SSI Prize Essay for Female Sexual Dysfunction—Clinical ‘Clinical evaluation of female sexual function: effects of age and estrogen status on subjective and physiologic sexual responses’

Abstract

Introduction: 30 ± 50% of American women complain of sexual dysfunction. Aging, menopause, and a decline in circulating estrogen levels signi®cantly increase the incidence of sexual complaints. Evaluaton of physiologic components of the female sexual response has, in the past, been technically challenging and dif®cult to standardize. We describe methodology for evaluating physiologic and subjective components of the female sexual response in the clinical setting and determine the effcts of age and estrogen status on them. Methods: 48 women with complaints of sexual dysfunction were evaluated. Physiologic measurements include genital blood peak systolic velocity, vaginal pH, intravaginal pressure ± volume changes (compliance), and genital vibratory perception thresholds. Measurements were recorded at baseline and following sexual stimulation. Baseline subjective sexual function was assessed using a Female Sexual Function Inventory. Age was then correlated with both physiologic and subjective sexual responses. Results: Sexual stimulation resulted in increased mean genital blood peak systolic velocity, vaginal pressure ± volume, and vaginal pH measurements (P`0.05) in all women. Older women (ages 55 ± 71 y) and menopausal women not on hormone replacement therapy had signi®cantly lower physiologic response sexual complaints. Baseline subjective sexual function complaints included low arousal (67%), low desire (21%), dif®culty achieving orgasm (92%), and pain or discomfort during andaor following intercourse (67%). Conclusions: Clinical evaluation of physiologic and subjective components of the female sexual response are possible using this comprehensive approach. Physiologic measurements were reproducible and easy to perform, and incidence and types of sexual complaints were assessed with the sexual function questionnaire. A comprehensive approach is necessary when evaluating female sexual dysfunction due to the signi®cant emotional and relational factors that can contribute to the problem. This combined subjectiveaphysiologic assessment may also prove useful when evaluating ef®cacy of pharmacotherapy in the future.

Vardenafil enhances clitoral and vaginal blood flow responses to pelvic nerve stimulation in female dogs

“…Indeed, several techniques are used to assess sexual function by measuring indices of genital blood flow in women. [11][12][13] The increase of genital blood flow in response to pelvic nerve stimulation has been reported in rabbit and rat models. [2][3][4] In our canine model, the electrical stimulation of the pelvic nerve resulted in consistent increases of vaginal and clitoral blood flow measured by the laser Doppler method.…”

Does sexual dysfunction correlate with deterioration of somatic sensory system in diabetic women?

“…Diabetic women with FSD should be evaluated with psychosexual counseling and Doppler ultrasonography of female genital organs such as clitoris, labia and vagina. 22 DM is a systemic disease affecting all parts of somatic sensory system. Therefore, with increasing the sites of the body evaluated with biothesiometry, we aimed to obtain more data about different sites such as nipple, lip, lobulus of ears, which might give us more effective results.…”

Female Sexual Dysfunction: The Important Points to Remember

“…30 Although somewhat controversial, a number of reports associate menopause with decreased female sexual function, suggesting a possible hormonal mechanism for female sexual function; however, the exact hormonal milieu of normal female sexual function continues to be incompletely understood. 13,16,18,27 Although estrogen replacement therapy may restore vaginal epithelial function, increase vaginal flow, and improve the overall sense of well-being in postmenopausal woman, it is not a guarantee of sexual well-being. 31,32 Some researchers have documented a decrease in sexual desire believed to be secondary to testosterone deficiency in those premenopausal women who have undergone oophorectomy; however, postmenopausal women demonstrate more variability in hormone-sensitive sexual desire than testosterone-deficient men.…”

“…Success rates in the 90% range for becoming orgasmic during masturbation and in the 75% range for attaining orgasm with a partner have been reported following therapy. 24,25,27,37,38 …”

“…[26][27][28][29] Sexual expectations of both partners should be assessed for compatibility. Also, seek overt or covert current relationship or social or job stress that may be causing anxiety.…”