Sexual Response Cycle

The Sexual Response Cycle

• The sexual response cycle consists of three stages: desire, orgasm, and resolution.
• Desire is spontaneous sexual interest, controlled by the brain, and includes sexual thoughts and erotic fantasies.

Desire

• Desire is affected by:
• Sight, sound, smell, touch, and taste
• Fantasy, memory, movement, and societal and cultural values
• Thoughts, feelings, and experiences (psychosexual medicine)
• Value judgment – a perception of good or bad
• Sexual desire can be triggered by various stimuli, such as sight, sound, smell, and touch.

Arousal and Excitement

• The body's physical response to desire differs between males and females.
• Arousal can last from minutes to hours, and can be lost and regained without progression.
• Common physiological responses in both sexes include:
• Raised blood pressure, pulse, and respiratory rate
• Flushing, nipple erection, genital and pelvic vascular engorgement, and muscle contraction

Female Arousal

• Female arousal is characterized by:
• Enlargement of breasts
• Erection of nipples
• Vasocongestion of the vaginal walls
• Vaginal lubrication
• Elongation and widening of the vaginal canal
• Tumescence and erection of the clitoris and labia
• Elevation of the cervix and uterus

Male Arousal

• Male arousal is characterized by:
• Penis erection
• Scrotum thickening and testes rising
• Sexual arousal does not always result in an erection
• Erection can occur during sleep

Plateau

• Plateau is the period of sexual excitement prior to orgasm, lasting up to 3 minutes.
• Plateau can be achieved, lost, and gained without orgasm.
• In males, plateau involves:
• Urethral sphincter contraction to prevent urine mixing with semen
• Pre-ejaculatory fluid (Cowper's gland) production
• Testes rising
• In females, plateau involves:
• 'Orgasmic platform'
• Increased Bartholin's secretions
• Continuing changes in the uterus, labia, areola, and nipples
• Clitoris sensitivity and withdrawal

Orgasm

• Orgasm is the conclusion of the plateau phase, releasing sexual tension and endorphins.
• Orgasm involves quick cycles of muscle contractions, with peak responses, blood pressure, pulse, and tension.
• Orgasm is accompanied by an euphoric sensation.

Orgasm in Males

• Orgasm in males is usually associated with ejaculation.
• Single via resolution involves 3-6 contractions of the urethra, pelvic floor, and anus.

Orgasm in Females

• Orgasm in females involves multiple contractions of muscles of the uterus, vagina, anus, and pelvic floor.
• Increased vaginal secretions occur during orgasm.

Resolution

• Resolution is characterized by relaxation, decreased blood pressure, pulse, and respiratory rate.
• Age affects the refractory period.
• Resolution is now visible on MRI.

Resolution in Males

• Resolution in males involves:
• Nipples and penis softening
• Scrotum relaxing
• Testes dropping

Resolution in Females

• Resolution in females involves:
• Blood vessels dilating
• Pelvic organs draining
• Cervix opening and dropping into the vagina (closes after 30 minutes)

Sexual Gratification and Fulfillment

• Penetration is not necessary for sexual gratification.
• Orgasms vary in intensity, from spasms to relaxation.
• Some women do not experience orgasm.

Effects of Ageing

• Age affects sexual response in both males and females.
• In males, ageing results in:
• Delayed erections
• Less firm erections
• Longer excitement stage and interval to ejaculation
• More direct stimulation needed to achieve erection
• Shorter plateau to ejaculation with smaller volume
• Longer refractory period
• In females, ageing results in:
• Reduced lubrication
• Reduced vascular engorgement
• Reduced muscle tension
• Reduced libido

Consultation Issues

• Consultation issues in sexual health include:
• Embarrassment
• Lack of language to describe emotions, sensations, and body parts
• Assumptions about gender and experience
• What is considered 'normal'

Attitudes, Values, and Bias

• Be aware of cultural and subcultural norms, which are open to value judgments.
• Consider diversity among orientations, emotional attractions, and complex interrelations.
• Sociocultural factors influence sexual attitudes and behaviors.