The purpose of this article is to introduce and comment on some peculiarities of the female genitals' sensibility and some of its implications for women, sex and gynecologic practice. The female genitals basically possess two different kinds of innervation and, consequently, of sensibility: the "somatic" and the visceral ( vegetative ) ones.

Sensations originating in parts of the body whose innervation is of the "somatic" type are perceived in a very accurate, precise and well-localized form ( see Note 1 below ). Conversely, sensations originated in the visceral organs ( whose innervation is of the visceral or vegetative type ) usually are extremely imprecise, diffuse and very difficult to be exactly "localized." Visceral pain often has, for instance, the characteristic of projecting itself on areas of the body that do not correspond to the exact origin of the painful stimulus, and this happens due to extremely intricate reflex pathways of metameric origin. ( Metameric: related to the embryonic development of the nervous system. )

In women, the external genitals ( vulva ), the lower part of the vagina ( basically the vaginal entrance ) and the perineal muscles possess the "somatic" type of innervation and, as areas directly related to the sexual response, they have an extremely precise and localized sensitivity for all kinds of stimuli. Conversely, the vaginal internal or upper two-thirds ( that is, most of the vagina ), the uterus, Fallopian tubes, ovaries and respective ligaments and surrounding structures possess the visceral ( vegetative ) type of innervation. These facts have several implications in gynecologic practice, in the female sexual response and in the ways through which women experience their sexual organs.

We can therefore understand why the vagina is an organ of sexual expression whose greatest part ( the inner or upper two-thirds ) presents a relatively small sexual sensitivity, behaving more as a visceral organ than as a sensory one. Sensations that come from the vaginal inner part present the diffuse, imprecise and vaguely localized features typical of the visceral kind of sensibility. Only the external third of this organ ( next to the vulva ) possesses a great sexual sensibility, as well as the other characteristics of the "somatic" type of sensibility.

The inner or upper two-thirds of the vagina have a restricted sexual sensitivity and the sensations originating there are vague and imprecise. For all these reasons, in repose conditions ( that is, in the absence of sexual intercourse and other forms of vaginal stimulation ), the greater part of the vagina almost does not send any kind of information to women. ( That is the reason why the existence of her vagina may not be known to a child, because it is not sensed. )

The aforementioned peculiarities of the kind of sensitivity of most of the vagina and all the woman's internal genitals perhaps may contribute to the creation, in the female psychology, of many mysterious fantasies regarding these organs. There is, for instance, the idea of the vagina as an "obscure and mysterious tunnel that leads to the intimacy of the female body". It is obvious that a great part of these fantasies are also due to the action of mythological and archetypal elements, and also to an extremely rich symbology.

These features of the innervation of the woman's sexual organs also have consequences in the routine of gynecologic consultations, mostly in anxious patients. During the gynecological examination, the dislike and discomfort that many women demonstrate even in procedures that, in normal circumstances, do not cause pain - procedures such as the intravaginal introduction and movement of the speculum, the taking of smears for vaginal and ectocervical cytology - make evident this peculiarity of the female anatomy and physiology.

As women have well-defined and correctly localized sensations only at the vulva and vaginal entrance, it is probable that, regarding the examination procedures performed at the inner part of the vagina and the uterine cervix, the sensations that reach their consciousness are very imprecise, diffuse and confused. The patient feels that "something" is being done inside her genitals, but she is not able to evaluate exactly what we are doing, and this can generate anxiety even when we explain in detail all that is being done.

Obviously the psychological features of this group of women aggravate the situation ( mostly if they exhibit neurotic attitudes concerning the gynecologic examination ), transforming the smaller stimuli originating from the examination into pain and discomfort. On the other hand, with regard to the taking of smears for endocervical cytology, the occurrence of some pain and uterine cramps is normal because the painful sensitivity of the cervical canal to mechanical stimulation is often great.

During the bimanual palpation of the uterus, Fallopian tubes and ovaries, the occurrence of some pain or discomfort even in the absence of pathology is also normal, because we need to press these organs through the vagina and the abdominal wall in order to perform the examination. The ovaries possess an especially great sensitivity to compression.

Considering that the purpose of this article was to analyse some clinical aspects of the sensitive innervation of the female genitals, all the other functions of the visceral ( vegetative ) and "somatic" innervation of these organs were not discussed here. For a detailed study of the innervation of the female pelvic organs, see my article "Fundamentos para o Estudo das Influências Neurovegetativas em Ginecologia" ( "Basis for the Study of the Neurovegetative Influences in Gynecology" ) ( See Note 2 below ). An introductory discussion about the still obscure functions of the vegetative innervation of these organs ( that is, their sympathetic and parasympathetic innervation ) can be found in this article.

Note 1: The "somatic" type of innervation is that of the skin, skeletal muscles, bones and joints, also including most of the other anatomic structures close or at the surface of the body ( including the mouth ).

Note 2: Soucasaux, Nelson - "Fundamentos para o Estudo das Influências Neurovegetativas em Ginecologia" ( "Basis for the Study of the Neurovegetative Influences in Gynecology" ) - in: Jornal Brasileiro de Medicina, vol 57, nº 4, October 1989, Rio de Janeiro.

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.

[ Home ] [ Consultório (Medical Office) ] [ Obras Publicadas (Published Works) ]
[ Novas Perspectivas em Ginecologia (New Perspectives in Gynecology) ]
[ Os Órgãos Sexuais Femininos (The Female Sexual Organs) ]
[ Temas Polêmicos (Polemical Subjects) ] [ Tópicos Diversos (Other Topics) (Part 1) ]
[ Tópicos Diversos (Other Topics) ( Part 2) ] [ Tópicos Diversos (Other Topics) (Part 3) ]
[ Tópicos Diversos (Other Topics) ( Part 4) ] [ Tópicos Diversos (Other Topics) (Part 5)]
[ Tópicos Diversos (Other Topics) ( Part 6) ] [ Ilustrações (Illustrations) ]

Email: nelsons@nelsonginecologia.med.br