Normal sexual response in women.

In summary, women's sexual response is characterized as highly variable and influenced by a wide range of determinants, including physiologic, psychosocial, and contextual factors. This complexity is reflected also in the multiple etiologic factors and determinants of sexual problems in women. It is evident in current conceptualizations of normal female sexual response, as presented in this article, in which the circularity and overlap of different components and aspects of sexual response in women are viewed differently from the more linear and invariable trajectory of sexual response in men. It is not surprising, therefore, that treatments that target limited physiologic aspects of women's sexual response, such as PDE-5 inhibitors and other vasoactive agents, have demonstrated little overall effectiveness in treating women's sexual dysfunctions [21, 22]. Rather there is consensus at present regarding the need for a more holistic or biopsychosocial approach to management of sexual dysfunction in women. Clearly the roles of psychologic and interpersonal determinants need to be taken into account in this approach. Perhaps most important and especially relevant for treating female sexual dysfunction is the emphasis on interpersonal factors as contributors to the ultimate sexual satisfaction of women. Clinicians should be especially mindful of this influence when addressing women's sexual problems. Another implication of this research is the need for broader definitions and conceptualization of sexual dysfunction in women. Current diagnostic definitions of female sexual dysfunction are based largely on the traditional sexual response cycle models of Masters and Johnson [7] and Kaplan [9]. With the development of new models and concepts of normal sexual response in women, it is increasingly necessary for new definitions and concepts of sexual dysfunction to be developed. Promising efforts have been made in this regard, although much work remains to be done.