Part of “CHAPTER 96 – DISORDERS OF MENSTRUATION, OVULATION, AND SEXUAL RESPONSE“

In women, complete sexual responses begin after puberty and can continue for the remainder of life. Sexual responses can be divided into four stages: excitement, plateau, orgasm, and resolution.210,211 Visual, tactile, auditory, and olfactory stimuli lead to physical and emotional excitement and genital vasodilation in the responsive individual. Vasodilation of the blood vessels in the labia and tissues surrounding the vagina occurs with localized perivaginal edema and subsequent vaginal lubrication, followed by ballooning and expansion of the vagina and elevation of the uterus. A high state of sexual arousal is maintained during the plateau phase, which may be short or long. A brief series of involuntary, 0.9-second clonic contractions of the ischiocavernosus and pubococcygeal muscles occurs with orgasm or “climax.” Although some women may resolve toward sleep after orgasm, many remain responsive to sexual stimulation and may undergo orgasm again with continued arousal.

Extragenital changes occur during sexual arousal as well, and responses may vary over time. Changes may occur in the breasts, with flushing and erection of the nipples. In some women, orgasm may be explosive and occur together with vocalization, and a few women may never experience orgasm. In many women, orgasm is intermittently absent. The intensity or even the presence of orgasm may be irrelevant to the satisfaction of the individual.

Sexual dysfunction may cause a woman to seek professional assistance or may be elicited or suspected when a patient has a complaint for which no abnormality is apparent.212,213,214 and 215 A sexual dysfunction may be lifelong or may be acquired after a period of normal sexual function. It may affect both partners or only one, and it may be psychologic or physical.