VIP, vagina, clitoral and periurethral glans--an update on human female genital arousal.

The sexually quiescent human vagina is a just moist, potential space with a minimal blood flow and very low luminal oxygen tension. The first measurable sign of sexual arousal is an increase in the blood flow. This creates the engorged condition, elevates the luminal oxygen tension and stimulates the production of surface vaginal fluid by an increased plasma transudation that saturates the fluid reabsorptive capacity of the epithelium. The vaginal lubrication created allows painless penile penetration and coital movements. The mechanisms underlying the changes appear to be mediated by Vasoactive Intestinal Peptide (VIP). VIP is present in nerves closely applied to blood vessels in the vaginal wall. Administration of VIP either intravenously, or by subepithelial injection in the vaginal wall, increases vaginal blood flow and induces vaginal fluid production. Increases in vaginal blood flow by sexual arousal are not blocked by atropine injection indicating that cholinergic mechanisms are unimportant. All the present evidence suggests that the local vaginal release of VIP induces the vaginal changes of arousal. Discourse on vaginal and pudendal anatomy (Sevely, 1987) has proposed that the female glans of the clitoris is not the true homologue of the penile glans because it has no urethral opening. The speculative suggestion is that the true female glans is the area surrounding the urethral opening (which has no specific anatomical name). Preliminary studies indicate that the area of this tissue (periurethral glans) decreases on vaginal penile insertion and reappears on withdrawal indicating that it is moved during coitus. How important such movement is to stimulate erotic sensation and how sensitive this area is to erotic stimulation are unanswered questions.