Understanding Sexual Arousal in Women
Sexual arousal in women is characterized by both subjective (mental) and physiological (genital) components that include genital vasocongestion, vaginal lubrication, and mental engagement during sexual activity.
Components of Female Sexual Arousal
- Sexual arousal in women comprises two primary components: genital (physiological) arousal and subjective (mental) arousal 1
- Genital arousal is characterized by genital vasocongestion, increased vaginal blood flow, and lubrication that occur in response to sexual stimuli 1, 2
- Subjective arousal refers to mental engagement and psychological aspects of arousal during sexual activity 1
- For some women, genital arousal enhances subjective arousal; for others, these two types of arousal may be desynchronous (not aligned) 1
Physiological Aspects of Arousal
- Physiological arousal includes measurable changes such as:
- Vaginal lubrication is a primary component of physiological sexual arousal and can be objectively measured 2
- After initial orgasm, vaginal engorgement in women can remain at high levels, creating the physiological foundation for multiple orgasmic responses 5
Hormonal Influences on Sexual Arousal
- Hormones play an important role in female sexual functioning 3
- Low serum estrogen can cause vaginal atrophy, higher vaginal pH, and reduced vaginal lubrication and expansion upon stimulation 3
- Estrogen indirectly regulates vaginal and clitoral nitric oxide, which promotes vaginal mucosal health and mediates relaxation of smooth muscle 3
Psychological Aspects of Arousal
- Women with sexual arousal concerns may experience differences in their perception of autonomic arousal compared to women without such concerns 4
- Relationship factors and context play significant roles in female sexual arousal 4
- Sexual arousal is highly cognitive in women, with mental engagement and psychological factors strongly influencing the experience 5
- The relationship between genital and subjective arousal varies among women and may not always be aligned 1
Assessment of Sexual Arousal
- Domains of sexual functioning that should be assessed include desire, arousal, lubrication, orgasm, satisfaction, and pain 3
- Standardized questionnaires such as the Female Sexual Function Index and Brief Index of Sexual Functioning-Women can be helpful in assessment 3
- The Brief Sexual Symptom Checklist is recommended as a primary screening tool 3
- Healthcare providers should initiate discussions about sexual function, as patients may be too embarrassed or believe there is no treatment 3
Common Pitfalls in Understanding Female Sexual Arousal
- Assuming that all women who report sexual arousal problems have decreased genital arousal, when studies show this is not always the case 1
- Confusing sexual arousal with sexual motivation, which are related but distinct concepts 6
- Overlooking the importance of psychological and relationship factors in female sexual arousal 4
- Failing to recognize that the relationship between physiological and subjective arousal varies significantly among women 1
- Assuming that physiological measures of sexual response necessarily reflect a woman's subjective experience 5
Treatment Approaches for Sexual Arousal Disorders
- Pelvic floor muscle training may improve sexual pain, arousal, lubrication, orgasm, and satisfaction 3, 7
- Cognitive behavioral therapy has shown efficacy for improving sexual function, particularly in cancer survivors 7
- Vaginal moisturizers and lubricants can be used for vaginal dryness and sexual pain 7
- The use of oral phosphodiesterase type 5 inhibitors (PDE5i) like sildenafil is not recommended for female sexual dysfunction due to lack of evidence regarding their effectiveness 3, 8
- Medications that promote nitric oxide-mediated smooth muscle relaxation may help treat female sexual arousal disorder, though more research is needed 3