Aboubakr Elnashar Benha university Hospital, Egypt

Master & Johonson (1966):

Excitement,

Plateau,

Orgasm &

Resolution.

Completely mechanistic , ignores feelings

Distinction between Excitement & Plateau is imprecise

Kaplan (1979):

Desire,

Excitement (Plateau is a part of Excitement).

Orgasm &

Resolution.

This fits better with FSD

The motivation & the inclination to be

sexual.It is subjective feeling state.

It is triggered by both internal (fantasy) &

external (an interested partner) sexual cues.

It is mediated by testosterone (CNS).

Excitation is dopamine dependent &

Inhibition is serotinine dependent

It is influenced by:

sexual orientation,

preference,

psychologic &

environmental status.

It is mediated by parasympathetic NS.

The primary response: Vasocongestion

Females: Tactile & psychic stimuli ,

more individual variability than male,

slower, not easily inhibited

Males: Visual stimuli, more rapid, easily

inhibited

Genital changes:

clitoral enlargement,

lubrication of the vagina,

proximal vaginal expansion,

labial engorgement

Extragenital changes:

increased P , B.P

muscle tension,

extrapelvic vascular dilatation (breast swelling,

nipple erection, areolar engorgement, skin flush)

It is mediated by parasympathetic NS.

The primary response: vasocongestion

It is the progression & intensification of the arousal phase

Changes:

1. Formation of an orgasmic platform: engorging & swelling of the outer 1/3 of the vagina, decreasing the inner diameter by 40%, & gripping the penis.

2. Retraction of the clitoris into the hood.

3. Elevation & ballooning of the proximal 2/3 of the vagina.

4.The uterus elevates fully out of the pelvis.

5. Further labial engorgement

It is mediated by sympathetic NS.

The primary response: Reflex clonic contractions

Female: individual variability, multiple, easily inhibited.

Male: Similar, single, not easily inhibited.

It is sudden release of the of the tension that

has built up during during arousal & plateau.

Initial contraction of the outer 1/3 of the vagina

& levator sling, followed by contraction of the

uterus & anal sphincter

It is return to the basal physiologic state.

Reversal of vasocongestion

Female: Slow

Male: rapid

Not existent in females, occurs only in males.

It is the time needed to refill seminal vesicles

Incidence of FSD

FSD is more common than MSD.

USA (Laumann et al, 1999):

FSD: 43% MSD: 31%

Egypt: no studies

However FSD are detected rarely by the gynecologist

1. Patient: find it is difficult to talk to their doctor

2. Doctor: little knowledge, little time, find it is inappropriate to ask.

Types of FSD

1. Sexual desire disorders:

Hypoactive sexual desire & sexual aversion

2. Sexual arousal disorders

3. Orgasmic disorders

4. Penetration disorders:

Dysparunia &

Vaginismus

5. Other sexual disorders:

Sexual phobias,

Anesthesia with arousal & orgasm,

Genital pain during non-coital activities.

Each is further classified into

1. Primary (lifelong) or

secondary acquired after a period of normal sexual function

2. Total (generalized) or

situational (SD in some situations only)

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