The Female Sexual Response
Dr. Nelson Soucasaux , Brazilian gynecologist
By sexual response, I mean the physiological aspects of sexuality. There
are considerable differences between women and men. For example, women have
no recovery period after orgasm that could impede the start of an immediate,
new excitatory cycle, contrary to what happens in males. This fact makes
it possible for women to have multiple and successive orgasms.
The main objective phenomena that take place in the female genitals
during the cycle of sexual response are: 1) vaginal lubrication (wetness);
2) vaginal lengthening and enlargement; 3) swelling of the external genitals;
4) swelling of the vaginal lower third, creating the so-called "orgasmic
platform"; 5) increase of the uterine volume; 6) ascent of the uterus
in the pelvis (which happens when the uterus is in anteversion, but does
not occur when this organ is in retroversion) (see Note
1, below); 7) during orgasm, the rhythmic contractions of the uterus
and the perineal muscles that surround the vaginal entrance; and 8) disappearance
of all these changes shortly after orgasm if a new excitatory cycle does
not begin.
All these phenomena are due to congestive (caused by expanding of the
blood vessels: vasodilation) and myotonic reactions (characterized by an
increase in the muscular excitability and contractility), and are controlled
by the vegetative innervation of the female pelvic organs. Detailed physiological
data on these physical, objective events originated by sexual excitement
can be found in Masters and Johnson's pioneer work (Masters, W.; Johnson,
V., "Human Sexual Response," Little, Brown and Company, Boston,
U.S.A., 1966). It is just after orgasm that the intense pelvic vasocongestion
resulting from sexual excitement quickly disappears. If orgasm is not attained,
this vasodilation takes much longer to disappear, a fact that, in women,
may cause painful phenomena due to the persistent engorgement of the inner
genitals.
As difficulty in reaching orgasm is, for several reasons, very frequent
in the female sex, prolonged sexual excitement unresolved by unattained
orgasmic response may lead to a gynecological condition characterized by
pelvic congestion, pain and discomfort. This difficulty in attaining orgasm
that torments many women is due, to a great extent, to the complexity of
the female sexual response. However, these difficulties inherent to the
female sexual physiology are considerably aggravated by the usual male "clumsiness"
and by the lack of knowledge of several basic facts regarding sexual response
and psychology on the part of both sexes.
Many women complain about vaginal discomfort and irritation after intercourse.
In the absence of the frequent vulvo-vaginal inflammatory-infectious conditions
and of the dryness and hypotrophy of these organs resulting from the post-menopausal
estrogen fall, one of the causes for this vaginal irritation after intercourse
is vaginal penetration before women are adequately excited. Considering
that the first reaction of the female genitals to sexual excitement is vaginal
lubrication, if a woman is penetrated without being properly excited and,
therefore, without the occurrence of the necessary physiological vaginal
lubrication, several symptoms of vulvo-vaginal discomfort may occur.
Another important question regarding the female sexual response is that
of the old controversy about the clitoral and vaginal orgasm. It is known
that orgasm, regarded here at the level of physiological response, is basically
the same, independently of which area of the body is stimulated. Only the
intensity, both of the response at the physical level and of the subjective
(psychological) experience, can vary. Nevertheless, it is a well-known fact
that the clitoris is, at the genital level, much more sensitive to stimulation
than the vagina, whose walls, mostly in its inner two-thirds, have in fact
a small specific sensitivity. In most women clitoral stimulation is more
effective than the vaginal one in creating an orgasm, though the vaginal
stimulation by the penis during intercourse is capable of producing a secondary
stimulation of the clitoris due to the movement and traction over the vulval
labia. Moreover, contact of the male pubis with the clitoral region can
also occur during sexual intercourse, mostly when women stay in the upper
position.
Even so, considering the complexity of the female sexual response, it
is known that a relatively small number of women usually achieve orgasm
during vaginal coitus. As we have seen, there are some physiological reasons
that account for this but, even so, they do not seem to be the main ones.
The female sexual response is much more complex and problematic than the
male one (a condition aggravated by frequent misunderstandings between the
two sexes due to the ignorance of the problem). Because of this, from the
point of view of the effectiveness of the physical stimulation during sexual
intercourse, vaginal coitus often is much more important to men than to
women.
The vagina is the ideal organ to stimulate the penis and lead men to
orgasm, but the penis is not always the ideal organ to lead women to orgasm
(though some women may disagree). Thus, in the strictly physical aspect
of sexual intercourse (and only in this physical aspect, I want to make
that quite clear), vaginal coitus seems to be more effective in satisfying
men. However, from the psychological and emotional points of view, which
undoubtedly are the most important ones, this observation is no longer valid,
and here the value of vaginal intercourse becomes equally enormous for both
sexes.
Even so, it is important to emphasize that such differences existing
at the physiological level frequently have several consequences to women
and are capable of generating several psychological and psychosomatic problems.
All of this becomes more complicated by the fact that it is vaginal coitus
that creates the constant risk of undesired pregnancies, therefore causing
one more preoccupation for women and obliging them to constantly search
for contraceptive methods. Examples of the aforementioned problems can vary
from an attitude of resentment against men (that can manifest itself in
the form of frigidity or dyspareunia) to painful symptoms of chronic pelvic
congestion resulting from cycles of prolonged sexual excitement unresolved
by the orgasmic response, frequently unattained.
As we have already observed, it is only after orgasm that the intense
vasocongestive reaction resulting from sexual excitement disappears quickly.
If orgasm does not take place, such pelvic vascular congestion takes much
longer to disappear, a condition that, in women, may cause pelvic pain and
discomfort as a consequence of the prolonged swelling and engorgement of
the internal genitals.
Note 1: Uterine anteversion: the typical
position of the uterus, in which the uterine corpus (main part) is bent
forward, towards the bladder. Retroversion: uterine position in which the
uterine corpus is bent backwards, towards the rectum (also known as uterine
retrodisplacement).
Also: As to the Gräfenberg Point,
a small structure located behind the vaginal anterior wall along the urethra
whose stimulation may also lead some women to orgasm, see page "Temas
Polêmicos" ("Polemical Subjects") at my Web site www.nelsonginecologia.med.br
(http://www.nelsonginecologia.med.br/temas.htm).
(Just click for English translation and scroll down the page.)
The text above is a modified and updated excerpt from my book "Novas
Perspectivas em Ginecologia" ("New Perspectives in Gynecology"),
published by Imago Editora, Rio de Janeiro, 1993. For information on the
book see page http://www.nelsonginecologia.med.br/novas.htm at my
aforementioned website.
Copyright Nelson Soucasaux 1990, 2003
________________________________________________
Nelson Soucasaux is a gynecologist dedicated to clinical, preventive
and psychosomatic gynecology. Graduated in 1974 by Faculdade de Medicina
da Universidade Federal do Rio de Janeiro, Brazil, he is the author of several
articles published in medical journals, and of the books "Novas Perspectivas
em Ginecologia" ("New Perspectives in Gynecology") and "Os
Órgãos Sexuais Femininos: Forma, Função, Símbolo
e Arquétipo" ("The Female Sexual Organs: Shape, Function,
Symbol and Archetype"), published by Imago Editora, Rio de Janeiro,
1990, 1993.
Website (Portuguese-English): www.nelsonginecologia.med.br
<http://www.nelsonginecologia.med.br>
Email: nelsons@nelsonginecologia.med.br