Sexual Arousal Disorder Research Articles

Disorders in sexual desire and sexual arousal in women, a 2010 state of the art

In this contribution, female sexual desire and arousal disorders are viewed from the perspective of incentive motivation and information processing models of sexual response. The effects of hormones, somatic disease, and medication on sexual arousability are discussed, as well as the influence of psychological factors, such as stimulus meaning, mood and cognition, and relational context on female sexual desire and arousal. Specific topics to attend to during the anamnesis of sexual desire and arousal problems, and empirically evaluated psychological and pharmacological treatments for these problems are discussed.

Should Sexual Desire and Arousal Disorders in Women Be Merged?

Should Sexual Desire and Arousal Disorders in Women Be Merged?

Female sexual dysfunction and adolescents

To review recent publications in the area of sexual dysfunction in females including the adolescent age group. Though as many as 40% of adult females have a sexual dysfunction, the incidence among adolescent females is unknown. Though over half of adolescents are sexually active, sexual dysfunction is not a term universally accepted among the general public as well as researchers. Research on sexual dysfunction in females typically starts with age 18 years or over. Causes of sexual dysfunction include medical disorders, gynecological problems, which started from the adolescent age, psychiatric disorders, and complications of medications such as selective serotonin reuptake inhibitors (SSRIs), antipsychotics, and others. Management includes identification of the specific sexual dysfunction and treatment of the underlying condition, including surgical treatment in such cases as absent vagina or obstetrics fistula. Psychological therapy is helpful when psychological factors are contributory to the dysfunction. Pharmacologic principles of management cases can, for example, include treatment of gynecological problems such as pelvic inflammatory disease (PID) or endometriosis as a cause of sexual dysfunction or include removal of the offending drug, use of glutamatergic strategies or trazodone in SSRI-association dysfunction, and addition of bupropion or other medications in select cases. No medication is FDA-approved for sexual dysfunction in females. Sexual dysfunction in females includes lack of sexual desire, sexual pain disorders (as dyspareunia), anorgasmia, and sexual arousal dysfunction. Acceptance of the high incidence of sexual dysfunction in all female populations is necessary to appreciate this phenomenon in the adolescent cohort, because some gynecological disease can arise from the adolescent age and can cause sexual dysfunction. Some sexual dysfunctions require immediate treatment, including surgical in the case of congenital anomaly, ovarian cyst, or tumor. Current understanding is based on extrapolation of research in the adult population. Management principles include removal of offending drugs and treatment of underlying disorders. Research in the adolescent population is recommended for more understanding and acceptance of this phenomenon in this age group.

Menopause and sexuality: key issues in premature menopause and beyond

Woman's sexuality encompasses sexual identity, sexual function, and sexual relationships. It is modulated throughout life by life and reproduction-related events, health, relationships, and sociocultural variables. The aging process and menopause are two potent contributors to female sexual dysfunction. The earlier the menopause, the more severe and complex the impact on sexuality is. The younger the woman, the less she realizes the different key goals of her life cycle (falling in love, having a satisfying sexual life, forming a stable couple, getting married, having a family) and the more pervasive the consequences on her sexual identity, sexual function, and sexual relationship can be. Premature menopause is an amplified paradigm of the complex impact menopause can have on women's and couple's sexuality. This paper will focus on biologically based sexual issues, namely desire, arousal, orgasm, and pain disorders, as well as key questions encountered in infertility. The concepts of "symptom inducer" and "symptom carrier" will also be addressed.

Sildenafil in women with sexual arousal disorder following spinal cord injury

Double-blind, placebo-controlled, flexible-dose study. To evaluate the efficacy, safety and tolerability of oral sildenafil in women with female sexual arousal disorder as a result of SCI (paraplegia/tetraplegia). The study was conducted at clinical practice sites in North America (n =23), 11 European countries (n =23), Australia (n =4) and South Africa (n =2). 129 women were randomized and treated with sildenafil or matching placebo. A 4-week baseline period was followed by 12 weeks of treatment, which could be increased from 50 to 100 mg or decreased to 25 mg once during the treatment period, depending on efficacy and tolerability. By use of an event log, sexual activity was monitored between screening and the end of treatment. The Sexual Function Questionnaire, the Sexual Quality of Life Questionnaire-Female, a global efficacy question and Sexual Distress Question were also assessed. Sildenafil-treated women and placebo-treated women had an increase in their percentage of sexual activities throughout the course of the study, with no statistically significant difference between groups in the percentage of successful sexual activities at end of treatment versus baseline. There were also no statistically significant differences between sildenafil- and placebo-treated women on the aforementioned measures. The most common adverse events included headache and vasodilatation. The results of this study are similar to other reports regarding a lack of clinically meaningful benefit of sildenafil in other populations of women. This study was sponsored by Pfizer Inc.

Sexual fantasies and sexual arousal in women with a history of childhood sexual abuse

Treatments of female sexual arousal dysfunction for childhood sexual abuse (CSA) survivors could greatly benefit from more information on mechanisms to the sexual arousal problems specific to this population. In this study, 60 CSA survivors and 120 women with no history of CSA (NCSA) participated in an Internet-based survey on sexual arousal and sexual fantasies. Self-reported sexual arousal was measured with the Female Sexual Function Index and a modified version of the Derogatis Sexual Function Inventory: Sexual Fantasies was used to assess frequency and types of sexual fantasies. The frequency of degrading and violent sexual fantasies was not associated with sexual arousal. The CSA group did not report more degrading and violent sexual fantasies than the NCSA group. Greater frequency of conventional fantasies (i.e. sex with one's partner, sex in unusual positions, oral sex) was associated with greater sexual arousal for both groups. Clinical implications derived from these findings include whether encouraging more conventional sexual fantasies could facilitate sexual arousal.

Differentiating Components of Sexual Well-Being in Women: Are Sexual Satisfaction and Sexual Distress Independent Constructs?

Sexual satisfaction and sexual distress are common outcome measures in studies of sexual health and well-being. However, confusion remains as to if and how the two constructs are related. While many researchers have conceptualized satisfaction and distress as polar opposites, with a lack of satisfaction indicating high distress and vice versa, there is a growing movement to view satisfaction and distress as relatively independent factors and measure them accordingly. The study aimed to assess the level of independence between sexual satisfaction and distress in female clinical and nonclinical samples. Ninety-nine women (mean age = 25.3) undergoing treatment (traditional sex therapy and/or gingko biloba) for sexual arousal disorder with or without coexistent hypoactive sexual desire disorder and/or orgasmic disorder completed surveys assessing sexual satisfaction, sexual distress, sexual functioning, and relational functioning at pretreatment, mid-treatment, posttreatment, and follow-up. Two hundred twenty sexually healthy women (mean age = 20.25) completed similar surveys at 1-month intervals. Sexually dysfunctional women completed the Sexual Satisfaction Scale for Women (SSS-W), the Female Sexual Function Index (FSFI), and the Dyadic Adjustment Scale. Sexually healthy women completed the SSS-W, the FSFI, the Relationship Assessment Scale, and the Dimensions of Relationship Quality Scale. Sexual satisfaction and distress were generally closely and inversely related; however, distress was more closely related to sexual functioning variables than was satisfaction in the clinical sample, and satisfaction was more closely related to relational variables than was distress in the nonclinical sample. Additionally, satisfaction and distress showed partially independent patterns of change over time, and scales of distress showed a larger change in response to treatment than did scales of satisfaction. Although sexual satisfaction and distress may be closely related, these findings suggest that they are, at least, partially independent constructs. Implications for research on sexual well-being and treatment outcome studies are discussed.

Neutral endopeptidase inhibition: could it have a role in the treatment of female sexual arousal disorder?

Female sexual arousal disorder (FSAD) is the inability to attain or maintain an adequate lubrication-swelling response of sexual excitement. The potentiation of vascular responses leading to increased blood flow in clitoris and vagina has represented the main focus in the pharmacological treatment of FSAD, including the evaluation of the type 5 phosphodiesterase (PDE5) inhibitors. However, due to a lack of clear efficacy, there is no approved pharmacotherapy for FSAD to date. In the present issue of the British Journal of Pharmacology, Wayman et al. show that the administration by intravenous or intravaginal routes of a novel neutral endopeptidase inhibitor, UK-414,445, results in enhanced genital blood flow responses to pelvic nerve stimulation in female rabbits, without significantly affecting blood pressure. Neutral endopeptidase inhibition, by preserving vasoactive peptides such as vasoactive intestinal polypeptide, raises the possibility of a new pharmacological approach to the treatment of FSAD.

UK‐414,495, a selective inhibitor of neutral endopeptidase, potentiates pelvic nerve‐stimulated increases in female genital blood flow in the anaesthetized rabbit

Female sexual arousal consists of a number of physiological responses resulting from increased genital blood. Vasoactive intestinal peptide (VIP), neuropeptide Y and to a lesser extent nitric oxide are neurotransmitters found in the vasculature of the genitalia. Neutral endopeptidase (NEP) modulates the activity of neuropeptides including VIP. The aim of this study was to investigate the control of genital blood flow by VIP and endogenous neuropeptides using a selective NEP inhibitor [UK-414,495, ((R)-2-({1-[(5-ethyl-1,3,4-thiadiazol-2-yl) carbamoyl]cyclopentyl}methyl) valeric acid)]. Vaginal and clitoral blood flow (VBF and CBF) were monitored using laser Doppler in terminally anaesthetized New Zealand rabbits. Increases in VBF and CBF were induced by either electrical stimulation of the pelvic nerve or by i.v. infusion of VIP. Stimulation of the pelvic nerve increased VBF and CBF, compared with basal flow. Increases were mimicked by infusion of exogenous VIP. UK-414,495 dose-dependently potentiated pelvic nerve-stimulated increases in VBF (EC(50)= 37 +/- 9 nM; 3.6 x IC(50) rabbit NEP). Nerve-stimulated increases in VBF and CBF were both enhanced after UK-414,495. UK-414,495 increased the amplitude and duration of VIP-induced increases in VBF. UK-414,495 had no effect on basal VBF or cardiovascular parameters. Inhibition of NEP potentiates pelvic nerve-stimulated increases in genital blood flow. This suggests that the endogenous neurotransmitter mediating genital blood flow is a substrate for NEP (most likely VIP). NEP inhibitors may restore sexual arousal in women adversely affected by female sexual arousal disorder.

713 EXPRESSION AND DISTRIBUTION OF KEY ENZYMES OF THE CYCLIC GMP SIGNALING IN THE HUMAN CLITORIS

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Basic Research I1 Apr 2010713 EXPRESSION AND DISTRIBUTION OF KEY ENZYMES OF THE CYCLIC GMP SIGNALING IN THE HUMAN CLITORIS Stefan Ückert, Matthias Oelke, Knut Albrecht, Dirk Breitmeier, Markus Kuczyk, and Petter Hedlund Stefan ÜckertStefan Ückert Hannover, Germany More articles by this author , Matthias OelkeMatthias Oelke Hannover, Germany More articles by this author , Knut AlbrechtKnut Albrecht Hannover, Germany More articles by this author , Dirk BreitmeierDirk Breitmeier Hannover, Germany More articles by this author , Markus KuczykMarkus Kuczyk Hannover, Germany More articles by this author , and Petter HedlundPetter Hedlund Milan, Italy More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1154AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The human clitoris contributes mainly to the normal female sexual response cycle. A significance of cyclic GMP has been assumed in the control of clitoral vascular smooth muscle. Recent research presented the expression of the phosphodiesterase type 5 (PDE5, cyclic GMP-specific PDE) in clitoral erectile tissue (UROLOGY 67: 1111-1116, 2006). However, knowledge on the mechanisms controlling this particular female genital organ is still sparse. This prompted us to evaluate in the human clitoris by means of immunohistochemistry the expression and distribution in relation to PDE5 of key enzymes of the cyclic GMP pathway: the endothelial nitric oxide synthase (eNOS), PDE2 (cyclic GMP-binding PDE), PDE5, and protein kinase G (cGK, cyclic GMP-dependent protein kinase). METHODS Human clitoral tissue was obtained from four female cadavers (age at death 18 y - 42 y). Sections of clitoral tissue were incubated (for 24 h) with antibodies directed against eNOS, PDE2, PDE5 and cGK followed by exposure for 2 h to fluorochrome-labeled (fluorescein isothiocyanate, Texas Red) secondary antibodies. Visualization was commenced by means of laser fluorescence microscopy. RESULTS Immunohistochemistry revealed the presence of PDE2, PDE5 and cGK in the smooth muscle wall of blood vessels transversing the clitoral supepithelial space. These vessels were characterized by the expression of NOS in the cells of the endothelial layer. Immunoreactivity specific for PDE2 was also identified in a meshwork of interstitial-like cells located in the basal epithelial layer. No signals specific for PDE2 and cGK were detected in non-vascular clitoral smooth muscle. CONCLUSIONS The results are in favour of a role of the cyclic GMP signaling in the control of clitoral blood flow. It seems likely that the cyclic GMP-binding PDE2 is also involved in the mechanism of local afferent transmission in the clitoris. The data may provide further rationale for the use of drugs interfering with the cyclic GMP pathway in the pharmacotherapy of female sexual arousal disorders. © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e278 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Stefan Ückert Hannover, Germany More articles by this author Matthias Oelke Hannover, Germany More articles by this author Knut Albrecht Hannover, Germany More articles by this author Dirk Breitmeier Hannover, Germany More articles by this author Markus Kuczyk Hannover, Germany More articles by this author Petter Hedlund Milan, Italy More articles by this author Expand All Advertisement Advertisement Loading ...

Women's Motivations for Sex: Exploring the Diagnostic and Statistical Manual, Fourth Edition, Text Revision Criteria for Hypoactive Sexual Desire and Female Sexual Arousal Disorders

There are problems with the existing definition of hypoactive sexual desire disorder (HSDD) in that desire for sex and sexual fantasy are not a universal experience. To explore: (i) women's motivations to engage in sexual activity; (ii) frequency and predictors of sexual fantasies; (iii) sexual arousal; (iv) recognition of sexual arousal; and (v) association between relationship duration and these variables. Three thousand six hundred eighty-seven women completed a web-based survey of previously pilot-tested items. Investigator-derived self-report questions of sexual desire and arousal, and sexual fantasies. Among women who easily became aroused, 15.5% reported only engaging in sex if they felt sexual desire at the outset whereas 30.7% typically or always accessed desire only once they were aroused. Women in longer-term relationships engaged in sex with no sexual desire more often (42%) than women in short-term relationships (22.4%) (P < 0.001). The percentage of women that reported fantasies only sometimes was 52.5%. A logistic regression revealed that religion (odds ratio [OR] = 1.45; P < 0.001), difficulty getting aroused (OR = 0.511; P < 0.001), responsive desire (OR = 0.919; P < 0.05), and frequency of orgasm (OR = 1.11; P < 0.05) were significantly associated with sexual fantasy. After controlling for age, relationship duration was negatively associated with frequency of initiating sex (r = -0.116, P < 0.001), women's satisfaction with their own sexuality (r = -0.173, P < 0.001) and sexual satisfaction with the partner (r = -0.162, P < 0.001). Results reflect diversity in women's motivations for sex, and there is evidence that responsive desire occurs in women with and without arousal difficulties. We strongly recommend relationship duration as well as adequacy of partner sexual stimulation to be recognized in any future diagnostic framework of dysfunction. Clinical implications as well as those for future diagnostic nomenclature are considered.

ORIGINAL RESEARCH—BASIC SCIENCE: I. Slow Oscillations in Vaginal Blood Flow: Alterations during Sexual Arousal in Rodents and Humans

This study investigated slow oscillatory rhythms in vaginal blood flow as a physiological marker of female sexual arousal in rodents, human healthy volunteers, and women with female sexual arousal disorder (FSAD). Vaginal blood flow was measured in urethane-anesthetized rodents using laser Doppler flowmetry, while in humans, vaginal photoplethysmography was used. Acquired data were filtered for frequency analysis in the range of 0.013-2.5 Hz in rodents and 0.01-0.5 Hz in humans. Rodents were assessed for changes in a high frequency range (HF = 0.6-2.5 Hz), and a low frequency range (LF = 0.013-0.6 Hz). Human data were assessed for total spectral power in the entire frequency range. During naturally induced arousal (exposure to male), oscillatory rhythms in vaginal blood flow from rodents demonstrated an increase in the ratio of LF oscillations to HF oscillations (LF/HF ratio). Drugs known to induce sexual arousal (apomorphine and melanotan II) were tested in anesthetized rodents. Both compounds induced an increase in the LF/HF ratio. In humans, visual sexual stimulation induced an increase in the total power of slow oscillatory activity in vaginal blood flow in healthy human volunteers. No such increase was observed in women with FSAD. This study demonstrated that slow oscillations in vaginal blood flow are correlated with subjective physiological arousal and display diminished responsiveness in women with FSAD. Slow oscillations in vaginal blood flow are entirely independent of vaginal vasocongestion as women with FSAD demonstrated a normal vasocongestion response to visual sexual stimulation. In conditions where rodents would be expected to be sexually aroused, slow oscillations in vaginal blood flow showed a shift from HFs to LFs. This technique will greatly enhance the investigation of female sexual function both clinically and preclinically.

II. Slow Oscillations in Vaginal Blood Flow: Regulation of Vaginal Blood Flow Patterns in Rat by Central and Autonomic Mechanisms

A new method for assessing female sexual arousal through changes in slow oscillatory patterns in vaginal blood flow was first described in the previous manuscript [1]. This method was translational and discriminated between normal healthy volunteers and women with female sexual arousal disorder. These studies addressed the influence of autonomic and central nervous systems on slow vaginal blood flow oscillations in rats. Vaginal blood flow oscillations were measured in urethane-anesthetized rodents using laser Doppler flowmetry. Acquired data were filtered for frequency analysis range of 0.013-2.5 Hz. Data were assessed for changes in a high frequency range (HF = 0.6-2.5 Hz), and low frequency range (LF = 0.013-0.6 Hz). The basal HF oscillatory component of vaginal blood flow was primarily vagally mediated, although could be modulated pharmacologically with p-chloroamphetamine in the absence of vagal innervation. The LF component could be modulated by antagonists of noradrenergic receptors but did not appear to be dependent upon tonic activation of sympathetic circuitry. The non-selective dopamine receptor agonist apomorphine induced changes in vaginal blood flow oscillations consistent with sexual arousal during metestrus in the presence of the peripheral antagonist domperidone but not in the presence of the centrally acting antagonist haloperidol. Electrical stimulation of the paraventricular nucleus (PVN) of the hypothalamus induced an anti-arousal response in vaginal blood flow oscillations. These data demonstrated that manipulation of the central nervous system alone (via centrally acting apomorphine or electrical stimulation of the PVN) could produce either a pro-arousal or an anti-arousal response in vaginal blood flow oscillations. Alterations in the LF/HF ratio measured from vaginal laser Doppler flowmetry were independently regulated from vasculature in the trunk, the tongue, and electrocardiogram-derived heart rate variability, and were independent of overall vasocongestion of the vagina as measured by mean blood flow. These data indicated that slow oscillations in vaginal blood flow from rodents may be utilized as an animal model of female sexual arousal. Changes in these oscillations are driven by the central nervous system and modulated by the autonomic nervous system.

The Sensitivity of Continuous Laboratory Measures of Physiological and Subjective Sexual Arousal for Diagnosing Women with Sexual Arousal Disorder

Past findings on the diagnostic sensitivity of vaginal photoplethysmography are limited by testing among women with heterogeneous sexual dysfunctions and by the use of statistical techniques that are unable to assess how changes in subjective arousal are associated with changes in physiological arousal. The aims of this study were to: (i) test the sensitivity of vaginal photoplethysmography and continuous measures of subjective sexual arousal in differentiating between women with and without sexual arousal or orgasm dysfunction; and (ii) examine the diagnostic utility of measuring the synchrony between genital and subjective sexual responses. Sexual arousal was assessed in sexually healthy women (n = 12), women with orgasm disorder (OD; n = 12), and 38 women who met the criteria for the three subcategories of sexual arousal dysfunction described by Basson et al. (i.e., genital sexual arousal disorder [GAD; n = 9], subjective sexual arousal disorder [SAD; n = 13], and combined genital and subjective arousal disorder [CAD; n = 16]). Physiological sexual arousal was assessed using vaginal photoplethysmography, and subjective sexual arousal was measured continuously and using a Likert-scale in response to sexual videos. Women with GAD showed the lowest and women with CAD showed the highest levels of vaginal pulse amplitude response to erotic stimuli. Women with sexual arousal disorder showed significantly lower levels of subjective sexual arousal to erotic stimuli than did sexually healthy women. Relations between subjective and physiological measures of sexual arousal were significantly weaker among women with sexual arousal disorder than sexually healthy women or women with OD. Preliminary support was provided for the diagnostic utility of measuring the synchrony between subjective and genital arousal in women with sexual arousal disorder. Findings do not support the sensitivity of using vaginal photoplethysmography, or continuous or Likert-scale measures of subjective arousal for differentiating between subtypes of women with sexual arousal disorder.

Sexual Function in Women With Overactive Bladder

: Overactive bladder (OAB) is a major cause of suffering in many patients, requiring long-term therapy to maintain symptoms relief. Incontinence or even the fear of leaking urine interferes with sexual function. However, studies evaluating the burden of OAB on female sexual function are limited. The aim of this study was to assess the prevalence of sexual dysfunction among women with OAB compared with healthy controls. : A total of 112 female patients with clinical and urodynamically proven OAB and 165 healthy controls, free from urinary symptoms were included in our study. Women younger than 18 or sexually inactive were excluded, while the 2 groups were matched to age, parity, and menopause status. All women were investigated in accordance with the Female Sexual Function Index (FSFI) which contains 19 questions and categorizes sexual dysfunction in 6 domains. : According to FSFI, and using as a cut off score, the value of 26.5, sexual dysfunction was diagnosed in 47% of urge incontinent women compared with 22% among healthy controls. We noticed that from the incontinent women with FSFI score lower than 26.5, 47% reported sexual pain disorders, 34% hypoactive sexual desire, 25% sexual arousal disorders, 25% lubrication disorder, and 22% complained of orgasmic deficiency. Furthermore 6 of 10 women with sexual arousal disorders and 10 of 15 with sexual pain disorders also complained for recurrent bacterial cystitis. The FSFI median values in both groups scored as follows (patients vs. controls: median value): desire: 2.9 versus 4.4; arousal: 2.9 versus 4.5; lubrication: 3.3 versus 4.6; orgasm: 3.5 versus 4.3; sexual satisfaction: 2.9 versus 4.4; sexual pain: 2.8 versus 4.3 and full scale 18.3 versus 26.5 (P < 0.001). : Women with OAB reported sexual dysfunction in a considerably higher number than a general, healthy female population without urinary symptoms.

Women's Sexual Desire and Arousal Disorders

A committee of five was convened to update the chapter on women's sexual dysfunctions from the perspective of diagnostic issues, pathophysiology, assessment, and treatment. To review the literature since 2003 and provide recommendations based on evidence. Research databases, conference proceedings, and articles in press were read for relevant new data on these topics for hypoactive sexual desire disorder (HSDD), female sexual arousal disorder (FSAD), female orgasmic disorder (FOD), and persistent genital arousal disorder (PGAD). Recommendations by five experts from five countries were formulated with associated grades. The definitions of HSDD, FSAD, and FOD in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text-Revised are imperfect and have been criticized over the last decade. Proposed new criteria that take into account empirical findings and the diversity across women are recommended. There has been a flurry of new epidemiological studies on women's sexual dysfunction; studies also assessing distress consistently find a much lower prevalence of dysfunction if distress is considered. Assessment of sexual difficulties is best achieved through a biopsychosocial clinical interview of the woman and her partner (if possible); though laboratory investigations, a physical examination, psychophysiological measurement, and self-report questionnaires can often supplement the interview information. There are currently no approved pharmacological treatments for women's sexual dysfunction in North America, though a number of promising agents have been studied. Evidence for the efficacy of psychological treatments is based on limited studies. There is an urgent need for more data on the assessment, etiology, and treatment of PGAD. Specific recommendations for the assessment and treatment of women's desire, arousal, and orgasm disorders are forwarded; however, more research into these domains is needed.

Neurologic Factors in Female Sexual Function and Dysfunction

Sexual dysfunction affects both men and women, involving organic disorders, psychological problems, or both. Overall, the state of our knowledge is less advanced regarding female sexual physiology in comparison with male sexual function. Female sexual dysfunction has received little clinical and basic research attention and remains a largely untapped field in medicine. The epidemiology of female sexual dysfunction is poorly understood because relatively few studies have been done in community settings. In the United States, female sexual dysfunction has been estimated to affect 40% of women in the general population. Among the elderly, however, it has been reported that up to 87% of women complain of sexual dissatisfaction. Several studies have shown that the prevalence of female sexual arousal disorders correlates significantly with increasing age. These studies have shown that sexual arousal and frequency of coitus in the female decreases with increasing age. The pathophysiology of female sexual dysfunction appears more complex than that of males, involving multidimensional hormonal, neurological, vascular, psychological, and interpersonal aspects. Organic female sexual disorders may include a wide variety of vascular, neural, or neurovascular factors that lead to problems with libido, lubrication, and orgasm. However, the precise etiology and mechanistic pathways of age-related female sexual arousal disorders are yet to be determined. In the past two decades, some advances have been made in exploring the basic hemodynamics and neuroregulation of female sexual function and dysfunction in both animal models and in human studies. In this review, we summarize neural regulation of sexual function and neurological causes of sexual dysfunction in women.

Vascular Alterations and Sexual Function in Systemic Sclerosis

Sexual dysfunction is common in systemic sclerosis (SSc). Male erectile dysfunction (MED) has been reported in around 80% of subjects and more than half of female patients fulfill criteria for diagnosis as female sexual arousal Disorder (FSAD). While some evidence supports a role for cavernosal fibrosis, abundant data suggest that MED is yet another clinical feature of SSc related to vasculopathy. The contribution of vasculopathy to the more complex issues of female sexual dysfunction is less clear. Inhibitors of Type V phosphodiesterase are effective in men with MED secondary to SSc. Limited study in women suggests inconsistent effects on behavior (frequency) but not on measures related to perfusion. Sexual activity is an important component of quality of life and an important domain for the caregiver to address; it is not clear that it warrants primary consideration as a consistent measure of scleroderma-related vasculopathy.

Treatment Options for Female Sexual Arousal Disorder: Part II

Female sexual arousal disorder (FSAD) occurs when a woman experiences distress due to the inability to attain or maintain adequate vaginal lubrication. Many treatments are still under investigation, and at this time, there are no FDA-approved medications available for the treatment of FSAD. Treatment options include "off-label" medications, vaginal estrogen, compounded preparations, and over-the-counter products.

Female Sexual Arousal Disorder with and without a Distress Criterion: Prevalence and Correlates in a Representative Czech Sample

Sexual medicine would benefit from large representative surveys examining the prevalence of genital female sexual arousal disorder (FSAD) symptoms (with and without the increasingly controversial distress criterion), as well as novel FSAD correlates and potential "protective" factors. To examine the extent to which genital FSAD symptoms, with and without a distress criterion, are associated with both historical and current aspects of sexual behavior. In a representative sample of the Czech population (aged 15-88), 1,000 women were asked whether they currently have impaired lubrication and vaginal swelling (and if so, if this produces marked distress or interpersonal difficulty). They provided details of vaginal orgasm (induced by penile-vaginal intercourse [PVI] without clitoral masturbation) consistency, feelings during their first PVI, estimates of their typical foreplay and PVI durations, their degree of mental focus on vaginal sensations during PVI, among other factors. The current prevalence of FSAD with and without a distress criterion and their associations with current and antecedent sexual behaviors and responses. The current prevalence of FSAD was 10.3% without, plus 7.5% with a distress criterion (which tended to be associated with more impairments than without distress). History of vaginal orgasm (odds ratio = 2.78), never masturbating (odds ratio = 2.4), not having felt pain and discomfort on first PVI (odds ratio = 2.27), and not having frequent anal intercourse are protective against FSAD with distress, but not without distress. Age (especially over 50) and inadequate focusing of mental attention on vaginal sensations during PVI are associated with increased FSAD risk both with and without distress. FSAD with and without distress appear to be different entities to some extent, with the distressed group showing more long-term signs of psychosexual impairment. We suggest that FSAD with and without distress be considered two different disorders.