Female sexual response: By Aboubakr Elnashar
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Transcript of Female sexual response: By Aboubakr Elnashar
Aboubakr Elnashar Benha university Hospital, Egypt
Master & Johonson (1966):
Excitement,
Plateau,
Orgasm &
Resolution.
Completely mechanistic , ignores feelings
Distinction between Excitement & Plateau is imprecise
Kaplan (1979):
Desire,
Excitement (Plateau is a part of Excitement).
Orgasm &
Resolution.
This fits better with FSD
The motivation & the inclination to be
sexual.It is subjective feeling state.
It is triggered by both internal (fantasy) &
external (an interested partner) sexual cues.
It is mediated by testosterone (CNS).
Excitation is dopamine dependent &
Inhibition is serotinine dependent
It is influenced by:
sexual orientation,
preference,
psychologic &
environmental status.
It is mediated by parasympathetic NS.
The primary response: Vasocongestion
Females: Tactile & psychic stimuli ,
more individual variability than male,
slower, not easily inhibited
Males: Visual stimuli, more rapid, easily
inhibited
Genital changes:
clitoral enlargement,
lubrication of the vagina,
proximal vaginal expansion,
labial engorgement
Extragenital changes:
increased P , B.P
muscle tension,
extrapelvic vascular dilatation (breast swelling,
nipple erection, areolar engorgement, skin flush)
It is mediated by parasympathetic NS.
The primary response: vasocongestion
It is the progression & intensification of the arousal phase
Changes:
1. Formation of an orgasmic platform: engorging & swelling of the outer 1/3 of the vagina, decreasing the inner diameter by 40%, & gripping the penis.
2. Retraction of the clitoris into the hood.
3. Elevation & ballooning of the proximal 2/3 of the vagina.
4.The uterus elevates fully out of the pelvis.
5. Further labial engorgement
It is mediated by sympathetic NS.
The primary response: Reflex clonic contractions
Female: individual variability, multiple, easily inhibited.
Male: Similar, single, not easily inhibited.
It is sudden release of the of the tension that
has built up during during arousal & plateau.
Initial contraction of the outer 1/3 of the vagina
& levator sling, followed by contraction of the
uterus & anal sphincter
It is return to the basal physiologic state.
Reversal of vasocongestion
Female: Slow
Male: rapid
Not existent in females, occurs only in males.
It is the time needed to refill seminal vesicles
Incidence of FSD
FSD is more common than MSD.
USA (Laumann et al, 1999):
FSD: 43% MSD: 31%
Egypt: no studies
However FSD are detected rarely by the gynecologist
1. Patient: find it is difficult to talk to their doctor
2. Doctor: little knowledge, little time, find it is inappropriate to ask.
Types of FSD
1. Sexual desire disorders:
Hypoactive sexual desire & sexual aversion
2. Sexual arousal disorders
3. Orgasmic disorders
4. Penetration disorders:
Dysparunia &
Vaginismus
5. Other sexual disorders:
Sexual phobias,
Anesthesia with arousal & orgasm,
Genital pain during non-coital activities.
Each is further classified into
1. Primary (lifelong) or
secondary acquired after a period of normal sexual function
2. Total (generalized) or
situational (SD in some situations only)
: صلي هللا عليه وسلم قال رسول هللا
كما تقع أحدكم علي امرأته اليقع
قيل و -وليكن بينهما رسول البهيمةالقبله ما الرسول يا رسول هللا ؟ قال
.والكالم
في مسند الفردوس عن أبومنصور الديلمي رواه
أنس رضي هللا عنه