Sexual Pain, Vaginismus

Virtually Everything You Need to Know, Want to Know or Have to Know. Knowledge and treatment of female sexual dysfunction is at the same point now where male erectile dysfunction studies and treatment was in 1975, but is rapidly closing the gap. With the advent of Viagra in 1998 treatments for male dysfunction have been utilized for females with certain types of sexual dysfunction.

In the process of developing these PDE-5 inhibitors (the mechanism for Viagra, for example) he physiology of the female sexual anatomy appears to be analogous to males and those diseases that effect males often impact females . Therefore, therapies for male treatment of ED may and should be effective in females as well, we are now finding.

Females are much more complex than males and the relationship between the psychogenic and physical aspects of sexuality are more closely interrelated and represent a more intimacy-based sexual drive cycle than in the males.

Scope of Problem

A 1999 survey at the University of Chicago, Department of Sociology, on 3,000 American men and women aged 18 to 59 revealed that 31 percent of men and 43 percent of women experience some degree of sexual dysfunction. Some 22 percent of those women had low sexual desire, 14 percent had arousal or lubrication difficulties, and 7 percent complained of sexual pain. Sexual difficulties appeared to occur in the less educated, unmarried, and sexually abused women. Sexual dysfunction was associated with negative experiences in relationships, low rate of happiness, and overall well-being. These negative impacts appeared to be much more severe for women than for men due to the closer relationship between the physical and the psychosocial aspects of sexuality.

Normal Female Sexual Response

The normal female sexual response cycle is usually divided in to four stages: desire, arousal (excitement), orgasm, and resolution.

Desire is defined as the development of the energy that allows an individual to initiate sexual activity or respond to sexual stimuli. In both sexes desire originates in the limbic system of the brain primarily in the hippocampus and the preoptic nuclei. These areas are dopamine sensitive excitatory centers and serotonin sensitive inhibitory centers. Testosterone, the male hormone, maintains the responsiveness of these centers in both males and females. Desire is also affected and modulated by connections with other areas of the brain such as those involved in emotional closeness and intimacy. A total of these positive and negative influences generates neurological impulses that pass down the spinal cord to the reflex centers that govern excitement and orgasm.

The second stage, excitement or arousal, is due to spinal cord release of parasympathetic nerve impulses traveling along the pelvic nerves to the uterovaginal plexus. The end result is vascular engorgement of the clitoris, which results in lengthening and thickening of the clitoral organ, vasodilatation of the perivaginal blood supply causing transudation of fluid through the vaginal epithelium which appears to the partners as "wetness" or "lubrication."

{mosbanner:id=1:right:0}Estrogen is required for this transudation and results in lubrication by maintaining the health of the vaginal mucosa. Continued vasocongestion of the vagina causes blood sequester in the upper half of the vagina leading to ballooning of the distal portion and elevation of the uterus. The excitement phase also causes vasodilatation in the breasts leading to increased breast size, nipple erection, and engorgement of the surrounding areola. Pulse, blood pressure, and respiratory rates increase and muscle tension throughout the body also increases. A sexual flush causing redness and erythema of the face, neck, chest, and frequently much of the body occurs in 75 percent of women. Pelvic and extragenital changes culminate in the "Plato phase" of the excitement stage where the clitoris retracts beneath its protective foreskin or hood. Vasocongestion occurs in the outer-third of the vagina with swelling to form the so called "orgasmic platform."

Orgasm is characterized by maximum physical and emotional excitement. This is accompanied by a series of involuntary ( 0.86 second) contractions of the rectal and urethral muscles as well as the uterus. Orgasm is a reflex and requires the woman to relinquish her sense of control and in addition for the orgasmic response to be activated stimulation primarily of the clitoris must be applied and must be of sufficient intensity and duration to reach the threshold for this reflex. Masters and Johnson showed that female orgasm almost always involves clitoral stimulation.

The last stage is resolution in which blood flow and pelvic congestion along with bodily tensions resolves within seconds unless the woman returns to orgasm. Females do not always fall back to the low excitement stage and many women are capable of returning to excitation with stimulation that can rapidly produce a repeat orgasm. Whether the orgasmic experience is multiple or single, resolution of all excitement phase changes may take one hour or longer in contrast to men.

Classification of Female Sexual Dysfunction

Classification of female sexual dysfunction was first developed by an international consensus conference in 1998 and formalized and published in 2000. FSD is divided into four categories: sexual desire disorder, sexual arousal disorder, orgasmic disorder, and sexual pain disorder. A significant addition was "causing personal distress." This has implication for women who are happy with their frequency and response to sexual activity; however, their partners may not be. This incompatibility among couples may require counseling; however, the women will no longer be labeled with the diagnosis of FSD.