nach oben

Current Sexual Health Reports

Erschienen in:

08.11.2022 | Preclinical and Psychophysiology (F Guarraci, Section Editor)

Local Responses to Genital Arousal — Mechanisms of Lubrication

verfasst von: Ariel B. Handy, Leah N. McMahon, Cindy M. Meston

Erschienen in: Current Sexual Health Reports | Ausgabe 4/2022

Einloggen, um Zugang zu erhalten

Abstract

Purpose of Review

The aim of this review is to outline the anatomical and physiological processes involved in vaginal lubrication and to examine the current options for its measurement in the laboratory.

Recent Findings

The literature suggests that androgens and estrogens play a crucial role in the maintenance of vaginal structure and vascular functions, thereby delivering positive downstream effects on vaginal lubrication. Estrogens and androgens help maintain healthy genital tissue and capillary beds. During sexual arousal, interactions among these hormones with various peptides encourage genital vasocongestion, which, by way of increased pressure on surrounding cells, is believed to facilitate lubrication. Litmus strips and Schirmer Tear Test strips circumvent many pitfalls of previous objective measurements and appear to be viable methods for assessing vaginal lubrication in the laboratory.

Summary

Vaginal lubrication is believed to result from increased vasocongestion and appears to be modulated by sex steroid hormones. Preliminary support has emerged for the use of litmus strips and Schirmer Tear Test strips to measure lubrication in response to sexual films in the laboratory, though more research is needed to determine the psychometric properties of these applications.

Basson R. Human sexual response. In: Handbook of clinical neurology. Elsevier, 2015:130:11–18. https://doi.org/10.1016/B978-0-444-63247-0.00002-X.

Janssen E, Everaerd W, Spiering M, Janssen J. Automatic processes and the appraisal of sexual stimuli: toward an information processing model of sexual arousal. J Sex Res. 2000;37:8–23. https://doi.org/10.1080/00224490009552016.CrossRef

Spiering M, Everaerd W, Janssen E. Priming the sexual system: implicit versus explicit activation. J Sex Res. 2003;40:134–45. https://doi.org/10.1080/00224490309552175.CrossRefPubMed

Chivers ML, Seto MC, Lalumière ML, Laan E, Grimbos T. Agreement of self-reported and genital measures of sexual arousal in men and women: a meta-analysis. Arch Sex Behav. 2010;39:5–56. https://doi.org/10.1007/s10508-009-9556-9.CrossRefPubMedPubMedCentral

Parish SJ, Goldstein AT, Goldstein SW, et al. Toward a more evidence-based nosology and nomenclature for female sexual dysfunctions—part II. J Sex Med. 2016;13:1888–906. https://doi.org/10.1016/j.jsxm.2016.09.020.CrossRefPubMed

Althof SE, Meston CM, Perelman MA, Handy AB, Kilimnik CD, Stanton AM. Opinion paper: on the diagnosis/classification of sexual arousal concerns in women. J Sex Med. 2015;14:1365–71. https://doi.org/10.1016/j.jsxm.2017.08.013.CrossRef

Lalumière ML, Sawatsky ML, Dawson SJ, Suschinsky KD. The empirical status of the preparation hypothesis: explicating women’s genital responses to sexual stimuli in the laboratory. Arch Sex Behav. 2020;51:709–28. https://doi.org/10.1007/s10508-019-01599-5.CrossRefPubMed

Levin RJ. The ins and outs of vaginal lubrication. Sex Relatsh Ther. 2003;18:509–13. https://doi.org/10.1080/14681990310001609859.CrossRef

Jozkowski KN, Peterson ZD. College students and sexual consent: unique insights. J Sex Res. 2013;50(6):517–23. https://doi.org/10.1080/00224499.2012.700739.CrossRefPubMed

10.

Berman JR. Physiology of female sexual function and dysfunction. Int J Impot Res. 2005;17(1):S44-51.CrossRefPubMed

11.

Clark GL, Pokutta-Paskaleva AP, Lawrence DJ, Lindsey SH, Desrosiers L, Knoepp LR, et al. Smooth muscle regional contribution to vaginal wall function. Interface Focus. 2019;9(4):20190025. https://doi.org/10.1098/rsfs.2019.0025.CrossRefPubMedPubMedCentral

12.

Hoyle CH, Stones RW, Robson T, Whitley K, Burnstock G. Innervation of vasculature and microvasculature of the human vagina by NOS and neuropeptide-containing nerves. J Anat. 1996;188(Pt 3):633.PubMedPubMedCentral

13.••

Dubinskaya A, Guthrie T, Anger JT, Eilber KS, Berman JR. Local genital arousal: mechanisms for vaginal lubrication. Curr Sex Health Rep. 2021:45–53. https://doi.org/10.1007/s11930-021-00305-8. This paper reviewed the existing literature on female sexual arousal with a focus on genital arousal and mechanisms of lubrication. Current treatment options for female sexual arousal disorder were discussed.

14.

Masters WH, Johnson VE. Human sexual response. 1st ed. Little: Brown & Co.; 1966.

15.

Park K, Kim NN. Anatomy and physiology of arousal. Textbook of female sexual function and dysfunction: diagnosis and treatment. 2018 May 22:107-25.

16.

Jannini EA, d’Amati G, Lenzi A. Histology and immunohistochemical studies of female genital tissue. Women’s sexual function and dysfunction: study, diagnosis and treatment. London: Taylor and Francis. 2006:125–33.

17.

Omole F, Kelsey RC, Phillips K, Cunningham K. Bartholin duct cyst and gland abscess: office management. Am Fam Physician. 2019;99(12):760–6.PubMed

18.

Giraldi, A, & Levin, RJ. Vascular physiology of female sexual function. In I. Goldstein, C. M. Meston, S. R. Davis, & A. M. Traish (Eds.) Women’s sexual function and dysfunction: study, diagnosis and treatment 2006:174–180. Boca Raton, Florida: Taylor & Francis. https://doi.org/10.1016/j.jsxm.2016.02.172.

19.

Levin RJ, Wagner G. Human vaginal fluid-ionic composition and modification by sexual arousal [proceedings]. J Physiol. 1977;266(1):62P-63P.PubMed

20.

Wagner G, Levin R. Oxygen tension of the vaginal surface during sexual stimulation in the human. Fertil Steril. 1978;30(1):50–3. https://doi.org/10.1016/S0015-0282(16)43395-9.CrossRefPubMed

21.

Wagner G, Levin R. Human vaginal pH and sexual arousal. Fertil Steril. 1984;41(3):389–94. https://doi.org/10.1016/S0015-0282(16)47717-4.CrossRefPubMed

22.

Goldstein I, Traish A, Kim N, Munarriz R. The role of sex steroid hormones in female sexual function and dysfunction. Clin Obstet Gynecol. 2004;47(2):471–84. https://doi.org/10.1097/00003081-200406000-00022.CrossRefPubMed

23.

Santoro N, Worsley R, Miller KK, Parish SJ, Davis SR. Role of estrogens and estrogen-like compounds in female sexual function and dysfunction. J Sex Med. 2016;13:305–16. https://doi.org/10.1016/j.jsxm.2015.11.015.CrossRefPubMed

24.

Davis SR, Worsley R, Miller KK, Parish SJ, Santoro N. Androgens and female sexual function and dysfunction--findings from the fourth international consultation of sexual medicine. J Sex Med. 2016:168–178. https://doi.org/10.1016/j.jsxm.2015.12.033.

25.

Rosenfield RL, Cooke DW, Radovick S. Puberty and its disorders in the female. In: Pediatric Endocrinology. 2014:569–663.e1. https://doi.org/10.1016/B978-1-4557-4858-7.00024-X.

26.

Cohen SD, Goldstein I. Diagnosis and management of female sexual arousal disorder. 2016:251–260. https://doi.org/10.1007/978-1-4939-3100-2_22

27.••

Maseroli E, Vignozzi L. Testosterone and vaginal function. Sex Med Rev. 2020;8(3):379–92. https://doi.org/10.1016/j.sxmr.2020.03.003.This paper summarizes pre-clinical and clinical data that shows testosterone plays a critical role in the maintenance of vaginal tissue structure and function.

28.•

Mandal S, Mukhopadhyay P, Ghosh S. Sexual dysfunction in Sheehan syndrome. Endocrine Practice. 2021;27(12):1212–5. https://doi.org/10.1016/j.eprac.2021.07.013. This paper evaluated sexual function in women with Sheehan syndrome, a condition marked by necrosis of the pituitary gland and severe androgen deficiency. Sheehan syndrome patients exhibited significantly lower scores in the domains of desire, arousal, lubrication, orgasm, and satisfaction, compared to healthy controls.

29.•

Mandal S, Mukhopadhyay P, Ghosh S. DHEA on sexual function in Sheehan syndrome: a randomized double-blind placebo-controlled crossover trial. J Clin Endocrinol Metab. 2022 Apr 27. https://doi.org/10.1210/clinem/dgac260. This crossover trial investigated the effect of DHEA supplementation (25 mg/twice daily) versus placebo on sexual functioning in patients with Sheehan syndrome. The findings suggest that DHEA supplementation improves sexual functioning in the domains of desire, arousal, lubrication, orgasm, and satisfaction.

30.

Hobeika E, Armouti M, Kala HS, Stocco C. Ovarian hormones. In: Hormonal signaling in biology and medicine. Elsevier, 2020:565–583. https://doi.org/10.1016/B978-0-12-813814-4.00025-0.

31.

Nappi RE, Polatti F. Continuing medical education: the use of estrogen therapy in women’s sexual functioning (CME). J Sex Med. 2009;6:603–16. https://doi.org/10.1111/j.1743-6109.2008.01198.x.CrossRefPubMed

32.

Kayisli UA, Basar M, Guzeloglu-Kayisli O, et al. Long-acting progestin-only contraceptives impair endometrial vasculature by inhibiting uterine vascular smooth muscle cell survival. Proc Natl Acad Sci USA. 2015;112:5153–8. https://doi.org/10.1073/pnas.1424814112.CrossRefPubMedPubMedCentral

33.•

De La Hoz FJ. Effects of combined oral contraceptives on women’s sexual function, Eje Cafetero, Colombia, 2016–2020. J Sex Med Res 2022;102. https://doi.org/10.47363/JSMR/2022. This cross-sectional study investigated sexual functioning among women using combined oral contraceptives. Women taking ethinylestradiol/drospirenone (EE₂/DSP) demonstrated decreased arousal and lubrication scores at 9 months; however, this finding was not observed among women taking Estradiol Valerate/Dienogest (VE₂/DNG) or ethinylestradiol/levonorgestrel (EE₂/LNG).

34.

Aritonang TR, Rahayu S, Sirait LI, Karo MB, Simanjuntak TP, Natzir R, et al. The role of FSH, LH, estradiol and progesterone hormone on estrus cycle of female rats. Int J Sci: Basic Appl Res. 2017;53(1):92–100.

35.

Pessina MA, Hoyt RF, Goldstein I, Traish AM. Differential effects of estradiol, progesterone, and testosterone on vaginal structural integrity. Endocrinology. 2006;147:61–9. https://doi.org/10.1210/en.2005-0870.CrossRefPubMed

36.

Witherby S, Johnson J, Demers L, Mount S, Littenberg B, Maclean CD, Wood M, Muss H. Topical testosterone for breast cancer patients with vaginal atrophy related to aromatase inhibitors: a phase I/II study. Oncologist. 2011;16:424–31. https://doi.org/10.1634/theoncologist.2010-0435.CrossRefPubMedPubMedCentral

37.

McEndree B. Clinical application of the vaginal maturation index. Nurse Pract. 1999;24:48–57.CrossRefPubMed

38.

Mac Bride MB, Rhodes DJ, Shuster LT. Vulvovaginal atrophy. Mayo Clin Proc. 2010;85:87–94. https://doi.org/10.4065/mcp.2009.0413.CrossRefPubMedPubMedCentral

39.

Traish AM, Botchevar E, Kim NN. Biochemical factors modulating female genital sexual arousal physiology. J Sex Med. 2010;7(9):2925–46.CrossRefPubMed

40.

Sharma H, Ji E, Yap P, Vilimas P, Kyloh M, Spencer NJ, et al. Innervation changes induced by inflammation in the murine vagina. Neuroscience. 2018;372:16–26. https://doi.org/10.1016/j.neuroscience.2017.12.026.CrossRefPubMed

41.

Hu JM, Cheng X, Wang L, Zhu JN, Zhou LH. Vasoactive intestinal peptide expression in the vaginal anterior wall of patients with pelvic organ prolapse. Taiwan J Obstet Gynecol. 2013;52(2):233–40.CrossRefPubMed

42.

Palle C, Bredkjœr HE, Fahrenkrug J, Ottesen B. Vasoactive intestinal polypeptide loses its ability to increase vaginal blood flow after menopause. Am J Obstet Gynecol. 1991;164:556–8. https://doi.org/10.1016/S0002-9378(11)80019-0.CrossRefPubMed

43.

Kim H, Kim SC, Seo K, Lee M. Effects of estrogen on the relaxation response of rabbit clitoral cavernous smooth muscles. Urol Res. 2002;30(1):26–30. https://doi.org/10.1007/s00240-002-0235-8.CrossRefPubMed

44.

Kim SW, Kim NN, Jeong S-J, Munarriz R, Goldstein I, Traish AM. Modulation of rat vaginal blood flow and estrogen receptor by estradiol. J Urol. 2004;172:1538–43. https://doi.org/10.1097/01.ju.0000137744.12814.2e.CrossRefPubMed

45.

Min K, Munarriz R, Kim NM, Choi S, O Connell L, Goldstein I, Traish AM et al. Effects of ovariectomy and estrogen replacement on basal and pelvic nerve stimulated vaginal lubrication in an animal model. J Sex Marital Ther 2003:29:77–84. https://doi.org/10.1080/713847131.

46.

Berman JR, McCarthy MM, Kyprianou N. Effect of estrogen withdrawal on nitricoxide synthase expression and apoptosis in the rat vagina. Urology. 1998;51:650–6. https://doi.org/10.1016/s0090-4295(97)00683-3.CrossRefPubMed

47.

Al-Hijji J, Larsson B, Batra S. Nitric oxide synthase in the rabbit uterus and vagina: hormonal regulation and functional significance. 2000:62:1387–1392.https://doi.org/10.1095/biolreprod62.5.1387

48.

Traish AM, Vignozzi L, Simon JA, Goldstein I, Kim NN. Role of androgens in female genitourinary tissue structure and function: implications in the genitourinary syndrome of menopause. Sex Med Rev. 2018;6:558–71. https://doi.org/10.1016/j.sxmr.2018.03.005.CrossRefPubMed

49.

Aversa A, Isidori AM, Spera G, Lenzi A, Fabbri A. Androgens improve cavernous vasodilation and response to sildenafil in patients with erectile dysfunction. Clin Endocrinol. 2003;58(5):632–8. https://doi.org/10.1046/j.1365-2265.2003.01764.x.CrossRef

50.

Burrows LJ, Basha M, Goldstein AT. The effects of hormonal contraceptives on female sexuality: a review. J Sex Med. 2012;9(9):2213–23. https://doi.org/10.1111/j.1743-6109.2012.02848.x.CrossRefPubMed

51.

Kennedy TG, Armstrong DT. Induction of vaginal mucification in rats with testosterone and 17β-hydroxy-5α-androstan-3-one. Steroids. 1976;27(3):423–30. https://doi.org/10.1016/0039-128X(76)90061-1.CrossRefPubMed

52.

Westwood FR. The female rat reproductive cycle: a practical histological guide to staging. Toxicol Pathol. 2008;36:375–84. https://doi.org/10.1177/0192623308315665.CrossRefPubMed

53.

Sarrel PM. Sexuality and menopause. Obstet Gynecol. 1990;75:26S-35S. https://doi.org/10.1016/S1701-2163(15)30464-3.CrossRefPubMed

54.

Alimi Y, Iwanaga J, Oskouian RJ, Loukas M, Tubbs RS. The clinical anatomy of dyspareunia: a review. Clin Anat 2018:1013–7. https://doi.org/10.1002/ca.23250.

55.

Ninomiya N, Sekiguchi Y. The study of the effectiveness of topical testosterone and estrogen for urinary tract symptoms of GSM. J Sex Med. 2022;19(5):S149. https://doi.org/10.1016/j.jsxm.2022.03.595.CrossRef

56.

Sarrel PM. Androgen deficiency: menopause and estrogen-related factors. Fertil Steril. 2002;1(77):63–7. https://doi.org/10.1016/s0015-0282(02)02967-9.CrossRef

57.

Handy AB, Freihart BK, Meston CM. The relationship between subjective and physiological sexual arousal in women with and without arousal concerns. J Sex Marital Ther. 2020;46(5):447–59. https://doi.org/10.1097/00003081-200406000-00022.CrossRefPubMed

58.

Handy AB, Stanton AM, Pulverman CS, Meston CM. Differences in perceived and physiologic genital arousal between women with and without sexual dysfunction. J Sex Med. 2018;15:52–63. https://doi.org/10.1016/j.jsxm.2017.11.009.CrossRefPubMed

59.

Laan E, Van Driel EM, Van Lunsen RH. Genital responsiveness in healthy women with and without sexual arousal disorder. J Sex Med. 2008;5(6):1424–35. https://doi.org/10.1111/j.1743-6109.2008.00827.x.CrossRefPubMed

60.

Stone A, Gamble CJ. The quantity of vaginal fluid. Am J Obstet Gynecol. 1959;78:279–81. https://doi.org/10.1016/0002-9378(59)90173-5.CrossRefPubMed

61.

Godley MJ. Quantitation of vaginal discharge in healthy volunteers. BJOG: Int J O&G 1985:92:739–742. https://doi.org/10.1111/j.1471-0528.1985.tb01457.x.

62.

Preti G, Huggins GR, Silverberg GD. Alterations in the organic compounds of vaginal secretions caused by sexual arousal. Fertil Steril. 1979;32:47–54. https://doi.org/10.1016/S0015-0282(16)44115-4.CrossRefPubMed

63.

Wagner G. Vaginal transudation. In: F. K. Beller & G. F. B. Schumacher, editors. The biology of the fluids of the female genital tract: workshop conference in Murnau, Bavaria, June 11–13. Elsevier North Holland; 1979.

64.

Riley AJ, Riley EJ. Cholinergic and adrenergic control of human sexual responses. In: Wheatley D, editor. Psychopharmacology and sexual disorders. Oxford University Press; 1983. p. 125–37.

65.

Carranza-Lira S, Fragoso-Dı́az N, MacGregor-Gooch AL, Garduño-Hernández MP, Rı́os-Calderón K, Aparicio H. Vaginal dryness assessment in postmenopausal women using pH test strip. Maturitas 2003:45:55–58. https://doi.org/10.1016/s0378-5122(03)00082-3.

66.

Dawson SJ, Sawatsky ML, Lalumiere ML. Assessment of introital lubrication. Arch Sex Behav. 2015;44(6):1527–35. https://doi.org/10.1007/s10508-015-0519-z.CrossRefPubMed

67.

Gáspár M, Benkő Zs, Dogossy G, Réczey K, Czigány T. Reducing water absorption in compostable starch-based plastics. Polym Degrad Stab 2005:90:563–569. https://doi.org/10.1016/j.polymdegradstab.2005.03.012.

68.

Handy AB, & Meston CM. 028 A novel technique for assessing vaginal lubrication. J Sex Med 2018:15(6):S108–S109. https://doi.org/10.1016/j.jsxm.2018.03.039

69.

Sall K, Stevenson OD, Mundorf TK, Reis BL. CsA Phase 3 Study Group. Two multicenter, randomized studies of the efficacy and safety of cyclosporine ophthalmic emulsion in moderate to severe dry eye disease. Ophthalmology. 2000;107(4):631–9. https://doi.org/10.1016/s0161-6420(99)00176-1

70.

Lindemann J, Tsakiropoulou E, Rettinger G, Gutter C, Scheithauer MO, Picavet V, Sommer F. The intranasal Schirmer test: a preliminary study to quantify nasal secretion. Eur Arch Otorhinolaryngol. 2014;271:2963–7. https://doi.org/10.1007/s00405-014-2988-4.CrossRefPubMed

71.

Wróbel-Dudzińska D, Kubik-Komar A, Rykwa D, Kosior-Jarecka E, Żarnowski T, Chałas R. The use of Schirmer strips to measure salivary and lacrimal flow in non-Sjögren patients. Clin Oral Invest. 2021;25(6):4107–14. https://doi.org/10.1007/s00784-020-03741-3.CrossRef

72.

Sawatsky ML, Dawson SJ, Lalumière ML. Genital lubrication: a cue-specific sexual response? Biol Psychol. 2018;134:103–13. https://doi.org/10.1016/j.biopsycho.2018.02.003.CrossRefPubMed

Titel: Local Responses to Genital Arousal — Mechanisms of Lubrication
verfasst von: Ariel B. Handy
Leah N. McMahon
Cindy M. Meston
Publikationsdatum: 08.11.2022
Verlag: Springer US
Erschienen in: Current Sexual Health Reports / Ausgabe 4/2022
Print ISSN: 1548-3584
Elektronische ISSN: 1548-3592
DOI: https://doi.org/10.1007/s11930-022-00350-x

Neu im Fachgebiet Urologie

Patrone im Penis bringt Urologen in Gefahr

30.05.2024 Operationen am Penis Nachrichten

In Lebensgefahr brachte ein junger Mann nicht nur sich selbst, sondern auch das urologische Team, das ihm zu Hilfe kam: Er hatte sich zur Selbstbefriedigung eine scharfe Patrone in die Harnröhre gesteckt.

15% bedauern gewählte Blasenkrebs-Therapie

29.05.2024 Urothelkarzinom Nachrichten

Ob Patienten und Patientinnen mit neu diagnostiziertem Blasenkrebs ein Jahr später Bedauern über die Therapieentscheidung empfinden, wird einer Studie aus England zufolge von der Radikalität und dem Erfolg des Eingriffs beeinflusst.

Costims – das nächste heiße Ding in der Krebstherapie?

28.05.2024 Onkologische Immuntherapie Nachrichten

„Kalte“ Tumoren werden heiß – CD28-kostimulatorische Antikörper sollen dies ermöglichen. Am besten könnten diese in Kombination mit BiTEs und Checkpointhemmern wirken. Erste klinische Studien laufen bereits.

Fehlerkultur in der Medizin – Offenheit zählt!

28.05.2024 Fehlerkultur Podcast

Darüber reden und aus Fehlern lernen, sollte das Motto in der Medizin lauten. Und zwar nicht nur im Sinne der Patientensicherheit. Eine negative Fehlerkultur kann auch die Behandelnden ernsthaft krank machen, warnt Prof. Dr. Reinhard Strametz. Ein Plädoyer und ein Leitfaden für den offenen Umgang mit kritischen Ereignissen in Medizin und Pflege.

Update Urologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

Local Responses to Genital Arousal — Mechanisms of Lubrication

Abstract

Purpose of Review

Recent Findings

Summary

Neu im Fachgebiet Urologie

Patrone im Penis bringt Urologen in Gefahr

15% bedauern gewählte Blasenkrebs-Therapie

Costims – das nächste heiße Ding in der Krebstherapie?

Fehlerkultur in der Medizin – Offenheit zählt!

Update Urologie

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

Abstract

Purpose of Review

Recent Findings

Summary

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 4/2022

“Pumpology”: Evolution of the Penile Implant Pump and What Is on the Horizon

Surgical Management of Male Stress Urinary Incontinence: Artificial Urinary Sphincter Versus Male Slings

Sexual Trauma Moderates Hormonal Mediators of Women’s Sexual Function

Gender and Labor in Supply Chains Capitalism: a Review

The Relationship Between Sleep and Sexual Function in Women

The Study of Sexual Fantasy in Women: a Review of the Findings and Methodological Challenges

Neu im Fachgebiet Urologie

Patrone im Penis bringt Urologen in Gefahr

15% bedauern gewählte Blasenkrebs-Therapie

Costims – das nächste heiße Ding in der Krebstherapie?

Fehlerkultur in der Medizin – Offenheit zählt!

Update Urologie