The Female Sexual Response

( Adapted excerpt from "Novas Perspectivas em Ginecologia" )

Nelson Soucasaux

Nelson Drawing 1977

By sexual response, I mean the more physiological aspects of sexuality. There are also considerable differences between women and men regarding these aspects. 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 below ); 7) during orgasm, the rhythmic contractions of the uterus and the perineal muscles that surround the vaginal entrance; 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 a dilation of the blood vessels ) 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: Uterine anteversion: the typical position of the uterus, in which the uterine corpus 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 a small structure located behind the vaginal anterior wall along the urethra whose stimulation may also lead some women to orgasm, see "The Gräfenberg Spot".

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, 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.

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