Goldstein I, Berman J R
Department of Urology, Boston University School of Medicine, USA.
Int J Impot Res. 1998 May;10 Suppl 2:S84-90; discussion S98-101.
The first phase of the female sexual response, associated with neurotransmitter-mediated vascular smooth muscle relaxation, results in increased vaginal lubrication, wall engorgement and luminal diameter as well as increased clitoral length and diameter. Specific physiologic impairments of vasculogenic female sexual dysfunction include vaginal engorgement and clitoral erectile insufficiency syndromes. These syndromes exist when during sexual stimulation abnormal arterial circulation into the vagina or clitoris, usually from atherosclerotic vascular disease, interferes with normal vascular physiologic processes. Clinical symptoms may include delayed vaginal engorgement, diminished vaginal lubrication, pain or discomfort with intercourse, diminished vaginal sensation, diminished vaginal orgasm, diminished clitoral sensation or diminished clitoral orgasm. An animal model of this syndrome, with significant physiologic responses between the control and the atherosclerotic pelvic nerve stimulated hemodynamic responses, is discussed. Non-atherosclerotic, traumatic vascular disease of the ilio-hypogastric-pudendal arterial bed from pelvic fractures or blunt perineal trauma may also result in diminished vaginal/clitoral arterial blood flow following sexual stimulation. Diagnostic studies assessing the hemodynamic integrity of the ilio-hypogastric-pudendal arterial bed to the vagina and clitoris and new oral/topical pharmacologic strategies for enhancing vaginal/clitoral blood flow in patients with vasculogenic female sexual dysfunction are discussed. There is a growing body of evidence that women with sexual dysfunction will commonly have physiologic abnormalities, such as vasculogenic female sexual dysfunction, contributing to their overall sexual health problems.
女性性反应的第一阶段与神经递质介导的血管平滑肌松弛有关，会导致阴道润滑增加、阴道壁充血、管腔直径增大，以及阴蒂长度和直径增加。血管源性女性性功能障碍的特定生理损害包括阴道充血和阴蒂勃起功能不全综合征。当在性刺激期间，通常由于动脉粥样硬化性血管疾病导致进入阴道或阴蒂的异常动脉循环干扰正常的血管生理过程时，就会出现这些综合征。临床症状可能包括阴道充血延迟、阴道润滑减少、性交时疼痛或不适、阴道感觉减退、阴道性高潮减弱、阴蒂感觉减退或阴蒂性高潮减弱。本文讨论了该综合征的动物模型，该模型在对照和刺激盆腔神经的动脉粥样硬化血流动力学反应之间具有显著的生理反应。骨盆骨折或钝性会阴创伤导致的非动脉粥样硬化性、创伤性髂腹下-阴部动脉床血管疾病，也可能导致性刺激后阴道/阴蒂动脉血流减少。本文还讨论了评估髂腹下-阴部动脉床至阴道和阴蒂的血流动力学完整性的诊断研究，以及用于增强血管源性女性性功能障碍患者阴道/阴蒂血流的新型口服/局部药物策略。越来越多的证据表明，性功能障碍的女性通常会有生理异常，如血管源性女性性功能障碍，这会导致她们整体的性健康问题。
