The Pelvic Floor As an Emotional Organ
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Physiology of Female Sexual Function and Dysfunction
International Journal of Impotence Research (2005) 17, S44–S51 & 2005 Nature Publishing Group All rights reserved 0955-9930/05 $30.00 www.nature.com/ijir Physiology of female sexual function and dysfunction JR Berman1* 1Director Female Urology and Female Sexual Medicine, Rodeo Drive Women’s Health Center, Beverly Hills, California, USA Female sexual dysfunction is age-related, progressive, and highly prevalent, affecting 30–50% of American women. While there are emotional and relational elements to female sexual function and response, female sexual dysfunction can occur secondary to medical problems and have an organic basis. This paper addresses anatomy and physiology of normal female sexual function as well as the pathophysiology of female sexual dysfunction. Although the female sexual response is inherently difficult to evaluate in the clinical setting, a variety of instruments have been developed for assessing subjective measures of sexual arousal and function. Objective measurements used in conjunction with the subjective assessment help diagnose potential physiologic/organic abnormal- ities. Therapeutic options for the treatment of female sexual dysfunction, including hormonal, and pharmacological, are also addressed. International Journal of Impotence Research (2005) 17, S44–S51. doi:10.1038/sj.ijir.3901428 Keywords: female sexual dysfunction; anatomy; physiology; pathophysiology; evaluation; treatment Incidence of female sexual dysfunction updated the definitions and classifications based upon current research and clinical practice. -
Pelvic Anatomyanatomy
PelvicPelvic AnatomyAnatomy RobertRobert E.E. Gutman,Gutman, MDMD ObjectivesObjectives UnderstandUnderstand pelvicpelvic anatomyanatomy Organs and structures of the female pelvis Vascular Supply Neurologic supply Pelvic and retroperitoneal contents and spaces Bony structures Connective tissue (fascia, ligaments) Pelvic floor and abdominal musculature DescribeDescribe functionalfunctional anatomyanatomy andand relevantrelevant pathophysiologypathophysiology Pelvic support Urinary continence Fecal continence AbdominalAbdominal WallWall RectusRectus FasciaFascia LayersLayers WhatWhat areare thethe layerslayers ofof thethe rectusrectus fasciafascia AboveAbove thethe arcuatearcuate line?line? BelowBelow thethe arcuatearcuate line?line? MedianMedial umbilicalumbilical fold Lateralligaments umbilical & folds folds BonyBony AnatomyAnatomy andand LigamentsLigaments BonyBony PelvisPelvis TheThe bonybony pelvispelvis isis comprisedcomprised ofof 22 innominateinnominate bones,bones, thethe sacrum,sacrum, andand thethe coccyx.coccyx. WhatWhat 33 piecespieces fusefuse toto makemake thethe InnominateInnominate bone?bone? PubisPubis IschiumIschium IliumIlium ClinicalClinical PelvimetryPelvimetry WhichWhich measurementsmeasurements thatthat cancan bebe mademade onon exam?exam? InletInlet DiagonalDiagonal ConjugateConjugate MidplaneMidplane InterspinousInterspinous diameterdiameter OutletOutlet TransverseTransverse diameterdiameter ((intertuberousintertuberous)) andand APAP diameterdiameter ((symphysissymphysis toto coccyx)coccyx) -
Psychosocial and Sexual Aspects of Female Circumcision
African Journal of Urology (2013) 19, 141–142 Pan African Urological Surgeons’ Association African Journal of Urology www.ees.elsevier.com/afju www.sciencedirect.com Opinion article Psychosocial and sexual aspects of female circumcision ∗ S. Abdel-Azim Psychiatry Department, Cairo University, Egypt Received 17 November 2012; received in revised form 3 December 2012; accepted 3 December 2012 KEYWORDS Abstract Female circumcision; Sexual behavior is a result of interaction of biology and psychology. Sexual excitement of the female can Psychological; be triggered by stimulation of erotogenic areas; part of which is the clitoris. Female circumcision is done Sexual to minimize sexual desire and to preserve virginity. This procedure can lead to psychological trauma to the child; with anxiety, panic attacks and sense of humiliation. Cultural traditions and social pressures can affect as well the unexcised girl. Female circumcision can reduce female sexual response, and may lead to anorgasmia and even frigidity. This procedure is now prohibited by law in Egypt. © 2013 Pan African Urological Surgeons’ Association. Production and hosting by Elsevier B.V. All rights reserved. Introduction human sexual response including excitement, orgasm and resolution phases. Later Kaplan [3] added the desire phase. The desire phase Sex is one of the basic drives. Impairment of this drive/sexual reflects motivations, drives and personality and is characterized by functioning can have a profound effect on the persons’ quality of sexual fantasies and the desire to have sexual activity, and in the life and other aspects of functioning. Sexual behavior represents a female is controlled mainly by androgens particularly testosterone very complex and interesting interaction of biology and psychology. -
Advanced Retroperitoneal Anatomy Andneuro-Anatomy of Thepelvis
APRIL 21-23 • 2016 • ST. LOUIS, MISSOURI, USA Advanced Retroperitoneal Anatomy and Neuro-Anatomy of the Pelvis Hands-on Cadaver Workshop with Focus on Complication Prevention in Minimally Invasive Surgery in Endometriosis, Urogynecology and Oncology WITH ICAPS FACULTY Nucelio Lemos, MD, PhD (Course Chair) Adrian Balica, MD (Course Co-Chair) Eugen Campian, MD, PhD Vadim Morozov, MD Jonathon Solnik, MD, FACOG, FACS An offering through: Practical Anatomy & Surgical Education Department of Surgery, Saint Louis University School of Medicine http://pa.slu.edu COURSE DESCRIPTION • Demonstrate the topographic anatomy of the pelvic sidewall, CREDIT DESIGNATION: This theoretical and cadaveric course is designed for both including vasculature and their relation to the ureter, autonomic Saint Louis University designates this live activity for a maximum intermediate and advanced laparoscopic gynecologic surgeons and somatic nerves and intraperitoneal structures; of 20.5 AMA PRA Category 1 Credit(s) ™. and urogynecologists who want to practice and improve their • Discuss steps of safe laparoscopic dissection of the pelvic ureter; laparoscopic skills and knowledge of retroperitoneal anatomy. • Distinguish and apply steps of safe and effective pelvic nerve Physicians should only claim credit commensurate with the The course will be composed of 3 full days of combined dissection and learn the landmarks for nerve-sparing surgery. extent of their participation in the activity. theoretical lectures on Surgical Anatomy and Pelvic Neuroanatomy with hands on practice of laparoscopic and ACCREDITATION: REGISTRATION / TUITION FEES transvaginal dissection. Saint Louis University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) Early Bird (up to Dec. 31st) ...........US ....$2,295 COURSE OBJECTIVES to provide continuing medical education for physicians. -
6Th Advanced Retroperitoneal Anatomy and Neuro-Anatomy of the Pelvis
Session I Theoretical Lectures will be given in Portuguese and Session II Lectures in English. Session I, June 9-10 will be presented in Portugese. Optional English and Portuguese speaking Faculty are available for the practical part of both sessions. Course Description SESSION I SESSION II SESSION III This theoretical and cadaveric course is designed for both intermediate and JUNE 9 - JUNE 13 advanced laparoscopic gynecologic surgeons and urogynecologists who want to ST. LOUIS, MISSOURI, USA Tuesday, June 9 7:30 am - 5:00 pm Wednesday, June 10 7:30 am - 5:00 pm Thursday, June 11 7:30 am - 5:00 pm Friday, June 12 7:30 am - 5:00 pm Saturday, June 13 7:30 am - 4:00 pm practice and improve their laparoscopic skills and knowledge of retroperitoneal 2020 From Books to Practice Simulcast: Parallel Theoretical From Books to Practice Simulcast: Parallel Theoretical anatomy. ➢ Pelvic Neuroanatomy and the Nerve Sparing Surgical ➢ Pelvic Neuroanatomy and the Nerve Sparing Surgical ➢ Hands-on Cadaver Lab: Presentations and Live Dissection Presentations and Live Dissection The course will be composed of 2 full days of combined theoretical lectures on Concept Concept Dissection of Lateral Pelvic Sidewall, Ureter, Vessels; ➢ The Avascular Spaces of the Pelvis Surgical Anatomy and Pelvic Neuroanatomy with hands on practice of laparoscopic From Books to Practice Simulcast: Parallel Theoretical ➢ The Avascular Spaces of the Pelvis From Books to Practice Simulcast: Parallel Theoretical Development of the Obturator Space and Identification and transvaginal dissection and a third optional dissection-only day, with a new 6th Advanced Retroperitoneal Anatomy Presentations and Live Dissection ➢ Diaphragmatic Anatomy and Strategies for Diaphragmatic Presentations and Live Dissection ➢ Diaphragmatic Anatomy and Strategies for Diaphragmatic of Obturator, Sciatic, and Pudendal Nerves; Identification specimen. -
The Effects of Yohimbine Plus L-Arginine Glutamate on Sexual Arousal in Postmenopausal Women with Sexual Arousal Disorder1
P1: GVG/FZN/GCY P2: GCV Archives of Sexual Behavior pp527-aseb-375624 July 4, 2002 13:29 Style file version July 26, 1999 Archives of Sexual Behavior, Vol. 31, No. 4, August 2002, pp. 323–332 (C 2002) The Effects of Yohimbine Plus L-arginine Glutamate on Sexual Arousal in Postmenopausal Women with Sexual Arousal Disorder1 , Cindy M. Meston, Ph.D.,2 4 and Manuel Worcel, M.D.3 Received August 17, 2001; revision received November 30, 2001; accepted December 31, 2001 This study examined the effects of the nitric oxide-precursor L-arginine combined with the 2-blocker yohimbine on subjective and physiological sexual arousal in postmenopausal women with Female Sex- ual Arousal Disorder. Twenty-four women participated in three treatment sessions in which self-report and physiological (vaginal photoplethysmograph) sexual responses to erotic stimuli were measured following treatment with either L-arginine glutamate (6 g) plus yohimbine HCl (6 mg), yohimbine alone (6 mg), or placebo, using a randomized, double-blind, three-way cross-over design. Sexual responses were measured at approximately 30, 60, and 90 min postdrug administration. The com- bined oral administration of L-arginine glutamate and yohimbine substantially increased vaginal pulse amplitude responses to the erotic film at 60 min postdrug administration compared with placebo. Sub- jective reports of sexual arousal were significantly increased with exposure to the erotic stimuli but did not differ significantly between treatment groups. KEY WORDS: yohimbine; L-arginine; female sexual arousal; photoplethysmography; nitric oxide; adrenergic. INTRODUCTION lubrication-swelling response of sexual excitement” which causes “marked distress or interpersonal difficulty.” Physiological sexual arousal in women involves Prevalence estimates of FSAD vary widely between an increase in pelvic vascular blood flow and resultant studies, likely due to different operational definitions of pelvic vasocongestion, vaginal engorgement, swelling of the disorder. -
Sexual Dysfunctions and Treatment Options
Osteopathic Overview Sexual Dysfunctions and Treatment Options By Laura Souders Dalton, DO lactinemia, breastfeeding and use of some lants—may decrease discomfort and help medications may also contribute. engorge the vaginal area. Zestra topical oil Diagnosing and treating sexual dysfunc- Some medications that may affect sex- has a small clinical trial that showed im- tions in your female patients is a complex ual desire include: antipsychotics, barbitu- provement in satisfaction and level of yet rewarding process. Fortunately, more rates, benzodiazepines, lithium selective arousal.3,4 Vaginal atrophy should be treat- media attention has led to an increased serotonin re-uptake inhibitors, tri-cyclic ed prior to using these products as they awareness of the problem and a readiness antidepressants, anti-lipid drugs, beta- may otherwise cause unpleasant burning. on the part of the patients to seek help. blockers, clonidine, digoxin, spironolac- Argin Max, a daily nutritional supple- Understanding the normal female sex- tone, danazol, estrogen therapy, GnRH an- ment has one study revealing increased de- ual response cycle has changed over recent tagonists, cort-icosteroids, H2 blockers, sire, satisfaction and number of orgasms.5 years. Basson’s nonlinear model more close- indomethacin, ketoconazole, phenytoin Evaluating placebo effect in the studies is ly explains the complexities of the female sodium, and oral contraceptives.2 difficult. There are multiple other herbal sexual experience. The cycle can be affect- Relationship problems or anger with a preparations claiming improved sexual ed by physical, social, relationship and psy- woman’s partner may also be factors. It is function, but most have no clinical trials. chological factors. -
Category-Specificity of Women's Sexual Arousal
Running head: CATEGORY‐SPECIFICITY ACROSS THE MENSTRUAL CYCLE CATEGORY-SPECIFICITY OF WOMEN’S SEXUAL AROUSAL ACROSS THE MENSTRUAL CYCLE by Jennifer A. Bossio A thesis submitted to the Department of Psychology in conformity with the requirements for the degree of Master of Science Queen’s University Kingston, Ontario, Canada (September 2011) Copyright © Jennifer A. Bossio, 2011 CATEGORY‐SPECIFICITY ACROSS THE MENSTRUAL CYCLE Abstract Unlike men, women’s genital arousal is category‐nonspecific with respect to sexual orientation, such that their genital responses do not differentiate stimuli by gender. A possible explanation for women’s nonspecific sexual response is the inclusion of women at different phases of the menstrual cycle or women using hormonal contraceptives in sexual psychophysiology research, which may be obscuring a specificity effect. The present study employs the ovulatory‐shift hypothesis – used to explain a shift in women’s preferences for masculine traits during peak fertility – as an explanatory model for women’s nonspecific sexual arousal. Twenty‐nine naturally‐cycling women were tested at two points in their menstrual cycles (follicular and luteal) to determine the role of hormonal variation, as estimated by fertility status, on the specificity of genital (using vaginal photoplethysmograph) and subjective sexual arousal. Cycle phase at the time of first testing was counterbalanced; however, no effect of order was observed. Inconsistent with the ovulatory‐shift model, the predicted mid‐cycle shift in preferences for masculinity or sexual activity at peak fertility was not obtained. Category‐specificity of genital arousal did not increase during the follicular phase. A statistical trend was observed for higher genital arousal to couple sex stimuli during the follicular phase compared to the luteal phase, suggesting that women’s genital arousal may be sensitive to fertility status with respect to sexual activity (specifically, couple sex), but not gender. -
Clinical Pelvic Anatomy
SECTION ONE • Fundamentals 1 Clinical pelvic anatomy Introduction 1 Anatomical points for obstetric analgesia 3 Obstetric anatomy 1 Gynaecological anatomy 5 The pelvic organs during pregnancy 1 Anatomy of the lower urinary tract 13 the necks of the femora tends to compress the pelvis Introduction from the sides, reducing the transverse diameters of this part of the pelvis (Fig. 1.1). At an intermediate level, opposite A thorough understanding of pelvic anatomy is essential for the third segment of the sacrum, the canal retains a circular clinical practice. Not only does it facilitate an understanding cross-section. With this picture in mind, the ‘average’ of the process of labour, it also allows an appreciation of diameters of the pelvis at brim, cavity, and outlet levels can the mechanisms of sexual function and reproduction, and be readily understood (Table 1.1). establishes a background to the understanding of gynae- The distortions from a circular cross-section, however, cological pathology. Congenital abnormalities are discussed are very modest. If, in circumstances of malnutrition or in Chapter 3. metabolic bone disease, the consolidation of bone is impaired, more gross distortion of the pelvic shape is liable to occur, and labour is likely to involve mechanical difficulty. Obstetric anatomy This is termed cephalopelvic disproportion. The changing cross-sectional shape of the true pelvis at different levels The bony pelvis – transverse oval at the brim and anteroposterior oval at the outlet – usually determines a fundamental feature of The girdle of bones formed by the sacrum and the two labour, i.e. that the ovoid fetal head enters the brim with its innominate bones has several important functions (Fig. -
Changes You Can Make to Improve Bladder Problems
CHANGES YOU CAN MAKE TO IMPROVE BLADDER PROBLEMS The SUFU Foundation OAB Clinical Care Path Way For more information on better bladder control visit: http://sufuorg.com/oab GUIDE TO PELVIC FLOOR MUSCLE TRAINING Your Pelvic Floor Muscles Your pelvic floor muscles are a group of muscles that support your bladder and help control the bladder opening. They attach to your pelvic bone and go around the rectum. These muscles form a sling or hammock that supports your pelvic organs (bladder, rectum, in women the uterus, in men the prostate). If the muscles weaken, the organs they support may change position. When this happens, you may have problems with urine leakage and other signs of overactive bladder (OAB) like urgency and frequency. That’s why it’s important to keep these muscles strong so they can properly support your pelvic organs. You can do this by exercising them regularly. Finding Your Pelvic Floor Muscles To begin these exercises, you first have to make sure that you know which muscles to contract. To do this, think of the muscles you would use to control the passing of gas or to hold back a bowel movement. Now, without using the muscles of your legs, buttocks, or stomach, tighten or squeeze the ring of muscles around your rectum as you would in those situations. These are your pelvic floor muscles. When you squeeze these muscles, you should feel a tightening or pulling in of your anus. Men may also see or feel their penis move and women may feel their vagina tightening or pulling up. -
The Pelvic Floor and Core Exercises
The pelvic floor and core exercises The pelvic floor muscles as part of the core Muscles play a key role during exercise, but did you know there is a hidden group of muscles, called pelvic floor muscles, that need special attention? Pelvic floor muscles form the base of the group of muscles commonly called the core. These muscles work with the deep abdominal (tummy) and back muscles and the diaphragm (breathing muscle) to support the spine and control the pressure inside the abdomen. The pelvic floor muscles play an important role in When this happens repeatedly during each supporting the pelvic organs, bladder and bowel exercise session, over time this may place a control and sexual function, in both men and downward strain on the pelvic organs and this may women. result in loss of bladder or bowel control, or pelvic organ prolapse. Pelvic floor symptoms can also be During exercise, the internal pressure in the potentially worsened if a problem already exists. abdomen changes. For example, when lifting a weight, the internal pressure increases, then returns Pelvic floor muscles need to be flexible to work as to normal when the weight is put down. part of the core, which means that they need to be able to relax as well as lift and hold. It is common In the ideal situation the regulation of pressure for people to brace their core muscles constantly within the abdomen happens automatically. For during exercise in the belief they are supporting example, when lifting a weight, the muscles of the spine, but constant bracing can lead to the the core work together well: the pelvic floor muscles becoming excessively tight and stiff. -
The Pelvic Floor Muscles - a Guide for Women This Booklet Is Supported by Wellbeing of Women Registered Charity No
The Pelvic Floor Muscles - a Guide for Women This booklet is supported by Wellbeing of Women Registered Charity No. 239281 www.wellbeingofwomen.org.uk Introduction Up to a third of all women experience a problem with their pelvic floor muscles at some time during their life. The most common problems are leaking with activity, sneezing or coughing (stress urinary incontinence) and pelvic organ prolapse (a feeling of something coming down in the vagina). All the bladder, bowel and sexual functions require good pelvic floor muscles. Effective pelvic floor muscles in pregnancy will reduce the risk of postnatal stress urinary incontinence (SUI). Bowel Uterus Bladder Pubic Bone Tailbone Pelvic floor muscles Vagina Urethra The pelvic floor muscles lie across the base of your pelvis to help keep the pelvic organs - bladder, uterus and bowel - in the correct position. The muscles are held in place by ligaments that support the organs especially when there is an increase of pressure in the abdomen that occurs with lifting, bending, carrying and straining. This is called intra-abdominal pressure and when it increases the pelvic floor and abdominal muscles brace so that the internal organs such as the uterus and bladder are not pushed downwards. The pelvic floor muscles work to help keep the bladder and bowel openings closed to prevent unwanted leakage (incontinence) and they relax to 1 allow easy bladder and bowel emptying. Good pelvic floor muscles can help with sex by improving the vaginal sensation and your ability to grip. Your pelvic floor muscles are important in posture and with the abdominal muscles help to support your spine.