Female Sexual Function and the Pelvic Floor

Sarit O. Aschkenazi;   Roger P. Goldberg


Expert Rev of Obstet Gynecol. 2009;4(2):165-178. 

In This Article

The Healthy Female Sexual Cycle

The healthy female sexual cycle has undergone evolution and modifications since it was first established by Masters and colleagues in the 1960s[26]. Based on their landmark research conducted in the 1960s, Masters et al. developed a linear four-phase model of sexual response: excitement, plateau, orgasm and resolution. Kaplan proposed an alternate model in 1979 and introduced the concept of desire into the normal sexual responses (Figure 1)[27]. In this model, desire leads to arousal, then plateau, followed by orgasm and resolution. This model was intended to reflect sexual response for males and females; however, researchers have recognized that some women do not experience all four phases of the cycle. As such, this model has been criticized since it does not reflect a woman's actual experiences.

Figure 1.

Linear model of sexual response cycle. This model is based on landmark research by Masters et al. in the 1960s, developing a linear four-phase model of sexual response: excitement, plateau, orgasm and resolution[83]. Kaplan proposed an alternate model in 1979 and introduced the concept of desire into normal sexual responses[27]. This model was created to reflect sexual cycle in men and women.

Basson proposed an alternative model to the traditional linear model to account for the cyclic nature of the female sexual response as opposed to the linear response seen in men[101]. This model is intimacy based and incorporates integral sexual stimuli that can be influenced by biological and psychological factors. It can be entered at any time along the cycle. Spontaneous desire, such as sexual thoughts and conscious wanting and fantasizing, can augment the cycle as well. This model reflects that sexual functioning in women, unlike the linear model, is dependent on the interaction of mind and body (Figure 2).

Figure 2.

Intimacy-based model for healthy female sexual function based on research conducted by Basson. This model is unique for women's sexuality. Various sexual elements work in synergy to achieve emotional intimacy. Data from[22].

A multinational study assessed the importance of sexuality and intimacy in 26,000 men and women aged 40-80 years in 29 countries[102]. Surveys were completed by telephone or face-to-face interview and results are based on a scale where 5 is extremely important and 1 is not at all. Most men (83%) and women (63%) thought sex was important (score: 3-5) in their overall life. Another random survey of 1300 American men and women aged 60 years and older was conducted by The National Council on Aging[28]. Participants were asked to comment on their feelings and experience with sex. Of those that stated being sexually active (≥once per month), 79 and 66% of men and women, respectively, said that an active sex life is an important aspect of their relationship with their partner. The study concluded that sexual activity plays an important role in relationships in both men and women aged 60 years and older.

Longitudinal studies have demonstrated that psychosocial factors and overall health are important determinants of healthy sexual function in women[29]. These include psychological well-being, partner relationship and developmental experiences, including history of abuse, physical health, medication use, substance abuse and lifestyle factors.


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