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Chapter 049. Sexual Dysfunction (Part 7)

Physiology of the Female Sexual Response The female sexual response requires the presence of estrogens. A role for androgens is also likely but less well-established. In the CNS, estrogens and androgens work synergistically to enhance sexual arousal and response. A number of studies report enhanced libido in women during preovulatory phases of the menstrual cycle, suggesting that hormones involved in the ovulatory surge (e.g., estrogens) increase desire. Sexual motivation is heavily influenced by context, including the environment and partner factors. Once sufficient sexual desire is reached, sexual arousal is mediated by the central and autonomic nervous systems. Cerebral sympathetic outflow is. | Chapter 049. Sexual Dysfunction Part 7 Physiology of the Female Sexual Response The female sexual response requires the presence of estrogens. A role for androgens is also likely but less well-established. In the CNS estrogens and androgens work synergistically to enhance sexual arousal and response. A number of studies report enhanced libido in women during preovulatory phases of the menstrual cycle suggesting that hormones involved in the ovulatory surge e.g. estrogens increase desire. Sexual motivation is heavily influenced by context including the environment and partner factors. Once sufficient sexual desire is reached sexual arousal is mediated by the central and autonomic nervous systems. Cerebral sympathetic outflow is thought to increase desire while peripheral parasympathetic activity results in clitoral vasocongestion and vaginal secretion lubrication . The neurotransmitters for clitoral corporal engorgement are similar to those in the male with a prominent role for neural smooth muscle and endothelial released nitric oxide NO . A fine network of vaginal nerves and arterioles promote a vaginal transudate. The major transmitters of this complex vaginal response are not certain but roles for NO and vasointestinal polypeptide VIP are suspected. Investigators studying the normal female sexual response have challenged the long-held construct of a linear and unmitigated relationship between initial desire arousal vasocongestion lubrication and eventual orgasm. Caregivers should consider a paradigm of a positive emotional and physical outcome with one many or no orgasmic peak and release. Although there are the obvious anatomic differences as well as variation in the density of vascular and neural beds in males and females the primary effectors of sexual response are strikingly similar. Intact sensation is important for arousal. Thus reduced levels of sexual functioning are more common in women with peripheral neuropathies e.g. diabetes . Vaginal lubrication is