cultural aspects of the sexual identity (Olivetti Belardinelli, 1982; Olivetti Belardinelli et al., 1990). The DSI is assessed following the construct revalidation by Olivetti Belardinelli (1994) of the Franck drawing completion test (FDCT) (Franck & Rosen, 1949), a projective test providing, according to this revalidation, quantitative scores on accordance non-accordance between self-reported and psychological sexual identity. The present fMRI study aimed to investigate the correlation between cerebral responses during sexual arousal evoked by erotic stimuli (videos) and DSI in male subjects. obtain the DSI prole, the projective drawing completions of the 36 FDCT items were therefore evaluated according to their accordance non-accordance to the subjects self-reported sex, thus providing quantitative scores that were organized in a three-factor prole for the male sexual identity and in a four-factor prole for the female sexual identity. The construct revalidation performed on 1120 Italian subjects demonstrated that the FDCT is a valid tool in assessing DSI (Olivetti Belardinelli, 1994). For this research, we combined in one general DSI score the three-factorial scores describing the male identity prole, thus obtaining a measure of the correspondence of each subjects DSI to the male typical model in Western culture.

Materials and methods

Subjects Eighteen healthy male self-professed heterosexual subjects (mean age 24.89 years, range 2032 years) were recruited. All subjects received a detailed explanation of the study design and gave their written informed consent according to the Declaration of Helsinki (World Medical Association Declaration of Helsinki, 1997). The protocol was approved by the School of Medicine Ethics Committee, University of Chieti, Italy. The inclusion criteria were a normal sexuality prole as dened by score values within 2 SDs from normative mean values at the following eld scales: (i) a sexual behaviour inventory (Sexuality Evaluation Schedule Assessment Monitoring; Boccadoro, 1996), identifying background information such as age, sexual status, availability of a current partner and sexual experience; and (ii) a battery of questionnaires (Cognitive Behavioral Assessment; Bertolotti, 1987), providing multidimensional distress indices (State-Trait Anxiety Inventories, Eysenck Personality Questionnaire, Depressive Symptoms Assessment Questionnaire and Maudsley ObsessiveCompulsive Questionnaire). Based on these inventories, the participants revealed neither symptoms of psychological disease or personality disorders nor problems regarding the psychological area of sexuality. The exclusion criteria were: any personal experience related to sexual aggression, abuse or phobia; experience of psychotherapy or counseling setting for explicit difculties related to sexuality; progressive neurological and or systemic disorder; any implanted metal; signicant unstable concurrent medical illness; hormone replacement therapy; administration of concomitant medication treatment that could alter mood or cerebral metabolism (e.g. benzodiazepines, antidepressants, mood stabilizers, stimulants, steroids) within 30 days prior to screening; a history of any substance alcohol abuse or dependence within the past 6 months (nicotine dependence was allowed); and being incapable of understanding or consenting to study procedures. It is of note that subjects did not receive any indication about refraining from sexual activity prior to the study, to avoid the development of anxiety about the experimental conditions. Furthermore, testosterone was not measured as the design of the study was focused on within-group correlation analysis (BOLD vs. psychological prole) and not comparisons between groups. Visual stimulation (video clips) The study was performed according to a standard block paradigm, with prolonged visual stimulation using erotic, sport and neutral video clips. Erotic video clips showed consensual sexual interactions between one man and one woman (petting, vaginal intercourse and oral sex), following the guidelines of Koukounas & Over (1997). Sport video clips depicted close-up scenes from rugby and football matches including men or women moving, in order to remove the confounding effect of non-sexual arousal or attention elicited by the view of human beings in physical contact with some amount of motion. The neutral video clips showed scenes with an emotionally feeble content (such as ordinary objects, houses or people). They were only used as a relaxing pause between different stimulation conditions and were never used as a baseline for the calculation of activation maps. The duration of erotic, sport and neutral clips was 3 min, 2 min and 30 s, respectively. The longer duration of the erotic movies with respect to the sport movies was selected on the basis of previous studies (Arnow et al., 2002; Ferretti et al., 2005) in order to obtain a complete penile response. However, this difference in block duration is not expected to affect the level of activation, given that transients of the BOLD response are much shorter than the mean stimulus duration used here. The 30-s duration of neutral video clips allowed emotional disengagement from the content of sport and erotic visual stimuli (Garret & Maddock, 2001). A total of six erotic, six sport and 12 neutral clips were presented in a single session. Video clips were presented alternately, in an ordered sequence in which a sport and a neutral clip always preceded an erotic clip, rather than in a randomized order, to avoid the occurrence of two consecutive erotic clips. In the latter case, due to the long-lasting mechanism of detumescence, there might have been a prolongation of the erection phase in the second erotic clip without the onset phase that would have normally occurred after a sport video clip. Subjects were asked to report their feeling of sexual arousal or lack of sexual interest by pressing a magnetic resonance imaging-compatible push-button and the subjective times of beginning and ending of sexual arousal, respectively, were recorded. The presentation of video clips was controlled by a MATLAB code running on a PC placed in the scanner console room. Visual stimuli were projected onto translucent glass placed on the back of the scanner bore by means of an LCD projector. A mirror xed to the head coil inside the magnet allowed the subjects to view the translucent glass. Subjects did not report any feeling of fear or violence after the observation of the videos. For more details on the stimuli selection method see also Karama et al. (2002) and Ferretti et al. (2005).

Assessment of DSI The subjects DSI was assessed by means of the FDCT, evaluated according to the construct revalidation of Olivetti Belardinelli (1994). Differently from all verbal measures of sexual identity, the FDCT is not affected by verbal and overt response bias (in particular the social desirability bias). According to an advanced approach to DSI assessment, the bipolar masculinity femininity dichotomy underlying the Francks general model and scoring technique was split into two independent dimensions (Olivetti Belardinelli, 1994). In order to

Physiological and fMRI data acquisition Penile erection was recorded continuously, during visual stimulation and fMRI data acquisition, by means of a custom-built magnetic

The Authors (2008). Journal Compilation Federation of European Neuroscience Societies and Blackwell Publishing Ltd European Journal of Neuroscience, 27, 29222927

2924 M. Brunetti et al. resonance imaging-compatible pneumatic device (for method see Ferretti et al., 2005). This measure was recorded to verify the effective sexual arousal in response to the erotic stimuli. BOLD contrast functional images were acquired with a Siemens Magnetom Vision scanner at 1.5 T by means of T2*-weighted echo planar imaging free induction decay sequences with the following parameters: TR 4087 ms, TE 60 ms, matrix size 64 64, FOV 256 mm, in-plane voxel size 4 4 mm, ip angle 90, slice thickness 4 mm and no gap; 535 functional volumes consisting of 24 transaxial slices were acquired. In order to minimize the susceptibility artifacts in the deep mesial temporal regions, we oriented the slices in an oblique-axial fashion to include in the scan volume the smallest possible portion of the temporal bone. Finally, a high-resolution structural volume was acquired at the end of the session via a three-dimensional MPRAGE sequence with the following features: sagittal, matrix 256 256, FOV 256 mm, slice thickness 1 mm, no gap, in-plane voxel size 1 1 mm, ip angle 12, TR 9.7 ms, TE 4 ms. Data were analysed by means of the Brain Voyager 4.9 software (Brain Innovation, The Netherlands). Due to the T1 saturation effects, the rst ve scans of each run were discarded from the analysis. Preprocessing of functional scans included motion correction and removal of linear trends from voxel time series. The motion correction was performed by means of a threedimensional rigid body transformation to match each functional volume to the reference volume (the sixth volume). The estimated translation and rotation parameters for each volume in the time course were inspected to check that the movement was not larger than approximately half of a voxel for each functional run and that no stimulus-correlated movement had occurred (Hajnal et al., 1994; Friston et al., 1996). Inspection of the raw signal time course in the deep mesial temporal regions and the hypothalamus in subjects that entered the analysis revealed no signal dropout due to susceptibility artifacts. Preprocessed functional volumes of a subject were coregistered with the corresponding structural data set. As the twodimensional functional and three-dimensional structural measurements were acquired in the same session, the coregistration transformation was determined using the Siemens slice position parameters of the functional images and the position parameters of the structural volume. Structural and functional volumes were transformed into Talairach space (Talairach & Tournoux, 1988) using a piecewise afne and continuous transformation. Functional volumes were resampled at a voxel size of 3 3 3 mm. Statistical analysis The statistical analysis was performed for individual subjects and the group using the general linear model (Friston et al., 1995) with correction for temporal autocorrelation (Bullmore et al., 1996; Woolrich et al., 2001), considering as predictor of interest the erotic video clips. The sport video clips were used as baseline and the neutral video clips were included in the model as a predictor of no interest. A standard hemodynamic response function was used in order to account for the hemodynamic delay (Boynton et al., 1996). The fMRI analysis using the penile erection data as a regressor is described in detail in the reference paper of this study (Ferretti et al., 2005). In the present study, the level of fMRI activation during the erotic condition (characterized by the general linear model beta value, representing the estimated amplitude of the mean BOLD response during the erotic condition with respect to the sport condition) was derived for each subject in a rst level voxel-wise analysis. These parameters and the DSI values were then entered in a second level voxel-wise group analysis in order to search for areas in which the BOLD response during the erotic video clips was correlated with the DSI score. In this analysis a statistical map was obtained for the group performing, voxel by voxel, the correlation between the BOLD responses and the DSI values across subjects. For the obtained statistical map an uncorrected P < 0.001 threshold was used, corresponding to P < 0.05 corrected for multiple comparisons by means of the false discovery rate (Genovese et al., 2002) and small volume correction. For this small volume correction, spheres having a radius of 9 mm and for center the coordinates obtained from the group analysis were considered for regions of a-priori expectation of activation on the basis of the previous literature (hypothalamus, anterior cingulate gyrus, amygdala and insula). Clusters of voxels showing a signicant correlation between the DSI score and the BOLD response during the erotic video clips were detected from the obtained statistical maps. Spearman correlation between the mean BOLD response from voxels belonging to a given cluster and the score of the DSI was also calculated.

Results
Penile erection and behavioral data Penile erection was never observed in the control movies without erotic content. In contrast, it was observed in all subjects while they were looking at the erotic movies. An example of the penile erection time course recorded for one of the subjects is shown in Fig. 1. It is of note that this measure was used only to verify the effective sexual arousal in response to the erotic stimuli. The mean delay across subjects between the start of the erotic video clips and a button depression indicating the beginning of subjective interest was 16 10 s (mean SD), whereas the mean delay between the end of the erotic clips and the button depression indicating the lack of sexual interest was 6 5 s (mean SD). DSI mean scores are shown in Table 1. For each subject the single score value for the three DSI factors was calculated and the mean value of the three factors for each subject was included in the fMRI analysis. The results showed that the global DSI score of the recruited males ranged from 8 to 10.67 as expected in clinically normal young subjects (013 scale). The correlation between the FDCT score and the penile erection was not statistically signicant (P > 0.05).

fMRI data and DSI prole The rst level of the analysis (general linear model considering as predictor of interest the erotic video clips, see Materials and methods) showed several brain activations during erotic stimulation in the recruited male subjects, replicating the nding of the previous study (Ferretti et al., 2005). Accordingly, these activations were distributed in anterior cingulated cortex, insula, amygdala, hypothalamus and other cortical areas (Table 2). The second level of analysis (correlation between BOLD and DSI) highlighted a totally original working hypothesis between brain activity and DSI. A statistically signicant correlation between global DSI score and brain BOLD response during the observation of erotic movies was observed only in bilateral hypothalamus as shown in Fig. 2 (right hypothalamus, r = 0.77, P = 0.0005; left hypothalamus, r = 0.73, P = 0.0005). This correlation was positive, meaning that the higher the accordance between the individual actual male prole and the culturally typical prole, as revealed by the global DSI score, the higher the BOLD activation in bilateral hypothalamus. Figure 2 also illustrates the scatterplot between the BOLD response in the right and left hypothalamus, respectively and the global DSI score across subjects. It is of note that a control analysis showed that the above bilateral hypothalamic BOLD activation was also

The Authors (2008). Journal Compilation Federation of European Neuroscience Societies and Blackwell Publishing Ltd European Journal of Neuroscience, 27, 29222927

Hypothalamus, sexual arousal and sexual identity 2925 sive Questionnaire). No statistically signicant correlation was found (P > 0.05).

Discussion
The present study focused on the relationship in individual selfprofessed heterosexual males between cerebral responses to sexual arousal and individual DSI measured on the degree of accordance non-accordance between self-reported male identity and the culturally typical male identity (Olivetti Belardinelli et al., 1990). The aim was to extend previous studies evaluating cerebral responses to erotic stimuli and to account for remarkable inter-individual differences in the psychological view and attitude to sex in human males. Therefore, we applied a general neurophysiological methodology used in a previous eld study on an independent group of subjects (Ferretti et al., 2005) in whom we assessed DSI (Olivetti Belardinelli, 1982, 1994). Specically, sexual arousal was probed by penile erection and cerebral activity was evaluated by means of fMRI during hard-core erotic movies and (control) sport movies. The DSI was assessed by means of the FDCT construct revalidated by Olivetti Belardinelli (1994), which was correlated with BOLD activity across subjects. The results showed that all subjects had penile erection, as a sign of sexual arousal, during erotic movies but not during control movies. As a main nding, the only correlation between the DSI score and the BOLD signal was detected in bilateral hypothalamus during the observation of erotic movies. The higher the DSI prole, the higher the BOLD activation in bilateral hypothalamus. The above activation of the hypothalamus did not depend on general aspects of personality or self-reported sexuality, such as

Fig. 1. Subject no. 5. Time course of penile erection as recorded by the penile tumescence-measuring device. The curve is shown against a schematic of the fMRI acquisition paradigm that consists of six identical epochs, each composed of a sport video clip (blue), a neutral video clip (light gray), an erotic video clip (red) and, nally, another neutral video clip (light gray). This measurement allowed verication that effective sexual arousal occurred only during erotic video clip vision.

correlated with penile erection, following the data analysis procedure used in a previous reference study (Ferretti et al., 2005). A control hypothesis is that the above hypothalamic activation generically depended on basic aspects of personality or self-reported features of sexuality. To test this control hypothesis, we correlated the BOLD activation in bilateral hypothalamus with the score of standard inventories on self-reported sexuality (Sexuality Evaluation Schedule Assessment Monitoring; Boccadoro, 1996), general cognition (Cognitive Behavioral Assessment; Bertolotti, 1987), stress anxiety (State-Trait Anxiety Inventories), extroversion (Eysenck Personality Questionnaire), depression (Depressive Symptoms Assessment Questionnaire) and compulsive tract (Maudsley ObsessiveCompul-

Fig. 2. Voxels in bilateral hypothalamus that revealed a statistically signicant positive correlation between the global DSI score and the BOLD response during the EROTIC condition (as compared with the SPORT condition) in bilateral hypothalamus, superimposed on the structural magnetic resonance imaging of one of the subjects (upper). Scatterplot of the BOLD response in the right and left hypothalamus and the DSI (Spearman correlation: n = 18; right hypothalamus, r = 0.737; P = 0.0005; left hypothalamus, r = 0.73; P = 0.0005) (lower). On the right side a coronal section shows the bilateral hypothalamus activation. The Authors (2008). Journal Compilation Federation of European Neuroscience Societies and Blackwell Publishing Ltd European Journal of Neuroscience, 27, 29222927

2926 M. Brunetti et al.

Table 1. The DSI mean score and BOLD signal change in the right and left hypothalami of each individual BOLD (% signal change) Age (years) 30 23 22 25 22 25 32 23 24 21 20 22 24 28 32 24 24 27 DSI mean score 8.5 9 9.67 10.33 10 9.33 8.5 9.33 10.67 10 10.67 8.33 9 9 9 9.67 8.67 8 Right hypothalamus 0.124 )0.403 0.323 0.796 0.734 0.364 0.038 0.449 0.904 1.122 1.116 )0.961 )0.064 0.252 )0.1 )0.143 )0.227 0.188 Left hypothalamus )0.324 )0.725 0.267 0.819 0.779 0.479 0.153 0.462 1.766 0.393 1.566 )0.246 )0.23 0.385 )0.254 )0.089 )0.174 0.519 Area Right precuneus Left precuneus Right IPL Left IPL Right DLPFC Left DLPFC Right SII Left SII Right VLPFC Right insula Left insula Right thalamus Left thalamus Right cuneus Left cuneus Right anterior cingulate Left anterior cingulate Left inferior temporal Right hypothalamus Left hypothalamus Right hippocampus Left hippocampus Right fusiform Left fusiform Right amygdala Left amygdala BA 7 7 40 40 18 18 24 24 28 28 37 37 Table 2. Group results obtained with the voxel-wise whole-brain randomeffects analysis Talairach coordinates x 28 )24 53 )55 47 )46 49 )52 38 40 )41 0 )1 24 )27 3 )2 )49 10 )3 15 )17 44 )44 24 )22 y )53 )48 )28 )30 5 4 )21 23 27 )1 0 )14 )12 )86 )89 25 21 )58 )5 )5 )20 )17 )51 )46 )1 )1 z 45 39 36 36 26 29 21 20 15 4 5 10 8 2 2 2 2 6 )9 )8 )8 )8 )17 )15 )16 )16 Z-scores 10.21 9.81 14.52 14.06 12.62 9.61 8.66 9.15 7.45 9.31 8.26 7.78 7.45 17.01 10.79 7.11 7.11 22.10 10.86 10.41 7.38 7.43 20.74 13.03 7.45 11.28

Subject 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

general cognition, stress anxiety, extroversion, depression and compulsive behaviour measured by means of standard questionnaires. The lack of correlative results between hypothalamus activation during sexual arousal and the score to questionnaires on personality and selfreported sexuality is not surprising. Tracts emerging from these questionnaires might be markedly affected by social compliance and peculiarities of the assessment setting. DSI would be less affected by these confounding variables. However, DSI also presents evident limitations for the explanation of a complex dimension such as human sexuality, which is linked to several genetic, physiological, psychological and sociological dimensions. At this early stage of psychophysiological research, we prefer to adopt a very simple denition of DSI as revealed by the FDCT construct revalidated by Olivetti Belardinelli (1994), i.e. the degree of concordance between selfreported and psychological sexual identity. The present results conrm and extend to the domain of individual differences the previous report about the response of hypothalamus during the observation of erotic visual stimuli in male subjects (Hamann et al., 2004; Ferretti et al., 2005) and underline the close connection between sexual arousal, hypothalamus activation and individual DSI differences. Furthermore, they extend previous literature providing convergent evidence pointing to a crucial role of hypothalamus in determining individual differences in sexual behavior (De Vries et al., 2002; Markham et al., 2003). It has been shown that sex-specic secretion of many hypothalamic and pituitary hormones regulates sexual, social and aggressive behavior. At this early stage of the research, a conclusive explanation of the present results is not possible. It can be speculated that bilateral hypothalamus may contribute to the specic pattern of individual emotional and neurovegetative (i.e. sweating, cardiac frequency and blood pressure, respiration frequency, release of adrenergic hormones, etc.) response accompanying sexual arousal in human males, in relation to the psychosexual identity as featured by the DSI, i.e. the accordance non-accordance between biological and psychological male identity (i.e. the personal self-representation of being a male individual). Future investigations should evaluate the intriguing hypothesis that typical erotic video stimuli are more arousing or appetitive (as revealed in the present study by penile tumescence) for

Talairach coordinates and Z-scores of the peak activity in brain areas activated during the video study, as revealed by the contrast Erotic vs. Sport visual stimulation. BA, Brodmann area; DLPFC, dorsolateral prefrontal cortex; IPL, inferior parietal lobule; SII, secondary somatosensory area; VLPFC, ventrolateral prefrontal cortex.

individuals who have greater concordance between self-reported and psychological sexual identity. The DSI has repeatedly been shown to differentiate the psychosexual identity of cognitive disables, paraplegics, homosexuals and transgenders of both sexes, as a demonstration of the relationships among somatic and psychological determinants of sexual personality and behavior in males and females (Olivetti Belardinelli, 1994; Olivetti Belardinelli & Federici, 2004). Therefore, the present psychophysiological methodology could be used in further experiments for the evaluation, at an individual level, of analysis of the relationships between BOLD activation in hypothalamus and DSI in females watching erotic stimuli. It is expected that amygdala and hypothalamus are more strongly activated in men than in women when viewing erotic movies (Hamann et al., 2004) and that males but not females presented signicant activation in the hypothalamus (Canli & Gabrieli, 2004).

Conclusions
In the present study, we investigated the relationship between cerebral responses, sexual arousal and psychosexual identity in healthy male self-professed heterosexual subjects. The results showed a statistically signicant positive correlation between cerebral activity (BOLD signal) in bilateral hypothalamus and male psychological identity (DSI) during erotic movies. The higher the activation in bilateral hypothalamus, the higher the accordance between biological and psychological male identity. These results suggest that the psychosexual identity of male subjects is strictly related to functional features

The Authors (2008). Journal Compilation Federation of European Neuroscience Societies and Blackwell Publishing Ltd European Journal of Neuroscience, 27, 29222927

Hypothalamus, sexual arousal and sexual identity 2927 of bilateral hypothalamus, a dimorphic brain region deeply implicated in instinctual drives including reproduction.
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Abbreviations
BOLD, blood oxygen level-dependent (signal); DSI, deep sexual identity; FDCT, Franck drawing completion test; fMRI, functional magnetic resonance imaging.

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The Authors (2008). Journal Compilation Federation of European Neuroscience Societies and Blackwell Publishing Ltd European Journal of Neuroscience, 27, 29222927