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Try out PMC Labs and tell us what you think. Learn More. Sex is a motive force bringing a man and a woman into intimate contact. Sexuality is a central aspect of being human throughout life and encompasses sex, gender identities and roles, sexual orientation, eroticism, pleasure, intimacy, and reproduction.
Sexuality is experienced and expressed in thoughts, fantasies, desires, beliefs, attitudes, values, behaviors, practices, roles and relationships. Though generally, women are sexually active during adolescence, they reach their peak orgasmic frequency in their 30 s, and have a constant level of sexual capacity up to the age of 55 with little evidence that aging affects it in later life.
Desire, arousal, and orgasm are the three principle stages of the sexual response cycle. Each stage is associated with unique physiological changes. Females are commonly affected by various disorders in relation to this sexual response cycle. There are a wide range of etiological factors like age, relationship with a partner, psychiatric and medical disorders, psychotropic and other medication. Counseling to overcome stigma and enhance awareness on sexuality is an essential step in management. There are several effective psychological and pharmacological therapeutic approaches to treat female sexual disorders.
This article is a review of female sexuality. Satisfying usual experience is an essential part of a healthy and enjoyable life for most people. Sexual activity is a multifaceted activity involving complex interactions between the nervous system, the endocrine system, the vascular system and a variety of structures that are instrumental in sexual excitement, intercourse, and satisfaction. Though essentially it is meant for procreation, it has also been a source of pleasure, a natural relaxant, it confirms one's gender, bolsters one's self-esteem and sense of attractiveness for mutually satisfying intimacy and relationship.
Sexuality is experienced and expressed in thoughts, fantasies, desires, beliefs, attitudes, values, behaviors, practices, roles, and relationships. While sexuality can include all of these dimensions, not all of them are always experienced or expressed.
Sexuality is influenced by the interaction of biological, psychological, social, economic, political, cultural, ethical, legal, historical, religious, and spiritual factors. The transformation occurred independently in three geographical regions: In China, in India and Persia, and in the Eastern Mediterranean, including Israel and Greece.
In this cultural transformation, a prevailing mythic, cosmic, ritualistic, collective consciousness embedded in a tribal matrix with the female in the foreground, slowly gave birth to a male dominated, rational, analytical, and individualistic consciousness. This transition in cultural values began very slowly after the last ice age retreated.
In a developing country like India, modern Hindu cultures even today contain a general disapproval of the erotic aspect of married life, a disapproval that cannot be disregarded as a mere medieval relic. Many Hindu women, especially those in the higher castes, do not even have a name for their genitals.
Though the perception of modern Indian women is transforming, many of them still consider the sexual activity a duty, an experience to be submitted to, often from a fear of abuse. According to Sigmund Freud, both sexes seem to pass through the early phases of libidinal development in the same manner. Psychologically, the male-female difference in sexuality starts only during the phallic phase, with the appearance of Oedipus complex. However, the difference becomes most clear only during the genital phase.
Masturbation is a mode of sexual activity for both men and women though it has been a source of social concern and censure throughout the human tradition. In women, masturbation can happen in many ways. Here the stimulation of the clitoris is the central issue. Typically the hand and finger make circular, back and forth or up and down movements against the mons and clitoral area. Most women avoid direct stimulation of the glans of the clitoris because of extreme sensitivity. Some women thrust the clitoral area against an object such as bedding or pillow, others by pressing thighs together and by teasing the pelvic floor muscles that underlie the vulva.
Contrary to what is depicted in pornography, vaginal insertion to reach an orgasm is not common. Some individuals use vibrators for added enjoyment and variation. Following the pioneering work of Masters and Kaplan, the sexual response cycle in both sexes is often categorized as a four-phase process, desire, excitement, orgasm, and resolution.
The first stage, sexual desire, consists of the motivational or appetitive aspects of sexual response.
Sexual urges, fantasies, and wishes are included in this phase. The second stage, sexual excitement, refers to a subjective feeling of sexual pleasure and accompanying physiological changes. This phase includes penile erection in males and vaginal lubrication in females. Plateauing, sometimes classified as a separate phase, is a heightened state of excitement attained with continued stimulation. There is marked sexual tension in this phase, which sets the stage for the orgasm.
The third stage, orgasm or climax is defined as the peak of sexual pleasure, with rhythmic contractions of the genital musculature in both men and women, associated with ejaculation in men. Graph 1 shows three different patterns of orgasm in females. Pattern 1 shows multiple orgasms.
Pattern 2 shows arousal that reaches the plateau level without going onto orgasm note that resolution occurs very slowly. Pattern 3 shows several brief drops in the excitement phase followed by an even more rapid resolution phase. This is the final phase, during which a general sense of relaxation and well-being is experienced.
Then, there is a refractory period in males, which is usually absent in females. Table 1 shows the physical changes in the female during the sexual response cycle. With respect to female sexuality, an important deviation from the earlier concept is that the difficulties in desire and arousal often simultaneously characterize the complaints of women.
Thus, the two entities are merged in DSM V. The sexual desire disorder in women is not listed separately. The Table 2 compares the nosological status of sexual dysfunction in females among the two diagnostic manuals. In general, there has been an acute dearth of valid or reliable statistical data on the epidemiology of female sexual disorders. This is particularly true when it comes to nonwestern settings. Women of different social groups demonstrate a different pattern of sexual dysfunction.
The experience of sexual dysfunction is more likely among women and men with poor physical and emotional health. The most common problems were a lack of desire, vaginal dryness, and infrequent orgasm. Some of the important associated etiological factors were older age, infrequent sexual activity, more than 10 years of marriage, more than three kids and husbands more than 40 years. The authors consider that the female sexual dysfunction is a ificant public health problem of women in that nation. The literature on etiological factors associated with sexual dysfunction infers that in women, Married female want sex Greece il com predominant association with arousal, orgasmic, and enjoyment problems was marital difficulties.
Vaginal dryness was found to increase with age after menopause. In general, sexual dysfunction was commonly associated with social problems in women. Sexual dysfunction includes disorders of i desire, ii arousal, iii orgasm and iv sexual Married female want sex Greece il com disorders.
It includes lack or loss of sexual desire, sexual aversion and lack of sexual enjoyment. Lack or loss of sexual desire is manifest by the diminution of seeking out sexual cues, of thinking about sex with associated feelings of desire or appetite, or of sexual fantasies. There is a lack of interest in initiating sexual activity either with a partner or by masturbation. Sexual aversion is defined as a disorder in which the prospect of sexual interaction with a partner produces sufficient aversion, fear or anxiety that sexual activity is avoided.
In the disorder of lack of sexual enjoyment, genital response orgasm occurs during sexual stimulation, but is not accompanied by pleasurable sensations or feelings of pleasant excitement. Chronic stress, anxiety, depression, prolonged period of abstinence from sex, hostility in relationship with partner, bad experience with sex, childhood sexual abuse, religious taboos, low biological drive, dysfunction of the hypothalamic pituitary axis, endocrinal disorders, ovarian failure, psychotropic, and cardiovascular drugs are the various etiological factors associated with low sexual desire.
The failure of genital response in females is experienced as the failure of vaginal lubrication, together with inadequate tumescence of the labia. However, a subjective sense of arousal is often poorly correlated with it in that a women complaining of lack of arousal may lubricate vaginally, but may not experience a subjective sense of excitement. There is also a lack of vaginal smooth muscle relaxation and decreased clitoral enjoyment. This dysfunction causes marked distress in women. The etiological factors include vasculogenic, neurogenic and endocrine factors, systemic diseases, psychotropic drugs and psychosocial factors.
Achieving orgasm adequately is highly treasured by women as it is seen as a mark of high self-esteem, and confidence in one's feminity resulting in a high desire for sexual activity. Persisting and recurring difficulty in achieving orgasm is termed as anorgasmia. Women who suffer solely form orgasmic dysfunction may have normal desire and arousal, but have great difficulty in reaching climax. However, the distress over inability to reach orgasm may lead on to decrease in desire and arousal.
Among the etiological factors for orgasmic disorders, the organic factors include neurological conditions that affect the nerve supply to the pelvis, like multiple sclerosis, spinal card tumors or trauma, nutritional deficiencies, diabetic neuropathy, vascular causes, endocrine disorders and drugs like methyldopa, antipsychotics, antidepressants, and benzodiazepines. An important psychosocial factor implicated in orgasmic disorders is the negative cultural conditioning. Specific developmental factors like traumatic sexual experiences during childhood, negative attitude toward sex and interpersonal factors like hostility toward spouse are also implicated in orgasmic disorders.
Dyspareunia is defined as recurrent or persistent genital pain before, during or after sexual activity. It can be divided into superficial, vaginal and deep. Superficial dyspareunia occurs with attempted penetration, usually secondary to anatomic or inflammatory conditions. Vaginal dyspareunia is pain related to friction. Deep dyspareunia is pain related to thrusting, often associated with the pelvic disease. The reason for this wide range could be that many prevalence studies do not include dyspareunia within their list of dysfunctions or fail to distinguish it from vaginismus, as dyspareunia is related to and often coincides with vaginismus.
Dyspareunia should not be diagnosed when it is primarily due to vaginismus or lack of lubrication. Traditionally the etiology of dyspareunia has been divided into organic and psychological. The organic factors are further divided into anatomic, pathologic and iatrogenic.
Anatomic factors are congenital factors like agenesis of the vagina and rigid hymen. The pathologic factors include multiple conditions like vulvar atrophy, cervical erosion, fibroids, ovarian cyst, endometriosis, prolapsed uterus, tender uterosacral ligaments, tender bladder, squamous metaplasia, infections, etc. The psychoanalytic and learning theories are the two major psychological theoretical perspectives.
The psychoanalytic theory treats dyspareunia as a hysterical or conversion symptom symbolizing an unconscious intrapsychic conflict and considers dyspareunia to be a result of phobic reactions, major anxiety conflicts, hostility or aversion to sexuality. Learning theory posits that dyspareunia is attributable to lack of or faulty learning which may contribute to a woman entering sexual relations with a set of negative expectations. Also developmental attitudes toward sexualitytraumatic prior aversive coital experiences and relational interpersonal disputes with a partner factors are the other psychological factors.
It is a recurrent or persistent involuntary spasm or constriction of the musculature surrounding the vaginal outlet and the outer third of the vagina that interferes with vaginal penetration.Married female want sex Greece il com
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The 'orgasm gap': Why it exists and what women can do about it