Female sexual dysfunction is a significant age–related, progressive and highly prevalent problem that affects a substantial number of women in the United States. The female sexual response cycle is initiated by neurotransmitter–mediated vascular and nonvascular smooth muscle relaxation resulting in increased pelvic blood flow, vaginal lubrication, and clitoral and labial engorgement. These mechanisms are mediated by a combination of neuromuscular and vasocongestive events. Physiological impairments that interfere with the normal female sexual response bring about complaints associated with diminished sexual arousal, libido, vaginal lubrication, genital sensation, and ability to achieve orgasm. Therapy aimed at restoring hormone levels as well as genital blood flow will be discussed.

Spector I, Carey M: Incidence and prevalence of the sexual dysfunction: A critical review of the empirical literature. Arch Sex Behav 1990; 19:389–408.
Laumann E, Paik A, Rosen R: Sexual dysfunction in the United States: Prevalence and predictors. JAMA 1999;281:537–544.
Masters EH, Johnson VE: Human Sexual Response. Boston, Little, Brown, 1966.
Kaplan HS: The New Sex Therapy. London, Bailliere, Tindall 1974.
Basson R, Berman J, Burnett A, et al: Report of the international consensus development conference on female sexual dysfunction: Definitions and classifications. J Urol 2000;183:888– 893.
Moore KL: Clinically Oriented Anatomy, ed 3. Baltimore, Williams & Wilkins, 1992.
Wagner G: Aspects of genital physiology and pathology. Semin Neurol 1992;12:87.
Levin RJ: The mechanism of human female sexual arousal. Annu Rev Sex Res 1992;3:1.
Schiavi RC, Segraves RT: The biology of sexual function. Psychiatr Clin North Am 1995; 18:7.
Levin RJ: The physiology of sexual function in women. Clin Obstet Gynecol 1980;7:213.
Levin RJ: VIP, vagina, clitoral and periurethral glans: An update on female genital arousal. Exp Clin Endocrinol 1991;98:61.
Ottesen B: Vasoactive intestinal peptide as a neurotransmitter in the female genital tract. Am J Obstet Gynecol 1983;147:208–224.
O’Connell H, Hutson J, Anderson C, Plenter R: Anatomic relationship between urethra and clitoris. J Urol 1998;159:1862–1897.
Bancroft J: Human Sexuality and Its Problems. Edinburgh, Churchill Livingstone, 1989.
Goldstein I, Berman JR: Vasculogenic female sexual dysfunction: Vaginal engorgement and clitoral erectile insufficiency syndromes. Int J Impot Rs 1998;10:S84–S90.
Toesca A, Stolfi VM, Cocchia D: Immunohistochemical study of the corpora cavernosa of the human clitoris. J Anat 1996;188:513–520.
Hilliges M, Falconer C, Ekman–Ordeberg G, Johanson O: Innervation of the human vaginal mucosa as revealed by PGP 9.5 immunohistochemistry. Acta Anat (Basel) 1995;153:119.
Burnett AL, Calvin DC, Silver RI, Peppas DS, Docimo SG: Immunohistochemical description of nitric oxide synthase isoforms in human clitoris. J Urol 1997;158:75–78.
Park K, Moreland RB, Goldstein I, Atala A, Traish A: Characterization of phosphodiesterase activity in human clitoral corpus cavernosum smooth muscle cells in culture. Biochem Biophys Res Commun 1998;249: 612–617.
Ottesen B, Pedersen B, Nielesen J, Dalgaard D, Wagner G, Fahrenkrug J: Vasoactive intestinal polypeptide provokes vaginal lubrication in normal women. Peptides 1987;8:797–800.
Ottesen B, Ulrichsen H, Frahenkrug J, Larsn JJ, Wagner G, Schierup L, Sondergaard F: Vasoactive intestinal polypeptide and the female genital tract: Relationship to reproductive phase and delivery. Am J Obstet Gynecol 1982;43:414–420.
Marson L: Central nervous system neurons identified after injection of pseudorabies virus into the rat clitoris. Neurosci Lett 1995;190: 41–44.
Natoin B, Maclusky NJ, Leranth CZ: The cellular effects of estrogens on neuroendocrine tissues. J Steroid Biochem 1988;30:195–207.
Sarrel PM: Ovarian hormones and vaginal blood flow using laser Doppler velocimetry to measure effects in a clinical trial of post–menopausal women. Int J Impot Res 1998;10: S91–S93.
Berman J, McCarthy M, Kyprianou N: Effect of estrogen withdrawal on nitric oxide synthase expression and apoptosis in the rat vagina. Urology 1998;44:650–656.
Sarrel PM: Sexuality and menopause. Obstet Gynecol 1990;75:26S–30S.
Pearce MJ, Hawton K: Psychological and sexual aspects of menopause and HRT. Baillières Clin Obstet Gynecol 1996;10:385–399.
Collins A, Landgren BM: Reproductive health, use of estrogen and experience of symptoms in perimenopausal women: A population–based study. Maturitas 1994; 20:101–111.
Ayton RA, Darling GM, Murkies AL, Farrell EA, Weisberg E, Selinus I, Fraser ID: A comparative study of safety and efficacy of continuous low dose estradiol released from a vaginal ring compared with conjugated equine estrogen vaginal cream in the treatment of postmenopausal vaginal atrophy. Br J Obstet Gynaecol 1996;103:351–358.
Sherwin BB, Gelfand MM: Differential symptom response to parental estrogen and androgen in the surgical menopause. Am J Obstet Gynecol 1985;151:153–160.
Sherwin BB, Gelfand MM: The role of androgen in the maintenance of sexual functioning in oophorectomized women. Psychosom Med 1987;49:397–409.
Myers LS, Morokof PJ. Physiological and subjective sexual arousal in pre– and postmenopausal women taking replacement therapy. Psychophysiology 1986;23:283.
Park K, Goldstein I, Andry C, Siroky MB, Krane RJ, Azadzoi KM: Vasculogenic female sexual dysfunction: The hemodynamic basis for vaginal engorgement insufficiency and clitoral erectile insufficiency. Int J Impot Res 1988;9:27–37.
Sipski ML, Alexander CJ, Rosen RC: Sexual Response in women with spinal cord injuries: Implications for our understanding of the able–bodied. J Sex Marital Ther 1999;25:11– 22.
Tarcan T, Park K, Goldstein I, Maio G, Fassina A, Krane RJ, Azadoi KM: Histomorphometric analysis of age–related structural changes in human clitoral cavernosal tissue. J Urol 1999; 161:940–944.
Nurnberg HG, Lodillo J, Hensley P, et al: Sildenafil for iatrogenic serotonergic antidepressant medication–induced sexual dysfunction in 4 patients. J Clin Psychiatry 1999;60: 33.
Rosen RC, Lane R, Menza M: Effects of SSRI on sexual dysfunction: A critical review. J Clin Psychopharmacol 1999;19:67.
Laan E, Everaerd W: Physiological measure of vaginal vasocongestion. Int J Impot Res 1998; 10:S107–S110.
Berman JR: Female sexual dysfunction: incidence, pathophysiology, evaluation and treatment options. Urology 1999;54:385–391.
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