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1.
Clin Anat ; 33(1): 136-145, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31691374

RESUMO

Stimulating the clitoris activates the brain to instigate changes in the female genital tract, namely, the enhancement of vaginal blood flow that increases vaginal luminal pO2 , vaginal transudate (lubrication) facilitating painless penile penetration and partial neutralization of the basal luminal acidic pH, vaginal tenting, and ballooning delaying sperm transport and allowing semen de-coagulation and capacitation (sperm activation) factors to act until arousal ends (often by orgasm induction). All these genital changes taken together are of major importance in facilitating the possibility of reproductive success (and thus gene propagation) no matter how or when the clitoris is stimulated-they reveal its overlooked reproductive function. Of course, also commensurate with these changes, is its activation of sexual pleasure. The clitoris thus has both procreative (reproductive) and recreative (pleasure) functions of equal importance. Clitoridectomy creates not only sexual disability but also a reproductive disability. Clin. Anat. 32:136-145, 2019. © 2019 Wiley Periodicals, Inc.


Assuntos
Nível de Alerta , Clitóris/anatomia & histologia , Clitóris/fisiologia , Fertilidade , Reprodução , Comportamento Sexual/fisiologia , Vagina/fisiologia , Circuncisão Feminina , Feminino , Humanos
2.
Neurourol Urodyn ; 38(3): 893-901, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30779374

RESUMO

AIMS: To analyze, in female rats, the anatomical and histological features of the urethra and its relationship with the vagina and clitoris, and its innervation. METHODS: Seventeen adult female Wistar rats were used. Gross anatomy and acetylcholinesterase (AchE) histochemistry were performed to describe the urethral features, adjacent structures, and innervation. The histomorphometric characteristics of the urethra were determined in transversal, longitudinal, or coronal sections stained with Masson's Trichrome. RESULTS: The female rat urethra is not a homogeneous tubular organ. The pre-pelvic and pelvic regions are firmly attached to the vagina with belt-like striated fibers forming a urethra-vaginal complex. The bulbar regions have curved segments and a narrow lumen. The clitoral region is characterized by a urethra-clitoral complex surrounded by a vascular plexus. The lumen area and thickness of the urethral layers significantly varied between regions (P < 0.05). Innervation of the urethra arrives from the major pelvic ganglion, the dorsal nerve of the clitoris (DNC), and the motor branch of the sacral plexus (MBSP). CONCLUSIONS: Differential tissular composition of the urethra may underlie urinary continence and voiding dysfunction through different physiological mechanisms. The urethra-vagina complex seems to be the main site controlling urinary continence through active muscular mechanisms, while the bulbar urethra provides passive mechanisms and the urethra-clitoris complex seems to be crucial for distal urethral closure by means of a periurethral vascular network.


Assuntos
Uretra/metabolismo , Uretra/fisiologia , Incontinência Urinária , Micção/fisiologia , Acetilcolinesterase/metabolismo , Animais , Composição Corporal , Clitóris/anatomia & histologia , Clitóris/inervação , Clitóris/fisiologia , Feminino , Plexo Hipogástrico/fisiologia , Plexo Lombossacral/fisiologia , Nervo Pudendo/fisiologia , Ratos , Ratos Wistar , Uretra/inervação , Vagina/anatomia & histologia , Vagina/inervação , Vagina/fisiologia
3.
Horm Behav ; 109: 1-9, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30690029

RESUMO

Fifty-kHz ultrasonic vocalizations (USVs) are emitted by adult rats during appetitive phases of behavior in response to stimuli thought to be associated with a positive affective state. In particular, 50-kHz USVs with rapid frequency oscillations, known as trills and flat-trills, in which these oscillations are flanked by a monotonic portion, are together positively correlated with appetitive behaviors such as rough and tumble play, drug and natural reward, and mating. Female rats produce 50-kHz USVs during a variety of sexual contexts, yet data are still vague as female sexual behavior is seldom studied on its own. Distributed clitoral stimulation (CLS) offers a unique approach to investigating female 50-kHz USVs as it mimics stimulation received during mating. Although CLS induces a sexual reward state, it is unknown whether CLS elicits trills and flat-trills. We addressed this question using eight ovariectomized rats, we investigated whether ovarian hormones augmented these call subtypes in response to CLS. The combined and separate effects of estradiol benzoate (EB) and progesterone (P), and oil vehicle were assessed through comparison of these call subtypes between CLS and inter-CLS interval. We found that CLS with EB + P significantly increased call duration and rate, lowered peak frequency, and widened the bandwidth of trills. Flat-trills showed a similar pattern except for call duration. Call distribution during the CLS and inter-CLS interval suggest that trill and flat-trills may be indicative of both anticipatory and sexual reward.


Assuntos
Hormônios Esteroides Gonadais/farmacologia , Estimulação Física/métodos , Comportamento Sexual Animal/efeitos dos fármacos , Vocalização Animal/efeitos dos fármacos , Animais , Comportamento Apetitivo/efeitos dos fármacos , Clitóris/fisiologia , Estradiol/análogos & derivados , Estradiol/farmacologia , Feminino , Hormônios Esteroides Gonadais/metabolismo , Ovário/metabolismo , Progesterona/farmacologia , Ratos , Ratos Long-Evans , Recompensa , Ultrassom , Vocalização Animal/fisiologia
4.
Clin Anat ; 31(5): 650-660, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29693269

RESUMO

This article reviews clitoral structures, their functions and how they are activated during the stages of female life. The paradox that occurs is that different procedures of activation are claimed by some to favor 'noxious outcomes' to the physical and psychic health of women who use it to achieve sexual arousal/orgasm with or without penile vaginal intercourse. A number of the difficulties and inconsistencies in relation to these claims are explored. The proposed justification for the 'noxious outcomes' is that 'evolution' punishes sexual arousals other than by coitus because it is the only one that leads to gene propagation. In this context, however, the new, evolutionary interpretation of clitoral function in the fertile years as a fundamental proximate mechanism for facilitating female reproductive fitness makes such a justification improbable. The role of coital alignment technique (CAT) in the treatment of female orgasmic disorder is discussed in relation to its features of introital, clitoral and periurethral glans stimulation. Attempts to control female sexuality through various 'clitoridectomies' are examined, and unanswered questions about clitoral stimulation are listed. Clin. Anat. 31:650-660, 2018. © 2018 Wiley Periodicals, Inc.


Assuntos
Clitóris/fisiologia , Orgasmo , Circuncisão Feminina , Feminino , Humanos , Masturbação , Disfunções Sexuais Fisiológicas/terapia
5.
Arch Sex Behav ; 47(5): 1497-1505, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29524055

RESUMO

During pregnancy, women go through a series of physical and emotional changes that may have an impact on their sexuality. The aim of the study was to examine modifications in sexual function during pregnancy by means of translabial ultrasonography and administration of questionnaires on sexual activity. Eighteen healthy and adult (25-35 years) pregnant women without sexual dysfunction and with a stable heterosexual relationship were examined at 10-12, 18-20, and 30-32 weeks of gestation. Patients underwent ultrasonographic translabial clitoral volume and labia minora thickness measurements and color Doppler assessment of the dorsal clitoral and posterior labial arteries. On the same day, each patient completed the two-factor Italian McCoy Female Questionnaire (MFSQ) and the Female Sexual Function Index (FSFI). The mean clitoral body volume progressively increased during pregnancy, and color Doppler analysis of the dorsal clitoral artery showed a significant decrease in the pulsatility index from the first to the third trimester. Similarly, the labia minora thickness increased and the posterior labial artery pulsatility index progressively decreased throughout gestation. The MFSQ score for sexuality and partnership and the number of intercourses/week did not significantly change during the study period. However, the MFSQ score for partnership reached the lowest value in the third trimester of pregnancy. Analysis of the FSFI data showed no significant differences throughout pregnancy for the majority of the domains (sexual desire, arousal, orgasm, lubrication, and pain), with the exception of the satisfaction item, which decreased during the third trimester. A significant proportion of women are concerned that changes in their body during pregnancy may have a detrimental effect on sexuality. Despite significant changes in genital morphology and vascularity throughout gestation, these modifications do not seem to have an impact on sexual function in pregnancy.


Assuntos
Clitóris , Gravidez/fisiologia , Clitóris/irrigação sanguínea , Clitóris/fisiologia , Feminino , Humanos , Estudos Longitudinais , Projetos Piloto , Comportamento Sexual/estatística & dados numéricos , Inquéritos e Questionários
6.
Arch Sex Behav ; 47(3): 605-613, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29079939

RESUMO

Most women report reliably experiencing orgasm from masturbation, but a smaller proportion of women report regularly experiencing orgasm from intercourse. Research suggests that concurrent clitoral stimulation during intercourse increases the likelihood of orgasm, yet most surveys of orgasm during intercourse leave unspecified whether vaginal intercourse does or does not include concurrent clitoral stimulation (assisted intercourse or unassisted intercourse, respectively). Using an online sample of 1569 men and 1478 women, we tested whether phrasing of questions about the occurrence of orgasm in intercourse modulates women's reported frequency and men's estimates of women's frequency of orgasm in intercourse. Participants provided estimates of orgasm when asked explicitly about intercourse with stimulation unspecified, assisted intercourse, and unassisted intercourse. Women's reports of orgasm occurrence were highest in response to assisted intercourse (51-60%), second highest in response to intercourse with clitoral stimulation unspecified (31-40%), and lowest in response to unassisted intercourse (21-30%). Men's estimates of women's orgasms were highest in response to assisted intercourse (61-70%), and lowest in response to unassisted intercourse (41-50%); in both conditions, men's estimates were significantly higher than women's reports. When clitoral stimulation was unspecified, women interpreted "orgasm in intercourse" in three ways: as from intercourse alone, as including concurrent clitoral stimulation though it was unspecified, or as an average of assisted and unassisted intercourse. Taken together, these results demonstrate that the phrasing of questions about women's orgasm produces markedly different orgasm estimates, and suggest that concurrent clitoral stimulation increases the likelihood of women experiencing orgasm in intercourse.


Assuntos
Clitóris/fisiologia , Coito/psicologia , Masturbação/psicologia , Orgasmo/fisiologia , Parceiros Sexuais/psicologia , Adulto , Coito/fisiologia , Feminino , Humanos , Masculino , Comportamento Sexual/psicologia
7.
J Sex Med ; 14(11): 1380-1391, 2017 11.
Artigo em Inglês | MEDLINE | ID: mdl-28986148

RESUMO

BACKGROUND: Although the literature on imaging of regional brain activity during sexual arousal in women and men is extensive and largely consistent, that on orgasm is relatively limited and variable, owing in part to the methodologic challenges posed by variability in latency to orgasm in participants and head movement. AIM: To compare brain activity at orgasm (self- and partner-induced) with that at the onset of genital stimulation, immediately before the onset of orgasm, and immediately after the cessation of orgasm and to upgrade the methodology for obtaining and analyzing functional magnetic resonance imaging (fMRI) findings. METHODS: Using fMRI, we sampled equivalent time points across female participants' variable durations of stimulation and orgasm in response to self- and partner-induced clitoral stimulation. The first 20-second epoch of orgasm was contrasted with the 20-second epochs at the beginning of stimulation and immediately before and after orgasm. Separate analyses were conducted for whole-brain and brainstem regions of interest. For a finer-grained analysis of the peri-orgasm phase, we conducted a time-course analysis on regions of interest. Head movement was minimized to a mean less than 1.3 mm using a custom-fitted thermoplastic whole-head and neck brace stabilizer. OUTCOMES: Ten women experienced orgasm elicited by self- and partner-induced genital stimulation in a Siemens 3-T Trio fMRI scanner. RESULTS: Brain activity gradually increased leading up to orgasm, peaked at orgasm, and then decreased. We found no evidence of deactivation of brain regions leading up to or during orgasm. The activated brain regions included sensory, motor, reward, frontal cortical, and brainstem regions (eg, nucleus accumbens, insula, anterior cingulate cortex, orbitofrontal cortex, operculum, right angular gyrus, paracentral lobule, cerebellum, hippocampus, amygdala, hypothalamus, ventral tegmental area, and dorsal raphe). CLINICAL TRANSLATION: Insight gained from the present findings could provide guidance toward a rational basis for treatment of orgasmic disorders, including anorgasmia. STRENGTHS AND LIMITATIONS: This is evidently the first fMRI study of orgasm elicited by self- and partner-induced genital stimulation in women. Methodologic solutions to the technical issues posed by excessive head movement and variable latencies to orgasm were successfully applied in the present study, enabling identification of brain regions involved in orgasm. Limitations include the small sample (N = 10), which combined self- and partner-induced stimulation datasets for analysis and which qualify the generalization of our conclusions. CONCLUSION: Extensive cortical, subcortical, and brainstem regions reach peak levels of activity at orgasm. Wise NJ, Frangos E, Komisaruk BR. Brain Activity Unique to Orgasm in Women: An fMRI Analysis. J Sex Med 2017;14:1380-1391.


Assuntos
Encéfalo/fisiologia , Clitóris/fisiologia , Orgasmo/fisiologia , Adulto , Mapeamento Encefálico/métodos , Córtex Cerebral/fisiologia , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Disfunções Sexuais Psicogênicas/prevenção & controle
8.
J Sex Med ; 14(2): 274-281, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-28161082

RESUMO

INTRODUCTION: Gender-affirming surgery is common for the treatment of gender dysphoria, but its effect on genital sensitivity is not well known. AIMS: To investigate genital sensory detection thresholds in male-to-female transgender women postoperatively and their relation to psychological well-being and variables of satisfaction. METHODS: Prospective study on 28 transgender women at least 18 years old operated on at least 3 months before the study by a single surgeon (N.M.J.). MAIN OUTCOME MEASURES: Medical complications; sensory detection thresholds for light touch, pressure, and vibration; and questionnaires on general and sexual satisfaction, sexual function, depression, and psychological well-being. RESULTS: Sensory detection thresholds ranged from 0.07 to 2.82 g for light touch, with the neck being most sensitive; from 20.23 to 34.64 g for pressure, with similar results for the neck and clitoris; and from 0.0052 to 0.0111 V for vibration, with similar findings for all stimulation points. Satisfaction with the appearance of the labia, vulva, clitoris, and sexual function was good to very good. Frequency of sexual activities increased significantly postoperatively for orogenital stimulation and decreased significantly for frequency of fantasies (t = -4.81; P < .0001). Orgasmic function was reported by 80% of participants. Psychological adjustment was good to very good, with low depression scores. Sexual satisfaction was statistically and positively correlated with vaginal function and depth, clitoral sensation, appearance of the vulva and labia minora, and natural lubrication and negatively correlated with depression scores. CONCLUSION: Gender-affirming surgery yields good results for satisfaction with appearance and function. Genital sensitivity showed the best results with pressure and vibration.


Assuntos
Clitóris/fisiologia , Satisfação do Paciente , Tato/fisiologia , Pessoas Transgênero/psicologia , Vagina/cirurgia , Adulto , Feminino , Humanos , Masculino , Orgasmo , Período Pós-Operatório , Estudos Prospectivos , Limiar Sensorial/fisiologia , Cirurgia de Readequação Sexual/métodos , Adulto Jovem
9.
Surg Technol Int ; 30: 221-227, 2016 Dec 13.
Artigo em Inglês | MEDLINE | ID: mdl-27960026

RESUMO

OBJECTIVE: The aim of this investigation was to determine, through two Investigational Review Board (IRB)-approved studies, if a new topical vasodilating cream (NTVC; Life Science Enhancement Corporation, Pittsburgh PA) could improve female sexual response. Study I subjectively evaluated sexual female response as accessed by a modification of the Female Intervention Efficacy Index (FIEI). FIEI was developed at the University of California as an immediate outcome measure of medical intervention to treat female sexual dysfunction.1 In Study II, 10 randomly selected positive responders from Study I were subsequently analyzed objectively with clitoral plethysmography in order to determine the effect of the NTVC and placebo on blood flow.2 RESULTS: In the subjective Study I (81 patients ranging in age from 18 to 63), a positive response trend for the NTVC was demonstrated compared to the placebo. In the objective Study II, 10 randomly selected patients who responded positive in Study I were objectively evaluated for response of increased blood flow in the clitoris after application of both the NTVC and placebo. The clitoral blood flow was shown to have increased with statistical significance for the NTVC in all 10 patients compared to the placebo, with the NTVC exhibiting an average 69% increase in clitoral blood flow. CONCLUSIONS: The female sexual response is complex. In the subjective Study I, the NTVC demonstrated positive trends for enhanced lubrication, genital sensation, intercourse, and overall sexual experience. In the objective Study II, 10 of the positive subjective responders from Study I were randomly selected to evaluate their response to the NTVC compared to the placebo. This was done via Doppler plethysmography (DP). All 10 patients demonstrated a statistically significant response rate for increase in clitoral blood flow using the NTVC compared to the placebo, with an average blood flow increase of 69%. This portion of the investigation demonstrates a significant positive end organ response to the NTVC. The positive subjective trends combined with the significant and substantial increase in clitoral blood flow may result in enhanced female sexual satisfaction.


Assuntos
Clitóris/irrigação sanguínea , Comportamento Sexual , Vasodilatadores/uso terapêutico , Adolescente , Adulto , Clitóris/fisiologia , Feminino , Humanos , Pessoa de Meia-Idade , Fluxo Sanguíneo Regional , Adulto Jovem
10.
J Sex Med ; 13(11): 1676-1685, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-27667356

RESUMO

INTRODUCTION: Most women report that clitoral stimulation is an integral aspect of their orgasm experience. Thus, recent claims that vaginal stimulation and vaginally generated orgasms are superior to clitoral stimulation and clitorally generated orgasms pathologize most women and maintain a clitoral vs vaginal dichotomy that might not accurately reflect the complexity of women's sexual experience. AIM: To have women report on their experienced source of orgasm, including combinations of vaginal and clitoral stimulation, the solo or partnered context of the stimulation, and the intensity of the orgasms from different sources and to predict indicators of mental health and sexual health using the orgasm source. METHODS: Eighty-eight women 18 to 53 years old answered detailed questions about their usual and recent orgasm experiences, sexual history, depression, and anxiety. Then, they viewed a series of neutral and sexual films. They were instructed to increase or decrease their sexual arousal or respond "as usual" to the sexual films. They reported their sexual arousal after each film. MAIN OUTCOME MEASURES: Outcomes assessed included mental health (depression and anxiety) and sexual health (orgasm quality, ability to regulate sexual response to sex films). Reported sexual arousal was analyzed for the regulation task. RESULTS: Most women (64%) reported that clitoral and vaginal stimulation contributed to their usual method of reaching orgasm. Women who reported that clitoral stimulation was primarily responsible for their orgasm reported a higher desire to self-stimulate and demonstrated greater control over their self-reported sexual arousal. The primary stimulation site for orgasm was unrelated to measurements of depression or anxiety despite sufficient statistical power. CONCLUSION: Most women reported that clitoral and vaginal stimulation is important in orgasm. Women experience orgasms in many varied patterns, a complexity that is often ignored by current methods of assessing orgasm source. The reported source of orgasm was unrelated to orgasm intensity, overall sex-life satisfaction, sexual distress, depression, or anxiety. Women who reported primarily stimulating their clitoris to reach orgasm reported higher trait sexual drive and higher sexual arousal to visual sexual stimulation and were better able to increase their sexual arousal to visual sexual stimulation when instructed than women who reported orgasms primarily from vaginal sources.


Assuntos
Clitóris/fisiologia , Libido/fisiologia , Orgasmo/fisiologia , Vagina/fisiologia , Adolescente , Adulto , Ansiedade/fisiopatologia , Ansiedade/psicologia , Transtornos de Ansiedade/fisiopatologia , Transtornos de Ansiedade/psicologia , Nível de Alerta/fisiologia , Depressão/fisiopatologia , Depressão/psicologia , Transtorno Depressivo/fisiopatologia , Transtorno Depressivo/psicologia , Feminino , Humanos , Pessoa de Meia-Idade , Satisfação Pessoal , Psicometria , Saúde Reprodutiva , Comportamento Sexual/psicologia , Inquéritos e Questionários , Tato/fisiologia , Adulto Jovem
11.
Sex Med Rev ; 4(2): 121-5, 2016 04.
Artigo em Inglês | MEDLINE | ID: mdl-27530381

RESUMO

INTRODUCTION: 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. AIM: To review available evidence of QST in the investigation of genital sensation in women with FSD. METHODS: 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. MAIN OUTCOME MEASURE: Use of QST for assessment of FSD. RESULTS: 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. CONCLUSION: 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.


Assuntos
Clitóris/inervação , Clitóris/fisiologia , Esclerose Múltipla/fisiopatologia , Sensação/fisiologia , Disfunções Sexuais Fisiológicas/diagnóstico , Temperatura Baixa , Feminino , Temperatura Alta , Humanos , Histerectomia/efeitos adversos , Prolapso de Órgão Pélvico/fisiopatologia , Disfunções Sexuais Fisiológicas/epidemiologia , Disfunções Sexuais Fisiológicas/etiologia , Vibração
12.
Kennedy Inst Ethics J ; 26(2): 105-44, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27477191

RESUMO

The spectrum of practices termed "Female Genital Mutilation" (or FGM) by the World Health Organization is sometimes held up as a counterexample to moral relativism. Those who advance this line of thought suggest the practices are so harmful in terms of their physical and emotional consequences, as well as so problematic in terms of their sexist or oppressive implications, that they provide sufficient, rational grounds for the assertion of a universal moral claim--namely, that all forms of FGM are wrong, regardless of the cultural context. However, others point to cultural bias and moral double standards on the part of those who espouse this argument, and have begun to question the received interpretation of the relevant empirical data on FGM as well. In this article I assess the merits of these competing perspectives. I argue that each of them involves valid moral concerns that should be taken seriously in order to move the discussion forward. In doing so, I draw on the biomedical "enhancement" literature in order to develop a novel ethical framework for evaluating FGM (and related interventions--such as female genital "cosmetic" surgery and nontherapeutic male circumcision) that takes into account the genuine harms that are at stake in these procedures, but which does not suffer from being based on cultural or moral double standards.


Assuntos
Melhoramento Biomédico , Circuncisão Feminina/etnologia , Circuncisão Feminina/ética , Circuncisão Masculina , Clitóris/cirurgia , Características Culturais , Emigrantes e Imigrantes , Estética , Relativismo Ético , Características da Família , Islamismo , Orgasmo , Saúde da Mulher/ética , Adolescente , África , Ásia , Austrália , Beleza , Melhoramento Biomédico/ética , Criança , Circuncisão Feminina/efeitos adversos , Circuncisão Feminina/legislação & jurisprudência , Circuncisão Feminina/métodos , Circuncisão Masculina/efeitos adversos , Circuncisão Masculina/ética , Circuncisão Masculina/etnologia , Clitóris/fisiologia , Emigrantes e Imigrantes/legislação & jurisprudência , Emigrantes e Imigrantes/psicologia , Análise Ética , Feminino , Prepúcio do Pênis/cirurgia , Heterossexualidade , Humanos , Consentimento Informado por Menores , Masculino , Oriente Médio , Orgasmo/fisiologia , Consentimento dos Pais , Percepção Social , Reino Unido , Estados Unidos , Saúde da Mulher/etnologia , Saúde da Mulher/normas , Saúde da Mulher/tendências , Organização Mundial da Saúde
13.
J Exp Zool B Mol Dev Evol ; 326(6): 326-337, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-27478160

RESUMO

The evolutionary explanation of female orgasm has been difficult to come by. The orgasm in women does not obviously contribute to the reproductive success, and surprisingly unreliably accompanies heterosexual intercourse. Two types of explanations have been proposed: one insisting on extant adaptive roles in reproduction, another explaining female orgasm as a byproduct of selection on male orgasm, which is crucial for sperm transfer. We emphasize that these explanations tend to focus on evidence from human biology and thus address the modification of a trait rather than its evolutionary origin. To trace the trait through evolution requires identifying its homologue in other species, which may have limited similarity with the human trait. Human female orgasm is associated with an endocrine surge similar to the copulatory surges in species with induced ovulation. We suggest that the homolog of human orgasm is the reflex that, ancestrally, induced ovulation. This reflex became superfluous with the evolution of spontaneous ovulation, potentially freeing female orgasm for other roles. This is supported by phylogenetic evidence showing that induced ovulation is ancestral, while spontaneous ovulation is derived within eutherians. In addition, the comparative anatomy of female reproductive tract shows that evolution of spontaneous ovulation is correlated with increasing distance of clitoris from the copulatory canal. In summary, we suggest that the female orgasm-like trait may have been adaptive, however for a different role, namely for inducing ovulation. With the evolution of spontaneous ovulation, orgasm was freed to gain secondary roles, which may explain its maintenance, but not its origin.


Assuntos
Evolução Biológica , Orgasmo/fisiologia , Ovulação/fisiologia , Animais , Clitóris/fisiologia , Coito/fisiologia , Copulação/fisiologia , Feminino , Genitália Feminina/anatomia & histologia , Humanos , Masculino , Mamíferos , Filogenia
14.
Int Urogynecol J ; 27(6): 915-8, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26740196

RESUMO

INTRODUCTION AND HYPOTHESIS: The objective was to evaluate vaginal and clitoral sensation before and after robotic sacrocolpopexy for the repair of pelvic organ prolapse. METHODS: Twenty-two women, mean age 63 years (range 41-77), were admitted for robotic sacrocolpopexy repair of pelvic organ prolapse; 4 were lost to follow-up. Quantitative sensory thresholds for warm, cold, and vibratory sensations were measured at the vagina (anterior and posterior areas) and clitoris 1 day before and a mean of 12 ± 4 months following surgery. Student's paired t test was used to compare sensory thresholds before and after surgery. RESULTS: For the 18 women who completed follow-up, sensitivity was significantly higher after surgery (sensory threshold decreased) at the clitoral and vaginal regions, to cold and warm stimuli. In contrast, the vaginal and clitoral vibratory sensory thresholds did not change significantly following surgery. CONCLUSION: The repair of pelvic organ prolapse by robotic sacrocolpopexy could potentially play a role in restoring clitoral and vaginal wall sensation. The effects of these sensory changes on sexual function and the quality of sexual life need further investigation.


Assuntos
Clitóris/fisiologia , Procedimentos Cirúrgicos em Ginecologia , Prolapso de Órgão Pélvico/cirurgia , Sensação Térmica , Vagina/fisiologia , Adulto , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Vibração
15.
Curr Biol ; 26(1): 106-13, 2016 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-26725197

RESUMO

Mammalian external genitals show sexual dimorphism [1, 2] and can change size and shape upon sexual arousal. Genitals feature prominently in the oldest pieces of figural art [3] and phallic depictions of penises informed psychoanalytic thought about sexuality [4, 5]. Despite this longstanding interest, the neural representations of genitals are still poorly understood [6]. In somatosensory cortex specifically, many studies did not detect any cortical representation of genitals [7-9]. Studies in humans debate whether genitals are represented displaced below the foot of the cortical body map [10-12] or whether they are represented somatotopically [13-15]. We wondered what a high-resolution mapping of genital representations might tell us about the sexual differentiation of the mammalian brain. We identified genital responses in rat somatosensory cortex in a region previously assigned as arm/leg cortex. Genital responses were more common in males than in females. Despite such response dimorphism, we observed a stunning anatomical monomorphism of cortical penis and clitoris input maps revealed by cytochrome-oxidase-staining of cortical layer 4. Genital representations were somatotopic and bilaterally symmetric, and their relative size increased markedly during puberty. Size, shape, and erect posture give the cortical penis representation a phallic appearance pointing to a role in sexually aroused states. Cortical genital neurons showed unusual multi-body-part responses and sexually dimorphic receptive fields. Specifically, genital neurons were co-activated by distant body regions, which are touched during mounting in the respective sex. Genital maps indicate a deep homology of penis and clitoris representations in line with a fundamentally bi-sexual layout [16] of the vertebrate brain.


Assuntos
Córtex Somatossensorial/fisiologia , Animais , Encéfalo/fisiologia , Mapeamento Encefálico/métodos , Clitóris/anatomia & histologia , Clitóris/fisiologia , Feminino , Masculino , Neurônios/fisiologia , Pênis/anatomia & histologia , Pênis/fisiologia , Estimulação Física , Ratos , Escroto/anatomia & histologia , Escroto/fisiologia , Caracteres Sexuais , Comportamento Sexual Animal/fisiologia , Tato , Vulva/anatomia & histologia , Vulva/fisiologia
16.
Sex Health ; 13(1): 63-72, 2016 02.
Artigo em Inglês | MEDLINE | ID: mdl-26567764

RESUMO

UNLABELLED: Background Research has highlighted the complex association between female sexual dysfunction (FSD) and distress regarding sexual activity, with decreased physical pleasure being an important mediator. The current study aims to elucidate the association between pleasurable and painful genital sensitivity and FSD, and to further investigate whether FSD may be distressing because it prevents the experience of sexual pleasure, induces pain or both. METHODS: Sexually active women (n=256; median, 22 years; range, 18-49 years) completed web-based questionnaires, including the Self-Assessment of Genital Anatomy and Sexual Function, the Female Sexual Function Index and the Female Sexual Distress Scale. RESULTS: Women reported their clitoris to be more sensitive than their vagina in terms of having more pleasurable responses (P<0.001), but not more painful responses (P=0.49). In women with FSD (n=36), impaired self-perceived genital sensation was found: they reported significantly less sexual pleasure and orgasm intensity, and more orgasm effort and discomfort within the clitoral and vaginal area than women without FSD (n=220) (P-value<0.05). The odds of having FSD were significantly greater in women with perceived increased discomfort in the vaginal area during stimulation (odds ratio=5.59, P=0.009, 95% confidence interval: 1.53-20.39), but not in the clitoral area. CONCLUSIONS: The data provide evidence of the relevance of self-perceived genital sensitivity to sexual pleasure and overall sexual experience. Enhancing the pleasurableness of genital sensations, especially during partnered sex, could decrease the likelihood of experiencing pain and concomitant FSD.


Assuntos
Clitóris/fisiologia , Dor , Disfunções Sexuais Fisiológicas , Disfunções Sexuais Psicogênicas , Adolescente , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Orgasmo , Prazer , Sensação , Comportamento Sexual , Inquéritos e Questionários , Adulto Jovem
17.
J Sex Med ; 12(12): 2324-38, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26632084

RESUMO

INTRODUCTION: The clitoral photoplethysmograph (CPP) is a relatively new device used to measure changes in clitoral blood volume (CBV); however, its construct validity has not yet been evaluated. AIM: To evaluate the discriminant and convergent validity of the CPP. For discriminant validity, CBV responses should differ between sexual and nonsexual emotional films if the CPP accurately assesses clitoral vasocongestion associated with sexual arousal; for convergent validity, CBV responses should significantly correlate with subjective reports of sexual arousal. METHODS: Twenty women (M age = 21.2 years, SD = 3.4) watched neutral, anxiety-inducing, exhilarating, and sexual (female-male sex) audiovisual stimuli while their genital responses were measured simultaneously using vaginal and clitoral photoplethysmographs and CPPs. Most of these participants continuously reported sexual arousal throughout each stimulus (n = 16), and all reported their sexual and nonsexual affect before and after each stimulus; subjective responses were recorded via button presses using a keypad. MAIN OUTCOME MEASURES: Vaginal pulse amplitude (VPA), CBV, and self-reported sexual arousal and nonsexual affect were used as main outcome measures. RESULTS: CBV demonstrated both discriminant and convergent validity. CBV responses were similar to VPA responses and self-reported sexual arousal; all responses differed significantly as a function of stimulus content, with the sexual stimulus eliciting greater relative changes than nonsexual stimuli. CBV, but not VPA, was significantly (negatively) correlated with continuous self-reported sexual arousal during the shorter sexual stimulus. CBV was significantly negatively correlated with VPA for the shorter sexual stimulus. CONCLUSION: CBV may be a valid measure of women's genital sexual arousal that provides complementary information to VPA and correlates with self-reported sexual arousal. Given our relatively small sample size, and that this is among the first research to use the CPP, the current findings must be replicated. More research using the CPP and other devices is required for a more comprehensive description of women's physiological sexual arousal.


Assuntos
Nível de Alerta/fisiologia , Clitóris/irrigação sanguínea , Fotopletismografia , Comportamento Sexual/fisiologia , Vagina/irrigação sanguínea , Adulto , Ansiedade , Clitóris/fisiologia , Emoções , Feminino , Frequência Cardíaca , Humanos , Projetos Piloto , Fluxo Sanguíneo Regional , Reprodutibilidade dos Testes , Autorrelato , Comportamento Sexual/psicologia , Adulto Jovem
18.
Gynecol Oncol ; 139(3): 471-5, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26499935

RESUMO

OBJECTIVE. The aim of this study was to evaluate the efficacy of fat grafting in the treatment of severe vulvar lichen sclerosus (LS). Our primary outcome was to assess the improvement of mucocutaneous trophism, the resolution/reduction of symptoms, and the histological features of the vulvar skin after treatment. The secondary outcome was to evaluate the improvement in life quality, and in resumption and quality of sexual life. METHODS. Between 2011 and 2014, 36 patients were offered fat grafting to treat LS. Inclusion criteria were age between 25 and 80 years, histopathologic diagnosis of LS, good health, failure of previous first line treatments. RESULTS. 34 out of 36 patients (94%) showed a better vulvar trophismof the skin and mucosae; 27 (75%) had an improvement in caliber and elasticity of the vaginal introitus; clitoris burying degree was reduced in 18 patients (50%), 30 (83%) reported an increased volume of labia major a and minor a, 34 (94%) had a complete disappearance of scratching lesions, and 28 (78%) showed a remission of white lesions. Eventually 34 patients (95%) stopped using topical corticosteroids routinely. The improvement in life quality was significant for both DLQI (p b 0001) and FSFI (p b 0001). CONCLUSIONS. Fat grafting may have a role as a support and completion treatment in selected cases of women with vulvar LS who do not respond to first line therapy or in severe cases where the anatomical impairment does not allow a regular sexual function and a good quality of life.


Assuntos
Tecido Adiposo/transplante , Regeneração , Vulva/fisiologia , Líquen Escleroso Vulvar/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Clitóris/fisiologia , Elasticidade/fisiologia , Feminino , Humanos , Pessoa de Meia-Idade , Membrana Mucosa/patologia , Membrana Mucosa/fisiologia , Qualidade de Vida , Sexualidade , Pele/patologia , Fenômenos Fisiológicos da Pele , Líquen Escleroso Vulvar/patologia , Líquen Escleroso Vulvar/fisiopatologia
19.
Plast Reconstr Surg ; 136(4): 442e-52e, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26397263

RESUMO

BACKGROUND: Little research has been conducted into the effects of labiaplasty on sensitivity of external genitalia. This study aimed to determine the effect of labia minora and clitoral hood reduction using the edge resection technique on external genitalia sensitivity. METHODS: Female subjects electing to undergo labia minora and clitoral hood reduction were enrolled. Subjects underwent sensitivity testing using monofilaments at five locations (one at the clitoral hood and four labial with each labium measured 0.5 cm from the leading edge and 1.5 cm distal to the hymen) at baseline; 2 weeks; and 3, 6, and 12 months postoperatively. Self-evaluations using the Sexual Function Questionnaire were performed at baseline and 3, 6, and 12 months postoperatively. RESULTS: Thirty-seven subjects undergoing labia minora and clitoral hood reduction were enrolled. Subjects experienced a median increase in sensitivity at month 6 of 0.118 mN at the 0.5-cm right labial location (p = 0.027) and 0.059 mN at the 0.5-cm left labial location (p = 0.046) compared with baseline. No change in sensitivity was demonstrated at the clitoral hood or either of the 1.5-cm labial locations. At 6 months, an increase in the number of sexual relations was observed in 44.1 percent of subjects (p = 0.011), an improvement in orgasm frequency was exhibited by 35.3 percent of subjects (p = 0.013), and an increase in orgasm strength was observed in 35.3 percent of subjects (p = 0.006). CONCLUSION: Labia minora and clitoral hood reduction as performed by the trim/edge resection method does not result in diminished sensitivity. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Técnicas Cosméticas/efeitos adversos , Hiperestesia/etiologia , Hipestesia/etiologia , Pressão , Vulva/cirurgia , Adulto , Clitóris/fisiologia , Clitóris/cirurgia , Autoavaliação Diagnóstica , Feminino , Humanos , Hiperestesia/diagnóstico , Hiperestesia/epidemiologia , Hipestesia/diagnóstico , Hipestesia/epidemiologia , Pessoa de Meia-Idade , Estudos Prospectivos , Comportamento Sexual , Vulva/fisiologia , Adulto Jovem
20.
Arch Sex Behav ; 44(6): 1573-87, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26054485

RESUMO

Previous studies have indicated that women with diabetes mellitus are at higher risk to develop sexual dysfunctions. In the current study, we hypothesized that lower genital arousal response-as a consequence of diabetes-related damage to nerves and blood vessels-might play a part in these higher prevalence rates. Vaginal blood flow, subjective sexual response, and clitoral sensitivity were compared between women with diabetes and healthy controls, and associations with diabetes complications were investigated. In pre- and postmenopausal women with type 1 diabetes (n = 42) and healthy controls (n = 46), vaginal blood flow was measured as vaginal pulse amplitude (VPA). VPA was assessed at rest, during erotic film viewing, and during vibrotactile clitoral stimulation. Subjective sexual arousal was measured using a questionnaire. Clitoral sensitivity was assessed by a vibration perception test. Data on diabetes complications were obtained from medical records, and neuropathy was assessed by quantitative sensory testing. VPA, subjective sexual arousal, and clitoral sensitivity were not significantly different between women with diabetes and controls. Nevertheless, women with diabetes who had retinopathy showed significantly lower VPA than women without retinopathy, and women with diabetes who had neuropathy showed significantly higher sensation thresholds for vibrotactile clitoral stimulation. The results do not support the hypothesis of a disrupted genital arousal response in women with diabetes. However, the observed associations between retinopathy and vaginal blood flow, and between neuropathy and clitoral sensitivity, suggest that diabetes-related complications might adversely affect the physiological basis of female sexual response.


Assuntos
Nível de Alerta/fisiologia , Diabetes Mellitus Tipo 1/fisiopatologia , Disfunções Sexuais Fisiológicas/sangue , Vagina/irrigação sanguínea , Adulto , Estudos de Casos e Controles , Clitóris/fisiologia , Diabetes Mellitus Tipo 1/complicações , Feminino , Humanos , Pessoa de Meia-Idade , Fluxo Sanguíneo Regional , Comportamento Sexual/fisiologia , Disfunções Sexuais Fisiológicas/etiologia , Inquéritos e Questionários , Vagina/patologia
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