DOCSLIB.ORG

The Relationship Between Pain Sensitivity and Vasocongestion Due to Sexual Arousal in Women with Provoked Vestibulodynia

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
The Relationship Between Pain Sensitivity and Vasocongestion Due to Sexual Arousal in Women with Provoked Vestibulodynia THE RELATIONSHIP BETWEEN PAIN SENSITIVITY AND VASOCONGESTION DUE TO SEXUAL AROUSAL IN WOMEN WITH PROVOKED VESTIBULODYNIA by Stéphanie C. Boyer 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, 2009) Copyright © Stéphanie C. Boyer, 2009 i Abstract Women with chronic vulvar pain report reduced sexual function in comparison to non- affected women, including decreased sexual arousal. Experimentally induced sexual arousal has been examined in women with and without chronic vulvar pain, with contradictory results: some studies have found that only subjective arousal is affected in women with versus without vulvar pain, while other research has suggested that only genital responsiveness is affected in women with pain. As a result of these inconsistent findings, the role of arousal mechanisms in the causation and maintenance of provoked vestibulodynia (PVD) remains unclear. Thirty women with (n = 15) and without PVD (n = 15) were recruited to examine the relationship among physiological and subjective arousal, pain sensitivity and psychological/sexual function. Laser Doppler imaging (LDI) directly measured blood flow to the external genitals in response to an erotic film, and pain sensitivity was assessed before and after imaging. The PVD group had significantly lower blood flow than the control group during the erotic film when baseline blood flow levels were controlled; there were, however, no group differences in ratings of subjective arousal during the erotic film. Vestibular pain thresholds were significantly lower in the PVD group before and after the erotic film compared to the control group. In contrast, pain intensity ratings were significantly higher pre-erotic film in the PVD group, but there was no group difference post-erotic film. Pain thresholds did not significantly change in either group following exposure to the erotic film. Lastly, the PVD group had significantly lower sexual and psychological function in comparison to the control group, and intercourse frequency and pain catastrophizing significantly predicted genital ii responsiveness in the PVD group. The results suggest that women with PVD show an attenuated physiological response to erotic stimuli in an experimental setting, in the absence of differences in subjective arousal. The findings thus support the role of arousal in the maintenance of PVD, potentially in interaction with other physical and psychological factors. The study also has implications for the assessment and treatment of PVD, whereby arousal processes should be explicitly and separately managed in women with this condition. iii Acknowledgements There are many individuals without whom this project would not have come to fruition. First and foremost, I would like to thank my supervisor Dr. Caroline Pukall who has provided me with endless guidance and support throughout the past two years. Your positive attitude and enthusiasm was a constant source of motivation. Collaborating with you on this project has been a wonderful experience and I look forward to continuing our work together in the years to come. To my committee members Dr. Ronald Holden, Dr. Patricia Minnes and Dr. Catherine Cahill, your feedback offered novel perspectives and insight; I am incredibly grateful for your contributions to this project. Many thanks to all the other members of the Sexual Health Research Laboratory who contributed to this project. To Dr. Sue Chamberlain for her role on the team, research assistants Sara Caird and Melyssa Wright, my LDI guru Samantha Waxman, and my dear friend Kelly Smith who was always just a phone call away. To my family and friends in Kingston, Montréal and beyond, thank you for all your support through the peaks and valleys of the past two years. I am eternally grateful for all the love and laughter you provided, even when I was at my most neurotic. To Jeremy, thank you for always knowing (better than me most of the time) when I needed to take a break; you were always there, whether it be for stats advice or a hug. To my parents, your love and dedication for your work has always inspired me. It means the world to know that you are always behind me and support everything I do. iv Table of Contents Abstract............................................................................................................................... ii Acknowledgements............................................................................................................ iv Table of Contents................................................................................................................ v List of Figures.................................................................................................................. viii List of Tables ..................................................................................................................... ix Chapter 1 Introduction........................................................................................................ 1 Chapter 2 Literature Review............................................................................................... 4 Vulvodynia: Definitions, Terminology and Prevalence.................................................. 4 Physical and Psychological Correlates of PVD .............................................................. 7 PVD and Sexual Arousal ................................................................................................ 8 Experimental Measurement of Female Sexual Arousal................................................ 10 Investigation of Sexual Arousal in PVD....................................................................... 13 The Relationship Between Pain Sensitivity and Sexual Arousal.................................. 15 Purpose and Rationale of Present Study ....................................................................... 19 Objectives...................................................................................................................... 21 Hypotheses .................................................................................................................... 22 Chapter 3 Method ............................................................................................................. 23 Participants.................................................................................................................... 23 Materials & Apparatus .................................................................................................. 24 Structured Interview .................................................................................................. 24 Questionnaires ........................................................................................................... 25 Measures of Sexual Arousal...................................................................................... 31 LDI......................................................................................................................... 31 Subjective sexual arousal....................................................................................... 32 Films. ..................................................................................................................... 33 Procedure....................................................................................................................... 34 Session I..................................................................................................................... 34 Session II ................................................................................................................... 35 v Chapter 4 Results.............................................................................................................. 42 Data Considerations ...................................................................................................... 42 Sample Characteristics .................................................................................................. 44 Demographics............................................................................................................ 44 Gynecological History............................................................................................... 49 Medical/Psychiatric History ...................................................................................... 52 PVD Vulvar Pain History and Characteristics .......................................................... 53 Menstrual Cycle......................................................................................................... 55 Questionnaire Measures of Psychological and Sexual Function .................................. 55 PVD Vulvar Pain Measures....................................................................................... 56 Pain Catastrophizing Scale (PCS) ............................................................................. 56 Sexual Function......................................................................................................... 60 Psychological Function ............................................................................................. 63 Self-Reported Difficulty With Arousal. .................................................................... 63 Physiological Arousal ................................................................................................... 64 Group Differences
Load more

Recommended publications
  • 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.
    [Show full text]
  • 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.
    [Show full text]
  • 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.
    [Show full text]
  • 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.
    [Show full text]
  • 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.
    [Show full text]
  • Women's Health Concerns
    WOMEN’S HEALTH Natalie Blagowidow. M.D. CONCERNS Gynecologic Issues and Ehlers- Danlos Syndrome/Hypermobility • EDS is associated with a higher frequency of some common gynecologic problems. • EDS is associated with some rare gynecologic disorders. • Pubertal maturation can worsen symptoms associated with EDS. Gynecologic Issues and Ehlers Danlos Syndrome/Hypermobility •Menstruation •Menorrhagia •Dysmenorrhea •Abnormal menstrual cycle •Dyspareunia •Vulvar Disorders •Pelvic Organ Prolapse Puberty and EDS • Symptoms of EDS can become worse with puberty, or can begin at puberty • Hugon-Rodin 2016 series of 386 women with hypermobile type EDS. • 52% who had prepubertal EDS symptoms (chronic pain, fatigue) became worse with puberty. • 17% developed symptoms of EDS with puberty Hormones and EDS • Conflicting data on effects of hormones on connective tissue, joint laxity, and tendons • Estriol decreases the formation of collagen in tendons following exercise • Joint laxity increases during pregnancy • Studies (Non EDS) • Heitz: Increased ACL laxity in luteal phase • Park: Increased knee laxity during ovulation in some, but no difference in hormone levels among all (N=26) Menstrual Cycle Hormonal Changes GYN Issues EDS/HDS:Menorrhagia • Menorrhagia – heavy menstrual bleeding 33-75%, worst in vEDS • Weakness in capillaries and perivascular connective tissue • Abnormal interaction between Von Willebrand factor, platelets and collagen Menstrual cycle : Endometrium HORMONAL CONTRACEPTIVE OPTIONS GYN Menorrhagia: Hormonal Treatment • Oral Contraceptive Pill • Progesterone only medication • Progesterone pill: Norethindrone • Progesterone long acting injection: Depo Provera • Long Acting Implant: Etonorgestrel • IUD with progesterone Hormonal treatment for Menorrhagia •Hernandez and Dietrich, EDS adolescent population in menorrhagia clinic •9/26 fine with first line hormonal medication, often progesterone only pill •15/26 required 2 or more different medications until found effective one.
    [Show full text]
  • The Pelvic Floor As an Emotional Organ
    25.02.2020 The Pelvic Floor as an Emotional Organ “The Mirror of the Soul” Y. Reisman MD, PhD, FECSM, ECPS Urologist & Sexologist Flare- Health Netherlands What is the pelvic floor (PF) a. Group of Muscles b. Region of the body c. Organ a, b and c are right 1 25.02.2020 What do Ob/gyn and urological textbooks say about the pelvic floor? ◦ The pelvic floor has 3 important functions: ◦ 1. The pelvic floor supports the bladder, intestines and uterus and helps to control the pee and the stool. ◦ 2. The pelvic floor, as part of the sphincters of anus and urethra, is essential for continence. ◦ 3. The pelvic floor of women is important in the birth process because of the resistance in the birth canal that is essential for the spindle rotation. Support Passage Functions of PF Support Mobility / Stability Passage (in & out) Sex Emotion 2 25.02.2020 Involvement of Pelvic Floor in Sex ◦ Enhancement of blood flow ◦ ischiocavernous muscle facilitates erection ◦ bulbocavernous maintaining the erection (pressing deep dorsal vein) ◦ Inhibit ejaculation ◦ relaxation of the bulbocavernous and ischiocavernous muscles 3 25.02.2020 Involvement of Pelvic Floor in Sex ◦ Adequate genital arousal & orgasm ◦ ischiocavernous muscle attached to the clitoris ◦ Arousal & orgasem ◦ contraction of the levator ani involved Graber G, J Clin Psychiatry 1979;40:348–51. Shafik A. J Pelvic Floor Dysfunct 2000;11:361–76. Bo K, Acta Obstet Gynecol Scand 2000;79:598–603. The Pelvic Floor as Emotional Organ FFF (FIGHT, FLIGHT or FREEZE) Anxiety provoking startles of reflexogenic contraction of pelvic- and shoulder musculature (van der Velde, Laan & Everaerd, 2001) 4 25.02.2020 Defence Mechanism 0,5 0,4 STIMULI 0,3 Neutral Anxiety 0,2 Sex EMG (∆µV) Sexual Threat 0,1 0 -0,1 PF m.
    [Show full text]
  • Two New Physiological Methods to Assess the Specificity of Sexual Responses Megan Leona Sawatsky a Thesis Submitted in Partial F
    Two New Physiological Methods to Assess the Specificity of Sexual Responses Megan Leona Sawatsky A thesis submitted in partial fulfillment of the requirements for the Doctorate in Philosophy degree in Clinical Psychology School of Psychology Faculty of Social Science University of Ottawa © Megan Leona Sawatsky, Ottawa, Canada, 2020 ii Author Declaration I hereby declare that I am the major contributing author of this dissertation. This is a true copy of the dissertation, including any required final revisions, as accepted by my examiners. I authorize the University of Ottawa to lend this dissertation to other institutions or individuals for the purpose of scholarly research. I further authorize the University of Ottawa to reproduce this dissertation by photocopying or by other means, in total or in part, at the request of other institutions or individuals for the purpose of scholarly research. I understand that my dissertation may be made electronically available to the public. Megan Leona Sawatsky iii Abstract Psychophysiological methods to study sexual response patterns in laboratory settings have revealed an intriguing, and puzzling, gender/sex difference in the cue-specificity of genital responses. Men’s penile responses differ across stimuli depending on the presence or absence of specific sexual cues (e.g., gender and age of individuals in a sexual stimulus), with substantial responses observed for cues that correspond with sexual preferences and much less response to nonpreferred cues. This is not the case for women. Women’s genital responses (vaginal vasocongestion) are elicited by almost any sexual cue and the response magnitude is much less affected by sexual preferences, particularly for heterosexual women.
    [Show full text]
  • Sexual Arousal: Similarities and Differences Between Men and Women the Journal of Men’S Health & Gender, 1 (2-3): 215-223, 2004
    Graziottin A. Sexual arousal: similarities and differences between men and women The Journal of Men’s Health & Gender, 1 (2-3): 215-223, 2004 DRAFT COPY – PERSONAL USE ONLY Sexual arousal: similarities and differences between men and women Alessandra Graziottin MD Centre of Gynaecology and Medical Sexology, Milan, Italy Abstract Sexual arousal encompasses activation of physiological systems that coordinate sexual function in both sexes and can be divided into central arousal, peripheral non-genital arousal, and genital arousal. Genital arousal leads to erection in men and to vaginal lubrication and clitoral/vulvar (vestibular bulb) congestion in women. Persisting biases in the understanding of the pathophysiology of sexual arousal are exemplified by the current differences in definitions. In men, sexual arousal disorders are identified with erectile disorders. In women, a more sophisticated set of definitions is described. It includes the subjective arousal disorder, the genital arousal disorder, the mixed arousal disorder, and the persistent sexual arousal disorder. Painful arousal, although not officially included in current nosology, should be considered. A preliminary critical consideration of similarities and differences in the definitions of arousal disorders, in the physiology of sexual arousal, in the causes of arousal disorders, and the influence of arousal disorders on satisfaction with the partner and happiness will be presented. In contrast to popular opinion, women’s arousal disorders influence their physical (OR= 7.04 (4.71-10.53) more than their emotional satisfaction (OR= 4.28 (2.96-6.20). Furthermore such disorders are reported to have a greater effect on women’s physical satisfaction (OR= 7.04 (4.71-10.53) than erectile dysfunction has on men’s physical satisfaction (OR= 4.38 (2.46-7.82).
    [Show full text]
  • Simultaneous Penile-Vaginal Induced Orgasms- Do They Facilitate Conception? RJ Levin* RJ Levin, 145 Dobcroft Road, Sheffield S7 2LT, Yorkshire, England
    Clinical Obstetrics, Gynecology and Reproductive Medicine Commentary Simultaneous penile-vaginal induced orgasms- do they facilitate conception? RJ Levin* RJ Levin, 145 Dobcroft Road, Sheffield S7 2LT, Yorkshire, England Van de Velde [1] declared, without any empirical studies, that the increased pO2 in the aroused vagina and the vaginal and semen ‘in normal and perfect coitus mutual orgasms must be simultaneous’ stimulants. Contact of the sperm with the latter male and female factors while Mace [2] opined that ‘simultaneous orgasm was the ideal for first induces pre-capacitation changes that facilitate full capacitation husband and wife’. Hannah Frith [3] reviewed the contemporary sex to occur later [10]. As the female orgasm lasts for approximately 20- advice literature and concluded that it has retained this ‘simultaneous 30 seconds [13], the uterine contractions that occur during it will orgasm as the yardstick for sexual intimacy between couples’ but the have no influence on sperm uptake because the elevated cervix is not feminist academic AnnaMarie Jagose regarded the goal as an ‘erotic in contact with the semen, it does not descend into the semen pool relic’ that most contemporary sexologists have abandoned [4]. In an until after the female orgasm occurs [10-12]. Some early controversial internet conducted survey of 2613 men and 2223 women simultaneous studies [14] proposed that the female orgasm increased the retention orgasm occurred only rarely for 38% of the men and 35% of the of spermatozoa and reduced their semen-leakage loss from the vagina women and never for 12% of the men and 21% of the women [5].
    [Show full text]
  • Menstruation: Science and Society
    Journal Articles 2020 Menstruation: science and society H. O. Critchley E. Babayev S. E. Bulun S. Clark I. Garcia-Grau See next page for additional authors Follow this and additional works at: https://academicworks.medicine.hofstra.edu/articles Part of the Medical Molecular Biology Commons Recommended Citation Critchley HO, Babayev E, Bulun SE, Clark S, Garcia-Grau I, Gregersen PK, Kilcoyne A, Kim JY, Metz CN, GriffithG, L . Menstruation: science and society. 2020 Jan 01; 223(5):Article 7169 [ p.]. Available from: https://academicworks.medicine.hofstra.edu/articles/7169. Free full text article. This Article is brought to you for free and open access by Donald and Barbara Zucker School of Medicine Academic Works. It has been accepted for inclusion in Journal Articles by an authorized administrator of Donald and Barbara Zucker School of Medicine Academic Works. For more information, please contact [email protected]. Authors H. O. Critchley, E. Babayev, S. E. Bulun, S. Clark, I. Garcia-Grau, P. K. Gregersen, A. Kilcoyne, J. Y. Kim, C. N. Metz, L. G. Griffith, and +11 additional authors This article is available at Donald and Barbara Zucker School of Medicine Academic Works: https://academicworks.medicine.hofstra.edu/articles/7169 1/4/2021 Menstruation: science and society SPONSORED DOCUMENT FROM AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY Am J Obstet Gynecol. 2020 Nov; 223(5): 624–664. PMCID: PMC7661839 doi: 10.1016/j.ajog.2020.06.004: 10.1016/j.ajog.2020.06.004 PMID: 32707266 Menstruation: science and society Hilary O.D. Critchley, MD,a,∗ Elnur Babayev, MD,b Serdar E. Bulun, MD,b Sandy Clark, MPA,c Iolanda Garcia-Grau, MS,d,e Peter K.
    [Show full text]
  • Seksuele Stoornissen En Genderidentiteitsstoornissen
    Annual Meeting 2015 anatomy & physiology of female sexual dysfunctions Nice, France, 10 June 2015 Bary Berghmans PhD MSc RPT clinical epidemiologist, health scientist, pelvic physiotherapist Pelvic care Center Maastricht Maastricht University Medical Center The Netherlands Netter-Anatomy Atlas-2009 ovary fallopian tube bladder abdomen uterus cervix pubic bone vagina urethra rectum clitoris Labium minus Labium majus anus vaginal orifice external urethra orifice G-spot female pelvic anatomy understanding essential to treat FSD internal and external genitalia internal: vagina, uterus, fallopian tubes, ovaries external: vulva consists of labia, interlabial space, clitoris, vestibular bulbs female pelvic anatomy: vagina wall vagina 3 layers: – inner aglandular mucous membrane epithelium . mucous type, squamous cell epithelium, cyclic changes – intermediary vascular muscularis layer . smooth muscle & extensive tree blood vessels, engorge during sexual arousal – outer adventitial supportive mesh . fibrosa layer providing structural support to vagina female pelvic anatomy: vagina vagina many ruggae needed for distensibility more prominent in lower third vagina (frictional tension during intercourse) abundance of nerve fibers anterior distal vagina compared to proximal vagina female pelvic anatomy: vagina during sexual arousal genital vasocongestion due to ↑ blood flow vaginal canal lubricated secretions uterine glands, and transudation subepithelial vascular bed by intercellular channels engorgement vaginal wall ↑ pressure inside capillaries
    [Show full text]