FEMALE SEXUALITY:
A CLINICIAN POINT OF VIEW
IHAB YOUNIS , M.D.
The sex response
cycle in females
is different than
that of males
Unlike men, women have a lower
biological urge to be sexual for
release of tension
No
44%
Yes
56%
Do men have a higher
sex drive than women?
%44
http://www.drlaurie.com/form1.html
About 50% of
women report
having sexual
thoughts less
than once a
month or never
Bancroft J et al ,J Endocrinol ,186, 411-427,2005
Women’s motivation to have sex
stems from a number of rewards
that are not strictly sexual
Bancroft J et al ,J Endocrinol ,186, 411-427,2005
Sexual arousal in
women is a mental
state that may NOT
be accompanied by
awareness of the
vasocongestive
changes in the
genitalia & other areas
Bancroft J et al ,J Endocrinol ,186, 411-427,2005
•A woman may sense no sexual desire per se
•Her motivations:emotional intimacy &
increasing her own well-being & self-image
• Sometimes there is spontaneous desire
If she is willing to become aroused and
enjoy a sexual experience, she focuses
on the sexual stimulation that her
partner supplies
If the stimulation is as she wishes,
sufficient time is available & she can
stay focused, her sexual excitement &
pleasure intensify
Sexual satisfaction:orgasm
emotional reward
Rosemary Basson,
CMAJ , 10: 172 2005
Spectrum of women with sexual
dysfunction
Vict
ems
Big
Pretenders
Victims’ husbands are
selfish, vicious and aragons
Big pretenders are vicious , always find
excuses not to have sex and are
usually of low socioeconomic standard
Tips while treating
‫قال رسول هللا صلى هللا عليه و سلم‪:‬‬
‫ام َرأَ َت ُه َج ْلدَ ا ْل َع ْب ِد َف َل َع َّل ُه‬
‫” َي ْع ِم ُد أَ َح ُد ُك ْم َف َي ْجلِ ُد ْ‬
‫ضا ِج ُع َها ِمنْ آخ ِِر َي ْو ِم ِه ”‬
‫ُي َ‬
‫متفق عليه‬
Husbands: clitoris is not a small penis
Wives: Don’t give a wrong signal
Husband and wife :search for the G-spot
Originally known as
the Grafenberg
Spot, the G-Spot
was named after
the gynecologist
Ernst Gräfenberg,
who first described
it in 1944
It is 2.5cm to 5cm inside the vagina on the
front wall
There are a number of different theories
about what the G-spot or area actually is
One view is that it is an area of prostatic
tissue similar to the male prostate. The
absence of the Y chromosome in the
developing female fetus deposits the cells
in a similar location
Another expert agrees with the prostate theory
but expands it to say that this is not the only
reason for sensitivity. He points to the clitoris
and the urethra as other sources of pleasure,
both of which can be stimulated via the front wall
of the vagina. Therefore there are a number of
erogenous zones and we should stop seeking
the elusive g-spot and instead rename it the
‘anterior wall erogenous complex’
A recent research has shown that
stimulation of the G-spot area can
increase pain threshold by up to 47%. If
the stimulation is arousing, the pain
threshold increases by up to 84% and a
massive 107% on orgasm. So,this area
may be a natural painkiller for childbirth
http://www.bbc.co.uk/relationships/sex_and_sexual_health
Testosterone
• There is evidence that testosterone
withdrawal and/or replacement can have
effects on women’s sexualit
• The evidence is inconsistent and
sometimes contradictory
• This is because sexuality of women is
powerfully influenced by mood, energy
and well-being as well as by other
psychological mechanisms
Bancroft J et al ,Journal of Endocrinology ,186, 411-427,2005
• Eight studies reported increased
frequency of satisfying sexual activity and
sexual desire after testosterone therapy in
menopausal women
• The most commonly reported side effects
are greasy skin & hair,alopecia&hirsutism
Arlt W.,Europ J Endocrinol,154: 1-11, 2006
No single androgen level is predictive of
low female sexual function, and the
majority of women with low DEAS levels
did not have low sexual function
Davis SR et al., JAMA, 6;294(1):91-6,2005
Bupropion-SR
Zyban®
• 29% of nondepressed females with hypoactive
sexual desire disorder responded to treatment
with bupropion SR
Segraves RTet al, J Sex Marital Ther. 2001 May-Jun;27(3):303-16
• Bupropion SR led to an increase in libido &
frequency of sexual activity compared with
placebo in women suffering from SSRI-induced
sexual dysfunction
Clayton AH, J Clin Psychiatry,65(1):62-7, 2004
• There were significant improvements in desire,
arousal, and orgasm in women who received
150 to 300 mg bupropion SR daily for 10 weeks
Defronzo Dobkin R et al,J Clin Psychopharmacol. ,Feb; 26(1): 21-26, 2006
Bremelanotide
• It is a melanocortin receptor agonist to be
used for the treatment of both male and
female sexual dysfunction
• It is intranasally administered
• Phase 1 safety studies indicated that
Bremelanotide had an excellent safety
profile
• Phase 2 efficacy studies demonstrated
positive safety and efficacy results in
patients with ED
• Phase 2B at-home efficacy study in
males&females will be done to enable
dose selection for Phase 3 studies
http://www.palatin.com/aboutpalatin/overview.asp
Thank you