Female Sexual Physiology

Question 1

What are the most commonly occurring sexual dysfunctions in women?

Answer 1

lack of interest (hormones, health problems, drugs, anxiety/depression, sexual trauma, SSRI)

sex not pleasurable (same as above)

unable to achieve orgasm (depression, health problems, fatigue, SSRIs, lack of knowledge)

painful intercourse (low estradiol, disorders/infection of the vagina or pelvis, irritation/damage to the clitoris

Question 2

What is the prevalence of women that have low desire, low arousal and orgasm difficulties?

Answer 2

6-12% of women; note that 40% of women with a sexual dysfunction also have concurrent depression and only 20% of women with dysfunction seek medical consultation

Question 3

What are the diagnostic criteria for female sexual interest and arousal disorder?

Answer 3

decreased or absent:

1. sexual interest
2. erotic thoughts of fantasies
3. invitation of sexual activity or responsiveness to a partner’s attempts to initiate it
4. absent excitement and pleasure
5. response to sexual cues
6. sensations during sexual activity, whether genital or non-genital

dx requires 3/6 criteria experienced for at least 6mo for 75-100% of the time unless medication induced and causing significant distress

Question 4

What hormone is thought to mediate the desire and interest in sex?

Answer 4

may be testosterone dependent (women think about sex less often than men do

Question 5

What aspects of sexuality do humans share with other mammals?

Answer 5

sexual intercourse, sexual arousal and sexual desire are shared with other mammals

sexual love is complex, elusive but real quality that may be uniquely human

Question 6

What is thought to be the neural basis of romantic love.

Answer 6

DA based, neural cortex motivation system that leads to various emotions (separate from brain centers activated by sexual arousal and desire)

Question 7

Define sexual desire and describe what sexual arousal includes.

Answer 7

sexual desire includes the neural processing of stimuli as sexual and the motivation to engage in sexual activity, including activation of DA regulated appetitive behavior

sexual arousal is complex and includes, sexual desire, general arousal, and genital responses (lubrication, clitoral reaction and labial enlargement)

there is a poor association between genital responses and perceived sexual arousal in women

Question 8

What are the two primary female sexual responses.

Answer 8

vasocongestion: increased blood flow to genitals causing vaginal lubrication, clitoral erection, labial swelling (like erection in men)
myotonia: muscle tension in pelvic area and throughout body (under sympathetic nervous control

Question 9

Physiological regulation of women’s sexuality involves sexual responses that can follow two patterns, name and briefly describe their steps.

Answer 9

linear progressive patterns (Masters and Johnson): excitement, plateau, orgasm and resolution

circular patterns

Question 10

Which pattern of sexual response is thought to model best the experiences of women with sexual dysfunction?

Answer 10

Bassoon’s circular model

Question 11

Describe the behavioral and physiological responses during the excitement phase.

Answer 11

stimuli raise sexual arousal or tension: vasocongestion and clitoral erection, lubrication through vaginal wall, expansion of vagina and labia become engorged

Question 12

Describe the behavioral and physiological responses during the plateau phase.

Answer 12

sexual arousal (myotonia) intensifies, orgasm is reached if stimulation is adequate: continued stimulation results in dimensional growth of vagina, uterus elevates upwards, increase in HR and BP

Question 13

Describe the behavioral and physiological responses during the orgasmic phase.

Answer 13

few seconds of involuntary climax, sexual arousal (muscle tension is relieved and explosive waves of intense pleasure move outward from clitoris

vaginal contractions occur at ~1 sec intervals, uterine contractions begin int eh fundus and spread to the lower uterine segment (oxytocin stimulated), rhythmic contraction of pelvic striated musculature (spinal cord reflexes), skin flushes, increased HR and BP; diminished blood flow in the prefrontal cortex (reduced executive functioning?)

> 25 increases in systolic and diastolic BP and pulse put to 180b/min

Question 14

Describe the behavioral and physiological responses during the orgasmic phase.

Answer 14

sexual arousal is dissipated: clitoral erection is lost, labia and vaginal detumesce, uterine and vaginal walls relax to their original positions, hemodynamics resolve

Question 15

Define the absolute refractory period in women.

Answer 15

sexual and arousal and organs is unlikely post orgasm, 15-40% of women experience multiple orgasms

thought to be mediated by increased prolactin levels as hyperprolactinemia cause reduced sexual desire and sexual arousal

Question 16

How does the neuronal response to partners over the course of a relationship (6mo v. 18mo) change and what is the associated frequency of sexual intercourse?

Answer 16

6mo: ventral tegmental (DA neurons- reward and high risk)
18mo: ventral putamen, palladium (attachment and bonding)

intercourse frequency diminishes with increasing length of relationship (highly varied frequency)

Question 17

How do sexual desire and sexual intercourse vary with menstrual cycle hormones?

Answer 17

sexual desire peaks when estradiol and androgens rapidly peak in cycle unopposed by progesterone (near to ovulation)

opportunity for sexual behavior is more relevant than cycle stage

peak female sexual desire and sexual intercourse may frequently fail to coincide

Question 18

How do menopause and HC effect sexual intercourse and sexual desire?

Answer 18

oral contraceptives can diminish perceived quality of sexual intercourse and sexual desire, these detrimental effect bay affect only a minority of women

low estradiol leads to dry vagina and painful vaginal intercourse in menopause

Question 19

What practice adopted by clinicians results in sexual problems being reported by patients?

Answer 19

twice as many sexual problems are reported and diagnosed if a clinician routinely asks patients about sex-related matters rather than waiting for the patient to bring the subject up

Question 20

What are other important ROS questions that may be important to ask in a post menopausal women with vaginal dryness?

Answer 20

any change in urination or incontinence?
how has this effected her sex life?
are you currently sexually active?
are you happy with your sex life?
are you able to achieve orgasm, is this important to you?

Question 21

What are available resources for post menapausal women with vaginal dryness/atrophy?

Answer 21

vaginal lubricants
vibrators/dilators
localized estrogen- estrogen cream, vagifem (tablets) or Estring (vaginal ring)

Question 22

What are ways to field a question from a 22yo female you has not been able to achieve orgasm?

Answer 22

acknowledge and validate her question (“This is a really important topic and I’m glad you brought it up.”)

Follow up questions:
Are you currently sexually active?
With males, females or both?
Have you tried masturbating? Are you comfortable touching yourself?

Question 23

What are resources you can offer your patients regarding their sexual health?

Answer 23

Our Bodies, Ourselves (book)
A Woman’s Touch (Madison sexual boutique)
Midwest Center for Psychotherapy and Sex Therapy