1. FEMALE SEXUALITY:
A CLINICIAN POINT OF VIEW
IHAB YOUNIS , M.D.

2. The sex response cycle in females is different than that of males

3. Unlike men, women have a lower biological urge to be sexual for release of tension
44%
44%
56%
Do men have a higher sex drive than women?

4. About 50% of women report having sexual thoughts less than once a month or never
Bancroft J et al ,J Endocrinol ,186, ,2005

5. Women’s motivation to have sex stems from a number of rewards that are not strictly sexual Bancroft J et al ,J Endocrinol ,186, ,2005

6. Sexual arousal in women is a mental state that may NOT be accompanied by awareness of the vasocongestive changes in the genitalia & other areas Bancroft J et al ,J Endocrinol ,186, ,2005

7. A woman may sense no sexual desire per se
Her motivations:emotional intimacy & increasing her own well-being & self-image
Sometimes there is spontaneous desire
If she is willing to become aroused and enjoy a sexual experience, she focuses on the sexual stimulation that her partner supplies
If the stimulation is as she wishes, sufficient time is available & she can stay focused, her sexual excitement & pleasure intensify
Sexual satisfaction:orgasm
emotional reward
Rosemary Basson, CMAJ , 10:

8. Spectrum of women with sexual dysfunction
Big Pretenders
Victems

9. selfish, vicious and aragons
Victims’ husbands are
selfish, vicious and aragons

10. Big pretenders are vicious , always find excuses not to have sex and are usually of low socioeconomic standard

11. Tips while treating

12. قال رسول الله صلى الله عليه و سلم:
”يَعْمِدُ أَحَدُكُمْ فَيَجْلِدُ امْرَأَتَهُ جَلْدَ الْعَبْدِ فَلَعَلَّهُ يُضَاجِعُهَا مِنْ آخِرِ يَوْمِهِ ”
متفق عليه

13. Husbands: clitoris is not a small penis

14. Wives: Don’t give a wrong signal

15. Husband and wife :search for the G-spot

16. Originally known as the Grafenberg Spot, the G-Spot was named after the gynecologist Ernst Gräfenberg, who first described it in 1944

17. It is 2.5cm to 5cm inside the vagina on the front wall

18. There are a number of different theories about what the G-spot or area actually is

19. One view is that it is an area of prostatic tissue similar to the male prostate. The absence of the Y chromosome in the developing female fetus deposits the cells in a similar location

20. Another expert agrees with the prostate theory but expands it to say that this is not the only reason for sensitivity. He points to the clitoris and the urethra as other sources of pleasure, both of which can be stimulated via the front wall of the vagina. Therefore there are a number of erogenous zones and we should stop seeking the elusive g-spot and instead rename it the ‘anterior wall erogenous complex’

21. A recent research has shown that stimulation of the G-spot area can increase pain threshold by up to 47%. If the stimulation is arousing, the pain threshold increases by up to 84% and a massive 107% on orgasm. So,this area may be a natural painkiller for childbirth

22. Testosterone

23. The evidence is inconsistent and sometimes contradictory
There is evidence that testosterone withdrawal and/or replacement can have effects on women’s sexualit
The evidence is inconsistent and sometimes contradictory
This is because sexuality of women is powerfully influenced by mood, energy and well-being as well as by other psychological mechanisms
Bancroft J et al ,Journal of Endocrinology ,186, ,2005

24. Eight studies reported increased frequency of satisfying sexual activity and sexual desire after testosterone therapy in menopausal women
The most commonly reported side effects are greasy skin & hair,alopecia&hirsutism
Arlt W.,Europ J Endocrinol,154: 1-11, 2006

25. No single androgen level is predictive of low female sexual function, and the majority of women with low DEAS levels did not have low sexual function
Davis SR et al., JAMA, 6;294(1):91-6,2005

26. Bupropion-SR
Zyban®

27. Clayton AH, J Clin Psychiatry,65(1):62-7, 2004
29% of nondepressed females with hypoactive sexual desire disorder responded to treatment with bupropion SR
Segraves RTet al, J Sex Marital Ther May-Jun;27(3):303-16
Bupropion SR led to an increase in libido & frequency of sexual activity compared with placebo in women suffering from SSRI-induced sexual dysfunction
Clayton AH, J Clin Psychiatry,65(1):62-7, 2004
There were significant improvements in desire, arousal, and orgasm in women who received 150 to 300 mg bupropion SR daily for 10 weeks
Defronzo Dobkin R et al,J Clin Psychopharmacol. ,Feb; 26(1): 21-26, 2006

28. Bremelanotide

29. It is a melanocortin receptor agonist to be used for the treatment of both male and female sexual dysfunction
It is intranasally administered
Phase 1 safety studies indicated that Bremelanotide had an excellent safety profile

30. Phase 2 efficacy studies demonstrated positive safety and efficacy results in patients with ED
Phase 2B at-home efficacy study in males&females will be done to enable dose selection for Phase 3 studies

32. Thank you