FSD is more typical as women age and is a progressive and widespread condition. Common symptoms associated with FSD include diminished vaginal lubrication, pain and discomfort upon intercourse, decreased sense of arousal and difficulty in achieving orgasm. Only a small percentage of women seek medical attention. In comparison to the overwhelming research and treatment for erectile dysfunction in males, specifically with the development of phosphodiesterase type 5 inhibitors, significantly less has been explored regarding FSD and treatment is primarily limited to psychological therapy.
Several cardiovascular diseases have been linked with FSD including atherosclerosis, peripheral arterial disease and hypertension, all of which are also pathological conditions associated with aging and erectile dysfunction in men.
Using animal models,
Kuly ral wife sexual dysfunction have expanded our understanding of FSD, however a tremendous amount is still to be learned in order to properly treat women suffering from FSD.
The aim of this review is to provide the most current knowledge on FSD, advances in basic science addressing this dysfunction, and explore developing therapeutic options. Human sexual function is an essential component of life, both in species propagation as well as quality of life. Sexual dysfunction can lead to reduced quality of life and potentially procreative advancement. Male sexual dysfunction, especially erectile dysfunction, has been extensively studied and effective therapies are available for men with this disorder.
However, female sexual dysfunction FSD is more complicated and significantly less is understood in comparison to male sexual dysfunction. Therefore, the present review focuses on therapies available or in development as well as challenges faced by investigators in the study of FSD. Other recent reviews articles may be useful for understanding additional aspects of FSD [ 1 — 3 ].
Sexual function results from a complex neurovascular process that is controlled by psychological and hormonal inputs. Like any coordinated physiological response, multiple systems are involved in this function. In respect to proper vaginal and clitoral function, a sufficient blood supply is required for a satisfying sexual experience. Vaginal and labial data were derived from partial oxygen pressures detected at each tissue site [ 4 ] while magnetic resonance imaging of Kuly ral wife sexual dysfunction clitoris measured changes in volume during neutral and stimulating visual imagery [ 5 ].
FSD is a multifaceted disorder, comprising anatomical, physiological, as well as social-interpersonal components.
The psychogenic and hemodynamic events of the normal female sexual cycle. Psychosexual responses from arousal, orgasm and post orgasm frame approximate vaginal and labial pressures as well as clitoral volume.
Increasing arousal that culminates in orgasm demonstrates increases in vaginal and labial pressures and filling of the clitoris. Data are compiled from several sources referenced in the text. Appreciating the uniqueness of each FSD facet is critical in our understanding and potential treatment of FSD in general terms.
Female sexual arousal disorders FASD can be defined as a recurrent inability to attain, or maintain until completion, sexual activity. Kuly ral wife sexual dysfunction arousal response consists of vasocongestion in the pelvis, vaginal lubrication, and expansion and swelling of external genitals.
Orgasmic disorders can be categorized with FASD and are described as the persistent or recurrent difficulty, delay in, or absence of, attaining orgasm following sufficient sexual stimulation and arousal that leads to personal distress. Sexual pain disorders are another form of FSD and are diagnosed as followed: By comparison, the Massachusetts Male Aging Study found that However, FSD remains relatively understudied and therapeutic breakthroughs, such as phosphodiesterase type 5 PDE 5 inhibitors used for erectile "Kuly ral wife sexual dysfunction," have yet to be discovered.
Throughout society, sexual disorders for women are influenced by both health-related and psychosocial factors. Taken together, this dynamic is associated with impaired quality of life and interpersonal relationships [ 11 ]. Significant improvements in overall clinical care have allowed the management of quality of life complications and not just the treatment of life-threatening diseases.
Importantly, several studies have linked cardiovascular diseases with sexual dysfunction, in both females [ 12 ] and males [ 13 ]. Therefore, the treatment of FSD as purely a lifestyle disorder may severely underestimate the seriousness of the situation.
Recently, Schwarz et al. Indeed, the prevalence of sexual dysfunction in women with chronic compensated heart failure suggests a reduction in quality of life.
Compared to the extensive sexual function studies conducted in diabetic men [ 15 ], substantially less is known regarding diabetic women. However, recent studies have demonstrated that diabetic women experience increased incidences of sexual dysfunction [ 16 — 18 ], including reduced sex drive, little to no arousal, vaginal dryness, difficulty in achieving orgasm and overall diminished sexual
Kuly ral wife sexual dysfunction [ 16 ].
Despite these observations, correlation between FSD and diabetes is not without controversy. A report on the frequency of psychosexual difficulties from diabetic women found secondary sexual dysfunction was reported in These authors concluded that, in diabetic women, sexual dysfunction was prominently a psychogenic complication. Therefore, a more comprehensive understanding of the etiology and treatment options of FSD is crucial for improving existing conditions seen in women, as well as preventative measures of future, more fatal, pathologies.
Animal models have been used to investigate female sexual function and dysfunction over the past 20 years and several experimental approaches have been developed.
Particular aspects of female sexual function, more specifically desire and peripheral arousal, are currently under investigation in basic science laboratory settings. Accurately modeling FSD is an experimental challenge. However, investigating comorbid diseases, such as diabetes, cardiovascular disease and depression models, allows end-point measurements involved in FSD to be examined.
This section will describe techniques currently in use and the challenges that face studying FSD.
Sexual desire in humans can be described as the presence of desire for sexual activity. Desire in animal models can be assessed by monitoring particular appetitive behaviors that occur during copulation as well as from certain unconditioned copulatory determinants [ 20 ].
In female rats, increased dopamine release in the striatum and nucleus accumbens leads to repetitive voluntary return by depressing an access lever to attain access to male rats [ 2122 ]. These authors also showed that cage pacing an animalistic sexual desire response was increased when the same central pathways were stimulated [ 2324 ]. Translating findings similar to these to the clinical setting has revealed that dopamine agonists discussed further in the following section indeed increase sexual desire in women and is a viable treatment option for women that suffer from HSDD.
Sexual arousal encompasses a variety of outputs, including vaginal blood flow, clitoral, labial and vestibular bulb engorgement [ 20 ]. These physiological responses are neuronally controlled, which affects the contractility of vascular smooth muscle cells
Kuly ral wife sexual dysfunction the genitals.
Pelvic nerve stimulation PNS is a common technique used to induce tumescence of erectile tissue.
Intracavernous pressure and blood flow can be measured by inserting a probe into vaginal tissue and the corpus cavernosum, and signals to a laser Doppler blood flow monitor and thus, following PNS, changes in vaginal and clitoral blood flow can be measured. Recently, Angulo and colleagues demonstrated that treatment with vardenafil, a PDE5 inhibitor, increased vaginal and clitoral blood flow following PNS, which was assessed
Kuly ral wife sexual dysfunction laser Doppler, in a FSD-rabbit model where the animals were treated with anti-depressants [ 25 ].
The use of the female New Zealand white rabbit has given tremendous insight into genital hemodynamic Kuly ral wife sexual dysfunction. Additionally, Giuliano and coworkers demonstrated using a scanning laser Doppler system that rat vaginal blood flow, as well as contractions and temperature were increased following PNS [ 27 ].
Ex vivo investigation of clitoral and vaginal strips, as well as the vasculature that delivers blood to these end-organs, have revealed contractility and relaxation states of these tissues.
By using wire myographs, we have begun to characterize the contractile properties of internal pudendal arteries as well as the clitoral arteries, the vasculature that feed blood to the clitoris and labia minora, in female rats [ 28 ]. Using this technique, we have measured alterations in contraction, relaxation, signaling, and drug effectiveness in physiological and pathological conditions Fig.
Kuly ral wife sexual dysfunction researchers have demonstrated that experimentally-induced diabetic rats have diminished adrenergic- cholinergic- and NANC-neurotransmitter mechanisms in the smooth muscle of the vagina compared to control [ 29 ].
As well, Myung and colleagues demonstrated that an overactive bladder model in female rabbits deteriorated clitoral engorgement, which was associated with greater force generation through increased calcium sensitization and subsequently decreased relaxation, via activation of endothelin-1 ET-1 and Rho-kinase system [ 30 ], which support our previous findings [ 28 ].
Representative trace showing changes in force contraction and relaxation of a female internal pudendal artery stimulated with increased concentrations of endothelin-1 ET-1 and acetylcholine AChrespectively. The internal pudendal artery supplies blood to the clitoris and labia minora of the vagina.
Relaxation of the internal pudendal artery is essential to achieve tumescence during sexual stimulation. A compromised state of relaxation in this artery may play a role in female sexual dysfunction. These basic science techniques have and continue to advance our understanding of FSD, however several experimental challenges still remain. Due to undefined anatomical characteristics and limitations in structure, physiological and pharmacological aspects of the rat have not been thoroughly investigated.
In contrast, clitoral function and characteristics have been studied in larger animal studies rabbits and dogshowever these species are limited in experimental design when compared to rat. The investigation of FSD is complicated by many factors. Experimentally, modeling FSD is challenging due to the multifaceted and varied inputs that define this disorder.
Therefore endpoint measurements such as clitoral and vaginal blood flow, internal pudendal artery compliance and nerve-stimulated increases in pressure assist in the quantification of animal responses.
Direct study of FSD in animal models has proven difficult and therefore the disorder has been investigated in the study of other comorbid conditions diabetes, hypertension, ect. This approach could complicate the study of FSD in that the researcher must interpret data in conjunction with an additional disease condition. However, this may be a more realistic approach due to the commonalities between FSD and some cardiovascular diseases. Currently there are few pharmacological options available in the treatment of "Kuly ral wife sexual dysfunction." Historically, FSD patients were treated through psychological therapy; however as we have come to understand the extensiveness of the disorder, more basic science research and clinical recognition have been developed to address the problem.
Several pharmacological initiatives are in development aimed at increasing blood flow to the genitals, improving androgen deficiencies and enhancing central nervous system stimulation.