Sexual function vagina-Vaginal anatomy and sexual function.

Sexual pleasure is fundamental for the maintenance of health and well-being, but it may be adversely affected by medical and psychosocial conditions. Many patients only feel that their health is fully restored after they resume normal sexual activities. Any discussion of sexuality in a doctor's office is typically limited, mainly because of a lack of models or protocols available to guide the discussion of the topic. To present a model designed to guide gynecologists in the management of female sexual complaints. This study presents a protocol used to assess women's sexual problems.

Disruption of any component can affect sexual desire, arousal or satisfaction, and treatment often involves more than one approach. A decrease in estrogen leads to decreased blood flow to the Sexual function vagina region, which can result in less genital sensation, as well as needing more time to build arousal and Sexual function vagina orgasm. Research efforts by a number of investigators in different laboratories are establishing experimental models needed for the investigation of the physiological mechanisms involved in the genital arousal response Private prep schools usa sexual function. Arousal is the state with specific feelings and physiologic changes usually associated with sexual activity involving the genitals. Clinical holistic medicine: teaching orgasm for females with chronic anorgasmia using the Betty Dodson method.

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More importantly, female sexual dysfunction is associated with negative sexual relationship experiences. The ovary is the only organ in the human body which is totally invaginated into the peritonium, Vagiina it the Gellar topless intraperitoneal organ. In these mid-layers of the epithelia, the cells begin to lose their mitochondria and other organelles. Research indicates that it forms a tissue cluster with the vagina. She reports feeling tired but otherwise doing well. Pathology of the Cervix. A small hole is left for the passage of urine and menstrual blood, and the vagina is opened up for sexual intercourse and childbirth. Another is that such conditions' causes are inextricably bound to humans' Sexual function vagina makeup, making results from other species difficult to apply to humans. Then, with an understanding of her problem in hand, what treatment options can you offer to her? Main articles: Vaginal discharge and Vaginal lubrication. Vulva : Labeled image of a vulva, vaginx external and internal views. Human Sexuality: An Encyclopedia. Vaginal Surgery for Incontinence and Prolapse. Increased intra-abdominal pressure pushes it downwards.

Although each specific condition can be separately defined in medical terms, clinically there is significant overlap in afflicted patients.

  • The vagina is an organ of the female reproductive tract.
  • ACIP recommends two options for pertussis vaccination.
  • These parts are internal; the vagina meets the external organs at the vulva, which includes the labia, clitoris, and urethra.

Although each specific condition can be separately defined in medical terms, clinically there is significant overlap in afflicted patients. The limited available data on female anatomy, physiology, biochemistry and molecular biology of the female sexual response makes this field particularly challenging to clinicians, psychologists and basic science researchers alike. The sexual response cycle consists of desire, arousal, orgasm and resolution both physiologic and psychologic.

Desire is the mental state created by external and internal stimuli that induces a need or want to partake in sexual activity. Desire may be said to consist of: 1 biologic roots, which in part are based on hormones such as androgen and estrogen, 2 motivational roots, which are in part based on intimacy, pleasure and relationship issues and 3 cognitive issues such as risk and wish.

Arousal is the state with specific feelings and physiologic changes usually associated with sexual activity involving the genitals. Arousal may be said to consist of: 1 central mechanisms including activation of thoughts, dreams and fantasies, 2 non-genital peripheral mechanisms such as salivation, sweating, cutaneous vasodilation and nipple erection and 3 genital mechanisms such as clitoral, labial and vaginal engorgement. Orgasm is the altered state of consciousness associated with primarily genital sensory input.

Orgasm consists of multiple sensory afferent information from trigger points such as clitoris, labia, vagina, periurethral glans, etc. Pleasurable sensory information is also carried to the cortical pleasure sites.

Well-designed, random-sample, community-based epidemiologic investigations of women with sexual dysfunction are limited. More importantly, female sexual dysfunction is associated with negative sexual relationship experiences. There is a paucity of data concerning the anatomy, physiology, pathophysiology of sexual function in women. The female external genitalia consist of various structures. The vagina is a midline cylindrical organ that connects the uterus with the external genitalia.

The vaginal wall consists of three layers: a an inner mucous type stratified squamous cell epithelium supported by a thick lamina propia, that undergoes hormone-related cyclical changes, b the muscularis composed of outer longitudinal smooth muscle fibers and inner circular fibers, and c an outer fibrous layer, rich in collagen and elastin, which provides structural support to the vagina. The vulva, bounded by the symphysis pubis, the anal sphincter and the ischial tuberosities, consists of labial formations, the interlabial space, and erectile tissue.

The labial formations are two paired cutaneous structures: a the labia majora are fatty folds covered by hair-bearing skin that fuses anteriorly with the mons veneris, or anterior prominence of the symphysis pubis, and posteriorly with the perineal body or posterior commissure b The labia minora are smaller folds covered by non-hearing skin laterally and by vaginal mucosa medially, that fuses anteriorly to form the prepuce of the clitoris, and posteriorly in the fossa navicularis.

The interlabial space is composed of the vestibule, the urinary meatus, and vaginal opening and is bounded by the space medial to the labia minora, the fossa navicularis and the clitoris. The clitoris is a cm Y shaped organ comprised of glans, body, and crura.

The body of the clitoris is surrounded by tunica albuginea and consists of two paired corpora cavernosa composed of trabecular smooth muscle and lacunar sinusoids. Finally, the vestibular bulb consists of paired structures located beneath the skin of the labia minora and represents the homologue of the corpus spongiosum in the male.

There is limited understanding of the precise location of autonomic neurovascular structures related to the uterus, cervix, and vagina. Uterine nerves arise from the inferior hypogastric plexus formed by the union of hypogastric nerves sympathetic TL1 and the splanchnic fibers parasympathetic S2-S4. This plexus provides innervation via the cardinal ligament and uterosacral ligaments to the cervix, upper vagina, urethra, vestibular bulbs and clitoris.

At the cervix, sympathetic and parasympathetic nerves form the paracervical ganglia. The larger one is called the uterine cervical ganglion. It is at this level that injury to the autonomic fibers of the vagina, labia, cervix may occur during hysterectomy.

Large gaps exist in our knowledge of how the central nervous system controls female sexual function. Limited data suggest that descending supraspinal modulation of female genital reflexes emanates from: 1 brainstem structures such as the nucleus paragigantocellularis inhibitory via serotonin , locus ceruleus norepinephrine, nocturnal engorgement during REM sleep and midbrain periaqueductal gray, 2 hypothalamic structures such as the medial pre-optic area, ventromedial nucleus and paraventricular nucleus and 3 forebrain structure such as the amygdala.

Multiple factors interact at the supraspinal levels to influence the excitability of spinal sexual reflexes such as: 1 gonadal hormones, 2 genital sensory information via the mylenated spinothalamic pathway and the unmyelinated spinoreticular pathway and 3 input from higher cortical centers of cognition.

The sexual arousal responses of the multiple genital and non-genital peripheral anatomic structures are largely the product of spinal cord reflex mechanisms. The spinal segments are under descending excitatory and inhibitory control from multiple supraspinal sites.

The afferent reflex arm is primarily via the pudendal nerve. The efferent reflex arm consists of coordinated somatic and autonomic activity. One spinal sexual reflex is the bulbocavernosus reflex involving sacral cord segments S 2,3 and 4 in which pudendal nerve stimulation results in pelvic floor muscle contraction. Another spinal sexual reflex involves vaginal and clitoral cavernosal autonomic nerve stimulation resulting in clitoral, labial and vaginal engorgement.

In the basal state, clitoral corporal and vaginal smooth muscles are under contractile tone. Following sexual stimulation, neurogenic and endothelial release of nitric oxide NO plays an important role in clitoral cavernosal artery and helicine arteriolar smooth muscle relaxation. This leads to a rise in clitoral cavernosal artery inflow, an increase in clitoral intracavernosal pressure, and clitoral engorgement.

The result is extrusion of the glans clitoris and enhanced sensitivity. In the basal state, the vaginal epithelium reabsorbs sodium from the submucosal capillary plasma transudate. Following sexual stimulation, a number of neurotransmitters including NO and vasoactive intestinal peptide VIP are released modulating vaginal vascular and nonvascular smooth muscle relaxation.

Dramatic increase in capillary inflow in the submucosa overwhelms Na-reabsorption leading to ml of vaginal transudate, enhancing lubrication essential for pleasurable coitus. Vaginal smooth-muscle relaxation results in increased vaginal length and luminal diameter, especially in the distal two-thirds of the vagina Fig.

Vasoactive intestinal polypeptide is a non-adrenergic non-cholinergic neurotransmitter that plays a role in enhancing vaginal blood flow, lubrication and secretions. I Results from in vivo animal studies: The absence of established animal models to investigate female sexual genital arousal has hampered progress in this field.

Recently, Park et al. This elegant study showed that pelvic nerve-stimulation caused an increase in vaginal blood flow, vaginal wall pressure, vaginal length, clitoral intracavernosal pressure and clitoral blood flow and a decrease in vaginal luminal pressure.

This study represents an approach to study genital arousal in an animal model and paved the way for the investigation of genital arousal in a laboratory setting. Using a rat model, Vachon et al. More recently, Giuliano et al. In addition, this study showed that atropine did not significantly affect vaginal blood flow response to pelvic nerve stimulation despite the fact that cholinergic fibers innervate vascular smooth muscle in the rat vagina, suggesting that acetylcholine may not be the primary neurotransmitter responsible for the increase in vaginal engorgement during sexual arousal.

These studies documented that genital arousal is a neurovascular event characterized by increase in genital blood flow and smooth muscle relaxation. These hemodynamic changes are mediated by neurotransmitters and vasoactive agents and modulated by the hormonal milieu. Park et al. They reported that ovariectomy significantly reduced vaginal and clitoral blood flow in response to pelvic nerve stimulation.

We also investigated the effects of ovariectomy and estrogen and androgen treatment on genital blood flow using a novel, non-invasive laser oximetry technique. In contrast to the observations made by Park et al. The discrepancy may be attributed to differences in methodologies. In our studies, we determined genital blood flow two-weeks post ovariectomy, while Park et al. The longer period of estrogen deprivation may have produced tissue structural changes that altered the engorgement response.

As a consequence, genital hemodynamic changes before and after ovariectomy may be minimal. In addition, laser oximetry was used in our studies to assess changes in genital blood flow, whereas Park et al. Further studies using other animal models that undergo menstrual cycling e. In our studies, treatment of ovariectomized animals with estradiol significantly increased pelvic nerve-stimulated genital blood flow above control levels Fig.

Interestingly, treatment with testosterone did not restore blood flow to that observed in control animals. In addition, the percentage of clitoral cavernosal smooth muscle was significantly decreased in ovariectomized animals. These studies suggest that estrogens modulate genital hemodynamics and are critical for maintaining tissue structural integrity.

Vaginal lubrication, an estrogen-dependent physiological process, is one of the indicators of genital arousal and tissue integrity. Min et al. In contrast, androgen treatment of ovariectomized animals with testosterone alone or in combination with estradiol did not restore vaginal lubrication to that observed in control animals.

Finally, it was noted that ovariectomy caused vaginal atrophy and reduced vaginal epithelial cell maturation, which was normalized by estrogen but not androgen treatment. In summary, data derived from in vivo animal models indicates that estrogen but not androgens modulate genital blood flow, vaginal lubrication and vaginal tissue structural integrity.

It should be noted that estradiol levels used in these studies were supra-physiological with potential pharmacologic effects different from those achieved physiologically. Although estrogen replacement increases vaginal lubrication and restores vaginal epithelial integrity, this therapy may not be appropriate for all patients, due to associated risk of breast and endometrial cancer. An alternative to hormonal treatment is the utilization of P2Y2 receptor agonists, which have been shown to increase mucin production and blood flow in other systems.

We investigated the effects of P2Y2 receptor agonists as a feasible non-hormonal alternative for the treatment of vaginal dryness in an animal model. P2Y2 receptors are expressed in cervical and vaginal tissues, and these agonists increased vaginal lubrication under conditions of estrogen deprivation. Effects of vasoactive substances on genital blood flow Limited data are available on the effects of vasoactive substances on genital hemodynamics. Sildenafil, a PDE5-selective inhibitor, has been utilized in the treatment of women with sexual arousal disorders with mixed results and pre-clinical data supporting the use of this agent in the management of female sexual dysfunction remains equivocal.

We have shown that sildenafil administration caused significant increase in genital blood flow and vaginal lubrication in intact and ovariectomized animals. However, this response was more pronounced in animals treated with estradiol. These data suggested that the NO-cGMP pathway is involved, at least in part, in the physiologic mechanism of female genital arousal and that sildenafil facilitates this response in an in vivo animal model. The effects of apomorphine, a non-selective dopamine receptor agonist, on genital blood flow were investigated by Tarcan et al.

In summary, data derived from in vivo animal models indicate that vasoactive agents play a role in genital arousal.

Although sildenafil and apomorphine enhanced genital blood flow in the animal model, clinical use of vasoactive agents remains controversial. Studies in organ baths:. Physiological studies of the arousal phase of the female sexual response involve, in part, an understanding of the various local regulatory mechanisms, which modulate tone in the clitoral erectile tissue and the vaginal muscularis.

There is physiological evidence supporting a role for the alpha-adrenergic system in female sexual arousal. The alpha-2 adrenergic agonist clonidine impaired both vaginal engorgement and lubrication when administered to healthy volunteers. There is limited data on the functional activity of the inhibitory non-adrenergic non-cholinergic transmission in the clitoral corpus cavernosum.

Cellek and Moncada have shown that electrical field stimulation induces NANC relaxation responses in the clitoral corpus cavernosum of the rabbit. It was concluded that nitrergic neurotransmission is responsible for the NANC relaxation responses in the clitoral corpus cavernosum of the rabbit. Furthermore, the role of phosphodiesterase type 5 inhibition in the modulation of female sexual dysfunction was investigated by Vemulapalli and Kurowski.

Pretreatment of clitoral corpus cavernosum strips with sildenafil enhanced the electrical field stimulation-induced relaxations, both in magnitude and duration. Thus, the NO pathway is critical for smooth muscle relaxation in the clitoris.

However, in the vagina, this pathway plays only a partial role, as demonstrated by Ziessen et al. These investigators showed that in the rat and rabbit vaginal wall, NANC relaxations were partly mediated by nitric oxide.

Main articles: Vaginal disease and Safe sex. Experimental models for investigation of female sexual genital arousal I Results from in vivo animal studies: The absence of established animal models to investigate female sexual genital arousal has hampered progress in this field. Usually each ovary takes turns releasing eggs each month. In this case, paroxysm was regarded as a medical treatment, and not a sexual release. Pleasurable sensory information is also carried to the cortical pleasure sites. Martin's Press. Retrieved February 17,

Sexual function vagina. The Female Reproductive System

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A Model for the Management of Female Sexual Dysfunctions

Sexual dysfunction refers to a problem during any phase of the sexual response cycle that prevents the individual or couple from experiencing satisfaction from the sexual activity. Hormones play an important role in regulating sexual function in women. With the decrease in the hormone estrogen that is related to aging and menopause , many women experience some changes in sexual function as they age.

Poor vaginal lubrication and decreased genital sensation are problems associated with changes in estrogen levels. Further, research suggests that low levels of the hormone testosterone also contribute to a decline in sexual arousal, genital sensation and orgasm.

Hormone therapy may improve certain conditions, such as loss of vaginal lubrication and genital sensation, that can create problems with sexual function. It should be noted that some postmenopausal women report an increase in sexual satisfaction.

This may be due to decreased anxiety associated with a fear of pregnancy. In addition, postmenopausal women often have fewer child-rearing responsibilities, allowing them to relax and enjoy intimacy with their partners. Some women may experience changes in sexual function after a hysterectomy. These changes may include a loss of desire, and decreased vaginal lubrication and genital sensation.

These problems may be associated with the hormonal changes that occur with the loss of the uterus and ovaries.

Further, nerves and blood vessels critical to sexual function can be damaged during the hysterectomy procedure. However, some women may find that a hysterectomy helps, as it can remove concerns about pain, bleeding, or pregnancy that may affect desire and sexual satisfaction. Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services.

Sexual Dysfunction in Females Female sexual dysfunction is a problem during any phase of the sexual response cycle that prevents a woman from experiencing satisfaction from the sexual activity. Causes can be either physical or psychological.

Appointments What is sexual dysfunction? How does sexual dysfunction affect women? The most common problems related to sexual dysfunction in women include: Inhibited sexual desire: Inhibited sexual desire is a lack of sexual desire or interest in sex.

Many factors can contribute to a lack of desire, including hormonal changes, medical conditions and treatments for example cancer and chemotherapy , depression , pregnancy , stress and fatigue. Boredom with regular sexual routines also may contribute to a lack of enthusiasm for sex, as can lifestyle factors, such as careers and the care of children.

Inability to become aroused: For women, the inability to become physically aroused during sexual activity often involves insufficient vaginal lubrication. The inability to become aroused also may be related to anxiety or inadequate stimulation. In addition, researchers are investigating how blood flow disorders affecting the vagina and clitoris may contribute to arousal problems. Lack of orgasm anorgasmia : The lack of orgasm is the delay or absence of sexual climax orgasm.

It can be caused by sexual inhibition, inexperience, lack of knowledge and psychological factors such as guilt, anxiety, or a past sexual trauma or abuse. Other factors contributing to anorgasmia include insufficient stimulation, certain medications and chronic diseases. Painful intercourse: Pain during intercourse dyspareunia can be caused by a number of problems, including endometriosis , pelvic mass, ovarian cysts , inflammation of the vagina vaginitis , poor lubrication, the presence of scar tissue from surgery and a sexually transmitted disease.

A condition called vaginismus is a painful, involuntary spasm of the muscles that surround the vaginal entrance. It may occur in women who fear that penetration will be painful and also may stem from a sexual phobia or from a previous traumatic or painful experience. How do hormones affect sexual function in women? What causes sexual dysfunction? These conditions include diabetes , heart disease, neurological disorders, hormonal imbalances, menopause, chronic diseases such as kidney or liver failure, and alcoholism and drug abuse.

In addition, the side effects of certain medications, including some antidepressant drugs , can affect sexual desire and function. Psychological causes: These include work-related stress and anxiety, concern about sexual performance, marital or relationship problems, depression , feelings of guilt, and the effects of a past sexual trauma.

What effect does a hysterectomy have on sexual function? Show More.