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Sex response cycle, showing responsive desire experienced during the sexual experience as well as variable initial (spontaneous) desire. At the "initial" stage (left) there is sexual neutrality, but with positive motivation. A woman's reasons for instigating or agreeing to sex include a desire to express love, to receive and share physical pleasure, to feel emotionally closer, to please the partner and to increase her own well-being. This leads to a willingness to find and consciously focus on sexual stimuli. These stimuli are processed in the mind, influenced by biological and psychological factors. The resulting state is one of subjective sexual arousal. Continued stimulation allows sexual excitement and pleasure to become more intense, triggering desire for sex itself: sexual desire, absent initially, is now present. Sexual satisfaction, with or without orgasm, results when the stimulation continues sufficiently long and the woman can stay focused, enjoys the sensation of sexual arousal and is free from any negative outcome such as pain. (Modified from Basson 2001, 14 and published with the permission of the American College of Obstetricians and Gynecologists.) 

Sex response cycle, showing responsive desire experienced during the sexual experience as well as variable initial (spontaneous) desire. At the "initial" stage (left) there is sexual neutrality, but with positive motivation. A woman's reasons for instigating or agreeing to sex include a desire to express love, to receive and share physical pleasure, to feel emotionally closer, to please the partner and to increase her own well-being. This leads to a willingness to find and consciously focus on sexual stimuli. These stimuli are processed in the mind, influenced by biological and psychological factors. The resulting state is one of subjective sexual arousal. Continued stimulation allows sexual excitement and pleasure to become more intense, triggering desire for sex itself: sexual desire, absent initially, is now present. Sexual satisfaction, with or without orgasm, results when the stimulation continues sufficiently long and the woman can stay focused, enjoys the sensation of sexual arousal and is free from any negative outcome such as pain. (Modified from Basson 2001, 14 and published with the permission of the American College of Obstetricians and Gynecologists.) 

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Acceptance of an evidence-based conceptualization of women's sexual response combining interpersonal, contextual, personal psychological and biological factors has led to recently published recommendations for revision of definitions of women's sexual disorders found in the American Psychiatric Association's Diagnostic and Statistical Manual (DSM-I...

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... and empirical studies, mainly of North Ameri- can and European adult women without sexual complaints, have clarified sexual response cycles that are different from the linear progression of discrete phases already men- tioned. Women describe overlapping phases of sexual re- sponse in a variable sequence that blends the responses of mind and body (Fig. 1). [11][12][13][14] That women have many reasons for initiating or agreeing to sex with their partners is an im- portant finding. 15 Women's sexual motivation is far more complex than simply the presence or absence of sexual de- sire (defined as thinking or fantasizing about sex and yearn- ing for sex between actual sexual ...
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... because the partner wanted to, to relieve tension) and to refrain (lack of interest, tiredness or physical problems [their own or their partner's], or no current partner). 15 These findings and those from other studies are in keeping with the sexual response cycle illustrated in Fig. ...
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... women report desire that appears to be spontaneous (also shown in Fig. 1), leading to arousal or to more enthusi- asm to find or be receptive to sexual stimuli. This type of de- sire has a broad spectrum across women and may be related to the menstrual cycle. 22 It decreases with age, 23 and at any age commonly increases with a new relationship. 12,21 Previous definitions of women's sexual dysfunctions un- ...
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... model in Fig. 1 clarifies the importance of women being able to become subjectively aroused. Many psycho- logical and biological factors may negatively influence this sexual ...
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... the various phases in patient's sex response cycle ( Fig. 1): her sexual motivations; the couple's emotional intimacy; their sexual skills; sexual stimuli and context, including interactions in the preceding hours; psychological factors, including distractions; and biological factors such as fatigue, depression or medications. Address abnormal loss of androgen activity* (e.g., from bilateral ...
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... on a careful history in which the physician helps the patient construct her sex response cycle (Fig. 1), prob- lem areas will be identified. 11 Thus the physician provides insight and direction to the many changes that need to be made by the woman and her partner. Having clarified the problems, the physician may be able to assist with some. For example, a partner's premature ejaculation can be addressed, the sexual context improved, ...

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... Problems with sexual function are even more frequent in patients with chronic kidney disease (CKD). Their frequency of up to 70% exceeds twofold the rate of difficulties in sexual functioning in the general population [10][11][12][13][14][15][16][17]. There are very few studies available on this particular issue. ...
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Purpose Difficulties in sexual functioning are very frequent in patients with chronic kidney disease (CKD). Sexual dysfunction (SD) can significantly diminish the quality of life (QOL) of affected individuals. The aim of this study was to determine the prevalence of SD in female patients undergoing chronic hemodialysis (CHD) and after renal transplantation (RTx) and to compare these groups with each other and with healthy control. Methods The survey was conducted among 123 female participants in a relationship, 28 of them undergoing CHD, 39 after RTx, and 56 healthy women without CKD. For the assessment of the sexual function and comorbidities, the Female Sexual Function Index (FSFI) questionnaire and Ifudu Comorbidity Index were used, respectively. Results Median age of all female participants was 60 (50–68). The median age of female CHD patients was 66 (61.3–72.8), RTx patients 56 (48–61), and the control group 59.5 (47.5–67.75). Among all participants, CHD female patients had the lowest scores in all sexual functioning domains. Compared to their age-adjusted control group, CHD patients had lower scores in desire, orgasm, and FSFI full score, whereas RTx patients had lower total FSFI scores and scores in all domains except for desire compared to their controls. Women with lower education, in marriage, and with more comorbidities had lower scores in sexual function domains. Conclusion Our study shows that SD in female patients undergoing CHD treatment or those after RTx is substantially higher than that in healthy women. We suggest that female patient treated for CKD should have proper care regarding their sexual health, and differences in demographic and medical factors should be taken into consideration during the treatment management.
... The third domain is "satisfaction with sex organs appearance and function". Normal sexual function is assessed based on the sexual response cycle, which is a combination of mind and body responses (21) . As body image affects all aspects of female sexual function (22) , the items of the third domain are related to the body and sexual self-image. ...
... In the third domain, not only female sexual function but also a spouse's sexual function is assessed from the women's viewpoint. In sexual dysfunction assessment, it is strongly recommended to evaluate sex partner-related factors regularly (18,21) . ...
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Background: This study aimed to develop and psychometrically validate the Sexual Health Instrument for Middle-Aged sexually active women (SHIMA). Methods: This study was a mixed exploratory study consisting of two phases. In phase one, we interviewed 19 middle-aged women and reviewed the existing instruments to generate an item pool. Then, a panel of experts (n = 16) examined the items. In the second phase, the psychometric properties of the instrument were assessed. For content and face validity, a panel of experts (n = 8) and a group of middle-aged women (n = 10) reviewed the items. For construct validity, a cross-sectional study was carried out on a sample of 407 married women. Finally, SHIMA's reliability was assessed. Results: In the first phase, the sexual health concept was explored, and a provisional scale including 60 items was generated. Next, 21 items were removed based on content and face validity. Accordingly, the results obtained from the exploratory factor analysis (EFA) indicated acceptable loading for 34 items tapping into six factors that jointly explained 48.67% of the total variance observed. The internal consistency evaluation revealed that Cronbach's alpha and McDonald's omega were greater than 0.7, and the average inter-item correlation was greater than 0.4, except for one factor that showed borderline results. Test-retest reliability over a 2-weeks interval was 0.90, indicating its high stability. Conclusion: The SHIMA is a reliable and valid scale for measuring sexual health in middle-aged married women. It can be used as a sexual health screening tool by healthcare professionals and for research purposes.
... Our results are similar to a meta-analysis conducted in 1999, which showed that sexual desire decreased slightly in the first trimester, had a different pattern in the second trimester, and significantly reduced in the third trimester [10]. In- creases in estrogen, progesterone, and prolactin in the first trimester lead to biological changes causing nausea and vomiting, weight gain, fatigue, and chest pain, affecting sexual desire and arousal [30]. Thus, the highest decrease in sexual desire was reported in the first trimester [31]. ...
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Introduction: Pregnancy is one of the most sensitive periods in a woman's life. Physical and psychological changes during pregnancy can significantly affect the couples' sexual relations. Healthy sexual desire during pregnancy is essential for the development of couples as parents. Objective: This meta-analysis study estimates the prevalence of sexual dysfunction overall and in different trimesters of pregnancy. Materials and Methods: This research is a systematic review and meta-analysis. A search was conducted in PubMed, Scopus, Science Direct, and Google Scholar databases to find cross-sectional and prospective cohort studies investigating the prevalence of sexual dysfunction in different trimesters using the female sexual function index (FSFI) published from 2000 to 2019. The methodological quality of each study was assessed using the modified from the STROBE (The Strengthening the Reporting of Observational Studies in Epidemiology) checklist to determine the risk of bias. The standard error of prevalence in each study was calculated based on the binomial distribution formula. Based on heterogeneity results, a random effect model was used to estimate the prevalence. Results: Fifteen articles met the inclusion criteria, with a total number of 3569 participants, of which 2538 were in cross-sectional studies and 1031 in prospective cohort studies. In the meta-analysis of both prospective cohort and cross-sectional studies, the prevalence rates of sexual dysfunction in the first, second, and third trimesters, and overall were estimated at 51.33% (95%CI; 37.41-65.25), 51.13% (95%CI; 38.93-63.33), 72.80% (95%CI; 65.78-79.81%), and 58.65% (95%CI; 51.50-65.80), respectively. Conclusion: The trimester of pregnancy has a predictive role in the prevalence of sexual dysfunction during pregnancy. The prevalence of sexual dysfunction is higher in the third trimester.
... This study evaluated and validated the claim of high efficacy of A. garckeana, in the treatment of female sexual arousal disorder. Sexual dysfunction affects about 30%-40% of women and the lack of sexual desire is the most common complaint among them [29]. In women, sexual dysfunction tends to increase as women age, but can affect women at any stage of life [30]. ...
Article
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Female sexual arousal and vagina lubrication are core complexes in achieving and enjoying a desirable sexual life in females. It has been noticed that female sexual arousal disorders have been kept away from public discus and statistics because of the lack of boldness on the part of women in speaking up about it, poor collation of medical cases, and the African mentality that tends to forbid women from being outspoken on sexual satisfaction. Azanza garckeana, a fruit native to northern Nigeria, is being used in traditional settings in diverse female sexual disorders and conditions. This study was designed to evaluate in-vivo, the female sex-enhancing claim of the plant. The study examined the vaginal width, ear twitching, and vagina lubrication in A. garckeana treated Oryctogalus cuniculus (American rabbit). Use of In-silico studies to dock previously identified secondary metabolites against targets and enzymes associated with female sexual arousal and vagina lubrication. The results show that the aqueous extract of A. garckeana caused a significant increase in the vagina width and lubrication of Oryctogalus cuniculus and significantly enhanced vaginal muscle relaxations and vaginal secretions upon sexual stimulation. This suggests the involvement of a mechanism that involves activation of female sexual excitatory systems and inhibition of those that depress female sexual arousal, or a combination of both. These findings corroborate findings from the molecular docking studies, which suggest that gossypol may play an important role in female sexual arousal and vagina lubrication because it looks to have some affinity with the targets of consideration in this study. Therefore, gossypol may well be responsible for the sex-enhancing activity of the plant.
... 44 All of these factors are speculated to be involved in this symptom and might be related to epigenetic alteration of androgen receptor (AR) and estrogen receptor (ER) densities due to influence of SSRIs on the epigenome. 45 Vaginal lubrication problems have been documented in PSSD. 10 This may simply be a consequence of diminished libido, but given the normal variability of the female sexual response, 46 the link with PSSD is unclear. Vaginal lubrication is dependent upon the synthesis of nitric oxide (NO), and the enzymatic function of NO synthesis is amplified by estrogen. ...
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Introduction Post-SSRI sexual-dysfunction (PSSD) is an iatrogenicsyndrome, the underlying neurobiological mechanisms of which areunclear. Symptom onset follows cessation of serotonergicantidepressants i.e. Selective Serotonin and Norepinephrine ReuptakeInhibitors (SSRI's, SNRI's), and Tricyclic antidepressants (TCA's). PSSDsymptoms include genital anesthesia, erectile dysfunction andorgasmic/ejaculatory anhedonia, and should be differentiated fromdepression-related sexual-dysfunction. Recently, accumulated data of numerous case-reports suggest additional non-sexual symptoms including, anhedonia, apathy, and blunted affect. PSSD gained official recognition after the European medical agency concluded that PSSD is a medical condition that persists after discontinuation of SSRI's and SNRI's. Objective To review possible underlying neurobiological mechanisms ofthis syndrome, update information on the pathophysiology, present a listof potential risk-factors and discuss potential management options forPSSD. Methods Extensive literature review on the main symptom-patterns ofthis disorder was undertaken using PubMed. It includes introductoryexplications of relevant neurobiology with the objective of generatinghypothesis. Results Precipitating factors for PSSD include previous exposure to certain drugs, genetic predisposition, psychological stress or chemical stressful reaction to antidepressants along pre-existing medical conditions affecting neuroplasticity. Different theories have been proposed to explain the pathophysiology of PSSD: epigenetic gene expression, dopamine-serotonin interactions, serotonin neurotoxicity and hormonal changes. The diagnosis of PSSD is by excluding all other etiologies of sexual-dysfunction. Treatment is challenging, and many strategies have been suggested without definitive outcomes. We offerthe contours of a future neurobiological research agenda, and propose several underlying mechanisms for the various symptoms of PSSD which could be the foundation for a future treatment algorithm. Conclusion There is a need for well-designed neurobiological research in this domain, as well as in the prevalence, pathophysiology, and treatment of PSSD. Practitioners should be alert to the distinctive features of PSSD. Misdiagnosing this syndrome might lead to harmful Sexual Medicine Reviews. Peleg LC, Rabinovitch D, Lavie Y, et al. Post-SSRI Sexual Dysfunction (PSSD): Biological Plausibility, Symptoms, Diagnosis, and Presumed Risk Factors. Sex Med Rev 2021;XX:XXX–XXX
... When we look at it from the sexual perspective, for women, sexuality is a broad concept that includes emotional, intellectual and sociocultural components as well as being desirable, childbearing ability and body image. Macromastia that affects sexuality directly or indirectly may disrupt sexual function and thus cause physical, mental and social problems in individuals [4,5]. ...
... It can be said that sexual performance is like a cycle that various biological and psychological factors or internal and external factors affect it (24). Sexual intelligence is related to different factors, such that matrimonial quality is confused with other variables of sex (25). ...
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Background: Sexual intelligence is one of the most vital topics in research and clinical fields. Therefore, the existence of a suitable instrument for measuring these structures is an inevitable necessity. This study designed a valid and reliable sexual intelligence scale. Methods: In this instrumental research, 225 students of Payame Noor University were selected by purposeful sampling and answered the questionnaire. A baseline questionnaire with 36 questions was provided to the participants. SPSS software, statistical analysis of factor analysis and correlation coefficient were used for data analysis. Results: In an exploratory factor analysis that was done on 19 materials of this test, results revealed 4 factors. Initial examination in this test showed that 4 important and prominent factors were found after rotation and by considering the sloping line diagram. Conclusion: The present study showed that the designed tool is of sufficient competence and can be used in clinical research and diagnosis.
... It can be said that sexual performance is like a cycle that various biological and psychological factors or internal and external factors affect it (24). Sexual intelligence is related to different factors, such that matrimonial quality is confused with other variables of sex (25). ...
Preprint
Full-text available
Background Sexual intelligence is one of the most vital topics in research and clinical fields. Therefore, the existence of a suitable instrument for measuring these structures is an inevitable necessity. This study designed a valid and reliable sexual intelligence scale. Methods In this instrumental research, 225 students of Payame Noor University were selected by purposeful sampling and answered the questionnaire. A baseline questionnaire with 36 questions was provided to the participants. SPSS software, statistical analysis of factor analysis and correlation coefficient were used for data analysis. Results In an exploratory factor analysis that was done on 19 materials of this test, results revealed 4 factors. Initial examination in this test showed that 4 important and prominent factors were found after rotation and by considering the sloping line diagram. Conclusion The present study showed that the designed tool is of sufficient competence and can be used in clinical research and diagnosis.
... Concerns about unwanted pregnancy have also been thought to contribute to women's sexual difficulties (Basson, 2005). However, there is a scarcity of clinical research focusing on sexual difficulties and conflicts around pregnancy, for example with regard to the risk for affected physical integrity or to the implications of 'motherhood' (both from an individual and societal perspective) as described by our participants. ...
Article
The origin of women’s sexual pain and difficulties with intercourse is still under-researched. The aim of this study was to examine women’s constructions of origins. Twenty-eight participants previously diagnosed with vaginismus or dyspareunia were recruited via patient lists and private practices. Interviews had a semi-structured biographic-narrative format; transcripts were analyzed using Grounded Theory. Participants’ narratives were constructed based on two major processes: Negotiating Womanhood and Othering the Body. They were integrated in an explanatory model. Identified processes permeated women’s subjective experience and construction of the origin of their sexual difficulties, and were related to societal discourses and women’s embodied experience.
... Um modelo proposto mais recentemente por Basson sugere que a adequada função ocorre como um ciclo, que sofre influência direta dos fatores extrínsecos, intrínsecos e interpessoais, em ordem variável e considerando a relação indivíduoindivíduo e indivíduo-situação. 3 Estas reflexões tornam possível a observação da função sexual de maneira mais ampla, com base em cada fase de resposta, mas também levando em consideração fatores pessoais e sociais, como desejo, interesse, preliminares, excitação pessoal e sintonia com o parceiro. 4 Possibilita, dessa forma, a ampliação das definições de disfunção sexual (DS) e, consequentemente, das vertentes para diagnóstico e tratamento dessas condições. ...
Article
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OBJETIVO: Verificar a frequência e os fatores associados à disfunção sexual em mulheres jovens universitárias. MÉTODOS: Trata-se de um estudo descritivo analítico de corte transversal. Participaram deste estudo 111 mulheres, estudantes, heterossexuais do curso de fisioterapia da Universidade Federal da Bahia. Cada participante respondeu a dois questionários auto aplicáveis “Investigação de fatores associados” e “Quociente sexual – versão feminina”, entre os meses de setembro e outubro de 2019. RESULTADOS: Foi encontrado nesta população prevalência de 8% de disfunção sexual. O sintoma de esforço evacuatório esteve associado à pior desempenho/satisfação sexual pelo score total do QS-F (p=0,03) e quando avaliado por agrupamento de questões foi encontrada associação entre esforço evacuatório e pior excitação (p=0,01), esforço evacuatório e mais dor (p=0,04); urgência urinária e mais dor (p=0,04); violência e pior excitação (p=0,05) e violência e menos satisfação/orgasmo (p=0,02). CONCLUSÃO: Os resultados sugerem que há baixa prevalência de disfunção sexual na população estudada, mas há associação entre sintomas de disfunções do assoalho pélvico e disfunções sexuais em mulheres jovens.