1. Aboubakr Elnashar
Benha university Hospital, Egypt

2. Master & Johonson (1966):
Excitement,
Plateau,
Orgasm &
Resolution.
Completely mechanistic , ignores
feelings
Distinction between Excitement &
Plateau is imprecise

3. Kaplan (1979):
Desire,
Excitement (Plateau is a part of Excitement).
Orgasm &
Resolution.
This fits better with FSD

4. The motivation & the inclination to be
sexual.It is subjective feeling state.
It is triggered by both internal (fantasy) &
external (an interested partner) sexual cues.
It is mediated by testosterone (CNS).

5. Excitation is dopamine dependent &
Inhibition is serotinine dependent
It is influenced by:
sexual orientation,
preference,
psychologic &
environmental status.

6. It is mediated by parasympathetic NS.
The primary response: Vasocongestion
Females: Tactile & psychic stimuli ,
more individual variability than male,
slower, not easily inhibited
Males: Visual stimuli, more rapid, easily
inhibited

7. Genital changes:
clitoral enlargement,
lubrication of the vagina,
proximal vaginal expansion,
labial engorgement
Extragenital changes:
increased P , B.P
muscle tension,
extrapelvic vascular dilatation (breast swelling,
nipple erection, areolar engorgement, skin flush)

8. It is mediated by parasympathetic NS.
The primary response: vasocongestion
It is the progression & intensification of
the arousal phase

9. Changes:
1. Formation of an orgasmic platform: engorging &
swelling of the outer 1/3 of the vagina, decreasing
the inner diameter by 40%, & gripping the penis.
2. Retraction of the clitoris into the hood.
3. Elevation & ballooning of the proximal 2/3 of the
vagina.
4.The uterus elevates fully out of the pelvis.
5. Further labial engorgement

10. It is mediated by sympathetic NS.
The primary response: Reflex clonic
contractions
Female: individual variability, multiple,
easily inhibited.
Male: Similar, single, not easily
inhibited.

11. It is sudden release of the of the tension that
has built up during during arousal & plateau.
Initial contraction of the outer 1/3 of the vagina
& levator sling, followed by contraction of the
uterus & anal sphincter

12. It is return to the basal physiologic
state.
Reversal of vasocongestion
Female: Slow
Male: rapid

13. Not existent in females, occurs only
in males.
It is the time needed to refill seminal
vesicles

14. Incidence of FSD
FSD is more common than MSD.
USA (Laumann et al, 1999):
FSD: 43% MSD: 31%
Egypt: no studies
However FSD are detected rarely by the
gynecologist
1. Patient: find it is difficult to talk to their
doctor
2. Doctor: little knowledge, little time, find it is
inappropriate to ask.

15. Types of FSD
1. Sexual desire disorders:
Hypoactive sexual desire & sexual
aversion
2. Sexual arousal disorders
3. Orgasmic disorders
4. Penetration disorders:
Dysparunia &
Vaginismus

16. 5. Other sexual disorders:
Sexual phobias,
Anesthesia with arousal & orgasm,
Genital pain during non-coital activities.

17. Each is further classified into
1. Primary (lifelong) or
secondary acquired after a period of normal
sexual function
2. Total (generalized) or
situational (SD in some situations only)

18. ‫هللا‬ ‫رسول‬ ‫قال‬‫وسلم‬ ‫عليه‬ ‫هللا‬ ‫صلي‬:
‫اليقع‬‫امرأته‬ ‫علي‬ ‫أحدكم‬‫تقع‬ ‫كما‬
‫البهيمة‬‫رسول‬ ‫بينهما‬ ‫وليكن‬-‫و‬ ‫قيل‬
‫قال‬ ‫؟‬ ‫هللا‬ ‫رسول‬ ‫يا‬ ‫الرسول‬ ‫ما‬‫القبله‬
‫والكالم‬.
‫رواه‬‫الديلمي‬ ‫أبومنصور‬‫عن‬ ‫الفردوس‬ ‫مسند‬ ‫في‬
‫عنه‬ ‫هللا‬ ‫رضي‬ ‫أنس‬