These two Case Studies come from a National Center on Case Studies. I think that a case study approach is very useful in applying knowledge and this is what makes….
The sexual response cycle describes the changes that occur in the body as men and women become sexually aroused. They divided the sexual response cycle into four phases: excitement, plateau, orgasm, and resolution. The sexual response cycle is characterized by vasocongestion and myotonia. Vasocongestion is the swelling of the genital tissues with blood. It causes erection of the penis and swelling of the area surrounding the vaginal opening. The testes, the nipples, and even the earlobes swell as blood vessels dilate in these areas (yes—the earlobes).
Myotonia is muscle tension. It causes facial grimaces, spasms in the hands and feet, and then the spasms of orgasm. Vasocongestion during the excitement phase can cause erection in young men as soon as 3 to 8 seconds after sexual stimulation begins.
The scrotal skin also thickens, becoming less baggy. The testes increase in size and become elevated. In the female, excitement is characterized by vaginal lubrication, which may start 10 to 30 seconds after sexual stimulation begins. Vasocongestion swells the clitoris and flattens and spreads the vaginal lips.
The inner part of the vagina expands. The breasts enlarge, and blood vessels near the surface become more prominent. The level of sexual arousal remains somewhat stable during the plateau phase of the cycle. Because of vasocongestion, men show some increase in the circumference of the head of the penis, which also takes on a purplish hue. The testes are elevated into position for ejaculation and may reach one and a half times their unaroused size. In women, vasocongestion swells the outer part of the vagina, contracting the vaginal opening in preparation for grasping the penis.
The Sexual Response Cycle 3 The Sexual Response Cycle The inner part of the vagina expands further. The clitoris withdraws beneath the clitoral hood and shortens. The orgasmic phase in the male consists of two stages of muscular contractions. In the first stage, semen collects at the base of the penis. The internal sphincter of the urinary bladder prevents urine from mixing with semen. In the second stage, muscle contractions propel the ejaculate out of the body. Sensations of pleasure tend to be related to the strength of the contractions and the amount of seminal fluid present. Orgasm in the female is manifested by 3 to 15 contractions of the pelvic muscles that surround the vaginal barrel. The contractions first occur at 0.8-second intervals.
As in the male, they produce release of sexual tension (Meston & Frohlich, 2000). Weaker and slower contractions follow. Erection, vaginal lubrication, and orgasm are all reflexes. That is, they occur automatically in response to adequate sexual stimulation. Of course, the decision to enter a sexual relationship is voluntary, as are the decisions to kiss and fondle each other, and so on. After orgasm the body returns to its unaroused state. This is called the resolution phase. After ejaculation, blood is released from engorged areas, so that the erection disappears. The testes return to their normal size. In women, orgasm also triggers the release of blood from engorged areas. The nipples return to their normal size. The clitoris and vaginal barrel gradually shrink to their unaroused sizes. Blood pressure, heart rate, and breathing also return to their levels before arousal. Both partners may feel relaxed and satisfied.
The Sexual Response Cycle 4 The Sexual Response Cycle Unlike women, men enter a refractory period during which they cannot experience another orgasm or ejaculate. The refractory period of adolescent males may last only minutes, whereas that of men age 50 and above may last from several minutes to a day. Women do not undergo a refractory period and therefore can become quickly rearoused to the point of repeated (multiple) orgasm if they desire and receive continued sexual stimulation. Sexual disfunctions:
Male sexual dysfunction is a problem with 1 of the 4 main components of male sexual function (libido, erection, ejaculation, orgasm) that interferes with interest in or ability to engage in sexual intercourse. Many drugs and numerous physical and psychologic disorders affect sexual function. Libido is the conscious component of sexual function. Decreased libido manifests as a lack of sexual interest or a decrease in the frequency and intensity of sexual thoughts, either spontaneous or in response to erotic stimuli. Libido is sensitive to testosterone levels as well as to general nutrition, health, and drugs. Conditions particularly likely to decrease libido include hypogonadism, uremia, and depression. (Bradley D. Anawalt, MD June 2007)
Erectile dysfunction is the inability to attain or sustain an erection satisfactory for sexual intercourse. Most erectile dysfunction is related to vascular, neurologic, and hormonal disorders; drug use and sometimes psychologic disorders are also causes. Evaluation typically includes screening for underlying diseases and measuring testosterone levels. Treatment options include oral phosphodiesterase inhibitors or apomorphine, intraurethral or intracavernosal prostaglandins, mechanical pump devices, and surgical implants. The Sexual Response Cycle 5
The Sexual Response Cycle Ejaculation is controlled by the sympathetic nervous system and muscles of the pelvic floor. In addition, the neck of the bladder closes, preventing retrograde ejaculation of semen into the bladder. Orgasm is the highly pleasurable sensation that occurs in the brain generally simultaneously with ejaculation. Anorgasmia may be a physical phenomenon due to decreased penile sensation (eg, from neuropathy) or a neuropsychological phenomenon due to psychiatric disorders or psychoactive drugs. (Bradley D. Anawalt, MD June 2007) Treatment:
Underlying organic disorders require appropriate treatment. Drugs that are temporally related to onset of ED should be stopped or switched. Depression may require treatment. For all patients, reassurance and education (including of the patient’s partner whenever possible) are important. For further therapy, noninvasive methods (mechanical devices and drugs) are tried first. All drugs and devices should be tried ≥ 5 times before being considered ineffective. (Bradley D. Anawalt, MD June 2007) There are 4 kinds of sexual problems in women. Desire disorders ¬- When you are not interested in having sex or have less desire for sex than you used to. Arousal disorders ¬- When you don’t feel a sexual response in your body or you cannot stay sexually aroused. Orgasmic disorders ¬- When you can’t have an orgasm or you have pain during orgasm. Sexual pain disorders ¬- When you have pain during or after sex. (Nancy A. Phillips, July 1, 2000)
The Sexual Response Cycle 6 The Sexual Response Cycle Many things can cause problems in your sex life. Certain medicines (such as oral contraceptives and chemotherapy drugs), diseases (such as diabetes or high blood pressure), excessive alcohol use or vaginal infections can cause sexual problems. Depression, relationship problems or abuse (current or past abuse) can also cause sexual dysfunction. Treatment:
If desire is the problem, try changing your usual routine. Try having sex at different times of the day, or try a different sexual position. Arousal disorders can often be helped if you use a vaginal cream or sexual lubricant for dryness. If you have gone through menopause, talk to your doctor about taking estrogen or using an estrogen cream. If you have a problem having an orgasm, you may not be getting enough foreplay or stimulation before actual intercourse begins. Extra stimulation (before you have sex with your partner) with a vibrator may be helpful.
If you’re having pain during sex, try different positions. When you are on top, you have more control over penetration and movement. Emptying your bladder before you have sex, using extra lubrication or taking a warm bath before sex all may help. If you still have pain during sex, talk to your doctor. Medication can also be prescribed by your doctors for female sexual disfunction.