There is speculation about the existence of a “G-spot,” named after Ernest Gr¨afenberg, who first described it in 1944 (5). This area of the vagina, located anteriorly midway between the symphysis pubis and cervix, is thought to be exquisitely sensitive to deep pressure. Stimulation of this area associated with orgasm and loss of ﬂuid was not scientifically proven to be anything other than dilute urine. Women who are normally continent often leak urine at orgasm; this is not abnormal and does not require medical intervention.
Sexual Response Cycle Sexual response reﬂects the fundamental interplay between the mind and body: psychological, interpersonal, cultural, environmental, and biological (hormonal, vascular, muscular, neurological) factors interact and modulate sexual experience. The initial phase of the sexual response cycle may be one of desire, but more often women, particularly those in long-term relationships, are motivated by factors other than sexual desire (3). Women initiate or consent to sex for many reasons, including a wish to increase emotional intimacy with their partners. By directing her attention to sexual stimulation, a woman’s subjective sexual arousal/pleasure/excitement triggers sexual desire. Desire and arousal coexist and compound each other (Fig. 11.1). Sexual satisfaction (with one, many, or no orgasms) can be achieved if a woman can stay focused, her pleasure continues, the duration of the stimulation is sufficiently long, and there is no negative outcome (e.g., pain or partner dysfunction). The response is circular, with phases overlapping and in variable order (e.g., desire may follow arousal, and higher arousal may follow the first orgasm). Desire, once triggered, increases the motivation to respond to sexual stimuli and to agree to or ask for more intensely erotic forms of stimulation. Any initial spontaneous desire will augment the response. This circular type of cycle can be experienced a number of times on any one occasion of sexual interaction. This motivation/incentives module reﬂecting the importance of the mind’s appraisal of sexual stimuli is supported by empirical research (6–7).
Do you have any sexual concerns now, such as pain with intercourse, lack of arousal, or lack of enjoyment? Yes No I will need to ask you more detailed questions (now or at a later visit) That is fine—sexual problems are common and most can be helped
Figure 11.1 The blended sex response cycle showing the many reasons/incentives for initiating/accepting sexual activity.