Physiology of Female Sexual Function

The underlying physiologic processes in both normal female sexual function and FSD are not yet well understood. Normal female sexual function is based on an interaction between intact anatomic, vascular, and neurologic factors. Sexual arousal is marked by physiologic changes secondary to increased genital blood flow, which leads to vaginal congestion and lubrication, facilitating intercourse. The normal vascular response is a result of cavernosal and arteriole smooth muscle relaxation via the androgen-dependent nitric oxide synthase system during sexual stimulation and arousal. This produces a vascular engorgement of the vestibule and clitoris. Vaginal lubrication is a transudate of serum that results from this normal increase of pelvic blood flow with arousal. Patients with arousal disorders may complain of decreased vaginal lubrication and dyspareunia.

Normal sensation is also critical in allowing sexual arousal, and the ability to achieve orgasm requires an intact sympathetic outflow tract. In women with diabetes or spinal cord injuries, the neuropathy may result in diminished levels of sexual functioning and orgasmic disorders. Similarly, after pelvic floor surgery, orgasmic function can be potentially affected by changes in the pelvic floor muscles because they modulate vaginal receptivity as well as the motor responses during orgasm.

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