Genital Sensation Research Articles

The Effects of Experimentally-Induced Sad and Happy Mood on Sexual Arousal in Sexually Healthy Women

In depressed women, common sexual difficulties include decreased sexual desire, sexual arousal and orgasmic difficulties, reduced sexual satisfaction, and reduced sexual pleasure. Experimental research on the influence of depressed mood on genital and subjective sexual arousal in women is scarce. To investigate the effects of sad mood on genital and subjective sexual arousal in sexually healthy women, using a mood induction procedure. Thirty-two subjects received a sad mood and a happy mood induction, on two different days, using a within subjects design. The mood induction procedure was a combination of the Velten procedure and music. In the Velten procedure, the subject is asked to read sad or happy self-referent sentences and to experience the mood suggested by these sentences. Immediately following mood induction, the subjects were exposed to an erotic film clip. Genital arousal was assessed using vaginal photoplethysmography. Self-report ratings of sad and happy mood, subjective sexual arousal and affective reactions were collected before and after the erotic clip. The sad and happy mood ratings indicated that the mood inductions affected mood as intended. No difference in genital sexual arousal was found between the sad and happy mood conditions. Subjects reported significantly less subjective sexual arousal and positive affect and marginally significant fewer genital sensations and more negative affect in the sad mood condition than in the happy mood condition. The results provide empirical support for the idea that mood can impact on subjective sexual arousal in women.

New Insights into Restless Genital Syndrome: Static Mechanical Hyperesthesia and Neuropathy of the Nervus Dorsalis Clitoridis

Systematic study of dysesthetic and paresthetic regions contributing to persistent genital arousal in women with restless genital syndrome (ReGS) is needed for its clinical management. To investigate distinct localizations of ReGS. Twenty-three women, fulfilling all five criteria of persistent genital arousal disorder were included into the study. In-depth interviews, routine and hormonal investigations, electroencephalographs, and magnetic resonance imaging (MRI) of brain and pelvis were performed in all women. The localizations of genital sensations were investigated by physical examination of the ramus inferior of the pubic bone (RIPB) and by sensory testing of the skin of the genital area with a cotton swab (genital tactile mapping test or GTM test). Sensitivity of RIPB, GTM test. Of 23 women included in the study, 18(78%), 16(69%), and 12(52%) reported restless legs syndrome, overactive bladder syndrome, and urethra hypersensitivity. Intolerance of tight clothes and underwear (allodynia or hyperpathia) was reported by 19 (83%) women. All women were diagnosed with ReGS. Sitting aggravated ReGS in 20(87%) women. In all women, MRI showed pelvic varices of different degree in the vagina (91%), labia minora and/or majora (35%), and uterus (30%). Finger touch investigation of the dorsal nerve of the clitoris (DNC) along the RIPB provoked ReGS in all women. Sensory testing showed unilateral and bilateral static mechanical Hyperesthesia on various trigger points in the dermatome of the pudendal nerve, particularly in the part innervated by DNC, including pelvic bone. In three women, sensory testing induced an uninhibited orgasm during physical examination. ReGS is highly associated with pelvic varices and with sensory neuropathy of the pudendal nerve and DNC, whose symptoms are suggestive for small fiber neuropathy (SFN). Physical examination for static mechanical Hyperesthesia is a diagnostic test for ReGS and is recommended for all individuals with complaints of persistent restless genital arousal in absence of sexual desire.

Genital vibratory sensation thresholds in postmenopausal women with female sexual dysfunction (FSD)

Genital vibratory sensation thresholds in postmenopausal women with female sexual dysfunction (FSD)

Predictors of Successful Sexual Partnering of Adults With Spina Bifida

We assessed sexual education and function of adults with spina bifida to identify predictors of relationships and sexual activity. A total of 290 patients with spina bifida were clustered into 6 groups based on lesion level, including men in group 1-less than L2, group 2-L3-L5 and group 3-less than S1, and women in group 4-greater than L2, group 5-L3-L5 and group 6-less than S1. Urinary continence, genital sensation and patient educational level were considered. A questionnaire on sexual education, relationship and sexual activity was administered. No difference in the incontinence rate was noted between males and females. Men had learned sex education from friends/media (41.6%) and women had learned it from parents (37.5%) or at school (33.7%). Genital sensation was normal in 7.2%, 53.3% and 53.5% of the patients in groups 1 to 3, respectively. Patients in group 3 had more frequent sexual intercourse than those in group 1 or 2 (30% vs 14.3% and 14.2%, respectively). Genital sensation was decreased in group 4 patients compared to those in groups 5 and 6 (44.4% vs 13% and 3.5%, respectively). Patients in group 4 were more sexually active than those in groups 5 and 6 (p <0.05). Lesion level did not affect the ability to form relationships in patients of either gender. Education level was the same across all patients with no difference when male/female groups were compared by lesion level. Predictors indicated that patients with the highest chance of finding a partner and engaging in sexual activity were those with the lowest lesion level. However, all other predictors were statistically significant (p <0.05). Sex counseling should be part of the regular medical care in patients with spina bifida. A difference exists between males and females when comparing lesion level and sexual activity.

Cosmetic Mucosal Vaginal Tightening (Lateral Colporrhaphy): Improving Sexual Sensitivity in Women with a Sensation of Wide Vagina

Sir: During life, up to 76 percent of women experience decreased genital sensation,1 most commonly with a feeling of a widened vagina. Occasionally, traditional colporrhaphies have been performed, showing an improvement in 94 percent of cases.2 Several studies3,4 would suggest that a lateral colporrhaphy could be more effective in reducing the size of the vagina without placing scars within the areas of highest sensitivity. This study was designed to test the hypothesis that a simple bilateral mucosal tightening of the caudal part of the vagina could improve the sensation of wide vagina. Forty women underwent cosmetic vaginal tightening from July of 2005 to January of 2007. The age of the patients ranged from 27 to 45 years (mean, 36.075 years; median, 37 years). A bilateral vaginal mucosal ellipse was excised in all cases (Fig. 1). The resulting wound was closed in layers with absorbable sutures (Fig. 2). Follow-up consultations were planned at 1 week, 1 month, 3 months, and 6 months. Six months after the procedure, patients were asked to grade the improvement with the sensation of wide vagina, and both patients and their partners where asked to grade the sexual sensation during intercourse.Fig. 1.: Schematic representation of the mucosal ellipses removed during the cosmetic mucosal vaginal tightening. The ellipses can occasionally have slightly different sizes, to obtain the desired level of tightening.Fig. 2.: Schematic representation of the position of the final sutures after a cosmetic mucosal vaginal tightening.With regard to vaginal sensitivity after 6 months, two patients (5 percent) did not notice any improvement, 16 (40 percent) noticed some improvement, and 22 (55 percent) noticed a significant improvement. Two patients (5 percent) did not notice any improvement in the sensation of wide vagina after 6 months, and 38 (95 percent) noticed a significant improvement. Eight partners (20 percent) did not notice any improvement after 6 months, 15 (37.5 percent) noticed some improvement, and 17 (42.5 percent) noticed a significant improvement. With regard to complications, there were two cases of localized infection (5 percent) that required treatment. One patient experienced vaginal bleeding on the fourth postoperative day. Traditional anterior and posterior colporrhaphies are occasionally performed in cosmetic patients, and this approach is generating significant criticism.5 Nevertheless, the results obtained with traditional techniques are encouraging and have shown that it is possible to improve the sensation of wide vagina. The cosmetic mucosal vaginal tightening, or bilateral colporrhaphy, optimizes the position of the surgical incisions, avoiding the areas of higher sensitivity of the vagina, mainly on the upper anterior wall and the lower posterior one, and reducing the risks for complications. Cosmetic mucosal vaginal tightening proved very effective in treating the sensation of wide vagina, with 95 percent of the patients reporting an improvement at 6 months and with 95 percent of them also reporting improved sexual sensitivity. Some limitations of our study will deserve further investigation in the future. It is not possible at the moment to predict how long the results of the vaginal tightening will last, and it may be safe to assume that the results will not be permanent, as with any rejuvenating procedure. Without direct measurements of vaginal dimensions, it is not possible to suggest specific correlations between reduction of vaginal size and improvement in sensation. Implications of cosmetic mucosal vaginal tightening for patients who elect to have children after the procedure are not known. The cosmetic mucosal vaginal tightening proved reliable, safe, and very effective in improving the sensation of wide vagina experienced by many women. Cosmetic mucosal vaginal tightening also produced improvement of erotic sensitivity in 95 percent of the patients undergoing the procedure and in 80 percent of their partners. Ciro Adamo, M.D., Ph.D. Monica Corvi, M.D. Xthetic Cosmetic Surgery Group Avellino, Italy

Persistent Genital Arousal Disorder in 18 Dutch Women: Part II—A Syndrome Clustered with Restless Legs and Overactive Bladder

A systematic study in women with persistent genital arousal disorder (PGAD) is urgently needed to develop its clinical management. To investigate the features, possible causes, and treatment of PGAD. Eighteen women who fulfilled the five criteria for PGAD were included in the study. In-depth interviews were combined with laboratory and imaging studies as reported in Part I of the study. Clinical responses were observed with drugs exerting activity against a number of different neuro-regulatory mechanisms. Detailed descriptions and clustering of some well established clinical syndromes. The majority of women experienced PGAD during early menopause without pre-existing psychiatric disorders and laboratory abnormalities. Most women had difficulties in describing the quality of the genital sensations. These were described in various terms and were diagnosed as dysesthesias and paresthesias. Their intensity was most severe during sitting. A few women reported PGAD during pregnancy and premenstrual. The majority of women also reported preexistent or coexistent restless legs syndrome (RLS) and overactive bladder syndrome (OBS). These strongly associated morbidities point into the direction of a clinical cluster, which harbors PGAD or PGAD plus these typical other disorders. Notably, as in RLS and OBS, it appeared that daily treatment with clonazepam 0.5-1.5 mg was effective in 56% of PGAD women. Also, oxazepam 10 mg and tramadol 50 mg elicited PGAD-reducing effect. PGAD seems to belong to a highly associated disease cluster including morbidities, which share an imperative urge to suppress dysesthesias and paresthesias by firm manipulative actions. PGAD--or as proposed by our group, restless genital syndrome (RGS) in the context of its strong association with restless legs--is probably the expression of a nonsexually driven hyperexcitability of the genitals and subsequent attempts to overcome it by genital manipulations.

Midodrine Improves Orgasm in Spinal Cord‐Injured Men: The Effects of Autonomic Stimulation

Orgasm is less frequent in men with spinal cord injury (SCI) than in able-bodied subjects, and is poorly understood. To assess the effect of autonomic stimulation on orgasm in SCI men using midodrine, an alpha1-adrenergic agonist agent. Penile vibratory stimulation (PVS) was performed in 158 SCI men on midodrine as part of a treatment for anejaculation, after they failed a baseline PVS. A maximum of four trials were performed, weekly, with increasing doses of midodrine. The presence and type of ejaculation, orgasm experiences, and cardiovascular data were collected. Ejaculation either antegrade or retrograde was obtained in 102 SCI men (65%). Orgasm without ejaculation was reported by 14 patients (9%) on baseline PVS. Ninety-three patients (59%) experienced orgasm during PVS on midodrine. Orgasm was significantly related to the presence of ejaculation in 86 patients (84%), and more strikingly to antegrade ejaculation (pure or mixed with retrograde), i.e., in 98% of 70 patients. Orgasm was significantly more frequent in patients with upper motor neuron and incomplete lesions who present somatic responses during PVS. There was no effect of the presence of psychogenic erection. There was a significant increase in both systolic and diastolic blood pressure. Sixteen patients, mainly tetraplegics, developed intense autonomic dysreflexia (AD) that required an oral nicardipine chlorhydrate. Orgasm is the brain's cognitive interpretation of genital sensations and somatic responses, AD, and ejaculation. Intact sacral and T10-L2 cord segments are mandatory, allowing coordination between internal and external sphincters. Autonomic stimulation with midodrine enhances orgasm rate, mainly by creating antegrade ejaculation.

Surgical Techniques: Dorsal Slit Surgery for Clitoral Phimosis

Female sexual dysfunction (FSD) is multifactorial, with psychological and organic elements. Genital sensation, an important component of sexual response, has until recently not been subjected to adequate clinical appraisal. During the past 15 years we have performed Quantitative Sensory Testing (QST) to assess genital sensation in healthy women and women with FSD.To review available evidence of QST in the investigation of genital sensation in women with FSD.We examined data obtained from assessment of genital sensation in normal women and those with different conditions, including multiple sclerosis, pelvic floor disorders, effect of hysterectomy, and vulvar vestibulitis.Use of QST for assessment of FSD.Normograms for healthy women were used to measure parameters during arousal, orgasm, and the refractory phase. Using QST, genital sensation was found to be impaired in women with multiple sclerosis. Clitoral vibratory sensation most significantly correlated with FSD parameters. Women with greater deficit in vibratory sensation encountered more sexual dysfunction. Women with urinary incontinence had a significant decrease in sensitivity to warm, cold, and vibratory thresholds in the anterior vaginal wall and clitoral area. A study comparing women with and without pelvic organ prolapse showed mean thresholds for vibratory and warm stimuli to be significantly higher and mean thresholds for cold stimuli to be significantly lower in the group with prolapse. QST of women undergoing hysterectomy showed a significant decrease in sensation to cold, warm, and vibratory stimuli at the anterior and posterior vaginal wall; clitoral thermal and vibratory sensation thresholds remained unchanged after surgery. In a study of vulvar vestibulitis, patients reported significantly lower heat pain thresholds compared with controls.QST appears useful for evaluating various gynecologic disorders associated with disturbed sexual function and with multiple sclerosis, which might be accompanied by disturbed genital sensation.

Effects of Appraisal of Sexual Stimuli on Sexual Arousal in Women with and Without Superficial Dyspareunia

This study examined the effects of appraisal of sexual stimuli on sexual arousal in women with superficial dyspareunia (n = 50) and sexually functional women (n = 25). To elicit different appraisals of an erotic film fragment, participants received an instruction prior to viewing it, with a focus on genital pain or on sexual enjoyment. A neutral instruction served as a control condition. Assignment to instruction condition was randomized. Genital arousal (vaginal pulse amplitude) and self-report ratings of affect and genital sensations were obtained in response to the erotic stimulus. As predicted, appraisal of the erotic stimulus affected genital responding, albeit marginally significant. Follow-up tests indicated that women who received the genital pain instruction responded with marginally significant lower genital arousal levels than women who received the sexual enjoyment instruction (d = 0.67). A significant instruction effect for negative affect was found, signifying that negative affect ratings were highest after the genital pain instruction and lowest after the sexual enjoyment instruction (d = 0.80). A marginally significant group by instruction interaction effect was observed for positive affect, indicating that women with dyspareunia reported significantly less positive affect than controls after the sexual enjoyment instruction (d = 1.48). Whereas women with dyspareunia reported overall marginally significant more negative affect than controls (d = 0.48), there were no differences in genital responsiveness between groups. These results provided preliminary evidence for the modulatory effects of appraisal of sexual stimuli on subsequent genital responding and affect in women with and without sexual complaints.

T09-P-12 Female genital sensation: our experience

Neurological pathology may be responsible for female sexual dysfunctions. Thanks to a new instrument called the Genito Sensory Analyzer (GSA), we have evaluated the normalcy curves and deviation standards of the external female genitalia. All tests were executed with the GSA (Genital Sensory Analyzer). The GSA is an instrument of great precision with extremely sensitive software capable of registering measurements in vibration and thermal sensitivity of hot and cold on the various zones researched (integrity and evaluation of the small fibers, callipers A- Delta and C). The tests included 46 women. The criteria for GSA testing included patients with the following: females with genital-urinary track infections, systemic maladies (including alcoholism, etc.), neurological pathologies and obviously psychiatric patients, and patients who abuse narcotics. The areas tested with the GSA were as follows: anterior and posterior vagina, the vulva and clitoris. The normogram regarding sensibility to vibration and temperature is clearly demonstrated. The results for thermal and vibratory testing of the vaginal regions and the clitoris are clinically reliable and repeatable. These results may be evaluated as diagnostic instruments for determining neurological female sexual dysfunctions.

Genital arousal in women: Problem, Pathology or Normative Response

Interest in women's sexual functioning has increased in recent years although the primary emphasis has been on deficits in both genital and subjective sexual response. Clinically, it is not uncommon for women of all ages to present with complaints of difficulty becoming or remaining sexually aroused. While hormonal deficits or pharmacological agents are often implicated etiologically in the genital arousal and lubrication problems of peri or postmenopausal women, psychological and interpersonal factors usually play a significant role as well. Given the high prevalence of sexual complaints generally in women, and the co-morbidity of desire and arousal disorders, it is, perhaps, not surprising, that there exists a common assumption that women's genital responsivity is less reliable and robust than that of males. Recent sexual psychophysiology research suggests that this is not the case and that, in fact, women are capable of greater sexual responsiveness than previously assumed. There are also women who complain of excessive genital arousal. This condition, originally named persistent sexual arousal syndrome (PSAS) was renamed persistent genital arousal disorder (PGAD, Leiblum, 2006) because the problem appeared to be primarily one of unwanted and intrusive sensations of genital, rather than sexual, arousal. PGAD is characterized by five features: (1) involuntary genital and clitoral arousal that persists for an extended period of time; (2) persistent genital arousal that feels intrusive and unwanted; (3) persistent genital arousal that does not completely resolve following one or more orgasms; (4) persistent genital arousal that appears to be unrelated to conscious feelings of sexual desire; and (5) persistent genital arousal that is experienced as moderately distressing. In 2003, it was included as a provisional diagnosis by an international committee of experts convened to recommend revisions in the nomenclature of women's sexual dysfunctions. While there are women at either extreme of the genital arousal continuum, that is, too little or too much arousal, there is a third group of women- women who report genital arousal that appears unsolicited but which may be experienced as relatively persistent, pleasurable and nondistressing. Today's talk will review the findings of the most recent research on PGAD and non-PGAD women and will present case illustrations of the four kinds of arousal complaints in women. We will suggest that what appears to be spontaneous genital arousal in some women may be the result of either subconscious processing of sexual stimuli in the environment - stimuli that are either consciously unacceptable or not noticed- and that are negatively evaluated. This negative evaluation of genital sensations may result in heightened vigilance, increased anxiety, pelvic tension and increased sensations which reinforces the condition. Psychological interventions may be helpful in treating this problem for a subset of women without an identifiable organic basis for their complaint.

T09-P-14 Persistent genital arousal in women: about two case reports

Female sexual psychophysiology research suggests that women are capable of greater sexual responsiveness than previously thought and can experience genital response in the absence of a subjective experience of sexual arousal. There are some women who report persistent genital arousal, both with and without accompanying distress, providing an idea for dissociation between genital and psychological sexual response. In this article, the authors describe two case reports of women with unprovoked genital arousal, intrusive and troubling genital sensations that did not dissipate with one or many orgasms and persisted for many hours or days. These two women assessed at the Clinical Sexology Department of the Coimbra University Hospital had average age of about thirty years old and were married. They both described a bad relationship with their husbands, refusing to have sex because the arousal triggered by sexual activity, persist after several orgasms in unpleasant way.

Short- and Long-term Effects of Ginkgo Biloba Extract on Sexual Dysfunction in Women

Ginkgo biloba extract (GBE) facilitates blood flow, influences nitric oxide systems, and has a relaxant effect on smooth muscle tissue. These processes are important to the sexual response in women and, hence, it is feasible that GBE may have a therapeutic effect. The present study was the first to provide an empirical examination of the effects of both short- and long-term GBE administration on subjective and physiological (vaginal photoplethysmography) measures of sexual function in women with Sexual Arousal Disorder. A single dose of 300 mg GBE had a small but significant facilitatory effect on physiological, but not subjective, sexual arousal compared to placebo in 99 sexually dysfunctional women. The long-term effects of GBE on sexual function were assessed in 68 sexually dysfunctional women who were randomly assigned to 8 weeks treatment of either (1) GBE (300 mg/daily), (2) placebo, (3) sex therapy which focused on training women to attend to genital sensations, or (4) sex therapy plus GBE. When combined with sex therapy, but not alone, long-term GBE treatment significantly increased sexual desire and contentment beyond placebo. Sex therapy alone significantly enhanced orgasm function compared with placebo. Long-term GBE administration did not significantly enhance arousal responses beyond placebo. It was concluded that (1) neither short- or long-term administration of GBE alone substantially impacts sexual function in women, (2) a substantial placebo effect on sexual function exists in women with sexual concerns, and (3) teaching women to focus on genital sensations during sex enhances certain aspects of women's sexual functioning.

Psychological, Medical, and Pharmacological Correlates of Persistent Genital Arousal Disorder

Little is known about the etiology or medical/psychological correlates of persistent genital arousal disorder (PGAD). The aims of this article were (i) to replicate the findings of earlier research identifying two subtypes of women with persistent arousal-those who meet all features of the condition and are at least moderately distressed, and those who meet only some features and are less distressed; and (ii) to identify the medical, psychological and/or pharmacological correlates of the condition. A comprehensive web-based survey of persistent genital arousal (PGA) was posted on several Internet websites. Of the 156 women who completed the survey, 76 met all five features qualifying for a persistent genital arousal disorder (PGAD) group, and 48 met only some features (non-PGAD group). The main outcome measures were endorsement of diagnostic signs of depression, anxiety, obsessive-compulsive disorder, and panic attack as well as medical illnesses and pharmacological preparations. Compared to non-PGA subjects, women with PGA were significantly more likely to be depressed (55% vs. 38%) and to report panic attacks (31.6% vs. 14.6%). They were more anxious and more likely to monitor their physical sensations. Both groups reported high rates of childhood and adult sexual abuse, although the PGA women reported a higher prevalence of sexual victimization. They were significantly more likely to endorse negative feelings about their genital sensations and also more likely to complain of chronic fatigue syndrome than women without the condition (10% vs. 0%). There were no significant relationships with pharmacologic agents and symptoms. Women who met all the criteria of PGAD were more likely than women who only met some of the criteria to report depression, anxiety, panic attacks, and certain obsessive-compulsive symptoms such as monitoring their physical sensations. It is hypothesized that for a subset of women, psychological factors, namely anxiety, reinforce exacerbate and maintain PGAD.

ORIGINAL RESEARCH—PHYSIOLOGY: Sensation and Sexual Arousal in Circumcised and Uncircumcised Men

Research, theory, and popular belief all suggest that penile sensation is greater in the uncircumcised as compared with the circumcised man. However, research involving direct measurement of penile sensation has been undertaken only in sexually functional and dysfunctional groups, and as a correlate of sexual behavior. There are no reports of penile sensation in sexually aroused subjects, and it is not known how arousal affects sensation. In principle, this should be more closely related to actual sexual function. This study therefore compared genital and nongenital sensation as a function of sexual arousal in circumcised and uncircumcised men. Twenty uncircumcised men and an equal number of age-matched circumcised participants underwent genital and nongenital sensory testing at baseline and in response to erotic and control stimulus films. Touch and pain thresholds were assessed on the penile shaft, the glans penis, and the volar surface of the forearm. Sexual arousal was assessed via thermal imaging of the penis. In response to the erotic stimulus, both groups evidenced a significant increase in penile temperature, which correlated highly with subjective reports of sexual arousal. Uncircumcised men had significantly lower penile temperature than circumcised men, and evidenced a larger increase in penile temperature with sexual arousal. No differences in genital sensitivity were found between the uncircumcised and circumcised groups. Uncircumcised men were less sensitive to touch on the forearm than circumcised men. A decrease in overall touch sensitivity was observed in both groups with exposure to the erotic film as compared with either baseline or control stimulus film conditions. No significant effect was found for pain sensitivity. These results do not support the hypothesized penile sensory differences associated with circumcision. However, group differences in penile temperature and sexual response were found.

927: Feminizing Genitoplasty: Genital Sensation in Adult Life

You have accessJournal of UrologyModerated Poster 27, Monday, May 21, 2007, 1:00 - 3:00 pm1 Apr 2007927: Feminizing Genitoplasty: Genital Sensation in Adult Life Arianna Lesma, Francesca Benedusi, Alberto Briganti, Nazareno Suardi, Antonino Sacca, Andrea Salonia, Aldo M. Bocciardi, Francesco Montorsi, and Patrizio Rigatti Arianna LesmaArianna Lesma More articles by this author , Francesca BenedusiFrancesca Benedusi More articles by this author , Alberto BrigantiAlberto Briganti More articles by this author , Nazareno SuardiNazareno Suardi More articles by this author , Antonino SaccaAntonino Sacca More articles by this author , Andrea SaloniaAndrea Salonia More articles by this author , Aldo M. BocciardiAldo M. Bocciardi More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , and Patrizio RigattiPatrizio Rigatti More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)31155-8AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "927: Feminizing Genitoplasty: Genital Sensation in Adult Life." The Journal of Urology, 177(4S), pp. 307–308 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 177Issue 4SApril 2007Page: 307-308 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Arianna Lesma More articles by this author Francesca Benedusi More articles by this author Alberto Briganti More articles by this author Nazareno Suardi More articles by this author Antonino Sacca More articles by this author Andrea Salonia More articles by this author Aldo M. Bocciardi More articles by this author Francesco Montorsi More articles by this author Patrizio Rigatti More articles by this author Expand All Advertisement Loading ...

Tum or Pum in Patients with Persistent Ugs and Cloacal Malformation? An Attempt to Explore the Morphological Routes of the Operation and Delineate the Structures which are Involved

Purpose Total urogenital or partial urogenital mobilizations are performed in correcting persistent urogenital sinus or persistent cloaca (J Pediatr Surg 32:263-268, 1997; BJU 83:820-822, 1999; J Pediatr Surg 39:470-479, 2004; Curr Opin Pediatr 17: 394-401, 2005). The safety regarding urinary continence and genital sensation is still under discussion. The aim of this investigation was to explore, from the morphological potential point of view, the risk for neural or vascular damage during these operations. Material and methods The anatomy of the plane of dissection of the UGS with special attention to the nerve supply of the urinary sphincter complex and the clitoris was investigated in 31 plastinated female pelves from 9th gestational week to term. The morphological routes of the operation are shown up and delniate the structures which are involved. Results In previously unoperated cases the dissection can be performed without disturbing the innervation or vascularization (branches from pudendel nerve and arteries). Conclusions The technique of TUM simplifies the surgical correction of UGS malformations. Urinary continence and genital sensation should not compromised by this technique in primary cases. In secondary cases or with additional spinal malformation incontinence can occur, because the plane of dissection may be scarred or the nerve supply not be well developed. Cautery should be used cautiously to avoid damage of the nerve/blood supply.

ORIGINAL RESEARCH—WOMEN’S SEXUAL HEALTH: Physiological Changes in Female Genital Sensation During Sexual Stimulation

A normal sexual response in the female depends on the integrity of afferent sensory input from the genital region. So far genital sensation has been investigated only during a non-excitatory state, and the sensory physiological changes, which occur during the sexual cycle in this region, are still obscured. To investigate the sensory status of the female genital region during sexual arousal and orgasm. Genital sensory thresholds measured by Quantitative Sensory Testing (vibratory and thermal) were compared in a non-excitatory vs. excitatory state in normal sexually functioning females. Eleven healthy female volunteers were recruited and attended three separate visits. During each session only one anatomical site, either clitoris or vagina was tested for either vibratory or thermal stimuli. A psychophysical method of limits was employed for threshold determination of warm or vibratory stimuli. In each session, all women were tested at baseline, immediately after arousal, after orgasm and three more measurements - 5, 10, and 20 minutes during the recovery state. A significant decrease in clitoral vibratory sensation threshold was observed between the baseline and the arousal phases (P = 0.003). Comparison of vibratory sensation between baseline and following orgasm at the clitoral and vaginal region showed a significant difference (P < 0.001) for both regions. These changes were not significant for thermal threshold sensation at the clitoral region (P = 0.6). This is the first time that genital sensation has been measured during the excitatory phase of the female sexual cycle. This normative data may serve as a baseline for further investigations of the sensory input of the genital organs during intercourse in pathological states.

The effect of pain-related fear on sexual arousal in women with superficial dyspareunia

The role of pain-related fear in the etiology and/or maintenance of superficial dyspareunia is still unclear. The objective of this experiment was to investigate the effects of pain-related fear on sexual arousal in women with superficial dyspareunia ( n = 48) and women without sexual complaints ( n = 48). To induce pain-related fear, participants were told that they had a 60% chance of receiving painful stimuli while being exposed to one of two erotic film clips. Genital arousal was assessed using vaginal photoplethysmography. Self-reported ratings of genital sensations and affect were collected after both erotic stimulus presentations. Elevated levels of skin conductance and higher ratings of experienced threat during the pain threat condition indicated that fear was successfully elicited. Pain-related fear impeded genital arousal in all women. Women of both groups reported significantly less positive affect and more negative affect when threatened. Although women with dyspareunia did not differ in their genital responsiveness from women without sexual complaints, they experienced overall significantly more negative affect than the control group. The present results indicate that pain-related fear reduces genital and subjective sexual responding in women with and without sexual problems.We conclude that emotional appraisal of the sexual situation determines genital responsiveness in both sexually dysfunctional and functional women.

ORIGINAL RESEARCH—ENDOCRINOLOGY: Transdermal Testosterone Gel prn Application for Hypoactive Sexual Desire Disorder in Premenopausal Women: A Controlled Pilot Study of the Effects on the Arizona Sexual Experiences Scale for Females and Sexual Function Questionnaire

Several studies suggest that increased plasma testosterone can improve sexual function and desire in post-oophorectomy or postmenopausal women. However, side effects of chronic daily testosterone raise questions about the generalizability of this treatment approach. Sublingual testosterone was reported to cause testosterone levels to peak after 15 minutes and then decline to baseline levels within 90 minutes. Three to 4 hours after reaching testosterone peak, increased genital sensations and sexual lust were reported. We hypothesized that a single dose of testosterone given 4-8 hours prior to planned intercourse in women with hypoactive sexual desire disorder (HSDD) might increase desire without side effects associated with chronic use. The design was randomized double-blind crossover. Premenstrual women with HSDD received eight packets of gel or identical placebo for use before intercourse twice weekly for 1 month. For a second month, the alternate treatment was given. Ratings were performed using the patient-rated Arizona Sexual Experiences Scale for females and the clinician-rated Sexual Function Questionnaire (SFQ-V1). Ten patients completed the study. On the five-item self-report Arizona, the item "How easily are you aroused?" was significantly improved on testosterone gel vs. placebo, P = 0.03. There were similar trends on the physician-rated SFQ-V1 "arousal-sensation" cluster. These preliminary results suggest that testosterone gel given prn before intercourse has effects on sexual arousal, and further research is needed to define dosage and time schedule to optimize this effect and determine its clinical relevance.